Distinct clinical characteristics of familial and solitary patients with bipolar disorder

Öz

Objective: Major mental disorders including bipolar disorder aggregate in families. There are also non-familial, solitary cases and familial and non-familial cases may differ. Most of the studies regarding familiality in bipolar disorder targeted similar and dissimilar characteristics of the disease within families. There is a lack of studies targeting between subject differences in patients from different families. The aim of this study is to assess and compare clinical characteristics of type I bipolar patients with and without a family history of bipolar disorders. Method: This study was conducted on outpatients of Raşit Tahsin Mood Disorders Centre of Bakırköy Research and Training Hospital. The medical records of 112 participants (69 female, 43 male, mean age: 41.54±11.19, range: 22-75, 64 of which had family history and 48 without family history) with type I Bipolar Disorder were collected. Missing information was obtained by phone interviews from both patients and first degree relatives. Information of the patients without a family history of any psychiatric disorder was checked with a senior family member. Results: Postpartum episode rates, comorbid psychiatric disorders, number of subjects ever had past mixed episodes, and nicotine dependency rates were found to be significantly higher in patients with family history. No significant difference was detected between groups in terms of age, gender, education, age at disease onset, number of episodes, and number of hospitalizations. Conclusions: Comorbidity, postpartum episodes, lifetime mixed episodes, and smoking were found to be higher in patients with family history and thus associated with bipolarity. Postpartum episodes and comorbidities can be expected to be more prevalent in patients with family history. However clinical characteristics should be further investigated in larger samples.

Anahtar Kelimeler

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İki uçlu bozukluğu olan ailesel ve münferit hastaların farklı klinik özellikleri

Öz

Amaç: İki uçlu bozukluk da dahil majör ruhsal bozukluklar ailelerde kümelenmektedirler. Ailesel olmayan, tek vakalar da görülmektedir ve ailesel ve ailesel olmayan vakalar klinik özellikler bakımından farklılık gösterebilirler. Aileselliği dikkate alan çalışmaların büyük bölümü aynı aileden hastalarda hastalığın benzer olan ve olmayan özelliklerini incelemişlerdir. Farklı ailelerden olan ve ailesel özelliklerine göre hastalık özelliklerinin karşılaştırıldığı yeterince çalışma yoktur. Bu çalışmada ailesel olan ve olmayan tip I iki uçlu bozukluğu olan hastaların klinik özellikler açısından incelenmesi ve karşılaştırılması amaçlanmıştır. Yöntem: Bu araştırma Bakırköy Prof. Dr. Mazhar Osman Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesine bağlı Raşit Tahsin Duygudurum Merkezi’nde tedavi görmekte olan hastalarla yapıldı. İki uçlu bozukluğu olan 112 hastanın (69 kadın, 43 erkek, ortalama yaş: 41.54±11.19, dağılım aralığı: 22-75, ailesinde hastalık öyküsü olan 64, olmayan 48 hasta) tıbbi kayıtları incelendi ve veriler hastalardan ve birinci derece akrabalarından telefonla teyit edildi. Ailesinde hastalık öyküsü olmayan hastaların ailelerine sorularak ailelede başka hastanın olmadığı doğrulandı. Bulgular: Psikiyatrik ekhastalıklar, doğum sonrası depresyon oranları, nikotin bağımlılığı, karma hastalık dönemi geçirmiş hasta sayısı ve halen antipsikotik kullanan hasta sayısı aile öyküsü olan hasta grubunda istatistiksel olarak anlamlı derecede daha fazla oldukları saptanan özelliklerdi. Hastalık başlangıç yaşı, hastalık dönemi sayıları ve hastaneye yatış sayıları açısından gruplar arasında fark saptanmadı. Sonuç: Psikiyatrik ekhastalık, doğum sonrası depresyon, karma hastalık dönemleri ve sigara kullanma ailesinde hastlalık öyküsü olan hastalarda daha fazla oranda bulundukları tespit edilen klinik özelliklerdir ve iki uçluluk ile ilişkilidirler. Psikiyatrik ekhastalık ve postpartum dönem geçirmeye yatkınlık aile öyküsü olan hastalarda daha fazla görülmesi beklenebilir. Fakat klinik özelliklerin gruplarda farklılık gösterip göstermediğinin belirlenebilmesi için daha başka büyük örneklemli çalışmalar da gerekmektedir.

