Seroreactive marker for inflammatory bowel disease and associations with antibodies to dietary proteins in bipolar disorder.
Bipolar Disord. 2013 Dec 6;
Authors: Severance EG, Gressitt KL, Yang S, Stallings CR, Origoni AE, Vaughan C, Khushalani S, Alaedini A, Dickerson FB, Yolken RH
OBJECTIVES: Immune sensitivity to wheat glutens and bovine milk caseins may affect a subset of individuals with bipolar disorder. Digested byproducts of these foods are exorphins that have the potential to impact brain physiology through action at opioid receptors. Inflammation in the gastrointestinal (GI) tract might accelerate exposure of food antigens to systemic circulation and help explain elevated gluten and casein antibody levels in individuals with bipolar disorder.
METHODS: We measured a marker of GI inflammation, anti-Saccharomyces cerevisiae antibodies (ASCA), in non-psychiatric controls (n = 207), in patients with bipolar disorder without a recent onset of psychosis (n = 226), and in patients with bipolar disorder with a recent onset of psychosis (n = 38). We compared ASCA levels to antibodies against gluten, casein, Epstein-Barr virus (EBV), herpes simplex virus 1 (HSV-1), influenza A, influenza B, measles, and Toxoplasma gondii.
RESULTS: Elevated ASCA conferred a 3.5-4.4-fold increased odds ratio of disease association (age-, race-, and gender-corrected multinomial logistic regressions, p ? 0.00001) that was independent of type of medication received. ASCA correlated with food antibodies in both bipolar disorder groups (R(2) = 0.29-0.59, p ? 0.0005), and with measles and T. gondii immunoglobulin G (IgG) in the recent onset psychosis bipolar disorder group (R(2) = 0.31-0.36, p ? 0.004-0.01).
CONCLUSIONS: Elevated seropositivity of a GI-related marker and its association with antibodies to food-derived proteins and self-reported GI symptoms suggest a GI comorbidity in at least a subgroup of individuals with bipolar disorder. Marker seroreactivity may also represent part of an overall heightened activated immune state inherent to this mood disorder.
PMID: 24313887 [PubMed - as supplied by publisher]
A follow-up on patients with severe mental disorders in Sardinia after two changes in regional policies: poor resources still correlate with poor outcomes.
BMC Psychiatry. 2013 Dec 6;13(1):333
Authors: Carta MG, Angermeyer MC, Sancassiani F, Tuligi F, Pirastu R, Pisano A, Pintus E, Mellino G, Pintus M, Pisanu E, Moro MF, Massidda D, Trincas G, Bhugra D
BACKGROUND: This survey followed a cohort of patients with chronic psychosis recruited from five catchment areas (DSMs) of the Sardinian community mental health services. The objective was to examine whether the amount of resources in the different sites may be a determinant of the outcomes.
METHODS: Naturalistic follow-up study on 309 consecutive users with diagnosis of schizophrenic disorder, schizoaffective disorder, bipolar affective disorder with psychotic symptoms (DSM-IV TR) of five Sardinian community mental health services. Mental state and clinical symptoms along with functioning were assessed using semi-structured clinical interviews (ANTAS), Clinical Global Impression Severity Scale (CGI-S), Global Assessment of Functioning Scale (GAF) and Health of the Nation Outcome Scales (HONOS). Assessments were conducted at the beginning of the study and after one year.
RESULTS: The proportion of professionals working in all DSMs participating in the study was found lower than the national Italian standard (0.7 vs 1.0 per 1,500 inhabitants). Follow-up revealed significant differences between DSMs in the improvement of the Honos scores (F = 5.932, p = 0.000). These differences correlate with the improvement of resources in terms of number of professionals during, and one year prior, to the trial.
CONCLUSIONS: The study shows that mental health services provided in the public sector in Sardinia are still very resource-poor, at least in terms of human resources. Our findings suggest that mental health service resources influence outcomes as regards the social functioning of users. We urge policy makers to take these observations into account when planning future services.
PMID: 24313930 [PubMed - as supplied by publisher]
Explanations for violent behaviour-An interview study among forensic in-patients.
Int J Law Psychiatry. 2013 Dec 3;
Authors: Radovic S, Höglund P
The alleged relation between mental disorder and violent criminal behaviour has been investigated mainly from an epidemiological perspective. Population-based registry studies have shown that violence occurs more frequently among people with mental disorders, like schizophrenia and bipolar disorder, compared with control subjects, but that the increased risk is largely mediated by drug abuse and socio-economic deprivation. The aim of this study was to explore how patients who have committed violent or sexual crimes and have been sentenced to forensic psychiatric care by a Swedish court of law construed their criminal actions in terms of causes. Forty-six participants from six different Swedish forensic psychiatric clinics were included in the study. A semi-structured interview study was conducted and the data was analysed using a thematic analysis. A large group of the participants did not believe that the mental disorder played any role in the criminal events. Contributing causes that were mentioned were drug abuse and social factors.
PMID: 24314798 [PubMed - as supplied by publisher]
Routine clinical assessment of cognitive functioning in schizophrenia, major depressive disorder, and bipolar disorder.
