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Colic L, Sankar A, Goldman DA, Kim JA, Blumberg HP. Towards a neurodevelopmental model of bipolar disorder: a critical review of trait- and state-related functional neuroimaging in adolescents and young adults. Mol Psychiatry 2024:10.1038/s41380-024-02758-4. [PMID: 39333385 DOI: 10.1038/s41380-024-02758-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/12/2024] [Accepted: 09/18/2024] [Indexed: 09/29/2024]
Abstract
Neurodevelopmental mechanisms are increasingly implicated in bipolar disorder (BD), highlighting the importance of their study in young persons. Neuroimaging studies have demonstrated a central role for frontotemporal corticolimbic brain systems that subserve processing and regulation of emotions, and processing of reward in adults with BD. As adolescence and young adulthood (AYA) is a time when fully syndromal BD often emerges, and when these brain systems undergo dynamic maturational changes, the AYA epoch is implicated as a critical period in the neurodevelopment of BD. Functional magnetic resonance imaging (fMRI) studies can be especially informative in identifying the functional neuroanatomy in adolescents and young adults with BD (BDAYA) and at high risk for BD (HR-BDAYA) that is related to acute mood states and trait vulnerability to the disorder. The identification of early emerging brain differences, trait- and state-based, can contribute to the elucidation of the developmental neuropathophysiology of BD, and to the generation of treatment and prevention targets. In this critical review, fMRI studies of BDAYA and HR-BDAYA are discussed, and a preliminary neurodevelopmental model is presented based on a convergence of literature that suggests early emerging dysfunction in subcortical (e.g., amygdalar, striatal, thalamic) and caudal and ventral cortical regions, especially ventral prefrontal cortex (vPFC) and insula, and connections among them, persisting as trait-related features. More rostral and dorsal cortical alterations, and bilaterality progress later, with lateralization, and direction of functional imaging findings differing by mood state. Altered functioning of these brain regions, and regions they are strongly connected to, are implicated in the range of symptoms seen in BD, such as the insula in interoception, precentral gyrus in motor changes, and prefrontal cortex in cognition. Current limitations, and outlook on the future use of neuroimaging evidence to inform interventions and prevent the onset of mood episodes in BDAYA, are outlined.
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Affiliation(s)
- Lejla Colic
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- German Center for Mental Health, partner site Halle-Jena-Magdeburg, Jena, Germany
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Anjali Sankar
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Neurobiology Research Unit, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Danielle A Goldman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT, USA
| | - Jihoon A Kim
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Hilary P Blumberg
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.
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2
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Peters JR, Schmalenberger KM, Eng AG, Stumper A, Martel MM, Eisenlohr-Moul TA. Dimensional Affective Sensitivity to Hormones across the Menstrual Cycle (DASH-MC): A transdiagnostic framework for ovarian steroid influences on psychopathology. Mol Psychiatry 2024:10.1038/s41380-024-02693-4. [PMID: 39143323 DOI: 10.1038/s41380-024-02693-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 08/16/2024]
Abstract
Fluctuations in progesterone (P4) and estradiol (E2) across the menstrual cycle can exert direct effects on biological systems implicated in neuropsychiatric disorders and represent a key biological source of variability in affective, cognitive, and behavioral disorders. Although these cyclical symptoms may be most readily identified when they occur exclusively in relation to the menstrual cycle, as in DSM-5 premenstrual dysphoric disorder, symptom changes of similar magnitude occur in a larger proportion of people with ongoing psychiatric disorders. Studies investigating cyclical regulation of brain and behavior often produce inconsistent results, which may be attributed to a lack of focus on specific hormonal events and individual differences in related sensitivities. We propose a transdiagnostic Dimensional Affective Sensitivity to Hormones across the Menstrual Cycle (DASH-MC) framework, postulating that atypical neural responses to several key hormonal events provoke specific temporal patterns of affective and behavioral change across the menstrual cycle. We review prospective and experimental evidence providing initial support for these dimensions, which include (1) luteal-onset negative affect caused by a sensitivity to E2 or P4 surges (mediated by neuroactive metabolites such as allopregnanolone), typified by irritability and hyperarousal; (2) perimenstrual-onset negative affect caused by a sensitivity to low or falling E2, typified by low mood and cognitive dysfunction; and (3) preovulatory-onset positive affect dysregulation caused by a sensitivity to E2 surges, typified by harmful substance use and other risky reward-seeking. This multidimensional, transdiagnostic framework for hormone sensitivity can inform more precise research on ovarian steroid regulation of psychopathology, including further mechanistic research, diagnostic refinement, and precision psychiatry treatment development. Additionally, given the high rates of hormone sensitivity across affective disorders, the DASH-MC may guide broader insights into the complex neurobiological vulnerabilities driving female-biased affective risk, as well as potential triggers and mechanisms of affective state change in psychiatric disorders.
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Affiliation(s)
- Jessica R Peters
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | | | - Ashley G Eng
- Department of Psychology, University of Kentucky, Lexington, KY, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Allison Stumper
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Michelle M Martel
- Department of Psychology, University of Kentucky, Lexington, KY, USA
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3
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Lin J, Nunez C, Susser L, Gershengoren L. Understanding premenstrual exacerbation: navigating the intersection of the menstrual cycle and psychiatric illnesses. Front Psychiatry 2024; 15:1410813. [PMID: 39176230 PMCID: PMC11338788 DOI: 10.3389/fpsyt.2024.1410813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/22/2024] [Indexed: 08/24/2024] Open
Abstract
Premenstrual exacerbation of an existing psychiatric disorder refers to the worsening of symptoms inherent to the condition during the premenstrual phase. Research consistently indicates that hormonal fluctuations during the menstrual cycle present a unique period of vulnerability for the onset or exacerbation of psychiatric symptoms, impacting diagnosis, risk assessment, and treatment. This review sought to elucidate the phenomenon of premenstrual exacerbation and its impact across a spectrum of psychiatric illnesses, including mood, anxiety, psychotic, obsessive-compulsive, personality, and trauma-related disorders. Despite the expanded research in recent years on premenstrual dysphoric disorder and premenstrual syndrome, premenstrual exacerbation remains underexplored and poorly defined. This review offers significant contributions to the diagnosis and management of psychiatric conditions, advocating for heightened awareness and novel treatment approaches in the context of premenstrual exacerbation.
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Affiliation(s)
- Jenny Lin
- Department of Psychiatry, New York University, New York, NY, United States
| | - Christine Nunez
- Department of Psychiatry, New York University, New York, NY, United States
| | - Leah Susser
- Department of Psychiatry, Weill Cornell Medicine, White Plains, NY, United States
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de Jong M, Wynchank DSMR, Michielsen M, Beekman ATF, Kooij JJS. A Female-Specific Treatment Group for ADHD-Description of the Programme and Qualitative Analysis of First Experiences. J Clin Med 2024; 13:2106. [PMID: 38610871 PMCID: PMC11012758 DOI: 10.3390/jcm13072106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The diagnostics and treatment of attention-deficit/hyperactivity disorder (ADHD) in women remain insufficient. Fluctuations of reproductive hormones during the premenstrual period, postpartum period, and (peri)menopause are neglected, even though they impact ADHD symptoms and associated mood disorders. Therefore, we created a female-specific treatment group for women with ADHD and premenstrual worsening of ADHD and/or mood symptoms. Methods: We describe the group programme and underlying rationale, offering a qualitative analysis of the participants' evaluation. Results: The seven bi-weekly sessions foreground the menstrual cycle and address several ADHD-specific topics in relation to this cyclical pattern. Concurrently, women track their menstrual cycle and (fluctuating) ADHD and mood symptoms with an adjusted premenstrual calendar. In total, 18 women (25-47 years) participated in three consecutive groups. We analysed the evaluation of the last group. Participants experienced the group as a safe and welcoming space. Recognition was valued by all. The topics discussed were deemed valuable, and the structure suited them well. Completing the premenstrual calendar augmented the awareness and recognition of individual cyclical symptoms. A lifespan approach increased self-understanding. Participants took their menstrual cycle more seriously, prioritising self-acceptance and self-care. Conclusions: Exploring a cyclical approach in a group setting seems to be a positive addition to treatment for female ADHD.
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Affiliation(s)
- M de Jong
- Expertise Centre Adult ADHD, PsyQ, 2593 HR The Hague, The Netherlands
- Department of Psychiatry, AmsterdamUMC/VUmc, 1081 HJ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU Medical Centre, 1081 HV Amsterdam, The Netherlands
| | - D S M R Wynchank
- Expertise Centre Adult ADHD, PsyQ, 2593 HR The Hague, The Netherlands
| | - M Michielsen
- Expertise Centre Adult ADHD, PsyQ, 2593 HR The Hague, The Netherlands
- Antes Older Adults Outpatient Treatment, 3079 DZ Rotterdam, The Netherlands
| | - A T F Beekman
- Department of Psychiatry, AmsterdamUMC/VUmc, 1081 HJ Amsterdam, The Netherlands
- GGZ inGeest, 1062 NP Amsterdam, The Netherlands
| | - J J S Kooij
- Expertise Centre Adult ADHD, PsyQ, 2593 HR The Hague, The Netherlands
- Department of Psychiatry, AmsterdamUMC/VUmc, 1081 HJ Amsterdam, The Netherlands
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Polo-Kantola P, Toffol E. The Relationship Between Mood and Sleep in Different Female Reproductive States. Sleep Med Clin 2023; 18:385-398. [PMID: 38501512 DOI: 10.1016/j.jsmc.2023.06.002] [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] [Indexed: 03/20/2024]
Abstract
Mood and sleep are tightly interrelated. Mood and sleep symptoms and disorders are more common in women than in men and often associated with reproductive events. This article reviews the current literature on the reciprocal relationships between mood and sleep across reproductive phases in women, such as menstrual cycle and related disorders, pregnancy, climacteric, and use of hormonal contraception and hormone replacement therapy. Mood and sleep symptoms seem to covary in relation to physiologic and pathologic reproductive conditions, although the relationship seems more clear for subjective than objective sleep.
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Affiliation(s)
- Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland.
| | - Elena Toffol
- Department of Public Health, University of Helsinki, PO Box 20, Helsinki 00014, Finland
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Reilly TJ, Knox CL, Marsh MS, Craig MC. A case series of premenstrual disorders presenting to the UK's National Female Hormone Clinic. BJPsych Bull 2023; 47:263-266. [PMID: 36239445 PMCID: PMC10764883 DOI: 10.1192/bjb.2022.63] [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: 01/25/2022] [Revised: 06/28/2022] [Accepted: 09/10/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS AND METHOD We aimed to describe the clinical characteristics of female patients presenting with premenstrual disorders to a tertiary service in the UK. We conducted a retrospective case-note review of referrals to the National Female Hormone Clinic from April 2014 to August 2020. Based on clinical assessment, we determined whether the patient met criteria for premenstrual dysphoric disorder or premenstrual exacerbation of an underlying psychiatric disorder. RESULTS Of 146 patients seen in clinic for premenstrual disorders, an ICD-10 psychiatric diagnosis was made in 130 (89.0%); a minority 16 (11.0%) did not have a psychiatric diagnosis. Following assessment, 94 patients (64.4%) met criteria for premenstrual dysphoric disorder and 67 (45.6%) had exacerbation of a psychiatric disorder. CLINICAL IMPLICATIONS Patients presenting to this specialist service had complex psychiatric comorbidity; almost half presented with exacerbation of a psychiatric disorder.
