Ji Hyun Baek

Toward interaction of affective and cognitive contributors to creativity in bipolar disorders: A controlled study

BACKGROUND Enhanced creativity in bipolar disorder patients may be related to affective and cognitive phenomena. METHODS 32 bipolar disorder patients (BP), 21 unipolar major depressive disorder patients (MDD), 22 creative controls (CC), and 42 healthy controls (HC) (all euthymic) completed the Revised Neuroticism Extraversion Openness Personality Inventory (NEO), the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), the Myers-Briggs Type Inventory (MBTI); the Barron-Welsh Art Scale (BWAS), the Adjective Check List Creative Personality Scale, and the Figural and Verbal Torrance Tests of Creative Thinking. Mean scores were compared across groups, and relationships between temperament/personality and creativity were assessed with bivariate correlation and hierarchical multiple linear regression. RESULTS BP and CC (but not MDD) compared to HC had higher BWAS-Total (46% and 42% higher, respectively, p<0.05) and BWAS-Dislike (83% and 93% higher, p<0.02) scores, and higher MBTI-Intuition preference type rates (78% vs. 50% and 96% vs. 50%, p<0.05). BP, MDD, and CC, compared to HC, had increased TEMPS-A-Cyclothymia scores (666%, 451% and 434% higher, respectively, p<0.0001), and NEO-Neuroticism scores (60%, 57% and 51% higher, p<0.0001). NEO-Neuroticism and TEMPS-A Cyclothymia correlated with BWAS-Dislike (and BWAS-Total), while MBTI-Intuition continuous scores and NEO-Openness correlated with BWAS-Like (and BWAS-Total). LIMITATIONS Relatively small sample size. CONCLUSIONS We replicate the role of cyclothymic and related temperaments in creativity, as well as that of intuitive processes. Further studies are needed to clarify relationships between creativity and affective and cognitive processes in bipolar disorder patients.

Serum lipids, recent suicide attempt and recent suicide status in patients with major depressive disorder.

OBJECTIVE Major depressive disorder (MDD) is associated with suicide. Although several studies have reported its association with low serum lipid, few studies have investigated relationships between current suicidality and lipid profiles, comparing with other blood measures in MDD patients. METHODS The study population consisted of 555 subjects with MDD who were ≥ 18 years old, evaluated by the Mini International Neuropsychiatric Interview (MINI) with the suicidality module. At the evaluation visit, we measured serum lipid profiles including total cholesterol, triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and very low-density lipoprotein (VLDL), and blood measures such as fasting glucose, total protein, albumin, blood urea nitrogen, creatinine, thyroid hormones, red and white blood cells, platelet count, hemoglobin, and hematocrit. RESULTS Recent attempters who had attempted suicide within the past month showed significantly lower TG and higher HDL levels than lifetime and never attempters, using Tukeys post-hoc analysis. Recent attempters exhibited lower TG and higher HDL than those with recent suicide ideation and wish to self-harm and those without previous attempt. Linear regression analysis revealed that TG was negatively associated with current suicidality scores (β = -0.187, p = 0.039), whereas VLDL was positively associated with the recent suicide status (β = 0.198, p = 0.032) after controlling for age and sex. There were no significant differences between the groups in terms of other serum lipid profiles and blood measures. CONCLUSIONS Low serum TG, high HDL and VLDL levels are associated with recent suicide attempt or recent suicide status in patients with MDD.

Association of seasonality and premenstrual symptoms in Bipolar I and Bipolar II disorders

BACKGROUND Although seasonal affective disorder and premenstrual syndrome (PMS) are frequently observed in mood disorders, little is known as to whether lifetime traits of seasonality and premenstrual distress are related to bipolar disorder independent of mood episodes. This study aimed at investigating these two cyclic traits with respect to bipolar I and II disorders as well as evaluating the association between them. METHODS Subjects included 61 female patients with bipolar I or II disorders and 122 healthy women. Seasonality and premenstrual symptoms were measured retrospectively on a lifetime basis using the Seasonal Pattern Assessment Questionnaire (SPAQ) and the Premenstrual Symptoms Screening Tool (PSST). RESULTS Patients showed higher global seasonality scores on the SPAQ compared to the normal controls. Further, the patient-control difference was more prominent in cases of bipolar II disorder (p<0.0001) than in bipolar I disorder (p=0.001). The prevalence of moderate to severe PMS as indicated on the PSST was also significantly higher in bipolar II disorder patients (51.6%) as compared to controls (19.7%). A significant association between seasonality and PMS was observed in both patient and control groups. CONCLUSIONS The results suggested that female patients with bipolar disorder experience seasonal and premenstrual changes in mood and behavior regardless of their mood episodes, and traits of seasonality and PMS are associated with each other. A common biological mechanism of these two cyclic conditions may be involved in the development of the cyclicity of bipolar disorder.

