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Grover S, Avasthi A, Chakravarty R, Dan A, Chakraborty K, Neogi R, Desouza A, Nayak O, Praharaj SK, Menon V, Deep R, Bathla M, Subramanyam AA, Nebhinani N, Ghosh P, Lakdawala B, Bhattacharya R. Disability and its correlates among persons with bipolar disorder: Exploratory findings from the bipolar disorder course and outcome study from India (BiD-CoIN study). Indian J Psychiatry 2023; 65:760-766. [PMID: 37645361 PMCID: PMC10461586 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_713_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 05/09/2023] [Accepted: 06/28/2023] [Indexed: 08/31/2023] Open
Abstract
Aim This study aimed to evaluate the disability and its correlates in persons with Bipolar Disorder during the remission phase. Materials and Methods As part of the multicentric study, 773 patients with bipolar disorder, currently in clinical remission, were evaluated for disability on the Indian Disability Assessment Evaluation Scale. Results About one-fifth of the participants had some level of disability in the domain of self-care, one-third had some level of disability in the interpersonal domain, one-fourth had some level of disability in communication and understanding, and a maximum proportion (43.7%) had some disability in the domain of work. Overall, about one-fifth (18.4%) were considered to have a benchmark disability (i.e., disability >40%). In terms of correlates, those with a disability had a short duration of current remission, a higher number of manic and mixed episodes, a higher mean number of total episodes, spent more time in the episodes, had lower severity of the depressive episodes, higher residual depressive and manic symptoms, had overall higher manic affective morbidity, had a higher level of cognitive deficits, and had poorer insight. Conclusion A significant proportion of patients with bipolar disorder have disability in work domain, and the presence of residual symptoms of either polarity are associated with higher level of disability.
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Affiliation(s)
- Sandeep Grover
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Chakravarty
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amitava Dan
- Burdwan Medical College and Hospital, Burdwan, Bardhaman, West Bengal, India
| | | | - Rajarshi Neogi
- R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Avinash Desouza
- Lokmanya Tilak Municipal General Hospital (Sion Hospital), Mumbai, Maharashtra, India
| | - Omkar Nayak
- Lokmanya Tilak Municipal General Hospital (Sion Hospital), Mumbai, Maharashtra, India
| | - Samir Kumar Praharaj
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vikas Menon
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raman Deep
- All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Manish Bathla
- Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Haryana, India
| | - Alka A. Subramanyam
- Topiwala National Medical College (Nair Hospital), Mumbai, Maharashtra, India
| | - Naresh Nebhinani
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Bhavesh Lakdawala
- Ahmedabad Municipal Corporation Medical Education Trust Medical College, Ahmedabad, Gujarat, India
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Zeng Y, Zhang F, Liu H, Li W, Ning Y, Zhou Y. Psychotic symptoms and neurocognition among patients with major depressive disorder: A chained mediation model of depressive symptoms and socio-occupational functioning. J Affect Disord 2023; 332:194-200. [PMID: 37044284 DOI: 10.1016/j.jad.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Depressive symptom and psychotic symptom have been identified as risk factors for impaired socio-occupational functioning in patients with major depressive disorder (MDD), while neurocognitive functioning is considered to be a potential protective factor against socio-occupational functioning. Nevertheless, little is known about the complex relationship among these factors in patients with MDD. The purpose of this research was to explore whether the relationship between depressive symptom severity and social-occupational functioning is mediated by neurocognitive functioning and psychotic symptom severity in MDD patients. METHODS A total of 659 eligible MDD patients included male and female, and their depressive symptoms and psychotic symptoms at baseline were assessed by the 17-item Hamilton Depression Scale (HAMD-17) and The Brief Psychiatric Rating Scale (BPRS) respectively. Cognitive domains were assessed by the MATRICS Consensus Cognitive Battery (MCCB), and subjective and objective functioning were measured by the Global Assessment of Functioning (GAF). LIMITATION The analysis is cross-sectional, which limits causal inference. RESULT (1) The correlation between depressive symptoms and thought disturbance was positive (r = 0.125, p = 0.001), whereas the correlations with visual learning and memory (r = -0.146, p < 0.001) and socio-occupational functioning (r = -0.175, p < 0.001) were negative. (2) Depressive symptoms mainly affect the socio-occupational functioning of MDD patients via three indirect effects: the single mediating effect of psychotic symptoms and neurocognitive functioning, and the chain mediating effect of psychotic symptoms and neurocognitive functioning. CONCLUSIONS The results suggest that the relationship between depressive symptom severity and socio-occupational functioning in MDD patients is partially mediated by psychotic symptom severity and neurocognitive functioning.
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Affiliation(s)
- Yexian Zeng
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Fan Zhang
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Haiyan Liu
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Weicheng Li
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yuping Ning
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Department of Psychology, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Yanling Zhou
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
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Chen WY, Huang MC, Chiu CC, Cheng YC, Kuo CJ, Chen PY, Kuo PH. The interactions between vitamin D and neurofilament light chain levels on cognitive domains in bipolar disorder. BJPsych Open 2022; 8:e207. [PMID: 36437810 PMCID: PMC9707506 DOI: 10.1192/bjo.2022.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Bipolar disorder is a chronic mental disorder related to cognitive deficits. Low serum vitamin D levels are significantly associated with compromised cognition in neuropsychiatric disorders. Although patients with bipolar disorder frequently exhibit hypovitaminosis D, the association between vitamin D and cognition in bipolar disorder, and their neuroaxonal integrity, is unclear. AIMS To investigate the interaction effects between vitamin D and neurofilament light chain (NfL) levels on cognitive domains in bipolar disorder. METHOD Serum vitamin D and NfL levels were determined in 100 euthymic patients with bipolar disorder in a cross-sectional study. Cognitive function was measured with the Brief Assessment of Cognition in Affective Disorders. We stratified by age groups and used general linear models to identify associations between vitamin D and NfL levels and their interaction effects on cognitive domains. RESULTS The mean vitamin D and NfL levels were 16.46 ng/nL and 11.10 pg/mL, respectively; 72% of patients were vitamin D deficient. In the older group, more frequent hospital admissions and lower physical activity were identified in the group with versus without vitamin D deficiency. The age-modified interaction effect of vitamin D and NfL was associated with composite neurocognitive scores and verbal fluency in both age groups, and with processing speed domain in the younger group. CONCLUSIONS We observed a high vitamin D deficiency prevalence in bipolar disorder. We identified the interaction of vitamin D and NfL on cognitive domains, and the effect was modified by age. Longitudinal or randomised controlled studies enrolling patients with various illness durations and mood statuses are required to validate our findings.
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Affiliation(s)
- Wen-Yin Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taiwan; and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taiwan; and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Chih Chiang Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taiwan; and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Ying-Chih Cheng
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan; and Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Taiwan
| | - Chian-Jue Kuo
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taiwan; and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Po-Yu Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taiwan; and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan; Department of Public Health, College of Public Health, National Taiwan University, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taiwan; and Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taiwan
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Ko H, Park D, Shin J, Yu R, Ryu V, Lee W. Cognitive profiles in bipolar I disorder and associated risk factors: Using Wechsler adult intelligence scale—IV. Front Psychol 2022; 13:951043. [PMID: 36275296 PMCID: PMC9582973 DOI: 10.3389/fpsyg.2022.951043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDespite the growing evidence of cognitive impairments in bipolar disorder (BD), little work has evaluated cognitive performances utilizing the latest version of the Wechsler Intelligence Scale-IV (WAIS-IV), which is one of the most widely used neurocognitive assessments in clinical settings. Furthermore, clinical characteristics or demographic features that negatively affect the cognitive functioning of BD were not systematically compared or evaluated. Accordingly, the present study aimed to examine the cognitive profile of bipolar I disorder (BD-I) patients and associated risk factors.MethodsParticipants included 45 patients, diagnosed with BD-I, current or most recent episode manic, and matching 46 healthy controls (HC). Cognitive performance was evaluated via WAIS-IV, and clinical characteristics of the BD-I group were examined via multiple self- and clinician-report questionnaires.ResultsMultivariate analysis of covariance (MANCOVA) results indicated that the BD-I group demonstrated significantly poorer performance compared to the HC group in subtests and indexes that reflect working memory and processing speed abilities. Redundancy analysis revealed that overall symptom severity, manic symptom severity, and anxiety were significant predictors of cognitive performance in BD-I, while age of onset, past mood disorder history, depression severity, and impulsiveness showed comparatively smaller predictive values.ConclusionThe current study suggests cognitive deterioration in the cognitive proficiency area while generalized ability, including verbal comprehension and most of the perceptual reasoning skills, remain intact in BD-I. The identified risk factors of cognitive performance provide specific clinical recommendations for intervention and clinical decision-making.
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Affiliation(s)
- Hayoung Ko
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - DongYeon Park
- Department of Psychiatry, National Center for Mental Health, Seoul, South Korea
| | - Jaehyun Shin
- School of Education, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Rina Yu
- Department of Mental Health Research, National Center for Mental Health, Seoul, South Korea
| | - Vin Ryu
- Department of Psychiatry, National Center for Mental Health, Seoul, South Korea
| | - Wonhye Lee
- Department of Clinical Psychology, National Center for Mental Health, Seoul, South Korea
- *Correspondence: Wonhye Lee,
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Simon E, Edwards AM, Sajatovic M, Jain N, Montoya JL, Levin JB. Systematic Literature Review of Text Messaging Interventions to Promote Medication Adherence Among People With Serious Mental Illness. Psychiatr Serv 2022; 73:1153-1164. [PMID: 35959534 PMCID: PMC9976730 DOI: 10.1176/appi.ps.202100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mobile health tools are feasible options to encourage behavior change among patients with serious mental illness. Mobile health tools vary widely, both in platforms used and content delivered. This literature review assessed the use of text messaging interventions to promote medication adherence among patients with serious mental illness. METHODS A systematic literature review using PRISMA guidelines examined short message service (SMS) text messaging interventions promoting medication adherence to people with a serious mental illness diagnosis. Databases included PubMed, Cochrane, CINAHL, and PsycINFO. Data extraction included demographic information, participant diagnoses, intervention components, medication class, adherence measures, research design, and study outcomes. Study quality was also assessed. RESULTS Of 114 full-text articles screened, 10 articles were selected from nine unique interventions (N=937 people with serious mental illness). Study durations ranged from 30 days to 18 months, with frequency of SMS ranging from twice weekly to 12 times daily. Of the nine unique trials, most reported using an automated server to deliver SMS messages (N=7), two-way SMS capabilities (N=6), customized message content or timing (N=7), and additional components (e.g., provider contact, educational content, and monetary rewards) (N=7). Seven of the 10 articles reported statistically significant improvement in medication adherence and in at least one clinical outcome. CONCLUSIONS Evidence to date indicates that text messaging interventions are feasible and appear to improve medication adherence and clinical outcomes among patients with serious mental illness. Future research should assess implementation approaches and how to scale up efforts in nonresearch settings.
