Jörn Conell

Relationship between sunlight and the age of onset of bipolar disorder: an international multisite study.

BACKGROUND The onset of bipolar disorder is influenced by the interaction of genetic and environmental factors. We previously found that a large increase in sunlight in springtime was associated with a lower age of onset. This study extends this analysis with more collection sites at diverse locations, and includes family history and polarity of first episode. METHODS Data from 4037 patients with bipolar I disorder were collected at 36 collection sites in 23 countries at latitudes spanning 3.2 north (N) to 63.4 N and 38.2 south (S) of the equator. The age of onset of the first episode, onset location, family history of mood disorders, and polarity of first episode were obtained retrospectively, from patient records and/or direct interview. Solar insolation data were obtained for the onset locations. RESULTS There was a large, significant inverse relationship between maximum monthly increase in solar insolation and age of onset, controlling for the country median age and the birth cohort. The effect was reduced by half if there was no family history. The maximum monthly increase in solar insolation occurred in springtime. The effect was one-third smaller for initial episodes of mania than depression. The largest maximum monthly increase in solar insolation occurred in northern latitudes such as Oslo, Norway, and warm and dry areas such as Los Angeles, California. LIMITATIONS Recall bias for onset and family history data. CONCLUSIONS A large springtime increase in sunlight may have an important influence on the onset of bipolar disorder, especially in those with a family history of mood disorders.

Influence of light exposure during early life on the age of onset of bipolar disorder

BACKGROUND Environmental conditions early in life may imprint the circadian system and influence response to environmental signals later in life. We previously determined that a large springtime increase in solar insolation at the onset location was associated with a younger age of onset of bipolar disorder, especially with a family history of mood disorders. This study investigated whether the hours of daylight at the birth location affected this association. METHODS Data collected previously at 36 collection sites from 23 countries were available for 3896 patients with bipolar I disorder, born between latitudes of 1.4 N and 70.7 N, and 1.2 S and 41.3 S. Hours of daylight variables for the birth location were added to a base model to assess the relation between the age of onset and solar insolation. RESULTS More hours of daylight at the birth location during early life was associated with an older age of onset, suggesting reduced vulnerability to the future circadian challenge of the springtime increase in solar insolation at the onset location. Addition of the minimum of the average monthly hours of daylight during the first 3 months of life improved the base model, with a significant positive relationship to age of onset. Coefficients for all other variables remained stable, significant and consistent with the base model. CONCLUSIONS Light exposure during early life may have important consequences for those who are susceptible to bipolar disorder, especially at latitudes with little natural light in winter. This study indirectly supports the concept that early life exposure to light may affect the long term adaptability to respond to a circadian challenge later in life.

Influence of birth cohort on age of onset cluster analysis in bipolar I disorder

PURPOSE Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database. METHODS The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared. RESULTS There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups. CONCLUSION These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.

Internet use by patients with bipolar disorder:results from an international multisite survey

There is considerable international interest in online education of patients with bipolar disorder, yet little understanding of how patients use the Internet and other sources to seek information. 1171 patients with a diagnosis of bipolar disorder in 17 countries completed a paper-based, anonymous survey. 81% of the patients used the Internet, a percentage similar to the general public. Older age, less education, and challenges in country telecommunications infrastructure and demographics decreased the odds of using the Internet. About 78% of the Internet users looked online for information on bipolar disorder or 63% of the total sample. More years of education in relation to the country mean, and feeling very confident about managing life decreased the odds of seeking information on bipolar disorder online, while having attended support groups increased the odds. Patients who looked online for information on bipolar disorder consulted medical professionals plus a mean of 2.3 other information sources such as books, physician handouts, and others with bipolar disorder. Patients not using the Internet consulted medical professionals plus a mean of 1.6 other information sources. The percentage of patients with bipolar disorder who use the Internet is about the same as the general public. Other information sources remain important.

[Is there an increased risk for renal tumors during long-term treatment with lithium?].

