Very small P values.
JAMA Psychiatry. 2014 Aug;71(8):968-9
Authors: Knapp TR, Hayat MJ
PMID: 25102904 [PubMed - indexed for MEDLINE]
JAMA Psychiatry. 2014 Aug;71(8):969
Authors: Hartz SM, Bierut LJ, Pato MT
PMID: 25102905 [PubMed - indexed for MEDLINE]
Self-Reported and Interviewer-Rated Oral Health in Patients With Schizophrenia, Bipolar Disorder, and Major Depressive Disorder.
Perspect Psychiatr Care. 2014 Dec 17;
Authors: Tang LR, Zheng W, Zhu H, Ma X, Chiu HF, Correll CU, Ungvari GS, Xiang YQ, Lai KY, Cao XL, Li Y, Zhong BL, Lok KI, Xiang YT
PURPOSE: To compare self-reported (SR) and interviewer-rated (IR) oral health between schizophrenia (SZ), bipolar disorder (BP), and major depressive disorder (MDD) patients.
DESIGN AND METHODS: 356 patients with SZ, BP, or MDD underwent assessments of psychopathology, side effects, SR, and IR oral health status.
FINDINGS: 118 patients (33.1%) reported poor oral health; the corresponding proportion was 36.4% in BP, 34.8% in SZ, and 25.5% in MD (p = .21). SR and IR oral health correlated only modestly (r = 0.17-0.36) in each group.
PRACTICE IMPLICATIONS: Psychiatric patients need to be assessed for both SR and IR oral health.
PMID: 25515779 [PubMed - as supplied by publisher]
Hypersomnia subtypes, sleep and relapse in bipolar disorder.
Psychol Med. 2014 Dec 17;:1-13
Authors: Kaplan KA, McGlinchey EL, Soehner A, Gershon A, Talbot LS, Eidelman P, Gruber J, Harvey AG
Background. Though poorly defined, hypersomnia is associated with negative health outcomes and new-onset and recurrence of psychiatric illness. Lack of definition impedes generalizability across studies. The present research clarifies hypersomnia diagnoses in bipolar disorder by exploring possible subgroups and their relationship to prospective sleep data and relapse into mood episodes. Method. A community sample of 159 adults (aged 18-70 years) with bipolar spectrum diagnoses, euthymic at study entry, was included. Self-report inventories and clinician-administered interviews determined features of hypersomnia. Participants completed sleep diaries and wore wrist actigraphs at home to obtain prospective sleep data. Approximately 7 months later, psychiatric status was reassessed. Factor analysis and latent profile analysis explored empirical groupings within hypersomnia diagnoses. Results. Factor analyses confirmed two separate subtypes of hypersomnia ('long sleep' and 'excessive sleepiness') that were uncorrelated. Latent profile analyses suggested a four-class solution, with 'long sleep' and 'excessive sleepiness' again representing two separate classes. Prospective sleep data suggested that the sleep of 'long sleepers' is characterized by a long time in bed, not long sleep duration. Longitudinal assessment suggested that 'excessive sleepiness' at baseline predicted mania/hypomania relapse. Conclusions. This study is the largest of hypersomnia to include objective sleep measurement, and refines our understanding of classification, characterization and associated morbidity. Hypersomnia appears to be comprised of two separate subgroups: long sleep and excessive sleepiness. Long sleep is characterized primarily by long bedrest duration. Excessive sleepiness is not associated with longer sleep or bedrest, but predicts relapse to mania/hypomania. Understanding these entities has important research and treatment implications.
PMID: 25515854 [PubMed - as supplied by publisher]
A Genetic Variant in 12q13, a Possible Risk Factor for Bipolar Disorder, Is Associated with Depressive State, Accounting for Stressful Life Events.
PLoS One. 2014;9(12):e115135
Authors: Shimasaki A, Kondo K, Saito T, Esaki K, Otsuka Y, Mano K, Ikeda M, Iwata N
Genome-wide association studies (GWASs) have identified a number of susceptibility genes for schizophrenia (SCZ) and bipolar disorder (BD). However, the identification of risk genes for major depressive disorder (MDD) has been unsuccessful because the etiology of MDD is more influenced by environmental factors; thus, gene-environment (G×E) interactions are important, such as interplay with stressful life events (SLEs). We assessed the G×E interactions and main effects of genes targeting depressive symptoms. Using a case-control design, 922 hospital staff members were evaluated for depressive symptoms according to Beck Depressive Inventory (BDI; "depression" and "control" groups were classified by scores of 10 in the BDI test), SLEs, and personality. A total of sixty-three genetic variants were selected on the basis of previous GWASs of MDD, SCZ, and BD as well as candidate-gene (SLC6A4, BDNF, DBH, and FKBP5) studies. Logistic regression analysis revealed a marginally significant interaction (genetic variant × SLE) at rs4523957 (Puncorrected?=?0.0034) with depression and a significant association of single nucleotide polymorphism identified from evidence of BD GWAS (rs7296288, downstream of DHH at 12q13.1) with depression as the main effect (Puncorrected?=?9.4×10-4, Pcorrected?=?0.0424). We also found that SLEs had a larger impact on depression (odds ratio?3), as reported previously. These results suggest that DHH plays a possible role in depression etiology; however, variants from MDD or SCZ GWAS evidence or candidate genes showed no significant associations or minimal effects of interactions with SLEs on depression.
PMID: 25517604 [PubMed - as supplied by publisher]
Prolonged peripheral nerve blockade in patients using lithium carbonate.
