Discuss Bipolar
Blog to discuss being Bipolar
Patients with bipolar I and bipolar II
disorder have distinct neuropathological substrates, study findings
show.
This is consistent with the heterogenous clinical presentations
and cognitive functions previously seen in these patients, note the
study researchers.
“The fiber alterations observed in the bipolar I patients were
majorly associated with cognitive dysfunction, whereas those in the
bipolar II patients were related to both cognitive and emotional
processing,” they report in the Journal of Affective
Disorders.
Li-Fen Chen, from National Yang-Ming University in Taipei,
Taiwan, and colleagues recruited 14 bipolar I disorder patients, 13
bipolar II disorder patients, and 21 mentally healthy individuals.
They compared fractional anisotropy (FA) values calculated from
diffusion tensor images among the groups.
Both groups of patients had lower FA values, indicating fiber
impairments, in the thalamus, anterior cingulate, and inferior
frontal areas, compared with controls.
The two patient groups differed, however, in that abnormal
regions in bipolar II patients were more bilaterally distributed,
extending to the left temporal lobe, whereas the fiber alterations
of bipolar I patients were more lateralized to the right
hemisphere.
Specifically, fiber alterations manifested in the thalamus and
inferior frontal and rostral anterior cingulate areas in bipolar I
patients but not bipolar II patients, while in bipolar II but not
bipolar I patients, fiber alterations were evident in the temporal
lobe.
Correlating these neuropathological findings with clinical
characteristics, the researchers found that fiber alterations in
the subgenual anterior cingulated cortices in both patient groups
affected working memory performance.
The brain regions with significant fiber alterations in bipolar
I patients are mainly related to cognitive functions.
The anterior cingulate cortex is highly involved in the network
regulating both cognitive and emotional processing, with the
rostral area, in particular, associated with monitoring of conflict
or interference, decision making, and response to errors, the
researchers explain. The thalamus is associated with the modulation
of attentional processing and self-regulation of affective states,
they add.
The brain areas with fiber deficits in the bipolar II patients
are mainly associated with emotional processing. The bilateral
subgenual anterior cingulated cortex is important in emotion
regulation, the middle and inferior temporal areas are related to
emotional appraisal processing, the middle temporal area modulates
audiospatial information, and the right inferior frontal area is
involved in emotional communicative processing based on facial
emotions.
“Our results suggest that bipolar I and II patients present
different neuropathological substrates in terms of the loss of
bundle coherence of the disruption of fiber tracts,” the
researchers conclude.
MedWire (www.medwire-news.md) is an independent clinical news
service provided by Current Medicine Group, a trading division of
Springer Healthcare Limited. © Springer Healthcare Ltd;
2010
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The benefits of marriage appear to be greater for women with bipolar disorder than for men with the disorder, US researchers report.
They note, however, that the extra benefit in women was limited to a reduction in depressive symptoms.
“Mental illnesses in general are responsive to varying levels of social support, and women appear to react more strongly to these variations than men do,” say Daniel Lieberman and colleagues from George Washington University School of Medicine and Health Sciences.
“The interpersonal and social rhythm therapy literature also suggest that women may benefit more from the increased lifestyle regularity that can be seen in stable marriages.”
The researchers used the National Institute of Mental Health Life Chart Methodology to collect data on episodes of depression, mania, and mixed states from the previous 2 years for 282 individuals (71 men and 211 women) with bipolar disorder.
In all, 28 (39%) of the men and 112 (53%) of the women were married, indicating that women with bipolar disorder were significantly more likely to be married than men with the condition. The remaining study participants had never been married.
Married women had fewer episodes of depression during the past 2 years than never-married women, at 6.1% versus 7.3%, and the cumulative severity of depression was lower, with average depression scores of 11.7 versus 14.5.
Married and unmarried women with bipolar disorder did not differ with regard to diagnostic subtype or age of onset, however.
By contrast, among men, bipolar I disorder was more common among those who had never been married (n=22 versus 9), and unmarried men had an earlier age at onset of bipolar disorder than their married peers (13.6 versus 20.2 years).
But there was no difference between married and unmarried men with bipolar disorders in terms of frequency, duration, or severity of mood episodes.
The researchers suggest in the journal Comprehensive Psychiatry that the gender differences in their study may be the “result of potential male spouses placing less weight on bipolar disorder as a selection factor or the illness manifesting itself differently in men and women.”
They conclude: “The finding that women with bipolar disorder may be more sensitive to the benefits of being married than men may be helpful in understanding bipolar disorder in men and women and in developing effective treatment strategies.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
Ecologically valid tests of cognitive function appear to be sensitive for detecting cognitive impairment in euthymic bipolar disorder patients, research shows.
Rory O’Shea and colleagues note that ecologically valid tests, such as the Test of Everyday Attention (TEA) and The Rivermead Behavioural Memory Test, Extended Version (RBMT-E), “have greater face validity and are likely to reflect patient’s functional abilities better than traditional tests.”
They add: “They can define areas where cognitive rehabilitation should focus.”
The researchers administered the TEA, the RBMT-E and the Behavioral Assessment of the Dysexecutive Syndrome (BADS), as a measure of executive function, to 29 euthymic bipolar disorder patients and 29 mentally healthy individuals, as well as carrying out clinical, functional, and mood assessments.
The two groups had similar scores on the Mini-Mental State Examination. However, patients were significantly impaired in general and social occupational functioning compared with controls, with average scores on the Global Assessment of Functioning and the Social and Occupational Functioning Assessment Scale of 69.55 versus 84.03 and 71.48 versus 85.55, respectively.
The patients also had significantly worse overall scores than controls on the TEA (66.29 vs 89.86), the RBMT-E (25.07 vs 32.45), and the BADS (95.93 vs 108.17).
The researchers note that these cognitive impairments were not accounted for by residual mood symptoms, as there was no difference in scores between the two groups on mood scales.
Cognitive impairment did worsen in line with a greater number of past manic episodes, however, which the researchers say “supports the intuitive clinical supposition that multiple manic episodes are poor long-term prognostic indicators.”
They were surprised to find that cognitive function did not correlate with general or social and occupational functioning, but note in the Journal of Affective Disorders that euthymic bipolar disorder patients with poorer attention were more likely to be unemployed.
“This study points to the value of using ecologically valid tests of cognitive function during the recovery phase and when patients are considering re-entering the workforce,” O’Shea and team suggest.
“Clinicians should consider using these tests… as they may be particularly helpful in showing where rehabilitation should focus.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
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