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Macoveanu J, Damgaard V, Ysbæk-Nielsen AT, Frangou S, Yatham LN, Chakrabarty T, Stougaard ME, Knudsen GM, Vinberg M, Kessing LV, Kjærstad HL, Miskowiak KW. Early longitudinal changes in brain structure and cognitive functioning in remitted patients with recently diagnosed bipolar disorder. J Affect Disord 2023; 339:153-161. [PMID: 37442440 DOI: 10.1016/j.jad.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/08/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Patients with bipolar disorder (BD) who are presenting with cognitive impairment and associated structural brain abnormalities have generally a poorer clinical outcome. This study aims to map the early longitudinal trajectories in brain structure and cognition in patients with recently diagnosed BD. METHODS Fully or partially remitted patients with a recent diagnosis of BD and matched healthy controls (HC) underwent structural MRI and neuropsychological testing at baseline (BD n = 97; HC n = 66) and again following an average of 16 (range 6-27) months (BD n = 50; HC n = 38). We investigated the differential trajectories in BD vs. HC in cortical gray matter volume and thickness, total cerebral white matter, hippocampal and amygdala volumes, estimated brain age, and cognitive functioning using linear mixed models. Within patients, we further investigated whether brain structural abnormalities detected at baseline were associated with subsequent mood episodes. RESULTS Compared to HC, patients showed a decline in total white matter volume over time and they had a larger amygdala volume, both at baseline and at follow-up time. Patients further showed lower cognitive performance at both times of investigation with no significant change over time. There were no differences between patients and HC in cortical gray matter volume or thickness, hippocampal volume, or brain-aging patterns. CONCLUSIONS Cognitive impairment and amygdala enlargement may represent stable markers of BD early in the course of illness, whereas subtle white matter decline may result from illness progression.
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Affiliation(s)
- Julian Macoveanu
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Viktoria Damgaard
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Psychology, University of Copenhagen, Denmark
| | - Alexander Tobias Ysbæk-Nielsen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Psychology, University of Copenhagen, Denmark
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lakshmi N Yatham
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Canada
| | - Marie Eschau Stougaard
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Gitte Moos Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Maj Vinberg
- Department of Clinical Medicine, University of Copenhagen, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Hanne Lie Kjærstad
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Psychology, University of Copenhagen, Denmark
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2
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Miola A, Alvarez-Villalobos NA, Ruiz-Hernandez FG, De Filippis E, Veldic M, Prieto ML, Singh B, Sanchez Ruiz JA, Nunez NA, Resendez MG, Romo-Nava F, McElroy SL, Ozerdem A, Biernacka JM, Frye MA, Cuellar-Barboza AB. Insulin resistance in bipolar disorder: A systematic review of illness course and clinical correlates. J Affect Disord 2023; 334:1-11. [PMID: 37086806 DOI: 10.1016/j.jad.2023.04.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Although insulin resistance (IR) and cardiometabolic syndrome are prevalent in patients with bipolar disorder (BD), only a few studies have attempted to precisely assess the degree and clinical impact of IR in BD. METHODS A comprehensive search was conducted from multiple research databases through May 2022, following a pre-defined protocol (PROSPERO: CRD42022359259). We extracted neuroimaging, cognition, illness course, and treatment response findings from individuals with BD with evidence of IR compared with euglycemic BD individuals. RESULTS Of 1436 identified articles, 10 reports fulfilling inclusion criteria were included (n = 1183). BD patients with IR displayed worse composite verbal memory scores and worse executive function and exhibited smaller hippocampal volumes along with prefrontal neurochemical alterations compared to euglycemic BD patients. Fixed-effect meta-analysis revealed that BD patients with impaired glucose metabolism (IGM) were more likely to develop a chronic and rapid cycling course when compared with euglycemic BD patients (k = 2, OR = 2.96, 95 % CI 1.69-5.17, OR = 2.88, 95 % CI 1.59-5.21, p < 0.001, respectively), with a trend for significantly lower Global Assessment of Functioning scores (k = 5, MD = -4, 95 % CI -8.23-0.23, p = 0.06). BD patients with IGM displayed a higher rate of poor response to mood stabilizers when compared with euglycemic BD patients (k = 2, OR = 6.74, 95 % CI 1.04-43.54, p = 0.04). LIMITATIONS Cross-sectional design and small sample sizes of studies included limit the generalizability of results. CONCLUSION IR is associated with worse clinical outcomes of BD and inadequate treatment response. Implementing strategies to prevent and treat IR in BD is crucial to improve the prognosis of such a difficult-to-treat population.
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Affiliation(s)
- Alessandro Miola
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Neri A Alvarez-Villalobos
- Department of Human Anatomy, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | | | | | - Marin Veldic
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Miguel L Prieto
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry, Facultad de Medicina, Universidad de los Andes, Santiago, Chile; Mental Health Service,, Clínica Universidad de los Andes, Santiago, Chile; Center for Biomedical Research and Innovation, Universidad de los Andes, Santiago, Chile
| | - Balwinder Singh
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Nicolas A Nunez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Manuel Gardea Resendez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Francisco Romo-Nava
- Lindner Center of HOPE, Mason, OH, USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Aysegul Ozerdem
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Joanna M Biernacka
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Alfredo B Cuellar-Barboza
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.
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3
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McWhinney SR, Abé C, Alda M, Benedetti F, Bøen E, del Mar Bonnin C, Borgers T, Brosch K, Canales-Rodríguez EJ, Cannon DM, Dannlowski U, Diaz-Zuluaga AM, Dietze LM, Elvsåshagen T, Eyler LT, Fullerton JM, Goikolea JM, Goltermann J, Grotegerd D, Haarman BCM, Hahn T, Howells FM, Ingvar M, Jahanshad N, Kircher TTJ, Krug A, Kuplicki RT, Landén M, Lemke H, Liberg B, Lopez-Jaramillo C, Malt UF, Martyn FM, Mazza E, McDonald C, McPhilemy G, Meier S, Meinert S, Meller T, Melloni EMT, Mitchell PB, Nabulsi L, Nenadic I, Opel N, Ophoff RA, Overs BJ, Pfarr JK, Pineda-Zapata JA, Pomarol-Clotet E, Raduà J, Repple J, Richter M, Ringwald KG, Roberts G, Ross A, Salvador R, Savitz J, Schmitt S, Schofield PR, Sim K, Stein DJ, Stein F, Temmingh HS, Thiel K, Thomopoulos SI, van Haren NEM, Vargas C, Vieta E, Vreeker A, Waltemate L, Yatham LN, Ching CRK, Andreassen OA, Thompson PM, Hajek T. Mega-analysis of association between obesity and cortical morphology in bipolar disorders: ENIGMA study in 2832 participants. Psychol Med 2023; 53:1-11. [PMID: 36846964 PMCID: PMC10600817 DOI: 10.1017/s0033291723000223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/05/2023] [Accepted: 01/19/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Obesity is highly prevalent and disabling, especially in individuals with severe mental illness including bipolar disorders (BD). The brain is a target organ for both obesity and BD. Yet, we do not understand how cortical brain alterations in BD and obesity interact. METHODS We obtained body mass index (BMI) and MRI-derived regional cortical thickness, surface area from 1231 BD and 1601 control individuals from 13 countries within the ENIGMA-BD Working Group. We jointly modeled the statistical effects of BD and BMI on brain structure using mixed effects and tested for interaction and mediation. We also investigated the impact of medications on the BMI-related associations. RESULTS BMI and BD additively impacted the structure of many of the same brain regions. Both BMI and BD were negatively associated with cortical thickness, but not surface area. In most regions the number of jointly used psychiatric medication classes remained associated with lower cortical thickness when controlling for BMI. In a single region, fusiform gyrus, about a third of the negative association between number of jointly used psychiatric medications and cortical thickness was mediated by association between the number of medications and higher BMI. CONCLUSIONS We confirmed consistent associations between higher BMI and lower cortical thickness, but not surface area, across the cerebral mantle, in regions which were also associated with BD. Higher BMI in people with BD indicated more pronounced brain alterations. BMI is important for understanding the neuroanatomical changes in BD and the effects of psychiatric medications on the brain.
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Affiliation(s)
| | - Christoph Abé
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Francesco Benedetti
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Psychiatry and Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Erlend Bøen
- Unit for Psychosomatics/CL Outpatient Clinic for Adults, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Caterina del Mar Bonnin
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Tiana Borgers
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | | | - Dara M. Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Ana M. Diaz-Zuluaga
- Research Group in Psychiatry GIPSI, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | | | - Torbjørn Elvsåshagen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lisa T. Eyler
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Desert-Pacific MIRECC, VA San Diego Healthcare, San Diego, CA, USA
| | - Janice M. Fullerton
- Neuroscience Research Australia, Randwick, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Jose M. Goikolea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Janik Goltermann
- Department of Psychiatry, University of Münster, Münster, Germany
| | | | - Bartholomeus C. M. Haarman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim Hahn
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Fleur M. Howells
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Tilo T. J. Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Axel Krug
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | | | - Mikael Landén
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hannah Lemke
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Benny Liberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Carlos Lopez-Jaramillo
- Research Group in Psychiatry GIPSI, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Ulrik F. Malt
- Unit for Psychosomatics/CL Outpatient Clinic for Adults, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Neurology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Fiona M. Martyn
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Elena Mazza
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Psychiatry and Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Genevieve McPhilemy
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Sandra Meier
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Susanne Meinert
- Department of Psychiatry, University of Münster, Münster, Germany
- Institute for Translational Neuroscience, University of Münster, Münster, Germany
| | - Tina Meller
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Germany
| | - Elisa M. T. Melloni
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Psychiatry and Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Philip B. Mitchell
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Leila Nabulsi
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Igor Nenadic
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Nils Opel
- Department of Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - Roel A. Ophoff
- UCLA Center for Neurobehavioral Genetics, Los Angeles, CA, USA
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Julia-Katharina Pfarr
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Julian A. Pineda-Zapata
- Research Group, Instituto de Alta Tecnología Médica, Ayudas diagnósticas SURA, Medellin, Colombia
| | | | - Joaquim Raduà
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
- Institute of Psychiartry, King's College Londen, London, UK
| | - Jonathan Repple
- Department of Psychiatry, University of Münster, Münster, Germany
- Department for Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Maike Richter
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Kai G. Ringwald
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Gloria Roberts
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Alex Ross
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Jonathan Savitz
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Simon Schmitt
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Peter R. Schofield
- Neuroscience Research Australia, Randwick, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Kang Sim
- West Region, Institute of Mental Health, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dan J. Stein
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- South African MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Henk S. Temmingh
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katharina Thiel
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Sophia I. Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Neeltje E. M. van Haren
- Department of Child and Adolescents Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Psychiatry, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cristian Vargas
- Research Group in Psychiatry GIPSI, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Eduard Vieta
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Annabel Vreeker
- Department of Child and Adolescents Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Psychiatry, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Erasmus School of Social and Behavioural Sciences Department of Psychology, Education & Child Studies Erasmus University, Rotterdam, The Netherlands
| | - Lena Waltemate
- Department of Psychiatry, University of Münster, Münster, Germany
| | | | - Christopher R. K. Ching
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Ole A. Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- National Institute of Mental Health, Klecany, Czech Republic
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4
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Bond DJ, Andreazza AC, Torres IJ, Honer WG, Lam RW, Yatham LN. Association of total peripheral inflammation with lower frontal and temporal lobe volumes in early-stage bipolar disorder: A proof-of-concept study. J Affect Disord 2022; 319:229-234. [PMID: 36155232 DOI: 10.1016/j.jad.2022.09.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 05/26/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND We previously reported that in early-stage bipolar disorder (BD), frontal and temporal lobe volume reductions were more pronounced in patients with elevated BMI and more rapidly progressive in patients with additional weight gain. Elevated BMI is a pro-inflammatory state, and inflammation may contribute to brain volume reductions in BD. However, few studies have investigated the relationship between inflammation and brain volumes. METHODS We conducted a proof-of-concept analysis to investigate whether a composite measure of total peripheral inflammation derived from 9 cytokines predicted lower frontal and temporal lobe volumes, measured with 3 T MRI, in early-stage BD. RESULTS In 25 early-stage patients, linear regression models showed that greater total inflammation predicted lower white matter (WM) volumes in the left frontal lobe (β = -0.691, p = 0.001) and bilateral temporal lobes (left: β = -0.617, p = 0.003; right: β = -0.636, p = 0.001). Greater inflammation also predicted lower right frontal WM, although this did not survive correction for multiple comparisons (β = -0.557, p = 0.020). It did not predict frontal or temporal GM. Total inflammation was a stronger predictor of lower WM volumes than were individual cytokines. LIMITATIONS Although the magnitude of the association between total inflammation and lower WM volumes was large, our sample was small. Our findings require confirmation in further studies, with samples large enough to determine whether inflammation mediates the relationship between elevated BMI and brain volumes. CONCLUSIONS This study supports the hypothesis that inflammation contributes to brain volume reductions in BD and suggests that total inflammatory burden best captures the impact of inflammation on the brain.
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Affiliation(s)
- David J Bond
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ana C Andreazza
- Departments of Psychiatry and Pharmacology, University of Toronto and Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ivan J Torres
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Raymond W Lam
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
| | - Lakshmi N Yatham
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada.
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5
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Zapparoli L, Devoto F, Giannini G, Zonca S, Gallo F, Paulesu E. Neural structural abnormalities behind altered brain activation in obesity: Evidence from meta-analyses of brain activation and morphometric data. Neuroimage Clin 2022; 36:103179. [PMID: 36088842 PMCID: PMC9474923 DOI: 10.1016/j.nicl.2022.103179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 12/14/2022]
Abstract
Obesity represents a risk factor for disability with a major bearing on life expectancy. Neuroimaging techniques are contributing to clarify its neurobiological underpinnings. Here, we explored whether structural brain abnormalities might accompany altered brain activations in obesity. We combined and compared data from brain activation studies for food stimuli and the data reported in structural voxel-based morphometry studies. We found that obese individuals have reduced grey matter density and functional activations in the thalamus and midbrain. A functional connectivity analysis based on these two clusters and its quantitative decoding showed that these regions are part of the reward system functional brain network. Moreover, we found specific grey matter hypo-densities in prefrontal cortex for the obese subjects, regions involved in controlled behaviour. These results support theories of obesity that point to reduced bottom-up reward processes (i.e., the Reward Deficit Theory), but also top-down theories postulating a deficit in cognitive control (i.e., the Inhibitory Control Deficit Theory). The same results also warrant a more systematic exploration of obesity whereby the reward of food and the intentional control over consummatory behaviour is manipulated.
