Biomedical subjects

E Serap Monkul

Publications and source records attributed to E Serap Monkul.

8 recordsLinked to original sources

PubMed2005

Structural brain changes in bipolar disorder using deformation field morphometry.

The objective of this study was to investigate anatomical brain abnormalities in adult bipolar patients using a deformation field morphometry technique. Our sample consisted of 32 right-handed bipolar I patients (men/women=16/16) and 32 right-handed, age and gender matched healthy controls. Deformation field morphometry analysis was performed on three-dimensional spoiled gradient recalled acquisition images. We found gender-specific structural differences between bipolar patients and healthy individuals. Bipolar men had significantly larger lateral ventricles (especially pronounced in the left hemisphere) and smaller left dorsolateral prefrontal cortex than healthy male controls. Our results are complementary to the findings of functional imaging and post-mortem studies that demonstrate abnormalities in the dorsolateral prefrontal cortex in bipolar patients.

Adolescent↗

PubMed2005

Attention deficits in bipolar disorder: a comparison based on the Continuous Performance Test.

Although attentional deficits measured by Continuous Performance Tests (CPTs) have been observed in patients with bipolar disorder, their relationship with clinical state is not well understood. The identical pairs Continuous Performance Test (CPT-IP) shows particular promise as a measure sensitive to trait abnormalities in attentional function. In this study, the CPT-IP was administered to 27 patients with bipolar disorder (22 type I, 5 type II) and 25 demographically matched healthy comparison subjects, in order to assess the presence and nature of attentional deficits as a function of mood symptoms. Results showed significantly impaired CPT performance in bipolar patients compared with healthy subjects. Patients made fewer hits (p < 0.01), were slower to respond (p < 0.007), and had poorer discrimination (p < 0.05) and bias (p < 0.006) than comparison subjects. Severity of mania and depression was not correlated with any of the CPT measures. Our findings suggest that attentional dysfunction may be a trait deficit associated with bipolar illness. However, within-subjects longitudinal studies examining fluctuations in performance over time are needed.

Adult↗

PubMed2005

Anatomical MRI abnormalities in bipolar disorder: do they exist and do they progress?

AIM: Morphometric brain imaging studies have revealed regional brain abnormalities in patients with bipolar disorder, which may play a role in illness pathophysiology. It is not known whether such changes are of neurodevelopmental, neurodegenerative, or combined origin. We reviewed the anatomical brain imaging literature in bipolar disorder, in an attempt to determine whether there is evidence to suggest that such abnormalities are progressive. METHOD: Literature searches were conducted using MEDLINE for the period from 1966 to June 2004, using specific key words; bipolar disorder and the names of the individual brain structures. Papers were selected according to their salience in relation to whether reported changes are progressive. RESULTS: Available findings suggest reduced grey matter in prefrontal brain regions such as anterior cingulate and subgenual prefrontal cortex, and abnormalities in amygdala size in adult and paediatric bipolar patients. White matter hyperintensities, which are non-specific abnormalities, are also common in bipolar patients. Bipolar patients may lose more brain grey matter by ageing. There is also evidence for impaired myelination of the corpus callosum in bipolar disorder. Lithium may reverse or prevent grey matter prefrontal cortex abnormalities in bipolar patients by its neuroprotective effects. CONCLUSIONS: Both early developmental and later neurodegenerative processes may play a role in the pathophysiology of bipolar disorder. Findings from anatomical brain imaging studies implicate key regions involved in mood regulation. The evidence for the progressive nature of this illness is tentative, as no follow-up study with bipolar patients has been reported to this date.

Amygdala↗

PubMed2004

Abnormal left superior temporal gyrus volumes in children and adolescents with bipolar disorder: a magnetic resonance imaging study.

Abnormalities in left superior temporal gyrus (STG) have been reported in adult bipolar patients. However, it is not known whether such abnormalities are already present early in the course of this illness. Magnetic resonance imaging (MRI) morphometric analysis of STG was performed in 16 DSM-IV children and adolescents with bipolar disorder (mean age+/-SD 15.5+/-3.4 years) and 21 healthy controls (mean age+/-SD 16.9+/-3.8 years). Subjects underwent a 3D spoiled gradient recalled acquisition MRI examination. Using analysis of covariance with age, gender and intra-cranial brain volume as covariates, we found significantly smaller left total STG volumes in bipolar patients (12.5+/-1.5 cm(3)) compared with healthy controls (13.6+/-2.5 cm(3)) (F=4.45, d.f.=1, 32, P=0.04). This difference was accounted for by significantly smaller left and right STG white matter volumes in bipolar patients. Decreased white matter connections may be the core of abnormalities in STG, which is an important region for speech, language and communication, and could possibly underlie neurocognitive deficits present in bipolar patients.

Adolescent↗

PubMed2004

Panic Disorder Severity Scale: reliability and validity of the Turkish version.

