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Psychotropics are overprescribed for adults with intellectual disabilities; there are few studies in children and young people.
To investigate antipsychotic and antidepressant prescribing in children and young people with and without intellectual disabilities, and prescribing trends.
Scotland's annual Pupil Census, which identifies pupils with and without intellectual disabilities, was record-linked to the Prescribing Information System. Antidepressant and antipsychotic data were extracted. Logistic regression was used to analyse prescribing between 2010 and 2013.
Of the 704 297 pupils, 16 142 (2.29%) had a record of intellectual disabilities. Antipsychotic and antidepressant use increased over time, and was higher in older pupils; antipsychotic use was higher in boys, and antidepressant use was higher in girls. Overall, antipsychotics were prescribed to 281 (1.74%) pupils with intellectual disabilities and 802 (0.12%) without (adjusted odds ratio 16.85, 95% CI 15.29–18.56). The higher use among those with intellectual disabilities fell each year (adjusted odds ratio 20.19 in 2010 v. 14.24 in 2013). Overall, 191 (1.18%) pupils with intellectual disabilities and 4561 (0.66%) without were prescribed antidepressants (adjusted odds ratio 2.28, 95% CI 2.03–2.56). The difference decreased each year (adjusted odds ratio 3.10 in 2010 v. 2.02 in 2013).
Significantly more pupils with intellectual disabilities are prescribed antipsychotics and antidepressants than are other pupils. Prescribing overall increased over time, but less so for pupils with intellectual disabilities; either they are not receiving the same treatment advances as other pupils, or possible overprescribing in the past is changing. More longitudinal data are required.
Recent work suggests that antihypertensive medications may be useful as repurposed treatments for mood disorders. Using large-scale linked healthcare data we investigated whether certain classes of antihypertensive, such as angiotensin antagonists (AAs) and calcium channel blockers, were associated with reduced risk of new-onset major depressive disorder (MDD) or bipolar disorder (BD).
Two cohorts of patients treated with antihypertensives were identified from Scottish prescribing (2009–2016) and hospital admission (1981–2016) records. Eligibility for cohort membership was determined by a receipt of a minimum of four prescriptions for antihypertensives within a 12-month window. One treatment cohort (n = 538 730) included patients with no previous history of mood disorder, whereas the other (n = 262 278) included those who did. Both cohorts were matched by age, sex and area deprivation to untreated comparators. Associations between antihypertensive treatment and new-onset MDD or bipolar episodes were investigated using Cox regression.
For patients without a history of mood disorder, antihypertensives were associated with increased risk of new-onset MDD. For AA monotherapy, the hazard ratio (HR) for new-onset MDD was 1.17 (95% CI 1.04–1.31). Beta blockers' association was stronger (HR 2.68; 95% CI 2.45–2.92), possibly indicating pre-existing anxiety. Some classes of antihypertensive were associated with protection against BD, particularly AAs (HR 0.46; 95% CI 0.30–0.70). For patients with a past history of mood disorders, all classes of antihypertensives were associated with increased risk of future episodes of MDD.
There was no evidence that antihypertensive medications prevented new episodes of MDD but AAs may represent a novel treatment avenue for BD.
Obesity remains one of the biggest health challenges worldwide. Sarcopenia, a progressive loss of muscle strength, is associated with a higher risk of disability and lower quality of life. Both conditions can occur independently of each other; however, share a common inflammatory pathway, leading to serious health problems. Previous studies have shown a positive association between severe sarcopenia and respiratory disease incidence/mortality, however, it is unclear if this association is modified by obesity. The aim of this work, therefore, was to investigate the association of severe sarcopenia and severe sarcopenic-obesity with respiratory incidence and mortality in the UK Biobank cohort.
Material and methods
242,572 white participants from the UK biobank study were included. Severe sarcopenia was defined as the combination of low muscle mass, low grip strength and slow gait speed. Severe sarcopenic-obesity was defined, using 3 different criteria. The combination of severe sarcopenia plus at least one of the following criteria: BMI ≥ 30 kg/m2, waist circumference (WC) > 88 cm in women and > 102 cm in men, or the two highest quintiles of body fat (60%). Associations between severe sarcopenic and severe sarcopenic-obesity and respiratory incidence and mortality were investigated using Cox-proportional hazard models.
In people without sarcopenia, high BMI, WC and body fat were associated with a reduced risk of respiratory disease mortality (HR: 0.70 [0.52; 0.85], HR: 0.74 [95%CI: 062: 088] and HR: 0.74 [95%CI: 0.63; 0.88], respectively). In comparison to people without sarcopenia or obesity, those with severe sarcopenia had three times higher risk of respiratory disease incidence (HR: 3.13 [95%CI: 2.25; 4.35]) and five times higher risk of mortality (HR: 5.37 [95%CI: 2.96: 9.74]). However, sarcopenic-obesity, based on WC and body fat, was only associated with a moderately increased respiratory disease incidence (HR 1.60 [95%CI: 1.04; 2.46] and HR: 1.52 [1.04: 2.22], respectively). There were no associations between respiratory mortality and sarcopenic-obesity.
Higher levels of adiposity may be a protective factor against respiratory mortality and could reduce the effect of severe sarcopenia over this disease. However, the mechanism behind this association needs to elucidate.
Cognitive impairment is strongly linked with persistent disability in people with mood disorders, but the factors that explain cognitive impairment in this population are unclear.
To estimate the total effect of (a) bipolar disorder and (b) major depression on cognitive function, and the magnitude of the effect that is explained by potentially modifiable intermediate factors.
