Hemostasis management during completely endoscopic removal of a highly vascular intraparenchymal brain tumor: technique assessment.
J Neurol Surg A Cent Eur Neurosurg. 2014 Jan;75(1):42-7
Authors: McLaughlin N, Kelly DF, Prevedello DM, Carrau RL, Kassam AB
BACKGROUND: Recently, stereotactic-guided removal of intraparenchymal lesions using endoscopic visualization through a brain port has been successfully reported. Although endoneurosurgical tumor resection uses the same principles as those used in microneurosurgery, the ability to control bleeding through the port requires an adapted technique.
MATERIAL AND METHODS: We present a patient that underwent a completely endoscopic resection of a vascular brain tumor through a brain port and describe the hemostatic technique.
RESULTS: A 68 year-old female presented with progressive gait difficulties. She had been previously treated for a breast cancer. Magnetic resonance imaging (MRI) showed a right subcortical solitary cerebellar lesion that homogeneously enhanced. The patient underwent an endoscopic brain port removal of a supposed brain metastasis. After port cannulation, the tumor partly delivered itself into the port. Following initial tumor biopsy, active bleeding occurred. Irrigation and application of Surgifoam allowed to control the bleeding. Coagulation with an adapted bipolar and removal of coagulated tissue with the side-cutting aspiration device were sequentially repeated. Once the tumor was resected, the suction served as counter-traction elongating the vessels whereas the bipolar cauterized them over a long segment. Hemostasis was performed circumferentially along the cavity's walls from deep to superficial, benefiting from the endoscope's dynamic properties and magnification. Pathology confirmed intraoperative suspicion of hemangioblastoma.
CONCLUSION: ?Removal of vascular tumors is feasible through the brain port, despite a relatively narrow corridor of 11.5 mm. However, specific hemostasis techniques are required and adapted instruments are needed to ensure hemostasis through these small corridors.
PMID: 23065778 [PubMed - indexed for MEDLINE]
The effectiveness of lifestyle interventions to reduce cardiovascular risk in patients with severe mental disorders: meta-analysis of intervention studies.
Community Ment Health J. 2014 Jan;50(1):81-95
Authors: Fernández-San-Martín MI, Martín-López LM, Masa-Font R, Olona-Tabueña N, Roman Y, Martin-Royo J, Oller-Canet S, González-Tejón S, San-Emeterio L, Barroso-Garcia A, Viñas-Cabrera L, Flores-Mateo G
Patients with severe mental illness have higher prevalences of cardiovascular risk factors (CRF). The objective is to determine whether interventions to modify lifestyles in these patients reduce anthropometric and analytical parameters related to CRF in comparison to routine clinical practice. Systematic review of controlled clinical trials with lifestyle intervention in Medline, Cochrane Library, Embase, PsycINFO and CINALH. Change in body mass index, waist circumference, cholesterol, triglycerides and blood sugar. Meta-analyses were performed using random effects models to estimate the weighted mean difference. Heterogeneity was determined using i(2) statistical and subgroups analyses. 26 studies were selected. Lifestyle interventions decrease anthropometric and analytical parameters at 3 months follow up. At 6 and 12 months, the differences between the intervention and control groups were maintained, although with less precision. More studies with larger samples and long-term follow-up are needed.
PMID: 23739948 [PubMed - indexed for MEDLINE]
[Short history of mixed states].
Encephale. 2013 Dec;39 Suppl 3:S129-33
Authors: Cermolacce M, Belzeaux R, Corréard N, Dassa D, Dubois M, Micoulaud-Franchi JA, Pringuey D, Fakra E, Maurel M, Azorin JM
The notion of mixed states is classically associated with descriptions and categories inherited from Kraepelin. However, simultaneous descriptions of depressive and manic manifestations can be traced back to ancient times. Semiology and definitions of these clinical associations have evolved across the times. We provide here a short insight on four distinct periods: Greek authors from ancient times, pre-Kraepelinian psychiatry (18th and 19th centuries), Kraepelin's conceptualization, and contemporary psychiatry (20th and 21st centuries).
PMID: 24359849 [PubMed - indexed for MEDLINE]
[Mixed states: evolution of classifications].
Encephale. 2013 Dec;39 Suppl 3:S134-8
Authors: Pringuey D, Cherikh F, Giordana B, Fakra E, Dassa D, Cermolacce M, Belzeaux R, Maurel M, Azorin JM
The nosological position of mixed states has followed the course of classifying methods in psychiatry, the steps of the invention of the clinic, progress in the organization of care, including the discoveries of psychopharmacology. The clinical observation of a mixture of symptoms emerging from usually opposite clinical conditions is classical. In the 70s, a syndromic specification fixed the main symptom combinations but that incongruous assortment failed to stabilize the nosological concept. Then stricter criteriology was proposed. To be too restrictive, a consensus operates a dimensional opening that attempts to meet the pragmatic requirements of nosology validating the usefulness of the class system. This alternation between rigor of categorization and return to a more flexible criteriological option reflects the search for the right balance between nosology and diagnosis. The definition of mixed states is best determined by their clinical and prognostic severity, related to the risk of suicide, their lower therapeutic response, the importance of their psychiatric comorbidities, anxiety, emotional lability, alcohol abuse. Trying to compensate for the lack of categorical definitions and better reflecting the clinical field problems, new definitions complement criteriology with dimensional aspects, particularly taking into account temperaments.
PMID: 24359850 [PubMed - indexed for MEDLINE]
[Recommendations for the treatment of mixed episodes in current guidelines].
Encephale. 2013 Dec;39 Suppl 3:S185-7
Authors: Azorin JM, Belzeaux R, Cermolacce M, Kaladjian A, Corréard N, Dassa D, Dubois M, Maurel M, Micoulaud Franchi JA, Pringuey D, Fakra E
A literature search on the pharmacological treatment of acute bipolar mixed episodes in current guidelines shows that only seven of them address the acute management of mixed episodes as a separate condition, whereas the vast majority of these guidelines include the treatment of mixed episodes in the chapter of mania. As a general rule, most guidelines advise to stop antidepressant treatment and mention the superiority of valproate over lithium. Specific recommendations for the treatment of "mixed states" can be found in two guidelines, while specific recommendations for that of "mixed mania" are present in five of them. Recommendations for the treatment of "mixed depression" exist in only three guidelines. If some consensus may be found for the treatment of "mixed states" as a whole, recommendations for the treatment of "mixed mania" appear to be variable, whereas those for the treatment of "mixed depression" seem to be limited.
PMID: 24359859 [PubMed - indexed for MEDLINE]
Metachromatic leukodystrophy presenting as bipolar disorder.
