Pharmacological treatment of comorbid posttraumatic stress disorder in patients with bipolar disorder

Introduction

The lifetime prevalence of comorbid posttraumatic stress disorder (PTSD) in patients with bipolar disorder (BD) is approximately 20%. Guidelines for BD give adequate pharmacological treatment options when there is a ‘pure’ bipolar disorder but lack of treatment options when there is a comorbid disorder present.

Objectives

The present study aimed to review the pharmacological treatment options for comorbid PTSD in patients with BD.

Methods

Literature research was conducted via PubMed, Embase and the Cochrane Library. Search terms included ‘bipolar disorder’, ‘posttraumatic stress disorder’, ‘PTSD’, ‘pharmacotherapy’ and ‘treatment’. Relevant studies were reviewed.

Results

No randomized controlled trials have been conducted in patients with bipolar disorder and comorbid PTSD. Most studies included open-label studies and case-reports. No convincing scientific evidence for pharmacological treatment of comorbid PTSD in patients with BD was found. Selective serotonin reuptake inhibitors (SSRIs) are effective in the treatment of PTSD. However, SSRIs or other antidepressants are complicated due to potential induction of a manic episode or promote rapid cycling. Nevertheless, it is important to treat the bipolar patient with a mood stabilizer first before antidepressants are prescribed.

Conclusions

The findings of this study show that there is no convincing scientific evidence for the pharmacological treatment of comorbid PTSD in patients with bipolar disorder. Therefore, psychotherapy is preferable. When psychotherapy is not effective, pharmacotherapy can be considered. However, randomized controlled trials are needed to obtain scientific evidence for pharmacological treatment options.

Disclosure

No significant relationships.

Unlocking the observation of different proton populations in fluorinated polymers by solid-state 1H and 19F double resonance NMR spectroscopy

Nafion proton exchange membranes (PEMs) for fuel cell applications are extensively studied and commercially applied, but their unique proton conduction capabilities are still somewhat unexplained. For studying proton dynamics in situ, molecular level spectroscopic techniques have been of limited utility so far. By solid-state ¹H and ¹⁹F double resonance nuclear magnetic resonance (NMR) spectroscopy using the recently revived multiple contact cross-polarization (MC-CP) pulse sequence along with double-quantum ¹H-¹H filtering, high resolution proton populations distinct from the dominant water resonance were observed in Nafion for the first time. This methodology quenches signal decay due to spin-lattice relaxation in the rotating frame and enables magnetization transfer between the relatively mobile ¹H and ¹⁹F spin baths in Nafion. Further studies of these previously unrevealed proton populations will lead to a better understanding of the Nafion proton conduction mechanism and proton exchange processes in general.

Radiography of the distal extremity of the manus in the donkey foal: Normal images and quantitative characterization from birth to 2 years of age: A pilot study

This study describes a radiographic survey of the anatomical development of the distal extremity of the manus in the donkey from 0 to 2 years of age. The right distal limb of 10 donkey foals, born in the spring of 2012, underwent radiographs every month for the first 6 months of age and every 3 months during the following 18 months. Latero-medial radiographs with and without barium marker at the coronary band and dorso-palmar radiographs with both front feet in weight bearing were obtained. The distal physis of the third metacarpal bone and the proximal physis of the proximal phalanx (phalanx proximalis) were closed at the mean age of 18.6 months. The distal physis of the proximal phalanx appeared as a clear radiolucent line at 2 weeks of age and was still subtly visible in some donkeys at 24 months. The proximal physis of the middle phalanx (phalanx media) was closed at the mean age of 16.7 months. The distal physis of this phalanx was visible at birth, but closed at 4 days. The distal phalanx (phalanx distalis) was triangular at birth. At the age of 20-21 months, the palmar processes (processus palmares) were both developed. The navicular bone (os sesamoideum distalis) was developed at the mean age of 9 months. The proximal sesamoid bones (ossa sesamoidea proximalia) were seen in continuously development during the 24 months. It seems that the physes in the distal extremity of the manus in the donkey close at an older age than the physes in the horse.

Abstract 51: Parasitic Soluble Egg Antigens Fight Atherosclerosis from 2 Different Angles

With intra-plaque inflammation being a major hallmark of atherosclerotic lesion growth and instability, modulation of the immune system may yield therapeutic potential in combating atherosclerosis. Helminths and their derivatives have immune modulating properties and are known for their anti-inflammatory effects. We investigated if immune modulation by Soluble Egg Antigens (SEA) derived from the helminth Schistosoma Mansoni can affect macrophage function and protect against atherosclerosis.

