BACKGROUND Major depressive disorder(MDD)and bipolar depression(BD-D)are both intricate,enduring,and profound psychiatric conditions characterized primarily by depressive episodes and cognitive dysfunction.However,dis...BACKGROUND Major depressive disorder(MDD)and bipolar depression(BD-D)are both intricate,enduring,and profound psychiatric conditions characterized primarily by depressive episodes and cognitive dysfunction.However,distinguishing the characteristics and influencing factors of cognitive impairment in unipolar and BD-D is crucial for identification and intervention.AIM To compare neurocognitive characteristics and investigate associations between cognitive function and clinical features in unipolar and BD-D.METHODS The THINC-integrated tool(THINC-it)as a cognitive assessment tool was applied to 295 individuals:75 patients with depressive disorders(MDD),120 individuals with BD-D,and 100 healthy controls.The Hamilton Depression Scale-17(HAMD),Hamilton Anxiety Scale-14(HAMA),and Pittsburgh Sleep Quality Index(PSQI)were employed to assess depression,anxiety,and sleep.Neurocognitive function characteristics and the relationships between cognitive impairment and general clinical attributes were analyzed.RESULTS There were no statistically significant differences in the overall THINC-it with each objective subscale.However,the subjective subscale(Perceived Deficits Questionnaire for Depression-5-item)showed significant differences between MDD and BD-D(P<0.001).Linear regression analyses were explored to determine associations.Age,years of education,age at onset,and HAMD were significantly co-associated with the overall THINC-it and each subscale in both MDD and BD-D(P<0.05).Furthermore,years of education showed a positive correlation with objective cognitive impairment(e.g.,Codebreaker,Trails)(P<0.05).There was a notable difference in that the number of depressive episodes,disease duration,hospitalizations,HAMA,and PSQI were significantly associated with the overall THINC-it with each subscale between MDD and BD-D(P<0.05).CONCLUSION Although both unipolar and BD-D showed similar objective cognitive impairments,there was a significant difference in subjective cognitive impairment.Our findings suggest that factors like age,years of education,age at onset,and depression severity might not be significantly difference in the influence of cognitive impairment.Furthermore,we found that education was a protective factor for cognitive impairment in both unipolar and BD-D.Our analysis revealed that distinct factors including disease duration,number of depressive episodes,hospitalizations,anxiety levels,and sleep quality influenced cognitive impairment between unipolar and BD-D.Therefore,it was important to investigate the specific characteristics of cognitive impairment and influencing factors to identify differentiating unipolar and BD-D.展开更多
Objective:Whether vortioxetine has a utility as an adjuvant drug in the treatment of bipolar depression remains controversial.This study aimed to validate the efficacy and safety of vortioxetine in bipolar depression....Objective:Whether vortioxetine has a utility as an adjuvant drug in the treatment of bipolar depression remains controversial.This study aimed to validate the efficacy and safety of vortioxetine in bipolar depression.Methods:Patients with bipolarⅡdepression were enrolled in this prospective,two-center,randomized,12-week pilot trial.The main indicator for assessing treatment effectiveness was a Montgomery-Asberg Depression Rating Scale(MADRS)of≥50%.All eligible patients initially received four weeks of lurasidone monotherapy.Patients who responded well continued to receive this kind of monotherapy.However,no-response patients were randomly assigned to either valproate or vortioxetine treatment for eight weeks.By comprehensively comparing the results of MADRS over a period of 4-12 weeks,a systematic analysis was conducted to determine whether vortioxetine could be used as an adjuvant drug for treating bipolar depression.Results:Thirty-seven patients responded to lurasidone monotherapy,and 60 patients were randomly assigned to the valproate or vortioxetine group for eight weeks.After two weeks of combined valproate or vortioxetine treatment,the MADRS score in the vortioxetine group was significantly lower than that in the valproate group.There was no difference in the MADRS scores between the two groups at 8 and 12 weeks.The incidence of side effects did not significantly differ between the valproate and vortioxetine groups.Importantly,three patients in the vortioxetine group appeared to switch to mania or hypomania.Conclusions:This study suggested that lurasidone combination with vortioxetine might have potential benefits to bipolar II depression in the early stage,while disease progression should be monitored closely for the risk of switching to mania.展开更多
Objective Non-suicidal self-injury(NSSI)has a higher prevalence in adolescents with depressive disorders than in community adolescents.This study examined the differences in NSSI behaviors between adolescents with uni...Objective Non-suicidal self-injury(NSSI)has a higher prevalence in adolescents with depressive disorders than in community adolescents.This study examined the differences in NSSI behaviors between adolescents with unipolar depression(UD)and those with bipolar depression(BD).Methods Adolescents with UD or BD were recruited from 20 general or psychiatric hospitals across China.The methods,frequency,and function of NSSI were assessed by Functional Assessment of Self-Mutilation.The Beck Suicide Ideation Scale was used to evaluate adolescents’suicidal ideation,and the 10-item Kessler Psychological Distress Scale to estimate the anxiety and depression symptoms.Results The UD group had higher levels of depression(19.16 vs.17.37,F=15.23,P<0.001)and anxiety symptoms(17.73 vs.16.70,F=5.00,P=0.026)than the BD group.Adolescents with BD had a longer course of NSSI than those with UD(2.00 vs.1.00 year,Z=−3.39,P=0.001).There were no statistical differences in the frequency and the number of methods of NSSI between the UD and BD groups.Depression(r=0.408,P<0.01)and anxiety(r=0.391,P<0.01)were significantly and positively related to NSSI frequency.Conclusion Adolescents with BD had a longer course of NSSI than those with UD.More importantly,NSSI frequency were positively and strongly correlated with depression and anxiety symptoms,indicating the importance of adequate treatment of depression and anxiety in preventing and intervening adolescents’NSSI behaviors.展开更多
