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Mauracher L, Serebriakova J, Niederstätter H, Parson W, Schurr T, Deisenhammer EA. Subclinical hypomanic experiences in young adults after sleep deprivation are independent of depressive disorders, chronotype or 5-HTTLPR polymorphism. World J Biol Psychiatry 2024; 25:384-392. [PMID: 39126213 DOI: 10.1080/15622975.2024.2382697] [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: 04/29/2024] [Revised: 07/01/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION The acute antidepressant effect of sleep deprivation (SD) in patients with depressive disorders has been studied for more than 60 years. However, hypomanic mood swings after partial or total SD have also been described in people without diagnosed mental disorders. Studying this phenomenon in the general population may yield insights about the mechanisms of therapeutic SD, mania and bipolar disorders. METHODS A cross-sectional sample of young adults was recruited and classified into those who described having regularly occurring subclinical hypomanic experiences (ROHE) after SD and those who did not. History of psychiatric and physical illness, with screening for depression and mania, as well as alcohol or drug consumption, family history of depressive disorders or suicide, 5-HTTLPR polymorphism, and MEQ-SA chronotype were collected. RESULTS A total of 251 participants were included; 39.0% indicated regularly having subclinical hypomanic experiences after SD. These experiences were not associated with depressive or mania screening, history of psychiatric illness, family history, 5-HTTLPR polymorphism, or MEQ-SA chronotype. CONCLUSIONS ROHE after non-therapeutic SD seem to be a relatively common phenomenon in young adults, independent of depressive mood state. Our results suggest that therapeutic SD may depend on a physiological phenomenon of subclinical affective disturbance after SD that affects a part of the general population, independent of psychiatric diagnosis. Further studies could elucidate associated factors and contribute to our understanding of (hypo-)manic mood states.
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Affiliation(s)
- Laurin Mauracher
- University Hospital for Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Jana Serebriakova
- University Hospital for Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Niederstätter
- Institute of Forensic Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Walther Parson
- Institute of Forensic Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Timo Schurr
- University Hospital for Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Eberhard A Deisenhammer
- University Hospital for Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
- University Hospital for Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
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Rizavas I, Gournellis R, Douzenis P, Efstathiou V, Bali P, Lagouvardos K, Douzenis A. A Systematic Review on the Impact of Seasonality on Severe Mental Illness Admissions: Does Seasonal Variation Affect Coercion? Healthcare (Basel) 2023; 11:2155. [PMID: 37570395 PMCID: PMC10418389 DOI: 10.3390/healthcare11152155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Coercion in psychiatry is associated mainly with involuntary admissions. The purpose of this study was to investigate the associations between hospital admissions of patients suffering from affective and schizophrenic disorders and seasonality. A systematic literature search using PubMed, Scopus and Google Scholar was conducted, including studies with affective and schizophrenia disorder admissions, published from October 1992 to August 2020. A total of 31 studies were included in the review. Four broad severe mental illness admission categories were identified regarding seasonality: affective disorders, schizophrenia disorders, involuntary admission affective disorders and involuntary admission schizophrenia disorders. There was clear and strong evidence for spring and summer peaks for severe mental illness admissions; data provided for age, gender and involuntary admissions was limited. Seasonality may have a significant effect on the onset and exacerbation of psychopathology of severe mental illness and should be considered as a risk factor in psychiatric admissions, violence and the risk of mental health coercion. A better understanding of the impact of seasonality on severe mental illness will help professionals to provide the best practices in mental health services in order to reduce and prevent psychiatric hospitalizations (especially involuntary admissions) resulting in further coercive measures.
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Affiliation(s)
- Ioannis Rizavas
- Psychiatric Hospital of Attica “Dafni”, 12462 Chaidari, Greece;
| | - Rossetos Gournellis
- Second Department of Psychiatry, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Chaidari, Greece; (R.G.); (A.D.)
| | - Phoebe Douzenis
- Medical School, University of Nottingham, Nottingham NG7 2UH, UK;
| | - Vasiliki Efstathiou
- Postgraduate Program “Liaison Psychiatry Integrative Care of Physical and Mental Health”, School of Medicine, National and Kapodistrian University of Athens, 12462 Chaidari, Greece;
| | - Panagiota Bali
- Second Department of Psychiatry, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Chaidari, Greece; (R.G.); (A.D.)
| | - Kostas Lagouvardos
- National Observatory of Athens, Institute for Environmental Research and Sustainable Development, 15236 Athens, Greece;
| | - Athanasios Douzenis
- Second Department of Psychiatry, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Chaidari, Greece; (R.G.); (A.D.)
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Hickie IB, Merikangas KR, Carpenter JS, Iorfino F, Scott EM, Scott J, Crouse JJ. Does circadian dysrhythmia drive the switch into high- or low-activation states in bipolar I disorder? Bipolar Disord 2023; 25:191-199. [PMID: 36661342 PMCID: PMC10947388 DOI: 10.1111/bdi.13304] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Emerging evidence suggests a role of circadian dysrhythmia in the switch between "activation" states (i.e., objective motor activity and subjective energy) in bipolar I disorder. METHODS We examined the evidence with respect to four relevant questions: (1) Are natural or environmental exposures that can disrupt circadian rhythms also related to the switch into high-/low-activation states? (2) Are circadian dysrhythmias (e.g., altered rest/activity rhythms) associated with the switch into activation states in bipolar disorder? (3) Do interventions that affect the circadian system also affect activation states? (4) Are associations between circadian dysrhythmias and activation states influenced by other "third" factors? RESULTS Factors that naturally or experimentally alter circadian rhythms (e.g., light exposure) have been shown to relate to activation states; however future studies need to measure circadian rhythms contemporaneously with these natural/experimental factors. Actigraphic measures of circadian dysrhythmias are associated prospectively with the switch into high- or low-activation states, and more studies are needed to establish the most relevant prognostic actigraphy metrics in bipolar disorder. Interventions that can affect the circadian system (e.g., light therapy, lithium) can also reduce the switch into high-/low-activation states. Whether circadian rhythms mediate these clinical effects is an unknown but valuable question. The influence of age, sex, and other confounders on these associations needs to be better characterised. CONCLUSION Based on the reviewed evidence, our view is that circadian dysrhythmia is a plausible driver of transitions into high- and low-activation states and deserves prioritisation in research in bipolar disorders.
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Affiliation(s)
- Ian B. Hickie
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
| | - Kathleen R. Merikangas
- Genetic Epidemiology Research Branch, Division of Intramural Research ProgramNational Institute of Mental HealthBethesdaMarylandUSA
| | - Joanne S. Carpenter
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
| | - Frank Iorfino
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
| | - Elizabeth M. Scott
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
| | - Jan Scott
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK
- Norwegian University of Science and TechnologyTrondheimNorway
- Université de ParisParisFrance
| | - Jacob J. Crouse
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
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Rodrigues Cordeiro C, Côrte-Real BR, Saraiva R, Frey BN, Kapczinski F, de Azevedo Cardoso T. Triggers for acute mood episodes in bipolar disorder: A systematic review. J Psychiatr Res 2023; 161:237-260. [PMID: 36940629 DOI: 10.1016/j.jpsychires.2023.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES To identify triggers of acute mood episodes in bipolar disorder (BD). METHODS We performed a systematic review in the following databases: Pubmed, Embase, and PsycInfo following the preferred reporting items for systematic reviews and meta-analysis guidelines. The systematic search encompassed all relevant studies published until May 23rd, 2022. RESULTS A total of 108 studies (case reports/case series, interventional, prospective and retrospective studies) were included in the systematic review. While several decompensation triggers were identified, pharmacotherapy was the one with the largest body of evidence, particularly the use of antidepressants as triggers of manic/hypomanic episodes. Other identified triggers for mania were brain stimulation, energy drinks, acetyl-l-carnitine, St. John's wort, seasonal changes, hormonal changes and viral infections. There is a relative paucity of evidence concerning triggers for depressive relapses in BD, with possible triggers including fasting, decreased sleep and stressful life events. CONCLUSIONS This is the first systematic review about triggers/precipitants of relapse in BD. Despite the importance of identification and management of potential triggers for BD decompensation, there is a lack of large observational studies addressing this topic, with most of the included studies being case reports/case series. Notwithstanding these limitations, antidepressant use is the trigger with the strongest evidence for manic relapse. More studies are needed to identify and manage triggers for relapse in BD.
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Affiliation(s)
- Catarina Rodrigues Cordeiro
- Department of Psychiatry and Mental Health, Centro Hospitalar Universitário Lisboa Norte, Av Prof. Egas Moniz, 1649-035, Lisboa, Portugal; Psychiatric and Medical Psychology University Clinic, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal.
| | - Beatriz Romão Côrte-Real
- Department of Psychiatry and Mental Health, Centro Hospitalar Universitário Lisboa Norte, Av Prof. Egas Moniz, 1649-035, Lisboa, Portugal; Psychiatric and Medical Psychology University Clinic, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal
| | - Rodrigo Saraiva
- Department of Psychiatry and Mental Health, Centro Hospitalar Universitário Lisboa Norte, Av Prof. Egas Moniz, 1649-035, Lisboa, Portugal; Psychiatric and Medical Psychology University Clinic, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisboa, Portugal
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, L8N 3K7, Canada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Graduate Program in Psychiatry, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil
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ŞEN GÖKÇEİMAM P, YAR SF, KUMSAR N. Bipolar affektif bozukluk tanılı hastalarda COVID- 19 korkusunun kalıntı belirtiler ve işlevsellik ile ilişkisi. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1176773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Amaç: Bu çalışmada bipolar affektif bozukluk tanılı hastalarda COVID-19 korkusu ile kalıntı belirtiler ve işlevsellik düzeyleri arasındaki ilişkinin saptanması amaçlanmıştır.
Gereç ve Yöntem: Çalışmaya DSM-5’e göre bipolar affektif bozukluk tanısı bulunan, 18-65 yaş arasında ve okur yazar olan, polikliniğe kendisi başvuran ardışık 85 bipolar affektif bozukluk tanılı hasta alınmıştır. Hastalar depresif /manik belirtiler gösteren, remisyonda olup da kalıntı belirtileri olanlar olarak gruplandırılmıştır.
Bulgular: YMDÖ’ye göre ‘manik kalıntı belirtileri olan’ olarak sınıflandırılan katılımcıların bu ölçekte medyan puanı 1 ± 1,14'tü. Katılımcılar arasında manik kalıntı belirti olup olmamasına göre COVID-19 Korkusu Ölçek puanları açısından anlamlı bir fark bulunmadı. Depresif kalıntı semptomu olmayan katılımcılar, depresif kalıntı semptomu olanlara göre COVID-19 Korkusu Ölçeğinde anlamlı şekilde daha düşük puanlar göstermiştir. HAM-D Ölçeği, . İşlevsellik Kısa Değerlendirme Testi ile COVID-19 Korkusu Ölçeği puanları arasında anlamlı düzeyde pozitif korelasyon saptanmıştır
Sonuç: Depresif kalıntı semptomu olan hastalar COVID -19 korku ölçeğinde anlamlı şekilde daha yüksek puan almışlardır. Stres döneminde hastalarda dayanıklılık hastalık korkusu ve kalıntı belirtilerin çalışılması da takip ve tedavi stratejilerinin belirlenmesi açısından kıymetli olacaktır.
