Birgitte Boye

The load of short telomeres is increased and associated with lifetime number of depressive episodes in bipolar II disorder

BACKGROUND It has recently been hypothesized that bipolar disorders are associated with accelerated aging. Telomere dysfunction, a biomarker of aging, is determined by the load of short telomeres, rather than by the mean telomere length. To our knowledge, the load of short telomeres has not been reported in any psychiatric disorder. The aims of the study were to examine the load of short telomeres and the mean telomere length and their relationships with illness duration and lifetime number of depressive episodes in bipolar II disorder (BD-II). METHODS Twenty-eight patients (mean age=34.8 ± 7.7) with a DSM-IV diagnosis of BD-II and 28 healthy control subjects (mean age=34.8 ± 9.2) matched for age, sex, and education participated. The load of short telomeres (percentage of telomeres <3 kilobases) and mean telomere length in peripheral blood mononuclear cells were measured using high-throughput quantitative fluorescence in situ hybridization. RESULTS The load of short telomeres was significantly increased in patients with BD-II relative to healthy controls and may represent 13 years of accelerated aging. The load of short telomeres and the mean telomere length were associated with lifetime number of depressive episodes, but not with illness duration. LIMITATIONS Modest sample size and cross-sectional design. CONCLUSIONS Our results suggest that BD-II is associated with an increased load of short telomeres. Depressive episode-related stress may accelerate telomere shortening and aging. However, longitudinal studies are needed to fully clarify telomere shortening and its relationship with clinical variables in BD-II.

INSPIRE study: Does stress management improve the course of inflammatory bowel disease and disease‐specific quality of life in distressed patients with ulcerative colitis or crohn's disease? A randomized controlled trial

Background: The use of stress management psychotherapy is hypothesized to produce greater improvement in disease course and disease‐specific quality of life (IBDQ) compared to usual medical care alone in patients with ulcerative colitis (UC) or Crohns disease (CD) showing high levels of stress (based on the Perceived Stress Questionnaire [PSQ]). Methods: Fifty‐eight patients with UC and 56 patients with CD who had experienced continuous disease activity or had relapsed over the previous 18 months, with an activity index for UC or CD ≥4, a PSQ ≥60, and without serious psychiatric disorders or other serious medical conditions were randomized to receive either treatment as usual (TAU) or TAU plus stress management psychotherapy. Psychotherapy consisted of three group sessions (psychoeducation, problem‐solving, relaxation) and 6–9 individual sessions based on cognitive behavior therapy‐related methods with 1–3 booster sessions at 6 and 12 months follow‐up. Gastroenterologists blinded to intervention group assessed disease activity and course at baseline and at 3, 6, 12, and 18 months. Patients completed the IBDQ at baseline, 6, 12, and 18 months. Results: The intervention did not improve disease or reduce relapse; however, it increased the IBDQ score (P = 0.009, mean differences 16.3 [SD 6.1]). On analysis of UC and CD separately, improvement of IBDQ was only found in the UC group. Conclusions: Stress management psychotherapy does not appear to improve disease course or reduce relapse in patients with IBD. It might improve quality of life, particularly in patients with UC. (Inflamm Bowel Dis 2011;)

Absence of somatization in non-coeliac gluten sensitivity

Abstract Objective. In contrast to coeliac disease (CD), the mechanism behind non-coeliac gluten sensitivity (NCGS) is unclear. The aims of the study were to measure the presence of somatization, personality traits, anxiety, depression, and health-related quality of life in NCGS individuals compared with CD patients and healthy controls, and to compare the response to gluten challenge between NCGS and CD patients. Material and methods. We examined 22 CD patients and 31 HLA-DQ2+ NCGS patients without CD, all on a gluten-free diet. All but five CD patients were challenged orally for 3 days with gluten; symptom registration was performed during challenge. A comparison group of 40 healthy controls was included. Patients and healthy controls completed questionnaires regarding anxiety, depression, neuroticism and lie, hostility and aggression, alexithymia and health locus of control, physical complaints, and health-related quality of life. Results. The NCGS patients reported more abdominal (p = 0.01) and non-abdominal (p < 0.01) symptoms after gluten challenge than CD patients. There were no significant differences between CD and NCGS patients regarding personality traits, level of somatization, quality of life, anxiety, and depressive symptoms. The somatization level was low in CD and NCGS groups. Symptom increase after gluten challenge was not related to personality in NCGS patients. Conclusions. NCGS patients did not exhibit a tendency for general somatization. Personality and quality of life did not differ between NCGS and CD patients, and were mostly at the same level as in healthy controls. NCGS patients reported more symptoms than CD patients after gluten challenge.