English-language literature cited in MEDLINE from January,1980 to October 30,2014 was searched by using terms of antipsychotic,generic and brand names of atypical antipsychotics, ＂bipolar depression/bipolar disorder...English-language literature cited in MEDLINE from January,1980 to October 30,2014 was searched by using terms of antipsychotic,generic and brand names of atypical antipsychotics, ＂bipolar depression/bipolar disorder＂, ＂placebo＂,and ＂trial＂.The parameters of response（≥50%improvement on MADRS,Montgomery-Asberg Depression Rating Scale total score）,remission（either ≤12 or 8 on MADRS total score at endpoint）,discontinuation due to adverse events（DAEs）,somnolence,≥7%weight gain,overall extrapyramidal side-effects（EPSs）,and akathisia,were extracted from originally published primary outcome papers.The number needed to treat to benefit（NNT） for response and remission or harm（NNH） for DAEs or other side effects relative to placebo were estimated and presented with the estimate and 95%confidence interval.Olanzapine monotherapy,olanzapine-fluoxetine combination（OFC）,quetiapine-IR monotherapy,quetiapine-XR monotherapy,lurasidone monotherapy,and lurasidone adjunctive therapy were superior to placebo with NNTs for responses of 11-12,4,7-8,4,4-5,and 7,and NNTs for remission of 11-12,4,5-11,7,6-7,and 6,respectively.There was no significant difference between OFC and lamotrigine,and between aripiprazole or ziprasidone and placebo in response and remission.Olanzapine monotherapy,quetiapine-IR,quetiapine-XR,aripiprazole,and ziprasidone 120-160 mg/day had significantly increased risk for DAEs with NNHs of 24,8-14,9,12,and 10,respectively.For somnolence,quetiapine-XR had the smallest NNH of 4.For ≥7%weight gain,olanzapine monotherapy and OFC had the smallest NNHs with both of 5.For akathisia,aripiprazole had the smallest NNH of 5.These findings suggest that among the FDA-approved agents including OFC,quetiapine-IR and-XR,lurasidone monotherapy and adjunctive therapy to a mood stabilizer,the differences in the NNTs for response and remission are small,but the differences in NNHs for DAEs and common side-effects are large.Therefore,the selection of an FDA-approved atypical antipsychotic for bipolar depression should be based upon safety and tolerability.展开更多
Background: It is not well analyzed whether there are differences in plasma levels of tryptophan (TRP) metabolites between healthy control people (HC) and patients of type II bipolar depression (BDII). Methods: Ultra ...Background: It is not well analyzed whether there are differences in plasma levels of tryptophan (TRP) metabolites between healthy control people (HC) and patients of type II bipolar depression (BDII). Methods: Ultra high-speed liquid chromatography/mass spectrometry has been used for the simultaneous determination of plasma levels of tryptophan metabolites in depressive patients. Results: Plasma levels of TRP are not different between HC and patients of BDII. Serotonin (5-HT) levels are higher in BDII than HC. Plasma levels of 5-HIAA of HC are higher than those of old women of BDII, but lower in young women of BDII. Plasma levels of kynurenine (KYN) of HC are not different from those of patients of BDII. Conclusion: Plasma levels of 5-HT are higher in patients of BDII than those of HC, which may suggest that use of drugs inhibiting the 5-HT transportation and lower transporter biding may increase plasma levels of 5-HT in patients of BD.展开更多
Objective： Although lithium has been a commonly prescribed neurotrophic/neuroprotective mood-stabilizing agents, its effect on spontaneous brain activity in patients with bipolar depression remains unclear. The aim o...Objective： Although lithium has been a commonly prescribed neurotrophic/neuroprotective mood-stabilizing agents, its effect on spontaneous brain activity in patients with bipolar depression remains unclear. The aim of this study is to reveal the basic mechanism underlying the pathological influences of lithium on resting-state brain function of bipolar depression patients. Methods：97 subjects including 9 bipolar depression patients with lithium treatment, 19 bipolar depression patients without lithium treatment and 69 healthy controls, were recruited to participate in this study. Amplitude of low-frequency fluctuation （ ALFF ） and fractional amplitude of low-frequency fluctuation （ fALFF） were used to capture the changes of spontane-ous brain activity among different groups. In addition, further analysis in terms of Hamilton Depression Rating Scale, the number of depressive episodes, and illness duration in pooled bipolar depression patients were conducted, which combined FLEF and fALEF to identify the basic neural features of bipolar depression patients. Results： It was observed from the imaging results that both the bipolar depression patients receiving lithium treatment and healthy control subjects showed signifi-cantly decreased ALFF/fALFF values in the right anterior cingulate cortex and right middle frontal gyrus compared to that from the bipolar depression patients without lithium treatmetn. The ALFF values of the right＆amp;nbsp;middle temporal gyrus was also found to be negative related to the number of depressive episode and the total episodes. Conclusions：Our findings suggested that the bipolar depression subjects were identified to have ab-normal ALFF/ fALFF in the corticolimbic systems, in-cluding regions like right anterior cingulate cortex, bilateral middle frontal gyrus, right orbital frontal gyrus, and right middle temporal gyrus. In addition, it was also revealed that the decreased ALFF/fALFF in the right anterior cingulate cortex and right middle frontal gyrus might be a biomarker that is related to the lithium effects.展开更多
Objective Using graph theory analysis,this study compares the topological and node attributes of the brain network to explore the differences in gray matter structural and functional network topological properties bet...Objective Using graph theory analysis,this study compares the topological and node attributes of the brain network to explore the differences in gray matter structural and functional network topological properties between bipolar depression(BD)patients with and without obsessive-compulsive symptoms(OCS).Methods A total of 90 BD patients(27 males,63 females;median age 19.0(22.0,25.0)years)were recruited from the psychiatric outpatient and inpatient departments of the First Affiliated Hospital of Jinan University between March 2018 and December 2022.Fifty healthy controls(19 males,31 females;median age:23.0(20.0,27.0)years)were also enrolled.The BD patients were divided into two groups based on the presence of OCS:53 with OCS(OCS group)and 37 without OCS(NOCS group).Resting-state structural and functional MRI data were collected for all