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Stix K, Dalkner N, Bengesser SA, Birner A, Fellendorf FT, Häussl A, Lenger M, Maget A, Painold A, Platzer M, Queissner R, Schmiedhofer F, Schönthaler E, Schwerdtfeger A, Stross T, Tmava-Berisha A, Weber B, Unterrainer HF, Reininghaus EZ. Theory of mind abilities during the course of bipolar disorder: A longitudinal study using mixed models. Psychiatry Res 2024; 339:116039. [PMID: 38924901 DOI: 10.1016/j.psychres.2024.116039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 03/11/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
Theory of mind (ToM) deficits, difficulties in recognizing the intentions, propensities, and beliefs of others have been shown in individuals with bipolar disorder in several studies; however, it is not yet elucidated how ToM abilities changes over the course of bipolar disorder and is related to illness symptoms. This is one of the first longitudinal studies to compare the ToM abilities of euthymic bipolar individuals and healthy controls over a four and a half years period. ToM abilities were measured using the Reading the Mind in the Eyes Test (RMET). A total of 91 euthymic bipolar individuals and 91 healthy controls were included in the analyses. Linear mixed models were used to compare ToM abilities of bipolar individuals and healthy controls. It was found that bipolar individuals scored lower on average on the RMET than healthy controls and that these RMET scores were stable over four and a half years. The results of this study suggest that ToM deficits are a stable (possibly endophenotypic) trait of bipolar disorder. This understanding can contribute to better identification, assessment, and treatment strategies for individuals with bipolar disorder, ultimately improving their overall care and outcome.
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Affiliation(s)
- Katharina Stix
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria.
| | - Susanne A Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Alfred Häussl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Franziska Schmiedhofer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Elena Schönthaler
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | | | - Tatjana Stross
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | - Adelina Tmava-Berisha
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria
| | | | - Human-F Unterrainer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria; Institute of Psychology, University of Graz, Austria; Faculty of Psychotherapy Science, Sigmund Freud University, Vienna, Austria; Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria; Department of Religious Studies, University of Vienna, Austria
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria
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Bjornson KJ, Vanderplow AM, Bhasker AI, Cahill ME. Increased regional activity of a pro-autophagy pathway in schizophrenia as a contributor to sex differences in the disease pathology. Cell Rep Med 2024; 5:101652. [PMID: 39019008 PMCID: PMC11293356 DOI: 10.1016/j.xcrm.2024.101652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/14/2024] [Accepted: 06/19/2024] [Indexed: 07/19/2024]
Abstract
Based on recent genome-wide association studies, it is theorized that altered regulation of autophagy contributes to the pathophysiology of schizophrenia and bipolar disorder. As activity of autophagy-regulatory pathways is controlled by discrete phosphorylation sites on the relevant proteins, phospho-protein profiling is one of the few approaches available for enabling a quantitative assessment of autophagic activity in the brain. Despite this, a comprehensive phospho-protein assessment in the brains of schizophrenia and bipolar disorder subjects is currently lacking. Using this direction, our broad screening identifies an increase in AMP-activated protein kinase (AMPK)-mediated phospho-activation of the pro-autophagy protein beclin-1 solely in the prefrontal cortex of female, but not male, schizophrenia subjects. Using a reverse translational approach, we surprisingly find that this increase in beclin-1 activity facilitates synapse formation and enhances cognition. These findings are interpreted in the context of human studies demonstrating that female schizophrenia subjects have a lower susceptibility to cognitive dysfunction than males.
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Affiliation(s)
- Kathryn J Bjornson
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Amanda M Vanderplow
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Aishwarya I Bhasker
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Michael E Cahill
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53706, USA.
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Yoldi-Negrete M, Fresán A, Jiménez-Rodríguez LI, Tirado-Durán EG. Cognition in Euthymic Patients with Bipolar Disorder: Do Not Forget to Account for Anxiety! Neuropsychiatr Dis Treat 2024; 20:1181-1189. [PMID: 38855382 PMCID: PMC11162183 DOI: 10.2147/ndt.s457186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/11/2024] [Indexed: 06/11/2024] Open
Abstract
Purpose Despite the high prevalence of anxiety disorders in BD and its known impact on cognitive performance, the presence and severity of anxious symptoms is not systematically evaluated in studies on cognition in BD. Our aim was to determine if attention and/or inhibition of cognitive interference in euthymic patients with type I Bipolar Disorder (BD-I) is affected by symptoms of anxiety. Patients and Methods Eighty-seven euthymic BD-I patients were included. Patients with comorbidities other than Generalized Anxiety Disorder (GAD) or Panic Disorder (PD) were excluded. State anxiety was measured with the Brief Inventory of Anxious Responses and Situations (ISRA-B). Subjective cognitive performance was evaluated with the COBRA scale, attention with the Digit-Span Forward task and inhibition of cognitive interference was assessed with the StroopTest interference score. Multiple linear regression models were used to test if anxious symptoms were associated with attention or inhibition of cognitive interference, considering other known contributors for cognitive impairment. Results Attention was unaffected by anxiety symptoms, but the overall regression for inhibition of cognitive interference was significant: years of schooling (β=1.12, p = 0.001), cognitive complaints (β=0.44, p = 0.008), and anxiety (β=-0.21, p = 0.017) explained 15% of the interference score of the Stroop test (R2 = 0.15). Conclusion Beyond residual affective symptoms, anxious symptoms seem to affect inhibition of cognitive interference. We recommend routine testing of anxiety when considering cognitive evaluations, especially when screening for cognitive deficits.
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Affiliation(s)
- María Yoldi-Negrete
- Clinical Epidemiology Laboratory, Clinical Research Directorate, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Ana Fresán
- Clinical Epidemiology Laboratory, Clinical Research Directorate, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Laura Ivone Jiménez-Rodríguez
- Department of Psychology, Neuropsychology, Clinical Services Directorate, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Elsa Georgina Tirado-Durán
- Department of Psychology, Neuropsychology, Clinical Services Directorate, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
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Razavi MS, Fathi M, Vahednia E, Ardani AR, Honari S, Akbarzadeh F, Talaei A. Cognitive rehabilitation in bipolar spectrum disorder: A systematic review. IBRO Neurosci Rep 2024; 16:509-517. [PMID: 38645887 PMCID: PMC11033165 DOI: 10.1016/j.ibneur.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024] Open
Abstract
Background and objectives Neurocognitive deficits in bipolar disorder (BD) have a negative impact on the quality of life, even during the euthymic phase. And many studies conducted to improve cognitive deficits in bipolar disorder. This systematic review aims to summarize studies on cognitive rehabilitation (CR) conducted in bipolar patients and evaluate its impact on neurocognitive deficits. The primary objective is to explore how CR interventions can enhance cognitive functioning, treatment outcomes, and overall quality of life in this population. Methods A comprehensive search was conducted on PubMed, Google Scholar, Scopus, Embase, and PsycINFO databases from 1950 to 2023, following the 2015 PRISMA-P guidelines, using search terms related to BD and CR. Results The initial search yielded 371 titles across the five databases. After applying inclusion and exclusion criteria through screening, a total of 23 articles were included in the study. The selected articles evaluated verbal memory, attention, executive functions, and social cognition. Conclusion The findings suggest that CR can be an effective treatment approach for bipolar patients, aimed at enhancing their cognitive abilities, treatment outcomes, and overall quality of life. The primary finding of this study indicates that cognitive-behavioral therapy (CBT) protocols, skill training, and homework exercises, which offer a daily structure, social support, and opportunities for exchanging coping strategies, are more effective in enhancing cognitive functions. However, it is important to acknowledge the notable limitations of this review. Firstly, we did not assess the methodological rigor of the included studies. Additionally, there was a lack of detailed analysis regarding specific cognitive rehabilitation approaches that adhere to core CR principles, resulting in increased heterogeneity within the reviewed studies.
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Affiliation(s)
| | | | - Elham Vahednia
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Rezaei Ardani
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Honari
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Akbarzadeh
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Talaei
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Birner A, Mairinger M, Elst C, Maget A, Fellendorf FT, Platzer M, Queissner R, Lenger M, Tmava-Berisha A, Bengesser SA, Reininghaus EZ, Kreuzthaler M, Dalkner N. Machine-based learning of multidimensional data in bipolar disorder - pilot results. Bipolar Disord 2024; 26:364-375. [PMID: 38531635 DOI: 10.1111/bdi.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Owing to the heterogenic picture of bipolar disorder, it takes approximately 8.8 years to reach a correct diagnosis. Early recognition and early intervention might not only increase quality of life, but also increase life expectancy as a whole in individuals with bipolar disorder. Therefore, we hypothesize that implementing machine learning techniques can be used to support the diagnostic process of bipolar disorder and minimize misdiagnosis rates. MATERIALS AND METHODS To test this hypothesis, a de-identified data set of only demographic information and the results of cognitive tests of 196 patients with bipolar disorder and 145 healthy controls was used to train and compare five different machine learning algorithms. RESULTS The best performing algorithm was logistic regression, with a macro-average F1-score of 0.69 [95% CI 0.66-0.73]. After further optimization, a model with an improved macro-average F1-score of 0.75, a micro-average F1-score of 0.77, and an AUROC of 0.84 was built. Furthermore, the individual amount of contribution per variable on the classification was assessed, which revealed that body mass index, results of the Stroop test, and the d2-R test alone allow for a classification of bipolar disorder with equal performance. CONCLUSION Using these data for clinical application results in an acceptable performance, but has not yet reached a state where it can sufficiently augment a diagnosis made by an experienced clinician. Therefore, further research should focus on identifying variables with the highest amount of contribution to a model's classification.
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Affiliation(s)
- Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Marco Mairinger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Clemens Elst
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Adelina Tmava-Berisha
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Susanne A Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Markus Kreuzthaler
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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Sleurs D, Speranza M, Etain B, Aouizerate B, Aubin V, Bellivier F, Belzeaux R, Carminati M, Courtet P, Dubertret C, Fredembach B, Haffen E, Groppi F, Laurent P, Leboyer M, Llorca PM, Olié E, Polosan M, Schwan R, Weill D, Passerieux C, Roux P. Functioning and neurocognition in very early and early-life onset bipolar disorders: the moderating role of bipolar disorder type. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02372-3. [PMID: 38702455 DOI: 10.1007/s00787-024-02372-3] [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: 12/09/2022] [Accepted: 01/08/2024] [Indexed: 05/06/2024]
Abstract
Defining homogeneous subgroups of bipolar disorder (BD) is a major goal in personalized psychiatry and research. According to the neurodevelopmental theory, age at onset may be a key variable. As potential trait markers of neurodevelopment, cognitive and functional impairment should be greater in the early form of the disease, particularly type 1 BD (BD I). The age at onset was assessed in a multicenter, observational sample of 4190 outpatients with BD. We used a battery of neuropsychological tests to assess six domains of cognition. Functioning was measured using the Functioning Assessment Short Test (FAST). We studied the potential moderation of the type of BD on the associations between the age at onset and cognitive and functioning in a subsample of 2072 euthymic participants, controlling for potential clinical and socio-demographic covariates. Multivariable analyses showed cognition to not be impaired in individuals with early (21-30 years) and very early-life (before 14 years) onset of BD. Functioning was equivalent between individuals with early and midlife-onset of BD II and NOS but better for individuals with early onset of BD I. In contrast, functioning was not worse in individuals with very early-onset BD I but worse in those with very early-onset BD II and NOS. Early-life onset BDs were not characterized by poorer cognition and functioning. Our results do not support the neurodevelopmental view that a worse cognitive prognosis characterizes early-life onset BD. This study suggests that functional remediation may be prioritized for individuals with midlife-onset BD I and very early life onset BD 2 and NOS.
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Affiliation(s)
- D Sleurs
- Fondation FondaMental, Créteil, France.
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie Et Addictologie, Hopital Louis Mourier, 178 Rue Des Renouillers, 92700, Colombes, France.
