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Pérez-Ramos A, Romero-López-Alberca C, Hidalgo-Figueroa M, Berrocoso E, Pérez-Revuelta JI. A systematic review of the biomarkers associated with cognition and mood state in bipolar disorder. Int J Bipolar Disord 2024; 12:18. [PMID: 38758506 PMCID: PMC11101403 DOI: 10.1186/s40345-024-00340-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a severe psychiatric disorder characterized by changes in mood that alternate between (hypo) mania or depression and mixed states, often associated with functional impairment and cognitive dysfunction. But little is known about biomarkers that contribute to the development and sustainment of cognitive deficits. The aim of this study was to review the association between neurocognition and biomarkers across different mood states. METHOD Search databases were Web of Science, Scopus and PubMed. A systematic review was carried out following the PRISMA guidelines. Risk of bias was assessed with the Newcastle-Ottawa Scale. Studies were selected that focused on the correlation between neuroimaging, physiological, genetic or peripheral biomarkers and cognition in at least two phases of BD: depression, (hypo)mania, euthymia or mixed. PROSPERO Registration No.: CRD42023410782. RESULTS A total of 1824 references were screened, identifying 1023 published articles, of which 336 were considered eligible. Only 16 provided information on the association between biomarkers and cognition in the different affective states of BD. The included studies found: (i) Differences in levels of total cholesterol and C reactive protein depending on mood state; (ii) There is no association found between cognition and peripheral biomarkers; (iii) Neuroimaging biomarkers highlighted hypoactivation of frontal areas as distinctive of acute state of BD; (iv) A deactivation failure has been reported in the ventromedial prefrontal cortex (vmPFC), potentially serving as a trait marker of BD. CONCLUSION Only a few recent articles have investigated biomarker-cognition associations in BD mood phases. Our findings underline that there appear to be central regions involved in BD that are observed in all mood states. However, there appear to be underlying mechanisms of cognitive dysfunction that may vary across different mood states in BD. This review highlights the importance of standardizing the data and the assessment of cognition, as well as the need for biomarkers to help prevent acute symptomatic phases of the disease, and the associated functional and cognitive impairment.
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Affiliation(s)
- Anaid Pérez-Ramos
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), ISCI-III, Madrid, Spain
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, Faculty of Medicine, University of Cadiz, Cadiz, Spain
| | - Cristina Romero-López-Alberca
- Centre for Biomedical Research in Mental Health (CIBERSAM), ISCI-III, Madrid, Spain.
- Personality, Evaluation and Psychological Treatment Area, Department of Psychology, University of Cadiz, Cadiz, Spain.
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cadiz, Spain.
| | - Maria Hidalgo-Figueroa
- Centre for Biomedical Research in Mental Health (CIBERSAM), ISCI-III, Madrid, Spain
- Neuropsychopharmacology and Psychobiology Research Group, Psychobiology Area, Department of Psychology, University of Cadiz, Cadiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cadiz, Spain
| | - Esther Berrocoso
- Centre for Biomedical Research in Mental Health (CIBERSAM), ISCI-III, Madrid, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cadiz, Spain
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, Faculty of Medicine, University of Cadiz, Cadiz, Spain
| | - Jose I Pérez-Revuelta
- Centre for Biomedical Research in Mental Health (CIBERSAM), ISCI-III, Madrid, Spain
- Clinical Management of Mental Health Unit, University Hospital of Jerez, Andalusian Health Service, Cadiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cadiz, Spain
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Little B, Anwyll M, Norsworthy L, Corbett L, Schultz-Froggatt M, Gallagher P. Processing speed and sustained attention in bipolar disorder and major depressive disorder: A systematic review and meta-analysis. Bipolar Disord 2024; 26:109-128. [PMID: 37973384 DOI: 10.1111/bdi.13396] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Cognitive impairment is a core feature of bipolar disorder (BD) and major depressive disorder (MDD). Deficits in processing speed (PS) and sustained attention (SA) may be particularly impaired and may underpin a broader profile of deficits, however current knowledge of the nature of these impairments is limited by heterogeneous results in the literature. Few reviews to date have attempted to disentangle sources of heterogeneity to assess the presence and magnitude of impairments in PS and SA in BD and MDD. METHODS One hundred and three studies were reviewed to examine performance in tests of PS and SA in BD (n = 3452) and MDD (n = 5461) compared to healthy controls (n = 8016). Neuropsychological methodology used in the literature was summarised. Data were meta-analysed to assess impairments in PS and SA for each neuropsychological test separately. Subgroup analysis was performed across mood states to investigate sources of heterogeneity. RESULTS Impairments were found across most neuropsychological tests, with small to large effect sizes for BD (range: d = 0.19-0.96) and MDD (range: d = 0.29-0.86). Impairments were present in symptomatic states and euthymia in most cases. Some outcome measures were not impaired in euthymia. Heterogeneity was observed for most neuropsychological tests and remained after separating by mood state. There inadequate data to meta-analyse some outcome measures, particularly for symptomatic groups. CONCLUSION Impairments in PS and SA in BD and MDD can be observed across most neuropsychological tests. Future research should further investigate the nature of these impairments across mood states, controlling for clinical confounds.
