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Guo YB, Jiao Q, Zhang XT, Xiao Q, Wu Z, Cao WF, Cui D, Yu GH, Dou RH, Su LY, Lu GM. Increased regional Hurst exponent reflects response inhibition related neural complexity alterations in pediatric bipolar disorder patients during an emotional Go-Nogo task. Cereb Cortex 2024; 34:bhad442. [PMID: 38031362 PMCID: PMC10793568 DOI: 10.1093/cercor/bhad442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Fractal patterns have been shown to change in resting- and task-state blood oxygen level-dependent signals in bipolar disorder patients. However, fractal characteristics of brain blood oxygen level-dependent signals when responding to external emotional stimuli in pediatric bipolar disorder remain unclear. Blood oxygen level-dependent signals of 20 PBD-I patients and 17 age- and sex-matched healthy controls were extracted while performing an emotional Go-Nogo task. Neural responses relevant to the task and Hurst exponent of the blood oxygen level-dependent signals were assessed. Correlations between clinical indices and Hurst exponent were estimated. Significantly increased activations were found in regions covering the frontal lobe, parietal lobe, temporal lobe, insula, and subcortical nuclei in PBD-I patients compared to healthy controls in contrast of emotional versus neutral distractors. PBD-I patients exhibited higher Hurst exponent in regions that involved in action control, such as superior frontal gyrus, inferior frontal gyrus, inferior temporal gyrus, and insula, with Hurst exponent of frontal orbital gyrus correlated with onset age. The present study exhibited overactivation, increased self-similarity and decreased complexity in cortical regions during emotional Go-Nogo task in patients relative to healthy controls, which provides evidence of an altered emotional modulation of cognitive control in pediatric bipolar disorder patients. Hurst exponent may be a fractal biomarker of neural activity in pediatric bipolar disorder.
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Affiliation(s)
- Yi-Bing Guo
- School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai’an 271000, China
- Brain and Mind Center, The University of Sydney, Sydney, NSW 2008, Australia
| | - Qing Jiao
- School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai’an 271000, China
| | - Xiao-Tong Zhang
- School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai’an 271000, China
| | - Qian Xiao
- Mental Health Centre of Xiangya Hospital, Central South University, Changsha 410083, China
| | - Zhou Wu
- School of Psychology, Nanjing Normal University, Nanjing 210097, China
| | - Wei-Fang Cao
- School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai’an 271000, China
| | - Dong Cui
- School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai’an 271000, China
| | - Guang-Hui Yu
- School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai’an 271000, China
| | - Ru-Hai Dou
- School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai’an 271000, China
| | - Lin-Yan Su
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha 410083, China
| | - Guang-Ming Lu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing 210023, China
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2
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Nunes A, Singh S, Allman J, Becker S, Ortiz A, Trappenberg T, Alda M. A critical evaluation of dynamical systems models of bipolar disorder. Transl Psychiatry 2022; 12:416. [PMID: 36171199 PMCID: PMC9519533 DOI: 10.1038/s41398-022-02194-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 12/02/2022] Open
Abstract
Bipolar disorder (BD) is a mood disorder involving recurring (hypo)manic and depressive episodes. The inherently temporal nature of BD has inspired its conceptualization using dynamical systems theory, which is a mathematical framework for understanding systems that evolve over time. In this paper, we provide a critical review of the dynamical systems models of BD. Owing to the heterogeneity of methodological and experimental designs in computational modeling, we designed a structured approach that parallels the appraisal of animal models by their face, predictive, and construct validity. This tool, the validity appraisal guide for computational models (VAG-CM), is not an absolute measure of validity, but rather a guide for a more objective appraisal of models in this review. We identified 26 studies published before November 18, 2021 that proposed generative dynamical systems models of time-varying signals in BD. Two raters independently applied the VAG-CM to the included studies, obtaining a mean Cohen's κ of 0.55 (95% CI [0.45, 0.64]) prior to establishing consensus ratings. Consensus VAG-CM ratings revealed three model/study clusters: data-driven models with face validity, theory-driven models with predictive validity, and theory-driven models lacking all forms of validity. We conclude that future modeling studies should employ a hybrid approach that first operationalizes BD features of interest using empirical data to achieve face validity, followed by explanations of those features using generative models with components that are homologous to physiological or psychological systems involved in BD, to achieve construct validity. Such models would be best developed alongside long-term prospective cohort studies involving a collection of multimodal time-series data. We also encourage future studies to extend, modify, and evaluate the VAG-CM approach for a wider breadth of computational modeling studies and psychiatric disorders.