Anahtar Kelimeler

• Ailesel, ailesel olmayan, iki uçlu bozukluk

Kaynakça

1. Smoller JW, Finn CT. Family, twin, and adoption studies of bipolar disorder. Am J Med Genet C Semin Med Genet 2003;123:48-58
2. Segurado R, Detera-Wadleigh SD, Levinson DF, Lewis CM, Gill M, Nurnberger JI Jr, Craddock N, DePaulo JR, Baron M, Gershon ES, Ekholm J, Cichon S, Turecki G, Claes S, Kelsoe JR, Schofield PR, Badenhop RF, Morissette J, Coon H, Blackwood D, McInnes LA, Foroud T, Edenberg HJ, Reich T, Rice JP, Goate A, McInnis MG, McMahon FJ, Badner JA, Goldin LR, Bennett P, Willour VL, Zandi PP, Liu J, Gilliam C, Juo SH, Berrettini WH, Yoshikawa T, Peltonen L, Lonnqvist J, Nothen MM, Schumacher J, Windemuth C, Rietschel M, Propping P, Maier W, Alda M, Grof P, Rouleau J, Del Favero J, Van Broeckhoven C, Mendlewicz J, Adolfsson R, Spence MA, Luebbert H, Adams LJ, Donald JA, Mitchell PB, Barden N, Shink E, Byerley W, Muir W, Visscher PM, Macgregor S, Gurling H, Kalsi G, McQuillin A, Escamilla MA, Reus VI, Leon P, Freimer NB, Ewald H, Kruse TA, Mors O, Radhakrishna U, Blouin JL, Antonarakis SE, Akarsu N. Genome scan meta-analysis of schizophrenia and bipolar disorder, part III: bipolar disorder. Am J Hum Genet 2003;73:49-62.
3. Badner JA, Gershon ES. Meta-analysis of whole-genome linkage scans of bipolar disorder and schizophrenia. Mol Psychiatry 2002;7:405-411.
4. McQueen MB, Devlin B, Faraone SV, Nimgaonkar VL, Sklar P, Smoller JW, Abou Jamra R, Albus M, Bacanu SA, Baron M, Barrett TB, Berrettini W, Blacker D, Byerley W, Cichon S, Coryell W, Craddock N, Daly MJ, Depaulo JR, Edenberg HJ, Foroud T, Gill M, Gilliam TC, Hamshere M, Jones I, Jones L, Juo SH, Kelsoe JR, Lambert D, Lange C, Lerer B, Liu J, Maier W, Mackinnon JD, McInnis MG, McMahon FJ, Murphy DL, Nothen MM, Nurnberger JI, Pato CN, Pato MT, Potash JB, Propping P, Pulver AE, Rice JP, Rietschel M, Scheftner W, Schumacher J, Segurado R, Van Steen K, Xie W, Zandi PP, Laird NM. Combined analysis from eleven linkage studies of bipolar disorder provides strong evidence of susceptibility loci on chromosomes 6q and 8q. Am J Hum Genet 2005;77:582-595.
5. Kassem L, Lopez V, Hedeker D, Steele J, Zandi P; The NIMH Genetics Initiative Bipolar Disorder Consortium, McMahon FJ. Polarity at onset is a familial feature of bipolar affective disorder. Am J Psychiatry 2006;163:1554-1560.
6. Jones I, Craddock N. Familiality of the Puerperal Trigger in Bipolar Disorder: Results of a Family Study. Am J Psych 2001;158:913-917.
7. Forty L, Jones L, Macgregor S, Caesar S, Cooper C, Hough A, Dean L, Dave S, Farmer A, McGuffin P, Brewster S, Craddock N, Jones I: Familiality of postpartum depression in unipolar disorder: results of a family study. Am J Psychiatry 2006;163:1549-1553.
8. Murphy-Eberenz K, Zandi PP, March D, Crowe RR, Scheftner WA, Alexander M, McInnis MG, Coryell W, Adams P, Depaulo JR Jr, Miller EB, Marta DH, Potash JB, Payne J, Levinson DF: Is perinatal depression familial? J Affect Disord 2006;90:49-55.