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Affiliation(s)
- Bethany Little
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - Megan Anwyll
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Norsworthy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Corbett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Mia Schultz-Froggatt
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Kopf J, Glöckner S, Althen H, Cevada T, Schecklmann M, Dresler T, Kittel-Schneider S, Reif A. Neural Responses to a Working Memory Task in Acute Depressed and Remitted Phases in Bipolar Patients. Brain Sci 2023; 13:brainsci13050744. [PMID: 37239216 DOI: 10.3390/brainsci13050744] [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: 03/14/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Cognitive impairments such as working memory (WM) deficits are amongst the most common dysfunctions characterizing bipolar disorder (BD) patients, severely contributing to functional impairment. We aimed to investigate WM performance and associated brain activation during the acute phase of BD and to observe changes in the same patients during remission. (2) Frontal brain activation was recorded using functional near-infrared spectroscopy (fNIRS) during n-back task conditions (one-back, two-back and three-back) in BD patients in their acute depressive (n = 32) and remitted (n = 15) phases as well as in healthy controls (n = 30). (3) Comparison of BD patients during their acute phase with controls showed a trend (p = 0.08) towards lower dorsolateral prefrontal cortex (dlPFC) activation. In the remitted phase, BD patients showed lower dlPFC and ventrolateral prefrontal cortex (vlPFC) activation (p = 0.02) compared to controls. No difference in dlPFC and vlPFC activation between BD patients' phases was found. (4) Our results showed decreased working memory performance in BD patients during the working memory task in the acute phase of disease. Working memory performance improved in the remitted phase of the disease but was still particularly attenuated for the more demanding conditions.
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Affiliation(s)
- Juliane Kopf
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Stefan Glöckner
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Heike Althen
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Thais Cevada
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Sport Science Program (PPGCEE), State University of Rio de Janeiro (UERJ), Rio de Janeiro 20550-013, Brazil
| | - Martin Schecklmann
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Regensburg, 93053 Regensburg, Germany
| | - Thomas Dresler
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health, University of Tuebingen, 72076 Tuebingen, Germany
- LEAD Graduate School & Research Network, University of Tuebingen, 72072 Tuebingen, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
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Prajapati N, Kumar M, Sharma V. Cognitive dysfunction in euthymic bipolar patients on prophylaxis of lithium monotherapy. Indian J Psychiatry 2022; 64:426-427. [PMID: 36060723 PMCID: PMC9435615 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_151_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 01/17/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Manoj Kumar
- Department of Psychiatry, IHBAS, East Delhi, India E-mail:
| | - Vibha Sharma
- Department of Clinical Psychology, IHBAS, East Delhi, India
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Sharma AK, Yerrabelli D, Sagili H, Sahoo JP, Gaur GS, Kumar A. Relationship between advanced glycated end products and maternal cognition in gestational diabetes: a case control study. J Matern Fetal Neonatal Med 2021; 35:7806-7811. [PMID: 34154496 DOI: 10.1080/14767058.2021.1937111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Gestational diabetes (GDM) is a form of glucose intolerance which manifests during pregnancy. There is lack of literature regarding the study of cognitive functions in GDM. Recent evidences suggests an increase in accumulation of serum Advanced glycated end products (AGE'S) during GDM. Accumulation of AGE's in brain can induce changes in permeability of blood brain barrier and creates oxidative stress and inflammation that can alter cognitive functions. In this study we hypothesize that diagnosis of GDM in pregnancy is related to lower cognitive scores which is correlated to increased serum AGE's level. METHOD This was a cross sectional case control study which recruited 60 participants in total consisting of two groups with 30 participants in each - diagnosed cases of GDM and healthy pregnant controls. Subjects were recruited from OPD of Obstetrics & Gynecology department in a tertiary care hospital in South India at gestational age of 32-36 weeks. On the first appointment, biochemical parameters of Fasting plasma glucose (FPG) & HbA1C was measured in both groups. Serum was obtained for testing levels of N Carboxy methyl lysine (N-CML) (a form of AGE). On second appointment, pen and paper neurocognitive tests including Montreal cognitive tests (MOCA) and Trail making test (TMT A & B) was presented. Event related potentials (ERP's) are time locked EEG wave signals produced in response to a sensory, motor or cognitive event. P300 is an "endogenous" ERP produced by cognitive processing in response to a stimuli presented to subject. P300 wave Latency and amplitude was recorded in both the groups as an objective marker of cognitive processing. Above mentioned biochemical and neurocognitive parameters were compared between both the groups and correlation analysis between serum AGE levels and neurocognitive parameters was performed using SPSS software. RESULTS Biochemical parameters of HbAIC & N-CML(A form of AGE) levels were increased in GDM group (HbA1C 6.01±0.30 and N CML 236.25 ± 68.9) vs Control group (HbA1C 4.11 ± 0.68 and NCML 198.42 ± 44.2). Scores in MOCA were significantly lower in GDM (28 (27-29)) group as compared to controls (24 (23-25)). GDM subjects took significantly greater time to perform TMT A (24.59 ± 2.60 s) test than controls (29.7 ± 1.72 s). Significant changes were not found in P300 Latency & amplitude in GDM group. Decreased MOCA scores and increased duration of TMT A attempt were correlated with increased serum AGE concentration in GDM group. CONCLUSIONS Our study indicates the vulnerability of women suffering from GDM to cognitive impairment during pregnancy. Lower scores in cognitive tests were correlated to AGE accumulation in GDM women.
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Affiliation(s)
- Akriti Kapila Sharma
- Department of Physiology, All India Institute of Medical Sciences, Rishikesh, India
| | - Dhanalakshmi Yerrabelli
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Haritha Sagili
- Department of Obstetrics & Gyanecology, Jawaharlal Institute of Post graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jay Prakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Post graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Girwar Singh Gaur
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Arun Kumar
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Pascual-Sánchez A, Jenaro C, Montes-Rodríguez JM. Quality of life in euthymic bipolar patients: A systematic review and meta-analysis. J Affect Disord 2019; 255:105-115. [PMID: 31150940 DOI: 10.1016/j.jad.2019.05.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/17/2019] [Accepted: 05/18/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with bipolar disorder, even euthymic, could suffer an impairment in their quality of life compared to healthy controls. Since no previous systematic review and meta-analysis has been conducted, the aim of the current study is to conduct a systematic review and meta-analysis of cross-sectional case-controlled studies on quality of life in adult euthymic Bipolar Disorder patients. METHODS A systematic review and meta-analysis that followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) was conducted. Major electronic databases were searched on August 2018 to assess the variables associated with quality of life in euthymic bipolar disorder patients. After selecting case-control studies, data collection, quality assessment and subsequently statistical analysis were done. RESULTS 66 studies were finally selected for systematic review and meta-analysis. Four different quality of life instruments were used among the different studies. Effect size analysis showed that there were significant differences in quality of life outcomes between euthymic bipolar disorder patients and healthy controls (d=-0.922; SE=0.316; 95%CI=-1.541--0.303; p=.004), with lower quality of life in the euthymic patients. Furthermore, time since euthymia explained 15.62% of variability, and age of control group explained 29.6% of variability. No other moderators were statiscally significant. LIMITATIONS The instruments used were heterogeneous. Moreover, the role of other clinical moderators could not be included due to the lack of this information in most of the articles. CONCLUSIONS Quality of life is lower in euthymic bipolar patients than in healthy controls. However, longer time in euthymia is associated with better outcomes.
