Bipolar Disorder

Three biotypes surpass traditional diagnostic categories when it comes to identifying subgroups of psychosis, a study showed.

“Classification and treatment of brain diseases subsumed by psychiatry rely on clinical phenomenology, despite the call for alternatives,” wrote Brett A. Clementz, Ph.D., of the University of Georgia, Athens, and his coinvestigators. “There is overlap in susceptibility genes and phenotypes across bipolar disorder with psychosis and schizophrenia, and considerable similarity between different psychotic disorders on symptoms, illness course, cognition, psychophysiology, and neurobiology [while] drug treatments for these conditions overlap extensively” (Am J Psychiatry. 2015. doi: 10.1176/appi.ajp.2015.14091200).

The researchers recruited 711 people from Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) consortium sites (probands). All subjects had diagnoses of schizophrenia, schizoaffective disorder, or bipolar disorder with psychosis, and underwent interviews and laboratory data collection at the time of enrollment. In addition, 883 first-degree relatives of the 711 initial enrollees also were clinically evaluated, along with a cohort of 278 people deemed “demographically comparable [and] healthy” by investigators.

Biotypes for all individuals enrolled in the study were determined through laboratory tasks designed to “assess brain function at the neurocogntive/perceptual level.” These tasks consisted of the Brief Assessment of Cognition in Schizophrenia (BACS), pro- and antisaccade tasks, stop signal tasks, auditory paired stimuli and oddball evoked brain responses, and MRI acquisition and voxel-based morphometry.

The Structured Clinical Interview for DSM-IV and the Structured Interview for DSM-IV Personality Disorders were used for interviewing enrollees. Data compiled from these tests underwent multivariate taxometric analyses to compare biomarker variance across the three cohorts, in order to determine what, if any, heterogeneity exists in psychosis biotypes.

According to the results, diagnoses made with the clinical DSM guidelines yielded a single-severity continuum showing schizophrenia to be the most severe, followed by schizoaffective disorder and bipolar psychosis. However, biotypes showed significant variation, with investigators noting that “the three biotypes had distinctive patterns of abnormality across biomarkers that were neither entirely nor efficiently captured by a severity continuum.”

Larger separations were seen in biotype cohorts than in the DSM, specifically among probands. Among probands, group separation from healthy subjects was –2.58, –1.94, and –0.35 for biotype 1, 2, and 3 respectively for the BACS. Separation was –0.99, –0.78, and –0.05 for the stop signal task, and 3.32, 1.90, and 1.19 for the antisaccade errors. On the other hand, DSM diagnostics revealed group differences of –1.01, –1.51, and –1.83 for bipolar disorder psychosis, schizoaffective disorders, and schizophrenia, respectively, for the BACS test. Separation was –0.41, –0.61, and –0.55 for the stop signal task, and 1.36, 1.66, and 2.45 for antisaccade errors.

“Each biotype included all DSM psychosis categories, but probands diagnosed with schizophrenia were more numerous in biotype 1 (although 20% had bipolar disorder with psychosis), and probands diagnosed with bipolar disorder with psychosis were more numerous in biotype 3 (although 32% had schizophrenia), respectively,” the investigators noted.

The authors added that “when considered across proband and relative data, the biotype subgroups were superior to DSM diagnostic classes in between-group separations on external validating measures, illustrating the former scheme’s superiority for capturing neurobiological distinctiveness.”

Investigators noted that their approach did not use social functioning, brain structure, and characteristics of biological relatives in the creation of biotypes, which could have led to stronger results. Also, trial participants were mostly already on medication, classified as chronically psychotic, and tested at least once previously. The trial also had no replication sample for this sample population.

The study was supported by grants from the National Institute of Mental Health. Dr. Clementz did not report any relevant financial disclosures. Dr. Matcheri S. Keshavan reported receiving a grant from Sunovion and serving as a consultant to Forum Pharmaceuticals. Dr. Carol A. Tamminga also reported potential conflicts.

[email protected]

Three biotypes surpass traditional diagnostic categories when it comes to identifying subgroups of psychosis, a study showed.

“Classification and treatment of brain diseases subsumed by psychiatry rely on clinical phenomenology, despite the call for alternatives,” wrote Brett A. Clementz, Ph.D., of the University of Georgia, Athens, and his coinvestigators. “There is overlap in susceptibility genes and phenotypes across bipolar disorder with psychosis and schizophrenia, and considerable similarity between different psychotic disorders on symptoms, illness course, cognition, psychophysiology, and neurobiology [while] drug treatments for these conditions overlap extensively” (Am J Psychiatry. 2015. doi: 10.1176/appi.ajp.2015.14091200).

The researchers recruited 711 people from Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) consortium sites (probands). All subjects had diagnoses of schizophrenia, schizoaffective disorder, or bipolar disorder with psychosis, and underwent interviews and laboratory data collection at the time of enrollment. In addition, 883 first-degree relatives of the 711 initial enrollees also were clinically evaluated, along with a cohort of 278 people deemed “demographically comparable [and] healthy” by investigators.

Biotypes for all individuals enrolled in the study were determined through laboratory tasks designed to “assess brain function at the neurocogntive/perceptual level.” These tasks consisted of the Brief Assessment of Cognition in Schizophrenia (BACS), pro- and antisaccade tasks, stop signal tasks, auditory paired stimuli and oddball evoked brain responses, and MRI acquisition and voxel-based morphometry.

The Structured Clinical Interview for DSM-IV and the Structured Interview for DSM-IV Personality Disorders were used for interviewing enrollees. Data compiled from these tests underwent multivariate taxometric analyses to compare biomarker variance across the three cohorts, in order to determine what, if any, heterogeneity exists in psychosis biotypes.

According to the results, diagnoses made with the clinical DSM guidelines yielded a single-severity continuum showing schizophrenia to be the most severe, followed by schizoaffective disorder and bipolar psychosis. However, biotypes showed significant variation, with investigators noting that “the three biotypes had distinctive patterns of abnormality across biomarkers that were neither entirely nor efficiently captured by a severity continuum.”