J Craniomaxillofac Surg. 2014 Apr;42(3):e33-5
Authors: Patil PM
Peripheral nerve blocks with local anaesthesia are routinely utilized in oral surgical procedures to achieve anaesthesia at the operative site. A number of local tissue factors as well as systemic conditions and medications may alter the onset, depth and duration of peripheral nerve blocks. This article describes two cases of extremely prolonged anaesthesia in patients treated with chronic oral lithium carbonate who had been administered inferior alveolar, lingual, long buccal, greater palatine and posterior superior alveolar nerve blocks with lidocaine with adrenaline for surgical removal of an upper and a lower third molar tooth. A possible relation with systemic lithium therapy and its probable mode of action are explored.
PMID: 23810516 [PubMed - indexed for MEDLINE]
Coping style and bipolarity.
Acta Neuropsychiatr. 2014 Apr;26(2):67-8
Authors: Grunze H
PMID: 24983090 [PubMed - indexed for MEDLINE]
Levels of C-reactive protein (CRP) in patients with schizophrenia, unipolar depression and bipolar disorder.
Nord J Psychiatry. 2014 Dec 10;:1-8
Authors: Wysoki?ski A, Margulska A, Strzelecki D, K?oszewska I
Objective: C-reactive protein (CRP) is the major acute-phase plasma protein. Studies show that patients with various mental disorders have elevated levels of CRP. The aim of the study was to determine differences in CRP serum level in patients with acute schizophrenia, unipolar depression, bipolar depression and bipolar mania. Method: Serum level of CRP was measured in 950 Caucasian inpatients (589 women, 62.0%; mean age 50.3 years). Results: Mean concentration of CRP in study groups was: schizophrenia (n = 485) 5.30 mg/l, unipolar depression (n = 319) 5.61 mg/l, bipolar disorder (n = 146) 4.65 mg/l, bipolar depression (n = 114) 3.82 mg/l and bipolar mania (n = 32) 7.36 mg/l. There was no difference for CRP levels between patients with schizophrenia, unipolar depression, bipolar depression and bipolar mania (P = 0.58). The overall rate of being above the high level of CRP (set at 3.0 mg/l) was 35.7% for schizophrenia, 38.6% for unipolar depression, 40.4% for bipolar disorder, 40.4% for bipolar depression and 40.6% for bipolar mania. There were no significant differences in the risk of having high level of CRP between the clinical groups. The rate of patients being above high level was higher in women. We also found that in whole study group CRP level was positively correlated with age (P = 0.002). Conclusions: Although there is no statistically significant difference in CRP serum level between patients with schizophrenia, unipolar depression, bipolar depression and bipolar mania, our results show that more than one-third (37.4%) of all subjects had CRP level > 3 mg/l, which is the cut-off point for high cardiovascular risk.
PMID: 25495587 [PubMed - as supplied by publisher]
An Integrated Risk Reduction Intervention can reduce body mass index in individuals being treated for bipolar I disorder: results from a randomized trial.
Bipolar Disord. 2014 Dec 12;
Authors: Frank E, Wallace ML, Hall M, Hasler B, Levenson JC, Janney CA, Soreca I, Fleming MC, Buttenfield J, Ritchey FC, Kupfer DJ
OBJECTIVES: We conducted a randomized, controlled trial comparing the efficacy of an Integrated Risk Reduction Intervention (IRRI) to a control condition with the objective of improving mood stability and psychosocial functioning by reducing cardiometabolic risk factors in overweight/obese patients with bipolar I disorder.
METHODS: A total of 122 patients were recruited from our outpatient services and randomly allocated to IRRI (n = 61) or psychiatric care with medical monitoring (n = 61). Individuals allocated to IRRI received psychiatric treatment and assessment, medical monitoring by a nurse, and a healthy lifestyle program from a lifestyle coach. Those allocated to the control condition received psychiatric treatment and assessment and referral, if indicated, for medical problems. A mixed-effects model was used to examine the impact of the interventions on body mass index (BMI). Exploratory moderator analyses were used to characterize those individuals likely to benefit from each treatment approach.
RESULTS: Analyses were conducted on data for the IRRI (n = 58) and control (n = 56) participants with ?1 study visit. IRRI was associated with a significantly greater rate of decrease in BMI (d = -0.51, 95% confidence interval: -0.91 to -0.14). Three variables (C-reactive protein, total cholesterol, and instability of total sleep time) contributed to a combined moderator of faster decrease in BMI with IRRI treatment.
CONCLUSIONS: Overweight/obese patients with bipolar disorder can make modest improvements in BMI, even when taking medications with known potential for weight gain. Our finding that a combination of three baseline variables provides a profile of patients likely to benefit from IRRI will need to be tested further to evaluate its utility in clinical practice.
PMID: 25495748 [PubMed - as supplied by publisher]
N-acetylaspartate normalization in bipolar depression after lamotrigine treatment.
Bipolar Disord. 2014 Dec 12;
Authors: Croarkin PE, Thomas MA, Port JD, Baruth JM, Choi DS, Abulseoud OA, Frye MA
OBJECTIVES: The aim of the present study was to examine N-acetylaspartate (NAA), a general marker of neuronal viability, and total NAA (tNAA), the combined signal of NAA and N-acetylaspartylglutamate, in bipolar depression before and after lamotrigine treatment. Given that NAA is synthesized through direct acetylation of aspartate by acetyl-coenzyme A-l-aspartate-N-acetyltransferase, we hypothesized that treatment with lamotrigine would be associated with an increase in NAA level.
METHODS: Patients with bipolar depression underwent two-dimensional proton magnetic resonance spectroscopy of the anterior cingulate at baseline (n = 15) and after 12 weeks of lamotrigine treatment (n = 10). A group of age-matched healthy controls (n = 9) underwent scanning at baseline for comparison.
