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Concerto C, Chiarenza C, Di Francesco A, Natale A, Privitera I, Rodolico A, Trovato A, Aguglia A, Fisicaro F, Pennisi M, Bella R, Petralia A, Signorelli MS, Lanza G. Neurobiology and Applications of Inositol in Psychiatry: A Narrative Review. Curr Issues Mol Biol 2023; 45:1762-1778. [PMID: 36826058 PMCID: PMC9955821 DOI: 10.3390/cimb45020113] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/07/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Inositol is a natural sugar-like compound, commonly present in many plants and foods. It is involved in several biochemical pathways, most of them controlling vital cellular mechanisms, such as cell development, signaling and nuclear processes, metabolic and endocrine modulation, cell growth, signal transduction, etc. In this narrative review, we focused on the role of inositol in human brain physiology and pathology, with the aim of providing an update on both potential applications and current limits in its use in psychiatric disorders. Overall, imaging and biomolecular studies have shown the role of inositol levels in the pathogenesis of mood disorders. However, when administered as monotherapy or in addition to conventional drugs, inositol did not seem to influence clinical outcomes in both mood and psychotic disorders. Conversely, more encouraging results have emerged for the treatment of panic disorders. We concluded that, despite its multifaceted neurobiological activities and some positive findings, to date, data on the efficacy of inositol in the treatment of psychiatric disorders are still controversial, partly due to the heterogeneity of supporting studies. Therefore, systematic use of inositol in routine clinical practice cannot be recommended yet, although further basic and translational research should be encouraged.
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Affiliation(s)
- Carmen Concerto
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Cecilia Chiarenza
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Antonio Di Francesco
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Antimo Natale
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Ivan Privitera
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Alessandro Rodolico
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Antonio Trovato
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy
| | - Rita Bella
- Department of Medical, Surgical, and Advanced Technology, University of Catania, Via Santa Sofia 87, 95123 Catania, Italy
| | - Antonino Petralia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Maria Salvina Signorelli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy
- CERNUT–Research Centre for Nutraceuticals and Health Products, University of Catania, Viale A. Doria 6, 95125 Catania, Italy
- Correspondence: ; Tel.: +39-095-3782448
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Chen C, Tallman MJ, Cecil KM, Patino LR, Blom TJ, DelBello MP, McNamara RK. Symptom Profiles, But Not Prefrontal Neurochemistry, Differentiate ADHD Youth With and Without a Family History of Bipolar I Disorder. J Atten Disord 2022; 26:1762-1773. [PMID: 35658594 DOI: 10.1177/10870547221101645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To identify clinical and central features that differentiate ADHD youth with and without familial risk for bipolar I disorder (BD). Methods: Psychostimulant-free ADHD youth (10-18 years) with and without a first-degree relative with BD and healthy controls were enrolled. Bilateral ventrolateral prefrontal cortex (VLPFC) proton magnetic resonance spectroscopy (1H MRS) scans and a range of symptom ratings were performed. Results: A total of n = 145 youth were enrolled. ADHD youth with a family history of BD exhibited greater manic and depressive symptom severity, ADHD hyperactivity/impulsive symptom severity, and higher parent-reported ratings of dysregulation compared with ADHD youth without a BD family history. Although VLPFC metabolite levels did not differ across groups, choline levels in the left VLPFC correlated with different symptom ratings. Conclusion: Symptom profiles including more severe mood and externalizing symptoms, but not VLPFC neurochemistry, differentiate psychostimulant-free ADHD youth with and without a family history of BD.
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Affiliation(s)
| | | | - Kim M Cecil
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, OH, USA
| | | | - Thomas J Blom
- University of Cincinnati College of Medicine, OH, USA
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Bravi B, Bollettini I, Di Pasquasio C, Falini A, Colombo C, Zanardi R, Poletti S, Benedetti F. Brain spectroscopic measures of glutamatergic and neuronal metabolism and glial activation influence white matter integrity in bipolar depression. Psychiatry Res Neuroimaging 2022; 326:111534. [PMID: 36049317 DOI: 10.1016/j.pscychresns.2022.111534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/27/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022]
Abstract
Bipolar disorder (BD) is associated with alterations in white matter (WM) microstructure, glutamatergic neurotransmission, and glia activity. Previous studies showed higher concentrations of glutamate (Glu), glutamate+glutamine (Glx), and reduced N-acetyl-aspartate (NAA) in BD. We investigated brain concentrations of Glu, Glx, NAA, mI as indirect marker of microglia activation, and Glx/NAA ratio as index of neuronal damage through 1H-MR, and WM integrity with Tract-Based Spatial Statistics in 93 depressed BD patients and 58 healthy controls (HC). We tested for linear effects of cited spectroscopic metabolites on DTI measures of WM integrity with general linear models for each group, then performing a conjunction analysis of Glx/NAA and mI concentration on the same measures. Statistical analyses (whole sample) revealed higher concentration of Glx/NAA, Glx and mI in BD patients compared to HC, and a positive association between mI and the ratio. DTI analyses (87 BD and 35 HC) showed a significant association of Glx/NAA ratio, and mI with WM microstructure. Conjunction analysis revealed a joint negative association between Glx/NAA and mI with fractional anisotropy. This is the first study showing an association between brain metabolites involved in neuronal damage, and glial activation and the alterations in WM consistently reported in BD.
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Affiliation(s)
- Beatrice Bravi
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Irene Bollettini
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy; C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), Vita-Salute San Raffaele University, Milan, Italy
| | - Camilla Di Pasquasio
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Andrea Falini
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy; Vita-Salute San Raffaele University, Milan, Italy; C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), Vita-Salute San Raffaele University, Milan, Italy
| | - Cristina Colombo
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Raffaella Zanardi
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Sara Poletti
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy; Vita-Salute San Raffaele University, Milan, Italy; C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), Vita-Salute San Raffaele University, Milan, Italy.
| | - Francesco Benedetti
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy; Vita-Salute San Raffaele University, Milan, Italy; C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), Vita-Salute San Raffaele University, Milan, Italy
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Watkins OC, Yong HEJ, Sharma N, Chan SY. A review of the role of inositols in conditions of insulin dysregulation and in uncomplicated and pathological pregnancy. Crit Rev Food Sci Nutr 2020; 62:1626-1673. [PMID: 33280430 DOI: 10.1080/10408398.2020.1845604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Inositols, a group of 6-carbon polyols, are highly bioactive molecules derived from diet and endogenous synthesis. Inositols and their derivatives are involved in glucose and lipid metabolism and participate in insulin-signaling, with perturbations in inositol processing being associated with conditions involving insulin resistance, dysglycemia and dyslipidemia such as polycystic ovary syndrome and diabetes. Pregnancy is similarly characterized by substantial and complex changes in glycemic and lipidomic regulation as part of maternal adaptation and is also associated with physiological alterations in inositol processing. Disruptions in maternal adaptation are postulated to have a critical pathophysiological role in pregnancy complications such as gestational diabetes and pre-eclampsia. Inositol supplementation has shown promise as an intervention for the alleviation of symptoms in conditions of insulin resistance and for gestational diabetes prevention. However, the mechanisms behind these affects are not fully understood. In this review, we explore the role of inositols in conditions of insulin dysregulation and in pregnancy, and identify priority areas for research. We particularly examine the role and function of inositols within the maternal-placental-fetal axis in both uncomplicated and pathological pregnancies. We also discuss how inositols may mediate maternal-placental-fetal cross-talk, and regulate fetal growth and development, and suggest that inositols play a vital role in promoting healthy pregnancy.
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Affiliation(s)
- Oliver C Watkins
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hannah E J Yong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Neha Sharma
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
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Vawter MP, Hamzeh AR, Muradyan E, Civelli O, Abbott GW, Alachkar A. Association of Myoinositol Transporters with Schizophrenia and Bipolar Disorder: Evidence from Human and Animal Studies. MOLECULAR NEUROPSYCHIATRY 2019; 5:200-211. [PMID: 31768373 PMCID: PMC6873027 DOI: 10.1159/000501125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 12/12/2022]
Abstract
Evidence from animal and human studies has linked myo-inositol (MI) with the pathophysiology and/or treatment of psychiatric disorders such as schizophrenia and bipolar disorder. However, there is still controversy surrounding the definitive role of MI in these disorders. Given that brain MI is differentially regulated by three transporters - SMIT1, SMIT2 and/or HMIT (encoded by the genes: SLC5A3, SLC5A11, and SLC2A13, respectively) - we used available datasets to describe the distribution in mouse and human brain of the different MI transporters and to examine changes in mRNA expression of these transporters in patients with schizophrenia and bipolar disorder. We found a differential distribution of the mRNA of each of the three MI transporters in both human and mouse brain regions. Interestingly, while individual neurons express SMIT1 and HMIT, non-neuronal cells express SMIT2, thus partially accounting for different uptake levels of MI and concordance to downstream second messenger signaling pathways. We also found that the expression of MI transporters is significantly changed in schizophrenia and bipolar disorder in a diagnostic-, brain region- and subtype-specific manner. We then examined the effects of germline deletion in mice of Slc5a3 on behavioral phenotypes related to schizophrenia and bipolar disorder. This gene deletion produces behavioral deficits that mirror some specific symptoms of schizophrenia and bipolar disorder. Finally, chronic administration of MI was able to reverse particular, but not all, behavioral deficits in Slc5a3 knockout mice; MI itself induced some behavioral deficits. Our data support a strong correlation between the expression of MI transporters and schizophrenia and bipolar disorder, and suggest that brain region-specific aberration of one or more of these transporters determines the partial behavioral phenotypes and/or symptomatic pattern of these disorders.
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Affiliation(s)
- Marquis P. Vawter
- Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Abdul Rezzak Hamzeh
- John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Edgar Muradyan
- Department of Pharmacology, School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Olivier Civelli
- Department of Pharmacology, School of Medicine, University of California, Irvine, Irvine, California, USA
- Department of Pharmaceutical Sciences, School of Medicine, University of California, Irvine, Irvine, California, USA
- Department of Developmental and Cell Biology, School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Geoffrey W. Abbott
- Bioelectricity Laboratory, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Amal Alachkar
- Department of Pharmacology, School of Medicine, University of California, Irvine, Irvine, California, USA
- Department of Pharmaceutical Sciences, School of Medicine, University of California, Irvine, Irvine, California, USA
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Zhong S, Wang Y, Lai S, Liu T, Liao X, Chen G, Jia Y. Associations between executive function impairment and biochemical abnormalities in bipolar disorder with suicidal ideation. J Affect Disord 2018; 241:282-290. [PMID: 30142586 DOI: 10.1016/j.jad.2018.08.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Executive dysfunction and biochemical abnormalities using proton magnetic resonance spectroscopy (1H-MRS) have been reported in bipolar disorder (BD). Much less is known about the information from BD with suicidal ideation (SI). This study aimed to assess alterations of execution function and biochemical metabolism in BD with SI, in BD without SI, and in healthy controls. The associations between execution function and biochemical metabolism in the two BD patient groups were also been studied. METHODS 92 patients with bipolar disorder during a depressive episode (50 with current SI, and 42 without SI), as well as, 43 healthy controls were recruited in our study. Executive function was assessed by Wisconsin Card Sorting Test (WCST). Bilateral metabolite levels of prefrontal cortex (PFC), anterior cingulated cortex (ACC), lenticular nucleus (LN) of basal ganglia and thalamus were obtained by 1H-MRS at 3.0 T, then determined the ratios of N-acetyl aspartate (NAA), choline-containing compounds (Cho), myo-inositol (mI) to creatine (Cr). RESULTS Number of categories completed (CC) in BD with SI was significantly less than healthy controls. NAA/Cr ratios of left PFC in the two BD patient groups (with or without SI) were significantly lower than healthy controls, and NAA/Cr ratios of left thalamus were significantly higher than healthy controls. Moreover, NAA/Cr ratio of right LN in BD without SI was higher than BD with SI and healthy controls. For BD with SI, NAA/Cr ratio of left thalamus was negatively correlated with number of CC. CONCLUSIONS These results suggested that BD with or without SI may have abnormal NAA metabolism, and NAA/Cr ratio of right LN may distinguish SI from the BD patients. Further, BD with SI may have executive function impairment, which may be associated with the abnormal NAA metabolism in the left thalamus.
