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Maksyutynska K, Stogios N, Prasad F, Gill J, Hamza Z, De R, Smith E, Horta A, Goldstein BI, Korczak D, Graff-Guerrero A, Hahn MK, Agarwal SM. Neurocognitive correlates of metabolic dysregulation in individuals with mood disorders: a systematic review and meta-analysis. Psychol Med 2024; 54:1245-1271. [PMID: 38450447 DOI: 10.1017/s0033291724000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Individuals with mood disorders are predisposed to metabolic dysfunction, while those with metabolic dysregulation such as diabetes and obesity experience more severe depressive symptoms. Both metabolic dysfunction and mood disorders are independently associated with cognitive deficits. Therefore, given their close association, this study aimed to explore the association between metabolic dysfunction in individuals with mood disorders in relation to cognitive outcomes. A comprehensive search comprised of these three domains was carried out; a random-effects meta-analysis pooling mean cognitive outcomes was conducted (PROSPERO ID: CRD42022295765). Sixty-three studies were included in this review; 26 were synthesized in a quantitative meta-analysis. Comorbid metabolic dysregulation was associated with significantly lower global cognition among individuals with mood disorders. These trends were significant within each mood disorder subgroup, including major depressive disorder, bipolar disorder, and self-report depression/depressive symptoms. Type 2 diabetes was associated with the lowest cognitive performance in individuals with mood disorders, followed by peripheral insulin resistance, body mass index ⩾25 kg/m2, and metabolic syndrome. Significant reduction in scores was also observed among individual cognitive domains (in descending order) of working memory, attention, executive function, processing speed, verbal memory, and visual memory. These findings demonstrate the detrimental effects of comorbid metabolic dysfunction in individuals with mood disorders. Further research is required to understand the underlying mechanisms connecting mood disorders, metabolism, and cognition.
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Affiliation(s)
- Kateryna Maksyutynska
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nicolette Stogios
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Femin Prasad
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jashan Gill
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Zaineb Hamza
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Riddhita De
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Emily Smith
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Angelina Horta
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Benjamin I Goldstein
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Daphne Korczak
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Margaret K Hahn
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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2
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Hiller JK, Jangmo A, Tesli MS, Jaholkowski PP, Hoseth EZ, Steen NE, Haram M. Lipid Biomarker Research in Bipolar Disorder: A Scoping Review of Trends, Challenges, and Future Directions. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:594-604. [PMID: 37881590 PMCID: PMC10593953 DOI: 10.1016/j.bpsgos.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 10/27/2023] Open
Abstract
Bipolar disorder (BD) is a disabling disorder with heterogeneous symptom profiles and trajectories. Like many other neuropsychiatric disorders, clinical decision making related to diagnoses and choice of treatment is based on clinical assessments alone, and risk prediction for treatment success or resistance at an individual level remains sparse. An enormous effort to add biological markers to this risk prediction is ongoing. The role of lipids in normal brain functioning is well established, and several hypotheses about the role of lipids in the pathogenesis of neuropsychiatric disorders, including BD, have been made. The frequent comorbidity between neuropsychiatric disorders and cardiovascular disease, the genetic overlap of risk genes for severe mental disorders and genes involved in lipid regulation, and the lipid-altering effects of antipsychotics and mood stabilizers indicate that lipids could hold promise as biomarkers for neuropsychiatric disorders, including BD. To date, reviews of lipid biomarkers in schizophrenia and major depression have noted caveats for future investigations, while reviews of lipid biomarker research in BD is missing. In the current scoping review, we present a comprehensive overview of trends in previous research on lipid biomarkers in BD. The current literature varies greatly in the phenotypes investigated and study designs, leading to divergent findings. Small sample size; potential confounders related to physical activity, nutritional status, and medication use; and cross-sectional designs were frequently reported limitations. Future research may benefit from pivoting toward utilization of newer laboratory techniques such as lipidomics, but consistent use of study methods across cohorts is also needed.
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Affiliation(s)
| | - Andreas Jangmo
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Martin Steen Tesli
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Research and Education in Forensic Psychiatry, Department of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Piotr Pawel Jaholkowski
- Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eva Zsuzsanna Hoseth
- Clinic of Mental Health and Addiction, Møre and Romsdal Health Trust, Kristiansund, Norway
| | - Nils Eiel Steen
- Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marit Haram
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Chen PH, Tsai SY, Pan CH, Chen YL, Chang HM, Su SS, Chen CC, Kuo CJ. Sex-specific risk profiles for suicide mortality in bipolar disorder: incidence, healthcare utilization and comorbidity. Psychol Med 2023; 53:1500-1509. [PMID: 34779754 DOI: 10.1017/s003329172100307x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Evidence on sex-specific incidence and comorbidity risk factors of suicide among patients with bipolar disorder is scarce. This study investigated the sex-specific risk profiles for suicide among the bipolar disorder population in terms of incidence, healthcare utilization and comorbidity. METHODS Using data from the Taiwan National Health Insurance Research Database between 1 January 2000 and 31 December 2016, this nationwide cohort study included patients with bipolar disorder (N = 46 490) and individuals representative of the general population (N = 185 960) matched by age and sex at a 1:4 ratio. Mortality rate ratios (MRRs) of suicide were calculated between suicide rates of bipolar disorder cohort and general population. In addition, a nested case-control study (1428 cases died by suicide and 5710 living controls) was conducted in the bipolar disorder cohort to examine the sex-specific risk of healthcare utilization and comorbidities. RESULTS Suicide risk was considerably higher in the cohort (MRR = 21.9) than in the general population, especially among women (MRR = 35.6). Sex-stratified analyses revealed distinct healthcare utilization patterns and physical comorbidity risk profiles between the sexes. Although female patients who died by suicide had higher risks of nonhypertensive cardiovascular disease, pneumonia, chronic kidney disease, peptic ulcer, irritable bowel syndrome, and sepsis compared to their living counterparts, male patients who died by suicide had higher risks of chronic kidney disease and sepsis compared to the living controls. CONCLUSIONS Patients with bipolar disorder who died by suicide had sex-specific risk profiles in incidence and physical comorbidities. Identifying these modifiable risk factors may guide interventions for suicide risk reduction.