Cross-sectional study using baseline data from the UK Biobank cohort. Participants were categorised as having bipolar disorder (n = 2709), major depression (n = 50 975) or no mood disorder (n = 102 931 and n = 105 284). The outcomes were computerised tests of reasoning, reaction time and memory. The potential mediators were cardiometabolic disease and psychotropic medication. Analyses were informed by graphical methods and controlled for confounding using regression, propensity score-based methods and G-computation.
Group differences of small magnitude were found on a visuospatial memory test. Z-score differences for the bipolar disorder group were in the range −0.23 to −0.17 (95% CI −0.39 to −0.03) across different estimation methods, and for the major depression group they were approximately −0.07 (95% CI −0.10 to −0.03). One-quarter of the effect was mediated via psychotropic medication in the bipolar disorder group (−0.05; 95% CI −0.09 to −0.01). No evidence was found for mediation via cardiometabolic disease.
In a large community-based sample in middle to early old age, bipolar disorder and depression were associated with lower visuospatial memory performance, in part potentially due to psychotropic medication use. Mood disorders and their treatments will have increasing importance for population cognitive health as the proportion of older adults continues to grow.
Declaration of interest
I.J.D. is a UK Biobank participant. J.P.P. is a member of the UK Biobank Steering Committee.
Intellectual ability may be an endophenotypic marker for bipolar disorder.
Within a large birth cohort, we aimed to assess whether childhood IQ (including both verbal IQ (VIQ) and performance IQ (PIQ) subscales) was predictive of lifetime features of bipolar disorder assessed in young adulthood.
We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a large UK birth cohort, to test for an association between measures of childhood IQ at age 8 years and lifetime manic features assessed at age 22–23 years using the Hypomania Checklist-32 (HCL-32; n=1881 individuals). An ordinary least squares linear regression model was used, with normal childhood IQ (range 90–109) as the referent group. We adjusted analyses for confounding factors, including gender, ethnicity, handedness, maternal social class at recruitment, maternal age, maternal history of depression and maternal education.
There was a positive association between IQ at age 8 years and lifetime manic features at age 22–23 years (Pearson's correlation coefficient 0.159 (95% CI 0.120–0.198), P>0.001). Individuals in the lowest decile of manic features had a mean full-scale IQ (FSIQ) which was almost 10 points lower than those in the highest decile of manic features: mean FSIQ 100.71 (95% CI 98.74–102.6) v. 110.14 (95% CI 107.79–112.50), P>0.001. The association between IQ and manic features was present for FSIQ, VIQ and for PIQ but was strongest for VIQ.
A higher childhood IQ score, and high VIQ in particular, may represent a marker of risk for the later development of bipolar disorder. This finding has implications for understanding of how liability to bipolar disorder may have been selected through generations. It will also inform future genetic studies at the interface of intelligence, creativity and bipolar disorder and is relevant to the developmental trajectory of bipolar disorder. It may also improve approaches to earlier detection and treatment of bipolar disorder in adolescents and young adults.
Low birth weight has been inconsistently associated with risk of
developing affective disorders, including major depressive disorder
(MDD). To date, studies investigating possible associations between birth
weight and bipolar disorder (BD), or personality traits known to
predispose to affective disorders such as neuroticism, have not been
conducted in large cohorts.
To assess whether very low birth weight (<1500 g) and low birth weight
(1500–2490 g) were associated with higher neuroticism scores assessed in
middle age, and lifetime history of either MDD or BD. We controlled for
possible confounding factors.
Retrospective cohort study using baseline data on the 83 545 UK Biobank
participants with detailed mental health and birth weight data. Main
outcomes were prevalent MDD and BD, and neuroticism assessed using the
Eysenck Personality Inventory Neuroticism scale - Revised (EPIN-R)
Referent to normal birth weight, very low/low birth weight were
associated with higher neuroticism scores, increased MDD and BD. The
associations between birth weight category and MDD were partially
mediated by higher neuroticism.
These findings suggest that intrauterine programming may play a role in
lifetime vulnerability to affective disorders.
The relative contribution of demographic, lifestyle and medication factors to the association between affective disorders and cardiometabolic diseases is poorly understood.
To assess the relationship between cardiometabolic disease and features of depresion and bipolar disorder within a large population sample.
Cross-sectional study of 145 991 UK Biobank participants: multivariate analyses of associations between features of depression or bipolar disorder and five cardiometabolic outcomes, adjusting for confounding factors.
There were significant associations between mood disorder features and ‘any cardiovascular disease’ (depression odds ratio (OR) = 1.15, 95% CI 1.12–1.19; bipolar OR = 1.28, 95% CI 1.14–1.43) and with hypertension (depression OR = 1.15, 95% CI 1.13–1.18; bipolar OR = 1.26, 95% CI 1.12–1.42). Individuals with features of mood disorder taking psychotropic medication were significantly more likely than controls not on psychotropics to report myocardial infarction (depression OR = 1.47, 95% CI 1.24–1.73; bipolar OR = 2.23, 95% CI 1.53–3.57) and stroke (depression OR = 2.46, 95% CI 2.10–2.80; bipolar OR = 2.31, 95% CI 1.39–3.85).
Associations between features of depression or bipolar disorder and cardiovascular disease outcomes were statistically independent of demographic, lifestyle and medication confounders. Psychotropic medication may also be a risk factor for cardiometabolic disease in individuals without a clear history of mood disorder.
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