1
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Parker G, Tavella G, Ricciardi T, Hadzi-Pavlovic D, Alda M, Hajek T, Dunner DL, O'Donovan C, Rybakowski JK, Goldberg JF, Bayes A, Sharma V, Boyce P, Manicavasagar V. Refined diagnostic criteria for the bipolar disorders: phase two of the AREDOC project. Acta Psychiatr Scand 2020; 142:193-202. [PMID: 33460033 DOI: 10.1111/acps.13218] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Accepted: 07/14/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE As limitations exist across DSM criteria sets for defining and differentiating the bipolar disorders generally and their component bipolar I (BP-1) and bipolar II (BP-II) sub-types, we sought to generate empirically based criteria. METHOD We formed an international Task Force (TF) comprising members with bipolar disorder expertise, and who recruited 74 patients with a TF-diagnosed bipolar I and 104 with a bipolar II condition (with patients responding to definitional queries and symptom questionnaires), while 33 unipolar depressed patients recruited by the first author also completed the symptom questionnaire. A factor analysis sought to determine granular hypo/manic constructs. RESULTS The bipolar disorder subjects strongly affirmed a new general definition of a bipolar disorder (capturing both manic and hypomanic episodes). While DSM-5 requires impaired functioning, we established that a high percentage of individuals with a BP-I or a BP-II disorder reported improved functioning and therefore modified this criterion. Analyses identified syptoms with differential high rates in individuals with bipolar disorder and its sub-types (and thus not simply capturing happiness), while a factor analysis generated seven symptom constructs both linked with and differing from DSM-5 bipolar symptom criteria. CONCLUSION This second-stage report details a new set of criteria for differentiating the bipolar disorders from unipolar depressive conditions, while arguing for BP-I and BP-II disorders being differentiated principally by the respective presence or absence of psychotic features. Future studies will evaluate whether further modifications are required and examine for differential treatment benefits for those with a BP-I versus a BP-II condition.
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Affiliation(s)
- G Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - G Tavella
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - T Ricciardi
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - D Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - T Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - D L Dunner
- Center for Anxiety and Depression, Mercer Island, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - C O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - J K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - J F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Bayes
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - V Sharma
- Department of Psychiatry, Western University, London, ON, Canada
| | - P Boyce
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - V Manicavasagar
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute Psychology Clinic, Sydney, NSW, Australia
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2
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Nunes A, Ardau R, Berghöfer A, Bocchetta A, Chillotti C, Deiana V, Garnham J, Grof E, Hajek T, Manchia M, Müller-Oerlinghausen B, Pinna M, Pisanu C, O'Donovan C, Severino G, Slaney C, Suwalska A, Zvolsky P, Cervantes P, Del Zompo M, Grof P, Rybakowski J, Tondo L, Trappenberg T, Alda M. Prediction of lithium response using clinical data. Acta Psychiatr Scand 2020; 141:131-141. [PMID: 31667829 DOI: 10.1111/acps.13122] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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] [Accepted: 10/23/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Promptly establishing maintenance therapy could reduce morbidity and mortality in patients with bipolar disorder. Using a machine learning approach, we sought to evaluate whether lithium responsiveness (LR) is predictable using clinical markers. METHOD Our data are the largest existing sample of direct interview-based clinical data from lithium-treated patients (n = 1266, 34.7% responders), collected across seven sites, internationally. We trained a random forest model to classify LR-as defined by the previously validated Alda scale-against 180 clinical predictors. RESULTS Under appropriate cross-validation procedures, LR was predictable in the pooled sample with an area under the receiver operating characteristic curve of 0.80 (95% CI 0.78-0.82) and a Cohen kappa of 0.46 (0.4-0.51). The model demonstrated a particularly low false-positive rate (specificity 0.91 [0.88-0.92]). Features related to clinical course and the absence of rapid cycling appeared consistently informative. CONCLUSION Clinical data can inform out-of-sample LR prediction to a potentially clinically relevant degree. Despite the relevance of clinical course and the absence of rapid cycling, there was substantial between-site heterogeneity with respect to feature importance. Future work must focus on improving classification of true positives, better characterizing between- and within-site heterogeneity, and further testing such models on new external datasets.
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Affiliation(s)
- A Nunes
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - R Ardau
- Unit of Clinical Pharmacology, San Giovanni di Dio Hospital, University Hospital of Cagliari, Cagliari, Italy
| | - A Berghöfer
- Charité University Medical Center, Institute for Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - A Bocchetta
- Unit of Clinical Pharmacology, San Giovanni di Dio Hospital, University Hospital of Cagliari, Cagliari, Italy
| | - C Chillotti
- Unit of Clinical Pharmacology, San Giovanni di Dio Hospital, University Hospital of Cagliari, Cagliari, Italy
| | - V Deiana
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - J Garnham
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - E Grof
- Mood Disorders Center of Ottawa, Ottawa, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - T Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - M Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | | | - M Pinna
- Centro Lucio Bini, Cagliari e Roma, Italy
| | - C Pisanu
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - C O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - G Severino
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - C Slaney
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - A Suwalska
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.,Department of Mental Health, Poznan University of Medical Sciences, Poznan, Poland
| | - P Zvolsky
- Department of Psychiatry, Charles University, Prague, Czech Republic
| | - P Cervantes
- Department of Psychiatry, McGill University Health Centre, Montreal, QC, Canada
| | - M Del Zompo
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - P Grof
- Mood Disorders Center of Ottawa, Ottawa, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - J Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.,Department of Psychiatric Nursing, Poznan University of Medical Sciences, Poznan, Poland
| | - L Tondo
- Centro Lucio Bini, Cagliari e Roma, Italy.,Harvard Medical School and McLean Hospital, Boston, MA, USA
| | - T Trappenberg
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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3
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Laidi C, Hajek T, Spaniel F, Kolenic M, d'Albis MA, Sarrazin S, Mangin JF, Duchesnay E, Brambilla P, Wessa M, Linke J, Polosan M, Favre P, Versace AL, Phillips ML, Manjon JV, Romero JE, Hozer F, Leboyer M, Coupe P, Houenou J. Cerebellar parcellation in schizophrenia and bipolar disorder. Acta Psychiatr Scand 2019; 140:468-476. [PMID: 31418816 DOI: 10.1111/acps.13087] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Accepted: 08/12/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The cerebellum is involved in cognitive processing and emotion control. Cerebellar alterations could explain symptoms of schizophrenia spectrum disorder (SZ) and bipolar disorder (BD). In addition, literature suggests that lithium might influence cerebellar anatomy. Our aim was to study cerebellar anatomy in SZ and BD, and investigate the effect of lithium. METHODS Participants from 7 centers worldwide underwent a 3T MRI. We included 182 patients with SZ, 144 patients with BD, and 322 controls. We automatically segmented the cerebellum using the CERES pipeline. All outputs were visually inspected. RESULTS Patients with SZ showed a smaller global cerebellar gray matter volume compared to controls, with most of the changes located to the cognitive part of the cerebellum (Crus II and lobule VIIb). This decrease was present in the subgroup of patients with recent-onset SZ. We did not find any alterations in the cerebellum in patients with BD. However, patients medicated with lithium had a larger size of the anterior cerebellum, compared to patients not treated with lithium. CONCLUSION Our multicenter study supports a distinct pattern of cerebellar alterations in SZ and BD.