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Affiliation(s)
- Pao-Huan Chen
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Yi-Lung Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Counseling Psychology, Chinese Culture University, Taipei, Taiwan
| | - Hu-Ming Chang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Sheng-Siang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
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Zhong Y, Pham S, Porta G, Douaihy A, Marsland A, Brent D, Melhem NM. Increased burden of cardiovascular risk among youth suicide attempters. Psychol Med 2022; 52:1901-1909. [PMID: 33070786 PMCID: PMC8053730 DOI: 10.1017/s0033291720003736] [Citation(s) in RCA: 4] [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: 01/03/2023]
Abstract
BACKGROUND Suicide and cardiovascular disease rank among the leading causes of disability and premature mortality worldwide. Young adult suicide attempters are at increased risk of mortality from cardiovascular disease even compared to those with major depressive disorder suggesting an increased burden of cardiovascular risk factors. We compared the cardiovascular risk burden between youth attempters and other high-risk individuals. METHODS Participants were from the Collaborative Psychiatric Epidemiology Surveys (CPES), a U.S. population-based study, aged 18-30 years [suicide attempt (SA): n = 303; suicidal ideation (SI): n = 451; controls: n = 3671]; and psychiatric inpatients admitted for a SA (n = 38) or SI (n = 40) and healthy controls (n = 37) aged 15-30 years. We computed a cardiovascular risk score and high- and low-risk latent classes based on risk factors of high blood pressure, obesity, and smoking. RESULTS Suicide attempters showed an increased cardiovascular risk score (CPES: B = 0.43, 95% confidence interval (CI) 0.31-0.54, p < 0.001; inpatient sample: B = 1.61, 95% CI 0.53-2.68, p = 0.004) compared to controls. They were also more likely to be classified in the high cardiovascular risk group (CPES: odds ratio (OR) 3.36, 95% CI 1.67-6.78, p = 0.001; inpatient sample: OR 9.89, 95% CI 1.38-85.39, p = 0.03) compared to those with SI (CPES: OR 1.15, 95% CI 0.55-2.39, p = 0.71; inpatient sample: OR 1.91, 95% CI 0.25-15.00, p = 0.53). CONCLUSIONS Youth attempters show an increased burden for cardiovascular risk compared to other high-risk individuals in inpatient and population-based samples. Clinicians should pay particular attention to cardiovascular risk factors among suicide attempters in order to reduce their risk for cardiovascular events.
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Affiliation(s)
- Yongqi Zhong
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Epidemiology, University of Pittsburgh, PA, USA
| | - Steven Pham
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Giovanna Porta
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Antoine Douaihy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anna Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nadine M Melhem
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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Kennedy KG, Grigorian A, Mitchell RHB, McCrindle BW, MacIntosh BJ, Goldstein BI. Association of blood pressure with brain structure in youth with and without bipolar disorder. J Affect Disord 2022; 299:666-674. [PMID: 34920038 DOI: 10.1016/j.jad.2021.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/25/2021] [Accepted: 12/12/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND We previously found that blood pressure (BP) is elevated, and associated with poorer neurocognition, in youth with bipolar disorder (BD). While higher BP is associated with smaller brain structure in adults, studies have not examined this topic in BD or youth. METHODS Participants were 154 youth, ages 13-20 (n = 81 BD, n = 73 HC). Structural magnetic resonance imaging and diastolic (DBP), and systolic (SBP) pressure were obtained. Region of interest (ROI; anterior cingulate cortex [ACC], insular cortex, hippocampus) and vertex-wise analyses controlling for age, sex, body-mass-index, and intracranial volume investigated BP-neurostructural associations; a group-by-BP interaction was also assessed. RESULTS In ROI analyses, higher DBP in the overall sample was associated with smaller insular cortex area (β=-0.18 p = 0.007) and was associated with smaller ACC area to a significantly greater extent in HC vs. BD (β=-0.14 p = 0.015). In vertex-wise analyses, higher DBP and SBP were associated with smaller area and volume in the insular cortex, frontal, parietal, and temporal regions in the overall sample. Additionally, higher SBP was associated with greater thickness in temporal and parietal regions. Finally, higher SBP was associated with smaller area and volume in frontal, parietal, and temporal regions to a significantly greater extent in BD vs. HC. LIMITATIONS Cross-sectional design, single assessment of BP. CONCLUSION BP is associated with brain structure in youth, with variability related to structural phenotype (volume vs. thickness) and psychiatric diagnosis (BD vs. HC). Future studies evaluating temporality of these findings, and the association of BP changes on brain structure in youth, are warranted.
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Affiliation(s)
- Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Rm 4326, 100 stokes street Way, Toronto, ON M6J 1H4, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Rm 4326, 100 stokes street Way, Toronto, ON M6J 1H4, Canada
| | - Rachel H B Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Brian W McCrindle
- Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Brain Sciences, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Rm 4326, 100 stokes street Way, Toronto, ON M6J 1H4, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada.