Lifetime Characteristics of Evening-Preference and Irregular Bed-Rise Time Are Associated With Lifetime Seasonal Variation of Mood and Behavior: Comparison Between Individuals With Bipolar Disorder and Healthy Controls

Sleep–wake cycle disruption and seasonal variation in mood and behavior have been associated with mood disorders. This study aimed to investigate the lifetime characteristics of the sleep–wake cycle and its association with the lifetime characteristics of seasonality in individuals with bipolar disorder. Circadian preference, regularity of bed–rise time, and seasonality were evaluated on a lifetime basis using the Composite Scale of Morningness, the Sleep Timing Questionnaire, and the Seasonal Pattern Assessment Questionnaire in clinically stable individuals with bipolar I/II disorders (n = 103/97) and healthy controls (n = 270). Bipolar groups were more likely to have evening preference and irregular bed–rise time. These characteristics were interrelated and, particularly, more prevalent in bipolar II disorder. Seasonality, which was also more prevalent in the bipolar groups, was associated with evening preference and irregularity of the weekday bed–rise time.

Tardive Dyskinesia and Tardive Dystonia With Second-Generation Antipsychotics in Non-Elderly Schizophrenic Patients Unexposed to First-Generation Antipsychotics: A Cross-Sectional and Retrospective Study

Abstract This study investigates the clinical nature, prevalence rates, and associated factors of second-generation antipsychotic (SGA)–related tardive dyskinesia and tardive dystonia. To date, these subjects have not been thoroughly investigated. The subjects were 80 non-elderly schizophrenic patients who received SGAs for more than 1 year without any previous exposure to first-generation antipsychotics. Multiple (≥2) direct assessments of movement symptoms were performed. Hospital records longer than 1 recent year describing any observed tardive movement symptoms were reviewed. A current or history of tardive dyskinesia and/or tardive dystonia associated with SGA was identified in 28 (35%) subjects. These patients were being treated with risperidone (n = 15), amisulpride, olanzapine, aripiprazole, ziprasidone, or clozapine at the time of the onset of the movement symptoms. Tardive dyskinesia was mostly in the orolingual area, and the most frequently observed tardive dystonia was torticollis. The median interval between the first exposure to the SGA and the movement syndrome onset was 15 months for tardive dyskinesia and 43 months for tardive dystonia. A history of acute dystonia was significantly associated with tardive dystonia, and comorbid obsessive-compulsive syndrome was related to both tardive movement syndromes. This study indicates that more clinical attention and research efforts are needed regarding SGA-associated tardive movement syndromes, including a larger-scale prevalence assessment. This study is the first to indicate that a comorbid obsessive-compulsive syndrome might be an associated factor of tardive movement syndrome. The association warrants further investigation.

Lithium tremor revisited: pathophysiology and treatment.

Tremor occurs frequently as a side‐effect of lithium, and it is, however, easily overlooked in the clinical setting. In this article, we attempt to review the pathophysiology and the clinical approach of lithium tremor.

Smoking and suicidality in subjects with major depressive disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

BACKGROUND Detailed characteristics of depressive smokers and its association with suicidality were still less investigated. The aim of this study was to delineate characteristics of smokers with major depressive disorder (MDD) and examine the relationship between these characteristics and suicidality using an epidemiologic database, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). METHODS A total of 5695 subjects with MDD, defined by the DSM-IV criteria, were included in our analysis. Current smokers, former smokers, and lifetime nonsmokers were compared in terms of demographic, clinical characteristics, and functional level. Suicidality, evaluated by history of suicide ideation and attempts while in a low mood was evaluated and compared among the groups. RESULTS Current smokers with MDD showed a greater number of DSM-IV symptoms while in acute episodes, a higher rate of alcohol and drug-use disorders, and poorer functional levels than nonsmokers. Previous smokers displayed intermediate characteristics between current smokers and nonsmokers. The logistic regression analysis revealed that both current and former smoking status predicted the risk of having a history of attempted suicide (current smokers: odds ratio 1.62, 95% C.I. 1.42-1.86; former smokers: odds ratio 1.37, 95% C.I. 1.13-1.66) after adjusting for demographic data, a history of subthreshold hypomania, and a lifetime axis II/anxiety/alcohol use/substance-use disorder. LIMITATIONS Retrospective, cross-sectional evaluation; suicidality assessed only in the most severe depressive episode. CONCLUSIONS The present study corroborates that smokers with MDD showed distinct clinical characteristics, and cigarette smoking can predict attempted suicide in a community representative sample of people with MDD.

