5501
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Schmidt F, Janssen G, Martin G, Lorenz R, Loeschke K, Soyka M, Folwaczny C, Schaefer M. Factors influencing long-term changes in mental health after interferon-alpha treatment of chronic hepatitis C. Aliment Pharmacol Ther 2009; 30:1049-59. [PMID: 19691667 DOI: 10.1111/j.1365-2036.2009.04123.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Antiviral treatment with interferon-alpha (IFN-alpha) is associated with several acute psychiatric side effects. Little is known about long-term effects on mental health after treatment independent from viral response and the influence of pre-existing psychiatric risk-factors. AIM To evaluate long-term effects of antiviral treatment with interferon-alpha (IFN-alpha) on mental health in patients with psychiatric risk factors. METHOD We prospectively investigated long-term mental health changes in 81 hepatitis C virus-infected patients. Psychiatric outcome was measured with the Montgomery-Asberg Depression Scale (MADRS), Brief Psychiatric Rating Scale, the Global Social Functioning Scale and the Global Clinical Impression Scale 6 months after the end of antiviral treatment with IFN-alpha and ribavirin. RESULTS Six months after antiviral therapy, 49% of the patients showed a worsening and 27.2% an improvement of depression scores. The most important predictor for a long-term improvement of depression scores was a pre-treatment MADRS score > or =5 (OR 14.21, 95% CI: 2.51-81.30). Patients with pre-existing psychiatric disorders (OR = 0.117, 95% CI: 0.024-0.558), methadone substitution (OR = 0.20, 95% CI: 0.045-0.887) or genotype 2/3 (OR = 0.341, 95% CI: 0.138-0.845) were significantly less likely to show a long-term worsening of depressive symptoms. CONCLUSIONS Pre-existing psychiatric risk factors increase the chance for a long-term improvement and reduce the risk for a long-term worsening of mental health after antiviral treatment of chronic hepatitis C with IFN-alpha.
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Affiliation(s)
- F Schmidt
- Department of Psychiatry, Ludwig-Maximilians University, Munich, Germany
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5502
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Belforte JE, Zsiros V, Sklar ER, Jiang Z, Yu G, Li Y, Quinlan EM, Nakazawa K. Postnatal NMDA receptor ablation in corticolimbic interneurons confers schizophrenia-like phenotypes. Nat Neurosci 2009; 13:76-83. [PMID: 19915563 DOI: 10.1038/nn.2447] [Citation(s) in RCA: 585] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 10/07/2009] [Indexed: 12/13/2022]
Abstract
Cortical GABAergic dysfunction may underlie the pathophysiology of psychiatric disorders, including schizophrenia. Here, we characterized a mouse strain in which the essential NR1 subunit of the NMDA receptor (NMDAR) was selectively eliminated in 40-50% of cortical and hippocampal interneurons in early postnatal development. Consistent with the NMDAR hypofunction theory of schizophrenia, distinct schizophrenia-related symptoms emerged after adolescence, including novelty-induced hyperlocomotion, mating and nest-building deficits, as well as anhedonia-like and anxiety-like behaviors. Many of these behaviors were exacerbated by social isolation stress. Social memory, spatial working memory and prepulse inhibition were also impaired. Reduced expression of glutamic acid decarboxylase 67 and parvalbumin was accompanied by disinhibition of cortical excitatory neurons and reduced neuronal synchrony. Postadolescent deletion of NR1 did not result in such abnormalities. These findings suggest that early postnatal inhibition of NMDAR activity in corticolimbic GABAergic interneurons contributes to the pathophysiology of schizophrenia-related disorders.
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Affiliation(s)
- Juan E Belforte
- Unit on Genetics of Cognition and Behavior, Mood and Anxiety Disorders Program, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
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5503
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Abstract
1 Here I put forth the hypothesis that noradrenaline (NA), which is a signalling molecule in the brain and sympathetic nervous system (SNS), is an aetiological factor in a number of diseases. 2 In a previous paper (Fitzgerald, Int. J. Cancer, 124, 2009, 257), I examined evidence that elevated NA is a factor in various types of cancer. Here I extend the argument to several other diseases, including diabetes mellitus, open-angle glaucoma, osteoarthritis and rheumatoid arthritis and asthma. 3 The principal hypothesis is that, largely as a result of genetics, elevated noradrenergic tone in the SNS predisposes a large number of individuals to a broad range of diseases. 4 For each of the above five diseases, I briefly examine the following four lines of evidence to assess the hypothesis: i) whether pharmacological studies in rodents that manipulate NA levels or receptors affect these diseases; ii) whether pharmacological manipulation of NA in humans affects these diseases; iii) whether bipolar disorder, excessive body weight, and hypertension, which may all three involve elevated NA, tend to be comorbid with these diseases and iv) whether psychological stressors tend to cause or exacerbate these conditions, since psychological stress is associated with increased release of NA. 5 The four lines of evidence tend to support the hypothesis.
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Affiliation(s)
- P J Fitzgerald
- The Zanvyl Krieger Mind/Brain Institute, Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, 338 Krieger Hall, 3400 N Charles St, Baltimore, MD 21218, USA
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5504
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Butler T, Nadiminti L, Anthony DT. Consciously-perceived generalized epileptiform discharges in a man with schizoaffective disorder. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:1563-4. [PMID: 19751791 DOI: 10.1016/j.pnpbp.2009.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2009] [Revised: 08/28/2009] [Accepted: 08/28/2009] [Indexed: 10/20/2022]
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5505
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Kapczinski F, Dias VV, Kauer-Sant'Anna M, Brietzke E, Vázquez GH, Vieta E, Berk M. The potential use of biomarkers as an adjunctive tool for staging bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:1366-71. [PMID: 19666076 DOI: 10.1016/j.pnpbp.2009.07.027] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 07/24/2009] [Accepted: 07/24/2009] [Indexed: 02/06/2023]
Abstract
Recent data show that biomarkers differ in early and late-stage bipolar disorder (BD). Here we propose a model of staging for bipolar disorder that emphasizes the potential use of biomarkers for differentiating early and late-stage BD patients in the inter-episodic period. The proposed model includes a Latent phase: patients at "ultra-high-risk" for developing BD, characterized by a family history of BD, temperament traits, mood, and anxiety symptoms as well as genetic vulnerability for developing the disorder; Stage I: patients who return to their baseline level of functioning when mood episodes resolve; Stage II: biomarkers and functioning impairment are related to comorbidities or rapid-cycling presentations; Stage III: persistent cognitive and functioning impairment in the inter-episode period as well as changes in biomarkers; and Stage IV: same findings as in Stage III associated with extreme cognitive and functioning impairment, to the point that patients are unable to live autonomously. Empirical testing will determine the ability of the present model to inform patients and clinicians about both prognosis and response to treatment.
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Affiliation(s)
- Flávio Kapczinski
- Bipolar Disorder Program and Molecular Psychiatry Unit, Hospital de Clínicas, UFRGS, INCT Translational Medicine, Porto Alegre, Brazil.
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5506
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Fajutrao L, Paulsson B, Liu S, Locklear J. Cost-effectiveness of quetiapine plus mood stabilizers compared with mood stabilizers alone in the maintenance therapy of bipolar I disorder: results of a Markov model analysis. Clin Ther 2009; 31 Pt 1:1456-68. [PMID: 19698903 DOI: 10.1016/j.clinthera.2009.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to estimate the following: (1) the number of acute mood events prevented by adjunctive quetiapine therapy, and the potential cost savings; (2) the number of acute mood event-associated hospitalizations avoided by using adjunctive quetiapine therapy, and the potential cost savings of this intervention; and (3) the economic value of adjunctive quetiapine therapy in the maintenance treatment of bipolar I disorder. METHODS A Markov model was developed to simulate the transitions of newly stabilized adult patients with bipolar I disorder across 4 possible health states: euthymia, acute mania, acute depression, and discontinued/ no active therapy. Clinical data were obtained from 2 randomized, double-blind, Phase III trials of up to 2 years' duration (D1447C00126 and D1447C00127) that evaluated the efficacy and tolerability of quetiapine (versus placebo) when coadministered with lithium or valproate in increasing the time to recurrence of acute mood events in patients with bipolar I disorder. The model evaluated clinical and economic outcomes in 8 quarterly cycles (24 months). Outcome measures included the number of acute mood events, number of hospitalizations related to acute mood events, and their costs. Quality-adjusted life-years (QALYs) were calculated as a secondary outcome. The model was conducted from the perspective of the UK National Health Service, base year 2007. RESULTS In the model analysis, adjunctive quetiapine with lithium or valproate was associated with a 54% reduction in the occurrence of acute mood events, a 29% reduction in acute mood event-related hospitalization costs, and a 4% improvement in QALY gains, with 5% lower total direct costs than placebo + lithium/valproate. The incremental cost-effectiveness ratios (in year-2007 pound) were 506 per additional acute mood event avoided, 4261 per additional acute mood event-related hospitalization prevented, and -7453 per additional QALY gained. The sensitivity analyses indicated that these results were robust. CONCLUSIONS The results of this Markov model with a 2-year time horizon suggest that adjunctive quetiapine and mood-stabilizer therapy with lithium or valproate, compared with mood-stabilizer therapy alone in the maintenance treatment of patients with bipolar I disorder, were associated with fewer acute mood events, fewer acute mood event-related hospitalizations, and lower total costs, thereby improving patient mental health outcomes and minimizing impact on payer budgets, from the perspective of the UK National Health Service.