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Affiliation(s)
- Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital, Jinan University, No. 613 West Huangpu Avenue Tianhe District, Guangzhou 510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Shunkai Lai
- Department of Psychiatry, First Affiliated Hospital, Jinan University, No. 613 West Huangpu Avenue Tianhe District, Guangzhou 510630, China
| | - Tao Liu
- Department of Psychiatry, First Affiliated Hospital, Jinan University, No. 613 West Huangpu Avenue Tianhe District, Guangzhou 510630, China
| | - Xiaoxiao Liao
- Department of Psychiatry, First Affiliated Hospital, Jinan University, No. 613 West Huangpu Avenue Tianhe District, Guangzhou 510630, China
| | - Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital, Jinan University, No. 613 West Huangpu Avenue Tianhe District, Guangzhou 510630, China.
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Biochemical abnormalities in basal ganglia and executive dysfunction in acute- and euthymic-episode patients with bipolar disorder: A proton magnetic resonance spectroscopy study. J Affect Disord 2018; 225:108-116. [PMID: 28818755 DOI: 10.1016/j.jad.2017.07.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent studies found abnormal biochemical metabolism and executive cognitive deficits in acute bipolar disorder (BD). However, the evidence concerning in euthymic BD is limited. Thus, a comparison between acute and euthymic BD is conductive to better understanding the association between cognition and the outcome of neuroimaging. This study sought to investigate the relationship between the executive function and the biochemical metabolism in acute- and euthymic-episode BD patients and delineate the prominent endophenotype of BD. METHODS Three groups of participants were recruited in this study: 30 BD patients with an acute depressive episode, 22 euthymic BD patients, and 31 healthy controls. All participants were interviewed using the Structured Clinical Interview for DSM-IV, and underwent two-dimensional multivoxel proton magnetic resonance spectroscopy (1H-MRS) to obtain the bilateral metabolite levels in the lenticular nucleus of basal ganglia(BG). The ratios of N-acetylaspartate (NAA)/creatine (Cr) and Choline-containing compounds (Cho) /Cr ratios were calculated. Executive function was assessed by using the Wisconsin Card Sorting Test (WCST) and Trail Making Test, Part-B(TMT-B). RESULTS The comparison of biochemical changes showed that the NAA/Cr ratios in bilateral lenticular nucleus in both acute and euthymic BD patients was significantly lower than that in healthy controls at a confidence level of p<0.05. In the comparison of executive function, both acute and euthymic BD patients showed significantly decreased numbers of categories completed, and increased numbers of total errors, perseverative and noperseverative errors, and TMT-B uptake compared to the healthy controls at a confidence level of p<0.05. There were no significant differences between the acute BD and euthymic BD groups in the biochemical metabolite ratios and executive function. We found that the NAA/Cr ratio in the left in BG in the acute -episode BD patients was positively correlated with the number of categories completed, whereas it was negatively correlated with the total errors and TMT-B uptake. There was no correlation between the NAA/Cr and Cho/Cr ratios in the bilateral BG and the scores of SWCT and TMT-B in euthymic-episode BD patients. LIMITATION The sample size was relatively small and not all the euthymic-episode patients are the ones with an acute episode. CONCLUSIONS Our findings suggest that biochemical abnormalities in the lenticular nucleus and the executive dysfunction may occur early in the course of BD, and persist during remission, and are the most likely markers of endophenotypes of BD. The dysfunction of the neuronal function in the lenticular nucleus may be correlated with the cold dysfunction in patients with acute BD.
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Thompson JR, Gustafsson HC, DeCapo M, Takahashi DL, Bagley JL, Dean TA, Kievit P, Fair DA, Sullivan EL. Maternal Diet, Metabolic State, and Inflammatory Response Exert Unique and Long-Lasting Influences on Offspring Behavior in Non-Human Primates. Front Endocrinol (Lausanne) 2018; 9:161. [PMID: 29740395 PMCID: PMC5924963 DOI: 10.3389/fendo.2018.00161] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/27/2018] [Indexed: 12/15/2022] Open
Abstract
Nutritional status influences brain health and gestational exposure to metabolic disorders (e.g. obesity and diabetes) increases the risk of neuropsychiatric disorders. The aim of the present study was to further investigate the role of maternal Western-style diet (WSD), metabolic state, and inflammatory factors in the programming of Japanese macaque offspring behavior. Utilizing structural equation modeling, we investigated the relationships between maternal diet, prepregnancy adiposity, third trimester insulin response, and plasma cytokine levels on 11-month-old offspring behavior. Maternal WSD was associated with greater reactive and ritualized anxiety in offspring. Maternal adiposity and third trimester macrophage-derived chemokine (MDC) exerted opposing effects on offspring high-energy outbursts. Elevated levels of this behavior were associated with low maternal MDC and increased prepregnancy adiposity. This is the first study to show that maternal MDC levels influence offspring behavior. We found no evidence suggesting maternal peripheral inflammatory response mediated the effect of maternal diet and metabolic state on aberrant offspring behavior. Additionally, the extent of maternal metabolic impairment differentially influenced chemokine response. Elevated prepregnancy adiposity suppressed third trimester chemokines, while obesity-induced insulin resistance augmented peripheral chemokine levels. WSD also directly increased maternal interleukin-12. This is the first non-human primate study to delineate the effects of maternal diet and metabolic state on gestational inflammatory environment and subsequent offspring behavior. Our findings give insight to the complex mechanisms by which diet, metabolic state, and inflammation during pregnancy exert unique influences on offspring behavioral regulation.
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Affiliation(s)
- Jacqueline R. Thompson
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, United States
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Beaverton, OR, United States
| | - Hanna C. Gustafsson
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, United States
| | - Madison DeCapo
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, United States
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Beaverton, OR, United States
| | - Diana L. Takahashi
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Beaverton, OR, United States
| | - Jennifer L. Bagley
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, United States
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Beaverton, OR, United States
| | - Tyler A. Dean
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Beaverton, OR, United States
| | - Paul Kievit
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Beaverton, OR, United States
| | - Damien A. Fair
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, United States
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States
| | - Elinor L. Sullivan
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, United States
- Division of Cardiometabolic Health, Oregon National Primate Research Center, Beaverton, OR, United States
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, United States
- Department of Human Physiology, University of Oregon, Eugene, OR, United States
- *Correspondence: Elinor L. Sullivan,
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Goldstein BI, Birmaher B, Carlson GA, DelBello MP, Findling RL, Fristad M, Kowatch RA, Miklowitz DJ, Nery FG, Perez‐Algorta G, Van Meter A, Zeni CP, Correll CU, Kim H, Wozniak J, Chang KD, Hillegers M, Youngstrom EA. The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research. Bipolar Disord 2017; 19:524-543. [PMID: 28944987 PMCID: PMC5716873 DOI: 10.1111/bdi.12556] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/14/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Over the past two decades, there has been tremendous growth in research regarding bipolar disorder (BD) among children and adolescents (ie, pediatric BD [PBD]). The primary purpose of this article is to distill the extant literature, dispel myths or exaggerated assertions in the field, and disseminate clinically relevant findings. METHODS An international group of experts completed a selective review of the literature, emphasizing areas of consensus, identifying limitations and gaps in the literature, and highlighting future directions to mitigate these gaps. RESULTS Substantial, and increasingly international, research has accumulated regarding the phenomenology, differential diagnosis, course, treatment, and neurobiology of PBD. Prior division around the role of irritability and of screening tools in diagnosis has largely abated. Gold-standard pharmacologic trials inform treatment of manic/mixed episodes, whereas fewer data address bipolar depression and maintenance/continuation treatment. Adjunctive psychosocial treatment provides a forum for psychoeducation and targets primarily depressive symptoms. Numerous neurocognitive and neuroimaging studies, and increasing peripheral biomarker studies, largely converge with prior findings from adults with BD. CONCLUSIONS As data have accumulated and controversy has dissipated, the field has moved past existential questions about PBD toward defining and pursuing pressing clinical and scientific priorities that remain. The overall body of evidence supports the position that perceptions about marked international (US vs elsewhere) and developmental (pediatric vs adult) differences have been overstated, although additional research on these topics is warranted. Traction toward improved outcomes will be supported by continued emphasis on pathophysiology and novel therapeutics.
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Affiliation(s)
- Benjamin I Goldstein
- Centre for Youth Bipolar DisorderSunnybrook Health Sciences CentreTorontoCanada,Departments of Psychiatry and PharmacologyUniversity of TorontoTorontoCanada
| | - Boris Birmaher
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Gabrielle A Carlson
- Department of PsychiatryStony Brook University School of MedicineStony BrookNYUSA
| | - Melissa P DelBello
- Department of Psychiatry & Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOHUSA
| | - Robert L Findling
- Department of Psychiatry & Behavioral SciencesThe Johns Hopkins UniversityBaltimoreMDUSA
| | - Mary Fristad
- Ohio State University Wexner Medical Center/Nationwide Children's HospitalColumbusOHUSA
| | - Robert A Kowatch
- Ohio State University Wexner Medical Center/Nationwide Children's HospitalColumbusOHUSA
| | | | - Fabiano G Nery
- Department of Psychiatry & Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOHUSA
| | | | - Anna Van Meter
- Ferkauf Graduate School of PsychologyYeshiva UniversityBronxNYUSA
| | | | - Christoph U Correll
- The Zucker Hillside HospitalDepartment of PsychiatryNorthwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineHofstra Northwell School of MedicineHempsteadNYUSA
| | - Hyo‐Won Kim
- Department of PsychiatryUniversity of Ulsan College of MedicineAsan Medical CenterSeoulKorea
| | - Janet Wozniak
- Clinical and Research Program in Pediatric PsychopharmacologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Kiki D Chang
- Department of PsychiatryStanford UniversityPalo AltoCAUSA
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry and PsychologyErasmus Medical Center‐SophiaRotterdamThe Netherlands
| | - Eric A Youngstrom
- Department of Psychology and NeuroscienceUniversity of North CarolinaChapel HillNCUSA
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Teixeira AL, Salem H, Frey BN, Barbosa IG, Machado-Vieira R. Update on bipolar disorder biomarker candidates. Expert Rev Mol Diagn 2016; 16:1209-1220. [PMID: 27737600 DOI: 10.1080/14737159.2016.1248413] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Bipolar disorder is a chronic and disabling mood disorder with a complex pathophysiological basis. A significant percentage of patients do not receive correct diagnosis which directly influences therapeutic response, rendering recovery troublesome. There is a long-standing need for proper non-clinically based tools for diagnosis, treatment selection and follow-up of such patients. Areas covered: In the past decade, the scientific community has shown a great interest in biomarker development. Here, we highlight the different potential biomarkers and we discuss their feasibility and their possible clinical relevance. Expert commentary: To date, despite the major ongoing trials and consortia with promising future perspectives, no reliable biomarker of bipolar disorder has been fully defined.
