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Sajatovic M, Rej S, Almeida OP, Altinbas K, Balanzá-Martínez V, Barbosa IG, Beunders AJM, Blumberg HP, Briggs FBS, Dols A, Forester BP, Forlenza OV, Gildengers AG, Jimenez E, Klaus F, Lafer B, Mulsant B, Mwangi B, Nunes PV, Olagunju AT, Oluwaniyi S, Orhan M, Patrick RE, Radua J, Rajji T, Sarna K, Schouws S, Simhandl C, Sekhon H, Soares JC, Sutherland AN, Teixeira AL, Tsai S, Vidal-Rubio S, Vieta E, Yala J, Eyler LT. Bipolar symptoms, somatic burden and functioning in older-age bipolar disorder: A replication study from the global aging & geriatric experiments in bipolar disorder database (GAGE-BD) project. Int J Geriatr Psychiatry 2024; 39:e6057. [PMID: 38511929 DOI: 10.1002/gps.6057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/10/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES The Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) project pools archival datasets on older age bipolar disorder (OABD). An initial Wave 1 (W1; n = 1369) analysis found both manic and depressive symptoms reduced among older patients. To replicate this finding, we gathered an independent Wave 2 (W2; n = 1232, mean ± standard deviation age 47.2 ± 13.5, 65% women, 49% aged over 50) dataset. DESIGN/METHODS Using mixed models with random effects for cohort, we examined associations between BD symptoms, somatic burden and age and the contribution of these to functioning in W2 and the combined W1 + W2 sample (n = 2601). RESULTS Compared to W1, the W2 sample was younger (p < 0.001), less educated (p < 0.001), more symptomatic (p < 0.001), lower functioning (p < 0.001) and had fewer somatic conditions (p < 0.001). In the full W2, older individuals had reduced manic symptom severity, but age was not associated with depression severity. Age was not associated with functioning in W2. More severe BD symptoms (mania p ≤ 0.001, depression p ≤ 0.001) were associated with worse functioning. Older age was significantly associated with higher somatic burden in the W2 and the W1 + W2 samples, but this burden was not associated with poorer functioning. CONCLUSIONS In a large, independent sample, older age was associated with less severe mania and more somatic burden (consistent with previous findings), but there was no association of depression with age (different from previous findings). Similar to previous findings, worse BD symptom severity was associated with worse functioning, emphasizing the need for symptom relief in OABD to promote better functioning.
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Affiliation(s)
- Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Soham Rej
- Jewish General Hospital/Lady Davis Hospital, McGill University, Montreal, Québec, Canada
| | - Osvaldo P Almeida
- University of Western Australia, Perth, Western Australia, Australia
| | - Kursat Altinbas
- Selçuk University Medical Faculty, Department of Psychiatry, Mazhar Osman Mood Clinic, Konya, Turkey
| | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
| | - Izabela G Barbosa
- Mental Health Department, Medicine School, Minas Gerais University, Belo Horizonte, Brazil
| | - Alexandra J M Beunders
- GGZ inGeest, Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farren B S Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Annemiek Dols
- Amsterdam UMC, VU University, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ariel G Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, ISCIII Barcelona, Barcelona, Catalonia, Spain
| | - Federica Klaus
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Beny Lafer
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Benoit Mulsant
- Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Benson Mwangi
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Houston, Houston, Texas, USA
| | - Paula Villela Nunes
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | | | - Melis Orhan
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Regan E Patrick
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Tarek Rajji
- Department of Psychiatry, Toronto Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada
| | - Kaylee Sarna
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Sigfried Schouws
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands
| | - Christian Simhandl
- Medical Faculty, Bipolar Center Wiener Neustadt, Sigmund Freud University Vienna, Wien, Austria
| | - Harmehr Sekhon
- Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, University of Texas/McGovern Medical School, Houston, Texas, USA
| | - Ashley N Sutherland
- Department of Psychiatry, University of California, San Diego, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
| | - Antonio L Teixeira
- Department of Psychiatry and Behavioral Sciences, University of Texas/McGovern Medical School, Houston, Texas, USA
- Faculdade Santa Casa BH, Belo Horizonte, Brazil
| | - Shangying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, ISCIII Barcelona, Barcelona, Catalonia, Spain
| | - Joy Yala
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California, San Diego, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
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Blanken MAJT, Oudega ML, Almeida OP, Schouws SNTM, Orhan M, Beunders AJM, Klumpers UMH, Sonnenberg C, Blumberg HP, Eyler LT, Forester BP, Forlenza OV, Gildengers A, Mulsant BH, Rajji T, Rej S, Sarna K, Sutherland A, Yala J, Vieta E, Tsai S, Briggs FBS, Sajatovic M, Dols A. Sex Differences Among Older Adults With Bipolar Disorder: Results From the Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) Project. Am J Geriatr Psychiatry 2024; 32:326-338. [PMID: 37981507 DOI: 10.1016/j.jagp.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Sex-specific research in adult bipolar disorder (BD) is sparse and even more so among those with older age bipolar disorder (OABD). Knowledge about sex differences across the bipolar lifespan is urgently needed to target and improve treatment. To address this gap, the current study examined sex differences in the domains of clinical presentation, general functioning, and mood symptoms among individuals with OABD. METHODS This Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) study used data from 19 international studies including BD patients aged ≥50 years (N = 1,185: 645 women, 540 men).A comparison of mood symptoms between women and men was conducted initially using two-tailed t tests and then accounting for systematic differences between the contributing cohorts by performing generalized linear mixed models (GLMMs). Associations between sex and other clinical characteristics were examined using GLMM including: age, BD subtype, rapid cycling, psychiatric hospitalization, lifetime psychiatric comorbidity, and physical health comorbidity, with study cohort as a random intercept. RESULTS Regarding depressive mood symptoms, women had higher scores on anxiety and hypochondriasis items. Female sex was associated with more psychiatric hospitalizations and male sex with lifetime substance abuse disorders. CONCLUSION Our findings show important clinical sex differences and provide support that older age women experience a more severe course of BD, with higher rates of psychiatric hospitalization. The reasons for this may be biological, psychological, or social. These differences as well as underlying mechanisms should be a focus for healthcare professionals and need to be studied further.
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Affiliation(s)
- Machteld A J T Blanken
- Department of Psychiatry (MAJTB, UMHJ, AD), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam, The Netherlands
| | - Mardien L Oudega
- Department of Psychiatry (MLO), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam Public Health, Mental Health Program, GGZ inGeest, Specialized Mental Health Care, Amsterdam, The Netherlands.
| | - Osvaldo P Almeida
- Medical School (OPA), University of Western Australia, Perth, Australia
| | - Sigfried N T M Schouws
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry (SNTMS, AJMB), Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Melis Orhan
- Department of Clinical Psychology (MO), Leiden University, Leiden, The Netherlands
| | - Alexandra J M Beunders
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry (SNTMS, AJMB), Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Ursula M H Klumpers
- Department of Psychiatry (MAJTB, UMHJ, AD), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam, The Netherlands
| | - Caroline Sonnenberg
- GGZ Parnassia NH, Specialized Mental Health Care (CS), Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
| | - Hilary P Blumberg
- Department of Psychiatry (HPB), Yale School of Medicine, New Haven, CT
| | - Lisa T Eyler
- Department of Psychiatry (LTE), University of California San Diego, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA
| | - Brent P Forester
- Division of Geriatric Psychiatry (BPF), McLean Hospital, Harvard Medical School, Boston, MA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry (OVF), HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ariel Gildengers
- Department of Psychiatry (AG), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Benoit H Mulsant
- Department of Psychiatry (BHM) and Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Tarek Rajji
- Adult Neurodevelopment and Geriatric Psychiatry Division (TR), Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Soham Rej
- Lady Davis Institute/Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - Kaylee Sarna
- Case Western Reserve University School of Medicine (KS), Cleveland, OH
| | - Ashley Sutherland
- Department of Psychiatry (AS), University of California San Diego, San Diego, CA
| | - Joy Yala
- Case Western Reserve University School of Medicine (JY), Cleveland, OH
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit (EV), Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Shangying Tsai
- Department of Psychiatry (ST), School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Farren B S Briggs
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine (MS), University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Annemiek Dols
- Department of Psychiatry (MAJTB, UMHJ, AD), Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep & Stress Program, Amsterdam, The Netherlands; Department of Psychiatry (AD), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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3
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Chen P, Sajatovic M, Briggs FBS, Mulsant B, Dols AA, Gildengers A, Yala J, Beunders AJM, Blumberg HP, Rej S, Forlenza OV, Jimenez E, Schouws S, Orhan M, Sutherland AN, Vieta E, Tsai S, Sarna K, Eyler LT. Sociodemographic and clinical characteristics of people with oldest older age bipolar disorder in a global sample: Results from the global aging and geriatric experiments in bipolar disorder project. Int J Geriatr Psychiatry 2024; 39:e6073. [PMID: 38393311 DOI: 10.1002/gps.6073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
OBJECTS Studies of older age bipolar disorder (OABD) have mostly focused on "younger old" individuals. Little is known about the oldest OABD (OOABD) individuals aged ≥70 years old. The Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) project provides an opportunity to evaluate the OOABD group to understand their characteristics compared to younger groups. METHODS We conducted cross-sectional analyses of the GAGE-BD database, an integrated, harmonized dataset from 19 international studies. We compared the sociodemographic and clinical characteristics of those aged <50 (YABD, n = 184), 50-69 (OABD, n = 881), and ≥70 (OOABD, n = 304). To standardize the comparisons between age categories and all characteristics, we used multinomial logistic regression models with age category as the dependent variable, with each characteristic as the independent variable, and clustering of standard errors to account for the correlation between observations from each of the studies. RESULTS OOABD and OABD had lower severity of manic symptoms (Mean YMRS = 3.3, 3.8 respectively) than YABD (YMRS = 7.6), and lower depressive symptoms (% of absent = 65.4%, and 59.5% respectively) than YABD (18.3%). OOABD and OABD had higher physical burden than YABD, especially in the cardiovascular domain (prevalence = 65% in OOABD, 41% in OABD and 17% in YABD); OOABD had the highest prevalence (56%) in the musculoskeletal domain (significantly differed from 39% in OABD and 31% in YABD which didn't differ from each other). Overall, OOABD had significant cumulative physical burden in numbers of domains (mean = 4) compared to both OABD (mean = 2) and YABD (mean = 1). OOABD had the lowest rates of suicidal thoughts (10%), which significantly differed from YABD (26%) though didn't differ from OABD (21%). Functional status was higher in both OOABD (GAF = 63) and OABD (GAF = 64), though only OABD had significantly higher function than YABD (GAF = 59). CONCLUSIONS OOABD have unique features, suggesting that (1) OOABD individuals may be easier to manage psychiatrically, but require more attention to comorbid physical conditions; (2) OOABD is a survivor cohort associated with resilience despite high medical burden, warranting both qualitative and quantitative methods to better understand how to advance clinical care and ways to age successfully with BD.
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Affiliation(s)
- Peijun Chen
- Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | - Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Farren B S Briggs
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Benoit Mulsant
- Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Annemiek A Dols
- GGZ inGeest, Amsterdam, the Netherlands
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joy Yala
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Alexandra J M Beunders
- GGZ inGeest, Amsterdam, the Netherlands
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Soham Rej
- Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada
| | - Orestes V Forlenza
- Department and Institute of Psychiatry, Laboratory of Neuroscience (LIM-27), HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
- Department of Psychiatry, Hospital Universitario de Alava, BIOARABA, UPV/EHU, CIBERSAM, Vitoria, Spain
| | - Sigfried Schouws
- GGZ inGeest, Amsterdam, the Netherlands
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands
| | - Melis Orhan
- Department of Clinical Psychology, Leiden University, Leiden, the Netherlands
| | - Ashley N Sutherland
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Shangying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kaylee Sarna
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
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4
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Mallu A, Chan CK, Eyler LT, Dols A, Rej S, Blumberg HP, Sarna K, Forester BP, Patrick RE, Forlenza OV, Jimenez E, Vieta E, Schouws S, Sutherland A, Yala J, Briggs FBS, Sajatovic M. Demographic and clinical associations to employment status in older-age bipolar disorder: Analysis from the GAGE-BD database project. Bipolar Disord 2023; 25:637-647. [PMID: 37798096 PMCID: PMC10843228 DOI: 10.1111/bdi.13381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE The current literature on employment in older adults with bipolar disorder (OABD) is limited. Using the Global Aging and Geriatric Experiments in Bipolar Disorder Database (GAGE-BD), we examined the relationship of occupational status in OABD to other demographic and clinical characteristics. METHODS Seven hundred and thirty-eight participants from 11 international samples with data on educational level and occupational status were included. Employment status was dichotomized as employed versus unemployed. Generalized linear mixed models with random intercepts for the study cohort were used to examine the relationship between baseline characteristics and employment. Predictors in the models included baseline demographics, education, psychiatric symptom severity, psychiatric comorbidity, somatic comorbidity, and prior psychiatric hospitalizations. RESULTS In the sample, 23.6% (n = 174) were employed, while 76.4% were unemployed (n = 564). In multivariable logistic regression models, less education, older age, a history of both anxiety and substance/alcohol use disorders, more prior psychiatric hospitalizations, and higher levels of BD depression severity were associated with greater odds of unemployment. In the subsample of individuals less than 65 years of age, findings were similar. No significant association between manic symptoms, gender, age of onset, or employment status was observed. CONCLUSION Results suggest an association between educational level, age, psychiatric severity and comorbidity in relation to employment in OABD. Implications include the need for management of psychiatric symptoms and comorbidity across the lifespan, as well as improving educational access for people with BD and skills training or other support for those with work-life breaks to re-enter employment and optimize the overall outcome.
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Affiliation(s)
- Amulya Mallu
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Carol K Chan
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
| | - Annemiek Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location VU Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Soham Rej
- Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kaylee Sarna
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Brent P Forester
- McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Regan E Patrick
- McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, ISCIII, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, ISCIII, Barcelona, Catalonia, Spain
| | - Sigfried Schouws
- GGZ inGeest, Amsterdam UMC, location VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ashley Sutherland
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Joy Yala
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Farren B S Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
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5
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Lavin P, Rej S, Olagunju AT, Teixeira AL, Dols A, Alda M, Almeida OP, Altinbas K, Balanzá-Martínez V, Barbosa IG, Blumberg HP, Briggs F, Calkin C, Cassidy K, Forester BP, Forlenza OV, Hajek T, Haarman BCM, Jimenez E, Lafer B, Mulsant B, Oluwaniyi SO, Patrick R, Radua J, Schouws S, Sekhon H, Simhandl C, Soares JC, Tsai SY, Vieta E, Villa LM, Sajatovic M, Eyler LT. Essential data dimensions for prospective international data collection in older age bipolar disorder (OABD): Recommendations from the GAGE-BD group. Bipolar Disord 2023; 25:554-563. [PMID: 36843436 DOI: 10.1111/bdi.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
BACKGROUND By 2030, over 50% of individuals living with bipolar disorder (BD) are expected to be aged ≥50 years. However, older age bipolar disorder (OABD) remains understudied. There are limited large-scale prospectively collected data organized in key dimensions capable of addressing several fundamental questions about BD affecting this subgroup of patients. METHODS We developed initial recommendations for the essential dimensions for OABD data collection, based on (1) a systematic review of measures used in OABD studies, (2) a Delphi consensus of international OABD experts, (3) experience with harmonizing OABD data in the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD, n ≥ 4500 participants), and (4) critical feedback from 34 global experts in geriatric mental health. RESULTS We identified 15 key dimensions and variables within each that are relevant for the investigation of OABD: (1) demographics, (2) core symptoms of depression and (3) mania, (4) cognition screening and subjective cognitive function, (5) elements for BD diagnosis, (6) descriptors of course of illness, (7) treatment, (8) suicidality, (9) current medication, (10) psychiatric comorbidity, (11) psychotic symptoms, (12) general medical comorbidities, (13) functioning, (14) family history, and (15) other. We also recommend particular instruments for capturing some of the dimensions and variables. CONCLUSION The essential data dimensions we present should be of use to guide future international data collection in OABD and clinical practice. In the longer term, we aim to establish a prospective consortium using this core set of dimensions and associated variables to answer research questions relevant to OABD.
