Jianbo Lai

Circulating T lymphocyte subsets, cytokines, and immune checkpoint inhibitors in patients with bipolar II or major depression: a preliminary study

This study aimed to investigate the less known activation pattern of T lymphocyte populations and immune checkpoint inhibitors on immunocytes in patients with bipolar II disorder depression (BD) or major depression (MD). A total of 23 patients with BD, 22 patients with MD, and 20 healthy controls (HCs) were recruited. The blood cell count of T lymphocyte subsets and the plasma level of cytokines (IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ) were selectively investigated. The expression of T-cell immunoglobulin and mucin-domain containing-3 (TIM-3), programmed cell death protein 1 (PD-1) and its ligands, PD-L1 and PD-L2, on T lymphocytes and monocytes, was detected. In results, blood proportion of cytotoxic T cells significantly decreased in BD patients than in either MD patients or HCs. The plasma level of IL-6 increased in patients with BD and MD. The expression of TIM-3 on cytotoxic T cells significantly increased, whereas the expression of PD-L2 on monocytes significantly decreased in patients with BD than in HCs. These findings extended our knowledge of the immune dysfunction in patients with affective disorders.

Efficacy of repetitive transcranial magnetic stimulation with quetiapine in treating bipolar II depression: a randomized, double-blinded, control study

The clinical and cognitive responses to repetitive transcranial magnetic stimulation (rTMS) in bipolar II depressed patients remain unclear. In this study, thirty-eight bipolar II depressed patients were randomly assigned into three groups: (i) left high-frequency (n = 12), (ii) right low-frequency (n = 13), (iii) sham stimulation (n = 13), and underwent four-week rTMS with quetiapine concomitantly. Clinical efficacy was evaluated at baseline and weekly intervals using the 17-item Hamilton Depression Rating Scale (HDRS-17) and Montgomery-Asberg Depression Rating Scale (MADRS). Cognitive functioning was assessed before and after the study with the Wisconsin Card Sorting Test (WCST), Stroop Word-Color Interference Test (Stroop), and Trail Making Test (TMT). Thirty-five patients were included in the final analysis. Overall, the mean scores of both the HDRS-17 and the MADRS significantly decreased over the 4-week trial, which did not differ among the three groups. Exploratory analyses revealed no differences in factor scores of HDRS-17s, or in response or remission rates. Scores of WCST, Stroop, or TMT did not differ across the three groups. These findings indicated active rTMS combined with quetiapine was not superior to quetiapine monotherapy in improving depressive symptoms or cognitive performance in patients with bipolar II depression.

Differing Default Mode Network Activities in Men with Homosexual or Heterosexual Preferences

INTRODUCTION Neuroimaging studies have reported differences in brain structure and function between homosexual and heterosexual men. The neural basis for homosexual orientation, however, is still unknown. AIM This study characterized the association of homosexual preference with measures of fractional amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) in the resting state. METHODS We collected echo planar magnetic resonance imaging data in 26 healthy homosexual men and 26 age-matched heterosexual men in the resting state. MAIN OUTCOME MEASURES Sexual orientation was evaluated using the Kinsey scale. We assessed group differences in fALFF and then, taking the identified group differences as seed regions, we compared groups on measures of FC from those seeds. The behavioral significance of the group differences in fALFF and FC was assessed by examining their associations with the Kinsey scores. RESULTS Compared with heterosexual participants, homosexual men showed significantly increased fALFF in the right middle frontal gyrus and right anterior cerebellum, and decreased fALFF in the left postcentral gyrus, left lingual gyrus, right pallidum, right postcentral gyrus, left interior parietal gyrus, right superior temporal gyrus, left cuneus, and left inferior frontal gyrus. Additionally, fALFF in the left postcentral gyrus and left cuneus correlated positively with Kinsey scores in the homosexual participants. When the seeds in the left cuneus, left cuneus, and left superior parietal gyrus also had reduced FC in homosexual participants, FC correlated positively with the Kinsey scores. CONCLUSIONS Differences in fALFF and FC suggest male sexual preference may influence the pattern activity in the default mode network.

