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Frequency and clinical correlates of bipolar features in acute coronary syndrome patients

Published online by Cambridge University Press:  15 April 2020

S. Pini ,
M. Abelli ,
C. Gesi ,
L. Lari ,
A. Cardini ,
L. Di Paolo ,
F. Felice ,
R. Di Stefano ,
G. Mazzotta  and
C. Oligeri
...Show all authors
S. Pini*
Affiliation:
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy
M. Abelli
Affiliation:
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy
C. Gesi
Affiliation:
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy
L. Lari
Affiliation:
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy
A. Cardini
Affiliation:
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy
L. Di Paolo
Affiliation:
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy
F. Felice
Affiliation:
Department of Surgical, Medical and Molecular Pathology and Critic Area, Cardiovascular Sector, University of Pisa, Pisa, Italy
R. Di Stefano
Affiliation:
Department of Surgical, Medical and Molecular Pathology and Critic Area, Cardiovascular Sector, University of Pisa, Pisa, Italy
G. Mazzotta
Affiliation:
Coronary Care Unit, Ospedale S. Andrea, La Spezia, Italy
C. Oligeri
Affiliation:
Coronary Care Unit, Ospedale S. Andrea, La Spezia, Italy
F.M. Bovenzi
Affiliation:
Coronary Care Unit, USL 2, Lucca, Italy
L. Borelli
Affiliation:
Coronary Care Unit, USL 2, Lucca, Italy
D. Bertoli
Affiliation:
Complex Care and Rehabilitating Unit of Cardiology, USL5 Sarzana (SP), Italy
P. Michi
Affiliation:
Department of Surgical, Medical and Molecular Pathology and Critic Area, Cardiovascular Sector, University of Pisa, Pisa, Italy
A. Muccignat
Affiliation:
Department of Surgical, Medical and Molecular Pathology and Critic Area, Cardiovascular Sector, University of Pisa, Pisa, Italy
J. Micchi
Affiliation:
Department of Surgical, Medical and Molecular Pathology and Critic Area, Cardiovascular Sector, University of Pisa, Pisa, Italy
A. Balbarini
Affiliation:
Department of Surgical, Medical and Molecular Pathology and Critic Area, Cardiovascular Sector, University of Pisa, Pisa, Italy
*
*Corresponding author. Tel.: +39 336 80 13 22. E-mail address: [email protected] (S. Pini).
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Abstract

Background:

Depression and acute coronary syndrome (ACS) are both extremely prevalent diseases. Studies aimed at evaluating whether depression is an independent risk factor for cardiac events provided no definitive results. In most of these studies, depression has been broadly defined with no differentiation between unipolar (MDD) versus bipolar forms (BD). The aim of this study was to evaluate the frequency of DSM-IV BD (bipolar I and bipolar II subtypes, cyclothymia), as well as temperamental or isolated bipolar features in a sample of 171 patients hospitalized for ACS. We also explored whether these psychopathological conditions were associated with some clinical characteristics of ACS.

Methods:

Patients with ACS admitted to three neighboring Cardiac Intensive Care Units (CICUs) in a 12-month continuative period of time were eligible for inclusion if they met the criteria for either acute myocardial infarct with or without ST-segment elevation or unstable angina, verified by standard ACS criteria. All patients underwent standardized cardiological and psychopathological evaluations.

Results:

Of the 171 ACS patients enrolled, 37 patients (21.7%) were found to have a DSM-IV mood disorder. Of these, 20 (11.7%) had bipolar type I or type II or cyclothymia, while 17 (10%) were the cases of MDD. Rapid mood switches ranged from 11% of ACS patients with no mood disorders, to 47% of those with MDD to 55% of those with BD. Linear regression analysis showed that a diagnosis of BD (p = .023), but not that of MDD (p = .721), was associated with a significant younger age at the index episode of ACS. A history of previous coronary events was more frequent in ACS patients with BD than in those with MDD.

