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BIPOLAR DISORDER, MOOD STABILIZERS AND COGNITIVE FLEXIBILITY: TRANSLATIONALLY DISSECTING ILLNESS FROM DRUG EFFECTS. Behav Brain Res 2022; 424:113799. [PMID: 35181389 DOI: 10.1016/j.bbr.2022.113799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/21/2022] [Accepted: 02/12/2022] [Indexed: 11/21/2022]
Abstract
Bipolar disorder (BD) effects on cognition are confounded by the putative cognitive impact of its major pharmacological treatments, given the neurotrophic potential of mood stabilizers, particularly lithium. We examined the area of cognitive flexibility (CF), aiming to disentangle BD from medication effects, using translational methodology. CF was assessed by CANTAB-IED (intra- extra-dimensional shift; Study 1, euthymic BD participants) and its animal analogue (Study 2, rats). Both studies included groups (1) control, (2) lithium, chronic, current treatment (LI-CHRON-C, A: >2 years, N=32; B: 2 months, N=11); (3) valproate, chronic, current treatment (VPA-CHRON-C, A: >2 years, N=30; B: 2 months, N=12). Study 2 included 2 additional groups; Group 4: LI-CHRON-PAST (2 months, stopped 1 month pretest, N=13); Group 5: LI-ACUTE (LI on test days only, N=13). In Study 1, neither total nor stage (discrimination: D; reversal R; intra- extra-dimensional shifts: IED) IED errors differed between groups [(Kruskal-Wallis: H(2, N= 94) 0.95 > p > 0.65]. Similarly in Study 2, errors did not differentiate the 5 pharmacological groups. Differences emerged only between LI-ACUTE and Controls in response latencies (D, R, IED ANOVAS: 0.002 > p > 0.0003; contrasts D, R: p = 0.002, 0.0001). In conclusion, LI and VPA BD patients were indistinguishable from Controls in IED errors, as were animals treated with LI-CHRON, current or past, or VPA-CHRON-C vs Controls. LI-ACUTE treatment produced significant latency deficits vs. Controls. Within the limitations of translational comparisons, our results suggest that the normal CF noted in euthymic BDs is not attributable to mood stabilizer effects.
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Jiang X, Mio M, Dimick MK, Zou Y, Sultan AA, Goldstein BI. Association of Lithium and Second-Generation Antipsychotics with Neurocognition in Youth with Bipolar Disorder. J Child Adolesc Psychopharmacol 2022; 32:61-69. [PMID: 35085001 PMCID: PMC8884166 DOI: 10.1089/cap.2021.0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: Numerous studies have examined the association of antimanic medications with neurocognition in adults with bipolar disorder (BD). However, few studies have examined this topic in youth. Thus, we aimed to examine the association of lithium and second-generation antipsychotics (SGAs), the first-line antimanic medications for youth with BD, with neurocognition in a relatively large sample of youth with BD. Methods: Participants included 91 youth with BD-I, -II, or -Not Otherwise Specified, aged 13-20 years (n = 14 current lithium use, n = 51 current SGA use). We examined four tests from the Cambridge Neuropsychological Test Automated Battery: Intra/Extra Dimensional Set-Shifting Task (IED), Rapid Visual Information Processing Task (RVP), Stockings of Cambridge Test (SOC), and Affective Go/No-Go (AGN). Within-sample Z-scores were computed, and a global neurocognitive composite score and g factor derived from these tests comprised the primary outcomes. Multivariable analyses controlled for age, sex, and IQ. Results: Current lithium use was significantly associated with poorer cognitive flexibility/set-shifting (IED). After further controlling for lifetime comorbid attention-deficit/hyperactivity disorder and current depression symptoms in sensitivity analyses, the lithium finding was no longer significant. Current SGA use was significantly associated with greater affective processing bias (AGN). No significant findings survived correction for multiple comparisons. All other cognitive outcomes were not significantly associated with current lithium use, current SGA use, or total number of current medications. Conclusions: Treatment with lithium or SGAs was associated with minimal neurocognitive impairments, with small effect sizes in primary multivariable analyses. This study adds to the limited body of literature examining medication use in relation to neurocognition in youth with BD. While the current study cannot rule out associations of smaller effect size, present findings suggest that leading mood-stabilizing medications are not associated with frank neurocognitive impairments in youth with BD.
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Affiliation(s)
- Xinyue Jiang
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Megan Mio
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Mikaela K. Dimick
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Alysha A. Sultan
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Benjamin I. Goldstein
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Address correspondence to: Benjamin I. Goldstein, MD, PhD, Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4, Canada
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The Dutch Bipolar Offspring Study: Cognitive Development and Psychopathology. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1559-1567. [PMID: 30887148 DOI: 10.1007/s10802-019-00532-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Various aspects of the relationship between cognitive impairment and bipolar disorder are not clear yet. This study examines cognitive and educational functioning prospectively in offspring at familial risk for bipolar disorder, in order to improve our understanding of the association between cognitive functioning and psychopathology. Bipolar offspring (N = 92) from the prospective Dutch bipolar offspring study were evaluated at adolescence and adulthood for IQ estimate, educational achievement and development of any psychiatric disorder. The main outcome was IQ estimate after 12 years of follow-up (offspring mean age 28 years). Generalized estimating equation (GEE) analyses showed that any lifetime DSM-IV axis I diagnosis was related to a lower cognitive outcome at adulthood as compared to unaffected bipolar offspring. No specific association was found for type of diagnosis. Early onset psychopathology (diagnosis at or before age 15 years) was significantly related to lower IQ estimate at adulthood, indicating a sensitive period for neurocognitive development.
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Daglas R, Cotton S, Allott K, Yücel M, Macneil C, Hasty M, Murphy B, Pantelis C, Hallam K, Henry L, Conus P, Ratheesh A, Kader L, Wong M, McGorry P, Berk M. A single-blind, randomised controlled trial on the effects of lithium and quetiapine monotherapy on the trajectory of cognitive functioning in first episode mania: A 12-month follow-up study. Eur Psychiatry 2020; 31:20-8. [DOI: 10.1016/j.eurpsy.2015.09.460] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/25/2015] [Accepted: 09/27/2015] [Indexed: 11/30/2022] Open
Abstract
AbstractBackgroundCognitive deficits have been reported during the early stages of bipolar disorder; however, the role of medication on such deficits remains unclear. The aim of this study was to compare the effects of lithium and quetiapine monotherapy on cognitive performance in people following first episode mania.MethodsThe design was a single-blind, randomised controlled trial on a cohort of 61 participants following first episode mania. Participants received either lithium or quetiapine monotherapy as maintenance treatment over a 12-month follow-up period. The groups were compared on performance outcomes using an extensive cognitive assessment battery conducted at baseline, month 3 and month 12 follow-up time-points.ResultsThere was a significant interaction between group and time in phonemic fluency at the 3-month and 12-month endpoints, reflecting greater improvements in performance in lithium-treated participants relative to quetiapine-treated participants. After controlling for multiple comparisons, there were no other significant interactions between group and time for other measures of cognition.ConclusionAlthough the effects of lithium and quetiapine treatment were similar for most cognitive domains, the findings imply that early initiation of lithium treatment may benefit the trajectory of cognition, specifically verbal fluency in young people with bipolar disorder. Given that cognition is a major symptomatic domain of bipolar disorder and has substantive effects on general functioning, the ability to influence the trajectory of cognitive change is of considerable clinical importance.
