1
|
Hafeman DM, Merranko J, Goldstein BI, Zwicker A, Uher R, Phillips ML, Birmaher B. Association between polygenic risk score and neural markers of risk for bipolar disorder. J Affect Disord 2024; 354:318-320. [PMID: 38479504 DOI: 10.1016/j.jad.2024.03.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/21/2024] [Accepted: 03/09/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Danella M Hafeman
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
| | - John Merranko
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Benjamin I Goldstein
- Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario, Canada
| | - Alyson Zwicker
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada; Dalhousie Medicine New Brunswick, Dalhousie University, Saint John, NB, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| |
Collapse
|
2
|
Sinyor M, Ekstein D, Prabaharan N, Fiksenbaum L, Vandermeer C, Schaffer A, Pirkis J, Heisel MJ, Goldstein BI, Redelmeier DA, Taylor P, Niederkrotenthaler T. Changes in Media Reporting Quality and Suicides Following National Media Engagement on Responsible Reporting of Suicide in Canada: Changements de la Qualité des reportages dans les médias sur les suicides suite à l'engagement des médias nationaux à la déclaration responsable du suicide au Canada. Can J Psychiatry 2024; 69:358-368. [PMID: 38174363 PMCID: PMC11032096 DOI: 10.1177/07067437231223334] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Responsible media reporting is an accepted strategy for preventing suicide. In 2015, suicide prevention experts launched a media engagement initiative aimed at improving suicide-related reporting in Canada; its impact on media reporting quality and suicide deaths is unknown. METHOD This pre-post observational study examined changes in reporting characteristics in a random sample of suicide-related articles from major publications in the Greater Toronto Area (GTA) media market. Articles (n = 900) included 450 from the 6-year periods prior to and after the initiative began. We also examined changes in suicide counts in the GTA between these epochs. We used chi-square tests to analyse changes in reporting characteristics and time-series analyses to identify changes in suicide counts. Secondary outcomes focused on guidelines developed by media professionals in Canada and how they may have influenced media reporting quality as well as on the overarching narrative of media articles during the most recent years of available data. RESULTS Across-the-board improvement was observed in suicide-related reporting with substantial reductions in many elements of putatively harmful content and substantial increases in all aspects of putatively protective content. However, overarching article narratives remained potentially harmful with 55.2% of articles telling the story of someone's death and 20.8% presenting an other negative message. Only 3.6% of articles told a story of survival. After controlling for potential confounders, a nonsignificant numeric decrease in suicide counts was identified after initiative implementation (ω = -5.41, SE = 3.43, t = 1.58, p = 0.12). CONCLUSIONS We found evidence that a strategy to engage media in Canada changed the content of reporting, but there was only a nonsignificant trend towards fewer suicides. A more fundamental change in media narratives to focus on survival rather than death appears warranted.
Collapse
Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Daniella Ekstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nivetha Prabaharan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | - Caroline Vandermeer
- Viterbi School of Engineering, University of Southern California, Los Angeles, USA
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Marnin J. Heisel
- Department of Psychiatry, The University of Western Ontario, London, Canada
| | - Benjamin I. Goldstein
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Youth Bipolar Disorder, Center for Addiction and Mental Health, Toronto, Canada
| | - Donald A. Redelmeier
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul Taylor
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Thomas Niederkrotenthaler
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
- Wiener Werkstaette for Suicide Research, Vienna, Austria
| |
Collapse
|
3
|
Maksyutynska K, Stogios N, Prasad F, Gill J, Hamza Z, De R, Smith E, Horta A, Goldstein BI, Korczak D, Graff-Guerrero A, Hahn MK, Agarwal SM. Neurocognitive correlates of metabolic dysregulation in individuals with mood disorders: a systematic review and meta-analysis. Psychol Med 2024; 54:1245-1271. [PMID: 38450447 DOI: 10.1017/s0033291724000345] [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: 03/08/2024]
Abstract
Individuals with mood disorders are predisposed to metabolic dysfunction, while those with metabolic dysregulation such as diabetes and obesity experience more severe depressive symptoms. Both metabolic dysfunction and mood disorders are independently associated with cognitive deficits. Therefore, given their close association, this study aimed to explore the association between metabolic dysfunction in individuals with mood disorders in relation to cognitive outcomes. A comprehensive search comprised of these three domains was carried out; a random-effects meta-analysis pooling mean cognitive outcomes was conducted (PROSPERO ID: CRD42022295765). Sixty-three studies were included in this review; 26 were synthesized in a quantitative meta-analysis. Comorbid metabolic dysregulation was associated with significantly lower global cognition among individuals with mood disorders. These trends were significant within each mood disorder subgroup, including major depressive disorder, bipolar disorder, and self-report depression/depressive symptoms. Type 2 diabetes was associated with the lowest cognitive performance in individuals with mood disorders, followed by peripheral insulin resistance, body mass index ⩾25 kg/m2, and metabolic syndrome. Significant reduction in scores was also observed among individual cognitive domains (in descending order) of working memory, attention, executive function, processing speed, verbal memory, and visual memory. These findings demonstrate the detrimental effects of comorbid metabolic dysfunction in individuals with mood disorders. Further research is required to understand the underlying mechanisms connecting mood disorders, metabolism, and cognition.
Collapse
Affiliation(s)
- Kateryna Maksyutynska
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nicolette Stogios
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Femin Prasad
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jashan Gill
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Zaineb Hamza
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Riddhita De
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Emily Smith
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Angelina Horta
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Benjamin I Goldstein
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Daphne Korczak
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Margaret K Hahn
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
4
|
Nogovitsyn N, Ballester P, Lasby M, Dunlop K, Ceniti AK, Squires S, Rowe J, Ho K, Suh J, Hassel S, Souza R, Casseb RF, Harris JK, Zamyadi M, Arnott SR, Strother SC, Hall G, Lam RW, Poppenk J, Lebel C, Bray S, Metzak P, MacIntosh BJ, Goldstein BI, Wang J, Rizvi SJ, MacQueen G, Addington J, Harkness KL, Rotzinger S, Kennedy SH, Frey BN. An empirical analysis of structural neuroimaging profiles in a staging model of depression. J Affect Disord 2024; 351:631-640. [PMID: 38290583 DOI: 10.1016/j.jad.2024.01.246] [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] [Received: 10/12/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024]
Abstract
We examine structural brain characteristics across three diagnostic categories: at risk for serious mental illness; first-presenting episode and recurrent major depressive disorder (MDD). We investigate whether the three diagnostic groups display a stepwise pattern of brain changes in the cortico-limbic regions. Integrated clinical and neuroimaging data from three large Canadian studies were pooled (total n = 622 participants, aged 12-66 years). Four clinical profiles were used in the classification of a clinical staging model: healthy comparison individuals with no history of depression (HC, n = 240), individuals at high risk for serious mental illness due to the presence of subclinical symptoms (SC, n = 80), first-episode depression (FD, n = 82), and participants with recurrent MDD in a current major depressive episode (RD, n = 220). Whole-brain volumetric measurements were extracted with FreeSurfer 7.1 and examined using three different types of analyses. Hippocampal volume decrease and cortico-limbic thinning were the most informative features for the RD vs HC comparisons. FD vs HC revealed that FD participants were characterized by a focal decrease in cortical thickness and global enlargement in amygdala volumes. Greater total amygdala volumes were significantly associated with earlier onset of illness in the FD but not the RD group. We did not confirm the construct validity of a tested clinical staging model, as a differential pattern of brain alterations was identified across the three diagnostic groups that did not parallel a stepwise clinical staging approach. The pathological processes during early stages of the illness may fundamentally differ from those that occur at later stages with clinical progression.
Collapse
Affiliation(s)
- Nikita Nogovitsyn
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Pedro Ballester
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Mike Lasby
- Electrical and Software Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Katharine Dunlop
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Amanda K Ceniti
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada; Arthur Sommer Rotenberg Suicide & Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Scott Squires
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Jessie Rowe
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Keith Ho
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada
| | - JeeSu Suh
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Stefanie Hassel
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Roberto Souza
- Electrical and Software Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Raphael F Casseb
- Neuroimaging Laboratory, University of Campinas, Campinas, SP, Brazil
| | | | - Mojdeh Zamyadi
- Rotman Research Institute, Baycrest, Toronto, ON, Canada
| | | | - Stephen C Strother
- Rotman Research Institute, Baycrest, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, ON, Canada
| | - Geoffrey Hall
- Department of Psychology, Neuroscience & Behaviour, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Jordan Poppenk
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Catherine Lebel
- Department of Radiology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Child & Adolescent Imaging Research (CAIR) Program, Calgary, AB, Canada
| | - Signe Bray
- Department of Radiology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Child & Adolescent Imaging Research (CAIR) Program, Calgary, AB, Canada
| | - Paul Metzak
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Bradley J MacIntosh
- Rotman Research Institute, Baycrest, Toronto, ON, Canada; Hurvitz Brain Sciences Program, Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada; Computational Radiology & Artificial Intelligence (CRAI) Unit, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry and Pharmacology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - JianLi Wang
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sakina J Rizvi
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada; Arthur Sommer Rotenberg Suicide & Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Glenda MacQueen
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Kate L Harkness
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Susan Rotzinger
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada; Arthur Sommer Rotenberg Suicide & Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada; Krembil Research Centre, University Health Network, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Sidney H Kennedy
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada; Arthur Sommer Rotenberg Suicide & Depression Studies Program, St. Michael's Hospital, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Krembil Research Centre, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| |
Collapse
|
5
|
Silverman AM, Dimick MK, Barton JS, Youngstrom EA, Goldstein BI. Comparing Symptoms of Major Depression in Youth with Confirmed Versus Suspected Bipolar Disorder. J Child Adolesc Psychopharmacol 2024. [PMID: 38588580 DOI: 10.1089/cap.2023.0090] [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] [Indexed: 04/10/2024]
Abstract
Background: While numerous studies have compared symptoms of major depressive episodes (MDEs) associated with bipolar disorder (BD; i.e., bipolar depression) versus major depressive disorder (MDD; i.e., unipolar depression), little is known about this topic in youth. We compared MDE symptoms in youth with BD with youth with suspected BD who have similar clinical and familial characteristics aside from having BD. Methods: MDE symptoms based on Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children (K-SADS) Depression Rating Scale items for the most severe past episode were compared in youth, ages 13-21 years, with BD (n = 208) versus suspected BD (n = 165). Diagnoses were confirmed via semistructured interviews. Symptoms with between-group differences (p < 0.05) in univariate analyses were evaluated in a multivariate forward stepwise regression. All analyses controlled for age and sex. Results: Youth with BD had significantly higher (more severe) ratings on depressed mood (p = 0.001, η2 = 0.05), irritability (p = 0.037, η2 = 0.02), anhedonia (p = 0.004, η2 = 0.04), negative self-image (p < 0.001, η2 = 0.07), hopelessness (p = 0.04, η2 = 0.02), fatigue (p = 0.001, η2 = 0.05), hypersomnia (p = 0.001, η2 = 0.05), suicidal ideation (p = 0.04, η2 = 0.02), and recurrent thoughts of death (p < 0.001, η2 = 0.05). In regression analyses, the only symptom that remained significant in the BD group was depressed mood (p = 0.002). Conclusions: These findings demonstrate greater severity of depressive symptoms in youth with BD versus MDD across mood, and cognitive and neurovegetative symptom domains. These differences are especially noteworthy given that the MDD group was highly similar to the BD group, aside from BD diagnosis. Present findings emphasize the need for novel treatment approaches to bipolar depression in youth, and for studies examining potential mechanisms underlying the increased severity of bipolar depression.
Collapse
Affiliation(s)
- Aaron M Silverman
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Jessica S Barton
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Eric A Youngstrom
- University of North Carolina at Chapel Hill and Helping Give Away Psychological Science, Inc., Chapel Hill, North Carolina, USA
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| |
Collapse
|
6
|
Goldstein BI. Editorial: The Challenge of Psychopharmacological Treatment of Anxiety Among Youth Offspring of Parents With Bipolar Disorder. J Am Acad Child Adolesc Psychiatry 2024; 63:396-398. [PMID: 37992856 DOI: 10.1016/j.jaac.2023.11.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
Mood disorders, including bipolar disorder (BD) and major depressive disorder (MDD), are leading causes of disability worldwide. MDD is the leading cause of disability beginning at age 10 years and thereafter, and BD is the fourth leading cause of disability in adolescents.1 Although one might expect that at a young age, and with a short duration of illness, mood disorders in youth are less complex than in adults, this is far from the reality. Even in epidemiologic, representative samples that do not have the same sample selection biases as clinical studies, mood disorders in youth are characterized by high rates of psychiatric comorbidity and suicidality.2-4 The perniciousness of mood disorders in youth necessitates strategies to enhance prediction of future mood disorders among those at risk, to guide prevention and early intervention strategies.
Collapse
Affiliation(s)
- Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
7
|
Kennedy KG, Ghugre NR, Roifman I, Qi X, Saul K, McCrindle BW, Macgowan CK, MacIntosh BJ, Goldstein BI. Impaired coronary microvascular reactivity in youth with bipolar disorder. Psychol Med 2024; 54:1196-1206. [PMID: 37905407 DOI: 10.1017/s0033291723003021] [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: 11/02/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is excessively prevalent and premature in bipolar disorder (BD), even after controlling for traditional cardiovascular risk factors. The increased risk of CVD in BD may be subserved by microvascular dysfunction. We examined coronary microvascular function in relation to youth BD. METHODS Participants were 86 youth, ages 13-20 years (n = 39 BD, n = 47 controls). Coronary microvascular reactivity (CMVR) was assessed using quantitative T2 magnetic resonance imaging during a validated breathing-paradigm. Quantitative T2 maps were acquired at baseline, following 60-s of hyperventilation, and every 10-s thereafter during a 40-s breath-hold. Left ventricular structure and function were evaluated based on 12-15 short- and long-axis cardiac-gated cine images. A linear mixed-effects model that controlled for age, sex, and body mass index assessed for between-group differences in CMVR (time-by-group interaction). RESULTS The breathing-paradigm induced a significant time-related increase in T2 relaxation time for all participants (i.e. CMVR; β = 0.36, p < 0.001). CMVR was significantly lower in BD v. controls (β = -0.11, p = 0.002). Post-hoc analyses found lower T2 relaxation time in BD youth after 20-, 30-, and 40 s of breath-holding (d = 0.48, d = 0.72, d = 0.91, respectively; all pFDR < 0.01). Gross left ventricular structure and function (e.g. mass, ejection fraction) were within normal ranges and did not differ between groups. CONCLUSION Youth with BD showed evidence of subclinically impaired coronary microvascular function, despite normal gross cardiac structure and function. These results converge with prior findings in adults with major depressive disorder and post-traumatic stress disorder. Future studies integrating larger samples, prospective follow-up, and blood-based biomarkers are warranted.