Conclusions:

Our data indicate that bipolar features and diagnosis are frequent in ACS patients. Bipolar disorder has a negative impact on cardiac symptomatology. Further research in this area is warranted.

Keywords

DepressionManiaBipolar disorderBipolar featuresAcute coronary syndrome
Type
Original articles
Information
European Psychiatry , Volume 29 , Issue 4 , May 2014 , pp. 253 - 258
Copyright
Copyright © European Psychiatric Association 2014

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References

Akiskal, H.S., Mendlowicz, M.V., Jean-Louis, G., Rapaport, M.H., Kelsoe, J.R., Gillin, J.C.et al.TEMPS-A: validation of a short version of a self-rated instrument designed to measure variations in temperament. J Affect Disord 2005;85:45–52.CrossRefGoogle Scholar
Angst, J., Hengartner, M.P., Gamma, A., von Zerssen, D., Angst, F.Mortality of 403 patients with mood disorders 48 to 52 years after their psychiatric hospitalisation. Eur Arch Psychiatry Clin Neurosci 2012 [Epub ahead of print] PubMed.Google ScholarPubMed
Baune, B.T., Stuart, M., Gilmour, A., Wersching, H., Heindel, W., Arolt, V.et al.The relationship between subtypes of depression and cardiovascular disease: a systematic review of biological models. Transl Psychiatry 2012;2:e92. http://dx.doi.org/10.1038/tp.2012.18.CrossRefGoogle ScholarPubMed
Beck, A.T., Steer, R.A., Brown, G.K.Beck Depression Inventory-second edition manual. San Antonio: The Psychological Corporation; 1996.Google Scholar
Bekke-Hansen, S., Trockel, M., Burg, M.M., Taylor, C.B.Depressive symptom dimensions and cardiac prognosis following myocardial infarction: results from the ENRICHD clinical trial. Psychol Med 2012;42:51–60.CrossRefGoogle ScholarPubMed
Berkman, L.F., Blumenthal, J., Burg, M., Carney, R.M., Catellier, D., Cowan, M.J.et al.Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA 2003;289:3106–3116.Google ScholarPubMed
Burg, M.M., Rieckmann, N., Clemow, L., Medina, V., Schwartz, J., Davidson, K.W.Treatment preferences among depressed patients after acute coronary syndrome: the COPES observational cohort. Psychother Psychosom 2011;80:380–382.CrossRefGoogle ScholarPubMed
Casella, G., Cassin, M., Chiarella, F., Chinaglia, A., Conte, M.R., Fradella, G.et al.BLITZ-3 Investigators Epidemiology and patterns of care of patients admitted to Italian Intensive Cardiac Care units: the BLITZ-3 registry. J Cardiovasc Med (Hagerstown) 2010;11:450–461.CrossRefGoogle ScholarPubMed
Cassano, G.B., Rucci, P., Benvenuti, A., Miniati, M., Calugi, S., Maggi, L.et al.The role of psychomotor activation in discriminating unipolar from bipolar disorders: a classification-tree analysis. J Clin Psychiatry 2012;73:22–28.CrossRefGoogle ScholarPubMed
Chida, Y., Steptoe, A.The association of anger and hostility with future coronary heart disease: a meta-analytic review of prospective evidence. J Am Coll Cardiol 2009;53:936–946.CrossRefGoogle ScholarPubMed
De Hert, M., Dekker, J.M., Wood, D., Kahl, K.G., Holt, R.I., Mueller, H.J.Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Eur Psychiatry 2009;24:412–424.CrossRefGoogle Scholar
de Jonge, P., Ormel, J., van den Brink, R.H., van Melle, J.P., Spijkerman, T.A., Kuijper, A.et al.Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis. Am J Psychiatry 2006;163:138–144.CrossRefGoogle ScholarPubMed
