Rare Encephalitis Affects NMDA Receptor

October 14, 2011 · Posted in Neurochemistry · Comment 
NMDA

NMDA

At the 57th Annual Meeting of the American Academy of Child and Adolescent Psychiatry (AACAP) in October 2010, Nadine Schwartz reported that in a rare type of encephalitis, antibodies specifically target and bind to N-methyl-D-aspartate (NMDA) receptors, the major receptors for excitatory neurotransmission in the brain. Individuals usually develop psychiatric symptoms before neurological ones, and were previously often thought to be malingering or inventing their illness. Eventually they may develop profound cognitive and motor deterioration and many may require treatment in an intensive care unit in order to provide adequate respiration. Studies show that children with this syndrome appear to respond to anti-immune therapeutic approaches including steroids, plasmaphoresis, and antimetabolites.

Editor’s Note:  The recognition that auto-antibodies can attack the major receptors for excitatory neurotransmission in brain brings to light another potential mechanism that could explain neurochemical dysregulation in the neuropsychiatric disorders.

Dopamine D2 and D3 Agonist Pramipexole May Enhance Cognitive Function in Bipolar I Disorder

September 7, 2011 · Posted in Potential Treatments · Comment 

Cognitive Functioning

Anil Malhotra from the Zucker Hillside Hospital found that pramipexole (Mirapex), a dopamine D2 and D3 agonist used in the treatment of Parkinson’s disease, improved measures of processing speed and working memory in euthymic bipolar patients (whose average age was 42) when compared with placebo in an adjunctive clinical trial.

Editor’s Note: Bipolar patients in a euthymic phase have consistently been shown to have some degree of cognitive dysfunction that is typically correlated with the number of prior depressive and/or manic episodes they have experienced. This is one of the first studies to directly target this cognitive dysfunction with a pharmacotherapeutic agent.

Pramipexole may be of additional value among depressed patients, because in two small, placebo-controlled studies, one led by Carlos Zarate at the National Institute of Mental Health and one led by Joseph F. Goldberg in New York, pramipexole has been shown to exert acute antidepressant effects in bipolar patients in the depressive phase of the illness. The new data from Malhotra raise the possibility that there could be a two-for-one benefit when pramipexole is used in the depressive phase of bipolar illness—improvement in both depression and cognition.

Other approaches to improving cognition in patients with bipolar disorder

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Inflammation and Oxidative Stress in Bipolar Disorder

January 6, 2011 · Posted in Current Treatments, Neurobiology, Potential Treatments · Comment 

A number of studies presented at the 4th Biennial Conference of the International Society for Bipolar Disorders conference in Sao Paulo, Brazil in March reported new data relevant to inflammation and oxidative stress. Both inflammation and oxidative stress increase risk of cardiovascular disorders, and patients with inadequately treated mood disorders lose 10 or more years of life expectancy from cardiovascular disorders compared to the general population. Inflammation and oxidative stress may also contribute to the symptoms, evolution, and progression of the mood disorders themselves.

It is possible that these two processes could become new targets for therapeutic intervention in addition to more traditional psychopharmacological drugs that primarily target the neurotransmitters dopamine, norepinephrine, serotonin, and the neurotrophic factor BDNF. Read more

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