Sex differences in schizophrenia, bipolar disorder and PTSD: Are gonadal hormones the link?

In this review, we describe the sex differences in prevalence, onset, symptom profiles and disease outcome that are evident in schizophrenia, bipolar disorder and post-traumatic stress disorder. Women with schizophrenia tend to exhibit less disease impairment than men; by contrast, women with post-traumatic stress disorder are more affected than men. The most likely candidates to explain these sex differences are gonadal hormones. This review details the clinical evidence that estradiol and progesterone are dysregulated in these psychiatric disorders. Notably, existing data on estradiol, and to a lesser extent, progesterone, suggest that low levels of these hormones may increase the risk of disease development and worsen symptom severity. We argue that future studies require a more inclusive, considered analysis of gonadal steroid hormones and the intricacies of the interactions between them, with methodological rigour applied, to enhance our understanding of the roles of steroid hormones in psychiatric disorders

Transdiagnostic subgroups of cognitive impairment in early affective and psychotic illness

Cognitively impaired and spared patient subgroups were identified in psychosis and depression, and in clinical high-risk for psychosis (CHR). Studies suggest differences in underlying brain structural and functional characteristics. It is unclear whether cognitive subgroups are transdiagnostic phenomena in early stages of psychotic and affective disorder which can be validated on the neural level. Patients with recent-onset psychosis (ROP; N = 140; female = 54), recent-onset depression (ROD; N = 130; female = 73), CHR (N = 128; female = 61) and healthy controls (HC; N = 270; female = 165) were recruited through the multi-site study PRONIA. The transdiagnostic sample and individual study groups were clustered into subgroups based on their performance in eight cognitive domains and characterized by gray matter volume (sMRI) and resting-state functional connectivity (rsFC) using support vector machine (SVM) classification. We identified an impaired subgroup (NROP = 79, NROD = 30, NCHR = 37) showing cognitive impairment in executive functioning, working memory, processing speed and verbal learning (all p < 0.001). A spared subgroup (NROP = 61, NROD = 100, NCHR = 91) performed comparable to HC. Single-disease subgroups indicated that cognitive impairment is stronger pronounced in impaired ROP compared to impaired ROD and CHR. Subgroups in ROP and ROD showed specific symptom- and functioning-patterns. rsFC showed superior accuracy compared to sMRI in differentiating transdiagnostic subgroups from HC (BACimpaired = 58.5%; BACspared = 61.7%, both: p < 0.01). Cognitive findings were validated in the PRONIA replication sample (N = 409). Individual cognitive subgroups in ROP, ROD and CHR are more informative than transdiagnostic subgroups as they map onto individual cognitive impairment and specific functioning- and symptom-patterns which show limited overlap in sMRI and rsFC. Clinical trial registry name: German Clinical Trials Register (DRKS). Clinical trial registry URL: https://www.drks.de/drks_web/. Clinical trial registry number: DRKS00005042

The International Consortium Investigating Neurocognition in Bipolar Disorder (ICONICâ BD)

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148257/1/bdi12748.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148257/2/bdi12748_am.pd

Affective cognition in bipolar disorder: A systematic review by the ISBD targeting cognition task force

Background: Impairments in affective cognition are part of the neurocognitive profile and possible treatment targets in bipolar disorder (BD), but the findings are heterogeneous. The International Society of Bipolar Disorder (ISBD) Targeting Cognition Task Force conducted a systematic review to (i) identify the most consistent findings in affective cognition in BD, and (ii) provide suggestions for affective cognitive domains for future study and meta‐analyses.Methods: The review included original studies reporting behavioral measures of affective cognition in BD patients vs controls following the procedures of the Preferred Reporting Items for Systematic reviews and Meta‐Analysis (PRISMA) statement. Searches were conducted on PubMed/MEDLINE, EMBASE, and PsychInfo from inception until November 2018.Results: A total of 106 articles were included (of which nine included data for several affective domains); 41 studies assessed emotional face processing; 23 studies investigated reactivity to emotional words and images; 3 investigated explicit emotion regulation; 17 assessed implicit emotion regulation; 31 assessed reward processing and affective decision making. In general, findings were inconsistent. The most consistent findings were trait‐related difficulties in facial emotion recognition and implicit emotion regulation, and impairments in reward processing and affective decision making during mood episodes. Studies using eye‐tracking and facial emotion analysis revealed subtle trait‐related abnormalities in emotional reactivity.Conclusion: The ISBD Task Force recommends facial expression recognition, implicit emotion regulation, and reward processing as domains for future research and meta‐analyses. An important step to aid comparability between studies in the field would be to reach consensus on an affective cognition test battery for BD

A sensorimotor control framework for understanding emotional communication and regulation

JHGW and CFH are supported by the Northwood Trust. TEVR was supported by a National Health and Medical Research Council (NHMRC) Early Career Fellowship (1088785). RP and MW were supported by the the Australian Research Council (ARC) Centre of Excellence for Cognition and its Disorders (CE110001021)Peer reviewedPublisher PD

Thinking, perceiving and regulating feeling: an investigation of neurocognition, social cognition andemotion regulation in bipolar disorder

This research comprehensively explored neurocognitive, social cognitive and emotion regulation features of bipolar disorder. It better characterised the profiles of these domains of function and provided an improved understanding of the intricate processes within them, as well as an understanding of their genetic aetiology, shared relationships, and their psychosocial consequences. The findings of this research support assertions that people with the disorder experience cognitive and emotion regulation deficits that meaningfully contribute to psychosocial dysfunction. They also suggest that there may be inherent overlap in brain processes underlying neurocognition and social cognition. Overall, this research has advanced the understanding of bipolar disorder, and it will ultimately contribute to better outcomes for people who experience it by increasing scientific knowledge in the field

Multimodal emotion integration in bipolar disorder: an investigation of involuntary cross-modal influences between facial and prosodic channels

Background: The ability to integrate information from different sensory channels is a vital process that serves to facilitate perceptual decoding in times of unimodal ambiguity. Despite its relevance to psychosocial functioning, multimodal integration of emotional information across facial and prosodic modes has not been addressed in bipolar disorder (BD). In light of this paucity of research we investigated multimodal processing in a BD cohort using a focussed attention paradigm. Method: 50 BD patients and 52 healthy controls completed a task assessing the cross-modal influence of emotional prosody on facial emotion recognition across congruent and incongruent facial and prosodic conditions, where attention was directed to the facial channel. Results: There were no differences in multi-modal integration between groups at the level of accuracy, but differences were evident at the level of response time; emotional prosody biased facial recognition latencies in the control group only, where a fourfold increase in response times was evident between congruent and incongruent conditions relative to patients. Conclusions: The results of this study indicate that the automatic process of integrating multimodal information from facial and prosodic sensory channels is delayed in BD. Given that interpersonal communication usually occurs in real time, these results have implications for social functioning in the disorder