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Affiliation(s)
- Thomas J. Reilly
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
- National Female Hormone Clinic, South London and Maudsley NHS Foundation Trust, London, UK
| | - Clare-Louise Knox
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Michael S. Marsh
- National Female Hormone Clinic, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Obstetrics and Gynaecology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Michael C. Craig
- National Female Hormone Clinic, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
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Barone JC, Butler MP, Ross A, Patterson A, Wagner-Schuman M, Eisenlohr-Moul TA. A scoping review of hormonal clinical trials in menstrual cycle-related brain disorders: Studies in premenstrual mood disorder, menstrual migraine, and catamenial epilepsy. Front Neuroendocrinol 2023; 71:101098. [PMID: 37619655 PMCID: PMC10843388 DOI: 10.1016/j.yfrne.2023.101098] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 08/26/2023]
Abstract
Cyclic variations in hormones during the normal menstrual cycle underlie multiple central nervous system (CNS)-linked disorders, including premenstrual mood disorder (PMD), menstrual migraine (MM), and catamenial epilepsy (CE). Despite this foundational mechanistic link, these three fields operate independently of each other. In this scoping review (N = 85 studies), we survey existing human research studies in PMD, MM, and CE to outline the exogenous experimental hormone manipulation trials conducted in these fields. We examine a broad range of literature across these disorders in order to summarize existing diagnostic practices and research methods, highlight gaps in the experimental human literature, and elucidate future research opportunities within each field. While no individual treatment or study design can fit every disease, there is immense overlap in study design and established neuroendocrine-based hormone sensitivity among the menstrual cycle-related disorders PMD, MM, and CE. SCOPING REVIEW STRUCTURED SUMMARY Background. The menstrual cycle can be a biological trigger of symptoms in certain brain disorders, leading to specific, menstrual cycle-linked phenomena such as premenstrual mood disorders (PMD), menstrual migraine (MM), and catamenial epilepsy (CE). Despite the overlap in chronicity and hormonal provocation, these fields have historically operated independently, without any systematic communication about methods or mechanisms. OBJECTIVE Online databases were used to identify articles published between 1950 and 2021 that studied hormonal manipulations in reproductive-aged females with either PMD, MM, or CE. We selected N = 85 studies that met the following criteria: 1) included a study population of females with natural menstrual cycles (e.g., not perimenopausal, pregnant, or using hormonal medications that were not the primary study variable); 2) involved an exogenous hormone manipulation; 3) involved a repeated measurement across at least two cycle phases as the primary outcome variable. CHARTING METHODS After exporting online database query results, authors extracted sample size, clinical diagnosis of sample population, study design, experimental hormone manipulation, cyclical outcome measure, and results from each trial. Charting was completed manually, with two authors reviewing each trial. RESULTS Exogenous hormone manipulations have been tested as treatment options for PMD (N = 56 trials) more frequently than MM (N = 21) or CE (N = 8). Combined oral contraceptive (COC) trials, specifically those containing drospirenone as the progestin, are a well-studied area with promising results for treating both PMDD and MM. We found no trials of COCs in CE. Many trials test ovulation suppression using gonadotropin-releasing hormone agonists (GnRHa), and a meta-analysis supports their efficacy in PMD; GnRHa have been tested in two MM-related trials, and one CE open-label case series. Finally, we found that non-contraceptive hormone manipulations, including but not limited to short-term transdermal estradiol, progesterone supplementation, and progesterone antagonism, have been used across all three disorders. CONCLUSIONS Research in PMD, MM, and CE commonly have overlapping study design and research methods, and similar effects of some interventions suggest the possibility of overlapping mechanisms contributing to their cyclical symptom presentation. Our scoping review is the first to summarize existing clinical trials in these three brain disorders, specifically focusing on hormonal treatment trials. We find that PMD has a stronger body of literature for ovulation-suppressing COC and GnRHa trials; the field of MM consists of extensive estrogen-based studies; and current consensus in CE focuses on progesterone supplementation during the luteal phase, with limited estrogen manipulations due to concerns about seizure provocation. We argue that researchers in any of these respective disciplines would benefit from greater communication regarding methods for assessment, diagnosis, subtyping, and experimental manipulation. With this scoping review, we hope to increase collaboration and communication among researchers to ultimately improve diagnosis and treatment for menstrual-cycle-linked brain disorders.
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Affiliation(s)
- Jordan C Barone
- University of Illinois at Chicago, Department of Psychiatry, USA; University of Illinois at Chicago, Medical Scientist Training Program, USA.
| | - Mitchell P Butler
- University of Illinois at Chicago, Medical Scientist Training Program, USA; University of Illinois at Chicago, Department of Neurology and Rehabilitation, USA
| | - Ashley Ross
- University of Illinois at Chicago, Department of Psychiatry, USA; University of Illinois at Chicago, Medical Scientist Training Program, USA
| | - Anna Patterson
- University of Illinois at Chicago, Department of Psychiatry, USA; University of Illinois at Chicago, Medical Scientist Training Program, USA
| | | | - Tory A Eisenlohr-Moul
- University of Illinois at Chicago, Department of Psychiatry, USA; University of Illinois at Chicago, Medical Scientist Training Program, USA
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Ortega MA, Álvarez-Mon MA, García-Montero C, Fraile-Martínez Ó, Monserrat J, Martinez-Rozas L, Rodríguez-Jiménez R, Álvarez-Mon M, Lahera G. Microbiota-gut-brain axis mechanisms in the complex network of bipolar disorders: potential clinical implications and translational opportunities. Mol Psychiatry 2023; 28:2645-2673. [PMID: 36707651 PMCID: PMC10615769 DOI: 10.1038/s41380-023-01964-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/02/2023] [Accepted: 01/13/2023] [Indexed: 01/28/2023]
Abstract
Bipolar disorders (BD) represent a severe leading disabling mental condition worldwide characterized by episodic and often progressive mood fluctuations with manic and depressive stages. The biological mechanisms underlying the pathophysiology of BD remain incompletely understood, but it seems that there is a complex picture of genetic and environmental factors implicated. Nowadays, gut microbiota is in the spotlight of new research related to this kind of psychiatric disorder, as it can be consistently related to several pathophysiological events observed in BD. In the context of the so-called microbiota-gut-brain (MGB) axis, it is shown to have a strong influence on host neuromodulation and endocrine functions (i.e., controlling the synthesis of neurotransmitters like serotonin or mediating the activation of the hypothalamic-pituitary-adrenal axis), as well as in modulation of host immune responses, critically regulating intestinal, systemic and brain inflammation (neuroinflammation). The present review aims to elucidate pathophysiological mechanisms derived from the MGB axis disruption and possible therapeutic approaches mainly focusing on gut microbiota in the complex network of BD. Understanding the mechanisms of gut microbiota and its bidirectional communication with the immune and other systems can shed light on the discovery of new therapies for improving the clinical management of these patients. Besides, the effect of psychiatric drugs on gut microbiota currently used in BD patients, together with new therapeutical approaches targeting this ecosystem (dietary patterns, probiotics, prebiotics, and other novelties) will also be contemplated.
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Affiliation(s)
- Miguel A Ortega
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain.
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain.
| | - Miguel Angel Álvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Óscar Fraile-Martínez
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Lucia Martinez-Rozas
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Roberto Rodríguez-Jiménez
- Department of Legal Medicine and Psychiatry, Complutense University, Madrid, Spain
- Institute for Health Research 12 de Octubre Hospital, (Imas 12)/CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine, University Hospital Príncipe de Asturias (CIBEREHD), Alcalá de Henares, Spain
- Psychiatry Service, Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Psychiatry Service, Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias, Alcalá de Henares, Spain
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Lyu N, Zhao Q, Fu B, Li J, Wang H, Yang F, Liu S, Huang J, Zhang X, Zhang L, Li R. Hormonal and inflammatory signatures of different mood episodes in bipolar disorder: a large-scale clinical study. BMC Psychiatry 2023; 23:449. [PMID: 37340368 DOI: 10.1186/s12888-023-04846-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/04/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is characterized by intensive mood fluctuations. While hormones imbalance plays important role in the mood swings, it is unknown whether peripheral hormones profiles could differentiate the manic and depressive mood episodes in BD. In this study, we investigated the changes of various hormones and inflammatory markers across distinct mood episodes of BD in a large clinical study to provide mood episode-specific peripheral biomarkers for BD. METHODS A total of 8332 BD patients (n = 2679 depressive episode; n = 5653 manic episode) were included. All patients were in acute state of mood episodes and need hospitalization. A panel of blood tests were performed for levels of sex hormones (serum levels of testosterone, estradiol, and progesterone), stress hormones (adrenocorticotropic hormone and cortisol), and an inflammation marker (C-reactive protein, CRP). A receiver operating characteristic (ROC) curve was used to analyze the discriminatory potential of the biomarkers for mood episodes. RESULTS In overall comparison between mood episodes, the BD patients expressed higher levels of testosterone, estradiol, progesterone, and CRP (P < 0.001) and lower adrenocorticotropic hormone (ACTH) level (P < 0.001) during manic episode. The episode-specific changes of testosterone, ACTH, and CRP levels remained between the two groups (P < 0.001) after correction for the confounding factors including age, sex, BMI, occupation, marital status, tobacco use, alcohol consumption, psychotic symptoms, and age at onset. Furthermore, we found a sex- and age-specific impact of combined biomarkers in mood episodes in male BD patients aged ≥ 45 years (AUC = 0.70, 95% CI, 0.634-0.747), not in females. CONCLUSIONS While both hormone and inflammatory change is independently associated with mood episodes, we found that the combination of sex hormones, stress hormones and CRP could be more effective to differentiate the manic and depressive episode. The biological signatures of mood episodes in BD patients may be sex- and age-specific. Our findings not only provide mood episode-related biological markers, but also better support for targeted intervention in BD treatments.
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Affiliation(s)
- Nan Lyu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
| | - Qian Zhao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
| | - Bingbing Fu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
| | - Jinhong Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
| | - Han Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
| | - Fan Yang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
| | - Sitong Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
| | - Juan Huang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
| | - Xinwei Zhang
- Beijing SmindU Medical Science & Technology Co., Ltd, Beijing, 100020, China
| | - Ling Zhang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China.
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China.
- The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, 5 Ankang Hutong Road, Beijing, 100088, Xicheng, China.
| | - Rena Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China.
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China.
- Center for Brain Disorders Research, Capital Medical University & Beijing Institute of Brain Disorders, Beijing, 100069, China.
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, 5 Ankang Hutong Road, Beijing, 100088, Xicheng, China.
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10
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Management of Bipolar Disorder During the Perinatal Period. Nurs Womens Health 2023; 27:42-52. [PMID: 36528074 DOI: 10.1016/j.nwh.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/13/2022] [Accepted: 11/05/2022] [Indexed: 12/15/2022]
Abstract
Bipolar disorder (BPD) is a lifelong mental health condition characterized by symptoms of mania, depression, and often anxiety. BPD can have detrimental consequences for individuals during pregnancy and the postpartum period, as well as for their offspring. This is often due to underdiagnosis and/or misdiagnosis as unipolar depression. There is a high incidence of first episodes of BPD in pregnant and postpartum persons. Perinatal care providers need to routinely screen for BPD and assess for relapse among those with a previous diagnosis during the pregnancy and postpartum periods. Medication management is complex and must be considered in the context of an individual's risk factors and perceptions about treatment as well as the limited evidence regarding fetal safety, using a shared decision-making model. Collaboration, consultation, and/or referral to mental health care providers are essential for managing acute and chronic BPD symptoms.