Dell’Osso, L., Armani, A., Rucci, P., Frank, E., Fagiolini, A., Corretti, G.et al.Measuring mood spectrum: comparison of interview (SCI-MOODS) and self-report (MOODS-SR) instruments. Compr Psychiatry 2002;43:69–73.CrossRefGoogle ScholarPubMed
Fagiolini, A., Dell’Osso, L., Pini, S., Armani, A., Bounani, S., Rucci, P.et al.Validity and reliability of a new instrument for assessing mood symptomatology: The Structured Clinical Interview for Mood Spectrum (SCI-MOODS). Int J Methods Psychiatr Res 1999;8:71–82.CrossRefGoogle Scholar
Fiedorowicz, J.G., He, J., Merikangas, K.R.The association between mood and anxiety disorders with vascular diseases and risk factors in a nationally representative sample. J Psychosom Res 2011;70:145–154.CrossRefGoogle Scholar
Fiedorowicz, J.G., Solomon, D.A., Endicott, J., Leon, A.C., Li, C., Rice, J.P.et al.Manic/hypomanic symptom burden and cardiovascular mortality in bipolar disorder. Psychosom Med 2009;71:598–606.CrossRefGoogle ScholarPubMed
Fiedorowicz, J.G., Coryell, W.H., Rice, J.P., Warren, L.L., Haynes, W.G.Vasculopathy related to manic/hypomanic symptom burden and first-generation antipsychotics in a sub-sample from the collaborative depression study. Psychother Psychosom 2012;81:235–243.CrossRefGoogle Scholar
First, M.B., Spitzer, R.L., Gibbon, M., Williams, J.B.W.Structured Clinical Interview for DSM–IV–TR Axis I Disorders, Research Version, Patient Edition SCID-1/P, New York, NY: Biometrics Research, New York State Psychiatric Institute; 2002.Google Scholar
Frasure-Smith, N., Lesperance, F.Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry 2008;65:62–71.CrossRefGoogle ScholarPubMed
Garcia-Portilla, M.P., Saiz, P.A., Bascaran, M.T., Martinez, S., Benabarre, A., Sierra, P.et al.Cardiovascular risk in patients with bipolar disorder. J Affect Disord 2009;115:302–308.CrossRefGoogle ScholarPubMed
Glassman, A.H., Bigger, J.T., Gaffney, M., Shapiro, P.A., Swenson, J.R.Onset of major depression associated with acute coronary syndromes: relationship of onset, major depressive disorder history, and episode severity to sertraline benefit. Arch Gen Psychiatry 2006;63:283–288.CrossRefGoogle ScholarPubMed
Hamilton, M.Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967;6:278–283.CrossRefGoogle ScholarPubMed
Hamilton, M.The assessment of anxiety states by rating. Br J Med Psychol 1959;32:50–55.CrossRefGoogle ScholarPubMed
Gadermann, A.M., Alonso, J., Vilagut, G., Zaslavsky, A.M., Kessler, R.C.Comorbidity and disease burden in the National Comorbidity Survey Replication (NCS-R). Depress Anxiety 2012;29:797–806.CrossRefGoogle Scholar
Judd, L.L., Schettler, P.J., Akiskal, H., Coryell, W., Fawcett, J., Fiedorowicz, J.G.et al.Prevalence and clinical significance of subsyndromal manic symptoms, including irritability and psychomotor agitation, during bipolar major depressive episodes. J Affect Disord 2012;138:440–448.CrossRefGoogle ScholarPubMed
Katon, W.J., Lin, E.H., Von Korff, M., Ciechanowski, P., Ludman, E.J., Young, B.et al.Collaborative care for patients with depression and chronic illnesses. N Engl J Med 2010;363:2611–2620.CrossRefGoogle ScholarPubMed
Kilbourne, A.M., Cornelius, J.R., Han, X., Pincus, H.A., Shad, M., Salloum, I.et al.Burden of general medical conditions among individuals with bipolardisorder. Bipolar Disord 2004;6:368–373.CrossRefGoogle Scholar
