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Long Y, Pan N, Yu Y, Zhang S, Qin K, Chen Y, Sweeney JA, DelBello MP, Gong Q. Shared and Distinct Neurobiological Bases of Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Comparative Meta-Analysis of Structural Abnormalities. J Am Acad Child Adolesc Psychiatry 2024; 63:586-604. [PMID: 38072245 DOI: 10.1016/j.jaac.2023.09.551] [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: 06/23/2023] [Revised: 09/14/2023] [Accepted: 12/01/2023] [Indexed: 01/02/2024]
Abstract
OBJECTIVE Pediatric bipolar disorder (PBD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur and share dysfunctions in affective and cognitive domains. As the neural substrates underlying their overlapping and dissociable symptomatology have not been well delineated, a meta-analysis of whole-brain voxel-based morphometry studies in PBD and ADHD was conducted. METHOD A systematic literature search was performed in PubMed, Web of Science, and Embase. The seed-based d mapping toolbox was used to identify altered clusters of PBD or ADHD and obtain their conjunctive and comparative abnormalities. Suprathreshold patterns were subjected to large-scale network analysis to identify affected brain networks. RESULTS The search revealed 10 PBD studies (268 patients) and 32 ADHD studies (1,333 patients). Decreased gray matter volumes in the right insula and anterior cingulate cortex relative to typically developing individuals were conjunctive in PBD and ADHD. Reduced volumes in the right inferior frontal gyrus, left orbitofrontal cortex, and hippocampus were more substantial in PBD, while decreased volumes in the left precentral gyrus, left inferior frontal gyrus, and right superior frontal gyrus were more pronounced in ADHD. Neurodevelopmental effects modulated patterns of the left hippocampus in PBD and those of the left inferior frontal gyrus in ADHD. CONCLUSION These findings suggest that PBD and ADHD are characterized by both common and distinct patterns of gray matter volume alterations. Their overlapping abnormalities may represent a transdiagnostic problem of attention and emotion regulation shared by PBD and ADHD, whereas the disorder-differentiating substrates may contribute to the relative differences in cognitive and affective features that define the 2 disorders. PLAIN LANGUAGE SUMMARY Pediatric bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur, with overlapping changes in emotional and cognitive functioning. This meta-analysis summarizes findings from 10 articles on BD and 32 articles on ADHD to identify similarities and differences in brain structure between youth with BD and youth with ADHD. The authors found that both disorders share decreased gray matter volumes in the right insula and anterior cingulate cortex, which play important roles in emotion processing and attention, respectively. Youth with BD had decreased gray matter volume in the right inferior frontal gyrus, left orbitofrontal gyrus, and left hippocampus, while youth with ADHD had decreased volumes in the left precentral gyrus, left inferior frontal gyrus, and right superior frontal gyrus. STUDY PREREGISTRATION INFORMATION Structural Brain Abnormalities of Attention-Deficit/Hyperactivity Disorder and Bipolar Disorder in Children/Adolescents: An Overlapping Meta-analysis; https://osf.io; trg4m.
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Affiliation(s)
- Yajing Long
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Nanfang Pan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; University of Cincinnati, Cincinnati, Ohio
| | - Yifan Yu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shufang Zhang
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Kun Qin
- University of Cincinnati, Cincinnati, Ohio; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ying Chen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; University of Cincinnati, Cincinnati, Ohio
| | | | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Xiamen Hospital of Sichuan University, Xiamen, China.
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Carlson GA, Althoff RR, Singh MK. Future Directions: The Phenomenology of Irritable Mood and Outbursts: Hang Together or Hang Separately 1. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:309-327. [PMID: 38588602 DOI: 10.1080/15374416.2024.2332999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Recognition of the importance of irritable mood and outbursts has been increasing over the past several decades. This "Future Directions" aims to develop a set of recommendations for future research emphasizing that irritable mood and outbursts "hang together," but have important distinctions and thus also need to "hang separately." Outbursts that are the outcome of irritable mood may be quite different from outbursts that are the trigger or driving force that make youth and his/her environment miserable. What, then, is the relation between irritable mood and outbursts? As the field currently stands, we not only cannot answer this question, but we may also lack the tools to effectively do so. Here, we will propose recommendations for understanding the phenomenology of irritable mood and outbursts so that more directed and clinically useful assessment tools can be designed. We discuss the transdiagnostic and treatment implications that relate to improvements in measurement. We describe the need to do more than repurpose our current assessment tools, specifically interviews and rating scales, which were designed for different purposes. The future directions of the study and treatment of irritable mood and outbursts will require, among others, using universally accepted nomenclature, supporting the development of tools to measure the characteristics of each irritable mood and outbursts, understanding the effects of question order, informant, development and longitudinal course, and studying the ways in which outbursts and irritable mood respond to treatment.
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Affiliation(s)
- Gabrielle A Carlson
- Psychiatry and Pediatrics, Renaissance School of Medicine at Stony Brook University
| | - Robert R Althoff
- Psychiatry, Pediatrics, & Psychological Science, University of Vermont
| | - Manpreet Kaur Singh
- Professor of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine
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Long JY, Li B, Ding P, Mei H, Li Y. Correlations between multimodal neuroimaging and peripheral inflammation in different subtypes and mood states of bipolar disorder: a systematic review. Int J Bipolar Disord 2024; 12:5. [PMID: 38388844 PMCID: PMC10884387 DOI: 10.1186/s40345-024-00327-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Systemic inflammation-immune dysregulation and brain abnormalities are believed to contribute to the pathogenesis of bipolar disorder (BD). However, the connections between peripheral inflammation and the brain, especially the interactions between different BD subtypes and episodes, remain to be elucidated. Therefore, we conducted the present study to provide a comprehensive understanding of the complex association between peripheral inflammation and neuroimaging findings in patients with bipolar spectrum disorders. METHODS This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42023447044) and conducted according to the Population, Intervention, Comparison, Outcomes, and Study Design (PICOS) framework. Online literature databases (PubMed, Web of Science, Scopus, EMBASE, MEDLINE, PsycINFO, and the Cochrane Library) were searched for studies that simultaneously investigated both peripheral inflammation-related factors and magnetic resonance neurography of BD patients up to July 01, 2023. Then, we analysed the correlations between peripheral inflammation and neuroimaging, as well as the variation trends and the shared and specific patterns of these correlations according to different clinical dimensions. RESULTS In total, 34 publications ultimately met the inclusion criteria for this systematic review, with 2993 subjects included. Among all patterns of interaction between peripheral inflammation and neuroimaging, the most common pattern was a positive relationship between elevated inflammation levels and decreased neuroimaging measurements. The brain regions most susceptible to inflammatory activation were the anterior cingulate cortex, amygdala, prefrontal cortex, striatum, hippocampus, orbitofrontal cortex, parahippocampal gyrus, postcentral gyrus, and posterior cingulate cortex. LIMITATIONS The small sample size, insufficiently explicit categorization of BD subtypes and episodes, and heterogeneity of the research methods limited further implementation of quantitative data synthesis. CONCLUSIONS Disturbed interactions between peripheral inflammation and the brain play a critical role in BD, and these interactions exhibit certain commonalities and differences across various clinical dimensions of BD. Our study further confirmed that the fronto-limbic-striatal system may be the central neural substrate in BD patients.
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Affiliation(s)
- Jing-Yi Long
- Wuhan Mental Health Center, No. 89, Gongnongbing Rd., Jiang'an District, Wuhan, 430012, Hubei Province, China
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Bo Li
- School of Public Administration, China University of Geosciences, Wuhan, 430074, China
| | - Pei Ding
- Wuhan Mental Health Center, No. 89, Gongnongbing Rd., Jiang'an District, Wuhan, 430012, Hubei Province, China
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Hao Mei
- Zhongnan Hospital of Wuhan University, No. 169, East Lake Rd., Wuchang District, Wuhan, 430062, Hubei Province, China.
| | - Yi Li
- Wuhan Mental Health Center, No. 89, Gongnongbing Rd., Jiang'an District, Wuhan, 430012, Hubei Province, China.
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
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Calcium imaging reveals depressive- and manic-phase-specific brain neural activity patterns in a murine model of bipolar disorder: a pilot study. Transl Psychiatry 2021; 11:619. [PMID: 34876553 PMCID: PMC8651770 DOI: 10.1038/s41398-021-01750-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 12/25/2022] Open
Abstract
Brain pathological features during manic/hypomanic and depressive episodes in the same patients with bipolar disorder (BPD) have not been described precisely. The study aimed to investigate depressive and manic-phase-specific brain neural activity patterns of BPD in the same murine model to provide information guiding investigation of the mechanism of phase switching and tailored prevention and treatment for patients with BPD. In vivo two-photon imaging was used to observe brain activity alterations in the depressive and manic phases in the same murine model of BPD. Two-photon imaging showed significantly reduced Ca2+ activity in temporal cortex pyramidal neurons in the depression phase in mice exposed to chronic unpredictable mild stress (CUMS), but not in the manic phase in mice exposed to CUMS and ketamine. Total integrated calcium values correlated significantly with immobility times. Brain Ca2+ hypoactivity was observed in the depression and manic phases in the same mice exposed to CUMS and ketamine relative to naïve controls. The novel object recognition preference ratio correlated negatively with the immobility time in the depression phase and the total distance traveled in the manic phase. With recognition of its limitations, this study revealed brain neural activity impairment indicating that intrinsic emotional network disturbance is a mechanism of BPD and that brain neural activity is associated with cognitive impairment in the depressive and manic phases of this disorder. These findings are consistent with those from macro-imaging studies of patients with BPD. The observed correlation of brain neural activity with the severity of depressive, but not manic, symptoms need to be investigated further.