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Affiliation(s)
- Laura Zapparoli
- Psychology Department and NeuroMi – Milan Centre for Neuroscience, University of Milano-Bicocca, Milan, Italy,IRCCS Orthopedic Institute Galeazzi, Milan, Italy,Corresponding authors.
| | - Francantonio Devoto
- Psychology Department and NeuroMi – Milan Centre for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Gianluigi Giannini
- Psychology Department and NeuroMi – Milan Centre for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Sara Zonca
- Psychology Department and NeuroMi – Milan Centre for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Francesca Gallo
- Psychology Department and NeuroMi – Milan Centre for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Eraldo Paulesu
- Psychology Department and NeuroMi – Milan Centre for Neuroscience, University of Milano-Bicocca, Milan, Italy,IRCCS Orthopedic Institute Galeazzi, Milan, Italy
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6
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McWhinney SR, Abé C, Alda M, Benedetti F, Bøen E, del Mar Bonnin C, Borgers T, Brosch K, Canales-Rodríguez EJ, Cannon DM, Dannlowski U, Diaz-Zuluaga AM, Lorielle Dietze, Elvsåshagen T, Eyler LT, Fullerton JM, Goikolea JM, Goltermann J, Grotegerd D, Haarman BCM, Hahn T, Howells FM, Ingvar M, Kircher TTJ, Krug A, Kuplicki RT, Landén M, Lemke H, Liberg B, Lopez-Jaramillo C, Malt UF, Martyn FM, Mazza E, McDonald C, McPhilemy G, Meier S, Meinert S, Meller T, Melloni EMT, Mitchell PB, Nabulsi L, Nenadic I, Opel N, Ophoff RA, Overs BJ, Pfarr JK, Pineda-Zapata JA, Pomarol-Clotet E, Raduà J, Repple J, Richter M, Ringwald KG, Roberts G, Ross A, Salvador R, Savitz J, Schmitt S, Schofield PR, Sim K, Stein DJ, Stein F, Temmingh HS, Thiel K, Thomopoulos SI, van Haren NEM, Van Gestel H, Vargas C, Vieta E, Vreeker A, Waltemate L, Yatham LN, Ching CRK, Andreassen O, Thompson PM, Hajek T. Diagnosis of bipolar disorders and body mass index predict clustering based on similarities in cortical thickness-ENIGMA study in 2436 individuals. Bipolar Disord 2022; 24:509-520. [PMID: 34894200 PMCID: PMC9187778 DOI: 10.1111/bdi.13172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS Rates of obesity have reached epidemic proportions, especially among people with psychiatric disorders. While the effects of obesity on the brain are of major interest in medicine, they remain markedly under-researched in psychiatry. METHODS We obtained body mass index (BMI) and magnetic resonance imaging-derived regional cortical thickness, surface area from 836 bipolar disorders (BD) and 1600 control individuals from 14 sites within the ENIGMA-BD Working Group. We identified regionally specific profiles of cortical thickness using K-means clustering and studied clinical characteristics associated with individual cortical profiles. RESULTS We detected two clusters based on similarities among participants in cortical thickness. The lower thickness cluster (46.8% of the sample) showed thinner cortex, especially in the frontal and temporal lobes and was associated with diagnosis of BD, higher BMI, and older age. BD individuals in the low thickness cluster were more likely to have the diagnosis of bipolar disorder I and less likely to be treated with lithium. In contrast, clustering based on similarities in the cortical surface area was unrelated to BD or BMI and only tracked age and sex. CONCLUSIONS We provide evidence that both BD and obesity are associated with similar alterations in cortical thickness, but not surface area. The fact that obesity increased the chance of having low cortical thickness could explain differences in cortical measures among people with BD. The thinner cortex in individuals with higher BMI, which was additive and similar to the BD-associated alterations, may suggest that treating obesity could lower the extent of cortical thinning in BD.
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Affiliation(s)
| | - Christoph Abé
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Francesco Benedetti
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Neuroscience, Psychiatry and Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Erlend Bøen
- Unit for Psychosomatics / CL Outpatient Clinic for Adults, Division of Mental Health and Addiction, Oslo University Hospital, Oslo Norway
| | - Caterina del Mar Bonnin
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Tiana Borgers
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | | | - Dara M. Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Ana M. Diaz-Zuluaga
- Research Group in Psychiatry GIPSI, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Lorielle Dietze
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Torbjørn Elvsåshagen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lisa T. Eyler
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Desert-Pacific MIRECC, VA San Diego Healthcare, San Diego, CA, USA
| | - Janice M. Fullerton
- Neuroscience Research Australia, Randwick, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Jose M. Goikolea
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Janik Goltermann
- Department of Psychiatry, University of Münster, Münster, Germany
| | | | - Bartholomeus C. M. Haarman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim Hahn
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Fleur M. Howells
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tilo T. J. Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Axel Krug
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.,Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | | | - Mikael Landén
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hannah Lemke
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Benny Liberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Carlos Lopez-Jaramillo
- Research Group in Psychiatry GIPSI, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Ulrik F. Malt
- Unit for Psychosomatics / CL Outpatient Clinic for Adults, Division of Mental Health and Addiction, Oslo University Hospital, Oslo Norway.,Institute of Clinical Medicine, Department of Neurology, University of Oslo, Oslo, Norway
| | - Fiona M. Martyn
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Elena Mazza
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Neuroscience, Psychiatry and Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Genevieve McPhilemy
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Sandra Meier
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Susanne Meinert
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Tina Meller
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Germany
| | - Elisa M. T. Melloni
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Neuroscience, Psychiatry and Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Philip B. Mitchell
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Leila Nabulsi
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Igor Nenadic
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Nils Opel
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Roel A. Ophoff
- UCLA Center for Neurobehavioral Genetics, Los Angeles, CA, USA.,Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Julia-Katharina Pfarr
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Julian A. Pineda-Zapata
- Research Group, Instituto de Alta Tecnología Médica, Ayudas diagnósticas SURA, Medellin, Colombia
| | | | - Joaquim Raduà
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Institute of Psychiartry, King’s College Londen, London, UK
| | - Jonathan Repple
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Maike Richter
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Kai G. Ringwald
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Gloria Roberts
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Alex Ross
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Jonathan Savitz
- Laureate Institute for Brain Research, Tulsa, OK, USA.,Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Simon Schmitt
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Peter R. Schofield
- Neuroscience Research Australia, Randwick, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Kang Sim
- West Region, Institute of Mental Health, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dan J. Stein
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,South African MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Henk S. Temmingh
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katharina Thiel
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Sophia I. Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Neeltje E. M. van Haren
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus University, Rotterdam, The Netherlands.,Department of Psychiatry, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Holly Van Gestel
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Cristian Vargas
- Research Group in Psychiatry GIPSI, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Eduard Vieta
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Annabel Vreeker
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus University, Rotterdam, The Netherlands
| | - Lena Waltemate
- Department of Psychiatry, University of Münster, Münster, Germany
| | | | - Christopher R. K. Ching
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Ole Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,National Institute of Mental Health, Klecany, Czech Republic
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Mosolov SN, Fedorova EY. The risk of developing cardiovascular disease in bipolar disorder. Biological factors and therapy. TERAPEVT ARKH 2022; 94:579-583. [DOI: 10.26442/00403660.2022.04.201455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Indexed: 11/22/2022]
Abstract
Background. Bipolar disorder (BD) is one of the most common mental disorders characterized by alternating episodes of mania/hypomania and depression, as well as the possibility of developing mixed conditions. Correct and timely diagnosis of BD is important due to the presence of a high suicidal risk and a high predisposition to the development of cardiovascular disease (CVD). The risk of CVD is higher in ВD than in other mental disorders.
Materials and methods. A sample assessment was made of current studies focusing on the vascular-bipolar link. The search was carried out in the PubMed and eLIBRARY databases for the following keywords: bipolar disorder, psychopharmacology, cardiovascular disease, biological mediators.
Results. There are several biological factors which explain the close association and common pathogenetic mechanisms of BD and CVD. The most interesting of them are inflammation, oxidative stress, and brain-derived neurotrophic factor. Neuroimaging methods have shown similar structural brain changes in people with BD and with CVD. There is some evidence of the efficacy of statins and angiotensin-converting enzyme inhibitors in reducing cardio-vascular risk factors in BD patients.
Conclusion. The predisposition of patients of BD to CVD is beyond doubt. It is necessary to consider the peculiarities of the course of BD and conduct active monitoring and preventive measures to reduce the risk of developing life-threatening CVDs. Further research focused on the pathogenetic relationship between BD and CVD could provide more insight into this area.
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8
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Grigorian A, Kennedy KG, Luciw NJ, MacIntosh BJ, Goldstein BI. Obesity and Cerebral Blood Flow in the Reward Circuitry of Youth With Bipolar Disorder. Int J Neuropsychopharmacol 2022; 25:448-456. [PMID: 35092432 PMCID: PMC9211014 DOI: 10.1093/ijnp/pyac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is associated with elevated body mass index (BMI) and increased rates of obesity. Obesity among individuals with BD is associated with more severe course of illness. Motivated by previous research on BD and BMI in youth as well as brain findings in the reward circuit, the current study investigates differences in cerebral blood flow (CBF) in youth BD with and without comorbid overweight/obesity (OW/OB). METHODS Participants consisted of youth, ages 13-20 years, including BD with OW/OB (BDOW/OB; n = 25), BD with normal weight (BDNW; n = 55), and normal-weight healthy controls (HC; n = 61). High-resolution T1-weighted and pseudo-continuous arterial spin labeling images were acquired using 3 Tesla magnetic resonance imaging. CBF differences were assessed using both region of interest and whole-brain voxel-wise approaches. RESULTS Voxel-wise analysis revealed significantly higher CBF in reward-associated regions in the BDNW group relative to the HC and BDOW/OB groups. CBF did not differ between the HC and BDOW/OB groups. There were no significant region of interest findings. CONCLUSIONS The current study identified distinct CBF levels relating to BMI in BD in the reward circuit, which may relate to underlying differences in cerebral metabolism, compensatory effects, and/or BD severity. Future neuroimaging studies are warranted to examine for changes in the CBF-OW/OB link over time and in relation to treatment.
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Affiliation(s)
- Anahit Grigorian
- Centre for Youth Bipolar Disorder, Department of Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Department of Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas J Luciw
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ontario, Canada,Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Correspondence: Benjamin I. Goldstein, MD, PhD, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, Canada, M6J 1H4 ()
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9
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Li L, Yu H, Zhong M, Liu S, Wei W, Meng Y, Li ML, Li T, Wang Q. Gray matter volume alterations in subjects with overweight and obesity: Evidence from a voxel-based meta-analysis. Front Psychiatry 2022; 13:955741. [PMID: 36226110 PMCID: PMC9548618 DOI: 10.3389/fpsyt.2022.955741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/05/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Obesity is a multi-systemic disease with complex etiology. And consistent evidence indicated obesity or overweight subjects render brain structure changes. Increasing evidence indicates these subjects have shown widespread structural brain gray matter volume (GMV) changes. However, results from other neuroimaging studies have been inconsistent. Consequently, the question remains whether body mass index (BMI), a gold standard to define obesity/overweight, is associated with brain structural changes. METHODS This study will apply an updated meta-analysis of voxel-based GMV studies to compare GMV changes in overweight and obese subjects. Online databases were used to build on relevant studies published before May 2022. The updated Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) explores GMV changes in individuals with overweight and obesity and further examines the correlation between GMV and obesity-related variables, specifically body mass index (BMI). RESULTS This research included fourteen studies and provided a whole-brain analysis of GMV distribution in overweight and obese individuals. It revealed lower GMV in brain regions, including the left putamen and right precentral gyrus, in individuals with overweight and obesity compared to lean controls. Further, meta-regression analyses revealed GMV in the left middle occipital gyrus was negatively correlated with the BMI of the whole sample. CONCLUSION GMV decreased was reported in reward circuit processing areas and sensorimotor processing areas of individuals with overweight and obesity diagnoses, suggesting an underlying structural basis for reward processing and sensorimotor processing dysregulation in overweight and obese subjects. Our results also suggest that GMV in occipital gyrus, a key region for food visual and gustatory encoding, is negatively associated with BMI. These results provide further evidence for the dysregulated reward circuit in individuals with overweight and obesity.
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Affiliation(s)
- Lei Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Hua Yu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Ming Zhong
- Department of Sport and Health Science, University of Exeter, Exeter, United Kingdom
| | - Siyi Liu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Wei Wei
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Yajing Meng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Ming-Li Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Tao Li
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qiang Wang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
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10
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McWhinney SR, Abé C, Alda M, Benedetti F, Bøen E, Del Mar Bonnin C, Borgers T, Brosch K, Canales-Rodríguez EJ, Cannon DM, Dannlowski U, Díaz-Zuluaga AM, Elvsåshagen T, Eyler LT, Fullerton JM, Goikolea JM, Goltermann J, Grotegerd D, Haarman BCM, Hahn T, Howells FM, Ingvar M, Kircher TTJ, Krug A, Kuplicki RT, Landén M, Lemke H, Liberg B, Lopez-Jaramillo C, Malt UF, Martyn FM, Mazza E, McDonald C, McPhilemy G, Meier S, Meinert S, Meller T, Melloni EMT, Mitchell PB, Nabulsi L, Nenadic I, Opel N, Ophoff RA, Overs BJ, Pfarr JK, Pineda-Zapata JA, Pomarol-Clotet E, Raduà J, Repple J, Richter M, Ringwald KG, Roberts G, Salvador R, Savitz J, Schmitt S, Schofield PR, Sim K, Stein DJ, Stein F, Temmingh HS, Thiel K, van Haren NEM, Gestel HV, Vargas C, Vieta E, Vreeker A, Waltemate L, Yatham LN, Ching CRK, Andreassen O, Thompson PM, Hajek T. Association between body mass index and subcortical brain volumes in bipolar disorders-ENIGMA study in 2735 individuals. Mol Psychiatry 2021; 26:6806-6819. [PMID: 33863996 PMCID: PMC8760047 DOI: 10.1038/s41380-021-01098-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/26/2021] [Accepted: 04/01/2021] [Indexed: 12/27/2022]
Abstract
Individuals with bipolar disorders (BD) frequently suffer from obesity, which is often associated with neurostructural alterations. Yet, the effects of obesity on brain structure in BD are under-researched. We obtained MRI-derived brain subcortical volumes and body mass index (BMI) from 1134 BD and 1601 control individuals from 17 independent research sites within the ENIGMA-BD Working Group. We jointly modeled the effects of BD and BMI on subcortical volumes using mixed-effects modeling and tested for mediation of group differences by obesity using nonparametric bootstrapping. All models controlled for age, sex, hemisphere, total intracranial volume, and data collection site. Relative to controls, individuals with BD had significantly higher BMI, larger lateral ventricular volume, and smaller volumes of amygdala, hippocampus, pallidum, caudate, and thalamus. BMI was positively associated with ventricular and amygdala and negatively with pallidal volumes. When analyzed jointly, both BD and BMI remained associated with volumes of lateral ventricles and amygdala. Adjusting for BMI decreased the BD vs control differences in ventricular volume. Specifically, 18.41% of the association between BD and ventricular volume was mediated by BMI (Z = 2.73, p = 0.006). BMI was associated with similar regional brain volumes as BD, including lateral ventricles, amygdala, and pallidum. Higher BMI may in part account for larger ventricles, one of the most replicated findings in BD. Comorbidity with obesity could explain why neurostructural alterations are more pronounced in some individuals with BD. Future prospective brain imaging studies should investigate whether obesity could be a modifiable risk factor for neuroprogression.
