Discuss Bipolar
Blog to discuss being Bipolar
Gender differences in bipolar I disorder are associated with memory function and may contribute to poor functional outcome particularly in men, UK researchers report.
They found gender by diagnosis interactions in patients with bipolar I disorder were present in immediate memory, both auditory and visual, but not in general intellectual ability, concept formation, and perseveration or response inhibition.
The researchers also note that it is unlikely that their findings “relate to potential differences in illness severity between men and women with bipolar I disorder,” because both patient groups were comparable in terms of age of onset, duration of illness, number of episodes or hospitalizations and global assessment of functioning (GAF) scores.
They evaluated the performances of 86 remitted patients with bipolar I disorder (36 men and 50 women) and 46 mentally healthy individuals (21 men and 25 women) on a series of cognitive tasks.
On the Weschler Memory Scale-III (WMS-III), patients with bipolar I disorder performed significantly worse than mentally healthy controls in immediate visual and auditory memory and auditory delayed memory, but not in visual delayed memory or auditory recognition delayed memory.
When the effects of gender were assessed, women with bipolar I disorder did not perform significantly worse than control women on any of these WMS-III variables, whereas men with bipolar I disorder performed significantly worse than men without the disorder in auditory (average score 96.5 vs 113.2) and visual immediate (92.2 vs 110.7) memory, and marginally worse in auditory delayed memory (92.3 vs 103.3).
Compared with women with bipolar I disorder, men with the condition performed worse in immediate memory (102.4 vs 93.4, respectively) and auditory delayed memory (105.8 vs 92.3), but not significantly so. Immediate memory was significantly correlated with male patients’ overall level of functioning, however, underscoring the importance of memory function in the outcome of bipolar disorder.
Further analysis of the abnormalities in immediate memory test performance, which could reflect either encoding or retrieval, showed that it was retrieval deficits that were greater in men than women with bipolar I disorder.
“This is further supported by the finding of gender differences in delayed auditory memory in bipolar disorder,” say Sophia Frangou, from King’s College London, and colleagues in the journal Psychological Medicine.
They conclude: “Our results support the notion that gender may modulate the degree of immediate memory dysfunction in bipolar disorder and its impact on overall level of function.
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
Adults with bipolar I disorder are at increased risk for cardiovascular disease and hypertension, which occur over a decade earlier than in adults without the disorder, researchers have discovered.
Despite previous studies demonstrating an increase in cardiovascular risk factors and mortality in patients with bipolar disorder, there is limited evidence on the association between cardiovascular disease itself and the disorder, as most studies have been constrained by restricted analyses.
To investigate further, Benjamin Goldstein, from Sunnybrook Health Sciences Center in Toronto, Ontario, Canada, and colleagues examined data from the 2001??”2002 National Epidemiologic Survey on Alcohol and Related Conditions on 1441 patients with bipolar I disorder, 6831 patients with major depressive disorder (MDD), and 34,851 controls without MDD or bipolar I disorder.
On unadjusted analysis, bipolar I disorder patients had a significantly higher prevalence of cardiovascular disease than MDD patients, at 10.1% versus 8.0%. MDD patients in turn had a significantly greater prevalence than controls, at 4.9%. In addition, bipolar I disorder and MDD patients had a significantly greater prevalence of hypertension than controls, at 22.1% and 21.6% versus 18.4%, with no significant differences between the two patient groups.
Adjusting for age, race, and gender, the team found that the risk for cardiovascular disease in bipolar I disorder patients was increased 4.95 times compared with controls and 1.80 times compared with MDD patients.. Bipolar I disorder patients also had a significantly greater prevalence of hypertension than MDD patients or controls, at respective odds ratios of 2.38 and 1.44.
The results remained significant after also taking into account education, income, marital status, obesity, anxiety, smoking, and substance use disorders, the researchers note in the journal Bipolar Disorders.
Bipolar I disorder patients with cardiovascular disease were significantly younger than controls or MDD patients with cardiovascular disease, at approximately 14 years and 6 years younger, respectively. Among hypertension patients, those with bipolar I disorder were also younger than controls and MDD patients, at approximately 13 years and 6.5 years younger, respectively.
The team writes: “Given the complexity of bipolar I disorder itself, compounded by the high rates of psychiatric comorbidity, integration of medical care with psychiatric care is needed in order to optimize medical and psychiatric outcomes and minimize costs.
“Preliminary evidence indicates that such integration may yield improvements in both psychiatric and medical health as well as reduce both forms of service utilization.”
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
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
- Bipolar Disorder - Eurand Announces FDA Approval Of EUR-1048 (Lamictal(R) ODT(TM)), Co-Developed With GlaxoSmithKline
- FADS2 gene expression elevated in bipolar patients]]>
There is no gradient in affective temperament scores from bipolar I disorder through unipolar depressive patients to healthy individuals, say UK researchers who found high dysthymic scores in both patient groups.