Anxiety symptoms are linked to new-onset suicidal ideation after six months of follow-up in outpatients with major depressive disorder

BACKGROUND Suicide risk evaluation is one of the most challenging assessments of patients with major depressive disorder (MDD). Initial risk evaluation might be insufficient in predicting emergence of suicidal ideation during the maintenance period. We aimed to elucidate factors associated with emergence or persistence of suicidal ideation 6 months after initiation of outpatient treatment in patients with MDD. METHODS A total of 300 participants with MDD defined by DSM-IV-TR criteria underwent face-to-face interview at baseline and follow-up phone interview at 6 months later. Severity of depression, suicidal ideation, and anxiety were evaluated. RESULTS Among participants who did not report any suicidal idea at baseline, 10.9% reported suicidal ideation during the 6-month phone interview, while 28.4% of participants who reported suicidal ideation at baseline reported suicidal ideation during the phone interview. No significant difference in remission rate of depression was observed between the groups, but subjects without suicidal ideation at baseline had a higher rate of symptom improvement at the 6-month phone interview. After controlling for age, sex, baseline severity of suicide risk and depression and lifetime history of suicide attempts, emergence of suicidal ideation was significantly associated with anxiety level at baseline (t=2.127, p=0.039) and severity of depression symptoms at 6 month (t=-3.028, p=0.004); persistence of suicidal ideation was associated with severity of depression symptoms at 6 month (t=-4.962, p<0.001). LIMITATION Follow-up evaluation was done by phone interview. CONCLUSION Anxiety at baseline needs to be carefully evaluated in assessing suicide risk of patients with MDD.

One-carbon metabolism and bipolar disorder

Objective: Folate is one of the most widely used nutraceuticals for the treatment of mood disorders. In this article, we review folate metabolism, its relationship with bipolar disorder, and its therapeutic potential. Methods: We searched PubMed and the Cochrane Library for relevant articles up to and including the year 2012. Background information, proposed mechanisms of action, and results from clinical trials were reviewed. Results: Folate is an essential cofactor involved in methylation reactions, which are critical for monoamine synthesis and homocysteine regulation. Folate level is thought to be associated with mood disorders and limited response to antidepressants. Functional deficiency, due to a common genetic variant of the methylenetetrahydrofolate reductase (NAD(P)H) (MTHFR) gene, could also affect the presentation of bipolar disorder. Sodium valproate and lamotrigine, commonly used mood stabilizers for the treatment of bipolar disorder, can potentially interfere with folate and homocysteine metabolism. Previous studies consistently support the efficacy of folate in the treatment of depression; one study showed efficacy in the treatment of mania. Biologically active forms of folate formulations, which do not require biochemical conversion, could be beneficial in the treatment of bipolar disorder. Conclusions: Folate augmentation could be effective for the treatment of bipolar disorder. A common genetic variant of the MTHFR gene might impact the treatment effect of folate augmentation. The biologically active form of folate could potentially correct mood stabilizer-associated functional folate deficiency, help normalize monoamine synthesis, and improve outcomes.

Association between ST8SIA2 and the Risk of Schizophrenia and Bipolar I Disorder across Diagnostic Boundaries.

Background Findings from family studies and recent genome-wide association studies have indicated overlap in the risk genes between schizophrenia and bipolar disorder (BD). After finding a linkage between the ST8SIA2 (ST8 alpha-N-acetyl-neuraminide alpha-2, 8-sicalyltransferase 2 gene) locus (15q26) and mixed families with schizophrenia and BD, several studies have reported a significant association between this gene and schizophrenia or BD. We investigated the genetic association between ST8SIA2 and both schizophrenia and BD in the Korean population. Methods A total of 582 patients with schizophrenia, 339 patients with BD, and 502 healthy controls were included. Thirty-one tag single nucleotide polymorphisms (SNPs) across the ST8SIA2 region and three other SNPs showing significant associations in previous studies were genotyped. The associations were evaluated by logistic regression analysis using additive, dominant, and recessive genetic models. Results Fourteen of 34 SNPs showed a nominally significant association (p < 0.05) with at least one diagnostic group. These association trends were strongest for the schizophrenia and combined schizophrenia and bipolar I disorder (BD-I) groups. The strongest association was observed in rs11637898 for schizophrenia (p = 0.0033) and BD-I (p = 0.0050) under the dominant model. The association between rs11637898 and the combined schizophrenia and BD-I group (p = 0.0006, under the dominant model) remained significant after correcting for multiple testing. Discussion We identified a possible role of ST8SIA2 in the common susceptibility of schizophrenia and BD-I. However, no association trend was observed for bipolar II disorder. Further efforts are needed to identify a specific phenotype associated with this gene crossing the current diagnostic categories.