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Biçer GY, Kurt A, Zor KR. Efficacy of automatic pupillometry as a screening technique to detect autonomic dysfunction in bipolar disorder. Clin Exp Optom 2023; 106:896-900. [PMID: 36436223 DOI: 10.1080/08164622.2022.2145182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/03/2022] [Indexed: 11/28/2022] Open
Abstract
CLINICAL RELEVANCE Autonomic nervous system abnormalities in the pathophysiology of bipolar disorder are controversial. Pupillary features may be affected as a result of autonomic nervous system abnormalities in bipolar disorder. Small changes in pupillary responses may not be noticeable on clinical examination. Automated pupillemetries can be helpful in demonstrating these changes reliably and quantitatively. BACKGROUND The aim of this study was to compare the static and dynamic pupillary responses of bipolar patients with healthy controls. In addition, pupillary response differences between mania, depression and remission stages were investigated. METHODS The bipolar patient group consisted of 39 eyes of 39 patients with 13 patients in each of the stages: mania, depression and remission. The control group consisted of 39 eyes of 39 healthy volunteers. After the ophthalmic examination, static and dynamic pupillometry measurements were made. The mean pupil dilatation speed was calculated according to dynamic measurements. Static pupillometry measurements including scotopic, mesopic and photopic pupil diameters; the first dynamic measurements at 0th second and pupillary dilatation speed were used for statistical analysis. RESULTS There was no difference static and the first dynamic pupillometry measurements between the bipolar and control groups (p > 0.05 for all parameters), but there was a significant difference in mean pupil dilatation speed (p = 0.041). No significant differences were found between the 3 groups for all static and the first dynamic pupillometry measurements and the mean pupil dilatation speed (p > 0.05). CONCLUSION Static and the first dynamic measurements of bipolar patients were not different from healthy controls. The mean pupil dilatation speed of bipolar patients was significantly lower, but this difference had a low effect size.
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Affiliation(s)
| | - Aydın Kurt
- Department of Psychiatry, Niğde Ömer Halisdemir Education and Research Hospital, Niğde, Turkey
| | - Kürşad Ramazan Zor
- Department of Ophthalmology, Niğde Ömer Halisdemir University, Niğde, Turkey
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2
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Ortner J, Bengesser SA, Wagner-Skacel J, Fellendorf FT, Fleischmann E, Ratzenhofer M, Lenger M, Queissner R, Tmava-Berisha A, Platzer M, Maget A, Pilz R, Birner A, Reininghaus E, Dalkner N. [COVID-19 and Bipolar Affective Disorder: Subjective Changes in Lifestyle Variables During the First Lockdown During the COVID-19 Pandemic in Austria]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 91:32-44. [PMID: 35882365 PMCID: PMC9873412 DOI: 10.1055/a-1871-9628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The COVID-19 pandemic with its protective measures (e. g. lockdown) had far-reaching effects on everyone's well-being. The aim of this study was to examine lifestyle variables during the first Austrian lockdown in patients with bipolar disorder in comparison to a healthy control group and to assess subjective changes caused by the pandemic. METHOD At the beginning of April 2020, an online survey of n=75 participants (35 people with bipolar disorder and 40 healthy controls) with standardized questionnaires (Beck Depression Inventory-2, Food Craving Inventory, Altman Self Rating Mania Scale) as well as non-standardized COVID-19-specific questions on the subject of "Psychological stress and effects of the COVID-19 pandemic in bipolar disorder" was created and distributed via LimeSurvey. RESULTS Both groups reported a negative impact on their mental health. The participants with bipolar disorder showed significantly higher values in the Beck Depression Inventory-2 score (p<0,001), in emotional distress due to social distancing (p=0,003) and significantly lower values in muscle-strengthening exercise (p=0,039) and in sport units (p=0,003) compared to the control group. In addition, patients with bipolar disorder smoked more often than individuals of the control group. People with bipolar disorder were 42,9% more likely to report they were less efficient during the pandemic, and 22,9% experienced weight gain compared to before the pandemic. The control group, on the other hand, was less efficient at 17,5% and 5,0% reported weight gain. However, a comparison with pre-pandemic data showed a decrease in food craving in both groups. CONCLUSION This study provided first evidence of self-reported adverse effects on mental stress and lifestyle in people with bipolar disorder at the beginning of the COVID-19 pandemic. Psychiatric care and early interventions for patients with bipolar disorder would be particularly important in times of crisis in order to help maintain a healthy lifestyle and thus counteract unfavourable developments.
