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Background: Bipolar disorder (BD) is a psychiatric condition characterized by alternating episodes of mania and depression frequently associated with cognitive impairments. BD is associated with brain alterations in fronto-temporal and limbic networks. Recent conceptualizations view BD as a neurodegenerative disorder characterized by progressive deterioration of grey and white matter (GM, WM) volumes and accelerated brain ageing. Therefore, we conducted a review gathering neuroimaging evidence about neurodegenerative processes in BD.Methods: A literature search was conducted on the PubMed, Scopus and Web of Science databases in September 2021. After title and abstract screening of the retrieved records, 19 studies that met our inclusion criteria were included in the review.Results: The available evidence suggests the presence of a progressive reduction of GM volumes at the whole-brain level and in the amygdala, prefrontal regions and the anterior cingulate cortex. Conversely, WM lesions and alterations seem to emerge only in the early phases of the condition masking the effects of normal ageing. Lastly, machine learning models indicate that the gap between predicted and chronological brain age differs considerably between healthy controls and BD patients, as the latter are characterized by larger gaps.Limitations: The included studies had cross-sectional study design, small sample sizes and heterogeneous methodology, and lack of control for pharmacological treatment.Conclusions: BD seems to be associated with generalized age-related structural GM volumes reductions and functional brain alterations thus suggesting the presence of neurodegenerative processes. Future systematic reviews and meta-analyses should be conducted to quantify the magnitude of brain ageing-related effects in BD. [ABSTRACT FROM AUTHOR]

Objectives: Bipolar disorder (BD) is a psychiatric condition causing shifts in mood, energy and activity levels severely altering the quality of life of the patients even in the euthymic phase. Although widely accepted, the neurobiological bases of the disorder in the euthymic phase remain elusive. This study aims at characterizing resting state functional activity of the BD euthymic phase in order to better understand the pathogenesis of the disease and build future neurobiological models. Methods: Fifteen euthymic BD patients (10 females; mean age 40.2; standard deviation 13.5; range 20–61) and 27 healthy controls (HC) (21 females; mean age 37; standard deviation 10.6; range 22–60) underwent a 3T functional MRI scan at rest. Resting state activity was extracted through independent component analysis (ICA) run with automatic dimensionality estimation. Results: ICA identified 22 resting state networks (RSNs). Within‐network analysis revealed decreased connectivity in the visual, temporal, motor and cerebellar RSNs of BD patients vs HC. Between‐network analysis showed increased connectivity between motor area and the default mode network (DMN) partially overlapping with the fronto‐parietal network (FPN) in BD patients. Conclusion: Within‐network analysis confirmed existing evidence of altered cerebellar, temporal, motor and visual networks in BD. Increased connectivity between the DMN and the motor area network suggests the presence of alterations of the fronto‐parietal regions, precuneus and cingulate cortex in the euthymic condition. These findings indicate that specific connectivity alterations might persist even in the euthymic state suggesting the importance of examining both within and between‐network connectivity to achieve a global understanding of the BD euthymic condition. [ABSTRACT FROM AUTHOR]

Background: Bipolar disorder (BD) is characterized by cognitive impairments that are known to predict psychosocial functioning and quality of life. While cognitive remediation (CR) was originally developed to directly target cognitive symptoms in traumatic brain injury and psychotic illnesses, the efficacy of CR in BD has begun to emerge only in the last decade. Functional Remediation (FR) is an integrated intervention that has been developed to restore psychosocial functioning by means of ecological neurocognitive techniques that involve psychoeducation about cognitive dysfunctions and their impact on the general functioning. Because of the heterogeneity of treatment targets and mechanisms of actions, here we aim to illustrate the effects induced by existing CR/FR approaches in BD.Methods: In this systematic review, we evaluated cognitive and functional outcomes after CR/FR in studies conducted in BD.Results: Eleven studies met inclusion criteria: 3 RCTs that compared CR/FR to one or more control condition (n = 354), 5 secondary analyses that further examined data from these trials, 2 single-arm studies, and 1 naturalistic study. While features such as the use of computerized training tools and a group-based format recurred across studies, CR/FR paradigms targeting different cognitive and functional domains showed specificity of training focus to outcomes. Effect sizes were in the medium-large range, suggesting that patients with BD respond to treatment at or above the level reported in psychotic patients. Integrated approaches that combined cognitive exercises with group-based experiences were associated with both cognitive and functional improvements.Conclusions: In this review, we found support for the use of CR/FR paradigms in patients with BD with evidence of cognitive and functional improvements. The scarcity of currently published RCTs as well as of data examining mechanisms of action and neural correlates limits the generalizability of our findings. [ABSTRACT FROM AUTHOR]

