Search

Background: Individuals with bipolar disorders (BD) are at risk of premature death, mainly due to medical comorbidities. Childhood maltreatment might contribute to this medical morbidity, which remains underexplored in the literature. Methods: We assessed 2891 outpatients with BD (according to DSM-IV criteria). Childhood maltreatment was assessed using the Childhood Trauma Questionnaire. Lifetime diagnoses for medical disorders were retrospectively assessed using a systematic interview and checked against medical notes. Medical morbidity was defined by the sum of medical disorders. We investigated associations between childhood maltreatment (neglect and abuse) and medical morbidity while adjusting for potential confounders. Results: One quarter of individuals had no medical comorbidities, while almost half of them had at least two. Multivariable regression showed that childhood maltreatment (mainly abuse, but also sexual abuse) was associated with a higher medical morbidity. Medical morbidity was also associated with sex, age, body mass index, sleep disturbances, lifetime anxiety disorders and lifetime density of mood episodes. Childhood maltreatment was associated with an increased prevalence of four (i.e. migraine/headache, drug eruption, duodenal ulcer, and thyroid diseases) of the fifteen most frequent medical disorders, however with no difference in terms of age at onset. Conclusions: This large cross-sectional study confirmed a high medical morbidity in BD and its association with childhood maltreatment. The assessment of childhood maltreatment in individuals with BD should be systematically included in routine care and the potential impact on physical health of psycho-social interventions targeting childhood maltreatment and its consequences should be evaluated. [ABSTRACT FROM AUTHOR]

Objectives: Childhood maltreatment, also referred as childhood trauma, increases the severity of bipolar disorders (BD). Childhood maltreatment has been associated with more frequent mood recurrences, however, mostly in retrospective studies. Since scarce, further prospective studies are required to identify whether childhood maltreatment may be associated with the time to recurrence in BD. Methods: Individuals with BD (N = 2008) were assessed clinically and for childhood maltreatment at baseline, and followed up for two years. The cumulative probability of mood recurrence over time was estimated with the Turnbull's extension of the Kaplan–Meier analysis for interval‐censored data, including childhood maltreatment as a whole, and then maltreatment subtypes as predictors. Analyses were adjusted for potential confounding factors. Results: The median duration of follow‐up was 22.3 months (IQR:12.0–24.8). Univariable analyses showed associations between childhood maltreatment, in particular all types of abuses (emotional, physical, and sexual) or emotional neglect, and a shorter time to recurrence (all p < 0.001). When including potential confounders into the multivariable models, the time to mood recurrence was associated with multiple/severe childhood maltreatment (i.e., total score above the 75th percentile) (HR = 1.32 95%CI (1.11–1.57), p = 0.002), and more specifically with moderate/severe physical abuse (HR = 1.44 95%CI(1.21–1.73), p < 0.0001). Living alone, lifetime anxiety disorders, lifetime number of mood episodes, baseline depressive and (hypo)manic symptoms, and baseline use of atypical antipsychotics were also associated with the time to recurrence. Conclusions: In addition to typical predictors of mood recurrences, an exposure to multiple/severe forms of childhood maltreatment, and more specifically to moderate to severe physical abuse, may increase the risk for a mood recurrence in BD. This leads to the recommendations of more scrutiny and denser follow‐up of the individuals having been exposed to such early‐life stressors. [ABSTRACT FROM AUTHOR]

Background This study aims at characterizing French psychiatrists' opinions regarding definition criteria and factors associated with lithium prophylactic response in patients with bipolar disorders. Methods After a literature review, an online survey targeted French psychiatrists in 2016. Results Literature review showed inconsistencies in reported definition criteria and clinical predictors of lithium prophylactic response. A total of 104 psychiatrists, mostly working in hospitals, completed the survey. The inconsistencies regarding definition criteria and predictors of lithium response were confirmed. Five factors were commonly reported by psychiatrists as positively associated with successful response (family history of lithium response and of bipolar I disorder, and lithium efficacy in acute mood phases treatment) or with an unsuccessful response (rapid cycling and alcohol misuse). Discussion The divergence in psychiatrists' opinions surely plays a major role in the variability of lithium prescriptions among psychiatrists. Currently, the large variations in response definitions, and in study designs used to quantify each factor's effect, preclude synthesizing the findings. A standardization of response measures is needed to explore factors that influence the prophylactic lithium efficacy. [ABSTRACT FROM AUTHOR]