participants to construct gray matter structural and functional networks.Graph therory analysis was aapplied to calculate network topological metrics such as small-world properties.The structural and functional network topological properties were compared among the BD-OCS,BD-nOCS,and control groups.Partial correlation analysis was conducted to examine the association between network topological metrics with significant group differences and Yale-Brown Obsessive-Compulsive Scale(Y-BOCS)scores.Support vector machines(SVM)were used with these metrics as classificationfeaturevalues toimproveediagnostic accuracy through pairwise group classification.Results Structural network analysis of gray matter:compared to HC group,both OCS group and NOCS group showed increasedshortesttpathlengthand standardized characteristic path length(shortest path length:0.78 and 0.80 vs.0.69;normalized characteristic path length:0.48 and 0.49 vs.0.43),and decreased global efficiency(0.21 and 0.21 vs.0.24)compared to the HC group(permutation test,all P<0.05).Compared to NOCS and HC groups,the OCS group showed increased nodal centrality and betweenness centrality in the right rolandic operculum and left superior occipital gyrus(permutation test,all P<0.05).Functional network analysis of gray matter:compared to the NOCS group,the OCS group showed increased node efficiency and decreased betweenness centrality in the cerebellum(t=2.15,-3.04;all P<0.05);compared to HC groups,the OCS group showed decreased betweenness centrality in the cerebellum and left inferior frontal gyrus,along with increased node centrality and nodal efficiency in the right transverse temporal gyrus(t=-2.99,-3.61,3.06,3.10;all P<0.05).In the 0CS group,betweenness centrality in the left inferior frontal gyrus positively correlated with Y-BOCS scale obsessive thinking score(r=0.303,P=0.034).Nodal centrality and node efficiency of the right transverse temporal gyrus negatively correlated with Y-BOCS total score(r=-0.301,-0.311)and Y-BOCS obsessional thinking scores(r=-0.385,-0.380)separately(all P<0.05).SVM classification:the combined network features achieved an area under the curve of 0.80 in distinguising OCS from NOCS patients.Conclusion BDOCS and BD-nOCS patients both exhibit consistent changes in gray matter structural network topology,with theOCSSgroup displaying more pronounced nodal topological abnormalities.Multi-network feature integration demostrates potential for diagnostic classfication.展开更多
Ojective:To explored the effectiveness and safety of acupuncture at back-shu points of five zang and Geshu(BL 17)for bipolar depression,and its mechanism from the aspect of the anti-inflammatory response.Background:Bi...Ojective:To explored the effectiveness and safety of acupuncture at back-shu points of five zang and Geshu(BL 17)for bipolar depression,and its mechanism from the aspect of the anti-inflammatory response.Background:Bipolar disorder is a very common,often misdiagnosed mental disorder strongly associated with comorbidity,disability,and premature mortality.Bipolar depression(ie,depressive episode in bipolar disorder)is poorly responsive to available treatments.Acupuncture at back-shu points of five zang and Geshu(BL 17),a prescription from Dr.Leting Wang,is a popular therapy for depression in China.Its effectiveness and safety for bipolar depression are yet to be verified by clinical studies.Methods:The study is a single-center,prospective,randomized controlled trial involving 72 patients diagnosed with bipolar depression.Participants will be randomized either to the study group or the control group in a 1:1 ratio.All participants will receive mood stabilizer therapy.In addition,the study group will receive acupuncture therapy at back-shu points of five zang and Geshu(BL 17),three times per week.The control group will orally take the antidepressant bupropion.Observation and intervention will last for 8 consecutive weeks.Outcome measurements include Hamilton Depression Rating Scale-17,Hamilton Anxiety Rating Scale,Clinical Global Impression Scale,Young Manic Rating Scale,Treatment Emergent Symptom Scale,serum levels of anti-inflammatory cytokines[interleukin-4(IL-40),IL-10,and transforming growth factor–β,pro-inflammatory cytokines(IL-1β,IL-6,and tumor necrosis factor–α),brain-derived neurotrophic factor,and C-reactive protein.Assessments will be conducted at baseline,first,second,fourth,and eighth weeks after randomization.Safety assessments will be performed throughout the study.Discussion:The results of this study are expected to verify the effectiveness and safety of acupuncture at back-shu points of five zang and Geshu(BL 17)for bipolar depression,and explore its therapeutic mechanisms from the point of anti-inflammation.展开更多
OBJECTIVE： To examine the efficacy and safety of short-term and long-term use of antidepres- sants in the treatment of bipolar disorder. DATA SOURCES： A literature search of randomized, double-blind, controlled tria...OBJECTIVE： To examine the efficacy and safety of short-term and long-term use of antidepres- sants in the treatment of bipolar disorder. DATA SOURCES： A literature search of randomized, double-blind, controlled trials published until December 2012 was performed using the PubMed, ISI Web of Science, Medline and Cochrane Central Register of Controlled Trials databases. The keywords ＂bipolar disorder, bipolar I disorder, bipolar II disorder, bipolar mania, bipolar depression, cyclothymia, mixed mania and depression, rapid cycling and bipolar disorder＂, AND ＂antidepressant agent, antidepressive agents second- generation, antidepressive agents tricyclic, monoamine oxidase inhibitor, noradrenaline uptake in- hibitor, serotonin uptake inhibitor, and tricyclic antidepressant agent＂ were used. The studies that were listed in the reference list of the published papers but were not retrieved in the above-mentioned databases were supplemented. STUDY SELECTION： Studies selected were double-blind randomized controlled trials assessing the efficacy and safety of antidepressants in patients with bipolar disorder. All participants were aged 18 years or older, and were diagnosed as having primary bipolar disorder. Antidepressants or antidepressants combined with mood stabilizers were used in experimental interventions. Placebos, mood stabilizers, antipsychotics and other antide pressants were used in the control interventions. Studies that were quasi-randomized studies, or used antidepressants in combination with antipsy- chotics in the experimental group were excluded. All analyses were conducted using Review Man- ager 5.1 provided by the Cochrane Collaboration.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> It is not well analyze...