Manic episodes associated with tramadol: a case report.
J Clin Psychopharmacol. 2015 Feb;35(1):111-3
Authors: Ceylan D, Kaçar M, Ula? H
PMID: 25357197 [PubMed - indexed for MEDLINE]
Deep brain stimulation of the nucleus accumbens shell attenuates cue-induced reinstatement of both cocaine and sucrose seeking in rats.
Behav Brain Res. 2015 Mar 15;281:125-30
Authors: Guercio LA, Schmidt HD, Pierce RC
Stimuli previously associated with drug taking can become triggers that can elicit craving and lead to relapse of drug-seeking behavior. Here, we examined the influence of deep brain stimulation (DBS) in the nucleus accumbens shell on cue-induced reinstatement of cocaine seeking, an animal model of relapse. Rats were allowed to self-administer cocaine (0.254 mg, i.v.) for 2 h daily for 21 days, with each infusion of cocaine being paired with a cue light. After 21 days of self-administration, cocaine-taking behavior was extinguished by replacing cocaine with saline in the absence of the cue light. Next, during the reinstatement phase, DBS was administered bilaterally into the nucleus accumbens shell through bipolar stainless steel electrodes immediately prior to re-exposure to cues previously associated with cocaine reinforcement. DBS continued throughout the 2 h reinstatement session. Parallel studies examined the influence of accumbens shell DBS on reinstatement induced by cues previously associated with sucrose reinforcement. Results indicated that DBS of the nucleus accumbens shell significantly attenuated cue-induced reinstatement of cocaine and sucrose seeking. Together, these results indicate that DBS of the accumbens shell disrupts cue-induced reinstatement associated with both a drug and a natural reinforcer.
PMID: 25529183 [PubMed - indexed for MEDLINE]
Animal Models of Bipolar Mania: The Past, Present and Future.
Neuroscience. 2015 Aug 24;
Authors: Logan RW, McClung CA
Bipolar disorder (BD) is the sixth leading cause of disability in the world according to the World Health Organization and affects nearly 6 million (?2.5% of the population) adults in the United State alone each year. BD is primarily characterized by mood cycling of depressive (e.g., helplessness, reduced energy and activity, and anhedonia) and manic (e.g., increased energy and hyperactivity, reduced need for sleep, impulsivity, reduced anxiety and depression), episodes. The following review describes several animal models of bipolar mania with a focus on more recent findings using genetically modified mice, including several with the potential of investigating the mechanisms underlying 'mood' cycling (or behavioral switching in rodents). We discuss whether each of these models satisfy criteria of validity (i.e., face, predictive, and construct), while highlighting their strengths and limitations. Animal models are helping to address critical questions related to pathophysiology of bipolar mania, in an effort to more clearly define necessary targets of first-line medications, lithium and valproic acid, and to discover novel mechanisms with the hope of developing more effective therapeutics. Future studies will leverage new technologies and strategies for integrating animal and human data to reveal important insights into the etiology, pathophysiology, and treatment of BD.
PMID: 26314632 [PubMed - as supplied by publisher]
An Untargeted Metabolomics Analysis of Antipsychotic Use in Bipolar Disorder.
Clin Transl Sci. 2015 Aug 27;
Authors: Burghardt KJ, Evans SJ, Wiese KM, Ellingrod VL
BACKGROUND: Second generation antipsychotic (SGA) use in bipolar disorder is common and has proven effective in short-term trials. There continues to be a lack of understanding of the mechanisms underlying many of their positive and negative effects in bipolar disorder. This study aimed to describe the metabolite profiles of bipolar subjects treated with SGAs by comparing to metabolite profiles of bipolar subjects treated with lithium, and schizophrenia subjects treated with SGAs.
METHODS: Cross-sectional, fasting untargeted serum metabolomic profiling was conducted in 82 subjects diagnosed with bipolar I disorder (n = 30 on SGAs and n = 32 on lithium) or schizophrenia (n = 20). Metabolomic profiles of bipolar subjects treated with SGAs were compared to bipolar subjects treated with lithium and schizophrenia subjects treated with SGAs using multivariate methods.
RESULTS: Partial lease square discriminant analysis (PLS-DA) plots showed separation between bipolar subjects treated with SGAs, bipolar subjects treated with lithium, or schizophrenia subjects treated with SGAs. Top influential metabolite features were associated with several pathways including that of polyunsaturated fatty acids, pyruvate, glucose, and branched chain amino acids.
CONCLUSIONS: The findings from this study require further validation in pre- and posttreated bipolar and schizophrenia subjects, but suggest that the pharmacometabolome may be diagnosis specific.
PMID: 26314700 [PubMed - as supplied by publisher]
Association of traumatic brain injury with subsequent neurological and psychiatric disease: a meta-analysis.
