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Singh B, Yocum AK, Strawbridge R, Burdick KE, Millett CE, Peters AT, Sperry SH, Fico G, Vieta E, Verdolini N, Godin O, Leboyer M, Etain B, Tso IF, Coombes BJ, McInnis MG, Nierenberg AA, Young AH, Ashton MM, Berk M, Williams LJ, Keramatian K, Yatham LN, Overs BJ, Fullerton JM, Roberts G, Mitchell PB, Andreassen OA, Andreazza AC, Zandi PP, Pham D, Biernacka JM, Frye MA. Patterns of pharmacotherapy for bipolar disorder: A GBC survey. Bipolar Disord 2024; 26:22-32. [PMID: 37463846 PMCID: PMC10794603 DOI: 10.1111/bdi.13366] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVES To understand treatment practices for bipolar disorders (BD), this study leveraged the Global Bipolar Cohort collaborative network to investigate pharmacotherapeutic treatment patterns in multiple cohorts of well-characterized individuals with BD in North America, Europe, and Australia. METHODS Data on pharmacotherapy, demographics, diagnostic subtypes, and comorbidities were provided from each participating cohort. Individual site and regional pooled proportional meta-analyses with generalized linear mixed methods were conducted to identify prescription patterns. RESULTS This study included 10,351 individuals from North America (n = 3985), Europe (n = 3822), and Australia (n = 2544). Overall, participants were predominantly female (60%) with BD-I (60%; vs. BD-II = 33%). Cross-sectionally, mood-stabilizing anticonvulsants (44%), second-generation antipsychotics (42%), and antidepressants (38%) were the most prescribed medications. Lithium was prescribed in 29% of patients, primarily in the Australian (31%) and European (36%) cohorts. First-generation antipsychotics were prescribed in 24% of the European versus 1% in the North American cohort. Antidepressant prescription rates were higher in BD-II (47%) compared to BD-I (35%). Major limitations were significant differences among cohorts based on inclusion/exclusion criteria, data source, and time/year of enrollment into cohort. CONCLUSIONS Mood-stabilizing anticonvulsants, second-generation antipsychotics, and antidepressants were the most prescribed medications suggesting prescription patterns that are not necessarily guideline concordant. Significant differences exist in the prescription practices across different geographic regions, especially the underutilization of lithium in the North American cohorts and the higher utilization of first-generation antipsychotics in the European cohorts. There is a need to conduct future longitudinal studies to further explore these differences and their impact on outcomes, and to inform and implement evidence-based guidelines to help improve treatment practices in BD.
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Affiliation(s)
- Balwinder Singh
- Mayo Clinic, Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anastasia K Yocum
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katherine E Burdick
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Caitlin E Millett
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amy T Peters
- Dauten Family Center for Bipolar Treatment Innovation, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah H Sperry
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
- Local Health Unit Umbria 1, Department of Mental Health, Mental Health Center of Perugia, Perugia, Italy
| | - Ophelia Godin
- INSERM U955, IMRB, Translational Neuro-Psychiatry, Fondation FondaMental, Univ Paris Est Créteil, Créteil, France
- Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), APHP, Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Marion Leboyer
- INSERM U955, IMRB, Translational Neuro-Psychiatry, Fondation FondaMental, Univ Paris Est Créteil, Créteil, France
- Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), APHP, Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Bruno Etain
- Groupe Hospitalo-universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, AP-HP, Paris, France
| | - Ivy F Tso
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Brandon J Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Melanie M Ashton
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Michael Berk
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lana J Williams
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Kamyar Keramatian
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Bronwyn J Overs
- Neuroscience Research Australia, Randwick, Sydney, New South Wales, Australia
| | - Janice M Fullerton
- Neuroscience Research Australia, Randwick, Sydney, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gloria Roberts
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Philip B Mitchell
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ole A Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ana C Andreazza
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter P Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Daniel Pham
- The Milken Institute, Washington, District of Columbia, USA
| | - Joanna M Biernacka
- Mayo Clinic, Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Groupe Hospitalo-universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, AP-HP, Paris, France
| | - Mark A Frye
- Mayo Clinic, Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
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Migó M, Chou T, Widge AS, Peters AT, Ellard K, Dougherty DD, Deckersbach T. Neural correlates of learning accommodation and consolidation in generalised anxiety disorder. Acta Neuropsychiatr 2023; 35:218-225. [PMID: 35621086 DOI: 10.1017/neu.2022.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE. Anxiety can interfere with attention and working memory, which are components that affect learning. Statistical models have been designed to study learning, such as the Bayesian Learning Model, which takes into account prior possibilities and behaviours to determine how much of a new behaviour is determined by learning instead of chance. However, the neurobiological basis underlying how anxiety interferes with learning is not yet known. Accordingly, we aimed to use neuroimaging techniques and apply a Bayesian Learning Model to study learning in individuals with generalised anxiety disorder (GAD). METHODS. Participants were 25 controls and 14 individuals with GAD and comorbid disorders. During fMRI, participants completed a shape-button association learning and reversal task. Using a flexible factorial analysis in SPM, activation in the dorsolateral prefrontal cortex, basal ganglia, and hippocampus was compared between groups during first reversal. Beta values from the peak of these regions were extracted for all learning conditions and submitted to repeated measures analyses in SPSS. RESULTS. Individuals with GAD showed less activation in the basal ganglia and the hippocampus only in the first reversal compared with controls. This difference was not present in the initial learning and second reversal. CONCLUSION. Given that the basal ganglia is associated with initial learning, and the hippocampus with transfer of knowledge from short- to long-term memory, our results suggest that GAD may engage these regions to a lesser extent during early accommodation or consolidation of learning, but have no longer term effects in brain activation patterns during subsequent learning.
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Affiliation(s)
- Marta Migó
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tina Chou
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alik S Widge
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Amy T Peters
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristen Ellard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- University of Applied Sciences, Diploma Hochschule, Germany
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Sylvia LG, Tovey RE, Katz D, Boccagno C, Stromberg AR, Peters AT, Temes CM, Gold AK, Mow J, Puvanich N, Albury EA, Stephan NJ, Faria CM, Nierenberg AA, Kamali MP. A New Treatment Program: Focused Integrated Team-based Treatment Program for Bipolar Disorder (FITT-BD). J Psychiatr Pract 2023; 29:176-188. [PMID: 37185884 DOI: 10.1097/pra.0000000000000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Bipolar disorder (BD) is complicated by a dynamic, chronic course along with multiple comorbid psychiatric and medical conditions, making it challenging for clinicians to treat and patients to thrive. To efficiently manage the complexity of BD and help patients recover, we developed a Focused Integrated Team-based Treatment Program for Bipolar Disorder (FITT-BD). The purpose of this paper is to describe how we developed this clinic and the lessons we learned. METHODS We developed FITT-BD by integrating strategies from stepped care, collaborative care, and learning health care systems. We describe the rationale, details, and lessons learned in developing FITT-BD. RESULTS By integrating stepped care, collaborative care, and a learning health care system approach, FITT-BD aims to reduce barriers to care, leverage the expertise of a multidisciplinary treatment team, ensure patient-centeredness, and use assessments to inform and continuously improve outcomes in real time. We learned that there are challenges in the creation of a web-based application that tracks the treatment of patients within a network of hospitals. CONCLUSIONS The success of FITT-BD will be determined by the degree to which it can increase treatment access, improve treatment adherence, and help individuals with BD achieve their treatment goals. We expect that FITT-BD will improve outcomes in the context of ongoing clinical care. PUBLIC HEALTH SIGNIFICANCE The treatment of BD is challenging and complex. We propose a new treatment model for BD: FITT-BD. We expect that this program will be a patient-centered approach that improves outcomes in the context of ongoing clinical care for patients with BD.
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Sylvia LG, Gold AK, Rakhilin M, Amado S, Modrow MF, Albury EA, George N, Peters AT, Selvaggi CA, Horick N, Rabideau DJ, Dohse H, Tovey RE, Turner JA, Schopfer DW, Pletcher MJ, Katz D, Deckersbach T, Nierenberg AA. Healthy hearts healthy minds: A randomized trial of online interventions to improve physical activity. J Psychosom Res 2023; 164:111110. [PMID: 36525851 DOI: 10.1016/j.jpsychores.2022.111110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 11/27/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Depressed individuals are more likely to die from cardiovascular disease (CVD) than those without depression. People with CVD have higher rates of depression than those without and have higher mortality rates if they have comorbid depression. While physical activity (PA) improves both, few people engage in enough. We compared self-guided internet-based cognitive behavior therapy (CBT) + Fitbit or mindfulness-based cognitive therapy (MBCT) + Fitbit, with Fitbit only to increase daily steps for participants with depression who have low PA. METHODS Adult participants (N = 340) were recruited from two online patient-powered research networks and randomized to one of three study interventions for 8 weeks with an additional 8 weeks of follow-up. Using linear mixed effects models, we evaluated the effect of the intervention on average daily steps (NCT03373110). RESULTS Average daily steps increased 2.8 steps per day in MBCT+Fitbit, 2.9 steps/day in CBT + Fitbit, but decreased 8.2 steps/day in Fitbit Only. These changes were not statistically different between the MBCT+Fitbit and CBT + Fitbit groups, but were different from Fitbit Only across the initial 8-week period. Group differences were not maintained across follow-up. Exploratory analyses identified comorbid anxiety disorders, self-reported PA, and employment status as moderators. DISCUSSION Changes in daily steps over both 8- and 16-week periods-regardless of intervention group-were minimal. The results emphasize the limits of using self-guided web-based psychotherapy with an activity tracker to increase PA in participants with a history of depression and low PA.
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Affiliation(s)
- Louisa G Sylvia
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Alexandra K Gold
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Marina Rakhilin
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Selen Amado
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | | | - Evan A Albury
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Nevita George
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Amy T Peters
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | | | - Nora Horick
- Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Dustin J Rabideau
- Harvard Medical School, Boston, MA, USA; Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Heidi Dohse
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Roberta E Tovey
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Jon A Turner
- Department of Information, Operations, and Management Sciences, Stern School of Business, New York University, New York, New York, USA
| | | | - Mark J Pletcher
- University of California San Francisco, San Francisco, CA, USA
| | - Doug Katz
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | | | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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5
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Burdick KE, Millett CE, Yocum AK, Altimus CM, Andreassen OA, Aubin V, Belzeaux R, Berk M, Biernacka JM, Blumberg HP, Cleare AJ, Diaz-Byrd C, Dubertret C, Etain B, Eyler LT, Forester BP, Fullerton JM, Frye MA, Gard S, Godin O, Haffen E, Klaus F, Lagerberg TV, Leboyer M, Martinez-Aran A, McElroy S, Mitchell PB, Olie E, Olorunfemi P, Passerieux C, Peters AT, Pham DL, Polosan M, Potter JR, Sajatovic M, Samalin L, Schwan R, Shanahan M, Solé B, Strawbridge R, Stuart AL, Torres I, Ueland T, Vieta E, Williams LJ, Wrobel AL, Yatham LN, Young AH, Nierenberg AA, McInnis MG. Predictors of functional impairment in bipolar disorder: Results from 13 cohorts from seven countries by the global bipolar cohort collaborative. Bipolar Disord 2022; 24:709-719. [PMID: 35322518 PMCID: PMC9500115 DOI: 10.1111/bdi.13208] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/25/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Persistent functional impairment is common in bipolar disorder (BD) and is influenced by a number of demographic, clinical, and cognitive features. The goal of this project was to estimate and compare the influence of key factors on community function in multiple cohorts of well-characterized samples of individuals with BD. METHODS Thirteen cohorts from 7 countries included n = 5882 individuals with BD across multiple sites. The statistical approach consisted of a systematic uniform application of analyses across sites. Each site performed a logistic regression analysis with empirically derived "higher versus lower function" as the dependent variable and selected clinical and demographic variables as predictors. RESULTS We found high rates of functional impairment, ranging from 41 to 75%. Lower community functioning was associated with depressive symptoms in 10 of 12 of the cohorts that included this variable in the analysis. Lower levels of education, a greater number of prior mood episodes, the presence of a comorbid substance use disorder, and a greater total number of psychotropic medications were also associated with low functioning. CONCLUSIONS The bipolar clinical research community is poised to work together to characterize the multi-dimensional contributors to impairment and address the barriers that impede patients' complete recovery. We must also identify the core features which enable many to thrive and live successfully with BD. A large-scale, worldwide, prospective longitudinal study focused squarely on BD and its heterogeneous presentations will serve as a platform for discovery and promote major advances toward optimizing outcomes for every individual with this illness.
