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Mitochondrial respiratory capacity in patients with acute episodes of bipolar disorder compared with clinical remission
- A. Giménez-Palomo, M. Guitart-Mampel, A. Meseguer, M. Valentí, L. Bracco, H. Andreu, E. Vieta, G. Garrabou, I. Pacchiarotti
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S80-S81
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Introduction
Bipolar disorder (BD) is a chronic and recurrent disease characterized by acute mood episodes alternated with periods of euthymia. The available literature postulates that a biphasic dysregulation of mitochondrial bioenergetics might be observed in BD.
ObjectivesWe aimed to explore differences in in vivo mitochondrial respiration (1) intra-individually: longitudinally within patients during an acute mood episode of BD and after clinical remission, and (2) inter-individually: between patients with BD on depressive or manic episodes and healthy controls (HC).
MethodsPatients admitted to our acute psychiatric ward with a manic episode or bipolar depression were recruited. Different mitochondrial oxygen consumption rates (OCRs) were assessed during the acute episode (T0) and after clinical remission (T1) in one million of peripheral blood mononuclear cells (PBMC): Routine, Leak, ETC and Rox. They were measured as picomoles of oxygen per million cells (pmol O2/million). This experiment was also conducted in HC. High-resolution respirometry was performed at 37°C by polarographic oxygen sensors in a two-chamber Oxygraph-2k system. Manic and depressive symptoms were assessed using standardized psychometric scales. Oxygen consumption capacity was compared (1) intra-individually, during acute episodes and after clinical remission, and (2) inter-individually, during acute manic and depressive episodes, and in HC. Statistical analyses were performed with SPSS, GraphPad and R Statistics.
Results20 patients with BD (15 manic, 5 depressed) and 10 HC were included. A significant increase in the maximal oxygen consumption capacity (ETC) was observed in clinical remission (27.4 ± 17.4) compared to the acute episodes (21.1 ± 11.7, p = 0.001), which remained significant after subtracting Rox from the other rates (p = 0.001). At T1, patients admitted with a manic episode tended to show higher mean ETC (31.2 ± 18.7) compared with T0 (24.1 ± 12.0, p = 0.074); the tendency persisted after Rox subtraction (p = 0.076). Patients admitted with a depressive episode also showed higher ETC means in T1 (16.3 ± 3.8) compared to T0 (12.1 ± 3.4), but there were not significant differences (p = 0.231). When HC, manic and depressive patients at T0 were compared between them, significant differences were observed in ETC (H =8.5; p =0.014) and Rox (H =13.8; p = 0.001). After Rox deduction, differences in ETC remained (H =11.7; p = 0.003). Individuals with bipolar depression showed lower ETC rates (12.1 ± 3.4) than those with a manic episode (24.1 ± 12.0; t = -3.5, p = 0.003), which was also found after Rox deduction (p = 0.001).
ConclusionsIn both manic and depressive episodes in BD, mitochondrial respiration might be reduced and increase after clinical remission. Further studies with larger samples will allow to confirm these results and also to identify potential mitochondrial state-dependent biomarkers.
Disclosure of InterestA. Giménez-Palomo Grant / Research support from: AGP is supported by a Rio Hortega 2021 grant (CM21/00094) from the Spanish Ministry of Health financed by ISCIII and cofinanced by Fondo Social Europeo Plus (FSE+)., M. Guitart-Mampel: None Declared, A. Meseguer: None Declared, M. Valentí: None Declared, L. Bracco: None Declared, H. Andreu: None Declared, E. Vieta: None Declared, G. Garrabou: None Declared, I. Pacchiarotti: None Declared
Impact of COVID-19 pandemic on psychiatric emergency care in a general hospital
- J. M. Rodríguez Capilla, A. Rubio Carramiñana, S. Vega Castellote, S. López Fernández, I. Arilla Herrera, J. M. Almenara Galdeano, A. Mora Prat, M. Campillo Benito, J. Albero Garcia, A. Valderrey Ratia, A. Grau Peñas, C. Pastor Fernández, M. Moreno Monzó, J. Guitart Gil, J. Martínez Raga, C. Knecht
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S405-S406
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Introduction
The SARS-CoV-2 pandemic has produced an unprecedented clinical situation, causing a direct and indirect impact on the physical and mental health of the population. In Spain, between March 15 and June 21 of 2020, it was decreed a home confinement that caused the interruption of the daily life of millions of people. However, there are few studies that analyze the changes produced in psychiatric care in the Emergency Department (ED).