In vitro , primary macrophages skewed by SEA showed an anti-inflammatory M2 phenotype. SEA induced the production of IL-10, an anti-inflammatory cytokine with known anti-atherogenic capacities, while inhibiting LPS-induced production of pro-inflammatory mediators. Likewise, peritoneal macrophages isolated from SEA-treated mice showed increased IL-10 production, thereby confirming the M2 macrophage-inducing potential of SEA in vivo . Additionally, T-lymphocytes showed a profound T H 2 polarization after SEA treatment in vivo .

To study the effect of SEA treatment on atherosclerosis, LDLR -/- mice (n=20) were weekly injected with SEA or vehicle before and during 9 weeks of high fat feeding. Examination of the aortic root showed a 44% decrease in plaque size by SEA treatment (386.2x10 3 μm 2 ± 159.3 vs. 214.3x10 3 μm 2 ± 58.7, p<0.0001) along with less advanced lesions compared to controls. Furthermore, pathological assessment revealed smaller necrotic cores and less monocyte adhesion in lesions from SEA-treated mice. Besides an additional lowering of plasma cholesterol (45.17 mM ± 6.1 vs. 36.99 mM ± 4.28, p<0.0001), SEA reduced high fat diet-induced leukocytosis (9900.6 cells/μl μm 2 ± 2503.6 vs. 7535.11x10 3 μm 2 ± 1892.1, p<0.05), in particular at the myeloid level. Interestingly, both blood monocytes and isolated peritoneal macrophages pointed towards an anti-inflammatory phenotype by SEA, characterized by less Ly6C high cells and increased IL-10 production respectively. Finally, peritoneal macrophages from SEA-treated mice showed less lipid accumulation .

In conclusion, SEA have the potential to reduce atherosclerosis from 2 perspectives: lowering plasma cholesterol levels and dampening the inflammatory (myeloid) immune status.

Comparison of treadmill and cycle ergometer measurements of force-velocity relationships and power output

Since body balance and weight-bearing factors present while running on the treadmill might cause additional muscle recruitment and thus could influence the force-velocity relationship and power, the present study was undertaken to find out whether the F-V and F-P relationships measured while running on the treadmill are different from the respective indices measured during cycling. On two separate occasions, 32 male subjects were tested using a series of 5 sec, all-out sprints against different braking forces on the Gymrol Sprint treadmill and on the Monark ergometer. The maximal peak power (PPmax) and maximal mean power (MPmax) were measured. The equation: EP = 0.5 maximal force (Fo) x0.5 maximal velocity (Vo) was used to calculate the estimated values of peak power (EPP) and mean power (EMP). The F-V relationship was linear in both cycle ergometer and treadmill measurements. PPmax, MPmax, EPP, and EMP values on the treadmill were lower than the respective values on the ergometer. EPP on the ergometer and on the treadmill, as well as EMP values on the ergometer, were slightly higher than the corresponding measured values of PPmax and MPmax. The levels of braking force at which PP, MP, PPmax, and MPmax were obtained were lower on the ergometer than on the treadmill. High correlation coefficients were found between PPmax, MPmax, EPP, and EMP measured on the ergometer and on the treadmill (r = 0.86, r = 0.84, r = 0.71, r = 0.78, respectively, P<0.01). In both tests, significant relationships between PPmax, MPmax, EPP, and EMP were observed. It is concluded that independent of the type of ergometry the force-velocity relationship is similar in the measured range of velocities which suggests that the number of muscle groups and joints engaged in movement are more important than body balance and weight-bearing factors present while running on a treadmill.

Transient inducible events in different tissues: in situ studies in the context of the development and expression of the immune responses to intracellular pathogens

Intracellular pathogens whether facultative like Mycobacterium sp., e.g. Bacillus Calmette Guérin, Listeria monocytogenes or strictly intracellular like Leishmania sp. initiate either asymptomatic infectious processes or disease depending both on factors of the host (genetic as well as environmental ones) and the infectious/pathogenic agents. In this contribution, we first summarized informations which justify to develop in situ analysis to decipher the sequential events that result in different modes/classes of immune responses. How the mode of the immune response is determined remains a main question to address. Although it has recently become clear, in vitro, that immunocompetent cells and their cytokines are critical to set on a stable mode of immune response, acting on naive T cells, this area deserves more in vivo studies. Indeed, peripheral T cells, at different stages of differentiation, may exist in vivo (a) naive/virgin, (b) experienced, (c) effector T cells, depending on the level of stimulation of the immune system by either endogenous or exogenous (e.g. gut flora) signals. The three chosen examples illustrate our contributions in this field focusing on three different non-lymphoid tissues which may become infected: bone marrow (Bacille de Calmette Guérin), liver (Listeria monocytogenes), skin (Leishmania major). These three illustrations also allow to attract attention on the interest of using mice of genetically different strains the immune response of which is set up under different modes.