Eur Neuropsychopharmacol. 2013 Nov 11;
Authors: Belgaied W, Samp J, Vimont A, Rémuzat C, Aballéa S, El Hammi E, Kooli A, Toumi M, Akhras K
As more evidence points to the association of cognitive dysfunction with mental health disorders, the assessment of cognitive function in routine clinical care of these disorders is increasingly important. Despite this, it remains unknown how cognitive function is measured in routine clinical practice. The objective of this study was to assess psychiatrists' awareness of cognitive dysfunction in mental health disorders and their methods of cognitive assessment. An online survey was disseminated to psychiatrists in Europe, Asia, Australia and the United States. The survey asked about their perceptions of cognitive dysfunction in several mental health disorders, knowledge of cognitive assessment, method of cognitive assessment, and instruments used to measure cognitive function. Among the 61 respondents, most perceived that schizophrenia was associated with the greatest cognitive dysfunction. Many were unaware whether guidelines were available on cognitive assessment. In schizophrenia, 59% of psychiatrists reportedly used cognitive instruments, while the remainder relied solely on patient history interviews. The use of instruments to assess cognition in major depressive disorder (MDD) and bipolar disorder (BPD) was lower, 38% and 37% respectively. Of the reported instruments used, only a few were actually appropriate for use in the diseases of interest (12% in schizophrenia, 3% in MDD and 0% in BPD). Other instruments reported were clinical measures that did not assess cognition. These findings reveal some inconsistencies in psychiatrists' routine clinical evaluation of cognitive function. There appeared to be low use of true cognitive assessment instruments in clinical practice and confusion regarding what constituted a cognitive assessment instrument.
PMID: 24314852 [PubMed - as supplied by publisher]
Disrupted action monitoring in recent-onset psychosis patients with schizophrenia and bipolar disorder.
Psychiatry Res. 2013 Nov 20;
Authors: Minzenberg MJ, Gomes GC, Yoon JH, Swaab TY, Carter CS
Schizophrenia patients experience cognitive control disturbances, manifest in altered neural signatures during action monitoring. It remains unclear whether error- and conflict-monitoring disturbances co-occur, and whether they are observed in recent-onset psychosis patients with schizophrenia or bipolar disorder. We tested electrophysiological measures of action monitoring in these patients. Seventy-three schizophrenia patients (SZ), 26 bipolar disorder type I patients (BP), each within one year of psychosis onset, and 54 healthy control subjects (HC) underwent EEG during Stroop task performance. In the trial-averaged EEG at three midline scalp electrodes, the error-related negativity (ERN), error positivity (Pe) and conflict-related N450 were measured. Compared to HC (1) SZ exhibited an attenuated ERN and N450, and Pe unchanged and (2) BP exhibited an attenuated ERN but normal Pe and N450. Between patient groups, SZ showed an attenuated N450; ERN and Pe were not significantly different. A small (n=10) SZ subgroup that was not receiving antipsychotic medication showed normal ERPs. Altered error- and conflict-monitoring occur together in the first-episode schizophrenia patients, and these measures are comparable in patients with the first-episode bipolar disorder. Antipsychotic medication may be associated with altered measures of error-monitoring in schizophrenia.
PMID: 24314907 [PubMed - as supplied by publisher]
Trends in pharmacotherapy in patients referred to a bipolar specialty clinic, 2000-2011.
J Affect Disord. 2013 Nov 21;
Authors: Hooshmand F, Miller S, Dore J, Wang PW, Hill SJ, Portillo N, Ketter TA
OBJECTIVE: To assess mood stabilizer (MS) and second-generation antipsychotic (SGA) prescribing trends in bipolar disorder (BD) outpatients referred to a bipolar disorder specialty clinic over the past 12 years.
METHOD: BD outpatients referred to the Stanford University Bipolar Disorder Clinic during 2000-2011 were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation. Prescription rates for MSs and SGAs were compared during the first (2000-2005) and second (2006-2011) six years.
RESULTS: Among 597 BD patients (mean±SD age 35.4±8.6 years; 58.1% female; 40.7% Type I, 43.6% Type II, and 15.7% Type Not Otherwise Specified; taking 2.6±1.7 prescription psychotropic medications), lamotrigine, quetiapine, and aripiprazole usage more than doubled, from 14.7% to 37.2% (p<0.0001), 7.2% to 19.7% (p<0.0001), and 3.1% to 10.9% (p=0.0003), respectively, while olanzapine and risperidone use decreased by more than half from 15.0% to 6.6% (p=0.0043), and from 8.7% to 3.8% (p=0.039), respectively. SGA use increased from 34.1% to 44.8% (p=0.013), although MS use continued to be more common (in 65.2% for 2006-2011). Use of other individual MSs and SGAs and MSs as a class did not change significantly.
CONCLUSIONS: Over 12 years, in patients referred to a BD specialty clinic, lamotrigine, quetiapine, and aripiprazole use more than doubled, and olanzapine and risperidone use decreased by more than half. Tolerability (for lamotrigine, aripiprazole, olanzapine, and risperidone) more than efficacy (for quetiapine) differences may have driven these findings. Additional studies are needed to explore the relative influences of enhanced tolerability versus efficacy upon prescribing practices in BD patients.
PMID: 24314912 [PubMed - as supplied by publisher]
A reevaluation of the possibility and characteristics in bipolar mania with mixed features: A retrospective chart review.
Psychiatry Res. 2013 Nov 12;
Authors: Shim IH, Woo YS, Jun TY, Bahk WM
The aim of the present study was to reevaluate the feasibility of diagnosing a mixed features behind bipolar mania and to elucidate the clinical characteristics, treatment response, and course of the illness throughout a 12-month follow-up. The subjects (n=171) were inpatients diagnosed with bipolar I disorder, manic, between 2003 and 2010 and were classified into three groups: "mania" (n=67), "mania with probable mixed features" (n=79), and "mania with definite mixed features" (n=25). Diagnoses were in accordance with the Cincinnati criteria, which include the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision characteristics for a major depressive episode, except for agitation and insomnia. The charts of subjects were retrospectively reviewed for demographic and clinical characteristics prior to the index episode, clinical data regarding the index episode, and treatment courses over a 12-month follow-up period. Subjects in the mania with definite mixed features were more likely to be young at admission, to be female, to have a familial affective loading, and to have a history of suicidality relative to the mania. The results of the present study suggest the need for regular assessment of symptoms associated with both polarities during an episode in routine practice.