- Inserm U1266, Faculté de Médecine, Université Paris Cité, Paris, France.
| | - M Speranza
- Fondation FondaMental, Créteil, France
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie de L'Enfant Et de L'Adolescent, Le Chesnay, France
- Université Paris-Saclay, Paris, France
- Université de Versailles Saint-Quentin-En-Yvelines, Versailles, France
- DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif, France
| | - B Etain
- Fondation FondaMental, Créteil, France
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Département de Psychiatrie Et de Médecine Addictologique, Hôpital Fernand Widal, Paris, France
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Université Paris Cité, Paris, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France
- Laboratoire NutriNeuro (UMR INRA 1286), Centre Hospitalier Charles Perrens, Université de Bordeaux, Bordeaux, France
| | - V Aubin
- Fondation FondaMental, Créteil, France
- Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - F Bellivier
- Fondation FondaMental, Créteil, France
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Département de Psychiatrie Et de Médecine Addictologique, Hôpital Fernand Widal, Paris, France
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Université Paris Cité, Paris, France
| | - R Belzeaux
- Fondation FondaMental, Créteil, France
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France
- INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - M Carminati
- Fondation FondaMental, Créteil, France
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Département de Psychiatrie Et de Médecine Addictologique, Hôpital Fernand Widal, Paris, France
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Université Paris Cité, Paris, France
| | - P Courtet
- Fondation FondaMental, Créteil, France
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France
- IGF, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie Et Addictologie, Hopital Louis Mourier, 178 Rue Des Renouillers, 92700, Colombes, France
- Inserm U1266, Faculté de Médecine, Université Paris Cité, Paris, France
| | - B Fredembach
- Fondation FondaMental, Créteil, France
- Grenoble Institut Des Neurosciences (GIN), Université Grenoble Alpes, CHU de Grenoble Et Des Alpes, Inserm U 1216, Grenoble, France
| | - E Haffen
- Fondation FondaMental, Créteil, France
- Département de Psychiatrie Clinique, CIC-1431 INSERM, CHU de Besançon, Besançon, France
- EA481 Neurosciences, Université Bourgogne Franche-Comté, Besançon, France
| | - F Groppi
- Fondation FondaMental, Créteil, France
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France
- INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - P Laurent
- Fondation FondaMental, Créteil, France
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie Et Addictologie, Hopital Louis Mourier, 178 Rue Des Renouillers, 92700, Colombes, France
- Inserm U1266, Faculté de Médecine, Université Paris Cité, Paris, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France
- Translational NeuroPsychiatry Laboratory, Univ Paris Est Créteil, INSERM U955, IMRB, Créteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie Et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France
- Département de Psychiatrie, Centre Hospitalier Et Universitaire, Clermont-Ferrand, France
- Université d'Auvergne, EA 7280, 63000, Clermont-Ferrand, France
| | - E Olié
- Fondation FondaMental, Créteil, France
- Grenoble Institut Des Neurosciences (GIN), Université Grenoble Alpes, CHU de Grenoble Et Des Alpes, Inserm U 1216, Grenoble, France
| | - M Polosan
- Fondation FondaMental, Créteil, France
- Centre Psychothérapique de Nancy, Université de Lorraine , Inserm U1254, Nancy, France
| | - R Schwan
- Fondation FondaMental, Créteil, France
- Centre Psychothérapique de Nancy, Université de Lorraine , Inserm U1254, Nancy, France
| | - D Weill
- Fondation FondaMental, Créteil, France
- Translational NeuroPsychiatry Laboratory, Univ Paris Est Créteil, INSERM U955, IMRB, Créteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie Et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - C Passerieux
- Fondation FondaMental, Créteil, France
- Université Paris-Saclay, Paris, France
- Université de Versailles Saint-Quentin-En-Yvelines, Versailles, France
- DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif, France
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d'Adultes Et d'Addictologie, Le Chesnay, France
| | - P Roux
- Fondation FondaMental, Créteil, France
- Université Paris-Saclay, Paris, France
- Université de Versailles Saint-Quentin-En-Yvelines, Versailles, France
- DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif, France
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d'Adultes Et d'Addictologie, Le Chesnay, France
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Khedr MA, El-Ashry AM, El-Sayed MM, Elkot MA, Hussein RM. The effect of physical exercises program on social functioning, alexithymia, and sense of coherence among patients with bipolar disorders: A randomized control trial. Arch Psychiatr Nurs 2024; 49:83-92. [PMID: 38734459 DOI: 10.1016/j.apnu.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/15/2023] [Accepted: 02/09/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Despite evidence that physical exercises have been helpful in the treatment of various psychiatric disorders, it is unclear whether these data can be generalized to bipolar disorder. The use of physical exercises is challenging and hopeful among patients with bipolar disorders. Few studies have examined the efficacy of physical exercise for patients with bipolar disorders. OBJECTIVE Investigate the effect of applying physical exercises program on social functioning, alexithymia, and sense of coherence among patients with bipolar disorders. METHODS This study followed a randomized control trial design "pre and post-test." Patients were randomly allocated to intervention (n = 25) and control groups (Waiting list) (n = 25). The Social Functioning Scale, Toronto Alexithymia Scale, and Sense of Coherence scales were applied in the study. Pre-test and post-tests were administered to investigate the effect of applying the physical exercises program between December 2022 to March 2023. RESULTS A statistically significant increase in the mean sense of coherence and social functioning scores among the study group. Mean alexithymia scores were significantly decreased among the study group between pre, immediately after, and after a three-month follow-up period. CONCLUSION Physical exercises are an adjunctive treatment modality that is helpful for patients with bipolar disorders. Nurse educators and service providers should reconsider the physical health care requirements for patients with bipolar disorders to equip them to manage the common comorbidities in people with mental illness.
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Affiliation(s)
- Mahmoud Abdelwahab Khedr
- Department of Nursing, College of Applied Medical Sciences, Hafr Albatin University, Hafr Albatin, Saudi Arabia.
| | - Ayman Mohamed El-Ashry
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Alexandria University, Egypt.
| | - Mona Metwally El-Sayed
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Alexandria University, Egypt.
| | - Mohamed Ali Elkot
- Department of Exercises, Faculty of Sports Education for Men, Alexandria University, Egypt.
| | - Rash Mohamed Hussein
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Zagazig University, Zagazig, Egypt; Department of Community and Psychiatric and Mental Health Nursing, College of Nursing, Qassim University, Buraidah, Saudi Arabia.
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8
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Deng F, Fan X, Liao J, Tang R, Sun X, Lin J, Zhang G, Pan J. The effect of neuroendocrine abnormalities on the risk of psychiatric readmission after hospitalization for bipolar disorder: A retrospective study. Prog Neuropsychopharmacol Biol Psychiatry 2024; 130:110922. [PMID: 38114056 DOI: 10.1016/j.pnpbp.2023.110922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The correlation between the endocrine system and bipolar disorder(BD) has been well recognized, yet the influence of neuroendocrine hormones on readmission risk post-hospitalization for BD remains largely unexplored. This retrospective cohort study was to scrutinize the impact of neuroendocrine functionality on the readmission of patients with BD post-hospitalization for mental disorders. METHODS The dataset was derived from the electronic medical records of the First Affiliated Hospital of Jinan University in Guangzhou, China. Both univariate and multivariate logistic regression analysis were conducted on all patients hospitalized for BD, and from 1 January 2017 to October 2022. RESULTS Of the 1110 eligible patients, 83 and 141 patients experienced psychiatric readmissions within 90 and 180 days post-discharge, respectively. Multivariate analysis revealed that high serum TSH levels (aOR = 1.079; 95%CI = 1.003-1.160) and thyroid disease comorbidities (aOR = 2.899; 95%CI = 1.303-6.452) were independently correlated with the risk of 90-day readmission; while increased serum TSH levels (aOR = 1.179; 95%CI = 1.081-1.287) represented a risk factor for 180-day readmission. These results indicate that high serum TSH levels and thyroid disease comorbidities may contribute to an elevated readmission risk in patients with BD following hospitalization. CONCLUSION Routinely evaluating and intervening in thyroid function is crucial in the treatment of BD, as it may aid in preventing re-hospitalization.
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Affiliation(s)
- Fangyi Deng
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China; Department of Psychiatry, Liyuan Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei 430077, China
| | - Xiaoxuan Fan
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jiwu Liao
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Rui Tang
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xizhe Sun
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jingjing Lin
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Guimei Zhang
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jiyang Pan
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China.
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9
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Sari A, Kokacya MH, Ide M. Periodontal conditions and association of periodontitis with oral-health-related quality of life in patients experiencing different episodes of bipolar disorder compared with healthy controls. J Clin Periodontol 2024; 51:274-287. [PMID: 37963629 DOI: 10.1111/jcpe.13897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 11/16/2023]
Abstract
AIM The aim of the present cross-sectional study was to evaluate periodontal conditions and the association of periodontitis with oral-health-related quality of life (OHRQoL) in patients with a history of bipolar disorder. MATERIALS AND METHODS A total of 160 participants were recruited in four groups for the study: 40 patients with euthymic episodes, 40 patients with depression, 40 patients with manic episodes and 40 systemically healthy individuals. Clinical periodontal parameters were recorded. Oral Health Impact Profile (OHIP-14) was used to measure the impact of oral health on the quality of life. RESULTS Bipolar disorder groups exhibited generally higher clinical parameters compared with the control group (p < .05). OHIP-14 total score (β = 3.32, 95% confidence interval [CI]: 0.08-6.56, p = .044), functional limitation (β = .89, 95% CI: 0.27-1.49, p = .005) and physical pain (β = .64, 95% CI: 0.01-1.27, p = .046) were associated with bipolar depression episodes. Psychological discomfort was associated with the presence of generalized periodontitis (β = .76, 95% CI: 0.01-1.51, p = .047) and psychological disability was associated with the presence of stage III-IV (β = .83, 95% CI: 0.07-1.59, p = .033) and generalized (β = .75, 95% CI: 0.07-1.42, p = .029) periodontitis. CONCLUSIONS According to this study, a history of bipolar disorder episodes (exposure) may be associated with increased prevalence and severity of periodontitis and related reported OHRQoL impacts (outcomes). Bipolar depression episodes had a higher impact on OHRQoL than other bipolar episodes.
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Affiliation(s)
- Aysegul Sari
- Department of Periodontology, Faculty of Dentistry, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
- Periodontology Unit, Centre for Host-Microbiome Interactions, King's College London Dental Institute, London, UK
| | - M Hanifi Kokacya
- Department of Psychiatry, Faculty of Dentistry, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Mark Ide
- Periodontology Unit, Centre for Host-Microbiome Interactions, King's College London Dental Institute, London, UK
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10
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Ciftci E, Farhad S, Metin B, Tarhan N. Neurocognition across bipolar disorder phases compared to healthy subjects. Cogn Neuropsychiatry 2024; 29:73-86. [PMID: 38335235 DOI: 10.1080/13546805.2024.2313387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 12/17/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Bipolar disorder (BD) is associated with cognitive abnormalities that may persist during euthymia and are linked to poor occupational performance. The cognitive differences between phases of BD are not well known. Therefore, a cross-sectional study with a relatively large population was conducted to evaluate the differences among BD phases in a wide range of neurocognitive parameters. METHODS Neuropsychological profile of 169 patients with a diagnosis of BD in manic, depressive, mixed, and euthymic phases between the ages of 18 and 70 years were compared to 45 healthy individuals' between ages of 24 and 69 years. The working memory (digit-span backward test), face recognition, executive functions (verbal fluency and Stroop test), face recognition, and visual and verbal memory (immediate and delayed recall) were evaluated. For BD subgroup analyses, we used the Kruskal-Wallis (KW) test. Then, for the comparison of BD versus healthy individuals, we used the Mann-Whitney U (MWU) test. RESULTS Analyses based on non-parametric tests showed impairments in BD for all tests. There were no significant differences between phases. CONCLUSION Cognitive performance in patients with BD appears to be mostly unrelated to the phase of the disorder, implying that cognitive dysfunction in BD is present even during remission.
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Affiliation(s)
- Elvan Ciftci
- Department of Psychiatry, NP Istanbul Brain Hospital, Uskudar University, Istanbul, Turkey
| | - Shams Farhad
- Clinical Neuroscience, NP Istanbul Brain Hospital, Uskudar University, Istanbul, Turkey
| | - Baris Metin
- Department of Neurology, NP Istanbul Brain Hospital, Uskudar University, Istanbul, Turkey
| | - Nevzat Tarhan
- Department of Psychiatry, NP Istanbul Brain Hospital, Uskudar University, Istanbul, Turkey
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11
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Vahapoğlu B, Aksoy Poyraz C, Özdemir A. Psychosocial Impairment in Older Patients With Bipolar I Disorder. J Psychiatr Pract 2024; 30:147-156. [PMID: 38526403 DOI: 10.1097/pra.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND The goal of this study was to assess psychosocial functioning in older patients with bipolar I disorder compared with healthy subjects and to identify the psychopathological factors associated with poor functioning in patients. METHODS We recruited 68 euthymic patients with bipolar I disorder from the outpatient unit and 89 healthy controls who were older than 50 years of age. In addition to clinical variables, we used other standardized measures, including the Young Mania Rating Scale, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Functional Assessment Short Test, and the Montreal Cognitive Assessment. RESULTS Older patients with bipolar I disorder had poorer psychosocial functioning in general and in the domains of occupation, autonomy, and cognition than the healthy controls on the basis of previously defined Functional Assessment Short Test cutoff scores. We found that 35.3% (95% CI: 23%-47%) of the patients did not have clinically significant functional impairment, 38.2% (95% CI: 26%-50%) had mild impairment, and 26.5% (95% CI: 16%-37%) had moderate impairment. Depressive symptoms and impaired cognition were associated with poor overall functioning. CONCLUSIONS The level of psychosocial functioning was heterogeneous among the patients. Subsyndromal depressive symptoms, even at low levels, and impaired cognition predicted poor functioning in euthymic middle-aged and older patients with bipolar I disorder.
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Affiliation(s)
- Berkay Vahapoğlu
- VAHAPOĞLU and ÖZDEMIR: Bakirköy Mazhar Osman Bakirköy Mental Health and Neurological Diseases Education and Research Hospital, Istanbul, Turkey; POYRAZ: Department of Psychiatry, İstanbul University-Cerrahpaşa Medical School, Istanbul, Turkey
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12
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Wang Y, Liu Y, Zhang X, Wu Q. Sex-Based Differences and Risk Factors for Comorbid Nonalcoholic Fatty Liver Disease in Patients with Bipolar Disorder: A Cross-Sectional Retrospective Study. Diabetes Metab Syndr Obes 2023; 16:3533-3545. [PMID: 37954889 PMCID: PMC10637207 DOI: 10.2147/dmso.s428523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose Sex-based differences in patients with bipolar disorders (BD) are well recognized, and it is well known that the prevalence and severity of nonalcoholic fatty liver disease (NAFLD) are both higher in men than in women. Although metabolic disorders such as NAFLD are common in patients with BD, sex differences and risk factors for NAFLD comorbidity in these patients have not been thoroughly explored. This study aimed to investigate sex differences in patients with comorbid NAFLD and BD and associated risk factors. Methods This retrospective cross-sectional study included 710 patients with BD. Clinical data of patients with BD, including information on fasting glucose, liver function-related enzymes, relevant lipid data, uric acid, the triglyceride-glucose index (TyG), and demographics, were derived from the hospital electronic medical record system from June 2020 to July 2022. We performed logistic regression analysis and calculated the odds ratios with 95% confidence intervals of factors using t-tests, χ²-tests, and receiver operating characteristic. NAFLD was diagnosed using liver ultrasonography. Results The prevalence of NAFLD was higher in male patients with BD than in female patients (50.9% vs 38.5%), and there were significant differences in the years of education and marital status (all P<0.05). Regression analysis showed that the risk factors for comorbidities were the body mass index (BMI), fasting glucose, and apolipoprotein B levels in male patients and the BMI, bipolar disease course, glutamine transpeptidase levels, and the TyG in female patients. Conclusion Sex-based differences exist in risk factors and in the prevalence of comorbid NAFLD among patients with BD. BMI is a sex-independent risk factor, and clinical attention should be targeted to risk factors associated with comorbid NAFLD related to sex, especially in female patients with BD who presenting a high TyG index.