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Affiliation(s)
- Katherine E Burdick
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Caitlin E Millett
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Cara M Altimus
- The Milken Institute, Washington, District of Columbia, USA
| | - Ole A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Valerie Aubin
- Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Raoul Belzeaux
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Joanna M Biernacka
- Mayo Clinic Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Department of Quantitative Health Sciences, Mayo Clinic, Rocester, MN, USA
| | | | - Anthony J Cleare
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Caroline Dubertret
- Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - Bruno Etain
- Université de Paris, AP-HP, Groupe Hospitalo-universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS, Paris, France
| | - Lisa T Eyler
- University of California San Diego, La Jolla, CA, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Janice M Fullerton
- Neuroscience Research Australia, Sydney, Australia
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Mark A Frye
- Mayo Clinic Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sébastien Gard
- Pôle de Psychiatrie Générale et Universitaire, Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Ophelia Godin
- Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Fondation FondaMental, Créteil, France
- APHP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Emmanuel Haffen
- Clinical Psychiatry Department, Treatment-Resistant Depression Fondamental Expert Center, EA 481 Neurosciences, Bourgogne Franche Comté University, Besançon, France
| | - Federica Klaus
- University of California San Diego, La Jolla, CA, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, California, USA
| | - Trine Vik Lagerberg
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marion Leboyer
- Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Fondation FondaMental, Créteil, France
- APHP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Anabel Martinez-Aran
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Susan McElroy
- SLM Lindner Center of HOPE, Mason, Ohio, USA
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Philip B Mitchell
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Emilie Olie
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Phebe Olorunfemi
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christine Passerieux
- Service Hospitalo-Universitaire de psychiatrie d'adulte et d'addictologie, Centre Hospitalier de Versailles, INSERM UMR1018, DisAP-DevPsy-CESP, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Amy T Peters
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel L Pham
- The Milken Institute, Washington, District of Columbia, USA
| | - Mircea Polosan
- Univ. Grenoble Alpes, CHU de Grenoble et des Alpes, Grenoble Institut des Neurosciences (GIN) Inserm U 1216, Grenoble, France
| | - Julia R Potter
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Martha Sajatovic
- University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Ludovic Samalin
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal (IP), Clermont-Ferrand, France
| | - Raymund Schwan
- Université de Lorraine, Inserm U 1114, Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie CPN, Laxou, France
| | - Megan Shanahan
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brisa Solé
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Amanda L Stuart
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Ivan Torres
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Torrill Ueland
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Lana J Williams
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Barwon Health, Geelong, Victoria, Australia
| | - Anna L Wrobel
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andrew A Nierenberg
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Wong KS, Chou T, Peters AT, Ellard KK, Nierenberg AA, Dougherty DD, Deckersbach T. Convergence between behavioral, neural, and self-report measures of cognitive control: The Frontal Systems Behavior Scale in bipolar disorder. J Psychiatr Res 2022; 150:317-323. [PMID: 35447525 DOI: 10.1016/j.jpsychires.2022.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 03/01/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Abstract
The Frontal Systems Behavior Scale (FrSBe) is a self-report measure that assesses difficulties with cognitive and emotional control such as apathetic behavior, lack of inhibitory control, and executive dysfunction. Previous neuroimaging studies highlight the involvement of the anterior cingulate cortex (ACC), orbitofrontal cortex (OFC), and dorsolateral prefrontal cortex (DLPFC) in these processes. In this study, we investigated whether there was convergence across subjective and objective measures of apathy, disinhibition, and executive dysfunction. Specifically, we studied whether ACC, OFC, and DLPFC activation during a modified version of the Multi-Source Interference Task (MSIT), is associated with FrSBe apathy, disinhibition, and executive dysfunction scores, in healthy controls (HC) and individuals with Bipolar Disorder (BD), who commonly exhibit difficulties in these domains. Individuals with BD (n = 31) and HCs (n = 31) with no current or past psychiatric illness completed the FrSBe and the MSIT during fMRI scanning. We investigated task-specific changes in the ACC, DLPFC, and OFC and their correlations with FrSBe apathy, disinhibition, and executive dysfunction subscale scores, respectively. Individuals with BD and the HC group demonstrated greater ACC, DLPFC, and OFC activation during MSIT interference conditions compared with non-interference conditions. Furthermore, there was a significant negative correlation between OFC activation and disinhibition scores, which remained significant after accounting for medication load. Together, these results demonstrate the FrSBe disinhibition subscale, in particular, can be a self-report measure that converges with behavioral and neural markers of disinhibition in BD.
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Affiliation(s)
- Karianne Sretavan Wong
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Tina Chou
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Amy T Peters
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA; Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Kristen K Ellard
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA; Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Darin D Dougherty
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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7
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Peters AT, Millett CE, Harder J, Potter J, Fichorova R, Nierenberg AA, Burdick KE. C-reactive protein and affective inhibition in bipolar disorder. J Affect Disord 2022; 306:39-46. [PMID: 35248663 PMCID: PMC9639620 DOI: 10.1016/j.jad.2022.02.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/14/2022] [Accepted: 02/27/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Individuals with bipolar disorder (BD) experience cognitive and affective processing deficits that often persist beyond the remission of acute mood symptoms. One possible biological mechanism for these deficits involves the potential effects of chronic low-grade peripheral inflammation on brain function. Peripheral inflammation has been associated with reduced executive functioning and memory performance, as well as altered reward processing in BD, but whether it is also implicated in cognitive-affective processing remains unknown. METHOD Peripheral inflammation was measured by serum C-reactive protein (CRP) in 119 adults with BD I or II, age 18-65. All participants completed the Affective Go/No-Go Task, a measure of cognitive-emotional processing. Correlations of CRP with discrimination of and response times to Negative, Positive, and Neutral words were performed before and after adjustment for severity of residual depressive symptoms and other demographic and clinical characteristics associated with inflammation. RESULTS Increased CRP was significantly associated with reduced negative target discriminability, which was also significantly reduced compared to positive and neutral target conditions. Additionally, greater CRP was associated with faster response times for both negative hits and commissions, as well as positive commissions. CONCLUSIONS This study adds to existing research demonstrating associations between inflammation and cognition or reward sensitivity and motivation separately in BD, by raising the possibility that inflammation is also implicated in the integration of cognitive-affective processing. Assessment of these associations over time is warranted to determine involvement of inflammation and cognitive-emotional processing in course of illness and identify critical periods for possible modulation of inflammation.
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Affiliation(s)
- Amy T Peters
- Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Caitlin E Millett
- Harvard Medical School, Boston, MA, United States of America; Brigham and Women's Hospital, Boston, MA, United States of America
| | - Jessica Harder
- Harvard Medical School, Boston, MA, United States of America; Brigham and Women's Hospital, Boston, MA, United States of America
| | - Julia Potter
- Harvard Medical School, Boston, MA, United States of America
| | - Raina Fichorova
- Harvard Medical School, Boston, MA, United States of America; Brigham and Women's Hospital, Boston, MA, United States of America
| | - Andrew A Nierenberg
- Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Katherine E Burdick
- Harvard Medical School, Boston, MA, United States of America; Brigham and Women's Hospital, Boston, MA, United States of America.
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8
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Dougherty DD, Peters AT, Grant JE, Peris TS, Ricketts EJ, Migó M, Chou T, O'Neill J, Stein DJ, Lochner C, Keuthen N, Piacentini J, Deckersbach T. Neural Basis of Associative Learning in Trichotillomania and Skin-Picking Disorder. Behav Brain Res 2022; 425:113801. [PMID: 35183617 PMCID: PMC8940679 DOI: 10.1016/j.bbr.2022.113801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 11/18/2022]
Abstract
Disorders such as Trichotillomania (TTM) and skin-picking disorder (SPD) are associated with reduced flexibility and increased internally focused attention. While the basal ganglia have been hypothesized to play a key role, the mechanisms underlying learning and flexible accommodation of new information is unclear. Using a Bayesian Learning Model, we evaluated the neural basis of learning and accommodation in individuals with TTM and/or SPD. Participants were 127 individuals with TTM and/or SPD (TTM/SPD) recruited from three sites (age 18-57, 84% female) and 26 healthy controls (HC). During fMRI, participants completed a shape-button associative learning and reversal fMRI task. Above-threshold clusters were identified where the Initial Learning-Reversals BOLD activation contrast differed significantly (p < .05 FDR-corrected) between the two groups. A priori, effects were anticipated in predefined ROIs in bilateral basal ganglia, with exploratory analyses in the hippocampus, dorsolateral prefrontal cortex (dlPFC), and dorsal anterior cingulate cortex (dACC). Relative to HC, individuals with TTM/SPD demonstrated reduced activation during initial learning compared to reversal learning in the right basal ganglia. Similarly, individuals with TTM/SPD demonstrated reduced activation during initial learning compared to reversal learning in several clusters in the dlPFC and dACC compared to HC. Individuals with TTM/SPD may form or reform visual stimulus-motor response associations through different brain mechanisms than healthy controls. The former exhibit altered activation within the basal ganglia, dlPFC, and dACC during an associative learning task compared to controls, reflecting reduced frontal-subcortical activation during initial learning. Future work should determine whether these neural deficits may be restored with targeted treatment.
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Affiliation(s)
- Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, MA, United States.
| | - Amy T Peters
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, MA, United States
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States
| | - Tara S Peris
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Marta Migó
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, MA, United States
| | - Tina Chou
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, MA, United States
| | - Joseph O'Neill
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Dan J Stein
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Christine Lochner
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Nancy Keuthen
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, MA, United States
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Thilo Deckersbach
- Psychology Program, University of Applied Sciences Europe, Berlin, Germany
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9
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Gold AK, Albury EA, Stromberg A, French NJ, Peters AT, Katz D, Nierenberg AA, Sylvia LG. Cigarette smokers with a mood symptom history enrolled in a physical activity trial. Bipolar Disord 2021; 23:842-843. [PMID: 34606143 PMCID: PMC8692438 DOI: 10.1111/bdi.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 08/31/2021] [Accepted: 09/25/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Alexandra K. Gold
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Evan A. Albury
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Audrey Stromberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Noah J. French
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Amy T. Peters
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Douglas Katz
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Andrew A. Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Louisa G. Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
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10
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Parzuchowski AS, Peters AT, Johnson-Sasso CP, Rydland KJ, Feinglass JM. County-level association of COVID-19 mortality with 2020 United States presidential voting. Public Health 2021; 198:114-117. [PMID: 34416573 PMCID: PMC9451615 DOI: 10.1016/j.puhe.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 11/15/2022]
Abstract
Objective The objective of this study was to assess the association between United States county-level COVID-19 mortality and changes in presidential voting between 2016 and 2020. Study design The study design is a county-level ecological study. Methods We analysed county-level population-weighted differences in partisan vote change, voter turnout and sociodemographic and health status characteristics across pre-election COVID-19 mortality quartiles. We estimated a population-weighted linear regression of the 2020–2016 Democratic vote change testing the significance of differences between quartiles of COVID-19 mortality, controlling for other county characteristics. Results The overall change in the 2020–2016 Democratic vote was +2.9% but ranged from a +4.3% increase in the lowest mortality quartile counties to +0.9% in the highest mortality quartile counties. Change in turnout ranged from +9.1% in the lowest mortality counties to only +6.2% in highest mortality counties. In regression estimates, the highest mortality quartile was associated with a −1.26% change in the Democratic 2020–2016 vote compared with the lowest quartile (P < 0.001). Conclusions Higher county-level COVID-19 mortality was associated with smaller increases in Democratic vote share in 2020 compared with 2016. Possible explanations to be explored in future research could include fear of in-person voting in heavily Democratic, high-mortality counties, fear of the economic effects of perceived Democratic support for tighter lockdowns and stay-at-home orders and general exhaustion that lowered political participation in hard-hit counties.
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Affiliation(s)
- A S Parzuchowski
- Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair St., Arkes Suite 2330, Chicago, IL, 60611, USA.
| | - A T Peters
- Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair St., Arkes Suite 2330, Chicago, IL, 60611, USA
| | - C P Johnson-Sasso
- Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair St., Arkes Suite 2330, Chicago, IL, 60611, USA
| | - K J Rydland
- Library Services, Northwestern University, 1970 Campus Drive, Evanston, IL, 60208, USA
| | - J M Feinglass
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Dr. 10th Floor, Chicago, IL, 60611, USA
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11
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Bessette KL, Karstens AJ, Crane NA, Peters AT, Stange JP, Elverman KH, Morimoto SS, Weisenbach SL, Langenecker SA. A Lifespan Model of Interference Resolution and Inhibitory Control: Risk for Depression and Changes with Illness Progression. Neuropsychol Rev 2020; 30:477-498. [PMID: 31942706 PMCID: PMC7363517 DOI: 10.1007/s11065-019-09424-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 12/06/2019] [Indexed: 12/20/2022]
Abstract
The cognitive processes involved in inhibitory control accuracy (IC) and interference resolution speed (IR) or broadly - inhibition - are discussed in this review, and both are described within the context of a lifespan model of mood disorders. Inhibitory control (IC) is a binary outcome (success or no for response selection and inhibition of unwanted responses) for any given event that is influenced to an extent by IR. IR refers to the process of inhibition, which can be manipulated by task design in earlier and later stages through use of distractors and timing, and manipulation of individual differences in response proclivity. We describe the development of these two processes across the lifespan, noting factors that influence this development (e.g., environment, adversity and stress) as well as inherent difficulties in assessing IC/IR prior to adulthood (e.g., cross-informant reports). We use mood disorders as an illustrative example of how this multidimensional construct can be informative to state, trait, vulnerability and neuroprogression of disease. We present aggregated data across numerous studies and methodologies to examine the lifelong development and degradation of this subconstruct of executive function, particularly in mood disorders. We highlight the challenges in identifying and measuring IC/IR in late life, including specificity to complex, comorbid disease processes. Finally, we discuss some potential avenues for treatment and accommodation of these difficulties across the lifespan, including newer treatments using cognitive remediation training and neuromodulation.
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Affiliation(s)
- Katie L Bessette
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL, USA
- Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Aimee J Karstens
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Natania A Crane
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Amy T Peters
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Jonathan P Stange
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Kathleen H Elverman
- Neuropsychology Center, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - Sarah Shizuko Morimoto
- Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Sara L Weisenbach
- Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake City, UT, 84108, USA
- Mental Health Services, VA Salt Lake City, Salt Lake City, UT, USA
| | - Scott A Langenecker
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL, USA.
- Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake City, UT, 84108, USA.