PMID: 24315032 [PubMed - as supplied by publisher]
Uptake of environmental toxicants by the locus ceruleus: A potential trigger for neurodegenerative, demyelinating and psychiatric disorders.
Med Hypotheses. 2013 Nov 21;
Authors: Pamphlett R
BACKGROUND: Damage to the locus ceruleus, with a subsequent decrease of CNS noradrenaline, occurs in a wide range of neurodegenerative, demyelinating and psychiatric disorders. The cause of the initial locus ceruleus damage remains unknown. Recently, inorganic mercury was found to enter human locus ceruleus neurons selectively. This has led to the formulation of a new hypothesis as to the cause of these disorders.
HYPOTHESIS: Toxicants enter locus ceruleus neurons selectively, aided by the extensive exposure these neurons have to CNS capillaries, as well as by stressors that upregulate locus ceruleus activity. The resulting noradrenaline dysfunction affects a wide range of CNS cells and can trigger a number of neurodegenerative (Alzheimer's, Parkinson's and motor neuron disease), demyelinating (multiple sclerosis), and psychiatric (major depression and bipolar disorder) conditions.
CONCLUSIONS: This hypothesis proposes that environmental toxicants entering the locus ceruleus can give rise to a variety of CNS disorders. Proposals are made for experiments to gain further evidence for this hypothesis. If it is shown that toxicants in the locus ceruleus are responsible for these conditions, attempts can be made to prevent the toxicant exposures or to remove the toxicants from the nervous system.
PMID: 24315447 [PubMed - as supplied by publisher]
Evidence of allelic imbalance in the schizophrenia susceptibility gene ZNF804A in human dorsolateral prefrontal cortex.
Schizophr Res. 2013 Dec 5;
Authors: Guella I, Sequeira A, Rollins B, Morgan L, Myers RM, Watson SJ, Akil H, Bunney WE, Delisi LE, Byerley W, Vawter MP
The rs1344706, an intronic SNP within the zinc-finger protein 804A gene (ZNF804A), was identified as one of the most compelling risk SNPs for schizophrenia (SZ) and bipolar disorder (BD). It is however not clear by which molecular mechanisms ZNF804A increases disease risk. We evaluated the role of ZNF804A in SZ and BD by genotyping the originally associated rs1344706 SNP and an exonic SNP (rs12476147) located in exon four of ZNF804A in a sample of 422 SZ, 382 BD, and 507 controls from the isolated population of the Costa Rica Central Valley. We also investigated the rs1344706 SNP for allelic specific expression (ASE) imbalance in the dorsolateral prefrontal cortex (DLPFC) of 46 heterozygous postmortem brains. While no significant association between rs1344706 and SZ or BD was observed in the Costa Rica sample, we observed an increased risk of SZ for the minor allele (A) of the exonic rs12476147 SNP (p=0.026). Our ASE assay detected a significant over-expression of the rs12476147 A allele in DLPFC of rs1344706 heterozygous subjects. Interestingly, cDNA allele ratios were significantly different according to the intronic rs1344706 genotypes (p-value=0.03), with the rs1344706 A allele associated with increased ZNF804A rs12476147 A allele expression (average 1.06, p-value=0.02, for heterozygous subjects vs. genomic DNA). In conclusion, we have demonstrated a significant association of rs12476147 with SZ, and using a powerful within-subject design, an allelic expression imbalance of ZNF804A exonic SNP rs12476147 in the DLPFC. Although this data does not preclude the possibility of other functional variants in ZNF804A, it provides evidence that the rs1344706 SZ risk allele is the cis-regulatory variant directly responsible for this allelic expression imbalance in adult cortex.
PMID: 24315717 [PubMed - as supplied by publisher]
Aripiprazole: A new risk factor for pathological gambling? A report of 8 case reports.
Addict Behav. 2013 Nov 10;
Authors: Gaboriau L, Victorri-Vigneau C, Gérardin M, Allain-Veyrac G, Jolliet-Evin P, Grall-Bronnec M
OBJECTIVE: It is commonly accepted that pathological gambling results from the interaction of multiple risk factors. Among these, dopamine replacement therapy (DRT) prescribed for Parkinson disease can be cited. Another dopamine agonist, aripiprazole, could be a new risk factor. We decided to explore this potential adverse drug reaction (ADR).
METHOD: Based on a cohort of 166 pathological gamblers starting treatment in our department, data of each of the 8 patients treated by aripiprazole at inclusion were analyzed.
RESULTS: The patients involved were schizophrenic or bipolar, mostly young men with a history of addictive disorders and regular gambling prior to the prescription of aripiprazole. For each one of them, the causality of aripiprazole was considered, using an algorithm. The probability that pathological gambling is actually due to aripiprazole is "possible" in 7 cases out of 8, and "doubtful" in one.
CONCLUSIONS: Adverse drug reactions were confronted with other already published case reports. Dopamine partial agonist mechanism of aripiprazole could explain the occurrence of pathological gambling.
PMID: 24315783 [PubMed - as supplied by publisher]
Motor cortex stimulation does not improve dystonia secondary to a focal basal ganglia lesion.
