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Parker G, Tavella G, Macqueen G, Berk M, Grunze H, Deckersbach T, Dunner DL, Sajatovic M, Amsterdam JD, Ketter TA, Yatham LN, Kessing LV, Bassett D, Zimmerman M, Fountoulakis KN, Duffy A, Alda M, Calkin C, Sharma V, Anand A, Singh MK, Hajek T, Boyce P, Frey BN, Castle DJ, Young AH, Vieta E, Rybakowski JK, Swartz HA, Schaffer A, Murray G, Bayes A, Lam RW, Bora E, Post RM, Ostacher MJ, Lafer B, Cleare AJ, Burdick KE, O'Donovan C, Ortiz A, Henry C, Kanba S, Rosenblat JD, Parikh SV, Bond DJ, Grunebaum MF, Frangou S, Goldberg JF, Orum M, Osser DN, Frye MA, McIntyre RS, Fagiolini A, Manicavasagar V, Carlson GA, Malhi GS. Revising Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for the bipolar disorders: Phase I of the AREDOC project. Aust N Z J Psychiatry 2018; 52:1173-1182. [PMID: 30378461 DOI: 10.1177/0004867418808382] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/05/2023]
Abstract
OBJECTIVE To derive new criteria sets for defining manic and hypomanic episodes (and thus for defining the bipolar I and II disorders), an international Task Force was assembled and termed AREDOC reflecting its role of Assessment, Revision and Evaluation of DSM and other Operational Criteria. This paper reports on the first phase of its deliberations and interim criteria recommendations. METHOD The first stage of the process consisted of reviewing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and recent International Classification of Diseases criteria, identifying their limitations and generating modified criteria sets for further in-depth consideration. Task Force members responded to recommendations for modifying criteria and from these the most problematic issues were identified. RESULTS Principal issues focussed on by Task Force members were how best to differentiate mania and hypomania, how to judge 'impairment' (both in and of itself and allowing that functioning may sometimes improve during hypomanic episodes) and concern that rejecting some criteria (e.g. an imposed duration period) might risk false-positive diagnoses of the bipolar disorders. CONCLUSION This first-stage report summarises the clinical opinions of international experts in the diagnosis and management of the bipolar disorders, allowing readers to contemplate diagnostic parameters that may influence their clinical decisions. The findings meaningfully inform subsequent Task Force stages (involving a further commentary stage followed by an empirical study) that are expected to generate improved symptom criteria for diagnosing the bipolar I and II disorders with greater precision and to clarify whether they differ dimensionally or categorically.
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Affiliation(s)
- Gordon Parker
- School of Psychiatry - University of New South Wales and Black Dog Institute, Randwick, NSW, Australia
| | - Gabriela Tavella
- School of Psychiatry - University of New South Wales and Black Dog Institute, Randwick, NSW, Australia
| | - Glenda Macqueen
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Michael Berk
- IMPACT SRC, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
- Department of Psychiatry, Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health and the Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Heinz Grunze
- Allgemeinpsychiatrie Ost, Klinikum am Weissenhof, Weinsberg, Germany
- Paracelsus Medical Private University (PMU) Nuremberg, Nuremberg, Germany
| | - Thilo Deckersbach
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David L Dunner
- Center for Anxiety & Depression, Mercer Island, WA, USA
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Martha Sajatovic
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jay D Amsterdam
- Depression Research Unit, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Terence A Ketter
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Lakshmi N Yatham
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Lars Vedel Kessing
- The Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Darryl Bassett
- Division of Psychiatry, School of Medicine, The University of Western Australia, Perth, WA, Australia
| | - Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown University, and Rhode Island Hospital, Providence, RI, USA
| | - Kostas N Fountoulakis
- 3rd Department of Psychiatry, Division of Neurosciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anne Duffy
