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Generoso MB, Shiozawa P, Mazaferro P, Sanches M. Adapt and Overcome: Results of a Brazilian Psychiatry Residency Program Reformulation during the COVID-19 Pandemic. Acad Psychiatry 2023; 47:694-695. [PMID: 37991683 DOI: 10.1007/s40596-023-01899-y] [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] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/02/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Marcelo Bruno Generoso
- Department of Public Health, City of São Paulo, São Paulo, Brazil.
- Santa Casa de São Paulo, São Paulo, Brazil.
| | | | - Paulo Mazaferro
- Department of Public Health, City of São Paulo, São Paulo, Brazil
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2
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Baldaçara L, Paschoal AB, Pinto AF, Loureiro FF, Gaiotto LAV, Veiga DDL, Almeida TM, Dos Santos DC, Malloy-Diniz LF, de Mello MF, de Mello AF, Sanches M, Gandarela LM, Bernik MA, Nardi AE, da Silva AG, Uchida RR. Brazilian Psychiatric Association guidelines for the treatment of generalized anxiety disorder (GAD). Pharmacological and Psychotherapy approach. Perspectives. Braz J Psychiatry 2023. [PMID: 37956131 DOI: 10.47626/1516-4446-2023-3235] [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] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/21/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE To combine elements of a systematic review and critical review to produce best evidence synthesis for the treatament of GAD. METHOD There was included systematic reviews, metanalysis, and randomized controlled trials. Descriptor used was "generalized anxiety disorder", resulting in 4860 articles and 7 other studies, of which 59 were selected. RESULTS Antidepressants and benzodiazepines are indicated, as well as pregabalin. From, atypical antipsychotics quetiapine has been studied. Cognitive behavior therapy (third wave of behavioral and cognitive therapies) as well as individual CBT proven to be effective. CONCLUSION There is extensive literature on many effective treatments for GAD. The present work summarizes the therapeutic possibilities, emphasizing those available in the Brazil. Further studies are still needed to compare other available medications, to assess psychotherapies in more depth, new treatments and specially to assess the ideal time for maintaining therapy.
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Affiliation(s)
- Leonardo Baldaçara
- Universidade Federal do Tocantins, Palmas, TO, Brazil. Associação Brasileira de Psiquiatria, Brazil
| | - Ana Beatriz Paschoal
- Mental Health Department, Santa Casa de São Paulo, School of Medical Sciences, São Paulo, SP, Brazil
| | - Aldo Felipe Pinto
- Mental Health Department, Santa Casa de São Paulo, School of Medical Sciences, São Paulo, SP, Brazil
| | - Fabiano Franca Loureiro
- Department of Mental Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. Clinical Neuroscience Research Laboratory, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Diogo de Lacerda Veiga
- Mental Health Department, Santa Casa de São Paulo, School of Medical Sciences, São Paulo, SP, Brazil
| | - Thales Marcon Almeida
- Mental Health Department, Santa Casa de São Paulo, School of Medical Sciences, São Paulo, SP, Brazil
| | - Diogo Cesar Dos Santos
- Mental Health Department, Santa Casa de São Paulo, School of Medical Sciences, São Paulo, SP, Brazil
| | | | | | | | - Marsal Sanches
- University of Texas Health Science Center, Houston, TX, USA
| | - Lucas Marques Gandarela
- Programa Ansiedade, Instituto de Psiquiatria, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Márcio Antonini Bernik
- Programa Ansiedade, Instituto de Psiquiatria, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Antonio E Nardi
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Ricardo R Uchida
- Mental Health Department, Santa Casa de São Paulo, School of Medical Sciences, São Paulo, SP, Brazil
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Sanches M, Nguyen LK, Chung TH, Nestadt P, Wilcox HC, Coryell WH, Soares JC, Selvaraj S. Corrigendum to "Anxiety symptoms and suicidal thoughts and behaviors among patients with mood disorders" [J. Affect. Disord. (2022) 307: 171-177]. J Affect Disord 2023; 323:898-899. [PMID: 36567155 DOI: 10.1016/j.jad.2022.11.076] [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: 12/24/2022]
Affiliation(s)
- Marsal Sanches
- UT Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA; Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, United States of America.
| | - Linh K Nguyen
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Tong Han Chung
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Paul Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Holly C Wilcox
- Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William H Coryell
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA
| | - Sudhakar Selvaraj
- UT Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA
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Abstract
The progressively improving understanding of the borderline personality disorder (BPD) has led to an increased interest in the better clarification of the integrated role of biological and psychosocial factors in the underlying pathophysiology of this condition. The influence of early childhood interactions and stress exposure in shaping our personalities during adulthood cannot be emphasized enough. In this review, we discuss the critical role of parenting-related factors including maladaptive parenting, parenting styles, and parenting psychopathology as early childhood influences in the developmental psychopathology of BPD. Protective factors that may impact the development of this disorder and possible preventive interventions are also briefly reviewed.
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Affiliation(s)
- Mandeep Kaur
- Department of Psychiatry and Behavioral Medicine, Cone Health, Greensboro, North Carolina, USA
| | - Marsal Sanches
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UT Health Center of Excellence on Mood Disorders, Houston, Texas, USA
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5
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van Velzen LS, Dauvermann MR, Colic L, Villa LM, Savage HS, Toenders YJ, Zhu AH, Bright JK, Campos AI, Salminen LE, Ambrogi S, Ayesa-Arriola R, Banaj N, Başgöze Z, Bauer J, Blair K, Blair RJ, Brosch K, Cheng Y, Colle R, Connolly CG, Corruble E, Couvy-Duchesne B, Crespo-Facorro B, Cullen KR, Dannlowski U, Davey CG, Dohm K, Fullerton JM, Gonul AS, Gotlib IH, Grotegerd D, Hahn T, Harrison BJ, He M, Hickie IB, Ho TC, Iorfino F, Jansen A, Jollant F, Kircher T, Klimes-Dougan B, Klug M, Leehr EJ, Lippard ETC, McLaughlin KA, Meinert S, Miller AB, Mitchell PB, Mwangi B, Nenadić I, Ojha A, Overs BJ, Pfarr JK, Piras F, Ringwald KG, Roberts G, Romer G, Sanches M, Sheridan MA, Soares JC, Spalletta G, Stein F, Teresi GI, Tordesillas-Gutiérrez D, Uyar-Demir A, van der Wee NJA, van der Werff SJ, Vermeiren RRJM, Winter A, Wu MJ, Yang TT, Thompson PM, Rentería ME, Jahanshad N, Blumberg HP, van Harmelen AL, Schmaal L. Structural brain alterations associated with suicidal thoughts and behaviors in young people: results from 21 international studies from the ENIGMA Suicidal Thoughts and Behaviours consortium. Mol Psychiatry 2022; 27:4550-4560. [PMID: 36071108 PMCID: PMC9734039 DOI: 10.1038/s41380-022-01734-0] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/24/2022] [Accepted: 08/05/2022] [Indexed: 12/14/2022]
Abstract
Identifying brain alterations associated with suicidal thoughts and behaviors (STBs) in young people is critical to understanding their development and improving early intervention and prevention. The ENIGMA Suicidal Thoughts and Behaviours (ENIGMA-STB) consortium analyzed neuroimaging data harmonized across sites to examine brain morphology associated with STBs in youth. We performed analyses in three separate stages, in samples ranging from most to least homogeneous in terms of suicide assessment instrument and mental disorder. First, in a sample of 577 young people with mood disorders, in which STBs were assessed with the Columbia Suicide Severity Rating Scale (C-SSRS). Second, in a sample of young people with mood disorders, in which STB were assessed using different instruments, MRI metrics were compared among healthy controls without STBs (HC; N = 519), clinical controls with a mood disorder but without STBs (CC; N = 246) and young people with current suicidal ideation (N = 223). In separate analyses, MRI metrics were compared among HCs (N = 253), CCs (N = 217), and suicide attempters (N = 64). Third, in a larger transdiagnostic sample with various assessment instruments (HC = 606; CC = 419; Ideation = 289; HC = 253; CC = 432; Attempt=91). In the homogeneous C-SSRS sample, surface area of the frontal pole was lower in young people with mood disorders and a history of actual suicide attempts (N = 163) than those without a lifetime suicide attempt (N = 323; FDR-p = 0.035, Cohen's d = 0.34). No associations with suicidal ideation were found. When examining more heterogeneous samples, we did not observe significant associations. Lower frontal pole surface area may represent a vulnerability for a (non-interrupted and non-aborted) suicide attempt; however, more research is needed to understand the nature of its relationship to suicide risk.
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Grants
- UG3 MH111929 NIMH NIH HHS
- R37 MH101495 NIMH NIH HHS
- R01 MH103291 NIMH NIH HHS
- P41 RR008079 NCRR NIH HHS
- UL1 TR001872 NCATS NIH HHS
- UL1 TR001863 NCATS NIH HHS
- R61 MH111929 NIMH NIH HHS
- RC1 MH088366 NIMH NIH HHS
- R01 MH117601 NIMH NIH HHS
- K23 MH090421 NIMH NIH HHS
- R21 AA027884 NIAAA NIH HHS
- K01 MH106805 NIMH NIH HHS
- R61 AT009864 NCCIH NIH HHS
- R01 MH069747 NIMH NIH HHS
- K01 AA027573 NIAAA NIH HHS
- R01 MH070902 NIMH NIH HHS
- K01 MH117442 NIMH NIH HHS
- R01 MH085734 NIMH NIH HHS
- R21 AT009173 NCCIH NIH HHS
- MQ Brighter Futures Award MQBFC/2 and the U.S. National Institute of Mental Health under Award Number R01MH117601. National Suicide Prevention Research Fund, managed by Suicide Prevention Australia
- MQ Brighter Futures Award MQBFC/2. Interdisziplinäres Zentrum für Klinische Forschung, UKJ
- Italian Ministry of Health grant RC17-18-19-20-21/A
- Instituto de Salud Carlos III through the projects PI14/00639, PI14/00918 and PI17/01056 (Co-funded by European Regional Development Fund/European Social Fund "Investing in your future") and Fundación Instituto de Investigación Marqués de Valdecilla (NCT0235832 and NCT02534363)
- National Institute of Mental Health (K23MH090421), the National Alliance for Research on Schizophrenia and Depression, the University of Minnesota Graduate School, the Minnesota Medical Foundation, and the Biotechnology Research Center (P41 RR008079 to the Center for Magnetic Resonance Research), University of Minnesota, and the Deborah E. Powell Center for Women’s Health Seed Grant, University of Minnesota
- Medical Leader Foundation of Yunnan Province (L2019011) and Famous Doctors Project of Yunnan Province Plan (YNWR-MY-2018-041)
- CJ Martin Fellowship (NHMRC app 1161356). “Investissements d’avenir” ANR-10-IAIHU-06
- German Research Foundation (DFG, grant FOR2107-DA1151/5-1 and DA1151/5-2 to UD, and DFG grants HA7070/2-2, HA7070/3, HA7070/4 to TH)
- Australian National Health and Medical Research Council of Australia (NHMRC) Project Grants 1024570 NHMRC Career Development Fellowships (1061757)
- Medical Faculty Münster, Innovative Medizinische Forschung (Grant IMF KO 1218 06)
- Australian National Medical and Health Research Council (Program Grant 1037196 and Investigator Grant 1177991 to PBM, Project Grant 1066177 to JMF), the Lansdowne Foundation, Good Talk and the Keith Pettigrew Family Bequest (PM) Janette Mary O’Neil Research Fellowship. IHG is supported in part by R37MH101495
- Australian National Health and Medical Research Council of Australia (NHMRC) Project Grants 1064643 (principal investigator, BJH) NHMRC Career Development Fellowships (1124472)
- National Institute of Mental Health (K01MH106805). Klingenstein Third Generation Foundation, the National Institute of Mental Health (K01MH117442), the Stanford Maternal Child Health Research Institute, and the Stanford Center for Cognitive and Neurobiological Imaging. TCH receives partial support from the Ray and Dagmar Dolby Family Fund
- German Research Foundation (DFG, grant FOR2107-JA 1890/7-1 and JA 1890/7-2 to AJ, and DFG, grant FOR2107-KI588/14-1 and FOR2107-KI588/14-2 to TK)
- NIAAA (K01AA027573, R21AA027884) and the American Foundation for Suicide Prevention
- National Institute of Mental Health (R01-MH103291)
- National Center for Complementary and Integrative Health (NCCIH) R21AT009173 and R61AT009864 National Center for Advancing Translational Sciences (CTSI), National Institutes of Health, through UCSF-CTSI UL1TR001872 American Foundation for Suicide Prevention (AFSP) SRG-1-141-18 UCSF Research Evaluation and Allocation Committee (REAC) and J. Jacobson Fund to TTY; by the National Institute of Mental Health (NIMH) R01MH085734 and the Brain and Behavior Research Foundation (formerly NARSAD)
- MQ Brighter Futures Award MQBFC/2 R61MH111929RC1MH088366, R01MH070902, R01MH069747, American Foundation for Suicide Prevention, International Bipolar Foundation, Brain and Behavior Research Foundation, For the Love of Travis Foundation and Women’s Health Research at Yale
- MQ Brighter Futures Award MQBFC/2 Social Safety and Resilience programme of Leiden University
- MQ Brighter Futures Award MQBFC/2 National Institute of Mental Health under Award Number R01MH117601 NHMRC Career Development Fellowship (1140764)
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Affiliation(s)
- Laura S van Velzen
- Orygen, Parkville, VIC, Australia.