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Affiliation(s)
- Paola Lavin
- Department of Geriatric Psychiatry, Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada
| | - Soham Rej
- Department of Geriatric Psychiatry, Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Antonio L Teixeira
- Department of Psychiatry and Behavioral Sciences, University of Texas/McGovern Medical School, Houston, Texas, USA
| | - Annemieke Dols
- Department of Old Age Psychiatry, GGZ inGeest, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Osvaldo P Almeida
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Kursat Altinbas
- Selçuk University Medical Faculty, Department of Psychiatry, Mazhar Osman Mood Clinic, Konya, Turkey
| | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
| | - Izabela G Barbosa
- Laboratório Interdisciplinar de Investigação Médica da Faculdad de Medicina, Universidad Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farren Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Cynthia Calkin
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kristin Cassidy
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdad de Medicina da Universidad de São Paulo, São Paulo, Brazil
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Barthomeus C M Haarman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Beny Lafer
- Department of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Benoit Mulsant
- Department of Psychiatry, University of Toronto, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Regan Patrick
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
| | - Joaquim Radua
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Solna, Sweden
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Sigfried Schouws
- Department of Old Age Psychiatry, GGZ inGeest, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Harmehr Sekhon
- Department of Geriatric Psychiatry, Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Simhandl
- Medical Faculty, Bipolar Center Wiener Neustadt, Sigmund Freud University, Wien, Austria
| | - Jair C Soares
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Houston, Texas, USA
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Luca M Villa
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Martha Sajatovic
- Departments of Psychiatry and of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
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6
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Conceição ASGG, Sant Ana LFG, Mattar GP, de Fátima R Silva M, Ramos AR, Oliveira AM, Carvalho CL, Gonçalves OR, Varotto BLR, Martinez LD, Leduc V, Fonseca LM, Forlenza OV. Balance and Gait: Associations With Cognitive Impairment and Dementia in Individuals With Down Syndrome. Alzheimer Dis Assoc Disord 2023; 37:349-356. [PMID: 37788381 DOI: 10.1097/wad.0000000000000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 08/14/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Atypical aging in Down syndrome (DS) is associated with neuropathological characteristics consistent with Alzheimer disease. Gait abnormalities have been shown to be associated with an increased risk of dementia for the general population. The aim of this study was to determine whether gait disorders are associated with worse cognitive performance and dementia in adults with DS. METHODS We evaluated 66 individuals with DS (≥20 y of age), divided into 3 groups: stable cognition, prodromal dementia, and dementia (presumed Alzheimer disease). Each individual was evaluated with the Performance-Oriented Mobility Assessment (POMA), Timed Up and Go test, and Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX-DS), in addition to a comprehensive clinical protocol to ascertain the occurrence of medical or psychiatric comorbidities. RESULTS The score on the POMA-Gait subscale score and body mass index were found to be independent predictors of prodromal dementia and dementia ( P <0.001 for both). With the exception of perception, all cognitive domains correlated with the POMA-Total score ( P <0.05). CONCLUSION A lower POMA-Gait score increases the chance of prodromal dementia and dementia in adults with DS. Unlike other research, in this study higher body mass index was also found to increase the chance of prodromal dementia and dementia. In those individuals, applying the POMA could facilitate the early diagnosis of dementia, help identify fall risks, and promote the adoption of geriatric interventions focused on improving functional mobility.
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Affiliation(s)
| | - Lívea F G Sant Ana
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry
| | - Guilherme P Mattar
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry
| | - Maria de Fátima R Silva
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry
- Old Age Research Group, Department and Institute of Psychiatry
| | - Andressa R Ramos
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry
| | | | - Claudia L Carvalho
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry
| | | | - Bruna L R Varotto
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry
| | - Luana D Martinez
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry
| | - Vinícius Leduc
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry
| | - Luciana M Fonseca
- Dental Team, Instituto de Psiquiatria do, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, Brazil
- Department of Community and Behavioral Health, Washington State University, Pullman, WA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry
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7
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Damiano RF, Rocca CCDA, Serafim ADP, Loftis JM, Talib LL, Pan PM, Cunha-Neto E, Kalil J, de Castro GS, Seelaender M, Guedes BF, Nagahashi Marie SK, de Souza HP, Nitrini R, Miguel EC, Busatto G, Forlenza OV. Cognitive impairment in long-COVID and its association with persistent dysregulation in inflammatory markers. Front Immunol 2023; 14:1174020. [PMID: 37287969 PMCID: PMC10242059 DOI: 10.3389/fimmu.2023.1174020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
Objective To analyze the potential impact of sociodemographic, clinical and biological factors on the long-term cognitive outcome of patients who survived moderate and severe forms of COVID-19. Methods We assessed 710 adult participants (Mean age = 55 ± 14; 48.3% were female) 6 to 11 months after hospital discharge with a complete cognitive battery, as well as a psychiatric, clinical and laboratory evaluation. A large set of inferential statistical methods was used to predict potential variables associated with any long-term cognitive impairment, with a focus on a panel of 28 cytokines and other blood inflammatory and disease severity markers. Results Concerning the subjective assessment of cognitive performance, 36.1% reported a slightly poorer overall cognitive performance, and 14.6% reported being severely impacted, compared to their pre-COVID-19 status. Multivariate analysis found sex, age, ethnicity, education, comorbidity, frailty and physical activity associated with general cognition. A bivariate analysis found that G-CSF, IFN-alfa2, IL13, IL15, IL1.RA, EL1.alfa, IL45, IL5, IL6, IL7, TNF-Beta, VEGF, Follow-up C-Reactive Protein, and Follow-up D-Dimer were significantly (p<.05) associated with general cognition. However, a LASSO regression that included all follow-up variables, inflammatory markers and cytokines did not support these findings. Conclusion Though we identified several sociodemographic characteristics that might protect against cognitive impairment following SARS-CoV-2 infection, our data do not support a prominent role for clinical status (both during acute and long-stage of COVID-19) or inflammatory background (also during acute and long-stage of COVID-19) to explain the cognitive deficits that can follow COVID-19 infection.
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Affiliation(s)
- Rodolfo Furlan Damiano
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Cristiana Castanho de Almeida Rocca
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | | | - Jennifer M. Loftis
- Research & Development Service, VA Portland Health Care System, Portland, OR, United States
- Departments of Psychiatry and Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States
| | - Leda Leme Talib
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Pedro Mário Pan
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Edecio Cunha-Neto
- Departamento de Cínica Médica, Universidade de São Paulo FMUSP, São Paulo, SP, Brazil
- Institute for Investigation in Immunology/National Institutes for Science and Technology (iii/INCT), São Paulo, Brazil
| | - Jorge Kalil
- Departamento de Cínica Médica, Universidade de São Paulo FMUSP, São Paulo, SP, Brazil
- Institute for Investigation in Immunology/National Institutes for Science and Technology (iii/INCT), São Paulo, Brazil
| | - Gabriela Salim de Castro
- Cancer Metabolism Research Group, Department of Surgery and LIM 26, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
| | - Marilia Seelaender
- Cancer Metabolism Research Group, Department of Surgery and LIM 26, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
| | - Bruno F. Guedes
- Departamento de Neurologia, Universidade de São Paulo FMUSP, São Paulo, Brazil
| | | | | | - Ricardo Nitrini
- Departamento de Neurologia, Universidade de São Paulo FMUSP, São Paulo, Brazil
| | - Euripedes Constantino Miguel
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Geraldo Busatto
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Orestes V. Forlenza
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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8
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Pais MV, Forlenza OV, Diniz BS. Plasma Biomarkers of Alzheimer's Disease: A Review of Available Assays, Recent Developments, and Implications for Clinical Practice. J Alzheimers Dis Rep 2023; 7:355-380. [PMID: 37220625 PMCID: PMC10200198 DOI: 10.3233/adr-230029] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 05/25/2023] Open
Abstract
Recently, low-sensitive plasma assays have been replaced by new ultra-sensitive assays such as single molecule enzyme-linked immunosorbent assay (Simoa), the Mesoscale Discovery (MSD) platform, and immunoprecipitation-mass spectrometry (IP-MS) with higher accuracy in the determination of plasma biomarkers of Alzheimer's disease (AD). Despite the significant variability, many studies have established in-house cut-off values for the most promising available biomarkers. We first reviewed the most used laboratory methods and assays to measure plasma AD biomarkers. Next, we review studies focused on the diagnostic performance of these biomarkers to identify AD cases, predict cognitive decline in pre-clinical AD cases, and differentiate AD cases from other dementia. We summarized data from studies published until January 2023. A combination of plasma Aβ42/40 ratio, age, and APOE status showed the best accuracy in diagnosing brain amyloidosis with a liquid chromatography-mass spectrometry (LC-MS) assay. Plasma p-tau217 has shown the best accuracy in distinguishing Aβ-PET+ from Aβ-PET-even in cognitively unimpaired individuals. We also summarized the different cut-off values for each biomarker when available. Recently developed assays for plasma biomarkers have undeniable importance in AD research, with improved analytical and diagnostic performance. Some biomarkers have been extensively used in clinical trials and are now clinically available. Nonetheless, several challenges remain to their widespread use in clinical practice.
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Affiliation(s)
- Marcos V. Pais
- UConn Center on Aging, University of Connecticut Health Center, Farmington, CT, USA
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, SP, Brazil
| | - Orestes V. Forlenza
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, SP, Brazil
| | - Breno S. Diniz
- UConn Center on Aging, University of Connecticut Health Center, Farmington, CT, USA
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9
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Beunders AJM, Klaus F, Kok AAL, Schouws SNTM, Kupka RW, Blumberg HP, Briggs F, Eyler LT, Forester BP, Forlenza OV, Gildengers A, Jimenez E, Mulsant BH, Patrick RE, Rej S, Sajatovic M, Sarna K, Sutherland A, Yala J, Vieta E, Villa LM, Korten NCM, Dols A. Bipolar I and bipolar II subtypes in older age: Results from the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) project. Bipolar Disord 2023; 25:43-55. [PMID: 36377516 DOI: 10.1111/bdi.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The distinction between bipolar I disorder (BD-I) and bipolar II disorder (BD-II) has been a topic of long-lasting debate. This study examined differences between BD-I and BD-II in a large, global sample of OABD, focusing on general functioning, cognition and somatic burden as these domains are often affected in OABD. METHODS Cross-sectional analyses were conducted with data from the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) database. The sample included 963 participants aged ≥50 years (714 BD-I, 249 BD-II). Sociodemographic and clinical factors were compared between BD subtypes including adjustment for study cohort. Multivariable analyses were conducted with generalized linear mixed models (GLMMs) and estimated associations between BD subtype and (1) general functioning (GAF), (2) cognitive performance (g-score) and (3) somatic burden, with study cohort as random intercept. RESULTS After adjustment for study cohort, BD-II patients more often had a late onset ≥50 years (p = 0.008) and more current severe depression (p = 0.041). BD-I patients were more likely to have a history of psychiatric hospitalization (p < 0.001) and current use of anti-psychotics (p = 0.003). Multivariable analyses showed that BD subtype was not related to GAF, cognitive g-score or somatic burden. CONCLUSION BD-I and BD-II patients did not differ in terms of general functioning, cognitive impairment or somatic burden. Some clinical differences were observed between the groups, which could be the consequence of diagnostic definitions. The distinction between BD-I and BD-II is not the best way to subtype OABD patients. Future research should investigate other disease specifiers in this population.
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Affiliation(s)
- Alexandra J M Beunders
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Mental Health, Amsterdam, The Netherlands
| | - Federica Klaus
- Department of Psychiatry, University of California San Diego, San Diego, California, USA.,Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, USA
| | - Almar A L Kok
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Mental Health, Amsterdam, The Netherlands
| | - Sigfried N T M Schouws
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Mental Health, Amsterdam, The Netherlands
| | - Ralph W Kupka
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Mental Health, Amsterdam, The Netherlands
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farren Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, California, USA.,Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, USA
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, Brazil
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Benoit H Mulsant
- Department of Psychiatry, Center for Addiction & Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Regan E Patrick
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Soham Rej
- GeriPARTy Research Group, Jewish General Hospital/ Lady Davis Institute, Montreal, Quebec, Canada.,McGill University, Montreal, Quebec, Canada
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Kaylee Sarna
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Ashley Sutherland
- Department of Psychiatry, University of California San Diego, San Diego, California, USA.,Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, USA
| | - Joy Yala
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Luca M Villa
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Nicole C M Korten
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Mental Health, Amsterdam, The Netherlands
| | - Annemieke Dols
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Mental Health, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands.,Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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10
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Gil S, Gualano B, de Araújo AL, de Oliveira Júnior GN, Damiano RF, Pinna F, Imamura M, Rocha V, Kallas E, Batistella LR, Forlenza OV, de Carvalho CRR, Busatto GF, Roschel H, Segurado A, Perondi B, Morais AM, Montal A, Letaif L, Fusco S, da Silva MFR, Rocha M, Marcilio I, Rios IC, Kawano FYO, de Jesus MA, Kallas ÉG, Carmo C, Tanaka C, de Souza HP, Marchini JFM, Carvalho C, Ferreira JC, de Oliveira MS, Guimarães T, dos Santos Lázari C, da Silva Duarte AJ, Sabino E, Magri MMC, Barros-Filho TEP, Francisco MCPB. Post-acute sequelae of SARS-CoV-2 associates with physical inactivity in a cohort of COVID-19 survivors. Sci Rep 2023; 13:215. [PMID: 36604523 PMCID: PMC9813883 DOI: 10.1038/s41598-022-26888-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to determine whether Post-acute Sequelae of SARS-CoV-2 Infection (PASC) are associated with physical inactivity in COVID-19 survivors. This is a cohort study of COVID-19 survivors discharged from a tertiary hospital in Sao Paulo, Brazil. Patients admitted as inpatients due to laboratory-confirmed COVID-19 between March and August 2020 were consecutively invited for a follow-up in-person visit 6 to 11 months after hospitalization. Ten symptoms of PASC were assessed using standardized scales. Physical activity was assessed by questionnaire and participants were classified according to WHO Guidelines. 614 patients were analyzed (age: 56 ± 13 years; 53% male). Frequency of physical inactivity in patients exhibiting none, at least 1, 1-4, and 5 or more symptoms of PASC was 51%, 62%, 58%, and 71%, respectively. Adjusted models showed that patients with one or more persistent PASC symptoms have greater odds of being physically inactive than those without any persistent symptoms (OR: 1.57 [95% CI 1.04-2.39], P = 0.032). Dyspnea (OR: 2.22 [1.50-3.33], P < 0.001), fatigue (OR: 2.01 [1.40-2.90], P < 0.001), insomnia (OR: 1.69 [1.16-2.49], P = 0.007), post-traumatic stress (OR: 1.53 [1.05-2.23], P = 0.028), and severe muscle/joint pain (OR: 1.53 [95% CI 1.08-2.17], P = 0.011) were associated with greater odds of being physically inactive. This study suggests that PASC is associated with physical inactivity, which itself may be considered as a persistent symptom among COVID-19 survivors. This may help in the early identification of patients who could benefit from additional interventions tailored to combat inactivity (even after treatment of PASC), with potential beneficial impacts on overall morbidity/mortality and health systems worldwide.
