DOCSLIB.ORG

Haematological and Biochemical Differences Between Mania and Euthymia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Haematological and Biochemical Differences Between Mania and Euthymia Eur. J. Psychiat. Vol. 30, N.° 3, (163-171) 2016 Keywords: Mania; Inflammation; Haemodilution. Haematological and biochemical differences between mania and euthymia Köse Çinar Rugüla,* Görgülü Yasemina Sönmez Mehmet Bülenta Kahyaci Kiliç Evnurb a Assistant Professor, MD, Department of Psychiatry, Trakya University Faculty of Medicine, Edirne b MD, Department of Psychiatry, Trakya University Faculty of Medicine, Edirne TURKEY ABSTRACT – Background and Objectives: The effects of transient hypothalamic dys- function on the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid axes can be shown by haematological and biochemical parameter changes. We hypothesized that manic episodes will be associated with subclinical inflammation, haemodilution and altered thyroid functions compared to euthymic states. Methods: Patients admitted to the psychiatry clinic with manic episodes were identified. Those having comorbidities, except for thyroid dysfunctions, hypertension, hyperlipidemia, and type 2 diabetes mellitus, were excluded. Complete blood counts, total protein, albumin, and thyroid tests were recorded during the admissions (manic episodes) (Maletic, 2014 #24) and one year later (euthymic states) for the same patients. Results: All studied parameters had significant differences between mania and euthymia. During manic episodes, patients had higher peripheral inflammatory indices (neutrophil/lym- phocyte ratio and platelet/lymphocyte ratio), haemodilution (lower haemoglobin, haemat- ocrit, total protein, and albumin), higher thyroxine and lower thyroid-stimulating hormone levels compared to euthymic states. Conclusions: This study supports the hypothesis that compared to euthymic states; manic episodes are associated with low-grade inflammation, haemodilution and thyroid function abnormalities. Monitoring patients’ blood compositions could result in better prognostic evaluations and aid in determining additional systemic treatment options, as well as in generating causal hypothesis to be tested in future studies. Received: 19 January 2016 Revised: 7 April 2016 Accepted: 14 April 2016 164 KÖSE ÇINAR RUGÜL ET AL. Introduction haemodilution in mania and haemoconcen- tration during depressive episodes9. Bipolar disorder (BD) can be counted The hypothalamus produces thyrotropin- among the diseases in which chronic cellular releasing hormone, which stimulates the re- stress plays a role in the aetiology1,2. In- lease of thyroid-stimulating hormone (TSH) flammation contributes to the initiation and from the anterior pituitary gland15. Stress has progression of several diseases that are ag- effects on the hypothalamic-pituitary-thyroid gravated by stress (e.g. dementia, cardiovas- (HPT) axis15,16. HPT axis abnormalities are cular and endocrinologic diseases, and some common in BD17. Thyroid patients present types of cancer)3. These diseases have high with higher rates of BD and hyperthyroidism prevalences and earlier ages of and earlier may increase the risk of developing BD18. ages of onset in patients with BD 4. Stress im- From a neurobiological perspective, patho- pairs the normal regulation of leukocyte func- logical conditions showing similarities and tions by the hypothalamic-pituitary-adrenal differences produce a disease state that we (HPA) axis and causes persistent low-grade call BD19. Current research emphasis is on inflammation2,5. The peripheral pathophysiol- the biological is on the biological markers ogy of BD appears to be related to systemic in- that can be used in the diagnosis and can of- flammatory mechanisms3. Moreover, inflam- fer therapeutic options. Candidate peripheral mation has been proposed to be a causative biomarkers, like inflammatory and oxidative factor for BD progression6. Persistent low- stress markers, neurotrophins and neuro- grade inflammation is more intense during transmitters, seem to change independently mood episodes, especially manic episodes, and from the mood state4,6,19,20. We wanted to less intense in depressive episodes. Even eu- compare mania and euthymia in the same thymia has been associated with detectable pe- patients to see if the blood analyses differ be- ripheral inflammatory activity4. Cytokines, tween the two states. which are produced by immune cells and play important roles in cell signalling, lead to changes in lymphocyte, neutrophil and platelet levels7. There are only a few psychiatric disor- der studies that have examined the neu- Methods trophil/lymphocyte ratio (NLR) and the platelet/lymphocyte ratio (PLR), both of which Subjects are considered inflammatory indices8-12. We reviewed electronic medical records of Between BD episodes, haematological and patients with BD diagnosed between January biochemical parameter differences were de- 2004 