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Affiliation(s)
- C Laidi
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955 - Translational Psychiatry, Institut Mondor de Recherche Biomédicale, Psychiatrie, Créteil, France.,Pôle de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine de Créteil, DHU PePsy, Hôpitaux Universitaires Mondor, Créteil, France.,Fondation Fondamental, Créteil, France.,NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - T Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,National Institute of Mental Health, Klecany, Czech Republic
| | - F Spaniel
- National Institute of Mental Health, Klecany, Czech Republic
| | - M Kolenic
- National Institute of Mental Health, Klecany, Czech Republic
| | - M-A d'Albis
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955 - Translational Psychiatry, Institut Mondor de Recherche Biomédicale, Psychiatrie, Créteil, France.,Pôle de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine de Créteil, DHU PePsy, Hôpitaux Universitaires Mondor, Créteil, France.,Fondation Fondamental, Créteil, France.,NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - S Sarrazin
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955 - Translational Psychiatry, Institut Mondor de Recherche Biomédicale, Psychiatrie, Créteil, France.,NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - J-F Mangin
- NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - E Duchesnay
- NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - P Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Wessa
- Department of Clinical Psychology and Neuropsychology, Johannes Gutenberg-University, Mainz, Germany
| | - J Linke
- Department of Clinical Psychology and Neuropsychology, Johannes Gutenberg-University, Mainz, Germany
| | - M Polosan
- Grenoble Institute of Neuroscience, INSERM U1216, Hôpital Grenoble Alpes, Grenoble Alpes University, Grenoble, France
| | - P Favre
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955 - Translational Psychiatry, Institut Mondor de Recherche Biomédicale, Psychiatrie, Créteil, France.,Fondation Fondamental, Créteil, France.,NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - A L Versace
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA, USA
| | - M L Phillips
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA, USA
| | - J V Manjon
- Instituto Universitario de Tecnologías de la Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, España
| | - J E Romero
- Instituto Universitario de Tecnologías de la Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, España
| | - F Hozer
- Department of Psychiatry, Assistance Publique-Hôpitaux de Paris (AP-HP) - Hôpital Corentin Celton, Paris Descartes University, Près Sorbonne Paris Cité, Issy-les- Moulineaux, France
| | - M Leboyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955 - Translational Psychiatry, Institut Mondor de Recherche Biomédicale, Psychiatrie, Créteil, France.,Pôle de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine de Créteil, DHU PePsy, Hôpitaux Universitaires Mondor, Créteil, France.,Fondation Fondamental, Créteil, France.,NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - P Coupe
- Pictura Research Group, Unité Mixte de Recherche Centre National de la Recherche Scientifique (UMR 5800), Laboratoire Bordelais de Recherche en Informatique, Centre National de la Recherche Scientifique, Talence, France.,Pictura Research Group, Unité Mixte de Recherche Centre National de la Recherche Scientifique (UMR 5800), Laboratoire Bordelais de Recherche en Informatique, University Bordeaux, Talence, France
| | - J Houenou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955 - Translational Psychiatry, Institut Mondor de Recherche Biomédicale, Psychiatrie, Créteil, France.,Pôle de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine de Créteil, DHU PePsy, Hôpitaux Universitaires Mondor, Créteil, France.,Fondation Fondamental, Créteil, France.,NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
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4
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Drobinin V, Slaney C, Garnham J, Propper L, Uher R, Alda M, Hajek T. Larger right inferior frontal gyrus volume and surface area in participants at genetic risk for bipolar disorders. Psychol Med 2019; 49:1308-1315. [PMID: 30058502 DOI: 10.1017/s0033291718001903] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND Larger grey matter volume of the inferior frontal gyrus (IFG) is among the most replicated biomarkers of genetic risk for bipolar disorders (BD). However, the IFG is a heterogeneous prefrontal region, and volumetric findings can be attributable to changes in cortical thickness (CT), surface area (SA) or gyrification. Here, we investigated the morphometry of IFG in participants at genetic risk for BD. METHODS We quantified the IFG cortical grey matter volume in 29 affected, 32 unaffected relatives of BD probands, and 42 controls. We then examined SA, CT, and cortical folding in subregions of the IFG. RESULTS We found volumetric group differences in the right IFG, with the largest volumes in unaffected high-risk and smallest in control participants (F2,192 = 3.07, p = 0.01). The volume alterations were localized to the pars triangularis of the IFG (F2,97 = 4.05, p = 0.02), with no differences in pars opercularis or pars orbitalis. Pars triangularis volume was highly correlated with its SA [Pearson r(101) = 0.88, p < 0.001], which significantly differed between the groups (F2,97 = 4.45, p = 0.01). As with volume, the mean SA of the pars triangularis was greater in unaffected (corrected p = 0.02) and affected relatives (corrected p = 0.05) compared with controls. We did not find group differences in pars triangularis CT or gyrification. CONCLUSIONS These findings strengthen prior knowledge about the volumetric findings in this region and provide a new insight into the localization and topology of IFG alterations. The unique nature of rIFG morphology in BD, with larger volume and SA early in the course of illness, could have practical implications for detection of participants at risk for BD.
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Affiliation(s)
- V Drobinin
- Department of Psychiatry,Dalhousie University,Halifax,Canada
| | - C Slaney
- Department of Psychiatry,Dalhousie University,Halifax,Canada
| | - J Garnham
- Department of Psychiatry,Dalhousie University,Halifax,Canada
| | - L Propper
- Department of Psychiatry,Dalhousie University,Halifax,Canada
| | - R Uher
- Department of Psychiatry,Dalhousie University,Halifax,Canada
| | - M Alda
- Department of Psychiatry,Dalhousie University,Halifax,Canada
| | - T Hajek
- Department of Psychiatry,Dalhousie University,Halifax,Canada
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5
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de Pierrefeu A, Löfstedt T, Laidi C, Hadj-Selem F, Bourgin J, Hajek T, Spaniel F, Kolenic M, Ciuciu P, Hamdani N, Leboyer M, Fovet T, Jardri R, Houenou J, Duchesnay E. Identifying a neuroanatomical signature of schizophrenia, reproducible across sites and stages, using machine learning with structured sparsity. Acta Psychiatr Scand 2018; 138:571-580. [PMID: 30242828 DOI: 10.1111/acps.12964] [Citation(s) in RCA: 13] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Structural MRI (sMRI) increasingly offers insight into abnormalities inherent to schizophrenia. Previous machine learning applications suggest that individual classification is feasible and reliable and, however, is focused on the predictive performance of the clinical status in cross-sectional designs, which has limited biological perspectives. Moreover, most studies depend on relatively small cohorts or single recruiting site. Finally, no study controlled for disease stage or medication's effect. These elements cast doubt on previous findings' reproducibility. METHOD We propose a machine learning algorithm that provides an interpretable brain signature. Using large datasets collected from 4 sites (276 schizophrenia patients, 330 controls), we assessed cross-site prediction reproducibility and associated predictive signature. For the first time, we evaluated the predictive signature regarding medication and illness duration using an independent dataset of first-episode patients. RESULTS Machine learning classifiers based on neuroanatomical features yield significant intersite prediction accuracies (72%) together with an excellent predictive signature stability. This signature provides a neural score significantly correlated with symptom severity and the extent of cognitive impairments. Moreover, this signature demonstrates its efficiency on first-episode psychosis patients (73% accuracy). CONCLUSION These results highlight the existence of a common neuroanatomical signature for schizophrenia, shared by a majority of patients even from an early stage of the disorder.
