Is Maternal Smoking During Pregnancy a Risk Factor for Cigarette Smoking in Offspring? A Longitudinal Controlled Study of ADHD Children Grown Up.
J Atten Disord. 2014 Nov 21;
Authors: Biederman J, Martelon M, Woodworth KY, Spencer TJ, Faraone SV
OBJECTIVE: This study examined whether exposure to maternal smoking during pregnancy in children with and without ADHD is associated with smoking in offspring and whether this association is selective to ADHD children.
METHOD: Ninety-six exposed and 400 unexposed participants were derived from two longitudinal studies of boys and girls with and without ADHD. Maternal smoking during pregnancy was defined by interviews with participants' mothers.
RESULTS: A significant association was observed between exposure to maternal smoking in pregnancy and cigarette smoking in offspring (p = .02). Exposed offspring were also more likely to have higher rates of major depression (p = .04), bipolar disorder (p = .04), and conduct disorder (p = .04), and lower IQ (p = .01), lower Global Assessment of Functioning (GAF) score (p = .02), and more impaired Social Adjustment Inventory for Children and Adolescents (SAICA) scores versus unexposed offspring, adjusting for social class.
CONCLUSION: Maternal smoking during pregnancy was found to increase the risk for smoking and a wide range of adverse psychiatric, cognitive, and functional outcomes in youth.
PMID: 25416463 [PubMed - as supplied by publisher]
Melancholia and catatonia: disorders or specifiers?
Curr Psychiatry Rep. 2015 Jan;17(1):536
Authors: Parker G, McClure G, Paterson A
The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 defines mental disorders as syndromes and also introduced disorder "specifiers" with the aim of providing increased diagnostic specificity by defining more homogeneous subgroups of those with the disorder and who share certain features. While the majority of specifiers in DSM-5 define a specific aspect of the disorder such as age at onset or severity, some define syndromes that appear to meet the DSM-5 definition of a mental disorder. Specifically, melancholia is positioned in DSM-5 as a major depressive disorder (non-coded) specifier, while catatonia is listed as both a disorder secondary to a medical condition and as a specifier associated with other mental disorders such as schizophrenia, major depressive disorder, and bipolar disorder. Despite decades of research supporting melancholia's status as a categorical "disorder" (a higher-order construct than a specifier), failure to provide convincing support for its disorder status has contributed to its current positioning in DSM-5. As DSM-5 has similar symptom criteria for major depression and for its melancholia specifier, research seeking to differentiate melancholic and non-melancholic depression according to DSM-5 criteria will have limited capacity to demonstrate "melancholia" as a separate disorder and risks melancholia continuing to be reified as a low-order specifier and thus clinical marginalization. There have been few advances in catatonia research in recent years with its positioning largely relying on opinion and clinical observation rather than on empirical studies.
PMID: 25417594 [PubMed - in process]
Interparental violence and maternal mood disorders as predictors of adolescent physical aggression within the family.
Aggress Behav. 2014 Nov 22;
Authors: Narayan AJ, Chen M, Martinez PP, Gold PW, Klimes-Dougan B
Although a wealth of research has examined the effects of parental mood disorders on offspring maladjustment, studies have not identified whether elevated interparental violence (IPV) may be an exacerbating influence in this pathway. This study examined levels of physical IPV perpetration and victimization in mothers with unipolar depression or Bipolar Disorder (BD) and the processes by which maternal physical IPV moderated adolescents' physical aggression in families with maternal mood disorders. Mothers with lifetime mood disorders were predicted to have elevated IPV compared to well mothers, and maternal IPV was expected to moderate the association between lifetime mood disorders and adolescent aggression. Participants included 61 intact families with maternal depression (n?=?24), BD (n?=?13), or well mothers (n?=?24) and two siblings (ages 10 to 18 years). Using the Conflict Tactics Scale, mothers reported on IPV perpetration and victimization, and adolescents reported on physical aggression. Mothers with BD reported significantly higher IPV perpetration, but not victimization, than depressed or well mothers. An interaction between maternal BD and IPV perpetration was a significant predictor of adolescent aggression. Main effects of maternal IPV victimization and interaction effects of maternal depression and either type of IPV on adolescent aggression were not significant. Adolescents of mothers who have BD and perpetrate IPV may be particularly vulnerable to being aggressive. Prevention and policy efforts to deter transmission of aggression in high-risk families should target families with maternal BD and intervene at the level of conflict resolution within the family. Aggr. Behav. 9999:XX-XX, 2014. © 2014 Wiley Periodicals, Inc.
PMID: 25418790 [PubMed - as supplied by publisher]
[Physical attacks in prison, mental illness as an associated risk factor].
Rev Esp Sanid Penit. 2014 Feb;16(3):84-90
Authors: Caravaca-Sánchez F, Falcón-Romero M, Luna-Maldonado A
OBJECTIVE: To analyze physical victimization in the prison population, taking into account the existence of some kind of mental illness, in the prison of Albolote (Granada).
METHODS: 270 inmates conducted an anonymous and voluntary survey about victimization.
RESULTS: 36.7% of all inmates suffered some form of physical victimization in prison. 62.2% of participants consider that they have anxiety, depression, bipolar disorder, schizophrenia or other mental illness, half of whom receive treatment for these problems.