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Affiliation(s)
- Jennifer Ortner
- Psychiatry, Medical University Graz, Austria Universitätsklinik
für Psychiatrie und Psychotherapeutische Medizin, Medizinische
Universität Graz, Österreich
| | - Susanne A. Bengesser
- Psychiatry, Medical University Graz, Austria Universitätsklinik
für Psychiatrie und Psychotherapeutische Medizin, Medizinische
Universität Graz, Österreich,Korrespondenzadresse Research Prof. Priv.-Doz. DDr. Susanne
A. Bengesser Medical University
GrazPsychiatryAuenbruggerplatz
318036
GrazAustria004331638586224004331638586224
| | - Jolana Wagner-Skacel
- Universitätsklinik für Medizinische Psychologie und
Psychotherapie, Medizinische Universität Graz,
Österreich
| | - Frederike T. Fellendorf
- Psychiatry, Medical University Graz, Austria Universitätsklinik
für Psychiatrie und Psychotherapeutische Medizin, Medizinische
Universität Graz, Österreich
| | - Eva Fleischmann
- Psychiatry, Medical University Graz, Austria Universitätsklinik
für Psychiatrie und Psychotherapeutische Medizin, Medizinische
Universität Graz, Österreich
| | - Michaela Ratzenhofer
- Psychiatry, Medical University Graz, Austria Universitätsklinik
für Psychiatrie und Psychotherapeutische Medizin, Medizinische
Universität Graz, Österreich
| | - Melanie Lenger
- Psychiatry, Medical University Graz, Austria Universitätsklinik
für Psychiatrie und Psychotherapeutische Medizin, Medizinische
Universität Graz, Österreich
| | - Robert Queissner
- Psychiatry, Medical University Graz, Austria Universitätsklinik
für Psychiatrie und Psychotherapeutische Medizin, Medizinische
Universität Graz, Österreich
| | - Adelina Tmava-Berisha
- Psychiatry, Medical University Graz, Austria Universitätsklinik
für Psychiatrie und Psychotherapeutische Medizin, Medizinische
Universität Graz, Österreich
| | - Martina Platzer
- Psychiatry, Medical University Graz, Austria Universitätsklinik
für Psychiatrie und Psychotherapeutische Medizin, Medizinische
Universität Graz, Österreich
| | - Alexander Maget
- Psychiatry, Medical University Graz, Austria Universitätsklinik
für Psychiatrie und Psychotherapeutische Medizin, Medizinische
Universität Graz, Österreich
| | - René Pilz
- Psychiatry, Medical University Graz, Austria Universitätsklinik
für Psychiatrie und Psychotherapeutische Medizin, Medizinische
Universität Graz, Österreich,FH JOANNEUM, Diätologie, Graz, Austria
| | - Armin Birner
- Psychiatry, Medical University Graz, Austria Universitätsklinik
für Psychiatrie und Psychotherapeutische Medizin, Medizinische
Universität Graz, Österreich
| | - Eva Reininghaus
- Psychiatry, Medical University Graz, Austria Universitätsklinik
für Psychiatrie und Psychotherapeutische Medizin, Medizinische
Universität Graz, Österreich
| | - Nina Dalkner
- Psychiatry, Medical University Graz, Austria Universitätsklinik
für Psychiatrie und Psychotherapeutische Medizin, Medizinische
Universität Graz, Österreich
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3
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Mutz J, Young AH, Lewis CM. Age-related changes in physiology in individuals with bipolar disorder. J Affect Disord 2022; 296:157-168. [PMID: 34601303 DOI: 10.1016/j.jad.2021.09.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/02/2021] [Accepted: 09/12/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Individuals with bipolar disorder have a reduced life expectancy and may experience accelerated biological ageing. In individuals with bipolar disorder and healthy controls, we examined differences in age-related changes in physiology. METHODS UK Biobank recruited more than 500,000 participants, aged 37-73, between 2006 and 2010. Generalised additive models were used to examine associations between age and grip strength, cardiovascular function, body composition, lung function and heel bone mineral density. RESULTS The main dataset included 271,118 adults (mean age = 56.04 years; 49.60% females). We found statistically significant differences between cases and controls for grip strength, blood pressure, pulse rate and body composition, with standardised mean differences of up to -0.24 (95% CI -0.28 to -0.19). Evidence of differences in lung function, heel bone mineral density or arterial stiffness was limited. Case-control differences were most evident for age-related changes in cardiovascular function (both sexes) and body composition (females). Differences did not uniformly narrow or widen with age and differed by sex. For example, the difference in systolic blood pressure between male cases and controls was -1.3 mmHg at age 50 and widened to -4.7 mmHg at age 65. Diastolic blood pressure in female cases was 1.2 mmHg higher at age 40 and -1.2 mmHg lower at age 65. LIMITATIONS Analyses did not distinguish between bipolar disorder subtypes. Results may not generalise to other age groups. CONCLUSIONS Differences between bipolar disorder cases and controls were most evident for cardiovascular and body composition measures. Targeted screening for cardiovascular and metabolic health in middle age is warranted to potentially mitigate excess mortality.