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Maria R Dauvermann
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lejla Colic
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- German Center for Mental Health, Halle-Jena-Magdeburg, Germany
| | - Luca M Villa
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Hannah S Savage
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Yara J Toenders
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Alyssa H Zhu
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Joanna K Bright
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
- Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Adrián I Campos
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, Australia
| | - Lauren E Salminen
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Sonia Ambrogi
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sevilla, Spain
| | - Nerisa Banaj
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Zeynep Başgöze
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jochen Bauer
- University Clinic for Radiology, University of Münster, Münster, Germany
| | - Karina Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Robert James Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, Marburg University, Marburg, Germany
- CMBB, Marburg, Germany
| | - Yuqi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical College, Kunming, China
- Yunnan Province Clinical Research Center for Psychiatry, Kunming, China
| | - Romain Colle
- MOODS Team, CESP, INSERM U1018, Faculté de Médecine, Univ Paris-Saclay, Le Kremlin Bicêtre, 94275, France
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France
| | - Colm G Connolly
- Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Emmanuelle Corruble
- MOODS Team, CESP, INSERM U1018, Faculté de Médecine, Univ Paris-Saclay, Le Kremlin Bicêtre, 94275, France
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France
| | - Baptiste Couvy-Duchesne
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, Australia
- Paris Brain Institute (ICM), Inserm (U1127), CNRS (UMR 7225), Sorbonne University, Inria Paris (Aramis project-team), Paris, France
| | - Benedicto Crespo-Facorro
- Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sevilla, Spain
- Virgen del Rocío University Hospital, IBiS, CSIC, University of Sevilla, Sevilla, Spain
| | - Kathryn R Cullen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Christopher G Davey
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Katharina Dohm
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Janice M Fullerton
- Neuroscience Research Australia, Randwick, NSW, Australia
- School of Medical Sciences, University of New South Wales, Kensington, NSW, Australia
| | - Ali Saffet Gonul
- SoCAT Lab, Department of Psychiatry, School of Medicine, Ege University, Izmir, Turkey
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tim Hahn
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Mengxin He
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical College, Kunming, China
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Tiffany C Ho
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, Marburg University, Marburg, Germany
- CMBB, Marburg, Germany
- Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Fabrice Jollant
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- MOODS Team, CESP, INSERM U1018, Faculté de Médecine, Univ Paris-Saclay, Le Kremlin Bicêtre, 94275, France
- Université de Paris & GHU Paris Psychiatrie et Neurosciences, Paris, France
- McGill University, Department of Psychiatry, Montréal, QC, Canada
- Academic Hospital (CHU), Nîmes, France
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Marburg University, Marburg, Germany
- CMBB, Marburg, Germany
| | | | - Melissa Klug
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Elizabeth T C Lippard
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Institute of Early Life Adversity Research, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Waggoner Center for Alcohol and Addiction Research, University of Texas at Austin, Austin, TX, USA
- Mulva Clinic for Neuroscience, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | | | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Institute for Translational Neuroscience, University of Münster, Münster, Germany
| | - Adam Bryant Miller
- Mental Health Risk and Resilience Research Program, RTI International, Research Triangle Park, NC, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Kensington, NSW, Australia
| | - Benson Mwangi
- Center Of Excellence On Mood Disorders, The University of Texas-Health Science Center at Houston, Houston, TX, USA
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas - Health Science Center at Houston, Houston, TX, USA
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, Marburg University, Marburg, Germany
- CMBB, Marburg, Germany
| | - Amar Ojha
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Julia-Katharina Pfarr
- Department of Psychiatry and Psychotherapy, Marburg University, Marburg, Germany
- CMBB, Marburg, Germany
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Kai G Ringwald
- Department of Psychiatry and Psychotherapy, Marburg University, Marburg, Germany
- CMBB, Marburg, Germany
| | - Gloria Roberts
- School of Psychiatry, University of New South Wales, Kensington, NSW, Australia
| | - Georg Romer
- Department of Child & Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Marsal Sanches
- Center Of Excellence On Mood Disorders, The University of Texas-Health Science Center at Houston, Houston, TX, USA
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas - Health Science Center at Houston, Houston, TX, USA
| | - Margaret A Sheridan
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jair C Soares
- Center Of Excellence On Mood Disorders, The University of Texas-Health Science Center at Houston, Houston, TX, USA
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas - Health Science Center at Houston, Houston, TX, USA
| | - Gianfranco Spalletta
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, Marburg University, Marburg, Germany
- CMBB, Marburg, Germany
| | - Giana I Teresi
- Department of Psychology, Stanford University, Stanford, CA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Diana Tordesillas-Gutiérrez
- Department of Radiology, IDIVAL, Marqués de Valdecilla University Hospital, Santander, Spain
- Advanced Computing and e-Science, Instituto de Física de Cantabria (UC-CSIC), Santander, Spain
| | - Aslihan Uyar-Demir
- SoCAT Lab, Department of Psychiatry, School of Medicine, Ege University, Izmir, Turkey
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Steven J van der Werff
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
- Leids Universitair Behandel- en Expertise Centrum, Leiden, The Netherlands
| | - Robert R J M Vermeiren
- Child and Adolescent Psychiatry Leiden University Medical Center, Leiden, The Netherlands
- Youz: Child and Adolescent Psychiatry, Leiden, The Netherlands
| | - Alexandra Winter
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Mon-Ju Wu
- Center Of Excellence On Mood Disorders, The University of Texas-Health Science Center at Houston, Houston, TX, USA
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas - Health Science Center at Houston, Houston, TX, USA
| | - Tony T Yang
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, UCSF, San Francisco, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Miguel E Rentería
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Anne-Laura van Harmelen
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
- Social Security and Resilience Programme, Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - Lianne Schmaal
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
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Wolfenberger T, Diaz AP, Bockmann T, Selvaraj S, Sanches M, Soares JC. Predominant polarity and associated post-traumatic stress disorder in patients with comorbid bipolar disorder and borderline personality disorder: a cross-sectional study. Braz J Psychiatry 2022; 44:557-558. [PMID: 35904414 PMCID: PMC9561839 DOI: 10.47626/1516-4446-2021-2418] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/04/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Taylor Wolfenberger
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Houston, TX, USA. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alexandre Paim Diaz
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Houston, TX, USA. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Taya Bockmann
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Houston, TX, USA
| | - Sudhakar Selvaraj
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Houston, TX, USA. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Marsal Sanches
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Houston, TX, USA. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Houston, TX, USA. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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7
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Sanches M, Nguyen LK, Chung TH, Nestadt P, Wilcox HC, Coryell WH, Soares JC, Selvaraj S. Anxiety symptoms and suicidal thoughts and behaviors among patients with mood disorders. J Affect Disord 2022; 307:171-177. [PMID: 35331824 PMCID: PMC9321173 DOI: 10.1016/j.jad.2022.03.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Though the association between anxiety disorders and suicidal behavior is well-described, the impact of anxiety symptoms on suicidal thoughts and behaviors (STB) across different mood disorders is still unclear. METHODS We performed a registry-based retrospective study utilizing outcome measure data collected by the National Network of Depression Centers (NNDC), a nationwide nonprofit consortium of 26 leading clinical and academic member centers in the United States. The sample consisted of 2607 outpatients with mood disorders (major depressive disorder or bipolar disorders). Demographic and clinical variables were compared based on the presence or absence of STB and severity of anxiety symptoms (minimal, mild, moderate, and severe). Univariate and multivariable logistic regressions were conducted to examine the correlations of STB, considering multicollinearity. RESULTS Patients with mild, moderate, and severe anxiety symptoms had higher odds of STB than those with minimal symptoms. Gender, marital status, age, and depressive symptoms were other strong predictors of STB. There was no difference in the odds of STB between patients with major depressive disorder (MDD) and those with bipolar disorders (BD). However, the odds of suicidal ideation were slightly lower among patients with BD than those with MDD. LIMITATIONS Our sample was comprised only of outpatients, limiting the generalization of our findings. Other limitations include the lack of structured interviews for diagnostic characterization of the patients and the utilization of data on anxiety and mood obtained solely through self-report scales. CONCLUSIONS We found a cross-sectional association between the severity of anxiety symptoms and STB among patients with mood disorders. This study demonstrates the need for a suicide risk assessment in patients with mood disorders reporting anxiety symptoms.
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Affiliation(s)
- Marsal Sanches
- UT Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA.
| | - Linh K Nguyen
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Tong Han Chung
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Paul Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Holly C Wilcox
- Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William H Coryell
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA
| | - Sudhakar Selvaraj
- UT Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA
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8
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Nishikawa M, Jin JW, Ho T, Manohar R, Sanches M, Cavalcanti S, Wu H. The Racial and Ethnic Differences in Impact and Knowledge of COVID-19 among Patients with Psychiatric Illnesses. CPRR 2022. [DOI: 10.2174/2666082218666220512111146] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction:
COVID-19 pandemic has been associated with increased rates of depression, anxiety, and suicidal ideation. Individuals with mental illnesses are disproportionately affected by additional complex health issues. This study aims to examine the knowledge and impact of COVID-19 among patients with mental disorders at the Harris County Psychiatric Center (HCPC).
Methods:
A retrospective review of surveys conducted for patients with mental illness at HCPC. Participants were surveyed on demographics, COVID-19 knowledge, and COVID-19 healthcare impact. The data was analyzed with SPSS 20 for Windows at a 0.05 significance level.
