-
Research Square Jan 2024Clinical care for bipolar disorder (BD) has a narrow focus on prevention and remission of episodes with pre/post treatment reductions in symptom severity as the 'gold...
BACKGROUND
Clinical care for bipolar disorder (BD) has a narrow focus on prevention and remission of episodes with pre/post treatment reductions in symptom severity as the 'gold standard' for outcomes in clinical trials and measurement-based care strategies. The study aim was to provide a novel method for measuring outcomes in BD that has clinical utility and can stratify individuals with BD based on mood instability.
METHODS
Participants were 603 with a BD (n=385), other or non-affective disorder (n=71), or no psychiatric history (n=147) enrolled in an intensive longitudinal cohort for at least 10 years that collects patient reported outcomes measures (PROMs) assessing depression, (hypo)mania, anxiety, and functioning every two months. Mood instability was calculated as the within-person variance of PROMs and stratified into low, moderate, and high thresholds, respectively.
OUTCOMES
Individuals with BD had significantly higher mood instability index's for depression, (hypo)mania, and anxiety compared to psychiatric comparisons (moderate effects, p's<.001) and healthy controls (large effects, p's<.001). A significantly greater proportion of individuals with BD fell into the moderate (depression: 52·8%; anxiety: 51·4%; (hypo)mania: 48·3%) and high instability thresholds (depression: 11·5%; anxiety: 9·1%; (hypo)mania: 10·8%) compared to psychiatric comparisons (moderate: 25·5 - 26·6%; high: 0% - 4·7%) and healthy controls (moderate: 2·9% - 17·1%; high: 0% - 1·4%). Being in the high or moderate instability threshold predicted worse health functioning (p's < .00, small to large effects).
INTERPRETATION
Mood instability, as measured in commonly used PROMs, characterized the course of illness over time, correlated with functional outcomes, and significantly differentiated those with BD from healthy controls and psychiatric comparisons. Results suggest a paradigm shift in monitoring outcomes in BD, by measuring mood instability as a primary outcome index.
PubMed: 38343860
DOI: 10.21203/rs.3.rs-3880090/v1 -
International Journal of Molecular... Jan 2024Bipolar disorder (BD) is a severe and common chronic mental illness characterized by recurrent mood swings between depression and mania. The biological basis of the...
Bipolar disorder (BD) is a severe and common chronic mental illness characterized by recurrent mood swings between depression and mania. The biological basis of the disease is poorly understood, and its treatment is unsatisfactory. Na, K-ATPase is a major plasma membrane transporter and signal transducer. The catalytic α subunit of this enzyme is the binding site for cardiac steroids. Three α isoforms of the Na, K-ATPase are present in the brain. Previous studies have supported the involvement of the Na, K-ATPase and endogenous cardiac steroids (ECS) in the etiology of BD. Decreased brain ECS has been found to elicit anti-manic and anti-depressive-like behaviors in mice and rats. However, the identity of the specific α isoform involved in these behavioral effects is unknown. Here, we demonstrated that decreasing ECS through intracerebroventricular (i.c.v.) administration of anti-ouabain antibodies (anti-Ou-Ab) decreased the activity of α1 mice in forced swimming tests but did not change the activity in wild type (wt) mice. This treatment also affected exploratory and anxiety behaviors in α1 but not wt mice, as measured in open field tests. The i.c.v. administration of anti-Ou-Ab decreased brain ECS and increased brain Na, K-ATPase activity in wt and α1 mice. The serum ECS was lower in α1 than wt mice. In addition, a study in human participants demonstrated that serum ECS significantly decreased after treatment. These results suggest that the Na, K-ATPase α1 isoform is involved in depressive- and manic-like behaviors and support that the Na, K-ATPase/ECS system participates in the etiology of BD.
Topics: Animals; Humans; Mice; Rats; Depression; Ouabain; Protein Isoforms; Sodium-Potassium-Exchanging ATPase; Steroids
PubMed: 38338921
DOI: 10.3390/ijms25031644 -
Journal of Affective Disorders Apr 2024The high prevalence of stress-related disorders and depression underscores the urgent need to unravel their impact on individual well-being. This study aim to...
