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Basquin L, Maruani J, Leseur J, Mauries S, Bazin B, Pineau G, Henry C, Lejoyeux M, Geoffroy PA. Study of the different sleep disturbances during the prodromal phase of depression and mania in bipolar disorders. Bipolar Disord 2024; 26:454-467. [PMID: 38653574 DOI: 10.1111/bdi.13429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND One of the challenges in bipolar disorder (BD) lies in early detection of the illness and its recurrences, to improve prognosis. Sleep disturbances (SD) have been proposed as reliable predictive markers of conversion. While preliminary studies have explored the relationship between SD and the onset of mood episodes, the results remain heterogeneous and a few have specifically examined patients' perception of prodromal symptoms and their progression until the episode occurs. Identifying prodromes represents a crucial clinical challenge, as it enables early intervention, thereby reducing the severity of BD. Therefore, the objective of this study is to better characterize and evaluate the progressive nature of SD as prodromal symptoms of mood episodes, and patients' perception of it. METHODS Patients diagnosed with BD, either hospitalized or seeking treatment for a (hypo)manic or depressive episode benefited from standardized questionnaires, structured interviews, and self-report questionnaires to evaluate SD prior to the current episode, as well as sociodemographic and clinical information. RESULTS Out of the 41 patients included, 59% spontaneously reported SD prior to the episode, appearing 90 days before depression and 35 days before mania (pre-indexed/spontaneous reports: 51.22% insomnia complaints, 4.88% hypersomnolence complaints, 7.32% parasomnias, 2.44% sleep movements). After inquiry about specific SD, the percentage of patients reporting prodromal SD increased significantly to 83%, appearing 210 days before depression and 112.5 days before mania (post-indexed reports: 75.61% presented with insomnia complaints appearing 150 days before depression and 20 days before mania, 46.34% had hypersomnolence complaints appearing 60 days before depression, 43.9% had parasomnias appearing 210 days before depression and 22.5 days before mania, 36.59% had sleep movements appearing 120 days before depression and 150 days before mania). Of note, bruxism appeared in 35% of patients before mania, and restless legs syndrome in 20% of patients before depression. CONCLUSION This study highlights the very high prevalence of SD prior to a mood episode in patients with BD with differences between depressive and manic episodes. The more systematic screening of sleep alterations of the prodromal phase improved the recognition and characterization of different symptoms onset by patients. This underscores the need for precise questioning regarding sleep patterns in patients, to better identify the moment of transition toward a mood episode, referred to as "Chronos syndrome". The study emphasizes the importance of educating patients about the disorder and its sleep prodromal symptoms to facilitate early intervention and prevent recurrences.
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Affiliation(s)
- Louise Basquin
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
| | - Julia Maruani
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- GHU Paris - Psychiatrie & Neurosciences, Paris, France
| | - Jeanne Leseur
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
| | - Sibylle Mauries
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- GHU Paris - Psychiatrie & Neurosciences, Paris, France
| | | | - Guillaume Pineau
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
| | - Chantal Henry
- GHU Paris - Psychiatrie & Neurosciences, Paris, France
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
- Université de Paris, Paris, France
| | - Michel Lejoyeux
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- GHU Paris - Psychiatrie & Neurosciences, Paris, France
| | - Pierre A Geoffroy
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- GHU Paris - Psychiatrie & Neurosciences, Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
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Ritish D, Reddy PV, Sreeraj VS, Chhabra H, Kumar V, Venkatasubramanian G, Muralidharan K. Oculomotor Abnormalities and Aberrant Neuro-Developmental Markers: Composite Endophenotype for Bipolar I Disorder: Anomalies Oculomotrices et Marqueurs Neuro-Développementaux Aberrants : Endophénotype Composite du Trouble Bipolaire I. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:590-597. [PMID: 38651336 PMCID: PMC11298092 DOI: 10.1177/07067437241248048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Neurological soft signs (NSSs), minor physical anomalies (MPAs), and oculomotor abnormalities were plausible biomarkers in bipolar disorder (BD). However, specific impairments in these markers in patients after the first episode mania (FEM), in comparison with first-degree relatives (high risk [HR]) of BD and healthy subjects (health control [HC]) are sparse. AIM OF THE STUDY This study aimed at examining NSSs, MPAs, and oculomotor abnormalities in remitted adult subjects following FEM and HR subjects in comparison with matched healthy controls. Investigated when taken together, could serve as composite endophenotype for BD. METHODS NSSs, MPAs, and oculomotor abnormalities were evaluated in FEM (n = 31), HR (n = 31), and HC (n = 30) subjects, matched for age (years) (p = 0.44) and sex (p = 0.70) using neurological evaluation scale, Waldrop's physical anomaly scale and eye tracking (SPEM) and antisaccades (AS) paradigms, respectively. RESULTS Significant differences were found between groups on NSSs, MPAs, and oculomotor parameters. Abnormalities are higher in FEM subjects compared to HR and HC subjects. Using linear discriminant analysis, all 3 markers combined accurately classified 72% of the original 82 subjects (79·2% BD, 56·70% HR, and 82·1% HC subjects). CONCLUSIONS AS and SPEM could enhance the utility of NSSs, and MPAs as markers for BD. The presence of these abnormalities in FEM suggests their role in understanding the etiopathogenesis of BD in patients who are in the early course of illness. These have the potential to be composite endophenotypes and have further utility in early identification in BD.
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Affiliation(s)
- Daniel Ritish
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Preethi V. Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vanteemar S. Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Harleen Chhabra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vijay Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Miñambres I, Rubio-Herrera MÁ, Nicolau J, Milad C, Morales MJ, Bueno M, Calañas A, Carceller-Sindreu M, de Hollanda A. Outcomes of Bariatric Surgery in Patients with Schizophrenia. Nutrients 2024; 16:2487. [PMID: 39125367 PMCID: PMC11313780 DOI: 10.3390/nu16152487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Outcomes of bariatric surgery (BS) in patients with schizophrenia are poorly understood. We aimed to analyze the effects of BS in patients with schizophrenia (SZ) or schizoaffective disorder (SZA). METHODS This was a multicenter, retrospective case-control study in patients with SZ or SZA who had undergone BS in seven public referral hospitals in Spain. Controls without psychiatric comorbidity were selected in a 1:4 ratio. Detailed clinical and biochemical data were collected preoperatively and at 12, 24, 36, 48, and 60 months after BS. RESULTS Twenty patients with SZ (n = 15; 75%) or SZA (n = 5; 25%) and 80 matched controls were studied. There were no differences between patients and controls concerning the evolution of the percentage of total weight loss. The remission rate of the main comorbidities was similar between groups except for hypertension, which was lower in patients with a psychotic disorder from year 3. There were no mortalities within 30 days of surgery in either group. The psychiatric medication burden did not change during follow-up. CONCLUSIONS BS is safe and effective in carefully selected patients with SZ. The course of the psychiatric disease does not seem to be worsened by the procedure.
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Affiliation(s)
- Inka Miñambres
- Servicio de Endocrinología, Hospital de La Santa Creu i Sant Pau, 08041 Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), 28029 Madrid, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Spain
| | - Miguel Ángel Rubio-Herrera
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, 28040 Madrid, Spain;
- Departamento de Medicina, Universidad Complutense, 28040 Madrid, Spain
| | - Joana Nicolau
- Servicio de Endocrinología, Hospital de Son Llàtzer, 07198 Mallorca, Spain;
| | - Camila Milad
- Servicio de Endocrinología, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (C.M.); (A.d.H.)
| | - Maria José Morales
- Servicio de Endocrinología, Complexo Hospitalario Universitario de Vigo, 36312 Pontevedra, Spain;
| | - Marta Bueno
- Servicio de Endocrinología y Nutrición, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain;
- Obesity, Diabetes and Metabolism (ODIM) Research Group, Institut de Recerca Biomèdica Lleida (IRB-Lleida), 25198 Lleida, Spain
| | - Alfonso Calañas
- Servicio de Endocrinología, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain;
| | - Mar Carceller-Sindreu
- Servicio de Psiquiatría, Hospital de La Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB-Sant Pau), 08041 Barcelona, Spain
| | - Ana de Hollanda
- Servicio de Endocrinología, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (C.M.); (A.d.H.)
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain
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Bu Y, Burks J, Yang K, Prince J, Borna A, Coe CL, Simmons A, Tu XM, Baker D, Kimball D, Rao R, Shah V, Huang M, Schwindt P, Coleman TP, Lerman I. Non-invasive ventral cervical magnetoneurography as a proxy of in vivo lipopolysaccharide-induced inflammation. Commun Biol 2024; 7:893. [PMID: 39075164 PMCID: PMC11286963 DOI: 10.1038/s42003-024-06435-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/10/2024] [Indexed: 07/31/2024] Open
Abstract
Maintenance of autonomic homeostasis is continuously calibrated by sensory fibers of the vagus nerve and sympathetic chain that convey compound action potentials (CAPs) to the central nervous system. Lipopolysaccharide (LPS) intravenous challenge reliably elicits a robust inflammatory response that can resemble systemic inflammation and acute endotoxemia. Here, we administered LPS intravenously in nine healthy subjects while recording ventral cervical magnetoneurography (vcMNG)-derived CAPs at the rostral Right Nodose Ganglion (RNG) and the caudal Right Carotid Artery (RCA) with optically pumped magnetometers (OPM). We observed vcMNG RNG and RCA neural firing rates that tracked changes in TNF-α levels in the systemic circulation. Further, endotype subgroups based on high and low IL-6 responders segregate RNG CAP frequency (at 30-120 min) and based on high and low IL-10 response discriminate RCA CAP frequency (at 0-30 min). These vcMNG tools may enhance understanding and management of the neuroimmune axis that can guide personalized treatment based on an individual's distinct endophenotype.
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Affiliation(s)
- Yifeng Bu
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Jamison Burks
- Department of Bioengineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Kun Yang
- Division of Biostatistics and Bioinformatics, University of California San Diego, La Jolla, CA, 92093, USA
| | - Jacob Prince
- Department of Bioengineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Amir Borna
- Quantum Information Sciences, Sandia National Laboratories, Albuquerque, NM, 87123, USA
| | - Christopher L Coe
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Alan Simmons
- Center for Stress and Mental Health (CESAMH) VA San Diego, La Jolla, CA, 92093, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
| | - Xin M Tu
- Division of Biostatistics and Bioinformatics, University of California San Diego, La Jolla, CA, 92093, USA
| | - Dewleen Baker
- Center for Stress and Mental Health (CESAMH) VA San Diego, La Jolla, CA, 92093, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
| | - Donald Kimball
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ramesh Rao
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Vishal Shah
- Quspin Laboratory Head Quarters, Boulder, CO, 80305, USA
| | - Mingxiong Huang
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, 92093, USA
- Department of Radiology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Peter Schwindt
- Quantum Information Sciences, Sandia National Laboratories, Albuquerque, NM, 87123, USA
| | - Todd P Coleman
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, 92093, USA
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Imanuel Lerman
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, 92093, USA.
- Center for Stress and Mental Health (CESAMH) VA San Diego, La Jolla, CA, 92093, USA.
- InflammaSense Incorporated Head Quarters, La Jolla, CA, 92093, USA.
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, 92093, USA.
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Tremain H, Fletcher K, Meyer D, Murray G. Who benefits from digital interventions for bipolar disorder? Stage of illness characteristics as predictors of changes in quality of life. Bipolar Disord 2024. [PMID: 39043620 DOI: 10.1111/bdi.13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
OBJECTIVES This study explored the potential role of stage-related variables in intervention outcomes in bipolar disorder (BD). Specifically, we aimed to identify which subgroups of individuals were most likely to experience improved quality of life following digitally delivered psychosocial interventions for BD. METHODS The study involved a secondary analysis of combined data from two randomised control trials (RCTs). Each trial assessed the effectiveness of digitally delivered interventions for improving quality of life, in late-stage (ORBIT RCT) or early-stage (BETTER RCT) BD. Three iterations of cluster analyses were performed, identifying subgroups of individuals based on (i) current phenomenology, (ii) course of illness and (iii) medication response. The resultant subgroups were compared with regard to changes in quality of life pre-post intervention, via repeated measures ANOVAs. RESULTS In each cluster analysis, two clusters were found. The current phenomenology clusters reflected two impairment levels, 'moderate impairment' and 'low impairment'. The course of illness clusters reflected 'more chronicity' and 'less chronicity' and the medication response clusters reflected 'good medication response' and 'poor medication response'. Differences in changes in quality of life over time were observed between the two current phenomenology clusters and between the medication response clusters, while the course of illness subgroups did not respond differently. CONCLUSIONS There are at least two distinct groups of treatment-seeking individuals with established BD, based on illness features with previously established links to different illness stages. Clusters within the current phenomenology and medication response domains demonstrated significantly different trajectories of QoL change over time in the context of our interventions, highlighting potential implications for treatment selection aligned with precision psychiatry.
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Affiliation(s)
- Hailey Tremain
- Centre for Mental Health and Brain Sciences, School of Health Sciences, Swinburne University, Melbourne, Victoria, Australia
| | - Kathryn Fletcher
- Centre for Mental Health and Brain Sciences, School of Health Sciences, Swinburne University, Melbourne, Victoria, Australia
| | - Denny Meyer
- Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University, Melbourne, Victoria, Australia
| | - Greg Murray
- Centre for Mental Health and Brain Sciences, School of Health Sciences, Swinburne University, Melbourne, Victoria, Australia
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Li D, Pan Q, Xiao Y, Hu K. Advances in the study of phencyclidine-induced schizophrenia-like animal models and the underlying neural mechanisms. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:65. [PMID: 39039065 PMCID: PMC11263595 DOI: 10.1038/s41537-024-00485-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/12/2024] [Indexed: 07/24/2024]
Abstract
Schizophrenia (SZ) is a chronic, severe mental disorder with heterogeneous clinical manifestations and unknown etiology. Research on SZ has long been limited by the low reliability of and ambiguous pathogenesis in schizophrenia animal models. Phencyclidine (PCP), a noncompetitive N-methyl-D-aspartate receptor (NMDAR) antagonist, rapidly induces both positive and negative symptoms of SZ as well as stable SZ-related cognitive impairment in rodents. However, the neural mechanism underlying PCP-induced SZ-like symptoms is not fully understood. Nondopaminergic pathophysiology, particularly excessive glutamate release induced by NMDAR hypofunction in the prefrontal cortex (PFC), may play a key role in the development of PCP-induced SZ-like symptoms. In this review, we summarize studies on the behavioral and metabolic effects of PCP and the cellular and circuitary targets of PCP in the PFC and hippocampus (HIP). PCP is thought to target the ventral HIP-PFC pathway more strongly than the PFC-VTA pathway and thalamocortical pathway. Systemic PCP administration might preferentially inhibit gamma-aminobutyric acid (GABA) neurons in the vHIP and in turn lead to hippocampal pyramidal cell disinhibition. Excitatory inputs from the HIP may trigger sustained, excessive and pathological PFC pyramidal neuron activation to mediate various SZ-like symptoms. In addition, astrocyte and microglial activation and oxidative stress in the cerebral cortex or hippocampus have been observed in PCP-induced models of SZ. These findings perfect the hypoglutamatergic hypothesis of schizophrenia. However, whether these effects direct the consequences of PCP administration and how about the relationships between these changes induced by PCP remain further elucidation through rigorous, causal and direct experimental evidence.
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Affiliation(s)
- Dabing Li
- Department of Physiology, School of Basic Medical Sciences, Southwestern Medical University, LuZhou, 646000, China.
| | - Qiangwen Pan
- Department of Physiology, School of Basic Medical Sciences, Southwestern Medical University, LuZhou, 646000, China
| | - Yewei Xiao
- Department of Physiology, School of Basic Medical Sciences, Southwestern Medical University, LuZhou, 646000, China
| | - Kehui Hu
- Department of rehabilitation Medicine, SuiNing Central Hospital, The Affiliated Hospital of Chongqing Medical University, SuiNing, 629000, China.