9. Jones I, Hamshere M, Nangle JM, Bennett P, Green E, Heron J, Segurado R, Lambert D, Holmans P, Corvin A, Owen M, Jones L, Gill M, Craddock N: Bipolar affective puerperal psychosis: genome-wide significant evidence for linkage to chromosome 16. Am J Psychiatry 2007;164:1099-1104.
10. Payne JL, Mackinnon DF, Mondimore FM, McInnis MG, Schweizer B, Zamoiski RB, McMahon FJ, Nurnberger JI Jr, Rice JP, Scheftner W, Coryell W, Berrettini WH, Kelsoe JR, Byerley W, Gershon ES, Depaulo JR Jr, Potash JB: Familial aggregation of postpartum mood symptoms in bipolar disorder pedigrees. Bipolar Disord 2008;10:38-44.
11. Mahon PB, Payne JL, MacKinnon DF, Mondimore FM, Goes FS, Schweizer B, Jancic D; NIMH Genetics Initiative Bipolar Disorder Consortium; BiGS Consortium, Coryell WH, Holmans PA, Shi J, Knowles JA, Scheftner WA, Weissman MM, Levinson DF, DePaulo JR Jr, Zandi PP, Potash JB. Genome-wide linkage and follow-up association study of postpartum mood symptoms. Am J Psychiatry 2009;166:1229-1237.
12. Burke JG, Murphy JC, Bray D, Walsh D, Kendler KS. Clinical similarities in siblings with schizophrenia. Am J Med Genet 1996;67:239-243.
13. Kendler KS, Karkowski-Shuman L, O’Neill FA, Straub RE, Maclean CJ, Walsh D. Resembla nce of psychotic symptoms and syndromes in affected sibling pairs from the Irish study of high density schizophrenia families: evidence for possible etiologic heterogeneity. Am J Psych 1997;154:191-198.
14. Kendler KS, Tsuang MT, Hays P. Age at onset in schizophrenia: a familial perspective.Archives of General Psychiatry 1987;44:881-890.
15. Kendler KS, Maclean CJ. Estimating familial effects on age of onset and liability to schizophrenia.I. Results of a large sample family study.Genet Epidemiol 1990;7:409-417.
16. Ritsner M, Ratner Y, Gibel A, Weizman R. Familiality in a fivefactor model of schizophrenia psychopathology: findings from a 16-month follow-up study. Psychiatry Res 2005;136:173-179.
17. Wickham H, Walsh C, Asherson P, Gill M, Owen MJ, McGuffin P, Murray R, Sham P. Familiality of clinical characteristics in schizophrenia. J Psychiatr Res 2002;36:325-329.
18. Silverman JM, Mohs RC, Davidson M, Losonczy MF, Keefe RSE, Breitner JCS, Sorokin JE, Davis KL. Familial schizophrenia and treatment response. Am J Psych 1987;144:1271-1276.
19. Vazquez-Barquero JL, Cuesta Nunez MJ, Herrera Castanedo S, Diez Manrique JF, Pardo G, Dunn G. Sociodemographic and clinical variables as predictors of the diagnostic characteristics of first episodes of schizophrenia. Acta Psychiat Scand 1996;94:149-155.
20. Malaspina D, Goetz RR, Yale S, Berman A, Friedman JH, Tremeau F, Printz D, Amador X, Johnson J, Brown A, Gorman JM. Relation of familial schizophrenia to negative symptoms but not to the deficit syndrome. Am J Psych 2000;157:994-1003.
21. Feldmann R, Hornung WP, Buchkremer G, Arolt V. The influence of familial loading on the course of schizophrenic symptoms and the success of psychoeducational therapy. Psychopathology 2000;34:192-197.
22. Lui S, Deng W, Huang X, Jiang L, Ouyang L, Borgwardt SJ, Ma X, Li D, Zou L, Tang H, Chen H, Li T, McGuire P, Gong Q. Neuroanatomical differences between familial and sporadic schizophrenia and their parents: an optimized voxel-based morphometry study. Psychiatry Res 2009;171:71-81.
23. Badner JA, Gershon ES. Meta-analysis of whole-genome linkage scans of bipolar disorder and schizophrenia. Mol Psychiatry 2002;7:405-411.
24. Berrettini WH. Are schizophrenic and bipolar disorders related? A review of family and molecular studies. Biol Psychiatry 2000;48:531-538.
25. Craddock N, O’Donovan MC, Owen MJ. The genetics of schizophrenia and bipolar disorder: dissecting psychosis. J Med Genet 2005;42:193-204.
