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Warner A, Palmier-Claus J, Holland C, Tyler E, Rhodes V, Settle G, Lobban F. The Changing Care of Older Adults With Bipolar Disorder: A Narrative Analysis. QUALITATIVE HEALTH RESEARCH 2024:10497323241263043. [PMID: 39076026 DOI: 10.1177/10497323241263043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Older adults with bipolar disorder experience distinct challenges compared to younger age groups with bipolar disorder. They potentially require adaptations to the care they receive. This study aimed to explore experiences of care and changing care needs in older adults with bipolar disorder. People with bipolar disorder (aged ≥60) were recruited through three NHS Trusts in the North West of England, charity organisations, a confidential university participant database, and social media. Participants completed single time-point biographical narrative interviews, which were analysed using narrative analysis. Sixteen participants' accounts led to the creation of four themes: (1) 'Navigating the disruption caused by diagnosis'; (2) 'The removal of services that provided hope'; (3) 'Later life: We are on our own now'; and (4) 'Changing care needs in later life: We still need support'. The care needs of older adults with bipolar disorder appear to change over time, and services often fail to offer adequate, tailored care for this group at present. Current support requires adaptation to be effective and appropriate and to enable this group to age well in later life.
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Affiliation(s)
- Aaron Warner
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Jasper Palmier-Claus
- Division of Health Research, Spectrum Centre for Mental Health Research, Lancaster, UK
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Carol Holland
- Division of Health Research, Centre for Aging Research, Lancaster, UK
| | - Elizabeth Tyler
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Verity Rhodes
- NIHR Applied Research Collaboration North West Coast, UK
| | - Geoff Settle
- NIHR Applied Research Collaboration North West Coast, UK
| | - Fiona Lobban
- Division of Health Research, Spectrum Centre for Mental Health Research, Lancaster, UK
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
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Sogut K, Gorgulu Y, Palabiyik O. The effect of subthreshold depressive symptoms on cognitive functions and peripheral biomarkers in bipolar disorder. Nord J Psychiatry 2023; 77:768-777. [PMID: 37668000 DOI: 10.1080/08039488.2023.2251448] [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: 03/05/2023] [Revised: 07/19/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE A global approach to factors responsible for functional impairment in patients with BD is necessary. METHOD Ninety-three euthymic patients with BD [49 patients with SD (subthreshold depression) and 44 patients without SD] and 48 healthy controls were invited for evaluation of demographic, clinical, and cognitive characteristics. To define SD, the lower limit was HDRS ≥4 points and the upper limit was HDRS <9 points. Stroop test, California verbal learning test, digit-span test, controlled word association test, and clock drawing test were performed. Serum BDNF levels were measured. Additionally in the BD group; blood drug (lithium, valproic acid), leukocyte, C-reactive protein (CRP), TSH, and vitamin B12 levels were measured. RESULTS We found no difference between serum BDNF levels of BD (n = 93) and controls. The cognitive performances of the BD group were worse than the control group (p < 0.001). Attention, working memory, and stroop performance of patients with SD were worse than patients without SD (p < 0.05). Verbal fluency, stroop test, and planning performance decreased as serum CRP level increased in patients with BD (p < 0.05). CONCLUSIONS Although the patient group with SD was in euthymia, their cognitive performance was worse than the group without SD. Poor cognitive performance in BD was associated with serum CRP levels.
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Affiliation(s)
- Kubra Sogut
- Department of Psychiatry, School of Medicine, Trakya University, Edirne, Turkey
| | - Yasemin Gorgulu
- Department of Psychiatry, School of Medicine, Trakya University, Edirne, Turkey
| | - Orkide Palabiyik
- Health Services Vocational College, Trakya University, Edirne, Turkey
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3
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Haddad C, Salameh P, Sacre H, Clément JP, Calvet B. Effects of antipsychotic and anticholinergic medications on cognition in chronic patients with schizophrenia. BMC Psychiatry 2023; 23:61. [PMID: 36694187 PMCID: PMC9872384 DOI: 10.1186/s12888-023-04552-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Patients with psychosis frequently use a variety of psychotropic medicines, many of which have anticholinergic effects that can impair cognition. Therefore, this study aimed to evaluate whether there is an association between medications used for neuropsychological disorders/symptoms and cognition in patients with schizophrenia, focusing on their anticholinergic load and antipsychotic doses. STUDY DESIGN A cross-sectional study between July 2019 and Mars 2020 at the Psychiatric Hospital of the Cross-Lebanon enrolled 120 inpatients diagnosed with schizophrenia. The total anticholinergic burden was calculated based on the Anticholinergic Drug Scale (ADS), and the chlorpromazine equivalent dose was calculated using the Andreasen method to assess the relative antipsychotic dose. Also, the objective cognition was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) tool. STUDY RESULTS A significantly higher BACS total score (r = -0.33, p < 0.001), higher verbal memory (r = -0.26, p = 0.004), higher working memory (r = -0.20, p = 0.03), higher motor speed (r = -0.36, p < 0.001), and higher attention and speed of information processing (r = -0.27, p = 0.003) were significantly associated with lower chlorpromazine equivalent dose. Higher ADS (Standardized Beta (SB) = -.22; p = .028), higher chlorpromazine equivalent dose (SB = -.30; p = .001), and taking mood stabilizer medications (SB = -.24; p = .004) were significantly associated with lower cognition. CONCLUSION This study confirms that the cognitive functions of chronic patients with schizophrenia may be affected by medications and their anticholinergic burden. More studies are needed to explain the role of cholinergic neurotransmission and general neurochemical mechanisms in the cognitive impairment of patients with schizophrenia.
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Affiliation(s)
- Chadia Haddad
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France. .,Centre Mémoire de Ressources Et de Recherche du Limousin, Centre Hospitalier Esquirol, 87000, Limoges, France. .,Research Department, Psychiatric Hospital of the Cross, P.O. Box 60096, Jal Eddib, Lebanon. .,INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon. .,School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon. .,School of Medicine, Lebanese American University, Byblos, Lebanon.
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon ,grid.411323.60000 0001 2324 5973School of Medicine, Lebanese American University, Byblos, Lebanon ,grid.413056.50000 0004 0383 4764Department of Primary Care and Population Health, University of Nicosia Medical School, 2417 Nicosia, Cyprus ,grid.411324.10000 0001 2324 3572Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Jean-Pierre Clément
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France ,grid.477071.20000 0000 9883 9701Centre Mémoire de Ressources Et de Recherche du Limousin, Centre Hospitalier Esquirol, 87000 Limoges, France ,grid.477071.20000 0000 9883 9701Pôle Universitaire de Psychiatrie de L’Adulte, de l’Agée Et d’Addictologie, Centre Hospitalier Esquirol, 87000 Limoges, France
| | - Benjamin Calvet
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France ,grid.477071.20000 0000 9883 9701Centre Mémoire de Ressources Et de Recherche du Limousin, Centre Hospitalier Esquirol, 87000 Limoges, France ,grid.477071.20000 0000 9883 9701Pôle Universitaire de Psychiatrie de L’Adulte, de l’Agée Et d’Addictologie, Centre Hospitalier Esquirol, 87000 Limoges, France
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Characterisation of Deficits and Sex Differences in Verbal and Visual Memory/Learning in Bipolar Disorder. J Int Neuropsychol Soc 2023; 29:12-23. [PMID: 35067269 DOI: 10.1017/s1355617721001442] [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: 02/01/2023]
Abstract
OBJECTIVE Cognitive impairment is consistently reported in bipolar disorder (BD), but few studies have characterised which memory component processes are affected. Further, it is unknown whether the component processes underlying memory impairment are moderated by sex. The present study examined diagnosis and sex differences in both verbal and visual memory/learning domains in patients with BD and psychiatrically healthy controls. METHOD Verbal and visual memory/learning were measured using the Hopkins Verbal Learning Test-Revised (HVLT-R) and Brief Visuospatial Memory Test-Revised (BVMT-R). 114 patients with BD (n = 50 males, n = 64 females), were compared to 105 psychiatrically healthy controls (n = 42 males, n = 63 females). RESULTS Patients with BD had worse performance in verbal and visual immediate and total recall, verbal and visual delayed free recall, and verbal recognition discrimination scores, but there were no group differences in learning slopes and cumulative learning index scores. There were trends for BD females to outperform BD males in visual memory/learning free recall and cumulative learning, but these results did not survive multiple testing correction. These findings did not change in a secondary sensitivity analysis comparing only strictly euthymic BD patients to controls (n = 64). CONCLUSION The present study found trait-like verbal and visual memory/learning impairment in BD that was attributable to deficient encoding and/or consolidation processes rather than deficits in learning. We did not find marked sex differences in either visual or verbal memory/learning measures, although some trend level effects were apparent and deserve exploration in future studies.
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BIPOLAR DISORDER, MOOD STABILIZERS AND COGNITIVE FLEXIBILITY: TRANSLATIONALLY DISSECTING ILLNESS FROM DRUG EFFECTS. Behav Brain Res 2022; 424:113799. [PMID: 35181389 DOI: 10.1016/j.bbr.2022.113799] [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: 07/19/2021] [Revised: 01/21/2022] [Accepted: 02/12/2022] [Indexed: 11/21/2022]
Abstract
Bipolar disorder (BD) effects on cognition are confounded by the putative cognitive impact of its major pharmacological treatments, given the neurotrophic potential of mood stabilizers, particularly lithium. We examined the area of cognitive flexibility (CF), aiming to disentangle BD from medication effects, using translational methodology. CF was assessed by CANTAB-IED (intra- extra-dimensional shift; Study 1, euthymic BD participants) and its animal analogue (Study 2, rats). Both studies included groups (1) control, (2) lithium, chronic, current treatment (LI-CHRON-C, A: >2 years, N=32; B: 2 months, N=11); (3) valproate, chronic, current treatment (VPA-CHRON-C, A: >2 years, N=30; B: 2 months, N=12). Study 2 included 2 additional groups; Group 4: LI-CHRON-PAST (2 months, stopped 1 month pretest, N=13); Group 5: LI-ACUTE (LI on test days only, N=13). In Study 1, neither total nor stage (discrimination: D; reversal R; intra- extra-dimensional shifts: IED) IED errors differed between groups [(Kruskal-Wallis: H(2, N= 94) 0.95 > p > 0.65]. Similarly in Study 2, errors did not differentiate the 5 pharmacological groups. Differences emerged only between LI-ACUTE and Controls in response latencies (D, R, IED ANOVAS: 0.002 > p > 0.0003; contrasts D, R: p = 0.002, 0.0001). In conclusion, LI and VPA BD patients were indistinguishable from Controls in IED errors, as were animals treated with LI-CHRON, current or past, or VPA-CHRON-C vs Controls. LI-ACUTE treatment produced significant latency deficits vs. Controls. Within the limitations of translational comparisons, our results suggest that the normal CF noted in euthymic BDs is not attributable to mood stabilizer effects.
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Jiang X, Mio M, Dimick MK, Zou Y, Sultan AA, Goldstein BI. Association of Lithium and Second-Generation Antipsychotics with Neurocognition in Youth with Bipolar Disorder. J Child Adolesc Psychopharmacol 2022; 32:61-69. [PMID: 35085001 PMCID: PMC8884166 DOI: 10.1089/cap.2021.0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: Numerous studies have examined the association of antimanic medications with neurocognition in adults with bipolar disorder (BD). However, few studies have examined this topic in youth. Thus, we aimed to examine the association of lithium and second-generation antipsychotics (SGAs), the first-line antimanic medications for youth with BD, with neurocognition in a relatively large sample of youth with BD. Methods: Participants included 91 youth with BD-I, -II, or -Not Otherwise Specified, aged 13-20 years (n = 14 current lithium use, n = 51 current SGA use). We examined four tests from the Cambridge Neuropsychological Test Automated Battery: Intra/Extra Dimensional Set-Shifting Task (IED), Rapid Visual Information Processing Task (RVP), Stockings of Cambridge Test (SOC), and Affective Go/No-Go (AGN). Within-sample Z-scores were computed, and a global neurocognitive composite score and g factor derived from these tests comprised the primary outcomes. Multivariable analyses controlled for age, sex, and IQ. Results: Current lithium use was significantly associated with poorer cognitive flexibility/set-shifting (IED). After further controlling for lifetime comorbid attention-deficit/hyperactivity disorder and current depression symptoms in sensitivity analyses, the lithium finding was no longer significant. Current SGA use was significantly associated with greater affective processing bias (AGN). No significant findings survived correction for multiple comparisons. All other cognitive outcomes were not significantly associated with current lithium use, current SGA use, or total number of current medications. Conclusions: Treatment with lithium or SGAs was associated with minimal neurocognitive impairments, with small effect sizes in primary multivariable analyses. This study adds to the limited body of literature examining medication use in relation to neurocognition in youth with BD. While the current study cannot rule out associations of smaller effect size, present findings suggest that leading mood-stabilizing medications are not associated with frank neurocognitive impairments in youth with BD.
