Prefrontal gray matter volume in adults bipolar I outpatients is associated with history of suicide attempts?

ABSTRACT Background: Patients with Bipolar Disorder (BD) have the highest lifetime risk for suicidal behavior (SB) compared to other psychiatric disorders. Neuroimaging research provides evidence of some structural and functional abnormalities in the brain of BD suicide attempters (SA), but interpretation of these findings may represent a number of features. Objective: The purpose of this study was to evaluate the volume of the prefrontal cortex in euthymic BD type I outpatients, with and without history of SA. Methods: 36 euthymic BD I outpatients (18 with and 18 without suicide attempt history) were underwent structural MRI and total and regional gray matter volumes were assessed and compared with 22 healthy controls (HC). Results: We did not found any differences in all areas between suicidal and non-suicidal BD I patients and BD patients as a group compared to HC as well. Discussion: our findings suggest that can be a different subgroups of patients in relation to prefrontal cortex volumes according to some clinical and socio-demographic caractheristics, such as number of previous episodes and continuous use of medical psychotropic drugs that may induce neuroplasticity phenomena, which restore cerebral volume and possibly can lead to long-term euthymia state.

Normal Metabolic Levels in Prefrontal Cortex in Euthymic Bipolar I Patients with and without Suicide Attempts.

Introduction/Objective. Evidence suggests that the prefrontal cortex has been implicated in the pathophysiology of bipolar disorder (BD), but few neurochemical studies have evaluated this region in bipolar patients and there is no information from BD suicide attempters using Proton Magnetic Resonance Spectroscopy (H(+)MRS). The objective was to evaluate the metabolic function of the medial orbital frontal cortex in euthymic BD type I suicide and nonsuicide attempters compared to healthy subjects by H(+)MRS. Methods. 40 euthymic bipolar I outpatients, 19 without and 21 with history of suicide attempt, and 22 healthy subjects were interviewed using the Structured Clinical Interview with the DSM-IV axis I, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, and the Barratt Impulsiveness Scale-11 and underwent H(+)MRS. Results. We did not find any metabolic abnormality in medial orbital frontal regions of suicide and nonsuicide BD patients and BD patients as a group compared to healthy subjects. Conclusions. The combined chronic use of psychotropic drugs with neuroprotective or neurotrophic effects leading to a euthymic state for longer periods of time may improve neurometabolic function, at least measured by H(+)MRS, even in suicide attempters. Besides, these results may implicate mood dependent alterations in brain metabolic activity. However, more studies with larger sample sizes of this heterogeneous disorder are warranted to clarify these data.

Personality disorders in euthymic bipolar patients: a systematic review

Objective: To identify, by means of a systematic review, the frequency with which comorbid personality disorders (PDs) have been assessed in studies of euthymic bipolar patients. Methods: PubMed, ciELO and PsychINFO databases were searched for eligible articles published between 1997 and 2013. After screening 1,249 empirical papers, two independent reviewers identified three articles evaluating the frequency of PDs in patients with bipolar disorders assessed in a state of euthymia. Results: The total sample comprised 376 euthymic bipolar patients, of whom 155 (41.2%) had at least one comorbid PD. Among them, we found 87 (23.1%) in cluster B, 55 (14.6%) in cluster C, and 25 (6.6%) in cluster A. The frequencies of PD subtypes were: borderline, 38 (10.1%); histrionic, 29 (7.7%); obsessive-compulsive, 28 (7.4%); dependent, 19 (5%); narcissistic, 17 (4.5%); schizoid, schizotypal, and avoidant, 11 patients each (2.95%); paranoid, five (1.3%); and antisocial, three (0.79%). Conclusion: The frequency of comorbid PD was high across the spectrum of euthymic bipolar patients. In this population, the most common PDs were those in cluster B, and the most frequent PD subtype was borderline, followed by histrionic and obsessive-compulsive. .

Personality disorders in euthymic bipolar patients: a systematic review.