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Shahini N, Salimi Z, Kiani D, Raftari A, Ziaee M. Relationship of serum estradiol and progesterone with symptoms and sex difference in schizophrenia: A cross-sectional study in Iran. Front Psychiatry 2023; 14:1075780. [PMID: 36970277 PMCID: PMC10030605 DOI: 10.3389/fpsyt.2023.1075780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/25/2023] [Indexed: 03/29/2023] Open
Abstract
Background Schizophrenia is a devastating disease characterized by frequent relapses, cognitive decline, and emotional and functional disability, with unknown causes. The phenomenology and clinical course of schizophrenic disorders are different between the two genders, which is thought to be related mainly to the effects of steroid sex hormones on the nervous system. Regarding inconsistencies in the studies, we aimed to compare the levels of estradiol and progesterone between schizophrenia patients and healthy individuals. Methods This cross-sectional study was conducted on 66 patients referred to the specialized clinical psychiatric ward of a teaching hospital in the north of Iran, for 5 months in 2021. Thirty-three schizophrenia patients confirmed by a psychiatrist based on DSM5 criteria were included in the case group, and 33 individuals without a psychiatric disease were included in the control group. We completed a demographic information checklist for each patient, along with the Simpson-Angus extrapyramidal side effect scale (SAS) for drug side effects and the positive and negative syndrome scale (PANSS) for the severity of the disease symptoms. Then, a 3-ml blood sample was taken from each participant to determine the serum levels of estradiol and progesterone. The data were analyzed by SPSS16 software. Results Thirty-four (51.5%) and 32 (48.5%) participants in this study were male and female, respectively. The mean serum level of estradiol was 22.33 ± 13.65 pm/dl in schizophrenia patients and 29.36 ± 21.32 pm/dl in the control group, showing no significant difference between the two groups (P = 0.4). However, the mean serum level of progesterone was significantly lower in schizophrenia patients (0.37 ± 1.39 pm/dl) than in control subjects (3.15 ± 5.73 pm/dl) (P < 0.001). The PANSS and SAS scores were not significantly correlated with the level of sex hormones (P > 0.05). Serum estradiol and progesterone levels based on sex significantly differed between the two groups (except for female estradiol). Conclusion Considering the hormonal differences between schizophrenia patients and control subjects, determining hormonal levels in these patients and using complementary hormonal therapies with estradiol or similar compounds can be beneficial as the starting point of schizophrenia treatment, where therapeutic responses can draw the future developmental framework.
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Affiliation(s)
- Najmeh Shahini
- Golestan Research Center of Psychiatry (GRCP), Golestan University of Medical Sciences, Gorgan, Iran
- Clinical Research Development Unit (CRDU), 5 Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zanireh Salimi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Dorsa Kiani
- Golestan Research Center of Psychiatry (GRCP), Golestan University of Medical Sciences, Gorgan, Iran
- Dorsa Kiani,
| | - Ahmad Raftari
- Golestan Research Center of Psychiatry (GRCP), Golestan University of Medical Sciences, Gorgan, Iran
| | - Maliheh Ziaee
- Department of Community Medicine, School of Medicine, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
- *Correspondence: Maliheh Ziaee,
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12
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Nolan LN, Hughes L. Premenstrual exacerbation of mental health disorders: a systematic review of prospective studies. Arch Womens Ment Health 2022; 25:831-852. [PMID: 35867164 DOI: 10.1007/s00737-022-01246-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
Mental health disorders can be exacerbated during periods of hormonal fluctuation (e.g. pregnancy, menopause), and the risk factors for sensitivity to these fluctuations are similar to those of mental disorders (e.g. trauma). However, the extent to which hormonal fluctuations during the menstrual cycle impact symptoms of preexisting mental disorders remains unclear. Prospective methodology is considered the gold standard for measuring symptoms across the menstrual cycle. Thus, the aim of the review was to address this knowledge gap by summarising all available studies prospectively measuring symptoms of mental disorders across the menstrual cycle. A systematic review with narrative synthesis was conducted; meta-analysis was precluded due to methodological heterogeneity of included studies. Electronic databases MEDLINE, Embase, PyschINFO and CINAHL were systematically searched from inception. Risk of bias for individual studies was assessed using a modified version of the Newcastle-Ottawa Scale. The search identified 629 studies from which 35 met inclusion criteria. There was clear evidence of symptom exacerbation during the perimenstrual phase for psychotic disorders, panic disorder, eating disorders, depression and borderline personality disorder. Less consistent evidence was found for anxiety, and a different pattern of symptom exacerbation was observed in bipolar disorder. Sample size and methodology varied considerably amongst studies. Overall, there was mixed evidence for perimenstrual exacerbation across mental disorders, which could be partly explained by methodological limitations of the studies. However, hormonal fluctuations during the menstrual cycle may exacerbate psychiatric symptoms in a subgroup of individuals who are hormone sensitive.
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Affiliation(s)
| | - Liz Hughes
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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13
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Sharma P, Kaur M, Kumar S, Khetarpal P. A cross-sectional study on prevalence of menstrual problems, lifestyle, mental health, and PCOS awareness among rural and urban population of Punjab, India. J Psychosom Obstet Gynaecol 2022; 43:349-358. [PMID: 34448673 DOI: 10.1080/0167482x.2021.1965983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Menstrual cycle gets affected by various modifiable risk factors. To assess prevalence of various types of menstrual problems, lifestyle and mental health status, identification of variables as predictors for menstrual problems and level of polycystic ovary syndrome (PCOS) awareness among rural and urban population of Punjab, the present study has been carried out. METHODS The study was conducted from November 2019 to July 2020 in the Malwa region of Punjab, India, with 2673 participants (15-25 years). Epidemiological information was collected using predesigned questionnaire along with depression, anxiety and stress (DASS-21) score mental health assessment tool. MS-Excel (2019) and IBM SPSS 18.0 (SPSS Inc., Chicago, IL) was used for statistical analysis. RESULTS The overall prevalence of different menstrual problems was 60.61%, with dysmenorrhea (50.64%) being most common problem. Body mass index (BMI), menarche age, physical activity, and mental health status are significant (p < 0.05) predictors of menstrual problem both in rural and urban population. Overall, only 3.30% subjects were aware about PCOS. CONCLUSION Dysmenorrhea is the most common menstrual problem, both in rural and urban population. BMI, sedentary lifestyle, electronic gadgets usage, and mental health are associated with menstrual problems. Low awareness on PCOS indicates need to create awareness as the condition can be easily managed with early intervention.
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Affiliation(s)
- Priya Sharma
- Department of Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda, India
| | - Mandeep Kaur
- Department of Human Genetics, Punjabi University, Patiala, India
| | - Sachin Kumar
- Department of Mathematics and Statistics, School of Basic and Applied Sciences, Central University of Punjab, Bathinda, India
| | - Preeti Khetarpal
- Department of Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda, India
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14
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Aragno E, Fagiolini A, Cuomo A, Paschetta E, Maina G, Rosso G. Impact of menstrual cycle events on bipolar disorder course: a narrative review of current evidence. Arch Womens Ment Health 2022; 25:257-266. [PMID: 35237876 DOI: 10.1007/s00737-022-01217-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/20/2022] [Indexed: 11/02/2022]
Abstract
Several lines of research suggest that reproductive-related hormonal events may affect the course of bipolar disorder in some women. However, data on associations between bipolar disorder and menarche, menstrual cycle, and menopause are mixed. This article reviews the literature on the potential effects of menarche, menstrual cycle, and menopause on bipolar disorder.A narrative review of published articles on bipolar disorder and menstrual cycle events was conducted. The primary outcome assessed was the impact of menarche, menstrual cycle and menopause on the course of bipolar illness. Databases searched were PubMed, Ovid, Scopus, PsycINFO, Medline, and Cochrane Libraries from inception to August 2021.Twenty-two studies were identified and included in the narrative synthesis. Research suggested that a subset of women with bipolar disorder are vulnerable to the impact of menstrual cycle events. Menarche seems to be associated with age at onset of bipolar illness especially in case of bipolar disorder type I and the specific age at menarche may predict some clinical features of the disorder. Menstrual cycle likely affects the course of bipolar disorder but the pattern of mood variability is not clear. Menopause appears to be not only a period of vulnerability to mood alteration, especially depressive episodes, and impairment of quality of life, but also a potential trigger of bipolar illness onset.The impact of menarche, menstrual cycle, and menopause on bipolar disorder is largely understudied. Preliminary evidence suggests that a subset of women with bipolar disorder may have their mood shifts affected by menstrual cycle events, with different patterns depending on the type of bipolar disorder also. Further researches are needed to deep the impact of menarche, menstrual cycle, and menopause on bipolar illness.
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Affiliation(s)
- Elena Aragno
- Department of Neurosciences "Rita Levi Montalcini", University of Torino, Turin, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Alessandro Cuomo
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | | | - Giuseppe Maina
- Department of Neurosciences "Rita Levi Montalcini", University of Torino, Turin, Italy.,Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy
| | - Gianluca Rosso
- Department of Neurosciences "Rita Levi Montalcini", University of Torino, Turin, Italy. .,Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy.
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Investigating biological rhythms disruptions across the menstrual cycle in women with comorbid bipolar disorder and premenstrual dysphoric disorder. Arch Womens Ment Health 2022; 25:345-353. [PMID: 35226173 DOI: 10.1007/s00737-022-01220-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/22/2022] [Indexed: 11/02/2022]
Abstract
We investigated whether women diagnosed with comorbid bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD) experience higher disruptions in biological rhythms in two independent study samples. The first study has a population-based sample of 727 women, including 104 women with PMDD only, 43 women with BD only, 24 women with comorbid PMDD and BD, and 556 women without BD or PMDD (controls). Biological rhythm disruptions were cross-sectionally evaluated using the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN). The second study enrolled 77 outpatient women who completed prospective assessments at two timepoints: during the mid-follicular and the late-luteal phases of their menstrual cycles, using the BRIAN, and included 19 women with PMDD, 16 with BD, 17 with comorbid PMDD and BD, and 25 controls. In the population-based sample, all the diagnostic groups (BD, PMDD, BDPMDD) presented greater biological rhythm disruption than controls. In addition, women with BD presented greater overall biological rhythms disruption, and greater disruption in sleep, activity, and eating patterns, than women with PMDD. In the outpatient sample study, women with BDPMDD showed greater disruption in the social domain than women with PMDD. In the outpatient sample, women with BDPMDD reported significantly higher disruptions in biological rhythms across both the follicular and the luteal phases of the menstrual cycle. The comorbidity between BD and PMDD may affect biological rhythms beyond the luteal phase of the menstrual cycle. These results support previous literature on the increased illness burden of women diagnosed with comorbid BD and PMDD.
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16
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Abstract
PURPOSE OF REVIEW In contrast to premenstrual dysphoric disorder (PMDD), premenstrual exacerbations (PMEs) of ongoing mood disorders are understudied. The aim of this review is to describe diagnostic issues, epidemiology, underlying mechanisms, and treatment for PME in unipolar depression and bipolar disorder, and to discuss clinical and research implications. RECENT FINDINGS Community-based and clinical studies estimate that in women with mood disorders around 60% report PME, while some women with bipolar disorder also show symptom exacerbations around ovulation. In general, PME predicts a more severe illness course and an increased burden. While heightened sensitivity to fluctuations of sex hormone levels across the menstrual cycle appears to contribute to PME and PMDD, the overlap of their underlying biological mechanisms remains unclear. Beneficial treatments for PMDD show less or no efficacy in PME. Pharmacological treatments for PME in mood disorders predominantly seem to profit from adjustable augmentation of treatment dosages during the luteal phase for the underlying disorder. However, the evidence is sparse and mainly based on earlier small studies and case reports. Previous research is mainly limited by the lack of a clear differentiation between PME and PMDD comorbidity with mood disorders. More systematic research with uniformly defined and prospectively assessed subgroups of PME in larger epidemiological and clinical samples is needed to receive reliable prevalence estimates and information on the clinical impact of PME of mood disorders, and to uncover underlying mechanisms. In addition, larger randomized controlled trials are warranted to identify efficacious pharmacological and psychotherapeutic treatments for affected women.