RESULTS: At baseline, patients with bipolar depression had significantly lower NAA [mean standard deviation (SD) = 1.13 (0.21); p = 0.02] than controls [mean (SD) = 1.37 (0.27)]. Significant increases in NAA [mean (SD) = 1.39 (0.21); p = 0.01] and tNAA [mean (SD) = 1.61 (0.25); p = 0.02] levels were found after 12 weeks of lamotrigine treatment.
CONCLUSIONS: These data suggest an NAA deficit in bipolar depression that is normalized after lamotrigine treatment. Future research is warranted to evaluate whether baseline NAA level is a potential biomarker for identifying lamotrigine response patterns and whether this functional brain change has an associated clinical response.
PMID: 25495884 [PubMed - as supplied by publisher]
Hippocampal structure and function in individuals with bipolar disorder: A systematic review.
J Affect Disord. 2014 Nov 10;174C:113-125
Authors: Otten M, Meeter M
INTRODUCTION: Bipolar disorder (BD) is a psychiatric disorder accompanied by deficits in declarative memory. Given the importance of the hippocampus in declarative memory, it is not surprising that BD patients have been reported to show hippocampal abnormalities.
OBJECTIVES: Review evidence about structural and functional hippocampal abnormalities in BD.
METHODS: Systematic review of studies comparing BD patients and healthy controls with respect to hippocampal structure or function.
RESULTS: Twenty-five studies were included, together involving 1043 patients, 21 of which compared patients to controls. Decrease in hippocampal volume was found in four of 18 studies using adult samples, and two of three samples using adolescents. Four studies revealed localized hippocampal deficits. Meta-analysis revealed a significant but small effect with lower hippocampal volumes when comparing all BD patients with controls. Lithium treatment was associated with larger hippocampal volumes across studies. The three functional studies yielded contradictory evidence.
LIMITATIONS: Studies were only cross-sectional in nature and all used MRI or fMRI to investigate hippocampal volume or function. Heterogeneous patients groups and different methodologies for hippocampal segmentation, may have contributed to difficulties when comparing the different studies.
CONCLUSIONS: There seems to be a small reduction in hippocampal volume in BD, which perhaps is more pronounced in early-onset BD and is counteracted by a neuroprotective effect of lithium treatment. However, how these structural abnormalities relate to functional deficits is largely unclear. Given the few functional neuroimaging studies and given the lack of congruence in these results, further investigation of especially hippocampal function in BD is recommended.
PMID: 25496759 [PubMed - as supplied by publisher]
Brain functional changes across the different phases of bipolar disorder.
Br J Psychiatry. 2014 Dec 11;
Authors: Pomarol-Clotet E, Alonso-Lana S, Moro N, Sarró S, Bonnin MC, Goikolea JM, Fernández-Corcuera P, Amann BL, Romaguera A, Vieta E, Blanch J, McKenna PJ, Salvador R
Background Little is known about how functional imaging changes in bipolar disorder relate to different phases of the illness. Aims To compare cognitive task activation in participants with bipolar disorder examined in different phases of illness. Method Participants with bipolar disorder in mania (n = 38), depression (n = 38) and euthymia (n = 38), as well as healthy controls (n = 38), underwent functional magnetic resonance imaging during performance of the n-back working memory task. Activations and de-activations were compared between the bipolar subgroups and the controls, and among the bipolar subgroups. All participants were also entered into a linear mixed-effects model. Results Compared with the controls, the mania and depression subgroups, but not the euthymia subgroup, showed reduced activation in the dorsolateral prefrontal cortex, the parietal cortex and other areas. Compared with the euthymia subgroup, the mania and depression subgroups showed hypoactivation in the parietal cortex. All three bipolar subgroups showed failure of de-activation in the ventromedial frontal cortex. Linear mixed-effects modelling revealed a further cluster of reduced activation in the left dorsolateral prefrontal cortex in the patients; this was significantly more marked in the mania than in the euthymia subgroup. Conclusions Bipolar disorder is characterised by mood state-dependent hypoactivation in the parietal cortex. Reduced dorsolateral prefrontal activation is a further feature of mania and depression, which may improve partially in euthymia. Failure of de-activation in the medial frontal cortex shows trait-like characteristics.
PMID: 25497296 [PubMed - as supplied by publisher]
Variation in response to short-term antidepressant treatment between patients with continuous and non-continuous cycling bipolar disorders.
J Affect Disord. 2014 Nov 27;174C:126-130
Authors: Tundo A, Calabrese JR, Proietti L, de Fillippis R
OBJECTIVES: The study aimed to compare effectiveness and safety of short-term antidepressant treatment between patients with continuous (CCC) and non-continuous (N-CCC) cycling bipolar disorders.
METHODS: The study sample included 101 patients with bipolar disorder, 22 (21.8%) CCC and 79 (78.2%) N-CCC. Response was defined as a HDRS21 total score <7 at 12 weeks of treatment and remission as a ?50% reduction of baseline HDRS21 total score sustained for 8 weeks.
RESULTS: Compared with N-CCC patients, CCC patients achieved a significantly lower percentage of response (respectively 50% vs. 82.3%, ?²=9.6, p=0.002) and remission (respectively 40.9% vs. 69.6%, ?²=6.11, p=0.013). Adjusted logistic regression analysis indicated that CCC patients were 4.3 times more likely to be non-responders and 3.3 times more likely to be non-remitters than N-CCC patients.
CONCERNING: AD safety, 1 (5.0%) CCC patient committed a suicide attempt and AD-emerging switch was observed in 2 patients with N-CCC (2.5%) and in 1 with CCC (4.5%).
LIMITATIONS: The observational nature of the study, retrospective assessment of course, and unblinded outcomes assessment.
