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Sample records for bipolar patients treated

  1. Switching bipolar disorder patients treated with clozapine to another antipsychotic medication: a mirror image study

    PubMed Central

    Ifteni, Petru; Teodorescu, Andreea; Moga, Marius Alexandru; Pascu, Alina Mihaela; Miclaus, Roxana Steliana

    2017-01-01

    Bipolar disorder (BD) is associated with periodic symptom exacerbations, leading to functional impairment, and increased risk of suicide. Although clozapine has never been approved for the treatment of BD, it is occasionally used in severe mania. The aim of the study is to evaluate the risks and benefits of switching clozapine in remitted BD patients. This is an observational, mirror image study of 62 consecutive remitted BD outpatients treated with clozapine. Twenty-five patients were switched to another antipsychotic following a change in a drug reimbursement rule, while 37 continued on clozapine. The mean time in remission was shorter for the switched group (9.2±4 months vs 13±6 months, P=0.018), and the number of patients who relapsed was larger (n=21 vs n=8, P<0.0001). The results suggest that switching from clozapine to another antipsychotic may increase the risk of relapses in remitted patients with BD. PMID:28182153

  2. Drug Treated Schizophrenia, Schizoaffective and Bipolar Disorder Patients Evaluated by qEEG Absolute Spectral Power and Mean Frequency Analysis

    PubMed Central

    Wix-Ramos, Richard; Moreno, Xiomara; Capote, Eduardo; González, Gilbert; Uribe, Ezequiel

    2014-01-01

    Objective Research of electroencephalograph (EEG) power spectrum and mean frequency has shown inconsistent results in patients with schizophrenic, schizoaffective and bipolar disorders during medication when compared to normal subjects thus; the characterization of these parameters is an important task. Methods We applied quantitative EEG (qEEG) to investigate 38 control, 15 schizophrenic, 7 schizoaffective and 11 bipolar disorder subjects which remaine under the administration of psychotropic drugs (except control group). Absolute spectral power (ASP), mean frequency and hemispheric electrical asymmetry were measured by 19 derivation qEEG. Group mean values were compared with non parametrical Mann-Whitney test and spectral EEG maps with z-score method at p < 0.05. Results Most frequent drug treatments for schizophrenic patients were neuroleptic+antiepileptic (40% of cases) or 2 neuroleptics (33.3%). Schizoaffective patients received neuroleptic+benzodiazepine (71.4%) and for bipolar disorder patients neuroleptic+antiepileptic (81.8%). Schizophrenic (at all derivations except for Fp1, Fp2, F8 and T6) and schizoaffective (only at C3) show higher values of ASP (+57.7% and +86.1% respectively) compared to control group. ASP of bipolar disorder patients did not show differences against control group. The mean frequency was higher at Fp1 (+14.2%) and Fp2 (+17.4%) in bipolar disorder patients than control group, but no differences were found in frequencies between schizophrenic or schizoaffective patients against the control group. Majority of spectral differences were found at the left hemisphere in schizophrenic and schizoaffective but not in bipolar disorder subjects. Conclusion The present report contributes to characterize quantitatively the qEEG in drug treated schizophrenic, schizoaffective or bipolar disorder patients. PMID:24851121

  3. Adult Patients with Congenital Muscular Torticollis Treated with Bipolar Release: Report of 31 Cases

    PubMed Central

    Lee, Gun Sang; Lee, Myung Ki; Kim, Woo Jae; Kim, Ho Sang; Kim, Jeong Ho; Kim, Yun-Suk

    2017-01-01

    Objective We assessed the surgical results of bipolar release in 31 adult patients with uncorrected congenital muscular torticollis (CMT) and more than 12 months of follow-up. Methods Thirty-one patients underwent a bipolar release of the sternocleidomastoid muscle (SCM) and were retrospectively analyzed. The mean follow-up period was 14.9 months (range, 12–30). The mean age at time of surgery was 30.3 years (range, 20–54). Patients were evaluated with a modified Lee’s scoring system, cervicomandibular angle (CMA) measurement, and a global satisfaction rating scale using patient self-reporting. Results The modified Lee’s scoring system indicated excellent results in 4 (12.9%) patients, good in 18 (58.1%), and fair in 9 (29.0%) at the last follow-up after surgery. The improvements in neck movement and head tilt were statistically significant (p<0.05). The preoperative mean CMA was 15.4° (range, 5.4–29.0), which was reduced to a mean of CMA of 6.3° (range, 0–25) after surgery (p<0.05). The global satisfaction rating scale was 93.7% (range, 90–100). A transient sensory deficit on the ipsilateral lower ear lobe was noted in three cases. No significant permanent complications occurred. Conclusion Bipolar release of the SCM is a safe and reliable technique for the treatment of CMT in adults. PMID:28061496

  4. Bipolar Treatment: Are Bipolar I and Bipolar II Treated Differently?

    MedlinePlus

    ... Daniel K. Hall-Flavin, M.D. Treatment for bipolar disorder, formerly called manic depression, generally involves medications and ... bipolar I disorder. In addition to medication for bipolar disorder, other treatment approaches include: Psychotherapy. As a key ...

  5. Augmentation of light therapy in difficult-to-treat depressed patients: an open-label trial in both unipolar and bipolar patients

    PubMed Central

    Camardese, Giovanni; Leone, Beniamino; Serrani, Riccardo; Walstra, Coco; Di Nicola, Marco; Della Marca, Giacomo; Bria, Pietro; Janiri, Luigi

    2015-01-01

    Objectives We investigated the clinical benefits of bright light therapy (BLT) as an adjunct treatment to ongoing psychopharmacotherapy, both in unipolar and bipolar difficult-to-treat depressed (DTD) outpatients. Methods In an open-label study, 31 depressed outpatients (16 unipolar and 15 bipolar) were included to undergo 3 weeks of BLT. Twenty-five completed the treatment and 5-week follow-up. Main outcome measures Clinical outcomes were evaluated by the Hamilton Depression Rating Scale (HDRS). The Snaith–Hamilton Pleasure Scale and the Depression Retardation Rating Scale were used to assess changes in anhedonia and psychomotor retardation, respectively. Results The adjunctive BLT seemed to influence the course of the depressive episode, and a statistically significant reduction in HDRS scores was reported since the first week of therapy. The treatment was well-tolerated, and no patients presented clinical signs of (hypo)manic switch during the overall treatment period. At the end of the study (after 5 weeks from BLT discontinuation), nine patients (36%, eight unipolar and one bipolar) still showed a treatment response. BLT augmentation also led to a significant improvement of psychomotor retardation. Conclusion BLT combined with the ongoing pharmacological treatment offers a simple approach, and it might be effective in rapidly ameliorating depressive core symptoms of vulnerable DTD outpatients. These preliminary results need to be confirmed in placebo-controlled, randomized, double-blind clinical trial on larger samples. PMID:26396517

  6. Dosing patterns and medication adherence in bipolar disorder patients treated with lurasidone: a US retrospective claims database analysis

    PubMed Central

    Sajatovic, Martha; Ng-Mak, Daisy; Solem, Caitlyn T.; Lin, Fang-Ju; Rajagopalan, Krithika; Loebel, Antony

    2016-01-01

    Background: The aim of this study was to describe dosing patterns and medication adherence among bipolar patients who initiated lurasidone in a real-world setting. Methods: Adult bipolar patients who initiated lurasidone between 1 November 2010 and 31 December 2012 (index period) with 6-month pre- and post-index continuous enrollment were identified from the IMS RWD Adjudicated Claims US database. Patients were grouped by starting lurasidone daily dose: 20 mg (7.1%), 40 mg (62.2%), 60–80 mg (28.7%), and 120–160 mg (2.1%). Patient characteristics were compared across doses using Cochran–Armitage trend tests. Multivariable ordinal logistic regression assessed the association between initial lurasidone dose and patient characteristics. Medication adherence was measured using medication possession ratio (MPR). Results: Of 1114 adult bipolar patients (mean age 40.6 years, 70.6% female), 90% initiated lurasidone at 40 mg or 80 mg/day (mean 51.9 mg/day). Of these, 16.2% initiated lurasidone as monotherapy. Mean lurasidone maintenance dose was 55.2 mg/day and mean MPR was 0.53 [standard deviation (SD) = 0.34] over the 6-month follow up. Substance use, hyperglycemia, obesity, and prior antipsychotic use were associated with higher initial lurasidone doses (p < 0.05). Odds of a 20 mg/day increase in initial lurasidone dose was 1.6-times higher for patients with substance use [95% confidence interval (CI): 1.16−2.24], 2.6-times higher with hyperglycemia problems (95% CI: 1.15−5.83), 1.7-times higher with obesity (95% CI: 1.05−2.60), and 1.3 (95% CI: 1.01−1.78) and 1.8-times higher (95% CI: 1.17−2.86) with prior use of second- and first-generation antipsychotics, respectively. Conclusions: This real-world analysis of bipolar patients indicated that 40 mg or 80 mg/day were the most common starting doses of lurasidone. A majority of patients used concomitant psychiatric medications (polypharmacy). Higher doses of lurasidone were prescribed to patients with

  7. Attention Deficit Hyperactivity Disorder Erroneously Diagnosed and Treated as Bipolar Disorder

    ERIC Educational Resources Information Center

    Atmaca, Murad; Ozler, Sinan; Topuz, Mehtap; Goldstein, Sam

    2009-01-01

    Objective: There is a dearth of literature on patients erroneously diagnosed and treated for bipolar disorder. Method: The authors report a case of an adult with attention deficit hyperactivity disorder erroneously diagnosed and treated for bipolar disorder for 6 years. At that point, methylphenidate was initiated. The patient was judged to be a…

  8. Inflammatory gene expression in monocytes of patients with schizophrenia: overlap and difference with bipolar disorder. A study in naturalistically treated patients.

    PubMed

    Drexhage, Roosmarijn C; van der Heul-Nieuwenhuijsen, Leonie; Padmos, Roos C; van Beveren, Nico; Cohen, Dan; Versnel, Marjan A; Nolen, Willem A; Drexhage, Hemmo A

    2010-11-01

    Accumulating evidence indicates an activated inflammatory response system as a vulnerability factor for schizophrenia (SZ) and bipolar disorder (BD). We aimed to detect a specific inflammatory monocyte gene expression signature in SZ and compare such signature with our recently described inflammatory monocyte gene signature in BD. A quantitative-polymerase chain reaction (Q-PCR) case-control gene expression study was performed on monocytes of 27 SZ patients and compared to outcomes collected in 56 BD patients (all patients naturalistically treated). For Q-PCR we used nine 'SZ specific genes' (found in whole genome analysis), the 19 BD signature genes (previously found by us) and six recently described autoimmune diabetes inflammatory monocyte genes. Monocytes of SZ patients had (similar to those of BD patients) a high inflammatory set point composed of three subsets of strongly correlating genes characterized by different sets of transcription/MAPK regulating factors. Subset 1A, characterized by ATF3 and DUSP2, and subset 1B, characterized by EGR3 and MXD1, were shared between BD and SZ patients (up-regulated in 67% and 51%, and 34% and 41%, respectively). Subset 2, characterized by PTPN7 and NAB2 was up-regulated in the monocytes of 62% BD, but down-regulated in the monocytes of 48% of SZ patients. Our approach shows that monocytes of SZ and BD patients overlap, but also differ in inflammatory gene expression. Our approach opens new avenues for nosological classifications of psychoses based on the inflammatory state of patients, enabling selection of those patients who might benefit from an anti-inflammatory treatment.

  9. Epidemiology and management of anxiety in patients with bipolar disorder.

    PubMed

    Kauer-Sant'Anna, Marcia; Kapczinski, Flavio; Vieta, Eduard

    2009-11-01

    Epidemiological and clinical studies have reported a high prevalence of anxiety symptoms in bipolar disorder, either in manic or depressive episodes, although these symptoms do not always meet criteria for a specific anxiety disorder. In addition to anxiety symptoms, bipolar disorder frequently presents with co-morbid axis I conditions, with anxiety disorders being the most common co-morbidity. Therefore, the objective of this article is to review clinical and epidemiological studies that have investigated the association between bipolar disorder and anxiety. Available data on the efficacy of treatments for bipolar disorder and co-morbid anxiety disorders are also reviewed. Existing guidelines do recognize that co-morbid anxiety has a negative impact on the course and outcome of bipolar disorder; however, there have been very few double-blind, controlled trials examining the treatment response of patients with bipolar disorder and co-occurring anxiety disorders. There is some positive evidence for quetiapine, olanzapine in combination with fluoxetine or lithium, and lamotrigine with lithium, and negative evidence for risperidone. Other therapies used for bipolar disorder, including several mood stabilizers, antidepressants, atypical antipsychotics and benzodiazepines, have been shown to reduce anxiety symptoms, but specific data for their effects in patients with anxiety symptoms co-morbid with bipolar disorder are not available. The co-occurrence of anxiety and bipolar disorder has implications for diagnosis, clinical outcome, treatment and prognosis. Careful screening for co-morbid anxiety symptoms and disorders is warranted when diagnosing and treating patients with bipolar disorder.

  10. Treating Bipolar Disorder in the Primary Care Setting: The Role of Aripiprazole

    PubMed Central

    McElroy, Susan L.

    2009-01-01

    Objective: The objective of this article is to present practical strategies for detecting and diagnosing bipolar disorder in the primary care setting and to review the evidence for the efficacy and safety of aripiprazole treatment for bipolar disorder. Data Sources: A review of the literature from 1980 to 2007 was conducted from November 2006 through February 2007 using a MEDLINE search and the key words bipolar disorder, primary care, detection, diagnosis, and aripiprazole. Study Selection: A total of 100 articles that focused on the accurate detection and diagnosis of bipolar disorder and the evidence of the efficacy and safety of aripiprazole in the treatment of bipolar disorder were selected. Data Synthesis: Patients with bipolar disorder often present to primary care physicians with depressive or mixed symptoms as opposed to purely hypomanic or manic symptoms. Accurate diagnosis of bipolar disorder is essential in order to provide timely and appropriate treatment. One treatment option available is aripiprazole, a partial agonist of dopamine (D)2 and D3 and serotonin (5-HT)1A receptors and an antagonist of the 5-HT2A receptor. Clinical trial data have shown aripiprazole to be effective in treating manic and mixed episodes associated with bipolar I disorder, both in the acute phase and over an extended period of treatment lasting from 6 months to 2 years. Conclusions: Accurate diagnosis and treatment of bipolar disorder are challenges increasingly faced by primary care physicians. Strategies geared toward detection, diagnosis, and management of bipolar I disorder and other bipolar spectrum disorders may improve the treatment outcome for patients. Aripiprazole may be considered as another first-line choice for the treatment of bipolar I disorder; however, its utility in patients with bipolar spectrum disorders is yet to be determined. PMID:19956463

  11. Adaptation and validation of the Portuguese version of the Lithium Knowledge Test (LKT) of bipolar patients treated with lithium: cross-over study

    PubMed Central

    2006-01-01

    Objective Adherence problems are a common feature among bipolar patients. A recent study showed that lithium knowledge was the main difference between adherent and non adherents bipolar patients. The Lithium Knowledge Test (LKT), a brief questionnaire, was developed as a means of identifying aspects of patients' practical and pharmacological knowledge which are important if therapy is to be safe and effective. The original English version is validated in psychiatric population, but a validated Portuguese one is not yet available. Methods One hundred six patients selected were diagnosed with bipolar disorder (I or II) according to DSM-IV criteria and had to be on lithium treatment for at least one month. The LKT was administered on only one occasion. We analysed the internal consis tency, concurrent validity, sensitivity and specificity of the LKT for the detection of the knowledge about lithium treatment of bipolar patients. Results The internal consistency, evaluated by Cronbach's alpha was 0.596. The mean of total score LKT by bipolar patients was 9.0 (SD: 0.75) for men and 8.74 (SD: 0.44) for women. Concurrent validity based on plasma lithium concentration showed a significant correlation between the total LKT score and plasma lithium (r = 0,232; p = 0.020). The sensitivity was 84% and specificity was 81%. Conclusion LKT is a rapid, reliable instrument which appears to be as effective as a lengthier standard interview with a lithium clinic doctor, and which has a high level of acceptability to lithium patients. We found that the psychometric assessment of the Portuguese version of LKT showed good internal consistency, sensitivity and specificity. PMID:17147815

  12. Adult presentation of congenital muscular torticollis: a series of 12 patients treated with a bipolar release of sternocleidomastoid and Z-lengthening.

    PubMed

    Patwardhan, S; Shyam, A K; Sancheti, P; Arora, P; Nagda, T; Naik, P

    2011-06-01

    Adult presentation of neglected congenital muscular torticollis is rare. We report 12 patients with this condition who underwent a modified Ferkel's release comprising a bipolar release of sternocleidomastoid with Z-lengthening. They had a mean age of 24 years (17 to 31) and were followed up for a minimum of two years. Post-operatively a cervical collar was applied for three weeks with intermittent supervised active assisted exercises for six weeks. Outcome was assessed using a modified Lee score and a Cheng and Tang score. The mean pre-operative rotational deficit was 8.25° (0° to 15°) and mean lateral flexion deficit was 20.42° (15° to 30°), which improved after treatment to a mean of 1.67° (0° to 5°) and 7.0° (4° to 14°) after treatment, respectively. According to the modified Lee scoring system, six patients had excellent results, two had good results and four had fair results, and using the Cheng and Tang score, eight patients had excellent results and four had good results. Surgical management of adult patients with neglected congenital muscular torticollis using a modified Ferkel's bipolar release gives excellent results. The range of neck movement and head tilt improved in all 12 patients and cosmesis improved in 11, despite the long-standing nature of the deformity.

  13. Family History in Patients with Bipolar Disorder

    PubMed Central

    ÖZDEMİR, Osman; COŞKUN, Salih; AKTAN MUTLU, Elif; ÖZDEMİR, Pınar Güzel; ATLI, Abdullah; YILMAZ, Ekrem; KESKİN, Sıddık

    2016-01-01

    Introduction In this study, we aimed to better understand the genetic transmission of bipolar disorder by examining the family history of patients. Methods Sixty-three patients with bipolar disorder and their families were included. The final sample comprised 156 bipolar patients and their family members. An inclusion criterion was the presence of bipolar disorder history in the family. The diagnosis of other family members was confirmed by analyzing their files, hospital records, and by calling them to the hospital. Results Sixty-five patients were women (41.6%) and 91 were men (58.3%) (ratio of men/women: 1.40). When analyzing the results in terms of the transition of disease from the mother’s or father’s side, similar results were obtained: 25 patients were from the mother’s side and 25 patients were from the father’s side in 63 cases. Conclusion The results of our study support the fact that a significant relationship exists between the degree of kinship and the heritability of bipolar disorder and, furthermore, that the effect of the maternal and paternal sides is similar on the transmission of genetic susceptibility. PMID:28373808

  14. An archetype of the collaborative efforts of psychotherapy and psychopharmacology in successfully treating dissociative identity disorder with comorbid bipolar disorder.

    PubMed

    Lakshmanan, Manu N; Meier, Stacey L Colton; Meier, Robert S; Lakshmanan, Ramaswamy

    2010-07-01

    We present a case where dissociative identity disorder was effectively treated with memory retrieval psychotherapy. However, the patient's comorbid bipolar disorder contributed to the patient's instability and fortified the amnesiac barriers that exist between alter personality states in dissociative identity disorder, which made memory retrieval difficult to achieve. Implications from this case indicate that a close collaboration between psychologist and psychiatrist focused on carefully diagnosing and treating existing comorbid conditions may be the most important aspect in treating dissociative identity disorder. We present our experience of successfully treating a patient with dissociative identity disorder and bipolar disorder using this collaborative method.

  15. Unmet needs of bipolar disorder patients

    PubMed Central

    Hajda, Miroslav; Prasko, Jan; Latalova, Klara; Hruby, Radovan; Ociskova, Marie; Holubova, Michaela; Kamaradova, Dana; Mainerova, Barbora

    2016-01-01

    Background Bipolar disorder (BD) is a serious mental illness with adverse impact on the lives of the patients and their caregivers. BD is associated with many limitations in personal and interpersonal functioning and restricts the patients’ ability to use their potential capabilities fully. Bipolar patients long to live meaningful lives, but this goal is hard to achieve for those with poor insight. With progress and humanization of society, the issue of patients’ needs became an important topic. The objective of the paper is to provide the up-to-date data on the unmet needs of BD patients and their caregivers. Methods A systematic computerized examination of MEDLINE publications from 1970 to 2015, via the keywords “bipolar disorder”, “mania”, “bipolar depression”, and “unmet needs”, was performed. Results Patients’ needs may differ in various stages of the disorder and may have different origin and goals. Thus, we divided them into five groups relating to their nature: those connected with symptoms, treatment, quality of life, family, and pharmacotherapy. We suggested several implications of these needs for pharmacotherapy and psychotherapy. Conclusion Trying to follow patients’ needs may be a crucial point in the treatment of BD patients. However, many needs remain unmet due to both medical and social factors. PMID:27445475

  16. Comparative Study of Bipolar Hemiarthroplasty for Femur Neck Fractures Treated with Cemented versus Cementless Stem

    PubMed Central

    Choi, Jung-Yun; Kim, Joo-Hyung

    2016-01-01

    Purpose To compare and analyze clinical and radiologic outcomes of cemented versus cementless bipolar hemiarthroplasty for treatment of femur neck fractures. Materials and Methods A total of 180 patients aged 65 years and over older who underwent bipolar hemiarthroplasty for treatment of displaced femur neck fractures (Garden stage III, IV) from March 2009 to February 2014 were included in this study. Among the 180 patients, 115 were treated with cemented stems and 65 patients with cementless stems. Clinical outcomes assessed were: i) postoperative ambulatory status, ii) inguinal and thigh pain, and iii) complications. The radiologic outcome was femoral stem subsidence measured using postoperative simple X-ray. Results The cemented group had significantly lower occurrence of complications (postoperative infection, P=0.04) compared to the cementless group. There was no significant difference in postoperative ambulatory status, inguinal and thigh pain, and femoral stem subsidence. Conclusion For patients undergoing bipolar hemiarthroplasty, other than complications, there was no statistically significant difference in clinical or radiologic outcomes in our study. Selective use of cemented stem in bipolar hemiarthroplasty may be a desirable treatment method for patients with poor bone quality and higher risk of infections. PMID:28097110

  17. Olanzapine Is Faster than Haloperidol in Inducing Metabolic Abnormalities in Schizophrenic and Bipolar Patients.

    PubMed

    Fabrazzo, Michele; Monteleone, Palmiero; Prisco, Vincenzo; Perris, Francesco; Catapano, Francesco; Tortorella, Alfonso; Monteleone, Alessio Maria; Steardo, Luca; Maj, Mario

    2015-01-01

    The effects of olanzapine and haloperidol on metabolic parameters in bipolar patients have been evaluated much less comprehensively than in schizophrenic patients. Therefore, in this study, medical records of 343 schizophrenic and bipolar patients treated with haloperidol or olanzapine for 1 year were retrospectively reviewed and metabolic outcomes were evaluated. After 12 months of follow-up, 25.9% of patients showed ≥3 metabolic abnormalities with a point prevalence of 27.2% in the bipolar and 24.9% in the schizophrenic group: 22.0% of the schizophrenic patients treated with haloperidol and 29.8% of those treated with olanzapine achieved ≥3 metabolic alterations; in bipolar patients, these percentages were 15.8% of those treated with haloperidol and 37.8% of those treated with olanzapine (p < 0.0001). Significant changes were reported over time in fasting glucose, triglycerides and cholesterol blood levels, systolic and diastolic blood pressure, body weight, and BMI. Overall, a significant number of schizophrenic and bipolar patients treated with olanzapine showed ≥3 metabolic alterations in the first month of treatment when compared to those treated with haloperidol. Moreover, the number of olanzapine-treated patients developing metabolic changes in the first month was significantly higher in both diagnostic groups when compared to those who reached metabolic abnormal values in the subsequent 11 months. These data suggest that both antipsychotics could increase the metabolic risk in schizophrenic and bipolar patients with a higher prevalence in olanzapine-treated patients. On the other hand, olanzapine-treated patients seem to achieve metabolic abnormalities faster than haloperidol-treated subjects in both diagnostic groups.

  18. Experience of Subjective Symptoms in Euthymic Patients with Bipolar Disorder

    PubMed Central

    Joe, Soohyun; Joo, Yeonho

    2008-01-01

    Bipolar patients often experience subjective symptoms even if they do not have active psychotic symptoms in their euthymic state. Most studies about subjective symptoms are conducted in schizophrenia, and there are few studies involving bipolar patients. We examined the nature of the subjective symptoms of bipolar patients in their euthymic state, and we also compared it to that of schizophrenia and normal control. Thirty bipolar patients, 25 patients with schizophrenia, and 21 normal control subjects were included. Subjective symptoms were assessed using the Korean version of the Frankfurter Beschwerde Fragebogen (K-FBF) and the Symptom Check List 90-R (SCL90-R). Euthymic state was confirmed by assessing objective psychopathology with the Positive and Negative Syndrome scale of Schizophrenia (PANSS), the Young Mania Rating Scale (YMRS), and the Montgomery Asberg Depression Rating Scale (MADRS). K-FBF score was significantly higher in bipolar patients than in normal controls, but similar to that in schizophrenia patients (F=5.86, p=0.004, R2=2033.6). In contrast, SCL90-R scores did not differ significantly among the three groups. Euthymic bipolar patients experience subjective symptoms that are more confined to cognitive domain. This finding supports the hypothesis that subtle cognitive impairments persists in euthymic bipolar patients. PMID:18303193

  19. An exploration of testosterone levels in patients with bipolar disorder

    PubMed Central

    Wooderson, Sarah C.; Gallagher, Peter; Watson, Stuart

    2015-01-01

    Background Testosterone influences well-being, mood and cognition and may play a role in the pathophysiology of bipolar disorder. Aim To examine testosterone levels in patients with bipolar disorder compared with healthy controls. Method We examined baseline total testosterone levels and current depression scores in male and female patients with bipolar disorder and mild to moderate depression and healthy controls. Results A significant interaction between diagnosis and gender was observed (F(2,97)=9.791, P=0.002). Testosterone levels were significantly lower for male patients with bipolar disorder compared with male controls (P=0.001). Women with bipolar disorder had significantly higher testosterone levels than female controls (P=0.03). Conclusions Disturbances in testosterone levels may represent an important neurobiological abnormality in bipolar disorder and may differ by gender. If these findings are confirmed, the use of gender appropriate treatment strategies for the normalisation of testosterone levels in bipolar disorder depression should be further explored. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence. PMID:27703738

  20. Adherence to Antipsychotic Medication in Bipolar Disorder and Schizophrenic Patients

    PubMed Central

    García, Saínza; Martínez-Cengotitabengoa, Mónica; López-Zurbano, Saioa; Zorrilla, Iñaki; López, Purificación; Vieta, Eduard; González-Pinto, Ana

    2016-01-01

    Abstract Antipsychotics are the drugs prescribed to treat psychotic disorders; however, patients often fail to adhere to their treatment, and this has a severe negative effect on prognosis in these kinds of illnesses. Among the wide range of risk factors for treatment nonadherence, this systematic review covers those that are most important from the point of view of clinicians and patients and proposes guidelines for addressing them. Analyzing 38 studies conducted in a total of 51,796 patients, including patients with schizophrenia spectrum disorders and bipolar disorder, we found that younger age, substance abuse, poor insight, cognitive impairments, low level of education, minority ethnicity, poor therapeutic alliance, experience of barriers to care, high intensity of delusional symptoms and suspiciousness, and low socioeconomic status are the main risk factors for medication nonadherence in both types of disorder. In the future, prospective studies should be conducted on the use of personalized patient-tailored treatments, taking into account risk factors that may affect each individual, to assess the ability of such approaches to improve adherence and hence prognosis in these patients. PMID:27307187

  1. Relapses in bipolar patients: changes in social rhythm?

    PubMed

    Kadri, Nadia; Mouchtaq, Nadia; Hakkou, Farid; Moussaoui, Driss

    2000-03-01

    The Ramadan month represents a valuable opportunity to test the hypothesis that the course of the illness of bipolar patients can be disrupted by the change in social rhythm which usually occurs during this month. The objectives of this study were to follow up the mood state and blood lithium level of fasting Muslim bipolar patients who had been on lithium therapy for at least 3 months, and were clinically stable before being included in the study. Twenty bipolar patients were enrolled during the month of Ramadan in 1997. Diagnosis of bipolar disorder was according to ICD-10 criteria. Patients were assessed during the week before Ramadan, the second and the fourth weeks of the fasting month and the first week after its end, with the Hamilton Depression and Bech-Rafaelsen scales. The plasma concentration of lithium was also assessed. The main finding of the study was that 45% of the patients relapsed, 70% during the second week and the remaining patients at the end of Ramadan. These relapses were not related to plasma concentration of lithium. Most of the relapses were manic (71.4 %). Patients who did not relapse had insomnia and anxiety during the second and third weeks of the study. Side-effects of lithium increased and were observed in 48% of the sample, mostly dryness of the mouth with thirst and tremor. The result of this pilot study indicates that the Ramadan month may disrupt the mood state of bipolar patients. More studies are needed to confirm this observation and to evaluate the validity of the Ramadan model to study the impact of social rhythms on bipolar patients.

  2. Effect of adjunctive benzodiazepines on clinical outcomes in lithium- or quetiapine-treated outpatients with bipolar I or II disorder: Results from the Bipolar CHOICE trial

    PubMed Central

    Bobo, William V.; Reilly-Harrington, Noreen A.; Ketter, Terence A.; Brody, Benjamin D.; Kinrys, Gustavo; Kemp, David E.; Shelton, Richard C.; McElroy, Susan L.; Sylvia, Louisa G.; Kocsis, James H.; McInnis, Melvin G.; Friedman, Edward S.; Singh, Vivek; Tohen, Mauricio; Bowden, Charles L.; Deckersbach, Thilo; Calabrese, Joseph R.; Thase, Michael E.; Nierenberg, Andrew A.; Rabideau, Dustin J.; Schoenfeld, David A.; Faraone, Stephen V.; Kamali, Masoud

    2014-01-01

    Background Little is known about the longer-term effects of adjunctive benzodiazepines on symptom response during treatment in patients with bipolar disorders. Methods The study sample consisted of 482 patients with bipolar I or II disorder enrolled in a 6-month, randomized, multi-site comparison of lithium- and quetiapine-based treatment. Changes in clinical measures (BISS total and subscales, CGI-BP, and CGI-Efficacy Index) were compared between participants who did and did not receive benzodiazepine treatment at baseline or during follow-up. Selected outcomes were also compared between patients who did and did not initiate benzodiazepines during follow-up using stabilized inverse probability weighted analyses. Results Significant improvement in all outcome measures occurred within each benzodiazepine exposure group. Benzodiazepine users (at baseline or during follow-up) experienced significantly less improvement in BISS total, BISS irritability, and CGI-BP scores than did benzodiazepine non-users. There were no significant differences in these measures between patients who did and did not initiate benzodiazepines during follow-up in the weighted analyses. There was no significant effect of benzodiazepine use on any outcome measure in patients with comorbid anxiety or substance use disorders. Limitations This is a secondary analysis of data from a randomized effectiveness trial that was not designed to address differential treatment response according to benzodiazepine use. Conclusions Adjunctive benzodiazepines may not significantly affect clinical outcome in lithium- or quetiapine-treated patients with bipolar I or II disorder over 6 months, after controlling for potential confounding factors. PMID:24751304

  3. Enhancing outcomes in patients with bipolar disorder: results from the Bipolar Disorder Center for Pennsylvanians Study

    PubMed Central

    Fagiolini, Andrea; Frank, Ellen; Axelson, David A; Birmaher, Boris; Cheng, Yu; Curet, David E; Friedman, Edward S; Gildengers, Ariel G; Goldstein, Tina; Grochocinski, Victoria J; Houck, Patricia R; Stofko, Mary G; Thase, Michael E; Thompson, Wesley K; Turkin, Scott R; Kupfer, David J

    2012-01-01

    Introduction We developed models of Specialized Care for Bipolar Disorder (SCBD) and a psychosocial treatment [Enhanced Clinical Intervention (ECI)] that is delivered in combination with SCBD. We investigated whether SCBD and ECI + SCBD are able to improve outcomes and reduce health disparities for young and elderly individuals, African Americans, and rural residents with bipolar disorder. Method Subjects were 463 individuals with bipolar disorder, type I, II, or not otherwise specified, or schizoaffective disorder, bipolar type, randomly assigned to SCBD or ECI + SCBD and followed longitudinally for a period of one to three years at four clinical sites. Results Both treatment groups significantly improved over time, with no significant differences based on age, race, or place of residence, except for significantly greater improvement among elderly versus adult subjects. Improvement in quality of life was greater in the ECI + SCBD group. Of the 299 participants who were symptomatic at study entry, 213 achieved recovery within 24 months, during which 86 of the 213 subjects developed a new episode. No significant difference was found for race, place of residence, or age between the participants who experienced a recurrence and those who did not. However, the adolescent patients were less likely than the adult and elderly patients to experience a recurrence. Conclusion This study demonstrated the effectiveness of SCBD and the additional benefit of ECI independent of age, race, or place of residence. It also demonstrated that new mood episodes are frequent in individuals with bipolar disorder who achieve recovery and are likely to occur in spite of specialized, guideline-based treatments. PMID:19500091

  4. Family Functionality and Coping Attitudes of Patients with Bipolar Disorder.

    PubMed

    Çuhadar, Döndü; Savaş, Haluk Asuman; Ünal, Ahmet; Gökpınar, Fatma

    2015-10-01

    The coping of patients with prodromal syndromes prevents relapses, and the differences in coping strategies affect the results of bipolar disorder. The various functionality levels of bipolar disorder patients such as work, marital relations, parental abilities and social presentation are significantly related with how well they cope. The objective of this study was to determine the family functionality and coping attitudes of bipolar disorder patients. The study planned as a descriptive one was carried with 81 bipolar disorder patients. Personal description form, family assessment device and Coping Attitudes Scale were used as data acquisition tools. It was determined that the adaptive coping attitudes used most frequently by the patients were religious coping, positive reinterpretation, active coping, problem-focused coping and emotional focused coping, beneficial social support use, emotional social support use, planning, suppression of competing activities and restraint coping; maladaptive coping attitudes used most frequently by the patients were "focusing on the problem and venting of emotions and mental disengagement." It was determined that family functions affected the coping attitudes of patients and that the patients who evaluated family functions in a healthy manner made use of adaptive coping strategies more at a statistically significant level.