and December 2014. We identified and tected, even though the measures remained in confirmed BD type I diagnoses via our inpa- the normal range9. This imbalance was ex- tient and outpatient clinical records. All diag- plained by changes in fluid intake, physical noses were made according to the Diagnostic activity levels or psychotropic drug use. Fluid and Statistical Manual of Mental Disorders, and electrolyte redistribution within body Fourth Edition, Text Revision (DSM-IV-TR). compartments between different episodes Manic episode admissions with Young Mania was another explanation9,13,14. The latter ex- Rating Scale scores greater than 20 were eval- planation has been shown to be more realis- uated. Patients having data from both the tic with a recent study showing a relative manic episode and the euthymic state (ap- INFLAMMATION AND HEMODILUTION IN MANIA 165 proximately 1 year later) were selected. Pa- Statistical Analysis tients having disease episodes within this 1- year period were excluded. From those pa- We used SPSS version 20 (SPSS, Inc., tients with repeated admissions, the final Chicago, IL, USA) for statistical analysis. De- admission was included in our data. scriptive statistics are expressed as mean ± standard deviation (SD) and rate (%). The We excluded patients under 18 years of Kolmogorov-Smirnov test was used to evalu- age. Patients having medical comorbidities, ate variable distributions. Haematological and except for thyroid dysfunctions, hyperten- biochemical parameters were compared be- sion, hyperlipidemia and type 2 diabetes mel- tween manic episodes and euthymic states in litus, were also excluded. We further ex- the same subjects. Student’s t-tests (paired- cluded patients having comorbid organic samples t-tests) were performed on continuous mental disorders or substance use disorders. variables with normal distributions, and This study was approved by the local ethics Wilcoxon signed-ranks tests were used for committee (TÜTF-BAEK 2015/61). continuous variables without normal distribu- tions. Correlations were assessed by Pearson’s or Spearman’s correlation coefficients. The Measures covariates included sex, age in years, cigarette Patients’ psychiatric evaluations and med- smoking, psychotic symptoms during the ical histories were recorded during their ad- manic episode admission, mood stabilizers and missions and in their outpatient clinical ex- antipsychotic treatments. A p value of < 0.05 aminations. Blood samples were collected was considered statistically significant. between 8 to 10 a.m. and analyses were per- formed by the medical faculty’s biochemical laboratories. NLR, PLR, haemoglobin (g/dL), haematocrit (%), total protein (g/dL), albu- Results min (mg/dL), thyroxine (free T4; ng/dL), and TSH (µIU/mL) levels were recorded. While In this retrospective study, we covered the NLR was calculated as the ratio between the absolute neutrophil and the absolute lym- data between 2004 and 2014. Data was gath- phocyte counts, PLR was calculated as the ra- ered from an electronic database and our out- tio between the absolute platelet and the ab- patient and inpatient clinical records. A total solute lymphocyte counts10,21. The total plas ma of 133 patients met the inclusion criteria. protein level was used as a direct measure and Their haematological and biochemical para- haemoglobin, haematocrit and albumin levels meters from their most recent manic episodes were used as indirect measures of haemodi- and from their euthymic states (approxi- lution/haemoconcentration9. mately 1 year after the manic episode) were analysed. The characteristics of the study We retrieved demographic and clinical data population are presented in Table 1. including sex, age in years at mania and eu- thymia, psychotic symptoms during the manic While all measurements were within the episode admission, and cigarette smoking. normal ranges, there were significant differ- We also recorded the use of mood stabilizers ences between mania and euthymia. During and antipsychotic treatments at admission for mania, NLR and PLR were higher than eu- the manic episode and during the euthymic thymia. However, mean haemoglobin, hae - state when blood samples were collected. matocrit, total protein and albumin levels 166 KÖSE ÇINAR RUGÜL ET AL. Table 1 Demographic and clinical characteristics of the study population (n = 133) Characteristics n (%) or mean ± SD Gender, female, n (%) 67 (50.4) Age at mania, mean ± SD 38.3 ± 11.2 Age at euthymia, mean ± SD 39.5 ± 11.7 Psychotic symptom presence (during mania), n (%) 87 (65.4) Treatment during mania, n (%) Lithium 18 (13.5) Valproate 21 (15.7) Atypical antipsychotics 37 (27.8) Typical antipsychotics 4 (3) Treatment during euthymia, n (%) Lithium 65 (48.9) Valproate 80 (60.2) Atypical antipsychotics
Load more

Recommended publications
  • Multidimensional Models of Perfectionism and Procrastination: Seeking Determinants of Both