CONCLUSIONS: Our findings indicate that the presence or absence of a free interval identifies two different forms of bipolar disorders with different response not only to prophylactic treatment, as previously reported, but also to short-term ADs. We submit that clinicians should take into consideration their patients? pattern of cycling when prescribing short-term AD treatment. Moreover, subtypes of bipolar disorders might be used as moderators of treatment response in studies assessing the efficacy or the effectiveness of antidepressant treatment.
PMID: 25497468 [PubMed - as supplied by publisher]
Clinical characteristics and temperament influences on 'happy' euphoric and 'snappy' irritable bipolar hypo/manic mood states.
J Affect Disord. 2014 Nov 29;174C:144-149
Authors: Graham RK, Parker GB, Breakspear M, Mitchell PB
BACKGROUND: While mood elevation and euphoria are the most commonly described phenotypic descriptors of hypo/mania, irritability and anger may dominate. This study was designed to pursue possible determinants of such differing states.
METHODS: Patients with bipolar I or II disorder were assigned to an 'irritable/snappy' or 'euphoric/happy' sub-set on the basis of their dominant hypo/manic symptoms. Group differences were examined across clinical, personality, lifestyle and illness impact measures.
RESULTS: The two sub-sets did not differ on age of depression onset, family history of mood disorders, or depression severity and impairment. The snappy sub-set reported higher levels of irritability in depressed phases and were more likely to have a comorbid anxiety disorder. Their hypo/manic episodes were shorter and they were more likely to be hospitalized at such times. On a temperament measure they scored as more irritable and self-focussed and as less cooperative and effective - indicative of higher levels of disordered personality functioning.
LIMITATIONS: Some comparison analyses were undertaken on a reduced sample size, giving rise to power issues. Our bipolar I and II diagnoses deviated to some extent from DSM-5 criteria in not imposing duration criteria for hypo/manic episodes.
CONCLUSIONS: Findings support a spectrum model for the bipolar disorders linking temperament to bipolar symptomatic state and which may have treatment implications.
PMID: 25497471 [PubMed - as supplied by publisher]
Preliminary study of anxiety symptoms, family dysfunction, and the brain-derived neurotrophic factor (BDNF) Val66Met genotype in offspring of parents with bipolar disorder.
J Psychiatr Res. 2014 Nov 27;
Authors: Park MH, Chang KD, Hallmayer J, Howe ME, Kim E, Hong SC, Singh MK
Several genetic and environmental factors place youth offspring of parents with bipolar disorder (BD) at high risk for developing mood and anxiety disorders. Recent studies suggest that anxiety symptoms, even at subclinical levels, have been associated with an increased risk for developing BD. The brain-derived neurotrophic factor (BDNF) gene has been implicated in the pathophysiology of both BD and anxiety disorders. We aimed to explore whether anxiety in BD offspring was associated with the BDNF Val66Met polymorphism. 64 BD offspring (mean age: 13.73 (S.D. 3.45) M = 30, F = 34) and 51 HC (mean age: 13.68 (S.D. 2.68) M = 23, F = 28) were compared on presence of the met allele and on scores from the Multidimensional Anxiety Scale for Children (MASC). To assess family function, we used the Family Adaptability and Cohesion Evaluation Scales (FACES-IV). The Baron & Kenny method was the statistical approach used to examine the moderating effects between variables. BD offspring showed higher levels of overall anxiety than did the HC group. BD offspring with the val/val genotype showed higher levels of anxiety than BD offspring with other genotypes. No significant levels of anxiety or its association with BDNF genotype were found in the HC group. BD offspring group showed significantly more family dysfunction when compared with the HC group and the family dysfunction moderated the association between the BDNF genotype and anxiety symptoms. This study demonstrated the potential interplay of three factors: BD offspring, anxiety symptoms and family dysfunction.
PMID: 25498133 [PubMed - as supplied by publisher]
Influence of birth cohort on age of onset cluster analysis in bipolar I disorder.
Eur Psychiatry. 2014 Dec 11;
Authors: Bauer M, Glenn T, Alda M, Andreassen OA, Angelopoulos E, Ardau R, Baethge C, Bauer R, Bellivier F, Belmaker RH, Berk M, Bjella TD, Bossini L, Bersudsky Y, Cheung EY, Conell J, Del Zompo M, Dodd S, Etain B, Fagiolini A, Frye MA, Fountoulakis KN, Garneau-Fournier J, Gonzalez-Pinto A, Harima H, Hassel S, Henry C, Iacovides A, Isometsä ET, Kapczinski F, Kliwicki S, König B, Krogh R, Kunz M, Lafer B, Larsen ER, Lewitzka U, Lopez-Jaramillo C, MacQueen G, Manchia M, Marsh W, Martinez-Cengotitabengoa M, Melle I, Monteith S, Morken G, Munoz R, Nery FG, O'Donovan C, Osher Y, Pfennig A, Quiroz D, Ramesar R, Rasgon N, Reif A, Ritter P, Rybakowski JK, Sagduyu K, Scippa AM, Severus E, Simhandl C, Stein DJ, Strejilevich S, Hatim Sulaiman A, Suominen K, Tagata H, Tatebayashi Y, Torrent C, Vieta E, Viswanath B, Wanchoo MJ, Zetin M, Whybrow PC
PURPOSE: Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.
METHODS: The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.
RESULTS: There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.
CONCLUSION: These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.
PMID: 25498240 [PubMed - as supplied by publisher]
Comparative neuropsychiatry: White matter abnormalities in children and adolescents with schizophrenia, bipolar affective disorder, and obsessive-compulsive disorder.
Eur Psychiatry. 2014 Dec 11;
Authors: White T, Langen C, Schmidt M, Hough M, James A
BACKGROUND: There is considerable evidence that white matter abnormalities play a key role in the pathogenesis of a number of major psychiatric disorders, including schizophrenia, bipolar affective disorder, and obsessive-compulsive disorder. Few studies, however, have compared white matter abnormalities early in the course of the illness.