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Affiliation(s)
- Antonio L Teixeira
- a Department of Psychiatry and Behavioral Sciences, McGovern Medical School , The University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Haitham Salem
- a Department of Psychiatry and Behavioral Sciences, McGovern Medical School , The University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Benicio N Frey
- b Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , ON , Canada.,c Mood Disorders Program and Women's Health Concerns Clinic , St. Joseph's Healthcare Hamilton , ON , Canada
| | - Izabela G Barbosa
- d Interdisciplinary Laboratory of Medical Investigation, School of Medicine , Federal University of Minas Gerais , Belo Horizonte , MG , Brazil
| | - Rodrigo Machado-Vieira
- e Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program , National Institute of Mental Health , Bethesda , MD , USA
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11
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[Intermittent Explosive Disorder: A Controversial Diagnosis]. REVISTA COLOMBIANA DE PSIQUIATRIA 2016; 45:214-23. [PMID: 27569016 DOI: 10.1016/j.rcp.2015.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/25/2015] [Accepted: 11/05/2015] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Intermittent explosive disorder (IED) is aan externalizing externalising disorder characterized characterised by recurrent aggression episodes. Even though this disorder was described several decades ago, and it carries personal and social consequences, there is little in the medical scientific literature on this. bibliographic production about it is scanty. OBJECTIVE To perform a conceptualization conceptualisation of this disorder, through the review and bibliometric analysis of the available scientific articles. MATERIAL AND METHODS A search was performed in databases with the english English terms intermittent explosive disorder, impulse disorders control [MeSH], in combination with other terms. A bibliometric analysis in the GoPubMed® search engineer was also performed using all data obtained in the search. was also perfomed. DISCUSSION IED prevalence ranges from 1.4% to 7%, it presents more frequently during middle adolescence, and with more noticeable repercussions in men males than in womenfemales. The psychopathological core of IED is the impulsive aggressive behaviour that presents in the form of «attacks» that occurs in response to a lower precipitating stimulus. Scientific publications about IED are few and relatively recent, and the vast majority is provided bycomes from the United States (56.56%), and headed by a single author. This fact highlights the need to replicate the findings described about the IED in order to demonstrate the validity and reliability of its diagnostic criteria. It is possible that doubts about the existence of a diagnosis lead have led to such a scant literature about the IED. CONCLUSIONS Available studies about IED allow have allowed characterizing a group of subjects with episodes of impulsive aggression to be characterised, but this description requires replication in different latitudesneeds to be repeated in different areas.
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12
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Ferrari F, Villa RF. The Neurobiology of Depression: an Integrated Overview from Biological Theories to Clinical Evidence. Mol Neurobiol 2016; 54:4847-4865. [DOI: 10.1007/s12035-016-0032-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/01/2016] [Indexed: 12/21/2022]
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13
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Singh N, Sharpley AL, Emir UE, Masaki C, Herzallah MM, Gluck MA, Sharp T, Harmer CJ, Vasudevan SR, Cowen PJ, Churchill GC. Effect of the Putative Lithium Mimetic Ebselen on Brain Myo-Inositol, Sleep, and Emotional Processing in Humans. Neuropsychopharmacology 2016; 41:1768-78. [PMID: 26593266 PMCID: PMC4770517 DOI: 10.1038/npp.2015.343] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/25/2015] [Accepted: 11/11/2015] [Indexed: 01/09/2023]
Abstract
Lithium remains the gold standard in treating bipolar disorder but has unwanted toxicity and side effects. We previously reported that ebselen inhibits inositol monophosphatase (IMPase) and exhibits lithium-like effects in animal models through lowering of inositol. Ebselen has been tested in clinical trials for other disorders, enabling us to determine for the first time the effect of a blood-brain barrier-penetrant IMPase inhibitor on human central nervous system (CNS) function. We now report that in a double-blind, placebo-controlled trial with healthy participants, acute oral ebselen reduced brain myo-inositol in the anterior cingulate cortex, consistent with CNS target engagement. Ebselen decreased slow-wave sleep and affected emotional processing by increasing recognition of some emotions, decreasing latency time in the acoustic startle paradigm, and decreasing the reinforcement of rewarding stimuli. In summary, ebselen affects the phosphoinositide cycle and has CNS effects on surrogate markers that may be relevant to the treatment of bipolar disorder that can be tested in future clinical trials.
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Affiliation(s)
- Nisha Singh
- Department of Pharmacology, University of Oxford, Oxford, UK,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Ann L Sharpley
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Uzay E Emir
- The Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Charles Masaki
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Mohammad M Herzallah
- Center for Molecular and Behavioral Neuroscience, Rutgers, The State University of New Jersey, Newark, NJ, USA,Palestinian Neuroscience Initiative, Faculty of Medicine, Al-Quds University, Abu Dis, Jerusalem, Palestine
| | - Mark A Gluck
- Center for Molecular and Behavioral Neuroscience, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Trevor Sharp
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | | | - Philip J Cowen
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Grant C Churchill
- Department of Pharmacology, University of Oxford, Oxford, UK,Department of Pharmacology, University of Oxford, Mansfield Road, Oxford OX1 3QT, UK, Tel: +44 (0)1865 271 635, Fax: +44 (0)1865 271 853, E-mail:
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14
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McNamara RK, Jandacek R, Rider T, Tso P, Chu WJ, Weber WA, Welge JA, Strawn JR, Adler CM, DelBello MP. Effects of fish oil supplementation on prefrontal metabolite concentrations in adolescents with major depressive disorder: a preliminary 1H MRS study. Nutr Neurosci 2016; 19:145-55. [PMID: 24915543 DOI: 10.1179/1476830514y.0000000135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To use proton magnetic resonance spectroscopy ((1)H MRS) to investigate the effects of fish oil (FO) supplementation on cortical metabolite concentrations in adolescents with major depressive disorder (MDD). METHODS Metabolite concentrations were determined by (1)H MRS in the anterior cingulate cortex and bilateral dorsolateral prefrontal cortex (DLPFC) of adolescents with MDD before and following 10-week open-label supplementation with low (2.4 g/day, n = 7) or high (16.2 g/day, n = 7) dose FO. Depressive symptom severity scores and erythrocyte fatty acid levels were also determined. RESULTS Baseline erythrocyte eicosapentaenoic acid (EPA) composition was positively correlated, and arachidonic acid (AA) and the AA/EPA ratio were inversely correlated, with choline (Cho) concentrations in the right DLPFC. Docosahexaenoic acid (DHA) composition was inversely correlated with myo-inositol (mI) concentrations in the left DLPFC. Erythrocyte EPA and DHA composition increased, and AA decreased, significantly following low-dose and high-dose FO supplementation. In the intent-to-treat sample, depressive symptom severity scores decreased significantly in the high-dose group (-40%, P < 0.0001) and there was a trend in the low-dose group (-20%, P = 0.06). There were no significant baseline-endpoint changes in metabolite levels in each voxel. In the low-dose group there were changes with large effect sizes, including a decrease in mI in the left DLPFC (-12%, P = 0.18, d = 0.8) and increases in glutamate + glutamine (Glx) (+12%, P = 0.19, d = 0.8) and Cho (+15%, P = 0.08, d = 1.2) in the right DLPFC. In the high-dose group, there was a trend for increases in Cho in the right DLPFC (+10%, P = 0.09, d = 1.2). DISCUSSION These preliminary data suggest that increasing the LCn-3 fatty acid status of adolescent MDD patients is associated with subtle changes in Glx, mI, and Cho concentrations in the DLPFC that warrant further evaluation in a larger controlled trial.
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Affiliation(s)
- Robert K McNamara
- a Department of Psychiatry and Behavioral Neuroscience, Center for Imaging Research, Division of Bipolar Disorders Research , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Ronald Jandacek
- b Department of Pathology , University of Cincinnati , Cincinnati , OH , USA
| | - Therese Rider
- b Department of Pathology , University of Cincinnati , Cincinnati , OH , USA
| | - Patrick Tso
- b Department of Pathology , University of Cincinnati , Cincinnati , OH , USA
| | - Wen-Jang Chu
- a Department of Psychiatry and Behavioral Neuroscience, Center for Imaging Research, Division of Bipolar Disorders Research , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Wade A Weber
- a Department of Psychiatry and Behavioral Neuroscience, Center for Imaging Research, Division of Bipolar Disorders Research , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Jeffrey A Welge
- a Department of Psychiatry and Behavioral Neuroscience, Center for Imaging Research, Division of Bipolar Disorders Research , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Jeffrey R Strawn
- a Department of Psychiatry and Behavioral Neuroscience, Center for Imaging Research, Division of Bipolar Disorders Research , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Caleb M Adler
- a Department of Psychiatry and Behavioral Neuroscience, Center for Imaging Research, Division of Bipolar Disorders Research , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Melissa P DelBello
- a Department of Psychiatry and Behavioral Neuroscience, Center for Imaging Research, Division of Bipolar Disorders Research , University of Cincinnati College of Medicine , Cincinnati , OH , USA
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Hermens DF, Naismith SL, Chitty KM, Lee RSC, Tickell A, Duffy SL, Paquola C, White D, Hickie IB, Lagopoulos J. Cluster analysis reveals abnormal hippocampal neurometabolic profiles in young people with mood disorders. Eur Neuropsychopharmacol 2015; 25:836-45. [PMID: 25795519 DOI: 10.1016/j.euroneuro.2015.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 02/10/2015] [Accepted: 02/25/2015] [Indexed: 01/01/2023]
Abstract
While numerous studies have employed magnetic resonance spectroscopy (MRS) to determine in vivo neurometabolite levels associated with mood disorders the findings in both unipolar depression and bipolar disorder have been mixed. Data-driven studies may shed new light on this literature by identifying distinct subgroups of patients who may benefit from different treatment strategies. The objective of the present study was to utilize hierarchical cluster analysis in order to generate new hypotheses with respect to neurometabolic profiling of mood disorder. Participants were 165 young persons (18-30 yrs) with a mood disorder and 40 healthy controls. Neurometabolite levels were recorded via proton-MRS ((1)H MRS). The ratios (relative to creatine) of glutamate (GLU), N-acetyl aspartate (NAA) and myo-inositol (MI) measured within the hippocampus. Self-reported and clinician rated symptoms as well as cognition were also measured. The unipolar depression (N=90) and bipolar disorder (N=75) groups did not significantly differ (from each other or controls) in their levels of GLU, NAA or MI. Cluster analyses derived four subgroups of patients who were distinguished by all three metabolites. There was a pattern of positive association between NAA and GLU, whereby clusters were abnormally increased (clusters 1, 2) or normal (cluster 4) or abnormally decreased (cluster 3) in these neurometabolites. These findings suggest that there are neurometabolic abnormalities in subgroups of young people with mood disorder, which may occur despite diagnostic similarities. Such evidence highlights that the underlying neurobiology of mood disorder is complex and MRS may have unique utility in delineating underlying neurobiology and targeting treatment strategies.
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Affiliation(s)
- Daniel F Hermens
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Australia.
| | - Sharon L Naismith
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Australia
| | - Kate M Chitty
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Australia
| | - Rico S C Lee
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Australia
| | - Ashleigh Tickell
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Australia
| | - Shantel L Duffy
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Australia
| | - Casey Paquola
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Australia
| | - Django White
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Australia
| | - Ian B Hickie
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Australia
| | - Jim Lagopoulos
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Australia
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16
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Sikoglu EM, Navarro AAL, Starr D, Dvir Y, Nwosu BU, Czerniak SM, Rogan RC, Castro MC, Edden RAE, Frazier JA, Moore CM. Vitamin D3 Supplemental Treatment for Mania in Youth with Bipolar Spectrum Disorders. J Child Adolesc Psychopharmacol 2015; 25:415-24. [PMID: 26091195 PMCID: PMC4491165 DOI: 10.1089/cap.2014.0110] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We aimed to determine the effect of an open-label 8 week Vitamin D3 supplementation on manic symptoms, anterior cingulate cortex (ACC) glutamate, and γ-aminobutyric acid (GABA) in youth exhibiting symptoms of mania; that is, patients with bipolar spectrum disorders (BSD). We hypothesized that an 8 week Vitamin D3 supplementation would improve symptoms of mania, decrease ACC glutamate, and increase ACC GABA in BSD patients. Single time point metabolite levels were also evaluated in typically developing children (TD). METHODS The BSD group included patients not only diagnosed with BD but also those exhibiting bipolar symptomology, including BD not otherwise specified (BD-NOS) and subthreshold mood ratings (Young Mania Rating Scale [YMRS] ≥8 and Clinical Global Impressions - Severity [CGI-S] ≥3). Inclusion criteria were: male or female participants, 6-17 years old. Sixteen youth with BSD exhibiting manic symptoms and 19 TD were included. BSD patients were asked to a take daily dose (2000 IU) of Vitamin D3 (for 8 weeks) as a supplement. Neuroimaging data were acquired in both groups at baseline, and also for the BSD group at the end of 8 week Vitamin D3 supplementation. RESULTS Baseline ACC GABA/creatine (Cr) was lower in BSD than in TD (F[1,31]=8.91, p=0.007). Following an 8 week Vitamin D3 supplementation, in BSD patients, there was a significant decrease in YMRS scores (t=-3.66, p=0.002, df=15) and Children's Depression Rating Scale (CDRS) scores (t=-2.93, p=0.01, df=15); and a significant increase in ACC GABA (t=3.18, p=0.007, df=14). CONCLUSIONS Following an 8 week open label trial with Vitamin D3, BSD patients exhibited improvement in their mood symptoms in conjunction with their brain neurochemistry.