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6
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Grigorian A, Kennedy KG, Luciw NJ, MacIntosh BJ, Goldstein BI. Obesity and Cerebral Blood Flow in the Reward Circuitry of Youth With Bipolar Disorder. Int J Neuropsychopharmacol 2022; 25:448-456. [PMID: 35092432 PMCID: PMC9211014 DOI: 10.1093/ijnp/pyac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is associated with elevated body mass index (BMI) and increased rates of obesity. Obesity among individuals with BD is associated with more severe course of illness. Motivated by previous research on BD and BMI in youth as well as brain findings in the reward circuit, the current study investigates differences in cerebral blood flow (CBF) in youth BD with and without comorbid overweight/obesity (OW/OB). METHODS Participants consisted of youth, ages 13-20 years, including BD with OW/OB (BDOW/OB; n = 25), BD with normal weight (BDNW; n = 55), and normal-weight healthy controls (HC; n = 61). High-resolution T1-weighted and pseudo-continuous arterial spin labeling images were acquired using 3 Tesla magnetic resonance imaging. CBF differences were assessed using both region of interest and whole-brain voxel-wise approaches. RESULTS Voxel-wise analysis revealed significantly higher CBF in reward-associated regions in the BDNW group relative to the HC and BDOW/OB groups. CBF did not differ between the HC and BDOW/OB groups. There were no significant region of interest findings. CONCLUSIONS The current study identified distinct CBF levels relating to BMI in BD in the reward circuit, which may relate to underlying differences in cerebral metabolism, compensatory effects, and/or BD severity. Future neuroimaging studies are warranted to examine for changes in the CBF-OW/OB link over time and in relation to treatment.
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Affiliation(s)
- Anahit Grigorian
- Centre for Youth Bipolar Disorder, Department of Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Department of Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas J Luciw
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ontario, Canada,Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Correspondence: Benjamin I. Goldstein, MD, PhD, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, Canada, M6J 1H4 ()
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Viapiana VF, Rodrigues ACRDBG, Peters R, Tramontina S, Passos IC, Fonseca RP. Pediatric bipolar disorder: Executive, linguistic, mnemonic, and cognitive efficiency mapping. APPLIED NEUROPSYCHOLOGY-CHILD 2021; 11:350-363. [PMID: 33496639 DOI: 10.1080/21622965.2020.1848568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Neuropsychological assessment can enrich our understanding of Pediatric Bipolar Disorder (PB). This study aimed to: (1) analyze the occurrence of neuropsychological frequency of deficits and difficulties in children with PB; (2) verify whether there is a performance difference between PB type I (PB-I) and PB type II (PB-II)/unspecified, and between PB with and without ADHD; and (3) verify the cognitive efficiency differences within the PB group and control groups, and among clinical subgroups. Participants in the study were 16 children diagnosed with PB and 40 children with typical development (6-12 years old). The results indicated a high frequency of deficits/difficulties in verbal fluency, cognitive efficiency in performing basic abilities, inhibitory control, cognitive flexibility, and working memory, with emphasis on verbal and executive losses. There were indications that type PB-I and comorbidity with ADHD negatively impact a child's neuropsychological development. The clinical group showed more cognitive efficiency losses compared with the control group, and greater losses were observed in PB-I and in PB with ADHD. The role of neuropsychological evaluation in multidomain and nonlinear statistical analysis is critical to gaining an understanding of the clinical and cognitive heterogeneity of PB.
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Affiliation(s)
- Vanisa Fante Viapiana
- Institute of Philosophy and Human Sciences, University of Passo Fundo, Passo Fundo, Brazil.,Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul - PUCRS, Porto Alegre, Brazil
| | | | - Roberta Peters
- Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul - PUCRS, Porto Alegre, Brazil
| | - Silzá Tramontina
- Child and Adolescent Psychiatry Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ives Cavalcante Passos
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil.,Department of Psychiatry, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rochele Paz Fonseca
- Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul - PUCRS, Porto Alegre, Brazil
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Van Rheenen TE, McIntyre RS, Balanzá-Martínez V, Berk M, Rossell SL. Cumulative Cardiovascular Disease Risk and Triglycerides Differentially Relate to Subdomains of Executive Function in Bipolar Disorder; preliminary findings. J Affect Disord 2021; 278:556-562. [PMID: 33022441 DOI: 10.1016/j.jad.2020.09.104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/26/2020] [Accepted: 09/26/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Cardiovascular disease is disproportionally prevalent in bipolar disorder (BD) and has been linked to cognition in preliminary studies. Herein we evaluate the association between known risk factors for cardiovascular disease and executive function in BD patients compared to healthy controls. METHODS In a sample of n=57 individuals (n=23 BD, n=34 controls) we assessed two subdomains of executive function; cognitive flexibility (using the Trail Making Test - Part B) and cognitive inhibition (using the Stroop Colour Word Interference Task). Cardiovascular risk was assessed by means of serum triglyceride levels, body mass index (BMI) and waist circumference, as well as dietary saturated fat intake and a sex-specific cumulative cardiovascular risk score calculated using the Framingham Heart Study method. RESULTS Patients with BD had higher BMI and waist circumference, with more BD patients categorized as having central obesity than controls. In the BD group only, higher triglyceride levels were associated with worse cognitive flexibility, and elevated cumulative cardiovascular disease risk was associated with worse cognitive inhibition. No correlations between cardiovascular risk factors and executive function were evident in the control group. LIMITATIONS The study was limited by the small sample size and should be considered hypothesis-generating CONCLUSIONS: The associations between triglyceride levels, cumulative cardiovascular disease risk and executive functioning evident in BD in this study preliminarily indicate the potential for mechanistic overlap of physical health and cognitive function in the disorder.
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Affiliation(s)
- Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia; Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia.
