1
|
Dell'Osso B, Cremaschi L, Macellaro M, Cafaro R, Girone N. Bipolar disorder staging and the impact it has on its management: an update. Expert Rev Neurother 2024:1-10. [PMID: 38753491 DOI: 10.1080/14737175.2024.2355264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The longitudinal course of bipolar disorder (BD) is associated with an active process of neuroprogression, characterized by structural brain alterations and progressive functional impairment. In the last decades, a growing need of a standardized staging model for BD arose, with the aim of a more appropriate definition of stage-specific clinical manifestations and the identification of more customized therapeutic tools. AREAS COVERED The authors review the literature on clinical aspects, neurobiological correlates and treatment issues related to BD progression. Thereafter, they address the definition, constructs, and evolution of the staging concept, focusing on the clinical applications of BD staging models available in literature. EXPERT OPINION Although several staging models for BD have been proposed to date, their application in clinical practice is still relatively scant. This may have a detrimental impact on the clinical and therapeutic management of BD, in terms of early and proper diagnosis as well as tailored treatment interventions according to the different stages of illness. Future research efforts should tend to the integration of recent insights on neuroimaging and epigenetic markers, toward a standardized and multidimensional staging model.
Collapse
Affiliation(s)
- Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
- CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
| | - Laura Cremaschi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Monica Macellaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
- CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
| | - Rita Cafaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Nicolaja Girone
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| |
Collapse
|
2
|
Flaaten CB, Melle I, Bjella T, Engen MJ, Åsbø G, Wold KF, Widing L, Gardsjord E, Øie MG, Lyngstad SH, Haatveit B, Simonsen C, Ueland T. Long-term course of cognitive functioning in bipolar disorder: A ten-year follow-up study. Bipolar Disord 2024; 26:136-147. [PMID: 37356974 DOI: 10.1111/bdi.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Cognitive impairments are common in bipolar disorder (BD), but the long-term course remains understudied. Longitudinal data on cognitive functioning from the start of the first treatment could help clarify pathophysiological processes that shape the illness outcome. We here aim to investigate the 10-year cognitive course in BD compared to healthy controls (HC) and the effects of clinical symptoms on cognitive trajectories. METHODS Fifty-six BD participants recruited within their first year of treatment and 108 HC completed clinical and cognitive assessments at baseline and 10-year follow-up. We derived eight cognitive domain scores and a cognitive composite score, which were further investigated using linear mixed model analyses. Correlation analyses were used to assess associations between the composite score and depressive, manic and psychotic symptoms. RESULTS BD participants performed poorer than HCs in all domains except mental speed and verbal fluency. Verbal learning and memory, verbal fluency and the composite score improved over time in both BD participants and HC, while short-term memory, mental speed, psychomotor speed and working memory were stable. We found no significant correlations between cognition and symptom level at either time point in BD participants. CONCLUSIONS We found evidence of long-term cognitive stability or improvement in BD participants from first treatment to 10-year follow-up. Though the BD group was impaired in all domains except mental speed and verbal fluency, the change in cognitive functioning was parallel to that of HCs. These findings are not consistent with the notion of neuroprogression in BD.
Collapse
Affiliation(s)
- Camilla Bärthel Flaaten
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas Bjella
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus Johan Engen
- Division of Mental Health and Addiction, Nydalen DPS, Oslo University Hospital, Oslo, Norway
| | - Gina Åsbø
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Kristin Fjelnseth Wold
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Line Widing
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erlend Gardsjord
- Division of Mental Health and Addiction, Unit for Early Intervention in Psychosis, Oslo University Hospital, Oslo, Norway
| | | | - Siv Hege Lyngstad
- Division of Mental Health and Addiction, Nydalen DPS, Oslo University Hospital, Oslo, Norway
| | - Beathe Haatveit
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Carmen Simonsen
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torill Ueland
- Division of Mental Health and Addiction, NORMENT, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| |
Collapse
|
3
|
Cattarinussi G, Pouya P, Grimaldi DA, Dini MZ, Sambataro F, Brambilla P, Delvecchio G. Cortical alterations in relatives of patients with bipolar disorder: A review of magnetic resonance imaging studies. J Affect Disord 2024; 345:234-243. [PMID: 37865341 DOI: 10.1016/j.jad.2023.10.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/11/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023]
Abstract
INTRODUCTION Bipolar disorder (BD) is a severe mental disorder characterized by high heritability rates. Widespread brain cortical alterations have been reported in BD patients, mostly involving the frontal, temporal and parietal regions. Importantly, also unaffected relatives of BD patients (BD-RELs) present abnormalities in cortical measures, which are not influenced by disease-related factors, such as medication use and illness duration. Here, we collected all available evidence on cortical measures in BD-RELs to further our knowledge on the potential cortical alterations associated with the vulnerability and the resilience to BD. METHODS A search on PubMed, Web of Science and Scopus was performed to identify neuroimaging studies exploring cortical alterations in BD-RELs, including cortical thickness (CT), surface area (SA), gyrification (GI) and cortical complexity. Eleven studies were included. Of these, five assessed CT, five examined CT and SA and one explored CT, SA and GI. RESULTS Overall, a heterogeneous pattern of cortical alterations emerged. The areas more consistently linked with genetic liability for BD were the prefrontal and sensorimotor regions. Mixed evidence was reported in the temporal and cingulate areas. LIMITATIONS The small sample size and the heterogeneity in terms of methodologies and the characteristics of the participants limit the generalizability of our results. CONCLUSIONS Our findings suggest that the genetic liability for BD is related to reduced CT in the prefrontal cortex, which might be a marker of risk for BD, and increased CT within the sensorimotor cortex, which could represent a marker of resilience.
Collapse
Affiliation(s)
- Giulia Cattarinussi
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Parnia Pouya
- Research Center for Evidence-Based Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran; Iranian EBM Center: A Joanna Briggs Institute Affiliated Group, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mahta Zare Dini
- Research Center for Evidence-Based Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran; Iranian EBM Center: A Joanna Briggs Institute Affiliated Group, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fabio Sambataro
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy; Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| |
Collapse
|
4
|
Timmi A, Morin A, Guillin O, Nicolas G. One Train May Hide Another: Two Cases of Co-Occurring Primary Familial Brain Calcification and Alzheimer's Disease. J Mol Neurosci 2024; 74:2. [PMID: 38180527 DOI: 10.1007/s12031-023-02184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/02/2023] [Indexed: 01/06/2024]
Abstract
Primary familial brain calcification (PFBC) is a rare disorder that can manifest with a wide spectrum of motor, cognitive, and psychiatric symptoms or even remain asymptomatic. Alzheimer disease (AD) is a common condition that typically starts as a progressive amnestic disorder and progresses to major cognitive impairment. Accurately attributing an etiology to cognitive impairment can sometimes be challenging, especially when multiple pathologies with potentially overlapping symptomatology contribute to the clinical phenotype. Here, we present the case of two patients with autosomal dominant PFBC and non-monogenic AD. Cerebrospinal fluid (CSF) biomarker analysis combined with genetic testing permitted the dual diagnosis. We emphasize the importance of thoroughly characterizing the patient's phenotype at onset and during the follow-up. Particular attention is placed on psychiatric symptoms given that both patients had a history of mood disorder, a frequent condition in the general population and in neurological diseases. We also discuss and challenge the paradigm of seeking a single diagnosis explaining all symptoms, remembering the possibility of a rare disease co-occurring with a common one.