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5507
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Thomsen MS, Hansen HH, Mikkelsen JD. Opposite effect of phencyclidine on activity-regulated cytoskeleton-associated protein (Arc) in juvenile and adult limbic rat brain regions. Neurochem Int 2009; 56:270-5. [PMID: 19897002 DOI: 10.1016/j.neuint.2009.10.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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: 07/10/2009] [Revised: 10/27/2009] [Accepted: 10/28/2009] [Indexed: 01/09/2023]
Abstract
The psychotomimetic effect of NMDA antagonists such as phencyclidine (PCP) in humans spurred the hypoglutamatergic theory of schizophrenia. This theory is supported by animal studies demonstrating schizophrenia-like behavioral and molecular changes following PCP administration to adult or neonatal animals. However, schizophrenia is believed to develop in part due to neurodevelopmental dysfunction during adolescence. Therefore, the effects of PCP in juvenile animals may better reflect the pathophysiology of schizophrenia. Here, we compare the effect of PCP (5mg/kg/day for 5 days) on activity-regulated cytoskeleton-associated protein (Arc) and parvalbumin mRNA expression in juvenile and adult rats. Arc is a marker for excitatory neurotransmission. Parvalbumin is a marker for GABAergic neurotransmission, known to be reduced in postmortem brains of schizophrenics. PCP reduced parvalbumin mRNA expression in the medial prefrontal cortex (mPFC), ventrolateral orbitofrontal cortex (VLO) and shell of the nucleus accumbens (ACCshell) in both juvenile and adult rats. Contrarily, PCP produced opposite effects on Arc mRNA expression in the mPFC, VLO and ACCshell, leading to decreased expression in juvenile and increased expression in adult rats. The differential effect of PCP in juvenile and adult rats may be caused by the immature functional state of the prefrontal cortex in juvenile rats. These results demonstrate differences between the effects of PCP in juvenile and adult rats. The decrease in Arc mRNA in juvenile rats corresponds best with the proposed "hypofrontality" in schizophrenia, suggesting the merits of using PCP in juvenile animals as a model for schizophrenia, as this would relate better to the typical onset and clinical features of schizophrenia.
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Affiliation(s)
- Morten S Thomsen
- Copenhagen University Hospital, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
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5508
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[Core symptoms of depression]. Nervenarzt 2009; 80:1371-6. [PMID: 19859684 DOI: 10.1007/s00115-009-2869-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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5509
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Wang G, Tse S, Michalak EE. Self-management techniques for bipolar disorder in a sample of New Zealand Chinese. International Journal of Therapy and Rehabilitation 2009. [DOI: 10.12968/ijtr.2009.16.11.44941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Grace Wang
- Department of Psychological Medicine, University of Auckland, New Zealand
| | - Samson Tse
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong; and and
| | - Erin E. Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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5510
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Zyss T. May depression be a form of epilepsy? Some remarks on the bioelectric nature of depression. Med Hypotheses 2009; 73:746-52. [DOI: 10.1016/j.mehy.2009.04.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 04/14/2009] [Accepted: 04/18/2009] [Indexed: 11/21/2022]
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5511
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Galanti M, Newport DJ, Pennell PB, Titchner D, Newman M, Knight BT, Stowe ZN. Postpartum depression in women with epilepsy: influence of antiepileptic drugs in a prospective study. Epilepsy Behav 2009; 16:426-30. [PMID: 19854113 PMCID: PMC3589524 DOI: 10.1016/j.yebeh.2009.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 06/18/2009] [Accepted: 07/05/2009] [Indexed: 11/17/2022]
Abstract
Patients with epilepsy are at high risk for major depressive disorder (MDD) and, according to one report, postpartum depression (PPD) as well. The study described here sought to determine the prevalence and risk factors for PPD among women with epilepsy. Fifty-six women with epilepsy participating in a prospective study of perinatal antiepileptic drug (AED) pharmacokinetics were included. Participants completed the Beck Depression Inventory (BDI) during pregnancy and the postpartum period. Fourteen participants (25.0%) had a postnatal BDI score > or =12 indicative of PPD. Logistic regression indicated that significant risk factors for PPD among women with epilepsy included multiparity (odds ratio=12.5) and AED polytherapy (odds ratio=9.3). The rate of PPD was unaffected by the use of specific AEDs. In conclusion, PPD rates are higher among women with epilepsy than the general population, particularly those who are multiparous or receiving AED polytherapy, and there is no evidence that AED selection modifies this risk.
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Affiliation(s)
- Melanie Galanti
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - D. Jeffrey Newport
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Page B. Pennell
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Denicia Titchner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Melanee Newman
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Bettina T. Knight
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Zachary N. Stowe
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
- Corresponding author. Address: Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, 1365 Clifton Road NE, Suite B6100, Atlanta, GA 30322, USA. Fax: +1 404 778 2535. (Z.N. Stowe)
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5512
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Abstract
OBJECTIVE To describe structural and biochemical evidence from postmortem brains that implicates the reciprocal connections between the mediodorsal thalamic nucleus and the prefrontal cortex in cognitive symptoms of schizophrenia. METHOD The estimation of the regional volumes and cell numbers was obtained using stereological methods. The biochemical analyses of molecular expression in postmortem brain involve quantitative measurement of transcripts and proteins by in-situ (RNA) or Western blot/autoradiography in brains from patients with schizophrenia and comparison subjects. RESULTS Stereological studies in postmortem brain from patients with schizophrenia have reported divergent and often opposing findings in the total number of neurons and volume of the mediodorsal (MD) thalamic nucleus, and to a lesser degree in its reciprocally associated areas of the prefrontal cortex. Similarly, quantitative molecular postmortem studies have found large inter-subject and between-study variance at both the transcript and protein levels for receptors and their interacting molecules of several neurotransmitter systems in these interconnected anatomical regions. Combined, large variation in stereological and molecular studies indicates a complex and heterogeneous involvement of the MD thalamic-prefrontal loop in schizophrenia. CONCLUSION Based on a considerable heterogeneity in patients suffering from schizophrenia, large variation in postmortem studies, including stereological and molecular postmortem studies of the MD thalamus and frontal cortex, might be expected and may in fact partly help to explain the variable endophenotypic traits associated with this severe psychiatric illness.
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Affiliation(s)
- B Pakkenberg
- Research Laboratory for Stereology and Neuroscience, Bispebjerg University Hospital, Copenhagen, Denmark.
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5513
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Xi D, Zhang W, Wang HX, Stradtman GG, Gao WJ. Dizocilpine (MK-801) induces distinct changes of N-methyl-D-aspartic acid receptor subunits in parvalbumin-containing interneurons in young adult rat prefrontal cortex. Int J Neuropsychopharmacol 2009; 12:1395-408. [PMID: 19435549 DOI: 10.1017/S146114570900042X] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
N-methyl-D-aspartic acid receptor (NMDAR) hypofunction has long been implicated in schizophrenia and NMDARs on gamma-aminobutyric acid (GABA)ergic interneurons are proposed to play an essential role in the pathogenesis. However, controversial results have been reported regarding the regulation of NMDAR expression, and direct evidence of how NMDAR antagonists act on specific subpopulations of prefrontal interneurons is missing. We investigated the effects of the NMDAR antagonist dizocilpine (MK-801) on the expression of NMDAR subtypes in the identified interneurons in young adult rat prefrontal cortex (PFC) by using laser microdissection and real-time polymerase chain reaction, combined with Western blotting and immunofluorescent staining. We found that MK-801 induced distinct changes of NMDAR subunits in the parvalbumin-immunoreactive (PV-ir) interneurons vs. pyramidal neurons in the PFC circuitry. The messenger RNA (mRNA) expression of all NMDAR subtypes, including NR1 and NR2A to 2D, exhibited inverted-U dose-dependent changes in response to MK-801 treatment in the PFC. In contrast, subunit mRNAs of NMDARs in PV-ir interneurons were significantly down-regulated at low doses, unaltered at medium doses, and significantly decreased again at high doses, suggesting a biphasic dose response to MK-801. The differential effects of MK-801 in mRNA expression of NMDAR subunits were consistent with the protein expression of NR2A and NR2B subunits revealed with Western blotting and double immunofluorescent staining. These results suggest that PV-containing interneurons in the PFC exhibit a distinct responsiveness to NMDAR antagonism and that NMDA antagonist can differentially and dose-dependently regulate the functions of pyramidal neurons and GABAergic interneurons in the prefrontal cortical circuitry.