The INSPIRE study: Are different personality traits related to disease‐specific quality of life (IBDQ) in distressed patients with ulcerative colitis and Crohn's disease?

Background: To explore the relationship between personality and disease‐specific quality of life [Inflammatory Bowel Disease Questionnaire (IBDQ)] in distressed [Perceived Stress Questionnaire (PSQ)] patients with ulcerative colitis (UC) and Crohns disease (CD). Methods: Included in the study were 56 patients with UC and 54 patients with CD ranging in age from 18 to 60 years with a relapse in the previous 18 months, a UC or CD activity index ≥ 4, a PSQ ≥ 60, and without serious mental or other serious medical condition. The patients completed the Buss‐Perry Aggression Questionnaire, the Neuroticism and Lie (social conformity/desirability) scales of the Eysenck Personality Questionnaire, the Multidimensional Health Locus of Control (LOC) Scale [Internal (I), Powerful Other (PO), Chance (C)], the Toronto Alexithymia Scale, and the IBDQ. Results: In linear regression controlling for sex, education (years), and clinical disease activity (AI) in separate analyses of UC and CD patients, higher IBDQ score was related to less social conformity in CD and less neuroticism in UC; higher emotional function score was related to less neuroticism in both CD and UC and less PO‐LOC in UC. Higher social function score was related to less social conformity in CD and lower I‐LOC and PO‐LOC in UC. Bowel function and systemic symptoms were unrelated to personality in either UC or CD. Conclusions: Although the emotional function subscale was related to neuroticism in both UC and CD, the social function subscale and total IBDQ were related to different personality traits in UC and CD. Personality traits should be taken into account when using IBDQ in studies.

The INSPIRE study: do personality traits predict general quality of life (Short form-36) in distressed patients with ulcerative colitis and Crohn's disease?

Objective. To assess the role of personality as a predictor of Short form-36 (SF-36) in distressed patients (perceived stress questionnaire, PSQ) with ulcerative colitis (UC) and Crohns disease (CD). Material and methods. Fifty-four patients with CD and 55 with UC (age 18–60 years) who had relapsed in the previous 18 months, i.e. with an activity index (AI) for UC or CD≥4, PSQ≥60, and without severe mental or other major medical conditions, completed the Buss-Perry Aggression Questionnaire (BPA), the Neuroticism and Lie scales of the Eysenck Personality Questionnaire (EPQ-N and -L), the Multidimensional Health Locus of Control Scale (LOC) (Internal (I), Powerful Other (PO), Chance (C)), the Toronto Alexithymia Scale (TAS) and the SF-36. Results. Multiple linear regression analyses controlling for gender, age and clinical disease activity (AI) in separate analyses for UC and CD showed that the mental and vitality subscales were predicted by neuroticism in both UC and CD. The highest explained variance was 43.8% on the “mental” subscale in UC. The social function subscale was related to alexithymia only in UC, while the role limitation and pain subscales were related to personality in CD only. The physical function subscale related differently to personality in UC and CD. Conclusions. While mental and vitality subscales were predicted by neuroticism in both UC and CD, other subscales had different relationships to personality, suggesting different psychobiological interactions in UC and CD.

Bipolar II disorder is associated with thinning of prefrontal and temporal cortices involved in affect regulation.

The neurobiological substrate of bipolar II disorder (BD‐II) remains largely unknown. A few previous studies have found evidence for cerebral cortical thinning in mixed samples of BD‐II and bipolar I disorder patients; however, no study of cortical thickness or surface area has been limited to BD‐II. In the present study, we compared magnetic resonance imaging (MRI)‐based indices of cortical thickness and surface area between individuals with BD‐II and healthy controls.