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Silver J, Carlson GA, Olino TM, Perlman G, Mackin D, Kotov R, Klein DN. Differential outcomes of tonic and phasic irritability in adolescent girls. J Child Psychol Psychiatry 2021; 62:1220-1227. [PMID: 33719059 DOI: 10.1111/jcpp.13402] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Irritable mood is a transdiagnostic clinical feature that is present in multiple psychiatric disorders. Although irritability is frequently examined as a unitary construct, two dimensions of irritability, tonic (i.e., irritable mood) and phasic (i.e., temper outbursts), have been hypothesized. However, few studies have examined whether tonic and phasic irritability are empirically separable and predict different forms of psychopathology. METHODS We utilized data from a longitudinal study of a community sample of 550 girls (age 13.5-15.5 years) followed at 9-month intervals for 3 years. We conducted exploratory factor analysis (EFA) using items from three self-report inventories: the International Personality Item Pool Anger scale, Temperament and Affectivity Inventory Anger scale, and Buss-Perry Aggression Questionnaire Anger scale. RESULTS The EFA identified dimensions that were consistent with tonic and phasic irritability. Tonic irritability at baseline independently predicted the development of depressive disorders and generalized anxiety disorder (GAD) in subsequent waves. Phasic irritability independently predicted a decreased probability of GAD, but an increased probability of oppositional defiant, conduct, and substance use disorder, and greater risky sexual behavior and relational aggression during the follow-up. CONCLUSIONS Tonic and phasic irritability appear to be separable constructs with unique implications for later psychopathology and related behavior among adolescent girls. It is important to consider this distinction in research on the etiology and pathophysiology of irritability and developing effective treatments.
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Affiliation(s)
- Jamilah Silver
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | | | - Thomas M Olino
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Greg Perlman
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Daniel Mackin
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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Toward a Quantification of Anhedonia: Unified Matching Law and Signal Detection for Clinical Assessment and Drug Development. Perspect Behav Sci 2021; 44:517-540. [DOI: 10.1007/s40614-021-00288-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 01/22/2023] Open
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Kangas BD, Wooldridge LM, Luc OT, Bergman J, Pizzagalli DA. Empirical validation of a touchscreen probabilistic reward task in rats. Transl Psychiatry 2020; 10:285. [PMID: 32792526 PMCID: PMC7426406 DOI: 10.1038/s41398-020-00969-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022] Open
Abstract
Anhedonia, the loss of pleasure from previously rewarding activities, is implicated in several neuropsychiatric conditions, including major depressive disorder (MDD). In order to accelerate drug development for mood disorders, quantitative approaches are needed to objectively measure responsiveness to reward as a means to identify deficits. One such approach, the probabilistic reward task (PRT), uses visual discrimination methodology to quantify reward learning. In this computerized task, humans make visual discriminations, and probabilistic contingencies are arranged such that correct responses to one alternative are rewarded more often (rich) than correct responses to the other (lean). Healthy participants consistently develop a response bias in favor of the rich alternative. However, participants with MDD typically exhibit lower response biases, and this blunting correlates with current and future anhedonia. The present studies validated a touchscreen-based PRT in rodents with formal and functional similarity to the human task. First, rats were trained to discriminate between two lines that differed in length. Next, parametric manipulations of probabilistic contingencies, line-length stimuli, and drug treatment (amphetamine, 0.32-3.2 mg/kg; scopolamine, 0.1-1.0 mg/kg; oxycodone, 0.1-1.0 mg/kg) on response bias were evaluated. Results demonstrated orderly shifts in bias and discriminability that varied as a function of, respectively, the asymmetry of rich/lean probabilities and disparity in line lengths. Drugs that enhance reward responsiveness (amphetamine and scopolamine, but not oxycodone) increased bias, verifying pharmacological task sensitivity. Finally, performance outcomes under optimized conditions were replicated in female rats. Collectively, the touchscreen-based rodent PRT appears to have high preclinical value as a quantitative assay of reward learning.
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Affiliation(s)
- Brian D. Kangas
- grid.240206.20000 0000 8795 072XMcLean Hospital, Belmont, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | | | - Oanh T. Luc
- grid.240206.20000 0000 8795 072XMcLean Hospital, Belmont, MA USA
| | - Jack Bergman
- grid.240206.20000 0000 8795 072XMcLean Hospital, Belmont, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Diego A. Pizzagalli
- grid.240206.20000 0000 8795 072XMcLean Hospital, Belmont, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
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Weintraub MJ, Zinberg J, Bearden CE, Miklowitz DJ. Applying a Transdiagnostic Cognitive-Behavioral Treatment to Adolescents at High Risk for Serious Mental Illness: Rationale and Preliminary Findings. COGNITIVE AND BEHAVIORAL PRACTICE 2020; 27:202-214. [PMID: 33519172 PMCID: PMC7842260 DOI: 10.1016/j.cbpra.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Given the chronic and deleterious course of serious mental illness (SMI; schizophrenia and bipolar disorder), significant efforts have been undertaken to improve prediction of SMI and provide treatment for adolescents in the early, putatively prodromal stage of these illnesses. While risk assessments and disorder-specific treatments for adolescents at risk for SMI have shown some efficacy, significant issues remain around disorder-specific treatments for these youth. There is substantial heterogeneity of psychopathology within adolescents at high risk for SMI that leads to many false-positives and varying diagnostic outcomes. As a result, initial treatment focusing on broad symptoms and skills has been proposed in place of disorder-specific treatments. We discuss the rationale for providing an already-developed and empirically supported transdiagnostic treatment for emotional disorders (termed the Unified Protocol) as a first-line staging of treatment for adolescents experiencing early SMI symptoms. Additionally, we outline the open trial we are piloting using this transdiagnostic treatment in adolescents between the ages of 13 - 17 who have begun experiencing distressing yet subsyndromal psychosis or bipolar mood symptoms. Preliminary findings suggest feasibility and acceptability as well as initial efficacy in improving psychiatric symptoms, quality of life, and difficulties regulating emotions. We also present case studies from our open trial. A unified, cognitive-behavioral treatment for early presentations of SMI has important clinical and public health benefits, including streamlining treatment and providing broad skills that are applicable to a wide range of psychopathology.
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Cui D, Guo Y, Cao W, Gao W, Qiu J, Su L, Jiao Q, Lu G. Correlation Between Decreased Amygdala Subnuclei Volumes and Impaired Cognitive Functions in Pediatric Bipolar Disorder. Front Psychiatry 2020; 11:612. [PMID: 32670120 PMCID: PMC7332860 DOI: 10.3389/fpsyt.2020.00612] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The amygdala has been proposed to be involved in the pathophysiology of pediatric and adult bipolar disorder (BD). The goal of this structural magnetic resonance imaging (sMRI) study was to investigate the morphometric characteristics of amygdala subnuclei in patients with pediatric bipolar disorder (PBD) compared to healthy controls (HCs). Simultaneously, we examined correlation between amygdala subnuclei volumes and cognitive dysfunction. MATERIALS AND METHODS We assessed 40 adolescent outpatients, diagnosed with manic or euthymic PBD according to the DSM-5 criteria for BD and 19 HCs. Cognitive functions were evaluated using a Stroop color-word test (SCWT), trail making test (TMT), visual reproduction immediate recall subtest (VR I), and digit span subtest (DST). Amygdala and its subnuclei structures were automated segmented using FreeSurfer software and the volumes of them were compared between groups and correlation with clinical and cognitive outcomes was conducted. RESULTS Manic patients exhibited significantly decreased volumes in the bilateral whole amygdala and its basal nucleus, cortico-amygdaloid transition (CAT), and accessory basal nucleus (ABN) compared with HCs. Euthymic patients had decreased volume in the bilateral ABN and left CAT. In addition, we found significant positive associations between VR I scores and the right whole amygdala and its bilateral basal, right lateral, and ABN volumes in the manic group. CONCLUSION These findings support previous reports of smaller amygdala volumes and cognitive dysfunctions in PBD, and further mapping abnormalities to specific amygdala subnuclei. Correlation between basolateral volume and VR I of PBD may expand our understanding of neural abnormalities that could be targeted by treatment.
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Affiliation(s)
- Dong Cui
- College of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences), Taian, China.,Collaborative Innovation Center of Magnetic Resonance Imaging of Brain Disease, Shandong First Medical University, Shandong Academy of MedicalSciences, Taian, China
| | - Yongxin Guo
- College of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences), Taian, China.,Collaborative Innovation Center of Magnetic Resonance Imaging of Brain Disease, Shandong First Medical University, Shandong Academy of MedicalSciences, Taian, China
| | - Weifang Cao
- College of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences), Taian, China.,Collaborative Innovation Center of Magnetic Resonance Imaging of Brain Disease, Shandong First Medical University, Shandong Academy of MedicalSciences, Taian, China
| | - Weijia Gao
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianfeng Qiu
- College of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences), Taian, China
| | - Linyan Su
- Mental Health Institute of The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qing Jiao
- College of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences), Taian, China.,Collaborative Innovation Center of Magnetic Resonance Imaging of Brain Disease, Shandong First Medical University, Shandong Academy of MedicalSciences, Taian, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Zhou S, Nie L, Wang Z, Wang M, Zheng Y. Aberrant reward dynamics in trait anticipatory anhedonia. Soc Cogn Affect Neurosci 2019; 14:899-909. [PMID: 31506689 PMCID: PMC6847339 DOI: 10.1093/scan/nsz062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 05/29/2019] [Accepted: 07/08/2019] [Indexed: 12/14/2022] Open
Abstract
As a cardinal feature of several psychiatric disorders, anhedonia includes a consummatory component (deficits in hedonic response to rewards) and an anticipatory component (a reduced motivation to pursue them). Although being conceptualized as impairments of reward system, the neural characterization of reward processing in anhedonia is hampered by the enormous heterogeneity in the reward phase (‘wanting’ vs ‘liking’) and comorbidity (inherent to disease states). The current event-related potential (ERP) study examined the reward dynamics of anticipatory anhedonia in a non-clinical sample. Anticipatory and consummatory ERP components were assessed with a monetary incentive delay task in a high anticipatory anhedonia (HAA) group and a low anticipatory anhedonia (LAA) group. HAA vs LAA group showed a diminished reward-related speeding during behavioral performance and reported overall reduced positive affect during anticipation and receipt of outcomes. Importantly, neural dynamics underlying reward processing were negatively associated with anticipatory anhedonia across the anticipatory phase indexed by the contingent negative variation and the consummatory phase indexed by the feedback P3. Our results suggest that anticipatory anhedonia in non-clinical individuals is linked to a poor modulation during both anticipatory and consummatory phases of reward processing.
