Impairment of C ognition in patients of B ipolar disorder in E uthymia in Indian population

Background: Bipolar disorder is one of the common mental disorders(CMD) in India. It leads to significant cognitive deficit even during the period of euthymia. So, it is important to identify the various cognitive deficits in euthymic bipolar disorder patients in Indian population. Methods: The study was conducted over a period of 2 years in AIIMS Jodhpur, Rajasthan. 30 cases and 30 controls were selected. Cases were selected by administering Hamilton dep ression rating scale (HAM - D) and Young mania rating scale (YMRS) to the bipolar disorder patient, recruited from Psychiatry OPD, to select the patients who were in euthymia. Cognitive domains such as attention, memory, fluency, language and Visuospatial we re tested in both the groups and compared. Kruskal - Wallis test was employed to compare the 2 sample groups for different variables. In this study we wanted to observe the decline in cognitive function in healthy vs euthymic bipolar disorder patients and to know the various domains of cognition that are affected. Results: This study shows a presence of cognitive decline in euthymic bipolar disorder patients as compared to controls. A significant difference was found in all the cognitive domains namely atte ntion, memory, fluency, language and visuospatial between cases and controls. Conclusion: This study shows a positive correlation between cognitive decline and bipolar patients during the period of euthymia. This suggests that even though the bipolar disor der patient is in remission, there is still a residual effect on cognition during euthymic state which can eventually affect the day to day life and can hamper the quality of life.

Resonancia magnética nuclear funcional en estado de reposo en pacientes con trastorno bipolar: más allá de la eutimia / Resting-state functional nuclear magnetic resonance imaging in patients with bipolar disorder: beyond euthymia

Resumen Introducción: La resonancia magnética funcional en estado de reposo (RMf-ER) permite identificar redes de conectividad funcional completas y los posibles correlatos neuronales de trastornos psiquiátricos. Se revisa la literatura sobre RMf-ER y trastorno bipolar (TB) haciendo énfasis en los hallazgos en las fases de manía, hipomanía y depresión. Métodos: Es una revisión narrativa de la literatura en la que se buscaron artículos en PubMed y EMBASE con las palabras clave en inglés "bipolar disorder" AND "resting state", sin límite en la fecha de publicación. Resultados: Los estudios de pacientes con TB en fases de manía e hipomanía sometidos a RMf-ER muestran resultados concordantes en cuanto a la disminución de la conectividad funcional cerebral entre la amígdala y algunas regiones corticales, lo cual indica que esta conexión funcional tendría alguna implicación en la regulación normal del afecto. Los pacientes en fase depresiva muestran disminución en la conectividad funcional cerebral, pero como son varias las estructuras anatómicas implicadas y las redes neuronales reportadas en los estudios, no es posible compararlos. Conclusiones: Hay disminución en la conectividad funcional en los pacientes con TB, pero la evidencia actual no permite establecer cambios específicos en redes de conectividad funcional cerebral puntuales. Sin embargo, ya hay algunos hallazgos que muestran correlación con la clínica de los pacientes.

ABSTRACT Introduction: imaging in the resting state (R-fMRI) Functional nuclear magnetic allows the identification of complete functional connectivity networks and the possible resonance neuronal correlations of psychiatric disorders. The literature on R-fMRI and bipolar disorder (BD) will be reviewed, emphasising the findings in the phases of mania, hypomania and depression. Methods: It is a narrative review of the literature in which articles were searched in PubMed and Embase, with the key words in English "bipolar disorder" AND "resting state", without limit on the date of publication. Results: The studies of BD patients in the mania and hypomania phases who underwent R-fMRI show concordant results in terms of decreased functional cerebral connectivity between the amygdala and some cortical regions, which indicates that this functional connection would have some implication in the normal affect regulation. Patients in the depressive phase show a decrease in functional brain connectivity, but as there are seve-ral anatomical structures involved and neural networks reported in the studies, it is not possible to compare them. Conclusions: There is a decrease in functional connectivity in patients with BD, but current evidence does not allow establishing specific changes in specific functional brain connectivity networks. However, there are already some findings that show correlation with the patients' symptoms.