Larger separations were seen in biotype cohorts than in the DSM, specifically among probands. Among probands, group separation from healthy subjects was –2.58, –1.94, and –0.35 for biotype 1, 2, and 3 respectively for the BACS. Separation was –0.99, –0.78, and –0.05 for the stop signal task, and 3.32, 1.90, and 1.19 for the antisaccade errors. On the other hand, DSM diagnostics revealed group differences of –1.01, –1.51, and –1.83 for bipolar disorder psychosis, schizoaffective disorders, and schizophrenia, respectively, for the BACS test. Separation was –0.41, –0.61, and –0.55 for the stop signal task, and 1.36, 1.66, and 2.45 for antisaccade errors.

“Each biotype included all DSM psychosis categories, but probands diagnosed with schizophrenia were more numerous in biotype 1 (although 20% had bipolar disorder with psychosis), and probands diagnosed with bipolar disorder with psychosis were more numerous in biotype 3 (although 32% had schizophrenia), respectively,” the investigators noted.

The authors added that “when considered across proband and relative data, the biotype subgroups were superior to DSM diagnostic classes in between-group separations on external validating measures, illustrating the former scheme’s superiority for capturing neurobiological distinctiveness.”

Investigators noted that their approach did not use social functioning, brain structure, and characteristics of biological relatives in the creation of biotypes, which could have led to stronger results. Also, trial participants were mostly already on medication, classified as chronically psychotic, and tested at least once previously. The trial also had no replication sample for this sample population.

The study was supported by grants from the National Institute of Mental Health. Dr. Clementz did not report any relevant financial disclosures. Dr. Matcheri S. Keshavan reported receiving a grant from Sunovion and serving as a consultant to Forum Pharmaceuticals. Dr. Carol A. Tamminga also reported potential conflicts.

[email protected]

Three biotypes surpass traditional diagnostic categories when it comes to identifying subgroups of psychosis, a study showed.

“Classification and treatment of brain diseases subsumed by psychiatry rely on clinical phenomenology, despite the call for alternatives,” wrote Brett A. Clementz, Ph.D., of the University of Georgia, Athens, and his coinvestigators. “There is overlap in susceptibility genes and phenotypes across bipolar disorder with psychosis and schizophrenia, and considerable similarity between different psychotic disorders on symptoms, illness course, cognition, psychophysiology, and neurobiology [while] drug treatments for these conditions overlap extensively” (Am J Psychiatry. 2015. doi: 10.1176/appi.ajp.2015.14091200).

The researchers recruited 711 people from Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) consortium sites (probands). All subjects had diagnoses of schizophrenia, schizoaffective disorder, or bipolar disorder with psychosis, and underwent interviews and laboratory data collection at the time of enrollment. In addition, 883 first-degree relatives of the 711 initial enrollees also were clinically evaluated, along with a cohort of 278 people deemed “demographically comparable [and] healthy” by investigators.

Biotypes for all individuals enrolled in the study were determined through laboratory tasks designed to “assess brain function at the neurocogntive/perceptual level.” These tasks consisted of the Brief Assessment of Cognition in Schizophrenia (BACS), pro- and antisaccade tasks, stop signal tasks, auditory paired stimuli and oddball evoked brain responses, and MRI acquisition and voxel-based morphometry.

The Structured Clinical Interview for DSM-IV and the Structured Interview for DSM-IV Personality Disorders were used for interviewing enrollees. Data compiled from these tests underwent multivariate taxometric analyses to compare biomarker variance across the three cohorts, in order to determine what, if any, heterogeneity exists in psychosis biotypes.

According to the results, diagnoses made with the clinical DSM guidelines yielded a single-severity continuum showing schizophrenia to be the most severe, followed by schizoaffective disorder and bipolar psychosis. However, biotypes showed significant variation, with investigators noting that “the three biotypes had distinctive patterns of abnormality across biomarkers that were neither entirely nor efficiently captured by a severity continuum.”

Larger separations were seen in biotype cohorts than in the DSM, specifically among probands. Among probands, group separation from healthy subjects was –2.58, –1.94, and –0.35 for biotype 1, 2, and 3 respectively for the BACS. Separation was –0.99, –0.78, and –0.05 for the stop signal task, and 3.32, 1.90, and 1.19 for the antisaccade errors. On the other hand, DSM diagnostics revealed group differences of –1.01, –1.51, and –1.83 for bipolar disorder psychosis, schizoaffective disorders, and schizophrenia, respectively, for the BACS test. Separation was –0.41, –0.61, and –0.55 for the stop signal task, and 1.36, 1.66, and 2.45 for antisaccade errors.

“Each biotype included all DSM psychosis categories, but probands diagnosed with schizophrenia were more numerous in biotype 1 (although 20% had bipolar disorder with psychosis), and probands diagnosed with bipolar disorder with psychosis were more numerous in biotype 3 (although 32% had schizophrenia), respectively,” the investigators noted.

The authors added that “when considered across proband and relative data, the biotype subgroups were superior to DSM diagnostic classes in between-group separations on external validating measures, illustrating the former scheme’s superiority for capturing neurobiological distinctiveness.”

Investigators noted that their approach did not use social functioning, brain structure, and characteristics of biological relatives in the creation of biotypes, which could have led to stronger results. Also, trial participants were mostly already on medication, classified as chronically psychotic, and tested at least once previously. The trial also had no replication sample for this sample population.

The study was supported by grants from the National Institute of Mental Health. Dr. Clementz did not report any relevant financial disclosures. Dr. Matcheri S. Keshavan reported receiving a grant from Sunovion and serving as a consultant to Forum Pharmaceuticals. Dr. Carol A. Tamminga also reported potential conflicts.

[email protected]

There is a link between poor decision making and suicidal tendencies in patients with unipolar depressive disorder and bipolar disorder, according to Dr. Stéphane Richard-Devantoy and his associates.