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Affiliation(s)
- Xinyue Jiang
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Megan Mio
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Mikaela K. Dimick
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Alysha A. Sultan
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Benjamin I. Goldstein
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Address correspondence to: Benjamin I. Goldstein, MD, PhD, Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4, Canada
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Badrfam R, Mostafavi SA, Khaleghi A, Akhondzadeh S, Zandifar A, Farid M, Mohammadian Khonsari N, Mohammadi MR. The efficacy of vitamin B6 as an adjunctive therapy to lithium in improving the symptoms of acute mania in patients with bipolar disorder, type 1; a double-blind, randomized, placebo-controlled, clinical trial. Brain Behav 2021; 11:e2394. [PMID: 34662000 PMCID: PMC8613435 DOI: 10.1002/brb3.2394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/14/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Vitamin B6 has been linked to a variety of probable roles, including anti-inflammatory, homocysteine-lowering, serotonin-regulating, and dopamine-lowering. In this study, we investigated the possible effect of vitamin B6 on bipolar disorder in manic episode with psychotic feature in a placebo-controlled double-blind clinical trial in a psychiatric hospital. METHODS This study was performed on 50 patients who were equally divided into two groups (each group included 25 patients) using 80 mg of vitamin B6 daily or placebo. At the beginning and end of the study, they were evaluated for lab tests, inflammatory biomarkers and level of blood homocysteine. Also, at the baseline and in weeks 2, 4, and 8, they were evaluated based on the anthropometric measurements, score obtained from the Young Mania Questionnaire, Mini-Mental State Examination (MMSE), and the Pittsburgh Sleep Questionnaire. RESULTS Accordingly, based on Yang Mania scoring scale, no significant difference was observed between the two groups receiving vitamin B6 and placebo (22.68 ± 5.39 vs. 21.80 ± 5.39 [p-value = .51]). Based on MMSE, significant improvement in cognitive status was obtained in group placebo compared to vitamin B6 group (25.24 ± 1.96 vs. 24.40 ± 3.25, respectively [p-value = .01]). At the Pittsburg scale (total, there was no statistically significant difference between the two groups receiving vitamin B6 and placebo (1.04 ± 0.20 vs. 0.48 ± 0.50 [p-value = .23]). Additionally, no significant difference was observed between the two groups regarding the anthropometric status. CONCLUSIONS According to this study, the daily dose of 80 mg of vitamin B6 for 8 weeks in patients with bipolar disorder in the manic episode with psychotic feature treated daily with lithium, was not associated with a significant improvement in mood status compared to the control-placebo group. It is recommended to perform similar studies in a multi-center manner with a larger sample size and longer duration.
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Affiliation(s)
- Rahim Badrfam
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed-Ali Mostafavi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Khaleghi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Zandifar
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Department of Psychiatry, Imam Hossein Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Malihe Farid
- Non communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Mohammad Reza Mohammadi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Stedal K, Broomfield C, Hay P, Touyz S, Scherer R. Neuropsychological functioning in adult anorexia nervosa: A meta-analysis. Neurosci Biobehav Rev 2021; 130:214-226. [PMID: 34453951 DOI: 10.1016/j.neubiorev.2021.08.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/10/2021] [Accepted: 08/22/2021] [Indexed: 02/07/2023]
Abstract
Several studies have conceptualized neuropsychological dysfunction as part of the core pathology and defining behaviors seen in the eating disorder anorexia nervosa (AN). The aim of the current review was to synthesize the differences in neuropsychological test performance between individuals with AN and healthy controls, quantify and explain their heterogeneity. The search and screening procedures resulted in fifty studies that comprised 186 neuropsychological test results. Utilizing random-effects meta-analyses, the results revealed evidence for significant, moderate underperformance in people with AN in overall neuropsychological functioning (g¯ = -0.43, 95 % CI [-0.50, -0.36]). Weighted mean effect sizes ranged from g¯ = -0.53 for visuospatial abilities to g¯ = -0.10 for planning. Study and participant characteristics, including body mass index (BMI) and age, had significant moderator effects, especially on executive function, memory, and visuospatial abilities. The findings from the current study provide an extensive and comprehensive overview of the possible impairments in neuropsychological functioning in adult patients diagnosed with AN.
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Affiliation(s)
- Kristin Stedal
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital Ullevål HF, Postboks 4956 Nydalen, 0424, Oslo, Norway.
| | - Catherine Broomfield
- School of Psychology, Faculty of Science, The University of Sydney, NSW, 2006, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Stephen Touyz
- School of Psychology, Faculty of Science, The University of Sydney, NSW, 2006, Australia
| | - Ronny Scherer
- Centre for Educational Measurement at the University of Oslo (CEMO), Faculty of Educational Sciences, University of Oslo, P.O. Box 1161 Blindern, 0318, Oslo, Norway
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A Single-Blind Randomized Comparison of Lithium and Lamotrigine as Maintenance Treatments for Managing Bipolar II Disorder. J Clin Psychopharmacol 2021; 41:381-388. [PMID: 34181361 DOI: 10.1097/jcp.0000000000001424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE/BACKGROUND No study to date has compared lithium and lamotrigine as maintenance mood stabilizers for bipolar II disorder. The aim of this study was to evaluate and compare these two medications in terms of their maintenance efficacy and side effect profile, thus evaluating their comparative cost/benefit profile. METHODS/PROCEDURES Forty-four subjects with a newly diagnosed bipolar II disorder were randomly assigned to receive either lithium or lamotrigine treatment in a 20-week single-blinded study. Subjects received either slow-release lithium progressively up-titrated to achieve a serum level of 0.8 mEq/L, or lamotrigine increased progressively to a maintenance dose of 200 mg/d. Our primary outcome measure examined daily data on hypomanic and depressive symptoms. Secondary measures evaluated hypomanic and depressive symptom severity, global functioning, and global improvement in hypomanic and depressive symptoms. FINDINGS/RESULTS We terminated the trial principally because of severe ongoing side effects experienced by many of those receiving lithium, and with additional concerns about initial severe side effects (including psychosis) experienced by several assigned to lamotrigine. Analyses of study completer data for 28 participants suggested comparable efficacy of both medications; however, lamotrigine had a distinctly lower rate of severe side effects across the study. We calculated that if study trends on outcome measures were valid, then an extremely large sample would be required to demonstrate superiority of either drug, thus making it unlikely that any such adequately powered study will be mounted in the future. IMPLICATIONS/CONCLUSIONS The small sample size limits any definitive conclusions, but our data suggest that lithium and lamotrigine are likely to have equal efficacy as mood stabilizers for those with a bipolar II condition but that, as maintenance treatments, lithium has more distinctive side effects.
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Hamdami M, Khalifeh S, Jamali-Raeufy N, Nasehi M. The effects of lithium chloride and cathodal/anodal transcranial direct current stimulation on conditional fear memory changes and the level of p-mTOR/mTOR in PFC of male NMRI mice. Metab Brain Dis 2021; 36:327-337. [PMID: 33219894 DOI: 10.1007/s11011-020-00643-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/03/2020] [Indexed: 12/23/2022]
Abstract
Lithium chloride clinically used to treat mental diseases but it has some side effects like cognitive impairment, memory deficit. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that is able to change neural activity and gene transcription in the brain. The aim of the study is to provide a conceptual theoretical framework based on behavioral and molecular effects of tDCS on memory changes induced by lithium in male mice. we applied Anodal-tDCS and Cathodal-tDCS over the left PFC for 3 consecutive days tDCS for 20 min with 2 mA after injection of different doses of lithium/saline.Trained in fear condition and finally the day after that tested their memory persistency factors (freezing-latency) and other behavior such as grooming and rearing percentage time in the fear conditioning. P-mTOR/mTOR was analyzed using western blotting. The results obtained from the preliminary analysis of behavioral fear memory showed that lithium had destructive effect in higher doses and decreased freezing percentage time. However, both cathodal and anodal tDCS significantly improved memory and increased P-mTOR/mTOR level in the PFC. The results of this study indicate that cathodal and anodal tDCS upon the left prefrontal increased memory and reduced lithium side effects on memory consolidation and altered expression of plasticity-associated genes in the prefrontal cortex.
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Affiliation(s)
- Mojgan Hamdami
- Department of Medical Physiology, Iran University of Medical Sciences, Tehran, Iran
- Student Research Committee, Iran University of Medical Science, Tehran, Iran
| | - Solmaz Khalifeh
- Cognitive and Neuroscience Research Center, Amir-Almomenin Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Nida Jamali-Raeufy
- Department of Medical Physiology, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Nasehi
- Cognitive and Neuroscience Research Center, Amir-Almomenin Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
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Majidi Zolbanin S, Salehian R, Nakhlband A, Ghanbari Jolfaei A. What Happens to Patients with Bipolar Disorder after Bariatric Surgery? A Review. Obes Surg 2021; 31:1313-1320. [PMID: 33389629 DOI: 10.1007/s11695-020-05187-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Abstract
Bipolar disorder (BD) patients are at high risk of obesity, which affects their quality of life (QOL). Since there is a high comorbidity between BD and obesity, most BD patients seek surgical intervention for obesity. Nowadays, bariatric surgery (BS) is considered appropriate for carefully selected patients with BD. Evaluations before performing BS and careful follow-up of patients with the bipolar spectrum are highly recommended. This study reviews the effects of BS on the course of BD and, at the same time, assesses the effect of BD on the consequences of the surgery. Our results showed that the number of studies approving the promising impact of surgery on BD was more than those disapproving it. However, more accurate results require more than 3-year follow-ups.
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Affiliation(s)
- Saeedeh Majidi Zolbanin
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Razieh Salehian
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ailar Nakhlband
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atefeh Ghanbari Jolfaei
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran. .,Psychosomatic Ward, Rasoul Akram Hospital, Tehran, 1445613131, Iran.
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Streicher JV, Wen H, Blom TJ, Tallman MJ, Strawn JR, Klein C, Patino LR, DelBello MP. A Preliminary Study of the Effects of Treatment with Lithium Versus Quetiapine on Attention of Adolescents with Bipolar Disorder. J Child Adolesc Psychopharmacol 2020; 30:465-469. [PMID: 32614262 PMCID: PMC7475083 DOI: 10.1089/cap.2019.0169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives: Despite attentional deficits being a prominent feature of bipolar disorder, there are limited data on the effects of common treatments for bipolar disorder on attention. Thus, we sought to compare the effects of lithium versus quetiapine on attention in adolescents with bipolar disorder. Methods: Adolescents ages 10-17 with bipolar disorder, type I, who were experiencing a manic or mixed episode, were recruited from outpatient settings and the inpatient psychiatric units at Cincinnati Children's Hospital Medical Center during their first manic episode. Healthy comparison subjects were recruited from outreach programs in the community. Patients were randomized to lithium or quetiapine, administered in a double-dummy, double-blinded manner for 6 weeks. Attentional deficits were assessed in all groups using the Identical Pairs Continuous Performance Task at baseline and at week 6. Results: Patients with bipolar disorder (n = 79) had impaired attention relative to the healthy group (n = 57) at both baseline and after 6 weeks of treatment. The lithium-treated group (n = 30) had poorer attentional performance than the healthy group at week 6. There was a difference in change in performance between lithium- and quetiapine-treated (n = 49) groups. Conclusion: Youth with bipolar disorder may have impaired attention relative to their healthy peers. Conclusions are limited by the high dropout rate in the lithium-treated group.
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Affiliation(s)
- Joshua V. Streicher
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Hongbo Wen
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Thomas J. Blom
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Maxwell J. Tallman
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jeffrey R. Strawn
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Christina Klein
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - L. Rodrigo Patino
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Melissa P. DelBello
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Address correspondence to: Melissa P. DelBello, MD, MS, Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH 45267, USA
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13
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Burdick KE, Millett CE, Russo M, Alda M, Alliey-Rodriguez N, Anand A, Balaraman Y, Berrettini W, Bertram H, Calabrese JR, Calkin C, Conroy C, Coryell W, DeModena A, Feeder S, Fisher C, Frazier N, Frye M, Gao K, Garnham J, Gershon ES, Glazer K, Goes FS, Goto T, Harrington GJ, Jakobsen P, Kamali M, Kelly M, Leckband S, Løberg EM, Lohoff FW, Maihofer AX, McCarthy MJ, McInnis M, Morken G, Nievergelt CM, Nurnberger J, Oedegaard KJ, Ortiz A, Ritchey M, Ryan K, Schinagle M, Schwebel C, Shaw M, Shilling P, Slaney C, Stapp E, Tarwater B, Zandi P, Kelsoe JR. The association between lithium use and neurocognitive performance in patients with bipolar disorder. Neuropsychopharmacology 2020; 45:1743-1749. [PMID: 32349118 PMCID: PMC7419515 DOI: 10.1038/s41386-020-0683-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/24/2020] [Accepted: 04/17/2020] [Indexed: 01/21/2023]
Abstract
Lithium remains the gold standard for the treatment of bipolar disorder (BD); however, its use has declined over the years mainly due to the side effects and the subjective experience of cognitive numbness reported by patients. In the present study, we aim to methodically test the effects of lithium on neurocognitive functioning in the largest single cohort (n = 262) of BD patients reported to date by harnessing the power of a multi-site, ongoing clinical trial of lithium monotherapy. At the cross-sectional level, multivariate analysis of covariance (MANCOVA) was conducted to examine potential group differences across neurocognitive tests [California Verbal Learning Test (CVLT trials 1-5,CVLT delayed recall), Wechsler Digit Symbol, Trail-making Test parts A and B (TMT-A; TMT-B), and a global cognition index]. At the longitudinal level, on a subset of patients (n = 88) who achieved mood stabilization with lithium monotherapy, we explored the effect of lithium treatment across time on neurocognitive functioning. There were no differences at baseline between BD patients that were taking lithium compared with those that were not. At follow-up a significant neurocognitive improvement in the global cognitive index score [F = 31.69; p < 0.001], CVLT trials 1-5 [F = 29.81; p < 0.001], CVLT delayed recall [F = 15.27; p < 0.001], and TMT-B [F = 6.64, p = 0.012] was detected. The cross-sectional and longitudinal (on a subset of 88 patients) investigations suggest that lithium may be beneficial to neurocognitive functioning in patients with BD and that at the very least it does not seem to significantly impair cognition when used therapeutically.