Lithium salts are the recommended first-line treatment (gold standard) in national and international treatment guidelines for acute and maintenance treatment of affective disorders, such as bipolar disorders. Lithium has also been shown to have a unique protective effect against suicide in patients suffering from affective disorders. Despite the well-known acute and long-term adverse effects lithium therapy can be safely administered if patients are properly educated and carefully monitored. A recent study from France now shows that patients with severely impaired renal function who had been treated with lithium salts for more than 10 years could have an increased risk for kidney tumors (benign and malignant). This resulted in an adjustment concerning information within the package leaflet by European authorities. The authors of this article reflect the currently available data in order to better understand and handle this new finding and to warn about uncritical reactions including withdrawal of lithium in successfully treated patients. This article provides clinical recommendations to provide further insight relating to the risk of kidney cancer in long-term lithium therapy.ZusammenfassungLithium wird aufgrund sehr gut belegter Wirksamkeit erfolgreich in der Akutbehandlung und Prophylaxe affektiver Erkrankungen, insbesondere bipolarer Störungen, eingesetzt. Es gilt in letzterer Indikation als der „Goldstandard“ in allen wichtigen nationalen und internationalen Leitlinien für bipolare Störungen. Lithium hat zudem eine gut belegte antisuizidale Wirkung, was bislang für keine andere psychotrope Substanz im Bereich der affektiven Störungen nachgewiesen wurde. Der Einsatz ist bei sorgfältiger Patientenaufklärung und unter Einhaltung der gebotenen Vorsichtsmaßnahmen und Monitoring der bekannten potenziellen Nebenwirkungen sicher. Eine neuere Studie aus Frankreich hat nun Hinweise erbracht, dass Patienten mit schwerer Niereninsuffizienz, die Lithium über mehr als 10 Jahre erhalten hatten, ein erhöhtes Risiko für Nierentumoren, einschließlich Karzinomen, haben könnten. Dieser Befund und weitere Hinweise haben dazu geführt, dass die Fachinformationen der Lithiumpräparate europaweit angepasst werden sollen. Die Autoren erläutern die aktuelle Datenlage, möchten helfen, diese angemessen einzuordnen und warnen vor vorschnellen Maßnahmen. Der Beitrag schließt mit konkreten klinischen Empfehlungen, bis gegebenenfalls weitere Erkenntnisse über das Nierenkarzinomrisiko bei Lithiumlangzeittherapie vorliegen.SummaryLithium salts are the recommended first-line treatment (gold standard) in national and international treatment guidelines for acute and maintenance treatment of affective disorders, such as bipolar disorders. Lithium has also been shown to have a unique protective effect against suicide in patients suffering from affective disorders. Despite the well-known acute and long-term adverse effects lithium therapy can be safely administered if patients are properly educated and carefully monitored. A recent study from France now shows that patients with severely impaired renal function who had been treated with lithium salts for more than 10 years could have an increased risk for kidney tumors (benign and malignant). This resulted in an adjustment concerning information within the package leaflet by European authorities. The authors of this article reflect the currently available data in order to better understand and handle this new finding and to warn about uncritical reactions including withdrawal of lithium in successfully treated patients. This article provides clinical recommendations to provide further insight relating to the risk of kidney cancer in long-term lithium therapy.