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Affiliation(s)
- Emily Simon
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland (Simon, Edwards, Sajatovic, Jain, Levin); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Levin); Department of Psychiatry, University of California, San Diego, San Diego (Montoya)
| | - Alyssa M Edwards
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland (Simon, Edwards, Sajatovic, Jain, Levin); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Levin); Department of Psychiatry, University of California, San Diego, San Diego (Montoya)
| | - Martha Sajatovic
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland (Simon, Edwards, Sajatovic, Jain, Levin); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Levin); Department of Psychiatry, University of California, San Diego, San Diego (Montoya)
| | - Nisha Jain
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland (Simon, Edwards, Sajatovic, Jain, Levin); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Levin); Department of Psychiatry, University of California, San Diego, San Diego (Montoya)
| | - Jessica L Montoya
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland (Simon, Edwards, Sajatovic, Jain, Levin); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Levin); Department of Psychiatry, University of California, San Diego, San Diego (Montoya)
| | - Jennifer B Levin
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland (Simon, Edwards, Sajatovic, Jain, Levin); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Levin); Department of Psychiatry, University of California, San Diego, San Diego (Montoya)
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Bozzatello P, Giordano B, Montemagni C, Rocca P, Bellino S. Real-World Functioning in Psychiatric Outpatients: Predictive Factors. J Clin Med 2022; 11:jcm11154400. [PMID: 35956015 PMCID: PMC9369214 DOI: 10.3390/jcm11154400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/17/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Investigations on predictors of real-world functioning were mainly performed in patients with schizophrenia, while fewer studies have been conducted in other psychiatric disorders. Objective: Our objective was to identify clinical, socio-demographic, and illness-related predictors of real-world functioning during 12 months of standard treatments in outpatients with different diagnoses. Methods: Outpatients (n = 1019) with schizophrenia (SZ), major depressive disorder (MDD), bipolar disorder (BD), and borderline personality disorder (BPD) were evaluated with the following tools: SCID-5-CV and SCID-5-PD, CGI-S, SAT-P, DAI-10, and PSP. Change of PSP (ΔPSP) between baseline and 12 months was used as the dependent variable in multiple regression analysis. Results: Higher PSP score at baseline and the achievement of main milestones predicted better functioning after follow-up in all subgroups of patients, with the exception of BD. In the total sample, ΔPSP was related to age of onset, treatments, and quality of life, and inversely related to psychiatric anamnesis, antidepressants, and global symptoms. In SZ, ΔPSP was related to adherence and quality of life. In MDD, ΔPSP was related to psychotherapy and quality of life, and inversely related to antidepressants and global symptoms. In BD, ΔPSP was related to age of onset, antipsychotics, and quality of life, while it was inversely related to psychiatric anamnesis. In BPD, antipsychotics, mood stabilizers, psychotherapy, and quality of life were directly related to ΔPSP, while suicidal attempts and global symptoms had an inverse relation. Conclusions: Several socio-demographic and illness-related variables predicted improvement of real-world functioning, besides psychopathology and severity of the disease.
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Visual electrophysiology and neuropsychology in bipolar disorders: a review on current state and perspectives. Neurosci Biobehav Rev 2022; 140:104764. [DOI: 10.1016/j.neubiorev.2022.104764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/21/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022]
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Koene J, Zyto S, van der Stel J, van Lang N, Ammeraal M, Kupka RW, van Weeghel J. The relations between executive functions and occupational functioning in individuals with bipolar disorder: a scoping review. Int J Bipolar Disord 2022; 10:8. [PMID: 35286505 PMCID: PMC8921376 DOI: 10.1186/s40345-022-00255-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 01/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Patients with bipolar disorder experience impairments in their occupational functioning, despite remission of symptoms. Previous research has shown that neurocognitive deficits, especially deficits in executive functions, may persist during euthymia and are associated with diminished occupational functioning. Objectives The aim of this scoping review was to identify published studies that report on the relationships between executive functions and occupational functioning in BD to review current knowledge and identify knowledge gaps. In addition to traditional neuropsychological approaches, we aimed to describe executive functioning from a self-regulation perspective, including emotion regulation. Methods We applied the methodological framework as described by Arksey and O’Malley (Int J Soc Res Methodol Theory Pract 8:19–32, 2005) and Levac et al. (Implement Sci 5:1–9, 2010). We searched PubMed and psycINFO for literature up to November 2021, after which we screened papers based on inclusion criteria. Two reviewers independently performed the screening process, data charting process, and synthesis of results. Results The search yielded 1202 references after deduplication, of which 222 remained after initial screening. The screening and inclusion process yielded 82 eligible papers in which relationships between executive functions and occupational functioning are examined. Conclusion Neurocognitive deficits, including in executive functions and self-regulation, are associated with and predictive of diminished occupational functioning. Definitions and measurements for neurocognitive functions and occupational functioning differ greatly between studies, which complicates comparisons. Studies on functional remediation show promising results for improving occupational functioning in patients with BD. In research and clinical practice more attention is needed towards the quality of work functioning and the various contexts in which patients with BD experience deficits. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00255-7.
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Affiliation(s)
- Juul Koene
- University of Applied Sciences Leiden, Leiden, The Netherlands.,Tranzo, Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| | - Susan Zyto
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. .,Mental Health Service Organisation North Holland North, Hoorn, The Netherlands.
| | | | | | - Marion Ammeraal
- GGZinGeest Center for Mental Health Care, Amsterdam, The Netherlands
| | - Ralph W Kupka
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands.,GGZinGeest Center for Mental Health Care, Amsterdam, The Netherlands
| | - Jaap van Weeghel
- Tranzo, Scientific Centre for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands.,Phrenos Center of Expertise, Utrecht, The Netherlands
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Jiménez-López E, Villanueva-Romero CM, Sánchez-Morla EM, Martínez-Vizcaíno V, Ortiz M, Rodriguez-Jimenez R, Vieta E, Santos JL. Neurocognition, functional outcome, and quality of life in remitted and non-remitted schizophrenia: A comparison with euthymic bipolar I disorder and a control group. Schizophr Res 2022; 240:81-91. [PMID: 34991042 DOI: 10.1016/j.schres.2021.12.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/28/2022]
Abstract
There are discrepancies about if the severity of the symptomatology in schizophrenia is related to neurocognitive performance, functional outcome, and quality of life (QoL). Also, there are controversial data about the comparison between euthymic bipolar patients and different subgroups of schizophrenia in neurocognition, functioning, and QoL level. The present study aimed to compare the neurocognitive performance, functional outcome, and QoL of remitted and non-remitted patients with SC with respect to a group of euthymic patients with BD, and a control group. It included 655 subjects: 98 patients with schizophrenia in remission (SC-R), 184 non-remitted patients with schizophrenia (SC-NR), 117 euthymic patients with bipolar I disorder (BD), and 256 healthy subjects. A comprehensive clinical, neurocognitive (six cognitive domains), functional, and QoL assessment was carried out. Remission criteria of Andreasen were used to classify schizophrenia patients as remitted or non-remitted. Compared with control subjects all groups of patients showed impaired neurocognitive performance, functioning and QoL. SC-R patients had an intermediate functioning between control subjects and SC-NR, all at a neurocognitive, functional, or QoL level. There were no significant differences between SC-R and BD. These results suggest that reaching clinical remission is essential to achieve a better level of psychosocial functioning, and QoL. Likewise, the results of this study suggest that euthymic patients with bipolar disorder and patients with schizophrenia in remission are comparable at the neurocognitive and functional levels, which might have implications in the pathophysiology of both disorders.
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Affiliation(s)
- Estela Jiménez-López
- Department of Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain; Universidad de Castilla-La Mancha. Health and Social Research Center, Cuenca, Spain; Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain
| | | | - Eva María Sánchez-Morla
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; CogPsy-Group, Universidad Complutense de Madrid (UCM), Spain.
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha. Health and Social Research Center, Cuenca, Spain; Universidad Autónoma de Chile. Facultad de Ciencias de la Salud, Talca, Chile
| | - M Ortiz
- Interdisciplinary Center for Security, Reliability and Trust (SnT), University of Luxembourg, 1855 Luxembourg, Luxembourg
| | - Roberto Rodriguez-Jimenez
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; CogPsy-Group, Universidad Complutense de Madrid (UCM), Spain
| | - Eduard Vieta
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - José Luis Santos
- Department of Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain; Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain
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Relationship between cognitive flexibility and subsequent course of mood symptoms and suicidal ideation in young adults with childhood-onset bipolar disorder. Eur Child Adolesc Psychiatry 2022; 31:299-312. [PMID: 33392723 PMCID: PMC8253874 DOI: 10.1007/s00787-020-01688-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/18/2020] [Indexed: 02/03/2023]
Abstract
Neurocognitive deficits, such as cognitive flexibility impairments, are common in bipolar disorder (BD) and predict poor academic, occupational, and functional outcomes. However, the association between neurocognition and illness trajectory is not well understood, especially across developmental transitions. This study examined cognitive flexibility and subsequent mood symptom and suicidal ideation (SI) course in young adults with childhood-onset BD-I (with distinct mood episodes) vs. BD-not otherwise specified (BD-NOS) vs. typically-developing controls (TDCs). Sample included 93 young adults (ages 18-30) with prospectively verified childhood-onset DSM-IV BD-I (n = 34) or BD-NOS (n = 15) and TDCs (n = 44). Participants completed cross-sectional neuropsychological tasks and clinical measures. Then participants with BD completed longitudinal assessments of mood symptoms and SI at 6-month intervals (M = 39.18 ± 16.57 months of follow-up data). Analyses included ANOVAs, independent-samples t tests, chi-square analyses, and multiple linear regressions. Participants with BD-I had significant deficits in cognitive flexibility and executive functioning vs. BD-NOS and TDCs, and impaired spatial working memory vs. TDCs only. Two significant BD subtype-by-cognitive flexibility interactions revealed that cognitive flexibility deficits were associated with subsequent percentage of time depressed and with SI in BD-I but not BD-NOS, regardless of other neurocognitive factors (full-scale IQ, executive functioning, spatial working memory) and clinical factors (current and prior mood and SI symptoms, age of BD onset, global functioning, psychiatric medications, comorbidity). Thus, cognitive flexibility may be an important etiological brain/behavior mechanism, prognostic indicator, and intervention target for childhood-onset BD-I, as this deficit appears to endure into young adulthood and is associated with worse prognosis for subsequent depression and SI.