ObjectivesTo analyze the changes produced in psychiatric emergencies, subanalysing paediatric population, during the first year of the pandemic (COV1/Y-COV1) compared to the previous year (NOCOV/Y-NOCOV1). To analyze the clinical features of patients attended during the lockdown period of the pandemic (LOCK) and compare it to the period of the pandemic after the lockdown (NOLOCK).
MethodsThrough the registry of computerized medical records, patients who attended the psychiatric hospital emergency department between 03/01/2019 and 02/28/2021 were identified. We also identified all attendances from 15/03 to 21/06 in 2019 and in 2020 to obtain variables from the lockdown period.
ResultsDuring period of this study, 2694 psychiatric visits made in the ED (1744 patients - 54.3% women, and 69.5% were between 25 and 64 years-), 1537 in NOCOV and 1157 in COV1. Significant differences were found between COV1 and NOCOV in sociodemographic variables, such as employment status and number of offspring. At a clinical level, in COV1, we observed an increase in attendance due to heteroaggressive behaviors, mania, insomnia and problems due to substance use. An increase in the prescription and/or modification of treatment was observed (59.3% vs 54.3%). During COV1, in terms of discharge follow-up in the month following the ED visit, telematic assistance increased (11.4% vs. 5.3%). During the period of study, 282 ED attendances were performed, 153 in Y-NOCOV and 129 in Y-COV1. At a clinical level, during Y-COV1, a decrease in attendances related to substance use was found significant. The sub-analysis carried out for LOCK and NOLOCK yields similar data to those obtained in the COV1 vs. NOCOV1 comparison. During lockdown, the face-to-face follow-up in the month following the ED was significantly lower (39,5% vs 57,1%) regarding telematic follow-up (24,4% vs 5,8%) In this period, an increase of adolescents without previous mental health follow-up was observed (44% LOCK vs. 22% NOLOCK).
ConclusionsOur work supports the hypothesis that the COVID-19 pandemic caused a change in psychiatric care in the ED. It also shows how lockdown changed the attendance in psychiatric emergencies, and also in the later community care attendance. Changes are detected in emergency care for adolescents during the pandemic compared to the previous year. Strikingly, our study does not reflect a quantitative increase in the demand. It would be of interest to continue collecting data after the time of the present project.
Disclosure of InterestNone Declared
Bioenergetic changes and mitochondrial dysfunction in mania versus euthymia in bipolar disorder type I
- A. Giménez-Palomo, M. Guitart-Mampel, G. Garrabou, X. Alsina-Restoy, A. Meseguer, L. Colomer, G. Roqué, F. J. García-García, E. Tobías, J. Moisés, M. Valentí, E. Vieta, I. Pacchiarotti
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S692-S693
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Introduction
Current evidence has hypothesized the involvement of mitochondrial dysfunction during the acute episodes of BD compared to symptomatic remission. So far, no studies have compared mitochondrial and bioenergetic functions both in-vivo (respiratory parameters) and ex-vivo (cellular respiration) in different phases of the disease in the same individuals.
ObjectivesThis multidisciplinary pilot study aims at assessing bioenergetic and mitochondrial intra-individual differences between manic and euthymic states.
MethodsFour patients with a manic episode admitted to our acute psychiatric ward were recruited. Bioenergetic parameters were measured at admission (T0) and after symptomatic remission (T1).
At admission (T0) and before discharge (T1), HAMD and YMRS total scores were obtained. For the assessment of cellular respiration, polymorphonuclear cells were obtained by a Ficoll density gradient centrifugation procedure. To determine oxygen consumption (at T0 and T1), a million of living peripheral blood mononuclear cells (PBMC) were used. High-resolution respirometry was performed at 37°C by polarographic oxygen sensors in a two-chamber Oxygraph-2k system.
Specific oxygen uptakes (Routine: basal oxygen consumption; Proton Leak: oxygen consumption not coupled to ATP synthesis; and ETC: maximal capacity of the electron transport chain) rates were obtained using mitochondrial chain inhibitors and uncouplers. Oxygen consumption was normalized for protein concentration. Results are expressed as picomoles of oxygen per millilitre (pmol O2/s*μg prot).
Also, a constant work rate exercise test was performed on a cycle ergometer and basal and effort respiratory variables were measured.
Statistical analysis was performed with the SPSS v. 25.0 and GraphPad. Results were expressed as means and SD. Nonparametric tests (Mann–Whitney, Pearson) were used to determine differences (significant at p value <0.05).
ResultsOne patient was a man and three patients were women, with a mean age of 28 years old. HAMD initial and final mean scores were 11.0 and 7.0, and mean YMRS scores were 21.5 and 7.0 respectively.
