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Revista Brasileira de Psiquiatria 03/2012; 34(1):119-20. · 1.20 Impact Factor
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ABSTRACT: Introduction: The dimensional approach of the obsessive-compulsive symptoms may help to find more homogeneous groups of patients. The brain derived neurotrophic factor (BDNF) may help to identify neurobiological differences between obsessive-compulsive symptom dimensions. Methods: We compared serum BDNF (pg/µg) levels of 25 unmedicated patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for obsessive-compulsive disorder (OCD) and 25 controls, using the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Yale-Brown Obsessive-Compulsive Scale and the Beck's Anxiety and Depression Inventories. Results: There were no sociodemographic differences between the groups. The standard error of mean serum BDNF levels were reduced in unmedicated OCD patients (0.47+0.038) when compared to healthy controls (0.75+0.060) (P<.001). The patients with the presence of sex/religion obsessive-compulsive symptoms (OCS) dimension (P=.002), with chronic course of OCS (P=.022) and the presence of lifetime major depression (P=.016) and social anxiety (P=.030) presented higher levels of BDNF than OCD patients without those features. The severity of aggression (P=.039) and sex/religion (P<.001) OCS dimension presented direct (moderate and strong, respectively) correlation with serum BDNF levels in this sample. Serum BDNF levels were decreased in OCD patients when compared to healthy controls. Discussion/Conclusion: Sexual and religious content of symptoms and aggression and sex/religion dimensions severity should be better explored, since these specific OCS dimensions could be based on neurocircuits diverse from those of the other OCS dimensions.
CNS spectrums 09/2011; · 2.20 Impact Factor
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ABSTRACT: Previous reports suggest that cytokines act as potential mediators of the interaction between the immune and neuroendocrine systems, and that a proinflammatory state may be associated with bipolar disorder and schizophrenia. The aim is to compare cytokine levels in both disorders.
Twenty euthymic bipolar disorder patients, 53 chronic stabilized schizophrenia patients and 80 healthy controls were recruited. Subjects were all non-smokers and non-obese. Cytokines TNF-α, IL-6, and IL-10 were examined by sandwich ELISA.
IL-6 levels were increased in schizophrenia patients when compared to controls (p < 0.0001) and euthymic bipolar disorder patients (p < 0.0001). IL-6 levels were no different in controls compared to euthymic bipolar disorder patients (p = 0.357). IL-10 was lower in controls compared to schizophrenia patients (p = 0.001) or to bipolar disorder patients (p = 0.004). There was no significant difference in TNF-α serum levels among the groups (p = 0.284). Gender-based classification did not significantly alter these findings, and no correlation was found between the antipsychotic dose administered and cytokine levels in patients with schizophrenia.
These findings evidence a chronic immune activation in schizophrenia. Bipolar disorder seems to present an episode-related inflammatory syndrome. Increased anti-inflammatory factor IL-10 in bipolar disorder and schizophrenia suggests different patterns of inflammatory balance between these two disorders. Results further support the need to investigate cytokines as possible biomarkers of disease activity or treatment response.
Revista Brasileira de Psiquiatria 09/2011; 33(3):268-74. · 1.20 Impact Factor
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ABSTRACT: Brain-derived neurotrophic factor (BDNF) plays a central role in synaptic plasticity and neurogenesis. Bipolar disorder (BD) is among the most disabling of all psychiatric disorders and is associated with poor outcomes. Some studies suggest that BDNF levels decrease during mood states and remain normal during euthymia, but other studies have contradicted this paradigm. Therefore, the aim of this study was to perform a meta-analysis of all studies that measured peripheral BDNF levels in adults with BD. We conducted a systematic review using electronic databases. Inclusion criteria were studies that measured BDNF in plasma or serum in vivo in adult patients with BD. The resulting studies were compiled to measure the effect sizes (ESs) of the differences in BDNF levels between BD patients in different mood states and controls. Thirteen studies were included with a total of 1113 subjects. The BDNF levels were decreased in both mania and depression when compared to controls (ES -0.81, 95% CI -1.11 to -0.52, p < 0.0001 and ES -0.97, 95% CI -1.79 to -0.51, p = 0.02, respectively). The BDNF levels were not different in euthymia when compared to controls (ES -0.20, 95% CI -0.61 to 0.21, p = 0.33). Meta-regression analyses in euthymia showed that age (p < 0.0001) and length of illness (p = 0.04) influenced the variation in ES. There was also an increase in BDNF levels following the treatment for acute mania (ES -0.63, 95% CI -1.11 to -0.15, p = 0.01). In conclusion, BDNF levels are consistently reduced during manic and depressive episodes and recover after treatment for acute mania. In euthymia, BDNF decreases with age and length of illness. These data suggest that peripheral BDNF could be used as a biomarker of mood states and disease progression for BD.