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Affiliation(s)
- Julian Mutz
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Medical and Molecular Genetics, Faculty of Life Sciences & Medicine, King's College London, London, UK
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4
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Freyberg J, Brage S, Kessing LV, Faurholt-Jepsen M. Differences in psychomotor activity and heart rate variability in patients with newly diagnosed bipolar disorder, unaffected relatives, and healthy individuals. J Affect Disord 2020; 266:30-36. [PMID: 32056891 PMCID: PMC7116568 DOI: 10.1016/j.jad.2020.01.110] [Citation(s) in RCA: 8] [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: 09/08/2019] [Revised: 11/22/2019] [Accepted: 01/20/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Heart rate variability (HRV) and psychomotor activity have been found reduced in bipolar disorder (BD) but has never been investigated in newly diagnosed BD and unaffected relatives. The present study aimed to compare HRV and psychomotor activity between newly diagnosed patients with BD, their unaffected first-degree relatives (UR), and healthy control individuals (HC). METHODS 20 newly diagnosed patients with BD, 20 of their UR, and 20 age- and sex-matched HC were included. Measurements of HRV for five minutes and heart rate and acceleration for seven days were conducted. Activity energy expenditure (AEE) was derived from the latter. Linear mixed effect regression models were conducted to compare the three groups. RESULTS HRV did not differ in any measure between the three groups of participants. Similarly, AEE (kJ/day/kg) did not differ between the three groups in neither daily means (BD: 63.6, UR: 64.1, HC: 62.1) nor when divided into quarter-daily intervals. LIMITATIONS The relatively small size of the study may affect the validity of the results. CONCLUSION Patients with newly diagnosed BD and UR do not present with decreased HRV or AEE. These results contrast prior findings from BD patients with more advanced stages of the disorder, suggesting that these outcomes progress with illness duration.
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Affiliation(s)
- Josefine Freyberg
- The Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Søren Brage
- MRC Epidemiology Unit, Cambridge, United Kingdom
| | - Lars Vedel Kessing
- The Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- The Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
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5
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Roux P, Etain B, Cannavo AS, Aubin V, Aouizerate B, Azorin JM, Bellivier F, Belzeaux R, Bougerol T, Cussac I, Courtet P, Kahn JP, Leboyer M, M'Bailara K, Payet MP, Olié E, Henry C, Passerieux C. Prevalence and determinants of cognitive impairment in the euthymic phase of bipolar disorders: results from the FACE-BD cohort. Psychol Med 2019; 49:519-527. [PMID: 29734950 DOI: 10.1017/s0033291718001186] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cognitive deficits are a well-established feature of bipolar disorders (BD), even during periods of euthymia, but risk factors associated with cognitive deficits in euthymic BD are still poorly understood. We aimed to validate classification criteria for the identification of clinically significant cognitive impairment, based on psychometric properties, to estimate the prevalence of neuropsychological deficits in euthymic BD, and identify risk factors for cognitive deficits using a multivariate approach. METHODS We investigated neuropsychological performance in 476 euthymic patients with BD recruited via the French network of BD expert centres. We used a battery of tests, assessing five domains of cognition. Five criteria for the identification of neuropsychological impairment were tested based on their convergent and concurrent validity. Uni- and multivariate logistic regressions between cognitive impairment and several clinical and demographic variables were performed to identify risk factors for neuropsychological impairment in BD. RESULTS One cut-off had satisfactory psychometric properties and yielded a prevalence of 12.4% for cognitive deficits in euthymic BD. Antipsychotics use were associated with the presence of a cognitive deficit. CONCLUSIONS This is the first study to validate a criterion for clinically significant cognitive impairment in BD. We report a lower prevalence of cognitive impairment than previous studies, which may have overestimated its prevalence. Patients with euthymic BD and cognitive impairment may benefit from cognitive remediation.