OBJECTIVE: To identify, by means of a systematic review, the frequency with which comorbid personality disorders (PDs) have been assessed in studies of euthymic bipolar patients. METHODS: PubMed, ciELO and PsychINFO databases were searched for eligible articles published between 1997 and 2013. After screening 1,249 empirical papers, two independent reviewers identified three articles evaluating the frequency of PDs in patients with bipolar disorders assessed in a state of euthymia. RESULTS: The total sample comprised 376 euthymic bipolar patients, of whom 155 (41.2%) had at least one comorbid PD. Among them, we found 87 (23.1%) in cluster B, 55 (14.6%) in cluster C, and 25 (6.6%) in cluster A. The frequencies of PD subtypes were: borderline, 38 (10.1%); histrionic, 29 (7.7%); obsessive-compulsive, 28 (7.4%); dependent, 19 (5%); narcissistic, 17 (4.5%); schizoid, schizotypal, and avoidant, 11 patients each (2.95%); paranoid, five (1.3%); and antisocial, three (0.79%). CONCLUSION: The frequency of comorbid PD was high across the spectrum of euthymic bipolar patients. In this population, the most common PDs were those in cluster B, and the most frequent PD subtype was borderline, followed by histrionic and obsessive-compulsive.

Religiosity and Impulsivity in Mental Health: Is There a Relationship?

Our aim is to evaluate the relationship between religiosity and impulsivity in patients with mental illness who had attempted suicide and in healthy individuals. This is a cross-sectional study that included 61 healthy individuals and 93 patients. The instruments used were a sociodemographic data questionnaire, the Mini International Neuropsychiatric Interview, the Barratt Impulsiveness Scale, and the Duke University Religion Index. The healthy individuals presented higher scores in the religiosity domains (organizational, p = 0.028; non-organizational, p = 0.000; intrinsic, p = 0.000). The patients presented higher scores in the impulsivity dimensions (attentional, p = 0.000; motor, p = 0.000; absence of planning, p = 0.000). In the patient group, intrinsic religiosity had a significant inverse relationship with total impulsivity (p = 0.023), attentional (p = 0.010), and absence of planning (p = 0.007), even after controlling for sociodemographic variables. Healthy individuals were more religious and less impulsive than patients. The relationship between religiosity, impulsiveness, and mental illness could be bidirectional; that is, just as mental illness might impair religious involvement, religiosity could diminish the expression of mental illness and impulsive behaviors.

Post-traumatic stress disorder as a comorbidity: impact on disease outcomes.

Post-traumatic stress disorder (PTSD) is associated with many psychiatric and nonpsychiatric comorbidities. Growing evidence suggests that PTSD as a comorbidity may impair drug adherence, quality of life and sleep quality, as well as increase rehospitalization rates, disease relapses, intensity of symptoms, morbidity and mortality. The aim of this article is to examine the literature regarding the effects of PTSD comorbidity on physical and mental health.

Reduced posterior corpus callosum area in suicidal and non-suicidal patients with bipolar disorder.

BACKGROUND: Impulsivity is a characteristic of bipolar disorder (BD) that can contribute to the risk for suicidal behavior. Evidence suggests that gray and white matter abnormalities are linked with impulsivity, but little is known about the association between corpus callosum (CC) and impulsivity in BD. We examined the CC area and impulsivity in euthymic bipolar I patients, with and without lifetime history of suicide attempts, and in healthy controls. METHODS: Nineteen bipolar patients with a suicide attempt history (BP-S), 21 bipolar patients without suicide attempt history (BP-NS), and 22 healthy controls (HC) underwent clinical assessment by the Structured Clinical Interview with the DSM-IV axis I (SCID-I), the Barratt Impulsiveness Scale (BIS-11), and MRI scan. RESULTS: No differences were observed for any CC subregion between BP-S and BP-NS groups. There was a significant reduction in the genu (p=0.04) and isthmus areas (p=0.01), in bipolar patients compared with HC. In the BP-S group, the BIS-11 total (p=0.01), attention (p=0.001) and non-planning (p=0.02) impulsivity scores were significantly higher than in the BP-NS and HC groups. LIMITATIONS: These results cannot establish causality because of the cross-sectional nature of the study. CONCLUSION: This report potentially provides evidence that a reduction in the CC area is present even in non-symptomatic bipolar patients, which may be evidence of a biological trait marker for BD. Furthermore, the study demonstrated that BP-S group had higher impulsivity even during euthymia, which points to a sustained association between lifetime history of suicide attempts and impulsivity in BD.

Relationship between structural abnormalities in the cerebellum and dementia, posttraumatic stress disorder and bipolar disorder.