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> It is not well analyzed whether there are differences in plasma levels of tryptophan (TRP) metabolites between healthy control people (HC) and patients of major monopolar depression (MMD). </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Ultra high-speed </span></span><span style="font-family:""><span style="font-family:Verdana;">liquid chromatography/mass spectrometry has been used for the simultaneous determination of plasma levels of tryptophan metabolites in depressive </span><span><span style="font-family:Verdana;">patients. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There are no significant differences between plasma levels of TRP between HC and MMD. Plasma levels of TRP of HC are higher in young men, young women, old men, and old women in this order. Serotonin (5-HT) levels are higher in MMD than HC. Plasma levels of 5-HIAA of HC are also higher than those of patients of MMD. Plasma levels of kynurenine (KYN) of healthy old men and old women are higher than those of young men and old women. Plasma levels of KYN are higher in old women and young men of MMD than those of HC. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Plasma levels of 5-HT are higher in patients of MMD than those of HC, which may suggest that use of drugs inhibiting the 5-HT transportation may increase plasma levels of 5-HT in MMD.展开更多
Bipolar disorder and unipolar depressive disorder（UD） may be different in brain structure. In the present study,we performed voxel-based morphometry（VBM） to quantify the grey matter volumes in 23 patients with bip...Bipolar disorder and unipolar depressive disorder（UD） may be different in brain structure. In the present study,we performed voxel-based morphometry（VBM） to quantify the grey matter volumes in 23 patients with bipolar I depressive disorder（BP1） and 23 patients with UD,and 23 age-,gender-,and educationmatched healthy controls（HCs） using magnetic resonance imaging. We found that compared with the HC and UD groups,the BP1 group showed reduced grey matter volumes in the right inferior frontal gyrus and middle cingulate gyrus,while the UD group showed reduced volume in the right inferior frontal gyrus compared to HCs. In addition,correlation analyses revealed that the grey matter volumes of these regions were negatively correlated with the Hamilton depression rating scores. Taken together,the results of our study suggest that decreased grey matter volume of the right inferior frontal gyrus is a common abnormality in BP1 and UD,and decreasedgrey matter volume in the right middle cingulate gyrus may be specifi c to BP1.展开更多
Background:The use of antidepressants in the treatment of bipolar depression remains controversial due to concerns about their potential to induce mood polarity switches.This multinational observational study aims to ...Background:The use of antidepressants in the treatment of bipolar depression remains controversial due to concerns about their potential to induce mood polarity switches.This multinational observational study aims to examine the association between the use of antidepressants and the risk of hypomanic/manic switch among bipolar depressive patients.Methods:Four electronic health record databases(IQVIA Disease Analyzer Germany,IQVIA Disease Analyzer France,IQVIA US Hospital Charge Data Master,and Beijing Anding Hospital)and one administrative claims database(IQVIA US Open Claims)were analyzed,and the study period covered from January 2013 until December 2017.Treatment patterns of patients with bipolar depression were collected.The hazard ratio(HR)was calculated by comparing the incidence of hypomanic/manic switch in patients who received antidepressants(AD group)with that in those who did not receive any antidepressant(non-AD group)in 730 days after the date of the first diagnosis of bipolar depression.Results:The analysis included a total of 122,843 patients from the 5 databases;60.6% of them received antidepressants for bipolar depression.Across the 5 data sources,the mean age at index date ranged from 37.50(15.72)to 52.10(16.22)years.After controlling potential confounders by propensity score matching,the AD group’s manic switch risk was not significantly higher than the non-AD group’s(HR 1.04[95%CI,0.96 to 1.13];P=0.989).Additionally,no statistically significant difference was observed between patients prescribed antimanic drugs and those who were not(HR 0.69[95%CI,0.38 to 1.25];P=0.535).Conclusions:This study indicated that antidepressants were widely used in clinical settings for managing bipolar depression.The use of antidepressants was not associated with the risk of mania/hypomania switch when compared to non-antidepressants treatment.Therefore,antidepressants could be considered a treatment option for bipolar depression.展开更多
Objective To explore the differences of cortico-cortical functional connectivity features among patients with bipolar and unipolar depression in resting state.Methods Whole-head magnetoencephalography scan was perform...Objective To explore the differences of cortico-cortical functional connectivity features among patients with bipolar and unipolar depression in resting state.Methods Whole-head magnetoencephalography scan was performed in an resting state condition in 12 bipolar depression patients,27 unipolar depression patients and展开更多
Adolescents represent a significant proportion of global psychiatric morbidity,with approximately 10%–20%affected by mental disorders,primarily including major depressive disorder(MDD),bipolar disorder(BD),and schizo...Adolescents represent a significant proportion of global psychiatric morbidity,with approximately 10%–20%affected by mental disorders,primarily including major depressive disorder(MDD),bipolar disorder(BD),and schizophrenia(SZ)[1,2].These mental disorders exhibit distinct clinical presentations compared with adult forms,including prominent somatic symptoms in MDD[3],rapid mood cycling in BD[4],and insidious onset in SZ[5].The symptom-based Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)framework faces challenges in differentiating these mental disorders because of overlapping manifestations and developmental heterogeneity[6],necessitating biologically anchored classification frameworks.展开更多
基金Supported by Science and Technology Development Fund of Shanghai Pudong New Area,No.PKJ2023-Y20Key Discipline Construction Fund of the Shanghai Pudong New Area Municipal Commission of Health and Family Planning,No.PWZxk2022-18Pudong New Area Construction Project of National Traditional Chinese Medicine Development Comprehensive Reform Pilot Zone,No.PDZY-2022-0501.