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Affiliation(s)
- Pınar ŞEN GÖKÇEİMAM
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL ERENKÖY APPLICATION AND RESEARCH CENTER FOR PSYCHIATRIC AND NERVE DISEASES
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Monteleone AM, D'Agostino G, Cascino G, Marciello F, Monteleone P, Maj M. Cortisol awakening response in bipolar patients with comorbid type 2 diabetes mellitus. World J Biol Psychiatry 2022; 23:278-286. [PMID: 34467828 DOI: 10.1080/15622975.2021.1973280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Bipolar disorder (BD) is frequently associated with type 2 diabetes mellitus (T2DM). The functioning of the hypothalamic-pituitary-adrenal (HPA) axis has been never investigated in BD with respect to the glucose metabolic status. Therefore, we assessed the cortisol awakening response (CAR) in bipolar patients with or without comorbid T2DM. METHODS Twenty euglycemic bipolar patients [12 males and eight females; mean age (±SD): 47.4 ± 14.4 years; mean (±SD) duration of illness: 18.3 ± 12.1 years], 16 BD patients with T2DM [11 males and five females; mean age (±SD): 63.6 ± 12.8 years; mean (±SD) duration of bipolar illness: 17.1 ± 10.8 years; mean (±SD) duration of T2DM: 5.2 ± 5.3 years], 18 healthy subjects [seven males and 11 females; mean age (±SD): 45.0 ± 12.1 years] and 12 non-psychiatric subjects with T2DM [eight males and four females; mean age (±SD): 56.7 ± 11.2 years; mean (±SD) duration of T2DM: 5.2 ± 3.5 years] were recruited. Saliva cortisol was measured at awakening and after 15, 30, and 60 min. RESULTS With respect to both healthy controls and controls with T2DM, euglycemic and diabetic BD patients exhibited a CAR occurring at significantly lower levels. No significant difference emerged in the CAR between the two groups of bipolar patients. Controls with T2DM had an overall post-awakening cortisol production significantly higher than healthy controls. CONCLUSIONS Our results show that the CAR of patients with BD is reduced in terms of overall cortisol production but normal in terms of cortisol reactivity independently from the occurrence of comorbid T2DM. The dampened CAR points to a tuning down of the functioning of the HPA axis. in both euglycemic and diabetic BD patients, which may be a factor of vulnerability, since a preserved HPA axis functioning is essential to deal with stressors, which may precipitate affective episodes.
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Affiliation(s)
| | - Giulia D'Agostino
- Section of Neurosciences, Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy
| | - Giammarco Cascino
- Section of Neurosciences, Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy
| | - Francesca Marciello
- Section of Neurosciences, Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy
| | - Palmiero Monteleone
- Section of Neurosciences, Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Saraiva R, Proença F, Gonçalves M, Sereijo C, Barandas R, Coentre R, Levy P. Poststroke Bipolar Disorder. J Nerv Ment Dis 2021; 209:851-854. [PMID: 34698700 DOI: 10.1097/nmd.0000000000001410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Various diseases that impact different systems and organs in the body may trigger manic episodes. Strokes are often associated with psychiatric symptoms, particularly depressive and, more rarely, manic. We herein report a case of bipolar disorder secondary to cerebrovascular disease in a 67-year-old man with no personal or family history of psychiatric illness who, at the age of 64, had a bilateral ischemic stroke in the middle cerebral artery territory. About 20 days after this stroke, he experienced a manic episode. Three years later, he experienced a second manic episode, with another hospitalization in a psychiatric ward. With this case, we intend to emphasize that, although rare, the diagnosis of mania after stroke should not be forgotten, and most important, one should be aware of the recurrence of affective episodes just as in non-medical-caused bipolar disorder.
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Affiliation(s)
| | - Filipa Proença
- Psychiatry and Mental Health Department, Centro Hospitalar Universitário Lisboa Norte
| | | | - Carolina Sereijo
- Psychiatry and Mental Health Department, Centro Hospitalar Universitário Lisboa Norte
| | | | | | - Pedro Levy
- Psychiatry and Mental Health Department, Centro Hospitalar Universitário Lisboa Norte
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Expert opinion in bipolar disorder: Impact of COVID-19 on outcomes and treatment of bipolar disorder. PERSONALIZED MEDICINE IN PSYCHIATRY 2021; 27:100074. [PMCID: PMC9767409 DOI: 10.1016/j.pmip.2021.100074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Bipolar disorder is a common mental illness with a high burden of disability and comorbidity including highly prevalent medical conditions that increase risk for severe COVID-19 illness. Moreover, increased vulnerability to stress, routine and lifestyle disruption in people living with bipolar disorder is well-established. Although data examining the impact of COVID-19 disease and the resulting pandemic on those with bipolar disorder are limited, the present paper aims to discuss existing research at the intersection of COVID-19 and mental health with the goal of considering potential impacts of COVID-19 on outcomes and treatment of bipolar disorder.
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Smedler E, Sparding T, Hattab A, Sellgren CM, Landén M. Reporting trigger factors for (hypo)manic episodes in bipolar disorder: association with personality and prognosis. Acta Psychiatr Scand 2020; 141:534-540. [PMID: 32306385 DOI: 10.1111/acps.13174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate external factors that trigger manic and hypomanic relapses and how this is associated with personality and clinical outcome measured as number of affective episodes over a 7-year period. METHOD This is a prospective cohort study of 204 meticulously characterized Swedish bipolar disorder patients. Personality was evaluated at baseline using the Swedish universities Scales of Personality in 170 patients, and 90 patients were followed up after approximately 7 years in order to evaluate clinical outcomes. RESULTS We found that 44% of the patients reported trigger factors, including sleep disturbance, work- or family-related issues, medication, and illicit drug use. There were no significant differences in any of the personality traits when comparing the 74 patients that reported triggers with the 90 patients that did not. At 7-year follow-up, there was no difference between the groups in number of affective episodes (depressive, hypomanic, manic, or mixed), involuntary commitments, suicide attempts, or self-harm incidents since baseline. CONCLUSIONS Around 40% of the patients reported external triggers for manic and hypomanic episodes. However, this was neither associated with personality traits nor number of affective episodes at 7-year follow-up.
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Affiliation(s)
- E Smedler
- Department of Psychiatry and Neurochemistry at Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - T Sparding
- Department of Psychiatry and Neurochemistry at Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - A Hattab
- Department of Psychiatry and Neurochemistry at Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - C M Sellgren
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm County, Stockholm, Sweden
| | - M Landén
- Department of Psychiatry and Neurochemistry at Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Jacob L, Bohlken J, Kostev K. Incidence of and factors associated with manic episodes and bipolar disorder in the decade following depression onset in Germany. J Affect Disord 2020; 266:534-539. [PMID: 32056923 DOI: 10.1016/j.jad.2020.02.004] [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: 12/27/2019] [Revised: 01/20/2020] [Accepted: 02/01/2020] [Indexed: 11/18/2022]
Abstract
AIM The goal of this retrospective cohort study was to analyze the incidence of and factors associated with manic episodes and bipolar disorder in the decade following a depression diagnosis in patients from Germany. METHODS This study included adults who were diagnosed with depression for the first time in one of 199 neuropsychiatric practices in Germany between 2007 and 2017 (index date). The cumulative incidence of a manic episode or bipolar disorder was estimated for up to 10 years after the index date using Kaplan-Meier curves. Multivariate Cox regression models were further used to investigate the association between demographic, clinical, and pharmaceutical variables and the incidence of manic episodes and bipolar disorder. RESULTS This study included 162,689 patients [mean (standard deviation) age 51.6 (14.9) years; 63.2% women]. Ten years after a depression diagnosis, the incidence of manic episodes and bipolar disorder ranged from 2.9% to 5.1%. Young age, severe depression, and the prescription of venlafaxine were identified as variables positively associated with manic episodes and bipolar disorder, while several clinical (e.g., somatoform disorders, extrapyramidal and movement disorders) and pharmaceutical variables (e.g., hypericum perforatum, amitriptyline) were negatively associated with bipolarity. CONCLUSIONS The incidence of manic episodes and bipolar disorder was relatively low in the decade following a depression diagnosis in Germany. Young age, depression severity, and several clinical and pharmaceutical variables were significantly associated with bipolarity in patients with depression.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France; Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain
| | - Jens Bohlken
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät der Universität 01403, Leipzig, Germany
| | - Karel Kostev
- Epidemiology, IQVIA, Main Airport Center, Unterschweinstiege 2-14, 60549 Frankfurt, Germany.
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Conley VM, Daack-Hirsch S, Halbmaier K, Shaw L. Bringing Personalized Medicine to a PACT Program: A Quality Improvement Project. J Am Psychiatr Nurses Assoc 2020; 26:77-85. [PMID: 30688546 DOI: 10.1177/1078390319826687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION: Programs for assertive community treatment (PACT) serve persons with severe mental illness who have been unsuccessful with traditional outpatient services. Many PACT clients struggle to obtain symptom relief with medications that often have poor efficacy and undesired side effects, which can result in nonadherence, relapse, and increased health care utilization with associated costs. AIMS: This quality improvement project aimed to improve client and PACT program outcomes by incorporating pharmacogenomic testing into the psychopharmacological decision-making process. METHODS: The project used a pre-posttest design with each client serving as their own control to evaluate changes in clients' symptoms and program outcomes resulting from pharmacogenomics-guided medication management. RESULTS: Following project implementation, clients' symptoms were decreased and both engagement in care and stability in the community increased. Psychiatric hospitalizations and associated costs decreased. CONCLUSIONS: This project suggests utility for using pharmacogenomics testing to personalize care for persons with severe mental illness.
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Affiliation(s)
- Virginia M Conley
- Virginia M. Conley, PhD, ARNP, FNP-BC, PMHNP-BC, FAANP, The University of Iowa, Iowa City, IA, USA; Eyerly Ball Community Mental Health Services, Des Moines, IA, USA
| | | | - Katie Halbmaier
- Katie Halbmaier, DNP, ARNP, FNP-BC, The University of Iowa, Iowa City, IA, USA
| | - Lisa Shaw
- Lisa Shah, PhD, RN, University of Pittsburg, Pittsburg, PA, USA
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Wendler E, de Souza CP, Dornellas APS, Santos LE, Ferreira ST, Galduróz JCF, Wöhr M, Schwarting RKW, Andreatini R. Mania-like elevated mood in rats: Enhanced 50-kHz ultrasonic vocalizations after sleep deprivation. Prog Neuropsychopharmacol Biol Psychiatry 2019; 88:142-150. [PMID: 29981775 DOI: 10.1016/j.pnpbp.2018.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/21/2018] [Accepted: 07/04/2018] [Indexed: 12/14/2022]
Abstract
Mania is characterized by elevated drive and mood but animal models of mania have often neglected elevated mood. Ultrasonic vocalizations (USV) of 50-kHz emitted by rats are thought to index the subject's positive affective state. Fifty-kHz USV emission is increased by amphetamine, an effect blocked by lithium administration. Sleep deprivation (SD) is an environmental model of mania and the present study evaluated SD effects on behavioral activity and USV emission, together with the impact of lithium treatment. Adult rats were submitted to 24h or 72h SD, and locomotor activity and USV emission were assessed. To test their sensitivity to a standard antimanic drug, these behavioral parameters were also evaluated after acute administration of lithium carbonate (25, 50 or 100 mg/kg, i.p.). Striatal monoamine content was measured post-mortem. SD (24h and 72h) led to increased locomotor activity, rearing behavior and 50-kHz USV emission, together with a change in the call profile characterized by an increase in the percentage of frequency-modulated 50-kHz USV, which may indicate the mania-like consequences of SD. Importantly, all SD effects were reverted by lithium administration. SD also led to a decrease in dopamine content in the ventral striatum, while increasing dopamine turnover. In conclusion, SD increased 50-kHz USV emission, an effect prevented by acute lithium administration. This suggests 50-kHz USV as a new marker for mania-like elevated mood, which shows construct validity (associated with increased dopaminergic tone), face validity (reflecting increased positive affect) and predictive validity (high sensitivity to lithium treatment).
