Yangbo Guo

Neuropsychological performance in bipolar I, bipolar II and unipolar depression patients: a longitudinal, naturalistic study.

BACKGROUND It has been suggested that cognitive deficits existed in mood disorders. Nevertheless, whether neuropsychological profiles differ three main subtypes of mood disorder (Bipolar I, Bipolar II and UP) remain understudied because most current studies include either mixed samples of bipolar I and bipolar II patients or mixed samples of different states of the illness. The main aim of the present study is to determine whether, or to some extent, specific cognitive domains could differentiate the main subtypes of mood disorders in the depressed and clinically remitted status. METHOD Three groups of bipolar I (n=92), bipolar II (n=131) and unipolar depression (UP) patients (n=293) were tested with a battery of neuropsychological tests both at baseline (during a depressive episode) and after 6 weeks of treatment, contrasting with 202 healthy controls on cognitive performance. The cognitive domains include processing speed, attention, memory, verbal fluency and executive function. RESULTS At the acute depressive state, the three patient groups (bipolar I, bipolar II and UP) showed cognitive dysfunction in processing speed, memory, verbal fluency and executive function but not in attention compared with controls. Post comparisons revealed that bipolar I depressed patients performed significantly worse in verbal fluency and executive function than bipolar II and UP depressed patients. No difference was found between bipolar II and UP depressed patients except for the visual memory. After 6 weeks of treatment, clinically remitted bipolar I and bipolar II patients only displayed cognitive impairment in processing speed and visual memory. Remitted UP patients showed cognitive impairment in executive function in addition to processing speed and visual memory. The three remitted patient groups scored similarly in processing speed and visual memory. LIMITATION Clinically remitted patients were just recovered from a major depressive episode after 6 weeks of treatment and in relatively unstable state. CONCLUSION Bipolar I, bipolar II and UP patients have a similar pattern of cognitive impairment during the state of acute depressive episode, but bipolar I patients experience greater impairment than bipolar II and UP patients. In clinical remission, both bipolar and UP patients show cognitive deficits in processing speed and visual memory, and executive dysfunction might be a status-maker for bipolar disorder, but a trait-marker for UP.

Increased suicide attempts in young depressed patients with abnormal temporal–parietal–limbic gray matter volume

BACKGROUND Suicide is a major cause of death throughout the world. Approximately 60% of all suicides have a history of depression. Previous studies of structural brain imaging have shown that suicide is often associated with abnormal fronto-limbic networks. However, the mechanism underlying suicide in depression remains poorly understood. METHOD Twenty sex- and age-matched suicidal unipolar patients were compared with 18 non-suicidal unipolar patients and 28 healthy controls. High-resolution T1-weighted 3T magnetic resonance imaging (MRI) scans were acquired. Hamilton Depressive Rating Scale (HAMD) and Self-Rating Depression scale (SDS) were evaluated. The criterion for suicidality was one or more documented lifetime suicide attempts. A whole-brain optimized voxel-based morphometry (VBM) approach was applied. The Dysfunctional Attitude Scale (DAS) was used to measure cognitive scheme in depressive patients. RESULTS Compared with controls, patients without suicide history showed significant decreased gray matter volume in the left insula lobe [-35 18 9], whereas patients with suicide history showed significantly decreased gray matter volume in the right middle temporal gyrus [60 -53 -8] and increased gray matter volume in the right parietal lobe [39 -39 60]. Compared with the non-suicidal depressed patient group, the suicidal group showed significant decreased gray matter volume in left limbic cingulated gyrus [-2 -21 28]. Moreover, the gray matter volume values in this significantly different brain region were negatively correlated with dysfunctional attitude scores in suicidal depressed patients. LIMITATIONS This study needs replication and further clarification in a larger patient population. CONCLUSIONS Suicide attempts in young depressed patients may be related to abnormal gray matter volumes in temporal-parietal-limbic networks. Specifically, small left limbic cingulate gyrus volumes may be a candidate for the prediction of suicide in young depressed patients.

