Male Bipolar Patients Research Articles

Elevated homocysteine levels in euthymic bipolar disorder patients showing functional deterioration.

Previous studies have found elevated plasma homocysteine levels in schizophrenic patients. This study examined homocysteine levels in euthymic bipolar patients. Homocysteine levels in 41 euthymic outpatients with bipolar disorder (DSM IV) were compared with 305 comparison subjects from a large employee health screening program. Homocysteine levels were assessed using high-pressure liquid chromatography by fluorescence detection following labeling of homocysteine with monobromobimane. Functional deterioration in patients was rated as 'present' or 'absent' by consensus of two treating clinicians. Data were analyzed by two-way (sex, patient versus control) ANCOVA, with age as the covariant. Significant effects were found for age (p < 0.001) and for sex (p < 0.001) and a significant two-way interaction was found for group by sex (p < 0.001). One-way (by group) ANCOVAs were then performed separately for each sex. For the male subjects, a main effect was found for group (p = 0.001) and for age (p < 0.001): young male bipolar patients have higher homocysteine levels than controls. Among the females, bipolar patients had homocysteine levels, which were lower than controls across all age groups (p < 0.05) with homocysteine levels increasing with age for both groups (p < 0.001). ANCOVA, which divided subjects into three groups - bipolar patients with and without functional deterioration versus comparison subjects - found a significant group by sex interaction (p < 0.05). Sheffe'post-hoc comparisons revealed that among the male subjects, bipolar patients showing deterioration had homocysteine levels which were significantly higher than those of comparison subjects, while bipolar subjects without deterioration had homocysteine levels which were almost identical to the comparison subjects. Bipolar patients who show functional deterioration have plasma levels of homocysteine, which are significantly elevated as compared with controls.

Aspects of the Suicidal Career in Severe Depression: A Comparison Between Attempts in Suicides and Controls

Suicide attempts in the long term course of illness were investigated in 89 suicides with a primary severe depression/melancholia and in matched controls. Multiaxial ratings at index admission between 1956 and 1969 enabled the selection of patients. These patients were tracked to January 1, 1984. A blind record evaluation was performed. Suicide attempts were more common among suicides than controls. General characteristics of attempts, such as severity, the use of a violent method, and repetition did not differentiate suicides from controls. Rather, there were differences in the pattern of suicide attempts. In suicides, only, re-attempts were related to number of episodes of mood disorder. Controls more often made re-attempts after a stressful life event. Serious attempts occurred early in the course of suicide attempts in female suicides, in contrast to controls. There was a correlation between the occurrence of a suicide attempt and completed suicide among male unipolar patients and female bipolar patients.

Differential frontal activation in schizophrenia and bipolar illness during verbal fluency

Introduction: The precise nature of frontal lobe dysfunction in schizophrenia remains unclear. We have previously demonstrated, using fMRI, a task-specific attenuation of frontal activation in schizophrenic patients. By using an identical methodology in matched bipolar subjects, we sought to determine whether this finding is specific to schizophrenia or a correlate of psychosis in general. Method: Five dextral male bipolar patients and matching groups of schizophrenic subjects and controls were studied using fMRI. Echoplanar images were acquired while subjects performed two paced tasks: covert verbal fluency and a semantic decision task. Generic brain activation maps were constructed from individual images by sinusoidal regression analysis. Between-group differences in the mean power of experimental response were identified on a voxel-wise basis by an analysis of variance (ANOVA). Results: The bipolar patients showed extensive prefrontal activation during verbal fluency which was significantly greater than in controls. There was no difference in the prefrontal BOLD response during the semantic decision task. Conclusions: These data indicate that bipolar patients show a strikingly different pattern of frontal responses compared to those with schizophrenia and provide further evidence that abnormal frontal activation in psychotic disorders is more apparent during verbal fluency than semantic decision.

Effects of short and long-term lithium treatment on serum prolactin levels in patients with bipolar affective disorder

1. In this study, the authors sought to test the hypothesis that Li (lithium) treatment can induce alterations in PRL (prolactin) secretion in euthymic bipolar patients compared to controls and that short and long-term administration can lead to prolactin changes different from each other. 2. Twenty euthymic bipolar male patients on long-term lithium carbonate treatment for more than 6 months and 15 euthymic male bipolar patients on short-term Li treatment for shorter than 6 months who met DSM-IV criteria for bipolar affective disorder were included in the study. Seventeen age-matched healthy control males were chosen among the hospital staff. The mean± SD duration of Li use was 68.93±46.31 months in the long-term lithium-treated group and 4±3.42 months in the short-term lithium-treated group. 3. Serum PRL values in the long-term Li-treated group were significantly lower than those of the control group, while there was no significant difference in PRL values between the short-term Li-treated group and the control group. 4. Our study documents that short-term (<6 months) Li treatment does not induce any significant changes in PRL release in bipolar patients compared to normal control subjects while long-term Li treatment (>6 months) lead to lower PRL release compared to the controls. Furthermore, PRL has wide intra-interindividual and circadian variations Li-PRL relationship seems to be very complex and probably depends on various interactions among dopamine, serotonin and PRL. Therefore, further studies are needed to confirm the data.