CONCLUSIONS: Physical attacks on people with mental illness are 2.5 times higher than on those who do not have a mental illness.
PMID: 25418828 [PubMed - in process]
Psychiatric comorbidities in patients with major depressive disorder.
Neuropsychiatr Dis Treat. 2014;10:2097-2103
Authors: Thaipisuttikul P, Ittasakul P, Waleeprakhon P, Wisajun P, Jullagate S
BACKGROUND: Psychiatric comorbidities are common in major depressive disorder (MDD). They may worsen outcome and cause economic burden. The primary objective was to examine the prevalence of psychiatric comorbidities in MDD. The secondary objectives were to compare the presence of comorbidities between currently active and past MDD, and between patients with and without suicidal risk.
METHODS: This was a cross-sectional study. A total of 250 patients with lifetime MDD and age ?18 years were enrolled. The Mini International Neuropsychiatric Interview (MINI), Thai version, was used to confirm MDD diagnosis and classify comorbidities. MDD diagnosis was confirmed in 190, and 60 patients were excluded due to diagnosis of bipolar disorder.
RESULTS: Of the 190 MDD patients, 25.8% had current MDD and 74.2% had past MDD. Eighty percent were women. The mean age at enrollment was 50 years, and at MDD onset was 41 years. Most patients were married (53.2%), employed (54.8%), and had ?12 years of education (66.9%). There were 67 patients (35.3%) with one or more psychiatric comorbidities. Comorbidities included dysthymia (19.5%), any anxiety disorders (21.1%) (panic disorder [6.8%], agoraphobia [5.8%], social phobia [3.7%], obsessive-compulsive disorder [OCD] [4.7%], generalized anxiety disorder [5.3%], and post-traumatic stress disorder [4.2%]), alcohol dependence (0.5%), psychotic disorder (1.6%), antisocial personality (1.1%), and eating disorders (0%). Compared with past MDD, the current MDD group had significantly higher OCD (P<0.001), psychotic disorder (P=0.048), past panic disorder (P=0.017), and suicidal risk (P<0.001). Suicidal risk was found in 32.1% of patients. Patients with suicidal risk had more comorbid anxiety disorder of any type (P=0.019) and psychotic disorder (P=0.032).
CONCLUSION: Several comorbidities were associated with MDD. Patients with active MDD had higher comorbid OCD, psychotic disorder, past panic disorder, and suicidal risk. Patients with suicide risk had higher comorbid anxiety and psychotic disorders.
PMID: 25419132 [PubMed - as supplied by publisher]
Hypomanic Experience in Young Adults Confers Vulnerability to Intrusive Imagery After Experimental Trauma: Relevance for Bipolar Disorder.
Clin Psychol Sci. 2014 Nov;2(6):675-684
Authors: Malik A, Goodwin GM, Hoppitt L, Holmes EA
Emotional mental imagery occurs across anxiety disorders, yet is neglected in bipolar disorder despite high anxiety comorbidity. Furthermore, a heightened susceptibility to developing intrusive mental images of stressful events in bipolar disorder and people vulnerable to it (with hypomanic experience) has been suggested. The current study assessed, prospectively, whether significant hypomanic experience (contrasting groups scoring high vs. low on the Mood Disorder Questionnaire, MDQ) places individuals at increased risk of visual reexperiencing after experimental stress. A total of 110 young adults watched a trauma film and recorded film-related intrusive images for 6 days. Compared to the low MDQ group, the high MDQ group experienced approximately twice as many intrusive images, substantiated by convergent measures. Findings suggest hypomanic experience is associated with developing more frequent intrusive imagery of a stressor. Because mental imagery powerfully affects emotion, such imagery may contribute to bipolar mood instability and offer a cognitive treatment target.
PMID: 25419498 [PubMed - as supplied by publisher]
Predominant polarity in bipolar disorder and validation of the polarity index in a German sample.
BMC Psychiatry. 2014 Nov 22;14(1):322
Authors: Volkert J, Zierhut KC, Schiele MA, Wenzel M, Kopf J, Kittel-Schneider S, Reif A
BackgroundA large number of patients with bipolar disorder (BD) can be characterized by predominant polarity (PP), which has important implications for relapse prevention. Recently, Popovic et al. (EUR NEUROPSYCHOPHARM 22(5): 339¿346, 2012) proposed the Polarity Index (PI) as a helpful tool in the maintenance treatment of BD. As a numeric expression, it reflects the efficacy of drugs used in treatment of BD. In the present retrospective study, we aimed to validate this Index in a large and well characterized German bipolar sample.MethodsWe investigated 336 bipolar patients (BP) according to their PP and calculated the PI for each patient in order to prove if maintenance treatment differs according to their PP. Furthermore, we analysed whether PP is associated with demographic and clinical characteristics of BP.ResultsIn our sample, 63.9% of patients fulfilled criteria of PP: 169 patients were classified as depressive predominant polarity (DPP), 46 patients as manic predominant polarity (MPP). The two groups differed significantly in their drug regime: Patients with DPP were more often medicated with lamotrigine and antidepressants, patients with MPP were more often treated with lithium, valproate, carbamazepine and first generation antipsychotics. However, patients with DPP and MPP did not differ significantly with respect to the PI, although they received evidence-based and guideline-driven treatment.ConclusionThe reason for this negative finding might well be that for several drugs, which were used frequently, no PI value is available. Nevertheless we suggest PP as an important concept in the planning of BD maintenance treatment.