METHODS: A total of 102 children and adolescents participated in the study, including 43 with early-onset schizophrenia, 13 with early-onset bipolar affective disorder, 17 with obsessive-compulsive disorder, and 29 healthy controls. Diffusion tensor imaging scans were obtained on all children and the images were assessed for the presence of non-spatially overlapping regions of white matter differences, a novel algorithm known as the pothole approach.
RESULTS: Patients with early-onset schizophrenia and early-onset bipolar affective disorder had a significantly greater number of white matter potholes compared to controls, but the total number of potholes did not differ between the two groups. The volumes of the potholes were significantly larger in patients with early-onset bipolar affective disorder compared to the early-onset schizophrenia group. Children and adolescents with obsessive-compulsive disorder showed no differences in the total number of white matter potholes compared to controls.
CONCLUSIONS: White matter abnormalities in early-onset schizophrenia and bipolar affective disorder are more global in nature, whereas children and adolescents with obsessive-compulsive disorder do not show widespread differences in FA.
PMID: 25498242 [PubMed - as supplied by publisher]
Pathways of polyunsaturated fatty acid utilization: Implications for brain function in neuropsychiatric health and disease.
Brain Res. 2014 Dec 8;
Authors: Liu JJ, Green P, John Mann J, Rapoport SI, Sublette ME
Essential polyunsaturated fatty acids (PUFAs) have profound effects on brain development and function. Abnormalities of PUFA status have been implicated in neuropsychiatric diseases such as major depression, bipolar disorder, schizophrenia, Alzheimer's disease, and attention deficit hyperactivity disorder. Pathophysiologic mechanisms could involve not only suboptimal PUFA intake, but also metabolic and genetic abnormalities, defective hepatic metabolism, and problems with diffusion and transport. This article provides an overview of physiologic factors regulating PUFA utilization, highlighting their relevance to neuropsychiatric disease.
PMID: 25498862 [PubMed - as supplied by publisher]
The structure and short-term stability of the emotional disorders: a dimensional approach.
Psychol Med. 2014 Dec 12;:1-12
Authors: Kotov R, Perlman G, Gámez W, Watson D
BACKGROUND: Factor-analytic studies have found that depressive, bipolar, post-traumatic, obsessive-compulsive, and anxiety disorders - jointly referred to as the emotional disorders - form an internalizing spectrum that includes distress and fear subfactors. However, placement of some disorders is uncertain. Also, prior research analysed dichotomous interview-based diagnoses or dimensional self-report measures. We investigated this structure using a third-generation measure - the Interview for Mood and Anxiety Symptoms (IMAS) - that combines strengths of a clinical interview with dimensional assessment.
METHOD: The interview was administered to 385 students and 288 psychiatric out-patients. Participants were reinterviewed 2 months later.
RESULTS: Exploratory and confirmatory factor analyses identified three factors: distress (depression, generalized anxiety, post-traumatic stress, irritability, and panic syndrome); fear (social anxiety, agoraphobia, specific phobia, and obsessive-compulsive); and bipolar (mania and obsessive-compulsive). The structure was consistent over time and across samples, except that panic and agoraphobia had higher factor loadings in patients. Longitudinal analyses revealed high temporal stability of the factors (test-retest r = 0.72 to 0.87), but also substantial disorder-specific stability.
CONCLUSIONS: This investigation - which bridges diagnostic and self-report studies - found three subfactors of internalizing psychopathology. It provided support for a new subfactor, clarified the placement of obsessive-compulsive and bipolar disorders, and demonstrated that this model generalizes across populations. The accumulating research suggests the need to recognize formally the close links among the emotional disorders, as well as empirical clusters within this spectrum. The IMAS demonstrated strong psychometric properties and can be useful for various research and clinical applications by providing dimensional, interview-based assessment of the emotional disorders.
PMID: 25499142 [PubMed - as supplied by publisher]
Cross-generational trans fat intake facilitates mania-like behavior: Oxidative and molecular markers in brain cortex.
Neuroscience. 2014 Dec 8;
Authors: Trevizol F, Roversi K, Dias VT, Roversi K, Barcelos RC, Kuhn FT, Pase CS, Golombieski R, Veit JC, Piccolo J, Pochmann D, Porciúncula LO, Emanuelli T, Rocha JB, Bürger ME
Since that fast food consumption have raised concerns about people's health, we evaluated the influence of trans fat consumption on behavioral, biochemical and molecular changes in the brain-cortex of second generation rats exposed to a model of mania. Two successive generations of female rats were supplemented with soybean oil (SO, rich in n-6 FA, control group), fish oil (FO, rich in n-3 FA) and hydrogenated vegetable fat (HVF, rich in trans FA) from pregnancy, lactation to adulthood, when male rats from 2nd generation received amphetamine (AMPH-4mg/kg-i.p., once a day, for 14days) treatment. AMPH increased locomotor index in all animals, which was higher in the HVF group. While the FO group showed increased n-3 polyunsaturated fatty acid (PUFA) incorporation and reduced n-6/n-3 PUFA ratio, HVF allowed trans fatty acid (TFA) incorporation and increased n-6/n-3 PUFA ratio in the brain-cortex. In fact, the FO group showed minor AMPH-induced hyperactivity, decreased reactive species (RS) generation per se, causing no changes in protein carbonyl (PC) levels and dopamine transporter (DAT). FO supplementation showed molecular changes, since proBDNF was increased per se and reduced by AMPH, decreasing the brain-derived neurotrophic factor (BDNF) level following drug treatment. Conversely, HVF was related to increased hyperactivity, higher PC level per se and higher AMPH-induced PC level, reflecting on DAT, whose levels were decreased per se as well as in AMPH-treated groups. In addition, while HVF increased BDNF-mRNA per se, AMPH reduced this value, acting on BDNF, whose level was lower in the same AMPH-treated experimental group. ProBDNF level was influenced by HVF supplementation, but it was not sufficient to modify BDNF level. These findings reinforce that prolonged consumption of trans fat allows TFA incorporation in the cortex, facilitating hyperactive behavior, oxidative damages and molecular changes. Our study is a warning about cross-generational consumption of processed food, since high trans fat may facilitate the development of neuropsychiatric conditions, including bipolar disorder (BD).