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Affiliation(s)
- Etieli Wendler
- Department of Pharmacology, Biological Sciences Sector, Federal University of Paraná, Centro Politécnico, C.P. 19031, 81540-990 Curitiba, PR, Brazil
| | - Camila Pasquini de Souza
- Department of Pharmacology, Biological Sciences Sector, Federal University of Paraná, Centro Politécnico, C.P. 19031, 81540-990 Curitiba, PR, Brazil
| | - Ana Paula Segantine Dornellas
- Department of Pharmacology, Biological Sciences Sector, Federal University of Paraná, Centro Politécnico, C.P. 19031, 81540-990 Curitiba, PR, Brazil
| | - Luis Eduardo Santos
- Institute of Biophysics Carlos Chagas Filho & Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-590, Brazil
| | - Sergio T Ferreira
- Institute of Biophysics Carlos Chagas Filho & Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-590, Brazil
| | - José Carlos Fernandes Galduróz
- Department of Psychobiology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo, SP 04024-002, Brazil
| | - Markus Wöhr
- Behavioural Neuroscience, Experimental and Biological Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032 Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), Philipps-University of Marburg, Hans-Meerwein-Str. 6, 35032 Marburg, Germany
| | - Rainer K W Schwarting
- Behavioural Neuroscience, Experimental and Biological Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032 Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), Philipps-University of Marburg, Hans-Meerwein-Str. 6, 35032 Marburg, Germany
| | - Roberto Andreatini
- Department of Pharmacology, Biological Sciences Sector, Federal University of Paraná, Centro Politécnico, C.P. 19031, 81540-990 Curitiba, PR, Brazil.
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13
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Aguglia A, Borsotti A, Cuniberti F, Serafini G, Amore M, Maina G. The influence of sunlight exposure on hospitalization in emergency psychiatry. Chronobiol Int 2017; 34:1413-1422. [DOI: 10.1080/07420528.2017.1374286] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
- “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
| | - Antonio Borsotti
- Psychiatric Clinic, “S Luigi Gonzaga Hospital” of Orbassano – “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
| | - Francesco Cuniberti
- Psychiatric Clinic, “S Luigi Gonzaga Hospital” of Orbassano – “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Giuseppe Maina
- Psychiatric Clinic, “S Luigi Gonzaga Hospital” of Orbassano – “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
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14
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Matthews M, Murnane E, Snyder J, Guha S, Chang P, Doherty G, Gay G. The double-edged sword: A mixed methods study of the interplay between bipolar disorder and technology use. COMPUTERS IN HUMAN BEHAVIOR 2017. [DOI: 10.1016/j.chb.2017.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Rihmer Z, Gonda X, Döme P. Is Mania the Hypertension of the Mood? Discussion of A Hypothesis. Curr Neuropharmacol 2017; 15:424-433. [PMID: 28503115 PMCID: PMC5405605 DOI: 10.2174/1570159x14666160902145635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 04/28/2016] [Accepted: 05/24/2016] [Indexed: 01/17/2023] Open
Abstract
Beyond both being biphasic/bidirectional disorders (hypo)mania and essential hypertension share a surprising number of similarities and an overlap between their genetics, biological background, underlying personality and temperamental factors, precipitating factors, comorbidity and response to treatment, indicating a possibly partially shared biological background. Based on theoretical knowledge, similarities related to characteristics, manifestation and course, and the results of pharmacological studies related to the effects and side effects of pharmacotherapies used in the treatment of these two distinct disorders, the authors outline a hypothesis discussing the similar origins of these two phenomena and thus mania being the hypertension of mood in memory of Athanasios Koukopoulos, one of the greatest researchers and theoreticists of mania of all time.
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Affiliation(s)
- Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health, Semmelweis University, Budapest, Hungary, and Laboratory of Suicide Research and Prevention, National Institute for Psychiatry and Addictions, Budapest, Hungary
| | - Xénia Gonda
- Department of Clinical and Theoretical Mental Health, Semmelweis University, Budapest, Hungary, and Laboratory of Suicide Research and Prevention, National Institute for Psychiatry and Addictions, Budapest, Hungary
| | - Péter Döme
- Department of Clinical and Theoretical Mental Health, Semmelweis University, Budapest, Hungary, and Laboratory of Suicide Research and Prevention, National Institute for Psychiatry and Addictions, Budapest, Hungary
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16
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Mental Health in Allergic Rhinitis: Depression and Suicidal Behavior. CURRENT TREATMENT OPTIONS IN ALLERGY 2017; 4:71-97. [PMID: 28966902 DOI: 10.1007/s40521-017-0110-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A high proportion of suicides visit their medical provider in the month prior to death, but depression, suicidal thoughts, and substance use are seldom addressed. For the clinicians routinely treating a substantial patient population with allergic diseases, there are additional concerns, as allergy has been linked with both depression and suicidal behavior. While psychotropic medications may affect diagnosis of allergies, medications used to treat allergies impact mood and behavior. Thus, we present an overview of the overlap of allergic rhinitis with depression and suicidal behavior in adults, based on clinical and epidemiological data, and our research and clinical experience. In summary, we suggest: 1) inquiring among patients with allergies about personal and family history of depression, substance use disorders, suicidal ideation and attempts 2) increased mindfulness regarding the potential effects of allergy medications on mood and behavior; and 3) for people identified with certain types of depression or increased suicide risk, a systematic multilevel collaborative approach. While for practical reasons the majority of patients with depression will continue to be treated by general or family practitioners, the allergy-treating provider should always consider integrated care for bipolar, psychotic or suicidal depression and incomplete remission, or relapsing and highly recurrent course. While awaiting results of much needed basic and clinical research to guide clinical approach for patients with comorbid allergic rhinitis and depression, the simple steps recommended here are expected to improved clinical outcomes in depression, including, on a large scale, reduced premature deaths by suicide.
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Garzón-Niño J, Rodríguez-Muñoz M, Cortés-Montero E, Sánchez-Blázquez P. Increased PKC activity and altered GSK3β/NMDAR function drive behavior cycling in HINT1-deficient mice: bipolarity or opposing forces. Sci Rep 2017; 7:43468. [PMID: 28240305 PMCID: PMC5327482 DOI: 10.1038/srep43468] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/25/2017] [Indexed: 01/18/2023] Open
Abstract
Mice with histidine triad nucleotide-binding protein 1 (HINT1) deletion exhibit manic-like symptoms that evolve into depressive-like behavior in response to stressful paradigms. Molecular and electrophysiological studies have indicated that HINT1−/− mice exhibit increased PKC, PKA, and GSK3β activities, as well as glutamate N-methyl-D-aspartate receptor (NMDAR)/α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic receptor (AMPAR) and NR2B/NR2A subunit ratios. Pharmacological interventions stabilized their behavior but through different mechanisms. GSK3β inhibitors and valproate directly attenuated the expression of the manic-like symptoms, whereas PKC inhibition, lamotrigine, or risperidone promoted NMDAR-mediated depressive-like behaviors that counterbalanced the preexisting manic-like symptoms. Naïve HINT1−/− mice exposed to stressful paradigms rapidly manifested depressive-like behaviors in subsequent stressful situations, a capacity that persisted for a couple of weeks thereafter. During the depressive-like phase, citalopram, amitriptyline and MK801 precipitated manic-like behaviors in stressed HINT1−/− mice. Notably, the antagonism of NMDARs prevented HINT1−/− mice from alternating behaviors in response to stress. A comparison with “manic” Black Swiss mice indicated that in HINT1−/− mice, PKC supports manic-like symptoms and reduces the expression of depressive-like behaviors via activation of GSK3β and regulation of NR2B-enriched NMDARs. HINT1−/− mice represent a suitable model for studying human BPD and may facilitate the identification of novel targets and drugs to treat this mental disorder.
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Affiliation(s)
- Javier Garzón-Niño
- Neuropharmacology, Department of Translational Neurosciences, Instituto Cajal, CSIC, Madrid E-28002, Spain
| | - María Rodríguez-Muñoz
- Neuropharmacology, Department of Translational Neurosciences, Instituto Cajal, CSIC, Madrid E-28002, Spain
| | - Elsa Cortés-Montero
- Neuropharmacology, Department of Translational Neurosciences, Instituto Cajal, CSIC, Madrid E-28002, Spain
| | - Pilar Sánchez-Blázquez
- Neuropharmacology, Department of Translational Neurosciences, Instituto Cajal, CSIC, Madrid E-28002, Spain
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Lex C, Bäzner E, Meyer TD. Does stress play a significant role in bipolar disorder? A meta-analysis. J Affect Disord 2017; 208:298-308. [PMID: 27794254 DOI: 10.1016/j.jad.2016.08.057] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/09/2016] [Accepted: 08/24/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is evidence that stressful life events (LE) play a crucial role in the etiology of bipolar affective disorder (BD). However, primary studies, as well as narrative reviews, have provided mixed results. The present meta-analysis combined and analyzed previous data in order to address these inconsistencies. METHOD Forty-two studies published in 53 records were identified by systematically searching MEDLINE, PsychINFO, and PSYCHINDEX using the terms "bipolar disorder" OR "manic-depressive" OR "bipolar affective disorder" OR "mania" AND "stress" OR "life event" OR "daily hassles" OR "goal attainment". Then, meta-analyses were conducted. RESULTS Individuals diagnosed with BD reported more LE before relapse when compared to euthymic phases. They also experienced more LE relative to healthy individuals and to physically ill patients. No significant difference in the number of LE was found when BD was compared to unipolar depression and schizophrenia. LIMITATIONS When interpreting the present meta-analytic findings one should keep in mind that most included studies were retrospective and often did not specify relevant information, e.g., if the LE were chronic or acute or if the individuals were diagnosed with BD I or II. We could not entirely rule out a publication bias. CONCLUSION The present meta-analyses found that individuals with BD were sensitive to LE, which corroborates recent theoretical models and psychosocial treatment approaches of BD. Childbirth, as a specific LE, affected individuals with BD more than individuals with unipolar depression. Future studies that investigate specific LE are warranted.