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Affiliation(s)
- Saulo Gil
- grid.11899.380000 0004 1937 0722Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, School of Physical Education and Sport, School of Medicine FMUSP, University of Sao Paulo, Av. Dr. Arnaldo, 455, Pacaembu, São Paulo, SP Brazil ,grid.11899.380000 0004 1937 0722Rheumatology Division, Faculdade de Medicina FMUSP Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP Brazil
| | - Bruno Gualano
- grid.11899.380000 0004 1937 0722Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, School of Physical Education and Sport, School of Medicine FMUSP, University of Sao Paulo, Av. Dr. Arnaldo, 455, Pacaembu, São Paulo, SP Brazil ,grid.11899.380000 0004 1937 0722Rheumatology Division, Faculdade de Medicina FMUSP Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP Brazil
| | - Adriana Ladeira de Araújo
- grid.11899.380000 0004 1937 0722Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Gersiel Nascimento de Oliveira Júnior
- grid.11899.380000 0004 1937 0722Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, School of Physical Education and Sport, School of Medicine FMUSP, University of Sao Paulo, Av. Dr. Arnaldo, 455, Pacaembu, São Paulo, SP Brazil ,grid.11899.380000 0004 1937 0722Rheumatology Division, Faculdade de Medicina FMUSP Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP Brazil
| | - Rodolfo Furlan Damiano
- grid.411074.70000 0001 2297 2036Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP Brazil
| | - Fabio Pinna
- grid.11899.380000 0004 1937 0722Otorrhinolaringoly Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, University of São Paulo, São Paulo, Brazil
| | - Marta Imamura
- grid.411074.70000 0001 2297 2036Instituto de Medicina Física e de Reabilitação, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- grid.411074.70000 0001 2297 2036Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil ,grid.411074.70000 0001 2297 2036Laboratório de Genética e Hematologia Molecular, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Esper Kallas
- grid.11899.380000 0004 1937 0722Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil ,grid.411074.70000 0001 2297 2036Departamento de Clínica Médica, Laboratório de Imunologia Clínica e Alergia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Linamara Rizzo Batistella
- grid.411074.70000 0001 2297 2036Instituto de Medicina Física e de Reabilitação, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Orestes V. Forlenza
- grid.411074.70000 0001 2297 2036Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP Brazil
| | - Carlos R. R. de Carvalho
- grid.11899.380000 0004 1937 0722Departamento de Cardio-Pneumologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Geraldo Filho Busatto
- grid.411074.70000 0001 2297 2036Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, School of Physical Education and Sport, School of Medicine FMUSP, University of Sao Paulo, Av. Dr. Arnaldo, 455, Pacaembu, São Paulo, SP, Brazil. .,Rheumatology Division, Faculdade de Medicina FMUSP Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP, Brazil.
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11
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Forlenza OV, Hajek T, Almeida OP, Beunders AJ, Blumberg HP, Briggs FB, De-Paula VJR, Dols A, Eyler LT, Forester BP, Gildengers A, Jimenez E, Korten NC, Lafer B, McWhinney SR, Mulsant B, Rej S, Sarna K, Schouws S, Sutherland A, Tsai S, Vieta E, Yala J, Sajatovic M. Demographic and clinical characteristics of lithium-treated older adults with bipolar disorder. Acta Psychiatr Scand 2022; 146:442-455. [PMID: 35837985 PMCID: PMC9588573 DOI: 10.1111/acps.13474] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVES There is limited information on the characteristics of older adults with bipolar disorder (OABD) treated with lithium, along with safety concerns about its use by older adults. The aim of the present study is to describe the demographic and clinical characteristics of OABD receiving lithium therapy, using data from the Global Ageing & Geriatric Experiments in Bipolar Disorder (GAGE-BD). EXPERIMENTAL PROCEDURES Cross-sectional analysis of the GAGE-BD dataset to determine differences and similarities between lithium users and non-users. We analysed data from 986 participants aged 50 years or older (mean age 63.5 years; 57.5% females) from 12 study sites. Two subgroups ('Lithium'; 'Non-lithium') were defined according to the current prescription of lithium. We compared several outcomes between these groups, controlling for age, gender, and study site. RESULTS OABD treated with lithium had lower scores on depression rating scales and were less likely to be categorised as with moderate or severe depression. There was a lower proportion of lithium users than non-users among those with evidence of rapid cycling and non-bipolar psychiatric diagnoses. Assessment of global cognitive state and functionality indicated better performance among lithium users. The current use of antipsychotics was less frequent among lithium users, who also reported fewer cardiovascular comorbidities than non-users. CONCLUSION We found several potentially relevant differences in the clinical profile of OABD treated with lithium compared with those treated with other mood stabilisers. However, the interpretation of the present results must take into account the methodological limitations inherent to the cross-sectional approach and data harmonisation.
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Affiliation(s)
- Orestes V. Forlenza
- Department & Institute of Psychiatry, Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, Brazil
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | | | - Alexandra J.M. Beunders
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, the Netherlands
| | | | - Farren B.S. Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Vanessa J. R. De-Paula
- Vanessa J. R. De-Paula, Laboratory of Neuroscience (LIM-27), Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, Brazil
| | - Annemiek Dols
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, the Netherlands
| | - Lisa T. Eyler
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, USA
| | - Brent P. Forester
- Division of Geriatric Psychiatry, McLean Hospital, Belmont; Harvard Medical School, Boston, USA
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Nicole C.M. Korten
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, the Netherlands
| | - Beny Lafer
- Department & Institute of Psychiatry, Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, Brazil
| | | | - Benoit Mulsant
- Benoit Mulsant, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada
| | - Soham Rej
- Soham Rej, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Canada
| | - Kaylee Sarna
- Kaylee Sarna, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Sigfried Schouws
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, the Netherlands
| | - Ashley Sutherland
- Ashley Sutherland, Department of Psychiatry, University of California at San Diego, San Diego, USA
| | - Shangying Tsai
- Shangying Tsai, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Joy Yala
- Kaylee Sarna, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Martha Sajatovic
- Kaylee Sarna, Case Western Reserve University School of Medicine, Cleveland, USA
- Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD): please see Supplemental Material for members of the GAGE-BD initiative
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12
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Lavin P, Buck G, Almeida OP, Su CL, Eyler LT, Dols A, Blumberg HP, Forester BP, Forlenza OV, Gildengers A, Mulsant BH, Tsai SY, Vieta E, Schouws S, Briggs FBS, Sutherland A, Sarna K, Yala J, Orhan M, Korten N, Sajatovic M, Rej S. Clinical correlates of late-onset versus early-onset bipolar disorder in a global sample of older adults. Int J Geriatr Psychiatry 2022; 37. [PMID: 36317317 DOI: 10.1002/gps.5833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/16/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Late-onset bipolar disorder (LOBD) represents a significant subgroup of bipolar disorder (BD). However, knowledge for this group is mostly extrapolated from small studies in subjects with early/mixed age of illness onset. In this global sample of older adults with BD (OABD: ≥50 years old) we aim to characterize the sociodemographic and clinical presentation of LOBD (≥40 years at BD onset) compared to early-onset BD (EOBD: <40 years at BD onset). METHODS The Global Aging and Geriatric Experiments in Bipolar Disorder consortium provided international data on 437 older age bipolar disorder participants. We compared LOBD versus EOBD on depression, mania, functionality, and physical comorbidities. Exploratory analyses were performed on participants with BD onset ≥50 years old. RESULTS LOBD (n = 105) did not differ from EOBD (n = 332) on depression, mania, global functioning, nor employment status (p > 0.05). Late-onset bipolar disorder was associated with higher endocrine comorbidities (odds ratio = 1.48, [95%CI = 1.0,12.1], p = 0.03). This difference did not remain significant when subjects with BD onset ≥50 years old were analyzed. LIMITATIONS This study is limited by the retrospective nature of the variable age of onset and the differences in evaluation methods across studies (partially overcame by harmonization processes). CONCLUSION The present analysis is in favor of the hypothesis that LOBD might represent a similar clinical phenotype as classic EOBD with respect to core BD symptomatology, functionality, and comorbid physical conditions. Large-scale global collaboration to improve our understanding of BD across the lifespan is needed.
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Affiliation(s)
- Paola Lavin
- GeriPARTy Research Group, Jewish General Hospital, Montreal, Quebec, Canada
- Lady Davis Research Institute, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Gabriella Buck
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Osvaldo P Almeida
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Chien-Lin Su
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, San Diego Healthcare System, San Diego, California, USA
| | - Annemieke Dols
- GGZ InGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Brent P Forester
- McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Orestes V Forlenza
- Laboratory of Neuroscience, Instituto de Psiquiatría, Hospital da Universidad de São Paulo, Sao Paulo, Brazil
| | - Ariel Gildengers
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Benoit H Mulsant
- Department of Psychiatry, Center for Addiction & Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Eduard Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Sigfried Schouws
- GGZ InGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Farren B S Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Ashley Sutherland
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Kaylee Sarna
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Joy Yala
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Melis Orhan
- GGZ InGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Nicole Korten
- GGZ InGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Soham Rej
- GeriPARTy Research Group, Jewish General Hospital, Montreal, Quebec, Canada
- Lady Davis Research Institute, McGill University, Montreal, Quebec, Canada
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13
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Eyler LT, Briggs FBS, Dols A, Rej S, Almeida OP, Beunders AJM, Blumberg HP, Forester BP, Patrick RE, Forlenza OV, Gildengers A, Jimenez E, Vieta E, Mulsant BH, Schouws S, Paans NPG, Strejilevich S, Sutherland A, Tsai S, Sajatovic M. Symptom Severity Mixity in Older-Age Bipolar Disorder: Analyses From the Global Aging and Geriatric Experiments in Bipolar Disorder Database (GAGE-BD). Am J Geriatr Psychiatry 2022; 30:1096-1107. [PMID: 35637088 PMCID: PMC10280310 DOI: 10.1016/j.jagp.2022.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Some individuals with bipolar disorder (BD) experience manic and depressive symptoms concurrently, but data are limited on symptom mixity in older age bipolar disorder (OABD). Using the Global Aging & Geriatric Experiments in Bipolar Disorder Database, we characterized mixity in OABD and associations with everyday function. METHODS The sample (n = 805), from 12 international studies, included cases with both mania and depression severity ratings at a single timepoint. Four mixity groups were created: asymptomatic (A), mixed (Mix), depressed only (Dep), and manic only (Man). Generalized linear mixed models used mixity group as the predictor variable; cohort was included as a random intercept. Everyday function was assessed with the Global Assessment of Functioning score. RESULTS Group proportions were Mix (69.6%; n = 560), followed by Dep (18.4%; n = 148), then A (7.8%; n = 63), then Man (4.2%; n= 34); levels of depression and mania were similar in Mix compared to Dep and Man, respectively. Everyday function was lowest in Mix, highest in A, and intermediate in Man and Dep. Within Mix, severity of depression was the main driver of worse functioning. Groups differed in years of education, with A higher than all others, but did not differ by age, gender, employment status, BD subtype, or age of onset. CONCLUSIONS Mixed features predominate in a cross-sectional, global OABD sample and are associated with worse everyday function. Among those with mixed symptoms, functional status relates strongly to current depression severity. Future studies should include cognitive and other biological variables as well as longitudinal designs to allow for evaluation of causal effects.
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Affiliation(s)
- Lisa T Eyler
- Department of Psychiatry (LTE), University of California San Diego, San Diego, CA; Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (LTE), San Diego, CA.
| | - Farren B S Briggs
- Department of Population and Quantitative Health Sciences (FBSB), Case Western Reserve University School of Medicine, Cleveland, OH
| | - Annemiek Dols
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute (AD, AJMB, SS, NPGP), Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program and Neurodegeneration program, Amsterdam, the Netherlands
| | - Soham Rej
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program and Neurodegeneration program, Amsterdam, the Netherlands
| | | | - Alexandra J M Beunders
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute (AD, AJMB, SS, NPGP), Amsterdam, the Netherlands
| | - Hilary P Blumberg
- Department of Psychiatry (HPB), Yale School of Medicine, New Haven, CT
| | - Brent P Forester
- Division of Geriatric Psychiatry (BPF), McLean Hospital, Belmont, MA; Harvard Medical School (BPF, REP), Boston, MA
| | - Regan E Patrick
- Harvard Medical School (BPF, REP), Boston, MA; Division of Geriatric Psychiatry (REP), McLean Hospital, Belmont, MA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry (OVF), HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ariel Gildengers
- Department of Psychiatry (AG), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic (EJ, EV), University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic (EJ, EV), University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Benoit H Mulsant
- Department of Psychiatry (BHM), University of Toronto, Center for Addiction & Mental Health, Toronto, Canada
| | - Sigfried Schouws
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute (AD, AJMB, SS, NPGP), Amsterdam, the Netherlands; GGZ inGeest, Amsterdam UMC (SS), VU Medical Center, Amsterdam, the Netherlands
| | - Nadine P G Paans
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute (AD, AJMB, SS, NPGP), Amsterdam, the Netherlands; GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute (NPGP), Amsterdam, the Netherlands
| | - Sergio Strejilevich
- AREA, Assistance and Research in Affective Disorders (SS), Buenos Aires, Argentina
| | - Ashley Sutherland
- Department of Psychiatry (AS), University of California San Diego, San Diego, CA
| | - Shangying Tsai
- Department of Psychiatry, School of Medicine (ST), College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine (MS), University Hospitals Cleveland Medical Center, Cleveland, OH
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14
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Busatto GF, de Araujo AL, Castaldelli-Maia JM, Damiano RF, Imamura M, Guedes BF, de Rezende Pinna F, Sawamura MVY, Mancini MC, da Silva KR, Garcia ML, Sumita N, Brunoni AR, da Silva Duarte AJ, Burdmann EA, Kallas EG, Cerri GG, Nitrini R, Bento RF, Rocha VG, de Souza HP, Miguel EC, de Carvalho CRR, Forlenza OV, Batistella LR. Post-acute sequelae of SARS-CoV-2 infection: relationship of central nervous system manifestations with physical disability and systemic inflammation. Psychol Med 2022; 52:2387-2398. [PMID: 35521752 PMCID: PMC9151630 DOI: 10.1017/s0033291722001374] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite the multitude of clinical manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC), studies applying statistical methods to directly investigate patterns of symptom co-occurrence and their biological correlates are scarce. METHODS We assessed 30 symptoms pertaining to different organ systems in 749 adults (age = 55 ± 14 years; 47% female) during in-person visits conducted at 6-11 months after hospitalization due to coronavirus disease 2019 (COVID-19), including six psychiatric and cognitive manifestations. Symptom co-occurrence was initially investigated using exploratory factor analysis (EFA), and latent variable modeling was then conducted using Item Response Theory (IRT). We investigated associations of latent variable severity with objective indices of persistent physical disability, pulmonary and kidney dysfunction, and C-reactive protein and D-dimer blood levels, measured at the same follow-up assessment. RESULTS The EFA extracted one factor, explaining 64.8% of variance; loadings were positive for all symptoms, and above 0.35 for 16 of them. The latent trait generated using IRT placed fatigue, psychiatric, and cognitive manifestations as the most discriminative symptoms (coefficients > 1.5, p < 0.001). Latent trait severity was associated with decreased body weight and poorer physical performance (coefficients > 0.240; p ⩽ 0.003), and elevated blood levels of C-reactive protein (coefficient = 0.378; 95% CI 0.215-0.541; p < 0.001) and D-dimer (coefficient = 0.412; 95% CI 0.123-0.702; p = 0.005). Results were similar after excluding subjects with pro-inflammatory comorbidities. CONCLUSIONS Different symptoms that persist for several months after moderate or severe COVID-19 may unite within one latent trait of PASC. This trait is dominated by fatigue and psychiatric symptoms, and is associated with objective signs of physical disability and persistent systemic inflammation.