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Affiliation(s)
- Elif M. Sikoglu
- Center for Comparative NeuroImaging, University of Massachusetts Medical School, Worcester, Massachusetts.,Child and Adolescent NeuroDevelopment Initiative, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Ana A. Liso Navarro
- Center for Comparative NeuroImaging, University of Massachusetts Medical School, Worcester, Massachusetts.,Child and Adolescent NeuroDevelopment Initiative, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.,Office Médico-Pédagogique, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Debra Starr
- Child and Adolescent NeuroDevelopment Initiative, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Yael Dvir
- Child and Adolescent NeuroDevelopment Initiative, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Benjamin Udoka Nwosu
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Suzanne M. Czerniak
- Center for Comparative NeuroImaging, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Ryan C. Rogan
- Center for Comparative NeuroImaging, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Martha C. Castro
- Child and Adolescent NeuroDevelopment Initiative, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Richard A. E. Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Jean A. Frazier
- Child and Adolescent NeuroDevelopment Initiative, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Constance M. Moore
- Center for Comparative NeuroImaging, University of Massachusetts Medical School, Worcester, Massachusetts.,Child and Adolescent NeuroDevelopment Initiative, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
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Kondo DG, Hellem TL, Shi XF, Sung YH, Prescot AP, Kim TS, Huber RS, Forrest LN, Renshaw PF. A review of MR spectroscopy studies of pediatric bipolar disorder. AJNR Am J Neuroradiol 2014; 35:S64-80. [PMID: 24557702 DOI: 10.3174/ajnr.a3844] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pediatric bipolar disorder is a severe mental illness whose pathophysiology is poorly understood and for which there is an urgent need for improved diagnosis and treatment. MR spectroscopy is a neuroimaging method capable of in vivo measurement of neurochemicals relevant to bipolar disorder neurobiology. MR spectroscopy studies of adult bipolar disorder provide consistent evidence for alterations in the glutamate system and mitochondrial function. In bipolar disorder, these 2 phenomena may be linked because 85% of glucose in the brain is consumed by glutamatergic neurotransmission and the conversion of glutamate to glutamine. The purpose of this article is to review the MR spectroscopic imaging literature in pediatric bipolar disorder, at-risk samples, and severe mood dysregulation, with a focus on the published findings that are relevant to glutamatergic and mitochondrial functioning. Potential directions for future MR spectroscopy studies of the glutamate system and mitochondrial dysfunction in pediatric bipolar disorder are discussed.
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Affiliation(s)
- D G Kondo
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, UtahDepartments of Psychiatry (D.G.K., X.F.S., Y.H.S., P.F.R.)
| | - T L Hellem
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, Utah
| | - X-F Shi
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, UtahDepartments of Psychiatry (D.G.K., X.F.S., Y.H.S., P.F.R.)
| | - Y H Sung
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, UtahDepartments of Psychiatry (D.G.K., X.F.S., Y.H.S., P.F.R.)
| | - A P Prescot
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, UtahRadiology (A.P.P.), University of Utah School of Medicine, Salt Lake City, Utah
| | - T S Kim
- and Department of Psychiatry (T.S.K.), Catholic University of Korea Graduate School of Medicine, Seoul, Republic of Korea
| | - R S Huber
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, Utah
| | - L N Forrest
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, Utah
| | - P F Renshaw
- From The Brain Institute (D.G.K., T.L.H., X.F.S., Y.H.S., A.P.P., R.S.H., L.N.F., P.F.R), University of Utah, Salt Lake City, UtahDepartments of Psychiatry (D.G.K., X.F.S., Y.H.S., P.F.R.)Veterans Integrated Service Network 19 Mental Illness Research (P.F.R.), Education and Clinical Center, VA Salt Lake City Health Care System, Salt Lake City, Utah
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Contributions of magnetic resonance spectroscopy to understanding development: potential applications in the study of adolescent alcohol use and abuse. Dev Psychopathol 2014; 26:405-23. [PMID: 24621605 DOI: 10.1017/s0954579414000030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A growing body of research has documented structural and functional brain development during adolescence, yet little is known about neurochemical changes that occur during this important developmental period. Magnetic resonance spectroscopy (MRS) is a well-developed technology that permits the in vivo quantification of multiple brain neurochemicals relevant to neuronal health and functioning. However, MRS technology has been underused in exploring normative developmental changes during adolescence and the onset of alcohol and drug use and abuse during this developmental period. This review begins with a brief overview of normative cognitive and neurobiological development during adolescence, followed by an introduction to MRS principles. The subsequent sections provide a comprehensive review of the existing MRS studies of development and cognitive functioning in healthy children and adolescents. The final sections of this article address the potential application of MRS in identifying neurochemical predictors and consequences of alcohol use and abuse in adolescence. MRS studies of adolescent populations hold promise for advancing our understanding of neurobiological risk factors for psychopathology by identifying the biochemical signatures associated with healthy brain development, as well as neurobiological and cognitive correlates of alcohol and substance use and abuse.
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Abstract
OBJECTIVES The investigation of the pathophysiology of bipolar disorder in patients at disease onset is a strategy to avoid the confounding effect of progression of disease or duration of treatment. Our purpose was to investigate in vivo neuronal metabolites in the hippocampus of bipolar disorder patients using proton magnetic resonance spectroscopy ((1)H-MRS) within 3 months after their first manic episode. METHODS Fifty-eight BD I patients meeting DSM-IV criteria following their first episode of mania and 27 healthy subjects were studied using (1)H-MRS with a 3.0 T Philips Achieva scanner. Voxels with 30 × 15 × 15 mm were placed in the hippocampus on both sides of the brain and the signal was collected using a PRESS sequence with TE = 35 ms and TR = 2000 ms. Data analysis was performed using the LC Model software. RESULTS N-Acetyl-aspartate (NAA), choline (Cho), myo-inositol (mI), creatine (Cre) and glutamine + glutamate (Glx) levels were compared between the groups and no statistically significant differences were found. CONCLUSIONS Our results suggest that early in the course of BD there are no alterations in neuronal metabolism or vulnerability in the hippocampus after the first manic episode.
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Affiliation(s)
- Alexandre Duarte Gigante
- Bipolar Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School , São Paulo - SP , Brazil
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Adleman NE, Barnea-Goraly N, Chang KD. Review of magnetic resonance imaging and spectroscopy studies in children with bipolar disorder. Expert Rev Neurother 2014; 4:69-77. [PMID: 15853617 DOI: 10.1586/14737175.4.1.69] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pediatric bipolar disorder is a serious condition that affects a child's ability to function normally during important developmental stages. Pediatric bipolar disorder often presents with a different symptom complex than adult-onset bipolar disorder, including higher rates of irritability and rapid cycling. Due to these differences, it is important to understand the neural substrates of the disease as it presents in children, especially when compared with adults. Understanding the brain abnormalities associated with pediatric bipolar disorder may provide much needed markers useful in diagnosing childhood-onset bipolar disorder, give insight into the neurobiological etiology of the disorder and lead to more effective treatments. Currently, there has been little neuroimaging research into pediatric bipolar disorder, specifically with regards to brain function. This review summarizes the neurobiological research that has been conducted on childhood- and adolescent-onset bipolar disorder using magnetic resonance technology. Future directions of research needed in this area also are discussed in the context of the existing literature.
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Affiliation(s)
- Nancy E Adleman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305 5719, USA.
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21
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Shi XF, Forrest LN, Kuykendall MD, Prescot AP, Sung YH, Huber RS, Hellem TL, Jeong EK, Renshaw PF, Kondo DG. Anterior cingulate cortex choline levels in female adolescents with unipolar versus bipolar depression: a potential new tool for diagnosis. J Affect Disord 2014; 167:25-9. [PMID: 25082110 PMCID: PMC4699311 DOI: 10.1016/j.jad.2014.05.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 05/23/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Delayed diagnosis in bipolar disorder (BD) due to misdiagnosis as major depressive disorder (MDD) is a significant public health concern. Thus, identification of relevant diagnostic biomarkers is a critical unmet need, particularly early in the course of illness. The anterior cingulate cortex (ACC) is thought to play an important role in mood disorder pathophysiology. Case-control studies utilizing proton-1 magnetic resonance spectroscopy ((1)H-MRS) have found increased total choline levels in several brain regions in MDD. However, there are no published (1)H-MRS reports directly comparing adolescents with MDD and BD. We hypothesized that ACC choline levels would be increased in adolescents with unipolar versus bipolar depression. METHODS We studied depressed adolescents with MDD (n=28; mean age 17.0±2.1 years) and BD (n=9; 17.3±3.1 years). A Siemens Verio 3-Tesla clinical MRI system was used to acquire scans, using a single-voxel PRESS sequence. The voxel (18.75 cm(3)) was positioned on the ACC in the midsagittal plane. To remove potential gender effects, only female adolescent participants were included. Data were analyzed using the ANOVA and post-hoc Tukey tests. RESULTS A significantly increased ACC choline/creatine ratio was observed in participants with MDD (mean=0.253±0.021) compared to BD (mean=0.219±0.020) (p=0.0002). There were no significant differences in the other (1)H-MRS metabolites. LIMITATIONS Cross sectional design, single gender sample, limited sample size. CONCLUSIONS The present findings suggest that ACC total choline may have the potential to serve as a diagnostic biomarker in adolescent mood disorders.
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Affiliation(s)
- Xian-Feng Shi
- The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA; Department of Psychiatry, University of Utah, School of Medicine, Salt Lake City, UT, USA.
| | - Lauren N. Forrest
- The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA
| | - M. Danielle Kuykendall
- The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA
| | - Andrew P. Prescot
- Department of Radiology, University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Young-Hoon Sung
- The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA,Department of Psychiatry, University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Rebekah S. Huber
- The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA
| | - Tracy L. Hellem
- The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA
| | - Eun-Kee Jeong
- Department of Radiology, University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Perry F. Renshaw
- The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA,Department of Psychiatry, University of Utah, School of Medicine, Salt Lake City, UT, USA,VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Douglas G. Kondo
- The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA,Department of Psychiatry, University of Utah, School of Medicine, Salt Lake City, UT, USA,VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
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Prospective neurochemical characterization of child offspring of parents with bipolar disorder. Psychiatry Res 2013; 214:153-60. [PMID: 24028795 PMCID: PMC3796054 DOI: 10.1016/j.pscychresns.2013.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 03/28/2013] [Accepted: 05/16/2013] [Indexed: 01/04/2023]
Abstract
We wished to determine whether decreases in N-acetyl aspartate (NAA) and increases in myoinositol (mI) concentrations as a ratio of creatine (Cr) occurred in the dorsolateral prefrontal cortex (DLPFC) of pediatric offspring of parents with bipolar disorder (BD) and a healthy comparison group (HC) over a 5-year period using proton magnetic resonance spectroscopy ((1)H-MRS). Paticipants comprised 64 offspring (9-18 years old) of parents with BD (36 with established BD, and 28 offspring with symptoms subsyndromal to mania) and 28 HCs, who were examined for group differences in NAA/Cr and mI/Cr in the DLPFC at baseline and follow-up at either 8, 10, 12, 52, 104, 156, 208, or 260 weeks. No significant group differences were found in metabolite concentrations at baseline or over time. At baseline, BD offspring had trends for higher mI/Cr concentrations in the right DLPFC than the HC group. mI/Cr concentrations increased with age, but no statistically significant group differences were found between groups on follow-up. It may be the case that with intervention youth at risk for BD are normalizing otherwise potentially aberrant neurochemical trajectories in the DLPFC. A longer period of follow-up may be required before observing any group differences.