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Lin K, Lu R, Chen K, Li T, Lu W, Kong J, Xu G. Differences in cognitive deficits in individuals with subthreshold syndromes with and without family history of bipolar disorder. J Psychiatr Res 2017; 91:177-183. [PMID: 28521253 DOI: 10.1016/j.jpsychires.2017.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/19/2017] [Accepted: 05/09/2017] [Indexed: 12/27/2022]
Abstract
Little is known about the development of cognitive deficits prior to the official onset of bipolar disorder (BP). The aim of this study was to investigate neurocognitive performance in two early stages of BP. This high-risk design study recruited a group of offspring of parents with BP (n = 58), aged 8-28 years. Based on the subthreshold syndromes, the "unaffected" offspring were further divided into high-risk (HR) and ultra-high-risk (UHR) stages. For comparison, a group of individuals with subthreshold symptoms but without family history of psychiatric disorder (n = 17) and 48 healthy controls (HCs) were included. The MATRICS Consensus Cognitive Battery (MCCB) and Tower of London task were applied to assess neuropsychological performance. The HR offspring performed significantly poorer on verbal learning and memory when compared with HCs, indicating that the deficits may serve as neurocognitive endophenotypes for BP. Deficits in working memory, visual-spatial memory, and cognitive planning were observed in the UHR offspring when compared with HCs, suggestive of risk of developing BP. The deficits observed in the UHR offspring were absent in the individuals with subthreshold symptoms without psychiatric family history. Our data suggest that cognitive deficits become apparent prior to the official onset of BP, with specific deficits observable in different early stages. These results nonetheless are based on small sample size and a cross-sectional design. Given this and the heterogeneity of bipolar disorders, these findings should be interpreted cautiously and require replication.
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Affiliation(s)
- Kangguang Lin
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Laboratory of Emotion and Cognition, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
| | - Rui Lu
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Laboratory of Emotion and Cognition, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Kun Chen
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Laboratory of Emotion and Cognition, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Ting Li
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Weicong Lu
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Jiehua Kong
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Laboratory of Emotion and Cognition, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Guiyun Xu
- Department of Affective Disorders, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; Laboratory of Emotion and Cognition, Guangzhou Brain Hospital, The Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
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Verbal fluency in bipolar disorders: A systematic review and meta-analysis. J Affect Disord 2017; 207:359-366. [PMID: 27744224 DOI: 10.1016/j.jad.2016.09.039] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/29/2016] [Accepted: 09/27/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND One of the main features of bipolar disorder (BD), besides mood dysregulation, is an alteration of the structure of language. Bipolar patients present changes in semantic contents, impaired verbal associations, abnormal prosody and abnormal speed of language highlighted with various experimental tasks. Verbal fluency tasks are widely used to assess the abilities of bipolar patients to retrieve and produce verbal material from the lexico-semantic memory. Studies using these tasks have however yielded discrepant results. The aim of this study was thus to determine the extent of the verbal fluency impairment in BD patients and to evaluate if the deficits are affected by the type of task or by mood states. METHODS A systematic literature search was conducted in MEDLINE, EBSCOHost and Google Scholar and relevant data were submitted to a meta-analysis. RESULTS Thirty-nine studies were retained providing data for 52 independent groups of BD patients. The overall meta-analysis revealed a moderate verbal fluency impairment in BD compared to healthy controls (effect size d=0.61). Comparisons between mood states showed significant differences only between euthymic and manic patients and only on category fluency performances. LIMITATIONS This review is limited by the heterogeneity between studies for the characteristics of BD populations. Also, few of the retained studies examined depressive or mixed episodes. CONCLUSIONS This work confirms that BD patients present with moderate verbal fluency impairments, and underlines the specific effect of mood state on category fluency. This emphasizes the need to distinguish semantic from phonological processes in verbal fluency assessments in BD.
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McCarthy JB, Weiss SR, Segovich KT, Barbot B. Impact of psychotic symptoms on cognitive functioning in child and adolescent psychiatric inpatients with severe mood disorders. Psychiatry Res 2016; 244:223-8. [PMID: 27497293 DOI: 10.1016/j.psychres.2016.07.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/08/2016] [Accepted: 07/24/2016] [Indexed: 10/21/2022]
Abstract
Despite established differences in cognitive functioning of adults with mood disorder-related psychosis and those with non-affective psychotic disorders, there is limited evidence of the impact of psychotic symptoms on the cognitive functioning of children and adolescents with mood disorders. This study investigates IQ, working memory, and processing speed scores in 80 child and adolescent inpatients discharged from an intermediate care state psychiatric hospital, using a retrospective chart review. Associations between diagnosis based on DSM-IV criteria (7 with Major Depression- MDD; 43 with Bipolar Disorders-BD, and 30 with Mood Disorders Not Otherwise Specified-NOS), presence of current psychotic features, and cognitive functioning (WISC-IV IQ, Coding, Symbol Search, and Digit Span) were investigated using Multivariate Analyses of Variance. No differences were found in cognitive functioning between patients with MDD and BD, or between those with severe Mood Disorders (MDD or BD) and those with NOS, when controlling for age, gender, and presence of psychotic features. However, patients with severe mood disorders and psychotic features showed lower IQs and greater working memory deficits than those without psychotic features or NOS. Results are discussed in terms of treatment planning for children and adolescents at risk for developing psychotic symptoms and severe mood disorders.
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Affiliation(s)
- James B McCarthy
- Pace University, Department of Psychology, New York City, NY, United States; Adelphi University, Garden City, NY, United States.
| | - Shira R Weiss
- Sagamore Children's Psychiatric Center, Dix Hills, NY, United States
| | - Kristin T Segovich
- Pace University, Department of Psychology, New York City, NY, United States
| | - Baptiste Barbot
- Pace University, Department of Psychology, New York City, NY, United States; Yale University, Child Study Center, New Haven, CT, United States.
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Marshall DF, Passarotti AM, Ryan KA, Kamali M, Saunders EFH, Pester B, McInnis MG, Langenecker SA. Deficient inhibitory control as an outcome of childhood trauma. Psychiatry Res 2016; 235:7-12. [PMID: 26707783 PMCID: PMC6639093 DOI: 10.1016/j.psychres.2015.12.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/04/2015] [Accepted: 12/09/2015] [Indexed: 01/27/2023]
Abstract
Childhood trauma has been linked to the development and severity of psychiatric disorders as well as deficits in cognitive functioning. This study aimed to investigate the performance of bipolar disorder (BD) patients and healthy controls (HC), with or without a history of childhood trauma, on a parametric Go/No-Go (PGNG) task measuring important aspects of executive functions, namely attention and inhibitory control. Two hundred and thirty-three individuals with BD and 90 HC completed diagnostic interview, childhood trauma questionnaire (CTQ), symptom severity scales, and a PGNG task. Four comparison groups were created using a 1.0 standard deviation cut-off of the mean of the HC total CTQ score: BD-trauma, BD-normative, HC-trauma and HC-normative. We assessed interactions between diagnosis and trauma on Go/No-Go levels of interest by using a two-way multivariate analysis of covariance. Results showed a significant main effect of trauma on inhibitory control accuracy, as the trauma group exhibited significantly poorer accuracy on inhibition trials compared to the normative group. There was also a main effect of diagnosis on response time. These findings suggest that early trauma might adversely impact the development of cognitive systems and brain circuits that support inhibitory aspects of executive functioning in individuals with a history of trauma.