Collapse
Affiliation(s)
- Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Nilesh R Ghugre
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Idan Roifman
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Xiuling Qi
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kayla Saul
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian W McCrindle
- Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher K Macgowan
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Division of Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Computational Radiology & Artificial Intelligence (CRAI) unit, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
8
|
Quilty LC, Tempelaar W, Andrade BF, Kidd SA, Lunsky Y, Chen S, Wang W, Wong JKY, Lau C, Sedrak AB, Kelly R, Sivakumar H, Jani M, Ameis SH, Cleverley K, Goldstein BI, Felsky D, Dickie EW, Foussias G, Kozloff N, Nikolova YS, Polillo A, Diaconescu AO, Wheeler AL, Courtney DB, Hawke LD, Rotenberg M, Voineskos AN. Cognition and Educational Achievement in the Toronto Adolescent and Youth Cohort Study: Rationale, Methods, and Early Data. Biol Psychiatry Cogn Neurosci Neuroimaging 2024; 9:265-274. [PMID: 37979945 DOI: 10.1016/j.bpsc.2023.10.012] [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] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Both cognition and educational achievement in youths are linked to psychosis risk. One major aim of the Toronto Adolescent and Youth (TAY) Cohort Study is to characterize how cognitive and educational achievement trajectories inform the course of psychosis spectrum symptoms (PSSs), functioning, and suicidality. Here, we describe the protocol for the cognitive and educational data and early baseline data. METHODS The cognitive assessment design is consistent with youth population cohort studies, including the NIH Toolbox, Rey Auditory Verbal Learning Test, Wechsler Matrix Reasoning Task, and Little Man Task. Participants complete an educational achievement questionnaire, and report cards are requested. Completion rates, descriptive data, and differences across PSS status are reported for the first participants (N = 417) ages 11 to 24 years, who were recruited between May 4, 2021, and February 2, 2023. RESULTS Nearly 84% of the sample completed cognitive testing, and 88.2% completed the educational questionnaire, whereas report cards were collected for only 40.3%. Modifications to workflows were implemented to improve data collection. Participants who met criteria for PSSs demonstrated lower performance than those who did not on numerous key cognitive indices (p < .05) and also had more academic/educational problems. CONCLUSIONS Following youths longitudinally enabled trajectory mapping and prediction based on cognitive and educational performance in relation to PSSs in treatment-seeking youths. Youths with PSSs had lower cognitive performance and worse educational outcomes than youths without PSSs. Results show the feasibility of collecting data on cognitive and educational outcomes in a cohort of youths seeking treatment related to mental illness and substance use.
Collapse
Affiliation(s)
- Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Wanda Tempelaar
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Brendan F Andrade
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sean A Kidd
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yona Lunsky
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sheng Chen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Wei Wang
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jimmy K Y Wong
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Chloe Lau
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychology, Western University, London, Ontario, Canada
| | - Andrew B Sedrak
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rachel Kelly
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Harijah Sivakumar
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Melanie Jani
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Stephanie H Ameis
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kristin Cleverley
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Felsky
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Erin W Dickie
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - George Foussias
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Kozloff
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yuliya S Nikolova
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Alexia Polillo
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andreea O Diaconescu
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anne L Wheeler
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Neurosciences and Mental Health Program, Toronto, Ontario, Canada
| | - Darren B Courtney
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lisa D Hawke
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Martin Rotenberg
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Aristotle N Voineskos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
9
|
Cleverley K, Foussias G, Ameis SH, Courtney DB, Goldstein BI, Hawke LD, Kozloff N, Quilty LC, Rotenberg M, Wheeler AL, Andrade BF, Aitken M, Mahleka D, Jani M, Frayne M, Wong JKY, Kelly R, Dickie EW, Felsky D, Haltigan JD, Lai MC, Nikolova YS, Tempelaar W, Wang W, Battaglia M, Husain MO, Kidd S, Kurdyak P, Levitan RD, Lewis SP, Polillo A, Szatmari P, van der Miesen AIR, Ahmadzadasl M, Voineskos AN. The Toronto Adolescent and Youth Cohort Study: Study Design and Early Data Related to Psychosis Spectrum Symptoms, Functioning, and Suicidality. Biol Psychiatry Cogn Neurosci Neuroimaging 2024; 9:253-264. [PMID: 37979943 DOI: 10.1016/j.bpsc.2023.10.011] [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] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Psychosis spectrum symptoms (PSSs) occur in a sizable percentage of youth and are associated with poorer cognitive performance, poorer functioning, and suicidality (i.e., suicidal thoughts and behaviors). PSSs may occur more frequently in youths already experiencing another mental illness, but the antecedents are not well known. The Toronto Adolescent and Youth (TAY) Cohort Study aims to characterize developmental trajectories in youths with mental illness and understand associations with PSSs, functioning, and suicidality. METHODS The TAY Cohort Study is a longitudinal cohort study that aims to assess 1500 youths (age 11-24 years) presenting to tertiary care. In this article, we describe the extensive diagnostic and clinical characterization of psychopathology, substance use, functioning, suicidality, and health service utilization in these youths, with follow-up every 6 months over 5 years, including early baseline data. RESULTS A total of 417 participants were enrolled between May 4, 2021, and February 2, 2023. Participants met diagnostic criteria for an average of 3.5 psychiatric diagnoses, most frequently anxiety and depressive disorders. Forty-nine percent of participants met a pre-established threshold for PSSs and exhibited higher rates of functional impairment, internalizing and externalizing symptoms, and suicidality than participants without PSSs. CONCLUSIONS Initial findings from the TAY Cohort Study demonstrate the feasibility of extensive clinical phenotyping in youths who are seeking help for mental health problems. PSS prevalence is much higher than in community-based studies. Our early data support the critical need to better understand longitudinal trajectories of clinical youth cohorts in relation to psychosis risk, functioning, and suicidality.
Collapse
Affiliation(s)
- Kristin Cleverley
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George Foussias
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie H Ameis
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Darren B Courtney
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa D Hawke
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Kozloff
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martin Rotenberg
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anne L Wheeler
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Neurosciences and Mental Health Program, Toronto, Ontario, Canada
| | - Brendan F Andrade
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Madison Aitken
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Don Mahleka
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Melanie Jani
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Margot Frayne
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jimmy K Y Wong
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rachel Kelly
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Erin W Dickie
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Felsky
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John D Haltigan
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Meng-Chuan Lai
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; National Taiwan University Hospital and College of Medicine, Taiwan
| | - Yuliya S Nikolova
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wanda Tempelaar
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wei Wang
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Marco Battaglia
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad Omair Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sean Kidd
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert D Levitan
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Alexia Polillo
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Szatmari
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Neurosciences and Mental Health Program, Toronto, Ontario, Canada
| | - Anna I R van der Miesen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Masoud Ahmadzadasl
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Aristotle N Voineskos
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
10
|
Levenson JC, Joseph HM, Merranko J, Hafeman DM, Monk K, Goldstein BI, Axelson D, Sakolsky D, Diler RS, Goldstein T, Birmaher B. Sleep patterns among preschool offspring of parents with and without psychopathology: Association with the development of psychopathology in childhood. Bipolar Disord 2024; 26:176-185. [PMID: 37558614 PMCID: PMC10853485 DOI: 10.1111/bdi.13376] [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] [Indexed: 08/11/2023]
Abstract
BACKGROUND Disturbed sleep during early childhood predicts social-emotional problems. However, it is not known how various early childhood sleep phenotypes are associated with the development of childhood psychopathology, nor whether these relationships vary as a function of parental psychopathology. We identified sleep phenotypes among preschool youth; examined whether these phenotypes were associated with child and parent factors; and determined if early sleep phenotypes predicted later childhood psychopathology. METHODS Using data from the Pittsburgh Bipolar Offspring study, parents with bipolar disorder (BD), non-BD psychopathology, and healthy controls reported about themselves and their offspring (n = 218) when their children were ages 2-5. Offspring and parents were interviewed directly approximately every 2 years from ages 6-18. Latent class analysis (LCA) identified latent sleep classes; we compared these classes on offspring demographics, parental sleep variables, and parental diagnoses. Kaplan-Meier survival models estimated hazard of developing any new-onset Axis-I disorders, as well as BD specifically, for each class. RESULTS The optimal LCA solution featured four sleep classes, which we characterized as (1) good sleep, (2) wake after sleep onset problems, (3) bedtime problems (e.g., trouble falling asleep, resists going to bed), and (4) poor sleep generally. Good sleepers tended to have significantly less parental psychopathology than the other three classes. Risk of developing new-onset Axis-I disorders was highest among the poor sleep class and lowest among the good sleep class. CONCLUSIONS Preschool sleep phenotypes are an important predictor of the development of psychopathology. Future work is needed to understand the biopsychosocial processes underlying these trajectories.
Collapse
Affiliation(s)
- Jessica C Levenson
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Heather M Joseph
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - John Merranko
- Western Psychiatric Hospital, UPMC, Pittsburgh, Pennsylvania, USA
| | - Danella M Hafeman
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kelly Monk
- Western Psychiatric Hospital, UPMC, Pittsburgh, Pennsylvania, USA
| | - Benjamin I Goldstein
- Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - David Axelson
- Department of Psychiatry and Behavioral Health, Nationwide Children's Hospital and The Ohio State College of Medicine, Columbus, Ohio, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rasim S Diler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Tina Goldstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Psychology, University of Pittsburgh Dietrich School of Arts and Sciences, Pittsburgh, Pennsylvania, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
11
|
Dickie EW, Ameis SH, Boileau I, Diaconescu AO, Felsky D, Goldstein BI, Gonçalves V, Griffiths JD, Haltigan JD, Husain MO, Rubin-Kahana DS, Iftikhar M, Jani M, Lai MC, Lin HY, MacIntosh BJ, Wheeler AL, Vasdev N, Vieira E, Ahmadzadeh G, Heyland L, Mohan A, Ogunsanya F, Oliver LD, Zhu C, Wong JKY, Charlton C, Truong J, Yu L, Kelly R, Cleverley K, Courtney DB, Foussias G, Hawke LD, Hill S, Kozloff N, Polillo A, Rotenberg M, Quilty LC, Tempelaar W, Wang W, Nikolova YS, Voineskos AN. Neuroimaging and Biosample Collection in the Toronto Adolescent and Youth Cohort Study: Rationale, Methods, and Early Data. Biol Psychiatry Cogn Neurosci Neuroimaging 2024; 9:275-284. [PMID: 37979944 DOI: 10.1016/j.bpsc.2023.10.013] [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] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND The Toronto Adolescent and Youth (TAY) Cohort Study will characterize the neurobiological trajectories of psychosis spectrum symptoms, functioning, and suicidality (i.e., suicidal thoughts and behaviors) in youth seeking mental health care. Here, we present the neuroimaging and biosample component of the protocol. We also present feasibility and quality control metrics for the baseline sample collected thus far. METHODS The current study includes youths (ages 11-24 years) who were referred to child and youth mental health services within a large tertiary care center in Toronto, Ontario, Canada, with target recruitment of 1500 participants. Participants were offered the opportunity to provide any or all of the following: 1) 1-hour magnetic resonance imaging (MRI) scan (electroencephalography if ineligible for or declined MRI), 2) blood sample for genomic and proteomic data (or saliva if blood collection was declined or not feasible) and urine sample, and 3) heart rate recording to assess respiratory sinus arrhythmia. RESULTS Of the first 417 participants who consented to participate between May 4, 2021, and February 2, 2023, 412 agreed to participate in the imaging and biosample protocol. Of these, 334 completed imaging, 341 provided a biosample, 338 completed respiratory sinus arrhythmia, and 316 completed all 3. Following quality control, data usability was high (MRI: T1-weighted 99%, diffusion-weighted imaging 99%, arterial spin labeling 90%, resting-state functional MRI 95%, task functional MRI 90%; electroencephalography: 83%; respiratory sinus arrhythmia: 99%). CONCLUSIONS The high consent rates, good completion rates, and high data usability reported here demonstrate the feasibility of collecting and using brain imaging and biosamples in a large clinical cohort of youths seeking mental health care.
Collapse
Affiliation(s)
- Erin W Dickie
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie H Ameis
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isabelle Boileau
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andreea O Diaconescu
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Felsky
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa Gonçalves
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John D Griffiths
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John D Haltigan
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad O Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dafna S Rubin-Kahana
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Myera Iftikhar
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Melanie Jani
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Meng-Chuan Lai
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; National Taiwan University Hospital and College of Medicine, Taiwan
| | - Hsiang-Yuan Lin
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Oslo University Hospital, Oslo, Norway
| | - Anne L Wheeler
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Hospital for Sick Children, Neurosciences and Mental Health, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Neil Vasdev
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Erica Vieira
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ghazaleh Ahmadzadeh
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lindsay Heyland
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Acadia University, Wolfville, Nova Scotia, Canada
| | - Akshay Mohan
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Feyi Ogunsanya
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychology, Western University, London, Ontario, Canada
| | - Lindsay D Oliver
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Cherrie Zhu
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute at Sinai Health, Toronto, Ontario, Canada
| | - Jimmy K Y Wong
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Colleen Charlton
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jennifer Truong
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lujia Yu
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rachel Kelly
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kristin Cleverley
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Darren B Courtney
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George Foussias
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa D Hawke
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sean Hill
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Nicole Kozloff
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alexia Polillo
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Martin Rotenberg
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wanda Tempelaar
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wei Wang
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Yuliya S Nikolova
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Aristotle N Voineskos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
12
|
Fiedorowicz JG, Merranko JA, Goldstein TR, Hower H, Iyengar S, Hafeman DM, Hunt JI, Strober M, Keller MB, Goldstein BI, Diler RS, Siddiqi S, Birmaher B. Validation of a youth suicide risk calculator in an adult sample with bipolar disorder. J Affect Disord 2024; 347:278-284. [PMID: 38007103 PMCID: PMC11022308 DOI: 10.1016/j.jad.2023.11.066] [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: 07/09/2023] [Revised: 11/08/2023] [Accepted: 11/18/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Bipolar disorder (BD) conveys the highest risk of suicide of all mental disorders. We sought to externally validate a risk calculator (RC) of suicide attempts developed in youth with BD from the Course and Outcome of Bipolar Youth (COBY) study in an adult sample. METHODS A prospective cohort of adults with BD from the National Institute of Mental Health Collaborative Depression Study (CDS; N = 427; mean (+/- SD) age at intake (36 +/- 13 years)) was secondarily analyzed to validate the COBY RC for one-year risk of suicide attempts/deaths. Nine of the ten predictor variables from the COBY RC were available in the CDS and used: age, age of mood disorder onset, first and second (partial) degree family history of suicide, history of psychotic symptoms, substance use disorder, prior suicide attempt, socioeconomic status, and non-suicidal self-injury (prospectively, incompletely at baseline). RESULTS Over a mean (SD) follow-up of 19 (10) years, 29 % of the CDS sample attempted suicide. The RC predicted suicide attempts/deaths over one-year follow-up with an area under the receiver operating characteristic curve (AUC) of 0.78 (95 % CI 0.75-0.80). The RC performed slightly better in those with a younger age of mood disorder onset. LIMITATIONS Clinical samples may limit generalizability; the RC does not assess more acute suicide risk. CONCLUSIONS One-year risk of suicide attempts/deaths can be predicted with acceptable accuracy in youth and adults with BD, comparable to commonly used RCs to predict cardiovascular risk. This RC may help identify higher-risk individuals with BD for personalized treatment and research. https://cobysuicideattemptsrc.shinyapps.io/Shiny.