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Affiliation(s)
- Claudia Lex
- Villach General Hospital, Department of Psychiatry, Austria
| | - Eva Bäzner
- Eberhard Karls University, Tübingen, Germany
| | - Thomas D Meyer
- Eberhard Karls University, Tübingen, Germany; McGovern Medical School, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, USA.
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19
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Medici CR, Vestergaard CH, Hadzi-Pavlovic D, Munk-Jørgensen P, Parker G. Seasonal variations in hospital admissions for mania: Examining for associations with weather variables over time. J Affect Disord 2016; 205:81-86. [PMID: 27423064 DOI: 10.1016/j.jad.2016.06.053] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/16/2016] [Accepted: 06/19/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Bipolar disorder is characterized by a seasonal pattern with emerging evidence that weather conditions may trigger symptoms. Thus, our aims were to investigate if year-to-year variations in admissions with mania correlated with year-to-year variations in key meteorological variables, if there was a secular trend in light of climate change and if gender or admission status influenced the seasonal pattern. METHODS We undertook a Danish register-based nationwide historical cohort study. We included all adults hospitalized to psychiatric care from 1995 to 2012 with mania using the Danish Psychiatric Central Research Register. The Danish Meteorological Institute provided the meteorological variables. The association between weather and admissions was tested using linear regression. RESULTS Our database comprised 24,313 admissions with mania. There was a seasonal pattern with admission rates peaking in summer. Higher admission rates were associated with more sunshine, more ultraviolet radiation, higher temperature and less snow but were unassociated with rainfall. We did not find a secular trend in the seasonal pattern. Finally, neither gender nor admission status impacted on the overall seasonal pattern of admissions with mania. LIMITATIONS Only patients in psychiatric care were included. We could not subdivide by type of bipolar disorder. CONCLUSION This cohort study based on more than 24,000 admissions identified a distinct seasonal pattern in hospital admissions for those with mania. We found no secular trend. This could indicate that the climate change is not impacting on seasonal patterns, that there is no link between the proposed variables or that change is currently not sufficiently distinctive.
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Affiliation(s)
- Clara Reece Medici
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Denmark; Clinic for OCD and Anxiety Disorders, Aarhus University Hospital, Risskov, Denmark; Psychiatric Research Academy, Department of Affective Disorders (Q2), Aarhus University Hospital, Risskov, Denmark.
| | | | - Dusan Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | | | - Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
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20
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Banks FD, Lobban F, Fanshawe TR, Jones SH. Associations between circadian rhythm instability, appraisal style and mood in bipolar disorder. J Affect Disord 2016; 203:166-175. [PMID: 27295373 DOI: 10.1016/j.jad.2016.05.075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/30/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Internal appraisal styles, in addition to circadian and social rhythm instability, have been implicated in the development of mood experiences in bipolar disorder (BD), yet potential interactions between these variables remain under researched. METHODS This study used online questionnaires to examine relationships between social and circadian rhythm instability, appraisal style and mood within populations at varying vulnerability for BD. RESULTS Participants with BD (n=51), and those at behavioural high-risk (BHR; n=77), exhibited poor sleep quality and a stronger tendency to form internal appraisals of both positive and negative experiences compared to non-clinical controls (n=498) and participants with fibromyalgia (n=80). Participants with BD also exhibited a stronger tendency to adopt an internal, negative appraisal style compared to individuals at BHR. Sleep disturbance and internal appraisal styles were significantly associated with low mood in BD. LIMITATIONS Sleep quality and social rhythm stability were assessed using self-report measures only, which may differ from objective measures. Causal relationships between constructs could not be examined due to the cross-sectional design. CONCLUSIONS The findings suggest the importance of attending to internal appraisal styles and sleep quality when working therapeutically with individuals diagnosed with BD. Potential differences in the effect of appraisal style at the state and trait level warrant further exploration.
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Affiliation(s)
- Faye D Banks
- School of Psychology, Newcastle University, United Kingdom.
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Lancaster University, United Kingdom
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Steven H Jones
- Spectrum Centre for Mental Health Research, Lancaster University, United Kingdom
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21
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Martino M, Magioncalda P, Saiote C, Conio B, Escelsior A, Rocchi G, Piaggio N, Marozzi V, Huang Z, Ferri F, Amore M, Inglese M, Northoff G. Abnormal functional-structural cingulum connectivity in mania: combined functional magnetic resonance imaging-diffusion tensor imaging investigation in different phases of bipolar disorder. Acta Psychiatr Scand 2016; 134:339-49. [PMID: 27273612 DOI: 10.1111/acps.12596] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The objective of the study was to investigate the relationship between structural connectivity (SC) and functional connectivity (FC) in the cingulum in bipolar disorder (BD) and its various phases. METHOD We combined resting-state functional magnetic resonance imaging and probabilistic tractographic diffusion tensor imaging to investigate FC and SC of the cingulum and its portions, the SC-FC relationship, and their correlations with clinical and neurocognitive measures on sustained attention in manic (n = 21), depressed (n = 20), and euthymic (n = 20) bipolar patients and healthy controls (HC) (n = 42). RESULTS First, we found decreased FC between the anterior and posterior parts of the cingulum in manic patients when compared to depressed patients and HC. Second, we observed decreased SC of the cingulum bundle, particularly in its anterior part, in manic patients when compared to HC. Finally, alterations in the cingulum FC (but not SC) correlated with clinical severity scores while changes in the cingulum SC (but not FC) were related with neurocognitive deficits in sustained attention in BD. CONCLUSION We demonstrate for the first time a reduction in FC and concomitantly in SC of the cingulum in mania, which correlated with psychopathological and neurocognitive parameters, respectively, in BD. This supports the central role of cingulum connectivity specifically in mania.
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Affiliation(s)
- M Martino
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
| | - P Magioncalda
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy.
| | - C Saiote
- Department of Neurology, Radiology and Neuroscience, Mount Sinai School of Medicine, New York, NY, USA
| | - B Conio
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
| | - A Escelsior
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
| | - G Rocchi
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
| | - N Piaggio
- Section of Neuroradiology, Department of Radiology, University of Genoa, Genoa, Italy
| | - V Marozzi
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Z Huang
- Mind, Brain Imaging, and Neuroethics, Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - F Ferri
- Mind, Brain Imaging, and Neuroethics, Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - M Amore
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
| | - M Inglese
- Department of Neurology, Radiology and Neuroscience, Mount Sinai School of Medicine, New York, NY, USA.,Magnetic Resonance Research Center on Nervous System Diseases, University of Genoa, Genoa, Italy.,Section of Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
| | - G Northoff
- Mind, Brain Imaging, and Neuroethics, Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada.,University of Ottawa Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan.,Taipei Medical University-Shuang Ho Hospital, Brain and Consciousness Research Center, New Taipei City, Taiwan.,National Chengchi University, Research Center for Mind, Brain and Learning, Taipei, Taiwan.,Centre for Cognition and Brain Disorders (CCBD), Normal University Hangzhou, Hangzhou, China.,ITAB, University of Chieti, Chieti, Italy
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Yüksel RN, Elyas Kaya Z, Dilbaz N, Cingi Yirün M. Cabergoline-induced manic episode: case report. Ther Adv Psychopharmacol 2016; 6:229-31. [PMID: 27354910 PMCID: PMC4910397 DOI: 10.1177/2045125315626345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cabergoline is an orally administered synthetic dopamine agonist that is used for the treatment of hyperprolactinemia, Parkinson's disease and antipsychotic-induced prolactin elevation. One of the main characteristics of cabergoline is its long duration of effect. It is highly effective in suppressing prolactin levels up to 21 days after a single 1 mg oral dose. The prolonged elimination half-life offers an advantage of once-daily dosing, but it might be a handicap in terms of washout of adverse effects such as psychosis. Cabergoline has been associated with adverse reactions consistent with other dopaminergic agonists including cardiovascular, gastrointestinal and neuropsychiatric effects. It is known that dopaminergic treatment is a remarkable risk factor for psychosis. A number of reports implicate dopamine agonists in the development of psychosis, but there is no knowledge in the literature of dopamine agonist-induced mania. In this case, we report the first manic episode occurring after cabergoline use for hyperprolactinemia treatment. In susceptible individuals, cabergoline can cause manic episodes and cabergoline should be used more carefully considering the risk-benefit ratio.
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Affiliation(s)
- Rabia Nazik Yüksel
- Ankara Numune Training and Research Hospital, Talatpasa Bulvari, No: 5, D Blok, 1. Kat Psikiyatri, Ankara, Turkey
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Minnai GP, Salis P, Manchia M, Pinna M, Tondo L. What happens to the course of bipolar disorder after electroconvulsive therapy? J Affect Disord 2016; 195:180-4. [PMID: 26896811 DOI: 10.1016/j.jad.2016.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 11/16/2015] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bipolar disorder (BD) encompasses manic and depressive episodes and an illness-free interval. Treatments used in BD patients may influence the ill phases with different actions on the illness-free interval. METHODS We performed a naturalistic mirror-image retrospective study analyzing the number of episodes and admissions in 41 BD patients for the same period of time of 5 years before and after electroconvulsive therapy (ECT). Furthermore, we assessed the duration of free intervals before and after ECT as a sign of prolonged well-being. Univariate analysis with t-test was used to compare differences before and after ECT, while analysis of variance was used to compare factors possibly associated with the efficacy on free-interval of ECT. RESULTS Comparing the 5-year periods before and after ECT, we found significantly longer [13.2 ± 9.0 months before ECT to 25.1 ± 19.1 after treatment (t=3.8; p<0.0001)] free intervals, as well as significant reductions in the number of episodes [5.9 ± 3.0 before ECT to 1.0 ± 1.7 after treatment (t=9.3; p<0.0001)], and in the number of admissions [2.2 ± 1.3 before ECT to 0.2 ± 0.5 after treatment (t=9.4; p<0.0001)]. LIMITATIONS The main limitations of this study consisted in the relatively small sample size, the mirror-image retrospective naturalistic study design and possibly patient selection bias. CONCLUSIONS Electroconvulsive therapy seemed to increase free-intervals and reduced number of BD episodes and admissions. It is plausible that ECT, along with suspending antidepressant treatment, might carry intrinsic stabilizing effect on the course of BD.
