Olfactory and gustatory functions in bipolar disorders: A systematic review

Olfactory and gustatory dysfunctions have been described in different psychiatric disorders. Several studies have found gustatory and olfactory function change in bipolar disorders with various results. The aim of this study is to have a systematic review of studies evaluating gustatory and olfactory function in bipolar disorders. After a systematic search, 15 studies on olfaction and 5 studies on taste were included in this review. The UPSIT (University of Pennsylvania Smell Identification Test) and Sniffin’ Sticks were the most widely used tests to evaluate smell. Some studies on olfaction described dysfunctions in smell identification as potential markers for bipolar disorders. Moreover, olfactory acuity was associated with psychosocial and cognitive performances. For taste, only few studies used standardized tests to evaluate gustation. These studies showed that patients with Bipolar disorders had more gustatory dysfunction compared to controls, and to non-bipolar depressed patients.     

Prolactin response to fenfluramine administration in patients with unipolar and bipolar depression and healthy controls

The hormonal response to the serotonin releasing agent/uptake inhibitor fenfluramine has been used as an indicator of central serotonin system function. The serotonergic system plays an important role in the etiology and pathogenesis of mood disorders. We compared the prolactin response to fenfluramine administration in unipolar depressed patients (major depressive disorder), depressed patients with bipolar disorder, and healthy controls. We found a trend towards a blunted prolactin response in depressed patients compared to healthy controls, after controlling for sex, family history, family history-by-gender interaction, and baseline levels. There was no significant difference between unipolar and bipolar patients in the baseline prolactin levels or the response to the fenfluramine administration. We also found a negative correlation between aggression and impulsivity scores and prolactin responses in subgroup with unipolar but not bipolar depression. Female patients with unipolar depression who had first-degree relatives with unipolar depression and normal controls had significantly higher prolactin responses than female patients with unipolar depression who did not have first-degree relatives with unipolar depression. The lack of difference in the response to fenfluramine administration between unipolar and bipolar depressed patients may indicate that overall serotonergic function in unipolar and bipolar depressed patients is similarly impaired.     

Psychomotor performance and monoamine function in bipolar and unipolar affective disorders.

BACKGROUND: Affective disorders are associated with prominent psychomotor abnormalities that may be related to changes in arousal or motivation due to altered catecholamine function. METHODS: We investigated relationships between performance on psychomotor tests of motor speed (reaction time and tapping speed) and visual tracking (trail making and dot placement) and catecholamine system function including cerebrospinal fluid (CSF) or urinary concentrations of catecholamines or their metabolites. Subjects were medicine-free inpatients with unipolar depression or with manic, depressive, or mixed episodes of bipolar disorder, and healthy controls matched by gender and stratified by age. RESULTS: Unipolar and bipolar depressed patients were impaired in motor speed, dexterity, and visual tracking, whereas manic and mixed patients did not differ from controls. Tapping speed correlated positively with CSF 3-methoxy-4-hydroxyphenylglycol in healthy controls and with CSF homovanillic acid in bipolar depressed subjects. Increased catecholamine function correlated with slowing in all other measures for patients with bipolar disorder. Relationships between catecholamines and psychomotor function were weaker in unipolar depressed subjects. Psychomotor function was related to severity of depression in bipolar, but not in unipolar, patients. CONCLUSIONS: These data suggest that catecholamine systems are associated with increased arousal and psychomotor impairment in patients with bipolar disorder. Similar behavioral changes have different neurotransmitter relationships in unipolar disorder.     