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12
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Tseng CEJ, Gilbert TM, Catanese MC, Hightower BG, Peters AT, Parmar AJ, Kim M, Wang C, Roffman JL, Brown HE, Perlis RH, Zürcher NR, Hooker JM. In vivo human brain expression of histone deacetylases in bipolar disorder. Transl Psychiatry 2020; 10:224. [PMID: 32641695 PMCID: PMC7343804 DOI: 10.1038/s41398-020-00911-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 02/08/2023] Open
Abstract
The etiology of bipolar disorder (BD) is unknown and the neurobiological underpinnings are not fully understood. Both genetic and environmental factors contribute to the risk of BD, which may be linked through epigenetic mechanisms, including those regulated by histone deacetylase (HDAC) enzymes. This study measures in vivo HDAC expression in individuals with BD for the first time using the HDAC-specific radiotracer [11C]Martinostat. Eleven participants with BD and 11 age- and sex-matched control participants (CON) completed a simultaneous magnetic resonance - positron emission tomography (MR-PET) scan with [11C]Martinostat. Lower [11C]Martinostat uptake was found in the right amygdala of BD compared to CON. We assessed uptake in the dorsolateral prefrontal cortex (DLPFC) to compare previous findings of lower uptake in the DLPFC in schizophrenia and found no group differences in BD. Exploratory whole-brain voxelwise analysis showed lower [11C]Martinostat uptake in the bilateral thalamus, orbitofrontal cortex, right hippocampus, and right amygdala in BD compared to CON. Furthermore, regional [11C]Martinostat uptake was associated with emotion regulation in BD in fronto-limbic areas, which aligns with findings from previous structural, functional, and molecular neuroimaging studies in BD. Regional [11C]Martinostat uptake was associated with attention in BD in fronto-parietal and temporal regions. These findings indicate a potential role of HDACs in BD pathophysiology. In particular, HDAC expression levels may modulate attention and emotion regulation, which represent two core clinical features of BD.
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Affiliation(s)
- Chieh-En J. Tseng
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129 USA
| | - Tonya M. Gilbert
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129 USA
| | - Mary C. Catanese
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129 USA
| | - Baileigh G. Hightower
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129 USA
| | - Amy T. Peters
- grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Anjali J. Parmar
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129 USA
| | - Minhae Kim
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129 USA
| | - Changning Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129 USA
| | - Joshua L. Roffman
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129 USA ,grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Hannah E. Brown
- grid.475010.70000 0004 0367 5222Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118 USA
| | - Roy H. Perlis
- grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Nicole R. Zürcher
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129 USA
| | - Jacob M. Hooker
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129 USA
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13
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Bessette KL, Jacobs RH, Heleniak C, Peters AT, Welsh RC, Watkins ER, Langenecker SA. Malleability of rumination: An exploratory model of CBT-based plasticity and long-term reduced risk for depressive relapse among youth from a pilot randomized clinical trial. PLoS One 2020; 15:e0233539. [PMID: 32555582 PMCID: PMC7299403 DOI: 10.1371/journal.pone.0233539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 05/06/2020] [Indexed: 11/29/2022] Open
Abstract
CLINICAL TRIALS REGISTRATION NCT01905267, https://clinicaltrials.gov/ct2/show/NCT01905267.
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Affiliation(s)
- Katie L. Bessette
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States of America
| | - Rachel H. Jacobs
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Charlotte Heleniak
- Department of Psychology, Columbia University, New York City, NY, United States of America
| | - Amy T. Peters
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Robert C. Welsh
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States of America
| | | | - Scott A. Langenecker
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States of America
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14
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Feldhaus CG, Jacobs RH, Watkins ER, Peters AT, Bessette K, Langenecker SA. Rumination-focused cognitive behavioral therapy decreases anxiety and increases behavioral activation among remitted adolescents. J Child Fam Stud 2020; 29:1982-1991. [PMID: 33737799 PMCID: PMC7968389 DOI: 10.1007/s10826-020-01711-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Rumination involves a repetitive, passive focus on one's thoughts and feelings and has been hypothesized as a mechanism contributing to multiple psychopathologies. The current investigation explores secondary outcomes from a pilot study to examine whether rumination-focused cognitive behavior therapy (RFCBT) alleviates symptoms of anxiety, increases behavioral activation, or increases global functioning among adolescents with a history of Major Depressive Disorder (MDD). METHODS Thirty-three adolescents were randomized to receive either RFCBT (n = 17) or assessment only (AO; n = 16) over the course of eight weeks. Mixed effects regression models were used to conduct intent-to-treat (ITT) analyses. RESULTS The quadratic interaction for group-by-time-by-time was significant for anxiety. Adolescents in the RFCBT group experienced a significant decrease in anxiety across the first six weeks of intervention (F = 7.01, df = 108.49, p = .009). The group-by-time interaction was significant for the behavioral activation outcome (F = 4.28, df = 25.60, p = .049) with youth randomized to RFCBT demonstrating increasing activation compared to AO. Global functioning did not significantly differ between groups (F = .40, df = 1, p > .05). CONCLUSIONS Preliminary evidence suggests that RFCBT may hold promise as an intervention that alleviates both depressive and anxiety symptoms when comorbid.
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Affiliation(s)
- Claudia G Feldhaus
- University of Illinois at Chicago, 1747 W. Roosevelt Rd., Chicago, IL 60608
| | - Rachel H Jacobs
- University of Illinois at Chicago, 1747 W. Roosevelt Rd., Chicago, IL 60608
| | - Edward R Watkins
- University of Exeter, Exeter, UK, Stocker Rd, Exeter EX4 4PY, United Kingdom
| | - Amy T Peters
- University of Illinois at Chicago, 1747 W. Roosevelt Rd., Chicago, IL 60608
| | - Katie Bessette
- University of Illinois at Chicago, 1747 W. Roosevelt Rd., Chicago, IL 60608
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15
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Testo AA, Felicione JM, Ellard KK, Peters AT, Chou T, Gosai A, Hahn E, Shea C, Sylvia L, Nierenberg AA, Dougherty DD, Deckersbach T. Neural correlates of the ADHD self-report scale. J Affect Disord 2020; 263:141-146. [PMID: 31818770 DOI: 10.1016/j.jad.2019.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/21/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The ADHD Self Report Scale is a self-report measure that assesses attentional problems. We sought to validate the ASRS by establishing neural correlates using functional magnetic imaging in healthy controls and individuals with bipolar disorder (BD), who commonly exhibit attentional problems. METHODS ASRS questionnaires and functional MRI data in conjunction with the Multi-source Interference Task (MSIT) were collected from 36 healthy control and 36 BD participants. We investigated task specific changes in the dorsal anterior cingulate cortex (dACC, Brodmann area 32) and their correlations with ASRS subscale scores, inattention and hyperactivity, in both cohorts. RESULTS As hypothesized, the dACC showed significant increases in BOLD activation between the interference and noninterference conditions. For the ASRS scale as well as its Inattention and Hyperactivity subscales, there was a significant negative correlation with the dACC BOLD for the whole group. CONCLUSIONS The ASRS is sensitive to attentional difficulties in BD, suggesting that it is a valid tool for assessing attentional difficulties in patients with BD.
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Affiliation(s)
- Abigail A Testo
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Julia M Felicione
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Kristen K Ellard
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Amy T Peters
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Tina Chou
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Aishwarya Gosai
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Emily Hahn
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Conor Shea
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Louisa Sylvia
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States.
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16
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Abstract
BACKGROUND Early-life adversity (ELA) is a risk factor for internalizing psychopathology (IP). ELA is also linked to alterations in neural phenotypes of emotion processing and maladaptive emotion regulatory strategies, such as ruminative brooding, in adulthood. We therefore expected that ELA would predict cortical brain activation to emotional faces in transdiagnostic IP and in turn, mediate the extent of rumination amongst patients with IPs and ELA (IP + ELA). METHOD One hundred and thirty-two individuals, including 102 treatment-seeking adults with heterogeneous IPs and 30 healthy controls (HCs) performed an Emotional Face-Matching Task during functional magnetic resonance imaging. Whole-brain analyses compared HC (n = 30), IP (n = 52), and IP + ELA (n = 50) neural responses to emotional (angry, fearful, happy, and sad) faces v. shapes, controlling for depression and anxiety symptoms. Parameter estimates of activation were extracted for significant between-group differences and tested as a mediator of ruminative brooding in IP + ELA. RESULTS IP + ELA demonstrated increased activation in the superior frontal gyrus and anterior cingulate cortex (fear), superior parietal lobule, precuneus, posterior cingulate, and inferior temporal gyrus (fear only), and cuneus (fear and angry). These regions were preferentially correlated with ruminative brooding in IP + ELA, many of which mediated the link between IP + ELA and ruminative brooding. CONCLUSIONS Results provide evidence that ELA history amongst IP patients augments engagement of brain regions involved in emotion processing, above and beyond what is accounted for by current symptoms. Though longitudinal designs are needed, alterations in the neural correlates of maladaptive processing of socio-emotional information may be a common pathway by which ELA poses risk for psychopathology.
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Affiliation(s)
- Amy T Peters
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
- Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Katie L Burkhouse
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA
| | - Kerry L Kinney
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA
| | - K. Luan Phan
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA
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17
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Peters AT, Ren X, Bessette KL, Goldstein BI, West AE, Langenecker SA, Pandey GN. Interplay between pro-inflammatory cytokines, childhood trauma, and executive function in depressed adolescents. J Psychiatr Res 2019; 114:1-10. [PMID: 30978658 DOI: 10.1016/j.jpsychires.2019.03.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/04/2019] [Accepted: 03/29/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pro-inflammatory cytokines have been linked to depression, early childhood trauma, and impairment in executive function in adults. Whether these links are present during adolescence, a time when vulnerability to depression is heightened, a point more proximal to childhood trauma, and a critical period of brain development, is not well understood. METHOD Serum levels of interleukin (IL)-6, IL-1β, and tumor necrosis factor alpha (TNF-α) were measured in 70 adolescents aged 12-17, including 40 with a DSM-IV depressive disorder (DEP), a sub-set (n = 22) of whom reported a history of childhood trauma (DEP-T), and 30 healthy controls (HCs). Participants completed performance-based (Parametric Go/No-Go Task) and observer-rated (Behavior Rating Inventory of Executive Function) measures of executive function. Procedures were conducted at a subspecialty clinic (Dec 2015-June 2017). RESULTS IL-6 was elevated in DEP and DEP-T adolescents compared to controls (p = .014) and TNF-α was elevated in DEP participants only (p = .040) compared to controls, whereas no group differences were found in IL-1β (p = .829). Additionally, DEP-T participants demonstrated relative deficits in performance-based (p = .044) and observer-rated inhibitory control (p = .049) compared to controls. Across the whole sample, TNF-α was associated with performance-based (r = -0.25, p = .039) and observer-rated (r = 0.32, p = .009) inhibitory control deficits. In subgroup analyses, TNF-α was associated with increased observer-rated inhibitory deficits in DEP, and at the trend level, with reduced inhibitory control performance in DEP-T. CONCLUSIONS The current results suggest that inflammation may be a marker of disease processes in adolescent depression. Though longitudinal studies are needed, depressed adolescents with childhood trauma exposure appear to constitute a uniquely vulnerable group in terms of objective risk for executive dysfunction. Immune dysregulation may partly contribute to this risk.
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Affiliation(s)
- Amy T Peters
- Massachusetts General Hospital, Department of Psychiatry, USA; Harvard Medical School, Department of Psychiatry, USA.
| | - Xinguo Ren
- University of Illinois at Chicago, Department of Psychiatry, USA
| | - Katie L Bessette
- University of Illinois at Chicago, Department of Psychiatry, USA; University of Utah, Department of Psychiatry, USA
| | - Benjamin I Goldstein
- Sunnybrook Health Sciences Centre, Department of Psychiatry, Canada; University of Toronto, Department of Pharmacology and Toxicology & Department of Psychiatry, Canada
| | - Amy E West
- Keck School of Medicine of the University of Southern California, Department of Pediatrics, USA
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18
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Peters AT, Jenkins LM, Stange JP, Bessette KL, Skerrett KA, Kling LR, Welsh RC, Milad MR, Phan KL, Langenecker SA. Pre-scan cortisol is differentially associated with enhanced connectivity to the cognitive control network in young adults with a history of depression. Psychoneuroendocrinology 2019; 104:219-227. [PMID: 30889471 PMCID: PMC6488402 DOI: 10.1016/j.psyneuen.2019.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/23/2019] [Accepted: 03/11/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND We have previously demonstrated that pre-scan salivary cortisol is associated with attentuated frontal-subcortical brain activation during emotion processesing and semantic list-learning paradigms in depressed subjects. Additionally, altered functional connectivity is observed after remission of acute depression symptoms (rMDD). It is unknown whether cortisol also predicts altered functional connectivity during remission. METHODS Participants were 47 healthy controls (HC) and 73 rMDD, 18-30 years old who provided salivary cortisol samples before and after undergoing resting-state fMRI. We tested whether salivary cortisol by diagnosis interactions were associated with seed-based resting connectivity of the default mode (DMN) and salience and emotion (SN) networks using whole-brain, cluster-level corrected (p < .01) regression in SPM8. RESULTS Pre-scan cortisol predicted decreased (HC) and increased (rMDD) cross-network connectivity to the dorsal anterior cingulate, dorso-medial and lateral- prefrontal cortex, brain stem and cerebellum (all seeds) and precuneus (DMN seeds). By and large, pre/post-scan cortisol change predicted the same pattern of findings. In network analyses, cortisol predominantly predicted enhanced cross-network connectivity to cognitive control network regions in rMDD. CONCLUSIONS The association of cortisol with connections of default and salience networks to executive brain networks differs between individuals with and without a history of depression. Further investigation is needed to better understand the role of cortisol and related stress hormones as a potential primary and interactive driver of network coherence in depression.
