Sustained attention-deficit confirmed in euthymic bipolar disorder but not in first-degree relatives of bipolar patients or euthymic unipolar depression

Background: Patients with bipolar disorder demonstrate increased sensitivity to appetitive/rewarding stimuli even during euthymia. On presentation of arousing pictures, they show a peculiar response, suggesting heightened vigilance. While responding to looming arousing cues, studies show subjects with anxiety spectrum disorders exhibit increased reaction time (RT), explained by the “looming-vulnerability model.” This study aimed to investigate the responses to looming arousing cues in euthymic bipolar patients and their first-degree relatives, as compared to healthy controls. Method: A looming appetitive and aversive cue paradigm was designed for assessing the RT of patients to process appetitive and aversive cues. The behavioral inhibition/activation and sensitivity to reward/punishment amongst the groups were also assessed. Results: The bipolar group showed significantly longer RT to process appetitive cues irrespective of the looming condition. Aversive cues elicited significantly longer RT in both the bipolar group and in first-degree relatives, but only when presented with the looming condition. Significant looming bias was elicited in the bipolar group which suggested a particular cognitive style to looming cues. A composite measure of RT along with sensitivity to reward/punishment distinguishes the bipolar group and their first-degree relatives from the healthy controls. Conclusion: The looming vulnerability model may provide important insights for future exploration of cognitive endophenotypes in bipolar disorder.

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Risk and coaggregation of major psychiatric disorders among first-degree relatives of patients with bipolar disorder: a nationwide population-based study

Psychological Medicine ◽

10.1017/s003329171800332x ◽

2018 ◽

Vol 49 (14) ◽

pp. 2397-2404 ◽

Cited By ~ 7

Author(s):

Mu-Hong Chen ◽

Ju-Wei Hsu ◽

Kei-Lin Huang ◽

Tung-Ping Su ◽

Cheng-Ta Li ◽

...

Keyword(s):

Bipolar Disorder ◽

Psychiatric Disorders ◽

Population Based ◽

Autism Spectrum ◽

The Public ◽

First Degree Relatives ◽

Relative Risks ◽

Dependent Relationship ◽

Increased Risk ◽

Bipolar Patients

AbstractBackgroundBipolar disorder is a highly heritable mental illness that transmits intergeneratively. Previous studies supported that first-degree relatives (FDRs), such as parents, offspring, and siblings, of patients with bipolar disorder, had a higher risk of bipolar disorder. However, whether FDRs of bipolar patients have an increased risk of schizophrenia, major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD) remains unclear.MethodsAmong the entire population in Taiwan, 87 639 patients with bipolar disorder and 188 290 FDRs of patients with bipolar disorder were identified in our study. The relative risks (RRs) of major psychiatric disorders were assessed among FDRs of patients with bipolar disorder.ResultsFDRs of patients with bipolar disorder were more likely to have a higher risk of major psychiatric disorders, including bipolar disorder (RR 6.12, 95% confidence interval (CI) 5.95–6.30), MDD (RR 2.89, 95% CI 2.82–2.96), schizophrenia (RR 2.64, 95% CI 2.55–2.73), ADHD (RR 2.21, 95% CI 2.13–2.30), and ASD (RR 2.10, 95% CI 1.92–2.29), than the total population did. These increased risks for major psychiatric disorders were consistent across different familial kinships, such as parents, offspring, siblings, and twins. A dose-dependent relationship was also found between risk of each major psychiatric disorder and numbers of bipolar patients.ConclusionsOur study was the first study to support the familial coaggregation of bipolar disorder with other major psychiatric disorders, including schizophrenia, MDD, ADHD, and ASD, in a Taiwanese (non-Caucasian) population. Given the elevated risks of major psychiatric disorders, the public health government should pay more attention to the mental health of FDRs of patients with bipolar disorder.