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Affiliation(s)
- Ying Wang
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei Fourth People’s Hospital, Hefei, People’s Republic of China
| | - Yiyi Liu
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei Fourth People’s Hospital, Hefei, People’s Republic of China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People’s Republic of China
| | - Xun Zhang
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei Fourth People’s Hospital, Hefei, People’s Republic of China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People’s Republic of China
| | - Qing Wu
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei Fourth People’s Hospital, Hefei, People’s Republic of China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People’s Republic of China
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13
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Nicoloro-SantaBarbara J, Majd M, Miskowiak K, Burns K, Goldstein BI, Burdick KE. Cognition in Bipolar Disorder: An Update for Clinicians. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:363-369. [PMID: 38695003 PMCID: PMC11058946 DOI: 10.1176/appi.focus.20230012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Bipolar disorder is associated with cognitive deficits, which persist across mood states and affect functional outcomes. This article provides an overview of recent progress in measuring cognition in bipolar disorder and its implications for both research and clinical practice. The authors summarize work conducted over the past decade that has helped guide researchers and clinicians in the appropriate measurement of cognitive functioning in bipolar disorder, the design of research studies targeting this domain for treatment, and the implementation of screening and psychoeducational tools in the clinic. Much of this work was conducted by the International Society for Bipolar Disorders Targeting Cognition Task Force. Here, the authors also highlight the need for clinicians to be informed about this aspect of illness and to be equipped with the necessary information to assess, track, and intervene on cognitive problems when appropriate. Finally, the article identifies gaps in the literature and suggests potential future directions for research in this area.
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Affiliation(s)
- Jennifer Nicoloro-SantaBarbara
- Department of Psychiatry, Brigham and Women's Hospital, Boston (Nicoloro-SantaBarbara, Majd, Burns, Burdick); Harvard Medical School, Boston (Nicoloro-SantaBarbara, Majd, Burdick); Department of Psychology, University of Copenhagen, and Mental Health Services, Capital Region of Denmark, Copenhagen (Miskowiak); Centre for Addiction and Mental Health, Toronto (Goldstein); and Department of Psychiatry and Department of Pharmacology, University of Toronto, Toronto (Goldstein)
| | - Marzieh Majd
- Department of Psychiatry, Brigham and Women's Hospital, Boston (Nicoloro-SantaBarbara, Majd, Burns, Burdick); Harvard Medical School, Boston (Nicoloro-SantaBarbara, Majd, Burdick); Department of Psychology, University of Copenhagen, and Mental Health Services, Capital Region of Denmark, Copenhagen (Miskowiak); Centre for Addiction and Mental Health, Toronto (Goldstein); and Department of Psychiatry and Department of Pharmacology, University of Toronto, Toronto (Goldstein)
| | - Kamilla Miskowiak
- Department of Psychiatry, Brigham and Women's Hospital, Boston (Nicoloro-SantaBarbara, Majd, Burns, Burdick); Harvard Medical School, Boston (Nicoloro-SantaBarbara, Majd, Burdick); Department of Psychology, University of Copenhagen, and Mental Health Services, Capital Region of Denmark, Copenhagen (Miskowiak); Centre for Addiction and Mental Health, Toronto (Goldstein); and Department of Psychiatry and Department of Pharmacology, University of Toronto, Toronto (Goldstein)
| | - Katharine Burns
- Department of Psychiatry, Brigham and Women's Hospital, Boston (Nicoloro-SantaBarbara, Majd, Burns, Burdick); Harvard Medical School, Boston (Nicoloro-SantaBarbara, Majd, Burdick); Department of Psychology, University of Copenhagen, and Mental Health Services, Capital Region of Denmark, Copenhagen (Miskowiak); Centre for Addiction and Mental Health, Toronto (Goldstein); and Department of Psychiatry and Department of Pharmacology, University of Toronto, Toronto (Goldstein)
| | - Benjamin I Goldstein
- Department of Psychiatry, Brigham and Women's Hospital, Boston (Nicoloro-SantaBarbara, Majd, Burns, Burdick); Harvard Medical School, Boston (Nicoloro-SantaBarbara, Majd, Burdick); Department of Psychology, University of Copenhagen, and Mental Health Services, Capital Region of Denmark, Copenhagen (Miskowiak); Centre for Addiction and Mental Health, Toronto (Goldstein); and Department of Psychiatry and Department of Pharmacology, University of Toronto, Toronto (Goldstein)
| | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, Boston (Nicoloro-SantaBarbara, Majd, Burns, Burdick); Harvard Medical School, Boston (Nicoloro-SantaBarbara, Majd, Burdick); Department of Psychology, University of Copenhagen, and Mental Health Services, Capital Region of Denmark, Copenhagen (Miskowiak); Centre for Addiction and Mental Health, Toronto (Goldstein); and Department of Psychiatry and Department of Pharmacology, University of Toronto, Toronto (Goldstein)
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Gkintoni E. Clinical neuropsychological characteristics of bipolar disorder, with a focus on cognitive and linguistic pattern: a conceptual analysis. F1000Res 2023; 12:1235. [PMID: 38434643 PMCID: PMC10905171 DOI: 10.12688/f1000research.141599.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 03/05/2024] Open
Abstract
Neuropsychology is an academic discipline that investigates the intricate interplay between the brain, mind, and behavior. It accomplishes this by examining the underlying structure and activities of the brain, with a particular focus on psychological phenomena such as language, motivation, memory, attention, thinking, consciousness, learning, and efficacy. The assessment of neuropsychological changes in individuals diagnosed with bipolar disorder has received limited attention in comparison to other psychiatric conditions, such as schizophrenia, for instance. Nevertheless, there has been a growing interest in the etiological implications, therapies, preventions, and prognostic factors related to social competence and the quality of life of patients. The objective of this review is to compile and analyze the existing research conducted thus far on the association between cognitive abnormalities and bipolar disorder. This study has examined research conducted across many stages of the condition, including depression and mania. Additionally, it has explored comparative studies involving people with schizophrenia, as well as the potential impact of psychopharmaceutical interventions.
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15
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Dalloul N, Moran EK, Gold JM, Carter CS, MacDonald AW, Ragland JD, Silverstein SM, Luck SJ, Barch DM. Transdiagnostic Predictors of Everyday Functioning: Examining the Relationships of Depression and Reinforcement Learning. Schizophr Bull 2023; 49:1281-1293. [PMID: 37382553 PMCID: PMC10483466 DOI: 10.1093/schbul/sbad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND AND HYPOTHESIS Impairments in function (ie, the ability to independently accomplish daily tasks) have been established in psychotic disorders. Identifying factors that contribute to these deficits is essential to developing effective interventions. The current study had several goals: examine potential differential relationships across domains of neurocognition, assess whether reinforcement learning is related to function, identify if predictors of function are transdiagnostic, determine whether depression and positive symptoms contribute to function, and to explore whether the modality of assessment impacts observed relationships. STUDY DESIGN Data from 274 participants were examined with schizophrenia/schizoaffective disorder (SZ; n = 195) and bipolar disorder (BD; n = 79). To reduce dimensionality, a PCA was completed on neurocognitive tasks which resulted in 3 components. These components and clinical interview data were used to investigate predictors of functional domains across measures of function (self- and informant-report SLOF and UPSA). RESULTS Two components, working memory/processing speed/episodic memory (βs = 0.18-0.42), and negative/positive reinforcement learning (β = -0.04), predicted different functional domains. Predictors of function were largely transdiagnostic with two exceptions: reinforcement learning had a positive association with self-reported interpersonal relationships for SZ and a negative association for BD (β = 0.34), and the negative association between positive symptoms and self-reported social acceptability was stronger for BD than for SZ (β = 0.93). Depression robustly predicted self-reported but not informant-reported function, and anhedonia predicted all domains of informant-reported function. CONCLUSIONS These findings imply that reinforcement learning may differentially relate to function across disorders, traditional domains of neurocognition can be effective transdiagnostic targets for interventions, and positive symptoms and depression play a critical role in self-perceived functional impairments.
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Affiliation(s)
- Nada Dalloul
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, USA
| | - Erin K Moran
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - James M Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Cameron S Carter
- Department of Psychiatry, University of California, Davis, CA, USA
| | - Angus W MacDonald
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - J Daniel Ragland
- Department of Psychiatry, University of California, Davis, CA, USA
| | | | - Steven J Luck
- Department of Psychology, University of California, Davis, CA, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
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16
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Montejo L, Orhan M, Chen P, Eyler LT, Gildengers A, Martinez-Aran A, Nunes PV, Olagunju AT, Patrick R, Vieta E, Dols A, Jimenez E. Functioning in older adults with bipolar disorder: A report on recommendations by the International Society of bipolar disorder (ISBD) older adults with bipolar disorder (OABD) task force. Bipolar Disord 2023; 25:457-468. [PMID: 37495508 DOI: 10.1111/bdi.13368] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Despite the importance of psychosocial functioning impairment in Bipolar Disorder (BD), its role among Older Adults with BD (OABD) is not well known. The development of guidelines for the assessment of psychosocial functioning helps to facilitate a better understanding of OABD and can lead to better tailored interventions to improve the clinical outcomes of this population. METHODS Through a series of virtual meetings, experts from eight countries in the International Society of Bipolar Disorder (ISBD) on OABD task force developed recommendations for the assessment of psychosocial functioning. RESULTS We present (1) a conceptualization of functioning in OABD and differences compared with younger patients; (2) factors related to functioning in OABD; (3) current measures of functioning in OABD and their strengths and limitations; and, (4) other potential sources of information to assess functioning. CONCLUSIONS The task force created recommendations for assessing functioning in OABD. Current instruments are limited, so measures specifically designed for OABD, such as the validated FAST-O scale, should be more widely adopted. Following the proposed recommendations for assessment can improve research and clinical care in OABD and potentially lead to better treatment outcomes.
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Affiliation(s)
- Laura Montejo
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences (UB Neuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Melis Orhan
- Department of Old Age Psychiatry, GGZ inGeest, Amsterdam, the Netherlands
| | - Peijun Chen
- Department of Psychiatry, Geriatric Research, Education, and Clinical Center, VA Northeast Ohio Health System Cleveland VA Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare, San Diego, California, USA
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anabel Martinez-Aran
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences (UB Neuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Paula Villela Nunes
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Regan Patrick
- Departments of Neuropsychology & Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences (UB Neuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Annemiek Dols
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences (UB Neuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
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Hamada F, Hori H, Iida H, Yokoyama H, Sugawara H, Hatanaka A, Gotoh L, Ogata M, Kumagai H, Yano R, Tomiyama Y, Yoshida T, Yamaguchi Y, Asada R, Masuda M, Okamoto Y, Kawasaki H. Effects of Exercise on Functional Recovery in Patients with Bipolar Depression: A Study Protocol for a Randomized Controlled Trial. Metabolites 2023; 13:981. [PMID: 37755261 PMCID: PMC10536584 DOI: 10.3390/metabo13090981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
Treatment of bipolar disorder is prone to prolongation despite various treatments, including medication. The efficacy of exercise treatment (i.e., interventions involving physical exercise and sports intervention) for major depressive disorders has been reported for depressive symptoms, cognitive function, and sleep disturbances. However, its efficacy for bipolar disorder has yet to be established. We designed a randomized, controlled, double-blind clinical trial that includes 100 patients with bipolar disorder aged 20-65 years. This will be a cluster-randomized, two-group trial that will be conducted in ten psychiatric hospitals. The hospitals will be randomly assigned to an exercise intervention + treatment as usual (exercise) group or a placebo exercise intervention (stretching) + treatment as usual (control) group. Patients will be assessed using an extensive battery of clinical tests, physical parameters, sleep status, biological parameters (cytokines, neurotrophic factors), and genetic parameters (DNA and RNA) at baseline after a 6-week intervention period, at 10-week follow-up, and at 6-month follow-up. This innovative study may provide important evidence for the effectiveness of exercise in the treatment of bipolar depression based on clinical, biological, genetic, and physiological markers.
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Affiliation(s)
- Fumito Hamada
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Hitoshi Iida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Hiroyuki Yokoyama
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Hiroko Sugawara
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Akito Hatanaka
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Leo Gotoh
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
- Laboratory of Neuroscience, Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan
| | - Muneaki Ogata
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Hiroki Kumagai
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Rika Yano
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Yuko Tomiyama
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Tetsuya Yoshida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Yoshimi Yamaguchi
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Ryo Asada
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Masato Masuda
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Yuta Okamoto
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
| | - Hiroaki Kawasaki
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka 8140180, Japan; (F.H.); (H.I.); (H.S.); (L.G.); (R.A.)