Results from mitochondrial oxygen consumption revealed that mean basal oxygen consumption tended to be higher in T1 (0.98±0.45) than in T0, and maximal respiratory capacity was significantly increased in T1 (2.26±0.33; p=0.028) compared to T0.
Mean lactate levels and pH levels were similar in T0 and T1. Scales scores were not correlated to different pH or lactate changes after the effort task. Higher initial oxygen consumption was significantly correlated to higher maximal capacity (p<0.05) in T0 and T1.
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ConclusionsOur preliminary results suggest that mania could imply lower oxygen consumption capacity, which should be confirmed in future studies. A bigger study is planned to determine changes in bioenergetic patterns and capacity for aerobic response in manic and depressive episodes.
Disclosure of InterestNone Declared
1840 – Pharmacokinetics Of Lithium During Delivery And In The Neonatal Period. a Preliminary Data
- M. Guitart, M.L. Imaz, D. Soy, M. Torra, A. González-Rodríguez, S. Hernández, C. Hernández Rambla, C. Soler, A. Torres, L. Garcia-Esteve
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- Journal:
- European Psychiatry / Volume 28 / Issue S1 / 2013
- Published online by Cambridge University Press:
- 15 April 2020, 28-E1092
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Introduction
Lithium has been used in the treatment of bipolar disorder in pregnant women. However, information on the pharmacokinetics of lithium during perinatal period is scarce.
ObjectivesTo study pharmacokinetics of lithium during delivery and in the neonatal period.
MethodsA prospective, observational and naturalistic study was conducted at the PERINATAL PSYCHIATRY PROGRAM CLÍNIC-BARCELONA, from 2005 to 2012. We included all consecutive cases of pregnant women with bipolar disorder I or II (n = 22), and on maintenance treatment with lithium monotherapy (n = 13) or polytherapy (n = 9) during pregnancy who elected artificial feeding. Lithium plasma concentrations in maternal blood and umbilical cord were detected. Lithium plasma concentrations in infants (n = 16) at delivery and in the neonatal period were obtained to calculate elimination half-life, which was estimated by lineal regression. Technique: AVL 9180 electrolyte analyser using a lithium-selective electrode (detection limit =0.10 mEq/L).
ResultsWomen did not fulfil diabetes criteria pre-pregnancy and during pregnancy. Attending to neonatal outcomes, infants exposed to polytherapy had a higher weight at birth (percentils) than those exposed to lithium alone [53.38 (33.40) vs. 70.22 (26.25)]. No statistically significant differences were found in umbilical cord:maternal plasma concentration ratio between those treated with lithium monotherapy and women treated with polytherapy (1.05 vs. 1.08). The lithium mean elimination half-life (SD) in infants was 6.73 (9.12) days.
ConclusionsLithium crosses placental barrier almost completely. Elimination half-life in neonates exposed to lithium in utero was 6.73 days. Moreover, lithium treatment during pregnancy requires therapeutics monitoring in exposed dyads.
Coping Strategies and Postpartum Depressive Symptoms: a Structural Equation Modelling Approach
- A. Gutiérrez-Zotes, J. Labad, R. Martín-Santos, L. García-Esteve, E. Gelabert, M. Jover, R. Guillamat, F. Mayoral, I. Gornemann, F. Canellas, M. Gratacós, M. Guitart, M. Roca, J. Costas, J. Luis Ivorra, R. Navinés, Y. de Diego-Otero, E. Vilella, J. Sanjuan
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- European Psychiatry / Volume 30 / Issue 6 / September 2015
- Published online by Cambridge University Press:
- 30 June 2015, pp. 701-708
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Background
Variables such as the mother's personality, social support, coping strategies and stressful events have been described as risk factors for postpartum depression. Structural Equation Modelling (SEM) analysis was used to examine whether neuroticism, perceived social support, perceived life events, and coping strategies are associated with postpartum depressive symptoms at the 8th and 32nd weeks.
MethodsA total of 1626 pregnant women participated in a longitudinal study. Different evaluations were performed 8 and 32 weeks after delivery. Several measures were used: the Edinburgh Postnatal Depression Scale (EPDS), the Diagnostic Interview for Genetic Studies (DIGS), the Eysenck Personality Questionnaire (EPQ-RS), the St. Paul Ramsey life events scale and the Duke-UNC Functional Social Support Questionnaire. The brief COPE scale was used to measure coping strategies. SEM analysis was conducted for all women and in those women with a clinical diagnosis of postpartum depression.
ResultsPassive coping strategies were associated with postpartum depressive symptoms at both visits (8th and 32nd weeks). Neuroticism was associated with more passive coping strategies and less active coping strategies. Neuroticism and life stress were positively correlated, and social support was negatively correlated with life stress and neuroticism.