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Affiliation(s)
| | - T Löfstedt
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - C Laidi
- NeuroSpin, CEA, Gif-sur-Yvette, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Institut Mondor de Recherche Biomédicale, Psychiatrie Translationnelle, Créteil, France.,Fondation Fondamental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine de Créteil, DHU PePsy, Hôpitaux Universitaires Mondor, Créteil, France
| | - F Hadj-Selem
- Energy Transition Institute: VeDeCoM, Versailles, France
| | - J Bourgin
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, Colombes, France.,INSERM U894, Centre for Psychiatry and Neurosciences, Paris, France
| | - T Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,National Institute of Mental Health, Klecany, Czech Republic
| | - F Spaniel
- National Institute of Mental Health, Klecany, Czech Republic
| | - M Kolenic
- National Institute of Mental Health, Klecany, Czech Republic
| | - P Ciuciu
- NeuroSpin, CEA, Gif-sur-Yvette, France.,INRIA, CEA, Parietal team, University of Paris-Saclay, Lille, France
| | - N Hamdani
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Institut Mondor de Recherche Biomédicale, Psychiatrie Translationnelle, Créteil, France.,Fondation Fondamental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine de Créteil, DHU PePsy, Hôpitaux Universitaires Mondor, Créteil, France
| | - M Leboyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Institut Mondor de Recherche Biomédicale, Psychiatrie Translationnelle, Créteil, France.,Fondation Fondamental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine de Créteil, DHU PePsy, Hôpitaux Universitaires Mondor, Créteil, France
| | - T Fovet
- Laboratoire de Sciences Cognitives et Sciences Affectives (SCALab-PsyCHIC), CNRS UMR 9193, University of Lille, Lille, France.,Pôle de Psychiatrie, Unité CURE, CHU Lille, Lille, France
| | - R Jardri
- INRIA, CEA, Parietal team, University of Paris-Saclay, Lille, France.,Laboratoire de Sciences Cognitives et Sciences Affectives (SCALab-PsyCHIC), CNRS UMR 9193, University of Lille, Lille, France.,Pôle de Psychiatrie, Unité CURE, CHU Lille, Lille, France
| | - J Houenou
- NeuroSpin, CEA, Gif-sur-Yvette, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Institut Mondor de Recherche Biomédicale, Psychiatrie Translationnelle, Créteil, France.,Fondation Fondamental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine de Créteil, DHU PePsy, Hôpitaux Universitaires Mondor, Créteil, France
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6
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Mikolas P, Hlinka J, Skoch A, Pitra Z, Bakstein E, Frodl T, Spaniel F, Hajek T. 07-Connectivity of the anterior insula differentiates participants with first-episode schizophrenia spectrum disorders from controls: A machine-learning study. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.01.027] [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: 11/25/2022]
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7
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Hibar DP, Westlye LT, Doan NT, Jahanshad N, Cheung JW, Ching CRK, Versace A, Bilderbeck AC, Uhlmann A, Mwangi B, Krämer B, Overs B, Hartberg CB, Abé C, Dima D, Grotegerd D, Sprooten E, Bøen E, Jimenez E, Howells FM, Delvecchio G, Temmingh H, Starke J, Almeida JRC, Goikolea JM, Houenou J, Beard LM, Rauer L, Abramovic L, Bonnin M, Ponteduro MF, Keil M, Rive MM, Yao N, Yalin N, Najt P, Rosa PG, Redlich R, Trost S, Hagenaars S, Fears SC, Alonso-Lana S, van Erp TGM, Nickson T, Chaim-Avancini TM, Meier TB, Elvsåshagen T, Haukvik UK, Lee WH, Schene AH, Lloyd AJ, Young AH, Nugent A, Dale AM, Pfennig A, McIntosh AM, Lafer B, Baune BT, Ekman CJ, Zarate CA, Bearden CE, Henry C, Simhandl C, McDonald C, Bourne C, Stein DJ, Wolf DH, Cannon DM, Glahn DC, Veltman DJ, Pomarol-Clotet E, Vieta E, Canales-Rodriguez EJ, Nery FG, Duran FLS, Busatto GF, Roberts G, Pearlson GD, Goodwin GM, Kugel H, Whalley HC, Ruhe HG, Soares JC, Fullerton JM, Rybakowski JK, Savitz J, Chaim KT, Fatjó-Vilas M, Soeiro-de-Souza MG, Boks MP, Zanetti MV, Otaduy MCG, Schaufelberger MS, Alda M, Ingvar M, Phillips ML, Kempton MJ, Bauer M, Landén M, Lawrence NS, van Haren NEM, Horn NR, Freimer NB, Gruber O, Schofield PR, Mitchell PB, Kahn RS, Lenroot R, Machado-Vieira R, Ophoff RA, Sarró S, Frangou S, Satterthwaite TD, Hajek T, Dannlowski U, Malt UF, Arolt V, Gattaz WF, Drevets WC, Caseras X, Agartz I, Thompson PM, Andreassen OA. Cortical abnormalities in bipolar disorder: an MRI analysis of 6503 individuals from the ENIGMA Bipolar Disorder Working Group. Mol Psychiatry 2018; 23:932-942. [PMID: 28461699 PMCID: PMC5668195 DOI: 10.1038/mp.2017.73] [Citation(s) in RCA: 422] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 02/04/2017] [Accepted: 02/10/2017] [Indexed: 12/13/2022]
Abstract
Despite decades of research, the pathophysiology of bipolar disorder (BD) is still not well understood. Structural brain differences have been associated with BD, but results from neuroimaging studies have been inconsistent. To address this, we performed the largest study to date of cortical gray matter thickness and surface area measures from brain magnetic resonance imaging scans of 6503 individuals including 1837 unrelated adults with BD and 2582 unrelated healthy controls for group differences while also examining the effects of commonly prescribed medications, age of illness onset, history of psychosis, mood state, age and sex differences on cortical regions. In BD, cortical gray matter was thinner in frontal, temporal and parietal regions of both brain hemispheres. BD had the strongest effects on left pars opercularis (Cohen's d=-0.293; P=1.71 × 10-21), left fusiform gyrus (d=-0.288; P=8.25 × 10-21) and left rostral middle frontal cortex (d=-0.276; P=2.99 × 10-19). Longer duration of illness (after accounting for age at the time of scanning) was associated with reduced cortical thickness in frontal, medial parietal and occipital regions. We found that several commonly prescribed medications, including lithium, antiepileptic and antipsychotic treatment showed significant associations with cortical thickness and surface area, even after accounting for patients who received multiple medications. We found evidence of reduced cortical surface area associated with a history of psychosis but no associations with mood state at the time of scanning. Our analysis revealed previously undetected associations and provides an extensive analysis of potential confounding variables in neuroimaging studies of BD.