    International Journal of Environmental Research and Public Health Article Multidimensional Models of Perfectionism and Procrastination: Seeking Determinants of Both Allison P. Sederlund, Lawrence R. Burns * and William Rogers Psychology Department, Grand Valley State University, Allendale, MI 49417, USA; [email protected] (A.P.S.); [email protected] (W.R.) * Correspondence: [email protected]; Tel.: +001-616-331-2862 Received: 16 May 2020; Accepted: 13 July 2020; Published: 15 July 2020 Abstract: Background: Perfectionism is currently conceptualized using a multidimensional model, with extensive research establishing the presence of both maladaptive and adaptive forms. However, the potential adaptability of procrastination, largely considered as a maladaptive construct, and its possible developmental connection to perfectionism remains unclear. The purpose of this study was to examine the individual differences of the multidimensional models of both perfectionism and procrastination, as well as investigating potential links between the two constructs. Methods: A convenience sample of 206 undergraduate students participated in this study. Participants completed a questionnaire consisting of 236 questions regarding the variables under investigation. Results: The adaptive model of procrastination yielded largely insignificant results and demonstrated limited links with adaptive perfectionism, while maladaptive procrastination was consistently associated with maladaptive perfectionism, lending further evidence of a unidimensional model of
    [Show full text]
  • Mood Disorders Workshop 2010
    Mood Disorders Workshop 2010 Dr Andrew Howie / Dr Tony Fernando Psychological Medicine Faculty of Medical and Health Sciences University of Auckland Goals To learn about the clinical presentation of mood disorders Signs and symptoms Mental status reporting How to ask questions To be able to differentiate the various types of pathological mood states Outline of treatment To understand how it is to have a mood disorder from a person who experiences it Not included in today’s workshop but student has to know… Etiology and Pathophysiology Genetics Social/ Developmental and Environmental factors Details of variant forms Neurobiology Abnormalities in neurotransmission Neuroimaging Neuroendocrine functioning Useful resources (for further reading) American Psychiatric Association guidelines: http://www.psych.org/MainMenu/PsychiatricPrac tice/PracticeGuidelines_1.aspx NICE Guidelines: http://www.nice.org.uk/ RANZCP Guidelines: http://www.ranzcp.org/resources/clinical- memoranda.html Concept of Mood Spectrum Euphoric Ecstatic Optimistic, cheerful “Glass half full” Even mood, stable, content Pessimistic “Glass half empty” Hopeless, worthless suicidal Individualized Set point/ range Reactivity to situations/ thoughts Neutral Positive Negative Despite fluctuations, the individual still is able to function socially, vocationally Modifiable? Pathologic equivalents Euphoric Manic Ecstatic Hypomanic Optimistic, cheerful Hyperthymic “Glass half full” Euthymia ( not pathologic) Even mood, stable, content Pessimistic
    [Show full text]
  • Neural Correlates of Irritability in Disruptive Mood Dysregulation and Bipolar Disorders
    ARTICLES Neural Correlates of Irritability in Disruptive Mood Dysregulation and Bipolar Disorders Jillian Lee Wiggins, Ph.D., Melissa A. Brotman, Ph.D., Nancy E. Adleman, Ph.D., Pilyoung Kim, Ph.D., Allison H. Oakes, B.A., Richard C. Reynolds, M.S., Gang Chen, Ph.D., Daniel S. Pine, M.D., Ellen Leibenluft, M.D. Objective: Bipolar disorder and disruptive mood dysregu- Results: Participants with DMDD and bipolar disorder lation disorder (DMDD) are clinically and pathophysiolog- showed similar levels of irritability and did not differ from each ically distinct, yet irritability can be a clinical feature of both other or from healthy youths in face emotion labeling ac- illnesses. The authors examine whether the neural mech- curacy. Irritability correlated with amygdala activity across all anisms mediating irritability differ between bipolar disorder intensities for all emotions in the DMDD group; such cor- and DMDD, using a face emotion labeling paradigm be- relation was present in the bipolar disorder group only for cause such labeling is deficient in both patient groups. The fearful faces. In the ventral visual stream, associations be- authors hypothesized that during face emotion labeling, tween neural activity and irritability were found more con- irritability would be associated with dysfunctional acti- sistently in the DMDD group than in the bipolar disorder vation in the amygdala and other temporal and prefron- group, especially in response to ambiguous angry faces. tal regions in both disorders, but that the nature of these associations would differ between DMDD and bipolar Conclusions: These results suggest diagnostic specificity in disorder. the neural correlates of irritability, a symptom of both DMDD and bipolar disorder.