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Affiliation(s)
- Paul Roux
- Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles,177 rue de Versailles, 78157 Le Chesnay,France
| | | | - Anne-Sophie Cannavo
- Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles,177 rue de Versailles, 78157 Le Chesnay,France
| | | | | | | | | | | | | | | | | | | | | | | | - Marion Perrin Payet
- Pôle de Psychiatrie et Psychologie Clinique - Centre Psychothérapique de Nancy,54520 Laxou,France
| | | | | | - Christine Passerieux
- Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles,177 rue de Versailles, 78157 Le Chesnay,France
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6
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Carr O, de Vos M, Saunders KEA. Heart rate variability in bipolar disorder and borderline personality disorder: a clinical review. EVIDENCE-BASED MENTAL HEALTH 2017; 21:23-30. [PMID: 29223951 PMCID: PMC5800347 DOI: 10.1136/eb-2017-102760] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/07/2017] [Accepted: 08/30/2017] [Indexed: 12/27/2022]
Abstract
Heart rate variability (HRV) in psychiatric disorders has become an increasing area of interest in recent years following technological advances that enable non-invasive monitoring of autonomic nervous system regulation. However, the clinical interpretation of HRV features remain widely debated or unknown. Standardisation within studies of HRV in psychiatric disorders is poor, making it difficult to reproduce or build on previous work. Recently, a Guidelines for Reporting Articles on Psychiatry and Heart rate variability checklist has been proposed to address this issue. Here we assess studies of HRV in bipolar disorder and borderline personality disorder against this checklist and discuss the implication for ongoing research in this area.
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Affiliation(s)
- Oliver Carr
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Maarten de Vos
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Kate E A Saunders
- University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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7
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Sarlon J, Plaszczyk S, Engel S, Oertel-Knöchel V. Electrophysiological parameters as biomarkers for psychiatry: Intra-individual variability and influencing factors. Int J Psychophysiol 2017; 123:42-47. [PMID: 29155050 DOI: 10.1016/j.ijpsycho.2017.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 10/21/2017] [Accepted: 11/15/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Jan Sarlon
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Heinrich-Hoffmann-Str. 10, 60528 Frankfurt am Main, Germany; Psychiatric Hospital, Oberbergkliniken, Oberberg 1, 78132 Hornberg, Germany.
| | - Simone Plaszczyk
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Heinrich-Hoffmann-Str. 10, 60528 Frankfurt am Main, Germany
| | - Sinah Engel
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Heinrich-Hoffmann-Str. 10, 60528 Frankfurt am Main, Germany; Department of Neurology, University of Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Viola Oertel-Knöchel
- Laboratory for Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Heinrich-Hoffmann-Str. 10, 60528 Frankfurt am Main, Germany
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8
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Mangone A, Yates KF, Sweat V, Joseph A, Convit A. Cognitive functions among predominantly minority urban adolescents with metabolic syndrome. APPLIED NEUROPSYCHOLOGY-CHILD 2017. [PMID: 28631969 DOI: 10.1080/21622965.2017.1284662] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The rise in the rate of adolescent obesity has led to a concurrent rise in the rate of metabolic syndrome (MetS) among young people. In addition to diabetes and cardiovascular disease, MetS has also been linked to cognitive dysfunction. The goal of this study was to assess whether cognitive differences exist between minority urban adolescents carrying excess weight who meet criteria for MetS as compared to their peers without MetS. Two hundred and ninety-six urban adolescents, predominantly Hispanic and carrying excess weight as defined by a BMI above 25 kg/m2, were screened for MetS and divided into MetS and no MetS groups. All participants completed the CNS Vital Signs (CNS-VS) computerized neurocognitive battery that assesses cognitive domains of Memory, Processing Speed, Reaction Time, Executive Function, Complex Attention, and Cognitive Flexibility. The MetS group (29.2%, n = 84) performed significantly lower on 2 of the 7 cognitive domains: Executive Function (EF) and Cognitive Flexibility. Additionally, waist circumference was determined to be a significant predictor of both these domains. These findings suggest EF is negatively impacted in adolescents with MetS, despite there being no statistical differences between MetS groups on most other measured cognitive domains. Due to the interrelated nature of obesity, waist circumference, and MetS, these findings have larger implications for the obesity epidemic as well.