Collapse
Affiliation(s)
- Jess G Fiedorowicz
- Departments of Psychiatry and Epidemiology, The University of Ottawa, 75 Laurier Ave. East, Ottawa, ON K1N 6N5, Canada.
| | - John A Merranko
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Tina R Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; Department of Psychiatry, University of California San Diego, 4510 Executive Drive, Suite 315, San Diego, CA 92121, USA
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, 230 S. Bouquet St., Pittsburgh, PA 15213, USA
| | - Danella M Hafeman
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Jeffrey I Hunt
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Department of Psychiatry, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Martin B Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Department of Psychiatry, University of Miami, 1120 NW 14(th) St., Miami, FL 33136, USA
| | - Benjamin I Goldstein
- Department of Psychiatry, CAMH, University of Toronto Faculty of Medicine, 2075 Bayview Ave., FG-53, Toronto, ON M4N-3M5, Canada
| | - Rasim S Diler
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Sara Siddiqi
- Departments of Psychiatry and Epidemiology, The University of Ottawa, 75 Laurier Ave. East, Ottawa, ON K1N 6N5, Canada
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| |
Collapse
|
13
|
Jiang X, Zai CC, Dimick MK, Kennedy JL, Young LT, Birmaher B, Goldstein BI. Psychiatric Polygenic Risk Scores Across Youth With Bipolar Disorder, Youth at High Risk for Bipolar Disorder, and Controls. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00062-5. [PMID: 38340895 DOI: 10.1016/j.jaac.2023.12.009] [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: 07/05/2023] [Revised: 11/23/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE There is a pronounced gap in knowledge regarding polygenic underpinnings of youth bipolar disorder (BD). This study aimed to compare polygenic risk scores (PRSs) in youth with BD, youth at high clinical and/or familial risk for BD (HR), and controls. METHOD Participants were 344 youths of European ancestry (13-20 years old), including 136 youths with BD, 121 HR youths, and 87 controls. PRSs for BD, schizophrenia, major depressive disorder, and attention-deficit/hyperactivity disorder were constructed using independent genome-wide summary statistics from adult cohorts. Multinomial logistic regression was used to examine the association between each PRS and diagnostic status (BD vs HR vs controls). All genetic analyses controlled for age, sex, and 2 genetic principal components. RESULTS The BD group showed significantly higher BD-PRS than the control group (odds ratio = 1.54, 95% CI = 1.13-2.10, p = .006), with the HR group numerically intermediate. BD-PRS explained 7.9% of phenotypic variance. PRSs for schizophrenia, major depressive disorder, and attention-deficit/hyperactivity disorder were not significantly different among groups. In the BD group, BD-PRS did not significantly differ in relation to BD subtype, age of onset, psychosis, or family history of BD. CONCLUSION BD-PRS derived from adult genome-wide summary statistics is elevated in youth with BD. Absence of significant between-group differences in PRSs for other psychiatric disorders supports the specificity of BD-PRS in youth. These findings add to the biological validation of BD in youth and could have implications for early identification and diagnosis. To enhance clinical utility, future genome-wide association studies that focus specifically on early-onset BD are warranted, as are studies integrating additional genetic and environmental factors. DIVERSITY & INCLUSION STATEMENT We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
Collapse
Affiliation(s)
- Xinyue Jiang
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Clement C Zai
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; University of Toronto, Toronto, Ontario, Canada; Tanenbaum Centre for Pharmacogenetics, Psychiatric Neurogenetics Section, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - James L Kennedy
- University of Toronto, Toronto, Ontario, Canada; Tanenbaum Centre for Pharmacogenetics, Psychiatric Neurogenetics Section, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - L Trevor Young
- University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Boris Birmaher
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
14
|
Mitchell RHB, Grigorian A, Robertson A, Toma S, Luciw NJ, Karthikeyan S, Mutsaerts HJMM, Fiksenbaum L, Metcalfe AWS, MacIntosh BJ, Goldstein BI. Sex differences in cerebral blood flow among adolescents with bipolar disorder. Bipolar Disord 2024; 26:33-43. [PMID: 37217255 DOI: 10.1111/bdi.13326] [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] [Indexed: 05/24/2023]
Abstract
BACKGROUND Abnormalities in cerebral blood flow (CBF) are common in bipolar disorder (BD). Despite known differences in CBF between healthy adolescent males and females, sex differences in CBF among adolescents with BD have never been studied. OBJECTIVE To examine sex differences in CBF among adolescents with BD versus healthy controls (HC). METHODS CBF images were acquired using arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) in 123 adolescents (72 BD: 30M, 42F; 51 HC: 22M, 29F) matched for age (13-20 years). Whole brain voxel-wise analysis was performed in a general linear model with sex and diagnosis as fixed factors, sex-diagnosis interaction effect, and age as a covariate. We tested for main effects of sex, diagnosis, and their interaction. Results were thresholded at cluster forming p = 0.0125, with posthoc Bonferroni correction (p = 0.05/4 groups). RESULTS A main effect of diagnosis (BD > HC) was observed in the superior longitudinal fasciculus (SLF), underlying the left precentral gyrus (F =10.24 (3), p < 0.0001). A main effect of sex (F > M) on CBF was detected in the precuneus/posterior cingulate cortex (PCC), left frontal and occipital poles, left thalamus, left SLF, and right inferior longitudinal fasciculus (ILF). No regions demonstrated a significant sex-by-diagnosis interaction. Exploratory pairwise testing in regions with a main effect of sex revealed greater CBF in females with BD versus HC in the precuneus/PCC (F = 7.1 (3), p < 0.01). CONCLUSION Greater CBF in female adolescents with BD versus HC in the precuneus/PCC may reflect the role of this region in the neurobiological sex differences of adolescent-onset BD. Larger studies targeting underlying mechanisms, such as mitochondrial dysfunction or oxidative stress, are warranted.
Collapse
Affiliation(s)
- Rachel H B Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrew Robertson
- Department of Kinesiology, Research Institute for Aging, University of Waterloo, Ontario, Canada
| | - Simina Toma
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Nicholas J Luciw
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Sudhir Karthikeyan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Henri J M M Mutsaerts
- Radiology and Nuclear Medicine Vrje Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, Netherlands
| | - Lisa Fiksenbaum
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Arron W S Metcalfe
- Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program , Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program , Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Si S, Bi A, Yu Z, See C, Kelly S, Ambrogi S, Arango C, Baeza I, Banaj N, Berk M, Castro-Fornieles J, Crespo-Facorro B, Crouse JJ, Díaz-Caneja CM, Fett AK, Fortea A, Frangou S, Goldstein BI, Hickie IB, Janssen J, Kennedy KG, Krabbendam L, Kyriakopoulos M, MacIntosh BJ, Morgado P, Nerland S, Pascual-Diaz S, Picó-Pérez M, Piras F, Rund BR, de la Serna E, Spalletta G, Sugranyes G, Suo C, Tordesillas-Gutiérrez D, Vecchio D, Radua J, McGuire P, Thomopoulos SI, Jahanshad N, Thompson PM, Barth C, Agartz I, James A, Kempton MJ. Mapping gray and white matter volume abnormalities in early-onset psychosis: an ENIGMA multicenter voxel-based morphometry study. Mol Psychiatry 2024:10.1038/s41380-023-02343-1. [PMID: 38195979 DOI: 10.1038/s41380-023-02343-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/13/2023] [Revised: 11/07/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Regional gray matter (GM) alterations have been reported in early-onset psychosis (EOP, onset before age 18), but previous studies have yielded conflicting results, likely due to small sample sizes and the different brain regions examined. In this study, we conducted a whole brain voxel-based morphometry (VBM) analysis in a large sample of individuals with EOP, using the newly developed ENIGMA-VBM tool. METHODS 15 independent cohorts from the ENIGMA-EOP working group participated in the study. The overall sample comprised T1-weighted MRI data from 482 individuals with EOP and 469 healthy controls. Each site performed the VBM analysis locally using the standardized ENIGMA-VBM tool. Statistical parametric T-maps were generated from each cohort and meta-analyzed to reveal voxel-wise differences between EOP and healthy controls as well as the individual-based association between GM volume and age of onset, chlorpromazine (CPZ) equivalent dose, and other clinical variables. RESULTS Compared with healthy controls, individuals with EOP showed widespread lower GM volume encompassing most of the cortex, with the most marked effect in the left median cingulate (Hedges' g = 0.55, p = 0.001 corrected), as well as small clusters of lower white matter (WM), whereas no regional GM or WM volumes were higher in EOP. Lower GM volume in the cerebellum, thalamus and left inferior parietal gyrus was associated with older age of onset. Deficits in GM in the left inferior frontal gyrus, right insula, right precentral gyrus and right superior frontal gyrus were also associated with higher CPZ equivalent doses. CONCLUSION EOP is associated with widespread reductions in cortical GM volume, while WM is affected to a smaller extent. GM volume alterations are associated with age of onset and CPZ equivalent dose but these effects are small compared to case-control differences. Mapping anatomical abnormalities in EOP may lead to a better understanding of the role of psychosis in brain development during childhood and adolescence.
Collapse
Affiliation(s)
- Shuqing Si
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
| | - Anbreen Bi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Zhaoying Yu
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Cheryl See
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sinead Kelly
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sonia Ambrogi
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Hospital Clinic Barcelona. CIBERSAM-ISCIII. Fundació de Recerca Clínic Barcelona - August Pi i Sunyer Biomedical Research Institute (FCRB-IDIBAPS). Institute of Neuroscience, Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Nerisa Banaj
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Michael Berk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Hospital Clinic Barcelona. CIBERSAM-ISCIII. Fundació de Recerca Clínic Barcelona - August Pi i Sunyer Biomedical Research Institute (FCRB-IDIBAPS). Institute of Neuroscience, Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Benedicto Crespo-Facorro
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Department of Psychiatry, CIBERSAM, IBiS-CSIC, Sevilla, Spain
| | - Jacob J Crouse
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Anne-Kathrin Fett
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- Department of Psychology, City, University of London, London, UK
| | - Adriana Fortea
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Hospital Clinic Barcelona. CIBERSAM-ISCIII. Fundació de Recerca Clínic Barcelona - August Pi i Sunyer Biomedical Research Institute (FCRB-IDIBAPS). Institute of Neuroscience, Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Sophia Frangou
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Joost Janssen
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, Madrid, Spain
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Lydia Krabbendam
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Institute for Brain and Behaviour (IBBA) Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marinos Kyriakopoulos
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 2CA-Braga Cinical Academic Center, Hospital de Braga, 4710-243, Braga, Portugal
| | - Stener Nerland
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Saül Pascual-Diaz
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain
| | - Maria Picó-Pérez
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Departamento de Psicología Básica, Clínica y Psicobiología, Universitat Jaume I, Castelló de la Plana, Spain
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Bjørn Rishovd Rund
- Research Department, Vestre Viken Hospital Trust, 3004, Drammen, Norway
- Department of Psychology, University of Oslo, P. O. box 1094, Blindern, 0317, Oslo, Norway
| | - Elena de la Serna
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Hospital Clinic Barcelona. CIBERSAM-ISCIII. Fundació de Recerca Clínic Barcelona - August Pi i Sunyer Biomedical Research Institute (FCRB-IDIBAPS). Institute of Neuroscience, Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Gianfranco Spalletta
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Hospital Clinic Barcelona. CIBERSAM-ISCIII. Fundació de Recerca Clínic Barcelona - August Pi i Sunyer Biomedical Research Institute (FCRB-IDIBAPS). Institute of Neuroscience, Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Chao Suo
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Diana Tordesillas-Gutiérrez
- Department of Radiology, Marqués de Valdecilla University Hospital, Valdecilla Biomedical Research Institute IDIVAL, Santander (Cantabria), Spain
- Advanced Computing and e-Science, Instituto de Física de Cantabria (UC-CSIC), Santander (Cantabria), Spain
| | - Daniela Vecchio
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Claudia Barth
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Agartz
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute & Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
| | - Anthony James
- Department of Psychiatry, University of Oxford, Oxford, UK
- Highfield Unit, Warneford Hospital, Oxford, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
16
|
Shao S, Zou Y, Kennedy KG, Dimick MK, MacIntosh BJ, Goldstein BI. Higher Levels of C-reactive Protein Are Associated With Higher Cortical Surface Area and Lower Cortical Thickness in Youth With Bipolar Disorder. Int J Neuropsychopharmacol 2023; 26:867-878. [PMID: 37947206 PMCID: PMC10726415 DOI: 10.1093/ijnp/pyad063] [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: 03/15/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Inflammation is implicated in the neuropathology of bipolar disorder (BD). The association of C-reactive protein (CRP) with brain structure has been examined in relation to BD among adults but not youth. METHODS Participants included 101 youth (BD, n = 55; control group [CG], n = 46; aged 13-20 years). Blood samples were assayed for levels of CRP. T1-weighted brain images were acquired to obtain cortical surface area (SA), volume, and thickness for 3 regions of interest (ROI; whole-brain cortical gray matter, prefrontal cortex, orbitofrontal cortex [OFC]) and for vertex-wise analyses. Analyses included CRP main effects and interaction effects controlling for age, sex, and intracranial volume. RESULTS In ROI analyses, higher CRP was associated with higher whole-brain SA (β = 0.16; P = .03) and lower whole-brain (β = -0.31; P = .03) and OFC cortical thickness (β = -0.29; P = .04) within the BD group and was associated with higher OFC SA (β = 0.17; P = .03) within the CG. In vertex-wise analyses, higher CRP was associated with higher SA and lower cortical thickness in frontal and parietal regions within BD. A significant CRP-by-diagnosis interaction was found in frontal and temporal regions, whereby higher CRP was associated with lower neurostructural metrics in the BD group but higher neurostructural metrics in CG. CONCLUSIONS This study found that higher CRP among youth with BD is associated with higher SA but lower cortical thickness in ROI and vertex-wise analyses. The study identified 2 regions in which the association of CRP with brain structure differs between youth with BD and the CG. Future longitudinal, repeated-measures studies incorporating additional inflammatory markers are warranted.
Collapse
Affiliation(s)
- Suyi Shao
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada (Ms Shao, Drs Zou and Goldstein)
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yi Zou
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Dr Sandra Black Centre for Brain Resilience and Recovery, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
17
|
Mio M, Kennedy KG, Grigorian A, Zou Y, Dimick MK, Selkirk B, Kertes PJ, Swardfager W, Hahn MK, Black SE, MacIntosh BJ, Goldstein BI. White matter microstructural integrity is associated with retinal vascular caliber in adolescents with bipolar disorder. J Psychosom Res 2023; 175:111529. [PMID: 37856933 DOI: 10.1016/j.jpsychores.2023.111529] [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] [Received: 04/25/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Reduced white matter integrity is observed in bipolar disorder (BD), and is associated with cardiovascular risk in adults. This topic is underexplored in youth, and in BD, where novel microvascular measures may help to inform understanding of the vascular-brain connection. We therefore examined the association of retinal vascular caliber with white matter integrity in a cross-sectional sample of adolescents with and without BD. METHODS Eighty-four adolescents (n = 42 BD, n = 42 controls) completed retinal imaging, yielding arteriolar and venular caliber. Diffusion tensor imaging measured white matter fractional anisotropy (FA). Multiple linear regression tested associations between retinal vascular caliber and FA in regions-of-interest; corpus callosum, anterior thalamic radiation, uncinate fasciculus, and superior longitudinal fasciculus. Complementary voxel-wise analyses were performed. RESULTS Arteriolar caliber was elevated in adolescents with BD relative to controls (F(1,79) = 6.15, p = 0.02, η2p = 0.07). In the overall sample, higher venular caliber was significantly associated with lower corpus callosum FA (β = -0.24, puncorrected = 0.04). In voxel-wise analyses, higher arteriolar caliber was significantly associated with lower corpus callosum and forceps minor FA in the overall sample (β = -0.46, p = 0.03). A significant diagnosis-by-venular caliber interaction on FA was noted in 5 clusters including the right retrolenticular internal capsule (β = 0.72, p = 0.03), corticospinal tract (β = 0.72, p = 0.04), and anterior corona radiata (β = 0.63, p = 0.04). In each instance, venular caliber was more positively associated with FA in BD vs. controls. CONCLUSION Retinal microvascular measures are associated with white matter integrity in BD, particularly in the corpus callosum. This study was proof-of-concept, designed to guide future studies focused on the vascular-brain interface in BD.