PMID: 25412678 [PubMed - as supplied by publisher]
Treating the bipolar spectrum mixed states: a new rating scale to diagnose them.
Psychiatr Danub. 2014 Nov;26 Suppl 1:6-9
Authors: Tavormina G
The mixed states are the most serious clinical state in the bipolar spectrum, having the major risk of sucidality among all sub-types of the spectrum. The aim of this study is to help diagnosis and treatment of the patients having bipolar disorder mixed state, giving to psychiatrists and physicians a new efficacy rating scale focusing on this illness.
PMID: 25413502 [PubMed - in process]
Could bipolarity be influenced by stressful life events? A reflection based on a case report.
Psychiatr Danub. 2014 Nov;26 Suppl 1:31-5
Authors: Bries A, Reynaert C, Zdanowicz N
INTRODUCTION: Bipolar disorder (BPD) has over the last fifteen years been considered as a biological disease with genetic bases, possibly triggered by stress factors. On the basis of a clinical case, we will question this theory.
SUBJECT AND METHODS: Mrs. X, a patient with a history of domestic violence, has two manic episodes that corresponded with conjugal difficulties. This would lead us to believe that stressful life events may have triggered the onset and the relapse of the illness of our patient. To confirm this, we made a literature review with the keywords bipolar disorder, stress, family functioning and domestic violence on three databases: PubMed, PsycInfo and PsycArticles.
RESULTS: Studies show that BPD has likely genetic and biological origins. It is also established in the literature that stressful life events influence the course of the disease, with for example the "Kindling" effect. However, there is very few data regarding the precise nature of these events. It is also established that the family interactions are affected by the BPD. Nonetheless, little is known about the influence of the family's interactions on the onset of the disease.
CONCLUSIONS: Our clinical case raises the question of the stress factors that may influence the onset and the course of BPD. It also raises the question of the possible link between BPD and domestic violence and the question of theeffect of stressors on the genetic and biological factors, introducing a more psychodynamic view of BPD. Further research on this subject should allow us to expand the treatment to more comprehensive care.
PMID: 25413508 [PubMed - in process]
Depression in Later-life: An Overview of Assessment and Management.
Psychiatr Danub. 2014 Nov;26 Suppl 1:78-84
Authors: Dines P, Hu W, Sajatovic M
The elderly are the fastest growing segment of the global population with the number of people age 60 or older having doubled since 1980 and the number of people age 80 or older expected to increase more than 4-fold (to 395 million) by the year 2050. While depression is overall less common in older people compared to younger people, there are sub-groups of elderly, such as those with significant medical comorbidity, who are at greatly elevated risk for depression. Negative consequences of late-life depression include functional decline and disability, increased use of non-mental health services, increased mortality rates due to cardiovascular causes, increased cancer rates, and substantially greater risk for suicide. Geriatric suicide is a global epidemic, which is worsened in many countries and cultures by socioeconomic disparities and cultural/social upheaval. Geriatric depression should be carefully assessed and treated. Treatments for geriatric depression include biological modalities such as antidepressant medications and Electroconvulsive therapy (ECT) as well as psychotherapy and psychosocial interventions. When they are prescribed pharmacotherapies for depression, older adults are especially likely to experience adverse drug effects as a result of their multiple chronic diseases, use of multiple concomitant medications, and the pharmacokinetic and pharmacodynamic changes that accompany aging. Antidepressants that minimize side effects are generally preferred in elderly individuals although the expected therapeutic response to drug treatment is generally modest. Psychosocial and psychotherapeutic measures can also be effective in late-life depression. Complexities of assessment and treatment include the risk of missing a bipolar depressive diagnosis, which would contra-indicate the use of antidepressant monotherapy. Given the projected increased proportions and overall numbers of older people with mental disorders there is a need for all clinicians to be familiar with mental health issues in elderly patients.
PMID: 25413518 [PubMed - in process]
Health Technology Assessment and Social Network in Mental Health: a pilot study to evaluate use of new technology communication in prevention, monitoring and treatment of mental disorders in Trentino region.
Psychiatr Danub. 2014 Nov;26 Suppl 1:142-3
Authors: Di Napoli W, Andreatta O
The clinical use of Information Communication Technology tools can facilitate the support of population groups at risk and / or with chronic conditions. Social networks and other forms of communication represent an opportunity to improve the quality of care and patient empowerment. The study intends to evaluate, in accordance with the dictates of the HTA, the possibilities related to the use of social networking technologies in the prevention and taking care of mental illness. On the basis of these results and in agreement with the context of the Trentino health system, several application proposals will be developed for the treatment of patients with bipolar disorder. The conclusion of the evaluation, and the related clinical and organizational data to support the implementation process in the Trentino health system is expected in the month of October 2014.
PMID: 25413531 [PubMed - in process]
Comorbidities and psychotic illness. Part 1: Philosophy and clinical consequences.