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Affiliation(s)
- Katherine E. Burdick
- grid.62560.370000 0004 0378 8294Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA ,James J Peters Veteran Administration (VA) Hospital, Bronx, NY USA
| | - Caitlin E. Millett
- grid.62560.370000 0004 0378 8294Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Manuela Russo
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Martin Alda
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | | | - Amit Anand
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Yokesh Balaraman
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Wade Berrettini
- grid.25879.310000 0004 1936 8972Center for Neurobiology and Behavior, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Holli Bertram
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Joseph R. Calabrese
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Cynthia Calkin
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | - Carla Conroy
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - William Coryell
- grid.214572.70000 0004 1936 8294University of Iowa, Iowa City, IA USA
| | - Anna DeModena
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Scott Feeder
- grid.66875.3a0000 0004 0459 167XMayo Clinic, Rochester, MN USA
| | - Carrie Fisher
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Nicole Frazier
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Mark Frye
- grid.66875.3a0000 0004 0459 167XMayo Clinic, Rochester, MN USA
| | - Keming Gao
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Julie Garnham
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | - Elliot S. Gershon
- grid.170205.10000 0004 1936 7822University of Chicago, Chicago, IL 60637 USA
| | - Kara Glazer
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Fernando S. Goes
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Toyomi Goto
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | | | - Petter Jakobsen
- grid.7914.b0000 0004 1936 7443NORMENT, Division of Psychiatry, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Masoud Kamali
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Marisa Kelly
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Susan Leckband
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Else Marie Løberg
- grid.7914.b0000 0004 1936 7443NORMENT, Division of Psychiatry, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Addiction Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Falk W. Lohoff
- grid.420085.b0000 0004 0481 4802National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, MD USA
| | - Adam X. Maihofer
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Michael J. McCarthy
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Melvin McInnis
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Gunnar Morken
- grid.412835.90000 0004 0627 2891Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | | | - John Nurnberger
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Ketil J. Oedegaard
- grid.7914.b0000 0004 1936 7443NORMENT, Division of Psychiatry, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Abigail Ortiz
- grid.17063.330000 0001 2157 2938Centre for Addiction and Mental Health, University of Toronto, Toronto, ON Canada
| | - Megan Ritchey
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Kelly Ryan
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Martha Schinagle
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Candice Schwebel
- grid.25879.310000 0004 1936 8972Center for Neurobiology and Behavior, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Martha Shaw
- grid.214572.70000 0004 1936 8294University of Iowa, Iowa City, IA USA
| | - Paul Shilling
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Claire Slaney
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | - Emma Stapp
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Bruce Tarwater
- grid.214572.70000 0004 1936 8294University of Iowa, Iowa City, IA USA
| | - Peter Zandi
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - John R. Kelsoe
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
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14
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Amiri S, Jafari-Sabet M, Keyhanfar F, Falak R, Shabani M, Rezayof A. Hippocampal and prefrontal cortical NMDA receptors mediate the interactive effects of olanzapine and lithium in memory retention in rats: the involvement of CAMKII-CREB signaling pathways. Psychopharmacology (Berl) 2020; 237:1383-1396. [PMID: 31984447 DOI: 10.1007/s00213-020-05465-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/16/2020] [Indexed: 12/20/2022]
Abstract
RATIONALE Treatment of bipolar disorder (BPD) with lithium and olanzapine concurrent administration is a major medicine issue with the elusive neurobiological mechanisms underlying the cognitive function. OBJECTIVE To clarify the precise mechanisms involved, the possible role of the hippocampus (HPC) and prefrontal cortical (PFC) NMDA receptors and CAMKII-CREB signaling pathway in the interactive effects of lithium and olanzapine in memory consolidation was evaluated. The dorsal hippocampal CA1 regions of adult male Wistar rats were bilaterally cannulated and a step-through inhibitory avoidance apparatus was used to assess memory consolidation. The changes in p-CAMKII/CAMKII and p-CREB/CREB ratio in the HPC and the PFC were measured by Western blot analysis. RESULTS Post-training administration of lithium (20, 30, and 40 mg/kg, i.p.) dose-dependently decreased memory consolidation whereas post-training administration olanzapine (2 and 5 mg/kg, i.p.) increased memory consolidation. Post-training administration of certain doses of olanzapine (1, 2, and 5 mg/kg, i.p.) dose-dependently improved lithium-induced memory impairment. Post-training administration of ineffective doses of the NMDA (10-5 and 10-4 μg/rat, intra-CA1) plus an ineffective dose of olanzapine (1 mg/kg, i.p.) dose-dependently improved the lithium-induced memory impairment. Post-training microinjection of ineffective doses of the NMDA (10-5 and 10-4 μg/rat, intra-CA1) dose-dependently potentiated the memory improvement induced by olanzapine (1 mg/kg, i.p.) on lithium-induced memory impairment which was associated with the enhancement of the levels of p-CAMKII and p-CREB in the HPC and the PFC. Post-training microinjection of ineffective doses of the noncompetitive NMDA receptor antagonist, MK-801 (0.0625 and 0.0125 μg/rat, intra-CA1), dose-dependently decreased the memory improvement induced by olanzapine (5 mg/kg, i.p.) on lithium-induced memory impairment which was related to the reduced levels of HPC and PFC CAMKII-CREB. CONCLUSION The results strongly revealed that there is a functional interaction among lithium and olanzapine through the HPC and the PFC NMDA receptor mechanism in memory consolidation which is mediated with the CAMKII-CREB signaling pathway.
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Affiliation(s)
- Shiva Amiri
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Jafari-Sabet
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Razi Drug Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Fariborz Keyhanfar
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Falak
- Immunology Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shabani
- Kerman Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | - Ameneh Rezayof
- Department of Animal Biology, School of Biology and Center of Excellence in Phylogeny of Living Organisms, College of Science, University of Tehran, Tehran, Iran
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15
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Szoke A, Meary A, Trandafir A, Bellivier F, Roy I, Schurhoff F, Leboyer M. Executive deficits in psychotic and bipolar disorders – Implications for our understanding of schizoaffective disorder. Eur Psychiatry 2020; 23:20-5. [DOI: 10.1016/j.eurpsy.2007.10.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Revised: 09/27/2007] [Accepted: 10/07/2007] [Indexed: 11/26/2022] Open
Abstract
AbstractObjectiveSchizoaffective disorder could be considered as a form of schizophrenia, a form of bipolar disorder, an independent disorder or a disorder intermediate between bipolar disorder and schizophrenia, within a psychotic continuum. The study of cognitive deficits in subjects with those diagnoses could help differentiate between these possibilities.MethodsWe compared cognitive performances of schizoaffective (SZAff) subjects with those of subjects with schizophrenia (SZ), bipolar disorder with psychotic symptoms (life-time) (BDP), bipolar disorder without life-time occurrence of psychotic symptoms (BD) and normal controls (NC). We used two tests of executive functions – the Wisconsin Card Sorting Test (WCST) and the Trail-making Test (TMT) – that are known to be impaired in those disorders.ResultsThe number of perseverative errors on WCST was highest in SZ subjects and gradually decreased in SZAff, BDP and, finally in BD subjects. By contrast, SZ and SZAff subjects obtained similar scores in the TMT, as did BD and BDP patients.ConclusionsThese results suggest that, for some deficits, there may be a continuum between SZ, SZAff and affective disorders, whereas SZAff patients most closely resemble SZ patients for other deficits. This implies that different conceptual views about schizoaffective disorder should be seen as complementary, rather than mutually exclusive.
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16
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Vainieri I, Adamo N, Michelini G, Kitsune V, Asherson P, Kuntsi J. Attention regulation in women with ADHD and women with bipolar disorder: An ex-Gaussian approach. Psychiatry Res 2020; 285:112729. [PMID: 31843208 DOI: 10.1016/j.psychres.2019.112729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 11/19/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) show certain overlapping features, such as increased reaction time variability. Here, we tested whether more detailed ex-Gaussian reaction time distribution measures identify shared or disorder-specific impairments in ADHD and BD. The total assessed sample consisted of 60 women (20 each in ADHD, BD and control groups). We compared the groups on ex-Gaussian measures of mu, sigma, and tau from a flanker task (congruent and incongruent conditions), an oddball task, and a four-choice reaction time task (baseline and fast-incentive conditions of the `fast task'). The ex-Gaussian measures mu and sigma reflect the speed and variability of typical responses, while tau captures variability in infrequent slow responses. Compared to controls, both ADHD and BD groups showed significantly increased tau in the fast task baseline condition. Participants with BD further showed a significantly increased sigma compared to ADHD and control groups in the flanker task incongruent condition. Our findings indicate that the ex-Gaussian approach is informative in detecting shared and disorder-specific cognitive impairments in ADHD and BD that may represent objective markers of these two disorders.
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Affiliation(s)
- Isabella Vainieri
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicoletta Adamo
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Giorgia Michelini
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry & Behavioral Health, Stony Brook University, Stony Brook, New York, USA
| | - Viryanaga Kitsune
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Philip Asherson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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17
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Conan GM. Frequently overlooked realistic moral bioenhancement interventions. JOURNAL OF MEDICAL ETHICS 2020; 46:43-47. [PMID: 31462452 DOI: 10.1136/medethics-2019-105534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/21/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
Many supporters of 'moral bioenhancement' (MBE), the use of biomedical interventions for moral improvement, have been criticised for having unrealistic proposals. The interventions they suggest have often been called infeasible and their implementation plans vague or unethical. I dispute these criticisms by showing that various interventions to implement MBE are practically and ethically feasible enough to warrant serious consideration. Such interventions include transcranial direct current stimulation over the medial and dorsolateral prefrontal cortex, as well as supplementation with lithium and omega-3. Considering their efficacy and feasibility, it is strange that these interventions have rarely been proposed or discussed as MBE. I review evidence that each of those interventions can reduce antisocial behaviour, reduce racial bias, increase executive function or increase prosocial traits like fairness and altruism. I then specify and defend realistic, ethically permissible ways to implement these interventions, especially for violent offenders and public servants-the former as rehabilitation and the latter to meet the high standards of their occupations. These interventions could be given to violent offenders in exchange for a reduced sentence or compulsorily in some cases. Potential intervention methods for non-prisoners include increasing the USDA-recommended dose of omega-3, encouraging food companies to supplement their products with omega-3 or trace lithium, requiring MBE for employment as a police officer or political leader, and insurance companies providing discounts for undergoing MBE. In some reasonably limited form, using these interventions may be a good first step to implement the project of MBE.
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Valtonen J, Karrasch M. Polypharmacy-induced cognitive dysfunction and discontinuation of psychotropic medication: a neuropsychological case report. Ther Adv Psychopharmacol 2020; 10:2045125320905734. [PMID: 32435446 PMCID: PMC7225781 DOI: 10.1177/2045125320905734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022] Open
Abstract
Polypharmacy is common in patients with a diagnosis of bipolar disorder. Although polypharmacy is known to increase the risk of iatrogenic neurological conditions, the recovery of cognitive function after drug withdrawal has been rarely documented in psychiatric patients using standardized neuropsychological methods. We present a neuropsychological case report of patient SN, a 41-year-old woman who developed a socially and occupationally detrimental condition of cognitive dysfunction likely induced by long-term exposure to lithium and other psychiatric medications. To shed light on SN's cognitive deficits and their recovery after drug withdrawal, neuropsychological assessments were conducted before, and approximately 2 years after, lithium and other psychiatric drugs were discontinued. Selective cognitive impairments were observed before drug discontinuation in visuomotor speed, visuoperceptual reasoning and delayed visual memory. Partial, but not complete, recovery of function was observed 2 years after drug withdrawal.
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Affiliation(s)
- Jussi Valtonen
- Department of Psychology, New York University, 6 Washington Place, New York, NY 10003, USA
| | - Mira Karrasch
- Department of Psychology, Åbo Akademi University, Turku, Finland
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19
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Yousef M, Kavraal Ş, Artış AS, Süer C. Effects of Chronic and Acute Lithium Treatment on the Long-term Potentiation and Spatial Memory in Adult Rats. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2019; 17:233-243. [PMID: 30905123 PMCID: PMC6478079 DOI: 10.9758/cpn.2019.17.2.233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/04/2018] [Accepted: 07/24/2018] [Indexed: 11/18/2022]
Abstract
Objective Although, accumulating evidence is delineating a neuroprotective and neurotrophic role for lithium (Li), inconsistent findings have also been reported in human studies especially. Moreover, the effects of Li infusion into the hippocampus are still unknown. The aims of this work were (a) to assess whether basal synaptic activity and long-term potentiation (LTP) in the hippocampus are different in regard to intrahippocampal Li infusion; (b) to assess spatial learning and memory in rats chronically treated with LiCO3 in the Morris water maze. Methods Field potentials were recorded form the dentate gyrus, stimulating perforant pathways, in rats chronically (20 mg/kg for 40 days) or acutely treated with LiCO3 and their corresponding control rats. In addition, performance of rats in a Morris water maze was measured to link behaviour of rats to electrophysiological findings. Results LiCO3 infusion into the hippocampus resulted in enhanced LTP, especially in the late phases, but attenuated LTP was observed in rats chronically treated with Li as compared to controls. Li-treated rats equally performed a spatial learning task, but did spend less time in target quadrant than saline-treated rats in Morris water maze. Conclusion Despite most data suggest that Li always yields neuroprotective effects against neuropathological conditions; we concluded that a 40-day treatment of Li disrupts hippocampal synaptic plasticity underlying memory processes, and that these effects of prolonged treatment are not associated with its direct chemical effect, but are likely to be associated with the molecular actions of Li at genetic levels, because its short-term effect preserves synaptic plasticity.
