Study results show that amygdala activation during motor response inhibition decreases between mania and remission in patients with bipolar disorder (BD).

Arthur Kaladijan (Universite de la Mediterranee, Marselle, France) and co-authors say that the study findings “place emphasis on amygdala responsiveness as one critical determinant of mood regulation in BD,” and suggest that psychotropic medications should reduce amygdala responsiveness in order to treat manic symptoms effectively.

For the study, the researchers used a longitudinal design to examine the functional changes associated with symptomatic remission from mania the brain network underlying motor response inhibition.

In total, 10 BD patients and 10 healthy controls were imaged twice, first during a manic state and then during full remission, using event-related functional magnetic resonance imaging (MRI) while performing a Go/NoGo task.

The researchers found that the left amygdala was the only brain region that showed a time-dependent change in activation, which was significantly different between BD patients and healthy individuals.

Further analysis showed that BD patients had a lower activation while in full remission than in a manic state, whereas no difference was seen in between both time points in healthy individuals. Additionally, BD patients showed a reduced activation at the left amygdala during remission compared with healthy individuals.

“This indicates that a decrease of the left amygdala activation over time distinguishes the BD group from the [healthy control] group,” write the researchers in the journal Bipolar Disorders.

Kaladijan and team say that clear explanation cannot be provided for why the mood-related change in amygdala activation was observed in only the left hemisphere. They do note, however, that the left and right amygdale have been shown to play different roles in emotional processing.

“Thus, a brain dysregulation that involves the amygdala may lead to different clinical expression according to which side of this structure is affected,” comment the authors.

The researchers also say that the decrease in amygdala activation associated with remission is unlikely to reflect the direct effect of drug administration, since no changes in regimen occurred during the study.

“Further longitudinal studies comparing drug responders to nonresponders are needed to confirm this hypothesis,” they say.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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The number of Americans under care for depression and other mental illnesses nearly doubled between 1996 and 2006, and the overall cost of treating them jumped by nearly two-thirds, according to the latest News and Numbers from HHS’ Agency for Healthcare Research and Quality.

According to the analysis by the federal agency, the number of patients treated for mental disorders, including depression and bipolar disease, increased from 19 million to 36 million. The overall treatment costs for mental disorders rose from $35 billion (in 2006 dollars) to nearly $58 billion, making it the costliest medical condition between 1996 and 2006.

In addition, the study concluded that:

• Heart disease, cancer, trauma-related disorders, and asthma were among other five most costly conditions in both 1996 and 2006. Overall spending for heart disease treatment increased the least, from $72 billion in 1996 to $78 billion in 2006.
• Spending for cancer treatment went from $47 billion to $58 billion; asthma costs rose from $36 billion to $51 billion; and the cost to treat trauma-related disorders climbed from $46 billion to $68 billion.
• In terms of average per-patient cost, Cancer accounted for the highest, up slightly from $5,067 to $5,178, but treatment costs for trauma and asthma rose more steeply, increasing from $1,220 to $1,953 and from $863 to $1,059, respectively. In contrast, average per-patient spending for heart conditions and mental disorder fell from $4,333 to $3,964 and $1,825 to $1,591, respectively.

Source
AHRQ

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The number of Americans under care for depression and other mental illnesses nearly doubled between 1996 and 2006, and the overall cost of treating them jumped by nearly two-thirds, according to the latest News and Numbers from HHS’ Agency for Healthcare Research and Quality.

According to the analysis by the federal agency, the number of patients treated for mental disorders, including depression and bipolar disease, increased from 19 million to 36 million. The overall treatment costs for mental disorders rose from $35 billion (in 2006 dollars) to nearly $58 billion, making it one of the top 5 costliest medical conditions between 1996 and 2006.

In addition, the study concluded that:

• Heart disease, cancer, trauma-related disorders, and asthma were among the other five most costly conditions in both 1996 and 2006. Overall spending for heart disease treatment increased the least, from $72 billion in 1996 to $78 billion in 2006.
• Spending for cancer treatment went from $47 billion to $58 billion; asthma costs rose from $36 billion to $51 billion; and the cost to treat trauma-related disorders climbed from $46 billion to $68 billion.
• In terms of average per-patient cost, Cancer accounted for the highest, up slightly from $5,067 to $5,178, but treatment costs for trauma and asthma rose more steeply, increasing from $1,220 to $1,953 and from $863 to $1,059, respectively. In contrast, average per-patient spending for heart conditions and mental disorder fell from $4,333 to $3,964 and $1,825 to $1,591, respectively.

