Neuroscientific basis of corticosteroid-induced changes in human cognitive and emotional processing: implications for affective illness.
J Psychiatr Pract. 2013 Jul;19(4):309-15
Authors: Young KD, Preskorn SH
In this column, the authors first present a composite of several cases of psychiatrically healthy individuals who developed manic-depressive symptoms after receiving a course of prednisone to treat symptoms of inflammatory processes, such as Crohn's disease. The next section summarizes keys points from 50 years of clinical experience with such cases. The authors then present an overview of the effects of exogenous administration of glucocorticoids on cognitive performance and emotional processing via effects on medial temporal lobe and prefrontal structures, including the amygdala, hippocampus, and dorsolateral prefrontal cortex. These effects include glucocorticoid-induced deficits in declarative and autobiographical memory, altered activation of medial temporal lobe structures, and delayed habituation of hemodynamic responses to emotional faces. Finally, these findings are connected in a discussion of how glucocorticoid exposure can result in mood disturbances and what light that may shed on the neurobiology underlying spontaneous bipolar and unipolar affective illnesses.
PMID: 23852106 [PubMed - indexed for MEDLINE]
[Physician colleague, how are you dealing with your illness? (interview by Dr. med. Bernhard Mäulen)].
MMW Fortschr Med. 2013 May 2;155(8):6-7
PMID: 24437115 [PubMed - indexed for MEDLINE]
[Treatment of depression by the general practitioner].
MMW Fortschr Med. 2013 May 2;155(8):43-6; quiz 47-8
Authors: Messner T, Tiltscher C
PMID: 24437137 [PubMed - indexed for MEDLINE]
[In Process Citation].
MMW Fortschr Med. 2013 Nov 7;155(19):22
PMID: 24475656 [PubMed - indexed for MEDLINE]
Drugs to treat bipolar disorders.
J Psychosoc Nurs Ment Health Serv. 2013 Jun 1;51(6):9-10
PMID: 24601309 [PubMed - in process]
Adherence to behavioral therapy and psychiatry visits in a safety-net setting in Virginia, USA.
Health Soc Care Community. 2014 Mar 6;
Authors: Moczygemba LR, Osborn RD, Lapane KL
Little is known about predictors of adherence to outpatient behavioural therapy and psychiatry visits in those who experience homelessness. Yet, consistent receipt of services in the community is critical to preventing use of acute care psychiatric services, which cause a significant cost burden to the mental health system. This retrospective study examined sociodemographic, housing instability and health-related factors associated with adherence to behavioural therapy and psychiatry appointments among 1711 clients served by an urban healthcare for the homeless centre in Virginia, USA. Clients ?18 years old with a behavioural health condition who had an intake assessment and at least one behavioural therapy or psychiatry appointment scheduled during October 2005-September 2009 were eligible for the study. Of those with scheduled behavioural therapy visits, 27.7% were high adherers and 19.3% did not attend any appointments, whereas of those with scheduled psychiatry visits, 13.6% were high adherers and 22.1% did not attend any appointments. African Americans, when compared with whites, and those with a primary diagnosis of bipolar disorder were less likely to be high adherers to behavioural therapy. Women and being ?35 years old were associated with a decreased likelihood of failing to attend psychiatry appointments, whereas African Americans, when compared with whites, and those with co-occurring disorders were more likely to not attend any psychiatry appointments. Understanding factors related to adherence to behavioural health services can help homeless care providers tailor strategies for improving visit adherence.
PMID: 24601944 [PubMed - as supplied by publisher]
Improving the early recognition and diagnosis of bipolar disorder.
J Clin Psychiatry. 2014 Feb;75(2):e03
Authors: McIntyre RS
Misdiagnosis of bipolar disorder is widespread, in part because of the overwhelming presence of depressive symptoms. In general, patients tend to seek help during a depressive episode rather than a manic one, leading clinicians to inaccurately provide a unipolar diagnosis rather than one of bipolar depression. To aid in making a bipolar diagnosis, clinicians can watch for several red flags in patients with depressive episodes, such as earlier age at onset, family history of bipolar disorder, and the presence of psychotic features. Other tools to identify bipolar disorder include the updated DSM-5 as well as evidence on the relationship between bipolar disorder and metabolic syndrome. A correct and timely diagnosis of bipolar disorder is crucial for the well-being and proper treatment of the patient.
PMID: 24602254 [PubMed - in process]
Olfactory sulcus morphology in established bipolar affective disorder.