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Affiliation(s)
- Marwa Yousef
- Department of Physiology, Medical Faculty of Erciyes University
| | | | - Ayşe Seda Artış
- Department of Physiology, Medical Faculty of Erciyes University
| | - Cem Süer
- Department of Physiology, Medical Faculty of Erciyes University
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20
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Wagner S, Helmreich I, Wollschläger D, Meyer K, Kaaden S, Reiff J, Roll SC, Braus D, Tüscher O, Müller-Dahlhaus F, Tadić A, Lieb K. Early improvement of executive test performance during antidepressant treatment predicts treatment outcome in patients with Major Depressive Disorder. PLoS One 2018; 13:e0194574. [PMID: 29668746 PMCID: PMC5905973 DOI: 10.1371/journal.pone.0194574] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 03/05/2018] [Indexed: 11/23/2022] Open
Abstract
Executive dysfunctions frequently occur in patients with Major Depressive Disorder and have been shown to improve during effective antidepressant treatment. However, the time course of improvement and its relationship to treatment outcome is unknown. The aim of the study was to assess the test performance and clinical outcome by repetitive assessments of executive test procedures during antidepressant treatment. Executive test performance was assessed in 209 –patients with Major Depressive Disorder (mean age 39.3 ± 11.4 years) and 84 healthy controls five times in biweekly intervals from baseline to week 8. Patients were treated by a defined treatment algorithm within the early medication change study (EMC trial; ClinicalTrials.gov NCT00974155), controls did not receive any intervention. Cognitive domains were processing speed, cognitive flexibility, phonemic and semantic verbal fluency. Intelligence was assessed at baseline. Depression severity was tested once a week by the Hamilton Depression Rating Scale (HAMD17). 130 patients (62%) showed executive dysfunctions in at least one of four tests at baseline. Linear mixed regression models revealed that the course of depression severity was associated to the course of cognitive flexibility (p = 0.004) and semantic verbal fluency (p = 0.020). Cognitive flexibility and semantic verbal fluency may be candidates easily to apply for therapy response prediction in clinical routine, which should be tested in further prospective studies. Trial registration: ClinicalTrials.gov NCT00974155 EudraCT: 2008-008280-96
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Affiliation(s)
- Stefanie Wagner
- Department of Psychiatry and Psychotherapy, University Medical Centre, Mainz, Germany
- * E-mail: (SW); (KL)
| | - Isabella Helmreich
- Department of Psychiatry and Psychotherapy, University Medical Centre, Mainz, Germany
| | - Daniel Wollschläger
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Mainz, Germany
| | | | - Sabine Kaaden
- Department of Psychiatry and Psychotherapy, HELIOS Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Julia Reiff
- Department of Psychiatry and Psychotherapy, HELIOS Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Sibylle C. Roll
- Department of Psychiatry and Psychotherapy, Vitos Rheingau, Eltville, Germany
| | - Dieter Braus
- Department of Psychiatry and Psychotherapy, HELIOS Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University Medical Centre, Mainz, Germany
| | | | - André Tadić
- Department of Psychiatry and Psychotherapy, University Medical Centre, Mainz, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Centre, Mainz, Germany
- * E-mail: (SW); (KL)
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21
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Girardi P, Brugnoli R, Manfredi G, Sani G. Lithium in Bipolar Disorder: Optimizing Therapy Using Prolonged-Release Formulations. Drugs R D 2018; 16:293-302. [PMID: 27770296 PMCID: PMC5114200 DOI: 10.1007/s40268-016-0139-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Lithium has been a gold standard in the treatment of bipolar disorder (BD) for several decades. Despite a general reduction in the use of lithium over the past several years, it is effective in the management of both manic and depressive episodes in BD and continues to be recommended as a first-line mood stabilizer. This review provides an overview of the pharmacology of lithium and highlights its clinical profile in the management of BD, focusing on the potential advantages of prolonged-release (PR) versus immediate-release (IR) formulations of lithium. A literature search using PubMed was performed to identify articles describing IR and PR lithium in BD using specific search terms like ‘lithium’, ‘prolonged-release’, ‘sustained-release’, ‘extended-release’, ‘bipolar disorder’, ‘adherence’ and ‘compliance’. Relevant pharmacodynamic and pharmacokinetic data were also included. Several clinical trials suggested that lithium is effective in the treatment of acute mania and prophylaxis of BD and reduces the risk of suicide in patients with BD; it may also be used in combination with other drugs in the treatment of bipolar depression. Treatment with lithium must be monitored to avoid lithium-associated toxicity. The prolonged PR formulation of lithium has several advantages including consistent serum lithium concentrations, fewer adverse events and improved adherence to therapy. Although direct comparative studies between PR and IR formulations of lithium are primarily limited to pharmacokinetic studies, PR formulation of lithium provides potential advantages over IR formulation and can be effectively used in the management of BD with lesser adverse events.
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Affiliation(s)
- Paolo Girardi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy. .,Psychiatric Department of Saint Andrea Hospital of Rome, Via di Grottarossa 1037, 00189, Rome, Italy. .,Centro Lucio Bini, Rome, Italy.
| | - Roberto Brugnoli
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.,Psychiatric Department of Saint Andrea Hospital of Rome, Via di Grottarossa 1037, 00189, Rome, Italy
| | - Giovanni Manfredi
- Psychiatric Department of Saint Andrea Hospital of Rome, Via di Grottarossa 1037, 00189, Rome, Italy.,Centro Lucio Bini, Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.,Psychiatric Department of Saint Andrea Hospital of Rome, Via di Grottarossa 1037, 00189, Rome, Italy.,Centro Lucio Bini, Rome, Italy
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22
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Assessment of cognitive functions in the euthymic phase in patients with bipolar I disorder attending the outpatient clinic of Assiut University Hospital. MIDDLE EAST CURRENT PSYCHIATRY 2018. [DOI: 10.1097/01.xme.0000526927.70993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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23
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Beyer DKE, Freund N. Animal models for bipolar disorder: from bedside to the cage. Int J Bipolar Disord 2017; 5:35. [PMID: 29027157 PMCID: PMC5638767 DOI: 10.1186/s40345-017-0104-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/11/2017] [Indexed: 12/28/2022] Open
Abstract
Bipolar disorder is characterized by recurrent manic and depressive episodes. Patients suffering from this disorder experience dramatic mood swings with a wide variety of typical behavioral facets, affecting overall activity, energy, sexual behavior, sense of self, self-esteem, circadian rhythm, cognition, and increased risk for suicide. Effective treatment options are limited and diagnosis can be complicated. To overcome these obstacles, a better understanding of the neurobiology underlying bipolar disorder is needed. Animal models can be useful tools in understanding brain mechanisms associated with certain behavior. The following review discusses several pathological aspects of humans suffering from bipolar disorder and compares these findings with insights obtained from several animal models mimicking diverse facets of its symptomatology. Various sections of the review concentrate on specific topics that are relevant in human patients, namely circadian rhythms, neurotransmitters, focusing on the dopaminergic system, stressful environment, and the immune system. We then explain how these areas have been manipulated to create animal models for the disorder. Even though several approaches have been conducted, there is still a lack of adequate animal models for bipolar disorder. Specifically, most animal models mimic only mania or depression and only a few include the cyclical nature of the human condition. Future studies could therefore focus on modeling both episodes in the same animal model to also have the possibility to investigate the switch from mania-like behavior to depressive-like behavior and vice versa. The use of viral tools and a focus on circadian rhythms and the immune system might make the creation of such animal models possible.
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Affiliation(s)
- Dominik K. E. Beyer
- Experimental and Molecular Psychiatry, LWL University Hospital, Ruhr University Bochum, Universitätsstr. 150, 44801 Bochum, Germany
| | - Nadja Freund
- Experimental and Molecular Psychiatry, LWL University Hospital, Ruhr University Bochum, Universitätsstr. 150, 44801 Bochum, Germany
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24
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Tournikioti K, Ferentinos P, Michopoulos I, Alevizaki M, Soldatos CR, Dikeos D, Douzenis A. Clinical and treatment-related predictors of cognition in bipolar disorder: focus on visual paired associative learning. Eur Arch Psychiatry Clin Neurosci 2017; 267:661-669. [PMID: 27783216 DOI: 10.1007/s00406-016-0743-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 10/17/2016] [Indexed: 11/29/2022]
Abstract
Bipolar disorder (BD) is associated with impairment in cognitive domains such as verbal memory and executive functions. However, visual paired associative learning (PAL) has been far less researched. Neurocognitive dysfunction in BD patients has been related to several clinical factors, but data on the effect of medication are relatively scarce and inconsistent. The aim of our study was to explore the effect of clinical and treatment-related parameters on executive functions and visual memory/learning, including PAL, in BD. Cognitive performance of 60 bipolar I patients and 30 healthy subjects was evaluated by using CANTAB battery tasks targeting spatial recognition memory, PAL and executive functions (set shifting, planning, inhibitory control). Bipolar patients showed poorer performance in PAL, set shifting, planning and inhibitory control than healthy subjects; however, only differences in PAL and planning survived correction for multiple comparisons. Number of previous manic episodes and illness duration predicted worse performance in set shifting and PAL, respectively, whereas current treatment with valproate predicted better performance in PAL. This is one of the first studies to assess clinical and treatment-related predictors of PAL in BD. We report a possibly beneficial effect of valproate on PAL, which warrants further investigation.
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Affiliation(s)
- Kalliopi Tournikioti
- 2nd Department of Psychiatry, Attikon General Hospital, University of Athens, Medical School, Rimini 1, 12462, Athens, Greece.
| | - Panagiotis Ferentinos
- 2nd Department of Psychiatry, Attikon General Hospital, University of Athens, Medical School, Rimini 1, 12462, Athens, Greece
| | - Ioannis Michopoulos
- 2nd Department of Psychiatry, Attikon General Hospital, University of Athens, Medical School, Rimini 1, 12462, Athens, Greece
| | - Maria Alevizaki
- Endocrine Unit, Department of Medical Therapeutics, Alexandra Hospital, University of Athens, Medical School, Athens, Greece
| | - Constantin R Soldatos
- Mental Health Care Unit, Evgenidion Hospital, University of Athens, Medical School, Athens, Greece
| | - Dimitris Dikeos
- 1st Department of Psychiatry, Eginition Hospital, University of Athens, Medical School, Athens, Greece
| | - Athanasios Douzenis
- 2nd Department of Psychiatry, Attikon General Hospital, University of Athens, Medical School, Rimini 1, 12462, Athens, Greece
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25
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Abstract
The aim of this article was to describe the current evidence regarding phenomenon of cognitive functioning and dementia in bipolar disorder (BD). Cochrane Library and PubMed searches were conducted for relevant articles, chapters, and books published before 2016. Search terms used included "bipolar disorder," "cognitive dysfunction," and "dementia." At the end of the selection process, 159 studies were included in our qualitative synthesis. As result, cognitive impairments in BD have been previously considered as infrequent and limited to the affective episodes. Nowadays, there is evidence of stable and lasting cognitive dysfunctions in all phases of BD, including remission phase, particularly in the following domains: attention, memory, and executive functions. The cause of cognitive impairment in BD raises the question if it subtends a neurodevelopmental or a neurodegenerative process. Impaired cognitive functioning associated with BD may contribute significantly to functional disability, in addition to the distorted affective component usually emphasized.
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26
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Hanak AS, Chevillard L, Lebeau R, Risède P, Laplanche JL, Benturquia N, Mégarbane B. Neurobehavioral effects of lithium in the rat: Investigation of the effect/concentration relationships and the contribution of the poisoning pattern. Prog Neuropsychopharmacol Biol Psychiatry 2017; 76:124-133. [PMID: 28336491 DOI: 10.1016/j.pnpbp.2017.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/06/2017] [Accepted: 03/17/2017] [Indexed: 01/29/2023]
Abstract
Severity of lithium poisoning depends on the ingested dose, previous treatment duration and renal function. No animal study has investigated neurobehavioral differences in relation to the lithium poisoning pattern observed in humans, while differences in lithium pharmacokinetics have been reported in lithium-pretreated rats mimicking chronic poisonings with enhanced brain accumulation in rats with renal failure. Our objectives were: 1)-to investigate lithium-related effects in overdose on locomotor activity, anxiety-like behavior, spatial recognition memory and anhedonia in the rat; 2)-to model the relationships between lithium-induced effects on locomotion and plasma, erythrocyte, cerebrospinal fluid and brain concentrations previously obtained according to the poisoning pattern. Open-field, elevated plus-maze, Y-maze and sucrose consumption tests were used. In acutely lithium-poisoned rats, we observed horizontal (p<0.001) and vertical hypolocomotion (p<0.0001), increased anxiety-like behavior (p<0.05) and impaired memory (p<0.01) but no altered hedonic status. Horizontal (p<0.01) and vertical (p<0.001) hypolocomotion peaked more markedly 24h after lithium injection and was more prolonged in acute-on-chronically vs. acutely lithium-poisoned rats. Hypolocomotion in chronically lithium-poisoned rats with impaired renal function did not differ from acutely poisoned rats 24h after the last injection. Interestingly, hypolocomotion/concentration relationships best fitted a sigmoidal Emax model in acute poisoning and a linear regression model linked to brain lithium in acute-on-chronic poisoning. In conclusion, lithium overdose alters rat behavior and consistently induces hypolocomotion which is more marked and prolonged in repeatedly lithium-treated rats. Our data suggest that differences between poisoning patterns regarding lithium-induced hypolocomotion are better explained by the duration of lithium exposure than by its brain accumulation.