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18
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Chakrabarty T, Frangou S, Torres IJ, Ge R, Yatham LN. Brain age and cognitive functioning in first-episode bipolar disorder. Psychol Med 2023; 53:5127-5135. [PMID: 35875930 PMCID: PMC10476063 DOI: 10.1017/s0033291722002136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is significant heterogeneity in cognitive function in patients with bipolar I disorder (BDI); however, there is a dearth of research into biological mechanisms that might underlie cognitive heterogeneity, especially at disease onset. To this end, this study investigated the association between accelerated or delayed age-related brain structural changes and cognition in early-stage BDI. METHODS First episode patients with BDI (n = 80) underwent cognitive assessment to yield demographically normed composite global and domain-specific scores in verbal memory, non-verbal memory, working memory, processing speed, attention, and executive functioning. Structural magnetic resonance imaging data were also collected from all participants and subjected to machine learning to compute the brain-predicted age difference (brainPAD), calculated by subtracting chronological age from age predicted by neuroimaging data (positive brainPAD values indicating age-related acceleration in brain structural changes and negative values indicating delay). Patients were divided into tertiles based on brainPAD values, and cognitive performance compared amongst tertiles with ANCOVA. RESULTS Patients in the lowest (delayed) tertile of brainPAD values (brainPAD range -17.9 to -6.5 years) had significantly lower global cognitive scores (p = 0.025) compared to patients in the age-congruent tertile (brainPAD range -5.3 to 2.4 yrs), and significantly lower verbal memory scores (p = 0.001) compared to the age-congruent and accelerated (brainPAD range 2.8 to 16.1 yrs) tertiles. CONCLUSION These results provide evidence linking cognitive dysfunction in the early stage of BDI to apparent delay in typical age-related brain changes. Further studies are required to assess how age-related brain changes and cognitive functioning evolve over time.
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Affiliation(s)
- Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
| | - Sophia Frangou
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
- Department of Psychiatry Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Ivan J. Torres
- British Columbia Mental Health and Substance Use Services, Vancouver, BC, Canada
| | - Ruiyang Ge
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
| | - Lakshmi N. Yatham
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1
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19
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Jawad MY, Qasim S, Ni M, Guo Z, Di Vincenzo JD, d'Andrea G, Tabassum A, Mckenzie A, Badulescu S, Grande I, McIntyre RS. The Role of Ketamine in the Treatment of Bipolar Depression: A Scoping Review. Brain Sci 2023; 13:909. [PMID: 37371387 DOI: 10.3390/brainsci13060909] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Bipolar depression remains a clinical challenge with a quarter of patients failing to respond to initial conventional treatments. Although ketamine has been extensively studied in unipolar depression, its role in bipolar disorder remains inconclusive. The aim of our scoping review was to comprehensively synthesize the current clinical literature around ketamine use in bipolar depression. A total of 10 clinical studies (5 randomized controlled trials and 5 open label studies) were selected. The preliminary evidence, albeit weak, suggests that ketamine is a promising treatment and calls for further interest from the research community. Overall, ketamine treatment appeared to be tolerable with minimal risk for manic/hypomanic switching and showed some effectiveness across parameters of depression and suicidality. Moreover, ketamine is a potential treatment agent in patients with treatment-resistant bipolar depression with promising data extracted from extant controlled trials and real-world effectiveness studies. Future studies are needed to identify ketamine's role in acute and maintenance treatment phases of bipolar depression. Moreover, future researchers should study the recurrence prevention and anti-suicidal effects of ketamine in the treatment of bipolar depression.
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Affiliation(s)
- Muhammad Youshay Jawad
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5T 2S8, Canada
- Institute for Mental Health Policy Research, Centre for Addictions and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Saleha Qasim
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Menglu Ni
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychology, University of Toronto, Toronto, ON M5S 3G3, Canada
| | - Ziji Guo
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
| | - Joshua D Di Vincenzo
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Giacomo d'Andrea
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", 66100 Chieti, Italy
| | - Aniqa Tabassum
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Andrea Mckenzie
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Sebastian Badulescu
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Iria Grande
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, C. Villarroel, 170, 08036 Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), C. Casanova, 143, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), P. de la Vall d'Hebron, 171, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5T 2S8, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
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20
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Chirio-Espitalier M, Harscoët YA, Duval M, Jupille J, Moret L, Grall-Bronnec M. The experience of caregivers providing therapeutic patient education for people living with bipolar disorder: a qualitative study. BMC Psychiatry 2023; 23:196. [PMID: 36964544 PMCID: PMC10039597 DOI: 10.1186/s12888-023-04623-0] [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: 11/14/2022] [Accepted: 02/22/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Therapeutic patient education (TPE) programs are psycho-educational treatments suggested for all chronic diseases. For several years, these programs have been developing for people living with bipolar disorder. However, to date, only few qualitative studies have explored the experience of caregivers. We wanted to explore the experience of caregivers working in psychiatry as facilitators of a therapeutic education program for people living with bipolar disorder. METHOD A single-center qualitative study was carried out. We conducted an inductive exploration, examining the content of the discourse produced in a focus group of eight caregivers in therapeutic education. The corpus was transcribed manually and a thematic analysis was conducted by two authors in a blinded fashion before combining. RESULTS Four dimensions and twenty themes were identified: i) facilitators' pleasant experiences of the TPE sessions with a secure climate and a sense of belonging to a group, ii) being a TPE facilitator with a new horizontal and collaborative posture valuing the experiential knowledge, iii) the role of the TPE sessions with knowledge provision, empowerment and destigmatization, and iv) perceived changes in patients with an appeasement, the awareness of a shared experience, openness to others, a phenomenon of identification to peers and a new commitment. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The observations noted overlap with the elements of the personal recovery well known CHIME framework (Connectedness, Hope, positive Identity, Meaning in life and Empowerment). Therapeutic education is a developing form of psychosocial rehabilitation care: through the mobilization of a new attitude of caring, the facilitation of TPE programs could be a lever for changing the posture of caregivers in favor of supporting the personal recovery of people with bipolar disorder. These results would need to be confirmed by further studies.
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Affiliation(s)
- Marion Chirio-Espitalier
- Psychiatry and Mental Health Department, University Hospital of Nantes, 85 Rue Saint-Jacques, 44093, Nantes Cedex 1, France.
- UMR INSERM U1246-SPHERE 'methodS for Patients-Centered Outcomes & HEalth REsearch', University of Nantes, University of Tours, 22 Boulevard Benoni Goullin, 44000, Nantes, France.
- CRehab'S, Support Center for Psychosocial Rehabilitation in the Loire Region, Nantes University Hospital and Angevin Mental Health Center, Nantes, France.
| | - Yves-Antoine Harscoët
- Psychiatry and Mental Health Department, University Hospital of Nantes, 85 Rue Saint-Jacques, 44093, Nantes Cedex 1, France
- CRehab'S, Support Center for Psychosocial Rehabilitation in the Loire Region, Nantes University Hospital and Angevin Mental Health Center, Nantes, France
| | - Mélanie Duval
- Public Health Department, University Hospital of Nantes, 85 Rue Saint-Jacques, 44093, Nantes Cedex 1, France
| | - Julien Jupille
- CRehab'S, Support Center for Psychosocial Rehabilitation in the Loire Region, Nantes University Hospital and Angevin Mental Health Center, Nantes, France
| | - Leïla Moret
- UMR INSERM U1246-SPHERE 'methodS for Patients-Centered Outcomes & HEalth REsearch', University of Nantes, University of Tours, 22 Boulevard Benoni Goullin, 44000, Nantes, France
- Public Health Department, University Hospital of Nantes, 85 Rue Saint-Jacques, 44093, Nantes Cedex 1, France
| | - Marie Grall-Bronnec
- Psychiatry and Mental Health Department, University Hospital of Nantes, 85 Rue Saint-Jacques, 44093, Nantes Cedex 1, France
- UMR INSERM U1246-SPHERE 'methodS for Patients-Centered Outcomes & HEalth REsearch', University of Nantes, University of Tours, 22 Boulevard Benoni Goullin, 44000, Nantes, France
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21
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de Siqueira Rotenberg L, Kjærstad HL, Varo C, Vinberg M, Kessing LV, Lafer B, Miskowiak KW. The longitudinal trajectory of emotional cognition in subgroups of recently diagnosed patients with bipolar disorder. Eur Neuropsychopharmacol 2023; 71:9-24. [PMID: 36965236 DOI: 10.1016/j.euroneuro.2023.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/27/2023]
Abstract
Although cross-sectional studies show heterogeneity in emotional cognition in bipolar disorder (BD), the temporal course within subgroups is unclear. In this prospective, longitudinal study we assessed the trajectories of emotional cognition subgroups within a 16-month follow-up period in recently diagnosed BD patients compared to healthy controls (HC). Recently diagnosed BD patients and HC underwent comprehensive emotional and non-emotional testing at baseline and again at follow-up. We employed hierarchical cluster analysis at baseline to identify homogenous emotional cognition subgroups of patients, and changes across the subgroups of BD and HC were assessed with linear mixed-model analyses. We found two emotional cognition subgroups: subgroup 1 (65%, n = 179), showing heightened negative emotional reactivity in neutral and negative social scenarios and faster recognition of emotional facial expressions than HC (ps<0.001, n = 190), and subgroup 2 (35%, n = 96) showing blunted reactivity in positive social scenarios, impaired emotion regulation, poorer recognition of positive and slower recognition of all facial expressions than HC (ps≤.03). Subgroup 1 exhibited normalization of the initial emotional cognition abnormalities in follow-up. In contrast, subgroup 2 showed a lack of improvement in reactivity positively-valenced emotional information. Patients in subgroup 2 presented more and longer mixed episodes during the follow-up time and were more often prescribed lithium. One third of patients display blunted emotional reactivity, impaired emotion regulation abilities and facial expression recognition difficulties also show persistent impairments and poorer course of illness. This subgroup may indicate a need for earlier and more targeted therapeutic interventions.
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Affiliation(s)
- Luisa de Siqueira Rotenberg
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Hanne Lie Kjærstad
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Denmark.
| | | | - Maj Vinberg
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Beny Lafer
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Denmark; Department of Psychology, University of Copenhagen, Denmark
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22
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Johnson DE, McIntyre RS, Mansur RB, Rosenblat JD. An update on potential pharmacotherapies for cognitive impairment in bipolar disorder. Expert Opin Pharmacother 2023; 24:641-654. [PMID: 36946229 DOI: 10.1080/14656566.2023.2194488] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Cognitive impairment is a core feature of bipolar disorder (BD) that impedes recovery by preventing the return to optimal socio-occupational functioning and reducing quality of life. Presently, there are no efficacious treatments for cognitive impairment in BD, but many pharmacological interventions are being considered as they have the potential to target the underlying pathophysiology of the disorder. AREAS COVERED This review summarizes the available evidence for pharmacological interventions for cognitive impairment in bipolar disorder. We searched PubMed, MedLine, and PsycInfo from inception to December 1st, 2022. Traditional treatments, such as lithium, anticonvulsants (lamotrigine), antipsychotics (aripiprazole, asenapine, cariprazine, lurasidone, and olanzapine), antidepressants (vortioxetine, fluoxetine, and tianeptine) and psychostimulants (modafinil), and emerging interventions, such as acetylcholinesterase inhibitors (galantamine and donepezil), dopamine agonists (pramipexole), erythropoietin, glucocorticoid receptor antagonists (mifepristone), immune modulators (infliximab, minocycline and doxycycline), ketamine, metabolic agents (insulin, metformin, and liraglutide), probiotic supplements, and Withania somnifera are discussed. EXPERT OPINION The investigation of interventions for cognitive impairment in BD is a relatively under-researched area. In the past, methodological pitfalls in BD cognition trials have also been a critical limiting factor. Expanding on the existing literature and identifying novel pharmacological and non-pharmacological treatments for cognitive impairment in BD should be a priority.
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Affiliation(s)
- Danica E Johnson
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Institute of Medical Science, University of Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Department of Psychiatry and Pharmacology, University of Toronto, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Department of Psychiatry, University of Toronto, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Department of Psychiatry, University of Toronto, Canada
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23
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Saccaro LF, Crokaert J, Perroud N, Piguet C. Structural and functional MRI correlates of inflammation in bipolar disorder: A systematic review. J Affect Disord 2023; 325:83-92. [PMID: 36621677 DOI: 10.1016/j.jad.2022.12.162] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/15/2022] [Accepted: 12/31/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is a common affective disorder characterized by recurrent oscillations between mood states and associated with inflammatory diseases and chronic inflammation. However, data on MRI abnormalities in BD and their relationship with inflammation are heterogeneous and no review has recapitulated them. METHODS In this pre-registered (PROSPERO: CRD42022308461) systematic review we searched Web of Science Core Collection and PubMed for articles correlating functional or structural MRI measures with immune-related markers in BD. RESULTS We included 23 studies (6 on functional, 16 on structural MRI findings, 1 on both, including 1'233 BD patients). Overall, the quality of the studies included was fair, with a low risk of bias. LIMITATIONS Heterogeneity in the methods and results of the studies and small sample sizes limit the generalizability of the conclusions. CONCLUSIONS A qualitative synthesis suggests that the links between immune traits and functional or structural MRI alterations point toward brain areas involved in affective and somatomotor processing, with a trend toward a negative correlation between peripheral inflammatory markers and brain regions volume. We discuss how disentangling the complex relationship between the immune system and MRI alterations in BD may unveil mechanisms underlying symptoms pathophysiology, potentially with quickly translatable diagnostic, prognostic, and therapeutic implications.