PMID: 25499313 [PubMed - as supplied by publisher]
Anxiety comorbidity in bipolar spectrum disorders: The mediational role of perfectionism in prospective depressive symptoms.
J Affect Disord. 2014 Nov 21;174C:180-187
Authors: O'Garro-Moore JK, Adams AM, Abramson LY, Alloy LB
BACKGROUND: Bipolar spectrum disorders (BSDs) are highly comorbid with anxiety, which is associated with an extended duration and exacerbation of depressive symptoms. Unfortunately, the underlying mechanisms are not known. This study examined the role of maladaptive cognitive styles in the co-occurrence of BSDs and anxiety disorders and prediction of depressive symptoms.
METHODS: Participants included 141 young adults (69.6% female, mean age=20.24, SD=2.11), in one of three groups: a BSD group (bipolar II, cyclothymia, n=48), a comorbid BSD/anxiety group (n=50), and a demographically-matched healthy control group (n=43), who were followed prospectively. Participants completed the Cognitive Style Questionnaire (CSQ), Depressive Experiences Questionnaire (DEQ), Dysfunctional Attitudes Scale (DAS), Sociotropy Autonomy Scale (SAS), Halberstadt Mania Inventory (HMI) and Beck Depression Inventory (BDI) at the initial assessment. One year later, participants completed the BDI and HMI again to assess severity of depressive and hypomanic/manic symptoms.
RESULTS: A multivariate analysis of co-variance (MANCOVA) revealed significant differences between the three groups on their DAS Perfectionism, DEQ Dependency, DEQ Self-Criticism, CSQ Negative, SAS Autonomy, and Time 2 BDI scores, with the BSD/anxiety group scoring higher than the BSD only group on all measures except the CSQ. Preacher and Hayes? (2008) bootstrapping method was used to test for mediational effects of the significant cognitive style measures on depressive symptoms at follow-up. The 95% confidence intervals for the indirect effect of group on follow-up depressive symptoms through DAS Perfectionism did not include zero, indicating the presence of a significant mediating relationship for perfectionism.
LIMITATIONS: This study only used two waves of data; three waves of data would allow one to investigate the full causal effect of one variable on another. Further, a comorbid anxiety diagnosis consisted of any anxiety disorder. Further research should separate groups by their specific anxiety diagnoses; this could afford a more complete understanding of the effect of types of anxiety on prospective depressive symptoms.
CONCLUSIONS: After taking into account initial levels of depressive and hypomanic/manic symptoms, we found that those with BSD/anxiety comorbidity experienced more severe depressive symptoms, but not more severe hypomanic/manic symptoms. Further, their more severe prospective depressive symptoms are explained by a perfectionistic cognitive style.
PMID: 25499686 [PubMed - as supplied by publisher]
Role of P2X7 Receptor in an Animal Model of Mania Induced by D-Amphetamine.
Mol Neurobiol. 2014 Dec 11;
Authors: Gubert C, Fries GR, Pfaffenseller B, Ferrari P, Coutinho-Silva R, Morrone FB, Kapczinski F, Battastini AM
The objective of this study was to explore the association between the P2X7 purinergic receptor (P2X7R) and neuroinflammation using a preclinical model of acute bipolar mania. We analyzed the modulatory effects of P2X7R agonist (3'-O-(4-benzoyl)benzoyl-adenosine 5'-triphosphate, BzATP) and antagonists (brilliant blue, BBG and 3-[[5-(2,3 dichlorophenyl)-1H-tetrazol-1-yl]methyl]pyridine hydrochloride, A438079) on assessments related to behavior (locomotor activity), neuroinflammation (interleukin-1 beta, IL-1?; tumor necrosis factor alpha, TNF-?; and interleukin- 6, IL-6), oxidative stress (thiobarbituric acid reactive substances, TBARS) and neuroplasticity (brain-derived neurotrophic factor, BDNF) markers in a pharmacological model of mania induced by acute and chronic treatment with D-amphetamine (AMPH) (2 mg/kg) in mice. An apparent lack of responsiveness to AMPH was observed in terms of the locomotor activity in animals with blocked P2X7R or with genetic deletion of P2X7R in knockout (P2X7R(-/-)) mice. Likewise, P2X7R participated in the AMPH-induced increase of the proinflammatory and excitotoxic environment, as demonstrated by the reversal of IL-1?, TNF-?, and TBARS levels caused by P2X7R blocking. Our results support the hypothesis that P2X7R plays a role in the neuroinflammation induced by AMPH in a preclinical model of mania, which could explain the altered behavior. The present data suggest that P2X7R may be a therapeutic target related to the neuroinflammation reported in bipolar disorder.
PMID: 25502294 [PubMed - as supplied by publisher]
Grey matter volume abnormalities in patients with bipolar I depressive disorder and unipolar depressive disorder: a voxel-based morphometry study.