Psychiatr Danub. 2014 Nov;26 Suppl 1:246-9
Authors: Agius M, Aquilina FF
This article aims at addressing the implications of defining 'comorbidity' within the field of psychiatry. We have looked at the standard definition of comorbidity and then discussed whether this definition can be applied to comorbidities in psychiatry. While comorbidities in physical illness are clearly the coexistence of two independent illnesses, Comorbidities in Mental illness are the result of the polygenic nature of mental illnesses, especially in psychotic illness whether schizophrenia or bipolar disorder. As a consequence, often the comorbidities of psychiatric illness are caused by two conditions which have in common the presence of particular single nucleotide polymorphisms (snps), which regulate the metabolism of neurotransmitters or the presence of neurotrophic factors . Thus inevitably, many such comorbidities are inextricably linked. We discuss the consequences of this form of comorbidity for the description, classification, and risk profile of mental illness.
PMID: 25413548 [PubMed - in process]
The multifactorial etiology of eating disorders outlined in a case of anorexia nervosa and complicated by psychiatric co-morbidities.
Psychiatr Danub. 2014 Nov;26 Suppl 1:250-5
Authors: Aquilina FF, Agius M, Sharma K
This article outlines a case of anorexia nervosa within the context of its multifactorial etiology and complex neurobiology. Additionally, it also highlights that in this case there were several co-morbid personality traits and other psychiatric co-morbidites such as OCD and bipolar disorder.
PMID: 25413549 [PubMed - in process]
Bipolar disorder: The importance of clinical assessment in identifying prognostic factors - An Audit. Part 1: An analysis of potential prognostic factors.
Psychiatr Danub. 2014 Nov;26 Suppl 1:289-300
Authors: Verdolini N, Dean J, Elisei S, Quartesan R, Zaman R, Agius M
BACKGROUND: Prognostic factors of bipolar disorder must be identified to assist in staging and treatment, and this may be done primarily during the initial psychiatric assessment. In fact, most of the prognostic factors, which determine disease outcome, could be detected from simple but often-unrecorded questions asked during the psychiatric clinic visit.
METHODS: We collected data from the clinical notes of 70 bipolar outpatients seen at the initial psychiatric assessment clinic about socio-demographic and clinical factors to determine whether various factors had relevance to prevalence, prognosis, or outcome.
RESULTS: The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) outpatients; a psychiatric comorbidity was noted in 26 patients (37.1%). 60.9% (42 patients) reported anxiety features and 12 patients (17.6%) were noted to have obsessive-compulsive characteristics. Percentages reported in our results are of the sample for which the data was available. Anhedonia is a depressive feature that was present in most of the population where this data was available (92.2%, 59 patients) and 81.8% (54 patients) reported suicidal thoughts during a depressive episode. 74.6% (47 patients) had a family history of bipolar disorder, depression, suicide or psychosis. 27 patients (39.7%) reported current alcohol use and 14 patients (22.6%) current illicit drug use. A comparison between 10 prognostic factors found that only the correlations between current illicit drug use/previous illicit drug use (?(2)=11.471, P<0.001), current alcohol use/previous alcohol use (?(2)=31.510, P<0.001) and current illicit drug use/anxiety (?(2)=5.094, P=0.022) were statistically significant; the correlation between previous illicit drug use/previous alcohol use (?(2)=5.071, P=0.023) and previous alcohol use/family history (?(2)=4.309, P=0.037) were almost statistically significant. 17 patients (24.3%) of the 70 bipolar patients were assigned to a care coordinator; we have evaluated the possible differences between the patients with or without a care coordinator on the basis of the presence of 10 possible prognostic factors and found no statistically significant differences between these two groups of patients.
CONCLUSIONS: We have identified several trends in our patients with bipolar disorder that agree with previous research. Our sample suggested that the assignation of a care coordinator is not done on a clinical basis. In our sample, some patients were found not to have information available so we suggest that a questionnaire to remind clinicians of potentially useful information would be helpful to aid in prognostication. In particular, specific features of the disease, like family history, age at onset, and features of depressive episodes may be highlighted as our sample suggests that these are often unrecorded when not known or negative.
PMID: 25413555 [PubMed - in process]
Bipolar disorder: The importance of clinical assessment in identifying prognostic factors - An Audit. Part 2: Mixed state features and rapid cycling.
Psychiatr Danub. 2014 Nov;26 Suppl 1:301-8
Authors: Verdolini N, Dean J, Elisei S, Quartesan R, Zaman R, Agius M
BACKGROUND: Rapid cycling in bipolar disorder complicates the clinical picture and worsens the long-term outcomes of bipolar disorder. Mixed states features do similarly and are known to present an increased risk to patients. Early recognition of these patterns can lead to better treatment strategies and improvement of the long-term course of the disease.
METHOD: We collected data from the clinical notes of 70 bipolar outpatients seen at an ASPA (initial assessment) clinic about socio-demographic and clinical characteristics.
RESULTS: The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) outpatients; percentages reported in our results are of the sample for which the data was available. 71.7% (33 patients) of the sample reported mixed states features and 32 patients (72.7%) are recorded to have more than 4 changes in mood in a year. There were no statistically significant correlations between mixed state features or rapid cycling and anhedonia, suicidal ideation, borderline symptoms, OCD symptoms, anxiety, positive psychiatric family history, current alcohol use, previous alcohol use, current illicit drug use, or previous illicit drug use. An almost significant correlation was found between mixed state features and anxiety. Assignation of a care coordinator did not seem to be associated with these prognostic factors.