ConclusionsEarly identification of potential risk for symptomatology of depression postpartum should include assessment of neuroticism, life events, social support and coping strategies.
Contributors
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- By W. Neil Adger, Jeroen Aerts, Armando Apan, Jessica Ayers, Jon Barnett, Juan F. Barrera, Simon P. J. Batterbury, Linda C. Botterill, Sarah Boulter, Edwin Castellanos, Declan Conway, Gustavo Cruz-Bello, W. Priyan, S. Dias, Markus G. Donat, Stephen Dovers, Thomas E. Downing, Hallie Eakin, C. J. Fotheringham, Andrew W. Garcia, Marisa C. Goulden, Daniela Guitart, John Handmer, Katharine Haynes, Sam S. L. Hettiarachchi, Saleemul Huq, Jiang Tong, David John Karoly, Jon E. Keeley, Diane Keogh, David King, Zbigniew W. Kundzewicz, Timothy M. Kusky, Karine Laaidi, Alain Le Tertre, Gregor C. Leckebusch, Matthew Mason, David M. Mills, Helda Morales, Michael J. Mortimore, Colette Mortreux, Karen O’Brien, Jean Palutikof, Mathilde Pascal, Bimal K. Paul, Munshi K. Rahman, William D. Snook, Su Buda, Alexandra D. Syphard, Melanie Thomas, Madeleine C. Thomson, Uwe Ulbrich, Pier Vellinga, George Walker, Joshua Whittaker
- Edited by Sarah Boulter, Griffith University, Queensland, Jean Palutikof, Griffith University, Queensland, David John Karoly, University of Melbourne, Daniela Guitart, Griffith University, Queensland
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- Natural Disasters and Adaptation to Climate Change
- Published online:
- 05 October 2013
- Print publication:
- 14 October 2013, pp ix-xii
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Research Letter: Is neuroticism a risk factor for postpartum depression?
- R. MARTÍN-SANTOS, E. GELABERT, S. SUBIRÀ, A. GUTIERREZ-ZOTES, K. LANGORH, M. JOVER, M. TORRENS, R. GUILLAMAT, F. MAYORAL, F. CANELLAS, J. L. IBORRA, M. GRATACOS, J. COSTAS, I. GORNEMANN, R. NAVINÉS, M. GUITART, M. ROCA, R. DE FRUTOS, E. VILELLA, M. VALDÉS, L. GARCÍA ESTEVE, J. SANJUAN
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- Journal:
- Psychological Medicine / Volume 42 / Issue 7 / July 2012
- Published online by Cambridge University Press:
- 16 April 2012, pp. 1559-1565
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Mood changes after delivery: role of the serotonin transporter gene
- J. Sanjuan, R. Martin-Santos, L. Garcia-Esteve, J. M. Carot, R. Guillamat, A. Gutierrez-Zotes, I. Gornemann, F. Canellas, E. Baca-Garcia, M. Jover, R. Navines, V. Valles, E. Vilella, Y. de Diego, J. A. Castro, J. L. Ivorra, E. Gelabert, M. Guitart, A. Labad, F. Mayoral, M. Roca, M. Gratacos, J. Costas, J. van Os, R. de Frutos
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- Journal:
- The British Journal of Psychiatry / Volume 193 / Issue 5 / November 2008
- Published online by Cambridge University Press:
- 02 January 2018, pp. 383-388
- Print publication:
- November 2008
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Background
Polymorphic variations in the serotonin transporter gene (5-HTT) moderate the depressogenic effects of tryptophan depletion. After childbirth there is a sharp reduction in brain tryptophan availability, thus polymorphic variations in 5-HTT may play a similar role in the post-partum period.
AimsTo study the role of 5-HTT polymorphic variations in mood changes after delivery.
MethodOne thousand, eight hundred and four depression-free Spanish women were studied post-partum. We evaluated depressive symptoms at 2–3 days, 8 weeks and 32 weeks post-partum. We used diagnostic interview to confirm major depression for all probable cases. Based on two polymorphisms of 5-HTT (5-HTTLPR and STin2 VNTR), three genotype combinations were created to reflect different levels of 5-HTT expression.
ResultsOne hundred and seventy-three women (12.7%) experienced major depression during the 32-week post-partum period. Depressive symptoms were associated with the high-expression 5-HTT genotypes in a dose–response fashion at 8 weeks post-partum, but not at 32 weeks.
ConclusionsHigh-expression 5-HTT genotypes may render women more vulnerable to depressive symptoms after childbirth.