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Affiliation(s)
- Geraldo F. Busatto
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Adriana Ladeira de Araujo
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - João Mauricio Castaldelli-Maia
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
- Departamento de Neurociências, Centro Universitário da Faculdade de Medicina do ABC, São Paulo, SP, Brasil
| | - Rodolfo Furlan Damiano
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Marta Imamura
- Departamento de Medicina Legal, Etica Medica e Medicina Social e do Trabalho, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Bruno F. Guedes
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Fabio de Rezende Pinna
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Marcio Valente Yamada Sawamura
- Departamento de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Márcio C. Mancini
- Unidade de Obesidade e Síndrome Metabólica, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Katia R. da Silva
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Michelle L. Garcia
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Nairo Sumita
- Departamento de Patologia Clínica, LIM/03 – Laboratório de Medicina Laboratorial, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Andre Russowsky Brunoni
- Departamento de Clínica Médica, LIM/27 – Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alberto J. da Silva Duarte
- Departamento de Dermatologia, Laboratório de Dermatologia e Imunodeficiências, LIM-56, Faculdade de Medicina e Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brasil
| | - Emmanuel A. Burdmann
- Departamento de Clínica Médica, LIM/12 – Laboratório de Pesquisa Básica em Doenças Renais, Disciplina de Nefrologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Esper G. Kallas
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Giovanni G. Cerri
- Departamento de Radiologia, Faculdade de Medicina, LIM/44, Laboratório de Ressonância Magnética em Neurorradiologia Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ricardo Nitrini
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Ricardo F. Bento
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
- Divisão de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Vanderson Geraldo Rocha
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Divisão de Clínica Médica I do ICHC, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Heraldo Possolo de Souza
- Departamento de Clínica Médica, Disciplina de Emergências Clínicas, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Euripedes C. Miguel
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Carlos R. R. de Carvalho
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Orestes V. Forlenza
- Departamento e Instituto de Psiquiatria, Laboratório de Neurociências – LIM-27, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Linamara Rizzo Batistella
- Departamento de Medicina Legal, Etica Medica e Medicina Social e do Trabalho, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
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15
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Busatto GF, de Araujo AL, Castaldelli-Maia JM, Damiano RF, Imamura M, Guedes BF, Pinna FDR, Sawamura MVY, Mancini MC, da Silva KR, Garcia ML, Sumita N, Brunoni AR, da Silva Duarte AJ, Burdmann EA, Kallas EG, Cerri GG, Nitrini R, Bento RF, Rocha VG, de Souza HP, Miguel EC, de Carvalho CRR, Forlenza OV, Batistella LR. Post-acute sequelae of SARS-CoV-2 infection: relationship of central nervous system manifestations with physical disability and systemic inflammation - CORRIGENDUM. Psychol Med 2022; 52:2400. [PMID: 35757988 PMCID: PMC9981469 DOI: 10.1017/s0033291722001799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Geraldo F Busatto
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Adriana Ladeira de Araujo
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - João Mauricio Castaldelli-Maia
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
- Departamento de Neurociências, Centro Universitário da Faculdade de Medicina do ABC, São Paulo, SP, Brasil
| | - Rodolfo Furlan Damiano
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Marta Imamura
- Departamento de Medicina Legal, Etica Medica e Medicina Social e do Trabalho, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Bruno F Guedes
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Fabio de Rezende Pinna
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Marcio Valente Yamada Sawamura
- Departamento de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Márcio C Mancini
- Unidade de Obesidade e Síndrome Metabólica, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Katia R da Silva
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Michelle L Garcia
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Nairo Sumita
- Departamento de Patologia Clínica, LIM/03 - Laboratório de Medicina Laboratorial, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Andre Russowsky Brunoni
- Departamento de Clínica Médica, LIM/27 -Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alberto J da Silva Duarte
- Departamento de Dermatologia, Laboratório de Dermatologia e Imunodeficiências, LIM-56, Faculdade de Medicina e Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brasil
| | - Emmanuel A Burdmann
- Departamento de Clínica Médica, LIM/12 - Laboratório de Pesquisa Básica em Doenças Renais, Disciplina de Nefrologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Esper G Kallas
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Giovanni G Cerri
- Departamento de Radiologia, Faculdade de Medicina, LIM/44, Laboratório de Ressonância Magnética em Neurorradiologia Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ricardo Nitrini
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Ricardo F Bento
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
- Divisão de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Vanderson Geraldo Rocha
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Divisão de Clínica Médica I do ICHC, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Heraldo Possolo de Souza
- Departamento de Clínica Médica, Disciplina de Emergências Clínicas, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Euripedes C Miguel
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Carlos R R de Carvalho
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Orestes V Forlenza
- Departamento e Instituto de Psiquiatria, Laboratório de Neurociências - LIM-27, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Linamara Rizzo Batistella
- Departamento de Medicina Legal, Etica Medica e Medicina Social e do Trabalho, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
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16
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Almeida OP, Singulani MP, Ford AH, Hackett ML, Etherton-Beer C, Flicker L, Hankey GJ, De Paula VJR, Penteado CT, Forlenza OV. Lithium and Stroke Recovery: A Systematic Review and Meta-Analysis of Stroke Models in Rodents and Human Data. Stroke 2022; 53:2935-2944. [PMID: 35968702 DOI: 10.1161/strokeaha.122.039203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Lithium has neuroprotective effects in animal models of stroke, but benefits in humans remain uncertain. This article aims to systematically review the available evidence of the neuroprotective and regenerative effects of lithium in animal models of stroke, as well as in observational and trial stroke studies in humans. METHODS This systematic review and meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched Medline, Embase, and PsycINFO for preclinical and clinical studies published between January 2000 and September 2021. A random-effects meta-analysis was conducted from observational studies. RESULTS From 1625 retrieved studies, 42 were included in the systematic review. Of those, we identified 36 rodent models of stroke using preinsult or postinsult treatment with lithium, and 6 studies were conducted in human samples, of which 4 could be meta-analyzed. The review of animal models was stratified according to the type of stroke and outcomes. Human data were subdivided into observational and intervention studies. Treatment of rodents with lithium was associated with smaller stroke volumes, decreased apoptosis, and improved poststroke function. In humans, exposure to lithium was associated with a lower risk of stroke among adults with bipolar disorder in 2 of 4 studies. Two small trials showed equivocal clinical benefits of lithium poststroke. CONCLUSIONS Animal models of stroke show consistent biological and functional evidence of benefits associated with lithium treatment, whereas human evidence remains sparse and inconclusive. The potential role of lithium in poststroke recovery is yet to be adequately tested in humans.
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Affiliation(s)
- Osvaldo P Almeida
- Medical School, University of Western Australia, Perth, Australia (O.P.A., A.H.F., C.E.B., L.F., G.J.H.)
| | - Monique P Singulani
- Laboratory of Neuroscience LIM27, Department and Institute of Psychiatry HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Brazil (M.P.S., V.J.R.D.P., C.T.P., O.V.F.)
| | - Andrew H Ford
- Medical School, University of Western Australia, Perth, Australia (O.P.A., A.H.F., C.E.B., L.F., G.J.H.)
| | - Maree L Hackett
- The George Institute for Global Health, the University of New South Wales, Sydney, Australia (M.L.H.)
| | - Christopher Etherton-Beer
- Medical School, University of Western Australia, Perth, Australia (O.P.A., A.H.F., C.E.B., L.F., G.J.H.)
| | - Leon Flicker
- Medical School, University of Western Australia, Perth, Australia (O.P.A., A.H.F., C.E.B., L.F., G.J.H.)
| | - Graeme J Hankey
- Medical School, University of Western Australia, Perth, Australia (O.P.A., A.H.F., C.E.B., L.F., G.J.H.)
| | - Vanessa J R De Paula
- Laboratory of Neuroscience LIM27, Department and Institute of Psychiatry HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Brazil (M.P.S., V.J.R.D.P., C.T.P., O.V.F.)
| | - Camila T Penteado
- Laboratory of Neuroscience LIM27, Department and Institute of Psychiatry HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Brazil (M.P.S., V.J.R.D.P., C.T.P., O.V.F.)
| | - Orestes V Forlenza
- Laboratory of Neuroscience LIM27, Department and Institute of Psychiatry HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Brazil (M.P.S., V.J.R.D.P., C.T.P., O.V.F.)
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17
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Ferreira JC, Moreira TCL, de Araújo AL, Imamura M, Damiano RF, Garcia ML, Sawamura MV, Pinna FR, Guedes BF, Gonçalves FAR, Mancini M, Burdmann EA, da Silva Filho DF, Polizel JL, Bento RF, Rocha V, Nitrini R, de Souza HP, Levin AS, Kallas EG, Forlenza OV, Busatto GF, Batistella LR, de Carvalho CRR, Mauad T, Gouveia N. Clinical, sociodemographic and environmental factors impact post-COVID-19 syndrome. J Glob Health 2022; 12:05029. [PMID: 35939273 PMCID: PMC9359428 DOI: 10.7189/jogh.12.05029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Sociodemographic and environmental factors are associated with incidence, severity, and mortality of COVID-19. However, little is known about the role of such factors in persisting symptoms among recovering patients. We designed a cohort study of hospitalized COVID-19 survivors to describe persistent symptoms and identify factors associated with post-COVID-19 syndrome. Methods We included patients hospitalized between March to August 2020 who were alive six months after hospitalization. We collected individual and clinical characteristics during hospitalization and at follow-up assessed ten symptoms with standardized scales, 19 yes/no symptoms, a functional status and a quality-of-life scale and performed four clinical tests. We examined individual exposure to greenspace and air pollution and considered neighbourhood´s population density and socioeconomic conditions as contextual factors in multilevel regression analysis. Results We included 749 patients with a median follow-up of 200 (IQR = 185-235) days, and 618 (83%) had at least one of the ten symptoms measured with scales. Pain (41%), fatigue (38%) and posttraumatic stress disorder (35%) were the most frequent. COVID-19 severity, comorbidities, BMI, female sex, younger age, and low socioeconomic position were associated with different symptoms. Exposure to ambient air pollution was associated with higher dyspnoea and fatigue scores and lower functional status. Conclusions We identified a high frequency of persistent symptoms among COVID-19 survivors that were associated with clinical, sociodemographic, and environmental variables. These findings indicate that most patients recovering from COVID-19 will need post-discharge care, and an additional burden to health care systems, especially in LMICs, should be expected.
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Affiliation(s)
- Juliana Carvalho Ferreira
- Divisao de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil.,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brasil
| | - Tiana C Lopes Moreira
- Departamento de Patologia, LIM/05- Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Adriana Ladeira de Araújo
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Marta Imamura
- Instituto de Medicina fisica e Reabilitação do Hospital das Clinicas, Departamento de Medicina Legal, Etica Médica e Medicina Social e do Trabalho, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Rodolfo F Damiano
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Michelle L Garcia
- Divisao de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
| | - Marcio Vy Sawamura
- Departamento de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Fabio R Pinna
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Bruno F Guedes
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Fabio A Rodrigues Gonçalves
- Departamento de Cardiopneumologia, Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Marcio Mancini
- Unidade de Obesidade e Síndrome Metabólica, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Emmanuel A Burdmann
- Departamento de Clínica Médica, LIM/12 - Laboratório de Pesquisa Básica em Doenças Renais, Disciplina de Nefrologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Jefferson Lordello Polizel
- Departamento de Ciências Florestais-ESALQ/USP, Laboratório de Métodos Quantitativos, Universidade de São Paulo, Piracicaba, SP, Brasil
| | - Ricardo F Bento
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil.,Divisão de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Vanderson Rocha
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Divisão de Clínica Médica I do ICHC, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Ricardo Nitrini
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Heraldo Possolo de Souza
- Departamento de Clínica Médica, Disciplina de Emergências Clínicas, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Anna S Levin
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Esper G Kallas
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Orestes V Forlenza
- Departamento e Instituto de Psiquiatria, Laboratório de Neurociências - LIM-27, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Geraldo F Busatto
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil.,Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Linamara R Batistella
- Instituto de Medicina fisica e Reabilitação do Hospital das Clinicas, Departamento de Medicina Legal, Etica Médica e Medicina Social e do Trabalho, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Carlos R Ribeiro de Carvalho
- Divisao de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
| | - Thais Mauad
- Departamento de Patologia, LIM/05- Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Nelson Gouveia
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
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18
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Loureiro JC, Silva LFAL, Pais MV, Forlenza OV. Anti-amyloid agents for treating incipient Alzheimer's disease: a new hope? Braz J Psychiatry 2022; 44:368-369. [PMID: 35729067 PMCID: PMC9375665 DOI: 10.47626/1516-4446-2022-2503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Julia C Loureiro
- Laboratório de Neurociências, Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Fernando A L Silva
- Laboratório de Neurociências, Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcos V Pais
- Laboratório de Neurociências, Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Orestes V Forlenza
- Laboratório de Neurociências, Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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19
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Chen P, Eyler LT, Gildengers A, Beunders AJ, Blumberg HP, Briggs FB, Dols A, Rej S, Forlenza OV, Jimenez E, Mulsant B, Schouws S, Orhan M, Sarna K, Sutherland AN, Vieta E, Tsai S, Yala J, Villa LM, Sajatovic M. Demographic and Clinical Characteristics of Antipsychotic Drug-Treated Older Adults with Bipolar Disorder from the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD). Psychopharmacol Bull 2022; 52:8-33. [PMID: 35721813 PMCID: PMC9172555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Objectives Antipsychotic drugs (APS) are widely used to treat patients with bipolar disorder (BD), but there is limited information in older-age bipolar disorder (OABD). This analysis of the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) investigated characteristics of OABD patients prescribed APS vs. those not prescribed APS. Experimental Design The observational analysis used baseline, cross-sectional data from 16 international studies for adults aged ≥ 50 years with BD comprising 1,007 individuals with mean age 63.2 years (SD = 9.0), 57.4% women, and mean age of onset 31.6 years (SD = 15.0). The dependent variable was current APS treatment status. The independent variables included demographic and clinical variables, and a random effect for study, that were included in generalized mixed models. Principal Observations 46.6% of individuals (n = 469) were using APS. The multivariate model results suggest that those treated with APS were younger (p = 0.01), less likely to be employed (p < 0.001), had more psychiatric hospitalizations (p = 0.009) and were less likely to be on lithium (p < 0.001). Of individuals on APS, only 6.6% of those (n = 27) were on first-generation antipsychotics (FGAs) and experienced a greater burden of psychiatric hospitalizations (p = 0.012). Conclusions APS are widely prescribed in OABD, observed in nearly half of this sample with great variation across sites. Individuals with OABD on APS have more severe illness, more frequent hospitalizations and are more often unemployed vs. those not on APS. Future studies need to examine longitudinal outcomes in OABD prescribed APS to characterize underlying causal relationships.
