Inflammation, anxiety, and stress in bipolar disorder and borderline personality disorder: A narrative review.

Bipolar disorder (BD) and borderline personality disorder (BPD) are serious and prevalent psychiatric diseases that share common phenomenological characteristics: symptoms (such as anxiety, affective lability or emotion dysregulation), neuroimaging features, risk factors and comorbidities. While several studies have focused on the link between stress and peripheral inflammation in other affective disorders such as anxiety or depression, fewer have explored this relationship in BD and BPD. This review reports on evidence showing an interplay between immune dysregulation, anxiety and stress, and how an altered acute neuroendocrine stress response may exist in these disorders. Moreover, we highlight limitations and confounding factors of these existing studies and discuss multidirectional hypotheses that either suggest inflammation or stress and anxiety as the primum movens in BD and BPD pathophysiology, or inflammation as a consequence of the pathophysiology of these diseases. Untangling these associations and implementing a transdiagnostic approach will have diagnostic, therapeutic and prognostic implications for BD and BPD patients

Reflections on teaching mindfulness to teenagers: from research to clinic

Increased stress reactivity during adolescence has been associated with vulnerability for psychiatric disorders in adulthood and mindfulness-based interventions (MBI) seem to be an option to stress. However, there is still debate on how to best teach MBI to teenagers. For the last 6 years, authors have been proposing the “Mindfulteen” (MT) to teenagers between 12 and 19 years in Geneva. The MT was first applied in different clinical trials and in a qualitative study and, as the results were encouraging, is now proposed in a clinical context at the University Hospital. Authors aim to share here some lessons learned from this experience: 1. Motivation and curiosity are key to engagement, and this is particularly important in school settings; 2. Even if adaptation is needed for different age groups, the program’s core remains easily the same; 3. Short formal practices with not much silence are needed, and metaphors can help; 4. Clarifying the intention of each practice can improve engagement, and the same explicit attitude can be brought into inquiry; 5. A trauma-sensitive approach is crucial, especially in clinical settings; 7. Proposing different versions of the same practice facilitates home practice; 8. Even if participants are not practicing between sessions, it doesn’t mean that they are not integrating mindfulness into their lives; 9. Creative and playful activities can provide rich mindful moments. In conclusion, there are open questions about teaching mindfulness to adolescents and authors believe that sharing and exchanging experiences is important to find some of the answers.&nbsp

Neural correlates of generation and inhibition of verbal association patterns in mood disorders

Objectives: Thought disorders such as rumination or flight of ideas are frequent in patients with mood disorders, and not systematically linked to mood state. These symptoms point to anomalies in cognitive processes mediating the generation and control of thoughts; for example, associative thinking and inhibition. However, their neural substrates are not known. Method: To obtain an ecological measure of neural processes underlying the generation and suppression of spontaneous thoughts, we designed a free word association task during fMRI allowing us to explore verbal associative patterns in patients with mood disorders and matched controls. Participants were presented with emotionally negative, positive or neutral words, and asked to produce two words either related or unrelated to these stimuli. Results: Relative to controls, patients produced a reverse pattern of answer typicality for the related vs unrelated conditions. Controls activated larger semantic and executive control networks, as well as basal ganglia, precuneus and middle frontal gyrus. Unlike controls, patients activated fusiform gyrus, parahippocampal gyrus and medial prefrontal cortex for emotional stimuli. Conclusions: Mood disorder patients are impaired in automated associative processes, but prone to produce more unique/personal associations through activation of memory and self-related area

Sleep sharpens sensory stimulus coding in human visual cortex after fear conditioning

Efficient perceptual identification of emotionally-relevant stimuli requires optimized neural coding. Because sleep contributes to neural plasticity mechanisms, we asked whether the perceptual representation of emotionally-relevant stimuli within sensory cortices is modified after a period of sleep. We show combined effects of sleep and aversive conditioning on subsequent discrimination of face identity information, with parallel plasticity in the amygdala and visual cortex. After one night of sleep (but neither immediately nor after an equal waking interval), a fear-conditioned face was better detected when morphed with another identity. This behavioral change was accompanied by increased selectivity of the amygdala and face-responsive fusiform regions. Overnight neural changes can thus sharpen the representation of threat-related stimuli in cortical sensory areas, in order to improve detection in impoverished or ambiguous situations. These findings reveal an important role of sleep in shaping cortical selectivity to emotionally-relevant cues and thus promoting adaptive responses to new dangers. (C) 2014 Elsevier Inc. All rights reserved