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Brain and Cognition Discovery Foundation University of Toronto, Toronto, Canada
| | - Vicent Balanzá-Martínez
- Teaching unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia; Barwon Health, PO Box 281, Geelong, Victoria, 3220, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, the Department of Psychiatry, and the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; Department of Psychiatry, St Vincent's Hospital, VIC, Australia
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9
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Laurent JS, Watts R, Mackey S. Toward Inclusion of Youths With Psychiatric Disorders in Brain-Body Research-Reply. JAMA Pediatr 2020; 174:907-908. [PMID: 32539091 DOI: 10.1001/jamapediatrics.2020.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jennifer S Laurent
- University of Vermont College of Nursing and Health Sciences, Burlington
| | | | - Scott Mackey
- Larner College of Medicine, Department of Psychiatry, University of Vermont, Burlington
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10
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Goldstein BI, Islam A, Naiberg M. Toward Inclusion of Youths With Psychiatric Disorders in Brain-Body Research. JAMA Pediatr 2020; 174:906-907. [PMID: 32539106 DOI: 10.1001/jamapediatrics.2020.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alvi Islam
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Melanie Naiberg
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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11
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Burdick KE, Millett CE, Russo M, Alda M, Alliey-Rodriguez N, Anand A, Balaraman Y, Berrettini W, Bertram H, Calabrese JR, Calkin C, Conroy C, Coryell W, DeModena A, Feeder S, Fisher C, Frazier N, Frye M, Gao K, Garnham J, Gershon ES, Glazer K, Goes FS, Goto T, Harrington GJ, Jakobsen P, Kamali M, Kelly M, Leckband S, Løberg EM, Lohoff FW, Maihofer AX, McCarthy MJ, McInnis M, Morken G, Nievergelt CM, Nurnberger J, Oedegaard KJ, Ortiz A, Ritchey M, Ryan K, Schinagle M, Schwebel C, Shaw M, Shilling P, Slaney C, Stapp E, Tarwater B, Zandi P, Kelsoe JR. The association between lithium use and neurocognitive performance in patients with bipolar disorder. Neuropsychopharmacology 2020; 45:1743-1749. [PMID: 32349118 PMCID: PMC7419515 DOI: 10.1038/s41386-020-0683-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/24/2020] [Accepted: 04/17/2020] [Indexed: 01/21/2023]
Abstract
Lithium remains the gold standard for the treatment of bipolar disorder (BD); however, its use has declined over the years mainly due to the side effects and the subjective experience of cognitive numbness reported by patients. In the present study, we aim to methodically test the effects of lithium on neurocognitive functioning in the largest single cohort (n = 262) of BD patients reported to date by harnessing the power of a multi-site, ongoing clinical trial of lithium monotherapy. At the cross-sectional level, multivariate analysis of covariance (MANCOVA) was conducted to examine potential group differences across neurocognitive tests [California Verbal Learning Test (CVLT trials 1-5,CVLT delayed recall), Wechsler Digit Symbol, Trail-making Test parts A and B (TMT-A; TMT-B), and a global cognition index]. At the longitudinal level, on a subset of patients (n = 88) who achieved mood stabilization with lithium monotherapy, we explored the effect of lithium treatment across time on neurocognitive functioning. There were no differences at baseline between BD patients that were taking lithium compared with those that were not. At follow-up a significant neurocognitive improvement in the global cognitive index score [F = 31.69; p < 0.001], CVLT trials 1-5 [F = 29.81; p < 0.001], CVLT delayed recall [F = 15.27; p < 0.001], and TMT-B [F = 6.64, p = 0.012] was detected. The cross-sectional and longitudinal (on a subset of 88 patients) investigations suggest that lithium may be beneficial to neurocognitive functioning in patients with BD and that at the very least it does not seem to significantly impair cognition when used therapeutically.
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Affiliation(s)
- Katherine E. Burdick
- grid.62560.370000 0004 0378 8294Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA ,James J Peters Veteran Administration (VA) Hospital, Bronx, NY USA
| | - Caitlin E. Millett
- grid.62560.370000 0004 0378 8294Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Manuela Russo
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Martin Alda
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | | | - Amit Anand
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Yokesh Balaraman
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Wade Berrettini
- grid.25879.310000 0004 1936 8972Center for Neurobiology and Behavior, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Holli Bertram
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Joseph R. Calabrese
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Cynthia Calkin
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | - Carla Conroy
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - William Coryell
- grid.214572.70000 0004 1936 8294University of Iowa, Iowa City, IA USA
| | - Anna DeModena
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Scott Feeder
- grid.66875.3a0000 0004 0459 167XMayo Clinic, Rochester, MN USA
| | - Carrie Fisher
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Nicole Frazier
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Mark Frye
- grid.66875.3a0000 0004 0459 167XMayo Clinic, Rochester, MN USA
| | - Keming Gao
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Julie Garnham
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | - Elliot S. Gershon
- grid.170205.10000 0004 1936 7822University of Chicago, Chicago, IL 60637 USA
| | - Kara Glazer
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Fernando S. Goes
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Toyomi Goto
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | | | - Petter Jakobsen
- grid.7914.b0000 0004 1936 7443NORMENT, Division of Psychiatry, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Masoud Kamali
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Marisa Kelly
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Susan Leckband
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Else Marie Løberg
- grid.7914.b0000 0004 1936 7443NORMENT, Division of Psychiatry, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Addiction Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Falk W. Lohoff
- grid.420085.b0000 0004 0481 4802National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, MD USA