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Cynthia Calkin
- Departments of Psychiatry and Medical Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Verinder Sharma
- Department of Psychiatry, Western University, London, ON, Canada
| | - Amit Anand
- Center for Behavioral Health, Cleveland Clinic, Cleveland, OH, USA
| | - Manpreet K Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Philip Boyce
- Discipline of Psychiatry, Westmead Clinical School, Sydney Medical School, University of Sydney, Westmead, NSW, Australia
| | - Benicio N Frey
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - David J Castle
- The University of Melbourne and St Vincent's Hospital, Melbourne, VIC, Australia
| | - Allan H Young
- The Centre for Affective Disorders, King's College London, London, UK
| | - Eduard Vieta
- Hospital Clinic of Barcelona, Clinic Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Holly A Swartz
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Adam Bayes
- School of Psychiatry - University of New South Wales and Black Dog Institute, Randwick, NSW, Australia
| | - Raymond W Lam
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Emre Bora
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Robert M Post
- School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA
- Bipolar Collaborative Network, Bethesda, MD, USA
| | - Michael J Ostacher
- Department of Psychiatry, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Beny Lafer
- Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Anthony J Cleare
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | | | - Claire O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Chantal Henry
- AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan
| | | | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - David J Bond
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michael F Grunebaum
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margo Orum
- Open Sky Psychology, Ryde, NSW, Australia
| | - David N Osser
- Veterans Affairs Boston Healthcare System, Harvard Medical School, Boston, MA, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto and Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Vijaya Manicavasagar
- Psychology Clinic, University of New South Wales, Sydney, NSW, Australia
- Psychology Clinic, Black Dog Institute, Randwick, NSW, Australia
| | - Gabrielle A Carlson
- Department of Psychiatry and Behavioral Health, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Gin S Malhi
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Ramasubbu R, Burgess A, Gaxiola-Valdez I, Cortese F, Clark D, Kemp A, Goodyear B, Macqueen G, Bech-Hansen NT, Foster J, Diwadkar VA. Amygdala responses to quetiapine XR and citalopram treatment in major depression: the role of 5-HTTLPR-S/Lg polymorphisms. Hum Psychopharmacol 2016; 31:144-55. [PMID: 26879101 DOI: 10.1002/hup.2521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/27/2015] [Accepted: 12/18/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Genotype and drug pharmacology may contribute to variations in brain response to antidepressants. We examined the impact of two antidepressants with differential actions on serotonin transporter and the 5-HHTLPR-S/Lg polymorphisms on amygdala responses in major depressive disorder (MDD). METHODS Caucasians with MDD were given either citalopram or quetiapine extended release for 8 weeks. Patients were genotyped for 5-HTTLPR. Clinical efficacy was assessed using the Hamilton Depression Rating Scale. fMRI responses to negative emotional faces were acquired at baseline, week 1 and week 8. The outcome measure was change in amygdala responses at week 8. RESULTS Citalopram had no effect on amygdala responses in MDD patients with S/Lg alleles at weeks 1 and 8 compared with baseline, whereas it induced changes in amygdala responses in LL homozygotes. By contrast, quetiapine decreased amygdala responses at both time points in S/Lg carriers, and changes in amygdala responses at week 8 correlated with a reduction in depression scores. The small number of LL homozygotes in quetiapine group was a limitation. Efficacy of both treatments was comparable. CONCLUSIONS These preliminary data suggest that pharmacological mechanisms and genetics need to be considered in the development of neuroimaging markers for the evaluation of antidepressant treatments.