Relationship of childhood physical and sexual abuse to adult bipolar disorder.

To characterize whether adult depressives with either bipolar or unipolar disorder differ in the prevalence of childhood sexual or physical abuse. The investigators reviewed data from patients who were evaluated over a 2-year period by a semi-structured clinical interview. In total, 333 cases with a bipolar or unipolar diagnosis were included in the present study. A childhood history of abuse, in particular sexual abuse, was significantly more frequent in bipolar subjects compared with unipolar subjects. Consistent with previous studies, women reported higher rates of sexual abuse than men, although no interaction by diagnosis was shown. Sexual abuse incidence in male samples was markedly dissimilar, with male bipolar subjects demonstrating a significantly increased rate of sexual abuse and combined sexual and physical abuse compared with unipolar male subjects. The increased incidence of sexual abuse in women supports growing evidence of gender differences in sexual abuse among adult depressives. In contrast to literature reports, the finding that male bipolar patients have significantly increased rates of sexual abuse histories suggests differences in psychiatric depressive subgroups. This result may reflect the particular characteristics of our cohort (treatment resistant, privately insured, and educated). Further work will aid in characterizing sexual abuse prevalence in other male bipolar samples.

The dexamethasone/corticotropin-releasing hormone test in depression in bipolar and unipolar affective illness

The combined dexamethasone/corticotropin-releasing hormone (DEX/CRH) test was performed in forty patients with depression (12 male, 28 female), aged 20–68 years, in the course of affective illness (16 bipolar, 24 unipolar) both during acute depressive episode and in remission. The results were compared with those of 20 healthy control subjects (10 male, 10 female), aged 22–52 years. During acute depressive episode, cortisol concentration at 16 h after dexamethasone, 1.5 mg, and cortisol release after subsequent infusion of CRH, 100 μg, were significantly elevated in bipolar patients compared with unipolar ones and with control subjects. Patients with multiple episodes of unipolar depression exhibited greater cortisol levels after CRH than control subjects. In remission, significantly higher cortisol concentrations measured at 30 min–1 h after CRH infusion were found in bipolar than in unipolar patients. Male bipolar patients had significantly higher cortisol level than bipolar females before and at 1.5 h after CRH. First episode unipolar patients during remission had lower levels of cortisol than control subjects before and at 1.5 h after CRH. Correlation between the magnitude of cortisol response and age was found within unipolar depressed patients but not in bipolar ones. On the other hand, correlation of test results with intensity of depression measured by Hamilton scale as well as with insomnia and anxiety subscales was more robust in bipolar subjects than in unipolar ones. It is concluded that the dysregulation of hypothalamic-pituitary-adrenal (HPA) axis activity, detected by DEX/CRH test is significantly more marked in patients with depression in the course of bipolar affective illness than in unipolar depression. Within unipolar depression, this dysregulation may increase with the time course of the illness.

Divalproex Sodium Treatment in Elderly Male Bipolar Patients

Divalproex Sodium Treatment in Elderly Male Bipolar Patients

Ventricular abnormalities in affective disorder: clinical and demographic correlates

Ventricle-brain ratio was measured by CT scan in 24 bipolar patients, 27 unipolar patients with major depression, 108 schizophrenic patients, and 75 normal control subjects. The male bipolar patients had significantly larger ventricles, but the depressive patients did not. The findings suggest the possibility that ventricular enlargement in bipolar patients is independent of age, as it appears to be in schizophrenia, whereas in depressed patients it may be related to the aging process. Ventricular enlargement in bipolar patients was not related to relevant clinical correlates, such as response to treatment, history of substance abuse, history of ECT, or cognitive impairment.

Erythrocyte cation transport in endogenous depression: clinical and psychophysiological correlates.

