Bipolar Disorders
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Volumetric brain imaging findings in mood disorders Volumetric neuroimaging is increasingly being used by researchers of affective disorders to assess potential involvement of different brain structures in mood regulation and to test neuroanatomic models of mood disorders. In unipolar depression, findings suggest abnormalities in the frontal lobe (particularly the subgenual prefrontal cortex), basal ganglia (particularly the caudate and putamen), cerebellum, and hippocampus/amygdala complex. In bipolar disorder, abnormalities in the third ventricle, frontal lobe, cerebellum, and possibly the temporal lobe are noted. We review the findings for the various regions of the brain, and discuss the implications on the understanding of mood disorders. Directions for future research in volumetric imaging is then discussed.
Bipolar Disorders - Tập 4 Số 2 - Trang 89-104 - 2002
Increased rates of white matter hyperintensities in late‐onset bipolar disorder Objectives: Magnetic resonance imaging (MRI) studies have reported an increased frequency of white matter hyperintensities (WMH) in association with late‐onset (LO) depression, and this has supported the notion that vascular‐related mechanisms may be implicated in the pathophysiology of LO mood disorders. Recent clinical studies have also suggested a link between LO bipolar disorder (LO‐BD) and cerebrovascular risk factors, but this has been little investigated with neuroimaging techniques. In order to ascertain whether there could be a specific association between WMH and LO‐BD, we directly compared WMH rates between LO‐BD subjects (illness onset ≥ 60 years), early‐onset BD subjects (EO‐BD, illness onset <60 years), and elderly healthy volunteers.Methods: T2‐weighted MRI data were acquired in LO‐BD subjects (n = 10, age = 73.60 ± 4.09), EO‐BD patients (n = 49, age = 67.78 ± 4.44), and healthy subjects (n = 24, age = 69.00 ± 7.22). WMH rates were assessed using the Scheltens scale.Results: There was a greater prevalence of WMH in LO‐BD patients relative to the two other groups in the deep parietal region (p = 0.018) and basal ganglia (p < 0.045). When between‐group comparisons of mean WMH scores were conducted taking account of age differences (ANCOVA), there were more severe scores in LO‐BD patients relative to the two other groups in deep frontal and parietal regions, as well as in the putamen (p < 0.05).Conclusions: Our results provide empirical support to the proposed link between vascular risk factors and LO‐BD. If extended in future studies with larger samples, these findings may help to clarify the pathophysiological distinctions between bipolar disorder emerging at early and late stages of life.
Bipolar Disorders - Tập 10 Số 7 - Trang 765-775 - 2008
Total white matter hyperintensity volume in bipolar disorder patients and their healthy relatives Tighe SK, Reading SA, Rivkin P, Caffo B, Schweizer B, Pearlson G, Potash JB, DePaulo J Raymond, Bassett SS.
Total white matter hyperintensity volume in bipolar disorder patients and their healthy relatives.
Bipolar Disord 2012: 14: 888–893. © 2012 John Wiley & Sons A/S.Published by Blackwell Publishing Ltd. Objectives: White matter hyperintensities (WMH) are more common in subjects with bipolar disorder (BP) than in healthy subjects (HS). Few studies have examined the effect of the diagnostic type of bipolar illness on WMH burden, and none have approached this question through a direct measurement of the volume of affected white matter in relationship to familiality. In this pilot study, we utilized a volumetric measurement of WMH to investigate the relationship between the total volume of WMH and the familiality and type of BP.Methods: Forty‐five individuals with bipolar I disorder (BP‐I) with psychotic features, BP‐I without psychotic features, or bipolar II disorder (BP‐II), seven of their unaffected relatives, and 32 HS were recruited for participation. T‐2 weighted magnetic resonance imaging scans were obtained on all subjects, and the total volume of all WMH for each subject was measured in cubic centimeters. The significance of difference between groups was tested using ANOVA with post‐hoc adjustment for multiple comparisons. Further, we used logistic regression to test for trends between symptom load and total WMH volume.Results: The mean total volume of WMH in BP‐I patients with psychotic features was significantly higher (p < 0.05) than that of HS. Further, we observed a positive linear trend by familiality and type of affectedness when comparing mean total WMH volume of HS, unaffected family members, subjects with BP‐II, and BP‐I with and without a history of psychosis (p < 0.05).Conclusions: Based on a quantitative technique, WMH burden appears to be associated with familiality and type of BP. The significance of these findings remains to be fully elucidated.