In the first part of the study, suicide attempters with unipolar and bipolar disorders took the Iowa Gambling Task (IGT), as did a control group of non–suicide attempters with unipolar and bipolar disorders. IGT scores were significantly worse in the suicide-attempting group, compared with the control group, with most of the difference coming from patients with unipolar disorder. Women who attempted suicide also had significantly worse IGT scores than did male suicide attempters.

In a subsequent meta-analysis of 10 studies and 1,148 participants, impaired decision making in suicide attempters with unipolar and bipolar disorders, compared with nonattempters with unipolar and bipolar disorders was confirmed with a moderate effect size. The effect size was moderate between unipolar suicide attempters and a healthy control group, and large between bipolar suicide attempters and a healthy control group.

“Examination of sex differences in brain functioning appears to be necessary in [the] suicide field. Indeed, females consistently attempt suicide more than males,whereas males consistently die by suicide more frequently than females. In spite of the important role gender plays in the expression of suicidal behavior, the perspective of future tailor-made therapeutic modalities in suicide attempters is needed,” the investigators noted.

Find the full study in the Journal of Affective Disorders (doi: 10.1016/j.jad.2015.10.001).

[email protected]

There is a link between poor decision making and suicidal tendencies in patients with unipolar depressive disorder and bipolar disorder, according to Dr. Stéphane Richard-Devantoy and his associates.

In the first part of the study, suicide attempters with unipolar and bipolar disorders took the Iowa Gambling Task (IGT), as did a control group of non–suicide attempters with unipolar and bipolar disorders. IGT scores were significantly worse in the suicide-attempting group, compared with the control group, with most of the difference coming from patients with unipolar disorder. Women who attempted suicide also had significantly worse IGT scores than did male suicide attempters.

In a subsequent meta-analysis of 10 studies and 1,148 participants, impaired decision making in suicide attempters with unipolar and bipolar disorders, compared with nonattempters with unipolar and bipolar disorders was confirmed with a moderate effect size. The effect size was moderate between unipolar suicide attempters and a healthy control group, and large between bipolar suicide attempters and a healthy control group.

“Examination of sex differences in brain functioning appears to be necessary in [the] suicide field. Indeed, females consistently attempt suicide more than males,whereas males consistently die by suicide more frequently than females. In spite of the important role gender plays in the expression of suicidal behavior, the perspective of future tailor-made therapeutic modalities in suicide attempters is needed,” the investigators noted.

Find the full study in the Journal of Affective Disorders (doi: 10.1016/j.jad.2015.10.001).

[email protected]

There is a link between poor decision making and suicidal tendencies in patients with unipolar depressive disorder and bipolar disorder, according to Dr. Stéphane Richard-Devantoy and his associates.

In the first part of the study, suicide attempters with unipolar and bipolar disorders took the Iowa Gambling Task (IGT), as did a control group of non–suicide attempters with unipolar and bipolar disorders. IGT scores were significantly worse in the suicide-attempting group, compared with the control group, with most of the difference coming from patients with unipolar disorder. Women who attempted suicide also had significantly worse IGT scores than did male suicide attempters.

In a subsequent meta-analysis of 10 studies and 1,148 participants, impaired decision making in suicide attempters with unipolar and bipolar disorders, compared with nonattempters with unipolar and bipolar disorders was confirmed with a moderate effect size. The effect size was moderate between unipolar suicide attempters and a healthy control group, and large between bipolar suicide attempters and a healthy control group.

“Examination of sex differences in brain functioning appears to be necessary in [the] suicide field. Indeed, females consistently attempt suicide more than males,whereas males consistently die by suicide more frequently than females. In spite of the important role gender plays in the expression of suicidal behavior, the perspective of future tailor-made therapeutic modalities in suicide attempters is needed,” the investigators noted.

Find the full study in the Journal of Affective Disorders (doi: 10.1016/j.jad.2015.10.001).

[email protected]

Unaffected first-degree relatives of bipolar disorder patients show no differences in gray-matter volume compared with other healthy adults, Dr. Fabiano G. Nery of the University of São Paulo and colleagues reported.

Investigators took magnetic resonance images of the brains of 25 patients with bipolar disorder, 23 unaffected relatives, and 27 healthy controls recruited from outpatient facilities at the university and the local community. The total gray-matter volume from images was 646.64 mL plus or minus 71.87 among bipolar disorder patients, 645.97 mL plus or minus 48.20 in unaffected relatives, and 637.87 mL plus or minus 62.50 in healthy controls, indicating no significant differences. Bipolar disorder patients, however, had reduced gray-matter volumes in the bilateral thalamus, compared with healthy controls.

This finding was present after controlling for possible confounding effects of age and gender, suggesting that the thalamus “may be involved in the neurocircuitry responsible for the clinical manifestations of” bipolar disorder, they wrote.

“These results suggest that there is no structural endophenotype for [bipolar disorder] and support the role of the thalamus in the pathophysiology of” bipolar disorder, the authors noted.

Read the article in Psychiatry Research: Neuroimaging (doi: 10.1016/j.pscychresns.2015.09.005).

Unaffected first-degree relatives of bipolar disorder patients show no differences in gray-matter volume compared with other healthy adults, Dr. Fabiano G. Nery of the University of São Paulo and colleagues reported.

Investigators took magnetic resonance images of the brains of 25 patients with bipolar disorder, 23 unaffected relatives, and 27 healthy controls recruited from outpatient facilities at the university and the local community. The total gray-matter volume from images was 646.64 mL plus or minus 71.87 among bipolar disorder patients, 645.97 mL plus or minus 48.20 in unaffected relatives, and 637.87 mL plus or minus 62.50 in healthy controls, indicating no significant differences. Bipolar disorder patients, however, had reduced gray-matter volumes in the bilateral thalamus, compared with healthy controls.

This finding was present after controlling for possible confounding effects of age and gender, suggesting that the thalamus “may be involved in the neurocircuitry responsible for the clinical manifestations of” bipolar disorder, they wrote.