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Affiliation(s)
- Abraham Nunes
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada.
| | - Selena Singh
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
| | - Jared Allman
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Suzanna Becker
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
| | - Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction & Mental Health, Toronto, ON, Canada
| | | | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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3
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Ortiz A, Hintze A, Burnett R, Gonzalez-Torres C, Unger S, Yang D, Miao J, Alda M, Mulsant BH. Identifying patient-specific behaviors to understand illness trajectories and predict relapses in bipolar disorder using passive sensing and deep anomaly detection: protocol for a contactless cohort study. BMC Psychiatry 2022; 22:288. [PMID: 35459150 PMCID: PMC9026652 DOI: 10.1186/s12888-022-03923-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Predictive models for mental disorders or behaviors (e.g., suicide) have been successfully developed at the level of populations, yet current demographic and clinical variables are neither sensitive nor specific enough for making individual clinical predictions. Forecasting episodes of illness is particularly relevant in bipolar disorder (BD), a mood disorder with high recurrence, disability, and suicide rates. Thus, to understand the dynamic changes involved in episode generation in BD, we propose to extract and interpret individual illness trajectories and patterns suggestive of relapse using passive sensing, nonlinear techniques, and deep anomaly detection. Here we describe the study we have designed to test this hypothesis and the rationale for its design. METHOD This is a protocol for a contactless cohort study in 200 adult BD patients. Participants will be followed for up to 2 years during which they will be monitored continuously using passive sensing, a wearable that collects multimodal physiological (heart rate variability) and objective (sleep, activity) data. Participants will complete (i) a comprehensive baseline assessment; (ii) weekly assessments; (iii) daily assessments using electronic rating scales. Data will be analyzed using nonlinear techniques and deep anomaly detection to forecast episodes of illness. DISCUSSION This proposed contactless, large cohort study aims to obtain and combine high-dimensional, multimodal physiological, objective, and subjective data. Our work, by conceptualizing mood as a dynamic property of biological systems, will demonstrate the feasibility of incorporating individual variability in a model informing clinical trajectories and predicting relapse in BD.
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Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
- Centre for Addiction and Mental Health (CAMH), 100 Stokes St., Rm 4229, Toronto, ON, Canada.
| | - Arend Hintze
- Department of Computer Science, Dalarna University, Dalarna, Sweden
| | - Rachael Burnett
- Centre for Addiction and Mental Health (CAMH), 100 Stokes St., Rm 4229, Toronto, ON, Canada
| | - Christina Gonzalez-Torres
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health (CAMH), 100 Stokes St., Rm 4229, Toronto, ON, Canada
| | - Samantha Unger
- Centre for Addiction and Mental Health (CAMH), 100 Stokes St., Rm 4229, Toronto, ON, Canada
| | - Dandan Yang
- Centre for Addiction and Mental Health (CAMH), 100 Stokes St., Rm 4229, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Jingshan Miao
- Centre for Addiction and Mental Health (CAMH), 100 Stokes St., Rm 4229, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health (CAMH), 100 Stokes St., Rm 4229, Toronto, ON, Canada
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4
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Bos FM, Schreuder MJ, George SV, Doornbos B, Bruggeman R, van der Krieke L, Haarman BCM, Wichers M, Snippe E. Anticipating manic and depressive transitions in patients with bipolar disorder using early warning signals. Int J Bipolar Disord 2022; 10:12. [PMID: 35397076 PMCID: PMC8994809 DOI: 10.1186/s40345-022-00258-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background In bipolar disorder treatment, accurate episode prediction is paramount but remains difficult. A novel idiographic approach to prediction is to monitor generic early warning signals (EWS), which may manifest in symptom dynamics. EWS could thus form personalized alerts in clinical care. The present study investigated whether EWS can anticipate manic and depressive transitions in individual patients with bipolar disorder. Methods Twenty bipolar type I/II patients (with ≥ 2 episodes in the previous year) participated in ecological momentary assessment (EMA), completing five questionnaires a day for four months (Mean = 491 observations per person). Transitions were determined by weekly completed questionnaires on depressive (Quick Inventory for Depressive Symptomatology Self-Report) and manic (Altman Self-Rating Mania Scale) symptoms. EWS (rises in autocorrelation at lag-1 and standard deviation) were calculated in moving windows over 17 affective and symptomatic EMA states. Positive and negative predictive values were calculated to determine clinical utility. Results Eleven patients reported 1–2 transitions. The presence of EWS increased the probability of impending depressive and manic transitions from 32-36% to 46–48% (autocorrelation) and 29–41% (standard deviation). However, the absence of EWS could not be taken as a sign that no transition would occur in the near future. The momentary states that indicated nearby transitions most accurately (predictive values: 65–100%) were full of ideas, worry, and agitation. Large individual differences in the utility of EWS were found. Conclusions EWS show theoretical promise in anticipating manic and depressive transitions in bipolar disorder, but the level of false positives and negatives, as well as the heterogeneity within and between individuals and preprocessing methods currently limit clinical utility. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00258-4.