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5514
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Bromberg A, Bersudsky Y, Levine J, Agam G. Global leukocyte DNA methylation is not altered in euthymic bipolar patients. J Affect Disord 2009; 118:234-9. [PMID: 19269035 DOI: 10.1016/j.jad.2009.01.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 01/30/2009] [Accepted: 01/30/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bipolar disorder is a complex disorder hypothesized to involve an interaction of multiple susceptibility genes and environmental factors. The environmental factors may be mediated via epigenetic mechanisms such as DNA methylation. Since a different extent of DNA methylation has recently been reported in lymphoblastoid cells derived from monozygotic twins discordant for bipolar disorder, we hypothesized that bipolar patients exhibit a different extent of leukocyte global DNA methylation compared with healthy controls. METHODS DNA was extracted from peripheral blood leukocytes of 49 euthymic bipolar patients and 27 matched healthy controls. Percent of global genome DNA methylation was measured using the cytosine-extension method. Plasma homocysteine levels were measured by HPLC. RESULTS Leukocyte global DNA methylation did not differ between bipolar patients [62.3%+/-18.0 (S.D)] and control subjects (63.9%+/-14.6), p=0.70. Bipolar patients' plasma homocysteine levels (11.5 microM+/-4.8) did not differ from those of healthy controls (11.4+/-2.9), p=0.92. LIMITATIONS The assay we used, based on restriction by methylation-sensitive/insensitive enzymes followed by a radioactive DNA polymerase reaction was approved to accurately measure global DNA methylation, but has technical limitations i.e. restriction enzymes do not cleave all potential methylation sites in the genome and restriction sites may be altered by mutations or polymorphisms. CONCLUSIONS The lack of difference in leukocyte global DNA methylation between euthymic bipolar patients and healthy controls does not rule out the possibility that altered methylation of specific promoter regions is involved in the etiology of the disorder.
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Affiliation(s)
- A Bromberg
- Psychiatry Research Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev and Mental Health Center, PO Box 4600 Beer-Sheva 84170, Israel
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5515
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Abstract
Psychopharmacotherapy should now be regulated in the sense of evidence-based medicine (EBM), as is the case in other areas of clinical treatment in medicine. In general this is a meaningful development, which will principally have a positive impact on routine health care in psychiatry. But several related problems should not be ignored. So far consensus on an internationally accepted evidence graduation could not be reached, due to several difficulties related to this. A principle question is also whether it is sufficient to base EBM primarily on the results of phase III trials with their high internal validity. Restrictions to generalise findings of phase III trials suggest the need for additional sources of evidence, amongst others "effectiveness" studies and other kinds of phase IV studies with their less restrictive methodological standards. Attempts to regulate psychopharmacotherapy in the sense of evidence-based medicine come closer to their limits the more complex the clinical situation and the respective decision-making logic are. Even in times of evidence-based medicine we are faced with the situation that a large part of complex clinical decision-making in psychopharmacotherapy still relies more on personal clinical experience and a group consensus about clinical experience, traditions and belief systems than on results of efficacy oriented phase III and effectiveness-oriented phase IV clinical studies.
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Affiliation(s)
- Hans-Jürgen Möller
- Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336 Munich, Germany.
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5516
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Abstract
Epidemiological and clinical studies have reported a high prevalence of anxiety symptoms in bipolar disorder, either in manic or depressive episodes, although these symptoms do not always meet criteria for a specific anxiety disorder. In addition to anxiety symptoms, bipolar disorder frequently presents with co-morbid axis I conditions, with anxiety disorders being the most common co-morbidity. Therefore, the objective of this article is to review clinical and epidemiological studies that have investigated the association between bipolar disorder and anxiety. Available data on the efficacy of treatments for bipolar disorder and co-morbid anxiety disorders are also reviewed. Existing guidelines do recognize that co-morbid anxiety has a negative impact on the course and outcome of bipolar disorder; however, there have been very few double-blind, controlled trials examining the treatment response of patients with bipolar disorder and co-occurring anxiety disorders. There is some positive evidence for quetiapine, olanzapine in combination with fluoxetine or lithium, and lamotrigine with lithium, and negative evidence for risperidone. Other therapies used for bipolar disorder, including several mood stabilizers, antidepressants, atypical antipsychotics and benzodiazepines, have been shown to reduce anxiety symptoms, but specific data for their effects in patients with anxiety symptoms co-morbid with bipolar disorder are not available. The co-occurrence of anxiety and bipolar disorder has implications for diagnosis, clinical outcome, treatment and prognosis. Careful screening for co-morbid anxiety symptoms and disorders is warranted when diagnosing and treating patients with bipolar disorder.
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Affiliation(s)
- Marcia Kauer-Sant'Anna
- Bipolar Disorders Program and Molecular Psychiatry Unit, INCT-Translational Medicine, Hospital de Clinicas (HCPA), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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5517
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Abstract
Background: The Internet is commonly used to advertise and sell medications and dietary supplements directly to consumers. Prescriptions are often not needed, and consumers may engage in unmonitored and risky health practices. No systematic attempt has been made to evaluate reported cases of adverse events following such purchases. Objective: To systematically identify and examine reported cases of adverse events associated with the purchase of medications and dietary supplements from the Internet. Methods: MEDLINE (1990-June 2009), EMBASE (1990-June 2009), IBIDS (to June 2009), TOXNET (to June 2009), bibliographies of identified articles, and Web sites of relevant health ministries and professional associations in the US and Canada were reviewed to identify eligible articles that describe adverse events associated with the purchase of medications or dietary supplements from the Internet. Results: Thirty-two reports of 41 cases of adverse consequences of pharmaceutical products (n = 31) or dietary supplements (n = 10) were identified. Purchases were made by people in the 30- to 50-year-old age group in 36% of cases. Prescription medications were implicated in 27% of cases and narcotic and controlled drugs were implicated in 49% of cases. Drug abuse was responsible for harm in 73% of cases, whereas adverse drug reactions occurred in 27% of cases. Nine (22%) patients died as a result of adverse consequences following such purchases. The remaining patients suffered serious adverse events such as seizures, liver damage, and hallucinations. Conclusions: An unexpectedly large number of case reports were identified from the literature; however, these reports do not fully illustrate the magnitude of the problem. Life-endangering adverse consequences signify a need for increased regulation and control of Internet Web sites and a need for healthcare provider involvement. Pharmacists should know where their patients obtain medications, how to verify the validity of the sources of prescriptions, and how to report adverse consequences.
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Affiliation(s)
- Della Kwan
- DELLA KWAN BScPhm MSc, Graduate Student, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Beyene
- JOSEPH BEYENE MSc PhD, Associate Professor, Research Institute of the Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto
| | - Prakesh S Shah
- PRAKESH S SHAH MSc MBBS MD DCH MRCP MRCPCH FRCPC, Associate Professor, Department of Paediatrics and Department of Health Policy, Management and Evaluation, Mount Sinai Hospital and University of Toronto
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5518
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Bramness JG, Weitoft GR, Hallas J. Use of lithium in the adult populations of Denmark, Norway and Sweden. J Affect Disord 2009; 118:224-8. [PMID: 19249102 DOI: 10.1016/j.jad.2009.01.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 01/20/2009] [Accepted: 01/20/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Lithium is an important drug in the treatment of bipolar disorder. Earlier epidemiological studies of lithium use have depended on sales statistics, clinical surveys or population surveys. The national prescription databases in Denmark, Norway and Sweden may help provide more reliable information on the epidemiology of lithium use. METHODS Data were taken from the three national prescription databases in Denmark, Norway and Sweden from July 2005 until June 2006, encompassing 1 year of prescription data. Similar methods were used to identify a number of different pharmacoepidemiological measures and data were collected for adults aged 18-69 at the time of prescription. RESULTS Norway and Sweden had higher sales and more prevalent use than Denmark. In all three countries, more female than males were treated and the prevalence of use increased linearly with age. In all, 0.17, 0.21, and 0.25% of the populations in Denmark, Norway and Sweden respectively redeemed at least 1 prescription for lithium in the period studied. The amount prescribed per user per year varied with age, increasing to maximum doses at 40 years of age and then decreasing. CONCLUSION This study is the first attempt to use prescription databases in all three Scandinavian countries to describe in detail the epidemiology of a drug's use. The analysis revealed subtle differences in the clinical use of lithium that cannot be explained by differences in the epidemiology of bipolar disorder.
