Brain correlates of impaired goal management in bipolar mania

Background Although executive impairment has been reported in mania, its brain functional correlates have been relatively little studied. This study examined goal management, believed to be more closely related to executive impairment in daily life than other executive tasks, using a novel functional magnetic resonance imaging (fMRI) paradigm in patients in this illness phase. Methods Twenty-one currently manic patients with bipolar disorder and 30 matched healthy controls were scanned while performing the Computerized Multiple Elements Test (CMET). This requires participants to sequentially play four simple games, with transition between games being made either voluntarily (executive condition) or automatically (control condition). Results CMET performance was impaired in the manic patients compared to the healthy controls. Manic patients failed to increase activation in the lateral frontal, cingulate and inferior parietal cortex when the executive demands of the task increased, while this increase was observed in the healthy controls. Activity in these regions was associated with task performance. Conclusions Manic patients show evidence of impaired goal management, which is associated with a pattern of reduced medial and lateral frontal and parietal activity.

Complexity and Variability Analyses of Motor Activity Distinguish Mood States in Bipolar Disorder

Aims Changes in motor activity are core symptoms of mood episodes in bipolar disorder. The manic state is characterized by increased variance, augmented complexity and irregular circadian rhythmicity when compared to healthy controls. The aim was to characterize differences in motor activity when comparing manic patients to their euthymic selves. Methods Motor activity was collected from 14 bipolar inpatients in mania and remission. 24-h recordings and 2-h time series in the morning and evening were analyzed for mean activity, variability and complexity. Lastly, the recordings were analyzed with the similarity graph algorithm and graph theory concepts such as edges, bridges, connected components and cliques. Results When compared to euthymia, over the duration of approximately one circadian cycle, the manic state presented reduced variability, displayed by decreased standard deviation (p = 0.013) and augmented complexity shown by increased sample entropy (p = 0.025). During mania there were also fewer edges (p = 0.039) and more bridges (p = 0.026). Similar changes in variability and complexity were observed in the 2-h morning and evening sequences, mainly in the estimates of the similarity graph algorithm. A comparison of morning and evening sequences within states revealed no significant change in estimates for mania. Contrarily, the euthymic state showed significant evening differences in variance and complexity, displayed by fewer edges (p = 0.010) and an increased number of connected components (p = 0.009). Conclusion The motor activity of mania is characterized by altered complexity, variability, and circadian rhythms when compared within-subject to euthymia.

Increased electro-convulsive therapy stimulus intensity and cognitive functioning in manic patients

Background: Temporary changes in cognitive functions after electro-convulsive therapy (ECT) have been documented. The researchers are exploring if increasing the stimulus intensity of ECT produce better recovery from psychopathology also trying to map effects of increased stimulus intensity on side effects profile including cognitive functions. In the present study, we are reporting effects of increased stimulus intensity of ECT on cognitive functions in manic patients.Methods: The present study is a prospective analytical case control study conducted in the department of psychiatry, Institute of Mental Health and Hospital, Agra, after getting clearance from hospital ethical committee. The study included 60 patients with the diagnosis of manic psychopathologyfrom May 2018 to September 2019. Sample was divided into two groups: 1.5 times of threshold and 2.0 times of threshold. The ECT was delivered as per specified protocol of the study. The scores on Montreal cognitive assessment (MoCA) were compared both within and between groups at baseline and follow up.Results: The results suggested that both level of stimulus intensity produced mild level of disruptions in cognitive functioning at follow ups and the higher stimulus intensity i.e. 2.0 times of threshold resulted in more impairment in cognitive functions.Conclusions: The impact of ECT by increasing its current intensity for two times, on cognitive functions as seen clinically, suggested no serious adverse effects on any of the patients included in the sample.

Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte and Monocyte-to-Lymphocyte Ratio in Bipolar Disorder

Background: Several inflammatory hypotheses have been suggested to explain the etiopathogenesis of bipolar disorder (BD) and its different phases. Neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and monocyte-to-lymphocyte (MLR) ratios have been proposed as potential peripheral biomarkers of mood episodes. Methods: We recruited 294 patients affected by BD, of which 143 were experiencing a (hypo)manic episode and 151 were in a depressive phase. A blood sample was drawn to perform a complete blood count. NLR, PLR, and MLR were subsequently calculated. A t-test was performed to evaluate differences in blood cell counts between depressed and (hypo)manic patients and a regression model was then computed. Results: Mean values of neutrophils, platelets, mean platelet volume, NLR, PLR, and MLR were significantly higher in (hypo)manic than depressed individuals. Logistic regression showed that PLR may represent an independent predictor of (hypo)mania. Conclusions: Altered inflammatory indexes, particularly PLR, may explain the onset and recurrence of (hypo)manic episodes in patients with BD. As inflammatory ratios represent economical and accessible markers of inflammation, further studies should be implemented to better elucidate their role as peripheral biomarkers of BD mood episodes.

A Humoral Recognition-Behavioral Stress-Coping Glycolipid Considered As another Biomarker of Psychotic Symptoms of Schizophrenia

Background: Mammalians have the recognition-behavioral stress-coping system regulated via the neuronal modules followed by some humoral glycolipids. A sulfated Galbeta1-4GlcNAc-lipid which promotes the serotonergic module, keeps physical strength by regulating emotional behaviors. GalNAcalpha1-3GalNAc-lipid which promotes the adrenergic module, induces stress-coping behaviors. A sulfated Fucalpha1-2Gal-lipid protects the cholinergic module maintaining stress-coping memories from the ischemic stress. Sialalpha2-3Gal-lipid which promotes the dopaminergic module, integrates these recognition-behaviors. It is considered stresses are closely related to onset of schizophrenia, and the psychotic symptoms are not necessarily deleted after long-time medication. Schizophrenic patients might abnormally produce the humoral recognition-behavioral stress-coping glycolipids even under medication. Materials and Methods: I examined the humoral stress-coping glycolipids of medicated schizophrenic patients and those of medicated manic patients without psychotic symptoms for comparison. Results: The medicated manic patients increased sulfated Galbeta1-4GlcNAc-lipid production. The medicated schizophrenic patients increased sulfated Galbeta1-4GlcNAc-lipid production, and remarkably produced Sialalpha2- 3Gal-lipid. These indicate the manic patients and the schizophrenic patients had a stress to be coped with the serotonergic module activity, and psychotic symptoms of the schizophrenic patients would be induced via stress-coping Sialalpha2-3Gal-lipid production. Conclusion: The stressors are not clear, however, I understood humoral Sialalpha2-3Gal-lipid would be considered as another biomarker of psychotic symptoms of schizophrenia.

The structure of mania: An overview of factorial analysis studies

Background. Operational definitions of mania are based on expert consensus rather than empirical data. The aim of this study is to identify the key domains of mania, as well as the relevance of the different signs and symptoms of this clinical construct. Methods. A review of latent factor models studies in manic patients was performed. Before extraction, a harmonization of signs and symptoms of mania and depression was performed in order to reduce the variability between individual studies. Results. We identified 12 studies fulfilling the inclusion criteria and comprising 3039 subjects. Hyperactivity was the clinical item that most likely appeared in the first factor, usually covariating with other core features of mania, such as increased speech, thought disorder, and elevated mood. Depressive–anxious features and irritability–aggressive behavior constituted two other salient dimensions of mania. Altered sleep was frequently an isolated factor, while psychosis appeared related to grandiosity, lack of insight and poor judgment. Conclusions. Our results confirm the multidimensional nature of mania. Hyperactivity, increased speech, and thought disorder appear as core features of the clinical construct. The mood experience could be heterogeneous, depending on the co-occurrence of euphoric (elevated mood) and dysphoric (irritability and depressive mood) emotions of varying intensity. Results are also discussed regarding their relationship with other constitutive elements of bipolar disorder, such as mixed and depressive states.