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Affiliation(s)
- Amy T. Peters
- Massachusetts General Hospital, Department of Psychiatry
| | - Lisanne M. Jenkins
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences
| | | | - Katie L. Bessette
- University of Illinois at Chicago, Department of Psychiatry,University of Utah, Department of Psychiatry
| | | | - Leah R. Kling
- University of Illinois at Chicago, Department of Psychiatry
| | | | | | - K. Luan Phan
- University of Illinois at Chicago, Department of Psychiatry,University of Illinois-Chicago, Department of Anatomy and Cell Biology & Graduate Program in Neuroscience
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19
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Ellard KK, Gosai AK, Felicione JM, Peters AT, Shea CV, Sylvia LG, Nierenberg AA, Widge AS, Dougherty DD, Deckersbach T. Deficits in frontoparietal activation and anterior insula functional connectivity during regulation of cognitive-affective interference in bipolar disorder. Bipolar Disord 2019; 21:244-258. [PMID: 30565822 PMCID: PMC6504612 DOI: 10.1111/bdi.12709] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 07/17/2018] [Accepted: 09/30/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Bipolar disorders (BD) are characterized by emotion and cognitive dysregulation. Mapping deficits in the neurocircuitry of cognitive-affective regulation allows for potential identification of intervention targets. This study used functional MRI data in BD patients and healthy controls during performance on a task requiring cognitive and inhibitory control superimposed on affective images, assessing cognitive and affective interference. METHODS Functional MRI data were collected from 39 BD patients and 36 healthy controls during performance on the Multi-Source Interference Task overlaid on images from the International Affective Picture System (MSIT-IAPS). Analyses examined patterns of activation in a priori regions implicated in cognitive and emotional processing. Functional connectivity to the anterior insula during task performance was also examined, given this region's role in emotion-cognition integration. RESULTS BD patients showed significantly less activation during cognitive interference trials in inferior parietal lobule, dorsomedial prefrontal cortex, anterior insula, mid-cingulate, and ventrolateral prefrontal cortex regardless of affective valence. BD patients showed deviations in functional connectivity with anterior insula in regions of the default mode and frontoparietal control networks during negatively valenced cognitive interference trials. CONCLUSIONS Our findings show disruptions in cognitive regulation and inhibitory control in BD patients in the presence of irrelevant affective distractors. Results of this study suggest one pathway to dysregulation in BD is through inefficient integration of affective and cognitive information, and highlight the importance of developing interventions that target emotion-cognition integration in BD.
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Affiliation(s)
- Kristen K Ellard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aishwarya K Gosai
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julia M Felicione
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amy T Peters
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Conor V Shea
- Department of Neuroscience, Boston University, Boston, Massachusetts
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alik S Widge
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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20
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Langenecker SA, Klumpp H, Peters AT, Crane NA, DelDonno SR, Bessette KL, Ajilore O, Leow A, Shankman SA, Walker SJ, Ransom MT, Hsu DT, Phan KL, Zubieta JK, Mickey BJ, Stange JP. Multidimensional imaging techniques for prediction of treatment response in major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2019; 91:38-48. [PMID: 30009871 PMCID: PMC6556149 DOI: 10.1016/j.pnpbp.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/31/2018] [Accepted: 07/03/2018] [Indexed: 12/21/2022]
Abstract
A large number of studies have attempted to use neuroimaging tools to aid in treatment prediction models for major depressive disorder (MDD). Most such studies have reported on only one dimension of function and prediction at a time. In this study, we used three different tasks across domains of function (emotion processing, reward anticipation, and cognitive control, plus resting state connectivity completed prior to start of medication to predict treatment response in 13-36 adults with MDD. For each experiment, adults with MDD were prescribed only label duloxetine (all experiments), whereas another subset were prescribed escitalopram. We used a KeyNet (both Task derived masks and Key intrinsic Network derived masks) approach to targeting brain systems in a specific match to tasks. The most robust predictors were (Dichter et al., 2010) positive response to anger and (Gong et al., 2011) negative response to fear within relevant anger and fear TaskNets and Salience and Emotion KeyNet (Langenecker et al., 2018) cognitive control (correct rejections) within Inhibition TaskNet (negative) and Cognitive Control KeyNet (positive). Resting state analyses were most robust for Cognitive control Network (positive) and Salience and Emotion Network (negative). Results differed by whether an -fwhm or -acf (more conservative) adjustment for multiple comparisons was used. Together, these results implicate the importance of future studies with larger sample sizes, multidimensional predictive models, and the importance of using empirically derived masks for search areas.
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Affiliation(s)
| | - Heide Klumpp
- University of Illinois at Chicago,University of Michigan
| | | | | | | | | | | | | | | | - Sara J. Walker
- University of Michigan,University of Oregon Health Sciences
| | | | | | - K. Luan Phan
- University of Illinois at Chicago,University of Michigan
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21
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Hymen EA, Rao JA, Peters AT, Jenkins LM, Weisenbach SL, Kassel MT, Farah LB, Skerrett KA, Haywood JT, Angers K, Pester B, Baker A, Zubieta JK, Ryan KA, Langenecker SA. Memory differences by sex, but not by previous diagnosis of major depressive disorder. Appl Neuropsychol Adult 2019; 27:134-142. [PMID: 30811264 DOI: 10.1080/23279095.2018.1496334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Memory difficulties are consistently reported in Major Depressive Disorder (MDD). Nonetheless, it has not been thoroughly investigated as to whether these deficits persist during remission from MDD. A group of 32 healthy young adults with no history of a mood disorder (Mage = 20.8, SD = 2.1) and 62 remitted depressed young adults (Mage = 21.1, SD = 1.9) completed a neuropsychological battery. The test battery included two measures of nonverbal memory, two measures of verbal memory, and a measure of performance validity. The testing session was repeated three to six weeks later to determine performance stability. No differences were found between healthy controls and remitted depressed patients in either memory domain (all ps > .05) and improvement in performance was exhibited over time for both groups (p = 0.004). Potential practice effects are examined. We found a stronger performance for women than men (p = 0.003), particularly for the Semantic List Learning Task (SLLT) (p = .047). Verbal and nonverbal memory and effort may not be impacted in those who are in a remitted state of MDD, early in the course of the illness. Women demonstrated auditory memory superiority over men, similar to prior research.
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Affiliation(s)
- Erica A Hymen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Julia A Rao
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Amy T Peters
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lisanne M Jenkins
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sara L Weisenbach
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA.,Jesse Brown Veterans Administration Hospital Research & Development Program, Chicago, Illinois, USA
| | - Michelle T Kassel
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Laura B Farah
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Kristy A Skerrett
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Joshua T Haywood
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kaley Angers
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Bethany Pester
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Amanda Baker
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Jon-Kar Zubieta
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Kelly A Ryan
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Scott A Langenecker
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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22
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Burkhouse KL, Stange JP, Jacobs RH, Bhaumik R, Bessette KL, Peters AT, Crane NA, Kreutzer KA, Fitzgerald K, Monk C, Welsh RC, Phan KL, Langenecker SA. Developmental changes in resting-state functional networks among individuals with and without internalizing psychopathologies. Depress Anxiety 2019; 36:141-152. [PMID: 30516853 PMCID: PMC6519436 DOI: 10.1002/da.22864] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 10/31/2018] [Accepted: 11/06/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Three well-established intrinsic connectivity networks (ICNs) involved in cognitive-affective processing include the cognitive control network (CCN), default mode network (DMN), and salience and emotional network (SEN). Despite recent advances in understanding developmental changes in these ICNs, the majority of research has focused on single seeds or networks in isolation with limited age ranges. Additionally, although internalizing psychopathologies (IPs), such as anxiety and depression, are often characterized by maladaptive cognitive-affective processing styles, it is not clear how IP history influences age-related changes in brain networks. METHOD The current study aimed to characterize the normative development of the CCN, DMN, and SEN across a large age-span (7-29 year olds) of typically developing (TD) individuals (n = 97). We also explore how age may impact differences in network connectivity between TD individuals and patients with IPs (n = 136). RESULTS Among TD individuals, DMN and CCN connectivity strengthened with age, whereas connectivity between the SEN and ventromedial prefrontal cortex weakened across development. When exploring group (IP vs. TD) differences, the IP group was characterized by greater connectivity between the CCN and cerebellum and between the SEN and caudate from childhood to early adulthood, relative to TD individuals. In addition, patients with IPs, versus TD individuals, exhibited reduced connectivity between the SEN and medial frontal gyrus from adolescence to adulthood. CONCLUSIONS The current findings shed light on differential age-related changes in brain network patterns among psychiatrically free, TD individuals and those with internalizing disorders, and may provide plausible targets for novel mechanism-based treatments that differ based on developmental stage.
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Affiliation(s)
| | | | | | - Runa Bhaumik
- University of Illinois-Chicago; Department of Psychiatry
| | - Katie L. Bessette
- University of Illinois-Chicago; Department of Psychiatry
- University of Illinois-Chicago; Department of Psychology
| | - Amy T. Peters
- University of Illinois-Chicago; Department of Psychiatry
- University of Illinois-Chicago; Department of Psychology
| | | | | | | | | | - Robert C. Welsh
- The University of Utah Medical Center, Department of Psychiatry
| | - K. Luan Phan
- University of Illinois-Chicago; Department of Psychiatry
- University of Illinois-Chicago; Department of Psychology
- Jesse Brown VA Medical Center; Mental Health Service Line
- University of Illinois-Chicago; Department of Anatomy and Cell Biology & the Graduate Program in Neuroscience
| | - Scott A. Langenecker
- University of Illinois-Chicago; Department of Psychiatry
- University of Illinois-Chicago; Department of Psychology
- The University of Utah Medical Center, Department of Psychiatry
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23
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Peters AT, Burkhouse KL, Kujawa A, Afshar K, Fitzgerald KD, Monk CS, Hajcak G, Phan KL. Impact of pubertal timing and depression on error-related brain activity in anxious youth. Dev Psychobiol 2019; 61:69-80. [PMID: 30043447 PMCID: PMC6318038 DOI: 10.1002/dev.21763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 01/07/2023]
Abstract
Anxiety disorders are associated with enhanced error-related negativity (ERN) across development but it remains unclear whether alterations in brain electrophysiology are linked to the timing of puberty. Pubertal timing and alterations of prefrontal and limbic development are implicated in risk for depression, but the interplay of these factors on the ERN-anxiety association has not been assessed. We examined the unique and interactive effects of pubertal timing and depression on the ERN in a sample of youth 10-19 years old with anxiety disorders (n = 30) or no history of psychopathology (n = 30). Earlier pubertal maturation was associated with an enhanced ERN. Among early, but not late maturing youth, higher depressive symptoms were associated with a reduced ERN. The magnitude of neural reactivity to errors is sensitive to anxiety, depression, and development. Early physical maturation and anxiety may heighten neural sensitivity to errors yet predict opposing effects in the context of depression.
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Affiliation(s)
- Amy T. Peters
- University of Illinois at Chicago, Department of Psychiatry, 1747 W Roosevelt Road, Chicago, IL, 60608
| | - Katie L. Burkhouse
- University of Illinois at Chicago, Department of Psychiatry, 1747 W Roosevelt Road, Chicago, IL, 60608
| | - Autumn Kujawa
- Vanderbilt University, Department of Psychology and Human Development, 230 Appleton Place, Nashville, TN 37203
| | - Kaveh Afshar
- University of Illinois at Chicago, Department of Psychiatry, 1747 W Roosevelt Road, Chicago, IL, 60608
| | - Kate D. Fitzgerald
- University of Michigan, Department of Psychiatry, 1500 E Medical Center Drive, Ann Arbor, MI 48109
| | - Christopher S. Monk
- University of Michigan, Department of Psychiatry, 1500 E Medical Center Drive, Ann Arbor, MI 48109
- University of Michigan, Department of Psychology, 530 Church Street, Ann Arbor, MI 48109
| | - Greg Hajcak
- Florida State University, Department of Psychology and Biomedical Sciences, 1107 W. Call Street, Tallahassee, FL 32306
| | - K. Luan Phan
- University of Illinois at Chicago, Department of Psychiatry, 1747 W Roosevelt Road, Chicago, IL, 60608
- University of Illinois-Chicago, Department of Anatomy and Cell Biology & Graduate Program in Neuroscience, 840 S Wood St, Chicago, IL 60612
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24
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Weinstein SM, Cruz RA, Isaia AR, Peters AT, West AE. Child- and Family-Focused Cognitive Behavioral Therapy for Pediatric Bipolar Disorder: Applications for Suicide Prevention. Suicide Life Threat Behav 2018; 48:797-811. [PMID: 29044718 PMCID: PMC5902658 DOI: 10.1111/sltb.12416] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 08/16/2017] [Indexed: 12/14/2022]
Abstract
Despite high rates of suicide ideation (SI) and behavior in youth with pediatric bipolar disorder (PBD), little work has examined how psychosocial interventions impact suicidality among this high-risk group. The current study examined SI outcomes in a randomized clinical trial comparing Child- and Family-Focused Cognitive Behavioral Therapy (CFF-CBT) for PBD versus psychotherapy treatment-as-usual (TAU). Although not designed for suicide prevention, CFF-CBT addresses child and family factors related to suicide risk and thus was hypothesized to generalize to the treatment of suicidality. Participants included 71 youth aged 7-13 years (M = 9.17, SD = 1.60) with DSM-IV-TR bipolar I, II, or not otherwise specified randomly assigned, with parent(s), to receive CFF-CBT or TAU. Both treatments consisted of 12 weekly and 6 monthly booster sessions. Suicide ideation was assessed via clinician interview at baseline, posttreatment, and 6-month follow-up. Results indicated that SI was prevalent pretreatment: 39% of youth reported current suicidal thoughts. All youth significantly improved in the likelihood and intensity of ideation across treatment, but group differences were not significant. Thus, findings suggest that early intervention for these high-risk youth may reduce SI, and at this stage of suicidality, youth may be responsive to even nonspecialized treatment.