Gibt es bei der Lithiumlangzeitbehandlung ein erhöhtes Risiko für Nierentumoren

Lithium salts are the recommended first-line treatment (gold standard) in national and international treatment guidelines for acute and maintenance treatment of affective disorders, such as bipolar disorders. Lithium has also been shown to have a unique protective effect against suicide in patients suffering from affective disorders. Despite the well-known acute and long-term adverse effects lithium therapy can be safely administered if patients are properly educated and carefully monitored. A recent study from France now shows that patients with severely impaired renal function who had been treated with lithium salts for more than 10 years could have an increased risk for kidney tumors (benign and malignant). This resulted in an adjustment concerning information within the package leaflet by European authorities. The authors of this article reflect the currently available data in order to better understand and handle this new finding and to warn about uncritical reactions including withdrawal of lithium in successfully treated patients. This article provides clinical recommendations to provide further insight relating to the risk of kidney cancer in long-term lithium therapy.ZusammenfassungLithium wird aufgrund sehr gut belegter Wirksamkeit erfolgreich in der Akutbehandlung und Prophylaxe affektiver Erkrankungen, insbesondere bipolarer Störungen, eingesetzt. Es gilt in letzterer Indikation als der „Goldstandard“ in allen wichtigen nationalen und internationalen Leitlinien für bipolare Störungen. Lithium hat zudem eine gut belegte antisuizidale Wirkung, was bislang für keine andere psychotrope Substanz im Bereich der affektiven Störungen nachgewiesen wurde. Der Einsatz ist bei sorgfältiger Patientenaufklärung und unter Einhaltung der gebotenen Vorsichtsmaßnahmen und Monitoring der bekannten potenziellen Nebenwirkungen sicher. Eine neuere Studie aus Frankreich hat nun Hinweise erbracht, dass Patienten mit schwerer Niereninsuffizienz, die Lithium über mehr als 10 Jahre erhalten hatten, ein erhöhtes Risiko für Nierentumoren, einschließlich Karzinomen, haben könnten. Dieser Befund und weitere Hinweise haben dazu geführt, dass die Fachinformationen der Lithiumpräparate europaweit angepasst werden sollen. Die Autoren erläutern die aktuelle Datenlage, möchten helfen, diese angemessen einzuordnen und warnen vor vorschnellen Maßnahmen. Der Beitrag schließt mit konkreten klinischen Empfehlungen, bis gegebenenfalls weitere Erkenntnisse über das Nierenkarzinomrisiko bei Lithiumlangzeittherapie vorliegen.SummaryLithium salts are the recommended first-line treatment (gold standard) in national and international treatment guidelines for acute and maintenance treatment of affective disorders, such as bipolar disorders. Lithium has also been shown to have a unique protective effect against suicide in patients suffering from affective disorders. Despite the well-known acute and long-term adverse effects lithium therapy can be safely administered if patients are properly educated and carefully monitored. A recent study from France now shows that patients with severely impaired renal function who had been treated with lithium salts for more than 10 years could have an increased risk for kidney tumors (benign and malignant). This resulted in an adjustment concerning information within the package leaflet by European authorities. The authors of this article reflect the currently available data in order to better understand and handle this new finding and to warn about uncritical reactions including withdrawal of lithium in successfully treated patients. This article provides clinical recommendations to provide further insight relating to the risk of kidney cancer in long-term lithium therapy.

International multi-site survey on the use of online support groups in bipolar disorder

Abstract Background: Peer support is an established component of recovery from bipolar disorder, and online support groups may offer opportunities to expand the use of peer support at the patient’s convenience. Prior research in bipolar disorder has reported value from online support groups. Aims: To understand the use of online support groups by patients with bipolar disorder as part of a larger project about information seeking. Methods: The results are based on a one-time, paper-based anonymous survey about information seeking by patients with bipolar disorder, which was translated into 12 languages. The survey was completed between March 2014 and January 2016 and included questions on the use of online support groups. All patients were diagnosed by a psychiatrist. Analysis included descriptive statistics and general estimating equations to account for correlated data. Results and conclusions: The survey was completed by 1222 patients in 17 countries. The patients used the Internet at a percentage similar to the general public. Of the Internet users who looked online for information about bipolar disorder, only 21.0% read or participated in support groups, chats, or forums for bipolar disorder (12.8% of the total sample). Given the benefits reported in prior research, clarification of the role of online support groups in bipolar disorder is needed. With only a minority of patients using online support groups, there are analytical challenges for future studies.

Erratum to: Online information seeking by patients with bipolar disorder: results from an international multisite survey (Int J Bipolar Disord, (2016), 4, (1), 10.1186/s40345-016-0058-0)

Online information seeking by patients with bipolar disorder: results from an international multisite survey (Int J Bipolar Disord, (2016), 4, (1), 10.1186/s40345-0160058-0) Conell, Jörn; Bauer, Rita; Glenn, Tasha; Alda, Martin; Ardau, Raffaella; Baune, Bernhard T.; Berk, Michael; Bersudsky, Yuly; Bilderbeck, Amy; Bocchetta, Alberto; Bossini, Letizia; Paredes Castro, Angela Marianne; Cheung, Eric Yat Wo; Chillotti, Caterina; Choppin, Sabine; Del Zompo, Maria; Dias, Rodrigo; Dodd, Seetal; Duffy, Anne; Etain, Bruno; Fagiolini, Andrea; Garnham, Julie; Geddes, John; Gildebro, Jonas; Gonzalez-Pinto, Ana; Goodwin, Guy M.; Grof, Paul; Harima, Hirohiko; Hassel, Stefanie; Henry, Chantal; Hidalgo-Mazzei, Diego; Kapur, Vaisnvy; Kunigiri, Girish; Lafer, Beny; Lam, Chun; Larsen, Erik Roj; Lewitzka, Ute; Licht, Rasmus W.; Lund, Anne Hvenegaard; Misiak, Blazej; Piotrowski, Patryk; Monteith, Scott; Munoz, Rodrigo; Nakanotani, Takako; Nielsen, René E.; O’Donovan, Claire; Okamura, Yasushi; Osher, Yamima; Reif, Andreas; Ritter, Philipp; Rybakowski, Janusz K.; Sagduyu, Kemal; Sawchuk, Brett; Schwartz, Elon; Scippa, Ângela Miranda; Slaney, Claire; Sulaiman, Ahmad Hatim; Suominen, Kirsi; Suwalska, Aleksandra; Tam, Peter; Tatebayashi, Yoshitaka; Tondo, Leonardo; Vieta, Eduard; Vinberg, Maj; Viswanath, Biju; Volkert, Julia; Zetin, Mark; Zorrilla, Iñaki; Whybrow, Peter C.; Bauer, Michael