Collapse
Affiliation(s)
- Andrea Timmi
- Department of Psychiatry, Rouvray Hospital, Univ Rouen Normandie, F-76000, Rouen, France
| | - Alexandre Morin
- Department of Psychiatry, Rouvray Hospital, Univ Rouen Normandie, F-76000, Rouen, France
- Univ Rouen Normandie, Normandie Univ and CHU Rouen, Department of Neurology, F-76000, Rouen, France
| | - Olivier Guillin
- Department of Psychiatry, Rouvray Hospital, Univ Rouen Normandie, F-76000, Rouen, France
- Univ Rouen Normandie, Normandie Univ, Inserm U1245 and CHU Rouen, Department of Psychiatry, F-76000, Rouen, France
| | - Gaël Nicolas
- Univ Rouen Normandie, Normandie Univ, Inserm U1245 and CHU Rouen, Department of Genetics and CNR-MAJ, F-76000, Rouen, France.
| |
Collapse
|
5
|
Macoveanu J, Damgaard V, Ysbæk-Nielsen AT, Frangou S, Yatham LN, Chakrabarty T, Stougaard ME, Knudsen GM, Vinberg M, Kessing LV, Kjærstad HL, Miskowiak KW. Early longitudinal changes in brain structure and cognitive functioning in remitted patients with recently diagnosed bipolar disorder. J Affect Disord 2023; 339:153-161. [PMID: 37442440 DOI: 10.1016/j.jad.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/08/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Patients with bipolar disorder (BD) who are presenting with cognitive impairment and associated structural brain abnormalities have generally a poorer clinical outcome. This study aims to map the early longitudinal trajectories in brain structure and cognition in patients with recently diagnosed BD. METHODS Fully or partially remitted patients with a recent diagnosis of BD and matched healthy controls (HC) underwent structural MRI and neuropsychological testing at baseline (BD n = 97; HC n = 66) and again following an average of 16 (range 6-27) months (BD n = 50; HC n = 38). We investigated the differential trajectories in BD vs. HC in cortical gray matter volume and thickness, total cerebral white matter, hippocampal and amygdala volumes, estimated brain age, and cognitive functioning using linear mixed models. Within patients, we further investigated whether brain structural abnormalities detected at baseline were associated with subsequent mood episodes. RESULTS Compared to HC, patients showed a decline in total white matter volume over time and they had a larger amygdala volume, both at baseline and at follow-up time. Patients further showed lower cognitive performance at both times of investigation with no significant change over time. There were no differences between patients and HC in cortical gray matter volume or thickness, hippocampal volume, or brain-aging patterns. CONCLUSIONS Cognitive impairment and amygdala enlargement may represent stable markers of BD early in the course of illness, whereas subtle white matter decline may result from illness progression.
Collapse
Affiliation(s)
- Julian Macoveanu
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Viktoria Damgaard
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Psychology, University of Copenhagen, Denmark
| | - Alexander Tobias Ysbæk-Nielsen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Psychology, University of Copenhagen, Denmark
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lakshmi N Yatham
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Canada
| | - Marie Eschau Stougaard
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Gitte Moos Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Maj Vinberg
- Department of Clinical Medicine, University of Copenhagen, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Hanne Lie Kjærstad
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Psychology, University of Copenhagen, Denmark
| |
Collapse
|
6
|
Bridges JFP, Goldberg JF, Fitzgerald HM, Chumki SR, Beusterien K, Will O, Citrome L. Prioritizing Treatment Goals of People Diagnosed with Bipolar I Disorder in the US: Best-Worst Scaling Results. Patient Prefer Adherence 2023; 17:2545-2555. [PMID: 37849618 PMCID: PMC10578617 DOI: 10.2147/ppa.s419143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
Purpose Bipolar I disorder (BP-I) is associated with significant disease burden, but evidence on treatment goals in people diagnosed with BP-I is scarce. This study sought to quantify treatment goals related to the pharmacological management of BP-I in adults in the US and to identify if subgroups of people with similar treatment goals exist. Patients and Methods A best-worst scaling (BWS) of treatment goals was developed based on available literature and input from experts and patients and was distributed as part of a survey between August and September 2021. Survey participants were adults with a self-reported diagnosis of BP-I who were recruited via an online panel in the US. Participants were asked to prioritize the importance of 16 treatment goals using BWS. BWS scores were computed using multinomial logistic regression, with the scores across all goals summing to 100 for each participant. Subgroups of people with similar preferences were identified using latent class analysis. Results The most important treatment goals for people diagnosed with BP-I (N=255) were "being less impulsive, angry, or irritable" (score: 9.73), or being "able to feel pleasure or happiness" (score: 9.54). Goals related to reducing the incidence of various potential adverse events of medication (scores: ≤4.51) or "reducing dependence on others" (score: 3.04) were less important. Two subgroups were identified. One subgroup (n=111) prioritized symptom-focused goals, considering "reducing frequency of mania, depression, and mixed episodes" and "being less impulsive, angry or irritable" the most important (scores: 12.46 and 11.85, respectively). The other subgroup (n=144) placed significantly more importance on social functioning-focused goals, including beginning or maintaining a relationship with a partner/significant other, and with family and/or friends (scores: 8.45 and 7.70, respectively). Conclusion People diagnosed with BP-I prioritized emotional improvements. Subgroups of people with BP-I prioritized either symptom-focused or social functioning-focused treatment goals.
Collapse
Affiliation(s)
- John F P Bridges
- Department of Biomedical Informatics, the Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Sanjeda R Chumki
- Medical Affairs, Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, USA
| | | | | | - Leslie Citrome
- Department of Psychiatry & Behavioral Sciences, New York Medical College, Valhalla, NY, USA
| |
Collapse
|
7
|
Jones BDM, Zhukovsky P, Hawco C, Ortiz A, Cipriani A, Voineskos AN, Mulsant BH, Husain MI. Protocol for a systematic review and meta-analysis of coordinate-based network mapping of brain structure in bipolar disorder across the lifespan. BJPsych Open 2023; 9:e178. [PMID: 37811544 PMCID: PMC10594157 DOI: 10.1192/bjo.2023.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/03/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Studies about brain structure in bipolar disorder have reported conflicting findings. These findings may be explained by the high degree of heterogeneity within bipolar disorder, especially if structural differences are mapped to single brain regions rather than networks. AIMS We aim to complete a systematic review and meta-analysis to identify brain networks underlying structural abnormalities observed on T1-weighted magnetic resonance imaging scans in bipolar disorder across the lifespan. We also aim to explore how these brain networks are affected by sociodemographic and clinical heterogeneity in bipolar disorder. METHOD We will include case-control studies that focus on whole-brain analyses of structural differences between participants of any age with a standardised diagnosis of bipolar disorder and controls. The electronic databases Medline, PsycINFO and Web of Science will be searched. We will complete an activation likelihood estimation analysis and a novel coordinate-based network mapping approach to identify specific brain regions and brain circuits affected in bipolar disorder or relevant subgroups. Meta-regressions will examine the effect of sociodemographic and clinical variables on identified brain circuits. CONCLUSIONS Findings from this systematic review and meta-analysis will enhance understanding of the pathophysiology of bipolar disorder. The results will identify brain circuitry implicated in bipolar disorder, and how they may relate to relevant sociodemographic and clinical variables across the lifespan.
Collapse
Affiliation(s)
- Brett D. M. Jones
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Peter Zhukovsky
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Colin Hawco
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Abigail Ortiz
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK; and Oxford Precision Psychiatry Laboratory, NIHR Oxford Health Biomedical Research Centre, UK
| | - Aristotle N. Voineskos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Benoit H. Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Muhammad Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| |
Collapse
|
8
|
de Jesus JR, de Araujo Andrade T, de Figueiredo EC. Biomarkers in psychiatric disorders. Adv Clin Chem 2023; 116:183-208. [PMID: 37852719 DOI: 10.1016/bs.acc.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Psychiatric disorders represent a significant socioeconomic and healthcare burden worldwide. Of these, schizophrenia, bipolar disorder, major depressive disorder and anxiety are among the most prevalent. Unfortunately, diagnosis remains problematic and largely complicated by the lack of disease specific biomarkers. Accordingly, much research has focused on elucidating these conditions to more fully understand underlying pathophysiology and potentially identify biomarkers, especially those of early stage disease. In this chapter, we review current status of this endeavor as well as the potential development of novel biomarkers for clinical applications and future research study.
Collapse
Affiliation(s)
| | | | - Eduardo Costa de Figueiredo
- Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, Alfenas, Minas Gerais, Brazil
| |
Collapse
|
9
|
Goto J, Shono M, Abe Y, Fujita Y, Ueda K, Yoshida B, Nabeshima Y. Preventive effect of aripiprazole once monthly on rehospitalization for bipolar disorder: A multicenter 1-year retrospective mirror image study. Neuropsychopharmacol Rep 2023; 43:425-433. [PMID: 37560818 PMCID: PMC10496053 DOI: 10.1002/npr2.12371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
AIM We conducted a 1-year retrospective mirror-image study to investigate the effect of aripiprazole once monthly (AOM) on rehospitalization for bipolar disorder. METHODS Participants were recruited from psychiatric emergency and acute care hospitals in western Japan. We included 39 participants with bipolar disorder who had been administered AOM for at least 1 year with no missing medical records during the observational period. The primary outcomes were rehospitalization rate, number of rehospitalizations, total hospitalization days, and time to rehospitalization in the context of overall psychiatric readmissions. The significance level was set at p < 0.05. RESULTS AOM significantly reduced the rehospitalization rate from 23/39 (59%) to 7/39 (18%) (p = 0.001). The number of rehospitalizations decreased significantly from a mean of 0.85 per person-year to 0.41 per person-year (p = 0.048). The total hospitalization days significantly decreased from a mean of 34.9 days to 14.4 days (p = 0.008). AOM significantly prolonged the time to rehospitalization (p < 0.001). CONCLUSION This study found that AOM reduces overall psychiatric rehospitalization for bipolar disorder based on data from 1 year before and after AOM administration in the real-world setting. Future studies should examine the robustness and persistence of the rehospitalization preventive effect of AOM with larger sample sizes and longer observation periods beyond 1 year.