Expression of matrix metalloproteinases in patients with bipolar disorder

Objective: High cardiovascular mortality rates have been reported in patients with bipolar disorder (BD). Studies indicate that matrix metalloproteinases (MMPs) are implicated in cardiovascular diseases. We evaluated the expression pattern of MMP-2 and MMP-9 in blood from patients with BD during acute mania and after euthymia, in comparison with healthy controls. Methods: Twenty patients and 20 controls were recruited and matched for sex and age. MMP messenger RNA (mRNA) levels were measured using real-time quantitative polymerase chain reaction (PCR). Body mass index (BMI) was calculated for all subjects. Results: There were no significant differences in MMP-2 and MMP-9 mRNA expression between patients and controls. mRNA levels were not significantly different during mania and euthymia. However, MMP-2 mRNA levels were negatively associated with BMI in BD patients and positively associated with BMI in controls. There was no difference in the pattern of MMP-9 expression between patients and controls. Conclusions: Our results suggest a different pattern of association between MMP-2 and BMI in BD patients as compared with controls. Despite some study limitations, we believe that the role of MMPs in BD should be further investigated to elucidate its relationship with cardiovascular risk. .

Resonancia magnética funcional en pacientes adultos eutímicos con trastorno bipolar tipo I: una visión neuropsicológica y neurofuncional / Functional Magnetic Resonance Imaging in euthymic Adult Patients with Bipolar Disorder Type I: Neuropsychological and Neurofunctional Aspects

Introducción: En la última década se han realizado varios estudios de resonancia magnética funcional en la fase eutímica del trastorno bipolar tipo I; por lo tanto, es necesario hacer una revisión crítica de los hallazgos reportados. Métodos: Revisión de la literatura, consistente en búsqueda, lectura y análisis de los estudios de resonancia magnética funcional en adultos eutímicos con trastorno bipolar tipo I en las bases de datos científicas PubMed, EMBASE, SciELO y Lilacs, sin límite cronológico. Resultados: Los hallazgos neuroanatómicos y neuropsicológicos se presentan en dos bloques: primero, memoria de trabajo con paradigmas N Back y Stenberg y, segundo, función ejecutiva con interferencia en atención selectiva o pruebas tipo Stroop (palabra/color, numérico y emocional) y control inhibitorio con pruebas go/no go. Conclusiones: Los resultados fueron contradictorios por diferencias en los paradigmas, criterios de inclusión, síntomas residuales, medicamentos e historia de psicoactivos. En pruebas Stroop y de memoria de trabajo se identificó una disfunción prefrontal en comparación con los controles (específicamente en la región dorsolateral), por lo que fue propuesta como un rasgo característico del trastorno. La región frontopolar (AB 10) parece ser clave en la disfunción frontal; por su parte, el cíngulo anterior, la corteza parietal y la prefrontal ventral necesitan ser replicadas en investigaciones posteriores en las que haya un mejor control de los factores de confusión.

Introduction: Several studies using functional magnetic resonance imaging during the euthymic phase of bipolar disorder type I have been performed in the last decade. A critical review of the findings is therefore required. Methods: The major databases (Pubmed, EMBASE, Lilacs, and Scielo) were consulted searching studies of fMRI in euthymic adults with Bipolar disorder type I without timeframe limits. Results: The neuroanatomical and neuropsycholo gical findings are presented in two parts: 1) working memory with N_back and Stenberg paradigms, and 2) Executive function with interference in selective attention or Stroop test (word / color, counting and emotional) and inhibitory control with go / no go tasks. Conclusions: The results were contradictory due to differences in paradigms, inclusion criteria, residual symptoms, and history of drugs. Prefrontal dysfunction was identified in the Stroop test and in working memory tasks compared with controls (specifically dorsolateral region) which has been proposed as a feature of the disorder. Frontopolar area (BA 10) appears to be important in frontal dysfunction. Findings in areas such as the anterior cingulate and parietal and ventral prefrontal cortex need to be replicated in subsequent research with a closer control of confounding factors.

