Cognitive correlates of impulsive aggression in youth with pediatric bipolar disorder and bipolar offspring

Cognitive Correlates of Borderline Personality Disorder Features in Youth with Bipolar Spectrum Disorders and Bipolar Offspring

Background: Bipolar disorder (BD) and borderline personality disorder (BPD) share common cognitive impairments. These deficits are also shared by bipolar offspring (BD-OFF). Nevertheless, little is known regarding the association between cognitive impairments and BPD features in youth with BD and BD-OFF. Objectives: This study aimed to investigate the association between BPD features and cognitive impairments in youth with BD and BD-OFF. Methods: Thirty-nine participants (7-17 years) with BD, 18 BD-OFF, and 50 healthy controls (HCs) were recruited. BPD features were assessed using the Borderline Personality Features Scale for Children (BPFS-C). Deficits in executive functions and affective processing were assessed using tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB), namely, the Cambridge gambling task (CGT), the stockings of Cambridge (SOC), and the Affective Go/No-Go (AGN) and rapid visual processing (RVP) tasks. Between-group differences were analyzed through ANOVAs. Relationships between the BPFS-C and cognitive tasks were examined using multiple linear regressions in youth with BD and BD-OFF. Results: Youth with BD and BD-OFF showed higher scores on the BPFS-C. Youth with BD had increased deficits in the CGT and SOC compared to HCs. In both youth with BD and BD-OFF, BPD features were associated with increased deficits in the CGT, and a bias toward positive emotions in the AGN task. Conclusions: In youth with BD and BD-OFF, clinical and cognitive assessments for BPD features are of relevance as they have the potential to inform targeted interventions.

Association between overt aggression and suicidal ideation in patients with major depressive disorder: the mediational role of cognitive symptoms

Suicidal ideation, under the dominion of suicidal behavior, represents the most severe consequence of depressive disorders. Overt aggressive behaviors leading to agitated symptoms, coupled with cognitive symptoms during a depressive episode, both impact suicidal ideation and behavior. However, the precise mechanisms by which cognitive symptoms and overt aggressive behaviors influence suicidal ideation in patients with depressive disorders remain unclear. This cross-sectional study analyzed 301 MDD patients from the Shanghai Mental Health Centre between May 2017 and July 2020. Depression severity and cognitive symptoms were assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17), overt aggression with the Modified Overt Aggression Scale (MOAS), and suicidal ideation with the Beck Scale for Suicide Ideation (BSSI). A multivariate logistic regression was conducted to identify risk factors for suicidal ideation. Patients with suicidal ideation had higher levels of cognitive impairment and overt aggression (Z = - 5.527, P < 0.01; Z = - 3.482, P < 0.01). Overt aggressive symptoms positively correlated with suicide ideation (r = 0.177, P = 0.006) and cognitive performance scores (r = 0.173, P = 0.035). And cognitive performance scores also positively correlated with suicide ideation (r = 0.308, P < 0.001). Logistic regression identified cognitive symptoms (OR 1.47) and overt aggression (OR 1.40) as predictors of suicidal ideation in MDD patients (P < 0.05). Mediation analysis revealed that cognitive symptoms mediated the relationship between overt aggression and suicidal ideation (indirect effect: 0.1903). In MDD, cognitive symptoms and overt aggression are significant predictors of suicidal ideation, with cognitive symptoms playing a mediating role. These findings suggest potential targets for therapeutic intervention.

Aggressive Behavior in Children and Adolescents With Bipolar Spectrum Disorder: A Systematic Review of the Prevalence, Associated Factors, and Treatment

Objective

Bipolar disorder (BD) in childhood and adolescence is associated with aggressive behaviors, which might be common and in turn associated with poor clinical outcomes. This is the first systematic review to provide a comprehensive view of the current status of the knowledge about aggressive behaviors in youth with BD.

Method

We conducted a PRISMA-compliant systematic review of studies investigating aggressive behaviors in children and adolescents with BD (PROSPERO: CRD42023431674). A systematic multi-step literature search was performed on PubMed and the Web of Science. Literature search and data extraction were carried out independently. We provided a systematic synthesis of the findings from the included studies We assessed risk of bias using a modified version of the Newcastle-Ottawa Scale for cross-sectional and cohort studies.

Results

Of the 2,277 identified records 35 were included; mean age was 12.4 years, and 57.1% were male individuals. 7 studies reported on the prevalence of aggressive behavior among BD children and adolescent population, with 5 of them reporting a prevalence of over 69.0%. Aggressive behaviors were more common in children and adolescents with BD than in those with ADHD or depression. Aggressive behaviors were associated with borderline personality disorder features and poor family functioning. Valproic acid received empirical support for its efficacy in reducing aggressive behavior in BD.

Conclusion

Aggressive behaviors are prevalent among youth with BD and warrant clinical attention and specific evidence-based management. Further research on prognostic factors and psychosocial interventions evaluated prospectively is required.

Diversity & Inclusion Statement

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.

Neurocognitive correlates of polygenic risk for bipolar disorder among youth with and without bipolar disorder

INTRODUCTION

There is well-established evidence of reduced neurocognitive performance in adults and youth with bipolar disorder (BD). However, little is known about the polygenic underpinnings of neurocognition in individuals with BD, particularly in youth. The current study aimed to examine the association between polygenic risk score for BD (BD-PRS) and neurocognition among youth with BD and healthy controls (HC).

METHODS

129 youth of European ancestry (72 BD, 57 HC), ages 13-20 years, were included. Six neurocognitive tasks within the Cambridge Neuropsychological Test Automated Battery were assessed. General linear models were used to examine the association between BD-PRS and neurocognitive composite scores, controlling for age, sex, IQ, and two genetic principal components.

