A proton magnetic resonance spectroscopy study in schizoaffective disorder: Comparison of bipolar disorder and schziophrenia

The aim of this study was to compare schizoaffective disorder, bipolar disorder and schizophrenia based on (1)H-MRS metabolite values in dorsolateral prefrontal cortex and executive functions. The subjects comprised 15 patients with bipolar disorder type I (BD), 15 with schizophrenia (SCH), 15 with schizoaffective disorder (SAD) and 15 healthy controls. We performed proton magnetic resonance spectroscopy ((1)H-MRS) of the dorsolateral prefrontal cortex (DLPFC) bilaterally. Levels of N-acetyl aspartate (NAA), choline-containing compounds (Cho) and creatine-containing compounds (Cr) were measured in the DLPFC using (1)H-MRS. We administered the Wisconsin Card Sorting Test (WCST) and the Stroop Test (ST) to evaluate executive functions. The SAD, BD and SCH patients had lower levels of NAA than the control group. The SAD and BD patients had low levels of Cho compared to the control group. The left DLPFC Cr levels in all of the patient groups and the right DLPFC Cr levels in the BD and SAD groups were lower than in the control group. The levels of NAA Cho and Cr were not related to executive functions and attention performance. Cr level were related to attention processes, only in SCH. Our results indicate that NAA levels are reduced in schizoaffective disorder, bipolar disorder and schizophrenia, but the reduction in the levels of NAA is not a distinctive feature among these three illnesses. Schizoaffective and bipolar disorders have similar features related to the levels of compounds containing Cho and Cr. This similarity may be related to these illnesses both having an affective basis.     

Physiology of schizophrenia, bipolar disorder, and schizoaffective disorder

OBJECTIVE: Endophenotypes have been proposed to identify the genetic and biological substrates of complex disorders. Three physiological inhibitory endophenotypes of large effect size in schizophrenia include suppression of P50 auditory evoked responses, inhibition of leading (small anticipatory) saccades during smooth pursuit eye movements, and cancellation of reflexive saccades in the antisaccade eye movement task. The aim of this study was to determine if the pattern of endophenotype abnormalities within individuals with schizophrenia differed from that within individuals with bipolar disorder. A second aim was to determine whether subjects with schizoaffective disorder, bipolar type, were neurophysiologically more similar to subjects with schizophrenia or subjects with bipolar disorder. METHOD: Endophenotypes were recorded for subjects diagnosed with schizophrenia (N=29), bipolar disorder (DSM-IV-TR) (N=40), and schizoaffective disorder, bipolar type (N=18). Data from normal comparison subjects were used to establish normal performance. RESULTS: Logistic regression determined that P50 ratio and frequency of leading saccades identified subjects with schizophrenia and bipolar disorder with a sensitivity of 95% and a specificity of 83%. The schizoaffective disorder group was split, with six subjects physiologically classified as schizophrenia-like and 12 subjects as bipolar-like. Those classified as schizophrenia-like were significantly younger at illness onset and had higher symptom ratings. CONCLUSION: A composite endophenotype of P50 ratio and frequency of leading saccades is consistent with the current clinical nosology of schizophrenia and bipolar disorder and parses patients with schizoaffective disorder, bipolar type, into two subgroups.     

A family study of psychotic symptomatology in schizophrenia,schizoaffective disorder,unipolar depression,and bipolar disorder

Summary An evaluation was made of schizophrenics (140), schizoaffectives (40), unipolar depressives (59), and bipolars (30), and their relatives who had a chart diagnosis of psychosis or depressive neurosis. The purpose was to determine whether the psychosis (delusions and hallucinations) was transmitted independently of the illness itself. If this were true, there would be an excess of pairs of probands and relatives both positive for psychosis and pairs of relatives and probands both negative for psychosis when compared to relatives and probands who were not concordant for the variable. This was found to be true in schizophrenia and schizoaffective disorder and is probably the result of the simple transmission of an illness which includes the presence of psychotic symptoms in the definition. Thus, this would be a manifestation of the genetic propensity in schizophrenia. For the affective disorders there was no evidence that psychotic probands were more likely than the nonpsychotic to have psychotic relatives. So far the reason why some patients have psychosis and others not in the affective disorders remains unexplained.     

A prospective study of bipolar disorder in children and adolescents from India

Bipolar disorder in adults is known to run an episodic course. However, little information exists on the long-term naturalistic course of bipolar disorder in juvenile populations. The present study was undertaken with the objectives of (i) documenting the rates of recovery and relapse, (ii) identifying the predictors of recovery and relapse and (iii) assessing the rates of comorbid conditions. A total of 30 subjects with onset of bipolar illness (according to DSM-III-R criteria) in childhood and adolescence were assessed systematically at baseline and 4 to 5 years later. All 30 subjects (100%) had recovered from their index episodes and none had exhibited chronicity. Twenty of the 30 subjects (67%) had relapsed, with most relapses occurring within 2 years of recovery from index episodes. No predictors of recovery and relapse could be identified. Conduct disorder was the only comorbid diagnosis in two subjects (7%). The main implication of our study, in view of the high rates of relapse in the crucial developmental phase of a young individual, is that long-term maintenance medication should be considered in juvenile bipolar patients, even if it is a first episode.     