    [Show full text]
  • Anxiety Disorders
    TECHNICAL COMMENTARY Anxiety disorders Introduction excluded from the library. The PRISMA flow diagram is a suggested way of providing Anxiety disorders are a group of mental information about studies included and disorders characterised by excessive fear or excluded with reasons for exclusion. Where no worrying. It is important to recognise comorbid flow diagram has been presented by individual anxiety as it may influence treatment strategies reviews, but identified studies have been and outcomes. described in the text, reviews have been Anxiety disorders include generalised anxiety checked for this item. Note that early reviews disorder, which is characterised by continuous may have been guided by less stringent and excessive worrying for six months or more. reporting checklists than the PRISMA, and that Specific phobias are characterised by anxiety some reviews may have been limited by journal provoked by a feared object/situation, resulting guidelines. in avoidance. Social phobia is anxiety provoked Evidence was graded using the Grading of by social or performance situations. Recommendations Assessment, Development Agoraphobia is anxiety about situations where and Evaluation (GRADE) Working Group escape may be difficult or help might not be approach where high quality evidence such as available. Panic disorder is characterised by a that gained from randomised controlled trials panic attack, which is a distinct episode where (RCTs) may be downgraded to moderate or low a person experiences sudden apprehension if review and study quality is limited, if there is and fearfulness, where they may present with inconsistency in results, indirect comparisons, shortness of breath, palpitations, chest pain or imprecise or sparse data and high probability of choking.
    [Show full text]
  • Decreased Empathy Response to Other People's Pain in Bipolar
    www.nature.com/scientificreports OPEN Decreased empathy response to other people’s pain in bipolar disorder: evidence from an event- Received: 28 June 2016 Accepted: 29 November 2016 related potential study Published: 06 January 2017 Jingyue Yang1,2,3,*, Xinglong Hu3,*, Xiaosi Li3, Lei Zhang1,2,4, Yi Dong3, Xiang Li5, Chunyan Zhu1,2,4, Wen Xie3, Jingjing Mu3, Su Yuan3, Jie Chen3, Fangfang Chen1,2,4, Fengqiong Yu1,2,4,* & Kai Wang6,1,2,4,* Bipolar disorder (BD) patients often demonstrate poor socialization that may stem from a lower capacity for empathy. We examined the associated neurophysiological abnormalities by comparing event-related potentials (ERP) between 30 BD patients in different states and 23 healthy controls (HCs, matched for age, sex, and education) during a pain empathy task. Subjects were presented pictures depicting pain or neutral images and asked to judge whether the person shown felt pain (pain task) and to identify the affected side (laterality task) during ERP recording. Amplitude of pain-empathy related P3 (450–550 ms) of patients versus HCs was reduced in painful but not neutral conditions in occipital areas [(mean (95% confidence interval), BD vs. HCs: 4.260 (2.927, 5.594) vs. 6.396 (4.868, 7.924)] only in pain task. Similarly, P3 (550–650 ms) was reduced in central areas [4.305 (3.029, 5.581) vs. 6.611 (5.149, 8.073)]. Current source density in anterior cingulate cortex differed between pain-depicting and neutral conditions in HCs but not patients. Manic severity was negatively correlated with P3 difference waves (pain – neutral) in frontal and central areas (Pearson r = −0.497, P = 0.005; r = −0.377, P = 0.040).