Evidence for Impaired Neocortical Synaptic Plasticity in Bipolar II Disorder

BACKGROUND Synaptic plasticity might play an important role in the pathophysiology and treatment of bipolar disorders. There is, however, a paucity of human evidence supporting this hypothesis, mainly due to a lack of methods for noninvasive assessment of synaptic plasticity. It has recently been demonstrated that plasticity of the visual evoked potential (VEP) induced by repeated visual stimulation might reflect synaptic plasticity. In this study, we examined VEP plasticity in healthy control subjects and patients with bipolar II disorder (BD-II). METHODS Forty healthy control subjects and 26 individuals with a DSM-IV diagnosis of BD-II matched for age and gender participated. The VEPs were evoked by checkerboard reversal stimulation before and after a modulation block of prolonged (10 min) visual stimulation. RESULTS The modulation block resulted in significant VEP plasticity in healthy control subjects. The VEP plasticity was significantly impaired in patients with BD-II. Explorative analyses indicated a trend toward a less severe impairment in medicated than in unmedicated patients. CONCLUSIONS Visual evoked potential plasticity might represent a reliable and robust assay for studies of synaptic plasticity in vivo in humans. In addition, our findings support the hypothesis of impaired synaptic plasticity in BD-II. Longitudinal studies are needed to fully clarify the effects of medication and mood state on VEP plasticity.

Different impulsivity profiles in borderline personality disorder and bipolar II disorder

INTRODUCTION Borderline personality disorder (BPD) and bipolar II disorder (BP II) share clinical characteristics including impulsivity. Their relationship is disputed. In this study, we investigated self-reported impulsivity in these patient groups and in a healthy control group. Effects of current mood state and of traumatic childhood experiences were explored. METHODS Twenty-five patients with BPD without comorbid bipolar disorder; 20 patients with BP II without comorbid BPD; and 44 healthy control subjects completed the UPPS questionnaire which yields assessments of four components of impulsivity: Urgency, Lack of Premeditation, Lack of Perseverance, and Sensation Seeking. Current mood state was rated using the Montgomery Asberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS). Traumatic childhood experiences were assessed using the Childhood Trauma Questionnaire (CTQ). Group differences in UPPS levels; and effects of mood state and CTQ score on UPPS scores in patients were investigated. RESULTS BPD patients showed significantly higher levels of Urgency and Lack of Perseverance than BP II patients and controls, and a significantly higher level of Lack of Premeditation than controls. BP II patients showed higher levels of Urgency and Lack of Perseverance than controls. In BP II, higher MADRS scores were associated with higher impulsivity scores. Also, higher CTQ scores were associated with higher Urgency scores in BP II. LIMITATIONS Relatively small sample size; cross-sectional assessment of influence of mood state. CONCLUSIONS BPD patients exhibited markedly elevated UPPS impulsivity scores compared with healthy controls and BP II patients, and the elevations were not related to current mood state. BP II patients showed moderately elevated impulsivity scores which were associated with a depressed mood state and to some extent with a history of childhood trauma. The findings suggest that BPD and BP II have different impulsivity profiles.

Evidence for reduced dentate gyrus and fimbria volume in bipolar II disorder.

Objectives:  Dentate gyrus (DG)‐dependent inhibition of the stress response might play an important role in mood disorders. During stress, hippocampal projections traversing the fimbria, a white matter bundle on the hippocampal surface, inhibit the hypothalamic–pituitary–adrenal (HPA) axis. The aim of the present study was to measure the volumes of the DG–cornu ammonis 4 (DG–CA4) and fimbria in patients with bipolar II disorder (BD‐II) and healthy controls using a recently developed magnetic resonance imaging (MRI)‐based technique.

Relatives’ emotional warmth towards patients with schizophrenia or related psychoses: demographic and clinical predictors

Despite the importance of relatives’ emotional warmth for outcome in schizophrenia, no studies to date have addressed demographic and clinical predictors of warmth. We examined a Norwegian sample of 47 recently hospitalized patients (with schizophrenia or schizophreniform disorder) and 72 key relatives. Relatives’ emotional warmth was assessed by means of the Camberwell Family Interview. Regression analyses showed that no substance abuse (especially amphetamines), better premorbid adjustment (12–15 years), a chronic social security status, and the relative not being a parent were the strongest predictors of emotional warmth. Emotional warmth was not related to patients’ symptoms.