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Affiliation(s)
- David F. Marshall
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA,Corresponding author at: Department of Psychiatry, University of Michigan, 2101 Commonwealth Blvd, Suite C, Ann Arbor, MI 48105, USA. Tel.: + 1 734 763 9259, Fax: + 1 734 936 9262,
| | | | - Kelly A. Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Masoud Kamali
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Erika F. H. Saunders
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA,Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Bethany Pester
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Melvin G. McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Scott A. Langenecker
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA,Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
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Bersani G, Quartini A, Zullo D, Iannitelli A. Potential neuroprotective effect of lithium in bipolar patients evaluated by neuropsychological assessment: preliminary results. Hum Psychopharmacol 2016; 31:19-28. [PMID: 26563456 DOI: 10.1002/hup.2510] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/20/2015] [Accepted: 10/03/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Accumulating evidence is delineating a neuroprotective/neurotrophic role for lithium. However, its primary effects on cognition remain ambiguous. We sought to investigate the profile of cognitive impairment in patients with bipolar disorder and to determine whether continued treatment with lithium preserves cognitive functioning. METHODS In this cross-sectional study, we tested 15 euthymic patients with bipolar I disorder undergoing long-term clinical maintenance treatment with lithium (for at least 12 months), 15 matched patients treated with other mood-stabilizing drugs and who had never received lithium, and 15 matched healthy subjects on the Cambridge Neuropsychological Test Automated Battery. Investigated cognitive domains were visual memory, executive functions, attention, decision-making/impulsivity, and response inhibition. We controlled for age, gender, intelligence, and residual psychiatric symptomatology. RESULTS Taken together, bipolar patients demonstrated robust deficits in visual memory and executive functions. Once subdivided in treatment subgroups, only non-lithium bipolar patients demonstrated impairments in visual memory. Attention, decision-making, and response inhibition were preserved in both groups. No correlation emerged between neuropsychological tests performance, clinical, and psychological variables. CONCLUSIONS This study is the first to our knowledge to have demonstrated, by means of a highly sensitive test of visual memory, a potential hippocampus neuroprotective effect of lithium in patients with bipolar disorder. Besides, it confirms prior findings of cognitive deficits in euthymic bipolar patients.
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Affiliation(s)
- Giuseppe Bersani
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, DSM ASL/LT-Unit of Psychiatry, "A. Fiorini" Hospital, Via Firenze, Terracina (LT), Italy
| | - Adele Quartini
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, DSM ASL/LT-Unit of Psychiatry, "A. Fiorini" Hospital, Via Firenze, Terracina (LT), Italy
| | - Daiana Zullo
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, DSM ASL/LT-Unit of Psychiatry, "A. Fiorini" Hospital, Via Firenze, Terracina (LT), Italy
| | - Angela Iannitelli
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, DSM ASL/LT-Unit of Psychiatry, "A. Fiorini" Hospital, Via Firenze, Terracina (LT), Italy.,Department of Health Sciences, University of L'Aquila, Italy
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O'Shea KS, McInnis MG. Neurodevelopmental origins of bipolar disorder: iPSC models. Mol Cell Neurosci 2015; 73:63-83. [PMID: 26608002 DOI: 10.1016/j.mcn.2015.11.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 10/14/2015] [Accepted: 11/18/2015] [Indexed: 12/22/2022] Open
Abstract
Bipolar disorder (BP) is a chronic neuropsychiatric condition characterized by pathological fluctuations in mood from mania to depression. Adoption, twin and family studies have consistently identified a significant hereditary component to BP, yet there is no clear genetic event or consistent neuropathology. BP has been suggested to have a developmental origin, although this hypothesis has been difficult to test since there are no viable neurons or glial cells to analyze, and research has relied largely on postmortem brain, behavioral and imaging studies, or has examined proxy tissues including saliva, olfactory epithelium and blood cells. Neurodevelopmental factors, particularly pathways related to nervous system development, cell migration, extracellular matrix, H3K4 methylation, and calcium signaling have been identified in large gene expression and GWAS studies as altered in BP. Recent advances in stem cell biology, particularly the ability to reprogram adult somatic tissues to a pluripotent state, now make it possible to interrogate these pathways in viable cell models. A number of induced pluripotent stem cell (iPSC) lines from BP patient and healthy control (C) individuals have been derived in several laboratories, and their ability to form cortical neurons examined. Early studies suggest differences in activity, calcium signaling, blocks to neuronal differentiation, and changes in neuronal, and possibly glial, lineage specification. Initial observations suggest that differentiation of BP patient-derived neurons to dorsal telencephalic derivatives may be impaired, possibly due to alterations in WNT, Hedgehog or Nodal pathway signaling. These investigations strongly support a developmental contribution to BP and identify novel pathways, mechanisms and opportunities for improved treatments.
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Affiliation(s)
- K Sue O'Shea
- Department of Cell and Developmental Biology, University of Michigan, 3051 BSRB, 109 Zina Pitcher PL, Ann Arbor, MI 48109-2200, United States; Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109-5765, United States.
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109-5765, United States
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Dell'Osso B, Cinnante C, Di Giorgio A, Cremaschi L, Palazzo MC, Cristoffanini M, Fazio L, Dobrea C, Avignone S, Triulzi F, Bertolino A, Altamura AC. Altered prefrontal cortex activity during working memory task in Bipolar Disorder: A functional Magnetic Resonance Imaging study in euthymic bipolar I and II patients. J Affect Disord 2015; 184:116-22. [PMID: 26074021 DOI: 10.1016/j.jad.2015.05.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/17/2015] [Accepted: 05/11/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Working memory (WM) deficits are among the most frequently impaired cognitive domains in patients with Bipolar Disorder (BD), being considered promising cognitive endophenotype of the disorder. However, the related neurobiological correlates still deserve further investigation. The present study was aimed to explore whether dorsolateral prefrontal cortex (DLPFC) activity during WM processing was abnormal in euthymic bipolar patients and may represent a potential trait-related phenotype associated with the disorder. METHODS Using 3 Tesla functional Magnetic Resonance Imaging (3T fMRI), we studied 28 euthymic bipolar patients (15 BDI and 13 BDII), and 27 healthy controls (HCs), matched for a series of socio-demographic variables, while performing the N-back task for WM assessment. RESULTS We found that euthymic bipolar patients showed increased right middle frontal gyrus engagement compared with HCs (FWE-corrected p = 1 × 10(-3)), regardless of WM load, and in spite of similar WM behavioral performance between groups. In particular, BDI patients had greater BOLD signal change compared to HCs (post-hoc Tukey HSD, p = 1 × 10(-3)), while BDII patients expressed an intermediate pattern of activation between BDI patients and HCs. No other significant effects were detected in the corrected whole-brain analysis. LIMITATIONS Sample size, cross-sectional assessment and potential influence of some clinical variables. CONCLUSIONS Results provide direct evidence of a primary physiological abnormality in DLPFC function in BDI and II, even in the absence of behavioral differences with HCs. Such exaggerated fMRI response suggests inefficient WM processing in prefrontal circuitry, and further studies are warranted to investigate whether the dysfunction is related to the genetic risk for the disorder.