文摘BACKGROUND Major depressive disorder(MDD)and bipolar depression(BD-D)are both intricate,enduring,and profound psychiatric conditions characterized primarily by depressive episodes and cognitive dysfunction.However,distinguishing the characteristics and influencing factors of cognitive impairment in unipolar and BD-D is crucial for identification and intervention.AIM To compare neurocognitive characteristics and investigate associations between cognitive function and clinical features in unipolar and BD-D.METHODS The THINC-integrated tool(THINC-it)as a cognitive assessment tool was applied to 295 individuals:75 patients with depressive disorders(MDD),120 individuals with BD-D,and 100 healthy controls.The Hamilton Depression Scale-17(HAMD),Hamilton Anxiety Scale-14(HAMA),and Pittsburgh Sleep Quality Index(PSQI)were employed to assess depression,anxiety,and sleep.Neurocognitive function characteristics and the relationships between cognitive impairment and general clinical attributes were analyzed.RESULTS There were no statistically significant differences in the overall THINC-it with each objective subscale.However,the subjective subscale(Perceived Deficits Questionnaire for Depression-5-item)showed significant differences between MDD and BD-D(P<0.001).Linear regression analyses were explored to determine associations.Age,years of education,age at onset,and HAMD were significantly co-associated with the overall THINC-it and each subscale in both MDD and BD-D(P<0.05).Furthermore,years of education showed a positive correlation with objective cognitive impairment(e.g.,Codebreaker,Trails)(P<0.05).There was a notable difference in that the number of depressive episodes,disease duration,hospitalizations,HAMA,and PSQI were significantly associated with the overall THINC-it with each subscale between MDD and BD-D(P<0.05).CONCLUSION Although both unipolar and BD-D showed similar objective cognitive impairments,there was a significant difference in subjective cognitive impairment.Our findings suggest that factors like age,years of education,age at onset,and depression severity might not be significantly difference in the influence of cognitive impairment.Furthermore,we found that education was a protective factor for cognitive impairment in both unipolar and BD-D.Our analysis revealed that distinct factors including disease duration,number of depressive episodes,hospitalizations,anxiety levels,and sleep quality influenced cognitive impairment between unipolar and BD-D.Therefore,it was important to investigate the specific characteristics of cognitive impairment and influencing factors to identify differentiating unipolar and BD-D.
基金partially supported by the Construction Fund of Key Medical Disciplines of Hangzhou(No.OO2020491)the National Key Research and Development Program of China(No.2023YFC2506200)+4 种基金the Zhejiang Provincial Key Research and Development Program(No.2021C03107)the Research Project of Jinan Microecological Biomedicine Shandong Laboratory(No.JNL-2023001B)the Leading Talent of Scientific and Technological Innovation-“Ten Thousand Talents Program”of Zhejiang Province(No.2021R52016)the Innovation Team for Precision Diagnosis and Treatment of Major Brain Diseases(No.2020R01001)the Chinese Medical Education Association(No.2022KTZ004).
文摘Objective:Whether vortioxetine has a utility as an adjuvant drug in the treatment of bipolar depression remains controversial.This study aimed to validate the efficacy and safety of vortioxetine in bipolar depression.Methods:Patients with bipolarⅡdepression were enrolled in this prospective,two-center,randomized,12-week pilot trial.The main indicator for assessing treatment effectiveness was a Montgomery-Asberg Depression Rating Scale(MADRS)of≥50%.All eligible patients initially received four weeks of lurasidone monotherapy.Patients who responded well continued to receive this kind of monotherapy.However,no-response patients were randomly assigned to either valproate or vortioxetine treatment for eight weeks.By comprehensively comparing the results of MADRS over a period of 4-12 weeks,a systematic analysis was conducted to determine whether vortioxetine could be used as an adjuvant drug for treating bipolar depression.Results:Thirty-seven patients responded to lurasidone monotherapy,and 60 patients were randomly assigned to the valproate or vortioxetine group for eight weeks.After two weeks of combined valproate or vortioxetine treatment,the MADRS score in the vortioxetine group was significantly lower than that in the valproate group.There was no difference in the MADRS scores between the two groups at 8 and 12 weeks.The incidence of side effects did not significantly differ between the valproate and vortioxetine groups.Importantly,three patients in the vortioxetine group appeared to switch to mania or hypomania.Conclusions:This study suggested that lurasidone combination with vortioxetine might have potential benefits to bipolar II depression in the early stage,while disease progression should be monitored closely for the risk of switching to mania.
基金supported by the Sanming Project of Medicine in Shenzhen(No.SZSM202011014)Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties(No.SZGSP013)+1 种基金Shenzhen Key Medical Discipline Construction Fund(No.SZXK072)Shenzhen Science and Technology Research and Development Fund for Sustainable Development Project(No.KCXFZ20201221173613036).
文摘Objective Non-suicidal self-injury(NSSI)has a higher prevalence in adolescents with depressive disorders than in community adolescents.This study examined the differences in NSSI behaviors between adolescents with unipolar depression(UD)and those with bipolar depression(BD).Methods Adolescents with UD or BD were recruited from 20 general or psychiatric hospitals across China.The methods,frequency,and function of NSSI were assessed by Functional Assessment of Self-Mutilation.The Beck Suicide Ideation Scale was used to evaluate adolescents’suicidal ideation,and the 10-item Kessler Psychological Distress Scale to estimate the anxiety and depression symptoms.Results The UD group had higher levels of depression(19.16 vs.17.37,F=15.23,P<0.001)and anxiety symptoms(17.73 vs.16.70,F=5.00,P=0.026)than the BD group.Adolescents with BD had a longer course of NSSI than those with UD(2.00 vs.1.00 year,Z=−3.39,P=0.001).There were no statistical differences in the frequency and the number of methods of NSSI between the UD and BD groups.Depression(r=0.408,P<0.01)and anxiety(r=0.391,P<0.01)were significantly and positively related to NSSI frequency.Conclusion Adolescents with BD had a longer course of NSSI than those with UD.More importantly,NSSI frequency were positively and strongly correlated with depression and anxiety symptoms,indicating the importance of adequate treatment of depression and anxiety in preventing and intervening adolescents’NSSI behaviors.