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Affiliation(s)
- Jørgen G Bramness
- Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
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5519
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Oedegaard KJ, Syrstad VEG, Morken G, Akiskal HS, Fasmer OB. A study of age at onset and affective temperaments in a Norwegian sample of patients with mood disorders. J Affect Disord 2009; 118:229-33. [PMID: 19243836 DOI: 10.1016/j.jad.2009.01.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 01/26/2009] [Accepted: 01/26/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Early age at onset of bipolar disorder is clinically important since it predicts a more severe course of illness and a poorer prognosis. Recently the age at onset (AAO) of bipolar disorder (BPD) has been reported different in samples from the USA and Europe (Bipolar Collaborative Network). We have examined the AAO of first major affective episode in major depressive disorder (MDD) and bipolar disorder in a sample of patients consecutively admitted to an affective ward in Norway. We also examined the relation between AAO and affective temperaments. METHODS Semi-structured interview of 119 patients consecutively admitted to an affective ward. Patients were diagnosed according to DSM-IV criteria for major affective disorders and affective temperaments were assessed using Akiskal Mallya criteria. RESULTS Childhood-onset of BPD (before age 13) was found in 13.5% of patients, and early onset BPD (before age 20) in 61.6%. The AAO of first major affective disorder was significantly higher in MDD (n=67) compared to BPD (n=52); (28 Years Median (Min 10-Max 57) vs. 18 Years Median (Min 8-Max 41), p<0.001, Mann-Whitney U). Comparing patients with and without affective temperaments, showed that patients with such temperaments had an earlier AAO in both MDD and BPD (MDD: 20 Years Median (Min 10-Max 56), vs. 30 Years Median (Min 12-Max 57) p=0.006, Mann-Whitney U); BPD: 16 Years Median (Min 8-Max 30) vs. 20 Years Median (Min 12-Max 41, p=0.011, Mann-Whitney U). CONCLUSION Our Norwegian data are more in line with the US than the European data regarding age at onset of bipolar disorders. The presence of an affective temperament presents an additional affirmation of the early occurrence of mood symptoms in early onset forms of both MDD and BPD.
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Affiliation(s)
- Ketil J Oedegaard
- Department of Clinical Medicine, Section for Psychiatry, Faculty of Medicine, University of Bergen, Bergen, Norway.
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5520
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Cavanagh J, Schwannauer M, Power M, Goodwin GM. A novel scale for measuring mixed states in bipolar disorder. Clin Psychol Psychother 2009; 16:497-509. [DOI: 10.1002/cpp.633] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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5521
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McAllister EJ, Dhurandhar NV, Keith SW, Aronne LJ, Barger J, Baskin M, Benca RM, Biggio J, Boggiano MM, Eisenmann JC, Elobeid M, Fontaine KR, Gluckman P, Hanlon EC, Katzmarzyk P, Pietrobelli A, Redden DT, Ruden DM, Wang C, Waterland RA, Wright SM, Allison DB. Ten putative contributors to the obesity epidemic. Crit Rev Food Sci Nutr 2009; 49:868-913. [PMID: 19960394 PMCID: PMC2932668 DOI: 10.1080/10408390903372599] [Citation(s) in RCA: 429] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The obesity epidemic is a global issue and shows no signs of abating, while the cause of this epidemic remains unclear. Marketing practices of energy-dense foods and institutionally-driven declines in physical activity are the alleged perpetrators for the epidemic, despite a lack of solid evidence to demonstrate their causal role. While both may contribute to obesity, we call attention to their unquestioned dominance in program funding and public efforts to reduce obesity, and propose several alternative putative contributors that would benefit from equal consideration and attention. Evidence for microorganisms, epigenetics, increasing maternal age, greater fecundity among people with higher adiposity, assortative mating, sleep debt, endocrine disruptors, pharmaceutical iatrogenesis, reduction in variability of ambient temperatures, and intrauterine and intergenerational effects as contributing factors to the obesity epidemic are reviewed herein. While the evidence is strong for some contributors such as pharmaceutical-induced weight gain, it is still emerging for other reviewed factors. Considering the role of such putative etiological factors of obesity may lead to comprehensive, cause specific, and effective strategies for prevention and treatment of this global epidemic.
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Affiliation(s)
- Emily J McAllister
- Department of Infections and Obesity, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA.
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5522
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Abstract
Lamotrigine is an anticonvulsant that appears to have a mainly antidepressant effect and is indicated for the maintenance treatment of bipolar depression. Literature associated with obsessional symptoms related to lamotrigine treatment is limited. We report the emergence of obsessive symptoms during treatment with lamotrigine in a patient who subsequently experienced significant improvement after dose reduction and stopping of this medication. The obsessive symptoms associated with lamotrigine treatment were observed after the lamotrigine dose was increased to 100 mg/day. The possible mechanisms, including inhibition on the presynaptic release of glutamate and alteration of striatal dopamine uptake, are discussed. It is unclear why lamotrigine induces obsessions in some patients. Controlled studies are necessary to identify the population at risk for obsessionality in bipolar illness following treatment with lamotrigine and to investigate a possible dose-response relationship between obsessive symptoms and lamotrigine.
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Affiliation(s)
- M Kuloglu
- Department of Psychiatry, Ataturk Education and Research Hospital, Ankara, Turkey.
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5523
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McIntyre RS, Cohen M, Zhao J, Alphs L, Macek TA, Panagides J. A 3-week, randomized, placebo-controlled trial of asenapine in the treatment of acute mania in bipolar mania and mixed states. Bipolar Disord 2009; 11:673-86. [PMID: 19839993 DOI: 10.1111/j.1399-5618.2009.00748.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Asenapine is approved for bipolar disorder and schizophrenia. This was a 3-week, randomized, double-blind, placebo-controlled trial of asenapine for treating acute bipolar mania. METHODS After a single-blind placebo run-in period, adults (n = 488) experiencing manic or mixed episodes were randomized to flexible-dose sublingual asenapine (10 mg BID on day 1; 5 or 10 mg BID thereafter; n = 194), placebo (n = 104), or oral olanzapine (15 mg BID on day 1; 5-20 mg QD thereafter; n = 191). Primary efficacy, change in Young Mania Rating Scale (YMRS) total score from baseline to day 21, was assessed using analysis of covariance with last observation carried forward [(LOCF); primary analysis]. A mixed model for repeated measures [(MMRM); prespecified secondary analysis] was also used to assess efficacy. Tolerability and safety assessments included adverse events, physical examinations, extrapyramidal symptom ratings, and laboratory values. RESULTS Mean daily dosages were asenapine 18.2 mg and olanzapine 15.8 mg. Significantly greater least squares (LS) mean +/- SE changes in YMRS scores were observed on day 2 with asenapine (-3.0 +/- 0.4) and olanzapine (-3.4 +/- 0.4) versus placebo (-1.5 +/- 0.5, both p < 0.01) and were maintained until day 21 (-10.8 +/- 0.8 with asenapine, -12.6 +/- 0.8 with olanzapine; both p < or = 0.0001 versus placebo, -5.5 +/- 1.1) with LOCF. The results of MMRM analyses were consistent with those of LOCF. Asenapine had a modest impact on weight and metabolic measures. CONCLUSIONS These results indicate that asenapine is rapidly acting, efficacious, and well tolerated for patients with bipolar I disorder experiencing an acute manic episode.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada.