Neurology. 2013 Dec 6;
Authors: Rieu I, Aya Kombo M, Thobois S, Derost P, Pollak P, Xie J, Pereira B, Vidailhet M, Burbaud P, Lefaucheur JP, Lemaire JJ, Mertens P, Chabardes S, Broussolle E, Durif F
OBJECTIVE: To assess the efficacy of epidural motor cortex stimulation (MCS) on dystonia, spasticity, pain, and quality of life in patients with dystonia secondary to a focal basal ganglia (BG) lesion.
METHODS: In this double-blind, crossover, multicenter study, 5 patients with dystonia secondary to a focal BG lesion were included. Two quadripolar leads were implanted epidurally over the primary motor (M1) and premotor cortices, contralateral to the most dystonic side. The leads were placed parallel to the central sulcus. Only the posterior lead over M1 was activated in this study. The most lateral or medial contact of the lead (depending on whether the dystonia predominated in the upper or lower limb) was selected as the anode, and the other 3 as cathodes. One month postoperatively, patients were randomly assigned to on- or off-stimulation for 3 months each, with a 1-month washout between the 2 conditions. Voltage, frequency, and pulse width were fixed at 3.8 V, 40 Hz, and 60 ?s, respectively. Evaluations of dystonia (Burke-Fahn-Marsden Scale), spasticity (Ashworth score), pain intensity (visual analog scale), and quality of life (36-Item Short Form Health Survey) were performed before surgery and after each period of stimulation.
RESULTS: Burke-Fahn-Marsden Scale, Ashworth score, pain intensity, and quality of life were not statistically significantly modified by MCS.
CONCLUSIONS: Bipolar epidural MCS failed to improve any clinical feature in dystonia secondary to a focal BG lesion.
CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that bipolar epidural MCS with the anode placed over the motor representation of the most affected limb failed to improve any clinical feature in dystonia secondary to a focal BG lesion.
PMID: 24319038 [PubMed - as supplied by publisher]
Boosting the Power of Schizophrenia Genetics by Leveraging New Statistical Tools.
Schizophr Bull. 2013 Dec 6;
Authors: Andreassen OA, Thompson WK, Dale AM
Genome-wide association studies (GWAS) have identified a large number of gene variants associated with schizophrenia, but these variants explain only a small portion of the heritability. It is becoming increasingly clear that schizophrenia is influenced by many genes, most of which have effects too small to be identified using traditional GWAS statistical methods. By applying recently developed Empirical Bayes statistical approaches, we have demonstrated that functional genic elements show differential contribution to phenotypic variance, with some elements (regulatory regions and exons) showing strong enrichment for association with schizophrenia. Applying related methods, we also showed abundant genetic overlap (pleiotropy) between schizophrenia and other phenotypes, including bipolar disorder, cardiovascular disease risk factors, and multiple sclerosis. We estimated the number of gene variants with effects in schizophrenia and bipolar disorder to be approximately 1.2%. By applying our novel statistical framework, we dramatically improved gene discovery and detected a large number of new gene loci associated with schizophrenia that have not yet been identified with standard GWAS methods. Utilizing independent schizophrenia substudies, we showed that these new loci have high replication rates in de novo samples, indicating that they likely represent true schizophrenia risk genes. The new statistical tools provide a powerful approach for uncovering more of the missing heritability of schizophrenia and other complex disorders. In conclusion, the highly polygenic architecture of schizophrenia strongly suggests the utility of research approaches that recognize schizophrenia neuropathology as a complex dynamic system, with many small gene effects integrated in functional networks.
PMID: 24319118 [PubMed - as supplied by publisher]
A systematic review of gender-specific rates of unipolar and bipolar disorders in community studies of pre-pubertal children.
Bipolar Disord. 2013 Dec 5;
Authors: Douglas J, Scott J
OBJECTIVES: Gender-specific rates of unipolar and bipolar disorders are well established for cases with post-pubertal onset. However, there is less certainty about these rates in pre-pubertal children. We undertook a systematic review of community studies that report gender-specific rates for unipolar and bipolar disorders in young children, particularly cases of major depression and mania.
METHOD: Computer databases (Medline, EMBASE, Index to Theses, and PsychInfo) were searched for non-clinical observational studies using recognized diagnostic criteria to identify unipolar and bipolar disorders in children aged ?12 years. A meta-analysis was undertaken to calculate pooled odds ratios (ORs) for caseness for major depression by gender. The limited data on bipolar disorder were summarized.
RESULTS: Analysis of 12 studies (>15,000 children), indicated that the community prevalence of unipolar disorders was higher in boys (1.3%) than in girls (0.8%). Rates of major depression were low (0.61%), but boys were significantly more likely to meet diagnostic criteria than girls (OR = 1.61; 95% confidence interval: 1.11-2.35). Five studies, assessing >5,000 children, identified only one case with a probable diagnosis of mania.
CONCLUSIONS: This systematic review suggests that boys aged ?12 years are significantly more likely to experience major depression than girls. However, in younger children, community rates of major depression are low, and it is frequently suggested (but not proven) that most cases are comorbid. The absence of mania suggests either that childhood bipolar phenotypes do not resemble post-pubertal onset cases or that there are problems of case ascertainment.
PMID: 24305108 [PubMed - as supplied by publisher]
Cross-national prevalence and cultural correlates of bipolar I disorder.
Soc Psychiatry Psychiatr Epidemiol. 2013 Dec 4;
Authors: Johnson KR, Johnson SL
PURPOSE: Bipolar disorder has been consistently related to heightened sensitivity to reward. Greater reward sensitivity predicts the onset of disorder, a more severe course, and conversion from milder to severe forms. No studies consider whether cultural factors related to reward sensitivity influence the course of bipolar disorder. This study examines the relationship of reward-relevant cultural values to global prevalence rates of bipolar I disorder.