Psychiatry Res. 2014 Feb 18;
Authors: Takahashi T, Malhi GS, Nakamura Y, Suzuki M, Pantelis C
This MRI study examined the morphology of the olfactory sulcus, a potential marker of early neurodevelopment in 26 patients with bipolar I disorder and 24 matched controls. Bipolar patients had significantly shallower olfactory sulci bilaterally compared to controls, suggesting that neurodevelopmental abnormalities contribute to the neurobiology of bipolar disorder.
PMID: 24602518 [PubMed - as supplied by publisher]
Neuropathological and neuromorphometric abnormalities in bipolar disorder: View from the medial prefrontal cortical network.
Neurosci Biobehav Rev. 2014 Mar 3;
Authors: Savitz JB, Price JL, Drevets WC
The question of whether BD is primarily a developmental disorder or a progressive, neurodegenerative disorder remains unresolved. Here, we review the morphometric postmortem and neuroimaging literature relevant to the neuropathology of bipolar disorder (BD). We focus on the medial prefrontal cortex (mPFC) network, a key system in the regulation of emotional, behavioral, endocrine, and innate immunological responses to stress. We draw four main conclusions: the mPFC is characterized by (1) a decrease in volume, (2) reductions in neuronal size, and/or changes in neuronal density, (3) reductions in glial cell density, and (4) changes in gene expression. These data suggest the presence of dendritic atrophy of neurons and the loss of oligodendroglial cells in BD, although some data additionally suggest a reduction in the cell counts of specific subpopulations of GABAergic interneurons. Based on the weight of the postmortem and neuroimaging literature discussed herein, we favor a complex hypothesis that BD primarily constitutes a developmental disorder, but that additional, progressive, histopathological processes also are associated with recurrent or chronic illness. Conceivably BD may be best conceptualized as a progressive neurodevelopmental disorder.
PMID: 24603026 [PubMed - as supplied by publisher]
Does comorbid bipolar disorder increase neuropsychological impairment in children and adolescents with ADHD?
Rev Bras Psiquiatr. 2014 Jan-Mar;36(1):53-9
Authors: Narvaez JC, Zeni CP, Coelho RP, Wagner F, Pheula GF, Ketzer CR, Trentini CM, Tramontina S, Rohde LA
Objective: To assess differences in executive functioning between children and adolescents with attention-deficit/hyperactivity disorder (ADHD) comorbid or not with bipolar disorder (BD), and to study the neuropsychological profile of subjects with the comorbidity in a clinical sample from a developing country. Method: Case-control study comparing 23 participants with BD + ADHD and 85 ADHD-only subjects aged 6 to 17 years old. Both groups were drug-free. Executive function domains were assessed with the Stroop Test, the Wisconsin Card Sorting Test, and the Continuous Performance Test II. Results: The group with juvenile BD + ADHD showed a significantly worse performance on the Stroop task, including time in color (p = 0.002), time in color-word (p < 0.001), interference, number or errors in color and color-word (p = 0.001), and number of errors in word cards (p = 0.028). No between-group differences were found in other tests. Conclusions: Our findings suggest that ADHD-only and ADHD + BD do not show differences in inhibitory control and set-shifting domains. However, children and adolescents with BD and comorbid ADHD show greater impairment in processing speed and interference control. This suggests a potentially higher impairment in the dorsolateral prefrontal cortex and may be a potential neuropsychological signature of juvenile BD comorbid with ADHD.
PMID: 24604462 [PubMed - in process]
Cardiovascular risk in bipolar disorder: beyond medication effects and lifestyle factors.
Rev Bras Psiquiatr. 2014 Jan-Mar;36(1):100
Authors: Soreca I, Kupfer DJ
PMID: 24604467 [PubMed - in process]
Clinical differences between unipolar and bipolar depression: interest of BDRS (Bipolar Depression Rating Scale).
Compr Psychiatry. 2013 Aug;54(6):605-10
Authors: Galvão F, Sportiche S, Lambert J, Amiez M, Musa C, Nieto I, Dubertret C, Lepine JP
OBJECTIVES: It is currently assumed that there are no important differences between the clinical presentations of unipolar and bipolar depression. Failure to distinguish bipolar from unipolar depression may lead to inappropriate treatment and poorer outcomes. We hereby compare unipolar and bipolar depressed subjects, in order to identify distinctive clinical specificities of bipolar depression.