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5524
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Chou JC. Mixed episodes with psychotic features. CNS Spectr 2009; 14:6-8; discussion 12-4. [PMID: 20173694 DOI: 10.1017/s1092852900003886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mixed episode is one of the more difficult-to-treat conditions in bipolar disorder. The presence of mixed features (symptoms of both depression and mania in a single acute episode) is associated with both poorer acute treatment response and poorer longitudinal outcomes, including shorter subsequent inter-episode periods and greater suicidality. Mixed features are indicative of an overall greater severity of both acute and chronic illness (Slide 1).
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5525
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Swann AC. Pharmacologic mood destabilization: case vignettes. CNS Spectr 2009; 14:9-11; discussion 12-4. [PMID: 20173695 DOI: 10.1017/s1092852900003898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bipolar disorder is an illness characterized by inherent mood instability that produces a predisposition to depressive, hypomanic, or manic episodes. This predisposition to affective episodes, rather than the episodes themselves (which can have many causes), is arguably the hallmark of bipolar disorder.Most episodes of bipolar disorder, including the first episode, are depressive. This exposes an inherent flaw in our nosological system, which requires a manic or hypomanic episode for diagnosis of bipolar disorder. Treatment of a depressive episode in undiagnosed bipolar disorder can entail the use of medications that were developed to treat a different disorder (major depressive illness) and that may have mood-destabilizing or activating properties.
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5526
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Brenner CA, Krishnan GP, Vohs JL, Ahn WY, Hetrick WP, Morzorati SL, O'Donnell BF. Steady state responses: electrophysiological assessment of sensory function in schizophrenia. Schizophr Bull 2009; 35:1065-77. [PMID: 19726534 PMCID: PMC2762626 DOI: 10.1093/schbul/sbp091] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [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] [Indexed: 11/12/2022]
Abstract
Persons with schizophrenia experience subjective sensory anomalies and objective deficits on assessment of sensory function. Such deficits could be produced by abnormal signaling in the sensory pathways and sensory cortex or later stage disturbances in cognitive processing of such inputs. Steady state responses (SSRs) provide a noninvasive method to test the integrity of sensory pathways and oscillatory responses in schizophrenia with minimal task demands. SSRs are electrophysiological responses entrained to the frequency and phase of a periodic stimulus. Patients with schizophrenia exhibit pronounced auditory SSR deficits within the gamma frequency range (35-50 Hz) in response to click trains and amplitude-modulated tones. Visual SSR deficits are also observed, most prominently in the alpha and beta frequency ranges (7-30 Hz) in response to high-contrast, high-luminance stimuli. Visual SSR studies that have used the psychophysical properties of a stimulus to target specific visual pathways predominantly report magnocellular-based deficits in those with schizophrenia. Disruption of both auditory and visual SSRs in schizophrenia are consistent with neuropathological and magnetic resonance imaging evidence of anatomic abnormalities affecting the auditory and visual cortices. Computational models suggest that auditory SSR abnormalities at gamma frequencies could be secondary to gamma-aminobutyric acid-mediated or N-methyl-D-aspartic acid dysregulation. The pathophysiological process in schizophrenia encompasses sensory processing that probably contributes to alterations in subsequent encoding and cognitive processing. The developmental evolution of these abnormalities remains to be characterized.
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Affiliation(s)
- Colleen A. Brenner
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada,To whom correspondence should be addressed; tel: 604-822-4650; fax: 604-822-6923; e-mail:
| | - Giri P. Krishnan
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN
| | - Jenifer L. Vohs
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN
| | - Woo-Young Ahn
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN
| | - William P. Hetrick
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN,Larue D. Carter Memorial Hospital, Indianapolis, IN
| | - Sandra L. Morzorati
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Brian F. O'Donnell
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN,Larue D. Carter Memorial Hospital, Indianapolis, IN
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5527
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Vieta E, Angst J, Reed C, Bertsch J, Haro JM; EMBLEM advisory board. Predictors of switching from mania to depression in a large observational study across Europe (EMBLEM). J Affect Disord 2009; 118:118-23. [PMID: 19269690 DOI: 10.1016/j.jad.2009.02.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 02/12/2009] [Accepted: 02/12/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND The risk of switching from mania to depression in bipolar disorder has been poorly studied. Large observational studies may be useful in identifying variables that predict switch to depression after mania and provide data on medication use and outcomes in "real world" patients. METHOD EMBLEM (European Mania in Bipolar Longitudinal Evaluation of Medication) is a 2-year, prospective, observational study of patients with a manic/mixed episode. Symptom severity measures included Clinical Global Impression-Bipolar Disorder scale (CGI-BP), Young Mania Rating Scale (YMRS) and 5-item Hamilton Depression Rating Scale. Switching was defined using CGI-BP mania and depression such that patients changed from manic and not depressed to depressed but not manic over two consecutive observations within the first 12 weeks of follow-up. Cox proportional hazards models identified baseline variables independently associated with switch to depression. RESULTS Of 2390 patients who participated in the maintenance phase (i.e. up to 24 months), 120 (5.0%) switched to depression within the first 12 weeks. Factors associated with greater switching to depression include previous depressive episodes, substance abuse, greater CGI-BP overall severity and benzodiazepine use. Factors associated with lower switching rates were greater CGI-BP depression, lower YMRS severity and atypical antipsychotic use. LIMITATIONS The definition of switching biased against patients with mixed episodes being likely to switch. CONCLUSIONS Strictly defined, switch to depression from mania occurs in a small proportion of bipolar patients. Clinical history, illness severity, co-morbidities and treatment patterns are associated with switching to depression. Atypical antipsychotics may protect against switch to depression.
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5528
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Fairhurst AM, Xie C, Fu Y, Wang A, Boudreaux C, Zhou XJ, Cibotti R, Coyle A, Connolly JE, Wakeland EK, Mohan C. Type I interferons produced by resident renal cells may promote end-organ disease in autoantibody-mediated glomerulonephritis. J Immunol 2009; 183:6831-8. [PMID: 19864599 DOI: 10.4049/jimmunol.0900742] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Increased Type I IFNs or IFN-I have been associated with human systemic lupus erythematosus. Interestingly augmenting or negating IFN-I activity in murine lupus not only modulates systemic autoimmunity, but also impacts lupus nephritis, suggesting that IFN-I may be acting at the level of the end-organ. We find resident renal cells to be a dominant source of IFN-I in an experimental model of autoantibody-induced nephritis. In this model, augmenting IFN-I amplified antibody-triggered nephritis, whereas ablating IFN-I activity ameliorated disease. One mechanism through which increased IFN-I drives immune-mediated nephritis might be operative through increased recruitment of inflammatory monocytes and neutrophils, though this hypothesis needs further validation. Collectively, these studies indicate that an important contribution of IFN-I toward the disease pathology seen in systemic autoimmunity may be exercised at the level of the end-organ.
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Affiliation(s)
- Anna-Marie Fairhurst
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX 75390-8884, USA
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5529
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Yang C, Garrett-Mayer E, Schneider JS, Gollomp SM, Tilley BC. Repeatable battery for assessment of neuropsychological status in early Parkinson's disease. Mov Disord 2009; 24:1453-60. [PMID: 19452561 DOI: 10.1002/mds.22552] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Adequate reliability and valid factor structure are prerequisites for appropriate use of a measure in a population. Although the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) has been used to examine cognition in Parkinson's disease (PD), its reliability and factor structure have not been examined in this population. This study examined the reliability and factor structure of the RBANS in participants with de novo PD recruited for two NIH Exploratory Trials in Parkinson's Disease (NET-PD), using Cronbach's alpha and factor analysis. Confirmatory factor analysis (CFA) was implemented on the factor structure proposed in the RBANS manual, and exploratory factor analysis (EFA) was conducted to identify a valid factor structure given the proposed one was not supported. The RBANS exhibited poor reliability in participants with NET-PD. Cronbach's alpha ranged from 0.03 to 0.74 for the five domains and the full scale. CFA results indicated that the proposed factor structure in the RBANS manual was not supported in this sample. EFA identified a two-factor structure for six of the 12 RBANS items. Six items were eliminated due to low correlation with other items or severe ceiling effects. This new factor structure was validated by another CFA. The two domains have fair reliability. Cronbach's alpha ranged from 0.65 to 0.74 for the two factors in the two datasets. These results suggest that the current RBANS domain and total scores may not provide valid measurement of the neuropsychological status for patients with early PD.
