P300 event-related potential in euthymic patients with bipolar disorder

https://doi.org/10.1016/j.pnpbp.2008.09.017Get rights and content

Abstract

Auditory P300 event-related potential (ERP) and performance on Sustained Attention were evaluated in 24 euthymic bipolar patients and 38 healthy volunteers. There were no significant differences between groups, and performance in sustained attention had no significant influence in the P300 responses. P300 response might be driven by the presence of mood symptoms.

Introduction

Compared to schizophrenia, there have only been a handful of studies of the P300 event related potential (ERP) component in bipolar disorder, and the relationship of P300 abnormalities and patient state is not well characterized. Muir et al. (1991) reported that patients with bipolar disorder exhibited increase in P300 latency and reduction inP300 amplitude, similar to patients with schizophrenia but not to control subjects. This observation was corroborated by Souza et al. (1995) and Vilela et al. (1999), although it should be noted that, in this last study, a large proportion of the bipolar patients had prominent mood symptoms. There are also reports of reduced P300 amplitude in patients with psychotic mania (Salisbury et al., 1999) and of prolonged P300 latency in patients with manic or mixed episodes (O'Donnell et al., 2004, Strik et al., 1998). Prolonged P300 latency in patients with major depression has been described by some authors (Röschke et al., 1996, Gangadhar et al., 1993), but not by others (Bruder et al., 1991, Swanwick et al., 1996, Hansenne et al., 1994. Salisbury et al. (1998) reported that patients with first-episode schizophrenia had reduced P300 amplitude compared to both patients with first-episode affective psychosis and control subjects. Interestingly, Muir et al. (1991) observed P300 latency prolongation in patients with bipolar disorder and psychotic symptoms but not in patients with unipolar depression, and Santosh et al. (1994) found P300 reduction only in depressed patients with hallucinations. In recent years, Pierson et al. (2000) reported latency prolongation in 19 first-degree relatives of patients with bipolar disorder, and Hall et al. (2007) found a genetic correlation between P300 amplitude reduction and bipolar disorder. A very recent study has shown that bipolar patients with a history of psychosis and their unaffected relatives showed significantly delayed P300 latency compared to controls (Schultze et al., 2008). These observations place P300 on the select list of candidate endophenotypes for bipolar disorder (Lenox et al., 2002), although it is still unclear whether P300 event-related potentials fulfill the requisite of being state independent because, as also occurs in neurocognitive studies of bipolar patients, mood—a crucial confounding factor—is not always monitored.

The main aim of this study was to compare P300 abnormalities in bipolar patients in a strictly defined euthymic state when compared to healthy volunteers of similar characteristics. We also assessed the correlation between P300 abnormalities and sustained attention.

Section snippets

Patients and control subjects

Twenty-four euthymic patients with bipolar disorder were recruited from 3 outpatient clinics. The patients all met the DSM-IV-TR criteria for type I bipolar disorder, and they had been euthymic for the previous three months. Evaluation was completed with the life-time version of the standardised interview Schedule for Affective Disorders and Schizophrenia (SADS, Spitzer et al., 1978). Euthymia was defined as a score of less than 7 on both the Hamilton Rating Scale for Depression (1960) and the

Results

The mean age and proportion of male and female participants were similar in both the study group and the control group (Table 1). The mean (SD) duration of the illness was 18.0 (9.3) years and the mean number of affective episodes were 7.5 (4.7). Mean number of administered drugs was 2.39 (SD 1.22). Regarding the type of drug, 29.1% of patients were taken “mood stabilizers”, 20.8% “mood stabilizers + antipsychotics” and 50.0% “other combinations”.