Components of biological variation in prolyl endopeptidase and dipeptidyl-peptidase IV activity in plasma of healthy subjects

We investigated the components of biological variation in plasma prolyl endopeptidase (PEP; EC 3.4.21.26) and dipeptidyl-peptidase IV (DPP IV; EC 3.4..14.5) activity in healthy individuals. We took monthly blood samples from 26 healthy volunteers for determination of plasma PEP and DPP IV activity during one calendar year. The estimated CVs for PEP activity were: total (CVt) = 25.0%, interindividual (CVg) = 13.9%, and intraindividual (CVi) = 16.8%. There was a statistically significant (P < 0.0001) seasonal pattern in plasma PEP activity, with significantly higher values in the fall than in the other seasons. The peak-trough difference in the yearly variation in PEP activity, expressed as a percentage of the mean, was as high as 56.8%. The estimated CVs for DPP IV activity were: CVt = 17.1%, CVg = 14.5%, and CVi = 8.2%. DPP IV activity was significantly (P < 0.0001) higher in summer than in the other seasons but the amplitude of the yearly variation was small.

Components of biological variation in prolyl endopeptidase and dipeptidyl-peptidase IV activity in plasma of healthy subjects

We investigated the components of biological variation in plasma prolyl endopeptidase (PEP; EC 3.4.21.26) and dipeptidyl-peptidase IV (DPP IV; EC 3.4..14.5) activity in healthy individuals. We took monthly blood samples from 26 healthy volunteers for determination of plasma PEP and DPP IV activity during one calendar year. The estimated CVs for PEP activity were: total (CVt) = 25.0%, interindividual (CVg) = 13.9%, and intraindividual (CVi) = 16.8%. There was a statistically significant (P &lt; 0.0001) seasonal pattern in plasma PEP activity, with significantly higher values in the fall than in the other seasons. The peak-trough difference in the yearly variation in PEP activity, expressed as a percentage of the mean, was as high as 56.8%. The estimated CVs for DPP IV activity were: CVt = 17.1%, CVg = 14.5%, and CVi = 8.2%. DPP IV activity was significantly (P &lt; 0.0001) higher in summer than in the other seasons but the amplitude of the yearly variation was small.

Characterization of liver lymphomyeloid cells in mice infected with Plasmodium yoelii sporozoites

We have isolated, characterized and quantified the immunocompetent cells present in the extravascular hepatic compartment at various stages after Plasmodium yoelii malaria infection with sporozoites. Cytological analyses revealed a predominantly lymphoid population. In mice with a primary infection, the predominant cells were CD4+, CD8+ and B lymphocytes. In fully protected mice, CD3+ CD4- CD8- and polymorphonuclear cells, particularly eosinophils, were most common. The significance of changes in subpopulations is discussed in relation to antigen presentation and host-protective mechanisms.

Rat brain acetylcholinesterase turnover in vivo: use of a radioactive methylphosphonothiate irreversible inhibitor

A new organophosphorus compound was used in its non radioactive and tritiated forms in order to study rat brain acetylcholinesterase. We measured the activity recovery of the total enzyme and of its two main molecular forms (4 S and 10 S) as a function of time following the inhibition. The radioactive compound allowed us to study the disappearance of the inhibitor irreversibly bound to the enzyme in the main cholinergic areas. Both approaches gave similar results: acetylcholinesterase turn-over proceeds in two steps, a rapid one of about 30 mn and a slow one of about 2 days. Our results suggest an in vivo reactivation process concerning a fraction of the bound inhibitor.

Central nervous system pressor responses in rats susceptible and resistant to sodium chloride hypertension

1. The pressor responses to hypertonic saline and angiotensin II introduced into the left lateral ventricle were both significantly greater in salt-sensitive (S) rats compared with salt-resistant (R) rats, with all rats on a low Na diet. 2. When S rats were given thiazide to nullify the pressor effect of dietary NaCl, their blood pressure averaged only 5 mmHg higher than that of the R rats; nevertheless, these S rats had significantly higher central nervous system pressor responses to angiotensin II and hypertonic saline. 3. Thus, if excessive dietary Na increases blood pressure by way of action on the central nervous system, these heightened pressor responses could partially account for the NaCl hypertension in S rats. Alternatively, depressed central nervous system pressor responses in R rats could partially explain the resistance of R rats to NaCl hypertension.