CONCLUSIONS: The two subgroups of mixed state features and rapid cycling patients share very common clinical characteristics: high incidence of suicidal thoughts, high levels of anxiety, and high previous substance use - but low levels of current alcohol and drug use and high levels of features of atypical depression. These features of mixed state bipolar disorder and rapid cycling bipolar disorder should be identified during psychiatric assessment to identify useful information for prognosis.
PMID: 25413556 [PubMed - in process]
Bipolar disorder: The importance of clinical assessment in identifying prognostic factors - An Audit. Part 3: A comparison between Italian and English mental health services and a survey of bipolar disorder.
Psychiatr Danub. 2014 Nov;26 Suppl 1:309-14
Authors: Verdolini N, Dean J, Massucci G, Elisei S, Quartesan R, Zaman R, Agius M
BACKGROUND: Most of the prognostic factors of bipolar disorder, which determine disease course and outcome, could be detected from simple but often-unrecorded questions asked during the psychiatric clinic assessments. In previous parts of this research, we analysed various prognostic factors and focused on mixed states and rapid cycling subsets. We now compare our sample in England with a small sample from Italy to demonstrate the utility of focused prognostic questioning and of international comparison.
METHODS: We collected data from the clinical notes of 70 English bipolar and 8 Italian bipolar outpatients seen at the initial psychiatric assessment clinic about socio-demographic and clinical factors to determine whether various factors had relevance to prevalence, prognosis, or outcome.
RESULTS: The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) English outpatients and 7 bipolar I (87.5%) and 1 bipolar II (12.5%) Italian outpatients. Differences between the groups are seen mainly in terms of age of onset, duration of both depressive and hypomanic episodes, presence of psychiatric family history, incidence of mixed state features and rapid cycling, presence of elated mood in response to past antidepressant treatment, and misuse of illicit drugs and alcohol.
CONCLUSIONS: In order to promote improved mental health primary care, mental health systems in all countries should develop standardized epidemiological tools that are shared between countries. We recommend the use of a questionnaire that reminds clinicians of potentially prognostic information and suggest that this might identify important components of a potential standardized diagnostic and prognostic tool.
PMID: 25413557 [PubMed - in process]
Atypical Anti-Psychotics in Adult Bipolar Disorder: Current Evidence and Updates in the NICE guidelines.
Psychiatr Danub. 2014 Nov;26 Suppl 1:322-9
Authors: Poo SX, Agius M
BACKGROUND: The introduction of atypical antipsychotics in the management of adult bipolar disorder has been increasingly adopted in clinical setting. While new studies continue to emerge, NICE has recently updated the guidelines on the assessment and management of bipolar disorder.
AIM: To review the efficacy and tolerability profiles of atypical antipsychotics used to treat adult bipolar disorder in clinical practice, in relation to the latest NICE guidelines.
METHODS: The recent NICE guidelines (CG185), published in September 2014 was analysed to identify second generation antipsychotics (SGA) for the various presentations of bipolar disorder in adults. A qualitative literature search was conducted to review the evidence to support these changes, and identify randomized controlled trials on off-label and newer SGAs.
RESULTS AND CONCLUSIONS: With respect to atypical antipsychotics, NICE guidelines introduced olanzapine and fluoxetine combination therapy as first line treatment for moderate to severe bipolar depression; and improved clarity on the treatment of mania, hypomania and rapid cycling bipolar disorder. Evidence from our literature search favour these changes; and recognized other atypical antipsychotics such as aripiprazole, asenapine, lurasidone, ziprasidone and clozapine which could be of potential clinical benefit.
PMID: 25413559 [PubMed - in process]
Co-Morbidity Part 2 - Neurobiology and Suicide Risk; Modelling the consequences of Bipolar and Anxiety Co-Morbidity.
Psychiatr Danub. 2014 Nov;26 Suppl 1:336-9
Authors: Agius M, Verdolini N, Aquilina FF, Butler S
We review the evidence that Bipolar Disorder with Comorbid Anxiety, Rapid Cycling Bipolar Disorder, Mixed Affective states, are all related to each other and to Dopamine Transmission in Bipolar Disorder. All these states are related to the presence of particular polymorphisms of the genes of the D2 and D3 receptors. All these states increase the risk of suicidality. Substance and alcohol abuse comorbid with bipolar disorder increases the risk of both Rapid Cycling and Suicidality. We present a model which demonstrates these relationships.
PMID: 25413561 [PubMed - in process]
Internet-delivered cognitive behavior therapy for anxiety disorders is here to stay.
Curr Psychiatry Rep. 2015 Jan;17(1):533
Authors: Andrews G, Newby JM, Williams AD
Anxiety disorders are common and disabling. Cognitive behavior therapy is the treatment of choice but is often difficult to obtain. Automated, internet-delivered, cognitive behavior therapy (iCBT) courses may be an answer. There are three recent systematic reviews of randomized controlled trials that show that the benefits are substantial (d?=?1.0) and similar to face to face CBT. There are two large effectiveness trials that demonstrate strong effects when iCBT is used in primary care; 60 % of patients who complete the courses no longer meet diagnostic criteria. The courses are suitable for most people with a primary anxiety disorder. Research studies usually exclude people whose anxiety is secondary to schizophrenia, bipolar disorder, or substance abuse or who are actively suicidal. Little additional input from clinicians is required. Patients find the courses very convenient. Clinically, the principal advantage is the fidelity of the treatment. What you prescribe is what the patient sees.