Olfactory identification and preference in bipolar disorder and schizophrenia

Olfactory identification deficit appears to be an enduring feature of schizophrenia, but it is unclear whether it is specific to schizophrenia or present in psychotic disorders in general. The aim of the present study was to compare olfactory identification and olfactory preference in schizophrenia and bipolar disorder. Individuals with schizophrenia or bipolar disorder and demographically matched healthy participants were given the University of Pennsylvania Smell Identification Test (UPSIT) to assess olfactory identification ability. To examine olfactory hedonic judgment, participants were also asked to indicate their preference for each UPSIT item on a 5-point rating scale, immediately after odor identification. Clinical symptoms and social competence were also assessed. Both schizophrenic and bipolar groups showed olfactory identification deficits compared with the healthy controls, but schizophrenic patients were more impaired than bipolar patients on the UPSIT accuracy. Interestingly, both bipolar and schizophrenic patients rated odors to be more pleasant than did healthy controls, but all groups preferred odors that they could correctly identify to unidentified smells. Restricted range of preference ratings was associated with the severity of negative symptoms in schizophrenia, and with mania in bipolar disorder. Social competence was associated with better olfactory identification performance. These findings suggest that olfactory identification and preference are compromised in bipolar disorder as well as in schizophrenia, but the precise nature of these abnormalities needs to be further elucidated.     

Implicit and explicit self-associations in bipolar disorder: A comparison with healthy controls and unipolar depressive disorder

According to cognitive theory, negative self-schemas are involved in the occurrence of depression. Whereas implicit depressive self-associations have been found in unipolar depression, it is unknown whether impaired associations with regard to the self are also involved in Bipolar Disorder (BD). This study investigated whether a bias in self-associations is a characteristic of bipolar disorder and whether discrepancies between implicit and explicit self-evaluations may be relevant for understanding bipolar psychopathology. Implicit and explicit self-associations were assessed in patients with BD (n=99), in patients with depressive disorder (n=1236), and healthy controls (n=387). Analyses of variance and correlation analyses were used to compare bipolar patients to controls and unipolar patients on implicit self-associations and the discrepancy between implicit and explicit self-associations. Similar to unipolar patients, patients with BD showed stronger implicit depressive self-associations than controls. Specifically for bipolar patients there was no significant correlation between implicit and explicit depressive self-associations. In a similar vein, discrepancies between implicit and explicit self-associations were relatively pronounced in symptomatic bipolar patients as compared to both healthy controls and unipolar depressed patients. Thus automatic depressive self-associations were characteristic for all mood disorders whereas a lack of concordance between implicit and explicit self-associations was specific for BD.     

Comorbid disorders in hospitalized bipolar adolescents compared with unipolar depressed adolescents

This study examined comorbid psychiatric disorders in adolescents with bipolar disorder. Hospitalized bipolar adolescents (N=10) were compared to hospitalized adolescents with unipolar depression (N=33), and to adolescents with nonaffective psychiatric disorders (N=11). Results showed conduct disorder, attention-deficit hyperactivity disorder, psychosis, and having any DSM-III-R psychoactive substance use disorder were all significantly more common in the bipolar group than the unipolar depressed group. Comorbid anxiety disorder was present in 40–45% of the subjects in the unipolar and bipolar groups, but in none of the control group subjects. This study is supported in part by a grant to Dr. Borchardt from the University of Minnesota Graduate School.     

单双相抑郁患者的情感气质特征及其与抗抑郁治疗反应的关系

目的探索单相抑郁、双相I型和双相II型抑郁患者情感气质特征的差异及其与抗抑郁治疗反应的关系。方法收集广州医科大学附属脑科医院和暨南大学第一附属医院的住院和门诊患者,包括332例单相抑郁患者、116例双相I型患者和152例双相II型患者,所有患者均处于重性抑郁发作期。在为期6周的半自然临床试验中,所有患者均接受抗抑郁药治疗,完成情感气质问卷中文版(TEMPS-A)和汉密尔顿抑郁量表17项版(HAMD-17)评定。比较治疗4、6周末不同气质类型为主导气质患者HAMD-17评分减分率。结果双相I型患者旺盛情感气质评分高于单相抑郁患者和双相II型患者[(9.91±4.53)分vs.(8.20±4.34)分vs.(8.53±4.14),F=6.562,P=0.002];而双相II型患者环性气质评分高于单相抑郁患者[(10.05±5.02)分vs.(7.47±5.22)分,F=12.89,P0.01]。治疗6周后,情感旺盛气质主导组HAMD-17评分减分率高于情感旺盛气质非主导组(F=6.44,P=0.011)。结论单双相抑郁患者的情感旺盛气质和环性气质的特征有所差异,旺盛情感气质可能可以作为处于重性抑郁发作期的情感障碍患者抗抑郁治疗反应的预测因子。     

