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The Australian and New Zealand Journal... Mar 2023Bipolar disorder may undertake a progressive course in a subset of patients, and research efforts have been made to understand the biological basis underlying this... (Review)
Review
BACKGROUND
Bipolar disorder may undertake a progressive course in a subset of patients, and research efforts have been made to understand the biological basis underlying this process. This systematic review examined the literature available on biological markers associated with illness progression in bipolar disorder.
METHODS
Peer-reviewed articles were assessed using Embase, PsycINFO and PubMed, as well as from external sources. After initial screening, a total of 871 citations from databases and other sources were identified. Participants with a diagnosis of bipolar disorder were included in our systematic review; however, studies with participants younger than 15 or older than 65 were excluded. All studies were assessed using the Newcastle-Ottawa Scale assessment tool, and data pertaining to the results were extracted into tabular form using Google Sheets and Google Documents. The systematic review was registered on PROSPERO international prospective register of systematic reviews (ID Number: CRD42020154305).
RESULTS
A total of 35 studies were included in the systematic review. Increased ventricular size and reduction of grey matter volume were the most common brain changes associated with illness progression in bipolar disorder. Among the several biomarkers evaluated in this systematic review, findings also indicate a role of peripheral inflammatory markers in this process.
DISCUSSION
The studies evaluating the biological basis of the illness progression in bipolar disorder are still scarce and heterogeneous. However, current evidence supports the notion of neuroprogression, the pathophysiological process related to progressive brain changes associated with clinical progression in patients with bipolar disorder. The increase in peripheral inflammatory biomarkers and the neuroanatomical changes in bipolar disorder suggest progressive systemic and structural brain alterations, respectively.
Topics: Humans; Biomarkers; Bipolar Disorder; Brain; Disease Progression
PubMed: 35403455
DOI: 10.1177/00048674221091731 -
Bipolar Disorders Dec 2023Glutamatergic transmission and N-methyl-D-aspartate receptors (NMDARs) have been implicated in the pathophysiology schizophrenic spectrum and major depressive disorders.... (Review)
Review
OBJECTIVES
Glutamatergic transmission and N-methyl-D-aspartate receptors (NMDARs) have been implicated in the pathophysiology schizophrenic spectrum and major depressive disorders. Less is known about the role of NMDARs in bipolar disorder (BD). The present systematic review aimed to investigate the role of NMDARs in BD, along with its possible neurobiological and clinical implications.
METHODS
We performed a computerized literature research on PubMed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, using the following string: (("Bipolar Disorder"[Mesh]) OR (manic-depressive disorder[Mesh]) OR ("BD") OR ("MDD")) AND ((NMDA [Mesh]) OR (N-methyl-D-aspartate) OR (NMDAR[Mesh]) OR (N-methyl-D-aspartate receptor)).
RESULTS
Genetic studies yield conflicting results, and the most studied candidate for an association with BD is the GRIN2B gene. Postmortem expression studies (in situ hybridization and autoradiographic and immunological studies) are also contradictory but suggest a reduced activity of NMDARs in the prefrontal, superior temporal cortex, anterior cingulate cortex, and hippocampus.
CONCLUSIONS
Glutamatergic transmission and NMDARs do not appear to be primarily involved in the pathophysiology of BD, but they might be linked to the severity and chronicity of the disorder. Disease progression could be associated with a long phase of enhanced glutamatergic transmission, with ensuing excitotoxicity and neuronal damage, resulting into a reduced density of functional NMDARs.
Topics: Humans; Receptors, N-Methyl-D-Aspartate; Bipolar Disorder; Depressive Disorder, Major; Neurons; Gyrus Cinguli
PubMed: 37208966
DOI: 10.1111/bdi.13335 -
Journal of Affective Disorders Apr 2019Bipolar disorder is a chronic, episodic mental illness, affecting around 2.4% of the population worldwide. Psychological and/or physiological comorbidities are a common...
BACKGROUND
Bipolar disorder is a chronic, episodic mental illness, affecting around 2.4% of the population worldwide. Psychological and/or physiological comorbidities are a common consequence, and osteoporosis is one such possible comorbidity. Thus, this systematic review aimed to collate, evaluate, and discuss the literature examining the link between bipolar disorder and bone health.
METHODS
We conducted an e-search of PubMed/OVID/MEDLINE, PsychINFO and CINAHL to identify studies that investigated associations between bipolar disorder and bone in adults aged ≥18. Two reviewers determined eligibility according to pre-determined criteria, and methodological quality was assessed using a previously published methodological scoring system. Due to heterogeneity, a best-evidence synthesis was performed.