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Dominiak M, Jażdżyk P, Antosik-Wójcińska AZ, Konopko M, Bieńkowski P, Świȩcicki Ł, Sienkiewicz-Jarosz H. The impact of bipolar spectrum disorders on professional functioning: A systematic review. Front Psychiatry 2022; 13:951008. [PMID: 36090375 PMCID: PMC9448890 DOI: 10.3389/fpsyt.2022.951008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
AIMS The impact of bipolar spectrum (BS) disorders on professional functioning has not been systematically reviewed yet. Since even subsyndromal symptoms may disturb functioning, the determination of the prognostic value of the spectrum of bipolarity for employment seems extremely relevant. The aim of this study was to assess the impact of BS disorders on professional functioning. MATERIALS AND METHODS A systematic review of the literature (namely, cohort and cross-sectional studies) investigating a link between BS disorders and employment was performed in accordance with PRISMA guidelines. BS was defined based on the concept of two-dimensional BS by Angst. Occupational outcomes and factors affecting employment were evaluated as well. RESULTS Seventy-four studies were included. All disorders comprising BS had a negative impact on occupational status, work performance, work costs, and salary, with the greatest unfavorable effect reported by bipolar disorder (BD), followed by borderline personality disorder (BPD), major depressive disorder (MDD), and dysthymia. Employment rates ranged from 40 to 75% (BD), 33 to 67% (BPD), 61 to 88% (MDD), and 86% (dysthymia). The factors affecting employment most included: cognitive impairments, number/severity of symptoms, namely, subsyndromal symptoms (mainly depressive), older age, education, and comorbidity (substance abuse, personality disorders, anxiety, depression, ADHD, PTSD). CONCLUSION Bipolar spectrum symptoms exert a negative impact on professional functioning. Further evaluation of affecting factors is crucial for preventing occupational disability.
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Affiliation(s)
- Monika Dominiak
- Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Piotr Jażdżyk
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland.,Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | | | - Magdalena Konopko
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Łukasz Świȩcicki
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
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12
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Onitsuka T, Hirano Y, Nemoto K, Hashimoto N, Kushima I, Koshiyama D, Koeda M, Takahashi T, Noda Y, Matsumoto J, Miura K, Nakazawa T, Hikida T, Kasai K, Ozaki N, Hashimoto R. Trends in big data analyses by multicenter collaborative translational research in psychiatry. Psychiatry Clin Neurosci 2022; 76:1-14. [PMID: 34716732 PMCID: PMC9306748 DOI: 10.1111/pcn.13311] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/01/2021] [Accepted: 10/17/2021] [Indexed: 12/01/2022]
Abstract
The underlying pathologies of psychiatric disorders, which cause substantial personal and social losses, remain unknown, and their elucidation is an urgent issue. To clarify the core pathological mechanisms underlying psychiatric disorders, in addition to laboratory-based research that incorporates the latest findings, it is necessary to conduct large-sample-size research and verify reproducibility. For this purpose, it is critical to conduct multicenter collaborative research across various fields, such as psychiatry, neuroscience, molecular biology, genomics, neuroimaging, cognitive science, neurophysiology, psychology, and pharmacology. Moreover, collaborative research plays an important role in the development of young researchers. In this respect, the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) consortium and Cognitive Genetics Collaborative Research Organization (COCORO) have played important roles. In this review, we first overview the importance of multicenter collaborative research and our target psychiatric disorders. Then, we introduce research findings on the pathophysiology of psychiatric disorders from neurocognitive, neurophysiological, neuroimaging, genetic, and basic neuroscience perspectives, focusing mainly on the findings obtained by COCORO. It is our hope that multicenter collaborative research will contribute to the elucidation of the pathological basis of psychiatric disorders.
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Affiliation(s)
- Toshiaki Onitsuka
- Department of Neuroimaging Psychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoji Hirano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Itaru Kushima
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Medical Genomics Center, Nagoya University Hospital, Nagoya, Japan
| | - Daisuke Koshiyama
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Michihiko Koeda
- Department of Neuropsychiatry, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.,Department of Neuropsychiatry, Nippon Medical School, Tama Nagayama Hospital, Tokyo, Japan
| | - Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takanobu Nakazawa
- Department of Bioscience, Tokyo University of Agriculture, Tokyo, Japan
| | - Takatoshi Hikida
- Laboratory for Advanced Brain Functions, Institute for Protein Research, Osaka University, Osaka, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), Tokyo, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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13
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Ikenouchi A, Konno Y, Fujino Y, Adachi N, Kubota Y, Azekawa T, Ueda H, Edagawa K, Katsumoto E, Goto E, Hongo S, Kato M, Tsuboi T, Yasui-Furukori N, Nakagawa A, Kikuchi T, Watanabe K, Yoshimura R. Relationship Between Employment Status and Unstable Periods in Outpatients with Bipolar Disorder: A Multicenter Treatment Survey for Bipolar Disorder in Psychiatric Outpatient Clinics (MUSUBI) Study. Neuropsychiatr Dis Treat 2022; 18:801-809. [PMID: 35422623 PMCID: PMC9005072 DOI: 10.2147/ndt.s353460] [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] [Received: 12/19/2021] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To clarify the relationship between the length of unstable periods and employment status of patients with bipolar disorder. PATIENTS AND METHODS Medical records of outpatients with bipolar disorder who visited 176 member clinics of the Japanese Association of Neuro-Psychiatric Clinics were investigated during September-October 2016, and details of their medical care and employment were surveyed using a questionnaire. The odds ratios (ORs) of length of unstable period and unemployment were analyzed with a logistic regression model. RESULTS The study included 816 patients, of whom 707 were employed full-time (continuous employment) and 70 were unemployed (loss of employment). Univariate analysis showed that ORs were statistically significant for patients who were unstable for "almost all" of the year (OR = 10.4 [4.48-24.28] p < 0.001), but not for "few" unstable periods (OR = 1.06 [0.56-1.98] p = 0.849) and for "significant" unstable periods (OR = 1.65 [0.73-3.74] p = 0.231) were not significantly different. Multivariate analysis showed that ORs were statistically "significant" for patients who were unstable for "almost all" (OR = 12.1 [4.37-33.3] p < 0.001), but not for "few" unstable periods (OR = 1.07 [0.55-2.07] p = 0.846) and for "significant" unstable periods (OR = 1.62 [0.66-3.98] p = 0.290) did not differ significantly. CONCLUSION Patients with bipolar disorder with a long unstable period were associated with a higher risk of unemployment.
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Affiliation(s)
- Atsuko Ikenouchi
- Department of Psychiatry, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.,Medical Center for Dementia, Hospital of the University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Yusuke Konno
- Department of Psychiatry, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.,Department of Environmental Epidemiology, Institute of Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Naoto Adachi
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Yukihisa Kubota
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Takaharu Azekawa
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Hitoshi Ueda
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Koji Edagawa
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Eiichi Katsumoto
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Eiichiro Goto
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Seiji Hongo
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Masaki Kato
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.,Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Takashi Tsuboi
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.,Department of Neuropsychiatry, Kyorin University, Tokyo, Japan
| | - Norio Yasui-Furukori
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.,Department of Psychiatry, Dokkyo Medical University, Tochigi, Japan
| | - Atsuo Nakagawa
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.,Department of Neuropsychiatry, Keio University, Tokyo, Japan
| | - Toshiaki Kikuchi
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.,Department of Neuropsychiatry, Keio University, Tokyo, Japan
| | - Koichiro Watanabe
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.,Department of Neuropsychiatry, Kyorin University, Tokyo, Japan
| | - Reiji Yoshimura
- Department of Psychiatry, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.,The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
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14
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Chen WY, Liu HC, Cheng YC, Li H, Huang CC, Ding YW, Huang MC, Chiu CC, Tu YK, Kuo PH. Effect of Pharmacological and Neurostimulation Interventions for Cognitive Domains in Patients with Bipolar Disorder: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Clin Epidemiol 2021; 13:1039-1049. [PMID: 34744458 PMCID: PMC8565895 DOI: 10.2147/clep.s335584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/20/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION The priority of interventions to alleviate cognitive deficits in patients with bipolar disorder (BD) is inconclusive. We systematically evaluate the efficacy of pharmacological or neurostimulation interventions for cognitive function in BD through a network meta-analysis. METHODS The PubMed, PsycINFO, Embase, and Cochrane Library databases were searched from database inception to September 30, 2021. Following PRISMA guidelines, all eligible studies were randomized controlled trials of adult bipolar patients that provided detailed cognitive outcomes. Studies were excluded if participants limited to comorbid substance use disorder or the intervention was a psychotherapy. Network meta-analysis comparing different interventions was conducted for 8 cognitive domains. Partially ordered set with Hasse diagram was used to resolve conflicting rankings between outcomes. The study was preregistered on PROSPERO database (CRD42020152044). RESULTS Total 21 RCTs including 42 tests for assessing intervention effects on cognition were retrieved. Adjunctive erythropoietin (SMD = 0.61, 95% CI = 0.00-1.23), Withania somnifera (SMD = 0.58, 95% CI = 0.03-1.13), and galantamine (SMD = 1.22, 95% CI = 0.10-2.35) was more beneficial for attention, working memory, and verbal learning in euthymic BD patients than treatment as usual, respectively. Hasse diagram suggested ranking of choice when multiple domains were combined. CONCLUSION Considerable variability in measurements of cognitive domains in BD was observed, and no intervention resulted in superior benefits across all domains. We suggested interventions priority can be tailored according to individual patients' cognitive deficits. As current findings from relatively small and heterogeneous dataset, future trials with consensus should be applied for building further evidence.
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Affiliation(s)
- Wen-Yin Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsing-Cheng Liu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ying-Chih Cheng
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
| | - Hua Li
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chi-Chieh Huang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Wei Ding
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chiang Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
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15
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Macoveanu J, Freeman KO, Kjaerstad HL, Knudsen GM, Kessing LV, Miskowiak KW. Structural brain abnormalities associated with cognitive impairments in bipolar disorder. Acta Psychiatr Scand 2021; 144:379-391. [PMID: 34245569 DOI: 10.1111/acps.13349] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/18/2021] [Accepted: 07/07/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Cognitive impairment has been highlighted as a core feature of bipolar disorder (BD) that often persists during remission. The specific brain correlates of cognitive impairment in BD remain unclear which impedes efficient therapeutic approaches. In a large sample of remitted BD patients, we investigated whether morphological brain abnormalities within dorsal prefrontal cortex (PFC) and hippocampus were related to cognitive deficits. METHODS Remitted BD patients (n = 153) and healthy controls (n = 52) underwent neuropsychological assessment and structural MRI. Based on hierarchical cluster analysis of neuropsychological test performance, patients were classified as either cognitively impaired (n = 91) or cognitively normal (n = 62). The neurocognitive subgroups were compared amongst each other and with healthy controls in terms of dorsal PFC cortical thickness and volume, hippocampus shape and volume, and total cerebral grey and white matter volumes. RESULTS Cognitively impaired patients displayed greater left dorsomedial prefrontal thickness compared to cognitively normal patients and healthy controls. Hippocampal grey matter volume and shape were similar across patient subgroups and healthy controls. At a whole-brain level, cognitively impaired patients had lower cerebral white matter volume compared to the other groups. Across all participants, lower white matter volume correlated with more impaired neuropsychological test performance. CONCLUSIONS Our findings associate cognitive impairment in bipolar disorder with cerebral white matter deficits, factors which may relate to the observed morphological changes in dorsomedial PFC possibly due to increased neurocognitive effort to maintain symptom stability in these remitted patients.