“These results suggest that there is no structural endophenotype for [bipolar disorder] and support the role of the thalamus in the pathophysiology of” bipolar disorder, the authors noted.

Read the article in Psychiatry Research: Neuroimaging (doi: 10.1016/j.pscychresns.2015.09.005).

Unaffected first-degree relatives of bipolar disorder patients show no differences in gray-matter volume compared with other healthy adults, Dr. Fabiano G. Nery of the University of São Paulo and colleagues reported.

Investigators took magnetic resonance images of the brains of 25 patients with bipolar disorder, 23 unaffected relatives, and 27 healthy controls recruited from outpatient facilities at the university and the local community. The total gray-matter volume from images was 646.64 mL plus or minus 71.87 among bipolar disorder patients, 645.97 mL plus or minus 48.20 in unaffected relatives, and 637.87 mL plus or minus 62.50 in healthy controls, indicating no significant differences. Bipolar disorder patients, however, had reduced gray-matter volumes in the bilateral thalamus, compared with healthy controls.

This finding was present after controlling for possible confounding effects of age and gender, suggesting that the thalamus “may be involved in the neurocircuitry responsible for the clinical manifestations of” bipolar disorder, they wrote.

“These results suggest that there is no structural endophenotype for [bipolar disorder] and support the role of the thalamus in the pathophysiology of” bipolar disorder, the authors noted.

Read the article in Psychiatry Research: Neuroimaging (doi: 10.1016/j.pscychresns.2015.09.005).

Cerebellar soft signs are common symptoms in schizophrenia and bipolar disorder, a study suggests.

“While many authors used [neurological soft signs] scales to measure severity and progression of [schizophrenia ] and [bipolar disorder], we propose [cerebellar soft signs] scale as an accurate measure of cerebellar signs, which seems to co-occur in both diseases,” Adrian Andrzej Chrobak and his colleagues wrote.

The study included 30 patients with bipolar disorder, 30 patients with schizophrenia, and 28 individuals who had not been diagnosed with either bipolar or schizophrenia. The criteria for schizophrenia and bipolar disorder patient participation in the study included being in a state of symptomatic remission, as defined as scoring less than 3 on the Positive and Negative Syndrome Scale, and being treated with antipsychotic drugs from the dibenzoxazepine class (clozapine, quetiapine, and olanzapine). Schizophrenia and bipolar disorder patients treated with lithium or who had a history of alcohol or drug abuse; severe, acute or chronic neurologic and somatic diseases; and severe personality disorders were not allowed to participate in the study.

The researchers used the Neurological Evaluation Scale (NES) and the International Cooperative Ataxia Rating Scale (ICARS) to determine the presence and severity of neurological soft signs and cerebellar soft signs, respectively, in all of the study participants.

The average ICARS scores for the schizophrenia and groups were significantly higher than the mean ICARS score of the control group. No significant differences were found between the schizophrenia group and bipolar disorder group’s total ICARS and ICARS subscales scores. While the schizophrenia group scored significantly higher in all ICARS subscales than the control group, the bipolar disorder group only scored significantly higher than controls in the ICARS subscales of posture, gait disturbances, and oculomotor disorders.

The NES scores for the schizophrenia and bipolar groups also were significantly higher than that of the control group. No statistically significant differences between the schizophrenia group and bipolar group’s total NES and NES subscales were found.

“Our results suggest that there is no significant difference in both [neurological soft signs] and [cerebellar soft signs] scores between [bipolar disorder] and [schizophrenia] groups. This stays in tune with the theory of schizophrenia-bipolar disorder boundary and points to [the] cerebellum as a possible target for further research in this field,” according to the researchers.

Read the full study in Progress in Neuro-Psychopharmacology & Biological Psychiatry (doi: 10.1016/j.pnpbp.2015.07.009).

[email protected]

Cerebellar soft signs are common symptoms in schizophrenia and bipolar disorder, a study suggests.

“While many authors used [neurological soft signs] scales to measure severity and progression of [schizophrenia ] and [bipolar disorder], we propose [cerebellar soft signs] scale as an accurate measure of cerebellar signs, which seems to co-occur in both diseases,” Adrian Andrzej Chrobak and his colleagues wrote.

The study included 30 patients with bipolar disorder, 30 patients with schizophrenia, and 28 individuals who had not been diagnosed with either bipolar or schizophrenia. The criteria for schizophrenia and bipolar disorder patient participation in the study included being in a state of symptomatic remission, as defined as scoring less than 3 on the Positive and Negative Syndrome Scale, and being treated with antipsychotic drugs from the dibenzoxazepine class (clozapine, quetiapine, and olanzapine). Schizophrenia and bipolar disorder patients treated with lithium or who had a history of alcohol or drug abuse; severe, acute or chronic neurologic and somatic diseases; and severe personality disorders were not allowed to participate in the study.

The researchers used the Neurological Evaluation Scale (NES) and the International Cooperative Ataxia Rating Scale (ICARS) to determine the presence and severity of neurological soft signs and cerebellar soft signs, respectively, in all of the study participants.

The average ICARS scores for the schizophrenia and groups were significantly higher than the mean ICARS score of the control group. No significant differences were found between the schizophrenia group and bipolar disorder group’s total ICARS and ICARS subscales scores. While the schizophrenia group scored significantly higher in all ICARS subscales than the control group, the bipolar disorder group only scored significantly higher than controls in the ICARS subscales of posture, gait disturbances, and oculomotor disorders.

The NES scores for the schizophrenia and bipolar groups also were significantly higher than that of the control group. No statistically significant differences between the schizophrenia group and bipolar group’s total NES and NES subscales were found.

“Our results suggest that there is no significant difference in both [neurological soft signs] and [cerebellar soft signs] scores between [bipolar disorder] and [schizophrenia] groups. This stays in tune with the theory of schizophrenia-bipolar disorder boundary and points to [the] cerebellum as a possible target for further research in this field,” according to the researchers.

