Neurocognitive Functions in Bipolar Disorder in Relation to Comorbid ADHD.

INTRODUCTION: Bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD) often co-occur in adult population. Both conditions present various neurocognitive and behavioral problems. We aimed to examine neurocognitive functions in adult patients with comorbid BD and ADHD (BD+ADHD) in comparison to patients with only BD, only ADHD and healthy controls (HCs). METHOD: An extensive cognitive battery which evaluates verbal learning and memory, visual memory, processing speed, attention, executive functions, working memory and verbal fluency, was used to assess neurocognitive functions respectively in adult (age 18-65 years) patients with BD (n=37), ADHD (n=43), BD+ADHD (n=20) in comparison to HCs (n=51). The Multivariate Analysis of Covariance models, where age, level of education and total BIS-11 scores were included as covariates, were used for comparing neurocognitive scores among groups. RESULTS: Both BD and BD+ADHD groups showed significantly poorer performance than HCs in processing speed, attention, executive functions, and verbal fluency domains. The BD group had additional significant deficits in executive functions, verbal learning and memory domains. There were no significant differences between BD and BD+ADHD groups with regards to verbal learning and memory, visual memory, processing speed, attention, executive functions, working memory and verbal fluency domains. Patients with only ADHD showed significantly poorer performance than HCs in verbal fluency domain. CONCLUSIONS: Our results show similarities in the neurocognitive functions of adults with BD and BD+ADHD across a wide range of cognitive domains. The findings point to the need for further exploration of diverging and converging neurodevelopmental trajectories of BD and ADHD.

Increased Beta Frequency (15-30 Hz) Oscillatory Responses in Euthymic Bipolar Patients Under Lithium Monotherapy.

The effect of lithium on neurocognition is not still fully explored. Brain oscillatory activity is altered in bipolar disorder. We aimed to assess the oscillatory responses of euthymic bipolar patients and how they are affected by lithium monotherapy. Event-related oscillations in response to visual target stimulus during an oddball paradigm in 16 euthymic drug-free and 13 euthymic lithium-treated bipolar patients were compared with 16 healthy controls. The maximum peak-to-peak amplitudes were measured for each subject's averaged beta (15-30 Hz) responses in the 0- to 300-ms time window over frontal (F3, Fz, F4), central (C3, Cz, C4), temporal (T7, T8), temporo-parietal (TP7, TP8), parietal (P3, Pz, P4), and occipital (O1, Oz, O2) areas. Patients under lithium monotherapy had significantly higher beta responses to visual target stimuli than healthy controls (P=.017) and drug-free patients (P=.015). The increase in beta response was observed at all electrode locations, however, the difference was statistically significant for the left (T7; P=.016) and right (T8; P=.031) temporal beta responses. Increased beta responses in drug-free patients and further significant increase in lithium-treated patients may be indicative of a core pathophysiological process of bipolar disorder and how it is affected by lithium. Whether the finding corresponds to lithium's corrective effect on the underlying pathology or to its neurocognitive side effect remains to be further explored. In either case, the finding is a sign that the oscillatory activity may be useful in tracking medication effect in bipolar disorder.

Lithium excessively enhances event related beta oscillations in patients with bipolar disorder.

BACKGROUND: Previous resting-state electroencephalography studies have consistently shown that lithium enhances delta and theta oscillations in default mode networks. Cognitive task based networks differ from resting-state networks and this is the first study to investigate effects of lithium on evoked and event-related beta oscillatory responses of patients with bipolar disorder. METHODS: The study included 16 euthymic patients with bipolar disorder on lithium monotherapy, 22 euthymic medication-free patients with bipolar disorder and 21 healthy participants. The maximum peak-to-peak amplitudes were measured for each subject's averaged beta responses (14-28 Hz) in the 0-300 ms time window. Auditory simple and oddball paradigm were presented to obtain evoked and event-related beta oscillatory responses. RESULTS: There were significant differences in beta oscillatory responses between groups (p=0.010). Repeated measures ANOVA revealed location (p=0.007), laterality X group (p=0.043) and stimulus X location (p=0.013) type effects. Serum lithium levels were correlated with beta responses. LIMITATIONS: The lithium group had higher number of previous episodes, suggesting that patients of the lithium were more severe cases than patients of the medication-free group. DISCUSSION: Lithium stimulates neuroplastic cascades and beta oscillations become prominent during neuroplastic changes. Excessively enhanced beta oscillatory responses in the lithium-treated patients may be indicative of excessive activation of the neuron groups of the certain cognitive networks and dysfunctional GABAergic modulation during cognitive activity.