Bipolar depression in a low-income primary care clinic

OBJECTIVE: This study estimated the proportion of patients attending an urban general medical practice with current major depression and a history of bipolar disorder and compared the history, presentation, and treatment of patients with unipolar and bipolar depression. METHOD: A group of 1,143 patients was assessed with measures of past and current mental health and treatment. Patients were partitioned into bipolar and unipolar groups based on a predefined cutoff on the Mood Disorder Questionnaire. The groups were compared on sociodemographic characteristics, depressive symptoms, comorbid mental disorders, and mental health treatment. RESULTS: Approximately one-quarter of the patients with major depression had lifetime bipolar depression. Patients with unipolar and bipolar depression did not significantly differ on background or health characteristics. Patients with bipolar depression were significantly more likely to report hallucinations, current suicidal ideation, and low self-esteem than patients with unipolar depression but less likely to report disturbed appetite. Patients with bipolar depression were significantly more likely to have an alcohol use disorder and to report inpatient psychiatric care and antipsychotic treatment during the past month than patients with unipolar depression. Nearly one-half of the patients with bipolar depression had taken an antidepressant in the last month, but most were not also being treated with an antipsychotic or mood stabilizer. CONCLUSIONS: Bipolar depression is common in urban general medicine practice. When patients took antidepressants, they seldom received concurrent antimanic medications. Because of the risks of treating bipolar disorder with antidepressant monotherapy, physicians should assess their depressed patients for mania before prescribing antidepressants.     

Perception of facial emotion in adults with bipolar or unipolar depression and controls

Previous research indicates that patients with depression display deficits in their ability to perceive emotions. However, few studies have used animated facial stimuli or explored sensitivity to facial expressions in depressed individuals. Moreover, limited research is available on facial processing in unipolar versus bipolar depression. In this study, 34 patients with DSM-IV major depressive disorder (MDD), 21 patients with DSM-IV bipolar disorder (BPD) in the depressed phase, and 24 never-depressed controls completed the Emotional Expression Multimorph Task, which presents facial emotions in gradations from neutral to 100% emotional expression (happy, sad, surprised, fearful, angry, and disgusted). Groups were compared in terms of sensitivity and accuracy in identifying emotions. Our preliminary findings suggest that subjects with bipolar depression may have emotional processing abnormalities relative to controls.     

双相抑郁与单相抑郁的临床对照研究

目的：探讨双相抑郁与单相抑郁临床特征的区别。方法：惧单相抑郁症患者３２例,双相抑郁症患者４０便,从临床的角度进行对照研究。结果：单相抑郁症患者多见焦虑、自杀行为;而双相抑郁却以精神运动性迟滞突出。治疗上单相抑郁症患者抗抑郁剂疗铲明显优于舒必利,而对双相抑郁症病从舒必利与抗抑郁剂同样有效,且舒必利有药物副反应小,不易转躁的特点。结论：舒必利可作为双相抑郁症病伯首选药物,临床特征有助于对双相抑郁与单相     

The Montgomery Asberg Depression Rating Scale in bipolar II and unipolar out-patients: A 405-patient case study

The aim of the present study was to find if the Montgomery Asberg Depression Rating Scale (MADRS) can identify symptom differences between bipolar II and unipolar depression. Four hundred and five consecutive bipolar II and unipolar depressed out-patients were interviewed with the Comprehensive Assessment of Symptoms and History structured interview, following DSM-IV criteria, the MADRS, and the Global Assessment of Functioning Scale. The Montgomery Asberg Depression Rating Scale items were not significantly different between bipolar II and unipolar patients. Comparisons among atypical and non-atypical bipolar II and unipolar patients showed that only MADRS items of 'reduced sleep' and 'reduced appetite' were significantly different between atypical and non-atypical patients.     

