Blood–cerebrospinal fluid barrier dysfunction in patients with bipolar disorder in relation to antipsychotic treatment

AbstractThe presentations and clinical courses of patients with bipolar disorder differ greatly by gender. In addition, medical therapy must be tailored differently for men and women because of emerging safety concerns unique to the female reproductive system. In November 2005, these topics were explored by a panel of experts in psychiatry, neurology, and reproductive health at a closed roundtable meeting in Dallas, Texas. This clinical information monograph summarizes the highlights of that meeting.Compared to men with bipolar disorder, women have more pervasive depressive symptoms and experience more major depressive episodes. They are also at higher risk for obesity and certain other medical and psychiatric comorbidities. Mood changes across the menstrual cycle are common, although the severity, timing, and type of changes are variable. Bipolar disorder is frequently associated with menstrual abnormalities and ovarian dysfunction, including polycystic ovarian syndrome. Although some cases of menstrual disturbance precede the treatment of bipolar disorder, it is possible that valproate and/or antipsychotic treatment may play a contributory role in young women.Pregnancy does not protect against mood episodes in untreated women. Maintenance of euthymia during pregnancy is critical because relapse during this period strongly predicts a difficult postpartum course. Suspending therapy in the first months of pregnancy may be an option for some women with mild-to-moderate illness, or those with a long history of euthymia during pre-pregnancy treatment. However, a mood stabilizer should be reintroduced either in the later stages of pregnancy or in the immediate postpartum period. Preliminary data suggest that fetal exposure to some mood stabilizers may raise the risk of major congenital malformations and neurodevelopmental delays. For women planning to become pregnant, clinicians may consider switching to other drugs before conception. The value and drawbacks of breastfeeding during treatment must be considered in partnership with the patient, with close monitoring of nursing infants thereafter. The risks and benefits of medical treatment for women with bipolar disorder should be carefully reconsidered at each stage of their reproductive lives, with a flexible approach that is responsive to the changing needs of patients and their families.

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2643 – Metabolic syndrome and antipsychotic treatment: How about schizophrenia and bipolar disorder?

European Psychiatry ◽

10.1016/s0924-9338(13)77274-2 ◽

2013 ◽

Vol 28 ◽

pp. 1

Author(s):

V. Prisco ◽

F. Perris ◽

T. De Santis ◽

A. Palermito ◽

F. Catapano ◽

...

Keyword(s):

Metabolic Syndrome ◽

Bipolar Disorder ◽

Antipsychotic Treatment

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Microscopic Particles in Two Fractions of Fresh Cerebrospinal Fluid in Twins with Schizophrenia or Bipolar Disorder and in Healthy Controls

PLoS ONE ◽

10.1371/journal.pone.0045994 ◽

2012 ◽

Vol 7 (9) ◽

pp. e45994 ◽

Cited By ~ 8

Author(s):

Viktoria Johansson ◽

Rolf Nybom ◽

Lennart Wetterberg ◽

Christina M. Hultman ◽

Tyrone D. Cannon ◽

...

Keyword(s):

Bipolar Disorder ◽

Cerebrospinal Fluid ◽

Healthy Controls

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Pathophysiological subtypes of Alzheimer’s disease based on cerebrospinal fluid proteomics

10.1101/2020.03.25.20043158 ◽

2020 ◽

Author(s):

Betty M. Tijms ◽

Johan Gobom ◽

Lianne Reus ◽

Iris Jansen ◽

Shengjun Hong ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cerebrospinal Fluid ◽