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Freyberg Z, Andreazza AC, McClung CA, Phillips ML. Linking mitochondrial dysfunction, neurotransmitter, neural network abnormalities and mania: Elucidating neurobiological mechanisms of the therapeutic effect of the ketogenic diet in Bipolar Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00199-X. [PMID: 39053576 DOI: 10.1016/j.bpsc.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/25/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
There is growing interest in the ketogenic diet as a treatment for Bipolar Disorder (BD), with promising anecdotal and small case study reports of efficacy. Yet, the neurobiological mechanisms by which diet-induced ketosis might ameliorate BD symptoms remain to be determined, particularly in manic and hypomanic states - defining features of BD. Identifying these mechanisms will therefore provide new markers to guide personalized interventions and provide targets for novel treatment developments for individuals with BD. In this critical review, we describe recent findings highlighting two types of neurobiological abnormalities in BD: 1) mitochondrial dysfunction; and 2) neurotransmitter and neural network functional abnormalities. We will consequently link these abnormalities lead to mania/hypomania and depression in BD and then describe the biological underpinnings by which the ketogenic diet might have a beneficial effect in individuals with BD. We end the review by describing future approaches that can be employed to elucidate the neurobiology underlying the therapeutic effect of the ketogenic diet in BD. In so doing, this may provide marker predictors to identify individuals who will respond well to the ketogenic diet, as well as offer neural targets for novel treatment developments for BD.
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Affiliation(s)
- Zachary Freyberg
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
| | - Ana C Andreazza
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada; Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Colleen A McClung
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Temes CM, Boccagno C, Gold AK, Kobaissi H, Hsu I, Montinola S, Sylvia LG. Comorbidity of bipolar disorder and borderline personality disorder: Phenomenology, course, and treatment considerations. Bipolar Disord 2024. [PMID: 39034111 DOI: 10.1111/bdi.13465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
AIM Bipolar disorder (BD) and borderline personality disorder (BPD) are both serious psychiatric conditions that elevate the risk for harmful outcomes. Although these conditions represent distinct diagnostic entities, existing research suggests that approximately 20% of individuals with BD meet the criteria for comorbid BPD. Individuals with comorbid BD/BPD appear to have a markedly more severe and phenomenologically distinct clinical course when compared with those with BD alone. However, treatments have generally not been tested in this specific population, and currently, no formal treatment guidelines exist for this subgroup of patients. METHOD In the current paper, we review the epidemiological and descriptive research characterizing those with comorbid BD/BPD and discuss the impact of this comorbidity on psychosocial treatment. We also review current findings on evidence-based treatments for BD and BPD that show promise in treating those with comorbid BD/BPD. RESULTS In our review of the literature, we highlight the importance of recognizing this comorbidity and discuss avenues for developing and integrating evidence-based treatment approaches for this understudied clinical population. CONCLUSIONS Although formal trials of interventions targeted to comorbid BD/BPD are limited, there is promising evidence regarding the possibility of using or integrating existing evidence-based approaches for this population. There are also several areas of clinical practice improvement and future research directions that stem from this literature.
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Affiliation(s)
- Christina M Temes
- Massachusetts General Hospital, Dauten Center for Bipolar Treatment Innovation, Boston, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Chelsea Boccagno
- Massachusetts General Hospital, Dauten Center for Bipolar Treatment Innovation, Boston, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
- Harvard T.H. Chan School for Public Health, Department of Epidemiology, Boston, Massachusetts, USA
| | - Alexandra K Gold
- Massachusetts General Hospital, Dauten Center for Bipolar Treatment Innovation, Boston, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Hadi Kobaissi
- Massachusetts General Hospital, Dauten Center for Bipolar Treatment Innovation, Boston, Massachusetts, USA
| | - Ingrid Hsu
- Massachusetts General Hospital, Dauten Center for Bipolar Treatment Innovation, Boston, Massachusetts, USA
| | - Sofia Montinola
- Massachusetts General Hospital, Dauten Center for Bipolar Treatment Innovation, Boston, Massachusetts, USA
| | - Louisa G Sylvia
- Massachusetts General Hospital, Dauten Center for Bipolar Treatment Innovation, Boston, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
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Pantovic-Stefanovic M, Petronijevic N, Dunjic-Kostic B, Velimirovic M, Jurisic V, Nikolic T, Dodic S, Ivkovic M. Differentiating Stages of Bipolar and Unipolar Depression-The Possible Role of sICAM-1 and sVCAM-1. Cells 2024; 13:1213. [PMID: 39056795 PMCID: PMC11274993 DOI: 10.3390/cells13141213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/27/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Increased immune-inflammatory activation has been repeatedly linked to etiopathogenesis and the progression of both major depressive disorder (MDD) and bipolar depression (BD). We explore the role of soluble intercellular cell adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) in diagnostic differentiation and disorder progression in patients with MDD and BD. Serum levels of sICAM-1 and sVCAM-1 were measured in 137 patients (MDD = 93 and BD = 44) and compared with 73 healthy controls. The severity of psychopathology was assessed using the Hamilton Depression Rating Scale and Clinical Global Impression Scale. After adjustment for multiple confounders, we noticed significant downregulation of sVCAM-1 and upregulation of sICAM-1 levels in both patient groups. Decreased sVCAM-1 levels were detected in patients with acute episodes of BD when compared to MDD. Immune mediators were related to indicators of progression in both mood disorders. They also followed different post-treatment normalization patterns in MDD and BD and in relation to the stage of each disorder. Adhesion molecules could potentially be useful in discriminating between patients with MDD and BD and determining the possible progression of the disorders. Future nosological methods should include time-dependent pathoplasticity and biological correlates, at least for affective disorders.
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Affiliation(s)
- Maja Pantovic-Stefanovic
- Department of Bipolar Disorders, Clinic for Psychiatry, University Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia; (M.P.-S.)
- School of Medicine, University of Belgrade, Dr Subotica 8 st., 11000 Belgrade, Serbia; (N.P.)
| | - Natasa Petronijevic
- School of Medicine, University of Belgrade, Dr Subotica 8 st., 11000 Belgrade, Serbia; (N.P.)
- Institute of Clinical and Medical Biochemistry, Pasterova 2, 11000 Belgrade, Serbia
| | - Bojana Dunjic-Kostic
- Department of Bipolar Disorders, Clinic for Psychiatry, University Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia; (M.P.-S.)
- School of Medicine, University of Belgrade, Dr Subotica 8 st., 11000 Belgrade, Serbia; (N.P.)
| | - Milica Velimirovic
- School of Medicine, University of Belgrade, Dr Subotica 8 st., 11000 Belgrade, Serbia; (N.P.)
- Institute of Clinical and Medical Biochemistry, Pasterova 2, 11000 Belgrade, Serbia
| | - Vladimir Jurisic
- Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 11000 Kragujevac, Serbia
| | - Tatjana Nikolic
- School of Medicine, University of Belgrade, Dr Subotica 8 st., 11000 Belgrade, Serbia; (N.P.)
- Institute of Clinical and Medical Biochemistry, Pasterova 2, 11000 Belgrade, Serbia
| | - Sara Dodic
- Department of Bipolar Disorders, Clinic for Psychiatry, University Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia; (M.P.-S.)
- School of Medicine, University of Belgrade, Dr Subotica 8 st., 11000 Belgrade, Serbia; (N.P.)
| | - Maja Ivkovic
- Department of Bipolar Disorders, Clinic for Psychiatry, University Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia; (M.P.-S.)
- School of Medicine, University of Belgrade, Dr Subotica 8 st., 11000 Belgrade, Serbia; (N.P.)
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Primavera D, Urban A, Cantone E, Nonnis M, Aviles Gonzalez CI, Perra A, Tusconi M, Sancassiani F. The Impact on Anxiety Symptoms of an Immersive Virtual Reality Remediation Program in Bipolar Disorders: A Randomized Clinical Trial. J Clin Med 2024; 13:4203. [PMID: 39064243 PMCID: PMC11277986 DOI: 10.3390/jcm13144203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/03/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Background: The objective of this work is to investigate the effectiveness of a cognitive remediation intervention on anxiety symptoms in people with bipolar disorder and the therapeutic effect on people whose anxiety symptoms were above the threshold for a screener and whose comorbidity could be identified as an anxiety disorder. Methods: The experimental intervention included 24 sessions (around 45 min each), two for each week over three months. The entire program was inspired by user-centered rehabilitation principles in a recovery-oriented perspective and an approach to bipolar disorder in an evolutionary and non-discriminating vision. The primary outcomes measure the score of the Zung Self-Rating Anxiety Scale (SAS), hypothesizing a higher decrease in the experimental group than in the control group. The survey has been conducted per the CONSORT guidelines for feasibility studies. Results: We evaluate a decrease in the overall SAS score from T0 to T1 to be higher in the experimental group compared to the control group, indicating an improvement in anxiety symptoms (p < 0.0001). Conclusions: The study suggests that virtual reality could have a role in treating anxiety symptoms and disorders in young adults with bipolar disorders or anxiety symptoms in people with hyperactivity and novelty-seeking behaviorsunder stress and high risk for bipolar disorder.
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Affiliation(s)
- Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
| | - Antonio Urban
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
- University Hospital of Cagliari, 09042 Cagliari, Italy
| | - Elisa Cantone
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
| | - Marcello Nonnis
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09123 Cagliari, Italy;
| | - Cesar Ivan Aviles Gonzalez
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
- Department of Nursing, Universidad Popular del Cesar, Valledupar 200001, Colombia
| | - Alessandra Perra
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
| | | | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
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Shaker Z, Goudarzi Z, Ravangard R, Shaker Z, Hedayati A, Keshavarz K. The economic burden of bipolar disorder: a case study in Southern Iran. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:55. [PMID: 39026286 PMCID: PMC11264727 DOI: 10.1186/s12962-024-00560-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 06/12/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Bipolar Disorder (BD) imposes considerable economic and social burdens on the community. Therefore, the present study aimed to determine the economic burden of bipolar disorder in patients referred to single-specialty psychiatric hospitals at the secondary and tertiary care level in 2022. METHODS This partial economic evaluation was conducted as a cross-sectional study in the south of Iran in 2022, and 916 patients were selected through the census method. The prevalence-based and bottom-up approaches were used to collect cost information and calculate the costs, respectively. The data on Direct Medical Costs (DMC), Direct Non-Medical Costs (DNMC), and Indirect costs (IC) were obtained using the information from the patients' medical records and bills as well as the self-reports by the patients or their companions. The human capital approach was also used to calculate IC. FINDINGS The results showed that in 2022, the annual cost of bipolar disorder was $4,227 per patient. The largest share of the costs was that of DMC (77.66%), with hoteling and ordinary beds accounting for the highest expenses (55.40%). The shares of DNMC and IC were 6.37% and 15.97%, respectively, and the economic burden of the disease in the country was estimated at $2,799,787,266 as well. CONCLUSION In general, the costs of bipolar disorder treatment could impose a heavy economic burden on the community, the health system, the insurance system, and the patients themselves. Considering the high costs of hoteling and ordinary beds, it is suggested that hospitalization of BD patients be reduced by managing treatment solutions along with prevention methods to reduce the economic burden of this disease. Furthermore, in order to reduce the costs, proper and fair distribution of psychiatrists and psychiatric beds as well as expansion of home care services and use of the Internet and virtual technologies to follow up the treatment of these patients are recommended.
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Affiliation(s)
- Zohreh Shaker
- Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Goudarzi
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Ravangard
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zinab Shaker
- Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Arvin Hedayati
- Department of Psychiatry, School of Medicine, Research Center for Psychiatry and Behavior Science, Hafez Hospital, Ebnesina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
- Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Lo HKY, Ho FYY, Yeung JWF, Ng STW, Wong EYT, Chung KF. Self-help interventions for the prevention of relapse in mood disorder: a systematic review and meta-analysis. Fam Pract 2024:cmae036. [PMID: 39016242 DOI: 10.1093/fampra/cmae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Self-help interventions may offer a scalable adjunct to traditional care, but their effectiveness in relapse prevention is not well-established. Objectives: This review aimed to assess their effectiveness in preventing relapses among individuals with mood disorders. METHODS We systematically reviewed the pertinent trial literature in Web of Science, EMBASE, PubMed, PsycINFO, and Cochrane databases until May 2024. Randomized controlled trials that examined the self-help interventions among individuals diagnosed with major depressive disorder (MDD) or bipolar disorder (BD) were included. The random-effects model computed the pooled risk ratios of relapse, with subgroup analyses and meta-regression analyses to explore heterogeneity sources. RESULTS Fifteen papers and 16 comparisons of randomized trials involving 2735 patients with mood disorders were eligible for this meta-analysis. Adjunct self-help interventions had a small but significant effect on reducing the relapse rates of major depressive disorder (pooled risk ratio: 0.78, 95% confidence interval (CI): 0.66-0.92, P = 0.0032, NNT = 11), and were marginally better in bipolar disorder (pooled risk ratio: 0.62, 95% CI: 0.40-0.97, P = .0344, NNT = 12), as compared to treatment as usual (TAU). No subgroup difference was found based on intervention components, settings, delivery method, or guidance levels. The average dropout rate for self-help interventions (18.9%) did not significantly differ from TAU dropout rates. The examination of treatment adherence was highly variable, precluding definitive conclusions. CONCLUSIONS Self-help interventions demonstrate a modest preventative effect on relapse in mood disorders, despite low to very low certainty. Future research is essential to identify which elements of self-help interventions are most effective.
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Affiliation(s)
- Heidi Ka-Ying Lo
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Fiona Yan-Yee Ho
- Department of Psychology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jerry Wing-Fai Yeung
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Stephy Tim-Wai Ng
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Eva Yuen-Ting Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ka-Fai Chung
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Trac C, Zecopoulos A, Ross C, Weeda E, McGraw D. Comparison of Weight-Based Valproic Acid Dosing in Treatment of Mental Illness Among Obese and Nonobese Patients. J Clin Psychopharmacol 2024:00004714-990000000-00267. [PMID: 39008862 DOI: 10.1097/jcp.0000000000001883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
PURPOSE/BACKGROUND A weight-based dosing approach of 20-30 mg/kg per day of valproic acid (VPA) has been shown to achieve rapid attainment of mood symptom control. Due to interindividual pharmacokinetic variability, therapeutic drug monitoring may be a useful tool to avoid VPA toxicity. Limited research exists on the impact of patient body weight on VPA pharmacokinetic profiles. This analysis aims to explore the correlation between steady-state serum levels of VPA and weight-based dosing strategies, including total body weight (TBW), ideal body weight (IBW), and adjusted body weight (AdjBW), between obese and nonobese patients. METHODS/PROCEDURES This single-center, retrospective, observational cohort analysis evaluated weight-based dosing of VPA in obese and nonobese patients admitted to inpatient psychiatry at a large academic medical center between July 1, 2017, and July 1, 2022. FINDINGS/RESULTS This analysis included 93 obese and 93 nonobese patients. No significant difference in median VPA serum concentrations was observed between groups (P = 0.82). However, the obese group received a lower median weight-based dose (15.6 mg/kg) compared with the nonobese group (19.5 mg/kg, P < 0.001). A stronger correlation was found between VPA dose and therapeutic serum levels in the obese group compared with the nonobese group regardless of weight-based dosing strategy. Dosing with AdjBW in obese patients most closely approximated dosing with TBW in nonobese patients. IMPLICATIONS/CONCLUSIONS In obese patients, our analysis suggests dosing VPA using AdjBW may be considered as the preferred dosing strategy over IBW or TBW to minimize toxicity risk. Further research is needed with larger sample sizes and diverse patient populations to confirm these findings.