RESULTS
Our search yielded 1409 articles, of which three (all cohorts) met predetermined criteria. The studies from Taiwan and the United States of America analysed administrative data, albeit spanning different years, and comprised a total of 344,497 participants. No studies investigating bone quantity or quality were identified. Bipolar disorder was associated with an increased risk of fracture (range 20-80%); and fracture-free survival time for those with bipolar disorder decreased substantially with advancing age, and for women (10-30% shorter than men). Fracture incidence per 1000 person years (py) was 21.4 and 10.8 in those with and without bipolar disorder, respectively.
LIMITATIONS
Limited data and marked methodological heterogeneity prevented the pooling of these data for a numerical synthesis.
CONCLUSIONS
Increased fracture risk was observed in individuals with bipolar disorder, independent of older age, sex, comorbidities and medication use. The operative mechanisms, risk and treatment factors warrant further enquiry.
Topics: Adult; Bipolar Disorder; Bone Density; Bone and Bones; Comorbidity; Female; Fractures, Bone; Humans; Male; Osteoporosis
PubMed: 30784723
DOI: 10.1016/j.jad.2019.02.013 -
Journal of Psychiatric Research Sep 2018The hippocampus is a complex structure consisting of subregions with specialized cytoarchitecture and functions. Magnetic resonance imaging (MRI) studies in psychotic... (Meta-Analysis)
Meta-Analysis Review
The hippocampus is a complex structure consisting of subregions with specialized cytoarchitecture and functions. Magnetic resonance imaging (MRI) studies in psychotic disorders show hippocampal subfield abnormalities, but affected regions differ between studies. We here present an overview of hippocampal anatomy and function relevant to psychosis, and the first systematic review and meta-analysis of MRI studies of hippocampal subfield morphology in schizophrenia and bipolar disorder. Twenty-one MRI studies assessing hippocampal subfield volumes or shape in schizophrenia or bipolar disorder were included (n 15-887 subjects). Nine volumetric group comparison studies (total n = 2593) were included in random effects meta-analyses of group differences. The review showed mixed results, with volume reductions reported in most subfields in schizophrenia and bipolar disorder. Volumetric studies using ex-vivo based image analysis templates corresponded best with the shape studies, with CA1 as the most affected region. The meta-analyses showed volume reductions in all subfields in schizophrenia and bipolar disorder compared to healthy controls (all p < .005; schizophrenia: d = 0.28-0.49, bipolar disorder: d = 0.20-0.35), and smaller left CA2/3 and right subiculum in schizophrenia than bipolar disorder. In conclusion, the hippocampal subfields appear to be differently affected in psychotic disorders. However, due to the lack of control for putative confounders such as medication, alcohol and illicit substance use, and illness stage, the results from the meta-analysis should be interpreted with caution. Methodological subfield segmentation weaknesses should be addressed in future studies.
Topics: Bipolar Disorder; Hippocampus; Humans; Neuroimaging; Schizophrenia
PubMed: 30107268
DOI: 10.1016/j.jpsychires.2018.08.012 -
Neuroscience and Biobehavioral Reviews Mar 2022Evidence suggests that individuals with autism spectrum disorder have increased rates of co-occurring psychosis and/or bipolar disorder. Considering the peak age of... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Evidence suggests that individuals with autism spectrum disorder have increased rates of co-occurring psychosis and/or bipolar disorder. Considering the peak age of onset for psychosis and bipolar disorder occurs in adulthood, we investigated the co-occurrence of these disorders in adults with autism.
METHODS
We conducted a systematic review and meta-analysis (PROSPERO Registration Number: CRD42018104600) to (1) examine the prevalence of psychosis and bipolar disorder in adults with autism, and (2) review potential risk factors associated with their co-occurrence.
RESULTS
Fifty-three studies were included. The pooled prevalence for the co-occurrence of psychosis in adults with autism was 9.4 % (N = 63,657, 95 %CI = 7.52, 11.72). The pooled prevalence for the co-occurrence of bipolar disorders in adults with autism was 7.5 % (N = 31,739, 95 %CI = 5.79, 9.53).
CONCLUSIONS
Psychosis and bipolar disorder occur at a substantially higher prevalence in adults with autism compared to general population estimates. While there is an overall dearth of research examining risk factors for these disorders in autism, males had increased likelihood of co-occurring psychosis, and females of co-occurring bipolar disorder. These results highlight the need for ongoing assessment and monitoring of these disorders in adults with autism.