• Brain incidental findings are more frequent in psychotic patients. • Periventricular white matter hyperintensities are characteristic of chronic patients. • Hyperintensities and ventricular asymmetries are found in first-episode patients. • We indicate possible vulnerability factors preceeding the onset of psychosis. Brain incidental findings (IFs) are unexpected brain abnormalities detected by a structural magnetic resonance (MRI) examination. We conducted a study to assess whether brain IFs are associated with first-episode psychosis (FEP) and chronic psychosis (affective vs. non-affective) compared to healthy controls (HC). Chi-squared analyses were run to compare the frequency of several IFs across groups. Logistic regression analyses were run to explore the association between group and IFs, accounting for sex, age, MRI field strength. We observed a higher frequency of most IFs in both FEP and chronic psychosis groups compared to HC, however most of the chi-squared tests did not reach significance. Patients with FEP and chronic psychosis were 3–4 times more likely to show deep white matter hyperintensities (WMH) than HC. Patients with FEP and affective chronic psychosis were 3–4 times more likely to show ventricular asymmetries than HC. All chronic patients were more likely to show periventricular WMH, liquoral spaces enlargements and ventricular system enlargements respectively. Our results suggest that deep WMH and ventricular asymmetries are associated with both the early and the chronic stages of psychosis, thus representing potential vulnerability factors already present before the onset of the symptoms, possibly due to neurodevelopmental insults. [ABSTRACT FROM AUTHOR]

The Locked-In Syndrome (LIS) is a very rare but devastating condition, characterized by the complete paralysis of the voluntary musculature, except for some eye and eyelid movements. Sometimes, however, the oculomotor control is so compromised, for example in an advanced phase of Amyotrophic Lateral Sclerosis (ALS), that these patients lose the possibility to communicate and interact with the external world. We have developed a prototype of Brain-Computer-Interface (BCI) based on the voluntary shift of attention (gaze) from a far target to a near target, which is associated to a decrease of pupil size, an automatic sympathetic response [1]. In a sample of healthy volunteers, we explored the possibility of exploiting this pupillary response (Pupillary Accommodative Response) in combination with the oscillatory response of the pupil (Pupillary Oscillatory Response) and the visual cortex (Steady-State Visual Evoked Potentials) to flickering stimuli, to establish binary communication (shifting attention to a near target meaning "yes", holding attention on a far target meaning "no"). These three signals (PAR, POR and SSVEP) discriminated when the observer's attention was on the far or the near target, and were decoded by means of a binary classifier (Support Vector Machine) to detect subject's voluntary response. Our results suggest that multiple signal decoding during a simple attention shift in the depth plane can be a robust strategy to communicate with LIS patients when oculomotor control is too poor to use traditional assistive aids based on eye tracking. [ABSTRACT FROM AUTHOR]

Background: In the last 10 years, psychological approaches based on mindfulness techniques have been proposed for the management of psychotic experiences.Method: In this brief review we summarized, to our knowledge for the first time, published studies on mindfulness-based interventions (MBIs) applied to the early phase of major psychoses (affective and non-affective).Results: Despite the great variability in terms of MBIs protocols, available studies on young people at risk to develop or with a first episode of psychosis suggest MBIs as a feasible, well-tolerated and effective approach in ameliorating symptoms, functioning, emotion regulation, and finally reducing the psychological distress associated with the onset of mania and/or psychotic experience.Limitations: The small sample size and inconsistencies between studies in terms of design, MBIs protocols and outcome measures suggest being cautious in interpreting and generalizing results. Moreover, specific guidelines are missing for the adaptation of MBIs to youth at risk of developing affective psychoses.Conclusions: Preliminary findings show that MBIs may be considered a promising adjunctive therapy for the treatment of major psychoses in the early phases of the illness. However, the conduct of further studies in larger samples and with a more rigorous methodology is warranted to confirm the beneficial effect of MBIs in the early stages of major psychoses. [ABSTRACT FROM AUTHOR]