Aripiprazole augmentation treatment in treatment resistant bipolar depression: two patient reports.

It is known that in patients with bipolar disorder, depressive episodes last longer than mixed or manic/hypomanic episodes and there are reports detailing the difficulties confronted in its treatment. The concept of treatment resistant depression in bipolar disorder has not been as well described as that in treatment resistant unipolar depression. Here we present two patients with treatment resistant bipolar depression. The first patient in our study is a 51 year old woman whose diagnoses were bipolar disorder, depressive episode and multiple sclerosis (in remission with interferon treatment) at the time of augmentation with aripiprazole. The second patient is a 43 year old woman with bipolar disorder, depressive disorder without any comorbid illness at the time of augmentation with aripiprazole. Aripiprazole was administered variably between 20-30mg/daily based on tolerability and efficacy. In both cases, depression was assessed using the Hamilton Depression Rating scale (HDRS). Both patients responded to aripiprazole augmentation treatment. The effect of aripiprazole on bipolar depression needs to be further evaluated in double blind controlled studies. However, augmentation with aripiprazole in bipolar patients may be a future routine treatment for treatment resistant bipolar depression. In this report, treatment of refractory bipolar depression and the efficacy of aripiprazole augmentation treatment in bipolar depression are discussed through two patients in depressive episode who remitted with aripiprazole augmentation.

Heroin-dependent patients attempting and not attempting suicide: a comparison.

OBJECTIVE: Heroin dependence is a serious illness associated with an increased risk of suicidal behaviour. There are many risk factors associated with heroin dependence. The current study examined the sociodemographic and clinical characteristics of a number of young adult heroin-dependent patients who had attempted suicide. METHODS: We studied a group of 108 young adult heroin-dependent patients in our in-patient clinics. All diagnoses were made according to DSM-IV diagnostic criteria using the Structured Clinical Interview for DSM-IV Axis I-II Disorders (SCID-I, II). The age range of patients was 18-24 years. Their substance abuse histories were assessed by semistructured interview. The Addiction Severity Index (ASI) was administered to all the patients. Serum total cholesterol and high-density lipoprotein cholesterol (HDL-C) levels were routinely measured. In the statistical analyses, Student's t test, and chi-squared tests were applied. RESULTS: Of the 108 heroin-dependent patients, 40 (37.0%) had histories of attempted suicide. There was a statistically significant difference in the age at which heroin use had commenced between female attempters [mean = 16.82, standard deviation (SD) = 3.06] and nonattempters (mean = 18.32, SD = 2.68, t= 2.25, P < 0.05). Both the male (mean = 33.35, SD = 4.05) and the female (mean = 28.00, SD = 5.36) attempters had significantly higher ASI scores than did the male (mean = 20.16, SD = 3.80) and the female (mean = 18.88, SD = 4.14) nonattempters (t= 14.34, P < 0.001; t= 5.25, P < 0.001, respectively). A significant difference in total cholesterol (mean = 131.8, SD = 19.3; mean = 172.2, SD = 21.3, t= 3.9, P < 0.05) and HDL-C (mean = 30.9, SD = 1.0 and mean = 54.8, SD = 13.7; t= 5.1, P < 0.05) levels between the group of violent and nonviolent suicide attempters was revealed. CONCLUSIONS: These results suggest that suicide attempts in young adult heroin-dependent patients are associated with more profound biopsychosocial pathology and decreased serum cholesterol levels. In particular, low levels of total cholesterol and HDL-C might indeed be associated with violent suicide attempts in young heroin-dependent patients.