    [Show full text]
  • Socio-Emotional Functioning in Bipolar Disorder Versus Typical Development: Behavioral and Neural Differences
    Georgia State University ScholarWorks @ Georgia State University Psychology Faculty Publications Department of Psychology 2009 Socio-emotional Functioning in Bipolar Disorder Versus Typical Development: Behavioral and Neural Differences Erin B. Tone Georgia State University, [email protected] Follow this and additional works at: https://scholarworks.gsu.edu/psych_facpub Part of the Psychology Commons Recommended Citation Tone, Erin B., "Socio-emotional Functioning in Bipolar Disorder Versus Typical Development: Behavioral and Neural Differences" (2009). Psychology Faculty Publications. 118. https://scholarworks.gsu.edu/psych_facpub/118 This Article is brought to you for free and open access by the Department of Psychology at ScholarWorks @ Georgia State University. It has been accepted for inclusion in Psychology Faculty Publications by an authorized administrator of ScholarWorks @ Georgia State University. For more information, please contact [email protected]. Socio-emotional Functioning in Bipolar Disorder 1 RUNNING HEAD: Socio-emotional Functioning in Bipolar Disorder Socio-emotional Functioning in Bipolar Disorder Versus Typical Development: Behavioral and Neural Differences Erin B. McClure-Tone Georgia State University McClure-Tone, E. B. (2009). Socio-emotional functioning in bipolar disorder versus typical development: Behavioral and neural differences. Clinical Psychology: Science and Practice, 16(2), 98-113. DOI: 10.1111/j.1468-2850.2009.01150.x Socio-emotional Functioning in Bipolar Disorder 2 Abstract Socio-emotional dysfunction is a core feature of bipolar disorder (BD) across the lifespan. Recent evidence indicates associations between this atypical functioning and the presence of neurally-based anomalies. This article critically reviews the literature on two types of core socio- emotional skills that may represent endophenotypes for BD, with a focus on differences between individuals with BD, both youth and adults, and their typically developing peers.
    [Show full text]
  • Young Mania Rating Scale (YMRS)
    PATIENT EDUCATION TOOLS Young Mania Rating Scale (YMRS) OVERVIEW The Young Mania Rating Scale (YMRS) is one of the most frequently utilized rating scales to assess manic symptoms. The scale has 11 items and is based on the patient’s subjective report of his or her clinical condition over the previous 48 hours. Additional information is based upon clinical observations made during the course of the clinical interview. The items are selected based upon published descriptions of the core symptoms of mania. The YMRS follows the style of the Hamilton Rating Scale for Depression (HAM-D) with each item given a severity rating. There are four items that are graded on a 0 to 8 scale (irritability, speech, thought content, and disruptive/aggressive behavior), while the remaining seven items are graded on a 0 to 4 scale. These four items are given twice the weight of the others to compensate for poor cooperation from severely ill patients. There are well described anchor points for each grade of severity. The authors encourage the use of whole or half point ratings once experience with the scale is acquired. Typical YMRS baseline scores can vary a lot. They depend on the patients’ clinical features such as mania (YMRS = 12), depression (YMRS = 3), or euthymia (YMRS = 2). Sometimes a clinical study entry requirement of YMRS > 20 generates a mean YMRS baseline of about 30. Strengths of the YMRS include its brevity, widely accepted use, and ease of administration. The usefulness of the scale is limited in populations with diagnoses other than mania. The YMRS is a rating scale used to evaluate manic symptoms at baseline and over time in individuals with mania.