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Affiliation(s)
- Fionneke M Bos
- Department of Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. .,Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Marieke J Schreuder
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandip V George
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Computer Science , University College London , London, United Kingdom
| | - Bennard Doornbos
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Richard Bruggeman
- Department of Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Lian van der Krieke
- Department of Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.,Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bartholomeus C M Haarman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke Wichers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Evelien Snippe
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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5
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Gruichich TS, Gomez JCD, Zayas-Cabán G, McInnis MG, Cochran AL. A digital self-report survey of mood for bipolar disorder. Bipolar Disord 2021; 23:810-820. [PMID: 33587813 PMCID: PMC8364560 DOI: 10.1111/bdi.13058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/13/2020] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Bipolar disorder (BP) is commonly researched in digital settings. As a result, standardized digital tools are needed to measure mood. We sought to validate a new survey that is brief, validated in digital form, and able to separately measure manic and depressive severity. METHODS We introduce a 6-item digital survey, called digiBP, for measuring mood in BP. It has three depressive items (depressed mood, fidgeting, fatigue), two manic items (increased energy, rapid speech), and one mixed item (irritability); and recovers two scores (m and d) to measure manic and depressive severity. In a secondary analysis of individuals with BP who monitored their symptoms over 6 weeks (n = 43), we perform a series of analyses to validate the digiBP survey internally, externally, and as a longitudinal measure. RESULTS We first verify a conceptual model for the survey in which items load onto two factors ("manic" and "depressive"). We then show weekly averages of m and d scores from digiBP can explain significant variation in weekly scores from the Young Mania Rating Scale (R2 = 0.47) and SIGH-D (R2 = 0.58). Lastly, we examine the utility of the survey as a longitudinal measure by predicting an individual's future m and d scores from their past m and d scores. CONCLUSIONS While further validation is warranted in larger, diverse populations, these validation analyses should encourage researchers to consider digiBP for their next digital study of BP.
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6
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Ortiz A, Bradler K, Mowete M, MacLean S, Garnham J, Slaney C, Mulsant BH, Alda M. The futility of long-term predictions in bipolar disorder: mood fluctuations are the result of deterministic chaotic processes. Int J Bipolar Disord 2021; 9:30. [PMID: 34596784 PMCID: PMC8486895 DOI: 10.1186/s40345-021-00235-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/17/2021] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Understanding the underlying architecture of mood regulation in bipolar disorder (BD) is important, as we are starting to conceptualize BD as a more complex disorder than one of recurring manic or depressive episodes. Nonlinear techniques are employed to understand and model the behavior of complex systems. Our aim was to assess the underlying nonlinear properties that account for mood and energy fluctuations in patients with BD; and to compare whether these processes were different in healthy controls (HC) and unaffected first-degree relatives (FDR). We used three different nonlinear techniques: Lyapunov exponent, detrended fluctuation analysis and fractal dimension to assess the underlying behavior of mood and energy fluctuations in all groups; and subsequently to assess whether these arise from different processes in each of these groups. RESULTS There was a positive, short-term autocorrelation for both mood and energy series in all three groups. In the mood series, the largest Lyapunov exponent was found in HC (1.84), compared to BD (1.63) and FDR (1.71) groups [F (2, 87) = 8.42, p < 0.005]. A post-hoc Tukey test showed that Lyapunov exponent in HC was significantly higher than both the BD (p = 0.003) and FDR groups (p = 0.03). Similarly, in the energy series, the largest Lyapunov exponent was found in HC (1.85), compared to BD (1.76) and FDR (1.67) [F (2, 87) = 11.02; p < 0.005]. There were no significant differences between groups for the detrended fluctuation analysis or fractal dimension. CONCLUSIONS The underlying nature of mood variability is in keeping with that of a chaotic system, which means that fluctuations are generated by deterministic nonlinear process(es) in HC, BD, and FDR. The value of this complex modeling lies in analyzing the nature of the processes involved in mood regulation. It also suggests that the window for episode prediction in BD will be inevitably short.
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Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Centre for Addiction & Mental Health, CAMH 100 Stokes St., Rm 4229, Toronto, ON, M6J 1H4, Canada.