We assessed the reliability and validity of the Turkish version of the seven-item Panic Disorder Severity Scale (PDSS). We recruited 174 subjects, including 104 with current DSM-IV panic disorder with (n=76) or without(n=28)agoraphobia, 14 with a major depressive episode, 24 with a non-panic anxiety disorder, and 32 healthy controls. Assessment instruments were Panic Disorder Severity Scale, Panic and Agoraphobia Scale, both the observer-rated (P&Ao) and self-rating (P& Asr); Clinical Global Impression Scale (CGI); Hamilton Anxiety Scale, and Beck Depression Inventory. We repeated the measures for a group of panic disorder patients (n = 51) after 4 weeks to assess test-retest reliability. The internal consistency (Cronbach's alpha) of the PDSS was .92-94. The inter-rater correlation coefficient was .79. The test-retest correlation coefficient after 4 weeks was .63. In discriminant validity analyses, the highest correlation for PDSS was with P&Ao, P&Asr (r=.87 and.87, respectively) and CGI (r=.76) and the lowest with Beck Depression Inventory (r=.29). The cut-off point was six/seven, associated with high sensitivity (99%) and specificity (98%). This study confirmed the objectivity, reliability and validity of the Turkish version of the PDSS.

Adult↗

PubMed2004

[Magnetic resonance spectroscopy (MRS) applications in bipolar disorder].

OBJECTIVE: Magnetic resonance spectroscopy (MRS) is a noninvasive in vivo imaging technique that can directly assess the living biochemistry in localized brain regions without involving ionizing radiation. This review provides a brief description of spectroscopy, followed by a literature review of the key spectroscopy findings in bipolar disorder. METHOD: We conducted a Medline literature review for the period 1966-2003, and included all the controlled studies using MRS in bipolar disorder, as well as other relevant papers with important findings. RESULTS: Studies showed an increase in choline (Cho) levels in basal ganglia and cingulate, and a decrease in dorsolateral prefrontal cortical (DLPFC) and hippocampal N-acetyl aspartate (NAA) levels. Frontal lobe phosphomonoester (PME) levels were decreased in the euthymic state and were higher in the manic and depressive states. Myoinositol (mI) was reduced by lithium treatment and this decrease was positively correlated with treatment response. CONCLUSION: The findings from MRS studies of bipolar disorder demonstrate alterations in the neurochemistry of key brain regions participating in the fronto-limbic-subcortical circuits implicated in the pathophysiology of the disorder. These findings suggest abnormalities of the membrane phospholipid metabolism, cellular energy metabolism and myelin formation /maintenance in the DLPFC, cingulate, hippocampus and basal ganglia in bipolar disorder. Further studies are needed to distinguish between the changes that are due to the pathophysiology of bipolar disorder and those due to the effects of medications.

Bipolar Disorder↗

PubMed2004

[Panic-agoraphobic spectrum].

Current diagnostic classification systems have provided reliable, objective and valid diagnoses of mental disorders. They present both categorical and dichotomous approaches to mental disorders. However, rigid usage of diagnostic criteria may cause high comorbidity rates. Moreover, these classification systems fail to identify subthreshold conditions, atypical signs and symptoms, and personality traits associated with the core symptoms of a given mental disorder. These subclinical manifestations are clinically meaningful in terms of disability and effects on quality of life. For these reasons, many researchers have begun to develop dimensional or spectral approaches for a number of mental disorders. Studies on panic disorder with or without agoraphobia have revealed a substantial clinical heterogeneity. The panic-agoraphobic spectrum concept was defined to overcome these difficulties. This concept includes DSM-IV and ICD-10 diagnostic criteria together with atypical and subthreshold symptoms of panic disorder, and constitutes a broader band of panic and agoraphobia symptoms. The panic-agoraphobic spectrum incorporates eight domains of clinical features: 1) separation sensitivity, 2) panic-like symptoms, 3) stress sensitivity, 4) medication and substance sensitivity, 5) anxious expectation, 6) agoraphobia, 7) illness phobia and hypochondriasis, 8) reassurance orientation. In this article, we reviewed the spectrum conceptualization of panic disorder and agoraphobia, particularly focusing on the domains of the panic-agoraphobic spectrum and their assessment.

Agoraphobia↗

PubMed2003

[Structural magnetic resonance imaging (MRI) studies in bipolar disorder].

To review structural MRI studies in bipolar disorder. A computer-assisted literature search of the Medline Ovid files for the period 1966 to November 2002 was performed, augmented by the use of articles meeting the criteria of this study from recent reviews. The studies included in this review show that there are abnormalities in the regions playing a role in the prefrontal-subcortical circuits that have been implicated in the pathophysiology of bipolar disorder, rather than generalized abnormalities like cerebral volume reduction or ventricular enlargement. The most widely studied and frequently reported finding of T2 signal hyperintensities is not considered to be specific to bipolar disorder. The findings of dorsolateral and subgenual prefrontal cortical volumetric reductions are in agreement with the findings of few neuropathological studies of bipolar disorder and suggest that prefrontal cortex plays an important role in the pathophysiology of the disorder. Among the medial temporal structures, the increase in amygdala volume seems to be specific to bipolar disorder. The findings in structures like the striatum and thalamus are conflicting, due to difficulties in the detailed measuring of the volumes of these structures with current techniques. Bipolar disorder is associated with brain abnormalities detected with structural MRI. Studies integrating structural neuroimaging methods with functional neuroimaging are needed to specifically determine how these abnormalities affect the function of these brain regions.

Bipolar Disorder↗