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Affiliation(s)
- Sean R McWhinney
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Christoph Abé
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Francesco Benedetti
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Psychiatry and Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Erlend Bøen
- Unit for Psychosomatics / CL Outpatient Clinic for Adults, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Caterina Del Mar Bonnin
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Tiana Borgers
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | | | - Dara M Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Ana M Díaz-Zuluaga
- Research Group in Psychiatry GIPSI, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Torbjørn Elvsåshagen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lisa T Eyler
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Desert-Pacific MIRECC, VA San Diego Healthcare, San Diego, CA, USA
| | - Janice M Fullerton
- Neuroscience Research Australia, Randwick, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Jose M Goikolea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Janik Goltermann
- Department of Psychiatry, University of Münster, Münster, Germany
| | | | - Bartholomeus C M Haarman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim Hahn
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Fleur M Howells
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tilo T J Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Axel Krug
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | | | - Mikael Landén
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hannah Lemke
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Benny Liberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Carlos Lopez-Jaramillo
- Research Group in Psychiatry GIPSI, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Ulrik F Malt
- Unit for Psychosomatics / CL Outpatient Clinic for Adults, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Department of Neurology, University of Oslo, Oslo, Norway
| | - Fiona M Martyn
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Elena Mazza
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Psychiatry and Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Genevieve McPhilemy
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Sandra Meier
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Susanne Meinert
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Tina Meller
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Germany
| | - Elisa M T Melloni
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Psychiatry and Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Leila Nabulsi
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Igor Nenadic
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Nils Opel
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Roel A Ophoff
- UCLA Center for Neurobehavioral Genetics, Los Angeles, CA, USA
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Julia-Katharina Pfarr
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Julian A Pineda-Zapata
- Research Group, Instituto de Alta Tecnología Médica, Ayudas diagnósticas SURA, Medellín, Colombia
| | | | - Joaquim Raduà
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institute of Psychiartry, King's College Londen, London, UK
| | - Jonathan Repple
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Maike Richter
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Kai G Ringwald
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Gloria Roberts
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Jonathan Savitz
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Simon Schmitt
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Peter R Schofield
- Neuroscience Research Australia, Randwick, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Kang Sim
- West Region, Institute of Mental Health, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dan J Stein
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- South African MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Henk S Temmingh
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katharina Thiel
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Neeltje E M van Haren
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus University, Rotterdam, The Netherlands
- Department of Psychiatry, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Holly Van Gestel
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Cristian Vargas
- Research Group in Psychiatry GIPSI, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Eduard Vieta
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Annabel Vreeker
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus University, Rotterdam, The Netherlands
| | - Lena Waltemate
- Department of Psychiatry, University of Münster, Münster, Germany
| | | | - Christopher R K Ching
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Ole Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
- National Institute of Mental Health, Klecany, Czech Republic.
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11
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Longitudinal grey matter changes following first episode mania in bipolar I disorder: A systematic review. J Affect Disord 2021; 291:198-208. [PMID: 34049189 DOI: 10.1016/j.jad.2021.04.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/12/2021] [Accepted: 04/25/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND While widespread grey matter (GM) changes are seen in bipolar I disorder (BD-I), it is unclear how early in the illness such changes emerge. To date there has been little synthesis of findings regarding longitudinal grey matter changes early in the course of BD-I. We conducted a systematic review to examine the evolution of GM changes in BD-I patients following the first episode of mania (FEM). METHODS Following PRISMA guidelines, we conducted a systematic review of studies examining longitudinal changes in GM volume (GMV), cortical thickness and/or surface area in BD-I patients following FEM. We qualitatively synthesized results regarding longitudinal GM changes in BD-I patients. RESULTS Fifteen studies met inclusion criteria, all examining GMV changes. Longitudinal ACC volume decrease following FEM was the most replicated finding, but was only reported in 4 out of 7 studies that examined this region as part of a whole brain/region of interest analysis, with 2 of these positive studies using an overlapping patient sample. The impact of episode recurrence, medications, and other clinical factors was inconsistently examined. LIMITATIONS The literature regarding GM changes early in BD-I is highly inconsistent, likely due to heterogeneity in participant characteristics, imaging methodology/analysis and duration of follow up. CONCLUSIONS Though there was some suggestion that structural ACC changes may represent a marker for neuroprogression following FEM, results were too inconsistent to draw any conclusions. Larger longitudinal studies examining cortical thickness/surface area, and the influence of relevant clinical factors, are needed to better understand neuroprogression in early BD-I.
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12
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Bond DJ, Silveira LE, Torres IJ, Lam RW, Yatham LN. Weight gain as a risk factor for progressive neurochemical abnormalities in first episode mania patients: a longitudinal magnetic resonance spectroscopy study. Psychol Med 2021; 52:1-9. [PMID: 33706825 DOI: 10.1017/s0033291721000544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We previously reported that bipolar disorder (BD) patients with clinically significant weight gain (CSWG; ⩾7% of baseline weight) in the 12 months after their first manic episode experienced greater limbic brain volume loss than patients without CSWG. It is unknown whether CSWG is also a risk factor for progressive neurochemical abnormalities. METHODS We investigated whether 12-month CSWG predicted greater 12-month decreases in hippocampal N-acetylaspartate (NAA) and greater increases in glutamate + glutamine (Glx) following a first manic episode. In BD patients (n = 58) and healthy comparator subjects (HS; n = 34), we measured baseline and 12-month hippocampal NAA and Glx using bilateral 3-Tesla single-voxel proton magnetic resonance spectroscopy. We used general linear models for repeated measures to investigate whether CSWG predicted neurochemical changes. RESULTS Thirty-three percent of patients and 18% of HS experienced CSWG. After correcting for multiple comparisons, CSWG in patients predicted a greater decrease in left hippocampal NAA (effect size = -0.52, p = 0.005). CSWG also predicted a greater decrease in left hippocampal NAA in HS with a similar effect size (-0.53). A model including patients and HS found an effect of CSWG on Δleft NAA (p = 0.007), but no diagnosis effect and no diagnosis × CSWG interaction, confirming that CSWG had similar effects in patients and HS. CONCLUSION CSWG is a risk factor for decreasing hippocampal NAA in BD patients and HS. These results suggest that the well-known finding of reduced NAA in BD may result from higher body mass index in patients rather than BD diagnosis.
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Affiliation(s)
- David J Bond
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
| | - Leonardo E Silveira
- Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, and INCT for Translational Medicine, Porto Alegre, RS, Brazil
| | - Ivan J Torres
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
| | - Raymond W Lam
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
| | - Lakshmi N Yatham
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
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13
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Restivo MR, Hall GB, Frey BN, McKinnon MC, Taylor VH. Neural correlates of verbal recognition memory in obese adults with and without major depressive disorder. Brain Behav 2020; 10:e01848. [PMID: 32964681 PMCID: PMC7749585 DOI: 10.1002/brb3.1848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/18/2020] [Accepted: 08/22/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Obesity and major depressive disorder (MDD) independently contribute to memory impairment. Little is known about shared neural mechanisms that may result in the cognitive impairment experienced by these populations. This study's aim was to determine how obesity impacts neural activity during a verbal recognition memory task in individuals both with and without MDD. METHODS Functional magnetic resonance imaging was employed to examine whether differences in neural activation patterns would be seen across three groups during the Warrington's Recognition Memory Test. Three study groups are reported: 20 subjects with obesity but without MDD (bariatric controls), 23 subjects with past or current MDD and obesity, and 20 normal BMI controls (healthy controls). RESULTS Three-group conjunction analyses indicated that overlapping neural regions were activated during both encoding and retrieval processes across all groups. However, second-level 2-group t-contrasts indicated that neural activation patterns differed when comparing healthy and bariatric controls, and when comparing bariatric controls and bariatric MDD participants. DISCUSSION Results indicate that obesity in conjunction with MDD confers a subtle impact on neural functioning. Given high rates of obesity and MDD comorbidity, and the role of cognition on ability to return to premorbid level of functioning, this association should inform treatment decisions.
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Affiliation(s)
- Maria R. Restivo
- Women’s College Research InstituteWomen’s College HospitalTorontoONCanada
| | - Geoffrey B. Hall
- Department of Psychology, Neuroscience & BehaviourMcMaster UniversityHamiltonONCanada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Margaret C. McKinnon
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
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14
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Chen EY, Eickhoff SB, Giovannetti T, Smith DV. Obesity is associated with reduced orbitofrontal cortex volume: A coordinate-based meta-analysis. Neuroimage Clin 2020; 28:102420. [PMID: 32961404 PMCID: PMC7509458 DOI: 10.1016/j.nicl.2020.102420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 01/01/2023]
Abstract
Neural models of obesity vary in their focus upon prefrontal and striatal differences. Animal and human studies suggest that differential functioning of the orbitofrontal cortex is associated with obesity. However, meta-analyses of functional neuroimaging studies have not found a clear relationship between the orbitofrontal cortex and obesity. Meta-analyses of structural imaging studies of obesity have shown mixed findings with regards to an association with reduced orbitofrontal cortex gray matter volume. To clarify these findings, we conducted a meta-analysis of 25 voxel-based morphometry studies, and found that greater body mass index is associated with decreased gray matter volume in the right orbitofrontal cortex (Brodmanns' areas 10 and 11), where family-wise corrected p < .05, N = 7,612. Use of the right orbitofrontal cortex as a seed in a Neurosynth Network Coactivation analysis showed that this region is associated with activity in the left frontal medial cortex, left temporal lobe, right precuneus cortex, posterior division of the left middle temporal gyrus, and right frontal pole. When Neurosynth Network Coactivation results were submitted as regions of interest in the Human Connectome Project data, we found that greater body mass index was associated with greater activity in left frontal medial cortex response to the Gambling Task, where p < .05, although this did not survive Bonferroni-correction. Our findings highlight the importance of the orbitofrontal cortex structure and functioning in neural models of obesity. Exploratory analyses suggest more studies are needed that examine the functional significance of reduced orbitofrontal cortex gray matter volume in obesity, and the effect of age and weight changes on this relationship using longitudinal designs.
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Affiliation(s)
| | - Simon B Eickhoff
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Germany
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15
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Goldstein BI, Baune BT, Bond DJ, Chen P, Eyler L, Fagiolini A, Gomes F, Hajek T, Hatch J, McElroy SL, McIntyre RS, Prieto M, Sylvia LG, Tsai S, Kcomt A, Fiedorowicz JG. Call to action regarding the vascular-bipolar link: A report from the Vascular Task Force of the International Society for Bipolar Disorders. Bipolar Disord 2020; 22:440-460. [PMID: 32356562 PMCID: PMC7522687 DOI: 10.1111/bdi.12921] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The association of bipolar disorder with early and excessive cardiovascular disease was identified over a century ago. Nonetheless, the vascular-bipolar link remains underrecognized, particularly with regard to how this link can contribute to our understanding of pathogenesis and treatment. METHODS An international group of experts completed a selective review of the literature, distilling core themes, identifying limitations and gaps in the literature, and highlighting future directions to bridge these gaps. RESULTS The association between bipolar disorder and vascular disease is large in magnitude, consistent across studies, and independent of confounding variables where assessed. The vascular-bipolar link is multifactorial and is difficult to study given the latency between the onset of bipolar disorder, often in adolescence or early adulthood, and subsequent vascular disease, which usually occurs decades later. As a result, studies have often focused on risk factors for vascular disease or intermediate phenotypes, such as structural and functional vascular imaging measures. There is interest in identifying the most relevant mediators of this relationship, including lifestyle (eg, smoking, diet, exercise), medications, and systemic biological mediators (eg, inflammation). Nonetheless, there is a paucity of treatment studies that deliberately engage these mediators, and thus far no treatment studies have focused on engaging vascular imaging targets. CONCLUSIONS Further research focused on the vascular-bipolar link holds promise for gleaning insights regarding the underlying causes of bipolar disorder, identifying novel treatment approaches, and mitigating disparities in cardiovascular outcomes for people with bipolar disorder.
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Affiliation(s)
- Benjamin I. Goldstein
- Centre for Youth Bipolar DisorderSunnybrook Health Sciences CentreTorontoONCanada,Departments of Psychiatry & PharmacologyFaculty of MedicineUniversity of TorontoTorontoONCanada
| | - Bernhard T. Baune
- Department of Psychiatry and PsychotherapyUniversity of MünsterMünsterGermany,Department of PsychiatryMelbourne Medical SchoolThe University of MelbourneMelbourneVICAustralia,The Florey Institute of Neuroscience and Mental HealthThe University of MelbourneParkvilleVICAustralia
| | - David J. Bond
- Department of Psychiatry and Behavioral ScienceUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - Pao‐Huan Chen
- Department of PsychiatryTaipei Medical University HospitalTaipeiTaiwan,Department of PsychiatrySchool of MedicineCollege of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Lisa Eyler
- Department of PsychiatryUniversity of California San DiegoSan DiegoCAUSA
| | | | - Fabiano Gomes
- Department of PsychiatryQueen’s University School of MedicineKingstonONCanada
| | - Tomas Hajek
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada,National Institute of Mental HealthKlecanyCzech Republic
| | - Jessica Hatch
- Centre for Youth Bipolar DisorderSunnybrook Health Sciences CentreTorontoONCanada,Departments of Psychiatry & PharmacologyFaculty of MedicineUniversity of TorontoTorontoONCanada
| | - Susan L. McElroy
- Department of Psychiatry and Behavioral NeuroscienceUniversity of Cincinnati College of MedicineCincinnatiOHUSA,Lindner Center of HOPEMasonOHUSA
| | - Roger S. McIntyre
- Departments of Psychiatry & PharmacologyFaculty of MedicineUniversity of TorontoTorontoONCanada,Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada
| | - Miguel Prieto
- Department of PsychiatryFaculty of MedicineUniversidad de los AndesSantiagoChile,Mental Health ServiceClínica Universidad de los AndesSantiagoChile,Department of Psychiatry and PsychologyMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | - Louisa G. Sylvia
- Department of PsychiatryMassachusetts General HospitalBostonMAUSA,Department of PsychiatryHarvard Medical SchoolCambridgeMAUSA
| | - Shang‐Ying Tsai
- Department of PsychiatryTaipei Medical University HospitalTaipeiTaiwan,Department of PsychiatrySchool of MedicineCollege of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Andrew Kcomt
- Hope+Me—Mood Disorders Association of OntarioTorontoONCanada
| | - Jess G. Fiedorowicz
- Departments of Psychiatry, Internal Medicine, & EpidemiologyCarver College of MedicineUniversity of IowaIowa CityIAUSA
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16
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Luckhoff HK, du Plessis S, Kilian S, Asmal L, Scheffler F, Phahladira L, Olivier RM, Emsley R. Hippocampal subfield volumes and change in body mass over 12 months of treatment in first-episode schizophrenia spectrum disorders. Psychiatry Res Neuroimaging 2020; 300:111084. [PMID: 32388386 DOI: 10.1016/j.pscychresns.2020.111084] [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: 08/29/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
In this study, we explored the relationship between baseline hippocampal subfield volumes and change in body mass over 12 months of treatment in 90 first-episode schizophrenia spectrum disorder patients (66 males, 24 females; mean age= 24.7 ± 6.8 years). Body mass index was assessed in patients at baseline, and at months 3, 6, 9 and 12. Hippocampal subfields of interest were assessed at baseline using a segmentation algorithm included in the FreeSurfer 6.0 software program. Linear regression revealed a significant interactive effect between sex and anterior hippocampus size as predictors of change in body mass over 12 months, adjusting for age, substance use, and treatment duration. In an exploratory post-hoc sub-analysis, partial correlations showed a significant association between weight gain and smaller CA1, CA3 and subiculum volumes in females, but not males, adjusting for age and substance use, with similar trends evident for the CA4 and presubiculum subfields. In conclusion, our findings suggest that smaller anterior hippocampal subfields at baseline are associated with the development of weight gain over the course of treatment in first-episode schizophrenia spectrum disorders in a sex-specific fashion. This may be related to the greater increase in body mass evident for female patients in our study.