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Affiliation(s)
- Julian Macoveanu
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Katherine Olivia Freeman
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hanne Lie Kjaerstad
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Neurobiology Research Unit and Center for Integrated Molecular imaging, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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16
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Chen WY, Huang MC, Lee YC, Chang CE, Lin SK, Chiu CC, Liu HC, Kuo CJ, Weng SH, Chen PY, Kuo PH. The Heterogeneity of Longitudinal Cognitive Decline in Euthymic Bipolar I Disorder With Clinical Characteristics and Functional Outcomes. Front Psychiatry 2021; 12:684813. [PMID: 34366918 PMCID: PMC8335543 DOI: 10.3389/fpsyt.2021.684813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/24/2021] [Indexed: 12/01/2022] Open
Abstract
We characterized the heterogeneity and risk factors of cognitive decline in euthymic bipolar disorder (BD), and their magnitude of associations with subjective daily functions. In this retrospective cohort, BD type I patients (N = 128) were followed for an average of 6.5 years. Intelligence quotient (IQ) at index date was recorded, and premorbid IQ was estimated. We used Brief Assessment of Cognition in Affective Disorders (BAC-A) to assess cognition at follow-up. We evaluated current functions with World Health Organization Disability Assessment Schedule 2.0. Clinical and sociodemographic factors were examined for their independent effects on longitudinal cognitive decline. In addition, we employed multivariate adaptive regression spline to detect inflection points for the nature of slope changes in cognitive decline among BD patients. During follow-up years, 21 BD patients (16.4%) showed longitudinal cognitive decline. In cognitive decline group, all cognitive domains of BAC-A were significantly worsened. We found that density of episodes with psychotic features was an independent risk factor for cognitive decline after adjusted for age, gender and dose of mood stabilizer. After the age of 42 years, a steeper cognitive change was observed in the cognitive decline group. The correlation pattern between cognitive domains and functional outcomes differed between patients with and without cognitive decline. The present study characterized cognitive heterogeneity longitudinally in BD patients. As density of episodes play roles for cognitive decline, our results emphasize the importance of relapse prevention. Our findings provide hints for future personalized interventions and facilitating genetic and biological studies for dissecting the heterogeneity of bipolar illness.
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Affiliation(s)
- Wen-Yin Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ya-Chin Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chiao-Erh Chang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shih-Ku Lin
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih Chiang Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsing-Cheng Liu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chian-Jue Kuo
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Han Weng
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Po-Yu Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
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17
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Quality of life and subjective sleep-related measures in bipolar disorder and major depressive disorder. Qual Life Res 2021; 31:117-124. [PMID: 34263443 PMCID: PMC8800916 DOI: 10.1007/s11136-021-02929-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Abstract
Purpose Diminished quality of life (QoL) has been reported in patients with mood disorders. QoL has also been shown to be decreased by sleep disturbances. Since sleep disorders are common in mood disorders, the aim of this study was to determine whether sleep characteristics are associated to QoL among patients with Bipolar Disorder (BD) and unipolar Major Depressive Disorders (MDD). Methods QoL was assessed in 170 patients with mood disorders (61 BD and 109 MDD), who also completed questionnaires measuring the severity of insomnia, sleepiness, chronotype preference and obstructive sleep apnea (OSA) probability index. Results Analyses showed that BD and MDD groups had similar QoL and sleep measures but the MDD group had higher OSA scores. In BD, correlations indicated a relationship between QoL and insomnia complaints and sleepiness, whereas in MDD, correlations indicated an association between QoL and insomnia complaints and OSA score. In both groups, QoL was related to depressive symptomatology. Linear regressions showed that, in BD, QoL was related to insomnia complaints and sleepiness even in the euthymic state, whereas in MDD, QoL was related to insomnia complaints but not in euthymic patients. Conclusion QoL is related to sleep differently in BD and MDD. The results suggest that insomnia and sleepiness are particularly high in BD even when patients are euthymic. These findings suggest that focusing on insomnia and sleepiness during different mood states of BD could increase QoL.
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18
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Liu X, Ma X, Wang W, Zhang J, Sun X, Luo X, Zhang Y. The functional impairment of different subtypes and occupational states in euthymic patients with bipolar disorder. BMC Psychiatry 2021; 21:240. [PMID: 33957876 PMCID: PMC8103625 DOI: 10.1186/s12888-021-03242-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/26/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The aim was to explore the associations between clinical symptoms, demographic variables, social and neurocognitive functioning in euthymic patients with bipolar disorder (BD) stratified by subgroups of DSM-IV BD (type I (BD-I) and type II (BD-II)) and occupational status (employed/unemployed), and to highlight the significance of occupational status when assessing social and neurocognitive functioning in euthymic BD patients. METHODS A total of 81 euthymic BD patients were participated in the study. The severity of the depressive and manic/hypomanic symptoms was measured using the 17-item Hamilton Depression Rating Scale (HDRS-17) and the Young Mania Rating Scale (YMRS), respectively. Social functioning and neurocognitive functioning were evaluated by the Functioning Assessment Short Test (FAST) and neurocognitive measures, respectively. RESULTS Employed BD patients displayed greater social functioning (autonomy, occupational functioning, interpersonal relationship domain) and better verbal learning performance and speed of processing than unemployed BD patients. The correlation between neurocognitive functioning and social functioning was stronger in the employed group than in the unemployed group. There were no significant differences in neurocognitive and social functioning between the BD-I and BD-II groups, and the correlation between neurocognitive functioning and social functioning was similar between the BD-I and BD-II groups. CONCLUSION Employed BD patients may present greater occupational functioning and interpersonal relationships, as well as better verbal learning performance and speed of processing.
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Affiliation(s)
- Xinyu Liu
- Henan Key Laboratory of Neurorestoratology, the first Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Unit of Bipolar Disorder, Tianjin Anding Hospital, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | | | - Wenchen Wang
- Unit of Bipolar Disorder, Tianjin Anding Hospital, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Jian Zhang
- Unit of Bipolar Disorder, Tianjin Anding Hospital, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Xia Sun
- Unit of Bipolar Disorder, Tianjin Anding Hospital, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Yong Zhang
- Henan Key Laboratory of Neurorestoratology, the first Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.
- Unit of Bipolar Disorder, Tianjin Anding Hospital, 13 Liulin Road, Hexi District, Tianjin, 300222, China.
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19
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Palaniappan P, Easwaran K. Theory of Mind Deficits and Their Influence on Functional Impairment in Remitted Phase of Bipolar Disorder. Indian J Psychol Med 2021; 43:195-202. [PMID: 34345094 PMCID: PMC8287390 DOI: 10.1177/0253717620930315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/31/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Functional impairment has been convincingly established in the euthymic/ remitted phase of bipolar disorder (BD). Though deficits in social cognition, especially theory of mind (ToM), predict functional impairment, the association has not been consistently proven. METHODS Thirty remitted subjects with BD (as per DSM 5) and 30 age- and gender-matched healthy controls were screened for eligibility and the sociodemographic details and ToM scores, that is, first-order ToM, second-order ToM, and Faux pas, were collected. In subjects with BD, functioning was assessed using Functioning Assessment Short Test (FAST) and illness variables were collected. RESULTS No significant difference was found in occupation or education between the groups. Remitted subjects with BD had statistically significant deficits in all domains of ToM, that is, first-order ToM (r = 0.65), second-order ToM (r = 0.69), and Faux pas (r = 0.75). Significant correlations existed between first-order ToM and FAST total score, as well as second-order ToM and FAST total score, but the correlations dropped after controlling for duration of illness and number of depressive episodes. Quantile regression analysis showed that the only factors which predicted global functional impairment was a higher number of episodes (βτ= -0.45, SE = 3.51, t = 0.13, P = 0.04), while all other illness variables and ToM failed to predict the global functioning. CONCLUSION Though there seems to be an association between ToM and functioning, only illness variables predicted functional impairment in subjects with BD. We need prospective studies to delineate the contributors to functional impairment.
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Affiliation(s)
- Pradeep Palaniappan
- Dept. of Psychiatry, PSG Institute of Medical Sciences & Research, Coimbatore, India
| | - Krishnapriya Easwaran
- Dept. of Psychiatry, PSG Institute of Medical Sciences & Research, Coimbatore, India
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Inferior frontal gyrus seed-based resting-state functional connectivity and sustained attention across manic/hypomanic, euthymic and depressive phases of bipolar disorder. J Affect Disord 2021; 282:930-938. [PMID: 33601737 DOI: 10.1016/j.jad.2020.12.199] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/20/2020] [Accepted: 12/31/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Seed-based resting-state functional connectivity (rs-FC) of inferior frontal gyrus (IFG), as well as sustained attention cognitive deficit are consistently reported to be impaired in bipolar disorders. However, whether these deficits exist across mood states and euthymic state are lacking. We compared rs-FC of IFG and sustained attention of bipolar patients in (hypo) mania, depression and euthymia, with controls. We also explored the interrelationships between clinical, cognitive, and imaging measurements. METHODS Participants included 110 bipolar subjects: 46 manic/hypomanic, 35 euthymic, and 29 depressed, matched with 41 healthy controls (HCs) underwent structural magnetic resonance imaging (MRI) and resting-state functional MRI scans. Seed-based functional connectivity analyses were performed focused on bilateral IFG seeds. Clinical symptoms and sustained attention function were measured. Stepwise linear regression analysis was conducted to explore predictors of sustained attention measurements. RESULTS Increased rs-FC between right IFG and bilateral frontal pole/superior frontal gyrus, precuneus, and posterior cingulate gyrus, as well as decreased rs-FC between right IFG and sensorimotor areas, anterior middle cingulate gyrus were found in all three bipolar subgroups compared with HCs. Impaired sustained attention measurement was found in bipolar manic/hypomanic and depressive subgroups compared with HCs. Linear regression analyses revealed a significant impact of the manic symptoms and psychotic symptoms on the performance of sustained attention task. CONCLUSIONS Our results revealed that IFG seed-based resting-state functional networks involved in emotion regulation and cognitive function were trait-like deficit in bipolar patients. Higher manic levels and psychotic symptoms were predictors of a worse sustained attention performance.