| | - Adam X. Maihofer
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Michael J. McCarthy
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Melvin McInnis
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Gunnar Morken
- grid.412835.90000 0004 0627 2891Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | | | - John Nurnberger
- grid.411377.70000 0001 0790 959XIndiana University, Bloomington, IN USA
| | - Ketil J. Oedegaard
- grid.7914.b0000 0004 1936 7443NORMENT, Division of Psychiatry, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Abigail Ortiz
- grid.17063.330000 0001 2157 2938Centre for Addiction and Mental Health, University of Toronto, Toronto, ON Canada
| | - Megan Ritchey
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Kelly Ryan
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA
| | - Martha Schinagle
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Candice Schwebel
- grid.25879.310000 0004 1936 8972Center for Neurobiology and Behavior, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Martha Shaw
- grid.214572.70000 0004 1936 8294University of Iowa, Iowa City, IA USA
| | - Paul Shilling
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Claire Slaney
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University Halifax, Halifax, NS B3H 2E2 Canada
| | - Emma Stapp
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Bruce Tarwater
- grid.214572.70000 0004 1936 8294University of Iowa, Iowa City, IA USA
| | - Peter Zandi
- grid.21107.350000 0001 2171 9311Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - John R. Kelsoe
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
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12
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Mehrhof SZ, Popel N, Mio M, Lu W, Heyn CC, Fiksenbaum LM, MacIntosh BJ, Goldstein BI. Prevalence of white matter hyperintensities is not elevated in a large sample of adolescents and young adults with bipolar disorder. ACTA ACUST UNITED AC 2020; 43:147-152. [PMID: 32785453 PMCID: PMC8023160 DOI: 10.1590/1516-4446-2020-0886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/31/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The increased prevalence rate of white matter hyperintensities is one of the most consistently reported brain abnormalities in adults with bipolar disorder. However, findings in children and adolescents with bipolar disorder are less consistent. Prior studies have been constrained by small sample sizes and/or poor age- and sex-matching of healthy controls. We examined this topic in the largest sample of adolescents with bipolar disorder to date. METHODS T2-weighted 3-Tesla magnetic resonance imaging data were acquired for 83 adolescents with bipolar disorder diagnosed via the Kiddie Schedule for Affective Disorders and the Schizophrenia, Present and Lifetime version semi-structured interview and 64 age- and sex-matched healthy controls. All acquired scans were examined by neuroradiologists and the presence or absence of white matter hyperintensities was determined for each participant. RESULTS The prevalence of white matter hyperintensities did not differ between adolescents with bipolar disorder (13.3%) and controls (21.9%; χ2 = 1.90; p = 0.168). CONCLUSION In contrast to the study hypothesis, the prevalence of white matter hyperintensities was not higher in adolescents with bipolar disorder than controls. The large sample size and good matching for age and sex bolster the reliability of this negative finding. Future studies are warranted to evaluate the prevalence, incidence, and predictors of white matter hyperintensities in early-onset bipolar disorder prospectively.
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Affiliation(s)
- Sara Z Mehrhof
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Najla Popel
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Pharmacology, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Megan Mio
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Pharmacology, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Weicong Lu
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Chinthaka C Heyn
- Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Lisa M Fiksenbaum
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto Faculty of Medicine, Toronto, ON, Canada.,Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Pharmacology, University of Toronto Faculty of Medicine, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, ON, Canada
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13
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Goldstein BI, Baune BT, Bond DJ, Chen P, Eyler L, Fagiolini A, Gomes F, Hajek T, Hatch J, McElroy SL, McIntyre RS, Prieto M, Sylvia LG, Tsai S, Kcomt A, Fiedorowicz JG. Call to action regarding the vascular-bipolar link: A report from the Vascular Task Force of the International Society for Bipolar Disorders. Bipolar Disord 2020; 22:440-460. [PMID: 32356562 PMCID: PMC7522687 DOI: 10.1111/bdi.12921] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The association of bipolar disorder with early and excessive cardiovascular disease was identified over a century ago. Nonetheless, the vascular-bipolar link remains underrecognized, particularly with regard to how this link can contribute to our understanding of pathogenesis and treatment. METHODS An international group of experts completed a selective review of the literature, distilling core themes, identifying limitations and gaps in the literature, and highlighting future directions to bridge these gaps. RESULTS The association between bipolar disorder and vascular disease is large in magnitude, consistent across studies, and independent of confounding variables where assessed. The vascular-bipolar link is multifactorial and is difficult to study given the latency between the onset of bipolar disorder, often in adolescence or early adulthood, and subsequent vascular disease, which usually occurs decades later. As a result, studies have often focused on risk factors for vascular disease or intermediate phenotypes, such as structural and functional vascular imaging measures. There is interest in identifying the most relevant mediators of this relationship, including lifestyle (eg, smoking, diet, exercise), medications, and systemic biological mediators (eg, inflammation). Nonetheless, there is a paucity of treatment studies that deliberately engage these mediators, and thus far no treatment studies have focused on engaging vascular imaging targets. CONCLUSIONS Further research focused on the vascular-bipolar link holds promise for gleaning insights regarding the underlying causes of bipolar disorder, identifying novel treatment approaches, and mitigating disparities in cardiovascular outcomes for people with bipolar disorder.