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Affiliation(s)
- H K Luckhoff
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa.
| | - S du Plessis
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa
| | - S Kilian
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa
| | - L Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa
| | - F Scheffler
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa
| | - L Phahladira
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa
| | - R M Olivier
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa
| | - R Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa
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17
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Bond DJ, Torres IJ, Lam RW, Yatham LN. Serum epidermal growth factor, clinical illness course, and limbic brain volumes in early-stage bipolar disorder. J Affect Disord 2020; 270:30-35. [PMID: 32275217 DOI: 10.1016/j.jad.2020.03.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/29/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Epidermal growth factor (EGF) belongs to a family of growth factors implicated in the etiology of psychiatric illnesses. We conducted this cross-sectional case-control study to determine whether (1) serum EGF levels differ between bipolar disorder (BD) patients and non-BD comparison subjects, (2) EGF levels in patients are influenced by mood illness related factors (number of past mood episodes, medication treatment) and non-mood illness related factors (body mass index), and (3) lower EGF levels predict lower limbic brain volumes in BD. METHODS We measured serum EGF in 51 early-stage BD patients and 22 healthy comparison subjects (HS). A subset of 25 patients underwent cerebral magnetic resonance imaging (MRI). Participants were assessed at the University of British Columbia Mood Disorders Centre between June 2004 and June 2012. RESULTS A general linear model with diagnosis and BMI category (overweight/obese vs normal weight) as factors showed that patients had lower mean log(e)-transformed EGF (LnEGF) than HS (4.99 vs 5.47, p = .011). There was no effect of BMI and no diagnosis x BMI interaction. Multiple linear regression models showed that in patients, more past mood episodes predicted lower LnEGF (β = -0.358, t = -2.585, p = .013) and lower LnEGF predicted lower bilateral temporal lobe volumes (left: β = 0.560, p = .011; right: β = 0.543, p = .009). LIMITATIONS Our cross-sectional study design limits our ability to make inferences about the causal directions of the relationships between EGF, diagnosis, mood episodes, and brain volumes. CONCLUSIONS These findings provide preliminary evidence that EGF is a novel biomarker that may play a role in the pathophysiology of BD.
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Affiliation(s)
- David J Bond
- Department of Psychiatry and Behavioral Science, University of Minnesota Medical School, Minneapolis, Minnesota, USA; Mood Disorders Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ivan J Torres
- Mood Disorders Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymond W Lam
- Mood Disorders Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lakshmi N Yatham
- Mood Disorders Centre, University of British Columbia, Vancouver, British Columbia, Canada.
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18
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Chalopin S, Betry C, Coumes S, Wion N, Reche F, Arvieux C, Borel AL. Benefits and risks of bariatric surgery in patients with bipolar disorders. Surg Obes Relat Dis 2020; 16:798-805. [PMID: 32209316 DOI: 10.1016/j.soard.2020.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 10/24/2022]
Abstract
The prevalence of bipolar disorders in patients requesting bariatric surgery is estimated to be 1.5% to 3.4%. There are currently no specific recommendations regarding the way bariatric surgery should be managed in the context of bipolar disorder. The aim was to document the benefit-risk of bariatric surgery in patients with bipolar disorders. A systematic literature review was carried out. In addition, results were reported from a survey of current clinical practice in French referent centers for obesity care. Finally, 3 clinical cases from the "Severe Obesity Outcome Network" cohort are described. This systematic review shows there are few studies in the literature regarding the outcomes of bariatric surgery in patients with bipolar disorders and no randomized, controlled trials. Weight loss appeared similar in all patients, but psychiatric complications were sometimes reported in those with bipolar disorders. Almost all 11 referent centers for obesity care that responded had carried out bariatric surgery in patients with stable bipolar disorders. Postsurgical psychiatric destabilization occurred and included, at least, a need to reinforce treatment and follow-up. In the 3 case studies, postsurgical manic or hypomanic decompensation occurred. Thus, although effective in terms of weight loss, bariatric surgery could be a destabilizing factor for those with bipolar disorders. Current practice is to contraindicate surgery in patients with unstable disorders. There are insufficient data to conclude on the benefits and safety of bariatric surgery in patients with stable bipolar disease. Further studies are required to fully determine the benefits and risks.
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Affiliation(s)
- Sarah Chalopin
- Endocrinology, Diabetology, Nutrition, University Hospital Grenoble Alpes, Grenoble, France
| | - Cécile Betry
- Endocrinology, Diabetology, Nutrition, University Hospital Grenoble Alpes, Grenoble, France
| | - Sandrine Coumes
- Endocrinology, Diabetology, Nutrition, University Hospital Grenoble Alpes, Grenoble, France
| | - Nelly Wion
- Endocrinology, Diabetology, Nutrition, University Hospital Grenoble Alpes, Grenoble, France
| | - Fabian Reche
- Digestive Surgery, University Hospital Grenoble Alpes, Grenoble, France
| | - Catherine Arvieux
- Digestive Surgery, University Hospital Grenoble Alpes, Grenoble, France
| | - Anne-Laure Borel
- Endocrinology, Diabetology, Nutrition, University Hospital Grenoble Alpes, Grenoble, France; Hypoxia Physiopathology (HP2) Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France.
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19
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Abstract
Patients with psychotic disorders are at high risk for type 2 diabetes mellitus, and there is increasing evidence that patients display glucose metabolism abnormalities before significant antipsychotic medication exposure. In the present study, we examined insulin action by quantifying insulin sensitivity in first-episode psychosis (FEP) patients and unaffected siblings, compared to healthy individuals, using a physiological-based model and comprehensive assessment battery. Twenty-two unaffected siblings, 18 FEP patients, and 15 healthy unrelated controls were evaluated using a 2-h oral glucose tolerance test (OGTT), with 7 samples of plasma glucose and serum insulin concentration measurements. Insulin sensitivity was quantified using the oral minimal model method. Lipid, leptin, free fatty acids, and inflammatory marker levels were also measured. Anthropometric, nutrient, and activity assessments were conducted; total body composition and fat distribution were determined using whole-body dual-energy X-ray absorptiometry. Insulin sensitivity significantly differed among groups (F = 6.01 and 0.004), with patients and siblings showing lower insulin sensitivity, compared to controls (P = 0.006 and 0.002, respectively). Body mass index, visceral adipose tissue area (cm2), lipids, leptin, free fatty acids, inflammatory markers, and activity ratings were not significantly different among groups. There was a significant difference in nutrient intake with lower total kilocalories/kilogram body weight in patients, compared to siblings and controls. Overall, the findings suggest that familial abnormal glucose metabolism or a primary insulin signaling pathway abnormality is related to risk for psychosis, independent of disease expression and treatment effects. Future studies should examine underlying biological mechanisms of insulin signaling abnormalities in psychotic disorders.
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20
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Bora E, McIntyre RS, Ozerdem A. Neurococognitive and neuroimaging correlates of obesity and components of metabolic syndrome in bipolar disorder: a systematic review. Psychol Med 2019; 49:738-749. [PMID: 30326979 DOI: 10.1017/s0033291718003008] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Individuals with bipolar disorder (BD) have a higher prevalence of obesity and metabolic syndrome (MetS) compared with the general population. Obesity and MetS are associated with cognitive deficits and brain imaging abnormalities in the general population. Obesity and components of MetS might potentially associate with neuroimaging and neurocognitive findings in BD. METHODS A literature search of studies investigating the association between obesity (and other components of MetS) and neurocognitive and neuroimaging findings in BD was conducted. In addition to a systematic review, a random-effects meta-analysis was conducted when sufficient data were available. RESULTS Twenty-three studies were included in the current systematic review. Overweight/obese patients were significantly associated with impaired neurocognition compared normal weight individuals with BD (d = 0.37). The most robust association between obesity and cognitive deficits in BD was observed in the cognitive subdomain of executive functions (d = 0.61). There was also evidence for a significant relationship between cognitive impairment in BD and other components of MetS including hypertension, dyslipidemia, and diabetes. Overweight/obese individuals with BD had more pronounced brain imaging abnormalities than normal weight individuals with BD. CONCLUSIONS Obesity and related cardiovascular risk factors significantly are associated with more severe cognitive and brain imaging abnormalities in BD. Medical co-morbidities can potentially contribute to functional decline observed in some patients throughout the course of BD.
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Affiliation(s)
- Emre Bora
- Department of Psychiatry,Dokuz Eylul University School of Medicine,Izmir,Turkey
| | - Roger S McIntyre
- Department of Psychiatry,University of Toronto,Toronto, ON,Canada
| | - Aysegul Ozerdem
- Department of Psychiatry,Dokuz Eylul University School of Medicine,Izmir,Turkey
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21
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Bond DJ, Su W, Honer WG, Dhanoa T, Batres-Y-Carr T, Lee SS, Torres IJ, Lam RW, Yatham LN. Weight gain as a predictor of frontal and temporal lobe volume loss in bipolar disorder: A prospective MRI study. Bipolar Disord 2019; 21:50-60. [PMID: 30422375 DOI: 10.1111/bdi.12722] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES A sizable fraction of people with bipolar I disorder (BDI) experience a deteriorating clinical course with increasingly frequent mood episodes and chronic disability. This is believed to result from neurobiological illness progression, or neuroprogression. Excessive weight gain predicts neuroprogression across multiple brain illnesses, but no prospective studies have investigated this in BDI. The objective of this study was to determine whether BDI patients who experienced clinically significant weight gain (CSWG; gaining ≥7% of baseline weight) over 12 months had greater 12-month brain volume loss in frontal and temporal regions important to BDI. METHODS In 55 early-stage BDI patients we measured (i) rates of CSWG, (ii) the number of days with mood symptoms, using NIMH LifeCharts, and (iii) baseline and 12-month brain volumes, using 3T MRI. We quantified brain volumes using the longitudinal processing stream in FreeSurfer v6.0. We used general linear models for repeated measures to investigate whether CSWG predicted volume loss, adjusting for potentially confounding clinical and treatment variables. RESULTS After correction for multiple comparisons, CSWG in patients predicted greater volume loss in the left orbitofrontal cortex (effect size [ES; Cohen's d] = -1.01, P = 0.002), left cingulate gyrus (ES = -1.31, P < 0.001), and left middle temporal gyrus (ES = -0.96, P = 0.004). Middle temporal volume loss predicted more days with depression (β = -0.406, P = 0.010). CONCLUSIONS These are the first prospective data on weight gain and neuroprogression in BDI. CSWG predicted neuroprogression, and neuroprogression predicted a worse clinical illness course. Trials of weight loss interventions are needed to confirm the causal direction of the weight gain-neuroprogression relationship, and to determine whether weight loss is a disease-modifying treatment.
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Affiliation(s)
- David J Bond
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota
- Mood Disorders Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Taj Dhanoa
- Mood Disorders Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tegan Batres-Y-Carr
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Susanne S Lee
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Ivan J Torres
- Mood Disorders Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymond W Lam
- Mood Disorders Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lakshmi N Yatham
- Mood Disorders Centre, University of British Columbia, Vancouver, British Columbia, Canada
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22
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Tsai SY, Gildengers AG, Hsu JL, Chung KH, Chen PH, Huang YJ. Inflammation associated with volume reduction in the gray matter and hippocampus of older patients with bipolar disorder. J Affect Disord 2019; 244:60-66. [PMID: 30317016 DOI: 10.1016/j.jad.2018.10.093] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/22/2018] [Accepted: 10/05/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Bipolar disorder (BD) and aging appear to be associated with inflammatory activation. Inflammatory processes might affect hippocampal function, neurogenesis, and gray matter loss. This study investigated the relationship between BD-specific brain regions and the total gray matter volume, peripheral inflammatory markers, and clinical features in older patients with BD. METHODS We recruited euthymic patients with bipolar I disorder aged ≥50 years to undergo whole-brain magnetic resonance imaging. Each brain region was divided by an individual's total intracranial volume to obtain that brain region's volume in percentage relative to the total intracranial volume. We measured the plasma levels of soluble tumor necrosis factor receptor-1 (sTNF-R1), soluble interleukin (IL)-2 receptor (sIL-2R), sIL-6R, IL-1β, and IL-1 receptor antagonist when patients were euthymic. Clinical data were obtained by reviewing available medical records and interviewing patients along with their reliable others. RESULTS There were 32 patients with a mean age of 61.2 ± 8.3 years and a mean age at illness onset of 33.4 ± 13.8 years in this study. Stepwise regression showed that the right hippocampal volume was negatively associated with the levels of sIL-2R and sTNF-R1. The left hippocampal volume were negatively associated with the sIL-2R level and body mass index. The total gray matter volume had an inverse relationship with sTNF-R1 and IL-1β levels. The duration of bipolar illness, lithium treatment, and antipsychotic use were not associated with hippocampal and total gray matter volumes. CONCLUSIONS It is suggested that persistent inflammation is associated with reduction of hippocampal and gray matter volumes in older patients with BD. This phenomenon is supported by increases in sTNF-R1, sIL-2R, and IL-1β levels. Neuroinflammation due to aging, obesity, and BD pathophysiology may play a role in BD neuroprogression across the life span.