Collapse
Affiliation(s)
- Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Beth Selkirk
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada
| | - Peter J Kertes
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada; University of Toronto, Ophthalmology and Vision Sciences, Toronto, Canada
| | - Walter Swardfager
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Margaret K Hahn
- Schizophrenia Department, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| |
Collapse
|
18
|
Jiang X, Zai CC, Sultan AA, Dimick MK, Nikolova YS, Felsky D, Young LT, MacIntosh BJ, Goldstein BI. Association of polygenic risk for bipolar disorder with resting-state network functional connectivity in youth with and without bipolar disorder. Eur Neuropsychopharmacol 2023; 77:38-52. [PMID: 37717349 DOI: 10.1016/j.euroneuro.2023.08.503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 05/04/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/19/2023]
Abstract
Little is known regarding the polygenic underpinnings of anomalous resting-state functional connectivity (rsFC) in youth bipolar disorder (BD). The current study examined the association of polygenic risk for BD (BD-PRS) with whole-brain rsFC at the large-scale network level in youth with and without BD. 99 youth of European ancestry (56 BD, 43 healthy controls [HC]), ages 13-20 years, completed resting-state fMRI scans. BD-PRS was calculated using summary statistics from the latest adult BD genome-wide association study. Data-driven independent component analyses of the resting-state fMRI data were implemented to examine the association of BD-PRS with rsFC in the overall sample, and separately in BD and HC. In the overall sample, higher BD-PRS was associated with lower rsFC of the salience network and higher rsFC of the frontoparietal network with frontal and parietal regions. Within the BD group, higher BD-PRS was associated with higher rsFC of the default mode network with orbitofrontal cortex, and altered rsFC of the visual network with frontal and occipital regions. Within the HC group, higher BD-PRS was associated with altered rsFC of the frontoparietal network with frontal, temporal and occipital regions. In conclusion, the current study found that BD-PRS generated based on adult genetic data was associated with altered rsFC patterns of brain networks in youth. Our findings support the usefulness of BD-PRS to investigate genetically influenced neuroimaging markers of vulnerability to BD, which can be observed in youth with BD early in their course of illness as well as in healthy youth.
Collapse
Affiliation(s)
- Xinyue Jiang
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Clement C Zai
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Alysha A Sultan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yuliya S Nikolova
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel Felsky
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Totonto, ON, Canada
| | - L Trevor Young
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Sandra E Black Centre for Brain Resilience and Recovery, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
19
|
Jiang X, Zai CC, Kennedy KG, Zou Y, Nikolova YS, Felsky D, Young LT, MacIntosh BJ, Goldstein BI. Association of polygenic risk for bipolar disorder with grey matter structure and white matter integrity in youth. Transl Psychiatry 2023; 13:322. [PMID: 37852985 PMCID: PMC10584947 DOI: 10.1038/s41398-023-02607-y] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023] Open
Abstract
There is a gap in knowledge regarding the polygenic underpinnings of brain anomalies observed in youth bipolar disorder (BD). This study examined the association of a polygenic risk score for BD (BD-PRS) with grey matter structure and white matter integrity in youth with and without BD. 113 participants were included in the analyses, including 78 participants with both T1-weighted and diffusion-weighted MRI images, 32 participants with T1-weighted images only, and 3 participants with diffusion-weighted images only. BD-PRS was calculated using PRS-CS-auto and was based on independent adult genome-wide summary statistics. Vertex- and voxel-wise analyses examined the associations of BD-PRS with grey matter metrics (cortical volume [CV], cortical surface area [CSA], cortical thickness [CTh]) and fractional anisotropy [FA] in the combined sample, and separately in BD and HC. In the combined sample of participants with T1-weighted images (n = 110, 66 BD, 44 HC), higher BD-PRS was associated with smaller grey matter metrics in frontal and temporal regions. In within-group analyses, higher BD-PRS was associated with lower CTh of frontal, temporal, and fusiform gyrus in BD, and with lower CV and CSA of superior frontal gyrus in HC. In the combined sample of participants with diffusion-weighted images (n = 81, 49 BD, 32 HC), higher BD-PRS was associated with lower FA in widespread white matter regions. In summary, BD-PRS calculated based on adult genetic data was negatively associated with grey matter structure and FA in youth in regions implicated in BD, which may suggest neuroimaging markers of vulnerability to BD. Future longitudinal studies are needed to examine whether BD-PRS predicts neurodevelopmental changes in BD vs. HC and its interaction with course of illness and long-term medication use.
Collapse
Affiliation(s)
- Xinyue Jiang
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Clement C Zai
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yuliya S Nikolova
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel Felsky
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - L Trevor Young
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Sandra E Black Centre for Brain Resilience and Recovery, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
20
|
Hafeman DM, Merranko J, Joseph HM, Goldstein TR, Goldstein BI, Levenson J, Axelson D, Monk K, Sakolsky D, Iyengar S, Birmaher B. Early indicators of bipolar risk in preschool offspring of parents with bipolar disorder. J Child Psychol Psychiatry 2023; 64:1492-1500. [PMID: 36577710 PMCID: PMC10300228 DOI: 10.1111/jcpp.13739] [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] [Accepted: 11/17/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Offspring of parents with bipolar disorder (BD-I/II) are at increased risk to develop the disorder. Previous work indicates that bipolar spectrum disorder (BPSD) is often preceded by mood/anxiety symptoms. In school-age offspring of parents with BD, we previously built a risk calculator to predict BPSD onset, which generates person-level risk scores. Here, we test whether preschool symptoms predict school-age BPSD risk. METHODS We assessed 113 offspring of parents with BD 1-3 times during preschool years (2-5 years old) and then approximately every 2 years for a mean of 10.6 years. We used penalized (lasso) regression with linear mixed models to assess relationships between preschool mood, anxiety, and behavioral symptoms (parent-reported) and school-age predictors of BPSD onset (i.e., risk score, subthreshold manic symptoms, and mood lability), adjusting for demographics and parental symptomatology. Finally, we conducted survival analyses to assess associations between preschool symptoms and school-age onset of BPSD and mood disorder. RESULTS Of 113 preschool offspring, 33 developed new-onset mood disorder, including 19 with new-onset BPSD. Preschool irritability, sleep problems, and parental factors were lasso-selected predictors of school-age risk scores. After accounting for demographic and parental factors, preschool symptoms were no longer significant. Lasso regressions to predict mood lability and subthreshold manic symptoms yielded similar predictors (irritability, sleep problems, and parental affective lability), but preschool symptoms remained predictive even after adjusting for parental factors (ps < .005). Exploratory analyses indicated that preschool irritability univariately predicted new-onset BPSD (p = .02) and mood disorder (p = .02). CONCLUSIONS These results provide initial prospective evidence that, as early as preschool, youth who will develop elevated risk scores, mood lability, and subthreshold manic symptoms are already showing symptomatology; these preschool symptoms also predict new-onset BPSD. While replication of findings in larger samples is warranted, results point to the need for earlier assessment of risk and development of early interventions.
Collapse
Affiliation(s)
- Danella M. Hafeman
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - John Merranko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Heather M. Joseph
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Tina R. Goldstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Benjamin I. Goldstein
- Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Jessica Levenson
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - David Axelson
- Nationwide Children’s Hospital and Ohio State College of Medicine, Columbus, OH
| | - Kelly Monk
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, Pittsburgh, PA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| |
Collapse
|
21
|
Dimick MK, Sultan AA, Kennedy KG, Rizvi SJ, Forbes EE, Sinyor M, McIntyre RS, Youngstrom EA, Goldstein BI. Risk-Sensitive Decision-Making and Self-Harm in Youth Bipolar Disorder. J Clin Psychiatry 2023; 84:22m14693. [PMID: 37672015 DOI: 10.4088/jcp.22m14693] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Background: Youth with bipolar disorder (BD) are at high risk for suicide and have high rates of self-harm, which includes both suicide attempts and non-suicidal self-injury. Greater risk-taking has been associated with suicide attempts in youth with major depression, although there are no studies examining the relationship between risk-related decision-making and self-harm in youth with BD. We aimed to examine the association of suicide risk with risk-sensitive decision-making in a controlled sample of youth with BD. Methods: Eighty-one youth with BD (based on DSM-IV criteria; 52 youth with a history of self-harm [BDSH+]; 29 without a history of self-harm [BDSH-]) and 82 age- and sex-matched control youth aged 13-20 years were recruited between 2012 and 2020. Decision-making and risk-taking performance were assessed via the Cambridge Gambling Task within the Cambridge Neuropsychological Test Automated Battery (CANTAB). General linear models were used to examine differences between groups with control for age, sex, and IQ. Results: There was a significant difference in the overall proportion of points bet (F2,157 = 3.87, P = .02, η2 = 0.23) such that BDSH- youth performed better than both BDSH+ (P = .02) and control youth (P = .04). Mean latency was significant (F3,156 = 4.12, P = .017, η2 = 0.03), with BDSH- youth deliberating longer than controls (P = .03). Risk-taking significantly differed between groups (F2,157 = 3.83, P = .02, η2 = 0.23), with BDSH- youth showing greater self-control compared to BDSH+ (P = .01) and control youth (P = .01). Conclusions: BDSH- youth had greater self-control and lower risk-taking. We speculate this finding may be reflective of a compensatory process among BDSH- youth serving a protective role in suicide risk. Future longitudinal studies are needed to examine the temporal association of neurocognition and self-harm among youth with BD.
Collapse
Affiliation(s)
- Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alysha A Sultan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sakina J Rizvi
- ASR Suicide and Depression Studies Unit, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Erika E Forbes
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Corresponding Author: Benjamin I. Goldstein, MD, PhD, Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J 1H4, Canada
| |
Collapse
|
22
|
Sultan AA, Mio M, Dimick MK, Zou Y, Karthikeyan S, Kolla N, Lanctot K, Zack M, Goldstein BI. Association of cannabis use with neurocognition in adolescents with bipolar disorder. J Psychopharmacol 2023; 37:920-927. [PMID: 37497695 DOI: 10.1177/02698811231187128] [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] [Indexed: 07/28/2023]
Abstract
BACKGROUND Bipolar disorder (BD) and cannabis use are each associated with neurocognitive deficits in adolescents. However, little is known regarding the association of neurocognition with cannabis use among adolescents with BD. Therefore, we examined this topic in a sample of adolescents with BD and healthy control (HC) adolescents. METHODS Participants included 121 adolescents (n = 32 with BD and lifetime cannabis use (BDCB+), n = 31 with BD and no lifetime cannabis use (BDCB-), n = 58 HC with no lifetime cannabis use), aged 14-20 years. Five neurocognitive subtests of the computerized CANTAB battery were assessed. Groups were compared using an analysis of covariance (ANCOVA) covarying for age, sex, and intelligence quotient. RESULTS The three groups differed significantly on tests of visuospatial working memory (F = 4.41, p = 0.014, η p 2 = 0 . 07 ) and sustained attention (F = 5.15, p = 0.007, η p 2 = 0 . 08 ). Post hoc analyses revealed working memory scores were significantly worse in BDCB+ versus HC (p = 0.04, d = 0.59), and sustained attention was significantly worse in BDCB- versus HC (p = 0.006, d = 0.70). CONCLUSION These preliminary findings suggest that cannabis use among adolescents with BD is associated with working memory deficits. Future studies in larger samples are warranted to evaluate causation versus predisposition to cannabis use, and to evaluate duration, quantity, and potency of cannabis on neurocognition among adolescents with BD.
Collapse
Affiliation(s)
- Alysha A Sultan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Nathan Kolla
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Krista Lanctot
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Martin Zack
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
23
|
Yan NE, Dimick MK, Kennedy KG, Zai CC, Kennedy JL, MacIntosh BJ, Goldstein BI. Vascular Endothelial Growth Factor Polymorphism rs699947 Is Associated with Neurostructural Phenotypes in Youth with Bipolar Disorder. J Child Adolesc Psychopharmacol 2023; 33:243-254. [PMID: 37459144 DOI: 10.1089/cap.2022.0083] [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: 08/18/2023]
Abstract
Background: Vascular endothelial growth factor (VEGF) may be relevant to bipolar disorder (BD) and brain structure. We evaluated VEGF rs699947 single-nucleotide polymorphism in relation to structural neuroimaging phenotypes in youth BD. Methods: We collected 3 T anatomical magnetic resonance images from 154 youth (79 BD and 75 healthy control [HC]) genotyped for VEGF rs699947. The participants were age (BD = 17.28 ± 1.40 and HC = 17.01 ± 1.83, t = -1.02, p = 0.31) and sex (BD = 63.3% females and HC = 52.0% females, χ2 = 2.01, p = 0.16) matched. Cortical thickness, surface area (SA), and volume were examined by region-of-interest (ROI) and vertex-wise analyses using general linear models (GLMs). ROI investigations selected for the prefrontal cortex (PFC), amygdala, and hippocampus. Vertex-wise analyses controlled for age, sex, and intracranial volume. Results: ROI results found lower PFC SA (p = 0.003, ηp2 = 0.06) and volume (p = 0.04, ηp2 = 0.03) in BD and a main effect of rs699947 on hippocampal volume (p = 0.03, ηp2 = 0.05). The latter two findings did not survive multiple comparisons. Vertex-wise analyses found rs699947 main effects on left postcentral gyrus volume (p < 0.001), right rostral anterior cingulate SA (p = 0.004), and right superior temporal gyrus thickness (p = 0.004). There were significant diagnosis-by-genotype interactions in the left superior temporal, left caudal middle frontal, left superior frontal, right fusiform, and right lingual gyri, and the left insular cortex. Posthoc analyses revealed the AA allele was associated with larger brain structures among HC, but smaller brain structures in BD for most clusters. Conclusions: Overall, we found preliminary evidence of divergent associations between BD and HC youth in terms of neurostructural correlates of VEGF rs699947 encompassing highly relevant frontotemporal regions.
Collapse
Affiliation(s)
- Nicole E Yan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Clement C Zai
- Neurogenetics Section and Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - James L Kennedy
- Neurogenetics Section and Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
24
|
Goldstein BI. Comorbidity in pediatric bipolar disorder: An unmet challenge in need of treatment studies. Acta Psychiatr Scand 2023; 148:107-109. [PMID: 37439358 PMCID: PMC10471138 DOI: 10.1111/acps.13591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Departments of Psychiatry and Pharmacology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Luciw NJ, Grigorian A, Dimick MK, Jiang G, Chen JJ, Graham SJ, Goldstein BI, MacIntosh BJ. Classifying youth with bipolar disorder versus healthy youth using cerebral blood flow patterns. J Psychiatry Neurosci 2023; 48:E305-E314. [PMID: 37643801 PMCID: PMC10473037 DOI: 10.1503/jpn.230012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/14/2023] [Accepted: 05/27/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Clinical neuroimaging studies often investigate group differences between patients and controls, yet multivariate imaging features may enable individual-level classification. This study aims to classify youth with bipolar disorder (BD) versus healthy youth using grey matter cerebral blood flow (CBF) data analyzed with logistic regressions. METHODS Using a 3 Tesla magnetic resonance imaging (MRI) system, we collected pseudo-continuous, arterial spin-labelling, resting-state functional MRI (rfMRI) and T 1-weighted images from youth with BD and healthy controls. We used 3 logistic regression models to classify youth with BD versus controls, controlling for age and sex, using mean grey matter CBF as a single explanatory variable, quantitative CBF features based on principal component analysis (PCA) or relative (intensity-normalized) CBF features based on PCA. We also carried out a comparison analysis using rfMRI data. RESULTS The study included 46 patients with BD (mean age 17 yr, standard deviation [SD] 1 yr; 25 females) and 49 healthy controls (mean age 16 yr, SD 2 yr; 24 females). Global mean CBF and multivariate quantitative CBF offered similar classification performance that was above chance. The association between CBF images and the feature map was not significantly different between groups (p = 0.13); however, the multivariate classifier identified regions with lower CBF among patients with BD (ΔCBF = -2.94 mL/100 g/min; permutation test p = 0047). Classification performance decreased when considering rfMRI data. LIMITATIONS We cannot comment on which CBF principal component is most relevant to the classification. Participants may have had various mood states, comorbidities, demographics and medication records. CONCLUSION Brain CBF features can classify youth with BD versus healthy controls with above-chance accuracy using logistic regression. A global CBF feature may offer similar classification performance to distinct multivariate CBF features.