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Chitty KM, Lagopoulos J, Lee RSC, Hickie IB, Hermens DF. A systematic review and meta-analysis of proton magnetic resonance spectroscopy and mismatch negativity in bipolar disorder. Eur Neuropsychopharmacol 2013; 23:1348-63. [PMID: 23968965 DOI: 10.1016/j.euroneuro.2013.07.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 07/16/2013] [Accepted: 07/26/2013] [Indexed: 12/15/2022]
Abstract
Aberrant glutamate neurotransmission has been implicated in the pathophysiology of bipolar disorder with accumulating evidence from imaging, post-mortem and pathology studies. Studies investigating in vivo changes to the glutamatergic system have not been as consistent and warrant clarification. Studies utilizing proton-magnetic resonance spectroscopy ((1)H-MRS) have reported increased levels of combined glutamate and glutamine ("Glx"), which have been linked to impairments in N-methyl-d-aspartate (NMDA) receptor function. Similarly, neurophysiological studies utilising mismatch negativity (MMN) as an index of NMDA receptor function, have reported impairments in bipolar disorder. Here, we provide a systematic review of the literature in regards to the concentration of Glx and the magnitude of MMN in bipolar disorder. Separate meta-analyses revealed that bipolar disorder was associated with increased Glx concentration and decreased MMN-both measured frontally. The current findings corroborate previous evidence indicating that bipolar disorder is characterized by a perturbed frontal glutamate system. These observed changes in bipolar disorder might manifest as impairments in neuronal-glial interactions that lead to disrupted neuronal output and ultimately result in the characteristic neurocognitive sequelae associated with this disorder.
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Affiliation(s)
- Kate M Chitty
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia.
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Gigante AD, Bond DJ, Lafer B, Lam RW, Young LT, Yatham LN. Brain glutamate levels measured by magnetic resonance spectroscopy in patients with bipolar disorder: a meta-analysis. Bipolar Disord 2012; 14:478-87. [PMID: 22834460 DOI: 10.1111/j.1399-5618.2012.01033.x] [Citation(s) in RCA: 167] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Bipolar disorder (BD) is a common and highly disabling disease characterized by substantial cognitive and functional impairment. The exact neurobiological mechanisms underlying the expression of symptoms in this condition remain unknown but there is growing evidence that glutamate might play an important role. Using proton magnetic resonance spectroscopy (¹H-MRS), a number of studies have examined brain glutamate/glutamine levels in patients with bipolar disorder, but they have produced conflicting results. The objective of this paper was to conduct a systematic review and meta-analysis of the literature on brain glutamate/glutamine in BD as measured by ¹H-MRS. METHODS A Medline search for the period January 1980-April 2010 was conducted to identify published studies that used ¹H-MRS to measure glutamate + glutamine (Glx), the Glx/creatine (Cr) ratio, glutamate (Glu), or the Glu/Cr ratio in any brain region in adult or child/adolescent patients with BD and healthy subjects. A meta-analysis of the pooled data was conducted. RESULTS BD patients were found to have increased Glx compared to healthy subjects when all brain areas were combined. This finding remained true in medicated and non-medicated patients, and in frontal brain areas in adults. There was a non-significant trend (p = 0.09) for an increase in whole-brain Glx/Cr and Glu in patients compared with healthy subjects. No significant difference was found in Glu/Cr. CONCLUSIONS The results of this meta-analysis suggest that brain Glx levels are elevated in BD patients and support the idea that glutamate might play an important role in the pathophysiology of BD.
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Chang K, DelBello M, Chu WJ, Garrett A, Kelley R, Mills N, Howe M, Bryan H, Adler C, Eliassen J, Spielman D, Strakowski SM. Neurometabolite effects of response to quetiapine and placebo in adolescents with bipolar depression. J Child Adolesc Psychopharmacol 2012; 22:261-8. [PMID: 22849427 PMCID: PMC3472676 DOI: 10.1089/cap.2011.0153] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Mood stabilizers have been reported to affect brain concentrations of myo-inositol (mI) and N-acetylaspartate (NAA). We examined the effects of quetiapine (QUET), an atypical antipsychotic, on these neurochemicals, and potential predictors of response to QUET in adolescents with bipolar depression. METHODS Twenty-six adolescents with bipolar depression participated in an 8-week placebo-controlled trial of QUET monotherapy. Subjects were scanned at baseline and after 8 weeks with proton magnetic resonance spectroscopy (1H-MRS) at 3T and 4T at two sites, with 8 cm(3) voxels placed in the right and left dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC). LCModel was used to calculate absolute concentrations of NAA and mI. RESULTS Twenty-six subjects had pre- and posttreatment scans (mean age=15.6 years, 9 boys). Of these subjects, 5 out of 16 subjects receiving QUET and 5 out of 10 receiving placebo (PBO) were responders (50% decrease in Children's Depression Rating Scale [CDRS] score). Although baseline ACC mI did not predict responder status, responders had significantly lower posttreatment ACC mI values than did nonresponders (3.27±.71 vs. 4.23±.70; p=0.004). There were no significant differences in the changes in ACC and DLPFC NAA levels in the QUET group compared with the PBO group (ACC: -0.55±1.3 vs.+0.25±1.5, p=0.23; right-DLPFC: -0.55±1.3 vs. 0.33±0.89, p=0.13; left-DLPFC: -0.04±0.91 vs.+0.29±0.61, p=0.41). CONCLUSION We found that posttreatment, not baseline, ACC mI levels were associated with response to QUET in adolescents with bipolar depression. There were no differences in NAA concentration changes between the QUET and PBO groups. Larger studies including different brain regions would help to clarify the effects of QUET on neurochemistry in patients with bipolar disorder.
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Affiliation(s)
- Kiki Chang
- Pediatric Bipolar Disorders Program, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California 94305-5540, USA.
| | - Melissa DelBello
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Wen-Jang Chu
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amy Garrett
- Pediatric Bipolar Disorders Program, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Ryan Kelley
- Pediatric Bipolar Disorders Program, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Neil Mills
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Meghan Howe
- Pediatric Bipolar Disorders Program, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Holly Bryan
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Cal Adler
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jim Eliassen
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Daniel Spielman
- Pediatric Bipolar Disorders Program, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Stephen M. Strakowski
- Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Hajek T, Bauer M, Pfennig A, Cullis J, Ploch J, O’Donovan C, Bohner G, Klingebiel R, Young LT, MacQueen GM, Alda M. Large positive effect of lithium on prefrontal cortex N-acetylaspartate in patients with bipolar disorder: 2-centre study. J Psychiatry Neurosci 2012; 37:185-92. [PMID: 22353634 PMCID: PMC3341410 DOI: 10.1503/jpn.110097] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Neuroprotective effects of lithium (Li) have been well documented in tissue cultures and animal models, whereas human data continue to be limited. Previous studies investigating the association between Li treatment and brain N-acetylaspartate (NAA), a putative neuronal marker, showed mixed results because of methodological heterogeneity. METHODS To investigate the effects of Li on prefrontal cortex NAA levels, we compared patients with bipolar disorder from specialized Li clinics in Berlin and Halifax with at least 2 years of ongoing Li treatment (Li group), patients with lifetime Li exposure of less than 3 months more than 2 years ago (non-Li group) and healthy controls. Participants in both patient groups had at least 10 years of illness and 5 episodes. We measured left prefrontal NAA levels using 1.5-T magnetic resonance spectroscopy. RESULTS We enrolled 27 participants in the Li, 16 in the non-Li and 21 in the healthy control groups. The non-Li group had lower prefrontal NAA levels than the Li group (t41 = -3.44, corrected p < 0.01) or control participants (t35 = -2.91, corrected p < 0.05), who did not differ from the Li group (t46 = -0.14, p = 0.89). The same pattern of prefrontal NAA differences was replicated in both sites. In addition, there was a negative correlation between prefrontal NAA and duration of illness in the non-Li group (r = -0.60, p = 0.019) but not in the Li group (r = 0.07, p = 0.74). LIMITATIONS Study limitations include the crosssectional design and exposure to other medications. CONCLUSION Whereas patients with bipolar disorder, substantial illness burden and limited lifetime Li exposure had significantly lower prefrontal NAA levels than controls, Li-treated patients with similar illness burden showed prefrontal NAA levels comparable to those of healthy controls. These findings provide indirect support for neuroprotective effects of Li and for negative effects of illness burden on prefrontal NAA levels in patients with bipolar disorder.
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Affiliation(s)
- Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS.
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Towards a glutamate hypothesis of depression: an emerging frontier of neuropsychopharmacology for mood disorders. Neuropharmacology 2011; 62:63-77. [PMID: 21827775 DOI: 10.1016/j.neuropharm.2011.07.036] [Citation(s) in RCA: 718] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 07/22/2011] [Accepted: 07/23/2011] [Indexed: 12/12/2022]
Abstract
Half a century after the first formulation of the monoamine hypothesis, compelling evidence implies that long-term changes in an array of brain areas and circuits mediating complex cognitive-emotional behaviors represent the biological underpinnings of mood/anxiety disorders. A large number of clinical studies suggest that pathophysiology is associated with dysfunction of the predominant glutamatergic system, malfunction in the mechanisms regulating clearance and metabolism of glutamate, and cytoarchitectural/morphological maladaptive changes in a number of brain areas mediating cognitive-emotional behaviors. Concurrently, a wealth of data from animal models have shown that different types of environmental stress enhance glutamate release/transmission in limbic/cortical areas and exert powerful structural effects, inducing dendritic remodeling, reduction of synapses and possibly volumetric reductions resembling those observed in depressed patients. Because a vast majority of neurons and synapses in these areas and circuits use glutamate as neurotransmitter, it would be limiting to maintain that glutamate is in some way 'involved' in mood/anxiety disorders; rather it should be recognized that the glutamatergic system is a primary mediator of psychiatric pathology and, potentially, also a final common pathway for the therapeutic action of antidepressant agents. A paradigm shift from a monoamine hypothesis of depression to a neuroplasticity hypothesis focused on glutamate may represent a substantial advancement in the working hypothesis that drives research for new drugs and therapies. Importantly, despite the availability of multiple classes of drugs with monoamine-based mechanisms of action, there remains a large percentage of patients who fail to achieve a sustained remission of depressive symptoms. The unmet need for improved pharmacotherapies for treatment-resistant depression means there is a large space for the development of new compounds with novel mechanisms of action such as glutamate transmission and related pathways. This article is part of a Special Issue entitled 'Anxiety and Depression'.
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Caetano SC, Olvera RL, Hatch JP, Sanches M, Chen HH, Nicoletti M, Stanley JA, Fonseca M, Hunter K, Lafer B, Pliszka SR, Soares JC. Lower N-acetyl-aspartate levels in prefrontal cortices in pediatric bipolar disorder: a ¹H magnetic resonance spectroscopy study. J Am Acad Child Adolesc Psychiatry 2011; 50:85-94. [PMID: 21156273 DOI: 10.1016/j.jaac.2010.10.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 10/15/2010] [Accepted: 10/19/2010] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The few studies applying single-voxel ¹H spectroscopy in children and adolescents with bipolar disorder (BD) have reported low N-acetyl-aspartate (NAA) levels in the dorsolateral prefrontal cortex (DLPFC), and high myo-inositol / phosphocreatine plus creatine (PCr+Cr) ratios in the anterior cingulate. The aim of this study was to evaluate NAA, glycerophosphocholine plus phosphocholine (GPC+PC) and PCr+Cr in various frontal cortical areas in children and adolescents with BD. We hypothesized that NAA levels within the prefrontal cortex are lower in BD patients than in healthy controls, indicating neurodevelopmental alterations in the former. METHOD We studied 43 pediatric patients with DSM-IV BD (19 female, mean age 13.2 ± 2.9 years) and 38 healthy controls (19 female, mean age 13.9 ± 2.7 years). We conducted multivoxel in vivo ¹H spectroscopy measurements at 1.5 Tesla using a long echo time of 272 ms to obtain bilateral metabolite levels from the medial prefrontal cortex (MPFC), DLPFC (white and gray matter), cingulate (anterior and posterior), and occipital lobes. We used the nonparametric Mann-Whitney U test to compare neurochemical levels between groups. RESULTS In pediatric BD patients, NAA and GPC+PC levels in the bilateral MPFC, and PCr+Cr levels in the left MPFC were lower than those seen in the controls. In the left DLPFC white matter, levels of NAA and PCr+Cr were also lower in BD patients than in controls. CONCLUSIONS Lower NAA and PCr+Cr levels in the PFC of children and adolescents with BD may be indicative of abnormal dendritic arborization and neuropil, suggesting neurodevelopmental abnormalities.