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Affiliation(s)
- Anne-Sophie Hanak
- Inserm, UMR-S1144, Paris, France; Paris-Descartes University, Paris, France; Paris-Diderot University, Paris, France
| | - Lucie Chevillard
- Inserm, UMR-S1144, Paris, France; Paris-Descartes University, Paris, France; Paris-Diderot University, Paris, France
| | - Rodolphe Lebeau
- Inserm, UMR-S1144, Paris, France; Paris-Descartes University, Paris, France; Paris-Diderot University, Paris, France
| | - Patricia Risède
- Inserm, UMR-S1144, Paris, France; Paris-Descartes University, Paris, France; Paris-Diderot University, Paris, France
| | - Jean-Louis Laplanche
- Inserm, UMR-S1144, Paris, France; Paris-Descartes University, Paris, France; Paris-Diderot University, Paris, France
| | - Nadia Benturquia
- Inserm, UMR-S1144, Paris, France; Paris-Descartes University, Paris, France; Paris-Diderot University, Paris, France
| | - Bruno Mégarbane
- Inserm, UMR-S1144, Paris, France; Paris-Descartes University, Paris, France; Paris-Diderot University, Paris, France; Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, Department of Medical and Toxicological Critical Care, Paris, France.
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27
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Bilderbeck AC, Atkinson LZ, Geddes JR, Goodwin GM, Harmer CJ. The effects of medication and current mood upon facial emotion recognition: findings from a large bipolar disorder cohort study. J Psychopharmacol 2017; 31:320-326. [PMID: 27678089 DOI: 10.1177/0269881116668594] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Emotional processing abnormalities have been implicated in bipolar disorder (BD) but studies are typically small and uncontrolled. Here, facial expression recognition was explored in a large and naturalistically recruited cohort of BD patients. METHODS 271 patients with BD completed the facial expression recognition task. The effects of current medication together with the influence of current mood state and diagnostic subtype were assessed whilst controlling for the effects of demographic variables. RESULTS Patients who were currently receiving treatment with lithium demonstrated significantly poorer accuracy in recognising angry faces, an effect that held in a monotherapy sub-analysis comparing those participants on lithium only and those who were medication-free. Accuracy in recognising angry faces was also lower amongst participants currently taking dopamine antagonists (antipsychotics). Higher levels of current depressive symptoms were linked to poorer accuracy at identifying happy faces. CONCLUSION Use of lithium and possibly dopamine antagonists may be associated with reduced processing of anger cues in BD. Findings support the existence of mood-congruent negative biases associated with depressive symptoms in BD. Observational cohort studies provide opportunities to explore the substantial effects of demographic, psychometric and clinical variables on cognitive performance and emotional processing.
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Affiliation(s)
| | | | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, UK
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28
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Roux P, Raust A, Cannavo AS, Aubin V, Aouizerate B, Azorin JM, Bellivier F, Belzeaux R, Bougerol T, Cussac I, Courtet P, Etain B, Gard S, Job S, Kahn JP, Leboyer M, Olié E, Henry C, Passerieux C. Cognitive profiles in euthymic patients with bipolar disorders: results from the FACE-BD cohort. Bipolar Disord 2017; 19:146-153. [PMID: 28421717 DOI: 10.1111/bdi.12485] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/12/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Although cognitive deficits are a well-established feature of bipolar disorders (BD), even during periods of euthymia, little is known about cognitive phenotype heterogeneity among patients with BD. METHODS We investigated neuropsychological performance in 258 euthymic patients with BD recruited via the French network of expert centers for BD. We used a test battery assessing six domains of cognition. Hierarchical cluster analysis of the cross-sectional data was used to determine the optimal number of subgroups and to assign each patient to a specific cognitive cluster. Subsequently, subjects from each cluster were compared on demographic, clinical functioning, and pharmacological variables. RESULTS A four-cluster solution was identified. The global cognitive performance was above normal in one cluster and below normal in another. The other two clusters had a near-normal cognitive performance, with above and below average verbal memory, respectively. Among the four clusters, significant differences were observed in estimated intelligence quotient and social functioning, which were lower for the low cognitive performers compared to the high cognitive performers. CONCLUSIONS These results confirm the existence of several distinct cognitive profiles in BD. Identification of these profiles may help to develop profile-specific cognitive remediation programs, which might improve functioning in BD.
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Affiliation(s)
- Paul Roux
- Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, France.,Laboratoire HandiRESP-EA4047, UFR des sciences de la santé Simone Veil, Université de Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France.,Fondation Fondamental, Créteil, France
| | - Aurélie Raust
- Fondation Fondamental, Créteil, France.,AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France.,Université Paris Est, Faculté de Médecine, Créteil, France.,Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France
| | - Anne Sophie Cannavo
- Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, France.,Laboratoire HandiRESP-EA4047, UFR des sciences de la santé Simone Veil, Université de Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France.,Fondation Fondamental, Créteil, France
| | - Valérie Aubin
- Fondation Fondamental, Créteil, France.,Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - Bruno Aouizerate
- Fondation Fondamental, Créteil, France.,Hôpital Charles Perrens, Centre Expert Trouble Bipolaire, Pôle de Psychiatrie Générale et Universitaire (3/4/7), Bordeaux, France
| | - Jean-Michel Azorin
- Fondation Fondamental, Créteil, France.,AP-HM, Hôpital Sainte-Marguerite, Pôle de Psychiatrie, Marseille, France
| | - Frank Bellivier
- Fondation Fondamental, Créteil, France.,AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris, France.,Université Paris Diderot, UMR-S 1144, Paris, France
| | - Raoul Belzeaux
- Fondation Fondamental, Créteil, France.,AP-HM, Hôpital Sainte-Marguerite, Pôle de Psychiatrie, Marseille, France
| | - Thierry Bougerol
- Fondation Fondamental, Créteil, France.,University Joseph Fourier, Grenoble I, BP 53, Grenoble, France.,CHU de Grenoble, CS10217, Grenoble, France.,Grenoble Institut des Neurosciences (GIN), Inserm U 836, Chemin Fortuné Ferrini, La Tronche, France
| | - Iréna Cussac
- Fondation Fondamental, Créteil, France.,Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - Philippe Courtet
- Fondation Fondamental, Créteil, France.,Psychiatric Emergency Department, CHRU, Montpellier, France.,INSERM U1061, Montpellier University, Montpellier, France
| | - Bruno Etain
- Fondation Fondamental, Créteil, France.,AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris, France.,Université Paris Diderot, UMR-S 1144, Paris, France.,Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sébastien Gard
- Fondation Fondamental, Créteil, France.,Hôpital Charles Perrens, Centre Expert Trouble Bipolaire, Pôle de Psychiatrie Générale et Universitaire (3/4/7), Bordeaux, France
| | - Sophie Job
- Fondation Fondamental, Créteil, France.,Pôle de Psychiatrie et Psychologie Clinique - Centre Psychothérapique de Nancy, Laxou, France
| | - Jean-Pierre Kahn
- Fondation Fondamental, Créteil, France.,Pôle de Psychiatrie et Psychologie Clinique - Centre Psychothérapique de Nancy, Laxou, France.,Université de Lorraine, Nancy, France
| | - Marion Leboyer
- Fondation Fondamental, Créteil, France.,AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France.,Université Paris Est, Faculté de Médecine, Créteil, France.,Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France
| | - Emilie Olié
- Fondation Fondamental, Créteil, France.,Psychiatric Emergency Department, CHRU, Montpellier, France.,INSERM U1061, Montpellier University, Montpellier, France
| | | | - Chantal Henry
- Fondation Fondamental, Créteil, France.,AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France.,Université Paris Est, Faculté de Médecine, Créteil, France.,Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France.,Institut Pasteur, Unité Perception et Mémoire, Paris, France
| | - Christine Passerieux
- Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, France.,Laboratoire HandiRESP-EA4047, UFR des sciences de la santé Simone Veil, Université de Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France.,Fondation Fondamental, Créteil, France
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29
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Abstract
Although a percentage of patients report cognitive side-effects when taking lithium, it can be difficult to determine from the literature whether any cognitive changes reflect lithium itself, the lithium serum level, residual mood symptoms, the underlying nature of bipolar disorder, or biological alterations such as hypothyroidism. This review was carried out to synthesize and evaluate relevant literature examining any cognitive impact of lithium in those with bipolar disorder. The effect of lithium in those with bipolar disorder was examined across the cognitive domains of attention, psychomotor speed, processing speed, working memory, intellectual functioning, verbal memory, visual memory, and executive functioning by reviewing the published empirical literature. Any impact of hypothyroidism and lithium toxicity was also examined. The literature supports the conclusion that lithium has a distinct impact on psychomotor speed in participants with bipolar disorder. In contrast, there appears to be no impact on attention. Any impact of lithium on memory in patients with bipolar disorder is unclear as the literature is contradictory and any such effect may be overshadowed by the greater impact of residual mood symptoms. The impact on processing speed, intellectual abilities, and executive functioning also remains unclear. Several clinical management strategies are recommended.
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30
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Bostock ECS, Kirkby KC, Garry MI, Taylor BVM. Systematic Review of Cognitive Function in Euthymic Bipolar Disorder and Pre-Surgical Temporal Lobe Epilepsy. Front Psychiatry 2017; 8:133. [PMID: 28848456 PMCID: PMC5552675 DOI: 10.3389/fpsyt.2017.00133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 07/10/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) and temporal lobe epilepsy (TLE) overlap in domains including epidemiology, treatment response, shared neurotransmitter involvement and temporal lobe pathology. Comparison of cognitive function in both disorders may indicate temporal lobe mediated processes relevant to BD. This systematic review examines neuropsychological test profiles in euthymic bipolar disorder type I (BD-I) and pre-surgical TLE and compares experimental designs used. METHODS A search of PubMed, PsychINFO, and Scopus using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Inclusion criteria were comparison group or pre- to post-surgical patients; reported neuropsychological tests; participants aged 18-60 years. Fifty six studies met criteria: 27 BD-I; 29 TLE. RESULTS Deficits in BD-I compared to healthy controls (HC) were in executive function, attention span and verbal memory. Deficits in TLE compared to HC were in executive function and memory. In the pre- to post-surgical comparisons, verbal memory in left temporal lobe (LTL) and, less consistently, visuospatial memory in right temporal lobe (RTL) epilepsy declined following surgery. BD-I studies used comprehensive test batteries in well-defined euthymic patients compared to matched HC groups. TLE studies used convenience samples pre- to post-surgery, comparing LTL and RTL subgroups, few included comparisons to HC (5 studies). TLE studies typically examined a narrow range of known temporal lobe-mediated neuropsychological functions, particularly verbal and visuospatial memory. CONCLUSION Both disorders exhibit deficits in executive function and verbal memory suggestive of both frontal and temporal lobe involvement. However, deficits in TLE are measured pre- to post-surgery and not controlled at baseline pre-surgery. Further research involving a head-to-head comparison of the two disorders on a broad range of neuropsychological tests is needed to clarify the nature and extent of cognitive deficits and potential overlaps.
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Affiliation(s)
| | - Kenneth C Kirkby
- Psychiatry, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Michael I Garry
- Psychology, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V M Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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31
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Mechanisms underlying the benefits of anticonvulsants over lithium in the treatment of bipolar disorder. Neuroreport 2016; 27:131-5. [PMID: 26702549 DOI: 10.1097/wnr.0000000000000510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Close to 3% of the world's population suffers from bipolar disease (I and II). Of this 3%, bipolar disease affects largely women (∼ 3 : 2 compared with men). The median age of diagnosis is 25 in women and even lower in men. A diagnosis of bipolar disease is an expensive psychiatric diagnosis, costing patients more than twice as much money as a diagnosis of unipolar depression. Bipolar I is characterized by one or more manic or mixed episodes, with both mania and depression occurring each day for at least 1 week, whereas bipolar II is characterized by one or more major depressive episode and at least one episode of hypomania. Bipolar I is the more severe diagnosis. A wide range of medications are available to help patients maintain a healthy lifestyle, including lithium, antidepressants, and anticonvulsants. Improved methods for identifying bipolar disease, including a more structured approach and a more complete use of medical records, have increased the rate of diagnosis, especially in children, which underscores the need for innovation in development and in practice of new treatment options for treating bipolar disease. Although lithium has been the 'gold standard' for treating bipolar disorder for decades, new research into other forms of treatment has shown anticonvulsants to be a particularly useful therapy for treating bipolar disease. Anticonvulsants have remarkable mood-stabilization abilities and they do not lead to serious side effects, which increases the tolerability, and consequently, patient adherence to this form of treatment. Recent studies have shown that anticonvulsants improve behavior in bipolar disease by modulating the balance of excitatory and inhibitory synapses through a number of complementary molecular cascades that affect gene expression and cell survival.