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Affiliation(s)
- D P Hibar
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA,Janssen Research & Development, San Diego, CA, USA
| | - L T Westlye
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway,Department of Psychology, University of Oslo, Oslo, Norway
| | - N T Doan
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - N Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA
| | - J W Cheung
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA
| | - C R K Ching
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA,Neuroscience Interdepartmental Graduate Program, University of California, Los Angeles, Los Angeles, CA, USA
| | - A Versace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - A C Bilderbeck
- University Department of Psychiatry and Oxford Health NHS Foundation Trust, University of Oxford, Oxford, UK
| | - A Uhlmann
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa,MRC Unit on Anxiety and Stress Disorders, Groote Schuur Hospital (J-2), University of Cape Town, Cape Town, South Africa
| | - B Mwangi
- UT Center of Excellence on Mood Disorders, Department of Psychiatry & Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - B Krämer
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - B Overs
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - C B Hartberg
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - C Abé
- Department of Clinical Neuroscience, Osher Centre, Karolinska Institutet, Stockholm, Sweden
| | - D Dima
- Department of Psychology, City University London, London, UK,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - D Grotegerd
- Department of Psychiatry, University of Münster, Münster, Germany
| | - E Sprooten
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E Bøen
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - E Jimenez
- Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - F M Howells
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - G Delvecchio
- IRCCS "E. Medea" Scientific Institute, San Vito al Tagliamento, Italy
| | - H Temmingh
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J Starke
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J R C Almeida
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - J M Goikolea
- Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - J Houenou
- INSERM U955 Team 15 ‘Translational Psychiatry’, University Paris East, APHP, CHU Mondor, Fondation FondaMental, Créteil, France,NeuroSpin, UNIACT Lab, Psychiatry Team, CEA Saclay, Gif Sur Yvette, France
| | - L M Beard
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - L Rauer
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - L Abramovic
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Bonnin
- Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - M F Ponteduro
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M Keil
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - M M Rive
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - N Yao
- Department of Psychiatry, Yale University, New Haven, CT, USA,Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
| | - N Yalin
- Centre for Affective Disorders, King’s College London, London, UK
| | - P Najt
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - P G Rosa
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, São Paulo, Brazil
| | - R Redlich
- Department of Psychiatry, University of Münster, Münster, Germany
| | - S Trost
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - S Hagenaars
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - S C Fears
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA,West Los Angeles Veterans Administration, Los Angeles, CA, USA
| | - S Alonso-Lana
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - T G M van Erp
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - T Nickson
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - T M Chaim-Avancini
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, São Paulo, Brazil
| | - T B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA,Laureate Institute for Brain Research, Tulsa, OK, USA
| | - T Elvsåshagen
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - U K Haukvik
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Adult Psychiatry, University of Oslo, Oslo, Norway
| | - W H Lee
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A H Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - A J Lloyd
- Academic Psychiatry and Northern Centre for Mood Disorders, Newcastle University/Northumberland Tyne & Wear NHS Foundation Trust, Newcastle, UK
| | - A H Young
- Centre for Affective Disorders, King’s College London, London, UK
| | - A Nugent
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - A M Dale
- MMIL, Department of Radiology, University of California San Diego, San Diego, CA, USA,Department of Cognitive Science, Neurosciences and Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - A Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - A M McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - B Lafer
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - B T Baune
- Department of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - C J Ekman
- Department of Clinical Neuroscience, Osher Centre, Karolinska Institutet, Stockholm, Sweden
| | - C A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - C E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA,Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - C Henry
- INSERM U955 Team 15 ‘Translational Psychiatry’, University Paris East, APHP, CHU Mondor, Fondation FondaMental, Créteil, France,Institut Pasteur, Unité Perception et Mémoire, Paris, France
| | - C Simhandl
- Bipolar Center Wiener Neustadt, Wiener Neustadt, Austria
| | - C McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C Bourne
- University Department of Psychiatry and Oxford Health NHS Foundation Trust, University of Oxford, Oxford, UK,Department of Psychology & Counselling, Newman University, Birmingham, UK
| | - D J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa,MRC Unit on Anxiety and Stress Disorders, Groote Schuur Hospital (J-2), University of Cape Town, Cape Town, South Africa
| | - D H Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - D M Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - D C Glahn
- Department of Psychiatry, Yale University, New Haven, CT, USA,Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
| | - D J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - E Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - E Vieta
- Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - E J Canales-Rodriguez
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - F G Nery
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - F L S Duran
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, São Paulo, Brazil
| | - G F Busatto
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, São Paulo, Brazil
| | - G Roberts
- School of Psychiatry and Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - G D Pearlson
- Department of Psychiatry, Yale University, New Haven, CT, USA,Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
| | - G M Goodwin
- University Department of Psychiatry and Oxford Health NHS Foundation Trust, University of Oxford, Oxford, UK
| | - H Kugel
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - H C Whalley
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - H G Ruhe
- University Department of Psychiatry and Oxford Health NHS Foundation Trust, University of Oxford, Oxford, UK,Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry & Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - J M Fullerton
- Neuroscience Research Australia, Sydney, NSW, Australia,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - J K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - J Savitz
- Laureate Institute for Brain Research, Tulsa, OK, USA,Faculty of Community Medicine, The University of Tulsa, Tulsa, OK, USA
| | - K T Chaim
- Department of Radiology, University of São Paulo, São Paulo, Brazil,LIM44-Laboratory of Magnetic Resonance in Neuroradiology, University of São Paulo, São Paulo, Brazil