We observed no differences between the study group

Discussion

Our study of bipolar patients in a strictly defined euthymic state revealed no evidence of the auditory event-related potential abnormalities that have been described in patients with acute mood disturbances (O'Donnell et al., 2004, Salisbury et al., 1999, Strik et al., 1998, Röschke et al., 1996, Gangadhar et al., 1993). There was no significant sustained attention deficit detected in the group of bipolar patients, despite its observation as a marked tendency. This tendency (possibly not

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      History of psychosis was associated with 811 (60.9%) patients. There were more than 3 studies that measured P3a amplitude with an auditory paradigm (Andersson et al., 2008; Hamm et al., 2013; Jahshan et al., 2012; Suazo et al., 2016), P3b amplitude with an auditory paradigm (Andersson et al., 2008; Bersani et al., 2015; Bestelmeyer et al., 2009; Dutt et al., 2012; Ethridge et al., 2015, 2012; Fridberg et al., 2009; Hall et al., 2015a, 2014, 2007; Hall et al., 2009; Hamm et al., 2013; Johannesen et al., 2013; Kaya et al., 2007; Lahera et al., 2009; Muir et al., 1991; O'Donnell et al., 2004; Salisbury et al., 1999; Schulze et al., 2008; Souza et al., 1995; Strik et al., 1998; Suazo et al., 2016; Vuurman et al., 2002), P3b latency with an auditory paradigm (Andersson et al., 2008; Bersani et al., 2015; Bestelmeyer et al., 2009; Dutt et al., 2012; Ethridge et al., 2015, 2012; Fridberg et al., 2009; Hall et al., 2015a, 2014, 2007; Hall et al., 2009; Johannesen et al., 2013; Kaya et al., 2007; Lahera et al., 2009; Muir et al., 1991; O'Donnell et al., 2004; Salisbury et al., 1999; Schulze et al., 2008; Souza et al., 1995; Strik et al., 1998; Vuurman et al., 2002), P3b amplitude with a visual paradigm (Bange and Bathien, 1998; Bestelmeyer, 2012; Bestelmeyer et al., 2009; Di Giorgio Silva et al., 2016; Maekawa et al., 2013; Ryu et al., 2010; Sokhadze et al., 2011), P3b latency with a visual paradigm (Bange and Bathien, 1998; Bestelmeyer, 2012; Bestelmeyer et al., 2009; Di Giorgio Silva et al., 2016; Maekawa et al., 2013; Sokhadze et al., 2011), P3b amplitude with an auditory paradigm in patients who had history of psychosis (Dutt et al., 2012; Ethridge et al., 2015, 2012; Fridberg et al., 2009; Hall et al., 2015a, 2014, 2007; Hall et al., 2009; Hamm et al., 2013; O'Donnell et al., 2004; Salisbury et al., 1999; Schulze et al., 2008; Suazo et al., 2016), P3b latency with an auditory paradigm in patients who had history of psychosis (Dutt et al., 2012; Ethridge et al., 2015, 2012; Fridberg et al., 2009; Hall et al., 2015a, 2014, 2007; Hall et al., 2009; O'Donnell et al., 2004; Salisbury et al., 1999; Schulze et al., 2008), P3b amplitude with an auditory paradigm at euthymic phase (Andersson et al., 2008; Bersani et al., 2015; Bestelmeyer et al., 2009; Dutt et al., 2012; Ethridge et al., 2015, 2012; Hall et al., 2015a, 2014, 2007; Hamm et al., 2013; Kaya et al., 2007; Lahera et al., 2009; Muir et al., 1991; Souza et al., 1995; Suazo et al., 2016; Vuurman et al., 2002), P3b amplitude with a visual paradigm at euthymic phase (Bestelmeyer et al., 2009; Di Giorgio Silva et al., 2016; Maekawa et al., 2013; Sokhadze et al., 2011), P3b latency with an auditory paradigm at euthymic phase (Andersson et al., 2008; Bersani et al., 2015; Bestelmeyer et al., 2009; Dutt et al., 2012; Ethridge et al., 2015, 2012; Hall et al., 2015a, 2014, 2009; Kaya et al., 2007; Lahera et al., 2009; Muir et al., 1991; Souza et al., 1995; Vuurman et al., 2002), P3b latency with a visual