Bipolar disorders

Bipolar disorder is characterized by (hypo)manic episodes and depressive episodes which alternate with euthymic periods. It causes serious disability with poor outcome, increased suicidality risk, and significant societal costs. This chapter describes the findings of the PET/SPECT research efforts and the current ideas on the pathophysiology of bipolar disorder. First, the cerebral blood flow and cerebral metabolism findings in the prefrontal cortex, limbic system, subcortical structures, and other brain regions are discussed, followed by an overview of the corticolimbic theory of mood disorders that explains these observations. Second, the neurotransmitter studies are discussed. The serotonin transporter alterations are described, and the variation in study results is explained, followed by an overview of the results of the various dopamine receptor and transporter molecules studies, taking into account also the relation to psychosis. Third, a concise overview is given of dominant bipolar disorder pathophysiological models, proposing starting points for future molecular imaging studies. Finally, the most important conclusions are summarized, followed by remarks about the observed molecular imaging study designs specific for bipolar disorder.</p

Long-term follow-up in depressed patients treated with ECT

Design: The aim was to study the long-term effects of electroconvulsive therapy (ECT) in depression. 55 patients were followed-up 20-24 years after an ECT series. 13 patients were still alive and 10 agreed to participate in the study. All 55 patients had been investigated with clinical and neuropsychological assessment and with neurophysiological measurements; regional Cerebral Blood Flow (rCBF) and EEG before the first ECT, six months later and after about one year. These investigations were now repeated in the 10 patients. Results: Before the original ECT series all patients had suffered from severe mood disorder. At the follow-up the 10 patients showed no clear signs of mood disorder or cognitive impairment. There was a slightly subnormal performance in working memory and in verbal as well as visual episodic memory on all three occasions after the ECT series. The rCBF measurement showed a significant average CBF decrease from the first to the last measurement. There was, moreover, a significant rCBF decrease in frontal areas at the last measurement compared to the three previous assessments. Conclusion: All ten patients followed-up 20 – 24 years after an ECT series were mentally healthy and thus besides a moderate visual memory dysfunction no severe side effects were observed with clinical and neuroimaging techniques