Evaluación del componente afectivo de la depresión: análisis factorial del ST/DEP revisado

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Abstract: Depression is a main Public Health problem due to its high prevalence and to the costs for intervention and treatment. Therefore, it is necessary to identify strategies that allow an adequate assessment that would let us obtain a more precise and useful diagnosis. Nevertheless, animportant obstacle for this task, is a lack of theoretical clarity in regard to diagnostic criteria or, especially, to symptoms which are relevant for depression. This fact is obvious in the scales focused on depression assessment, which have a broad variety of symptoms to assess, and it is possible to overestimate some areas or to underestimate others, related to theoretical criterions which were involved in test construction. So, depression is evaluated in accordance with the questionnaire that is used and, of course, depending of theoretical framework that supports this tool. Therefore, depression is defined in line with the criteria which evaluates it, with regard to assessment s criteria, which could explain the usual difficulty to identify common symptoms when some tools are used, which are then identified as genuine symptoms of depression. As the aim of this paper is to improve some of this limitations, the State/Trait Depression Questionnaire (ST/DEP) is showed as an useful tool for clinical and research work. It offers an assessment of one of the component of depression, the affective one, providing two measures: State and Trait. This allows to differentiate between intensity and frequency. Main-axis factor analysis has been made and the results have shown two main factors in affectivity: Dysthymia (negative affection) and Euthymia (positive affection). The interest on positive affection assessment aims to obtain a more precise tool. So, when scores are inverted in positive items, it is possible to obtain a measurement of low levels on affectation. The relevance of this fact is emphasized because it has been neglected in most of depression scales, that only identify presence or absence, a fact that limits the ability to estimate slight modifications. This issue is very useful at two levels: clinic and research. At a clinical level because it permits to identify slight changes in affectation, which could be important as measurement oftherapeutic efficacyand ofsymptoms remission. In research, because it offers the possibility to dispose of one able tool to differenciate of low levels of affectation, which allow a more accurate estimation of the depression symptoms, specially when working with a nonclinical population. The present study was carried out with a sample of 300 participants (103 males and 197 females), with mean age of 21.82 (2.74 s.d.) for males and 22.26 (3.66 s.d.) for females. It was an instrumental study where the Spanish Experimental Version of Stat-Trait Depression (ST/DEP) was used. All participants received information about research and they answered the questionnaires voluntarily. The findings are shown separately for the two scales (State and Trait) and for the two sub-scales (Dysthymia and Euthymia). Data indicated significant differences between males and females, being the highest scores for females. This is an evidence related to the higher prevalence of depression in women. It is very important to remark that essentially the same strong state and trait factors were found for both males and females, according to the factor structure of the Spanish Experimental Version of the State-Trait Depression Questionnaire (ST/DEP). These factors explained the 54% variance for females and of 53% for males. The Promax Rotation differentiated two factors clearly: Dysthimia and Euthymia. That was similar to what was found in the original English form of the ST-DEP. The factorial structure was then confirmed, because of the bifactorial structure which differentiated the negative and positive affectivity of Depression. Another positive result was the test ability to detect slight changes on affectivity, which will be useful to differentiate between clinical and non clinical population. It is important to point out that the ST/DEP is a measurement of one component of depression: affectivity, which has been identified as a relevant component in this disorder, but this tool is not enough to diagnose depression. This fact is relevant, because some tools for depression assessment are used as a diagnostic criteria, a fact that increases confusion in making a differential diagnostic between anxiety and depression or some other symptoms and clinical problems. All this results provide evidences of the psychometric properties of the Spanish ST-DEP, and make this scale a fruitful and useful assessment instrument.