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Affiliation(s)
- Cindy Trac
- From the NYC Health and Hospitals/Woodhull, Brooklyn, NY
| | | | | | - Erin Weeda
- University of South Carolina School of Medicine Greenville, Greenville, SC
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Zhao Y, Zhang Y, Zheng S, Fang M, Huang J, Zhang L. Manic Residual Symptoms Also Deserve Attention: A Symptom Network Analysis of Residual Symptoms in Bipolar Disorder. Neuropsychiatr Dis Treat 2024; 20:1397-1408. [PMID: 39049936 PMCID: PMC11268721 DOI: 10.2147/ndt.s466090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024] Open
Abstract
Background Lots of patients with bipolar disorder (BD) continue to have residual symptoms after treatment in their remission, BD exhibits intricate characteristics and transformation patterns in its residual symptoms, residual symptoms of different polarities and degrees can mix with and transform to each other. There is a need for further investigation of BD as a comprehensive multivariate disease system. The current research lacks network analyses focusing on BD's residual and subsyndromal symptoms. Methods 242 patients were included with bipolar disorder in remission. We compared demographic data and differences in symptoms between populations with and without residual symptoms using t-tests and chi-square tests, with FDR applied for multiple comparison correction. Logistic regression was used to identify influencing factors for residual symptoms. Symptom networks were compared by network analysis to analyze the relationships between different types of residual symptoms. Results Depressive residual symptoms (N=111) were more common than manic residual symptoms (n=29) in the patients included. The comparison between two groups with and without residual symptoms shows no difference in demographic data and medical history information. The main influencing factors related to residual symptoms were time from diagnosis to first treatment (OR=0.88), the first(OR=1.51) and second (OR=17.1)factors of the Mood Disorder Questionnaire (MDQ), the Quick Inventory of Depressive Symptomatology Self-Report (QIDS)(OR=5.28), the psychological(OR=0.68) and environment (OR=1.53) subscale of the World Health Organization Quality of Life Short Form (WHOQOL-BREF). There was a significant difference in network structure between the groups with and without residual symptoms (network invariance difference=0.4, p =0.025). At the same time, there was no significant difference between the groups with and without depressive residual symptoms. However, the symptom network in patients with depressive residual symptoms is more loosely structured than in those without, with symptoms exhibiting weaker interconnections. When there is no depressive or manic residual symptom, it can still form a symptom network and cause an impact on social function. Conclusion This study underscores the complexity of bipolar disorder's residual symptoms. Although it primarily manifests as loosely structured depressive residual symptoms, manic residual symptoms should not be ignored. Future research should explore network-based interventions targeting specific symptom clusters or connections to improve residual symptom management and patient outcomes.
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Affiliation(s)
- Yan Zhao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100088, People’s Republic of China
| | - Yin Zhang
- Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, 100700, People’s Republic of China
| | - Sisi Zheng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100088, People’s Republic of China
| | - Meng Fang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100088, People’s Republic of China
| | - Juan Huang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100088, People’s Republic of China
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100088, People’s Republic of China
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Barlattani T, Soltmann B, D'Amelio C, Socci V, Pacitti F, Pompili M, Ritter P. The influence of PER3 VNTR genotypes on the age of onset in a group of bipolar I disorder patients: an exploratory study. Int J Bipolar Disord 2024; 12:25. [PMID: 38992306 PMCID: PMC11239620 DOI: 10.1186/s40345-024-00346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 06/18/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND PER3 is a circadian gene that contains a variable number of tandem repeats (VNTR) which codifies for three genotypes: 4/4; 4/5; and 5/5 and is involved in non-visual response to light, a critical process associated with bipolar disorder onset. Benedetti et al. (Neurosci Lett 445(2):184-7) related this VNTR with bipolar disorder age of onset and linked genotype 5/5 with an earlier onset. In this study, we aimed to investigate these associations of PER3 VNTR genotypes with age of onset in a homogenous sample of German patients with bipolar I disorder through Kaplan-Meier curves. METHODS 45 patients were enrolled and divided into three groups according to PER3 VNTR genotypes. Recognizing common biological features, we built a combined group of -5 allele carriers (4/5 + 5/5). As a primary outcome, Kaplan-Meier analysis was conducted to delineate the three genotypes' influence on age of onset. The secondary Kaplan-Meier analysis aimed to evaluate the relation between the 4/4 homozygotes group and the combined group (4/5 + 5/5) with age of onset. Finally, we proceeded to compare groups through a Log Rank Test and performed an analysis of covariance (ANCOVA). RESULTS The Kaplan-Meier analysis with three separate genotypes didn't replicate the findings of Benedetti's study. The analysis comparing genotype 4/4 with the combined group showed the influence of PER3 VNTR variants on the age of onset and relates genotype 4/4 to an earlier onset. ANCOVA between the combined and the 4/4 genotype groups, correlated genotype 4/4 with an increased number of depressive episodes. CONCLUSION This study showed no significant effect of PER3 VNTR genotypes on the age of onset and in linking genotype 5/5 with an earlier onset age. Contrasting results may arise from intrinsic differences between the two studies but also shed light on hypothetically different levels of functioning of PER3 VNTR genotypes in the context of bipolar pathology. Further studies will require bigger and more homogeneous clinical samples.
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Affiliation(s)
- Tommaso Barlattani
- Chair of Psychiatry, Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, Coppito 2, L'Aquila, 67100, Italy.
| | - Bettina Soltmann
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Chiara D'Amelio
- Chair of Psychiatry, Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, Coppito 2, L'Aquila, 67100, Italy
| | - Valentina Socci
- Chair of Psychiatry, Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, Coppito 2, L'Aquila, 67100, Italy
| | - Francesca Pacitti
- Chair of Psychiatry, Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, Coppito 2, L'Aquila, 67100, Italy
| | - Maurizio Pompili
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Unit of Psychiatry, Sapienza University, Sant'Andrea University Hospital, Rome, Italy
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Menculini G, Cinesi G, Scopetta F, Cardelli M, Caramanico G, Balducci PM, De Giorgi F, Moretti P, Tortorella A. Major challenges in youth psychopathology: treatment-resistant depression. A narrative review. Front Psychiatry 2024; 15:1417977. [PMID: 39056019 PMCID: PMC11269237 DOI: 10.3389/fpsyt.2024.1417977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
Major depressive disorder (MDD) represents a major health issue in adolescents and young adults, leading to high levels of disability and profoundly impacting overall functioning. The clinical presentation of MDD in this vulnerable age group may slightly differ from what can be observed in adult populations, and psychopharmacological strategies do not always lead to optimal response. Resistance to antidepressant treatment has a prevalence estimated around 40% in youths suffering from MDD and is associated with higher comorbidity rates and suicidality. Several factors, encompassing biological, environmental, and clinical features, may contribute to the emergence of treatment-resistant depression (TRD) in adolescents and young adults. Furthermore, TRD may underpin the presence of an unrecognized bipolar diathesis, increasing the overall complexity of the clinical picture and posing major differential diagnosis challenges in the clinical practice. After summarizing current evidence on epidemiological and clinical correlates of TRD in adolescents and young adults, the present review also provides an overview of possible treatment strategies, including novel fast-acting antidepressants. Despite these pharmacological agents are promising in this population, their usage is expected to rely on risk-benefit ratio and to be considered in the context of integrated models of care.
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Affiliation(s)
- Giulia Menculini
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gianmarco Cinesi
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Francesca Scopetta
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Matteo Cardelli
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Guido Caramanico
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Pierfrancesco Maria Balducci
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Community Mental Health Center “CSM Terni”, Department of Psychiatry, Local Health Unit USL Umbria 2, Terni, Italy
| | - Filippo De Giorgi
- Division of Psychiatry, Clinical Psychology and Rehabilitation, General Hospital of Perugia, Perugia, Italy
| | - Patrizia Moretti
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alfonso Tortorella
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Shen Y, Zhao M, Zhao P, Meng L, Zhang Y, Zhang G, Taishi Y, Sun L. Molecular mechanisms and therapeutic potential of lithium in Alzheimer's disease: repurposing an old class of drugs. Front Pharmacol 2024; 15:1408462. [PMID: 39055498 PMCID: PMC11269163 DOI: 10.3389/fphar.2024.1408462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline and memory loss. Despite advances in understanding the pathophysiological mechanisms of AD, effective treatments remain scarce. Lithium salts, recognized as mood stabilizers in bipolar disorder, have been extensively studied for their neuroprotective effects. Several studies indicate that lithium may be a disease-modifying agent in the treatment of AD. Lithium's neuroprotective properties in AD by acting on multiple neuropathological targets, such as reducing amyloid deposition and tau phosphorylation, enhancing autophagy, neurogenesis, and synaptic plasticity, regulating cholinergic and glucose metabolism, inhibiting neuroinflammation, oxidative stress, and apoptosis, while preserving mitochondrial function. Clinical trials have demonstrated that lithium therapy can improve cognitive function in patients with AD. In particular, meta-analyses have shown that lithium may be a more effective and safer treatment than the recently FDA-approved aducanumab for improving cognitive function in patients with AD. The affordability and therapeutic efficacy of lithium have prompted a reassessment of its use. However, the use of lithium may lead to potential side effects and safety issues, which may limit its clinical application. Currently, several new lithium formulations are undergoing clinical trials to improve safety and efficacy. This review focuses on lithium's mechanism of action in treating AD, highlighting the latest advances in preclinical studies and clinical trials. It also explores the side effects of lithium therapy and coping strategies, offering a potential therapeutic strategy for patients with AD.
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Affiliation(s)
- Yanxin Shen
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, Jilin Province, China
- Cognitive Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, Jilin Province, China
| | - Meng Zhao
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, Jilin Province, China
- Cognitive Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, Jilin Province, China
| | - Panpan Zhao
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, Jilin Province, China
- Cognitive Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, Jilin Province, China
| | - Lingjie Meng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, Jilin Province, China
- Cognitive Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, Jilin Province, China
| | - Yan Zhang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, Jilin Province, China
- Cognitive Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, Jilin Province, China
| | - Guimei Zhang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, Jilin Province, China
- Cognitive Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, Jilin Province, China
| | - Yezi Taishi
- Department of Cadre Ward, The First Hospital of Jilin University, Jilin University, Changchun, Jilin Province, China
| | - Li Sun
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, Jilin Province, China
- Cognitive Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, Jilin Province, China
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Chumakov E, Ashenbrenner Y, Gvozdetskii A, Limankin O, Petrova N. Individual Burden of Illness Index in Bipolar Disorder Remission: A Cross-Sectional Study. CONSORTIUM PSYCHIATRICUM 2024; 5:17-30. [PMID: 39072003 PMCID: PMC11272304 DOI: 10.17816/cp15471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/31/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND A population-based method for estimating disease burden is commonly used. Nevertheless, these measurements do not entirely capture the comprehensive burden of illness on an individual patient. To address the problem, the Individual Burden of Illness Index (IBI index) Index was created and validated, specifically for major depressive disorder. The IBI represents the overall influence of the condition, encompassing distress from symptom intensity, functional impairment, and the patient's quality of life. AIM The aim of the study was to approve and validate the IBI index for the integral assessment of disease burden in patients with bipolar disorder (BD) in remission. METHODS The cross-sectional study was conducted in the outpatient psychiatric services in Saint Petersburg, Russia, from April through October 2020. Eighty-five patients aged 18 to 45 (mean age 36.6±5.7 years) with BD (type I - 75%, n=64; type II - 25%, n=21) in remission were examined. The study procedure included a structured clinical interview and the use of clinical scales: the World Health Organization's Quality of Life Questionnaire, Hamilton Rating Scale for Depression (HDRS), Young Mania Rating Scale (YMRS), and Personal and the Social Performance Scale. RESULTS The principal component analysis in accordance with the adjusted one showed that the burden of illness in patients with BD in remission is directly related to the severity of residual depressive symptoms, reflected in the HDRS score: as the HDRS score increases (0.27, p <0.001), residual mania (-0.14, p <0.001), social functioning (-0.06, p <0.001), and quality of life (-0.04, p <0.001) decrease. In contrast, when there are remaining residual mania symptoms, as indicated by the YMRS score, the result tends to be a lower burden, better social functioning, and enhanced quality of life. CONCLUSION The study has demonstrated through statistical means a successful adaptation and validation of the previously calculated IBI index for patients with BD in remission. Residual affective symptoms were shown to have different impacts on the social functioning of patients with BD in remission, indicating the need for a timely assessment and targeted therapy of these symptoms in such patients.
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Kriner P, Brieger P, Pogarell O, Schüle C, Mußmann L, Korbmacher J, Seemüller F. Treatment of bipolar depression: clinical practice vs. adherence to guidelines-data from a Bavarian drug surveillance project. Front Psychiatry 2024; 15:1425549. [PMID: 39015883 PMCID: PMC11250482 DOI: 10.3389/fpsyt.2024.1425549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/07/2024] [Indexed: 07/18/2024] Open
Abstract
Objectives Pharmacotherapy of bipolar depression (BPD) is confronted with major clinical challenges, like limited evidence-based treatment options, regular cases of treatment resistance, and risk of treatment-emergent affective switches. Medical guidelines can support practitioners to make decisions based on current scientific evidence. The objective of this study is to evaluate to what extent recommendations of the 2019 German S3 guidelines "Diagnosis and Treatment of Bipolar Disorders" are reflected in clinical practice in inpatient treatment. Methods We conducted a descriptive analysis of prescription numbers in 2,627 patients with BPD in a naturalistic inpatient setting analyzing data from the ongoing Bavarian multicenter drug safety project Pharmaco-Epidemiology and Vigilance (Pharmako-EpiVig) from the years 2014-2022. Results Of the patients, 38% were not administered any drug explicitly recommended for treatment of BPD, that is, quetiapine, lamotrigine, carbamazepine, or olanzapine. Only 6% of the patients received monotherapy with one of those drugs. Of the patients, 34% were administered ≥4 psychotropic drugs simultaneously. Patients received 912 different therapy regimens of mono or combination therapy with mood stabilizers (MS), atypical antipsychotics (AAP), and antidepressants. Of the patients, 72% received an antidepressant and 6% without concomitant prescription of an AAP or MS. Prescription rates of venlafaxine (21% to 14%) and tricyclic antidepressants (9% to 6%) decreased significantly from the first (2014-2016) to the last (2020-2022) observed time period. Of the patients, 60% received an MS. Prescription rate of valproate (22% to 14%) decreased significantly, while lithium prescription increased significantly (29% to 35%). Of the patients, 71% were administered an AAP. Quetiapine was the most prescribed drug overall (43%). Only two patients were administered a combination of olanzapine and fluoxetine. Conclusion Our results demonstrate a substantial gap between guideline recommendations and current clinical practice. The remarkable heterogeneity in treatment regimens, with no discernible dominant treatment approach, is in part a reflection of the complexity of bipolar disorder but also substantiates the need of comprehensive recommendations regarding combination therapies. Increase in lithium prescription is an encouraging development due to its unique efficacy in maintenance treatment. To improve the quality of clinical practice guideline implementation, more randomized controlled trials should be conducted in the future to prospectively investigate different implementation strategies.
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Affiliation(s)
- Paul Kriner
- Department of Psychiatry and Psychotherapy, kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Peter Brieger
- Department of Psychiatry and Psychotherapy, kbo-Isar-Amper-Klinikum, Haar, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Cornelius Schüle
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Lisa Mußmann
- Bavarian Institute for Data, Analysis and Quality Assurance, Munich, Germany
| | - Julie Korbmacher
- Bavarian Institute for Data, Analysis and Quality Assurance, Munich, Germany
| | - Florian Seemüller
- Department of Psychiatry and Psychotherapy, kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
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Sakurai H, Nakashima M, Tsuboi T, Baba K, Nosaka T, Watanabe K, Kawakami K. Effect of prior depression diagnosis on bipolar disorder outcomes: A retrospective cohort study using a medical claims database. Neuropsychopharmacol Rep 2024. [PMID: 38955798 DOI: 10.1002/npr2.12457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/16/2024] [Accepted: 05/23/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Bipolar disorder often emerges from depressive episodes and is initially diagnosed as depression. This study aimed to explore the effects of a prior depression diagnosis on outcomes in patients diagnosed with bipolar disorder. METHODS This cohort study analyzed data of patients aged 18-64 years who received a new bipolar disorder diagnosis in Japan, using medical claims data from January 2005 to October 2020 provided by JMDC, Inc. The index month was defined as the time of the bipolar diagnosis. The study assessed the incidence of psychiatric hospitalization, all-cause hospitalization, and mortality, stratified by the presence of a preceding depression diagnosis and its duration (≥1 or <1 year). Hazard ratios (HRs) and p-values were estimated using Cox proportional hazards models, adjusted for potential confounders, and supported by log-rank tests. RESULTS Of the 5595 patients analyzed, 2460 had a history of depression, with 1049 experiencing it for over a year and 1411 for less than a year. HRs for psychiatric hospitalization, all hospitalizations, and death in patients with a history of depression versus those without were 0.92 (95% CI = 0.78-1.08, p = 0.30), 0.87 (95% CI = 0.78-0.98, p = 0.017), and 0.61 (95% CI = 0.33-1.12, p = 0.11), respectively. In patients with preceding depression ≥1 year versus <1 year, HRs were 0.89 (95% CI = 0.67-1.19, p = 0.43) for psychiatric hospitalization, 0.85 (95% CI = 0.71-1.00, p = 0.052) for all hospitalizations, and 0.25 (95% CI = 0.07-0.89, p = 0.03) for death. CONCLUSION A prior history and duration of depression may not elevate psychiatric hospitalization risk after bipolar disorder diagnosis and might even correlate with reduced hospitalization and mortality rates.
