Bipolar Update: Shared Brain Abnormalities and Common Comorbidities

Patients with mood and anxiety disorders have the same abnormalities in regions of the brain involved in emotional and cognitive control. A meta-analysis was performed to determine whether the clinical overlap of BD, major depressive disorder, post-traumatic stress disorder, and anxiety disorders is reflected at the neurobiological level. The most consistent transdiagnostic abnormalities in task-related brain activity converged in regions primarily associated with inhibitory control and salience processing. The findings may contribute to the development of new treatments that target these regions.

More psychiatric comorbidities are seen in inpatients who have BD than in general inpatients. Most prevalent in a cross-sectional analysis were drug abuse, anxiety disorders, and alcohol abuse. The likelihood of comorbid borderline personality disorders was 7-fold higher in inpatients with BD. More medical comorbidities also were seen, especially hypertension, asthma, diabetes, obesity, and hypothyroidism. The authors called for a collaborative care model for early comorbidity diagnosis and management to improve health-related quality of life.

Measurement of immune response to stress along with cognitive-behavioral therapy (CBT) treatment for adolescent mood disorders was found to be feasible in a preliminary pilot study. Interleukin 6 (IL-6) and IL-12β were sensitive to acute laboratory stress, and there were significant correlations between life stress, inflammation, and depression both pre- and post–CBT group. Inflammation pre-group measured by IL-12 and IL-1β predicted depressive symptoms after treatment. Incorporating psychobiological response to stress induction into treatment planning and outcome evaluation may have clinical utility.

Low levels of self-compassion and nonattachment to self were found in persons with BD in an international randomized controlled trial. Lower self-compassion and nonattachment to self in persons who had BD were associated with greater severity of depression than in those who did not on both self- and clinician-rated scales. Nonattachment to self also was negatively associated with hypo/mania symptomology. The authors concluded that self-compassion and nonattachment to self may be meaningful targets in psychological interventions for persons with BD.

In an investigation of whether vulnerability to BD is linked with sleep disturbances in healthy subjects, higher Hypomanic Personality Scale scores were associated with greater intra-individual sleep variability, more disturbed sleep, and more daytime sleepiness. Core hypomanic features were especially associated with self-reported sleep impairments. The authors suggested that their findings support the assumption of disturbed sleep as a predisposing factor for BD and that sleep improvement is a potential target for early prevention.