Topics: Adult; Autism Spectrum Disorder; Autistic Disorder; Bipolar Disorder; Female; Humans; Male; Prevalence; Psychotic Disorders
PubMed: 35063494
DOI: 10.1016/j.neubiorev.2022.104543 -
The British Journal of Psychiatry : the... Dec 2016The relationship between childhood adversity and bipolar affective disorder remains unclear. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The relationship between childhood adversity and bipolar affective disorder remains unclear.
AIMS
To understand the size and significance of this effect through a statistical synthesis of reported research.
METHOD
Search terms relating to childhood adversity and bipolar disorder were entered into Medline, EMBASE, PsycINFO and Web of Science. Eligible studies included a sample diagnosed with bipolar disorder, a comparison sample and a quantitative measure of childhood adversity.
RESULTS
In 19 eligible studies childhood adversity was 2.63 times (95% CI 2.00-3.47) more likely to have occurred in bipolar disorder compared with non-clinical controls. The effect of emotional abuse was particularly robust (OR = 4.04, 95% CI 3.12-5.22), but rates of adversity were similar to those in psychiatric controls.
CONCLUSIONS
Childhood adversity is associated with bipolar disorder, which has implications for the treatment of this clinical group. Further prospective research could clarify temporal causality and explanatory mechanisms.
Topics: Adult Survivors of Child Adverse Events; Bipolar Disorder; Humans
PubMed: 27758835
DOI: 10.1192/bjp.bp.115.179655 -
Biosensors & Bioelectronics Jan 2023Bipolar disorder is one of the severe mental diseases. Its high misdiagnosis rate and long-time delayed diagnosis are related to the fact that the diagnosis procedure is... (Review)
Review
Bipolar disorder is one of the severe mental diseases. Its high misdiagnosis rate and long-time delayed diagnosis are related to the fact that the diagnosis procedure is mainly conducted by doctors' subjective judgment. The diagnosis methods of bipolar disorder mainly include the International Classification of Diseases (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria and clinical guidelines based on clinical performance. To help psychiatrists make a more accurate diagnosis, in vitro diagnostic (IVD) techniques for bipolar disorder have been developed as the biomarkers research on bipolar disorder steadily increases. Here, we systematically review the recent studies in this area, summarizing the development of instant test products, potentially benefiting clinicians and their patients. The controversy over these biomarkers is discussed, pointing out that multilevel testing with more than one biomarker may provide better confidence in diagnoses. In some cases, more attention should be paid to the different reference values of some biomarkers in terms of age, gender, etc. The review on biomarkers for bipolar disorder may open new doors for the development of point-of-care testing (POCT) and instructing the R&D of future products.
Topics: Humans; Bipolar Disorder; Biosensing Techniques; Diagnostic and Statistical Manual of Mental Disorders; Psychotic Disorders; Biomarkers
PubMed: 36347076
DOI: 10.1016/j.bios.2022.114842 -
JAMA Psychiatry Feb 2017Increased activity and energy alongside mood change are identified in the DSM-5 as cardinal symptoms of mania and hypomania. A wide range of existing research suggests... (Review)
Review
IMPORTANCE
Increased activity and energy alongside mood change are identified in the DSM-5 as cardinal symptoms of mania and hypomania. A wide range of existing research suggests that this revision may be valid, but systematic integration of the evidence has not been reported. The term activation is understood as emerging from underlying physiological change and having objective (observable motor activity) and related subjective (energy) levels.
OBJECTIVES
To systematically review studies of the clinical phenomenon of activation in bipolar disorder, to determine whether activation is statistically abnormal in bipolar disorder and demonstrably distinct from mood, and to identify any significant between- and within-individual differences in the dynamics of activation.
EVIDENCE REVIEW
This systematic review of MEDLINE, PsycINFO, EMBASE, CINAHL, and PubMed databases from January 1, 1970, until September 30, 2016, identified 56 of a possible 3284 citations for (1) data-driven analyses of the dimensions and factor structure of mania and bipolar depression and (2) longitudinal studies reporting real-time objective monitoring or momentary assessment of daytime activity in individuals with bipolar disorder compared with other clinical or healthy control samples. Hand search of reference lists, specialty journals, websites, published conference proceedings, and dissertation abstracts and contact with other researchers ensured inclusion of gray literature and additional analyses as well as raw data if appropriate. Quality assessment was perfomed using the National Institutes of Health quality assessment tool.