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Affiliation(s)
- Hitoshi Sakurai
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Masayuki Nakashima
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kenji Baba
- Medical Science, Sumitomo Pharma Co., Ltd., Tokyo, Japan
| | - Tadashi Nosaka
- Medical Science, Sumitomo Pharma Co., Ltd., Tokyo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Zimmermann-Rösner A, Prehn-Kristensen A. The Microbiome in Child and Adolescent Psychiatry. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2024; 52:213-226. [PMID: 38240707 DOI: 10.1024/1422-4917/a000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
Recent research has increasingly emphasized the function of the microbiome in human health. The gut microbiome is essential for digesting food and seems to play a vital role in mental health as well. This review briefly overviews the gut microbiome and its interplay with the central nervous system. We then summarize some of the latest findings on the possible role of the microbiome in psychiatric disorders in children and adolescents. In particular, we focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, anorexia nervosa, bipolar disorder, and major depressive disorder. Although the role of microbiota in mental development and health still needs to be researched intensively, it has become increasingly apparent that the impact of microbiota must be considered to better understand psychiatric disorders.
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Affiliation(s)
| | - Alexander Prehn-Kristensen
- Institute for Child and Adolescent Psychiatry, Center of Integrative Psychiatry GmbH, Kiel, Germany
- Department of Psychology, Faculty of Human Sciences, MSH Medical School Hamburg - University of Applied Sciences and Medical University, Hamburg, Germany
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Popiolek K, Arnison T, Bejerot S, Fall K, Landén M, Nordenskjöld A. Association between electroconvulsive therapy and time to readmission after a manic episode. Acta Psychiatr Scand 2024; 150:22-34. [PMID: 38604233 DOI: 10.1111/acps.13689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE The majority of patients hospitalized for treatment of a manic episode are readmitted within 2 years despite maintenance treatment. Electroconvulsive therapy (ECT) has been associated with lower rehospitalization rates in some psychiatric conditions, but its association with readmission after a manic episode has not been investigated. Therefore, the aim of this study was to determine whether the time to readmission in patients with mania treated with ECT was longer than in patients not treated with ECT and whether there were subgroups of patients that benefited more. METHODS This was a nationwide register-based, observational study. All patients diagnosed with bipolar disorder, manic episode, admitted to any hospital in Sweden between 2012 and 2021 were included. Patients contributed data to the study for every admission. All admissions were followed up until psychiatric readmission, death, or the end of the study (December 31, 2021). Association between ECT and time to readmission was analyzed. A paired samples model was performed for 377 patients with at least two admissions for mania, treated with ECT at one admission and without ECT at the other admission. Times to readmission were analyzed. RESULTS A total of 12,337 admissions were included; mean (SD) age 47.7 (17.2), 5443 (44.1%) men. Readmission rate within 1 year was 54.6%. ECT was administered in 902 (7.3%) admissions. Within 30 days after admission, 182 out of 894 (20.4%) patients treated with ECT versus 2105 out of 11,305 (18.6%) patients treated without ECT were readmitted. There was no association between ECT and time to readmission (aHR 1.00, 95% CI 0.86-1.16, p = 0.992) in the model with all admissions. The paired samples model included 754 admissions (377 patients), mean (SD) age during admission without ECT was 45.6 (16.5), and with ECT 46.6 (16.4), 147 (39.0%) were men. In that model, readmission rate within 30 days for treatment with ECT was 19.0%, and for treatments without ECT, 24.1% (aHR 0.75, 95% CI 0.55-1.02, p = 0.067). CONCLUSION Readmission rates after inpatient treatment of mania were high. ECT was not significantly associated with longer time to readmission, but there was a trend toward a protective effect of ECT when admissions with and without ECT were compared within the same patients.
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Affiliation(s)
- Katarzyna Popiolek
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tor Arnison
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Susanne Bejerot
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Katja Fall
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mikael Landén
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Axel Nordenskjöld
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Moodie EEM, Bian Z, Coulombe J, Lian Y, Yang AY, Shortreed SM. Variable selection in high dimensions for discrete-outcome individualized treatment rules: Reducing severity of depression symptoms. Biostatistics 2024; 25:633-647. [PMID: 37660312 DOI: 10.1093/biostatistics/kxad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/14/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Despite growing interest in estimating individualized treatment rules, little attention has been given the binary outcome setting. Estimation is challenging with nonlinear link functions, especially when variable selection is needed. We use a new computational approach to solve a recently proposed doubly robust regularized estimating equation to accomplish this difficult task in a case study of depression treatment. We demonstrate an application of this new approach in combination with a weighted and penalized estimating equation to this challenging binary outcome setting. We demonstrate the double robustness of the method and its effectiveness for variable selection. The work is motivated by and applied to an analysis of treatment for unipolar depression using a population of patients treated at Kaiser Permanente Washington.
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Affiliation(s)
- Erica E M Moodie
- McGill University, Department of Epidemiology & Biostatistics, 2001 McGill College Ave, Suite 1200, Montreal, QC Canada H3A 1G1
| | - Zeyu Bian
- McGill University, Department of Epidemiology & Biostatistics, 2001 McGill College Ave, Suite 1200, Montreal, QC Canada H3A 1G1
| | - Janie Coulombe
- Université de Montréal, Department of Mathematics & Statistics, Pavillon André-Aisenstadt, Montréal, QC Canada H3C 3J7
| | - Yi Lian
- McGill University, Department of Epidemiology & Biostatistics, 2001 McGill College Ave, Suite 1200, Montreal, QC Canada H3A 1G1
| | - Archer Y Yang
- McGill University, Department of Mathematics & Statistics, 805 Sherbrooke Street West Montreal, QC Canada H3A 0B9
| | - Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101
- University of Washington, Department of Biostatistics, 1705 NE Pacific St, Seattle, WA 98195
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Rohde C, Østergaard SD, Jefsen OH. A Nationwide Target Trial Emulation Assessing the Risk of Antidepressant-Induced Mania Among Patients With Bipolar Depression. Am J Psychiatry 2024; 181:630-638. [PMID: 38946271 DOI: 10.1176/appi.ajp.20230477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
OBJECTIVE Antidepressants are commonly used to treat bipolar depression but may increase the risk of mania. The evidence from randomized controlled trials, however, is limited by short treatment durations, providing little evidence for the long-term risk of antidepressant-induced mania. The authors performed a target trial emulation to compare the risk of mania among individuals with bipolar depression treated or not treated with antidepressants over a 1-year period. METHODS The authors emulated a target trial using observational data from nationwide Danish health registers. The study included 979 individuals with bipolar depression recently discharged from a psychiatric ward. Of these, 358 individuals received antidepressant treatment, and 621 did not. The occurrence of mania and bipolar depression over the following year was ascertained, and the intention-to-treat effect of antidepressants was analyzed by using Cox proportional hazards regression with adjustment for baseline covariates to emulate randomized open-label treatment allocation. RESULTS The fully adjusted analyses revealed no statistically significant associations between treatment with an antidepressant and the risk of mania in the full sample (hazard rate ratio=1.08, 95% CI=0.72-1.61), in the subsample concomitantly treated with a mood-stabilizing agent (hazard rate ratio=1.16, 95% CI=0.63-2.13), and in the subsample not treated with a mood-stabilizing agent (hazard rate ratio=1.16, 95% CI=0.65-2.07). Secondary analyses revealed no statistically significant association between treatment with an antidepressant and bipolar depression recurrence. CONCLUSIONS These findings suggest that the risk of antidepressant-induced mania is negligible and call for further studies to optimize treatment strategies for individuals with bipolar depression.
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Affiliation(s)
- Christopher Rohde
- Department of Clinical Medicine, Aarhus University (Rohde, Østergaard, Jefsen), and Department of Affective Disorders (Rohde, Østergaard, Jefsen) and Psychosis Research Unit (Jefsen), Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - Søren Dinesen Østergaard
- Department of Clinical Medicine, Aarhus University (Rohde, Østergaard, Jefsen), and Department of Affective Disorders (Rohde, Østergaard, Jefsen) and Psychosis Research Unit (Jefsen), Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - Oskar Hougaard Jefsen
- Department of Clinical Medicine, Aarhus University (Rohde, Østergaard, Jefsen), and Department of Affective Disorders (Rohde, Østergaard, Jefsen) and Psychosis Research Unit (Jefsen), Aarhus University Hospital-Psychiatry, Aarhus, Denmark
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Tocco M, Mao Y. Efficacy and Safety of Adding Lurasidone to Ongoing Therapy With Lithium or Valproate for the Treatment of an Acute Bipolar Depressive Episode: A Post Hoc Analysis of 2 Placebo-Controlled Trials. J Clin Psychopharmacol 2024; 44:345-352. [PMID: 38639433 DOI: 10.1097/jcp.0000000000001850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
PURPOSE The aim of this study was to compare the efficacy and safety profile of lurasidone combined with either lithium or valproate, in the short-term treatment of patients with bipolar depression. METHODS Data were pooled from two 6-week, double-blind, placebo-controlled trials of patients with bipolar depression on stable doses of lithium or valproate randomized to lurasidone (20-120 mg/d) or placebo. Efficacy measures included the Montgomery-Åsberg Depression Rating Scale, Clinical Global Impressions Bipolar Scale, and the Quick Inventory of Depressive Symptomatology via self-assessment and were analyzed using a mixed model for repeated measures approach. RESULTS Notably larger week 6 effect sizes were observed when lurasidone was added to lithium, compared with when lurasidone was added to valproate, on 2 of the 3 depression outcome measures, Montgomery-Åsberg Depression Rating Scale total score (d = 0.45 vs 0.22) and Quick Inventory of Depressive Symptomatology via self-assessment (d = 0.63 vs 0.29); the efficacy advantage was smaller on the Clinical Global Impressions Bipolar Scale depression score (d = 0.34 vs 0.29). Similar adverse event profiles were observed for lurasidone treatment in combination with either lithium or valproate. The most frequently reported events (≥5%) in both groups were nausea, parkinsonism, somnolence, akathisia, and insomnia. Minimal changes in weight, lipids, and measures of glycemic control were observed during treatment with lurasidone combined with either lithium or valproate. CONCLUSIONS Lurasidone added to either lithium or valproate was found to be an effective treatment for bipolar depression, with a larger antidepressant effect observed when lurasidone was combined with lithium. There were no clinically meaningful differences in the safety or tolerability of lurasidone when used adjunctively with lithium or valproate.
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Affiliation(s)
- Michael Tocco
- From the Sumitomo Pharma America, Inc, Teaneck, NJ, and Marlborough, MA
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Cheng CM, Chen MH, Tsai SJ, Chang WH, Tsai CF, Lin WC, Bai YM, Su TP, Chen TJ, Li CT. Susceptibility to Treatment-Resistant Depression Within Families. JAMA Psychiatry 2024; 81:663-672. [PMID: 38568605 PMCID: PMC10993159 DOI: 10.1001/jamapsychiatry.2024.0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/22/2024] [Indexed: 04/06/2024]
Abstract
Importance Antidepressant responses and the phenotype of treatment-resistant depression (TRD) are believed to have a genetic basis. Genetic susceptibility between the TRD phenotype and other psychiatric disorders has also been established in previous genetic studies, but population-based cohort studies have not yet provided evidence to support these outcomes. Objective To estimate the TRD susceptibility and the susceptibility between TRD and other psychiatric disorders within families in a nationwide insurance cohort with extremely high coverage and comprehensive health care data. Design, Setting, and Participants This cohort study assessed data from the Taiwan national health insurance database across entire population (N = 26 554 001) between January 2003 and December 2017. Data analysis was performed from August 2021 to April 2023. TRD was defined as having experienced at least 3 distinct antidepressant treatments in the current episode, each with adequate dose and duration, based on the prescribing records. Then, we identified the first-degree relatives of individuals with TRD (n = 34 467). A 1:4 comparison group (n = 137 868) of first-degree relatives of individuals without TRD was arranged for the comparison group, matched by birth year, sex, and kinship. Main Outcomes and Measures Modified Poisson regression analyses were performed and adjusted relative risks (aRRs) and 95% CIs were calculated for the risk of TRD, the risk of other major psychiatric disorders, and different causes of mortality. Results This study included 172 335 participants (88 330 male and 84 005 female; mean [SD] age at beginning of follow-up, 22.9 [18.1] years). First-degree relatives of individuals with TRD had lower incomes, more physical comorbidities, higher suicide mortality, and increased risk of developing TRD (aRR, 9.16; 95% CI, 7.21-11.63) and higher risk of other psychiatric disorders than matched control individuals, including schizophrenia (aRR, 2.36; 95% CI, 2.10-2.65), bipolar disorder (aRR, 3.74; 95% CI, 3.39-4.13), major depressive disorder (aRR, 3.65; 95% CI, 3.44-3.87), attention-deficit/hyperactivity disorders (aRR, 2.38; 95% CI, 2.20-2.58), autism spectrum disorder (aRR, 2.26; 95% CI, 1.86-2.74), anxiety disorder (aRR, 2.71; 95% CI, 2.59-2.84), and obsessive-compulsive disorder (aRR, 3.14; 95% CI, 2.70-3.66). Sensitivity and subgroup analyses validated the robustness of the findings. Conclusions and Relevance To our knowledge, this study is the largest and perhaps first nationwide cohort study to demonstrate TRD phenotype transmission across families and coaggregation with other major psychiatric disorders. Patients with a family history of TRD had an increased risk of suicide mortality and tendency toward antidepressant resistance; therefore, more intensive treatments for depressive symptoms might be considered earlier, rather than antidepressant monotherapy.
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Affiliation(s)
- Chih-Ming Cheng
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Wen-Han Chang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Graduate Institute of Statistics National Central University, Taoyuan, Taiwan
| | - Chia-Fen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Wei-Chen Lin
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu branch, Hsinchu, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
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Frileux S, Boltri M, Doré J, Leboyer M, Roux P. Cognition and gut microbiota in schizophrenia spectrum and mood disorders: A systematic review. Neurosci Biobehav Rev 2024; 162:105722. [PMID: 38754717 DOI: 10.1016/j.neubiorev.2024.105722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/11/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
FRILEUX, M., BOLTRI M. and al. Cognition and Gut microbiota in schizophrenia spectrum and mood disorders: a Systematic Review. NEUROSCI BIOBEHAV REV (1) 2024 Schizophrenia spectrum disorders and major mood disorders are associated with cognitive impairments. Recent studies suggest a link between gut microbiota composition and cognitive functioning. Here, we review the relationship between gut microbiota and cognition in these disorders. To do this, we conducted a systematic review, searching Cochrane Central Register of Controlled Trials, EBSCOhost, Embase, Pubmed, Scopus, and Web of Science. Studies were included if they investigated the relationship between gut microbiota composition and cognitive function through neuropsychological assessments in patients with bipolar, depressive, schizophrenia spectrum, and other psychotic disorders. Ten studies were identified. Findings underscore a link between gut dysbiosis and cognitive impairment. This relationship identified specific taxa (Haemophilus, Bacteroides, and Alistipes) as potential contributors to bolstered cognitive performance. Conversely, Candida albicans, Toxoplasma gondii, Streptococcus and Deinococcus were associated with diminished performance on cognitive assessments. Prebiotics and probiotics interventions were associated with cognitive enhancements, particularly executive functions. These results emphasize the role of gut microbiota in cognition, prompting further exploration of the underlying mechanisms paving the way toward precision psychiatry.