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Affiliation(s)
- Shiyu Zhou
- Department of Psychology, Dalian Medical University, Dalian, China
| | - Lu Nie
- Department of Psychology, Dalian Medical University, Dalian, China
| | - Zhao Wang
- Department of Psychology, Dalian Medical University, Dalian, China
| | - Mengyao Wang
- Department of Psychology, Dalian Medical University, Dalian, China
| | - Ya Zheng
- Department of Psychology, Dalian Medical University, Dalian, China
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Simonetti A, Lijffijt M, Kahlon RS, Gandy K, Arvind RP, Amin P, Arciniegas DB, Swann AC, Soares JC, Saxena K. Early and late cortical reactivity to passively viewed emotional faces in pediatric bipolar disorder. J Affect Disord 2019; 253:240-247. [PMID: 31060010 DOI: 10.1016/j.jad.2019.04.076] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/30/2019] [Accepted: 04/17/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND We studied emotional information processing in youth with pediatric bipolar disorder (pBD) using the late positive potential (LPP), assessing automatic allocation of attentional resources to emotionally salient stimuli, and the occipital P1, assessing early sensory processing. METHODS Participants were 20 youth with pBD and 26 healthy controls (HC). Participants passively viewed faces with a fearful, neutral or happy expressions. Group differences were tested with general linear models. P1 was included to examine modulating effects on LPP. We calculated Bayes factor (BF) values to express strength of evidence for choosing one hypothesis over another. RESULTS A significant emotion by group interaction for LPP amplitude was associated with a larger amplitude for happy faces for pBD than HC (F[1,40] = 6.04, p = .018); this was not modulated by P1 amplitude or latency. P1 amplitude did not differ between groups, although P1 peaked earlier for HC (F[1,40] = 5.45, p = .025). BF for LPP was 2.93, suggesting moderate evidence favoring H1. BF for P1 latency of 14.58 suggests strong evidence favoring H1. LIMITATIONS Inclusion of children and adolescents prohibited careful control for neurodevelopmental effects. CONCLUSIONS Larger LPP amplitude for happy faces without change in P1 suggests enhanced automatic allocation of attentional resources to positive information in pBD. Delayed P1 latency in pBD suggests slower early processing of emotional information.
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Affiliation(s)
- Alessio Simonetti
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Neurology and Psychiatry, Sapienza University of Rome, Italy; Centro Lucio Bini, Rome, Italy.
| | - Marijn Lijffijt
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Ramandeep S Kahlon
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Psychiatry, Texas Children's Hospital, Houston, TX, USA
| | - Kellen Gandy
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Psychiatry, Texas Children's Hospital, Houston, TX, USA
| | - Ruchir P Arvind
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA
| | - Pooja Amin
- Center for Leading Edge Addiction Research (CLEAR), Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | - David B Arciniegas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Behavioral Neurology Section, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA; Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alan C Swann
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA
| | - Kirti Saxena
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Psychiatry, Texas Children's Hospital, Houston, TX, USA
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Der-Avakian A, Pizzagalli DA. Translational Assessments of Reward and Anhedonia: A Tribute to Athina Markou. Biol Psychiatry 2018; 83:932-939. [PMID: 29615189 PMCID: PMC5953796 DOI: 10.1016/j.biopsych.2018.02.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/24/2018] [Accepted: 02/14/2018] [Indexed: 12/18/2022]
Abstract
Loss of pleasure (clinically referred to as anhedonia), impairments in other reward-related processes such as reward learning, motivation, and reward valuation, and blunted affect characterize several mood and other psychiatric disorders. Despite the availability of many therapeutic options for these disorders, reward-related impairments remain challenging to treat and often persist despite alleviation of other symptoms. Lack of animal models of reward-related impairments and affect that have high construct and predictive validity is a key obstacle to developing novel treatments. This review highlights 1) guidelines to consider when developing translatable animal models; and 2) recent efforts to develop new reward-related assessments in humans and nonhuman animals that have been translated or back-translated from one species to another. The procedures described in this review are used to assess aspects of reward learning, motivated behavior, reward valuation, and affect. In several cases, researchers have attempted to implement task parameters that are as identical as possible to the parallel parameters used in existing cross-species tasks, with the goal of improving the translation of preclinical drug discovery findings to the clinic. In this regard, Dr. Athina Markou, who worked tirelessly throughout her career to understand and treat reward-related impairments across several psychiatric disorders, had great influence on conceptualizing the development and use of translational animal models of reward-related processes.
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Affiliation(s)
- Andre Der-Avakian
- Department of Psychiatry, University of California San Diego, La Jolla, California.
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13
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Using machine learning and surface reconstruction to accurately differentiate different trajectories of mood and energy dysregulation in youth. PLoS One 2017; 12:e0180221. [PMID: 28683115 PMCID: PMC5500381 DOI: 10.1371/journal.pone.0180221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/12/2017] [Indexed: 11/19/2022] Open
Abstract
Difficulty regulating positive mood and energy is a feature that cuts across different pediatric psychiatric disorders. Yet, little is known regarding the neural mechanisms underlying different developmental trajectories of positive mood and energy regulation in youth. Recent studies indicate that machine learning techniques can help elucidate the role of neuroimaging measures in classifying individual subjects by specific symptom trajectory. Cortical thickness measures were extracted in sixty-eight anatomical regions covering the entire brain in 115 participants from the Longitudinal Assessment of Manic Symptoms (LAMS) study and 31 healthy comparison youth (12.5 y/o;-Male/Female = 15/16;-IQ = 104;-Right/Left handedness = 24/5). Using a combination of trajectories analyses, surface reconstruction, and machine learning techniques, the present study aims to identify the extent to which measures of cortical thickness can accurately distinguish youth with higher (n = 18) from those with lower (n = 34) trajectories of manic-like behaviors in a large sample of LAMS youth (n = 115; 13.6 y/o; M/F = 68/47, IQ = 100.1, R/L = 108/7). Machine learning analyses revealed that widespread cortical thickening in portions of the left dorsolateral prefrontal cortex, right inferior and middle temporal gyrus, bilateral precuneus, and bilateral paracentral gyri and cortical thinning in portions of the right dorsolateral prefrontal cortex, left ventrolateral prefrontal cortex, and right parahippocampal gyrus accurately differentiate (Area Under Curve = 0.89;p = 0.03) youth with different (higher vs lower) trajectories of positive mood and energy dysregulation over a period up to 5years, as measured by the Parent General Behavior Inventory-10 Item Mania Scale. Our findings suggest that specific patterns of cortical thickness may reflect transdiagnostic neural mechanisms associated with different temporal trajectories of positive mood and energy dysregulation in youth. This approach has potential to identify patterns of neural markers of future clinical course.
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Son YD, Han DH, Kim SM, Min KJ, Renshaw PF. A functional connectivity comparison between attention deficit hyperactivity disorder and bipolar disorder in medication-naïve adolescents with mood fluctuation and attention problems. Psychiatry Res Neuroimaging 2017; 263:1-7. [PMID: 28264765 DOI: 10.1016/j.pscychresns.2017.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 02/15/2017] [Accepted: 02/15/2017] [Indexed: 11/23/2022]
Abstract
In order to compare patterns of connectivity between affective and attention networks in adolescents with bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD), we investigated differences in resting state functional connectivity (RSFC) between these populations. Study participants were medication-naïve adolescents (aged 13-18 years) with BD (N=22) or ADHD (N=25) and age- and sex-matched healthy adolescents (healthy controls [HC]) (N=22). Forty-seven adolescents with mood fluctuation and attention problems showed increased functional correlation (FC) between two pairs of regions within the affective network (AFN), compared to 22 HC: the left orbitofrontal cortex (OFC) to the left thalamus and the left OFC to the right thalamus. In post-hoc testing, adolescents with BD showed increased FC between two pairs of regions compared to ADHD: the right amygdala to the left temporoparietal junction (TPJ) and the right amygdala to the right TPJ. Adolescents with BD showed increased FC within the attention network (ATN) as well as increased FC between the ATN and the AFN, while those with ADHD showed decreased FC within the ATN. The current suggests that these features could be used as biomarkers for differentiating BD from ADHD in adolescents.
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Affiliation(s)
- Young Don Son
- Department of Biomedical Engineering, Gachon University, Incheon, South Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung Ang University Hospital, Seoul, South Korea.
| | - Sun Mi Kim
- Department of Psychiatry, Chung Ang University Hospital, Seoul, South Korea
| | - Kyung Joon Min
- Department of Psychiatry, Chung Ang University Hospital, Seoul, South Korea
| | - Perry F Renshaw
- Brain Institute, University of Utah, Salt Lake City, UT, USA
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15
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Defining and measuring irritability: Construct clarification and differentiation. Clin Psychol Rev 2017; 53:93-108. [DOI: 10.1016/j.cpr.2017.01.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/23/2016] [Accepted: 01/30/2017] [Indexed: 11/22/2022]
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Diler RS. Neuroimaging can help identify biomarkers of early onset bipolar disorder. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20120214113908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Rasim Somer Diler
- University of Pittsburgh, Western Psychiatric Institute and Clinic, Medical Director, Inpatient Child & Adolescent Bipolar Services, BFT 539, 3811 O'Hara Street, Pittsburgh, PA 15213 Tel: Fax:
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17
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Portugal LCL, Rosa MJ, Rao A, Bebko G, Bertocci MA, Hinze AK, Bonar L, Almeida JRC, Perlman SB, Versace A, Schirda C, Travis M, Gill MK, Demeter C, Diwadkar VA, Ciuffetelli G, Rodriguez E, Forbes EE, Sunshine JL, Holland SK, Kowatch RA, Birmaher B, Axelson D, Horwitz SM, Arnold EL, Fristad MA, Youngstrom EA, Findling RL, Pereira M, Oliveira L, Phillips ML, Mourao-Miranda J. Can Emotional and Behavioral Dysregulation in Youth Be Decoded from Functional Neuroimaging? PLoS One 2016; 11:e0117603. [PMID: 26731403 PMCID: PMC4701457 DOI: 10.1371/journal.pone.0117603] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 12/15/2015] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION High comorbidity among pediatric disorders characterized by behavioral and emotional dysregulation poses problems for diagnosis and treatment, and suggests that these disorders may be better conceptualized as dimensions of abnormal behaviors. Furthermore, identifying neuroimaging biomarkers related to dimensional measures of behavior may provide targets to guide individualized treatment. We aimed to use functional neuroimaging and pattern regression techniques to determine whether patterns of brain activity could accurately decode individual-level severity on a dimensional scale measuring behavioural and emotional dysregulation at two different time points. METHODS A sample of fifty-seven youth (mean age: 14.5 years; 32 males) was selected from a multi-site study of youth with parent-reported behavioral and emotional dysregulation. Participants performed a block-design reward paradigm during functional Magnetic Resonance Imaging (fMRI). Pattern regression analyses consisted of Relevance Vector Regression (RVR) and two cross-validation strategies implemented in the Pattern Recognition for Neuroimaging toolbox (PRoNTo). Medication was treated as a binary confounding variable. Decoded and actual clinical scores were compared using Pearson's correlation coefficient (r) and mean squared error (MSE) to evaluate the models. Permutation test was applied to estimate significance levels. RESULTS Relevance Vector Regression identified patterns of neural activity associated with symptoms of behavioral and emotional dysregulation at the initial study screen and close to the fMRI scanning session. The correlation and the mean squared error between actual and decoded symptoms were significant at the initial study screen and close to the fMRI scanning session. However, after controlling for potential medication effects, results remained significant only for decoding symptoms at the initial study screen. Neural regions with the highest contribution to the pattern regression model included cerebellum, sensory-motor and fronto-limbic areas. CONCLUSIONS The combination of pattern regression models and neuroimaging can help to determine the severity of behavioral and emotional dysregulation in youth at different time points.