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Affiliation(s)
- Christine Kuehner
- Research Group Longitudinal and Intervention Research, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, J5, 68159, Mannheim, Germany.
| | - Sibel Nayman
- Research Group Longitudinal and Intervention Research, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, J5, 68159, Mannheim, Germany
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17
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Perich T, Fraser I, Ussher J. "Extreme emotions" - the impact of reproductive life events for women living with bipolar disorder. Health Care Women Int 2021; 42:1379-1392. [PMID: 33749527 DOI: 10.1080/07399332.2021.1884683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Little is known about how women with bipolar disorder construct and experience reproductive life events across the lifespan. We analyzed qualitative data from 29 semi-structured interviews with women aged 22-63 years (reproductive, menopause and post-menopause phases) using thematic analysis through a social constructionist framework. Themes of "Losing a sense of self-agency and self-worth" contained accounts of feeling out of control because of both bipolar disorder and reproductive life events. "Building a sense of personal autonomy and positive self-image" included accounts of acceptance and management of mood change over time, particularly for women in menopause and post-menopause life phases.
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Affiliation(s)
- Tania Perich
- Clinical and Health Psychology Research Initiative (CaHPRI), School of Psychology, Western Sydney University, Penrith, Australia.,Translational Health Research Institute, Western Sydney University, Australia
| | - Isabel Fraser
- Clinical and Health Psychology Research Initiative (CaHPRI), School of Psychology, Western Sydney University, Penrith, Australia
| | - Jane Ussher
- Translational Health Research Institute, Western Sydney University, Australia
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18
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Federoff M, McCarthy MJ. Sleep and circadian rhythm disruption is corrected by lithium in a case of bipolar disorder with familial BRCA1 mutation. Bipolar Disord 2021; 23:101-103. [PMID: 33012081 DOI: 10.1111/bdi.13014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Monica Federoff
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Michael J McCarthy
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,Mental Health Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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19
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Perich T, Ussher J, Fraser I, Perz J. Quality of life and psychological symptoms for women with bipolar disorder - a comparison between reproductive, menopause transition and post-menopause phases. Maturitas 2020; 143:72-77. [PMID: 33308639 DOI: 10.1016/j.maturitas.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/31/2020] [Accepted: 09/11/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The menopause transition may be associated with increased symptoms for women living with bipolar disorder; however, few have explored how this compares with other reproductive phases. The aim of this study was to compare women at reproductive, menopause transition and post-menopause phases on measures of quality of life and psychological symptoms associated with bipolar disorder. STUDY DESIGN Women with bipolar disorder took part in a large international survey conducted online and were categorised into reproductive stages using the STRAW and Monash criteria. The 498 participants were divided into three groups: 202 (41%) in the reproductive age group, 101 (20%) in the menopause transition group and 195 (39%) in the post-menopause group. MAIN OUTCOME MEASURES The Menopause Rating Scale (MRS), the Depression Anxiety and Stress Scales - 21 (DASS-21), the Altman Mania Rating Scale (ASRM) and the Bipolar Disorder Quality of Life scale (BD-QoL). RESULTS BD-QoL scores were significantly lower in the menopause transition group than in the other groups and that group was more likely to report being constantly depressed over the past year than the other groups. Anxiety was significantly higher in the menopause transition and post-menopause groups compared with the reproductive age group. CONCLUSIONS Quality of life and depression are impacted by the menopause transition for women with bipolar disorder. However, anxiety may be a clinical issue for women in both the post-menopause and the menopause transition phases. Research is needed to determine how symptoms vary across the reproductive life cycle for women with bipolar disorder and if targeted treatments may assist.
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Affiliation(s)
- Tania Perich
- Clinical and Health Psychology Research Initiative (CaHPRI), School of Psychology, Western Sydney University, Australia; Translational Health Research Institute, Western Sydney University, Australia.
| | - Jane Ussher
- Translational Health Research Institute, Western Sydney University, Australia
| | - Isabel Fraser
- Clinical and Health Psychology Research Initiative (CaHPRI), School of Psychology, Western Sydney University, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Australia
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20
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Smedler E, Sparding T, Hattab A, Sellgren CM, Landén M. Reporting trigger factors for (hypo)manic episodes in bipolar disorder: association with personality and prognosis. Acta Psychiatr Scand 2020; 141:534-540. [PMID: 32306385 DOI: 10.1111/acps.13174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate external factors that trigger manic and hypomanic relapses and how this is associated with personality and clinical outcome measured as number of affective episodes over a 7-year period. METHOD This is a prospective cohort study of 204 meticulously characterized Swedish bipolar disorder patients. Personality was evaluated at baseline using the Swedish universities Scales of Personality in 170 patients, and 90 patients were followed up after approximately 7 years in order to evaluate clinical outcomes. RESULTS We found that 44% of the patients reported trigger factors, including sleep disturbance, work- or family-related issues, medication, and illicit drug use. There were no significant differences in any of the personality traits when comparing the 74 patients that reported triggers with the 90 patients that did not. At 7-year follow-up, there was no difference between the groups in number of affective episodes (depressive, hypomanic, manic, or mixed), involuntary commitments, suicide attempts, or self-harm incidents since baseline. CONCLUSIONS Around 40% of the patients reported external triggers for manic and hypomanic episodes. However, this was neither associated with personality traits nor number of affective episodes at 7-year follow-up.
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Affiliation(s)
- E Smedler
- Department of Psychiatry and Neurochemistry at Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - T Sparding
- Department of Psychiatry and Neurochemistry at Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - A Hattab
- Department of Psychiatry and Neurochemistry at Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - C M Sellgren
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm County, Stockholm, Sweden
| | - M Landén
- Department of Psychiatry and Neurochemistry at Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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21
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Sharma V, Sharma P, Sharma S. Managing bipolar disorder during pregnancy and the postpartum period: a critical review of current practice. Expert Rev Neurother 2020; 20:373-383. [PMID: 32172610 DOI: 10.1080/14737175.2020.1743684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Despite increased interest in the pharmacotherapy of bipolar disorder during pregnancy and the postpartum period, management of the disorder during these critical periods in a woman's life remains challenging.Areas covered: The authors review the effect of pregnancy and the postpartum period on the course of bipolar disorder, describe adverse pregnancy and birth outcomes, and discuss the pharmacotherapy of bipolar disorder during and after pregnancy.Expert opinion: When treating women with bipolar disorder of childbearing age, clinicians should consider the possibility of pregnancy. Pre-conception counseling should be an integral part of the overall plan to manage bipolar disorder during and after pregnancy. Peripartum management of bipolar disorder is challenging and requires balancing of risks associated with the use of drugs and the potentially deleterious effects of untreated bipolar disorder on the fetus/child. Formulation of personalized treatment requires knowledge of both current (episode type, symptom severity, psychiatric comorbidity, and safety concerns) and historical (episode frequency, response to drugs and psychotherapy, and the effect of reproductive events including pregnancy and postpartum period) factors. Close monitoring is essential for early detection and management of mood episodes. Routine safety assessments are necessary to identify women at risk of harming themselves or the newborn.
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Affiliation(s)
- Verinder Sharma
- Departments of Psychiatry and Obstetrics & Gynecology, University of Western Ontario, London, Canada.,Parkwood Institute Mental Health, London, Canada
| | - Priya Sharma
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Canada
| | - Sapna Sharma
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, Canada
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22
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Gust K, Caccese C, Larosa A, Nguyen TV. Neuroendocrine Effects of Lactation and Hormone-Gene-Environment Interactions. Mol Neurobiol 2020; 57:2074-2084. [PMID: 31927723 DOI: 10.1007/s12035-019-01855-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/11/2019] [Indexed: 12/12/2022]
Abstract
While correlational studies suggest that lactation may confer a certain level of protection from mental illness, this benefit is not uniformly expressed in all women who choose to breastfeed. We propose here that the neuroendocrine "resetting" induced by lactation may predispose toward positive affect states in a subset of hormone-sensitive mothers, with hormone-gene and hormone-environment interactions determining the ultimate psychological outcome. We find evidence to suggest that higher secretion of prolactin/oxytocin as well as lower secretion of vasopression/androgens in lactating mothers may protect against postpartum depression and anxiety, decrease levels of irritability, and optimize stress responses. On the other hand, while the abrupt withdrawal of estradiol/progesterone in the immediate postpartum period tends to be associated with adverse psychological outcomes, the chronic suppression of estrogens/progestogens induced by lactation may have antidepressant and anxiolytic effects over time. Finally, the hypo-cortisolemic state seen in lactating mothers appears to be associated with improved stress reactivity and circadian rhythms. We also discuss hormone-gene and hormone-environment interactions likely to modulate any potential psychological benefits related to lactation and focus on those factors that are either easy to screen for or known to be modifiable. In sum, neuroendocrine alterations induced by lactation may play a key role in determining reproductive psychiatric risk in a subset of hormone-sensitive women. Using these neuroendocrine factors as an individualized index of risk can help in devising targeted programs to support these women in pursuing lactation or, for those not able or willing, accessing psychological interventions in a timely manner.
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Affiliation(s)
- Kirsten Gust
- Reproductive Psychiatry Program, Departments of Psychiatry and Obstetrics-Gynecology, McGill University Health Centre, Montreal, QC, Canada
| | - Christina Caccese
- Department of Psychiatry, McGill University, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
| | - Amanda Larosa
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada.,Neuroscience Division, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Tuong-Vi Nguyen
- Reproductive Psychiatry Program, Departments of Psychiatry and Obstetrics-Gynecology, McGill University Health Centre, Montreal, QC, Canada.
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23
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Sepede G, Brunetti M, Di Giannantonio M. Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges. Neuropsychiatr Dis Treat 2020; 16:415-426. [PMID: 32103961 PMCID: PMC7020916 DOI: 10.2147/ndt.s202881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/30/2020] [Indexed: 12/16/2022] Open
Abstract
Bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD) are two cyclic mood illnesses, sometimes presenting together. Their comorbidity appears to be linked to common biological mechanisms and usually results in more severity of mood symptoms and a poorer long-term outcome. Nevertheless, the management of comorbid PMDD/BD has been scarcely studied. Therefore, the aim of the present paper was to review the published literature on the treatment of comorbid PMDD/BD and to provide point-by-point hypotheses to address these complex clinical cases. We searched PubMed to identify the studies focused on the treatment and management of comorbid PMDD/BD using the following search words, alone and in combination: premenstrual dysphoric disorder, bipolar disorder, comorbid, treatment, management, pharmacotherapy, psychotherapy. The search was conducted on the 1st of June 2019 and yielded 55 records. Four papers met our inclusion/exclusion criteria and were therefore included in our qualitative synthesis. Integrating the few data pertaining to the treatment of comorbid PMDD/BD with the large amount of published data on the two conditions separately, we can suggest that the management of comorbid PMDD/BD needs as a first step to stabilize the bipolar symptoms by means of optimal dosages of mood stabilizers. Then, in euthymic BD patients, the PMDD symptoms could be treated with estroprogestins (first-line treatment). On the contrary, during acute phases of BD, antidepressants (for major depressive episodes) and atypical antipsychotics/hormonal modulators (for manic episodes) could be considered as promising add-on treatments to mood stabilizers. In case of resistant PMDD/BD symptoms, combined strategies should be taken into account, as well as alternative treatments, such as lifestyle changes. In conclusion, RCTs on comorbid PMDD/BD are still lacking. The management of this complex condition is therefore challenging and it requires a tailored treatment.