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Affiliation(s)
- S Frileux
- Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Centre Hospitalier de Versailles, 177, rue de Versailles, Le Chesnay-Rocquencourt 78157, France; Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif 94807, France.
| | - M Boltri
- Department of Psychology, Catholic University of Sacred Heart, Milan, Italy; I.R.C.C.S. Istituto Auxologico Italiano, Experimental Laboratory for Metabolic Neurosciences Research, Piancavallo, Italy
| | - J Doré
- Université Paris-Saclay, INRA, MetaGenoPolis, AgroParisTech, MICALIS, Jouy-en-Josas 78350, France
| | - M Leboyer
- Inserm U955 IMRB, Translational Neuropsychiatry Laboratory, AP-HP, DMU IMPACT, Fédération Hospitalo-Universitaire de médecine de précision en psychiatrie (FHU ADAPT), Paris Est Créteil University and Fondation FondaMental, Créteil 94010, France; Fondation Fondamental, Créteil 94010, France
| | - P Roux
- Service Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie, Centre Hospitalier de Versailles, 177, rue de Versailles, Le Chesnay-Rocquencourt 78157, France; Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif 94807, France
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Kessing LV, Knudsen MB, Rytgaard HCW, Torp-Pedersen C, Berk M. Lithium versus anticonvulsants and the risk of physical disorders - Results from a comprehensive long-term nation-wide population-based study emulating a target trial. Eur Neuropsychopharmacol 2024; 84:48-56. [PMID: 38663126 DOI: 10.1016/j.euroneuro.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 06/19/2024]
Abstract
Bipolar disorder is associated with increased rates of many physical disorders, but the effects of medication are unclear. We systematically investigated the associations between sustained use of first line maintenance agents, lithium versus lamotrigine and valproate, and the risk of physical disorders using a nation-wide population-based target trial emulation covering the entire 5.9 million inhabitants in Denmark. We identified two cohorts. Cohort 1: patients with a diagnosis of bipolar disorder prior to first purchase (N = 12.607). Cohort 2: all 156.678 adult patients who had their first ever purchase (since 1995) of either lithium, lamotrigine or valproate between 1997 and 2021 regardless of diagnosis. Main analyses investigated the effect of sustained exposure defined as exposure for all consecutive 6-months periods during a 10-year follow-up. Outcomes included a diagnosis of incident stroke, arteriosclerosis, angina pectoris, myocardial infarction, diabetes mellitus, myxedema, osteoporosis, dementia, Parkinson's disease, chronic kidney disease and cancer (including subtypes). In both Cohorts 1 and 2, there were no systematic statistically significant differences in associations between sustained use of lithium versus lamotrigine and valproate, respectively, and any physical disorder, including subtypes of disorders, except myxedema, for which exposure to lithium increased the absolute risk of myxedema with 7-10 % compared with lamotrigine or valproate. In conclusion, these analyses emulating a target trial of "real world" observational register-based data show that lithium does not increase the risk of developing any kind of physical disorders, except myxedema, which may be a result of detection bias.
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Affiliation(s)
- Lars Vedel Kessing
- Copenhagen Affective disorder Research Center (CADIC), Psychiatric Center Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Mark Bech Knudsen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | | | | | - Michael Berk
- School of Medicine, Deakin University, Australia
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Azevedo J, Swales M, Carreiras D, Guiomar R, Macedo A, Castilho P. BI-REAL: A 12-session DBT skills group intervention adapted for bipolar disorder - A feasibility randomised pilot trial. J Affect Disord 2024; 356:394-404. [PMID: 38615843 DOI: 10.1016/j.jad.2024.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/21/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
International guidelines endorse psychological treatment for Bipolar Disorder (BD); however, the absence of a recognised gold-standard intervention requires further research. A Dialectical Behaviour Therapy (DBT) skills group intervention with 12 sessions was developed. This pilot randomised controlled trial (RCT) aims to evaluate the feasibility, acceptability, and outcomes variance of Bi-REAL - Respond Effectively, Assertively, and Live mindfully, tailored for individuals with BD, in preparation for a future RCT. METHODS 52 participants (female = 62.7 %; mean age = 43.2 ± 11.1) with BD were randomised by blocks to either the experimental group (EG; n = 26; Bi-REAL + Treatment as Usual, TAU) receiving 12 weekly 90-minutes sessions, or the control group (CG; n = 26, TAU). Feasibility and acceptability were assessed with a multimethod approach (qualitative interviews, semi-structured clinical interviews and a battery of self-report questionnaires - candidate main outcomes Bipolar Recovery Questionnaire (BRQ) and brief Quality of Life for Bipolar Disorder (QoL.BD)). All participants were evaluated at baseline (T0), post-intervention (T1) and 3-month follow-up (T2). RESULTS Acceptability was supported by participants' positive feedback and ratings of the sessions and programme overall, as well as the treatment attendance (86.25 % of sessions attended). The trial overall retention rate was 74.5 %, with CG having a higher dropout rate across the 3-timepoints (42.31 %). A significant Time × Group interaction effect was found for BRQ and QoL.BD favouring the intervention group (p < .05). LIMITATIONS The assessors were not blind at T1 (only at T2). Recruitment plan was impacted due to COVID-19 restrictions and replication is questionable. High attrition rates in the CG. CONCLUSIONS The acceptability of Bi-REAL was sustained, and subsequent feasibility testing will be necessary to establish whether the retention rates of the overall trial improve and if feasibility is confirmed, before progressing to a definitive trial.
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Affiliation(s)
- Julieta Azevedo
- University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Portugal; Bangor University, School of Human and Behavioural Sciences, United Kingdom; Department of Psychology, University of Exeter, Exeter, UK.
| | - Michaela Swales
- Bangor University, School of Human and Behavioural Sciences, United Kingdom
| | - Diogo Carreiras
- University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Portugal
| | - Raquel Guiomar
- University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Portugal
| | - António Macedo
- University of Coimbra, Faculty of Medicine, Institute of Psychological Medicine (IPM), Portugal; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Portugal; Centro Hospitalar e Universitário de Coimbra, EPE (CHUC), Coimbra, Portugal
| | - Paula Castilho
- University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Portugal
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80
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Fico G, Vieta E. Antidepressant use in bipolar disorder: Shifting focus from 'Whether' to 'Whom'. Eur Neuropsychopharmacol 2024; 84:1-2. [PMID: 38640608 DOI: 10.1016/j.euroneuro.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/01/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Giovanna Fico
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, Barcelona 08036, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, Barcelona 08036, Spain; Institute of Neurosciences (UBNeuro), Spain
| | - Eduard Vieta
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, Barcelona 08036, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, Barcelona 08036, Spain; Institute of Neurosciences (UBNeuro), Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
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81
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Ebrahim N, Al Saihati HA, Alali Z, Aleniz FQ, Mahmoud SYM, Badr OA, Dessouky AA, Mostafa O, Hussien NI, Farid AS, El-Sherbiny M, Salim RF, Forsyth NR, Ali FEM, Alsabeelah NF. Exploring the molecular mechanisms of MSC-derived exosomes in Alzheimer's disease: Autophagy, insulin and the PI3K/Akt/mTOR signaling pathway. Biomed Pharmacother 2024; 176:116836. [PMID: 38850660 DOI: 10.1016/j.biopha.2024.116836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/16/2024] [Accepted: 05/26/2024] [Indexed: 06/10/2024] Open
Abstract
Alzheimer's disease (AD) is a devastating neurological condition characterized by cognitive decline, motor coordination impairment, and amyloid plaque accumulation. The underlying molecular mechanisms involve oxidative stress, inflammation, and neuronal degeneration. This study aimed to investigate the therapeutic effects of mesenchymal stem cell-derived exosomes (MSC-exos) on AD and explore the molecular pathways involved, including the PI3K/Akt/mTOR axis, autophagy, and neuroinflammation. To assess the potential of MSC-exos for the treatment of AD, rats were treated with AlCl3 (17 mg/kg/once/day) for 8 weeks, followed by the administration of an autophagy activator (rapamycin), or MSC-exos with or without an autophagy inhibitor (3-methyladenin; 3-MA+ chloroquine) for 4 weeks. Memory impairment was tested, and brain tissues were collected for gene expression analyses, western blotting, histological studies, immunohistochemistry, and transmission electron microscopy. Remarkably, the administration of MSC-exos improved memory performance in AD rats and reduced the accumulation of amyloid-beta (Aβ) plaques and tau phosphorylation. Furthermore, MSC-exos promoted neurogenesis, enhanced synaptic function, and mitigated astrogliosis in AD brain tissues. These beneficial effects were associated with the modulation of autophagy and the PI3K/Akt/mTOR signalling pathway, as well as the inhibition of neuroinflammation. Additionally, MSC-exos were found to regulate specific microRNAs, including miRNA-21, miRNA-155, miRNA-17-5p, and miRNA-126-3p, further supporting their therapeutic potential. Histopathological and bioinformatic analyses confirmed these findings. This study provides compelling evidence that MSC-exos hold promise as a potential therapeutic approach for AD. By modulating the PI3K/Akt/mTOR axis, autophagy, and neuroinflammation, MSC-exos have the potential to improve memory, reduce Aβ accumulation, enhance neurogenesis, and mitigate astrogliosis. These findings shed light on the therapeutic potential of MSC-exos and highlight their role in combating AD.
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Affiliation(s)
- Nesrine Ebrahim
- Department of Medical Histology and Cell Biology Faculty of Medicine, Benha University, Benha, Egypt; Stem Cell Unit, Faculty of Medicine, Benha University, Egypt; Benha National University, Faculty of Medicine. student at Keele University, UK; Department of Anatomy, Mansoura Faculty of Medicine, Mansoura University, Egypt.
| | - Hajer A Al Saihati
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hafr Albatin, Saudi Arabia; Department of Anatomy, Mansoura Faculty of Medicine, Mansoura University, Egypt.
| | - Zahraa Alali
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hafr Al Batin, P.O Box 1803, Hafr Al Batin 31991, Saudi Arabia
| | - Faris Q Aleniz
- Department of Immunology, Collage of Applied Science, Alkharj
| | - Sabry Younis Mohamed Mahmoud
- Biology Department, College of Sciences, University of Hafr Al Batin, P. O. Box 1803, Hafar Al Batin 31991, Saudi Arabia. Agricultural Microbiology Department, Faculty of Agriculture, Sohag University, Sohag, Egypt
| | - Omnia A Badr
- Department of Genetics and Genetic Engineering, Faculty of Agriculture, Benha University, Benha, Egypt
| | - Arigue A Dessouky
- Department of Medical Histology and Cell Biology, Faculty of Medicine, Zagazig University, Egypt
| | - Ola Mostafa
- Department of Medical Histology and Cell Biology Faculty of Medicine, Benha University, Benha, Egypt
| | - Noha I Hussien
- Department of Physiology, Faculty of Medicine, Benha University, Egypt
| | - Ayman Samir Farid
- Department of Clinical Pathology, Faculty of Veterinary Medicine, Benha University, Moshtohor, Toukh, Qalyubia 13736, Egypt
| | - Mohamed El-Sherbiny
- Department of Basic Medical Sciences, College of Medicine, AlMaarefa University, Riyadh, Saudi Arabia
| | - Rabab F Salim
- Department of Medical Biochemistry and molecular biology, Faculty of Medicine, Benha University, Egypt
| | - Nicholas Robert Forsyth
- School of Pharmacy and Bioengineering, Keele University. Vice Principals' Office, University of Aberdeen, Kings College, Aberdeen, AB24 3FX, UK
| | - Fares E M Ali
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, Egypt
| | - Nimer F Alsabeelah
- Assistant Professor of Pharmacology Pharmacy Practice Department, Pharmacy College University of Hafr Al Batin, P.O. Box 1803, Hafr Al Batin 31991, Saudi Arabia
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Ferraz-Gonçalves JA, Silva AS, Reis JS, Assis JG, Matos MI, Matias P, Alves S. How are agitated patients dealt with in internal medicine departments? Porto Biomed J 2024; 9:260. [PMID: 38993951 PMCID: PMC11236411 DOI: 10.1097/j.pbj.0000000000000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 07/13/2024] Open
Abstract
Background Studies on agitation in internal medicine departments are scarce, especially regarding how doctors and nurses act in these situations. The objective of this study was to clarify how agitation is dealt with in these departments. Methods This prospective observational study was performed in the internal medicine departments of four Portuguese hospitals. The researchers at each hospital contacted the nursing team that identifies patients who were agitated in the previous shifts. The researcher reviewed these patients' files, recording the research protocol's parameters. Results During the study period, 331 patients were observed; 177 (54%) were female, and the median age was 80 years (19-99). Episodes of agitation occurred in 69 patients (21%); of them, 44 (64%) were female, and the median age was 84 years (31-98). In the first episode of agitation, the doctor on duty was called in 49 times (71%). These doctors prescribed a new medication for the crisis in 30 cases (43%). After the crisis, the assistant doctor recorded the episode in the patient file in 41 cases (59%). According to the medical notes, after the acute phase, in only 21 patients (30%), there was an attempt to clarify the cause of agitation. The prescription after the crisis was regular medication in 32 cases (46%), rescue medication in 27 (39%), and physical restraint in 9 (13%), isolated or in various combinations. Conclusion This study suggests that there is room to improve how agitated patients are managed in internal medicine departments.
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Affiliation(s)
| | - Ana Sofia Silva
- Serviço de Medicina Interna, Unidade Local de Saúde Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Joana Silva Reis
- Serviço de Oncologia Médica, Unidade Local de Saúde São João, Porto, Portugal
| | - José Guilherme Assis
- Serviço de Medicina Interna, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Maria Inês Matos
- Serviço de Medicina Interna, Unidade Local de Saúde São João, Porto, Portugal
| | - Paula Matias
- Serviço de Medicina Interna, Unidade Local de Saúde São João, Porto, Portugal
| | - Sérgio Alves
- Serviço de Medicina Interna, Unidade Local de Saúde Nordeste, Bragança, Portugal
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Wang T, Yang J, Zhu Y, Niu N, Ding B, Wang P, Zhao H, Li N, Chao Y, Gao S, Dong X, Wang Z. Evaluation of metabolomics-based urinary biomarker models for recognizing major depression disorder and bipolar disorder. J Affect Disord 2024; 356:1-12. [PMID: 38548210 DOI: 10.1016/j.jad.2024.03.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 03/01/2024] [Accepted: 03/23/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) and bipolar disorder (BD) are psychiatric disorders with overlapping symptoms, leading to high rates of misdiagnosis due to the lack of biomarkers for differentiation. This study aimed to identify metabolic biomarkers in urine samples for diagnosing MDD and BD, as well as to establish unbiased differential diagnostic models. METHODS We utilized a metabolomics approach employing ultra-high performance liquid chromatography-mass spectrometry (UHPLC-MS) to analyze the metabolic profiles of urine samples from individuals with MDD (n = 50), BD (n = 12), and healthy controls (n = 50). The identification of urine metabolites was verified using MS data analysis tools and online metabolite databases. RESULTS Two diagnostic panels consisting of a combination of metabolites and clinical indicators were identified-one for MDD and another for BD. The discriminative capacity of these panels was assessed using the area under the receiver operating characteristic (ROC) curve, yielding an area under the curve (AUC) of 0.9084 for MDD and an AUC value of 0.9017 for BD. CONCLUSIONS High-resolution mass spectrometry-based assays show promise in identifying urinary biomarkers for depressive disorders. The combination of urine metabolites and clinical indicators is effective in differentiating healthy controls from individuals with MDD and BD. The metabolic pathway indicating oxidative stress is seen to significantly contribute to depressive disorders.