New evidence suggests that the cerebellum has structural and functional abnormalities in psychiatric disorders. OBJECTIVE: In this research, the goal was to measure the volume of the cerebellum and its subregions in individuals with psychiatric disorders and to relate these findings to their symptoms. METHODS: Patients with different degrees of cognitive impairment (Epidemiology of the Elderly - UNIFESP) and patients with post-traumatic stress disorder (PTSD) from population studies were analyzed. Also, patients with bipolar disorder from an outpatient clinic (Center for the Study of Mood and Anxiety Disorders, Universidade Federal da Bahia) were recruited for this study. All subjects underwent a 1.5T structural magnetic resonance scan. Volumetric measures and symptom measurements, by psychometric scales, were performed and compared between patients and controls. RESULTS: The cerebellum volume was reduced in patients with cognitive impairment without dementia and with dementia, in patients with PTSD, and in patients with bipolar disorder compared to controls. In dementia and PTSD, the left cerebellar hemisphere and vermis volume were reduced. In bipolar disorder, volumes of both hemispheres and the vermis were reduced. In the first two studies, these cerebellar volumetric reductions correlated with symptoms of the disease. CONCLUSION: The exact nature of cerebellar involvement in mental processes is still not fully understood. However, abnormalities in cerebellar structure and its functions have been reported in some of these diseases. Future studies with larger samples are needed to clarify these findings and investigate whether they are important for treatment and prognosis.

Novas evidências sugerem que o cerebelo apresenta alterações estruturais e funcionais nos transtornos psiquiátricos. OBJETIVO: Medir o volume do cerebelo e de suas sub-regiões em indivíduos portadores de transtornos psiquiátricos e relacionar tais achados aos sintomas. MÉTODOS: Foi realizada a identificação de pacientes com diferentes graus de prejuízo cognitivo proveniente de um estudo populacional (Epidemiologia do Idoso - UNIFESP), pacientes com transtorno do estresse pós-traumático proveniente de outro estudo populacional e portadores de transtorno bipolar proveniente de um ambulatório especializado (Universidade Federal da Bahia). Todos os sujeitos foram submetidos à ressonância magnética estrutural de 1.5T. As medidas de volume, assim como os sintomas medidos por escalas psicométricas foram comparadas entre pacientes e controles. RESULTADOS: Foi observado que o volume do cerebelo está reduzido nos portadores de prejuízo cognitivo sem demência e com demência, no transtorno do estresse pós-traumático e no transtorno bipolar quando comparados aos controles. Na demência e no transtorno do estresse pós-traumático o volume do hemisfério cerebelar esquerdo e do vérmis estão reduzidos. No transtorno bipolar os volumes de ambos os hemisférios e do vérmis estão reduzidos. Nos dois primeiros estudos estas reduções correlacionaram com os sintomas. CONCLUSÃO: A natureza exata do envolvimento do cerebelo nos processos mentais ainda não é compreendida. Entretanto, anormalidades na estrutura cerebelar e em suas funções têm sido relatadas em algumas dessas doenças. Pesquisas futuras, com amostras maiores, ainda são necessárias para esclarecer tais achados e investigar se são importantes para o tratamento e prognóstico.

Lower rates of comorbidities in euthymic bipolar patients.

OBJECTIVE: This study assessed the frequency of axis I psychiatric comorbidities in euthymic bipolar patients and the clinical differences between patients with and without comorbidities. METHOD: In this study, 62 euthymic bipolar outpatients assessed using a clinical questionnaire underwent a structured diagnostic interview (SCID/CV-DSM-IV) as well as a symptoms evaluation (YMRS and HAM-D-17). RESULTS: The lifetime frequency of patients with comorbidities was 27.4%. The most frequent comorbidities were anxiety disorders (33.7%), and the positive associated variables were more advanced age, the presence of a steady partner, a first episode of the depressive type and lifetime attempted suicide. CONCLUSIONS: The lower frequency of comorbidities found in our study in comparison with those described in the literature may be due to the evaluation restricted only to euthymic patients. This suggests the importance of assessing psychiatric comorbidity in bipolar individuals while not in acute phases of the disorder.

[Awareness of disease in dementia: preliminary results in patients with mild and moderate Alzheimer's disease]. / Consciência da doença na demência: resultados preliminares em pacientes com doença de Alzheimer leve e moderada.