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Autobiographical Memory and Episodic Specificity Across Different Affective States in Bipolar Disorder

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.641221 ◽

2021 ◽

Vol 12 ◽

Author(s):

Rafael de Assis da Silva ◽

Marcelo Baggi Tancini ◽

Renata Lage ◽

Rodrigo L. Nascimento ◽

Cristina M. T. Santana ◽

...

Keyword(s):

Bipolar Disorder ◽

Autobiographical Memory ◽

Sense Of Self ◽

Time Integration ◽

Unipolar Depression ◽

Mood States ◽

Affective States ◽

Psychiatric Interview ◽

Self Identity ◽

Bipolar Patients

Autobiographical memory is essential to ground a sense of self-identity, contributing to social functioning and the development of future plans, and being an essential source for the psychiatric interview. Previous studies have suggested loss of autobiographical episodic specificity in unipolar depression, but relatively fewer investigations have been conducted in bipolar disorder (BD) patients, particularly across different mood states. Similarly, there is a scarcity of systematic investigations about mood-congruent and mood-dependent memory in relation to autobiographical memory in BD. Considering this, a total of 74 patients with BD (24 in euthymia, 26 in mania, and 24 in depression) responded with autobiographical memories to cue words belonging to four categories: mania, depression, BD, and neutral. Episodic specificity was scored according to the Autobiographical Interview, with high intra- and inter-rater reliability. Results indicated that patients in mania generally re-experience more episodic details than those in depression. Depressed bipolar patients reported fewer details of perception and less time integration of memories than those in euthymia or mania. Words linked to depression and BD induced greater episodic re-experiencing than neutral words, just as words about BD provided greater episodic re-experiencing and more details of emotion/thoughts than words about mania. Words linked to depression provoked more time details about the recalled episodes than words on BD or neutral themes. No mood-congruent or mood-dependent effects were observed. Current findings may improve the ability of clinicians to conduct psychiatric interviews and the diagnosis of BD, with special attention to how memory details are generated across different mood states of the condition. Additionally, interventions to foster autobiographical recollection in BD may be developed, similar to what has already been done in the context of schizophrenia.

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Prevalence of Bipolar Depression

CNS Spectrums ◽

10.1017/s1092852900028765 ◽

2003 ◽

Vol 8 (S12) ◽

pp. 2-3

Author(s):

Robert M. Post

Keyword(s):

Bipolar Disorder ◽

Bipolar Depression ◽

Unipolar Depression ◽

The United States ◽

Mood Stabilizers ◽

Positive Screen ◽

Specificity And Sensitivity ◽

Academic Settings ◽

Mood Disorder Questionnaire ◽

Bipolar Patients

Recent data indicate that bipolar illness is underdiagnosed and therefore undertreated in the community (Slide 1). A recent survey of >85,000 households in the United States found a 3.7% positive screen for prominent bipolar symptomatology. Using the Mood Disorder Questionnaire, which has good specificity and sensitivity in outpatient clinics, the study also found that the prevalence was higher, 9.3%, among patients 18–24 years of age. However, most disappointing was that only 20% of the positive screens were diagnosed as bipolar, and among those, most were not treated with mood stabilizers. In addition, 31% of patients had been diagnosed with unipolar depression. Several studies have shown that approximately 20% to 40% of presumptively unipolar patients actually have bipolar II or bipolar disorder not otherwise specified. Combined, the data show that bipolar disorder, bipolar depression in particular, is highly prevalent and often misdiagnosed or unrecognized.Two recent studies found virtually the same data showing that depression is the predominant problem in naturalistically treated bipolar outpatients. Judd and colleagues found that depression was three times more prevalent than mania in bipolar patients. This is exactly what was found in the Stanley Foundation bipolar outpatient follow-up study, which rated the study's first 258 patients every day for 1 year (Slide 2). The study found that patients were ill almost 50% of the time; they were depressed 33% of the days in the year, and hypomanic or manic 10.8% of the days. This occurred despite aggressive treatment with a variety of agents, such as mood stabilizers, antidepressants, and benzodiazepines in 50% of the patients, and typical or atypical neuroleptics in almost 50% of the patients. Thus, even bipolar patients who are intensively treated in academic settings have a very substantial degree of morbidity, particularly depression.