METHODS: Two independent samples of depressed patients (unipolar and bipolar) were recruited, with 55 patients in one sample, and 49 in the other. In both samples, unipolar and bipolar patients were compared on a broad range of parameters, including sociodemographic characteristics, comorbidities, Montgomery and Asberg Depression Scale (MADRS; assessing depression severity), CORE (assessing psychomotor disturbance) and Bipolar Depression Rating Scale (assessing specific bipolar depression symptoms).
RESULTS: Results were similar in both samples. MADRS scores were similar in bipolar and unipolar subjects (median score 33 vs 34; p=0.74). On the CORE, there was a trend to higher scores among the bipolar subjects. BDRS scores were higher in bipolar than in unipolar subjects (median score 33 vs 27; p<0.001). The difference was particularly marked on the "mixed" subscale of the BDRS. We tested the ability of the mixed subscale of the BDRS to distinguish bipolar from unipolar depression, using different cut off points: a cut off point of 3 can predict bipolar depression, with a sensibility of 62% and a specificity of 82%.
CONCLUSIONS: Presence of mixed symptoms during a depressive episode is in favour of bipolar depression. The BDRS scale should be integrated in a probabilistic approach to distinguish bipolar from unipolar depression.
PMID: 23375261 [PubMed - indexed for MEDLINE]
[Association between suicidal behaviour and cyclothymic temperament in patients with recurrent depressive disorder].
Tunis Med. 2013 Aug-Sep;91(8-9):509-13
Authors: Mechri A, Kerkeni N, Hassine R, Khalfaoui S, Touati I, Bacha M
BACKGROUND: Suicidal behaviour is a major health problem, particularly among patients with depressive disorders.
AIMS: To determine the frequency of suicidal behavior among sample of patients with recurrent depressive disorder and to explore the relationship between suicidal behavior and cyclothymic temperament in these patients.
METHODS: This was a cross-sectional study bearing on 98 patients (43 men and 55 women, mean age of 46.8 ± 9.9 years) followed for recurrent depressive disorder according to the criteria of DSM-IV recruited during partial or complete recovery interval. Information about suicidal behavior was collected from medical records. Cyclothymic temperament (CT) was assessed using the cyclothymic subscale (21 items). Patients who had scores above the threshold score of 10 and were considered as cyclothymic (CT+ group) and other patients were considered non-cyclothymic (CT- group).
RESULTS: History of suicide attempts were reported in 22.4% of patients. The mean number of previous suicide attempts was significantly higher among patients in the TC+ group (0.7 ± 1.4) versus 0.2 ± 0.6 for patients in the TC- group (p=0.01). Recurrent thoughts of death and suicide attempts in the last depressive episode, were significantly higher in the CT+ group, with a 57.5% versus 24.6% in the CT- group, (p=0.001) and 33.3% versus 10.7% in the TC- group (p=0.006). A multivariate analysis retained the TC as an independent factor associated with suicidal behavior, with two other factors: the young age of patients and the frequency of previous hospitalizations.
CONCLUSION: Our findings the frequency of suicidal behavior and suggest the involvement of CT in the increased risk of suicide among patients with recurrent depressive disorder.
PMID: 24227508 [PubMed - indexed for MEDLINE]
A review of FDA-approved treatment options in bipolar depression.
CNS Spectr. 2013 Dec;18 Suppl 1:4-20; quiz 21
Authors: McIntyre RS, Cha DS, Kim RD, Mansur RB
UNLABELLED: OBJECTIVES/INTRODUCTION: Herein we review the evidence supporting Food and Drug Administration (FDA) approved and emerging treatments for bipolar depression.
METHODS: A PubMed search of all English-language articles published up to July 2013 was conducted. The search terms were quetiapine, olanzapine-fluoxetine, olanzapine, lurasidone, ketamine, modafinil/armodafinil, and lamotrigine. The search was augmented with a manual review of relevant article reference lists, as well as posters presented at national and international meetings. Articles selected for review were based on the adequacy of sample size, the use of standardized diagnostic instruments, validated assessment measures, and overall manuscript quality.