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Affiliation(s)
- Gianna Sepede
- Department of Neuroscience, Imaging, and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Marcella Brunetti
- Department of Neuroscience, Imaging, and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging, and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy.,Department of Mental Health - Chieti, National Health Trust, Chieti, Italy
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Rosso G, Aragno E, Mehanović E, Di Salvo G, Maina G. Age at Menarche in Women With Bipolar Disorder: Correlation With Clinical Features and Peripartum Episodes. Front Psychiatry 2020; 11:00851. [PMID: 33033479 PMCID: PMC7509456 DOI: 10.3389/fpsyt.2020.00851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/04/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is related to reproductive cycles. However, findings on putative correlation between age at menarche and course of BD are particularly scarce and conflicting. The aim of the present study is to analyze the relationship between age at menarche and characteristics of BD, including comorbid medical conditions and peripartum mood episodes. METHODS The study sample consists of 288 women with BD type I, II, or not otherwise specified (NOS). Age at menarche was both considered as a continuous variable and categorized into three groups: early menarche (≤11 years), normal menarche (12-14 years), and late menarche (≥15 years). The study focused on two sets of comparisons, by age at menarche and women with vs. without children. Spearman correlation matrix was produced to calculate correlations between the variables of interest. Socio-demographic and clinical characteristics between early, normal and late menarche, and women with vs. without children were examined through descriptive statistics. Finally, adjusted logistic regression analysis was run to examine the association between variables. RESULTS Out of 288 women included in the study, 21.5% had early menarche, 55.6% had normal, and 22.9% had late menarche. Women with early menarche had higher rates of metabolic syndrome compared to women with normal menarche even after adjustment for age. The subgroup of women with children does not present clinical differences compared to women without children except a lower rate of psychiatric comorbidities. At least one mood episode with peripartum onset occurred in 29.6% of the women with children. After controlling for confounding variables, women with late menarche were associated with lower probability of BD peripartum episodes compared to women with normal menarche. CONCLUSION Age at menarche may be related to specific characteristics of women with BD. The results deserve to be deepened in further studies.
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Affiliation(s)
- Gianluca Rosso
- Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy.,Psychiatric Unit, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Elena Aragno
- Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy
| | - Emina Mehanović
- Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy
| | - Gabriele Di Salvo
- Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy
| | - Giuseppe Maina
- Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy.,Psychiatric Unit, San Luigi Gonzaga University Hospital, Torino, Italy
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Reilly TJ, Sagnay de la Bastida VC, Joyce DW, Cullen AE, McGuire P. Exacerbation of Psychosis During the Perimenstrual Phase of the Menstrual Cycle: Systematic Review and Meta-analysis. Schizophr Bull 2020; 46:78-90. [PMID: 31071226 PMCID: PMC6942155 DOI: 10.1093/schbul/sbz030] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Psychotic disorders can be exacerbated by the hormonal changes associated with childbirth, but the extent to which exacerbations occur with the menstrual cycle is unclear. We addressed this issue by conducting a systematic review. Embase, Medline, and PsychINFO databases were searched for studies that measured exacerbations of psychotic disorders in relation to the menstrual cycle. We extracted exacerbation measure, definition of menstrual cycle phase, and measurement of menstrual cycle phase. Standard incidence ratios were calculated for the perimenstrual phase based on the observed admissions during this phase divided by the expected number of admissions if the menstrual cycle had no effect. Random effects models were used to examine pooled rates of psychiatric admission in the perimenstrual phase. Nineteen studies, comprising 1193 participants were eligible for inclusion. Eleven studies examined psychiatric admission rates, 5 examined symptoms scores, 2 examined self-reported exacerbation, and 1 examined both admission rates and symptom scores. A random effects model demonstrated the rate of admissions during the perimenstrual phase was 1.48 times higher than expected (95% CI: 1.31-1.67), with no significant heterogeneity detected. Four of six symptom score studies reported perimenstrual worsening, but lack of consistency in timepoints precluded meta-analysis. Two studies examining self-reported menstrual exacerbations reported prevalences ranging from 20% to 32.4%. Psychiatric admission rates are significantly higher than expected during the perimenstrual phase. There is some evidence that a worsening of psychotic symptoms also occurs during this phase, but further research with more precise measurement of the menstrual cycle and symptomatology is required.
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Affiliation(s)
- Thomas J Reilly
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, SE5 8AF, UK,To whom correspondence should be addressed; Department of Psychosis, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, SE5 8AF, UK; tel: +44-20-7848-5233, fax: +44-20-7848-0976, e-mail:
| | - Vanessa C Sagnay de la Bastida
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Dan W Joyce
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, SE5 8AF, UK
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Gogos A, Ney LJ, Seymour N, Van Rheenen TE, Felmingham KL. Sex differences in schizophrenia, bipolar disorder, and post-traumatic stress disorder: Are gonadal hormones the link? Br J Pharmacol 2019; 176:4119-4135. [PMID: 30658014 PMCID: PMC6877792 DOI: 10.1111/bph.14584] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/13/2018] [Accepted: 11/25/2018] [Indexed: 12/30/2022] Open
Abstract
In this review, we describe the sex differences in prevalence, onset, symptom profiles, and disease outcome that are evident in schizophrenia, bipolar disorder, and post-traumatic stress disorder. Women with schizophrenia tend to exhibit less disease impairment than men. By contrast, women with post-traumatic stress disorder are more affected than men. The most likely candidates to explain these sex differences are gonadal hormones. This review details the clinical evidence that oestradiol and progesterone are dysregulated in these psychiatric disorders. Notably, existing data on oestradiol, and to a lesser extent, progesterone, suggest that low levels of these hormones may increase the risk of disease development and worsen symptom severity. We argue that future studies require a more inclusive, considered analysis of gonadal steroid hormones and the intricacies of the interactions between them, with methodological rigour applied, to enhance our understanding of the roles of steroid hormones in psychiatric disorders. LINKED ARTICLES: This article is part of a themed section on The Importance of Sex Differences in Pharmacology Research. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.21/issuetoc.
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Affiliation(s)
- Andrea Gogos
- Hormones in Psychiatry LaboratoryFlorey Institute of Neuroscience and Mental HealthParkvilleVictoriaAustralia
| | - Luke J. Ney
- School of Medicine (Psychology)University of TasmaniaSandy BayTasmaniaAustralia
| | - Natasha Seymour
- Hormones in Psychiatry LaboratoryFlorey Institute of Neuroscience and Mental HealthParkvilleVictoriaAustralia
- Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Tamsyn E. Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of PsychiatryUniversity of MelbourneParkvilleVictoriaAustralia
- Centre for Mental Health, School of Health Sciences, Faculty of Health, Arts and DesignSwinburne UniversityMelbourneVictoriaAustralia
| | - Kim L. Felmingham
- School of Psychological SciencesUniversity of MelbourneParkvilleVictoriaAustralia
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Abstract
Women undergo developmental and cyclic changes in hormonal exposures that affect brain function and mental health. Some women are more vulnerable to the effects of these hormonal exposures, for reasons that remain to be determined. Evidence to date indicates that anxiety and mood disorders are the most sensitive to hormonal fluctuations in women but there is also growing evidence for a protective effect of female reproductive hormones on schizophrenia. The hormonal exposures of the menstrual cycle, pregnancy, the postpartum period, lactation, and menopause are quite different and may be associated with at least partially distinct symptom profiles.
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Affiliation(s)
- Margaret Altemus
- VA Connecticut Health Care System, Women's Clinic, Building 2, Room 7-165, 950 Campbell Avenue, New Haven, CT 06516, USA.
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Robakis T, Williams KE, Nutkiewicz L, Rasgon NL. Hormonal Contraceptives and Mood: Review of the Literature and Implications for Future Research. Curr Psychiatry Rep 2019; 21:57. [PMID: 31172309 DOI: 10.1007/s11920-019-1034-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW We examine recent studies that investigate the effects of hormonal contraception on mood in different populations of women, including women in the general population and women with diagnosed psychiatric and gynecologic disorders. We address the mechanisms of several types of hormonal contraceptives and assess how these may affect mood and gynecologic disorders. RECENT FINDINGS The effects of hormonal contraceptives seem to be most relevant in selected subsets of women, as they may promote improved mental health in particular psychiatric disorders such as PMDD. Currently, there is no consistent evidence for negative effects of most hormonal contraceptives in the general population. Even though some studies reveal that certain individuals appear susceptible to negative mood effects from some forms of hormonal contraceptives, more research is needed to better identify these susceptible individuals.
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Affiliation(s)
- Thalia Robakis
- Psychiatry & Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94304, USA.
| | - Katherine E Williams
- Psychiatry & Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94304, USA
| | - Lexi Nutkiewicz
- Psychiatry & Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94304, USA
| | - Natalie L Rasgon
- Psychiatry & Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94304, USA
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Lithium and valproate serum level fluctuations within the menstrual cycle: a systematic review. Int Clin Psychopharmacol 2019; 34:143-150. [PMID: 30907774 DOI: 10.1097/yic.0000000000000253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Some women affected by mood disorders experience mood instability during the premenstrual phase. Assuming that fluctuations in drug serum levels may contribute to the worsening of mood symptoms, we carried out a systematic review of available studies that investigated changes in lithium and valproate levels in relation to menstrual phases. We selected five studies; four of which assessed menstrual fluctuations in lithium serum levels and one in valproate levels. Study samples included women in their fertile age affected by bipolar disorder, epilepsy as well as healthy ones. Preliminary results showed a close relationship between cyclic premenstrual exacerbation of affective symptoms and a significant decrease in lithium levels during the luteal phase, despite stable oral doses, in bipolar women. In healthy women, lithium levels were influenced by neither menstrual cycle phases nor oral contraceptives use. Valproate serum levels in epileptic women showed a small, nonsignificant decline during the mid-luteal phase. Pharmacokinetic sex differences in adsorption, volume distribution, hepatic metabolism, and renal excretion of mood stabilizers have been supposed to partly explain such menstrual serum level fluctuations. A better understanding in this field could help to counteract the distress related to premenstrual phase, improving therapeutic management of mood disorders in women.
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Eisenlohr-Moul T. Premenstrual Disorders: A Primer and Research Agenda for Psychologists. THE CLINICAL PSYCHOLOGIST 2019; 72:5-17. [PMID: 32362679 PMCID: PMC7193982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Tory Eisenlohr-Moul
- Department of Psychiatry, University of Illinois at Chicago
- Department of Psychology, University of Illinois at Chicago
- International Association for Premenstrual Disorders Clinical Advisory Board
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Abstract
PURPOSE OF REVIEW Risk for suicidal behavior may fluctuate across the menstrual cycle. Here, we use the RDoC framework to review potential mechanisms by which the cycle may increase acute suicide risk. RECENT FINDINGS The menstrual cycle impacts the majority of RDoC constructs linked to suicide risk, particularly among hormone-sensitive women, such as those with premenstrual dysphoric disorder or premenstrual exacerbation of a psychiatric disorder. Despite this, there are no published studies examining suicidal ideation, planning, or behavior longitudinally across the cycle. More work is needed to understand how hormone sensitivity may relate to both trait and state suicide risk. Intensive multilevel investigations of cyclical hormone effects on suicide risk through specific RDoC mechanisms are suggested. This is a fertile research area and may provide key insights regarding the mechanisms of acute suicide risk.