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Affiliation(s)
- Sally M. Weinstein
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL,Corresponding Author: Sally M. Weinstein, Ph.D., Department of Psychiatry, University of Illinois at Chicago, 1747 W Roosevelt Road, Chicago, IL, 60608, , Phone: 312-413-7551, Fax: 312-413-7757
| | - Rick A. Cruz
- Department of Psychology, Utah State University, Logan, UT
| | - Ashley R. Isaia
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - Amy T. Peters
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - Amy E. West
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
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25
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Peters AT, Smith RA, Kassel MT, Hagan M, Maki P, Van Meter A, Briceño EM, Ryan KA, Weldon AL, Weisenbach SL, Starkman MN, Langenecker SA. A pilot investigation of differential neuroendocrine associations with fronto-limbic activation during semantically-cued list learning in mood disorders. J Affect Disord 2018; 239:180-191. [PMID: 30014958 DOI: 10.1016/j.jad.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/18/2018] [Accepted: 07/01/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Decreased volume and disrupted function in neural structures essential for memory formation (e.g. medial temporal lobe and prefrontal cortex) are common among individuals with depression. Hypothalamic-pituitary-axis function, as reflected by measurement of cortisol levels, is linked to neural activity during memory encoding in healthy people. However, it is not as well understood whether cortisol is associated with alterations in fronto-temporal recruitment during memory encoding in depression. METHODS In this pilot study, we evaluated associations between cortisol and neural activation during memory encoding in 62 adults (18-65 years) with mood disorders (MD; n = 39, 66.7% female), including major depression (n = 28) and bipolar I disorder (n = 11), and healthy controls (HC; n = 23, 43.5% female). Participants provided salivary cortisol samples before and after completing a semantically-cued list-learning task during 3-Tesla fMRI. Links between pre-scan cortisol (and cortisol change) and activation during encoding were evaluated using block and event-related models. RESULTS Overall, pre-scan cortisol level was positively associated with greater engagement of fronto-limbic activation during the encoding block. However, in MD, pre-scan cortisol was associated with attenuated activation during encoding in medial frontal, superior and middle temporal gyri, insula, lingual gyrus, and claustrum relative to HCs. Cortisol-related attenuation of activation in MD was also observed during encoding of words subsequently recalled in the ventral anterior cingulate, hypothalamus, and middle temporal gyrus. By and large, cortisol change (pre/post scan) predicted the same pattern of findings in both block and event-related contrasts. LIMITATIONS Although analyses accounted for variations in scanner time of day, circadian alterations in cortisol may have introduced variability into the results. CONCLUSIONS Pre-scan cortisol may selectively interfere with recruitment of important fronto-temporal memory circuitry in mood disorders. The inverted associations between cortisol and neural function in MD relative to HC also elucidate potentially unique pathophysiological markers of mood disorders.
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Affiliation(s)
- A T Peters
- Department of Psychiatry, University of Illinois at Chicago, USA
| | - R A Smith
- Department of Psychiatry, University of Illinois at Chicago, USA
| | - M T Kassel
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | - M Hagan
- Department of Psychology, San Francisco State University, USA; Department of Psychiatry, University of California, San Francisco, USA
| | - P Maki
- Department of Psychiatry, University of Illinois at Chicago, USA
| | - A Van Meter
- Department of Psychiatry Research, The Feinstein Institute for Medical Research, Zucker Hillside Hospital, USA
| | - E M Briceño
- Department of Psychiatry, University of Michigan Medical Center, USA
| | - K A Ryan
- Department of Psychiatry, University of Michigan Medical Center, USA
| | - A L Weldon
- Department of Psychology, University of Illinois Urbana-Champaign, USA
| | - S L Weisenbach
- Department of Psychiatry, University of Utah, USA; VA Salt Lake City Healthcare System, USA
| | - M N Starkman
- Department of Psychiatry, University of Michigan Medical Center, USA
| | - S A Langenecker
- Department of Psychiatry, University of Illinois at Chicago, USA.
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Gold AK, Peters AT, Otto MW, Sylvia LG, Magalhaes PVDS, Berk M, Dougherty DD, Miklowitz DJ, Frank E, Nierenberg AA, Deckersbach T. The impact of substance use disorders on recovery from bipolar depression: Results from the Systematic Treatment Enhancement Program for Bipolar Disorder psychosocial treatment trial. Aust N Z J Psychiatry 2018; 52:847-855. [PMID: 30047784 PMCID: PMC6778400 DOI: 10.1177/0004867418788172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Up to 60% of patients with bipolar disorder develop a substance use disorder during their lifetime. The purpose of this paper was to assess the impact of substance use disorders on depression recovery among bipolar patients randomly assigned to different psychotropic medications and psychosocial interventions. We hypothesized that patients with a comorbid substance use disorder would benefit less from psychotherapy regardless of treatment intensity/length compared to patients without a comorbid substance use disorder. METHOD We conducted post hoc analyses among bipolar disorder patients ( n = 270) with and without comorbid substance use disorders enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder randomized psychosocial intervention trial. All patients entered during or shortly after the onset of a bipolar depressive episode. Logistic regression and Cox proportional hazard models were used to assess whether current or past substance use disorders moderated the response of patients to intensive psychosocial intervention or brief psychoeducation with collaborative care, operationalized as full recovery from an episode of bipolar depression. RESULTS Current comorbid substance use disorders significantly predicted likelihood of recovery (odds ratio = 2.25, p = 0.025) and time to recovery (odds ratio = 1.71, p = 0.006) from bipolar depression. We found that 74.5% of patients with a current substance use disorder, compared to 56.5% without a current substance use disorder, recovered from bipolar depression. Past substance use disorders did not predict likelihood of recovery or time to recovery. Current substance use disorders did not significantly moderate response to intensive psychotherapy versus collaborative care. CONCLUSION Contrary to our hypotheses, bipolar disorder participants with a current comorbid substance use disorder were more likely to recover from psychosocial treatment for bipolar depression than patients without a current comorbid substance use disorder. If this finding is replicated, it has implications for the ordering of treatment for patients with comorbid bipolar disorder and substance use disorders.
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Affiliation(s)
- Alexandra K Gold
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - Amy T Peters
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Michael W Otto
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | | | - Michael Berk
- Impact Strategic Research Centre, Deakin University, Melbourne, VIC, Australia,Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - David J Miklowitz
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ellen Frank
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
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27
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Imoto Y, Kato A, Takabayashi T, Sakashita M, Norton JE, Suh LA, Carter RG, Weibman AR, Hulse KE, Stevens W, Harris KE, Peters AT, Grammer LC, Tan BK, Welch K, Conley DB, Kern RC, Fujieda S, Schleimer RP. Short-chain fatty acids induce tissue plasminogen activator in airway epithelial cells via GPR41&43. Clin Exp Allergy 2018; 48:544-554. [PMID: 29431874 DOI: 10.1111/cea.13119] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 11/30/2017] [Accepted: 12/22/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a heterogeneous chronic inflammatory disease generally divided based on the presence or absence of nasal polyps (NPs). One of the features of NPs is excessive fibrin deposition, which is associated with down-regulation of tissue plasminogen activator (t-PA) in NPs. As t-PA is expressed in epithelial cells, and epithelium is readily accessible to topical therapies, identifying compounds that can mediate the induction of t-PA would be a potential new strategy for the treatment of NPs. OBJECTIVE The objective of this study was to determine whether short-chain fatty acids (SCFAs) can induce t-PA in airway epithelial cells via their known receptors GPR41 and GPR43. METHODS We performed immunohistochemistry (IHC) to determine whether receptors for SCFAs, known as G protein-coupled receptor 41/free fatty acid receptor 3 (GPR41/FFAR3) and GPR43/FFAR2, are expressed in nasal tissue. Primary normal human bronchial epithelial (NHBE) cells were stimulated with different concentrations of SCFAs to test induction of t-PA, which was analysed by expression of mRNA and protein. Mediation of responses by SCFA receptors was evaluated by specific receptor gene silencing with siRNA. RESULTS Immunohistochemistry study revealed that airway epithelial cells expressed GPR41 and GPR43. Acetic acid, propionic acid, butyric acid and valeric acid significantly induced t-PA expression from two- to tenfolds. The strongest inducer of t-PA from NHBE cells was propionic acid; cells stimulated with propionic acid released t-PA into the supernatant in its active form. Gene silencing of GPR41 and GPR43 revealed that induction of t-PA by SCFAs was dependent upon both GPR41 and GPR43. CONCLUSIONS AND CLINICAL RELEVANCE Short-chain fatty acids were shown to induce airway epithelial cell expression of t-PA via GPR41 and GPR43. Topical delivery of potent compounds that activate these receptors may have value by reducing fibrin deposition and shrinking nasal polyp growth.
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Affiliation(s)
- Y Imoto
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - A Kato
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - T Takabayashi
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - M Sakashita
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - J E Norton
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - L A Suh
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R G Carter
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A R Weibman
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - K E Hulse
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - W Stevens
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - K E Harris
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - L C Grammer
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - B K Tan
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - K Welch
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - D B Conley
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R C Kern
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Fujieda
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - R P Schleimer
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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28
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Deckersbach T, Peters AT, Shea C, Gosai A, Stange JP, Peckham AD, Ellard KK, Otto MW, Rauch SL, Dougherty DD, Nierenberg AA. Memory performance predicts response to psychotherapy for depression in bipolar disorder: A pilot randomized controlled trial with exploratory functional magnetic resonance imaging. J Affect Disord 2018; 229:342-350. [PMID: 29331692 PMCID: PMC5807220 DOI: 10.1016/j.jad.2017.12.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/21/2017] [Accepted: 12/26/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This pilot randomized controlled trial compared Cognitive Behavior Therapy (CBT) and Supportive Psychotherapy (SP) for the treatment of depression in bipolar I disorder. We also examined whether exploratory verbal memory, executive functioning, and neural correlates of verbal memory during functional magnetic resonance imaging (fMRI) predicted change in depression severity. METHODS Thirty-two adults (ages 18-65) with DSM-IV bipolar I disorder meeting current criteria for a major depressive episode were randomized to 18 weeks of CBT or SP. Symptom severity was assessed before, at the mid-point, and after the 18-week intervention. All participants completed a brief pre-treatment neuropsychological testing battery (including the California Verbal Learning Test-2nd Edition, Delis Kaplan Executive Functioning System [DKEFS] Trail-making Test, and DKEFS Sorting Test), and a sub-set of 17 participants provided usable fMRI data while completing a verbal learning paradigm that consisted of encoding word lists. RESULTS CBT and SP yielded comparable improvement in depressive symptoms from pre- to post-treatment. Better retention of learned information (CVLT-II long delay free recall vs. Trial 5) and recognition (CVLT-II hits) were associated with greater improvement in depression in both treatments. Increased activation in the left dorsolateral prefrontal cortex and right hippocampus during encoding was also related to depressive symptom improvement. LIMITATIONS Sample size precluded tests of clinical factors that may interact with cognitive/neural function to predict treatment outcome. CONCLUSION Neuropsychological assessment and fMRI offer additive information regarding who is most likely to benefit from psychotherapy for bipolar depression.
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Affiliation(s)
- Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Amy T Peters
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Conor Shea
- Department of Neuroscience, Boston University, Boston, MA, USA
| | - Aishwarya Gosai
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan P Stange
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Andrew D Peckham
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Kristen K Ellard
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Michael W Otto
- Department of Psychology, Boston University, Boston, MA, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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29
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Peters AT, Jacobs RH, Crane NA, Ryan KA, Weisenbach SL, Ajilore O, Lamar M, Kassel MT, Gabriel LB, West AE, Zubieta JK, Langenecker SA. Domain-specific impairment in cognitive control among remitted youth with a history of major depression. Early Interv Psychiatry 2017; 11:383-392. [PMID: 26177674 PMCID: PMC4844809 DOI: 10.1111/eip.12253] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/08/2015] [Indexed: 12/29/2022]
Abstract
AIM Impairment in neuropsychological functioning is common in major depressive disorder (MDD), but it is not clear to what degree these deficits are related to risk (e.g. trait), scar, burden or state effects of MDD. The objective of this study was to use neuropsychological measures, with factor scores in verbal fluency, processing speed, attention, set-shifting and cognitive control in a unique population of young, remitted, unmedicated, early course individuals with a history of MDD in hopes of identifying putative trait markers of MDD. METHODS Youth aged 18-23 in remission from MDD (rMDD; n = 62) and healthy controls (HC; n = 43) were assessed with neuropsychological tests at two time points. These were from four domains of executive functioning, consistent with previous literature as impaired in MDD: verbal fluency and processing speed, conceptual reasoning and set-shifting, processing speed with interference resolution, and cognitive control. RESULTS rMDD youth performed comparably to HCs on verbal fluency and processing speed, processing speed with interference resolution, and conceptual reasoning and set-shifting, reliably over time. Individuals with rMDD demonstrated relative decrements in cognitive control at Time 1, with greater stability than HC participants. CONCLUSION MDD may be characterized by regulatory difficulties that do not pertain specifically to active mood state or fluctuations in symptoms. Deficient cognitive control may represent a trait vulnerability or early course scar of MDD that may prove a viable target for secondary prevention or early remediation.