Neuropsychological performance in melancholic, atypical and undifferentiated major depression during depressed and remitted states: a prospective longitudinal study

BACKGROUND Considerable evidence has demonstrated that melancholic and atypical major depression have distinct biological correlates relative to undifferentiated major depression, but few studies have specifically delineated neuropsychological performance for them. METHOD In a six-week prospective longitudinal study, we simultaneously compared neuropsychological performance among melancholic depression (n=142), atypical depression (n=76), undifferentiated major depression (n=91), and healthy controls (n=200) during a major depressive episode and a clinically remitted state, respectively. We administered neuropsychological tests assessing processing speed, attention, shifting, planning, verbal fluency, visual spatial memory, and verbal working memory to all participants. RESULTS During the depressive state, the three subtypes displayed extensive cognitive impairment, except for attention, when compared with the healthy controls. Melancholic depression significantly differed from atypical depression in processing speed and verbal fluency. In the remitted state, the three subtypes recovered their visual spatial memory and verbal working memory functions to the healthy control level. The recovery of the other domains (processing speed, set shifting, planning, and verbal fluency), however, was different across the subtypes. No predictive relationship existed between neuropsychological performance and the treatment outcome. LIMITATIONS The drop-out rate in the six-week longitudinal study was relatively high. CONCLUSION Our data provide preliminary evidence that during depressed states the three major depressive subtypes display similar cognitive deficits in some domains but differ in such domains as processing speed and verbal fluency. The recovery of the cognitive deficits following clinical remission from depression may be associated with subtypes of major depressive disorder.

Association of affective temperaments measured by TEMPS-A with cognitive deficits in patients with bipolar disorder

BACKGROUND Affective temperaments such as cyclothymia, which may be the fundamental substrates for bipolar disorder and bipolar II in particular, have been reported to be associated with abnormalities in the regions that are related to cognitive deficits in bipolar disorder. However, few studies have examined the effects of affective temperaments on neuropsychological performance in individuals with bipolar disorder. METHOD In a six-week prospective study, we administered Chinese version of TEMPS-A (Temperament Evaluation of Memphis, Pisa, San Diego-Autoquestionnair) to 93 patients with bipolar I depression, 135 patients with bipolar II depression, and 101 healthy controls. Cognitive function was assessed with a battery of neuropsychological tasks, including attention, processing speed, set shifting, planning, verbal working memory, verbal fluency, and visual spatial memory. Mixed-effects statistical models were used to assess the effects of affective temperaments on cognitive function. RESULTS Bipolar patients with hyperthymic temperament showed greater cognitive deficits in set shifting (p=0.05) and verbal working memory (p=0.026) than did bipolar patients with non-predominant temperaments (predominant temperament was defined as one standard deviation above the mean). The differences in estimated marginal means were -0.624 (95% CI, -1.25 to 0) and -0.429 (95% CI, -0.81 to -0.05), respectively. Significant temperament X bipolar subtype interaction effects were observed for set shifting (Wald X(2)=18.161, p<0.001), planning (Wald X(2)=7.906, p=0.048), and visual spatial memory (Wald X(2)=16.418, p=0.001). LIMITATION The anxious temperament was not evaluated. CONCLUSION Our data suggest that hyperthymic temperament may be associated with cognitive deficits in some specific domains in bipolar disorder; and that the effect of temperaments may be different across subtypes of bipolar disorder.

The use of 15-point hypomanic checklist in differentiating bipolar I and bipolar II disorder from major depressive disorder.

OBJECTIVES Individuals with bipolar disorder (BP) are often misdiagnosed with major depressive disorder (MDD). In this study, we developed a Chinese version of 15-point hypomania scale (HCL-15) in order to determine its sensitivity and specificity in the diagnosis of BP and BP-II in particular. METHODS A total of 623 individuals suffering a major depressive episode (MDE) were systematically interviewed with both Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Patient Edition, and HCL-15. A cutoff score of 8 or more in HCL-15 was suggested for BP. RESULTS Of the 623 depressed patients, 115 (18.5%) actually required a diagnosis of BP-I, and another 159 (25.5%) could be more appropriately diagnosed with BP-II, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. The sensitivity of 15-HCL in detection of BP-II was 0.78 and 0.46 for BP-I; the specificity was 0.9 and 0.69, respectively. The specificity of HCL-15 for BP versus MDD was as high as 0.93. Approximately 60%-80% of all questions in the HCL-15 questionnaire revealed positive responses from patients, while items 11 and 12, measuring the consumption of alcohol, coffee and cigarettes, demonstrated a low positive response rate. CONCLUSIONS The HCL-15 assessment scale was fairly sensitive and highly specific for a BP-II diagnosis but not for a BP-I diagnosis. Some items in the HCL-15 symptom list need to be further modified to better fit Chinese culture and customs. The HCL-15 scale could be a useful tool in clinical practice for screening individuals with BP-II in order to avoid a misdiagnosis of MDD.

Neuropsychological performance of patients with soft bipolar spectrum disorders

There is much evidence that shows that a substantial number of individuals with DSM‐IV‐defined unipolar depression (UP) manifest hypomanic sub‐syndrome and bipolar diathesis. Other definitions have conceptualized the term soft bipolar spectrum (SBP) for these individuals. Little is known about the cognitive profiles of individuals with SBP. We hypothesized that they are representative of individuals with bipolar II disorder and are different from that of ‘strict’ UP.