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Affiliation(s)
- Liana C. L. Portugal
- Department of Computer Science, Centre for Computational Statistics and Machine Learning, University College London, London, United Kingdom
- Department of Physiology and Pharmacology, Federal Fluminense University, Niteroi, Brazil
| | - Maria João Rosa
- Department of Computer Science, Centre for Computational Statistics and Machine Learning, University College London, London, United Kingdom
| | - Anil Rao
- Department of Computer Science, Centre for Computational Statistics and Machine Learning, University College London, London, United Kingdom
| | - Genna Bebko
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Michele A. Bertocci
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Amanda K. Hinze
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Lisa Bonar
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Jorge R. C. Almeida
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Susan B. Perlman
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Amelia Versace
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Claudiu Schirda
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Michael Travis
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Christine Demeter
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, United States of America
| | - Vaibhav A. Diwadkar
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University, Detroit, United States of America
| | - Gary Ciuffetelli
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Eric Rodriguez
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Erika E. Forbes
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Jeffrey L. Sunshine
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, United States of America
| | - Scott K. Holland
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, United States of America
| | - Robert A. Kowatch
- The Research Institute at Nationwide Children’s Hospital, Columbus, United States of America
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - David Axelson
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
| | - Sarah M. Horwitz
- Department of Child Psychiatry, New York University School of Medicine, New York, United States of America
| | - Eugene L. Arnold
- Department of Psychiatry, Ohio State University, Columbus, United States of America
| | - Mary A. Fristad
- Department of Psychiatry, Ohio State University, Columbus, United States of America
| | - Eric A. Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Robert L. Findling
- University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, United States of America
- Department of Psychiatry, Johns Hopkins University, Baltimore, United States of America
| | - Mirtes Pereira
- Department of Physiology and Pharmacology, Federal Fluminense University, Niteroi, Brazil
| | - Leticia Oliveira
- Department of Physiology and Pharmacology, Federal Fluminense University, Niteroi, Brazil
| | - Mary L. Phillips
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, United States of America
- Department of Psychological Medicine, Cardiff University, Cardiff, United Kingdom
| | - Janaina Mourao-Miranda
- Department of Computer Science, Centre for Computational Statistics and Machine Learning, University College London, London, United Kingdom
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Barata PC, Holtzman S, Cunningham S, O'Connor BP, Stewart DE. Building a Definition of Irritability From Academic Definitions and Lay Descriptions. EMOTION REVIEW 2015; 8:164-172. [PMID: 27134650 DOI: 10.1177/1754073915576228] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The current work builds a definition of irritability from both academic definitions and lay perspectives. In Study 1, a quantitative content analysis of academic definitions resulted in eight main content categories (i.e., behaviour, emotion or affect, cognition, physiological, qualifiers, irritant, stability or endurance, and other). In Study 2, a community sample of 39 adults participated in qualitative interviews. A deductive thematic analysis resulted in two main themes. The first main theme dealt with how participants positioned irritability in relation to other negative states. The second dealt with how participants constructed irritability as both a loss of control and as an experience that should be controlled. The discussion integrates the findings of both studies and provides a concise, but comprehensive definition.
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Affiliation(s)
| | - Susan Holtzman
- Department of Psychology, University of British Columbia, Canada
| | | | - Brian P O'Connor
- Department of Psychology, University of British Columbia, Canada
| | - Donna E Stewart
- Women's Health Program, Department of Psychiatry, University Health Network, University of Toronto, Canada
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Goldstein TR, Fersch-Podrat RK, Rivera M, Axelson DA, Merranko J, Yu H, Brent DA, Birmaher B. Dialectical behavior therapy for adolescents with bipolar disorder: results from a pilot randomized trial. J Child Adolesc Psychopharmacol 2015; 25:140-9. [PMID: 25010702 PMCID: PMC4367513 DOI: 10.1089/cap.2013.0145] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to conduct a pilot randomized trial of dialectical behavior therapy (DBT) versus psychosocial treatment as usual (TAU) for adolescents diagnosed with bipolar disorder (BP). METHODS We recruited participants 12-18 years of age with a primary BP diagnosis (I, II, or operationalized not otherwise specified [NOS] criteria) from a pediatric specialty clinic. Eligible patients were assigned using a 2:1 randomization structure to either DBT (n=14) or psychosocial TAU (n=6). All patients received medication management from a study-affiliated psychiatrist. DBT included 36 sessions (18 individual, 18 family skills training) over 1 year. TAU was an eclectic psychotherapy approach consisting of psychoeducational, supportive, and cognitive behavioral techniques. An independent evaluator, blind to treatment condition, assessed outcomes including affective symptoms, suicidal ideation and behavior, nonsuicidal self-injurious behavior, and emotional dysregulation, quarterly over 1 year. RESULTS Adolescents receiving DBT attended significantly more therapy sessions over 1 year than did adolescents receiving TAU, possibly reflecting greater engagement and retention; both treatments were rated as highly acceptable by adolescents and parents. As compared with adolescents receiving TAU, adolescents receiving DBT demonstrated significantly less severe depressive symptoms over follow-up, and were nearly three times more likely to demonstrate improvement in suicidal ideation. Models indicate a large effect size, for more weeks being euthymic, over follow-up among adolescents receiving DBT. Although there were no between-group differences in manic symptoms or emotional dysregulation with treatment, adolescents receiving DBT, but not those receiving TAU, evidenced improvement from pre- to posttreatment in both manic symptoms and emotional dysregulation. CONCLUSIONS DBT may offer promise as an adjunct to pharmacotherapy in the treatment of depressive symptoms and suicidal ideation for adolescents with BP. The DBT focus on commitment to treatment may be important for the treatment of early-onset BP. Larger controlled trials are needed to establish the efficacy of this approach, examine impact on suicidal behavior, and demonstrate cost effectiveness.
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Affiliation(s)
- Tina R. Goldstein
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rachael K. Fersch-Podrat
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Maribel Rivera
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - John Merranko
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Haifeng Yu
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David A. Brent
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Frías Á, Palma C, Farriols N. Psychosocial interventions in the treatment of youth diagnosed or at high-risk for pediatric bipolar disorder: A review of the literature. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2015; 8:146-56. [PMID: 25620426 DOI: 10.1016/j.rpsm.2014.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/17/2014] [Accepted: 11/27/2014] [Indexed: 10/24/2022]
Abstract
Pediatric bipolar disorder (PBD) has emerged as a research field in which psychosocial treatments have provided a plethora of empirical findings over the last decade. We addressed this issue through a systematic review aimed of establishing their effectiveness and feasibility as adjunctive therapies for youth with PBD or at high-risk for PBD. A comprehensive search of databases was performed between 1990 and September 2014. Overall, 33 studies were specifically related to the issue and 20 of them were original articles. Evidence suggests that both "multi-family psychoeducational psychotherapy' and "family-focused therapy" are possible effective treatments for PBD. Likewise, "child and family-focused cognitive-behavioral therapy" may be characterized as a treatment in its experimental phase. The remaining therapies fail to obtain enough empirical support due to inconsistent findings among clinical trials or data solely based on case reports. Studies of psychosocial treatments provide concluding results concerning their feasibility and acceptability. Larger sample sizes and more randomized controlled trials are mandatory for diminishing methodological shortcomings encountered in the treatments displayed.
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Affiliation(s)
- Álvaro Frías
- Facultat de Psicologia, Ciències de l'Educació i l'Esport (FPCEE) Blanquerna, Universidad de Ramon-Llull, Barcelona, España.
| | - Cárol Palma
- Facultat de Psicologia, Ciències de l'Educació i l'Esport (FPCEE) Blanquerna, Universidad de Ramon-Llull, Barcelona, España
| | - Núria Farriols
- Facultat de Psicologia, Ciències de l'Educació i l'Esport (FPCEE) Blanquerna, Universidad de Ramon-Llull, Barcelona, España
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Translational Assessment of Reward and Motivational Deficits in Psychiatric Disorders. Curr Top Behav Neurosci 2015; 28:231-62. [PMID: 26873017 DOI: 10.1007/7854_2015_5004] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Deficits in reward and motivation are common symptoms characterizing several psychiatric and neurological disorders. Such deficits may include anhedonia, defined as loss of pleasure, as well as impairments in anticipatory pleasure, reward valuation, motivation/effort, and reward learning. This chapter describes recent advances in the development of behavioral tasks used to assess different aspects of reward processing in both humans and non-human animals. While earlier tasks were generally developed independently with limited cross-species correspondence, a newer generation of translational tasks has emerged that are theoretically and procedurally analogous across species and allow parallel testing, data analyses, and interpretation between human and rodent behaviors. Such enhanced conformity between cross-species tasks will facilitate investigation of the neurobiological mechanisms underlying discrete reward and motivated behaviors and is expected to improve our understanding and treatment of neuropsychiatric disorders characterized by reward and motivation deficits.