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Affiliation(s)
- Sarah A Owens
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tory Eisenlohr-Moul
- Department of Psychiatry, Women's Mental Health Research Program, University of Illinois at Chicago, 912 S Wood St., South Tower, Room 335, Chicago, IL, 60612, USA.
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, 60612, USA.
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Syan SK, Smith M, Frey BN, Remtulla R, Kapczinski F, Hall GBC, Minuzzi L. Resting-state functional connectivity in individuals with bipolar disorder during clinical remission: a systematic review. J Psychiatry Neurosci 2018; 43:298-316. [PMID: 30125243 PMCID: PMC6158027 DOI: 10.1503/jpn.170175] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/21/2017] [Accepted: 01/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Bipolar disorder is chronic and debilitating. Studies investigating resting-state functional connectivity in individuals with bipolar disorder may help to inform neurobiological models of illness. METHODS We conducted a systematic review with the following goals: to summarize the literature on resting-state functional connectivity in bipolar disorder during clinical remission (euthymia) compared with healthy controls; to critically appraise the literature and research gaps; and to propose directions for future research. We searched PubMed/MEDLINE, Embase, PsycINFO, CINAHL and grey literature up to April 2017. RESULTS Twenty-three studies were included. The most consistent finding was the absence of differences in resting-state functional connectivity of the default mode network (DMN), frontoparietal network (FPN) and salience network (SN) between people with bipolar disorder and controls, using independent component analysis. However, 2 studies in people with bipolar disorder who were positive for psychosis history reported DMN hypoconnectivity. Studies using seed-based analysis largely reported aberrant resting-state functional connectivity with the amygdala, ventrolateral prefrontal cortex, cingulate cortex and medial prefrontal cortex in people with bipolar disorder compared with controls. Few studies used regional homogeneity or amplitude of low-frequency fluctuations. LIMITATIONS We found heterogeneity in the analysis methods used. CONCLUSION Stability of the DMN, FPN and SN may reflect a state of remission. Further, DMN hypoconnectivity may reflect a positive history of psychosis in patients with bipolar disorder compared with controls, highlighting a potentially different neural phenotype of psychosis in people with bipolar disorder. Resting-state functional connectivity changes between the amygdala, prefrontal cortex and cingulate cortex may reflect a neural correlate of subthreshold symptoms experienced in bipolar disorder euthymia, the trait-based pathophysiology of bipolar disorder and/or a compensatory mechanism to maintain a state of euthymia.
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Affiliation(s)
- Sabrina K Syan
- From the MiNDS Neuroscience Graduate Program, McMaster University (Syan, Frey, Kapczinski, Hall, Minuzzi); the Women's Health Concerns Clinic (Syan, Frey, Remtulla, Minuzzi); the Mood Disorders Program, St. Joseph's Healthcare (Frey, Kapczinski, Minuzzi); the Department of Psychiatry and Behavioural Neurosciences, McMaster University (Smith, Frey, Kapczinski, Minuzzi, Smith); and the Department of Psychology, Neuroscience and Behaviour, McMaster University (Hall), Hamilton, Ontario, Canada
| | - Mara Smith
- From the MiNDS Neuroscience Graduate Program, McMaster University (Syan, Frey, Kapczinski, Hall, Minuzzi); the Women's Health Concerns Clinic (Syan, Frey, Remtulla, Minuzzi); the Mood Disorders Program, St. Joseph's Healthcare (Frey, Kapczinski, Minuzzi); the Department of Psychiatry and Behavioural Neurosciences, McMaster University (Smith, Frey, Kapczinski, Minuzzi, Smith); and the Department of Psychology, Neuroscience and Behaviour, McMaster University (Hall), Hamilton, Ontario, Canada
| | - Benicio N Frey
- From the MiNDS Neuroscience Graduate Program, McMaster University (Syan, Frey, Kapczinski, Hall, Minuzzi); the Women's Health Concerns Clinic (Syan, Frey, Remtulla, Minuzzi); the Mood Disorders Program, St. Joseph's Healthcare (Frey, Kapczinski, Minuzzi); the Department of Psychiatry and Behavioural Neurosciences, McMaster University (Smith, Frey, Kapczinski, Minuzzi, Smith); and the Department of Psychology, Neuroscience and Behaviour, McMaster University (Hall), Hamilton, Ontario, Canada
| | - Raheem Remtulla
- From the MiNDS Neuroscience Graduate Program, McMaster University (Syan, Frey, Kapczinski, Hall, Minuzzi); the Women's Health Concerns Clinic (Syan, Frey, Remtulla, Minuzzi); the Mood Disorders Program, St. Joseph's Healthcare (Frey, Kapczinski, Minuzzi); the Department of Psychiatry and Behavioural Neurosciences, McMaster University (Smith, Frey, Kapczinski, Minuzzi, Smith); and the Department of Psychology, Neuroscience and Behaviour, McMaster University (Hall), Hamilton, Ontario, Canada
| | - Flavio Kapczinski
- From the MiNDS Neuroscience Graduate Program, McMaster University (Syan, Frey, Kapczinski, Hall, Minuzzi); the Women's Health Concerns Clinic (Syan, Frey, Remtulla, Minuzzi); the Mood Disorders Program, St. Joseph's Healthcare (Frey, Kapczinski, Minuzzi); the Department of Psychiatry and Behavioural Neurosciences, McMaster University (Smith, Frey, Kapczinski, Minuzzi, Smith); and the Department of Psychology, Neuroscience and Behaviour, McMaster University (Hall), Hamilton, Ontario, Canada
| | - Geoffrey B C Hall
- From the MiNDS Neuroscience Graduate Program, McMaster University (Syan, Frey, Kapczinski, Hall, Minuzzi); the Women's Health Concerns Clinic (Syan, Frey, Remtulla, Minuzzi); the Mood Disorders Program, St. Joseph's Healthcare (Frey, Kapczinski, Minuzzi); the Department of Psychiatry and Behavioural Neurosciences, McMaster University (Smith, Frey, Kapczinski, Minuzzi, Smith); and the Department of Psychology, Neuroscience and Behaviour, McMaster University (Hall), Hamilton, Ontario, Canada
| | - Luciano Minuzzi
- From the MiNDS Neuroscience Graduate Program, McMaster University (Syan, Frey, Kapczinski, Hall, Minuzzi); the Women's Health Concerns Clinic (Syan, Frey, Remtulla, Minuzzi); the Mood Disorders Program, St. Joseph's Healthcare (Frey, Kapczinski, Minuzzi); the Department of Psychiatry and Behavioural Neurosciences, McMaster University (Smith, Frey, Kapczinski, Minuzzi, Smith); and the Department of Psychology, Neuroscience and Behaviour, McMaster University (Hall), Hamilton, Ontario, Canada
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G, Milev RV, Ravindran A, O'Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B, Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord 2018; 20:97-170. [PMID: 29536616 PMCID: PMC5947163 DOI: 10.1111/bdi.12609] [Citation(s) in RCA: 952] [Impact Index Per Article: 158.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022]
Abstract
The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.
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Affiliation(s)
- Lakshmi N Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | | | - Sagar V Parikh
- Department of PsychiatryUniversity of MichiganAnn ArborMIUSA
| | - Ayal Schaffer
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - David J Bond
- Department of PsychiatryUniversity of MinnesotaMinneapolisMNUSA
| | - Benicio N Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Verinder Sharma
- Departments of Psychiatry and Obstetrics & GynaecologyWestern UniversityLondonONCanada
| | | | - Soham Rej
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Serge Beaulieu
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Glenda MacQueen
- Department of PsychiatryUniversity of CalgaryCalgaryABCanada
| | - Roumen V Milev
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Arun Ravindran
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | | | - Diane McIntosh
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Raymond W Lam
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Gustavo Vazquez
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | | | - Jan Kozicky
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
| | | | - Beny Lafer
- Department of PsychiatryUniversity of Sao PauloSao PauloBrazil
| | - Trisha Suppes
- Bipolar and Depression Research ProgramVA Palo AltoDepartment of Psychiatry & Behavioral Sciences Stanford UniversityStanfordCAUSA
| | - Joseph R Calabrese
- Department of PsychiatryUniversity Hospitals Case Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Eduard Vieta
- Bipolar UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Gin Malhi
- Department of PsychiatryUniversity of SydneySydneyNSWAustralia
| | - Robert M Post
- Department of PsychiatryGeorge Washington UniversityWashingtonDCUSA
| | - Michael Berk
- Deakin UniveristyIMPACT Strategic Research CentreSchool of Medicine, Barwon HealthGeelongVic.Australia
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Ogasawara K, Nakamura Y, Kimura H, Aleksic B, Ozaki N. Issues on the diagnosis and etiopathogenesis of mood disorders: reconsidering DSM-5. J Neural Transm (Vienna) 2017; 125:211-222. [PMID: 29275445 DOI: 10.1007/s00702-017-1828-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
The authors present a narrative review from the diagnostic and nosologic viewpoints of mood disorders (bipolar and depressive ones) by revisiting the revision from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision to DSM-5, including the following: the separation of the bipolar and depressive sections; the addition of increased energy and continuation of symptoms to the hypo/manic criteria; the elimination of mixed episodes; the creation of new categories and specifiers ("other specified bipolar and related disorder", "disruptive mood dysregulation disorder", "with anxious distress", "with mixed features", "with peripartum onset"); the categorization of hypo/manic episodes during antidepressant treatment into bipolar disorder; the elimination of the "bereavement exclusion"; the ambiguous separation between bipolar I and II; the insufficient distinction between "other specified bipolar and related disorders" and major depressive disorder; the differentiation regarding borderline personality disorder; agitation; premenstrual dysphoric disorder; and society and psychiatry. Through this analysis, we point out both the achievements and limitations of DSM-5. In addition, to examine the future direction of psychiatry, we introduce our cohort study regarding maternal depression and an outline of the National Institute of Mental Health's Research Domain Criteria project in the US. Finally, we advocate the importance of elucidating etiopathogeneses by starting from or going beyond the DSM operational diagnostic system, which has shown great efficacy.
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Affiliation(s)
- Kazuyoshi Ogasawara
- Bioethics Research Center, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. .,Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yukako Nakamura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroyuki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Branko Aleksic
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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35
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Hamstra DA, de Kloet ER, de Rover M, Van der Does W. Oral contraceptives positively affect mood in healthy PMS-free women: A longitudinal study. J Psychosom Res 2017; 103:119-126. [PMID: 29167038 DOI: 10.1016/j.jpsychores.2017.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/01/2017] [Accepted: 10/19/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Menstrual cycle phase and oral contraceptives (OC) use influence mood and cognition and these effects may be moderated by the mineralocorticoid receptor (MR) genotype. The effect of menstrual cycle phase on mood may be increased if participants know that this is the focus of study. We assessed aspects associated with reproductive depression such as mood, interpersonal sensitivity, affect lability and depressive cognitions in MR-genotyped OC-users and naturally cycling (NC) women in a carefully masked design. METHODS A homogenous sample of healthy, PMS-free, pre-menopausal MR-genotyped women (n=92) completed online questionnaires eight times during two consecutive cycles. RESULTS The masking of the research question was successful. OC-users did not differ significantly from NC women in positive and negative affect at the time of assessment, personality characteristics (e.g. neuroticism) or mental and physical health. Both groups reported more shifts in anger in the first cycle week (p<0.001; ηp2=0.08). Compared to NC women, OC-users reported fewer mood-shifts between depression and elation in the mid-luteal phase of the menstrual cycle (p=0.002; ηp2=0.10) and had fewer ruminating thoughts at all phases (p=0.003; ηp2=0.11). Effects of MR-genotype were not significant after correction for multiple comparisons. CONCLUSION OC users scored more favorably on measures associated with reproductive depression. OC users also showed a decreased affect variability possibly indicating an emotional blunting effect, which is in line with previous reports on affect-stabilizing effects of OC. Limitations were loss of cases due to irregularities in the menstrual cycle length and possible confounding by the 'survivor effect', since almost all OC-users took OC for more than a year.