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Affiliation(s)
- Ana Pascual-Sánchez
- Service of Psychiatry, University Hospital Ramón y Cajal, Ctra. Colmenar Viejo km. 9.1, 28034 Madrid, Spain.
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Ballesio A, Aquino MRJV, Kyle SD, Ferlazzo F, Lombardo C. Executive Functions in Insomnia Disorder: A Systematic Review and Exploratory Meta-Analysis. Front Psychol 2019; 10:101. [PMID: 30761049 PMCID: PMC6363670 DOI: 10.3389/fpsyg.2019.00101] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/14/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Executive functions (EFs) are involved in the control of basic psychological processes such as attention and memory and also contribute to emotion regulation. Research on the presence of EFs impairments in insomnia yielded inconsistent results. Therefore, we performed a systematic review of the literature on three EFs: inhibitory control, working memory, and cognitive flexibility in adults with insomnia in order to investigate the presence and magnitude of insomnia-related EFs impairments. Methods: PubMed, Scopus, Medline, and PsycINFO were searched. Risk of bias assessment of included studies was performed by two independent researchers. Findings were summarised using both a narrative approach and meta-analysis. Cohen's d was calculated at 95% confidence interval (CI) as effect size of between groups differences. Results: Twenty-eight studies comparing adult individuals with a diagnosis of insomnia and healthy controls on neuropsychological measures of EFs were included. Narrative synthesis revealed substantial variability across study findings. Factors that were primarily hypothesised to account for this variability are: objective sleep impairments and test sensitivity. Exploratory meta-analysis showed impaired performance of small to moderate magnitude in individuals with insomnia as compared to controls in reaction times, but not accuracy rates, of inhibitory control (d = -0.32, 95% CI: -0.52 to -0.13) and cognitive flexibility tasks (d = -0.30, 95% CI: -0.59 to -0.01). Performance in working memory tasks was also significantly impacted (d = -0.19, 95% CI: -0.38 to -0.00). Effects sizes were larger when insomnia was associated with objective sleep impairments, rather than normal sleep. Conclusions: We gathered evidence supporting small to moderate deficits in EFs in individuals with insomnia. Due to the small sample size results should be considered preliminary and interpreted carefully.
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Affiliation(s)
- Andrea Ballesio
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Raisa Jessica V Aquino
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Fabio Ferlazzo
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Caterina Lombardo
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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C-reactive protein levels and cognitive functions in patients with bipolar I disorder. MIDDLE EAST CURRENT PSYCHIATRY 2018. [DOI: 10.1097/01.xme.0000534677.38455.46] [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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Sagar R, Sahu A, Pattanayak RD, Chatterjee B. Assessment of cognitive functions in bipolar I disorder: A 1-year naturalistic follow-up study. Bipolar Disord 2018; 20:248-259. [PMID: 29314557 DOI: 10.1111/bdi.12584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 10/18/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Available findings from cross-sectional studies have demonstrated cognitive impairments in bipolar I disorder (BD-I) during various phases of illness. However, very little is known about the longitudinal course of these cognitive impairments. The purpose of the study was to explore the longitudinal pattern of changes in cognitive functioning of BD-I patients. METHODS A total of 129 BD-I subjects (manic, depressed and euthymic groups) and 49 healthy controls were recruited using predefined selection criteria. All four study groups were assessed on various clinical and cognitive parameters (for attention, memory, executive functions and working memory) at study intake and at 3-monthly intervals over the next year. RESULTS All three patient groups performed poorly compared to controls on all cognitive measures at study intake and on some cognitive measures at the 3-, 6-, 9- and 12-month assessments. No significant time effects were observed for any cognitive test. A significant group by time interaction effect was found for executive functions (β = -44.74; P = .018) and working memory (β = 0.77; P ≤ .019) in the depressed group at 12 months; for visual memory (β = 1.21; P = .039) and working memory (β = 1.17; P ≤ .029) in the manic group at 12 months; and for working memory (β = -0.52; P ≤ .036) in the euthymic group at 12 months. CONCLUSION The patient groups showed significant impairments in all or some test domains relative to controls at all time-points. The cognitive functions largely remained stable in all patient groups, with slight improvement over time in a few tests. Further investigation is warranted in larger samples in longitudinal studies.
