Brietzke, Elisa Macedo

Bücker, Joana

Gama, Clarissa Severino

Pedrini, Mariana Guedes

Sulzbach, Miréia Fortes Vianna

Brazilian Journal of Psychiatry

English

Lume 5.8

LETTERS TO THE EDITORSHippocampus size does notcorrelate with body massindex in bipolar disorderRev Bras Psiquiatr. 2016;38:86–87doi:10.1590/1516-4446-2015-1816The hippocampus has been a focus of attention inneuroimaging studies of bipolar disorder (BD). This structurehas been recognized as particularly vulnerable to theneurotoxic effects of obesity, and it is apparently subject tosynergistic, deleterious action from obesity and mooddisorders.1 Comorbid obesity is highly prevalent in peoplewith BD.2,3 In addition, there is a robust body of evidenceshowing that obese individuals with BD have poor cognitiveperformance and increased levels of inflammatory mediatorsas compared to those with normal weight.4 Thus, theobjective of this study was to ascertain whether anassociation exists between body mass index (BMI) andhippocampal volume in individuals with BD and to comparehippocampal volumes between patients and healthy controls.Sixty-five subjects were enrolled: 26 patients with BD ineuthymia and 39 controls. Inclusion criteria for patientswere: a) age 4 18 years; b) DSM-IV criteria for bipolar I;and c) criteria for remission, defined as scores o 7 on the17-item Hamilton Depression Scale (HAM-D) and on theYoung Mania Rating Scale (YMRS) for at least 1 monthprior to assessment. Patients with severe clinical illnesseswere excluded. The control group consisted of healthyvolunteers who had no current or previous history and nofirst-degree family history of a major psychiatric disorder,including dementia, as assessed by the non-patientversion of the Structured Clinical Interview for DSM-IV.Written informed consent was obtained from all subjects inaccordance with the Declaration of Helsinki, and the studyprotocol was approved by the local ethics committee.Magnetic resonance imaging data were obtained ina Philips Achieva 1.5-tesla scanner (Amsterdam, theNetherlands). T1 high-resolution sagittal 3D magnetiza-tion-prepared rapid acquisition gradient-echo (MPRAGE)sequences were acquired with NEX = 1, image matrix =256 x 232, flip angle = 8 degrees, echo time = 4 ms,repetition time = 8.63 ms, and voxel size 1 x 1 x 1 mm3,yielding 160 slices. Subcortical volumetric segmentationswere performed with the Freesurfer image analysis suite,version 5.1.0 (http://surfer.nmr.mgh.harvard.edu/). Intra-cranial volume was regressed out from hippocampalvolume. Descriptive analyses are presented as mean(standard deviation) or median (interquartile range).Appropriate tests for parametric or nonparametric dis-tribution are indicated in Table 1. Correlations wereobtained by Spearman rank correlation coefficients.Clinical and demographic characteristics of the sampleare summarized in Table 1. There was no significant diff-erence in total hippocampus size between patients andcontrols (p = 0.123). There was no correlation betweentotal hippocampus size and BMI in the overall sample (p =0.153, rho = -0.194), nor separately in the BD (p = 0.084,rho = -0.345) and control (p = 0.823, rho = -0.043) groups.Significant BMI and BD diagnosis interactions for whiteand gray matter reductions have been described3,5;furthermore, obesity in BD has been associated withworse disease progression, suggesting that nutritionalinterventions are highly desirable for better outcomes.Although obesity is a potentially modifiable condition thatis highly prevalent in individuals with BD and the hippo-campus is very susceptible to the neurotoxic effects ofobesity, this study did not find an association betweenhippocampus size and BMI.Miréia Viana-Sulzbach,1 Mariana Pedrini,2Joana Bücker,1 Elisa Brietzke,2,3 Clarissa S. Gama11Laboratório de Psiquiatria Molecular, Instituto Nacional de Ciência eTecnologia – Medicina Translacional (INCT-MT), Hospital deClı́nicas de Porto Alegre (HCPA), Universidade Federal do RioGrande do Sul (UFRGS), Porto Alegre, RS, Brazil. 2LaboratórioInterdisciplinar de Neurociências Clı́nicas (LiNC), Departamento dePsiquiatria, Universidade Federal de São Paulo (UNIFESP), SãoPaulo, SP, Brazil. 3Programa de Esquizofrenia (PROESQ),Departamento de Psiquiatria, UNIFESP, São Paulo, SP, BrazilSubmitted Sep 20 2015, accepted Sep 30 2015.DisclosureThe authors report no conflicts of interest.Table 1 Characteristics of healthy controls and patients with BDBD (n=26) Controls (n=30) p-valueAge (years) 45.77614.14 44.00611.07 0.602*Gender (male/female) 8/18 15/15 0.145wIllness duration (years) 11 (17.75) - -Number of mood episodes 8 (12) - -Suicide attempts 2 (1) - -YMRS 0 (3) - -HAM-D 2 (5) - -Total hippocampus size 21.36 (928.92) 372.18 (870.80) 0.123=BMI 28.9266.28 27.6364.62 0.382*Data presented as mean 6 standard deviation or median (interquartile range), unless otherwise specified.BD = bipolar disorder; BMI = body mass index; HAM-D = Hamilton Depression Scale; YMRS = Young Mania Rating Scale.* t test, wchi-square test,=Mann-Whitney U test.Revista Brasileira de Psiquiatria. 2016;38& 2016 Associação Brasileira de PsiquiatriaReferences1 Fotuhi M, Do D, Jack C. Modifiable factors that alter the size of thehippocampus with ageing. Nat Rev Neurol. 2012;8:189-202.2 Bond DJ, Ha TH, Lang DJ, Su W, Torres IJ, Honer WG, et al. Bodymass index-related regional gray and white matter volume reductionsin first-episode mania patients. Biol Psychiatry. 