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Subthreshold Manifestations of Bipolar Disorders as Health Care’s tool

European Psychiatry ◽

10.1016/s0924-9338(09)70820-x ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

M. Mazza ◽

D. Harnic ◽

G. Marano ◽

V. Catalano ◽

L. Janiri ◽

...

Keyword(s):

Quality Of Life ◽

Bipolar Disorder ◽

Bipolar Disorders ◽

Unipolar Depression ◽

Response To Treatment ◽

Type I ◽

Male Patients ◽

Bipolar Patients ◽

Disorder Type

Introdution:Our study represents a pilot evaluation about how the MOOD-SR recognizes subthreshold manifestations that may be associated with clinical symptomatology in a group of bipolar patients.Methods:At Day Hospital of Psychiatry, Policlinico “A. Gemelli”, Bipolar Disorders Unit, it has been conducted an experimental study on a heterogeneous sample of 24 patients with a diagnosis of Bipolar Disorder type I. Patients have been assessed with the MOOD-SR, a clinical self-reported interview, that is specific for the spectrum of subthreshold pathology, and with the Quality of Life (QoL), that investigates the patient's quality of life.Results:We have found that 16 patients on 24 report a score higher than 60 (68,4%). Among these, 10 female patients on 15 have a total score higer than 61 (68.75%) while 6 male patients on 9 obtain a total score higher than 60 (62,5%). However, these results have only preliminary value, further studies are needed in order to obtain a deeper evaluation.Conclusion:Spectrum manifestations are both indicator of course and response to treatment and predictive for relapse. This finding may represent an important preventive instrument for maniacal relapse in patients with Bipolar Disorder, that is often underdiagnosed or confused for Unipolar Depression. By adequately recognizing the problem we will be able to refine diagnosis and individualize therapy.

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A study to assess the magnitude of various minor physical anomalies in bipolar disorders and to compare them between bipolar disorder patients and their first degree relatives

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20195235 ◽

2019 ◽

Vol 6 (6) ◽

pp. 1826

Author(s):

Abhinav Pandey ◽

Haseeb Khan ◽

Dinesh M. S. Rathore

Keyword(s):

Bipolar Disorder ◽

Medial Temporal Lobe ◽

Bipolar Disorders ◽

Sampling Technique ◽

Total Sample ◽

Stressful Events ◽

Mri Findings ◽

Cross Sectional ◽

First Degree Relatives ◽

Bipolar Patients

Background: Bipolar disorder appears to be related to anatomic abnormalities in medial temporal lobe, in particular amygdale, prefrontal cortex and cerebellum. Two recent MRI findings have supported a neuro developmental etiology of bipolar disorders.Methods: It was a cross-sectional comparative hospital based study. The subjects were recruited for the study by the purposive sampling technique. The study was conducted at the Institute of Mental Health and Hospital Mathura Road Agra. The study sample consisted of 20 bipolar disorder patients diagnosed as per ICD-10 DCR (WHO, 1992) criteria, 20 first degree relatives, one for each patient. Total sample size is 40.Results: It was observed that in bipolar patients’ maximum anomalies were seen in Mouth (0.35±0.48) head (0.30±0.57) followed by anomalies of eyes (0.25±0.55) hand (0.20±0.41) and ear (0.05±0.22). It was observed that in Bipolar FDRs maximum anomalies were seen in mouth (0.20±0.04) ear (0.15±0.45) head (0.1±0.3) and then anomalies of eye and hand in equal propensity (0.05±0.22) and least anomalies in feet (0.00±0.00).Conclusions: The rate of MPAs in bipolar patients was more than their FDRs but not statically significant. Both sibling groups had fewer MPAs than the patients. When viewed within a vulnerability-stress model, the results are consistent with the theory that MPAs may reflect early, largely extra-genetic, stressful events.