Innate Immune ◽

Barrier Dysfunction ◽

Physiological Processes ◽

Increased Risk ◽

Biological Heterogeneity ◽

Subtype 3 ◽

Non Negative Matrix Factorization

AbstractAlzheimer’s disease (AD) is biologically heterogeneous, and detailed understanding of the processes involved in patients is critical for development of treatments. Cerebrospinal fluid (CSF) contains hundreds of proteins, with concentrations reflecting ongoing (patho)physiological processes. This provides the opportunity to study many biological processes at the same time in patients. We studied whether AD biological subtypes can be detected in cerebrospinal fluid (CSF) proteomics using the dual clustering technique non-negative matrix factorization. In two independent cohorts (EMIF-AD MBD and ADNI) we found that 705 (77% of 913 tested) proteins differed between AD (defined as having abnormal amyloid, n=425) and controls (defined as having normal CSF amyloid and tau and intact cognition, n=127). Using these proteins for data-driven clustering, we identified within each cohorts three robust pathophysiological AD subtypes showing 1) hyperplasticity and increased BACE1 levels; 2) innate immune activation; and 3) blood-brain barrier dysfunction with low BACE1 levels. In both cohorts, the majority of individuals was labelled as having subtype 1 (80, 36% in EMIF-AD MBD; 117, 59% in ADNI), 71 (32%) in EMIF-AD MBD and 41 (21%) in ADNI were labelled as subtype 2, 72 (32%) in EMIF-AD MBD and 39 (20%) individuals in ADNI were labelled as subtype 3. Genetic analyses showed that all subtypes had an excess of genetic risk for AD (all p>0.01). Additional pathological comparisons that were available for a subset in ADNI only further showed that subtypes showed similar severity of AD pathology, and did not differ in the frequencies of co-pathologies, providing further support that these differences truly reflect AD heterogeneity. Compared to controls all non-demented AD individuals had increased risk to show clinical progression, and compared to subtype 1, subtype 2 showed faster progression to after correcting for age, sex, level of education and tau levels (HR (95%CI) subtype 2 vs 1 = 2.5 (1.2, 5.1), p = 0.01), and subtype 3 at trend level (HR (95%CI) = 2.1 (1.0, 4.4)). Together, these results demonstrate the value of CSF proteomics to study biological heterogeneity in AD patients, and suggest that subtypes may require tailored therapy.

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Tryptophan Catabolites in Bipolar Disorder: A Meta-Analysis

Frontiers in Immunology ◽

10.3389/fimmu.2021.667179 ◽

2021 ◽

Vol 12 ◽

Author(s):

Kaat Hebbrecht ◽

Katrien Skorobogatov ◽

Erik J. Giltay ◽

Violette Coppens ◽

Livia De Picker ◽

...

Keyword(s):

Bipolar Disorder ◽

Cerebrospinal Fluid ◽

Methodological Quality ◽

Meta Analysis ◽

Random Effect ◽

Healthy Controls ◽

Significant Difference ◽

Subgroup Analyses ◽

Tryptophan Catabolites

ObjectiveTryptophan catabolites (TRYCATs) are implicated in the pathophysiology of mood disorders by mediating immune-inflammation and neurodegenerative processes. We performed a meta-analysis of TRYCAT levels in bipolar disorder (BD) patients compared to healthy controls.MethodsA systematic literature search in seven electronic databases (PubMed, Embase, Web of Science, Cochrane, Emcare, PsycINFO, Academic Search Premier) was conducted on TRYCAT levels in cerebrospinal fluid or peripheral blood according to the PRISMA statement. A minimum of three studies per TRYCAT was required for inclusion. Standardized mean differences (SMD) were computed using random effect models. Subgroup analyses were performed for BD patients in a different mood state (depressed, manic). The methodological quality of the studies was rated using the modified Newcastle-Ottawa Quality assessment Scale.ResultsTwenty-one eligible studies were identified. Peripheral levels of tryptophan (SMD = -0.44; p < 0.001), kynurenine (SMD = - 0.3; p = 0.001) and kynurenic acid (SMD = -.45; p = < 0.001) were lower in BD patients versus healthy controls. In the only three eligible studies investigating TRP in cerebrospinal fluid, tryptophan was not significantly different between BD and healthy controls. The methodological quality of the studies was moderate. Subgroup analyses revealed no significant difference in TRP and KYN values between manic and depressed BD patients, but these results were based on a limited number of studies.ConclusionThe TRYCAT pathway appears to be downregulated in BD patients. There is a need for more and high-quality studies of peripheral and central TRYCAT levels, preferably using longitudinal designs.