Collapse
Affiliation(s)
- Nicholas J Luciw
- From Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont. (Luciw, Jiang, Graham, MacIntosh); the Department of Medical Biophysics, University of Toronto, Toronto, Ont. (Luciw, Jiang, Chen, Graham, MacIntosh); the Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ont. (Grigorian, Dimick, Goldstein); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Dimick, Goldstein); the Rotman Research Institute, Baycrest Health Sciences, Toronto, Ont. (Chen); the Institute of Biomedical Engineering, University of Toronto, Toronto, Ont. (Chen); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Goldstein); the Sandra Black Centre for Brain Resilience & Recovery, Toronto, Ont. (MacIntosh); the Computational Radiology & Artificial Intelligence Unit, Oslo University Hospital, Norway (MacIntosh)
| | - Anahit Grigorian
- From Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont. (Luciw, Jiang, Graham, MacIntosh); the Department of Medical Biophysics, University of Toronto, Toronto, Ont. (Luciw, Jiang, Chen, Graham, MacIntosh); the Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ont. (Grigorian, Dimick, Goldstein); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Dimick, Goldstein); the Rotman Research Institute, Baycrest Health Sciences, Toronto, Ont. (Chen); the Institute of Biomedical Engineering, University of Toronto, Toronto, Ont. (Chen); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Goldstein); the Sandra Black Centre for Brain Resilience & Recovery, Toronto, Ont. (MacIntosh); the Computational Radiology & Artificial Intelligence Unit, Oslo University Hospital, Norway (MacIntosh)
| | - Mikaela K Dimick
- From Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont. (Luciw, Jiang, Graham, MacIntosh); the Department of Medical Biophysics, University of Toronto, Toronto, Ont. (Luciw, Jiang, Chen, Graham, MacIntosh); the Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ont. (Grigorian, Dimick, Goldstein); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Dimick, Goldstein); the Rotman Research Institute, Baycrest Health Sciences, Toronto, Ont. (Chen); the Institute of Biomedical Engineering, University of Toronto, Toronto, Ont. (Chen); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Goldstein); the Sandra Black Centre for Brain Resilience & Recovery, Toronto, Ont. (MacIntosh); the Computational Radiology & Artificial Intelligence Unit, Oslo University Hospital, Norway (MacIntosh)
| | - Guocheng Jiang
- From Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont. (Luciw, Jiang, Graham, MacIntosh); the Department of Medical Biophysics, University of Toronto, Toronto, Ont. (Luciw, Jiang, Chen, Graham, MacIntosh); the Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ont. (Grigorian, Dimick, Goldstein); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Dimick, Goldstein); the Rotman Research Institute, Baycrest Health Sciences, Toronto, Ont. (Chen); the Institute of Biomedical Engineering, University of Toronto, Toronto, Ont. (Chen); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Goldstein); the Sandra Black Centre for Brain Resilience & Recovery, Toronto, Ont. (MacIntosh); the Computational Radiology & Artificial Intelligence Unit, Oslo University Hospital, Norway (MacIntosh)
| | - J Jean Chen
- From Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont. (Luciw, Jiang, Graham, MacIntosh); the Department of Medical Biophysics, University of Toronto, Toronto, Ont. (Luciw, Jiang, Chen, Graham, MacIntosh); the Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ont. (Grigorian, Dimick, Goldstein); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Dimick, Goldstein); the Rotman Research Institute, Baycrest Health Sciences, Toronto, Ont. (Chen); the Institute of Biomedical Engineering, University of Toronto, Toronto, Ont. (Chen); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Goldstein); the Sandra Black Centre for Brain Resilience & Recovery, Toronto, Ont. (MacIntosh); the Computational Radiology & Artificial Intelligence Unit, Oslo University Hospital, Norway (MacIntosh)
| | - Simon J Graham
- From Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont. (Luciw, Jiang, Graham, MacIntosh); the Department of Medical Biophysics, University of Toronto, Toronto, Ont. (Luciw, Jiang, Chen, Graham, MacIntosh); the Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ont. (Grigorian, Dimick, Goldstein); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Dimick, Goldstein); the Rotman Research Institute, Baycrest Health Sciences, Toronto, Ont. (Chen); the Institute of Biomedical Engineering, University of Toronto, Toronto, Ont. (Chen); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Goldstein); the Sandra Black Centre for Brain Resilience & Recovery, Toronto, Ont. (MacIntosh); the Computational Radiology & Artificial Intelligence Unit, Oslo University Hospital, Norway (MacIntosh)
| | - Benjamin I Goldstein
- From Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont. (Luciw, Jiang, Graham, MacIntosh); the Department of Medical Biophysics, University of Toronto, Toronto, Ont. (Luciw, Jiang, Chen, Graham, MacIntosh); the Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ont. (Grigorian, Dimick, Goldstein); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Dimick, Goldstein); the Rotman Research Institute, Baycrest Health Sciences, Toronto, Ont. (Chen); the Institute of Biomedical Engineering, University of Toronto, Toronto, Ont. (Chen); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Goldstein); the Sandra Black Centre for Brain Resilience & Recovery, Toronto, Ont. (MacIntosh); the Computational Radiology & Artificial Intelligence Unit, Oslo University Hospital, Norway (MacIntosh)
| | - Bradley J MacIntosh
- From Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ont. (Luciw, Jiang, Graham, MacIntosh); the Department of Medical Biophysics, University of Toronto, Toronto, Ont. (Luciw, Jiang, Chen, Graham, MacIntosh); the Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ont. (Grigorian, Dimick, Goldstein); the Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ont. (Dimick, Goldstein); the Rotman Research Institute, Baycrest Health Sciences, Toronto, Ont. (Chen); the Institute of Biomedical Engineering, University of Toronto, Toronto, Ont. (Chen); the Department of Psychiatry, University of Toronto, Toronto, Ont. (Goldstein); the Sandra Black Centre for Brain Resilience & Recovery, Toronto, Ont. (MacIntosh); the Computational Radiology & Artificial Intelligence Unit, Oslo University Hospital, Norway (MacIntosh)
| |
Collapse
|
26
|
Mitchell RHB, Kozloff N, Sanches M, Goldstein BI, Amini J, Bridge JA, Sinyor M. Sex Differences in Suicide Trends Among Adolescents Aged 10 to 14 Years in Canada. Can J Psychiatry 2023; 68:547-549. [PMID: 37132039 PMCID: PMC10408560 DOI: 10.1177/07067437231173370] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Rachel H. B. Mitchell
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Nicole Kozloff
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Canada
| | - Marcos Sanches
- Biostatistics Core, Centre for Addiction and Mental Health, Toronto, Canada
| | - Benjamin I. Goldstein
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Youth Bipolar Disorder, Center for Addiction and Mental Health, Toronto, Canada
| | - Jasmine Amini
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Toronto, Canada
| | - Jeffrey A. Bridge
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mark Sinyor
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| |
Collapse
|
27
|
Dimick MK, Hird MA, Sultan AA, Mitchell RHB, Sinyor M, MacIntosh BJ, Goldstein BI. Resting-state functional connectivity indicators of risk and resilience for self-harm in adolescent bipolar disorder. Psychol Med 2023; 53:3377-3386. [PMID: 35256032 PMCID: PMC10277718 DOI: 10.1017/s0033291721005419] [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] [Received: 04/05/2021] [Revised: 10/29/2021] [Accepted: 12/14/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Suicide is the second leading cause of death in all youth and among adults with bipolar disorder (BD). The risk of suicide in BD is among the highest of all psychiatric conditions. Self-harm, including suicide attempts and non-suicidal self-injury, is a leading risk factor for suicide. Neuroimaging studies suggest reward circuits are implicated in both BD and self-harm; however, studies have yet to examine self-harm related resting-state functional connectivity (rsFC) phenotypes within adolescent BD. METHODS Resting-state fMRI data were analyzed for 141 adolescents, ages 13-20 years, including 38 with BD and lifetime self-harm (BDSH+), 33 with BD and no self-harm (BDSH-), and 70 healthy controls (HC). The dorsolateral prefrontal cortex (dlPFC), orbitofrontal cortex (OFC) and amygdala were examined as regions of interest in seed-to-voxel analyses. A general linear model was used to explore the bivariate correlations for each seed. RESULTS BDSH- had increased positive rsFC between the left amygdala and left lateral occipital cortex, and between the right dlPFC and right frontal pole, and increased negative rsFC between the left amygdala and left superior frontal gyrus compared to BDSH+ and HC. BDSH+ had increased positive rsFC of the right OFC with the precuneus and left paracingulate gyrus compared to BDSH- and HC. CONCLUSIONS This study provides preliminary evidence of altered reward-related rsFC in relation to self-harm in adolescents with BD. Between-group differences conveyed a combination of putative risk and resilience connectivity patterns. Future studies are warranted to evaluate changes in rsFC in response to treatment and related changes in self-harm.
Collapse
Affiliation(s)
- Mikaela K. Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Hurvitz Brain Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Megan A. Hird
- MD Program, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Alysha A. Sultan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Hurvitz Brain Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rachel H. B. Mitchell
- Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bradley J. MacIntosh
- Hurvitz Brain Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Benjamin I. Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Hurvitz Brain Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| |
Collapse
|
28
|
Kennedy KG, Karthikeyan S, Sultan AA, McCrindle BW, Miller GE, Goldstein BI. Endothelial Function in Youth With Bipolar Disorder: Preliminary Evidence for Mood Polarity Differences. J Clin Psychiatry 2023; 84. [PMID: 37134116 DOI: 10.4088/jcp.22m14608] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Background: Bipolar disorder (BD) confers risk for accelerated atherosclerosis and early cardiovascular disease (CVD). In adults, mood symptom burden is associated with CVD. Here we examine endothelial dysfunction, considered an early predictor of CVD, in relation to mood states and symptoms among youth with BD. Methods: Participants were 209 youth, aged 13-20 years, including 114 with BD and 95 healthy controls (HC) recruited between 2012 and 2020. Diagnoses and mood symptoms were ascertained using validated, semi-structured interviews based on DSM-IV-TR criteria. Reactive hyperemia index (RHI), a measure of endothelial function, was assessed non-invasively via pulse amplitude tonometry (PAT). RHI was compared across 4 groups: BD-euthymic (n = 34), BD-depressed (n = 36), BD-hypomanic/mixed (n = 44), and HC (n = 95) controlling for age, sex, and obesity. Analyses also examined for RHI-mood associations in the overall BD group. Results: RHI was significantly different between groups (F3,202 = 4.47, P = .005, ηp2 = 0.06). Specifically, RHI was lower in the BD-depressed group compared to HC (P = .04, d = 0.4). Additionally, the BD-hypomanic/mixed group had higher RHI compared to the BD-euthymic (P = .02, d = 0.55), BD-depressed (P < .001, d = 0.79), and HC (P = .04, d = 0.55) groups. Lastly, within the BD group, higher RHI was associated with higher mania scores (P = .006, β = 0.26), but not depression scores. All analyses remained significant in sensitivity analyses further controlling for cardiovascular risk factors and for current lithium, second-generation antipsychotic, and any medication use. Conclusions: We found that symptomatic youth with BD have anomalous RHI, which varies according to mood polarity. Future studies in larger samples, with prospective repeated measures, should investigate whether endothelial dysfunction partially subserves the psychiatric symptoms and cardiovascular risk observed in BD.
Collapse
Affiliation(s)
- Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Sudhir Karthikeyan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alysha A Sultan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Gregory E Miller
- Institute for Policy Research & Department of Psychology, Northwestern University, Evanston, Illinois
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Corresponding author: Benjamin I. Goldstein, MD, PhD, Centre for Addiction and Mental Health, 100 Stokes St, M6J 1H4, Toronto, ON, Canada
| |
Collapse
|
29
|
Goldstein BI, Fiedorowicz JG. The Vascular - Bipolar Link. J Affect Disord 2023; 332:201-202. [PMID: 37024016 DOI: 10.1016/j.jad.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/08/2023]
Affiliation(s)
- Benjamin I Goldstein
- Departments of Psychiatry and Pharmacology, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Jess G Fiedorowicz
- Departments of Psychiatry and Epidemiology, The University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| |
Collapse
|
30
|
Zwicker A, Fullerton JM, Mullins N, Rice F, Hafeman DM, van Haren NEM, Setiaman N, Merranko JA, Goldstein BI, Ferrera AG, Stapp EK, de la Serna E, Moreno D, Sugranyes G, Herrero SM, Roberts G, Toma C, Schofield PR, Edenberg HJ, Wilcox HC, McInnis MG, Powell V, Propper L, Denovan-Wright E, Rouleau G, Castro-Fornieles J, Hillegers MHJ, Birmaher B, Thapar A, Mitchell PB, Lewis CM, Alda M, Nurnberger JI, Uher R. Polygenic Scores and Onset of Major Mood or Psychotic Disorders Among Offspring of Affected Parents. Am J Psychiatry 2023; 180:285-293. [PMID: 36856707 DOI: 10.1176/appi.ajp.20220476] [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] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Family history is an established risk factor for mental illness. The authors sought to investigate whether polygenic scores (PGSs) can complement family history to improve identification of risk for major mood and psychotic disorders. METHODS Eight cohorts were combined to create a sample of 1,884 participants ages 2-36 years, including 1,339 offspring of parents with mood or psychotic disorders, who were prospectively assessed with diagnostic interviews over an average of 5.1 years. PGSs were constructed for depression, bipolar disorder, anxiety, attention deficit hyperactivity disorder (ADHD), schizophrenia, neuroticism, subjective well-being, p factor, and height (as a negative control). Cox regression was used to test associations between PGSs, family history of major mental illness, and onsets of major mood and psychotic disorders. RESULTS There were 435 onsets of major mood and psychotic disorders across follow-up. PGSs for neuroticism (hazard ratio=1.23, 95% CI=1.12-1.36), schizophrenia (hazard ratio=1.15, 95% CI=1.04-1.26), depression (hazard ratio=1.11, 95% CI=1.01-1.22), ADHD (hazard ratio=1.10, 95% CI=1.00-1.21), subjective well-being (hazard ratio=0.90, 95% CI=0.82-0.99), and p factor (hazard ratio=1.14, 95% CI=1.04-1.26) were associated with onsets. After controlling for family history, neuroticism PGS remained significantly positively associated (hazard ratio=1.19, 95% CI=1.08-1.31) and subjective well-being PGS remained significantly negatively associated (hazard ratio=0.89, 95% CI=0.81-0.98) with onsets. CONCLUSIONS Neuroticism and subjective well-being PGSs capture risk of major mood and psychotic disorders that is independent of family history, whereas PGSs for psychiatric illness provide limited predictive power when family history is known. Neuroticism and subjective well-being PGSs may complement family history in the early identification of persons at elevated risk.
