77 research outputs found
Racial disparities in bipolar disorder treatment and research: a call to action
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146344/1/bdi12638.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146344/2/bdi12638_am.pd
Widespread white matter microstructural abnormalities in bipolar disorder: evidence from mega- and meta-analyses across 3033 individuals
Fronto-limbic white matter (WM) abnormalities are assumed to lie at the heart of the pathophysiology of bipolar disorder (BD);
however, diffusion tensor imaging (DTI) studies have reported heterogeneous results and it is not clear how the clinical
heterogeneity is related to the observed differences. This study aimed to identify WM abnormalities that differentiate patients with
BD from healthy controls (HC) in the largest DTI dataset of patients with BD to date, collected via the ENIGMA network. We gathered
individual tensor-derived regional metrics from 26 cohorts leading to a sample size of N = 3033 (1482 BD and 1551 HC). Mean
fractional anisotropy (FA) from 43 regions of interest (ROI) and average whole-brain FA were entered into univariate mega- and
meta-analyses to differentiate patients with BD from HC. Mega-analysis revealed significantly lower FA in patients with BD
compared with HC in 29 regions, with the highest effect sizes observed within the corpus callosum (R2 = 0.041, Pcorr < 0.001) and
cingulum (right: R2 = 0.041, left: R2 = 0.040, Pcorr < 0.001). Lithium medication, later onset and short disease duration were related to
higher FA along multiple ROIs. Results of the meta-analysis showed similar effects. We demonstrated widespread WM abnormalities
in BD and highlighted that altered WM connectivity within the corpus callosum and the cingulum are strongly associated with BD.
These brain abnormalities could represent a biomarker for use in the diagnosis of BD. Interactive three-dimensional visualization of the results is available at www.enigma-viewer.org
Broadening the diagnosis of bipolar disorder: benefits vs. risks
There is considerable debate over whether bipolar and related disorders
that share common signs and symptoms, but are currently defined as distinct
clinical entities in DSM-IV and ICD-10, may be better characterized as falling
within a more broadly defined “bipolar spectrum”. With a spectrum
view in mind, the possibility of broadening the diagnosis of bipolar disorder
has been proposed. This paper discusses some of the rationale for an expanded
diagnostic scheme from both clinical and research perspectives in light of
potential drawbacks. The ultimate goal of broadening the diagnosis of bipolar
disorder is to help identify a common etiopathogenesis for these conditions
to better guide treatment. To help achieve this goal, bipolar researchers
have increasingly expanded their patient populations to identify objective
biological or endophenotypic markers that transcend phenomenological observation.
Although this approach has and will likely continue to produce beneficial
results, the upcoming DSM-IV and ICD-10 revisions will place increasing scrutiny
on psychiatry’s diagnostic classification systems and pressure to re-evaluate
our conceptions of bipolar disorder. However, until research findings can
provide consistent and converging evidence as to the validity of a broader
diagnostic conception, clinical expansion to a dimensional bipolar spectrum
should be considered with caution
Poszerzenie diagnozy zaburzenia dwubiegunowego: Korzyści i zagrożenia
There is considerable debate over whether bipolar and related disorders that share common signs and symptoms, but are currently defined as distinct clinical entities in DSM-IV and ICD-10, may be better characterized as falling within a more broadly defined "bipolar spectrum". With a spectrum view in mind, the possibility of broadening the diagnosis of bipolar disorder has been proposed. This paper discusses some of the rationale for an expanded diagnostic scheme from both clinical and research perspectives in light of potential drawbacks. The ultimate goal of broadening the diagnosis of bipolar disorder is to help identify a common etiopathogenesis for these conditions to better guide treatment. To help achieve this goal, bipolar researchers have increasingly expanded their patient populations to identify objective biological or endophenotypic markers that transcend phenomenological observation. Although this approach has and will likely continue to produce beneficial results, the upcoming DSM-IV and ICD-10 revisions will place increasing scrutiny on psychiatry's diagnostic classification systems and pressure to re-evaluate our conceptions of bipolar disorder. However, until research findings can provide consistent and converging evidence as to the validity of a broader diagnostic conception, clinical expansion to a dimensional bipolar spectrum should be considered with caution. © 2006 Instytut Psychiatrii i Neurologii
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