PMID: 25413639 [PubMed - in process]
Neuroinformatic analyses of common and distinct genetic components associated with major neuropsychiatric disorders.
Front Neurosci. 2014;8:331
Authors: Lotan A, Fenckova M, Bralten J, Alttoa A, Dixson L, Williams RW, van der Voet M
Major neuropsychiatric disorders are highly heritable, with mounting evidence suggesting that these disorders share overlapping sets of molecular and cellular underpinnings. In the current article we systematically test the degree of genetic commonality across six major neuropsychiatric disorders-attention deficit hyperactivity disorder (ADHD), anxiety disorders (Anx), autistic spectrum disorders (ASD), bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia (SCZ). We curated a well-vetted list of genes based on large-scale human genetic studies based on the NHGRI catalog of published genome-wide association studies (GWAS). A total of 180 genes were accepted into the analysis on the basis of low but liberal GWAS p-values (<10(-5)). 22% of genes overlapped two or more disorders. The most widely shared subset of genes-common to five of six disorders-included ANK3, AS3MT, CACNA1C, CACNB2, CNNM2, CSMD1, DPCR1, ITIH3, NT5C2, PPP1R11, SYNE1, TCF4, TENM4, TRIM26, and ZNRD1. Using a suite of neuroinformatic resources, we showed that many of the shared genes are implicated in the postsynaptic density (PSD), expressed in immune tissues and co-expressed in developing human brain. Using a translational cross-species approach, we detected two distinct genetic components that were both shared by each of the six disorders; the 1st component is involved in CNS development, neural projections and synaptic transmission, while the 2nd is implicated in various cytoplasmic organelles and cellular processes. Combined, these genetic components account for 20-30% of the genetic load. The remaining risk is conferred by distinct, disorder-specific variants. Our systematic comparative analysis of shared and unique genetic factors highlights key gene sets and molecular processes that may ultimately translate into improved diagnosis and treatment of these debilitating disorders.
PMID: 25414627 [PubMed - as supplied by publisher]
Addiction and reward-related genes show altered expression in the postpartum nucleus accumbens.
Front Behav Neurosci. 2014;8:388
Authors: Zhao C, Eisinger BE, Driessen TM, Gammie SC
Motherhood involves a switch in natural rewards, whereby offspring become highly rewarding. Nucleus accumbens (NAC) is a key CNS region for natural rewards and addictions, but to date no study has evaluated on a large scale the events in NAC that underlie the maternal change in natural rewards. In this study we utilized microarray and bioinformatics approaches to evaluate postpartum NAC gene expression changes in mice. Modular Single-set Enrichment Test (MSET) indicated that postpartum (relative to virgin) NAC gene expression profile was significantly enriched for genes related to addiction and reward in five of five independently curated databases (e.g., Malacards, Phenopedia). Over 100 addiction/reward related genes were identified and these included: Per1, Per2, Arc, Homer2, Creb1, Grm3, Fosb, Gabrb3, Adra2a, Ntrk2, Cry1, Penk, Cartpt, Adcy1, Npy1r, Htr1a, Drd1a, Gria1, and Pdyn. ToppCluster analysis found maternal NAC expression profile to be significantly enriched for genes related to the drug action of nicotine, ketamine, and dronabinol. Pathway analysis indicated postpartum NAC as enriched for RNA processing, CNS development/differentiation, and transcriptional regulation. Weighted Gene Coexpression Network Analysis (WGCNA) identified possible networks for transcription factors, including Nr1d1, Per2, Fosb, Egr1, and Nr4a1. The postpartum state involves increased risk for mental health disorders and MSET analysis indicated postpartum NAC to be enriched for genes related to depression, bipolar disorder (BPD), and schizophrenia. Mental health related genes included: Fabp7, Grm3, Penk, and Nr1d1. We confirmed via quantitative PCR Nr1d1, Per2, Grm3, Penk, Drd1a, and Pdyn. This study indicates for the first time that postpartum NAC involves large scale gene expression alterations linked to addiction and reward. Because the postpartum state also involves decreased response to drugs, the findings could provide insights into how to mitigate addictions.
PMID: 25414651 [PubMed - as supplied by publisher]
Progress in the Study of the Effects of Exercise on Affective and Anxiety Disorders.
Front Psychiatry. 2014;5:153
Authors: Schuch FB
PMID: 25414673 [PubMed - as supplied by publisher]
WORKING MEMORY IMPAIRMENT AS AN ENDOPHENOTYPIC MARKER OF A SCHIZOPHRENIA DIATHESIS.