Journal of psychiatric research 05/2011; 45(8):995-1004. · 3.72 Impact Factor
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ABSTRACT: Bipolar disorder (BD) has been increasingly associated with abnormalities in neuroplasticity. Previous studies demonstrated that neurotrophin-3 (NT-3) plays a role in the pathophysiology of mood disorders. The influence of medication in these studies has been considered a limitation. Thus, studies with drug-free vs. medicated patients are necessary to evaluate the role of medication in serum NT-3 levels. About 10 manic and 10 depressive drug-free, and 10 manic and 10 depressive medicated patients with BD type I were matched with 20 controls for sex and age. Patients were assessed using SCID-I, YMRS and HDRS. Serum NT-3 levels in drug-free and medicated patients is increased when compared with controls (2.51+/-0.59, 2.56+/-0.44 and 1.97+/-0.33, respectively, p<0.001 for drug-free/medicated vs. control). Serum NT-3 levels do not differ between medicated and drug-free patients. When analyzing patients according to mood states, serum NT-3 levels are increased in both manic and depressive episodes, as compared with controls (2.47+/-0.43, 2.60+/-0.59 and 1.97+/-0.33, respectively, p<0.001 for manic/depressive patients vs. controls). There is no difference in serum BDNF between manic and depressive patients. Results suggest that increased serum NT-3 levels in BD are likely to be associated with the pathophysiology of manic and depressive symptoms.
Journal of psychiatric research 07/2010; 44(9):561-5. · 3.72 Impact Factor
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ABSTRACT: Although bipolar disorder is a major contributor to functional impairment worldwide, an independent impact of bipolar disorder and ageing on functioning has yet to be demonstrated. The objective of the present study was to evaluate the effect of bipolar disorder on age-related functional status using matched controls as a standard.
One-hundred patients with bipolar disorder and matched controls were evaluated for disability. Age-related effects controlled for confounders were cross-sectionally evaluated.
Patients were significantly more impaired than controls. Regression showed effects for aging in both groups. The effect, size, however, was significantly stronger in patients.
Bipolar disorder was an important effect modifier of the age impact on functioning. While a longitudinal design is needed to effectively demonstrate this different impact, this study further depicts bipolar disorder as a chronic and progressively impairing illness.
Revista Brasileira de Psiquiatria 12/2009; 31(4):354-7. · 1.20 Impact Factor
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ABSTRACT: As the use of functioning outcomes is increasingly being advocated in multinational clinical trials and comparative studies, making available instruments with known validity and reliability in several languages is required. Here we present data on the Portuguese validation of the Functioning Assessment Short Test (FAST), which was explicitly designed to gauge functioning dimensions empirically linked to bipolar disorder.
One hundred patients with bipolar disorder and matched controls were assessed with the FAST, which was evaluated regarding discriminant, content and construct validity, concurrent validity with functioning instruments, internal consistency and test-retest reliability.
The FAST displayed a five-factor structure very similar to its conceptualization, successfully discriminated patient and control groups, and correlated highly with other functioning measures; it also showed excellent test-retest reliability and internal consistency.
The FAST is a measure with sufficient validity and reliability, with potential for the use in international clinical trials and comparative studies.