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Affiliation(s)
- Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Ariel G Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jung-Lung Hsu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Kuo-Hsuan Chung
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Pao-Huan Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Jui Huang
- Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
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23
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Kolenic M, Franke K, Hlinka J, Matejka M, Capkova J, Pausova Z, Uher R, Alda M, Spaniel F, Hajek T. Obesity, dyslipidemia and brain age in first-episode psychosis. J Psychiatr Res 2018; 99:151-158. [PMID: 29454222 DOI: 10.1016/j.jpsychires.2018.02.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Obesity and dyslipidemia may negatively affect brain health and are frequent medical comorbidities of schizophrenia and related disorders. Despite the high burden of metabolic disorders, little is known about their effects on brain structure in psychosis. We investigated, whether obesity or dyslipidemia contributed to brain alterations in first-episode psychosis (FEP). METHODS 120 participants with FEP, who were undergoing their first psychiatric hospitalization, had <24 months of untreated psychosis and were 18-35 years old and 114 controls within the same age range participated in the study. We acquired 3T brain structural MRI, fasting lipids and body mass index. We used machine learning trained on an independent sample of 504 controls to estimate the individual brain age of study participants and calculated the BrainAGE score by subtracting the chronological from the estimated brain age. RESULTS In a multiple regression model, the diagnosis of FEP (B = 1.15, SE B = 0.31, p < 0.001) and obesity/overweight (B = 0.92, SE B = 0.35, p = 0.008) were each additively associated with BrainAGE scores (R2 = 0.22, F(3, 230) = 21.92, p < 0.001). BrainAGE scores were highest in participants with FEP and obesity/overweight (3.83 years, 95%CI = 2.35-5.31) and lowest in normal weight controls (-0.27 years, 95%CI = -1.22-0.69). LDL-cholesterol, HDL-cholesterol or triglycerides were not associated with BrainAGE scores. CONCLUSIONS Overweight/obesity may be an independent risk factor for diffuse brain alterations manifesting as advanced brain age already early in the course of psychosis. These findings raise the possibility that targeting metabolic health and intervening already at the level of overweight/obesity could slow brain ageing in FEP.
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Affiliation(s)
- Marian Kolenic
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic; 3rd School of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic
| | - Katja Franke
- Structural Brain Mapping Group, Department of Neurology, Jena University Hospital, Erlanger Alle 101, D - 07747, Jena, Germany
| | - Jaroslav Hlinka
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic; Institute of Computer Science, Czech Academy of Sciences, Pod Vodarenskou Vezi 271/2, 182 07, Prague, Czech Republic
| | - Martin Matejka
- 3rd School of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic; Psychiatric Hospital Bohnice, Ústavní 91, 181 00, Prague, Czech Republic; Psychiatric Hospital Kosmonosy, Lípy 15, 293 06, Kosmonosy, Czech Republic
| | - Jana Capkova
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic; 3rd School of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic
| | - Zdenka Pausova
- The Hospital for Sick Children, University of Toronto, 686 Bay Street, 10-9705, Toronto, ON M5G 0A4, Canada
| | - Rudolf Uher
- Dalhousie University, Department of Psychiatry, 5909, Veteran's Memorial Lane, Halifax, NS B3H 2E2, Canada
| | - Martin Alda
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic; Dalhousie University, Department of Psychiatry, 5909, Veteran's Memorial Lane, Halifax, NS B3H 2E2, Canada
| | - Filip Spaniel
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Tomas Hajek
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic; Dalhousie University, Department of Psychiatry, 5909, Veteran's Memorial Lane, Halifax, NS B3H 2E2, Canada.
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24
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Pezzoli S, Emsell L, Yip SW, Dima D, Giannakopoulos P, Zarei M, Tognin S, Arnone D, James A, Haller S, Frangou S, Goodwin GM, McDonald C, Kempton MJ. Meta-analysis of regional white matter volume in bipolar disorder with replication in an independent sample using coordinates, T-maps, and individual MRI data. Neurosci Biobehav Rev 2018; 84:162-170. [PMID: 29162519 PMCID: PMC5771263 DOI: 10.1016/j.neubiorev.2017.11.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/20/2017] [Accepted: 11/14/2017] [Indexed: 12/15/2022]
Abstract
Converging evidence suggests that bipolar disorder (BD) is associated with white matter (WM) abnormalities. Meta-analyses of voxel based morphometry (VBM) data is commonly performed using published coordinates, however this method is limited since it ignores non-significant data. Obtaining statistical maps from studies (T-maps) as well as raw MRI datasets increases accuracy and allows for a comprehensive analysis of clinical variables. We obtained coordinate data (7-studies), T-Maps (12-studies, including unpublished data) and raw MRI datasets (5-studies) and analysed the 24 studies using Seed-based d Mapping (SDM). A VBM analysis was conducted to verify the results in an independent sample. The meta-analysis revealed decreased WM volume in the posterior corpus callosum extending to WM in the posterior cingulate cortex. This region was significantly reduced in volume in BD patients in the independent dataset (p=0.003) but there was no association with clinical variables. We identified a robust WM volume abnormality in BD patients that may represent a trait marker of the disease and used a novel methodology to validate the findings.
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Affiliation(s)
- Stefania Pezzoli
- Department of Neuroscience, Medical School, University of Sheffield, Sheffield, UK; Department of Psychosis Studies, Institute of Psychiatry Psychology & Neuroscience, King's College London, UK
| | - Louise Emsell
- Translational MRI, Department of Imaging & Pathology, KU Leuven, Belgium; Department of Old Age Psychiatry, University Psychiatry Centre (UPC), KU Leuven, Belgium; Neuroimaging, Cognition & Genomics Centre (NICOG) & NCBES Galway Neuroscience Centre, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Sarah W Yip
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Danai Dima
- Department of Psychology, City, University of London, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK
| | | | - Mojtaba Zarei
- National Brain Mapping Centre, Shahid Beheshti University, General and Medical Campus, Tehran, Iran
| | - Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry Psychology & Neuroscience, King's College London, UK
| | - Danilo Arnone
- Centre for Affective Disorders, Institute of Psychiatry Psychology & Neuroscience, King's College London, UK
| | - Anthony James
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Sven Haller
- Affidea CDRC - Centre Diagnostique Radiologique de Carouge, Switzerland; Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden; Department of Neuroradiology, University Hospital Freiburg, Germany; Faculty of Medicine of the University of Geneva, Switzerland
| | | | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Colm McDonald
- Neuroimaging, Cognition & Genomics Centre (NICOG) & NCBES Galway Neuroscience Centre, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry Psychology & Neuroscience, King's College London, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK.
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25
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Islam AH, Metcalfe AWS, MacIntosh BJ, Korczak DJ, Goldstein BI. Greater body mass index is associated with reduced frontal cortical volumes among adolescents with bipolar disorder. J Psychiatry Neurosci 2017; 43:170041. [PMID: 29077553 PMCID: PMC5837884 DOI: 10.1503/jpn.170041] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/05/2017] [Accepted: 09/05/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Higher body mass index (BMI) and obesity is common among youth with bipolar disorder (BD) and is associated with greater psychiatric illness severity, including suicidality. Obesity has been associated with frontal, temporal and subcortical volumetric reductions in adults with BD. We examined the neurostructural correlates of BMI in adolescents early in their course of BD. METHODS We processed T1-weighted images of adolescents with BD and psychiatrically healthy controls using FreeSurfer to derive a priori region of interest (ROI) volumes/cortical thickness for the frontal lobe (FL), prefrontal cortex (PFC) and orbitofrontal cortex (OFC) as well as volumes for the amygdala and hippocampus. General linear models assessed the association between BMI and the ROIs, controlling for age, sex and intracranial volume. We also conducted exploratory within-BD group and whole brain vertex-wise analyses. RESULTS We included 40 adolescents with BD and 48 controls in our analyses. In addition to a main effect of BMI on the ROIs, there were significant diagnosis × BMI interaction effects on FL volumes. In the BD group only, BMI was negatively associated with FL, OFC and PFC cortical thickness. Whole brain analysis of BMI-volume correlations revealed 2 significant interaction clusters: 1 in the medial OFC and 1 in the caudal anterior cingulate cortex, with BD showing a stronger negative correlation. LIMITATIONS Reliance on BMI rather than a more nuanced measure of obesity may have influenced the findings. CONCLUSION Our results suggest that elevated BMI among adolescents with BD is associated with frontal neurostructural differences that are not observed in controls. Prospective studies examining the direction of the observed associations and the effect of BMI optimization on brain structure in adolescents with BD are warranted.
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Affiliation(s)
- Alvi H Islam
- From the Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (Islam, Metcalfe, Goldstein); the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Korczak, Goldstein); the Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh); the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh, Goldstein); the Hospital for Sick Children, Toronto, Ont., Canada (Korczak); the Department of Medical Biophysics, University of Toronto, Toronto, Ont., Canada (MacIntosh); the Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (MacIntosh); and the Department of Pharmacology, University of Toronto, Toronto, Ont., Canada (Goldstein)
| | - Arron W S Metcalfe
- From the Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (Islam, Metcalfe, Goldstein); the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Korczak, Goldstein); the Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh); the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh, Goldstein); the Hospital for Sick Children, Toronto, Ont., Canada (Korczak); the Department of Medical Biophysics, University of Toronto, Toronto, Ont., Canada (MacIntosh); the Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (MacIntosh); and the Department of Pharmacology, University of Toronto, Toronto, Ont., Canada (Goldstein)
| | - Bradley J MacIntosh
- From the Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (Islam, Metcalfe, Goldstein); the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Korczak, Goldstein); the Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh); the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh, Goldstein); the Hospital for Sick Children, Toronto, Ont., Canada (Korczak); the Department of Medical Biophysics, University of Toronto, Toronto, Ont., Canada (MacIntosh); the Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (MacIntosh); and the Department of Pharmacology, University of Toronto, Toronto, Ont., Canada (Goldstein)
| | - Daphne J Korczak
- From the Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (Islam, Metcalfe, Goldstein); the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Korczak, Goldstein); the Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh); the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh, Goldstein); the Hospital for Sick Children, Toronto, Ont., Canada (Korczak); the Department of Medical Biophysics, University of Toronto, Toronto, Ont., Canada (MacIntosh); the Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (MacIntosh); and the Department of Pharmacology, University of Toronto, Toronto, Ont., Canada (Goldstein)
| | - Benjamin I Goldstein
- From the Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (Islam, Metcalfe, Goldstein); the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Korczak, Goldstein); the Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh); the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh, Goldstein); the Hospital for Sick Children, Toronto, Ont., Canada (Korczak); the Department of Medical Biophysics, University of Toronto, Toronto, Ont., Canada (MacIntosh); the Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (MacIntosh); and the Department of Pharmacology, University of Toronto, Toronto, Ont., Canada (Goldstein)
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26
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Minichino A, Ando' A, Francesconi M, Salatino A, Delle Chiaie R, Cadenhead K. Investigating the link between drug-naive first episode psychoses (FEPs), weight gain abnormalities and brain structural damages: Relevance and implications for therapy. Prog Neuropsychopharmacol Biol Psychiatry 2017; 77:9-22. [PMID: 28363765 DOI: 10.1016/j.pnpbp.2017.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 03/08/2017] [Accepted: 03/20/2017] [Indexed: 02/08/2023]
Abstract
Evidence suggests that obesity and overweight may be associated with severe brain structural abnormalities and poor cognitive and functional outcomes in the general population. Despite these observations and the high prevalence of weight gain abnormalities in patients with psychosis spectrum disorders (PSDs), no studies have investigated the impact that these metabolic disturbances may have on brain structures and development in the earliest stages of PSDs. In the present review we shed light on the association between weight gain and brain structural abnormalities that may affect the course of illness in drug-naïve FEPs. Given the lack of studies directly investigating this issue, we firstly identified and critically evaluated the literature assessing weight gain abnormalities and gray or white matter (GM, WM) volumes (either globally or in specific regions of interest) in otherwise healthy obese/overweight adolescents and young adults. We then compared the results of this systematic review with those of two recent meta-analysis investigating GM and WM abnormalities in drug-naïve FEPs. Weight gain in otherwise healthy subjects was consistently associated with frontal and temporal GM atrophy and with reduced integrity of WM in the corpus callosum. Of relevance, all these brain regions are affected in drug-naïve FEPs, and their integrity is associated with clinical, cognitive and functional outcomes. The underlying mechanisms that may explain the association between weight gain, adiposity, and brain damage in both healthy subjects and drug-naïve FEPs are widely discussed. On the basis of this knowledge, we tried: a) to deduce an integrative model for the development of obesity in psychosis spectrum disorders; b) to identify the key vulnerability factors underlying the association between weight gain and psychosis; c) to provide information on new potential targets of intervention.
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Affiliation(s)
- Amedeo Minichino
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy; Department of Psychiatry, UCSD, La Jolla, CA, United States.
| | - Agata Ando'
- Department of Psychology, University of Turin, Italy
| | - Marta Francesconi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy; Department of Psychiatry, UCSD, La Jolla, CA, United States
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27
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Mazza E, Poletti S, Bollettini I, Locatelli C, Falini A, Colombo C, Benedetti F. Body mass index associates with white matter microstructure in bipolar depression. Bipolar Disord 2017; 19:116-127. [PMID: 28418197 DOI: 10.1111/bdi.12484] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 03/06/2017] [Accepted: 03/12/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Obesity has been reported in over 60% of bipolar disorder (BD) patients. It worsens the severity of illness, and influences cognition and functional outcomes. White matter (WM) abnormalities are one of the most consistently reported findings in neuroimaging studies of BD. We hypothesized that body mass index (BMI) could correlate with WM integrity in bipolar patients. METHODS We evaluated BMI in a sample of 164 depressed patients affected by BD. We performed whole-brain tract-based spatial statistics with threshold-free cluster enhancement for the diffusion tensor imaging (DTI) measures of WM integrity: fractional anisotropy; axial, radial, and mean diffusivity. RESULTS We observed that BMI was associated with DTI measures of WM integrity in several fiber tracts: anterior corona radiata, anterior thalamic radiation, inferior fronto-occipital fasciculus and corpus callosum. CONCLUSIONS The association of BMI in key WM tracts that are crucial to mood regulation and neurocognitive functioning suggests that BMI might contribute to the pathophysiology of BD through a detrimental action on structural connectivity in critical cortico-limbic networks.