OBJECTIVE: To evaluate the presence and the level of awareness of disease in mild and moderate Alzheimer's disease (AD). METHOD: Cross-sectional evaluation of patients with mild/moderate AD (n=42) assessed by Assessment of Psychosocial Impact of the Dementia Diagnosis (APSID), Mini-mental State Examination (MMSE) and Clinical Dementia Rating Scale (CDR). RESULTS: Awareness of disease and its consequences were present in 66.7% patients with mild AD (n=18). In moderate AD (n=24), 20.8% presented total awareness, 45.8% presented only awareness of cognitive symptoms. Unawareness of disease was observed in 33.3%. CONCLUSIONS: The present data show association between awareness and level of severity of disease. CDR 1 patients show a better recognition of cognitive and daily life activity symptoms, whereas CDR 2 patients recognized their cognitive symptoms but failed to appraise their severity and consequences in daily life activities.

Consciência da doença na demência: resultados preliminares em pacientes com doença de Alzheimer leve e moderada / Awareness of disease in dementia: preliminary results in patients with mild and moderate Alzheimer's disease

OBJETIVO: Avaliar a presença e o grau de consciência da doença na doença de Alzheimer (DA) em estágio leve e moderado. MÉTODO: Pacientes com DA leve/moderada (n=42) avaliados em corte transversal através da Escala de Avaliação do Impacto Psicossocial do Diagnóstico de Demência (APSID), Mini-Exame do Estado Mental (MEEM) e Estadiamento Clínico das Demências (CDR). RESULTADOS: No estágio leve (n=18), 66,7 por cento dos pacientes perceberam os sintomas cognitivos e os prejuízos causados na vida cotidiana. No estágio moderado (n=24), 20,8 por cento tinham consciência da doença preservada; em 45,8 por cento observou-se somente a noção sobre a presença de sintomas cognitivos; ausência total de consciência da doença foi encontrada em 33,3 por cento. CONCLUSÃO: Os dados encontrados indicam a associação entre consciência e evolução clínica da doença. Pacientes com CDR 1 reconhecem melhor os sintomas cognitivos e dificuldades de atividade de vida diária. A maioria dos pacientes com CDR 2 reconhece seus sintomas, mas não percebe a gravidade e as conseqüências nas atividades de vida diária.

Functional and motor response to low dose olanzapine in Huntington's disease: case report.

Previous reports on the use of olanzapine in Huntington's disease (HD) used doses ranging from 10-30 mg. We report a case of HD with marked delusions and behavioral impairment assessed by the Unified Huntington's Disease Rating Scale at baseline and four months later treated with a low dose of olanzapine. The patient improved in motor, psychiatric and activity of daily living symptoms after four months of treatment. The response to a low dose of olanzapine in HD may be an indicator of efficacy in similar cases. Further randomized controlled trials can properly assess these findings.

Functional and motor response to low dose olanzapine in huntington's disease: case report

Relatos de casos sobre o uso de olanzapina na doença de Huntington (DH) usaram doses variando de 10-30 mg. Este é um relato de caso de DH avaliado pela Unified Huntington Rating Scale no início e quatro meses depois com uma dose baixa de olanzapina. A paciente melhorou dos sintomas motores, psiquiátricos e nas atividades de vida diária após os quatro meses de tratamento. A resposta a baixas doses de olanzapina na DH pode ser um indicador de eficácia em casos similares. Mais estudos controlados randomizados podem avaliar apropriadamente esses achados.

Paradigmas do moderno em educacao: Francisco Campos e Anisio Teixeira

Procurou-se fazer um confronto entre as concepcoes de moderno de Francisco Campos e de Anisio Teixeira que de muitas maneiras marcaram a institucionalidade educacional brasileira contemporanea. O moderno em Campos forjou instituicoes que acabaram por constituir agentes educacionais novos. Porem, por outro lado, tais instituicoes impuseram o enquadramento do outro, o nao-moderno, sem respeitar a cultura daquele com quem interagia. Ja Anisio e expressao de um moderno que nega modelos educacionais e acentua a autonomia do fazer educativo. Trata-se de uma autonomia que exige o reconhecimento daquele que se incorpora ao processo educativo, sem pretensoes de lhe dirigir o destino, mas de lhe abrir possibilidades.