RESULTS: Olanzapine-fluoxetine combination (OFC), quetiapine, and lurasidone are FDA-approved for the acute treatment of bipolar depression. Lurasidone is the most recently approved agent for bipolar depression. Olanzapine-fluoxetine combination and quetiapine are approved as single modality therapies while lurasidone is approved as a monotherapy and as an adjunct to lithium or divalproex. The overall effect size of the 3 treatments in mitigating depressive symptoms is similar. Clinically significant weight gain and metabolic disruption as well as sedation are significant limitations of OFC and quetiapine. The minimal propensity for weight gain as well as the metabolic neutrality of lurasidone in the bipolar population is a clinically significant advantage. Evidence also supports lamotrigine with compelling evidence as an adjunct to lithium and in recurrence prevention paradigm; suggested evidence also exists for ketamine and modafinil/armodafinil; notwithstanding, these treatments remain investigational.
CONCLUSION: Relatively few agents are FDA-approved for bipolar depression. The selection and sequencing of agents in bipolar depression should give primacy to those agents that are FDA-approved. Further refinement of the selection process will need to pay careful attention to the relative hazards of weight gain and metabolic disruption in this highly susceptible population. Other agents with differential mechanisms (eg, ketamine) offer a promising alternative in bipolar depression.
PMID: 24237641 [PubMed - indexed for MEDLINE]
SSI. ALJ failed to properly evaluate woman's medical records.
AIDS Policy Law. 2013 Oct;28(11):5
PMID: 24563955 [PubMed - indexed for MEDLINE]
16th Annual Conference of the International Society for Bipolar Disorders, March 18-21, 2014, COEX - Seoul, South Korea.
Bipolar Disord. 2014 Mar;16 Suppl 1:1-132
PMID: 24593313 [PubMed - in process]
Risky alcohol use predicts temporal mismatch negativity impairments in young people with bipolar disorder.
Biol Psychol. 2014 Mar 1;
Authors: Chitty KM, Kaur M, Lagopoulos J, Hickie IB, Hermens DF
Alcohol misuse in bipolar disorder (BD) has a negative impact on illness progression. The NMDA/glutamatergic system is implicated in BD pathophysiology and is critically involved in the effects of alcohol on the brain. Mismatch negativity (MMN) is purported to reflect NMDA receptor output, providing a measure for investigating this association. Forty-two patients and 34 controls (16 - 30 years) were split into low and high-risk drinkers (based on the Alcohol Use Disorders Identification Test) and underwent a two-tone passive auditory oddball, duration deviant MMN paradigm. Multiple regression models revealed risky drinking and BD diagnosis were predictors of impaired temporal MMN. Potentially reflecting an additive effect of alcohol on a perturbed NMDA/glutamatergic system in BD, these findings highlight alcohol as both a modifiable risk factor of neurobiological impairments and as a potential confounder in MMN studies. Given the increasing use of glutamatergic agents for BD treatment, this finding is important clinically.
PMID: 24594113 [PubMed - as supplied by publisher]
Transcriptome profiling of human hippocampus dentate gyrus granule cells in mental illness.
Transl Psychiatry. 2014;4:e366
Authors: Kohen R, Dobra A, Tracy JH, Haugen E
This study is, to the best of our knowledge, the first application of whole transcriptome sequencing (RNA-seq) to cells isolated from postmortem human brain by laser capture microdissection. We investigated the transcriptome of dentate gyrus (DG) granule cells in postmortem human hippocampus in 79 subjects with mental illness (schizophrenia, bipolar disorder, major depression) and nonpsychiatric controls. We show that the choice of normalization approach for analysis of RNA-seq data had a strong effect on results; under our experimental conditions a nonstandard normalization method gave superior results. We found evidence of disrupted signaling by miR-182 in mental illness. This was confirmed using a novel method of leveraging microRNA genetic variant information to indicate active targeting. In healthy subjects and those with bipolar disorder, carriers of a high- vs those with a low-expressing genotype of miR-182 had different levels of miR-182 target gene expression, indicating an active role of miR-182 in shaping the DG transcriptome for those subject groups. By contrast, comparing the transcriptome between carriers of different genotypes among subjects with major depression and schizophrenia suggested a loss of DG miR-182 signaling in these conditions.
PMID: 24594777 [PubMed - in process]
Bipolar disorder in Pendred syndrome: A case report of two siblings.
Aust N Z J Psychiatry. 2014 Mar 4;
Authors: Chauhan S, Tripathi P, Goyal P, Kumar D
PMID: 24595510 [PubMed - as supplied by publisher]
Mindfulness-based cognitive therapy for recurrent depression: A translational research study with 2-year follow-up.
