Approximately 1/3 of Bipolar Disorder (BD) patients attempt suicide, often in the context of exacerbated impulsivity. In humans and animal models, a buildup of neurotoxic metabolites and contributes to orbital frontal white matter abnormalities. Hypofrontality is associated with impulsivity. However, what factors contribute to mechanisms underlying these cerebral alterations in humans in general and BD in particular remain unclear. Ubiquitous environmental human infections (Cytomegalovirus;CMV), fluctuate between latency and reactivation, potentially triggered by exposure to psychosocial stressors. While CMV reactivation has been shown to induce pro-inflammatory cytokines (e.g. TNF-α) which are themselves associated with depression, suicidality, and neurotoxic metabolite induction, investigations of CMV and its contribution to impulsivity in BD are lacking. We investigated 150 BD type I and 109 healthy control volunteers to determine if CMV IgG antibody concentrations were associated with measures of impulsivity and suicidality in BD-I. Using standard viral assay techniques, we quantified plasma CMV IgG antibodies. CMV antibody concentration was higher in BD-I than in healthy control volunteers (T254 = 2.9, p = 0.004), significantly correlating with measures of neurotic coping style (NEO-PI N5 impulsivity) (p < 0.05) which further correlated to other clinical measures of impulsivity (BIS-11) (r = 0.44, p = 0.002). This is the first study to identify a diagnostic relationship between BD-I and CMV antibodies. The data presented supports the hypothesis that CMV infection and subsequent immune activation may contribute to exacerbation of impulsive behavior in BD-I.
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