Stability of self-esteem in bipolar disorder: comparisons among remitted bipolar patients, remitted unipolar patients and healthy controls

OBJECTIVES: Changes in beliefs about the self are a central feature of bipolar disorder, with grandiose self-belief common in mania and low self-esteem evident in periods of depression. We investigated whether unstable self-esteem is a characteristic of bipolar disorder in remission. METHODS: We compared 18 patients with DSM-IV bipolar disorder in remission, 16 patients with unipolar disorder in remission, and 19 healthy controls. The primary measure was a diary kept for one week and completed twice each day, measuring self-esteem and positive and negative affect. We also administered Winters and Neale's (J Abnorm Psychol 1985; 94: 282-290) implicit measure of attributional style. RESULTS: Whereas mean levels of self-esteem and affect were not abnormal in the remitted bipolar patients, the bipolar patients showed strong fluctuations in these processes. In common with the unipolar patients, they also showed a pessimistic attributional style on the Pragmatic Inference Task (PIT). CONCLUSIONS: Instability of self-esteem and affect is present in bipolar patients, even when their symptoms are in remission, and has previously been found in people at genetic risk of the disorder. It may be a marker of vulnerability to the disorder.     

HTR2A−1438A/G polymorphism influences the risk of schizophrenia but not bipolar disorder or major depressive disorder: A meta‐analysis

The incidence of psychiatric disorders has been shown to have a strong genetic component, and we conducted this study to investigate whether the ?1438A/G polymorphism of the HTR2A gene was associated with susceptibility to schizophrenia (SZ), bipolar disorder (BD), and major depressive disorder (MDD). Pooled odd ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using data obtained from a total 27 studies that investigated an association between the HTR2A ?1438A/G polymorphism and SZ (15), BD (7), and MDD (4). We failed to observe an association between the HTR2A ?1438A/G polymorphism and BD and MDD, and we found contrary results with regard to SZ. Our results showed that the ?1438A/G polymorphism was a risk factor for SZ, especially in Caucasians (allele model: OR, 1.12; 95% CI, 1.05–1.20; I² = 17.3%; dominant model: OR, 1.14; 95% CI, 1.03–1.27; I² = 15.3%; recessive model: OR, 1.20; 95% CI, 1.06–1.37; I² = 0.0%; codominant model 1: OR, 1.16; 95% CI, 1.01–1.32; I² = 0.0%). We found that the association of the HTR2A ?1438A/G polymorphism with SZ depends on the ethnic origin of the study population, and this genetic variant does not modify the susceptibility to BD or MDD. © 2013 Wiley Periodicals, Inc.     

The Inventory of Depressive Symptomatology (IDS): Clinician (IDS‐C) and Self‐Report (IDS‐SR) ratings of depressive symptoms

This paper describes the rationale and methods entailed in developing the Inventory of Depressive Symptomatology (IDS) in both clinician‐rated (IDS‐C) and self‐reported (IDS‐SR) formats. Psychometric features of the both the IDS‐C and IDS‐SR are presented. These scales are compared to the Hamilton Rating Scale for Depression (HRS‐D) in the detection of symptom change in patients with major depressive (n = 184) or bipolar disorder (n = 141). The face validity and established psychometric features of the IDS‐C and IDS‐SR indicate that either may be useful in detecting symptom change, as well as in detecting residual symptoms in depressed patients. Further efforts to shorten each measure are indicated. Copyright © 2000 Whurr Publishers Ltd.     

重性抑郁障碍与双相障碍患者躯体疾病共病调查

目的:了解重性抑郁障碍(MDD)与双相障碍(BD)患者躯体疾病共病情况。方法:对141例MDD和52例BD患者进行一般情况、躯体疾病调查及精神疾病评估。结果:MDD和BD患者躯体疾病的共病率分别为68.1%、46.2%,共病的躯体疾病以慢性病为主,依次为高血压、慢性胃炎、腰椎间盘突出、糖尿病。与非共病患者比较,共病患者年龄及起病年龄大,精神疾病复发次数多(P0.05或P0.01)。MDD共病患者自杀意念风险明显增加(P0.01)。结论:较高龄及较高龄起病的MDD、BD患者更易共病慢性躯体疾病。     

