Browsing by Author "Bonnin, Caterina del Mar"
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Item e-HCL-32: a useful, valid and user friendly tool in the screening of bipolar II disorder(Elsevier Inc, 2015) Hidalgo-Mazzei, Diego; Mateu, Ainoa; Undurraga, Juan; Adriane, Rosa; Pacchiarotti, Isabella; Bonnin, Caterina del Mar; Sánchez-Moreno, José; Colom, Francesc; Vieta, EduardBACKGROUND AND OBJECTIVES: Bipolar type II (BDII) is a frequent disorder with high morbidity and mortality, characterized by depressive and hypomanic episodes. Early diagnosis can be effective in improving long-term prognosis. However, diagnosing BDII is challenging due to the difficulty in detecting past hypomanic episodes. The HCL-32 is a widely used and reliable screening instrument for the detection of past hypomanic episodes. Making this tool available to more patients could help diagnose and treat undetected cases of BDII earlier. New technologies such as the Internet have been previously used for this purpose with favorable outcomes. Accordingly, the objective of this study is to evaluate the acceptability, validity, reliability and equivalence of an online version of this questionnaire. METHODS: From May 2012 to March 2013, 52 participants attending an outpatient mental health clinic completed a paper version of the HCL-32 (HCL-32) and its online version (e-HCL-32) within two weeks. After its completion, they were asked to answer a brief satisfaction survey. RESULTS: No differences were found (HCL-32 mean total score=17.73 (SD=7.37), e-HCL-32 mean total score=18.28 (SD=7.09). T=-1.720, p=0.092, 95% CI=-1.21 to 0.09) between the results of the paper and pencil HCL-32 compared to its online version (e-HCL-32). The psychometric properties of the online version of the hypomania checklist (e-HCL-32) were good and comparable to the paper and pencil version. 80% of participants found online questionnaires to be easier to answer and more user-friendly. CONCLUSION: The results of this study support the use of an online screening tool for the detection of previous hypomanic episodes (necessary for BDII diagnosis) as it showed to have a similar validity and reliability to the traditional paper and pencil method.Item Los costos y consumo de recursos sanitarios asociados a episodios maníacos en la práctica clínica diaria: el estudio MANACOR(SEP y SEPB. Published by Elsevier España., 2015) Hidalgo-Mazzei, Diego; Undurraga, Juan; Reinares, María; Bonnin, Caterina del Mar; Sáez, Cristina; Mur, María; Nieto, Evaristo; Vieta, Eduardntroducción El Trastorno Bipolar (TB) es una enfermedad con frecuentes recaídas y remisiones que afecta a aproximadamente el 1 al 2% de la población mundial. Aún con la eficacia de los tratamientos disponibles actualmente, las recaídas son frecuentes. Por tanto, el costo y consumo de recursos asociados a cada nuevo episodio tienen un impacto importante en el sistema sanitario. El principal objetivo de este estudio fue el de estimar los costos directos y recursos sanitarios empleados durante el tratamiento de episodios maníacos en la práctica clínica diaria, teniendo en cuenta además variables clínicas. Métodos Fueron incluidos de manera consecutiva pacientes quiénes hayan presentado recientemente un episodio maníaco agudo según los criterios del DSM-IV. Se recogieron de manera retrospectiva variables sociodemográficas y durante los siguientes 6 meses se realizaron evaluaciones clínicas sistemáticas que incluían YMRS,HDRS-17,FAST and CGI-BP-M. El consumo de recursos sanitarios y los costos asociados fueron estimados a partir de los días de hospitalización, el tratamiento farmacológico, las visitas a urgencias y ambulatorias. Resultados Se incluyeron 169 pacientes de 4 hospitales universitarios de Cataluña, España. El costo directo medio de cada episodio maníaco fue de €4771. De estos, 77% (€3651) correspondía a los costos de hospitalización, 14% (€684) al tratamiento farmacológico, 8% (€386) a las visitas ambulatorias y solo 1% (€50) a visitas en urgencias. Los días de hospitalización fueron el mayor componente del costo total. Un puntaje inicial de FAST >41 predijo de forma significativa un mayor costo directo. Conclusiones Nuestros resultados demuestran el elevado costo y consumo de recursos sanitarios asociados al TB y reflejan la