Aust N Z J Psychiatry. 2014 Sep 18;
Authors: Velakoulis D, Ting A, Winton-Brown T, Walterfang M, Gaillard F
PMID: 25237139 [PubMed - as supplied by publisher]
An evaluation of the DSM-5 rules defining mania and hypomania with identical symptom criteria.
J Affect Disord. 2014 Sep 4;170C:91-94
Authors: Parker GB, Graham RK
BACKGROUND: DSM-IV and DSM-5 provide identical symptom criteria and cut-off scores in defining mania and hypomania, a model seemingly counter-intuitive for classificatory differentiation. We designed a study to examine the impact of such DSM criteria and propose alternative models.
METHODS: Prevalence and severity of hypo/manic symptoms as measured by the Mood Swings Questionnaire (MSQ) were compared in age and gender-matched bipolar I and II patients. Use of the MSQ allowed both DSM and additional items to be evaluated in terms of their capacity to differentiate the two bipolar conditions.
RESULTS: In comparison to bipolar II participants, the bipolar I participants reported higher prevalence scores on six MSQ symptoms, severity scores on twelve MSQ symptoms and total MSQ scores. While bipolar I and II participants reported similar prevalence rates of DSM-5 symptoms, bipolar I participants returned higher prevalence rates on five (non-DSM) MSQ items.
LIMITATIONS: Bipolar sub-type was not formally assessed by a structured diagnostic interview. The degree to which assigned MSQ items corresponded with DSM items might not necessarily have high equivalence. The study would have been enriched by evaluating a number of other symptom constructs.
CONCLUSIONS: Findings suggest several optional approaches to differentiating mania and hypomania. The model we favor is one with a core set of features integral to mania and hypomania that is complemented by certain differentiating features. Psychotic features and over-valued ideas might provide the domain for such differentiation.
PMID: 25237731 [PubMed - as supplied by publisher]
General medical conditions in 347 bipolar disorder patients: Clinical correlates of metabolic and autoimmune-allergic diseases.
J Affect Disord. 2014 Sep 6;170C:95-103
Authors: Perugi G, Quaranta G, Belletti S, Casalini F, Mosti N, Toni C, Dell?Osso L
BACKGROUND: Patients with bipolar disorder (BD) suffer from greater physical morbidity and mortality than the general population. The aim of the present study is to explore the prevalence and clinical correlates of General Medical Conditions (GMC) in a large consecutive sample of patients with BD.
METHOD: The study sample comprised of 347 patients who met DSM-IV-TR criteria for BD I (n=207, 59.7%), BD II or Cyclothymic Disorder (n=140, 40.3). Diagnostic information was collected by means of the Structured Clinical Interview for DSM-IV Axis I Disorders- Clinical Version (SCID-I), and information about personal and family history were collected by the Semi-Structured Interview for Mood Disorder-Revised (SIMD-R). Standardized procedure was used to assess the diagnosis of GMC, which was considered present only if a specific therapy to treat the condition was prescribed by a specialist or a general practitioner. In order to explore possible relationships between physical comorbidity and clinical features of BD, we compared patients with (MD) and without (No-MD) Metabolic Diseases (MD) and patients with (AAD) and without (No-AAD) Autoimmune-Allergic Diseases (AAD).
RESULTS: The most commonly reported GMCs were: Headache, Hypercholesterolemia (>200mg/dl), Chronic Constipation, Obesity, Arterial Hypertension (BP >140/90mmHg), Hypothyroidism, Allergic Rhino-Conjunctivitis, Irritable Bowel Syndrome, Hypertriglyceridemia (>150mg/dl), Metabolic Syndrome, Hiatus Hernia, Dysmenorrhea, Urticaria, Atopic Dermatitis, Psoriasis, Seborrheic Dermatitis, Diabetes Mellitus, Bronchial Asthma, Cardiac Arrhythmias, Biliary Lithiasis, and COPD. In our sample, MD (n=148, 42.7%) and AAD (n=167, 48.1%) were the most common categories of GMCs. Interestingly, the lifetime prevalence of cancer and neoplastic diseases was very low: 1 patient (.3%) reported Lung Adenocarcinoma and 2 (.6%) patients Bowel Cancer. In the group comparisons, length of pharmacological treatment (OR=1.054; 95% CI=1.030-1.078), age at onset of first major episode (OR=1.043; 95% CI=1.019-1.067), length of the current episode (OR=1.025; 95% CI=1.020-1.533) and absence of lifetime comorbid substance abuse (OR=.373; 95% CI=.141-.989) were statistically associated with the presence of comorbid MD; while only AD-induced hypomania (OR=1.62; 95% CI=1.011-2.597), and cyclothymic temperament (OR=1.051; 95% CI=1.016-1.087) were statistically associated with the presence of comorbid AAD.
LIMITATIONS: Possible referral and selection bias; retrospective, non-blind, cross-sectional evaluation.
CONCLUSION: MD and AAD were highly represented in our sample, while cancer and neoplastic diseases were uncommon. The clinical correlates of different sub-groups of GMC suggest different interpretations. The presence of MD seems to be correlated with the progression of BD and the chronic medication exposure, while comorbid AAD seems to correlate with a specific clinical subtype of BD, characterized by mood reactivity and temperamental mood instability. If the link with autoimmune-allergic diathesis will be confirmed, it could provide an interesting new paradigm for the study of the "systemic" nature of mood disorders and a promising target for future treatment options.
PMID: 25237732 [PubMed - as supplied by publisher]
Different impulsivity profiles in borderline personality disorder and bipolar II disorder.
J Affect Disord. 2014 Aug 29;170C:104-111
Authors: Bøen E, Hummelen B, Elvsåshagen T, Boye B, Andersson S, Karterud S, Malt UF
INTRODUCTION: Borderline personality disorder (BPD) and bipolar II disorder (BP II) share clinical characteristics including impulsivity. Their relationship is disputed. In this study, we investigated self-reported impulsivity in these patient groups and in a healthy control group. Effects of current mood state and of traumatic childhood experiences were explored.
METHODS: Twenty-five patients with BPD without comorbid bipolar disorder; 20 patients with BP II without comorbid BPD; and 44 healthy control subjects completed the UPPS questionnaire which yields assessments of four components of impulsivity: Urgency, Lack of Premeditation, Lack of Perseverance, and Sensation Seeking. Current mood state was rated using the Montgomery Asberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS). Traumatic childhood experiences were assessed using the Childhood Trauma Questionnaire (CTQ). Group differences in UPPS levels; and effects of mood state and CTQ score on UPPS scores in patients were investigated.