J Neurosurg. 2015 Aug 28;:1-16
Authors: Perry DC, Sturm VE, Peterson MJ, Pieper CF, Bullock T, Boeve BF, Miller BL, Guskiewicz KM, Berger MS, Kramer JH, Welsh-Bohmer KA
OBJECT Mild traumatic brain injury (TBI) has been proposed as a risk factor for the development of Alzheimer's disease, Parkinson's disease, depression, and other illnesses. This study's objective was to determine the association of prior mild TBI with the subsequent diagnosis (that is, at least 1 year postinjury) of neurological or psychiatric disease. METHODS All studies from January 1995 to February 2012 reporting TBI as a risk factor for diagnoses of interest were identified by searching PubMed, study references, and review articles. Reviewers abstracted the data and assessed study designs and characteristics. RESULTS Fifty-seven studies met the inclusion criteria. A random effects meta-analysis revealed a significant association of prior TBI with subsequent neurological and psychiatric diagnoses. The pooled odds ratio (OR) for the development of any illness subsequent to prior TBI was 1.67 (95% CI 1.44-1.93, p < 0.0001). Prior TBI was independently associated with both neurological (OR 1.55, 95% CI 1.31-1.83, p < 0.0001) and psychiatric (OR 2.00, 95% CI 1.50-2.66, p < 0.0001) outcomes. Analyses of individual diagnoses revealed higher odds of Alzheimer's disease, Parkinson's disease, mild cognitive impairment, depression, mixed affective disorders, and bipolar disorder in individuals with previous TBI as compared to those without TBI. This association was present when examining only studies of mild TBI and when considering the influence of study design and characteristics. Analysis of a subset of studies demonstrated no evidence that multiple TBIs were associated with higher odds of disease than a single TBI. CONCLUSIONS History of TBI, including mild TBI, is associated with the development of neurological and psychiatric illness. This finding indicates that either TBI is a risk factor for heterogeneous pathological processes or that TBI may contribute to a common pathological mechanism.
PMID: 26315003 [PubMed - as supplied by publisher]
Reduced contextual effects on visual contrast perception in schizophrenia and bipolar affective disorder.
Psychol Med. 2015 Aug 28;:1-11
Authors: Schallmo MP, Sponheim SR, Olman CA
BACKGROUND: The salience of a visual stimulus is often reduced by nearby stimuli, an effect known as surround suppression of perceived contrast, which may help in locating the borders of an object. Weaker surround suppression has been observed in schizophrenia but it is unclear whether this abnormality is present in other mental disorders with similar symptomatology, or is evident in people with genetic liability for schizophrenia.
METHOD: By examining surround suppression among subjects with schizophrenia or bipolar affective disorder, their unaffected biological relatives and healthy controls we sought to determine whether diminished surround suppression was specific to schizophrenia, and if subjects with a genetic risk for either disorder would show similar deficits. Measuring perceived contrast in different surround conditions also allowed us to investigate how this suppression depends on the similarity of target and surrounding stimuli.
RESULTS: Surround suppression was weaker among schizophrenia patients regardless of surround configuration. Subjects with bipolar affective disorder showed an intermediate deficit, with stronger suppression than in schizophrenia but weaker than control subjects. Surround suppression was normal in relatives of both patient groups. Findings support a deficit in broadly tuned (rather than sharply orientation- or direction-selective) suppression mechanisms.
CONCLUSIONS: Weak broadly tuned suppression during visual perception is evident in schizophrenia and bipolar affective disorder, consistent with impaired gain control related to the clinical expression of these conditions.
PMID: 26315020 [PubMed - as supplied by publisher]
Immune activation as a mediator of the gut-brain axis in manic episodes.
Aust N Z J Psychiatry. 2015 Aug 27;
Authors: Passos IC, Kapczinski F
PMID: 26316004 [PubMed - as supplied by publisher]
Epilepsy and bipolar disorder.
Epilepsy Behav. 2015 Aug 24;
Authors: Knott S, Forty L, Craddock N, Thomas RH
It is well recognized that mood disorders and epilepsy commonly co-occur. Despite this, our knowledge regarding the relationship between epilepsy and bipolar disorder is limited. Several shared features between the two disorders, such as their episodic nature and potential to run a chronic course, and the efficacy of some antiepileptic medications in the prophylaxis of both disorders, are often cited as evidence of possible shared underlying pathophysiology. The present paper aims to review the bidirectional associations between epilepsy and bipolar disorder, with a focus on epidemiological links, evidence for shared etiology, and the impact of these disorders on both the individual and wider society. Better recognition and understanding of these two complex disorders, along with an integrated clinical approach, are crucial for improved evaluation and management of comorbid epilepsy and mood disorders.
PMID: 26316422 [PubMed - as supplied by publisher]
Mice lacking circadian clock components display different mood-related behaviors and do not respond uniformly to chronic lithium treatment.