Bipolar Disorders - Tập 14 Số 8 - Trang 888-893 - 2012
Neuroprogression in bipolar disorder Schneider MR, DelBello MP, McNamara RK, Strakowski SM, Adler CM. Neuroprogression in bipolar disorder.
Bipolar Disord 2012: 14: 356–374. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objective: Recent theories regarding the neuropathology of bipolar disorder suggest that both neurodevelopmental and neurodegenerative processes may play a role. While magnetic resonance imaging has provided significant insight into the structural, functional, and connectivity abnormalities associated with bipolar disorder, research assessing longitudinal changes has been more limited. However, such research is essential to elucidate the pathophysiology of the disorder. The aim of our review is to examine the extant literature for developmental and progressive structural and functional changes in individuals with and at risk for bipolar disorder.Methods: We conducted a literature review using MEDLINE and the following search terms: bipolar disorder, risk, child, adolescent, bipolar offspring, MRI, fMRI, DTI, PET, SPECT, cross‐sectional, longitudinal, progressive, and developmental . Further relevant articles were identified by cross‐referencing with identified manuscripts.Conclusions: There is some evidence for developmental and progressive neurophysiological alterations in bipolar disorder, but the interpretation of correlations between neuroimaging findings and measures of illness exposure or age in cross‐sectional studies must be performed with care. Prospective longitudinal studies placed in the context of normative developmental and atrophic changes in neural structures and pathways thought to be involved in bipolar disorder are needed to improve our understanding of the neurodevelopmental underpinnings and progressive changes associated with bipolar disorder.
Bipolar Disorders - Tập 14 Số 4 - Trang 356-374 - 2012
Comparing diagnostic checklists for pediatric bipolar disorder in academic and community mental health settings Objectives: To compare six promising mania measures, the Parent Mood Disorder Questionnaire (P‐MDQ), the Adolescent self‐report MDQ, the 10‐item short form of the Parent General Behavior Inventory (PGBI‐SF10), the 28‐item Adolescent General Behavior Inventory (AGBI), the Parent Young Mania Rating Scale (P‐YMRS), and the adolescent YMRS, in a demographically diverse outpatient sample.Methods: Participants were 262 outpatients (including 164 males and 131 African‐Americans) presenting to either an academic medical center (n = 153) or a community mental health center (n = 109). Diagnoses were based on semi‐structured interviews with the parent and then youth sequentially.Results: Ninety youths (34%) met criteria for a bipolar spectrum disorder. Parent measures yielded Areas Under the Receiver Operating Curve (AUROC) values of 0.81 for the PGBI‐SF10 to 0.66 for the P‐YMRS. Adolescent report measures performed significantly less well, with AUROCs ranging from 0.65 to 0.50. There were no significant differences in the diagnostic performance of the measures across the sites or by racial groups, although the reliability of measures tended to be lower in the urban community mental health site. The PGBI‐SF10 made a significant contribution to logistic regression models examining all combinations of the instruments. The P‐MDQ added information in the younger age group, and no measure improved classification of bipolar cases after controlling for the PGBI‐SF10 in the older age group.Discussion: Results replicate previous findings that, in decreasing order of efficiency, the PGBI‐SF10, P‐MDQ, and P‐YMRS significantly discriminate bipolar from non‐bipolar cases in youths aged 5–18; and they appear robust in a demographically diverse community setting. Adolescent self‐report measures are significantly less efficient, sometimes performing no better than chance at detecting bipolar cases.