RESULTS: BPD patients showed significantly higher levels of Urgency and Lack of Perseverance than BP II patients and controls, and a significantly higher level of Lack of Premeditation than controls. BP II patients showed higher levels of Urgency and Lack of Perseverance than controls. In BP II, higher MADRS scores were associated with higher impulsivity scores. Also, higher CTQ scores were associated with higher Urgency scores in BP II.
LIMITATIONS: Relatively small sample size; cross-sectional assessment of influence of mood state.
CONCLUSIONS: BPD patients exhibited markedly elevated UPPS impulsivity scores compared with healthy controls and BP II patients, and the elevations were not related to current mood state. BP II patients showed moderately elevated impulsivity scores which were associated with a depressed mood state and to some extent with a history of childhood trauma. The findings suggest that BPD and BP II have different impulsivity profiles.
PMID: 25237733 [PubMed - as supplied by publisher]
Optimizing delivery of recovery-oriented online self-management strategies for bipolar disorder: a review.
Bipolar Disord. 2014 Sep 19;
Authors: Leitan ND, Michalak EE, Berk L, Berk M, Murray G
OBJECTIVES: Self-management is emerging as a viable alternative to difficult-to-access psychosocial treatments for bipolar disorder (BD), and has particular relevance to recovery-related goals around empowerment and personal meaning. This review examines data and theory on BD self-management from a recovery-oriented perspective, with a particular focus on optimizing low-intensity delivery of self-management tools via the web.
METHODS: A critical evaluation of various literatures was undertaken. Literatures on recovery, online platforms, and self-management in mental health and BD are reviewed.
RESULTS: The literature suggests that the self-management approach aligns with the recovery framework. However, studies have identified a number of potential barriers to the utilization of self-management programs for BD and it has been suggested that utilizing an online environment may be an effective way to surmount many of these barriers.
CONCLUSIONS: Online self-management programs for BD are rapidly developing, and in parallel the recovery perspective is becoming the dominant paradigm for mental health services worldwide, so research is urgently required to assess the efficacy and safety of optimization methods such as professional and/or peer support, tailoring and the development of 'online communities'.
PMID: 25238632 [PubMed - as supplied by publisher]
[Therapeutic management of bipolar disorder in France and Europe: A multinational longitudinal study (WAVE-bd).]
Encephale. 2014 Sep 16;
Authors: Bellivier F, Delavest M, Coulomb S, Figueira ML, Langosch JM, Souery D, Vieta E
BACKGROUND: Bipolar disorder is a complex disease which requires multiple healthcare resources and complex medical care programs including pharmacological and non pharmacological treatment. If mood stabilizers remain the corner stone for bipolar disorder treatment, the development of atypical antipsychotics and their use as mood stabilizers has significantly modified therapeutic care. At the present time, psychiatrists have a large variety of psychotropic drugs for bipolar disorder: mood stabilizers, atypical antipsychotics, antidepressants, anxiolytics? However, despite the publication of guidelines on pharmacological treatment, with a high degree of consensus, everyday clinical practices remain heterogeneous. Moreover, there are few longitudinal studies to describe therapeutic management of bipolar disorder, whatever the phase of the disease is. Indeed, most of the studies are carried out on a specific phase of the disease or treatment. And there is no study comparing French and European practices.
OBJECTIVES: In this paper, we aim to present the comparison of the management of pharmacological treatments of bipolar disorder between France and Europe, using the data of the observational Wide AmbispectiVE study of the clinical management and burden of bipolar disorder (WAVE-bd study).
METHODS: The WAVE-bd study is a multinational, multicentre and non-interventional cohort study of patients diagnosed with BD type I or type II, according to DSM IV-TR criteria, in any phase of the disorder, who have experienced at least one mood event during the 12 months before enrolment. In total, 2507 patients have been included across 8 countries of Europe (480 in France). Data collection was retrospective (from 3 to 12 months), but also prospective (from 9 to 15 months) for a total study length of 12 to 27 months. Main outcome measures were the healthcare resource use and pharmacological treatments.
RESULTS: Our results show differences in the therapeutic management of bipolar disorder between France and other European countries. Regarding healthcare resource use, our results show that French patients consult more frequently a psychiatrist or a psychologist and less frequently a general practitioner or the emergency ward in comparison with patients from other European countries. In the whole European population, including France, atypical antipsychotics are widely used. Only 25% of the patients receive lithium and more than 50% of the patients receive antidepressants, while their use in bipolar disorder remains controversial. Most of the patients receive polymedication. Considering all phases of the disease pooled, less lithium and less atypical antipsychotics are prescribed to French patients, whereas they receive more antidepressants and more benzodiazepines than patients from other European countries. On the over hand, prescription of anticonvulsants and electroconvulsive therapy are equal. Moreover, data analyses by polarity of the episodes globally confirm these trends. There are a few exceptions: mixed states, in which lithium is twice more prescribed in France in comparison to other countries; depressive states, in which antidepressants are even more prescribed in other countries than in France; and less prescription of anticonvulsants in manic, mixed and euthymic phases in France.
CONCLUSION: The WAVE-bd study is the first observational study conducted on a large sample of bipolar I and II patients that compares therapeutic management between France and other European countries. The differences observed in therapeutic care across the different phases of the disease show that treatments differ depending on the countries studied, but also according to the preventive or curative phases, polarity of the bipolar disorder, comorbidities, impact of guidelines, and care organization. Although French patients have been treated by less lithium and less atypical antipsychotics than other European patients, they receive more antidepressants and more benzodiazepines. Finally, patients generally receive polymedication and the diversity in prescriptions shows how bipolar disorder is a complex disorder.
PMID: 25238903 [PubMed - as supplied by publisher]
[Bipolar disorder and quality of life: A cross-sectional study including 104 Tunisian patients.]
Encephale. 2014 Sep 17;
Authors: Marrag I, Hajji K, Hadj Ammar M, Zarrouk L, Kachouri R, Nasr M
INTRODUCTION: Bipolar disorder affects many psychosocial and functional aspects, leading to a real social handicap and an alteration in quality of life.
AIM OF THE STUDY: To evaluate bipolar patients' quality of life and to identify the risk factors responsible for a deterioration.
DESIGN: Our cross-sectional study lasted for four months and included 104 bipolar patients treated at the psychiatry consultation of the university hospital in Mahdia. The data were collected through a questionnaire composed of 52 items exploring the general characteristics of subjects, the clinical and evolutional characteristics of bipolar disorder and providing information on the treatment. Quality of life was measured using the SF-36 (Short form) generic scale. A global average score was calculated and it was considered that quality of life was altered if the score was less than 66.7, according to the threshold value of Léan. Moreover, an average score was calculated for each dimension, thus permitting us to identify those most affected. We standardized initial average scores.