Results:
A total of 46 patients were included in the study. We found that the patient population with mental disorders has different methods of obtaining information regarding COVID-19 and practices varying safety measures. To be precise, more women (52.2%) than men (21.7%) learned about COVID-19 through family and friends [p=0.032]. More Hispanic (21.4%) compared to non-Hispanic (0%) patients learned about COVID-19 through resources from the World Health Organization (WHO) [p=0.032]. Fewer African American (AA) patients avoided contact with people who were sick (39% vs. 81% Caucasian [p=0.01] and 100% Asian/Native American/Pacific Islander [ANAPI] patients [p=0.04]). We found more non-Hispanic (50.0%) vs. Hispanic (7.1%) patients reported that their personal time (time outside of work) was unchanged by COVID-19 [p=0.007]. More Hispanic (57.1%) vs. non-Hispanic (17.9%) patients reported increased time with family members [p=0.009]. Compared to Hispanic patients, more non-Hispanic patients reported unchanged difficulty scheduling appointments (46.4% vs. 7.1%) [p=0.015], obtaining prescription (71.4% vs. 35.7%) [p=0.045], and finding housing placement (53.6% vs. 21.4%) [p=0.047]. Furthermore, more Caucasian compared to AA patients reported more changes in how they feel (35.7% vs. 76.2%) [p=0.033], anxiety (52.6% vs. 0%) [p=0.002], stress (47.4% vs. 7.7%) [p=0.024], and sadness (30% vs. 0%) [p=0.031]. Finally, more ANAPI (67%) compared to AA patients (0%) reported increased anxiety [p=0.025].
Conclusion:
Our findings suggest that African American patients report less knowledge of COVID-19 prevention and less impact on their mental health by the pandemic compared to other racial groups. Our findings suggest that African American patients may have limited knowledge of COVID-19 prevention compared to other races, Caucasian and Asian/Native American/Pacific Islander patients may have increased mood changes, and Hispanic patients may be experiencing more healthcare inequality amidst the pandemic. However, further investigation of the impending ramifications of the pandemic is warranted.
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Affiliation(s)
- Millie Nishikawa
- The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Jeff Wang Jin
- University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Tiffany Ho
- University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Roja Manohar
- The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Marsal Sanches
- McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Stefanie Cavalcanti
- University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Hanjing Wu
- University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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9
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Fenoy AJ, Schulz PE, Sanches M, Selvaraj S, Burrows CL, Asir B, Conner CR, Quevedo J, Soares JC. Deep brain stimulation of the "medial forebrain bundle": sustained efficacy of antidepressant effect over years. Mol Psychiatry 2022; 27:2546-2553. [PMID: 35288633 DOI: 10.1038/s41380-022-01504-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 11/20/2021] [Revised: 02/11/2022] [Accepted: 02/22/2022] [Indexed: 12/15/2022]
Abstract
Deep brain stimulation (DBS) to the superolateral branch of the medial forebrain bundle (MFB) has emerged as a quite efficacious therapy for treatment resistant depression (TRD), leading to rapid antidepressant effects. In this study, we complete our assessment of our first 10 enrolled patients throughout one year post-implantation, showing sustained antidepressant effect up to 5 years. The primary outcome measure was a 50% reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) score, which was interpreted as a response. Deterministic fiber tracking was used to individually map the target area. An insertional effect was seen during the 4-week sham stimulation phase (29% mean MADRS reduction, p = 0.02). However, after 2 weeks of initiating stimulation, five patients met response criteria (47% mean MADRS reduction, p < 0.001). One patient withdrew from study participation at 6 weeks. Twelve weeks after initiating stimulation, six of nine remaining patients had a >50% decrease in MADRS scores relative to baseline (52% mean MADRS reduction, p = 0.001); these same six patients continued to meet response criteria at 52 weeks (63% overall mean MADRS reduction, p < 0.001). Four of five patients who achieved the 5-year time point analysis continued to be responders (81% mean MADRS reduction, p < 0.001). Evaluation of modulated fiber tracts reveals significant common prefrontal/orbitofrontal connectivity to the target region in all responders. Key points learned from this study that we can incorporate in future protocols to better elucidate the effect of this therapy are a longer blinded sham stimulation phase and use of scheduled discontinuation concomitant with functional imaging.
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Affiliation(s)
- Albert J Fenoy
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA. .,Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, (UT Health), Houston, TX, USA.
| | - Paul E Schulz
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA
| | - Marsal Sanches
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, (UT Health), Houston, TX, USA
| | - Sudhakar Selvaraj
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, (UT Health), Houston, TX, USA
| | - Christina L Burrows
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA
| | - Bashar Asir
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, (UT Health), Houston, TX, USA
| | - Christopher R Conner
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA
| | - Joao Quevedo
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, (UT Health), Houston, TX, USA
| | - Jair C Soares
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, (UT Health), Houston, TX, USA
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10
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Leung E, Lau EW, Liang A, de Dios C, Suchting R, Östlundh L, Masdeu JC, Fujita M, Sanches M, Soares JC, Selvaraj S. Alterations in brain synaptic proteins and mRNAs in mood disorders: a systematic review and meta-analysis of postmortem brain studies. Mol Psychiatry 2022; 27:1362-1372. [PMID: 35022529 DOI: 10.1038/s41380-021-01410-9] [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] [Received: 07/11/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 11/09/2022]
Abstract
The pathophysiological mechanisms underlying bipolar (BD) and major depressive disorders (MDD) are multifactorial but likely involve synaptic dysfunction and dysregulation. There are multiple synaptic proteins but three synaptic proteins, namely SNAP-25, PSD-95, and synaptophysin, have been widely studied for their role in synaptic function in human brain postmortem studies in BD and MDD. These studies have yielded contradictory results, possibly due to the small sample size and sourcing material from different cortical regions of the brain. We performed a systematic review and meta-analysis to understand the role of these three synaptic proteins and other synaptic proteins, messenger RNA (mRNA) and their regional localizations in BD and MDD. A systematic literature search was conducted and the review is reported in accordance with the MOOSE Guidelines. Meta-analysis was performed to compare synaptic marker levels between BD/MDD groups and controls separately. 1811 papers were identified in the literature search and screened against the preset inclusion and exclusion criteria. A total of 72 studies were screened in the full text, of which 47 were identified as eligible to be included in the systematic review. 24 of these 47 papers were included in the meta-analysis. The meta-analysis indicated that SNAP-25 protein levels were significantly lower in BD. On average, PSD-95 mRNA levels were lower in BD, and protein levels of SNAP-25, PSD-95, and syntaxin were lower in MDD. Localization analysis showed decreased levels of PSD-95 protein in the frontal cortex. We found specific alterations in synaptic proteins and RNAs in both BD and MDD. The review was prospectively registered online in PROSPERO international prospective register of systematic reviews, registration no. CRD42020196932.
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Affiliation(s)
- Edison Leung
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Depression Research Program, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ethan W Lau
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Andi Liang
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Constanza de Dios
- Depression Research Program, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Robert Suchting
- Depression Research Program, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Linda Östlundh
- The National Medical Library, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Joseph C Masdeu
- Houston Methodist Neurological Institute, Houston, TX, USA.,Weill Cornell Medicine, New York, NY, USA
| | - Masahiro Fujita
- Weill Cornell Medicine, New York, NY, USA.,PET Core Facility, Houston Methodist Research Insitute, Houston, TX, USA
| | - Marsal Sanches
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Depression Research Program, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jair C Soares
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Depression Research Program, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sudhakar Selvaraj
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA. .,Depression Research Program, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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11
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Diaz AP, Fernandes BS, Teixeira AL, Mwangi B, Hasan KM, Wu MJ, Selvaraj S, Suen P, Zanao TA, Brunoni AR, Sanches M, Soares JC. White matter microstructure associated with anhedonia among individuals with bipolar disorders and high-risk for bipolar disorders. J Affect Disord 2022; 300:91-98. [PMID: 34936916 PMCID: PMC8828704 DOI: 10.1016/j.jad.2021.12.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Anhedonia - a key symptom of depression - is highly associated with poorer outcomes and suicidal behavior. Alterations in the circuitry of reward-related brain regions have been robustly associated with anhedonia in unipolar depression, but not bipolar disorder (BD). We investigated white matter microstructures associated with anhedonia in participants with BD types I and II and first-degree relatives of patients with BD (BD-siblings). METHODS Eighty participants (BD types I and II: 56 [70%], and BD-siblings: 24 [30%]) underwent diffusion tensor imaging (DTI); Fractional anisotropy (FA) of different tracts were computed. Anhedonia was assessed using item 8, ("inability to feel'') of the MADRS scale. General linear models were used to compare the FA of different tracts in participants with and without anhedonia controlling for several clinical and demographic variables. RESULTS The mean age of the sample was 37 (± 11) years old, and 68.8% were female. Participants with anhedonia (32.5%) presented lower mean FA in the left uncinate fasciculus (UF) (p = 0.005), right temporal endings of the superior longitudinal fasciculus (SLFT) (p = 0.04), and in the left and right parietal endings of the superior longitudinal fasciculus (SLFP) (p = 0.003, and p = 0.04, respectively). Similar comparisons between participants with or without current depressive episodes and between participants with or without inner tension according to the MADRS did not show significant differences, specificity of the findings for anhedonia. CONCLUSIONS Lower FA in the left UF and SLF are potential neuroimaging markers of anhedonia in individuals with BD and high-risk for BD.
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Affiliation(s)
- Alexandre Paim Diaz
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Road, Suite 3130, Houston, TX 77054, United States.
| | - Brisa S. Fernandes
- The University of Texas Health Science Center at Houston, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, Houston, Texas
| | - Antonio Lucio Teixeira
- The University of Texas Health Science Center at Houston, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, Houston, Texas
| | - Benson Mwangi
- The University of Texas Health Science Center at Houston, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, Houston, Texas
| | - Khader M. Hasan
- The University of Texas Health Science Center at Houston, Department of Diagnostic and Interventional Imaging, Diffusion MRI Research Lab, Houston, Texas
| | - Mon-Ju Wu
- The University of Texas Health Science Center at Houston, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, Houston, Texas
| | - Sudhakar Selvaraj
- The University of Texas Health Science Center at Houston, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, Houston, Texas
| | - Paulo Suen
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Tamires Araujo Zanao
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Andre R. Brunoni
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marsal Sanches
- The University of Texas Health Science Center at Houston, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, Houston, Texas
| | - Jair C. Soares
- The University of Texas Health Science Center at Houston, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, Houston, Texas
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12
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Sanches M. Mixed States, Pathoplasticity, and the Bipolar Spectrum. Psychiatr Danub 2022; 34:532-533. [PMID: 36257002] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Marsal Sanches
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. Director of Research Education, The Menninger Clinic, Houston, TX, USA,
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13
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Nascimento F, Diaz AP, Sanches M, Fenoy AJ, Soares JC, Quevedo J. Concomitant deep brain stimulation and vagus nerve stimulation for treatment-resistant depression: a case report. Braz J Psychiatry 2021; 43:679-680. [PMID: 34878002 PMCID: PMC8639022 DOI: 10.1590/1516-4446-2021-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Flavio Nascimento
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Alexandre Paim Diaz
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Marsal Sanches
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Albert J Fenoy
- Department of Neurosurgery, McGovern Medical School, UTHealth, Houston, TX, USA
| | - Jair C Soares
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Joao Quevedo
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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14
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Sanches M. Time-driven interventions for affective disorders and resistance to treatment. Trends Psychiatry Psychother 2021; 43:240-241. [PMID: 34861109 PMCID: PMC8638716 DOI: 10.47626/2237-6089-2020-0178] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Marsal Sanches
- UT Health Center of Excellence on Mood Disorders, Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, Houston, TX, USA
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15
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Olmos C, Pigott T, Soares JC, Sanches M. Religiosity as a protective factor for suicidality among inpatients with bipolar disorder. Asian J Psychiatr 2021; 66:102875. [PMID: 34634658 DOI: 10.1016/j.ajp.2021.102875] [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] [Received: 08/23/2021] [Revised: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Carolina Olmos
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA; UT Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA
| | - Teresa Pigott
- UT Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA; UT Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA
| | - Marsal Sanches
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA; UT Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA
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16
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Affiliation(s)
- Marsal Sanches
- The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
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17
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Sanches M, Teixeira AL. The renin-angiotensin system, mood, and suicide: Are there associations? World J Psychiatry 2021; 11:581-588. [PMID: 34631462 PMCID: PMC8474990 DOI: 10.5498/wjp.v11.i9.581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/29/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
Available evidence points to a possible role of the renin-angiotensin system (RAS) in the pathophysiology of mood disorders and suicide. We carried out a critical analysis of literature data regarding this role, with a focus on the proposed association between RAS dysfunction and suicidal behavior. Epidemiological, genetic, and biochemical findings are described, and the pathophysiological hypothesis aiming at explaining the possible relationship between RAS and suicide are discussed. Available findings do support the involvement of the RAS in the neurobiology of suicide, although the exact mechanisms underlying this involvement are still unknown.
