Levels of Active Brain Response to Facial-Expressed Emotion in Alcoholism

Many social and physiologic factors can lead recovering alcoholics to relapse, including anxiety disorders, anger, and social pressure. According to a new study, the brains of alcoholics may have a significantly diminished ability to recognize and process certain emotions such as fear or disgust, which may explain a propensity for alcohol relapse.

The study used functional magnetic resonance imaging (fMRI) to examine the blood-oxygen level dependent (BOLD) responses of 11 male alcoholics who were subjected to a variety of facial emotions in emotion-decoding tests. Lead author, Jasmin B. Salloum, PhD, of the National Institute on Alcohol Abuse and Alcoholism, has published other studies on fMRI imaging and emotional-recognition.

The alcoholic patients’ responses to facial expressions of happiness, sadness, anger, fear, and disgust were compared to the responses of 11 male, non-alcoholic controls. Alcoholic patients and non-alcoholic controls both identified the intensity of emotions accurately during a non-complicated emotional decoding task. The two groups, however, showed significantly different BOLD responses during a facial emotion recognition task. Brain activation for the alcoholic patients was generally lower than that of the non-alcoholic group and varied most during the decoding of facial-expressed emotions of fear and disgust. For example, the affective division of the anterior cingulate cortex (ACC), which has been associated with autonomic cognitive processing and emotional processing, showed decreased activity in alcoholic patients. Anger was the only facial-expressed emotion that caused significant ACC activation in alcoholic patients; those BOLD results were not significantly different than those of controls.

According to the authors of this study, the “blunted” ACC activation demonstrated by alcoholic patients may affect their ability to recognize dangerous situations, such as bars or social scenes where drinking behavior occurs. In turn, there may be an increased possibility of alcohol relapse. In addition, the failure to properly interpret facial-expressed emotions of others can lead to social disregard, or to indifference to interventions by clinicians or loved ones.

Several limitations to this study include a small sample size as well as comorbid pathology and substance use in the alcoholic patient group. The authors acknowledge that alcoholic patients with no serious comorbidities could show different results.

Funding for this research was provided by the National Institute on Alcohol Abuse and Alcoholism and the National Institute of Mental Health. (Alcohol Clin Exp Res. 2007;31(9):1490-504). —LS


Coronary Artery Disease is More Significant in Patients Suffering from Incident MDD

Coronary artery disease (CAD) is the world’s most common form of heart disease. It can result in heart attack and angina and can contribute to heart failure and arrhythmias. Recent research has found high rates of recurrent and incident major depressive disorder (MDD) in this patient population.

Karina Davidson, PhD, from Columbia University College of Physicians and Surgeons in New York City, and colleagues, investigated 88 patients to assess CAD severity in patients suffering from incident and recurrent MDD. The authors assessed history of depression and current depressive symptoms through patient interviews. They evaluated CAD severity via coronary angiography within 1 month of the aforementioned interviews. CAD severity was defined as: 0=no vessels significantly affected; 1=only one vessel affected; 2=two vessels affected; and 3=three vessels affected and/or left main obstruction.

Davidson and colleagues found that approximately 24% of acute coronary syndrome patients have comorbid MDD. Of these patients, approximately 67% had recurrent MDD and 33% had incident MDD. However, the authors found that the patients suffering from incident MDD had more severe types of CAD compared to patients with recurrent MDD patients. The mean CAD severity scores for incident MDD patients was 2.4 while the mean CAD severity scores for recurrent MDD patients was 1.6 (P=.043).

Due to these findings, Davidson and colleagues believe that patients with incident MDD should be differentiated from patients with recurrent MDD via two distinct subtypes. They propose using angiograms as a means of determining CAD severity. Future studies should explore the mechanisms underlying these differences. (J Psychiatr Res. In Press.) —CN


Effects of Mania and Depression on Functional Impairment and Disability

Bipolar disorder is a disabling condition that affects both moods and daily functioning. Gregory E. Simon, MD, MPH, at the Center for Health Studies in Seattle, Washington, and colleagues, reviewed data from 441 patients in a randomized trial of a care management and psychoeducational intervention in order to measure the relationship between changes in mood symptoms and changes in functioning in patients treated for bipolar disorder.