Schizophr Res Cogn. 2014 Sep 1;1(3):127-136
Authors: Park S, Gooding DC
This chapter focuses on the viability of working memory impairment as an endophenotypic marker of a schizophrenia diathesis. It begins with an introduction of the construct of working memory. It follows with a review of the operational criteria for defining an endophenotype. Research findings regarding the working memory performance of schizophrenia and schizophrenia-spectrum patients, first-degree relatives of schizophrenia patients and healthy controls, are reviewed in terms of the criteria for being considered an endophenotypic marker. Special attention is paid to specific components of the working memory deficit (namely, encoding, maintenance, and manipulation), in terms of which aspects are likely to be the best candidates for endophenotypes. We consider the extant literature regarding working memory performance in bipolar disorder and major depression in order to address the issue of relative specificity to schizophrenia. Despite some unresolved issues, it appears that working memory impairment is a very promising candidate for an endophenotypic marker of a schizophrenia diathesis but not for mood disorders. Throughout this chapter, we identify future directions for research in this exciting and dynamic area of research and evaluate the contribution of working memory research to our understanding of schizophrenia.
PMID: 25414816 [PubMed - as supplied by publisher]
GADL1 gene polymorphisms and lithium response in bipolar I disorder: lack of association from an Indian population.
Psychiatr Genet. 2014 Nov 20;
Authors: Kotambail A, Mathur A, Bhat SM, Rai PS, Sharma PS, Satyamoorthy K
PMID: 25415457 [PubMed - as supplied by publisher]
Personality development and intellectual disability.
Curr Opin Psychiatry. 2014 Nov 19;
Authors: Roy M, Retzer A, Sikabofori T
PURPOSE OF REVIEW: This review examines the factors that shape personality and how they can inform on the behaviour of people with intellectual disability both to help them function at least at their cognitive level and add a developmental dimension to treatment plans.
RECENT FINDINGS: People with intellectual disability experience more failure, rejection and social deprivation leading to personality traits that may impede their ability to learn and predispose them to depression. Brain changes due to genetic conditions may be responsible for the behavioural phenotypes, although the autism phenotype is associated with different causes. Schizophrenia has a strong neurodevelopmental component and it could be on a gradient of decreasing neurodevelopmental impairment between intellectual disability and autism on one hand and bipolar disorder on the other.
SUMMARY: Understanding how early-life experience and current-life situations give rise to personality traits and taking a developmental perspective, for example, mental age, could clarify the clinical presentation. Developments in molecular genetics and brain imaging may clarify how brain changes lead to personality features. Finally, it may be time to address whether it is still helpful to have categorical diagnoses when there is increasing evidence from genetic studies supporting a continuum of neurodevelopmental disorders.
PMID: 25415494 [PubMed - as supplied by publisher]
Reward processing dysfunction in major depression, bipolar disorder and schizophrenia.
Curr Opin Psychiatry. 2014 Nov 19;
Authors: Whitton AE, Treadway MT, Pizzagalli DA
PURPOSE OF REVIEW: This article reviews the recent literature on reward processing dysfunction in major depression (MDD), bipolar disorder and schizophrenia, with a focus on approach motivation, reward learning and reward-based decision-making.
RECENT FINDINGS: Emerging evidence indicates the presence of reward processing abnormalities across all three disorders, supporting a transdiagnostic approach. In particular, findings are consistent with a role of abnormal phasic striatal dopamine signaling, which is critical for reinforcement learning, efficient mobilization of effort to obtain reward and allocation of attention to reward-predictive cues. Specifically, reward-related striatal signaling appears blunted in MDD and the negative symptoms of schizophrenia, elevated in bipolar (hypo)mania, and contextually misallocated in the positive symptoms of psychosis. However, whether shared or distinct pathophysiological mechanisms contribute to abnormal striatal signaling across the three disorders remains unknown.
SUMMARY: New evidence of reward processing abnormalities in MDD, bipolar disorder and schizophrenia has led to a greater understanding of the neural processes associated with symptomatology common across these conditions (e.g., anhedonia). Dissecting various subcomponents of reward processing that map onto partially different neurobiological pathways and investigating their dysregulation in different psychiatric disorders holds promise for developing more targeted, and hopefully efficacious treatment and intervention strategies.
PMID: 25415499 [PubMed - as supplied by publisher]
The status of screening measures for bipolar disorder.
Curr Opin Psychiatry. 2014 Nov 19;
Authors: Graham RK, Parker GB
PURPOSE OF REVIEW: Screening measures for bipolar disorder are positioned as playing an important role in improving diagnostic accuracy. This review considers the principal screening measures developed over the past decade.
RECENT FINDINGS: Although the development and evaluation of bipolar screening measures were distinct between 2000 and 2010, there has been a decrease in research and evaluation in recent years. This article considers the main impetus for the development of screening measures for bipolar disorder and provides a description and critique of the principal measures used in both clinical and community settings.
SUMMARY: Screening measures have an important role in identifying bipolar disorder but are best positioned as a first-stage strategy rather than as definitive diagnostic measures. Although several have been developed and well validated in clinical settings, there is a distinct need for extension studies exploring their classificatory properties in community settings as well as clinical impact studies to determine their 'real world' utility.