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Affiliation(s)
- Amy T Peters
- Departments of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Rachel H Jacobs
- Departments of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Natania A Crane
- Departments of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Kelly A Ryan
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sara L Weisenbach
- Research & Development Program, The Jesse Brown VA Medical Center, Chicago, Illinois.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Olusola Ajilore
- Departments of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Melissa Lamar
- Departments of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Michelle T Kassel
- Departments of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Laura B Gabriel
- Departments of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Amy E West
- Departments of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Jon-Kar Zubieta
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Scott A Langenecker
- Departments of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
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30
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Stange JP, Bessette KL, Jenkins LM, Peters AT, Feldhaus C, Crane NA, Ajilore O, Jacobs RH, Watkins ER, Langenecker SA. Attenuated intrinsic connectivity within cognitive control network among individuals with remitted depression: Temporal stability and association with negative cognitive styles. Hum Brain Mapp 2017; 38:2939-2954. [PMID: 28345197 DOI: 10.1002/hbm.23564] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 02/06/2023] Open
Abstract
Many individuals with major depressive disorder (MDD) experience cognitive dysfunction including impaired cognitive control and negative cognitive styles. Functional connectivity magnetic resonance imaging studies of individuals with current MDD have documented altered resting-state connectivity within the default-mode network and across networks. However, no studies to date have evaluated the extent to which impaired connectivity within the cognitive control network (CCN) may be present in remitted MDD (rMDD), nor have studies examined the temporal stability of such attenuation over time. This represents a major gap in understanding stable, trait-like depression risk phenotypes. In this study, resting-state functional connectivity data were collected from 52 unmedicated young adults with rMDD and 47 demographically matched healthy controls, using three bilateral seeds in the CCN (dorsolateral prefrontal cortex, inferior parietal lobule, and dorsal anterior cingulate cortex). Mean connectivity within the entire CCN was attenuated among individuals with rMDD, was stable and reliable over time, and was most pronounced with the right dorsolateral prefrontal cortex and right inferior parietal lobule, results that were corroborated by supplemental independent component analysis. Attenuated connectivity in rMDD appeared to be specific to the CCN as opposed to representing attenuated within-network coherence in other networks (e.g., default-mode, salience). In addition, attenuated connectivity within the CCN mediated relationships between rMDD status and cognitive risk factors for depression, including ruminative brooding, pessimistic attributional style, and negative automatic thoughts. Given that these cognitive markers are known predictors of relapse, these results suggest that attenuated connectivity within the CCN could represent a biomarker for trait phenotypes of depression risk. Hum Brain Mapp 38:2939-2954, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | | | - Amy T Peters
- University of Illinois at Chicago, Chicago, Illinois
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31
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Feldman S, Kasjanski R, Poposki J, Hernandez D, Chen JN, Norton JE, Suh L, Carter RG, Stevens WW, Peters AT, Kern RC, Conley DB, Tan BK, Shintani-Smith S, Welch KC, Grammer LC, Harris KE, Kato A, Schleimer RP, Hulse KE. Chronic airway inflammation provides a unique environment for B cell activation and antibody production. Clin Exp Allergy 2017; 47:457-466. [PMID: 28000955 DOI: 10.1111/cea.12878] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 12/06/2016] [Accepted: 12/11/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND B cells play many roles in health and disease. However, little is known about the mechanisms that drive B cell responses in the airways, especially in humans. Chronic rhinosinusitis (CRS) is an inflammatory disease of the upper airways that affects 10% of Europeans and Americans. A subset of CRS patients develop nasal polyps (NPs), which are characterized by type 2 inflammation, eosinophils and group 2 innate lymphoid cells (ILC2s). We have reported that NP contain elevated levels of B cells and antibodies, making NP an ideal system for studying B cells in the airways. OBJECTIVE We sought to determine the mechanisms that drive B cell activation and antibody production during chronic airway inflammation. METHODS We analysed B cells from NP or tonsil, or after ILC2 coculture, by flow cytometry. Antibody production from tissue was measured using Luminex assays and the frequency of antibody-secreting cells by ELISpot. Formation of B cell clusters was assessed using immunohistochemistry. Expression of genes associated with B cell activation and class switch recombination was measured by qRT-PCR. RESULTS NP contained significantly elevated frequencies of plasmablasts, especially those that expressed the extrafollicular marker Epstein-Barr virus-induced protein 2 (EBI2), but significantly fewer germinal centre (GC) B cells compared with tonsil. Antibody production and the frequency of antibody-secreting cells were significantly elevated in NP, and there was evidence for local class switch recombination in NP. Finally, ILC2s directly induced EBI2 expression on B cells in vitro. CONCLUSIONS AND CLINICAL RELEVANCE Our data suggest there is a unique B cell activation environment within NP that is distinct from classic GC-mediated mechanisms. We show for the first time that ILC2s directly induce EBI2 expression on B cells, indicating that ILC2s may play an important role in B cell responses. B cell-targeted therapies may provide new treatment options for CRSwNP.
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Affiliation(s)
- S Feldman
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R Kasjanski
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J Poposki
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - D Hernandez
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J N Chen
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J E Norton
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - L Suh
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R G Carter
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - W W Stevens
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A T Peters
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R C Kern
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - D B Conley
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - B K Tan
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Shintani-Smith
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - K C Welch
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - L C Grammer
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - K E Harris
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A Kato
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R P Schleimer
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - K E Hulse
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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32
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Jacobs RH, Watkins ER, Peters AT, Feldhaus CG, Barba A, Carbray J, Langenecker SA. Targeting Ruminative Thinking in Adolescents at Risk for Depressive Relapse: Rumination-Focused Cognitive Behavior Therapy in a Pilot Randomized Controlled Trial with Resting State fMRI. PLoS One 2016; 11:e0163952. [PMID: 27880789 PMCID: PMC5120778 DOI: 10.1371/journal.pone.0163952] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/13/2016] [Indexed: 01/17/2023] Open
Abstract
This pilot randomized control trial was designed to examine whether Rumination-Focused Cognitive Behavior Therapy (RFCBT) reduces rumination and residual depressive symptoms among adolescents with a history of Major Depressive Disorder (MDD) who are at risk for relapse. We also examined whether these changes in symptoms were associated with changes in functional connectivity of the posterior cingulate cortex (PCC), a key node in the default mode network (DMN). Thirty-three adolescents (ages 12–18) were randomized to eight weeks of RFCBT or an assessment only (AO) control. Twenty two adolescents successfully completed fMRI scans pre- and post-intervention. Adolescents were recruited from the clinic and community and met criteria for at least one previous episode of MDD and were currently in full or partial remission. An Independent Evaluator interviewed parent and child before and after the eight-week intervention. The left PCC (-5, -50, 36) seed was used to probe resting state functional connectivity of the DMN. Adolescents who received RFCBT demonstrated reduced rumination (F = -2.76, df = 112, p < .01, 95% CI [-4.72,-0.80]) and self-report depression across eight weeks (F = -2.58, df = 113, p < .01, 95% CI [-4.21, -0.94]). Youth who received RFCBT also demonstrated significant decreases in connectivity between the left PCC and the right inferior frontal gyrus (IFG) and bilateral inferior temporal gyri (ITG). Degree of change in connectivity was correlated with changes in self-report depression and rumination. These data suggest that rumination can be reduced over eight weeks and that this reduction is associated with parallel decreases in residual depressive symptoms and decreased functional connectivity of the left PCC with cognitive control nodes. These changes may enhance the ability of vulnerable youth to stay well during the transition to adulthood. Trial Registration: ClinicalTrials.gov NCT01905267
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Affiliation(s)
- Rachel H. Jacobs
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
- * E-mail:
| | | | - Amy T. Peters
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Claudia G. Feldhaus
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Alyssa Barba
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Julie Carbray
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Scott A. Langenecker
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
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33
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Peters AT, Van Meter A, Pruitt PJ, Briceño EM, Ryan KA, Hagan M, Weldon AL, Kassel MT, Vederman A, Zubieta JK, McInnis M, Weisenbach SL, Langenecker SA. Acute cortisol reactivity attenuates engagement of fronto-parietal and striatal regions during emotion processing in negative mood disorders. Psychoneuroendocrinology 2016; 73:67-78. [PMID: 27474908 PMCID: PMC5048542 DOI: 10.1016/j.psyneuen.2016.07.215] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Depression and bipolar disorder (negative mood disorders, NMD) are associated with dysregulated hypothalamic-pituitary-adrenal (HPA)-axis function and disrupted emotion processing. The neural networks involved in attenuation of HPA-axis reactivity overlap with the circuitry involved in perception and modulation of emotion; however, direct links between these systems are understudied. This study investigated whether cortisol activity prior to undergoing fMRI was related to neural processing of emotional information in participants with NMD. METHODS Forty-one adults (Mage=40.33, SD=15.57) with major depression (n=29) or bipolar disorder (n=12) and 23 healthy control comparisons (Mage=36.43, SD=17.33) provided salivary cortisol samples prior to completing a facial emotion perception test during 3-Tesla fMRI. RESULTS Overall, pre-scan cortisol level was positively associated with greater engagement of the dorsal anterior cingulate (dACC), inferior parietal lobule, insula, putamen, precuneus, middle and medial frontal and postcentral gyri, posterior cingulate, and inferior temporal gyrus during emotion processing of all faces. NMD status moderated this effect; in NMD participants' pre-scan cortisol was associated with attenuated activation of the insula, postcentral gyrus, precuneus, and putamen for fearful faces and the medial frontal gyrus for angry faces relative to HCs. Cortisol-related attenuation of activation among NMD participants was also observed for facial identification in the dACC, putamen, middle temporal gyrus, precuneus, and caudate. CONCLUSIONS Across all participants, cortisol was associated with greater activation in several regions involved in the perception and control of emotion. However, cortisol responsivity was associated with hypoactivation of several of these regions in the NMD group, suggesting that HPA-axis activity may selectively interfere with the potentially adaptive recruitment of circuits supporting emotion perception, processing and/or regulation in mood disorders.
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Affiliation(s)
- Amy T. Peters
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA
| | - Anna Van Meter
- Ferkauf Graduate School, Yeshiva University, Bronx, NY, USA
| | - Patrick J. Pruitt
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Emily M. Briceño
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Kelly A. Ryan
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Melissa Hagan
- Department of Psychology, San Francisco State University, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Anne L. Weldon
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Michelle T. Kassel
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Aaron Vederman
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Jon-Kar Zubieta
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Melvin McInnis
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI, USA
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Deckersbach T, Peters AT, Sylvia LG, Gold AK, da Silva Magalhaes PV, Henry DB, Frank E, Otto MW, Berk M, Dougherty DD, Nierenberg AA, Miklowitz DJ. A cluster analytic approach to identifying predictors and moderators of psychosocial treatment for bipolar depression: Results from STEP-BD. J Affect Disord 2016; 203:152-157. [PMID: 27289316 PMCID: PMC4976005 DOI: 10.1016/j.jad.2016.03.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/12/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND We sought to address how predictors and moderators of psychotherapy for bipolar depression - identified individually in prior analyses - can inform the development of a metric for prospectively classifying treatment outcome in intensive psychotherapy (IP) versus collaborative care (CC) adjunctive to pharmacotherapy in the Systematic Treatment Enhancement Program (STEP-BD) study. METHODS We conducted post-hoc analyses on 135 STEP-BD participants using cluster analysis to identify subsets of participants with similar clinical profiles and investigated this combined metric as a moderator and predictor of response to IP. We used agglomerative hierarchical cluster analyses and k-means clustering to determine the content of the clinical profiles. Logistic regression and Cox proportional hazard models were used to evaluate whether the resulting clusters predicted or moderated likelihood of recovery or time until recovery. RESULTS The cluster analysis yielded a two-cluster solution: 1) "less-recurrent/severe" and 2) "chronic/recurrent." Rates of recovery in IP were similar for less-recurrent/severe and chronic/recurrent participants. Less-recurrent/severe patients were more likely than chronic/recurrent patients to achieve recovery in CC (p=.040, OR=4.56). IP yielded a faster recovery for chronic/recurrent participants, whereas CC led to recovery sooner in the less-recurrent/severe cluster (p=.034, OR=2.62). LIMITATIONS Cluster analyses require list-wise deletion of cases with missing data so we were unable to conduct analyses on all STEP-BD participants. CONCLUSIONS A well-powered, parametric approach can distinguish patients based on illness history and provide clinicians with symptom profiles of patients that confer differential prognosis in CC vs. IP.