METHODS: Lifetime prevalence of bipolar I disorder for 17 countries was drawn from epidemiological studies that used structured diagnostic interviews of large community samples. Bivariate correlations were used to assess the relationship of bipolar disorder prevalence with national scores on four reward-relevant cultural dimensions (Power Distance, Individualism, Long-Term Orientation, and Performance Orientation).
RESULTS: The prevalence of bipolar I disorder was correlated in the predicted manner with Power Distance and Individualism, and with Long-Term Orientation and Performance Orientation after outliers were removed.
CONCLUSIONS: Findings provide evidence for a cultural model of reward sensitivity in bipolar disorder.
PMID: 24306039 [PubMed - as supplied by publisher]
Disruption of Cortical Association Networks in Schizophrenia and Psychotic Bipolar Disorder.
JAMA Psychiatry. 2013 Dec 4;
Authors: Baker JT, Holmes AJ, Masters GA, Yeo BT, Krienen F, Buckner RL, Ongür D
IMPORTANCE Psychotic disorders (including schizophrenia, schizoaffective disorder, and psychotic bipolar disorder) are devastating illnesses characterized by breakdown in the integration of information processing. Recent advances in neuroimaging allow for the estimation of brain networks on the basis of intrinsic functional connectivity, but the specific network abnormalities in psychotic disorders are poorly understood. OBJECTIVE To compare intrinsic functional connectivity across the cerebral cortex in patients with schizophrenia spectrum disorders or psychotic bipolar disorder and healthy controls. DESIGN, SETTING, AND PARTICIPANTS We studied 100 patients from an academic psychiatric hospital (28 patients with schizophrenia, 32 patients with schizoaffective disorder, and 40 patients with bipolar disorder with psychosis) and 100 healthy controls matched for age, sex, race, handedness, and scan quality from December 2009 to October 2011. MAIN OUTCOMES AND MEASURES Functional connectivity profiles across 122 regions that covered the entire cerebral cortex. RESULTS Relative to the healthy controls, individuals with a psychotic illness had disruption across several brain networks, with preferential reductions in functional connectivity within the frontoparietal control network (P?<?.05, corrected for family-wise error rate). This functionally defined network includes portions of the dorsolateral prefrontal cortex, posteromedial prefrontal cortex, lateral parietal cortex, and posterior temporal cortex. This effect was seen across diagnoses and persisted after matching patients and controls on the basis of scan quality. CONCLUSIONS AND RELEVANCE Our study results support the view that cortical information processing is disrupted in psychosis and provides new evidence that disruptions within the frontoparietal control network may be a shared feature across both schizophrenia and affective psychosis.
PMID: 24306091 [PubMed - as supplied by publisher]
Quetiapine-induced manic episode: a paradox for contemplation.
BMJ Case Rep. 2013;2013
Authors: Gnanavel S
A 24-year-old man with bipolar disorder who was started on quetiapine as an adjunct to valproate (mood stabiliser) after a depressive episode switched to a manic episode while on the drug. The manic episode resolved following the withdrawal of quetiapine. This case illustrates the rare possibility of quetiapine emergent manic episode which a clinician needs to be aware of in the context of the management of bipolar disorders.
PMID: 24306631 [PubMed - in process]
Internet Psychoeducation for Bipolar Affective Disorder: Basis for Preparation and First Experiences.
Psychiatr Q. 2013 Dec 4;
Authors: Latalova K, Prasko J, Kamaradova D, Jelenova D, Ociskova M, Sedlackova Z
There is growing evidence that patients with bipolar affective disorder (BAD), who use medication, respond well to further psychotherapeutic interventions. Internet-based psychoeducation is typically centered on the interaction between a client and therapist via the Internet. Multiple methods were required to investigate existing psychoeducational and psychotherapeutic strategies used on patients suffering from BAD. Systematic reviews and original reports of all trials of psychoeducation in BAD patients were retrieved. Patients with BAD, who were hospitalized in a psychiatric department or attended a day hospital program, were exposed to the first version of the program during the treatment, and then questioned about understandability, comprehensibility, and usefulness of each lecture. Twelve modules of the Internet E-Program for BAD were developed and the intervention was a pilot tested with twelve patients. Internet psychoeducation program for BAD is an intervention designed for universal implementation that addresses heightened learning needs of patients suffering from BAD. It is designed to promote confidence and reduce the number of episodes of the disorder by providing skills in monitoring warning signs, planning daily activities and practicing communication skills.
PMID: 24307178 [PubMed - as supplied by publisher]
Pharmacotherapy of suicidal behaviour in major depression, schizophrenia and bipolar disorder.