    [Show full text]
  • Course and Treatment of Mood and Anxiety Disorders During Pregnancy : Lessons Learned Across Two Decades
    Course and Treatment of Mood and Anxiety Disorders During Pregnancy : Lessons Learned Across Two Decades Lee S. Cohen, MD Director, Ammon-Pinizzotto Center for Women’s Mental Health Massachusetts General Hospital Edmund and Carroll Carpenter Professor of Psychiatry Harvard Medical School www.mghcme.org Disclosures My spouse/partner and I have the following relevant financial relationship with a commercial interest to disclose: 12-Month Disclosure Research Support for the National Pregnancy Registry for Atypical Antipsychotics: Alkermes Biopharmaceuticals; Otsuka Pharmaceuticals; Sunovion Pharmaceuticals, Inc.; Teva Pharmaceuticals; Janssen Pharmaceutica ; Other research support: Brain & Behavior Research Foundation; JayMac Pharmaceuticals; National Institute on Aging; National Institutes of Health; SAGE Therapeutics Advisory/Consulting: Alkermes Biopharmaceuticals ,Praxis Precision Medicines, Inc.(through MGH Clinical Trials Network Initiative); Honoraria: None Royalty/patent, other income: None www.mghcme.org Reproductive Psychiatry and the COVID-19 Pandemic • Family planning and the pandemic • Telemedicine and implications for pregnancy and postpartum period • Infertility treatment and the pandemic • Perinatal anxiety during the COVID 19 crisis • Importance of euthymia during pregnancy • Reframing postpartum experience JAMA Psychiatry. Published online July 15, 2020. doi:10.1001/jamapsychiatry.2020.1947 https://womensmentalhealth.org/obgyn/reproductive-psychiatry-during-the-covid-19-pandemic/ www.mghcme.org3 Virtual Rounds at CWMH during COVID : Wednesdays at 2 PM https://womensmentalhealth.org/posts/resource-join-us-for-virtual-rounds-at-the-center-for-womens-mental-health-on-wednesdays/ www.mghcme.org Treatment considerations for women with MDD in pregnancy and the postpartum period • Depression during pregnancy is strongest predictor of postpartum depression • Nothing is more important maternal euthymia www.mghcme.org Major Depression During Pregnancy Are pregnant women protected against relapse or new onset of major depression? O’Hara et al.
    [Show full text]
  • Inhibitory Control for Emotional and Neutral Scenes in Competition
    Biological Psychology 127 (2017) 82–88 Contents lists available at ScienceDirect Biological Psychology journal homepage: www.elsevier.com/locate/biopsycho Inhibitory Control for Emotional and Neutral Scenes in Competition: An Eye- MARK Tracking Study in Bipolar Disorder ⁎ Ana García-Blancoa,b, , Ladislao Salmerónc, Manuel Pereac,d a Health Research Institute La Fe, Valencia, Spain b Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, Valencia, Spain c ERI-Lectura, University of Valencia, Valencia, Spain d Basque Center on Cognition, Brain, and Language, San Sebastián, Spain ARTICLE INFO ABSTRACT Keywords: This study examined the inhibitory control of attention to social scenes in manic, depressive, and euthymic Emotional processing episodes of bipolar disorder (BD). Two scenes were simultaneously presented (happy/threatening/neutral Mood-congruent biases [target] versus control). Participants were asked either to look at the emotional pictures (i.e., attend-to- Attention emotional block) or to avoid looking at the emotional pictures (i.e., attend-to-neutral block) while their eye Inhibitory control movements were recorded. The initial orienting (latency and percentage of first fixation) and subsequent Bipolar disorder attentional engagement (gaze duration) were computed. Manic patients showed a higher percentage of initial fixations on happy scenes than on the other scenes, regardless of the instructions. However, in the attend-to- neutral block, their gaze durations were longest for threatening scenes. Inhibitory control was not modulated by the scene's emotional salience in the other groups. Thus, manic patients had difficulties voluntarily ignoring emotional information – this was characterized by a happy-related bias during initial orienting, but a threat- related bias during attentional engagement.