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Affiliation(s)
- Tianjiao Wang
- School of Medicine, Shanghai University, Shanghai 200444, China; Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai 200083, China
| | - Jingzhi Yang
- Institute of Translational Medicine, Shanghai University, Shanghai 200444, China
| | - Yuncheng Zhu
- Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai 200083, China; Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai 200083, China
| | - Na Niu
- Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai 200083, China
| | - Binbin Ding
- Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai 200083, China
| | - Ping Wang
- Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai 200083, China
| | - Hongxia Zhao
- Zhanjiang Institute of Clinical Medicine, Central People's Hospital of Zhanjiang, Zhanjiang 524045, China
| | - Na Li
- School of Medicine, Shanghai University, Shanghai 200444, China
| | - Yufan Chao
- School of Medicine, Shanghai University, Shanghai 200444, China
| | - Songyan Gao
- Institute of Translational Medicine, Shanghai University, Shanghai 200444, China
| | - Xin Dong
- School of Medicine, Shanghai University, Shanghai 200444, China; Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai 200083, China.
| | - Zuowei Wang
- Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai 200083, China; Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai 200083, China.
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Chatterton ML, Lee YY, Le LKD, Nichols M, Carter R, Berk M, Mihalopoulos C. Cost-utility analysis of adjunct repetitive transcranial magnetic stimulation for treatment resistant bipolar depression. J Affect Disord 2024; 356:639-646. [PMID: 38657770 DOI: 10.1016/j.jad.2024.04.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/30/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of repetitive transcranial magnetic stimulation (rTMS) as an adjunct to standard care from an Australian health sector perspective, compared to standard care alone for adults with treatment-resistant bipolar depression (TRBD). METHODS An economic model was developed to estimate the cost per disability-adjusted life-year (DALY) averted and quality-adjusted life-year (QALY) gained for rTMS added to standard care compared to standard care alone, for adults with TRBD. The model simulated the time in three health states (mania, depression, residual) over one year. Response to rTMS was sourced from a meta-analysis, converted to a relative risk and used to modify the time in the depressed state. Uncertainty and sensitivity tested the robustness of results. RESULTS Base-case incremental cost-effectiveness ratios (ICERs) were $72,299 per DALY averted (95 % Uncertainty Interval (UI): $60,915 to $86,668) and $46,623 per QALY gained (95 % UI: $39,676 - $55,161). At a willingness to pay (WTP) threshold of $96,000 per DALY averted, the base-case had a 100 % probability of being marginally cost-effective. At a WTP threshold of $64,000 per QALY gained, the base-case had a 100 % probability of being cost-effective. Sensitivity analyses decreasing the number of sessions provided, increasing the disability weight or the time spent in the depression state for standard care improved the ICERs for rTMS. CONCLUSIONS Dependent on the outcome measure utilised and assumptions, rTMS would be considered a very cost-effective or marginally cost-effective adjunct to standard care for TRBD compared to standard care alone.
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Affiliation(s)
- Mary Lou Chatterton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Yong Yi Lee
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; School of Public Health, The University of Queensland, Herston, Australia; Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Long Khanh-Dao Le
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melanie Nichols
- Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Rob Carter
- Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Institute for Health Transformation, Deakin University, Geelong, Australia
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Berardelli I, Amerio A, Bartoli F, Cuomo A, Deste G, Orsolini L, Sampogna G, Pompili M. Rethinking the role of trazodone in the different depressive dimensions. Expert Rev Neurother 2024; 24:619-632. [PMID: 38881379 DOI: 10.1080/14737175.2024.2363843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/31/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION The efficacy of trazodone for several psychopathologic dimensions of depression has been shown in the literature. Trazodone has been widely used in some clinical contexts (e.g. for insomnia and depression in the elderly). However, the role of trazodone in several aspects of depression is not well known. AREA COVERED Eight experts from academic and medical centers across Italy met to identify the difficulties and barriers faced in daily clinical practice in the assessment and management of major depressive disorder and how the use of trazodone could address some unmet needs. The objective of the expert meetings and the present document was to increase knowledge of particular areas of treatment with trazodone. EXPERT OPINION Evidence of the role of trazodone in patients affected by major depressive disorder with anxiety symptoms, insomnia, agitation, cognitive deficits, alcohol use disorders, physical comorbidities, and suicide risk has been identified, showing the effectiveness of trazodone in different presentations of major depressive disorder. The main characteristics of patients with depression for whom trazodone seems to be most effective have been identified, providing clinicians with information on possible uses of this drug in such population of patients.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Bartoli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alessandro Cuomo
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Valcamonica, Esine, Italy
| | - Laura Orsolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Cintrón Pastrana MA, Irizarry Flores JC, Rothschild AJ. Challenges in the Treatment of Psychotic Bipolar Depression. J Clin Psychopharmacol 2024; 44:407-412. [PMID: 38901001 DOI: 10.1097/jcp.0000000000001879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
BACKGROUND Psychotic bipolar depression (PBD) is a prevalent yet understudied psychiatric illness, and there are no specific guidelines or Food and Drug Administration-approved medications for its treatment. Recent studies suggest that some antipsychotics and mood stabilizers may be effective in managing bipolar depression; however, their effectiveness for PBD remains unclear. Given the urgent need for more focused research for managing PBD, we conducted a literature review to summarize the existing literature on PBD. METHODS We conducted an electronic literature search from the 1960s to 2023, utilizing PubMed, MEDLINE, EMBASE, and Google, and selected studies based on their relevance to PBD. FINDINGS PBD is a complex disorder, with 50%-75% of patients with bipolar disorder exhibiting psychotic features. This likelihood increases among those with a history of psychotic mania. Treatment guidelines often recommend a combination of mood stabilizers, antipsychotics, or electroconvulsive therapy, but they do not specify a first-line treatment. PBD symptoms can be masked by mixed high mood and energy feelings, potentially delaying diagnosis and treatment while increasing suicide risk. Limited research has evaluated outcomes of various treatments for PBD, and despite the lack of evidence for superior efficacy, in clinical practice, antipsychotics are frequently prescribed. Notably, combining an antipsychotic with selective noradrenaline reuptake inhibitors or tricyclic antidepressants may be effective, but including a mood stabilizer is necessary. CONCLUSION PBD poses a significant challenge in mental health due to its severity and the lack of consensus on optimal treatment approaches. There is a critical need for more dedicated clinical trials and research to answer key questions about the effective treatment of acute PBD, ideal follow-up care, traits of responders to different therapies, and decision models for subsequent treatments.
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Taniguchi K, Kaneko N, Wada M, Moriyama S, Nakajima S, Mimura M, Noda Y. Neurophysiological profiles of patients with bipolar disorders as probed with transcranial magnetic stimulation: A systematic review. Neuropsychopharmacol Rep 2024. [PMID: 38932486 DOI: 10.1002/npr2.12458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
AIM Bipolar disorder (BD) has a significant impact on global health, yet its neurophysiological basis remains poorly understood. Conventional treatments have limitations, highlighting the need for a better understanding of the neurophysiology of BD for early diagnosis and novel therapeutic strategies. DESIGN Employing a systematic review approach of the PRISMA guidelines, this study assessed the usefulness and validity of transcranial magnetic stimulation (TMS) neurophysiology in patients with BD. METHODS Databases searched included PubMed, MEDLINE, Embase, and PsycINFO, covering studies from January 1985 to January 2024. RESULTS Out of 6597 articles screened, nine studies met the inclusion criteria, providing neurophysiological insights into the pathophysiological basis of BD using TMS-electromyography and TMS-electroencephalography methods. Findings revealed significant neurophysiological impairments in patients with BD compared to healthy controls, specifically in cortical inhibition and excitability. In particular, short-interval cortical inhibition (SICI) was consistently diminished in BD across the studies, which suggests a fundamental impairment of cortical inhibitory function in BD. This systematic review corroborates the potential utility of TMS neurophysiology in elucidating the pathophysiological basis of BD. Specifically, the reduced cortical inhibition in the SICI paradigm observed in patients with BD suggests gamma-aminobutyric acid (GABA)-A receptor-mediated dysfunction, but results from other TMS paradigms have been inconsistent. Thus, complex neurophysiological processes may be involved in the pathological basis underlying BD. This study demonstrated that BD has a neural basis involving impaired GABAergic function, and it is highly expected that further research on TMS neurophysiology will further elucidate the pathophysiological basis of BD.
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Affiliation(s)
- Keita Taniguchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Naotsugu Kaneko
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Masataka Wada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Sotaro Moriyama
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Rizzo Pesci N, Teobaldi E, Maina G, Rosso G. Climate Change and Psychiatry: The Correlation between the Mean Monthly Temperature and Admissions to an Acute Inpatient Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:826. [PMID: 39063403 PMCID: PMC11276805 DOI: 10.3390/ijerph21070826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Psychiatric disorders are large contributors to the global disease burden, but research on the impact of climate change on them is limited. Our aim is to investigate the correlation between temperature and exacerbations of psychiatric disorders to help inform clinical management and future public health policies. METHODS Temperature records for the summer months from 2013 to 2022 were obtained from the meteorological station of the Department of Physics of Turin University. Data on patients admitted to the acute psychiatric unit were extracted from registries of San Luigi Gonzaga University Hospital (Turin, Italy). Regression analyses were used to investigate the correlation between temperature and number of admissions and to test for confounding variables. RESULTS A total of 1600 admissions were recorded. The monthly temperature and number of admissions were directly correlated (p = 0.0020). The correlation was significant for the subgroup of admissions due to Bipolar Disorders (p = 0.0011), but not for schizophrenia or major depressive disorder. After multiple regression analyses, the effect of temperature remained significant (p = 0.0406). CONCLUSIONS These results confirm the impact of meteorological factors on mental disorders, particularly on BD. This can contribute to personalised follow-up and efficient resource allocation and poses grounds for studies into etiopathological mechanisms and therapeutic implications.
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Affiliation(s)
- Nicola Rizzo Pesci
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (N.R.P.); (E.T.); (G.M.)
| | - Elena Teobaldi
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (N.R.P.); (E.T.); (G.M.)
- Psychiatric Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Giuseppe Maina
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (N.R.P.); (E.T.); (G.M.)
- Psychiatric Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Gianluca Rosso
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (N.R.P.); (E.T.); (G.M.)
- Psychiatric Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
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Hart XM, Gründer G, Ansermot N, Conca A, Corruble E, Crettol S, Cumming P, Hefner G, Frajerman A, Howes O, Jukic M, Kim E, Kim S, Manisalco I, Moriguchi S, Müller DJ, Nakajima S, Osugo M, Paulzen M, Ruhe HG, Scherf-Clavel M, Schoretsanitis G, Serretti A, Spina E, Spigset O, Steimer W, Süzen HS, Uchida H, Unterecker S, Vandenberghe F, Verstuyft C, Zernig G, Hiemke C, Eap CB. Optimisation of pharmacotherapy in psychiatry through therapeutic drug monitoring, molecular brain imaging and pharmacogenetic tests: focus on antipsychotics. World J Biol Psychiatry 2024:1-123. [PMID: 38913780 DOI: 10.1080/15622975.2024.2366235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 06/06/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND For psychotic disorders (i.e. schizophrenia), pharmacotherapy plays a key role in controlling acute and long-term symptoms. To find the optimal individual dose and dosage strategy, specialized tools are used. Three tools have been proven useful to personalize drug treatments: therapeutic drug monitoring (TDM) of drug levels, pharmacogenetic testing (PG), and molecular neuroimaging. METHODS In these Guidelines, we provide an in-depth review of pharmacokinetics, pharmacodynamics, and pharmacogenetics for 50 antipsychotics. Over 30 international experts in psychiatry selected studies that have measured drug concentrations in the blood (TDM), gene polymorphisms of enzymes involved in drug metabolism, or receptor/transporter occupancies in the brain (positron emission tomography (PET)). RESULTS Study results strongly support the use of TDM and the cytochrome P450 (CYP) genotyping and/or phenotyping to guide drug therapies. Evidence-based target ranges are available for titrating drug doses that are often supported by PET findings. CONCLUSION All three tools discussed in these Guidelines are essential for drug treatment. TDM goes well beyond typical indications such as unclear compliance and polypharmacy. Despite its enormous potential to optimize treatment effects, minimize side effects and ultimately reduce the global burden of diseases, personalized drug treatment has not yet become the standard of care in psychiatry.
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Affiliation(s)
- X M Hart
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - G Gründer
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- German Center for Mental Health (DZPG), partner site Mannheim - Heidelberg - Ulm
| | - N Ansermot
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - A Conca
- Dipartimento di Psichiatria, Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | - E Corruble
- Université Paris-Saclay, AP-HP, Service Hospitalo-Universitaire de Psychiatrie, Hôpital de Bicêtre
- Equipe MOODS, Inserm U1018, CESP (Centre de Recherche en Epidémiologie et Sante des Populations), Le Kremlin-Bicêtre, France
| | - S Crettol
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - P Cumming
- Department of Nuclear Medicine, Bern University Hospital, Bern, Switzerland
- School of Psychology and Counseling, Queensland University of Technology, Brisbane, Australia
| | - G Hefner
- Vitos Clinic for Forensic Psychiatry, Forensic Psychiatry, Eltville, Germany
| | - A Frajerman
- Université Paris-Saclay, AP-HP, Service Hospitalo-Universitaire de Psychiatrie, Hôpital de Bicêtre
- Equipe MOODS, Inserm U1018, CESP (Centre de Recherche en Epidémiologie et Sante des Populations), Le Kremlin-Bicêtre, France
| | - O Howes
- Department of Psychosis Studies, IoPPN, King's College London, De Crespigny Park, London, SE5 8AF, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - M Jukic
- Department of Physiology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia and Pharmacogenetics Section, Department of Physiology and Pharmacology, Karolinska Institutet, Solna, Sweden
| | - E Kim
- Department of Psychiatry, Seoul National University College of Medicine, Republic of Korea
| | - S Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Republic of Korea
| | - I Manisalco
- Dipartimento di Psichiatria, Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | - S Moriguchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - D J Müller
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - S Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - M Osugo
- Department of Psychosis Studies, IoPPN, King's College London, De Crespigny Park, London, SE5 8AF, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - M Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University
- JARA - Translational Brain Medicine, Aachen, Germany; Alexianer Center for Mental Health, Aachen, Germany
| | - H G Ruhe
- Department of psychiatry, Radboudumc, Nijmegen, Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - M Scherf-Clavel
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - G Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland
| | - A Serretti
- Department of Medicine and Surgery, Kore University of Enna, Italy
| | - E Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - O Spigset
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - W Steimer
- Institute of Clinical Chemistry and Pathobiochemistry, Technical University Munich, Munich, Germany
| | - H S Süzen
- Department of Pharmaceutic Toxicology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - H Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - S Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - F Vandenberghe
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - C Verstuyft
- Department of Molecular Genetics, Pharmacogenetics and Hormonology Bicêtre University Hospital Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, F-94275, France
- CESP, MOODS Team, INSERM UMR 1018, Medicine Faculty, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - G Zernig
- Department of Pharmacology, Medical University Innsbruck; Private Practice for Psychotherapy and Court-Certified Witness, Hall in Tirol, Austria
| | - C Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Germany
| | - C B Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Department of Psychiatry, Centre for Psychiatric Neuroscience, Lausanne University Hospital, University of Lausanne, 1008 Prilly, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, University of Lausanne, Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland
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Carta A, Cavassa V, Puci MV, Averna R, Sotgiu G, Valeri G, Vicari S, Sotgiu S. Treatment of Aggressive Behavior and Agitation in an 11-Year-Old Boy with Co-Occurring Autism and ADHD: A Case Report and Literature Review on the Use of Intravenous Valproate in Emergency Psychiatry. J Clin Med 2024; 13:3573. [PMID: 38930101 PMCID: PMC11204411 DOI: 10.3390/jcm13123573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/29/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Autism spectrum disorder (ASD) is a persistent neurodevelopmental disorder frequently co-occurring with attention-deficit/hyperactivity disorder (ADHD) and behavior-related disorders. While behavioral therapy is the first-line option to manage the core symptoms of ASD, pharmacological therapy is sometimes needed to treat acute problems, such as agitation and aggressive behaviors. Recent guidelines recommend the use of neuroleptics to reduce psychomotor agitation in patients with ASD. However, as children with ASD are often drug-resistant, alternative treatments are often justified. Reports from the literature have indicated that intravenous valproate (IV-VPA) can be effective in reducing agitation in psychiatric patients, with a lower frequency of adverse events compared to conventional treatments. However, as the related findings are occasionally inconsistent, IV-VPA is not yet an approved option in the context of clinical psychiatry. We aim to improve knowledge of the IV-VPA treatment option for emergency psychiatric treatment in pediatric patients. Methods: We report the case of an 11-year-old boy suffering from a complex neurodevelopmental condition who experienced a psychotic episode with severe aggressive and disruptive behaviors and was successfully treated with IV-VPA. Furthermore, we provide an updated literature review on this topic. Conclusion: In our case, first-line therapies proved to be ineffective. To the contrary, IV-VPA led to safe and prompt clinical success, which is in line with other reports. Based on our literature review, IV-VPA can be highly effective and reduces the risk of adverse events that frequently occur with the use of high-dose standard medications in emergency psychiatry.