Value in Health 06/2009; 12(4):624-7. · 2.19 Impact Factor
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ABSTRACT: Bipolar disorder (BD) has been associated with abnormalities in neuroplasticity and previous studies suggest an important role for BDNF in the pathophysiology of BD. The confounding effect of the use of medication in these studies has been considered a limitation. Thus, studies with both drug-free and medicated patients are necessary to assess the role of medication in serum BDNF levels. Twenty-two manic and depressed drug-free and 22 medicated BD type I patients were matched to 22 controls according to sex and age in a cross-sectional study. BDNF serum levels were assessed using sandwich-ELISA. Serum BDNF levels in drug-free (0.23+/-0.09), and medicated (0.29+/-0.19) BD patients were decreased when compared to controls (0.40+/-0.12) - drug-free/medicated vs. control p<0.001. The BDNF levels did not differ between medicated and drug-free BD patients. When analyzing patients according to mood states, serum BDNF levels were lower in BD patients during both manic (0.28+/-0.11) and depressive episodes (0.22+/-0.17), as compared with healthy controls (0.40+/-0.12) - manic/depressed patients vs. controls p<0.001. Results suggest that the association of lower serum BDNF and BD mood episodes is kept even in medicated patients, which strengthens the notion that BDNF serum levels may be considered a biomarker of mood episodes in BD.
Journal of psychiatric research 06/2009; 43(14):1171-4. · 3.72 Impact Factor
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ABSTRACT: Alcohol use is highly prevalent in patients with bipolar disorder (BD) and is associated with significant mortality and morbidity. The detrimental effects of each condition are compounded by the presence of the other. The objective of this study was to examine the impact of alcohol abuse and of alcohol dependence in BD in a Brazilian sample, as indicated by clinical severity, functional impairment, and quality of life (QOL). A cross-sectional survey of 186 bipolar outpatients were interviewed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-4th Edition. The primary outcome measures were functioning, as indicated by the Global Assessment of Functioning Scale scores and QOL, as indicated by the World Health Organization Quality of Life Instrument. Secondary outcomes were clinical severity features. Alcohol abuse and dependence were associated with male gender, lower education, earlier age of onset, psychosis within first episode, depressive symptoms, and worse functioning. In addition, the presence of alcohol abuse or dependence was associated with remarkably high rates of suicide attempt. Our findings suggest that the co-occurrence of alcohol abuse/dependence with BD increases the risk for suicide attempt, which may reflect in part the greater severity of symptoms and impaired functioning. This subgroup of bipolar patients requires a treatment tailored to address both conditions.
Alcohol 10/2008; 42(6):451-7. · 2.47 Impact Factor
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Lísia Rejane Guimarães,
Felice N Jacka,
Clarissa Severino Gama,
Michael Berk,
Carmen Lúcia Leitão-Azevedo,
Martha Guerra Belmonte de Abreu,
Maria Inês Lobato,
Ana Cristina Andreazza, Keila Maria Ceresér,
Flávio Kapczinski,
Paulo Belmonte-de-Abreu
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ABSTRACT: Dietary factors influence BDNF in animal studies, but there is no comparable data in clinical populations. We examined the effect of a dietary intervention on BDNF serum levels in 67 DSM-IV schizophrenic outpatients (51 males and 16 females). Two groups were assessed in a cross-sectional study: one on a hypocaloric diet (HD) and the other not on a hypocaloric diet. Weight, height and BMI data were collected concurrently with 5-ml blood sampling of each subject. BDNF levels were measured with a sandwich-ELISA. The blood sample was obtained a minimum of one month after the exposure to dietary intervention. Serum BDNF levels were significantly higher in patients on the HD (p=0.023). Additional research examining the interaction among patterns of nutritional food behavior and underlying physiopathology may result in insights upon which evidence-based decisions regarding dietary interventions can be made in people identified with major psychiatric disorders, such as schizophrenia.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 07/2008; 32(6):1595-8. · 3.25 Impact Factor
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Ana Cristina Andreazza,
Carina Cassini,
Adriane Ribeiro Rosa,
Marina Concli Leite,
Lucia M V de Almeida,
Patrícia Nardin,
Angelo B N Cunha, Keila Maria Ceresér,
Aida Santin,
Carmem Gottfried,
Mirian Salvador,
Flavio Kapczinski,
Carlos Alberto Gonçalves
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ABSTRACT: Bipolar disorder (BD) is a chronic, severe, and highly disabling psychiatric disorder; peripheral markers have been used to assess biochemical alterations associated with BD and/or possibly involved in its pathophysiology. Beyond neuronal commitment, many groups have proposed the involvement of glial activity in psychiatric disorders. Other biochemical markers, particularly associated with oxidative stress, have been studied in BD. In the present study, we evaluated glial involvement and oxidative stress in patients with BD. Glial activity was assessed by measuring serum S100B content; oxidative stress was assessed using serum thiobarbituric acid reactive substances (TBARS) and activities of antioxidant enzymes in BD patients during different episodes of disease. We found a significant increment of serum S100B during episodes of mania and depression, but not in euthymic patients. Superoxide dismutase (SOD) activity, as well the SOD/glutathione peroxidase plus catalase ratio, was also increased in manic and depressed patients. On the other hand, TBARS levels were increased in BD patients regardless of the phase of the disorder. These findings suggest a potential oxidative damage in BD patients. This peripheral oxidative imbalance indicates that systemic changes are taking place during the active phases of the illness. Such changes appear to relate to astrocyte function, as indicated by serum S100B elevation.