Coll Antropol. 2013 Sep;37(3):1039-44
Authors: Filakovi? P, Eri? AP
The psychopathological dynamics in suicidality overcomes actual diagnostic distribution therefore pharmacotherapy has restricted role in overall prevention of suicidal behaviour among mentally ill and is demanding for clinician. This role is achieved through reduction and alleviation of suicidal risk with rational and individual pharmacotherapeutic approach emphasising effective, safe and tolerable treatment. The genetic and epigenetic factors, dysfunction of neurotransmitter, neuroendocrine system and stress response system has been determining for neurobiology of suicidality. Therefore, pharmacotherapeutic approach should be focused, not only on prevention and reduction of suicidality, but adjusted for general and diagnosis-specific risk factors. Suicidality represents trans-diagnostic issue, however making the correct diagnosis is of great importance. Identical group of psychiatric medications or even the same drug, could be palliating for suicidal behaviour in one diagnostic category and in other aggravating concerning suicidal ideations. Clinician should be reserved towards epidemiological studies about reducing suicidal rate due to increased consumption of antidepressants. Detailed data analysis showed there is no relevancy which antidepressants were given to specific patient, in what age and phase of illness. The FDA has issued warnings about possible increased risk of suicidal behaviour in children and adolescents when given antidepressant therapy. In general, serotoninergic drugs have neutral or mildly protective effect on potential suicidal behaviour while noradrenergic drugs may have activating effect or could even worsen suicidal ideation in certain phase of the illness. When given in appropriate dose and the right time, dual or noradrenergic antidepressants, could also have good protective impact on specific patient. In patients with bipolar disorder, antidepressive drug could be trigger for suicidal behaviour. Greater susceptibility when diagnosing bipolar disorder and broader usage of mood stablizing medications, alone or combined with other psychopharmacotherapy, has the significant role in suppression and elimination of suicidal behaviour. The lithium and sodium valproate are found to be particularly suitable for prevention and elimination of suicidal behaviour along with some other mood stabilizers. Pharmacotherapy of suicidality in patients with schizophrenia represents specific problem. Confirmed drug with anti-suicidal effect, clozapine, is not first choice medication and does not represent general solution for suicidality in schizophrenia. For clinician, the pharmacotherapy of suicidal behaviour consists of skilled individual and rational drug administration accompanied with appropriate psychotherapeutic support.
PMID: 24308257 [PubMed - in process]
The relationship between neurotrophins and bipolar disorder.
Expert Rev Neurother. 2013 Nov 22;
Authors: Wu R, Fan J, Zhao J, Calabrese JR, Gao K
Relationship between neurotrophins, especially brain-derived neurotrophic factor (BDNF) and bipolar disorder (BPD) has been widely investigated, but results have been inconsistent. BDNF polymorphism may be associated with the susceptibility to subtype BPD such as rapid cycling BPD or early onset BPD. Met allele carriers of Val66Met of BDNF gene had smaller gray matter (GM) in both patients and healthy controls, but bipolar patients carrying Met allele had better response to lithium treatment. Decreased serum/plasma BDNF levels were observed at different mood states. BDNF may interact with other systems to execute its neuroprotective effects. Overall data suggest that neurotrophins may be involved in the pathogenesis of BPD and treatment response, but the magnitude of their role needs further investigation with large sample size studies.
PMID: 24308275 [PubMed - as supplied by publisher]
Recognition, diagnosis and treatment of postpartum bipolar depression.
Expert Rev Neurother. 2013 Nov 26;
Authors: Pope CJ, Sharma V, Mazmanian D
Bipolar disorder is a serious and often chronic disorder characterized by episodes of depression, hypomania, mania or mixed states that affects many individuals worldwide, and is a leading cause of years of 'healthy' life lost as a result of disability and premature mortality. For women, bipolar disorder tends to cluster during the childbearing years. Detection of bipolar disorder can be complicated and therefore it is essential that women presenting with mood episodes after childbirth receive a comprehensive examination to allow for accurate diagnosis, with particular attention to manic symptoms. Once a diagnosis of bipolar disorder is confirmed, pharmacotherapy with consideration made to breastfeeding status may be considered alone or in combination with psychotherapy.
PMID: 24308278 [PubMed - as supplied by publisher]
An ASMT variant associated with bipolar disorder influences sleep and circadian rhythms: a pilot study(1.)
Genes Brain Behav. 2013 Nov 11;
Authors: Geoffroy PA, Boudebesse C, Henrion A, Jamain S, Henry C, Leboyer M, Bellivier F, Etain B
Patients with bipolar disorder (BD) experience persistent circadian rhythm and sleep abnormalities during periods of remission, and biological studies have shown that these patients have abnormal melatonin secretion profiles or reactivity to light. We previously reported the association with BD of a common polymorphism (rs4446909) of the promoter of the acetylserotonin O-methyltransferase (ASMT) gene, encoding one of the two enzymes involved in melatonin biosynthesis. This variant was associated with weaker transcription and lower levels of ASMT activity in lymphoblastoid cell lines. Actigraphy, based on the use of a mobile portable device for the analysis of sleep/wake cycles in natural conditions, may be useful for studies of carriers of the at-risk allele. We studied the association between the ASMT rs4446909 variant and sleep/activity, as assessed with the Pittsburgh Sleep Quality Index (PSQI) and by actigraphy, in 53 subjects (25 patients with BD in remission and 28 healthy controls). The two groups were similar for age, sex ratio, current mood symptoms, body mass index and risk of sleep apnea syndrome. In the total sample, the GG at-risk genotype was associated with longer sleep duration (P?=?0.03), greater activity in active periods of sleep (P?=?0.015) and greater interday stability (P?=?0.003). These associations remained significant when disease status was included in the model. Only the association with interday stability remained significant after correction for multiple testing. This pilot study thus shows that a BD-associated functional variant involved in the melatonin synthesis pathway influences sleep and circadian rhythms in bipolar patients in remission and controls.
PMID: 24308489 [PubMed - as supplied by publisher]
No association between serum cholesterol and death by suicide in patients with schizophrenia, bipolar affective disorder, or major depressive disorder.
Behav Brain Funct. 2013 Dec 5;9(1):45
Authors: Park S, Yi KK, Na R, Lim A, Hong JP
BACKGROUND: Previous research on serum total cholesterol and suicidality has yielded conflicting results. Several studies have reported a link between low serum total cholesterol and suicidality, whereas others have failed to replicate these findings, particularly in patients with major affective disorders. These discordant findings may reflect the fact that studies often do not distinguish between patients with bipolar and unipolar depression; moreover, definitions and classification schemes for suicide attempts in the literature vary widely.