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Affiliation(s)
- Marsal Sanches
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77054, United States
| | - Antonio Lucio Teixeira
- UT Health Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77054, United States
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18
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Dandekar MP, Diaz AP, Rahman Z, Silva RH, Nahas Z, Aaronson S, Selvaraj S, Fenoy AJ, Sanches M, Soares JC, Riva-Posse P, Quevedo J. A narrative review on invasive brain stimulation for treatment-resistant depression. ACTA ACUST UNITED AC 2021; 44:317-330. [PMID: 34468549 PMCID: PMC9169472 DOI: 10.1590/1516-4446-2021-1874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/22/2021] [Indexed: 12/20/2022]
Abstract
While most patients with depression respond to pharmacotherapy and psychotherapy, about one-third will present treatment resistance to these interventions. For patients with treatment-resistant depression (TRD), invasive neurostimulation therapies such as vagus nerve stimulation, deep brain stimulation, and epidural cortical stimulation may be considered. We performed a narrative review of the published literature to identify papers discussing clinical studies with invasive neurostimulation therapies for TRD. After a database search and title and abstract screening, relevant English-language articles were analyzed. Vagus nerve stimulation, approved by the U.S. Food and Drug Administration as a TRD treatment, may take several months to show therapeutic benefits, and the average response rate varies from 15.2-83%. Deep brain stimulation studies have shown encouraging results, including rapid response rates (> 30%), despite conflicting findings from randomized controlled trials. Several brain regions, such as the subcallosal-cingulate gyrus, nucleus accumbens, ventral capsule/ventral striatum, anterior limb of the internal capsule, medial-forebrain bundle, lateral habenula, inferior-thalamic peduncle, and the bed-nucleus of the stria terminalis have been identified as key targets for TRD management. Epidural cortical stimulation, an invasive intervention with few reported cases, showed positive results (40-60% response), although more extensive trials are needed to confirm its potential in patients with TRD.
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Affiliation(s)
- Manoj P Dandekar
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Alexandre P Diaz
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Ziaur Rahman
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Ritele H Silva
- Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Ziad Nahas
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Scott Aaronson
- Clinical Research Programs, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Sudhakar Selvaraj
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Albert J Fenoy
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Deep Brain Stimulation Program, Department of Neurosurgery, McGovern Medical School, UTHealth, Houston, TX, USA
| | - Marsal Sanches
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Jair C Soares
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Joao Quevedo
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil.,Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth, Houston, TX, USA
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19
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Marx W, McGuinness AJ, Rocks T, Ruusunen A, Cleminson J, Walker AJ, Gomes-da-Costa S, Lane M, Sanches M, Diaz AP, Tseng PT, Lin PY, Berk M, Clarke G, O'Neil A, Jacka F, Stubbs B, Carvalho AF, Quevedo J, Soares JC, Fernandes BS. The kynurenine pathway in major depressive disorder, bipolar disorder, and schizophrenia: a meta-analysis of 101 studies. Mol Psychiatry 2021; 26:4158-4178. [PMID: 33230205 DOI: 10.1038/s41380-020-00951-9] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [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: 07/31/2020] [Revised: 09/29/2020] [Accepted: 11/02/2020] [Indexed: 12/29/2022]
Abstract
The importance of tryptophan as a precursor for neuroactive compounds has long been acknowledged. The metabolism of tryptophan along the kynurenine pathway and its involvement in mental disorders is an emerging area in psychiatry. We performed a meta-analysis to examine the differences in kynurenine metabolites in major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SZ). Electronic databases were searched for studies that assessed metabolites involved in the kynurenine pathway (tryptophan, kynurenine, kynurenic acid, quinolinic acid, 3-hydroxykynurenine, and their associate ratios) in people with MDD, SZ, or BD, compared to controls. We computed the difference in metabolite concentrations between people with MDD, BD, or SZ, and controls, presented as Hedges' g with 95% confidence intervals. A total of 101 studies with 10,912 participants were included. Tryptophan and kynurenine are decreased across MDD, BD, and SZ; kynurenic acid and the kynurenic acid to quinolinic acid ratio are decreased in mood disorders (i.e., MDD and BD), whereas kynurenic acid is not altered in SZ; kynurenic acid to 3-hydroxykynurenine ratio is decreased in MDD but not SZ. Kynurenic acid to kynurenine ratio is decreased in MDD and SZ, and the kynurenine to tryptophan ratio is increased in MDD and SZ. Our results suggest that there is a shift in the tryptophan metabolism from serotonin to the kynurenine pathway, across these psychiatric disorders. In addition, a differential pattern exists between mood disorders and SZ, with a preferential metabolism of kynurenine to the potentially neurotoxic quinolinic acid instead of the neuroprotective kynurenic acid in mood disorders but not in SZ.
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Affiliation(s)
- Wolfgang Marx
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.
| | - Amelia J McGuinness
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Tetyana Rocks
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Anu Ruusunen
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Jasmine Cleminson
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Adam J Walker
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Susana Gomes-da-Costa
- Bipolar and Depression Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Melissa Lane
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Marsal Sanches
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Alexandre P Diaz
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Ping-Tao Tseng
- Institute of Biomedical Sciences and Prospect Clinic for Otorhinolaryngology & Neurology, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Gerard Clarke
- Department of Psychiatry and Neurobehavioural Science and APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Adrienne O'Neil
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Felice Jacka
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - João Quevedo
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Jair C Soares
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Brisa S Fernandes
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA. .,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
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20
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Jabbari-Zadeh F, Cao B, Stanley JA, Liu Y, Wu MJ, Tannous J, Lopez M, Sanches M, Mwangi B, Zunta-Soares GB, Soares JC. Evidence of altered metabolism of cellular membranes in bipolar disorder comorbid with post-traumatic stress disorder. J Affect Disord 2021; 289:81-87. [PMID: 33951550 DOI: 10.1016/j.jad.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
In proton magnetic resonance spectroscopy (¹H MRS) studies, aberrant levels of choline-containing compounds that include glycerophosphocholine plus phosphocholine (GPC+PC), can signify alterations in the metabolism of cellular membrane phospholipids (MPLs) from a healthy baseline. In a recent ¹H MRS study, we reported increased GPC+PC in cortical and subcortical areas of adult patients with bipolar disorder I (BP-I). Post-traumatic stress disorder (PTSD) can worsen the severity of BP-I, but it is unclear whether the effect of a PTSD comorbidity in BP-I is associated with altered MPL metabolism. The purpose of this study was to re-investigate the ¹H MRS data to determine whether the regional extent of elevated GPC+PC was greater in BP-I patients with PTSD (BP-I/wPTSD) compared to BP-I without comorbid PTSD (BP-I/woPTSD) patients and healthy controls. GPC+PC levels from four brain areas [the anterior cingulate cortex (ACC), anterior-dorsal ACC, caudate, and putamen] were measured in 14 BP-I/wPTSD, 36 BP-I/woPTSD, and 44 healthy controls using a multi-voxel 1H MRS approach on a 3 Tesla system with high spatial resolution and absolute quantification. Results show a significant increase in GPC+PC levels from the caudate and putamen of BP-I/wPTSD patients compared to healthy controls (P<0.05) and in the putamen compared to BP-I/woPTSD patients (P<0.05). These findings are consistent with evidence of elevated degradation of MPLs in the neuropil that is more pronounced in BP-I patients with comorbid PTSD.
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Affiliation(s)
- Faramarz Jabbari-Zadeh
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Canada
| | - Bo Cao
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Canada.
| | - Jeffrey A Stanley
- Department of Psychiatry & Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Yang Liu
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Canada
| | - Mon-Ju Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, TX 77054, USA
| | - Jonika Tannous
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, TX 77054, USA
| | - Mizuki Lopez
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Canada
| | - Marsal Sanches
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, TX 77054, USA
| | - Benson Mwangi
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, TX 77054, USA
| | - Giovana B Zunta-Soares
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, TX 77054, USA
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, TX 77054, USA
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21
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Diaz AP, Fernandes BS, Quevedo J, Sanches M, Soares JC. Treatment-resistant bipolar depression: concepts and challenges for novel interventions. ACTA ACUST UNITED AC 2021; 44:178-186. [PMID: 34037084 PMCID: PMC9041963 DOI: 10.1590/1516-4446-2020-1627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/16/2021] [Indexed: 02/06/2023]
Abstract
Treatment-resistant bipolar depression (TRBD) has been reported in about one-quarter of patients with bipolar disorders, and few interventions have shown clear and established effectiveness. We conducted a narrative review of the published medical literature to identify papers discussing treatment-resistant depression concepts and novel interventions for bipolar depression that focus on TRBD. We searched for potentially relevant English-language articles published in the last decade. Selected articles (based on the title and abstract) were retrieved for a more detailed evaluation. A number of promising new interventions, both pharmacological and non-pharmacological, are being investigated for TRBD treatment, including ketamine, lurasidone, D-cycloserine, pioglitazone, N-acetylcysteine, angiotensin-converting enzyme inhibitors, angiotensin II type 1 receptor blockers, cyclooxygenase 2 inhibitors, magnetic seizure therapy, intermittent theta-burst stimulation, deep transcranial magnetic stimulation, vagus nerve stimulation therapy, and deep brain stimulation. Although there is no consensus about the concept of TRBD, better clarification of the neurobiology associated with treatment non-response could help identify novel strategies. More research is warranted, mainly focusing on personalizing current treatments to optimize response and remission rates.