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32
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Milienne-Petiot M, Kesby JP, Graves M, van Enkhuizen J, Semenova S, Minassian A, Markou A, Geyer MA, Young JW. The effects of reduced dopamine transporter function and chronic lithium on motivation, probabilistic learning, and neurochemistry in mice: Modeling bipolar mania. Neuropharmacology 2016; 113:260-270. [PMID: 27732870 DOI: 10.1016/j.neuropharm.2016.07.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/21/2016] [Accepted: 07/24/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Bipolar disorder (BD) mania patients exhibit poor cognition and reward-seeking/hypermotivation, negatively impacting a patient's quality of life. Current treatments (e.g., lithium), do not treat such deficits. Treatment development has been limited due to a poor understanding of the neural mechanisms underlying these behaviors. Here, we investigated putative mechanisms underlying cognition and reward-seeking/motivational changes relevant to BD mania patients using two validated mouse models and neurochemical analyses. METHODS The effects of reducing dopamine transporter (DAT) functioning via genetic (knockdown vs. wild-type littermates), or pharmacological (GBR12909- vs. vehicle-treated C57BL/6J mice) means were assessed in the probabilistic reversal learning task (PRLT), and progressive ratio breakpoint (PRB) test, during either water or chronic lithium treatment. These tasks quantify reward learning and effortful motivation, respectively. Neurochemistry was performed on brain samples of DAT mutants ± chronic lithium using high performance liquid chromatography. RESULTS Reduced DAT functioning increased reversals in the PRLT, an effect partially attenuated by chronic lithium. Chronic lithium alone slowed PRLT acquisition. Reduced DAT functioning increased motivation (PRB), an effect attenuated by lithium in GBR12909-treated mice. Neurochemical analyses revealed that DAT knockdown mice exhibited elevated homovanillic acid levels, but that lithium had no effect on these elevated levels. CONCLUSIONS Reducing DAT functioning recreates many aspects of BD mania including hypermotivation and improved reversal learning (switching), as well as elevated homovanillic acid levels. Chronic lithium only exerted main effects, impairing learning and elevating norepinephrine and serotonin levels of mice, not specifically treating the underlying mechanisms identified in these models.
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Affiliation(s)
- Morgane Milienne-Petiot
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, USA; Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - James P Kesby
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, USA
| | - Mary Graves
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, USA
| | - Jordy van Enkhuizen
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, USA; Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Svetlana Semenova
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, USA
| | - Arpi Minassian
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, USA
| | - Athina Markou
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, USA
| | - Mark A Geyer
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, USA; Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Jared W Young
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, USA; Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
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Mury FB, da Silva WC, Barbosa NR, Mendes CT, Bonini JS, Sarkis JES, Cammarota M, Izquierdo I, Gattaz WF, Dias-Neto E. Lithium activates brain phospholipase A2 and improves memory in rats: implications for Alzheimer's disease. Eur Arch Psychiatry Clin Neurosci 2016; 266:607-18. [PMID: 26661385 DOI: 10.1007/s00406-015-0665-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/30/2015] [Indexed: 02/07/2023]
Abstract
Phospholipase A2 (Pla2) is required for memory retrieval, and its inhibition in the hippocampus has been reported to impair memory acquisition in rats. Moreover, cognitive decline and memory deficits showed to be reduced in animal models after lithium treatment, prompting us to evaluate possible links between Pla2, lithium and memory. Here, we evaluated the possible modulation of Pla2 activity by a long-term treatment of rats with low doses of lithium and its impact in memory. Wistar rats were trained for the inhibitory avoidance task, treated with lithium for 100 days and tested for perdurability of long-term memory. Hippocampal samples were used for quantifying the expression of 19 brain-expressed Pla2 genes and for evaluating the enzymatic activity of Pla2 using group-specific radio-enzymatic assays. Our data pointed to a significant perdurability of long-term memory, which correlated with increased transcriptional and enzymatic activities of certain members of the Pla2 family (iPla2 and sPla2) after the chronic lithium treatment. Our data suggest new possible targets of lithium, add more information on its pharmacological activity and reinforce the possible use of low doses of lithium for the treatment of neurodegenerative conditions such as the Alzheimer's disease.
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Affiliation(s)
- Fábio B Mury
- Laboratório de Neurociências (LIM27), Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, Rua Ovídio Pires de Campos, 785, 05403-010, São Paulo, SP, Brazil
- Pós-Graduação Interunidades em Biotecnologia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Weber C da Silva
- Centro de Memória, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Departamento de Farmácia, Universidade Estadual do Centro-Oeste, Guarapuava, PR, Brazil
| | - Nádia R Barbosa
- Laboratório de Neurociências (LIM27), Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, Rua Ovídio Pires de Campos, 785, 05403-010, São Paulo, SP, Brazil
| | - Camila T Mendes
- Laboratório de Neurociências (LIM27), Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, Rua Ovídio Pires de Campos, 785, 05403-010, São Paulo, SP, Brazil
- Pós-Graduação Interunidades em Biotecnologia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliana S Bonini
- Centro de Memória, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Departamento de Farmácia, Universidade Estadual do Centro-Oeste, Guarapuava, PR, Brazil
| | - Jorge Eduardo Souza Sarkis
- Instituto de Pesquisas Energéticas e Nucleares-IPEN-CNEN/SP, Grupo de Caracterização Química e Isotópica, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Martin Cammarota
- Laboratório de Pesquisa de Memória, Instituto do Cérebro, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Ivan Izquierdo
- Centro de Memória, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Wagner F Gattaz
- Laboratório de Neurociências (LIM27), Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, Rua Ovídio Pires de Campos, 785, 05403-010, São Paulo, SP, Brazil.
| | - Emmanuel Dias-Neto
- Laboratório de Neurociências (LIM27), Instituto de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, Rua Ovídio Pires de Campos, 785, 05403-010, São Paulo, SP, Brazil.
- Laboratório de Genômica Médica, Centro Internacional de Pesquisas, AC Camargo Cancer Center, São Paulo, SP, Brazil.
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Parsaei L, Torkaman-Boutorabi A, Asadi F, Zarrindast MR. Interaction between dorsal hippocampal NMDA receptors and lithium on spatial learning consolidation in rats. Brain Res Bull 2016; 127:1-10. [DOI: 10.1016/j.brainresbull.2016.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 07/04/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
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Tan D, Özerdem A, Güntekin B, Atagün MI, Tülay E, Karadağ F, Başar E. Increased Beta Frequency (15-30 Hz) Oscillatory Responses in Euthymic Bipolar Patients Under Lithium Monotherapy. Clin EEG Neurosci 2016; 47:87-95. [PMID: 25465436 DOI: 10.1177/1550059414561056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/27/2014] [Indexed: 11/17/2022]
Abstract
The effect of lithium on neurocognition is not still fully explored. Brain oscillatory activity is altered in bipolar disorder. We aimed to assess the oscillatory responses of euthymic bipolar patients and how they are affected by lithium monotherapy. Event-related oscillations in response to visual target stimulus during an oddball paradigm in 16 euthymic drug-free and 13 euthymic lithium-treated bipolar patients were compared with 16 healthy controls. The maximum peak-to-peak amplitudes were measured for each subject's averaged beta (15-30 Hz) responses in the 0- to 300-ms time window over frontal (F3, Fz, F4), central (C3, Cz, C4), temporal (T7, T8), temporo-parietal (TP7, TP8), parietal (P3, Pz, P4), and occipital (O1, Oz, O2) areas. Patients under lithium monotherapy had significantly higher beta responses to visual target stimuli than healthy controls (P=.017) and drug-free patients (P=.015). The increase in beta response was observed at all electrode locations, however, the difference was statistically significant for the left (T7; P=.016) and right (T8; P=.031) temporal beta responses. Increased beta responses in drug-free patients and further significant increase in lithium-treated patients may be indicative of a core pathophysiological process of bipolar disorder and how it is affected by lithium. Whether the finding corresponds to lithium's corrective effect on the underlying pathology or to its neurocognitive side effect remains to be further explored. In either case, the finding is a sign that the oscillatory activity may be useful in tracking medication effect in bipolar disorder.
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Affiliation(s)
- Devran Tan
- Department of Psychiatry, Maltepe University, Faculty of Medicine, Istanbul, Turkey
| | - Ayşegül Özerdem
- Department of Psychiatry, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey Department of Neuroscience, Dokuz Eylul University Health Sciences Institute, Izmir, Turkey Multidisciplinary Brain Dynamics Research Center, Dokuz Eylul University, Izmir, Turkey
| | - Bahar Güntekin
- Brain Dynamics, Cognition, and Complex Systems Research Center, Istanbul Kultur University, Istanbul, Turkey
| | - M Ilhan Atagün
- Department of Psychiatry, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Elif Tülay
- Brain Dynamics, Cognition, and Complex Systems Research Center, Istanbul Kultur University, Istanbul, Turkey
| | - Figen Karadağ
- Department of Psychiatry, Maltepe University, Faculty of Medicine, Istanbul, Turkey
| | - Erol Başar
- Brain Dynamics, Cognition, and Complex Systems Research Center, Istanbul Kultur University, Istanbul, Turkey
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Lewandowski KE, Sperry SH, Ongur D, Cohen BM, Norris LA, Keshavan MS. Cognitive remediation versus active computer control in bipolar disorder with psychosis: study protocol for a randomized controlled trial. Trials 2016; 17:136. [PMID: 26969299 PMCID: PMC4788830 DOI: 10.1186/s13063-016-1275-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 03/03/2016] [Indexed: 11/04/2022] Open
Abstract
Background Cognitive dysfunction is a major feature of bipolar disorder with psychosis and is strongly associated with functional outcomes. Computer-based cognitive remediation has shown promise in improving cognition in patients with schizophrenia. However, despite similar neurocognitive deficits between patients with schizophrenia and bipolar disorder, few studies have extended neuroscience-based cognitive remediation programs to this population. Methods/Design The Treatment to Enhance Cognition in Bipolar Disorder study is an investigator-initiated, parallel group, randomized, blinded clinical trial of an Internet-based cognitive remediation protocol for patients with bipolar disorder I with psychosis (n = 100). We also describe the development of our dose-matched active control paradigm. Both conditions involve 70 sessions of computer-based activities over 24 weeks. The control intervention was developed to mirror the treatment condition in dose and format but without the neuroplasticity-based task design and structure. All participants undergo neuropsychological and clinical assessment at baseline, after approximately 25 hours of study activities, post treatment, and after 6 months of no study contact to assess durability. Neuroimaging at baseline and post treatment are offered in an “opt-in” format. The primary outcomes are scores on the MATRICS battery; secondary and exploratory outcomes include measures of clinical symptoms, community functioning, and neuroimaging changes. Associations between change in cognitive measures and change in community functioning will be assessed. Baseline predictors of treatment response will be examined. Discussion The present study is the first we are aware of to implement an Internet-based cognitive remediation program in patients with bipolar disorder with psychosis and to develop a comparable web-based control paradigm. The mixed online and study-site format allows accessible treatment while providing weekly staff contact and bridging. Based on user-provided feedback, participant blinding is feasible. Trial registration ClinicalTrials.gov NCT01470781; 11 July 2011.
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Affiliation(s)
| | - Sarah H Sperry
- McLean Hospital/Harvard Medical School, 115 Mill St., Belmont, MA, 02478, USA
| | - Dost Ongur
- McLean Hospital/Harvard Medical School, 115 Mill St., Belmont, MA, 02478, USA
| | - Bruce M Cohen
- McLean Hospital/Harvard Medical School, 115 Mill St., Belmont, MA, 02478, USA
| | - Lesley A Norris
- McLean Hospital/Harvard Medical School, 115 Mill St., Belmont, MA, 02478, USA
| | - Matcheri S Keshavan
- Beth Israel Deaconess Medical Center/Harvard Medical School, 75 Fenwood Rd., Boston, MA, 02115, USA
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Vreeker A, Boks MP, Abramovic L, Verkooijen S, van Bergen AH, Hillegers MH, Spijker AT, Hoencamp E, Regeer EJ, Riemersma-Van der Lek RF, Stevens AW, Schulte PF, Vonk R, Hoekstra R, van Beveren NJ, Kupka RW, Brouwer RM, Bearden CE, MacCabe JH, Ophoff RA. High educational performance is a distinctive feature of bipolar disorder: a study on cognition in bipolar disorder, schizophrenia patients, relatives and controls. Psychol Med 2016; 46:807-818. [PMID: 26621616 PMCID: PMC5824688 DOI: 10.1017/s0033291715002299] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Schizophrenia is associated with lower intelligence and poor educational performance relative to the general population. This is, to a lesser degree, also found in first-degree relatives of schizophrenia patients. It is unclear whether bipolar disorder I (BD-I) patients and their relatives have similar lower intellectual and educational performance as that observed in schizophrenia. METHOD This cross-sectional study investigated intelligence and educational performance in two outpatient samples [494 BD-I patients, 952 schizophrenia spectrum (SCZ) patients], 2231 relatives of BD-I and SCZ patients, 1104 healthy controls and 100 control siblings. Mixed-effects and regression models were used to compare groups on intelligence and educational performance. RESULTS BD-I patients were more likely to have completed the highest level of education (odds ratio 1.88, 95% confidence interval 1.66-2.70) despite having a lower IQ compared to controls (β = -9.09, S.E. = 1.27, p < 0.001). In contrast, SCZ patients showed both a lower IQ (β = -15.31, S.E. = 0.86, p < 0.001) and lower educational levels compared to controls. Siblings of both patient groups had significantly lower IQ than control siblings, but did not differ on educational performance. IQ scores did not differ between BD-I parents and SCZ parents, but BD-I parents had completed higher educational levels. CONCLUSIONS Although BD-I patients had a lower IQ than controls, they were more likely to have completed the highest level of education. This contrasts with SCZ patients, who showed both intellectual and educational deficits compared to healthy controls. Since relatives of BD-I patients did not demonstrate superior educational performance, our data suggest that high educational performance may be a distinctive feature of bipolar disorder patients.