paradigm at euthymic phase (Bestelmeyer et al., 2009; Di Giorgio Silva et al., 2016; Maekawa et al., 2013; Sokhadze et al., 2011), P3b amplitude with an auditory paradigm at manic phase (Muir et al., 1991; Salisbury et al., 1999; Strik et al., 1998), P3b latency with an auditory paradigm at manic phase (Muir et al., 1991; Salisbury et al., 1999; Strik et al., 1998), P3b amplitude with an auditory paradigm in patients with BD-I (Bersani et al., 2015; Dutt et al., 2012; Ethridge et al., 2015, 2012; Fridberg et al., 2009; Hall et al., 2015a, 2014, 2007; Hall et al., 2009; Johannesen et al., 2013; Kaya et al., 2007; Lahera et al., 2009; Muir et al., 1991; O'Donnell et al., 2004; Salisbury et al., 1999; Schulze et al., 2008; Souza et al., 1995; Strik et al., 1998; Suazo et al., 2016; Vuurman et al., 2002), P3b amplitude with a visual paradigm in patients with BD-I (Bestelmeyer, 2012; Ryu et al., 2010; Sokhadze et al., 2011), P3b latency with an auditory paradigm in patients with BD-I (Bersani et al., 2015; Dutt et al., 2012; Ethridge et al., 2015, 2012; Fridberg et al., 2009; Hall et al., 2015a, 2014, 2007; Hall et al., 2009; Johannesen et al., 2013; Kaya et al., 2007; Lahera et al., 2009; Muir et al., 1991; O'Donnell et al., 2004; Salisbury et al., 1999; Schulze et al., 2008; Souza et al., 1995; Strik et al., 1998; Vuurman et al., 2002), P3b amplitude with an auditory paradigm in patients with BD-II (Andersson et al., 2008; Bersani et al., 2015; Muir et al., 1991; Vuurman et al., 2002), and P3b latency with an auditory paradigm in patients with BD-II (Andersson et al., 2008; Bersani et al., 2015; Muir et al., 1991). We were not able to conduct meta-analyses of the studies with the other paradigms including P3a amplitude with a visual paradigm, P3a latency whit any paradigm, P3a amplitude or latency with any paradigm in patients with psychosis, euthymic phase, manic phase, depressive phase, BD-I, BD-II, P3b amplitude or latency with a visual paradigm patients with psychosis, manic phase or BD-II, P3b amplitude or latency with any paradigm in patients at depressive phase, P3b latency with visual paradigm in patients with BD-I due to insufficient number of studies.

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      The majority of studies investigating P300 in euthymic BD focused on P3b activity. While most studies found significantly reduced amplitudes in the auditory modality (Muir et al., 1991; Fridberg et al., 2009; Bestelmeyer et al., 2009; Bersani et al., 2015a; Kaya et al., 2007), one study contradicted these findings and demonstrated comparable P3b amplitudes in euthymic bipolar disorder to healthy controls (Lahera et al., 2009). In the visual modality, two studies demonstrated comparable P3b in euthymic BD to healthy controls (Bestelmeyer et al., 2009; Bestelmeyer, 2012), while one study observed reduced P3b amplitudes (Morsel et al., 2014).

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      Previous ERP studies in BD mainly focused on processes relating to allocation of attention to a stimulus. Many studies demonstrated lower P3 amplitudes (Bersani et al., 2015; Fridberg et al., 2009; Salisbury et al., 1999; Hall et al., 2009) in BD compared with healthy controls, yet not all studies corroborated these findings (Lahera et al., 2009; Souza et al., 1995). Importantly, most studies did not investigate inhibitory control in BD, but rather investigated stimulus processing in a standard oddball task where subjects had to respond to the rare stimuli instead of suppressing a response.

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