RESULTS

In the overall sample, higher BD-PRS was associated with significantly poorer affective processing (β = -0.25, p = 0.01), decision-making (β = -0.23, p = 0.02), and sustained attention (β = -0.28, p = 0.002). Secondary analyses revealed that higher BD-PRS was associated with significantly poorer sustained attention within the BD group (β = -0.27, p = 0.04), and with significantly poorer affective processing within the HC group (β = -0.29, p = 0.04).

LIMITATIONS

Cross-sectional design. Modest sample size may have reduced power to detect smaller effect sizes.

CONCLUSION

The current study found that higher BD-PRS generated based on adult GWAS was associated with poorer neurocognitive performance in youth with BD and HC. Future longitudinal studies incorporating repeated neurocognitive assessments would further inform whether the associations of BD-PRS with neurocognition vary from youth to adulthood, and whether BD-PRS is associated with differential neurodevelopmental trajectories in individuals with and without BD.

Disrupted white matter microstructure correlates with impulsivity in children and adolescents with bipolar disorder

Altered white matter (WM) microstructure likely occurs in children with bipolar disorder (BD) with impulsivity representing one of the core features. However, altered WM microstructures and their age-related trendlines in children with BD and those at high-risk of developing BD, as well as correlations of WM microstructures with impulsivity, have been poorly investigated. In this study, diffusion MRI, cognitive, and impulsivity assessments were obtained from children/adolescents diagnosed with BD, offspring of individuals with BD (high-risk BD) and age-matched healthy controls. A novel atlas-based WM skeleton measurement approach was used to quantify WM microstructural integrity with all diffusion-tensor-imaging (DTI) metrics including fractional anisotropy, axial, mean and radial diffusivity to survey entire WM tracts and ameliorate partial volume effects. Among all DTI-derived metric measures, radial diffusivity quantifying WM myelination was found significantly higher primarily in corpus callosum and in the corona radiata in children with BD compared to controls. Distinguished from age-related progressively decreasing diffusivities and increasing fractional anisotropy in healthy controls, flattened age-related trendlines were found in BD group, and intermediate developmental rates were observed in high-risk group. Larger radial diffusivity in the corpus callosum and corona radiata significantly correlated with shorter response times to affective words that indicate higher impulsivity in the BD group, whereas no such correlation was found in the healthy control group. This work corroborates the progressive nature of pediatric BD and suggests that WM microstructural disruption involved in affective regulation and sensitive to impulsivity may serve as a biomarker of pediatric BD progression.

Neuroanatomical Correlates of the Late Positive Potential in Youth with Pediatric Bipolar Disorder

BACKGROUND

The late positive potential (LPP) could be a marker of emotion dysregulation in youth with pediatric bipolar disorder (PBD). However, the neuroanatomical correlates of the LPP are still not clarified.

OBJECTIVE

To provide cortical and deep gray matter correlates of the LPP in youth, specifically, youth with PBD.

METHODS

Twenty-four 7 to 17 years-old children with PBD and 28 healthy controls (HC) underwent cortical thickness and deep gray matter volumes measurements through magnetic resonance imaging and LPP measurement elicited by passively viewing emotional faces through electroencephalography. T-tests compared group differences in LPP, cortical thickness, and deep gray matter volumes. Linear regressions tested the relationship between LPP amplitude and cortical thickness/deep gray matter volumes.

RESULTS

PBD had a more pronounced LPP amplitude for happy faces and a thinner cortex in prefrontal areas than HC. While considering both groups, a higher LPP amplitude was associated with a thicker cortex across occipital and frontal lobes, and with a smaller right globus pallidus volume. In addition, a higher LPP amplitude for happy faces was associated with smaller left caudate and left globus pallidus volumes across both groups. Finally, the LPP amplitude correlated negatively with right precentral gyrus thickness across youth with PBD, but positively across HC.

CONCLUSION

Neural correlates of LPP in youth included fronto-occipital areas that have been associated also with emotion processing and control. The opposite relationship between BPD and HC of LPP amplitude and right precentral gyrus thickness might explain the inefficacy of the emotional control system in PBD.

Cortical Correlates of Impulsive Aggressive Behavior in Pediatric Bipolar Disorder

Background: Impulsive aggression represents a frequent characteristic of pediatric bipolar disorder (PBD). Cortical alterations associated with impulsive aggression and its multiple facets have not been investigated yet in youth with bipolar disorder. Aim: To investigate the relationship between cortical thickness and facets of impulsive aggression in youth with PBD. Materials and Methods: Twenty-three youth with PBD and 23 healthy controls (HC) were administered the aggression questionnaire (AQ) and underwent 3T magnetic resonance imaging scan. Cortical thickness was assessed with FreeSurfer. Canonical correlation analyses were used to investigate the relationship between AQ total and subscale scores and cortical thickness in youth with PBD. Results: Youth with PBD had increased scores in the subscales of AQ-anger and AQ-hostility and cortical thinning in in areas belonging to the affective network (AN), frontoparietal network (FPN) and cingulo-opercular network (CON), i.e., right rostral anterior cingulate, right caudal anterior cingulate, right lateral orbitofrontal, right medial orbitofrontal, left and right inferior parietal, left posterior cingulate, left and right supramarginal left lingual cortices. Greater thickness in these networks positively correlated with the AQ-hostility subscale and negatively correlated with AQ-anger subscale. Conclusions: The opposite patterns observed between areas belonging to AN, FPN, CON, and the two facets of IA, namely anger and hostility, corroborate clinical findings supporting the different nature of these two constructs.