RESULTS: The assessment of quality of life revealed a global average of 52.2 and an alteration in 78.8% of patients. The study of the dimensional average scores revealed that all dimensions were affected. The standardization also revealed deterioration in all dimensions, the mental component being particularly more affected than the physical component with respectively estimated scores of 31.7 and 40.5. The analytic approach concerned the relationship between qualitative and quantitative variables and the occurrence of an alteration in quality of life. For this effect, a bivariate study displayed a statistically significant correlation between the eight dimensions of the SF-36 and 8 variables. In order to take into account the relationships that link each variable to the others, and to avoid the bias of the bivariate study, a logistic regression analysis was performed. Only 4 variables with discriminating weight emerged from this analysis. According to the number of dimensions affected, the following factors were classified in decreasing order: absence of leisure activities, lack of stable budgetary resources, absence of professional activity and the association of a psychotropic medication.
CONCLUSION: This clinimetric approach permitted us to consider the global life of each patient suffering from bipolar disorder.
PMID: 25238905 [PubMed - as supplied by publisher]
Limbic white matter microstructure plasticity reflects recovery from depression.
J Affect Disord. 2014 Aug 29;170C:143-149
Authors: Bracht T, Jones DK, Müller TJ, Wiest R, Walther S
BACKGROUND: White matter microstructure alterations of limbic and reward pathways have been reported repeatedly for depressive episodes in major depressive disorder (MDD) and bipolar disorder (BD). However, findings during remission are equivocal. It was the aim of this study to investigate if white matter microstructure changes during the time course of clinical remission.
METHODS: Fifteen depressed patients (11 MDD, 4 BD) underwent diffusion-weighted MRI both during depression, and during remission following successful antidepressive treatment (average time interval between scans=6 months). Fractional anisotropy (FA) was sampled along reconstructions of the supero-lateral medial forebrain bundle (slMFB), the cingulum bundle (CB), the uncinate fasciculus (UF), the parahippocampal cingulum (PHC) and the fornix. Repeated measures ANCOVAs controlling for the effect of age were calculated for each tract.
RESULTS: There was a significant main effect of time (inter-scan interval) for mean-FA for the right CB and for the left PHC. For both pathways there was a significant time×age interaction. In the right CB, FA increased in younger patients, while FA decreased in older patients. In the left PHC, a reverse pattern was seen. FA changes in the right CB correlated positively with symptom reductions. Mean-FA of UF, slMFB and fornix did not change between the two time points.
LIMITATIONS: All patients were medicated, sample size, and lack of control group.
CONCLUSIONS: Right CB and left PHC undergo age-dependent plastic changes during the course of remission and may serve as a state marker in depression. UF, slMFB and FO microstructure remains stable.
PMID: 25240841 [PubMed - as supplied by publisher]
Cyclothymic temperament rather than polarity is associated with hopelessness and suicidality in hospitalized patients with mood disorders.
J Affect Disord. 2014 Sep 6;170C:161-165
Authors: Innamorati M, Rihmer Z, Akiskal H, Gonda X, Erbuto D, Murri MB, Perugi G, Amore M, Girardi P, Pompili M
BACKGROUND: The aim of the present study was to assess sociodemographic and clinical differences between inpatients with major mood disorders (bipolar disorder - BD - and major depression - MDD) and the cyclothymic phenotype (CYC), and pure BDs or MDDs.
METHODS: Participants were 281 adult inpatients (134 men and 147 women) consecutively admitted to the Department of Psychiatry of the Sant?Andrea University Hospital in Rome, Italy, between January 2008 and June 2010. The patients completed the Hamilton Scale for Depression (HAMD17), the Young Mania Rating Scale, the TEMPS-A (Temperament Evaluation of the Memphis, Pisa, Paris and San Diego-Autoquestionnaire), and the Beck Hopelessness Scale.
RESULTS: 38.7% of the MDD patients and 48.3% of the BD patients satisfied criteria to be included in the cyclothymic groups. Above 92% of the patients with the cyclothymic phenotype reported suicidal ideation at the item #3 of the HAMD17. Furthermore, patients with the cyclothymic phenotype reported higher hopelessness than other patients.
LIMITATIONS: Our results are potentially limited by the small number of MDD-CYC patients included in the sample.
CONCLUSIONS: Our results support the clinical usefulness of the concept of soft bipolar spectrum. Patients with the cyclothymic phenotype differ from pure MDD patients and BD patients for temperamental profile and clinical variables.
PMID: 25240844 [PubMed - as supplied by publisher]
The prevalence and effect of life events in 222 bipolar I and II patients: A prospective, naturalistic 4 year follow-up study.
J Affect Disord. 2014 Sep 6;170C:166-171
Authors: Simhandl C, Radua J, König B, Amann BL
BACKGROUND: Life events may very well increase the likelihood of affective episodes in bipolar disorder, but prospective data on survival are inconsistent.
METHODS: The authors examined the prevalence of negative and goal-attainment life events within 6 months prior to the index episode and after the index episode and their impact on the risk of relapse. Two hundred twenty-two consecutively admitted ICD-10 bipolar I (n=126) and II (n=96) patients were followed-up naturalistically over a period of 4 years.
RESULTS: One-hundred thirty-eight (62.2%) of the patients had at least one life event 6 month before the index episode. Seventy patients (31.5%) experienced one, 48 (21.6%) two, and 20 (9.0%) three (or more) life events. Regarding life events after the index episode, 110 (49.5%) patients had at least one life event. Fifty-four patients (24.3%) experienced one, 31 (14.0%) two, and 25 (11.3%) three (or more) life events. The number of life events was larger in patients with bipolar II disorder than in patients with bipolar I disorder (p=0.004). Using a Cox regression analysis, the risk of a depressive relapse in bipolar I patients was associated with the number of life events after the index episode (p=0.002). This was independent of the quality of the life event.
LIMITATIONS: Standardized life event scales, defined dosages of drugs or blood sampling during all visits were not performed.
CONCLUSIONS: Our data suggest a high and continuous number of life events prior to affective episodes. Life events after the index episode worsened the course of bipolar I patients with more depressive episodes. This underlines the importance of detection and treatment of emerging life events.
PMID: 25240845 [PubMed - as supplied by publisher]
A primate-specific functional GTTT-repeat in the core promoter of CYTH4 is linked to bipolar disorder in human.