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Affiliation(s)
- Danielle A Hamstra
- Institute of Psychology, Leiden University; Leiden Institute of Brain and Cognition, Leiden University.
| | | | - Mischa de Rover
- Institute of Psychology, Leiden University; Leiden Institute of Brain and Cognition, Leiden University
| | - Willem Van der Does
- Institute of Psychology, Leiden University; Leiden Institute of Brain and Cognition, Leiden University; Department of Psychiatry, Leiden University Medical Center
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Perich T, Ussher J, Parton C. "Is it menopause or bipolar?": a qualitative study of the experience of menopause for women with bipolar disorder. BMC WOMENS HEALTH 2017; 17:110. [PMID: 29145856 PMCID: PMC5689207 DOI: 10.1186/s12905-017-0467-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/07/2017] [Indexed: 12/25/2022]
Abstract
Background Menopause can be a time of change for women and may be marked by disturbances in mood. For women living with a mental illness, such as bipolar disorder, little is known about how they experience mood changes during menopause. This study aimed to explore how women with bipolar disorder constructed mood changes during menopause and how this impacted on treatment decisions. Methods Semi-structured interviews were undertaken with fifteen women who reported they had been diagnosed with bipolar disorder. Data was analysed using thematic analysis guided by a social constructionist framework. Results Themes identified included ‘Constructions of mood change: menopause or bipolar disorder?’,‘ Life events, bipolar disorder and menopause coming together’; ‘Treatment choices for mood change during menopause’. Conclusions The accounts suggested that women related to the experience of mood changes during menopause through the lens of their existing framework of bipolar disorder, with implications for understanding of self and treatment choices. Electronic supplementary material The online version of this article (10.1186/s12905-017-0467-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tania Perich
- Clinical and Health Psychology Research Initiative (CaHPRI), School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia. .,School of Psychiatry, University of New South Wales, Sydney, Australia.
| | - Jane Ussher
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Chloe Parton
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
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Dinsdale NL, Crespi BJ. Revisiting the wandering womb: Oxytocin in endometriosis and bipolar disorder. Horm Behav 2017; 96:69-83. [PMID: 28919554 DOI: 10.1016/j.yhbeh.2017.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/07/2017] [Accepted: 09/09/2017] [Indexed: 12/23/2022]
Abstract
Hippocrates attributed women's high emotionality - hysteria - to a 'wandering womb'. Although hysteria diagnoses were abandoned along with the notion that displaced wombs cause emotional disturbance, recent research suggests that elevated levels of oxytocin occur in both bipolar disorder and endometriosis, a gynecological condition involving migration of endometrial tissue beyond the uterus. We propose and evaluate the hypothesis that elevated oxytocinergic system activity jointly contributes to bipolar disorder and endometriosis. First, we provide relevant background on endometriosis and bipolar disorder, and then we examine evidence for comorbidity between these conditions. We next: (1) review oxytocin's associations with personality traits, especially extraversion and openness, and how they overlap with bipolar spectrum traits; (2) describe evidence for higher oxytocinergic activity in both endometriosis and bipolar disorder; (3) examine altered hypothalamic-pituitary-gonadal axis functioning in both conditions; (4) describe data showing that medications that treat one condition can improve symptoms of the other; (5) discuss fitness-related impacts of endometriosis and bipolar disorder; and (6) review a pair of conditions, polycystic ovary syndrome and autism, that show evidence of involving reduced oxytocinergic activity, in direct contrast to endometriosis and bipolar disorder. Considered together, the bipolar spectrum and endometriosis appear to involve dysregulated high extremes of normally adaptive pleiotropy in the female oxytocin system, whereby elevated levels of oxytocinergic activity coordinate outgoing sociality with heightened fertility, apparently characterizing, overall, a faster life history. These findings should prompt a re-examination of how mind-body interactions, and the pleiotropic endocrine systems that underlie them, contribute to health and disease.
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Affiliation(s)
- Natalie L Dinsdale
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, BC, Canada; Department of Psychology, 9 Campus Drive, 154 Arts, University of Saskatchewan, Saskatoon S7N 5A5, SK, Canada.
| | - Bernard J Crespi
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, BC, Canada.
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Örüm MH, Kalenderoğlu A. Cotard and Capgras delusions in a patient with bipolar disorder: “I’ll prove, I’m dead!”. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1371661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Mehmet Hamdi Örüm
- Department Psychiatry, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
| | - Aysun Kalenderoğlu
- Department Psychiatry, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
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Abstract
Women undergo developmental and cyclic changes in hormonal exposures that affect brain function and mental health. Some women are more vulnerable to the effects of these hormonal exposures, for reasons that remain to be determined. Evidence to date indicates that anxiety and mood disorders are the most sensitive to hormonal fluctuations in women but there is also growing evidence for a protective effect of female reproductive hormones on schizophrenia. The hormonal exposures of the menstrual cycle, pregnancy, the postpartum period, lactation, and menopause are quite different and may be associated with at least partially distinct symptom profiles.
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Affiliation(s)
- Margaret Altemus
- VA Connecticut Health Care System, Women's Clinic, Building 2, Room 7-165, 950 Campbell Avenue, New Haven, CT 06516, USA.
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40
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The hormonal sensitivity hypothesis: A review and new findings. Med Hypotheses 2017; 102:69-77. [DOI: 10.1016/j.mehy.2017.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 01/10/2023]
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Syan SK, Minuzzi L, Smith M, Allega OR, Hall GB, Frey BN. Resting state functional connectivity in women with bipolar disorder during clinical remission. Bipolar Disord 2017; 19:97-106. [PMID: 28258639 DOI: 10.1111/bdi.12469] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Periods of euthymia in bipolar disorder (BD) serve as a valuable time to study trait-based pathophysiology. The use of resting state functional connectivity (Rs-FC) can aid in the understanding of BD pathophysiology free of task or mood state biases. The present study investigated two unexplored areas of Rs-FC research in bipolar remission: (i) Rs-FC in women, controlling for the potential influence of premenstrual symptoms, and (ii) the use of both independent component analysis (ICA) and seed-based analysis (SBA) to investigate Rs-FC. METHODS We investigated Rs-FC of the default mode network, meso-paralimbic network and fronto-parietal network in a sample of 32 euthymic women with BD and 36 age-matched controls during the mid-follicular phase of their menstrual cycle. Rs-FC was assessed with ICA and SBA using the posterior cingulate cortex (PCC), amygdala and dorsolateral prefrontal cortex (dlPFC) as seed points for their respective resting state networks. RESULTS In BD, compared to controls, SBAs revealed increased coupling between the PCC and the angular gyrus (P=.002, false discovery rate [FDR]-corrected) and between the right dlPFC and the brainstem (P=.03, FDR-corrected). In BD only, PCC-angular gyrus coupling was correlated with anxiety symptoms. Group differences in Rs-FC using ICA did not survive multiple comparisons. CONCLUSIONS Negative findings from whole-brain ICA Rs-FC may reflect a state of clinical remission in BD. Heightened activation between the PCC and the angular gyrus and between the dlPFC and the brainstem may reflect (i) an abnormal trait integration of affective information during clinical remission and/or (ii) an adaptive compensatory mechanism required for clinical stabilization.
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Affiliation(s)
- Sabrina K Syan
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Luciano Minuzzi
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Mara Smith
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Olivia R Allega
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Geoffrey Bc Hall
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Benicio N Frey
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Perich TA, Roberts G, Frankland A, Sinbandhit C, Meade T, Austin MP, Mitchell PB. Clinical characteristics of women with reproductive cycle-associated bipolar disorder symptoms. Aust N Z J Psychiatry 2017; 51:161-167. [PMID: 27687774 DOI: 10.1177/0004867416670015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Although there is clear evidence that reproductive cycle events are associated with mood episodes for women with bipolar disorder, few studies have examined for relationships between these and specific clinical characteristics of the disorder. This study aimed to explore the relationship between mood symptoms associated with reproductive cycle events and features of the disorder indicative of a more severe lifetime course. METHOD Totally, 158 women of at least 18 years of age participated in the study. Subjects were recruited through a specialist clinic at the Black Dog Institute, Sydney, Australia. RESULTS In total, 77% of women reported increases in mood symptoms during perimenstrual, postnatal or menopausal periods. These women had an earlier age of onset for depressive and hypo/manic episodes and a greater likelihood of comorbid anxiety disorders, rapid cycling and mixed mood compared to those who did not report such reproductive cycle-associated mood changes. Women who experienced postnatal episodes were also more likely to experience worse mood symptoms perimenstrually and menopausally. CONCLUSION First, reproductive cycle event-related worsening of mood was associated with a more severe lifetime course of bipolar disorder, and, second, it appears that some women have a greater propensity to mood worsening at each of these reproductive cycle events. If replicated, these findings provide important information for clinicians treating women with reproductive cycle event mood changes and highlight the need for improved therapeutics for such presentations.
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Affiliation(s)
- Tania A Perich
- 1 School of Psychiatry, The University of New South Wales and Black Dog Institute, Randwick, NSW, Australia.,2 Clinical and Health Psychology Research Initiative (CaHPRI), School of Social Sciences & Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Gloria Roberts
- 1 School of Psychiatry, The University of New South Wales and Black Dog Institute, Randwick, NSW, Australia
| | - Andrew Frankland
- 1 School of Psychiatry, The University of New South Wales and Black Dog Institute, Randwick, NSW, Australia
| | - Carina Sinbandhit
- 1 School of Psychiatry, The University of New South Wales and Black Dog Institute, Randwick, NSW, Australia
| | - Tanya Meade
- 2 Clinical and Health Psychology Research Initiative (CaHPRI), School of Social Sciences & Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Marie-Paul Austin
- 1 School of Psychiatry, The University of New South Wales and Black Dog Institute, Randwick, NSW, Australia
| | - Philip B Mitchell
- 1 School of Psychiatry, The University of New South Wales and Black Dog Institute, Randwick, NSW, Australia
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Regidor PA, Volko CD, Schindler AE, Rohr UD. The evolution of genomic stability to a mechanism in reproduction and psychiatry. Horm Mol Biol Clin Investig 2017; 29:1-11. [PMID: 27269896 DOI: 10.1515/hmbci-2016-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/23/2016] [Indexed: 11/15/2022]
Abstract
There are two forms of immune defense, the specific or adaptive immune defense and the unspecific innate immune defense. Vaccination is utilized against specific bacteria via the adaptive immune system. The innate immunity DNA stress defense is a non-toxic mechanism developed in yeasts and conserved in mammals and in plants. Although the steroidal hormone cascade has overtaken the stress response and allows superfast response via non-genomic receptors, the old innate immunity response is still mediated via the steroidal hormones cascade. The classical drug/receptor model has provided for many solutions, however, in antibiotics, cancer, and in severe mental diseases this model reaches to certain limits. The NIH/Department of Mental Health has developed a new model that shows severe mental diseases may be immune diseases that can be treated by replacing old diseased nerve cells by new healthy nerve cells, where the old innate immunity may be exploited. This means that severe mental diseases are physical diseases. A newly developed model, where modifications of the steroidal hormone cascade help to understand bipolarity, schizophrenia, and PTSD in men and women can be transferred to gynecological hormone modifications in women, where innate immunity is mediated via the same steroidal hormone cascade. Treatment via immune response via the DNA cascade should be developed in cancer, infections and severe mental disease, because foreign cells or diseased cells may be removed by the unspecific innate immunity.