Laursen, T.M.Life expectancy among persons with schizophrenia or bipolar affective disorder. Schizophr Res. 2011;131(1–3):101–104.CrossRefGoogle ScholarPubMed
Lesperance, F., Frasure-Smith, N., Talajic, M.Major depression before and after myocardial infarction: its nature and consequences. Psychosom Med 1996;58:99–110.CrossRefGoogle ScholarPubMed
MacKinnon, D.F., Zandi, P.P., Gershon, E., Nurnberger, J.I. Jr.Reich, T., DePaulo, J.R.Rapid switching of mood in families with multiple cases of bipolar disorder. Arch Gen Psychiatry 2003;60:921–928.CrossRefGoogle ScholarPubMed
Murray, D.P., Weiner, M., Prabhakar, M., Fiedorowicz, J.G.Mania and mortality: why the excess cardiovascular risk in bipolar disorder? Curr Psychiatry Rep 2009;11:475–480.CrossRefGoogle ScholarPubMed
Nusslock, R., Frank, E.Subthreshold bipolarity: diagnostic issues and challenges. Bipolar Disord 2011;13:587–603.CrossRefGoogle ScholarPubMed
Perlis, R.H., Ostacher, M.J., Goldberg, J.F., Miklowitz, D.J., Friedman, E., Calabrese, J.et al.Transition to mania during treatment of bipolar depression. Neuropsychopharmacology 2010;35:2545–2552.CrossRefGoogle ScholarPubMed
Reese, R.L., Freedland, K.E., Steinmeyer, B.C., Rich, M.W., Rackley, J.W., Carney, R.M.Depression and rehospitalization following acute myocardial infarction. Circ Cardiovasc Qual Outcomes 2011;4:626–633.CrossRefGoogle ScholarPubMed
Rush, A.J., Kraemer, H.C., Sackeim, H.A., Fava, M., Trivedi, M.H., Frank, E.et al.ACNP Task Force Report by the ACNP Task Force on response and remission in major depressive disorder. Neuropsychopharmacology 2006;31:1841–1853.CrossRefGoogle ScholarPubMed
Slomka, J.M., Piette, J.D., Post, E.P., Krein, S.L., Lai, Z., Goodrich, D.E.et al.Mood disorder symptoms and elevated cardiovascular disease risk in patients with bipolar disorder. J Affect Disord 2012;138:405–408.CrossRefGoogle ScholarPubMed
Sodhi, S.K., Linder, J., Chenard, C.A., Miller del, D., Haynes, W.G., Fiedorowicz, J.G.Evidence for accelerated vascular aging in bipolar disorder. J Psychosom Res 2012;73:175–179.CrossRefGoogle ScholarPubMed
Steptoe, A., Kivimaki, M.Stress and cardiovascular disease. Nat Rev Cardiol 2012;9:360–370.CrossRefGoogle ScholarPubMed
Strakowski, S.M., Fleck, D.E., Maj, M.Broadening the diagnosis of bipolar disorder: benefits vs. risks. World Psychiatry 2011;10:181–186.CrossRefGoogle Scholar
Swann, A.C., Lafer, B., Perugi, G., Frye, M.A., Bauer, M., Bahk, W.M.et al.Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis. Am J Psychiatry 2013;170:31–42.CrossRefGoogle ScholarPubMed
Swartz, H.A., Fagiolini, A.Cardiovascular disease and bipolar disorder: risk and clinical implications. J Clin Psychiatry. 2012;73:1563–1565.CrossRefGoogle ScholarPubMed
Thombs, B.D., Bass, E.B., Ford, D.E., Stewart, K.J., Tsilidis, K.K., Patel, U.et al.Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med 2006;21:30–38.CrossRefGoogle ScholarPubMed
Weiner, M., Warren, L., Fiedorowicz, J.G.Cardiovascular morbidity and mortality in bipolar disorder. Ann Clin Psychiatry 2011;23:40–47.Google ScholarPubMed
Williams, J.M., Gandhi, K.K., Lu, S.E., Steinberg, M.L., Benowitz, N.L.Nicotine intake and smoking topography in smokers with bipolar disorder. Bipolar Disord 2012;14:618–627.CrossRefGoogle ScholarPubMed
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