Bipolar Disorder I or II
Conditions
Keywords
bipolar disorder, lithium, lithium MR imaging, ultra-high field imaging, clinical response, clinical, 7 Tesla
Brief summary
The main goal of this study is to determine if brain lithium-concentrations predict clinical lithium treatment-response. Secondary, to study correlations between intracerebral distribution-patterns of lithium with clinical treatment outcome. Brain lithium concentrations will be measured using ultra-high field (7 Tesla) lithium magnetic resonance (MR) imaging, which has recently been introduced. Determining lithium-concentrations in the brain has been difficult so far due to lithium's relatively low concentration (compared to protons, which are targeted in conventional MRI). 7T lithium MR imaging has the potential to produce much more detailed MR images compared with previous studies, for the first time. The BLISS study is expected to yield new insights, helping to better understand why clinical lithium response varies between individuals.
Detailed description
Introduction Lithium treatment is considered the first-line pharmacological treatment for bipolar disorder. However, individual responses vary greatly, which undermines the ability to achieve rapid stabilization in many patients with bipolar disorder. The neurobiological mechanisms underlying lithium's action are still largely unknown, which hampers the development of clinically applicable predictors for individual treatment response. The recent introduction of ultra-high-field lithium magnetic resonance imaging offers a promising avenue to better link brain measures with clinical responses to lithium treatment. Methods and Analysis This is a longitudinal observational study involving 80 adults with bipolar disorder who are initiating lithium as part of their regular treatment regimen. Ultra-high-field lithium magnetic resonance imaging of the brain will be performed within four weeks of reaching stable therapeutic serum lithium concentrations. The primary outcome is clinical response to lithium treatment at one-year follow-up, as measured using a validated questionnaire. Linear regression analysis will be used to establish correlations between brain lithium concentrations-including whole brain, voxel-wise, parcellation, mean, and region-of-interest approaches-and clinical lithium response.
Interventions
OTHERLithium MR imaging
After obtaining written informed consent and within four weeks of reaching a stable therapeutic serum lithium concentration, lithium MR imaging will be performed using a 7 Tesla MR system (Achieva, Philips Medical Systems, Eindhoven, The Netherlands) with a dual-tuned 7Li/1H volume head coil (RAPID Biomedical GmbH, Rimpar, Germany). Various approaches, including whole-brain, voxel-wise, parcellation, mean, and regions of interest, will be applied to measure lithium concentrations.
Sponsors
PsyQ
GGZ Rivierduinen
Leiden University Medical Center
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. age 18 years or above, 2. a clinical diagnosis of bipolar disorder type I or type II , 3. having reached stable therapeutic serum lithium concentrations (reference values 0.6-1.0 mM in age to 65 years; 0.4-0.8 in age 65 years and above) within four weeks prior to study participation, and 4. provided written informed consent.
Exclusion criteria
1. insufficient comprehension of the Dutch language, 2. unable to provide informed consent, 3. drug or alcohol abuse over a period of two weeks prior to study participation, and 4. meeting any exclusion criterium for MR imaging.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clinical lithium response | At 12-month follow-up. | Clinical lithium response will be assessed using a validated questionnaire. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Serum lithium concentrations | Baseline | Serum lithium concentrations will be determined to establish correlations with brain lithium concentrations. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Manic and depressive symptom severity | Baseline | Manic and depressive symptom rating scales will be used to assess mood state at the day of scan acquisition. |
Countries
Netherlands
Contacts
Primary ContactE Boere
Backup ContactOnderzoekscentrum Psychiatrie, OZC
Outcome results
None listed