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Affiliation(s)
- Thilo Deckersbach
- Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | | | - Louisa G. Sylvia
- Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | | | | | | | | | | | - Michael Berk
- Deakin University, Melbourne, AU,University of Melbourne, Melbourne, AU
| | - Darin D. Dougherty
- Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
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Peters AT, Burkhouse K, Feldhaus CC, Langenecker SA, Jacobs RH. Aberrant resting-state functional connectivity in limbic and cognitive control networks relates to depressive rumination and mindfulness: A pilot study among adolescents with a history of depression. J Affect Disord 2016; 200:178-81. [PMID: 27136416 DOI: 10.1016/j.jad.2016.03.059] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/17/2016] [Accepted: 03/18/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Resting state functional connectivity (RSFC) research among adults indicates abnormalities within and between neural networks during acute depressive episodes, some of which are likely to remain into remission. The examination of RSFC among adolescents within the remitted state of MDD may implicate markers of illness course during a critical developmental window wherein secondary prevention can be implemented. METHODS RSFC data were collected on a 3.0T GE scanner from adolescents (12-18, M=15.61, SD=1.90; 57% female) in full or partial remission from MDD (rMDD; n=23) and age- and gender-matched healthy controls (HC; n=10). RSFC data were examined using seed-based connectivity of the left amygdala, left dorsolateral prefrontal cortex (dlPFC), and left posterior cingulate cortex (PCC). These seeds were chosen to probe the emotional salience, cognitive control, and default mode networks, respectively. RESULTS rMDD adolescents demonstrated relative hyperconnectivity from the left amygdala to the right PCC, as well as from the left dlPFC to the right middle frontal and left inferior frontal gyri (MFG, IFG). Amygdala to PCC connectivity was correlated with greater rumination, dlPFC to MFG connectivity was positively associated with depression severity, and dlPFC to IFG connectivity was inversely associated with mindfulness. CONCLUSIONS Aberrant functional connectivity within and between neural networks responsible for salience attribution, introspective thought, and executive control can be observed among adolescents in the remitted phase of MDD and is associated with residual clinical symptoms. These patterns may confer risk for future relapse or alternatively, support wellness.
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Affiliation(s)
- Amy T Peters
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, United States
| | - Katie Burkhouse
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, United States; Binghamton University, State University of New York, Department of Psychology, Binghamton, NY, United States
| | - Claudia C Feldhaus
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, United States
| | - Scott A Langenecker
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, United States
| | - Rachel H Jacobs
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, United States.
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Peters AT, Shesler LW, Sylvia L, da Silva Magalhaes PV, Miklowitz DJ, Otto MW, Frank E, Berk M, Dougherty DD, Nierenberg AA, Deckersbach T. Medical burden, body mass index and the outcome of psychosocial interventions for bipolar depression. Aust N Z J Psychiatry 2016; 50:667-77. [PMID: 26590023 DOI: 10.1177/0004867415616694] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Individuals with bipolar disorder experience a disproportionately high incidence of medical co-morbidity and obesity. These health-related problems are a barrier to recovery from mood episodes and have been linked with unfavorable responses to pharmacological treatment. However, little is known about whether and how these characteristics affect responses to adjunctive psychotherapy. METHOD Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy plus pharmacotherapy with collaborative care (a three-session psycho-educational intervention) plus pharmacotherapy. We conducted a post-hoc analysis to evaluate whether medical burden and body mass index predicted and/or moderated the likelihood of recovery and time until recovery from a depressive episode among patients in the two treatments. RESULTS Participants who had medical co-morbidity and body mass index data constituted 199 of the 293 patients in the original Systematic Treatment Enhancement Program for Bipolar Disorder trial. Higher medical burden predicted a lower likelihood of recovery from depression in both treatment conditions (odds ratio = 0.89), but did not moderate responses to intensive psychotherapy vs collaborative care. Intensive psychotherapy yielded superior recovery rates for individuals of normal body mass index (odds ratio= 2.39) compared with collaborative care, but not among individuals who were overweight or obese. CONCLUSION Medical co-morbidity and body weight impacts symptom improvement and attention to this co-morbidity may inform the development of more personalized treatments for bipolar disorder.
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Affiliation(s)
- Amy T Peters
- University of Illinois at Chicago, Chicago, IL, USA
| | - Leah W Shesler
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Louisa Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | | | | | | | - Ellen Frank
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Berk
- Deakin University, Melbourne, VIC, Australia University of Melbourne, Melbourne, VIC, Australia
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
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Peters AT, Jacobs RH, Feldhaus C, Henry DB, Albano AM, Langenecker SA, Reinecke MA, Silva SG, Curry JF. Trajectories of Functioning Into Emerging Adulthood Following Treatment for Adolescent Depression. J Adolesc Health 2016; 58:253-9. [PMID: 26576820 PMCID: PMC4836911 DOI: 10.1016/j.jadohealth.2015.09.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/18/2015] [Accepted: 09/18/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE It is well established that empirically supported treatments reduce depressive symptoms for most adolescents; however, it is not yet known whether these interventions lead to sustained improvements in global functioning. The goal of this study is to assess the clinical characteristics and trajectories of long-term psychosocial functioning among emerging adults who have experienced adolescent-onset major depressive disorder. METHODS Global functioning was assessed using the Clinical Global Assessment Scale for children (participants ≤18 years), the Global Assessment of Functioning (participants ≥ 19 years) and the Health of the Nation Outcome Scales for Adolescents among 196 adolescents who elected to complete 3.5 years of naturalistic follow-up subsequent to their participation in the Treatment for Adolescents with Depression Study. The Treatment for Adolescents with Depression Study examined the efficacy of cognitive behavior therapy, fluoxetine, and the combination of cognitive behavior therapy and fluoxetine (combination treatment) over the course of 36 weeks. Mixed-effects regression models were used to identify trajectories and clinical predictors of functioning over the naturalistic follow-up. RESULTS Global functioning and achievement of developmental milestones (college, employment) improved over the course of follow-up for most adolescents. Depressive relapse, initial randomization to the placebo group, and the presence of multiple psychiatric comorbidities conferred risk for relatively poorer functioning. CONCLUSIONS Functioning generally improves among most adolescents who have received empirically supported treatments. However, the presence of recurrent major depressive disorder and multiple psychiatric comorbidities is associated with poorer functioning trajectories, offering targets for maintenance treatment or secondary prevention.
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Affiliation(s)
- Amy T Peters
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Rachel H Jacobs
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Claudia Feldhaus
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - David B Henry
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Anne Marie Albano
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Scott A Langenecker
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Mark A Reinecke
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Susan G Silva
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - John F Curry
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina.
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Peters AT, Shankman SA, Deckersbach T, West AE. Predictors of first-episode unipolar major depression in individuals with and without sub-threshold depressive symptoms: A prospective, population-based study. Psychiatry Res 2015; 230:150-6. [PMID: 26343831 PMCID: PMC4692357 DOI: 10.1016/j.psychres.2015.08.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/25/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND The aim of this study is to assess predictors of first-episode major depression in a community-based sample of adults with and without sub-threshold depression. METHOD Data were from Waves 1 and 2 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Participants meeting criteria for a sub-threshold depressive episode (sMDE; n=3901) reported lifetime depressed mood/loss of interest lasting at least two weeks and at least two of the seven other DSM-IV symptoms of MDD. Predictors of MDE 3 years later were compared in those with and without (n=31022) sMDE. RESULTS Being female, history of alcohol or substance use, and child abuse increased the odds of developing MDD to a greater degree in individuals without sMDE relative to those with sMDE. Among those with sMDE and additional risk factors (low education, substance use), younger age was associated with marginally increased risk of MDD. CONCLUSION Several demographic risk factors may help identify individuals at risk for developing MDD in individuals who have not experienced an sMDE who may be candidates for early intervention. Future work should assess whether preventative interventions targeting substance/alcohol use and child abuse could reduce the risk of depression.
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Affiliation(s)
- Amy T. Peters
- University of Illinois at Chicago, Departments of Psychiatry and Psychology
| | | | - Thilo Deckersbach
- Massachusetts General Hospital, Department of Psychiatry,Harvard Medical School, Department of Psychiatry
| | - Amy E. West
- University of Illinois at Chicago, Departments of Psychiatry and Psychology
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Poposki JA, Peterson S, Welch K, Schleimer RP, Hulse KE, Peters AT, Norton J, Suh LA, Carter R, Harris KE, Grammer LC, Tan BK, Chandra RK, Conley DB, Kern RC, Kato A. Elevated presence of myeloid dendritic cells in nasal polyps of patients with chronic rhinosinusitis. Clin Exp Allergy 2015; 45:384-93. [PMID: 25469646 DOI: 10.1111/cea.12471] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 11/23/2014] [Accepted: 11/28/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by Th2 inflammation, the mechanism underlying the onset and amplification of this inflammation has not been fully elucidated. Dendritic cells (DCs) are major antigen-presenting cells, central inducers of adaptive immunity and critical regulators of many inflammatory diseases. However, the presence of DCs in CRS, especially in nasal polyps (NPs), has not been extensively studied. OBJECTIVE The objective of this study was to characterize DC subsets in CRS. METHODS We used real-time PCR to assess the expression of mRNA for markers of myeloid DCs (mDCs; CD1c), plasmacytoid DCs (pDCs; CD303) and Langerhans cells (LCs; CD1a, CD207) in uncinate tissue (UT) from controls and patients with CRS as well as in NP. We assayed the presence of DCs by immunohistochemistry and flow cytometry. RESULTS Compared to UT from control subjects (n = 15) and patients with CRS without NP (CRSsNP) (n = 16) and CRSwNP (n = 17), mRNAs for CD1a and CD1c were significantly elevated in NPs (n = 29). In contrast, CD207 mRNA was not elevated in NPs. Immunohistochemistry showed that CD1c(+) cells but not CD303(+) cells were significantly elevated in NPs compared to control subjects or patients with CRSsNP. Flow cytometric analysis showed that CD1a(+) cells in NPs might be a subset of mDC1s and that CD45(+) CD19(-) CD1c(+) CD11c(+) CD141(-) CD303(-) HLA-DR(+) mDC1s and CD45(+) CD19(-) CD11c(+) CD1c(-) CD141(high) HLA-DR(+) mDC2s were significantly elevated in NPs compared to UT from controls and CRSsNP, but CD45(+) CD11c(-) CD303(+) HLA-DR(+) pDCs were only elevated in NPs compared to control UT. CONCLUSION AND CLINICAL RELEVANCE Myeloid DCs are elevated in CRSwNP, especially in NPs. Myeloid DCs thus may indirectly contribute to the inflammation observed in CRSwNP.
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Affiliation(s)
- J A Poposki
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Papadopoulos NG, Bernstein JA, Demoly P, Dykewicz M, Fokkens W, Hellings PW, Peters AT, Rondon C, Togias A, Cox LS. Phenotypes and endotypes of rhinitis and their impact on management: a PRACTALL report. Allergy 2015; 70:474-94. [PMID: 25620381 DOI: 10.1111/all.12573] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2015] [Indexed: 12/29/2022]
Abstract
Rhinitis is an umbrella term that encompasses many different subtypes, several of which still elude complete characterization. The concept of phenotyping, being the definition of disease subtypes on the basis of clinical presentation, has been well established in the last decade. Classification of rhinitis entities on the basis of phenotypes has facilitated their characterization and has helped practicing clinicians to efficiently approach rhinitis patients. Recently, the concept of endotypes, that is, the definition of disease subtypes on the basis of underlying pathophysiology, has emerged. Phenotypes/endotypes are dynamic, overlapping, and may evolve into one another, thus rendering clear-cut definitions difficult. Nevertheless, a phenotype-/endotype-based classification approach could lead toward the application of stratified and personalized medicine in the rhinitis field. In this PRACTALL document, rhinitis phenotypes and endotypes are described, and rhinitis diagnosis and management approaches focusing on those phenotypes/endotypes are presented and discussed. We emphasize the concept of control-based management, which transcends all rhinitis subtypes.
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Affiliation(s)
- N G Papadopoulos
- Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK; Allergy Department, 2nd Paediatric Clinic, University of Athens, Athens, Greece
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Weinstein SM, Van Meter A, Katz AC, Peters AT, West AE. Cognitive and family correlates of current suicidal ideation in children with bipolar disorder. J Affect Disord 2015; 173:15-21. [PMID: 25462390 PMCID: PMC4258538 DOI: 10.1016/j.jad.2014.10.058] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 10/23/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Suicidality among youth with bipolar disorder is an extreme, but largely unaddressed, public health problem. The current study examined the psychosocial characteristics differentiating youth with varying severities of suicidal ideation that may dictate targets for suicide prevention interventions. METHODS Participants included 72 youth aged 7-13 (M=9.19, SD=1.61) with DSM-IV-TR bipolar I, II, or NOS and a parent/caregiver. Current suicidal ideation and correlates were assessed at intake, including: demographics and clinical factors (diagnosis, symptom severity, psychiatric comorbidity); child factors (cognitive risk and quality of life); and family factors (parenting stress, family cohesion, and family rigidity). RESULTS Current ideation was prevalent in this young sample: 41% endorsed any ideation, and 31% endorsed active forms. Depression symptoms, quality of life, hopelessness, self-esteem, and family rigidity differentiated youth with increasing ideation severity. Separate logistic regressions examined all significant child- and family-level factors, controlling for demographic and clinical variables. Greater family rigidity and lower self-esteem remained significant predictors of current planful ideation. Diagnosis, index episode, comorbidity, and mania severity did not differentiate non-ideators from those with current ideation. LIMITATIONS Limitations include the small sample to examine low base-rate severe ideation, cross-sectional analyses and generalizability of findings beyond the outpatient clinical sample. CONCLUSIONS Findings underscore the importance of assessing and addressing suicidality in preadolescent youth with bipolar disorder, before youth progress to more severe suicidal behaviors. Results also highlight child self-esteem and family rigidity as key treatment targets to reduce suicide risk in pediatric bipolar disorder.