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PMH31 ASSOCIATION BETWEEN CHOICE OF ANTIPSYCHOTIC TREATMENT AND SUBSEQUENT COSTS OF MEDICAL CARE IN PATIENTS WITH BIPOLAR DISORDER

Value in Health ◽

10.1016/s1098-3015(10)73952-8 ◽

2009 ◽

Vol 12 (3) ◽

pp. A178

Author(s):

MA Mychaskiw ◽

KN Sanders ◽

J Alvir ◽

LB Montejano ◽

G Lenhart ◽

...

Keyword(s):

Bipolar Disorder ◽

Medical Care ◽

Antipsychotic Treatment

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Switching antipsychotic treatment in patients with bipolar disorder: reasons and outcome

Annals of General Psychiatry ◽

10.1186/1744-859x-5-s1-s301 ◽

2006 ◽

Vol 5 (S1) ◽

Author(s):

Konstantinos Alexandropoulos ◽

Theodoros Mougiakos ◽

Efthimios Bargiotas ◽

Georgios Fryssas ◽

Georgios Gevrekis ◽

...

Keyword(s):

Bipolar Disorder ◽

Antipsychotic Treatment

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Effects of In Utero Exposure to AEDs on Morphology and Neurodevelopment

CNS Spectrums ◽

10.1017/s1092852900025700 ◽

2006 ◽

Vol 11 (S5) ◽

pp. 9-10

Author(s):

Martha J. Morrell

Keyword(s):

Bipolar Disorder ◽

Clinical Information ◽

Mood Stabilizer ◽

Mood Stabilizers ◽

Antipsychotic Treatment ◽

Close Monitoring ◽

History Of ◽

Major Congenital Malformations ◽

Major Depressive Episodes ◽

Depressive Episodes

AbstractThe presentations and clinical courses of patients with bipolar disorder differ greatly by gender. In addition, medical therapy must be tailored differently for men and women because of emerging safety concerns unique to the female reproductive system. In November 2005, these topics were explored by a panel of experts in psychiatry, neurology, and reproductive health at a closed roundtable meeting in Dallas, Texas. This clinical information monograph summarizes the highlights of that meeting.Compared to men with bipolar disorder, women have more pervasive depressive symptoms and experience more major depressive episodes. They are also at higher risk for obesity and certain other medical and psychiatric comorbidities. Mood changes across the menstrual cycle are common, although the severity, timing, and type of changes are variable. Bipolar disorder is frequently associated with menstrual abnormalities and ovarian dysfunction, including polycystic ovarian syndrome. Although some cases of menstrual disturbance precede the treatment of bipolar disorder, it is possible that valproate and/or antipsychotic treatment may play a contributory role in young women.Pregnancy does not protect against mood episodes in untreated women. Maintenance of euthymia during pregnancy is critical because relapse during this period strongly predicts a difficult postpartum course. Suspending therapy in the first months of pregnancy may be an option for some women with mild-to-moderate illness, or those with a long history of euthymia during pre-pregnancy treatment. However, a mood stabilizer should be reintroduced either in the later stages of pregnancy or in the immediate postpartum period. Preliminary data suggest that fetal exposure to some mood stabilizers may raise the risk of major congenital malformations and neurodevelopmental delays. For women planning to become pregnant, clinicians may consider switching to other drugs before conception. The value and drawbacks of breastfeeding during treatment must be considered in partnership with the patient, with close monitoring of nursing infants thereafter. The risks and benefits of medical treatment for women with bipolar disorder should be carefully reconsidered at each stage of their reproductive lives, with a flexible approach that is responsive to the changing needs of patients and their families.

Download Full-text