| | | | - Maxine Mowete
- Department of Electrical Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Stephane MacLean
- Institute for Mental Health Research, The Royal Ottawa Hospital, Ottawa, ON, Canada
| | | | | | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction & Mental Health, CAMH 100 Stokes St., Rm 4229, Toronto, ON, M6J 1H4, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- National Institute of Mental Health, Klecany, Czech Republic
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7
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Wan L, Ai JQ, Yang C, Jiang J, Zhang QL, Luo ZH, Huang RJ, Tu T, Pan A, Tu E, Manavis J, Xiao B, Yan XX. Expression of the Excitatory Postsynaptic Scaffolding Protein, Shank3, in Human Brain: Effect of Age and Alzheimer's Disease. Front Aging Neurosci 2021; 13:717263. [PMID: 34504419 PMCID: PMC8421777 DOI: 10.3389/fnagi.2021.717263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022] Open
Abstract
Shank3 is a postsynaptic scaffolding protein of excitatory synapses. Mutations or variations of SHANK3 are associated with various psychiatric and neurological disorders. We set to determine its normal expression pattern in the human brain, and its change, if any, with age and Alzheimer’s disease (AD)-type β-amyloid (Aβ) and Tau pathogenesis. In general, Shank3 immunoreactivity (IR) exhibited largely a neuropil pattern with differential laminar/regional distribution across brain regions. In youth and adults, subsets of pyramidal/multipolar neurons in the cerebrum, striatum, and thalamus showed moderate IR, while some large-sized neurons in the brainstem and the granule cells in the cerebellar cortex exhibited light IR. In double immunofluorescence, Shank3 IR occurred at the sublemmal regions in neuronal somata and large dendrites, apposing to synaptophysin-labeled presynaptic terminals. In aged cases, immunolabeled neuronal somata were reduced, with disrupted neuropil labeling seen in the molecular layer of the dentate gyrus in AD cases. In immunoblot, levels of Shank3 protein were positively correlated with that of the postsynaptic density protein 95 (PSD95) among different brain regions. Levels of Shank3, PSD95, and synaptophysin immunoblotted in the prefrontal, precentral, and cerebellar cortical lysates were reduced in the aged and AD relative to youth and adult groups. Taken together, the differential Shank3 expression among brain structures/regions indicates the varied local density of the excitatory synapses. The enriched Shank3 expression in the forebrain subregions appears inconsistent with a role of this protein in the modulation of high cognitive functions. The decline of its expression in aged and AD brains may relate to the degeneration of excitatory synapses.
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Affiliation(s)
- Lily Wan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jia-Qi Ai
- Department of Anatomy and Neurobiology, Central South University Xiangya School of Medicine, Changsha, China
| | - Chen Yang
- Department of Anatomy and Neurobiology, Central South University Xiangya School of Medicine, Changsha, China
| | - Juan Jiang
- Department of Anatomy and Neurobiology, Central South University Xiangya School of Medicine, Changsha, China
| | - Qi-Lei Zhang
- Department of Anatomy and Neurobiology, Central South University Xiangya School of Medicine, Changsha, China
| | - Zhao-Hui Luo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Rou-Jie Huang
- Medical Doctor Program, Xiangya School of Medicine, Central South University, Changsha, China
| | - Tian Tu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Aihua Pan
- Department of Anatomy and Neurobiology, Central South University Xiangya School of Medicine, Changsha, China
| | - Ewen Tu
- Department of Neurology, Brain Hospital of Hunan Province, Changsha, China
| | - Jim Manavis
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiao-Xin Yan
- Department of Anatomy and Neurobiology, Central South University Xiangya School of Medicine, Changsha, China
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8
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Wan L, Liu D, Xiao WB, Zhang BX, Yan XX, Luo ZH, Xiao B. Association of SHANK Family with Neuropsychiatric Disorders: An Update on Genetic and Animal Model Discoveries. Cell Mol Neurobiol 2021; 42:1623-1643. [PMID: 33595806 DOI: 10.1007/s10571-021-01054-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
The Shank family proteins are enriched at the postsynaptic density (PSD) of excitatory glutamatergic synapses. They serve as synaptic scaffolding proteins and appear to play a critical role in the formation, maintenance and functioning of synapse. Increasing evidence from genetic association and animal model studies indicates a connection of SHANK genes defects with the development of neuropsychiatric disorders. In this review, we first update the current understanding of the SHANK family genes and their encoded protein products. We then denote the literature relating their alterations to the risk of neuropsychiatric diseases. We further review evidence from animal models that provided molecular insights into the biological as well as pathogenic roles of Shank proteins in synapses, and the potential relationship to the development of abnormal neurobehavioral phenotypes.
