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Range of normal mood variation by sub group
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... However, it should be highlighted that the concept of the BS itself is still being discussed. In general, the BS concept can be approached in two different ways: (1) manic-depressive spectrum-continuum between bipolar and unipolar, and (2) restricted to bipolar disorder with a continuum between full-blown illness (BD-I) through milder illness to temperament traits (83). In particular, the inclusion of MDD and dysthymia in BS disorders can be controversial. ...
Aims
The impact of bipolar spectrum (BS) disorders on professional functioning has not been systematically reviewed yet. Since even subsyndromal symptoms may disturb functioning, the determination of the prognostic value of the spectrum of bipolarity for employment seems extremely relevant. The aim of this study was to assess the impact of BS disorders on professional functioning.
Materials and methods
A systematic review of the literature (namely, cohort and cross-sectional studies) investigating a link between BS disorders and employment was performed in accordance with PRISMA guidelines. BS was defined based on the concept of two-dimensional BS by Angst. Occupational outcomes and factors affecting employment were evaluated as well.
Results
Seventy-four studies were included. All disorders comprising BS had a negative impact on occupational status, work performance, work costs, and salary, with the greatest unfavorable effect reported by bipolar disorder (BD), followed by borderline personality disorder (BPD), major depressive disorder (MDD), and dysthymia. Employment rates ranged from 40 to 75% (BD), 33 to 67% (BPD), 61 to 88% (MDD), and 86% (dysthymia). The factors affecting employment most included: cognitive impairments, number/severity of symptoms, namely, subsyndromal symptoms (mainly depressive), older age, education, and comorbidity (substance abuse, personality disorders, anxiety, depression, ADHD, PTSD).
Conclusion
Bipolar spectrum symptoms exert a negative impact on professional functioning. Further evaluation of affecting factors is crucial for preventing occupational disability.
... They have received increased research attention because they improve sleep quality and attenuate the syndrome of brain-related disorders [17], and can also have a positive impact on mood, stress, and depression [18]. In the Vedas, 5000 years ago, aromatherapy was reported to regulate the central nervous system [19]. ...
... Od ponad 20 lat rozszerzane jest znaczenie pojęcia "dwubiegunowość" (Reddy, 2012). W literaturze opisano m.in. ...
Choroba afektywna dwubiegunowa cechuje się wysoką nawrotowością, wczesnym początkiem, rodzinnym występowaniem
i tendencją do progresji. Bardzo często zdarza się, że długo pozostaje nierozpoznana albo niewłaściwie zakwalifikowana jako
inne zaburzenie (nawet ⅓ pacjentów może być błędnie zdiagnozowana przez 10 lat lub dłużej). Najczęściej mylona jest
z depresją nawracającą, zaburzeniami lękowymi, schizofrenią i zaburzeniami osobowości. Zbyt późne wykrycie objawów
dwubiegunowości i postawienie diagnozy choroby afektywnej dwubiegunowej pociąga za sobą istotne konsekwencje
kliniczne, w tym opóźnienie rozpoczęcia właściwej farmakoterapii, wyższą liczbę nawrotów, większą częstość prób
samobójczych i hospitalizacji, rozwój oporności na leczenie i ryzyko szybkiej zmiany faz. Trudności diagnostyczne wynikają
m.in. z faktu, że obraz kliniczny spektrum choroby afektywnej dwubiegunowej jest bardzo zróżnicowany, a choroba przebiega
z nietypowymi bądź subklinicznymi objawami. Ponadto wiedza na temat kryteriów rozpoznawania zaburzeń z kręgu
spektrum dwubiegunowego nie jest wystarczająco rozpowszechniona, a pacjenci i ich bliscy bywają bezkrytyczni i zbyt
rzadko zgłaszają objawy maniakalne/hipomaniakalne. W celu zwiększenia precyzji procesu diagnostycznego zaleca się –
m.in. u osób z diagnozą depresji – stosowanie przesiewowych kwestionariuszy oraz zwracanie szczególnej uwagi
na specyficzne cechy depresji, które częściej występują w zaburzeniach ze spektrum choroby afektywnej dwubiegunowej.
Obecnie diagnozę stawia się na podstawie wywiadu i obserwacji obrazu klinicznego. Trwają jednak poszukiwania wskaźników
biologicznych (biomarkerów), które mogłyby odzwierciedlać obecność stanu chorobowego czy też korelować z fazami
choroby i jej nasileniem.
... Long-term naturalistic studies have to be taken into account to correlate research evidence and the clinical experience. Spectrum concept of BD [10] has to be cautiously thought through and should await strengthening by clinically applicable biological research including the development of biomarkers, before we consider leaving the time-tested categorical constructs to embrace the newer dimensional constructs. ...