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21
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Frank RG, Glied SAM, Shields M. Jobs for People With Mental Health Conditions: Trends and Prospects. Psychiatr Serv 2021; 72:143-147. [PMID: 32966178 PMCID: PMC7869603 DOI: 10.1176/appi.ps.202000243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE For individuals with serious mental illness, work can play an important role in improving quality of life and community integration. Since the 1960s, demand has shifted away from routine cognitive (e.g., clerical work) and manual skills (warehouse picking and packing) toward nonroutine analytical (computer coding), interpersonal (nursing), and manual skills (home health attendant). This study aimed to determine whether individuals with serious mental illness are likely to hold the types of jobs that are in decline and to assess their ability to compete for the types of jobs that have been in increased demand. METHODS Using data from the National Health Interview Survey and the Occupational Information Network database on occupational skills (N=387,240 person-year responses), this study explored changes in patterns of employment from 1997 to 2017 for people with mental illnesses. RESULTS Individuals with any mental health condition experienced a 10.9 percentage point decline in employment in jobs requiring routine cognitive or any manual skills. Much of this decline was offset by an increase in employment in jobs involving nonroutine cognitive skills. However, individuals with serious psychological distress experienced a 7.9 percentage point decline in employment in jobs requiring routine cognitive or any manual skills, and about 75% of this decline coincided with reduced levels of employment rather than a shift toward employment in nonroutine cognitive jobs. These patterns were more striking among men. CONCLUSIONS Likely directions for interventions include renewed efforts at workplace accommodations, greater investment in evidence-based return-to-work programs, and efforts to popularize early intervention programs.
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Affiliation(s)
- Richard G Frank
- Department of Health Care Policy, Harvard Medical School, Boston (Frank); Wagner School of Public Service, New York University, New York (Glied); Department of Psychiatry, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields)
| | - Sherry A M Glied
- Department of Health Care Policy, Harvard Medical School, Boston (Frank); Wagner School of Public Service, New York University, New York (Glied); Department of Psychiatry, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields)
| | - Morgan Shields
- Department of Health Care Policy, Harvard Medical School, Boston (Frank); Wagner School of Public Service, New York University, New York (Glied); Department of Psychiatry, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields)
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22
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Çelik HEA, Ceylan D, Ongun CH, Erdoğan A, Tan D, Gümüşkesen P, Bağci B, Özerdem A. Neurocognitive Functions in Bipolar Disorder in Relation to Comorbid ADHD. ACTA ACUST UNITED AC 2021; 58:87-93. [PMID: 34188588 DOI: 10.29399/npa.27290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/20/2020] [Indexed: 11/07/2022]
Abstract
Introduction Bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD) often co-occur in adult population. Both conditions present various neurocognitive and behavioral problems. We aimed to examine neurocognitive functions in adult patients with comorbid BD and ADHD (BD+ADHD) in comparison to patients with only BD, only ADHD and healthy controls (HCs). Method An extensive cognitive battery which evaluates verbal learning and memory, visual memory, processing speed, attention, executive functions, working memory and verbal fluency, was used to assess neurocognitive functions respectively in adult (age 18-65 years) patients with BD (n=37), ADHD (n=43), BD+ADHD (n=20) in comparison to HCs (n=51). The Multivariate Analysis of Covariance models, where age, level of education and total BIS-11 scores were included as covariates, were used for comparing neurocognitive scores among groups. Results Both BD and BD+ADHD groups showed significantly poorer performance than HCs in processing speed, attention, executive functions, and verbal fluency domains. The BD group had additional significant deficits in executive functions, verbal learning and memory domains. There were no significant differences between BD and BD+ADHD groups with regards to verbal learning and memory, visual memory, processing speed, attention, executive functions, working memory and verbal fluency domains. Patients with only ADHD showed significantly poorer performance than HCs in verbal fluency domain. Conclusions Our results show similarities in the neurocognitive functions of adults with BD and BD+ADHD across a wide range of cognitive domains. The findings point to the need for further exploration of diverging and converging neurodevelopmental trajectories of BD and ADHD.
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Affiliation(s)
- Hidayet Ece Arat Çelik
- Maltepe University, Faculty of Medicine, Department of Psychiatry, İstanbul, Turkey.,Dokuz Eylül University, Institute of Health Sciences, Department of Neuroscience, İzmir, Turkey
| | - Deniz Ceylan
- Koç University, Faculty of Medicine, Department of Psychiatry, İstanbul, Turkey
| | | | - Ayşe Erdoğan
- Dokuz Eylül University, Institute of Health Sciences, Department of Neuroscience, İzmir, Turkey
| | - Devran Tan
- Nişantaşı University, Faculty of Economics, Administrative and Scocial Sciences, Department of Psychology, İstanbul, Turkey
| | - Peren Gümüşkesen
- Dokuz Eylül University, Institute of Health Sciences, Department of Neuroscience, İzmir, Turkey
| | - Başak Bağci
- Katip Çelebi University, Ataturk Training and Research Hospital, Department of Psychiatry, İzmir, Turkey
| | - Ayşegül Özerdem
- Mayo Clinic, Department of Psychiatry and Psychology, Rochester, MN, USA
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Holm M, Taipale H, Tanskanen A, Tiihonen J, Mitterdorfer‐Rutz E. Employment among people with schizophrenia or bipolar disorder: A population-based study using nationwide registers. Acta Psychiatr Scand 2021; 143:61-71. [PMID: 33155273 PMCID: PMC7839734 DOI: 10.1111/acps.13254] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the employment rate and the related background factors among people with schizophrenia or bipolar disorder. METHODS We identified all people in Sweden aged 18-64 years diagnosed with schizophrenia or bipolar disorder in nationwide registers in the years 2006-2013. The identified individuals were grouped by main activity or source of income. The association between background factors and employment was analyzed with generalized estimating equations (GEE). RESULTS Three years before the first psychosis or bipolar disorder diagnosis, 24% of the individuals with schizophrenia and 45% of the individuals with bipolar disorder were employed. However, the employment rate dropped around the time of the first diagnosis. Five years later, 10% of the individuals with schizophrenia and 34% of the individuals with bipolar disorder were employed. The most important factors associated with employment after diagnosis were a high level of education, older age at the first registered diagnosis, no substance use disorder, and a low number of previous hospitalizations. Marriage or cohabiting, higher level of education, and higher age at the first diagnosis were associated with an increased employment rate especially among people with schizophrenia, and substance use was associated with a lower employment rate, especially among people with bipolar disorder. Men with bipolar disorder had a higher employment rate than women. CONCLUSION The employment rate is low among people with schizophrenia and higher among people with bipolar disorder. The association of background characteristics with employment was mostly in the same direction both in schizophrenia and in bipolar disorder.
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Affiliation(s)
- Minna Holm
- Mental Health UnitFinnish Institute for Health and WelfareHelsinkiFinland,Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Heidi Taipale
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden,School of PharmacyUniversity of Eastern FinlandKuopioFinland,Department of Forensic PsychiatryNiuvanniemi HospitalUniversity of Eastern FinlandKuopioFinland
| | - Antti Tanskanen
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden,Department of Forensic PsychiatryNiuvanniemi HospitalUniversity of Eastern FinlandKuopioFinland,The Impact Assessment UnitNational Institute for Health and WelfareHelsinkiFinland
| | - Jari Tiihonen
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden,Department of Forensic PsychiatryNiuvanniemi HospitalUniversity of Eastern FinlandKuopioFinland
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López-Villarreal A, Sánchez-Morla EM, Jiménez-López E, Martínez-Vizcaíno V, Aparicio AI, Mateo-Sotos J, Rodriguez-Jimenez R, Vieta E, Santos JL. Progression of the functional deficit in a group of patients with bipolar disorder: a cluster analysis based on longitudinal data. Eur Arch Psychiatry Clin Neurosci 2020; 270:947-957. [PMID: 31422453 DOI: 10.1007/s00406-019-01050-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 08/07/2019] [Indexed: 12/23/2022]
Abstract
We aimed to examine the trajectory of psychosocial functioning in a sample of euthymic patients with bipolar disorder (BD) throughout a 5-year follow-up. Ninety-nine euthymic bipolar patients and 40 healthy controls (HC) were included. A neurocognitive assessment (17 neurocognitive measures grouped in 6 domains) was carried out at baseline. The split version of the Global Assessment of Functioning scale (GAF-F) and the Functioning Assessment Short Test (FAST) were used to examine psychosocial functioning at baseline (T1), and after a 5-year follow-up (T2). The statistical analysis was performed through repeated measures ANOVA and hierarchical cluster analysis based on the GAF-F and the FAST scores at T1 and T2. Eighty-seven patients (87.9%) were evaluated at T2. The cluster analysis identified two groups of patients. The first group included 44 patients (50.6%) who did not show a progression of the functional impairment (BD-NPI). The second cluster, which included 43 patients (49.4%), was characterized by a progression of the functional impairment (BD-PI). The BD-PI had a higher number of relapses and a higher number of hospitalizations during the follow-up period, as well as worse neurocognitive functioning than the BD-NPI. The repeated measures ANOVA confirmed that the psychosocial performance of BD-NPI is stable while there was a progression of the functional deterioration in BD-PI. The trajectory of the psychosocial functioning of patients with BD is not homogeneous. Our results suggest that in at least one subset of patients with BD, which might account for half of the patients, the disease has a progressive course.
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Affiliation(s)
- Ana López-Villarreal
- Department of Psychiatry, Hospital Virgen de La Luz CIBERSAM, Cuenca, Spain.,Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Eva María Sánchez-Morla
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERSAM, Madrid, Spain. .,CogPsy-Group, Universidad Complutense de Madrid (UCM), Madrid, Spain. .,Department of Psychiatry, Hospital Universitario 12 de Octubre, Avda. Córdoba km. 5400, 28041, Madrid, Spain.
| | - Estela Jiménez-López
- Department of Psychiatry, Hospital Virgen de La Luz CIBERSAM, Cuenca, Spain.,Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain.,Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Ana Isabel Aparicio
- Department of Psychiatry, Hospital Virgen de La Luz CIBERSAM, Cuenca, Spain.,Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Jorge Mateo-Sotos
- Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Roberto Rodriguez-Jimenez
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERSAM, Madrid, Spain.,CogPsy-Group, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Eduard Vieta
- Department of Psychiatry, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - José Luis Santos
- Department of Psychiatry, Hospital Virgen de La Luz CIBERSAM, Cuenca, Spain.,Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
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Léda-Rêgo G, Bezerra-Filho S, Miranda-Scippa Â. Functioning in euthymic patients with bipolar disorder: A systematic review and meta-analysis using the Functioning Assessment Short Test. Bipolar Disord 2020; 22:569-581. [PMID: 32243046 DOI: 10.1111/bdi.12904] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Systematically review the prevalence of functional impairment (FI) in euthymic patients with bipolar disorder (BD), as assessed only with the Functioning Assessment Short Test (FAST), explore the prevalence of this impairment among all the domains, identify the most compromised of them and the clinical variables associated with low functioning in this population. METHODS Meta-analyses were performed, searching for relevant papers published from 2007 to 2019 in Medline, Embase, Cochrane, PsycINFO databases and via hand-searching, without language restrictions. 1128 studies were initially identified, 13 of which were ultimately chosen based on the eligibility criteria. A two-step meta-analysis was performed using the mean difference with a 95% confidence interval for continuous variables and proportion estimation with a fixed-effects model for categorical variables. RESULTS In the first step, all FAST domains showed worse FI in patients than in healthy controls, with significant differences between groups. In the second step, the prevalence of FI domains were as follows: global, 58.6%; occupational, 65.6%; cognitive, 49.2%; autonomy, 42.6%; interpersonal relationships, 42.1%; leisure, 29.2%; and financial issues, 28.8%. Residual depressive symptoms were the most frequently cited variable associated with FI. CONCLUSIONS This study reinforces the relevant functional impact of BD in this population and suggests that the occupational domain may be the most impaired. Greater efforts should be directed toward targeting functioning in patient care, as it constitutes the most meaningful endpoint of response to treatment, especially with occupational and cognitive rehabilitation, thus allowing patients to overcome the course of illness and carry fulfilling lives.