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Purper-Ouakil D. Le trouble disruptif avec dysrégulation de l’humeur. ANNALES MEDICO-PSYCHOLOGIQUES 2014. [DOI: 10.1016/j.amp.2014.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Geoffroy PA, Jardri R, Etain B, Thomas P, Rolland B. [Bipolar disorder in children and adolescents: a difficult diagnosis]. Presse Med 2014; 43:912-20. [PMID: 24935683 DOI: 10.1016/j.lpm.2014.02.025] [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] [Received: 06/24/2013] [Revised: 01/12/2014] [Accepted: 02/05/2014] [Indexed: 10/25/2022] Open
Abstract
Bipolar disorder (BD) is a severe mental condition with neurodevelopmental features that clinically results in pathological fluctuations of mood. Whereas it was classically or traditionally considered as an adult-onset disorder, recent findings suggest that BD may occur very early in the life course, thus, determining what is now called Juvenile bipolar disorder (JBD). One of the reasons for which JBD has been so difficult to identify is that JBD primary symptoms vary much from the typical adulthood BD clinical expression. Euphoric mood is rare in JBD, while irritability mood, aggressive temper, mixed manic state onset, rapid cycling, anger outbursts and chronic course of symptoms are much more frequent. This specific clinical presentation makes JBD difficult to differentiate from other diagnoses related to pathological externalizing behaviours, including conduct disorder, oppositional provocative disorder, and attention deficit-hyperactivity disorder.
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Affiliation(s)
- Pierre Alexis Geoffroy
- Université Lille Nord de France, 59000 Lille, France; CHRU de Lille, service de pédopsychiatrie, 59000 Lille, France; Inserm, U955, psychiatrie génétique, 94000 Créteil, France; AP-HP, hôpital A.-Chenevier, centre expert bipolaire, 94000 Créteil, France.
| | - Renaud Jardri
- Université Lille Nord de France, 59000 Lille, France; CHRU de Lille, service de pédopsychiatrie, 59000 Lille, France; École Normale Supérieure, GNT, Inserm U960, 75005 Paris, France
| | - Bruno Etain
- Inserm, U955, psychiatrie génétique, 94000 Créteil, France; AP-HP, hôpital A.-Chenevier, centre expert bipolaire, 94000 Créteil, France
| | - Pierre Thomas
- Université Lille Nord de France, 59000 Lille, France; CHRU de Lille, pole de psychiatrie, 59000 Lille, France
| | - Benjamin Rolland
- Université Lille Nord de France, 59000 Lille, France; CHRU de Lille, service d'addictologie, 59000 Lille, France
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Gender-specific association of the SLC6A4 and DRD2 gene variants in bipolar disorder. Int J Neuropsychopharmacol 2014; 17:211-22. [PMID: 24229495 DOI: 10.1017/s1461145713001296] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Findings on the association between the risk for developing bipolar disorder and the functions of the serotonin transporter-linked polymorphic region gene (5-HTTLPR) and dopamine D2 receptor gene (DRD2) variants are contradictory. One explanation for this is that a gender difference may exist for genetic contributions. We compared the gender-related main effects and the gene-to-gene interaction between serotonin transporter gene (SLC6A4) and DRD2 in adult male and female patients with bipolar I (BP-I) and bipolar II (BP-II) disorder. Patients with BP-I (n = 400) and BP-II (n = 493), and healthy controls (n = 442) were recruited from Taiwan's Han Chinese population. The genotypes of the 5-HTTLPR and DRD2 Taq-IA polymorphisms were determined using polymerase chain reaction-restriction fragment length polymorphism analysis. Logistic regression analysis showed a significant gender-specific association of the DRD2 A1/A1 and the 5-HTTLPR S/S, S/LG , and LG/LG (S+) (p = 0.01) genotypes in men with BP-I (p = 0.002 and 0.01, respectively) and BP-II (p = 0.001 and 0.007, respectively), but not in women. A significant interaction for the DRD2 A1/A1 and 5-HTTLPR S+ polymorphisms was also found only in men with BP-I and BP-II (p = 0.003 and 0.001, respectively). We provide preliminary evidence for a gender-specific effect of the SLC6A4 and DRD2 gene variants for the risk of BP-I and of BP-II. We also found gender-specific interaction between 5-HTTLPR and DRD2 Taq-IA polymorphisms in patients with bipolar disorder.
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Krieger FV, Leibenluft E, Stringaris A, Polanczyk GV. Irritability in children and adolescents: past concepts, current debates, and future opportunities. BRAZILIAN JOURNAL OF PSYCHIATRY 2014; 35 Suppl 1:S32-9. [PMID: 24142126 DOI: 10.1590/1516-4446-2013-s107] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Irritability is defined as a low threshold to experience anger in response to frustration. It is one of the most common symptoms in youth and is part of the clinical presentation of several disorders. Irritability can present early in life and is a predictor of long-term psychopathology; yet, the diagnostic status of irritability is a matter of intense debate. In the present article, we address two main components of the debate regarding irritability in youth: the misdiagnosis of chronic irritability as pediatric bipolar disorder, and the proposal of a new diagnosis in the DSM-5, disruptive mood dysregulation disorder, whose defining symptoms are chronic irritability and temper outbursts.
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Bebko G, Bertocci MA, Fournier JC, Hinze AK, Bonar L, Almeida JRC, Perlman SB, Versace A, Schirda C, Travis M, Gill MK, Demeter C, Diwadkar VA, Ciuffetelli G, Rodriguez E, Olino T, Forbes E, Sunshine JL, Holland SK, Kowatch RA, Birmaher B, Axelson D, Horwitz SM, Arnold LE, Fristad MA, Youngstrom EA, Findling RL, Phillips ML. Parsing dimensional vs diagnostic category-related patterns of reward circuitry function in behaviorally and emotionally dysregulated youth in the Longitudinal Assessment of Manic Symptoms study. JAMA Psychiatry 2014; 71:71-80. [PMID: 24285346 PMCID: PMC4238412 DOI: 10.1001/jamapsychiatry.2013.2870] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Pediatric disorders characterized by behavioral and emotional dysregulation pose diagnostic and treatment challenges because of high comorbidity, suggesting that they may be better conceptualized dimensionally rather than categorically. Identifying neuroimaging measures associated with behavioral and emotional dysregulation in youth may inform understanding of underlying dimensional vs disorder-specific pathophysiologic features. OBJECTIVE To identify, in a large cohort of behaviorally and emotionally dysregulated youth, neuroimaging measures that (1) are associated with behavioral and emotional dysregulation pathologic dimensions (behavioral and emotional dysregulation measured with the Parent General Behavior Inventory 10-Item Mania Scale [PGBI-10M], mania, depression, and anxiety) or (2) differentiate diagnostic categories (bipolar spectrum disorders, attention-deficit/hyperactivity disorder, anxiety, and disruptive behavior disorders). DESIGN, SETTING, AND PARTICIPANTS A multisite neuroimaging study was conducted from February 1, 2011, to April 15, 2012, at 3 academic medical centers: University Hospitals Case Medical Center, Cincinnati Children's Hospital Medical Center, and University of Pittsburgh Medical Center. Participants included a referred sample of behaviorally and emotionally dysregulated youth from the Longitudinal Assessment of Manic Symptoms (LAMS) study (n = 85) and healthy youth (n = 20). MAIN OUTCOMES AND MEASURES Region-of-interest analyses examined relationships among prefrontal-ventral striatal reward circuitry during a reward paradigm (win, loss, and control conditions), symptom dimensions, and diagnostic categories. RESULTS Regardless of diagnosis, higher PGBI-10M scores were associated with greater left middle prefrontal cortical activity (r = 0.28) and anxiety with greater right dorsal anterior cingulate cortical (r = 0.27) activity to win. The 20 highest (t = 2.75) and 20 lowest (t = 2.42) PGBI-10M-scoring youth showed significantly greater left middle prefrontal cortical activity to win compared with 20 healthy youth. Disruptive behavior disorders were associated with lower left ventrolateral prefrontal cortex activity to win (t = 2.68) (all P < .05, corrected). CONCLUSIONS AND RELEVANCE Greater PGBI-10M-related left middle prefrontal cortical activity and anxiety-related right dorsal anterior cingulate cortical activity to win may reflect heightened reward sensitivity and greater attention to reward in behaviorally and emotionally dysregulated youth regardless of diagnosis. Reduced left ventrolateral prefrontal cortex activity to win may reflect reward insensitivity in youth with disruptive behavior disorders. Despite a distinct reward-related neurophysiologic feature in disruptive behavior disorders, findings generally support a dimensional approach to studying neural mechanisms in behaviorally and emotionally dysregulated youth.
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Affiliation(s)
- Genna Bebko
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Michele A. Bertocci
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Jay C. Fournier
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Amanda K. Hinze
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Lisa Bonar
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Jorge R. C. Almeida
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Susan B. Perlman
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Amelia Versace
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Claudiu Schirda
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Michael Travis
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Christine Demeter
- University Hospitals Case Medical Center/Case Western Reserve University
| | - Vaibhav A. Diwadkar
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University
| | - Gary Ciuffetelli
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Eric Rodriguez
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Thomas Olino
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Erika Forbes
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | | | - Scott K Holland
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati
| | | | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - David Axelson
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Sarah M. Horwitz
- Department of Child Psychiatry, New York University School of Medicine
| | | | | | | | - Robert L. Findling
- University Hospitals Case Medical Center/Case Western Reserve University,Department of Psychiatry, Johns Hopkins University
| | - Mary L. Phillips
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh,Department of Psychological Medicine, Cardiff University
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Difficulties in emotional regulation and substance use disorders: a controlled family study of bipolar adolescents. Drug Alcohol Depend 2013; 132:114-21. [PMID: 23422834 PMCID: PMC3683118 DOI: 10.1016/j.drugalcdep.2013.01.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 01/17/2013] [Accepted: 01/19/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Self-regulatory mechanisms appear etiologically operant in the context of both substance use disorders (SUD) and bipolar disorder (BD), however, little is known about the role of deficits in emotional self-regulation (DESR) as it relates to SUD in context to mood dysregulation. To this end, we examined to what extent DESR was associated with SUD in a high-risk sample of adolescents with and without BD. METHODS 203 families were assessed with a structured psychiatric interview. Using the Child Behavior Checklist (CBCL), a subject was considered to have DESR when he or she had an average elevation of 1 standard deviation (SD) above the norm on 3 clinical scale T scores (attention, aggression, and anxiety/depression; scores: 60 × 3 ≥ 180). RESULTS Among probands and siblings with CBCL data (N=303), subjects with DESR were more likely to have any SUD, alcohol use disorder, drug use disorder, and cigarette smoking compared to subjects with scores <180 (all p values <0.001), even when correcting for BD. We found no significant differences in the risk of any SUD and cigarette smoking between those with 1SD and 2SD above the mean (all p values >0.05). Subjects with cigarette smoking and SUD had more DESR compared to those without these disorders. CONCLUSIONS Adolescents with DESR are more likely to smoke cigarettes and have SUD. More work is needed to explore DESR in longitudinal samples.