Sleep sharpens sensory stimulus coding in human visual cortex after fear conditioning

Efficient perceptual identification of emotionally-relevant stimuli requires optimized neural coding. Because sleep contributes to neural plasticity mechanisms, we asked whether the perceptual representation of emotionally-relevant stimuli within sensory cortices is modified after a period of sleep. We show combined effects of sleep and aversive conditioning on subsequent discrimination of face identity information, with parallel plasticity in the amygdala and visual cortex. After one night of sleep (but neither immediately nor after an equal waking interval), a fear-conditioned face was better detected when morphed with another identity. This behavioral change was accompanied by increased selectivity of the amygdala and face-responsive fusiform regions. Overnight neural changes can thus sharpen the representation of threat-related stimuli in cortical sensory areas, in order to improve detection in impoverished or ambiguous situations. These findings reveal an important role of sleep in shaping cortical selectivity to emotionally-relevant cues and thus promoting adaptive responses to new dangers

Phénoménologie des pensées accélérées et grouillantes dans les troubles de l'humeur : une réévaluation théorique

La tachypsychie ou accélération du cours de la pensée est un symptôme fréquent des troubles de l'humeur, en particulier des états dépressifs mixtes (plus de 50% des cas). Ce travail a pour but de résumer notre connaissance actuelle du sujet, et de proposer un modèle théorique. En effet, si dans le cadre d'un état hypomane la tachypsychie peut apparaître comme une production excessive et linéaire de pensées, dans le contexte d'un état dépressif par contre ce symptôme est probablement mieux décrit comme des pensées "grouillantes", comprenant aussi un sentiment de persistance. Le patient se plaint d'avoir trop d'idées en même temps dans son champ de conscience, ce qui induit habituellement une sensation déplaisante. Nous en concluons que deux processus sous-tendent probablement de manière différenciée ces troubles du cours de la pensée: la production de pensées d'une part et la capacité à inhiber les pensées actuelles d'autre part. Cette distinction pourrait aider à mieux comprendre et diagnostiquer les états dépressifs mixtes

Neural correlates of thought disorders in mood disorders

Les patients présentant des troubles de l'humeur ont souvent des troubles de la pensée, et notamment des pensées accélérées, grouillantes ou des ruminations. Nous voulions investiguer des processus cognitifs qui pourraient être à la base de ces symptômes et leurs substrats neuronaux. Nous avons donc comparé un groupe de patients avec troubles de l'humeur (N=32) et un groupe de participants appariés, afin de tester leur flexibilité cognitive/inhibition, et leur mode d'associations verbales. Les résultats montrent qu'en effet les patients ont plus de difficulté à passer d'une tâche à l'autre, ce qui correspond à une activation inefficace de régions du réseau fronto-pariétal. Ils ont aussi de la peine à désactiver le cortex cingulaire subgénual lors de condition d'inhibition. Lors d'une tâche d'association de mots, les patients inhibent difficilement les automatismes (associé à moins d'activité du réseau sémantique), et activent plus des régions liées au self en réponse à des stimuli émotionnels

Processus cérébraux impliqués dans la régulation de l’humeur

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Neural substrates of cognitive switching and inhibition in a face processing task.

We frequently need to change our current occupation, an operation requiring additional effortful cognitive demands. Switching from one task to another may involve two distinct processes: inhibition of the previously relevant task-set, and initiation of a new one. Here we tested whether these two processes are underpinned by separate neural substrates, and whether they differ depending on the nature of the task and the emotional content of stimuli. We used functional magnetic resonance imaging in healthy human volunteers who categorize emotional faces according to three different judgment rules (color, gender, or emotional expression). Our paradigm allowed us to separate neural activity associated with inhibition and switching based on the sequence of the tasks required on successive trials. We found that the bilateral medial superior parietal lobule and left intraparietal sulcus showed consistent activation during switching regardless of the task. On the other hand, no common region was activated (or suppressed) as a consequence of inhibition across all tasks. Rather, task-specific effects were observed in brain regions that were more activated when switching to a particular task but less activated after inhibition of the same task. In addition, compared to other conditions, the emotional task elicited a similar switching cost but lower inhibition cost, accompanied by selective decrease in the anterior cingulate cortex when returning to this task shortly after inhibiting it. These results demonstrate that switching relies on domain-general processes mediated by postero-medial parietal areas, engaged across all tasks, but also provide novel evidence that task inhibition produces domain-specific decreases as a function of particular task demands, with only the latter inhibition component being modulated by emotional information