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Affiliation(s)
- Alexander Mangone
- a Department of Psychiatry , New York University School of Medicine , New York , NY , USA
| | - Kathy F Yates
- a Department of Psychiatry , New York University School of Medicine , New York , NY , USA.,d Nathan Kline Institute for Psychiatric Research, Orangeburg , New York , NY , USA
| | - Victoria Sweat
- a Department of Psychiatry , New York University School of Medicine , New York , NY , USA
| | - Adriana Joseph
- a Department of Psychiatry , New York University School of Medicine , New York , NY , USA
| | - Antonio Convit
- a Department of Psychiatry , New York University School of Medicine , New York , NY , USA.,b Department of Medicine , New York University School of Medicine , New York , NY , USA.,c Department of Radiology , New York University School of Medicine , New York , NY , USA.,d Nathan Kline Institute for Psychiatric Research, Orangeburg , New York , NY , USA
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9
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Faurholt-Jepsen M, Brage S, Kessing LV, Munkholm K. State-related differences in heart rate variability in bipolar disorder. J Psychiatr Res 2017; 84:169-173. [PMID: 27743529 PMCID: PMC6200128 DOI: 10.1016/j.jpsychires.2016.10.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/09/2016] [Accepted: 10/07/2016] [Indexed: 12/31/2022]
Abstract
Heart rate variability (HRV) is a validated measure of sympato-vagal balance in the autonomic nervous system. HRV appears decreased in patients with bipolar disorder (BD) compared with healthy individuals, but the extent of state-related alterations has been sparingly investigated. The present study examined differences in HRV between affective states in BD. A heart rate and movement sensor weighing 8 g collected average acceleration, heart rate and the two slowest and fastest heart beats (of the most recent 16 beats) every 30 s over a period of at least three consecutive weekdays and nights in a prospective longitudinal design from a total of 31 different affective states in 16 outpatients with BD. A proxy measure of HRV was calculated as the difference between the second-shortest and the second-longest inter-beat-interval collected during each of the epochs. Analyses were based on over 100.000 HRV data-points. In unadjusted analyses and in analyses adjusted for age, gender and heart rate, during a manic state HRV was increased by 18% compared with a depressed state (eB = 1.18, 95% CI: 1.16-1.20, p < 0.001) and increased by 17% compared with a euthymic state (eB = 1.17, 95% CI: 1.15-1.19, p < 0.001), whereas there was no difference between a depressive state and a euthymic state (eB = 0.98, 95% CI: 0.96-1.00, p = 0.12). Further inclusion of BMI as a covariate did not alter any of the associations. HRV appears to be altered in a state-dependent manner in bipolar disorder and could represent a candidate state marker. Further studies with larger sample sizes are warranted.
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Affiliation(s)
| | - Søren Brage
- MRC Epidemiology Unit, Cambridge, United Kingdom
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10
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Faurholt-Jepsen M, Kessing LV, Munkholm K. Heart rate variability in bipolar disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2016; 73:68-80. [PMID: 27986468 DOI: 10.1016/j.neubiorev.2016.12.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 11/04/2016] [Accepted: 12/09/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Heart rate variability (HRV) has been suggested reduced in bipolar disorder (BD) compared with healthy individuals (HC). This meta-analysis investigated: HRV differences in BD compared with HC, major depressive disorder or schizophrenia; HRV differences between affective states; HRV changes from mania/depression to euthymia; and HRV changes following interventions. METHODS A systematic review and meta-analysis reported according to the PRISMA guidelines was conducted. MEDLINE, Embase, PsycINFO, The Cochrane Library and Scopus were searched. A total of 15 articles comprising 2534 individuals were included. RESULTS HRV was reduced in BD compared to HC (g=-1.77, 95% CI: -2.46; -1.09, P<0.001, 10 comparisons, n=1581). More recent publication year, larger study and higher study quality were associated with a smaller difference in HRV. Large between-study heterogeneity, low study quality, and lack of consideration of confounding factors in individual studies were observed. CONCLUSIONS This first meta-analysis of HRV in BD suggests that HRV is reduced in BD compared to HC. Heterogeneity and methodological issues limit the evidence. Future studies employing strict methodology are warranted.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, Rigshospitalet, University of Copenhgaen, Blegdamsvej 9, DK- 2100 Copenhagen, Denmark.
