Chantal Henry

Affective lability and affect intensity as core dimensions of bipolar disorders during euthymic period

Bipolar disorders are usually defined by alternative mood states, but a more precise characterization of the euthymic period could provide further insights into the pathophysiology of bipolar disorders. Surprisingly, few studies have investigated core affective dimensions in euthymic bipolar patients. In this study, we assessed 179 euthymic bipolar patients (score<12 on the Montgomery-Asberg Depression Scale and a score<6 on the Bech-Rafaelsen Mania Scale) compared with 86 control subjects using French versions of the Affective Lability Scale (ALS) and the Affect Intensity Measure (AIM). Data were analyzed by logistic regression. Our results showed that euthymic bipolar subjects reported having more intense emotions than controls and also had a higher affective lability. High scores in both affective dimensions were associated with a significantly higher risk for psychiatric axis I comorbidity. Moreover, a high affective lability score was associated with an earlier age of onset for bipolar disease. Affective lability and affect intensity might be two core dimensions of bipolar disorder during euthymic periods, suggesting that bipolar disorder is not circumscribed to mood episodes but also affects emotional reactivity between episodes. Both dimensions could account for the stress reactivity of bipolar patients that may lead to relapses.

Antidepressant-induced mania, rapid cycling and the serotonin transporter gene polymorphism

ABSTRACTThe genes involved in the serotonin system are major candidates in association studies on affective disorders and responses to antidepressants. We studied a functional polymorphism of the serotonin transporter (5-HTT) gene (a 44u2009bp insertion/deletion in the 5-HTT-linked polymorphic region (5-HTTLPR)) and lifetime history of antidepressant-induced mania (AIM) in a population of 305 patients with bipolar affective disorder. AIM was defined using a broad definition and a restrictive definition. No association was found between the ‘s’ allele of the 5-HTTLPR and AIM for either definition. However, we found an association between the 5-HTTLPR and lifetime history of rapid cycling in a subsample of patients (for allele and genotype distributions: exact probability, p=0.0009 and χ2=9.4; df=1; p=0.002, respectively). These results may help to explain the conflicting association results obtained with the 5-HTT gene polymorphism, in particular with AIM. Indeed, the precise phenotype associated with the 5-HTT gene is unclear. The association between the ‘s’ allele and rapid cycling may provide further evidence for an association between the 5-HTTLPR ‘s’ allele and a pattern of affective instability.

Transient neonatal elevation in hypothalamic estrogen receptor mRNA in prenatally-stressed male rats

Prenatal stress in rats has been found to alter the sexual dimorphism of brain structures and the sexual behavior of male offspring, pointing to an impaired masculinization of the brain during the perinatal period of brain sexual differentiation. Masculinization of the brain depends on the presence during this critical period of three main elements: adequate levels of testosterone, aromatase activity (locally converting testosterone to estradiol), and brain estrogen receptor (ER) density. In the present study, we measured by reverse transcription-polymerase chain reaction (RT-PCR) the levels of ER messenger RNA (mRNA) expression in the hypothalamus of either prenatally-stressed or control male rats at postnatal (P) days 3, 12 and 90. During the early postnatal period (P3), hypothalamic ER mRNA expression was higher in prenatally stressed male rats (6.12 +/- 0.37) than in controls (4.51 +/- 0.55) (P = 0.015). This difference was not, however, found at a later developmental stage (P12, 5.39 +/- 0.65 versus 5.39 +/- 0.47) or in adult animals (P90, 6.79 +/- 1.55 versus 7.07 +/- 1.11). This transient elevation of hypothalamic ER mRNA expression resembles the developmental profile of ER mRNA in females. These observations support the idea that androgens play a pivotal role in the demasculinization process, and suggest that testosterone production or aromatization is reduced in prenatally-stressed males during the perinatal period of sexual differentiation, leading to a transient upregulation of unstimulated estrogen receptors.

Intérêt de l'analyse du tempérament chez les sujets bipolaires

Resume Nous avons realise une revue de la litterature sur l’interet de l’etude des temperaments chez les sujets bipolaires, tels que decrits par Kraepelin et operationalises par Akiskal. A la lueur de ces etudes, il apparait que l’evaluation de ces temperaments permet de definir des sous-groupes de patients bipolaires caracterises par l’evolution des troubles, la comorbidite et certaines reponses aux traitements. Ainsi, les patients bipolaires presentant un temperament de base de type depressif presentent davantage d’episodes depressifs, un risque suicidaire accru et ont plus souvent une comorbidite anxieuse. Inversement, les sujets bipolaires hyperthymiques presentent plus d’etats maniaques et sont davantage susceptibles de faire un virage de l’humeur sous antidepresseurs. De plus, l’apparition d’un episode thymique de polarite opposee au temperament de base favorise l’emergence d’un etat mixte. Mais au-dela de l’etude des temperaments, il semblerait utile de mieux caracteriser la periode normothymique des patients bipolaires a travers des dimensions fondamentales.

Labilidad afectiva e intensidad del afecto como dimensiones básicas de los trastornos bipolares durante el periodo eutímico

Los trastornos bipolares suelen definirse por estados de humor alternativos, pero una caracterizacion mas precisa del periodo eutimico podria proporcionar una comprension adicional de la fisiopatologia de estos trastornos. Sorprendentemente, pocos estudios han investigado las dimensiones afectivas esenciales en pacientes bipolares eutimicos. En el presente estudio, evaluamos a 179 pacientes bipolares eutimicos (puntuacion