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Affiliation(s)
- Benjamin I. Goldstein
- Centre for Youth Bipolar DisorderSunnybrook Health Sciences CentreTorontoONCanada,Departments of Psychiatry & PharmacologyFaculty of MedicineUniversity of TorontoTorontoONCanada
| | - Bernhard T. Baune
- Department of Psychiatry and PsychotherapyUniversity of MünsterMünsterGermany,Department of PsychiatryMelbourne Medical SchoolThe University of MelbourneMelbourneVICAustralia,The Florey Institute of Neuroscience and Mental HealthThe University of MelbourneParkvilleVICAustralia
| | - David J. Bond
- Department of Psychiatry and Behavioral ScienceUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - Pao‐Huan Chen
- Department of PsychiatryTaipei Medical University HospitalTaipeiTaiwan,Department of PsychiatrySchool of MedicineCollege of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Lisa Eyler
- Department of PsychiatryUniversity of California San DiegoSan DiegoCAUSA
| | | | - Fabiano Gomes
- Department of PsychiatryQueen’s University School of MedicineKingstonONCanada
| | - Tomas Hajek
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada,National Institute of Mental HealthKlecanyCzech Republic
| | - Jessica Hatch
- Centre for Youth Bipolar DisorderSunnybrook Health Sciences CentreTorontoONCanada,Departments of Psychiatry & PharmacologyFaculty of MedicineUniversity of TorontoTorontoONCanada
| | - Susan L. McElroy
- Department of Psychiatry and Behavioral NeuroscienceUniversity of Cincinnati College of MedicineCincinnatiOHUSA,Lindner Center of HOPEMasonOHUSA
| | - Roger S. McIntyre
- Departments of Psychiatry & PharmacologyFaculty of MedicineUniversity of TorontoTorontoONCanada,Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada
| | - Miguel Prieto
- Department of PsychiatryFaculty of MedicineUniversidad de los AndesSantiagoChile,Mental Health ServiceClínica Universidad de los AndesSantiagoChile,Department of Psychiatry and PsychologyMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | - Louisa G. Sylvia
- Department of PsychiatryMassachusetts General HospitalBostonMAUSA,Department of PsychiatryHarvard Medical SchoolCambridgeMAUSA
| | - Shang‐Ying Tsai
- Department of PsychiatryTaipei Medical University HospitalTaipeiTaiwan,Department of PsychiatrySchool of MedicineCollege of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Andrew Kcomt
- Hope+Me—Mood Disorders Association of OntarioTorontoONCanada
| | - Jess G. Fiedorowicz
- Departments of Psychiatry, Internal Medicine, & EpidemiologyCarver College of MedicineUniversity of IowaIowa CityIAUSA
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14
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Abstract
OBJECTIVE Severe behavioural issues such as impulsive action and suicide have since long been associated with low levels of cholesterol. While it is known that cholesterol plays a role in neural development and hence low levels of serum lipids could have long-term effects on behaviour, no longitudinal studies showed the association of serum lipids levels with impulsivity. We aimed to examine the prognostic properties of serum lipid levels during childhood and adolescence on measures of impulsivity during early adulthood in a representative birth cohort sample. METHODS We have investigated whether serum lipid levels measured at 9, 15, 18 and 25 years of age have an association with impulsivity in 25 years old young adults. This analysis was based on data of the birth cohort representative samples of the Estonian Children Personality Behaviour and Health Study (original n = 1238). Impulsivity was self-reported with the Adaptive and Maladaptive Impulsivity Scale. RESULTS Total and low-density lipoprotein (LDL) cholesterol measured in boys aged 9, 15 and 18 years predicted disinhibition and thoughtlessness in 25-year-old young adults. High scores of disinhibition were associated with low total and LDL cholesterol levels in males but, while less consistently, with high total and LDL cholesterol levels in females. Cross-sectional analysis did not result in systematic outcomes. CONCLUSIONS Serum lipid levels could have an impact on the development of Maladaptive Impulsivity starting from an early age. This effect of cholesterol continues throughout adolescence into young adulthood.
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15
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Bora E, McIntyre RS, Ozerdem A. Neurococognitive and neuroimaging correlates of obesity and components of metabolic syndrome in bipolar disorder: a systematic review. Psychol Med 2019; 49:738-749. [PMID: 30326979 DOI: 10.1017/s0033291718003008] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Individuals with bipolar disorder (BD) have a higher prevalence of obesity and metabolic syndrome (MetS) compared with the general population. Obesity and MetS are associated with cognitive deficits and brain imaging abnormalities in the general population. Obesity and components of MetS might potentially associate with neuroimaging and neurocognitive findings in BD. METHODS A literature search of studies investigating the association between obesity (and other components of MetS) and neurocognitive and neuroimaging findings in BD was conducted. In addition to a systematic review, a random-effects meta-analysis was conducted when sufficient data were available. RESULTS Twenty-three studies were included in the current systematic review. Overweight/obese patients were significantly associated with impaired neurocognition compared normal weight individuals with BD (d = 0.37). The most robust association between obesity and cognitive deficits in BD was observed in the cognitive subdomain of executive functions (d = 0.61). There was also evidence for a significant relationship between cognitive impairment in BD and other components of MetS including hypertension, dyslipidemia, and diabetes. Overweight/obese individuals with BD had more pronounced brain imaging abnormalities than normal weight individuals with BD. CONCLUSIONS Obesity and related cardiovascular risk factors significantly are associated with more severe cognitive and brain imaging abnormalities in BD. Medical co-morbidities can potentially contribute to functional decline observed in some patients throughout the course of BD.
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Affiliation(s)
- Emre Bora
- Department of Psychiatry,Dokuz Eylul University School of Medicine,Izmir,Turkey
| | - Roger S McIntyre
- Department of Psychiatry,University of Toronto,Toronto, ON,Canada
| | - Aysegul Ozerdem
- Department of Psychiatry,Dokuz Eylul University School of Medicine,Izmir,Turkey
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16
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Social stress response in adolescents with bipolar disorder. Psychoneuroendocrinology 2018; 91:159-168. [PMID: 29567620 PMCID: PMC6823638 DOI: 10.1016/j.psyneuen.2018.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/05/2018] [Accepted: 02/17/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Theoretical models posit that stressors contribute to the onset and maintenance of bipolar disorder in adolescence through disruptions in stress physiology, but physiological response to stressors has not been evaluated in adolescents with bipolar illness. The present study tests the hypothesis that adolescents with bipolar disorder will have greater reactivity to a laboratory social stress task than healthy adolescents. METHOD Adolescents with bipolar illness (n = 27) and healthy adolescents (n = 28) completed a modified version of the Trier Social Stress Task. Stress response was assessed using high frequency heart rate variability (HF-HRV), heart rate (HR), mean arterial blood pressure (MAP), salivary cortisol, and subjective stress. Multilevel models were used to test for group differences in resting-state physiology, and stress reactivity and recovery. RESULTS Adolescents with bipolar disorder had greater reactivity in HF-HRV (z = 3.32), but blunted reactivity in MAP (z = -3.08) and cortisol (z = -2.60), during the stressor compared to healthy adolescents. They also had lower resting HF-HRV (z = -3.49) and cortisol (z = -2.86), and higher resting HR (z = 3.56), than healthy adolescents. CONCLUSIONS These results indicate that bipolar disorder is associated with disruptions in autonomic and endocrine response to stress during adolescence, including greater HF-HRV reactivity. Further research should evaluate whether these individual differences in stress physiology precede and predict the onset of mood episodes.