Read the full study in Progress in Neuro-Psychopharmacology & Biological Psychiatry (doi: 10.1016/j.pnpbp.2015.07.009).

[email protected]

Cerebellar soft signs are common symptoms in schizophrenia and bipolar disorder, a study suggests.

“While many authors used [neurological soft signs] scales to measure severity and progression of [schizophrenia ] and [bipolar disorder], we propose [cerebellar soft signs] scale as an accurate measure of cerebellar signs, which seems to co-occur in both diseases,” Adrian Andrzej Chrobak and his colleagues wrote.

The study included 30 patients with bipolar disorder, 30 patients with schizophrenia, and 28 individuals who had not been diagnosed with either bipolar or schizophrenia. The criteria for schizophrenia and bipolar disorder patient participation in the study included being in a state of symptomatic remission, as defined as scoring less than 3 on the Positive and Negative Syndrome Scale, and being treated with antipsychotic drugs from the dibenzoxazepine class (clozapine, quetiapine, and olanzapine). Schizophrenia and bipolar disorder patients treated with lithium or who had a history of alcohol or drug abuse; severe, acute or chronic neurologic and somatic diseases; and severe personality disorders were not allowed to participate in the study.

The researchers used the Neurological Evaluation Scale (NES) and the International Cooperative Ataxia Rating Scale (ICARS) to determine the presence and severity of neurological soft signs and cerebellar soft signs, respectively, in all of the study participants.

The average ICARS scores for the schizophrenia and groups were significantly higher than the mean ICARS score of the control group. No significant differences were found between the schizophrenia group and bipolar disorder group’s total ICARS and ICARS subscales scores. While the schizophrenia group scored significantly higher in all ICARS subscales than the control group, the bipolar disorder group only scored significantly higher than controls in the ICARS subscales of posture, gait disturbances, and oculomotor disorders.

The NES scores for the schizophrenia and bipolar groups also were significantly higher than that of the control group. No statistically significant differences between the schizophrenia group and bipolar group’s total NES and NES subscales were found.

“Our results suggest that there is no significant difference in both [neurological soft signs] and [cerebellar soft signs] scores between [bipolar disorder] and [schizophrenia] groups. This stays in tune with the theory of schizophrenia-bipolar disorder boundary and points to [the] cerebellum as a possible target for further research in this field,” according to the researchers.

Read the full study in Progress in Neuro-Psychopharmacology & Biological Psychiatry (doi: 10.1016/j.pnpbp.2015.07.009).

[email protected]

The prevalence of bipolar disorder might be higher among rheumatoid arthritis patients than in the general population, Dr. Adir Farhi of Sheba Medical Center in Tel-Hashomer, Israel, and colleagues reported in the Journal of Affective Disorders.

In a case-control study of nearly 70,000 members of Clalit Health Services, the largest health maintenance organization in Israel, the prevalence of bipolar disorder was found to be greater in patients with rheumatoid arthritis (RA) than in case-matched controls (0.6% vs 0.4%; odds ratio, 1.34; 95% confidence interval, 1.02-1.76; P less than .05). The study included 11,782 patients with RA and 57,973 subjects matched by age and sex.

When stratified by age, the association was significant only in the two extreme age groups: age younger than 19 years (P less than .005) and age older than 75 years (P less than .005). However, in a logistic regression model, RA showed a trend for positive association with bipolar disorder that was not statistically significant, and age had a weak but statistically significant association. Smoking was positively and independently associated with bipolar disorder (multivariate OR, 1.66; 95% CI, 1.31-2.11; P less than .001).

“Our data implied that patients with RA have a greater prevalence of bipolar disorder than matched controls,” the authors wrote. But because the association may have been confounded by smoking status, “further research is warranted before making inferences about this association.”

Read the article in the Journal of Affective Disorders (doi: http://dx.doi.org/10/1016/j.jad.2015.09.058).

The prevalence of bipolar disorder might be higher among rheumatoid arthritis patients than in the general population, Dr. Adir Farhi of Sheba Medical Center in Tel-Hashomer, Israel, and colleagues reported in the Journal of Affective Disorders.

In a case-control study of nearly 70,000 members of Clalit Health Services, the largest health maintenance organization in Israel, the prevalence of bipolar disorder was found to be greater in patients with rheumatoid arthritis (RA) than in case-matched controls (0.6% vs 0.4%; odds ratio, 1.34; 95% confidence interval, 1.02-1.76; P less than .05). The study included 11,782 patients with RA and 57,973 subjects matched by age and sex.

When stratified by age, the association was significant only in the two extreme age groups: age younger than 19 years (P less than .005) and age older than 75 years (P less than .005). However, in a logistic regression model, RA showed a trend for positive association with bipolar disorder that was not statistically significant, and age had a weak but statistically significant association. Smoking was positively and independently associated with bipolar disorder (multivariate OR, 1.66; 95% CI, 1.31-2.11; P less than .001).

“Our data implied that patients with RA have a greater prevalence of bipolar disorder than matched controls,” the authors wrote. But because the association may have been confounded by smoking status, “further research is warranted before making inferences about this association.”

Read the article in the Journal of Affective Disorders (doi: http://dx.doi.org/10/1016/j.jad.2015.09.058).

The prevalence of bipolar disorder might be higher among rheumatoid arthritis patients than in the general population, Dr. Adir Farhi of Sheba Medical Center in Tel-Hashomer, Israel, and colleagues reported in the Journal of Affective Disorders.

In a case-control study of nearly 70,000 members of Clalit Health Services, the largest health maintenance organization in Israel, the prevalence of bipolar disorder was found to be greater in patients with rheumatoid arthritis (RA) than in case-matched controls (0.6% vs 0.4%; odds ratio, 1.34; 95% confidence interval, 1.02-1.76; P less than .05). The study included 11,782 patients with RA and 57,973 subjects matched by age and sex.