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Affiliation(s)
- Bernardo Dell'Osso
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Dipartimento di Salute Mentale, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy; Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, United States.
| | - Claudia Cinnante
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - Annabella Di Giorgio
- Servizio di Consulenza Psichiatrica, IRCCS "Casa Sollievo della Sofferenza", Viale Cappuccini 1, 71013 San Giovanni Rotondo, Italy
| | - Laura Cremaschi
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Dipartimento di Salute Mentale, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - M Carlotta Palazzo
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Dipartimento di Salute Mentale, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - Marta Cristoffanini
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - Leonardo Fazio
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience and Sense Organs, "Aldo Moro" University, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Cristina Dobrea
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Dipartimento di Salute Mentale, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - Sabrina Avignone
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - Fabio Triulzi
- U.O. Neuroradiologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - Alessandro Bertolino
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience and Sense Organs, "Aldo Moro" University, Piazza Giulio Cesare 11, 70124 Bari, Italy; pRED, NORD DTA, F. Hoffman-La Roche Ltd., Basel, Switzerland
| | - A Carlo Altamura
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Dipartimento di Salute Mentale, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
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12
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Neurocognitive impairments among youth with pediatric bipolar disorder: a systematic review of neuropsychological research. J Affect Disord 2014; 166:297-306. [PMID: 25012445 DOI: 10.1016/j.jad.2014.05.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/18/2014] [Accepted: 05/19/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pediatric bipolar disorder (PBD) has emerged as a field of research in which neuropsychological studies are continuously providing new empirical findings. Despite this, a comprehensive framework for neurocognitive impairments is still lacking, and most of the evidence remains unconnected. We addressed this question through a systematic review of neuropsychological research, with the aim of elucidating the main issues concerning this topic. METHOD A comprehensive search of databases (PubMed, PsycINFO) was performed. Published manuscripts between 1990 and January 2014 were identified. Overall, 124 studies fulfilled inclusion criteria. Methodological differences between studies required a descriptive review of findings. RESULTS Evidence indicates that verbal/visual-spatial memory, processing speed, working memory, and social cognition are neurocognitive domains impaired in PBD youth. Furthermore, these deficits are greater among those who suffer acute affective symptoms, PBD type I, and/or attention deficit hyperactivity disorder (ADHD) comorbidity. In addition, several neurocognitive deficits imply certain changes in prefrontal cortex activity and are somewhat associated with psychosocial and academic disabilities. Strikingly, these deficits are consistently similar to those encountered in ADHD as well as severe mood dysregulation (SMD). Besides, some neurocognitive impairments appear before the onset of the illness and tend to maintain stable across adolescence. Finally, any therapy has not yet demonstrated to be effective on diminishing these neurocognitive impairments. LIMITATIONS More prolonged follow-up studies aimed at delineating the course of treatment and the response to it are warranted. CONCLUSIONS Despite noteworthy research on the neurocognitive profile of PBD, our knowledge is still lagging behind evidence from adult counterparts.
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Wang YC, Wang EN, Wang CC, Huang CL, Huang ACW. Dissociating effects of spatial learning from locomotor activity for ouabain-induced bipolar disorder-like rats. Psychiatry Res 2014; 216:432-7. [PMID: 24656518 DOI: 10.1016/j.psychres.2014.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 02/26/2014] [Accepted: 03/01/2014] [Indexed: 12/11/2022]
Abstract
Whether ouabain, a Na+ - and K+-activated adenosine triphosphatase inhibitor, mimics cognitive impairments that can be dissociated from motor effects in the bipolar disorder-like animal model remains unclear. Ouabain and the vehicle aCSF were microinjected into the left lateral ventricle immediately, after 4h, and after 24h. The results showed that (a) locomotion responses of the Immediate group were significantly decreased compared to those of the aCSF group, particularly the first five minutes. (b) The ouabain-treated rats have longer latency and total distance traveled in the water maze task; however, the velocity was not affected for the ouabain group. (c) The analysis of covariance showed that the latency time (but not the total distance traveled and velocity) of the ouabain group was more impaired than that of the aCSF group, regardless of omitting total distance traveled and cross movement in the open field test. The latency might be more sensitive than the distance traveled and the velocity for assessing spatial learning. Dissociating the spatial learning from the movement may allow testing drug treatments of cognitive deficits independent of locomotor effects associated with bipolar disorder.
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Affiliation(s)
- Ying-Chou Wang
- Department of Clinical Psychology, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - En-Nan Wang
- Department of Clinical Psychology, Fu Jen Catholic University, New Taipei City 24205, Taiwan; Department of Psychiatry, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Graduate Institute of Humanities in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Chuan Wang
- School of Medicine, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Chung-Lei Huang
- Department of Psychology, Fo Guang University, Yilan County 26247, Taiwan
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14
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Savitz JB, Price JL, Drevets WC. Neuropathological and neuromorphometric abnormalities in bipolar disorder: view from the medial prefrontal cortical network. Neurosci Biobehav Rev 2014; 42:132-47. [PMID: 24603026 DOI: 10.1016/j.neubiorev.2014.02.008] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/20/2014] [Accepted: 02/19/2014] [Indexed: 12/15/2022]
Abstract
The question of whether BD is primarily a developmental disorder or a progressive, neurodegenerative disorder remains unresolved. Here, we review the morphometric postmortem and neuroimaging literature relevant to the neuropathology of bipolar disorder (BD). We focus on the medial prefrontal cortex (mPFC) network, a key system in the regulation of emotional, behavioral, endocrine, and innate immunological responses to stress. We draw four main conclusions: the mPFC is characterized by (1) a decrease in volume, (2) reductions in neuronal size, and/or changes in neuronal density, (3) reductions in glial cell density, and (4) changes in gene expression. These data suggest the presence of dendritic atrophy of neurons and the loss of oligodendroglial cells in BD, although some data additionally suggest a reduction in the cell counts of specific subpopulations of GABAergic interneurons. Based on the weight of the postmortem and neuroimaging literature discussed herein, we favor a complex hypothesis that BD primarily constitutes a developmental disorder, but that additional, progressive, histopathological processes also are associated with recurrent or chronic illness. Conceivably BD may be best conceptualized as a progressive neurodevelopmental disorder.
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Affiliation(s)
- Jonathan B Savitz
- Laureate Institute for Brain Research, Tulsa, OK, USA; Faculty of Community Medicine, University of Tulsa, Tulsa, OK, USA.
| | - Joseph L Price
- Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Wayne C Drevets
- Laureate Institute for Brain Research, Tulsa, OK, USA; Janssen Pharmaceuticals of Johnson & Johnson, Inc., Titusville, NJ, USA
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15
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Monotherapy with lithium or valproate or respectively combination therapy with quetiapine have similar effect on cognitive functions in Chinese euthymic patients with bipolar disorder: a cross-sectional survey. J Clin Psychopharmacol 2013; 33:817-9. [PMID: 23963059 DOI: 10.1097/jcp.0b013e31829c96e9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Schenkel LS, Passarotti AM, Sweeney JA, Pavuluri MN. Negative emotion impairs working memory in pediatric patients with bipolar disorder type I. Psychol Med 2012; 42:2567-77. [PMID: 22564881 PMCID: PMC3652422 DOI: 10.1017/s0033291712000797] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND We investigated affect recognition and the impact of emotional valence on working memory (using happy, angry, and neutral faces) in pediatric patients with bipolar disorder (BD) and healthy control (HC) subjects. METHOD Subjects (N=70) consisted of unmedicated patients with BD type I (BD I, n=23) and type II (BD II, n=16) and matched HC subjects (n=31). All subjects completed tasks of emotion recognition (Chicago Pediatric Emotional Acuity Task; Chicago PEAT) and working memory for happy, angry, and neutral faces (Affective N-Back Memory Task; ANMT). RESULTS Compared to HC subjects, BD patients performed significantly more poorly when identifying the intensity of happy and angry expressions on the Chicago PEAT, and demonstrated working-memory impairments regardless of the type of facial emotional stimuli. Pediatric BD patients displayed the most impaired accuracy and reaction time performance with negative facial stimuli relative to neutral stimuli, but did not display this pattern with positive stimuli. Only BD I patients displayed working-memory deficits, while both BD I and BD II patients displayed emotion-identification impairments. Results remained significant after controlling for co-morbid ADHD and mood state. CONCLUSIONS Both BD I and BD II youth demonstrate emotion-identification deficits. BD youth also demonstrate working-memory impairments for facial stimuli irrespective of emotional valence; however, working-memory deficits were the most pronounced with negative emotional stimuli. These deficits appear to be specific to BD I patients, and suggest therefore that a more severe form of illness is characterized by more severe social-cognitive impairment.