| | - M Fatjó-Vilas
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - M G Soeiro-de-Souza
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - M P Boks
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M V Zanetti
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, São Paulo, Brazil
| | - M C G Otaduy
- Department of Radiology, University of São Paulo, São Paulo, Brazil,LIM44-Laboratory of Magnetic Resonance in Neuroradiology, University of São Paulo, São Paulo, Brazil
| | - M S Schaufelberger
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, São Paulo, Brazil
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - M Ingvar
- Department of Clinical Neuroscience, Osher Centre, Karolinska Institutet, Stockholm, Sweden,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - M L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M J Kempton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M Landén
- Department of Clinical Neuroscience, Osher Centre, Karolinska Institutet, Stockholm, Sweden,Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the Gothenburg University, Goteborg, Sweden
| | - N S Lawrence
- Department of Psychology, University of Exeter, Exeter, UK
| | - N E M van Haren
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N R Horn
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - N B Freimer
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - O Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - P R Schofield
- Neuroscience Research Australia, Sydney, NSW, Australia,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - P B Mitchell
- School of Psychiatry and Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - R S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Lenroot
- Neuroscience Research Australia, Sydney, NSW, Australia,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - R Machado-Vieira
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil,National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - R A Ophoff
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands,Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - S Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - S Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T D Satterthwaite
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - T Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,National Institute of Mental Health, Klecany, Czech Republic
| | - U Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | - U F Malt
- Division of Clinical Neuroscience, Department of Research and Education, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - V Arolt
- Department of Psychiatry, University of Münster, Münster, Germany
| | - W F Gattaz
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - W C Drevets
- Janssen Research & Development, Titusville, NJ, USA
| | - X Caseras
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - I Agartz
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - P M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, USA
| | - O A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway,NORMENT, KG Jebsen Centre for Psychosis Research—TOP Study, Oslo University Hospital, Ullevål, Building 49, Kirkeveien 166, PO Box 4956, Nydalen, 0424, Oslo, Norway. E-mail:
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Mikolas P, Hlinka J, Pitra Z, Skoch A, Frodl T, Spaniel F, Hajek T. Classification of first-episode schizophrenia spectrum disorders and controls from whole brain white matter fractional anisotropy using machine learning. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.2122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BackgroundSchizophrenia is a chronic disorder with an early onset and high disease burden in terms of life disability. Its early recognition may delay the resulting brain structural/functional alterations and improve treatment outcomes. Unlike conventional group-statistics, machine-learning techniques made it possible to classify patients and controls based on the disease patterns on an individual level. Diagnostic classification in first-episode schizophrenia to date was mostly performed on sMRI or fMRI data. DTI modalities have not gained comparable attention.MethodsWe performed the classification of 77 FES patients and 77 healthy controls matched by age and sex from fractional anisotropy data from using linear support-vector machine (SVM). We further analyzed the effect of medication and symptoms on the classification performance using standard statistical measures (t-test, linear regression) and machine learning (Kernel–Ridge regression).ResultsThe SVM distinguished between patients and controls with significant accuracy of 62.34% (P = 0.005). There was no association between the classification performance and medication nor symptoms. Group level statistical analysis yielded brain-wide significant differences in FA.ConclusionThe SVM in combination with brain white-matter fractional anisotropy might help differentiate FES from HC. The performance of our classification model was not associated with symptoms or medications and therefore reflects trait markers in the early course of the disease.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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9
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Hibar DP, Westlye LT, van Erp TGM, Rasmussen J, Leonardo CD, Faskowitz J, Haukvik UK, Hartberg CB, Doan NT, Agartz I, Dale AM, Gruber O, Krämer B, Trost S, Liberg B, Abé C, Ekman CJ, Ingvar M, Landén M, Fears SC, Freimer NB, Bearden CE, Sprooten E, Glahn DC, Pearlson GD, Emsell L, Kenney J, Scanlon C, McDonald C, Cannon DM, Almeida J, Versace A, Caseras X, Lawrence NS, Phillips ML, Dima D, Delvecchio G, Frangou S, Satterthwaite TD, Wolf D, Houenou J, Henry C, Malt UF, Bøen E, Elvsåshagen T, Young AH, Lloyd AJ, Goodwin GM, Mackay CE, Bourne C, Bilderbeck A, Abramovic L, Boks MP, van Haren NEM, Ophoff RA, Kahn RS, Bauer M, Pfennig A, Alda M, Hajek T, Mwangi B, Soares JC, Nickson T, Dimitrova R, Sussmann JE, Hagenaars S, Whalley HC, McIntosh AM, Thompson PM, Andreassen OA. Subcortical volumetric abnormalities in bipolar disorder. Mol Psychiatry 2016; 21:1710-1716. [PMID: 26857596 PMCID: PMC5116479 DOI: 10.1038/mp.2015.227] [Citation(s) in RCA: 310] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/08/2015] [Accepted: 12/11/2015] [Indexed: 11/29/2022]
Abstract
Considerable uncertainty exists about the defining brain changes associated with bipolar disorder (BD). Understanding and quantifying the sources of uncertainty can help generate novel clinical hypotheses about etiology and assist in the development of biomarkers for indexing disease progression and prognosis. Here we were interested in quantifying case-control differences in intracranial volume (ICV) and each of eight subcortical brain measures: nucleus accumbens, amygdala, caudate, hippocampus, globus pallidus, putamen, thalamus, lateral ventricles. In a large study of 1710 BD patients and 2594 healthy controls, we found consistent volumetric reductions in BD patients for mean hippocampus (Cohen's d=-0.232; P=3.50 × 10-7) and thalamus (d=-0.148; P=4.27 × 10-3) and enlarged lateral ventricles (d=-0.260; P=3.93 × 10-5) in patients. No significant effect of age at illness onset was detected. Stratifying patients based on clinical subtype (BD type I or type II) revealed that BDI patients had significantly larger lateral ventricles and smaller hippocampus and amygdala than controls. However, when comparing BDI and BDII patients directly, we did not detect any significant differences in brain volume. This likely represents similar etiology between BD subtype classifications. Exploratory analyses revealed significantly larger thalamic volumes in patients taking lithium compared with patients not taking lithium. We detected no significant differences between BDII patients and controls in the largest such comparison to date. Findings in this study should be interpreted with caution and with careful consideration of the limitations inherent to meta-analyzed neuroimaging comparisons.