When stratified by age, the association was significant only in the two extreme age groups: age younger than 19 years (P less than .005) and age older than 75 years (P less than .005). However, in a logistic regression model, RA showed a trend for positive association with bipolar disorder that was not statistically significant, and age had a weak but statistically significant association. Smoking was positively and independently associated with bipolar disorder (multivariate OR, 1.66; 95% CI, 1.31-2.11; P less than .001).

“Our data implied that patients with RA have a greater prevalence of bipolar disorder than matched controls,” the authors wrote. But because the association may have been confounded by smoking status, “further research is warranted before making inferences about this association.”

Read the article in the Journal of Affective Disorders (doi: http://dx.doi.org/10/1016/j.jad.2015.09.058).

Bipolar disorder patients’ perceptions of their overall physical health can predict the severity of their functioning over the next 2 years, according to research published in the Journal of Affective Disorders.

Analyzing longitudinal data from the Systematic Treatment Enhancement Program for Bipolar Disorder on the physical subscales of the 36-Item Short Form Health Survey, Emily Bernstein and her colleagues at Harvard Medical School and Massachusetts General Hospital in Boston found that individuals with more negative views of their physical well-being tended to have more severe mood symptoms and worse functioning across 2 years of observation. “Perceptions of role limitations due to physical health problems predicted depressive symptoms and poor life satisfaction, while worse bodily pain predicted symptoms of mania and hypomania,” the authors wrote. Physical functioning was not a significant predictor of clinical outcomes.

“These data suggest that addressing broad attitudes or thoughts about physical health is important in treating individuals with bipolar disorder as subjective perceptions seem to impact course of illness,” Dr. Bernstein and her colleagues wrote. Introducing stress management or relaxation training into treatments for bipolar disorder could help reduce patients’ sensations of pain and their consequences for course of illness, particularly mania and hypomania, the investigators said. Psychotherapy also could play a beneficial role for such patients “in targeting and modifying the way they think about their health.”

Read the article in the Journal of Affective Disorders (doi: http://dx.doi.org/10.1016/j.jad.2015.09.052).

Bipolar disorder patients’ perceptions of their overall physical health can predict the severity of their functioning over the next 2 years, according to research published in the Journal of Affective Disorders.

Analyzing longitudinal data from the Systematic Treatment Enhancement Program for Bipolar Disorder on the physical subscales of the 36-Item Short Form Health Survey, Emily Bernstein and her colleagues at Harvard Medical School and Massachusetts General Hospital in Boston found that individuals with more negative views of their physical well-being tended to have more severe mood symptoms and worse functioning across 2 years of observation. “Perceptions of role limitations due to physical health problems predicted depressive symptoms and poor life satisfaction, while worse bodily pain predicted symptoms of mania and hypomania,” the authors wrote. Physical functioning was not a significant predictor of clinical outcomes.

“These data suggest that addressing broad attitudes or thoughts about physical health is important in treating individuals with bipolar disorder as subjective perceptions seem to impact course of illness,” Dr. Bernstein and her colleagues wrote. Introducing stress management or relaxation training into treatments for bipolar disorder could help reduce patients’ sensations of pain and their consequences for course of illness, particularly mania and hypomania, the investigators said. Psychotherapy also could play a beneficial role for such patients “in targeting and modifying the way they think about their health.”

Read the article in the Journal of Affective Disorders (doi: http://dx.doi.org/10.1016/j.jad.2015.09.052).

Bipolar disorder patients’ perceptions of their overall physical health can predict the severity of their functioning over the next 2 years, according to research published in the Journal of Affective Disorders.

Analyzing longitudinal data from the Systematic Treatment Enhancement Program for Bipolar Disorder on the physical subscales of the 36-Item Short Form Health Survey, Emily Bernstein and her colleagues at Harvard Medical School and Massachusetts General Hospital in Boston found that individuals with more negative views of their physical well-being tended to have more severe mood symptoms and worse functioning across 2 years of observation. “Perceptions of role limitations due to physical health problems predicted depressive symptoms and poor life satisfaction, while worse bodily pain predicted symptoms of mania and hypomania,” the authors wrote. Physical functioning was not a significant predictor of clinical outcomes.

“These data suggest that addressing broad attitudes or thoughts about physical health is important in treating individuals with bipolar disorder as subjective perceptions seem to impact course of illness,” Dr. Bernstein and her colleagues wrote. Introducing stress management or relaxation training into treatments for bipolar disorder could help reduce patients’ sensations of pain and their consequences for course of illness, particularly mania and hypomania, the investigators said. Psychotherapy also could play a beneficial role for such patients “in targeting and modifying the way they think about their health.”

Read the article in the Journal of Affective Disorders (doi: http://dx.doi.org/10.1016/j.jad.2015.09.052).

The burden of psychiatric comorbidity is greater in patients with multiple sclerosis (MS), compared with the general population, reported Dr. Ruth Ann Marrie and coauthors from the departments of psychiatry and medicine at the University of Manitoba, Winnipeg.

A study of 44,452 MS patients and 220,849 controls in four Canadian provinces from 1995 to 2005 found that the incidence of depression in the MS group was 0.98% (95% CI; 0.81%-1.15%), compared with 0.72% (95% CI; 0.67%-0.76%) in the control group. The prevalence of depression was 20.1% in MS patients (19.5%-20.6%), compared with 11.9% (11.8%-12.1%) in the matched population, the authors noted.

HUNG KUO CHUN/Thinkstock

Also, the incidence and prevalence of anxiety disorder in the MS population was 0.64% (0.54%-0.73%) and 8.7% (8.4%-9.1%), respectively, compared with 0.42% (0.39%-0.45%) and 5.1% (4.9%-5.2%) in controls .

For bipolar disorder, the MS group had an incidence of 0.33% (0.26%-0.39%), compared with 0.16% (0.14%-0.18%) in controls. Prevalence was 4.7% (4.4%-4.9%) in the MS group and 2.3% (2.2%-2.3%) in controls .