PMID: 25415500 [PubMed - as supplied by publisher]
Hyperbaric Oxygen Therapy for Adults with Mental Illness: A Review of the Clinical Effectiveness
Book. 2014 08 27
Mental illness, including major depressive episode, bipolar disorder, generalized anxiety disorder, alcohol abuse, and other drug abuse or dependence, affects approximately 1 in 3 Canadians at some point in their lives. Depression is the most common mood disorder, with a lifetime incidence of 11.3%, while the lifetime incidence of generalized anxiety disorder is 8.7%. Hyperbaric oxygen therapy (HBOT) is administered inside a treatment chamber and provides the patient with 100% oxygen at high atmospheric pressures. There have been a number of medical conditions in which treatment with hyperbaric oxygen has been investigated, including, but not limited to, treatment of carbon monoxide poisoning, improved wound healing, and decompression sickness and air embolism due to ascending too quickly in aviation or deep water diving. It has been hypothesized that hyperbaric oxygen therapy may be beneficial in the treatment of certain mental health disorders such as post-traumatic stress disorder occurring in the setting of a traumatic brain injury. In an uncontrolled pre-post study, a group of patients with blast-induced post-concussion syndrome with or without post-traumatic stress disorder demonstrated improvement in a number of physical, psychological, and cognitive measured hen tested within a week of completing 30 days of HBOT. The proposed mechanism of action of hyperbaric oxygen in traumatic brain injury is that increasing oxygenation of blood and tissues to supraphysiological levels results in the improvement of neuronal functioning by the reactivation of metabolic or electrical pathways. Stem cell mobilization to sites of injury, immune modulation and impact on neurotransmitters have also been hypothesized as possible mechanisms. Currently, the value of using hyperbaric oxygen therapy in the treatment of mental illness has not been well-established. The purpose of this report was to review existing studies on the use of hyperbaric oxygen therapy for adults with post-traumatic stress disorder, generalized anxiety disorder, or depression.
Myelin versus Axon Abnormalities in White Matter in Bipolar Disorder.
Neuropsychopharmacology. 2014 Nov 20;
Authors: Lewandowski KE, Ongür D, Sperry SH, Cohen BM, Sehovic S, Goldbach JR, Du F
White matter (WM) abnormalities are among the most commonly reported neuroimaging findings in bipolar disorder. Nonetheless, the specific nature and pathophysiology of these abnormalities remains unclear. Use of a combination of magnetization transfer ratio (MTR) and diffusion tensor spectroscopy (DTS) permits examination of myelin and axon abnormalities separately. We aimed to examine myelination and axon geometry in euthymic patients with bipolar disorder with psychosis (BDP) by combining these two complementary non-invasive MRI techniques. We applied a combined MRI approach using MTR to study myelin content and DTS to study metabolite (NAA) diffusion within axons in patients with BDP (n=21) and healthy controls (n=24). Data were collected from a 1 × 3 × 3?cm voxel within the right prefrontal cortex WM at 4 Tesla. Clinical and cognitive data were examined in association with MTR and DTS data. MTR was significantly reduced in BDP, suggesting reduced myelin content. The apparent diffusion coefficient of N-acetylaspartate (NAA) did not differ from healthy controls, suggesting no changes in axon geometry in patients with BDP. These findings suggest that patients with BDP exhibit reduced myelin content, but no changes in axon geometry compared to controls. These findings are in contrast with our recent findings, using the same techniques, in patients with schizophrenia (SZ), which suggest both myelination and axon abnormalities in SZ. This difference may indicate that alterations in WM in BDP may have unique causes and may be less extensive than WM abnormalities seen in SZ.Neuropsychopharmacology accepted article preview online, 20 November 2014. doi:10.1038/npp.2014.310.
PMID: 25409595 [PubMed - as supplied by publisher]
Decreased quinolinic acid in the hippocampus of depressive patients: evidence for local anti-inflammatory and neuroprotective responses?
Eur Arch Psychiatry Clin Neurosci. 2014 Nov 20;
Authors: Busse M, Busse S, Myint AM, Gos T, Dobrowolny H, Müller UJ, Bogerts B, Bernstein HG, Steiner J
Disturbances of glutamatergic neurotransmission and mononuclear phagocyte system activation have been described uni- and bipolar depression (UD/BD). Linking the glutamate and immune hypotheses of depression, quinolinic acid (QUIN) is synthesized by activated microglia and acts as an endogenous N-methyl-D-aspartate glutamate receptor (NMDA-R) agonist with neurotoxic properties. Recently, we observed an increased microglial QUIN expression in the subgenual and supracallosal, but not in the pregenual part of the anterior cingulate cortex in postmortem brains of suicide cases with severe depression. Since several hints point to a role of the hippocampus in depression, we extended our study and addressed the question whether microglial QUIN is also changed in subregions of the hippocampus (CA1 and CA2/3 areas) in these patients. Postmortem brains of 12 acutely depressed patients (UD, n = 6; BD, n = 6) and 10 neuropsychiatric healthy age- and gender-matched control subjects were analyzed using QUIN-immunohistochemistry. Hippocampal volumes were determined in order to assess possible neurotoxic or neurodegenerative aspects. Microglial QUIN expression in the whole group of depressed patients was either comparable (left CA1, right CA2/3) or decreased (right CA1: p = 0.004, left CA2/3: p = 0.044) relative to controls. Post hoc tests showed that QUIN was reduced both in UD and BD in the right CA1 field (UD, p = 0.048; BD, p = 0.031). No loss of hippocampal volume was detected. Our data indicate that UD and BD are associated with a local reduction in QUIN-immunoreactive microglia in the hippocampus and underline the importance of the NMDA-R signaling in depressive disorders.
PMID: 25409655 [PubMed - as supplied by publisher]