Gender differences in outcomes of acute mania: a 12-month follow-up study

Sex differences in bipolar disorder: The dorsolateral prefrontal cortex as an etiopathogenic region

Bipolar disorder (BD) is worldwide a prevalent mental illness and a leading risk factor for suicide. Over the past three decades, it has been discovered that sex differences exist throughout the entire panorama of BD, but the etiologic regions and mechanisms that generate such differences remain poorly characterized. Available evidence indicates that the dorsolateral prefrontal cortex (DLPFC), a critical region that controls higher-order cognitive processing and mood, exhibits biological disparities between male and female patients with psychiatric disorders, which are highly correlated with the co-occurrence of psychotic symptoms. This review addresses the sex differences in BD concerning epidemiology, cognitive impairments, clinical manifestations, neuroimaging, and laboratory abnormalities. It also provides strong evidence linking DLPFC to the etiopathogenesis of these sex differences. We emphasize the importance of identifying gene signatures using human brain transcriptomics, which can depict sexually different variations, explain sex-biased symptomatic features, and provide novel targets for sex-specific therapeutics.

Mania risk is characterized by an aberrant optimistic update bias for positive life events

BACKGROUND

Early cognitive models of mania posit that a cognitive triad consisting of unrealistically optimistic beliefs about the self, world and future may predispose vulnerable individuals to develop manic symptoms. Hypomanic personality traits (HYP) pose such a vulnerability factor in the etiopathogenesis of mania.

METHODS

To test the cognitive tenet of overly optimistic views of the future, 24 individuals with high-HYP and 24 age- and sex-matched controls (low-HYP) performed a belief update paradigm, during which they estimated their personal chances to experience future positive and negative life events. Afterwards, they were presented with the statistical likelihood of each event occurring to a peer living in the same socio-cultural environment and given the chance to adjust their initial estimates.

RESULTS

High-HYP individuals exhibited an asymmetric belief revision for positive events, reflected by an exaggerated incorporation of better-than-expected and an impaired integration of worse-than-expected information, relative to their low-HYP control counterparts. The strength of this optimistic update bias was linked to the trait sensitivity of the behavioral approach system. Furthermore, high-HYP individuals demonstrated a more optimistic initial prediction bias, characterized by greater overestimations of their likelihood to experience positive events, and reported enhanced trait optimism.

LIMITATIONS

The cross-sectional study relied on an extreme-group design to define mania risk.

CONCLUSIONS

Due to the crucial role of future-oriented beliefs in guiding decision-making and goal-directed behavior, this optimistic update bias for positive events may cognitively underpin the mania-typical engagement in highly pleasurable activities despite warnings for harmful consequences.

Sex differences in cognitive functioning in patients with bipolar disorder who recently recovered from a first episode of mania: data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM)

BACKGROUND

Studies investigating bipolar disorder (BD) showed that healthy patterns of sex differences in cognitive functioning are altered within this population, but is it unknown whether these alterations are present in BD patients early in their course of illness.

METHODS

Patients with bipolar I disorder (36 males, 38 female), who had recently experienced their first manic or mixed episode were tested along with healthy controls (39 males, 59 females) similar in age, sex and premorbid IQ. Cognitive function was assessed through a comprehensive neuropsychological test battery.

RESULTS

Significant group effects were found in a majority of administered tests (p<0.05) with patients performing worse than healthy controls. Significant sex effects (p<0.05) were observed on tasks of spatial working memory and sustained attention, with males performing better than females. No significant group by sex interaction was found in any of the tasks administered.

LIMITATIONS

The cognitive battery employed in this study may not have been optimally sensitive in detecting sex differences.

CONCLUSIONS

The results suggest that unlike patients with long standing multi-episode BD or schizophrenia, healthy cognitive sex differences are maintained in patients with early BD, following recovery from a first-episode of mania. These findings highlight the progressive nature of the illness and provide justification for an early intervention.

Gender differences in first episode psychotic mania

BACKGROUND

The aim of this paper was to delineate the impact of gender on premorbid history, onset, and 18 month outcomes of first episode psychotic mania (FEPM) patients.

METHODS

Medical file audit assessment of 118 (male = 71; female = 47) patients with FEPM aged 15 to 29 years was undertaken on clinical and functional measures.

RESULTS

Males with FEPM had increased likelihood of substance use (OR = 13.41, p <.001) and forensic issues (OR = 4.71, p = .008), whereas females were more likely to have history of sexual abuse trauma (OR = 7.12, p = .001). At service entry, males were more likely to be using substances, especially cannabis (OR = 2.15, p = .047), had more severe illness (OR = 1.72, p = .037), and poorer functioning (OR = 0.96, p = .045). During treatment males were more likely to decrease substance use (OR = 5.34, p = .008) and were more likely to be living with family (OR = 4.30, p = .009). There were no gender differences in age of onset, psychopathology or functioning at discharge.

CONCLUSIONS

Clinically meaningful gender differences in FEPM were driven by risk factors possibly associated with poor outcome. For males, substance use might be associated with poorer clinical presentation and functioning. In females with FEPM, the impact of sexual trauma on illness course warrants further consideration.

Gender differences in service use in a sample of people with schizophrenia and other psychoses

Objective. The main objective is to analyze the use of mental health services in a sample of people with schizophrenia and other psychoses according to gender. Method. The sample of this observational and retrospective study (n = 7483) consisted of all the persons who visited any mental health service of the Parc Sanitari Sant Joan de Déu from 2001 to 2007 with a diagnosis of schizophrenia and other psychoses. The main measures analyzed regarding gender were the frequency of patients for each diagnosis, their risk of being admitted into hospital, and the number and length of hospitalizations for the subsample of inpatient people during the study period. Results. Men are more frequent in the total sample (58.1%). For diagnosis of schizoaffective or delusional disorder, women have a higher frequency than men. Women with diagnosis of schizophrenia have a lower risk of being admitted to the hospital (RR = 0.84, 95% CI (0.72, 0.97)). We found a higher risk of longer stays for men with schizophrenia of the disorganized type (RR = 0.49, 95% CI (0.30, 0.81)), undifferentiated (RR = 0.41, 95% CI (0.27, 0.61)), or delusional disorder (RR = 0.65, 95% CI (0.49, 0.87)). Conclusion. Gender of patients is a relevant variable in mental health service use by patients with schizophrenia and other psychoses.