Lastly, in schizophrenia, MS patients had an incidence of 0.060% (0.031%-0.080%), compared with 0.018% (0.011%-0.024%) in controls. Prevalence was 1.28% (1.15%-1.41%), in the MS group and 1.03% (0.99%-1.08%) in controls, the investigators said.

The findings suggest a “nonspecific effect of MS on psychiatric comorbidity,” Dr. Marrie and colleagues said in the report.

“From a policy perspective, this implies the need for general psychiatric support rather than illness-specific strategies,” they concluded.

Read the study in Neurology.

[email protected]

The burden of psychiatric comorbidity is greater in patients with multiple sclerosis (MS), compared with the general population, reported Dr. Ruth Ann Marrie and coauthors from the departments of psychiatry and medicine at the University of Manitoba, Winnipeg.

A study of 44,452 MS patients and 220,849 controls in four Canadian provinces from 1995 to 2005 found that the incidence of depression in the MS group was 0.98% (95% CI; 0.81%-1.15%), compared with 0.72% (95% CI; 0.67%-0.76%) in the control group. The prevalence of depression was 20.1% in MS patients (19.5%-20.6%), compared with 11.9% (11.8%-12.1%) in the matched population, the authors noted.

HUNG KUO CHUN/Thinkstock

Also, the incidence and prevalence of anxiety disorder in the MS population was 0.64% (0.54%-0.73%) and 8.7% (8.4%-9.1%), respectively, compared with 0.42% (0.39%-0.45%) and 5.1% (4.9%-5.2%) in controls .

For bipolar disorder, the MS group had an incidence of 0.33% (0.26%-0.39%), compared with 0.16% (0.14%-0.18%) in controls. Prevalence was 4.7% (4.4%-4.9%) in the MS group and 2.3% (2.2%-2.3%) in controls .

Lastly, in schizophrenia, MS patients had an incidence of 0.060% (0.031%-0.080%), compared with 0.018% (0.011%-0.024%) in controls. Prevalence was 1.28% (1.15%-1.41%), in the MS group and 1.03% (0.99%-1.08%) in controls, the investigators said.

The findings suggest a “nonspecific effect of MS on psychiatric comorbidity,” Dr. Marrie and colleagues said in the report.

“From a policy perspective, this implies the need for general psychiatric support rather than illness-specific strategies,” they concluded.

Read the study in Neurology.

[email protected]

The burden of psychiatric comorbidity is greater in patients with multiple sclerosis (MS), compared with the general population, reported Dr. Ruth Ann Marrie and coauthors from the departments of psychiatry and medicine at the University of Manitoba, Winnipeg.

A study of 44,452 MS patients and 220,849 controls in four Canadian provinces from 1995 to 2005 found that the incidence of depression in the MS group was 0.98% (95% CI; 0.81%-1.15%), compared with 0.72% (95% CI; 0.67%-0.76%) in the control group. The prevalence of depression was 20.1% in MS patients (19.5%-20.6%), compared with 11.9% (11.8%-12.1%) in the matched population, the authors noted.

HUNG KUO CHUN/Thinkstock

Also, the incidence and prevalence of anxiety disorder in the MS population was 0.64% (0.54%-0.73%) and 8.7% (8.4%-9.1%), respectively, compared with 0.42% (0.39%-0.45%) and 5.1% (4.9%-5.2%) in controls .

For bipolar disorder, the MS group had an incidence of 0.33% (0.26%-0.39%), compared with 0.16% (0.14%-0.18%) in controls. Prevalence was 4.7% (4.4%-4.9%) in the MS group and 2.3% (2.2%-2.3%) in controls .

Lastly, in schizophrenia, MS patients had an incidence of 0.060% (0.031%-0.080%), compared with 0.018% (0.011%-0.024%) in controls. Prevalence was 1.28% (1.15%-1.41%), in the MS group and 1.03% (0.99%-1.08%) in controls, the investigators said.

The findings suggest a “nonspecific effect of MS on psychiatric comorbidity,” Dr. Marrie and colleagues said in the report.

“From a policy perspective, this implies the need for general psychiatric support rather than illness-specific strategies,” they concluded.

Read the study in Neurology.

[email protected]

When screening for bipolar disorders, Mood Disorders Questionnaire scores proved more sensitive – but showed less specificity – in an inpatient mood disorders setting than an outpatient psychiatric population, a retrospective study shows. The results suggest that the MDQ can be used effectively on an inpatient psychiatry mood disorders unit, reported Dr. Simon Kung and his associates.

Dr. Kung of the Mayo Clinic in Rochester, Minn., and his associates evaluated 1,330 patients who checked into a mood disorders unit and administered the MDQ upon entry. After excluding patients with diagnoses that were neither unipolar or bipolar, 860 MDQs were ultimately used. Sensitivity and specificity were calculated for each number of questionnaire items checked positive.

The researchers determined that the optimal cutoff score for MDQs was 8, resulting in a sensitivity/specificity of 86%/71%, compared with 92%/64% using the recommended outpatient cutoff of 7.

Read the full article here: (J Affect Disord. 201515;188:97-100. doi:10.1016/j.jad.2015.08.060)

[email protected]

When screening for bipolar disorders, Mood Disorders Questionnaire scores proved more sensitive – but showed less specificity – in an inpatient mood disorders setting than an outpatient psychiatric population, a retrospective study shows. The results suggest that the MDQ can be used effectively on an inpatient psychiatry mood disorders unit, reported Dr. Simon Kung and his associates.

Dr. Kung of the Mayo Clinic in Rochester, Minn., and his associates evaluated 1,330 patients who checked into a mood disorders unit and administered the MDQ upon entry. After excluding patients with diagnoses that were neither unipolar or bipolar, 860 MDQs were ultimately used. Sensitivity and specificity were calculated for each number of questionnaire items checked positive.