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Affiliation(s)
- Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Anamika Sahu
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | | | - Biswadip Chatterjee
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Bipolar disorder (BD) is a severe, recurrent mood disorder, associated with a significant morbidity and mortality, with high rates of suicides and medical comorbidities. There is a high risk of mood disorders among the first-degree relatives of patients with BD. In the current clinical practice, the diagnosis of BD is made by history taking, interview and behavioural observations, thereby lacking an objective, biological validation. This approach may result in underdiagnosis, misdiagnosis and eventually poorer outcomes. Due to the heterogeneity of BD, the possibility of developing a single, specific biomarker is still remote; however, there is a set of promising biomarkers which may serve as predictive, prognostic or treatment markers in the future. The review presents a critical appraisal and update on some of the most promising candidates for biomarkers, namely, neuroimaging markers, peripheral biomarkers and genetic markers, including a brief discussion on cognitive endophenotypes as indicative of genetic risk. The lessons learnt from other fields and specialties in medicine need to be applied to psychiatry to translate the knowledge from ‘bench to bedside’ by means of clinically useful biomarkers. Overall, the biomarkers may help in pushing the shift towards personalized medicine for psychiatric patients.
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Affiliation(s)
- Rajesh Sagar
- Department of Psychiatry, All Institute of Medical Sciences, New Delhi, India
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Dickinson T, Becerra R, Coombes J. Executive functioning deficits among adults with Bipolar Disorder (types I and II): A systematic review and meta-analysis. J Affect Disord 2017; 218:407-427. [PMID: 28501741 DOI: 10.1016/j.jad.2017.04.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/04/2017] [Accepted: 04/07/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Executive functioning (EF) deficits contribute to a significant proportion of the burden of disease associated with bipolar disorder (BD). Yet, there is still debate in the literature regarding the exact profile of executive functioning in BD. The purpose of the present project was to assess whether EF deficits exist among adults suffering BD, and whether these deficits (if apparent) differ by BD subtype. METHODS A systematic search identified relevant literature. Randomised controlled trials that used neuropsychological assessment to investigate EF among adults 16-65 years) with a remitted DSM diagnosis of BD (type I or II) were included. Studies were published between 1994 and 2015. A systematic review and meta-analysis were undertaken. For individual studies, standardised mean differences (Cohen's d) and 95% confidence intervals were calculated and represented in forest plots to illustrate differences in executive performance between groups. Summary effects were produced and tests of heterogeneity employed to assess the dispersion and generalisability of results. RESULTS Thirty-six studies met criteria for inclusion. Six domains of EF were identified: Set-shifting (SS), inhibition (INH), planning (PLA), verbal fluency (VF), working memory (WM), and attention (ATT). BD1s performed worse than HCs in all domains. BD2s demonstrated impairment in VF, WM, SS, and ATT. The results were mixed for comparisons between BD1s and BD2s, but revealed that BD2s can experience similar (or sometimes greater) EF impairment. LIMITATIONS Only a limited number of studies that included BD2 samples were available for inclusion in the current study. Subgroup analysis to elucidate potential moderators of within-study variance was not undertaken. CONCLUSION This is the first systematic review and meta-analysis to have compared the EF of remitted BD1s, BD2s, and HCs. The results provided useful insight into the EF profile of patients with BD, and offered commentary as to some of the contradictory results reported in the literature. A standardised methodological protocol for assessment of EF in BD was proposed. The information in this review could enhance our understanding of EF impairment inherent in BD, and the methods and efficacy with which clinicians assess and treat this population.
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Affiliation(s)
- Tania Dickinson
- Clear Health Psychology, Edith Cowan University, 99 Central Avenue, Mount Lawley, Western Australia 6050, Australia.
| | - Rodrigo Becerra
- School of Psychology and Social Science, Edith Cowan Univeristy, Room 30.129, Building 30, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia.
| | - Jacqui Coombes
- Centre for Learning and Teaching, Edith Cowan University, Room 5.119, Building 5, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia.
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Performance of Bipolar Disorder Patients in Attention Testing: Comparison with Normal Controls and Among Manic, Depressive, and Euthymic Phases. Psychiatr Q 2017; 88:55-63. [PMID: 27021904 DOI: 10.1007/s11126-016-9430-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Several studies on cognition in bipolar disorder (BD) have been developed on the last decade. Neuropsychological evaluation of attention in BD patients is fundamental since alterations in attention affect other cognitive functions. Evaluate if performance of BD patients in attention tests varies according to each phase of the disease and verify if there are differences in attention when comparing BD patients with normal controls. The study included 101 BD patients, with ages between 18 and 65 years, being 52 euthymic, 22 manic and 27 depressive, besides 30 normal controls. All subjects were evaluated though Hamilton Depression Scale, Young Mania Rating Scale and Global Assessment of Functioning, bipolar version (CGI-BP). Attention was evaluated through a neuropsychological battery. Normal controls had a better performance in selective attention tests than BD patients. No differences were found among manic, depressive and euthymic phases. Attention is markedly impaired in BD. Nevertheless, the results of this study do not imply that the severity of the attention deficit in BD patients varies according to decease phase.
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Lee D, Cha B, Park CS, Kim BJ, Lee CS, Lee SJ, Seo JY, Cho YA, Ha JH, Choi JW. Effects of resilience on quality of life in patients with bipolar disorder. J Affect Disord 2017; 207:434-441. [PMID: 27969568 DOI: 10.1016/j.jad.2016.08.075] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 08/12/2016] [Accepted: 08/27/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few studies have examined the effects of resilience on quality of life (QOL) in patients with bipolar disorder (BD). Therefore, this study investigated the association between resilience and QOL in patients with BD and compared it to the relationship between resilience and QOL in healthy individuals. METHODS Participants were 68 euthymic patients with BD and 68 age-, sex-, and length of education-matched controls. Sociodemographic characteristics and clinical variables of the two groups were obtained using face-to-face interviews, and all participants completed the Connor-Davidson Resilience Scale, the World Health Organization QOL-Brief Form. RESULTS The QOL of the BD group was significantly impaired compared with that of the controls. Degree of resilience, number of depressive episodes, Clinical Global Impression scores, degree of impulsivity, and length of education were significantly correlated with QOL in the BD group. Resilience was significantly associated with overall QOL, physical subdomains of QOL, psychological subdomains of QOL, social subdomains of QOL, and environmental subdomains of QOL in the BD group, even after controlling for confounders. In the control group, resilience was significantly associated with overall QOL, the physical subdomains of QOL, psychological subdomains of QOL, and social subdomains of QOL. LIMITATIONS The number of participants in each group was 68, which is a relatively small sample size. CONCLUSIONS Resilience in patients with BD was independently and positively correlated with various areas of QOL. Various strategies to reinforce resilience in patients with BD are needed to improve the low QOL in this population.