Journal of Psychiatric Research 10/2007; 41(6):523-9. · 4.66 Impact Factor
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ABSTRACT: The aim of this study was to assess the association between suicide attempts and the use of multiple drugs in patients with bipolar disorder.
One hundred sixty-nine bipolar disorder outpatients diagnosed using the DSM-IV Structured Clinical Interview were included. Demographic and socioeconomic data, number of medications currently in use, history of suicide attempts, number of years undiagnosed, age of onset and current psychiatric co-morbidities were assessed using a structured questionnaire and DSM-IV criteria. The main outcome measure was the number of psychotropic drugs currently in use.
Approximately half of all patients (48.5%) presented a history of suicide attempt; 84% were using more than one medication, and 19% were using more than three drugs. The most frequent combinations of drugs used by these patients were: lithium + valproate (17%); lithium + antipsychotics (10%); lithium + valproate + antipsychotics (9%); and antidepressants + any drug (6%). The number of suicide attempts was associated with the use of multiple drugs.
Our findings support the notion that the use of combination therapy in bipolar disorder may be related to severity of the BD, such as number of suicide attempts.
Revista Brasileira de Psiquiatria 04/2007; 29(1):35-8. · 1.20 Impact Factor
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ABSTRACT: The aim of the present study is to compare quality of life among currently depressed, subsyndromal and remitted patients with bipolar disorder (BD) and to assess whether the level of depression correlates with the scores of quality of life in BD patients.
Sixty bipolar outpatients diagnosed using the Structured Clinical Interview for DSM-IV who met criteria for diagnosis of BD type I, II or not otherwise specified (BD-NOS), and who were not currently on a manic or mixed episode were included. The main variables of interest were quality of life (QOL) assessed using the 26-item World Health Organization QOL instrument (WHOQOL-BREF) and depression assessed using the 17-item Hamilton Depression Rating Scale (HDRS).
A linear trend test showed a dose response association between patients' current mood state and all domains of quality of life. Higher quality of life scores were found among remitted patients, followed by subsyndromal patients; depressed patients presented lower scores of quality of life, except for the social domain. The four domains of the WHOQOL scale correlated negatively with the HDRS.
Our findings suggest that bipolar depression and residual symptoms of depression are negatively correlated with QOL in BD patients.
Revista Brasileira de Psiquiatria 07/2006; 28(2):93-6. · 1.20 Impact Factor
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ABSTRACT: This study assessed the impact of number of years undiagnosed (NYU) on current morbidity in patients with bipolar disorder.
The sample size used was rather small, which may make difficult the generalization of our findings to larger datasets. The data about age of onset and age when patients received their diagnosis may present a certain degree of recall error.
Sixty-five bipolar outpatients diagnosed using the Structured Clinical Interview for DSM were included. The main outcome measurements were quality of life (QOL) assessed using the 26-item World Health Organization QOL instrument (WHOQOL-Bref) and depression assessed using the 17-item Hamilton Depression Rating Scale (HDRS).
Age of onset and years of disorder were not correlated with the outcomes assessed. The NYU were associated with higher scores of HDRS (P<0.01), lower scores of QOL within the physical (p<0.01) and psychological (p<0.05) domains of QOL.
Our findings suggest that the NYU may be an important predictor of the current clinical status of bipolar patients.
Journal of Affective Disorders 06/2005; 86(2-3):313-6. · 3.52 Impact Factor