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Affiliation(s)
- Luigi F Saccaro
- Psychiatry Department, Faculty of Medicine, University of Geneva, Switzerland; Psychiatry Department, Geneva University Hospital, Switzerland.
| | - Jasper Crokaert
- Psychiatry Department, Faculty of Medicine, University of Geneva, Switzerland; Child and Adolescence Psychiatry Division, Geneva University Hospital, Switzerland
| | - Nader Perroud
- Psychiatry Department, Faculty of Medicine, University of Geneva, Switzerland; Psychiatry Department, Geneva University Hospital, Switzerland
| | - Camille Piguet
- Psychiatry Department, Faculty of Medicine, University of Geneva, Switzerland; Psychiatry Department, Geneva University Hospital, Switzerland; Child and Adolescence Psychiatry Division, Geneva University Hospital, Switzerland
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24
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Lin CC, Yeh LL, Pan YJ. Degree of exposure to psychotropic medications and mortality in people with bipolar disorder. Acta Psychiatr Scand 2023; 147:186-197. [PMID: 36217288 DOI: 10.1111/acps.13509] [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: 07/07/2022] [Revised: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To investigate the associations between psychotropic medication dosage and mortality in patients with bipolar disorder. METHODS A nationwide cohort of individuals aged ≥15 years who had received a diagnosis of bipolar disorder in 2010 was identified from the Taiwanese national health-care database linked with the mortality registry and followed up for 5 years. The mean defined daily dose (DDD) of mood stabilizers, antipsychotics, antidepressants, and sedative-hypnotics was estimated, and survival analyses were conducted to assess the effects of degree of exposure to psychotropic medications on mortality. RESULTS A total of 49,298 individuals (29,048 female individuals, 58.92%) with bipolar disorder were included. Compared with individuals without exposure to mood stabilizers, those prescribed mood stabilizers had a decreased overall mortality risk, regardless of exposure dosage. By contrast, compared with a reference group with no exposure to antipsychotics, individuals using antipsychotics had dose-dependent, increased mortality in both overall causes of deaths and deaths due to cardiovascular diseases, with hazard ratios of 1.13 (95% CI: 1.21-1.42) in the low-dose (<0.5 DDD) group, 1.69 (1.51-1.90) in the moderate-dose (0.5-1.5 DDD) group, and 2.08 (1.69-2.57) in the high-dose (>1.5 DDD) group for overall mortality. CONCLUSIONS In sum, mood stabilizers were associated with decreased overall mortality in individuals with bipolar disorder, regardless of the dosage. However, the use of antipsychotics appeared to be associated with a dose-dependent increased mortality risk. Owing to study limitations, precise information on prior use of psychotropic medications, and patient's adherence to medication are not available. Potential adverse effects and benefits should be carefully considered when prescribing psychotropic medications for long-term use in patients with bipolar disorder.
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Affiliation(s)
- Chu-Chun Lin
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ling-Ling Yeh
- Graduate School of Humanities and Social Sciences, Dharma Drum Institute of Liberal Arts, New Taipei City, Taiwan
| | - Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Institute of Public Health, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
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25
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Hasse-Sousa M, Martins DS, Petry-Perin C, Britto MJSD, Remus IB, Lapa CDO, Reckziegel RDFX, Sales SCD, Jesus LSD, Philippsen M, Massuda R, Van Rheenen TE, Gama CS, Czepielewski LS. The role of semantic clustering in the relationship between verbal memory and psychosocial functioning in schizophrenia and bipolar disorder: Possible distinct cognitive pathway compared to healthy controls. J Affect Disord 2023; 320:330-339. [PMID: 36162669 DOI: 10.1016/j.jad.2022.09.077] [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: 11/24/2021] [Revised: 09/02/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Verbal memory (VM) is impaired in schizophrenia (SZ) and bipolar disorder (BD), and predicts psychosocial functioning. However, there is a lack of research exploring the role of VM component processes, including semantic clustering, in these disorders. Semantic clustering might impact this association, as effective semantic memory strategies may reflect unimpaired executive control, leading to an adequate functioning. We aimed to investigate VM components in SZ and BD, and the role of semantic clustering in the relationship between VM and functioning. METHODS We included 495 participants (156 SZ, 172 BD, and 167 healthy controls (HC)) that underwent an assessment using the Hopkins Verbal Learning Test - Revised for VM and the Functioning Assessment Short Test for psychosocial functioning. We compared groups through ANOVAs and investigated the effect of semantic clustering in the relationship between VM total immediate free recall and functioning through linear regression models. RESULTS SZ had worse overall VM performance compared to BD, which performed worse than HCs. HCs used more semantic clustering than SZ and BD, but there were no differences between the two clinical groups. In HCs, semantic clustering impacted the relationship between VM performance and functioning, while no interaction was observed in SZ or BD. LIMITATIONS Cross-sectional design; no medication effects or other cognitive functions were assessed. CONCLUSIONS SZ and BD may use an alternative cognitive pathway in which the relationship between VM and functioning is independent of complex cognitive processes such as semantic clustering, supporting the cognitive remediation targeting of VM in these disorders.
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Affiliation(s)
- Mathias Hasse-Sousa
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Psicologia, Departamento de Psicologia do Desenvolvimento e da Personalidade, Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Dayane Santos Martins
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carolina Petry-Perin
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Julia Silva de Britto
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Isadora Bosini Remus
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Clara de Oliveira Lapa
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ramiro de Freitas Xavier Reckziegel
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sarah Corrêa de Sales
- Psychosis Treatment and Research Program, Department of Forensic Medicine and Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Letícia Stephane de Jesus
- Psychosis Treatment and Research Program, Department of Forensic Medicine and Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Marielli Philippsen
- Psychosis Treatment and Research Program, Department of Forensic Medicine and Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Raffael Massuda
- Psychosis Treatment and Research Program, Department of Forensic Medicine and Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, VIC, Australia
| | - Clarissa Severino Gama
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Letícia Sanguinetti Czepielewski
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Psicologia, Departamento de Psicologia do Desenvolvimento e da Personalidade, Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Wartchow KM, Scaini G, Quevedo J. Glial-Neuronal Interaction in Synapses: A Possible Mechanism of the Pathophysiology of Bipolar Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1411:191-208. [PMID: 36949311 DOI: 10.1007/978-981-19-7376-5_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Bipolar disorder (BD) is a severe and chronic psychiatric disorder that affects approximately 1-4% of the world population and is characterized by recurrent episodes of mania or hypomania and depression. BD is also associated with illnesses marked by immune activation, such as metabolic syndrome, obesity, type 2 diabetes mellitus, and cardiovascular diseases. Indeed, a connection has been suggested between neuroinflammation and peripheral inflammatory markers in the pathophysiology of BD, which can be associated with the modulation of many dysfunctional processes, including synaptic plasticity, neurotransmission, neurogenesis, neuronal survival, apoptosis, and even cognitive/behavioral functioning. Rising evidence suggests that synaptic dysregulations, especially glutamatergic system dysfunction, are directly involved in mood disorders. It is becoming clear that dysregulations in connection and structural changes of glial cells play a central role in the BD pathophysiology. This book chapter highlighted the latest findings that support the theory of synaptic dysfunction in BD, providing an overview of the alterations in neurotransmitters release, astrocytic uptake, and receptor signaling, as well as the role of inflammation on glial cells in mood disorders. Particular emphasis is given to the alterations in presynaptic and postsynaptic neurons and glial cells, all cellular elements of the "tripartite synapse," compromising the neurotransmitters system, excitatory-inhibitory balance, and neurotrophic states of local networks in mood disorders. Together, these studies provide a foundation of knowledge about the exact role of the glial-neuronal interaction in mood disorders.
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Affiliation(s)
- Krista M Wartchow
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Giselli Scaini
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - João Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
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Siciliano L, Olivito G, Lupo M, Urbini N, Gragnani A, Saettoni M, Delle Chiaie R, Leggio M. The role of the cerebellum in sequencing and predicting social and non-social events in patients with bipolar disorder. Front Cell Neurosci 2023; 17:1095157. [PMID: 36874211 PMCID: PMC9974833 DOI: 10.3389/fncel.2023.1095157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction Advances in the operational mode of the cerebellum indicate a role in sequencing and predicting non-social and social events, crucial for individuals to optimize high-order functions, such as Theory of Mind (ToM). ToM deficits have been described in patients with remitted bipolar disorders (BD). The literature on BD patients' pathophysiology reports cerebellar alterations; however, sequential abilities have never been investigated and no study has previously focused on prediction abilities, which are needed to properly interpret events and to adapt to changes. Methods To address this gap, we compared the performance of BD patients in the euthymic phase with healthy controls using two tests that require predictive processing: a ToM test that require implicit sequential processing and a test that explicitly assesses sequential abilities in non-ToM functions. Additionally, patterns of cerebellar gray matter (GM) alterations were compared between BD patients and controls using voxel-based morphometry. Results Impaired ToM and sequential skills were detected in BD patients, specifically when tasks required a greater predictive load. Behavioral performances might be consistent with patterns of GM reduction in cerebellar lobules Crus I-II, which are involved in advanced human functions. Discussion These results highlight the importance of deepening the cerebellar role in sequential and prediction abilities in patients with BD.
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Affiliation(s)
- Libera Siciliano
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Ataxia Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Giusy Olivito
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Ataxia Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Michela Lupo
- Servizio di Tutela della Salute Mentale e Riabilitazione dell'Età Evolutiva ASL, Rome, Italy
| | - Nicole Urbini
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Ataxia Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Andrea Gragnani
- Scuola di Psicoterapia Cognitiva SPC, Grosseto, Italy.,Associazione Psicologia Cognitiva (APC)/Scuola di Psicoterapia Cognitiva (SPC), Rome, Italy
| | - Marco Saettoni
- Scuola di Psicoterapia Cognitiva SPC, Grosseto, Italy.,Unità Funzionale Salute Mentale Adulti ASL Toscana Nord-Ovest Valle del Serchio, Pisa, Italy
| | - Roberto Delle Chiaie
- Department of Neuroscience and Mental Health-Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Leggio
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Ataxia Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
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The relative contributions of insight and neurocognition to intrinsic motivation in schizophrenia. SCHIZOPHRENIA 2022; 8:18. [PMID: 35260585 PMCID: PMC8904546 DOI: 10.1038/s41537-022-00217-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
Abstract
Intrinsic motivation was described as the mental process of pursuing a task or an action because it is enjoyable or interesting in itself and was found to play a central role in the determination of the functional outcome of schizophrenia. Neurocognition is one of the most studied determinants of intrinsic motivation in clinically stable schizophrenia while little is known about the role of insight. Following this need we decided to focus on the contribution of different aspects of insight and of neurocognition to intrinsic motivation in a large sample (n = 176) of patients with stable schizophrenia. We performed three hierarchical linear regressions from which resulted that, among different insight aspects, the ability to correctly attribute signs and symptoms to the mental disorder made the strongest contribution to intrinsic motivation. Neurocognition, also, was significantly related to intrinsic motivation when analyzed simultaneously with insight. Moreover, even after accounting for sociodemographic and clinical variables significantly correlated with intrinsic motivation, the relationship between insight and neurocognition and intrinsic motivation remained statistically significant. These findings put the emphasis on the complex interplay between insight, neurocognition, and intrinsic motivation suggesting that interventions targeting both insight and neurocognition might possibly improve this motivational deficit in stable schizophrenia should.
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29
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McIntyre RS, Alda M, Baldessarini RJ, Bauer M, Berk M, Correll CU, Fagiolini A, Fountoulakis K, Frye MA, Grunze H, Kessing LV, Miklowitz DJ, Parker G, Post RM, Swann AC, Suppes T, Vieta E, Young A, Maj M. The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management. World Psychiatry 2022; 21:364-387. [PMID: 36073706 PMCID: PMC9453915 DOI: 10.1002/wps.20997] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal-ity interventions, the majority of persons affected by this disorder do not achieve and sustain full syndromal recovery. It is eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multi-omic" measures, electronic health records), analyzed using advanced computational methods (e.g., machine learning), will inform future diagnosis and treatment selection. In the interim, identifying clinically meaningful subgroups of persons with the disorder having differential response to specific treatments at point-of-care is an empirical priority. This paper endeavours to synthesize salient domains in the clinical characterization of the adult patient with bipolar disorder, with the overarching aim to improve health outcomes by informing patient management and treatment considerations. Extant data indicate that characterizing select domains in bipolar disorder provides actionable information and guides shared decision making. For example, it is robustly established that the presence of mixed features - especially during depressive episodes - and of physical and psychiatric comorbidities informs illness trajectory, response to treatment, and suicide risk. In addition, early environmental exposures (e.g., sexual and physical abuse, emotional neglect) are highly associated with more complicated illness presentations, inviting the need for developmentally-oriented and integrated treatment approaches. There have been significant advances in validating subtypes of bipolar disorder (e.g., bipolar I vs. II disorder), particularly in regard to pharmacological interventions. As with other severe mental disorders, social functioning, interpersonal/family relationships and internalized stigma are domains highly relevant to relapse risk, health outcomes, and quality of life. The elevated standardized mortality ratio for completed suicide and suicidal behaviour in bipolar disorder invites the need for characterization of this domain in all patients. The framework of this paper is to describe all the above salient domains, providing a synthesis of extant literature and recommendations for decision support tools and clinical metrics that can be implemented at point-of-care.
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Affiliation(s)
- Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Ross J Baldessarini
- Harvard Medical School, Boston, MA, USA
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
- Mailman Research Center, McLean Hospital, Belmont, MA, USA
| | - Michael Bauer
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
- Orygen, National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Kostas Fountoulakis
- 3rd Department of Psychiatry, Division of Neurosciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Heinz Grunze
- Allgemeinpsychiatrie Ost, Klinikum am Weissenhof, Weinsberg, Germany
- Paracelsus Medical Private University Nuremberg, Nuremberg, Germany
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Center, Psychiatric Center Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David J Miklowitz
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles (UCLA) Semel Institute, Los Angeles, CA, USA
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Robert M Post
- School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
- Bipolar Collaborative Network, Bethesda, MD, USA
| | - Alan C Swann
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Trisha Suppes
- Department of Psychiatry and Behavioural Sciences, Stanford School of Medicine and VA Palo Alto Health Care -System, Palo Alto, CA, USA
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Allan Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Adu MK, Eboreime E, Sapara AO, Agyapong VIO. The Use of Repetitive Transcranial Magnetic Stimulations for the Treatment of Bipolar Disorder: A Scoping Review. Behav Sci (Basel) 2022; 12:263. [PMID: 36004834 PMCID: PMC9404915 DOI: 10.3390/bs12080263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/14/2022] [Accepted: 07/27/2022] [Indexed: 12/02/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive neuromodulation technique that involves the application of magnetic pulses on hyperactive or hypoactive cortical brain areas. rTMS is considered a high therapeutic tool in many neuropsychiatric conditions. Despite its wide and continuous usage for the treatment of psychiatric disorders, information about the use of rTMS in bipolar disorders is limited and not well-established in the literature. Objectives: This scoping review aims to explore the literature available regarding the application of rTMS for the management of bipolar disorders, to garner evidence in support of it uses in the management of bipolar disorders, and for recommendations on future clinical and research work. Method: We electronically conducted a data search in five research databases (MEDLINE, CINAHL, Psych INFO, SCOPUS, and EMBASE) using all identified keywords across all the databases to identify evidence-based studies. Articles were included if they were published randomized control designs aimed at the use of rTMS in the management of bipolar disorders. Overall, nine studies were eligible for this review. The search results are up to date as of the final date of data search-20 December 2020. Only full-text published articles written in English were reviewed. Review articles on treatment with rTMS for conditions either than bipolar disorders were excluded. Conclusion: The application of rTMS intervention for bipolar disorders looks promising despite the diversity of its outcomes and its clinical significance. However, to be able to draw a definite conclusion on the clinical effectiveness of the technique, more randomized controlled studies with well-defined stimulation parameters need to be conducted with large sample sizes in the future.