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Affiliation(s)
- Rajamannar Ramasubbu
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada.,Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ashley Burgess
- Brain Imaging Research Division, Department of Psychiatry & Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
| | | | - Filomeno Cortese
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Darren Clark
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada.,Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Anne Kemp
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
| | - Bradley Goodyear
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Glenda Macqueen
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada.,Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | | | - Jane Foster
- Neuroscience and Behavioral Neurosciences Program, McMaster University, Hamilton, ON, Canada
| | - Vaibhav A Diwadkar
- Brain Imaging Research Division, Department of Psychiatry & Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
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Parikh SV, Hawke LD, Zaretsky A, Beaulieu S, Patelis-Siotis I, Macqueen G, Young LT, Yatham L, Velyvis V, Bélanger C, Poirier N, Enright J, Cervantes P. Psychosocial interventions for bipolar disorder and coping style modification: similar clinical outcomes, similar mechanisms? Can J Psychiatry 2013; 58:482-6. [PMID: 23972110 DOI: 10.1177/070674371305800807] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate changes in the use of coping styles in response to early symptoms of mania in cognitive-behavioural therapy (CBT), compared with psychoeducation, for bipolar disorder. METHOD Data were drawn from a randomized controlled trial comparing CBT and psychoeducation. A subsample of 119 participants completed the Coping Inventory for the Prodromes of Mania and symptom assessments before treatment and 72 weeks later. RESULTS Both CBT and psychoeducation were associated with similar improvements in symptom burden. Both treatments also produced equivalent improvements in stimulation reduction and problem-directed coping styles, but no statistically significant change on the endorsement of help-seeking behaviours. A treatment interaction showed that a reduction in denial and blame was present only in the CBT treatment condition. CONCLUSIONS CBT and psychoeducation have similar impacts on coping styles for the prodromes of mania. The exception to this is denial and blame, which is positively impacted only by CBT but which does not translate into improved outcome. Given the similar change in coping styles and mood burden, teaching patients about how to cope in adaptive ways with the symptoms of mania may be a shared mechanism of change for CBT and psychoeducation. CLINICAL TRIAL REGISTRATION NUMBER NCT00188838.
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Déry N, Pilgrim M, Gibala M, Gillen J, Wojtowicz JM, Macqueen G, Becker S. Adult hippocampal neurogenesis reduces memory interference in humans: opposing effects of aerobic exercise and depression. Front Neurosci 2013; 7:66. [PMID: 23641193 PMCID: PMC3639381 DOI: 10.3389/fnins.2013.00066] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 04/14/2013] [Indexed: 01/05/2023] Open
Abstract
Since the remarkable discovery of adult neurogenesis in the mammalian hippocampus, considerable effort has been devoted to unraveling the functional significance of these new neurons. Our group has proposed that a continual turnover of neurons in the DG could contribute to the development of event-unique memory traces that act to reduce interference between highly similar inputs. To test this theory, we implemented a recognition task containing some objects that were repeated across trials as well as some objects that were highly similar, but not identical, to ones previously observed. The similar objects, termed lures, overlap substantially with previously viewed stimuli, and thus, may require hippocampal neurogenesis in order to avoid catastrophic interference. Lifestyle factors such as aerobic exercise and stress have been shown to impact the local neurogenic microenvironment, leading to enhanced and reduced levels of DG neurogenesis, respectively. Accordingly, we hypothesized that healthy young adults who take part in a long-term aerobic exercise regime would demonstrate enhanced performance on the visual pattern separation task, specifically at correctly categorizing lures as “similar.” Indeed, those who experienced a proportionally large change in fitness demonstrated a significantly greater improvement in their ability to correctly identify lure stimuli as “similar.” Conversely, we expected that those who score high on depression scales, an indicator of chronic stress, would exhibit selective deficits at appropriately categorizing lures. As expected, those who scored high on the Beck Depression Inventory (BDI) were significantly worse than those with relatively lower BDI scores at correctly identifying lures as “similar,” while performance on novel and repeated stimuli was identical. Taken together, our results support the hypothesis that adult-born neurons in the DG contribute to the orthogonalization of incoming information.