Collapse
Affiliation(s)
- Alyson Zwicker
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Janice M Fullerton
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Niamh Mullins
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Frances Rice
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Danella M Hafeman
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Neeltje E M van Haren
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Nikita Setiaman
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - John A Merranko
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Benjamin I Goldstein
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Alessandra G Ferrera
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Emma K Stapp
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Elena de la Serna
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Dolores Moreno
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Gisela Sugranyes
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Sergio Mas Herrero
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Gloria Roberts
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Claudio Toma
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Peter R Schofield
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Howard J Edenberg
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Holly C Wilcox
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Melvin G McInnis
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Victoria Powell
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Lukas Propper
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Eileen Denovan-Wright
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Guy Rouleau
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Josefina Castro-Fornieles
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Manon H J Hillegers
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Boris Birmaher
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Anita Thapar
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Philip B Mitchell
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Cathryn M Lewis
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Martin Alda
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - John I Nurnberger
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| | - Rudolf Uher
- Department of Psychiatry (Zwicker, Propper, Denovan-Wright, Alda, Uher) and Department of Pharmacology (Denovan-Wright), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax (Zwicker, Alda, Uher); Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada (Zwicker); Neuroscience Research Australia, Randwick, New South Wales, Australia (Fullerton, Toma, Schofield); School of Medical Sciences, University of New South Wales, Kensington, Australia (Fullerton, Toma, Schofield); Department of Genetics and Genomic Sciences and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Mullins); Wolfson Centre for Young People's Mental Health, Section of Child and Adolescent Psychiatry, Division of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, U.K. (Rice, Powell, Thapar); Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh (Hafeman, Merranko, Birmaher); Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands (van Haren, Setiaman, Hillegers); Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands (van Haren, Setiaman, Hillegers); Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario (Goldstein); Department of Psychiatry (Ferrera, Nurnberger) and Stark Neurosciences Research Institute (Nurnberger), Indiana University School of Medicine, Indianapolis; NIMH, Bethesda, Md. (Stapp); Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain (de la Serna, Moreno, Sugranyes, Castro-Fornieles); Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Spain (de la Serna, Sugranyes, Castro-Fornieles); Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid (Moreno); Department of Psychiatry, Universitat de Barcelona, Spain (Herrero); School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia (Roberts, Mitchell); Centro de Biología Molecular "Severo Ochoa," Universidad Autónoma de Madrid/CSIC, Madrid (Toma); Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis (Edenberg); Department of Psychiatry and Behavioral Sciences, Division of Child Psychiatry and Public Health, Johns Hopkins Medicine, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Wilcox); Department of Psychiatry, University of Michigan, Ann Arbor (McInnis); IWK Health Centre, Halifax (Propper); Montreal Neurological Institute and Department of Neurology, McGill University, Montreal (Rouleau); Department of Medicine, University of Barcelona, Barcelona, Spain (Castro-Fornieles); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Lewis)
| |
Collapse
|
31
|
Kennedy KG, Islam AH, Karthikeyan S, Metcalfe AWS, McCrindle BW, MacIntosh BJ, Black S, Goldstein BI. Differential association of endothelial function with brain structure in youth with versus without bipolar disorder. J Psychosom Res 2023; 167:111180. [PMID: 36764023 DOI: 10.1016/j.jpsychores.2023.111180] [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: 11/17/2022] [Revised: 01/22/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mood symptoms and disorders are associated with impaired endothelial function, a marker of early atherosclerosis. Given the increased vascular burden and neurostructural differences among individuals with mood disorders, we investigated the endothelial function and brain structure interface in relation to youth bipolar disorder (BD). METHODS This cross-sectional case-controlled study included 115 youth, ages 13-20 years (n = 66 BD; n = 49 controls [CG]). Cortical thickness and volume for regions of interest (ROI; insular cortex, ventrolateral prefrontal cortex [vlPFC], temporal lobe) were acquired from FreeSurfer processed T1-weighted MRI images. Endothelial function was assessed using pulse amplitude tonometry, yielding a reactive hyperemia index (RHI). ROI and vertex-wise analyses controlling for age, sex, obesity, and intracranial volume investigated for RHI-neurostructural associations, and RHI-by-diagnosis interactions. RESULTS In ROI analyses, higher RHI (i.e., better endothelial function) was associated with lower thickness in the insular cortex (β = -0.19, pFDR = 0.03), vlPFC (β = -0.30, pFDR = 0.003), and temporal lobe (β = -0.22, pFDR = 0.01); and lower temporal lobe volume (β = -0.16, pFDR = 0.01) in the overall sample. In vertex-wise analyses, higher RHI was associated with lower cortical thickness and volume in the insular cortex, prefrontal cortex (e.g., vlPFC), and temporal lobe. Additionally, higher RHI was associated with lower vlPFC and temporal lobe volume to a greater extent in youth with BD vs. CG. CONCLUSIONS Better endothelial function was associated with lower regional brain thickness and volume, contrasting the hypothesized associations. Additionally, we found evidence that this pattern was exaggerated in youth with BD. Future studies examining the direction of the observed associations and underlying mechanisms are warranted.
Collapse
Affiliation(s)
- Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
| | - Alvi H Islam
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sudhir Karthikeyan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Arron W S Metcalfe
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Brian W McCrindle
- Faculty of Medicine, University of Toronto, Toronto, Canada; Hospital for Sick Children, Toronto, Canada; Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada; Computational Radiology & Artificial Intelligence (CRAI) Unit, Dept of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
| | - Sandra Black
- Faculty of Medicine, University of Toronto, Toronto, Canada; Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada.
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, Canada.
| |
Collapse
|
32
|
Sultan AA, Dimick MK, Zai CC, Kennedy JL, MacIntosh BJ, Goldstein BI. The association of CNR1 genetic variants with resting-state functional connectivity in youth bipolar disorder. Eur Neuropsychopharmacol 2023; 71:41-54. [PMID: 36972648 DOI: 10.1016/j.euroneuro.2023.03.004] [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: 10/19/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/29/2023]
Abstract
Cannabinoid 1 receptors coded by the CNR1 gene are implicated in mood disorders and addiction. Given the prevalence and negative correlates of cannabis use in bipolar disorder (BD), we examined CNR1 polymorphism rs1324072 in relation to resting-state functional connectivity (rsFC) in youth BD. Participants included 124 youth, ages 13-20 years: 17 BD G-carriers, 48 BD non-carriers, 16 healthy controls (HC) G-carriers, and 43 HC non-carriers. rsFC was obtained using 3T-MRI. General linear models examined main effects of diagnosis, gene, and diagnosis-by-gene interaction, controlling for age, sex, and race. Regions-of-interests in seed-to-voxel analyses included: bilateral amygdala, hippocampus, nucleus accumbens (NAc), and orbitofrontal cortex (OFC). Main effects of diagnosis were observed for rsFC between the right amygdala seed and right occipital pole, and between the left NAc seed and left superior parietal lobe. Interaction analyses identified 6 significant clusters. G-allele was associated with negative connectivity in BD and positive connectivity in HC for: left amygdala seed with right intracalcarine cortex; right NAc seed with left inferior frontal gyrus; and right hippocampal seed with bilateral cuneal cortex (all p<0.001). G-allele was associated with positive connectivity in BD and negative connectivity in HC for: right hippocampal seed with left central opercular cortex (p = 0.001), and left NAc seed with left middle temporal cortex (p = 0.002). In conclusion, CNR1 rs1324072 was differentially associated with rsFC in youth with BD in regions relevant to reward and emotion. Future studies powered to integrate CNR1 alongside cannabis use are warranted to examine the inter-relationship between rs1324072 G-allele, cannabis use, and BD.
Collapse
Affiliation(s)
- Alysha A Sultan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Clement C Zai
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Psychiatric Neurogenetics Section, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - James L Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Psychiatric Neurogenetics Section, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Computational Radiology and Artificial Intelligence unit, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Hurvitz Brain Sciences Program, Sandra E Black Centre for Brain Resilience & Recovery, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
33
|
Kennedy KG, Mio M, Goldstein BI, Brambilla P, Delvecchio G. Systematic review and meta-analysis of retinal microvascular caliber in bipolar disorder, major depressive disorder, and schizophrenia. J Affect Disord 2023; 331:342-351. [PMID: 36958491 DOI: 10.1016/j.jad.2023.03.040] [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: 01/20/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Individuals with a severe mental illness (SMI), such as bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia (SZ), have increased rates of cardiovascular and cerebrovascular disease. Interestingly, it has been reported that retinal microvessels, a proxy cerebrovascular measure, non-invasively assessed via retinal imaging, predict future cardiovascular disease, with some studies also showing anomalous retinal microvascular caliber in SMI. Therefore, this review and meta-analysis evaluated whether retinal microvascular caliber differs between individuals with SMI vs controls and summarized current findings. METHODS A systematic literature search for retinal microvascular caliber and SMI was conducted in Embase and MEDLINE. Studies needed to be published in English before 2022 December 1st and examine retinal microvascular caliber in individuals diagnosed with a SMI. Finally, a meta-analysis of arteriolar and venular caliber in SMI case-controlled studies was also conducted. RESULTS The search yielded 65 unique articles, 11 were included in the review and 6 in the meta-analysis. The meta-analysis found that the SMI group had significantly wider venules than controls (SMD = -0.53; 95 % CI = 0.24, 0.81; p = 0.0004) but not arterioles (SMD = 0.07; 95 % CI = -0.29, 0.44; p = 0.70). Additionally, the systematic review found that poorer retinal microvascular health is associated with greater illness severity. LIMITATIONS Large heterogeneity of findings and small sample size. CONCLUSION This systematic review and meta-analysis found that SMI, specifically SZ, is associated with wider retinal venules. Retinal imaging, a fast, cost-effective, and non-invasive assay of cerebrovascular health, may provide insight into the pathophysiological processes of SMI. However, future longitudinal studies investigating these findings are warranted.
Collapse
Affiliation(s)
- Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| |
Collapse
|
34
|
Puramat P, Dimick MK, Kennedy KG, Zai CC, Kennedy JL, MacIntosh BJ, Goldstein BI. Neurostructural and neurocognitive correlates of APOE ε4 in youth bipolar disorder. J Psychopharmacol 2023; 37:408-419. [PMID: 36919310 DOI: 10.1177/02698811221147151] [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] [Indexed: 03/16/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is a clinical risk factor for Alzheimer's disease (AD). Apolipoprotein E ε4 (APOE ε4), a genetic risk factor for AD, has been associated with brain structure and neurocognition in healthy youth. AIMS We evaluated whether there was an association between APOE ε4 with neurostructure and neurocognition in youth with BD. METHODS Participants included 150 youth (78 BD:19 ε4-carriers, 72 controls:17 ε4-carriers). 3T-magnetic resonance imaging yielded measures of cortical thickness, surface area, and volume. Regions-of-interest (ROI) and vertex-wise analyses of the cortex were conducted. Neurocognitive tests of attention and working memory were examined. RESULTS Vertex-wise analyses revealed clusters with a diagnosis-by-APOE ε4 interaction effect for surface area (p = 0.002) and volume (p = 0.046) in pars triangularis (BD ε4-carriers > BD noncarriers), and surface area (p = 0.03) in superior frontal gyrus (controls ε4-carriers > other groups). ROI analyses were not significant. A significant interaction effect for working memory (p = 0.001) appeared to be driven by nominally poorer performance in BD ε4-carriers but not control ε4-carriers; however, post hoc contrasts were not significant. CONCLUSIONS APOE ε4 was associated with larger neurostructural metrics in BD and controls, however, the regional association of APOE ε4 with neurostructure differed between groups. The role of APOE ε4 on neurodevelopmental processes is a plausible explanation for the observed differences. Future studies should evaluate the association of APOE ε4 with pars triangularis and its neurofunctional implications among youth with BD.
Collapse
Affiliation(s)
- Parnian Puramat
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Clement C Zai
- Neurogenetics Section and Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - James L Kennedy
- Neurogenetics Section and Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Hurvitz Brain Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
35
|
Jones BDM, Umer M, Kittur ME, Finkelstein O, Xue S, Dimick MK, Ortiz A, Goldstein BI, Mulsant BH, Husain MI. A systematic review on the effectiveness of dialectical behavior therapy for improving mood symptoms in bipolar disorders. Int J Bipolar Disord 2023; 11:6. [PMID: 36739574 PMCID: PMC9899872 DOI: 10.1186/s40345-023-00288-6] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/25/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence-based psychotherapies available to treat patients with bipolar disorders (BD) are limited. Dialectical behavior therapy (DBT) may target several common symptoms of BD. We conducted a systematic review on the efficacy of DBT for mood symptoms in patients with BD. The systematic search used key words related to DBT and BD in Medline, Embase, PsycInfo, CINAHL, and Cochrane Library databases from 1980 to April 1st, 2022. We included studies that enrolled patients with a BD I or II diagnosis (DSM or ICD), age 12 and older who received a DBT-based intervention. Studies reviewed were clinical trials including observational studies that reported at least one outcome related to BD mood symptoms or severity. We did not exclude based upon psychiatric or physical co-morbidity. RESULTS We screened 848 abstracts and reviewed 28 full texts; 10 publications with 11 studies met our pre-determined eligibility criteria. All but one were feasibility pilot studies and most included participants in all mood states except for mania. The studies provided preliminary evidence suggesting these interventions may be effective for improving several core symptoms of BD. Overall, all the studies consistently supported that DBT-based interventions are feasible and acceptable for patients with BD. CONCLUSION DBT may be an effective treatment for BD; however, the confidence in this conclusion is limited by the small sample sizes, heterogeneity, and high risk of bias in all published trials. Larger well-designed RCTs are now required to establish the effectiveness of DBT in BD.
Collapse
Affiliation(s)
- Brett D. M. Jones
- grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, Canada
| | - Madeha Umer
- grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, Canada
| | - Mary E. Kittur
- grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, Canada
| | - Ofer Finkelstein
- grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, Canada
| | - Siqi Xue
- grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, Canada
| | - Mikaela K. Dimick
- grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, Canada
| | - Abigail Ortiz
- grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, Canada
| | - Benjamin I. Goldstein
- grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, Canada
| | - Benoit H. Mulsant
- grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, Canada
| | - Muhammad I. Husain
- grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, Canada
| |
Collapse
|
36
|
Jiang X, Sultan AA, Dimick MK, Zai CC, Kennedy JL, MacIntosh BJ, Goldstein BI. The association of genetic variation in CACNA1C with resting-state functional connectivity in youth bipolar disorder. Int J Bipolar Disord 2023; 11:3. [PMID: 36637564 PMCID: PMC9839925 DOI: 10.1186/s40345-022-00281-5] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/13/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND CACNA1C rs1006737 A allele, identified as a genetic risk variant for bipolar disorder (BD), is associated with anomalous functional connectivity in adults with and without BD. Studies have yet to investigate the association of CACNA1C rs1006737 with resting-state functional connectivity (rsFC) in youth BD. METHODS Participants included 139 youth with BD-I, -II, or -not otherwise specified, ages 13-20 years, including 27 BD A-carriers, 41 BD non-carriers, 32 healthy controls (HC) A-carriers, and 39 HC non-carriers. Anterior cingulate cortex (ACC), amygdala, and orbitofrontal cortex (OFC) were examined as regions-of-interest in seed-to-voxel analyses. General linear models included main effects of diagnosis and rs1006737, and an interaction term, controlling for age, sex, and race. RESULTS We observed a main effect of BD diagnosis on rsFC between the right amygdala and the right occipital pole (p = 0.02), and a main effect of rs1006737 genotypes on rsFC between the right OFC and bilateral occipital cortex (p < 0.001). Two significant BD diagnosis-by-CACNA1C rs1006737 interactions were also identified. The A allele was associated with positive rsFC between the right ACC and right amygdala in BD but negative rsFC in HC (p = 0.01), and negative rsFC between the left OFC and left putamen in BD but positive rsFC in HC (p = 0.01). CONCLUSION This study found that the rs1006737 A allele, identified as a genetic risk variant for BD in adults, was differentially associated with rsFC in youth with BD in regions relevant to emotion, executive function, and reward. Future task-based approaches are warranted to better understand brain connectivity in relation to CACNA1C in BD.