Aust N Z J Psychiatry. 2014 Mar 4;
Authors: Meadows GN, Shawyer F, Enticott JC, Graham AL, Judd F, Martin PR, Piterman L, Segal Z
Objective:While mindfulness-based cognitive therapy (MBCT) has demonstrated efficacy in reducing depressive relapse/recurrence over 12-18 months, questions remain around effectiveness, longer-term outcomes, and suitability in combination with medication. The aim of this study was to investigate within a pragmatic study design the effectiveness of MBCT on depressive relapse/recurrence over 2 years of follow-up.Method:This was a prospective, multi-site, single-blind trial based in Melbourne and the regional city of Geelong, Australia. Non-depressed adults with a history of three or more episodes of depression were randomised to MBCT + depression relapse active monitoring (DRAM) (n=101) or control (DRAM alone) (n=102). Randomisation was stratified by medication (prescribed antidepressants and/or mood stabilisers: yes/no), site of usual care (primary or specialist), diagnosis (bipolar disorder: yes/no) and sex. Relapse/recurrence of major depression was assessed over 2 years using the Composite International Diagnostic Interview 2.1.Results:The average number of days with major depression was 65 for MBCT participants and 112 for controls, significant with repeated-measures ANOVA (F(1, 164)=4.56, p=0.03). Proportionally fewer MBCT participants relapsed in both year 1 and year 2 compared to controls (odds ratio 0.45, p<0.05). Kaplan-Meier survival analysis for time to first depressive episode was non-significant, although trends favouring the MBCT group were suggested. Subgroup analyses supported the effectiveness of MBCT for people receiving usual care in a specialist setting and for people taking antidepressant/mood stabiliser medication.Conclusions:This work in a pragmatic design with an active control condition supports the effectiveness of MBCT in something closer to implementation in routine practice than has been studied hitherto. As expected in this translational research design, observed effects were less strong than in some previous efficacy studies but appreciable and significant differences in outcome were detected. MBCT is most clearly demonstrated as effective for people receiving specialist care and seems to work well combined with antidepressants.
PMID: 24595511 [PubMed - as supplied by publisher]
Diffusion tensor imaging in Alzheimer's disease and affective disorders.
Eur Arch Psychiatry Clin Neurosci. 2014 Mar 5;
Authors: Teipel SJ, Walter M, Likitjaroen Y, Schönknecht P, Gruber O
The functional organization of the brain in segregated neuronal networks has become a leading paradigm in the study of brain diseases. Diffusion tensor imaging (DTI) allows testing the validity and clinical utility of this paradigm on the structural connectivity level. DTI in Alzheimer's disease (AD) suggests a selective impairment of intracortical projecting fiber tracts underlying the functional disorganization of neuronal networks supporting memory and other cognitive functions. These findings have already been tested for their utility as clinical markers of AD in large multicenter studies. Affective disorders, including major depressive disorder (MDD) and bipolar disorder (BP), show a high comorbidity with AD in geriatric populations and may even have a pathogenetic overlap with AD. DTI studies in MDD and BP are still limited to small-scale monocenter studies, revealing subtle abnormalities in cortico-subcortial networks associated with affect regulation and reward/aversion control. The clinical utility of these findings remains to be further explored. The present paper presents the methodological background of diffusion imaging, including DTI and diffusion spectrum imaging, and discusses key findings in AD and affective disorders. The results of our review strongly point toward the necessity of large-scale multicenter multimodal transnosological networks to study the structural and functional basis of neuronal disconnection underlying different neuropsychiatric diseases.
PMID: 24595744 [PubMed - as supplied by publisher]
Letter to the Editor in response to 2012 article by Frances and Jones.
Bipolar Disord. 2014 Mar;16(2):214-5
Authors: Suppes T, Frank E, Depaulo JR, Davis L, Zarate CA, Angst J, Fawcett J
PMID: 24597757 [PubMed - in process]
Reply to Suppes et al.
Bipolar Disord. 2014 Mar;16(2):216
Authors: Frances A
PMID: 24597758 [PubMed - in process]
Type and duration of subsyndromal symptoms in youth with bipolar I disorder prior to their first manic episode.
Bipolar Disord. 2014 Mar 5;
Authors: Correll CU, Hauser M, Penzner JB, Auther AM, Kafantaris V, Saito E, Olvet D, Carrión RE, Birmaher B, Chang KD, Delbello MP, Singh MK, Pavuluri M, Cornblatt BA
OBJECTIVES: The aim of the present study was to systematically evaluate the prodrome to mania in youth.