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Affiliation(s)
- Nicolas Déry
- Department of Psychology, Neuroscience and Behaviour, McMaster University Hamilton, ON, Canada
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, O'Donovan C, Macqueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Milev R, Bond DJ, Frey BN, Goldstein BI, Lafer B, Birmaher B, Ha K, Nolen WA, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord 2013; 15:1-44. [PMID: 23237061 DOI: 10.1111/bdi.12025] [Citation(s) in RCA: 540] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Canadian Network for Mood and Anxiety Treatments published guidelines for the management of bipolar disorder in 2005, with updates in 2007 and 2009. This third update, in conjunction with the International Society for Bipolar Disorders, reviews new evidence and is designed to be used in conjunction with the previous publications.The recommendations for the management of acute mania remain largely unchanged. Lithium, valproate, and several atypical antipsychotic agents continue to be first-line treatments for acute mania. Monotherapy with asenapine, paliperidone extended release (ER), and divalproex ER, as well as adjunctive asenapine, have been added as first-line options.For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, as well as olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. Lurasidone monotherapy and the combination of lurasidone or lamotrigine plus lithium or divalproex have been added as a second-line options. Ziprasidone alone or as adjunctive therapy, and adjunctive levetiracetam have been added as not-recommended options for the treatment of bipolar depression. Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone long-acting injection, and adjunctive ziprasidone continue to be first-line options for maintenance treatment of bipolar disorder. Asenapine alone or as adjunctive therapy have been added as third-line options.
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Affiliation(s)
- Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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6
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, O'Donovan C, Macqueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Milev R, Bond DJ, Frey BN, Goldstein BI. The evolution of CANMAT Bipolar Disorder Guidelines: past, present, and future. Bipolar Disord 2013; 15:58-60. [PMID: 23339676 DOI: 10.1111/bdi.12038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 12/18/2022]
Affiliation(s)
- Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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McIntyre RS, Soczynska JK, Woldeyohannes HO, Miranda A, Vaccarino A, Macqueen G, Lewis GF, Kennedy SH. A randomized, double-blind, controlled trial evaluating the effect of intranasal insulin on neurocognitive function in euthymic patients with bipolar disorder. Bipolar Disord 2012; 14:697-706. [PMID: 23107220 DOI: 10.1111/bdi.12006] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [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: 12/19/2022]
Abstract
BACKGROUND Neurocognitive deficits are prevalent, persistent, and implicated as mediators of functional impairment in adults with bipolar disorder. Notwithstanding progress in the development of pharmacological treatments for various phases of bipolar disorder, no available treatment has been proven to be reliably efficacious in treating neurocognitive deficits. Emerging evidence indicates that insulin dysregulation may be pertinent to neurocognitive function. In keeping with this view, we tested the hypothesis that intranasal insulin administration would improve measures of neurocognitive performance in euthymic adults with bipolar disorder. METHODS Sixty-two adults with bipolar I/II disorder (based on the Mini International Neuropsychiatric Interview 5.0) were randomized to adjunctive intranasal insulin 40 IU q.i.d. (n = 34) or placebo (n = 28) for eight weeks. All subjects were prospectively verified to be euthymic on the basis of a total score of ≤ 3 on the seven-item Hamilton Depression Rating Scale (HAMD-7) and ≤ 7 on the 11-item Young Mania Rating Scale (YMRS) for a minimum of 28 consecutive days. Neurocognitive function and outcome was assessed with a neurocognitive battery. RESULTS There were no significant between-group differences in mean age of the subjects {i.e., mean age 40 [standard deviation (SD) = 10.15] years in the insulin and 39 [SD = 10.41] in the placebo groups, respectively}. In the insulin group, n = 27 (79.4%) had bipolar I disorder, while n = 7 (21.6%) had bipolar II disorder. In the placebo group, n = 25 (89.3%) had bipolar I disorder, while n = 3 (10.7%) had bipolar II disorder. All subjects received concomitant medications; medications remained stable during study enrollment. A significant improvement versus placebo was noted with intranasal insulin therapy on executive function (i.e., Trail Making Test-Part B). Time effects were significant for most California Verbal Learning Test indices and the Process Dissociation Task-Habit Estimate, suggesting an improved performance from baseline to endpoint with no between-group differences. Intranasal insulin was well tolerated; no subject exhibited hypoglycemia or other safety concerns. CONCLUSIONS Adjunctive intranasal insulin administration significantly improved a single measure of executive function in bipolar disorder. We were unable to detect between-group differences on other neurocognitive measures, with improvement noted in both groups. Subject phenotyping on the basis of pre-existing neurocognitive deficits and/or genotype [e.g., apolipoprotein E (ApoE)] may possibly identify a more responsive subgroup.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Rosenbluth M, Macqueen G, McIntyre RS, Beaulieu S, Schaffer A. The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid personality disorders. Ann Clin Psychiatry 2012; 24:56-68. [PMID: 22303522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND The association between mood disorders and personality disorders (PDs) is complicated clinically, conceptually, and neurobiologically. There is a need for recommendations to assist clinicians in treating these frequently encountered patients. METHODS The literature was reviewed with the purpose of identifying clinically relevant themes. MedLine searches were supplemented with manual review of the references in relevant papers. From the extant evidence, consensus-based recommendations for clinical practice were developed. RESULTS Key issues were identified with regards to the overlap of PDs and mood disorders, including whether certain personality features predispose to mood disorders, whether PDs can reliably be recognized if there is an Axis I disorder present, whether personality disturbances arise as a consequence or are a forme fruste of mood disorders, and whether personality traits or disorders modify treatment responsiveness and outcome of mood disorders. CONCLUSION This paper describes consensus-based clinical recommendations that arise from a consideration of how signals from the literature can impact clinical practice in the treatment of patients with comorbid mood and personality pathology. Additional treatment studies of patients with the comorbid conditions are required to further inform clinical practice.