Citation:

Soni, Anita. The Five Most Costly Conditions, 1996 and 2006: Estimates for the U.S. Civilian
Noninstitutionalized Population. Statistical Brief #248. July 2009. Agency for Healthcare Research and
Quality, Rockville, MD. PDF.

Source
AHRQ

• Bipolar Disorder 'misdiagnosed In A Quarter Of Cases'

Accelerated loss of prefrontal gyrification in bipolar disorder is linked to having at least one brain-derived neurotropgic factor (BDNF) variant, although the overall rate is no higher in such patients, say UK researchers.

Studies have shown that there are structural cerebral abnormalities in bipolar disorder patients, but it is not clear whether they are present at disease-onset or develop over time. As a measure of brain morphology, the gyrification index (GI) of cortical folding has been found to be increased in patients with acute schizophrenia and decreased in those with chronic schizophrenia.

To examine GI changes in bipolar disorder, Ajay Mirakhur and colleagues, from the University of Edinburgh, performed magnetic resonance imaging at baseline and after 4 years in 18 bipolar I disorder patients and 18 healthy controls. They calculated prefrontal GI as the ratio of folded inner contour to exposed outer contour.

Both bipolar disorder patients and healthy controls had a significant decrease in GI over 4 years for dorsal and ventral prefrontal quadrants bilaterally, with no significant difference in the rate of change between patients and controls.

The team also found that bipolar disorder patients with at least one BDNF val⁶⁶met met allele experienced a significantly increased change in GI, particularly in the right dorsal prefrontal cortex, compared with patients with no copies of the BDNF val⁶⁶met met allele, with, GIs at baseline and at follow-up of 2.48 versus 2.31 and 2.47 versus 2.42, respectively.

Interestingly, the team notes in the journal Biological Psychiatry that carriers of the met allele were significantly older than non-carriers, at 43.9 years versus 35.1 years. After taking age into account, the associations between the met allele and change in GI were significant only in the dorsal quadrants. Taking into account medications had no effect on the findings.

“These findings suggest that GI is not purely a neurodevelopmental measure and raise the possibility that GI may be a sensitive measure of morphological change with time,” the researchers conclude.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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Study results show a high prevalence of the metabolic syndrome in Taiwanese bipolar disorder (BD) patients, with metabolic abnormalities particularly common among patients co-treated with mood-stabilizers and second-generation antipsychotics (SGAs).

Although epidemiologic evidence in Western countries has shown increased metabolic disturbances in medicated BD patients, prevalence in Asian countries has not been widely reported.

To address this gap in knowledge, Po See Chen (National Cheng Kung University, Tainan, Taiwan) and colleagues conducted a cross-sectional study investigating the prevalence of the metabolic syndrome in 117 BD patients treated with lithium, valproate, or both.

The researchers found that 33.9% of patients met the International Diabetes Federation (IDF) 2005 criteria for the metabolic syndrome. Furthermore, 13.7%, 36.8%, 53.0%, 18.6%, and 61.0% of patients presented hyperglycemia, hypertriglyceridemia, low high-density lipoprotein (HDL) cholesterol, hypertension, and large waist circumference, respectively.

Compared with female patients, male patients had significantly lower HDL cholesterol (89.7 vs 101.6 mg/dl), higher systolic blood pressures (108.6 vs 117.8 mm Hg), and waist-to-hip ratios (0.86 vs 0.89).

As approximately 40% of the patients were co-treated with SGAs and one or both mood stabilizers, Chen and team examined the relationship between SGAs and metabolic abnormalities in the same cohort.

They found that co-treated BD patients had a significantly higher prevalence of metabolic abnormalities including hyperglycemia (18.0% vs 9.0%), higher triglycerides (42.0% vs 16.4%), and larger waist circumferences (69.7% vs 50.0%) than patients taking either lithium or valproate, or both, only.

“However, it remains unclear how mood stabilizer and SGAs collaborate together to cause higher prevalence of metabolic abnormalities,” write the researchers in the Journal of Affective Disorders.

Additionally, co-treated patients had a significantly longer duration of illness (5.9 vs 1.7 years) and were more likely to be diagnosed as BD I (86.0% vs 16.4%) compared with those not taking SGAs.

The team concludes: “In addition to balancing the benefits and adverse effects conferred by the medications, clinicians need to closely monitor the patient’s metabolic status.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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