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Affiliation(s)
- Gian Paolo Minnai
- Psychiatry Unit, San Martino Hospital - Health Agency N. 5, Oristano, Sardinia, Italy
| | - Piergiorgio Salis
- Psychiatry Unit, San Martino Hospital - Health Agency N. 5, Oristano, Sardinia, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Public Health, Molecular and Clinical Medicine, University of Cagliari, Sardinia, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martina Pinna
- Psychiatry Unit, San Martino Hospital - Health Agency N. 5, Oristano, Sardinia, Italy
| | - Leonardo Tondo
- Lucio Bini Mood Disorder Center, Rome, Italy; Lucio Bini Mood Disorder Centers, Cagliari, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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24
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Magioncalda P, Martino M, Conio B, Piaggio N, Teodorescu R, Escelsior A, Marozzi V, Rocchi G, Roccatagliata L, Northoff G, Inglese M, Amore M. Patterns of microstructural white matter abnormalities and their impact on cognitive dysfunction in the various phases of type I bipolar disorder. J Affect Disord 2016; 193:39-50. [PMID: 26766032 DOI: 10.1016/j.jad.2015.12.050] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/30/2015] [Accepted: 12/24/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND In recent years, diffusion tensor imaging (DTI) studies have detected subtle microstructural abnormalities of white matter (WM) in type I bipolar disorder (BD). However, WM alterations in the different phases of BD remain to be explored. The aims of this study is to investigate the WM alterations in the various phases of illness and their correlations with clinical and neurocognitive features. METHODS We investigated the DTI-derived fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD) in patients with type I BD (n=61) subdivided in manic (n=21), depressive (n=20) and euthymic phases (n=20) vs. healthy controls (n=42), using a tract-based spatial statistics (TBSS) approach. Then, we investigated whether the subgroups of patients in the various phases of illness present different patterns of WM abnormalities. Finally we studied the correlations between WM alterations and clinical-cognitive parameters. RESULTS We found a widespread alteration in WM microstructure (decrease in FA and increase in MD and RD) in BD when compared to controls. The various subgroups of BD showed different spatial patterns of WM alterations. A gradient of increasing WM abnormalities from the euthymic (low degree and localized WM alterations mainly in the midline structures) to the manic (more diffuse WM alterations affecting both midline and lateral structures) and, finally, to the depressive phase (high degree and widespread WM alterations), was found. Furthermore, the WM diffuse alterations correlated with cognitive deficits in BD, such as decreased fluency prompted by letter and decreased hits and increased omission errors at the continuous performance test. LIMITATIONS Patients under treatment. CONCLUSIONS The WM alterations in type I BD showed different spatial patterns in the various phases of illness, mainly affecting the active phases, and correlated with some cognitive deficits. This suggests a complex trait- and state-dependent pathogenesis of WM abnormalities in BD.
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Affiliation(s)
- Paola Magioncalda
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
| | - Matteo Martino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
| | - Benedetta Conio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
| | - Niccolò Piaggio
- Department of Radiology, Section of Neuroradiology, University of Genoa, Genoa, Italy.
| | - Roxana Teodorescu
- Department of Neurology, Radiology and Neuroscience, Mount Sinai School of Medicine, New York, USA.
| | - Andrea Escelsior
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
| | - Valentina Marozzi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
| | - Giulio Rocchi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
| | - Luca Roccatagliata
- Magnetic Resonance Research Center on Nervous System Diseases, University of Genoa, Genoa, Italy.
| | - Georg Northoff
- Institute of Mental Health Research, University of Ottawa, Ottawa, Canada; Taipei Medical University, Graduate Institute of Humanities in Medicine, Taipei, Taiwan; Taipei Medical University-Shuang Ho Hospital, Brain and Consciousness Research Center, New Taipei City, Taiwan; National Chengchi University, Research Center for Mind, Brain and Learning, Taipei, Taiwan; Centre for Cognition and Brain Disorders (CCBD), Normal University Hangzhou, Hangzhou, China.
| | - Matilde Inglese
- Department of Neurology, Radiology and Neuroscience, Mount Sinai School of Medicine, New York, USA; Magnetic Resonance Research Center on Nervous System Diseases, University of Genoa, Genoa, Italy.
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
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Levenson JC, Wallace ML, Anderson BP, Kupfer DJ, Frank E. Social rhythm disrupting events increase the risk of recurrence among individuals with bipolar disorder. Bipolar Disord 2015; 17:869-79. [PMID: 26614534 PMCID: PMC4702482 DOI: 10.1111/bdi.12351] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 09/16/2015] [Accepted: 09/28/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVES As outlined in the social zeitgeber hypothesis, social rhythm disrupting (SRD) life events begin a cascade of social and biological rhythm disruption that may lead to the onset of affective episodes in those vulnerable to bipolar disorder. Thus, the study of SRD events is particularly important in individuals with this chronic condition. The purpose of the current study was to evaluate (i) the extent to which SRD life events increased the risk of recurrence of a bipolar mood episode, and (ii) whether the social rhythm disruption associated with the event conferred an increased risk of recurrence, after accounting for the level of threat associated with the life event. METHODS We examined the effect of SRD events on recurrence during preventative treatment in a sample of 118 patients with bipolar disorder who achieved remission from an acute episode after receiving psychotherapy and pharmacotherapy. Life events were measured with the Bedford College Life Events and Difficulty Schedule and were rated for degree of SRD and threat. RESULTS Time-dependent Cox proportional hazards models showed that having a higher SRD rating was significantly associated with an increased risk of recurrence, even when accounting for the threat effect of a life event and psychosocial treatment (hazard ratio = 1.33, 95% confidence interval: 1.04-1.70, p = 0.023). However, this finding fell below conventional levels of statistical significance when accounting for other covariates. CONCLUSIONS Our findings lend partial support to the social zeitgeber hypothesis.
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Affiliation(s)
| | | | | | - David J. Kupfer
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Ellen Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Psychology, University of Pittsburgh
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26
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Pirkola S, Eriksen HA, Partonen T, Kieseppä T, Veijola J, Jääskeläinen E, Mylläri-Figuerola EM, Salo PM, Paunio T. Seasonal variation in affective and other clinical symptoms among high-risk families for bipolar disorders in an Arctic population. Int J Circumpolar Health 2015; 74:29671. [PMID: 26589395 PMCID: PMC4654770 DOI: 10.3402/ijch.v74.29671] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/14/2015] [Accepted: 10/26/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In bipolar disorder (BD), seasonality of symptoms is common and disturbances in circadian rhythms have been reported. OBJECTIVES We identified high-penetrance families in a geographically restricted area in Northern Fennoscandia and studied the seasonal variation of clinical symptoms among BD subjects and their healthy relatives. DESIGN We explored the clinical characteristics of subjects living in Northern Fennoscandia, with extreme annual variation in daylight. Among known indigenous high-risk families for BD, we compared the affected ones (N=16) with their healthy relatives (N=15), and also included 18 healthy non-related controls from the same geographical area. Seasonal fluctuation in clinical measures was followed up at the 4 most demarcated photoperiodic time points of the annual cycle: around the summer solstice and autumn equinox in 2013, the winter solstice in 2013/2014, and the spring equinox in 2014. In the baseline, lifetime manic symptoms [Mood Disorder Questionnaire (MDQ)] and morningness-eveningness questionnaire type (MEQ) were registered, whereas in the follow-up, depressive [Beck Depression Inventory (BDI)] and distress [General Health Questionnaire (GHQ-12)] symptoms and alcohol consumption and sleep were recorded. RESULTS Possibly indicative or statistically significant differences in symptoms between the affected subjects and their healthy relatives were the BDI winter (13.3 vs. 2.6, t=-2.51, p=0.022) and spring scores (12.6 vs. 3.2, t=-1.97, p=0.063) and GHQ winter (4.2 vs. 0.82, t=-2.08, p=0.052) and spring scores (3.8 vs. 0.82, t=-1.97, p=0.063). Scores were higher among the affected subjects, exceeding a possibly diagnostic threshold (10 and 3) at all the time points, and without the notable seasonality which was observed among the healthy relatives. In the overall population, MDQ and MEQ scores had an inverse correlation (-0.384, significant at 0.016), indicating increased lifetime manic behaviour among "the night owl" chronotype subjects. CONCLUSIONS In an Arctic population sample, we found different seasonal fluctuation in mood and distress symptoms and sleep duration scores between subjects with bipolar spectrum disorders and their healthy relatives. Despite the relatively small sample size, the results indicate that the symptoms and signs of BD relate to a disturbance in seasonal variation. Seasonal variation can be considered as an interesting endophenotype for BD and a promising target for further genetic studies.
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Affiliation(s)
- Sami Pirkola
- Department of Psychiatry, University and University Hospital of Oulu, Oulu, Finland.,National Institute of Health and Welfare, Helsinki, Finland.,Depertment of Social Psychiatry, School of Health Sciences, University of Tampere, Tampere, Finland;
| | - Heidi A Eriksen
- Centre of Arctic Medicine, Thule Institute, University of Oulu, Oulu, Finland
| | - Timo Partonen
- National Institute of Health and Welfare, Helsinki, Finland
| | - Tuula Kieseppä
- Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Juha Veijola
- Department of Psychiatry, University and University Hospital of Oulu, Oulu, Finland
| | - Erika Jääskeläinen
- Department of Psychiatry, University and University Hospital of Oulu, Oulu, Finland
| | | | - Paula M Salo
- National Institute of Health and Welfare, Helsinki, Finland
| | - Tiina Paunio
- National Institute of Health and Welfare, Helsinki, Finland.,Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
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Comparison of precipitating factors for mania and partial seizures: Indicative of shared pathophysiology? J Affect Disord 2015; 183:57-67. [PMID: 26001664 DOI: 10.1016/j.jad.2015.04.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/23/2015] [Accepted: 04/30/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Mania in bipolar disorder (BD) and partial (focal) seizures (PS) arising from the temporal lobes, have a number of similarities. Typically, a chronic course of the disorders is punctuated by acute illness episodes. Common features of episodes may include sensory, perceptual, cognitive and affective changes. Both respond to anticonvulsant treatment. Common mechanisms imputed include neurotransmitters and kindling processes. Further investigation may improve understanding of the occurrence of both mania and PS, casting light on the relevance of temporal lobe mediated processes and pathology. One avenue of investigation is to compare aetiological factors and determine the extent of overlap which may indicate shared brain localization or pathophysiology. Aetiology includes predisposing, precipitating or perpetuating factors. This paper examines the literature on precipitating factors of mania, first or subsequent episode, and of PS in diagnosed epilepsy, which is the second or subsequent seizure, to identify the extent and nature of their overlap. METHOD Narrative review based on a literature search of PubMed and Google Scholar. RESULTS Precipitating factors for both mania and PS were stress, sleep deprivation, antidepressant medication and, tentatively, emotion. For mania alone, goal-attainment events, spring and summer season, postpartum, and drugs include steroids and stimulants. For PS alone, winter season, menstruation and specific triggers in complex reflex epilepsies. Those not substantiated include lunar phase and menopause. A wide range of chemicals may provoke isolated seizures but by definition epilepsy requires at least two seizures. CONCLUSIONS The overlap of precipitating factors in mania and PS imply that common brain processes may contribute to both, consistent with findings from neuroscience research.
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28
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Thomson D, Turner A, Lauder S, Gigler ME, Berk L, Singh AB, Pasco JA, Berk M, Sylvia L. A brief review of exercise, bipolar disorder, and mechanistic pathways. Front Psychol 2015; 6:147. [PMID: 25788889 PMCID: PMC4349127 DOI: 10.3389/fpsyg.2015.00147] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/28/2015] [Indexed: 01/09/2023] Open
Abstract
Despite evidence that exercise has been found to be effective in the treatment of depression, it is unclear whether these data can be extrapolated to bipolar disorder. Available evidence for bipolar disorder is scant, with no existing randomized controlled trials having tested the impact of exercise on depressive, manic or hypomanic symptomatology. Although exercise is often recommended in bipolar disorder, this is based on extrapolation from the unipolar literature, theory and clinical expertise and not empirical evidence. In addition, there are currently no available empirical data on program variables, with practical implications on frequency, intensity and type of exercise derived from unipolar depression studies. The aim of the current paper is to explore the relationship between exercise and bipolar disorder and potential mechanistic pathways. Given the high rate of medical co-morbidities experienced by people with bipolar disorder, it is possible that exercise is a potentially useful and important intervention with regard to general health benefits; however, further research is required to elucidate the impact of exercise on mood symptomology.