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Affiliation(s)
- Elena Mazza
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Sara Poletti
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, Milan, Italy.,C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
| | - Irene Bollettini
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, Milan, Italy.,C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
| | - Clara Locatelli
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, Milan, Italy.,C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Falini
- C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy.,Department of Neuroradiology, Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Cristina Colombo
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Francesco Benedetti
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, Milan, Italy.,C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
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28
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Bond DJ, Torres IJ, Lee SS, Kozicky JM, Silveira LE, Dhanoa T, Lam RW, Yatham LN. Lower cognitive functioning as a predictor of weight gain in bipolar disorder: a 12-month study. Acta Psychiatr Scand 2017; 135:239-249. [PMID: 27995622 DOI: 10.1111/acps.12674] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In cross-sectional studies, elevated body mass index (BMI) is associated with cognitive impairment in bipolar disorder (BD). We investigated the direction of this association by prospectively examining changes in BMI and cognition. METHOD We measured BMI and performance in six cognitive domains over 12 months in 80 adolescent and young adult BD patients and 46 healthy comparison subjects (HS). Ninety-three percent of patients received pharmacotherapy and 84% were euthymic. We used repeated-measures ancova and longitudinal mixed models to investigate whether (i) higher BMI and increasing BMI over time predicted lower subsequent cognitive functioning, and (ii) lower cognitive functioning and changes in cognition predicted increasing BMI. RESULTS Neither baseline BMI nor BMI change predicted lower cognitive functioning. Lower baseline scores in attention, verbal memory, working memory, and a composite measure of global cognition predicted increasing BMI in patients and HS. In patients, lower cognitive functioning remained associated with increasing BMI when clinical and treatment variables were adjusted for. Improvement in working memory predicted a smaller subsequent BMI increase in patients. CONCLUSION Lower cognitive functioning in specific domains predicts increasing BMI in patients with BD and healthy young adults. Targeting cognition may be important for minimizing weight gain in BD.
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Affiliation(s)
- D J Bond
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - I J Torres
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
| | - S S Lee
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J-M Kozicky
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
| | - L E Silveira
- Laboratory of Molecular Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - T Dhanoa
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
| | - R W Lam
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
| | - L N Yatham
- Mood Disorders Centre, University of British Columbia, Vancouver, BC, Canada
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Diagnosis and body mass index effects on hippocampal volumes and neurochemistry in bipolar disorder. Transl Psychiatry 2017; 7:e1071. [PMID: 28350397 PMCID: PMC5404613 DOI: 10.1038/tp.2017.42] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 11/14/2016] [Accepted: 01/15/2017] [Indexed: 12/14/2022] Open
Abstract
We previously reported that higher body mass index (BMI) was associated with greater hippocampal glutamate+glutamine in people with bipolar disorder (BD), but not in non-BD healthy comparator subjects (HSs). In the current report, we extend these findings by examining the impact of BD diagnosis and BMI on hippocampal volumes and the concentrations of several additional neurochemicals in 57 early-stage BD patients and 31 HSs. Using 3-T magnetic resonance imaging and magnetic resonance spectroscopy, we measured bilateral hippocampal volumes and the hippocampal concentrations of four neurochemicals relevant to BD: N-acetylaspartate+N-acteylaspartylglutamate (tNAA), creatine+phosphocreatine (Cre), myoinositol (Ins) and glycerophosphocholine+phosphatidylcholine (Cho). We used multivariate factorial analysis of covariance to investigate the impact of diagnosis (patient vs HS) and BMI category (normal weight vs overweight/obese) on these variables. We found a main effect of diagnosis on hippocampal volumes, with patients having smaller hippocampi than HSs. There was no association between BMI and hippocampal volumes. We found diagnosis and BMI effects on hippocampal neurochemistry, with patients having lower Cre, Ins and Cho, and overweight/obese subjects having higher levels of these chemicals. In patient-only models that controlled for clinical and treatment variables, we detected an additional association between higher BMI and lower tNAA that was absent in HSs. To our knowledge, this was the first study to investigate the relative contributions of BD diagnosis and BMI to hippocampal volumes, and only the second to investigate their contributions to hippocampal chemistry. It provides further evidence that diagnosis and elevated BMI both impact limbic brain areas relevant to BD.
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Hu C, Torres IJ, Qian H, Wong H, Halli P, Dhanoa T, Ahn S, Wang G, Bond DJ, Lam RW, Yatham LN. Trajectories of body mass index change in first episode of mania: 3-year data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM). J Affect Disord 2017; 208:291-297. [PMID: 27794253 DOI: 10.1016/j.jad.2016.08.048] [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] [Received: 05/20/2016] [Revised: 07/23/2016] [Accepted: 08/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Overweight/obesity is common in patients with bipolar disorder (BD). However, little is known about longitudinal trends in body mass index (BMI) in patients with BD. Furthermore, most studies on the association between BMI and clinical outcomes are restricted by retrospective and cross-sectional designs. This study uses prospectively-gathered data from a first episode mania (FEM) cohort to examine the trajectories of BMI change and analyze their association with clinical outcomes during a 3-year period. METHODS A total of 110 FEM patients receiving maintenance treatment and 57 healthy subjects were included. The comparisons of BMI trajectories were examined using linear mixed-effects models. The effects of BMI on time to any mood episode were assessed by Cox proportional-hazards models. RESULTS The estimated mean BMI in FEM patients significantly increased from 24.0kg/m2 to 25.4kg/m2 within 6 months. FEM patients had a significant BMI increase trend over the entire 3 years follow-up, which was not observed in the control group. No significant difference in BMI trajectory between patient subgroups (baseline normal-weight vs. overweight/obese; male vs. female) was observed. BMI increase predicted an increased risk of recurrence during follow-up visits (HR=1.50, 95% CI: 1.06-2.13; p=0.02). LIMITATIONS Naturalistic design does not allow the accurate assessments of the impact of pharmacologic treatments on BMI. CONCLUSIONS FEM patients showed a significantly increased BMI trajectory compared to healthy subjects. Furthermore, BMI increase is independently associated with an increased risk of recurrence to a new mood episode during 3-year follow-up. Thus, weight control prevention is needed in the early course of BD.
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Affiliation(s)
- Chen Hu
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada; Mood Disorders Centre, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Ivan J Torres
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada
| | - Hong Qian
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - Hubert Wong
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Priyanka Halli
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada
| | - Taj Dhanoa
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada
| | - Sharon Ahn
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada
| | - Gang Wang
- Mood Disorders Centre, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - David J Bond
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada; Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Raymond W Lam
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada
| | - Lakshmi N Yatham
- Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada.
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31
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Viana-Sulzbach M, Pedrini M, Bücker J, Brietzke E, Gama CS. Hippocampus size does not correlate with body mass index in bipolar disorder. BRAZILIAN JOURNAL OF PSYCHIATRY 2017; 38:86-7. [PMID: 27111704 PMCID: PMC7115466 DOI: 10.1590/1516-4446-2015-1816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 09/30/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Miréia Viana-Sulzbach
- Laboratório de Psiquiatria Molecular, Instituto Nacional de Ciência e Tecnologia - Medicina Translacional (INCT-MT), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Mariana Pedrini
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Joana Bücker
- Laboratório de Psiquiatria Molecular, Instituto Nacional de Ciência e Tecnologia - Medicina Translacional (INCT-MT), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Elisa Brietzke
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Clarissa S Gama
- Laboratório de Psiquiatria Molecular, Instituto Nacional de Ciência e Tecnologia - Medicina Translacional (INCT-MT), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Syan SK, Minuzzi L, Smith M, Costescu D, Allega OR, Hall GBC, Frey BN. Brain Structure and Function in Women with Comorbid Bipolar and Premenstrual Dysphoric Disorder. Front Psychiatry 2017; 8:301. [PMID: 29367847 PMCID: PMC5768056 DOI: 10.3389/fpsyt.2017.00301] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/18/2017] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Hormonal fluctuations associated with female reproductive life events may precipitate or worsen affective episodes in women with bipolar disorder (BD). Previous studies have shown that women with BD report higher rates of premenstrual dysphoric disorder (PMDD) than controls. Further, bipolar women who report premenstrual worsening of mood display a worse course of their bipolar illness. Despite this, the neural correlates of comorbid BD and PMDD have not been investigated. METHODOLOGY Eighty-five [CTRL, n = 25; PMDD, n = 20; BD, n = 21; BD with comorbid PMDD (BDPMDD), n = 19], regularly cycling women, not on hormonal contraception, underwent two MRI scans: during their mid-follicular and late luteal menstrual phases. We investigated resting-state functional connectivity (Rs-FC), cortical thickness, and subcortical volumes of brain regions associated with the pathophysiology of BD and PMDD between groups, in the mid-follicular and late luteal phases of the menstrual cycle. All BD subjects were euthymic for at least 2 months prior to study entry. RESULTS Women in the BDPMDD group displayed greater disruption in biological rhythms and more subthreshold depressive and anxious symptoms through the menstrual cycle compared to other groups. Rs-FC was increased between the L-hippocampus and R-frontal cortex and decreased between the R-hippocampus and R-premotor cortex in BDPMDD vs. BD (FDR-corrected, p < 0.05). Cortical thickness analysis revealed decreased cortical thickness of the L-pericalcarine, L-superior parietal, R-middle temporal, R-rostral middle frontal, and L-superior frontal, as well as increased cortical thickness of the L-superior temporal gyri in BDPMDD compared to BD. We also found increased left-caudate volume in BDPMDD vs. BD (pCORR < 0.05). CONCLUSION Women with BD and comorbid PMDD display a distinct clinical and neurobiological phenotype of BD, which suggests differential sensitivity to endogenous hormones.
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Affiliation(s)
- Sabrina K Syan
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Luciano Minuzzi
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Mara Smith
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Dustin Costescu
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Olivia R Allega
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Geoffrey B C Hall
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Benicio N Frey
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Goldstein BI, Blanco C, He JP, Merikangas K. Correlates of Overweight and Obesity Among Adolescents With Bipolar Disorder in the National Comorbidity Survey-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 2016; 55:1020-1026. [PMID: 27871636 DOI: 10.1016/j.jaac.2016.08.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/23/2016] [Accepted: 09/21/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Despite substantial evidence on the prevalence and correlates of overweight and obesity (OW/OB) in adults with bipolar disorder (BD), little is known about this topic in adolescents with BD. METHOD The method consisted of the National Comorbidity Survey-Adolescent Supplement, a face-to-face survey of mental disorders from 2001 through 2004, using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview. Participants were adolescents 13 to 17 years of age, with bipolar disorder I or II (n = 295), major depressive disorder (n = 1,112), or controls with neither mood disorder (n = 8,716). Analyses examined for group differences in the prevalence of OW/OB and for correlates of OW/OB in the group with BD. RESULTS There were no significant differences in weight categories across groups. OW and OB in adolescents with BD were associated with significantly higher lifetime rates of suicide attempt (odds ratio 3.02, 95% CI 1.11-8.24), physical or sexual abuse (2.82, 1.20-6.60), binge eating or bulimia (2.66, 1.13-6.26), and conduct disorder (2.60, 1.10-6.13) in covariate-adjusted analyses. OW and OB also were significantly associated with seeing a professional for depression, being hospitalized overnight for depression, and receiving general medical treatment. CONCLUSION The similar prevalence of OW/OB in adolescents with and without BD suggests that this potent association in adults likely comprises a consequence of BD or its correlates. In contrast, the strong association of OW/OB with proxies for depression severity, including suicide attempts and hospitalization, is already evident even in this young, nonclinical sample. Studies are warranted to determine whether early intervention of OW/OB in BD might optimize physical and mental health.
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Affiliation(s)
- Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, and the University of Toronto, Toronto, Canada.
| | - Carlos Blanco
- National Institute on Drug Abuse and the Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD
| | - Jian-Ping He
- Genetic Epidemiology Research Branch and the Developmental Trajectories of Mental Disorders Branch, National Institute of Mental Health
| | - Kathleen Merikangas
- Genetic Epidemiology Research Branch and the Developmental Trajectories of Mental Disorders Branch, National Institute of Mental Health
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Chouinard VA, Pingali SM, Chouinard G, Henderson DC, Mallya SG, Cypess AM, Cohen BM, Öngür D. Factors associated with overweight and obesity in schizophrenia, schizoaffective and bipolar disorders. Psychiatry Res 2016; 237:304-10. [PMID: 26805561 DOI: 10.1016/j.psychres.2016.01.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 11/17/2015] [Accepted: 01/13/2016] [Indexed: 12/19/2022]
Abstract
Evidence suggests abnormal bioenergetic status throughout the body in psychotic disorders. The present study examined predictors of elevated body mass index (BMI) across diagnostic categories of schizophrenia, schizoaffective and bipolar disorders. In a cross-sectional study, we studied demographic and clinical risk factors for overweight and obesity in a well-characterized sample of 262 inpatients and outpatients with schizophrenia (n=59), schizoaffective disorder (n=81) and bipolar I disorder (n=122). Across the three diagnostic categories, the prevalence of overweight (29.4%) and obesity (33.2%) combined was 62.6% (164/262). Logistic regression analyses, adjusted for age, sex and ethnicity, showed that schizoaffective disorder, lifetime major depressive episode, presence of prior suicide attempt, and more than 5 lifetime hospitalizations were significantly associated with BMI≥25. Patients with schizophrenia had significantly lower risk for overweight and obesity. Overall, we found that affective components of illness were associated with elevated BMI in our cross-diagnostic sample. Our results show that patients with schizoaffective disorder have a greater risk for obesity. Identifying predictors of elevated BMI in patients with psychotic and mood disorders will help prevent obesity and related cardiovascular and cerebral complications. Future studies are needed to elucidate the mechanistic nature of the relationship between obesity and psychiatric illness.
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Affiliation(s)
- Virginie-Anne Chouinard
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA.
| | | | - Guy Chouinard
- Clinical Pharmacology and Toxicology Program, McGill University and Mental Health Institute of Montreal Fernand Seguin Research Centre, Montreal, Canada
| | - David C Henderson
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA; Schizophrenia Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sonal G Mallya
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA
| | - Aaron M Cypess
- Translational Physiology Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
| | - Bruce M Cohen
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
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Association of peripheral inflammation with body mass index and depressive relapse in bipolar disorder. Psychoneuroendocrinology 2016; 65:76-83. [PMID: 26731572 DOI: 10.1016/j.psyneuen.2015.12.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/14/2015] [Accepted: 12/14/2015] [Indexed: 01/21/2023]
Abstract
Bipolar I disorder (BD) is associated with increased inflammation, which is believed to be central to disease etiology and progression. However, BD patients also have high rates of obesity, itself an inflammatory condition, and the relative contributions of mood illness and obesity to inflammation are unknown. Moreover, the impact of inflammation on clinical illness course has not been well studied. The objectives of this analysis were therefore: (1) to determine if inflammation in BD is mood illness-related or secondary to elevated body mass index (BMI), and (2) to investigate the impact of inflammation on prospectively-ascertained relapse into depression and mania. We measured the serum levels of 7 inflammatory cytokines (TNF-α, γ-interferon, monocyte chemoattractant protein-1 [MCP-1], IL-1α, IL-2, IL-6, and IL-8) and 2 anti-inflammatory cytokines (IL-4 and IL-10) in 52 early-stage BD patients and 22 healthy subjects. In patients, a multivariate multiple regression model that controlled for psychotropic medications found that higher BMI, but not recent (past-6-month) mood episodes, predicted greater inflammatory cytokines (p=.05). Healthy subjects also had a BMI-related increase in inflammatory cytokines (p<.01), but it was counter-balanced by a compensatory increase in anti-inflammatory cytokines (p=.02), reducing their total inflammatory burden from higher BMI. In patients, linear regression showed that two inflammatory cytokines predicted depressive relapse in the 12 months after cytokine measurement: IL-1α (p<.01) and MCP-1 (p<.01). These results suggest that elevated BMI is a significant contributor to inflammation in BD, more so even than recent mood illness severity. They also point to inflammation as an important predictor of illness course, particularly depressive relapse.