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Seymour KE, Pescosolido MF, Reidy BL, Galvan T, Kim KL, Young M, Dickstein DP. Emotional face identification in youths with primary bipolar disorder or primary attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2013; 52:537-546.e3. [PMID: 23622855 PMCID: PMC4418014 DOI: 10.1016/j.jaac.2013.03.011] [Citation(s) in RCA: 22] [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] [Received: 07/09/2012] [Revised: 02/28/2013] [Accepted: 03/15/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) are often comorbid or confounded; therefore, we evaluated emotional face identification to better understand brain/behavior interactions in children and adolescents with either primary BD, primary ADHD, or typically developing controls (TDC). METHOD Participants included individuals 7 to 17 years of age (overall sample mean age 12.40 ± 3.01 years), with "narrow-phenotype" pediatric BD (n = 30) or ADHD (n = 38), or typically developing controls (TDC) with no psychiatric disorders themselves or in their first-degree relatives (n = 41). In the BD group, comorbid diagnoses were allowed; however, youth in the ADHD group were excluded for comorbid mood or anxiety disorders. Patient groups were not excluded for psychotropic medication use. Emotional face identification was assessed using the computerized Diagnostic Analysis of Non-Verbal Accuracy (DANVA). RESULTS Participants with BD made significantly more identification errors on child happy faces than either TDCs (p = .03) or participants with ADHD (p = .01). Furthermore, youth with BD (0.33 ± 0.55) were more likely than youth with ADHD (0.11 ± 0.31) to make errors on low-intensity child happy faces (p = .05) but not high-intensity happy faces (p = NS). Participants with BD and ADHD made significantly more total errors in child face labeling than did TDCs, although participants with BD and ADHD did not differ from one another. CONCLUSION Our data suggest that youths with BD have specific alterations in emotional face identification of happy faces, an important finding that supports theories that response to positively valenced emotional stimuli may be especially salient in BD. Clinical trial registration information-Brain Imaging and Computer Games in Children With Either Bipolar Disorder, ADHD, Anxiety or Healthy Controls (BBPP); http://clinicaltrials.gov/; NCT01570426.
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Affiliation(s)
- Karen E Seymour
- Bradley Hospital's Pediatric Mood, Imaging, and NeuroDevelopmental (PediMIND) Program and the Alpert Medical School of Brown University, RI 02915, USA.
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Geoffroy PA, Etain B, Jamain S, Bellivier F, Leboyer M. [Early onset bipolar disorder: validation from admixture analyses and biomarkers]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:240-8. [PMID: 23547648 DOI: 10.1177/070674371305800410] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Bipolar affective disorder (BD) is a multifactorial disorder with heterogeneous clinical presentations, in particular according to age at onset (AAO). The relevance of such an indicator has been discussed as a potential specifier in future nosographical classification. METHOD We summarize available evidence of admixture analyses and biomarkers in early onset BD. RESULTS Numerous clinical arguments have led us to conclude that the early onset BD subgroup is clinically homogeneous, with particular, recurrent, and severe characteristics.Eight admixture studies have demonstrated the existence of 3 subgroups of patients with BD according to AAO (early, intermediate, and late AAO), with 2 cut-off points of 21 (21.33) [SD 1.41]) and 35 years (34.67 [SD 5.52]). Differential clinical features and outcome measures characterize the early onset subgroup: higher rate of suicide attempts, rapid cycling, alcohol and drugs misuse, psychotic symptoms, and comorbid anxiety disorders. This may partially explain the delayed diagnosis and late initiation of mood stabilizers. Genetic, biological, imaging, and cognitive arguments may be considered as potential markers in providing external validity of the existence of this early onset subgroup. Implementation of AAO in the algorithms of treatment may be discussed, although the level of proof for focused medication strategies remains to be consolidated. CONCLUSION Given the high frequency (44.80%) of early onset BD, awareness of clinicians should be stimulated to provide an early and accurate detection, preventive strategies, and possibly specific treatments.The forthcoming DSM-5 should include AAO as a specifier, given its relevance for course and outcome.
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Affiliation(s)
- Pierre Alexis Geoffroy
- Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, et Fondation Fonda Mental, Créteil, France
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30
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Dialectical Behavior Therapy for Adolescents: Theory, Treatment Adaptations, and Empirical Outcomes. Clin Child Fam Psychol Rev 2012; 16:59-80. [DOI: 10.1007/s10567-012-0126-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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31
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Liu J, Blond BN, van Dyck LI, Spencer L, Wang F, Blumberg HP. Trait and state corticostriatal dysfunction in bipolar disorder during emotional face processing. Bipolar Disord 2012; 14:432-41. [PMID: 22524493 PMCID: PMC3361579 DOI: 10.1111/j.1399-5618.2012.01018.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Convergent evidence supports limbic, anterior paralimbic, and prefrontal cortex (PFC) abnormalities in emotional processing in bipolar disorder (BD) and suggests that some abnormalities are mood-state dependent and others persist into euthymia. However, few studies have assessed elevated, depressed, and euthymic mood states while individuals processed emotional stimuli of varying valence to investigate trait- and state-related neural system responses. Here, regional brain responses to positive, negative, and neutral emotional stimuli were assessed in individuals with BD during elevated, depressed, and euthymic mood states. METHODS One hundred and thirty-four subjects participated in functional magnetic resonance imaging scanning while processing faces depicting happy, fearful, and neutral expressions: 76 with BD (18 in elevated mood states, 19 depressed, 39 euthymic) and 58 healthy comparison (HC) individuals. Analyses were performed for BD trait- and mood state-related features. RESULTS Ventral anterior cingulate cortex (VACC), orbitofrontal cortex (OFC), and ventral striatum responses to happy and neutral faces were decreased in the BD group, compared to the HC group, and were not influenced by mood state. Elevated mood states were associated with decreased right rostral PFC activation to fearful and neutral faces, and depression was associated with increased left OFC activation to fearful faces. CONCLUSIONS The findings suggest that abnormal VACC, OFC, and ventral striatum responses to happy and neutral stimuli are trait features of BD. Acute mood states may be associated with additional lateralized abnormalities of diminished right rostral PFC responses to fearful and neutral stimuli in elevated states and increased left OFC responses to fearful stimuli in depressed states.
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Affiliation(s)
- Jie Liu
- Department of Psychiatry, Yale School of Medicine, New Haven
| | | | | | - Linda Spencer
- Department of Psychiatry, Yale School of Medicine, New Haven
| | - Fei Wang
- Department of Psychiatry, Yale School of Medicine, New Haven
| | - Hilary P. Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven,Department of Diagnostic Radiology, Yale School of Medicine, New Haven,The Child Study Center, Yale School of Medicine, New Haven,Research Enhancement Award Program Depression Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
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Talbot LS, Stone S, Gruber J, Hairston IS, Eidelman P, Harvey AG. A test of the bidirectional association between sleep and mood in bipolar disorder and insomnia. JOURNAL OF ABNORMAL PSYCHOLOGY 2012; 121:39-50. [PMID: 21842957 PMCID: PMC3477806 DOI: 10.1037/a0024946] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present study investigates sleep, mood, and the proposed bidirectional relationship between the two in psychiatric disorders. Participants with interepisode bipolar disorder (n = 49), insomnia (n = 34), and no psychiatric history (n = 52) completed seven consecutive days of sleep diaries and mood measures. The interepisode bipolar and insomnia participants exhibited greater sleep disturbance than the healthy control individuals. Negative mood was equally heightened in both interepisode bipolar disorder and insomnia, and there were no differences between the three groups in positive mood. Total wake time was associated with next morning negative mood in bipolar disorder, whereas evening negative mood was associated with subsequent total wake time in both bipolar disorder and insomnia. Additionally, positive mood was associated with subsequent total wake time for the insomnia group. Results support the theory that disruptions in nighttime sleep and daytime mood may be mutually maintaining and suggest the potential importance of transdiagnostic or universal processes.
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Affiliation(s)
- Lisa S Talbot
- Department of Psychology, University of California, Berkeley, CA 94720-1650, USA
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33
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Differential patterns of abnormal activity and connectivity in the amygdala-prefrontal circuitry in bipolar-I and bipolar-NOS youth. J Am Acad Child Adolesc Psychiatry 2011; 50:1275-89.e2. [PMID: 22115148 PMCID: PMC3268077 DOI: 10.1016/j.jaac.2011.09.023] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 09/20/2011] [Accepted: 09/27/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The functioning of neural systems supporting emotion processing and regulation in youth with bipolar disorder not otherwise specified (BP-NOS) remains poorly understood. We sought to examine patterns of activity and connectivity in youth with BP-NOS relative to youth with bipolar disorder type I (BP-I) and healthy controls (HC). METHOD Participants (18 BP-I youth, 16 BP-NOS youth, and 18 HC) underwent functional magnetic resonance imaging while performing two emotional-face gender labeling tasks (happy/neutral, fearful/neutral). Analyses focused on a priori neural regions supporting emotion processing (amygdala) and emotion regulation (ventromedial prefrontal cortex (VMPFC), dorsolateral prefrontal cortex (DLPFC). Connectivity analyses used VMPFC as a seed region. RESULTS During the happy-face task, BP-I youth had greater amygdala, VMPFC, and DLPFC activity to happy faces whereas BP-NOS youth had reduced VMPFC and DLPFC activity to neutral faces relative to HC, and reduced amygdala, VMPFC, and DLPFC activity to neutral faces versus BP-I. During the fearful-face task, BP-I youth had reduced DLPFC activity to fearful faces whereas BP-NOS youth had reduced DLPFC activity to neutral faces relative to HC. BP-NOS youth showed greater VMPFC-DLPFC connectivity to happy faces relative to HC and BP-I youth. BP-I youth showed reduced VMPFC-amygdala connectivity to fearful faces relative to HC and BP-NOS youth. CONCLUSIONS This is the first study to document differential patterns of abnormal neural activity in, and connectivity between, neural regions supporting emotion processing and regulation in BP-NOS versus BP-I youth. Findings suggest that despite similarities in symptom presentation, there are differential patterns of abnormal neural functioning in BP-NOS and BP-I relative to HC, which might reflect an "intermediate state" in the course of BP-I illness. Future longitudinal studies are needed to relate these findings with future conversion to BP-I/II.