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Affiliation(s)
- Peijun Chen
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lisa T Eyler
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ariel Gildengers
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Alexandra Jm Beunders
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Hilary P Blumberg
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Farren Bs Briggs
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Annemiek Dols
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Soham Rej
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Orestes V Forlenza
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Esther Jimenez
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Benoit Mulsant
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sigfried Schouws
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Melis Orhan
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kaylee Sarna
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ashley N Sutherland
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Eduard Vieta
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Shangying Tsai
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Joy Yala
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luca M Villa
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Martha Sajatovic
- Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Damiano RF, Neto DB, Oliveira JVR, Magalhães Santos J, Alves JVR, Guedes BF, Nitrini R, de Araújo AL, Oliveira M, Brunoni AR, Voegels RL, Bento RF, Busatto G, Miguel EC, Forlenza OV, de Rezende Pinna F. Association between chemosensory impairment with neuropsychiatric morbidity in post-acute COVID-19 syndrome: results from a multidisciplinary cohort study. Eur Arch Psychiatry Clin Neurosci 2022; 273:325-333. [PMID: 35633395 PMCID: PMC9142732 DOI: 10.1007/s00406-022-01427-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/02/2022] [Indexed: 12/19/2022]
Abstract
Preliminary methodologically limited studies suggested that taste and smell known as chemosensory impairments and neuropsychiatric symptoms are associated in post-COVID-19. The objective of this study is to evaluate whether chemosensory dysfunction and neuropsychiatric impairments in a well-characterized post-COVID-19 sample. This is a cohort study assessing adult patients hospitalized due to moderate or severe forms of COVID-19 between March and August 2020. Baseline information includes several clinical and hospitalization data. Further evaluations were made using several different reliable instruments designed to assess taste and smell functions, parosmia, and neuropsychiatric disorders (using standardized psychiatric and cognitive measures). Out of 1800 eligible individuals, 701 volunteers were assessed on this study. After multivariate analysis, patients reporting parosmia had a worse perception of memory performance (p < 0.001). Moderate/severe hypogeusia was significantly associated with a worse performance on the word list memory task (p = 0.012); Concomitant moderate/severe olfactory and gustatory loss during the acute phase of COVID-19 was also significantly associated with episodic memory impairment (p = 0.006). We found a positive association between reported chemosensory (taste and olfaction) abnormalities and cognition dysfunction in post-COVID-19 patients. These findings may help us identify potential mechanisms linking these two neurobiological functions, and also support the speculation on a possible route through which SARS-CoV-2 may reach the central nervous system.
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Affiliation(s)
- Rodolfo Furlan Damiano
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP, 05403-903, Brazil.
| | - Deusdedit Brandão Neto
- Departamento de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Julia Vallin Rodrigues Alves
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Bruno F. Guedes
- Departamento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Departamento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Adriana Ladeira de Araújo
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP Brazil
| | - Melaine Oliveira
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - André R. Brunoni
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Richard Louis Voegels
- Departamento de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Ferreira Bento
- Departamento de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Geraldo Busatto
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Euripedes Constantino Miguel
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Orestes V. Forlenza
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Fabio de Rezende Pinna
- Departamento de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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21
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Polho GB, Cardillo GM, Kerr DS, Chile T, Gattaz WF, Forlenza OV, Brentani HP, De-Paula VJ. Antipsychotics preserve telomere length in peripheral blood mononuclear cells after acute oxidative stress injury. Neural Regen Res 2022; 17:1156-1160. [PMID: 34558545 PMCID: PMC8552857 DOI: 10.4103/1673-5374.324852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/04/2021] [Accepted: 05/12/2021] [Indexed: 11/04/2022] Open
Abstract
Antipsychotics may prolong or retain telomere length, affect mitochondrial function, and then affect the metabolism of nerve cells. To validate the hypothesis that antipsychotics can prolong telomere length after oxidative stress injury, leukocytes from healthy volunteers were extracted using Ficoll-Histopaque density gradient. The mononuclear cells layer was resuspended in cell culture medium. Oxidative stress was induced with hydrogen peroxide in cultured leukocytes. Four days later, leukocytes were treated with aripiprazole, haloperidol or clozapine for 7 days. Real-time PCR revealed that treatments with aripiprazole and haloperidol increased the telomere length by 23% and 20% in peripheral blood mononuclear cells after acute oxidative stress injury. These results suggest that haloperidol and aripiprazole can reduce the damage to telomeres induced by oxidative stress. The experiment procedure was approved by the Ethics Committee of Faculty of Medicine of the University of São Paulo (FMUSP/CAAE approval No. 52622616.8.0000.0065).
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Affiliation(s)
- Gabriel B. Polho
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
| | - Giancarlo M. Cardillo
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
| | - Daniel S. Kerr
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
| | - Thais Chile
- Laboratório de Psicobiologia (LIM-23), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
| | - Wagner F. Gattaz
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
| | - Orestes V. Forlenza
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
| | - Helena P. Brentani
- Laboratório de Psicobiologia (LIM-23), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
| | - Vanessa J. De-Paula
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
- Laboratório de Psicobiologia (LIM-23), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
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22
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Sajatovic M, Dols A, Rej S, Almeida OP, Beunders AJ, Blumberg HP, Briggs FB, Forester BP, Patrick RE, Forlenza OV, Gildengers A, Jimenez E, Vieta E, Mulsant B, Schouws S, Paans N, Strejilevich S, Sutherland A, Tsai S, Wilson B, Eyler LT. Bipolar symptoms, somatic burden, and functioning in older-age bipolar disorder: Analyses from the Global Aging & Geriatric Experiments in Bipolar Disorder Database project. Bipolar Disord 2022; 24:195-206. [PMID: 34314549 PMCID: PMC8792096 DOI: 10.1111/bdi.13119] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/22/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Literature on older-age bipolar disorder (OABD) is limited. This first-ever analysis of the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) investigated associations among age, BD symptoms, comorbidity, and functioning. METHODS This analysis used harmonized, baseline, cross-sectional data from 19 international studies (N = 1377). Standardized measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), and Global Assessment of Functioning (GAF). RESULTS Mean sample age was 60.8 years (standard deviation [SD] 12.2 years), 55% female, 72% BD I. Mood symptom severity was low: mean total YMRS score of 4.3 (SD 5.4) and moderate-to-severe depression in only 22%. Controlled for sample effects, both manic and depressive symptom severity appeared lower among older individuals (p's < 0.0001). The negative relationship between older age and symptom severity was similar across sexes, but was stronger among those with lower education levels. GAF was mildly impaired (mean =62.0, SD = 13.3) and somatic burden was high (mean =2.42, SD = 1.97). Comorbidity burden was not associated with GAF. However, higher depressive (p < 0.0001) and manic (p < 0.0001) symptoms were associated with lower GAF, most strongly among older individuals. CONCLUSIONS Findings suggest an attenuation of BD symptoms in OABD, despite extensive somatic burden. Depressive symptom severity was strongly associated with worse functioning in older individuals, underscoring the need for effective treatments of BD depression in older people. This international collaboration lays a path for the development of a better understanding of aging in BD.
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Affiliation(s)
- Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Annemiek Dols
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Soham Rej
- Lady Davis Institute, McGill University, Montreal, Canada
| | | | - Alexandra J.M. Beunders
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Hilary P. Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farren B.S. Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Brent P. Forester
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts, USA and Harvard Medical School, Boston, MA
| | - Regan E. Patrick
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Orestes V. Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Benoit Mulsant
- Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada
| | - Sigfried Schouws
- GGZ ingest, Amsterdam UMC, VU Medical Center, Amsterdam, the Netherlands
| | - Nadine Paans
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Sergio Strejilevich
- AREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina
| | - Ashley Sutherland
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Shangying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Betsy Wilson
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lisa T. Eyler
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA
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23
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Damiano RF, Caruso MJG, Cincoto AV, de Almeida Rocca CC, de Pádua Serafim A, Bacchi P, Guedes BF, Brunoni AR, Pan PM, Nitrini R, Beach S, Fricchione G, Busatto G, Miguel EC, Forlenza OV. Post-COVID-19 psychiatric and cognitive morbidity: Preliminary findings from a Brazilian cohort study. Gen Hosp Psychiatry 2022; 75:38-45. [PMID: 35134702 PMCID: PMC8734055 DOI: 10.1016/j.genhosppsych.2022.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The present study aims to investigate the occurrence of psychiatric and cognitive impairments in a cohort of survivors of moderate or severe forms of COVID-19. METHOD 425 adults were assessed 6 to 9 months after hospital discharge with a structured psychiatric interview, psychometric tests and a cognitive battery. A large, multidisciplinary, set of clinical data depicting the acute phase of the disease, along with relevant psychosocial variables, were used to predict psychiatric and cognitive outcomes using the 'Least Absolute Shrinkage and Selection Operator' (LASSO) method. RESULTS Diagnoses of 'depression', 'generalized anxiety disorder' and 'post-traumatic stress disorder' were established respectively in 8%, 15.5% and 13.6% of the sample. After pandemic onset (i.e., within the previous year), the prevalence of 'depression' and 'generalized anxiety disorder' were 2.56% and 8.14%, respectively. Memory decline was subjectively reported by 51.1% of the patients. Psychiatric or cognitive outcomes were not associated with any clinical variables related to the severity of acute-phase disease, nor by disease-related psychosocial stressors. CONCLUSIONS This is the first study to access rates of psychiatric and cognitive morbidity in the long-term outcome after moderate or severe forms of COVID-19 using standardized measures. As a key finding, there was no significant association between clinical severity in the acute-phase of SARS-CoV-2 infection and the neuropsychiatric impairment 6 to 9 months thereafter.
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Affiliation(s)
- Rodolfo Furlan Damiano
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil.
| | - Maria Julia Guimarães Caruso
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Alissom Vitti Cincoto
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Cristiana Castanho de Almeida Rocca
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Antonio de Pádua Serafim
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Pedro Bacchi
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Bruno F. Guedes
- Departamento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - André R. Brunoni
- Centro de Pesquisas Clínicas e Epidemiológicas, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil,Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil,Departamento e Instituto de Psiquiatria, Laboratory of Neurosciences (LIM-27), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil,Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Pedro Mario Pan
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ricardo Nitrini
- Departamento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Scott Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Geraldo Busatto
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Euripedes Constantino Miguel
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
| | - Orestes V. Forlenza
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brazil
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24
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Stella F, Pais MV, Loureiro JC, Radanovic M, Forlenza OV. Neuropsychiatric symptoms and cerebrovascular risk in non-demented elders: cross-sectional study using the mild behavioural impairment checklist (MBI-C). Psychogeriatrics 2022; 22:55-66. [PMID: 34704636 DOI: 10.1111/psyg.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/20/2021] [Accepted: 10/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) may represent early clinical manifestations of evolving brain diseases. Studies underpin the occurrence of NPS in the context of mild cognitive impairment (MCI) and prodromal Alzheimer's disease, where symptoms referred to as 'mild behavioural impairment' (MBI) have been shown to predict conversion to dementia and to hasten cognitive/functional decline. However, the association between NPS and cerebrovascular risk factors has been poorly investigated, despite the high prevalence of the latter among individuals with MCI. The aim of the present study was to investigate the association between MBI and cerebrovascular risk in a clinical sample of non-demented elders. METHODS Sixty-five MCI and 15 cognitively unimpaired older adults were cross-sectionally assessed with the Mild Behavioural Impairment Checklist (MBI-C), using the cut-off score > 6.5 to define positive screening. Participants were submitted to the Hachinski Ischaemic Score (HIS) to account for cerebrovascular symptoms, vascular risk, and related comorbidities. Neuroimaging scans (magnetic resonance imaging and/or 18F-fluorodeoxyglucose-positron emission tomography) and apolipoprotein E genotype were obtained. RESULTS Positive associations were found between total MBI-C scores and increasing number of comorbidities present (0-2 comorbidities), but not with three comorbidities. Two domains of the MBI-C-impulse dyscontrol and social inappropriateness-followed the same trend of the MBI-C total score, with higher scores with the increasing numbers of comorbidities. No significant associations were found between MBI symptoms and HIS or cerebrovascular burden in neuroimaging assessment. CONCLUSION We found weak associations between MBI-C total score and the presence of comorbidities with cerebrovascular risk, but not with structural or functional neuroimaging abnormalities or HIS. This finding may represent that the presence of comorbidities adds limited risk to the occurrence of MBI in this sample of non-demented elders.
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Affiliation(s)
- Florindo Stella
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil.,UNESP-Universidade Estadual Paulista, Instituto de Biociências, Sao Paulo, Brazil
| | - Marcos V Pais
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| | - Júlia C Loureiro
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| | - Marcia Radanovic
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
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25
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De-Paula VJ, Forlenza OV. Lithium modulates multiple tau kinases with distinct effects in cortical and hippocampal neurons according to concentration ranges. Naunyn Schmiedebergs Arch Pharmacol 2021; 395:105-113. [PMID: 34751792 DOI: 10.1007/s00210-021-02171-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
The hyperphosphorylation of tau is a central mechanism in the pathogenesis of Alzheimer's disease (AD). Lithium is a potent inhibitor of glycogen synthase kinase-3beta (GSK3β), the most important tau kinase in neurons, and may also affect tau phosphorylation by modifying the expression and/or activity of other kinases, such as protein kinase A (PKA), Akt (PKB), and calcium calmodulin kinase-II (CaMKII). The aim of the present study is to determine the effect of chronic lithium treatment on the protein expression of tau and its major kinases in cortical and hippocampal neurons, at distinct working concentrations. Primary cultures of cortical and hippocampal neurons were treated with sub-therapeutic (0.02 mM and 0.2 mM) and therapeutic (2 mM) concentrations of lithium for 7 days. Protein expression of tau and tau-kinases was determined by immunoblotting. An indirect estimate of GSK3β activity was determined by the GSK3β ratio (rGSKβ). Statistically significant increments in the protein expression of tau and CaMKII were observed both in cortical and hippocampal neurons treated with subtherapeutic doses of lithium. GSK3β activity was increased in cortical, but decreased in hippocampal neurons. Distinct patterns of changes in the expression of the remaining tau tau-kinases were observed: in cortical neurons, lithium treatment was associated with consistent decrements in Akt and PKA, whereas hippocampal neurons displayed increased protein expression of Akt and decreased PKA. Our results suggest that chronic lithium treatment may yield distinct biological effects depending on the concentration range, with regional specificity. We further suggest that hippocampal neurons may be more sensitive to the effect of lithium, presenting with changes in the expression of tau-related proteins at subtherapeutic doses, which may not be mirrored by the effects observed in cortical neurons.
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Affiliation(s)
- V J De-Paula
- Laboratório de Neurociências (LIM-27), Departamento E Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
- Laboratório de Psicobiologia (LIM-23), Instituto de Psiquiatria, Hospital das Clinicas da Faculdade de Medicina da USP, Rua Dr. Ovídio Pires de Campos 785, São Paulo, SP, 05403-903, Brazil.
| | - O V Forlenza
- Laboratório de Neurociências (LIM-27), Departamento E Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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26
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Damiano RF, Di Santi T, Beach S, Pan PM, Lucchetti AL, Smith FA, Forlenza OV, Fricchione GL, Miguel EC, Lucchetti G. Mental health interventions following COVID-19 and other coronavirus infections: a systematic review of current recommendations and meta-analysis of randomized controlled trials. Braz J Psychiatry 2021; 43:665-678. [PMID: 33852690 PMCID: PMC8639008 DOI: 10.1590/1516-4446-2020-1582] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/07/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To review the most common mental health strategies aimed at alleviating and/or preventing mental health problems in individuals during the coronavirus disease 2019 (COVID-19) and other coronavirus pandemics. METHODS We conducted a systematic review of the literature assessing three databases (PubMed, SCOPUS, and PsycINFO). A meta-analysis was performed with data from randomized controlled trials (RCTs). For non-RCT studies, a critical description of recommendations was performed. RESULTS From a total of 2,825 articles, 125 were included. Of those, three RCTs were included in the meta-analysis. The meta-analysis revealed that the interventions promoted better overall mental health outcomes as compared to control groups (standardized mean difference [SMD] = 0.87 [95%CI 0.33-1.41], p < 0.001, I2 = 69.2%), but did not specifically improve anxiety (SMD = 0.98 [95%CI -0.17 to 2.13], p > 0.05; I2 = 36.8%). Concerning the systematic review, we found a large body of scientific literature proposing recommendations involving psychological/psychiatric interventions, self-care, education, governmental programs, and the use of technology and media. CONCLUSIONS We found a large body of expert recommendations that may help health practitioners, institutional and governmental leaders, and the general population cope with mental health issues during a pandemic or a crisis period. However, most articles had a low level of evidence, stressing the need for more studies with better design (especially RCTs) investigating potential mental health interventions during COVID-19. PROSPERO REGISTRATION CRD42020190212.