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McElroy SL, Kemp DE, Friedman ES, Reilly-Harrington NA, Sylvia LG, Calabrese JR, Rabideau DJ, Ketter TA, Thase ME, Singh V, Tohen M, Bowden CL, Bernstein EE, Brody BD, Deckersbach T, Kocsis JH, Kinrys G, Bobo WV, Kamali M, McInnis MG, Leon AC, Faraone S, Nierenberg AA, Shelton RC. Obesity, but not metabolic syndrome, negatively affects outcome in bipolar disorder. Acta Psychiatr Scand 2016; 133:144-153. [PMID: 26114830 PMCID: PMC4844561 DOI: 10.1111/acps.12460] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Examine the effects of obesity and metabolic syndrome on outcome in bipolar disorder. METHOD The Comparative Effectiveness of a Second Generation Antipsychotic Mood Stabilizer and a Classic Mood Stabilizer for Bipolar Disorder (Bipolar CHOICE) study randomized 482 participants with bipolar disorder in a 6-month trial comparing lithium- and quetiapine-based treatment. Baseline variables were compared between groups with and without obesity, with and without abdominal obesity, and with and without metabolic syndrome respectively. The effects of baseline obesity, abdominal obesity, and metabolic syndrome on outcomes were examined using mixed effects linear regression models. RESULTS At baseline, 44.4% of participants had obesity, 48.0% had abdominal obesity, and 27.3% had metabolic syndrome; neither obesity, nor abdominal obesity, nor metabolic syndrome were associated with increased global severity, mood symptoms, or suicidality, or with poorer functioning or life satisfaction. Treatment groups did not differ on prevalence of obesity, abdominal obesity, or metabolic syndrome. By contrast, among the entire cohort, obesity was associated with less global improvement and less improvement in total mood and depressive symptoms, suicidality, functioning, and life satisfaction after 6 months of treatment. Abdominal obesity was associated with similar findings. Metabolic syndrome had no effect on outcome. CONCLUSION Obesity and abdominal obesity, but not metabolic syndrome, were associated with less improvement after 6 months of lithium- or quetiapine-based treatment.
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Affiliation(s)
- Susan L McElroy
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH and Lindner Center of HOPE, Mason, OH, USA
| | - David E Kemp
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
| | - Edward S Friedman
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Noreen A Reilly-Harrington
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Joseph R Calabrese
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
| | - Dustin J Rabideau
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Terence A Ketter
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael E Thase
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Vivek Singh
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Mauricio Tohen
- Department of Psychiatry, University of New Mexico Health Science Center, Albuquerque, NM, USA
| | - Charles L Bowden
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Emily E Bernstein
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin D Brody
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - James H Kocsis
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Gustavo Kinrys
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Masoud Kamali
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Andrew C. Leon
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Stephen Faraone
- Department of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Richard C Shelton
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA
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Bond DJ, da Silveira LE, MacMillan EL, Torres IJ, Lang DJ, Su W, Honer WG, Lam RW, Yatham LN. Relationship between body mass index and hippocampal glutamate/glutamine in bipolar disorder. Br J Psychiatry 2016; 208:146-52. [PMID: 26585092 DOI: 10.1192/bjp.bp.115.163360] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 02/14/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND We previously reported that patients with early-stage bipolar disorder, but not healthy comparison controls, had body mass index (BMI)-related volume reductions in limbic brain areas, suggesting that the structural brain changes characteristic of bipolar disorder were more pronounced with increased weight. AIMS To determine whether the most consistently reported neurochemical abnormality in bipolar disorder, increased glutamate/glutamine (Glx), was also more prominent with higher BMI. METHOD We used single-voxel proton magnetic resonance spectroscopy to measure hippocampal Glx in 51 patients with first-episode mania (mean BMI = 24.1) and 28 healthy controls (mean BMI = 23.3). RESULTS In patients, but not healthy controls, linear regression demonstrated that higher BMI predicted greater Glx. Factorial ANCOVA showed a significant BMI × diagnosis interaction, confirming a distinct effect of weight on Glx in patients. CONCLUSIONS Together with our volumetric studies, these results suggest that higher BMI is associated with more pronounced structural and neurochemical limbic brain changes in bipolar disorder, even in early-stage patients with low obesity rates.
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Affiliation(s)
- David J Bond
- David J. Bond, MD, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada and Department of Psychiatry, University of Minnesota, Minneapolis, USA; Leonardo Evangelista da Silveira, MD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, Porto Alegre and INCT for Translational Medicine, Porto Alegre, Brazil; Erin L. MacMillan, PhD, Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada; Ivan J. Torres, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada; Donna J. Lang, PhD, Wayne Su, MSc, William G. Honer, MD, Centre for Complex Disorders, University of British Columbia, Vancouver, Canada; Raymond W. Lam, MD, Lakshmi N. Yatham, MBBS, Mood Disorders Centre, University of British Columbia, Vancouver, Canada
| | - Leonardo Evangelista da Silveira
- David J. Bond, MD, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada and Department of Psychiatry, University of Minnesota, Minneapolis, USA; Leonardo Evangelista da Silveira, MD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, Porto Alegre and INCT for Translational Medicine, Porto Alegre, Brazil; Erin L. MacMillan, PhD, Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada; Ivan J. Torres, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada; Donna J. Lang, PhD, Wayne Su, MSc, William G. Honer, MD, Centre for Complex Disorders, University of British Columbia, Vancouver, Canada; Raymond W. Lam, MD, Lakshmi N. Yatham, MBBS, Mood Disorders Centre, University of British Columbia, Vancouver, Canada
| | - Erin L MacMillan
- David J. Bond, MD, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada and Department of Psychiatry, University of Minnesota, Minneapolis, USA; Leonardo Evangelista da Silveira, MD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, Porto Alegre and INCT for Translational Medicine, Porto Alegre, Brazil; Erin L. MacMillan, PhD, Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada; Ivan J. Torres, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada; Donna J. Lang, PhD, Wayne Su, MSc, William G. Honer, MD, Centre for Complex Disorders, University of British Columbia, Vancouver, Canada; Raymond W. Lam, MD, Lakshmi N. Yatham, MBBS, Mood Disorders Centre, University of British Columbia, Vancouver, Canada
| | - Ivan J Torres
- David J. Bond, MD, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada and Department of Psychiatry, University of Minnesota, Minneapolis, USA; Leonardo Evangelista da Silveira, MD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, Porto Alegre and INCT for Translational Medicine, Porto Alegre, Brazil; Erin L. MacMillan, PhD, Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada; Ivan J. Torres, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada; Donna J. Lang, PhD, Wayne Su, MSc, William G. Honer, MD, Centre for Complex Disorders, University of British Columbia, Vancouver, Canada; Raymond W. Lam, MD, Lakshmi N. Yatham, MBBS, Mood Disorders Centre, University of British Columbia, Vancouver, Canada
| | - Donna J Lang
- David J. Bond, MD, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada and Department of Psychiatry, University of Minnesota, Minneapolis, USA; Leonardo Evangelista da Silveira, MD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, Porto Alegre and INCT for Translational Medicine, Porto Alegre, Brazil; Erin L. MacMillan, PhD, Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada; Ivan J. Torres, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada; Donna J. Lang, PhD, Wayne Su, MSc, William G. Honer, MD, Centre for Complex Disorders, University of British Columbia, Vancouver, Canada; Raymond W. Lam, MD, Lakshmi N. Yatham, MBBS, Mood Disorders Centre, University of British Columbia, Vancouver, Canada
| | - Wayne Su
- David J. Bond, MD, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada and Department of Psychiatry, University of Minnesota, Minneapolis, USA; Leonardo Evangelista da Silveira, MD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, Porto Alegre and INCT for Translational Medicine, Porto Alegre, Brazil; Erin L. MacMillan, PhD, Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada; Ivan J. Torres, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada; Donna J. Lang, PhD, Wayne Su, MSc, William G. Honer, MD, Centre for Complex Disorders, University of British Columbia, Vancouver, Canada; Raymond W. Lam, MD, Lakshmi N. Yatham, MBBS, Mood Disorders Centre, University of British Columbia, Vancouver, Canada
| | - William G Honer
- David J. Bond, MD, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada and Department of Psychiatry, University of Minnesota, Minneapolis, USA; Leonardo Evangelista da Silveira, MD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, Porto Alegre and INCT for Translational Medicine, Porto Alegre, Brazil; Erin L. MacMillan, PhD, Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada; Ivan J. Torres, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada; Donna J. Lang, PhD, Wayne Su, MSc, William G. Honer, MD, Centre for Complex Disorders, University of British Columbia, Vancouver, Canada; Raymond W. Lam, MD, Lakshmi N. Yatham, MBBS, Mood Disorders Centre, University of British Columbia, Vancouver, Canada
| | - Raymond W Lam
- David J. Bond, MD, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada and Department of Psychiatry, University of Minnesota, Minneapolis, USA; Leonardo Evangelista da Silveira, MD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, Porto Alegre and INCT for Translational Medicine, Porto Alegre, Brazil; Erin L. MacMillan, PhD, Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada; Ivan J. Torres, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada; Donna J. Lang, PhD, Wayne Su, MSc, William G. Honer, MD, Centre for Complex Disorders, University of British Columbia, Vancouver, Canada; Raymond W. Lam, MD, Lakshmi N. Yatham, MBBS, Mood Disorders Centre, University of British Columbia, Vancouver, Canada
| | - Lakshmi N Yatham
- David J. Bond, MD, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada and Department of Psychiatry, University of Minnesota, Minneapolis, USA; Leonardo Evangelista da Silveira, MD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada, Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre, Porto Alegre and INCT for Translational Medicine, Porto Alegre, Brazil; Erin L. MacMillan, PhD, Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada; Ivan J. Torres, PhD, Mood Disorders Centre, University of British Columbia, Vancouver, Canada; Donna J. Lang, PhD, Wayne Su, MSc, William G. Honer, MD, Centre for Complex Disorders, University of British Columbia, Vancouver, Canada; Raymond W. Lam, MD, Lakshmi N. Yatham, MBBS, Mood Disorders Centre, University of British Columbia, Vancouver, Canada
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Abstract
PURPOSE OF REVIEW Type 2 diabetes mellitus (T2DM) negatively affects brain structure and function. Meta-analytical data show that relative to age and sex matched non-psychiatric controls, patients with bipolar disorders have double the risk of T2DM. We review the evidence for association between T2DM and adverse clinical and brain imaging changes in bipolar disorders and summarize studies investigating effects of diabetes treatment on psychiatric and brain outcomes. RECENT FINDINGS Participants with bipolar disorders and T2DM or insulin resistance demonstrate greater morbidity, chronicity and disability, and lower treatment response to Li. Bipolar disorders complicated by insulin resistance/T2DM are associated with smaller hippocampal and cortical gray matter volumes and lower prefrontal N-acetyl aspartate (neuronal marker). Treatment of T2DM yields preservation of brain gray matter and insulin sensitizers, such as pioglitazone, improve symptoms of depression in unipolar or bipolar disorders. SUMMARY T2DM or insulin resistance frequently cooccur with bipolar disorders and are associated with negative psychiatric clinical outcomes and compromised brain health. This is clinically concerning, as patients with bipolar disorders have an increased risk of metabolic syndrome and yet often receive suboptimal medical care. At the same time treatment of T2DM and insulin resistance has positive effects on psychiatric and brain outcomes. These findings create a rich agenda for future research, which could enhance psychiatric pharmacopeia and directly impact patient care.
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Schulz SC, Murray A, Silberschmidt A, Bond DJ. A Multidisciplinary First-Episode Psychosis Program. Psychiatr Ann 2015. [DOI: 10.3928/00485713-20151103-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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40
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de Groot C, Felius A, Trompet S, de Craen AJM, Blauw GJ, van Buchem MA, Delemarre-van de Waal HA, van der Grond J. Association of the fat mass and obesity-associated gene risk allele, rs9939609A, and reward-related brain structures. Obesity (Silver Spring) 2015; 23:2118-22. [PMID: 26337140 DOI: 10.1002/oby.21191] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/27/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Recently, the fat mass and obesity-associated gene (FTO) has been identified as a genetic risk factor for developing obesity. The underlying mechanisms remain speculative. SNPs within FTO have been associated with brain atrophy in frontal and occipital regions, suggesting that FTO might affect body weight through cerebral pathways. Behavioral studies suggested a relationship between FTO and the reward-related behavioral traits. Therefore the relationship between the FTO risk allele rs9939609A and volumes of reward-related brain structures has been investigated. METHODS Four hundred and ninety-two Dutch individuals (56% males, age: 70-82 years) participating in the PROSPER study underwent a 3D-T1-weighted MRI to assess the volumes of reward-related brain structures (e.g., amygdala, nucleus accumbens) and of gray matter and white matter. Linear regression analysis was performed to test for the association of subcortical and cortical structures with rs9939609A. RESULTS rs9939609A is associated with lower volumes of the nucleus accumbens (p=0.03) and trended toward lower cortical gray matter volumes (p=0.08). This association is independent of gender, age, and BMI, FDR corrected. CONCLUSIONS The FTO risk allele is associated with lower nucleus accumbens volumes, suggesting that the higher body weight of risk-allele carriers might be due to changes within reward-related brain structures.