Identifying functional neuroimaging biomarkers of bipolar disorder: toward DSM-V

Bipolar disorder is one of the most debilitating and common illnesses worldwide. Individuals with bipolar disorder frequently present to clinical services when depressed but are often misdiagnosed with unipolar depression, leading to inadequate treatment and poor outcome. Increased accuracy in diagnosing bipolar disorder, especially during depression, is therefore a key long-term goal to improve the mental health of individuals with the disorder. The attainment of this goal can be facilitated by identifying biomarkers reflecting pathophysiologic processes in bipolar disorder, namely impaired emotion regulation, impaired attention, and distractibility, which persist during depression and remission and are not common to unipolar depression. In this critical review, we examine the feasibility of identifying biomarker of bipolar disorder by discussing existing findings regarding functional abnormalities in neural systems underlying emotion processing (amygdala centered), working memory, and attention (dorsolateral prefrontal cortex centered) that persist through bipolar depression and remission and are bipolar specific rather than common to unipolar depression. We then focus on future research goals relating to major clinical problems in bipolar disorder, including, the identification of biomarkers allowing detection of individuals at risk of subsequent development of the disorder. Bipolar disorder is a common, debilitating, and potentially fatal disorder. Current and future research in bipolar disorder should focus on identification of disorder biomarkers to improve diagnostic accuracy and the mental heath of those with the disorder.     

Prevalence of antithyroid antibodies in mood disorders

We examined the prevalence of antimicrosomal and antithyroglobulin antibodies in psychiatric inpatients with unipolar depression (N = 218), bipolar disorder manic (N = 51), bipolar disorder depressed (N = 19), and bipolar disorder mixed (N = 26) in comparison with two control groups: psychiatric inpatients with adjustment disorder (N = 80) and family medicine outpatients without current psychiatric illness (N = 144). A statistical analysis that controlled for age and sex revealed the frequency of positive antibody titers not to be increased in patients with a diagnosis of unipolar depression (6.9%) or bipolar disorder manic (3.9%), when compared with patients with adjustment disorder (2.5%) and non-psychiatric subjects (6.9%). There was a weak trend toward an increased prevalence of antithyroid antibodies in patients with bipolar disorder, mixed (19%) or depressed subtype (16%). The excess occurrence of antibodies in patients with either mixed or depressed bipolar disorder did not appear to be related to lithium exposure, which was similar in all bipolar subgroups. When the intervening influences of age and sex are taken into account, unipolar depression does not appear to be associated with an excessive rate of antithyroid antibodies; however thyroid autoimmunity may be weakly associated with subtypes of bipolar disorder in which depressive symptoms are prominent. Depression and Anxiety 5:91–96, 1997. © 1997 Wiley-Liss, Inc     

Insight into illness in schizophrenia, schizoaffective disorder, and mood disorders with psychotic features

OBJECTIVE: Deficits in insight have been found in one study to be more common and severe in patients with schizophrenia than in patients with schizoaffective and major depression with and without psychosis but not more severe than they are in patients with bipolar disorder. The goals of this study were to replicate this finding independently and to clarify whether patients with schizophrenia differ from patients with bipolar disorder in a larger study group. METHOD: Using the Scale to Assess Unawareness of Mental Disorder, the authors evaluated 29 inpatients with schizophrenia, 24 with schizoaffective disorder, and 183 with mood disorders with psychotic features (153 with bipolar disorder and 30 with unipolar depression). RESULTS: Patients with schizophrenia had poorer insight than patients with schizoaffective disorder and patients with psychotic unipolar depression but did not differ from patients with bipolar disorder. CONCLUSIONS: The lack of significant differences between patients with schizophrenia and patients with bipolar disorder was not a result of low statistical power. This replication and more detailed examination of diagnostic group differences in insight have clinical, theoretical, and nosological implications.     