  5. Clinical features, comorbidity, and cognitive impairment in elderly bipolar patients

    PubMed Central

    Rise, Ida Vikan; Haro, Josep Maria; Gjervan, Bjørn

    2016-01-01

    Introduction Data specific to late-life bipolar disorder (BD) are limited. Current research is sparse and present guidelines are not adapted to this group of patients. Objectives We present a literature review on clinical characteristics, comorbidities, and cognitive impairment in patients with late-life BD. This review discusses common comorbidities that affect BD elders and how aging might affect cognition and treatment. Methods Eligible studies were identified in MedLine by the Medical Subject Headings terms “bipolar disorder” and “aged”. We only included original research reports published in English between 2012 and 2015. Results From 414 articles extracted, 16 studies were included in the review. Cardiovascular and respiratory conditions, type II diabetes, and endocrinological abnormalities were observed as highly prevalent. BD is associated with a high suicide risk. Bipolar elderly had an increased risk of dementia and performed worse on cognitive screening tests compared to age-matched controls across different levels of cognition. Despite high rates of medical comorbidity among bipolar elderly, a systematic under-recognition and undertreatment of cardiovascular disease have been suggested. Conclusion There was a high burden of physical comorbidities and cognitive impairment in late-life BD. Bipolar elderly might be under-recorded and undertreated in primary medical care, indicating that this group needs an adapted clinical assessment and specific clinical guidelines need to be established. PMID:27274256

  6. Identification of MAC1: A Small Molecule That Rescues Spindle Bipolarity in Monastrol-Treated Cells.

    PubMed

    Al-Obaidi, Naowras; Mitchison, Timothy J; Crews, Craig M; Mayer, Thomas U

    2016-06-17

    The genetic integrity of each organism is intimately tied to the correct segregation of its genome during mitosis. Insights into the underlying mechanisms are fundamental for both basic research and the development of novel strategies to treat mitosis-relevant diseases such as cancer. Due to their fast mode of action, small molecules are invaluable tools to dissect mitosis. Yet, there is a great demand for novel antimitotic compounds. We performed a chemical genetic suppression screen to identify compounds that restore spindle bipolarity in cells treated with Monastrol, an inhibitor of the mitotic kinesin Eg5. We identified one compound-MAC1-that rescued spindle bipolarity in cells lacking Eg5 activity. Mechanistically, MAC1 induces the formation of additional microtubule nucleation centers, which allows kinesin Kif15-dependent bipolar spindle assembly in the absence of Eg5 activity. Thus, our chemical genetic suppression screen revealed novel unexpected insights into the mechanism of spindle assembly in mammalian cells.

  7. Stigma experiences in bipolar patients: the impact upon functioning.

    PubMed

    Thomé, E S; Dargél, A A; Migliavacca, F M; Potter, W A; Jappur, D M C; Kapczinski, F; Ceresér, K M

    2012-10-01

    The aim of this study was to investigate the impact of self-rated stigma and functioning in patients with bipolar disorder in South Brazil. This is a cross-sectional study. Sixty participants with bipolar disorder were recruited from an outpatient Bipolar Disorder Program. Experiences with and impact of perceived stigma were evaluated using the Inventory of Stigmatizing Experiences. Functional impairment was assessed with the Functioning Assessment Short Test (FAST). Higher scores of self-perceived stigma were correlated with higher FAST scores, indicating more disability. After linear correlation analysis, current depressive symptoms, age at onset of treatment, age at diagnosis and functioning were correlated with self-perceived stigma. The study demonstrated a correlation between stigma and poor functioning in bipolar disorder. Perceived stigma is really important to individuals with bipolar disorder, both to how they experience their illness and to its results on functioning. Potential consequences of such results for mental health care professionals are discussed. Differential clinical features, sociocultural factors and the sample size limit the generalization of the present findings.

  8. Bipolar Disorder.

    PubMed

    Miller, Thomas H

    2016-06-01

    Bipolar disorder is a chronic mental health disorder that is frequently encountered in primary care. Many patients with depression may actually have bipolar disorder. The management of bipolar disorder requires proper diagnosis and awareness or referral for appropriate pharmacologic therapy. Patients with bipolar disorder require primary care management for comorbidities such as cardiovascular and metabolic disorders.

  9. The relationship between religious involvement and clinical status of patients with bipolar disorder

    PubMed Central

    Cruz, Mario; Pincus, Harold Alan; Welsh, Deborah E; Greenwald, Devra; Lasky, Elaine; Kilbourne, Amy M

    2009-01-01

    Objective Religion and spirituality are important coping strategies in depression but have been rarely studied within the context of bipolar disorder. The present study assessed the association between different forms of religious involvement and the clinical status of individuals treated for bipolar disorder. Methods A cross-sectional observation study of follow-up data from a large cohort study of patients receiving care for bipolar disorder (n = 334) at an urban Veterans Affairs mental health clinic was conducted. Bivariate and multivariate analyses were performed to assess the association between public (frequency of church attendance), private (frequency of prayer/meditation), as well as subjective forms (influence of beliefs on life) of religious involvement and mixed, manic, depressed, and euthymic states when demographic, anxiety, alcohol abuse, and health indicators were controlled. Results Multivariate analyses found significant associations between higher rates of prayer/meditation and participants in a mixed state [odds ratio (OR) = 1.29; 95% confidence interval (CI) = 1.10-1.52, chi square = 9.42, df = 14, p < 0.05], as well as lower rates of prayer/meditation and participants who were euthymic (OR = 0.84; 95% CI = 0.72-0.99, chi square = 4.60, df = 14, p < 0.05). Depression and mania were not associated with religious involvement. Conclusions Compared to patients with bipolar disorder in depressed, manic, or euthymic states, patients in mixed states have more active private religious lives. Providers should assess the religious activities of individuals with bipolar disorder in mixed states and how they may complement/deter ongoing treatment. Future longitudinal studies linking bipolar states, religious activities, and treatment-seeking behaviors are needed. PMID:20148868

  10. Treating Insomnia Improves Mood State, Sleep, and Functioning in Bipolar Disorder: A Pilot Randomized Controlled Trial

    PubMed Central

    Harvey, Allison G.; Soehner, Adriane M.; Kaplan, Kate A.; Hein, Kerrie; Lee, Jason; Kanady, Jennifer; Rabe-Hesketh, Sophia; Neylan, Thomas C.; Li, Descartes; Ketter, Terence A.; Buysse, Daniel J.

    2015-01-01

    Objective To determine if a treatment for interepisode bipolar disorder I patients with insomnia improves mood state, sleep, and functioning. Method Alongside psychiatric care, interepisode bipolar disorder I participants with insomnia were randomly allocated to a bipolar disorder–specific modification of cognitive behavior therapy for insomnia (CBTI-BP; n = 30) or psychoeducation (PE; n = 28) as a comparison condition. Outcomes were assessed at baseline, the end of 8 sessions of treatment, and 6 months later. This pilot was conducted to determine initial feasibility and generate effect size estimates. Results During the 6-month follow-up, the CBTI-BP group had fewer days in a bipolar episode relative to the PE group (3.3 days vs. 25.5 days). The CBTI-BP group also experienced a significantly lower hypomania/mania relapse rate (4.6% vs. 31.6%) and a marginally lower overall mood episode relapse rate (13.6% vs. 42.1%) compared with the PE group. Relative to PE, CBTI-BP reduced insomnia severity and led to higher rates of insomnia remission at posttreatment and marginally higher rates at 6 months. Both CBTI-BP and PE showed statistically significant improvement on selected sleep and functional impairment measures. The effects of treatment were well sustained through follow-up for most outcomes, although some decline on secondary sleep benefits was observed. Conclusions CBTI-BP was associated with reduced risk of mood episode relapse and improved sleep and functioning on certain outcomes in bipolar disorder. Hence, sleep disturbance appears to be an important pathway contributing to bipolar disorder. The need to develop bipolar disorder–specific sleep diary scoring standards is highlighted. Public Health Significance This study suggests that an intervention to improve sleep and circadian functioning reduces risk of relapse and improves sleep and overall functioning among individuals who meet diagnostic criteria for bipolar disorder. PMID:25622197

  11. Humor appreciation in remitted patients with bipolar disorder.

    PubMed

    Bozikas, Vasilis P; Kosmidis, Mary H; Tonia, Thomy; Garyfallos, George; Focas, Kostas; Karavatos, Athanasios

    2007-09-01

    The purpose of the present study was to investigate humor appreciation in a group of remitted patients with bipolar disorder. We examined 19 patients (8 men) with bipolar disorder I, currently remitted, and 22 (9 men) healthy controls, matched on age, education, and gender, on a computerized test comprising captionless cartoons, the Penn's Humor Appreciation Test (PHAT). Residual manic symptoms were evaluated with the Young Mania Rating Scale and residual depressive symptoms with the Montgomery-Asberg Depression Rating Scale. Patients with bipolar disorder performed worse than the healthy group on the PHAT, but this difference was not statistically significant. Performance on the PHAT did not significantly correlate with age of onset and duration of illness, or with residual manic or depressive symptoms measured by Young Mania Rating Scale and Montgomery-Asberg Depression Rating Scale, respectively. Humor appreciation, based on captionless cartoons, in bipolar disorder does not seem to be deficient at least during remission, suggesting that this high-order cognitive function may not be considered a trait deficit of the disorder.

  12. Electrical mapping in bipolar disorder patients during the oddball paradigm.

    PubMed

    Di Giorgio Silva, Luiza Wanick; Cartier, Consuelo; Cheniaux, Elie; Novis, Fernanda; Silveira, Luciana Angélica; Cavaco, Paola Anaquim; de Assis da Silva, Rafael; Batista, Washington Adolfo; Tanaka, Guaraci Ken; Gongora, Mariana; Bittencourt, Juliana; Teixeira, Silmar; Basile, Luis Fernando; Budde, Henning; Cagy, Mauricio; Ribeiro, Pedro; Velasques, Bruna

    2016-01-01

    Bipolar disorder (BD) is characterized by an alternated occurrence between acute mania episodes and depression or remission moments. The objective of this study is to analyze the information processing changes in BP (Bipolar Patients) (euthymia, depression and mania) during the oddball paradigm, focusing on the P300 component, an electric potential of the cerebral cortex generated in response to external sensorial stimuli, which involves more complex neurophysiological processes related to stimulus interpretation. Twenty-eight bipolar disorder patients (BP) (17 women and 11 men with average age of 32.5, SD: 9.5) and eleven healthy controls (HC) (7 women and 4 men with average age of 29.78, SD: 6.89) were enrolled in this study. The bipolar patients were divided into 3 major groups (i.e., euthymic, depressive and maniac) according to the score on the Clinical Global Impression--Bipolar Version (CGI-BP). The subjects performed the oddball paradigm simultaneously to the EEG record. EEG data were also recorded before and after the execution of the task. A one-way ANOVA was applied to compare the P300 component among the groups. After observing P300 and the subcomponents P3a and P3b, a similarity of amplitude and latency between euthymic and depressive patients was observed, as well as small amplitude in the pre-frontal cortex and reduced P3a response. This can be evidence of impaired information processing, cognitive flexibility, working memory, executive functions and ability to shift the attention and processing to the target and away from distracting stimuli in BD. Such neuropsychological impairments are related to different BD symptoms, which should be known and considered, in order to develop effective clinical treatment strategies.

  13. Efficacy of bipolar release in neglected congenital muscular torticollis patients.

    PubMed

    Seyhan, Nevra; Jasharllari, Lorenc; Keskin, Mustafa; Savacı, Nedim

    2012-06-01

    Surgical correction of the congenital muscular torticollis (CMT) is recommended for patients with unsuccessful conservative treatment. The aim of this study is to evaluate the efficacy of surgical release of congenital muscular torticollis in neglected cases. We retrospectively evaluated the data of our patients in terms of age, sex, clinical presentation, localization of the lesion, diagnostic tests, and additional abnormalities. The age at operation ranged from 6 to 23 years. Complete muscular release as determined by pre-operative and postoperative range of motion measurements was achieved in all of the patients by bipolar release. In this study, neck motion and head tilt showed marked improvement with surgical treatment in cases with CMT who were admitted to the hospital lately. Congenital muscular torticollis patients can benefit from surgical intervention above the age of 5. Bipolar release is an adequate and complication-free method.

  14. ESPECTRA: Searching the Bipolar Spectrum in Eating Disorder patients

    PubMed Central

    2011-01-01

    Background Bipolar Disorder (BD) is a chronic, recurrent and highly prevalent illness. Despite the need for correct diagnosis to allow proper treatment, studies have shown that reaching a diagnosis can take up to ten years due to the lack of recognition of the broader presentations of BD. Frequent comorbidities with other psychiatric disorders are a major cause of misdiagnosis and warrant thorough evaluation. Methods/Design ESPECTRA (Occurrence of Bipolar Spectrum Disorders in Eating Disorder Patients) is a single-site cross-sectional study involving a comparison group, designed to evaluate the prevalence of bipolar spectrum in an eating disorder sample. Women aged 18-45 years will be evaluated using the SCID-P and Zurich criteria for diagnosis and the HAM-D, YOUNG, SCI-MOODS, HCL-32, BIS-11, BSQ, WHOQoL and EAS instruments for rating symptoms and measuring clinical correlates. Discussion The classificatory systems in psychiatry are based on categorical models that have been criticized for simplifying the diagnosis and leading to an increase in comorbidities. Some dimensional approaches have been proposed aimed at improving the validity and reliability of psychiatric disorder assessments, especially in conditions with high rates of comorbidity such as BD and Eating Disorder (ED). The Bipolar Spectrum (BS) remains under-recognized in clinical practice and its definition is not well established in current diagnostic guidelines. Broader evaluation of psychiatric disorders combining categorical and dimensional views could contribute to a more realistic understanding of comorbidities and help toward establishing a prognosis. PMID:21489298

  15. [Cognitions and functioning in euthymic bipolar patients: screening and treatment].

    PubMed

    Bellivier, Frank

    2012-12-01

    Persistent cognitive deficits in euthymic bipolar patients are now well documented. Indeed, several studies and meta-analyzes clearly establish the existence of cognitive deficits in specific domains: attention (in particular sustained attention), Memory (in particular verbal memory) and executive functions. The impact of cognitive deficits on patient's functioning is also well documented and their role appear to be more important than expected by comparison with the impairment related to thymic residual symptoms. The development of specific cognitive remediation strategies is therefore a major hope for improving the quality of remission and functional outcome. The aetiology of these deficits remains poorly understood. However, the implication of factors related to the biological/genetic vulnerability to bipolar disorder is likely well as a "neurotoxic" effects of major mood episodes, in particular acute manic episodes that seems to play a important role in the worsening of these deficits over time. This further stresses the importance maintenance strategies for long-term functional outcome.

  16. Synchronization of EEG activity in patients with bipolar disorder

    NASA Astrophysics Data System (ADS)

    Panischev, O. Yu; Demin, S. A.; Muhametshin, I. G.; Demina, N. Yu

    2015-12-01

    In paper we apply the method based on the Flicker-Noise Spectroscopy (FNS) to determine the differences in frequency-phase synchronization of the cortical electroencephalographic (EEG) activities in patients with bipolar disorder (BD). We found that for healthy subjects the frequency-phase synchronization of EEGs from long-range electrodes was significantly better for BD patients. In BD patients a high synchronization of EEGs was observed only for short-range electrodes. Thus, the FNS is a simple graphical method for qualitative analysis can be applied to identify the synchronization effects in EEG activity and, probably, may be used for the diagnosis of this syndrome.

  17. Risk factors for an anxiety disorder comorbidity among Thai patients with bipolar disorder: results from the Thai Bipolar Disorder Registry

    PubMed Central

    Paholpak, Suchat; Kongsakon, Ronnachai; Pattanakumjorn, Wasana; Kanokvut, Roongsang; Wongsuriyadech, Wiroj; Srisurapanont, Manit

    2014-01-01

    Background The aim of the study was to determine in a clinical setting the risk factors for current anxiety disorder (AD) comorbidity among Thai patients with bipolar disorder (BD), being treated under the Thai Bipolar Disorder Registry Project (TBDR). Methods The TBDR was a multisite naturalistic study conducted at 24 psychiatric units (ie, at university, provincial mental, and government general hospitals) between February 2009 and January 2011. Participants were in- or out-patients over 18 years of age who were diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Instruments used in this study included the Thai Mini International Neuropsychiatric Interview version 5; Thai Montgomery–Åsberg Depression Rating Scale (MADRS); Thai Young Mania Rating Scale; Clinical Global Impression of Bipolar Disorder-Severity (CGI-BP-S), CGI-BP-S-mania, CGI-BPS-depression, and CGI-BP-S-overall BP illness; and the Thai SF-36 quality of life questionnaire. Results Among the 424 BD patients, 404 (95.3%) had BD type I. The respective mean ± standard deviation of age of onset of mood disturbance, first diagnosis of BD, and first treatment of BD was 32.0±11.9, 36.1±12.2, and 36.2±12.2 years. The duration of illness was 10.7±9.0 years. Fifty-three (12.5%) of the 424 participants had a current AD while 38 (9%) had a substance use disorder (SUD). The univariate analysis revealed 13 significant risks for current AD comorbidity, which the multivariate analysis narrowed to age at first diagnosis of BD (odds ratio =0.95, P<0.01), family history of SUD (odds ratio =2.18, P=0.02), and having a higher current MADRS score (odds ratio =1.11, P<0.01). Conclusion A diagnosis of AD comorbid with BD is suggested by early-age onset of BD together with a higher MADRS score and a family history of SUD. The likelihood of AD comorbidity decreases by 5% with each passing year; early-age onset of BD is a risk while later age onset is protective. Our

  18. Perceptions of social dominance through facial emotion expressions in euthymic patients with bipolar I disorder.

    PubMed

    Kim, Sung Hwa; Ryu, Vin; Ha, Ra Yeon; Lee, Su Jin; Cho, Hyun-Sang

    2016-04-01

    The ability to accurately perceive dominance in the social hierarchy is important for successful social interactions. However, little is known about dominance perception of emotional stimuli in bipolar disorder. The aim of this study was to investigate the perception of social dominance in patients with bipolar I disorder in response to six facial emotional expressions. Participants included 35 euthymic patients and 45 healthy controls. Bipolar patients showed a lower perception of social dominance based on anger, disgust, fear, and neutral facial emotional expressions compared to healthy controls. A negative correlation was observed between motivation to pursue goals or residual manic symptoms and perceived dominance of negative facial emotions such as anger, disgust, and fear in bipolar patients. These results suggest that bipolar patients have an altered perception of social dominance that might result in poor interpersonal functioning. Training of appropriate dominance perception using various emotional stimuli may be helpful in improving social relationships for individuals with bipolar disorder.

  19. Olanzapine in Chinese patients with schizophrenia or bipolar disorder: a systematic literature review

    PubMed Central

    Xue, Hai Bo Haber; Liu, Li; Zhang, Hena; Montgomery, William; Treuer, Tamás

    2014-01-01

    Background Despite the burden of schizophrenia and bipolar disorder in the Chinese population, country-specific data to guide practitioners regarding antipsychotic therapy are lacking. The primary aim of this systematic review was to examine evidence of the efficacy, effectiveness, and safety of olanzapine in Chinese populations. Methods A systematic literature search was conducted using databases covering international and Chinese core journals using search terms related to schizophrenia and bipolar disorder, specified countries (People’s Republic of China, Hong Kong, Taiwan), and olanzapine treatment. Following initial screening, inclusion and exclusion criteria were applied to the search results to identify relevant studies from which data were extracted. Results A total of 489 publications were retrieved and 61 studies were identified for inclusion. Most studies were related to schizophrenia (n=54), with six studies related to bipolar disorder and one study related to both conditions. The quality of study methods and reporting in international journals was noticeably better than in Chinese language journals. Most studies included relatively small patient populations and were of short duration. The efficacy of olanzapine in Chinese populations was confirmed by multiple comparative and noncomparative studies that found statistically significant reductions in symptom measures in studies conducted for ≥6 weeks (schizophrenia) or ≥3 weeks (bipolar disorder). Findings related to effectiveness (treatment discontinuation, quality of life, and neurocognitive improvements) were generally consistent with those observed in non-Chinese populations. No new safety signals specific for Chinese populations were raised for olanzapine. Conclusion Chinese and non-Chinese populations with schizophrenia or bipolar disorder treated with olanzapine display broadly similar responses. Differences between these populations, especially in relation to the relative efficacy of

  20. Alterations in Cerebrospinal Fluid in Patients with Bipolar Syndromes

    PubMed Central

    Endres, Dominique; Dersch, Rick; Hottenrott, Tilman; Perlov, Evgeniy; Maier, Simon; van Calker, Dietrich; Hochstuhl, Benedikt; Venhoff, Nils; Stich, Oliver; van Elst, Ludger Tebartz

    2016-01-01

    Bipolar disorder (BD) is a severe and lifelong condition. Primary endogenic polygenetic forms are common. Secondary organic forms have received increasing interest recently due to the detection of immunological encephalopathies that mimic various psychiatric syndromes, including BD. However, only limited data about routine findings of cerebrospinal fluid (CSF) analyses in BD are available. Therefore, we investigated the frequency of alterations in the CSF in patients with BD and the association with autoantibodies, cerebral magnetic resonance imaging, and electroencephalography findings. CSF samples of patients with BD collected from January 1998 until December 2015 were analyzed retrospectively. Patients with preexisting causes for alterations in the CSF (e.g., patients with obvious past or current neurological disorders) were excluded. In total, 63 patients with BD fulfilled the inclusion criteria for the study. In 1.6% of the patients with BD, an increased white blood cell count was found in the CSF. Increased albumin quotients were found in 12.9% of the patients, oligoclonal bands (OCBs) in 1.6%, and increased immunoglobulin (Ig) G indices in 3.2% (OCBs were not measured in case of increased IgG indices). No significant differences in CSF findings were found between patients with manic and depressive episodes. The main findings of this open uncontrolled study are that alterations in the CSF may be found in a small, but potentially relevant, subgroup of patients with BD. These findings are discussed in light of the new concepts of mild encephalitis and immunological encephalopathy. The detection of patients with possibly secondary organic bipolar syndromes could open up new causal treatment options with immunomodulatory medication. PMID:28008318

  1. Affect recognition across manic and euthymic phases of bipolar disorder in Han-Chinese patients.

    PubMed

    Pan, Yi-Ju; Tseng, Huai-Hsuan; Liu, Shi-Kai

    2013-11-01

    Patients with bipolar disorder (BD) have affect recognition deficits. Whether affect recognition deficits constitute a state or trait marker of BD has great etiopathological significance. The current study aims to explore the interrelationships between affect recognition and basic neurocognitive functions for patients with BD across different mood states, using the Diagnostic Analysis of Non-Verbal Accuracy-2, Taiwanese version (DANVA-2-TW) as the index measure for affect recognition. To our knowledge, this is the first study examining affect recognition deficits of BPD across mood states in the Han Chinese population. Twenty-nine manic patients, 16 remitted patients with BD, and 40 control subjects are included in the study. Distinct association patterns between affect recognition and neurocognitive functions are demonstrated for patients with BD and control subjects, implicating alternations in emotion associated neurocognitive processing. Compared to control subjects, manic patients but not remitted subjects perform significantly worse in the recognition of negative emotions as a whole and specifically anger, after adjusting for differences in general intellectual ability and basic neurocognitive functions. Affect recognition deficit may be a relatively independent impairment in BD rather than consequences arising from deficits in other basic neurocognition. The impairments of manic patients in the recognition of negative emotions, specifically anger, may further our understanding of core clinical psychopathology of BD and have implications in treating bipolar patients across distinct mood phases.

  2. Acute Interventions and Referral of Patients With Bipolar Disorder by the Psychiatric Consultation Liaison Service in a General Hospital in Germany: A Retrospective Analysis

    PubMed Central

    Anderson, Christina

    2014-01-01

    Objective: To investigate the population of bipolar patients in a general hospital in Germany who required treatment by a consultant psychiatrist. Method: A retrospective analysis was conducted of the clinical records of 47 patients diagnosed with bipolar disorder (DSM-IV-TR criteria) who were treated by a consultant psychiatrist between 2009 and 2012 in one of the general hospitals of Charité Berlin, Campus Benjamin Franklin, Berlin, Germany. We investigated the sections of the hospital that requested psychiatric consultations for bipolar patients, the status of these patients, and their primary cause of treatment, as well as the intervention (including pharmacotherapy) recommended by the consultant psychiatrist. Results: For more than half of the patients, their psychiatric illness was either directly or indirectly the reason they presented to the hospital. The remaining bipolar patients were treated for various somatic illnesses unrelated to their bipolar disorder throughout the hospital, with a relative overrepresentation of patients in the neurology department. More than half of the patients were referred to a psychiatric hospital by the consultant psychiatrist. Benzodiazepines were the most commonly administered drugs for acute pharmacologic intervention. Conclusions: Psychiatric consultations are not frequently requested for bipolar patients compared to those with other psychiatric disorders. However, more than half of the bipolar patients needed further psychiatric treatment in a psychiatric hospital. This finding emphasizes the importance of psychiatric consultations in a general hospital for bipolar patients. The administration of benzodiazepines as an acute treatment seems to be the standard pharmacologic procedure, not a specific pharmacotherapy like mood stabilizers. PMID:25133062

  3. Bipolar clavicular injury.

    PubMed

    Pang, K P; Yung, S W; Lee, T S; Pang, C E

    2003-10-01

    While clavicular injuries are fairly common, bipolar clavicular injuries are not. They may involve dislocations at both ends of the clavicle, or a fracture at one end and a dislocation at the other. We present two cases; a patient with a bipolar clavicular dislocation, and another with a fracture in both medial and lateral ends of the clavicle with anterior dislocation of the sternoclavicular joint. Both were treated conservatively, with fairly good range of motion and return to normal activity.

  4. Medication adherence and utilization in patients with schizophrenia or bipolar disorder receiving aripiprazole, quetiapine, or ziprasidone at hospital discharge: A retrospective cohort study

    PubMed Central

    2012-01-01

    Background Schizophrenia and bipolar disorder are chronic debilitating disorders that are often treated with second-generation antipsychotic agents, such as aripiprazole, quetiapine, and ziprasidone. While patients who are hospitalized for schizophrenia and bipolar disorder often receive these agents at discharge, comparatively little information exists on subsequent patterns of pharmacotherapy. Methods Using a database linking hospital admission records to health insurance claims, we identified all patients hospitalized for schizophrenia (ICD-9-CM diagnosis code 295.XX) or bipolar disorder (296.0, 296.1, 296.4-296.89) between January 1, 2001 and September 30, 2008 who received aripiprazole, quetiapine, or ziprasidone at discharge. Patients not continuously enrolled for 6 months before and after hospitalization (“pre-admission” and “follow-up”, respectively) were excluded. We examined patterns of use of these agents during follow-up, including adherence with treatment (using medication possession ratios [MPRs] and cumulative medication gaps [CMGs]) and therapy switching. Analyses were undertaken separately for patients with schizophrenia and bipolar disorder, respectively. Results We identified a total of 43 patients with schizophrenia, and 84 patients with bipolar disorder. During the 6-month period following hospitalization, patients with schizophrenia received an average of 101 therapy-days with the second-generation antipsychotic agent prescribed at discharge; for patients with bipolar disorder, the corresponding value was 68 therapy-days. Mean MPR at 6 months was 55.1% for schizophrenia patients, and 37.3% for those with bipolar disorder; approximately one-quarter of patients switched to another agent over this period. Conclusions Medication compliance is poor in patients with schizophrenia or bipolar disorder who initiate treatment with aripiprazole, quetiapine, or ziprasidone at hospital discharge. PMID:22856540

  5. Predominant mania course in Indian patients with bipolar I disorder.

    PubMed

    Rangappa, Sushma Bilichodu; Munivenkatappa, Shashidhara; Narayanaswamy, Janardhanan C; Jain, Sanjeev; Reddy, Y C Janardhan

    2016-08-01

    Many long-term follow-up studies suggest that bipolar disorder (BD) is highly recurrent and that depressive episodes are commoner than hypomania/manic episodes. However, some studies from tropical countries including India suggest that the patients experience a greater proportion of manic episodes than depressive episodes. The aim of the present study was to examine the course of BD type 1 (BD I) in a sample of hospitalized Indian subjects. We examined the clinical course of 285 BD I subjects with at least 5 years of illness using standard life charting method. These subjects were hospitalized between October 2010 and October 2012. The predominant polarity (having at least two-thirds of their lifetime episodes at one polarity) was mania (79%). Unipolar mania (≥ 3 mania episodes and no episodes of depression) was observed in 48% of the subjects. The frequency of rapid cycling course was noted in 2.5% of the subjects. Predominant manic polarity group had the illness onset mostly with a manic episode (88.9%) and the predominant depressive polarity group with a depressive episode (73.8%). Mania was the predominant polarity with a high rate of unipolar mania and a majority of the subjects had greater number of manic episodes than depressive/mixed episodes. The onset polarity determined the predominant polarity during the course of illness. Predominantly, mania course could have significant implications in the treatment of bipolar disorder.

  6. Patients' perspectives on residual symptoms in bipolar disorder: a focus group study.

    PubMed

    Samalin, Ludovic; Bellivier, Frank; Giordana, Bruno; Yon, Liova; Milhiet, Vanessa; El-Hage, Wissam; Courtet, Philippe; Hacques, Evguenia; Bedira, Nabil; Dillenschneider, Anne; Llorca, Pierre Michel

    2014-07-01

    Euthymic bipolar patients are often impacted by residual symptoms (RSs) that increase the risk of relapse or low functioning. We aimed to identify the perceptions of RSs, barriers to management, and service needs in euthymic bipolar patients. A qualitative methodology (focus group) was used. The interviews were investigated using a semistructured guide, tape-recorded, transcribed verbatim, and analyzed thematically. Twenty-three bipolar patients expressed concern about several RSs, such as emotional dysregulation, circadian rhythm disruption, cognitive impairment, low self-esteem, and physical symptoms. They reported concern about the impact of RSs on their functioning and about the need for more systematic assessment of RSs during interepisode visits. Selection bias may have occurred because the recruitment was limited to France and there may be cultural differences in the perceptions of RSs. Bipolar patients experienced bipolar disorder as a chronic disorder because they frequently continued to suffer from RSs associated with a functional impact.

  7. Internet use by patients with bipolar disorder: Results from an international multisite survey.

    PubMed

    Bauer, Rita; Conell, Jörn; Glenn, Tasha; Alda, Martin; Ardau, Raffaella; Baune, Bernhard T; Berk, Michael; Bersudsky, Yuly; Bilderbeck, Amy; Bocchetta, Alberto; Bossini, Letizia; Castro, Angela M Paredes; Cheung, Eric Yw; Chillotti, Caterina; Choppin, Sabine; Del Zompo, Maria; Dias, Rodrigo; Dodd, Seetal; Duffy, Anne; Etain, Bruno; Fagiolini, Andrea; Hernandez, Miryam Fernández; Garnham, Julie; Geddes, John; Gildebro, Jonas; Gonzalez-Pinto, Ana; Goodwin, Guy M; Grof, Paul; Harima, Hirohiko; Hassel, Stefanie; Henry, Chantal; Hidalgo-Mazzei, Diego; Kapur, Vaisnvy; Kunigiri, Girish; Lafer, Beny; Larsen, Erik R; Lewitzka, Ute; Licht, Rasmus W; Lund, Anne Hvenegaard; Misiak, Blazej; Monteith, Scott; Munoz, Rodrigo; Nakanotani, Takako; Nielsen, René E; O'Donovan, Claire; Okamura, Yasushi; Osher, Yamima; Piotrowski, Patryk; Reif, Andreas; Ritter, Philipp; Rybakowski, Janusz K; Sagduyu, Kemal; Sawchuk, Brett; Schwartz, Elon; Scippa, Ângela M; Slaney, Claire; Sulaiman, Ahmad H; Suominen, Kirsi; Suwalska, Aleksandra; Tam, Peter; Tatebayashi, Yoshitaka; Tondo, Leonardo; Vieta, Eduard; Vinberg, Maj; Viswanath, Biju; Volkert, Julia; Zetin, Mark; Whybrow, Peter C; Bauer, Michael

    2016-08-30

    There is considerable international interest in online education of patients with bipolar disorder, yet little understanding of how patients use the Internet and other sources to seek information. 1171 patients with a diagnosis of bipolar disorder in 17 countries completed a paper-based, anonymous survey. 81% of the patients used the Internet, a percentage similar to the general public. Older age, less education, and challenges in country telecommunications infrastructure and demographics decreased the odds of using the Internet. About 78% of the Internet users looked online for information on bipolar disorder or 63% of the total sample. More years of education in relation to the country mean, and feeling very confident about managing life decreased the odds of seeking information on bipolar disorder online, while having attended support groups increased the odds. Patients who looked online for information on bipolar disorder consulted medical professionals plus a mean of 2.3 other information sources such as books, physician handouts, and others with bipolar disorder. Patients not using the Internet consulted medical professionals plus a mean of 1.6 other information sources. The percentage of patients with bipolar disorder who use the Internet is about the same as the general public. Other information sources remain important.

  8. Temperament and character traits in patients with bipolar disorder and associations with comorbid alcoholism or anxiety disorders.

    PubMed

    Nery, Fabiano G; Hatch, John P; Glahn, David C; Nicoletti, Mark A; Monkul, E Serap; Najt, Pablo; Fonseca, Manoela; Bowden, Charles L; Cloninger, C Robert; Soares, Jair C

    2008-06-01

    Temperament and character traits may determine differences in clinical presentations and outcome of bipolar disorder. We compared personality traits in bipolar patients and healthy individuals using the Temperament and Character Inventory (TCI) and sought to verify whether comorbidity with alcoholism or anxiety disorders is associated with specific personality traits. Seventy-three DSM-IV bipolar patients were compared to 63 healthy individuals using the TCI. In a second step, the bipolar sample was subgrouped according to the presence of psychiatric comorbidity (alcoholism, n=10; anxiety disorders; n=23; alcoholism plus anxiety disorders, n=21; no comorbidity, n=19). Bipolar patients scored statistically higher than the healthy individuals on novelty seeking, harm avoidance and self-transcendence and lower on self-directedness and cooperativeness. Bipolar patients with only comorbid alcoholism scored statistically lower than bipolar patients without any comorbidity on persistence. Bipolar patients with only comorbid anxiety disorders scored statistically higher on harm avoidance and lower on self-directedness than bipolar patients without any comorbidity. Limitations of this study include the cross-sectional design and the small sample size, specifically in the analysis of the subgroups. However, our results suggest that bipolar patients exhibit a different personality structure than healthy individuals and that presence of psychiatric comorbidity in bipolar disorder is associated with specific personality traits. These findings suggest that personality, at least to some extent, mediates the comorbidity phenomena in bipolar disorder.