necesidad de diseñar más y mejores estrategias costo-efectivas en el manejo y prevención de episodios maníacos a fin de evitar ingresos hospitalarios. Un peor estado funcional basal es predictivo de mayores costos, indicando la importancia de realizar una evaluación funcional en el TB de manera sistemática.Item Making sense of DSM-5 mania with depressive features(The Royal Australian and New Zealand College of Psychiatrists, 2015) Reinares, María; Bonnin, Caterina del Mar; Hidalgo-Mazzei, Diego; Undurraga, Juan; Mur, María; Nieto, Evaristo; Sáez, Cristina; Vieta, EduardOBJECTIVE: The assessment of the depressive component during mania has become critical for the accurate diagnosis of mixed states, which were defined very narrowly in the past classification systems before Diagnostic and Statistical Manual of Mental Disorders (5th ed.). The aim of this study was to compare socio-demographic, clinical and therapeutic characteristics, as well as clinical and functional outcomes, between manic patients with and without mixed features to validate the relevance of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) mixed specifier. METHODS: This is a subanalysis of a multicentre naturalistic study MANía Aguda y COnsumo de Recursos (acute mania and health resource consumption [MANACOR]) on the burden of mania in bipolar patients from four hospitals in Catalonia (Spain). The sample consisted of 169 adult patients presenting a manic episode and systematically assessed during a 6-month period. RESULTS: A total of 27% (n = 46/169) of manic patients showed mixed features. Total number of episodes (p = 0.027), particularly depressive and mixed, was greater in manic patients with mixed features, as well as depressive onset (p = 0.018), suicide ideation (p = 0.036), rapid cycling (p = 0.035) and personality disorders (p = 0.071). In contrast, a higher percentage of pure manic subjects were inpatients (p = 0.035), started the illness with mania (p = 0.018) and showed family history of bipolar disorder (p = 0.037), congruent psychotic symptoms (p = 0.001) and cannabis use (p = 0.006). At baseline, pure manic patients received more risperidone (p = 0.028), while mixed patients received more valproate (p = 0.049) and antidepressants (p = 0.005). No differences were found in syndromic recovery at the end of the study. However, depressive change was higher in the mixed group (p = 0.010), while manic change was higher in the pure manic group (p = 0.029). At the end of follow-up, the group with mixed features showed a significant trend towards higher psychosocial dysfunction. CONCLUSION: A total of 27% of manic patients showed mixed features. Groups differed regarding clinical characteristics, course of illness, psychosocial functioning, prescribed treatment and symptom progress. Depressive symptoms in mania should be routinely assessed and considered to guide treatment.Item Predictors of functional outcome after a manic episode(Elsevier B.V, 2015) Bonnin, Caterina del Mar; Reinares, María; Hidalgo-Mazzei, Diego; Undurraga, Juan; Mur, María; Sáez, Cristina; Nieto, Evaristo; Vázquez, Gustavo; Balanzá-Martínez, Vicent; Tabarés-Seisdedos, Rafael; Vieta, EduardThe identification of functional outcome predictors after acute episodes of bipolar disorders (BD) may allow designing appropriate treatment aiming at restoring psychosocial functioning. Our objective was to identify the best functional outcome predictors at a 6-month follow-up after an index manic episode. METHODS: We conducted a naturalistic trial (MANACOR) focusing on the global burden of BD, with special emphasis on manic episode-associated costs. We observed patients with BD seen in services of four hospitals in Catalonia (Spain).The total sample included 169 patients with chronic DSM-IV-TR BD I suffering from an acute manic episode who were followed-up for 6 months. In this subanalysis we report the results of a stepwise multiple regression conducted by entering in the model those clinical and sociodemographic variables that were identified through preliminary bivariate Pearson correlations and using total scores on the Functioning Assessment Short Test (FAST) at the 6-month follow-up as the dependent variable. RESULTS: Number of previous depressive episodes (Beta=3.25; t=3.23; p=0.002), presence