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Affiliation(s)
- Alexandre P Diaz
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Brisa S Fernandes
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Joao Quevedo
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Marsal Sanches
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Jair C Soares
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
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22
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Ortiz A, Husain I, Moorti P, Alda M, Sanches M, Mulsant B. Higher illness burden is associated with reduced heart rate variability in bipolar disorder. Eur Psychiatry 2021. [PMCID: PMC9471159 DOI: 10.1192/j.eurpsy.2021.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Bipolar disorder (BD) is associated with premature death and ischemic heart disease is the main cause of excess mortality. The predictive power of heart rate variability (HRV) for mortality has been confirmed in patients with or without cardiovascular disease. While several studies have analyzed the association between HRV and BD, their results are incongruent; and none has analyzed the effect of the clinical factors characterizing illness burden on HRV. Objectives To assess the association between HRV and the following factors characterizing illness burden: illness duration, number and type of previous episode(s), duration of the most severe depressive or hypomanic/manic episode, severity of episodes, co-morbid psychiatric disorders, family history of BD or suicide, and duration and polarity of current episode in participants experiencing one. Methods We used a wearable device in 53 BD participants to assess the association between HRV using 4 measures (RMSSD, SDANN, SDNN and RR Triangular Index) and the abovementioned clinical factors characterizing illness burden. For each of the 4 HRV measures we ran 11 models, one for each burden of illness clinical factor as an independent variable. Results Longer illness duration, higher number of depressive episodes, and family history of suicide were negatively correlated with HRV; in the 14 participants experiencing a depressive episode, the MADRS score was negatively correlated with HRV Conclusions Our study analyzed the association between burden of illness and HRV in BD, while controlling for functional cardiovascular status, age, sex, BMI, education, and treatment. Our results showed that high illness burden is associated with reduced HRV. Disclosure No significant relationships.
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23
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Kaur M, Sanches M. Experimental Therapeutics in Treatment-Resistant Major Depressive Disorder. J Exp Pharmacol 2021; 13:181-196. [PMID: 33658867 PMCID: PMC7917305 DOI: 10.2147/jep.s259302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/27/2021] [Indexed: 12/11/2022] Open
Abstract
Treatment-Resistant Depression (TRD) patients remain a challenging sub-division of patients with Major Depressive Disorder (MDD) in day to day clinical practice. As with any diagnostic condition, comprehensive evaluation, exclusion of other psychiatric conditions, assessment of co-morbid medical and psychiatric illnesses and psychosocial stressors are the keys to appropriate diagnosis and subsequent management. There are various management options available for the treatment of MDD, however, about 30% of the patients fail to achieve full remission of symptoms despite multiple trials and belong to this sub-category of MDD. This article brings forth discussion of other non-conventional medication and non-medication treatment alternatives that merit exploration of their efficacy in TRD. Many of the proposed novel medications and other treatment modalities such as Deep Brain Stimulation, exercise, yoga are already used for other medical and psychiatric disorders and have some evidence suggesting their potential benefits in TRD in conjunction with conventional medications or even as monotherapy. Nevertheless, more research is needed in this direction to establish effectiveness.
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Affiliation(s)
- Mandeep Kaur
- Department of Behavioral Medicine, Cone Health, Greensboro, NC, USA
| | - Marsal Sanches
- UT Health Center of Excellence on Mood Disorders, Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, Houston, TX, USA
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Abstract
Introduction: 'Nutritional Psychiatry' is an emerging area of research that has great potential as an adjunctive tool for the prevention and treatment of diverse neuropsychiatric disorders. Several nutrition-related aspects, such as obesity, dietary patterns, gut microbiome composition and gut permeability, bioactive food compounds, and nutrients can influence pathways implicated in the pathophysiology of mood disorders.Areas covered: Here, the authors review the current evidence on nutrition-mood interaction and nutrition-based treatments for the two main mood disorders, i.e., major depressive disorder and bipolar disorder.Expert opinion: Consistent evidence from observational studies has pointed out the association between a 'healthy' diet, generally characterized by a higher intake of fruits, vegetables, legumes, nuts, whole grains, and good quality sources of protein (i.e. fish and/or seafood), and decreased risk of mood disorders and the parallel association between a 'Western' diet pattern and increased risk. However, only a few clinical trials have evaluated the effect of nutritional interventions on the treatment of these conditions. The bidirectional interaction between the brain and the gut, named 'brain-gut-microbiome axis' or 'gut-brain axis', plays a key role in the link between nutrition and mood disorders. Therefore, nutrition-based strategies for gut microbiota modulation are promising fields in mood disorders.
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Affiliation(s)
- Lais B Martins
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, Texas, United States.,Departamento de Nutrição, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Jenneffer Rayane Braga Tibães
- Departamento de Nutrição, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Agricultural, Food and Nutritional Science, Division of Human Nutrition, University of Alberta, Edmonton, Alberta, Canada
| | - Marsal Sanches
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, Texas, United States
| | - Felice Jacka
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia.,College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Black Dog Institute, Randwick, New South Wales, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Antônio L Teixeira
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, Texas, United States.,Instituto de Ensino e Pesquisa, Santa Casa, Belo Horizonte, Minas Gerais, Brazil
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25
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Sanches M, Quevedo J, Soares JC. New agents and perspectives in the pharmacological treatment of major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110157. [PMID: 33159975 PMCID: PMC7750246 DOI: 10.1016/j.pnpbp.2020.110157] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 08/17/2020] [Revised: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
Despite the important advances in the understanding of the pathophysiology of MDD, a large proportion of depressed patients do not respond well to currently available pharmacological agents. The present review focuses on new targets and future directions in the pharmacological treatment of MDD. Novel agents and their efficacy in the treatment of depression are discussed, with a focus on the respectively target pathophysiological pathways and the level of available evidence. Although it is expected that classic antidepressants will remain the cornerstone of MDD treatment, at least for the near future, a large number of novel compounds is currently under investigation as for their efficacy in the treatment of MDD, many of which with promising results.
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Affiliation(s)
- Marsal Sanches
- UT Health Center of Excellence on Mood Disorders, Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
| | - Joao Quevedo
- UT Health Center of Excellence on Mood Disorders, Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA; Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Jair C Soares
- UT Health Center of Excellence on Mood Disorders, Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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26
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Affiliation(s)
- Marsal Sanches
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth); and UTHealth Center of Excellence on Mood Disorders, Houston, Texas
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27
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Sanches M, Colpo GD, Cuellar VA, Bockmann T, Rogith D, Soares JC, Teixeira AL. Decreased Plasma Levels of Angiotensin-Converting Enzyme Among Patients With Bipolar Disorder. Front Neurosci 2021; 15:617888. [PMID: 33642980 PMCID: PMC7904895 DOI: 10.3389/fnins.2021.617888] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background Dysfunctions in the renin-angiotensin system (RAS) seem to be involved in the pathophysiology of several mental illness, including schizophrenia and mood disorders. We carried out a cross-sectional study assessing the levels of RAS-related molecules among bipolar disorder (BD) patients compared to healthy controls. Methods our sample consisted of 30 outpatients with BD type 1 (10 males, 20 females, age = 35.53 ± 10.59 years, 14 euthymic, 16 experiencing mood episodes) and 30 healthy controls (10 males, 20 females, age = 34.83 ± 11.49 years). Plasma levels of angiotensin-converting enzyme (ACE), angiotensin-converting enzyme 2 (ACE2), angiotensin-II (Ang II), and angiotensin (1–7) [Ang-(1–7)] were determined by ELISA. Results BD patients experiencing ongoing mood episodes had significantly lower ACE levels compared to controls (median: 459.00 vs. 514.10, p < 0.05). There was no association between the levels of these biomarkers and clinical parameters. Conclusion Our findings support the involvement of RAS dysfunction in the pathophysiology of BD. Considering the potential therapeutic implications linked to a better understanding of the role of RAS dysfunction in BD, studies allowing a better characterization of RAS-related molecules level and activity across different mood states are of high interest.
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Affiliation(s)
- Marsal Sanches
- Department of Psychiatry and Behavioral Sciences, UT Center of Excellence on Mood Disorders, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Gabriela D Colpo
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Valeria A Cuellar
- Department of Psychiatry and Behavioral Sciences, UT Center of Excellence on Mood Disorders, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Taya Bockmann
- Department of Psychiatry and Behavioral Sciences, UT Center of Excellence on Mood Disorders, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Deevakar Rogith
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, UT Center of Excellence on Mood Disorders, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Antonio L Teixeira
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Diaz AP, Cuellar VA, Vinson EL, Suchting R, Durkin K, Fernandes BS, Scaini G, Kazimi I, Zunta-Soares GB, Quevedo J, Sanches M, Soares JC. The Greater Houston Area Bipolar Registry-Clinical and Neurobiological Trajectories of Children and Adolescents With Bipolar Disorders and High-Risk Unaffected Offspring. Front Psychiatry 2021; 12:671840. [PMID: 34149481 PMCID: PMC8211873 DOI: 10.3389/fpsyt.2021.671840] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/05/2021] [Indexed: 12/02/2022] Open
Abstract
The aims of this article are to discuss the rationale, design, and procedures of the Greater Houston Area Bipolar Registry (HBR), which aims at contributing to the effort involved in the investigation of neurobiological mechanisms underlying bipolar disorder (BD) as well as to identify clinical and neurobiological markers able to predict BD clinical course. The article will also briefly discuss examples of other initiatives that have made fundamental contributions to the field. This will be a longitudinal study with participants aged 6-17 at the time of enrollment. Participants will be required to meet diagnostic criteria for BD, or to be offspring of a parent with BD. We will also enroll healthy controls. Besides clinical information, which includes neurocognitive performance, participants will be asked to provide blood and saliva samples as well as to perform neuroimaging exams at baseline and follow-ups. Several studies point to the existence of genetic, inflammatory, and brain imaging alterations between individuals at higher genetic risk for BD compared with healthy controls. Longitudinal designs have shown high conversion rates to BD among high-risk offspring, with attempts to identify clinical predictors of disease onset, as well as clarifying the burden associated with environmental stressors. The HBR will help in the worldwide effort investigating the clinical course and neurobiological mechanisms of affected and high-risk children and adolescents with BD.
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Affiliation(s)
- Alexandre Paim Diaz
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Valeria A Cuellar
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Elizabeth L Vinson
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Robert Suchting
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Kathryn Durkin
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Brisa S Fernandes
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Giselli Scaini
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Iram Kazimi
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Methodist Hospital, Houston, TX, United States
| | - Giovana B Zunta-Soares
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - João Quevedo
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States.,Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina, Criciúma, SC, Brazil
| | - Marsal Sanches
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jair C Soares
- Center of Excellence on Mood Disorders, McGovern Medical School, Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Mohite S, Sanches M, Teixeira AL. Exploring the Evidence Implicating the Renin-Angiotensin System (RAS) in the Physiopathology of Mood Disorders. Protein Pept Lett 2020; 27:449-455. [PMID: 31868144 DOI: 10.2174/0929866527666191223144000] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/12/2019] [Accepted: 11/05/2019] [Indexed: 01/01/2023]
Abstract
Mood disorders include Major Depressive Disorder (MDD), Bipolar Disorder (BD) and variations of both. Mood disorders has a public health significance with high comorbidity, suicidal mortality and economic burden on the health system. Research related to mood disorders has evolved over the years to relate it with systemic conditions. The Renin Angiotensin System (RAS) has been noticed to play major physiological roles beyond renal and cardiovascular systems. Recent studies have linked RAS not only with neuro-immunological processes, but also with psychiatric conditions like mood and anxiety disorders. In this comprehensive review, we integrated basic and clinical studies showing the associations between RAS and mood disorders. Animal studies on mood disorders models - either depression or mania - were focused on the reversal of behavioral and/or cognitive symptoms through the inhibition of RAS components like the Angiotensin- Converting Enzyme (ACE), Angiotensin II Type 1 receptor (AT1) or Mas receptors. ACE polymorphisms, namely insertion-deletion (I/D), were linked to mood disorders and suicidal behavior. Hypertension was associated with neurocognitive deficits in mood disorders, which reversed with RAS inhibition. Low levels of RAS components (renin activity or aldosterone) and mood symptoms improvement with ACE inhibitors or AT1 blockers were also observed in mood disorders. Overall, this review reiterates the strong and under-researched connection between RAS and mood disorders.