Collapse
|
10
|
Decker K, Murata S, Baig N, Hasan S, Halaris A. Utilizing the Systemic Immune-Inflammation Index and Blood-Based Biomarkers in Association with Treatment Responsiveness amongst Patients with Treatment-Resistant Bipolar Depression. J Pers Med 2023; 13:1245. [PMID: 37623494 PMCID: PMC10455950 DOI: 10.3390/jpm13081245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: Inflammation is associated with depressive illness and treatment resistance. This study assessed a novel inflammatory index, the Systemic Immune-Inflammation Index (SII), in patients diagnosed with treatment-resistant bipolar depression (TRBDD) before and after treatment with escitalopram (ESC) and celecoxib (CBX) add-on or ESC and placebo (PBO), and compared them to healthy control (HC) subjects. (2) Methods: This is a secondary biological analysis from a double-blind randomized placebo-controlled trial of CBX augmentation in TRBDD. Our subsample with available complete blood count (CBC) data included 52 TRBDD subjects, randomized into an ESC + CBX, (n = 29), an ESC + PBO arm (n = 23), and an HC group (n = 32). SII was calculated from the CBC with differential (SII = platelets x neutrophils/lymphocytes) at baseline and end of treatment (8 weeks). Blood inflammation biomarkers, growth factors, and kynurenine metabolites were determined at both timepoints. Depressive symptom severity was the primary outcome, using the HAMD-17 rating scale score to quantitate treatment response and remission rates. (3) Results: Baseline SII did not discriminate TRBDD from HC, nor was it associated with HAMD-17 score at any timepoint, although it was significantly associated with lower baseline VEGF (p = 0.011) and higher week 8 levels of IL1-β (p = 0.03) and CRP (p = 0.048). Post-treatment HAMD-17 was not independently predicted using baseline SII unless an interaction with age was present (p = 0.003 was included), even after relevant adjustments. A similar effect was seen with baseline neutrophils. (4) Conclusions: While SII was not an independent predictor of treatment outcome, elevated baseline SII was a predictor of poor treatment response amongst older patients with TRBDD.
Collapse
Affiliation(s)
- Kyle Decker
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA; (K.D.); (N.B.); (A.H.)
- Stritch School of Medicine, Loyola University, Maywood, IL 60153, USA
| | - Stephen Murata
- Pine Rest Christian Mental Health Services, Michigan State University, Grand Rapids, MI 49548, USA
| | - Nausheen Baig
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA; (K.D.); (N.B.); (A.H.)
- Stritch School of Medicine, Loyola University, Maywood, IL 60153, USA
| | - Sakibur Hasan
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48824, USA;
| | - Angelos Halaris
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA; (K.D.); (N.B.); (A.H.)
| |
Collapse
|
11
|
Chakrabarty T, Frangou S, Torres IJ, Ge R, Yatham LN. Brain age and cognitive functioning in first-episode bipolar disorder. Psychol Med 2023; 53:5127-5135. [PMID: 35875930 PMCID: PMC10476063 DOI: 10.1017/s0033291722002136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is significant heterogeneity in cognitive function in patients with bipolar I disorder (BDI); however, there is a dearth of research into biological mechanisms that might underlie cognitive heterogeneity, especially at disease onset. To this end, this study investigated the association between accelerated or delayed age-related brain structural changes and cognition in early-stage BDI. METHODS First episode patients with BDI (n = 80) underwent cognitive assessment to yield demographically normed composite global and domain-specific scores in verbal memory, non-verbal memory, working memory, processing speed, attention, and executive functioning. Structural magnetic resonance imaging data were also collected from all participants and subjected to machine learning to compute the brain-predicted age difference (brainPAD), calculated by subtracting chronological age from age predicted by neuroimaging data (positive brainPAD values indicating age-related acceleration in brain structural changes and negative values indicating delay). Patients were divided into tertiles based on brainPAD values, and cognitive performance compared amongst tertiles with ANCOVA. RESULTS Patients in the lowest (delayed) tertile of brainPAD values (brainPAD range -17.9 to -6.5 years) had significantly lower global cognitive scores (p = 0.025) compared to patients in the age-congruent tertile (brainPAD range -5.3 to 2.4 yrs), and significantly lower verbal memory scores (p = 0.001) compared to the age-congruent and accelerated (brainPAD range 2.8 to 16.1 yrs) tertiles. CONCLUSION These results provide evidence linking cognitive dysfunction in the early stage of BDI to apparent delay in typical age-related brain changes. Further studies are required to assess how age-related brain changes and cognitive functioning evolve over time.
Collapse
Affiliation(s)
- Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
| | - Sophia Frangou
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
- Department of Psychiatry Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Ivan J. Torres
- British Columbia Mental Health and Substance Use Services, Vancouver, BC, Canada
| | - Ruiyang Ge
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
| | - Lakshmi N. Yatham
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
| |
Collapse
|
12
|
Degraff Z, Souza GS, Santos NA, Shoshina II, Felisberti FM, Fernandes TP, Sigurdsson G. Brain atrophy and cognitive decline in bipolar disorder: Influence of medication use, symptomatology and illness duration. J Psychiatr Res 2023; 163:421-429. [PMID: 37276646 DOI: 10.1016/j.jpsychires.2023.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/02/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
Bipolar disorder (BPD) is a chronic condition characterized by recurrent episodes of mania and depression. To date, the association of biological and psychopathological processes in BPD has not been extensively studied on a cognitive and cortical basis at the same time. We investigated whether brain atrophy (in prefrontal, temporal and occipital cortices) was associated with cognitive, biological and clinical processes in patients with BPD and healthy controls (HCs). A total of 104 participants (56 with BPD) completed tasks that measured attention, memory, information processing speed, inhibitory control, visuospatial working memory and cognitive flexibility. In addition, structural brain scans were obtained using high-resolution MRI. Outcomes of the measurements were examined using robust multiple mediation analyses. BPD patients showed greater cortical atrophy across all regions of interest when compared to HCs, linked to cognitive decline. BPD patients had slower reaction times and markedly increased errors of commission on the tasks. The outcomes were significantly influenced by medication use, symptomatology and illness duration. The findings showcase the complexity of brain structures and networks as well as the physiological mechanisms underlying diverse BPD symptomatology and endophenotypes. These differences were pronounced in patients with BPD, motivating further investigations of pathophysiological mechanisms involved in brain atrophy and cognitive decline.
Collapse
Affiliation(s)
- Zeke Degraff
- Svenskagier Neurologie, Stockholm, Sweden; Institute of Neurology, Belgium.
| | | | | | | | | | - Thiago P Fernandes
- Federal University of Para, Para, Brazil; Federal University of Paraiba, Paraiba, Brazil
| | | |
Collapse
|
13
|
Abé C, Liberg B, Klahn AL, Petrovic P, Landén M. Mania-related effects on structural brain changes in bipolar disorder - a narrative review of the evidence. Mol Psychiatry 2023; 28:2674-2682. [PMID: 37147390 PMCID: PMC10615759 DOI: 10.1038/s41380-023-02073-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/07/2023]
Abstract
Cross-sectional neuroimaging studies show that bipolar disorder is associated with structural brain abnormalities, predominantly observed in prefrontal and temporal cortex, cingulate gyrus, and subcortical regions. However, longitudinal studies are needed to elucidate whether these abnormalities presage disease onset or are consequences of disease processes, and to identify potential contributing factors. Here, we narratively review and summarize longitudinal structural magnetic resonance imaging studies that relate imaging outcomes to manic episodes. First, we conclude that longitudinal brain imaging studies suggest an association of bipolar disorder with aberrant brain changes, including both deviant decreases and increases in morphometric measures. Second, we conclude that manic episodes have been related to accelerated cortical volume and thickness decreases, with the most consistent findings occurring in prefrontal brain areas. Importantly, evidence also suggests that in contrast to healthy controls, who in general show age-related cortical decline, brain metrics remain stable or increase during euthymic periods in bipolar disorder patients, potentially reflecting structural recovering mechanisms. The findings stress the importance of preventing manic episodes. We further propose a model of prefrontal cortical trajectories in relation to the occurrence of manic episodes. Finally, we discuss potential mechanisms at play, remaining limitations, and future directions.