METHODS: New-onset/worsening symptoms/signs of ? moderate severity preceding first mania were systematically assessed in 52 youth (16.2 ± 2.8 years) with a research diagnosis of bipolar I disorder (BD-I). Youth and/or caregivers underwent semi-structured interviews, using the Bipolar Prodrome Symptom Scale-Retrospective.
RESULTS: The mania prodrome was reported to start gradually in most youth (88.5%), with either slow (59.6%) or rapid (28.8%) deterioration, while a rapid-onset-and-deterioration prodrome was rare (11.5%). The manic prodrome, conservatively defined as requiring ? 3 symptoms, lasted 10.3 ± 14.4 months [95% confidence interval (CI): 6.3-14.4], being present for ? 4 months in 65.4% of subjects. Among prodromal symptoms reported in ? 50% of youth, three were subthreshold manic in nature (irritability: 61.5%, racing thoughts: 59.6%, increased energy/activity: 50.0%), two were nonspecific (decreased school/work functioning: 65.4%, mood swings/lability: 57.7%), and one each was depressive (depressed mood: 53.8%) or subthreshold manic/depressive (inattention: 51.9%). A decreasing number of youth had ? 1 (84.6%), ? 2 (48.1%), or ? 3 (26.9%) 'specific' subthreshold mania symptoms (i.e., elation, grandiosity, decreased need for sleep, racing thoughts, or hypersexuality), lasting 9.5 ± 14.9 months (95% CI: 5.0-14.0), 3.5 ± 3.5 months (95% CI: 2.0-4.9), and 3.0 ± 3.2 months (95% CI: 1.0-5.0) for ? 1, ? 2, or ? 3 specific symptoms, respectively.
CONCLUSIONS: In youth with BD-I, a relatively long, predominantly slow-onset mania prodrome appears to be common, including subthreshold manic and depressive psychopathology symptoms. This suggests that early clinical identification and intervention may be feasible in bipolar disorder. Identifying biological markers associated with clinical symptoms of impending mania may help to increase chances for early detection and prevention before full mania.
PMID: 24597782 [PubMed - as supplied by publisher]
Toward an Understanding of Decision Making in Severe Mental Illness.
J Neuropsychiatry Clin Neurosci. 2014 Mar 5;
Authors: Cáceda R, Nemeroff CB, Harvey PD
A commonality of patients with major psychiatric disorders is their propensity to make poor decisions, which is intimately related to poor real-life outcomes. We reviewed the literature on decision making as applied to severe psychiatric disorders, with particular focus on advances in cognitive neuroscience. Deficits in reward sensitivity, avoidance learning, and temporal discounting are reported in depression. Besides abnormalities in hedonic capacity, other cognitive distortions required for flexible control of behavior occur in patients with bipolar disorder and schizophrenia. A conceptual framework of abnormal decision making in mental illness could generate targeted interventions to improve quality of life and clinical outcomes.
PMID: 24599051 [PubMed - as supplied by publisher]
Mortality following hospital discharge with a diagnosis of eating disorder: National record linkage study, England, 2001-2009.
Int J Eat Disord. 2014 Mar 5;
Authors: Hoang U, Goldacre M, James A
OBJECTIVE: To calculate mortality of people with eating disorders (ED) in England, relative to that of people of the same age and sex, between 2001 and 2009. We were specifically interested in mortality amongst adolescents and young adults (15-24 years), and older adults (25-44 years).
METHOD: We analyzed a NHS Hospital Episode Statistics (HES) dataset for all England, linked to death registrations, to calculate age- and sex-specific discharge rates for people with a diagnosis of ED and their subsequent mortality by one year after discharge.
RESULTS: The standardized mortality ratio (SMR) for adolescents and young adults with a diagnosis of ED was 7.8 (95% confidence interval: 4.4-11.2). This compares with an SMR for people of the same age with schizophrenia of 10.2 (8.3-12.2), with bipolar disorder of 3.6 (1.1-6.1, and with depression of 4.5 (3.6-5.3). Of the ED, the SMR for anorexia nervosa (AN) in people aged 15-24 was 11.5 (6.0-17.0), for bulimia nervosa (BN) was 4.1 (0-8.7), and eating disorders not otherwise specified (ED NOS) was 1.4 (0-4.0). For older adults aged 25-44 years, the SMR for ED was 10.7 (7.7-13.6). Specifically, for AN was 14.0 (9.2-18.8), for BN was 7.7 (3.5-11.9), and ED NOS was 4.7 (1.4-8.0), for schizophrenia was 7.3 (6.6-7.9), for bipolar disorder was 4.3 (3.5-5.1) and for depression was 4.9 (4.6-5.3). No deaths were recorded below 15 years of age.
