Neural correlates of hallucinations in bipolar disorder

Objective: Approximately one-half of all patients affected by bipolar disorder present with psychotic features on at least one occasion. Several studies have found that alterations in the activity of mesolimbic and prefrontal regions are related to aberrant salience in psychotic patients. The aim of the present study was to investigate the structural correlates of a history of hallucinations in a sample of euthymic patients with bipolar I disorder (BD-I). Methods: The sample consisted of 21 euthymic patients with BD-I and no comorbid axis I DSM-IV-TR disorders. Voxel based morphometry (VBM) was used to compare patients with and without a lifetime history of hallucinations. Preprocessing was performed using the Diffeomorphic Anatomical Registration through Exponentiated Lie Algebra (DARTEL) algorithm for VBM in SPM8. Images were processed using optimized VBM. Results: The main finding of the present study was a reduction in gray matter volume in the right posterior insular cortex of patients with BD-I and a lifetime history of hallucinations, as compared to subjects with the same diagnosis but no history of hallucinations. Conclusions: This finding supports the presence of abnormalities in the salience network in BD patients with a lifetime history of hallucinations. These alterations may be associated with an aberrant assignment of salience to the elements of one’s own experience, which could result in psychotic symptoms.

Depression rather than liver impairment reduces quality of life in patients with hepatitis C

Objective: Patients with chronic hepatitis C (CHC) have a poorer quality of life than those with other chronic liver diseases. However, some of the factors that determine health-related quality of life (HRQOL) in these patients, such as the degree of liver fibrosis, are still controversial. Therefore, the aim of the present study was to investigate the impact of CHC on HRQOL by conducting clinical, psychiatric, and sociodemographic evaluations. Methods: One hundred and twenty-four consecutive patients attending a referral center for hepatitis were evaluated using the Mini-International Neuropsychiatry Interview, the Hamilton Depression Rating Scale, the Hospital Anxiety and Depression Scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey. Multiple linear regression analyses were used to quantify independent associations between HRQOL and the clinical, psychiatric, and sociodemographic variables of interest. Results: Reduced HRQOL was independently associated with major depressive disorder (MDD) and with elevated levels of alanine aminotransferase, but was not associated with hepatic cirrhosis. Conclusions: MDD rather than the grade of liver fibrosis was strongly associated with HRQOL impairment in patients with CHC. These findings highlight that, in patients with CHC, the psychological effects of the disease deserve more attention and the implementation of integrated medical, psychiatric, and psychological care may be helpful. .

A neurobiologia do suicídio: evidências do papel do sistema serotoninérgico / Neurobiology of suicide: evidences of the role of serotonergic system

O suicídio figura entre as principais causas de morte nos países industrializados e, a despeito de tentativas de prevenção, suas taxas são crescentes, o que tem estimulado as pesquisas na biologia do suicídio, com o objetivo de auxiliar o clínico na identificação do suicida em potencial. Existem hoje muitas evidências oriundas de estudos com diferentes metodologias (estudos postðmortem, estudos de concentrações liquóricas de 5ðHIAA, estudos neuroendocrinológicos) mostrando que anormalidades no sistema serotoninérgico estariam associadas ao comportamento suicida. Hoje, o foco principal das pesquisas, após as evidências dos estudos de epidemiologia genética de que o suicídio seria, pelo menos parcialmente, geneticamente determinado, são os estudos de genética molecular. Esta abordagem, apesar de estar ainda em fase inicial e de ter resultados às vêzes inconsistentes, é promissora, e seus resultados sugerem que, pelo menos em parte, fatores genéticos influenciam o comportamento suicida através do sistema serotoninérgico. As pesquisas devem continuar, principalmente focando a associação de características psicopatológicas básicas, potencialmente associadas ao comportamento suicida, como a impulsividade, e sua associação com genes ligados à função serotoninérgica, assim como estudos postðmortem que podem examinar a expressão gênica e suas proteínas