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Kondo DG, Hellem TL, Sung YH, Kim N, Jeong EK, DelMastro KK, Shi X, Renshaw PF. Review: magnetic resonance spectroscopy studies of pediatric major depressive disorder. DEPRESSION RESEARCH AND TREATMENT 2010; 2011:650450. [PMID: 21197097 PMCID: PMC3003951 DOI: 10.1155/2011/650450] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 08/20/2010] [Indexed: 12/22/2022]
Abstract
Introduction. This paper focuses on the application of Magnetic Resonance Spectroscopy (MRS) to the study of Major Depressive Disorder (MDD) in children and adolescents. Method. A literature search using the National Institutes of Health's PubMed database was conducted to identify indexed peer-reviewed MRS studies in pediatric patients with MDD. Results. The literature search yielded 18 articles reporting original MRS data in pediatric MDD. Neurochemical alterations in Choline, Glutamate, and N-Acetyl Aspartate are associated with pediatric MDD, suggesting pathophysiologic continuity with adult MDD. Conclusions. The MRS literature in pediatric MDD is modest but growing. In studies that are methodologically comparable, the results have been consistent. Because it offers a noninvasive and repeatable measurement of relevant in vivo brain chemistry, MRS has the potential to provide insights into the pathophysiology of MDD as well as the mediators and moderators of treatment response.
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Affiliation(s)
- Douglas G. Kondo
- The Brain Institute at the University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108-1201, USA
- Department of Psychiatry, University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, UT 84132, USA
| | - Tracy L. Hellem
- The Brain Institute at the University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108-1201, USA
| | - Young-Hoon Sung
- The Brain Institute at the University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108-1201, USA
- Department of Psychiatry, University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, UT 84132, USA
| | - Namkug Kim
- The Brain Institute at the University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108-1201, USA
| | - Eun-Kee Jeong
- Department of Radiology, University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, UT 84132, USA
| | - Kristen K. DelMastro
- The Brain Institute at the University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108-1201, USA
| | - Xianfeng Shi
- The Brain Institute at the University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108-1201, USA
| | - Perry F. Renshaw
- The Brain Institute at the University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108-1201, USA
- Department of Psychiatry, University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, UT 84132, USA
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Zheng H, Zhang L, Li L, Liu P, Gao J, Liu X, Zou J, Zhang Y, Liu J, Zhang Z, Li Z, Men W. High-frequency rTMS treatment increases left prefrontal myo-inositol in young patients with treatment-resistant depression. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:1189-95. [PMID: 20600472 DOI: 10.1016/j.pnpbp.2010.06.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 05/24/2010] [Accepted: 06/15/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Neuroimaging studies suggest that the prefrontal cortex (PFC) is involved in the pathophysiology of major depression. Repetitive transcranial magnetic stimulation (rTMS) as an antidepressant intervention has increasingly been investigated in the last two decades. In this study metabolic changes within PFC of severely depressed patients before and after rTMS were evaluated by proton magnetic resonance spectroscopy (1H-MRS). METHOD Thirty-four young depressed patients with treatment-resistant unipolar depression were enrolled in a double-blind, randomized study active ((n=19) vs. sham(n=15)), and the PFC was investigated before and after high-frequency (15 Hz) rTMS using 3-tesla proton magnetic resonance spectroscopy. Response was defined as a 50% reduction of the Hamilton depression rating scale. The results were compared with 28 age- and gender-matched healthy controls. RESULTS In depressive patients a significant reduction in myo-inositol (m-Ino) was observed pre-rTMS (p<0.001). After successful treatment, m-Ino increased significantly in left PFC and the levels no longer differed from those of age-matched controls. In addition to a positive correlation between clinical improvement and an increment in m-Ino ratio, a correlation between clinical improvement and early age onset was observed. CONCLUSIONS Our results support the notion that major depressive disorder is accompanied by state-dependent metabolic alterations, especially in myo-inositol metabolism, which can be partly reversed by successful rTMS.
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Affiliation(s)
- Huirong Zheng
- Mental Health Institute, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
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Singh M, Spielman D, Adleman N, Alegria D, Howe M, Reiss A, Chang K. Brain glutamatergic characteristics of pediatric offspring of parents with bipolar disorder. Psychiatry Res 2010; 182:165-71. [PMID: 20413280 PMCID: PMC2866778 DOI: 10.1016/j.pscychresns.2010.01.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 11/13/2009] [Accepted: 01/12/2010] [Indexed: 11/28/2022]
Abstract
We wished to determine whether decreases in prefrontal glutamate concentrations occur in offspring of parents with bipolar disorder with and at high risk for mania. Sixty children and adolescents, 9-18 years old, of parents with bipolar I or II disorder (20 offspring with established history of mania, "BD", 20 offspring with symptoms subsyndromal to mania, "SS", and 20 healthy controls "HC") were examined using proton magnetic resonance spectroscopy at 3T to study glutamatergic metabolite concentrations in the anterior cingulate cortex (ACC). A signal for reductions in absolute glutamate concentrations in the ACC was seen in the BD compared with HC and SS groups. No other statistically significant differences among groups were found. Offspring of parents with BD with prior histories of mania may have disruptions in glutamatergic function compared with HC or children at risk for BD who have not yet developed mania. Longitudinal studies are necessary to confirm whether prefrontal glutamate decreases only after the onset of full mania.
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Affiliation(s)
- Manpreet Singh
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA.
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Ohnishi T, Watanabe A, Ohba H, Iwayama Y, Maekawa M, Yoshikawa T. Behavioral analyses of transgenic mice harboring bipolar disorder candidate genes, IMPA1 and IMPA2. Neurosci Res 2010; 67:86-94. [PMID: 20153384 DOI: 10.1016/j.neures.2010.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 02/02/2010] [Accepted: 02/03/2010] [Indexed: 12/01/2022]
Abstract
The inositol depletion hypothesis proposes the inhibition of IMPase (myo-inositol monophosphatase) by lithium, a mood stabilizer, as a mechanism of lithium's efficacy. This hypothesis predicts that the upregulation of this biochemical pathway may underlie the pathophysiology of bipolar disorder. In favor of this idea, IMPA2 encoding IMPase is a candidate susceptibility gene for bipolar disorder and that the risk-conferring single nucleotide polymorphisms enhance the promoter activity of IMPA2. However, it is yet unknown whether such upregulation has a biological role in bipolar disorder. To address this issue, we generated transgenic mice for the two IMPase genes (IMPA1 and IMPA2). The expression levels of the transgene were robust in IMPA2 Tg lines, but moderate in IMPA1 Tg lines, when compared to those of endogenous proteins. The transgenic mice behaved normally under drug-naïve conditions, and did not exhibit signs for manic change when an antidepressant amitriptyline was administrated. Interestingly, the male transgenic mice for IMPA2 exhibited a lithium-resistant phenotype in the forced swim test. The current study, as a whole, did not support a substantial role of the upregulation of IMPase in bipolar disorder, although the lithium-insensitivity trait seen in IMPA2 transgenic mice might represent some aspect relevant to the inositol depletion hypothesis.
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Affiliation(s)
- Tetsuo Ohnishi
- Laboratory for Molecular Psychiatry, RIKEN Brain Science Institute, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan.
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Potenza MN, Koran LM, Pallanti S. The relationship between impulse-control disorders and obsessive-compulsive disorder: a current understanding and future research directions. Psychiatry Res 2009; 170:22-31. [PMID: 19811840 PMCID: PMC2792582 DOI: 10.1016/j.psychres.2008.06.036] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 07/03/2007] [Accepted: 06/12/2008] [Indexed: 10/20/2022]
Abstract
Impulse-control disorders (ICDs) constitute a heterogeneous group of conditions linked diagnostically by difficulties in resisting "the impulse, drive, or temptation to perform an act that is harmful to the person or to others." Specific ICDs share clinical, phenomenological and biological features with obsessive-compulsive disorder (OCD) that have suggested that these disorders might be categorized together. However, other data suggest significant differences between OCD and ICDs. In this article, clinical, phenomenological and biological features of the formal ICDs are reviewed and compared and contrasted with those of OCD. Available data indicate substantial differences between ICDs and OCD that suggest independent categorizations. Existing research gaps are identified and avenues for future research suggested.
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Affiliation(s)
- Marc Nicholas Potenza
- Associate Professor of Psychiatry, Department of Psychiatry, Yale University School of Medicine, Connecticut Mental Health Center, Room S-104, 34 Park Street, New Haven, CT, 06519, USA, . Tel: 203-974-7356. Fax: 203-974-7366
| | - Lorrin Michael Koran
- Professor of Psychiatry, Emeritus, Department of Psychiatry and Behavioural Sciences, Stanford University Medical Center, Stanford, CA, 94305
| | - Stefano Pallanti
- Professor of Psychiatry, University of the Studies of Florence, Florence, Italy, Adjunct Professor of Psychiatry, Mount Sinai School of Medicine, NY, New York.
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Silverstone PH, Asghar SJ, O'Donnell T, Ulrich M, Hanstock CC. Lithium and valproate protect against dextro-amphetamine induced brain choline concentration changes in bipolar disorder patients. World J Biol Psychiatry 2009; 5:38-44. [PMID: 15048634 DOI: 10.1080/15622970410029906] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Lithium may affect brain choline concentrations, and this effect has been proposed to potentially explain its clinical efficacy. Since dextro-amphetamine is a useful human model of mania, we were interested in determining firstly whether dextro-amphetamine would alter brain choline concentrations, and secondly to determine if lithium would protect against any such changes in bipolar patients. In addition, we wanted to determine if valproate would also have any effects upon choline levels. METHODS Healthy controls (n=18) were compared with euthymic Bipolar Disorder patients (Type I and Type II) who were taking lithium (n=14) or valproate (n=11). We utilized (1)H-magnetic resonance spectroscopy ((1)H-MRS) in a 3.0T scanner to examine brain choline/phosphocholine+creatine (Cho/Cr) ratios. Changes in this ratio were measured to determine any changes in choline concentrations in the temporal lobe. RESULTS The results showed that administration of dextro-amphetamine decreased the Cho/Cr ratios. In contrast, in both the lithium-treated and valproate-treated patients this decrease was not seen; this attenuation in the change in Cho/Cr ratio changes was statistically significant. It should be noted that Cho/Cr ratios were significantly higher at baseline in the controls compared to both groups of patients, which may have influenced the results. CONCLUSIONS These findings are the first to examine the effects of dextro-amphetamine on brain choline concentrations. They show that while in controls dextro-amphetamine decreases choline concentrations, lithium and valproate both appear to protect against this effect in bipolar patients. However, as brain ratios were measured rather than the absolute concentration of choline, and these ratios were lowered in patients at baseline, these results must be regarded as preliminary and require replication in future studies.
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Affiliation(s)
- Peter H Silverstone
- Department of Psychiatry, University of Alberta, 1E1.07 Mackenzie Center, 8440 - 112 Street, Edmonton AB, Canada.