of psychotic symptoms during the manic index episode (Beta=7.007; t=2.2; p=0.031) and the Body Mass Index (BMI) at baseline (Beta=0.62; t=2.09; p=0.041) were best predictors of functional outcome after a manic episode. LIMITATIONS: The main limitations of this study include the retrospective assessment of the episodes, which can be a source of bias, and the 6-month follow-up might have been too short for assessing the course of a chronic illness. CONCLUSIONS: Psychotic symptoms at index episode, number of past depressive episodes, and BMI predict worse outcome after 6 months follow-up after a manic episode, and may constitute the target of specific treatment strategies.Item Risk factors for rapid cycling in bipolar disorder.(John Wiley & Sons A/S. Published by John Wiley & Sons Ltd., 2015) Valenti, Marc; Pacchiarotti, Isabella; Undurraga, Juan; Bonnin, Caterina del Mar; Popovic, Dina; Goikolea, José; Torrent, Carla; Hidalgo-Mazzei, Diego; Colom, Francesc; Vieta, EduardThe aim of this study was to investigate the clinical factors associated with the development of rapid cycling, as well as to elucidate the role of antidepressants. METHODS: The present study (NCT01503489) is a prospective, naturalistic cohort study conducted in a sample of 289 patients diagnosed with bipolar disorder followed and treated for up to 14 years. The patients were divided into two groups on the basis of the development of a rapid cycling course (n = 48) or no development of such a course (n = 241), and compared regarding sociodemographic, clinical, and outcome variables. RESULTS: Among the 289 patients, 48 (16.6%) developed a rapid cycling course during the follow-up. Several differences were found between the two groups, but after performing Cox regression analysis, only atypical depressive symptoms (p = 0.001), age at onset (p = 0.015), and number of suicide attempts (p = 0.030) persisted as significantly associated with the development of a rapid cycling course. CONCLUSIONS: The development of rapid cycling during the course of bipolar disorder is associated with a tendency to chronicity, with a poorer outcome, and with atypical depressive symptomatology. Our study also suggests that the development of rapid cycling is associated with a higher use of antidepressants.Item Self-monitoring and psychoeducation in bipolar patients with a smart-phone application (SIMPLe) project: design, development and studies protocols(BioMed Central Ltd., 2015) Hidalgo-Mazzei, Diego; Mateu, Ainoa; Reinares, María; Undurraga, Juan; Bonnin, Caterina del Mar; Sánchez-Moreno, José; Vieta, Eduard; Colom, FrancescBACKGROUND: New technologies have recently been used for monitoring signs and symptoms of mental health illnesses and particularly have been tested to improve the outcomes in bipolar disorders. Web-based psychoeducational programs for bipolar disorders have also been implemented, yet to our knowledge, none of them have integrated both approaches in one single intervention. The aim of this project is to develop and validate a smartphone application to monitor symptoms and signs and empower the self-management of bipolar disorder, offering customized embedded psychoeducation contents, in order to identify early symptoms and prevent relapses and hospitalizations. METHODS/DESIGN: The project will be carried out in three complementary phases, which will include a feasibility study (first phase), a qualitative study (second phase) and a randomized controlled trial (third phase) comparing the smartphone application (SIMPLe) on top of treatment as usual with treatment as usual alone. During the first phase, feasibility and satisfaction will be assessed with the application usage log data and with an electronic survey. Focus groups will be conducted and technical improvements will be incorporated at the second phase. Finally, at the third phase, survival analysis with multivariate data analysis will be performed and relationships between socio-demographic, clinical variables and assessments scores with relapses in each group will be explored. DISCUSSION: This project could result in a highly available, user-friendly and not costly monitoring and psychoeducational intervention that could improve the outcome of people suffering from bipolar disorders in a practical and secure way.