TRH-induced TSH response in unipolar, bipolar, and secondary depressions: possible utility in clinical assessment and differential diagnosis

(1) The effect of TRH on TSH and GH release was studied in 32 depressed patients. (2) Patients were diagnosed as having a primary (unipolar or bipolar) or secondary depression and rated with Hamilton ratings at the time of TRH testing. (3) The magnitude of the TRH-induced TSH responses significantly differentiated unipolar and bipolar depressed patients who had similar symptoms, cortisol secretion, and Hamilton ratings. (4) GH responses to TRH were only observed in primary affective, depressed patients. (5) The fact that bipolar depressives had augmented TSH responses while unipolar patients had blunted TSH responses supports the clinical differentiation of these patients and suggests that different neurobiological factors may be involved in these clinically similar states. TRH-induced TSH response may ‘switch’ from augmented to blunted as the patient's clinical state changes from depressed to manic. (6) The neural mechanism mediating these TRH test data is difficult to discern on the basis of current studies reported in the literature.     

诊断为单相抑郁症者中未识别的双相障碍（英文）

The diagnosis of bipolar rather than unipolar depression is currently a clinical diagnosis which cannot be validated by specific biological measures,such as laboratory tests.Certainly the characteristics of bipolar depression frequently differ from unipolar major depression in that patients with bipolar depression generally have an earlier age of onset and more frequent episodes than individuals with unipolar major depression     

情感性障碍患者关联性负变改变初探

目的 探讨情感性障碍与正常成人在关联性负变(CNV)检测中的不同表现。方法 应用光和声两种成对刺激,对29例情感性障碍患者和22例正常成人的CNV作了检测。结果 躁狂相组患者波幅B增高,抑郁相组患者A-S＇_2面积缩小,并且躁狂相组波幅B较抑郁相组(单相)高,抑郁相单相组或双相组A-S＇_2面积均较躁狂相缩小。结论 CNV和指令信号后负变化等指标有助于鉴别躁狂相与抑郁相。     

Lateralized auditory processing in depression: Dichotic click detection

The intensity needed to detect dichotic click stimuli was measured in 14 bipolar depressed patients, 19 unipolar depressed patients, and 15 normal controls. The results replicated, in unmedicated bipolar depressed patients, an earlier finding of reserved lateral asymmetry in medicated affective psychotic patients. Two new findings concern the relation of lateral asymmetry patterns to diagnostic subtypes of the Research Diagnostic Criteria and symptom ratings on the Schedule for Affective Disorders and Schizophrenia. First, patients with bipolar disorders (history of mania or hypomania) were more likely than patients with unipolar disorders to display reversed lateral asymmetry. Second, greater severity of depressive or endogenous symptoms was associated with less lateral asymmetry.     

Bipolar depression: phenomenological overview and clinical characteristics

OBJECTIVES: There has been increasing interest in the depressed phase of bipolar disorder (bipolar depression). This paper aims to review the clinical characteristics of bipolar depression, focusing upon its prevalence and phenomenology, related neuropsychological dysfunction, suicidal behaviour, disability and treatment responsiveness. METHODS: Studies on the prevalence of depression in bipolar disorder, the comparative phenomenology of bipolar and unipolar depression, as well as neuropsychology and brain imaging studies, are reviewed. To identify relevant papers, a literature search using MEDLINE and PubMed was undertaken. RESULTS: Depression is the predominant mood disturbance in bipolar disorder, and most frequently presents as subsyndromal, minor or dysthymic depression. Compared with major depressive disorder (unipolar depression), bipolar depression is more likely to manifest with psychosis, melancholic symptoms, psychomotor retardation (in bipolar I disorder) and 'atypical' symptoms. The few neuropsychological studies undertaken indicate greater impairment in bipolar depression. Suicide rates are high in bipolar disorder, with suicidal ideation, suicide attempts and completed suicides all occurring predominantly in the depressed phase of this condition. Furthermore, the depressed phase (even subsyndromal) appears to be the major contributant to the disability related to this condition. CONCLUSIONS: The significance of the depressed phase of bipolar disorder has been markedly underestimated. Bipolar depression accounts for most of the morbidity and mortality due to this illness. Current treatments have significant limitations.