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Affiliation(s)
- Dongyun Lee
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Boseok Cha
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea; Department of Psychiatry, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
| | - Chul-Soo Park
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea; Department of Psychiatry, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Bong-Jo Kim
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea; Department of Psychiatry, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Cheol-Soon Lee
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea; Department of Psychiatry, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - So-Jin Lee
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea; Department of Psychiatry, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Ji-Yeong Seo
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Young Ah Cho
- Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jong Hun Ha
- Department of Microbiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jae-Won Choi
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
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Bostock ECS, Kirkby KC, Garry MI, Taylor BVM. Systematic Review of Cognitive Function in Euthymic Bipolar Disorder and Pre-Surgical Temporal Lobe Epilepsy. Front Psychiatry 2017; 8:133. [PMID: 28848456 PMCID: PMC5552675 DOI: 10.3389/fpsyt.2017.00133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 07/10/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) and temporal lobe epilepsy (TLE) overlap in domains including epidemiology, treatment response, shared neurotransmitter involvement and temporal lobe pathology. Comparison of cognitive function in both disorders may indicate temporal lobe mediated processes relevant to BD. This systematic review examines neuropsychological test profiles in euthymic bipolar disorder type I (BD-I) and pre-surgical TLE and compares experimental designs used. METHODS A search of PubMed, PsychINFO, and Scopus using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Inclusion criteria were comparison group or pre- to post-surgical patients; reported neuropsychological tests; participants aged 18-60 years. Fifty six studies met criteria: 27 BD-I; 29 TLE. RESULTS Deficits in BD-I compared to healthy controls (HC) were in executive function, attention span and verbal memory. Deficits in TLE compared to HC were in executive function and memory. In the pre- to post-surgical comparisons, verbal memory in left temporal lobe (LTL) and, less consistently, visuospatial memory in right temporal lobe (RTL) epilepsy declined following surgery. BD-I studies used comprehensive test batteries in well-defined euthymic patients compared to matched HC groups. TLE studies used convenience samples pre- to post-surgery, comparing LTL and RTL subgroups, few included comparisons to HC (5 studies). TLE studies typically examined a narrow range of known temporal lobe-mediated neuropsychological functions, particularly verbal and visuospatial memory. CONCLUSION Both disorders exhibit deficits in executive function and verbal memory suggestive of both frontal and temporal lobe involvement. However, deficits in TLE are measured pre- to post-surgery and not controlled at baseline pre-surgery. Further research involving a head-to-head comparison of the two disorders on a broad range of neuropsychological tests is needed to clarify the nature and extent of cognitive deficits and potential overlaps.
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Affiliation(s)
| | - Kenneth C Kirkby
- Psychiatry, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Michael I Garry
- Psychology, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V M Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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15
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Proxy-reported quality of life in adolescents and adults with dyskinetic cerebral palsy is associated with executive functions and cortical thickness. Qual Life Res 2016; 26:1209-1222. [PMID: 27766516 DOI: 10.1007/s11136-016-1433-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Quality of life (QOL) is a key outcome for people with cerebral palsy (CP), and executive functioning is an important predictor of QOL in other health-related conditions. Little is known about this association in CP or about its neural substrate. We aim to analyze the influence of executive functioning (including cognitive flexibility) as well as that of other psychological, motor, communication and socioeconomic variables on QOL and to identify neuroanatomical areas related to QOL in adolescents and adults with CP. METHODS Fifty subjects diagnosed with dyskinetic CP (mean age 25.96 years) were recruited. Their caregivers completed the primary caregiver proxy report version of the CP QOL-Teen questionnaire. Motor status, communication, IQ, four executive function domains, anxiety/depression and socioeconomic status were evaluated. Correlations and multiple linear regression models were used to relate CP QOL domains and total score to these variables. Thirty-six participants underwent an MRI assessment. Correlations were examined between cortical thickness and CP QOL total score and between cortical thickness and variables that might predict the CP QOL total score. RESULTS Executive functions predict scores in four domains of CP QOL (General well-being and participation, Communication and physical health, Family health and Feelings about functioning) in the regression model. Among the cognitive domains that comprise executive function, only cognitive flexibility measured in terms of performance on the Wisconsin card sorting test (WCST) predicts the CP QOL total score. Monthly income, fine motor functioning and communication ability predict scores on the domains Access to services and Family Health, Feelings about functioning and School well-being, respectively. The clusters resulting from the correlation between cortical thickness and both CP QOL total score and WCST performance overlapped in the posterior cingulate and precuneus cortices. CONCLUSIONS Cognitive flexibility predicts proxy report CP QOL-Teen total score in dyskinetic CP. This relationship has its anatomical correlate in the posterior cingulate and precuneus cortices.