Differences in psychiatric comorbidity patterns in patients diagnosed with chronic stress-induced exhaustion disorder and depression - A cohort study in the total population of Region Stockholm.
The high prevalence of stress-related disorders and depression underscores the urgent need to unravel their impact on individual well-being. This study aim to investigate common psychiatric and stress-related diagnoses, along with postviral fatigue, in individuals with prior stress-induced exhaustion disorder (SED) and prior depression compared to those without prior SED or depression, and to study whether the psychiatric comorbidity patterns differ. The study includes individuals in Region Stockholm who, in 2011, did not have a diagnosis of SED or depression. ICD-10 diagnosis of SED, depression, or both, recorded in 2012-2013, were compared to individuals without prior SED or depression in a cohort (n = 1,362,886), aged 18 to 65. Odds ratios (OR) with 99 % confidence intervals, adjusted for age and neighborhood socioeconomic status, were calculated for psychiatric disorders and post-viral fatigue in 2014-2022. Patients with prior SED showed associations primarily with stress related diagnoses, including acute stress reaction, reaction to severe stress, as well as post-COVID-19 and post-viral fatigue syndrome. These ORs were all larger for SED than depression. Depression was primarily associated with post-traumatic stress disorder (PTSD), alcohol related and substance use disorders, schizophrenia, schizotypal disorders, delusional disorders, manic episode, bipolar affective disorder, persistent mood disorder, neurotic disorder, borderline personality disorder, autistic disorder, Asperger's syndrome, attention -deficit hyperactivity disorder, attention-deficit disorders ADHD/ADD), and suicide attempt. These ORs were all higher for depression, although autistic disorders, ADHD/ADD and PTSD were also highly associated with prior SED (OR > 3.5). The divergent psychiatric comorbidity patterns suggest different underlying mechanisms and clinical prognosis.
Topics: Humans; Stress Disorders, Post-Traumatic; Cohort Studies; Depression; Comorbidity; Attention Deficit Disorder with Hyperactivity; Fatigue Syndrome, Chronic; Fatigue
PubMed: 38331048
DOI: 10.1016/j.jad.2024.01.273 -
Cureus Jan 2024There is growing evidence that coronavirus disease-2019 (COVID-19) infection may have various neuropsychiatric manifestations and long-term outcomes. In this article,...
There is growing evidence that coronavirus disease-2019 (COVID-19) infection may have various neuropsychiatric manifestations and long-term outcomes. In this article, the authors report a rare case of a 16-year-old male with no previous history of psychiatric illness who presented with an acute manic episode, including laughing for no evident reason, talking to himself, isolation, irritability, sleeplessness, decreased appetite, prolonged staring episodes, having delusions about being harmed or controlled, and aggression. Despite initiating outpatient treatment with a mood stabilizer and antipsychotic for presumed bipolar disorder with psychotic features, his symptoms worsened, and he became catatonic with a decreased level of consciousness, leading to his hospitalization on day 10. Although he had not shown typical evidence of infection with COVID-19 in the days leading up to or during his hospitalization and his initial COVID-19 test was negative, his COVID-19 test was positive on day 14, and his chest X-ray showed infiltrations. His acute manic symptoms and catatonia were identified to be associated with COVID-19 encephalitis after excluding other causes. He responded well to treatment with lorazepam for catatonia and a course of intravenous immunoglobulin, methylprednisolone, and remdesivir for COVID-19 encephalitis. This case demonstrates the workup and treatment of a rare neuropsychiatric manifestation of COVID-19 encephalitis in an adolescent, which started with no past psychiatric history and no typical symptoms of COVID-19 infection.