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Affiliation(s)
- Daniel Thomson
- Department of Applied Sciences, Royal Melbourne Institute of Technology University , Bundoora, VIC, Australia
| | - Alyna Turner
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University , Geelong, VIC, Australia ; Department of Psychiatry, University of Melbourne , Parkville, VIC, Australia ; Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle , Callaghan, NSW, Australia
| | - Sue Lauder
- Department of Psychiatry, University of Melbourne , Parkville, VIC, Australia ; Federation University Australia , Ballarat, VIC, Australia
| | - Margaret E Gigler
- Department of Psychiatry, Massachusetts General Hospital , Boston, MA, USA
| | - Lesley Berk
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University , Geelong, VIC, Australia ; Mental Health and Wellbeing Strategic Research Centre, School of Psychology, Deakin University , Geelong, VIC, Australia
| | - Ajeet B Singh
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University , Geelong, VIC, Australia
| | - Julie A Pasco
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University , Geelong, VIC, Australia ; Department of Medicine, NorthWest Academic Centre, University of Melbourne , St Albans, VIC, Australia
| | - Michael Berk
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University , Geelong, VIC, Australia ; Department of Psychiatry, University of Melbourne , Parkville, VIC, Australia ; Florey Institute for Neuroscience and Mental Health , Parkville, VIC, Australia ; Orygen, The National Centre of Excellence in Youth Mental Health , Parkville, VIC, Australia
| | - Louisa Sylvia
- Department of Psychiatry, Massachusetts General Hospital , Boston, MA, USA ; Harvard Medical School, Harvard University , Boston, MA, USA
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29
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Contributions of the social environment to first-onset and recurrent mania. Mol Psychiatry 2015; 20:329-36. [PMID: 24751965 PMCID: PMC4206672 DOI: 10.1038/mp.2014.36] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 01/27/2014] [Accepted: 03/10/2014] [Indexed: 12/02/2022]
Abstract
In treated cohorts, individuals with bipolar disorder are more likely to report childhood adversities and recent stressors than individuals without bipolar disorder; similarly, in registry-based studies, childhood adversities are more common among individuals who later become hospitalized for bipolar disorder. Because these types of studies rely on treatment-seeking samples or hospital diagnoses, they leave unresolved the question of whether or not social experiences are involved in the etiology of bipolar disorder. We investigated the role of childhood adversities and adulthood stressors in liability for bipolar disorder using data from the National Epidemiologic Survey on Alcohol and Related Conditions (n=33 375). We analyzed risk for initial-onset and recurrent DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) manic episodes during the study's 3-year follow-up period. Childhood physical abuse and sexual maltreatment were associated with significantly higher risks of both first-onset mania (odds ratio (OR) for abuse: 2.23; 95% confidence interval (CI)=1.71, 2.91; OR for maltreatment: 2.10; CI=1.55, 2.83) and recurrent mania (OR for abuse: 1.55; CI=1.00, 2.40; OR for maltreatment: 1.60; CI=1.00, 2.55). In addition, past-year stressors in the domains of interpersonal instability and financial hardship were associated with a significantly higher risk of incident and recurrent mania. Exposure to childhood adversity potentiated the effects of recent stressors on adult mania. Our findings demonstrate a role of social experiences in the initial onset of bipolar disorder, as well as in its prospective course, and are consistent with etiologic models of bipolar disorder that implicate deficits in developmentally established stress-response pathways.
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30
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Ryu V, Kook S, Lee SJ, Ha K, Cho HS. Effects of emotional stimuli on time perception in manic and euthymic patients with bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2015; 56:39-45. [PMID: 25101544 DOI: 10.1016/j.pnpbp.2014.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 07/20/2014] [Accepted: 07/26/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Time perception, which plays a fundamental role in decision-making and the evaluation of the environment, is also influenced by emotions. Patients with bipolar disorder have impairments in emotional processing as well as interval timing. We investigated the effects of emotional stimuli on time estimation and reproduction in manic and euthymic bipolar patients compared with healthy controls. METHODS We recruited 22 manic bipolar patients, 24 euthymic bipolar patients and 24 healthy controls. Each subject performed time estimation and reproduction tasks using standardized affective pictures that were classified into 4 stimulus groups according to valence and level of arousal and presented for durations of 2, 4, and 6s. We analyzed temporal performance on these tasks using transformed data expressed as a proportion of the target period. RESULTS The interactions between arousal and valence were different in manic patients compared with euthymic patients and healthy controls in both time estimation and reproduction tasks. Manic patients showed no effect of positive valence low arousal stimuli in the time estimation task compared to euthymic patients and healthy controls. In the time reproduction task, the effect of emotional stimuli was reversed in manic patients compared to euthymic patients and healthy controls. Significant correlations between the severity of manic symptoms or illness severity and average temporal performance scores were found in manic patients. CONCLUSION Our results suggest that altered emotion-related time judgments may be a state-dependent phenomenon observed in manic patients only. This difference in time perception for emotional stimuli may be related to the underlying neurobiological mechanisms of the manic state.
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Affiliation(s)
- Vin Ryu
- Department of Psychiatry, Seoul National Hospital, Seoul, South Korea
| | - Sodahm Kook
- Department of Psychiatry, Myongji Hospital, Gyeonggi-do, South Korea
| | - Su Jin Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyooseob Ha
- Department of Psychiatry, Seoul National Hospital, Seoul, South Korea; Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Hyun-Sang Cho
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea.
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31
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Houtepen LC, Boks MPM, Kahn RS, Joëls M, Vinkers CH. Antipsychotic use is associated with a blunted cortisol stress response: a study in euthymic bipolar disorder patients and their unaffected siblings. Eur Neuropsychopharmacol 2015; 25:77-84. [PMID: 25453485 DOI: 10.1016/j.euroneuro.2014.10.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 09/09/2014] [Accepted: 10/13/2014] [Indexed: 11/30/2022]
Abstract
There is ample evidence that the acute stress response is altered in schizophrenia and bipolar disorder. However, it is not clear whether such changes are related to the illness, a genetic vulnerability, or is the result of medication that is used in the majority of these patients. Therefore, we investigated determinants of the acute endocrine and autonomic stress response in healthy controls (n=48), euthymic BD1 patients (n=49) and unaffected siblings of BD1 patients (n=27). All participants completed a validated psychosocial stress task, the Trier Social Stress Test for Groups (TSST-G). Saliva levels of alpha-amylase and cortisol were measured before, during, and after exposure to stress. Compared to controls, we found a significantly blunted cortisol stress response in BD1 patients. Conversely, BD1 patients displayed exaggerated alpha-amylase levels in response to stress. Antipsychotic use was a significant contributing factor to the blunted cortisol stress response in BD1 patients. Unaffected BD1 siblings displayed similar stress-induced cortisol and alpha-amylase levels as controls, suggesting that familial risk for BD1 did not have a large effect on the functionality of the stress system. In conclusion, this study shows that euthymic BD1 patients have a substantially blunted endocrine stress response but an exaggerated autonomic stress response and that the endocrine stress response differences can be largely contributed to antipsychotic use rather than constitute a specific BD1 phenotype or vulnerability.
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Affiliation(s)
- L C Houtepen
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
| | - M P M Boks
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - R S Kahn
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - M Joëls
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - C H Vinkers
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
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Boulle F, Massart R, Stragier E, Païzanis E, Zaidan L, Marday S, Gabriel C, Mocaer E, Mongeau R, Lanfumey L. Hippocampal and behavioral dysfunctions in a mouse model of environmental stress: normalization by agomelatine. Transl Psychiatry 2014; 4:e485. [PMID: 25423137 PMCID: PMC4259995 DOI: 10.1038/tp.2014.125] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/16/2014] [Accepted: 10/19/2014] [Indexed: 12/30/2022] Open
Abstract
Stress-induced alterations in neuronal plasticity and in hippocampal functions have been suggested to be involved in the development of mood disorders. In this context, we investigated in the hippocampus the activation of intracellular signaling cascades, the expression of epigenetic markers and plasticity-related genes in a mouse model of stress-induced hyperactivity and of mixed affective disorders. We also determined whether the antidepressant drug agomelatine, a MT1/MT2 melatonergic receptor agonist/5-HT2C receptor antagonist, could prevent some neurobiological and behavioral alterations produced by stress. C57BL/6J mice, exposed for 3 weeks to daily unpredictable socio-environmental stressors of mild intensity, were treated during the whole procedure with agomelatine (50 mg kg(-1) per day, intraperitoneal). Stressed mice displayed robust increases in emotional arousal, vigilance and motor activity, together with a reward deficit and a reduction in anxiety-like behavior. Neurobiological investigations showed an increased phosphorylation of intracellular signaling proteins, including Atf1, Creb and p38, in the hippocampus of stressed mice. Decreased hippocampal level of the repressive epigenetic marks HDAC2 and H3K9me2, as well as increased level of the permissive mark H3K9/14ac suggested that chronic mild stress was associated with increased gene transcription, and clear-cut evidence was further indicated by changes in neuroplasticity-related genes, including Arc, Bcl2, Bdnf, Gdnf, Igf1 and Neurod1. Together with other findings, the present data suggest that chronic ultra-mild stress can model the hyperactivity or psychomotor agitation, as well as the mixed affective behaviors often observed during the manic state of bipolar disorder patients. Interestingly, agomelatine could normalize both the behavioral and the molecular alterations induced by stress, providing further insights into the mechanism of action of this new generation antidepressant drug.