Aripiprazole augmentation in managing comorbid obsessive–compulsive disorder and bipolar disorder: a case with suicidal attempts

Comorbid obsessive–compulsive disorder (OCD) and bipolar disorder (BD) have long been an intractable problem in clinical practice. The increased risk of manic/hypomanic switch hinders the use of antidepressants for managing coexisting OCD symptoms in BD patients. We herein present a case of a patient with BD–OCD comorbidity, who was successfully treated with mood stabilizers and aripiprazole augmentation. The young female patient reported recurrent depressive episodes and aggravating compulsive behaviors before hospitalization. Of note, the patient repetitively attempted suicide and reported dangerous driving because of intolerable mental sufferings. The preexisting depressive episode and OCD symptoms prompted the use of paroxetine, which consequently triggered the manic switching. Her diagnosis was revised into bipolar I disorder. Minimal response with mood stabilizers prompted the addition of aripiprazole (a daily dose of 10 mg), which helped to achieve significant remission in emotional and obsessive–compulsive symptoms. This case highlights the appealing efficacy of a small dose of aripiprazole augmentation for treating BD–OCD comorbidity. Well-designed clinical trials are warranted to verify the current findings.

Possible sertraline-induced extrapyramidal adverse effects in an adolescent.

Sertraline has been considered to be a relatively safe selective serotonin reuptake inhibitor for adolescents for a long time. We report herein a case of a 16-year-old Chinese boy with depression who experienced extrapyramidal-like effects, for example, facial spasm, upper limb dystonia, akathisia, and other disturbed behaviors, while being treated with sertraline 200 mg per day. His movement symptoms were significantly alleviated after the discontinuation of sertraline and the administration of scopolamine. This finding indicates that albeit infrequent, sertraline may cause severe extrapyramidal symptoms in adolescent patients, suggesting that clinicians should be alert to the neurological side effects of sertraline in young patients.

Reframing delusional infestation: perspectives on unresolved puzzles

Delusional infestation (DI), a debilitating psychocutaneous condition, featured as a false fixed belief of being infested accompanied by somatosensory abnormality, behavior alteration, and cognitive impairment. Although management of primary causes and pharmacotherapy with antipsychotics and/or antidepressants can help to alleviate symptoms in most patients, the underlying etiology of DI still remains unclear. Morgellons disease (MD), characterized by the presence of cutaneous filaments projected from or embedded in skin, is also a polemic issue because of its relationship with spirochetal infection. This review aims to discuss the following topics that currently confuse our understandings of DI: 1) the relationship of real/sham “infestation” with DI/MD; 2) behavior alterations, such as self-inflicted trauma; 3) neuroimaging abnormality and disturbance in neurotransmitter systems; and 4) impaired insight in patients with this disease. In discussion, we try to propose a multifactorial approach to the final diagnosis of DI/MD. Future studies exploring the neurobiological etiology of DI/MD are warranted.

Association of Genetic Polymorphisms with Age at Onset in Han Chinese Patients with Bipolar Disorder