Collapse
Affiliation(s)
- Christoph Abé
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Quantify Research, Stockholm, Sweden
| | - Benny Liberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Luisa Klahn
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Chemistry and Molecular Biology, University of Gothenburg, Gothenburg, Sweden
| | - Predrag Petrovic
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Cognitive and Computational Neuropsychiatry, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
14
|
Faurholt-Jepsen M, Busk J, Bardram JE, Stanislaus S, Frost M, Christensen EM, Vinberg M, Kessing LV. Mood instability and activity/energy instability in patients with bipolar disorder according to day-to-day smartphone-based data - An exploratory post hoc study. J Affect Disord 2023; 334:83-91. [PMID: 37149047 DOI: 10.1016/j.jad.2023.04.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/21/2023] [Accepted: 04/29/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Alterations and instability in mood and activity/energy has been associated with impaired functioning and risk of relapse in bipolar disorder. The present study aimed to investigate whether mood instability and activity/energy instability are associated, and whether these instability measures are associated with stress, quality of life and functioning in patients with bipolar disorder. METHODS Data from two studies were combined for exploratory post hoc analyses. Patients with bipolar disorder provided smartphone-based evaluations of mood and activity/energy levels from day-to-day. In addition, information on functioning, perceived stress and quality of life was collected. A total of 316 patients with bipolar disorder were included. RESULTS A total of 55,968 observations of patient-reported smartphone-based data collected from day-to-day were available. Regardless of the affective state, there was a statistically significant positive association between mood instability and activity/energy instability in all models (all p-values < 0.0001). There was a statistically significant association between mood and activity/energy instability with patient-reported stress and quality of life (e.g., mood instability and stress: B: 0.098, 95 % CI: 0.085; 0.11, p < 0.0001), and between mood instability and functioning (B: 0.045, 95 % CI: 0.0011; 0.0080, p = 0.010). LIMITATIONS Findings should be interpreted with caution since the analyses were exploratory and post hoc by nature. CONCLUSION Mood instability and activity/energy instability is suggested to play important roles in the symptomatology of bipolar disorder. This highlight that monitoring and identifying subsyndromal inter-episodic fluctuations in symptoms is clinically recommended. Future studies investigating the effect of treatment on these measures would be interesting.
Collapse
Affiliation(s)
- Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Jonas Busk
- Department of Energy Conversion and Storage, Technical University of Denmark, Lyngby, Denmark
| | - Jakob Eyvind Bardram
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Sharleny Stanislaus
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | - Ellen Margrethe Christensen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| |
Collapse
|
15
|
de Siqueira Rotenberg L, Kjærstad HL, Varo C, Vinberg M, Kessing LV, Lafer B, Miskowiak KW. The longitudinal trajectory of emotional cognition in subgroups of recently diagnosed patients with bipolar disorder. Eur Neuropsychopharmacol 2023; 71:9-24. [PMID: 36965236 DOI: 10.1016/j.euroneuro.2023.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/27/2023]
Abstract
Although cross-sectional studies show heterogeneity in emotional cognition in bipolar disorder (BD), the temporal course within subgroups is unclear. In this prospective, longitudinal study we assessed the trajectories of emotional cognition subgroups within a 16-month follow-up period in recently diagnosed BD patients compared to healthy controls (HC). Recently diagnosed BD patients and HC underwent comprehensive emotional and non-emotional testing at baseline and again at follow-up. We employed hierarchical cluster analysis at baseline to identify homogenous emotional cognition subgroups of patients, and changes across the subgroups of BD and HC were assessed with linear mixed-model analyses. We found two emotional cognition subgroups: subgroup 1 (65%, n = 179), showing heightened negative emotional reactivity in neutral and negative social scenarios and faster recognition of emotional facial expressions than HC (ps<0.001, n = 190), and subgroup 2 (35%, n = 96) showing blunted reactivity in positive social scenarios, impaired emotion regulation, poorer recognition of positive and slower recognition of all facial expressions than HC (ps≤.03). Subgroup 1 exhibited normalization of the initial emotional cognition abnormalities in follow-up. In contrast, subgroup 2 showed a lack of improvement in reactivity positively-valenced emotional information. Patients in subgroup 2 presented more and longer mixed episodes during the follow-up time and were more often prescribed lithium. One third of patients display blunted emotional reactivity, impaired emotion regulation abilities and facial expression recognition difficulties also show persistent impairments and poorer course of illness. This subgroup may indicate a need for earlier and more targeted therapeutic interventions.
Collapse
Affiliation(s)
- Luisa de Siqueira Rotenberg
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Hanne Lie Kjærstad
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Denmark.
| | | | - Maj Vinberg
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Beny Lafer
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Denmark; Department of Psychology, University of Copenhagen, Denmark
| |
Collapse
|
16
|
Chrobak AA, Soltys Z, Dudek D, Siwek M. Neurological and cerebellar soft signs in bipolar disorder: The role of staging, type and history of psychotic symptoms. Prog Neuropsychopharmacol Biol Psychiatry 2023; 121:110673. [PMID: 36349610 DOI: 10.1016/j.pnpbp.2022.110673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
AIM Bipolar disorder (BD) patients show neurological abnormalities in form of neurological and cerebellar soft signs (NSS and CSS). NSS represents heterogeneous group of symptoms representing i.a. deficits of motor coordination, sequencing of complex motor acts and sensory integration. CSS were introduced as group of the neurological deficits of posture, gait, kinetic functions, eye movements and speech, associated more specifically to cerebellar abnormalities than NSS. Studies show significant effect size variability of those symptoms in BD group suggesting the existence of differing subpopulations. The aim of our study was to evaluate the effect of BD type, stage and the history of psychotic symptoms (HoPS) on the severity of CSS and NSS as none of the previous studies had verified the role of those categories. METHODS This study involved 181 participants: 116 euthymic BD patients (66 BD I, 50 BD II) and 65 healthy controls (HC). CSS was assessed with the International Cooperative Ataxia Rating Scale and NSS with Neurological Evaluation Scale. Patients were divided into early and late stage of the disorder according to Kapczinski's criteria. Rater was blind to patients' stage, type and HoPS. RESULTS Staging was related to vast majority of CSS and NSS scores. HoPS was related to oculomotor deficits. The effect of BD type was the least significant. Late stage BD showed more severe CSS and NSS than HC in every measure. There were no differences between early stage BD and HC, apart of posture and gait disturbances. Except of sensory integration scores, late stage BD showed higher CSS and NSS rates than early stage patients. CONCLUSION In this hitherto the largest study of neurological abnormalities in BD we have shown significant role of staging in CSS and NSS severity. Progression criteria based on inter-episode psychosocial functioning may stand as unrecognised factor responsible for variability observed in previous studies evaluating neurological abnormalities in BD. Our study suggests that in clinical practice NSS and CSS may be potentially used as easy-to-assess biological marker of BD staging. Observed severity of neurological impairments of BD patients may more likely correspond to the disease progression than to BD type and HoPS.
Collapse
Affiliation(s)
- Adrian Andrzej Chrobak
- Jagiellonian University Medical College, Department of Adult Psychiatry, Kopernika St. 21a, 31-501 Cracow, Poland
| | - Zbigniew Soltys
- Jagiellonian University, Institute of Zoology and Biomedical Research, Laboratory of Experimental Neuropathology, Gronostajowa 9, 30-387 Cracow, Poland
| | - Dominika Dudek
- Jagiellonian University Medical College, Department of Adult Psychiatry, Kopernika St. 21a, 31-501 Cracow, Poland
| | - Marcin Siwek
- Jagiellonian University Medical College, Department of Affective Disorders, Kopernika St. 21a, 31-501 Cracow, Poland.