Symptom severity was assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, structured clinical interview, and functional status was measured with the social subscale of the 36-item Short-form Health Survey (SF-36). Patients were enrolled between August 1999 and October 2000, and follow-up data were collected until October 2001. Patients were assessed at baseline and every 3 months during the 12-month follow-up period.

Four measures of impairment and disability were utilized and included the SF-36 Role-Emotional score, SF-36 Social Function score, days unable to perform household duties, and days disabled from performing other activities (P<.001 for all comparisons). Severity of depressive symptoms were strongly and consistently associated with all measures, even after adjustment for co-ocurring manic symptoms. Compared to patients in remission, patients with a depressive episode scored approximately 60 points lower on the SF-36 scales and were unable to participate in daily activities for an additional 15 days. Severity of mania and hypomania symptoms showed significant association with all measures as well (P<.001 for all comparisons); however, associations were weaker after factoring in co-ocurring depressive symptoms. Compared with patients in remission, patients with mania or hypomania scored approximately 30 points lower on the SF-36 scale and reported 9 additional days of disability.

“Our study shows that symptoms of bipolar disorder have a significant impact on daily functioning and disability,” Dr. Simon said. “When symptoms of bipolar disorder improve, daily functioning improves as well.”

Dr. Simon added that this relationship was stronger and more consistent for symptoms of depression than for symptoms of mania or agitation.

The study was limited in that it was an observational study as opposed to a randomized trial.

“We can show that improvement in depression is followed by improvement in disability,” Dr. Simon said, “but we cannot absolutely prove that the improvement in depression caused the improvement in disability.”

Funding for this research was provided by the National Institute of Mental Health. (J Clin Psychiatry. 2007;68:1237-1245) —DC


Possible Genetic Link Found for Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is more than just a severe case of premenstrual syndrome. Affecting approximately 8% of women, PMDD is characterized by a noticeably depressed mood, anxiety, and/or irritability in the week leading up to a woman’s menstrual cycle. In order to receive an official diagnosis, the symptoms must also be severe enough to cause impairment in daily life. Though not included in the main text of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, PMDD is listed as an area requiring further study.

Though researchers have suspected that the underlying cause of PMDD is hormonal, a new study by Liang Huo, MD, at the National Institutes of Mental Health, and colleagues, was the first to link PMDD to an estrogen receptor gene. The study included 91 women with PMDD and 56 women without PMDD or any history of mood disorders linked to their menstrual cycle. The women had an average age of 40 years and were Caucasian with similar demographic and socioeconomic backgrounds. Blood samples from each woman were analyzed. Researchers looked specifically at numerous single nucleotide polymorphisms (SNPs) in three specific genes: ESR1, ESR2 and COMT.

ESR1 and ESR2 are two types of estrogen receptors while COMT is involved in the process of metabolizing estrogen. The results showed that four SNPs located on the ESR1 were significantly more prominent in the PMDD group. Even after removing 29 women with a history of major depressive disorder from the PMDD group, the results were still significant. David R. Rubinow, MD, a study co-author, noted that while this study suggests the involvement of specific genes linked to estrogen, the patients had normal levels of estrogen. The problem, therefore, may lie in the abnormal response to a normal level of hormones.

Huo and colleagues also note that the absence of the SNPs in the control group could be as telling as their presence in the PMDD group. The control group may have some sort of protective factor against menstrual-related mood disorders. However, further research is needed given the relatively small sample size of the current study.

Funding for this research was provided by the Intramural Research Program at the National Institute of Mental Health.

(Biol Psychiatry. 2007; June 26; Epub ahead of print.) —VJ

Psychiatric Dispatches is written by Dena Croog, Virginia Jackson, Christopher Naccari, and Lonnie Stoltzfoos.