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Syan SK, Minuzzi L, Smith M, Costescu D, Allega OR, Hall GBC, Frey BN. Brain Structure and Function in Women with Comorbid Bipolar and Premenstrual Dysphoric Disorder. Front Psychiatry 2017; 8:301. [PMID: 29367847 PMCID: PMC5768056 DOI: 10.3389/fpsyt.2017.00301] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/18/2017] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Hormonal fluctuations associated with female reproductive life events may precipitate or worsen affective episodes in women with bipolar disorder (BD). Previous studies have shown that women with BD report higher rates of premenstrual dysphoric disorder (PMDD) than controls. Further, bipolar women who report premenstrual worsening of mood display a worse course of their bipolar illness. Despite this, the neural correlates of comorbid BD and PMDD have not been investigated. METHODOLOGY Eighty-five [CTRL, n = 25; PMDD, n = 20; BD, n = 21; BD with comorbid PMDD (BDPMDD), n = 19], regularly cycling women, not on hormonal contraception, underwent two MRI scans: during their mid-follicular and late luteal menstrual phases. We investigated resting-state functional connectivity (Rs-FC), cortical thickness, and subcortical volumes of brain regions associated with the pathophysiology of BD and PMDD between groups, in the mid-follicular and late luteal phases of the menstrual cycle. All BD subjects were euthymic for at least 2 months prior to study entry. RESULTS Women in the BDPMDD group displayed greater disruption in biological rhythms and more subthreshold depressive and anxious symptoms through the menstrual cycle compared to other groups. Rs-FC was increased between the L-hippocampus and R-frontal cortex and decreased between the R-hippocampus and R-premotor cortex in BDPMDD vs. BD (FDR-corrected, p < 0.05). Cortical thickness analysis revealed decreased cortical thickness of the L-pericalcarine, L-superior parietal, R-middle temporal, R-rostral middle frontal, and L-superior frontal, as well as increased cortical thickness of the L-superior temporal gyri in BDPMDD compared to BD. We also found increased left-caudate volume in BDPMDD vs. BD (pCORR < 0.05). CONCLUSION Women with BD and comorbid PMDD display a distinct clinical and neurobiological phenotype of BD, which suggests differential sensitivity to endogenous hormones.
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Affiliation(s)
- Sabrina K Syan
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Luciano Minuzzi
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Mara Smith
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Dustin Costescu
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Olivia R Allega
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Geoffrey B C Hall
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Benicio N Frey
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Câmara RA, Köhler CA, Maes M, Nunes-Neto PR, Brunoni AR, Quevedo J, Fernandes BS, Perugi G, Hyphantis TN, Carvalho AF. Affective temperaments and emotional traits are associated with a positive screening for premenstrual dysphoric disorder. Compr Psychiatry 2016; 71:33-38. [PMID: 27607359 DOI: 10.1016/j.comppsych.2016.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/04/2016] [Accepted: 08/15/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Preliminary evidence indicates that premenstrual dysphoric disorder (PMDD) may be frequently co-morbid with bipolar spectrum disorders. In addition, the manifestations of PMDD seem similar to a subthreshold depressive mixed state. Nevertheless, the associations between PMDD and affective temperaments and emotional traits have not been previously investigated. METHODS A consecutive sample of 514 drug-free Brazilian women (mean age: 22.8; SD=5.4years) took part in this cross-sectional study. Screening for PMDD was obtained with the validated Brazilian Portuguese version of the Premenstrual Symptoms Screening Tool (PSST). Affective temperaments and emotional dimensions were evaluated with the Affective and Emotional Composite Temperament Scale (AFECTS). In addition, socio-demographic and data on menstrual cycle were collected. RESULTS According to the PSST, 83 (16.1%) women screened positive for PMDD, while 216 (42.0%) women had no/mild premenstrual symptoms. The cyclothymic temperament was independently associated with PMDD (OR=4.57; 95% CI: 2.11-9.90), while the euthymic temperament had an independent association with a lower likelihood of a positive screening for PMDD (OR=0.28; 95% CI: 0.12-0.64). In addition, anger and sensitivity emerged as emotional dimensions significantly associated with PMDD. CONCLUSIONS A positive screening for PMDD was associated with a predominant cyclothymic temperament, while an euthymic temperament was associated with a lower likelihood for a positive screening for PMDD. These data deserve replication in prospective studies.
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Affiliation(s)
- Rachel A Câmara
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Cristiano A Köhler
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Michael Maes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, Australia; Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Faculty of Medicine, State University of Londrina, Londrina, Brazil; Department of Psychiatry, Medical University Plovdiv, Plovdiv, Bulgaria; Revitalis, Waalre, The Netherlands
| | - Paulo R Nunes-Neto
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - André R Brunoni
- Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA), University Hospital, University of São Paulo, São Paulo, Brazil; Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, Faculty of Medicine of University of São Paulo, São Paulo, Brazil; Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - João Quevedo
- Laboratório de Neurociências, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Brazil; Center for Translational Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, USA
| | - Brisa S Fernandes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, Australia; Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Giulio Perugi
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy; Institute of Behavioral Sciences "G. De Lisio", Pisa, Italy
| | - Thomas N Hyphantis
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - André F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
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Hamstra DA, de Kloet ER, Tollenaar M, Verkuil B, Manai M, Putman P, Van der Does W. Mineralocorticoid receptor haplotype moderates the effects of oral contraceptives and menstrual cycle on emotional information processing. J Psychopharmacol 2016; 30:1054-61. [PMID: 27222270 DOI: 10.1177/0269881116647504] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
RATIONALE The processing of emotional information is affected by menstrual cycle phase and by the use of oral contraceptives (OCs). The stress hormone cortisol is known to affect emotional information processing via the limbic mineralocorticoid receptor (MR). OBJECTIVES We investigated in an exploratory study whether the MR-genotype moderates the effect of both OC-use and menstrual cycle phase on emotional cognition. METHODS Healthy premenopausal volunteers (n=93) of West-European descent completed a battery of emotional cognition tests. Forty-nine participants were OC users and 44 naturally cycling, 21 of whom were tested in the early follicular (EF) and 23 in the mid-luteal (ML) phase of the menstrual cycle. RESULTS In MR-haplotype 1/3 carriers, ML women gambled more than EF women when their risk to lose was relatively small. In MR-haplotype 2, ML women gambled more than EF women, regardless of their odds of winning. OC-users with MR-haplotype 1/3 recognised fewer facial expressions than ML women with MR-haplotype 1/3. CONCLUSION MR-haplotype 1/3 carriers may be more sensitive to the influence of their female hormonal status. MR-haplotype 2 carriers showed more risky decision-making. As this may reflect optimistic expectations, this finding may support previous observations in female carriers of MR-haplotype 2 in a naturalistic cohort study.
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Affiliation(s)
- Danielle A Hamstra
- Institute of Psychology, Leiden University, Leiden, the Netherlands Leiden Institute of Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - E Ronald de Kloet
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marieke Tollenaar
- Institute of Psychology, Leiden University, Leiden, the Netherlands Leiden Institute of Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Bart Verkuil
- Institute of Psychology, Leiden University, Leiden, the Netherlands Leiden Institute of Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Meriem Manai
- Institute of Psychology, Leiden University, Leiden, the Netherlands Leiden Institute of Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Peter Putman
- Institute of Psychology, Leiden University, Leiden, the Netherlands Leiden Institute of Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Willem Van der Does
- Institute of Psychology, Leiden University, Leiden, the Netherlands Leiden Institute of Brain and Cognition, Leiden University, Leiden, the Netherlands Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
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Kuroki T, Ishitobi M, Kamio Y, Sugihara G, Murai T, Motomura K, Ogasawara K, Kimura H, Aleksic B, Ozaki N, Nakao T, Yamada K, Yoshiuchi K, Kiriike N, Ishikawa T, Kubo C, Matsunaga C, Miyata H, Asada T, Kanba S. Current viewpoints on DSM-5 in Japan. Psychiatry Clin Neurosci 2016; 70:371-93. [PMID: 27414748 DOI: 10.1111/pcn.12421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2016] [Indexed: 01/10/2023]
Abstract
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, and its official Japanese version was published in 2014. The Japanese Government uses classifications from the 10th revision of the I nternational C lassification of D iseases (ICD-10) to categorize disorders and determine treatment fees. However, since the publication of the DSM-III, the use of the DSM system has become prevalent in research and educational settings in Japan. In addition to traditional psychiatry, both the ICD and the DSM are taught by many Japanese medical schools, and virtually all clinical research and trials refer to the DSM to define targeted disorders. Amid the current backdrop in which the reputation of the DSM-5 is being established, the editorial board of P sychiatry and C linical N eurosciences has asked Japanese experts across 12 specialties to examine the structure of the DSM-5, including the following categories: Neurodevelopmental Disorders, Schizophrenia Spectrum Disorders, Major Depression, Bipolar Disorders, Obsessive-Compulsive Disorders, Somatic Symptom Disorder, Eating Disorders, Substance-Related and Addictive Disorders, Gender Dysphoria, and Neurocognitive Disorders. Although opinions were only obtained from these selected experts, we believe that we have succeeded, to a certain extent, in presenting views that are representative of each specialty.
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Affiliation(s)
- Toshihide Kuroki
- Department of Clinical Psychology Practice, Graduate School of Human Environment Studies, Kyushu University, Fukuoka, Japan
| | - Makoto Ishitobi
- Department of Child and Adolescent Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoko Kamio
- Department of Child and Adolescent Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Genichi Sugihara
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keisuke Motomura
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuyoshi Ogasawara
- Department of Human Care, Nagoya University of Arts and Sciences, Nagoya, Japan
| | - Hiroyuki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Branko Aleksic
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuo Yamada
- Department of Psychiatry, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuo Kiriike
- Department of Neuropsychiatry, Osaka City University, Osaka, Japan
| | - Toshio Ishikawa
- Department of Psychosomatic Medicine, Kohnodai Hospital, Tokyo, Japan
| | - Chiharu Kubo
- Department of Psychosomatic Medicine, Kyushu University, Fukuoka, Japan
| | - Chiaki Matsunaga
- Chiaki Clinic, Jikei University School of Medicine, Tokyo, Japan
| | - Hisatsugu Miyata
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Asada
- Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Premenstrual Dysphoric Disorder Without Comorbid Psychiatric Conditions: A Systematic Review of Therapeutic Options. Clin Neuropharmacol 2016; 39:241-61. [DOI: 10.1097/wnf.0000000000000173] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mathews SB, Epperson CN. Neuropsychiatric Disorders Among Aging Women: Assessing Risk Factors and Tailoring Treatment. Curr Behav Neurosci Rep 2015. [DOI: 10.1007/s40473-015-0057-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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