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Henin A, Micco JA, Wozniak J, Briesch JM, Narayan AJ, Hirshfeld-Becker DR. Neurocognitive functioning in bipolar disorder. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1468-2850.2009.01162.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Terry J, Lopez-Larson M, Frazier JA. Magnetic resonance imaging studies in early onset bipolar disorder: an updated review. Child Adolesc Psychiatr Clin N Am 2009; 18:421-39, ix-x. [PMID: 19264271 DOI: 10.1016/j.chc.2008.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Over the past 5-10 years, advances in neuroimaging methods and study designs have begun to appear in the literature of early-onset bipolar disorder (onset before 18 years of age). This article contains an updated review of the literature regarding neuroimaging in youths with bipolar disorder (BPD), highlighting important new study designs and techniques. Overall, structural, functional (fMRI) and magnetic resonance spectroscopy (MRS) report consistent abnormalities in regions of the frontal lobe and limbic structures. Functional MRI and MRS studies also frequently report striatal and thalamic abnormalities in early-onset BPD. Future neuroimaging studies in youths with BPD should include longitudinal studies incorporating multimodal neuroimaging techniques.
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Affiliation(s)
- Janine Terry
- The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA
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Potter M, Moses A, Wozniak J. Alternative treatments in pediatric bipolar disorder. Child Adolesc Psychiatr Clin N Am 2009; 18:483-514, xi. [PMID: 19264275 DOI: 10.1016/j.chc.2008.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There has been growing interest in the use of complementary and alternative treatments in pediatric bipolar disorder (BPD). There are limited data, however, regarding the safety and efficacy of these treatments. This article discusses select complementary and alternative treatments that have been considered for use in pediatric BPD and/or depression, including omega-3-fatty acids, inositol, St. John's wort, SAMe, melatonin, lecithin, and acupuncture. Background information, reference to available adult and pediatric data, proposed mechanisms of action, dosing, side effects, and precautions of these treatments are included. Across the board, more research is necessary and warranted regarding the long-term safety and efficacy of available complementary and alternative treatments for the management of pediatric BPD.
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Affiliation(s)
- Mona Potter
- Department of Child and Adolescent Psychiatry, Massachusetts General Hospital and McLean Hospital, Yawkey Center for Outpatient Care, 55 Fruit Street, Boston, MA 02114, USA
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Dickstein DP, Towbin KE, Van Der Veen JW, Rich BA, Brotman MA, Knopf L, Onelio L, Pine DS, Leibenluft E. Randomized double-blind placebo-controlled trial of lithium in youths with severe mood dysregulation. J Child Adolesc Psychopharmacol 2009; 19:61-73. [PMID: 19232024 PMCID: PMC2692186 DOI: 10.1089/cap.2008.044] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The diagnosis and treatment of youth with severe nonepisodic irritability and hyperarousal, a syndrome defined as severe mood dysregulation (SMD) by Leibenluft, has been the focus of increasing concern. We conducted the first randomized double-blind, placebo-controlled trial in SMD youth, choosing lithium on the basis of its potential in treating irritability and aggression and neuro-metabolic effects. METHODS SMD youths 7-17 years were tapered off their medications. Those who continued to meet SMD criteria after a 2-week, single-blind, placebo run-in were randomized to a 6-week double-blind trial of either lithium (n = 14) or placebo (n = 11). Clinical outcome measures were: (1) Clinical Global Impressions-Improvement (CGI-I) score less than 4 at trial's end and (2) the Positive and Negative Syndrome Scale (PANSS) factor 4 score. Magnetic resonance spectroscopy (MRS) outcome measures were myoinositol (mI), N-acetyl-aspartate (NAA), and combined glutamate/glutamine (GLX), all referenced to creatine (Cr). RESULTS In all, 45% (n = 20/45) of SMD youths were not randomized due to significant clinical improvement during the placebo run-in. Among randomized patients, there were no significant between-group differences in either clinical or MRS outcome measures. CONCLUSION Our study suggests that although lithium may not result in significant clinical or neurometabolic alterations in SMD youths, further SMD treatment trials are warranted given its prevalence.
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Affiliation(s)
- Daniel P. Dickstein
- Present address: E.P. Bradley Hospital, an affiliate of the Alpert Medical School of Brown University
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Patel NC, Cecil KM, Strakowski SM, Adler CM, DelBello MP. Neurochemical alterations in adolescent bipolar depression: a proton magnetic resonance spectroscopy pilot study of the prefrontal cortex. J Child Adolesc Psychopharmacol 2008; 18:623-7. [PMID: 19108667 PMCID: PMC2935834 DOI: 10.1089/cap.2007.151] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Identifying neurochemical alterations in adolescent bipolar depression may enhance our understanding of the neurophysiology of bipolar disorder across the age spectrum. The objective of this study was to compare in vivo neurometabolite concentrations in bipolar adolescents with a depressed episode and healthy adolescents using proton magnetic resonance spectroscopy ((1)H MRS). METHOD Bipolar adolescents with a depressed episode (n = 28) and healthy adolescents (n = 10) underwent a (1)H MRS scan. Anterior cingulate (ACC) and left and right ventral lateral prefrontal (LVLPFC, RVLPFC) metabolite concentrations were calculated and compared between groups using analysis of covariance (ANCOVA). RESULTS ANCOVA showed significant group differences in ACC N-acetyl-aspartate (NAA) (F(1,33) = 17.8, p = 0.0002), LVLPFC choline (Cho) (F(1,32) = 13.1, p = 0.001), creatine/phosphocreatine (Cr) (F(1,32) = 18.5, p = 0.0002), and NAA (F(1,32) = 13.6, p = 0.0008), and RVLPFC Cr (F(1,32) = 9.6, p = 0.004), mI (F(1,32) = 11.1, p = 0.002), and NAA (F(1,32) = 11.4, p = 0.002) concentrations. In general, the bipolar depressed group had higher neurometabolite concentrations than the healthy group. CONCLUSIONS There may be localized alterations in brain neurometabolites in adolescents with bipolar depression. Limitations include lack of bipolar adolescents in other mood states and potential confounding effects of prior psychotropic medication use. Confirmatory (1)H MRS studies in larger samples of youths with bipolar depression are needed.
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Affiliation(s)
- Nick C. Patel
- LifeSynch, Fort Worth, Texas.,Department of Psychiatry & Health Behavior, Medical College of Georgia, Augusta, Georgia
| | - Kim M. Cecil
- Imaging Research Center of the Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephen M. Strakowski
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Caleb M. Adler
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Melissa P. DelBello
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Proton magnetic resonance spectroscopy in youth with severe mood dysregulation. Psychiatry Res 2008; 163:30-9. [PMID: 18403184 DOI: 10.1016/j.pscychresns.2007.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 09/11/2007] [Accepted: 11/19/2007] [Indexed: 12/18/2022]
Abstract
Increasing numbers of youth are presenting for psychiatric evaluation with markedly irritable mood plus "hyperarousal" symptoms. Diagnostically homeless in current nosology, the syndrome (as well as its underlying neurobiology) is little understood. To address this problem, we conducted an exploratory proton magnetic resonance spectroscopy (MRS) study in a large sample of youth with chronic, functionally disabling irritability accompanied by hyperarousal, a clinical syndrome known as "severe mood dysregulation" (SMD), which may represent a broad phenotype of pediatric bipolar disorder. Medication-free SMD youth (N=36) and controls (N=48) underwent 1.5 Tesla MRS in four regions of interest. The following three neurometabolites, relative to creatine (Cr), were quantified with LCModel Software: (a) myo-inositol (mI), a marker of intra-cellular second messengers linked to the neurobiology of bipolar disorder; (b) glutamate/glutamine (GLX), a marker of the major excitatory neurotransmitter glutamate; and (c) N-acetyl aspartate (NAA), a marker of neuronal energetics. SMD subjects had significantly lower temporal mI/Cr versus controls. However, this difference did not survive correction for multiple comparisons. Given studies implicating mI in lithium's action in BD adults and youth, further work is necessary to determine potential therapeutic implications of our present finding and how SMD youth differ pathophysiologically from those with strictly defined BD.
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Assessing the role of cingulate cortex in bipolar disorder: neuropathological, structural and functional imaging data. ACTA ACUST UNITED AC 2008; 59:9-21. [PMID: 18539335 DOI: 10.1016/j.brainresrev.2008.04.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 04/05/2008] [Accepted: 04/08/2008] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Most of the neuroanatomical models of bipolar disorder (BD) propose a key role for the anterior cingulate cortex (ACC). We provide here a review of currently available data regarding the CC neuroimaging and neuropathological alterations in BD. MATERIALS AND METHODS After an exploratory search of the MEDLINE, we first identified all English-written articles that provide separate data for BD patients and report original experimental data on cingulate gyrus. Subsequently, we selected those including neuroimaging or neuropathological data. Among the 161 articles updated through June 2007, 81 articles were retained using this procedure. RESULTS The review of in vivo volumetric imaging data, as well as ex vivo morphometric and histological studies indicates that BD patients show volume changes of the subgenual ACC (sgACC-BA 25 and part of 24) during the early stages of the disease. Whether this phenomenon is due to neuronal and glial depletion or damage of corticocortical connections is still a matter of debate. The resting state activity in the left BA 25 appears to be state dependent showing significant increase during mania and decrease during depressive phases. The presence of a deficient GABAergic activity in ACC is also documented. Pharmacological treatment partly restores BD-related functional imaging changes. CONCLUSION The present review reveals the striking discrepancies of the experimental results present both for functional and structural imaging studies but also for neuropathological analyses. Methodological and conceptual limitations are addressed with particular reference to the heterogeneity of BD clinical patterns. We also critically discuss the validity of CC changes as possible trait- or state-markers of the disease.
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Abstract
In the past decade, interest in and research on pediatric bipolar disorder (BD) has increased substantially. Prevalence rates of the disorder have doubled in outpatient settings, while twice as many research articles on pediatric BD were published in the past five years as in the prior decade. This review focuses on recent developments in the study of pediatric BD. We examine current research on the diagnostic boundaries of BD in youths, in particular the issues of episodicity and irritability, and provide assessment guidelines. We review data elucidating the pathophysiology of pediatric BD, with a focus on how these results may inform diagnosis. Finally, we discuss treatment approaches for pediatric BD, particularly psychotherapeutic interventions. Throughout the review, we pay particular attention to youths with severe chronic irritability, hyperarousal, and hyperreactivity, who reflect the population in whom the diagnosis of BD is most debated.
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Affiliation(s)
- Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda MD, USA.
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Capizzano AA, Jorge RE, Acion LC, Robinson RG. In vivo proton magnetic resonance spectroscopy in patients with mood disorders: a technically oriented review. J Magn Reson Imaging 2008; 26:1378-89. [PMID: 17968885 DOI: 10.1002/jmri.21144] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Proton MR spectroscopy (1HMRS) has been extensively used among mood disorders patients. A review of the published literature in 1HMRS studies of mood disorders was carried out for the period 1991 to July 2006. Of 71 1HMRS studies, 77.5% were done at 1.5T and 66.2% used single voxel sequences (SVS), implying limitations of spectral resolution and anatomic coverage, respectively. In all, 47.9% of studies relied on creatine (Cr) as internal signal standard, although Cr changes were reported in major depression (MD). Most reported metabolic alterations related to mood state affected the left frontal lobe. Depressed adult and pediatric MD patients had reduced glutamate (Glu) in frontal lobe regions, which reversed with successful treatment. A consistent reduction of N-acetyl-aspartate (NAA) was reported in the hippocampal formation among bipolar disorder (BD) patients, along with an increment in frontal Glu. The differences in results of 1HMRS studies in mood disorders reflect heterogeneity of technical factors and subject selection. Future studies should benefit from higher spectral resolution and more extensive anatomic coverage as well as standardized data-processing protocols and subject selection criteria.