DISCUSSION: This study confirms the high SMR associated with ED, notably with anorexia and bulimia. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014).
PMID: 24599787 [PubMed - as supplied by publisher]
Brain regions associated with risk and resistance for bipolar I disorder: a voxel-based MRI study of patients with bipolar disorder and their healthy siblings.
Bipolar Disord. 2014 Mar 4;
Authors: Eker C, Simsek F, Y?lmazer EE, Kitis O, Cinar C, Eker OD, Coburn K, Gonul AS
OBJECTIVE: Bipolar I disorder is a highly heritable disorder but not all siblings manifest with the illness, even though they may share similar genetic and environmental risk factors. Thus, sibling studies may help to identify brain structural endophenotypes associated with risk and resistance for the disorder.
METHODS: Structural magnetic resonance imaging (MRI) scans were acquired for 28 euthymic patients with bipolar disorder, their healthy siblings, and 30 unrelated healthy controls. Statistical Parametric Mapping 8 (SPM8) was used to identify group differences in regional gray matter volume by voxel-based morphometry (VBM).
RESULTS: Using analysis of covariance, gray matter analysis of the groups revealed a group effect indicating that the left orbitofrontal cortex [Brodmann area (BA) 11] was smaller in patients with bipolar disorder than in unrelated healthy controls [F = 14.83, p < 0.05 (family-wise error); 7 mm(3) ]. Paired t-tests indicated that the orbitofrontal cortex of patients with bipolar disorder [t = 5.19, p < 0.05 (family-wise error); 37 mm(3) ] and their healthy siblings [t = 3.89, p < 0.001 (uncorrected); 63 mm(3) ] was smaller than in unrelated healthy controls, and that the left dorsolateral prefrontal cortex was larger in healthy siblings than in patients with bipolar disorder [t = 4.28, p < 0.001 (uncorrected); 323 mm(3) ] and unrelated healthy controls [t = 4.36, p < 0.001 (uncorrected); 245 mm(3) ]. Additional region-of-interest analyses also found volume deficits in the right cerebellum of patients with bipolar disorder [t = 3.92, p < 0.001 (uncorrected); 178 mm(3) ] and their healthy siblings [t = 4.23, p < 0.001 (uncorrected); 489 mm(3) ], and in the left precentral gyrus of patients with bipolar disorder [t = 3.61, p < 0.001 (uncorrected); 115 mm(3) ] compared to unrelated healthy controls.
CONCLUSIONS: The results of this study suggest that a reduction in the volume of the orbitofrontal cortex, which plays a role in the automatic regulation of emotions and is a part of the medial prefrontal network, is associated with the heritability of bipolar disorder. Conversely, increased dorsolateral prefrontal cortex volume may be a neural marker of a resistance factor as it is part of a network of voluntary emotion regulation and balances the effects of the disrupted automatic emotion regulation system.
PMID: 24589068 [PubMed - as supplied by publisher]
Parental expressed emotion and suicidal ideation in adolescents with bipolar disorder.
Psychiatry Res. 2014 Feb 18;
Authors: Ellis AJ, Portnoff LC, Axelson DA, Kowatch RA, Walshaw P, Miklowitz DJ
Family environmental variables are risk factors for recurrent courses of mood disorder in adolescents. The present study examined the association between parental expressed emotion (EE)-critical, hostile and/or emotionally overinvolved attitudes toward a concurrently ill offspring-and suicidal ideation in adolescents with bipolar disorder. The sample consisted of 95 adolescents with a bipolar I or II diagnosis who had experienced a mood episode in the prior 3 months. Participants (mean age=15.54 years, S.D.=1.4) were interviewed and completed questionnaires regarding current and past suicidal ideation prior to their participation in a treatment trial. Parents completed five-minute speech samples from which levels of EE were assessed. High EE attitudes in parents were associated with current suicidal ideation in adolescents. This relationship was independent of the effects of age, gender, current depressive or manic symptoms, comorbid diagnoses, bipolar I/II subtypes, family adaptability, and family cohesion. These results underscore the importance of addressing the emotional reactivity of caregivers in treating adolescents with bipolar disorder who have suicidal ideation.