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Affiliation(s)
- Annabel Vreeker
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, The Netherlands
| | - Marco P.M. Boks
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, The Netherlands
| | - Lucija Abramovic
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, The Netherlands
| | - Sanne Verkooijen
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, The Netherlands
| | - Annet H. van Bergen
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, The Netherlands
| | - Manon H.J. Hillegers
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, The Netherlands
| | - Annet T. Spijker
- Department of Mood Disorders, PsyQ, The Hague, The Netherlands
- Department of Mood Disorder, PsyQ Rijnmond, Rotterdam, The Netherlands
| | - Erik Hoencamp
- Parnassia BAVO Group, The Hague, The Netherlands
- Leiden University, Institute of Psychology, Leiden, The Netherlands
| | - Eline J. Regeer
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
| | | | | | | | - Ronald Vonk
- Reinier van Arkel Group, ‘s-Hertogenbosch, The Netherlands
| | - Rocco Hoekstra
- Delta Center for Mental Health Care, Rotterdam, The Netherlands
| | - Nico J.M. van Beveren
- Delta Center for Mental Health Care, Rotterdam, The Netherlands
- Erasmus University Medical Center, Department of Psychiatry, Rotterdam, The Netherlands
- Erasmus University Medical Center, Department of Neuroscience, Rotterdam, The Netherlands
| | - Ralph W. Kupka
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
- VU University Medical Center, Department of Psychiatry, Amsterdam, The Netherlands
| | - Rachel M. Brouwer
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, The Netherlands
| | - Carrie E. Bearden
- Semel Institute For Neuroscience and Human Behavior, University of California-Los Angeles, Los Angeles, California USA
- Department of Psychology, University of California-Los Angeles, Los Angeles, California USA
| | - James H. MacCabe
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Roel A. Ophoff
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, The Netherlands
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California USA
| | - GROUP investigators
- Corresponding author: René S. Kahn, MD, PhD, Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3508 GA Utrecht, PO box 85500, tel: 0031887556025, fax: 0031887555443 ()
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Malhi GS, McAulay C, Gershon S, Gessler D, Fritz K, Das P, Outhred T. The Lithium Battery: assessing the neurocognitive profile of lithium in bipolar disorder. Bipolar Disord 2016; 18:102-15. [PMID: 27004564 DOI: 10.1111/bdi.12375] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The aim of the present study was to characterize the neurocognitive effects of lithium in bipolar disorder to inform clinical and research approaches for further investigation. METHODS Key words pertaining to neurocognition in bipolar disorder and lithium treatment were used to search recognized databases to identify relevant literature. The authors also retrieved gray literature (e.g., book chapters) known to them and examined pertinent articles from bibliographies. RESULTS A limited number of studies have examined the effects of lithium on neurocognition in bipolar disorder and, although in some domains a consistent picture emerges, in many domains the findings are mixed. Lithium administration appears to reshape key components of neurocognition - in particular, psychomotor speed, verbal memory, and verbal fluency. Notably, it has a sophisticated neurocognitive profile, such that while lithium impairs neurocognition across some domains, it seemingly preserves others - possibly those vulnerable to the effects of bipolar disorder. Furthermore, its effects are likely to be direct and indirect (via mood, for example) and cumulative with duration of treatment. Disentangling the components of neurocognition modulated by lithium in the context of a fluctuating and complex illness such as bipolar disorder is a significant challenge but one that therefore demands a stratified and systematic approach, such as that provided by the Lithium Battery. CONCLUSIONS In order to delineate the effects of lithium therapy on neurocognition in bipolar disorder within both research and clinical practice, a greater understanding and measurement of the relatively stable neurocognitive components is needed to examine those that indeed change with lithium treatment. In order to achieve this, we propose a Lithium Battery-Clinical and a Lithium Battery-Research that can be applied to these respective settings.
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Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St. Leonards, Sydney, NSW, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Claire McAulay
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St. Leonards, Sydney, NSW, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Samuel Gershon
- Emeritus Professor of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Mind and Brain Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Danielle Gessler
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St. Leonards, Sydney, NSW, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Kristina Fritz
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St. Leonards, Sydney, NSW, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Pritha Das
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St. Leonards, Sydney, NSW, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Tim Outhred
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St. Leonards, Sydney, NSW, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
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Sabater A, García-Blanco AC, Verdet HM, Sierra P, Ribes J, Villar I, Lara MJ, Arnal P, Rojo L, Livianos L. Comparative neurocognitive effects of lithium and anticonvulsants in long-term stable bipolar patients. J Affect Disord 2016; 190:34-40. [PMID: 26480209 DOI: 10.1016/j.jad.2015.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/20/2015] [Accepted: 10/02/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of choosing a mood-stabilizing drug (lithium or anticonvulsants) or a combination of them with minimal neurocognitive effects is to stimulate the development of criteria for a therapeutic adequacy, particularly in Bipolar Disorder (BD) patients who are clinically stabilized. METHOD Three groups of BD patients were established according to their treatment: (i) lithium monotherapy (n=29); (ii) lithium together with one or more anticonvulsants (n=28); and (iii) one or more anticonvulsants (n=16). A group of healthy controls served as the control (n=25). The following tests were applied: Wechsler Adult Intelligence Scale, Trail Making Test, Wechsler Memory Scale, Rey Complex Figure Test, Stroop color-word test, Wisconsin Card Sorting Test, Tower of Hanoi, Frontal Assessment Battery, and Reading the Mind in the Eyes Test. RESULTS Relative to healthy controls, BD patients showed the following: (i) those on lithium monotherapy, but not other BD groups, had preserved short-term auditory memory, long-term memory, and attention; (ii) those who took only anticonvulsants showed worse findings in short-term visual memory, working memory, and several executive functions; and (iii) all BD patients showed worse performance in processing speed, resistance to interference, and emotion recognition. LIMITATIONS Medication alone cannot explain why all BD patients showed common cognitive deficits despite different pharmacological treatment. CONCLUSION The impairment on some executive functions and emotion recognition is an inherent trait in BD patients, regardless of their pharmacological treatment. However, while memory, attention, and most of the executive functions are preserved in long-term stable BD patients, these cognitive functions are impaired in those who take anticonvulsants.
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Affiliation(s)
- Ana Sabater
- Department of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ana C García-Blanco
- Health Research Institute La Fe, Valencia, Spain; University of Valencia, Spain.
| | - Hélade M Verdet
- Department of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pilar Sierra
- Department of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; University of Valencia, Spain; CIBERESP, Spain
| | - Josep Ribes
- Department of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Irene Villar
- Department of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Mª José Lara
- Department of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pilar Arnal
- Department of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Rojo
- Department of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; University of Valencia, Spain; CIBERESP, Spain
| | - Lorenzo Livianos
- Department of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; University of Valencia, Spain; CIBERESP, Spain
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Bersani G, Quartini A, Zullo D, Iannitelli A. Potential neuroprotective effect of lithium in bipolar patients evaluated by neuropsychological assessment: preliminary results. Hum Psychopharmacol 2016; 31:19-28. [PMID: 26563456 DOI: 10.1002/hup.2510] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/20/2015] [Accepted: 10/03/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Accumulating evidence is delineating a neuroprotective/neurotrophic role for lithium. However, its primary effects on cognition remain ambiguous. We sought to investigate the profile of cognitive impairment in patients with bipolar disorder and to determine whether continued treatment with lithium preserves cognitive functioning. METHODS In this cross-sectional study, we tested 15 euthymic patients with bipolar I disorder undergoing long-term clinical maintenance treatment with lithium (for at least 12 months), 15 matched patients treated with other mood-stabilizing drugs and who had never received lithium, and 15 matched healthy subjects on the Cambridge Neuropsychological Test Automated Battery. Investigated cognitive domains were visual memory, executive functions, attention, decision-making/impulsivity, and response inhibition. We controlled for age, gender, intelligence, and residual psychiatric symptomatology. RESULTS Taken together, bipolar patients demonstrated robust deficits in visual memory and executive functions. Once subdivided in treatment subgroups, only non-lithium bipolar patients demonstrated impairments in visual memory. Attention, decision-making, and response inhibition were preserved in both groups. No correlation emerged between neuropsychological tests performance, clinical, and psychological variables. CONCLUSIONS This study is the first to our knowledge to have demonstrated, by means of a highly sensitive test of visual memory, a potential hippocampus neuroprotective effect of lithium in patients with bipolar disorder. Besides, it confirms prior findings of cognitive deficits in euthymic bipolar patients.
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Affiliation(s)
- Giuseppe Bersani
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, DSM ASL/LT-Unit of Psychiatry, "A. Fiorini" Hospital, Via Firenze, Terracina (LT), Italy
| | - Adele Quartini
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, DSM ASL/LT-Unit of Psychiatry, "A. Fiorini" Hospital, Via Firenze, Terracina (LT), Italy
| | - Daiana Zullo
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, DSM ASL/LT-Unit of Psychiatry, "A. Fiorini" Hospital, Via Firenze, Terracina (LT), Italy
| | - Angela Iannitelli
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, DSM ASL/LT-Unit of Psychiatry, "A. Fiorini" Hospital, Via Firenze, Terracina (LT), Italy.,Department of Health Sciences, University of L'Aquila, Italy
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Vierck E, Porter RJ, Joyce PR. Facial recognition deficits as a potential endophenotype in bipolar disorder. Psychiatry Res 2015; 230:102-7. [PMID: 26337483 DOI: 10.1016/j.psychres.2015.08.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 07/21/2015] [Accepted: 08/17/2015] [Indexed: 01/12/2023]
Abstract
Bipolar disorder (BD) is considered a highly heritable and genetically complex disorder. Several cognitive functions, such as executive functions and verbal memory have been suggested as promising candidates for endophenotypes. Although there is evidence for deficits in facial emotion recognition in individuals with BD, studies investigating these functions as endophenotypes are rare. The current study investigates emotion recognition as a potential endophenotype in BD by comparing 36 BD participants, 24 of their 1st degree relatives and 40 healthy control participants in a computerised facial emotion recognition task. Group differences were evaluated using repeated measurement analysis of co-variance with age as a covariate. Results revealed slowed emotion recognition for both BD and their relatives. Furthermore, BD participants were less accurate than healthy controls in their recognition of emotion expressions. We found no evidence of emotion specific differences between groups. Our results provide evidence for facial recognition as a potential endophenotype in BD.
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Affiliation(s)
- Esther Vierck
- Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, New Zealand.
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, New Zealand
| | - Peter R Joyce
- Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, New Zealand
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Vierck E. Intact interference and inhibitory functions in participants with bipolar disorder and their first-degree relatives. J Clin Exp Neuropsychol 2015; 37:1124-35. [DOI: 10.1080/13803395.2015.1081157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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van Enkhuizen J, Geyer MA, Minassian A, Perry W, Henry BL, Young JW. Investigating the underlying mechanisms of aberrant behaviors in bipolar disorder from patients to models: Rodent and human studies. Neurosci Biobehav Rev 2015; 58:4-18. [PMID: 26297513 DOI: 10.1016/j.neubiorev.2015.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 08/03/2015] [Accepted: 08/16/2015] [Indexed: 11/18/2022]
Abstract
Psychiatric patients with bipolar disorder suffer from states of depression and mania, during which a variety of symptoms are present. Current treatments are limited and neurocognitive deficits in particular often remain untreated. Targeted therapies based on the biological mechanisms of bipolar disorder could fill this gap and benefit patients and their families. Developing targeted therapies would benefit from appropriate animal models which are challenging to establish, but remain a vital tool. In this review, we summarize approaches to create a valid model relevant to bipolar disorder. We focus on studies that use translational tests of multivariate exploratory behavior, sensorimotor gating, decision-making under risk, and attentional functioning to discover profiles that are consistent between patients and rodent models. Using this battery of translational tests, similar behavior profiles in bipolar mania patients and mice with reduced dopamine transporter activity have been identified. Future investigations should combine other animal models that are biologically relevant to the neuropsychiatric disorder with translational behavioral assessment as outlined here. This methodology can be utilized to develop novel targeted therapies that relieve symptoms for more patients without common side effects caused by current treatments.
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Affiliation(s)
- Jordy van Enkhuizen
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, United States; Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Mark A Geyer
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States.
| | - Arpi Minassian
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, United States
| | - William Perry
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, United States
| | - Brook L Henry
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, United States
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States
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Vreeker A, van Bergen AH, Kahn RS. Cognitive enhancing agents in schizophrenia and bipolar disorder. Eur Neuropsychopharmacol 2015; 25:969-1002. [PMID: 25957798 DOI: 10.1016/j.euroneuro.2015.04.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 04/10/2015] [Indexed: 12/20/2022]
Abstract
Cognitive dysfunction is a core feature of schizophrenia and is also present in bipolar disorder (BD). Whereas decreased intelligence precedes the onset of psychosis in schizophrenia and remains relatively stable thereafter; high intelligence is a risk factor for bipolar illness but cognitive function decreases after onset of symptoms. While in schizophrenia, many studies have been conducted on the development of cognitive enhancing agents; in BD such studies are almost non-existent. This review focuses on the pharmacological agents with putative effects on cognition in both schizophrenia and bipolar illness; specifically agents targeting the dopaminergic, cholinergic and glutamatergic neurotransmitter pathways in schizophrenia and the cognitive effects of lithium, anticonvulsants and antipsychotics in BD. In the final analysis we conclude that cognitive enhancing agents have not yet been produced convincingly for schizophrenia and have hardly been studied in BD. Importantly, studies should focus on other phases of the illness. To be able to treat cognitive deficits effectively in schizophrenia, patients in the very early stages of the illness, or even before - in the ultra-high risk stages - should be targeted. In contrast, cognitive deficits occur later in BD, and therefore drugs should be tested in BD after the onset of illness. Hopefully, we will then find effective drugs for the incapacitating effects of cognitive deficits in these patients.