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17
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Goldstein BI. Bipolar Disorder and the Vascular System: Mechanisms and New Prevention Opportunities. Can J Cardiol 2017; 33:1565-1576. [DOI: 10.1016/j.cjca.2017.10.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 12/19/2022] Open
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18
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Goldstein BI, Birmaher B, Carlson GA, DelBello MP, Findling RL, Fristad M, Kowatch RA, Miklowitz DJ, Nery FG, Perez‐Algorta G, Van Meter A, Zeni CP, Correll CU, Kim H, Wozniak J, Chang KD, Hillegers M, Youngstrom EA. The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research. Bipolar Disord 2017; 19:524-543. [PMID: 28944987 PMCID: PMC5716873 DOI: 10.1111/bdi.12556] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/14/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Over the past two decades, there has been tremendous growth in research regarding bipolar disorder (BD) among children and adolescents (ie, pediatric BD [PBD]). The primary purpose of this article is to distill the extant literature, dispel myths or exaggerated assertions in the field, and disseminate clinically relevant findings. METHODS An international group of experts completed a selective review of the literature, emphasizing areas of consensus, identifying limitations and gaps in the literature, and highlighting future directions to mitigate these gaps. RESULTS Substantial, and increasingly international, research has accumulated regarding the phenomenology, differential diagnosis, course, treatment, and neurobiology of PBD. Prior division around the role of irritability and of screening tools in diagnosis has largely abated. Gold-standard pharmacologic trials inform treatment of manic/mixed episodes, whereas fewer data address bipolar depression and maintenance/continuation treatment. Adjunctive psychosocial treatment provides a forum for psychoeducation and targets primarily depressive symptoms. Numerous neurocognitive and neuroimaging studies, and increasing peripheral biomarker studies, largely converge with prior findings from adults with BD. CONCLUSIONS As data have accumulated and controversy has dissipated, the field has moved past existential questions about PBD toward defining and pursuing pressing clinical and scientific priorities that remain. The overall body of evidence supports the position that perceptions about marked international (US vs elsewhere) and developmental (pediatric vs adult) differences have been overstated, although additional research on these topics is warranted. Traction toward improved outcomes will be supported by continued emphasis on pathophysiology and novel therapeutics.
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Affiliation(s)
- Benjamin I Goldstein
- Centre for Youth Bipolar DisorderSunnybrook Health Sciences CentreTorontoCanada,Departments of Psychiatry and PharmacologyUniversity of TorontoTorontoCanada
| | - Boris Birmaher
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Gabrielle A Carlson
- Department of PsychiatryStony Brook University School of MedicineStony BrookNYUSA
| | - Melissa P DelBello
- Department of Psychiatry & Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOHUSA
| | - Robert L Findling
- Department of Psychiatry & Behavioral SciencesThe Johns Hopkins UniversityBaltimoreMDUSA
| | - Mary Fristad
- Ohio State University Wexner Medical Center/Nationwide Children's HospitalColumbusOHUSA
| | - Robert A Kowatch
- Ohio State University Wexner Medical Center/Nationwide Children's HospitalColumbusOHUSA
| | | | - Fabiano G Nery
- Department of Psychiatry & Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOHUSA
| | | | - Anna Van Meter
- Ferkauf Graduate School of PsychologyYeshiva UniversityBronxNYUSA
| | | | - Christoph U Correll
- The Zucker Hillside HospitalDepartment of PsychiatryNorthwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineHofstra Northwell School of MedicineHempsteadNYUSA
| | - Hyo‐Won Kim
- Department of PsychiatryUniversity of Ulsan College of MedicineAsan Medical CenterSeoulKorea
| | - Janet Wozniak
- Clinical and Research Program in Pediatric PsychopharmacologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Kiki D Chang
- Department of PsychiatryStanford UniversityPalo AltoCAUSA
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry and PsychologyErasmus Medical Center‐SophiaRotterdamThe Netherlands
| | - Eric A Youngstrom
- Department of Psychology and NeuroscienceUniversity of North CarolinaChapel HillNCUSA
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19
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Islam AH, Metcalfe AWS, MacIntosh BJ, Korczak DJ, Goldstein BI. Greater body mass index is associated with reduced frontal cortical volumes among adolescents with bipolar disorder. J Psychiatry Neurosci 2017; 43:170041. [PMID: 29077553 PMCID: PMC5837884 DOI: 10.1503/jpn.170041] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/05/2017] [Accepted: 09/05/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Higher body mass index (BMI) and obesity is common among youth with bipolar disorder (BD) and is associated with greater psychiatric illness severity, including suicidality. Obesity has been associated with frontal, temporal and subcortical volumetric reductions in adults with BD. We examined the neurostructural correlates of BMI in adolescents early in their course of BD. METHODS We processed T1-weighted images of adolescents with BD and psychiatrically healthy controls using FreeSurfer to derive a priori region of interest (ROI) volumes/cortical thickness for the frontal lobe (FL), prefrontal cortex (PFC) and orbitofrontal cortex (OFC) as well as volumes for the amygdala and hippocampus. General linear models assessed the association between BMI and the ROIs, controlling for age, sex and intracranial volume. We also conducted exploratory within-BD group and whole brain vertex-wise analyses. RESULTS We included 40 adolescents with BD and 48 controls in our analyses. In addition to a main effect of BMI on the ROIs, there were significant diagnosis × BMI interaction effects on FL volumes. In the BD group only, BMI was negatively associated with FL, OFC and PFC cortical thickness. Whole brain analysis of BMI-volume correlations revealed 2 significant interaction clusters: 1 in the medial OFC and 1 in the caudal anterior cingulate cortex, with BD showing a stronger negative correlation. LIMITATIONS Reliance on BMI rather than a more nuanced measure of obesity may have influenced the findings. CONCLUSION Our results suggest that elevated BMI among adolescents with BD is associated with frontal neurostructural differences that are not observed in controls. Prospective studies examining the direction of the observed associations and the effect of BMI optimization on brain structure in adolescents with BD are warranted.