PubMed: 38327961
DOI: 10.7759/cureus.51829 -
International Journal of General... 2024Depression is a prevalent mental disorder and has a profound impact on an individual's psychological and physical well-being. It is characterized by a persistently... (Review)
Review
Depression is a prevalent mental disorder and has a profound impact on an individual's psychological and physical well-being. It is characterized by a persistently depressed mood, loss of interest, energy loss, and cognitive dysfunction. In recent years, more and more people have changed to mental diseases, such as depression, anxiety, mania and so on. In the incidence of depression, covering all ages, but still mainly young and middle-aged women. Traditional treatments for depression mainly rely on medication and psychotherapy, but these methods are not effective for all patients and are often accompanied by certain side effects. Therefore, finding safe and effective alternative or adjuvant treatments has become a priority. Here we highlight the research progress of acupuncture in the treatment of depression and to explore the mechanism of acupuncture in the treatment of depression. Acupuncture treatment of depression is an ancient and effective method, the mechanism involves multiple biological pathways, for example, by regulating neurotransmitter levels, regulating the neuroendocrine axis, improving neuroplasticity, anti-inflammatory and other effects, improving emotional state and play an antidepressant role. To provide evidence to support the widespread use of acupuncture in clinical practice. We hope to provide new treatment ideas and methods for patients with depression, and even reduce the incidence of depression.
PubMed: 38314195
DOI: 10.2147/IJGM.S448031 -
Journal of Affective Disorders Apr 2024We conducted a one-year, retrospective, mirror-image study to investigate the clinical effectiveness and safety of aripiprazole once monthly (AOM) in patients with...
BACKGROUND
We conducted a one-year, retrospective, mirror-image study to investigate the clinical effectiveness and safety of aripiprazole once monthly (AOM) in patients with bipolar disorder (BD). We compared pre-treatment conditions with outcomes after 12 months of AOM treatment.
METHODS
Seventy-five bipolar patients were recruited from 12 hospitals in Korea. We included 75 patients with BD who had received at least three AOM treatments from September 2019 to September 2022 and had accessible electronic medical record (EMRs) for the year before and after the baseline visit.
RESULTS
The overall number of mood episodes significantly decreased from a mean of 1.5 ± 1.2 episodes pre-AOM to 0.5 ± 1.2 episodes post-AOM. Manic episodes significantly decreased from 0.8 ± 0.8 episodes pre-AOM to 0.2 ± 0.5 episodes post-AOM, and depressive episodes significantly decreased from 0.5 ± 0.8 episodes pre-AOM to 0.2 ± 0.6 episodes post-AOM (p = 0.017). Moreover, the number of psychiatric medications and pills and the proportion of patients treated with complex polypharmacy were significantly decreased post-AOM.
LIMITATIONS
The small sample size was insufficient to fully represent the entire population of individuals with BD, and potential selection bias was introduced due to only including subjects who received AOM three or more times.
CONCLUSION
The results of this study suggest that AOM can reduce mood episode relapse and may be clinically beneficial in the treatment of BD patients, potentially reducing issues associated with polypharmacy in some individuals.
Topics: Humans; Antipsychotic Agents; Aripiprazole; Bipolar Disorder; Recurrence; Retrospective Studies
PubMed: 38302064
DOI: 10.1016/j.jad.2024.01.257 -
General Psychiatry 2024Bipolar disorder is characterised by recurrent and alternating episodes of mania/hypomania and depression. Current breakthroughs in functional MRI techniques have... (Review)
Review
Bipolar disorder is characterised by recurrent and alternating episodes of mania/hypomania and depression. Current breakthroughs in functional MRI techniques have uncovered the functional neuroanatomy of bipolar disorder. However, the pathophysiology underlying mood instability, mood switching and the development of extreme mood states is less well understood. This review presents a comprehensive overview of current evidence from functional MRI studies from the perspective of mood states. We first summarise the disrupted brain activation patterns and functional connectivity that have been reported in bipolar disorder, irrespective of the mood state. We next focus on research that solely included patients in a single mood state for a better understanding of the pathophysiology of bipolar disorder and research comparing patients with different mood states to dissect mood state-related effects. Finally, we briefly summarise current theoretical models and conclude this review by proposing potential avenues for future research. A comprehensive understanding of the pathophysiology with consideration of mood states could not only deepen our understanding of how acute mood episodes develop at a neurophysiological level but could also facilitate the identification of biological targets for personalised treatment and the development of new interventions for bipolar disorder.
PubMed: 38292862
DOI: 10.1136/gpsych-2023-101398 -
Frontiers in Psychiatry 2024Periventricular heterotopia (PH) is a developmental malformation in the brain. Because the clinical symptoms are heterogeneous, few studies have investigated the...