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Affiliation(s)
- Satyajit Mohite
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX 77054, United States
| | - Marsal Sanches
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX 77054, United States
| | - Antonio L Teixeira
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX 77054, United States
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30
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Sanches M, Quevedo J, Soares JC. Antidepressants, genetic risk, and the prevention of bipolar disorder. Braz J Psychiatry 2020; 42:461-462. [PMID: 32876129 PMCID: PMC7524425 DOI: 10.1590/1516-4446-2020-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/05/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Marsal Sanches
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Joao Quevedo
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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31
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Mohite S, Cordeiro T, Tannous J, Mwangi B, Selvaraj S, Soares JC, Sanches M, Teixeira AL. Eotaxin-1/CCL11 correlates with left superior temporal gyrus in bipolar disorder: A preliminary report suggesting accelerated brain aging. J Affect Disord 2020; 273:592-596. [PMID: 32560958 DOI: 10.1016/j.jad.2020.05.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Neuropsychiatric disorders have been linked to immune mechanisms. Altered peripheral levels of eotaxin-1/CCL11; a cytokine implicated in allergic reactions and aging process; have been reported in bipolar disorder (BD). Several brain areas, especially the temporal lobe, seem to display volume loss and accelerated aging in BD. This study aimed at exploring potential associations between eotaxins and brain volumes in patients with BD compared to controls. METHODS Twenty-two euthymic patients with BD and 22 controls were enrolled in this study. Serum levels of eotaxin-1/CCL11, eotaxin-2/CCL24 and eotaxin-3/CCL26 were determined alongside brain volumes. RESULTS There were no differences in the levels of eotaxins between patients and controls. A negative correlation was found between eotaxin-1/CCL11 levels and left-hemisphere's superior-temporal volume only in BD patients, which persisted with covariate adjusted model. CONCLUSION This study corroborates the emerging evidence of association between inflammation and brain volumes in BD. Our preliminary results also support the hypothesis of a possible role of eotaxin-1/CCL11 in accelerated brain aging in BD.
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Affiliation(s)
- Satyajit Mohite
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, 1941 East Road, Houston, Texas, 77054, USA.
| | - Thiago Cordeiro
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, 1941 East Road, Houston, Texas, 77054, USA.
| | - Jonika Tannous
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, 1941 East Road, Houston, Texas, 77054, USA.
| | - Benson Mwangi
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, 1941 East Road, Houston, Texas, 77054, USA.
| | - Sudhakar Selvaraj
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, 1941 East Road, Houston, Texas, 77054, USA.
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, 1941 East Road, Houston, Texas, 77054, USA.
| | - Marsal Sanches
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, 1941 East Road, Houston, Texas, 77054, USA.
| | - Antonio L Teixeira
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, 1941 East Road, Houston, Texas, 77054, USA.
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Sanches M. On the unique utility of digital technology for bipolar disorder: Is there still room for phenomenology? Bipolar Disord 2020; 22:530-531. [PMID: 32276283 DOI: 10.1111/bdi.12908] [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: 11/28/2022]
Affiliation(s)
- Marsal Sanches
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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Takeuchi H, Borlido C, Sanches M, Teo C, Harber L, Agid O, Remington G. Adherence to clozapine vs. other antipsychotics in schizophrenia. Acta Psychiatr Scand 2020; 142:87-95. [PMID: 32627168 DOI: 10.1111/acps.13208] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 04/25/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND To date, there have been no studies evaluating adherence to clozapine with electronic adherence monitoring (EAM) such as the Medication Event Monitoring System (MEMS® ). METHODS In outpatients with schizophrenia, we conducted a 3-month prospective study investigating antipsychotic adherence with EAM (eCAP® ). Participants were treated with different oral antipsychotics, including clozapine, and blind to EAM monitoring; all were on antipsychotic monotherapy administered once daily. Outcome measures included adherence rate, missed dose, and medication gap. Adherence trajectory patterns were also analyzed for clozapine vs. other antipsychotics collectively. RESULTS A total of 111 patients were included in the study; 33 and 78 patients received clozapine or other antipsychotics, respectively. Adherence rates, defined as proportion of days that the subject took the medication at the prescribed time ± 3 h and proportion of subjects with ≥80% adherence, were numerically higher in patients receiving clozapine vs. other antipsychotics (72.0% vs. 65.1%, P = 0.10; 49.5% vs. 35.7%, P = 0.11, respectively). Along similar lines, some of the missed dose and medication gap outcomes were significantly better in patients receiving clozapine vs. other antipsychotics. Three adherence trajectory patterns were identified for both clozapine and other antipsychotics, with two shared by both groups (i.e., low adherence with a slight decrease over time; high and stable adherence). CONCLUSION Findings suggest that in patients with schizophrenia clozapine adherence is at least comparable, if not slightly better, compared with other antipsychotics.
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Affiliation(s)
- H Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - C Borlido
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - M Sanches
- Biostatistical Consulting Service, Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - C Teo
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - L Harber
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - O Agid
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - G Remington
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Sanches M. The Limits between Bipolar Disorder and Borderline Personality Disorder: A Review of the Evidence. Diseases 2019; 7:diseases7030049. [PMID: 31284435 PMCID: PMC6787615 DOI: 10.3390/diseases7030049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 01/18/2023] Open
Abstract
Bipolar disorder and borderline personality disorder are among the most frequently diagnosed psychiatric conditions. However, the nosological aspects and diagnostic boundaries of both conditions have historically been the object of considerable controversy. The present paper critically analyzes this debate, in light of available evidence. Clinical and neurobiological differences between bipolar disorder and borderline personality disorder are discussed, as well as the factors possibly involved in the overlap between both conditions and the potential implications of this.
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Affiliation(s)
- Marsal Sanches
- UT Health Department of Psychiatry & Behavioral Sciences, McGovern Medical School, Houston, TX 77021, USA.
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35
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Sanches M. Memories of an undercover attending: Reflections on completing a second residency training. Med Teach 2019; 41:842-843. [PMID: 30134754 DOI: 10.1080/0142159x.2018.1497150] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The author, originally a full-trained psychiatrist in his home country, describes his personal experience as a resident physician in the Unites States, from a critical standpoint. The challenges and peculiarities inherent to undergoing second residency training are addressed. The singularities of the situation in question are discussed. Finally, the author provides some recommendations for teaching physicians involved in the supervision of residents, emphasizing the need for taking into consideration their trainee's respective backgrounds and their potential implications.
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Affiliation(s)
- Marsal Sanches
- a St. Alexius Medical Center, Department of Psychiatry and Behavioral Sciences , University of North Dakota Medical School , Bismarck , ND , USA
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Sanches M, Amorim E, Mwangi B, Zunta-Soares GB, Soares JC. Smaller left anterior cingulate cortex in non-bipolar relatives of patients with bipolar disorder. ACTA ACUST UNITED AC 2018; 41:254-256. [PMID: 30540025 PMCID: PMC6794124 DOI: 10.1590/1516-4446-2018-0051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 09/12/2018] [Indexed: 11/25/2022]
Abstract
Objective: Bipolar disorder (BD) is highly heritable. The present study aimed at identifying brain morphometric features that could represent markers of BD vulnerability in non-bipolar relatives of bipolar patients. Methods: In the present study, structural magnetic resonance imaging brain scans were acquired from a total of 93 subjects, including 31 patients with BD, 31 non-bipolar relatives of BD patients, and 31 healthy controls. Volumetric measurements of the anterior cingulate cortex (ACC), lateral ventricles, amygdala, and hippocampus were completed using the automated software FreeSurfer. Results: Analysis of covariance (with age, gender, and intracranial volume as covariates) indicated smaller left ACC volumes in unaffected relatives as compared to healthy controls and BD patients (p = 0.004 and p = 0.037, respectively). No additional statistically significant differences were detected for other brain structures. Conclusion: Our findings suggest smaller left ACC volume as a viable biomarker candidate for BD.
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Affiliation(s)
- Marsal Sanches
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Psychiatry and Behavioral Sciences, University of North Dakota School of Medicine, Bismarck, ND, USA
| | - Edilberto Amorim
- Massachusetts General Hospital & Brigham and Women's Hospital, Boston, MA, USA
| | - Benson Mwangi
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Giovana B Zunta-Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Sanches M. The potential role of scales in discriminating unipolar and bipolar depression. J bras psiquiatr 2018. [DOI: 10.1590/0047-2085000000216] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bauer IE, Suchting R, Cazala F, Alpak G, Sanches M, Nery FG, Zunta-Soares GB, Soares JC. Changes in amygdala, cerebellum, and nucleus accumbens volumes in bipolar patients treated with lamotrigine. Psychiatry Res Neuroimaging 2018; 278:13-20. [PMID: 29944976 DOI: 10.1016/j.pscychresns.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 12/21/2022]
Abstract
The neural mechanisms underlying the therapeutic effects of lamotrigine in bipolar depression are still unexplored. This preliminary study compares the effects of a 12-week treatment with lamotrigine on brain volumes in adults with bipolar disorder (BD).12 BD type II patients (age: 49.33 ± 9.95 years, 3 males, 9 females) and 12 age and gender-matched healthy controls (HC) (HC; age: 41 ± 8.60 years, 3 males, 9 females). BD patients were initially administered 25 mg/day of lamotrigine, which was progressively escalated to 200 mg/d. BD participants underwent brain imaging prior to and following lamotrigine treatment. A 50% reduction in depressive scores indicated "remission". Bayesian general linear models controlled for age, gender and intracranial volume were used to examine changes in relevant brain region following treatment. A posterior probability > 0.90 indicated evidence that there was an effect of diagnosis or remission on brain volumes. Probability distributions of interaction effects between remission and time indicated that BD responders displayed decreased amygdala, cerebellum and nucleus accumbens volumes following lamotrigine treatment. No serious adverse side effects were reported. The antidepressant effects of lamotrigine may be linked to volumetric changes in brain regions involved in mood and emotional regulation. These findings are preliminary and replication in a larger sample is warranted.