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Affiliation(s)
- Annabel Vreeker
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, The Netherlands
| | - Annet H van Bergen
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, The Netherlands
| | - René S Kahn
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, The Netherlands.
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45
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O'Leary O, Nolan Y. Glycogen synthase kinase-3 as a therapeutic target for cognitive dysfunction in neuropsychiatric disorders. CNS Drugs 2015; 29:1-15. [PMID: 25380674 DOI: 10.1007/s40263-014-0213-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The serine/threonine kinase glycogen synthase kinase-3 (GSK-3) is involved in a broad range of cellular processes including cell proliferation, apoptosis and inflammation. It is now also increasingly acknowledged as having a role to play in cognitive-related processes such as neurogenesis, synaptic plasticity and neural cell survival. Cognitive impairment represents a major debilitating feature of many neurodegenerative and psychiatric disorders, including Alzheimer's disease, mood disorders, schizophrenia and fragile X syndrome, as well as being a result of traumatic brain injury or cranial irradiation. Accordingly, GSK-3 has been identified as an important therapeutic target for cognitive impairment, and recent preclinical studies have yielded important evidence demonstrating that GSK-3 inhibitors may be useful therapeutic interventions for restoring cognitive function in some of these brain disorders. The current review summarises the role of GSK-3 as a regulator of cognitive-dependent functions, examines current preclinical and clinical evidence of the potential of GSK-3 inhibitors as therapeutic agents for cognitive impairments in neuropsychiatric disorders, and offers some insight into the current obstacles that are impeding the clinical use of selective GSK-3 inhibitors in the treatment of cognitive impairment.
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Affiliation(s)
- Olivia O'Leary
- Department of Anatomy and Neuroscience, Western Gateway Building, University College Cork, Room 4.10, Cork, Ireland
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46
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Pfennig A, Alda M, Young T, MacQueen G, Rybakowski J, Suwalska A, Simhandl C, König B, Hajek T, O'Donovan C, Wittekind D, von Quillfeldt S, Ploch J, Sauer C, Bauer M. Prophylactic lithium treatment and cognitive performance in patients with a long history of bipolar illness: no simple answers in complex disease-treatment interplay. Int J Bipolar Disord 2014; 2:1. [PMID: 25540718 PMCID: PMC4275548 DOI: 10.1186/s40345-014-0016-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/15/2014] [Indexed: 11/10/2022] Open
Abstract
Cognitive impairment in patients with bipolar disorder (BD) is not restricted to symptomatic phases. It is also present in euthymia. There is evidence of differences in the brain's structure between bipolar patients and healthy individuals, as well as changes over time in patients. Lithium constitutes the gold standard in long-term prophylactic treatment. Appropriate therapy that prevents new episodes improves the disease's course and reduces the frequency of harmful outcomes. Interestingly, preclinical data suggest that lithium has a (additional) neuroprotective effect. There is limited data on its related effects in humans and even less on its long-term application. In this multi-center cross-sectional study from the International Group for the Study of Lithium-treated Patients (IGSLi), we compared three groups: bipolar patients without long-term lithium treatment (non-Li group; <3 months cumulative lithium exposure, ≥24 months ago), bipolar patients with long-term lithium treatment (Li group, ongoing treatment ≥24 months), and healthy subjects (controls). Strict inclusion and exclusion criteria were defined; the inclusion criteria for patients were diagnosis of BD types I or II, duration of illness ≥10 years, ≥5 episodes in patient's history and a euthymic mood state. Neurocognitive functioning was assessed using the Wechsler Adult Intelligence Scale-Revised (WAIS-R), the California Verbal Learning Test (CVLT), and a visual backward masking (VBM) task. A total of 142 subjects were included, 31 in the non-Li and 58 in the Li group, as well as 53 healthy controls. Treated patients with long-standing BD and controls did not differ significantly in overall cognitive functioning and verbal learning, recall, and recognition; regardless of whether lithium had been part of the treatment. Patients, however, demonstrated poorer early visual information processing than healthy controls, with the lithium-treated patients performing worse than those without. Our data suggest that bipolar patients with a long illness history and effective prophylactic treatment do not reveal significantly impaired general cognitive functioning or verbal learning and memory. However, they are worse at processing early visual information. Accompanying volumetric and spectroscopic data suggest cell loss in patients not treated with lithium that may be counterbalanced by long-term lithium treatment.
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Affiliation(s)
- Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany ; International Group for the Study of Lithium-Treated Patients (IGSLi), Berlin, Germany
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Canada ; International Group for the Study of Lithium-Treated Patients (IGSLi), Berlin, Germany
| | - Trevor Young
- Department of Psychiatry, University of British Columbia Faculty of Medicine, Vancouver, Canada ; International Group for the Study of Lithium-Treated Patients (IGSLi), Berlin, Germany
| | - Glenda MacQueen
- Department of Psychiatry, Faculty of Medicine, University of Calgary, Calgary, Canada ; International Group for the Study of Lithium-Treated Patients (IGSLi), Berlin, Germany
| | - Janusz Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland ; International Group for the Study of Lithium-Treated Patients (IGSLi), Berlin, Germany
| | - Aleksandra Suwalska
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland ; International Group for the Study of Lithium-Treated Patients (IGSLi), Berlin, Germany
| | - Christian Simhandl
- Department of Psychiatry, Hospital Neunkirchen, CS now: Bipolar Centre, Vienna, Austria ; International Group for the Study of Lithium-Treated Patients (IGSLi), Berlin, Germany
| | - Barbara König
- Department of Psychiatry, Hospital Neunkirchen, CS now: Bipolar Centre, Vienna, Austria ; International Group for the Study of Lithium-Treated Patients (IGSLi), Berlin, Germany
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Canada ; International Group for the Study of Lithium-Treated Patients (IGSLi), Berlin, Germany
| | - Claire O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, Canada ; International Group for the Study of Lithium-Treated Patients (IGSLi), Berlin, Germany
| | - Dirk Wittekind
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Susanne von Quillfeldt
- Department of Psychiatry and Psychotherapy, Charité Berlin, Campus Mitte, Berlin, Germany
| | - Jana Ploch
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany ; International Group for the Study of Lithium-Treated Patients (IGSLi), Berlin, Germany
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Lam RW, Kennedy SH, McIntyre RS, Khullar A. Cognitive dysfunction in major depressive disorder: effects on psychosocial functioning and implications for treatment. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:649-54. [PMID: 25702365 PMCID: PMC4304584 DOI: 10.1177/070674371405901206] [Citation(s) in RCA: 242] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Raymond W Lam
- Professor, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Sidney H Kennedy
- Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Roger S McIntyre
- Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Atul Khullar
- Assistant Clinical Professor, Department of Psychiatry, University of Alberta, Edmonton, Alberta
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48
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Lee RSC, Hermens DF, Scott J, Redoblado-Hodge MA, Naismith SL, Lagopoulos J, Griffiths KR, Porter MA, Hickie IB. A meta-analysis of neuropsychological functioning in first-episode bipolar disorders. J Psychiatr Res 2014; 57:1-11. [PMID: 25016347 DOI: 10.1016/j.jpsychires.2014.06.019] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/25/2014] [Accepted: 06/23/2014] [Indexed: 11/19/2022]
Abstract
Broad neuropsychological deficits have been consistently demonstrated in well-established bipolar disorder. The aim of the current study was to systematically review neuropsychological studies in first-episode bipolar disorders to determine the breadth, extent and predictors of cognitive dysfunction at this early stage of illness through meta-analytic procedures. Electronic databases were searched for studies published between January 1980 and December 2013. Twelve studies met eligibility criteria (N = 341, mean age = 28.2 years), and pooled effect sizes (ES) were calculated across eight cognitive domains. Moderator analyses were conducted to identify predictors of between-study heterogeneity. Controlling for known confounds, medium to large deficits (ES ≥ 0.5) in psychomotor speed, attention and working memory, and cognitive flexibility were identified, whereas smaller deficits (ES 0.20-0.49) were found in the domains of verbal learning and memory, attentional switching, and verbal fluency. A medium to large deficit in response inhibition was only detected in non-euthymic cases. Visual learning and memory functioning was not significantly worse in cases compared with controls. Overall, first-episode bipolar disorders are associated with widespread cognitive dysfunction. Since euthymia was not associated with superior cognitive performance in most domains, these results indicate that even in the earliest stages of disease, cognitive deficits are not mood-state dependent. The current findings have important implications for whether cognitive impairments represent neurodevelopmental or neurodegenerative processes. Future studies need to more clearly characterise the presence of psychotic features, and the nature and number of previous mood episodes.
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Affiliation(s)
- Rico S C Lee
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, Australia; Department of Psychology, Macquarie University, Sydney, Australia.
| | - Daniel F Hermens
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, UK; Centre for Affective Disorders, Institute of Psychiatry, London, UK
| | | | - Sharon L Naismith
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - Jim Lagopoulos
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - Kristi R Griffiths
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - Melanie A Porter
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Ian B Hickie
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, Australia
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Liu CC, Tsai CW, Deak F, Rogers J, Penuliar M, Sung YM, Maher JN, Fu Y, Li X, Xu H, Estus S, Hoe HS, Fryer JD, Kanekiyo T, Bu G. Deficiency in LRP6-mediated Wnt signaling contributes to synaptic abnormalities and amyloid pathology in Alzheimer's disease. Neuron 2014; 84:63-77. [PMID: 25242217 DOI: 10.1016/j.neuron.2014.08.048] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2014] [Indexed: 11/30/2022]
Abstract
Alzheimer's disease (AD) is an age-related neurological disorder characterized by synaptic loss and dementia. The low-density lipoprotein receptor-related protein 6 (LRP6) is an essential coreceptor for Wnt signaling, and its genetic variants have been linked to AD risk. Here we report that neuronal LRP6-mediated Wnt signaling is critical for synaptic function and cognition. Conditional deletion of Lrp6 gene in mouse forebrain neurons leads to age-dependent deficits in synaptic integrity and memory. Neuronal LRP6 deficiency in an amyloid mouse model also leads to exacerbated amyloid pathology due to increased APP processing to amyloid-β. In humans, LRP6 and Wnt signaling are significantly downregulated in AD brains, likely by a mechanism that depends on amyloid-β. Our results define a critical pathway in which decreased LRP6-mediated Wnt signaling, synaptic dysfunction, and elevated Aβ synergistically accelerate AD progression and suggest that restoring LRP6-mediated Wnt signaling can be explored as a viable strategy for AD therapy.
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Affiliation(s)
- Chia-Chen Liu
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA; Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, College of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Chih-Wei Tsai
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ferenc Deak
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA; Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma HSC, Oklahoma City, OK 73104, USA
| | - Justin Rogers
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Michael Penuliar
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - You Me Sung
- Department of Neuroscience, Georgetown University, Washington, D.C. 20057, USA
| | - James N Maher
- Department of Neuroscience, Georgetown University, Washington, D.C. 20057, USA
| | - Yuan Fu
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Xia Li
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Huaxi Xu
- Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, College of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Steven Estus
- Department of Physiology and Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40506, USA
| | - Hyang-Sook Hoe
- Department of Neuroscience, Georgetown University, Washington, D.C. 20057, USA; Convergence Brain Research Department, Korea Brain Research Institute (KBRI), 425, Jungang-daero, Jung-gu, Daegu, Korea
| | - John D Fryer
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA; Neurobiology of Disease Graduate Program, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA
| | - Takahisa Kanekiyo
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Guojun Bu
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA; Neurobiology of Disease Graduate Program, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA; Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, College of Medicine, Xiamen University, Xiamen, Fujian, China.
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O'Bryan RA, Brenner CA, Hetrick WP, O'Donnell BF. Disturbances of visual motion perception in bipolar disorder. Bipolar Disord 2014; 16:354-65. [PMID: 24382259 PMCID: PMC4138967 DOI: 10.1111/bdi.12173] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 09/17/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES While cognitive deficits have been well documented in patients with bipolar disorder, visual perception has been less well characterized. Such deficits appear in schizophrenia, which shares genetic risk factors with bipolar disorder, and may contribute to disturbances in visual cognition and learning. METHODS The present study investigated visual perception in bipolar disorder using psychophysical tests of contrast sensitivity, dot motion discrimination, and form discrimination. The relationship of these measures to mood state, medication status, and cognitive function was investigated. Sixty-one patients with type I bipolar disorder and 67 comparison subjects were tested. RESULTS Results indicated a deficit in dot motion trajectory discrimination in both euthymic and ill individuals with bipolar disorder, as well as a global deficit in moving grating contrast sensitivity. Ill individuals with bipolar disorder were impaired in psychomotor processing, but this finding was not related to visual processing performance. CONCLUSIONS These findings could be due to disturbances in specific visual pathways involved in the processing of motion properties, or to a more general deficit which impairs processing of temporally modulated stimuli.
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Affiliation(s)
- Rebecca A O'Bryan
- Indiana University Health, Southern Indiana Physicians, Bloomington, IN, USA
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