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Affiliation(s)
- Lily Wan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Du Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Taikang Tongji Hospital, Wuhan, 430050, Hubei, China
| | - Wen-Biao Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Bo-Xin Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Xiao-Xin Yan
- Department of Anatomy and Neurobiology, Central South University, Changsha, 410013, Hunan, China
| | - Zhao-Hui Luo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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9
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Sulis W. The Continuum Between Temperament and Mental Illness as Dynamical Phases and Transitions. Front Psychiatry 2021; 11:614982. [PMID: 33536952 PMCID: PMC7848037 DOI: 10.3389/fpsyt.2020.614982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/21/2020] [Indexed: 12/31/2022] Open
Abstract
The full range of biopsychosocial complexity is mind-boggling, spanning a vast range of spatiotemporal scales with complicated vertical, horizontal, and diagonal feedback interactions between contributing systems. It is unlikely that such complexity can be dealt with by a single model. One approach is to focus on a narrower range of phenomena which involve fewer systems but still cover the range of spatiotemporal scales. The suggestion is to focus on the relationship between temperament in healthy individuals and mental illness, which have been conjectured to lie along a continuum of neurobehavioral regulation involving neurochemical regulatory systems (e.g., monoamine and acetylcholine, opiate receptors, neuropeptides, oxytocin), and cortical regulatory systems (e.g., prefrontal, limbic). Temperament and mental illness are quintessentially dynamical phenomena, and need to be addressed in dynamical terms. A meteorological metaphor suggests similarities between temperament and chronic mental illness and climate, between individual behaviors and weather, and acute mental illness and frontal weather events. The transition from normative temperament to chronic mental illness is analogous to climate change. This leads to the conjecture that temperament and chronic mental illness describe distinct, high level, dynamical phases. This suggests approaching biopsychosocial complexity through the study of dynamical phases, their order and control parameters, and their phase transitions. Unlike transitions in physical systems, these biopsychosocial phase transitions involve information and semiotics. The application of complex adaptive dynamical systems theory has led to a host of markers including geometrical markers (periodicity, intermittency, recurrence, chaos) and analytical markers such as fluctuation spectroscopy, scaling, entropy, recurrence time. Clinically accessible biomarkers, in particular heart rate variability and activity markers have been suggested to distinguish these dynamical phases and to signal the presence of transitional states. A particular formal model of these dynamical phases will be presented based upon the process algebra, which has been used to model information flow in complex systems. In particular it describes the dual influences of energy and information on the dynamics of complex systems. The process algebra model is well-suited for dealing with the particular dynamical features of the continuum, which include transience, contextuality, and emergence. These dynamical phases will be described using the process algebra model and implications for clinical practice will be discussed.
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Affiliation(s)
- William Sulis
- Collective Intelligence Laboratory, Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada
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10
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Xue S, Husain MI, Ortiz A, Husain MO, Daskalakis ZJ, Mulsant BH. COVID-19: Implications for bipolar disorder clinical care and research. SAGE Open Med 2020; 8:2050312120981178. [PMID: 33403113 PMCID: PMC7739076 DOI: 10.1177/2050312120981178] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/24/2020] [Indexed: 01/12/2023] Open
Abstract
The COVID-19 pandemic has posed significant challenges to health care globally, and individuals with bipolar disorder are likely disproportionally affected. Based on review of literature and collective clinical experience, we discuss that without special intervention, individuals with bipolar disorder will experience poorer physical and mental health outcomes due to interplay of patient, provider and societal factors. Some risk factors associated with bipolar disorder, including irregular social rhythms, risk-taking behaviours, substantial medical comorbidities, and prevalent substance use, may be compounded by lockdowns, social isolation and decrease in preventive and maintenance care. We further discuss implications for clinical research of bipolar disorders during the pandemic. Finally, we propose mitigation strategies on working with individuals with bipolar disorder in a clinical and research context, focusing on digital medicine strategies to improve quality of and accessibility to service.
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Affiliation(s)
- Siqi Xue
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - M Omair Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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11
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Rajula HSR, Manchia M, Carpiniello B, Fanos V. Big data in severe mental illness: the role of electronic monitoring tools and metabolomics. Per Med 2020; 18:75-90. [PMID: 33124507 DOI: 10.2217/pme-2020-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
There is an increasing interest in the development of effective early detection and intervention strategies in severe mental illness (SMI). Ideally, these efforts should lead to the delineation of accurate staging models of SMI enabling personalized interventions. It is plausible that big data approaches will be instrumental in describing the developmental trajectories of SMI by facilitating the incorporation of data from multiple sources, including those pertaining to the biological make-up of affected subjects. In this review, we first aimed to offer a perspective on how big data are helping the delineation of personalized approaches in SMI, and, second, to offer a quantitative synthesis of big data approaches in metabolomics of SMI. We finally described future directions of this research area.