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Affiliation(s)
- Gabriela Léda-Rêgo
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil
| | - Severino Bezerra-Filho
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil
| | - Ângela Miranda-Scippa
- Mood and Anxiety Disorders Program (CETHA), Federal University of Bahia (UFBA), Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil.,Department of Neurosciences and Mental Health, Medical School, UFBA, Salvador, Brazil
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26
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López-Villarreal A, Sánchez-Morla EM, Jiménez-López E, Martínez-Vizcaíno V, Aparicio AI, Mateo-Sotos J, Rodriguez-Jimenez R, Vieta E, Santos JL. Predictive factors of functional outcome in patients with bipolar I disorder: a five-year follow-up. J Affect Disord 2020; 272:249-258. [PMID: 32553365 DOI: 10.1016/j.jad.2020.03.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/13/2020] [Accepted: 03/29/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Functional impairment is commonly encountered among patients with bipolar disorder (BD) during periods of remission. The distribution of the impairment of the functional outcome is heterogeneous. The objective of this current investigation was to identify neurocognitive and clinical predictors of psychosocial functioning in a sample of patients with BD. METHODS Seventy-six patients (59.2% females) and 40 healthy controls (50% females), aged 18 to 55 years, were assessed using a comprehensive neurocognitive battery (six neurocognitive domains), and the Functioning Assessment Short Test (FAST), at baseline and after a 5-year follow-up. Stepwise regression models were used to identify predictor variables related to psychosocial functioning. RESULTS The number of hospitalizations during the follow-up, the change occurred in the neurocognitive composite index (NCI change), and NCI at baseline explained 30.8% of the variance of functioning. The number of hospitalizations during the follow-up was the variable that explained a greater percentage of the variance (16.9%). Verbal memory at baseline and the change in sustained attention during the follow-up explained 10% and 5.9% of the variance of the psychosocial functioning, respectively. LIMITATIONS The interval of 5 years between the two assessments could be too short to detect a possible progression in functional outcome for the overall sample. CONCLUSIONS The clinical course during the follow-up is the factor that has a greater impact on psychosocial functioning in patients with BD. Thus, the interventions aimed to promote prevention of relapses should be considered as essential for avoiding functional impairment in these patients.
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Affiliation(s)
- Ana López-Villarreal
- Department of Psychiatry, Hospital Virgen de La Luz, CIBERSAM, Cuenca, Spain; Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Eva María Sánchez-Morla
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERSAM, Madrid, Spain; CogPsy-Group, Universidad Complutense de Madrid (UCM), Spain.
| | - Estela Jiménez-López
- Department of Psychiatry, Hospital Virgen de La Luz, CIBERSAM, Cuenca, Spain; Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain; Universidad de Castilla-La Mancha. Health and Social Research Center, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha. Health and Social Research Center, Cuenca, Spain; Universidad Autónoma de Chile. Facultad de Ciencias de la Salud, Talca, Chile
| | - Ana Isabel Aparicio
- Department of Psychiatry, Hospital Virgen de La Luz, CIBERSAM, Cuenca, Spain; Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Jorge Mateo-Sotos
- Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Roberto Rodriguez-Jimenez
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERSAM, Madrid, Spain; CogPsy-Group, Universidad Complutense de Madrid (UCM), Spain
| | - Eduard Vieta
- Department of Psychiatry, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - José Luis Santos
- Department of Psychiatry, Hospital Virgen de La Luz, CIBERSAM, Cuenca, Spain; Neurobiological Research Group. Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
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27
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Li C, Palka JM, Brown ES. Cognitive impairment in individuals with bipolar disorder with and without comorbid alcohol and/or cocaine use disorders. J Affect Disord 2020; 272:355-362. [PMID: 32553378 PMCID: PMC7305419 DOI: 10.1016/j.jad.2020.03.179] [Citation(s) in RCA: 4] [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] [Received: 05/30/2019] [Revised: 02/27/2020] [Accepted: 03/29/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bipolar disorder (BD) frequently co-occurs with substance use disorders (SUDs), and both are associated with cognitive impairment. This study compares cognition between individuals with BD with and without current alcohol use disorder (AUD), cocaine use disorder (CUD), or both, as these disorders may be linked with additive cognitive impairment. METHODS Baseline data were analyzed from five clinical studies of individuals with the aforementioned disorders (N = 373). Participants were grouped as follows: BD-only, BD + AUD, BD + CUD, or BD + AUD + CUD. Cognition was assessed with the Rey Auditory Verbal Learning Test (RAVLT) (verbal learning and memory) and Stroop Color Word Test (executive function). Multiple linear regression models determined if SUD diagnosis, among other demographic and clinical variables, predicted each cognitive test's T-score. Regression equations were used to compute each group's mean T-scores. RESULTS All groups demonstrated below-average mean T-scores on all tests, with no significant between-group score differences. RAVLT total T-scores were lower than Stroop color-word T-scores within all groups (non-overlapping 95% confidence intervals). Higher daily cocaine use predicted higher Stroop T-scores (p < 0.01) and RAVLT delayed recall T-scores (p < 0.05). No other non-demographic variable, including AUD/CUD group status, predicted cognitive performance. LIMITATIONS A full cognitive battery and some relevant variables (e.g. BD lifetime illness course) were not available. Many participants (42.1%) had additional SUDs. CONCLUSIONS BD with and without AUD/CUD was found to be associated with greater deficits in verbal learning and memory than in executive function. Addressing these impaired domains in dually-diagnosed patients may improve treatment and functional outcomes.
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Affiliation(s)
- Chengxi Li
- Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. MC 8849, Dallas, TX 75390-8849, USA
| | - Jayme M Palka
- Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. MC 8849, Dallas, TX 75390-8849, USA
| | - E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. MC 8849, Dallas, TX 75390-8849, USA.
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28
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Chen WY, Chen JC, Cheng YC, Liu HC, Kuo PH, Huang MC. Gene polymorphisms of cognitive function in patients with bipolar disorder: A systematic review and meta-analysis. TAIWANESE JOURNAL OF PSYCHIATRY 2020. [DOI: 10.4103/tpsy.tpsy_2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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29
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Camodeca A. Theory of Mind Performance in Broad Autism Phenotype Groups: Between-Group Differences and Predictor Variables. J Autism Dev Disord 2019; 49:4079-4096. [PMID: 31267287 DOI: 10.1007/s10803-019-04126-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Investigated between-group differences in cognitive/affective theory of mind (ToM) and predictors of cognitive ToM both within broad autism phenotype/non (BAP/Non-BAP) groups as well as across the sample. The BAP group (n = 45) performed worse than the Non-BAP group (n = 102) on the unexpected outcomes test (UOT), but groups were similar regarding reading the mind in the eyes test (RMET). Stepwise regression indicated RMET best predicted UOT for the BAP group; block design best predicted UOT in the Non-BAP group. BAP traits did not mediate the relation of RMET to UOT performance. While RMET and UOT appear similarly related in BAP/Non-BAP samples, use of emotion recognition abilities in a cognitive ToM task may reflect over-reliance on this skill in the BAP.
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Affiliation(s)
- Amy Camodeca
- Psychology Department, The Pennsylvania State University, 100 University Drive, Monaca, PA, 15061, USA.
- University of Windsor, 100 University Drive, Windsor, ON, Canada.
- The Pennsylvania State University, Beaver Campus, 100 University Drive, Monaca, PA, 15108, USA.
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30
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Pacciardi B, Calcedo A, Messer T. Inhaled Loxapine for the Management of Acute Agitation in Bipolar Disorder and Schizophrenia: Expert Review and Commentary in an Era of Change. Drugs R D 2019; 19:15-25. [PMID: 30721526 PMCID: PMC6380965 DOI: 10.1007/s40268-019-0262-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Agitation is a common and costly phenomenon associated with a number of psychiatric conditions including schizophrenia and bipolar disorder. Early identification and prompt intervention to relieve the symptoms of agitation are essential to avoid symptomatic escalation and emergence of aggressive behaviour. Recent consensus guidelines emphasise the need for non-coercive management strategies to protect the therapeutic alliance between patients and their healthcare providers—an alliance that is critical for the effective management of chronic psychiatric conditions. Rapid symptom relief and de-escalation of agitation are necessary to avoid the costly and traumatic use of coercive techniques of physical restraint and seclusion, which require admission and prolonged hospitalisation. Inhaled loxapine is approved for the treatment of acute agitation in patients with schizophrenia or bipolar disorder. Clinical studies have confirmed the efficacy, rapid onset of action, and safety and tolerability of this agent in the psychiatric emergency and hospital settings. Emerging data have indicated the potential for inhaled loxapine as a self-administered agent for use in the community setting without the direct supervision of a healthcare professional. We discuss the evolving treatment paradigm and the place of inhaled medications for acutely agitated patients both within and outside the emergency and hospital setting.