Bipolar disorder (BD) is a chronic and disabling disorder characterized by manic, hypomanic, or depressive episodes, with an estimated lifetime prevalence ranging from 1% to 5%. Globally, it is a leading cause of disability and a socioeconomic burden. Gene-environment interactions are thought to be involved in the neurobiology of BD, with genetic factors contributing to 60%–85% of BD patients. Twin studies have shown a heritability of 59%, and an increased risk of BD has been found in first-degree relatives of probands [1]. Currently, many genes have been reported as possible risk factors for BD, including PBRM1, CACNA1C, ANK3, ODZ4, SYNE1, ITIH1, GABRB1, DAOA, NCAN, and TRANK1. Environmental factors such as maternal stress, prenatal malnutrition, preterm birth, childhood abuse, stressful life events, and cannabis use can also contribute to the development of BD. Early recognition and treatment of BD can improve treatment responses and the prognosis [2]. However, there is always a long delay from the onset of disease to a definite diagnosis. Nearly half of BD patients develop their first mood episode at puberty. Kataoka et al. have found a significant association of early disease onset in BD probands with de novo protein-altering mutations when compared with non-carriers [3]. Therefore, age at onset (AAO) may be a potential clinical marker for genetic susceptibility to BD. The relationship between risk genes for BD and AAO, however, has not been fully investigated. In this study, we aimed to explore the correlation between high-risk single-nucleotide polymorphism (SNP) loci and AAO in Chinese patients with BD. A total of 224 Han Chinese participants with BD were consecutively recruited from the First Affiliated Hospital of Zhejiang University School of Medicine from August 2011 to March 2016. The diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and further confirmed by the Structural Clinical Interview for DSM-IV. All patients were diagnosed with either type I or II BD. The exclusion criteria included prior or current comorbidity of other psychiatric diseases, alcohol or other psychoactive substance abuse, poisoning, or other physical conditions that could cause emotional lability. After a search of gene linkage analysis or genomewide association studies in databases (PubMed, EMBASE, and the Cochrane Library) up to February 2016, 35 SNP loci were screened as candidates. The genotypes were determined by the MassArray system (Agena iPLEX assay, San Diego, CA), with a 384-element SpectroCHIP gene array. Given our small sample size, the minor allele frequency of each SNP locus was required to be [ 0.05, and 26 SNP loci were finally included in the analysis. To determine the relationship between SNP loci and AAO of BD, Plink and Haploview statistical software was used and logistic regression analysis was performed. All study & Yi Xu xuyizju@zju.edu.cn

Laxative use and clinical correlates in hospitalized patients with obsessive-compulsive disorder: a retrospective descriptive study

Background Constipation is a common clinical problem with insufficient attention. Medication-emergent constipation is a rarely studied adverse reaction in patients with obsessive-compulsive disorder (OCD). Methods In this descriptive study, we retrospectively investigated the prevalence of laxative use and its relationship with clinical characteristics in hospitalized OCD patients. A total of 51 OCD patients were included in the final analysis. Results The proportion of patients using laxatives was 31.4%, and the commonly used laxatives were phenolphthalein tablet, lactulose and congrongtongbian oral liquid (a patent herbal medicine). In the laxative group, hospital stays were longer when compared to the nonlaxative group. Moreover, the dose of paroxetine was higher in patients treated with laxatives than in those without laxative use. Correlation analysis indicated that laxative use was positively associated with hospital stays, as well as the dose of paroxetine. Conclusion The current study provided a preliminary picture of constipation and laxative use in hospitalized OCD patients. Close monitoring and treatment of constipation are recommended in OCD patients with pharmacotherapy.

Cryptococcal meningitis mimicking cerebral infarction: a case report

Cryptococcal meningitis (CM) is the most common type of fungal meningitis. The clinical symptoms of CM are nonspecific, and neuroimaging characteristics are variable. Herein, we present a case of a senile female with CM that was once misdiagnosed as cerebral infarction. Her condition worsened and she developed hydrocephalus. No apparent predisposing factors of CM were reported in this patient. The diagnosis of CM was definitely made after India ink staining of cerebrospinal fluid was positive. This case indicates that clinicians should bear cryptococcal infection in mind when the symptoms are nonspecific and neuroimaging findings are atypical.

Convulsive syncope related to a small dose of quetiapine in an adolescent with bipolar disorder

Quetiapine, an atypical antipsychotic, has been extensively used in patients with bipolar disorder. Overdose of quetiapine can result in severe complications, such as coma, seizure, respiratory depression, arrhythmia, and even death. However, the paucity of toxicological evaluation in adolescence causes more potential risks in this population. Herein, we present a case of hypotension and convulsive syncope after exposure to a small dose of quetiapine in a 16-year-old who was diagnosed with bipolar disorder. After cessation of quetiapine, no additional convulsive movements were reported. This case indicates that even in young patients without predisposing factors, close monitoring of adverse effects should be warranted for safety concerns, especially at the initiation of quetiapine treatment.