Objective: To identify, by means of a systematic review, the frequency with which comorbid personality disorders (PDs) have been assessed in studies of euthymic bipolar patients. Methods: PubMed, SciELO and PsychINFO databases were searched for eligible articles published between 1997 and 2013. After screening 1,249 empirical papers, two independent reviewers identified three articles evaluating the frequency of PDs in patients with bipolar disorders assessed in a state of euthymia.Results: The total sample comprised 376 euthymic bipolar patients, of whom 155 (41.2%) had at least one comorbid PD. Among them, we found 87 (23.1%) in cluster B, 55 (14.6%) in cluster C, and 25 (6.6%) in cluster A. The frequencies of PD subtypes were: borderline, 38 (10.1%); histrionic, 29 (7.7%); obsessive-compulsive, 28 (7.4%); dependent, 19 (5%); narcissistic, 17 (4.5%); schizoid, schizotypal, and avoidant, 11 patients each (2.95%); paranoid, five (1.3%); and antisocial, three (0.79%). Conclusion: The frequency of comorbid PD was high across the spectrum of euthymic bipolar patients. In this population, the most common PDs were those in cluster B, and the most frequent PD subtype was borderline, followed by histrionic and obsessive-compulsive.
New evidence suggests that the cerebellum has structural and functional
abnormalities in psychiatric disorders.ObjectiveIn this research, the goal was to measure the volume of the cerebellum and
its subregions in individuals with psychiatric disorders and to relate these
findings to their symptoms.MethodsPatients with different degrees of cognitive impairment (Epidemiology of the
Elderly - UNIFESP) and patients with post-traumatic stress disorder (PTSD)
from population studies were analyzed. Also, patients with bipolar disorder
from an outpatient clinic (Center for the Study of Mood and Anxiety
Disorders, Universidade Federal da Bahia) were recruited for this study. All
subjects underwent a 1.5T structural magnetic resonance scan. Volumetric
measures and symptom measurements, by psychometric scales, were performed
and compared between patients and controls.ResultsThe cerebellum volume was reduced in patients with cognitive impairment
without dementia and with dementia, in patients with PTSD, and in patients
with bipolar disorder compared to controls. In dementia and PTSD, the left
cerebellar hemisphere and vermis volume were reduced. In bipolar disorder,
volumes of both hemispheres and the vermis were reduced. In the first two
studies, these cerebellar volumetric reductions correlated with symptoms of
the disease.ConclusionThe exact nature of cerebellar involvement in mental processes is still not
fully understood. However, abnormalities in cerebellar structure and its
functions have been reported in some of these diseases. Future studies with
larger samples are needed to clarify these findings and investigate whether
they are important for treatment and prognosis.
The lower frequency of comorbidities found in our study in comparison with those described in the literature may be due to the evaluation restricted only to euthymic patients. This suggests the importance of assessing psychiatric comorbidity in bipolar individuals while not in acute phases of the disorder.
Introduction/Objective. Evidence suggests that the prefrontal cortex has been implicated in the pathophysiology of bipolar disorder (BD), but few neurochemical studies have evaluated this region in bipolar patients and there is no information from BD suicide attempters using Proton Magnetic Resonance Spectroscopy (H+MRS). The objective was to evaluate the metabolic function of the medial orbital frontal cortex in euthymic BD type I suicide and nonsuicide attempters compared to healthy subjects by H+MRS. Methods. 40 euthymic bipolar I outpatients, 19 without and 21 with history of suicide attempt, and 22 healthy subjects were interviewed using the Structured Clinical Interview with the DSM-IV axis I, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, and the Barratt Impulsiveness Scale-11 and underwent H+MRS. Results. We did not find any metabolic abnormality in medial orbital frontal regions of suicide and nonsuicide BD patients and BD patients as a group compared to healthy subjects. Conclusions. The combined chronic use of psychotropic drugs with neuroprotective or neurotrophic effects leading to a euthymic state for longer periods of time may improve neurometabolic function, at least measured by H+MRS, even in suicide attempters. Besides, these results may implicate mood dependent alterations in brain metabolic activity. However, more studies with larger sample sizes of this heterogeneous disorder are warranted to clarify these data.
Background: Advances in neuroimaging techniques have produced evidence about disrupted frontolimbic circuits related to emotional regulation. These neuroimaging studies may suggest impairments in cellular plasticity in bipolar disorder (BD) patients. However, the long-term use of mood stabilizers may restore these dysfunctions by neurotrophic effects Objectives: Review the major structures of the brain that underpin this disorder, synthesize the main findings in neuroimaging in BD, and debate neuroplastic effects of psychopharmacological treatment on findings from the neuroimaging studies.
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