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Affiliation(s)
- Chengwu Yang
- Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, South Carolina, USA
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5530
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Abstract
Multiple studies indicate that adenosine released in the basal forebrain during prolonged wakefulness could affect recovery sleep. It is still unclear which of adenosine receptors provide its sleep-modulating effects in the basal forebrain. We infused adenosine A1 and A2A receptors antagonists into the rat basal forebrain during sleep deprivation and compared characteristics of recovery non-rapid eye movement (non-REM) sleep (its amount and non-REM sleep delta power) after sleep deprivation, and after sleep deprivation combined with perfusion of antagonists. A1 receptor antagonist significantly reduced recovery sleep amount and delta power, whereas A2A receptor antagonist had no effect on recovery sleep. We conclude that adenosine can promote recovery non-REM sleep when acting through A1 receptors in the basal forebrain.
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5531
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Abstract
OBJECTIVE To review the clinical data investigating the efficacy and safety of quetiapine in bipolar depression. DATA SOURCES Searches of MEDLINE and PubMed (1977-July 2009) were conducted using the key words quetiapine and bipolar depression. The references of literature found were cross-referenced. The pharmaceutical company that produces quetiapine was contacted to obtain the posters for the EMBOLDEN I and EMBOLDEN II trials. STUDY SELECTION AND DATA EXTRACTION Only double-blind, placebo-controlled trials were included for review, as well as any subanalyses of the literature that matched this criterion. DATA SYNTHESIS There was a total of 5 double-blind, placebo-controlled trials and 5 subanalyses reviewed. The results of these data demonstrated quetiapine's efficacy in the treatment of depressive phases of bipolar disorder, including statistically significant improvement in the Montgomery-Asberg Depression Rating Scale (MADRS). In the trials reviewed in this article, the change in MADRS scores ranged from -15.4 to -16.94 within the quetiapine groups, and from -10.26 to -11.93 in the placebo groups. There were also statistically significant improvements in the Hamilton Anxiety Rating Scale, the Short Form of the Quality of Life Enjoyment and Satisfaction Questionnaire, the Pittsburgh Sleep Quality Index, and the Sheehan Disability Scale. All of these trials had a duration of 8 weeks and therefore cannot be applied to the long-term use of quetiapine in bipolar depression. The most common adverse events were sedation, somnolence, and dry mouth. The overall dropout rates for the trials reviewed ranged from 24% to 47%. CONCLUSIONS Based on the literature reviewed here, quetiapine appears to be a safe and efficacious short-term treatment option for bipolar depression. Patients with bipolar type I showed greater improvement on the MADRS than those with bipolar type II. Patients with a rapid-cycling disease course showed an improvement in depressive symptoms, regardless of bipolar type.
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5532
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Abstract
Major depressive disorder (MDD) is highly prevalent, potentially disabling, and sometimes fatal. Antidepressants (ADs) have improved its treatment, but incomplete response, sustained morbidity, recurrences, agitation, substance abuse, excess medical mortality, and suicide remain unsolved problems among mood disorder patients. AD treatment itself sometimes induces adverse behavioral responses. Several anticonvulsants (ACs) used to treat bipolar disorder (BPD) might also be of value for MDD. Accordingly, we reviewed published reports on ACs for MDD, identifying studies by computerized searches. We excluded reports dealing only with BPD patients or with sedatives, classified trials by design quality, and evaluated treatment of acute episodes and recurrences of adult MDD. We found 36 reports involving 41 relevant trials of carbamazepine (12 trials), valproate (11), lamotrigine (9), gabapentin (3), topiramate (3), phenytoin (2), and tiagabine (1). They include 9 blinded, controlled trials (of 28-70 days), involving carbamazepine (3 trials), lamotrigine (3), phenytoin (2), or topiramate (1) as primary treatments (5) or AD adjuncts (4). Some of these trials, as well as 7 of lesser quality, suggest benefits of carbamazepine, lamotrigine, and valproate, mainly as adjuncts to ADs. Another 20 anecdotes or small trials further suggest that these ACs might be useful as AD adjuncts-specifically to treat irritability or agitation in MDD. Overall, these reports provide suggestive evidence of beneficial effects of carbamazepine, lamotrigine, and valproate that require further study, especially for long-term adjunctive use, particularly in patients with recurring MDD with prominent irritability or agitation.
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Affiliation(s)
- Daniel V Vigo
- Department of Psychiatry, Harvard Medical School, MA, USA.
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5533
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Ma J, Tai SK, Leung LS. Ketamine-induced deficit of auditory gating in the hippocampus of rats is alleviated by medial septal inactivation and antipsychotic drugs. Psychopharmacology (Berl) 2009; 206:457-67. [PMID: 19655127 DOI: 10.1007/s00213-009-1623-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 07/12/2009] [Indexed: 10/20/2022]
Abstract
RATIONALE Gating of sensory responses is impaired in schizophrenic patients and animal models of schizophrenia. Ketamine, an N-methyl-D-aspartate receptor antagonist, is known to induce schizophrenic-like symptoms including sensory gating deficits in humans. OBJECTIVE This study aims to investigate the mechanisms underlying ketamine's effect on gating of auditory evoked potentials in the hippocampus of freely moving rats. METHODS Gating was measured by the ratio of the test-click response (T) to the conditioning-click response (C), or T/C, with T and C measured as peak amplitudes. RESULTS Ketamine (1, 3, or 6 mg/kg s.c.) injection dose-dependently increased T/C ratio as compared to saline injection (s.c.). T/C ratio was 0.48 +/- 0.05 after saline injection and 0.73 +/- 0.17 after ketamine (3 mg/kg s.c.) injection. The increase in T/C ratio after ketamine was blocked by prior inactivation of the medial septum with GABA(A) receptor agonist muscimol or by systemic administration of antipsychotic drugs, including chlorpromazine (5 mg/kg i.p.), haloperidol (1 mg/kg i.p.), or clozapine (7.5 mg/kg i.p.). Infusion of muscimol into the medial septum or injection of an antipsychotic drug alone did not affect the T/C ratio. However, rats with selective lesion of the septohippocampal cholinergic neurons by 192 IgG-saporin showed a significantly higher T/C ratio (0.86 +/- 0.10) than sham lesion rats (0.26 +/- 0.07), and ketamine did not further increase T/C ratio in rats with septohippocampal cholinergic neuron lesion. CONCLUSIONS Ketamine's disruption of hippocampal auditory gating was normalized by inactivation of the medial septum; in addition, septal cholinergic neurons participate in normal auditory gating.
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Affiliation(s)
- Jingyi Ma
- Department of Physiology and Pharmacology, Medical Sciences Building, The University of Western Ontario, London, ON, Canada N6A 5C1.
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5534
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Affiliation(s)
- H Grunze
- Newcastle University, Institute of Neuroscience, Division of Psychiatry, RVI Leazes Wing, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
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5535
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Shelley BP, Trimble MR. "All that spikes is not fits", mistaking the woods for the trees: the interictal spikes--an "EEG chameleon" in the interface disorders of brain and mind: a critical review. Clin EEG Neurosci 2009; 40:245-61. [PMID: 19780346 DOI: 10.1177/155005940904000407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent research into mammalian cortical neurophysiology, after 6 decades of Berger's seminal work on electroencephalography, has shifted the older concept of interictal epileptiform activity (IEA) away from that of a mere electrographic graphoelement of relevance to diagnostic implications in epilepsy. Instead, accumulating information has stressed the neuropsychological implications, cognitive and/or behavioral consequence of these electrophysiological events, which are the phenotypic expression of aberrations of actual biophysical cellular function. We feel that this review is germane to neuropsychiatry, however, a rather neglected area of research. There is a great scope for brain-behavior-EEG research in the future that can be complimented by other techniques of "neurobehavioral electrophysiology". This review does not address the "pearls, perils and pitfalls" in the use of EEG in epilepsy, but critically and systematically reappraises the published electroencephalographic correlates of human behavior. We reiterate that epileptiform and other paroxysmal EEG dysrhythmias unrelated to clinical seizures do have neuropsychological, cognitive and/or behavioral implications as seen in the various neuropsychiatric and neurobehavioral disorders discussed in this article. IEA and EEG dysrhythmias should neither be ignored as irrelevant nor automatically attributed to epilepsy. The relevance of these EEG aberrations in the disorders of the brain-mind interface extend beyond epilepsy, and may be an electrophysiological endophenotype of aberrant neuronal behavior indicative of underlying morpho-functional brain abnormalities. Magnetoencephalography (MEG), data fusion models (EEG-fMRI-BOLD), transcranial magnetic stimulation (TMS), evoked potentials (EP); intracranial electrophysiology, and EEG neurofeedback complemented by current functional neuroimaging techniques (fMRI and PET) would certainly help in further understanding the broader relationship between brain and behavior.