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Affiliation(s)
- Medard Kofi Adu
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (E.E.); (A.O.S.); (V.I.O.A.)
| | - Ejemai Eboreime
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (E.E.); (A.O.S.); (V.I.O.A.)
| | - Adegboyega Oyekunbi Sapara
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (E.E.); (A.O.S.); (V.I.O.A.)
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (E.E.); (A.O.S.); (V.I.O.A.)
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada
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31
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Bozzatello P, Giordano B, Montemagni C, Rocca P, Bellino S. Real-World Functioning in Psychiatric Outpatients: Predictive Factors. J Clin Med 2022; 11:4400. [PMID: 35956015 PMCID: PMC9369214 DOI: 10.3390/jcm11154400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/17/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Investigations on predictors of real-world functioning were mainly performed in patients with schizophrenia, while fewer studies have been conducted in other psychiatric disorders. OBJECTIVE Our objective was to identify clinical, socio-demographic, and illness-related predictors of real-world functioning during 12 months of standard treatments in outpatients with different diagnoses. METHODS Outpatients (n = 1019) with schizophrenia (SZ), major depressive disorder (MDD), bipolar disorder (BD), and borderline personality disorder (BPD) were evaluated with the following tools: SCID-5-CV and SCID-5-PD, CGI-S, SAT-P, DAI-10, and PSP. Change of PSP (ΔPSP) between baseline and 12 months was used as the dependent variable in multiple regression analysis. RESULTS Higher PSP score at baseline and the achievement of main milestones predicted better functioning after follow-up in all subgroups of patients, with the exception of BD. In the total sample, ΔPSP was related to age of onset, treatments, and quality of life, and inversely related to psychiatric anamnesis, antidepressants, and global symptoms. In SZ, ΔPSP was related to adherence and quality of life. In MDD, ΔPSP was related to psychotherapy and quality of life, and inversely related to antidepressants and global symptoms. In BD, ΔPSP was related to age of onset, antipsychotics, and quality of life, while it was inversely related to psychiatric anamnesis. In BPD, antipsychotics, mood stabilizers, psychotherapy, and quality of life were directly related to ΔPSP, while suicidal attempts and global symptoms had an inverse relation. Conclusions: Several socio-demographic and illness-related variables predicted improvement of real-world functioning, besides psychopathology and severity of the disease.
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Affiliation(s)
- Paola Bozzatello
- Department of Neuroscience, University of Turin, 10126 Turin, Italy; (B.G.); (C.M.); (P.R.); (S.B.)
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Visual electrophysiology and neuropsychology in bipolar disorders: a review on current state and perspectives. Neurosci Biobehav Rev 2022; 140:104764. [DOI: 10.1016/j.neubiorev.2022.104764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/21/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022]
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Clinical Value of Inflammatory and Neurotrophic Biomarkers in Bipolar Disorder: A Systematic Review and Meta-Analysis. Biomedicines 2022; 10:biomedicines10061368. [PMID: 35740389 PMCID: PMC9220136 DOI: 10.3390/biomedicines10061368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
Bipolar disorder (BD) is a multifactorial chronic psychiatric disease highly defined by genetic, clinical, environmental and social risk factors. The present systematic review and meta-analysis aimed to examine the relationship between inflammatory and neurotrophic factors and clinical, social and environmental factors involved in the development and the characterization of BD. Web of Science, PubMed, PsycINFO, Scopus and Science Direct were searched by two independent reviewers. The systematic review was registered in PROSPERO (CRD42020180626). A total of 51 studies with 4547 patients with a diagnosis of BD were selected for systematic review. Among them, 18 articles were included for meta-analysis. The study found some evidence of associations between BDNF and/or inflammatory factors and different stressors and functional and cognitive impairment, but limitations prevented firm conclusions. The main finding of the meta-analysis was a negative correlation between circulating levels of BDNF and depression severity score (standardized mean difference = −0.22, Confidence Interval 95% = −0.38, −0.05, p = 0.01). Evidence indicates that BDNF has a role in the depressive component of BD. However, the poor consistency found for other inflammatory mediators clearly indicates that highly controlled studies are needed to identity precise biomarkers of this disorder.
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Hsu HE, Chen PY, Chang HM, Pan CH, Su SS, Tsai SY, Chen CC, Kuo CJ. Incidence of and risk factors for alcohol dependence in bipolar disorder: A population-based cohort and nested case-control study. Aust N Z J Psychiatry 2022; 57:725-735. [PMID: 35642594 DOI: 10.1177/00048674221100153] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Although alcohol dependence is highly prevalent in patients with bipolar disorder, the causal relationship is not yet well-established. This study estimated the incidence of alcohol dependence in a nationwide bipolar disorder cohort and examined risk factors for alcohol dependence. METHODS Patients aged 15-65 years with consistent bipolar disorder who had their first psychiatric admission between 1999 and 2012 (n = 21,791) were enrolled from the National Health Insurance Research Database in Taiwan. We calculated the adjusted incidence rate ratio of alcohol dependence in the bipolar cohort relative to the general population after stratification by age and sex. In the nested case-control study, we included patients with incident alcohol dependence as cases and four age- and sex-matched controls for each case to analyze health care utilization, comorbidities and concomitant medications between them. RESULTS We identified 1261 patients with bipolar disorder with incident alcohol dependence. Relative to the general population, the adjusted incidence rate ratio of alcohol dependence was 9.20 in the bipolar cohort. All adjusted incidence rate ratios were high across all age subgroups. Cases had higher psychiatric and nonpsychiatric health care utilization than did controls. Multivariate analysis revealed that cases tended to have cardiovascular disease, diabetes mellitus, chronic hepatic disease, pneumonia and delirium before alcohol dependence diagnosis. Cases had higher psychiatric comorbidities, namely drug-induced mental disorders, anxiety disorder, personality disorder, adjustment disorder and sleep disorder. CONCLUSION The bipolar cohort had a higher incidence of alcohol dependence. We identified specific groups with a high risk of alcohol dependence. Additional strategies for early detection, treatment and intervention for alcohol dependence should be developed.
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Affiliation(s)
- Haw-En Hsu
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei
| | - Po-Yu Chen
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei
| | - Hu-Ming Chang
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei
| | - Chun-Hung Pan
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei.,Department of Psychology, National Chengchi University, Taipei
| | - Sheng-Shiang Su
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Department of Psychiatry, Mackay Memorial Hospital, Taipei.,Department of Psychiatry, Mackay Medical College, Taipei
| | - Chian-Jue Kuo
- Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei
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Lage RR, de Assis da Silva R, Tancini MB, Nardi AE, Mograbi DC, Cheniaux E. Suicidal Ideation in Bipolar Disorder: The Relation with Clinical and Sociodemographic Variables. Psychiatr Q 2022; 93:453-461. [PMID: 34664176 DOI: 10.1007/s11126-021-09965-0] [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: 07/31/2021] [Revised: 07/31/2021] [Accepted: 09/30/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Bipolar disorder (BD) has the highest risk of suicide among all mental disorders. Thus, identifying factors related to suicidal ideation is essential for a better assessment of the risk of suicide in BD. OBJECTIVE To analyze the relationship between suicidal ideation and clinical and sociodemographic characteristics in BD patients. METHOD This is a cross-sectional study that included eighty individuals with BD. Information regarding sociodemographic data and history of attempted suicide were collected, and the Hamilton Depression Scale, Young Mania Rating Scale, Positive And Negative Syndrome Scale/positive symptom subscale, Clinical Global Impressions Scale for use in bipolar illness, Insight Scale for Affective Disorders, and Barratt Impulsiveness Scale were administered. The presence and severity of suicidal ideation were assessed using the Beck Scale for Suicidal Ideation. RESULTS All regression models significantly predicted suicidal ideation. In the model that had the lowest AIC score and the highest cross-validity, the severity of depressive and of manic symptoms (standardized β = 0.49, p < 0.001; standardized β = 0.42, p = 0.007), the insight level (standardized β = - 0.38, p = 0.012) and previous suicide attempt (standardized β = 0.20, p = 0.036) acted as predictors of suicidal ideation, while degree of impulsivity (β standardized = 0.13, p = 0.229) and educational level (standardized β = - 0.16, p = 0.108) did not give a significant contribution. CONCLUSION According to our results, more severe depression and mania symptoms, higher level of insight and a history of suicide attempt indicate the occurrence of suicidal ideation in BD.
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Affiliation(s)
- Renata Reis Lage
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Av. Venceslau Brás, 71, fundos, CEP 22290-140, Rio de Janeiro, RJ, Brazil.
| | - Rafael de Assis da Silva
- Department of Psychology, Pontifícia Universidade Católica-Rio, Rio de Janeiro, Brazil.,School of Medicine and Surgery, Federal University of the State of Rio de Janeiro (Unirio), Rio de Janeiro, Brazil
| | - Marcelo Baggi Tancini
- Department of Psychology, Pontifícia Universidade Católica-Rio, Rio de Janeiro, Brazil
| | - Antonio Egidio Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Av. Venceslau Brás, 71, fundos, CEP 22290-140, Rio de Janeiro, RJ, Brazil
| | - Daniel C Mograbi
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Av. Venceslau Brás, 71, fundos, CEP 22290-140, Rio de Janeiro, RJ, Brazil.,Department of Psychology, Pontifícia Universidade Católica-Rio, Rio de Janeiro, Brazil.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Elie Cheniaux
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Av. Venceslau Brás, 71, fundos, CEP 22290-140, Rio de Janeiro, RJ, Brazil.,Medical Sciences College, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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36
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Koene J, Zyto S, van der Stel J, van Lang N, Ammeraal M, Kupka RW, van Weeghel J. The relations between executive functions and occupational functioning in individuals with bipolar disorder: a scoping review. Int J Bipolar Disord 2022; 10:8. [PMID: 35286505 PMCID: PMC8921376 DOI: 10.1186/s40345-022-00255-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 01/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Patients with bipolar disorder experience impairments in their occupational functioning, despite remission of symptoms. Previous research has shown that neurocognitive deficits, especially deficits in executive functions, may persist during euthymia and are associated with diminished occupational functioning. Objectives The aim of this scoping review was to identify published studies that report on the relationships between executive functions and occupational functioning in BD to review current knowledge and identify knowledge gaps. In addition to traditional neuropsychological approaches, we aimed to describe executive functioning from a self-regulation perspective, including emotion regulation. Methods We applied the methodological framework as described by Arksey and O’Malley (Int J Soc Res Methodol Theory Pract 8:19–32, 2005) and Levac et al. (Implement Sci 5:1–9, 2010). We searched PubMed and psycINFO for literature up to November 2021, after which we screened papers based on inclusion criteria. Two reviewers independently performed the screening process, data charting process, and synthesis of results. Results The search yielded 1202 references after deduplication, of which 222 remained after initial screening. The screening and inclusion process yielded 82 eligible papers in which relationships between executive functions and occupational functioning are examined. Conclusion Neurocognitive deficits, including in executive functions and self-regulation, are associated with and predictive of diminished occupational functioning. Definitions and measurements for neurocognitive functions and occupational functioning differ greatly between studies, which complicates comparisons. Studies on functional remediation show promising results for improving occupational functioning in patients with BD. In research and clinical practice more attention is needed towards the quality of work functioning and the various contexts in which patients with BD experience deficits. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00255-7.
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Affiliation(s)
- Juul Koene
- University of Applied Sciences Leiden, Leiden, The Netherlands.,Tranzo, Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| | - Susan Zyto
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. .,Mental Health Service Organisation North Holland North, Hoorn, The Netherlands.
| | | | | | - Marion Ammeraal
- GGZinGeest Center for Mental Health Care, Amsterdam, The Netherlands
| | - Ralph W Kupka
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands.,GGZinGeest Center for Mental Health Care, Amsterdam, The Netherlands
| | - Jaap van Weeghel
- Tranzo, Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands.,Phrenos Center of Expertise, Utrecht, The Netherlands
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Nutrition, Overweight, and Cognition in Euthymic Bipolar Individuals Compared to Healthy Controls. Nutrients 2022; 14:nu14061176. [PMID: 35334832 PMCID: PMC8955549 DOI: 10.3390/nu14061176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 12/10/2022] Open
Abstract
Bipolar disorder (BD) is associated with impairments in cognitive functions, in which metabolic factors, e.g., overweight, seem to play a significant role. The aim of this study was to investigate the association between nutritional factors and cognitive performance in euthymic individuals with BD. A study cohort of 56 euthymic individuals with BD was compared to a sample of 53 mentally healthy controls. To assess cognitive function, the following tests were applied: California Verbal Learning Test, Trail Making Test A/B, d2 Test of Attention-Revised, and Stroop’s Color-Word Interference Test. Furthermore, a 4-day food record was processed to evaluate dietary intake of macronutrients, specific micronutrients, and food diversity. Body mass index and waist to height ratio were calculated to assess overweight and central obesity. Results showed no nutritional differences between individuals with BD and controls. Individuals with BD performed worse in the d2 test than controls. Hierarchical regression analyses yielded no association between cognitive and nutritional parameters. However, waist to height ratio was negatively correlated with almost all cognitive tests. Central obesity seems to affect cognitive functioning in BD, while the lack of finding differences in nutritional data might be due to problems when collecting data and the small sample size. Consequently, further studies focusing on objectively measuring food intake with adequate sample size are needed.