Bipolar Disorders - Tập 7 Số 6 - Trang 507-517 - 2005
Bipolar disorder and <i>myo</i>‐inositol: a review of the magnetic resonance spectroscopy findings Objectives: Myo ‐inositol is an important component of the phosphatidylinositol second messenger system (PI‐cycle). Alterations in PI‐cycle activity have been suggested to be involved in the pathophysiology and/or treatment of bipolar disorder. More specifically, lithium has been suggested to act primarily by lowering myo ‐inositol concentrations, the so‐called inositol‐depletion hypothesis. myo ‐Inositol concentrations can be measured in vivo with magnetic resonance spectroscopy (MRS).Methods: The current review primarily examines animal and human MRS studies that evaluated the role of myo ‐inositol in bipolar illness and treatment.Results: Studies have been carried out in patients who are manic, depressed, and euthymic, both on and off treatment. However, there are several limitations of these studies.Conclusions: The preclinical and clinical MRS findings were generally supportive of the involvement of myo ‐inositol in bipolar disorder and its treatment. Overall, in bipolar patients who are manic or depressed there are abnormalities in brain myo ‐inositol concentrations, with changes in frontal and temporal lobes, as well as the cingulate gyrus and basal ganglia. These abnormalities are not seen in either euthymic patients or healthy controls, possibly due to a normalizing effect of treatment with either lithium or sodium valproate. There is also increasing evidence that sodium valproate may also act upon the PI‐cycle. Nonetheless, it remains uncertain if these changes in myo ‐inositol concentration are primary or secondary. Findings regarding the specific inositol‐depletion hypothesis are also generally supportive in acutely ill patients, although it is not yet possible to definitively confirm or refute this hypothesis based on the current MRS evidence.
Bipolar Disorders - Tập 7 Số 1 - Trang 1-10 - 2005
Influence of cognitive reserve on neuropsychological functioning in bipolar disorder: Findings from a 5‐year longitudinal study Objectives The present study examined the 5‐year longitudinal course of cognitive functioning in a large sample of well‐characterized patients with bipolar disorder (BP ), compared to healthy controls (HC s), and the influence of cognitive reserve factors (e.g., education and IQ ) on cognitive change over time. Methods Participants included 159 individuals diagnosed with BP and 54 HC s recruited as part of a longitudinal naturalistic study of BP who had completed neuropsychological testing at the time of their enrollment and again 5 years later. Results The overall relative rate of change did not differ between the BP and HC groups. In total, 46.5% of the BP group and 37% of the HC group showed evidence of decline on at least one measure over time. T‐test analyses did not find differences between BP ‘decliners’ and ‘non‐decliners’ in cognitive reserve variables. However, we found that higher baseline intellectual ability was associated with more stability in cognitive test scores over time for the BP group. Results of linear regression modeling revealed that lower verbal IQ and education were related to increased cognitive decline in specific domains in the BP group. Conclusions This study has explored the influence of cognitive reserve on preservation of specific cognitive abilities over time in BP. The BP group did not demonstrate accelerated cognitive decline over 5 years compared to the HC group. Although the trajectory of cognitive change over time was similar between BP patients and HC s, higher overall intellectual ability may be a protective factor against cognitive decline, particularly for BP patients.