Lactate in bipolar disorder: A systematic review and meta‐analysis

Bipolar disorder (BD) is a debilitating mood disorder with no specific biological marker. No novel treatment has been developed specifically for BD in the last several decades. Although the pathophysiology of BD remains unclear, there is strong evidence in the literature supporting the role of mitochondrial dysfunction in BD. In this systematic review, we identified and investigated 12 studies that measure lactate, which is a direct marker for mitochondrial dysfunction, in BD patients and healthy controls. Six studies measured lactate levels in the brain through proton echo‐planar spectroscopy or magnetic resonance spectroscopy and five of these studies reported significantly elevated lactate levels in patients with BD. Two studies reporting cerebrospinal fluid lactate levels also found significantly elevated lactate in BD compared to healthy controls. Two other studies that reported peripheral lactate levels did not demonstrate significant findings. The meta‐analysis, using standardized means and a random‐effect model for five studies that measured brain lactate levels, corroborated the findings of the systematic review. Although the meta‐analysis had a nearly significant overall effect (Z = 1.97, P = 0.05), high statistical heterogeneity (I² = 86%) and possible publication bias suggest that the results should be interpreted with caution. To validate lactate abnormalities in BD, further studies should be carried out, including larger sample sizes, not excluding female patients, and using standardized methodologies. Peripheral lactate levels and other bioenergetic markers should be thoroughly studied to better understand the role of mitochondrial dysfunction in BD and to help develop more objective diagnostic tools.     

双极性指数对双相障碍的识别效能

目的:探讨双极性指数(bipolarity index,BPX)对双相障碍(BD)的识别效能。方法:对经简明国际神经精神访谈(MINI)、符合美国精神障碍诊断与统计手册第4版(DSM-IV)BD及复发性抑郁症(RMDD)诊断标准的住院患者各60例进行BPX评估表评估,BPX总分包含躁狂发作特征、发病年龄、病程/相关特征、治疗反应及家族史5个维度。结果:BD组BPX为35~95分,平均(67.4±13.0)分;RMDD组为7~27分,平均(15.3±4.1)分;BD组BPX评分显著高于RMDD组(P0.05)。以BPX 44分为分界值,筛查BD的灵敏度为93.7%,特异度为100%,漏诊率为6.3%,阴性预测值93.7%;以BPX38.5分为界值分,筛查BD的灵敏度为98.3%,特异度为100%,漏诊率为1.7%,阴性预测值98.3%。RMDD组没有1例≥38.5分。BD组和RMDD组BPX评分均与首发年龄、治疗反应呈正相关(P均0.01);BD组BPX评分亦与文化程度及家族史呈正相关(P均0.05)。结论:应用BPX筛检BD具有较高的灵敏度和特异度。有家族史、发作频繁、首次发作年龄小的患者BPX评分高。     

Comorbidity of anxiety disorders in patients with remitted bipolar disorder

Comorbidity between bipolar disorder and anxiety disorders has attracted considerable attention in recent years. However, a majority of the earlier studies examined anxiety disorders in acutely ill patients resulting in a possible confounding effect of the affective episodes. This study examines the prevalence of anxiety disorders in remitted bipolar subjects recruited from a psychiatric hospital in India and their effect on the severity of bipolar illness. A total of eighty remitted DSM-IV adult bipolar subjects and 50 non-psychiatric controls were recruited over a 10-month period. They were evaluated using a structured interview and various scales. The effect of anxiety disorders on bipolar severity was analyzed using multiple regression analyses. Anxiety disorders were highly prevalent in bipolar subjects compared to controls (49 [61%] vs. 7 [14%], χ² = 28.01, P < 0.001). Commonest lifetime anxiety disorder was obsessive-compulsive disorder (35%). Lifetime anxiety disorder had significant effect on all four indices of severity of illness, that included (1) percentage of time spent in episodes (Beta = 18.67, SE = 5.11, P < 0.001), (2) maximum period of continuous euthymia in the preceding 2 years (Beta = −5.26, SE = 1.71, P = 0.003), (3) presence of psychosis (Beta = 3.22, SE = 1.02, P = 0.002), and 4) response to mood stabilizers (Beta = −2.11, SE = 0.76, P = 0.006). The findings of this study confirm previous observations of the high prevalence and negative impact of comorbid anxiety disorders in bipolar disorder and also demonstrate that the findings are similar in culturally diverse settings. Future studies should systematically examine the various treatment options for anxiety disorders in bipolar patients. It is also necessary to examine the neurobiological and family/genetic correlates of anxious bipolar subjects to validate if they are a subgroup of bipolar disorders.     

