Impulsividad, búsqueda de sensaciones y agresividad en pacientes bipolares tipo I y II

Left Ventrolateral Prefrontal Cortical Activity During Reward Expectancy and Mania Risk

Importance

Mania/hypomania is the pathognomonic feature of bipolar disorder (BD). As BD is often misdiagnosed as major depressive disorder (MDD), replicable neural markers of mania/hypomania risk are needed for earlier BD diagnosis and pathophysiological treatment development.

Objective

To replicate the previously reported positive association between left ventrolateral prefrontal cortex (vlPFC) activity during reward expectancy (RE) and mania/hypomania risk, to explore the effect of MDD history on this association, and to compare RE-related left vlPFC activity in individuals with and at risk of BD.

Design, Setting, and Participants

This cross-sectional study was conducted from July 2014 to December 2023 at the University of Pittsburgh, Pittsburgh, Pennsylvania. Three samples were formed comprising young adults (aged 18 to 30 years) without BD and with a range of subsyndromal-syndromal affective and anxiety psychopathologies, including a new sample and 2 test samples from our previous research; a sample of individuals aged 18 to 30 years with euthymic BD was also included. All participants were recruited from the community through advertising.

Exposures

Functional magnetic resonance imaging during an RE task.

Main Outcomes and Measures

New sample: whole-brain activity during RE regressed to the Mood Spectrum Self-Report Lifetime Questionnaire (MOODS-SR-L) manic domain score in all participants and in those without history of MDD and RE-related whole-brain activity regressed to the MOODS-SR-L depressive domain score to determine specificity to mania/hypomania risk. Test samples: these associations were examined using parameter estimates of activity extracted from respective masks created from activity in the new sample. A tertile split of MOODS-SR-L manic domain score divided the new sample into 3 mania/hypomania risk groups. Comparison of RE-related activity (extracted parameter estimates) was performed in risk groups and individuals with BD.

Results

Among the 113 individuals in the new sample, 73 were female, and the mean (SD) age was 23.88 (3.32) years. In each of the test samples, there were 52 individuals (39 female; mean [SD] age, 21.94 [2.12] years) and 65 individuals (47 female; mean [SD] age, 21.39 [2.11] years). The euthymic BD group had 37 individuals (30 female; mean [SD] age, 25.12 [3.81] years). In the new sample, 8 clusters of RE-related activity, including left vlPFC activity, showed a positive association with mania/hypomania risk, which remained after excluding individuals with MDD history and was specific to mania/hypomania risk. In the test samples, this association was shown in test sample 1 only (β, 0.21; 95% CI, 0.08-0.35; P = .002; q(false discovery rate [FDR]), 0.006; R2, 0.04). Test sample 2 had a higher proportion with MDD history (49 of 65 [75.3%] compared to 31 of 52 [59.6%] in sample 1). Combining individuals without history of MDD in both test samples replicated the association (β, 0.32; 95% CI, 0.08-0.58; P = .01; q[FDR], 0.023; R2, 0.02). RE-related left vlPFC activity was significantly greater in individuals at highest risk vs lowest (Cohen d, 1.01; 95% CI, 0.29-0.79; P < .001) and medium (Cohen d, 0.59; 95% CI, 0.12-0.63; P = .004) risk, as well as the euthymic BD group (Cohen d, 0.54; 95% CI, 0.07-0.58; P = .01), potentially due to medication effects.

Conclusion and Relevance

Elevated RE-related left vlPFC activity was associated with mania/hypomania risk and attenuated by MDD history. These findings provide a neural target to help develop pathophysiological interventions for individuals with or at risk of mania/hypomania.

Nutrition risk screening methods for adults living with severe mental illness: A scoping review

AIM

Adults living with severe mental illness experience a greater burden of physical comorbidities and earlier mortality than the general population. Malnutrition, overnutrition, dysphagia, constipation and disordered eating have been observed in this population and can lead to poor nutritional status. Early identification of such conditions may reduce their impact on functional status, quality of life and health outcomes. This scoping review aimed to identify all nutrition risk screening methods published in English internationally for use with adults living with severe mental illness and ascertain which, if any, were validated for the target population.

METHODS

A four-step search strategy was used to search six electronic databases and grey literature, from inception to April 2020, for articles reporting nutrition risk screening methods used in this population. Information on the content and validity of screening methods was extracted and analysed by three independent reviewers.

RESULTS

Seventeen nutrition risk screening methods were identified, of which three were validated within a population of adults with severe mental illness. One screening method was found for both malnutrition and dysphagia risk, respectively, and three for constipation risk. No single method was found for overnutrition. Eleven screening methods were identified for disordered eating risk, of which two were validated for the target population.

CONCLUSIONS

Nutrition risk screening methods and their validation in adults living with severe mental illness are inadequately researched. This scoping review highlights the need for future research to develop new or validate existing screening methods specifically for the target population.

Conceptuación y Medición de la Agresividad: Validación de una Escala

El objetivo de esta investigación fue construir una escala de agresividad confiable y culturalmente relevante para adultos mexicanos. Se elaboraron 96 reactivos en escala Likert a partir de indicadores obtenidos en un estudio preliminar y de planteamientos teóricos. Participaron voluntarios de la Ciudad de México. Se obtuvieron cinco factores que agrupan 25 reactivos que explican el 61.59 % de la varianza, ‚α=0.92. En otro estudio, se realizó un análisis factorial confirmatorio que mostró índices de ajuste adecuados. Posteriormente, se obtuvieron correlaciones entre la personalidad y la agresividad. Los resultados muestran que los factores extroversión, afabilidad, responsabilidad y apertura se asocian negativamente a la agresividad; mientras que el neuroticismo se asocia positivamente. Respecto a las diferencias por sexo, los resultados indican que los hombres muestran niveles más elevados de reactividad y las mujeres de frustración. Se concluye que la escala es un instrumento válido y confiable que permite reconocer diferencias entre los cinco grandes factores de personalidad, así como en hombres y mujeres.

Impulsivity in bipolar disorders in a Tunisian sample

Impulsivity as a trait characteristic is increased in bipolar disorder and may be a core factor of the illness. The objectives of our work are to evaluate the level of impulsivity among patients with bipolar disorder and to study its relation with mood state, alcohol misuse, suicide attempts and other socio-demographic and clinical factors. We measured impulsivity in 60 subjects with bipolar disorder in relationship to socio-demographic and clinical variables. The subjects completed Data included socio-demographic details and clinical variables, the Barratt Impulsiveness Scale (BIS-11) in an Arabic version to assess impulsivity, The Mini International Neuropsychiatric Interview "MINI" version 05 to screen for alcohol abuse or dependence and mood graphic rate scale (MGRS) to evaluate mood state. Our results show that the mean score of BIS-11 was 71.5. Fifty-five per cent of the patients had a high level of impulsiveness. No differences were found relating to mood state. Impulsivity was related to Male gender, lower educational level, early age of onset, smoking, alcohol and drug misuse and prior suicide attempts. The treatment of patients with BD should consider to reduce impulsivity to improve morbidity.