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, University of Copenhgaen, Blegdamsvej 9, DK- 2100 Copenhagen, Denmark
| | - Klaus Munkholm
- Psychiatric Center Copenhagen, Rigshospitalet, University of Copenhgaen, Blegdamsvej 9, DK- 2100 Copenhagen, Denmark
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11
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Valenza G, Nardelli M, Lanata A, Gentili C, Bertschy G, Kosel M, Scilingo EP. Predicting Mood Changes in Bipolar Disorder Through Heartbeat Nonlinear Dynamics. IEEE J Biomed Health Inform 2016; 20:1034-1043. [DOI: 10.1109/jbhi.2016.2554546] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Chin-Lun Hung G, Hahn J, Alamiri B, Buka SL, Goldstein JM, Laird N, Nelson CA, Smoller JW, Gilman SE. Socioeconomic disadvantage and neural development from infancy through early childhood. Int J Epidemiol 2015; 44:1889-99. [PMID: 26675752 DOI: 10.1093/ije/dyv303] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Early social experiences are believed to shape neurodevelopment, with potentially lifelong consequences. Yet minimal evidence exists regarding the role of the social environment on children's neural functioning, a core domain of neurodevelopment. METHODS We analysed data from 36 443 participants in the United States Collaborative Perinatal Project, a socioeconomically diverse pregnancy cohort conducted between 1959 and 1974. Study outcomes included: physician (neurologist or paediatrician)-rated neurological abnormality neonatally and thereafter at 4 months and 1 and 7 years; indicators of neurological hard signs and soft signs; and indicators of autonomic nervous system function. RESULTS Children born to socioeconomically disadvantaged parents were more likely to exhibit neurological abnormalities at 4 months [odds ratio (OR) = 1.20; 95% confidence interval (CI) = 1.06, 1.37], 1 year (OR = 1.35; CI = 1.17, 1.56), and 7 years (OR = 1.67; CI = 1.48, 1.89), and more likely to exhibit neurological hard signs (OR = 1.39; CI = 1.10, 1.76), soft signs (OR = 1.26; CI = 1.09, 1.45) and autonomic nervous system dysfunctions at 7 years. Pregnancy and delivery complications, themselves associated with socioeconomic disadvantage, did not account for the higher risks of neurological abnormalities among disadvantaged children. CONCLUSIONS Parental socioeconomic disadvantage was, independently from pregnancy and delivery complications, associated with abnormal child neural development during the first 7 years of life. These findings reinforce the importance of the early environment for neurodevelopment generally, and expand knowledge regarding the domains of neurodevelopment affected by environmental conditions. Further work is needed to determine the mechanisms linking socioeconomic disadvantage with children's neural functioning, the timing of such mechanisms and their potential reversibility.
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Affiliation(s)
- Galen Chin-Lun Hung
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan Department of Public Health, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Jill Hahn
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Bibi Alamiri
- Section of Child & Adolescent Psychiatry, Lahey Hospital & Medical Center, Burlington, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Stephen L Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Jill M Goldstein
- Departments of Psychiatry and Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Nan Laird
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Charles A Nelson
- Department of Pediatrics, Harvard Medical School/Boston Children's Hospital, Boston, MA, USA
| | - Jordan W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit Department of Psychiatry Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen E Gilman
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA Department of Psychiatry Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
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13
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Greco A, Valenza G, Lanata A, Rota G, Scilingo EP. Electrodermal activity in bipolar patients during affective elicitation. IEEE J Biomed Health Inform 2015; 18:1865-73. [PMID: 25375684 DOI: 10.1109/jbhi.2014.2300940] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Bipolar patients are characterized by a pathological unpredictable behavior, resulting in fluctuations between states of depression and episodes of mania or hypomania. In the current clinical practice, the psychiatric diagnosis is made through clinician-administered rating scales and questionnaires, disregarding the potential contribution provided by physiological signs. The aim of this paper is to investigate how changes in the autonomic nervous system activity can be correlated with clinical mood swings. More specifically, a group of ten bipolar patients underwent an emotional elicitation protocol to investigate the autonomic nervous system dynamics, through the electrodermal activity (EDA), among different mood states. In addition, a control group of ten healthy subjects were recruited and underwent the same protocol. Physiological signals were analyzed by applying the deconvolutive method to reconstruct EDA tonic and phasic components, from which several significant features were extracted to quantify the sympathetic activation. Experimental results performed on both the healthy subjects and the bipolar patients supported the hypothesis of a relationship between autonomic dysfunctions and pathological mood states.