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Affiliation(s)
- D P Hibar
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
| | - L T Westlye
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - T G M van Erp
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - J Rasmussen
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - C D Leonardo
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
| | - J Faskowitz
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
| | - U K Haukvik
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - C B Hartberg
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - N T Doan
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - I Agartz
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - A M Dale
- MMIL, Department of Radiology, University of California, San Diego, CA, USA
- Department of Cognitive Science, Neurosciences and Psychiatry, University of California, San Diego, CA, USA
| | - O Gruber
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, Georg August University Goettingen, Goettingen, Germany
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - B Krämer
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, Georg August University Goettingen, Goettingen, Germany
| | - S Trost
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, Georg August University Goettingen, Goettingen, Germany
| | - B Liberg
- Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - C Abé
- Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - C J Ekman
- Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - M Ingvar
- Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska MR Research Center, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - M Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - S C Fears
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Center for Neurobehavioral Genetics, University of California, Los Angeles, CA, USA
| | - N B Freimer
- Center for Neurobehavioral Genetics, University of California, Los Angeles, CA, USA
| | - C E Bearden
- Center for Neurobehavioral Genetics, University of California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - the Costa Rica/Colombia Consortium for Genetic Investigation of Bipolar Endophenotypes
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- MMIL, Department of Radiology, University of California, San Diego, CA, USA
- Department of Cognitive Science, Neurosciences and Psychiatry, University of California, San Diego, CA, USA
- Center for Translational Research in Systems Neuroscience and Psychiatry, Department of Psychiatry and Psychotherapy, Georg August University Goettingen, Goettingen, Germany
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
- Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska MR Research Center, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Center for Neurobehavioral Genetics, University of California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford, CT, USA
- Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
- Department of Psychiatry, Brown University, Providence, RI, USA
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- School of Psychology, University of Exeter, Exeter, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Neurospin, Uniact, I2BM, CEA Saclay, Saclay, France
- Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France
- Université Paris-Est, UMR-S955, UPEC, Créteil, France
- Department of Psychosomatic Medicine, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Education, Oslo University Hospital, Oslo, Norway
- Norwegian Research Network On Mood Disorders, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Centre for Affective Disorders, King's College London, London, UK
- Academic Psychiatry and Regional Affective Disorders Service, Newcastle University, Newcastle, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychology and Counselling, Newman University, Birmingham, UK
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- National Institute of Mental Health, Klecany, Czech Republic
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - E Sprooten
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford, CT, USA
| | - D C Glahn
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford, CT, USA
| | - G D Pearlson
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford, CT, USA
- Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA
| | - L Emsell
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J Kenney
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C Scanlon
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C McDonald
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - D M Cannon
- Clinical Neuroimaging Laboratory, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J Almeida
- Department of Psychiatry, Brown University, Providence, RI, USA
| | - A Versace
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - X Caseras
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - N S Lawrence
- School of Psychology, University of Exeter, Exeter, UK
| | - M L Phillips
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - D Dima
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - G Delvecchio
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T D Satterthwaite
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - D Wolf
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - J Houenou
- Neurospin, Uniact, I2BM, CEA Saclay, Saclay, France
- Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France
| | - C Henry
- Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France
- Université Paris-Est, UMR-S955, UPEC, Créteil, France
| | - U F Malt
- Department of Psychosomatic Medicine, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Education, Oslo University Hospital, Oslo, Norway
| | - E Bøen
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Department of Psychosomatic Medicine, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Research Network On Mood Disorders, Oslo, Norway
| | - T Elvsåshagen
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
- Department of Psychosomatic Medicine, Oslo University Hospital—Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - A H Young
- Centre for Affective Disorders, King's College London, London, UK
| | - A J Lloyd
- Academic Psychiatry and Regional Affective Disorders Service, Newcastle University, Newcastle, UK
| | - G M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - C E Mackay
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - C Bourne
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychology and Counselling, Newman University, Birmingham, UK
| | - A Bilderbeck
- Department of Psychiatry, University of Oxford, Oxford, UK
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
| | - L Abramovic
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - M P Boks
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - N E M van Haren
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - R A Ophoff
- Center for Neurobehavioral Genetics, University of California, Los Angeles, CA, USA
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - R S Kahn
- Department of Psychiatry, University Medical Centre Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - M Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - A Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - T Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - B Mwangi
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - J C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, TX, USA
| | - T Nickson
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - R Dimitrova
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - J E Sussmann
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - S Hagenaars
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - H C Whalley
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - A M McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - P M Thompson
- Imaging Genetics Center, University of Southern California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - O A Andreassen
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
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Mikolas P, Melicher T, Skoch A, Matejka M, Slovakova A, Bakstein E, Hajek T, Spaniel F. Connectivity of the anterior insula differentiates participants with first-episode schizophrenia spectrum disorders from controls: a machine-learning study. Psychol Med 2016; 46:2695-2704. [PMID: 27451917 DOI: 10.1017/s0033291716000878] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Early diagnosis of schizophrenia could improve the outcomes and limit the negative effects of untreated illness. Although participants with schizophrenia show aberrant functional connectivity in brain networks, these between-group differences have a limited diagnostic utility. Novel methods of magnetic resonance imaging (MRI) analyses, such as machine learning (ML), may help bring neuroimaging from the bench to the bedside. Here, we used ML to differentiate participants with a first episode of schizophrenia-spectrum disorder (FES) from healthy controls based on resting-state functional connectivity (rsFC). METHOD We acquired resting-state functional MRI data from 63 patients with FES who were individually matched by age and sex to 63 healthy controls. We applied linear kernel support vector machines (SVM) to rsFC within the default mode network, the salience network and the central executive network. RESULTS The SVM applied to the rsFC within the salience network distinguished the FES from the control participants with an accuracy of 73.0% (p = 0.001), specificity of 71.4% and sensitivity of 74.6%. The classification accuracy was not significantly affected by medication dose, or by the presence of psychotic symptoms. The functional connectivity within the default mode or the central executive networks did not yield classification accuracies above chance level. CONCLUSIONS Seed-based functional connectivity maps can be utilized for diagnostic classification, even early in the course of schizophrenia. The classification was probably based on trait rather than state markers, as symptoms or medications were not significantly associated with classification accuracy. Our results support the role of the anterior insula/salience network in the pathophysiology of FES.
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Affiliation(s)
- P Mikolas
- Psychiatric Hospital Bohnice,Prague,Czech Republic
| | - T Melicher
- 3rd Faculty of Medicine,Charles University,Prague,Czech Republic
| | - A Skoch
- National Institute of Mental Health,Klecany,Czech Republic
| | - M Matejka
- Psychiatric Hospital Bohnice,Prague,Czech Republic
| | - A Slovakova
- Psychiatric Hospital Bohnice,Prague,Czech Republic
| | - E Bakstein
- National Institute of Mental Health,Klecany,Czech Republic
| | - T Hajek
- 3rd Faculty of Medicine,Charles University,Prague,Czech Republic
| | - F Spaniel
- 3rd Faculty of Medicine,Charles University,Prague,Czech Republic
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Siebenhaller S, Hajek T, Zibek S, Syldatk C. Enzymatische Synthese von Biotensiden aus der Cellulosefraktion des Organosolvprozesses. CHEM-ING-TECH 2016. [DOI: 10.1002/cite.201650171] [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: 11/10/2022]
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12
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Skorpil J, Paraforos A, Mandak J, Cohn WE, Hajek T, Friedrich I. 341 * EFFECTIVE AND RAPID SEALING OF CORONARY, AORTIC AND ATRIAL SUTURE LINES. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.341] [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: 11/14/2022] Open
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13
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Hajek T, Bauer M, Simhandl C, Rybakowski J, O'Donovan C, Pfennig A, König B, Suwalska A, Yucel K, Uher R, Young LT, MacQueen G, Alda M. Neuroprotective effect of lithium on hippocampal volumes in bipolar disorder independent of long-term treatment response. Psychol Med 2014; 44:507-517. [PMID: 23721695 DOI: 10.1017/s0033291713001165] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neuroimaging studies have demonstrated an association between lithium (Li) treatment and brain structure in human subjects. A crucial unresolved question is whether this association reflects direct neurochemical effects of Li or indirect effects secondary to treatment or prevention of episodes of bipolar disorder (BD). METHOD To address this knowledge gap, we compared manually traced hippocampal volumes in 37 BD patients with at least 2 years of Li treatment (Li group), 19 BD patients with <3 months of lifetime Li exposure over 2 years ago (non-Li group) and 50 healthy controls. All BD participants were followed prospectively and had at least 10 years of illness and a minimum of five episodes. We established illness course and long-term treatment response to Li using National Institute of Mental Health (NIMH) life charts. RESULTS The non-Li group had smaller hippocampal volumes than the controls or the Li group (F 2,102 = 4.97, p = 0.009). However, the time spent in a mood episode on the current mood stabilizer was more than three times longer in the Li than in the non-Li group (t(51) = 2.00, p = 0.05). Even Li-treated patients with BD episodes while on Li had hippocampal volumes comparable to healthy controls and significantly larger than non-Li patients (t(43) = 2.62, corrected p = 0.02). CONCLUSIONS Our findings support the neuroprotective effects of Li. The association between Li treatment and hippocampal volume seems to be independent of long-term treatment response and occurred even in subjects with episodes of BD while on Li. Consequently, these effects of Li on brain structure may generalize to patients with neuropsychiatric illnesses other than BD.
