Comparison of precipitating factors for mania and partial seizures: Indicative of shared pathophysiology?

Bostock, Emmanuelle C. S.; Kirkby, Kenneth C.; Garry, Michael I.; Taylor, Bruce

doi:10.1016/j.jad.2015.04.057

Cited by 15 publications

(10 citation statements)

References 177 publications

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“…In ADHD, disturbed sleep architecture has been described including shorter REM latencies, reduced REM sleep, and increased delta sleep percentage (88). It should also be noted that sleep deprivation can precipitate mania in bipolar disorder and seizures in epilepsy (89) and can be used as a treatment for depression (90). The specific effects of KD on these mental disorder-related sleep symptoms has not been studied in detail, but interactions are likely and may be possible mediators of a therapeutic effect.…”

Section: Discussionmentioning

confidence: 99%

The Current Status of the Ketogenic Diet in Psychiatry

Bostock

Kirkby

Taylor³

2017

Front. Psychiatry

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107

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BackgroundThe ketogenic diet (KD) has been used in treatment-resistant epilepsy since the 1920s. It has been researched in a variety of neurological conditions in both animal models and human trials. The aim of this review is to clarify the potential role of KD in psychiatry.MethodsNarrative review of electronic databases PubMED, PsychINFO, and Scopus.ResultsThe search yielded 15 studies that related the use of KD in mental disorders including anxiety, depression, bipolar disorder, schizophrenia, autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD). These studies comprised nine animal models, four case studies, and two open-label studies in humans. In anxiety, exogenous ketone supplementation reduced anxiety-related behaviors in a rat model. In depression, KD significantly reduced depression-like behaviors in rat and mice models in two controlled studies. In bipolar disorder, one case study reported a reduction in symptomatology, while a second case study reported no improvement. In schizophrenia, an open-label study in female patients (n = 10) reported reduced symptoms after 2 weeks of KD, a single case study reported no improvement. In a brief report, 3 weeks of KD in a mouse model normalized pathological behaviors. In ASD, an open-label study in children (n = 30) reported no significant improvement; one case study reported a pronounced and sustained response to KD. In ASD, in four controlled animal studies, KD significantly reduced ASD-related behaviors in mice and rats. In ADHD, in one controlled trial of KD in dogs with comorbid epilepsy, both conditions significantly improved.ConclusionDespite its long history in neurology, the role of KD in mental disorders is unclear. Half of the published studies are based on animal models of mental disorders with limited generalizability to the analog conditions in humans. The review lists some major limitations including the lack of measuring ketone levels in four studies and the issue of compliance to the rigid diet in humans. Currently, there is insufficient evidence for the use of KD in mental disorders, and it is not a recommended treatment option. Future research should include long-term, prospective, randomized, placebo-controlled crossover dietary trials to examine the effect of KD in various mental disorders.

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Section: Discussionmentioning

confidence: 99%

The Current Status of the Ketogenic Diet in Psychiatry

Bostock

Kirkby

Taylor³

2017

Front. Psychiatry

Self Cite

107

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“…In this case, the beneficial effect of some antiepileptics in these three clinically different disorders might indicate that they have an at least partially shared biological background. In addition to the elevated comorbidity and shared treatment response between bipolar disorder and epilepsy a recent review suggested that the great overlap of several precipitating factors in mania and temporal lobe epilepsy imply that common brain processes may contribute to both superficially different disorders  and this is indicative of shared pathophysiology [8]. Furthermore, bipolar disorder and epilepsy have further common characteristics, such as the kindling phenomenon which is recognisable in both cases [9].…”

Section: Establishing the Similarities And Relationship Between Clinimentioning

confidence: 99%

Is Mania the Hypertension of the Mood? Discussion of A Hypothesis

Rihmer

Gonda²,

Döme³

2017

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Beyond both being biphasic/bidirectional disorders (hypo)mania and essential hypertension share a surprising number of similarities and an overlap between their genetics, biological background, underlying personality and temperamental factors, precipitating factors, comorbidity and response to treatment, indicating a possibly partially shared biological background. Based on theoretical knowledge, similarities related to characteristics, manifestation and course, and the results of pharmacological studies related to the effects and side effects of pharmacotherapies used in the treatment of these two distinct disorders, the authors outline a hypothesis discussing the similar origins of these two phenomena and thus mania being the hypertension of mood in memory of Athanasios Koukopoulos, one of the greatest researchers and theoreticists of mania of all time.

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“…Alternatively, there may be synergistic effects of a HM and a conventional medicine reflecting common mechanisms of action such as neurotransmitter regulation. Drug dosage is one important factor in such herb-drug interactions as well as in interactions with underlying biological diatheses ( 80 ). In approximately one third of the cases reviewed the dosage of the HM was unknown.…”

Section: Discussionmentioning

confidence: 99%

Mania Associated With Herbal Medicines, Other Than Cannabis: A Systematic Review and Quality Assessment of Case Reports

et al. 2018

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Background: DSM-5 introduced the diagnostic category of substance/medication-induced bipolar and related disorder. This systematic review examines published reports linking mania with the consumption of herbal medicines (HM), excluding cannabis. Putative pathophysiological mechanisms that may account for the reported HM being associated with mania are discussed.Methods: A systematic search of EMBASE, CINAHL, Health Source, PsychINFO, and PubMed. The quality of case reports meeting inclusion criteria was assessed using the modified Quality Assessment Scale by Agbabiaka.Results: Nineteen single and seven multiple-case reports met inclusion criteria. These yielded a study sample of 35 case reports, 28 of herbal medicine associated mania, 5 of hypomania, and two mixed states, in 17 females [age in years M(SD) = 43.1(13.2)] and 18 males [40.7(18.1)]. A total of 11 herbal medicines were implicated. Case reports by herbal medicine (number of reports) comprised: St John's wort (Hypericum perforatum) (14); Ginseng (Panax ginseng) (5); brindleberry (Garcinia cambogia) (4); ma-huang (Ephedra sinica) (3); “herbal slimming pills” (2); Herbalife products (2); Hydroxycut (1); horny goat weed (Epimedium grandiflorum) (1); “herbal body tonic” (1); celery root (Apium graveolans) (1), and a “herbal mixture” (1). All case reports were associated with use rather than withdrawal of herbal medicines. Only one case report was rated for probability of association using a standardized algorithm. Laboratory assays to confirm composition of the herbal preparation were reported in only one article describing two cases and indicating admixture of a likely causal pharmaceutical in the herbal preparation.Conclusions: Causal attributions are problematic given the limited number of reports, antidepressant co-prescribing in 7 cases, insufficient data regarding pattern and type of herbal medicine use, and lack of a reference frequency for spontaneous mania.The quality assessment scores across the 26 papers (35 case reports) were as follows: low quality (0), lower-medium quality (9), upper-medium quality (10) and high quality (7). Putative pathophysiological mechanisms were postulated for nine of the 11 herbal medicines and centered on HPA-axis activation and increased monoamine activity. Systematic study of the association between herbal medicines and the course of bipolar disorder may contribute to defining targets for pathophysiological research.

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Comparison of precipitating factors for mania and partial seizures: Indicative of shared pathophysiology?

Cited by 15 publications

References 177 publications

The Current Status of the Ketogenic Diet in Psychiatry

The Current Status of the Ketogenic Diet in Psychiatry

Is Mania the Hypertension of the Mood? Discussion of A Hypothesis

Mania Associated With Herbal Medicines, Other Than Cannabis: A Systematic Review and Quality Assessment of Case Reports

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