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Affiliation(s)
- Michael Rosenbluth
- Toronto East General Hospital Day, Treatment Program, East York, Ontario, Canada.
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Ramasubbu R, Masalovich S, Gaxiola I, Peltier S, Holtzheimer PE, Heim C, Goodyear B, Macqueen G, Mayberg HS. Differential neural activity and connectivity for processing one's own face: a preliminary report. Psychiatry Res 2011; 194:130-40. [PMID: 21962775 PMCID: PMC4410711 DOI: 10.1016/j.pscychresns.2011.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 06/01/2011] [Accepted: 07/06/2011] [Indexed: 11/24/2022]
Abstract
The experience of self is unique and pivotal to clinically relevant cognitive and emotional functions. However, well-controlled data on specialized brain regions and functional networks underlying the experience of self remain limited. This functional magnetic resonance imaging study investigated neural activity and connectivity specific to processing one's own face in healthy women by examining neural responses to the pictures of the subjects' own faces in contrast to faces of their own mothers, female friends and strangers during passive viewing, emotional and self-relevance evaluations. The processing of one's own face in comparison to processing of familiar faces revealed significant activity in right anterior insula (AI) and left inferior parietal lobule (IPL), and less activity in right posterior cingulate/precuneus (PCC/PCu) across all tasks. Further, the seed-based correlation analysis of right AI, and left IPL, showed differential functional networks in self and familiar faces contrasts. There were no differences in valence and saliency ratings between self and familiar others. Our preliminary results suggest that the self-experience cued by self-face is processed predominantly by brain regions and related networks that link interoceptive feelings and sense of body ownership to self-awareness and less by regions of higher order functioning such as autobiographical memories.
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Affiliation(s)
- Rajamannar Ramasubbu
- Department of Psychiatry/Clinical Neurosciences, University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada.
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Morehouse R, Macqueen G, Kennedy SH. Barriers to achieving treatment goals: a focus on sleep disturbance and sexual dysfunction. J Affect Disord 2011; 132 Suppl 1:S14-20. [PMID: 21575992 DOI: 10.1016/j.jad.2011.03.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 03/17/2011] [Accepted: 03/17/2011] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients who meet the criteria for a major depressive episode experience a constellation of symptoms, and different symptom configurations may reflect distinct underlying neurological disturbances. Similarly, the differing receptor profiles of the various antidepressants may explain relatively low remission rates and persistent symptoms even after remission. In particular, depressed patients frequently display altered circadian rhythms, sleep disturbances, and diurnal mood variation. Exploring treatments that can restore mood while having a positive impact on circadian rhythms and sleep would greatly improve the ability to treat this core features of depression. METHODS The mechanisms of action of the various classes of antidepressants, their effects on sleep and issues beyond sleep, including sexual dysfunction, are explored, along with questions relating to adherence. RESULTS Unfortunately, persistent sleep problems are among the most difficult-to-treat residual symptoms of depression. Many of the currently available antidepressants have adverse effects on circadian processes, including sleep, and may actually worsen sleep problems. Tolerability is also an enduring issue; SSRI and SNRI antidepressants are associated with central nervous sysytem and gastrointestinal effects, sexual side effects and suicidality. Improved drug tolerability would not only minimize distressing adverse effects, but would also improve adherence, thus maximizing the chances of successful treatment. CONCLUSIONS The complexity of managing a major depressive episode is well illustrated by sleep disturbance and sexual dysfunction, two core symptoms of MDD that may also be caused or exacerbated by antidepressant therapy. Future antidepressants should alleviate symptoms without adversely affecting sleep or sexual function.