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Affiliation(s)
- T Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - M Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - C Simhandl
- Psychiatrische Abteilung, Krankenhaus Neunkirchen, Austria
| | - J Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poland
| | - C O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - A Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - B König
- Psychiatrische Abteilung, Krankenhaus Neunkirchen, Austria
| | - A Suwalska
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poland
| | - K Yucel
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - R Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - L T Young
- Department of Psychiatry, University of Toronto, ON, Canada
| | - G MacQueen
- Department of Psychiatry, University of Calgary, AB, Canada
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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El-Essawi A, Hajek T, Skorpil J, Böning A, Sabol F, Ostrovsky Y, Hausmann H, Harringer W. Are minimized perfusion circuits the better heart lung machines? Final results of a prospective randomized multicentre study. Perfusion 2011; 26:470-8. [DOI: 10.1177/0267659111419035] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Minimized perfusion circuits (MPCs), although aiming at minimizing the adverse effects of cardiopulmonary bypass, have not yet gained popularity. This can be attributed to concerns regarding their safety, as well as lack of sufficient evidence of their benefit. Methods: Described is a randomized, multicentre study comparing the MPC - ROCsafeRX to standard cardiopulmonary bypass in patients undergoing elective coronary artery bypass grafting and/ or aortic valve replacement. Results: Five hundred patients were included in the study (252 randomized to the ROCsafeRX group and 248 to standard cardiopulmonary bypass). Both groups were well matched for demographic characteristics and type of surgery. No operative mortality and no device-related complications were encountered. Transfusion requirement (333 ± 603 vs. 587 ± 1010 ml; p=0.001), incidence of atrial fibrillation (16.3% vs. 24.2%; p=0.03) and the incidence of major adverse events (9.1% vs. 16.5%; p=0.02) were all in favour of the MPC group. Conclusion: These results confirm both the safety and efficacy of the ROCsafeRX MPC for a large variety of cardiac patients. Minimized perfusion circuits should, therefore, play a greater role in daily practice so that as many patients as possible can benefit from their advantages.
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Affiliation(s)
- A El-Essawi
- Department of Thoracic and Cardiovascular Surgery, Klinikum Braunschweig, Braunschweig, Germany
| | - T Hajek
- Department of Cardiac Surgery, University Hospital Pilsen, Pilsen, Czech Republic
| | - J Skorpil
- Department of Cardiac Surgery, University Hospital Pilsen, Pilsen, Czech Republic
| | - A Böning
- Department of Cardiovascular Surgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - F Sabol
- Heart Surgery Department, Pavol Jozef Safarik University Kosice, Kosice, Slovak Republic
| | - Y Ostrovsky
- Cardiovascular Surgery, Byelorussian Center of Cardiovascular Surgery, Minsk, Belarus
| | - H Hausmann
- Cardiovascular, Thoracic and Intensive Care, Mediclin Herzzentrum Coswig, Coswig, Germany
| | - W Harringer
- Department of Thoracic and Cardiovascular Surgery, Klinikum Braunschweig, Braunschweig, Germany
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Abstract
OBJECTIVE To describe and integrate observations from bipolar patients responsive to lithium stabilization and their children. METHOD Selected findings are described from the clinical and biological investigations of adults meeting research criteria for bipolar disorder and for responsiveness to lithium stabilization; and from prospective studies of the children of lithium responders and non-responders. RESULTS Response to prophylactic lithium identifies a valid subtype of bipolar disorder, however the search for biological markers of lithium response, while promising, has so far remained inconclusive. Adult responders to lithium stabilization exhibit definable clinical features which are also observable in their affected children. In prospective studies the children of bipolar parents develop symptoms earlier than reported previously, with marked differences between the offspring of lithium responders and non-responders. The illness evolves in predictable clinical stages, first from non-specific sleep and anxiety disorders to mood symptoms and then, often starting in adolescence, major depressive and later activated episodes. CONCLUSION Investigating and comparing unequivocal responders and non-responders to long-term lithium treatment and their offspring is a fertile research strategy for addressing a multitude of clinical and research questions.
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Affiliation(s)
- P Grof
- Mood Disorders Center of Ottawa, Ottawa, ON, Canada.
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Kutschka I, Skorpil J, El Essawi A, Hajek T, Harringer W. Beneficial effects of modern perfusion concepts in aortic valve and aortic root surgery. Perfusion 2009; 24:37-44. [DOI: 10.1177/0267659109106727] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Minimized perfusion circuits (MPC) were found to reduce side effects of standard extracorporeal circulation (ECC). We evaluated the safety and efficacy of the ROCsafe™ MPC for aortic valve and aortic root surgery. One hundred and seventy patients were randomized for surgery using either MPC [n = 85, 30 female/55 male, mean age: 69.8 ± 11.8 years; aortic valve replacement (AVR): n = 40; AVR + coronary artery bypass graft (CABG): n = 31; David operation: n = 3; aortic root replacement (ARR): n = 11] or ECC [n = 85, 29 female/56 male, mean age: 67.7 ± 9.5 years; AVR: n = 39; AVR+CABG: n = 35, David operation: n = 2; ARR: n = 9]. Neurological status, length of ICU stay, C-reactive protein (CRP), blood count, transfusion requirements and bleeding volume were analyzed. The MPC system provided ultrasound-controlled de-airing. A small roller pump and a flexible reservoir were used for left ventricular venting. As a control, we used a standard ECC with cardiotomy suction and hard-shell reservoir. Cross-clamp time (MPC: 76.5 ± 29.5; ECC: 79.0 ± 34.0 min) and bypass time (MPC: 103.0 ± 37.9; ECC: 106.9 ± 44.9 min) were comparable between groups. Transfusion requirements (red blood cells: MPC: 1.5 ± 1.5 vs. ECC: 2.2 ± 2.1 units [p = 0.05], frozen plasma: MPC: 1.2 ± 1.8 vs. ECC: 1.9 ± 2.4 units [p = 0.03]), postoperative bleeding (MPC: 521 ± 283 vs. ECC: 615 ± 326 ml/24 h, p = 0.09) were lower using MPC. ICU stay was shorter with MPC (1.6 ± 1.6 days) compared to ECC (2.4 ± 2.8 days, p = 0.001). One stroke occurred in each group. The ROCsafe™ MPC provides safe circulatory support for a wide range of aortic valve surgeries. Transfusion requirements, postoperative bleeding and length of ICU stay were markedly reduced compared to standard extracorporeal perfusion.
