Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Department of Psychiatry, University Medical Center Utrecht - Brain Centre Rudolf Magnus, Utrecht, The Netherlands.
Psychiatry Clin Neurosci. 2016 Jun;70(6):227-44. doi: 10.1111/pcn.12386. Epub 2016 Apr 28.
We carried out a systematic review of the available literature about potential biomarkers of psychotic bipolar disorder (BD-P), a specific subset presenting worse outcome and greater risk of relapse than non-psychotic bipolar disorder (BD-NP).
We searched the main psychiatric databases (PubMed, ISI Web of Knowledge, PsychInfo). Only original articles with the main topic of BD-P compared to schizophrenia/BD-NP/healthy controls (HC) written in English from 1994 to 2015 were included.
BD-P patients presented higher kynurenic acid levels in the cerebrospinal fluid, elevated anti- S accharomyces cerevisiae antibodies levels, and lower serum levels of dehydroepiandrosterone sulfate and progesterone than BD-NP/HC. Event-related potentials abnormalities have been identified in BD-P with respect to BD-NP. BD-P patients also presented bigger ventricles but similar hippocampal volumes compared to BD-NP/HC. Although the results are contrasting, some cognitive deficits seemed to be related to the psychotic dimension of bipolar affective disorder, such as impairment in verbal/logical memory, working memory, verbal and semantic fluency and executive functioning. Finally, polymorphisms of genes, such as NRG1, 5HTTLPR (s), COMT, DAOA and some chromosome regions (16p12 and 13q), were positively associated with BD-P.
Data about the identification of specific biomarkers for BD-P are promising, but most of them have not yet been replicated. They could lead the clinicians to an early diagnosis and proper treatment, thus ameliorating outcome of BD-P and reducing the biological changes associated with a long duration of illness. Further studies with bigger samples are needed to detect more specific biological markers of the psychotic dimension of bipolar affective disorder.
我们对现有的关于精神病性双相障碍（BD-P）潜在生物标志物的文献进行了系统回顾，BD-P 是一种特定的亚组，其预后较差，复发风险高于非精神病性双相障碍（BD-NP）。
我们检索了主要的精神科数据库（PubMed、ISI Web of Knowledge、PsychInfo）。仅纳入了 1994 年至 2015 年间以英文撰写的、主要主题为 BD-P 与精神分裂症/BD-NP/健康对照（HC）比较的原创文章。
BD-P 患者脑脊液中犬尿氨酸酸水平升高，抗酿酒酵母抗体水平升高，血清脱氢表雄酮硫酸酯和孕酮水平降低，而与 BD-NP/HC 相比。与 BD-NP 相比，BD-P 患者的事件相关电位异常。BD-P 患者的脑室也较大，但与 BD-NP/HC 相比，海马体积相似。尽管结果存在差异，但一些认知缺陷似乎与双相情感障碍的精神病性维度有关，例如言语/逻辑记忆、工作记忆、言语和语义流畅性以及执行功能受损。最后，一些基因的多态性，如 NRG1、5HTTLPR（s）、COMT、DAOA 和一些染色体区域（16p12 和 13q），与 BD-P 呈正相关。
关于 BD-P 特定生物标志物的识别数据很有前景，但大多数尚未得到复制。它们可以引导临床医生进行早期诊断和适当治疗，从而改善 BD-P 的预后，并减少与疾病长期持续相关的生物学变化。需要进一步开展更大样本量的研究，以发现更具特异性的双相情感障碍精神病性维度的生物学标志物。