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Affiliation(s)
- Hema Sekhar Reddy Rajula
- Department of Surgical Sciences, Neonatal Intensive Care Unit, Neonatal Pathology & Neonatal Section, University of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Department of Medical Science & Public Health, Section of Psychiatry, University of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3H4R2, Canada.,Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Bernardo Carpiniello
- Department of Medical Science & Public Health, Section of Psychiatry, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, Neonatal Intensive Care Unit, Neonatal Pathology & Neonatal Section, University of Cagliari, Cagliari, Italy
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12
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Nunes A, Trappenberg T, Alda M. The definition and measurement of heterogeneity. Transl Psychiatry 2020; 10:299. [PMID: 32839448 PMCID: PMC7445182 DOI: 10.1038/s41398-020-00986-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 07/21/2020] [Accepted: 08/10/2020] [Indexed: 12/31/2022] Open
Abstract
Heterogeneity is an important concept in psychiatric research and science more broadly. It negatively impacts effect size estimates under case-control paradigms, and it exposes important flaws in our existing categorical nosology. Yet, our field has no precise definition of heterogeneity proper. We tend to quantify heterogeneity by measuring associated correlates such as entropy or variance: practices which are akin to accepting the radius of a sphere as a measure of its volume. Under a definition of heterogeneity as the degree to which a system deviates from perfect conformity, this paper argues that its proper measure roughly corresponds to the size of a system's event/sample space, and has units known as numbers equivalent. We arrive at this conclusion through focused review of more than 100 years of (re)discoveries of indices by ecologists, economists, statistical physicists, and others. In parallel, we review psychiatric approaches for quantifying heterogeneity, including but not limited to studies of symptom heterogeneity, microbiome biodiversity, cluster-counting, and time-series analyses. We argue that using numbers equivalent heterogeneity measures could improve the interpretability and synthesis of psychiatric research on heterogeneity. However, significant limitations must be overcome for these measures-largely developed for economic and ecological research-to be useful in modern translational psychiatric science.
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Affiliation(s)
- Abraham Nunes
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Thomas Trappenberg
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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13
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A O, K B, J G, C S, S M, M A. Nonlinear dynamics of mood regulation in unaffected first-degree relatives of bipolar disorder patients. J Affect Disord 2019; 243:274-279. [PMID: 30248639 DOI: 10.1016/j.jad.2018.09.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/14/2018] [Accepted: 09/15/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Mood regulation is a complex and poorly understood process. In this study, we aimed to analyze the underlying dynamics of mood regulation in unaffected first degree relatives of patients diagnosed with bipolar disorder using time-series analysis. METHODS We recruited 30 unaffected first-degree relatives of bipolar disorder patients. Participants rated their mood, anxiety and energy levels using a paper-based visual analog scale; they recorded their sleep and life events as well. Participants provided information on these variables over a three month period, twice per day. We compared their data using Box-Jenkins time series analysis with data from 30 healthy controls (HC) and 30 euthymic bipolar patients (BD) to obtain information on the autocorrelation and cross-correlation of the series, and calculated entropy for mood, anxiety and energy series. RESULTS We analyzed 14,980 data points: 5200 in the healthy control group; 4970 in the bipolar group and 4810 in the unaffected relatives group. There were no significant differences between groups in terms of age, sex or education levels. Using Kolmogorov-Smirnov test, we found that individual measures were normally distributed in the whole sample (D = 0.23, p > 0.1). Autocorrelation functions for mood in all groups are governed by the ARIMA (1,1,0) model, which means that current values in the series are related to one previous point only. In terms of entropy for the mood series, unaffected relatives and bipolar patients showed lower values [mean (SD) : 1.028 ± 0.679; 1.042 ± 0.680], respectively, compared to healthy controls [(1.476 ± 0.33); F (2,74) = 4.39, p < 0.01]. The same case was seen in the energy series, with lower values in the unaffected relatives and bipolar patient groups [mean (SD) : 1.644 ± 0.566; 1.511 ± 0.879], respectively, compared to healthy controls [2.230 ± 0.531; F(2, 75) = 7.89, p < 0.001]. LIMITATIONS Low resolution for the visual analog scale. CONCLUSIONS Using nonlinear analyses, we found that the underlying structure of mood regulation in unaffected relatives is undistinguishable from the one found in bipolar patients. Compared to healthy controls, both bipolar patients and their unaffected relatives showed lower entropy levels, which is in keeping with a more rigid system, not as flexible to cope with the demands of a changing environment.