METHODS: Subjects were patients with one of the three major psychiatric disorders commonly associated with suicide: schizophrenia, bipolar affective disorder, and major depressive disorder (MDD). We compared serum lipid levels in patients who died by suicide (82 schizophrenia, 23 bipolar affective disorder, and 67 MDD) and non-suicide controls (200 schizophrenia, 49 bipolar affective disorder, and 175 MDD).
RESULTS: Serum lipid profiles did not differ between patients who died by suicide and control patients in any diagnostic group.
CONCLUSIONS: Our results do not support the use of biological indicators such as serum total cholesterol to predict suicide risk among patients with a major psychiatric disorder.
PMID: 24308827 [PubMed - as supplied by publisher]
Quality of Life of Patients With Euthymic Bipolar Disorder and Its Associations With Demographic and Clinical Characteristics, Psychopathology, and Cognitive Deficits.
Perspect Psychiatr Care. 2013 May 31;
Authors: Xiang YT, Li LJ, Zhou JJ, Wang CY, Dixon LB, Dickerson F, Zhou FC, Ungvari GS, Zhang XY, Shum DH, Au RW, Tang WK, Man D, Chiu HF
PURPOSE: Little is known about quality of life (QOL) in Chinese patients with bipolar disorder (BD) in remission (euthymia). This study examined the QOL of such a cohort of BD patients and its demographic, clinical, and cognitive correlates.
DESIGN AND METHODS: Forty-seven euthymic BD patients and 47 matched healthy controls formed the study sample. Socio-demographic characteristics, prospective memory, retrospective memory, intelligence quotient, and executive functioning were measured in all participants together with patients' psychopathology ratings.
FINDINGS: Multivariate analyses revealed that compared to controls, euthymic BD patients had significantly lower satisfaction with physical QOL domain. Only subthreshold depressive symptoms independently contributed to reduced satisfaction with physical and environmental QOL domains, whereas no variable predicted its psychological and social domains.
PRACTICE IMPLICATIONS: Contrary to findings from Western settings, demographic variables and cognitive deficits had no associations with any QOL domain in euthymic Chinese BD patients. Control of subthreshold depressive symptoms in euthymic BD patients might enhance their QOL.
PMID: 24308864 [PubMed - as supplied by publisher]
[Neuropsychological profiles of adolescents with bipolar disorder and adolescents with a high risk of bipolar disorder].
Turk Psikiyatri Derg. 2013;24(4):221-30
Authors: Nuri Karakurt M, Karabekiro?llu MZ, Yüce M, Baykal S, Senses A
PURPOSE: In recent years evidence of an association between bipolar disorder (BD), and specific neuropsychological impairment and familial transmission of BD has been mounting. The aim of this study was to identify the clinical and neuropsychological features of BD in adolescents, to assess the clinical and neuropsychological parameters in adolescents with a high risk of familial transmission of BD, and to identify probable early markers of the disorder.
MATERIALS AND METHODS: The study included 25 patients aged 12-18 years that were diagnosed as BD (case group), 25 adolescents without a mood disorder that had a parent and/or sibling diagnosed as BD, (risk group), and 25 typically developing adolescents (control group). To determine neuropsychological profiles the participants were administered the Wisconsin Card Sorting Test (WCST), Stroop Color Word Test (SCWT), and Continuous Performance Test (CPT), and to evaluate clinical and behavioral profiles the Children's Depression Inventory (CDI), Parent-Young Mania Rating Scale (P-YMRS), Youth Self-Report (YSR), and Conners' Parent Rating Scale (CPRS-48) were administered.
RESULTS: The case group performed significantly lower on the WCST, SCWT, and CPT in terms of executive and attention functions, whereas there wasn't a difference between the risk group and control group. In addition, significantly more of the adolescents in the case and risk groups had clinical and behavioral problems than those in the control group.
CONCLUSION: The findings show that behavioral and clinical problems were more common in the risk group than in the control group, and that the frequency of attention and executive function impairment was similar in both of those groups. The findings suggest that BD itself may be associated with attention and executive function impairments, whereas a familial risk of BD may be associated with some behavioral problems. Follow-up and neuroimaging studies conducted with a larger number of participants, and neuropsychological test profiles may provide more detailed information about the neuropsychological profiles of individuals with a genetic risk for BD and may provide descriptive data about where and how the biological and psychometric deterioration initiate.
PMID: 24310088 [PubMed - in process]
[Internalized stigmatization in bipolar patients: relationship with clinical properties, quality of life and treatment compliance].
Turk Psikiyatri Derg. 2013;24(4):231-9
Authors: Ustünda? MF, Kesebir S
OBJECTIVE: This study aimed to investigate the impact of the internalized stigmatization on bipolar disorder (BD) patients.
MATERIALS AND METHODS: The study included 100 BD patients that provided written informed consent to participate. Diagnosis of the BD patients that were in remission and receiving outpatient treatment was performed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and patient data were recorded using SKIP-TURK. In addition, the patients were administered the Internalized Stigma of Mental Illness Scale (ISMI), Mood Stabilizer Compliance Questionnaire (MSQC), and World Health Organization Quality of Life Assessment, abbreviated form (WHOQOL-BREF).
RESULTS: Internalized stigmatization was observed in 46% of the BD patients; these patients had higher functionality scores, shorter regression periods, and more depressive episodes than those without internalized stigmatization. Although internalized stigmatization occurred more frequently in seasonal and rapid cycling patients, both attributes were prodrome of internalized stigmatization. Internalized stigmatization was observed more frequently in patients with low socioeconomic status, low level of education, rural residence, lack of work, and more children. There was a strong correlation between ISMI score, and WHOQOL-BREF and MSQC scores.
