Decreased core symptoms of mania and utilization of lithium/mood stabilizing anticonvulsants in U.S. bipolar I patients of African vs European ancestry

Margaret Akinhanmi, Suliman El-Amin, Joyce Balls-Berry, Eric J. Vallender, Mark Ladner, Jennifer Geske, Brandon Coombes, Joanna M Biernacka, John Kelsoe, Mark A Frye

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)361-365
Number of pages5
JournalJournal of Affective Disorders
Volume260
DOIs
StatePublished - Jan 1 2020

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Bipolar Disorder
Lithium
Anticonvulsants
Hallucinations
Interviews
Diagnostic Errors
Delusions
Information Services
Psychotic Disorders
Databases
Research

Keywords

  • Bipolar
  • Health disparity
  • Lithium
  • Psychosis

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Decreased core symptoms of mania and utilization of lithium/mood stabilizing anticonvulsants in U.S. bipolar I patients of African vs European ancestry. / Akinhanmi, Margaret; El-Amin, Suliman; Balls-Berry, Joyce; Vallender, Eric J.; Ladner, Mark; Geske, Jennifer; Coombes, Brandon; Biernacka, Joanna M; Kelsoe, John; Frye, Mark A.

In: Journal of Affective Disorders, Vol. 260, 01.01.2020, p. 361-365.

Research output: Contribution to journalArticle

Akinhanmi, Margaret ; El-Amin, Suliman ; Balls-Berry, Joyce ; Vallender, Eric J. ; Ladner, Mark ; Geske, Jennifer ; Coombes, Brandon ; Biernacka, Joanna M ; Kelsoe, John ; Frye, Mark A. / Decreased core symptoms of mania and utilization of lithium/mood stabilizing anticonvulsants in U.S. bipolar I patients of African vs European ancestry. In: Journal of Affective Disorders. 2020 ; Vol. 260. pp. 361-365.
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abstract = "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.",
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AU - El-Amin, Suliman

AU - Balls-Berry, Joyce

AU - Vallender, Eric J.

AU - Ladner, Mark

AU - Geske, Jennifer

AU - Coombes, Brandon

AU - Biernacka, Joanna M

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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.

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