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Affiliation(s)
- Aristides A Capizzano
- Psychiatry Department, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
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Wang JF. Defects of mitochondrial electron transport chain in bipolar disorder: implications for mood-stabilizing treatment. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2007; 52:753-62. [PMID: 18186175 DOI: 10.1177/070674370705201202] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Converging lines of evidence indicate that defects in the mitochondrial electron transport chain (ETC) are associated with bipolar disorder (BD), and that mood-stabilizing drugs produce neuroprotective effects. Our objective is to review the most recent findings regarding this research. METHOD We searched MEDLINE and have reviewed here the most recently published articles. RESULTS There are deletions, mutation, and decreased expression of mitochondrial ETC complexes in BD. Because ETC is a major source of reactive oxygen species, these factors, along with decreased expression of antioxidant enzymes in BD, suggest the presence of oxidative damage in this disorder. Numerous recent studies have shown that mood-stabilizing drugs produce neuroprotective effects against oxidative damage and increase expression and activities of endogenous antioxidant enzymes in the rat brain. CONCLUSION These findings indicate that the process of oxidative damage could be a significant therapeutic target for the treatment of BD with mood-stabilizing drugs.
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Affiliation(s)
- Jun-Feng Wang
- Department of Psychiatry, University of British Columbia, Vancouver.
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Abstract
Children and adolescents with a bipolar disorder experience mood dysregulation that is often chronic with little interepisodic recovery. Although bipolar disorder in youth is recognized by more and more clinicians, much is still not known regarding how best to accurately diagnose and effectively treat it. As a result, children and adolescents with bipolar disorder are often symptomatic for long periods of time before receiving appropriate treatment. In this review of the pediatric bipolar disorder literature, the phenomenology, longitudinal course, and risk factors associated with the illness' development are discussed. Also, recent research pertaining to neuroimaging and pharmacologic and psychological treatments are considered. Because pediatric bipolar disorder is such a pernicious condition, it is recommended that clinicians complete a careful assessment of mood symptoms and comorbid conditions when this illness is suspected so that they can provide treatments with the best chance of benefit in a timely manner.
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Malhi GS, Ivanovski B, Wen W, Lagopoulos J, Moss K, Sachdev P. Measuring mania metabolites: a longitudinal proton spectroscopy study of hypomania. Acta Psychiatr Scand 2007:57-66. [PMID: 17688464 DOI: 10.1111/j.1600-0447.2007.01060.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Using single-voxel proton spectroscopy we aimed to investigate changes in metabolite levels in key brain regions during hypomania and euthymia in patients with bipolar disorder (BD). METHOD Nine patients with a diagnosis of BD and nine age, sex, education, and handedness-matched comparison subjects underwent magnetic resonance proton spectroscopy (H(1)-MRS) using a 1.5 T magnet. Patients were assessed whilst hypomanic and euthymic. Metabolite (N-acetyl asparTate, NAA; myo-inositol, mI; choline, Cho) levels in the basal ganglia (BG), anterior cingulate cortex (AC), and frontal cortex (FC) were compared both between groups and within the patient group. RESULTS Multivariate analysis revealed significant complex relationships between metabolite levels and brain regions with significant differences observed both between bipolar patients (hypomanic and euthymic) and controls, and across the two mood states. Hypomanic patients had lower mean metabolite levels when averaged across the AC and FC regions, compared with the controls. They also had a smaller difference in mean metabolite levels between the BG and FC than the control group. Euthymic patients were also found to have a smaller difference in the level of NAA between the BG and AC than the control group. CONCLUSION This exploratory study of BD demonstrates significant differences in metabolite levels that vary both with respect to brain region and mood state. Not withstanding the confounding effects of medication and the limitation of small sample size the findings are important as they demonstrate that a longitudinal approach is a useful design especially in the context of a long-term phasic illness.
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Affiliation(s)
- G S Malhi
- Department of Psychological Medicine, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.
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Olvera RL, Caetano SC, Fonseca M, Nicoletti M, Stanley JA, Chen HH, Hatch JP, Hunter K, Pliszka SR, Soares JC. Low levels of N-acetyl aspartate in the left dorsolateral prefrontal cortex of pediatric bipolar patients. J Child Adolesc Psychopharmacol 2007; 17:461-73. [PMID: 17822341 DOI: 10.1089/cap.2007.0102] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Increasing evidence suggests abnormalities in the structure, function, and neurochemistry of the frontal cortex in pediatric bipolar (BP) patients. We conducted a single-voxel proton magnetic resonance spectroscopy ((1)H MRS) of the left dorsolateral prefrontal cortex (DLPFC) of pediatric BP patients, expecting lower N-acetyl-aspartate (NAA) levels within that brain region compared to healthy comparison subjects. METHODS We studied 35 pediatric BP (23 BP type I, 12 BP type II; mean age +/- SD = 13.2 +/- 2.9 years; 18 females) and 36 healthy controls (mean age +/- SD = 13.7 +/- 2.6 years, 17 females). A short echo time, single-voxel (1)H spectroscopy approach point-resolved spectroscopy (PRESS) sequence, measurements of metabolites was performed on a 1.5T Philips MR system. RESULTS BP subjects had significantly lower NAA levels in the left DLPFC compared to healthy controls (F = 4.21, df = 1, 68, p = 0.04). There was not a significant difference between groups for phosphocreatine + creatine (PCr+Cr), glycerolphosphocholine + phosphocholine (GPC + PC), myo-inositol (mI), or glutamate. Further analyses revealed a significant reduction of NAA in our early puberty group compared to controls (Mann-Whitney U-test statistic = 52.00, p = 0.014), but not for BP versus controls in other pubertal groups. CONCLUSIONS BP subjects have lower NAA levels in the left DLPFC compared to healthy subjects, suggesting neuronal dysfunction in this region.
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Affiliation(s)
- Rene L Olvera
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Moore CM, Frazier JA, Glod CA, Breeze JL, Dieterich M, Finn CT, Frederick BD, Renshaw PF. Glutamine and glutamate levels in children and adolescents with bipolar disorder: a 4.0-T proton magnetic resonance spectroscopy study of the anterior cingulate cortex. J Am Acad Child Adolesc Psychiatry 2007; 46:524-34. [PMID: 17420688 PMCID: PMC4090056 DOI: 10.1097/chi.0b013e31802f5f2c] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of this study was to use proton magnetic resonance spectroscopy, at 4.0 T, to explore the glutamine and glutamate levels in the anterior cingulate cortex of children and adolescents with bipolar disorder (BPD; medicated and unmedicated) and healthy comparison subjects (HCSs). We hypothesized that unmedicated children with BPD would have reduced glutamine and glutamate levels compared with HCSs and medicated children with BPD. METHOD Spectra were acquired from the anterior cingulate cortex in 22 children and adolescents with DSM-IV-TR BPD, type 1 (13 female: age 12.6 +/- 4.4 years: 7 of the subjects with BPD were unmedicated at the time of the scan) and 10 HCSs (7 female: age 12.3 +/- 2.5 years). RESULTS Unmedicated subjects with BPD had significantly lower glutamine levels than HCSs or medicated subjects with BPD. There were no differences in glutamate levels between the three groups. CONCLUSIONS These results are consistent with there being an abnormality in anterior cingulate cortex glia in untreated children and adolescents with BPD. The results of this pilot study may be important in helping us better understand the pathophysiology of child and adolescent BPD. In addition, this observation may help to develop better and more targeted treatments, in particular those affecting the metabolism of glutamine, perhaps by regulation of glutamine synthetase activity.
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Dickstein DP, Nelson EE, McCLURE EB, Grimley ME, Knopf L, Brotman MA, Rich BA, Pine DS, Leibenluft E. Cognitive flexibility in phenotypes of pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 2007; 46:341-355. [PMID: 17314720 DOI: 10.1097/chi.0b013e31802d0b3d] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Clinicians and researchers debate whether children with chronic, nonepisodic irritability should receive the diagnosis of bipolar disorder (BD). To address this debate, we evaluated cognitive flexibility, or the ability to adapt to changing contingencies, in three groups of children: narrow-phenotype BD (NP-BD; full-duration manic episodes of elevated/expansive mood; N = 50; 13.1 +/- 2.9 years), severe mood dysregulation (SMD; chronic, nonepisodic irritability; N = 44; 12.2 +/- 2.1 years), and healthy controls (N = 43; 13.6 +/- 2.4 years). Cognitive flexibility is relevant to symptoms of BD involving dysfunctional reward systems (e.g., excessive goal-directed activity and pleasure-seeking in mania; anhedonia in depression). METHOD We studied simple and compound reversal stages of the intra-/extradimensional shift task and change task that involves inhibiting a prepotent response and substituting a novel response. RESULTS On the simple reversal, NP-BD youths were significantly more impaired than both the SMD group and controls. On the compound reversal, NP-BD and SMD youths performed worse than controls. On the change task, NP-BD youths were slower to adapt than SMD subjects. CONCLUSIONS Phenotypic differences in cognitive flexibility may reflect different brain/behavior mechanisms in these two patient populations.
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Affiliation(s)
- Daniel P Dickstein
- All authors were affiliated with the National Institute of Mental Health (NIMH) Division of Intramural Research Program when this work was prepared; Dr. McClure is currently with the Department of Psychology, Georgia State University.
| | - Eric E Nelson
- All authors were affiliated with the National Institute of Mental Health (NIMH) Division of Intramural Research Program when this work was prepared; Dr. McClure is currently with the Department of Psychology, Georgia State University
| | - Erin B McCLURE
- All authors were affiliated with the National Institute of Mental Health (NIMH) Division of Intramural Research Program when this work was prepared; Dr. McClure is currently with the Department of Psychology, Georgia State University
| | - Mary E Grimley
- All authors were affiliated with the National Institute of Mental Health (NIMH) Division of Intramural Research Program when this work was prepared; Dr. McClure is currently with the Department of Psychology, Georgia State University
| | - Lisa Knopf
- All authors were affiliated with the National Institute of Mental Health (NIMH) Division of Intramural Research Program when this work was prepared; Dr. McClure is currently with the Department of Psychology, Georgia State University
| | - Melissa A Brotman
- All authors were affiliated with the National Institute of Mental Health (NIMH) Division of Intramural Research Program when this work was prepared; Dr. McClure is currently with the Department of Psychology, Georgia State University
| | - Brendan A Rich
- All authors were affiliated with the National Institute of Mental Health (NIMH) Division of Intramural Research Program when this work was prepared; Dr. McClure is currently with the Department of Psychology, Georgia State University
| | - Daniel S Pine
- All authors were affiliated with the National Institute of Mental Health (NIMH) Division of Intramural Research Program when this work was prepared; Dr. McClure is currently with the Department of Psychology, Georgia State University
| | - Ellen Leibenluft
- All authors were affiliated with the National Institute of Mental Health (NIMH) Division of Intramural Research Program when this work was prepared; Dr. McClure is currently with the Department of Psychology, Georgia State University
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Pavuluri MN, Henry DB, Nadimpalli SS, O'Connor MM, Sweeney JA. Biological risk factors in pediatric bipolar disorder. Biol Psychiatry 2006; 60:936-41. [PMID: 16806102 DOI: 10.1016/j.biopsych.2006.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Revised: 02/28/2006] [Accepted: 04/07/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND The current study attempted to determine whether neurodevelopmental and acquired brain abnormalities are more common in pediatric bipolar disorder (PBD). METHODS The study sample consisted of 98 subjects with a mean age of 11.5 +/- 3.3 years comprising three demographically matched groups: healthy controls (HC, n = 28), subjects with bipolar disorder - Type I (PBD, n = 37), and bipolar disorder - Type I combined with attention deficit hyperactivity disorder (PBD+ADHD, n = 33). Family history of PBD was determined using the Family History Screen. Additional measures were administered to assess the history on perinatal risk, development milestones, serious physical illnesses, and head injury. RESULTS Logistic regression showed that that family history and perinatal risk factors predicted the diagnosis of PBD. PBD diagnosis was 15 times higher among those with a family history of BD. Second, for every additional perinatal risk factor such as prenatal exposure to drugs or birth complications, the risk of having a PBD diagnosis increased more than six-fold. CONCLUSIONS Having a positive familial history of BD in a first degree relative and perinatal insults may elevate the risk for developing PBD. Presence of these risk factors, especially in the context of clinical signs of affect dysregulation, should alert clinicians to screen for PBD.
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Affiliation(s)
- Mani N Pavuluri
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA.
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