Collapse
Affiliation(s)
- Xinyue Jiang
- grid.155956.b0000 0000 8793 5925Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON Canada
| | - Alysha A. Sultan
- grid.155956.b0000 0000 8793 5925Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON Canada
| | - Mikaela K. Dimick
- grid.155956.b0000 0000 8793 5925Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON Canada
| | - Clement C. Zai
- grid.155956.b0000 0000 8793 5925Tanenbaum Centre for Pharmacogenetics, Psychiatric Neurogenetics Section, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Canada
| | - James L. Kennedy
- grid.155956.b0000 0000 8793 5925Tanenbaum Centre for Pharmacogenetics, Psychiatric Neurogenetics Section, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Bradley J. MacIntosh
- grid.17063.330000 0001 2157 2938Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Medical Biophysics, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON Canada
| | - Benjamin I. Goldstein
- grid.155956.b0000 0000 8793 5925Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Canada
| |
Collapse
|
37
|
Khoubaeva D, Dimick M, Timmins VH, Fiksenbaum LM, Mitchell RHB, Schaffer A, Sinyor M, Goldstein BI. Clinical correlates of suicidality and self-injurious behaviour among Canadian adolescents with bipolar disorder. Eur Child Adolesc Psychiatry 2023; 32:41-51. [PMID: 34028609 DOI: 10.1007/s00787-021-01803-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 09/21/2020] [Accepted: 05/09/2021] [Indexed: 11/26/2022]
Abstract
There is high risk of suicidality in bipolar disorder (BD), particularly in early onset cases. The literature regarding correlates and putative predictors of suicide attempts (SA), non-suicidal self-injury (NSSI) and suicidal ideation (SI) among youth with BD remains sparse. Participants included 197 adolescents with BD, divided into 4 groups: SA (with or without NSSI), NSSI (with or without SI), SI only, and comparison group (CG; no SA/NSSI/SI). Diagnoses, treatment, and suicidality measures were determined via semi-structured interviews, conducted between 2009 and 2017. Univariate analyses were followed by multinomial regression. Overall, 73.6% of participants had history of SA, NSSI, and/or SI. In comparison to CG, SA and NSSI were each associated with BD-II/-NOS (odds ratio [OR] = 15.99, p = 0.002; OR = 16.76, p = 0.003), female sex (OR = 6.89, p = 0.006; OR = 3.76, p = 0.02), and emotion dysregulation (OR = 1.10, p < 0.001; OR = 1.07, p = 0.004). NSSI and SI were each associated with most severe lifetime depression (OR = 1.10, p = 0.01; OR = 1.10, p = 0.01). SA and SI were associated with psychiatric hospitalization (OR = 19.45, p = 0.001; OR = 6.09, p = 0.03). SA was associated with poorer global functioning at most severe episode (OR = 0.88, p = 0.008). NSSI was associated with not living with both natural parents (OR = 0.22, p = 0.009). Study limitations include cross-sectional and retrospective design, stringent cut-offs for SA and NSSI, and recruitment from a tertiary clinical setting. Three quarters of adolescents with BD have had suicidality and/or self-injury. SA and NSSI were most similar to one another, and most different from CG, supporting the broader construct of self-harm. Future research should address the gap in knowledge regarding how sex differences and neurobiology are associated with the observed clinical differences.
Collapse
Affiliation(s)
- Diana Khoubaeva
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | - Mikaela Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Vanessa H Timmins
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | | | - Rachel H B Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
38
|
Zou Y, Heyn C, Grigorian A, Tam F, Andreazza AC, Graham SJ, Maclntosh BJ, Goldstein BI. Measuring Brain Temperature in Youth Bipolar Disorder Using a Novel Magnetic Resonance Imaging Approach: A Proof-of-concept Study. Curr Neuropharmacol 2023; 21:1355-1366. [PMID: 36946483 PMCID: PMC10324328 DOI: 10.2174/1570159x21666230322090754] [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] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND There is evidence of alterations in mitochondrial energy metabolism and cerebral blood flow (CBF) in adults and youth with bipolar disorder (BD). Brain thermoregulation is based on the balance of heat-producing metabolism and heat-dissipating mechanisms, including CBF. OBJECTIVE To examine brain temperature, and its relation to CBF, in relation to BD and mood symptom severity in youth. METHODS This study included 25 youth participants (age 17.4 ± 1.7 years; 13 BD, 12 control group (CG)). Magnetic resonance spectroscopy data were acquired to obtain brain temperature in the left anterior cingulate cortex (ACC) and the left precuneus. Regional estimates of CBF were provided by arterial spin labeling imaging. Analyses used general linear regression models, covarying for age, sex, and psychiatric medications. RESULTS Brain temperature was significantly higher in BD compared to CG in the precuneus. A higher ratio of brain temperature to CBF was significantly associated with greater depression symptom severity in both the ACC and precuneus within BD. Analyses examining the relationship of brain temperature or CBF with depression severity score did not reveal any significant finding in the ACC or the precuneus. CONCLUSION The current study provides preliminary evidence of increased brain temperature in youth with BD, in whom reduced thermoregulatory capacity is putatively associated with depression symptom severity. Evaluation of brain temperature and CBF in conjunction may provide valuable insight beyond what can be gleaned by either metric alone. Larger prospective studies are warranted to further evaluate brain temperature and its association with CBF concerning BD.
Collapse
Affiliation(s)
- Yi Zou
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Chinthaka Heyn
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Fred Tam
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Ana Cristina Andreazza
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, M5T 1R8, ON, Canada
| | - Simon J. Graham
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Bradley J. Maclntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Benjamin I. Goldstein
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, M5T 1R8, ON, Canada
| |
Collapse
|
39
|
Mio M, Grigorian A, Zou Y, Dimick MK, Selkirk B, Kertes P, McCrindle BW, Swardfager W, Hahn MK, Black SE, MacIntosh BJ, Goldstein BI. Neurovascular correlates of retinal microvascular caliber in adolescent bipolar disorder. J Affect Disord 2023; 320:81-90. [PMID: 36162693 DOI: 10.1016/j.jad.2022.09.082] [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: 12/14/2021] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The connection between vascular and brain metrics is well-studied in older adults, but neglected in youth and in psychiatric populations at increased cardiovascular risk. We therefore examined the association of retinal vascular caliber with cerebral blood flow (CBF) in adolescents with and without bipolar disorder (BD). METHODS Ninety-four adolescents (n = 48 BD, n = 46 controls) completed retinal fundus imaging, yielding estimates of arteriolar and venular diameter. Arterial spin labelling MRI was performed to measure CBF. We tested for associations between retinal vascular caliber and CBF in regions of interest; anterior cingulate cortex (ACC), middle frontal gyrus, and hippocampus in BD and controls separately. Complementary voxel-wise analyses were also performed. RESULTS In the BD group, higher arteriovenous ratio (AVR) was associated with greater ACC CBF (β = 0.34, puncorrected = 0.02), after controlling for age, sex, and BMI, however this finding did not survive correction for multiple comparisons. The control group did not show any associations (β = 0.13, puncorrected = 0.40). Voxel-wise analyses within the BD group detected a significant positive association between AVR and regional CBF in two distinct clusters: i) left hippocampus (p < 0.0001); ii) right middle temporal gyrus (p = 0.04). LIMITATIONS Limited sample size; young, medically healthy sample limits signal detection; cross-sectional design. CONCLUSION This study reveals that higher AVR is associated with higher regional CBF in adolescents with BD. Present findings advance understanding of potential neurofunctional mechanisms linking retinal vascular caliber with psychiatric diagnoses. This proof-of-concept study was designed to generate initial insights to guide future studies focusing on the vascular-brain connection in youth and in psychiatry.
Collapse
Affiliation(s)
- Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada.
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Beth Selkirk
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada
| | - Peter Kertes
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada; University of Toronto, Ophthalmology and Vision Sciences, Toronto, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Walter Swardfager
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Margaret K Hahn
- Schizophrenia Department, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| |
Collapse
|
40
|
Kim WSH, Dimick MK, Omrin D, Mitchell RHB, Riegert D, Levitt A, Schaffer A, Belo S, Iazzetta J, Detzler G, Choi M, Choi S, Herrmann N, McIntyre RS, MacIntosh BJ, Orser BA, Goldstein BI. Proof-of-concept randomized controlled trial of single-session nitrous oxide treatment for refractory bipolar depression: Focus on cerebrovascular target engagement. Bipolar Disord 2022; 25:221-232. [PMID: 36579458 DOI: 10.1111/bdi.13288] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 12/30/2022]
Abstract
BACKGROUND There remain few efficacious treatments for bipolar depression, which dominates the course of bipolar disorder (BD). Despite multiple studies reporting associations between depression and cerebral blood flow (CBF), little is known regarding CBF as a treatment target, or predictor and/or indicator of treatment response, in BD. Nitrous oxide, an anesthetic gas with vasoactive and putative antidepressant properties, has a long history as a neuroimaging probe. We undertook an experimental medicine paradigm, coupling in-scanner single-session nitrous oxide treatment of bipolar depression with repeated measures of CBF. METHODS In this double-blind randomized controlled trial, 25 adults with BD I/II and current treatment-refractory depression received either: (1) nitrous oxide (20 min at 25% concentration) plus intravenous saline (n = 12), or (2) medical air plus intravenous midazolam (2 mg total; n = 13). Study outcomes included changes in depression severity (Montgomery-Asberg Depression Rating Scale scores, primary) and changes in CBF (via arterial spin labeling magnetic resonance imaging). RESULTS There were no significant between-group differences in 24-h post-treatment MADRS change or treatment response. However, the nitrous oxide group had significantly greater same-day reductions in depression severity. Lower baseline regional CBF predicted greater 24-h post-treatment MADRS reductions with nitrous oxide but not midazolam. In region-of-interest and voxel-wise analyses, there was a pattern of regional CBF reductions following treatment with midazolam versus nitrous oxide. CONCLUSIONS Present findings, while tentative and based on secondary endpoints, suggest differential associations of nitrous oxide versus midazolam with bipolar depression severity and cerebral hemodynamics. Larger studies integrating neuroimaging targets and repeated nitrous oxide treatment sessions are warranted.
Collapse
Affiliation(s)
- William S H Kim
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Danielle Omrin
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rachel H B Mitchell
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Riegert
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anthony Levitt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ayal Schaffer
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Susan Belo
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John Iazzetta
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Mabel Choi
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Choi
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Beverley A Orser
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
41
|
Zou Y, Grigorian A, Kennedy KG, Zai CC, Shao S, Kennedy JL, Andreazza AC, Ameis SH, Heyn C, Maclntosh BJ, Goldstein BI. Differential association of antioxidative defense genes with white matter integrity in youth bipolar disorder. Transl Psychiatry 2022; 12:504. [PMID: 36476443 PMCID: PMC9729619 DOI: 10.1038/s41398-022-02261-w] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 11/03/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Oxidative stress is associated with white matter diffusion metrics in adults with bipolar disorder (BD). We examined the association of single-nucleotide polymorphisms in the oxidative stress system, superoxide dismutase-2 (SOD2) rs4880 and glutathione peroxidase-3 (GPX3) rs3792797 with fractional anisotropy (FA) and radial diffusivity (RD) in youth with BD. Participants included 104 youth (age 17.5 ± 1.7 years; 58 BD, 46 healthy controls). Saliva samples were obtained for genotyping, and diffusion tensor imaging was acquired. Voxel-wise whole-brain white matter diffusion analyses controlled for age, sex, and race. There were significant diagnosis-by-SOD2 rs4880 interaction effects for FA and RD in major white matter tracts. Within BD, the group with two copies of the G-allele (GG) showed lower FA and higher RD than A-allele carriers. Whereas within the control group, the GG group showed higher FA and lower RD than A-allele carriers. Additionally, FA was higher and RD was lower within the control GG group compared to the BD GG group. No significant findings were observed for GPX3 rs3793797. The current study revealed that, within matter tracts known to differ in BD, associations of SOD2 rs4880 GG genotype with both FA and RD differed between BD vs healthy control youth. The SOD2 enzyme encoded by the G-allele, has higher antioxidant capacity than the enzyme encoded by the A-allele. We speculate that the current findings of lower FA and higher RD of the BD GG group compared to the other groups reflects attenuation of the salutary antioxidant effects of GG genotype on white matter integrity in youth with BD, in part due to predisposition to oxidative stress. Future studies incorporating other genetic markers and oxidative stress biomarkers are warranted.
Collapse
Affiliation(s)
- Yi Zou
- grid.17063.330000 0001 2157 2938Department of Pharmacology, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Anahit Grigorian
- grid.155956.b0000 0000 8793 5925Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Kody G. Kennedy
- grid.17063.330000 0001 2157 2938Department of Pharmacology, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Clement C. Zai
- grid.155956.b0000 0000 8793 5925Psychiatric Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8 Canada
| | - Suyi Shao
- grid.17063.330000 0001 2157 2938Department of Pharmacology, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - James L. Kennedy
- grid.155956.b0000 0000 8793 5925Psychiatric Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8 Canada
| | - Ana C. Andreazza
- grid.17063.330000 0001 2157 2938Department of Pharmacology, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8 Canada
| | - Stephanie H. Ameis
- grid.155956.b0000 0000 8793 5925Cundill Centre for Child and Youth Depression, Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.42327.300000 0004 0473 9646Department of Psychiatry, The Hospital for Sick Children, Toronto, ON Canada
| | - Chinthaka Heyn
- grid.413104.30000 0000 9743 1587Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Bradley J. Maclntosh
- grid.17063.330000 0001 2157 2938Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Medical Biophysics, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON Canada
| | - Benjamin I. Goldstein
- grid.17063.330000 0001 2157 2938Department of Pharmacology, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8 Canada
| |
Collapse
|
42
|
Friedlander ANH, Mitchell RHB, Dimick MK, Kennedy KG, MacIntosh BJ, Goldstein BI. Clinical and neuroimaging characteristics of monozygotic 16-Year-Old twins discordant for bipolar disorder: A case study. Bipolar Disord 2022; 24:836-839. [PMID: 36117325 DOI: 10.1111/bdi.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/30/2022]
Affiliation(s)
- Alana N H Friedlander
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rachel H B Mitchell
- Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Child and Youth Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| |
Collapse
|
43
|
Dimick MK, Toma S, MacIntosh BJ, Grigorian A, Fiksenbaum L, Youngstrom EA, Robertson AD, Goldstein BI. Cerebral Blood Flow and Core Mood Symptoms in Youth Bipolar Disorder: Evidence for Region-Symptom Specificity. J Am Acad Child Adolesc Psychiatry 2022; 61:1455-1465. [PMID: 35487335 DOI: 10.1016/j.jaac.2022.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/21/2021] [Revised: 02/03/2022] [Accepted: 04/19/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Building on prior findings in adults, this study investigated regional cerebral blood flow (CBF) in relation to DSM-5 criterion A symptoms of depression and mania in youth with bipolar disorder (BD). METHOD The study recruited 81 youths with BD and 75 healthy controls 13-20 years old. CBF was ascertained using pseudocontinuous arterial spin labeling magnetic resonance imaging. Region-of-interest analyses examined the amygdala, anterior cingulate cortex (ACC), middle frontal gyrus, and global gray matter CBF. The association of criterion A depression and mania symptoms with CBF was examined dimensionally in youth with BD in regression analyses with continuous symptom severity scores. Age and sex were included as covariates. False discovery rate (FDR) was used to correct for 28 tests (4 regions by 7 symptoms; α < .0017). CBF for BD and healthy control groups was compared to give context for findings. RESULTS In youth with BD, depressed mood inversely correlated with ACC (β = -0.31, puncorrected = .004, pFDR = .056) and global (β = -0.27, puncorrected = .013, pFDR = .09) CBF. The same pattern was observed for anhedonia (ACC CBF: β = -0.33, puncorrected = .004, pFDR = .056; global CBF: β = -0.29, puncorrected = .008, pFDR = .07). There were no significant findings for manic symptoms or in BD vs healthy control contrasts. CONCLUSION The present findings, while not significant after correction for multiple testing, highlight the potential value of focusing on ACC in relation to depressed mood and anhedonia, and demonstrate that CBF is sensitive to depression symptom severity in youth. Lack of findings regarding manic symptoms may relate to the exclusion of fully manic participants in this outpatient sample.
Collapse
Affiliation(s)
- Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; University of Toronto, Canada
| | - Simina Toma
- University of Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Bradley J MacIntosh
- University of Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | | | - Eric A Youngstrom
- University of North Carolina at Chapel Hill and Helping Give Away Psychological Science, Inc., Chapel Hill, North Carolina
| | | | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; University of Toronto, Canada.
| |
Collapse
|
44
|
Sheldrake E, Lam B, Al-Hakeem H, Wheeler AL, Goldstein BI, Dunkley BT, Ameis S, Reed N, Scratch SE. A Scoping Review of Magnetic Resonance Modalities Used in Detection of Persistent Postconcussion Symptoms in Pediatric Populations. J Child Neurol 2022; 38:85-102. [PMID: 36380680 DOI: 10.1177/08830738221120741] [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] [Indexed: 11/17/2022]
Abstract
Up to 30% of youth with concussion experience PPCSs (PPCS) lasting 4 weeks or longer, and can significantly impact quality of life. Magnetic resonance imaging (MRI) has the potential to increase understanding of causal mechanisms underlying PPCS. However, there are no clear modalities to assist in detecting PPCS. This scoping review aims to synthesize findings on utilization of MRI among children and youth with PPCS, and summarize progress and limitations. Thirty-six studies were included from 4907 identified papers. Many studies used multiple modalities, including (1) structural (n = 27) such as T1-weighted imaging, diffusion weighted imaging, and susceptibility weighted imaging; and (2) functional (n = 23) such as functional MRI and perfusion-weighted imaging. Findings were heterogeneous among modalities and regions of interest, which warrants future reviews that report on the patterns and potential advancements in the field. Consideration of modalities that target PPCS prediction and sensitive modalities that can supplement a biopsychosocial approach to PPCS would benefit future research.