Bipolar Disorders - Tập 19 Số 1 - Trang 50-59 - 2017
Five‐year follow‐up of cognitive impairment in older adults with bipolar disorder Objective To date, cognitive impairment has been thought to be an integral part of bipolar disorder. In clinical staging models, cognitive impairment is one of the hallmarks to define the clinical stage and it plays an important role in identifying the risk factors for progression to later stages of the illness. It is important to examine neurocognitive performance over longer periods to test the hypothesis of neuroprogression of bipolar disorder. Methods A comprehensive neuropsychological test battery was applied at baseline and five years later to 56 euthymic older outpatients with bipolar disorder (mean age = 68.35 years, range: 60–90 years) and to a demographically matched sample of 44 healthy subjects. A group‐by‐time repeated measures multivariate analysis of variance was performed to measure changes over time for the two groups. The impact of baseline illness characteristics on the intra‐individual change in neurocognitive performance within the bipolar disorder group was studied by using logistic regression analysis. Results At baseline and at follow‐up, patients with bipolar disorder performed worse on all neurocognitive measures compared to the matched healthy subjects. However, there was no significant group‐by‐time interaction between the patients with bipolar disorder and the comparison group. Conclusions Although older patients with bipolar disorder had worse cognitive function than healthy subjects, they did not have greater cognitive decline over a five‐year period. The change in acquired cognitive impairment of patients with bipolar disorder might parallel the cognitive development as seen in normal aging.
Bipolar Disorders - Tập 18 Số 2 - Trang 148-154 - 2016
Neurocognitive impairment in bipolar disorder patients: functional implications Background: Functional recovery among treated bipolar disorder (BPD) patients is far less likely than syndromal and even symptomatic recovery. We hypothesized that increasingly well‐documented aspects of cognitive impairment may contribute to poor functional outcomes in BPD patients, and reviewed the available research on the topic.Methods: Computerized literature searching identified 12 studies with 13 comparisons that simultaneously evaluated cognitive and functional status in euthymic (n = 8) or non‐euthymic (n = 5 comparisons) adult BPD patients versus otherwise similar healthy controls.Results: In 6/8 studies of euthymic BPD patients and 5/5 studies of non‐euthymic BPD patients, neurocognitive impairment was significantly associated with impaired psychosocial functioning, even after adjusting for residual mood symptoms and relevant demographic and clinical variables. Cognitive status was consistently assessed with standardized, performance‐based neuropsychological tests, but functional status usually was based on subjective self‐appraisals. Approximately 55% of BPD patients were unemployed.Conclusions: Available studies are limited by subjective assessments of functional status rather than objective, performance‐based measures. Nevertheless, they support the hypothesis that enduring aspects of cognitive impairment found even in euthymic BPD patients are associated with inferior functioning. These findings encourage further studies with better assessment methods and greater rehabilitative efforts in BPD patients.
Bipolar Disorders - Tập 11 Số 2 - Trang 113-125 - 2009
Cognitive impairment in later life in patients with early‐onset bipolar disorder Objectives: Cognitive impairment may interfere with psychosocial functioning in bipolar disorder (BD). There is limited information regarding the cognitive function of elderly bipolar patients with onset at a young age. The present study aimed to investigate the frequency and the determinants of cognitive impairment in elderly early‐onset bipolar patients.Methods: Using the Clock‐drawing Test (CDT), the Mini Mental State Examination (MMSE), and the Cognitive Abilities Screening Instrument (CASI), we examined euthymic patients with bipolar I disorder in Taiwan, aged 60 years and older. Clinical data were obtained by reviewing medical records and personal interviews with patients and their family members. The onset of BD prior to the age of 40 years is defined as ‘early‐onset’.Results: Of the 52 early‐onset patients, 42.3% were determined to have cognitive impairment by exhibiting either abnormal CDT or education‐adjusted MMSE scores. In a multiple regression model, years of education and the age at the last manic/hypomanic (but not depressive) episode accounted for the greatest variance in both MMSE and CASI scores. While educational level and the age at the last manic/hypomanic episode were not considered in the regression model, onset with depressive syndrome and current age explained 21.5% of the variance in MMSE scores. Age at the first depressive episode, the first manic episode before the age of 40 years, and comorbid diabetes accounted for 16.7% of the variance in CASI scores.Conclusions: There appeared to be a sizable proportion of elderly early‐onset bipolar patients having cognitive impairment. It is suggested that clinical manifestation of first‐onset affective episode and impact of medical comorbidity affect the cognition of early‐onset BD in later life.
Bipolar Disorders - Tập 9 Số 8 - Trang 868-875 - 2007
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