  9. Treating an Adolescent with Long QT Syndrome for Bipolar Disorder: A Case Presentation

    PubMed Central

    Önen, Özlem; Kutlu, Ayşe; Erkuran, Handan Özek

    2017-01-01

    Objectives Long QT syndrome (LQTS) is described as the development of sudden syncope attacks or death as a result of ventricular tachycardia (VT) episodes that might be observed as elongated QT interval in electrocardiography (ECG). Implantable Cardioverter Defibrillator (ICD) is recommended as first-line treatment for the condition in guidelines. We aimed to present an adolescent recently diagnosed with Bipolar Disorder (BD) who had LQTS that was treated with ICD, discussing her follow up and treatment along with relevant literature. Methods Psychiatric assessment of the case that applied to our child psychiatry unit due to manic symptoms were carried out by using Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) criteria. Symptom severity was monitored via Young Mania Rating Scale scores (YMRSS). Results The case met criteria for Bipolar Disorder Type I (BD-I). She had improvement in her mood symptoms with treatment regimen as risperidone 3 mg/day, valproate 1000 mg/day and lorazepam 1 mg/dayi after her 2–week follow up as well as no reported ICD activity, reflecting fine cardiac functions and rhythm. Conclusions LQTS is a serious health issue for children and adolescents diagnosed with BD. This condition should be kept in mind especially in cases where familial risk factors are present and precautions need to be maintained upon required assessments. These cases need to be closely monitored due to risk factors related to both BD and LQTS, in a multidisciplinary fashion, involving both psychiatry and cardiology divisions. PMID:28138202

  10. Elevated levels of plasma brain derived neurotrophic factor in rapid cycling bipolar disorder patients.

    PubMed

    Munkholm, Klaus; Pedersen, Bente Klarlund; Kessing, Lars Vedel; Vinberg, Maj

    2014-09-01

    Impaired neuroplasticity may be implicated in the pathophysiology of bipolar disorder, involving peripheral alterations of the neurotrophins brain derived neurotrophic factor (BDNF) and neurotrophin 3 (NT-3). Evidence is limited by methodological issues and is based primarily on case-control designs. The aim of this study was to investigate whether BDNF and NT-3 levels differ between patients with rapid cycling bipolar disorder and healthy control subjects and whether BDNF and NT-3 levels alter with affective states in rapid cycling bipolar disorder patients. Plasma levels of BDNF and NT-3 were measured in 37 rapid cycling bipolar disorder patients and in 40 age- and gender matched healthy control subjects using enzyme-linked immunosorbent assay (ELISA). In a longitudinal design, repeated measurements of BDNF and NT-3 were evaluated in various affective states in bipolar disorder patients during a 6-12 months period and compared with repeated measurements in healthy control subjects. Careful attention was given to standardization of all procedures and adjustment for potential confounders of BDNF and NT-3. In linear mixed models, adjusting for demographical and lifestyle factors, levels of BDNF were significantly elevated in bipolar disorder patients in euthymic- (p<0.05), depressed- (p<0.005) and manic/hypomanic (p<0.005) states compared with healthy control subjects. Within bipolar disorder patients, adjusting for medication, there was no significant difference in BDNF levels between affective states, with equally elevated levels present in euthymic-, depressive- and manic/hypomanic patients. Levels of BDNF were higher in patients with longer duration of illness compared with patients with shorter duration of illness. We found no difference in NT-3 levels between bipolar disorder patients in any affective state compared with healthy control subjects and no difference in NT-3 levels between affective states in bipolar disorder patients. The results suggest that

  11. Increased Suicidal Ideation in Patients with Co-Occurring Bipolar Disorder and Post-Traumatic Stress Disorder.

    PubMed

    Carter, Julia M; Arentsen, Timothy J; Cordova, Matthew J; Ruzek, Josef; Reiser, Robert; Suppes, Trisha; Ostacher, Michael J

    2016-06-16

    Suicide risk increases for those with Bipolar Disorder or PTSD, however little research has focused on risk for co-occurring Bipolar Disorder and PTSD. The aim of this article was to evaluate increased suicide risk in co-occurring disorders, and differences in suicide risk for patients with Bipolar I versus Bipolar II. This study evaluated suicide risk in patients with co-occurring PTSD and Bipolar Disorder (n = 3,158), using the MADRS and Suicide Questionnaire. Those with history of PTSD had significantly higher suicidal ideation than those without (U = 1063375.00, p < .0001). Those with Bipolar I had higher risk than those with Bipolar II. Patients with Bipolar I and PTSD were at higher risk for suicidal ideation, implying the importance of diagnosis and risk assessment.

  12. Differential responses to lithium in hyperexcitable neurons from patients with bipolar disorder.

    PubMed

    Mertens, Jerome; Wang, Qiu-Wen; Kim, Yongsung; Yu, Diana X; Pham, Son; Yang, Bo; Zheng, Yi; Diffenderfer, Kenneth E; Zhang, Jian; Soltani, Sheila; Eames, Tameji; Schafer, Simon T; Boyer, Leah; Marchetto, Maria C; Nurnberger, John I; Calabrese, Joseph R; Ødegaard, Ketil J; McCarthy, Michael J; Zandi, Peter P; Alda, Martin; Alba, Martin; Nievergelt, Caroline M; Mi, Shuangli; Brennand, Kristen J; Kelsoe, John R; Gage, Fred H; Yao, Jun

    2015-11-05

    Bipolar disorder is a complex neuropsychiatric disorder that is characterized by intermittent episodes of mania and depression; without treatment, 15% of patients commit suicide. Hence, it has been ranked by the World Health Organization as a top disorder of morbidity and lost productivity. Previous neuropathological studies have revealed a series of alterations in the brains of patients with bipolar disorder or animal models, such as reduced glial cell number in the prefrontal cortex of patients, upregulated activities of the protein kinase A and C pathways and changes in neurotransmission. However, the roles and causation of these changes in bipolar disorder have been too complex to exactly determine the pathology of the disease. Furthermore, although some patients show remarkable improvement with lithium treatment for yet unknown reasons, others are refractory to lithium treatment. Therefore, developing an accurate and powerful biological model for bipolar disorder has been a challenge. The introduction of induced pluripotent stem-cell (iPSC) technology has provided a new approach. Here we have developed an iPSC model for human bipolar disorder and investigated the cellular phenotypes of hippocampal dentate gyrus-like neurons derived from iPSCs of patients with bipolar disorder. Guided by RNA sequencing expression profiling, we have detected mitochondrial abnormalities in young neurons from patients with bipolar disorder by using mitochondrial assays; in addition, using both patch-clamp recording and somatic Ca(2+) imaging, we have observed hyperactive action-potential firing. This hyperexcitability phenotype of young neurons in bipolar disorder was selectively reversed by lithium treatment only in neurons derived from patients who also responded to lithium treatment. Therefore, hyperexcitability is one early endophenotype of bipolar disorder, and our model of iPSCs in this disease might be useful in developing new therapies and drugs aimed at its clinical

  13. Differential responses to lithium in hyperexcitable neurons from patients with bipolar disorder

    PubMed Central

    Mertens, Jerome; Wang, Qiu-Wen; Kim, Yongsung; Yu, Diana X.; Pham, Son; Yang, Bo; Zheng, Yi; Diffenderfer, Kenneth E.; Zhang, Jian; Soltani, Sheila; Eames, Tameji; Schafer, Simon T.; Boyer, Leah; Marchetto, Maria C.; Nurnberger, John I.; Calabrese, Joseph R.; Oedegaard, Ketil J.; McCarthy, Michael J.; Zandi, Peter P.; Alda, Martin; Nievergelt, Caroline M.; Mi, Shuangli; Brennand, Kristen J.; Kelsoe, John R.; Gage, Fred H.; Yao, Jun

    2015-01-01

    Bipolar disorder is a complex neuropsychiatric disorder that is characterized by intermittent episodes of mania and depression; without treatment, 15% of patients commit suicide1. Hence, it has been ranked by the World Health Organization as a top disorder of morbidity and lost productivity2. Previous neuropathological studies have revealed a series of alterations in the brains of patients with bipolar disorder or animal models3, such as reduced glial cell number in the prefrontal cortex of patients4, upregulated activities of the protein kinase A and C pathways5–7 and changes in neurotransmission8–11. However, the roles and causation of these changes in bipolar disorder have been too complex to exactly determine the pathology of the disease. Furthermore, although some patients show remarkable improvement with lithium treatment for yet unknown reasons, others are refractory to lithium treatment. Therefore, developing an accurate and powerful biological model for bipolar disorder has been a challenge. The introduction of induced pluripotent stem-cell (iPSC) technology has provided a new approach. Here we have developed an iPSC model for human bipolar disorder and investigated the cellular phenotypes of hippocampal dentate gyrus-like neurons derived from iPSCs of patients with bipolar disorder. Guided by RNA sequencing expression profiling, we have detected mitochondrial abnormalities in young neurons from patients with bipolar disorder by using mitochondrial assays; in addition, using both patch-clamp recording and somatic Ca2+ imaging, we have observed hyperactive action-potential firing. This hyperexcitability phenotype of young neurons in bipolar disorder was selectively reversed by lithium treatment only in neurons derived from patients who also responded to lithium treatment. Therefore, hyperexcitability is one early endophenotype of bipolar disorder, and our model of iPSCs in this disease might be useful in developing new therapies and drugs aimed at its

  14. Comorbidity of Adult Attention Deficit and Hyperactivity Disorder in Bipolar Patients: Prevalence, Sociodemographic and Clinical Correlates

    PubMed Central

    BERKOL, Tonguç Demir; YARGIÇ, İlhan; ÖZYILDIRIM, İlker; YAZICI, Olcay

    2014-01-01

    Introduction The aims of this study were to determine the frequency of adult attention deficit and hyperactivity disorder (ADHD) comorbidity in bipolar patients and to investigate the influence of this comorbidity on the clinical characteristics of bipolar disorder (BD). Method A total of 135 patients with BD type I and II and BD not otherwise specified were included in this study. First, the Adult ADD/ADHD DSM-IV-Based Diagnostic Screening and Rating Scale (ADHD scale) was administered to all patients, and all of the patients were also interviewed for the diagnosis. Patients who were diagnosed as having ADHD comorbidity (n=23) on the basis of DSM-IV and those who were not diagnosed to have ADHD comorbidity (n=32) were compared in terms of sociodemographic and clinical correlates. Results Twenty-three of 135 patients (17%) were found to have ADHD comorbidity. In the ADHD comorbidity group, the level of education and the number of suicide attempts were higher (p=.011 and .043, respectively). Although not significant, subthreshold depressive symptoms in interepisodic periods, the lifetime history of antidepressant use and the total number of lifetime depressive episodes tended to be more frequent in bipolar disorder with ADHD comorbidity group than in the control group. Conclusion Bipolar disorder has a frequent comorbidity with ADHD, and contrary to expectations, it might be related to the depressive aspect, rather than the manic aspect, of bipolar disorder. Early diagnosis of ADHD comorbidity in bipolar patients might help to prevent serious risk factors.

  15. Differential Neurodevelopmental Trajectories in Patients With Early-Onset Bipolar and Schizophrenia Disorders

    PubMed Central

    Arango, Celso

    2014-01-01

    Schizophrenia and bipolar disorders share not only clinical features but also some risk factors such as genetic markers and childhood adversity, while other risk factors such as urbanicity and obstetric complications seem to be specific to schizophrenia. An intriguing question is whether the well-established abnormal neurodevelopment present in many children and adolescents who eventually develop schizophrenia is also present in bipolar patients. The literature on adult bipolar patients is controversial. We report data on a subgroup of patients with pediatric-onset psychotic bipolar disorder who seem to share some developmental trajectories with patients with early-onset schizophrenia. These early-onset psychotic bipolar patients have low intelligence quotient, more neurological signs, reduced frontal gray matter at the time of their first psychotic episode, and greater brain changes than healthy controls in a pattern similar to early-onset schizophrenia cases. However, patients with early-onset schizophrenia seem to have more social impairment, developmental abnormalities (eg, language problems), and lower academic achievement in childhood than early-onset bipolar patients. We suggest that some of these abnormal developmental trajectories are more related to the phenotypic features (eg, early-onset psychotic symptoms) of these 2 syndromes than to categorically defined Diagnostic and Statistical Manual of Mental Disorders disorders. PMID:24371326

  16. Deficits in docosahexaenoic acid and associated elevations in the metabolism of arachidonic acid and saturated fatty acids in the postmortem orbitofrontal cortex of patients with bipolar disorder.

    PubMed

    McNamara, Robert K; Jandacek, Ronald; Rider, Therese; Tso, Patrick; Stanford, Kevin E; Hahn, Chang-Gyu; Richtand, Neil M

    2008-09-30

    Previous antemortem and postmortem tissue fatty acid composition studies have observed significant deficits in the omega-3 fatty acid docosahexaenoic acid (DHA, 22:6n-3) in red blood cell (RBC) and postmortem cortical membranes of patients with unipolar depression. In the present study, we determined the fatty acid composition of postmortem orbitofrontal cortex (OFC, Brodmann area 10) of patients with bipolar disorder (n=18) and age-matched normal controls (n=19) by gas chromatography. After correction for multiple comparisons, DHA (-24%), arachidonic acid (-14%), and stearic acid (C18:0) (-4.5%) compositions were significantly lower, and cis-vaccenic acid (18:1n-7) (+12.5%) composition significantly higher, in the OFC of bipolar patients relative to normal controls. Based on metabolite:precursor ratios, significant elevations in arachidonic acid, stearic acid, and palmitic acid conversion/metabolism were observed in the OFC of bipolar patients, and were inversely correlated with DHA composition. Deficits in OFC DHA and arachidonic acid composition, and elevations in arachidonic acid metabolism, were numerically (but not significantly) greater in drug-free bipolar patients relative to patients treated with mood-stabilizer or antipsychotic medications. OFC DHA and arachidonic acid deficits were greater in patients plus normal controls with high vs. low alcohol abuse severity. These results add to a growing body of evidence implicating omega-3 fatty acid deficiency as well as the OFC in the pathoaetiology of bipolar disorder.

  17. Metabolic syndrome in patients enrolled in a clinical trial of aripiprazole in the maintenance treatment of bipolar I disorder

    PubMed Central

    Kemp, David E; Calabrese, Joseph R; Tran, Quynh-Van; Pikalov, Andrei; Eudicone, James M; Baker, Ross A

    2013-01-01

    Objectives To compare the effects of maintenance treatment with aripiprazole or placebo on the incidence of metabolic syndrome in bipolar disorder. Methods Patients with bipolar I disorder were stabilized on aripiprazole for 6–18 weeks prior to double-blind randomization to aripiprazole or placebo for 26 weeks. The rate of metabolic syndrome in each group was calculated at maintenance phase baseline (randomization) and endpoint for evaluable patients using an LOCF approach. Metabolic syndrome was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. Results At entry into the maintenance phase, overall 45/125 patients (36.0%) met criteria for metabolic syndrome. Mean changes in the five components of metabolic syndrome (waist circumference, triglycerides, high-density lipoprotein cholesterol, blood pressure and glucose) from baseline to Week 26 were small except for a meaningful reduction in triglycerides (placebo −18.9 mg/dL; aripiprazole −11.5 mg/dL). By the end of the maintenance phase (endpoint, LOCF), 5/18 placebo-treated patients (27.8%) and 4/14 aripiprazole-treated patients (28.6%) no longer met metabolic syndrome criteria. The proportion of patients with metabolic syndrome was similar in the placebo and aripiprazole groups both at baseline and Week 26. There were no significant changes in any of the individual components of metabolic syndrome between aripiprazole- and placebo-treated patients during maintenance phase treatment. Conclusions The prevalence of metabolic syndrome in patients with bipolar disorder is higher than commonly reported in the general population. The effect of 26 weeks of treatment with aripiprazole on the incidence of metabolic syndrome and its components was similar to placebo. PMID:20492838

  18. Comparison of Subjective and Objective Sleep Estimations in Patients with Bipolar Disorder and Healthy Control Subjects

    PubMed Central

    Sauer, Cathrin; Pfeiffer, Steffi; Bauer, Michael; Pfennig, Andrea

    2016-01-01

    Background. Several studies have described but not formally tested discrepancies between subjective and objective measures of sleep. Study Objectives. To test the hypothesis that patients with bipolar disorder display a systematic bias to underestimate sleep duration and overestimate sleep latency. Methods. Actimetry was used to assess sleep latency and duration in 49 euthymic participants (bipolar = 21; healthy controls = 28) for 5–7 days. Participants simultaneously recorded estimated sleep duration and sleep latency on a daily basis via an online sleep diary. Group differences in the discrepancy between subjective and objective parameters were calculated using t-tests and corrected for multiple comparisons. Results. Patients with bipolar disorder significantly underestimated their sleep duration but did not overestimate their sleep latency compared to healthy controls. Conclusions. Studies utilizing diaries or questionnaires alone in patients with bipolar disorders may systematically underestimate sleep duration compared to healthy controls. The additional use of objective assessment methods such as actimetry is advisable. PMID:27891255

  19. Manic patients exhibit more utilitarian moral judgments in comparison with euthymic bipolar and healthy persons.

    PubMed

    Kim, Sung Hwa; Kim, Tae Young; Ryu, Vin; Ha, Ra Yeon; Lee, Su Jin; Ha, Kyooseob; Cho, Hyun-Sang

    2015-04-01

    Both emotional and cognitive processes are involved in moral judgments. Ventromedial prefrontal lesions are related to impaired prosocial emotions and emotional dysregulation, and patients with these lesions exhibit increased utilitarian judgments of emotionally salient personal moral dilemmas. Bipolar patients experiencing manic episode also have impaired emotional regulation and behavioral control. We investigated the characteristics of moral judgment in manic and euthymic patients with bipolar disorder using the 50 hypothetical moral dilemma task (17 non-moral, 20 personal, and 13 impersonal). Our study included 27 manic bipolar patients, 26 euthymic bipolar patients, and 42 healthy controls. Subjects were instructed to determine whether or not each dilemma was morally acceptable, and their reaction times were recorded. Manic patients showed significantly greater utilitarian judgment than euthymic patients and normal controls for personal moral dilemmas. However, there were no significant between-group differences for the non-moral and impersonal moral dilemmas. Our results suggest that increased utilitarian judgments of personal moral dilemmas may be a state-related finding observed only in manic patients. This difference in moral judgment assessments may reflect the decision-making characteristics and underlying neurobiological mechanisms of bipolar disorder, especially during the manic state.

  20. Evidence-based guidelines for treating bipolar disorder: revised second edition--recommendations from the British Association for Psychopharmacology.

    PubMed

    Goodwin, G M

    2009-06-01

    The British Association for Psychopharmacology guidelines specify the scope and target of treatment for bipolar disorder. The second version, like the first, is based explicitly on the available evidence and presented, like previous Clinical Practice guidelines, as recommendations to aid clinical decision making for practitioners: they may also serve as a source of information for patients and carers. The recommendations are presented together with a more detailed but selective qualitative review of the available evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from participants and interested parties. The strength of supporting evidence was rated. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in treatment of episodes, relapse prevention and stopping treatment.

  1. Bipolar depression and treatment with antidepressants.

    PubMed

    Goodwin, Guy M

    2012-01-01

    Treatment of bipolar disorder with antidepressants tested almost exclusively in unipolar cases is common but unsupported by an appropriate body of evidence. This anomaly is highlighted by a large Taiwanese study, which implies that patients with depression difficult to treat with antidepressants are quite likely to be diagnosed subsequently with bipolar disorder.

  2. Bipolar Disorder and Cognitive Therapy: A Commentary

    ERIC Educational Resources Information Center

    Riskind, John H.

    2005-01-01

    This article comments on the three articles (Leahy, 2005; Newman, 2005; and Reilly-Harrington & Knauz, 2005) that deal with the applications of cognitive therapy to treatment of bipolar disorder. They focus on the uses of cognitive therapy in treating three important facets of the special problems of bipolar patients: rapid cycling, severe…

  3. Association of age-of-onset groups with GWAS significant schizophrenia and bipolar disorder loci in Romanian bipolar I patients.

    PubMed

    Grigoroiu-Serbanescu, Maria; Diaconu, Carmen C; Heilmann-Heimbach, Stefanie; Neagu, Ana Iulia; Becker, Tim

    2015-12-30

    We investigated the influence of the age-of-onset (AO) on the association of 45 loci conferring risk for bipolar disorder (BP) and schizophrenia with BP-type-I in a Romanian sample (461 patients, 436 controls). The AO-analysis implicated the EGFR gene, as well as loci in other genes, in the AO variation of BP-type-I and revealed for the first time the link between BP-type-I and risk variants considered specific to schizophrenia (polymorphisms in MMP16/RIPK2 and CNNM2 genes).

  4. Clinical profile and outcome of bipolar disorder patients receiving electroconvulsive therapy: A study from north India

    PubMed Central

    Bharadwaj, Vineet; Grover, Sandeep; Chakrabarti, Subho; Avasthi, Ajit; Kate, Natasha

    2012-01-01

    Background: Although electroconvulsive therapy (ECT) is used quite frequently among the bipolar patients in developing countries, very little data are available with regard to its effectiveness from the developing countries. Aim: A retrospective case note review was carried out of bipolar disorder patients who were given ECT. Materials and Methods: Details of demographic and clinical profile, indications for ECT, response patterns, adverse effects, etc. were recorded. Results: Among all the patients who received ECT, 18% were diagnosed to have bipolar disorder. ECT was administered most commonly for mania with psychotic symptoms, followed by severe depression with psychotic symptoms. Comorbid physical problems were seen in many patients. Nearly 90% of patients in both the subgroups showed more than 50% response (based on reduction in the standardized rating scales) with ECT. Few patients (22%) reported some kind of side effects. Conclusions: ECT is useful in the management of acute phase of mania and depression. PMID:22556436

  5. Self-esteem in recovered bipolar and unipolar out-patients.

    PubMed

    Pardoen, D; Bauwens, F; Tracy, A; Martin, F; Mendlewicz, J

    1993-12-01

    The hypothesis of a low self-esteem in depressive patients was tested using the Rosenberg Self-Esteem Scale in 24 recovered unipolar and 27 recovered bipolar patients, compared with a normal control group of 26 subjects matched for age and sex. The hypothesis was confirmed only for unipolars; bipolar patients presented a self-esteem score not significantly different from normal scores. Self-esteem was not related to clinical characteristics of the affective disorder, suggesting that low self-esteem may be a basic component of a depression-prone personality. The investigation of the relationship between self-esteem and social adjustment confirmed the presence of social conformism in bipolar patients and rigidly set low self-esteem in unipolar patients. These results should stimulate the evaluation of different psychotherapeutic treatments in the long-term psychosocial management of affectively ill patients.

  6. Long-term management strategies to achieve optimal function in patients with bipolar disorder.

    PubMed

    Keck, Paul E

    2006-12-01

    Predictors of poor functional outcome in patients with bipolar disorder include psychiatric and medical comorbidity, interepisode subsyndromal symptoms, psychosis during manic or mixed episode, and low premorbid functioning. Cognitive dysfunction may also contribute to functional impairment. Psychosocial intervention has shown success in improving syndromal outcomes for people with bipolar disorder. Lithium, lamotrigine, olanzapine, and aripiprazole have all shown substantial improvements in relapse rates compared with placebo. Combination therapy with antipsychotics and antidepressants has also been shown to produce improvement in symptoms in people with bipolar disorder. However, limited evidence is available for the effects of these treatments on cognitive outcomes. This review discusses treatment strategies for the long-term management of bipolar disorder and functional outcome measures associated with these treatments.

  7. Magnetic resonance spectroscopy imaging of lactate in patients with bipolar disorder.

    PubMed

    Chu, Wen-Jang; Delbello, Melissa P; Jarvis, Kelly B; Norris, Mathew M; Kim, Mi-Jung; Weber, Wade; Lee, Jing-Huei; Strakowski, Stephen M; Adler, Caleb M

    2013-09-30

    Although brain lactate levels are typically low and difficult to measure, a few previous investigators have reported that brain lactate levels are elevated in patients with bipolar disorder. The present study investigated the distribution of lactate in bipolar and healthy brains using 2D proton magnetic resonance spectroscopic imaging on a 4-Tesla magnetic resonance imaging system. Ratios of the concentration of lactate to N-acetylaspartate, and of lactate to total creatine, were significantly higher in bipolar than in healthy subjects. Lactate signals were primarily localized to the bipolar subjects' caudate and anterior cingulate cortices, components of the frontal-subcortical circuit, suggesting that affective dysregulation may be related to metabolic abnormalities in this network.

  8. Contributors to Suicidal Ideation among Bipolar Patients with and without a History of Suicide Attempts

    ERIC Educational Resources Information Center

    Allen, Michael H.; Chessick, Cheryl A.; Miklowitz, David J.; Goldberg, Joseph F.; Wisniewski, Stephen R.; Miyahara, Sachiko; Calabrese, Joseph R.; Marangell, Lauren; Bauer, Mark S.; Thomas, Marshall R.; Bowden, Charles L.; Sachs, Gary S.

    2005-01-01

    This study was designed to develop models for vulnerability to suicidal ideation in bipolar patients. Logistic regression models examined correlates of suicidal ideation in patients who had versus had not attempted suicide previously. Of 477 patients assessed, complete data on demographic, illness history, and personality variables were available…

  9. Patients with bipolar disorder show differential executive dysfunctions: A case-control study.

    PubMed

    Leung, Meranda M W; Lui, Simon S Y; Wang, Ya; Tsui, Chi F; Au, Angie C W; Yeung, Hera K H; Yang, Tian-Xiao; Li, Zhi; Cheng, Chi-Wai; Cheung, Eric F C; Chan, Raymond C K

    2016-04-30

    Executive deficits in euthymic bipolar I disorder were examined in a fractionated manner based on the "Supervisory Attentional System" (SAS) model, and the relationship between the degree of executive impairment and the demographic and clinical characteristics of bipolar I participants was explored. A battery of neurocognitive tests capturing specific components of executive function was administered on 30 patients with bipolar I disorder in euthymic state, and compared with 30 healthy controls who were matched by age, gender and IQ. A differential impairment in executive function was demonstrated in euthymic bipolar I participants by using a fractionated approach of the SAS. Euthymic bipolar I patients were found to have significantly poorer performance in immediate and delayed visual memory; and in the executive domains of "initiation", "sustained attention", and "attention allocation and planning". Those with a greater number of executive impairments had lower IQ and higher negative sub-scores on PANSS. These findings might provide a the basis for further studies on identifying the executive components that are associated with particular disease characteristics of bipolar disorder, and those with poorer functional outcome, so that rehabilitation can be focused on the selective domains concerned.

  10. Mindfulness-based Cognitive Therapy for Non-remitted Patients with Bipolar Disorder

    PubMed Central

    Deckersbach, Thilo; Hölzel, Britta K.; Eisner, Lori R.; Stange, Jonathan P.; Peckham, Andrew D.; Dougherty, Darin D.; Rauch, Scott L.; Lazar, Sara; Nierenberg, Andrew A.

    2013-01-01

    Introduction Bipolar disorder is characterized by recurrent episodes of depression and/or mania along with inter-episodic mood symptoms that interfere with psychosocial functioning. Despite periods of symptomatic recovery, many individuals with bipolar disorder continue to experience substantial residual mood symptoms that often lead to the recurrence of mood episodes. Aims The present study explored whether a new mindfulness-based cognitive therapy (MBCT) for bipolar disorder would increase mindfulness, reduce residual mood symptoms, and increase emotion regulation abilities, psychological well-being, positive affect and psychosocial functioning. Following a baseline clinical assessment, 12 individuals with DSM-IV bipolar disorder were treated with 12 group sessions of MBCT. Results At the end of treatment, as well as at the 3-months follow-up, participants showed increased mindfulness, lower residual depressive mood symptoms, less attentional difficulties, and increased emotion regulation abilities, psychological well-being, positive affect and psychosocial functioning. Conclusions These findings suggest that treating residual mood symptoms with MBCT may be another avenue to improving mood, emotion regulation, well-being and functioning in individuals with bipolar disorder. PMID:22070469

  11. Efficacy of unilateral deep brain stimulation of the thalamic ventralis intermedius nucleus in a patient with bipolar disorder associated with Klinefelter syndrome and essential tremor. Case report.

    PubMed

    Telfeian, A E; Boockvar, J A; Simuni, T; Jaggi, J; Skolnick, B; Baltuch, G H

    2000-07-01

    Deep brain stimulation (DBS) of the ventralis intermedius nucleus (Vim) is a safe and effective treatment for essential tremor. Bipolar disorder and essential tremor had each been reported to occur in association with Klinefelter syndrome but the three diseases have been reported to occur together in only one patient. The genetic basis and natural history of these disorders are not completely understood and may be related rather than coincidental. The authors report on a 23-year-old man with Klinefelter syndrome (47,XXY) and bipolar disorder who was treated successfully with unilateral DBS of the thalamic Vim for essential tremor.

  12. A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder

    PubMed Central

    Cohen, Ronny; Lysenko, Alla; Mallet, Thierry; Mirrer, Brooks; Gale, Michael; Loarte, Pablo; McCue, Robert

    2015-01-01

    We present a case of drug-induced myocarditis manifesting as acute heart failure in a young patient with bipolar disorder being treated for depression. The case describes a 20-year-old man being treated in the psychiatry ward for worsening depression when he started complaining of chest pain and shortness of breath. His list of medications included clozapine, lithium, lorazepam, and haloperidol. The main findings on physical examination were tachycardia, low-grade fever, crackles in both lung bases on auscultation, and the absence of any notable edema. Abnormal labs included a troponin of 0.9, with a CK of 245 and CK-MB of 3.1. An ECG revealed sinus tachycardia and left anterior fascicular block (LAFB). An echocardiogram revealed global hypokinesis, severe left ventricular dysfunction with an ejection fraction estimated at 20%. The patient had an admitting diagnosis of acute left ventricular systolic dysfunction likely secondary to drug-induced myocarditis (suspect clozapine) versus acute coronary syndrome. He was managed conservatively and transferred to another facility for endomyocardial biopsy confirming myocarditis. This case is an example of one of the most typical presentations of suspected drug-induced acute myocarditis and will hopefully prompt the reader to think of this underdiagnosed entity in the right clinical setting. PMID:26413355

  13. Effectiveness of methylphenidate as augmentation therapy after failure of adjunctive neuromodulation for patients with treatment-refractory bipolar depression: a case report.

    PubMed

    Adida, Marc; Azorin, Jean-Michel

    2014-01-01

    Adjunctive use of methylphenidate, a central stimulant, has been considered as a potential therapeutic choice for patients with refractory unipolar, geriatric, or bipolar depression, and depression secondary to medical illness. We present a case of bipolar depression in which the patient responded significantly to augmentation with methylphenidate, without any side effects, after failure of adjunctive repetitive transcranial magnetic stimulation and electroconvulsive therapy. Mr U, a 56-year-old man with bipolar I disorder, had melancholic symptoms during his sixth episode of bipolar depression. After failure of repetitive transcranial magnetic stimulation and electroconvulsive therapy, he was treated with fluoxetine 80 mg/day, duloxetine 360 mg/day, mirtazapine 60 mg/day, and sodium valproate 1,000 mg/day, with no improvement. We added methylphenidate at a dose of 10 mg/day for one week, which resulted in mild clinical improvement, and then methylphenidate extended-release 20 mg/day for one week, with significant clinical improvement. He tolerated his medications well. His clinical recovery was stable over one year. The patient's antidepressants and methylphenidate were gradually tapered and finally discontinued after one year with no withdrawal syndrome. To date, he remains well on sodium valproate as monotherapy and is being followed up at our bipolar department. This case suggests that methylphenidate augmentation might be a therapeutic option when treating highly treatment-resistant patients with bipolar depression, even if they had not responded to adjunctive neuromodulation. In these clinical situations, physicians might be interested in prescribing methylphenidate because of its efficacy and safety.

  14. Subjective Symptoms in Euthymic Bipolar Disorder and Remitted Schizophrenia Patients: A Comparative Study

    PubMed Central

    Kumar, Manish; Sinha, Vinod Kumar; Mondal, Anwesha

    2016-01-01

    Background: Subjective experience means subtle, not yet psychotic abnormalities of experience that might be present during remitted phase and also in prodromal phase of schizophrenia and might be accurately efficient in identifying individuals at risk of eminent psychosis (Parnas et al., 2003). Apart from schizophrenic patients, bipolar patients also experience certain subjective symptoms in their euthymic state. They often experience subtle cognitive impairment and functional disturbances during their euthymic states. These subjective experiences may be related to distorted cognitive functions in these patients. These experiences include a great variety of cognitive dysfunction complaints about attention, perception, memory, thinking, language, movement, and emotion. Objective: To measure the experience of subjective symptoms and compare them between euthymic bipolar and remitted schizophrenia patients. Materials and Methods: Thirty euthymic bipolar patients and 30 remitted schizophrenia patients as per International Classification of Diseases Tenth Revision were selected for the purpose of the study. At first, sociodemographic data were collected. And then, the patients were assessed using the scales; positive and negative syndrome scale, Young Mania Rating Scale, Hamilton Depression Rating Scale, Symptom Checklist-90-Revised, and Frankfurt Complaint Questionnaire-24. Results: Both the groups showed significant differences in terms of subjective symptoms. However, no significant correlation has been found between the objective psychopathology and subjective experience in the two groups. Conclusion: It can be suggested that the patients with schizophrenia show significantly higher subjective experience when compared with the patients of bipolar disorder. PMID:27114621

  15. Structural and Functional Brain Correlates of Cognitive Impairment in Euthymic Patients with Bipolar Disorder

    PubMed Central

    Goikolea, José M.; Bonnin, Caterina M.; Sarró, Salvador; Segura, Barbara; Amann, Benedikt L.; Monté, Gemma C.; Moro, Noemi; Fernandez-Corcuera, Paloma; Maristany, Teresa; Salvador, Raymond; Vieta, Eduard; Pomarol-Clotet, Edith; McKenna, Peter J.

    2016-01-01

    Introduction Cognitive impairment in the euthymic phase is a well-established finding in bipolar disorder. However, its brain structural and/or functional correlates are uncertain. Methods Thirty-three euthymic bipolar patients with preserved memory and executive function and 28 euthymic bipolar patients with significant memory and/or executive impairment, as defined using two test batteries, the Rivermead Behavioural Memory Test (RBMT) and the Behavioural Assessment of the Dysexecutive Syndrome (BADS), plus 28 healthy controls underwent structural MRI using voxel-based morphometry (VBM). Twenty-seven of the cognitively preserved patients, 23 of the cognitively impaired patients and 28 controls also underwent fMRI during performance of the n-back working memory task. Results No clusters of grey or white matter volume difference were found between the two patient groups. During n-back performance, the cognitively impaired patients showed hypoactivation compared to the cognitively preserved patients in a circumscribed region in the right dorsolateral prefrontal cortex. Both patient groups showed failure of de-activation in the medial frontal cortex compared to the healthy controls. Conclusions Cognitive impairment in euthymic bipolar patients appears from this study to be unrelated to structural brain abnormality, but there was some evidence for an association with altered prefrontal function. PMID:27448153

  16. Reducing the Risk of Suicide in Patients with Bipolar Disorder: Interventions and Safeguards

    ERIC Educational Resources Information Center

    Newman, Cory F.

    2005-01-01

    Bipolar disorder exacts a terrible toll on its sufferers owing to the repeated, severe disruptions in the patients' lives, the discomfort and uncertainties of being on rigorous, ongoing pharmacotherapy regimens, the emotional difficulties inherent in experiencing depression and mania, and the fear of a deteriorating course. Patients with bipolar…

  17. Cognitive Dysfunction Is Worse among Pediatric Patients with Bipolar Disorder Type I than Type II

    ERIC Educational Resources Information Center

    Schenkel, Lindsay S.; West, Amy E.; Jacobs, Rachel; Sweeney, John A.; Pavuluri, Mani N.

    2012-01-01

    Background: Impaired profiles of neurocognitive function have been consistently demonstrated among pediatric patients with bipolar disorder (BD), and may aid in the identification of endophenotypes across subtypes of the disorder. This study aims to determine phenotypic cognitive profiles of patients with BD Type I and II. Methods: Subjects (N =…

  18. Successful and rapid response to electroconvulsive therapy of a suicidal patient with comorbid bipolar I disorder and histrionic personality disorder.

    PubMed

    Rapinesi, Chiara; Serata, Daniele; Del Casale, Antonio; Simonetti, Alessio; Milioni, Mara; Mazzarini, Lorenzo; Scatena, Paola; Fensore, Claudio; Carbonetti, Paolo; Kotzalidis, Giorgio D; Tatarelli, Roberto; Pompili, Maurizio; Girardi, Paolo

    2012-03-01

    A woman with bipolar disorder I, histrionic personality disorder, and suicidal ideation with repeated suicide attempts, who had been treated for 2 years with mood stabilizers, antipsychotics, and benzodiazepines, received a total of 8 bitemporal-biparietal electroconvulsive therapy sessions. Her suicidal ideation and self-harm behavior disappeared immediately after the first session and her psychopathology soon after. This supports the existence of a relatively independent suicidal syndrome and confirms data on its immediate responsiveness to electroconvulsive therapy. Electroconvulsive therapy must not be long withheld from patients with such characteristics to reduce unnecessary sufferance and suicidality.