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Affiliation(s)
- Rachel Morehouse
- Department of Psychiatry, Dalhousie University (Dalhousie Medicine New Brunswick), Saint John, NB, Canada.
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11
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Abstract
BACKGROUND The brain-gut axis is a key regulator of normal intestinal physiology; for example, psychological stress is linked to altered gut barrier function, development of food allergies and changes in behaviour. Whether intestinal events, such as enteric bacterial infections and bacterial colonisation, exert a reciprocal effect on stress-associated behaviour is not well established. OBJECTIVE To determine the effects of either acute enteric infection or absence of gut microbiota on behaviour, including anxiety and non-spatial memory formation. METHODS Behaviour was assessed following infection with the non-invasive enteric pathogen, Citrobacter rodentium in both C57BL/6 mice and germ-free Swiss-Webster mice, in the presence or absence of acute water avoidance stress. Whether daily treatment with probiotics normalised behaviour was assessed, and potential mechanisms of action evaluated. RESULTS No behavioural abnormalities were observed, either at the height of infection (10 days) or following bacterial clearance (30 days), in C rodentium-infected C57BL/6 mice. When infected mice were exposed to acute stress, however, memory dysfunction was apparent after infection (10 days and 30 days). Memory dysfunction was prevented by daily treatment of infected mice with probiotics. Memory was impaired in germ-free mice, with or without exposure to stress, in contrast to conventionally reared, control Swiss-Webster mice with an intact intestinal microbiota. CONCLUSIONS The intestinal microbiota influences the ability to form memory. Memory dysfunction occurs in infected mice exposed to acute stress, while in the germ-free setting memory is altered at baseline.
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Affiliation(s)
- Mélanie G Gareau
- Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
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12
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Yucel K, McKinnon M, Chahal R, Taylor V, Macdonald K, Joffe R, Macqueen G. Increased subgenual prefrontal cortex size in remitted patients with major depressive disorder. Psychiatry Res 2009; 173:71-6. [PMID: 19464154 DOI: 10.1016/j.pscychresns.2008.07.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 05/21/2008] [Accepted: 07/04/2008] [Indexed: 11/26/2022]
Abstract
Bilateral reductions in the volume of the anterior cingulate cortex have been reported in patients with major depressive disorder (MDD) when compared with findings in healthy controls. We compared regional brain volumes in the subgenual prefrontal cortex (SGPFC; Brodmann area (BA) 24(sg)), subcallosal gyrus (BA25) and paracingulate gyrus (BA32) in healthy control subjects and a large and well-characterized sample of patients with recurrent MDD, all of whom had received extensive antidepressant therapy. Patients with a remitted episode of MDD had SGPFC volumes larger than those of healthy controls, while those in an active illness episode did not differ from controls. There were no differences in subcallosal gyrus and paracingulate gyrus volumes between patients with MDD and healthy controls, with the exception that women with MDD had smaller paracingulate volumes than their sex-matched controls. This effect was not related to duration of illness, number of previous episodes, age at illness onset, or age at the time of scanning. Our findings demonstrate SGPFC volume increases in association with long-term antidepressant therapy and suggest that this result may be linked to positive clinical response.