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Affiliation(s)
- Rodolfo F. Damiano
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Talita Di Santi
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Scott Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Pedro M. Pan
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Alessandra L. Lucchetti
- Departamento de Medicina, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Felicia A. Smith
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Orestes V. Forlenza
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gregory L. Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Eurípedes C. Miguel
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Giancarlo Lucchetti
- Departamento de Medicina, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
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27
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Ibarra R, Radanovic M, Pais MV, Talib LL, Forlenza OV. AD-Related CSF Biomarkers Across Distinct Levels of Cognitive Impairment: Correlations With Global Cognitive State. J Geriatr Psychiatry Neurol 2021; 34:659-667. [PMID: 32757819 DOI: 10.1177/0891988720944237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM Associations between cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease (AD) with the severity of cognitive impairment are unclear. We examined the correlations between CSF biomarkers and cognitive performance in the AD continuum. METHODS We studied 143 elderly patients: cognitively unimpaired (n = 51), mild cognitive impairment (MCI) amnestic (n = 55) and nonamnestic (n = 20), and mild AD (n = 17) assessed with the Cambridge Cognitive Test (CAMCOG). We correlated total CAMCOG and its subdomains with CSF Aβ42, T-tau, p-tau levels, and Aβ42/p-tau. RESULTS In the total sample, T-tau and Aβ42/p-tau correlated with the total CAMCOG (P < .01); all biomarkers correlated with memory (P < .001); T-tau correlated with language (P < .01). CONCLUSION Memory and T-tau levels may be the most suitable parameters to reflect cognitive/CSF biomarker correlations. At present, such correlations are of little use in routine clinical practice.
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Affiliation(s)
- Romel Ibarra
- Laboratorio de Neurociencias (LIM-27), Faculdade de Medicina, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Brazil
| | - Marcia Radanovic
- Laboratorio de Neurociencias (LIM-27), Faculdade de Medicina, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Brazil
| | - Marcos V Pais
- Laboratorio de Neurociencias (LIM-27), Faculdade de Medicina, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Brazil
| | - Leda L Talib
- Laboratorio de Neurociencias (LIM-27), Faculdade de Medicina, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Brazil
| | - Orestes V Forlenza
- Laboratorio de Neurociencias (LIM-27), Faculdade de Medicina, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Brazil
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Rocha NKR, Themoteo R, Brentani H, Forlenza OV, De Paula VDJR. Corrigendum: Neuronal-Glial Interaction in a Triple-Transgenic Mouse Model of Alzheimer's Disease: Gene Ontology and Lithium Pathways. Front Neurosci 2021; 15:726983. [PMID: 34630017 PMCID: PMC8495629 DOI: 10.3389/fnins.2021.726983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Nicole Kemberly R Rocha
- Laboratório de Psicobiologia (LIM23), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rafael Themoteo
- Laboratorio de Neurociencias (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Helena Brentani
- Laboratório de Psicobiologia (LIM23), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Orestes V Forlenza
- Laboratorio de Neurociencias (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vanessa De Jesus Rodrigues De Paula
- Laboratório de Psicobiologia (LIM23), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Laboratorio de Neurociencias (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Valiengo L, Maia A, Cotovio G, Gordon PC, Brunoni AR, Forlenza OV, Oliveira-Maia AJ. Repetitive Transcranial Magnetic Stimulation for Major Depressive Disorder in Older Adults: Systematic Review and Meta-Analysis. J Gerontol A Biol Sci Med Sci 2021; 77:851-860. [PMID: 34432865 DOI: 10.1093/gerona/glab235] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Major Depressive Disorder (MDD) in older adults is a serious public health concern. Repetitive transcranial magnetic stimulation (rTMS) is a non-pharmacological intervention approved for Major Depressive Disorder (MDD) treatment in adults, but its value in older adults remains unknown. The present study aims to systematically review and meta-analyze evidence of rTMS efficacy in MDD treatment among older adults. METHODS We systematically reviewed the literature for randomized controlled trials (RCTs) and open-label studies assessing rTMS for the treatment of MDD in patients older than 50 years-old, published until June 2020. Random-effects meta-analyses using standardized mean differences (SMD) were conducted to assess change in depression severity score (primary outcome), while odds-ratios (OR) were used to assess secondary categorical outcomes (response and remission). Additionally, univariate meta-regression analyses were performed to identify potential predictors of change in depression severity scores. RESULTS Fourteen RCTs were included in meta-analyses and 26 studies (10 RCTs and 16 open-label studies) in meta-regression. Active rTMS was significantly superior to sham-treatment for reduction of severity (SMD=0.36; 95%CI=0.13-0.60), as well as response (OR=3.26; 95%CI=2.11-5.04) and remission (OR=4.63; 95%CI=2.24-9.55). Studies were of moderate to high quality, with funnel plots and Egger's regression test not suggestive of publication bias. In meta-regressions, higher mean age and number of sessions were significantly associated to greater improvement. CONCLUSIONS Our results support that rTMS is an effective, safe and well-tolerated treatment for MDD in older adults, and that it should be considered in the treatment of this vulnerable population.
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Affiliation(s)
- Leandro Valiengo
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.,Serviço Interdisciplinar de Neuromodulação (SIN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Ana Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Gonçalo Cotovio
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Pedro C Gordon
- Serviço Interdisciplinar de Neuromodulação (SIN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.,Department of Neurology & Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - André R Brunoni
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.,Serviço Interdisciplinar de Neuromodulação (SIN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Orestes V Forlenza
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Albino J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
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30
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Stella F, Valiengo LCL, de Paula VJR, de Mendonça Lima CA, Forlenza OV. Medical cannabinoids for treatment of neuropsychiatric symptoms in dementia: systematic review. Trends Psychiatry Psychother 2021; 43:243-255. [PMID: 34374269 PMCID: PMC8835388 DOI: 10.47626/2237-6089-2021-0288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/14/2021] [Indexed: 11/20/2022]
Abstract
Introduction Neuropsychiatric symptoms are an integral component of the natural history of dementia, occurring from prodromal to advanced stages of the disease process and causing increased burden and morbidity. Clinical presentations are pleomorphic and clinical management often requires combinations of pharmacological and non-pharmacological interventions. However, limited efficacy and a non-negligible incidence of adverse psychotropic drug events emphasize the need for novel therapeutic options. Objectives To review the evidence supporting use of medical cannabinoids for treatment of neuropsychiatric symptoms (NPS) of dementia. Methods We conducted a systematic review of the medical literature to examine scientific publications reporting use of medical cannabinoids for treatment of NPS. Medical Subject Headings (MeSH) were used to search for relevant publications and only papers reporting original clinical information were included. A secondary search was performed within selected publications to capture relevant citations that were not retrieved by the systematic review. The papers selected were categorized according to the level of evidence generated by the studies in relation to this clinical application, i.e. (1) controlled clinical trials; (2) open-label or observational studies; and (3) case reports. Results Fifteen publications with original clinical data were retrieved: five controlled clinical trials, three open-label/observational studies, and seven case reports. Most studies indicated that use of medical cannabinoids engendered favorable outcomes for treatment of NPS related to moderate and advanced stages of dementia, particularly agitation, aggressive behavior, sleep disorder, and sexual disinhibition. Conclusion Medical cannabinoids constitute a promising pharmacological approach to treatment of NPS with preliminary evidence of benefit in at least moderate to severe dementia. Controlled trials with longitudinal designs and larger samples are required to examine the long-term efficacy of these drugs in different types and stages of dementia, in addition to their adverse events and risk of interactions with other drugs. Many pharmacological details are yet to be determined, such as dosing, treatment duration, and concentrations of active compounds (e.g., cannabidiol [CBD]/ Δ9-tetrahydrocannabinol [THC] ratio) in commercial preparations of medical cannabinoids.
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Affiliation(s)
- Florindo Stella
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil; UNESP - Universidade Estadual Paulista, Instituto de Biociências, Câmpus de Rio Claro, São Paulo, Brazil
| | - Leandro C Lane Valiengo
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| | - Vanessa J R de Paula
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
| | | | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Sao Paulo, Brazil
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31
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Singulani MP, De Paula VJR, Forlenza OV. Mitochondrial dysfunction in Alzheimer's disease: Therapeutic implications of lithium. Neurosci Lett 2021; 760:136078. [PMID: 34161823 DOI: 10.1016/j.neulet.2021.136078] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 01/12/2023]
Abstract
Alzheimer's disease (AD) is one of the most prevalent neurodegenerative diseases, characterized by the accumulation of abnormal tau proteins within neurons and amyloid plaques in the brain parenchyma, which leads to progressive loss of neurons in the brain. While the detailed mechanism of the pathogenesis of AD is still unknown, evidence suggests that mitochondrial dysfunction likely plays a fundamental role in the pathogenesis of this disease. Due to the relevance of mitochondrial alterations in AD, recent works have suggested the therapeutic potential of mitochondrial-targeted lithium. Lithium has been shown to possess neuroprotective and neurotrophic properties that could also be related to the upregulation of mitochondrial function. In the current work, we perform a comprehensive investigation of the significance of mitochondrial dysfunction in AD and pharmacological treatment with lithium as imperative in this pathology, through a brief review of the major findings on the effects of lithium as a therapeutic approach targeting mitochondria in the context of AD.
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Affiliation(s)
- Monique P Singulani
- Laboratory of Neurosciences - LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vanessa J R De Paula
- Laboratory of Neurosciences - LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Orestes V Forlenza
- Laboratory of Neurosciences - LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Doifode T, Giridharan VV, Generoso JS, Bhatti G, Collodel A, Schulz PE, Forlenza OV, Barichello T. The impact of the microbiota-gut-brain axis on Alzheimer's disease pathophysiology. Pharmacol Res 2021; 164:105314. [PMID: 33246175 DOI: 10.1016/j.phrs.2020.105314] [Citation(s) in RCA: 132] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 12/17/2022]
Abstract
The gut microbiota is a complex ecosystem that comprises of more than 100 trillion symbiotic microbial cells. The microbiota, the gut, and the brain form an association, 'the microbiota-gut-brain axis,' and synchronize the gut with the central nervous system and modify the behavior and brain immune homeostasis. The bidirectional communication between gut and brain occurs via the immune system, the vagus nerve, the enteric nervous system, and microbial metabolites, including short-chain fatty acids (SCFAs), proteins, and tryptophan metabolites. Recent studies have implicated the gut microbiota in many neurodegenerative diseases, including Alzheimer's disease (AD). In this review, we present an overview of gut microbiota, including Firmicutes, Bacteroidetes, SCFA, tryptophan, bacterial composition, besides age-related changes in gut microbiota composition, the microbiota-gut-brain axis pathways, the role of gut metabolites in amyloid-beta clearance, and gut microbiota modulation from experimental and clinical AD models. Understanding the role of the microbiota may provide new targets for treatment to delay the onset, progression, or reverse AD, and may help in reducing the prevalence of AD.
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Affiliation(s)
- Tejaswini Doifode
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Vijayasree V Giridharan
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Jaqueline S Generoso
- Experimental Physiopathology Laboratory, Graduate Program in Health Sciences, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Gursimrat Bhatti
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Allan Collodel
- Experimental Physiopathology Laboratory, Graduate Program in Health Sciences, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Paul E Schulz
- Neurocognitive Disorders Center, Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Tatiana Barichello
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Experimental Physiopathology Laboratory, Graduate Program in Health Sciences, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
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33
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De-Paula VJ, Dos Santos CCC, Luque MCA, Ali TM, Kalil JE, Forlenza OV, Cunha-Neto E. Acute and chronic lithium treatment increases Wnt/β-catenin transcripts in cortical and hippocampal tissue at therapeutic concentrations in mice. Metab Brain Dis 2021; 36:193-197. [PMID: 33170418 DOI: 10.1007/s11011-020-00638-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 10/27/2020] [Indexed: 12/27/2022]
Abstract
Lithium activates Wnt/β-catenin signaling leading to stabilization of free cytosolic β-catenin. The aim of the present study is to evaluate the in vivo effect of acute and chronic lithium treatment on the expression of β-catenin target genes, addressing its transcripts HIG2, Bcl-xL, Cyclin D1, c-myc, in cortical and hippocampal tissue from adult mice. Lithium doses were established to yield therapeutic working concentrations. In acute treatment, mice received a 300µL of a 350 mg/kg solution of LiCl by gavage, and were euthanized after 2 h, 6 h and 12 h. To determine the effect of chronic treatment, animals were continuously fed either with chow supplemented with 2 g/kg Li2CO3, or regular chow (controls), being euthanized after 30 days. All animals had access to drinking water and 0.9% saline ad libitum. After acute and chronic treatments samples of peripheral blood were obtained from the tail vein for each animal, and serum concentrations of lithium were determined. All transcripts were up-regulated in cortical and hippocampal tissues of lithium-treated mice, both under acute and chronic treatments. There was a positive correlation between serum lithium concentrations and the increment in the expression of all transcripts. This effect was observed in all time points of the acute treatment (i.e., 2, 6 and 12 hours) and also after 30 days. We conclude that Wnt/β-catenin transcriptional response (HIG2, Bcl-xL, Cyclin D1 and c-myc) is up-regulated in the mouse brain in response to acute and chronic lithium treatment at therapeutic concentrations.
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Affiliation(s)
- Vanessa J De-Paula
- Laboratório de Psicobiologia (LIM23), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil.
- Laboratorio de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil.
- Laboratory of Neuroscience, Department and Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
| | - Carla Cristine C Dos Santos
- Laboratório de Imunologia Clínica e Alergia (LIM60), Divisão de Imunologia Clínica e Alergia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Maria Carolina A Luque
- Laboratório de Imunologia Clínica e Alergia (LIM60), Divisão de Imunologia Clínica e Alergia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
- Laboratorio de Imunologia, Instituto do Coração (InCor), Faculty of Medicine, Universidade de Sao Paulo, SP, Sao Paulo, Brasil
| | - Taccyana M Ali
- Laboratório de Imunologia Clínica e Alergia (LIM60), Divisão de Imunologia Clínica e Alergia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
- Laboratorio de Imunologia, Instituto do Coração (InCor), Faculty of Medicine, Universidade de Sao Paulo, SP, Sao Paulo, Brasil
| | - Jorge E Kalil
- Laboratorio de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
- Laboratorio de Imunologia, Instituto do Coração (InCor), Faculty of Medicine, Universidade de Sao Paulo, SP, Sao Paulo, Brasil
- Instituto de Investigação em Imunologia (iii)-INCT, São Paulo, Brazil
| | | | - Edecio Cunha-Neto
- Laboratório de Imunologia Clínica e Alergia (LIM60), Divisão de Imunologia Clínica e Alergia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
- Laboratorio de Imunologia, Instituto do Coração (InCor), Faculty of Medicine, Universidade de Sao Paulo, SP, Sao Paulo, Brasil
- Instituto de Investigação em Imunologia (iii)-INCT, São Paulo, Brazil
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Rocha NKR, Themoteo R, Brentani H, Forlenza OV, De Paula VDJR. Neuronal-Glial Interaction in a Triple-Transgenic Mouse Model of Alzheimer's Disease: Gene Ontology and Lithium Pathways. Front Neurosci 2020; 14:579984. [PMID: 33335468 PMCID: PMC7737403 DOI: 10.3389/fnins.2020.579984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/30/2020] [Indexed: 12/16/2022] Open
Abstract
Neuronal-glial interactions are critical for brain homeostasis, and disruption of this process may lead to excessive glial activation and inadequate pro-inflammatory responses. Abnormalities in neuronal-glial interactions have been reported in the pathophysiology of Alzheimer’s disease (AD), where lithium has been shown to exert neuroprotective effects, including the up-regulation of cytoprotective proteins. In the present study, we characterize by Gene Ontology (GO) the signaling pathways related to neuronal-glial interactions in response to lithium in a triple-transgenic mouse model of AD (3×-TgAD). Mice were treated for 8 months with lithium carbonate (Li) supplemented to chow, using two dose ranges to yield subtherapeutic working concentrations (Li1, 1.0 g/kg; and Li2, 2.0 g/kg of chow), or with standard chow (Li0). The hippocampi were removed and analyzed by proteomics. A neuronal-glial interaction network was created by a systematic literature search, and the selected genes were submitted to STRING, a functional network to analyze protein interactions. Proteomics data and neuronal-glial interactomes were compared by GO using ClueGo (Cytoscape plugin) with p ≤ 0.05. The proportional effects of neuron-glia interactions were determined on three GO domains: (i) biological process; (ii) cellular component; and (iii) molecular function. The gene ontology of this enriched network of genes was further stratified according to lithium treatments, with statistically significant effects observed in the Li2 group (as compared to controls) for the GO domains biological process and cellular component. In the former, there was an even distribution of the interactions occurring at the following functions: “positive regulation of protein localization to membrane,” “regulation of protein localization to cell periphery,” “oligodendrocyte differentiation,” and “regulation of protein localization to plasma membrane.” In cellular component, interactions were also balanced for “myelin sheath” and “rough endoplasmic reticulum.” We conclude that neuronal-glial interactions are implicated in the neuroprotective response mediated by lithium in the hippocampus of AD-transgenic mice. The effect of lithium on homeostatic pathways mediated by the interaction between neurons and glial cells are implicated in membrane permeability, protein synthesis and DNA repair, which may be relevant for the survival of nerve cells amidst AD pathology.