  19. Efficacy of repetitive transcranial magnetic stimulation with quetiapine in treating bipolar II depression: a randomized, double-blinded, control study

    PubMed Central

    Hu, Shao-hua; Lai, Jian-bo; Xu, Dong-rong; Qi, Hong-li; Peterson, Bradley S.; Bao, Ai-min; Hu, Chan-chan; Huang, Man-li; Chen, Jing-kai; Wei, Ning; Hu, Jian-bo; Li, Shu-lan; Zhou, Wei-hua; Xu, Wei-juan; Xu, Yi

    2016-01-01

    The clinical and cognitive responses to repetitive transcranial magnetic stimulation (rTMS) in bipolar II depressed patients remain unclear. In this study, thirty-eight bipolar II depressed patients were randomly assigned into three groups: (i) left high-frequency (n = 12), (ii) right low-frequency (n = 13), (iii) sham stimulation (n = 13), and underwent four-week rTMS with quetiapine concomitantly. Clinical efficacy was evaluated at baseline and weekly intervals using the 17-item Hamilton Depression Rating Scale (HDRS-17) and Montgomery-Asberg Depression Rating Scale (MADRS). Cognitive functioning was assessed before and after the study with the Wisconsin Card Sorting Test (WCST), Stroop Word-Color Interference Test (Stroop), and Trail Making Test (TMT). Thirty-five patients were included in the final analysis. Overall, the mean scores of both the HDRS-17 and the MADRS significantly decreased over the 4-week trial, which did not differ among the three groups. Exploratory analyses revealed no differences in factor scores of HDRS-17s, or in response or remission rates. Scores of WCST, Stroop, or TMT did not differ across the three groups. These findings indicated active rTMS combined with quetiapine was not superior to quetiapine monotherapy in improving depressive symptoms or cognitive performance in patients with bipolar II depression. PMID:27460201

  20. Effectiveness of methylphenidate as augmentation therapy after failure of adjunctive neuromodulation for patients with treatment-refractory bipolar depression: a case report

    PubMed Central

    Adida, Marc; Azorin, Jean-Michel

    2014-01-01

    Adjunctive use of methylphenidate, a central stimulant, has been considered as a potential therapeutic choice for patients with refractory unipolar, geriatric, or bipolar depression, and depression secondary to medical illness. We present a case of bipolar depression in which the patient responded significantly to augmentation with methylphenidate, without any side effects, after failure of adjunctive repetitive transcranial magnetic stimulation and electroconvulsive therapy. Mr U, a 56-year-old man with bipolar I disorder, had melancholic symptoms during his sixth episode of bipolar depression. After failure of repetitive transcranial magnetic stimulation and electroconvulsive therapy, he was treated with fluoxetine 80 mg/day, duloxetine 360 mg/day, mirtazapine 60 mg/day, and sodium valproate 1,000 mg/day, with no improvement. We added methylphenidate at a dose of 10 mg/day for one week, which resulted in mild clinical improvement, and then methylphenidate extended-release 20 mg/day for one week, with significant clinical improvement. He tolerated his medications well. His clinical recovery was stable over one year. The patient’s antidepressants and methylphenidate were gradually tapered and finally discontinued after one year with no withdrawal syndrome. To date, he remains well on sodium valproate as monotherapy and is being followed up at our bipolar department. This case suggests that methylphenidate augmentation might be a therapeutic option when treating highly treatment-resistant patients with bipolar depression, even if they had not responded to adjunctive neuromodulation. In these clinical situations, physicians might be interested in prescribing methylphenidate because of its efficacy and safety. PMID:24729710

  1. Results From an Online Survey of Patient and Caregiver Perspectives on Unmet Needs in the Treatment of Bipolar Disorder

    PubMed Central

    Tracy, Natasha

    2014-01-01

    Objective: To look at the manner in which patients and caregivers perceive the treatment of bipolar disorder compared with the evidence base for bipolar treatment. Method: Between April 2013 and March 2014, 469 respondents took a 14-question online survey on demographics, medications taken, and perspectives on bipolar treatment and medications. Participants were recruited through social media outlets (Facebook and Twitter accounts) of Global Medical Education (New York, New York) and the blog Bipolar Burble, which has a primary audience of people with bipolar disorder. There were no exclusion criteria to participation, and both patients and health care professionals were encouraged to participate. Results: Most respondents were taking ≥ 3 medications, and the greatest unmet need in treatment was for bipolar depression. In general, respondent perspectives on the effectiveness of individual medication treatments did not align with the available literature. Weight gain was the greatest side effect concern for both antipsychotics and mood stabilizers. Conclusions: Our survey demonstrates that there are still many unmet needs in the treatment of bipolar disorder. There is also a mismatch between the evidence base for treatments in bipolar disorder and patient perception of the relative efficacy of different medications. In order to achieve better outcomes, there is a need to provide patients and clinicians greater quality education with regard to the best evidence-based treatments for bipolar disorder. PMID:25664214

  2. Comorbidity of Adult Attention Deficit and Hyperactivity Disorder in Bipolar and Unipolar Patients

    PubMed Central

    HARMANCI, Hatice; ÇAM ÇELİKEL, Feryal; ETİKAN, İlker

    2016-01-01

    Introduction The co-occurrence of attention deficit hyperactivity disorder (ADHD) in affective disorder patients is considerably high. The aims of the present study were to search for the frequency and impact of ADHD co-occurrence on the clinical features of affective disorders and to examine the relationship between the dominant affective temperaments and ADHD. Methods In total, 100 patients with bipolar disorder (BD), 100 patients with major depressive disorder (MDD), and 100 healthy controls (HC) were included. All diagnoses were assigned according to DSM-IV-TR criteria. The Adult Attention Deficit and Hyperactivity Self-Report Scale (ASRS); Wender Utah Rating Scale (WURS); and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) were applied to all participants. Results The percentage of BD patients meeting the criteria for a diagnosis of current ADHD was 48% compared with the percentage of MDD patients and HCC subjects, i.e., 25% and 12%, respectively. ADHD was significantly more frequent in bipolar adults than in not only HC but also depressive patients. In the BD group, patients with a comorbid ADHD diagnosis had significantly more suicidal history than those without ADHD. The scores of the temperament traits, namely depressive, cyclothymic, irritable, and anxious, were significantly higher in subjects with ADHD in all groups, including in HC. Conclusion The most important findings of the present study were the observations that (1) the frequency of ADHD is considerably high among bipolar patients; (2) the frequency of suicide attempts is high in the bipolar patient group with comorbid ADHD; and (3) depressive, cyclothymic, irritable, and anxious temperaments are significantly associated with ADHD comorbidity in bipolar and depressive patients as well as in HC. The high comorbidity and chronic course of ADHD and its possible negative influence on the course of both disorders increase the importance of screening for adult

  3. [Nursing care of a patient with bipolar disorder and lithium-induced nephrogenic diabetes insipidus].

    PubMed

    García de la Orden, Lucía; García Carretero, Rafael

    2015-01-01

    Bipolar disorder is one of the most common, severe and persistent mental disorders. The evaluation of all data and variables related to bipolar disorder is a difficult task, because there is no clear agreement on what should be included in this category. One of the traditional treatments for this disease is the lithium metal that is administered in the form of lithium salt. Lithium has a narrow therapeutic window and there is a significant risk of complications arising from its use, mainly neurological and renal. In the case presented, the preparation of a care plan is described for a patient diagnosed with bipolar disorder who suffered a complication with lithium treatment. To do this, it was decided to use a standardized care plan and later completed it with diagnostic, objectives and interventions to the specific needs of the patient, aimed at achieving optimal levels of independence.

  4. Antihypertensive therapy in patients on chronic lithium treatment for bipolar disorders.

    PubMed

    Bisogni, Valeria; Rossitto, Giacomo; Reghin, Francesco; Padrini, Roberto; Rossi, Gian Paolo

    2016-01-01

    Bipolar disorders are chronic conditions treated with lithium, which exerts deleterious effects on the kidney, among which nephrogenic diabetes insipidus, tubular acidosis and ultimately chronic kidney disease. Conversely, drugs that alter renal function can modify its serum levels and lead to the potentially fatal lithium intoxication. A search in the main library databases from 1975 to 2015 to identify interactions between antihypertensive drugs and lithium using the Population Intervention Comparison Outcome strategy provided only 30 reports of lithium intoxication. A regression analysis showed that the severity of lithium intoxication was significantly predicted by female, age, and use of certain classes of antihypertensive agents. A model including certain albeit not all diuretics and/or inhibitors of the renin-angiotensin system, but not age, serum lithium or creatinine levels at baseline and/or on admission to the hospital, predicted lithium toxicity. The true incidence of lithium intoxication is unknown but probably low, albeit underestimated. Nonetheless, in patients treated with lithium, monitoring of the serum lithium levels and clinical conditions is mandatory after the introduction of antihypertensive drugs, as diuretics and renin-aldosterone system inhibitors.

  5. Investigating the underlying mechanisms of aberrant behaviors in bipolar disorder from patients to models

    PubMed Central

    van Enkhuizen, Jordy; Geyer, Mark A.; Minassian, Arpi; Perry, William; Henry, Brook L.; Young, Jared W.

    2015-01-01

    Psychiatric patients with bipolar disorder suffer from states of depression and mania, during which a variety of symptoms are present. Current treatments are limited and neurocognitive deficits in particular often remain untreated. Targeted therapies based on the biological mechanisms of bipolar disorder could fill this gap and benefit patients and their families. Developing targeted therapies would benefit from appropriate animal models which are challenging to establish, but remain a vital tool. In this review, we summarize approaches to create a valid model relevant to bipolar disorder. We focus on studies that use translational tests of multivariate exploratory behavior, sensorimotor gating, decision-making under risk, and attentional functioning to discover profiles that are consistent between patients and rodent models. Using this battery of translational tests, similar behavior profiles in bipolar mania patients and mice with reduced dopamine transporter activity have been identified. Future investigations should combine other animal models that are biologically relevant to the neuropsychiatric disorder with translational behavioral assessment as outlined here. This methodology can be utilized to develop novel targeted therapies that relieve symptoms for more patients without common side effects caused by current treatments. PMID:26297513

  6. When to start aripiprazole therapy in patients with bipolar mania

    PubMed Central

    Sayyaparaju, Kiran Kumar; Grunze, Heinz; Fountoulakis, Kostas N

    2014-01-01

    Aripiprazole is a third generation atypical antipsychotic with compelling evidence as a highly effective treatment option in the management of acute manic and mixed episodes of bipolar I disorders. It has a unique mode of action, acting as a partial agonist at dopamine D2 and D3, and serotonin 5-HT1A; and exhibiting antagonistic action at the 5-HT2A and H1 receptors. Overall, it has a favorable safety and tolerability profile, with low potential for clinically significant weight gain and metabolic effects, especially compared to other well-established treatments. It also has a superior tolerability profile when used as maintenance treatment. Side effects like headache, insomnia, and extrapyramidal side effects (EPSEs), such as tremor and akathisia may be treatment limiting in some cases. It is efficacious in both acute mania and mixed states, and in the long-term prevention of manic relapses. Aripiprazole therefore, is a significant player in the current portfolio of anti-manic pharmacological treatments. The data sources for this article are from EMBASE, MEDLINE, and the clinical trial database searches for all the literature published between January 2003 and September 2013. The key search terms were “aripiprazole” combined with “bipolar disorder”, “mania”, “antipsychotics”, “mood stabilizer”, “randomized controlled trial”, and “pharmacology”. Abstracts and proceedings from national and international psychiatric meetings were also reviewed, along with reviews of the reference lists of relevant articles. PMID:24648740

  7. Relationship between personality traits and perceived internalized stigma in bipolar patients and their treatment partners.

    PubMed

    Bassirnia, Anahita; Briggs, Jessica; Kopeykina, Irina; Mednick, Amy; Yaseen, Zimri; Galynker, Igor

    2015-12-15

    Internalized stigma of mental disorders has significant negative outcomes for patients with bipolar disorder and their families. The aim of this study is to evaluate the association between personality traits and internalized stigma of mental disorders in bipolar patients and their treatment partners. Five different questionnaires were utilized in this study: (1) Demographic data questionnaire, (2) Millon Clinical Multiaxial Inventory-III (MCMI-III) for personality traits, (3) Internalized Stigma of Mental Illness (ISMI) for stigma, (4) Self Report Manic Inventory (SRMI) for mania and (5) Center for Epidemiological Studies-Depression Scale (CES-D) for depression. The scores of personality traits were combined to create externalizing and internalizing personality trait scores. Results showed that patients with bipolar disorder and their treatment partners both experienced internalized stigma of mental health disorders. There was a significant positive correlation between internalized stigma and internalizing personality traits, but not externalizing traits. In a multi-variate regression analysis, internalizing personality trait score was found to be a significant predictor of internalized stigma. In conclusion, patients with bipolar disorder and their treatment partners perceive higher level of internalized stigma of mental disorders if they have internalizing personality traits.

  8. Patients' Expectancies, the Alliance in Pharmacotherapy, and Treatment Outcomes in Bipolar Disorder

    ERIC Educational Resources Information Center

    Gaudiano, Brandon A.; Miller, Ivan W.

    2006-01-01

    Bipolar disorder is characterized by a chronic and fluctuating course of illness. Although nonadherence to pharmacotherapy is a frequent problem in the disorder, few studies have systematically explored psychosocial factors related to treatment discontinuation. Previous research with depressed patients receiving psychotherapy has suggested that…

  9. An Acceptance-Based Psychoeducation Intervention to Reduce Expressed Emotion in Relatives of Bipolar Patients

    ERIC Educational Resources Information Center

    Eisner, Lori R.; Johnson, Sheri L.

    2008-01-01

    Expressed emotion (EE) is a robust predictor of outcome in bipolar disorder. Despite decades of research, interventions to reduce EE levels have had only modest effects. This study used an expanded model of EE to develop an intervention. Research has demonstrated a strong link between attributions and EE in families of patients with psychiatric…

  10. What happens after diagnosis? Understanding the experiences of patients with newly‐diagnosed bipolar disorder

    PubMed Central

    Proudfoot, Judith G; Parker, Gordon B; Benoit, Megan; Manicavasagar, Vijaya; Smith, Meg; Gayed, Aimee

    2009-01-01

    Abstract Bipolar disorder is chronic condition involving episodes of both depression and elevated mood, associated with significant disability and high relapse rates. Recent estimates suggest a lifetime prevalence of 5%. Little is known about the subjective experiences of patients after receiving a diagnosis of bipolar disorder, and the impact of these experiences on patients' willingness and ability to work with their health professionals to find the most effective combination of treatments and to set up self‐management plans. Objective  This paper describes a qualitative study exploring the experiences and difficulties faced by patients after they have received a diagnosis of bipolar disorder, as expressed online to expert patients trained to provide informed support. Design  Qualitative study. Setting  Online communication within a public health service setting. Participants  Twenty‐six participants with recently‐diagnosed bipolar disorder communicated online with ‘Informed Supporters’, people who had been managing their bipolar disorder effectively for 2 years or more, as part of an online psycho‐education programme. Results  Participants cited unwanted side‐effects of medication, coping with unpleasant symptoms, positive and negative reactions to the diagnosis, identifying early warning signs and triggers of the illness, the loss of a sense of self, uncertainty about their future and stigma as issues of major importance after diagnosis. Conclusions  Personal concerns and difficulties following diagnosis can undermine effective treatment, thwart self‐management efforts and interfere with effective functioning. Such data are important for clinicians to take into account when they work in partnership with their patients to fine‐tune treatments and help them set up self‐management plans. PMID:19538647

  11. Working Memory and Response Inhibition in Patients With Bipolar I Disorder During Euthymic Period

    PubMed Central

    Farahmand, Zahra; Tehrani-Doost, Mehdi; Amini, Homayoun; Mohammadi, Abolfazl; Mirzaei, Mosleh; Mohamadzadeh, Azar

    2015-01-01

    Background: Several cognitive domains, including attention, memory, and executive functions are impaired in bipolar disorder. Objectives: This study aimed to investigate two executive functions (working memory and response inhibition) in patients with bipolar I disorder during remission of the symptoms. Patients and Methods: In this case-control design, 30 bipolar I patients (18 to 45 years old) were matched with 30 ones in the control group in terms of age, gender, and education. The patients were selected from Roozbeh Psychiatric Hospital (a hospital affiliated to Tehran University of Medical Sciences) from May to October 2013. They were evaluated and contrasted using working memory (Spatial Span and Spatial Working Memory (SSP and SWM)) and response inhibition (Stop Signal Task (SST)) tests. Results: We used independent t-tests for comparing and contrasting 2 groups on total and sub-scales scores of these 3 tests. In terms of SWM test there was a significant difference in between-group error between the two groups (P = 0.05); there was also a meaningful difference between the strategies used by two groups (P = 0.05). In SSP test, a significant difference appeared between averages of span length of the two groups. In the first and last item delays, there was also a clear difference, but the total error index was not noticeably different. In SST test, the direction error indicator in start-stop trials indicated a major difference, while in successful stops ratio, the case group had a lower ratio. In addition, reaction time to stop signs in bipolar group was meaningfully lower than the control group. Conclusion: In conclusion, even during remission phase, executive dysfunction is detectable at least in some areas in patients with bipolar disorder. PMID:26251656

  12. Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses

    PubMed Central

    Murray, Bethany; McNew, Brittany

    2015-01-01

    Abstract Purpose This review article provides an overview of the frequency, burden of illness, diagnosis, and treatment of bipolar disorder (BD) from the perspective of the advanced practice nurses (APNs). Data sources PubMed searches were conducted using the following keywords: “bipolar disorder and primary care,” restricted to dates 2000 to present; “bipolar disorder and nurse practitioner”; and “bipolar disorder and clinical nurse specialist.” Selected articles were relevant to adult outpatient care in the United States, with a prioritization of articles written by APNs or published in nursing journals. Conclusions BD has a substantial lifetime prevalence in the population at 4%. Because the manic or depressive symptoms of BD tend to be severe and recurrent over a patient's lifetime, the condition is associated with significant burden to the individual, caregivers, and society. Clinician awareness that BD may be present increases the likelihood of successful recognition and appropriate treatment. A number of pharmacological and nonpharmacological treatments are available for acute and maintenance treatments, with the prospect of achieving reduced symptom burden and increased functioning for many patients. Implications for practice Awareness of the disease burden, diagnostic issues, and management choices in BD has the potential to enhance outcome in substantial proportions of patients. PMID:26172568

  13. Clinical and cognitive factors affecting psychosocial functioning in remitted patients with bipolar disorder.

    PubMed

    Konstantakopoulos, G; Ioannidi, N; Typaldou, M; Sakkas, D; Oulis, P

    2016-01-01

    Impaired interpersonal, social, and occupational functioning is very often observed in patients with bipolar disorder, not only at the acute stages of the illness but in remission as well. This finding raises the question of multiple factors that might affect psychosocial functioning in bipolar patients, such as residual subsyndromal symptoms and neuropsychological deficits. Social cognition impairment, especially impaired Theory of Mind (ToM), might also play an important role in bipolar patients' every-day functioning, similarly to what was found in patients with schizophrenia. The present study aimed to investigate the potential effect of clinical and cognitive factors on the psychosocial functioning of patients with bipolar disorder during remission, assessing ToM along with a broad range of basic cognitive functions. Forty-nine patients with bipolar disorder type I in remission and 53 healthy participants were assessed in general intelligence, working memory, attention, speed processing, verbal learning and memory, and executive functions using a comprehensive battery of neuropsychological tests. The Faux Pas Recognition Test was used to assess ToM. The two groups were matched for gender, age and education level. The Hamilton Rating Scale for Depression (HDRS), the Young Mania Rating Scale (YMRS), and the Brief Psychiatric Rating Scale (BPRS) were also administered to the patients. Every-day functioning was assessed with the Global Assessment of Functioning (GAF). In order to examine the contribution of many factors in psychosocial functioning, we used hierarchical multiple regression analysis. Bipolar patients presented significant impairment compared to healthy participants in all the basic cognitive functions tested with the exception of verbal memory. Moreover, patients had significant poorer performance than healthy controls in overall psyand cognitive ToM but not in affective ToM as measured by Faux Pas. Psychosocial functioning in patient group was

  14. Evidence-based guidelines for treating bipolar disorder: revised third edition Recommendations from the British Association for Psychopharmacology

    PubMed Central

    Goodwin, G.M.; Haddad, P. M.; Ferrier, I.N.; Aronson, J.K.; Barnes, T.R.H.; Cipriani, A.; Coghill, D.R.; Fazel, S.; Geddes, J.R.; Grunze, H.; Holmes, E.A.; Howes, O.; Hudson, S.; Hunt, N.; Jones, I.; Macmillan, I.C.; McAllister-Williams, H.; Miklowitz, D.M.; Morriss, R.; Munafò, M.; Paton, C.; Saharkian, B.J.; Saunders, K.E.A.; Sinclair, J.M.A.; Taylor, D.; Vieta, E.; Young, A.H.

    2016-01-01

    The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines: in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change. PMID:26979387

  15. Challenges in the management of bipolar depression.

    PubMed

    Suppes, Trisha; Kelly, Dorothy I; Perla, Jessica M

    2005-01-01

    Bipolar depression has started to receive more attention in clinical trials only relatively recently, despite the fact that patients spend more time in the depressed phase than in the manic phase of bipolar disorder. The diagnosis and management of bipolar depression are challenging, and many patients are undiagnosed or misdiagnosed due to symptom similarities with unipolar depression or other illnesses and/or comorbidities. Untreated or inappropriately treated bipolar depression adds to the burden of illness and is associated with a greater risk of suicide. Treatment options include lithium, lamotrigine, atypical antipsychotics, and traditional antidepressants, such as the selective serotonin reuptake inhibitors. However, traditional antidepressants are recommended with caution due to their potential risk of switching patients into mania. Some atypical antipsychotics have shown efficacy in bipolar depression, although longer-term studies are warranted. The choice of treatment for different subgroups of patients with bipolar depression, including those with comorbid anxiety, may vary and also needs further study. Other important issues that require further investigation include the recognition of the core features of bipolar depression and the threshold symptoms for treatment, as well as the optimal treatment choices for monotherapy or combination therapy, and acute versus long-term management of bipolar depression.

  16. Metabolic Abnormalities Related to Treatment With Selective Serotonin Reuptake Inhibitors in Patients With Schizophrenia or Bipolar Disorder

    PubMed Central

    Fjukstad, Katrine Kveli; Engum, Anne; Lydersen, Stian; Dieset, Ingrid; Steen, Nils Eiel; Andreassen, Ole A.; Spigset, Olav

    2016-01-01

    Objective The aim of the present study was to examine the effect of selective serotonin reuptake inhibitors (SSRIs) on cardiovascular risk factors in patients with schizophrenia or bipolar disorder. Method We used data from a cross-sectional study on 1301 patients with schizophrenia or bipolar disorder, of whom 280 were treated with SSRIs. The primary outcome variable was the serum concentration of total cholesterol. Secondary outcome variables were low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol, triglyceride and glucose levels, body mass index, waist circumference, and systolic and diastolic blood pressure. Results After adjusting for potential confounders, an SSRI serum concentration in the middle of the reference interval was associated with an increase of the total cholesterol level by 14.56 mg/dL (95% confidence interval (CI) 5.27–23.85 mg/dL, P = 0.002), the LDL cholesterol level by 8.50 mg/dL (CI 0.22–16.77 mg/dL, P = 0.044), the triglyceride level by 46.49 mg/dL (CI 26.53–66.46 mg/dL, P < 0.001) and the occurrence of the metabolic syndrome by a factor of 2.10 (CI 1.21–3.62, P = 0.008). There were also significant associations between the SSRI dose and total cholesterol and LDL cholesterol levels. Conclusions This study is the first to reveal significant associations between SSRI use and metabolic abnormalities in patients with schizophrenia or bipolar disorder. Although the effects were statistically significant, alterations were small. Thus, the clinical impact of the findings is most likely limited. PMID:27749681

  17. How Patients Contribute to an Online Psychoeducation Forum for Bipolar Disorder: A Virtual Participant Observation Study

    PubMed Central

    Smith, Daniel; Simpson, Sharon

    2015-01-01

    Background In a recent exploratory randomized controlled trial, an online psychoeducation intervention for bipolar disorder has been found to be feasible and acceptable to patients and may positively impact on their self-management behaviors and quality of life. Objective The objective of the study was to investigate how these patients contribute to an online forum for bipolar disorder and the issues relevant for them. Methods Participants in the intervention arm of the Bipolar Interactive PsychoEDucation (“BIPED”) trial were invited to contribute to the Beating Bipolar forum alongside receiving interactive online psychoeducation modules. Within this virtual participant observation study, forum posts were analyzed using thematic analysis, incorporating aspects of discourse analysis. Results The key themes which arose from the forum posts included: medication, employment, stigma, social support, coping strategies, insight and acceptance, the life chart, and negative experiences of health care. Participants frequently provided personal narratives relating to their history of bipolar disorder, life experiences, and backgrounds, which often contained emotive language and humor. They regularly sought and offered advice, and expressed encouragement and empathy. The forum would have benefitted from more users to offer a greater support network with more diverse views and experiences. Conclusions Online forums are inexpensive to provide and may offer peer support and the opportunity for patients to share their experiences and explore issues related to their illness anonymously. Future research should focus on how to enhance patient engagement with online health care forums. Trial Registration ISRCTN81375447; http://www.isrctn.com/ISRCTN81375447 (Archived by WebCite at http://www.webcitation.org/6YzWtHUqu). PMID:26543925

  18. What is the real significance and management of major thyroid disorders in bipolar patients?

    PubMed

    Sierra, Pilar; Cámara, Rosa; Tobella, Helena; Livianos, Lorenzo

    2014-01-01

    Thyroid disfunction affects negatively emotional stability and worsens the clinical course of bipolar affective disorder. The main stabilizer used in this illness, lithium carbonate has numerous effects on the physiology of the thyroid, with the most significant being the inhibition of thyroid hormone release that may occur at therapeutic levels. These dysfunctions have also been reported most frequently in bipolar patients not undergoing treatment with lithium, and was not completely explained by the effects of this drug. Apart from the numerous medical complications and mood disturbances, the cognitive or perceptual system may also be affected. In fact, the presence of thyroid disease increases the rates of obsessive compulsive disorder, phobias, panic disorder, major depressive disorder, cyclothymia, or bipolar disorder. In severe cases of hypothyroidism, the clinical symptoms and signs can be similar to a melancholic depression or dementia. It is therefore important to know well all these possible complications in daily clinical practice. This review will cover the main thyroid dysfunctions present in bipolar patients, whether ot not produced by treatment with lithium carbonate, and will provide a series of recommendations for clinical management.

  19. Divergent Relationship of Depression Severity to Social Reward Responses Among Patients with Bipolar Versus Unipolar Depression

    PubMed Central

    Sharma, Anup; Satterthwaite, Theodore D.; Vandekar, Lillie; Katchmar, Natalie; Daldal, Aylin; Ruparel, Kosha; A.Elliott, Mark; Baldassano, Claudia; Thase, Michael E.; Gur, Raquel E.; Kable, Joseph W.; Wolf, Daniel H.

    2016-01-01

    Neuroimaging studies of mood disorders demonstrate abnormalities in brain regions implicated in reward processing. However, there is a paucity of research investigating how social rewards affect reward circuit activity in these disorders. Here, we evaluated the relationship of both diagnostic category and dimensional depression severity to reward system function in bipolar and unipolar depression. In total, 86 adults were included, including 24 patients with bipolar depression, 24 patients with unipolar depression, and 38 healthy comparison subjects. Participants completed a social reward task during 3T BOLD fMRI. On average, diagnostic groups did not differ in activation to social reward. However, greater depression severity significantly correlated with reduced bilateral ventral striatum activation to social reward in the bipolar depressed group, but not the unipolar depressed group. In addition, decreased left orbitofrontal cortical activation correlated with more severe symptoms in bipolar depression, but not unipolar depression. These differential dimensional effects resulted in a significant voxelwise group by depression severity interaction. Taken together, these results provide initial evidence that deficits in social reward processing are differentially related to depression severity in the two disorders. PMID:27295401

  20. [Self-assessment questionnaires for the investigation of bipolarity].

    PubMed

    Tsopelas, Ch; Konstantinidou, D; Douzenis, A

    2010-01-01

    Contemporary research shows that bipolar disorders are very often faced initially as depression, while the precise diagnosis usually delay 8-10 years or more. As a result of this delay in the diagnosis, the patients do not receive appropriate treatment and are not led to recession of their symptoms. Roughly one third of depressed patients are treated at mental health services and two thirds at the primary care health services. Regarding the psychiatric patients that are treated in the secondary and trietary services of mental health, various researches indicate that the bipolar disorders and especially Bipolar Disorder II are under-diagnosed and consequently they do not receive satisfactory treatment with important repercussions in the professional and social existence of Bipolar Disorders' patients. The imperative need for early diagnosis and treatment in patients with bipolar disorders is obvious, in order to decrease the big time of delay in the diagnosis of Bipolar disorders. Patient self-completed questionnaires, which are small in duration and well structured, can contribute in the early recognition of disorders of bipolar spectrum in patients that are treated at the outpatient clinics. In this bibliographic research we compare two questionnaires (the MDQ and the HCL-32) with regard to their psychometrics faculties and the possibility of use in the early diagnosis and treatment of individuals that suffers from disorders of Bipolar spectrum.

  1. Putative transcriptomic biomarkers in the inflammatory cytokine pathway differentiate major depressive disorder patients from control subjects and bipolar disorder patients.

    PubMed

    Powell, Timothy R; McGuffin, Peter; D'Souza, Ursula M; Cohen-Woods, Sarah; Hosang, Georgina M; Martin, Charlotte; Matthews, Keith; Day, Richard K; Farmer, Anne E; Tansey, Katherine E; Schalkwyk, Leonard C

    2014-01-01

    Mood disorders consist of two etiologically related, but distinctly treated illnesses, major depressive disorder (MDD) and bipolar disorder (BPD). These disorders share similarities in their clinical presentation, and thus show high rates of misdiagnosis. Recent research has revealed significant transcriptional differences within the inflammatory cytokine pathway between MDD patients and controls, and between BPD patients and controls, suggesting this pathway may possess important biomarker properties. This exploratory study attempts to identify disorder-specific transcriptional biomarkers within the inflammatory cytokine pathway, which can distinguish between control subjects, MDD patients and BPD patients. This is achieved using RNA extracted from subject blood and applying synthesized complementary DNA to quantitative PCR arrays containing primers for 87 inflammation-related genes. Initially, we use ANOVA to test for transcriptional differences in a 'discovery cohort' (total n = 90) and then we use t-tests to assess the reliability of any identified transcriptional differences in a 'validation cohort' (total n = 35). The two most robust and reliable biomarkers identified across both the discovery and validation cohort were Chemokine (C-C motif) ligand 24 (CCL24) which was consistently transcribed higher amongst MDD patients relative to controls and BPD patients, and C-C chemokine receptor type 6 (CCR6) which was consistently more lowly transcribed amongst MDD patients relative to controls. Results detailed here provide preliminary evidence that transcriptional measures within inflammation-related genes might be useful in aiding clinical diagnostic decision-making processes. Future research should aim to replicate findings detailed in this exploratory study in a larger medication-free sample and examine whether identified biomarkers could be used prospectively to aid clinical diagnosis.

  2. The functional exercise capacity in patients with bipolar disorder versus healthy controls: A pilot study.

    PubMed

    Vancampfort, Davy; Wyckaert, Sabine; Sienaert, Pascal; De Hert, Marc; Stubbs, Brendon; Buys, Roselien; Schueremans, Ans; Probst, Michel

    2015-09-30

    The aim of the current study was to compare the functional exercise capacity of patients with bipolar disorder with age-, gender- and body mass index (BMI)-matched healthy controls. Thirty patients (16 ♂, 40.8±11.6 years) and healthy controls (16 ♂, 40.5±10.8 years) were included. All participants performed a 6-min walk test to assess the functional exercise capacity and completed the International Physical Activity Questionnaire. Patients were screened for psychiatric symptoms using the Quick Inventory of Depressive Symptomatology and Hypomania Checklist-32. Results demonstrated that patients with bipolar disorder demonstrated a significantly poorer functional exercise capacity (590.8±112.6 versus 704.2±94.3m). A backward stepwise regression analyses showed that the level of depression and existing foot or ankle static problems and back pain before the test explained 70.9% of the variance in the distance achieved on the 6-min walk test (functional exercise capacity). The current study demonstrates that foot and back pain appear to be important negative predictors of functional exercise capacity in patients with bipolar disorder. Physical activity interventions delivered by physical therapists may help ameliorate pain symptoms and improve functional exercise capacity.

  3. Extreme Appraisals of Internal States and Duration of Remission in Remitted Bipolar Patients

    PubMed Central

    TOSUN, Ahmet; MAÇKALI, Zeynep; ÇAĞIN TOSUN, Özlem; KAPUCU ERYAR, Aycan; MANSELL, Warren

    2015-01-01

    Introduction To identify dysfunctional attitudes seen in bipolar disorder (BPD) is important for the cognitive theories of BPD and corresponding psychosocial interventions. Cognitions are seen as vulnerability factors in the development and maintenance of BPD. The present study aims to contribute to the cognitive literature on BPD by examining depressive and hypomanic attitudes and their contribution to the prediction of BPD diagnosis as well as by exploring the relationship between dysfunctional cognitions and clinical features (types of episodes experienced, duration of illness, and duration of remission). Methods One hundred and eighteen remitted bipolar patients and 103 healthy controls completed the Mood Disorder Questionnaire (MDQ), Turkish Brief-Hypomanic Interpretations and Positive Predictions Inventory (HAPPI), and Dysfunctional Attitudes Scale. Results The bipolar group had significantly higher depressive and hypomanic attitudes than the control group. No significant differences were found regarding the types of episodes experienced and duration of illness. However, both types of attitudes decreased as the duration of remission increased. They were also found to contribute to the prediction of bipolar diagnosis together with the screening of the MDQ. Conclusion The results pointed out that dysfunctional cognitions may be utilized as possible indicators for the risk of relapse in clinical groups and vulnerability for BPD among other populations.

  4. Designing a patient monitoring system for bipolar disorder using Semantic Web technologies.

    PubMed

    Thermolia, Chryssa; Bei, Ekaterini S; Petrakis, Euripides G M; Kritsotakis, Vangelis; Tsiknakis, Manolis; Sakkalis, Vangelis

    2015-01-01

    The new movement to personalize treatment plans and improve prediction capabilities is greatly facilitated by intelligent remote patient monitoring and risk prevention. This paper focuses on patients suffering from bipolar disorder, a mental illness characterized by severe mood swings. We exploit the advantages of Semantic Web and Electronic Health Record Technologies to develop a patient monitoring platform to support clinicians. Relying on intelligently filtering of clinical evidence-based information and individual-specific knowledge, we aim to provide recommendations for treatment and monitoring at appropriate time or concluding into alerts for serious shifts in mood and patients' non response to treatment.