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Affiliation(s)
| | - Alfredo Calcedo
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Thomas Messer
- Danuvius Klinik GmbH, Pfaffenhofen an Der Ilm, Germany
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Roberts BZ, Young JW, He YV, Cope ZA, Shilling PD, Feifel D. Oxytocin improves probabilistic reversal learning but not effortful motivation in Brown Norway rats. Neuropharmacology 2019; 150:15-26. [PMID: 30844406 DOI: 10.1016/j.neuropharm.2019.02.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 01/30/2023]
Abstract
Deficits in cognition and motivation are common and debilitating aspects of psychiatric disorders, yet still go largely untreated. The neuropeptide oxytocin (OT) is a potential novel therapeutic for deficits in social cognition and motivation in psychiatric patients. However, the effects of OT on clinically relevant domains of non-social cognition and motivation remain under studied. The present study investigated the effects of acute and chronic (21-day) administration of subcutaneous OT (0.04, 0.2, and 1 mg/kg) in cross-species translatable operant paradigms of reward learning and effortful motivation in male and female Brown Norway (BN) rats (n = 8-10/group). Reward learning was assessed using the probabilistic reversal learning task (PRLT) and effortful motivation was measured using the progressive ratio breakpoint task (PRBT). As predicted, BN rats exhibited baseline deficits in the detection of reversals of reward contingency in the PRLT relative to Long Evans (LE) rats. The two strains performed equally in the PRBT. Thirty minutes after a single OT injection (1 mg/kg), measures of both initial probabilistic learning (trials to first criterion) and subsequent reversal learning (contingency switches) were significantly improved to levels comparable with LE rats. The OT effect on switches persisted in male, but not female, BN rats 30 min, 24 h, and 6 days after long-term OT administration, suggesting the induction of neuroplastic changes. OT did not affect effortful motivation at any time-point. The beneficial effects of OT on reward learning in the absence of increased effortful motivation support the development of OT as a novel therapeutic to improve cognitive functioning.
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Affiliation(s)
- Benjamin Z Roberts
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, USA
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, USA; VISN-22 Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA.
| | - Yinong V He
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, USA
| | - Zackary A Cope
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, USA
| | - Paul D Shilling
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, USA
| | - David Feifel
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, USA; Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA, USA.
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Steullet P, Cabungcal JH, Bukhari SA, Ardelt MI, Pantazopoulos H, Hamati F, Salt TE, Cuenod M, Do KQ, Berretta S. The thalamic reticular nucleus in schizophrenia and bipolar disorder: role of parvalbumin-expressing neuron networks and oxidative stress. Mol Psychiatry 2018; 23:2057-2065. [PMID: 29180672 PMCID: PMC5972042 DOI: 10.1038/mp.2017.230] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 08/29/2017] [Accepted: 09/08/2017] [Indexed: 02/06/2023]
Abstract
Growing evidence points to a disruption of cortico-thalamo-cortical circuits in schizophrenia (SZ) and bipolar disorder (BD). Clues for a specific involvement of the thalamic reticular nucleus (TRN) come from its unique neuronal characteristics and neural connectivity, allowing it to shape the thalamo-cortical information flow. A direct involvement of the TRN in SZ and BD has not been tested thus far. We used a combination of human postmortem and rodent studies to test the hypothesis that neurons expressing parvalbumin (PV neurons), a main TRN neuronal population, and associated Wisteria floribunda agglutinin-labeled perineuronal nets (WFA/PNNs) are altered in SZ and BD, and that these changes may occur early in the course of the disease as a consequence of oxidative stress. In both disease groups, marked decreases of PV neurons (immunoreactive for PV) and WFA/PNNs were observed in the TRN, with no effects of duration of illness or age at onset. Similarly, in transgenic mice with redox dysregulation, numbers of PV neurons and WFA/PNN+PV neurons were decreased in transgenic compared with wild-type mice; these changes were present at postnatal day (P) 20 for PV neurons and P40 for WFA/PNN+PV neurons, accompanied by alterations of their firing properties. These results show profound abnormalities of PV neurons in the TRN of subjects with SZ and BD, and offer support for the hypothesis that oxidative stress may play a key role in impacting TRN PV neurons at early stages of these disorders. We put forth that these TRN abnormalities may contribute to disruptions of sleep spindles, focused attention and emotion processing in these disorders.
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Affiliation(s)
- Pascal Steullet
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital-CHUV, Prilly-Lausanne, Switzerland
| | - Jan-Harry Cabungcal
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital-CHUV, Prilly-Lausanne, Switzerland
| | - Syed A. Bukhari
- Translational Neuroscience Laboratory, Mclean Hospital, Belmont, MA, USA
| | | | - Harry Pantazopoulos
- Translational Neuroscience Laboratory, Mclean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Fadi Hamati
- Translational Neuroscience Laboratory, Mclean Hospital, Belmont, MA, USA
| | - Thomas E. Salt
- The Institute of Ophthalmology, University College London, London, UK
| | - Michel Cuenod
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital-CHUV, Prilly-Lausanne, Switzerland
| | - Kim Q. Do
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital-CHUV, Prilly-Lausanne, Switzerland
| | - Sabina Berretta
- Translational Neuroscience Laboratory, Mclean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Program in Neuroscience, Harvard Medical School, Boston, MA, USA
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Oliveira T, Marinho V, Carvalho V, Magalhães F, Rocha K, Ayres C, Teixeira S, Nunes M, Bastos VH, Pinto GR. Genetic polymorphisms associated with circadian rhythm dysregulation provide new perspectives on bipolar disorder. Bipolar Disord 2018; 20:515-522. [PMID: 29441659 DOI: 10.1111/bdi.12624] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/24/2017] [Accepted: 01/07/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The objective of this study was to present a broad view of how genetic polymorphisms in genes that control the rhythmicity and function of circadian rhythm may influence the etiology, pathophysiology and treatment of bipolar disorder (BD). METHODS A bibliographic search was performed to identify and select papers reporting studies on variations in circadian genes and BD. A search of Medline, Google Scholar, Scopus, and Web of Science was carried out to review the literature. RESULTS Several studies provide evidence of contributions of variations in circadian genes to disease etiology, pathophysiological variations and lithium drug response. Dysfunction of the sleep-wake cycle, an important brain function regulator, is indicated as the primary means by which circadian gene variations act in mood disorders. CONCLUSIONS Investigations of the effects of circadian genes have suggested that the chronotype offers hope for guiding and improving management of patients with BD. However, BD is a disease of a complex nature and presents multiple endophenotypes determined by different associations between genetics and the environment. Thus, new genomic studies to delimit variations that may help improve the clinical condition of these patients are extremely important.
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Affiliation(s)
- Thomaz Oliveira
- Brain Mapping and Plasticity Laboratory, Federal University of Piauí, Parnaíba, Brazil
- Genetics and Molecular Biology Laboratory, Federal University of Piauí, Parnaíba, Brazil
| | - Victor Marinho
- Brain Mapping and Plasticity Laboratory, Federal University of Piauí, Parnaíba, Brazil
- Genetics and Molecular Biology Laboratory, Federal University of Piauí, Parnaíba, Brazil
- The Northeast Biotechnology Network (RENORBIO), Federal University of Piauí, Teresina, Brazil
| | - Valécia Carvalho
- Brain Mapping and Plasticity Laboratory, Federal University of Piauí, Parnaíba, Brazil
- The Northeast Biotechnology Network (RENORBIO), Federal University of Piauí, Teresina, Brazil
| | - Francisco Magalhães
- Brain Mapping and Plasticity Laboratory, Federal University of Piauí, Parnaíba, Brazil
- The Northeast Biotechnology Network (RENORBIO), Federal University of Piauí, Teresina, Brazil
| | - Kaline Rocha
- Brain Mapping and Plasticity Laboratory, Federal University of Piauí, Parnaíba, Brazil
- The Northeast Biotechnology Network (RENORBIO), Federal University of Piauí, Teresina, Brazil
| | - Carla Ayres
- Brain Mapping and Plasticity Laboratory, Federal University of Piauí, Parnaíba, Brazil
| | - Silmar Teixeira
- Brain Mapping and Plasticity Laboratory, Federal University of Piauí, Parnaíba, Brazil
- The Northeast Biotechnology Network (RENORBIO), Federal University of Piauí, Teresina, Brazil
| | - Monara Nunes
- Brain Mapping and Functionality Laboratory, Federal University of Piauí, Parnaíba, Brazil
| | - Victor Hugo Bastos
- Brain Mapping and Functionality Laboratory, Federal University of Piauí, Parnaíba, Brazil
| | - Giovanny R Pinto
- Genetics and Molecular Biology Laboratory, Federal University of Piauí, Parnaíba, Brazil
- The Northeast Biotechnology Network (RENORBIO), Federal University of Piauí, Teresina, Brazil
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Solé B, Bonnin CM, Jiménez E, Torrent C, Torres I, Varo C, Valls E, Montejo L, Gómez-Ocaña C, Tomioka Y, Vieta E, Martinez-Aran A, Reinares M. Heterogeneity of functional outcomes in patients with bipolar disorder: a cluster-analytic approach. Acta Psychiatr Scand 2018; 137:516-527. [PMID: 29508379 DOI: 10.1111/acps.12871] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The aim was to examine the heterogeneity of psychosocial outcomes in euthymic bipolar disorder (BD) patients and analyse the potential influence of distinct variables on functioning. METHOD Using a hierarchical cluster exploratory analysis, 143 euthymic patients with diagnosis of BD were grouped according to their functional performance based on domains scores of the Functioning Assessment Short Test (FAST). The resulting groups were compared on sociodemographic, clinical and neurocognitive variables to find factors associated with each functional cluster. RESULTS Patients were grouped in three functional profiles: patients with good functioning in all the FAST areas, patients with an intermediate profile showing great difficulties in the occupational domain and milder difficulties in most of the rest domains, and a third group with serious difficulties in almost all functional areas. Both functionally impaired groups were characterized by higher subthreshold symptoms (depressive and manic) and higher unemployment rates. The most functionally impaired group also showed lower scores on some measures of processing speed. CONCLUSION Two of three functional profiles showed some kind of impairment which was associated with subsyndromal symptoms and cognitive performance. These patterns should be taken into consideration to develop more individualized interventions to restore, or improve, psychosocial outcomes.
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Affiliation(s)
- B Solé
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - C M Bonnin
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - E Jiménez
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - C Torrent
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - I Torres
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - C Varo
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - E Valls
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - L Montejo
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - C Gómez-Ocaña
- Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Y Tomioka
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - E Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - A Martinez-Aran
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - M Reinares
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
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Hergenrather KC, Emmanuel D, McGuire-Kuletz M, Rhodes SD. Employment as a Social Determinant of Health: Exploring the Relationship Between Neurocognitive Function and Employment Status. REHABILITATION RESEARCH, POLICY, AND EDUCATION 2018. [DOI: 10.1891/2168-6653.32.2.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose:To explore employment as a social determinant of health through examining the relationship between neurocognitive function and employment status.Method:The authors explored the causal relationship between employment status and neurocognitive function by conducting a systematic review of 15 longitudinal studies. The identified studies were conducted in Australia, Denmark, Norway, and the United States.Results:Five neurocognitive function domains were identified (i.e., complex attention, executive function, learning and memory, language, perceptual-motor function) across diagnosis (i.e., bipolar disorder, first-episode psychosis, human immunodeficiency virus, major depression, schizophrenia-spectrum disorders, traumatic brain injury). Unemployment was correlated with poorer attention, executive function, learning and memory, perceptual-motor function, and language. Employment was correlated with better attention, executive function, learning and memory, perceptual-motor function.Conclusion:The acknowledgment of the relationship between neurocognitive function and employment status can assist service providers in assessing and developing strategies to enhance and maintain employment outcomes. The assessment of neurocognitive function could be further explored by identifying standard measures and assessment timelines to assess the six domains across diagnosis. Vocational rehabilitation services could integrate cognitive interventions (cognitive rehabilitation, cognitive enhancement therapy, cognitive remediation) to explore the effect on neurocognitive function and employment outcomes. Further longitudinal research studies are needed, for both persons with disabilities and persons without disabilities, to elucidate the relationship between employment status and neurocognitive function.