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38
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The efficacy of cariprazine on cognition: a post hoc analysis from phase II/III clinical trials in bipolar mania, bipolar depression, and schizophrenia. CNS Spectr 2022; 28:319-330. [PMID: 35193729 DOI: 10.1017/s109285292200013x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the effect of cariprazine on cognitive symptom change across bipolar I disorder and schizophrenia. METHODS Post hoc analyses of 3- to 8-week pivotal studies in bipolar I depression and mania were conducted; one schizophrenia trial including the Cognitive Drug Research System attention battery was also analyzed. Outcomes of interest: Montgomery-Åsberg Depression Rating Scale [MADRS], Functioning Assessment Short Test [FAST], Positive and Negative Syndrome Scale [PANSS]). LSMDs in change from baseline to end of study were reported in the overall intent-to-treat population and in patient subsets with specified levels of baseline cognitive symptoms or performance. RESULTS In patients with bipolar depression and at least mild cognitive symptoms, LSMDs were statistically significant for cariprazine vs placebo on MADRS item 6 (3 studies; 1.5 mg=-0.5 [P<.001]; 3 mg/d=-0.2 [P<.05]) and on the FAST Cognitive subscale (1 study; 1.5 mg/d=-1.4; P=.0039). In patients with bipolar mania and at least mild cognitive symptoms, the LSMD in PANSS Cognitive subscale score was statistically significant for cariprazine vs placebo (3 studies; -2.1; P=.001). In patients with schizophrenia and high cognitive impairment, improvement in power of attention was observed for cariprazine 3 mg/d vs placebo (P=.0080), but not for cariprazine 6 mg/d; improvement in continuity of attention was observed for cariprazine 3 mg/d (P=.0012) and 6 mg/d (P=.0073). CONCLUSION These post hoc analyses provide preliminary evidence of greater improvements for cariprazine vs placebo across cognitive measures in patients with bipolar I depression and mania, and schizophrenia, suggesting potential benefits for cariprazine in treating cognitive symptoms.
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Montejo L, Jiménez E, Solé B, Murru A, Arbelo N, Benabarre A, Valentí M, Clougher D, Rodríguez MA, Borràs R, Martínez-Arán A, Vieta E, Bonnín CDM, Torrent C. Identifying neurocognitive heterogeneity in Older Adults with Bipolar Disorder: a cluster analysis. J Affect Disord 2022; 298:522-531. [PMID: 34788686 DOI: 10.1016/j.jad.2021.11.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cognitive profiles of BD patients show a demonstrated heterogeneity among young and middle-aged patients, but this issue has not yet deeply explored in Older Adults with bipolar disorder (OABD). The aim of the present study was to analyze cognitive variability in a sample of OABD. METHODS A total of 138 OABD patients and 73 healthy controls were included in this study. A comprehensive neuropsychological assessment was administered. We performed a k-means cluster analysis method based on the neurocognitive performance to detect heterogeneous subgroups. Demographic, clinical, cognitive and functional variables were compared. Finally, univariate logistic regressions were conducted to detect variables associated with the severity of the cognitive impairment. RESULTS We identified three distinct clusters based on the severity of cognitive impairment: (1) a preserved group (n = 58; 42%) with similar cognitive performance to HC, (2) a group showing mild cognitive deficits in all cognitive domains (n = 64; 46%) and, finally, (3) a group exhibiting severe cognitive impairment (n = 16; 12%). Older age, late onset, higher number of psychiatric admissions and lower psychosocial functioning were associated with the greatest cognitive impairment. Lower age, more years of education and higher estimated IQ were associated with a preserve cognitive functioning. LIMITATIONS The small sample size of the severely impaired group. CONCLUSIONS Cognitive heterogeneity remains at late-life bipolar disorder. Demographic and specific illness factors are related to cognitive dysfunction. Detecting distinct cognitive subgroups may have significant clinical implications for tailoring specific intervention strategies adapted to the level of the impairment and also to prevent cognitive decline.
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Affiliation(s)
- Laura Montejo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Esther Jiménez
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Brisa Solé
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Néstor Arbelo
- Barcelona Clínic Schizophrenia Unit, Hospital Clínic of Barcelona, Department of Medicine, Neuroscience Institute, Barcelona, Catalonia, Spain
| | - Antonio Benabarre
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Marc Valentí
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Derek Clougher
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Manuel Arturo Rodríguez
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Roger Borràs
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Anabel Martínez-Arán
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain.
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain.
| | - Caterina Del Mar Bonnín
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain; Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carla Torrent
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
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40
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Aidelbaum R, Goghari V. A Visual Task-Based Assessment of Theory of Mind and Social Perception Within Bipolar Disorder. J Nerv Ment Dis 2022; 210:37-44. [PMID: 34743085 DOI: 10.1097/nmd.0000000000001408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Evidence suggests that theory of mind (TOM) and social perception (SP) may be impaired within bipolar disorder (BD). However, it remains unclear whether these deficits are facet specific and predictive of functioning. This study assessed the manifestation of TOM and SP in a BD sample. Twenty-six individuals diagnosed with BD and 25 controls were recruited and assessed for TOM, SP, and functioning. Whereas differences were observed regarding functional outcome, differences were not observed regarding social cognitive performance, regardless of facet. Correlations between social cognitive and functional outcome domains were nonsignificant, whereas significant associations were observed between the social cognitive measures. Results suggest that despite functional differences, TOM and SP, independent of facet assessed, seem preserved within the BD sample. Although evidence was not provided supporting the utility of TOM and SP in the prediction of functional outcome, evidence supports the possible dependence of these social cognitive domains on shared underlying processes.
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Affiliation(s)
- Robert Aidelbaum
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada
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41
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Dominiak M, Jażdżyk P, Antosik-Wójcińska AZ, Konopko M, Bieńkowski P, Świȩcicki Ł, Sienkiewicz-Jarosz H. The impact of bipolar spectrum disorders on professional functioning: A systematic review. Front Psychiatry 2022; 13:951008. [PMID: 36090375 PMCID: PMC9448890 DOI: 10.3389/fpsyt.2022.951008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
AIMS The impact of bipolar spectrum (BS) disorders on professional functioning has not been systematically reviewed yet. Since even subsyndromal symptoms may disturb functioning, the determination of the prognostic value of the spectrum of bipolarity for employment seems extremely relevant. The aim of this study was to assess the impact of BS disorders on professional functioning. MATERIALS AND METHODS A systematic review of the literature (namely, cohort and cross-sectional studies) investigating a link between BS disorders and employment was performed in accordance with PRISMA guidelines. BS was defined based on the concept of two-dimensional BS by Angst. Occupational outcomes and factors affecting employment were evaluated as well. RESULTS Seventy-four studies were included. All disorders comprising BS had a negative impact on occupational status, work performance, work costs, and salary, with the greatest unfavorable effect reported by bipolar disorder (BD), followed by borderline personality disorder (BPD), major depressive disorder (MDD), and dysthymia. Employment rates ranged from 40 to 75% (BD), 33 to 67% (BPD), 61 to 88% (MDD), and 86% (dysthymia). The factors affecting employment most included: cognitive impairments, number/severity of symptoms, namely, subsyndromal symptoms (mainly depressive), older age, education, and comorbidity (substance abuse, personality disorders, anxiety, depression, ADHD, PTSD). CONCLUSION Bipolar spectrum symptoms exert a negative impact on professional functioning. Further evaluation of affecting factors is crucial for preventing occupational disability.
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Affiliation(s)
- Monika Dominiak
- Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Piotr Jażdżyk
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland.,Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | | | - Magdalena Konopko
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Łukasz Świȩcicki
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
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42
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Hogg B, Valiente-Gómez A, Redolar-Ripoll D, Gardoki-Souto I, Fontana-McNally M, Lupo W, Jiménez E, Madre M, Blanco-Presas L, Reinares M, Cortizo R, Massó-Rodriguez A, Castaño J, Argila I, Castro-Rodríguez JI, Comes M, Doñate M, Herrería E, Macias C, Mur E, Novo P, Rosa AR, Vieta E, Radua J, Padberg F, Pérez-Solà V, Moreno-Alcázar A, Amann BL. High incidence of PTSD diagnosis and trauma-related symptoms in a trauma exposed bipolar I and II sample. Front Psychiatry 2022; 13:931374. [PMID: 36339849 PMCID: PMC9632656 DOI: 10.3389/fpsyt.2022.931374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/30/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is an established comorbidity in Bipolar Disorder (BD), but little is known about the characteristics of psychological trauma beyond a PTSD diagnosis and differences in trauma symptoms between BD-I and BD-II. OBJECTIVE (1) To present characteristics of a trauma-exposed BD sample; (2) to investigate prevalence and trauma symptom profile across BD-I and BD-II; (3) to assess the impact of a lifetime PTSD diagnosis vs. a history of trauma on BD course; and (4) to research the impacts of sexual and physical abuse. METHODS This multi-center study comprised 79 adult participants with BD with a history of psychological trauma and reports baseline data from a trial registered in Clinical Trials (https://clinicaltrials.gov; ref: NCT02634372). Clinical variables were gathered through clinical interview, validated scales and a review of case notes. RESULTS The majority (80.8%) of our sample had experienced a relevant stressful life event prior to onset of BD, over half of our sample 51.9% had a lifetime diagnosis of PTSD according to the Clinician Administered PTSD scale. The mean Impact of Event Scale-Revised scores indicated high levels of trauma-related distress across the sample, including clinical symptoms in the PTSD group and subsyndromal symptoms in the non-PTSD group. Levels of dissociation were not higher than normative values for BD. A PTSD diagnosis (vs. a history of trauma) was associated with psychotic symptoms [2(1) = 5.404, p = 0.02] but not with other indicators of BD clinical severity. There was no significant difference between BD-I and BD-II in terms of lifetime PTSD diagnosis or trauma symptom profile. Sexual abuse significantly predicted rapid cycling [2(1) = 4.15, p = 0.042], while physical abuse was not significantly associated with any clinical indicator of severity. CONCLUSION Trauma load in BD is marked with a lack of difference in trauma profile between BD-I and BD-II. Although PTSD and sexual abuse may have a negative impact on BD course, in many indicators of BD severity there is no significant difference between PTSD and subsyndromal trauma symptoms. Our results support further research to clarify the role of subsyndromic PTSD symptoms, and highlight the importance of screening for trauma in BD patients.
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Affiliation(s)
- Bridget Hogg
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,PhD Programme, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
| | - Alicia Valiente-Gómez
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
| | - Diego Redolar-Ripoll
- Neuromodulation Unit, Institut Brain, Barcelona, Spain.,Cognitive NeuroLab, Faculty of Psychology and Educational Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Itxaso Gardoki-Souto
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain.,PhD Programme, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Fontana-McNally
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Walter Lupo
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Esther Jiménez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain.,Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, L'Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mercè Madre
- Addictive Behaviours Unit, Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Hospital Benito Menni-CASM, Sant Boi de Llobregat, Barcelona, Spain.,FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Laura Blanco-Presas
- Hospital Benito Menni-CASM, Sant Boi de Llobregat, Barcelona, Spain.,FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain.,Programa TEPT-AGRESX, Instituto de Neurociencias (ICN), Hospital Clinic, Barcelona, Spain
| | - María Reinares
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain.,Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, L'Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Romina Cortizo
- Centro Salud Mental Adultos Ciutat Vella, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Centro Salud Mental Adultos (CSMA), Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Anna Massó-Rodriguez
- Centro de Salud Mental Infantil y Juvenil (CSMIJ), Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Juan Castaño
- Centro Salud Mental Adultos (CSMA), Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Isabel Argila
- Hospital Benito Menni-CASM, Sant Boi de Llobregat, Barcelona, Spain.,FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - José Ignacio Castro-Rodríguez
- Centro Salud Mental Adultos (CSMA), Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Mercè Comes
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain.,Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, L'Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Doñate
- Centro Salud Mental Adultos (CSMA), Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain.,Parc Sanitari Sant Joan de Deu, Sant Boi de Llobegrat, Spain
| | - Elvira Herrería
- Hospital Benito Menni-CASM, Sant Boi de Llobregat, Barcelona, Spain
| | - Cristina Macias
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain.,Centre Emili Mira, Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Estanislao Mur
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Centro Salud Mental Adultos (CSMA), Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Patricia Novo
- Centro de Salud Mental Infantil y Juvenil (CSMIJ), Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain.,Day Hospital, Centro de Psicoterapia de Barcelona (CPB), Barcelona, Spain
| | - Adriane R Rosa
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Departamento de Farmacologia, Instituto de Ciéncias Básicas de Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande doSul (UFRGS), Porto Alegre, Brazil
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain.,Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, L'Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joaquim Radua
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain.,Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, L'Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Clinical Neuroscience, Karolinska Institutet (KI), Solna, Sweden.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Frank Padberg
- Clinic for Psychiatry and Psychotherapy, Klinikum der Universität München, Munich, Germany
| | - Victor Pérez-Solà
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain.,Centro Salud Mental Adultos (CSMA), Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain.,Departamento de Medicina y Ciencias de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ana Moreno-Alcázar
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
| | - Benedikt L Amann
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain.,Clinic for Psychiatry and Psychotherapy, Klinikum der Universität München, Munich, Germany.,Departamento de Medicina y Ciencias de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
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43
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Dombi ZB, Szendi I, Burnet PWJ. Brain Derived Neurotrophic Factor and Cognitive Dysfunction in the Schizophrenia-Bipolar Spectrum: A Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:827322. [PMID: 35686181 PMCID: PMC9170985 DOI: 10.3389/fpsyt.2022.827322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/27/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Cognitive impairment is a core feature of disorders on the schizophrenia-bipolar spectrum, i.e., schizophrenia, bipolar disorder, and schizoaffective disorder. Brain-derived neurotrophic factor (BDNF) has been proposed to be a biomarker of cognitive impairment in these disorders as it plays a critical role in neuroplasticity and proposed to mediate some of the psychotropic effects of medication. However, despite numerous studies investigating the association between circulating BDNF and these disorders, no solid conclusions have been drawn regarding its involvement in cognitive impairment. OBJECTIVES The current systematic review and meta-analysis aims to examine blood BDNF levels and cognitive dysfunction in patients on the schizophrenia-bipolar spectrum as well as to evaluate whether circulating BDNF measurements can act as a biomarker for cognitive dysfunction. METHODS Studies were identified by searching Embase and Medline databases for English language articles published in peer-reviewed journals between 2000 January and 2021 June according to the PRISMA guidelines. A total of 815 articles were identified of which 32 met the inclusion criteria for the systematic review - reporting on comparisons between blood BDNF levels and cognitive functions of schizophrenia or bipolar disorder patients versus healthy controls (no studies involving schizoaffective patients were specifically obtained for the time being). Twenty-four of these studies (19 with schizophrenia and 5 with bipolar disorder patients) were eligible to be included in the meta-analysis. RESULTS Our findings indicated that circulating BDNF levels were significantly reduced in patients experiencing an acute episode of schizophrenia or bipolar disorder compared to healthy controls. Cognitive function was also found to be significantly worse in patients, however, correlations between BDNF levels and cognitive impairment were not always detected. Interventions, especially pharmacotherapy seemed to improve certain aspects of cognition and increase circulating BDNF levels. CONCLUSION Circulating BDNF alone does not seem to be a valid biomarker of cognitive dysfunction in patients with disorders on the schizophrenia-bipolar spectrum, owing to several confounding factors. Changes of the circulating levels of BDNF should be evaluated in a wider context of other stress-, immune-, and inflammatory-related factors.