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Affiliation(s)
- Isabelle E Bauer
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Houston, TX 77054, United States.
| | - Robert Suchting
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Houston, TX 77054, United States
| | - Fadwa Cazala
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Houston, TX 77054, United States
| | - Gokay Alpak
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Houston, TX 77054, United States
| | - Marsal Sanches
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Houston, TX 77054, United States
| | - Fabiano G Nery
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, United States
| | - Giovana B Zunta-Soares
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Houston, TX 77054, United States
| | - Jair C Soares
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Houston, TX 77054, United States
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Bauer IE, Diniz BS, Meyer TD, Teixeira AL, Sanches M, Spiker D, Zunta-Soares G, Soares JC. Increased reward-oriented impulsivity in older bipolar patients: A preliminary study. J Affect Disord 2018; 225:585-592. [PMID: 28886499 PMCID: PMC5626658 DOI: 10.1016/j.jad.2017.08.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/02/2017] [Accepted: 08/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Impulsivity is a well-established trait of bipolar disorder (BD) that persists across mood phases. It is, however, still unknown whether, in BD, impulsivity remains stable or varies in intensity over the lifespan. This cross-sectional study compared impulsive behavior in older euthymic BD patients and healthy individuals using a range of self-rating and behavioral measures of impulsivity. METHODS 28 BD patients (56.07 ± 4.08 years, 16 women) and 15 healthy controls (HC; 55.1 ± 3.95 years, 6 women) were administered the Barratt Impulsivity Scale (BIS) and selected tasks of the Cambridge Neuropsychological Test Automated Batter (CANTAB) reflecting impulsivity. Multivariate analysis of variance controlled for age compared impulsivity measures across BD and HC. RESULTS BD patients displayed poor decision making, risk taking, and increased delay aversion. Other measures of impulsivity such as response inhibition, sustained cognitive control, and BIS scores were, overall, comparable between BD and HC. CONCLUSIONS These preliminary findings suggest that, in BD, aspects of impulsivity related to reward-based decision making persist into late adulthood. Large scale, longitudinal studies are needed to evaluate the relationship of age to impulsivity over time, and explore the link between impulsivity and illness progression in elderly individuals with BD.
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Affiliation(s)
- Isabelle E. Bauer
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Breno Satler Diniz
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Thomas D. Meyer
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Antonio Lucio Teixeira
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Marsal Sanches
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States,Archway Mental Health Services, 58502 Bismarck, ND, United States
| | - Danielle Spiker
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Giovana Zunta-Soares
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Jair C. Soares
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
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Bauer IE, Meyer TD, Sanches M, Spiker D, Zunta-Soares G, Soares JC. Are self-rated and behavioural measures of impulsivity in bipolar disorder mainly related to comorbid substance use problems? Cogn Neuropsychiatry 2017; 22:298-314. [PMID: 28490234 DOI: 10.1080/13546805.2017.1324951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Impulsivity is a multidimensional feature observed in bipolar disorder (BD) and substance use disorder (SUD). We previously found a relationship between SUD and risk taking in BD. It is still unclear whether self-rated and behavioral impulsivity measures differ between BD with and without comorbid SUD, or are specific to BD. METHODS 93 adults with BD with comorbid SUD, 91 BD without SUD, and 93 healthy controls (HC) were administered the Barratt Impulsivity Scale (BIS), the Behavioral Inhibition/Behavioral Activation System Scale (BIS/BAS), and the Cambridge Neuropsychological Test Automated Battery. Analyses compared impulsivity measures across groups controlling for age. Discriminant function analyses (DFA) assessed the combination of variables effectively predicting group membership. RESULTS BD displayed increased BIS, BIS/BAS scores, reduced performance on the Cambridge Gambling and Rapid Visual Processing, and Affective Go/No-Go tasks compared to HC. Comparisons between BD with and without SUD showed increased BIS Motor impulsiveness. The overall predictive power of DFA was weak. CONCLUSIONS Some facets of impulsivity are a core trait of BD and are partially independent from the presence of SUD. Motor impulsiveness may be distinctive of BD+SUD. More research is needed to understand the role of impulsive behaviors as risk factors for relapse in SUD.
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Affiliation(s)
- Isabelle E Bauer
- a Department of Psychiatry and Behavioral Sciences , McGovern Medical School, University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Thomas D Meyer
- a Department of Psychiatry and Behavioral Sciences , McGovern Medical School, University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Marsal Sanches
- a Department of Psychiatry and Behavioral Sciences , McGovern Medical School, University of Texas Health Science Center at Houston , Houston , TX , USA.,b Archway Mental Health Services , Bismarck , ND , USA
| | - Danielle Spiker
- a Department of Psychiatry and Behavioral Sciences , McGovern Medical School, University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Giovana Zunta-Soares
- a Department of Psychiatry and Behavioral Sciences , McGovern Medical School, University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Jair C Soares
- a Department of Psychiatry and Behavioral Sciences , McGovern Medical School, University of Texas Health Science Center at Houston , Houston , TX , USA
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Gatley JM, Sanches M, Callaghan R. Impacts of Canadian drinking age laws on sexual assault victimization of young women, 2009-2013. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw167.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wu MJ, Mwangi B, Bauer IE, Passos IC, Sanches M, Zunta-Soares GB, Meyer TD, Hasan KM, Soares JC. Identification and individualized prediction of clinical phenotypes in bipolar disorders using neurocognitive data, neuroimaging scans and machine learning. Neuroimage 2016; 145:254-264. [PMID: 26883067 DOI: 10.1016/j.neuroimage.2016.02.016] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/14/2016] [Accepted: 02/08/2016] [Indexed: 12/28/2022] Open
Abstract
Diagnosis, clinical management and research of psychiatric disorders remain subjective - largely guided by historically developed categories which may not effectively capture underlying pathophysiological mechanisms of dysfunction. Here, we report a novel approach of identifying and validating distinct and biologically meaningful clinical phenotypes of bipolar disorders using both unsupervised and supervised machine learning techniques. First, neurocognitive data were analyzed using an unsupervised machine learning approach and two distinct clinical phenotypes identified namely; phenotype I and phenotype II. Second, diffusion weighted imaging scans were pre-processed using the tract-based spatial statistics (TBSS) method and 'skeletonized' white matter fractional anisotropy (FA) and mean diffusivity (MD) maps extracted. The 'skeletonized' white matter FA and MD maps were entered into the Elastic Net machine learning algorithm to distinguish individual subjects' phenotypic labels (e.g. phenotype I vs. phenotype II). This calculation was performed to ascertain whether the identified clinical phenotypes were biologically distinct. Original neurocognitive measurements distinguished individual subjects' phenotypic labels with 94% accuracy (sensitivity=92%, specificity=97%). TBSS derived FA and MD measurements predicted individual subjects' phenotypic labels with 76% and 65% accuracy respectively. In addition, individual subjects belonging to phenotypes I and II were distinguished from healthy controls with 57% and 92% accuracy respectively. Neurocognitive task variables identified as most relevant in distinguishing phenotypic labels included; Affective Go/No-Go (AGN), Cambridge Gambling Task (CGT) coupled with inferior fronto-occipital fasciculus and callosal white matter pathways. These results suggest that there may exist two biologically distinct clinical phenotypes in bipolar disorders which can be identified from healthy controls with high accuracy and at an individual subject level. We suggest a strong clinical utility of the proposed approach in defining and validating biologically meaningful and less heterogeneous clinical sub-phenotypes of major psychiatric disorders.
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Affiliation(s)
- Mon-Ju Wu
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - Benson Mwangi
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA.
| | - Isabelle E Bauer
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - Ives C Passos
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - Marsal Sanches
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - Giovana B Zunta-Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - Thomas D Meyer
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - Khader M Hasan
- Department of Diagnostic & Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
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Sandoval H, Soares JC, Mwangi B, Asonye S, Alvarado LA, Zavala J, Ramirez ME, Sanches M, Enge LR, Escamilla MA. Confirmation of MRI anatomical measurements as endophenotypic markers for bipolar disorder in a new sample from the NIMH Genetics of Bipolar Disorder in Latino Populations study. Psychiatry Res Neuroimaging 2016; 247:34-41. [PMID: 26670713 DOI: 10.1016/j.pscychresns.2015.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 09/02/2015] [Accepted: 11/17/2015] [Indexed: 01/01/2023]
Abstract
The main objective of this study is to establish potential neuromorphometric differences which might act as markers of genetic risk for bipolar disorder and therefore serve as endophenotypes for discovery of genes that contribute to bipolar disorder. Magnetic resonance imaging (MRI) was used to assess structural brain volumes of 49 subjects. Volumetric analyses were first performed to test possible differences in the volume of brain structures between subjects with bipolar disorder type I (BPI) and control subjects in a new sample, based on regions previously reported in the literature as being either increased or decreased in size in bipolar patients. Subsequently, for those brain regions showing statistical difference between subjects with BPI and control subjects in our new sample, we tested whether unaffected first degree relatives (UFRs) of the BPI subjects also showed similar differences compared with controls. Four specific regions (right prefrontal, right middle prefrontal, right globus pallidus and left globus pallidus) met criteria for being possible endophenotypes for BPI in this sample.
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Affiliation(s)
- Hugo Sandoval
- Center of Excellence for Neurosciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - Benson Mwangi
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - Stephanie Asonye
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - Luis A Alvarado
- Division of Biostatistics and Epidemiology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Juan Zavala
- Center of Excellence for Neurosciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA; Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University, Health Sciences Center, El Paso, TX, USA
| | - Mercedes E Ramirez
- Center of Excellence for Neurosciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA; Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University, Health Sciences Center, El Paso, TX, USA
| | - Marsal Sanches
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - Luke R Enge
- Department of Psychology, Social Cognitive and Neurosciences, University of Texas at El Paso, El Paso, TX, USA
| | - Michael A Escamilla
- Center of Excellence for Neurosciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA; Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University, Health Sciences Center, El Paso, TX, USA.
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Brandl EJ, Tiwari AK, Zai CC, Nurmi EL, Chowdhury NI, Arenovich T, Sanches M, Goncalves VF, Shen JJ, Lieberman JA, Meltzer HY, Kennedy JL, Müller DJ. Genome-wide association study on antipsychotic-induced weight gain in the CATIE sample. Pharmacogenomics J 2015; 16:352-6. [DOI: 10.1038/tpj.2015.59] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/01/2015] [Indexed: 01/05/2023]
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Bauer IE, Meyer TD, Sanches M, Zunta-Soares G, Soares JC. Does a history of substance abuse and illness chronicity predict increased impulsivity in bipolar disorder? J Affect Disord 2015; 179:142-7. [PMID: 25863910 DOI: 10.1016/j.jad.2015.03.010] [Citation(s) in RCA: 9] [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: 11/25/2014] [Revised: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Impulsivity is a common feature shared by bipolar disorder (BD) and substance use disorder (SUD). SUD and recurrent mood episodes are considered to be risk factors for poor outcome in BD. However, the association between impulsivity, illness chronicity and SUD in BD remains unexplored. METHODS 103 BD patients with and without a lifetime history of SUD (36.82±11.34 years, 40 males) were recruited. Participants completed the SCID interview and were administered measures of impulsivity including the Barratt Impulsivity Scale (BIS) and selected tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB). Hierarchical regression analyses explored the relationship between illness chronicity, SUD, and impulsivity. RESULTS Variance in the BIS, number of false alarms on the Rapid Visual Processing task and other impulsivity indicators of the Cambridge Gambling Task (CGT) was not explained by the chosen variables. Only an increased number of commission errors in the negative condition of the Affective Go/No Go task was significantly associated with illness chronicity. Furthermore there was a trend suggesting a relationship between a lifetime history of SUD and increased propensity to risk-taking during the CGT. LIMITATIONS Potential limitations include medication and patients׳ remission status from SUD. CONCLUSIONS Contrary to our expectations impulsivity was generally not predicted by indicators of illness chronicity or SUD. While impulsivity could still be a marker of BD that is present before the onset of the disorder, the link between the number of mood episodes and specific indicators of impulsivity may be related to mechanisms of neuroprogression.
