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Identification database searching (n = 88) Records identified through other
Records identified through
sources (n = 3)

Screening Records after duplicates removed (n = 91) Excluded after abstract
screening (reviews)
(n = 12)

Full-text articles excluded, with
reasons (n = 30)
(1) Failure to report on
Eligibility Full-text articles inflammatory markers or oxidative
assessed for
markers or neurotrophins in BD
eligibility (n = 34)
patients (n = 3); (2) included adult
subjects (n = 19); and (3) examined
biomarkers in non affected BD
offspring (n = 3)

Included qualitative synthesis (n = 9)
Studies included in

Figure 1: Flow diagram

Table 1: Summary of studies on biological markers in juvenile bipolar disorder
Study Type of Subjects Age Psychiatric Biological Main findings
study (Dx) (years) measures markers
Barzman Cross‑ n = 10 (BD‑I) 12‑17 WASH‑U‑ TNF gene TNF gene expression correlates with
et al. [35] sectional KSADS; both brain activations in amygdala,
BRACHA ACG, and OFC and aggression in
adolescents with BD
Birmaher Cross‑ n = 30 (18 BD‑I; 1 12‑19 K‑SADS‑PL; IL‑6; Manic symptom severity was
et al. [22] sectional BD‑II; 11 BD‑NOS) MRS; FHS hsCRP; significantly associated with hsCRP
BDNF levels
BDNF levels were not correlated with
any illness phase
Pandey Longitudinal n = 47 (26 BD; 21 HC) 7‑17 YMRS; BDNF Lymphocyte BDNF mRNA and platelet
et al. [37] (8 weeks) CDRS‑R BDNF levels in drug‑free BD subjects
were significantly lower than in HCs
Lymphocyte BDNF mRNA was
significantly increased in medicated
BD subjects compared to drug‑free BD
subjects
Lymphocyte BDNF mRNA levels in
long‑term treated BD subjects was
similar to HCs
Chitty Cross‑ n = 50 (24 BD‑II; 9 BD 18‑30; AUDIT; GSH Decreased GSH in the ACC of high risk
et al. [39] sectional BD‑spectrum; 17 HC) HC 20‑29 DASS; drinkers BD subjects
Kessler‑10 No differences in GSH concentration
between BD subjects and HCs
Lagopoulos Cross‑ n = 104 (13 BD‑I; 16‑33 HDRS; GSH No differences in GSH concentration
et al. [38] sectional 25 BD‑II; 15 BPRS; between BD subjects and HCs
BP‑spectrum; 51 HC) YMRS; No significant association between GSH
SOFAS; and age of onset or duration of illness
K‑10 No significant correlations between
GSH concentration and mania or
depressive symptoms
Contd...

246 Neuroimmunol Neuroinflammation | Volume 2 | Issue 4 | October 15, 2015