Periventricular heterotopia (PH) is a developmental malformation in the brain. Because the clinical symptoms are heterogeneous, few studies have investigated the psychiatric symptoms associated with PH. We describe the case of a 17-year-old male with bipolar disorder (BD), who had been treated for attention deficit-hyperactivity disorder (ADHD) and developmental delay in childhood. He had experienced depression for 1 year and was admitted to the emergency room following a suicide attempt. He was admitted to the psychiatric ward for further evaluation and treatment for elated mood, decreased need for sleep, increased sexuality, and delusion. The patient was diagnosed with BP-I disorder and PH via brain magnetic resonance imaging. After combined treatment with valproic acid and aripiprazole, his manic symptoms stabilized. To our knowledge, this is the first report of an adolescent PH case with a history of early onset BD and ADHD in childhood.
PubMed: 38283846
DOI: 10.3389/fpsyt.2024.1289850 -
Journal of Affective Disorders Apr 2024Bipolar disorder (BD) is a highly burdensome psychiatric disorder characterized by alternating states of mania and depression. A major challenge in the clinic is the...
Chronic exposure to imipramine induces a switch from depression-like to mania-like behavior in female serotonin transporter knockout rats: Role of BDNF signaling in the infralimbic cortex.
BACKGROUND
Bipolar disorder (BD) is a highly burdensome psychiatric disorder characterized by alternating states of mania and depression. A major challenge in the clinic is the switch from depression to mania, which is often observed in female BD patients during antidepressant treatment such as imipramine. However, the underlying neural basis is unclear.
METHODS
To investigate the potential neuronal pathways, serotonin transporter knockout (SERT KO) rats, an experimental model of female BD patients, were subjected to a battery of behavioral tests under chronic treatment of the antidepressant imipramine. In addition, the expression of brain-derived neurotrophic factor (BDNF) and its downstream signaling was examined in the prefrontal cortex.
RESULTS
Chronic exposure to imipramine reduced anxiety and sociability and problem-solving capacity, and increased thigmotaxis and day/night activity in all animals, but specifically in female SERT KO rats, compared to female wild-type (WT) rats. Further, we found an activation of BDNF-TrkB-Akt pathway signaling in the infralimbic, but not prelimbic, cortex after chronic imipramine treatment in SERT KO, but not WT, rats.
LIMITATIONS
Repeated testing behaviors could potentially affect the results. Additionally, the imipramine induced changes in behavior and in the BDNF system were measured in separate animals.
CONCLUSIONS
Our study indicates that female SERT KO rats, which mirror the female BD patients with the 5-HTTLPR s-allele, are at higher risk of a switch to mania-like behaviors under imipramine treatment. Activation of the BDNF-TrkB-Akt pathway in the infralimbic cortex might contribute to this phenotype, but causal evidence remains to be provided.
Topics: Humans; Rats; Female; Animals; Imipramine; Brain-Derived Neurotrophic Factor; Serotonin Plasma Membrane Transport Proteins; Mania; Depression; Proto-Oncogene Proteins c-akt; Antidepressive Agents; Hippocampus
PubMed: 38280571
DOI: 10.1016/j.jad.2024.01.186 -
Frontiers in Psychiatry 2023The behavioural variant of Frontotemporal Dementia (bvFTD) is a neurodegenerative condition characterized by behavioural and cognitive symptoms. Mood disturbances,...
The behavioural variant of Frontotemporal Dementia (bvFTD) is a neurodegenerative condition characterized by behavioural and cognitive symptoms. Mood disturbances, including manic-like episodes, can occur in bvFTD, posing diagnostic and therapeutic challenges. This case report presents a 62-year-old male with bvFTD exhibiting weekly mood fluctuations alternating between manic and depressive-like states. While initial treatment with quetiapine and trazodone showed partial improvement, the periodicity of mood fluctuations persisted. Subsequently, lithium was introduced, resulting in a notable reduction in symptom severity for both manic and depressive episodes. This report highlights the potential use of lithium as a mood stabilizer in bvFTD patients with periodic mood fluctuations, refractory to standard treatments. Further research is needed to elucidate the mechanisms underlying lithium's efficacy in bvFTD and to establish treatment guidelines.
PubMed: 38264640
DOI: 10.3389/fpsyt.2023.1325145