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Affiliation(s)
- Isabelle E Bauer
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 1941 East Road, Houston, TX 77054, United States.
| | - Thomas D Meyer
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 1941 East Road, Houston, TX 77054, United States.
| | - Marsal Sanches
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 1941 East Road, Houston, TX 77054, United States
| | - Giovana Zunta-Soares
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 1941 East Road, Houston, TX 77054, United States
| | - Jair C Soares
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 1941 East Road, Houston, TX 77054, United States
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Lavagnino L, Cao B, Mwangi B, Wu MJ, Sanches M, Zunta-Soares GB, Kapczinski F, Soares J. Changes in the corpus callosum in women with late-stage bipolar disorder. Acta Psychiatr Scand 2015; 131:458-64. [PMID: 25640667 PMCID: PMC4932908 DOI: 10.1111/acps.12397] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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] [Accepted: 01/12/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study investigated the differences in corpus callosum (CC) volumes between women with early-stage and late-stage bipolar I (BP I) disorder using the criteria previously described in the literature. METHOD We compared women with early- and late-stage BP I using criteria described in the Staging Systems Task Force Report of the International Society for Bipolar Disorders. We included 20 patients with early stage and 21 patients with late-stage BP I and a group of 25 healthy controls. Patients and controls underwent structural magnetic resonance imaging. Information on the clinical features of bipolar disorder was collected using a standardized questionnaire. Anatomical volumes of five regions of CC were compared between the three groups. RESULTS Women with late-stage BP I disorder had reduced posterior CC volumes compared with early-stage bipolar I patients and controls (F = 6.05; P = 0.004). The difference was significant after controlling for age, comorbidity with post-traumatic stress disorder, psychotic symptoms during mood episodes, and current use of medication. CONCLUSION The posterior CC was significantly decreased in volume in women with late-stage bipolar disorder. These findings suggest that CC may be an anatomical target of neuroprogression in the course of bipolar disorder in women.
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Affiliation(s)
- L. Lavagnino
- Department of Psychiatry and Behavioral Sciences; UT Houston Medical School; UT Center of Excellence on Mood Disorders; Houston TX USA
| | - B. Cao
- Department of Psychiatry and Behavioral Sciences; UT Houston Medical School; UT Center of Excellence on Mood Disorders; Houston TX USA
| | - B. Mwangi
- Department of Psychiatry and Behavioral Sciences; UT Houston Medical School; UT Center of Excellence on Mood Disorders; Houston TX USA
| | - M.-J. Wu
- Department of Psychiatry and Behavioral Sciences; UT Houston Medical School; UT Center of Excellence on Mood Disorders; Houston TX USA
| | - M. Sanches
- Department of Psychiatry and Behavioral Sciences; UT Houston Medical School; UT Center of Excellence on Mood Disorders; Houston TX USA
| | - G. B. Zunta-Soares
- Department of Psychiatry and Behavioral Sciences; UT Houston Medical School; UT Center of Excellence on Mood Disorders; Houston TX USA
| | - F. Kapczinski
- Department of Psychiatry and Behavioral Sciences; UT Houston Medical School; UT Center of Excellence on Mood Disorders; Houston TX USA
| | - J. Soares
- Department of Psychiatry and Behavioral Sciences; UT Houston Medical School; UT Center of Excellence on Mood Disorders; Houston TX USA
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Wu MJ, Wu HE, Mwangi B, Sanches M, Selvaraj S, Zunta-Soares GB, Soares JC. Prediction of pediatric unipolar depression using multiple neuromorphometric measurements: a pattern classification approach. J Psychiatr Res 2015; 62:84-91. [PMID: 25687738 PMCID: PMC4355046 DOI: 10.1016/j.jpsychires.2015.01.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 08/12/2014] [Revised: 12/16/2014] [Accepted: 01/28/2015] [Indexed: 12/05/2022]
Abstract
BACKGROUND Diagnosis of pediatric neuropsychiatric disorders such as unipolar depression is largely based on clinical judgment - without objective biomarkers to guide diagnostic process and subsequent therapeutic interventions. Neuroimaging studies have previously reported average group-level neuroanatomical differences between patients with pediatric unipolar depression and healthy controls. In the present study, we investigated the utility of multiple neuromorphometric indices in distinguishing pediatric unipolar depression patients from healthy controls at an individual subject level. METHODS We acquired structural T1-weighted scans from 25 pediatric unipolar depression patients and 26 demographically matched healthy controls. Multiple neuromorphometric indices such as cortical thickness, volume, and cortical folding patterns were obtained. A support vector machine pattern classification model was 'trained' to distinguish individual subjects with pediatric unipolar depression from healthy controls based on multiple neuromorphometric indices and model predictive validity (sensitivity and specificity) calculated. RESULTS The model correctly identified 40 out of 51 subjects translating to 78.4% accuracy, 76.0% sensitivity and 80.8% specificity, chi-square p-value = 0.000049. Volumetric and cortical folding abnormalities in the right thalamus and right temporal pole respectively were most central in distinguishing individual patients with pediatric unipolar depression from healthy controls. CONCLUSIONS These findings provide evidence that a support vector machine pattern classification model using multiple neuromorphometric indices may qualify as diagnostic marker for pediatric unipolar depression. In addition, our results identified the most relevant neuromorphometric features in distinguishing PUD patients from healthy controls.
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Affiliation(s)
- Mon-Ju Wu
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - Hanjing Emily Wu
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - Benson Mwangi
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA.
| | - Marsal Sanches
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - Sudhakar Selvaraj
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - Giovana B. Zunta-Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - Jair C. Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
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Bauer IE, Ouyang A, Mwangi B, Sanches M, Zunta-Soares GB, Keefe RSE, Huang H, Soares JC. Reduced white matter integrity and verbal fluency impairment in young adults with bipolar disorder: a diffusion tensor imaging study. J Psychiatr Res 2015; 62:115-22. [PMID: 25684152 PMCID: PMC4355300 DOI: 10.1016/j.jpsychires.2015.01.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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: 07/09/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Clinical evidence shows that bipolar disorder (BD) is characterized by white matter (WM) microstructural abnormalities. However, little is known about the biological mechanisms associated with these abnormalities and their relationship with cognitive functioning. METHODS 49 adult BD patients ((M±SD): 29.27 ± 7.92 years; 17 males, 32 females; 34 BD-I, 10 BD-II, and 5 BD-NOS) and 28 age-matched normal subjects ((M±SD): 29.19 ± 7.35 years; 10 males and 18 females) underwent diffusion tensor imaging (DTI) imaging. DTI metrics were computed using whole-brain tract-based spatial statistics (TBSS) as part of the FMRIB Software Library. Measures of WM coherence (fractional anisotropy - FA) and axonal structure (mean, axial and radial diffusivity - MD, AD and RD) were employed to characterize the microstructural alterations in the limbic, commissural, association and projection fiber tracts. All participants performed the Brief Assessment of Cognition for Affective disorders (BAC-A). RESULTS BD patients performed poorly on verbal fluency tasks and exhibited large clusters of altered FA, RD and MD values within the retrolenticular part of the internal capsule, the superior and anterior corona radiata, and the corpus callosum. Increased FA values in the left IFOF and the forceps minor correlated positively with verbal fluency scores. Altered RD parameters in the corticospinal tract and the forceps minor were associated with reduced visuomotor abilities. CONCLUSIONS The reported verbal fluency deficits and FA, RD and MD alterations in WM structures are potential cognitive and neural markers of BD. Abnormal RD values may be associated with progressive demyelination.
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Affiliation(s)
- Isabelle E Bauer
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States.
| | - Austin Ouyang
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Benson Mwangi
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Marsal Sanches
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Giovana B Zunta-Soares
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Richard S E Keefe
- Division of Medical Psychology, Duke University, Medical Centre, 27710 Durham, NC, United States
| | - Hao Huang
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania PA, United States
| | - Jair C Soares
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
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Bauer IE, Keefe RSE, Sanches M, Suchting R, Green CE, Soares JC. Evaluation of cognitive function in bipolar disorder using the Brief Assessment of Cognition in Affective Disorders (BAC-A). J Psychiatr Res 2015; 60:81-6. [PMID: 25455513 PMCID: PMC4314318 DOI: 10.1016/j.jpsychires.2014.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/25/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although cognitive impairment is a core feature of bipolar disorder (BD) there is no instrument of choice for the assessment of bipolar patients. The aim of this study is to assess cognitive performance using the Brief Assessment of Cognition in Affective Disorders (BAC-A), a comprehensive test battery developed specifically for BD, and determine its suitability to estimate global functioning. METHODS The BAC-A was administered to 93 BD patients (M ± S.E: 35.18 ± 1.39 years) and 56 healthy controls (HC - M ± S.E: 36.17 ± 1.91 years). The scores of the BAC-A were combined in eight summary scores: visuomotor, immediate affective and non-affective memory, verbal fluency, delayed affective and non-affective memory, inhibition, and problem solving. Post hoc analyses were performed on subtests of the summary scores found to be significantly different between BD patients and HC. Correlational analyses explored the association between the Global Assessment of Functioning (GAF) score and cognitive functioning. RESULTS Compared to HC, BD patients showed a significant impairment in short-term non-affective memory and verbal fluency. Poorer performance in verbal memory and verbal fluency summary scores correlated positively with reduced GAF. CONCLUSIONS Our results are consistent with previous reports of verbal memory and verbal fluency impairment in BD. The deficits in short-term memory and semantic fluency may indicate inefficient learning strategies and/or difficulties in retrieving information. The BAC-A could be used to estimate global functioning in BD patients.
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Affiliation(s)
- Isabelle E. Bauer
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Richard S. E. Keefe
- Division of Medical Psychology, Duke University, Medical Centre, 27710 Durham, NC, United States
| | - Marsal Sanches
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, Houston, TX, United States
| | - Robert Suchting
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Charles E. Green
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Jair C. Soares
- University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
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Sharma AN, Bauer IE, Sanches M, Galvez JF, Zunta-Soares GB, Quevedo J, Kapczinski F, Soares JC. Common biological mechanisms between bipolar disorder and type 2 diabetes: Focus on inflammation. Prog Neuropsychopharmacol Biol Psychiatry 2014; 54:289-98. [PMID: 24969830 DOI: 10.1016/j.pnpbp.2014.06.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 04/29/2014] [Revised: 06/11/2014] [Accepted: 06/15/2014] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bipolar disorder (BD) patients present a 3-5 fold greater risk of developing type 2 diabetes (T2D) compared to general population. The underlying mechanisms for the increased prevalence of T2D in BD population are poorly understood. OBJECTIVES The purpose of this review is to critically review evidence suggesting that inflammation may have an important role in the development of both BD and T2D. RESULTS The literature covered in this review suggests that inflammatory dysregulation take place among many BD patients. Such dysregulated and low grade chronic inflammatory process may also increase the prevalence of T2D in BD population. Current evidence supports the hypothesis of dysregulated inflammatory processes as a critical upstream event in BD as well as in T2D. CONCLUSIONS Inflammation may be a factor for the development of T2D in BD population. The identification of inflammatory markers common to these two medical conditions will enable researchers and clinicians to better understand the etiology of BD and develop treatments that simultaneously target all aspects of this multi-system condition.
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Affiliation(s)
- Ajaykumar N Sharma
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA; Center for Experimental Models in Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA; Center for Molecular Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Isabelle E Bauer
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Marsal Sanches
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Juan F Galvez
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Giovana B Zunta-Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Joao Quevedo
- Center for Experimental Models in Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA; Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciuma, SC, Brazil
| | - Flavio Kapczinski
- Center for Molecular Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA; Laboratory of Molecular Psychiatry, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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