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Vlad M, Raucher-Chéné D, Henry A, Kaladjian A. Functional outcome and social cognition in bipolar disorder: Is there a connection? Eur Psychiatry 2018; 52:116-125. [PMID: 29787961 DOI: 10.1016/j.eurpsy.2018.05.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Interest in social cognition in bipolar disorder (BD) has increased considerably over the past decade, with studies highlighting major impairments, especially in mental state reasoning, even during euthymia. A causal relationship between social cognition deficits and social functioning has already been established in individuals with schizophrenia, but there is still little information about links between social cognition and social functioning in BD. Our aim was therefore to review the relationship between functional outcome and social cognition in patients with BD. METHODS We conducted a systematic review of the literature. Relevant articles were identified through literature searches in the MEDLINE/PubMed, EBSCOHost and Google Scholar databases for the years 2000-2017, using the keywords bipolar, social cognition, theory of mind, mentalizing, emotion recognition, emotion processing, and functioning. A total of 20 studies met our inclusion/exclusion criteria. RESULTS We found that functioning was significantly correlated with three domains of social cognition (ToM, emotion processing, and attribution bias). Twelve of 13 studies reported a correlation with emotion processing, but a correlation with ToM was only found in three of the 11 studies that assessed it. Six studies found an effect of depressive symptoms on emotion processing and no significant association was found with manic symptomatology. CONCLUSIONS To the best of our knowledge, the present review is the first to specifically explore the relationship between social cognition and social functioning in patients with BD. This exploration is of interest, as it enhances current understanding of this disorder and, by so doing, should improve patient outcomes.
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Affiliation(s)
- Maria Vlad
- Psychiatry Department, University Hospital, Reims, France
| | - Delphine Raucher-Chéné
- Psychiatry Department, University Hospital, Reims, France; Cognition, Health & Society (C2S - EA 6291) Laboratory, University of Reims Champagne-Ardenne, Reims, France.
| | - Audrey Henry
- Psychiatry Department, University Hospital, Reims, France; Cognition, Health & Society (C2S - EA 6291) Laboratory, University of Reims Champagne-Ardenne, Reims, France
| | - Arthur Kaladjian
- Psychiatry Department, University Hospital, Reims, France; Cognition, Health & Society (C2S - EA 6291) Laboratory, University of Reims Champagne-Ardenne, Reims, France; Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
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Jiménez-López E, Sánchez-Morla EM, Aparicio AI, López-Villarreal A, Martínez-Vizcaíno V, Rodriguez-Jimenez R, Vieta E, Santos JL. Psychosocial functioning in patients with psychotic and non-psychotic bipolar I disorder. A comparative study with individuals with schizophrenia. J Affect Disord 2018; 229:177-185. [PMID: 29316520 DOI: 10.1016/j.jad.2017.12.094] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/21/2017] [Accepted: 12/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND More than 50% of individuals with bipolar disorder (BD) do not reach full psychosocial functioning, even during periods of euthymia. It has been suggested that history of psychotic symptoms is one of the factors which are associated with a worse functional outcome. The objective was to compare psychosocial functioning between patients with BD, with (BD-P), and without (BD-NP) a history of psychotic symptoms, and to examine whether the history of psychotic symptoms, or other clinical or neurocognitive variables predict psychosocial functioning. METHODS Psychosocial functioning and neurocognition were examined in 100 euthymic patients with bipolar I disorder (50 BD-P, and 50 BD-NP), compared to 50 stabilised patients with schizophrenia (SZ), and 51 healthy controls (HC). RESULTS 1) There were no differences between BD-P and BD-NP in the GAF-F score or in the FAST total score. 2) The two groups of patients with BD had better scores than SZ both in the GAF-F, and in all measures of the FAST, except for the subscale leisure time. 3) The neurocognitive composite index, verbal memory and subclinical depressive symptoms were the variables which explained a higher percentage of the variance of functional outcome. LIMITATIONS The cross-sectional design, and the relatively small sample size are the main limitations. CONCLUSIONS A history of psychotic symptoms has no relevant impact on the level of psychosocial functioning in BD. Neurocognitive dysfunction and subclinical depressive symptoms are the variables that best explain the functional impairment. These findings have important clinical implications.
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Affiliation(s)
- Estela Jiménez-López
- Department of Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Eva María Sánchez-Morla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, Research Institute of Hospital 12 de Octubre (imas 12), Madrid, Spain; CogPsy-Group, Universidad Complutense de Madrid (UCM), Spain
| | - Ana Isabel Aparicio
- Department of Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | | | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha. Health and Social Research Center, Cuenca, Spain; Universidad Autónoma de Chile. Facultad de Ciencias de la Salud, Talca, Chile
| | - Roberto Rodriguez-Jimenez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, Research Institute of Hospital 12 de Octubre (imas 12), Madrid, Spain; CogPsy-Group, Universidad Complutense de Madrid (UCM), Spain
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - José Luis Santos
- Department of Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
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Szmulewicz AG, Valerio MP, Lomastro J, Smith JM, Chiappe V, Martino DJ, Igoa A. Neurocognitive functioning in first-episode Bipolar Disorder: Relationship with functional status. J Affect Disord 2018; 228:97-100. [PMID: 29245093 DOI: 10.1016/j.jad.2017.12.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/18/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to assess if an association between neurocognitive deficits and psychosocial functioning exists in first-episode BD patients. METHODS Twenty-five euthymic first-episode BD patients and thirty-seven healthy controls were recruited. History of suicide attempts, psychiatric comorbidities, pharmacological exposure, and previous depressive episodes were investigated. Performances on neurocognitive domains (verbal memory, attention, processing speed, and executive functions) as well as a measure of psychosocial functioning were used as outcomes. RESULTS First-episode BD patients showed medium-to-large size deficits on measures of attention, processing speed, and executive functions. A significant association between verbal memory and psychosocial functioning at the moment of BD diagnosis was detected (beta coefficient -3.9, IC 95% -6.7 to -1.2, p < 0.01). CONCLUSIONS A relationship between cognitive performance at the moment of BD diagnosis and psychosocial functioning was detected. Possible therapeutic implications of this finding are discussed.
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Affiliation(s)
- Alejandro G Szmulewicz
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; Pharmacology Department, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
| | - Marina P Valerio
- National Council of Scientific and Technical Research (CONICET), Argentina; Psychiatric Emergencies Hospital Torcuato de Alvear, Buenos Aires, Argentina
| | - Julieta Lomastro
- Psychiatric Emergencies Hospital Torcuato de Alvear, Buenos Aires, Argentina
| | - José M Smith
- Psychiatric Department, Medical Education and Clinical Research Center Norberto Quirno, CEMIC, Buenos Aires, Argentina
| | - Virginia Chiappe
- Psychiatric Emergencies Hospital Torcuato de Alvear, Buenos Aires, Argentina
| | - Diego J Martino
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina; Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Ana Igoa
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina; Psychiatric Emergencies Hospital Torcuato de Alvear, Buenos Aires, Argentina
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Kavitha RR, Kamalam S, Rajkumar RP. Functional Ability of Clients with Bipolar Disorders in Tertiary Hospital, Puducherry. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2018; 6:21-28. [PMID: 29344532 PMCID: PMC5747569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Bipolar Disorder (BD) is a common long standing mental illness which is episodic in nature, affecting approximately1-2% of the world adult population. BD frequently affects the patient's life. Few studies have examined the functional impairment in patients with affective illness. The main objective of the current study was to assess specific domains of functioning as well as the overall functioning of the clients with BD. METHODS This cross-sectional study aimed to assess the level of function among the clients with BD in JIPMER Hospital, Puducherry during 2015-2016 and to identify the socio- demographic and clinical factors associated with the level of functioning. Ninety clients who fulfilled the inclusion criteria of having the diagnosis of BD were selected after written informed consents were obtained. After collecting basic demographic and clinical variables, function was assessed using 2 different sets of tools LIFE-RIFT and FAST. Data were analyzed using SPSS 20. Independent sample t-test, ANOVA and Pearson correlation were used as different statistical methods. A P value less than .05 was considered as statistically significant. RESULTS Based on the results, the functional level assessed using LIFE -RIFT showed a mean score of 26.7±4.7for the admitted clients and 21±12.5 for outpatients. The functional level of clients was significantly related to admission and remission status of the clients with a P=0.001 Similarly, FAST scale score for the admitted clients was 51±4.5, clients on remission had 24±12.1 with a P=0.001. CONCLUSION Results revealed that even during remission the clients with BD had functional impairment. More interventions are needed to improve the functional ability of clients with BD.
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Affiliation(s)
| | | | - Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, JIPMER, Puducherry
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Khan MM. Translational Significance of Selective Estrogen Receptor Modulators in Psychiatric Disorders. Int J Endocrinol 2018; 2018:9516592. [PMID: 30402099 PMCID: PMC6196929 DOI: 10.1155/2018/9516592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/10/2018] [Accepted: 09/02/2018] [Indexed: 12/11/2022] Open
Abstract
Accumulating data from various clinical trial studies suggests that adjuvant therapy with ovarian hormones (estrogens) could be effective in reducing cognitive deficit and psychopathological symptoms in women with psychiatric disorders. However, estrogen therapy poses serious limitations and health issues including feminization in men and increased risks of thromboembolism, hot flashes, breast hyperplasia, and endometrium hyperplasia when used for longer duration in older women (aged ≥ 60 years) or in women who have genetic predispositions. On the other hand, selective estrogen receptor modulators (SERMs), which may (or may not) carry some risks of hot flashes, thromboembolism, breast hyperplasia, and endometrial hyperplasia, are generally devoid of feminization effect. In clinical trial studies, adjuvant therapy with tamoxifen, a triphenylethylene class of SERM, has been found to reduce the frequency of manic episodes in patients with bipolar disorder, whereas addition of raloxifene, a benzothiophene class of SERM, to regular doses of antipsychotic drugs has been found to reduce cognitive deficit and psychological symptoms in men and women with schizophrenia, including women with treatment refractory psychosis. These outcomes together with potent neurocognitive, neuroprotective, and cardiometabolic properties suggest that SERMs could be the potential targets for designing effective and safer therapies for psychiatric disorders.
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Affiliation(s)
- Mohammad M. Khan
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Zawia, P.O. Box 16418, Az-Zawiyah, Libya
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