26. Fisfalen ME, Schulze TG, DePaulo JR Jr, DeGroot LJ, Badner JA, McMahon FJ. Familial variation in episode frequency in bipolar affective disorder. Am J Psychiatry 2005;162:1266-1272.
27. Schulze TG, Hedeker D, Zandi P, Rietschel M, McMahon FJ. What is familial about familial bipolar disorder? Resemblance among relatives across a broad spectrum of phenotypic characteristics. Arch Gen Psychiatry 2006;63:1368-1376.
28. O’Mahony E, Corvin A, O’Connell R, Comerford C, Larsen B, Jones R, McCandless F, Kirov G, Cardno AG, Craddock N, Gill M. Sibling pairs with affective disorders: resemblance of demographic and clinical features. Psychol Med 2002;32:55-61.
29. Okan İbiloğlu A, Çayköylü A. Clinical Features of Patients with Bipolar and Unipolar Affective Disorder whose Relatives Have Received a Mental Disorder Diagnosis. Yeni Symposium 2011;49:19-26.
30. Steinhausen HC, Foldager L, Perto G, Munk-Jørgensen P. Family aggregation of mental disorders in the nationwide Danish three generation study. Eur Arch Psychiatry Clin Neurosci 2009;259:270277.
31. Jones I, Craddock N. Do puerperal psychotic episodes identify a more familial subtype of bipolar disorder? Results of a family history study. Psychiatr Genet 2002;12:177-180.
32. Kendell RE, Chalmer JC, Platz C. Epidemiology of puerperal psychosis. Br J Psychiatry 1987;150:662-673.
33. Schopf J, Bryois C, Jonquiere M, Scharfetter C. A family hereditary study of post-partum “psychosis”. Eur Arch Psychiatry Neurol Sci 1985;235:164-170.
34. Dean C, Williams RJ, brockington IF. Is puerperal psychosis the same as bipolar manic-depressive disorder? a family study. Psychol Med 1989;19:637-647.
35. Platz C, Kendell RE. A matched-control follow-up and family study of “puerperal psychosis”. Br J Psychiatr 1988;153:90-94.
36. MacKinnon DF, Zandi PP, Cooper J, Potash JB, Simpson SG, Gershon E, Nurnberger J, Reich T, DePaulo JR. Comorbid bipolar disorder and panic disorder in families with a high prevalence of bipolar disorder. Am J Psychiatry 2002:159:30-35.
37. MacKinnon DF, McMahon FJ, Simpson SG, McInnis MG, DePaulo JR. Panic disorder with familial bipolar disorder. Biol Psychatry 1997;42:90-95.
38. Glick H, Endicott J, Nee J. Premenstrual changes: are they familial. Acta Psychiatr Scand 1993;88:149-155.
39. Mrad A, Mechri A, Rouissi K, Khiari G, Gaha L. Clinical characteristics of bipolar I patients according to their family history of affective disorders. Encephale 2007;33:762-767.
40. Vanable PA, Carey MP, Carey KB, Maisto SA. Smoking among psychiatric outpatients: relationship to substance use, diagnosis, and illness severity. Psychol Addict Behav 2003;17:259-265.
41. Waxmonsky JA, Thomas MR, Miklowitz DJ, Allen MH, Wisniewski SR, Zhang H, Ostacher MJ, Fossey MD. Prevalence and correlates of tobacco use in bipolar disorder: data from the first 2000 participants in the Systematic Treatment Enhancement Program. Gen Hosp Psychiatry 2005;27:321-328.
42. Corvin A, O’Mahony E, O’Regan M, Comerford C, O’Connell R, Craddock N, Gill M. Cigarette smoking and psychotic symptoms in bipolar affective disorder. Br J Psychiatry 2001;179:35-38.
43. Ostacher MJ, Nierenberg AA, Perlis RH, Eidelman P, Borrelli DJ, Tran TB, Marzilli Ericson G, Weiss RD, Sachs GS. The relationship between smoking and suicidal behavior, comorbidity, and course of illness in bipolar disorder. J Clin Psychiatry 2006;67:1907-1911.
44. Grunebaum MF, Galfalvy HC, Nichols CM, Caldeira NA, Sher L, Dervic K, Burke AK, Mann JJ, Oquendo MA. Aggression and substance abuse in bipolar disorder. Bipolar Disord 2006;8:496502.