Does the number of previous mood episodes moderate the relationship between alcohol use, smoking and mood in bipolar outpatients?

BACKGROUND

Evidence suggests that alcohol use and smoking are negatively associated with mood in bipolar disorders (BD). It is unknown if this relationship is moderated by the number of previous mood episodes. Therefore, this paper aims to examine whether the number of previous mood episodes moderates the relationship between alcohol use and smoking, and mood.

METHOD

This study assessed the outcomes of 108 outpatients with BD I and II in a prospective observational cohort study. For 1 year, subjects daily registered mood symptoms and substance use with the prospective Life Chart Method. The relationship between the average daily consumption of alcohol and tobacco units in the whole year and mood were examined by multiple linear regression analyses. Number of previous mood episodes, grouped into its quartiles, was added as effect moderator. Outcome was the number of depressive, hypomanic and manic days in that year.

RESULTS

The number of depressive days in a year increased by 4% (adjusted β per unit tobacco = 1.040; 95% CI 1.003-1.079; p = 0.033) per unit increase in average daily tobacco consumption in that same year. Interaction analyses showed that in those subjects with less than 7 previous mood episodes, the number of manic and hypomanic days increased by 100.3% per unit increase in alcohol consumption (adjusted β per unit alcohol = 2.003; 95% CI 1.225-3.274; p = 0.006). In those with 7 to 13 previous mood episodes, the number of manic and hypomanic days decreased by 28.7% per unit increase in alcohol consumption (adjusted β per unit alcohol = 0.713; 95% CI 0.539-0.944; p = 0.019); and in subjects with 14 to 44 previous mood episodes, the number of manic and hypomanic days decreased by 7.2% per unit increase in tobacco consumption (adjusted β per unit tobacco = 0.928; 95% CI 0.871-0.989; p = 0.021).

CONCLUSIONS

The number of previous mood episodes moderates the relationship between alcohol use and smoking and mood; and smoking is adversely associated with the number of depressive days.

Increased Metabolic Activity in Nucleus Basalis of Meynert Neurons in Elderly Individuals With Mild Cognitive Impairment as Indicated by the Size of the Golgi Apparatus

In this study, we examined the metabolic activity of nucleus basalis of Meynert (NBM) neurons in individuals clinically diagnosed with no cognitive impairment (NCI, n = 8), mild cognitive impairment (MCI, n = 9), and subjects with moderate Alzheimer disease (AD, n = 7). We used Golgi apparatus (GA) size as a measure of neuronal metabolic activity. Subjects with MCI showed increased NBM metabolic activity; they had significantly more neurons with larger GA size as compared with NCI and AD subjects. In contrast, more NBM neurons with extremely small GA sizes, indicating reduced metabolic activity, were seen in AD. When these cases were classified according to their AD pathology (Braak I-II, III-IV, or V-VI), Braak III-IV subjects showed significantly increased GA sizes, comparable with the increase in clinically diagnosed MCI, whereas in Braak V-VI, GA sizes were dramatically reduced. Of all MCI and NCI subjects with similar Braak III-IV pathology, the MCI subjects again had significantly larger GA sizes. The larger NBM neuronal GA size seen in MCI suggests increased metabolic activity, associated with both the clinical progression from NCI to MCI, and with the early stages of AD pathology.