Bipolar Disorder Carvalho, Andre F; Firth, Joseph; Vieta, Eduard
The New England journal of medicine,
07/2020, Letnik:
383, Številka:
1
Journal Article
Recenzirano
Bipolar disorder has a yearly prevalence of 2%. Other mental and physical conditions occur with bipolar disorder, which is also associated with an increased risk of suicide. Treatment is complex and ...relies on lithium or intermittent use of antipsychotic drugs.
Coordinate-based meta-analyses (CBMA) are very useful for summarizing the large number of voxel-based neuroimaging studies of normal brain functions and brain abnormalities in neuropsychiatric ...disorders. However, current CBMA methods do not conduct common voxelwise tests, but rather a test of convergence, which relies on some spatial assumptions that data may seldom meet, and has lower statistical power when there are multiple effects. Here we present a new algorithm that can use standard voxelwise tests and, importantly, conducts a standard permutation of subject images (PSI). Its main steps are: a) multiple imputation of study images; b) imputation of subject images; and c) subject-based permutation test to control the familywise error rate (FWER). The PSI algorithm is general and we believe that developers might implement it for several CBMA methods. We present here an implementation of PSI for seed-based d mapping (SDM) method, which additionally benefits from the use of effect sizes, random-effects models, Freedman-Lane-based permutations and threshold-free cluster enhancement (TFCE) statistics, among others. Finally, we also provide an empirical validation of the control of the FWER in SDM-PSI, which showed that it might be too conservative. We hope that the neuroimaging meta-analytic community will welcome this new algorithm and method.
•We present a new algorithm for coordinate-based meta-analyses (CBMA) methods.•Opposed to current methods, it conducts common permutation tests.•It may be implemented in several CBMA methods.•We detail and validate its implementation for seed-based d mapping (SDM).
Summary Bipolar disorder is a recurrent chronic disorder characterised by fluctuations in mood state and energy. It affects more than 1% of the world's population irrespective of nationality, ethnic ...origin, or socioeconomic status. Bipolar disorder is one of the main causes of disability among young people, leading to cognitive and functional impairment and raised mortality, particularly death by suicide. A high prevalence of psychiatric and medical comorbidities is typical in affected individuals. Accurate diagnosis of bipolar disorder is difficult in clinical practice because onset is most commonly a depressive episode and looks similar to unipolar depression. Moreover, there are currently no valid biomarkers for the disorder. Therefore, the role of clinical assessment remains key. Detection of hypomanic periods and longitudinal assessment are crucial to differentiate bipolar disorder from other conditions. Current knowledge of the evolving pharmacological and psychological strategies in bipolar disorder is of utmost importance.
Highly specialised care may have both pros and cons. Centralised expert treatment may be more effective than standard community care for bipolar disorder. Rather than trying to solve the false ...dichotomy between specialised v. community care, the rational integration of both approaches may enhance quality of care and cost-effectiveness.
Abstract Background Several studies using functional magnetic resonance imaging (fMRI) in bipolar disorder (BD) have been performed in the last decade. Some of them have applied novel neuroimaging ...techniques such as resting-state functional connectivity magnetic resonance imaging (rs-fcMRI). Methods We reviewed the top-quality rs-fcMRI studies in BD available in the PubMed and Embase databases up to November, 2012 to identify brain activation networks and research techniques that may benefit future research. Results We present and discuss the methods and findings of eight articles. Most of these studies used the regions-of-interest (ROI) and independent component analysis (ICA) methods, and some used approaches such as amplitude of low-frequency fluctuation (ALFF), restricted global brain connectivity (rGBC) and regional homogeneity (ReHO). The largest differences in their results were found in the connectivity of the medial prefrontal cortex (mPFC) and the anterior cingulated cortex with limbic-striatal structures, and in spatial extent in ReHo when studying the default mode network (DMN). Limitations The heterogeneity of the analytical methods used to explore the resting-state network (RSN) and the characteristics of the sample of each study limit the conclusions. Conclusions Despite the variation among the results of the reviewed papers, they all support the cortico-limbic hypothesis and suggest that connectivity can be more complex and that intra-regional disturbances should also be studied. Recommendations for future studies include consideration of intra-regional disturbances, better control of confounding factors, use of larger scale methods, and a consensus regarding how to approach the study of resting-state networks and interpret the results obtained.
Abstract
Background:
The current paper introduces the actual International College of Neuro-Psychopharmacology clinical guidelines for the treatment of bipolar disorder.
Concept and structure of the ...guidelines:
The current clinical guidelines are based on evidence-based data, but they also intend to be clinically useful, while a rigid algorithm was developed on the basis of firm evidence alone. Monotherapy was prioritized over combination therapy. There are separate recommendations for each of the major phases of bipolar disorder expressed as a 5-step algorithm.
Discussion:
The current International College of Neuro-Psychopharmacology clinical guidelines for the treatment of bipolar disorder are the most up-to-date guidance and are as evidence based as possible. They also include recommendations concerning the use of psychotherapeutic interventions, again on the basis of available evidence. This adherence of the workgroup to the evidence in a clinically oriented way helped to clarify the role of specific antidepressants and traditional agents like lithium, valproate, or carbamazepine. The additional focus on specific clinical characteristics, including predominant polarity, mixed features, and rapid cycling, is also a novel approach. Many issues need further studies, data are sparse and insufficient, and many questions remain unanswered. The most important and still unmet need is to merge all the guidelines that concern different phases of the illness into a single one and in this way consider BD as a single unified disorder, which is the real world fact. However, to date the research data do not permit such a unified approach.
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