文摘English-language literature cited in MEDLINE from January,1980 to October 30,2014 was searched by using terms of antipsychotic,generic and brand names of atypical antipsychotics, ＂bipolar depression/bipolar disorder＂, ＂placebo＂,and ＂trial＂.The parameters of response（≥50%improvement on MADRS,Montgomery-Asberg Depression Rating Scale total score）,remission（either ≤12 or 8 on MADRS total score at endpoint）,discontinuation due to adverse events（DAEs）,somnolence,≥7%weight gain,overall extrapyramidal side-effects（EPSs）,and akathisia,were extracted from originally published primary outcome papers.The number needed to treat to benefit（NNT） for response and remission or harm（NNH） for DAEs or other side effects relative to placebo were estimated and presented with the estimate and 95%confidence interval.Olanzapine monotherapy,olanzapine-fluoxetine combination（OFC）,quetiapine-IR monotherapy,quetiapine-XR monotherapy,lurasidone monotherapy,and lurasidone adjunctive therapy were superior to placebo with NNTs for responses of 11-12,4,7-8,4,4-5,and 7,and NNTs for remission of 11-12,4,5-11,7,6-7,and 6,respectively.There was no significant difference between OFC and lamotrigine,and between aripiprazole or ziprasidone and placebo in response and remission.Olanzapine monotherapy,quetiapine-IR,quetiapine-XR,aripiprazole,and ziprasidone 120-160 mg/day had significantly increased risk for DAEs with NNHs of 24,8-14,9,12,and 10,respectively.For somnolence,quetiapine-XR had the smallest NNH of 4.For ≥7%weight gain,olanzapine monotherapy and OFC had the smallest NNHs with both of 5.For akathisia,aripiprazole had the smallest NNH of 5.These findings suggest that among the FDA-approved agents including OFC,quetiapine-IR and-XR,lurasidone monotherapy and adjunctive therapy to a mood stabilizer,the differences in the NNTs for response and remission are small,but the differences in NNHs for DAEs and common side-effects are large.Therefore,the selection of an FDA-approved atypical antipsychotic for bipolar depression should be based upon safety and tolerability.
文摘Background: It is not well analyzed whether there are differences in plasma levels of tryptophan (TRP) metabolites between healthy control people (HC) and patients of type II bipolar depression (BDII). Methods: Ultra high-speed liquid chromatography/mass spectrometry has been used for the simultaneous determination of plasma levels of tryptophan metabolites in depressive patients. Results: Plasma levels of TRP are not different between HC and patients of BDII. Serotonin (5-HT) levels are higher in BDII than HC. Plasma levels of 5-HIAA of HC are higher than those of old women of BDII, but lower in young women of BDII. Plasma levels of kynurenine (KYN) of HC are not different from those of patients of BDII. Conclusion: Plasma levels of 5-HT are higher in patients of BDII than those of HC, which may suggest that use of drugs inhibiting the 5-HT transportation and lower transporter biding may increase plasma levels of 5-HT in patients of BD.
基金Acknowlegements ： The authors gratefully acknowledge the Beijing Normal University Imaging Center for Brain Research and Prof. Yufeng Zang for their contributions in MRI data acquisition. This study was supported by grants from the Beijing Municipal Science ＆ Technology Commission （Grant no. D121100005012002） , Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support （ Grant no. ZYLX201403） , the National Natural Science Foundation of China （ Grant no. 81471389 ） , the High level health technical personnel in Beijing （ Grant no. 2014 - 3-095）, the MYRG2014 - 00093 - FHS and MYRG 2015-00036- FHS grants from the University of Macao in Macao, and FDCT 026/2014/A1 and FDCT 025/ 2015/A1 grants from Macao government.
文摘Objective： Although lithium has been a commonly prescribed neurotrophic/neuroprotective mood-stabilizing agents, its effect on spontaneous brain activity in patients with bipolar depression remains unclear. The aim of this study is to reveal the basic mechanism underlying the pathological influences of lithium on resting-state brain function of bipolar depression patients. Methods：97 subjects including 9 bipolar depression patients with lithium treatment, 19 bipolar depression patients without lithium treatment and 69 healthy controls, were recruited to participate in this study. Amplitude of low-frequency fluctuation （ ALFF ） and fractional amplitude of low-frequency fluctuation （ fALFF） were used to capture the changes of spontane-ous brain activity among different groups. In addition, further analysis in terms of Hamilton Depression Rating Scale, the number of depressive episodes, and illness duration in pooled bipolar depression patients were conducted, which combined FLEF and fALEF to identify the basic neural features of bipolar depression patients. Results： It was observed from the imaging results that both the bipolar depression patients receiving lithium treatment and healthy control subjects showed signifi-cantly decreased ALFF/fALFF values in the right anterior cingulate cortex and right middle frontal gyrus compared to that from the bipolar depression patients without lithium treatmetn. The ALFF values of the right＆amp;nbsp;middle temporal gyrus was also found to be negative related to the number of depressive episode and the total episodes. Conclusions：Our findings suggested that the bipolar depression subjects were identified to have ab-normal ALFF/ fALFF in the corticolimbic systems, in-cluding regions like right anterior cingulate cortex, bilateral middle frontal gyrus, right orbital frontal gyrus, and right middle temporal gyrus. In addition, it was also revealed that the decreased ALFF/fALFF in the right anterior cingulate cortex and right middle frontal gyrus might be a biomarker that is related to the lithium effects.