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Affiliation(s)
- F Boulle
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, Paris, France,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands,European Graduate School for Neuroscience (EURON), Maastricht, The Netherlands,Université Paris Descartes Paris 5, Paris, France
| | - R Massart
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
| | - E Stragier
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, Paris, France,UPMC, Université Paris 6, UMR S677, Paris, France
| | - E Païzanis
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, Paris, France,UPMC, Université Paris 6, UMR S677, Paris, France
| | - L Zaidan
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, Paris, France,UPMC, Université Paris 6, UMR S677, Paris, France
| | - S Marday
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, Paris, France,UPMC, Université Paris 6, UMR S677, Paris, France
| | | | | | - R Mongeau
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, Paris, France,Université Paris Descartes Paris 5, Paris, France
| | - L Lanfumey
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, Paris, France,UPMC, Université Paris 6, UMR S677, Paris, France,Faculté de Médecine Pierre et Marie Curie, Site Pitié-Salpêtrière, 91, Boulevard de l'Hôpital, INSERM UMR 894, 75634 Paris, France. E-mail:
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Proudfoot J, Whitton AE, Parker G, Manicavasagar V, Nicholas J, Smith M. Evidence of weekly cyclicity in mood and functional impairment in those with a bipolar disorder. Psychiatry Res 2014; 218:290-4. [PMID: 24844980 DOI: 10.1016/j.psychres.2014.04.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 04/21/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
Abstract
A key characteristic of bipolar disorder is fluctuation in mood symptoms and functional capacity, yet assessment of bipolar symptomatology often relies heavily on interval measurement that is unable to capture the full range of daily symptom variability and severity. The current study provides a detailed analysis of the variability in mood symptoms, functional impairment and medication compliance in a large sample of individuals newly diagnosed with bipolar disorder. Individuals diagnosed with bipolar disorder in the previous 12 months (n=192) rated their mood, functional impairment, medication compliance and symptom triggers daily over 10 consecutive weeks. High mood, low mood and functional impairment were found to vary on a weekly cycle, independently of medication compliance. Low mood and functional impairment were worse on weekdays, particularly Mondays and Tuesdays, whereas mood was most elevated on Saturdays. Work-related stressors were the most common symptom triggers on weekdays, whereas sleep-related problems and positive social events were the most common triggers on weekends. This study provides evidence that individuals newly diagnosed with bipolar disorder experience fluctuations in mood and functioning that vary according to a weekly cycle. This finding has implications for the assessment and treatment of patients, and for future research.
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Affiliation(s)
- Judith Proudfoot
- School of Psychiatry, University of NSW and Black Dog Institute, Hospital Road, Randwick, Sydney, NSW 2031, Australia
| | - Alexis E Whitton
- School of Psychiatry, University of NSW and Black Dog Institute, Hospital Road, Randwick, Sydney, NSW 2031, Australia.
| | - Gordon Parker
- School of Psychiatry, University of NSW and Black Dog Institute, Hospital Road, Randwick, Sydney, NSW 2031, Australia
| | - Vijaya Manicavasagar
- School of Psychiatry, University of NSW and Black Dog Institute, Hospital Road, Randwick, Sydney, NSW 2031, Australia
| | - Jennifer Nicholas
- School of Psychiatry, University of NSW and Black Dog Institute, Hospital Road, Randwick, Sydney, NSW 2031, Australia
| | - Meg Smith
- School of Social Sciences, University of Western Sydney, Penrith South DC, NSW, Australia
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Benti L, Manicavasagar V, Proudfoot J, Parker G. Identifying early indicators in bipolar disorder: a qualitative study. Psychiatr Q 2014; 85:143-53. [PMID: 24174009 DOI: 10.1007/s11126-013-9279-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The identification of early markers has become a focus for early intervention in bipolar disorder. Using a retrospective, qualitative methodology, the present study compares the early experiences of participants with bipolar disorder to those with unipolar depression up until their first diagnosed episode. The study focuses on differences in early home and school environments as well as putative differences in personality characteristics between the two groups. Finally we a compare and contrast prodromal symptoms in these two populations. Thirty-nine participants, 20 diagnosed with unipolar depression and 19 diagnosed with bipolar disorder, took part in the study. A semi-structured interview was developed to elicit information about participants' experiences prior to their first episode. Participants with bipolar disorder reported disruptive home environments, driven personality features, greater emotion dysregulation and adverse experiences during the school years, whereas participants with depression tended to describe more supportive home environments, and more compliant and introvert personality traits. Retrospective data collection and no corroborative evidence from other family members. No distinction was made between bipolar I and bipolar II disorder nor between melancholic and non-melancholic depression in the sample. Finally the study spanned over a 12-month period which does not allow for the possibility of diagnostic reassignment of some of the bipolar participants to the unipolar condition. These findings indicate that there may be benefits in combining both proximal and distal indicators in identifying a bipolar disorder phenotype which, in turn, may be relevant to the development of early intervention programs for young people with bipolar disorder.
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Affiliation(s)
- Liliane Benti
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia,
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Alterations in circadian rhythms are associated with increased lipid peroxidation in females with bipolar disorder. Int J Neuropsychopharmacol 2014; 17:715-22. [PMID: 24438530 DOI: 10.1017/s1461145713001740] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Disturbances in both circadian rhythms and oxidative stress systems have been implicated in the pathophysiology of bipolar disorder (BD), yet no studies have investigated the relationship between these systems in BD. We studied the impact of circadian rhythm disruption on lipid damage in 52 depressed or euthymic BD females, while controlling for age, severity of depressive symptoms and number of psychotropic medications, compared to 30 healthy controls. Circadian rhythm disruption was determined by a self-report measure (Biological Rhythm Interview of Assessment in Neuropsychiatry; BRIAN), which measures behaviours such as sleep, eating patterns, social rhythms and general activity. Malondialdehyde (MDA) levels were measured as a proxy of lipid peroxidation. We also measured the activity of total and extracellular superoxide dismutase (SOD), catalase (CAT) and glutathione S-transferase (GST). Multiple linear regressions showed that circadian rhythm disturbance was independently associated with increased lipid peroxidation in females with BD (p < 0.05). We found decreased extracellular SOD (p < 0.05), but no differences in total SOD, CAT or GST activity between bipolar females and controls. Circadian rhythms were not associated with lipid peroxidation in healthy controls, where aging was the only significant predictor. These results suggest an interaction between the circadian system and redox metabolism, in that greater disruption in daily rhythms was associated with increased lipid peroxidation in BD only. Antioxidant enzymes have been shown to follow a circadian pattern of expression, and it is possible that disturbance of sleep and daily rhythms experienced in BD may result in decreased antioxidant defence and therefore increased lipid peroxidation. This study provides a basis for further investigation of the links between oxidative stress and circadian rhythms in the neurobiology of BD.
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Inglis AJ, Hippman CL, Carrion PB, Honer WG, Austin JC. Mania and depression in the perinatal period among women with a history of major depressive disorders. Arch Womens Ment Health 2014; 17:137-43. [PMID: 24402681 PMCID: PMC3961475 DOI: 10.1007/s00737-013-0408-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
Abstract
Women with a history of major depressive disorder (MDD) have increased risks for postpartum depression, but less is known about postpartum mania in this population. The objectives of this study were to prospectively determine the frequency with which mania occurs in the postpartum among women who have a history of MDD and to explore temporal relationships between onset of mania/hypomania and depression. We administered the Structured Clinical Interview for DSM IV disorders (SCID) to pregnant women with a self-reported history of MDD to confirm diagnosis and exclude women with any history of mania/hypomania. Participants completed the Edinburgh Postnatal Depression Scale and Altman Self-Rating Mania Scale (ASRM) once during the pregnancy (∼26 weeks) and 1 week, 1 month, and 3 months postpartum. Among women (n = 107) with a SCID-confirmed diagnosis of MDD, 34.6 % (n = 37) experienced mania/hypomania (defined by an ASRM score of ≥6) at ≥1 time point during the postpartum, and for just over half (20/37, 54 %), onset was during the postpartum. The highest frequency of mania/hypomania (26.4 %, n = 26) was at 1 week postpartum. Women who experienced mania/hypomania at 1 week postpartum had significantly more symptoms of mania/hypomania later in the postpartum. A substantive proportion of women with a history of MDD may experience first onset of mania/hypomania symptoms in the early postpartum, others may experience first onset during pregnancy. Taken with other recent data, these findings suggest a possible rationale for screening women with a history of MDD for mania/hypomania during the early postpartum period, but issues with screening instruments are discussed.
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Affiliation(s)
- Angela J Inglis
- Department of Medical Genetics, University of British Columbia, Vancouver
| | - Catriona L Hippman
- Department of Psychiatry, University of British Columbia, Vancouver,Women’s Health Research Institute, BC Women’s Hospital & Health Centre, Vancouver
| | | | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver
| | - Jehannine C Austin
- Department of Medical Genetics, University of British Columbia, Vancouver,Department of Psychiatry, University of British Columbia, Vancouver
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Delle Chiaie R, Trabucchi G, Girardi N, Marini I, Pannese R, Vergnani L, Caredda M, Zerella MP, Minichino A, Corrado A, Patacchioli FR, Simeoni S, Biondi M. Group psychoeducation normalizes cortisol awakening response in stabilized bipolar patients under pharmacological maintenance treatment. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 82:264-6. [PMID: 23736884 DOI: 10.1159/000348609] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 01/17/2013] [Indexed: 11/19/2022]
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Strauss JS, Khare T, De Luca V, Jeremian R, Kennedy JL, Vincent JB, Petronis A. Quantitative leukocyte BDNF promoter methylation analysis in bipolar disorder. Int J Bipolar Disord 2013; 1:28. [PMID: 25505691 PMCID: PMC4215812 DOI: 10.1186/2194-7511-1-28] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 12/09/2013] [Indexed: 01/26/2023] Open
Abstract
Background Bipolar disorder (BD) is a complex psychiatric phenotype with a high heritability and a multifactorial etiology. Multisite collaborative efforts using genome-wide association studies (GWAS) have identified only a portion of DNA sequence-based risk factors in BD. In addition to predisposing DNA sequence variants, epigenetic misregulation may play an etiological role in BD and account for monozygotic twin discordance, parental origin effects, and fluctuating course of BD. In this study, we investigated DNA methylation of the brain-derived neurotrophic factor (BDNF) gene in BD. Methods Fifty participants with BD were compared to the same number of age- and sex-matched controls for DNA methylation differences at BDNF promoters 3 and 5. DNA methylation reads were obtained using a mass spectrophotometer for 64 cytosine-guanine (CpG) sites in 36 CpG ‘units’ across three amplicons of BDNF promoters 3 and 5. Results and Discussion Methylation fractions differed between BD participants and controls for 11 of 36 CpG units. Five CpG units, mostly in promoter 5, remained significant after false discovery rate correction (FDR) (p values ≤ 0.004) with medium to large effect sizes (Cohen's d ≥ 0.61). Several of the significant CpGs overlapped with or were immediately adjacent to transcription factor binding sites (TFBSs) - including two of the FDR-significant CpG units in promoter 5. For the CpGs in promoter 3, there was a positive and significant correlation between age at sample collection and DNA methylation fraction (rho = 0.56, p = 2.8 ×10−5) in BD cases, but not in controls. Statistically significant differences in mean methylation fraction at 5/36 CpG units (after FDR), some at or immediately adjacent to TFBSs, suggest possible relevance for the current findings to BD etiopathogenesis. The positive correlation between age and methylation seen in promoter 3 is consistent with age-related decline in BDNF expression previously reported. Future studies should provide more exhaustive epigenetic study of the BDNF locus to better characterize the relationship between BDNF methylation differences and BD. Electronic supplementary material The online version of this article (doi:10.1186/2194-7511-1-28) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John S Strauss
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON M6J1H4 Canada
| | - Tarang Khare
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON M6J1H4 Canada
| | - Vincenzo De Luca
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON M6J1H4 Canada
| | - Richie Jeremian
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON M6J1H4 Canada
| | - James L Kennedy
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON M6J1H4 Canada
| | - John B Vincent
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON M6J1H4 Canada
| | - Arturas Petronis
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON M6J1H4 Canada
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Kerner B, Rao AR, Christensen B, Dandekar S, Yourshaw M, Nelson SF. Rare Genomic Variants Link Bipolar Disorder with Anxiety Disorders to CREB-Regulated Intracellular Signaling Pathways. Front Psychiatry 2013; 4:154. [PMID: 24348429 PMCID: PMC3842585 DOI: 10.3389/fpsyt.2013.00154] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 11/09/2013] [Indexed: 11/28/2022] Open
Abstract
Bipolar disorder is a common, complex, and severe psychiatric disorder with cyclical disturbances of mood and a high suicide rate. Here, we describe a family with four siblings, three affected females and one unaffected male. The disease course was characterized by early-onset bipolar disorder and co-morbid anxiety spectrum disorders that followed the onset of bipolar disorder. Genetic risk factors were suggested by the early onset of the disease, the severe disease course, including multiple suicide attempts, and lack of adverse prenatal or early life events. In particular, drug and alcohol abuse did not contribute to the disease onset. Exome sequencing identified very rare, heterozygous, and likely protein-damaging variants in eight brain-expressed genes: IQUB, JMJD1C, GADD45A, GOLGB1, PLSCR5, VRK2, MESDC2, and FGGY. The variants were shared among all three affected family members but absent in the unaffected sibling and in more than 200 controls. The genes encode proteins with significant regulatory roles in the ERK/MAPK and CREB-regulated intracellular signaling pathways. These pathways are central to neuronal and synaptic plasticity, cognition, affect regulation and response to chronic stress. In addition, proteins in these pathways are the target of commonly used mood-stabilizing drugs, such as tricyclic antidepressants, lithium, and valproic acid. The combination of multiple rare, damaging mutations in these central pathways could lead to reduced resilience and increased vulnerability to stressful life events. Our results support a new model for psychiatric disorders, in which multiple rare, damaging mutations in genes functionally related to a common signaling pathway contribute to the manifestation of bipolar disorder.