FINDINGS
A total of 56 studies met eligibility criteria for inclusion in the review including 29 analyses of the factor structure of bipolar disorder, 3 of activity data from experimental sampling or ecological momentary assessment, and 20 actigraphy and 4 laboratory-based studies. Synthesizing findings across the studies revealed that the most robust finding was that mean levels of activity are lower during euthymia and depression in patients with bipolar disorder compared with healthy controls and other comparison groups (11 studies). The 7 ecological and laboratory studies show less organized or predictable patterns of behavior and a relative lack of habituation among patients with bipolar disorders compared with others. Factor analytic studies provide fairly consistent evidence that mood and activation represent distinct dimensions of bipolar disorder. Ten studies that examined interindividual and intraindividual patterns of activity suggest that mania may be better characterized by differences in robustness, variability, predictability, or complexity of activation rather than mean levels of activity.
CONCLUSIONS AND RELEVANCE
Within the limitations of the data, this synthesis of available evidence broadly supports the elevation of activation as a criterion A symptom for bipolar disorder in DSM-5. Although the importance of activation in bipolar disorders has been acknowledged for more than a century, this review suggests that this critical construct is understudied and should be the topic of more systematic high-quality research.
Topics: Arousal; Bipolar Disorder; Diagnostic and Statistical Manual of Mental Disorders; Humans; Motor Activity; Reference Values
PubMed: 28002572
DOI: 10.1001/jamapsychiatry.2016.3459 -
Trends in Psychiatry and Psychotherapy 2015A growing body of evidence suggests that bipolar disorder (BD) is a progressive disease according to clinical, biochemical and neuroimaging findings. This study reviewed... (Review)
Review
INTRODUCTION
A growing body of evidence suggests that bipolar disorder (BD) is a progressive disease according to clinical, biochemical and neuroimaging findings. This study reviewed the literature on the relationship between specific biomarkers and BD stages.
METHODS
A comprehensive literature search of MEDLINE and PubMed was conducted to identify studies in English and Portuguese using the keywords biomarker, neurotrophic factors, inflammation, oxidative stress, neuroprogression and staging models cross-referenced with bipolar disorder.
RESULTS
Morphometric studies of patients with BD found neuroanatomic abnormalities, such as ventricular enlargement, grey matter loss in the hippocampus and cerebellum, volume decreases in the prefrontal cortex and variations in the size of the amygdala. Other studies demonstrated that serum concentrations of neurotrophic factors, inflammatory mediators and oxidative stress may be used as BD biomarkers.
CONCLUSIONS
The analysis of neurobiological changes associated with BD progression and activity may confirm the existence of BD biomarkers, which may be then included in staging models that will lead to improvements in treatment algorithms and more effective, individually tailored treatment regimens. Biomarkers may also be used to define early interventions to control disease progression.
Topics: Biomarkers; Bipolar Disorder; Disease Progression; Humans
PubMed: 25860561
DOI: 10.1590/2237-6089-2014-0002 -
The Journal of Clinical Psychiatry Oct 2022Since depression represents the most predominant mood polarity in bipolar disorder (BD), the prevalence rates of a diagnosis of premenstrual dysphoric disorder (PMDD)...
Since depression represents the most predominant mood polarity in bipolar disorder (BD), the prevalence rates of a diagnosis of premenstrual dysphoric disorder (PMDD) in women with BD and those of a diagnosis of BD in women with PMDD deserve systematic review. A systematic search of PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane Reviews databases was carried out on November 19, 2021, using the terms [late luteal phase disorder OR premenstrual dysphoric disorder] AND comorbidity AND bipolar disorder. Articles from 1987-2021 were searched. Case studies, intervention studies, reviews, and systematic analyses were excluded. All studies that included a diagnosis of PMDD and BD were included. The selected articles were reviewed to extract data using a data extraction form developed for this study. A total of 5 studies were included in the review. Extant literature, although limited, suggests that PMDD is more common among women with BD than in the general population. Similarly, BD is more common among women with PMDD than in the general population. The proportion of people with PMDD and diagnosed with BD ranged from 10% to 15%. Conversely, the proportion of people with BD who received a diagnosis of PMDD ranged from 27% to 76%. Only a small number of relevant studies were available, and the findings from these were limited by the failure to employ prospective monitoring of symptoms-perhaps the most important feature necessary for confirming PMDD and differentiating it from premenstrual exacerbation of BD. Given the important clinical and heuristic implications, prospective studies are needed to clarify the relationship between the two disorders in order to improve their detection, diagnosis, and treatment.
Topics: Humans; Female; Premenstrual Dysphoric Disorder; Bipolar Disorder; Premenstrual Syndrome; Prospective Studies; Luteal Phase
PubMed: 36300994
DOI: 10.4088/JCP.22r14416