  5. Association between gastrointestinal symptoms and affectivity in patients with bipolar disorder

    PubMed Central

    Karling, Pontus; Maripuu, Martin; Wikgren, Mikael; Adolfsson, Rolf; Norrback, Karl-Fredrik

    2016-01-01

    AIM To study if anxiety, depression and experience of stress are associated with gastrointestinal (GI) symptoms in patients with bipolar disorder. METHODS A total of 136 patients with bipolar disorder (mean age 49.9 years; 61% women) and 136 controls from the general population (mean age 51.0 years; 60% women) were included in the study. GI symptoms were assessed with The Gastrointestinal Symptom Rating Scale-irritable bowel syndrome (GSRS-IBS), level of anxiety and depression with The Hospital Anxiety and Depression Scale (HADS) and stress-proneness with Perceived Stress Questionnaire. Over a ten year period, all visits in primary care were retrospectively recorded in order to identify functional GI disorders. RESULTS In subjects with low total HADS-score, there were no significant differences in GI-symptoms between patients and controls (GSRS-IBS 7.0 vs 6.5, P = 0.513). In the patients with bipolar disorder there were significant correlations between all GSRS and HADS subscores for all symptom clusters except for “constipation” and “reflux”. Factors associated to GI symptoms in the patient group were female sex (adjusted OR = 2.37, 95%CI: 1.07-5.24) and high HADS-Depression score (adjusted OR = 3.64, 95%CI: 1.07-12.4). These patients had also significantly more visits for IBS than patients with low HADS-Depression scores (29% vs 8%, P = 0.008). However, there was no significant differences in consulting behaviour for functional GI disorders between patients and controls (25% vs 17%, P = 0.108). CONCLUSION Female patients and patients with high HADS depression score reported significantly more GI symptoms, whereas patients with low HADS scores did not differ from control subjects. PMID:27784966

  6. Identify bipolar spectrum disorders.

    PubMed

    Mynatt, Sarah; Cunningham, Patricia; Manning, J Sloan

    2002-06-01

    Patients with bipolar spectrum disorders commonly present with depressive symptoms to primary care clinicians. This article details bipolar spectrum disorder assessment, treatment, and treatment response. By intervening early in the course of depressive and hypomanic episodes, you can help decrease the morbidity and suffering associated with bipolar spectrum disorders.

  7. A bipolar disorder patient becoming asymptomatic after adjunctive anti-filiarasis treatment: a case report

    PubMed Central

    2013-01-01

    Background Evidence suggests that neurotropic infectious agents might be involved in bipolar disorder. So far, few have been written for the association between parasitic infection and bipolar disorder. Filariasis is a parasitic disease acting ruthlessly via mosquitos and affecting more than 120 million people worldwide. We present here, to our knowledge, the first description of a filariasis infected manic bipolar disorder patient fully improved in terms of psychiatric symptoms by anti-heminthic treatment. Case presentation The patient is a 31 years-old man native of Congo. At inclusion, he presented a severe manic episode with dangerous behaviour unresolved by classic treatments. A diagnosis of filariasis bancrofti infection was made after the discovery of a systemic hypereosinophilia. Therefore, a bi-therapy of anthelmintics was conducted allowing a successful improvement with clear reduction of agitation and aggressive behaviours that could not be attributed to a modification of psychotropic treatments or filarial encephalopathy or acute disseminated encephalomyelitis. Conclusion The ineffectiveness of psychotropic treatment of a manic episode requires the evaluation of co-morbid medical conditions such as infections which can interfere with adequate mood stabilizing medication. Filariasis by inducing chronic inflammation and immunopathologic reactions seems to play a major role in infected affective disorders patients by changing levels of cytokines of the Th1 system or indirectly damaging the brain tissue. The beneficial combination of antihelmintics and mood stabilizers, in this case, could be explained by the potential of such association to downregulate neuroinflammation and excitotoxicity processes. Altogether, these data pinpoint the requirement to explore the parasitic infectious status in case of bipolar disorder patients resistant to classic treatments and originating or living in endemic geographical areas. PMID:23497411

  8. Normal Metabolic Levels in Prefrontal Cortex in Euthymic Bipolar I Patients with and without Suicide Attempts

    PubMed Central

    Rocha, Marlos Vasconcelos; Nery-Fernandes, Fabiana; Guimarães, José Luiz; Quarantini, Lucas de Castro; de Oliveira, Irismar Reis; Ladeia-Rocha, Giovanna G.; Jackowski, Andrea Parolin; de Araujo Neto, César; Miranda-Scippa, Ângela

    2015-01-01

    Introduction/Objective. Evidence suggests that the prefrontal cortex has been implicated in the pathophysiology of bipolar disorder (BD), but few neurochemical studies have evaluated this region in bipolar patients and there is no information from BD suicide attempters using Proton Magnetic Resonance Spectroscopy (H+MRS). The objective was to evaluate the metabolic function of the medial orbital frontal cortex in euthymic BD type I suicide and nonsuicide attempters compared to healthy subjects by H+MRS. Methods. 40 euthymic bipolar I outpatients, 19 without and 21 with history of suicide attempt, and 22 healthy subjects were interviewed using the Structured Clinical Interview with the DSM-IV axis I, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, and the Barratt Impulsiveness Scale-11 and underwent H+MRS. Results. We did not find any metabolic abnormality in medial orbital frontal regions of suicide and nonsuicide BD patients and BD patients as a group compared to healthy subjects. Conclusions. The combined chronic use of psychotropic drugs with neuroprotective or neurotrophic effects leading to a euthymic state for longer periods of time may improve neurometabolic function, at least measured by H+MRS, even in suicide attempters. Besides, these results may implicate mood dependent alterations in brain metabolic activity. However, more studies with larger sample sizes of this heterogeneous disorder are warranted to clarify these data. PMID:26075096

  9. Impact of living with bipolar patients: Making sense of caregivers’ burden

    PubMed Central

    Pompili, Maurizio; Harnic, Désirée; Gonda, Xenia; Forte, Alberto; Dominici, Giovanni; Innamorati, Marco; Fountoulakis, Konstantinos N; Serafini, Gianluca; Sher, Leo; Janiri, Luigi; Rihmer, Zoltan; Amore, Mario; Girardi, Paolo

    2014-01-01

    The aim of the present review was to examine objective and subjective burdens in primary caregivers (usually family members) of patients with bipolar disorder (BD) and to list which symptoms of the patients are considered more burdensome by the caregivers. In order to provide a critical review about caregiver’s burden in patients with bipolar disorder, we performed a detailed PubMed, BioMedCentral, ISI Web of Science, PsycINFO, Elsevier Science Direct and Cochrane Library search to identify all papers and book chapters in English published during the period between 1963 and November 2011. The highest levels of distress were caused by the patient’s behavior and the patient’s role dysfunction (work, education and social relationships). Furthermore, the caregiving role compromises other social roles occupied by the caregiver, becoming part of the heavy social cost of bipolar affective disorder. There is a need to better understand caregivers’ views and personal perceptions of the stresses and demands arising from caring for someone with BD in order to develop practical appropriate interventions and to improve the training of caregivers. PMID:24660140

  10. Can structural MRI aid in clinical classification? A machine learning study in two independent samples of patients with schizophrenia, bipolar disorder and healthy subjects.

    PubMed

    Schnack, Hugo G; Nieuwenhuis, Mireille; van Haren, Neeltje E M; Abramovic, Lucija; Scheewe, Thomas W; Brouwer, Rachel M; Hulshoff Pol, Hilleke E; Kahn, René S

    2014-01-01

    Although structural magnetic resonance imaging (MRI) has revealed partly non-overlapping brain abnormalities in schizophrenia and bipolar disorder, it is unknown whether structural MRI scans can be used to separate individuals with schizophrenia from those with bipolar disorder. An algorithm capable of discriminating between these two disorders could become a diagnostic aid for psychiatrists. Here, we scanned 66 schizophrenia patients, 66 patients with bipolar disorder and 66 healthy subjects on a 1.5T MRI scanner. Three support vector machines were trained to separate patients with schizophrenia from healthy subjects, patients with schizophrenia from those with bipolar disorder, and patients with bipolar disorder from healthy subjects, respectively, based on their gray matter density images. The predictive power of the models was tested using cross-validation and in an independent validation set of 46 schizophrenia patients, 47 patients with bipolar disorder and 43 healthy subjects scanned on a 3T MRI scanner. Schizophrenia patients could be separated from healthy subjects with an average accuracy of 90%. Additionally, schizophrenia patients and patients with bipolar disorder could be distinguished with an average accuracy of 88%.The model delineating bipolar patients from healthy subjects was less accurate, correctly classifying 67% of the healthy subjects and only 53% of the patients with bipolar disorder. In the latter group, lithium and antipsychotics use had no influence on the classification results. Application of the 1.5T models on the 3T validation set yielded average classification accuracies of 76% (healthy vs schizophrenia), 66% (bipolar vs schizophrenia) and 61% (healthy vs bipolar). In conclusion, the accurate separation of schizophrenia from bipolar patients on the basis of structural MRI scans, as demonstrated here, could be of added value in the differential diagnosis of these two disorders. The results also suggest that gray matter pathology in

  11. Risk factors associated with lifetime suicide attempts in bipolar I patients: findings from a French National Cohort.

    PubMed

    Azorin, Jean-Michel; Kaladjian, Arthur; Adida, Marc; Hantouche, Elie; Hameg, Ahcene; Lancrenon, Sylvie; Akiskal, Hagop Souren

    2009-01-01

    Risk factors that may be associated with suicide attempts in bipolar disorder are still a matter of debate. We compared demographic, illness course, clinical, and temperamental features of suicide attempters vs those of nonattempters in a large sample of bipolar I patients admitted for an index manic episode. One thousand ninety patients (attempters = 382, nonattempters = 708) were included in the study. Multivariate analysis evidenced 8 risk factors associated with lifetime suicide attempts as follows: multiple hospitalizations, depressive or mixed polarity of first episode, presence of stressful life events before illness onset, younger age at onset, no free intervals between episodes, female sex, higher number of previous episodes, and cyclothymic temperament. These characteristics may help identify subjects at risk for suicide attempt throughout the course of bipolar disorder. We finally propose to integrate such characteristics into a stress-diathesis model of suicidal behavior, adapted to bipolar patients.

  12. Eye movement desensitization and reprocessing therapy in subsyndromal bipolar patients with a history of traumatic events: a randomized, controlled pilot-study.

    PubMed

    Novo, Patricia; Landin-Romero, Ramon; Radua, Joaquim; Vicens, Victor; Fernandez, Isabel; Garcia, Francisca; Pomarol-Clotet, Edith; McKenna, Peter J; Shapiro, Francine; Amann, Benedikt L

    2014-09-30

    Traumatic events are frequent in bipolar patients and can worsen the course of the disease. Psychotherapeutic interventions for these events have not been studied so far. Twenty DSM-IV bipolar I and II patients with subsyndromal mood symptoms and a history of traumatic events were randomly assigned to Eye Movement Desensitization and Reprocessing therapy (n=10) or treatment as usual (n=10). The treatment group received between 14 and 18 Eye Movement Desensitization and Reprocessing sessions during 12 weeks. Evaluations of affective symptoms, symptoms of trauma and trauma impact were carried out by a blind rater at baseline, 2 weeks, 5 weeks, 8 weeks, 12 weeks and at 24 weeks follow-up. Patients in the treatment group showed a statistically significant improvement in depressive and hypomanic symptoms, symptoms of trauma and trauma impact compared to the treatment as usual group after intervention. This effect was only partly maintained in trauma impact at the 24 weeks follow-up visit. One patient dropped from Eye Movement Desensitization and Reprocessing group whereas four from the treatment as usual group. This pilot study suggests that Eye Movement Desensitization and Reprocessing therapy may be an effective and safe intervention to treat subsyndromal mood and trauma symptoms in traumatized bipolar patients.

  13. Can body mass index help predict outcome in patients with bipolar disorder?

    PubMed Central

    Calkin, Cynthia; van de Velde, Caroline; Růžičková, Martina; Slaney, Claire; Garnham, Julie; Hajek, Tomas; O’Donovan, Claire; Alda, Martin

    2013-01-01

    Objective Several studies have reported higher prevalence of obesity in patients suffering from bipolar disorder (BD). To study the relation of elevated body mass index (BMI) in patients with BD more closely, we investigated differences in sociodemographic, clinical, and medical characteristics with respect to BMI, with the hypothesis that BMI is related to prognosis and outcome. Methods We measured the BMI of 276 subjects of a tertiary care sample from the Maritime Bipolar Registry. Subjects were 16 to 83 years old, with psychiatric diagnoses of bipolar I disorder (n = 186), bipolar II disorder (n = 85), and BD not otherwise specified (n = 5). The registry included basic demographic data and details of the clinical presentation. We first examined the variables showing a significant association with BMI; subsequently, we modeled the relationship between BMI and psychiatric outcome using structural equation analysis. Results The prevalence of obesity in our sample was 39.1%. We found higher BMI in subjects with a chronic course (p < 0.001) and longer duration of illness (p = 0.02), lower scores on the Global Assessment of Functioning Scale (p = 0.02), and on disability (p = 0.002). Overweight patients had more frequent comorbid subthreshold social (p = 0.02) and generalized anxiety disorders (p = 0.05), diabetes mellitus type II (p < 0.001), and hypertension (p = 0.001). Subjects who achieved complete remission of symptoms on lithium showed significantly lower BMI (p = 0.01). Conclusions Our findings suggest that BMI is associated with the prognosis and outcome of BD. Whether this association is causal remains to be determined. PMID:19689507

  14. Social Aspect of Functioning Deteriorates More Than Individual Aspect in Patients with Remitted Bipolar Disorder

    PubMed Central

    TIĞLI FİLİZER, Arzu; CERİT, Cem; TÜZÜN, Başak; AKER, Ahmet Tamer

    2016-01-01

    Introduction Many studies have demonstrated that patients with bipolar disorder (BD) suffer from significant functional impairment, even during remission periods. This study aimed to assess the levels of overall functioning and specific areas of functioning in remitted patients with BD compared with those in healthy controls. Methods Eighty completely remitted patients with BD and 80 healthy controls were included in the study. The Bipolar Disorder Functioning Questionnaire (BDFQ), Young Mania Rating Scale, and Beck Depression Inventory were used. Results There were fewer married and employed cohorts in the BD group than in the control group. Compared with healthy controls, patients with BD exhibited a worse functioning in terms of intellectual and sexual functioning, feelings of stigmatization, social withdrawal, household relationships, relationships with friends, and participation in social activities. There was no difference between the groups in terms of emotional functioning, daily activities and hobbies, taking initiative and self-sufficiency, and occupation. The total BDFQ scores of patients were lower than those of healthy controls. A better functionality was observed in patients using only a mood stabilizer than in patients using three or more drugs. Conclusion Remarkably, remitted patients with BD tended to perform daily activities well when these activities were not in a social context. Stigma-oriented interpersonal approaches can be particularly beneficial for these patients. PMID:28360789

  15. Relapsing-remitting behavioural variant of frontotemporal dementia in a bipolar patient

    PubMed Central

    Vorspan, Florence; Bertoux, Maxime; Brichant-Petitjean, Clara; Dubois, Bruno; Lépine, Jean-Pierre

    2012-01-01

    Summary We report the case of a bipolar I patient who was diagnosed with frontotemporal dementia at the age of 54 during a manic episode. Her neurological state improved when this episode ended. Each subsequent thymic relapse was associated with cognitive deficits which subsided when the patient became euthymic, even though SPECT continued to show the same frontal hypoperfusion. We here discuss the hypothesis that the cognitive reserve of this patient, a former journalist, may, except during her mood episodes, have provided her with sufficient resources to meet her life demands despite her underlying neurological disorder. PMID:23402681

  16. Bipolar disorder is associated with HIV transmission risk behavior among patients in treatment for HIV

    PubMed Central

    Meade, Christina S.; Bevilacqua, Lisa A.; Key, Mary D.

    2013-01-01

    This study examined HIV transmission risk behavior among 63 patients with bipolar disorder (BD), major depressive disorder (MDD), and no mood disorder (NMD); half had substance use disorders (SUDs). Patients with BD were more likely than others to report unprotected intercourse with HIV-negative partners and < 95% adherence to antiretroviral medications. In multivariate models, BD and SUD were independent predictors of both risk behaviors. Participants with poorer medication adherence were more likely to have detectable HIV viral loads and unprotected intercourse with HIV-negative partners. Patients with BD deserve careful evaluation and HIV prevention services to reduce HIV transmission risk behaviors. PMID:22614744

  17. Nutrition and Bipolar Depression.

    PubMed

    Beyer, John L; Payne, Martha E

    2016-03-01

    As with physical conditions, bipolar disorder is likely to be impacted by diet and nutrition. Patients with bipolar disorder have been noted to have relatively unhealthy diets, which may in part be the reason they also have an elevated risk of metabolic syndrome and obesity. An improvement in the quality of the diet should improve a bipolar patient's overall health risk profile, but it may also improve their psychiatric outcomes. New insights into biological dysfunctions that may be present in bipolar disorder have presented new theoretic frameworks for understanding the relationship between diet and bipolar disorder.

  18. Interaction between Personality and Mood in Unipolar and Bipolar Patients.

    ERIC Educational Resources Information Center

    Alexander, Gene E.; And Others

    Much of the literature on affective disorders has been devoted to categorizing, assessing, and treating the mood and behavioral symptoms typically associated with depressive illness, and much research has studied how personality traits interact with these state symptoms. The personality scales of the Millon Clinical Multiaxial Inventory (MCMI) are…

  19. Anticonvulsant drugs in bipolar disorder

    PubMed Central

    Grunze, Heinz; Schlösser, Sandra; Amann, Benedikt; Walden, Jörg

    1999-01-01

    Although much progress has been made in successfully treating bipolar disorder, there is increasing awareness of the limitations of traditional treatment regimens such as lithium and neuroleptics. The large family of anticonvulsant drugs, however, appears to be capable of providing new treatment options, not only as medication of second choice in patients refractory to treatment, but often as a treatment standard with high efficacy and low incidence of side effects. Besides established mood stabilizers such as carbamazepine and valproate, new antiepileptic drugs are entering the field with promising initial results in the treatment of bipolar patients. Furthermore, bringing to light the mechanisms of action of anticonvulsants and the similarities between anticonvulsants effective in bipolar disorder may also deepen our understanding of the pathophysiological basis of the disorder. PMID:22033602

  20. Diminished serum repetin levels in patients with schizophrenia and bipolar disorder.

    PubMed

    Wang, Shuai; Ren, Huixun; Xu, Jie; Yu, Yanjun; Han, Shuiping; Qiao, Hui; Cheng, Shaoli; Xu, Chang; An, Shucheng; Ju, Bomiao; Yu, Chengyuan; Wang, Chanyuan; Wang, Tao; Yang, Zhenjun; Taylor, Ethan Will; Zhao, Lijun

    2015-01-23

    Repetin (RPTN) protein is a member of S100 family and is known to be expressed in the normal epidermis. Here we show that RPTN is ubiquitously expressed in both mouse and human brain, with relatively high levels in choroid plexus, hippocampus and prefrontal cortex. To investigate the expression of RPTN in neuropsychiatric disorders, we determined serum levels of RPTN in patients with schizophrenia (n = 88) or bipolar disorder (n = 34) and in chronic psychostimulant users (n = 91). We also studied its expression in a mouse model of chronic unpredictable mild stress (CUMS). The results showed that serum RPTN levels were significantly diminished in patients with schizophrenia and bipolar disorder or in psychostimulant users, compared with healthy subjects (n = 115) or age-matched controls (n = 92) (p < 0.0001). In CUMS mice, RPTN expression in hippocampus and prefrontal cortex was reduced with progression of the CUMS procedure; the serum RPTN level remained unchanged. Since CUMS is a model for depression and methamphetamine (METH) abuse induced psychosis recapitulates many of the psychotic symptoms of schizophrenia, the results from this study may imply that RPTN plays a potential role in emotional and cognitive processing; its decrease in serum may indicate its involvement in the pathogenesis of schizophrenia and bipolar disorder.

  1. Smartphone-based recognition of states and state changes in bipolar disorder patients.

    PubMed

    Grünerbl, Agnes; Muaremi, Amir; Osmani, Venet; Bahle, Gernot; Ohler, Stefan; Tröster, Gerhard; Mayora, Oscar; Haring, Christian; Lukowicz, Paul

    2015-01-01

    Today's health care is difficult to imagine without the possibility to objectively measure various physiological parameters related to patients' symptoms (from temperature through blood pressure to complex tomographic procedures). Psychiatric care remains a notable exception that heavily relies on patient interviews and self-assessment. This is due to the fact that mental illnesses manifest themselves mainly in the way patients behave throughout their daily life and, until recently there were no "behavior measurement devices." This is now changing with the progress in wearable activity recognition and sensor enabled smartphones. In this paper, we introduce a system, which, based on smartphone-sensing is able to recognize depressive and manic states and detect state changes of patients suffering from bipolar disorder. Drawing upon a real-life dataset of ten patients, recorded over a time period of 12 weeks (in total over 800 days of data tracing 17 state changes) by four different sensing modalities, we could extract features corresponding to all disease-relevant aspects in behavior. Using these features, we gain recognition accuracies of 76% by fusing all sensor modalities and state change detection precision and recall of over 97%. This paper furthermore outlines the applicability of this system in the physician-patient relations in order to facilitate the life and treatment of bipolar patients.

  2. The Relationship Between Educational Years and Phonemic Verbal Fluency (PVF) and Semantic Verbal Fluency (SVF) Tasks in Spanish Patients Diagnosed With Schizophrenia, Bipolar Disorder, and Psychotic Bipolar Disorder.

    PubMed

    García-Laredo, Eduardo; Maestú, Fernando; Castellanos, Miguel Ángel; Molina, Juan D; Peréz-Moreno, Elisa

    2015-09-01

    Semantic and verbal fluency tasks are widely used as a measure of frontal capacities. It has been well described in literature that patients affected by schizophrenic and bipolar disorders present a worse execution in these tasks. Some authors have also noted the importance of educational years. Our objective is to analyze whether the effect of cognitive malfunction caused by apathology is superior to the expected effect of years of education in phonemic verbal fluency (PVF) and semantic verbal fluency (SVF) task execution. A total of 62 individuals took part in this study, out of which 23 were patients with schizophrenic paranoid disorder, 11 suffered from bipolar disorder with psychotic symptomatology, 13 suffered from bipolar disorder without psychotic symptomatology, and 15 participants were nonpathological individuals. All participants were evaluated with the PVF and SVF tests (animals and tools). The performance/execution results were analyzed with a mixed-model ANCOVA, with educational years as a covariable. The effect of education seems to be more determined by PVF FAS tests than by SVF. With PVF FAS tasks, the expected effect of pathology disappears when the covariable EDUCATION is introduced. With SVF tasks, the effect continues to be significant, even though the EDUACTION covariable dims such effect. These results suggest that SVF tests (animals category) are better evaluation tools as they are less dependent on the patients' education than PVF FAS tests.

  3. Course of illness in comorbid bipolar disorder and obsessive-compulsive disorder patients.

    PubMed

    Amerio, A; Tonna, M; Odone, A; Stubbs, B; Ghaemi, S N

    2016-04-01

    Psychiatric comorbidity is extremely common. One of the most common and difficult to manage comorbid conditions is the co-occurrence of bipolar disorder (BD) and obsessive compulsive disorder (OCD). We updated our recent systematic review searching the electronic databases MEDLINE, Embase, and PsycINFO to investigate course of illness in BD-OCD patients. We identified a total of 13 relevant papers which found that the majority of comorbid OCD cases appeared to be related to mood episodes. OC symptoms in comorbid patients appeared more often during depressive episodes, and comorbid BD and OCD cycled together, with OC symptoms often remitting during manic/hypomanic episodes.

  4. Bipolar Medications and Weight Gain

    MedlinePlus

    Bipolar medications and weight gain Do all bipolar medications cause weight gain? Answers from Daniel K. Hall-Flavin, M. ... disorder can be treated with a number of medications. Some of these medications can increase your appetite ...

  5. Spontaneous dissociation of bipolar hip hemiarthroplasty in a patient with nerve palsy: A case report and review of the literature

    PubMed Central

    Yuenyongviwat, Varah; Iamthanaporn, Khanin; Hongnaparak, Theerawit

    2015-01-01

    Introduction Dislocation after bipolar hemiarthroplasty is a common complication but dissociation of the prosthesis is rare. There are some reports of bipolar hemiarthroplasty dissociation at the inner head and outer shell. However, there are limited reports on acute spontaneous dissociation of the head and neck at the taper interface in bipolar hemiarthroplasty. Presentation of case A 65-year-old female had cemented bipolar hemi hip replacement after fixation failure of a dynamic hip screw. She had left lower limb weakness for ten years after previous spinal surgery. At the sixth week of postoperation, the patient had dissociation of the components of the bipolar hemiarthroplasty at the femoral head and neck junction. The patient had open reduction and femoral head revision. There was no re-dislocation at one-year follow-up. Discussion Dissociation of bipolar hemiarthroplasty is a complex complication that can happen from the modularity of the implant. This condition requires operative treatment. The mechanism and cause of failure should be identified before the operation. Conclusion To prevent this condition, preoperative planning and proper techniques should be done as an index procedure. In the case of marked shortening of the limb after an operation in patients with lower limb muscle weakness, we hypothesize that early full weight bearing with immediate use of a shoe lift might help prevent this condition. PMID:26339788

  6. The Relationship Between Educational Years and Phonemic Verbal Fluency (PVF) and Semantic Verbal Fluency (SVF) Tasks in Spanish Patients Diagnosed With Schizophrenia, Bipolar Disorder, and Psychotic Bipolar Disorder

    PubMed Central

    García-Laredo, Eduardo; Maestú, Fernando; Castellanos, Miguel Ángel; Molina, Juan D.; Peréz-Moreno, Elisa

    2015-01-01

    Abstract Semantic and verbal fluency tasks are widely used as a measure of frontal capacities. It has been well described in literature that patients affected by schizophrenic and bipolar disorders present a worse execution in these tasks. Some authors have also noted the importance of educational years. Our objective is to analyze whether the effect of cognitive malfunction caused by apathology is superior to the expected effect of years of education in phonemic verbal fluency (PVF) and semantic verbal fluency (SVF) task execution. A total of 62 individuals took part in this study, out of which 23 were patients with schizophrenic paranoid disorder, 11 suffered from bipolar disorder with psychotic symptomatology, 13 suffered from bipolar disorder without psychotic symptomatology, and 15 participants were nonpathological individuals. All participants were evaluated with the PVF and SVF tests (animals and tools). The performance/execution results were analyzed with a mixed-model ANCOVA, with educational years as a covariable. The effect of education seems to be more determined by PVF FAS tests than by SVF. With PVF FAS tasks, the expected effect of pathology disappears when the covariable EDUCATION is introduced. With SVF tasks, the effect continues to be significant, even though the EDUACTION covariable dims such effect. These results suggest that SVF tests (animals category) are better evaluation tools as they are less dependent on the patients’ education than PVF FAS tests. PMID:26426640

  7. Distressing cutaneous lesion among bipolar affective disorder patients on lithium therapy: A retrospective cross-sectional study

    PubMed Central

    Ummar, Syed; Dorai, B. Lakshmi; Ramanathan, Shree Aarthi

    2016-01-01

    Aim: To assess the incidence of cutaneous lesion in bipolar affective disorder (BPAD) patients on lithium therapy. To evaluate the relationship between duration of lithium therapy, dosage of lithium, serum lithium level, and cutaneous lesions. To assess whether reduction/stoppage of dose of lithium has any change in the course of cutaneous side effects. To look for a relationship between addition of isotretinoin and the course of mood disorder. Methodology: We retrospectively collected hospital case records of 125 consecutive BPAD patients initiated lithium therapy, assessed with inclusion and exclusion criteria. We follow up them for 2½ years for the assessment of above said aims. Results: The prevalence of skin reaction in BPAD patients with lithium therapy was 19.8%. Among patients on lithium therapy, cutaneous lesion emerged in initial 6 months and later after 1 year of treatment. Nearly 55% of patients on higher doses of lithium (1200 mg) had a cutaneous lesion. Patient on therapeutic serum level of lithium had a higher incidence of skin lesion. Out of six patients in whom dosage of lithium was reduced, three of them had reduced lesions (P = 0.6), in two patients, skin lesion increased, and one patient had no change. Among 11 patients treated with isotretinoin, only two patients had emergence of depressive symptoms. Conclusion: Lithium continues to increase the incidence of multiple cutaneous lesions among BPAD patients on lithium therapy. Incidence of cutaneous side effects directly correlates with the dose of lithium and therapeutic range of serum lithium level. Altering the dose of lithium does not statistically influence the cutaneous lesion. PMID:28196994

  8. Bipolar versus monopolar transurethral resection of the prostate for benign prostatic hyperplasia: safe in patients with high surgical risk

    PubMed Central

    Yang, Er J.; Li, Hao; Sun, Xin B.; Huang, Li; Wang, Li; Gong, Xiao X.; Yang, Yong

    2016-01-01

    Here, we compared the effects of bipolar and monopolar transurethral resection of the prostate (B-TURP, M-TURP) for treating elderly patients (≥75 years) with benign prostatic hyperplasia(BPH) who had internal comorbidities. Eligible BPH patients were aged ≥75 years and had at least one internal comorbidity. In this open-label, prospective trial, patients were assigned to B-TURP (n = 75) and M-TURP (n = 88) groups. Data on prostate volume (PV), urination, and time during perioperative period were compared; data associated with urination and complications at one year postoperatively were also compared. Finally, follow-up data were available for 68 and 81 patients in the B-TURP and M-TURP group, respectively. No deaths were recorded. Intraoperative bleeding was lower and irrigation time, indwelling catheter time, and hospital stay were shorter in the B-TURP group than in the M-TURP group (p < 0.001). No difference was observed with respect to operation time (p = 0.058). At one year after the operation, differences with respect to urination and complications were not significant. In conclusion, Short-term efficacy of B-TURP or M-TURP was satisfactory for elderly patients with BPH who had internal comorbidities. Besides, B-TURP is a more sensible choice because it has a lower prevalence of adverse effects. PMID:26892901

  9. Theory of Mind in Euthymic Bipolar Patients and First-Degree Relatives.

    PubMed

    Santos, Josep Manel; Pousa, Esther; Soto, Estel; Comes, Anna; Roura, Pere; Arrufat, Francesc X; Obiols, Jordi E

    2017-03-01

    The present study analyzed the capacity for mentalization of patients with bipolar disorder (BD) and their first-degree relatives (FDR) and examined the implications of clinical variables and cognitive deficits. The study recruited 31 patients with type I BD, 18 FDR, and 31 paired healthy controls. Their capacity for mentalization was explored by means of first- and second-order false-belief tasks, the hinting task, and the Movie for the Assessment of Social Cognition (MASC). Patients and FDR were found to have a theory of mind (ToM) deficit when they were evaluated with the MASC, which was also related to a worse neurocognitive performance and to being a patient or FDR. The evidence of ToM deficits in FDRs supports the hypothesis that these deficits could be an independent trait marker for cognitive deficit. Further research is needed on FDR of patients with BD, using sensitive ToM assessment instruments such as the MASC.

  10. Suicide attempts and psychological risk factors in patients with bipolar and unipolar affective disorder.

    PubMed

    Pawlak, Joanna; Dmitrzak-Węglarz, Monika; Skibińska, Maria; Szczepankiewicz, Aleksandra; Leszczyńska-Rodziewicz, Anna; Rajewska-Rager, Aleksandra; Maciukiewicz, Małgorzata; Czerski, Piotr; Hauser, Joanna

    2013-01-01

    Suicide is an important clinical problem in psychiatric patients. The highest risk of suicide attempts is noted in affective disorders. The aim of the study was looking for suicide risk factors among personality dimensions and value system in patients with diagnosis of unipolar and bipolar affective disorder (n=189 patients, n=101 controls). To establish the diagnosis, we used SCID (Structured clinical interview for diagnostic and statistical manual of mental disorders, fourth edition) questionnaire, TCI (Temperament and Character Inventory) questionnaire and Value Survey--to assess the personality. The main limitations of the study are number of participants, lack of data about stressful life events and treatment with lithium. Novelty seeking and harm avoidance dimensions constituted suicide attempt risk factors in the group of patients with affective disorders. Protective role of cooperativeness was discovered. Patients with and without suicide attempt in lifetime history varied in self-esteem position in Value Survey.

  11. Reevaluation of patients with bipolar disorder on manic episode: improving the diagnosing of mixed episode.

    PubMed

    Kim, Kyung Ran; Cho, Hyun-Sang; Kim, Se Joo; Seok, Jeong-Ho; Lee, Eun; Jon, Duk-In

    2013-08-01

    Mixed manic/depressive episodes in patients with bipolar disorder are underdiagnosed because of restrictive diagnostic criteria. Using the broader definition of a mixed episode represented by the Cincinnati criteria, we reevaluated the medical records of patients with bipolar disorder hospitalized for a manic episode. We also examined the predictive power of previously unrecognized depressive symptoms. Of 520 inpatients with mania, we retrospectively diagnosed 59 (11.3%) as having a probable mixed episode. Compared with the patients with pure mania, the patients with mixed episodes were more likely to have a family history of psychiatric illness, comorbid personality disorder, and a history of suicide attempts. Binary logistic regression revealed that loss of interest, loss of energy, feelings of worthlessness, and feelings of helplessness had good positive predictive value (>0.7) for mixed episodes. Accurate diagnosis of mixed episodes may require a broadening of diagnostic criteria and emphasis on symptoms such as loss of interest, loss of energy, and feelings of worthlessness and helplessness.

  12. Neuropsychology, social cognition and global functioning among bipolar, schizophrenic patients and healthy controls: preliminary data

    PubMed Central

    Caletti, Elisabetta; Paoli, Riccardo A.; Fiorentini, Alessio; Cigliobianco, Michela; Zugno, Elisa; Serati, Marta; Orsenigo, Giulia; Grillo, Paolo; Zago, Stefano; Caldiroli, Alice; Prunas, Cecilia; Giusti, Francesca; Consonni, Dario; Altamura, A. Carlo

    2013-01-01

    This study aimed to determine the extent of impairment in social and non-social cognitive domains in an ecological context comparing bipolar (BD), schizophrenic (SKZ) patients and healthy controls (HC). The sample was enrolled at the Department of Psychiatry of Policlinico Hospital, University of Milan; it includes stabilized SKZ patients (n = 30), euthymic bipolar patients (n = 18) and HC (n = 18). Patients and controls completed psychiatric assessment rating scales, the Brief Assessment of Cognition in Schizophrenia (BACS) and the Executive and Social Cognition Battery (ESCB) that contains both ecological tests of executive function and social cognition, in order to better detect cognitive deficits in patients with normal results in standard executive batteries. The three groups differed significantly for gender and substance abuse, however, the differences did not influence the results. BD patients showed less impairment on cognitive performance compared to SKZ patients, even in “ecological” tests that mimic real life scenarios. In particular, BD performed better than SKZ in verbal memory (p < 0.0038) and BACS symbol coding (p < 0.0043). Regarding the ESCB tests, in the Hotel task SKZ patients completed significantly less tasks (p < 0.001), showed a greater number of errors in Multiple Errands Test (MET-HV) (p < 0.0248) and a worse performance in Theory of Mind (ToM) tests (p < 0.001 for the Eyes test and Faux pas test). Both patients' groups performed significantly worse than HC. Finally, significant differences were found between the two groups in GAF scores, being greater among BD subjects (p < 0.001). GAF was correlated with BACS and ESCB scores showing the crucial role of cognitive and ecological performances in patients' global functioning. PMID:24146642

  13. Phosphoinositide-specific Phospholipase C β1 gene deletion in bipolar disorder affected patient.

    PubMed

    Lo Vasco, Vincenza Rita; Longo, Lucia; Polonia, Patrizia

    2013-03-01

    The involvement of phosphoinositides (PI) signal transduction pathway and related molecules, such as the Phosphoinositide-specific Phospholipase C (PI-PLC) enzymes, in the pathophysiology of mood disorders is corroborated by a number of recent evidences. Our previous works identified the deletion of PLCB1 gene, which codifies for the PI-PLC β1 enzyme, in 4 out 15 patients affected with schizophrenia, and no deletion both in major depression affected patients and in normal controls. By using interphase fluorescent in situ hybridization methodology, we analyzed PLCB1 in paraffin embedded samples of orbito-frontal cortex of 15 patients affected with bipolar disorder. Deletion of PLCB1 was identified in one female patient.