Chronobiol Int. 2015 Aug 28;:1-15
Authors: Schnell A, Sandrelli F, Ranc V, Ripperger JA, Brai E, Alberi L, Rainer G, Albrecht U
Genomic studies suggest an association of circadian clock genes with bipolar disorder (BD) and lithium response in humans. Therefore, we tested mice mutant in various clock genes before and after lithium treatment in the forced swim test (FST), a rodent behavioral test used for evaluation of depressive-like states. We find that expression of circadian clock components, including Per2, Cry1 and Rev-erb?, is affected by lithium treatment, and thus, these clock components may contribute to the beneficial effects of lithium therapy. In particular, we observed that Cry1 is important at specific times of the day to transmit lithium-mediated effects. Interestingly, the pathways involving Per2 and Cry1, which regulate the behavior in the FST and the response to lithium, are distinct as evidenced by the phosphorylation of GSK3? after lithium treatment and the modulation of dopamine levels in the striatum. Furthermore, we observed the co-existence of depressive and mania-like symptoms in Cry1 knock-out mice, which resembles the so-called mixed state seen in BD patients. Taken together our results strengthen the concept that a defective circadian timing system may impact directly or indirectly on mood-related behaviors.
PMID: 26317159 [PubMed - as supplied by publisher]
Cognitive function in euthymic bipolar disorder (BP I) patients with a history of psychotic symptoms vs. schizophrenia.
Psychiatry Res. 2015 Aug 7;
Authors: Nenadic I, Langbein K, Dietzek M, Forberg A, Smesny S, Sauer H
Patients with bipolar disorder show cognitive deficits including executive function, which appear to be related to social functioning and outcome. However, subgroups within the spectrum as well as psychopathological features, current mood state/euthymia and disease stage might be confounding factors. We analysed data tests from the Wechsler Intelligence Scale (WIE), verbal fluency (COWA) and trail making tests (TMT-A and TMT-B) obtained in a selected subgroup of currently bipolar I disorder patients, who were currently euthymic and had a history of psychotic symptoms, and compared them to patients with schizophrenia (in remission) and healthy controls, all matched for age, gender, and handedness. Schizophrenia patients showed more severe cognitive impairment, including digit symbol and arithmetic tests, as well as TMT-B (compared to healthy controls), but bipolar patients had stronger impairment on the letter number sequencing test, an indicator of working memory and processing speed. There were no group effects on most verbal fluency tasks (except impairment of schizophrenia patients on one subscale of category fluency). Within the limitations of the study design, our results suggest that even in subgroups of presumably more severely impaired bipolar patients, some cognitive dimensions might achieve remission, possibly related to considerable state effects at testing.
PMID: 26319738 [PubMed - as supplied by publisher]
Treatment Resistant Schizophrenia is associated to the worst community functioning among severely-ill highly-disabling psychiatric conditions and is the most relevant predictor of poorer achievements in functional milestones.
Prog Neuropsychopharmacol Biol Psychiatry. 2015 Aug 25;
Authors: Iasevoli F, Giordano S, Balletta R, Latte G, Formato MV, Prinzivalli E, De Berardis D, Tomasetti C, de Bartolomeis A
The aim of this work was to compare achievements in milestones of community functioning in highly disabling psychiatric conditions, including Treatment Resistant Schizophrenia (TRS), schizophrenia (responsive to antipsychotics), bipolar disorder, anxiety/depressive diseases. Also, we investigated the predictors of community functioning outcomes across several domains. Among consecutive patients screened, 188 met inclusion criteria and 118 ultimately entered the study. Diagnosis of TRS was made by stringent criteria, including historic and perspective evaluations and excluding potential confounding factors. Achievements in functional milestones of everyday living were recorded. Performances in discrete cognitive tasks were assessed. The Positive and Negative Syndrome Scale, the Personal and Social Performance scale, the Drug Attitude Inventory-10, and the Quality of Life Enjoyment and Satisfaction Questionnaire were administered. TRS patients showed the highest impairment in community functioning among diagnostic groups. TRS were found to have more severe psychopathology, more impaired cognitive functioning, and poorer psychosocial adjustment compared to all the other groups. In the whole sample, the main predictors of community functioning were the diagnostic group (with TRS diagnosis associated to worst functioning) and achievements in the other functional milestones. In psychotic patients, however, the main predictors of community functioning were clinical and psychopathological variables. These results may support the hypothesis that TRS represents a separate schizophrenia subtype, with its own neurobiology, psychopathology and clinical course. Our results identify a group of modifiable predictors to be addressed to prevent community disability.
PMID: 26320028 [PubMed - as supplied by publisher]
A manic episode with psychotic features improved by methylprednisolone in a patient with multiple sclerosis.