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Affiliation(s)
- Ortiz A
- Mood Disorders Program, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Bradler K
- Department of Mathematics, University of Ottawa, Ottawa, ON, Canada
| | - Garnham J
- Mood Disorders Program, Capital Health District Authority, Halifax, NS, Canada
| | - Slaney C
- Mood Disorders Program, Capital Health District Authority, Halifax, NS, Canada
| | - McLean S
- Mood Disorders Program, Royal Ottawa Hospital, Ottawa, ON, Canada
| | - Alda M
- Mood Disorders Program, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada; National Institute of Mental Health, Klecany, Czech Republic
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14
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Affiliation(s)
- Abigail Ortiz
- From the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Ortiz); the Department of Psychiatry, Dalhousie University, Halifax, NS, Canada (Alda); and the National Institute of Mental Health, Klecany, Czech Republic(Alda)
| | - Martin Alda
- From the Department of Psychiatry, University of Toronto, Toronto, Ont., Canada (Ortiz); the Department of Psychiatry, Dalhousie University, Halifax, NS, Canada (Alda); and the National Institute of Mental Health, Klecany, Czech Republic(Alda)
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15
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Sulis W. Assessing the continuum between temperament and affective illness: psychiatric and mathematical perspectives. Philos Trans R Soc Lond B Biol Sci 2018; 373:20170168. [PMID: 29483352 PMCID: PMC5832692 DOI: 10.1098/rstb.2017.0168] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 12/21/2022] Open
Abstract
Temperament of healthy people and mental illnesses, particularly affective disorders, have been conjectured to lie along a continuum of neurobehavioural regulation. Understanding the nature of this continuum may better inform the construction of taxonomies for both categories of behaviour. Both temperament and mental illness refer to patterns of behaviour that manifest over long time scales (weeks to years) and they appear to share many underlying neuroregulatory systems. This continuum is discussed from the perspectives of nonlinear dynamical systems theory, neurobiology and psychiatry as applied to understanding such multiscale time-series behaviour. Particular emphasis is given to issues of generativity, fungibility, metastability, non-stationarity and contextuality. Implications of these dynamical properties for the development of taxonomies will be discussed. Problems with the over-reliance of psychologists on statistical and mathematical methods in deriving their taxonomies (particularly those based on factor analysis) will be discussed from a dynamical perspective. An alternative approach to temperament based upon functionality, and its discriminative capabilities in mental illness, is presented.This article is part of the theme issue 'Diverse perspectives on diversity: multi-disciplinary approaches to taxonomies of individual differences'.
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Affiliation(s)
- William Sulis
- Collective Intelligence Laboratory, Department of Psychiatry and Behavioral Science, McMaster University, 92 Bowman Street, Hamilton, Ontario, Canada
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16
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Ortiz A, Bradler K, Hintze A. Episode forecasting in bipolar disorder: Is energy better than mood? Bipolar Disord 2018; 20:470-476. [PMID: 29356281 DOI: 10.1111/bdi.12603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 09/27/2017] [Accepted: 12/15/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Bipolar disorder is a severe mood disorder characterized by alternating episodes of mania and depression. Several interventions have been developed to decrease high admission rates and high suicides rates associated with the illness, including psychoeducation and early episode detection, with mixed results. More recently, machine learning approaches have been used to aid clinical diagnosis or to detect a particular clinical state; however, contradictory results arise from confusion around which of the several automatically generated data are the most contributory and useful to detect a particular clinical state. Our aim for this study was to apply machine learning techniques and nonlinear analyses to a physiological time series dataset in order to find the best predictor for forecasting episodes in mood disorders. METHODS We employed three different techniques: entropy calculations and two different machine learning approaches (genetic programming and Markov Brains as classifiers) to determine whether mood, energy or sleep was the best predictor to forecast a mood episode in a physiological time series. RESULTS Evening energy was the best predictor for both manic and depressive episodes in each of the three aforementioned techniques. This suggests that energy might be a better predictor than mood for forecasting mood episodes in bipolar disorder and that these particular machine learning approaches are valuable tools to be used clinically. CONCLUSIONS Energy should be considered as an important factor for episode prediction. Machine learning approaches provide better tools to forecast episodes and to increase our understanding of the processes that underlie mood regulation.
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Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Kamil Bradler
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, ON, Canada
| | - Arend Hintze
- Department of Integrative Biology, Michigan State University, East Lansing, MI, USA
- Department of Computer Science and Engineering, Michigan State University, East Lansing, MI, USA
- BEACON Center for studying Evolution in Action, Michigan State University, East Lansing, MI, USA
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17
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Harrison PJ, Cipriani A, Harmer CJ, Nobre AC, Saunders K, Goodwin GM, Geddes JR. Innovative approaches to bipolar disorder and its treatment. Ann N Y Acad Sci 2017; 1366:76-89. [PMID: 27111134 PMCID: PMC4850752 DOI: 10.1111/nyas.13048] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/25/2016] [Accepted: 03/01/2016] [Indexed: 12/29/2022]
Abstract
All psychiatric disorders have suffered from a dearth of truly novel pharmacological interventions. In bipolar disorder, lithium remains a mainstay of treatment, six decades since its effects were serendipitously discovered. The lack of progress reflects several factors, including ignorance of the disorder's pathophysiology and the complexities of the clinical phenotype. After reviewing the current status, we discuss some ways forward. First, we highlight the need for a richer characterization of the clinical profile, facilitated by novel devices and new forms of data capture and analysis; such data are already promoting a reevaluation of the phenotype, with an emphasis on mood instability rather than on discrete clinical episodes. Second, experimental medicine can provide early indications of target engagement and therapeutic response, reducing the time, cost, and risk involved in evaluating potential mood stabilizers. Third, genomic data can inform target identification and validation, such as the increasing evidence for involvement of calcium channel genes in bipolar disorder. Finally, new methods and models relevant to bipolar disorder, including stem cells and genetically modified mice, are being used to study key pathways and drug effects. A combination of these approaches has real potential to break the impasse and deliver genuinely new treatments.