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Affiliation(s)
- Corjan de Groot
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Abraham Felius
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Stella Trompet
- Section of Gerontology and Geriatrics of the Department of General Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anton J M de Craen
- Section of Gerontology and Geriatrics of the Department of General Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerard J Blauw
- Section of Gerontology and Geriatrics of the Department of General Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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41
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Hajek T, Cooke C, Kopecek M, Novak T, Hoschl C, Alda M. Using structural MRI to identify individuals at genetic risk for bipolar disorders: a 2-cohort, machine learning study. J Psychiatry Neurosci 2015; 40:316-24. [PMID: 25853284 PMCID: PMC4543094 DOI: 10.1503/jpn.140142] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Brain imaging is of limited diagnostic use in psychiatry owing to clinical heterogeneity and low sensitivity/specificity of between-group neuroimaging differences. Machine learning (ML) may better translate neuroimaging to the level of individual participants. Studying unaffected offspring of parents with bipolar disorders (BD) decreases clinical heterogeneity and thus increases sensitivity for detection of biomarkers. The present study used ML to identify individuals at genetic high risk (HR) for BD based on brain structure. METHODS We studied unaffected and affected relatives of BD probands recruited from 2 sites (Halifax, Canada, and Prague, Czech Republic). Each participant was individually matched by age and sex to controls without personal or family history of psychiatric disorders. We applied support vector machines (SVM) and Gaussian process classifiers (GPC) to structural MRI. RESULTS We included 45 unaffected and 36 affected relatives of BD probands matched by age and sex on an individual basis to healthy controls. The SVM of white matter distinguished unaffected HR from control participants (accuracy = 68.9%, p = 0.001), with similar accuracy for the GPC (65.6%, p = 0.002) or when analyzing data from each site separately. Differentiation of the more clinically heterogeneous affected familiar group from healthy controls was less accurate (accuracy = 59.7%, p = 0.05). Machine learning applied to grey matter did not distinguish either the unaffected HR or affected familial groups from controls. The regions that most contributed to between-group discrimination included white matter of the inferior/middle frontal gyrus, inferior/middle temporal gyrus and precuneus. LIMITATIONS Although we recruited 126 participants, ML benefits from even larger samples. CONCLUSION Machine learning applied to white but not grey matter distinguished unaffected participants at high and low genetic risk for BD based on regions previously implicated in the pathophysiology of BD.
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Affiliation(s)
- Tomas Hajek
- Correspondence to: T. Hajek, Department of Psychiatry, Dalhousie University, QEII HSC, A.J. Lane Bldg., Rm. 3093, 5909 Veteran’s Memorial Lane, Halifax, NS B3H 2E2;
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Winkler AM, Webster MA, Vidaurre D, Nichols TE, Smith SM. Multi-level block permutation. Neuroimage 2015; 123:253-68. [PMID: 26074200 PMCID: PMC4644991 DOI: 10.1016/j.neuroimage.2015.05.092] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 05/22/2015] [Accepted: 05/24/2015] [Indexed: 12/12/2022] Open
Abstract
Under weak and reasonable assumptions, mainly that data are exchangeable under the null hypothesis, permutation tests can provide exact control of false positives and allow the use of various non-standard statistics. There are, however, various common examples in which global exchangeability can be violated, including paired tests, tests that involve repeated measurements, tests in which subjects are relatives (members of pedigrees) - any dataset with known dependence among observations. In these cases, some permutations, if performed, would create data that would not possess the original dependence structure, and thus, should not be used to construct the reference (null) distribution. To allow permutation inference in such cases, we test the null hypothesis using only a subset of all otherwise possible permutations, i.e., using only the rearrangements of the data that respect exchangeability, thus retaining the original joint distribution unaltered. In a previous study, we defined exchangeability for blocks of data, as opposed to each datum individually, then allowing permutations to happen within block, or the blocks as a whole to be permuted. Here we extend that notion to allow blocks to be nested, in a hierarchical, multi-level definition. We do not explicitly model the degree of dependence between observations, only the lack of independence; the dependence is implicitly accounted for by the hierarchy and by the permutation scheme. The strategy is compatible with heteroscedasticity and variance groups, and can be used with permutations, sign flippings, or both combined. We evaluate the method for various dependence structures, apply it to real data from the Human Connectome Project (HCP) as an example application, show that false positives can be avoided in such cases, and provide a software implementation of the proposed approach.
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Affiliation(s)
- Anderson M Winkler
- Oxford Centre for Functional MRI of the Brain, University of Oxford, Oxford, UK.
| | - Matthew A Webster
- Oxford Centre for Functional MRI of the Brain, University of Oxford, Oxford, UK
| | - Diego Vidaurre
- Oxford Centre for Human Brain Activity, University of Oxford, Oxford, UK
| | - Thomas E Nichols
- Oxford Centre for Functional MRI of the Brain, University of Oxford, Oxford, UK; Department of Statistics & Warwick Manufacturing Group, University of Warwick, Coventry, UK
| | - Stephen M Smith
- Oxford Centre for Functional MRI of the Brain, University of Oxford, Oxford, UK
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43
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Fears SC, Schür R, Sjouwerman R, Service SK, Araya C, Araya X, Bejarano J, Knowles E, Gomez-Makhinson J, Lopez MC, Aldana I, Teshiba TM, Abaryan Z, Al-Sharif NB, Navarro L, Tishler TA, Altshuler L, Bartzokis G, Escobar JI, Glahn DC, Thompson PM, Lopez-Jaramillo C, Macaya G, Molina J, Reus VI, Sabatti C, Cantor RM, Freimer NB, Bearden CE. Brain structure-function associations in multi-generational families genetically enriched for bipolar disorder. Brain 2015; 138:2087-102. [PMID: 25943422 DOI: 10.1093/brain/awv106] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/14/2015] [Indexed: 01/10/2023] Open
Abstract
Recent theories regarding the pathophysiology of bipolar disorder suggest contributions of both neurodevelopmental and neurodegenerative processes. While structural neuroimaging studies indicate disease-associated neuroanatomical alterations, the behavioural correlates of these alterations have not been well characterized. Here, we investigated multi-generational families genetically enriched for bipolar disorder to: (i) characterize neurobehavioural correlates of neuroanatomical measures implicated in the pathophysiology of bipolar disorder; (ii) identify brain-behaviour associations that differ between diagnostic groups; (iii) identify neurocognitive traits that show evidence of accelerated ageing specifically in subjects with bipolar disorder; and (iv) identify brain-behaviour correlations that differ across the age span. Structural neuroimages and multi-dimensional assessments of temperament and neurocognition were acquired from 527 (153 bipolar disorder and 374 non-bipolar disorder) adults aged 18-87 years in 26 families with heavy genetic loading for bipolar disorder. We used linear regression models to identify significant brain-behaviour associations and test whether brain-behaviour relationships differed: (i) between diagnostic groups; and (ii) as a function of age. We found that total cortical and ventricular volume had the greatest number of significant behavioural associations, and included correlations with measures from multiple cognitive domains, particularly declarative and working memory and executive function. Cortical thickness measures, in contrast, showed more specific associations with declarative memory, letter fluency and processing speed tasks. While the majority of brain-behaviour relationships were similar across diagnostic groups, increased cortical thickness in ventrolateral prefrontal and parietal cortical regions was associated with better declarative memory only in bipolar disorder subjects, and not in non-bipolar disorder family members. Additionally, while age had a relatively strong impact on all neurocognitive traits, the effects of age on cognition did not differ between diagnostic groups. Most brain-behaviour associations were also similar across the age range, with the exception of cortical and ventricular volume and lingual gyrus thickness, which showed weak correlations with verbal fluency and inhibitory control at younger ages that increased in magnitude in older subjects, regardless of diagnosis. Findings indicate that neuroanatomical traits potentially impacted by bipolar disorder are significantly associated with multiple neurobehavioural domains. Structure-function relationships are generally preserved across diagnostic groups, with the notable exception of ventrolateral prefrontal and parietal association cortex, volumetric increases in which may be associated with cognitive resilience specifically in individuals with bipolar disorder. Although age impacted all neurobehavioural traits, we did not find any evidence of accelerated cognitive decline specific to bipolar disorder subjects. Regardless of diagnosis, greater global brain volume may represent a protective factor for the effects of ageing on executive functioning.
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Affiliation(s)
- Scott C Fears
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA
| | - Remmelt Schür
- 2 Academisch Medisch Centrum, Department of Paediatric Neurology/Emma Children's Hospital, Amsterdam, The Netherlands
| | - Rachel Sjouwerman
- 3 University Medical Centre Utrecht, Neuroscience, Utrecht, The Netherlands
| | - Susan K Service
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA
| | - Carmen Araya
- 4 Cell and Molecular Biology Research Centre, Universidad de Costa Rica, San Pedro de Montes de Oca, Costa Rica
| | - Xinia Araya
- 4 Cell and Molecular Biology Research Centre, Universidad de Costa Rica, San Pedro de Montes de Oca, Costa Rica
| | - Julio Bejarano
- 4 Cell and Molecular Biology Research Centre, Universidad de Costa Rica, San Pedro de Montes de Oca, Costa Rica
| | - Emma Knowles
- 5 Department of Psychiatry, Yale University and Olin Neuropsychiatric Research Centre, Institute of Living, Hartford Hospital, Hartford, Connecticut, USA
| | - Juliana Gomez-Makhinson
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA
| | - Maria C Lopez
- 6 Grupo de Investigación en Psiquiatría [Research Group in Psychiatry (GIPSI)], Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia. Medellín, Colombia
| | - Ileana Aldana
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA
| | - Terri M Teshiba
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA
| | - Zvart Abaryan
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA
| | - Noor B Al-Sharif
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA
| | - Linda Navarro
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA
| | - Todd A Tishler
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA
| | - Lori Altshuler
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA
| | - George Bartzokis
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA
| | - Javier I Escobar
- 7 Department of Psychiatry and Family Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - David C Glahn
- 5 Department of Psychiatry, Yale University and Olin Neuropsychiatric Research Centre, Institute of Living, Hartford Hospital, Hartford, Connecticut, USA
| | - Paul M Thompson
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA
| | - Carlos Lopez-Jaramillo
- 6 Grupo de Investigación en Psiquiatría [Research Group in Psychiatry (GIPSI)], Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia. Medellín, Colombia
| | - Gabriel Macaya
- 4 Cell and Molecular Biology Research Centre, Universidad de Costa Rica, San Pedro de Montes de Oca, Costa Rica
| | - Julio Molina
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA 8 BioCiencias Laboratory, Guatemala, Guatemala
| | - Victor I Reus
- 9 Department of Psychiatry, University of California, San Francisco, California, USA
| | - Chiara Sabatti
- 10 Department of Health Research and Policy, Stanford University, Stanford, California, USA
| | - Rita M Cantor
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA 11 Department of Human Genetics, University of California, Los Angeles, California, USA
| | - Nelson B Freimer
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA
| | - Carrie E Bearden
- 1 Department of Psychiatry and Biobehavioural Science, University of California, Los Angeles, California, USA
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Cermolacce M, Belzeaux R, Adida M, Azorin JM. [Affective disorders: endocrine and metabolic comorbidities]. Encephale 2015; 40 Suppl 3:S33-9. [PMID: 25550238 DOI: 10.1016/s0013-7006(14)70129-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Links between affective and endocrine-metabolic disorders are numerous and complex. In this review, we explore most frequent endocrine-metabolic comorbidities. On the one hand, these comorbidities imply numerous iatrogenic effects from antipsychotics (metabolic side-effects) or from lithium (endocrine side-effects). On the other hand, these comorbidities are also associated with affective disorders independently from medication. We will successively examine metabolic syndrome, glycemic disturbances, obesity and thyroid disorders among patients with affective disorders. Endocrinemetabolic comorbidities can be individually encountered, but can also be associated. Therefore, they substantially impact morbidity and mortality by increasing cardiovascular risk factors. Two distinct approaches give an account of processes involved in these comorbidities: common environmental factors (iatrogenic effects, lifestyle), and/or shared physiological vulnerabilities. In conclusion, we provide a synthesis of important results and recommendations related to endocrine-metabolic comorbidities in affective disorders : heavy influence on morbidity and mortality, undertreatment of somatic diseases, importance of endocrine and metabolic side effects from main mood stabilizers, impact from sex and age on the prevalence of comorbidities, influence from previous depressive episodes in bipolar disorders, and relevance of systematic screening for subclinical (biological) disturbances.
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Affiliation(s)
- M Cermolacce
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France; Laboratoire de Neurosciences Cognitives, UMR CNRS 6155 & Aix-Marseille Université, Fédération 3C, Marseille, France.
| | - R Belzeaux
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France
| | - M Adida
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France
| | - J-M Azorin
- Pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 13274 Marseille cedex 9, France
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Hajek T, Calkin C, Blagdon R, Slaney C, Uher R, Alda M. Insulin resistance, diabetes mellitus, and brain structure in bipolar disorders. Neuropsychopharmacology 2014; 39:2910-8. [PMID: 25074491 PMCID: PMC4200504 DOI: 10.1038/npp.2014.148] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/27/2014] [Accepted: 06/05/2014] [Indexed: 12/21/2022]
Abstract
Type 2 diabetes mellitus (T2DM) damages the brain, especially the hippocampus, and frequently co-occurs with bipolar disorders (BD). Reduced hippocampal volumes are found only in some studies of BD subjects and may thus be secondary to the presence of certain clinical variables. Studying BD patients with abnormal glucose metabolism could help identify preventable risk factors for hippocampal atrophy in BD. We compared brain structure using optimized voxel-based morphometry of 1.5T MRI scans in 33 BD subjects with impaired glucose metabolism (19 with insulin resistance/glucose intolerance (IR/GI), 14 with T2DM), 15 euglycemic BD participants and 11 euglycemic, nonpsychiatric controls. The group of BD patients with IR, GI or T2DM had significantly smaller hippocampal volumes than the euglycemic BD participants (corrected p=0.02) or euglycemic, nonpsychiatric controls (corrected p=0.004). Already the BD subjects with IR/GI had smaller hippocampal volumes than euglycemic BD participants (t(32)=-3.15, p=0.004). Age was significantly more negatively associated with hippocampal volumes in BD subjects with IR/GI/T2DM than in the euglycemic BD participants (F(2, 44)=9.96, p=0.0003). The gray matter reductions in dysglycemic subjects extended to the cerebral cortex, including the insula. In conclusion, this is the first study demonstrating that T2DM or even prediabetes may be risk factors for smaller hippocampal and cortical volumes in BD. Abnormal glucose metabolism may accelerate the age-related decline in hippocampal volumes in BD. These findings raise the possibility that improving diabetes care among BD subjects and intervening already at the level of prediabetes could slow brain aging in BD.
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Affiliation(s)
- Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Prague Psychiatric Center, Department of Psychiatry and Medical Psychology, 3rd School of Medicine, Charles University, Prague, Czech Republic,Department of Psychiatry, Dalhousie University, QEII HSC, A.J.Lane Bldg., Room 3093, 5909 Veteran's Memorial Lane, Halifax, NS B3H 2E2, Canada, Tel: +1 902 473 8299, Fax: +1 902 473 1583, E-mail:
| | - Cynthia Calkin
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Ryan Blagdon
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Claire Slaney
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Prague Psychiatric Center, Department of Psychiatry and Medical Psychology, 3rd School of Medicine, Charles University, Prague, Czech Republic
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Vanderwal T. Questions about time and space in development. J Am Acad Child Adolesc Psychiatry 2014; 53:1037-8. [PMID: 25245343 DOI: 10.1016/j.jaac.2014.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 07/20/2014] [Indexed: 12/01/2022]
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