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Affiliation(s)
- Zsófia B Dombi
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Medical Division, Gedeon Richter Plc., Budapest, Hungary
| | - István Szendi
- Department of Psychiatry, Kiskunhalas Semmelweis Hospital, Kiskunhalas, Hungary.,Department of Software Engineering, University of Szeged, Szeged, Hungary
| | - Philip W J Burnet
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Farias CDA, Cardoso TDA, da Silva MM, D'Angelo F, Mondin TC, Souza LDDM, da Silva RA, Kapczinski F, Jansen K, Magalhães PVS. Socioeconomic and substance use changes in emerging adults and their relationship with mood disorders in a population-based cohort. Front Psychiatry 2022; 13:932484. [PMID: 36090374 PMCID: PMC9448898 DOI: 10.3389/fpsyt.2022.932484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
In this report, we aim to assess the interaction of bipolar disorder and major depressive disorder with the evolution of social roles, economic classification, and substance misuse in emerging adults. This is a longitudinal population-based study (n = 231 at baseline), in which participants were reassessed at a mean of 5 years after baseline. A structured clinical interview was used to diagnose the participants with bipolar disorder and major depression; a control group without mood disorders was included. Men with mood disorders were less likely to be married in the beginning of the study and less likely to work in the follow-up. Women with major depression were less likely to study and more likely to be in a lower economic class at the beginning of the study. In comparison, women with bipolar disorder were less likely to live with their parents and more likely to live with their children in the first wave of the study. Substance misuse was more likely in people with mood disorders, especially in men, and women with bipolar disorder had the highest likelihood in the follow-up. Albeit longitudinal analyses were limited by a possibly insufficient sample size and mediating mechanisms for change, such as stigma, were not explored, the study suggests sex-related specificities regarding the change in social roles and substance use in people with mood disorders. Emerging adults, especially those with mood disorders, are in a period of change and instability and at a greater risk for substance use and abuse.
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Affiliation(s)
- Clarisse de Azambuja Farias
- Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Taiane de Azevedo Cardoso
- Graduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Marielle Moro da Silva
- Faculty of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Francesca D'Angelo
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Thaise Campos Mondin
- Graduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil
| | | | | | - Flavio Kapczinski
- Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.,Faculty of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Karen Jansen
- Graduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Pedro V S Magalhães
- Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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45
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Sollier-Guillery M, Fortier A, Dondaine T, Batail JM, Robert G, Drapier D, Lacroix A. Emotions and cognitive control: A comparison of bipolar disorder and schizophrenia. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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46
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Saccaro LF, Amatori G, Cappelli A, Mazziotti R, Dell'Osso L, Rutigliano G. Portable technologies for digital phenotyping of bipolar disorder: A systematic review. J Affect Disord 2021; 295:323-338. [PMID: 34488086 DOI: 10.1016/j.jad.2021.08.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/30/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bias-prone psychiatric interviews remain the mainstay of bipolar disorder (BD) assessment. The development of digital phenotyping promises to improve BD management. We present a systematic review of the evidence about the use of portable digital devices for the identification of BD, BD types and BD mood states and for symptom assessment. METHODS We searched Web of KnowledgeSM, Scopus ®, IEEE Xplore, and ACM Digital Library databases (until 5/1/2021) for articles evaluating the use of portable/wearable digital devices, such as smartphone apps, wearable sensors, audio and/or visual recordings, and multimodal tools. The protocol is registered in PROSPERO (CRD42020200086). RESULTS We included 62 studies (2325 BD; 724 healthy controls, HC): 27 using smartphone apps, either for recording self-assessments (n = 10) or for passively gathering metadata (n = 7) or both (n = 10); 15 using wearable sensors for physiological parameters; 17 analysing audio and/or video recordings; 3 using multiple technologies. Two thirds of the included studies applied artificial intelligence (AI)-based approaches. They achieved fair to excellent classification performances. LIMITATIONS The included studies had small sample sizes and marked heterogeneity. Evidence of overfitting emerged, limiting generalizability. The absence of clear guidelines about reporting classification performances, with no shared standard metrics, makes results hardly interpretable and comparable. CONCLUSIONS New technologies offer a noteworthy opportunity to BD digital phenotyping with objectivity and high granularity. AI-based models could deliver important support in clinical decision-making. Further research and cooperation between different stakeholders are needed for addressing methodological, ethical and socio-economic considerations.
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Affiliation(s)
- Luigi F Saccaro
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy; Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Raffaele Mazziotti
- Institute of Neuroscience of the Italian National Research Council (CNR), Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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47
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Aidelbaum R, Shakeel MK, Goghari V. A self-report and behavioural assessment of impulsivity in bipolar disorder: Evidence of elevated trait but not behavioural facets. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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48
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Zhao S, Zhang X, Zhou Y, Xu H, Li Y, Chen Y, Zhang B, Sun X. Comparison of thyroid function in different emotional states of drug-naïve patients with bipolar disorder. BMC Endocr Disord 2021; 21:210. [PMID: 34674686 PMCID: PMC8532266 DOI: 10.1186/s12902-021-00869-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 10/08/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Previous studies have shown that bipolar disorder is closely related to thyroid dysfunction. Psychiatric drugs have a large or small effect on thyroid function, and thyroid hormone levels can also affect the effect of drug treatment. Therefore, the purpose of this study is assessment the thyroid function of drug-naive bipolar disorder across different mood states, with the expectation of providing support for treatment options. METHODS The present study is a cross-sectional study. Patients diagnosed with bipolar disorder according to the International Classification of Diseases diagnostic Criteria, Edition 10 (ICD 10) and who had never received medication were included in the study. The Montgomery Depression Scale (MADRS) was used to assess depressive symptoms and the Young Mania Rating Scale (YMRS) for manic symptoms. Thyroid function indicators include thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), total triiodothyronine (TT3), free thyroxine (FT4), and total thyroxine (TT4). Levels of TSH, TT4, FT4, TT3, and FT3 were measured within 48 h of hospitalization, between 06:00 and 08:00. RESULTS The data analysis finally covered the data of 291 subjects (136 in a bipolar manic group, 128 in a bipolar depressive group, and 27 in a bipolar mixed group), including 140 males and 151 females, with an average age of 27.38 ± 8.01. There was no significant difference in age, sex, marital status, work status, family history, and course of illness among the manic group, depressive group, and mixed group. The level of FT3, the rate of thyroid hormone increased secretion, and the total abnormality rate of thyroid hormone secretion in the manic group were significantly higher than those in the depressive group. CONCLUSION These findings indicate that thyroid functions were significantly different between depressive and manic episodes in BD patients. In clinical practice, it is necessary to take into account the differences in thyroid hormone levels in patients with BD across different emotional states in choosing drug.
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Affiliation(s)
- Shengnan Zhao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Xu Zhang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan China
| | - Yaling Zhou
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Hao Xu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Yuwei Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Yuexin Chen
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan China
| | - Bo Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Xueli Sun
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan China
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49
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Cañada Y, Sabater A, Sierra P, Balanzá-Martínez V, Berk M, Dodd S, Navalón P, Livianos L, García-Blanco A. The effect of concomitant benzodiazepine use on neurocognition in stable, long-term patients with bipolar disorder. Aust N Z J Psychiatry 2021; 55:1005-1016. [PMID: 33153268 DOI: 10.1177/0004867420969819] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Neurocognitive dysfunction is a common feature of bipolar disorder even in euthymia, and psychopharmacological treatment could have an effect on cognition. Long-term prescription of benzodiazepines in bipolar disorder is a common practice, and their effect on neurocognition has not been well studied in this population. The aim of this study was to evaluate the impact of concomitant benzodiazepine long-term use on neurocognitive function in stable euthymic bipolar disorder patients. METHODS Seventy-three euthymic bipolar disorder outpatients and 40 healthy individuals were assessed using a neurocognitive battery. Patients were classified in two groups according to the presence of benzodiazepines in their treatment: the benzodiazepine group (n = 34) and the non- benzodiazepine group (n = 39). Neurocognitive performance was compared between the groups using a multivariate analysis of covariance, considering age, number of depressive episodes, adjuvant antipsychotic drugs, Young Mania Rating Scale score and Hamilton Depression Rating Scale score as covariates. RESULTS Both bipolar disorder groups (benzodiazepine and non-benzodiazepine) showed an impairment in memory domains (Immediate Visual Memory [p = 0.013], Working Memory [p < 0.001], and Letter-Number Sequence [p < 0.001] from the Wechsler Memory Scale-Revised-III) and slower processing speed functions (Stroop Colour [p < 0.001]) relative to the control group. Nevertheless, the benzodiazepine group showed a greater impairment in executive functions (Conceptual Level Responses [p = 0.024] from the Wisconsin Card Sorting Test and Frontal Assessment Battery [p = 0.042]). CONCLUSION Although memory and processing speed impairments were found in bipolar disorder, regardless of their benzodiazepine treatment, benzodiazepine users presented additional neurocognitive impairments in terms of executive functioning. These findings support restricted prescription of benzodiazepines in individuals with bipolar disorder.
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Affiliation(s)
- Yolanda Cañada
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ana Sabater
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pilar Sierra
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - Vicent Balanzá-Martínez
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain.,Center of Biomedical Investigation Network in Mental Health (CIBERSAM), Madrid, Spain
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia.,Orygen - The National Centre for Excellence in Youth Mental Health, Parkville, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, Parkville, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Seetal Dodd
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia.,Orygen - The National Centre for Excellence in Youth Mental Health, Parkville, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Pablo Navalón
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain.,Neonatal Research Unit, La Fe Health Research Institute, Valencia, Spain
| | - Lorenzo Livianos
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain.,CIBERESP-17, Valencia, Spain
| | - Ana García-Blanco
- Department of Psychiatry and Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain.,Neonatal Research Unit, La Fe Health Research Institute, Valencia, Spain.,Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain
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50
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Vieta E, Calabrese JR, Whelan J, Tohen M, Earley WR. The efficacy of cariprazine on function in patients with bipolar depression: a post hoc analysis of a randomized controlled trial. Curr Med Res Opin 2021; 37:1635-1643. [PMID: 34034612 DOI: 10.1080/03007995.2021.1932446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Individuals with bipolar depression often experience functional impairment that interferes with recovery. These analyses examined the effects of cariprazine on functional outcomes in patients with bipolar I disorder. METHODS Prespecified analyses of data from a randomized, double-blind, placebo-controlled pivotal trial of cariprazine in bipolar I depression (NCT01396447) evaluated mean changes from baseline to week 8 in Functional Assessment Short Test (FAST) total score. Post hoc analyses with no adjustment for multiplicity evaluated FAST subscale scores, functional recovery and remission (FAST total score ≤11 and ≤20, respectively), and 30% or 50% improvement from baseline. RESULTS There were 393 patients with bipolar I disorder (placebo = 132; cariprazine: 1.5 mg/d = 135, 3 mg/d = 126) in the FAST analysis population. Statistically significant differences were noted for cariprazine 1.5 mg/d versus placebo in mean change from baseline in FAST total score (p<.01) and on 5 of 6 subscale scores (p<.05); cariprazine 3 mg/d was significantly different than placebo on the Interpersonal Relationship subscale (p<.05). Rates of functional remission and recovery, and ≥30% or ≥50% improvement were significantly greater for cariprazine 1.5 mg/d versus placebo (p<.05 all); the percentage of patients with ≥30% improvement was significantly different for cariprazine 3 mg/d versus placebo (p<.05). CONCLUSION At week 8, statistically significant improvements in FAST outcomes were observed for cariprazine versus placebo in patients with bipolar I depression; more consistent results were noted for 1.5 mg/d than 3 mg/d. In addition to improving bipolar depression symptoms, these results suggest that cariprazine may improve functional outcomes.
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Affiliation(s)
- Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Joseph R Calabrese
- Mood Disorders Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jessica Whelan
- Department of Nursing, Maryville University, Saint Louis, MO, USA
- Holon Inclusive Health Care, Dupo, IL, USA
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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