Gen Hosp Psychiatry. 2015 Jul 14;
Authors: Hotier S, Maltete D, Bourre B, Jegouzo X, Bourgeois V, Guillin O
Several studies have reported a higher prevalence of unipolar depression and bipolar disorder among patients with multiple sclerosis (MS). However, only a few studies have reported manic episodes concomitant with new lesions enhanced by gadolinium on brain magnetic resonance imaging (MRI). Here we report the case of a 47-year-old woman suffering from MS admitted for a manic episode with psychotic features. Brain MRI revealed three new T2 lesions enhanced by gadolinium located in the corpus callosum and in ventromedial prefrontal regions. She rapidly recovered with intravenous methylprednisolone in combination with risperidone. In conclusion, in this patient, the fact that gadolinium-enhancing lesion coincided with new symptoms which responded quickly to corticosteroids suggests that the manic episode was an acute manifestation of MS.
PMID: 26321022 [PubMed - as supplied by publisher]
Antimanic-like activity of candesartan in mice: Possible involvement of antioxidant, anti-inflammatory and neurotrophic mechanisms.
Eur Neuropsychopharmacol. 2015 Aug 17;
Authors: de Souza Gomes JA, de Souza GC, Berk M, Cavalcante LM, de Sousa FC, Budni J, de Lucena DF, Quevedo J, Carvalho AF, Macêdo D
Activation of the brain angiotensin II type 1 receptor (AT1R) triggers pro-oxidant and pro-inflammatory mechanisms which are involved in the neurobiology of bipolar disorder (BD). Candesartan (CDS) is an AT1 receptor antagonist with potential neuroprotective properties. Herein we investigated CDS effects against oxidative, neurotrophic inflammatory and cognitive effects of amphetamine (AMPH)-induced mania. In the reversal protocol adult mice were given AMPH 2mg/kg i.p. or saline and between days 8 and 14 received CDS 0.1, 0.3 or 1mg/kg orally, lithium (Li) 47.5mg/kg i.p., or saline. In the prevention treatment, mice were pretreated with CDS, Li or saline prior to AMPH. Locomotor activity and working memory performance were assessed. Glutathione (GSH), thiobarbituric acid-reactive substance (TBARS) and TNF-? levels were evaluated in the hippocampus (HC) and cerebellar vermis (CV). Brain-derived neurotrophic factor (BDNF) and glycogen synthase kinase 3-beta (GSK-3beta) levels were measured in the HC. CDS and Li prevented and reversed the AMPH-induced increases in locomotor activity. Only CDS prevented and reversed AMPH-induced working memory deficits. CDS prevented AMPH-induced alterations in GSH (HC and CV), TBARS (HC and CV), TNF-? (HC and CV) and BDNF (HC) levels. Li prevented alterations in BDNF and phospho-Ser9-GSK3beta. CDS reversed AMPH-induced alterations in GSH (HC and CV), TBARS (HC), TNF-? (CV) and BDNF levels. Li reversed AMPH-induced alterations in TNF-? (HC and CV) and BDNF (HC) levels. CDS is effective in reversing and preventing AMPH-induced behavioral and biochemical alterations, providing a rationale for the design of clinical trials investigating CDS?s possible therapeutic effects.
PMID: 26321203 [PubMed - as supplied by publisher]
Bipolar disorder: Functional neuroimaging markers in relatives.
Neurosci Biobehav Rev. 2015 Aug 28;
Authors: Piguet C, Fodoulian L, Aubry JM, Vuilleumier P, Houenou J
Neural models of anatomical and functional alterations have been proposed for bipolar disorders (BD). However, studies in affected patients do not allow disentangling alterations linked to the liability to BD from those associated with the evolution, medication and comorbidities of BD. Explorations in high risk subjects allow the study of these risk markers. We reported and summarized all functional magnetic resonance imaging (fMRI) studies focusing on first-degree relatives of BD patients. We found 29 studies reporting neural correlates of working memory (WM), emotional processing, executive functions and resting state in relatives of BD patients, compared to healthy subjects. Overall, the same regions that have been involved in patients, such as the inferior frontal gyrus and limbic areas, seem to be functionally altered in high-risk subjects. We conclude that the same brain regions already implicated in the pathophysiology of the disease such as the amygdala are also associated with the risk of BD. However longitudinal studies are required to understand their implication in the transition to BD.
PMID: 26321590 [PubMed - as supplied by publisher]
Self-images in the present and future: Role of affect and the bipolar phenotype.
J Affect Disord. 2015 Aug 21;187:97-100
Authors: Di Simplicio M, Holmes EA, Rathbone CJ
BACKGROUND: Bipolar Spectrum Disorder (BPSD) is associated with changes in self-related processing and affect, yet the relationship between self-image and affect in the BPSD phenotype is unclear.
METHODS: 47 young adults were assessed for hypomanic experiences (BPSD phenotype) using the Mood Disorders Questionnaire. Current and future self-images (e.g. I am? I will be?) were generated and rated for emotional valence, stability, and (for future self-images only) certainty. The relationship between self-image ratings and measures of affect (depression, anxiety and mania) were analysed in relation to the BPSD phenotype.