PMID: 24589450 [PubMed - as supplied by publisher]
Consult Pharm. 2014 Mar 1;29(3):191-5
Authors: Leung JG
Objective: To report a case of mania associated with the titration of donepezil in an elderly patient.Setting: A 400-bed academic acute care psychiatric facility.Case Summary: A 70-year-old male with a history of paranoid schizophrenia, alcohol dependence, and mild cognitive impairment was admitted after concerns that he was responding to internal stimuli and exhibited increased disorganization. The patient was initiated on quetiapine, titrated to 500 mg at bedtime, to address disorganization, hallucinations, and poor sleep. After improvement of psychotic symptoms and assessment of cognitive function, donepezil 5 mg daily was initiated and titrated to 10 mg daily after two weeks. Days following the increase of donepezil to 10 mg daily, the patient exhibited symptoms of mania and became hyperverbal with elevated mood and agitation. A decreased need for sleep with an increase in cleaning activities throughout the day was noted. Donepezil was suspected to have induced the new symptoms and was discontinued. Following discontinuation, the manic symptoms completely resolved over a two-week period.Conclusion: The titration of donepezil was associated with the onset of mania. Previous trials involving off-label donepezil use in patients with bipolar disorder, but not schizophrenia, have reported the development of manic symptoms. Although rare, there is mounting evidence that donepezil is associated with the emergence of mania. Clinicians should be aware of this potential side effect in all patients treated with donepezil.
PMID: 24589768 [PubMed - in process]
Thirty-Day Prevalence of DSM-IV Mental Disorders Among Nondeployed Soldiers in the US Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).
JAMA Psychiatry. 2014 Mar 5;
Authors: Kessler RC, Heeringa SG, Stein MB, Colpe LJ, Fullerton CS, Hwang I, Naifeh JA, Nock MK, Petukhova M, Sampson NA, Schoenbaum M, Zaslavsky AM, Ursano RJ, for the Army STARRS Collaborators
IMPORTANCE Although high rates of current mental disorder are known to exist in the US Army, little is known about the proportions of these disorders that had onsets prior to enlistment. OBJECTIVE To estimate the proportions of 30-day DSM-IV mental disorders among nondeployed US Army personnel with first onsets prior to enlistment and the extent which role impairments associated with 30-day disorders differ depending on whether the disorders had pre-vs post-enlistment onsets. DESIGN, SETTING, AND PARTICIPANTS A representative sample of 5428 soldiers participating in the Army Study to Assess Risk and Resilience in Servicemembers completed self-administered questionnaires and consented to linkage of questionnaire responses with administrative records. MAIN OUTCOMES AND MEASURES Thirty-day DSM-IV internalizing (major depressive, bipolar, generalized anxiety, panic, and posttraumatic stress) and externalizing (attention-deficit/hyperactivity, intermittent explosive, alcohol/drug) disorders were assessed with validated self-report scales. Age at onset was assessed retrospectively. Role impairment was assessed with a modified Sheehan Disability Scale. RESULTS A total of 25.1% of respondents met criteria for any 30-day disorder (15.0% internalizing; 18.4% externalizing) and 11.1% for multiple disorders. A total of 76.6% of cases reported pre-enlistment age at onset of at least one 30-day disorder (49.6% internalizing; 81.7% externalizing). Also, 12.8% of respondents reported severe role impairment. Controlling for sociodemographic and Army career correlates, which were broadly consistent with other studies, 30-day disorders with pre-enlistment (?28?=?131.8, P?<?.001) and post-enlistment (?27?=?123.8, P?<?.001) ages at onset both significantly predicted severe role impairment, although pre-enlistment disorders were more consistent powerful predictors (7 of 8 disorders significant; odds ratios, 1.6-11.4) than post-enlistment disorders (5 of 7 disorders significant; odds ratios, 1.5-7.7). Population-attributable risk proportions of severe role impairment were 21.7% for pre-enlistment disorders, 24.3% for post-enlistment disorders, and 43.4% for all disorders. CONCLUSIONS AND RELEVANCE Interventions to limit accession or increase resilience of new soldiers with pre-enlistment mental disorders might reduce prevalence and impairments of mental disorders in the US Army.
PMID: 24590120 [PubMed - as supplied by publisher]