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14
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Volkert J, Kopf J, Kazmaier J, Glaser F, Zierhut KC, Schiele MA, Kittel-Schneider S, Reif A. Evidence for cognitive subgroups in bipolar disorder and the influence of subclinical depression and sleep disturbances. Eur Neuropsychopharmacol 2015; 25:192-202. [PMID: 25156468 DOI: 10.1016/j.euroneuro.2014.07.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/18/2014] [Accepted: 07/26/2014] [Indexed: 01/29/2023]
Abstract
Recent research in bipolar disorder (BD) points to the relevance and persistence of cognitive deficits even in euthymia. Up to now, the mechanisms behind why some bipolar patients (BP) do not reach their former level of cognitive performance and psychosocial functioning while others remit completely, are not understood. In this study we aimed to identify a "cognitive deficit" vs. "non-deficit" subgroup within BD by using an extensive neuropsychological test battery. The test performance of 70 euthymic outpatients (BD-I and II, recruited as a sample of convenience from our bipolar disorder programme) was compared to 70 matched, healthy controls (HC). Furthermore, we investigated the association between demographic/clinical variables and the cognitive performance of BP. As expected, our sample of euthymic BP performed significantly worse than HC in psychomotor speed, divided attention, working memory, verbal memory, word fluency and problem solving. However, 41.4% of the patients did not have any neurocognitive deficits at all, and whether or not a patient belonged to the non-deficit group was not influenced by disease severity. Instead, our results demonstrate that patients suffering from persistent sleep disturbances and sub-threshold depressive symptomatology show more severe cognitive dysfunctions. In addition, antipsychotic treatment and comorbid anxiety disorder were associated with cognitive deficits. In sum, these results suggest that a major part of cognitive impairment is due to current symptomatology, especially sleep disorder and sub-syndromal depression. Rigorous treatment of these symptoms thus might well improve cognitive deficits and, as a consequence, overall functioning in BD.
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Affiliation(s)
- J Volkert
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, D-97080 Wuerzburg, Germany.
| | - J Kopf
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, D-97080 Wuerzburg, Germany
| | - J Kazmaier
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, D-97080 Wuerzburg, Germany
| | - F Glaser
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, D-97080 Wuerzburg, Germany
| | - K C Zierhut
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, D-97080 Wuerzburg, Germany
| | - M A Schiele
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, D-97080 Wuerzburg, Germany
| | - S Kittel-Schneider
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, D-97080 Wuerzburg, Germany
| | - A Reif
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, D-97080 Wuerzburg, Germany
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15
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Valenza G, Citi L, Gentili C, Lanata A, Scilingo EP, Barbieri R. Characterization of Depressive States in Bipolar Patients Using Wearable Textile Technology and Instantaneous Heart Rate Variability Assessment. IEEE J Biomed Health Inform 2015; 19:263-74. [DOI: 10.1109/jbhi.2014.2307584] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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16
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Lanata A, Valenza G, Nardelli M, Gentili C, Scilingo EP. Complexity Index From a Personalized Wearable Monitoring System for Assessing Remission in Mental Health. IEEE J Biomed Health Inform 2015; 19:132-9. [DOI: 10.1109/jbhi.2014.2360711] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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17
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Levy B. Illness severity, trait anxiety, cognitive impairment and heart rate variability in bipolar disorder. Psychiatry Res 2014; 220:890-5. [PMID: 25219620 DOI: 10.1016/j.psychres.2014.07.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 06/28/2014] [Accepted: 07/24/2014] [Indexed: 11/29/2022]
Abstract
Numerous studies have documented a significant association between symptom severity and cognitive functioning in bipolar disorder (BD). These findings advanced speculations about a potential link between the physiological stress associated with illness severity and cognitive dysfunction. To explore this hypothesis, the current study employed heart rate variability (HRV) as a physiological measure that is sensitive to the effects of chronic stress, and a scale of trait anxiety for assessing a psychological condition that is correlated with hyper sympathetic arousal. Analyses indicated that BD patients with High Illness Severity reported more symptoms of trait-anxiety (i.e., State Trait Anxiety Inventory), performed more poorly on a computerized neuropsychological battery (i.e., CNS Vital Signs), and exhibited a more constricted HRV profile (i.e., lower SDNN with elevated LF/HF ratio) than patients with Low Illness Severity. Illness severity was determined by a history of psychosis, illness duration, and number of mood episodes. A third group of healthy controls (n=22) performed better on the neuropsychological battery and exhibited a healthier HRV profile than the BD groups. This study provides preliminary evidence that illness severity and cognitive impairment in BD may be associated with state anxiety and neuro-cardiac alterations that are sensitive to physiological stress.