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Affiliation(s)
- L S Schenkel
- Department of Psychology, Rochester Institute of Technology, Rochester, NY, USA.
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17
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Shi XF, Kondo DG, Sung YH, Hellem TL, Fiedler KK, Jeong EK, Huber RS, Renshaw PF. Frontal lobe bioenergetic metabolism in depressed adolescents with bipolar disorder: a phosphorus-31 magnetic resonance spectroscopy study. Bipolar Disord 2012; 14:607-17. [PMID: 22816670 PMCID: PMC4651435 DOI: 10.1111/j.1399-5618.2012.01040.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To compare the concentrations of high-energy phosphorus metabolites associated with mitochondrial function in the frontal lobe of depressed adolescents with bipolar disorder (BD) and healthy controls (HC). METHODS We used in vivo phosphorus-31 magnetic resonance spectroscopy ((31) P-MRS) at 3 Tesla to measure phosphocreatine (PCr), beta-nucleoside triphosphate (β-NTP), inorganic phosphate (Pi), and other neurometabolites in the frontal lobe of eight unmedicated and six medicated adolescents with bipolar depression and 24 adolescent HCs. RESULTS Analysis of covariance, including age as a covariate, revealed differences in PCr (p=0.037), Pi (p=0.017), and PCr/Pi (p=0.002) between participant groups. Percentage neurochemical differences were calculated with respect to mean metabolite concentrations in the HC group. Post-hoc Tukey-Kramer analysis showed that unmedicated BD participants had decreased Pi compared with both HC (17%; p=0.038) and medicated BD (24%; p=0.022). The unmedicated BD group had increased PCr compared with medicated BD (11%; p=0.032). The PCr/Pi ratio was increased in unmedicated BD compared with HC (24%; p=0.013) and with medicated BD (39%; p=0.002). No differences in β-NTP or pH were observed. CONCLUSIONS Our results support the view that frontal lobe mitochondrial function is altered in adolescent BD and may have implications for the use of Pi as a biomarker. These findings join volumetric studies of the amygdala, and proton MRS studies of n-acetyl aspartate in pointing to potential differences in neurobiology between pediatric and adult BD.
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Affiliation(s)
- Xian-Feng Shi
- The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA.
| | - Douglas G Kondo
- The Brain Institute, University of Utah School of Medicine, Salt Lake City, UT, USA,Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA,VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Young-Hoon Sung
- The Brain Institute, University of Utah School of Medicine, Salt Lake City, UT, USA,Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Tracy L Hellem
- The Brain Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kristen K Fiedler
- The Brain Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Eun-Kee Jeong
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Rebekah S Huber
- The Brain Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Perry F Renshaw
- The Brain Institute, University of Utah School of Medicine, Salt Lake City, UT, USA,Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA,VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
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18
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Schenkel LS, West AE, Jacobs R, Sweeney JA, Pavuluri MN. Cognitive dysfunction is worse among pediatric patients with bipolar disorder Type I than Type II. J Child Psychol Psychiatry 2012; 53:775-81. [PMID: 22339488 PMCID: PMC3415381 DOI: 10.1111/j.1469-7610.2011.02519.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Impaired profiles of neurocognitive function have been consistently demonstrated among pediatric patients with bipolar disorder (BD), and may aid in the identification of endophenotypes across subtypes of the disorder. This study aims to determine phenotypic cognitive profiles of patients with BD Type I and II. METHODS Subjects (N = 79) consisted of BD I (n = 27) and BD II (n = 19) patients and demographic and intellectually matched healthy controls (HC; n = 33) that completed a battery of neurocognitive tasks. RESULTS Bipolar disorder Type I patients performed significantly more poorly compared to HC on all domains of cognitive function including attention, executive function, working memory, visual memory, and verbal learning and memory. BD I patients also performed more poorly compared to BD II patients on all domains of cognitive functioning with the exception of working memory, whereas BD II patients did poorly relative to HC only on verbal learning and memory. CONCLUSIONS Findings from the current study indicate that BD I patients are characterized by more severe cognitive impairment relative to BD II patients who show an intermediate pattern of performance between BD I patients and HC. Verbal learning and memory may effectively differentiate pediatric BD patients and controls, regardless of the subtype of BD, and may serve as a cognitive endophenotype for the disorder. Additionally, these findings move us closer to developing effective cognitive interventions tailored to specific subtypes of pediatric BD patients.
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Affiliation(s)
| | - Amy E. West
- Pediatric Mood Disorders Program, University of Illinois at Chicago
| | - Rachel Jacobs
- Pediatric Mood Disorders Program, University of Illinois at Chicago
| | - John A. Sweeney
- Center for Cognitive Medicine, University of Illinois at Chicago
| | - Mani N. Pavuluri
- Pediatric Mood Disorders Program, University of Illinois at Chicago,Center for Cognitive Medicine, University of Illinois at Chicago
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19
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Neurocognitive performance in children and adolescents with bipolar disorder: a review. Eur Child Adolesc Psychiatry 2011; 20:433-50. [PMID: 21904806 DOI: 10.1007/s00787-011-0209-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 07/28/2011] [Indexed: 10/17/2022]
Abstract
A number of studies have reported the evidence of cognitive deficits in adult bipolar patients. Recently, there has been a shift in research on neurocognitive performance in bipolar disorder (BD) towards examining younger age groups. A review of the literature on neurocognitive impairments in BD in childhood and adolescence was conducted. We searched systematically for studies in samples of age groups younger than 18 years of age in average that included either a healthy control group or normative data for the cognitive tests used. Twenty-one original articles were found and reviewed. Children and adolescents with BD show deficits in a variety of cognitive areas. The most consistent results were found for impairments in verbal memory. A majority of studies also indicated impairments in working memory. Similar pattern of neurocognitive impairment was found in children and adolescents as compared to adults suffering from BD. The neurocognitive deficits need to be recognized and incorporated into individual treatment programs.
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20
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Nieto RG, Castellanos FX. A meta-analysis of neuropsychological functioning in patients with early onset schizophrenia and pediatric bipolar disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2011; 40:266-80. [PMID: 21391023 DOI: 10.1080/15374416.2011.546049] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite the nosological distinction between bipolar disorder and schizophrenia, there is increasing evidence that these conditions share phenomenological characteristics. To examine the similarities in their patterns of cognitive impairment, we conducted a meta-analysis from 12 studies of Early Onset Schizophrenia (EOS) and 12 studies of Pediatric Bipolar Disorder (PBD). We found that individuals with PBD suffer from cognitive deficits (e.g., verbal learning and memory, processing speed, or executive control) that are milder but similar in nature to those of patients with EOS. Qualitative similarities between the neuropsychological profiles produced by these groups of patients might represent a "continuum of psychosis" or reflect some degree of genetic biological overlap.
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Affiliation(s)
- Rebeca Garcia Nieto
- Child Study Center, New York University Langone Medical Center, New York, NY, USA.