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Affiliation(s)
| | - Anna Van Meter
- University of Illinois at Chicago, Chicago, IL, USA; Yeshiva University, New York, NY, USA
| | | | - Amy T Peters
- University of Illinois at Chicago, Chicago, IL, USA
| | - Amy E West
- University of Illinois at Chicago, Chicago, IL, USA
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West AE, Weinstein SM, Peters AT, Katz A, Henry D, Cruz R, Pavuluri M. Child- and family-focused cognitive-behavioral therapy for pediatric bipolar disorder: a randomized clinical trial. J Am Acad Child Adolesc Psychiatry 2014; 53:1168-78, 1178.e1. [PMID: 25440307 PMCID: PMC4254579 DOI: 10.1016/j.jaac.2014.08.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/28/2014] [Accepted: 09/04/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Previous studies have found that family-based psychosocial treatments are effective adjuncts to pharmacotherapy among adults and adolescents with bipolar disorder (BD). The objective of this study was to compare the efficacy of adjunctive child- and family-focused cognitive-behavioral therapy (CFF-CBT) to psychotherapy as usual (control) for mood symptom severity and global functioning in children with BD. METHOD Sixty-nine youth, aged 7 to 13 years (mean = 9.19, SD = 1.61) with DSM-IV-TR bipolar I, II, or not otherwise specified (NOS) disorder were randomly assigned to CFF-CBT or control groups. Both treatments consisted of 12 weekly sessions followed by 6 monthly booster sessions delivered over a total of 9 months. Independent evaluators assessed participants at baseline, week 4, week 8, week 12 (posttreatment), and week 39 (6-month follow-up). RESULTS Participants in CFF-CBT attended more sessions, were less likely to drop out, and reported greater satisfaction with treatment than controls. CFF-CBT demonstrated efficacy compared to the control treatment in reducing parent-reported mania at posttreatment and depression symptoms at posttreatment and follow-up. Global functioning did not differ at posttreatment but was higher among CFF-CBT participants at follow-up. CONCLUSION CFF-CBT may be efficacious in reducing acute mood symptoms and improving long-term psychosocial functioning among children with BD.
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Abstract
The majority of patients treated for bipolar disorder receive multiple psychotropic medications concurrently (polypharmacy), despite a lack of empirical evidence for any combination of three or more medications. Some patients benefit from the skillful management of a complex medication regimen, but iterative additions to a treatment regimen often do not lead to clinical improvement, are expensive, and can confound assessment of the underlying mood disorder. Given these potential problems of polypharmacy, this paper reviews the evidence supporting the use of multiple medications and seeks to identify patient personality traits that may put patients at a greater risk for ineffective complex chronic care. Patients with bipolar disorder (n = 89), ages 18 and older, were assessed on the Montgomery Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), and the NEO Five Factor Inventory (NEO-FFI), and completed a treatment history questionnaire to report psychotropic medication use. We found that patients with lower scores on openness had significantly more current psychotropic medications than patients with higher scores on openness (3.7 ± 1.9 vs. 2.8 ± 1.8, p < 0.05). Patients with the highest lifetime medication use had significantly lower extraversion (21.8 ± 8.9 vs. 25.4 ± 7.6, p < 0.05) and lower conscientiousness (21.9 ± 8.2 vs. 27.9 ± 8.2, p < 0.01) than those reporting lower lifetime medication use. Low levels of openness, extraversion, and conscientiousness may be associated with increased psychotropic medication use. Investigating the role of individual differences, such as patient personality traits, in moderating effective polypharmacy warrants future research.
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Affiliation(s)
- G S Sachs
- Massachusetts General Hospital,Boston, MA,USA
| | - A T Peters
- Massachusetts General Hospital,Boston, MA,USA
| | - L Sylvia
- Massachusetts General Hospital,Boston, MA,USA
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Peters AT, Peckham AD, Stange JP, Sylvia LG, Hansen NS, Salcedo S, Rauch SL, Nierenberg AA, Dougherty DD, Deckersbach T. Correlates of real world executive dysfunction in bipolar I disorder. J Psychiatr Res 2014; 53:87-93. [PMID: 24655587 PMCID: PMC4045408 DOI: 10.1016/j.jpsychires.2014.02.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 02/14/2014] [Accepted: 02/20/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bipolar disorder is characterized by impairments in cognitive functioning, both during acute mood episodes and periods of euthymia, which interfere with functioning. Cognitive functioning is typically assessed using laboratory-based tests, which may not capture how cognitive dysfunction is experienced in real-life settings. Little is known about the specific illness characteristics of bipolar disorder that contribute to cognitive dysfunction in everyday life. METHODS Participants met DSM-IV criteria for bipolar I disorder (n = 68) in a depressed or euthymic state. Everyday executive functioning was evaluated using the Behavior Rating Inventory of Executive Functioning (BRIEF) and the Frontal Systems Behavior Rating Scale (FrSBe). Participants completed clinician rated measures of mood state (Hamilton Depression Rating Scale, Young Mania Rating Scale), prior illness course and co-morbidities (Mini International Neuropsychiatric Interview), as well as self-report measures of psychotropic medication use and medical co-morbidity. RESULTS Individuals in this study reported significant impairment in every domain of executive functioning. These deficits were associated with a multitude of illness factors, some directly impacted by mood symptoms and others shaped by illness chronicity, psychiatric comorbidity, medical co-morbidity, and medication use. DISCUSSION Executive functioning problems observed in everyday functioning in bipolar disorder are not entirely mood-state dependent. Cognitive rehabilitation for executive dysfunction should be considered an important adjunctive treatment for many individuals with bipolar disorder.
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Affiliation(s)
- Amy T Peters
- University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Louisa G Sylvia
- Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - Scott L Rauch
- Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - Andrew A Nierenberg
- Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Darin D Dougherty
- Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Thilo Deckersbach
- Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Deckersbach T, Peters AT, Sylvia L, Urdahl A, Magalhães PV, Otto MW, Frank E, Miklowitz DJ, Berk M, Kinrys G, Nierenberg A. Do comorbid anxiety disorders moderate the effects of psychotherapy for bipolar disorder? Results from STEP-BD. Am J Psychiatry 2014; 171:178-86. [PMID: 24077657 PMCID: PMC3946300 DOI: 10.1176/appi.ajp.2013.13020225] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE At least 50% of individuals with bipolar disorder have a lifetime anxiety disorder. Individuals with both bipolar disorder and a co-occurring anxiety disorder experience longer illness duration, greater illness severity, and poorer treatment response. The study explored whether comorbid lifetime anxiety in bipolar patients moderates psychotherapy treatment outcome. METHOD In the Systematic Treatment Enhancement Program randomized controlled trial of psychotherapy for bipolar depression, participants received up to 30 sessions of intensive psychotherapy (family-focused therapy, interpersonal and social rhythm therapy, or cognitive-behavioral therapy) or collaborative care, a three-session comparison treatment, plus pharmacotherapy. Using the number needed to treat, we computed effect sizes to analyze the relationship between lifetime anxiety disorders and rates of recovery across treatment groups after 1 year. RESULTS A total of 269 patients (113 women) with a comorbid lifetime anxiety disorder (N=177) or without a comorbid lifetime anxiety disorder (N=92) were included in the analysis. Participants with a lifetime anxiety disorder were more likely to recover with psychotherapy than with collaborative care (66% compared with 49% recovered over 1 year; number needed to treat=5.88, small to medium effect). For patients without a lifetime anxiety disorder, there was no difference between rates of recovery in psychotherapy compared with collaborative care (64% compared with 62% recovered; number needed to treat=50, small effect). Participants with one lifetime anxiety disorder were likely to benefit from intensive psychotherapy compared with collaborative care (84% compared with 53% recovered; number needed to treat=3.22, medium to large effect), whereas patients with multiple anxiety disorders exhibited no difference in response to the two treatments (54% compared with 46% recovered; number needed to treat=12.5, small effect). CONCLUSIONS Depressed patients with bipolar disorder and comorbid anxiety may be in particular need of additional psychotherapy for treating acute depression. These results need to be replicated in studies that stratify bipolar patients to treatments based on their anxiety comorbidity status.
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Sylvia LG, Peters AT, Deckersbach T, Nierenberg AA. Nutrient-based therapies for bipolar disorder: a systematic review. Psychother Psychosom 2013; 82:10-9. [PMID: 23147067 DOI: 10.1159/000341309] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 06/22/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pharmacotherapy is the first line of treatment for bipolar disorder, but many patients continue to experience persistent subthreshold symptoms. Alternative adjunct treatments, including nutritional therapies, may have the potential to alleviate residual symptoms and improve the outcomes of standard pharmacotherapy. The aim of this paper is to critically review the current clinical evidence and mechanisms of action of nutrient-based therapies alone or in combination with commonly used pharmacotherapies for mania and bipolar depression. METHODS We conducted a Medline search for clinical trials conducted with humans, published in English from 1960 to 2012 using nutritional supplements such as n-3, chromium, inositol, choline, magnesium, folate and tryptophan alone or in combination with pharmacotherapies for the treatment of bipolar disorder. RESULTS Preliminary data yields conflicting but mainly positive evidence for the use of n-3 fatty acids and chromium in the treatment of bipolar depression. Limited evidence found that inositol may be helpful for bipolar depression, but larger sample sizes are needed. Preliminary randomized, controlled trials suggest that choline, magnesium, folate and tryptophan may be beneficial for reducing symptoms of mania. CONCLUSIONS Given the potential public health impact of identifying adjunct treatments that improve psychiatric as well as physical health outcomes, nutritional treatments appear promising for the management of bipolar disorder but require further study.
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Affiliation(s)
- Louisa G Sylvia
- Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
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McMurrich S, Sylvia LG, Dupuy JM, Peckham AD, Peters AT, Deckersbach T, Perlis RH. Course, outcomes, and psychosocial interventions for first-episode mania. Bipolar Disord 2012; 14:797-808. [PMID: 22963164 DOI: 10.1111/bdi.12001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The course of bipolar disorder tends to worsen over time, highlighting the importance of early intervention. Despite the recognized need for adjunctive psychosocial treatments in first-episode mania, very few studies have evaluated psychological interventions for this period of significant risk. In this empirical review, we evaluate existing research on first-episode bipolar disorder, compare this body of research to parallel studies of first-episode schizophrenia, and identify strategies for future research. METHODS A comprehensive literature search of the MEDLINE and PsychINFO databases was conducted to identify studies of first-episode mania, as well as first-episode schizophrenia. Recovery and relapse rates were compared across studies. RESULTS In contrast to a number of studies of first-episode schizophrenia, the authors identified only seven independent programs assessing first-episode mania. Findings from these studies suggest that, while pharmacological treatment helps patients achieve recovery from acute episodes, it fails to bring patients to sustained remission. Early psychosocial intervention may be imperative in reducing residual symptoms, preventing recurrence of mood episodes, and improving psychosocial functioning. However, very few studies of psychosocial interventions for first-episode mania have been systematically studied. CONCLUSIONS Studies of first-episode mania indicate a gap between syndromal/symptomatic and functional recovery. Novel psychosocial interventions for first-episode mania may help bridge this gap, but require controlled study.
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Affiliation(s)
- Stephanie McMurrich
- Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
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Keswani A, Chustz RT, Suh L, Carter R, Peters AT, Tan BK, Chandra R, Kim SH, Azam T, Dinarello CA, Kern RC, Schleimer RP, Kato A. Differential expression of interleukin-32 in chronic rhinosinusitis with and without nasal polyps. Allergy 2012; 67:25-32. [PMID: 21899560 DOI: 10.1111/j.1398-9995.2011.02706.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by local inflammation of the upper airways and sinuses and is frequently divided into polypoid CRS (CRSwNP) and nonpolypoid CRS (CRSsNP). However, the mechanism of inflammation in CRS has still not been fully elucidated. The aim of the study was to investigate the role of interleukin-32 (IL-32), a recently discovered proinflammatory cytokine, in CRS. METHODS We collected nasal epithelial cells and nasal tissue from patients with CRS and control subjects. We assayed mRNA for IL-32 by real-time PCR and measured IL-32 protein using ELISA, Western blot, and immunohistochemistry. RESULTS The expression of mRNA for IL-32 was elevated in epithelial cells from uncinate tissue from patients with CRSsNP compared with patients with CRSwNP (P < 0.05), control subjects (P=0.06), and epithelial cells from nasal polyp (NP) tissue (P < 0.05). Production of IL-32 was induced by IFN-γ, TNF, and dsRNA in primary airway epithelial cells. In whole-tissue extracts, the expression of IL-32 protein was significantly elevated in patients with CRSwNP compared with patients with CRSsNP and control subjects. Immunohistochemistry data showed that IL-32 was detected in mucosal epithelial cells and inflammatory cells in the lamina propria. Levels of IL-32 were correlated with the levels of CD3 and macrophage mannose receptor in NP tissue. Immunofluorescence data showed IL-32 co-localization with CD3-positive T cells and CD68-positive macrophages in NPs. CONCLUSION Overproduction of IL-32 may be involved in the pathogenesis of CRS, although the role of IL-32 in the inflammation in CRSsNP and CRSwNP may be different.
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Affiliation(s)
- A Keswani
- Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, 240 E. Huron,Chicago, IL 60611, USA
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Peters AT, Nierenberg AA. Stepping back to step forward: lessons from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). J Clin Psychiatry 2011; 72:1429-31. [PMID: 22075103 DOI: 10.4088/jcp.11ac07357] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Amy T Peters
- Bipolar Clinic and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MD, USA.
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Peters AT, Nierenberg AA, Deckersbach T. A 32-Year-Old Male with Mania, Leg Pain, Migraines. Psychiatr Ann 2011. [DOI: 10.3928/00485713-20110627-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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