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Tan D, Özerdem A, Güntekin B, Atagün MI, Tülay E, Karadağ F, Başar E. Increased Beta Frequency (15-30 Hz) Oscillatory Responses in Euthymic Bipolar Patients Under Lithium Monotherapy. Clin EEG Neurosci 2016; 47:87-95. [PMID: 25465436 DOI: 10.1177/1550059414561056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/27/2014] [Indexed: 11/17/2022]
Abstract
The effect of lithium on neurocognition is not still fully explored. Brain oscillatory activity is altered in bipolar disorder. We aimed to assess the oscillatory responses of euthymic bipolar patients and how they are affected by lithium monotherapy. Event-related oscillations in response to visual target stimulus during an oddball paradigm in 16 euthymic drug-free and 13 euthymic lithium-treated bipolar patients were compared with 16 healthy controls. The maximum peak-to-peak amplitudes were measured for each subject's averaged beta (15-30 Hz) responses in the 0- to 300-ms time window over frontal (F3, Fz, F4), central (C3, Cz, C4), temporal (T7, T8), temporo-parietal (TP7, TP8), parietal (P3, Pz, P4), and occipital (O1, Oz, O2) areas. Patients under lithium monotherapy had significantly higher beta responses to visual target stimuli than healthy controls (P=.017) and drug-free patients (P=.015). The increase in beta response was observed at all electrode locations, however, the difference was statistically significant for the left (T7; P=.016) and right (T8; P=.031) temporal beta responses. Increased beta responses in drug-free patients and further significant increase in lithium-treated patients may be indicative of a core pathophysiological process of bipolar disorder and how it is affected by lithium. Whether the finding corresponds to lithium's corrective effect on the underlying pathology or to its neurocognitive side effect remains to be further explored. In either case, the finding is a sign that the oscillatory activity may be useful in tracking medication effect in bipolar disorder.
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Affiliation(s)
- Devran Tan
- Department of Psychiatry, Maltepe University, Faculty of Medicine, Istanbul, Turkey
| | - Ayşegül Özerdem
- Department of Psychiatry, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey Department of Neuroscience, Dokuz Eylul University Health Sciences Institute, Izmir, Turkey Multidisciplinary Brain Dynamics Research Center, Dokuz Eylul University, Izmir, Turkey
| | - Bahar Güntekin
- Brain Dynamics, Cognition, and Complex Systems Research Center, Istanbul Kultur University, Istanbul, Turkey
| | - M Ilhan Atagün
- Department of Psychiatry, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Elif Tülay
- Brain Dynamics, Cognition, and Complex Systems Research Center, Istanbul Kultur University, Istanbul, Turkey
| | - Figen Karadağ
- Department of Psychiatry, Maltepe University, Faculty of Medicine, Istanbul, Turkey
| | - Erol Başar
- Brain Dynamics, Cognition, and Complex Systems Research Center, Istanbul Kultur University, Istanbul, Turkey
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17
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Samalin L, de Chazeron I, Vieta E, Bellivier F, Llorca PM. Residual symptoms and specific functional impairments in euthymic patients with bipolar disorder. Bipolar Disord 2016; 18:164-73. [PMID: 26946486 DOI: 10.1111/bdi.12376] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/16/2015] [Accepted: 12/30/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aims of the present study were to confirm the impact of residual symptoms on overall functioning in a large sample of euthymic patients with bipolar disorder in real-life conditions and to explore the relationship between residual symptoms and specific areas of functional impairment. METHODS This was a multicenter, cross-sectional, non-interventional study of euthymic outpatients with bipolar disorder. The Functioning Assessment Short Test was used to assess overall and specific domains of functioning (autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time). Various residual symptoms were assessed (residual mood symptoms, emotional dysregulation, sleep and sexual disorders, stigma, and perceived cognitive impairment). Logistic regression was used to determine the best model of association between functional domains and residual symptoms. RESULTS Almost half of the 468 patients included (42%) had poor overall functioning. Residual depressive symptoms appeared to have an impact on overall functioning and in nearly all areas of functioning. In addition, specific residual symptoms had significantly more negative effects on some domains of functioning in euthymic patients with bipolar disorder (residual manic symptoms and occupational stigma on autonomy, emotional inhibition on occupational functioning, residual manic symptoms on financial issues, family stigma on interpersonal relationships, and sexual function and occupational stigma on leisure time). CONCLUSIONS Our findings highlight the importance of evaluating overall functioning in clinical practice as well as functional domains. They also indicate that some residuals symptoms in patients with bipolar disorder should be targeted in personalized treatment plans, in order to improve functioning in the domains in which the patient is most impaired.
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Affiliation(s)
- Ludovic Samalin
- CHU Clermont-Ferrand, University of Auvergne, Clermont-Ferrand, France
| | | | - Eduard Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Frank Bellivier
- AP-HP, CHU Saint-Louis Lariboisière, Hôpital Fernand Widal, INSERM UMRS 1144, Paris, France
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18
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Gul A, Khan K. Emotion regulation strategies can predict task-switching abilities in euthymic bipolar patients. Front Hum Neurosci 2014; 8:847. [PMID: 25386129 PMCID: PMC4209808 DOI: 10.3389/fnhum.2014.00847] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 10/02/2014] [Indexed: 11/13/2022] Open
Abstract
This study examined task-switching abilities and emotion regulation strategies in euthymic bipolar patients (EBP). Forty EBP and 40 healthy individuals performed face categorization tasks where they switched between emotion and non-emotion (i.e., gender) features among faces and completed emotion regulation questionnaire (Gross and John, 2003). Subject groups showed substantial differences in task-switching abilities and emotion regulation strategies: (1) there was a dissociation between emotion and gender classification in EBP. The switch cost was larger [i.e., higher reaction times (RTs) on switch as compared to no-switch trials] for gender categorization as compared to the emotion categorization task. In contrast, such asymmetries were absent among healthy participants. The differential pattern of task switching reflected functional disturbances in frontotemporal neural system and an attentional bias to emotion features of the faces in EBP. This suggests that when a euthymic bipolar patient is preoccupied with emotion recognition, an instruction to perform gender categorization results in greater cost on RTs. (2) In contrast to healthy individuals, EBP reported more frequent use of emotion suppression and lesser use of cognitive reappraisal as emotion regulation strategy. (3) Emotion regulation was found to be a significant predictor of task-switching abilities. It is argued that task switching deficits rely on maladaptive emotion regulation strategies in EBP specifically when tasks of emotional significance are involved.