Prog Neuropsychopharmacol Biol Psychiatry. 2014 Sep 17;
Authors: Rezazadeh M, Gharesouran J, Mirabzadeh A, Khorram Khorshid HR, Biglarian A, Ohadi M
Evidence of primate-specific genes and gene regulatory mechanisms linked to bipolar disorder (BD) lend support to evolutionary/adaptive processes in the pathogenesis of this disorder. Following a genome-scale analysis of the entire protein coding genes annotated in the GeneCards database, we have recently reported that cytohesin-4 (CYTH4) contains the longest tetra-nucleotide short tandem repeat (STR) identified in a human protein-coding gene core promoter, which may be of adaptive advantage to this species. In the current study, we analyzed the evolutionary trend of this STR across evolution. We also analyzed the functional implication and distribution of this STR in a group of patients with type 1 BD (n=233) and controls (n=262). We found that this STR is exceptionally expanded in primates (Fisher exact p<0.00003). Association was observed between type I BD and the 6-repeat allele of this STR, (GTTT)6 (Yates corrected ?(2)=12.68, p<0.0001, OR: 1.68). This allele is the shortest length of the GTTT-repeat identified in the human subjects studied. Consistent with that finding, excess homozygosity was observed for the shorter alleles, (GTTT)6 and (GTTT)7, vs. the longer alleles, (GTTT)8 and (GTTT)9 in the BD group (Yates corrected ?(2)=5.18, p<0.01, 1 df, OR: 1.96). Using Dual Glo luciferase system in HEK-293 cells, a trend for gene expression repression was observed from the 6- to the 9-repeat allele (p<0.003), and the GTTT-repeat significantly down-regulated gene expression, per se (p<0.0006). This is the first evidence of a link between a primate-specific STR and a major psychiatric disorder in human. It may be speculated that the CYTH4 GTTT-repeat in primates may have conferred selective advantage to this order, reflected in neural function and neurophenotypes. The role of the CYTH4 gene in the pathogenesis of type I BD remains to be clarified in the future studies.
PMID: 25240857 [PubMed - as supplied by publisher]
IgG dynamics of dietary antigens point to cerebrospinal fluid barrier or flow dysfunction in first-episode schizophrenia.
Brain Behav Immun. 2014 Sep 17;
Authors: Severance EG, Gressitt KL, Alaedini A, Rohleder C, Enning F, Bumb JM, Müller JK, Schwarz E, Yolken RH, Leweke FM
Schizophrenia is a complex brain disorder that may be accompanied by idiopathic inflammation. Classic central nervous system (CNS) inflammatory disorders such as viral encephalitis or multiple sclerosis can be characterized by incongruent serum and cerebrospinal fluid (CSF) IgG due in part to localized intrathecal synthesis of antibodies. The dietary antigens, wheat gluten and bovine milk casein, can induce a humoral immune response in susceptible individuals with schizophrenia, but the correlation between the food-derived serological and intrathecal IgG response is not known. Here, we measured IgG to wheat gluten and bovine milk casein in matched serum and CSF samples from 105 individuals with first-episode schizophrenia (n=75 antipsychotic-naïve), and 61 controls. We found striking correlations in the levels of IgG response to dietary proteins between serum and CSF of schizophrenia patients, but not controls (schizophrenia, R(2)=0.34-0.55, p?0.0001; controls R(2)=0.05-0.06, p>0.33). A gauge of blood-CSF barrier permeability and CSF flow rate, the CSF-to-serum albumin ratio, was significantly elevated in cases compared to controls (p?0.001-0.003). Indicators of intrathecal IgG production, the CSF IgG index and the specific Antibody Index, were not significantly altered in schizophrenia compared to controls. Thus, the selective diffusion of bovine milk casein and wheat gluten antibodies between serum and CSF in schizophrenia may be the function of a low-level anatomical barrier dysfunction or altered CSF flow rate, which may be transient in nature.
PMID: 25241021 [PubMed - as supplied by publisher]
Elevated reward-related neural activation as a unique biological marker of bipolar disorder: Assessment and treatment implications.
Behav Res Ther. 2014 Sep 1;
Authors: Nusslock R, Young CB, Damme KS
Growing evidence indicates that risk for bipolar disorder is characterized by elevated activation in a fronto-striatal reward neural circuit involving the ventral striatum and orbitofrontal cortex, among other regions. It is proposed that individuals with abnormally elevated reward-related neural activation are at risk for experiencing an excessive increase in approach-related motivation during life events involving rewards or goal striving and attainment. In the extreme, this increase in motivation is reflected in hypomanic/manic symptoms. By contrast, unipolar depression (without a history of hypomania/mania) is characterized by decreased reward responsivity and decreased reward-related neural activation. Collectively, this suggests that risk for bipolar disorder and unipolar depression are characterized by distinct and opposite profiles of reward processing and reward-related neural activation. The objective of the present paper is threefold. First, we review the literature on reward processing and reward-related neural activation in bipolar disorder, and in particular risk for hypomania/mania. Second, we propose that reward-related neural activation reflects a biological marker of differential risk for bipolar disorder versus unipolar depression that may help facilitate psychiatric assessment and differential diagnosis. We also discuss, however, the challenges to using neuroscience techniques and biological markers in a clinical setting for assessment and diagnostic purposes. Lastly, we address the pharmacological and psychosocial treatment implications of research on reward-related neural activation in bipolar disorder.
PMID: 25241675 [PubMed - as supplied by publisher]
Abnormal Development of Monoaminergic Neurons is Implicated in Mood Fluctuations and Bipolar Disorder.
Neuropsychopharmacology. 2014 Sep 22;
Authors: Jukic M, Carrillo-Roa T, Bar M, Becker G, Jovanovic V, Zega K, Binder EB, Brodski C
Subtle mood fluctuations are normal emotional experiences, whereas drastic mood swings can be a manifestation of bipolar disorder. Despite their importance for normal and pathological behavior, the mechanisms underlying endogenous mood instability are largely unknown. During embryogenesis, the transcription factor Otx2 orchestrates the genetic networks directing the specification of dopaminergic and serotonergic neurons. Here, we behaviorally phenotyped mouse mutants overexpressing Otx2 in the hindbrain, resulting in an increased number of dopaminergic neurons and a decreased number of serotonergic neurons in both developing and mature animals. Over the course of one month, control animals exhibited stable locomotor activity in their home cages, whereas mutants showed extended periods of elevated or decreased activity relative to their individual average. Additional behavioral paradigms, testing for manic- and depressive-like behavior, demonstrated that mutants showed an increase in intra-individual fluctuations in locomotor activity, habituation, risk-taking behavioral parameters, social interaction, and hedonic-like behavior. Olanzapine, lithium, and carbamazepine ameliorated the behavioral alterations of the mutants, as did the mixed serotonin receptor agonist quipazine and the specific 5HT2C receptor agonist CP-809101. Testing the relevance of the genetic networks specifying monoaminergic neurons for bipolar disorder in humans, we applied an interval-based enrichment analysis tool for genome-wide association studies. We observed that the genes specifying dopaminergic and serotonergic neurons exhibit a significant level of aggregated association with bipolar disorder but not with schizophrenia or major depressive disorder. The results of our translational study suggest that aberrant development of monoaminergic neurons leads to mood fluctuations and may be associated with bipolar disorder.Neuropsychopharmacology accepted article preview online, 22 September 2014. doi:10.1038/npp.2014.244.