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Spencer TJ, Faraone SV, Surman CBH, Petty C, Clarke A, Batchelder H, Wozniak J, Biederman J. Toward defining deficient emotional self-regulation in children with attention-deficit/hyperactivity disorder using the Child Behavior Checklist: a controlled study. Postgrad Med 2011; 123:50-9. [PMID: 21904086 DOI: 10.3810/pgm.2011.09.2459] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Deficient emotional self-regulation (DESR) is characterized by deficits in self-regulating the physiological arousal caused by strong emotions. We examined whether a unique profile of the Child Behavior Checklist (CBCL) would help identify DESR in children with attention-deficit/hyperactivity disorder (ADHD). METHODS Subjects included 197 children with ADHD and 224 children without ADHD. We defined DESR if a child had an aggregate cut-off score of > 180 but < 210 on the Anxiety/Depression, Aggression, and Attention scales of the CBCL (CBCL-DESR). This profile was selected because of: 1) its conceptual congruence with the clinical concept of DESR; and 2) because its extreme (> 210) form has been previously associated with severe forms of mood and behavioral dysregulation in children with ADHD. All subjects were comprehensively assessed with structured diagnostic interviews and a wide range of functional measures. RESULTS Forty-four percent of children with ADHD had a positive CBCL-DESR profile versus 2% of controls (P < 0.001). The CBCL-DESR profile was associated with elevated rates of anxiety and disruptive behavior disorders, as well as significantly more impairments in emotional and interpersonal functioning. CONCLUSIONS The CBCL-DESR profile helped identify a subgroup of children with ADHD who had a psychopathological and functional profile consistent with the clinical concept of DESR.
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Affiliation(s)
- Thomas J Spencer
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA 02114, USA.
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Pavlova B, Uher R, Dennington L, Wright K, Donaldson C. Reactivity of affect and self-esteem during remission in bipolar affective disorder: an experimental investigation. J Affect Disord 2011; 134:102-11. [PMID: 21641043 DOI: 10.1016/j.jad.2011.04.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 04/18/2011] [Accepted: 04/18/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bipolar affective disorder (BPAD) is characterised by a lifelong vulnerability to develop episodes of depressed or elevated mood in response to stressful life events involving achievement or failure. We hypothesised that this latent vulnerability can manifest as reactivity of affect and self-esteem to experimentally induced experiences of success and failure and is shaped by history of childhood adversity. METHODS Twenty-four people with remitted BPAD and twenty-four healthy controls underwent anagram-solving tasks designed to generate experiences of success and failure in two separate sessions. Positive and negative affect and implicit and explicit self-esteem were measured before and after each task. Early adversity was measured by Childhood Trauma Questionnaire. RESULTS People with BPAD showed larger reactivity of affect and explicit self-esteem in response to experimental success and failure than did healthy controls. There were no significant differences in reactivity of implicit self-esteem. History of childhood trauma predicted increased affective reactivity to failure but not to success. LIMITATIONS We used a convenience sample. CONCLUSIONS The present experimental paradigm reveals reactivity of affect and self-esteem as features of BPAD, which are present even during good remission and thus are accessible as targets of interventions aiming at relapse prevention. Differential associations with childhood adversity indicate aetiological heterogeneity, with reactivity to failure influenced by early trauma and reactivity to success driven by other mechanisms.
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36
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Gruber J. A Review and Synthesis of Positive Emotion and Reward Disturbance in Bipolar Disorder. Clin Psychol Psychother 2011; 18:356-65. [DOI: 10.1002/cpp.776] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- June Gruber
- Psychology Department; Yale University; New Haven; CT; USA
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Tijssen MJA, van Os J, Wittchen HU, Lieb R, Beesdo K, Mengelers R, Wichers M. Prediction of transition from common adolescent bipolar experiences to bipolar disorder: 10-year study. Br J Psychiatry 2010; 196:102-8. [PMID: 20118453 DOI: 10.1192/bjp.bp.109.065763] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although (hypo)manic symptoms are common in adolescence, transition to adult bipolar disorder is infrequent. AIMS To examine whether the risk of transition to bipolar disorder is conditional on the extent of persistence of subthreshold affective phenotypes. METHOD In a 10-year prospective community cohort study of 3021 adolescents and young adults, the association between persistence of affective symptoms over 3 years and the 10-year clinical outcomes of incident DSM-IV (hypo)manic episodes and incident use of mental healthcare was assessed. RESULTS Transition to clinical outcome was associated with persistence of symptoms in a dose-dependent manner. Around 30-40% of clinical outcomes could be traced to prior persistence of affective symptoms. CONCLUSIONS In a substantial proportion of individuals, onset of clinical bipolar disorder may be seen as the poor outcome of a developmentally common and usually transitory non-clinical bipolar phenotype.
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Affiliation(s)
- Marijn J A Tijssen
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, The Netherlands
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Cuellar AK, Johnson SL, Ruggero CJ. Affective reactivity in response to criticism in remitted bipolar disorder: a laboratory analog of Expressed Emotion. J Clin Psychol 2009; 65:925-41. [PMID: 19459195 DOI: 10.1002/jclp.20596] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Potential mechanisms to explain the relationship between Expressed Emotion (EE) and poor outcome within bipolar disorder are poorly understood. One possibility is that people with bipolar disorder have difficulty regulating their affect in response to criticism. The present study examined whether participants with bipolar disorder were more affectively dysregulated than control participants when presented with a criticism by a confederate. There was a trend for people with bipolar disorder to react more negatively to the criticism, but there was also evidence that they recovered as quickly as controls. Exploratory analyses found that female gender, the perception of the criticism as more negative, being disabled, and having fewer positive relationships predicted greater reactivity to criticism among people with bipolar disorder.
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Talbot LS, Hairston IS, Eidelman P, Gruber J, Harvey AG. The effect of mood on sleep onset latency and REM sleep in interepisode bipolar disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2009; 118:448-58. [PMID: 19685943 PMCID: PMC4185310 DOI: 10.1037/a0016605] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present study investigates whether interepisode mood regulation impairment contributes to disturbances in sleep onset latency (SOL) and rapid eye movement (REM) sleep. Individuals with interepisode bipolar disorder (n = 28) and healthy controls (n = 28) slept in the laboratory for 2 baseline nights, a happy mood induction night, and a sad mood induction night. There was a significant interaction whereby on the happy mood induction night the bipolar group exhibited significantly longer SOL than did the control group, while there was no difference on the baseline nights. In addition, control participants exhibited shorter SOL on the happy mood induction night compared to the baseline nights, a finding that was not observed in the bipolar group. On the sad mood induction night, participants in both groups had shorter SOL and increased REM density when compared to the baseline nights. Bipolar participants exhibited heightened REM density compared to control participants on both nights. These results raise the possibility that regulation of positive stimuli may be a contributor to difficulties with SOL, while hyperactivity may be characteristic of REM sleep.
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Affiliation(s)
- Lisa S Talbot
- Department of Psychology, University of California, Berkeley, CA 94720-1650, USA
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Abstract
OBJECTIVE Previous study supports the presence of reduced volume and elevated response to emotional stimuli in amygdala in adolescents with bipolar disorder (BD). In the present study, structural and functional magnetic resonance imaging scans were obtained during the same neuroimaging session to examine amygdala structure-function relations in adolescents with BD. We hypothesized that amygdala volume would be inversely associated with amygdala response to emotional stimuli, such that BD participants with the smallest amygdala volumes would exhibit the highest amygdala response. METHOD Fifty-one adolescents (21 with BD I and 30 control adolescents, ages 10-18 years) underwent structural and functional magnetic resonance imaging scans. Amygdala volume (n = 49) and signal change (n = 44) during emotional face processing were compared between groups, and structure-function correlations were examined within the BD group (n = 16). RESULTS Adolescents with BD showed decreased amygdala volume (p =.009) and increased amygdala response to emotional faces (p =.043). There was no significant interaction between diagnosis and emotion type. A significant inverse association between amygdala volume and activation during emotional face processing was observed (r = -0.54, p =.029). CONCLUSIONS Decreased volume and increased response to emotional stimuli in the amygdala in adolescents with BD are consistent with previous reports. This study represents the first report, to our knowledge, of the two findings in the same adolescent BD sample and supports an amygdala structure-function relation characterized by an inverse association between volume and response to emotional stimuli. This preliminary finding requires replication and suggests a possible pathophysiological link between abnormalities in amygdala structure and response to emotional stimuli in BD.
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Henin A, Micco JA, Wozniak J, Briesch JM, Narayan AJ, Hirshfeld-Becker DR. Neurocognitive functioning in bipolar disorder. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1468-2850.2009.01162.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Littlefield AK, Sher KJ, Wood PK. Is "maturing out" of problematic alcohol involvement related to personality change? JOURNAL OF ABNORMAL PSYCHOLOGY 2009; 118:360-74. [PMID: 19413410 PMCID: PMC2742487 DOI: 10.1037/a0015125] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Problematic alcohol involvement typically peaks in the early 20s and declines with age. This maturing out of alcohol involvement is usually attributed to individuals attaining adult statuses incompatible with heavy drinking. Nevertheless, little is known about how changes in problematic alcohol use during emerging/early adulthood relate to changes in etiologically relevant personality traits that also change during this period. This study examined the relation between changes in problematic alcohol involvement and personality (measures of impulsivity, neuroticism, and extraversion) from ages 18 to 35 in a cohort of college students (N = 489) at varying risk for alcohol use disorders. Latent growth models indicated that both normative and individual changes in alcohol involvement occur between ages 18 and 35 and that these changes are associated with changes in neuroticism and impulsivity. Moreover, marital and parental role statuses did not appear to be third-variable explanations of the associated changes in alcohol involvement and personality. Findings suggest that personality change may be an important mechanism in the maturing-out effect.
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Affiliation(s)
- Andrew K Littlefield
- Department of Psychological Sciences, University of Missouri-Columbia, 200 South 7th Street, Columbia, MO 65211-0001, USA.