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21
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Diwadkar VA, Goradia D, Hosanagar A, Mermon D, Montrose DM, Birmaher B, Axelson D, Rajarathinem R, Haddad L, Amirsadri A, Zajac-Benitez C, Rajan U, Keshavan MS. Working memory and attention deficits in adolescent offspring of schizophrenia or bipolar patients: comparing vulnerability markers. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1349-54. [PMID: 21549798 PMCID: PMC3126676 DOI: 10.1016/j.pnpbp.2011.04.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 04/15/2011] [Accepted: 04/18/2011] [Indexed: 01/14/2023]
Abstract
BACKGROUND Working memory deficits abound in schizophrenia and attention deficits have been documented in schizophrenia and bipolar disorder. Adolescent offspring of patients may inherit vulnerabilities in brain circuits that subserve these cognitive domains. Here we assess impairments in offspring of schizophrenia (SCZ-Offspring) or bipolar (BP-Offspring) patients compared to controls (HC) with no family history of mood or psychotic disorders to the second degree. METHODS Three groups (n=100 subjects; range: 10-20 yrs) of HC, SCZ-Offspring and BP-Offspring gave informed consent. Working memory was assessed using a delayed spatial memory paradigm with two levels of delay (2s & 12s); sustained attention processing was assessed using the Continuous Performance Task-Identical Pairs version. RESULTS SCZ-Offspring (but not BP-Offspring) showed impairments in working memory (relative to HC) at the longer memory delay indicating a unique deficit. Both groups showed reduced sensitivity during attention but only BP-Offspring significantly differed from controls. CONCLUSIONS These results suggest unique (working memory/dorsal frontal cortex) and potentially overlapping (attention/fronto-striatal cortex) vulnerability pathways in adolescent offspring of patients with schizophrenia and bipolar disorder. Working memory and attention assessments in these offspring may assist in the clinical characterization of the adolescents vulnerable to SCZ or BP.
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Affiliation(s)
- Vaibhav A. Diwadkar
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM,Dept of Psychiatry, University of Pittsburgh SOM,Address Correspondence to: Vaibhav A. Diwadkar, PhD, Division of Brain Research & Imaging Neuroscience, Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM, UHC 9B, 4201 St. Antoine Blvd, Detroit MI 48301, U.S.A., Ph: 1.313.577.0164, Fax: 1.313.577.5900,
| | - Dhruman Goradia
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | | | - Diana Mermon
- Dept of Psychiatry, University of Pittsburgh SOM
| | | | | | | | - R. Rajarathinem
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | - Luay Haddad
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | - Ali Amirsadri
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | | | - Usha Rajan
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM
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Impact of executive function deficits in youth with bipolar I disorder: a controlled study. Psychiatry Res 2011; 186:58-64. [PMID: 20864180 PMCID: PMC3026851 DOI: 10.1016/j.psychres.2010.08.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 08/25/2010] [Accepted: 08/27/2010] [Indexed: 11/23/2022]
Abstract
Although psychometrically-defined executive function deficits (EFDs) and ecologically valid functional outcomes have been documented among youth with bipolar I (BP-I) disorder, little is known about their association. We hypothesized that EFDs would be associated with significant ecologically valid impairments beyond those predicted by having BP-I disorder. Youth with BP-I disorder were ascertained from psychiatric clinics and community sources. We defined EFDs as having at least two out of eight EF measures impaired from a battery of six tests. Significantly more youth with BP-I disorder had EFDs than controls (45% versus 17%). Comparisons were made between controls without EFDs (N=81), controls with EFDs (N=17), BP-I youth without EFDs (N=76), and BP-I youth with EFDs (N=62). EFDs were associated with an increased risk for placement in a special class and a decrease in academic achievement (WRAT-3 reading and arithmetic). EFDs in BP-I subjects were associated with an increased risk for speech/language disorder (as assessed in the K-SADS-E) relative to BP-I subjects without EFDs. Youth with BP-I disorder and EFDs are at high risk for significant impairments in academic functioning.
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23
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James A, Hough M, James S, Burge L, Winmill L, Nijhawan S, Matthews PM, Zarei M. Structural brain and neuropsychometric changes associated with pediatric bipolar disorder with psychosis. Bipolar Disord 2011; 13:16-27. [PMID: 21320249 DOI: 10.1111/j.1399-5618.2011.00891.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To identify neuropsychological and structural brain changes using a combination of high-resolution structural and diffusion tensor imaging in pediatric bipolar disorder (PBD) with psychosis (presence of delusions and or hallucinations). METHODS We recruited 15 patients and 20 euthymic age- and gender-matched healthy controls. All subjects underwent high-resolution structural and diffusion tensor imaging. Voxel-based morphometry (VBM), tract-based spatial statistics (TBSS), and probabilistic tractography were used to analyse magnetic resonance imaging data. RESULTS The PBD subjects had normal overall intelligence with specific impairments in working memory, executive function, language function, and verbal memory. Reduced gray matter (GM) density was found in the left orbitofrontal cortex, left pars triangularis, right premotor cortex, occipital cortex, right occipital fusiform gyrus, and right crus of the cerebellum. TBSS analysis showed reduced fractional anisotropy (FA) in the anterior corpus callosum. Probabilistic tractography from this cluster showed that this region of the corpus callosum is connected with the prefrontal cortices, including those regions whose density is decreased in PBD. In addition, FA change was correlated with verbal memory and working memory, while more widespread reductions in GM density correlated with working memory, executive function, language function, and verbal memory. CONCLUSIONS The findings suggest widespread cortical changes as well as specific involvement of interhemispheric prefrontal tracts in PBD, which may reflect delayed myelination in these tracts.
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Affiliation(s)
- Anthony James
- Highfield Family and Adolescent Unit, Warneford Hospital Oxford Centre for Functional MRI of the Brain (FMRIB), John Radcliffe Hospital, Oxford GSK Clinical Imaging Centre, Imperial College London, London, UK.
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24
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Caetano SC, Olvera RL, Hatch JP, Sanches M, Chen HH, Nicoletti M, Stanley JA, Fonseca M, Hunter K, Lafer B, Pliszka SR, Soares JC. Lower N-acetyl-aspartate levels in prefrontal cortices in pediatric bipolar disorder: a ¹H magnetic resonance spectroscopy study. J Am Acad Child Adolesc Psychiatry 2011; 50:85-94. [PMID: 21156273 DOI: 10.1016/j.jaac.2010.10.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 10/15/2010] [Accepted: 10/19/2010] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The few studies applying single-voxel ¹H spectroscopy in children and adolescents with bipolar disorder (BD) have reported low N-acetyl-aspartate (NAA) levels in the dorsolateral prefrontal cortex (DLPFC), and high myo-inositol / phosphocreatine plus creatine (PCr+Cr) ratios in the anterior cingulate. The aim of this study was to evaluate NAA, glycerophosphocholine plus phosphocholine (GPC+PC) and PCr+Cr in various frontal cortical areas in children and adolescents with BD. We hypothesized that NAA levels within the prefrontal cortex are lower in BD patients than in healthy controls, indicating neurodevelopmental alterations in the former. METHOD We studied 43 pediatric patients with DSM-IV BD (19 female, mean age 13.2 ± 2.9 years) and 38 healthy controls (19 female, mean age 13.9 ± 2.7 years). We conducted multivoxel in vivo ¹H spectroscopy measurements at 1.5 Tesla using a long echo time of 272 ms to obtain bilateral metabolite levels from the medial prefrontal cortex (MPFC), DLPFC (white and gray matter), cingulate (anterior and posterior), and occipital lobes. We used the nonparametric Mann-Whitney U test to compare neurochemical levels between groups. RESULTS In pediatric BD patients, NAA and GPC+PC levels in the bilateral MPFC, and PCr+Cr levels in the left MPFC were lower than those seen in the controls. In the left DLPFC white matter, levels of NAA and PCr+Cr were also lower in BD patients than in controls. CONCLUSIONS Lower NAA and PCr+Cr levels in the PFC of children and adolescents with BD may be indicative of abnormal dendritic arborization and neuropil, suggesting neurodevelopmental abnormalities.