| |
Collapse
|
17
|
Kjærstad HL, de Siqueira Rotenberg L, Knudsen GM, Vinberg M, Kessing LV, Macoveanu J, Lafer B, Miskowiak KW. The longitudinal trajectory of emotion regulation and associated neural activity in patients with bipolar disorder: A prospective fMRI study. Acta Psychiatr Scand 2022; 146:568-582. [PMID: 36054343 PMCID: PMC9804505 DOI: 10.1111/acps.13488] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/12/2022] [Accepted: 08/10/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Impaired emotion regulation is a key feature of bipolar disorder (BD) that presents during acute mood episodes and in remission. The neural correlates of voluntary emotion regulation seem to involve deficient prefrontal top-down regulation already at BD illness onset. However, the trajectory of aberrant neuronal activity during emotion regulation in BD is unclear. METHODS We investigated neural activity during emotion regulation in response to aversive pictures from the International Affective Picture System in patients with recently diagnosed BD (n = 43) in full or partial remission and in healthy controls (HC) (n = 38) longitudinally at baseline and 16 months later. RESULTS Patients with BD exhibited stable hypo-activity in the left dorsomedial prefrontal cortex (DMPFC) and right dorsolateral prefrontal cortex (DLPFC) and impaired emotion regulation compared to HC over the 16 months follow-up time. More DLPFC hypo-activity during emotion regulation correlated with less successful down-regulation (r = 0.16, p = 0.045), more subsyndromal depression (r = -0.18, p = 0.02) and more functional impairment (r = -0.24, p = 0.002), while more DMPFC hypo-activity correlated with less efficient emotion regulation (r = 0.16, p = 0.048). Finally, more DMPFC hypo-activity during emotion regulation at baseline was associated with an increased likelihood of subsequent relapse during the 16 months follow-up time (β = -2.26, 95% CI [0.01; 0.99], p = 0.048). CONCLUSION The stable DLPFC and DMPFC hypo-activity during emotion regulation represents a neuronal trait-marker of persistent emotion regulation difficulties in BD. Hypo-activity in the DMPFC may contribute to greater risk of relapse.
Collapse
Affiliation(s)
- Hanne Lie Kjærstad
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre CopenhagenCopenhagen University HospitalRigshospitaletDenmark
| | - Luisa de Siqueira Rotenberg
- Bipolar Disorder Program (PROMAN), Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloBrazil
| | - Gitte Moos Knudsen
- Neurobiology Research UnitCopenhagen University HospitalRigshospitaletDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Maj Vinberg
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre CopenhagenCopenhagen University HospitalRigshospitaletDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark,Mental Health Center, Northern ZealandCopenhagen University Hospital – Mental Health Services CPHCopenhagenDenmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre CopenhagenCopenhagen University HospitalRigshospitaletDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Julian Macoveanu
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre CopenhagenCopenhagen University HospitalRigshospitaletDenmark
| | - Beny Lafer
- Bipolar Disorder Program (PROMAN), Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloBrazil
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre CopenhagenCopenhagen University HospitalRigshospitaletDenmark,Department of PsychologyUniversity of CopenhagenCopenhagenDenmark
| |
Collapse
|
18
|
De Prisco M, Oliva V, Fico G, Fornaro M, de Bartolomeis A, Serretti A, Vieta E, Murru A. Defining clinical characteristics of emotion dysregulation in bipolar disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 142:104914. [DOI: 10.1016/j.neubiorev.2022.104914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 11/17/2022]
|
19
|
Clergue-Duval V, Coulbault L, Questel F, Cabé N, Laniepce A, Delage C, Boudehent C, Bloch V, Segobin S, Naassila M, Pitel AL, Vorspan F. Alcohol Withdrawal Is an Oxidative Stress Challenge for the Brain: Does It Pave the Way toward Severe Alcohol-Related Cognitive Impairment? Antioxidants (Basel) 2022; 11:2078. [PMID: 36290801 DOI: 10.3390/antiox11102078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/22/2022] [Accepted: 10/19/2022] [Indexed: 11/21/2022] Open
Abstract
Alcohol use is a leading cause of mortality, brain morbidity, neurological complications and minor to major neurocognitive disorders. Alcohol-related neurocognitive disorders are consecutive to the direct effect of chronic and excessive alcohol use, but not only. Indeed, patients with severe alcohol use disorders (AUD) associated with pharmacological dependence suffer from repetitive events of alcohol withdrawal (AW). If those AW are not managed by adequate medical and pharmacological treatment, they may evolve into severe AW, or be complicated by epileptic seizure or delirium tremens (DT). In addition, we suggest that AW favors the occurrence of Wernicke’s encephalopathy (WE) in patients with known or unknown thiamine depletion. We reviewed the literature on oxidative stress as a core mechanism in brain suffering linked with those conditions: AW, epileptic seizure, DT and WE. Thus, we propose perspectives to further develop research projects aiming at better identifying oxidative stress brain damage related to AW, assessing the effect of repetitive episodes of AW, and their long-term cognitive consequences. This research field should develop neuroprotective strategies during AW itself or during the periwithdrawal period. This could contribute to the prevention of severe alcohol-related brain damage and cognitive impairments.
Collapse
|
20
|
Poletti S, Paolini M, Ernst J, Bollettini I, Melloni E, Vai B, Harrington Y, Bravi B, Calesella F, Lorenzi C, Zanardi R, Benedetti F. Long-term effect of childhood trauma: Role of inflammation and white matter in mood disorders. Brain Behav Immun Health 2022; 26:100529. [PMID: 36237478 PMCID: PMC9550612 DOI: 10.1016/j.bbih.2022.100529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 10/27/2022] Open
Abstract
Bipolar disorder (BD) and major depressive disorder (MDD) are severe psychiatric illnesses that share among their environmental risk factors the exposure to adverse childhood experiences (ACE). Exposure to ACE has been associated with long-term changes in brain structure and the immune response. In the lasts decades, brain abnormalities including alterations of white matter (WM) microstructure and higher levels of peripheral immune/inflammatory markers have been reported in BD and MDD and an association between inflammation and WM microstructure has been shown. However, differences in these measures have been reported by comparing the two diagnostic groups. The aim of the present study was to investigate the interplay between ACE, inflammation, and WM in BD and MDD. We hypothesize that inflammation will mediate the association between ACE and WM and that this will be different in the two groups. A sample of 200 patients (100 BD, 100 MDD) underwent 3T MRI scan and ACE assessment through Childhood Trauma Questionnaire. A subgroup of 130 patients (75 MDD and 55 BD) underwent blood sampling for the assessment of immune/inflammatory markers. We observed that ACE associated with higher peripheral levels of IL-2, IL-17, bFGF, IFN-γ, TNF-α, CCL3, CCL4, CCL5, and PDGF-BB only in the BD group. Further, higher levels of CCL3 and IL-2 associated with lower FA in BD. ACE were found to differently affect WM microstructure in the two diagnostic groups and to be negatively associated with FA and AD in BD patients. Mediation analyses showed a significant indirect effect of ACE on WM microstructure mediated by IL-2. Our findings suggest that inflammation may mediate the detrimental effect of early experiences on brain structure and different mechanisms underlying brain alterations in BD and MDD.
Collapse
Affiliation(s)
- Sara Poletti
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy,Vita-Salute San Raffaele University, Milano, Italy,Corresponding author. San Raffaele Turro, Via Stamira d’Ancona 20, 20127, Milano, Italy.
| | - Marco Paolini
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Julia Ernst
- Vita-Salute San Raffaele University, Milano, Italy
| | - Irene Bollettini
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy
| | - Elisa Melloni
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Benedetta Vai
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Yasmin Harrington
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Beatrice Bravi
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Federico Calesella
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Cristina Lorenzi
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Raffaella Zanardi
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Francesco Benedetti
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, Scientific Institute IRCCS Ospedale San Raffaele, Milano, Italy,Vita-Salute San Raffaele University, Milano, Italy
| |
Collapse
|
21
|
McInnis MG, Andreassen OA, Andreazza AC, Alon U, Berk M, Brister T, Burdick KE, Cui D, Frye M, Leboyer M, Mitchell PB, Merikangas K, Nierenberg AA, Nurnberger JI, Pham D, Vieta E, Yatham LN, Young AH. Strategies and foundations for scientific discovery in longitudinal studies of bipolar disorder. Bipolar Disord 2022; 24:499-508. [PMID: 35244317 PMCID: PMC9440950 DOI: 10.1111/bdi.13198] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Bipolar disorder (BD) is a complex and dynamic condition with a typical onset in late adolescence or early adulthood followed by an episodic course with intervening periods of subthreshold symptoms or euthymia. It is complicated by the accumulation of comorbid medical and psychiatric disorders. The etiology of BD remains unknown and no reliable biological markers have yet been identified. This is likely due to lack of comprehensive ontological framework and, most importantly, the fact that most studies have been based on small nonrepresentative clinical samples with cross-sectional designs. We propose to establish large, global longitudinal cohorts of BD studied consistently in a multidimensional and multidisciplinary manner to determine etiology and help improve treatment. Herein we propose collection of a broad range of data that reflect the heterogenic phenotypic manifestations of BD that include dimensional and categorical measures of mood, neurocognitive, personality, behavior, sleep and circadian, life-story, and outcomes domains. In combination with genetic and biological information such an approach promotes the integrating and harmonizing of data within and across current ontology systems while supporting a paradigm shift that will facilitate discovery and become the basis for novel hypotheses.
Collapse
Affiliation(s)
| | - Ole A. Andreassen
- NORMENT CentreUniversity of Oslo and Oslo University HospitalOsloNorway
| | - Ana C. Andreazza
- Department of Pharmacology & ToxicologyTemerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | | | - Michael Berk
- Deakin UniversityIMPACT – the Institute for Mental and Physical Health and Clinical TranslationSchool of MedicineBarwon HealthGeelongAustralia
- OrygenThe National Centre of Excellence in Youth Mental HealthCentre for Youth Mental HealthFlorey Institute for Neuroscience and Mental Health and the Department of PsychiatryThe University of MelbourneMelbourneAustralia
| | - Teri Brister
- National Alliance on Mental IllnessArlingtonVirginiaUSA
| | | | - Donghong Cui
- Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghai Mental Health CenterShangaiChina
| | | | - Marion Leboyer
- Département de psychiatrieUniversité Paris Est Creteil (UPEC)AP‐HPHôpitaux Universitaires H. MondorDMU IMPACTINSERM, translational NeuropsychiatryFondation FondaMentalCreteilFrance
| | | | - Kathleen Merikangas
- Intramural Research ProgramNational Institute of Mental HealthBethesdaMarylandUSA
| | | | | | - Daniel Pham
- Milken InstituteCenter for Strategic PhilanthopyWashingtonDistrict of ColumbiaUSA
| | - Eduard Vieta
- Bipolar and Depressive disorders UnitHospital ClinicInstitute of NeuroscienceUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaCataloniaSpain
| | | | - Allan H. Young
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and NeuroscienceKing’s College London & South London and Maudsley NHS Foundation TrustBethlem Royal HospitalBeckenhamKentUK
| |
Collapse
|
22
|
Tanrıkulu AB, İnanlı İ, Arslan S, Çalışkan AM, Çiçek İE, Eren İ. White matter characteristics in the early and late stages of bipolar disorder: A diffusion tensor imaging study. J Affect Disord 2022; 308:353-9. [PMID: 35398113 DOI: 10.1016/j.jad.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/14/2022] [Accepted: 04/02/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is characterized by recurrent mood episodes that may progress over time. Staging models may be used to follow the long-term course of BD. BD is associated with microstructural changes in white matter (WM). This study aims to compare the WM integrity within patients groups who are in different stages of BD and healthy controls and investigate whether WM integrity changes may be a biomarker that can be used in the clinical staging of BD. METHODS The study sample included euthymic 54 patients diagnosed with BD according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and 27 healthy volunteers. Early-stage patients (n = 26) were determined as patients who have not had any mood episodes after the first manic episode, and late-stage patients (n = 28) determined as patients with recurrent mood episodes. MRI was performed using a 1.5 Tesla MR system and DTI sequences were acquired. RESULTS Region of interest (ROI) analyses showed that late-stage patients had significantly reduced fractional anisotropy (FA) in the right sagittal stratum and genu of the corpus callosum compared with healthy controls and early-stage patients. Regression models show that corpus callosum genu and right sagittal stratum FA values are predictive for the late-stage patient group. LIMITATIONS There are some limitations of the ROI method. The cross-sectional design is another limitation of this study. CONCLUSIONS WM integrity of corpus callosum genu and right sagittal stratum may be a biomarker for clinical staging of BD. Identifying stage-specific biomarkers may help us predict the neuroprogressive course of BD. Longitudinal studies would be required to detect stage-specific biomarkers.
Collapse
|
23
|
Lima Santos JP, Bertocci M, Bebko G, Goldstein T, Kim T, Iyengar S, Bonar L, Gill M, Merranko J, Yendiki A, Birmaher B, Phillips ML, Versace A. White Matter Correlates of Early-Onset Bipolar Illness and Predictors of One-Year Recurrence of Depression in Adults with Bipolar Disorder. J Clin Med 2022; 11. [PMID: 35743502 DOI: 10.3390/jcm11123432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
Diffusion Magnetic Resonance Imaging (dMRI) studies have reported abnormalities in emotion regulation circuits in BD; however, no study has examined the contribution of previous illness on these mechanisms. Using global probabilistic tractography, we aimed to identify neural correlates of previous BD illness and the extent to which these can help predict one-year recurrence of depressive episodes. dMRI data were collected in 70 adults with early-onset BD who were clinically followed for up to 18 years and 39 healthy controls. Higher number of depressive episodes during childhood/adolescence and higher percentage of time with syndromic depression during longitudinal follow-up was associated with lower fractional anisotropy (FA) in focal regions of the forceps minor (left, F = 4.4, p = 0.003; right, F = 3.1, p = 0.021) and anterior cingulum bundle (left, F = 4.7, p = 0.002; right, F = 7.0, p < 0.001). Lower FA in these regions was also associated with higher depressive and anxiety symptoms at scan. Remarkably, those having higher FA in the right cluster of the forceps minor (AOR = 0.43, p = 0.017) and in a cluster of the posterior cingulum bundle (right, AOR = 0.50, p = 0.032) were protected against the recurrence of depressive episodes. Previous depressive symptomatology may cause neurodegenerative effects in the forceps minor that are associated with worsening of BD symptomatology in subsequent years. Abnormalities in the posterior cingulum may also play a role.
Collapse
|
24
|
Shoshina II, Almeida NL, Oliveira MEC, Trombetta BNT, Silva GM, Fars J, Santos NA, Fernandes TP. Serum levels of olanzapine are associated with acute cognitive effects in bipolar disorder. Psychiatry Res 2022; 310:114443. [PMID: 35286918 DOI: 10.1016/j.psychres.2022.114443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/03/2022] [Accepted: 02/12/2022] [Indexed: 11/16/2022]
Abstract
Bipolar (BPD) patients have deficits in cognition, but there are still controversies about the effects of some medications on their cognitive performance. Here, we investigated the relationship between cognition in terms of executive functions, memory, and attention in both first-episode medication-naive BPD patients and BPD patients taking olanzapine. Forty-one healthy controls, 40 unmedicated drug-naive BPD patients, and 34 BPD patients who took only olanzapine were recruited for the study. Cognitive performance was assessed using the Flanker test, Stroop test, and Corsi-block test. Bayesian multivariate regression analysis was run considering maximum robustness to avoid bias and to predict the outcomes. Our results revealed that unmedicated medication-naive BPD patients performed worse than healthy controls and the olanzapine group in some tasks. Additionally, BPD patients who took olanzapine had better cognitive performance than healthy controls and unmedicated BPD patients. The acute cognitive effects were predicted by olanzapine dosage and serum levels (i.e., large effects). The potential pro-cognitive effects of olanzapine in BPD patients should be carefully interpreted by considering various other clinical variables. We expect that our findings will contribute to further research in this area, with the goal of helping other researchers, patients, and the population.
Collapse
Affiliation(s)
- Irina I Shoshina
- Pavlov Institute of Physiology, RAS, Laboratory of Vision Physiology, Saint-Petersburg, Russia; St. Petersburg State University, Institute for Cognitive Research, Saint-Petersburg, Russia
| | - Natalia L Almeida
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil; Perception, Neuroscience and Behaviour Laboratory, Federal University of Paraiba, Brazil
| | - Milena E C Oliveira
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil; Perception, Neuroscience and Behaviour Laboratory, Federal University of Paraiba, Brazil
| | - Bianca N T Trombetta
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil; Perception, Neuroscience and Behaviour Laboratory, Federal University of Paraiba, Brazil
| | - Gabriella M Silva
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil; Perception, Neuroscience and Behaviour Laboratory, Federal University of Paraiba, Brazil
| | - Julien Fars
- Department of Ophthalmology, University Hospital Erlangen, Erlangen, Germany
| | - Natanael A Santos
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil; Perception, Neuroscience and Behaviour Laboratory, Federal University of Paraiba, Brazil
| | - Thiago P Fernandes
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil; Perception, Neuroscience and Behaviour Laboratory, Federal University of Paraiba, Brazil.
| |
Collapse
|
25
|
Agarwal K, Manza P, Chapman M, Nawal N, Biesecker E, McPherson K, Dennis E, Johnson A, Volkow ND, Joseph PV. Inflammatory Markers in Substance Use and Mood Disorders: A Neuroimaging Perspective. Front Psychiatry 2022; 13:863734. [PMID: 35558424 PMCID: PMC9086785 DOI: 10.3389/fpsyt.2022.863734] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/17/2022] [Indexed: 12/21/2022] Open
Abstract
Chronic exposure to addictive drugs in substance use disorders and stressors in mood disorders render the brain more vulnerable to inflammation. Inflammation in the brain, or neuroinflammation, is characterized by gliosis, microglial activation, and sustained release of cytokines, chemokines, and pro-inflammatory factors compromising the permeability of the blood-brain barrier. There is increased curiosity in understanding how substance misuse and/or repeated stress exposure affect inflammation and contribute to abnormal neuronal activity, altered neuroplasticity, and impaired cognitive control, which eventually promote compulsive drug-use behaviors and worsen mood disorders. This review will emphasize human imaging studies to explore the link between brain function and peripheral markers of inflammation in substance use disorders and mood disorders.