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Affiliation(s)
- Amara Gul
- Department of Applied Psychology, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Kamran Khan
- Department of Applied Psychology, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
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19
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Mackala SA, Torres IJ, Kozicky J, Michalak EE, Yatham LN. Cognitive performance and quality of life early in the course of bipolar disorder. J Affect Disord 2014; 168:119-24. [PMID: 25043323 DOI: 10.1016/j.jad.2014.06.045] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 06/24/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Several studies have reported cognitive functioning as a significant predictor of quality of life (QoL) in patients with established bipolar disorder (BD), in addition to mood symptoms. However, it is unclear whether cognitive functioning predicts QoL early in the course of illness. The purpose of this study was therefore to evaluate the relationship between mood and neuropsychological variables and self-reported QoL early in the course of BD. METHODS Patients with BD-I (n=54) completed a neuropsychological battery and clinical assessment within 3 months of resolution of their first manic episode. QoL was assessed 6 months later using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Cognitive predictors of QoL were assessed through Pearson correlations and hierarchical multiple regression. RESULTS After accounting for mood rating scores at the time of cognitive testing (ΔR²=.27, p<.001), measures of sustained attention (ΔR²=.08, p<.05), verbal memory (ΔR²=.09, p<.01), working memory (ΔR²=.06, p<.05), and executive functioning (ΔR²=.08, p<.05) each predicted QoL when entered independently in separate regression models. When entered simultaneously, the cognitive domains explained 15% (R(2)=.42, p<.05) of the variance in QoL beyond mood. LIMITATIONS Some aspects of QoL that are particularly important in BD may be missing as a result of using the Q-LES-Q, because the measure was not specifically developed to assess QoL in BD. CONCLUSIONS In addition to mood symptoms, poorer cognitive functioning is a significant predictor of reduced QoL early in the course of BD. Recently diagnosed patients with BD may benefit from early cognitive-enhancing interventions to maintain or restore their QoL.
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Affiliation(s)
- Sylvia A Mackala
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Addictions Services, Vancouver, BC, Canada
| | - Jan Kozicky
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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20
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Bauer IE, Pascoe MC, Wollenhaupt-Aguiar B, Kapczinski F, Soares JC. Inflammatory mediators of cognitive impairment in bipolar disorder. J Psychiatr Res 2014; 56:18-27. [PMID: 24862657 PMCID: PMC4167370 DOI: 10.1016/j.jpsychires.2014.04.017] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Recent studies have pointed to neuroinflammation, oxidative stress and neurotrophic factors as key mediators in the pathophysiology of mood disorders. Little is however known about the cascade of biological episodes underlying the cognitive deficits observed during the acute and euthymic phases of bipolar disorder (BD). The aim of this review is to assess the potential association between cognitive impairment and biomarkers of inflammation, oxidative stress and neurotrophic activity in BD. METHODS Scopus (all databases), Pubmed and Ovid Medline were systematically searched with no language or year restrictions, up to November 2013, for human studies that collected both inflammatory markers and cognitive data in BD. Selected search terms were bipolar disorder, depression, mania, psychosis, inflammatory, cognitive and neurotrophic. RESULTS Ten human studies satisfied the criteria for consideration. The findings showed that high levels of peripheral inflammatory-cytokine, oxidative stress and reduced brain derived neurotrophic factor (BDNF) levels were associated with poor cognitive performance. The BDNF val66met polymorphism is a potential vulnerability factor for cognitive impairment in BD. CONCLUSIONS Current data provide preliminary evidence of a link between the cognitive decline observed in BD and mechanisms of neuroinflammation and neuroprotection. The identification of BD specific inflammatory markers and polymorphisms in inflammatory response genes may be of assistance for therapeutic intervention.
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Affiliation(s)
- Isabelle E. Bauer
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Michaela C. Pascoe
- Department of Clinical Neuroscience and Rehabilitation, Sahlgrenska Academy at University of Gothenburg, Box 440, 40530 Gothenburg, Sweden
| | - Bianca Wollenhaupt-Aguiar
- Laboratório de Psiquiatria Molecular, Instituto Nacional de Ciência e Tecnologia – Translacional em Medicina (INCT), Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Flavio Kapczinski
- Laboratório de Psiquiatria Molecular, Instituto Nacional de Ciência e Tecnologia – Translacional em Medicina (INCT), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Jair C. Soares
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
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Sepede G, Spano MC, Lorusso M, Berardis DD, Salerno RM, Giannantonio MD, Gambi F. Sustained attention in psychosis: Neuroimaging findings. World J Radiol 2014; 6:261-273. [PMID: 24976929 PMCID: PMC4072813 DOI: 10.4329/wjr.v6.i6.261] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/07/2014] [Accepted: 05/16/2014] [Indexed: 02/06/2023] Open
Abstract
To provide a systematic review of scientific literature on functional magnetic resonance imaging (fMRI) studies on sustained attention in psychosis. We searched PubMed to identify fMRI studies pertaining sustained attention in both affective and non-affective psychosis. Only studies conducted on adult patients using a sustained attention task during fMRI scanning were included in the final review. The search was conducted on September 10th, 2013. 15 fMRI studies met our inclusion criteria: 12 studies were focused on Schizophrenia and 3 on Bipolar Disorder Type I (BDI). Only half of the Schizophrenia studies and two of the BDI studies reported behavioral abnormalities, but all of them evidenced significant functional differences in brain regions related to the sustained attention system. Altered functioning of the insula was found in both Schizophrenia and BDI, and therefore proposed as a candidate trait marker for psychosis in general. On the other hand, other brain regions were differently impaired in affective and non-affective psychosis: alterations of cingulate cortex and thalamus seemed to be more common in Schizophrenia and amygdala dysfunctions in BDI. Neural correlates of sustained attention seem to be of great interest in the study of psychosis, highlighting differences and similarities between Schizophrenia and BDI.