Repetitive transcranial magnetic stimulation (rTMS) to treat depression has been thoroughly investigated in recent years. However, the underlying mechanisms are not fully understood. In this study, a chronic unpredictable mild stress (CUMS) paradigm was applied to male Sprague Dawley rats. Then rTMS was performed for 7 consecutive days, and the anti-depressive effects were evaluated by the sucrose preference test (SPT), the forced swimming test (FST), and the open-field test (OFT). Hippocampal cannabinoid type I receptor (CB1) expression was measured, and the expression levels of brain-derived neurotrophic factor (BDNF), Bcl-2, and Bax and the number of bromodeoxyuridine (BrdU)-positive cells were also investigated. These parameters were also observed after the selective CB1 receptor antagonist AM251 was used as a blocking agent. The results showed that CUMS induced a significant decrease in sucrose preference, a significant increase in immobility time in the FST, and a significantly decreased horizontal distance in the OFT. In addition, reduced hippocampal CB1 receptor, BDNF, and Bcl-2/Bax protein expression levels in CUMS rats, as well as decreased cell proliferation were also observed in the dentate gyrus. Meanwhile, rTMS treatment up-regulated cell proliferation; elevated CB1 receptor, BDNF, and Bcl-2/Bax expression levels in the hippocampus; and ameliorated depressive-like behaviors. All of these beneficial effects were abolished by AM251. These results indicate that rTMS increases BDNF production and hippocampal cell proliferation to protect against CUMS-induced changes through its effect on CB1 receptors.
Current efforts to improve clinical effectiveness and utility of repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depression (MD) include theta burst stimulation (TBS), a patterned form of rTMS. Here, we investigated the efficacy of bilateral TBS to the dorsolateral prefrontal cortex (dlPFC) in patients with MD in additon to ongoing medication and psychotherapy.
In this randomized-controlled trial, thirty-two patients with MD were treated for six weeks (thirty sessions) with either successively intermittent, activity enhancing TBS (iTBS) to the left and continuous, inhibiting TBS (cTBS) to the right dlPFC or with bilateral sham stimulation. Primary outcome measure was the proportion of treatment response defined as a Montgomery-Åsberg Depression Rating Scale (MADRS)≤50% compared to baseline. Secondary outcomes comprised response and remission rates of the Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI).
A larger number of responders were found in the cTBS (n=9) compared to the sham-stimulation (n=4) group (odds ratio: 3.86; Wald χ(2)=3.9, p=0.048). On secondary endpoint analysis, patient-reported outcome as assessed by the BDI, pointed towards a higher rate of remitters in the cTBS (n=6) than in the sham (n=1) group (odds ratio: 9; Wald χ(2)=3.5, p=0.061).
With regard to the pilot character of the study and the small sample size, the results have to be considered as preliminary.
These findings provide first evidence that six weeks treatment of MDD with iTBS to the left and cTBS to the right dlPFC for six weeks is safe, feasible and superior to sham stimulation applied add-on to pharmacological and psychotherapeutic treatment.
Eating disorders (ED) are chronic and sometimes deadly illnesses. Existing treatments have limited proven efficacy, especially in the case of adults with anorexia nervosa (AN). Emerging neural models of ED provide a rationale for more targeted, brain-directed interventions.
This systematic review has examined the effects of neuromodulation techniques on eating behaviours and body weight and assessed their potential for therapeutic use in ED.
All articles in PubMed, PsychInfo and Web of Knowledge were considered and screened against a priori inclusion/exclusion criteria. The effects of repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, vagus nerve stimulation (VNS) and deep brain stimulation (DBS) were examined across studies in ED samples, other psychiatric and neurological disorders, and animal models.
Sixty studies were identified. There is evidence for ED symptom reduction following rTMS and DBS in both AN and bulimia nervosa. Findings from studies of other psychiatric and neurological disorders and from animal studies demonstrate that increases in food intake and body weight can be achieved following DBS and that VNS has potential value as a means of controlling eating and inducing weight loss.
Neuromodulation tools have potential for reducing ED symptomatology and related behaviours, and for altering food intake and body weight. In response to such findings, and emerging neural models of ED, treatment approaches are highly unlikely to remain 'brainless'. More research is required to evaluate the potential of neuromodulation procedures for improving long-term outcomes in ED. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.
Although the majority of randomised controlled trials suggest that major depressive disorder (MDD, major depression) and treatment-resistant depression can be effectively treated by applying either high- (HF) or low-frequency (LF) repetitive transcranial magnetic stimulation (rTMS) to the left and right dorsolateral prefrontal cortex (DLPFC), respectively, it is not clear which rTMS approach is more effective or safer. This systematic review and meta-analysis was conducted on randomised controlled trials on HF and LF rTMS applied to the left and right DLPFC, respectively, for the treatment of MDD. Eight randomised controlled trials composed of 249 patients were selected to compare the effects of LF (≤1Hz) rTMS over the right DLPFC to HF (10-20Hz) rTMS over the left DLPFC. The therapeutic effects of both approaches were similar (odds ratio (OR) = 1.15; 95% confidence interval = 0.65-2.03). Dropout analysis based on only two studies was insufficient to draw a conclusion on the tolerability of LF rTMS. The pooled examination demonstrated that both rTMS methods were equally effective therapies for MDD. However, considering that LF right-sided rTMS produces fewer side effects and is more protective against seizures, its clinical applicability shows greater promise and should be explored further.