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Affiliation(s)
- Kaan Yucel
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
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13
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Hajek T, Gunde E, Bernier D, Slaney C, Propper L, Macqueen G, Duffy A, Alda M. Pituitary volumes in relatives of bipolar patients: high-risk study. Eur Arch Psychiatry Clin Neurosci 2008; 258:357-62. [PMID: 18437280 DOI: 10.1007/s00406-008-0804-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 01/22/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Increased, decreased, as well as unchanged pituitary volumes have been reported in bipolar disorders (BD). It is unclear, whether abnormal pituitary volumes increase vulnerability for BD (primary vulnerability marker), or are secondary to burden of illness. To address this question, we performed the first high-risk study of pituitary volumes in affected and unaffected relatives of bipolar subjects. METHOD High-risk participants (age range 15-30 years) were recruited from families multiply affected with BD and included 24 unaffected, 19 affected subjects with first or second degree bipolar I or II relative, matched by age and sex with 31 controls without a personal or family history of psychiatric disorders. Pituitary volumes were measured on 1.5 T 3D anatomical MRI images using standard methods. RESULTS We found comparable pituitary volumes among unaffected, affected relatives of bipolar patients and controls. There were no differences in pituitary volumes between male and female subjects nor was there any sex by group interaction. Analyzing 26 participants with bipolar I parent or excluding 5 medicated subjects did not change the results. There were no differences between subjects from families containing bipolar I versus families containing only bipolar II subjects. CONCLUSIONS The lack of abnormalities in unaffected and also affected subjects early in the course of illness in our study, as well as previous investigations of bipolar and familial unipolar children and adolescents, suggest that pituitary volume abnormalities are unlikely to be a primary risk factor for mood disorders.
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Affiliation(s)
- Tomas Hajek
- Department of Psychiatry, Dalhousie University, Room 3089, QEII HSC, A.J. Lane Bldg 5909 Veteran's Memorial Lane, B3H 2E2, Halifax, NS, Canada
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14
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Mahler C, Macqueen G, Samaan Z. A postmenopausal woman presenting with Ekbom syndrome associated with recurrent depressive disorder: a case report. Cases J 2008; 1:54. [PMID: 18647415 PMCID: PMC2499991 DOI: 10.1186/1757-1626-1-54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 07/22/2008] [Indexed: 11/10/2022]
Abstract
BACKGROUND Ekbom syndrome is a rare psychiatric disorder that can manifest as a delusion, overvalued idea or hallucination of parasitic infestations. It is more prevalent in postmenopausal women and patients are usually seeking dermatology rather than psychiatry consultation for their symptoms. CASE PRESENTATION We present a case of Ekbom syndrome associated with recurrent depressive disorder in an elderly patient. The patient presented with tactile hallucinations of insects crawling just under her skin. These hallucinations resolved with Mirtazepine and electroconvulsive therapy treatment in the absence of an antipsychotic pharmacological agent. CONCLUSION This case report highlights the presence of a rare psychiatric presentation of Ekbom syndrome within the context of depression. The majority of such cases will not be seen by psychiatrists but by dermatologists. Therefore collaborative consultations between dermatologists and psychiatrists of patients presenting with symptoms of Ekbom are essential for the identification and management of such cases. The case also takes a look at possible aetiologies and the importance of descriptive psychopathology in distinguishing psychotic symptoms in depressive disorder.
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Affiliation(s)
- Courtney Mahler
- McMaster University, 1280 Main St, West, Hamilton, Ontario, L8S 4L8, Canada.
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15
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Abstract
Asthma has long been considered a condition in which psychological factors have a role. As in many illnesses, psychological variables may affect outcome in asthma via their effects on treatment adherence and symptom reporting. Emerging evidence suggests that the relation between asthma and psychological factors may be more complex than that, however. Central cognitive processes may influence not only the interpretation of asthma symptoms but also the manifestation of measurable changes in immune and physiologic markers of asthma. Furthermore, asthma and major depressive disorder share several risk factors and have similar patterns of dysregulation in key biologic systems, including the neuroendocrine stress response, cytokines, and neuropeptides. Despite the evidence that depression is common in people with asthma and exerts a negative impact on outcome, few treatment studies have examined whether improving symptoms of depression do, in fact, result in better control of asthma symptoms or improved quality of life in patients with asthma.