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Affiliation(s)
- I Kutschka
- Department of Thoracic and Cardiovascular Surgery, Klinikum Braunschweig, Germany; Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - J Skorpil
- Department of Thoracic and Cardiovascular Surgery, Pilsner University Hospital Pilsen, Pilsen, Czech Republic
| | - A El Essawi
- Department of Thoracic and Cardiovascular Surgery, Klinikum Braunschweig, Germany
| | - T Hajek
- Department of Thoracic and Cardiovascular Surgery, Pilsner University Hospital Pilsen, Pilsen, Czech Republic
| | - W Harringer
- Department of Thoracic and Cardiovascular Surgery, Klinikum Braunschweig, Germany
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17
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Topolcan O, Holubec L, Polivkova V, Svobodova S, Pesek M, Treska V, Safranek J, Hajek T, Bartunek L, Rousarova M, Finek J. Tumor markers in pleural effusions. Anticancer Res 2007; 27:1921-4. [PMID: 17649796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
AIM The aim of this study was to determine the diagnostic capabilities of tumor markers in pleural effusion and their importance for assessment of the etiology of pleural effusions. PATIENTS AND METHODS In pleural effusions from 166 patients hospitalized during the period 2003-2005 at the Department of Oncology and Radiotherapy, Faculty Hospital in Pilsen, the following tumor markers were determined: thymidine kinase (TK), neuron-specific enolase (NSE), cytokeratins [tissue polypeptide antigen (TPA), tissue polypeptide-specific antigen (TPS) and cytokeratin fragment 19 (CYFRA 21-1)], carcinoembryonic antigen (CEA) and mucinous markers (CA 15-3, CA 19-9, CA 125). The inflammatory marker procalcitonin-PCT was also assessed. RESULTS Tumor markers CA 125, TPA, TPS were significantly elevated in exudates, irrespective of the etiology, as a non-specific reaction in mesothelial cells. TK had a sensitivity of over 80% for all the types of cancer examined, while CA 15-3 had a sensitivity of over 90%. CONCLUSION Significant positivity of PCT and CA 15-3 in pleural effusions indicate a suspicion of inflammatory disease. Positivity of TK and CA 15-3 indicate a strong suspicion of malignant exudates.
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Affiliation(s)
- O Topolcan
- Department of Nuclear Medicine, Charles University, Medical School and Teaching Hospital Plzen, Czech Republic.
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18
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Linhartova K, Sterbakova G, Hanisova I, Bernat I, Beranek V, Hajek T. Mo-P4:295 Age and male gender are independent predictors of significant coronary artery disease in patients with severe aortic stenosis. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80428-9] [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: 10/23/2022]
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19
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Abstract
The search for susceptibility genes for bipolar disorder (BD) depends on appropriate definitions of the phenotype. In this paper, we review data on diagnosis and clinical features of BD that could be used in genetic studies to better characterize patients or to define homogeneous subgroups. Clinical symptoms, long-term course, comorbid conditions, and response to prophylactic treatment may define groups associated with more or less specific loci. One such group is characterized by symptoms of psychosis and linkage to 13q and 22q. A second group includes mainly bipolar II patients with comorbid panic disorder, rapid mood switching, and evidence of chromosome 18 linkage. A third group comprises typical BD with an episodic course and favourable response to lithium prophylaxis. Reproducibility of cognitive deficits across studies raises the possibility of using cognitive profiles as endophenotypes of BD, with deficits in verbal explicit memory and executive function commonly reported. Brain imaging provides a more ambiguous data set consistent with heterogeneity of the illness.
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Affiliation(s)
- G M MacQueen
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
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20
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Stritesky M, Semrad M, Kunstyr J, Hajek T, Demes R, Tosovsky J. On-pump cardiac surgery in a conscious patient using a thoracic epidural anesthesia--an ultra fast track method. BRATISL MED J 2004; 105:51-5. [PMID: 15253535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To demonstrate the applicability and efficacy of spontaneous ventilation during cardiac surgery. METHODS From March 1999 through December 2002, 129 awake patients were operated on; 90 on-pump and 39 off-pump. A thoracic epidural space blockage was performed one hour prior to an incision being made at the Th 2-Th 4 level. Medial approach was used and the hanging drop method was routinely employed for epidural space detection. RESULTS There were 82 male and 47 female patients with a mean age of 64.5 years. Forty two cases were aortic valve replacement, 32 patients underwent on-pump coronary artery bypass grafting (CABG), 12 underwent mitral valve replacement, 27 patients were indicated for sternal wound reexploration, 12 for off-pump CABG, one for aortic valve replacement with aortic arch reconstruction and aortic valve replacement together with CABG was performed three times. There were ten conversions to general anesthesia and there was no death. Mean duration of the stay in the intensive care unit was 7.2 hours and in the hospital 5.1 days. We did not observe low cardiac output syndrome, stroke, renal insufficiency or pulmonary dysfunction in patients who sufficiently underwent thoracic epidural anesthesia. Less pain at assessments was demonstrated (Visual Analgetic Score=3.3). CONCLUSION The recent interest in rapid recovery and early out-patient care of patients after cardiac surgery has prompted investigations into the use of neuraxial analgesia for these procedures. The above mentioned technique would be beneficial for patients with preoperative pulmonary dysfunction and may be particularly useful in endoscopic cardiac surgery. (Tab. 1, Fig. 2, Ref. 18.)
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Affiliation(s)
- M Stritesky
- Department of Anesthesiology, General Teaching Hospital, Charles University, 1st Medical Faculty, Prague, Czech Republic.
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21
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Abstract
There is an increasing evidence that corticosteroids damage the hippocampus in rodents and in primates. Hippocampal atrophy induced by corticosteroids may play an important role in the pathogenesis of a range of neuropsychiatric disorders. Hippocampus is necessary for short-term memory consolidation and HPA axis regulation. Signs of hippocampal damage (HPA dysregulation in combination with memory impairment) are found in affective disorders, Alzheimer's disease and in posttraumatic stress disorder. MRI volumetry reveals reduced hippocampal volume in these diseases. Evidence supporting the "glucocorticoid hypothesis" of psychiatric disorders is reviewed in the first part of the paper. Unresolved questions concerning temporary aspects of neurodegeneration, causality, reversibility, type of damage, factors increasing hippocampal vulnerability, and both pharmacological (CRH antagonists, antiglucocorticoid drugs, GABA-ergic, serotonergic, glutamatergic agents) and non-pharmacological (psychotherapy) treatment approaches are discussed in the second part.
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Affiliation(s)
- C Höschl
- Prague Psychiatric Centre, Czech Republic.
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