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Ragland JD, Cools R, Frank M, Pizzagalli DA, Preston A, Ranganath C, Wagner AD. CNTRICS final task selection: long-term memory. Schizophr Bull 2009; 35:197-212. [PMID: 18927344 PMCID: PMC2643960 DOI: 10.1093/schbul/sbn134] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Long-term memory (LTM) is a multifactorial construct, composed of different stages of information processing and different cognitive operations that are mediated by distinct neural systems, some of which may be more responsible for the marked memory problems that limit the daily function of individuals with schizophrenia. From the outset of the CNTRICS initiative, this multidimensionality was appreciated, and an effort was made to identify the specific memory constructs and task paradigms that hold the most promise for immediate translational development. During the second CNTRICS meeting, the LTM group identified item encoding and retrieval and relational encoding and retrieval as key constructs. This article describes the process that the LTM group went through in the third and final CNTRICS meeting to select nominated tasks within the 2 LTM constructs and within a reinforcement learning construct that were judged most promising for immediate development. This discussion is followed by each nominating authors' description of their selected task paradigm, ending with some thoughts about future directions.
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Affiliation(s)
- John D. Ragland
- Department of Psychiatry and Behavioral Sciences, UC Davis Imaging Research Center, University of California at Davis, 4701 X Street, Sacramento, CA 95817,To whom correspondence should be addressed; tel: 916-734-5802, fax: 916-734-8750, e-mail:
| | | | | | | | - Alison Preston
- Department of Psychology and Center for Learning and Memory, University of Texas at Austin
| | | | - Anthony D. Wagner
- Department of Psychology and Neurosciences Program, Stanford University
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Neeren AM, Alloy LB, Abramson LY. History of Parenting and Bipolar Spectrum Disorders. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2008. [DOI: 10.1521/jscp.2008.27.9.1021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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A neural model of voluntary and automatic emotion regulation: implications for understanding the pathophysiology and neurodevelopment of bipolar disorder. Mol Psychiatry 2008; 13:829, 833-57. [PMID: 18574483 PMCID: PMC2745893 DOI: 10.1038/mp.2008.65] [Citation(s) in RCA: 872] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The ability to regulate emotions is an important part of adaptive functioning in society. Advances in cognitive and affective neuroscience and biological psychiatry have facilitated examination of neural systems that may be important for emotion regulation. In this critical review we first develop a neural model of emotion regulation that includes neural systems implicated in different voluntary and automatic emotion regulatory subprocesses. We then use this model as a theoretical framework to examine functional neural abnormalities in these neural systems that may predispose to the development of a major psychiatric disorder characterized by severe emotion dysregulation, bipolar disorder.
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Pizzagalli DA, Goetz E, Ostacher M, Iosifescu DV, Perlis RH. Euthymic patients with bipolar disorder show decreased reward learning in a probabilistic reward task. Biol Psychiatry 2008; 64:162-8. [PMID: 18242583 PMCID: PMC2464620 DOI: 10.1016/j.biopsych.2007.12.001] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 11/29/2007] [Accepted: 12/01/2007] [Indexed: 01/26/2023]
Abstract
BACKGROUND Bipolar disorder (BPD) features cycling mood states ranging from depression to mania with intermittent phases of euthymia. Bipolar disorder subjects often show excessive goal-directed and pleasure-seeking behavior during manic episodes and reduced hedonic capacity during depressive episodes, indicating that BPD might involve altered reward processing. Our goal was to test the hypothesis that BPD is characterized by impairments in adjusting behavior as a function of prior reinforcement history, particularly in the presence of residual anhedonic symptoms. METHODS Eighteen medicated BPD subjects and 25 demographically matched comparison subjects performed a probabilistic reward task. To identify putative dysfunctions in reward processing irrespective of mood state, primary analyses focused on euthymic BPD subjects (n = 13). With signal-detection methodologies, response bias toward a more frequently rewarded stimulus was used to objectively assess the participants' propensity to modulate behavior as a function of reinforcement history. RESULTS Relative to comparison subjects, euthymic BPD subjects showed a reduced and delayed acquisition of response bias toward the more frequently rewarded stimulus, which was partially due to increased sensitivity to single rewards of the disadvantageous stimulus. Analyses considering the entire BPD sample revealed that reduced reward learning correlated with self-reported anhedonic symptoms, even after adjusting for residual manic and anxious symptoms and general distress. CONCLUSIONS The present study provides preliminary evidence indicating that BPD, even during euthymic states, is characterized by dysfunctional reward learning in situations requiring integration of reinforcement information over time and thus offers initial insights about the potential source of dysfunctional reward processing in this disorder.
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Affiliation(s)
| | - Elena Goetz
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Michael Ostacher
- Bipolar Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Dan V. Iosifescu
- Bipolar Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy H. Perlis
- Bipolar Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
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Henry C, Van den Bulke D, Bellivier F, Roy I, Swendsen J, M'Baïlara K, Siever LJ, Leboyer M. Affective lability and affect intensity as core dimensions of bipolar disorders during euthymic period. Psychiatry Res 2008; 159:1-6. [PMID: 18295902 DOI: 10.1016/j.psychres.2005.11.016] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Revised: 09/17/2005] [Accepted: 11/08/2005] [Indexed: 10/22/2022]
Abstract
Bipolar disorders are usually defined by alternative mood states, but a more precise characterization of the euthymic period could provide further insights into the pathophysiology of bipolar disorders. Surprisingly, few studies have investigated core affective dimensions in euthymic bipolar patients. In this study, we assessed 179 euthymic bipolar patients (score<12 on the Montgomery-Asberg Depression Scale and a score<6 on the Bech-Rafaelsen Mania Scale) compared with 86 control subjects using French versions of the Affective Lability Scale (ALS) and the Affect Intensity Measure (AIM). Data were analyzed by logistic regression. Our results showed that euthymic bipolar subjects reported having more intense emotions than controls and also had a higher affective lability. High scores in both affective dimensions were associated with a significantly higher risk for psychiatric axis I comorbidity. Moreover, a high affective lability score was associated with an earlier age of onset for bipolar disease. Affective lability and affect intensity might be two core dimensions of bipolar disorder during euthymic periods, suggesting that bipolar disorder is not circumscribed to mood episodes but also affects emotional reactivity between episodes. Both dimensions could account for the stress reactivity of bipolar patients that may lead to relapses.
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Affiliation(s)
- Chantal Henry
- Département de Psychiatrie adulte, Bâtiment Lescure, CHS Charles Perrens, 121 rue de la Béchade, 33076 Bordeaux Cedex, France.
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Urosević S, Abramson LY, Harmon-Jones E, Alloy LB. Dysregulation of the behavioral approach system (BAS) in bipolar spectrum disorders: review of theory and evidence. Clin Psychol Rev 2008; 28:1188-205. [PMID: 18565633 DOI: 10.1016/j.cpr.2008.04.004] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 04/19/2008] [Accepted: 04/22/2008] [Indexed: 02/07/2023]
Abstract
In recent years, a call for increased research on bipolar disorder has been answered with methodologically diverse studies exploring goal striving, life events, cognitive style, decision-making, and neurobiological abnormalities in bipolar disorder. In order to further this spurt of research and to systematize our understanding of bipolar disorder, an integrative perspective is warranted. The behavioral approach system (BAS) dysregulation theory, proposed by Richard Depue and colleagues, provides such an integrated model for understanding psychosocial and biological aspects of bipolar disorder. In this paper, we review studies on life events, cognitive style and other psychosocial and neurobiological factors to examine whether the BAS dysregulation theory is supported by existing data. Then, we draw on recent advances in the study of emotion and motivation, and propose an expansion of the BAS dysregulation model of bipolar spectrum disorders to foster further biopsychosocial investigations of bipolar disorder. This expanded model provides greater specificity in predictions, especially about the nature of BAS dysregulation, environmental factors and psychological processes (e.g., appraisal processes) featured in a causal chain culminating in bipolar symptoms. Finally, we discuss the implications of the expanded BAS model for the course of bipolar spectrum disorders.
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Affiliation(s)
- Snezana Urosević
- University of Wisconsin, Madison; 1202 W. Johnson St, Madison, WI 53706, USA.
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Harmon-Jones E, Abramson LY, Nusslock R, Sigelman JD, Urosevic S, Turonie LD, Alloy LB, Fearn M. Effect of bipolar disorder on left frontal cortical responses to goals differing in valence and task difficulty. Biol Psychiatry 2008; 63:693-8. [PMID: 17919457 DOI: 10.1016/j.biopsych.2007.08.004] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Revised: 07/13/2007] [Accepted: 08/06/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND The behavioral activation system (BAS) dysregulation theory of bipolar disorder predicts that bipolar individuals will show an excessive increase in approach motivation during reward striving. Building on past research showing that the left frontal cortical region is involved in approach motivation, we predicted that individuals with bipolar disorder would evidence increased relative left frontal cortical activity in response to goal striving, particularly in response to positive challenges. METHODS Right-handed individuals (age 18-24) with a bipolar spectrum diagnosis (n = 41) and individuals with no major affective psychopathology (n = 53) were presented with cues indicating that, on a given trial, an easy, medium, or hard anagram (scrambled word) would be presented in 7 seconds and that they would receive money or avoid losing money for the correct solution (10 anagrams of each of the 6 types). During this preparation period, electroencephalogram (EEG) alpha power was measured and hemispheric asymmetry indexes were computed. RESULTS Compared with the nonbipolar individuals, individuals with bipolar disorder showed greater relative left frontal cortical activation in preparation for the hard/win trials. Whereas nonbipolar individuals showed a decrease in left frontal cortical activation from medium to hard win trials, bipolar individuals did not. In addition, among bipolar individuals, current self-reported activation related to greater left frontal activation to the hard/win trials. CONCLUSIONS These results provide support for an integrative biopsychosocial model of bipolar disorder, BAS dysregulation theory, and suggest that relative left frontal activity, which may be involved in mania, is triggered by challenging and potentially rewarding events.
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Affiliation(s)
- Eddie Harmon-Jones
- Department of Psychology, Texas A&M University, College Station, Texas 77843, USA.
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Abstract
In the past decade, interest in and research on pediatric bipolar disorder (BD) has increased substantially. Prevalence rates of the disorder have doubled in outpatient settings, while twice as many research articles on pediatric BD were published in the past five years as in the prior decade. This review focuses on recent developments in the study of pediatric BD. We examine current research on the diagnostic boundaries of BD in youths, in particular the issues of episodicity and irritability, and provide assessment guidelines. We review data elucidating the pathophysiology of pediatric BD, with a focus on how these results may inform diagnosis. Finally, we discuss treatment approaches for pediatric BD, particularly psychotherapeutic interventions. Throughout the review, we pay particular attention to youths with severe chronic irritability, hyperarousal, and hyperreactivity, who reflect the population in whom the diagnosis of BD is most debated.
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Affiliation(s)
- Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda MD, USA.
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