2014;76:138-45.3 Bond DJ, Kauer-Sant’Anna M, Lam RW, Yatham LN. Weight gain,obesity, and metabolic indices following a first manic episode: prospective12-month data from the Systematic Treatment Optimization Program forEarly Mania (STOP-EM). J Affect. Disord. 2010;124:108-17.4 Yim CY, Soczynska JK, Kennedy CH, Woldeyohannes HO, Brietzke E,McIntyre RS. The effect of overweight/obesity on cognitive function ineuthymic individuals with bipolar disorder. Eur Psychiatry. 2010;27:223-8.5 Bond DJ, Lang DJ, Noronha MM, Kunz M, Torres IJ, Su W, et al. Theassociation of elevated body mass index with reduced brain volumesin first-episode mania. Biol Psychiatry. 2011;70:381-7.Intimate partner violenceduring pregnancy: casereport of a forensicpsychiatric evaluationRev Bras Psiquiatr. 2016;38:87–88doi:10.1590/1516-4446-2015-1820Intimate partner violence (IPV), also known as domesticviolence, is defined by the World Health Organization1 as‘‘any behavior within an intimate relationship that causesphysical, psychological, or sexual harm to those in therelationship.’’ While IPV may be perpetrated by womenagainst men or in homosexual relations of both sexes,most cases (85%) consist of men victimizing women. Thisproduces a worldwide problem with serious implicationsfor women’s health and well-being.2,3Special populations of women are at increased risk of IPV,including pregnant women (especially in unplanned pregnan-cies), those living in low-income settings, rural women, andolder, indigenous, military, and immigrant women. Within thiscontext, a study on the prevalence of IPV among Japanesewomen noted that all those victimized before pregnancycontinued to suffer violence during pregnancy.4 A prospectivecohort study conducted by Silva et al. in Recife, state ofPernambuco, Brazil, found a high incidence of IPV in thepostpartum period (9.3%), with predominance of psychologi-cal violence.5Lévesque & Chamberland investigated IPV in the per-inatal period in young women and warned about thedifficulty these women experience in identifying themselvesas victims and categorizing the acts of their partners asdomestic violence. The fear of family separation and thevictims’ desire to protect their children contribute to thecomplexity of violence experienced during maternity.6In addition to the sequelae experienced by non-pregnantwomen victimized by conjugal violence, IPV can have addi-tional negative effects when perpetrated against pregnantwomen, increasing the risk of inappropriate antenatal care,poor weight gain, anemia, infections, bleeding, maternaldepression, and suicidal ideation and suicide attempts.We illustrate the aspects listed above with the case of ayoung couple from the Southern region of Brazil. Thehusband was an unemployed man with a criminal recordwho kept his wife (5 months along a planned pregnancy)under false imprisonment while causing her grievous bodilyharm. A complaint to police was made by neighbors whonoticed the false imprisonment. Although there was aprevious history of domestic violence, the victim and theperpetrator minimized the aggressive acts to the police,judge, and forensic psychiatrists who evaluated the case.The victim did not report any concerns about the baby’shealth or physical integrity during any of the psychiatricinterviews. Surprisingly, both the wife and the husbandattributed the responsibility of the facts to the victim,including in a handwritten letter by the wife, directed tothe judge in the case, blaming herself for having receivedsuch treatment from her husband. Forensic psychiatricevaluation of the offender identified controlling behavior andnarcissistic personality traits. He was considered fullycapable of understanding the nature of his offense and ofcontrolling his actions voluntarily.This report demonstrates the pathological familydynamics common in such cases. Future research shouldfocus on the motivational and psychopathological char-acteristics of perpetrators and victims alike, aiming at amore comprehensive knowledge of this type of criminalbehavior, as well as preventive assistance through mon-itoring of high-risk groups. Professionals involved inantenatal and psychiatric care must remain vigilant ofthe possibility of IPV during pregnancy.Lisieux E. de B. Telles,1 Alcina J. Barros,2Caroline G. Moreira,3 Mariana R. Almeida,3Mateus de B. Telles,4 Vivian P. Day51Departamento de Psiquiatria, Faculdade de Medicina, UniversidadeFederal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.2Programa de Pós-Graduação em Psiquiatria, UFRGS, PortoAlegre, RS, Brazil. 3Programa de Residência em PsiquiatriaForense, Hospital de Clı́nicas de Porto Alegre (HCPA), UFRGS,Porto Alegre, RS, Brazil. 4Pontifı́cia Universidade Católica do RioGrande do Sul (PUCRS), Porto Alegre, RS, Brazil. 5Centro deEstudos Luı́s Guedes, UFRGS, Porto Alegre, RS, Brazil.Submitted Sep 24 2015, accepted Oct 26 2015.DisclosureThe authors report no conflicts of interest.Rev Bras Psiquiatr. 2016;38(1)Letters to the Editors 87

Hippocampus size does not correlate with body mass index in bipolar disorder

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Hippocampus size does not correlate with body mass index in bipolar disorder

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