Ramiro de Freitas Xavier Reckziegel

Verbal episodic memory along the course of schizophrenia and bipolar disorder: A new perspective

Impairment on episodic memory (EM) has been strongly correlated with psychiatric disorders, including schizophrenia (SZ) and bipolar disorder (BD). Morevover, the effects of course and progression of the illness on cognitive functioning have not been well established. The aim of the present study is to assess performance of episodic memory in BD and SZ according to their clinical stages. Subjects who met DSM-IV criteria for bipolar disorder (n=43) and schizophrenia (31), on euthymia or clinical remission, were recruited from the outpatients facilities at Hospital de Clínicas de Porto Alegre (Brazil). They were classified into two clinical stages (early or late for BD, and recent onset or chronic for SZ) and compared to 54 healthy controls. Episodic memory performance was assessed by means the Hopkins Verbal Learning Test-Revised (HVLT-R) that measures verbal learning and episodic memory in both disorders. Our results showed that patients in early stage of BD (EBD) performed better performance on the total immediate free recall (p<0.0001, F=12.060) as well as in delayed free recall (p<0.0001, F=13.914) compared to late stage (LBD) and SZ groups. In the ability to retain words learned, LBD and chronic (CSZ) were more impaired than other groups. Furthermore, the variation of learning (i.e, learning effects) along the 3 trials of immediate free recall was similar between groups. In conclusion, we found a cognitive decline alongside with the progression of BD whereas such impairment was evident in the early of SZ. Despite this, both groups (BD and SZ) seem to maintain the ability to learn. It emphasizes the relevance of studying new therapeutic strategies, in particular, cognitive rehabilitation/remediation techniques as promissory treatment for psychiatric patients, even in those with moderate disabilities.

Elevated serum protein oxidative stress in siblings of patients with schizophrenia.

Fig. 1. (A) Serum levels of protein carbonyl content (PCC), (B) Thiobarbituric acid-reactive substance (TBARS) levels and (C) glutathione peroxidase (GPx) in siblings of patients with schizophrenia comparedwith healthy controls. Horizontal lines indicate median in (A) and (B). In (C) thehorizontal line indicates themean. Data points show individual values. Statistical significance is given by the indicated p value. A and B were analyzed using Mann– Whitney test. C was analyzed using t-test. Elevated serum protein oxidative stress in siblings of patients with schizophrenia

Daytime sleepiness, sleep disturbance and functioning impairment in bipolar disorder

Objective To verify the prevalence and clinical impact of excessive daytime sleepiness (EDS) in outpatients with bipolar disorder. Methods Eighty‐one outpatients with bipolar disorder and 79 healthy control subjects were recruited. Patients were required not to be acutely manic or depressed. We used the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index and the Functioning Assessment Short Test to assess sleepiness, sleep problems and functioning, respectively. Results Patients had a higher prevalence of sleepiness (40%) than the control group (18%). Sleepiness and sleep disturbance had independent impacts on disability in the multivariable model. Conclusions This study suggests that EDS is a relevant clinical dimension in patients with bipolar disorder. It is a frequent symptom that often overlaps with other sleep disturbances. This study also reveals that once present it has the potential to increase functional impairment.

Cardiovascular risk and bipolar disorder: factors associated with a positive coronary calcium score in patients with bipolar disorder type 1

Objective: Cardiovascular disease is the leading cause of death in patients with bipolar disorder. The aim of this study was to evaluate the factors associated with positive coronary calcium score (CCS) in individuals with bipolar disorder type 1. Methods: Patients from the Bipolar Disorder Program at Hospital de Clínicas de Porto Alegre, Brazil, underwent computed tomography scanning for calcium score measurement. Clinical and sociodemographic variables were compared between patients according to their CCS status: negative (CCS = 0) or positive (CCS > 0). Poisson regression analysis was used to examine the association of CCS with number of psychiatric hospitalizations. Results: Out of 41 patients evaluated, only 10 had a positive CCS. Individuals in the CCS-positive group were older (55.2±4.2 vs. 43.1±10.0 years; p = 0.001) and had more psychiatric hospitalizations (4.7±3.0 vs. 2.6±2.5; p = 0.04) when compared with CCS- negative subjects. The number of previous psychiatric hospitalizations correlated positively with CCS (p < 0.001). Conclusion: Age and number of psychiatric hospitalizations were significantly associated with higher CCS, which might be a potential method for diagnosis and stratification of cardiovascular disease in bipolar patients. There is a need for increased awareness of risk assessment in this population.