Gray Matter Volume Abnormalities in Depressive Patients With and Without Anxiety Disorders

AbstractComorbidity with anxiety disorder is a relatively common occurrence in major depressive disorder. However, the unique and shared neuroanatomical characteristics of depression and anxiety disorders have not been fully identified. The aim of this study was to identify gray matter abnormalities and their clinical correlates in depressive patients with and without anxiety disorders.We applied voxel-based morphometry and region-of-interest analyses of gray matter volume (GMV) in normal controls (NC group, n = 28), depressive patients without anxiety disorder (DP group, n = 18), and depressive patients with anxiety disorder (DPA group, n = 20). The correlations between regional GMV and clinical data were analyzed.The DP group showed decreased GMV in the left insula (INS) and left triangular part of the inferior frontal gyrus when compared to the NC group. The DPA group showed greater GMV in the midbrain, medial prefrontal cortex, and primary motor/somatosensory cortex when compared to the NC group. Moreover, the DPA group showed greater GMV than the DP group in the frontal, INS, and temporal lobes. Most gray matter anomalies were significantly correlated with depression severity or anxiety symptoms. These correlations were categorized into 4 trend models, of which 3 trend models (ie, Models I, II, and IV) revealed the direction of the correlation between regional GMV and depression severity to be the opposite of that between regional GMV and anxiety symptoms. Importantly, the left INS showed a trend Model I, which might be critically important for distinguishing depressive patients with and without anxiety disorder.Our findings of gray matter abnormalities, their correlations with clinical data, and the trend models showing opposite direction may reflect disorder-specific symptom characteristics and help explain the neurobiological differences between depression and anxiety disorder.

Prevalence of childhood trauma and correlations between childhood trauma, suicidal ideation, and social support in patients with depression, bipolar disorder, and schizophrenia in southern China

BACKGROUND Childhood trauma has long-term adverse effects on physical and psychological health. Previous studies demonstrated that suicide and mental disorders were related to childhood trauma. In China, there is insufficient research available on childhood trauma in patients with mental disorders. METHODS Outpatients were recruited from a psychiatric hospital in southern China, and controls were recruited from local communities. The demographic questionnaire, the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and the Social Support Rating Scale (SSRS) were completed by all participants, and the Self-rating Idea of Suicide Scale (SIOSS) were completed only by patients. Prevalence rates of childhood trauma were calculated. Kruskal-Wallis test and Dunnett test were used to compare CTQ-SF and SSRS scores between groups. Logistic regression was used to control demographic characteristics and examine relationships between diagnosis and CTQ-SF and SSRS scores. Spearmans rank correlation test was conducted to analyze relationships between suicidal ideation and childhood trauma and suicidal ideation and social support. RESULTS The final sample comprised 229 patients with depression, 102 patients with bipolar, 216 patient with schizophrenia, and 132 healthy controls. In our sample, 55.5% of the patients with depression, 61.8% of the patients with bipolar disorder, 47.2% of the patients with schizophrenia, and 20.5% of the healthy people reported at least one type of trauma. In patient groups, physical neglect (PN) and emotional neglect (EN) were most reported, and sexual abuse (SA) and physical abuse (PA) were least reported. CTQ-SF and SSRS total scores, and most of their subscale scores in patient groups were significantly different from the control group. After controlling demographic characteristics, mental disorders were associated with higher CTQ-SF scores and lower SSRS scores. CTQ-SF scores and number of trauma types were positively correlated with the SIOSS score. Negative correlations existed between SSRS scores and the SIOSS score. LIMITATIONS Our sample may not be sufficiently representative. Some results might have been interfered by demographic characteristics. The SIOSS was not completed by controls. Data from self-report scales were not sufficiently objective. CONCLUSIONS In southern China, childhood trauma is more severe and more prevalent in patients with mental disorders (depression, bipolar disorder and schizophrenia) than healthy people. Among patients with mental disorders in southern China, suicidal ideation is associated with childhood trauma and poor social support.

Using Support Vector Machine to Identify Imaging Biomarkers of Major Depressive Disorder and Anxious Depression

Comorbidity with anxiety disorders is a relatively common occurrence in major depressive disorder. However, there are no objective, neurological markers which can be used to identify depressive disorder with and without anxiety disorders. The aim of this study was to examine the diagnostic value of structural MRI to distinguish depressive patients with and without ss using support vector machine. In this paper, we applied voxel-based morphometry of gray matter volume (GMV), then choose discriminative features to classify different group using linear support vector machine (SVM) classifier. The experimental results showed that specific structural brain regions may be a potential biomarkers for disease diagnosis.