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Affiliation(s)
- Boaz Levy
- Department of Counseling and School Psychology, University of Massachusetts Boston, Wheatley Building, Second Floor, Room 143-9, 100 Morriseey Boulevard, Boston, MA 02125, USA.
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18
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Borjon JI, Ghazanfar AA. Convergent evolution of vocal cooperation without convergent evolution of brain size. BRAIN, BEHAVIOR AND EVOLUTION 2014; 84:93-102. [PMID: 25247613 DOI: 10.1159/000365346] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
One pragmatic underlying successful vocal communication is the ability to take turns. Taking turns - a form of cooperation - facilitates the transmission of signals by reducing the amount of their overlap. This allows vocalizations to be better heard. Until recently, non-human primates were not thought of as particularly cooperative, especially in the vocal domain. We recently demonstrated that common marmosets (Callithrix jacchus), a small New World primate species, take turns when they exchange vocalizations with both related and unrelated conspecifics. As the common marmoset is distantly related to humans (and there is no documented evidence that Old World primates exhibit vocal turn taking), we argue that this ability arose as an instance of convergent evolution, and is part of a suite of prosocial behavioral tendencies. Such behaviors seem to be, at least in part, the outcome of the cooperative breeding strategy adopted by both humans and marmosets. Importantly, this suite of shared behaviors occurs without correspondence in encephalization. Marmoset vocal turn taking demonstrates that a large brain size and complex cognitive machinery is not needed for vocal cooperation to occur. Consistent with this idea, the temporal structure of marmoset vocal exchanges can be described in terms of coupled oscillator dynamics, similar to quantitative descriptions of human conversations. We propose a simple neural circuit mechanism that may account for these dynamics and, at its core, involves vocalization-induced reductions of arousal. Such a mechanism may underlie the evolution of vocal turn taking in both marmoset monkeys and humans.
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Affiliation(s)
- Jeremy I Borjon
- Princeton Neuroscience Institute, Princeton University, Princeton, N.J., USA
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19
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Valenza G, Nardelli M, Lanata A, Gentili C, Bertschy G, Paradiso R, Scilingo EP. Wearable Monitoring for Mood Recognition in Bipolar Disorder Based on History-Dependent Long-Term Heart Rate Variability Analysis. IEEE J Biomed Health Inform 2014; 18:1625-35. [DOI: 10.1109/jbhi.2013.2290382] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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Valenza G, Nardelli M, Bertschy G, Lanatà A, Barbieri R, Scilingo EP. Maximal-radius multiscale entropy of cardiovascular variability: a promising biomarker of pathological mood states in bipolar disorders. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2014; 2014:6663-6666. [PMID: 25571524 DOI: 10.1109/embc.2014.6945156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Complexity measures from Multiscale Entropy (MSE) analysis of cardiovascular variability may provide potential biomarkers of pathological mental states such as major depression. To this extent, in this study we investigate whether complexity of Heart Rate Variability (HRV) is also affected in mental disorders such as bipolar disorders (BD). As part of the European project PSYCHE, eight BD patients experiencing multiple pathological mood states among depression, hypomania, and euthymia (i.e., good affective balance) underwent long-term night recordings through a comfortable sensing t-shirt with integrated fabric electrodes and sensors. Standard radius, i.e., 20% of the HRV standard deviation, and a maximal-radius choice for the sample entropy estimation were compared along with a further multiscale Renyi Entropy analysis. We found that, despite the inter-subject variability, the maximal-radius MSE analysis is able to discern the considered pathological mental states of BD. As the current clinical practice in diagnosing BD is only based on verbal interviews and scores from specific questionnaires, these findings provide evidence on the possibility of using heartbeat complexity as the basis of novel clinical biomarkers of mental disorders.
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