Clinical (psychometric), psychophysiological and biochemical (erythrocyte membrane transport) variables were studied in 44 patients with endogenous depression (unipolar/bipolar) during acute depressive episode and in remission. All parameters studied showed paralleled and unidirectional changes when depression was compared with remission period. During a depressive episode, unipolar patients had greater intensity of depression than bipolar patients. Ouabain-dependent sodium fluxes were significantly lower in female than in male patients during depression than in remission. In male bipolar patients, the indexes of active transport in erythrocytes showed significant correlations with clinical ratings and with results of psychophysiological tests. The results point to a possible relationship between various levels of physiological functioning in endogenous depression. This suggests a generalised "background" defect of energy-dependent membrane transport pertaining to both erythrocytes and nerve cells, which may be linked to disturbances of activational processes within the central nervous system.

Postpartum psychoses in female and male bipolar manic-depressive patients.

Bipolar manic-depressive women are considered a special risk for recurrence of a childbirth-related affective episode. In a chart study of 40 fathers who are former bipolar patients, 21 had histories of an affective episode in proximity to a wife's pregnancy. When these bipolar fathers were compared with the 19 for whom no such episodes were recorded, differences were found on several parameters. Therapeutic implications of the findings are considered, and recommendations for further study are offered.

Urinary MHPG in Subgroups of Depressed Patients and Normal Controls

3-Methoxy-4-hydroxyphenylglycol (MHPG), the urinary metabolite thought best to reflect brain norepinephrine metabolism, was studied in a large group of hospitalized depressed patients with primary affective disorder and in normal controls, as part of an ongoing effort to evaluate the role of central amine dysfunction in affective illness. Overall there was no difference in MHPG between the depressed patients and controls. Hosever, within the depressed population the bipolar patients excreted significantly less MHPG than the unipolars and, as a group, the male bipolar patients had significantly lower MHPG than male controls. MHPG correlated positively with age, age of onset, rating of anxiety and psychosis and, most importantly, with systolic blood pressure. These data support the concept of biological heterogeneity among individuals with major depressive disorders. However, the relationship between MHPG excretion and various psychological and physiological parameters is both intriguing and complex and warrants careful interpretation.

Suicidal behavior in bipolar manic-depressive patients and their families

There is a high risk of suicidal behavior in patients with primary affective disorder. An extensive investigation in patients with primary affective disorder reported attempted suicide in 26% of bipolar patients and 21% of unipolar patients, the highest rate occurring in female bipolar patients. 1 Woodruff et al. 20 found attempted suicide in 14% of unipolar patients as against 32% of bipolar patients with the highest rate in male bipolar patients. Winokur 18 in a study of bipolar manic depressive patients found that 25% of patients had made at least one suicidal attempt and 70% had made threats of suicide at least some time in their lives. Venkabo Rao 16 reported that suicidal ideas occurred in 75% of patients with recurrent affective disorder. Family studies have also reported a high incidence of suicide in the relatives of patients with affective disorder. 8 Mendlewicz et al. 7 studying a matched group of bipolar probands with and without a family history of manic depressive illness, found high rates of suicide in first and second degree relatives but there was no significant difference in relation to sex or family history. The diagnosis of the relative that suicided was not stated. A study of relatives of patients with primary affective disorder 10 reported that 79% of the suicides in first degree relatives were associated with a diagnosis of probable affective disorder and 10% by a diagnosis of probable alcoholism in the relative. Fathers in index cases were more likely to have committed suicide than mothers. A family history of suicide is considered a major risk factor in assessment of potentially suicidal patients, 13 however, the relationship between attempted suicide in patients and suicide or attempted suicide in relatives has received little attention and the nature and predictability of this association is uncertain. The following report concerns an analysis of suicidal behavior in a population of bipolar manic-depressive patients and the relationship of this attempt to suicide or attempted suicide in their first and second degree relatives.

Transfer of sodium ions across the erythrocyte membrane in manic — Depressive illness: Treatment with lithium carbonate

The efflux of 22Na from erythrocytes was measured in vitro under experimental conditions such that rate constants due to efflux either by active transport, passive diffusion, or exchange diffusion could be calculated. No significant differences were found in the rate constants for 22Na efflux between seven male bipolar depressed patients and eight male control subjects, who had no personal or family history of psychiatric illness. Treatment of patients with lithium carbonate either for less than one week or for 4–5 weeks produced no changes in the rate constants describing the efflux of 22Na from red cells. Also, addition of 1mM LiCl in vitro did not alter the active transport of 22Na from erythrocytes. These data provide no evidence for either an abnormality in 22Na transfer across the red cell membrane of bipolar depressives or an effect of the lithium ion upon such transfer.