Gibt es bei der Lithiumlangzeitbehandlung ein erhöhtes Risiko für Nierentumoren?@@@Is there an increased risk for renal tumors during long-term treatment with lithium?

Lithium salts are the recommended first-line treatment (gold standard) in national and international treatment guidelines for acute and maintenance treatment of affective disorders, such as bipolar disorders. Lithium has also been shown to have a unique protective effect against suicide in patients suffering from affective disorders. Despite the well-known acute and long-term adverse effects lithium therapy can be safely administered if patients are properly educated and carefully monitored. A recent study from France now shows that patients with severely impaired renal function who had been treated with lithium salts for more than 10 years could have an increased risk for kidney tumors (benign and malignant). This resulted in an adjustment concerning information within the package leaflet by European authorities. The authors of this article reflect the currently available data in order to better understand and handle this new finding and to warn about uncritical reactions including withdrawal of lithium in successfully treated patients. This article provides clinical recommendations to provide further insight relating to the risk of kidney cancer in long-term lithium therapy.ZusammenfassungLithium wird aufgrund sehr gut belegter Wirksamkeit erfolgreich in der Akutbehandlung und Prophylaxe affektiver Erkrankungen, insbesondere bipolarer Störungen, eingesetzt. Es gilt in letzterer Indikation als der „Goldstandard“ in allen wichtigen nationalen und internationalen Leitlinien für bipolare Störungen. Lithium hat zudem eine gut belegte antisuizidale Wirkung, was bislang für keine andere psychotrope Substanz im Bereich der affektiven Störungen nachgewiesen wurde. Der Einsatz ist bei sorgfältiger Patientenaufklärung und unter Einhaltung der gebotenen Vorsichtsmaßnahmen und Monitoring der bekannten potenziellen Nebenwirkungen sicher. Eine neuere Studie aus Frankreich hat nun Hinweise erbracht, dass Patienten mit schwerer Niereninsuffizienz, die Lithium über mehr als 10 Jahre erhalten hatten, ein erhöhtes Risiko für Nierentumoren, einschließlich Karzinomen, haben könnten. Dieser Befund und weitere Hinweise haben dazu geführt, dass die Fachinformationen der Lithiumpräparate europaweit angepasst werden sollen. Die Autoren erläutern die aktuelle Datenlage, möchten helfen, diese angemessen einzuordnen und warnen vor vorschnellen Maßnahmen. Der Beitrag schließt mit konkreten klinischen Empfehlungen, bis gegebenenfalls weitere Erkenntnisse über das Nierenkarzinomrisiko bei Lithiumlangzeittherapie vorliegen.SummaryLithium salts are the recommended first-line treatment (gold standard) in national and international treatment guidelines for acute and maintenance treatment of affective disorders, such as bipolar disorders. Lithium has also been shown to have a unique protective effect against suicide in patients suffering from affective disorders. Despite the well-known acute and long-term adverse effects lithium therapy can be safely administered if patients are properly educated and carefully monitored. A recent study from France now shows that patients with severely impaired renal function who had been treated with lithium salts for more than 10 years could have an increased risk for kidney tumors (benign and malignant). This resulted in an adjustment concerning information within the package leaflet by European authorities. The authors of this article reflect the currently available data in order to better understand and handle this new finding and to warn about uncritical reactions including withdrawal of lithium in successfully treated patients. This article provides clinical recommendations to provide further insight relating to the risk of kidney cancer in long-term lithium therapy.