  14. Bipolar Disorder Center for Pennsylvanians: Implementing an Effectiveness Trial to Improve Treatment for At-Risk Patients

    PubMed Central

    Kupfer, David J.; Friedman, Edward S.; Reynolds, Charles F.; Axelson, David A.; Grochocinski, Victoria J.; Stofko, Mary G.; Birmaher, Boris; Houck, Patricia R.; Swartz, Holly A.; Brown, Charlotte; Kilbourne, Amy M.; Thase, Michael E.; Curet, David E.; Mulsant, Benoit H.; Turkin, Scott R.; Fagiolini, Andrea; Pollock, Bruce G.; Whyte, Ellen M.; Frank, Ellen

    2012-01-01

    Objective Adolescents, elderly persons, African Americans, and rural residents with bipolar disorder are less likely than their middle-aged, white, urban counterparts to be diagnosed, receive adequate treatment, remain in treatment once identified, and have positive outcomes. The Bipolar Disorder Center for Pennsylvanians (BDCP) study was designed to address these disparities. This report highlights the methods used to recruit, screen, and enroll a cohort of difficult-to-recruit individuals with bipolar disorder. Methods Study sites included three specialty clinics for bipolar disorder in a university setting and a rural behavioral health clinic. Study operations were standardized, and all study personnel were trained in study procedures. Several strategies were used for recruitment. Results It was possible to introduce the identical assessment and screening protocol in settings regardless of whether they had a history of implementing research protocols. This protocol was also able to be used across the age spectrum, in urban and rural areas, and in a racially diverse cohort of participants. Across the four sites 515 individuals with bipolar disorder were enrolled as a result of these methods (69 African Americans and 446 non–African Americans). Although clinical characteristics at study entry did not differ appreciably between African Americans and non–African Americans, the pathways into treatment differed significantly. Conclusions Rigorous recruitment and assessment procedures can be successfully introduced in different settings and with different patient cohorts, thus facilitating access to high-quality treatment for individuals who frequently do not receive appropriate care for bipolar disorder. PMID:19564218

  15. Fractal analysis of MRI data for the characterization of patients with schizophrenia and bipolar disorder.

    PubMed

    Squarcina, Letizia; De Luca, Alberto; Bellani, Marcella; Brambilla, Paolo; Turkheimer, Federico E; Bertoldo, Alessandra

    2015-02-21

    Fractal geometry can be used to analyze shape and patterns in brain images. With this study we use fractals to analyze T1 data of patients affected by schizophrenia or bipolar disorder, with the aim of distinguishing between healthy and pathological brains using the complexity of brain structure, in particular of grey matter, as a marker of disease. 39 healthy volunteers, 25 subjects affected by schizophrenia and 11 patients affected by bipolar disorder underwent an MRI session. We evaluated fractal dimension of the brain cortex and its substructures, calculated with an algorithm based on the box-count algorithm. We modified this algorithm, with the aim of avoiding the segmentation processing step and using all the information stored in the image grey levels. Moreover, to increase sensitivity to local structural changes, we computed a value of fractal dimension for each slice of the brain or of the particular structure. To have reference values in comparing healthy subjects with patients, we built a template by averaging fractal dimension values of the healthy volunteers data. Standard deviation was evaluated and used to create a confidence interval. We also performed a slice by slice t-test to assess the difference at slice level between the three groups. Consistent average fractal dimension values were found across all the structures in healthy controls, while in the pathological groups we found consistent differences, indicating a change in brain and structures complexity induced by these disorders.

  16. Fractal analysis of MRI data for the characterization of patients with schizophrenia and bipolar disorder

    NASA Astrophysics Data System (ADS)

    Squarcina, Letizia; De Luca, Alberto; Bellani, Marcella; Brambilla, Paolo; Turkheimer, Federico E.; Bertoldo, Alessandra

    2015-02-01

    Fractal geometry can be used to analyze shape and patterns in brain images. With this study we use fractals to analyze T1 data of patients affected by schizophrenia or bipolar disorder, with the aim of distinguishing between healthy and pathological brains using the complexity of brain structure, in particular of grey matter, as a marker of disease. 39 healthy volunteers, 25 subjects affected by schizophrenia and 11 patients affected by bipolar disorder underwent an MRI session. We evaluated fractal dimension of the brain cortex and its substructures, calculated with an algorithm based on the box-count algorithm. We modified this algorithm, with the aim of avoiding the segmentation processing step and using all the information stored in the image grey levels. Moreover, to increase sensitivity to local structural changes, we computed a value of fractal dimension for each slice of the brain or of the particular structure. To have reference values in comparing healthy subjects with patients, we built a template by averaging fractal dimension values of the healthy volunteers data. Standard deviation was evaluated and used to create a confidence interval. We also performed a slice by slice t-test to assess the difference at slice level between the three groups. Consistent average fractal dimension values were found across all the structures in healthy controls, while in the pathological groups we found consistent differences, indicating a change in brain and structures complexity induced by these disorders.

  17. CASE-REPORT Case study of a patient presenting both type II bipolar affective disorder and Klinefelter syndrome.

    PubMed

    Delavenne, H; Khoury, J M; Thibaut, F; Garcia, F D

    2016-10-17

    Klinefelter syndrome (KS) is the most common sex chromosomal disorder with an estimated prevalence of 1 in 500-1000. Increased incidences of anxiety, depression, substance abuse, psychotic and behavioral disorders, and sexual disorders have been reported in patients with KS. The aim of this case study was to report a case of a man with untreated KS who was also diagnosed with type II bipolar disorder. This case report raises awareness regarding psychiatric diagnoses that may be associated with such a highly prevalent condition. A 46-year-old man who had previously been diagnosed with an untreated KS was examined in our Psychiatric Department with an acute hypomanic episode. Clinical improvement was observed within 4 days and psychiatric symptoms were resolved in 7 days without use of medication. A psychiatric history of a depressive episode and at least two hypomanic episodes, as well as a family history of two relatives diagnosed with bipolar disorder, strongly suggest that our patient has type II bipolar disorder. Bipolar disorder may be a comorbid disorder in patients with KS. Routine screening for mood disorders and appropriate referral and evaluation should be performed. Future genetic research is warranted to explore why some chromosomal abnormalities (e.g., duplications), especially those located on the X chromosome, such as Klinefelter syndrome, may be associated with a bipolar or psychotic disorder in some individuals but not in others.

  18. Stroop and emotional Stroop interference in unaffected relatives of patients with schizophrenic and bipolar disorders: distinct markers of vulnerability?

    PubMed

    Besnier, Nathalie; Richard, Floriane; Zendjidjian, Xavier; Kaladjian, Arthur; Mazzola-Pomietto, Pascale; Adida, Marc; Azorin, Jean-Michel

    2009-01-01

    Reduced inhibition has been demonstrated in both schizophrenic and bipolar patients through the findings of increased interference on the Stroop Colour-Word Task (SCWT) and increased emotional interference on specific versions of the Emotional Stroop Task (EST). Despite previous findings of enhanced interference in unaffected relatives of schizophrenic and bipolar patients, it remains unclear whether interference might be a candidate endophenotype to both disorders. Moreover, data regarding emotional interference in unaffected relatives are critically lacking. In the present study, we aimed to compare unaffected relatives of patients with schizophrenia (SZ-rel, N = 30) and bipolar disorder (BD-rel, N= 30) with normal controls (N = 60) when performing the SCWT and an EST designed with neutral, depressive, paranoid and manic words. SZ-rel exhibited greater interference effect on both the SCWT and the EST as compared to either BD-rel or normal controls. BD-rel, and by contrast to SZ-rel and controls, showed increased emotional interference effect on the EST that was specifically associated to the disease-related words. The findings support the hypothesis of different markers of vulnerability to schizophrenic and bipolar disorders; impairment in cognitive inhibition could characterize high-risk individuals for schizophrenia whereas an emotional bias towards mood-related information could be a trait marker of bipolar disease.

  19. A comparative genomic study in schizophrenic and in bipolar disorder patients, based on microarray expression profiling meta-analysis.

    PubMed

    Logotheti, Marianthi; Papadodima, Olga; Venizelos, Nikolaos; Chatziioannou, Aristotelis; Kolisis, Fragiskos

    2013-01-01

    Schizophrenia affecting almost 1% and bipolar disorder affecting almost 3%-5% of the global population constitute two severe mental disorders. The catecholaminergic and the serotonergic pathways have been proved to play an important role in the development of schizophrenia, bipolar disorder, and other related psychiatric disorders. The aim of the study was to perform and interpret the results of a comparative genomic profiling study in schizophrenic patients as well as in healthy controls and in patients with bipolar disorder and try to relate and integrate our results with an aberrant amino acid transport through cell membranes. In particular we have focused on genes and mechanisms involved in amino acid transport through cell membranes from whole genome expression profiling data. We performed bioinformatic analysis on raw data derived from four different published studies. In two studies postmortem samples from prefrontal cortices, derived from patients with bipolar disorder, schizophrenia, and control subjects, have been used. In another study we used samples from postmortem orbitofrontal cortex of bipolar subjects while the final study was performed based on raw data from a gene expression profiling dataset in the postmortem superior temporal cortex of schizophrenics. The data were downloaded from NCBI's GEO datasets.

  20. Memory mood congruency phenomenon in bipolar I disorder and major depression disorder patients

    PubMed Central

    Delgado, V.B.; Kapczinski, F.; Chaves, M.L.F.

    2012-01-01

    The objective of the present study was to evaluate memory performance in tasks with and without affective content (to confirm the mood congruency phenomenon) in acutely admitted patients with bipolar I disorder (BD) and major depression disorder (MDD) and in healthy participants. Seventy-eight participants (24 BD, 29 MDD, and 25 healthy controls) were evaluated. Three word lists were used as the memory task with affective content (positive, negative and indifferent). Psychiatric symptoms were also evaluated with rating scales (Young Mania Rating Scale for mania and Hamilton Depression Rating Scale for depression). Patients were selected during the first week of hospitalization. BD patients showed higher scores in the word span with positive tone than MDD patients and healthy controls (P = 0.002). No other difference was observed for tests with affective tone. MDD patients presented significantly lower scores in the Mini-Mental State Exam, logical memory test, visual recognition span, and digit span, while BD patients presented lower scores in the visual recognition test and digit span. Mood congruency effect was found for word span with positive tone among BD patients but no similar effect was observed among MDD patients for negative items. MDD patients presented more memory impairment than BD patients, but BD patients also showed memory impairment. PMID:22714812

  1. Atomoxetine Induced Hypomania in a Patient with Bipolar Disorder and Adult Attention Deficit Hyperactivity Disorder

    PubMed Central

    Kumar, Vijaya; Varambally, Shivarama

    2017-01-01

    Comorbidity of bipolar disorder (BD) with attention deficit hyperactivity disorder (ADHD) is frequent. The management of comorbid ADHD and BD is complicated by the risk of induction of (hypo) mania by the medications used for ADHD treatment. Earlier reports in children and adolescents with ADHD-BD suggest that the possibility of (hypo) mania induction is low when atomoxetine is used along mood stabilizers or antipsychotics. Here, we report induction of hypomania by atomoxetine when used for the treatment of comorbid ADHD in a BD patient while on prophylactic treatment with mood stabilizers. This report indicates that atomoxetine carries the risk of induction of (hypo) mania even in stabilized BD patients. Clinicians should closely monitor such patients for (hypo) mania symptoms. PMID:28250566

  2. Bipolar disorder

    MedlinePlus

    Manic depression; Bipolar affective disorder; Mood disorder - bipolar; Manic depressive disorder ... happiness and high activity or energy (mania) or depression and low activity or energy (depression). The following ...

  3. Significant Treatment Effect of Bupropion in Patients With Bipolar Disorder but Similar Phase-Shifting Rate as Other Antidepressants

    PubMed Central

    Li, Dian-Jeng; Tseng, Ping-Tao; Chen, Yen-Wen; Wu, Ching-Kuan; Lin, Pao-Yen

    2016-01-01

    Abstract Bupropion is widely used for treating bipolar disorder (BD), and especially those with depressive mood, based on its good treatment effect, safety profile, and lower risk of phase shifting. However, increasing evidence indicates that the safety of bupropion in BD patients may not be as good as previously thought. The aim of this study was to summarize data on the treatment effect and safety profile of bupropion in the treatment of BD via a meta-analysis. Electronic search through PubMed and ClinicalTrials.gov was performed. The inclusion criteria were: (i) studies comparing changes in disease severity before and after bupropion treatment or articles comparing the treatment effect of bupropion in BD patients with those receiving other standard treatments; (ii) articles on clinical trials in humans. The exclusion criteria were (i) case reports/series, and (ii) nonclinical trials. All effect sizes from 10 clinical trials were pooled using a random effects model. We examined the possible confounding variables using meta-regression and subgroup analysis. Bupropion significantly improved the severity of disease in BD patients (P < 0.001), and the treatment effect was similar to other antidepressants/standard treatments (P = 0.220). There were no significant differences in the dropout rate (P = 0.285) and rate of phase shifting (P = 0.952) between BD patients who received bupropion and those who received other antidepressants. We could not perform a detailed meta-analysis of every category of antidepressant, nor could we rule out the possible confounding effect of concurrent psychotropics or include all drug side effects. Furthermore, the number of studies recruited in the meta-analysis was relatively small. Our findings reconfirm the benefits of bupropion for the treatment of bipolar depression, which are similar to those of other antidepressants. However, the rate of phase shifting with bupropion usage was not as low compared to other

  4. Alterations of cerebral glutamate in the euthymic state of patients with bipolar disorder.

    PubMed

    Ehrlich, André; Schubert, Florian; Pehrs, Corinna; Gallinat, Jürgen

    2015-08-30

    The pathophysiology of bipolar disorder (BD) mostly remains unclear. However, some findings argue for a dysfunction in glutamatergic neurotransmission in BD. Proton magnetic resonance spectroscopy at 3T was used to determine glutamate concentrations in the anterior cingulate cortex (ACC) and the hippocampus (HC) of euthymic outpatients with BP-I disorder and age- and sex-matched healthy controls. In patients with BD, glutamate concentrations were significantly increased in the ACC and decreased in the HC compared with concentrations in controls. Significant group differences were also measured for N-acetyl aspartate and choline; no differences were found for other metabolites examined. An inverse correlation was observed for glutamate concentrations in the ACC and number of episodes. The findings of the study add to the concept of abnormalities in glutamatergic regulation in the ACC and HC in patients with BD.

  5. Antecedents of Manic versus Other First-Psychotic Episodes in 263 Bipolar-I Disorder Patients

    PubMed Central

    Salvatore, Paola; Baldessarini, Ross J.; Khalsa, Hari-Mandir K.; Vázquez, Gustavo; Perez, Jesus; Faedda, Gianni L.; Amore, Mario; Maggini, Carlo; Tohen, Mauricio

    2013-01-01

    Objective Since initial episode-type can predict later morbidity in bipolar disorder, we tested the hypothesis that clinical antecedents might predict initial episode-types. Method We studied 263 first-episode, adult, DSM-IV-TR type-I bipolar disorder (BD-I) subjects within the McLean-Harvard-International First-Episode Project. Based on blinded assessments of antecedents from SCID examinations and clinical records, we compared first-lifetime Manic vs. Other (mixed, depressive, or nonaffective) major psychotic-episodes. Results We identified 32 antecedents arising at early, intermediate or later times, starting 12.3±10.7 years prior to first-lifetime major psychotic-episodes. Based on multivariate modeling, antecedents associated significantly and independently with Other (n=113) more than Manic (n=150) first-lifetime major psychotic-episodes ranked by Odds Ratio: more early attentional disturbances, more late depression, more early perplexity, more detoxification, more early unstable-mixed affects, more antidepressants, more early dysphoria, more intermediate depression, more early impulsivity, more late anhedonia, longer early-to-intermediate intervals, more intermediate substance abuse, more family history of major depression, and younger at earliest antecedents. Antecedents selectively preceding Manic more than Other first-psychotic episodes included more late behavioral problems and more risk of familial BD-I. Conclusion Clinical antecedents in adult, BD-I patients, beginning a decade before first major-episodes and progressing through sequential stages were dissimilar in Manic versus Other first-psychotic-episodes. PMID:23837831

  6. Investigating Aggressive Styles and Defense Mechanisms in Bipolar Patients and in their Parents.

    PubMed

    Bragazzi, Nicola Luigi; Pezzoni, Franca; Del Puente, Giovanni

    2014-11-06

    Bipolar disorder (BD) is a very common mental health disorder, whose etiology concerning aggressive styles and defense mechanisms is still poorly known despite the efforts dedicated to develop psychological and biological theories. After obtaining written signed informed consent, this study will recruit inpatients with a clinical diagnosis of BD, based on Structured Clinical Interview and the Diagnostic and Statistical Manual of Mental Disorders criteria, and their parents. The Bus-Perry Aggression Questionnaire, the Defense Style Questionnaire 40, the Symptom check list SCL-90-R, developed by DeRogatis will be administered to the participants, together with a semi-structured questionnaire concerning demographic data (age, gender, employment, education) and only for the patients clinical information (onset year of the disorder, presence of co-morbidities, alcohol and drug use, suicide tendencies, kind of treatment). All the questionnaires are in the Italian validated version. The successful completion of this study will shed light on the relationship between aggressive styles and defensive mechanisms in bipolar inpatients and in their parents, helping the clinicians to develop ad hoc psychological interventions.

  7. Increased Subsequent Risk of Peptic Ulcer Diseases in Patients With Bipolar Disorders.

    PubMed

    Hsu, Yi-Chao; Hsu, Chih-Chao; Chang, Kuang-Hsi; Lee, Chang-Yin; Chong, Lee-Won; Wang, Yu-Chiao; Kao, Chia-Hung

    2015-07-01

    Previous studies have reported that patients with bipolar disorders (BDs) exhibit increased physical comorbidity and psychological distress. Studies have shown that schizophrenia and anxiety increase the risk of peptic ulcer diseases (PUDs). Therefore, we conducted this study to determine the association between these 2 diseases and examine the possible risk factors. We used patients diagnosed with BDs from the Taiwan National Health Insurance Research Database. A comparison cohort comprising patients without BDs was frequency matched by age, sex, and comorbidities, and the occurrence of PUDs was evaluated in both the cohorts. The BD and non-BD cohort consisted of 21,060 patients with BDs and 84,240 frequency-matched patients without BDs, respectively. The incidence of PUDs (hazard ratio, 1.51; 95% confidence interval, 1.43-1.59; P < 0.001) was higher among the patients with BDs than the control patients. Cox models showed that irrespective of comorbidities, BDs were an independent risk factor for PUDs. Patients with BDs exhibit a substantially higher risk for developing PUDs. According to our data, we suggest that, following a diagnosis of BD, practitioners could notice the occurrence of PUD and associated prevention. Further prospective clinical studies investigating the relationship between BDs and PUDs are warranted.

  8. Illness perception of dropout patients followed up at bipolar outpatient clinic, Turkey.

    PubMed

    Oflaz, Serap; Guveli, Hulya; Kalelioglu, Tevfik; Akyazı, Senem; Yıldızhan, Eren; Kılıc, Kasım Candas; Basyigit, Sehnaz; Ozdemiroglu, Filiz; Akyuz, Fatma; Gokce, Esra; Bag, Sevda; Kurt, Erhan; Oral, Esat Timucin

    2015-06-01

    Dropout is a common problem in the treatment of psychiatric illnesses including bipolar disorders (BD). The aim of the present study is to investigate illness perceptions of dropout patients with BD. A cross sectional study was done on the participants who attended the Mood Disorder Outpatient Clinic at least 3 times from January 2003 through June 2008, and then failed to attend clinic till to the last one year, 2009, determined as dropout. Thirty-nine dropout patients and 39 attendent patients with BD were recruited for this study. A sociodemographic form and brief illness perception questionnaire were used to capture data. The main reasons of patients with BD for dropout were difficulties of transport (31%), to visit another doctor (26%), giving up drugs (13%) and low education level (59%) is significant for dropout patients. The dropout patients reported that their illness did not critically influence their lives, their treatment had failed to control their illnesses, they had no symptoms, and that their illness did not emotionally affect them. In conclusion, the nonattendance of patients with serious mental illness can result in non-compliance of therapeutic drug regimens, and a recurrence of the appearance symptoms. The perception of illness in dropout patients with BD may be important for understanding and preventing nonattendance.

  9. Affective prosody perception in symptomatically remitted patients with schizophrenia and bipolar disorder.

    PubMed

    Hoertnagl, Christine M; Yalcin-Siedentopf, Nursen; Baumgartner, Susanne; Biedermann, Falko; Deisenhammer, Eberhard A; Hausmann, Armand; Kaufmann, Alexandra; Kemmler, Georg; Mühlbacher, Moritz; Rauch, Anna-Sophia; Fleischhacker, Wolfgang W; Hofer, Alex

    2014-09-01

    Affect perception has frequently been shown to be impaired in patients suffering from schizophrenia or bipolar disorder (BD), but it remains unclear whether these impairments exist during symptomatic remission and whether the two disorders differ from each other in this regard. Most previous studies have investigated facial affect recognition, but not the ability to decode mental states from emotional tone of voice, i.e. affective prosody perception (APP). Accordingly, the present study directly compared APP in symptomatically remitted patients with schizophrenia or BD and healthy control subjects and investigated its relationship with residual symptomatology in patients. Patients with schizophrenia and BD showed comparable APP impairments despite being symptomatically remitted. In comparison to healthy control subjects, overall APP deficits were found in BD but not in schizophrenia patients. Both patient groups were particularly impaired in the identification of anger and confounded it with neutral prosody. In addition, schizophrenia patients frequently confused sadness with happiness, anger, or fright. There was an inverse association between the degree of residual positive symptoms and the ability to correctly recognize happiness in schizophrenia patients. Overall, these data indicate that impairments in APP represent an enduring deficit and a trait marker of both schizophrenia and BD and that the level of impairment is comparable between disorders.

  10. Non-Compliance and Related Factors in Patients With Bipolar I Disorder: A Six Month Follow-Up Study

    PubMed Central

    Azadforouz, Sanaz; Shabani, Amir; Nohesara, Shabnam; Ahmadzad-Asl, Masoud

    2016-01-01

    Background Medication treatment compliance among bipolar patients is quite widespread. Objectives Treatment compliance depends on multiple factors. The aim of this study was to evaluate the predicting factors of noncompliance in patients with bipolar I disorder admitted to an Iranian hospital during a six-month follow up period. Materials and Methods This cross-sectional study included 47 bipolar I disorder subjects who were admitted to the Iran psychiatric hospital and that were chosen using a non-randomized convenient sampling model. The patients were assessed at baseline, and at two and six months after admission. For evaluating the patients, we used the medication possession ratio (MPR), the drug attitude inventory (DIA-10), the young mania rating scale (Y-MRS) and the scale for the assessment of positive symptoms (SAPS). The data were analyzed using a general linear model by SPSS 16 software. Results The repeated measures analysis revealed that medication compliance increased successively (P = 0.045), and age, gender and symptom severity did not alter the pattern. Conclusions There is an increasing pattern in treatment compliance in bipolar I disorder patients, regardless of the known predicting factors for nonadherence. PMID:27803718

  11. Investigating the underlying mechanisms of aberrant behaviors in bipolar disorder from patients to models: Rodent and human studies.

    PubMed

    van Enkhuizen, Jordy; Geyer, Mark A; Minassian, Arpi; Perry, William; Henry, Brook L; Young, Jared W

    2015-11-01

    Psychiatric patients with bipolar disorder suffer from states of depression and mania, during which a variety of symptoms are present. Current treatments are limited and neurocognitive deficits in particular often remain untreated. Targeted therapies based on the biological mechanisms of bipolar disorder could fill this gap and benefit patients and their families. Developing targeted therapies would benefit from appropriate animal models which are challenging to establish, but remain a vital tool. In this review, we summarize approaches to create a valid model relevant to bipolar disorder. We focus on studies that use translational tests of multivariate exploratory behavior, sensorimotor gating, decision-making under risk, and attentional functioning to discover profiles that are consistent between patients and rodent models. Using this battery of translational tests, similar behavior profiles in bipolar mania patients and mice with reduced dopamine transporter activity have been identified. Future investigations should combine other animal models that are biologically relevant to the neuropsychiatric disorder with translational behavioral assessment as outlined here. This methodology can be utilized to develop novel targeted therapies that relieve symptoms for more patients without common side effects caused by current treatments.

  12. Specific subcellular changes in oxidative stress in prefrontal cortex from patients with bipolar disorder.

    PubMed

    Andreazza, Ana C; Wang, Jun-Feng; Salmasi, Faraz; Shao, Li; Young, Lionel T

    2013-11-01

    Previously, we found decreased mitochondrial complex I subunits levels and increased protein oxidation and nitration in postmortem prefrontal cortex (PFC) from patients with bipolar disorder (BD) and schizophrenia (SCZ). The objectives of this study were to replicate our findings in an independent sample of subjects with BD, and to examine more specifically oxidative and nitrosative damage to mitochondrial and synaptosomal proteins and lipid peroxidation in myelin. We isolated mitochondria, synaptosomes, and myelin using a percoll gradient from postmortem PFC from patients with BD, SCZ, and healthy controls. Levels of mitochondrial complex I and III proteins, protein oxidation (carbonylation), and nitration (3-nitrotyrosine) were assessed using immunobloting analysis. Lipid peroxidation [lipid hydroperoxides (LPH), 8-isoprostane (8-Iso), 4-hydroxy-2-nonenal (4-HNE)] were measured using colorimetric or ELISA assays. We found decreased complex I subunits levels in BD subjects compared with control (CTL), but no difference in complex III subunits. Carbonylation was increased in synaptosomes from BD group while 3-nitrotyrosine was increased in mitochondria from BD and SCZ groups. 8-Iso was found increased in the BD group while 4-HNE was increased in both SCZ and BD when compared with controls with no differences in LPH. Our results suggest that in BD mitochondrial proteins are more susceptible to potentially reversible nitrosative damage while more longstanding oxidative damage occurs to synaptic proteins. Oxidative stress has been shown to be higher in the brain of patients with bipolar disorder (BD). Here, we demonstrated increased levels of protein oxidation in synaptosomes from postmortem prefrontal cortex from patients from BD group, while 3-nitrotyrosine was increased in mitochondria from BD and schizophrenia (SCZ) groups. Moreover, lipid peroxidation was found increased in the BD when compared with controls; suggesting that in BD mitochondrial proteins are more

  13. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009.

    PubMed

    Yatham, Lakshmi N; Kennedy, Sidney H; Schaffer, Ayal; Parikh, Sagar V; Beaulieu, Serge; O'Donovan, Claire; MacQueen, Glenda; McIntyre, Roger S; Sharma, Verinder; Ravindran, Arun; Young, L Trevor; Young, Allan H; Alda, Martin; Milev, Roumen; Vieta, Eduard; Calabrese, Joseph R; Berk, Michael; Ha, Kyooseob; Kapczinski, Flávio

    2009-05-01

    The Canadian Network for Mood and Anxiety Treatments (CANMAT) published guidelines for the management of bipolar disorder in 2005, with a 2007 update. This second update, in conjunction with the International Society for Bipolar Disorders (ISBD), reviews new evidence and is designed to be used in conjunction with the previous publications. The recommendations for the management of acute mania remain mostly unchanged. Lithium, valproate, and several atypical antipsychotics continue to be first-line treatments for acute mania. Tamoxifen is now suggested as a third-line augmentation option. The combination of olanzapine and carbamazepine is not recommended. For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. New data support the use of adjunctive modafinil as a second-line option, but also indicate that aripiprazole should not be used as monotherapy for bipolar depression. Lithium, lamotrigine, valproate, and olanzapine continue to be first-line options for maintenance treatment of bipolar disorder. New data support the use of quetiapine monotherapy and adjunctive therapy for the prevention of manic and depressive events, aripiprazole monotherapy for the prevention of manic events, and risperidone long-acting injection monotherapy and adjunctive therapy, and adjunctive ziprasidone for the prevention of mood events. Bipolar II disorder is frequently overlooked in treatment guidelines, but has an important clinical impact on patients' lives. This update provides an expanded look at bipolar II disorder.

  14. Modeling bipolar disorder in mice by increasing acetylcholine or dopamine: Chronic lithium treats most, but not all features

    PubMed Central

    van Enkhuizen, Jordy; Milienne-Petiot, Morgane; Geyer, Mark A.; Young, Jared W.

    2015-01-01

    Rationale Bipolar disorder (BD) is a disabling and life-threatening disease characterized by states of depression and mania. New and efficacious treatments have not been forthcoming partly due to a lack of well-validated models representing both facets of BD. Objectives We hypothesized that cholinergic- and dopaminergic-pharmacological manipulations would model depression and mania respectively, each attenuated by lithium treatment. Methods C57BL/6J mice received the acetylcholinesterase inhibitor physostigmine or saline before testing for ‘behavioral despair’ (immobility) in the tail-suspension test (TST) and forced-swim test (FST). Physostigmine effects on exploration and sensorimotor gating were assessed using the cross-species behavioral pattern monitor (BPM) and prepulse inhibition (PPI) paradigms. Other C57BL/6J mice received chronic lithium drinking water (300, 600, or 1200 mg/l) before assessing their effects alone in the BPM or with physostigmine on FST performance. Another group was tested with acute GBR12909 (dopamine transporter inhibitor) and chronic lithium (1000 mg/l) in the BPM. Results Physostigmine (0.03 mg/kg) increased immobility in the TST and FST without affecting activity, exploration, or PPI. Lithium (600 mg/l) resulted in low therapeutic serum concentrations and normalized the physostigmine-increased immobility in the FST. GBR12909 induced mania-like behavior in the BPM of which hyper-exploration was attenuated, though not reversed, after chronic lithium (1000 mg/ml). Conclusions Increased cholinergic levels induced depression-like behavior and hyperdopaminergia induced mania-like behavior in mice, while chronic lithium treated some, but not all, facets of these effects. These data support a cholinergic-monoaminergic mechanism for modeling BD aspects and provide a way to assess novel therapeutics. PMID:26141192

  15. Family Functioning and Mood Disorders: A Comparison between Patients with Major Depressive Disorder and Bipolar I Disorder

    ERIC Educational Resources Information Center

    Weinstock, Lauren M.; Keitner, Gabor I.; Ryan, Christine E.; Solomon, David A.; Miller, Ivan W.

    2006-01-01

    Within a sample of patients with major depressive disorder (MDD; n = 121) and bipolar affective disorder (BPAD; n = 69), the authors examined (a) diagnostic differences in family functioning at acute episode, (b) diagnostic differences in family functioning at episode recovery, (c) within-group changes in family functioning from acute episode to…

  16. No association of Disrupted-in-Schizophrenia-1 variation with prefrontal function in patients with schizophrenia and bipolar disorder.

    PubMed

    Prata, D P; Mechelli, A; Picchioni, M; Fu, C H Y; Kane, F; Kalidindi, S; McDonald, C; Kravariti, E; Toulopoulou, T; Bramon, E; Walshe, M; Murray, R; Collier, D A; McGuire, P K

    2011-04-01

    The Disrupted-in-Schizophrenia-1 (DISC1) gene has been implicated in both schizophrenia and bipolar disorder by linkage and genetic association studies. Altered prefrontal cortical function is a pathophysiological feature of both disorders, and we have recently shown that variation in DISC1 modulates prefrontal activation in healthy volunteers. Our goal was to examine the influence of the DISC1 polymorphism Cys704Ser on prefrontal function in schizophrenia and bipolar disorder. From 2004 to 2008, patients with schizophrenia (N = 44), patients with bipolar disorder (N = 35) and healthy volunteers (N = 53) were studied using functional magnetic resonance imaging while performing a verbal fluency task. The effect of Cys704Ser on cortical activation was compared between groups as Cys704 carriers vs. Ser704 homozygotes. In contrast to the significant effect on prefrontal activation we had previously found in healthy subjects, no significant effect of Cys704Ser was detected in this or any other region in either the schizophrenia or bipolar groups. When controls were compared with patients with schizophrenia, there was a diagnosis by genotype interaction in the left middle/superior frontal gyrus [family-wise error (FWE) P = 0.002]. In this region, Ser704/ser704 controls activated more than Cys704 carriers, and there was a trend in the opposite direction in schizophrenia patients. In contrast to its effect in healthy subjects, variation in DISC1 Cys704Ser704 genotype was not associated with altered prefrontal activation in patients with schizophrenia or bipolar disorder. The absence of an effect in patients may reflect interactions of the effects of DISC1 genotype with the effects of other genes associated with these disorders, and/or with the effects of the disorders on brain function.

  17. Investigation of Heschl's Gyrus and Planum Temporale in Patients with Schizophrenia and Bipolar Disorder: a Proton Magnetic Resonance Spectroscopy Study

    PubMed Central

    Atagün, M.İ.; Şıkoğlu, E.M.; Can, S.S.; Karakaş-Uğurlu, G.; Ulusoy-Kaymak, S.; Çayköylü, A.; Algın, O.; Phillips, M.L.; Moore, C.M.; Öngür, D.

    2014-01-01

    Background Superior temporal cortices include brain regions dedicated to auditory processing and several lines of evidence suggest structural and functional abnormalities in both schizophrenia and bipolar disorder within this brain region. However, possible glutamatergic dysfunction within this region has not been investigated in adult patients. Methods Thirty patients with schizophrenia (38.67 ± 12.46 years of age), 28 euthymic patients with bipolar I disorder (35.32 ± 9.12 years of age), and 30 age-, gender- and education- matched healthy controls were enrolled. Proton Magnetic Resonance Spectroscopy data were acquired using a 3.0T Siemens MAGNETOM TIM Trio MR system and single voxel Point REsolved Spectroscopy Sequence (PRESS) in order to quantify brain metabolites within the left and right Heschl's Gyrus and Planum Temporale of superior temporal cortices. Results There were significant abnormalities in Glutamate (Glu) (F(2,78)=8.52, p<0.0001), n-Acetyl Aspartate (tNAA) (F(2,81)=5.73, p=0.005), Creatine (tCr) (F(2,83)=5.91, p=0.004) and Inositol (Ins) (F(2,82)=8.49, p<0.0001) concentrations in the left superior temporal cortex. In general, metabolite levels were lower for bipolar disorder patients when compared to healthy participants. Moreover, patients with bipolar disorder exhibited significantly lower tCr and Ins concentrations when compared to schizophrenia patients. In addition, we have found significant correlations between the superior temporal cortex metabolites and clinical measures. Conclusion As the left auditory cortices are associated with language and speech, left hemisphere specific abnormalities may have clinical significance. Our findings are suggestive of shared glutamatergic abnormalities in schizophrenia and bipolar disorder. PMID:25480359

  18. Psychosocial and neurocognitive profiles in depressed patients with major depressive disorder and bipolar disorder.

    PubMed

    Godard, Julie; Grondin, Simon; Baruch, Philippe; Lafleur, Martin F

    2011-12-30

    Previous studies have revealed psychosocial and cognitive impairments in patients during depression. The primary aim of this study was to investigate whether patients with major depression (MDD) and bipolar disorder (BD) differ in psychosocial and neurocognitive profiles. A second aim was to examine whether cognitive impairments are homogeneous among depressed patients. Patients with MDD (n=16) and BD (n=14) were enrolled during a major depressive episode. About half of them had comorbidities, including personality, substance use, and anxiety disorders. Information was collected about symptomatology and psychosocial functioning, whereas an exhaustive neuropsychological battery was administered to assess cognition. During a depressive episode, MDD and BD patients had global psychosocial dysfunction, characterized by occupational and relational impairments. A cognitive slowing was also observed, as well as deficits related to alertness, spontaneous flexibility, sustained and divided attention. Moreover, severity of depression and cognitive functions were significantly associated with psychosocial functioning. In the case of severe mood disorders, psychosocial and neurocognitive functioning seem similar among MDD and BD patients during a depressive episode. In addition to an altered daily functioning, the neurocognitive profile was heterogeneous with regard to the nature and extent of cognitive deficits. Executive functions, as well as verbal learning and memory, were preserved better than attentional processes.