PMID: 25241801 [PubMed - as supplied by publisher]
Tyrosine 251 at the C-terminus of neuronal glycoprotein M6a is critical for neurite outgrowth.
J Neurosci Res. 2014 Sep 19;
Authors: Formoso K, Billi SC, Frasch AC, Scorticati C
Neuronal glycoprotein M6a is involved in neuronal plasticity, promoting neurite and filopodia outgrowth and, likely, synaptogenesis. Polymorphisms in the human M6a gene GPM6A have recently been associated with mental illnesses such as schizophrenia, bipolar disorders, and claustrophobia. Nevertheless, the molecular bases underlying these observations remain unknown. We have previously documented that, to induce filopodia formation, M6a depends on the association of membrane lipid microdomains and the activation of Src and mitogen-activated protein kinase kinases. Here, in silico analysis of the phosphorylation of tyrosine 251 (Y251) at the C-terminus of M6a showed that it could be a target of Src kinases. We examined whether phosphorylation of M6a at Y251 affects neurite and filopodia outgrowth and the targets involved in its signal propagation. This work provides evidence that the Src kinase family and the phosphatidylinositide 3-kinase (PI3K), but not Ras, participate in M6a signal cascade leading to neurite/filopodia outgrowth in hippocampal neurons and murine neuroblastoma N2a cells. Phosphorylation of M6a at Y251 is essential only for neurite outgrowth by the PI3K/AKT-mediated pathway and, moreover, rescues the inhibition caused by selective Src inhibitor and external M6a monoclonal antibody treatment. Thus, we suggest that phosphorylation of M6a at Y251 is critical for a specific stage of neuronal development and triggers redundant signaling pathways leading to neurite extension. © 2014 Wiley Periodicals, Inc.
PMID: 25242528 [PubMed - as supplied by publisher]
Are rates of pediatric bipolar disorder increasing? Results from a nationwide register study.
Int J Bipolar Disord. 2014;2(1):10
Authors: Kessing LV, Vradi E, Andersen PK
Studies from the USA suggest that rates of pediatric bipolar disorder have increased since the mid-90s, but no study outside the USA has been published on the rates of pediatric bipolar disorder. Further, it is unclear whether an increase in rates reflects a true increase in the illness or more diagnostic attention. Using nationwide registers of all inpatients and outpatients contacts to all psychiatric hospitals in Denmark, we investigated (1) gender-specific rates of incident pediatric mania/bipolar disorder during a period from 1995 to 2012, (2) whether age and other characteristics for pediatric mania/bipolar disorder changed during the calendar period (1995 to 2003 versus 2004 to 2012), and (3) whether the diagnosis is more often made at first psychiatric contact in recent time compared to earlier according to gender. Totally, 346 patients got a main diagnosis of a manic episode (F30) or bipolar affective disorder (F31) at least once during the study period from 1995 to 2012. For both sexes, annual rates of mania/bipolar disorder two to four doubled during the study period (0.001% before year 2004 to 0.002%-0.004% in 2010). Median age at the index diagnosis was very similar during the two calendar periods (17.2, quartiles, 16.2-18.3 versus 17.4, quartiles, 16.1-18.2) indicating that the diagnosis of mania/bipolar disorder was not made earlier in the recent calendar period. Similarly, there were no differences between early versus late in the study period in the fractions of first contact diagnosis of mania/bipolar disorder diagnoses, the contact number at which patients got the diagnosis or the duration from first psychiatric contact to the diagnosis of mania/bipolar disorder. The rate of diagnosis of mania/bipolar disorder increased from 1995 to 2014, which did not seem to be explained by more diagnostic attention.
PMID: 25243107 [PubMed - as supplied by publisher]
Correlation between DNA methylation and gene expression in the brains of patients with bipolar disorder and schizophrenia.
Bipolar Disord. 2014 Sep 22;
Authors: Chen C, Zhang C, Cheng L, Reilly JL, Bishop JR, Sweeney JA, Chen HY, Gershon ES, Liu C
OBJECTIVES: Aberrant DNA methylation and gene expression have been reported in postmortem brain tissues of psychotic patients, but until now there has been no systematic evaluation of synergistic changes in methylation and expression on a genome-wide scale in brain tissue.
METHODS: In this study, genome-wide methylation and expression analyses were performed on cerebellum samples from 39 patients with schizophrenia, 36 patients with bipolar disorder, and 43 unaffected controls, to screen for a correlation between gene expression and CpG methylation.
RESULTS: Out of 71,753 CpG gene pairs (CGPs) tested across the genome, 204 were found to significantly correlate with gene expression after correction for multiple testing [p < 0.05, false discovery rate (FDR) q < 0.05]. The correlated CGPs were tested for disease-associated expression and methylation by comparing psychotic patients with bipolar disorder and schizophrenia to healthy controls. Four of the identified CGPs were found to significantly correlate with the differential expression and methylation of genes encoding phosphoinositide-3-kinase, regulatory subunit 1 (PIK3R1), butyrophilin, subfamily 3, member A3 (BTN3A3), nescient helix-loop-helix 1 (NHLH1), and solute carrier family 16, member 7 (SLC16A7) in psychotic patients (p < 0.05, FDR q < 0.2). Additional expression and methylation datasets were used to validate the relationship between DNA methylation, gene expression, and neuropsychiatric diseases.
CONCLUSIONS: These results suggest that the identified differentially expressed genes with an aberrant methylation pattern may represent novel candidate factors in the etiology and pathology of neuropsychiatric disorders.
PMID: 25243493 [PubMed - as supplied by publisher]
Resilience and impulsivity in euthymic patients with bipolar disorder.