Neurosci Bull. 2014 Dec 11;
Authors: Cai Y, Liu J, Zhang L, Liao M, Zhang Y, Wang L, Peng H, He Z, Li Z, Li W, Lu S, Ding Y, Li L
Bipolar disorder and unipolar depressive disorder (UD) may be different in brain structure. In the present study, we performed voxel-based morphometry (VBM) to quantify the grey matter volumes in 23 patients with bipolar I depressive disorder (BP1) and 23 patients with UD, and 23 age-, gender-, and education-matched healthy controls (HCs) using magnetic resonance imaging. We found that compared with the HC and UD groups, the BP1 group showed reduced grey matter volumes in the right inferior frontal gyrus and middle cingulate gyrus, while the UD group showed reduced volume in the right inferior frontal gyrus compared to HCs. In addition, correlation analyses revealed that the grey matter volumes of these regions were negatively correlated with the Hamilton depression rating scores. Taken together, the results of our study suggest that decreased grey matter volume of the right inferior frontal gyrus is a common abnormality in BP1 and UD, and decreased grey matter volume in the right middle cingulate gyrus may be specific to BP1.
PMID: 25502401 [PubMed - as supplied by publisher]
Life chart methodology: risks associated with failing to assess patient preferences and the sources of poor insight for patients with bipolar disorder.
J Am Psychiatr Nurses Assoc. 2014 Nov;20(6):386-8
Authors: Lysaker PH, James AV, Leonhardt BL
PMID: 25502642 [PubMed - in process]
Social Functioning and Age Across Affective and Nonaffective Psychoses.
J Nerv Ment Dis. 2014 Dec 10;
Authors: Martin EA, Ongür D, Cohen BM, Lewandowski KE
Both nonaffective and affective psychoses are associated with deficits in social functioning across the course of the illness. However, it is not clear how social functioning varies among diagnostic groups as a function of age. The current study examined the relationship between social functioning and age in schizophrenia (SZ), schizoaffective disorder (SZA), and psychotic bipolar disorder (PBD). We found that individuals with PBD had the highest functioning, whereas individuals with SZ had the poorest. The functioning of individuals with SZA fell in between those of other groups. We also found that older ages were associated with poorer functioning. Although there was not a significant diagnostic group by age interaction, visual inspection of our data suggests a subtly steeper trajectory of decline in PBD. Overall, these results indicate that early interventions targeting social functioning may benefit individuals with either non-affective or affective psychoses to slow a projected decline.
PMID: 25503785 [PubMed - as supplied by publisher]
Individualized Texting for Adherence Building (iTAB): Improving Antiretroviral Dose Timing Among HIV-Infected Persons with Co-occurring Bipolar Disorder.
AIDS Behav. 2014 Dec 13;
Authors: Moore DJ, Poquette A, Casaletto KB, Gouaux B, Montoya JL, Posada C, Rooney AS, Badiee J, Deutsch R, Letendre SL, Depp CA, Grant I, Atkinson JH, The HIV Neurobehavioral Research Program (HNRP) Group
HIV+ persons with co-occurring bipolar disorder (HIV+/BD+) have elevated rates of medication nonadherence. We conducted a 30-day randomized controlled trial of a two-way, text messaging system, iTAB (n = 25), compared to an active comparison (CTRL) (n = 25) to improve antiretroviral (ARV) and psychotropic (PSY) adherence and dose timing. Both groups received medication adherence psychoeducation and daily texts assessing mood. The iTAB group additionally received personalized medication reminder texts. Participants responded to over 90 % of the mood and adherence text messages. Mean adherence, as assessed via electronic monitoring caps, was high and comparable between groups for both ARV (iTAB 86.2 % vs. CTRL 84.8 %; p = 0.95, Cliff's d = 0.01) and PSY (iTAB 78.9 % vs. CTRL 77.3 %; p = 0.43, Cliff's d = -0.13) medications. However, iTAB participants took ARVs significantly closer to their intended dosing time than CTRL participants (iTAB: 27.8 vs. CTRL: 77.0 min from target time; p = 0.02, Cliff's d = 0.37). There was no group difference on PSY dose timing. Text messaging interventions may represent a low-burden approach to improving timeliness of medication-taking behaviors among difficult-to-treat populations. The benefits of improved dose timing for long-term medication adherence require additional investigation.
PMID: 25504449 [PubMed - as supplied by publisher]
Physical activity and sleep: Day-to-day associations among individuals with and without Bipolar Disorder.
Ment Health Phys Act. 2014 Sep 1;7(3):183-190
Authors: McGlinchey EL, Gershon A, Eidelman P, Kaplan KA, Harvey AG
OBJECTIVE: To evaluate the relative role of psychopathology in the relationship between physical activity and sleep, the present study investigated the day-to-day relationship between physical activity and sleep in individuals without a psychiatric disorder and individuals with bipolar disorder using a longitudinal, naturalistic design.
METHOD: Participants in two groups-a healthy group with no psychiatric illness (N=36) and an inter-episode bipolar disorder group (N=32)- were studied over a two-month period. Physical health was assessed by the SF-36. Daily subjective and objective measures of physical activity and sleep were collected. A total of 6,670 physical activity measurements and 6,548 sleep measurements were logged.
RESULTS: The bipolar disorder group exhibited poorer physical health on the SF-36 and more sleep disturbance relative to the healthy group. No group differences were found in physical activity, nor in models examining the relationship between physical activity and sleep. Hierarchical linear models indicated that for every standard deviation increase in sleep disturbance (i.e., increased total wake time), there was a three percent decrease in subsequent day physical activity, in both the healthy and bipolar groups. Increased physical activity was associated with improved sleep for participants who reported greater average sleep disturbance.
CONCLUSIONS: The results for all participants in the study suggest that reduced physical activity and sleep difficulties may be mutually maintaining processes, particularly for individuals who suffer from poor sleep. Findings also raise the potential importance of targeting physical activity and sleep concurrently in interventions aimed at improving physical and mental health.