文摘Objective Using graph theory analysis,this study compares the topological and node attributes of the brain network to explore the differences in gray matter structural and functional network topological properties between bipolar depression(BD)patients with and without obsessive-compulsive symptoms(OCS).Methods A total of 90 BD patients(27 males,63 females;median age 19.0(22.0,25.0)years)were recruited from the psychiatric outpatient and inpatient departments of the First Affiliated Hospital of Jinan University between March 2018 and December 2022.Fifty healthy controls(19 males,31 females;median age:23.0(20.0,27.0)years)were also enrolled.The BD patients were divided into two groups based on the presence of OCS:53 with OCS(OCS group)and 37 without OCS(NOCS group).Resting-state structural and functional MRI data were collected for all participants to construct gray matter structural and functional networks.Graph therory analysis was aapplied to calculate network topological metrics such as small-world properties.The structural and functional network topological properties were compared among the BD-OCS,BD-nOCS,and control groups.Partial correlation analysis was conducted to examine the association between network topological metrics with significant group differences and Yale-Brown Obsessive-Compulsive Scale(Y-BOCS)scores.Support vector machines(SVM)were used with these metrics as classificationfeaturevalues toimproveediagnostic accuracy through pairwise group classification.Results Structural network analysis of gray matter:compared to HC group,both OCS group and NOCS group showed increasedshortesttpathlengthand standardized characteristic path length(shortest path length:0.78 and 0.80 vs.0.69;normalized characteristic path length:0.48 and 0.49 vs.0.43),and decreased global efficiency(0.21 and 0.21 vs.0.24)compared to the HC group(permutation test,all P<0.05).Compared to NOCS and HC groups,the OCS group showed increased nodal centrality and betweenness centrality in the right rolandic operculum and left superior occipital gyrus(permutation test,all P<0.05).Functional network analysis of gray matter:compared to the NOCS group,the OCS group showed increased node efficiency and decreased betweenness centrality in the cerebellum(t=2.15,-3.04;all P<0.05);compared to HC groups,the OCS group showed decreased betweenness centrality in the cerebellum and left inferior frontal gyrus,along with increased node centrality and nodal efficiency in the right transverse temporal gyrus(t=-2.99,-3.61,3.06,3.10;all P<0.05).In the 0CS group,betweenness centrality in the left inferior frontal gyrus positively correlated with Y-BOCS scale obsessive thinking score(r=0.303,P=0.034).Nodal centrality and node efficiency of the right transverse temporal gyrus negatively correlated with Y-BOCS total score(r=-0.301,-0.311)and Y-BOCS obsessional thinking scores(r=-0.385,-0.380)separately(all P<0.05).SVM classification:the combined network features achieved an area under the curve of 0.80 in distinguising OCS from NOCS patients.Conclusion BDOCS and BD-nOCS patients both exhibit consistent changes in gray matter structural network topology,with theOCSSgroup displaying more pronounced nodal topological abnormalities.Multi-network feature integration demostrates potential for diagnostic classfication.
基金funded by the Beijing Municipal Administration of Hospitals Incubating Program(No.PZ2022032).
文摘Ojective:To explored the effectiveness and safety of acupuncture at back-shu points of five zang and Geshu(BL 17)for bipolar depression,and its mechanism from the aspect of the anti-inflammatory response.Background:Bipolar disorder is a very common,often misdiagnosed mental disorder strongly associated with comorbidity,disability,and premature mortality.Bipolar depression(ie,depressive episode in bipolar disorder)is poorly responsive to available treatments.Acupuncture at back-shu points of five zang and Geshu(BL 17),a prescription from Dr.Leting Wang,is a popular therapy for depression in China.Its effectiveness and safety for bipolar depression are yet to be verified by clinical studies.Methods:The study is a single-center,prospective,randomized controlled trial involving 72 patients diagnosed with bipolar depression.Participants will be randomized either to the study group or the control group in a 1:1 ratio.All participants will receive mood stabilizer therapy.In addition,the study group will receive acupuncture therapy at back-shu points of five zang and Geshu(BL 17),three times per week.The control group will orally take the antidepressant bupropion.Observation and intervention will last for 8 consecutive weeks.Outcome measurements include Hamilton Depression Rating Scale-17,Hamilton Anxiety Rating Scale,Clinical Global Impression Scale,Young Manic Rating Scale,Treatment Emergent Symptom Scale,serum levels of anti-inflammatory cytokines[interleukin-4(IL-40),IL-10,and transforming growth factor–β,pro-inflammatory cytokines(IL-1β,IL-6,and tumor necrosis factor–α),brain-derived neurotrophic factor,and C-reactive protein.Assessments will be conducted at baseline,first,second,fourth,and eighth weeks after randomization.Safety assessments will be performed throughout the study.Discussion:The results of this study are expected to verify the effectiveness and safety of acupuncture at back-shu points of five zang and Geshu(BL 17)for bipolar depression,and explore its therapeutic mechanisms from the point of anti-inflammation.