F174. OBESITY AND BRAIN INTEGRITY IN SCHIZOPHRENIA AND BIPOLAR DISORDER: DIVERGENT PATTERNS OF WHITE MATTER MICROSTRUCTURE DAMAGE IN A TRANSDIAGNOSTIC APPROACH

Abstract Background Obesity is associated with both structural and functional changes of the central nervous system, and is frequent in psychiatry settings. The increased prevalence of obesity in schizophrenia (SCZ) and bipolar disorder (BD) is associated with illness severity, functioning impairment and cognitive deficits. It cannot be attributed to biases inherent in treatment-seeking samples, given that this association is detectable even in drug-naïve patients. Diffusion tensor imaging (DTI) analyses of major brain fibers in both disorders show shared abnormalities of white matter. DTI has been employed as a highly sensitive tool to investigate microstructural changes in white matter structure. While gray matter alterations in obesity point to a consistent reduction with increasing body mass index (BMI), volumetric changes in white matter are more complex and less conclusive. Fractional anisotropy (FA) is the most commonly used parameter as it is the best estimate of fiber integrity as well as axonal and myelin degeneration, and has been reported an association with BMI in depressed BD patients, but not explored in SCZ nor in comparison with a control group (CTR). The aim of this study was to analyze the relationship between obesity and brain alterations assessed by DTI in SCZ, BD and CTR. Methods In one-hundred fifty (N=150) individuals (SCZ:49; BD:35; CTR:66) were administered clinical rating scales, collected sociodemographic data and submitted to magnetic resonance imaging (MRI) acquisition in a 1.5 T machine. Linear regression models were performed independently for each group in order to test the relationship of BMI on each brain fiber FA, using gender, age and years of disease for the patients as covariates. Results The mean BMI was different among groups (F(143)6.533; P= .002), higher in BD group (BD 29.69 ± 6.55; CTR: 25.54 ± 4.25; SCZ: 26.42 ± 6.02). In BD, the model that predicted FA in the left cingulate gyrus endings was significant controlling for covariates (F(4,21)= 3.273; p = .031; Adj. R2= .384), with a main effect of BMI (t=-2.870; p= .009; β=- .531). For SCZ and CTR groups, we did not find significant models to predict brain fiber FAs from BMI controlling for covariates. Discussion BMI was associated with reduced FA in cingulate gyrus in BD, implying that obesity may play a role in microstructure damage in the limbic system. These findings are in consonance with the literature and may be related with processing of emotional and cognitive responses disrupted in BD. Conversely, it did not predicted FA in SCZ or CTR connection bundles, possibly because of the lower BMI levels in these groups. Also, we were not able to control for treatment adherence, a variable correlated with both white matter integrity and weight gain. At last, obesity appears to be correlated with white matter microstructure in a heterogeneous and disease specific course depending on the underlying psychopathology, showing association with impairment in BD but not SCZ and CTR. Further studies are needed to explore the role of treatment in the interpretation of these findings.

Volumetric brain magnetic resonance imaging predicts functioning in bipolar disorder: A machine learning approach

Neuroimaging studies have been steadily explored in Bipolar Disorder (BD) in the last decades. Neuroanatomical changes tend to be more pronounced in patients with repeated episodes. Although the role of such changes in cognition and memory is well established, daily-life functioning impairments bulge among the consequences of the proposed progression. The objective of this study was to analyze MRI volumetric modifications in BD and healthy controls (HC) as possible predictors of daily-life functioning through a machine learning approach. Ninety-four participants (35 DSM-IV BD type I and 59 HC) underwent clinical and functioning assessments, and structural MRI. Functioning was assessed using the Functioning Assessment Short Test (FAST). The machine learning analysis was used to identify possible candidates of regional brain volumes that could predict functioning status, through a support vector regression algorithm. Patients with BD and HC did not differ in age, education and marital status. There were significant differences between groups in gender, BMI, FAST score, and employment status. There was significant correlation between observed and predicted FAST score for patients with BD, but not for controls. According to the model, the brain structures volumes that could predict FAST scores were: left superior frontal cortex, left rostral medial frontal cortex, right white matter total volume and right lateral ventricle volume. The machine learning approach demonstrated that brain volume changes in MRI were predictors of FAST score in patients with BD and could identify specific brain areas related to functioning impairment.