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Affiliation(s)
- Alessandra Carta
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Pharmacy, University Hospital of Sassari, Viale San Pietro 43/B, 07100 Sassari, Italy;
| | - Vanna Cavassa
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Pharmacy, University Hospital of Sassari, Viale San Pietro 43/B, 07100 Sassari, Italy;
- Department of Biomedical Sciences—Section of Neuroscience and Clinical Pharmacology, University of Cagliari (Branch of Sassari), 09121 Cagliari, Italy
| | - Mariangela Valentina Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (M.V.P.); (G.S.)
| | - Roberto Averna
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital (OPBG), Scientific Institute for Research, Hospitalization and Healthcare, 00146 Rome, Italy; (R.A.); (G.V.); (S.V.)
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (M.V.P.); (G.S.)
| | - Giovanni Valeri
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital (OPBG), Scientific Institute for Research, Hospitalization and Healthcare, 00146 Rome, Italy; (R.A.); (G.V.); (S.V.)
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital (OPBG), Scientific Institute for Research, Hospitalization and Healthcare, 00146 Rome, Italy; (R.A.); (G.V.); (S.V.)
- Life Sciences and Public Health Department, Catholic University, 00168 Rome, Italy
| | - Stefano Sotgiu
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Pharmacy, University Hospital of Sassari, Viale San Pietro 43/B, 07100 Sassari, Italy;
- Department of Biomedical Sciences—Section of Neuroscience and Clinical Pharmacology, University of Cagliari (Branch of Sassari), 09121 Cagliari, Italy
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Musoni-Rwililiza E, Arnbjerg CJ, Rurangwa NU, Bendtsen MG, Carlsson J, Kallestrup P, Vindbjerg E, Gishoma D. Adaption and validation of the Rwandese version of the Young Mania Rating Scale to measure the severity of a manic or hypomanic episode. BMC Psychiatry 2024; 24:450. [PMID: 38890629 PMCID: PMC11186071 DOI: 10.1186/s12888-024-05890-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Bipolar Disorder is one of the most incapacitating diseases among young persons, leading to cognitive and functional impairment and raised mortality, particularly death by suicide. Managing a manic episode and developing new and more effective treatment modalities requires sensitive and reliable instruments. This study aims to translate the English version of the YMRS questionnaire into Kinyarwanda, adapt it to the Rwandan context, and assess its validity. METHODS The original English version of The Young Mania Rating Scale questionnaire was translated into Kinyarwanda. The translation process followed a standardized approach, including back-translation, cross-cultural adaptation, and final adjustments. A total of 130 inpatients with bipolar disorder in a manic episode from CARAES Ndera Teaching Hospital were included. The descriptive statistics and test-retest correlations were carried out, as well as the CFA for validation and Rasch-analysis. RESULTS The Rwandese version of The Young mania rating scale had an adequate internal consistency (Cronbach's alpha = 0.90). Item 11 provided the lowest standardized loading in both ratings (0.51 and 0.55). The second lowest loading involved the highly correlated item pairs 5 & 9, with item 5 loading 0.51 in rating 1 and item 9 loading 0.57 in rating 2. The remaining loadings ranged from 0.59 to 0.79. This relatively narrow range indicated that a fit to a Rasch model was plausible if excluding item 11. CONCLUSION The findings demonstrate that the translated YMRS, the R-YMRS, can be used as a reliable and valid instrument for assessing mania in the Rwandese population in clinical and research settings. However, the results supported using an unweighted total score of 32 and removing items 5, 9, and 11. Studies on this revised scale with an added interview guide for less-trained clinical staff are recommended.
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Affiliation(s)
- E Musoni-Rwililiza
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
- Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.
- University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda.
| | - C J Arnbjerg
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - N U Rurangwa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - M G Bendtsen
- Competence Centre for Transcultural Psychiatry (CTP), Mental Health Centre Ballerup, Ballerup, Denmark
| | - J Carlsson
- Competence Centre for Transcultural Psychiatry (CTP), Mental Health Centre Ballerup, Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - P Kallestrup
- Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - E Vindbjerg
- Competence Centre for Transcultural Psychiatry (CTP), Mental Health Centre Ballerup, Ballerup, Denmark
| | - D Gishoma
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Li C, Tian H, Li R, Jia F, Wang L, Ma X, Yang L, Zhang Q, Zhang Y, Yao K, Zhuo C. Molecular mechanisms of quetiapine bidirectional regulation of bipolar depression and mania based on network pharmacology and molecular docking: Evidence from computational biology. J Affect Disord 2024; 355:528-539. [PMID: 38518857 DOI: 10.1016/j.jad.2024.03.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Quetiapine monotherapy is recommended as the first-line option for acute mania and acute bipolar depression. However, the mechanism of action of quetiapine is unclear. Network pharmacology and molecular docking were employed to determine the molecular mechanisms of quetiapine bidirectional regulation of bipolar depression and mania. METHODS Putative target genes for quetiapine were collected from the GeneCard, SwissTargetPrediction, and DrugBank databases. Targets for bipolar depression and bipolar mania were identified from the DisGeNET and GeneCards databases. A protein-protein interaction (PPI) network was generated using the String database and imported into Cytoscape. DAVID and the Bioinformatics platform were employed to perform the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of the top 15 core targets. The drug-pathway-target-disease network was constructed using Cytoscape. Finally, molecular docking was performed to evaluate the interactions between quetiapine and potential targets. RESULTS Targets for quetiapine actions against bipolar depression (126 targets) and bipolar mania (81 targets) were identified. Based on PPI and KEGG pathway analyses, quetiapine may affect bipolar depression by targeting the MAPK and PI3K/AKT insulin signaling pathways via BDNF, INS, EGFR, IGF1, and NGF, and it may affect bipolar mania by targeting the neuroactive ligand-receptor interaction signaling pathway via HTR1A, HTR1B, HTR2A, DRD2, and GRIN2B. Molecular docking revealed good binding affinity between quetiapine and potential targets. LIMITATIONS Pharmacological experiments should be conducted to verify and further explore these results. CONCLUSIONS Our findings suggest that quetiapine affects bipolar depression and bipolar mania through distinct biological core targets, and thus through different mechanisms. Furthermore, our results provide a theoretical basis for the clinical use of quetiapine and possible directions for new drug development.
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Affiliation(s)
- Chao Li
- Computational Biology Centre (CBC), Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Medical University Affiliated Tianjin Anding Hospital, Tianjin 300222, China; Laboratory of Psychiatric-Neuroimaging-Genetic and Co-morbidity (PGNP_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Hongjun Tian
- Animal Imaging Center (AIC) of Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin 300140, China
| | - Ranli Li
- Computational Biology Centre (CBC), Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Medical University Affiliated Tianjin Anding Hospital, Tianjin 300222, China
| | - Feng Jia
- Computational Biology Centre (CBC), Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Medical University Affiliated Tianjin Anding Hospital, Tianjin 300222, China
| | - Lina Wang
- Laboratory of Psychiatric-Neuroimaging-Genetic and Co-morbidity (PGNP_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Xiaoyan Ma
- Laboratory of Psychiatric-Neuroimaging-Genetic and Co-morbidity (PGNP_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Lei Yang
- Laboratory of Psychiatric-Neuroimaging-Genetic and Co-morbidity (PGNP_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Qiuyu Zhang
- Laboratory of Psychiatric-Neuroimaging-Genetic and Co-morbidity (PGNP_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Ying Zhang
- Laboratory of Psychiatric-Neuroimaging-Genetic and Co-morbidity (PGNP_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Kaifang Yao
- Laboratory of Psychiatric-Neuroimaging-Genetic and Co-morbidity (PGNP_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Chuanjun Zhuo
- Computational Biology Centre (CBC), Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Medical University Affiliated Tianjin Anding Hospital, Tianjin 300222, China; Laboratory of Psychiatric-Neuroimaging-Genetic and Co-morbidity (PGNP_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin 300222, China.
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Meyhoefer I, Sprenger A, Derad D, Grotegerd D, Leenings R, Leehr EJ, Breuer F, Surmann M, Rolfes K, Arolt V, Romer G, Lappe M, Rehder J, Koutsouleris N, Borgwardt S, Schultze-Lutter F, Meisenzahl E, Kircher TTJ, Keedy SS, Bishop JR, Ivleva EI, McDowell JE, Reilly JL, Hill SK, Pearlson GD, Tamminga CA, Keshavan MS, Gershon ES, Clementz BA, Sweeney JA, Hahn T, Dannlowski U, Lencer R. Evidence from comprehensive independent validation studies for smooth pursuit dysfunction as a sensorimotor biomarker for psychosis. Sci Rep 2024; 14:13859. [PMID: 38879556 PMCID: PMC11180169 DOI: 10.1038/s41598-024-64487-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/10/2024] [Indexed: 06/19/2024] Open
Abstract
Smooth pursuit eye movements are considered a well-established and quantifiable biomarker of sensorimotor function in psychosis research. Identifying psychotic syndromes on an individual level based on neurobiological markers is limited by heterogeneity and requires comprehensive external validation to avoid overestimation of prediction models. Here, we studied quantifiable sensorimotor measures derived from smooth pursuit eye movements in a large sample of psychosis probands (N = 674) and healthy controls (N = 305) using multivariate pattern analysis. Balanced accuracies of 64% for the prediction of psychosis status are in line with recent results from other large heterogenous psychiatric samples. They are confirmed by external validation in independent large samples including probands with (1) psychosis (N = 727) versus healthy controls (N = 292), (2) psychotic (N = 49) and non-psychotic bipolar disorder (N = 36), and (3) non-psychotic affective disorders (N = 119) and psychosis (N = 51) yielding accuracies of 65%, 66% and 58%, respectively, albeit slightly different psychosis syndromes. Our findings make a significant contribution to the identification of biologically defined profiles of heterogeneous psychosis syndromes on an individual level underlining the impact of sensorimotor dysfunction in psychosis.
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Affiliation(s)
- Inga Meyhoefer
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
- Otto-Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Duesseldorf/LVR, Duesseldorf, Germany
| | - Andreas Sprenger
- Department of Neurology, University of Luebeck, Luebeck, Germany
| | - David Derad
- Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Ramona Leenings
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Fabian Breuer
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Marian Surmann
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Karen Rolfes
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Volker Arolt
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
- Otto-Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | - Georg Romer
- Department of Child Adolescence Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Markus Lappe
- Otto-Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
- Institute of Psychology, University of Muenster, Muenster, Germany
| | - Johanna Rehder
- Institute of Psychology, University of Muenster, Muenster, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University Munich, Munich, Germany
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Max-Planck-Institute of Psychiatry Munich, Munich, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Duesseldorf/LVR, Duesseldorf, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Duesseldorf/LVR, Duesseldorf, Germany
| | - Tilo T J Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Sarah S Keedy
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, USA
| | - Jeffrey R Bishop
- Department of Experimental and Clinical Pharmacology and Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
| | - Elena I Ivleva
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer E McDowell
- Departments of Psychology and Neuroscience, Bio-Imaging Research Center, University of Georgia, Athens, GA, USA
| | - James L Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Scot Kristian Hill
- Department of Psychology, Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - Godfrey D Pearlson
- Departments of Psychiatry and Neuroscience, Yale School of Medicine, and Olin Research Center, Institute of Living/Hartford Hospital, Hartford, CT, USA
| | - Carol A Tamminga
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Elliot S Gershon
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, USA
| | - Brett A Clementz
- Departments of Psychology and Neuroscience, Bio-Imaging Research Center, University of Georgia, Athens, GA, USA
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Tim Hahn
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany.
- Otto-Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany.
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany.
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Santoro V, Hou MD, Premoli I, Belardinelli P, Biondi A, Carobin A, Puledda F, Michalopoulou PG, Richardson MP, Rocchi L, Shergill SS. Investigating cortical excitability and inhibition in patients with schizophrenia: A TMS-EEG study. Brain Res Bull 2024; 212:110972. [PMID: 38710310 DOI: 10.1016/j.brainresbull.2024.110972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/24/2024] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) combined with electromyography (EMG) has widely been used as a non-invasive brain stimulation tool to assess excitation/inhibition (E/I) balance. E/I imbalance is a putative mechanism underlying symptoms in patients with schizophrenia. Combined TMS-electroencephalography (TMS-EEG) provides a detailed examination of cortical excitability to assess the pathophysiology of schizophrenia. This study aimed to investigate differences in TMS-evoked potentials (TEPs), TMS-related spectral perturbations (TRSP) and intertrial coherence (ITC) between patients with schizophrenia and healthy controls. MATERIALS AND METHODS TMS was applied over the motor cortex during EEG recording. Differences in TEPs, TRSP and ITC between the patient and healthy subjects were analysed for all electrodes at each time point, by applying multiple independent sample t-tests with a cluster-based permutation analysis to correct for multiple comparisons. RESULTS Patients demonstrated significantly reduced amplitudes of early and late TEP components compared to healthy controls. Patients also showed a significant reduction of early delta (50-160 ms) and theta TRSP (30-250ms),followed by a reduction in alpha and beta suppression (220-560 ms; 190-420 ms). Patients showed a reduction of both early (50-110 ms) gamma increase and later (180-230 ms) gamma suppression. Finally, the ITC was significantly lower in patients in the alpha band, from 30 to 260 ms. CONCLUSION Our findings support the putative role of impaired GABA-receptor mediated inhibition in schizophrenia impacting excitatory neurotransmission. Further studies can usefully elucidate mechanisms underlying specific symptoms clusters using TMS-EEG biometrics.
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Affiliation(s)
- V Santoro
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom; Headache Group, Wolfson SPaRC, Institute of Psychiatry Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom.
| | - M D Hou
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - I Premoli
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - P Belardinelli
- Cimec, Center for Mind/Brain Sciences, University of Trento, Trento, Italy
| | - A Biondi
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - A Carobin
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - F Puledda
- Headache Group, Wolfson SPaRC, Institute of Psychiatry Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - P G Michalopoulou
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - M P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - L Rocchi
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - S S Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom; Kent and Medway Medical School, Canterbury CT2 7FS, United Kingdom; Kent and Medway NHS and Social Care Partnership Trust, Maidstone, ME7 4JL, United Kingdom
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95
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Abady MM, Jeong JS, Kwon HJ, Assiri AM, Cho J, Saadeldin IM. The reprotoxic adverse side effects of neurogenic and neuroprotective drugs: current use of human organoid modeling as a potential alternative to preclinical models. Front Pharmacol 2024; 15:1412188. [PMID: 38948466 PMCID: PMC11211546 DOI: 10.3389/fphar.2024.1412188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/29/2024] [Indexed: 07/02/2024] Open
Abstract
The management of neurological disorders heavily relies on neurotherapeutic drugs, but notable concerns exist regarding their possible negative effects on reproductive health. Traditional preclinical models often fail to accurately predict reprotoxicity, highlighting the need for more physiologically relevant systems. Organoid models represent a promising approach for concurrently studying neurotoxicity and reprotoxicity, providing insights into the complex interplay between neurotherapeutic drugs and reproductive systems. Herein, we have examined the molecular mechanisms underlying neurotherapeutic drug-induced reprotoxicity and discussed experimental findings from case studies. Additionally, we explore the utility of organoid models in elucidating the reproductive complications of neurodrug exposure. Have discussed the principles of organoid models, highlighting their ability to recapitulate neurodevelopmental processes and simulate drug-induced toxicity in a controlled environment. Challenges and future perspectives in the field have been addressed with a focus on advancing organoid technologies to improve reprotoxicity assessment and enhance drug safety screening. This review underscores the importance of organoid models in unraveling the complex relationship between neurotherapeutic drugs and reproductive health.