PMID: 25506392 [PubMed - as supplied by publisher]
[New insights into ways of determining cortisol exposure in patients with bipolar disorder.]
Tijdschr Psychiatr. 2014;56(12):788-797
Authors: Spijker AT, Staufenbiel SM, van Rossum EF
BACKGROUND: Previous research has shown a relationship between the stress hormone cortisol and bipolar disorder. The level of cortisol exposure is usually examined by means of measurements that provide a snapshot of cortisol exposure or by means of dynamic testing. Recently, a new technique has been introduced which can measure, retrospectively, the cortisol level in scalp hair over longer periods of time.
AIM: To provide insight into various methods used in psychiatry for measuring the hypothalamus-pituitary-adrenal (HPA)-axis activity and also to highlight recent research into measurements of cortisol in scalp hair of patients with bipolar disorder.
METHOD: We give a brief overview of the literature relating to HPA-axis testing in psychiatric patients. As a result of our recent studies with 100 patients suffering from bipolar disorder, we are now able to determine the levels of cortisol in scalp hair.
RESULTS: Tests that measure hpa activity can be divided into three categories: point measurements, stimulation tests and inhibition tests. In our recent study of bipolar patients we found that a raised level of cortisol in scalp hair was related to a later onset of bipolar disorder (in patients over 30) or to multiple psychiatric diagnoses. Lower levels of cortisol level in scalp hair of bipolar patients were observed in bipolar patients with comorbid panic disorder.
CONCLUSION: The use of hair analysis to measure mean cortisol levels over long periods seems to give added value to the hpa-axis tests currently used for measuring cortisol exposure. The technique may make it easier to differentiate between various subtypes of bipolar disorder.
PMID: 25510453 [PubMed - as supplied by publisher]
Do people with mental illness receive adequate smoking cessation advice? A systematic review and meta-analysis.
Gen Hosp Psychiatry. 2014 Nov 21;
Authors: Mitchell AJ, Vancampfort D, De Hert M, Stubbs B
BACKGROUND: Prevalence rates of smoking in people with mental illness are high, and premature mortality attributed to tobacco related physical comorbidity is a major concern. We conducted a meta-analysis comparing rates of receipt of smoking cessation advice among people with and without mental illness.
METHOD: Major electronic databases were searched from inception till August 2014 for studies comparing rates of receipt of smoking cessation advice of people with and without a mental illness. Two independent authors completed methodological appraisal and extracted data. A random-effects meta-analysis was utilized.
RESULTS: Seven studies of satisfactory methodological quality (n mental illness=68,811, n control=652,847) were included. Overall there was no significant difference in smoking cessation advice rates between those with and without a mental illness [relative risk (RR)=1.02, 95% confidence interval (CI)=0.94-1.11, n=721,658, Q=1421, P<.001]. Subgroup analyses demonstrated people with severe mental illness (SMI) received comparable rates of smoking cessation advice to those without SMI (RR=1.09, 95% CI=0.98-1.2, n=559,122). This remained true for people with schizophrenia (RR=1.09, 95% CI=0.68-1.70) and bipolar disorder (RR=1.14, 95% CI=0.85-1.5). People with non-SMIs were slightly more likely to receive smoking cessation advice (RR=1.16, 95% CI=1.04-1.30, Q=1364, P<.001, n=580,206).
CONCLUSIONS: People with SMI receive similar smoking cessation advice rates to people without mental illness, while those with non-SMI are slightly more likely to receive smoking cessation advice. While progress has been made, offering smoking cessation advice should receive a higher priority in everyday clinical practice for patients with a mental health diagnosis.
PMID: 25510845 [PubMed - as supplied by publisher]
Sad mood induction has an opposite effect on amygdala response to emotional stimuli in euthymic patients with bipolar disorder and healthy controls.
J Psychiatry Neurosci. 2014 Dec 16;39(6):140044
Authors: Horacek J, Mikolas P, Tintera J, Novak T, Palenicek T, Brunovsky M, Höschl C, Alda M
BACKGROUND: Aberrant amygdala reactivity to affective stimuli represents a candidate factor predisposing patients with bipolar disorder (BD) to relapse, but it is unclear to what extent amygdala reactivity is state-dependent. We evaluated the modulatory influence of mood on amygdala reactivity and functional connectivity in patients with remitted BD and healthy controls.
METHODS: Amygdala response to sad versus neutral faces was investigated using fMRI during periods of normal and sad mood induced by autobiographical scripts. We assessed the functional connectivity of the amygdala to characterize the influence of mood state on the network responsible for the amygdala response.
RESULTS: We included 20 patients with remitted BD and 20 controls in our study. The sad and normal mood exerted opposite effects on the amygdala response to emotional faces in patients compared with controls (F1,38 = 5.85, p = 0.020). Sad mood amplified the amygdala response to sad facial stimuli in controls but attenuated the amygdala response in patients. The groups differed in functional connectivity between the amygdala and the inferior prefrontal gyrus (p ? 0.05, family-wise error-corrected) of ventrolateral prefrontal cortex (vlPFC) corresponding to Brodmann area 47. The sad mood challenge increased connectivity during the period of processing sad faces in patients but decreased connectivity in controls.
LIMITATIONS: Limitations to our study included long-term medication use in the patient group and the fact that we mapped only depressive (not manic) reactivity.
CONCLUSION: Our results support the role of the amygdala-vlPFC as the system of dysfunctional contextual affective processing in patients with BD. Opposite amygdala reactivity unmasked by the mood challenge paradigm could represent a trait marker of altered mood regulation in patients with BD.
PMID: 25510947 [PubMed - as supplied by publisher]