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22
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Abstract
Individuals with bipolar disorder (BD) may exhibit attentional deficits, however, the extent of impairment and long-term fluctuations in performance in attention are relatively unknown. We investigated the relationship between sustained attention and affective symptoms over time among BD patients. We also examined whether global differences in attentional capacity differed among BD versus normal comparison (NC) subjects. Participants included 106 outpatients with BD and 66 NC subjects who were administered symptom rating scales and a measure of sustained attention (Continuous Performance Test- Identical Pairs). Measures were repeated 6, 12, and 26 weeks post-baseline. Compared to NC subjects, participants with BD showed impairment in sustained attention across time. Within patient increases in manic symptoms were associated with increased false alarms; both manic and depressive symptoms were associated with worse discrimination. Neither manic nor depressive symptoms were related to hit rates. Our results indicate that the ability to inhibit a response to near miss stimuli (i.e., those that are close to but not identical to the target) is globally impaired among BD patients relative to NC subjects, as well as state-dependent, covarying with affective symptoms. Psychosocial interventions requiring high levels of attentional capacity may need to be adapted according to patients' current symptomatology.
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23
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Saunders EF, Novick DM, Fernandez-Mendoza J, Kamali M, Ryan KA, Langenecker SA, Gelenberg AJ, McInnis MG. Sleep quality during euthymia in bipolar disorder: the role of clinical features, personality traits, and stressful life events. Int J Bipolar Disord 2013; 1:16. [PMID: 25505683 PMCID: PMC4230686 DOI: 10.1186/2194-7511-1-16] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 08/16/2013] [Indexed: 11/16/2022] Open
Abstract
Background Poor sleep quality is known to precede the onset of mood episodes and to be associated with poor treatment outcomes in bipolar disorder (BD). We sought to identify modifiable factors that correlate with poor sleep quality in BD independent of residual mood symptoms. Methods A retrospective analysis was conducted to assess the association between the Pittsburgh Sleep Quality Index and clinical variables of interest in euthymic patients with DSM-IV BD (n = 119) and healthy controls (HC; n = 136) participating in the Prechter Longitudinal Study of Bipolar Disorder. Multivariable linear regression models were constructed to investigate the relationship between sleep quality and demographic and clinical variables in BD and HC participants. A unified model determined independent predictors of sleep quality. Results and discussion Euthymic participants with BD and HC differed in all domains. The best fitting unified multivariable model of poor sleep quality in euthymic participants with BD included rapid cycling (β = .20, p = .03), neuroticism (β = .28, p = 2 × 10−3), and stressful life events (β = .20, p = .02). Poor sleep quality often persists during euthymia and can be a target for treatment. Clinicians should remain vigilant for treating subjective sleep complaints independent of residual mood symptoms in those sensitive to poor sleep quality, including individuals with high neuroticism, rapid cycling, and recent stressful life events. Modifiable factors associated with sleep quality should be targeted directly with psychosocial or somatic treatment. Sleep quality may be a useful outcome measure in BD treatment studies.
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Affiliation(s)
- Erika Fh Saunders
- University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA
| | - Danielle M Novick
- University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA
| | - Julio Fernandez-Mendoza
- University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA
| | - Masoud Kamali
- University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA
| | - Kelly A Ryan
- University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA
| | - Scott A Langenecker
- University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA
| | | | - Melvin G McInnis
- University of Illinois at Chicago, Chicago, IL 60612 USA ; University of Illinois at Chicago, Chicago, IL 60612 USA
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Kim YS, Cha B, Lee D, Kim SM, Moon E, Park CS, Kim BJ, Lee CS, Lee S. The Relationship between Impulsivity and Quality of Life in Euthymic Patients with Bipolar Disorder. Psychiatry Investig 2013; 10:246-52. [PMID: 24302947 PMCID: PMC3843016 DOI: 10.4306/pi.2013.10.3.246] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 03/15/2013] [Accepted: 03/27/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Bipolar disorder (BD) is characterized by elevated impulsivity, even during periods of remission. Many recovered BD patients have functional impairments, which can lead to poor quality of life (QoL). The aim of this study was to investigate the association between impulsivity and QoL in euthymic BD patients. METHODS A total of 56 remitted or recovered patients with type I or II BD, diagnosed based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, were recruited. Psychiatrists administered the Clinical Global Impression (CGI) for BD and the Global Assessment of Functioning (GAF) scales and then interviewed the subjects to assess clinical variables. Patients completed the Barratt Impulsiveness Scale (BIS-11) and the World Health Organization Quality of Life Assessment Instrument-Brief Form (WHOQoL-BREF). Pearson correlations, univariate regression analyses, and multiple linear regression analyses were performed. RESULTS The BIS-11 total score was significantly correlated with the WHOQoL-BREF total score (r=-0.55, p<0.01) and with the WHOQoL-BREF subscales. After controlling for GAF score and other clinical variables, the BIS-11 total score (β=-0.43, p=0.001) was independently associated with overall QoL. Additionally, the BIS-11 total score was particularly strongly associated with the physical, psychological, and social domains of the multi-dimensional QoL scale. CONCLUSION Our results suggest that high impulsivity is related to low QoL in euthymic BD patients. Further studies are needed to examine whether interventions for high impulsivity effectively improve QoL in patients with BD.
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Affiliation(s)
- Yoon-Seok Kim
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Boseok Cha
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Dongyun Lee
- Medical Unit of 9th Division, Korea Army, Goyang, Republic of Korea
| | - Sun-Mi Kim
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Eunsoo Moon
- Department of Psychiatry, Pusan National University Hospital Medical Research Institute, Busan, Republic of Korea
| | - Chul-Soo Park
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Bong-Jo Kim
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Cheol-Soon Lee
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Sojin Lee
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
- Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
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