基金supported in part by the Key Projects of Science and Technology Research of the Department of Education in Henan Province,China,No.13A320869a special fund from Henan Health Science and Technology Innovation Talent Project,No.4173(2010-2015)
文摘OBJECTIVE： To examine the efficacy and safety of short-term and long-term use of antidepres- sants in the treatment of bipolar disorder. DATA SOURCES： A literature search of randomized, double-blind, controlled trials published until December 2012 was performed using the PubMed, ISI Web of Science, Medline and Cochrane Central Register of Controlled Trials databases. The keywords ＂bipolar disorder, bipolar I disorder, bipolar II disorder, bipolar mania, bipolar depression, cyclothymia, mixed mania and depression, rapid cycling and bipolar disorder＂, AND ＂antidepressant agent, antidepressive agents second- generation, antidepressive agents tricyclic, monoamine oxidase inhibitor, noradrenaline uptake in- hibitor, serotonin uptake inhibitor, and tricyclic antidepressant agent＂ were used. The studies that were listed in the reference list of the published papers but were not retrieved in the above-mentioned databases were supplemented. STUDY SELECTION： Studies selected were double-blind randomized controlled trials assessing the efficacy and safety of antidepressants in patients with bipolar disorder. All participants were aged 18 years or older, and were diagnosed as having primary bipolar disorder. Antidepressants or antidepressants combined with mood stabilizers were used in experimental interventions. Placebos, mood stabilizers, antipsychotics and other antide pressants were used in the control interventions. Studies that were quasi-randomized studies, or used antidepressants in combination with antipsy- chotics in the experimental group were excluded. All analyses were conducted using Review Man- ager 5.1 provided by the Cochrane Collaboration.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> It is not well analyzed whether there are differences in plasma levels of tryptophan (TRP) metabolites between healthy control people (HC) and patients of major monopolar depression (MMD). </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Ultra high-speed </span></span><span style="font-family:""><span style="font-family:Verdana;">liquid chromatography/mass spectrometry has been used for the simultaneous determination of plasma levels of tryptophan metabolites in depressive </span><span><span style="font-family:Verdana;">patients. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There are no significant differences between plasma levels of TRP between HC and MMD. Plasma levels of TRP of HC are higher in young men, young women, old men, and old women in this order. Serotonin (5-HT) levels are higher in MMD than HC. Plasma levels of 5-HIAA of HC are also higher than those of patients of MMD. Plasma levels of kynurenine (KYN) of healthy old men and old women are higher than those of young men and old women. Plasma levels of KYN are higher in old women and young men of MMD than those of HC. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Plasma levels of 5-HT are higher in patients of MMD than those of HC, which may suggest that use of drugs inhibiting the 5-HT transportation may increase plasma levels of 5-HT in MMD.
基金supported by grants from the National Natural Science Foundation of China (81171286 and 91232714)National Basic Research Development Program (973 program) of China (2013CB835100 and 2009CB918303)
文摘Bipolar disorder and unipolar depressive disorder（UD） may be different in brain structure. In the present study,we performed voxel-based morphometry（VBM） to quantify the grey matter volumes in 23 patients with bipolar I depressive disorder（BP1） and 23 patients with UD,and 23 age-,gender-,and educationmatched healthy controls（HCs） using magnetic resonance imaging. We found that compared with the HC and UD groups,the BP1 group showed reduced grey matter volumes in the right inferior frontal gyrus and middle cingulate gyrus,while the UD group showed reduced volume in the right inferior frontal gyrus compared to HCs. In addition,correlation analyses revealed that the grey matter volumes of these regions were negatively correlated with the Hamilton depression rating scores. Taken together,the results of our study suggest that decreased grey matter volume of the right inferior frontal gyrus is a common abnormality in BP1 and UD,and decreasedgrey matter volume in the right middle cingulate gyrus may be specifi c to BP1.
基金partially supported by the Beijing Municipal Administration of Hospitals Incubating Program(PX20211903 and PX2019071)Capital’s Funds for Health Improvement and Research(2024-4-2129)+1 种基金the Beijing Municipal Science&Technology Commission(Z221100007422010)the Beijing High Level Public Health Professionals Training Plan(xuekegugan-01-12).
文摘Background:The use of antidepressants in the treatment of bipolar depression remains controversial due to concerns about their potential to induce mood polarity switches.This multinational observational study aims to examine the association between the use of antidepressants and the risk of hypomanic/manic switch among bipolar depressive patients.Methods:Four electronic health record databases(IQVIA Disease Analyzer Germany,IQVIA Disease Analyzer France,IQVIA US Hospital Charge Data Master,and Beijing Anding Hospital)and one administrative claims database(IQVIA US Open Claims)were analyzed,and the study period covered from January 2013 until December 2017.Treatment patterns of patients with bipolar depression were collected.The hazard ratio(HR)was calculated by comparing the incidence of hypomanic/manic switch in patients who received antidepressants(AD group)with that in those who did not receive any antidepressant(non-AD group)in 730 days after the date of the first diagnosis of bipolar depression.Results:The analysis included a total of 122,843 patients from the 5 databases;60.6% of them received antidepressants for bipolar depression.Across the 5 data sources,the mean age at index date ranged from 37.50(15.72)to 52.10(16.22)years.After controlling potential confounders by propensity score matching,the AD group’s manic switch risk was not significantly higher than the non-AD group’s(HR 1.04[95%CI,0.96 to 1.13];P=0.989).Additionally,no statistically significant difference was observed between patients prescribed antimanic drugs and those who were not(HR 0.69[95%CI,0.38 to 1.25];P=0.535).Conclusions:This study indicated that antidepressants were widely used in clinical settings for managing bipolar depression.The use of antidepressants was not associated with the risk of mania/hypomania switch when compared to non-antidepressants treatment.Therefore,antidepressants could be considered a treatment option for bipolar depression.
文摘Objective To explore the differences of cortico-cortical functional connectivity features among patients with bipolar and unipolar depression in resting state.Methods Whole-head magnetoencephalography scan was performed in an resting state condition in 12 bipolar depression patients,27 unipolar depression patients and
基金supported by the Ministry of Science and Technology of China(2022YFA0806000)the National Natural Science Foundation of China Grants(32150005)+3 种基金the Clinical Research Operating Fund of Central High level hospitals(2022-PUMCH-E-001)the Medical and Scientific Innovation Project of the Chinese Academy of Medical Sciences(2022-12M-1-004)the Talent Program of the Chinese Academy of Medical Sciences(2022-RC310-10)Research Funds from the Health@InnoHK Program launched by the Innovation Technology Commission of the Hong Kong Special Administrative Region,and STI2030-Major Projects(2022ZD0212900).
文摘Adolescents represent a significant proportion of global psychiatric morbidity,with approximately 10%–20%affected by mental disorders,primarily including major depressive disorder(MDD),bipolar disorder(BD),and schizophrenia(SZ)[1,2].These mental disorders exhibit distinct clinical presentations compared with adult forms,including prominent somatic symptoms in MDD[3],rapid mood cycling in BD[4],and insidious onset in SZ[5].The symptom-based Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)framework faces challenges in differentiating these mental disorders because of overlapping manifestations and developmental heterogeneity[6],necessitating biologically anchored classification frameworks.