The researchers determined that the optimal cutoff score for MDQs was 8, resulting in a sensitivity/specificity of 86%/71%, compared with 92%/64% using the recommended outpatient cutoff of 7.

Read the full article here: (J Affect Disord. 201515;188:97-100. doi:10.1016/j.jad.2015.08.060)

[email protected]

When screening for bipolar disorders, Mood Disorders Questionnaire scores proved more sensitive – but showed less specificity – in an inpatient mood disorders setting than an outpatient psychiatric population, a retrospective study shows. The results suggest that the MDQ can be used effectively on an inpatient psychiatry mood disorders unit, reported Dr. Simon Kung and his associates.

Dr. Kung of the Mayo Clinic in Rochester, Minn., and his associates evaluated 1,330 patients who checked into a mood disorders unit and administered the MDQ upon entry. After excluding patients with diagnoses that were neither unipolar or bipolar, 860 MDQs were ultimately used. Sensitivity and specificity were calculated for each number of questionnaire items checked positive.

The researchers determined that the optimal cutoff score for MDQs was 8, resulting in a sensitivity/specificity of 86%/71%, compared with 92%/64% using the recommended outpatient cutoff of 7.

Read the full article here: (J Affect Disord. 201515;188:97-100. doi:10.1016/j.jad.2015.08.060)

[email protected]

Patients with bipolar disorder who perceive their overall physical health as poor experience worse disease outcomes, according to Emily E. Bernstein of Harvard University, Cambridge, Mass., and her associates.

Data were collected from the Systematic Treatment Enhancement Program for Bipolar Disorder and were analyzed via the Short Form Health Survey (SF-36). An increased sense of role limitation increased the risk of depressive symptoms, while increased physical pain raised the risk of mania/hypomania. “Reports of specific or concrete physical limitations in daily life showed no associations with psychiatric symptoms at concurrent assessments, but did predict worse course of illness” 1 year later, the researchers wrote.

“Though further research is warranted, changes in subjective physical health–related quality of life, even independent of objective health changes, may offer important insight into global well-being and be targets of psychotherapy treatment,” they concluded.

Find the study in the Journal of Affective Disorders (doi: 10.1016/j.jad.2015.09.052).

[email protected]

Patients with bipolar disorder who perceive their overall physical health as poor experience worse disease outcomes, according to Emily E. Bernstein of Harvard University, Cambridge, Mass., and her associates.

Data were collected from the Systematic Treatment Enhancement Program for Bipolar Disorder and were analyzed via the Short Form Health Survey (SF-36). An increased sense of role limitation increased the risk of depressive symptoms, while increased physical pain raised the risk of mania/hypomania. “Reports of specific or concrete physical limitations in daily life showed no associations with psychiatric symptoms at concurrent assessments, but did predict worse course of illness” 1 year later, the researchers wrote.

“Though further research is warranted, changes in subjective physical health–related quality of life, even independent of objective health changes, may offer important insight into global well-being and be targets of psychotherapy treatment,” they concluded.

Find the study in the Journal of Affective Disorders (doi: 10.1016/j.jad.2015.09.052).

[email protected]

Patients with bipolar disorder who perceive their overall physical health as poor experience worse disease outcomes, according to Emily E. Bernstein of Harvard University, Cambridge, Mass., and her associates.

Data were collected from the Systematic Treatment Enhancement Program for Bipolar Disorder and were analyzed via the Short Form Health Survey (SF-36). An increased sense of role limitation increased the risk of depressive symptoms, while increased physical pain raised the risk of mania/hypomania. “Reports of specific or concrete physical limitations in daily life showed no associations with psychiatric symptoms at concurrent assessments, but did predict worse course of illness” 1 year later, the researchers wrote.

“Though further research is warranted, changes in subjective physical health–related quality of life, even independent of objective health changes, may offer important insight into global well-being and be targets of psychotherapy treatment,” they concluded.

Find the study in the Journal of Affective Disorders (doi: 10.1016/j.jad.2015.09.052).

[email protected]

Both bipolar disorder (BD) patients and their first-degree relatives were slower than were healthy controls in an emotion recognition task, suggesting facial recognition may be an endophenotype in bipolar disorder, according to a study published in Psychiatry Research.

Dr. Esther Vierck of the University of Otago in New Zealand and her associates compared 36 BD patients and 40 healthy control participants in a computerized facial emotion recognition task – 24 of the BD patient group’s first-degree relatives also were measured.

The researchers noted that bipolar patients were less accurate in recognizing emotional expressions than were controls, but did not find any evidence for emotion specificity within the BD or BD relative groups.

Read the article here: doi:10.1016/j.psychres.2015.08.033.

[email protected]

Both bipolar disorder (BD) patients and their first-degree relatives were slower than were healthy controls in an emotion recognition task, suggesting facial recognition may be an endophenotype in bipolar disorder, according to a study published in Psychiatry Research.

Dr. Esther Vierck of the University of Otago in New Zealand and her associates compared 36 BD patients and 40 healthy control participants in a computerized facial emotion recognition task – 24 of the BD patient group’s first-degree relatives also were measured.

The researchers noted that bipolar patients were less accurate in recognizing emotional expressions than were controls, but did not find any evidence for emotion specificity within the BD or BD relative groups.

Read the article here: doi:10.1016/j.psychres.2015.08.033.

[email protected]

Both bipolar disorder (BD) patients and their first-degree relatives were slower than were healthy controls in an emotion recognition task, suggesting facial recognition may be an endophenotype in bipolar disorder, according to a study published in Psychiatry Research.

Dr. Esther Vierck of the University of Otago in New Zealand and her associates compared 36 BD patients and 40 healthy control participants in a computerized facial emotion recognition task – 24 of the BD patient group’s first-degree relatives also were measured.

The researchers noted that bipolar patients were less accurate in recognizing emotional expressions than were controls, but did not find any evidence for emotion specificity within the BD or BD relative groups.

Read the article here: doi:10.1016/j.psychres.2015.08.033.

[email protected]