TY - JOUR
T1 - Decreased core symptoms of mania and utilization of lithium/mood stabilizing anticonvulsants in U.S. bipolar I patients of African vs European ancestry
AU - Akinhanmi, Margaret
AU - El-Amin, Suliman
AU - Balls-Berry, Joyce E.
AU - Vallender, Eric J.
AU - Ladner, Mark
AU - Geske, Jennifer
AU - Coombes, Brandon
AU - Biernacka, Joanna
AU - Kelsoe, John
AU - Frye, Mark A.
N1 - Funding Information:
This work was made possible by CTSA Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
Funding Information:
We have 1 conflict of interest to disclose. Dr. Mark A. Frye has had grant support from Assurex Health, Mayo Foundation, Myriad, National Institute of Alcohol Abuse and Alcoholism (NIAAA), National Institute of Mental Health (NIMH), and Pfizer; and had past consultancy for Actify Neurotherapies, Allergan, Intra-Cellular Therapies, Inc., Janssen, Mitsubishi Tanabe Pharma Corporation, Myriad, Neuralstem Inc., Otsuka American Pharmaceutical, Sunovion, Takeda, and Teva Pharmaceuticals; he also has received past grant support from Johnson & Johnson and AssureRx (although not for this manuscript).The authors wish to thank the Bipolar Genome Study (BiGS) Co-authors:, John R. Kelsoe, Tiffany A. Greenwood, Caroline M. Nievergelt, Rebecca McKinney, Paul D. Shilling, Erin N. Smith – University of California, San Diego, CA, USA; Nicholas J. Schork, Cinnamon S. Bloss - Scripps Translational Science Institute, La Jolla, CA, USA; John I. Nurnberger, Jr. Howard J. Edenberg, Tatiana Foroud, Daniel L. Koller - Indiana University, Indianapolis, IN, USA; Elliot S. Gershon, Chunyu Liu, Judith A. Badner - University of Chicago, Chicago, IL, USA; William A. Scheftner - Rush University Medical Center, Chicago, IL, USA; William B. Lawson, Evaristus A. Nwulia, Maria Hipolito - Howard University, Washington, D.C. USA; William Coryell – University of Iowa, Iowa City, IA, USA; John Rice - Washington University, St. Louis, MO, USA; William Byerley - University of California, San Francisco, CA, USA; Francis J. McMahon, Thomas G. Schulze - National Institute of Mental Health Intramural Research Program, Bethesda, MD, USA; Wade H. Berrettini - University of Pennsylvania, Philadelphia, PA, USA; Peter P. Zandi, Pamela B. Mahon, James B. Potash - Johns Hopkins School of Medicine, Baltimore, MD, USA; Melvin G. McInnis, Sebastian Zo¨llner, Peng Zhang - University of Michigan, Ann Arbor, MI, USA; David W. Craig, Szabolcs Szelinger - The Translational Genomics Research Institute, Phoenix, AZ, USA; Thomas B. Barrett – Portland Veterans Affairs Medical Center, Portland, OR, USA. The original data set for the Genetic Information Association Network is available from National Institutes of Health Database of Genotype and Phenotype (dbGaP). https://www.ncbi.nlm.nih.gov/projects/gap/cgibin/study.cgi?study_id=phs000017.v3.p1, This work was made possible by CTSA Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH. Poster presented at the Annual Meeting of the Association for Clinical and Translational Science (ACTS), April 19–21, 2018, Washington D.C. Poster presented at the National Network of Depression Centers Annual Conference, October 17–19, 2018, Baltimore, Maryland.
Publisher Copyright:
© 2019
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Objective: Misdiagnosis is common in bipolar disorder and disproportionally affects racial and ethnic minorities. There is interest in better understanding the contribution of differential symptomatic illness presentation to misdiagnosis. Methods: Utilizing the Genetic Association Information Network (GAIN) public database, this study compared clinical phenomenology between bipolar patients of African vs European ancestry (AA = 415 vs EA = 480). The Diagnostic Interview for Genetic Studies (DIGS) was utilized to evaluate symptom endorsement contributing to diagnostic confirmation of bipolar I disorder (BPI) and lifetime medication use. Results: Elevated/euphoric mood was less endorsed in AA vs EA participants (p = 0.03). During the most severe episode of mania, AA participants, in comparison to EA participants, had a lower sum of manic symptoms (p = 0.006) and a higher rate of hallucinations (p = 0.01). During lifetime psychosis, AA participants, in comparison to EA participants, had a higher lifetime sum of delusions (p = 0.01) and hallucinations (p < 0.0001). AA participants reported lower use of lithium (p < 0.0001) and mood stabilizing anticonvulsants (p = 0.0003). Conclusions: The differential rate of manic and psychotic symptom endorsement from a semi-structured diagnostic interview may represent differential illness presentation based on biological differences or racial or study biases (e.g. ascertainment). Increased minority recruitment in bipolar research is therefore a necessary future direction. Limitations: Recall and interviewer bias may affect study results, but are likely diminished by the alignment of symptom endorsement and medication use.
AB - Objective: Misdiagnosis is common in bipolar disorder and disproportionally affects racial and ethnic minorities. There is interest in better understanding the contribution of differential symptomatic illness presentation to misdiagnosis. Methods: Utilizing the Genetic Association Information Network (GAIN) public database, this study compared clinical phenomenology between bipolar patients of African vs European ancestry (AA = 415 vs EA = 480). The Diagnostic Interview for Genetic Studies (DIGS) was utilized to evaluate symptom endorsement contributing to diagnostic confirmation of bipolar I disorder (BPI) and lifetime medication use. Results: Elevated/euphoric mood was less endorsed in AA vs EA participants (p = 0.03). During the most severe episode of mania, AA participants, in comparison to EA participants, had a lower sum of manic symptoms (p = 0.006) and a higher rate of hallucinations (p = 0.01). During lifetime psychosis, AA participants, in comparison to EA participants, had a higher lifetime sum of delusions (p = 0.01) and hallucinations (p < 0.0001). AA participants reported lower use of lithium (p < 0.0001) and mood stabilizing anticonvulsants (p = 0.0003). Conclusions: The differential rate of manic and psychotic symptom endorsement from a semi-structured diagnostic interview may represent differential illness presentation based on biological differences or racial or study biases (e.g. ascertainment). Increased minority recruitment in bipolar research is therefore a necessary future direction. Limitations: Recall and interviewer bias may affect study results, but are likely diminished by the alignment of symptom endorsement and medication use.
KW - Bipolar
KW - Health disparity
KW - Lithium
KW - Psychosis
UR - http://www.scopus.com/inward/record.url?scp=85072240981&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2019.09.022
DO - 10.1016/j.jad.2019.09.022
M3 - Article
C2 - 31539671
AN - SCOPUS:85072240981
SN - 0165-0327
VL - 260
SP - 361
EP - 365
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -