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Liška K, Dočkal T, Houdek P, Sládek M, Lužná V, Semenovykh K, Drapšin M, Sumová A. Lithium affects the circadian clock in the choroid plexus - A new role for an old mechanism. Biomed Pharmacother 2023; 159:114292. [PMID: 36701987 DOI: 10.1016/j.biopha.2023.114292] [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: 11/21/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
Lithium is an effective mood stabilizer, but the mechanism of its therapeutic action is not well understood. We investigated the effect of lithium on the circadian clock located in the ventricle barrier complex containing the choroid plexus (CP), a part of the glymphatic system that influences gross brain function via the production of cerebrospinal fluid. The mPer2Luc mice were injected with lithium chloride (LiCl) or vehicle, and their effects on the clock gene Nr1d1 in CP were detected by RT qPCR. CP organotypic explants were prepared to monitor bioluminescence rhythms in real time and examine the responses of the CP clock to LiCl and inhibitors of glycogen synthase kinase-3 (CHIR-99021) and protein kinase C (chelerythrine). LiCl affected Nr1d1 expression levels in CP in vivo and dose-dependently delayed the phase and prolonged the period of the CP clock in vitro. LiCl and CHIR-99021 had different effects on 1] CP clock parameters (amplitude, period, phase), 2] dexamethasone-induced phase shifts of the CP clock, and 3] dynamics of PER2 degradation and de novo accumulation. LiCl-induced phase delays were significantly reduced by chelerythrine, suggesting the involvement of PKC activity. The effects on the CP clock may be involved in the therapeutic effects of lithium and hypothetically improve brain function in psychiatric patients by aligning the function of the CP clock-related glymphatic system with the sleep-wake cycle. Importantly, our data argue for personalized timing of lithium treatment in BD patients.
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Affiliation(s)
- Karolína Liška
- Laboratory of Biological Rhythms, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Tereza Dočkal
- Laboratory of Biological Rhythms, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Pavel Houdek
- Laboratory of Biological Rhythms, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Martin Sládek
- Laboratory of Biological Rhythms, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Vendula Lužná
- Laboratory of Biological Rhythms, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Kateryna Semenovykh
- Laboratory of Biological Rhythms, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Milica Drapšin
- Laboratory of Biological Rhythms, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Alena Sumová
- Laboratory of Biological Rhythms, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic.
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Strege MV, Richey JA, Siegle GJ. What does "staying well" after depression mean? Chronic low grade symptomatology after treatment for depression is common. J Affect Disord 2022; 317:228-235. [PMID: 36029878 PMCID: PMC10012845 DOI: 10.1016/j.jad.2022.08.075] [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: 11/06/2021] [Revised: 05/25/2022] [Accepted: 08/22/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Persistent low grade depression symptoms are common and impairing in major depressive disorder (MDD) yet rarely reported in treatment follow-up studies (Judd et al., 1998a; Kennedy et al., 2004), suggesting that extant sustained remission rates may not reflect this important clinical feature. Furthermore, no long-term MDD treatment follow-up study has reported on quality of life ratings across functioning levels and years throughout the follow-up period, thus the severity, breadth, and persistence of functional impairment remain unclear. Accordingly, the current study evaluated the course of MDD with consideration of low grade depressive symptomatology and holistic features (e.g., quality of life). METHODS We report long-term (9-14 years) follow-up data from individuals with MDD (N = 37) who underwent either Cognitive Therapy (CBT) or a course of selective serotonin reuptake inhibitor (SSRI) treatment. Patients provided retrospective reports of depression symptoms and quality of life in the years following treatment. RESULTS Chronic depression symptoms (most often mild in severity) and decreased quality of life in multiple domains are frequent and suggest poorer sustained remission rates than previously observed in the literature. LIMITATIONS Study limitations include small sample size recruited via convenience sampling methods. CONCLUSIONS Findings support a conceptualization of depression recovery that entails persistent symptoms and vulnerabilities. Clinical recommendations are provided for discussing these features of depression recovery with patients.
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Affiliation(s)
- Marlene V Strege
- University of Pittsburgh, Department of Psychiatry, United States of America.
| | - John A Richey
- Virginia Polytechnic Institute and State University, Department of Psychology, United States of America
| | - Greg J Siegle
- University of Pittsburgh, Department of Psychiatry, United States of America
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Dagani J, Signorini G, Nielssen O, Bani M, Pastore A, Girolamo GD, Large M. Meta-analysis of the Interval between the Onset and Management of Bipolar Disorder. Can J Psychiatry 2017; 62:247-258. [PMID: 27462036 PMCID: PMC5407546 DOI: 10.1177/0706743716656607] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the length of the interval between the onset and the initial management of bipolar disorder (BD). METHOD We conducted a meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches located studies reporting estimates of the age of onset (AOO) and indicators of the age at initial management of BD. We calculated a pooled estimate of the interval between AOO and age at management. Factors influencing between-study heterogeneity were investigated using sensitivity analyses, meta-regression, and multiple meta-regression. RESULTS Twenty-seven studies, reporting 51 samples and a total of 9415 patients, met the inclusion criteria. The pooled estimate for the interval between the onset of BD and its management was 5.8 years (standardized difference, .53; 95% confidence interval, .45 to .62). There was very high between-sample heterogeneity ( I2 = 92.6; Q = 672). A longer interval was found in studies that defined the onset according to the first episode (compared to onset of symptoms or illness) and defined management as age at diagnosis (rather than first treatment or first hospitalization). A longer interval was reported among more recently published studies, among studies that used a systematic method to establish the chronology of illness, among studies with a smaller proportion of bipolar I patients, and among studies with an earlier mean AOO. CONCLUSIONS There is currently little consistency in the way researchers report the AOO and initial management of BD. However, the large interval between onset and management of BD presents an opportunity for earlier intervention.
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Affiliation(s)
- Jessica Dagani
- 1 Saint John of God Clinical Research Centre, Brescia, Italy
| | | | - Olav Nielssen
- 2 St. Vincent's Hospital Sydney, University of Sydney, University of New South Wales, New South Wales, Australia
| | - Moira Bani
- 1 Saint John of God Clinical Research Centre, Brescia, Italy
| | - Adriana Pastore
- 3 Department of Basic Medical Sciences, Neuroscience and Sense Organs, Childhood and Adolescence Neuropsychiatry Unit, University of Bari "Aldo Moro," Bari, Italy
| | | | - Matthew Large
- 4 The School of Psychiatry, University of New South Wales, New South Wales, Australia
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Ryu V, Kook S, Lee SJ, Ha K, Cho HS. Effects of emotional stimuli on time perception in manic and euthymic patients with bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2015; 56:39-45. [PMID: 25101544 DOI: 10.1016/j.pnpbp.2014.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 03/21/2014] [Revised: 07/20/2014] [Accepted: 07/26/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Time perception, which plays a fundamental role in decision-making and the evaluation of the environment, is also influenced by emotions. Patients with bipolar disorder have impairments in emotional processing as well as interval timing. We investigated the effects of emotional stimuli on time estimation and reproduction in manic and euthymic bipolar patients compared with healthy controls. METHODS We recruited 22 manic bipolar patients, 24 euthymic bipolar patients and 24 healthy controls. Each subject performed time estimation and reproduction tasks using standardized affective pictures that were classified into 4 stimulus groups according to valence and level of arousal and presented for durations of 2, 4, and 6s. We analyzed temporal performance on these tasks using transformed data expressed as a proportion of the target period. RESULTS The interactions between arousal and valence were different in manic patients compared with euthymic patients and healthy controls in both time estimation and reproduction tasks. Manic patients showed no effect of positive valence low arousal stimuli in the time estimation task compared to euthymic patients and healthy controls. In the time reproduction task, the effect of emotional stimuli was reversed in manic patients compared to euthymic patients and healthy controls. Significant correlations between the severity of manic symptoms or illness severity and average temporal performance scores were found in manic patients. CONCLUSION Our results suggest that altered emotion-related time judgments may be a state-dependent phenomenon observed in manic patients only. This difference in time perception for emotional stimuli may be related to the underlying neurobiological mechanisms of the manic state.
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Affiliation(s)
- Vin Ryu
- Department of Psychiatry, Seoul National Hospital, Seoul, South Korea
| | - Sodahm Kook
- Department of Psychiatry, Myongji Hospital, Gyeonggi-do, South Korea
| | - Su Jin Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyooseob Ha
- Department of Psychiatry, Seoul National Hospital, Seoul, South Korea; Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Hyun-Sang Cho
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea.
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van Bendegem MA, van den Heuvel SCGH, Kramer LJ, Goossens PJJ. Attitudes of patients with bipolar disorder toward the Life Chart Methodology: a phenomenological study. J Am Psychiatr Nurses Assoc 2014; 20:376-85. [PMID: 25367897 DOI: 10.1177/1078390314558420] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Dutch guideline for bipolar disorder (BD) recommends the use of the Life Chart Methodology (LCM) to help patients to monitor fluctuating mood patterns. But in practice patients show ambivalent attitudes toward this instrument. OBJECTIVE To describe attitudes and motivations of patients with BD for (non-)using the LCM. DESIGN A phenomenological study with unstructured in-depth interviews of 14 patients with BD. Patient narratives were audio-taped, transcribed verbatim, analyzed, and coded inductively. RESULTS The results show that despite variability in perceptions and willingness to work with the LCM, the general attitude toward this instrument was a recognized value for using the LCM. However, the emotional impact of daily mood charting was experienced as a substantial burden, particularly during the early stages of diagnosis. CONCLUSION The impact of the diagnosis of BD needs to be taken in account when introducing the instrument for the first time to a patient.
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Affiliation(s)
- Mischa A van Bendegem
- Mischa A. van Bendegem, APRN, RN, Mediant Centre for Bipolar Disorders, Enschede, Netherlands
| | - Silvio C G H van den Heuvel
- Silvio C. G. H. van den Heuvel, MA, RN, Saxion University of Applied Sciences, Deventer, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Dimence Centre for Bipolar Disorders, Deventer, Netherlands
| | - Laura J Kramer
- Laura J. Kramer, MSc, Mediant Centre Bipolar Disorders, Enschede, Netherlands
| | - Peter J J Goossens
- Peter J. J. Goossens, PhD, APRN, RN, FEANS, Dimence Centre for Bipolar Disorders, Deventer, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Ghent University, Ghent, Belgium; GGZ-VS Institute for the Education of Clinical Nurse Specialists in Mental Health, Utrecht, Netherlands
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Born C, Amann BL, Grunze H, Post RM, Schärer L. Saving time and money: a validation of the self ratings on the prospective NIMH Life-Chart Method (NIMH-LCM). BMC Psychiatry 2014; 14:130. [PMID: 24886463 PMCID: PMC4031162 DOI: 10.1186/1471-244x-14-130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 05/02/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Careful observation of the longitudinal course of bipolar disorders is pivotal to finding optimal treatments and improving outcome. A useful tool is the daily prospective Life-Chart Method, developed by the National Institute of Mental Health. However, it remains unclear whether the patient version is as valid as the clinician version. METHODS We compared the patient-rated version of the Lifechart (LC-self) with the Young-Mania-Rating Scale (YMRS), Inventory of Depressive Symptoms-Clinician version (IDS-C), and Clinical Global Impression-Bipolar version (CGI-BP) in 108 bipolar I and II patients who participated in the Naturalistic Follow-up Study (NFS) of the German centres of the Bipolar Collaborative Network (BCN; formerly Stanley Foundation Bipolar Network). For statistical evaluation, levels of severity of mood states on the Lifechart were transformed numerically and comparison with affective scales was performed using chi-square and t tests. For testing correlations Pearson´s coefficient was calculated. RESULTS Ratings for depression of LC-self and total scores of IDS-C were found to be highly correlated (Pearson coefficient r = -.718; p < .001), whilst the correlation of ratings for mania with YMRS compared to LC-self were slightly less robust (Pearson coefficient r = .491; p = .001). These results were confirmed by good correlations between the CGI-BP IA (mania), IB (depression) and IC (overall mood state) and the LC-self ratings (Pearson coefficient r = .488, r = .721 and r = .65, respectively; all p < .001). CONCLUSIONS The LC-self shows a significant correlation and good concordance with standard cross sectional affective rating scales, suggesting that the LC-self is a valid and time and money saving alternative to the clinician-rated version which should be incorporated in future clinical research in bipolar disorder. Generalizability of the results is limited by the selection of highly motivated patients in specialized bipolar centres and by the open design of the study.
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Affiliation(s)
- Christoph Born
- Department of Psychiatry, Ludwig Maximilians-University, Nußbaumstr. 7, Munich 80336, Germany
| | - Benedikt L Amann
- FIDMAG Research Foundation Germanes Hospitalàries, Barcelona, Spain
- CIBERSAM, Barcelona, Spain
| | - Heinz Grunze
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | | | - Lars Schärer
- Department of Psychiatry, Albert Ludwig-University, Freiburg, Germany
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Abstract
Because many patients with bipolar disorder seek treatment in primary care practices, physicians in these settings need to be able to diagnose bipolar disorder and common psychiatric and medical comorbidities and to initiate and manage treatment. Unfortunately, bipolar disorder is often underrecognized. The most common symptoms in patients with bipolar disorder are depressive, but these patients may also have anxiety, mood swings, sleep problems, irritability, difficulty concentrating, relationship issues, alcohol- or drug-related problems, and infections. Social and family history and screening tools can help clarify diagnosis. The goal of treatment should be recovery, but periodic relapse and medication nonadherence should be expected. Primary care physicians should decide what level of intervention their practices can support. To manage these patients effectively, practices may need to train office staff, set up monitoring and follow-up systems, establish links with referral and community support services, develop therapeutic alliances with patients, and provide psychoeducation for patients and significant others. Receiving comprehensive psychiatric and medical care and support can be life-changing for patients with bipolar disorder and their families.
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Affiliation(s)
- Larry Culpepper
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
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Abstract
OBJECTIVE Biological rhythm pathways are highlighted in a number of etiological models of bipolar disorder, and the management of circadian instability appears in consensus treatment guidelines. There are, however, significant conceptual and empirical limitations on our understanding of a hypothesised link between circadian, sleep, and emotion regulation processes in bipolar disorder. The aim of this article is to articulate the limits of scientific knowledge in relation to this hypothesis. METHODS A critical evaluation of various literatures was undertaken. The basic science of circadian and sleep processes, their involvement in normal emotion regulation, and the types of evidence suggesting circadian/sleep involvement in bipolar disorder are reviewed. RESULTS Multiple lines of evidence suggest that circadian and sleep-wake processes are causally involved in bipolar disorder. These processes demonstrably interact with other neurobiological pathways known to be important in bipolar disorder, but are unique in that they are open to behavioural manipulation. CONCLUSION Further research into biological rhythm pathways to bipolar disorder is warranted. Person-environment feedback loops are fundamental to circadian adaptation, and models of circadian pathogenesis (and treatment) should recognize this complexity.
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Affiliation(s)
- Greg Murray
- Faculty of Life and Social Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia.
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Abstract
This article reviews the current state of the literature on the assessment of bipolar disorder in adults. Research on reliable and valid measures for bipolar disorder has unfortunately lagged behind assessment research for other disorders, such as major depression. We review diagnostic tools, self-report measures to facilitate screening for bipolar diagnoses, and symptom severity measures. We briefly review other assessment domains, including measures designed to facilitate self-monitoring of symptoms. We highlight particular gaps in the field, including an absence of research on the reliable diagnosis of bipolar II and milder forms of disorder, a lack of empirical data on the best ways to integrate data from multiple domains, and a shortage of measures targeting a broader set of illness-related constructs relevant to bipolar disorder.
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Lechner HE, Kakebeeke TH, Hegemann D, Baumberger M. The Effect of Hippotherapy on Spasticity and on Mental Well-Being of Persons With Spinal Cord Injury. Arch Phys Med Rehabil 2007; 88:1241-8. [PMID: 17908564 DOI: 10.1016/j.apmr.2007.07.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine the effect of hippotherapy on spasticity and on mental well-being of persons with spinal cord injury (SCI), and to compare it with the effects of other interventions. DESIGN Crossover trial with 4 conditions. SETTING Swiss paraplegic center. PARTICIPANTS A volunteer sample of 12 people with spastic SCI (American Spinal Injury Association grade A or B). INTERVENTIONS Hippotherapy, sitting astride a Bobath roll, and sitting on a stool with rocking seat. Each session lasted 25 minutes and was conducted twice weekly for 4 weeks; the control condition was spasticity measurement without intervention. MAIN OUTCOME MEASURES Clinical rating by a blinded examiner of movement-provoked muscle resistance, using the Ashworth Scale; self-rating of spasticity by subjects on a visual analog scale (VAS); and mental well-being evaluated with the self-rated well-being scale Befindlichkeits-Skala of von Zerssen. Assessments were performed immediately after intervention sessions (short-term effect); data from the assessments were analyzed 3 to 4 days after the sessions to calculate the long-term effect. RESULTS By analyzing the clinically rated spasticity, only the effect of hippotherapy reached significance compared with the control condition (without intervention); median differences in the Ashworth scores' sum before and after hippotherapy sessions ranged between -8.0 and +0.5. There was a significant difference between the spasticity-reducing effect of hippotherapy and the other 2 interventions in self-rated spasticity by VAS; median differences of the VAS before and after hippotherapy sessions ranged between -4.6 and +0.05cm. There were no long-term effects on spasticity. Immediate improvements in the subjects' mental well-being were detected only after hippotherapy (P=.048). CONCLUSIONS Hippotherapy is more efficient than sitting astride a Bobath roll or on a rocking seat in reducing spasticity temporarily. Hippotherapy had a positive short-term effect on subjects' mental well-being.
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Schärer LO, Hartweg V, Valerius G, Graf M, Hoern M, Biedermann C, Walser S, Boensch A, Dittmann S, Forsthoff A, Hummel B, Grunze H, Walden J. Life charts on a palmtop computer: first results of a feasibility study with an electronic diary for bipolar patients. Bipolar Disord 2002; 4 Suppl 1:107-8. [PMID: 12479693 DOI: 10.1034/j.1399-5618.4.s1.51.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- L O Schärer
- Department of Psychiatry, University of Freiburg, Freiburg, Germany
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