The concept that certain affective temperaments may represent endophenotypic manifestations of bipolar spectrum disorder vulnerability has received increased interest in recent years. Alongside this, the boundaries of bipolarity have been expanded through the emerging concept of a clinically relevant broad “bipolar spectrum,” the researchers note.
To examine the notion that there is a gradient in affective temperament scores from bipolar I disorder, through bipolar II disorder and recurrent major depression disorder (MDD-R), to healthy controls, Arianna Di Florio, from University Hospital of Wales in Cardiff, and colleagues administered the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A) to 927 individuals.
The participants consisted of 298 patients with bipolar I disorder, 108 bipolar II disorder patients (including 70 patients diagnosed with MDD-R who scored ?20 on the Hypomania Checklist [HCL-32]), 312 MDD-R patients who scored ?19 on the HCL-32, and 209 mentally healthy controls.
Bipolar II disorder patients scored highest on the cyclothymic, irritable, and dysthymic subscales of the TEMPS-A, with controls scoring lowest. On the hyperthymic subscale, bipolar II disorder patients and controls scored highest. There were no differences in median scores on the anxious subscale. However, significant differences across all four groups were found on all five subscales.
Logistic regression analysis indicated that only the dysthymic subscale distinguished between patients and controls, with all three groups differing significantly from controls. There were no significant differences among the patient groups when taking into account number of manic and depressive episodes and age at onset.
Interestingly, the anxious subscale was able to distinguish between MDD-R patients and controls, with no other associations identified, the team writes in the Journal of Affective Disorders.
They conclude: “These data suggest that dysthymic temperament may be a common intermediate phenotype in affective disorders.”
The researchers add: “We failed to find evidence to support the hypothesis that affective temperament scores show a gradient between bipolar I disorder, bipolar II disorder, MDD-R, and controls.”
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; 2009
- Mental Health America Applauds Bipartisan Legislation To Help Treat Depression And Bipolar Disorders
- Patients With Bipolar Disorder At Increased Risk For Wide Range Of Health Problems, Thomson Reuters Study Finds
- Mental Illness Was One Of The Costliest Conditions Between 1996 To 2006
- 1A binding reductions in euthymic bipolar disorder patients]]>
- Communication Within The Brain Impaired By Genetic Variant With Possible Consequences Schizophrenia Or Manic Depression
- ">
Study findings suggest that disrupted auditory attention is observed in bipolar disorder (BD) patients independent of their mood state, medication status, or history of psychotic features, but may be influenced by the presence of a comorbid anxiety disorder.
Previous studies have shown that BD patients show aberrations of event-related potential (ERP) measures of auditory processing elicited during “oddball” discrimination tasks, in which infrequent target tones presented within a series of frequent distracter tones must be identified.
“Aberrations in auditory ERPs may reflect a neurophysiologic marker, or endophenotype, for BD, but the effect of patients’ mood state, current medication usage, or history of other psychiatric disorders on these measures are not well understood,” explain Daniel Fridberg (Indiana University, Bloomington, USA) and co-authors.
The team therefore administered an auditory “oddball” discrimination task to elicit ERPs in 69 patients with type I BD, of whom 14 were unmedicated, and 52 healthy individuals with no history of psychiatric disorders. Patients were placed into subgroups based on whether they were euthymic or symptomatic, and amplitude and peak latency measures from N100, P200, N200, and P300 ERP components were compared across subgroups.
The P300 ERP component is believed to provide an index of selective attention and general cognitive efficiency, with the peak latency believed to represent stimulus evaluation speed independent of reaction time, and its amplitude representing neural activity underlying attention and memory process involved in updating stimulus representations.
N100, P200, and N200 ERP components precede the P300 in time and reflect earlier stages of information processing, the authors explain.
P300 amplitude to target tones was reduced in both the symptomatic and euthymic BD patient groups compared with controls. BD patients also had a prolongation in P300 latency compared with controls, at 408.3 versus 380.4 ms.
Furthermore, symptomatic and euthymic BD patient groups did not differ on P300 amplitude or latency, and also showed reduced P200 amplitude to frequent tones compared with controls.
Regression analysis showed that history of comorbid anxiety disorder diagnosis was associated with reduced N200 peak latency but increased P300 peak latency. No effects of medication status, history of psychotic features, or mood state on ERP measures in BD patients were observed.
Writing in the journal Bipolar Disorders, the team says that “the present study provides further support for auditory P300 amplitude as a candidate endophenotype for BD,” and “indicates that P300 latency may be sensitive to the presence of a comorbid anxiety disorder in BD patients.”
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; 2009