Quality of life in bipolar and schizoaffective disorder — A naturalistic approach

Purpose

The aim of this study was to evaluate the health-related quality of life (HRQoL) in bipolar type I (BD I) and schizoaffective (SQA) patients during a 2-year period in a naturalistic study.

Methods

This study was based on the data generated by the Bipolar Comprehensive Outcome Study, a prospective, non-interventional, observational study of participants with BD I and SQA disorder. Mixed-Model Repeated Measures Analysis was used to analyze changes in the SF-36 and EQ-5D.

Results

Participants exhibited low health status at baseline with SF-36 mean scores of 46.7 ± 10.5 and 36.9 ± 12.9 (best imaginable health = 100, normal population ≈ 50) for physical and mental components, respectively. No significant differences were found between the ratings of the BD I and SQA patients on HRQoL. The SF-36 SMC improved significantly over 24 months although SPC scores remained consistent across the study. On the whole, the lowest SMC score was observed among the depressed patients (38.20), followed by the patients with a mixed state (39.01) and the manic patients (39.83).

Limitations

The observational design may have limited the causal relationships and the generalizability within the current findings.

Conclusions

HRQoL was significantly impaired in all stages of BD and SQA when compared to the general population. The impairment of HRQoL was most pronounced in the depressed state, followed by the mixed state and then the manic state. The euthymic patients showed the least impairment. In addition, patients showed a global improvement in their mental health satisfaction over the 2 years follow up period.     

Association study of 21 circadian genes with bipolar I disorder, schizoaffective disorder, and schizophrenia

Objective:  Published studies suggest associations between circadian gene polymorphisms and bipolar I disorder (BPI), as well as schizoaffective disorder (SZA) and schizophrenia (SZ). The results are plausible, based on prior studies of circadian abnormalities. As replications have not been attempted uniformly, we evaluated representative, common polymorphisms in all three disorders.
Methods:  We assayed 276 publicly available 'tag' single nucleotide polymorphisms (SNPs) at 21 circadian genes among 523 patients with BPI, 527 patients with SZ/SZA, and 477 screened adult controls. Detected associations were evaluated in relation to two published genome-wide association studies (GWAS).
Results:  Using gene-based tests, suggestive associations were noted between EGR3 and BPI (p = 0.017), and between NPAS2 and SZ/SZA (p = 0.034). Three SNPs were associated with both sets of disorders ( NPAS2 : rs13025524 and rs11123857; RORB: rs10491929; p < 0.05). None of the associations remained significant following corrections for multiple comparisons. Approximately 15% of the analyzed SNPs overlapped with an independent study that conducted GWAS for BPI; suggestive overlap between the GWAS analyses and ours was noted at ARNTL .
Conclusions:  Several suggestive, novel associations were detected with circadian genes and BPI and SZ/SZA, but the present analyses do not support associations with common polymorphisms that confer risk with odds ratios greater than 1.5. Additional analyses using adequately powered samples are warranted to further evaluate these results.     

Unipolar and bipolar schizoaffective disorders: A comparative study

Summary Seventy-two schizoaffective patients were investigated longitudinally (mean follow-up period 25.6 years). Unipolar (n = 37) and bipolar (n = 35) schizoaffectives were compared. Relevant differences in sociodemographic variables were found between the two groups, especially in: (a) sex distribution (more females among unipolar schizoaffectives), (b) social class, (c) occupational and educational level (higher in bipolars), and (d) premorbid personality (obsessoid and low-self-confidence personality types were more frequent in unipolars). Surprisingly there was no difference in age of onset, but some factors were identified that elevated the age of onset in bipolar and reduced it in unipolar schizoaffectives, which may explain this finding. Among bipolars there were more frequent relapses, but there was more suicidal symptomatology in unipolars. No differences were found with regard to long-term outcome, i.e. disability (Disability Assessment Schedule), level of functioning (Global Assessment Scale) or psychopathology at follow up.Supported by grants Ma 915-1/1 and Ma 915-1/2 from the German Research Association (Deutsche Forschungsgemeinschaft)     

Case series of diagnostic shift from bipolar disorder to schizoaffective disorder

Objective: To describe three cases of diagnostic shift from bipolar I disorder (BD) to schizoaffective disorder (SAD).

Methods: BD patients were clinically assessed and followed up in a mood disorder program. A questionnaire was applied to assess clinical and socio-demographic characteristics, and a Structured Clinical Interview (SCID-I) was conducted.

Results: We identified three patients with diagnosis conversion to SAD from 2005 to 2016. The mean time between BD diagnosis and the diagnostic shift to SAD was 9 years.