CONCLUSION: The clinical features of the BD and internalized stigmatization were observed to affect each other. Furthermore, stigmatization affected treatment compliance and quality of life.
PMID: 24310089 [PubMed - in process]
[The family transition experience: family-centered hospitalization care of bipolar disorder patients].
Hu Li Za Zhi. 2013 Dec;60(6):47-56
Authors: Lee HJ, Chen MB, Chiang LC
BACKGROUND: Differences in cognition and attitudes between bipolar disorder patients and their families frequently result in differences between the two in terms of opinions and perceptions on appropriate medical treatments and prognoses. Transforming patient-centered-care psychotherapy into an intervention that provides family-focused nursing, promotes interaction among family members, and changes communication styles may assist families to adapt and focus on pursuing the soundest medical treatment.
PURPOSE: This qualitative study explores the healing process of family transition in terms of family-centered care for bipolar disorder patients and nursing strategy intervention.
METHODS: A psychiatric nurse with clinical experience used four 60-90 minute semi-structured, in-depth interviews to collect data from 8 families. The process was recorded and transcribed verbatim. Content analysis was used to analyze and categorize the major themes.
RESULTS: Results were generalized into three themes that addressed the interaction-in-transition between patients and their families. These themes were: "All of the blame comes from the disease", "There is love in the family", and "Agreement to start over". Nurses increased their positive interaction with the family by facilitating cognitive, emotional, and behavioral change in the family. The 3 nursing strategy interventions used in this study to promote family adaptation in this study were: (1) guiding family experiences of the disease situation; (2) inspiring the potential strength in the families; (3) mobilizing the internal and external resources of families.
CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Nurses may help family healing by identifying family strengths and resources, looking for solutions to problems, transforming effective communicating style, and making family contracts.
PMID: 24310553 [PubMed - in process]
Mindfulness based cognitive therapy may improve emotional processing in bipolar disorder: pilot ERP and HRV study.
Metab Brain Dis. 2013 Dec 7;
Authors: Howells FM, Laurie Rauch HG, Ives-Deliperi VL, Horn NR, Stein DJ
Emotional processing in bipolar disorder (BD) is impaired. We aimed to measure the effects of mindfulness based cognitive-behavioral therapy (MBCT) in BD on emotional processing, as measured by event related potentials (ERP) and by heart rate variability (HRV). ERP and HRV were recorded during the completion of a visual matching task, which included object matching, affect matching, and affect labeling. Individuals with BD (n?=?12) were compared with controls (n?=?9) to obtain baseline data prior to the individuals with BD undergoing an 8-week MBCT intervention. ERP and HRV recording was repeated after the MBCT intervention in BD. Participants with BD had exaggerated ERP N170 amplitude and increased HRV HF peak compared to controls, particularly during the affect matching condition. After an 8-week MBCT intervention, participants with BD showed attenuation of ERP N170 amplitude and reduced HRV HF peak. Our findings support findings from the literature emphasizing that emotional processing in BD is altered, and suggesting that MBCT may improve emotional processing in BD.
PMID: 24311196 [PubMed - as supplied by publisher]
[Enduring pain II. Treatment].
Vertex. 2013 Sep;24(111):351-8
Authors: Baldessarini R, Selle V, Vigo DV
Pain disorders present highly challenging therapeutic problems, owing in part to complex co-morbidities associated with pain disorders, notably including psychiatric disorders characterized by depressed mood or anxiety. Many treatments are employed to treat pain-disorder patients, and most are unsatisfactory. Virtually all analgesic medicines in long-term use provide only partial efficacy and present substantial risks of adverse effects, loss of benefit over time, or dependency and risk of abuse. Commonly employed drugs with analgesic properties include non-opioids (mainly nonsteroidal anti-inflammatory agents [NSAIDs] or acetaminophen), many natural or synthetic opioids (including opiates and phenylpiperidines), some antidepressants (especially those with noradrenergic activity), a few anticonvulsants, skeletal muscle relaxants or topical remedies, and a growing variety of experimental treatments. The major overlap between pain and psychiatric disorders, as well as the currently unsatisfactory state of treatments available for chronic pain syndromes, encourage a comprehensive approach to assessment and clinical management of patients with chronic pain. Many current treatment programs for pain disorder patients offer narrowly specialized and incomplete treatment options. Ideally however, such care should be provided by multi-disciplinary teams with expertise in neurology, general medicine, pain management, physical medicine and rehabilitation, as well as psychiatry. Psychiatrists as well as pain specialists can serve an essential role in leading comprehensive assessment and general management of such complex and challenging patients who are typically only partially responsive to available treatments.
PMID: 24312919 [PubMed - in process]
Bipolar disorder in adolescence.
Adolesc Med State Art Rev. 2013 Aug;24(2):433-45, ix
Authors: DeFilippis M, Wagner KD
Bipolar disorder is a serious psychiatric condition that may have onset in childhood. It is important for physicians to recognize the symptoms of bipolar disorder in children and adolescents in order to accurately diagnose this illness early in its course. Evidence regarding the efficacy of various treatments is necessary to guide the management of bipolar disorder in youth. For example, several medications commonly used for adults with bipolar disorder have not shown efficacy for children and adolescents with bipolar disorder. This article reviews the prevalence, diagnosis, course, and treatment of bipolar disorder in children and adolescents and provides physicians with information that will aid in diagnosis and treatment.
PMID: 24298757 [PubMed - in process]
Thank you to reviewers.
Bipolar Disord. 2013 Dec;15(8):e2-4
PMID: 24299008 [PubMed - in process]