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Affiliation(s)
- Berit Kerner
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Aliz R. Rao
- Department of Human Genetics, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Sugandha Dandekar
- Department of Human Genetics, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael Yourshaw
- Department of Human Genetics, University of California Los Angeles, Los Angeles, CA, USA
| | - Stanley F. Nelson
- Department of Human Genetics, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Geoffroy PA, Bellivier F, Scott J, Boudebesse C, Lajnef M, Gard S, Kahn JP, Azorin JM, Henry C, Leboyer M, Etain B. Bipolar disorder with seasonal pattern: clinical characteristics and gender influences. Chronobiol Int 2013; 30:1101-7. [PMID: 23931033 DOI: 10.3109/07420528.2013.800091] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Bipolar disorder (BD) has a multifactorial etiology with heterogeneous clinical presentations. Around 25% of BD patients may present with a depressive seasonal pattern (SP). However, there are limited scientific data on the prevalence of SP, its clinical manifestations, and any gender influence. Four hundred and fifty-two BD I and II cases (62% female), recruited from three French university-affiliated psychiatric departments, were assessed for SP. Clinical, treatment, and sociodemographic variables were obtained from structured interviews. One hundred and two (23%) cases met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria for SP, with similar frequency according to gender. Multivariate analysis showed a significant association between SP and BD II (odds ratio [OR] = 1.99, p = 0.01), lifetime history of rapid cycling (OR = 2.05, p = 0.02), eating disorders (OR = 2.94, p = 0.003), and total number of depressive episodes (OR = 1.13, p = 0.002). Seventy-one percent of cases were correctly classified by this analysis. However, when stratifying the analyses by gender, SP was associated with BD II subtype (OR = 2.89, p = 0.017) and total number of depressive episodes (OR = 1.21, p = 0.0018) in males but with rapid cycling (OR = 3.02, p = 0.0027) and eating disorders (OR = 2.60, p = 0.016) in females. This is the first study to identify different associations between SP and clinical characteristics of BD according to gender. The authors suggest that SP represents a potentially important specifier of BD. These findings indicate that seasonality may reflect increased severity or complexity of disorder.
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Levenson JC, Nusslock R, Frank E. Life events, sleep disturbance, and mania: An integrated model. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/cpsp.12034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sung TI, Chen MJ, Su HJ. A positive relationship between ambient temperature and bipolar disorder identified using a national cohort of psychiatric inpatients. Soc Psychiatry Psychiatr Epidemiol 2013; 48:295-302. [PMID: 22763494 DOI: 10.1007/s00127-012-0542-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 06/15/2012] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study characterizes the positive relationship between daily temperature and bipolar disorder in a cohort of Taiwanese psychiatric inpatients. METHODS Meteorological data, provided by the Central Weather Bureau (CWB) of Taiwan, were interpolated to create representative estimates of mean diurnal temperatures for 352 townships. Psychiatric inpatient admissions enrolled in the national health-care insurance system were retrieved from the 1996-2007 Psychiatric Inpatient Medical Claim (PIMC) dataset. The generalized linear mixed models with Poisson distribution were used to evaluate the relative risks of mean diurnal temperature with respect to increased admissions for bipolar disorder, while adjusting for internal correlations and demographic covariates. RESULTS Increased relative risks of bipolar disorder admissions were associated with the increasing trends of temperature over 24.0 °C (50th ‰), especially for adults and females. The highest daily diurnal temperatures above 30.7 °C (99th ‰) had the greatest risks of bipolar hospitalizations. CONCLUSION Understanding the increase of bipolar disorder admissions occurring in extreme heat is important in the preparation and prevention of massive recurrences of bipolar episodes.
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Affiliation(s)
- Tzu-I Sung
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Rd, Tainan 704, Taiwan
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Proudfoot J, Whitton A, Parker G, Doran J, Manicavasagar V, Delmas K. Triggers of mania and depression in young adults with bipolar disorder. J Affect Disord 2012; 143:196-202. [PMID: 22884233 DOI: 10.1016/j.jad.2012.05.052] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 04/24/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Early intervention significantly decreases the impact of bipolar disorder. However, there is little research investigating triggers that may be unique precipitants of manic/hypomanic episodes, and how these may differ from triggers specific to bipolar depression, in young adults with the disorder. METHODS Individuals aged 18 to 30 years who had been diagnosed with bipolar disorder (n=198) completed an online survey to identify triggers unique to mania/hypomania and depression, as well as triggers which were common to both. Respondents rated how frequently a series of situations and behaviours had precipitated either a manic/hypomanic episode or a depressive episode in the past. Survey data was supplemented by in-depth face-to-face interviews (n=11). RESULTS Triggers specifically associated with the onset of manic/hypomanic episodes included falling in love, recreational stimulant use, starting a creative project, late night partying, going on vacation and listening to loud music. Triggers associated with depressive episodes included stressful life events, general stress, fatigue, sleep deprivation, physical injury or illness, menstruation and decreases in physical exercise. A further set of triggers were identified as being common to both manic/hypomanic and depressive episodes. Consistent themes arose from the analysis of face-to-face interviews, which extended and illuminated the findings of the survey data. CONCLUSIONS Identification of a unique set of triggers for mania/hypomania and a unique set for depression in young adults with bipolar disorder may allow for earlier identification of episodes, thus increasing opportunities for early intervention.
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Affiliation(s)
- Judith Proudfoot
- School of Psychiatry, University of NSW and Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia.
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Life events and social rhythms in bipolar spectrum disorders: an examination of social rhythm sensitivity. J Affect Disord 2012; 139:264-72. [PMID: 22381951 PMCID: PMC3368102 DOI: 10.1016/j.jad.2012.01.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 01/17/2012] [Accepted: 01/30/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To examine the presence of an underlying social rhythm sensitivity in individuals with bipolar spectrum disorders. METHODS The present study examined the impact of life events on sleep loss and social rhythm disruption in 184 individuals with bipolar spectrum disorders (BSD) compared to 197 demographically similar normal controls (NC) drawn from the Longitudinal Investigation of Bipolar Spectrum Disorders (LIBS) project. Life events data were obtained at three time points, each spaced four months apart, and included information on the intensity of the event (high or low), valence (negative or positive), and levels of sleep loss and social rhythm disruption brought about the event. We hypothesized that BSD participants would exhibit higher levels of social rhythm disruption and sleep loss than normal controls as a consequence of the same life events. RESULTS BSD participants experienced significantly more social rhythm disruption and sleep loss following all classes of life events. LIMITATIONS The cross-sectional design of this study limits the strength of the conclusions that can be drawn, primarily cause and effect relationships between social rhythms and symptoms. CONCLUSIONS Findings support the presence of an underlying social rhythm sensitivity in individuals with bipolar spectrum disorders. An additive effect of sleep loss and social rhythm disruption may contribute to subsequent mood symptomatology. Results from this study may inform early psychosocial interventions for at-risk individuals.
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Evolutionary origin of bipolar disorder-revised: EOBD-R. Med Hypotheses 2011; 78:113-22. [PMID: 22036090 DOI: 10.1016/j.mehy.2011.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 09/07/2011] [Accepted: 10/04/2011] [Indexed: 11/19/2022]
Abstract
The hypothesis of the evolutionary origin of bipolar disorder (EOBD) synthesized ideas about the biological clock and seasonal shifts in mood (Rosenthal, Wehr) with theorizing that bipolar disorder descends from a pyknic (compact, cold-adapted) group (Kretchmer). The hypothesis suggested that bipolar behaviors evolved in the northern temperate zone as highly derived adaptations to the selective pressures of severe climatic conditions during the Pleistocene. Given evidence of Neandertal contributions to the human genome, the hypothesis is extended (EOBD-R) to suggest Neandertal as the ancestral source for bipolar vulnerability genes (susceptibility alleles). The EOBD-R hypothesis explains and integrates existing observations: bipolar disorder has the epidemiology of an adaptation; it is correlated with a cold-adapted build, and its moods vary according to light and season. Since the hypothesis was first published, data consistent with it have continued to appear. Individuals with seasonal affective disorder, which is related to bipolar disorder, have been shown to manifest a biological signal of season change similar to that found in hibernating animals. The involvement of the circadian gene network in the pathophysiology of bipolar disorder has been confirmed. Because selective pressures during the Pleistocene would have been greatest for women of reproductive age, they are expected to manifest winter depression more than males or younger females, which is the case. (This sex difference is also found in hibernating mammals.) Because it is hypothesized that the evolution of bipolar disorder took place in the northern temperate zone during the Pleistocene, it is not expected that individuals of African descent, lacking Neandertal genes, will manifest circular bipolar I disorder, and in fact, the incidence of bipolar disorder among black individuals is less than among whites. A definitive test of the hypothesis is proposed: It is predicted that the bipolar and Neandertal genomes will be more similar than the modern human and Neandertal genomes, and the modern human and San and Yoruba genomes will be more similar than the bipolar and San and Yoruba genomes. Failure to confirm these predictions will falsify the EOBD-R hypothesis. The EOBD-R hypothesis has important implications in the search for bipolar vulnerability genes and our understanding of ourselves and our Neandertal ancestor. At a practical level, confirmation of the EOBD-R hypothesis will boost interest and research in the prevention and management of bipolar symptoms by manipulation of ambient light.
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