Collapse
Affiliation(s)
- Elena Sheldrake
- Bloorview Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Brendan Lam
- Bloorview Research Institute, Toronto, Ontario, Canada
| | | | - Anne L Wheeler
- Neuroscience and Mental Health Program, 7979Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- 7978Centre for Addiction and Mental Health, Toronto, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin T Dunkley
- Neuroscience and Mental Health Program, 7979Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Ameis
- 7978Centre for Addiction and Mental Health, Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Shannon E Scratch
- Bloorview Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
45
|
Barton J, Mio M, Timmins V, Mitchell RHB, Murray BJ, Goldstein BI. Factors Associated With Sleep Disturbance Amongst Youth With Bipolar Disorder. J Can Acad Child Adolesc Psychiatry 2022; 31:165-175. [PMID: 36425019 PMCID: PMC9661909] [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] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 07/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND While sleep disturbances and their impact on functioning are well-established in adults with bipolar disorder (BD), little is known about this topic in youth. OBJECTIVE This study investigates the prevalence and correlates of sleep disturbance among youth with BD. METHODS The study included 103 youth (72 BD, 31 healthy controls [HC]), ages 14-20 years. Study measures included a semi-structured diagnostic interview and the Pittsburgh Sleep Quality Index (PSQI). PSQI yields a global score and 7 subscale scores. Analyses examined between group differences in PSQI scores, and correlates of PSQI within BD. RESULTS BD youth had significantly higher (worse) global sleep scores, and higher scores on 5/7 subscales (quality, latency, disturbance, sleep medication use, daytime dysfunction). In univariate analyses, poorer sleep quality was associated with higher lifetime and current depression severity, mixed mood state, self-reported affective lability, and borderline personality traits. Lifetime lithium treatment and euthymic mood state were associated with better sleep scores. In multivariate analyses, greater current depression severity and self-reported affective lability were most robustly associated with poor sleep quality. CONCLUSIONS Converging with data from adults, present findings indicate greater sleep disturbance among youth with BD versus HC. Also convergent with adults with BD, mood disturbance, whether depression severity or emotional lability, comprised the predominant correlates of sleep disturbance among youth with BD. Future research is warranted to better understand the temporal association between sleep disturbance and its correlates in youth with BD. Relatedly, interventions that address both mood and sleep disturbances may help improve overall functioning.
Collapse
Affiliation(s)
- Jessica Barton
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Pharmacology, University of Toronto, Toronto, Ontario
| | - Vanessa Timmins
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Rachel H B Mitchell
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Brian J Murray
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Department of Pharmacology, University of Toronto, Toronto, Ontario
| |
Collapse
|
46
|
Metzak PD, Shakeel MK, Long X, Lasby M, Souza R, Bray S, Goldstein BI, MacQueen G, Wang J, Kennedy SH, Addington J, Lebel C. Brain connectomes in youth at risk for serious mental illness: an exploratory analysis. BMC Psychiatry 2022; 22:611. [PMID: 36109720 PMCID: PMC9476574 DOI: 10.1186/s12888-022-04118-4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Identifying early biomarkers of serious mental illness (SMI)-such as changes in brain structure and function-can aid in early diagnosis and treatment. Whole brain structural and functional connectomes were investigated in youth at risk for SMI. METHODS Participants were classified as healthy controls (HC; n = 33), familial risk for serious mental illness (stage 0; n = 31), mild symptoms (stage 1a; n = 37), attenuated syndromes (stage 1b; n = 61), or discrete disorder (transition; n = 9) based on clinical assessments. Imaging data was collected from two sites. Graph-theory based analysis was performed on the connectivity matrix constructed from whole-brain white matter fibers derived from constrained spherical deconvolution of the diffusion tensor imaging (DTI) scans, and from the correlations between brain regions measured with resting state functional magnetic resonance imaging (fMRI) data. RESULTS Linear mixed effects analysis and analysis of covariance revealed no significant differences between groups in global or nodal metrics after correction for multiple comparisons. A follow up machine learning analysis broadly supported the findings. Several non-overlapping frontal and temporal network differences were identified in the structural and functional connectomes before corrections. CONCLUSIONS Results suggest significant brain connectome changes in youth at transdiagnostic risk may not be evident before illness onset.
Collapse
Affiliation(s)
- Paul D. Metzak
- grid.22072.350000 0004 1936 7697Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
| | - Mohammed K. Shakeel
- grid.22072.350000 0004 1936 7697Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada ,grid.195094.00000 0000 9471 9454Department of Psychology, St.Mary’s University, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Mathison Centre, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6 Canada
| | - Xiangyu Long
- grid.22072.350000 0004 1936 7697Department of Radiology, University of Calgary, Calgary, AB Canada ,grid.413571.50000 0001 0684 7358Department of Radiology, Alberta Children’s Hospital Research Institute, Calgary, AB Canada ,Department of Radiology, Child and Adolescent Imaging Research Program, Calgary, AB Canada
| | - Mike Lasby
- grid.22072.350000 0004 1936 7697Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Electrical and Software Engineering, University of Calgary, Calgary, AB Canada
| | - Roberto Souza
- grid.22072.350000 0004 1936 7697Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Electrical and Software Engineering, University of Calgary, Calgary, AB Canada
| | - Signe Bray
- grid.22072.350000 0004 1936 7697Department of Radiology, University of Calgary, Calgary, AB Canada ,grid.413571.50000 0001 0684 7358Department of Radiology, Alberta Children’s Hospital Research Institute, Calgary, AB Canada ,Department of Radiology, Child and Adolescent Imaging Research Program, Calgary, AB Canada
| | - Benjamin I. Goldstein
- grid.155956.b0000 0000 8793 5925Centre for Youth Bipolar Disorder, Center for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Pharmacology, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Glenda MacQueen
- grid.22072.350000 0004 1936 7697Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
| | - JianLi Wang
- grid.55602.340000 0004 1936 8200Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Sidney H. Kennedy
- grid.231844.80000 0004 0474 0428Department of Psychiatry, University Health Network, Toronto, ON Canada ,grid.415502.7Department of Psychiatry, St. Michael’s Hospital, Toronto, ON Canada ,grid.415502.7Arthur Sommer Rotenberg Chair in Suicide and Depression Studies, St. Michael’s Hospital, Toronto, ON Canada ,grid.415502.7Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada ,grid.231844.80000 0004 0474 0428Krembil Research Institute, University Health Network, Toronto, ON Canada
| | - Jean Addington
- grid.22072.350000 0004 1936 7697Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
| | - Catherine Lebel
- grid.22072.350000 0004 1936 7697Department of Radiology, University of Calgary, Calgary, AB Canada ,grid.413571.50000 0001 0684 7358Department of Radiology, Alberta Children’s Hospital Research Institute, Calgary, AB Canada ,Department of Radiology, Child and Adolescent Imaging Research Program, Calgary, AB Canada
| |
Collapse
|
47
|
Dimick MK, Goldstein BI. Editorial: Embedding Functional Neuroimaging Within Clinical Trials for Mania: Toward Answering the Questions, Who, How, and When? J Am Acad Child Adolesc Psychiatry 2022; 61:974-976. [PMID: 35470030 DOI: 10.1016/j.jaac.2022.04.007] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/14/2022] [Indexed: 11/28/2022]
Abstract
Neurocognitive deficits are common in bipolar disorder (BD) across the life span, and functional neuroimaging studies have elucidated anomalous neural circuitry underlying these deficits. Nonetheless, the literature regarding changes in neural circuitry in the context of clinical trials in BD remains sparse. In this issue, Li and Lei et al.1 report results of a randomized, double-blind, controlled trial comparing treatment effects of lithium and quetiapine on functional neural circuitry during a continuous performance task probing vigilance and working memory. Participants completed the continuous performance task while undergoing functional magnetic resonance imaging (MRI) to determine functional connectivity. This method uses functional MRI data to examine temporal synchrony in activation of spatially distinct brain regions' coordinated activation, which is thought to reflect flow of neural information between brain regions. At baseline, compared with controls, youth with BD experiencing a manic episode exhibited relative deficits in connectivity within regions relevant to sensory processing, affective reactivity, and cognitive control. After 1 week of treatment, functional connectivity among youth with BD treated with quetiapine, but not lithium, became similar to controls. After 6 weeks of treatment, functional connectivity deficits were normalized in both treatment groups, with no significant differences between treatment groups. Youth with the greatest changes in manic symptoms and functional connectivity were older, but similar in terms of other baseline clinical characteristics. This study underscores the benefits of including functional neuroimaging in clinical trials, offering unique insights into differential effects of antimanic treatments on key brain processes thought to underlie symptoms and symptomatic improvement in youth with BD.
Collapse
Affiliation(s)
- Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario; University of Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario; University of Toronto, Ontario, Canada.
| |
Collapse
|
48
|
Barton J, Mio M, Timmins V, Mitchell RHB, Goldstein BI. Prevalence and correlates of childhood-onset bipolar disorder among adolescents. Early Interv Psychiatry 2022; 17:385-393. [PMID: 35702036 DOI: 10.1111/eip.13335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/02/2021] [Revised: 03/06/2022] [Accepted: 05/29/2022] [Indexed: 11/28/2022]
Abstract
AIM Early-onset bipolar disorder (BD) is associated with a more severe illness as well as a number of clinical factors among adults. Early-onset can be categorized as childhood- (age < 13) or adolescent- (age ≥ 13) onset, with the two displaying different clinical profiles. We set out to examine differences in clinical, and familial characteristics among adolescents with childhood- versus adolescent-onset BD. METHODS The study included 195 adolescents with BD, ages 14-18 years. Age of onset was determined retrospectively by self-report. Participants completed the semi-structured K-SADS-PL diagnostic interviews along with self-reported dimensional scales. Analyses examined between-group differences for clinical and familial variables. Variables associated with age of onset at p < 0.1 in univariate analyses were evaluated in a logistic regression model. RESULTS Approximately one-fifth of participants had childhood-onset BD (n = 35; 17.9%). A number of clinical and familial factors were significantly associated with childhood-onset BD. However, there were no significant differences in depressive and manic symptom severity. In multivariate analyses, the variables most strongly associated with childhood-onset were police contact, and family history of suicidal ideation. Smoking and psychiatric hospitalization were associated with adolescent-onset. CONCLUSIONS In this large clinical sample of adolescents with BD, one-fifth reported childhood-onset BD. Correlates of childhood-onset generally aligned with those observed in the literature. Future research is warranted to better understand the genetic and environmental implications of high familial loading of psychopathology associated with childhood-onset, and to integrate age-related treatment and prevention strategies.
Collapse
Affiliation(s)
- Jessica Barton
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa Timmins
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
49
|
Khoubaeva D, Dimick MK, Roane JL, Timmins VH, Mitchell RHB, Goldstein BI. Comorbid Eating Disorders in a Sample of Youth With Bipolar Disorder: Elevated Burden of Dimensional and Categorical Psychopathology. J Clin Psychiatry 2022; 83. [PMID: 35552527 DOI: 10.4088/jcp.21r14201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/18/2022]
Abstract
Objective: There is growing recognition of the importance of comorbid eating disorders (ED) among individuals with bipolar disorder (BD). However, most studies on this topic have focused on adult samples, and little is known regarding comorbid ED among youth with BD. Methods: The sample included 197 youth with DSM-IV BD (BD-I, BD-II, or BD-NOS [not otherwise specified]), aged 13-20 years and recruited from a subspecialized clinic within a tertiary academic health sciences center from 2009 to 2017. Univariate analyses examined demographic and clinical variables among participants with versus without lifetime DSM-IV ED. Variables significant at P < .10 were entered into a backward stepwise regression. Results: Fifty-six participants (28.4%) had lifetime DSM-IV ED (3.6% anorexia nervosa, 8.1% bulimia nervosa, 16.8% ED not otherwise specified). Significant correlates of lifetime ED were female sex (P < .001), BD-II subtype (P = .03), suicidal ideation (P = .006), suicide attempts (P = .004), non-suicidal self-injury (P < .001), sexual abuse (P = .02), cigarette smoking (P = .001), anxiety disorders (P = .004), posttraumatic stress disorder (P = .004), substance use disorders (P = .006), history of individual therapy (P = .01), and family history of anxiety (P = .01). Significant correlates of no lifetime ED were BD-I subtype (P < .001) and lifetime lithium use (P = .01). The ED group had significantly more severe lifetime depression (P < .001) and significantly more self-reported affective lability (P < .001) and borderline personality traits (P < .001). In multivariate analysis, the most robust predictors of lifetime ED were female sex (odds ratio [OR] = 4.61, P = .004), BD-I subtype (OR = 0.21, P = .03), cigarette smoking (OR = 2.78, P = .02), individual therapy (OR = 3.92, P = .03), family history of anxiety (OR = 2.86, P = .02), and borderline personality traits (OR = 1.01, P = .009). Conclusions: ED are common among youth with BD and associated with adverse clinical characteristics, many of which converge with prior adult literature. Future studies evaluating specific ED subtypes are warranted, as are treatment studies targeting comorbid ED in youth with BD.
Collapse
Affiliation(s)
- Diana Khoubaeva
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Jessica L Roane
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Vanessa H Timmins
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rachel H B Mitchell
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada.,Corresponding author: Benjamin I. Goldstein, MD, PhD, Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada M6J 1H4
| |
Collapse
|
50
|
Shapiro LR, Kennedy KG, Dimick MK, Goldstein BI. Elevated atherogenic lipid profile in youth with bipolar disorder during euthymia and hypomanic/mixed but not depressive states. J Psychosom Res 2022; 156:110763. [PMID: 35193092 DOI: 10.1016/j.jpsychores.2022.110763] [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: 08/02/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Abnormal blood lipid levels are common in individuals with bipolar disorder (BD). Previous studies have revealed lipid-mood associations in adults with BD, but no data on this relationship is available in youth populations. This cross-sectional study examined the associations of lipid levels with mood states and symptoms in a cohort of youth with BD. METHODS Participants were youth with BD and healthy controls (HCs) between the ages of 13-20 years. We compared the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and TG/HDL-C ratio between 4 participant episode groups: BD-euthymic (n = 28), BD-depressed (n = 29) BD-hypomanic/mixed (n = 31), and HCs (n = 89). We also examined for dimensional associations of lipids with mania and depression scores in the overall BD group and within BD episode subgroups. RESULTS TG levels were significantly higher in the BD-euthymic group (p = 0.008, d = 0.59) and in the BD-mixed/hypomanic group (p = 0.03, d = 0.44) compared to the HC group. TG/HDL-C ratio was also higher in the BD-euthymic group compared to the HC group (p = 0.01, d = 0.51). No dimensional associations were found between lipids and mood symptom scores in the overall BD group. However, within the BD-mixed/hypomanic subgroup, higher mania scores were associated with higher TG (β = 0.42, p = 0.04), TG/HDL-C ratio (β = 0.59, p = 0.002), and lower HDL-C (β = 0.56 p = 0.002). CONCLUSIONS Youth with BD demonstrate atherogenic lipid profiles. Higher atherogenic lipids were associated with hypomanic but, contrasting adult BD studies, not depressive symptoms. Future prospective studies are warranted to evaluate the temporal association between lipids and mood among youth with BD.
Collapse
Affiliation(s)
- Lila R Shapiro
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada.
| |
Collapse
|