J Affect Disord. 2014 Sep 6;170C:172-177
Authors: Choi JW, Cha B, Jang J, Park CS, Kim BJ, Lee CS, Lee SJ
BACKGROUND: Stress plays an important role in the onset and recurrence of bipolar disorder (BD). Resilience is the ability to cope with stress or adversity. Few studies have examined resilience in BD, and this study aimed to investigate the clinical correlates of resilience in euthymic patients with BD.
METHODS: A total of 62 outpatients with BD type I, II, and not otherwise specified (NOS) who were in remission and 62 healthy individuals matched with the BD group in terms of age and sex were recruited. All participants completed the Connor-Davidson Resilience Scale and Barratt Impulsiveness Scale. A psychiatrist interviewed the subjects to assess clinical characteristics. Multiple linear regression analysis was used to determine factors associated with resilience.
RESULTS: The BD group had significantly higher levels of impulsivity and lower levels of resilience compared with the control group. Degree of impulsivity, number of depressive episodes, Clinical Global Impression (CGI) scores, and length of education were significantly correlated with resilience. Attention impulsivity, non-planning impulsivity, and number of depressive episodes were associated with low levels of resilience, even when age, sex, length of education, and CGI scores were controlled.
LIMITATIONS: Because tertiary hospital patients were recruited, the generalizability of the findings is limited.
CONCLUSIONS: This study shows that low levels of resilience are related to high levels of impulsivity and to an increased number of depressive episodes in euthymic patients with BD. Given the reciprocal relationship between resilience and impulsivity, efforts to enhance resilience and reduce impulsivity may make important contributions to the treatment of patients with BD.
PMID: 25243746 [PubMed - as supplied by publisher]
Validation of the Chinese Version of the Short TEMPS-A and its application in patients with mood disorders.
J Affect Disord. 2014 Sep 3;170C:178-184
Authors: Yuan C, Huang J, Gao K, Wu Z, Chen J, Wang Y, Hong W, Yi Z, Hu Y, Cao L, Li Z, Akiskal KK, Akiskal HS, Wang B, Fang Y
BACKGROUND: The short version of Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego-Auto-questionnaire (TEMPS-A) is a useful instrument to measure affective temperaments. Aims of the present study are to validate the Chinese Version of the Short TEMPS-A, and to explore whether it could be useful to distinguish patients with mood disorders from healthy controls or differentiate patients with bipolar disorder (BPD) from those with major depressive disorder (MDD) in Chinese population.
METHODS: A sample of 715 participants, including 387 patients with MDD, 143 with BPD and 185 healthy controls, was recruited. All participants completed The Chinese Version of the Short TEMPS-A. Standard psychometric tests of reliability and validation were performed. ANOVA, non-parameter test and Multiple Logistic Regression were used to test the association between TEMPS-A scores and mood disorders.
RESULTS: The originally proposed five factors of the Chinese Version of the Short TEMPS-A were upheld. The Chronbach-Alpha coefficients of it varied from 0.70 to 0.89 and test-retest Spearman?s Correlation Coefficients varied from 0.52 to 0.85. Significant differences were found across the three groups on all five TEMPS-A subscales (P<0.001). Multiple Logistic Regression showed that hyperthymic temperament distinguished patients with BPD from those with MDD (OR 1.28, 95% CI 1.14-1.45, P<0.001) after controlling for age, gender and the severity of depression.
LIMITATIONS: The cross-sectional self-report design, unbalanced demographic characteristics and undifferentiated subtypes of bipolar disorders might limit the generalizability of the results.
CONCLUSION: The Chinese Version of the Short TEMPS-A shows good reliability and validity. It might be used as a screening tool in the general population to identify the vulnerability for developing a mood disorder and the potential risk for bipolar disorder among those who only have depressive symptoms.
PMID: 25243747 [PubMed - as supplied by publisher]
Recent negative life events increase hair cortisol concentrations in patients with bipolar disorder.
Stress. 2014 Sep 22;:1-27
Authors: Staufenbiel SM, Koenders MA, Giltay EJ, Elzinga BM, Manenschijn L, Hoencamp E, van Rossum EF, Spijker AT
Abstract Life events induce stress, which is considered to negatively impact the course of disease in patients with bipolar disorder (BD), its effects being predominantly mediated by cortisol. Cortisol in scalp hair has been identified as a biomarker for assessing long-term cortisol levels, and allows clarifying the relation between life events, hair cortisol concentrations (HCC), and clinical course over time. In 71 BD patients, we analyzed the proximal 3 cm of hair, reflecting 3 months of cortisol production, and investigated the association between HCC, the number of life events, the amount of social support, and mood in the 3 months prior to the hair assessment and between HCC and mood in the subsequent 3 months. Although the total number of life events was not associated with HCC (p > 0.05), the number of negative life events was associated with increased HCC (r(2) = 0.04, p = 0.02). Social support showed an inverse association with HCC in patients reporting negative life events (r(2) = 0.07, p = 0.03). HCC and mood were not associated in the 3 months prior to hair sampling or in the subsequent 3 months. This study indicates that patients who experienced recent negative life events have increased hair cortisol levels, which seem to be attenuated by social support.
PMID: 25243794 [PubMed - as supplied by publisher]
Severe mental illness and induction of labour: outcomes for women at a specialist antenatal clinic in Western Australia.
Aust N Z J Obstet Gynaecol. 2014 Apr;54(2):132-7
Authors: Frayne J, Lewis L, Allen S, Hauck Y, Nguyen T
BACKGROUND: Limited evidence is available around induction of labour (IOL) and obstetric outcomes for pregnant women with severe mental illness (SMI).
AIMS: Our study examined obstetric and neonatal outcomes for women attending a specialist childbirth and mental illness (CAMI) antenatal clinic in Perth, Western Australia (WA), who experienced or did not experience IOL.
METHODS: A retrospective study was conducted between December 2007 and May 2012 (n = 222), using patient records and computerised perinatal data collected by the Obstetrics and Gynaecology Clinical Care Unit. Descriptive statistics and univariate comparisons using Mann-Whitney tests and X(2) tests were conducted using SPSS.
RESULTS: The overall rate of IOL in this study group was 40%, which was significantly higher than the WA Mother Baby Statistics by 11.6% (95% CI 4.9-18.3%, P < 0.002). Of those induced, 30% (27 of 185) were induced for psychiatric reasons. Women with schizophrenia were more likely to have IOL for an obstetric/fetal reason than a psychiatric reason (45% vs. 15%, P = 0.051). Women who experienced an IOL were less likely to have a spontaneous vaginal delivery (SVD) and more likely to have an assisted vaginal birth or emergency caesarean section (P = 0.040). Irrespective of labour onset, special care nursery admission (SCN) rates were similar and high for both groups (36% vs. 32%, P = 0.599).