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25
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Mueller SC, Ng P, Temple V, Hardin MG, Pine DS, Leibenluft E, Ernst M. Perturbed reward processing in pediatric bipolar disorder: an antisaccade study. J Psychopharmacol 2010; 24:1779-84. [PMID: 20080923 PMCID: PMC2999669 DOI: 10.1177/0269881109353462] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pediatric bipolar disorder is a severe and impairing illness. Characterizing the impact of pediatric bipolar disorder on cognitive function might aid in understanding the phenomenology of the disorder. While previous studies of pediatric bipolar disorder have reported deficits in cognitive control and reward behavior, little is understood about how affective processes influence behavioral control. Relative to prior studies using manual-response paradigms, eye movement tasks provide a more precise assessment of reward sensitivity and cognitive and motor control. The current study compares 20 youths with bipolar disorder (mean age = 13.9 years ± 2.22) and 23 healthy subjects (mean age = 13.8 years ± 2.49) on a mixed pro-antisaccade task with monetary incentives. On both types of saccades, participants were presented with three types of incentives: those where subjects can win money, lose money, or neither win nor lose money. Impaired reward processing was found in youths with bipolar disorder relative to controls, particularly on antisaccades. This difference was reflected in lower error rates during incentive trials in the control but not in the bipolar disorder group. By comparison, no group differences were found on prosaccade trials. The results provide further evidence for deficits in cognitive and reward processing in bipolar disorder.
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Affiliation(s)
- Sven C Mueller
- Section of Developmental and Affective Neuroscience National Institute of Mental Health, National Institute of Health, 15k North Drive, Bethesda, MD 20814, USA.
| | - Pamela Ng
- Section of Developmental and Affective Neuroscience National Institute of Mental Health, National Institute of Health, Bethesda, MD, USA
| | - Veronica Temple
- Section of Developmental and Affective Neuroscience National Institute of Mental Health, National Institute of Health, Bethesda, MD, USA
| | - Michael G Hardin
- Section of Developmental and Affective Neuroscience National Institute of Mental Health, National Institute of Health, Bethesda, MD, USA
| | - Daniel S Pine
- Section of Developmental and Affective Neuroscience National Institute of Mental Health, National Institute of Health, Bethesda, MD, USA
| | - Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, National Institute of Mental Health, National Institute of Health, Bethesda, MD, USA
| | - Monique Ernst
- Section of Developmental and Affective Neuroscience National Institute of Mental Health, National Institute of Health, Bethesda, MD, USA
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Fronto-temporal spontaneous resting state functional connectivity in pediatric bipolar disorder. Biol Psychiatry 2010; 68:839-46. [PMID: 20739018 PMCID: PMC2955843 DOI: 10.1016/j.biopsych.2010.06.029] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 06/28/2010] [Accepted: 06/28/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND The recent upsurge in interest about pediatric bipolar disorder (BD) has spurred the need for greater understanding of its neurobiology. Structural and functional magnetic resonance imaging studies have implicated fronto-temporal dysfunction in pediatric BD. However, recent data suggest that task-dependent neural changes account for a small fraction of the brain's energy consumption. We now report the first use of task-independent spontaneous resting state functional connectivity (RSFC) to study the neural underpinnings of pediatric BD. METHODS We acquired task-independent RSFC blood oxygen level-dependent functional magnetic resonance imaging scans while participants were at rest and also a high-resolution anatomical image (both at three Tesla) in BD and control youths (n = 15 of each). We focused, on the basis of prior research, on the left dorsolateral prefrontal cortex (DLPFC), amygdala, and accumbens. Image processing and group-level analyses followed that of prior work. RESULTS Our primary analysis showed that pediatric BD participants had significantly greater negative RSFC between the left DLPFC and the right superior temporal gyrus versus control subjects. Secondary analyses using partial correlation showed that BD and control youths had opposite phase relationships between spontaneous RSFC fluctuations in the left DLPFC and right superior temporal gyrus. CONCLUSIONS Our data indicate that pediatric BD is characterized by altered task-independent functional connectivity in a fronto-temporal circuit that is also implicated in working memory and learning. Further study is warranted to determine the effects of age, gender, development, and treatment on this circuit in pediatric BD.
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Pan L, Keener MT, Hassel S, Phillips ML. Functional neuroimaging studies of bipolar disorder: examining the wide clinical spectrum in the search for disease endophenotypes. Int Rev Psychiatry 2010; 21:368-79. [PMID: 20374150 DOI: 10.1080/09540260902962164] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Bipolar disorder (BP) is among the top ten most disabling illnesses worldwide. This review includes findings from recent studies employing functional neuroimaging to examine functional abnormalities in neural systems underlying core domains of the psychopathology in BP: emotion processing, emotion regulation and executive control, and common comorbid features of BP, that are relevant to the wide spectrum of BP rather than focused on the more traditional BPI subtype, and that may facilitate future identification of diagnostically-relevant biomarkers of the disorder. In addition, an emerging number of studies are reviewed that demonstrate the use of neuroimaging to elucidate biomarkers whose identification may help to (1) identify at-risk individuals who will subsequently develop the illness to facilitate early intervention, (2) identify targets for treatment and markers of treatment response. The use of newer neuroimaging techniques and potential confounds of psychotropic medication upon neuroimaging findings in BP are also examined. These approaches will help to improve diagnosis and the mental well-being of all individuals with BP.
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Affiliation(s)
- Lisa Pan
- University of Pittsburgh Medical Center, Pittsburgh, Philadelphia, USA
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Walshaw PD, Alloy LB, Sabb FW. Executive function in pediatric bipolar disorder and attention-deficit hyperactivity disorder: in search of distinct phenotypic profiles. Neuropsychol Rev 2010; 20:103-20. [PMID: 20165924 PMCID: PMC2834768 DOI: 10.1007/s11065-009-9126-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 12/21/2009] [Indexed: 01/18/2023]
Abstract
Often, there is diagnostic confusion between bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD) in youth due to similar behavioral presentations. Both disorders have been implicated as having abnormal functioning in the prefrontal cortex; however, there may be subtle differences in the manner in which the prefrontal cortex functions in each disorder that could assist in their differentiation. Executive function is a construct thought to be a behavioral analogy to prefrontal cortex functioning. We provide a qualitative review of the literature on performance on executive function tasks for BD and ADHD in order to determine differences in task performance and neurocognitive profile. Our review found primary differences in executive function in the areas of interference control, working memory, planning, cognitive flexibility, and fluency. These differences may begin to establish a pediatric BD profile that provides a more objective means of differential diagnosis between BD and ADHD when they are not reliably distinguished by clinical diagnostic methods.
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Affiliation(s)
- Patricia D Walshaw
- Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, CA, USA.