  19. Carbamazepine in Bipolar Disorder With Pain: Reviewing Treatment Guidelines

    PubMed Central

    Campbell, Austin; O’Connell, Christopher R.; Nallapula, Kishan

    2014-01-01

    Objective: To determine if any monotherapy drug treatment has robust efficacy to treat comorbid bipolar disorder and chronic pain. Data Sources: The American Psychiatric Association (APA) treatment guidelines for bipolar mood disorder and the 2012 Cochrane database for pain disorders. Study Selection: We relied on the treatment guides to determine if the drugs that are APA guideline–supported to treat bipolar disorder have supporting data from the Cochrane database for chronic pain. Data Synthesis: No single drug was mentioned by either guideline to treat this comorbidity. However, carbamazepine was the only drug that has guideline-supported robust efficacy in the management of each condition separately. Conclusions: Carbamazepine was found to have strong preclinical data for the treatment of comorbid bipolar mood disorder and chronic pain disorders. While requiring more studies in this population, we propose that this treatment modality may benefit patients. PMID:25667814

  20. Clock genes associate with white matter integrity in depressed bipolar patients.

    PubMed

    Bollettini, Irene; Melloni, Elisa Maria Teresa; Aggio, Veronica; Poletti, Sara; Lorenzi, Cristina; Pirovano, Adele; Vai, Benedetta; Dallaspezia, Sara; Colombo, Cristina; Benedetti, Francesco

    2017-01-01

    Human genetic studies have implicated specific genes that constitute the molecular clock in the manifestation of bipolar disorder (BD). Among the clock genes involved in the control system of circadian rhythms, CLOCK 3111 T/C and Period3 (PER3) influence core psychopathological features of mood disorders, such as patterns of sleep, rest, and activity, diurnal preference, cognitive performances after sleep loss, age at the onset of the illness, and response to antidepressant treatment. Furthermore, several studies pointed out that bipolar symptomatology is associated with dysfunctions in white matter (WM) integrity, suggesting these structural alterations as a possible biomarker of the disorder. We hypothesise that CLOCK and PER3 polymorphisms could be potential factors affecting WM microstructure integrity in bipolar patients. The relationship between these clock genes and DTI measures of WM integrity in a sample of 140 (53 M; 87 F) patients affected by BD type I was studied. Tract-based spatial statistics analyses on DTI measures of WM integrity were performed for each clock gene polymorphism, between the genetic groups. We accounted for the effect of nuisance covariates known to influence WM microstructure: age, sex, lithium treatment, age at the onset of the illness, and the number of illness episodes. We found that compared to T homozygotes, CLOCK C carriers showed a widespread increase of the mean diffusivity in several WM tracts. Compared with PER3(5/5) homozygotes, PER3(4/4) homozygotes showed significantly increased radial diffusivity and reduced fractional anisotropy in several brain WM tracts. No significant difference was observed between heterozygotes and the other subgroups. Altogether, this pattern of results suggests WM disruption in CLOCK C carrier and in PER3(4) homozygotes. Sleep promotes myelination and oligodendrocyte precursor cell proliferation and associates with higher expression of genes coding for phospholipid synthesis and myelination in

  1. Influence of DGKH variants on amygdala volume in patients with bipolar affective disorder and schizophrenia.

    PubMed

    Kittel-Schneider, S; Wobrock, T; Scherk, H; Schneider-Axmann, T; Trost, S; Zilles, D; Wolf, C; Schmitt, A; Malchow, B; Hasan, A; Backens, M; Reith, W; Falkai, P; Gruber, O; Reif, A

    2015-03-01

    The diacylglycerol kinase eta (DGKH) gene, first identified in a genome-wide association study, is one of the few replicated risk genes of bipolar affective disorder (BD). Following initial positive studies, it not only was found to be associated with BD but also implicated in the etiology of other psychiatric disorders featuring affective symptoms, rendering DGKH a cross-disorder risk gene. However, the (patho-)physiological role of the encoded enzyme is still elusive. In the present study, we investigated primarily the influence of a risk haplotype on amygdala volume in patients suffering from schizophrenia or BD as well as healthy controls and four single nucleotide polymorphisms conveying risk. There was a significant association of the DGKH risk haplotype with increased amygdala volume in BD, but not in schizophrenia or healthy controls. These findings add to the notion of a role of DGKH in the pathogenesis of BD.

  2. Behavioral activation and inhibition system's role in predicting addictive behaviors of patients with bipolar disorder of Roozbeh Psychiatric Hospital

    PubMed Central

    Abbasi, Moslem; Sadeghi, Hasan; Pirani, Zabih; Vatandoust, Leyla

    2016-01-01

    Background: Nowadays, prevalence of addictive behaviors among bipolar patients is considered to be a serious health threat by the World Health Organization. The aim of this study is to investigate the role of behavioral activation and inhibition systems in predicting addictive behaviors of male patients with bipolar disorder at the Roozbeh Psychiatric Hospital. Materials and Methods: The research method used in this study is correlation. The study population consisted of 80 male patients with bipolar disorder referring to the psychiatrics clinics of Tehran city in 2014 who were referred to the Roozbeh Psychiatric Hospital. To collect data, the international and comprehensive inventory diagnostic interview, behavioral activation and inhibition systems scale, and addictive behaviors scale were used. Results: The results showed that there is a positive and significant relationship between behavioral activation systems and addictive behaviors (addictive eating, alcohol addiction, television addiction, cigarette addiction, mobile addiction, etc.). In addition, correlation between behavioral inhibition systems and addictive behaviors (addictive eating, alcohol addiction, TV addiction, cigarette addiction, mobile addiction) is significantly negative. Finally, regression analysis showed that behavioral activation and inhibition systems could significantly predict 47% of addictive behaviors in patients with bipolar disorder. Conclusions: It can be said that the patients with bipolar disorder use substance and addictive behaviors for enjoyment and as pleasure stimulants; they also use substances to suppress unpleasant stimulants and negative emotions. These results indicate that behavioral activation and inhibition systems have an important role in the incidence and exacerbation of addictive behaviors. Therefore, preventive interventions in this direction seem to be necessary. PMID:28194203

  3. Reduced prefrontal activation during performance of the Iowa Gambling Task in patients with bipolar disorder.

    PubMed

    Ono, Yasuki; Kikuchi, Mitsuru; Hirosawa, Tetsu; Hino, Shoryoku; Nagasawa, Tatsuya; Hashimoto, Takanori; Munesue, Toshio; Minabe, Yoshio

    2015-07-30

    The Iowa Gambling Task (IGT) is a complex decision-making task in which monetary wins and losses guide the development of strategies. The objective of this study was to evaluate hemodynamic responses of patients with bipolar disorder (BD) during performance of the IGT using near-infrared spectroscopy (NIRS). Participants comprised 13 patients and 15 healthy control subjects who were matched for age, sex, handedness, and intelligence quotient. Relative changes in oxygenated and deoxygenated hemoglobin (oxy-Hb and deoxy-Hb) levels in the frontal region were measured using a 46-channel NIRS system. All subjects were evaluated using NIRS during a verbal fluency task (VFT) and the IGT. During performance of the IGT, BD patients showed significantly decreased oxy-Hb levels in the bilateral orbitofrontal cortex (OFC) and left prefrontal cortex (PFC) compared with normal control subjects. However, during the VFT, patients with BD showed no significant changes in oxy-Hb levels compared with control subjects. Changes in oxy-Hb levels in the bilateral OFC and the PFC during the IGT were negatively correlated with total scores on the Hamilton Rating Scale for Depression (HAM-D). Although the IGT was useful for differentiating patients with BP from control subjects, no significant differences in autonomic activity were observed.

  4. The characteristics of sleep in patients with manifest bipolar disorder, subjects at high risk of developing the disease and healthy controls.

    PubMed

    Ritter, Philipp S; Marx, Carolin; Lewtschenko, Natalia; Pfeiffer, Steffi; Leopold, Karolina; Bauer, Michael; Pfennig, Andrea

    2012-10-01

    Sleep is highly altered during affective episodes in patients with bipolar disorder. There is accumulating evidence that sleep is also altered in euthymic states. A deficit in sleep regulation may be a vulnerability factor with aetiological relevance in the development of the disease. This study aims to explore the objective, subjective and lifetime sleep characteristics of patients with manifest bipolar disorder and persons with an elevated risk of developing the disease. Twenty-two patients with bipolar I and II disorder, nine persons with an elevated risk of developing the disorder and 28 healthy controls were evaluated with a structured interview to characterize subjective and lifetime sleeping habits. In addition, participants wore an actimeter for six nights. Patients with bipolar disorder had longer sleep latency and duration compared with healthy controls as determined by actigraphy. The subjective and lifetime sleep characteristics of bipolar patients differed significantly from healthy controls. The results of participants with an elevated risk of developing the disorder had subjective and lifetime characteristics that were largely analogous to those of patients with manifest bipolar disorder. In particular, both groups described recurring insomnia and hypersomnia, sensitivity to shifts in circadian rhythm, difficulties awakening and prolonged sleep latency. This study provides further evidence that sleep and circadian timing are profoundly altered in patients with bipolar disorder. It may also tentatively suggest that sleep may be altered prior to the first manic episode in subjects at high risk.

  5. Low neuropeptide Y in cerebrospinal fluid in bipolar patients is associated with previous and prospective suicide attempts.

    PubMed

    Sandberg, Johan V; Jakobsson, Joel; Pålsson, Erik; Landén, Mikael; Mathé, Aleksander A

    2014-12-01

    The attempted and accomplished suicide rates in patients with bipolar disorder are 40-50% and 15-20%, respectively. No biological markers that help predict suicide been identified. Human and experimental animal data indicate that dysregulation of the neuropeptide Y (NPY) system plays a role in depression, anxiety, and posttraumatic stress disorder (PTSD). The aim of this study was to explore if low cerebrospinal fluid (CSF) NPY is associated with (1) past suicide attempts, (2) future suicide attempts, and (3) trait anxiety. Lumbar puncture was performed on 120 clinically stable patients with bipolar disorder enrolled in the St Göran Bipolar Project, where the number of previous suicide attempts was documented. NPY-like immunoreactivity (NPY-LI) was determined in cerebrospinal fluid (CSF). Patients were reexamined one year after the lumbar puncture and suicide attempts were recorded. NPY-LI was significantly lower in patients with a history of suicide attempt than in patients who had not attempted suicide prior to lumbar puncture. Importantly, NPY-LI was markedly lower in patients who made a suicide attempt during the follow-up period compared to patients who did not. Patients who attempted suicide during the follow-up also had markedly lower NPY-LI than those with previous suicide attempts who did not reattempt. Our results suggest that low CSF NPY-LI predicts future suicide attempts. The data are in line with the hypothesis that NPY signaling is altered in affective disorders and states of emotional dysregulation.

  6. Suicidal ideation and depressive symptoms among bipolar patients as predictors of the health and well-being of caregivers

    PubMed Central

    Chessick, Cheryl A; Perlick, Deborah A; Miklowitz, David J; Dickinson, L Miriam; Allen, Michael H; Morris, Chad D; Gonzalez, Jodi M; Marangell, Lauren B; Cosgrove, Victoria; Ostacher, Michael

    2009-01-01

    Objectives Few studies have addressed the physical and mental health effects of caring for a family member with bipolar disorder. This study examined whether caregivers’ health is associated with changes in suicidal ideation and depressive symptoms among bipolar patients observed over one year. Methods Patients (N = 500) participating in the Systematic Treatment Enhancement Program for Bipolar Disorder and their primary caregivers (N = 500, including 188 parental and 182 spousal caregivers) were evaluated for up to one year as part of a naturalistic observational study. Caregivers’ perceptions of their own physical health were evaluated using the general health scale from the Medical Outcomes Study 36-item Short-Form Health Survey. Caregivers’ depression was evaluated using the Center for Epidemiological Studies of Depression Scale. Results Caregivers of patients who had increasing suicidal ideation over time reported worsening health over time compared to caregivers of patients whose suicidal ideation decreased or stayed the same. Caregivers of patients who had more suicidal ideation and depressive symptoms reported more depressed mood over a one-year reporting period than caregivers of patients with less suicidal ideation or depression. The pattern of findings was consistent across parent caregivers and spousal caregivers. Conclusions Caregivers, rightly concerned about patients becoming suicidal or depressed, may try to care for the patient at the expense of their own health and well-being. Treatments that focus on the health of caregivers must be developed and tested. PMID:19922556

  7. Risperidone long-acting injectable (Risperdal Consta®) for maintenance treatment in patients with bipolar disorder.

    PubMed

    Bobo, William V; Shelton, Richard C

    2010-11-01

    Poor adherence to pharmacotherapy during maintenance-phase treatment of bipolar disorder is a common occurrence, exposing patients to a high risk of illness relapses, rehospitalization and other negative outcomes. In view of this, there has been a reawakening of interest in the potential of long-acting injectable antipsychotic medications to improve treatment outcome during bipolar maintenance therapy. Indeed, long-acting injectable medications have practical advantages of assuring delivery of medication at a prescribed dose, and perhaps also making it easier to monitor adherence, at least to the long-acting drug. However, there are important limitations to the long-term use of depot typical neuroleptics in patients with bipolar disorder, including risk of extrapyramidal side effects and tardive dyskinesia, which may exceed that of patients with schizophrenia, and the potential for treatment-emergent exacerbation of depressive symptoms. Long-acting injectable risperidone (RLAI) has recently been approved for maintenance treatment in patients with bipolar I disorder. Evidence supporting the use of RLAI for this indication consists of several nonrandomized, open-label studies; one randomized, open-label trial; and two adequately powered randomized, double-blind trials. In general, these studies have shown RLAI to be effective for the prevention of relapse or hospitalization during bipolar maintenance treatment. In the double-blind studies, RLAI was associated with reduced relapse rates, increased time to relapse and greater control of clinical symptoms during maintenance treatment following initial stabilization, compared with oral medication treatment or placebo injection. RLAI appeared to be more effective for preventing manic/mixed episodes than depressive episodes. RLAI showed good tolerability across studies; however, dose-related extrapyramidal effects, sedation, weight gain and prolactin elevation may occur during long-term treatment. Responder

  8. Changes in absolute theta power in bipolar patients during a saccadic attention task.

    PubMed

    Cartier, Consuelo; Diniz, Claudia; Di Girogio, Luiza; Bittencourt, Juliana; Gongora, Mariana; Ken Tanaka, Guaraci; Teixeira, Silmar; Basile, Luis F; Novis, Fernanda; Angélica Silveira, Luciana; da Silva, Rafael de Assis; Cagy, Mauricio; Cheniaux, Elie; Ribeiro, Pedro; Velasques, Bruna

    2015-08-30

    The present study analyzed absolute theta power (ATP) in brain areas involved with attention in the three phase of BD while the patients performing a saccadic attention task. We hypothesized that patients in depression and mania states show a higher ATP compared to euthymic patients, since a higher ATP is indicative of attention deficit. We analyzed the frontal (F7, F3, Fz, F4 and F8) and central (C3, Cz and C4) areas. Thirty bipolar patients were enrolled in this study. The subjects performed a saccadic attention task while their brain activity pattern was recorded using quantitative electroencephalography (20 channels). Our results showed a main effect for group over C3, C4, Cz, F7, F4, F8 electrodes, and a main effect for moment over Cz, F7, F8 electrodes. These results indicate that both task and groups produce changes in theta activity in distinct cortical areas that participate in the organization of attention. Our results therefore demonstrate that, although it is well established in the literature that theta has a relevant role in the attention process, it is necessary to deepen the investigations to better understand the specifics of theta during visual processing tasks that have a demand for attention.

  9. Cognitive Performance and Cerebrospinal Fluid Biomarkers of Neurodegeneration: A Study of Patients with Bipolar Disorder and Healthy Controls

    PubMed Central

    Rolstad, Sindre; Jakobsson, Joel; Sellgren, Carl; Ekman, Carl-Johan; Blennow, Kaj; Zetterberg, Henrik; Pålsson, Erik; Landén, Mikael

    2015-01-01

    The purpose of the present study was to investigate if cerebrospinal fluid (CSF) biomarkers of neurodegeneration are associated with cognition in bipolar disorder and healthy controls, respectively. CSF concentrations of total and phosphorylated tau, amyloid beta (Aβ)1-42, ratios of Aβ42/40 and Aβ42/38, soluble amyloid precursor protein α and β, and neurofilament light chain protein were analyzed in relation to neuropsychological performance in 82 euthymic bipolar disorder patients and 71 healthy controls. Linear regression models were applied to account for performance in five cognitive domains using the CSF biomarkers. In patients, the CSF biomarkers explained a significant proportion of the variance (15–36%, p=.002 - <.0005) in all cognitive domains independently of age, medication, disease status, and bipolar subtype I or II. However, the CSF biomarkers specifically mirroring Alzheimer-type brain changes, i.e., P-tau and Aβ1-42, did not contribute significantly. In healthy controls, CSF biomarkers did not explain the variance in cognitive performance. Selected CSF biomarkers of neurodegenerative processes accounted for cognitive performance in persons with bipolar disorder, but not for healthy controls. Specifically, the ratios of Aβ42/40 and Aβ42/38 were consistently associated with altered cognitive performance. PMID:25954806

  10. Treatment options for children and adolescents with bipolar disorder.

    PubMed

    Findling, Robert L

    2009-09-01

    Bipolar disorder is an increasingly common diagnosis in children and adolescents. Although psychosocial interventions are important for these young patients, treatment guidelines presently focus on pharmacologic therapy in the acute treatment of pediatric bipolar I disorder. Placebo-controlled studies have been conducted with lithium, anticonvulsants, and atypical antipsychotics, but more research is needed, especially in areas other than acute manic and mixed episodes. Additional studies are needed to determine the safest and most effective agents for treating children and adolescents with bipolar disorder.

  11. Perceptions and impact of bipolar disorder in Japan: results of an Internet survey.

    PubMed

    Watanabe, Koichiro; Harada, Eiji; Inoue, Takeshi; Tanji, Yuka; Kikuchi, Toshiaki

    2016-01-01

    Bipolar disorder is a recurrent and episodic illness. This survey study assessed experiences and identified clinical insights of individuals with bipolar disorder. An Internet-based monitor system database was screened for patients with bipolar disorder in Japan (February and March 2013). Of 1,050 patients, 457 completed surveys, and results were analyzed with descriptive statistics. Approximately one-fourth of respondents were diagnosed with bipolar disorder on their first visit to medical institutions, although the most common initial diagnosis was depression/depressive state (65%). Mean time lag between first-time visit to a medical institution and receipt of correct diagnosis of bipolar disorder was 4 years; one-third of patients experienced more than 5 years of lag time. Three perceived reasons for lapsed time before correct diagnosis were "(patients) Did not consider manic symptoms as illness, and did not tell the doctor about them," "I (patient) did not know of bipolar disorder," and "Lack of communication between my doctor and myself (patient)." Among participants who believed that they were initially incorrectly diagnosed and improperly treated, most experienced socioeconomic problems, such as having long-term inability to work or to study (65%). Sources of encouragement for participants included "To have someone to consult with" (41%) followed by having "People around me treat me the same as before" (40%). Individuals with bipolar disorder reported a time lag of many years before accurate diagnosis, and substantial burden imposed by the illness. Encouragement should be provided for individuals to live positively with bipolar disorder.

  12. Behavioral Treatment of Insomnia in Bipolar Disorder

    PubMed Central

    Kaplan, Katherine A.; Harvey, Allison G.

    2014-01-01

    Sleep disturbance is common in bipolar disorder. Stimulus control and sleep restriction are powerful, clinically useful behavioral interventions for insomnia, typically delivered as part of cognitive-behavioral therapy for insomnia (CBT-I). Both involve short-term sleep deprivation. The potential for manic or hypomanic symptoms to emerge after sleep deprivation in bipolar disorder raises questions about the appropriateness of these methods for treating insomnia. In a series of patients with bipolar disorder who underwent behavioral treatment for insomnia, the authors found that regularizing bedtimes and rise times was often sufficient to bring about improvements in sleep. Two patients in a total group of 15 patients reported mild increases in hypomanic symptoms the week following instruction on stimulus control. Total sleep time did not change for these individuals. Two of five patients who underwent sleep restriction reported mild hypomania that was unrelated to weekly sleep duration. Sleep restriction and stimulus control appear to be safe and efficacious procedures for treating insomnia in patients with bipolar disorder. Practitioners should encourage regularity in bedtimes and rise times as a first step in treatment, and carefully monitor changes in mood and daytime sleepiness throughout the intervention. PMID:23820830

  13. Shape analysis of the cingulum, uncinate and arcuate fasciculi in patients with bipolar disorder

    PubMed Central

    Sun, Zhong Yi; Houenou, Josselin; Duclap, Delphine; Sarrazin, Samuel; Linke, Julia; Daban, Claire; Hamdani, Nora; d’Albis, Marc-Antoine; Le Corvoisier, Philippe; Guevara, Pamela; Delavest, Marine; Bellivier, Frank; Almeida, Jorge; Versace, Amelia; Poupon, Cyril; Leboyer, Marion; Phillips, Mary; Wessa, Michèle; Mangin, Jean-François

    2017-01-01

    Background Abnormal maturation of brain connectivity is supposed to underlie the dysfunctional emotion regulation in patients with bipolar disorder (BD). To test this hypothesis, white matter integrity is usually investigated using measures of water diffusivity provided by MRI. Here we consider a more intuitive aspect of the morphometry of the white matter tracts: the shape of the fibre bundles, which is associated with neurodevelopment. We analyzed the shape of 3 tracts involved in BD: the cingulum (CG), uncinate fasciculus (UF) and arcuate fasciculus (AF). Methods We analyzed diffusion MRI data in patients with BD and healthy controls. The fibre bundles were reconstructed using Q-ball–based tractography and automated segmentation. Using Isomap, a manifold learning method, the differences in the shape of the reconstructed bundles were visualized and quantified. Results We included 112 patients and 82 controls in our analysis. We found the left AF of patients to be further extended toward the temporal pole, forming a tighter hook than in controls. We found no significant difference in terms of shape for the left UF, the left CG or the 3 right fasciculi. However, in patients compared with controls, the ventrolateral branch of the left UF in the orbitofrontal region had a tendency to be larger, and the left CG of patients had a tendency to be smaller in the frontal lobe and larger in the parietal lobe. Limitations This was a cross-sectional study. Conclusion Our results suggest neurodevelopmental abnormalities in the left AF in patients with BD. The statistical tendencies observed for the left UF and left CG deserve further study. PMID:28234596

  14. Heredity in comorbid bipolar disorder and obsessive-compulsive disorder patients.

    PubMed

    Amerio, Andrea; Tonna, Matteo; Odone, Anna; Stubbs, Brendon; Ghaemi, S Nassir

    2015-10-01

    Partly due to the overlap of symptom groupings in DSM, psychiatric comorbidity is extremely common. One of the most common and difficult to manage comorbid conditions is the co-occurrence of bipolar disorder (BD) and obsessive compulsive disorder (OCD). However, the key nosological question about this condition - whether they are two distinct disorders or a subtype of one of the disorders - remains unresolved. In order to help address this unanswered question, we updated our recent systematic review, searching the electronic databases MEDLINE, Embase, and PsycINFO to specifically investigate the heredity in BD-OCD patients. We identified a total of 8 relevant papers, the majority of which found that, compared to non-BD-OCD patients, BD-OCD patients were more likely to have a family history for mood disorders and less likely to have a family history for OCD. These results support the view that the majority of cases of comorbid BD-OCD are, in fact, BD cases. If confirmed in larger, more focused studies, this conclusion would have important nosological and clinical implications.

  15. Abnormal high-energy phosphate molecule metabolism during regional brain activation in patients with bipolar disorder.

    PubMed

    Yuksel, C; Du, F; Ravichandran, C; Goldbach, J R; Thida, T; Lin, P; Dora, B; Gelda, J; O'Connor, L; Sehovic, S; Gruber, S; Ongur, D; Cohen, B M

    2015-09-01

    Converging evidence suggests bioenergetic abnormalities in bipolar disorder (BD). In the brain, phosphocreatine (PCr) acts a reservoir of high-energy phosphate (HEP) bonds, and creatine kinases (CK) catalyze the transfer of HEP from adenosine triphosphate (ATP) to PCr and from PCr back to ATP, at times of increased need. This study examined the activity of this mechanism in BD by measuring the levels of HEP molecules during a stimulus paradigm that increased local energy demand. Twenty-three patients diagnosed with BD-I and 22 healthy controls (HC) were included. Levels of phosphorus metabolites were measured at baseline and during visual stimulation in the occipital lobe using (31)P magnetic resonance spectroscopy at 4T. Changes in metabolite levels showed different patterns between the groups. During stimulation, HC had significant reductions in PCr but not in ATP, as expected. In contrast, BD patients had significant reductions in ATP but not in PCr. In addition, PCr/ATP ratio was lower at baseline in patients, and there was a higher change in this measure during stimulation. This pattern suggests a disease-related failure to replenish ATP from PCr through CK enzyme catalysis during tissue activation. Further studies measuring the CK flux in BD are required to confirm and extend this finding.

  16. Heredity in comorbid bipolar disorder and obsessive-compulsive disorder patients

    PubMed Central

    AMERIO, Andrea; TONNA, Matteo; ODONE, Anna; STUBBS, Brendon; GHAEMI, S. Nassir

    2015-01-01

    Summary Partly due to the overlap of symptom groupings in DSM, psychiatric comorbidity is extremely common. One of the most common and difficult to manage comorbid conditions is the co-occurrence of bipolar disorder (BD) and obsessive compulsive disorder (OCD). However, the key nosological question about this condition – whether they are two distinct disorders or a subtype of one of the disorders – remains unresolved. In order to help address this unanswered question, we updated our recent systematic review, searching the electronic databases MEDLINE, Embase, and PsycINFO to specifically investigate the heredity in BD-OCD patients. We identified a total of 8 relevant papers, the majority of which found that, compared to non-BD-OCD patients, BD-OCD patients were more likely to have a family history for mood disorders and less likely to have a family history for OCD. These results support the view that the majority of cases of comorbid BD-OCD are, in fact, BD cases. If confirmed in larger, more focused studies, this conclusion would have important nosological and clinical implications. PMID:26977128

  17. Relationships between pharmacokinetic parameters of carbamazepine and therapeutic response in patients with bipolar disease.

    PubMed

    Chbili, Chahra; Bannour, Souhail; Khlifi, Saida; Ben Hadj Ali, Bechir; Saguem, Saad

    2014-01-01

    This study aimed to assess the relationship between plasma levels of carbamazepine and its active metabolite 10,11-epoxide-carbamazepine, and the therapeutic response in patients with bipolar disease. Thirteen patients were kept on a fixed individual dose of carbamazepine for 19 weeks under psychiatric care. Steady-state plasma concentrations of carbamazepine and its metabolite 10,11-epoxide-carbamazepine were measured at weeks 4, 12, and 20 by HPLC essay. Simultaneously, the psychopathologic state was assessed using the Brief Psychiatric rating scale (BPRS). Upon correlational analysis, mean BPRS scores did not correlate with the plasma levels of carbamazepine, whereas both mean plasma levels of 10, 11-epoxide-carbamazepine concentrations and 10,11-epoxide-carbamazepine to plasma carbamazepine ratio were closely correlated with mean values of BPRS scores (r = 0.80, p =10(-4), r= -0.89, p =10(-3) respectively). Optimum therapeutic response was observed among patients who had a plasma metabolite level of 1.4 μg/mL and a plasma carbamazepine concentrations of 7 μg/mL simultaneously. These results suggest that both plasma carbamazepine and 10,11-epoxide-carbamazepine levels must be fixed to achieve optimum therapeutic response. In order to reach these conditions, inhibitor drugs (such as valproic acid) or inductor drugs (such as phenobarbital) of epoxyde-hydrolase might be coadministered with the carbamazepine in order to adapt the plasma level of 10,11-epoxide-carbamazepine.

  18. Systematic screening for mutations in the human serotonin 1F receptor gene in patients with bipolar affective disorder and schizophrenia

    SciTech Connect

    Shimron-Abarbanell, D.; Harms, H.; Erdmann, J.; Propping, P.; Noethen, M.M.

    1996-04-09

    Using single strand conformational analysis we screened the complete coding sequence of the serotonin 1F (5-HT{sub 1F}) receptor gene for the presence of DNA sequence variation in a sample of 137 unrelated individuals including 45 schizophrenic patients, 46 bipolar patients, as well as 46 healthy controls. We detected only three rare sequence variants which are characterized by single base pair substitutions, namely a silent T{r_arrow}A transversion in the third position of codon 261 (encoding isoleucine), a silent C{r_arrow}T transition in the third position of codon 176 (encoding histidine), and a C{r_arrow}T transition in position -78 upstream from the start codon. The lack of significant mutations in patients suffering from schizophrenia and bipolar affective disorder indicates that the 5-HT{sub 1F} receptor is not commonly involved in the etiology of these diseases. 12 refs., 1 fig., 2 tabs.

  19. [Pediatric bipolar disorder - case report of a bipolar patient with disease onset in childhood and adolescence: implications for diagnosis and therapy].

    PubMed

    Lackner, N; Birner, A; Bengesser, S A; Reininghaus, B; Kapfhammer, H P; Reininghaus, E

    2014-11-01

    In recent years, intense controversies have evolved about the existence and exact diagnostic criteria of pediatric bipolar affective disorder. The present study aims to discuss pediatric bipolar affective disorder based on the current literature focussing on the diagnostic prospects. Based on a case study, a process of bipolar disorder developed in childhood is depicted exemplarily. Because of the high comorbidity and overlapping symptoms of paediatric bipolar affective disorder and other psychiatric disorders, the major impact of the differential diagnosis has to be stressed. An early diagnosis and the treatment possibilities are discussed.

  20. The Effect of Group Psychoeducation Program on Medication Adherence in Patients with Bipolar Mood Disorders: a Randomized Controlled Trial

    PubMed Central

    Rahmani, Farnaz; Ebrahimi, Hossein; Ranjbar, Fatemeh; Razavi, Seyed Sajjad; Asghari, Elnaz

    2016-01-01

    Introduction: Medication nonadherence is highly prevalent in patients with bipolar disorders and often results in worsening disease prognosis. The purpose of this study was to investigate the effect of group psychoeducation on medication adherence in female patients with bipolar mood disorder type I. Methods: This randomized controlled trial was conducted on 76 patients with bipolar mood disorder admitted in female psychiatric wards of Razi teaching hospital, Tabriz, Iran. The participants were selected by convenience sampling method and were randomly assigned to experimental and control groups. Patients in experimental group received 10 continuous 90 minutes sessions of psychoeducation, two times a week. Medication adherence was measured using the medicine check list and medication adherence rating scale (MARS) before and after intervention. Data analysis was performed with SPSS ver.13. Results: There was no significant difference between two groups regarding medication adherence before the intervention. After the study intervention, the mean scores of medication adherence check list and medication adherence rating scale in the experimental group were significantly higher than the control group. Conclusion: Since group psychoeducation was effective in improving patients' medication adherence, it could be recommended for psychiatric nurses to apply this intervention in the clinical setting. PMID:28032073

  1. Do patients with bipolar disorder and subsyndromal symptoms benefit from functional remediation? A 12-month follow-up study.

    PubMed

    Sanchez-Moreno, Jose; Bonnín, Caterina; González-Pinto, Ana; Amann, Benedikt L; Solé, Brisa; Balanzá-Martínez, Vicent; Arango, Celso; Jimenez, Esther; Tabarés-Seisdedos, Rafael; Garcia-Portilla, M Paz; Ibáñez, Angela; Crespo, Jose Manuel; Ayuso-Mateos, Jose Luis; Vieta, Eduard; Martinez-Aran, Anabel; Torrent, Carla

    2017-01-23

    We analyzed the efficacy of functional remediation, in a sample of patients with bipolar disorder who presented with subsyndromal symptoms. From a total sample of 239 patients with bipolar I and II disorder, according to DSM-IV-TR diagnostic criteria, entering a randomized clinical trial, those patients who presented with subsyndromal symptoms were selected based on a method already described by Berk and colleagues was applied. It consists of using the Clinical Global Impression-Bipolar version (CGI-BP) to establish the scores of the Hamilton Depression Rating Scale (HAM-D) and of the Young Mania Rating Scale (YMRS) that correspond with 1 in the CGI-BP. Functional outcome and mood symptoms were assessed at 6 and at 12-month follow-up. A total of 99 patients were selected for this post-hoc analysis, allocated as follows: functional remediation (n=33); psychoeducation (n=37) and treatment as usual (TAU,n=29). The repeated-measures analyses at 12-month follow-up revealed a significant group x time interaction in favour of the patients who received functional remediation when compared to psychoeducation and TAU (F=2.93; p=0.02) at improving psychosocial functioning. Finally, mood symptoms did not significantly change in any of the three groups at any time of follow-up, as shown by the non-significant group x time interaction effect in HAM-D scores (F=1.57; p=0.18) and YMRS scores (F=1.51; p=0.20). Bipolar patients with subsyndromal symptoms improve their functional outcome when exposed to functional remediation regardless of the persistence of mood symptomatology.

  2. Efficacy and safety of olanzapine for treatment of patients with bipolar depression: Chinese subpopulation analysis of a double-blind, randomized, placebo-controlled study

    PubMed Central

    Wang, Gang; Cheng, Yan; Wang, Jia Ning; Wu, Sheng Hu; Xue, Hai Bo

    2016-01-01

    Background Depression in bipolar I disorder responds to the atypical antipsychotic olanzapine. This subpopulation analysis assessed whether olanzapine is superior to placebo specifically in the treatment of Chinese patients with bipolar I depression. Methods This was a subpopulation analysis of a 6-week, multicenter, double-blind, parallel, randomized, placebo-controlled trial among 12 Chinese study centers. Eligible inpatients and outpatients were randomized to olanzapine (5 to 20 mg/day) or placebo. Patients were primarily assessed by the Montgomery-Åsberg Depression Rating Scale total score. Secondary assessments used a range of other efficacy and safety measures. This subpopulation analysis was underpowered to show statistically significant differences between treatment groups. Results In total, 210 patients (mean age 32.9 years at baseline, 54.3% females) were random-ized. Similar proportions of patients treated with olanzapine (75.0%) and placebo (72.9%) completed the double-blind phase. Baseline-to-endpoint least-squares mean ± standard error decrease in the Montgomery-Åsberg Depression Rating Scale total score in the olanzapine group (−13.55±0.80) was similar to that noted in the parent trial (−13.82±0.65). However, the difference between olanzapine and placebo groups was not statistically significant (P=0.44); this finding was also true for the secondary efficacy measures. A post hoc analysis showed a greater emergence of mania in the placebo group, which likely reduced the treatment difference between olanzapine and placebo in the primary efficacy measure. Safety data were consistent with the known safety profile of olanzapine, including a higher incidence of weight gain (≥7%) in the olanzapine group (24.1% vs 1.4%, P<0.001). Conclusion Olanzapine provides similar improvement in depression among Chinese and non-Chinese bipolar I patients. The lack of a statistically significant difference between the olanzapine and placebo groups in this

  3. A limit cycle oscillator model for cycling mood variations of bipolar disorder patients derived from cellular biochemical reaction equations

    NASA Astrophysics Data System (ADS)

    Frank, T. D.