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Social cognition in first-degree relatives of bipolar disorder: Theory of Mind and nonverbal sensitivity

PLoS ONE ◽

10.1371/journal.pone.0246908 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0246908

Author(s):

Usue Espinós ◽

Enrique G. Fernández-Abascal ◽

Mercedes Ovejero ◽

Guillermo Lahera

Keyword(s):

Bipolar Disorder ◽

Social Cognition ◽

Theory Of Mind ◽

Social Cognitive ◽

Control Group ◽

Type I ◽

Nonverbal Sensitivity ◽

First Degree Relatives ◽

Significant Impairment ◽

Bipolar Patients

Social cognition might be impaired in first degree relatives (FDR) of BD but existing research shows controversial results about social cognitive impairments in this population. The aim of this study was to assess Theory of Mind (ToM) and nonverbal sensitivity in FDR of BD and compare the results with those of two groups of persons with remitted bipolar disorder (BD), type I and II, and a control group. Social cognitive ability was examined in first degree relatives of BD, with a biological parent, offspring or sibling diagnosed with the disorder. For this study, 37 FDRs of bipolar patients, 37 BD I, 40 BD II and 40 control participants were recruited. Social cognition was explored by means of the Reading the Mind in the Eyes Test and the MiniPONS. Results showed a significant impairment in FDR of BD in the ToM task, but not in nonverbal sensitivity. Performance of FDRs in social cognition is better than that of BDs (either type I or type II) but worse when compared with that of healthy individuals without a family history of psychiatric disorders. Nevertheless, no differences were found between BD I and BD II groups. Males and older participants showed a worse performance in all groups. Group family therapy with FDRs of BD might include training in the recognition of nonverbal cues, which might increase the understanding of their familiars with BD, in order to modify communication abilities.

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Sustained attention deficit in bipolar disorder is not a working memory impairment in disguise

Neuropsychologia ◽

10.1016/s0028-3932(02)00019-2 ◽

2002 ◽

Vol 40 (9) ◽

pp. 1586-1590 ◽

Cited By ~ 77

Author(s):

Catherine J Harmer ◽

Luke Clark ◽

Louise Grayson ◽

Guy M Goodwin

Keyword(s):

Bipolar Disorder ◽

Working Memory ◽

Sustained Attention ◽

Attention Deficit ◽

Memory Impairment

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Sustained attention deficit in bipolar disorder

The British Journal of Psychiatry ◽

10.1192/bjp.180.4.313 ◽

2002 ◽

Vol 180 (4) ◽

pp. 313-319 ◽

Cited By ~ 358

Author(s):

Luke Clark ◽

Susan D. Iversen ◽

Guy M. Goodwin

Keyword(s):

Bipolar Disorder ◽

Sustained Attention ◽

Attention Deficit ◽

Verbal Memory ◽

Neuropsychological Functioning ◽

Attentional Set ◽

Illness Onset ◽

Affective Symptoms ◽

Attentional Set Shifting ◽

Neuropsychological Tasks

BackgroundRecovery in bipolar disorder is central to its definition but is rarely complete. Previous work has suggested that neuropsychological impairment persists during the euthymic state but has been confounded partly by mild affective symptoms in remitted patients.AimsTo characterise neuropsychological functioning in the euthymic phase of bipolar disorder with an emphasis on tasks of executive functioning.MethodThirty euthymic patients with bipolar disorder were compared with thirty healthy controls on neuropsychological tasks differentially sensitive to damage within prefrontal cortex.ResultsBipolar I patients were impaired on tasks of attentional set shifting, verbal memory and sustained attention. Only sustained attention deficit survived controlling for mild affective symptoms. This deficit was related to progression of illness, but was none the less present in a subgroup of patients near illness onset.ConclusionsSustained attention deficit may represent a neuropsychological vulnerability marker for bipolar disorder, providing a focus for further understanding of the phenotype and analysis of the neuronal networks involved.

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