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Affiliation(s)
- Nicole Kemberly R Rocha
- Laboratório de Psicobiologia (LIM23), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rafael Themoteo
- Laboratorio de Neurociencias (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Helena Brentani
- Laboratório de Psicobiologia (LIM23), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Orestes V Forlenza
- Laboratorio de Neurociencias (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vanessa De Jesus Rodrigues De Paula
- Laboratório de Psicobiologia (LIM23), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Laboratorio de Neurociencias (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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35
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Penteado CT, Loureiro JC, Pais MV, Carvalho CL, Sant'Ana LFG, Valiengo LCL, Stella F, Forlenza OV. Mental Health Status of Psychogeriatric Patients During the 2019 New Coronavirus Disease (COVID-19) Pandemic and Effects on Caregiver Burden. Front Psychiatry 2020; 11:578672. [PMID: 33312138 PMCID: PMC7704440 DOI: 10.3389/fpsyt.2020.578672] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/08/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction: There is a growing awareness about the noxious effects of the 2019 Coronavirus Disease (COVID-19) pandemic on the mental health of the elderly. However, there is limited information from clinically driven research. The objectives of the present study were to examine the magnitude of psychiatric symptoms and to determine their association with caregiver distress, in a cross-section of community-dwelling older adults and a subsample of aging adults with Down syndrome (DS) attending a psychogeriatric service in São Paulo, Brazil. Method: Telephone-based interviews and electronically filled self-assessment questionnaires were used to collect information from patients and caregivers, addressing their impressions and concerns about the pandemic and related effects on the patient's emotional state and behavior. Clinical information was obtained from hospital charts, medical records, and psychometric tests administered through telephone interviews [Hospital Anxiety and Depression Scale (HADS) and Neuropsychiatric Inventory Questionnaire (NPI-Q)]. Results: We included 100 consecutive participants, comprising 71 older adults with psychogeriatric/neurocognitive disorders and 29 aging adults with DS. Higher HADS and NPI-Q scores were significantly associated with caregiver distress (p < 0.05) in both groups. Correlation analyses indicated strong, positive associations between caregiver burden and scores in HADS anxiety (HADS-A) and HADS depression (HADS-D) scales in the subsamples of euploid and DS subjects. Higher NPI-Q scores in the former group were also correlated with caregiver distress, with stronger associations for neuropsychiatric symptoms. Similar findings were observed among DS subjects. ANOVA tests indicated significant associations between NPI-Q scores and caregiver distress among dementia patients, as well as with HADS scores. Similar results were found after multiple linear regressions; as such, among the elderly subsample, higher scores in HADS-A (p = 0.002) and HADS-D (p = 0.001) predict a significant impact on caregiver burden (p < 0.00001, R 2 0.46); taking into consideration caregiver burden as a dependent variable and NPI-Q total score as an independent variable, we obtained significant strong prediction values for either DS (p < 0.00001, R 2 0.95) or elderly adults (p < 0.00001, R 2 0.88). Conclusion: During the COVID-19 pandemic, patients with neurocognitive disorders present with clinically relevant neuropsychiatric symptoms, with significant impact on caregiver distress. Apathy, aberrant motor behavior, sleep disorders, and psychoses were the main psychopathological domains, which had determined caregiver burden worsening.
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Affiliation(s)
- Camila T. Penteado
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | - Julia C. Loureiro
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | - Marcos V. Pais
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | - Cláudia L. Carvalho
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | - Lívea F. G. Sant'Ana
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | - Leandro C. L. Valiengo
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | - Florindo Stella
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | - Orestes V. Forlenza
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
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Forlenza OV, Stella F. Impact of SARS-CoV-2 pandemic on mental health in the elderly: perspective from a psychogeriatric clinic at a tertiary hospital in São Paulo, Brazil. Int Psychogeriatr 2020; 32:1147-1151. [PMID: 32522304 PMCID: PMC7327163 DOI: 10.1017/s1041610220001180] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Orestes V. Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Florindo Stella
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
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Loureiro JC, Pais MV, Forlenza OV. Cognitive impairment: an (in)dependent risk factor for mortality in older men? Braz J Psychiatry 2020; 42:577-578. [PMID: 32876138 PMCID: PMC7678900 DOI: 10.1590/1516-4446-2020-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Júlia C Loureiro
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Marcos V Pais
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Orestes V Forlenza
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Pais M, Martinez L, Ribeiro O, Loureiro J, Fernandez R, Valiengo L, Canineu P, Stella F, Talib L, Radanovic M, Forlenza OV. Early diagnosis and treatment of Alzheimer's disease: new definitions and challenges. Braz J Psychiatry 2020; 42:431-441. [PMID: 31994640 PMCID: PMC7430379 DOI: 10.1590/1516-4446-2019-0735] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/01/2019] [Indexed: 12/14/2022]
Abstract
The prevalence of Alzheimer's disease (AD), a progressive neurodegenerative disorder, is expected to more than double by 2050. Studies on the pathophysiology of AD have been changing our understanding of this disorder and setting a new scenario for drug development and other therapies. Concepts like the "amyloid cascade" and the "continuum of AD," discussed in this article, are now well established. From updated classifications and recommendations to advances in biomarkers of AD, we aim to critically assess the literature on AD, addressing new definitions and challenges that emerged from recent studies on the subject. Updates on the status of major clinical trials are also given, and future perspectives are discussed.
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Affiliation(s)
- Marcos Pais
- Laboratório de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Luana Martinez
- Laboratório de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Octávio Ribeiro
- Laboratório de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Júlia Loureiro
- Laboratório de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Romel Fernandez
- Laboratório de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Leandro Valiengo
- Laboratório de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Paulo Canineu
- Laboratório de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
- Programa de Gerontologia, Pontifícia Universidade Católica de São Paulo (PUC-SP), São Paulo, SP, Brazil
| | - Florindo Stella
- Laboratório de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
- Instituto de Biociências, Universidade Estadual Paulista (UNESP), Rio Claro, SP, Brazil
| | - Leda Talib
- Laboratório de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Marcia Radanovic
- Laboratório de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Orestes V. Forlenza
- Laboratório de Neurociências (LIM27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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39
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Loureiro JC, Stella F, Pais MV, Radanovic M, Canineu PR, Joaquim HPG, Talib LL, Forlenza OV. Cognitive impairment in remitted late-life depression is not associated with Alzheimer's disease-related CSF biomarkers. J Affect Disord 2020; 272:409-416. [PMID: 32553384 DOI: 10.1016/j.jad.2020.03.166] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/23/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cognitive impairment is a common feature of late-life depression (LLD). Early studies using Alzheimer's disease (AD) biomarkers inferred a biological link between AD pathology and LLD, but recent findings have challenged this association. The aim of this investigation was to determine a panel of AD-related cerebrospinal fluid (CSF) biomarkers in a cross-section of elders with mild cognitive impairment (MCI) with and without LLD. METHODS Subjects comprised 102 older adults: 27 with 'pure' amnestic MCI (aMCI), 53 with major depression and cognitive impairment - encompassing 22 late-onset (LOD) and 31 early-onset depression (EOD), and 22 euthymic elders without cognitive impairment (controls). Participants underwent lumbar puncture for determination of CSF concentrations of Aβ1-42, T-tau, and P-tau. Cut-off scores for suspected AD were: Aβ1-42 < 416p g/mL, P-tau > 36.1 pg/mL and Aβ/P-tau ratio < 9.53 (O. V. Forlenza et al. 2015). Statistical analyses consisted of analyses of variance (ANOVA), analyses of covariance (ANCOVA), Bonferroni post-hoc tests, and Pearson's chi-squared tests. RESULTS ANCOVA (age and schooling as covariates) displayed statistically significant results with respect to CSF biomarkers' profiles regardless of the socio-demographic divergencies previously identified by one-way ANOVA. Mean Aβ1-42 values (pg/mL) were: aMCI, 360.3 (p < 0.001); LOD, 486.6 (p < 0.001); EOD, 494.2 (p < 0.001); controls, 528.3 (p < 0.001); p< 0.05. Mean Aβ1-42/P-tau ratio: aMCI, 7.9 (p < 0.001); LOD 14.2 (p < 0.001); EOD, 15.3 (p < 0.001); controls, 17.1 (p < 0.001); p < 0.05. Post-hoc tests indicated that patients with aMCI showed significant differences in biomarker profile compatible with AD signature. LIMITATION The main limitation is the relatively small sample. CONCLUSION Our findings suggest that, distinctively from aMCI, cognitive impairment in LLD is not associated with AD's CSF pathological signature.
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Affiliation(s)
- Júlia C Loureiro
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil.
| | - Florindo Stella
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil; UNESP- Universidade Estadual Paulista, Instituto de Biociências, Rio Claro, SP, Brasil
| | - Marcos V Pais
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Marcia Radanovic
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Paulo R Canineu
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil; Programa de Gerontologia, Pontifícia Universidade Católica de São Paulo, São Paulo, SP, Brasil
| | - Helena P G Joaquim
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Leda L Talib
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Orestes V Forlenza
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
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Costa AC, Joaquim HPG, Forlenza OV, Gattaz WF, Talib LL. Three plasma metabolites in elderly patients differentiate mild cognitive impairment and Alzheimer's disease: a pilot study. Eur Arch Psychiatry Clin Neurosci 2020; 270:483-488. [PMID: 31218445 DOI: 10.1007/s00406-019-01034-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/15/2019] [Indexed: 12/11/2022]
Abstract
The metabolomic profile of patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) may suggest potential diagnostic biomarkers and provide information on the pathophysiology of dementia. Our aim was to quantify plasmatic metabolites of AD patients, MCI and controls. We investigated the metabolomic profile-using the AbsoluteIDQ®p180 assay-of 79 older adults with primary cognitive impairment (34 AD and 20 MCI) and 25 healthy elders (controls). A cluster analysis revealed that a combination C12-DC, C12 and PCaaC26:0 could differentiate the patients according to diagnostic. Future studies should combine metabolomic profiles with other biomarkers to identify diagnostic groups.
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Affiliation(s)
- Alana C Costa
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, 3º andar, Sao Paulo, 05403-010, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Sao Paulo, Brazil
| | - Helena P G Joaquim
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, 3º andar, Sao Paulo, 05403-010, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Sao Paulo, Brazil
| | - Orestes V Forlenza
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, 3º andar, Sao Paulo, 05403-010, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Sao Paulo, Brazil
| | - Wagner F Gattaz
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, 3º andar, Sao Paulo, 05403-010, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Sao Paulo, Brazil
| | - Leda L Talib
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, 3º andar, Sao Paulo, 05403-010, Brazil. .,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Sao Paulo, Brazil.
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Sajatovic M, Eyler LT, Rej S, Almeida OP, Blumberg HP, Forester BP, Forlenza OV, Gildengers A, Mulsant BH, Strejilevich S, Tsai S, Vieta E, Young RC, Dols A. The Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) project: Understanding older-age bipolar disorder by combining multiple datasets. Bipolar Disord 2019; 21:642-649. [PMID: 31081573 DOI: 10.1111/bdi.12795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE There is a dearth of research about the aging process among individuals with bipolar disorder (BD). One potential strategy to overcome the challenge of interpreting findings from existing limited older-age bipolar disorder (OABD) research studies is to pool or integrate data, taking advantage of potential overlap or similarities in assessment methods and harmonizing or cross-walking measurements where different measurement tools are used to evaluate overlapping construct domains. This report describes the methods and initial start-up activities of a first-ever initiative to create an integrated OABD-focused database, the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) project. METHODS Building on preliminary work conducted by members of the International Society for Bipolar Disorders OABD taskforce, the GAGE-BD project will be operationalized in four stages intended to ready the dataset for hypothesis-driven analyses, establish a consortium of investigators to guide exploration, and set the stage for prospective investigation using a common dataset that will facilitate a high degree of generalizability. RESULTS Initial efforts in GAGE-BD have brought together 14 international investigators representing a broad geographic distribution and data on over 1,000 OABD. Start-up efforts include communication and guidance on meeting regulatory requirements, establishing a Steering Committee to guide an incremental analysis strategy, and learning from existing multisite data collaborations and other support resources. DISCUSSION The GAGE-BD project aims to advance understanding of associations between age, BD symptoms, medical burden, cognition and functioning across the life span and set the stage for future prospective research that can advance the understanding of OABD.
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Affiliation(s)
- Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, California.,Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California
| | - Soham Rej
- Lady Davis Insitute, McGill University, Montreal, Canada
| | | | | | - Brent P Forester
- McLean Hospital, Belmont, Massachusetts.,Harvard Medical School, Boston, MA
| | - Orestes V Forlenza
- Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ariel Gildengers
- Ariel Gildengers, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Benoit H Mulsant
- Department of Psychiatry, Center for Addiction & Mental Health, University of Toronto, Toronto, Canada
| | - Sergio Strejilevich
- AREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina
| | - Shangying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Eduard Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Robert C Young
- Weill Cornell Medicine and New York-Presbyterian Hospital, White Plains, New York
| | - Annemiek Dols
- GGZ inGeest, Amsterdam UMC, location VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Radanovic M, Oshiro CA, Freitas TQ, Talib LL, Forlenza OV. Correlation between CSF biomarkers of Alzheimer's disease and global cognition in a psychogeriatric clinic cohort. Braz J Psychiatry 2019; 41:479-484. [PMID: 31166546 PMCID: PMC6899355 DOI: 10.1590/1516-4446-2018-0296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/05/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The relationship between biomarkers of amyloid-beta aggregation (Aβ1-42) and/or neurodegeneration (Tau protein) in cerebrospinal fluid (CSF) and cognitive decline is still unclear. We aimed to ascertain whether CSF biomarkers correlate with cognitive performance in healthy and cognitively impaired subjects, starting from clinical diagnoses. METHODS We tested for correlation between CSF biomarkers and Mini-Mental State Examination (MMSE) scores in 208 subjects: 54 healthy controls, 82 with mild cognitive impairment (MCI), 46 with Alzheimer's disease (AD), and 26 with other dementias (OD). RESULTS MMSE correlated weakly with all CSF biomarkers in the overall sample (r = 0.242, p < 0.0006). Aβ1-42 and MMSE correlated weakly in MCI (r = 0.247, p = 0.030), and moderately in OD (r = 0.440, p = 0.027). t-Tau showed a weak inverse correlation with MMSE in controls (r = -0.284, p = 0.043) and MCI (r = -0.241, p = 0.036), and a moderate/strong correlation in OD (r = 0.665), p = 0.0003). p-Tau correlated weakly with MMSE in AD (r = -0.343, p = 0.026) and moderately in OD (r = -0.540, p = 0.0005). The Aβ1-42/p-Tau ratio had a moderate/strong correlation with MMSE in OD (r = 0.597, p = 0.001). CONCLUSION CSF biomarkers correlated best with cognitive performance in OD. t-Tau correlated weakly with cognition in controls and patients with MCI. In AD, only p-Tau levels correlated with cognitive performance. This pattern, which has been reported previously, seems to indicate that CSF biomarkers might not be reliable as indicators of disease severity.