RESULTS: The presence of the BPSD phenotype significantly moderated the relationship between (1) affect and stability ratings for negative self-images, and (2) affect and certainty ratings for positive future self-images. Higher positivity ratings for current self-images were associated with lower depression and anxiety scores.
LIMITATIONS: This was a non-clinical group of young adults sampled for hypomanic experiences, which limits the extension of the work to clinical levels of psychopathology. This study cannot address the causal relationships between affect, self-images, and BPSD. Future work should use clinical samples and experimental mood manipulation designs.
CONCLUSIONS: BPSD phenotype can shape the relationship between affect and current and future self-images. This finding will guide future clinical research to elucidate BPSD vulnerability mechanisms and, consequently, the development of early interventions.
PMID: 26322714 [PubMed - as supplied by publisher]
TRPM2, a Susceptibility Gene for Bipolar Disorder, Regulates Glycogen Synthase Kinase-3 Activity in the Brain.
J Neurosci. 2015 Aug 26;35(34):11811-11823
Authors: Jang Y, Lee SH, Lee B, Jung S, Khalid A, Uchida K, Tominaga M, Jeon D, Oh U
Bipolar disorder (BD) is a psychiatric disease that causes mood swings between manic and depressed states. Although genetic linkage studies have shown an association between BD and TRPM2, a Ca(2+)-permeable cation channel, the nature of this association is unknown. Here, we show that D543E, a mutation of Trpm2 that is frequently found in BD patients, induces loss of function. Trpm2-deficient mice exhibited BD-related behavior such as increased anxiety and decreased social responses, along with disrupted EEG functional connectivity. Moreover, the administration of amphetamine in wild-type mice evoked a notable increase in open-field activity that was reversed by the administration of lithium. However, the anti-manic action of lithium was not observed in the Trpm2(-/-) mice. The brains of Trpm2(-/-) mice showed a marked increase in phosphorylated glycogen synthase kinase-3 (GSK-3), a key element in BD-like behavior and a target of lithium. In contrast, activation of TRPM2 induced the dephosphorylation of GSK-3 via calcineurin, a Ca(2+)-dependent phosphatase. Importantly, the overexpression of the D543E mutant failed to induce the dephosphorylation of GSK-3. Therefore, we conclude that the genetic dysfunction of Trpm2 causes uncontrolled phosphorylation of GSK-3, which may lead to the pathology of BD. Our findings explain the long-sought etiologic mechanism underlying the genetic link between Trpm2 mutation and BD.
SIGNIFICANCE STATEMENT: Bipolar disorder (BD) is a mental disorder that causes changes in mood and the etiology is still unknown. TRPM2 is highly associated with BD; however, its involvement in the etiology of BD is still unknown. We show here that TRPM2 plays a central role in causing the pathology of BD. We found that D543E, a mutation of Trpm2 frequently found in BD patients, induces the loss of function. Trpm2-deficient mice exhibited mood disturbances and impairments in social cognition. TRPM2 actively regulates the phosphorylation of GSK-3, which is a main target of lithium, a primary medicine for treating BD. Therefore, abnormal regulation of GSK-3 by hypoactive TRPM2 mutants accounts for the pathology of BD, providing the possible link between BD and TRPM2.
PMID: 26311765 [PubMed - as supplied by publisher]
Alzheimer´s Disease associated with Psychiatric Comorbidities.
An Acad Bras Cienc. 2015 Aug 25;
Authors: Garcez ML, Falchetti AC, Mina F, Budni J
Alzheimer's disease (AD) is the most common cause of dementia and has become a severe public health issue. It is estimated that globally, 35.6% of people have some form of dementia. This number is expected to double by 2030, and possibly even triple by 2050. The disease is associated with deficits in cognition/memory and a reduced ability in coping with everyday life. Moreover, patients can experience behavioral alterations such as mood swings, depression and hallucinations. Therefore, it is common to find the presence of neuropsychiatric comorbidities such as depression, schizophrenia and bipolar disorder during the course or development of AD. These disorders can become severe enough to interfere with the patients daily functioning, and can worsen the course of the disease. However, little is known about the causal relationship between psychiatric comorbidities and AD, or the reasons for the predisposition of some individuals to such disorders. Therefore, the purpose of this review is to clarify the causal relationship between depression, schizophrenia and bipolar disorder with AD.
PMID: 26312426 [PubMed - as supplied by publisher]
Severe Darier's disease in a psychiatric patient.
An Bras Dermatol. 2015 Jun;90(3 Suppl 1):66-68
Authors: Yang JJ, Lopes RS, Pereira MC, Tebcherani AJ, Pires MC
Darier's disease is characterized by dense keratotic lesions in the seborrheic areas of the body such as scalp, forehead, nasolabial folds, trunk and inguinal region. It is a rare genodermatosis, an autosomal dominant inherited disease that may be associated with neuropsichiatric disorders. It is caused by ATPA2 gene mutation, presenting cutaneous and dermatologic expressions. Psychiatric symptoms are depression, suicidal attempts, and bipolar affective disorder. We report a case of Darier's disease in a 48-year-old female patient presenting severe cutaneous and psychiatric manifestations.