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Affiliation(s)
- Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Anna C Nobre
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom.,Oxford Centre for Human Brain Activity, Warneford Hospital, Oxford, United Kingdom
| | - Kate Saunders
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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18
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Electronic monitoring of self-reported mood: the return of the subjective? Int J Bipolar Disord 2016; 4:28. [PMID: 27900735 PMCID: PMC5127918 DOI: 10.1186/s40345-016-0069-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 11/19/2016] [Indexed: 11/10/2022] Open
Abstract
This narrative review describes recent developments in the use of technology for utilizing the self-monitoring of mood, provides some relevant background, and suggests some promising directions. Subjective experience of mood is one of the valuable sources of information about the state of an integrated mind/brain system. During the past century, psychiatry and psychology moved away from subjectivity, emphasizing external observation, precise measurement, and laboratory techniques. This shift, however, provided only a limited improvement in the understanding of mood disorders, and it appears that self-monitoring of mood has the potential to enrich our knowledge, particularly when combined with the advances in technology. Modern technology, with its ability to transfer information from the individual directly to the researcher via electronic applications, enables us now to study mood regulation more thoroughly. Frequent subjective ratings can be helpful in identifying individualized treatment with effective mood stabilizers and recognizing subtypes of mood disorders. The variability of subjective ratings may also help us estimate the increased risk of recurrence and guide a tailored treatment.
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19
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Depp C, Torous J, Thompson W. Technology-Based Early Warning Systems for Bipolar Disorder: A Conceptual Framework. JMIR Ment Health 2016; 3:e42. [PMID: 27604265 PMCID: PMC5031894 DOI: 10.2196/mental.5798] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/03/2016] [Accepted: 06/04/2016] [Indexed: 12/21/2022] Open
Abstract
Recognition and timely action around "warning signs" of illness exacerbation is central to the self-management of bipolar disorder. Due to its heterogeneity and fluctuating course, passive and active mobile technologies have been increasingly evaluated as adjunctive or standalone tools to predict and prevent risk of worsening of course in bipolar disorder. As predictive analytics approaches to big data from mobile health (mHealth) applications and ancillary sensors advance, it is likely that early warning systems will increasingly become available to patients. Such systems could reduce the amount of time spent experiencing symptoms and diminish the immense disability experienced by people with bipolar disorder. However, in addition to the challenges in validating such systems, we argue that early warning systems may not be without harms. Probabilistic warnings may be delivered to individuals who may not be able to interpret the warning, have limited information about what behaviors to change, or are unprepared to or cannot feasibly act due to time or logistic constraints. We propose five essential elements for early warning systems and provide a conceptual framework for designing, incorporating stakeholder input, and validating early warning systems for bipolar disorder with a focus on pragmatic considerations.
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Affiliation(s)
- Colin Depp
- Stein Institute for Research on Aging, Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.
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20
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de la Torre-Luque A, Bornas X, Balle M, Fiol-Veny A. Complexity and nonlinear biomarkers in emotional disorders: A meta-analytic study. Neurosci Biobehav Rev 2016; 68:410-422. [PMID: 27267791 DOI: 10.1016/j.neubiorev.2016.05.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/18/2016] [Accepted: 05/23/2016] [Indexed: 11/15/2022]
Abstract
This meta-analysis aimed at gathering and summarising the findings on nonlinear biomarkers in the field of emotional disorders under the hypothesis that diseased systems show lowered complexity and hence less flexibility to adjust daily contexts. Scientific manuscripts from 1970 to 2014 were reviewed, 58 articles were analysed, and independent meta-analyses on anxiety disorders, bipolar disorders, and depressive disorders were conducted. Results revealed that anxious patients exhibited lower complexity than controls (p<0.05) despite panic patients showed more irregular respiratory activity. Inconclusive results were found for bipolar patients but pointed to higher randomness when suffering manic episodes. Finally, depressed patients showed a loss of complexity in the cardiac system and a loss of orderliness (despite a higher complexity) in brain and stress-related hormonal systems. As a conclusion, our findings highlight that either a loss of complexity or a loss of ordered complexity characterise the physiological systems of patients with emotional disorders. Several considerations for complexity, its related measurements, and suggestions for further research are discussed.
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Affiliation(s)
| | - Xavier Bornas
- Research Institute of Health Sciences, University of the Balearic Islands, Spain
| | - Maria Balle
- Research Institute of Health Sciences, University of the Balearic Islands, Spain
| | - Aina Fiol-Veny
- Research Institute of Health Sciences, University of the Balearic Islands, Spain
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