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Affiliation(s)
- Márcia Radanovic
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Carlos A. Oshiro
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Thiago Q. Freitas
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Leda L. Talib
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Orestes V. Forlenza
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Forlenza OV, Radanovic M, Talib LL, Gattaz WF. Clinical and biological effects of long-term lithium treatment in older adults with amnestic mild cognitive impairment: randomised clinical trial. Br J Psychiatry 2019; 215:668-674. [PMID: 30947755 DOI: 10.1192/bjp.2019.76] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Experimental studies indicate that lithium may facilitate neurotrophic/protective responses in the brain. Epidemiological and imaging studies in bipolar disorder, in addition to a few trials in Alzheimer's disease support the clinical translation of these findings. Nonetheless, there is limited controlled data about potential use of lithium to treat or prevent dementia. AIMS To determine the benefits of lithium treatment in patients with amnestic mild cognitive impairment (MCI), a clinical condition associated with high risk for Alzheimer's disease. METHOD A total of 61 community-dwelling, physically healthy, older adults with MCI were randomised to receive lithium or placebo (1:1) for 2 years (double-blind phase), and followed-up for an additional 24 months (single-blinded phase) (trial registration at clinicaltrials.gov: NCT01055392). Lithium carbonate was prescribed to yield subtherapeutic concentrations (0.25-0.5 mEq/L). Primary outcome variables were the cognitive (Alzheimer's Disease Assessment Scale - cognitive subscale) and functional (Clinical Dementia Rating - Sum of Boxes) parameters obtained at baseline and after 12 and 24 months. Secondary outcomes were neuropsychological test scores; cerebrospinal fluid (CSF) concentrations of Alzheimer's disease-related biomarkers determined at 0, 12 and 36 months; conversion rate from MCI to dementia (0-48 months). RESULTS Participants in the placebo group displayed cognitive and functional decline, whereas lithium-treated patients remained stable over 2 years. Lithium treatment was associated with better performance on memory and attention tests after 24 months, and with a significant increase in CSF amyloid-beta peptide (Aβ1-42) after 36 months. CONCLUSIONS Long-term lithium attenuates cognitive and functional decline in amnestic MCI, and modifies Alzheimer's disease-related CSF biomarkers. The present data reinforces the disease-modifying properties of lithium in the MCI-Alzheimer's disease continuum. DECLARATION OF INTEREST None.
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Affiliation(s)
- Orestes V Forlenza
- Laboratorio de Neurociencias (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Márcia Radanovic
- Laboratorio de Neurociencias (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Leda L Talib
- Laboratorio de Neurociencias (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Wagner F Gattaz
- Laboratorio de Neurociencias (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
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44
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Vacas SM, Stella F, Loureiro JC, Simões do Couto F, Oliveira-Maia AJ, Forlenza OV. Noninvasive brain stimulation for behavioural and psychological symptoms of dementia: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2019; 34:1336-1345. [PMID: 30246461 DOI: 10.1002/gps.5003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 07/30/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pharmacological and conventional nonpharmacological treatments for behavioural and psychological symptoms of dementia (BPSD) have only modest efficacy. Furthermore, pharmacotherapy carries the risk of important side effects. Noninvasive brain stimulation (repetitive transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS)) are valuable and safe for cognitive function in Alzheimer disease (AD). However, there have been few studies, and there is no consensus, regarding the use of these techniques to treat BPSD. METHODS We performed a systematic review of the literature and meta-analysis of studies reporting the effect of rTMS or tDCS on BPSD. RESULTS Seven articles were included: five randomized, controlled clinical trials and two open-label clinical trials. Five studies investigated the effects of rTMS and two the effects of tDCS. Both studies using tDCS reported no evidence of efficacy on BPSD, while two of the three RCTs using rTMS found statistically significant benefits. In an exploratory meta-analysis with four of the RCT studies, we did not find evidence of efficacy of noninvasive brain stimulation techniques, with an overall effect of -0.02 (95% CI = -0.90, 0.94; I2 = 85%). However, when we used only the data from the studies that applied rTMS, we found a positive effect on BPSD, with an overall effect of -0.58 (95% CI = -1.02, -0.14; I2 = 0%). With regards to the adverse effects reported, these were mild and not clinically relevant. CONCLUSIONS Our results establish a tendency for efficacy of rTMS protocols on BPSD, while corroborating their safety and tolerability, suggesting the need for further research.
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Affiliation(s)
- Sara M Vacas
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Hospital Beatriz Ângelo, Loures, Portugal
| | - Florindo Stella
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.,Biosciences Institute, Universidade Estadual Paulista (UNESP), Sao Paulo, SP, Brazil
| | - Julia C Loureiro
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Frederico Simões do Couto
- Dementia Study Group, Institute of Molecular Medicine, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Psychiatry and Psychology Departments, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,NOVA School of Medicine, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Orestes V Forlenza
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Faria DDP, Duran FL, Squarzoni P, Coutinho AM, Garcez AT, Santos PP, Brucki SM, de Oliveira MO, Trés ES, Forlenza OV, Nitrini R, Buchpiguel CA, Busatto Filho G. Topography of 11C-Pittsburgh compound B uptake in Alzheimer's disease: a voxel-based investigation of cortical and white matter regions. ACTA ACUST UNITED AC 2018; 41:101-111. [PMID: 30540022 PMCID: PMC6781685 DOI: 10.1590/1516-4446-2017-0002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 07/06/2018] [Indexed: 01/09/2023]
Abstract
Objective: To compare results of positron emission tomography (PET) with carbon-11-labeled Pittsburgh compound B (11C-PIB) obtained with cerebellar or global brain uptake for voxel intensity normalization, describe the cortical sites with highest tracer uptake in subjects with mild Alzheimer’s disease (AD), and explore possible group differences in 11C-PIB binding to white matter. Methods: 11C-PIB PET scans were acquired from subjects with AD (n=17) and healthy elderly controls (n=19). Voxel-based analysis was performed with statistical parametric mapping (SPM). Results: Cerebellar normalization showed higher 11C-PIB uptake in the AD group relative to controls throughout the cerebral cortex, involving the lateral temporal, orbitofrontal, and superior parietal cortices. With global uptake normalization, greatest cortical binding was detected in the orbitofrontal cortex; decreased 11C-PIB uptake in white matter was found in the posterior hippocampal region, corpus callosum, pons, and internal capsule. Conclusion: The present case-control voxelwise 11C-PIB PET comparison highlighted the regional distribution of amyloid deposition in the cerebral cortex of mildly demented AD patients. Tracer uptake was highest in the orbitofrontal cortex. Decreased 11C-PIB uptake in white-matter regions in this patient population may be a marker of white-matter damage in AD.
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Affiliation(s)
- Daniele de P Faria
- Laboratório de Medicina Nuclear (LIM 43), Departamento de Radiologia e Oncologia, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil
| | - Fabio L Duran
- Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil.,Laboratório de Neuroimagem em Psiquiatria (LIM 21), Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Paula Squarzoni
- Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil.,Laboratório de Neuroimagem em Psiquiatria (LIM 21), Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Artur M Coutinho
- Laboratório de Medicina Nuclear (LIM 43), Departamento de Radiologia e Oncologia, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil
| | - Alexandre T Garcez
- Laboratório de Medicina Nuclear (LIM 43), Departamento de Radiologia e Oncologia, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil
| | - Pedro P Santos
- Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil.,Laboratório de Neuroimagem em Psiquiatria (LIM 21), Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Sonia M Brucki
- Departamento de Neurologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Maira O de Oliveira
- Departamento de Neurologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Eduardo S Trés
- Departamento de Neurologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Orestes V Forlenza
- Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil.,Laboratório de Neurociências (LIM 27), Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Ricardo Nitrini
- Departamento de Neurologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Carlos A Buchpiguel
- Laboratório de Medicina Nuclear (LIM 43), Departamento de Radiologia e Oncologia, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil
| | - Geraldo Busatto Filho
- Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil.,Laboratório de Neuroimagem em Psiquiatria (LIM 21), Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
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Stella F, Loureiro JC, Pais MV, Canineu PR, Forlenza OV. Safety Limits of Antidepressant Use Plus Combinations: Focus on Cardiovascular Function. Curr Drug Metab 2018; 19:641-652. [PMID: 29283067 DOI: 10.2174/1389200219666171227203225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 10/27/2017] [Accepted: 11/01/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Antidepressants have been widely prescribed for depression, anxiety, sleep disorders, and in the management of behavioural symptoms of adult-old patients. Although generally safe, newer generation antidepressants are not devoid of the risk of inducing clinically relevant adverse events. OBJECTIVES To investigate the association between newer generation antidepressants and the occurrence of cardiovascular adverse events and electrocardiogram (ECG) abnormalities. METHOD Studies were included in the review according to the following criteria: a) clinical trials (placebo-controlled or not) or case reports; b) short- or long-term interventions with antidepressants; c) prescription of newer generation antidepressants as first-line treatment; d) samples of adult or adult-old patients. From a total of 301 articles addressing the association between antidepressants and cardiovascular adverse events as primary or secondary outcomes, we selected 30 controlled clinical trials and 10 case reports. RESULTS In most clinical studies, the effects of antidepressants on cardiac function are usually computed as secondary outcome variables, however with limited information. Conversely, case reports tend to present more comprehensive sets of clinical and laboratorial parameters, but the generalization of such data is limited by the small number of observations. The occurrence of QTc prolongation (with increased risk of torsade de pointes) has been reported. Aging, higher dosages of antidepressants, drug interaction, and pre-existing cardiovascular comorbidities were found as risk factors for the aforementioned cardiovascular and ECG abnormalities. CONCLUSION Prescribing antidepressants requires caution given their potential impact on cardiac function, and the clinician should carefully monitor cardiovascular and ECG parameters particularly in cases with underlying heart disease.
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Affiliation(s)
- Florindo Stella
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.,UNESP - Universidade Estadual Paulista, Instituto de Biociências, Rio Claro, SP, Brazil
| | - Julia C Loureiro
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marcos V Pais
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Paulo R Canineu
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.,Gerontology Program, Pontifícia Universidade Católica (PUC-SP), Sao Paulo, Brazil
| | - Orestes V Forlenza
- Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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de J.R. De-Paula V, Forlenza AS, Forlenza OV. Relevance of gutmicrobiota in cognition, behaviour and Alzheimer’s disease. Pharmacol Res 2018; 136:29-34. [DOI: 10.1016/j.phrs.2018.07.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 05/30/2018] [Accepted: 07/10/2018] [Indexed: 12/22/2022]
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Radanovic M, Facco G, Forlenza OV. Sensitivity and specificity of a briefer version of the Cambridge Cognitive Examination (CAMCog-Short) in the detection of cognitive decline in the elderly: An exploratory study. Int J Geriatr Psychiatry 2018; 33:769-778. [PMID: 29411413 DOI: 10.1002/gps.4857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 12/15/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To create a reduced and briefer version of the widely used Cambridge Cognitive Examination (CAMCog) battery as a concise cognitive test to be used in primary and secondary levels of health care to detect cognitive decline. Our aim was to reduce the administration time of the original test while maintaining its diagnostic accuracy. METHODS On the basis of the analysis of 835 CAMCog tests performed by 429 subjects (107 controls, 192 mild cognitive impairment [MCI], and 130 dementia patients), we extracted items that most contributed to intergroup differentiation, according to 2 educational levels (≤8 and >8 y of formal schooling). RESULTS The final 33-item "low education" and 24-item"high education" CAMCog-Short correspond to 48.5% and 35% of the original version and yielded similar rates of accuracy: area under ROC curves (AUC) > 0.9 in the differentiation between controls × dementia and MCI × dementia (sensitivities > 75%; specificities > 90%); AUC > 0.7 for the differentiation between controls and MCI (sensitivities > 65%; specificities > 75%). CONCLUSIONS The CAMCog-Short emerges as a promising tool for a brief, yet sufficiently accurate, screening tool for use in clinical settings. Further prospective studies designed to validate its diagnostic accuracy are needed.
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Affiliation(s)
- Marcia Radanovic
- Laboratorio de Neurociencias (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Giuliana Facco
- Laboratorio de Neurociencias (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Orestes V Forlenza
- Laboratorio de Neurociencias (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Santos GD, Ladeira RB, Almeida JG, Aprahamian I, Forlenza OV, Lafer B, Nunes PV. Caregiver burden regarding elderly with bipolar disorder: An underrecognized problem. Gen Hosp Psychiatry 2018; 51:134-135. [PMID: 29157952 DOI: 10.1016/j.genhosppsych.2017.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/29/2017] [Accepted: 10/30/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Glenda D Santos
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
| | - Rodolfo B Ladeira
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Jouce G Almeida
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ivan Aprahamian
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Orestes V Forlenza
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Beny Lafer
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Paula V Nunes
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Ciasca EC, Ferreira RC, Santana CLA, Forlenza OV, Dos Santos GD, Brum PS, Nunes PV. Art therapy as an adjuvant treatment for depression in elderly women: a randomized controlled trial. ACTA ACUST UNITED AC 2018; 40:256-263. [PMID: 29412335 PMCID: PMC6899401 DOI: 10.1590/1516-4446-2017-2250] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/18/2017] [Indexed: 11/23/2022]
Abstract
Objective: There are few quantitative studies on art therapy for the treatment of depression. The objective of this study was to evaluate if art therapy is beneficial as an adjuvant treatment for depression in the elderly. Methods: A randomized, controlled, single-blind study was carried out in a sample of elderly women with major depressive disorder (MDD) stable on pharmacotherapy. The experimental group (EG) was assigned to 20 weekly art therapy sessions (90 min/session). The control group (CG) was not subjected to any adjuvant intervention. Patients were evaluated at baseline and after 20 weeks, using the Geriatric Depression Scale (GDS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and cognitive measures. Results: Logistic regression analysis adjusted for age revealed that women in EG (n=31) had significant improvement in GDS (p = 0.007), BDI (p = 0.025), and BAI (p = 0.032) scores as compared with controls (n=25). No difference was found in the cognitive measures. Conclusion: Art therapy as an adjunctive treatment for MDD in the elderly can improve depressive and anxiety symptoms. Clinical trial registration: RBR-2YXY7Z
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Affiliation(s)
- Eliana C Ciasca
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), SãoPaulo, SP, Brazil
| | - Rita C Ferreira
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), SãoPaulo, SP, Brazil
| | - Carmen L A Santana
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), SãoPaulo, SP, Brazil
| | - Orestes V Forlenza
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), SãoPaulo, SP, Brazil
| | - Glenda D Dos Santos
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), SãoPaulo, SP, Brazil
| | - Paula S Brum
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo (FMUSP), SãoPaulo, SP, Brazil
| | - Paula V Nunes
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), SãoPaulo, SP, Brazil
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