Collapse
Affiliation(s)
- Khushbu Agarwal
- Section of Sensory Science and Metabolism Unit, Division of Intramural Research, Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States.,Section of Sensory Science and Metabolism, Division of Intramural Research, U.S. Department of Health and Human Services, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Peter Manza
- Laboratory of Neuroimaging, Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Marquis Chapman
- Section of Sensory Science and Metabolism Unit, Division of Intramural Research, Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Nafisa Nawal
- Section of Sensory Science and Metabolism Unit, Division of Intramural Research, Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Erin Biesecker
- Section of Sensory Science and Metabolism Unit, Division of Intramural Research, Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Katherine McPherson
- Section of Sensory Science and Metabolism Unit, Division of Intramural Research, Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Evan Dennis
- Section of Sensory Science and Metabolism Unit, Division of Intramural Research, Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Allison Johnson
- Section of Sensory Science and Metabolism Unit, Division of Intramural Research, Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Nora D Volkow
- Laboratory of Neuroimaging, Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Paule V Joseph
- Section of Sensory Science and Metabolism Unit, Division of Intramural Research, Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States.,Section of Sensory Science and Metabolism, Division of Intramural Research, U.S. Department of Health and Human Services, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
26
|
Grunze A, Mosolov S, Grunze H, Born C. The detrimental effects of smoking on the course and outcome in adults with bipolar disorder-A narrative review. Front Psychiatry 2022; 13:1114432. [PMID: 36699491 PMCID: PMC9870053 DOI: 10.3389/fpsyt.2022.1114432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Smoking is a substantial and avoidable risk for physical disability and premature death. Despite a declining tobacco use in the community of developed countries, smoking remains abundant in people with mental disorders. This narrative review highlights the epidemiology, consequences and treatment options of tobacco use disorder (TUD) and nicotine dependence (ND) in people with bipolar disorder (BD). METHODS The authors conducted a Medline literature search from 1970 to November 2022 using MeSH terms "bipolar disorder" x "smoking" or "nicotine" or "tobacco" that retrieved 770 results. Search results were complemented by additional literature retrieved from examining cross references and by hand search in text books. Finally, 92 references were considered as essential and selected for the educational purpose of this review. SUMMARY OF FINDINGS Lifetime and point prevalence of smoking in people with BD is in the range of 45-70% and thus about 2-3 times more frequent in BD than in community samples. Smoking, TUD and ND have a detrimental impact both on mental and physical health as well as mortality in people with BD. In the absence of large controlled studies in comorbid BD and TUD or ND, pharmacological treatment follows the individual guidance for each disorder. Community-based psychosocial interventions for TUD and ND appear to be suitable in people with BD, too, as well as Cognitive Behavioral (CBT) or Acceptance and Commitment (ACT) based psychotherapies. CONCLUSIONS Smoking is a modifiable risk factor causing increased risks both for mental and physical health in BD, and deserves more attention in treatment. More treatment research into pharmacological and psychosocial interventions in comorbid BD and TUD or ND are still needed to deliver evidence-based recommendations to physicians.
Collapse
Affiliation(s)
- Anna Grunze
- Psychiatrisches Zentrum Nordbaden, Wiesloch, Germany
| | - Sergey Mosolov
- Moscow Research Institute of Psychiatry, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany.,Paracelsus Medical University, Nuremberg, Germany
| | - Christoph Born
- Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany.,Paracelsus Medical University, Nuremberg, Germany
| |
Collapse
|
27
|
McLean M, Henderson TA, Pavel DG, Cohen P. Increased Asymmetric Perfusion of the Cerebral Cortices and Thalamus Indicates Individuals at Risk for Bipolar Disorder: A Family Cohort Single Photon Emission Computed Tomography Neuroimaging Study. Front Psychiatry 2022; 13:829561. [PMID: 35619621 PMCID: PMC9127269 DOI: 10.3389/fpsyt.2022.829561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/23/2022] [Indexed: 12/28/2022] Open
Abstract
Bipolar disorder is a significant mental illness affecting over 4 million people in North America and approximately 46 million worldwide. While the onset of bipolar disorder is typically in late adolescence and early adulthood, the correct diagnosis can be delayed for several years. This delay can result in inappropriate pharmaceutical interventions, loss of career or productivity, suicide, family hardship, and unnecessary expense. Moreover, prolonged untreated or inappropriately treated bipolar disorder may cause damage to the brain. Early diagnosis is a critical need to circumvent the damage, suffering, and expense caused by the current delay. Brain perfusion single photon emission computed tomography (SPECT) neuroimaging reveals visual correlates of brain function. Herein, a family cohort all with bipolar disorder is described and their symptoms correlated with findings on the individual SPECT brain scans. The family consisted of two parents and three children (one female). The scans were interpreted by a panel of experts. Then a post hoc region-of-interest (ROI) analysis was conducted on SPECT data normalized to the cerebellum maximum with comparison to similarly normalized data from a normative sample. These findings support two distinct patterns of SPECT perfusion scan changes that can be found in individuals with bipolar disorder. In addition, these findings indicate that SPECT scan findings may be predictive of individual risk for progressing to symptomatic bipolar disorder. While preliminary, the findings in this cohort support the need for larger, diverse cohort studies of bipolar and control subjects to assess the predictive value of these particular SPECT perfusion findings in bipolar disorder.
Collapse
Affiliation(s)
- Mary McLean
- Private Practice, Toronto, ON, Canada.,The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States
| | - Theodore A Henderson
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,The Synaptic Space, Inc., Denver, CO, United States.,Neuro-Luminance, Inc., Denver, CO, United States.,Dr. Theodore Henderson, Inc., Denver, CO, United States.,The Neuro-Laser Foundation, Denver, CO, United States
| | - Dan G Pavel
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,PathFinder Brain SPECT, Deerfield, IL, United States
| | - Phil Cohen
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Lions Gate Hospital, Vancouver, BC, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
28
|
Abstract
Bipolar disorder (BD) is a complex group of neuropsychiatric disorders, typically comprising both manic and depressive episodes. The underlying neuropathology of BD is not established, but a consistent feature is progressive thinning of cortical grey matter (GM) and white matter (WM) in specific pathways, due to loss of subpopulations of neurons and astrocytes, with accompanying disturbance of connectivity. Dysregulation of astrocyte homeostatic functions are implicated in BD, notably regulation of glutamate, calcium signalling, circadian rhythms and metabolism. Furthermore, the beneficial therapeutic effects of the frontline treatments for BD are due at least in part to their positive actions on astrocytes, notably lithium, valproic acid (VPA) and carbamazepine (CBZ), as well as antidepressants and antipsychotics that are used in the management of this disorder. Treatments for BD are ineffective in a large proportion of cases, and astrocytes represent new therapeutic targets that can also serve as biomarkers of illness progression and treatment responsiveness in BD.
