Gender differences in bipolar disorder: age of onset, course, comorbidity, and symptom presentation

Kawa, Izabela; Carter, Janet D.; Joyce, Peter R.; Doughty, Caroline J; Frampton, Chris; Wells, J. Elisabeth; Walsh, Annabel; Olds, R.J.

doi:10.1111/j.1399-5618.2004.00180.x

Cited by 186 publications

(143 citation statements)

References 44 publications

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“…Previous research has indicated that eating disorders are significantly more common among female bipolar patients as compared to males (27), a finding that is consistent with prevalence estimates from epidemiologic studies (28,29). One explanation for our discrepant results concerns the elevated rate of threshold and subthreshold BED in the present sample relative to rates of AN or BN.…”

Section: Discussioncontrasting

confidence: 34%

Eating disorders and illness burden in patients with bipolar spectrum disorders

Wildes

Marcus

Fagiolini

2007

Comprehensive Psychiatry

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Objectives-To evaluate the clinical significance of lifetime eating disorder co-morbidity in a welldefined sample of patients with bipolar spectrum disorders and to describe cognitive correlates of disordered eating in this group.Method-Twenty-six bipolar patients with a lifetime history of a DSM-IV defined eating disorder (n = 17) or a clinically significant subthreshold eating disorder (n = 9) (ED group) were compared to 46 bipolar patients with no history of an eating disorder (No ED group) on demographic and clinical characteristics at study presentation, history of bipolar illness, and other psychiatric co-morbidity. Measures included the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Clinical Global Impression-Severity Scale-Bipolar Version (CGI-S-BP), and the Eating Disorder Examination (EDE). Height and weight were recorded to calculate body mass index (BMI).Results-Patients in the ED group were heavier and were rated as more symptomatic on the CGI-S-BP than were patients in the No ED group. The ED group also had a higher number of lifetime depressive episodes and greater psychiatric co-morbidity, excluding eating and mood disorders. Finally, after controlling for BMI and CGI-S-BP rating, patients in the ED group had significantly higher EDE Restraint, Eating Concern, Shape Concern, Weight Concern, and Global scores than did patients in the No ED group.Conclusions-These findings highlight the need for a renewed emphasis on the evaluation and management of weight and eating in the mood disorders. In particular, this research suggests that eating disorder co-morbidity may be a marker for increased symptom load and illness burden in bipolar disorder.

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Section: Discussioncontrasting

confidence: 34%

Eating disorders and illness burden in patients with bipolar spectrum disorders

Wildes

Marcus

Fagiolini

2007

Comprehensive Psychiatry

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“…Impaired appetite is one of the common features of depressed or bipolar individuals (Diagnostic and Statistical Manual IV 1994, Sugahara et al 2004, Kawa et al 2005, Kishi & Elmquist 2005. However, a reduced appetite is observed in most depressive patients, while an increase in appetite is seen in fewer patients (Diagnostic and Statistical Manual IV 1994).…”

Section: Discussionmentioning

confidence: 99%

Temporal expression of estrogen receptor α in the hypothalamus and medulla oblongata during fasting: a role of noradrenergic neurons

Reyes¹,

Tsukamura²,

I’Anson³

et al. 2006

Journal of Endocrinology

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Fasting-induced LH suppression is augmented by estrogen in female rats. We investigated the temporal changes in the number of estrogen receptor a (ERa)-immunoreactive (ir) cells in various brain regions in ovariectomized rats fasted for 6, 24, 30, and 48 h, commencing at 1300 h. We also determined the anatomical relationship of ERa immunoreactivity and dopamine-b-hydroxylase (DBH) neurons in the A2 region of the nucleus of the solitary tract (NTS) and the paraventricular nucleus (PVN). The number of ERa-ir cells significantly increased after 30 h from the onset of fasting in the PVN and NTS compared with the unfasted controls and was sustained until 48 h. In the A2 region of 48-h fasted rats, 46$75% DBH-ir cells expressed ERa, and this was significantly higher than in unfasted controls (8$16% DBH-ir cells expressed ERa). In the PVN, most ERa-ir neurons were juxtaposed with DBH-ir varicosities. These results suggest that ERa is expressed in specific brain regions at a defined time from the onset of fasting. In addition, the anatomical relationship of noradrenergic and ERa-ir neurons in the A2 region and PVN may suggest a role for estrogen in increasing the activity of noradrenergic neurons in the A2 region and enhancing sensitivity of the PVN to noradrenergic input arising from the lower brainstem and thereby augmenting the suppression of LH secretion during fasting.

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“…Interestingly, both disorders display alterations in gating and psychomotor functions (Braff and Geyer, 1990) and are predominantly present in male subjects. For example, androgens have been shown to induce manic symptoms (Pope et al, 2000;Weiss et al, 1999), and the frequency of manic episodes is higher in bipolar male patients than in their female counterparts (Hendrick et al, 2000;Kawa et al, 2005). Similarly, TS incidence in men is four times higher than that in women (Pauls et al, 1990), and anabolic androgens exacerbate TS symptoms (Leckman and Scahill, 1990).…”

Section: -A-reductase Inhibitors In Models Of Psychosis M Bortolato mentioning

confidence: 99%

Antipsychotic-Like Properties of 5-α-Reductase Inhibitors

Bortolato

Frau

Orrù

et al. 2008

Neuropsychopharmacol

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Recent evidence indicates that neuroactive steroids may participate in the pathogenesis of schizophrenia spectrum disorders, yet the mechanisms of this involvement are elusive. As 5-a-reductase (5AR) is the rate-limiting enzyme of one of the two major metabolic pathways in brain steroidogenesis, we investigated the effects of its blockade in several rat models of psychotic-like behavior. The 5AR inhibitor finasteride (FIN, 60 or 100 mg/kg, intraperitoneal, i.p.) dose-and time-dependently antagonized prepulse inhibition (PPI) deficits induced by apomorphine (APO, 0.25 mg/kg, subcutaneous, s.c.) and d-amphetamine (AMPH, 5 mg/kg, s.c.), in a manner analogous to haloperidol (HAL, 0.1 mg/kg, i.p.) and clozapine (CLO, 5 mg/kg, i.p.). Similar results were observed with the other 5AR inhibitors dutasteride (DUT, 40 or 80 mg/kg, i.p.) and SKF 105111 (30 mg/kg, i.p.). FIN (60 or 100 mg/kg, i.p.) also reduced hyperlocomotion induced by AMPH (1 or 3 mg/kg, s.c.) and attenuated stereotyped behaviors induced by APO (0.25 mg/kg, s.c.). Nevertheless, FIN (100 mg/kg, i.p.) did not reverse the PPI disruption induced by the N-methyl-d-aspartate receptor antagonist dizocilpine (0.1 mg/kg, s.c.). FIN (60-300 mg/kg, i.p.) induced no catalepsy in either the bar test or the paw test. Our results suggest that 5AR inhibitors elicit antipsychotic-like effects in animals and may be proposed as a putative novel target in the management of psychotic disorders.

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Gender differences in bipolar disorder: age of onset, course, comorbidity, and symptom presentation

Abstract: Men and women were generally similar in their symptom presentation, age of onset of bipolar disorder, and in the total number of mood episodes. However, they differed in the type of episode at onset and comorbidity patterns.

Cited by 186 publications

References 44 publications

Eating disorders and illness burden in patients with bipolar spectrum disorders

Eating disorders and illness burden in patients with bipolar spectrum disorders

Temporal expression of estrogen receptor α in the hypothalamus and medulla oblongata during fasting: a role of noradrenergic neurons

Antipsychotic-Like Properties of 5-α-Reductase Inhibitors

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