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Neurocognition in bipolar disorders—A closer look at comorbidities and medications. Eur J Pharmacol 2010; 626:87-96. [PMID: 19836378 DOI: 10.1016/j.ejphar.2009.10.018] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 10/09/2009] [Indexed: 01/01/2023]
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Doyle AE, Wozniak J, Wilens TE, Henin A, Seidman LJ, Petty C, Fried R, Gross LM, Faraone SV, Biederman J. Neurocognitive impairment in unaffected siblings of youth with bipolar disorder. Psychol Med 2009; 39:1253-63. [PMID: 19079809 PMCID: PMC2853769 DOI: 10.1017/s0033291708004832] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is growing evidence for the familiality of pediatric bipolar disorder (BPD) and its association with impairments on measures of processing speed, verbal learning and 'executive' functions. The current study investigated whether these neurocognitive impairments index the familial risk underlying the diagnosis. METHOD Subjects were 170 youth with BPD (mean age 12.3 years), their 118 non-mood-disordered siblings and 79 non-mood-disordered controls. Groups were compared on a battery of neuropsychological tests from the Wechsler Intelligence Scales, the Stroop Color Word Test, the Wisconsin Card Sorting Test (WCST), the Rey-Osterrieth Complex Figure (ROCF), an auditory working memory Continuous Performance Test (CPT) and the California Verbal Learning Test-Children's Version (CVLT-C). Measures were factor analyzed for data reduction purposes. All analyses controlled for age, sex and attention-deficit/hyperactivity disorder (ADHD). RESULTS Principal components analyses with a promax rotation yielded three factors reflecting: (1) processing speed/verbal learning, (2) working memory/interference control and (3) abstract problem solving. The CPT working memory measure with interference filtering demands (WM INT) was only administered to subjects aged > or =12 years and was therefore analyzed separately. BPD youth showed impairments versus controls and unaffected relatives on all three factors and on the WM INT. Unaffected relatives exhibited impairments versus controls on the abstract problem-solving factor and the WM INT. They also showed a statistical trend (p=0.07) towards worse performance on the working memory/interference control factor. CONCLUSIONS Neurocognitive impairments in executive functions may reflect the familial neurobiological risk mechanisms underlying pediatric BPD and may have utility as endophenotypes in molecular genetic studies of the condition.
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Affiliation(s)
- A E Doyle
- Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Child Psychiatry Service, 55 Fruit Street, Boston, MA 02114, USA.
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Henin A, Micco JA, Wozniak J, Briesch JM, Narayan AJ, Hirshfeld-Becker DR. Neurocognitive functioning in bipolar disorder. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1468-2850.2009.01162.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE To examine white matter microstructure, as assessed via diffusion tensor imaging (DTI), in adolescents with bipolar I disorder compared with control volunteers. METHOD Twenty-six (12 male and 14 female subjects) adolescents (mean age, 16.0 years) with bipolar I disorder and 26 (14 male and 12 female subjects) control volunteers (mean age, 15.3 years) completed structural and DTI examinations. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) maps were compared between groups in the brain white matter using a voxelwise analysis after intersubject registration to Talairach space. Exploratory analyses were performed to assess structure-function correlations in a subgroup of 11 patients with available neuropsychological measures. RESULTS Compared with the control volunteers, the patients demonstrated abnormalities in white matter regions predicted to differ a priori between groups, including lower FA in the right orbital frontal lobe and higher ADC in the right and left subgenual region (p <.005, uncorrected; cluster size >or= 100). There were no areas of higher FA or lower ADC in patients compared with control volunteers. Lower FA across regions that differed significantly between groups correlated significantly with slower visuomotor speed among patients with bipolar disorder. CONCLUSIONS Abnormalities involving the orbital frontal and subgenual white matter in adolescents with bipolar disorder are consistent with neurobiological models that implicate dysregulation of affective systems and impulsivity in the pathophysiology of the disorder. Preliminary findings suggest that white matter abnormalities in pediatric bipolar disorder have functional correlates and may be useful in constructing neurobiological models of the disorder.
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Joseph MF, Frazier TW, Youngstrom EA, Soares JC. A quantitative and qualitative review of neurocognitive performance in pediatric bipolar disorder. J Child Adolesc Psychopharmacol 2008; 18:595-605. [PMID: 19108664 PMCID: PMC2768898 DOI: 10.1089/cap.2008.064] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Bipolar disorder (BD) is an increasingly prevalent diagnosis in youth. As a result, there has been a corresponding increase in interest about neuropsychological and cognitive profiles in children and adolescents diagnosed with BD. Meta-analysis of the existing literature comparing individuals with BD to healthy controls indicated that the largest differences are observed for measures of verbal memory (d = 0.77). Moderate differences were found in the areas of attention (d = 0.62), executive functioning (d = 0.62), working memory (d = 0.60), visual memory (d = 0.51), visual perceptual skills (d = 0.48), and verbal fluency (d = 0.45). Small differences were found for measures of reading (d = 0.40), motor speed (d = 0.33), and full-scale intelligence quotient (IQ) (d = 0.32). Often, few studies have provided relevant information for a particular neurocognitive domain. Despite this, several domains displayed heterogeneity of effect sizes across studies. Methodological factors explained the variance in effect sizes to different extents depending upon the cognitive domain. The changing influence of method artifacts is likely due to variable coverage of cognitive domains across studies and the use of different measures across studies. Findings are consistent with previous meta-analyses of the adult BD neurocognitive literature, suggesting that many of the deficits observed in adults are present earlier in the course of the illness. Study reporting guidelines are offered that may help clarify the impact of illness definitions, mood state, medication status, and other methodological variables on neurocognition in pediatric BD.
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Affiliation(s)
- Megan F. Joseph
- Department of Psychology, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina
| | - Thomas W. Frazier
- Pediatric Behavioral Medicine, The Cleveland Clinic
- Department of Psychology, University of North Carolina–Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Eric A. Youngstrom
- Department of Psychology, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina
| | - Jair C. Soares
- Department of Psychology, University of North Carolina–Chapel Hill School of Medicine, Chapel Hill, North Carolina
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Abstract
OBJECTIVE Early-onset bipolar disorder is thought to be a particularly severe variant of the illness. Continuity with the adult form of illness remains unresolved, but preliminary evidence suggests similar biological underpinnings. Recently, we observed localized hippocampal decreases in unmedicated adults with bipolar disorder that were not detectable with conventional volumetric measures. Using the same three-dimensional mapping methods, we sought to investigate whether a similar pattern exists in adolescents with bipolar disorder. METHOD High-resolution brain magnetic resonance images were acquired from 16 adolescents meeting DSM-IV criteria for bipolar disorder (mean age 15.5 +/- 3.4 years, 50% female) and 20 demographically matched, typically developing control subjects. Three-dimensional parametric mesh models of the hippocampus were created from manual tracings of the hippocampal formation. RESULTS Controlling for total brain volume, total hippocampal volume was significantly smaller in adolescent patients with bipolar disorder relative to controls (by 9.2%). Statistical mapping results, confirmed by permutation testing, revealed significant localized deformations in the head and tail of the left hippocampus in adolescents with bipolar disorder, relative to normal controls. In addition, there was a significant positive correlation between hippocampal size and age in patients with bipolar disorder, whereas healthy controls showed an inverse relation. DISCUSSION Localized hippocampal deficits in adolescent patients with bipolar disorder suggest a possible neural correlate for memory deficits observed in this illness. Moreover, age-related increases in hippocampal size in patients with bipolar disorder, not observed in healthy controls, may reflect abnormal developmental mechanisms in bipolar disorder. This possibility must be confirmed by longitudinal studies.
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