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Affiliation(s)
- Bhaskara P Shelley
- Department of Neurology, Father Muller Medical College, Mangalore 575 002, Kamataka, India
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5536
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Licht RW, Bech P. How to manage mania not responding to a first-step 2 weeks treatment with quetiapine--a report from a prematurely discontinued randomised clinical trial. Acta Psychiatr Scand 2009; 120:334-5. [PMID: 19689481 DOI: 10.1111/j.1600-0447.2009.01442.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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5537
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Médard E. Les troubles bipolaires et le milieu de travail. ARCH MAL PROF ENVIRO 2009. [DOI: 10.1016/j.admp.2009.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5538
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Woo YS, Bahk WM, Jon DI, Joo YH, Kim W, Seo JS, Ahn YM, Chung SK, Won SH, Shin YC, Yoon BH, Jung SH, Seok JH, Lee YS, Kim Y, Min KJ. Rash in adult patients receiving lamotrigine to treat bipolar I disorder in Korea: a multicenter, prospective, naturalistic, open-label trial. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:1147-52. [PMID: 19540298 DOI: 10.1016/j.pnpbp.2009.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 05/18/2009] [Accepted: 06/11/2009] [Indexed: 11/20/2022]
Abstract
The goal of this study was to assess the incidence of rash occurring in patients received lamotrigine to treat bipolar I disorder in a real world setting in Korea. We included a heterogeneous sample with multiple medications and medical comorbidities. Lamotrigine was added to the current therapy regime for DSM-IV bipolar I patients on an open-label basis for 12 weeks. The incidences of rash and other adverse events were assessed. The primary outcome measure was the incidence of rash. A total of 237 adult patients were included in the present study and 173 patients (73.0%) completed the 12 weeks of treatment. Thirty patients (12.7%) developed a rash, of whom 2 (0.8%) developed a serious rash. There were no patients who developed Stevens-Johnson syndrome or toxic epidermal necrolysis. The median time of rash onset was 16 days. As a group, patients who did not experience rash were significantly heavier than those who did. Our findings suggest that the incidence of serious rash associated with lamotrigine is low. The prescription of lamotrigine should be undertaken with appropriate consideration of the potential risk of adverse events including rash to the patient in relation to potential benefit from improvement of bipolar disorder.
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5539
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Rodríguez-landa JF, Contreras CM, García-ríos RI. Allopregnanolone microinjected into the lateral septum or dorsal hippocampus reduces immobility in the forced swim test: participation of the GABAA receptor. Behav Pharmacol 2009; 20:614-22. [DOI: 10.1097/fbp.0b013e328331b9f2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5540
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5541
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Post RM. This Issue: Bipolar Disorder, with a Focus on Childhood-Onset Bipolar Disorder. Psychiatr Ann 2009. [DOI: 10.3928/00485718-20090924-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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5542
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Potter MP, Liu HY, Monuteaux MC, Henderson CS, Wozniak J, Wilens TE, Biederman J. Prescribing patterns for treatment of pediatric bipolar disorder in a specialty clinic. J Child Adolesc Psychopharmacol 2009; 19:529-38. [PMID: 19877977 PMCID: PMC2861948 DOI: 10.1089/cap.2008.0142] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to describe prescribing practices in the treatment of pediatric bipolar disorder in a university practice setting. METHOD A retrospective chart review was performed on 53 youths diagnosed using Diagnostic and Statistical Manual of Mental Disorders, 4(th) edition (DSM-IV), criteria with bipolar spectrum disorder under the active care of child psychiatrists practicing in a pediatric psychopharmacology specialty clinic. Current medications, doses, and related adverse events were recorded. Clinicians were asked to provide a target disorder (bipolar mania/mixed state, depression, attention deficit hyperactivity disorder [ADHD], or anxiety) for each medication to the best of their ability. The Clinical Global Impressions-Severity (CGI-S) scale was used to measure severity of each disorder before treatment and the Clinical Global Impressions-Improvement (CGI-I) was used to quantify the magnitude of improvement with treatment. Meaningful improvement of the disorder was defined by CGI-I score of 1 or 2. RESULTS The mean number of psychotropic medications per patient was 3.0 +/- 1.6. A total of 68% of patients were treated for co-morbid disorders; 23% of patients were treated with monotherapy, primarily with second-generation antipsychotics. Mania improved in 80% of cases, mixed state improved in 57% of cases, ADHD improved in 56% of cases, anxiety improved in 61% of cases, and depression improved in 90% of cases. CONCLUSION The management of pediatric bipolar disorder often requires multiple medications. For the treatment of mania/mixed states, clinicians prescribed second-generation antipsychotics more frequently than mood stabilizers, especially in the context of monotherapy. Co-morbidity was a frequent problem with moderate success obtained with combined pharmacotherapy approaches. Further psychosocial strategies to augment pharmacotherapy may improve outcome while reducing the medication burden in pediatric bipolar disorder.
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Affiliation(s)
- Mona P. Potter
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | - Howard Y. Liu
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | - Michael C. Monuteaux
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | - Carly S. Henderson
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | - Janet Wozniak
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | - Timothy E. Wilens
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | - Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts
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5543
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Smith EG, Henry AD, Zhang J, Hooven F, Banks SM. Antidepressant adequacy and work status among medicaid enrollees with disabilities: a restriction-based, propensity score-adjusted analysis. Community Ment Health J 2009; 45:333-40. [PMID: 19763823 DOI: 10.1007/s10597-009-9199-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 05/01/2009] [Indexed: 10/20/2022]
Abstract
Abstract This cross-sectional study of adult survey respondents with disability and depression (n = 199) enrolled in Massachusetts' Medicaid program examined the association of adequately or inadequately prescribed antidepressant treatment and self-reported work status using conditional logistic regression, controlling for age, gender, race, marital status, education, receipt of SSI/SSDI, self-reported disabling condition, and health status. Confounding by severity was addressed by two methods: restriction of our sample and subsequent stratification by propensity score. Individuals receiving adequate antidepressant treatment had an increased odds of working compared to individuals receiving inadequate treatment, both in analyses in which restriction was used to limit confounding (OR = 3.45, 95% CI = 1.15-10.32, P < .03), and in analyses which combined restriction with adjustment by propensity score stratification (OR = 3.04, 95% CI = 1.01-9.62, P < .05). Among this sample of Medicaid enrollees with disability and depression, those receiving adequate antidepressant treatment were significantly more likely to report working.
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5544
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Abstract
OBJECTIVE To conduct a critical review of recent empirical research regarding mood, behaviour and nutrition factors including essential fatty acids, macronutrients, micronutrients and food additives. METHOD A literature search of databases Medline, PsycInfo, CINAHL and Embase up to October 2008. The search emphasised empirical research published in the last 10 years and also included older literature. Studies in both adults and children were addressed. RESULTS Research into omega-3 fatty acids has been substantial but evidence for their potential in treating mood and behaviour is modest. In comparison, there has been much less research into carbohydrate and protein intakes and little evidence for their ability to influence mood and behaviour. Recent trials with food additives suggest their removal from the diet may benefit susceptible children with hyperactivity disorders. Micronutrient supplementation appears to improve mood only in those who were initially deficient in micronutrients. CONCLUSIONS More stringent research designs such as longitudinal studies and the use of biologically inert placebos within randomised controlled trials are needed before supplemental use of omega-3 fatty acids to treat disorders of mood and behaviour can be recommended. Caution is advised regarding the indiscriminate use of diets free of artificial food additives in managing hyperactivity disorders, as they may place an undue burden on individuals and their families. Should omega-3 fatty acid supplementation or the elimination of certain food additives be established as effective, they may provide cost-effective, accessible and well-tolerated adjuncts to standard psychiatric treatments for mood and behavioural disturbances.