Conclusions: Psychotic symptoms may become persistent, chronic and unrelated to the presence of mood episodes many years after the beginning of BD. Psychiatrists should be aware of this and reassess the diagnosis during the longitudinal course of BD, especially in those patients who present psychotic symptoms     

Social competence in schizoaffective disorder, bipolar disorder, and negative and non-negative schizophrenia

Social skill and role functioning were assessed in matched groups of patients with DSM-III-R schizoaffective disorder, bipolar disorder, and schizophrenia. Schizophrenics were categorized as negative syndrome or non-negative on the basis of the SANS. The negative schizophrenics were significantly more impaired on almost every measure of social functioning. The other three groups were not consistently different from one another. The results suggest that when patients are comparable on dimensions such as duration and severity of illness, schizoaffectives do not occupy an intermediate position between schizophrenics without negative syndrome and bipolar patients. Rather, the three groups exhibit similar degrees of social disability. In contrast, negative syndrome schizophrenics were more impaired even when they were similar in chronicity and severity.     

Cigarette smoking and impulsivity in bipolar disorder

Heffner JL, Fleck DE, DelBello MP, Adler CM, Strakowski SM. Cigarette smoking and impulsivity in bipolar disorder. Bipolar Disord 2012: 14: 735–742. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objectives: There is a high prevalence of smoking among individuals with bipolar disorder, yet there have been few efforts to identify potential contributing factors as a means of improving prevention and treatment approaches. The goal of this study was to examine the association between impulsivity and the initiation or maintenance of smoking in bipolar disorder. Methods: Participants comprised 97 adolescents and adults, ages 16–50, with bipolar I disorder who were experiencing a mixed or manic episode at the time of study enrollment. Participants completed the Barratt Impulsiveness Scale‐11 (BIS‐11) as a self‐report indicator of trait impulsivity, and the Logan Stop‐Signal Task (SST), Delayed Reward Task (DRT), and Degraded Stimulus Continuous Performance Task (DSCPT) as behavioral measures of impulsivity. Results: Current smokers (34%) and former smokers (23%) generally reported higher trait impulsivity on the BIS‐11 than never smokers (43%), with minimal evidence for differences among the two ever‐smoking groups. No differences in impulsivity by smoking status emerged on the behavioral measures. Conclusions: Trait impulsivity is associated with the initiation, but not necessarily the maintenance, of cigarette smoking in adolescents and adults with bipolar disorder. Our findings provide no evidence that smoking is associated with impulsive responding on cognitive tasks during a symptomatic period during which impulsivity is elevated.     

Comparison of older patients with bipolar disorder and schizophrenia/schizoaffective disorder.

OBJECTIVE: The aim of this cross-sectional study was to explore differences in measures of symptoms and cognition, side effects, and functional impairment between older patients with schizophrenia and bipolar disorder. METHODS: Representative samples (N = 132) of older patients (age >54 years) with either bipolar disorder or schizophrenia and schizoaffective disorder were compared on several clinical and psychosocial variables. The measures used included the Brief Psychiatric Rating Scale, The Scale for the Assessment of Negative Symptoms, the Geriatric Depression Scale, the Abnormal Involuntary Movement Scale, the Clinical Global Impression, and the Mini-Mental Status Examination. RESULTS: Despite being similar in age (mean age: 68 years), patients with schizophrenia/schizoaffective disorder had significantly greater negative symptoms (Cohen's d = 1.2), a higher clinical global impression of impairment (Cohen's d = 1.16), were less likely to drive (Cohen's d = 0.79), were less likely to be married (Cohen's d = 0.55), and less likely to live independently (Cohen's d = 0.45). CONCLUSION: Although the absolute ratings suggested both diagnostic samples had significant disability, those with schizophrenia and schizoaffective disorder had a greater degree of impairment.     

A bidimensional solution for outcomes in bipolar disorder

Although depressive symptoms have been consistently associated with lower quality of life and increased disability in bipolar disorder, their relation to manic symptoms is not as clear cut. A great overlap between these outcomes complicates the understanding of how they cluster together. We used exploratory factor analysis to clarify the relation between these constructs. We consecutively recruited 320 patients with bipolar disorder, and interviewers rated the Hamilton Depression and Anxiety Rating Scales, the Young Mania Rating Scale (YMRS), Clinical Global Impression (CGI), and the Global Assessment of Functioning (GAF). The self-rated Sheehan Disability Scale and the World Health Organization Quality of Life-BREF questionnaires were also collected. Two distinct and large dimensions emerged. Depression and anxiety, along with the self-rated scales, loaded in the first factor, whereas the YMRS, the GAF, and the CGI loaded in the second. These findings imply that evaluating self- and observer-rated outcomes may make up for a more thorough evaluation because each conveys unique illness information.     

Association study of CAG repeats in the KCNN3 gene in Japanese patients with schizophrenia, schizoaffective disorder and bipolar disorder

To investigate a possible involvement of expanded triplet repeats of genome in the genomes of patients with endogenous psychoses, we examined a CAG repeat polymorphism in the coding region of the KCNN3 gene in schizophrenia, schizoaffective disorder, bipolar disorder and controls of the Japanese population. There were no significant differences in the CAG repeat number of longer or shorter alleles among the four diagnostic groups or among the schizophrenia hebephrenic and paranoid subtypes.