PMID: 26312677 [PubMed - as supplied by publisher]
Physical health indicators in major mental illness: data from the Quality and Outcome Framework in the UK.
Lancet. 2015 Feb 26;385 Suppl 1:S61
Authors: Martin JL, Lowrie R, McConnachie A, McLean G, Mair F, Mercer S, Smith D
BACKGROUND: In the UK, the Quality and Outcome Framework (QOF) has specific targets for general practictioners to record body-mass index (BMI) and blood pressure (BP) in major mental illness, diabetes, and chronic kidney disease. Although incentives are given for aspects of major mental illness (schizophrenia, bipolar disorder, and related psychoses), barriers to care can occur. Our aim was to compare recording of specific targets for BP and BMI in individuals with major mental illness relative to diabetes and chronic kidney disease across the UK.
METHODS: Using 2012 and 2013 QOF data from 9731 general practices across all four countries in the UK, we calculated median payment, population achievement, and exception rates for BP indicators in major mental illness and chronic kidney disease and BMI indicators in major mental illness and diabetes. Differences in unweighted rates between practices in the same UK country were tested with a sign test. Differences in population achievement rate between practices in different countries were compared with those in England by use of a quantile regression analysis.
FINDINGS: UK payment and population achievement rates for BMI recording in major mental illness were significantly lower than were those in diabetes (payment 92·7% vs 95·5% and population achievement 84·0% vs 92·5%, p<0·0001) and exception rates were higher (8·1% vs 2·0%, p<0·0001). For BP recording, UK payment and population achievement rates were significantly lower for major mental illness than for chronic kidney disease (94·1% vs 97·8% and 87·0% vs 97·1%, p<0·0001), whereas exception rate was higher (6·5% vs 0·0%, p<0·0001). This difference was observed for all UK countries. Median population achievement rates for BMI and BP recording in major mental illness were significantly lower in Scotland than in England (for BMI -1·5%, 99% CI -2·7 to -0·3, and for BP -1·8%, -2·7 to -0·9; p<0·0001 for both). There were no cross-jurisdiction differences for chronic kidney disease and diabetes.
INTERPRETATION: We found lower payment rates, higher exception rates, and lower population achievement rates for BMI and BP recording in major mental illness than in diabetes and chronic kidney disease throughout the UK. We also found variation in these rates between countries. This finding is probably multifactorial, reflecting a combination of patient, clinician, and wider organisational factors; however, it might also suggest inequality in access to certain aspects of health care for people with major mental illness.
PMID: 26312883 [PubMed - as supplied by publisher]
Bipolar Spectrum Disorders in Patients With Cerebellar Lesions: A Comparison With Parkinson's Disease.
J Nerv Ment Dis. 2015 Sep;203(9):725-729
Authors: Chiaie RD, Minichino A, Salviati M, Fiorentini S, Tonini A, Bersani FS, De Michele F, Caredda M, Biondi M
Nonmotor functions of the cerebellum are well known. Within this frame, the aim of this study was to compare psychiatric morbidity rates among patients affected by cerebellar diseases or Parkinson's disease (PD). Forty-seven patients (27 cerebellar and 20 PD) underwent a comprehensive psychiatric evaluation (psychopathological rating scales and the Structured Clinical Interview for DSM-IV-TR Axis I Disorders). Psychiatric disorders were slightly more frequent among cerebellar than among PD patients (89% vs. 75%; p = 0.21). Mood disorders were more frequent in the cerebellar than in the PD group (90% vs. 55%; p < 0.01). Among those subjects with no psychiatric history prior to the onset of neurological disease, bipolar spectrum disorders were more frequent within the cerebellar group (p < 0.01). These results confirm high rates of psychiatric disorders among cerebellar patients. The higher frequency of bipolar spectrum presentations found in the cerebellar group may suggest a specific involvement of cortico-cerebellar circuits in the pathophysiology of mood dysregulation.
PMID: 26313038 [PubMed - as supplied by publisher]
Group Psychoeducation for Relatives of Persons With Bipolar Disorder: Perceived Benefits for Participants and Patients.
J Nerv Ment Dis. 2015 Sep;203(9):730-734
Authors: Gex-Fabry M, Cuénoud S, Stauffer-Corminboeuf MJ, Aillon N, Perroud N, Aubry JM
Psychoeducation is a key element in the management of patients with bipolar disorders. The present study explored the perception of patients and family members with respect to group psychoeducation for relatives. Patients (n = 20) and relatives (n = 26) were assessed with questionnaires about perceived benefits and quality of life (median 4 years after participation). A large majority (>80%) of relatives acknowledged benefits with respect to easier detection of the early warning signs of relapse, improved quality of life, feeling more involved, and engaging in higher quality caregiving activities. Patients were less positive in general, but agreed that the program had helped them deal with crises, increased their feeling of being understood by relatives, and promoted positive changes in the family (>60%). Perceived positive changes in the family were associated with higher quality of life for relatives and patients. The present study highlights the importance of communication enhancement in group psychoeducation for relatives.