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Affiliation(s)
- Alvi H Islam
- From the Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (Islam, Metcalfe, Goldstein); the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Korczak, Goldstein); the Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh); the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh, Goldstein); the Hospital for Sick Children, Toronto, Ont., Canada (Korczak); the Department of Medical Biophysics, University of Toronto, Toronto, Ont., Canada (MacIntosh); the Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (MacIntosh); and the Department of Pharmacology, University of Toronto, Toronto, Ont., Canada (Goldstein)
| | - Arron W S Metcalfe
- From the Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (Islam, Metcalfe, Goldstein); the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Korczak, Goldstein); the Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh); the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh, Goldstein); the Hospital for Sick Children, Toronto, Ont., Canada (Korczak); the Department of Medical Biophysics, University of Toronto, Toronto, Ont., Canada (MacIntosh); the Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (MacIntosh); and the Department of Pharmacology, University of Toronto, Toronto, Ont., Canada (Goldstein)
| | - Bradley J MacIntosh
- From the Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (Islam, Metcalfe, Goldstein); the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Korczak, Goldstein); the Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh); the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh, Goldstein); the Hospital for Sick Children, Toronto, Ont., Canada (Korczak); the Department of Medical Biophysics, University of Toronto, Toronto, Ont., Canada (MacIntosh); the Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (MacIntosh); and the Department of Pharmacology, University of Toronto, Toronto, Ont., Canada (Goldstein)
| | - Daphne J Korczak
- From the Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (Islam, Metcalfe, Goldstein); the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Korczak, Goldstein); the Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh); the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh, Goldstein); the Hospital for Sick Children, Toronto, Ont., Canada (Korczak); the Department of Medical Biophysics, University of Toronto, Toronto, Ont., Canada (MacIntosh); the Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (MacIntosh); and the Department of Pharmacology, University of Toronto, Toronto, Ont., Canada (Goldstein)
| | - Benjamin I Goldstein
- From the Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (Islam, Metcalfe, Goldstein); the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Korczak, Goldstein); the Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh); the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ont., Canada (Metcalfe, MacIntosh, Goldstein); the Hospital for Sick Children, Toronto, Ont., Canada (Korczak); the Department of Medical Biophysics, University of Toronto, Toronto, Ont., Canada (MacIntosh); the Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada (MacIntosh); and the Department of Pharmacology, University of Toronto, Toronto, Ont., Canada (Goldstein)
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Naiberg MR, Hatch JK, Selkirk B, Fiksenbaum L, Yang V, Black S, Kertes PJ, Goldstein BI. Retinal photography: A window into the cardiovascular-brain link in adolescent bipolar disorder. J Affect Disord 2017; 218:227-237. [PMID: 28477501 DOI: 10.1016/j.jad.2017.04.066] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/21/2017] [Accepted: 04/28/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The burden of cardiovascular disease in bipolar disorder (BD) exceeds what can be explained by traditional cardiovascular risk factors (CVRFs), lifestyle, and/or medications. Moreover, neurocognitive deficits are a core feature of BD, and are also related to CVRFs. We examined retinal vascular photography, a proxy for cerebral microvasculature, in relation to CVRFs, peripheral microvascular function, and neurocognition among BD adolescents. METHODS Subjects were 30 adolescents with BD and 32 healthy controls (HC). Retinal photography was conducted using a Topcon TRC 50 DX, Type IA camera, following pupil dilation. Retinal arteriolar and venular caliber was measured, from which the arterio-venular ratio (AVR) was computed. All measures were conducted masked to participant diagnosis. Peripheral arterial tonometry measured endothelial function. Neurocognition was assessed using the Cambridge Neuropsychological Tests Automated Battery. RESULTS AVR was not significantly different between groups (Cohen's d=0.18, p=0.103). Higher diastolic blood pressure (BP) was associated with lower (worse) AVR in BD (r=-0.441, p=0.015) but not HC (r=-0.192, p=0.293). Similarly, in the BD group only, higher (better) endothelial function was associated with higher AVR (r=0.375, p=0.041). Hierarchical regression models confirmed that, independent of covariates, retinal vascular caliber was significantly associated with diastolic BP and endothelial function in BD. Within the BD group, mood scores were significantly negatively correlated with AVR (β=-0.451, p=0.044). LIMITATIONS This study's limitations include a small sample size, a cross-sectional study design, and a heterogeneous sample. CONCLUSION Retinal photography may offer unique insights regarding the cardiovascular and neurocognitive burden of BD. Larger longitudinal studies are warranted.
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Affiliation(s)
- Melanie R Naiberg
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Jessica K Hatch
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Beth Selkirk
- The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Department of Ophthalmology and Vision Sciences, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Lisa Fiksenbaum
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Victor Yang
- Sunnybrook Research Institute, Hurvitz Brain Sciences Research Program, Toronto, Canada; University of Toronto, Department of Neurosurgery, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Sandra Black
- Sunnybrook Research Institute, Hurvitz Brain Sciences Research Program, Toronto, Canada; University of Toronto, Department of Neurosurgery, Toronto, Canada; Sunnybrook Health Sciences Centre, Department of Medicine (Neurology), Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Peter J Kertes
- The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Department of Ophthalmology and Vision Sciences, Toronto, Canada; University of Toronto, Ophthalmology and Vision Sciences, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Benjamin I Goldstein
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada.
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