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Affiliation(s)
- Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON
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Abstract
OBJECTIVES Psychological studies have identified that different coping strategies affect outcome in bipolar disorder (BD), with the possibility of preventing mania by effective coping with prodromes. This study seeks to examine coping mechanisms using a recently developed scale to clarify the relationship of coping styles to clinical and demographic characteristics, and to identify coping differences between bipolar I and II subjects. METHODS The Coping Inventory for Prodromes of Mania (CIPM) was completed by 203 bipolar patients, along with other diagnostic and clinical measures. The CIPM is organized into four factors of coping including: stimulation reduction (SR), problem-oriented coping (PR), seeking professional help (SPH), denial and blame (DB). CIPM psychometric properties and its relationship to demographic and clinical factors, dysfunctional attitudes, and mood symptoms were examined. Coping profiles were generated by BD subtype (I versus II). RESULTS The CIPM displayed psychometric properties consistent with the single previous study with this instrument. Neither demographic/clinical characteristics nor mood symptoms showed any particular relationship with the CIPM. Clear differences in coping also emerged between BD I and BD II subjects. BD I tended to use a wider range of coping strategies and scored highly on the SPH factor as compared to BD II subjects. BD II participants preferred to use DB and PR, but were less likely to use SPH and SR. CONCLUSIONS The CIPM appears to be a valid measure of coping. Coping style preferences appear to differ according to bipolar subtype.
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Affiliation(s)
- Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Yücel K, Macqueen G. Hippocampal volumetry: Is a consensus definition of the posterior boundaries possible? Hippocampus 2006; 16:682-3; author reply 684. [PMID: 16807913 DOI: 10.1002/hipo.20192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Campbell S, Macqueen G. The role of the hippocampus in the pathophysiology of major depression. J Psychiatry Neurosci 2004; 29:417-26. [PMID: 15644983 PMCID: PMC524959] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Converging lines of research suggest that the hippocampal complex (HC) may have a role in the pathophysiology of major depressive disorder (MDD). Although postmortem studies show little cellular death in the HC of depressed patients, animal studies suggest that elevated glucocorticoid levels associated with MDD may negatively affect neurogenesis, cause excitotoxic damage or be associated with reduced levels of key neurotrophins in the HC. Antidepressant medications may counter these effects, having been shown to increase HC neurogenesis and levels of brain-derived neurotrophic factor in animal studies. Neuropsychological studies have identified deficits in hippocampus-dependent recollection memory that may not abate with euthymia, and such memory impairment has been the most reliably documented cognitive abnormality in patients with MDD. Finally, data from imaging studies suggest both structural changes in the volume of the HC and functional alterations in frontotemporal and limbic circuits that may be critical for mood regulation. The extent to which such functional and structural changes determine clinical outcome in MDD remains unknown; a related, but also currently unanswered, question is whether the changes in HC function and structure observed in MDD are preventable or modifiable with effective treatment for the depressive illness.
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Affiliation(s)
- Stephanie Campbell
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Abstract
Studies examining cognitive dysfunction in bipolar disorder have documented neuropsychologic impairment in some patients. Recollection memory, attention, and visual information processing may be particularly impaired in patients with bipolar illness. Cognitive impairment appears to worsen with illness progression, and may have a significant impact on function. Pharmacotherapy to treat bipolar disorder including lithium, anticonvulsants, antidepressants, and atypical antipsychotics may have varying effects on cognitive functioning. Treatment with atypical antipsychotics has been associated with improvement in various cognitive measures in patients with schizophrenia, and the little data available in patients with bipolar disorder suggest the potential for similar benefits. Studies to determine if current treatments for bipolar disorder can prevent, delay, or even improve cognitive dysfunction are needed.
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Affiliation(s)
- Glenda Macqueen
- St. Joseph's Center for Mental Health Services, D1, Mood Disorders Program, 100 West 5th St, Hamilton, ON, L9C 2E4, Canada.
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