CONCLUSION: Obstetric management for women with SMI is complex, and psychiatric factors as well as medical factors must be considered to ensure the best outcomes for mother and infant.
PMID: 24172035 [PubMed - indexed for MEDLINE]
Risk factors for suicide in schizophrenia: systematic review and clinical recommendations.
Acta Psychiatr Scand. 2014 Sep 18;
Authors: Popovic D, Benabarre A, Crespo JM, Goikolea JM, González-Pinto A, Gutiérrez-Rojas L, Montes JM, Vieta E
OBJECTIVE: To identify risk factors associated with suicide of patients with schizophrenia and provide clinical recommendations, which integrate research findings into a consensus based on clinical experience and evidence.
METHOD: A task force formed of experts and clinicians iteratively developed consensus through serial revisions using the Delphi method. Initial survey items were based on systematic literature review published up to June 2013.
RESULTS: Various risk factors were reported to be implicated in suicide in schizophrenia. Our findings indicate that suicide risk in schizophrenia is mainly related to affective symptoms, history of a suicide attempt and number of psychiatric admissions. Other risk factors identified are given by younger age, closeness to illness onset, older age at illness onset, male sex, substance abuse and period during or following psychiatric discharge. Integrating the evidence and the experience of the task force members, a consensus was reached on 14 clinical recommendations.
CONCLUSION: Identification of risk factors for suicide in individuals diagnosed with schizophrenia is imperative to improve clinical management and develop strategies to reduce the incidence of suicide in this population. This study provides the critical overview of available data and clinical recommendations on recognition and management of the above-mentioned risk factors.
PMID: 25230813 [PubMed - as supplied by publisher]
The -116C/G polymorphism in XBP1 gene is associated with psychiatric illness in Asian population: A meta-analysis.
Am J Med Genet B Neuropsychiatr Genet. 2014 Sep 17;
Authors: Cheng D, Zhang K, Zhen G, Xue Z
X-box binding protein 1 (XBP1) is a pivotal transcription factor and plays an important role in the pathogenesis of psychiatric illness. The association between XBP1 -116C/G polymorphism and risk of psychiatric illness has been investigated in different populations. However, the results of these studies remain conflicting. Therefore, we performed a systematic meta-analysis to evaluate the association between XBP1 -116C/G polymorphism and the overall psychiatric illness risk. Pubmed, Embase, and Chinese Biomedical Literature Database (CBM) were searched for case-control studies on the association between XBP1 -116C/G polymorphism and psychiatric illness risk published up to July 31, 2014. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to access the strength of this association. Fourteen case-control studies including 3,512 cases and 4,889 controls were included. Overall, no significant association was found between XBP1 -116C/G polymorphism and the risk of psychiatric illness (C/G vs. C/C: OR?=?1.04, 95%CI?=?0.92-1.17, P?=?0.54). However, there was a significant association between this polymorphism and the psychiatric illness in Asian population (C/G vs. C/C: OR?=?1.27, 95%CI?=?1.00-1.61, P?=?0.05; G/G?+?C/G vs. C/C: OR?=?1.32, 95%CI?=?1.05-1.65, P?=?0.02). Furthermore, we found a significant association between XBP1 -116C/G polymorphism and the risk of bipolar disorder in Asian population (C/G vs. C/C: OR?=?1.81, 95%CI?=?1.15-2.86, P?=?0.01). The XBP1 -116C/G polymorphism is associated with an increased risk of bipolar disorder in Asian population. © 2014 Wiley Periodicals, Inc.
PMID: 25231123 [PubMed - as supplied by publisher]
Significance of borderline personality-spectrum symptoms among adolescents with bipolar disorder.
J Affect Disord. 2014 Sep 3;170C:39-45
Authors: Fonseka TM, Swampillai B, Timmins V, Scavone A, Mitchell R, Collinger KA, Goldstein BI
BACKGROUND: Little is known regarding correlates of borderline personality-spectrum symptoms (BPSS) among adolescents with bipolar disorder (BP).
METHODS: Participants were 90 adolescents, 13-19 years of age, who fulfilled DSM-IV-TR criteria for BP using semi-structured diagnostic interviews. BPSS status was ascertained using the Life Problems Inventory which assessed identity confusion, interpersonal problems, impulsivity, and emotional lability. Analyses compared adolescents with "high" versus "low" BPSS based on a median split.
RESULTS: Participants with high, relative to low, BPSS were younger, and had greater current and past depressive episode severity, greater current hypo/manic episode severity, younger age of depression onset, and reduced global functioning. High BPSS participants were more likely to have BP-II, and had higher rates of social phobia, generalized anxiety disorder, conduct disorder, oppositional defiant disorder, homicidal ideation, assault of others, non-suicidal self-injury, suicidal ideation, and physical abuse. Despite greater illness burden, high BPSS participants reported lower rates of lithium use. The most robust independent predictors of high BPSS, identified in multivariate analyses, included lifetime social phobia, non-suicidal self-injury, reduced global functioning, and conduct and/or oppositional defiant disorder.
LIMITATIONS: The study design is cross-sectional and cannot determine causality.
CONCLUSIONS: High BPSS were associated with greater mood symptom burden and functional impairment. Presence of high BPSS among BP adolescents may suggest the need to modify clinical monitoring and treatment practices. Future prospective studies are needed to examine the direction of observed associations, the effect of treatment on BPSS, and the effect of BPSS as a moderator or predictor of treatment response.
PMID: 25233237 [PubMed - as supplied by publisher]
Mania risk and creativity: A multi-method study of the role of motivation.
J Affect Disord. 2014 Sep 3;170C:52-58
Authors: Ruiter M, Johnson SL
BACKGROUND: Substantial literature has linked bipolar disorder and risk for bipolar disorder with creative accomplishment, but few multimodal studies of creativity are available, and little is known about mechanisms.
METHODS: We use a multi-method approach to test the association of bipolar risk with several creativity measures, including creative accomplishments, creative personality traits, and a laboratory index of insight. We also examined whether multiple facets of motivation accounted for the links of bipolar risk with creativity. Among 297 undergraduates, mania risk, as measured with the Hypomanic Personality Scale was related to lifetime creativity and creative personality, but not to performance on the insight task. Motivational traits appeared to mediate the links of mania risk with both lifetime creative accomplishments and self-rated creativity.
LIMITATIONS: The study relied on a cross-sectional design and a convenience sample.
CONCLUSIONS: Future studies would benefit from exploring motivation as a positive aspect of manic vulnerability that may foster greater creativity.
PMID: 25233239 [PubMed - as supplied by publisher]