Increased mirror movements after epileptic seizure in a case of polymicrogyria.

BACKGROUND: Mirror movements (MM) are involuntary movements during the voluntary movements of the contralateral homologous body parts. REVIEW SUMMARY: We report a patient with an increase in MM after suffering an epileptic seizure of his upper and lower limbs due to the right frontoparietal polymicrogyria, including the supplementary motor area as evidenced by magnetic resonance imaging. MM have been investigated using transcranial magnetic stimulation and other electrophysiological techniques in our case. CONCLUSION: This case is notable in that it is the first recorded observation of a patient manifesting mirroring after apparently suffering an epileptic seizure. In our case, we suggest that epileptic seizure increases MM by inducing cortical reorganization.

Delirium-associated disulfiram and ethanol interactions.

BACKGROUND: Disulfiram, an agent used for the treatment of alcohol dependence, can exacerbate psychiatric syndromes (including psychosis, catatonia, delirium, depression, and mania) after extended use. However, delirium has yet to be reported following the short-term use of disulfiram in the setting of alcohol use. OBJECTIVES: We report a case with a neuropsychiatric presentation and discuss the prevention and the progression of delirium associated with an interaction of disulfiram and ethanol. CASE REPORT: We report the case of a 51-year-old woman who developed disorganized speech, diminished communication, a decrease in appetite, and thoughts of suicide 10 days after she began taking disulfiram (250 mg/day), to which she added 1 glass of alcoholic beverage for 2 days. Delirium developed in association with an interaction between disulfiram and alcohol. The patient met DSM-IV criteria for major depressive disorder, alcohol dependence, and delirium. DISCUSSION: Neuropsychiatric manifestations may develop in association with co-administration of disulfiram and alcohol; timely recognition and treatment are recommended.

Major depressive disorder with psychotic features induced by interferon-alpha treatment for hepatitis C in a polydrug abuser.

Infectious diseases, especially hepatitis C, are prevalent among drug abusers. Interferon-alpha (IFN-alpha) is the pharmacological treatment of choice for this condition. Patients being treated with IFN-alpha can be expected to experience such psychiatric side-effects as development of depression, mania, irritability, changes in personality, hallucinations or delirium. In addition, certain patients are considered to be at greater risk of developing neuropsychiatric side-effects. Individuals meeting the following criteria are particularly vulnerable: over 40 years of age; having central nervous system abnormalities; a previous neurological or psychiatric history; a past familial psychiatric history; use of narcotics or having alcohol or substance use disorders; being HIV-positive; coadministration of other cytokines; receiving high doses of IFN-alpha (> 6 million units). We report the case of a 29-year-old patient with chronic non-active hepatitis C, a previous psychiatric history of polydrug abuse (cannabis, heroin and illegal use of the psychotropic drug biperiden) and anxiety disorder. Two weeks after the initiation of IFN-alpha treatment, he developed fatigue, sleeplessness and persecutory delusions. The patient responded partially to the discontinuation of the IFN-alpha treatment. Due to the presence of three risk factors in this patient, he was considered to belong to the group of patients being 'at high risk' of developing neuropsychiatric side-effects. This is the first case report of major depressive disorder with psychotic features in such a 'high-risk patient'. This case report may prompt other research by showing the importance of the close monitoring, and the prevention of the progression of IFN-alpha-related psychiatric disorders in 'a high-risk patient'.

Childhood trauma in alcoholics.

AIMS: Many studies have been conducted to evaluate the relationship between childhood trauma and alcoholism. In this study 80 alcoholics were chosen according to their hospitalization order. The control group consisted of 60 subjects, with no history of alcohol use, matched with the patient group in age and sex. METHODS: A sociodemographic and clinical data form, a questionnaire focusing on traumatic life experiences in childhood and The Childhood Trauma Questionnaire, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale were applied to both groups. RESULTS: Significant differences were found between the two groups on traumatic life experiences in childhood. Results suggested that childhood trauma positively correlates with anxiety and affective symptoms among alcoholics. CONCLUSIONS: Further studies are needed concerning this issue.