非典型症状与双相障碍

概述：双相障碍（Bipolar Disorder,BD）临床症状多样,容易被误诊为抑郁症（Major depressive disorder, MDD）。非典型症状（Atypical Features,ATFs）是一个有用的指标,可以从抑郁状态中识别出双相障碍,有助于双相障碍与抑郁症的鉴别诊断。本文就非典型症状与双相障碍的相关性问题进行讨论。     

Cognition in older adults with bipolar disorder versus major depressive disorder

Gildengers AG, Butters MA, Chisholm D, Anderson SJ, Begley A, Holm M, Rogers JC, Reynolds CF III, Mulsant BH. Cognition in older adults with bipolar disorder versus major depressive disorder. Bipolar Disord 2012: 14: 198–205. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objectives: Bipolar disorder (BD) and major depressive disorder (MDD) are associated with cognitive dysfunction in older age during both acute mood episodes and remitted states. The purpose of this study was to investigate for the first time the similarities and differences in the cognitive function of older adults with BD and MDD that may shed light on mechanisms of cognitive decline. Methods: A total of 165 subjects with BD (n = 43) or MDD (n = 122), ages ≥ 65 years [mean (SD) 74.2 (6.2)], were assessed when euthymic, using comprehensive measures of cognitive function and cognitive–instrumental activities of daily living (C‐IADLs). Test results were standardized using a group of mentally healthy individuals (n = 92) of comparable age and education level. Results: Subjects with BD and MDD were impaired across all cognitive domains compared with controls, most prominently in Information Processing Speed/Executive Function. Despite the protective effects of having higher education and lower vascular burden, BD subjects were more impaired across all cognitive domains compared with MDD subjects. Subjects with BD and MDD did not differ significantly in C‐IADLs. Conclusion: In older age, patients with BD have worse overall cognitive function than patients with MDD. Our findings suggest that factors intrinsic to BD appear to be related to cognitive deterioration and support the understanding that BD is associated with cognitive decline.     

Age at onset in 3014 Sardinian bipolar and major depressive disorder patients

Tondo L, Lepri B, Cruz N, Baldessarini RJ. Age at onset in 3014 Sardinian bipolar and major depressive disorder patients. Objective: To test if onset age in major affective illnesses is younger in bipolar disorder (BPD) than unipolar‐major depressive disorder (UP‐MDD), and is a useful measure. Method: We evaluated onset‐age for DSM‐IV‐TR major illnesses in 3014 adults (18.5% BP‐I, 12.5% BP‐II, 69.0% UP‐MDD; 64% women) at a mood‐disorders center. Results: Median and interquartile range (IQR) onset‐age ranked: BP‐I = 24 (19–32) < BP‐II = 29 (20–40) < UP‐MDD = 32 (23–47) years (P < 0.0001), and has remained stable since the 1970s. In BP‐I patients, onset was latest for hypomania, and depression presented earlier than in BP‐II or UP‐MDD cases. Factors associated with younger onset included: i) being unmarried, ii) more education, iii) BPD‐diagnosis, iv) family‐history, v) being employed, vi) ever‐suicidal, vii) substance‐abuse and viii) ever‐hospitalized. Onset‐age distinguished BP‐I from UP‐MDD depressive onsets with weak sensitivity and specificity. Conclusion: Onset age was younger among BPD than MDD patients, and very early onset may distinguish BPD vs. UP‐MDD with depressive‐onset.     

Brain volume abnormalities in major depressive disorder: A meta‐analysis of magnetic resonance imaging studies

Objective . So far, there have been no attempts to integrate the growing number of all brain volumetric magnetic resonance imaging studies in depression. In this comprehensive meta‐analysis the magnitude and extent of brain volume differences between 2,418 patients with major depressive disorder and 1,974 healthy individuals from 64 studies was determined. Methods . A systematic research was conducted for volumetric magnetic resonance imaging studies of patients with major depressive disorder in relation to healthy control subjects. Studies had to report sufficient data for computation of effect sizes. For each study, the Cohen's d was calculated. All analyses were performed using the random effects model. Additionally, meta‐regression analyses were done to explore the effects of potential sources of heterogeneity. Results . Patients showed large volume reductions in frontal regions, especially in the anterior cingulate and orbitofrontal cortex with smaller reductions in the prefrontal cortex. The hippocampus, the putamen and caudate nucleus showed moderate volume reductions. Conclusions . This is the first comprehensive meta‐analysis in major depressive disorder demonstrating structural brain abnormalities, particularly in those brain areas that are involved in emotion processing and stress‐regulation. Hum Brain Mapp, 2009. © 2009 Wiley‐Liss, Inc.