PMID: 26313039 [PubMed - as supplied by publisher]
Association of arterial hypertension and cognitive impairment in euthymic bipolar disorder.
Neuro Endocrinol Lett. 2015 Aug 27;36(3):294-300
Authors: Hubenak J, Tuma I, Ba?ant J
OBJECTIVES: Cognitive impairment in euthymic phase of bipolar disorder has been documented in many studies. Several factors may contribute to such impairment, e.g. sedative medication, thyreopathy. Metabolic syndrome with its components represents another frequent condition found in bipolar disorder exerting probably adverse impact on cognition. Since it is treatable factor and current literature suggests possible connection with cognitive dysfunction, we aimed to explore such associations to identify promising targets of complex treatment.
METHODS: Forty euthymic bipolar patients have been enrolled. Their body and metabolic parameters were measured. Medical history data were collected. Cognition was evaluated using battery of tests. Neuropsychological performance was transformed into neurocognitive composite score. Cognition of subjects was compared dichotomously according to presence or absence of pathological body and metabolic parameters. Correlations of selected parameters and composite score were done.
RESULTS: Low neurocognitive score was found in presence of hypertension, metabolic syndrome, abdominal obesity and hyperglycemia. Only connection of hypertension and cognitive score reached sufficient statistical power. Patients presenting hypertension performed worse in all tested domains of cognition when compared with normal blood pressure group. Subjects using lithium performed substantially worse in cognitive tests. However, in comparison with anticonvulsant group, lithium users had markedly longer disorder history as well as longer duration of thymoprofylaxis. No significant correlation of HDRS score, insulinemia or HOMA-IR was found.
CONCLUSION: Despite relatively small sample size, noticeable association of hypertension and cognitive impairment was revealed. This might indicate possible way of enhancing cognition in bipolar disorder by treating elevated blood pressure.
PMID: 26313398 [PubMed - as supplied by publisher]
Adequacy of help received among individuals with severe mental disorders.
Adm Policy Ment Health. 2014 May;41(3):302-16
Authors: Fleury MJ, Grenier G, Bamvita JM, Piat M, Tremblay J
Using multiple linear regression analyses and a new assessment measure, this exploratory study identifies variables associated with help adequacy of 352 individuals with severe mental disorder. Help adequacy is higher with tobacco use, psychological distress domain, having a caregiver, help form services, being older, and lower with number of needs; accommodation, food, childcare and involvement in treatment decisions domains; number of suicide attempts, legal problems in previous year, and drugs problem. Results confirm the importance of a better collaboration with relatives, healthcare and social service providers to provide more adequate and satisfactory services for severe mental disorders individuals.
PMID: 23334467 [PubMed - indexed for MEDLINE]
Is depression one thing or many?
Br J Psychiatry. 2014 Jun;204(6):488
Authors: Amerio A, Odone A, Marchesi C, Ghaemi SN
PMID: 25029688 [PubMed - indexed for MEDLINE]
Clinical efficacy of formula-based bifrontal versus right unilateral electroconvulsive therapy (ECT) in the treatment of major depression among elderly patients: a pragmatic, randomized, assessor-blinded, controlled trial.
J Affect Disord. 2015 Apr 1;175:8-17
Authors: Bjølseth TM, Engedal K, Benth J?, Dybedal GS, Gaarden TL, Tanum L
BACKGROUND: No prior study has compared the efficacy of bifrontal (BF) vs right unilateral (RUL) electroconvulsive therapy (ECT) by including the subgroup that is most likely to receive it: only elderly patients with major depression (MD).
METHODS: This single-site, randomized, assessor-blinded, controlled trial was conducted from 2009 to 2013. Seventy-three elderly patients with MD, unipolar and bipolar, were treated with a course of formula-based BF ECT or RUL ECT. The 17-item Hamilton Rating Scale for Depression (HRSD17) was used to measure efficacy. Safety was assessed with the Mini Mental State Examination (MMSE).
RESULTS: Both electrode placements resulted in highly significant downward trends in symptom severity (all p<0.001), with a non-significant difference between methods (p=0.703). At the end of the ECT course, response rates for the BF and RUL group were 63.9% and 67.6%, respectively. Short-term remission, defined as an HRSD17 score?7, was achieved in 14 (38.9%) patients in the BF group and 19 (51.4%) patients in the RUL group. Global cognitive function, as measured by the MMSE, did not deteriorate in the two treatment groups.