Collapse
|
29
|
Chen M, Tian H, Huang G, Fang T, Lin X, Shan J, Cai Z, Chen G, Chen S, Chen C, Ping J, Cheng L, Chen C, Zhu J, Zhao F, Jiang D, Liu C, Huang G, Lin C, Zhuo C. Calcium imaging reveals depressive- and manic-phase-specific brain neural activity patterns in a murine model of bipolar disorder: a pilot study. Transl Psychiatry 2021; 11:619. [PMID: 34876553 DOI: 10.1038/s41398-021-01750-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 12/25/2022] Open
Abstract
Brain pathological features during manic/hypomanic and depressive episodes in the same patients with bipolar disorder (BPD) have not been described precisely. The study aimed to investigate depressive and manic-phase-specific brain neural activity patterns of BPD in the same murine model to provide information guiding investigation of the mechanism of phase switching and tailored prevention and treatment for patients with BPD. In vivo two-photon imaging was used to observe brain activity alterations in the depressive and manic phases in the same murine model of BPD. Two-photon imaging showed significantly reduced Ca2+ activity in temporal cortex pyramidal neurons in the depression phase in mice exposed to chronic unpredictable mild stress (CUMS), but not in the manic phase in mice exposed to CUMS and ketamine. Total integrated calcium values correlated significantly with immobility times. Brain Ca2+ hypoactivity was observed in the depression and manic phases in the same mice exposed to CUMS and ketamine relative to naïve controls. The novel object recognition preference ratio correlated negatively with the immobility time in the depression phase and the total distance traveled in the manic phase. With recognition of its limitations, this study revealed brain neural activity impairment indicating that intrinsic emotional network disturbance is a mechanism of BPD and that brain neural activity is associated with cognitive impairment in the depressive and manic phases of this disorder. These findings are consistent with those from macro-imaging studies of patients with BPD. The observed correlation of brain neural activity with the severity of depressive, but not manic, symptoms need to be investigated further.
Collapse
|
30
|
Musat EM, Marlinge E, Leroy M, Olié E, Magnin E, Lebert F, Gabelle A, Bennabi D, Blanc F, Paquet C, Cognat E. Characteristics of Bipolar Patients with Cognitive Impairment of Suspected Neurodegenerative Origin: A Multicenter Cohort. J Pers Med 2021; 11:1183. [PMID: 34834535 DOI: 10.3390/jpm11111183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022] Open
Abstract
Bipolar disorder is associated with an increased risk of dementia with aging. Little is known regarding this association, limiting appropriate diagnosis and management. We aimed to describe the characteristics of bipolar patients with late cognitive impairment for whom the hypothesis of an underlying neurodegenerative disease had been raised. We performed a retrospective multicenter study, recruiting bipolar patients over 50 years old from five French tertiary memory centers who had undergone cerebrospinal fluid (CSF) biomarker assessment for Alzheimer’s disease (AD). Clinical, neuropsychological, and paraclinical characteristics were analyzed and 78 patients were included. The mean age at the onset of cognitive impairment was 62.4 years (±9.2). The mean MMSE score was 22.8 (±4.5), the mean FAB was 11.7 (±3.9), and the mean FCRST was 15.8 (±7.4)/36.8 (±9.7) (free/total recall). A total of 48.6% of the patients displayed cognitive fluctuations, and 38.2% showed cognitive improvement during follow-ups; and 56.3% of the patients showed Parkinsonism, of which 12.7% had never received antipsychotics. Among patients who underwent DAT-scans, 35.3% displayed dopaminergic denervation; 10.3% of patients had CSF AD biological signature (“A+ T+” profile), while 56.4% had other abnormal CSF profiles. Thus, clinical presentation was dominated by executive dysfunction, episodic memory impairment, fluctuating cognition, and a high frequency of Parkinsonism. Specifically, high frequency of delusional episodes suggests limited tolerance of psychotropic drugs. Most patients had abnormal CSF biomarker profiles, but only a minority displayed AD’s specific biomarker signature. Therefore, while our results unveil shared common neurocognitive features in bipolar patients with cognitive impairment of suspected neurodegenerative origin they suggest a participation of various underlying pathologies rather than a common degenerative mechanism in the pathophysiology of this condition.
Collapse
|
31
|
Kupka R, Duffy A, Scott J, Almeida J, Balanzá‐Martínez V, Birmaher B, Bond DJ, Brietzke E, Chendo I, Frey BN, Grande I, Hafeman D, Hajek T, Hillegers M, Kauer‐Sant’Anna M, Mansur RB, van der Markt A, Post R, Tohen M, Tremain H, Vazquez G, Vieta E, Yatham LN, Berk M, Alda M, Kapczinski F. Consensus on nomenclature for clinical staging models in bipolar disorder: A narrative review from the International Society for Bipolar Disorders (ISBD) Staging Task Force. Bipolar Disord 2021; 23:659-678. [PMID: 34174130 PMCID: PMC9290926 DOI: 10.1111/bdi.13105] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Clinical staging is widely used in medicine to map disease progression, inform prognosis, and guide treatment decisions; in psychiatry, however, staging remains a hypothetical construct. To facilitate future research in bipolar disorders (BD), a well-defined nomenclature is needed, especially since diagnosis is often imprecise with blurred boundaries, and a full understanding of pathophysiology is lacking. METHODS Under the auspices of the International Society of Bipolar Disorders, a Task Force of international experts was convened to review, discuss, and integrate findings from the scientific literature relevant to the development of a consensus staging model and standardize a terminology that could be used to advance future research including staging of BD and related disorders. RESULTS Consensus opinion and areas of uncertainty or difference were identified in regard to terms referring to staging as it may apply to BD, to at-risk status and subthreshold stages, and to various clinical stages of BD as it is currently diagnosed. CONCLUSION The use of a standardized nomenclature about the clinical stages of BD will facilitate communication about research on clinical and pathological components of this heterogeneous group of disorders. The concepts presented are based on current evidence, but the template provided allows for further refinements as etiological advances come to light.
Collapse
Affiliation(s)
- Ralph Kupka
- Department of PsychiatryAmsterdam Public Mental Health Research InsituteAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
| | - Anne Duffy
- Department of PsychiatryDivision of Student Mental HealthQueen's UniversityCote Sharp Student Wellness CentreKingstonONCanada,Department of PsychiatryUniversity of OxfordOxfordUK
| | - Jan Scott
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK,Brain and Mind CentreThe University of SydneySydneyNSWAustralia
| | - Jorge Almeida
- Department of Psychiatry and Behavior SciencesDell Medical SchoolUniversity of Texas at AustinAustinTXUSA
| | - Vicent Balanzá‐Martínez
- Teaching Unit of Psychiatry and Psychological MedicineDepartment of MedicineUniversity of ValenciaCIBERSAMValenciaSpain
| | | | - David J. Bond
- Department of Psychiatry and Behavioral SciencesUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - Elisa Brietzke
- Department of PsychiatryQueen's University School of MedicineKingstonONCanada,Centre for Neuroscience StudiesQueen’s UniversityKingstonONCanada
| | - Ines Chendo
- Psychiatry DepartmentDepartment of NeurosciencesHospital Santa MariaLisbonPortugal,Clínica Universitária de PsiquiatriaFaculty of MedicineUniversity of LisbonLisbonPortugal
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada,Mood Disorders Program and Women's Health Concerns ClinicSt. Joseph's Healthcare HamiltonHamiltonONCanada
| | - Iria Grande
- Barcelona Bipolar Disorders and Depressive UnitHospital ClinicInstitute of NeurosciencesUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaSpain
| | - Danella Hafeman
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Tomas Hajek
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry/PsychologyErasmus Medical Center‐Sophia Children’s HospitalRotterdamThe Netherlands
| | - Marcia Kauer‐Sant’Anna
- Department of PsychiatryFaculty of MedicineUniversidade Federal do Rio Grande do Sul (UFRGSHospital de Clínicas de Porto Alegre (HCPAPorto AlegreBrazil
| | - Rodrigo B. Mansur
- Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada,Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - Afra van der Markt
- Department of PsychiatryAmsterdam Public Mental Health Research InsituteAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
| | - Robert Post
- George Washington University School of MedicineWashingtonDCUSA,Bipolar Collaborative NetworkBethesdaMDUSA
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral SciencesUniversity of New Mexico Health Sciences CenterAlbuquerqueNMUSA
| | - Hailey Tremain
- Centre for Mental HealthFaculty of Health Arts and DesignSwinburne UniversityMelbourneVicAustralia,OrygenThe National Centre of Excellence in Youth Mental HealthParkvilleVicAustralia
| | | | - Eduard Vieta
- Hospital ClinicInstitute of NeuroscienceUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaSpain
| | - Lakshmi N. Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Michael Berk
- IMPACT – the Institute for Mental and Physical Health and Clinical TranslationSchool of MedicineBarwon HealthDeakin UniversityGeelongVicAustralia,OrygenThe National Centre of Excellence in Youth Mental HealthCentre for Youth Mental HealthFlorey Institute for Neuroscience and Mental HealthDepartment of PsychiatryThe University of MelbourneMelbourneVicAustralia
| | - Martin Alda
- Department of PsychiatryMood Disorders ClinicDalhousie UniversityHalifaxNCCanada
| | - Flávio Kapczinski
- St. Joseph’s Healthcare Hamilton McMaster UniversityHamiltonONCanada,Universidade Federal do Rio Grande do SulUFRGSPorto AlegreBrazil
| |
Collapse
|