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Affiliation(s)
- Mariam M. Abady
- Organic Metrology Group, Division of Chemical and Material Metrology, Korea Research Institute of Standards and Science, Daejeon, Republic of Korea
- Department of Bio-Analytical Science, University of Science and Technology, Daejeon, Republic of Korea
- Department of Nutrition and Food Science, National Research Centre, Cairo, Egypt
| | - Ji-Seon Jeong
- Organic Metrology Group, Division of Chemical and Material Metrology, Korea Research Institute of Standards and Science, Daejeon, Republic of Korea
- Department of Bio-Analytical Science, University of Science and Technology, Daejeon, Republic of Korea
| | - Ha-Jeong Kwon
- Organic Metrology Group, Division of Chemical and Material Metrology, Korea Research Institute of Standards and Science, Daejeon, Republic of Korea
| | - Abdullah M. Assiri
- Deperament of Comparative Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Jongki Cho
- College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Islam M. Saadeldin
- Deperament of Comparative Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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96
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Werkmann NL, Luczejko AA, Hagelweide K, Stark R, Weigelt S, Christiansen H, Kieser M, Otto K, Reck C, Steinmayr R, Wirthwein L, Zietlow AL, Schwenck C. Facial emotion recognition in children of parents with a mental illness. Front Psychiatry 2024; 15:1366005. [PMID: 38938463 PMCID: PMC11210522 DOI: 10.3389/fpsyt.2024.1366005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/23/2024] [Indexed: 06/29/2024] Open
Abstract
Objective Facial emotion recognition (FER) is a fundamental social skill essential for adaptive social behaviors, emotional development, and overall well-being. FER impairments have been linked to various mental disorders, making it a critical transdiagnostic mechanism influencing the development and trajectory of mental disorders. FER has also been found to play a role in the transgenerational transmission of mental disorders, with the majority of research suggesting FER impairments in children of parents with a mental illness (COPMI). Previous research primarily concentrated on COPMI of parents with internalizing disorders, which does not cover the full spectrum of outpatient mental health service populations. Furthermore, research focuses on varying components of FER by using different assessment paradigms, making it challenging to compare study results. To address these gaps, we comprehensively investigated FER abilities in COPMI using multiple tasks varying in task characteristics. Methods We included 189 children, 77 COPMI and 112 children of parents without a diagnosed mental illness (COPWMI), aged 6 to 16 years. We assessed FER using three tasks with varying task demands: an emotional Go/NoGo task, a morphing task, and a task presenting short video sequences depicting different emotions. We fitted separate two-level hierarchical Bayesian models (to account for sibling pairs in our sample) for reaction times and accuracy rates for each task. Good model fit was assured by comparing models using varying priors. Results Contrary to our expectations, our results revealed no general FER deficit in COPMI compared to COPWMI. The Bayesian models fitted for accuracy in the morphing task and Go/NoGo task yielded small yet significant effects. However, Bayes factors fitted for the models suggested that these effects could be due to random variations or noise in the data. Conclusions Our study does not support FER impairments as a general feature of COPMI. Instead, individual factors, such as the type of parental disorder and the timing of its onset, may play a crucial role in influencing FER development. Future research should consider these factors, taking into account the diverse landscape of parental mental disorders.
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Affiliation(s)
- Naomi Leona Werkmann
- Department of Clinical Child and Adolescent Psychology, Justus Liebig University Giessen, Giessen, Germany
| | - Arleta Angelika Luczejko
- Department of Clinical Child and Adolescent Psychology, Justus Liebig University Giessen, Giessen, Germany
| | - Klara Hagelweide
- Department of Rehabilitation Sciences, Technical University Dortmund, Dortmund, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus-Liebig University Giessen, Giessen, Germany
| | - Sarah Weigelt
- Department of Rehabilitation Sciences, Technical University Dortmund, Dortmund, Germany
| | - Hanna Christiansen
- Department of Psychology, Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Kathleen Otto
- Department of Work and Organizational Psychology, Philipps-University Marburg, Marburg, Germany
| | - Corinna Reck
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ricarda Steinmayr
- Department of Psychology, Technical University Dortmund, Dortmund, Germany
| | - Linda Wirthwein
- Department of Psychology, Technical University Dortmund, Dortmund, Germany
| | - Anna-Lena Zietlow
- Clinical Child and Adolescent Psychology, Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Christina Schwenck
- Department of Clinical Child and Adolescent Psychology, Justus Liebig University Giessen, Giessen, Germany
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97
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Poletti S, Mazza MG, Benedetti F. Inflammatory mediators in major depression and bipolar disorder. Transl Psychiatry 2024; 14:247. [PMID: 38851764 PMCID: PMC11162479 DOI: 10.1038/s41398-024-02921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 06/10/2024] Open
Abstract
Major depressive disorder (MDD) and bipolar disorder (BD) are highly disabling illnesses defined by different psychopathological, neuroimaging, and cognitive profiles. In the last decades, immune dysregulation has received increasing attention as a central factor in the pathophysiology of these disorders. Several aspects of immune dysregulations have been investigated, including, low-grade inflammation cytokines, chemokines, cell populations, gene expression, and markers of both peripheral and central immune activation. Understanding the distinct immune profiles characterizing the two disorders is indeed of crucial importance for differential diagnosis and the implementation of personalized treatment strategies. In this paper, we reviewed the current literature on the dysregulation of the immune response system focusing our attention on studies using inflammatory markers to discriminate between MDD and BD. High heterogeneity characterized the available literature, reflecting the heterogeneity of the disorders. Common alterations in the immune response system include high pro-inflammatory cytokines such as IL-6 and TNF-α. On the contrary, a greater involvement of chemokines and markers associated with innate immunity has been reported in BD together with dynamic changes in T cells with differentiation defects during childhood which normalize in adulthood, whereas classic mediators of immune responses such as IL-4 and IL-10 are present in MDD together with signs of immune-senescence.
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Affiliation(s)
- Sara Poletti
- Psychiatry and Clinical Psychobiology Unit, Division of Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Mario Gennaro Mazza
- Psychiatry and Clinical Psychobiology Unit, Division of Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Benedetti
- Psychiatry and Clinical Psychobiology Unit, Division of Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
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98
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Sánchez-Ortí JV, Correa-Ghisays P, Balanzá-Martínez V, Macías Saint-Gerons D, Berenguer-Pascual E, Romá-Mateo C, Victor VM, Forés-Martos J, San-Martin C, Selva-Vera G, Tabarés-Seisdedos R. Systemic inflammation, oxidative damage and neurocognition predict telomere length in a transdiagnostic sample stratified by global DNA methylation levels. Sci Rep 2024; 14:13159. [PMID: 38849401 PMCID: PMC11161596 DOI: 10.1038/s41598-024-62980-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
Epigenetic mechanisms contribute to the maintenance of both type 2 diabetes mellitus (T2DM) and psychiatric disorders. Emerging evidence suggests that molecular pathways and neurocognitive performance regulate epigenetic dynamics in these disorders. The current combined and transdiagnostic study investigated whether inflammatory, oxidative stress, adhesion molecule, neurocognitive and functional performance are significant predictors of telomere dynamics in a sample stratified by global DNA methylation levels. Peripheral blood inflammation, oxidative stress and adhesion molecule biomarkers and neurocognitive function were assessed twice over a 1-year period in 80 individuals, including 16 with schizophrenia (SZ), 16 with bipolar disorder (BD), 16 with major depressive disorder (MDD), 15 with T2DM, and 17 healthy controls (HCs). Leukocyte telomere length (LTL) was measured by qRT-PCR using deoxyribonucleic acid (DNA) extracted from peripheral blood samples. A posteriori, individuals were classified based on their global methylation score (GMS) at baseline into two groups: the below-average methylation (BM) and above-average methylation (AM) groups. Hierarchical and k-means clustering methods, mixed one-way analysis of variance and linear regression analyses were performed. Overall, the BM group showed a significantly higher leukocyte telomere length (LTL) than the AM group at both time points (p = 0.02; η2p = 0.06). Moreover, the BM group had significantly lower levels of tumor necrosis factor alpha (TNF-α) (p = 0.03; η2p = 0.06) and C-reactive protein (CRP) (p = 0.03; η2p = 0.06) than the AM group at the 1-year follow-up. Across all participants, the regression models showed that oxidative stress (reactive oxygen species [ROS]) (p = 0.04) and global cognitive score [GCS] (p = 0.02) were significantly negatively associated with LTL, whereas inflammatory (TNF-α) (p = 0.04), adhesion molecule biomarkers (inter cellular adhesion molecule [ICAM]) (p = 0.009), and intelligence quotient [IQ] (p = 0.03) were significantly positively associated with LTL. Moreover, the model predictive power was increased when tested in both groups separately, explaining 15.8% and 28.1% of the LTL variance at the 1-year follow-up for the AM and BM groups, respectively. Heterogeneous DNA methylation in individuals with T2DM and severe mental disorders seems to support the hypothesis that epigenetic dysregulation occurs in a transdiagnostic manner. Our results may help to elucidate the interplay between epigenetics, molecular processes and neurocognitive function in these disorders. DNA methylation and LTL are potential therapeutic targets for transdiagnostic interventions to decrease the risk of comorbidities.
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Affiliation(s)
- Joan Vicent Sánchez-Ortí
- INCLIVA - Health Research Institute, Valencia, Spain
- TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain
- Faculty of Psychology, University of Valencia, Valencia, Spain
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Health Institute, Carlos III, Madrid, Spain
| | - Patricia Correa-Ghisays
- INCLIVA - Health Research Institute, Valencia, Spain
- TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain
- Faculty of Psychology, University of Valencia, Valencia, Spain
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Health Institute, Carlos III, Madrid, Spain
| | - Vicent Balanzá-Martínez
- INCLIVA - Health Research Institute, Valencia, Spain.
- TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain.
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Health Institute, Carlos III, Madrid, Spain.
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain.
- VALSME (VALencia Salut Mental i Estigma), University of Valencia, Valencia, Spain.
| | - Diego Macías Saint-Gerons
- INCLIVA - Health Research Institute, Valencia, Spain
- TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Health Institute, Carlos III, Madrid, Spain
| | | | - Carlos Romá-Mateo
- INCLIVA - Health Research Institute, Valencia, Spain
- CIBER de Enfermedades Raras (CIBERER), Health Institute, Carlos III, Madrid, Spain
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Víctor M Victor
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
- Service of Endocrinology and Nutrition, University Hospital Dr. Peset, Valencia, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Jaume Forés-Martos
- INCLIVA - Health Research Institute, Valencia, Spain
- TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Health Institute, Carlos III, Madrid, Spain
| | - Constanza San-Martin
- INCLIVA - Health Research Institute, Valencia, Spain
- TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Health Institute, Carlos III, Madrid, Spain
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Gabriel Selva-Vera
- INCLIVA - Health Research Institute, Valencia, Spain
- TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Health Institute, Carlos III, Madrid, Spain
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
| | - Rafael Tabarés-Seisdedos
- INCLIVA - Health Research Institute, Valencia, Spain.
- TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain.
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Health Institute, Carlos III, Madrid, Spain.
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain.
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99
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Helmink FGL, Mesman E, Hillegers MHJ. Beyond the Window of Risk? The Dutch Bipolar Offspring Study: 22-Year Follow-up. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00308-3. [PMID: 38851383 DOI: 10.1016/j.jaac.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/03/2024] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Adolescent offspring of parents with bipolar disorder (BD) are at high risk to develop BD and other psychopathology, yet how this risk continues into middle adulthood remains unknown. This study aimed to determine the window of risk for BD and other psychopathology in offspring of parents with BD followed from adolescence into adulthood. METHOD This study reported on the 22-year follow-up assessment of the Dutch Bipolar Offspring Study, a fixed cohort study of 140 participants established in 1997. Offspring (n = 100; mean [SD] age = 38.28 [2.74] years) of parents with bipolar I disorder or bipolar II disorder were assessed at baseline and 1-, 5-, 12-, and 22-year follow-up. RESULTS No new BD onsets occurred since the 12-year follow-up (lifetime prevalence = 11%-13%; bipolar I disorder = 4%; bipolar II disorder = 7%). Lifetime prevalence of any mood disorder was 65%; for major depressive disorder, prevalence was 36%; and for recurrent mood episodes, prevalence was 37%. Prevalence of major depressive disorder more than doubled in the past decade. Point prevalence of any psychopathology peaked between 20 and 25 years (38%-46%), subsiding to 29% to 35% per year after age 30. Overall, 71% of offspring contacted mental health services since the last assessment. CONCLUSION The risk for homotypic transmission of BD in offspring of parents with BD is highest during adolescence. The heterotypic risk for mood disorder onset and recurrences continues over the life course. Severe mood disorders are often preceded by milder psychopathology, emphasizing the need for early identification and interventions. This study allows for better understanding of the onset and course of mood disorders and specific windows of risk in a familial high-risk population.
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Affiliation(s)
| | - Esther Mesman
- Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
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100
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Yoldi-Negrete M, Fresán A, Jiménez-Rodríguez LI, Tirado-Durán EG. Cognition in Euthymic Patients with Bipolar Disorder: Do Not Forget to Account for Anxiety! Neuropsychiatr Dis Treat 2024; 20:1181-1189. [PMID: 38855382 PMCID: PMC11162183 DOI: 10.2147/ndt.s457186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/11/2024] [Indexed: 06/11/2024] Open
Abstract
Purpose Despite the high prevalence of anxiety disorders in BD and its known impact on cognitive performance, the presence and severity of anxious symptoms is not systematically evaluated in studies on cognition in BD. Our aim was to determine if attention and/or inhibition of cognitive interference in euthymic patients with type I Bipolar Disorder (BD-I) is affected by symptoms of anxiety. Patients and Methods Eighty-seven euthymic BD-I patients were included. Patients with comorbidities other than Generalized Anxiety Disorder (GAD) or Panic Disorder (PD) were excluded. State anxiety was measured with the Brief Inventory of Anxious Responses and Situations (ISRA-B). Subjective cognitive performance was evaluated with the COBRA scale, attention with the Digit-Span Forward task and inhibition of cognitive interference was assessed with the StroopTest interference score. Multiple linear regression models were used to test if anxious symptoms were associated with attention or inhibition of cognitive interference, considering other known contributors for cognitive impairment. Results Attention was unaffected by anxiety symptoms, but the overall regression for inhibition of cognitive interference was significant: years of schooling (β=1.12, p = 0.001), cognitive complaints (β=0.44, p = 0.008), and anxiety (β=-0.21, p = 0.017) explained 15% of the interference score of the Stroop test (R2 = 0.15). Conclusion Beyond residual affective symptoms, anxious symptoms seem to affect inhibition of cognitive interference. We recommend routine testing of anxiety when considering cognitive evaluations, especially when screening for cognitive deficits.
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Affiliation(s)
- María Yoldi-Negrete
- Clinical Epidemiology Laboratory, Clinical Research Directorate, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Ana Fresán
- Clinical Epidemiology Laboratory, Clinical Research Directorate, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Laura Ivone Jiménez-Rodríguez
- Department of Psychology, Neuropsychology, Clinical Services Directorate, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Elsa Georgina Tirado-Durán
- Department of Psychology, Neuropsychology, Clinical Services Directorate, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
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