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Affiliation(s)
- Nerissa L Soh
- 1Child and Adolescent Mental Health Services, Northern Sydney Central Coast Area Health, North Ryde, New South Wales, Australia
| | - Garry Walter
- 1Child and Adolescent Mental Health Services, Northern Sydney Central Coast Area Health, North Ryde, New South Wales, Australia
| | - Louise Baur
- 3Discipline of Paediatrics and Child Health, University of Sydney New South Wales, Australia
| | - Clare Collins
- 4Nutrition and Dietetics School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
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5545
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Lam RW, Kennedy SH, Grigoriadis S, McIntyre RS, Milev R, Ramasubbu R, Parikh SV, Patten SB, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacotherapy. J Affect Disord 2009; 117 Suppl 1:S26-43. [PMID: 19674794 DOI: 10.1016/j.jad.2009.06.041] [Citation(s) in RCA: 284] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 06/23/2009] [Indexed: 01/16/2023]
Abstract
BACKGROUND In 2001, the Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments (CANMAT) partnered to produce evidence-based clinical guidelines for the treatment of depressive disorders. A revision of these guidelines was undertaken by CANMAT in 2008-2009 to reflect advances in the field. METHODS The CANMAT guidelines are based on a question-answer format to enhance accessibility to clinicians. An evidence-based format was used with updated systematic reviews of the literature and recommendations were graded according to Level of Evidence using pre-defined criteria. Lines of Treatment were identified based on criteria that included Levels of Evidence and expert clinical support. This section on "Pharmacotherapy" is one of 5 guideline articles. RESULTS Despite emerging data on efficacy and tolerability differences amongst newer antidepressants, variability in patient response precludes identification of specific first choice medications for all patients. All second-generation antidepressants have Level 1 evidence to support efficacy and tolerability and most are considered first-line treatments for MDD. First-generation tricyclic and monoamine oxidase inhibitor antidepressants are not the focus of these guidelines but generally are considered second- or third-line treatments. For inadequate or incomplete response, there is Level 1 evidence for switching strategies and for add-on strategies including lithium and atypical antipsychotics. LIMITATIONS Most of the evidence is based on trials for registration and may not reflect real-world effectiveness. CONCLUSIONS Second-generation antidepressants are safe, effective and well tolerated treatments for MDD in adults. Evidence-based switching and add-on strategies can be used to optimize response in MDD that is inadequately responsive to monotherapy.
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5546
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SWANN ALANC, STEINBERG JOELL, LIJFFIJT MARIJN, MOELLER GERARDF. Continuum of depressive and manic mixed states in patients with bipolar disorder: quantitative measurement and clinical features. World Psychiatry 2009; 8:166-72. [PMID: 19812754 PMCID: PMC2758583 DOI: 10.1002/j.2051-5545.2009.tb00245.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [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] [Indexed: 12/17/2022] Open
Abstract
Bipolar mixed states combine depressive and manic features, presenting diagnostic and treatment challenges and reflecting a severe form of the illness. DSM-IV criteria for a mixed state require combined depressive and manic syndromes, but a range of mixed states has been described clinically. A unified definition of mixed states would be valuable in understanding their diagnosis, mechanism and treatment implications. We investigated the manner in which depressive and manic features combine to produce a continuum of mixed states. In 88 subjects with bipolar disorder (DSM-IV), we evaluated symptoms and clinical characteristics, and compared depression-based, mania-based, and other published definitions of mixed states. We developed an index of the extent to which symptoms were mixed (Mixed State Index, MSI) and characterized its relationship to clinical state. Predominately manic and depressive mixed states using criteria from recent literature, as well as Kraepelinian mixed states, had similar symptoms and MSI scores. Anxiety correlated significantly with depression scores in manic subjects and with mania scores in depressed subjects. Discriminant function analysis associated mixed states with symptoms of hyperactivity and negative cognitions, but not subjective depressive or elevated mood. High MSI scores were associated with severe course of illness. For depressive or manic episodes, characteristics of mixed states emerged with two symptoms of the opposite polarity. This was a cross-sectional study. Mixed states appear to be a continuum. An index of the degree to which depressive and manic symptoms combine appears useful in identifying and characterizing mixed states. We propose a depressive or manic episode with three or more symptoms of the opposite polarity as a parsimonious definition of a mixed state.
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Affiliation(s)
- ALAN C. SWANN
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School, 1300 Moursund Street, Houston, TX 77030, USA
| | - JOEL L. STEINBERG
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School, 1300 Moursund Street, Houston, TX 77030, USA
| | - MARIJN LIJFFIJT
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School, 1300 Moursund Street, Houston, TX 77030, USA
| | - GERARD F. MOELLER
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School, 1300 Moursund Street, Houston, TX 77030, USA
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5547
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Wozniak J, Mick E, Waxmonsky J, Kotarski M, Hantsoo L, Biederman J. Comparison of open-label, 8-week trials of olanzapine monotherapy and topiramate augmentation of olanzapine for the treatment of pediatric bipolar disorder. J Child Adolesc Psychopharmacol 2009; 19:539-45. [PMID: 19877978 DOI: 10.1089/cap.2009.0042] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to test the efficacy and safety of olanzapine + topiramate versus olanzapine monotherapy in the treatment of bipolar disorder (BPD) and treatment-attendant weight gain in children and adolescents. METHOD Subjects (N = 40) were outpatients of both sexes, 6-17 years of age, with a Diagnostic and Statistical Manual of Mental Disorders, 4(th) edition (DSM-IV) diagnosis of BPD (manic, hypomanic, or mixed) and Young Mania Rating Scale (YMRS) total score of >15 treated over 8-week periods in two partially concurrent open-label trials with olanzapine (n = 17) or olanzapine + topiramate (n = 23). RESULTS Subjects in both groups experienced a statistically significant reduction in YMRS scores after 8-week, open-label treatment with olanzapine (baseline YMRS = 26.7 +/- 9.5; end-point YMRS = 18.2 +/- 12.5, p = 0.04) and olanzapine +topiramate (baseline YMRS = 31.3 +/- 7.9; end-point YMRS = 20.4 +/- 11.4, p = 0.04). There was no difference in response between the two groups based on YMRS or Clinical Global Impressions-Improvement (CGI-I) scores. Adverse events were few and mild and similar between the two groups, with the exception of weight gain. The weight gain in the olanzapine group was 5.3 +/- 2.1 kg and the weight gain in the olanzapine + topiramate group was statistically significantly lower, 2.6 +/- 3.6 kg. CONCLUSIONS Augmentation of olanzapine with topiramate resulted in a reduced weight gain over the course of an 8-week, open-label trial when compared with olanzapine treatment alone, but did not lead to greater reduction in symptoms of mania.
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Affiliation(s)
- Janet Wozniak
- Pediatric Psychopharmacology Research Department, Massachusetts General Hospital , Department of Psychiatry at Harvard Medical School, Boston, Massachusetts, USA.
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5548
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McLoughlin GA, Ma D, Tsang TM, Jones DNC, Cilia J, Hill MD, Robbins MJ, Benzel IM, Maycox PR, Holmes E, Bahn S. Analyzing the effects of psychotropic drugs on metabolite profiles in rat brain using 1H NMR spectroscopy. J Proteome Res 2009; 8:1943-52. [PMID: 19714815 DOI: 10.1021/pr800892u] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The mechanism of action of standard drug treatments for psychiatric disorders remains fundamentally unknown, despite intensive investigation in academia and the pharmaceutical industry. So far, little is known about the effects of psychotropic medications on brain metabolism in either humans or animals. In this study, we investigated the effects of a range of psychotropic drugs on rat brain metabolites. The drugs investigated were haloperidol, clozapine, olanzapine, risperidone, aripiprazole (antipsychotics); valproate, carbamazapine (mood stabilizers) and phenytoin (antiepileptic drug). The relative concentrations of endogenous metabolites were determined using high-resolution proton nuclear magnetic resonance (1H NMR) spectroscopy. The results revealed that different classes of psychotropic drugs modulated a range of metabolites, where each drug induced a distinct neurometabolic profile. Some common responses across several drugs or within a class of drug were also observed. Antipsychotic drugs and mood stabilizers, with the exception of olanzapine, consistently increased N-acetylaspartate (NAA) levels in at least one brain area, suggesting a common therapeutic response on increased neuronal viability. Most drugs also altered the levels of several metabolites associated with glucose metabolism, neurotransmission (including glutamate and aspartate) and inositols. The heterogenic pharmacological response reflects the functional and physiological diversity of the therapeutic interventions, including side effects. Further study of these metabolites in preclinical models should facilitate the development of novel drug treatments for psychiatric disorders with improved efficacy and side effect profiles.
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Affiliation(s)
- Gerard A McLoughlin
- Department of Biomolecular Medicine, Division of SORA, Faculty of Medicine, Imperial College, London SW7 2AZ, UK
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5549
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5550
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Griend JPV, Linnebur SA, Bainbridge JL. Probable levetiracetam-associated depression in the elderly: Two case reports. ACTA ACUST UNITED AC 2009; 7:281-4. [DOI: 10.1016/j.amjopharm.2009.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2009] [Indexed: 11/28/2022]
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