LIMITATIONS: The small number of subjects may have led to reduced power to detect real differences. The MMSE is not sufficient to ascertain the negative effect of ECT on cognition.
CONCLUSIONS: This study indicates that formula-based BF and RUL ECT are equally efficacious, and that remission rates of formula-based dosing are lower than those previously reported for titrated dosing, in a clinical sample of elderly patients with MD.
TRIAL REGISTRATION: ClinicalTrials.gov NCT01559324.
PMID: 25590761 [PubMed - indexed for MEDLINE]
Insulin resistance in bipolar disorder: relevance to routine clinical care.
Bipolar Disord. 2015 Aug 26;
Authors: Calkin CV, Alda M
PMID: 26308475 [PubMed - as supplied by publisher]
The need for cost-effective choices to treat patients with bipolar 1 disorders including asenapine.
J Med Econ. 2015 Aug 26;:1-3
Authors: Godman B
BACKGROUND: Bipolar 1 disorders (BPD) are a chronic disorder with prevalence rates of up to 2.6% of the adult population or higher and appreciable direct and indirect costs. As a result, these are a concern to health authorities especially given the low age of onset. Consequently, there is a need to treat BPD patients well and improve their quality-of-life. Pharmacotherapy includes mood stabilizers and atypical antipsychotics (AAPs). AAPs have different mechanisms of action and side-effects, so treatment needs to be tailored. Asenapine in clinical trials is as effective as olanzapine, with less metabolic side-effects.
METHODS: Chitnis and colleagues assessed the cost-effectiveness of asenapine among patients in healthcare databases.
RESULTS AND CONCLUSION: They showed in routine care that asenapine also reduces hospital and emergency room admissions, making it cost neutral in BPD, which is of interest to health authorities and clinicians.
PMID: 26309020 [PubMed - as supplied by publisher]
Common psychiatric disorders share the same genetic origin: a multivariate sibling study of the Swedish population.
Mol Psychiatry. 2015 Aug 25;
Authors: Pettersson E, Larsson H, Lichtenstein P
Recent studies have shown that different mental-health problems appear to be partly influenced by the same set of genes, which can be summarized by a general genetic factor. To date, such studies have relied on surveys of community-based samples, which could introduce potential biases. The goal of this study was to examine whether a general genetic factor would still emerge when based on a different ascertainment method with different biases from previous studies. We targeted all adults in Sweden (n=3?475?112) using national registers and identified those who had received one or more psychiatric diagnoses after seeking or being forced into mental health care. In order to examine the genetic versus environmental etiology of the general factor, we examined whether participants' full- or half-siblings had also received diagnoses. We focused on eight major psychiatric disorders based on the International Classification of Diseases, including schizophrenia, schizoaffective disorder, bipolar disorder, depression, anxiety, attention-deficit/hyperactivity disorder, alcohol use disorder and drug abuse. In addition, we included convictions of violent crimes. Multivariate analyses demonstrated that a general genetic factor influenced all disorders and convictions of violent crimes, accounting for between 10% (attention-deficit/hyperactivity disorder) and 36% (drug abuse) of the variance of the conditions. Thus, a general genetic factor of psychopathology emerges when based on both surveys as well as national registers, indicating that a set of pleiotropic genes influence a variety of psychiatric disorders.Molecular Psychiatry advance online publication, 25 August 2015; doi:10.1038/mp.2015.116.
PMID: 26303662 [PubMed - as supplied by publisher]
Quetiapine-induced ischemic colitis. A case report.
Presse Med. 2015 May;44(5):538-41
Authors: Vernay J
PMID: 25908180 [PubMed - indexed for MEDLINE]
Investigating the underlying mechanisms of aberrant behaviors in bipolar disorder from patients to models: Rodent and human studies.
Neurosci Biobehav Rev. 2015 Aug 19;
Authors: van Enkhuizen J, Geyer MA, Minassian A, Perry W, Henry BL, Young JW
Psychiatric patients with bipolar disorder suffer from states of depression and mania, during which a variety of symptoms are present. Current treatments are limited and neurocognitive deficits in particular often remain untreated. Targeted therapies based on the biological mechanisms of bipolar disorder could fill this gap and benefit patients and their families. Developing targeted therapies would benefit from appropriate animal models which are challenging to establish, but remain a vital tool. In this review, we summarize approaches to create a valid model relevant to bipolar disorder. We focus on studies that use translational tests of multivariate exploratory behavior, sensorimotor gating, decision-making under risk, and attentional functioning to discover profiles that are consistent between patients and rodent models. Using this battery of translational tests, similar behavior profiles in bipolar mania patients and mice with reduced dopamine transporter activity have been identified. Future investigations should combine other animal models that are biologically relevant to the neuropsychiatric disorder with translational behavioral assessment as outlined here. This methodology can be utilized to develop novel targeted therapies that relieve symptoms for more patients without common side effects caused by current treatments.
PMID: 26297513 [PubMed - as supplied by publisher]