    [Show full text]
  • Intrusive Images in Psychological Disorders: Characteristics, Neural Mechanisms, and Treatment Implications
    Psychological Review © 2010 American Psychological Association 2010, Vol. 117, No. 1, 210–232 0033-295X/10/$12.00 DOI: 10.1037/a0018113 Intrusive Images in Psychological Disorders: Characteristics, Neural Mechanisms, and Treatment Implications Chris R. Brewin, James D. Gregory, Michelle Lipton, and Neil Burgess University College London Involuntary images and visual memories are prominent in many types of psychopathology. Patients with posttraumatic stress disorder, other anxiety disorders, depression, eating disorders, and psychosis fre- quently report repeated visual intrusions corresponding to a small number of real or imaginary events, usually extremely vivid, detailed, and with highly distressing content. Both memory and imagery appear to rely on common networks involving medial prefrontal regions, posterior regions in the medial and lateral parietal cortices, the lateral temporal cortex, and the medial temporal lobe. Evidence from cognitive psychology and neuroscience implies distinct neural bases to abstract, flexible, contextualized representations (C-reps) and to inflexible, sensory-bound representations (S-reps). We revise our previ- ous dual representation theory of posttraumatic stress disorder to place it within a neural systems model of healthy memory and imagery. The revised model is used to explain how the different types of distressing visual intrusions associated with clinical disorders arise, in terms of the need for correct interaction between the neural systems supporting S-reps and C-reps via visuospatial working
    [Show full text]
  • Impaired Regulation of Emotion: Neural Correlates of Reappraisal and Distraction in Bipolar Disorder and Unaffected Relatives
    OPEN Citation: Transl Psychiatry (2015) 5, e497; doi:10.1038/tp.2014.137 www.nature.com/tp ORIGINAL ARTICLE Impaired regulation of emotion: neural correlates of reappraisal and distraction in bipolar disorder and unaffected relatives P Kanske1, S Schönfelder2, J Forneck3 and M Wessa2 Deficient emotion regulation has been proposed as a crucial pathological mechanism in bipolar disorder (BD). We therefore investigated emotion regulation impairments in BD, the related neural underpinnings and their etiological relevance for the disorder. Twenty-two euthymic patients with bipolar-I disorder and 17 unaffected first-degree relatives of BD-I patients, as well as two groups of healthy gender-, age- and education-matched controls (N = 22/17, respectively) were included. Participants underwent functional magnetic resonance imaging while applying two different emotion regulation techniques, reappraisal and distraction, when presented with emotional images. BD patients and relatives showed impaired downregulation of amygdala activity during reappraisal, but not during distraction, when compared with controls. This deficit was correlated with the habitual use of reappraisal. The negative connectivity of amygdala and orbitofrontal cortex (OFC) observed during reappraisal in controls was reversed in BD patients and relatives. There were no significant differences between BD patients and relatives. As being observed in BD patients and unaffected relatives, deficits in emotion regulation through reappraisal may represent heritable neurobiological abnormalities
    [Show full text]
  • Diagnosing Bipolar Disorder in Children
    Treating Children with Anxiety and Bipolar Disorder Ellen Leibenluft, M.D. Chief, Section on Bipolar Spectrum Disorders Emotion and Development Branch National Institute of Mental Health National Institutes of Health Department of Health and Human Services All research funded by NIMH Intramural Research Program Talk Outline • Diagnosing bipolar disorder in children • In DSM, BD characterized by episodes • Is BD in children characterized by non-episodic, severe irritability? • No: research comparing youth with SMD vs. those with BD • Anxiety in BD • Common comorbidity in adults and youth • Anxiety as a risk factor for BD • Anxiety in SMD • Treatment Irritability across diagnoses Dx Healthy SMD BD Anxiety At risk N 77 67 35 39 35 ANX>HV, At Risk; ANX=BD; ANX < SMD Stringaris et al, unpublished Diagnosing bipolar disorder in youth Hospital discharge diagnoses in the U.S., 1996-2004 Rate of increase in d/c’s for BD: In adults, 56% In adolescents, 400% In children, 1.3 to 7.3 per 10,000 (~600%) Blader and Carlson, 2007 Diagnosing pediatric bipolar disorder: The controversy Is severe irritability and ADHD, without distinct manic episodes, a developmental form of bipolar disorder? DSM-IV Criteria for Manic Episode: Unique features A. Distinct period of elevated, expansive, or irritable mood ≥ 1 week B. Symptoms (3, or 4 if irritable) at the same time as “A” (1) grandiosity (2) decreased need for sleep (3) pressured speech (4) flight of ideas, racing thoughts (5) distractibility (6) increased goal-directed activity, psychomotor agitation (7) excessive pleasurable activities C. Marked impairment, hospitalization, or psychosis DSM-IV Criteria for Manic Epısode: Overlap with ADHD A.
    [Show full text]