    2013-08-01

    We derive a nonlinear limit cycle model for oscillatory mood variations as observed in patients with cycling bipolar disorder. To this end, we consider two signaling pathways leading to the activation of two enzymes that play a key role for cellular and neural processes. We model pathway cross-talk in terms of an inhibitory impact of the first pathway on the second and an excitatory impact of the second on the first. The model also involves a negative feedback loop (inhibitory self-regulation) for the first pathway and a positive feedback loop (excitatory self-regulation) for the second pathway. We demonstrate that due to the cross-talk the biochemical dynamics is described by an oscillator equation. Under disease-free conditions the oscillatory system exhibits a stable fixed point. The breakdown of the self-inhibition of the first pathway at higher concentration levels is studied by means of a scalar control parameter ξ, where ξ equal to zero refers to intact self-inhibition at all concentration levels. Under certain conditions, stable limit cycle solutions emerge at critical parameter values of ξ larger than zero. These oscillations mimic pathological cycling mood variations that emerge due to a disease-induced bifurcation. Consequently, our modeling analysis supports the notion of bipolar disorder as a dynamical disease. In addition, our study establishes a connection between mechanistic biochemical modeling of bipolar disorder and phenomenological nonlinear oscillator approaches to bipolar disorder suggested in the literature.

  4. Influence of family history of major depression, bipolar disorder, and suicide on clinical features in patients with major depression and bipolar disorder.

    PubMed

    Serretti, Alessandro; Chiesa, Alberto; Calati, Raffaella; Linotte, Sylvie; Sentissi, Othman; Papageorgiou, Konstantinos; Kasper, Siegfried; Zohar, Joseph; De Ronchi, Diana; Mendlewicz, Julien; Amital, Daniela; Montgomery, Stuart; Souery, Daniel

    2013-03-01

    The extent to which a family history of mood disorders and suicide could impact on clinical features of patients suffering from major depression (MD) and bipolar disorder (BD) has received relatively little attention so far. The aim of the present work is, therefore, to assess the clinical implications of the presence of at least one first- and/or second-degree relative with a history of MD, BD and suicide in a large sample of patients with MD or BD. One thousand one hundred and fifty-seven subjects with MD and 686 subjects with BD were recruited within the context of two large projects. The impact of a family history of MD, BD, and suicide-considered both separately and together-on clinical and socio-demographic variables was investigated. A family history of MD, BD, and suicide was more common in BD patients than in MD patients. A positive family history of mood disorders and/or suicide as well as a positive family history of MD and BD separately considered, but not a positive history of suicide alone, were significantly associated with a comorbidity with several anxiety disorders and inversely associated with age of onset. The clinical implications as well as the limitations of our findings are discussed.

  5. Bipolar Disorder

    MedlinePlus

    Bipolar disorder Overview By Mayo Clinic Staff Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows ( ...

  6. Bipolar Disorder

    MedlinePlus

    Bipolar disorder is a serious mental illness. People who have it go through unusual mood changes. They go ... The down feeling is depression. The causes of bipolar disorder aren't always clear. It runs in families. ...

  7. Altered expressions of apoptotic factors and synaptic markers in postmortem brain from bipolar disorder patients

    PubMed Central

    Kim, Hyung-Wook; Rapoport, Stanley I; Rao, Jagadeesh S

    2009-01-01

    Bipolar disorder (BD) is a progressive psychiatric disorder characterized by recurrent changes of mood, and is associated with cognitive decline. There is evidence of excitotoxicity, neuroinflammation, upregulated arachidonic acid (AA) cascade signaling and brain atrophy in BD patients. These observations suggest that BD pathology may be associated with apoptosis as well as with disturbed synaptic function. To test this hypothesis, we measured mRNA and protein levels of the pro-apoptotic (Bax, BAD, Caspase-9 and Caspase-3) and anti-apoptotic factors (BDNF and Bcl-2), and of pre- and post-synaptic markers (synaptophysin and drebrin), in postmortem brain from 10 BD patients and 10 age-matched controls. Consistent with the hypothesis, BD brains showed significant increases in protein and mRNA levels of the pro-apoptotic factors and significant decreases of levels of the anti-apoptotic factors and the synaptic markers, synaptophysin and drebrin. These differences may contribute to brain atrophy and progressive cognitive changes in BD. PMID:19945534

  8. Differential expression of exosomal microRNAs in prefrontal cortices of schizophrenia and bipolar disorder patients.

    PubMed

    Banigan, Meredith G; Kao, Patricia F; Kozubek, James A; Winslow, Ashley R; Medina, Juan; Costa, Joan; Schmitt, Andrea; Schneider, Anja; Cabral, Howard; Cagsal-Getkin, Ozge; Vanderburg, Charles R; Delalle, Ivana

    2013-01-01

    Exosomes are cellular secretory vesicles containing microRNAs (miRNAs). Once secreted, exosomes are able to attach to recipient cells and release miRNAs potentially modulating the function of the recipient cell. We hypothesized that exosomal miRNA expression in brains of patients diagnosed with schizophrenia (SZ) and bipolar disorder (BD) might differ from controls, reflecting either disease-specific or common aberrations in SZ and BD patients. The sources of the analyzed samples included McLean 66 Cohort Collection (Harvard Brain Tissue Resource Center), BrainNet Europe II (BNE, a consortium of 18 brain banks across Europe) and Boston Medical Center (BMC). Exosomal miRNAs from frozen postmortem prefrontal cortices with well-preserved RNA were isolated and submitted to profiling by Luminex FLEXMAP 3D microfluidic device. Multiple statistical analyses of microarray data suggested that certain exosomal miRNAs were differentially expressed in SZ and BD subjects in comparison to controls. RT-PCR validation confirmed that two miRNAs, miR-497 in SZ samples and miR-29c in BD samples, have significantly increased expression when compared to control samples. These results warrant future studies to evaluate the potential of exosome-derived miRNAs to serve as biomarkers of SZ and BD.

  9. Coping strategies used by poorly adherent patients for self-managing bipolar disorder

    PubMed Central

    Blixen, Carol; Levin, Jennifer B; Cassidy, Kristin A; Perzynski, Adam T; Sajatovic, Martha

    2016-01-01

    Background Bipolar disorder (BD) is a chronic mental illness associated with reduced quality of life, high rates of suicide, and high financial costs. Evidence indicates that psychosocial stress might play an important role in the onset and course of BD. Objective The objective of this study was to address the gap between coping theory and the clinical use of coping strategies used to self-manage BD. Methods In-depth interviews were conducted with a sample of 21 poorly adherent patients with BD. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes. Results Transcript-based analysis generated two major domains of coping strategies used to self-manage BD: 1) problem focused (altering eating habits, managing mood-stabilizing medications, keeping psychiatric appointments, seeking knowledge, self-monitoring, and socializing) and 2) emotion focused (distracting activities, denial, isolation, modifying/avoiding, helping others, and seeking social support). Participants used both types of coping strategies to deal with stressful situations brought about by the internal and external demands associated with self-management of BD. Conclusion This qualitative study provided a first step in evaluating coping strategies as a possible mediator in the self-management of BD and has implications for health care providers. Being able to characterize an individual’s coping behaviors can help patients modify or replace more maladaptive coping with better coping strategies in the self-management of this chronic mental illness. PMID:27524888

  10. Fatty acid composition of the postmortem prefrontal cortex of patients with schizophrenia, bipolar disorder, and major depressive disorder.

    PubMed

    Hamazaki, Kei; Maekawa, Motoko; Toyota, Tomoko; Dean, Brian; Hamazaki, Tomohito; Yoshikawa, Takeo

    2015-06-30

    Postmortem brain studies have shown abnormal levels of n-3 polyunsaturated fatty acids (PUFAs), especially docosahexaenoic acid, in the frontal cortex (particularly the orbitofrontal cortex) of patients with depression, schizophrenia, or bipolar disorder. However, the results from regions in the frontal cortex other than the orbitofrontal cortex are inconsistent. In this study we investigated whether patients with schizophrenia, bipolar disorder, or major depressive disorder have abnormalities in PUFA levels in the prefrontal cortex [Brodmann area (BA) 8]. In postmortem studies, fatty acids in the phospholipids of the prefrontal cortex (BA8) were evaluated by thin layer chromatography and gas chromatography. Specimens were evaluated for patients with schizophrenia (n=15), bipolar disorder (n=15), or major depressive disorder (n=15) and compared with unaffected controls (n=15). In contrast to previous studies, we found no significant differences in the levels of PUFAs or other fatty acids in the prefrontal cortex (BA8) between patients and controls. Subanalysis by sex also showed no significant differences. No significant differences were found in any individual fatty acids between suicide and non-suicide cases. These psychiatric disorders might be characterized by very specific fatty acid compositions in certain areas of the brain, and BA8 might not be involved in abnormalities of PUFA metabolism.

  11. Genes involved in pruning and inflammation are enriched in a large mega-sample of patients affected by Schizophrenia and Bipolar Disorder and controls.

    PubMed

    Calabrò, Marco; Marco, Calabrò; Drago, Antonio; Antonio, Drago; Sidoti, Antonina; Antonina, Sidoti; Serretti, Alessandro; Alessandro, Serretti; Crisafulli, Concetta; Concetta, Crisafulli

    2015-08-30

    A molecular pathway analysis has been performed in order to complement previous genetic investigations on Schizophrenia. 4486 Schizophrenic patients and 4477 controls served as the investigation sample. 3521 Bipolar patients and 3195 controls served as replication sample. A molecular pathway associated with the neuronal pruning activity was found to be enriched in subjects with Schizophrenia compared to controls. HLA-C and HLA-DRA had more SNPs associated with both Schizophrenia and Bipolar Disorder than expected by chance.

  12. Evaluation of Oxidative Status in Patients Treated with Electroconvulsive Therapy

    PubMed Central

    Şenyurt, Mahmut; Aybek, Hulya; Herken, Hasan; Kaptanoglu, Bunyamin; Korkmaz, Ali

    2017-01-01

    Objective Electroconvulsive therapy (ECT) is used in the treatment of many psychiatric diseases and this therapy may be effective on antioxidant defence system. In this study, we aimed to evaluate the effects of ECT on oxidative stress. Methods Fourteen major depression, 11 schizophrenia and 8 bipolar affective disorder patients diagnosed and received ECT treatment, and 37 healthy volunteers enrolled in the study. ECT was applied to all patients. Before ECT, after the first and last ECTs, serum samples were obtained. Serum total antioxidant status (TAS), total oxidant status (TOS), and calculated oxidative stress index (OSI) were measured in patients before and after ECTs. Results TOS values before ECT were higher in major depression (p=0.005) and schizophrenia (p=0.001) groups compared to the control group. TAS values were lower in major depression (p=0.0001), schizophrenia (p=0.004), bipolar affective disorder (p=0.004) groups compared to the controls. Also OSI values were higher in major depression (p=0.0001), schizophrenia (p=0.001), bipolar affective disorder (p=0.009) groups compared to healthy group. After the last ECT, TOS values were significantly lower compared to TOS values before ECT in major depression (p=0.004) and schizophrenia patients (p=0.004). TAS values after the first ECT were higher compared to values before ECT in major depression patients (p=0.004). After last ECT, OSI values were significantly lower compared to before ECT in schizophrenia patients (p=0.006). Conclusion As a result, it can be said that ECT did not increase oxidative stress. However, further studies with more patients are needed. PMID:28138109

  13. Compliance with maintenance treatment in bipolar disorder.

    PubMed

    Keck, P E; McElroy, S L; Strakowski, S M; Bourne, M L; West, S A

    1997-01-01

    Studies of compliance with pharmacologic treatment in patients with bipolar disorder have primarily involved outpatients receiving lithium. To date, very little data addresses the rates of noncompliance in patients with bipolar disorder treated with other available mood stabilizers (e.g. divalproex, carbamazepine). One hundred and forty patients initially hospitalized for a bipolar disorder, manic or mixed episode, were evaluated prospectively over 1 year to assess their compliance with pharmacotherapy. Compliance was assessed by a clinician-administered questionnaire, using information from the patient, treaters, and significant others. Seventy-one patients (51%) were partially or totally noncompliant with pharmacologic treatment during the 1-year followup period. Noncompliance was significantly associated with the presence of a comorbid substance use disorder. Denial of need was the most common reason cited for noncompliance. Compliance was associated with being male and Caucasian and with treatment with combined lithium and divalproex or with this combination and an antipsychotic. Noncompliance with pharmacotherapy remains a substantial problem in the treatment of patients with bipolar disorder.

  14. Altered Cortico-Striatal Connectivity in Offspring of Schizophrenia Patients Relative to Offspring of Bipolar Patients and Controls

    PubMed Central

    Solé-Padullés, Cristina; Castro-Fornieles, Josefina; de la Serna, Elena; Romero, Soledad; Calvo, Anna; Sánchez-Gistau, Vanessa; Padrós-Fornieles, Marta; Baeza, Inmaculada; Bargalló, Núria; Frangou, Sophia; Sugranyes, Gisela

    2016-01-01

    Schizophrenia (SZ) and bipolar disorder (BD) share clinical features, genetic risk factors and neuroimaging abnormalities. There is evidence of disrupted connectivity in resting state networks in patients with SZ and BD and their unaffected relatives. Resting state networks are known to undergo reorganization during youth coinciding with the period of increased incidence for both disorders. We therefore focused on characterizing resting state network connectivity in youth at familial risk for SZ or BD to identify alterations arising during this period. We measured resting-state functional connectivity in a sample of 106 youth, aged 7–19 years, comprising offspring of patients with SZ (N = 27), offspring of patients with BD (N = 39) and offspring of community control parents (N = 40). We used Independent Component Analysis to assess functional connectivity within the default mode, executive control, salience and basal ganglia networks and define their relationship to grey matter volume, clinical and cognitive measures. There was no difference in connectivity within any of the networks examined between offspring of patients with BD and offspring of community controls. In contrast, offspring of patients with SZ showed reduced connectivity within the left basal ganglia network compared to control offspring, and they showed a positive correlation between connectivity in this network and grey matter volume in the left caudate. Our findings suggest that dysconnectivity in the basal ganglia network is a robust correlate of familial risk for SZ and can be detected during childhood and adolescence. PMID:26885824

  15. Mechanisms underlying the benefits of anticonvulsants over lithium in the treatment of bipolar disorder.

    PubMed

    Corrado, Alisa C; Walsh, John P

    2016-02-10

    Close to 3% of the world's population suffers from bipolar disease (I and II). Of this 3%, bipolar disease affects largely women (∼ 3 : 2 compared with men). The median age of diagnosis is 25 in women and even lower in men. A diagnosis of bipolar disease is an expensive psychiatric diagnosis, costing patients more than twice as much money as a diagnosis of unipolar depression. Bipolar I is characterized by one or more manic or mixed episodes, with both mania and depression occurring each day for at least 1 week, whereas bipolar II is characterized by one or more major depressive episode and at least one episode of hypomania. Bipolar I is the more severe diagnosis. A wide range of medications are available to help patients maintain a healthy lifestyle, including lithium, antidepressants, and anticonvulsants. Improved methods for identifying bipolar disease, including a more structured approach and a more complete use of medical records, have increased the rate of diagnosis, especially in children, which underscores the need for innovation in development and in practice of new treatment options for treating bipolar disease. Although lithium has been the 'gold standard' for treating bipolar disorder for decades, new research into other forms of treatment has shown anticonvulsants to be a particularly useful therapy for treating bipolar disease. Anticonvulsants have remarkable mood-stabilization abilities and they do not lead to serious side effects, which increases the tolerability, and consequently, patient adherence to this form of treatment. Recent studies have shown that anticonvulsants improve behavior in bipolar disease by modulating the balance of excitatory and inhibitory synapses through a number of complementary molecular cascades that affect gene expression and cell survival.

  16. Health-care needs of remitted patients with bipolar disorder: A comparison with schizophrenia

    PubMed Central

    Neogi, Rajarshi; Chakrabarti, Subho; Grover, Sandeep

    2016-01-01

    AIM To investigate health-care needs and their correlates among patients with remitted bipolar disorder (BD) compared to patients with remitted schizophrenia. METHODS Outpatients with BD (n = 150) and schizophrenia (n = 75) meeting clearly defined remission criteria were included in the study along with their relatives. Diagnostic ascertainment was carried out using the Mini International Neuropsychiatric Interview. Demographic and clinical details were recorded using structured formats. Residual symptoms were assessed using standardized scales. Health-care needs were assessed on two separate scales. The principal instrument employed to assess health-care needs was the Camberwell Assessment of Need-Research version (CAN-R). To further evaluate health-care needs we felt that an additional instrument, which was more relevant for Indian patients and treatment-settings and designed to cover those areas of needs not specifically covered by the CAN-R was required. This instrument with a structure and scoring pattern similar to the CAN-R was used for additional evaluation of needs. Patients’ level of functioning was assessed using the Global Assessment of Functioning Scale and their quality of life (QOL) using the World Health Organization Quality Of Life-BREF version in Hindi. RESULTS An average of 6-7 needs was reported by patients with BD as well as their relatives. Commonly reported needs were in the areas of economic and welfare needs, informational needs, social needs and the need for treatment. According to the CAN-R, both patients and relatives reported that more than 60% of the total needs were being met. However, over 90% of the needs covered by the additional evaluation were unmet according to patients and relatives. Needs in the areas of economic and welfare-benefits, information, company, daytime activities and physical health-care were largely unmet according to patients and relatives. Total, met and unmet needs were significantly higher for schizophrenia

  17. N-acetyl cysteine restores brain glutathione loss in combined 2-cyclohexene-1-one and d-amphetamine-treated rats: relevance to schizophrenia and bipolar disorder.

    PubMed

    Dean, Olivia M; van den Buuse, Maarten; Berk, Michael; Copolov, David L; Mavros, Christine; Bush, Ashley I

    2011-07-25

    Oxidative stress and reduced brain levels of glutathione have been implicated in schizophrenia and bipolar disorder. N-acetyl cysteine (NAC) is a precursor of glutathione and has additional effects on glutamate neurotransmission, neurogenesis and inflammation. While NAC treatment has shown benefits in both schizophrenia and bipolar disorder, the mechanisms of action are largely unknown. Similarly, the interaction between oxidative stress and altered dopaminergic activities in psychiatric illness is not yet characterized. This study investigated the capacity of NAC in restoring brain glutathione depletion in rats that received 2-cyclohexene-1-one (CHX, 75 mg/kg), d-amphetamine (2.5mg/kg) or both. CHX, but not amphetamine, induced significant depletion of glutathione levels in the striatum and frontal cortex. Glutathione depletion was reversed by NAC (1000 mg/kg) in saline-treated and amphetamine-treated (frontal cortex only) rats. While NAC was shown to be beneficial in this model, the lack of additional glutathione depletion by amphetamine in combination with CHX does not support a summative interaction between oxidative stress and altered dopamine transmission.

  18. Bipolar Disorder, Bipolar Depression and Comorbid Illness.

    PubMed

    Manning, J Sloan

    2015-06-01

    There is a substantial need for the early recognition and treatment of the psychiatric and medical comorbidities of bipolar disorder in primary care. If comorbid conditions are recognized and treated, serious adverse health outcomes may be averted, including substantial morbidity and mortality.

  19. The Relationship between Cognitive Decline and Psychopathology in Patients with Schizophrenia and Bipolar Disorder

    PubMed Central

    Kim, Moon-Doo; Seo, Hye-Jin; Yun, Hyunju; Jung, Young-Eun; Park, Joon Hyuk; Lee, Chang-In; Moon, Ji Hyun; Hong, Seong-Chul; Yoon, Bo-Hyun; Bahk, Won-Myong

    2015-01-01

    Objective The primary goals of the present study were to assess intellectual function in participants with schizophrenia or bipolar disorder (BD) and to investigate the relationships between cognitive decline and the severity of each type of psychopathology. Methods The present study included 51 patients with schizophrenia and 42 with BD who were recruited from the psychiatry outpatient clinic of Jeju University Hospital between March 2011 and March 2014. The Korean Wechsler Adult Intelligence Scale (K-WAIS) was administered to each of the 93 participants, and they were categorized into two groups based on their current intelligence quotient (IQ) and their estimated premorbid IQ: severely impaired group (SIG) and mildly impaired group (MIG). The Minnesota Multiple Personality Inventory (MMPI) and the Brief Psychiatric Rating Scale (BPRS) were used to assess psychopathology. Results The SIG schizophrenia participants exhibited significantly higher scores on the frequent (F) and schizophrenia (Sc) subscales of the MMPI, but significantly lower scores on the correction (K) and psychopathic deviate (Pd) subscales compared with the MIG schizophrenia participants. Furthermore, the BPRS scores were significantly higher in the SIG schizophrenia participants relative to the MIG schizophrenia participants. The SIG BD participants had significantly higher F, masculinity-femininity (Mf), paranoia (Pa), and Sc but significantly lower Pd scores compared with the MIG BD participants. Conclusion The present findings revealed a significant discrepancy between the estimated premorbid levels of cognitive function and current cognitive function in participants with schizophrenia or BD. Moreover, this discrepancy was correlated with severity of psychopathology in both groups. PMID:25912543

  20. Delays before Diagnosis and Initiation of Treatment in Patients Presenting to Mental Health Services with Bipolar Disorder

    PubMed Central

    Patel, Rashmi; Shetty, Hitesh; Jackson, Richard; Broadbent, Matthew; Stewart, Robert; Boydell, Jane; McGuire, Philip; Taylor, Matthew

    2015-01-01

    underlying symptoms and offer appropriate treatment sooner in order to facilitate improved clinical outcomes, such as developing specialist early intervention services to identify and treat people with bipolar disorder. PMID:25992560

  1. Correlations between objective and subjective sleep and circadian markers in remitted patients with bipolar disorder.

    PubMed

    Boudebesse, Carole; Geoffroy, Pierre Alexis; Bellivier, Frank; Henry, Chantal; Folkard, Simon; Leboyer, Marion; Etain, Bruno

    2014-06-01

    Bipolar disorder (BD) is a chronic psychiatric condition characterized by recurrences of depressive and (hypo)manic episodes. Patients in remission report a wide range of sleep and circadian disturbances that correlate with several outcomes measures such as functioning or physical health. The most appropriate way to measure these abnormalities in clinical practice requires further investigation since the external validity of self-reports, as compared to more physiological measures (such as polysomnography or actigraphy), has been questioned. Despite the fact that questionnaires are inexpensive, fast and easy to use, they need to be validated against objective measures. This study aims to validate three sleep and circadian questionnaires, namely the Pittsburgh Sleep Quality Index (PSQI), the Composite Scale of Morningness (CSM) and the Circadian Type Inventory (CTI) - against actigraphy in BD patients in remission. Twenty-six carefully assessed BD patients in remission completed the PSQI, the CTI and the CSM, and wore an actigraph (AW7, Camntech) for 21 consecutive days. Phase preference assessed by the CSM strongly correlated with actigraphic phase markers (M10 onset ρ = -0.69 and L5 onset ρ = -0.63). Sleep duration and sleep latency assessed by the PSQI and by actigraphy were also highly correlated (ρ = -0.76; ρ = 0.50). Moderate correlation coefficients were observed between questionnaires and actigraphy for markers that explored the stability of rhythms, sleep quality, sleep latency and sleep disturbances (|ρ| > 0.40) although these were not significant after correcting for multiple testing. No correlation was observed between markers for the amplitude of rhythms. While the external validity of the CTI clearly requires further investigation, this study supported the external validity of the CSM and the PSQI for phase preference, sleep duration and latency. We conclude that the CSM and the PSQI could be useful in routine practice and

  2. ADHD comorbidity can matter when assessing cortical thickness abnormalities in patients with bipolar disorder

    PubMed Central

    Hegarty, Catherine E; Foland-Ross, Lara C; Narr, Katherine L; Sugar, Catherine A; McGough, James J; Thompson, Paul M; Altshuler, Lori L

    2012-01-01

    Objectives Attention-deficit hyperactivity disorder (ADHD) is prevalent in patients with bipolar disorder (BP), but very few studies consider this when interpreting magnetic resonance imaging findings. No studies, to our knowledge, have screened for or controlled for the presence of ADHD when examining cortical thickness in patients with BP. We used a 2 × 2 design to evaluate the joint effects of BP and ADHD on cortical thickness and uncover the importance of ADHD comorbidity in BP subjects. Methods The study included 85 subjects: 31 healthy controls, 17 BP-only, 19 ADHD-only, and 18 BP/ADHD. All patients with BP were subtype I, were euthymic, and were not taking lithium. Groups did not differ significantly in age or sex distribution. We used cortical thickness measuring tools combined with cortical pattern matching methods to align sulcal/gyral anatomy across participants. Significance maps were used to check for both main effects of BP and ADHD and their interaction. Post-hoc comparisons assessed how the effects of BP on cortical thickness varied as a function of the presence or absence of ADHD. Results Interactions of BP and ADHD diagnoses were found in the left subgenual cingulate and right orbitofrontal cortex, demonstrating that the effect of BP on cortical thickness depends on ADHD status. Conclusions Some brain abnormalities attributed to BP may result from the presence of ADHD. Diagnostic interactions were found in regions previously implicated in the pathophysiology of BP, making it vital to control for an ADHD comorbid diagnosis when attempting to isolate neural or genetic abnormalities specific to BP. PMID:23167934

  3. [Bone protection in corticosteroid treated patients].

    PubMed

    Savoldi, Silvana; Giacchino, Franca; Rollino, Cristiana; Manganaro, Marco; Besso, Luca; Izzo, Cristina; Gianoglio, Bruno; Amore, Alessandro; Fenoglio, Roberta; Stratta, Piero

    2015-01-01

    The Piedmont Group of Clinical Nephrology compared the activity of 15 nephrology centers in Piedmont and Aosta Valley as regards bone protection in patients on corticosteroids therapy. Fracture prevalence shows great variability: in 4/15 centers (27%) no fractures were found, in 6/15 centers (40%) fractures were present in 1-4% of cases, in 1 center in 18% of patients. Clinical risk of fracture was based on sex, age and postmenopausal status in 11/14 of the centers (79%), history of fractures and bone disease in 4/14 centers (27%), smoking and alcohol consumption in 3 and 2 centers respectively, glucocorticoid dose and duration in 4, in children bone age and calcium phosphorus status. Dual energy X-ray absorptiometry was performed in 12 centers based on risk factors, in 8 (57%) DXA was performed during the follow-up, in 4 it was performed after 12 months and in 2 after 2-3 years. DXA is not prescribed in children. Only in one center, risk assessment is based on FRAX. Most of the patients are treated with vitamin D supplementation at a dose of steroids of 5 mg/d (80%). Calcium carbonate is used in 9 centers (60%), in two it is used only in the presence of low ionized calcium or bone mineral density. Bisphosphonates are used following AIFA prescription, in particular alendronate in all centers, risedronate in seven and denosumab in one. The analysis shows the great variability of the clinical and therapeutic approach regarding bone protection in patients on corticosteroids therapy, in Piedmont and Aosta Valley.

  4. Treatment-adherence in bipolar disorder: A patient-centred approach

    PubMed Central

    Chakrabarti, Subho

    2016-01-01

    About half of the patients diagnosed with bipolar disorder (BD) become non-adherent during long-term treatment, a rate largely similar to other chronic illnesses and one that has remained unchanged over the years. Non-adherence in BD is a complex phenomenon determined by a multitude of influences. However, there is considerable uncertainty about the key determinants of non-adherence in BD. Initial research on non-adherence in BD mostly limited itself to examining demographic, clinical and medication-related factors impacting adherence. However, because of inconsistent results and failure of these studies to address the complexities of adherence behaviour, demographic and illness-related factors were alone unable to explain or predict non-adherence in BD. This prompted a shift to a more patient-centred approach of viewing non-adherence. The central element of this approach includes an emphasis on patients’ decisions regarding their own treatment based on their personal beliefs, life circumstances and their perceptions of benefits and disadvantages of treatment. Patients’ decision-making processes are influenced by the nature of their relationship with clinicians and the health-care system and by people in their immediate environment. The primacy of the patient’s perspective on non-adherence is in keeping with the current theoretical models and concordance-based approaches to adherence behaviour in BD. Research over the past two decades has further endorsed the critical role of patients’ attitudes and beliefs regarding medications, the importance of a collaborative treatment-alliance, the influence of the family, and the significance of other patient-related factors such as knowledge, stigma, patient satisfaction and access to treatment in determining non-adherence in BD. Though simply moving from an illness-centred to a patient-centred approach is unlikely to solve the problem of non-adherence in BD, such an approach is more likely to lead to a better

  5. Acute renal failure induced by markedly decreased appetite secondary to a depressive episode after discontinuation of long-term lithium therapy in an elderly patient with bipolar disorder.

    PubMed

    Okada, Akira

    2014-05-16

    Some elderly patients on chronic lithium therapy for bipolar disorder and their doctors may be faced with a therapeutic dilemma over whether or not to continue prescribing/taking lithium given their increased risk of reduced renal function. We present the case of a 78-year-old woman with bipolar disorder who discontinued lithium therapy due to increased risk factors for renal injury. After discontinuation, she experienced markedly decreased appetite secondary to a depressive episode, and developed acute renal failure, which subsequently progressed to a more advanced stage of chronic kidney disease. This case suggests that extreme care must be taken to prevent the recurrence of depression in elderly patients with bipolar disorder who discontinue lithium therapy, even when they had been emotionally stable for a long time while receiving lithium. Medications other than lithium for bipolar disorder may be needed at the time lithium therapy is discontinued.

  6. Effects of Omega-3 Supplement in the Treatment of Patients with Bipolar I Disorder

    PubMed Central

    Shakeri, Jalal; Khanegi, Maryam; Golshani, Sanobar; Farnia, Vahid; Tatari, Faeze; Alikhani, Mostafa; Nooripour, Roghih; Ghezelbash, Mohammad Saeed

    2016-01-01

    Background: Fatty acids play various physiological roles in the organism; they are crucial for the structure of cell membranes, metabolic processes, transmission of nerve impulses and brain functions. In recent years, particular attention has been paid to the rich sources of omega-3 for the treatment of many diseases, especially mental illnesses. The present study aimed to investigate the effects of omega-3 supplement in the treatment of patients with bipolar I disorder (BID). Methods: In this double-blind clinical trial, 100 patients suffering from BIDs were randomly divided into two, i.e. control (n = 50) and experimental (n = 50) groups. In addition to the other standard treatments, 1000 mg of omega-3 supplement was given to the experimental group on daily basis for 3 months and placebo was given to the control group. The Young Mania Rating Scale was completed for both groups before and after the intervention. Afterward, data were analyzed using paired t-test, independent t-test, and Chi-square test. Results: Before intervention, mean severity of mania in the experimental group (23.50 ± 7.02) and control group (23.70 ± 8.09) was not significant (P ≤ 0.89). The difference after the intervention in the experimental group (10.64 ± 3.3) and control group (20.12 ± 6.78) was significant (P < 0.01). The mean intensity of mania before (23.50 ± 7.02) and after (10.64 ± 3.3) intervention reported to be significant at P < 0.05. Conclusions: Since omega-3 supplement was effective for the treatment of BID, it is suggested to use omega-3 supplements as an adjuvant therapy along with the other pharmacotherapies. PMID:27280013

  7. Treatment response in relation to subthreshold bipolarity in patients with major depressive disorder receiving antidepressant monotherapy: a post hoc data analysis (KOMDD study)

    PubMed Central

    Park, Young-Min; Lee, Bun-Hee

    2016-01-01

    Background The aim of this observational study was to determine whether subthreshold bipolarity affects treatment response and remission in patients with major depressive disorder receiving antidepressant (AD) monotherapy over a 6-month follow-up period. Methods Seventy-eight patients with major depressive disorder were stratified into two subgroups according to the presence of subthreshold bipolarity, identified using the Korean version of the Mood Disorder Questionnaire (K-MDQ), which classifies patients as positive for a screening of bipolarity based on the cutoff for the total K-MDQ score (ie, 7 points). They received AD monotherapy such as escitalopram, sertraline, paroxetine, or tianeptine for 6 months. The Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Scale, and Beck Scale for Suicide Ideation were applied at baseline, 1 week, 3 weeks, 2 months, 3 months, and 6 months. Results The mean HAMD, BDI, and Beck Scale for Suicide Ideation scores were higher in the bipolarity group than in the nonbipolarity group at 3 weeks. The mean BDI score was also higher in the bipolarity group than in the nonbipolarity group at 6 months. Evaluation of the ratio of improvement for each scale revealed different patterns of percentage changes between the two groups over the 6-month follow-up period. Furthermore, the response and remission rates (as assessed using BDI and HAMD scores) were higher in the nonbipolarity group than in the bipolarity group, with the exception of HAMD scores at the 3-week follow-up time point. Conclusion The findings of this study showed that depressed patients with bipolarity had a worse response to AD monotherapy than did those without bipolarity. PMID:27274258

  8. Long-term management strategies to achieve optimal function in patients with bipolar disorder.

    PubMed

    Keck, Paul E

    2006-01-01

    Functional impairment is a problem for people with bipolar disorder. Predictors of poor functional outcome are psychiatric and medical comorbidity, interepisode subsyndromal symptoms, psychosis during a manic or mixed episode, and low premorbid functioning. Cognitive dysfunction may also be a contributory factor in functional impairment. Several psychosocial interventions designed for people with bipolar disorder have demonstrated success in improving syndromal outcomes, but the effects of psychosocial interventions on functioning and cognition have not been examined. Among pharmacologic interventions available for long-term treatment of bipolar disorder, there is a strong clinical trend away from monotherapy and toward combination therapy. Lithium, lamotrigine, olanzapine, and aripiprazole have all shown substantial improvements in relapse rates compared with placebo. Although some of these medications show superior results compared with the others in preventing the recurrence of either depressive or manic episodes, only anecdotal evidence exists regarding their effect on cognition. Combination therapy with antipsychotics or antidepressants has also been shown to produce better syndromal outcomes in people with bipolar disorder, but inadequate evidence is available on cognitive outcomes. Substantial information is needed regarding the prevalence and causes of cognitive dysfunction in bipolar disorder, the effects of existing treatments on cognition, and long-term treatments to improve cognition and functioning.

  9. Factors associated with work, social life and family life disability in bipolar disorder patients.

    PubMed

    Gutiérrez-Rojas, Luis; Jurado, Dolores; Gurpegui, Manuel

    2011-04-30

    We analyzed the presence of work, social life and family life disability in 108 outpatients with a Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) diagnosis of bipolar disorder and their association with previous course-of-illness variables and current psychopathology. Work disability was pragmatically defined as being on a disability pension or in the process of obtaining it; social life or family life disability was defined by a score ≥ 7 in the respective subscales of the Sheehan Disability Scale. At least one type of disability (for work, social life or family life) affected 52-54% of the patients; and two types, 37%. By logistic regression and multiple linear regression analyses we determined the variables independently associated with each type of disability: 1) Work disability was significantly associated with previous repeated manic episodes, three or more hospitalizations, with current depressive symptoms and inversely with the educational attainment. 2) Social life disability significantly increased with the number of hospitalizations and was associated with previous repeated depressive episodes and current depressive symptoms. In alternative models, nicotine dependence and lack of social support were significantly associated with work and social life disability respectively. And 3) family life disability significantly increased with number of hospitalizations, CAGE questionnaire score and age; and was associated with previous repeated manic episodes and current depressive symptoms. In conclusion, previous course-of-illness variables, particularly a high number of manic episodes, and current psychopathology - as indicated by the presence of nicotine dependence or depressive symptoms - may be indicators of disability; previous manic episodes appear to affect disability at work or at family life whereas previous depressive episodes seem to be related with social life disability.

  10. Elucidating semantic disorganisation from a word comprehension task: do patients with schizophrenia and bipolar disorder show differential processing of nouns, verbs and adjectives?

    PubMed

    Rossell, Susan L; Batty, Rachel A

    2008-07-01

    Memory deficits have been reported in schizophrenia and bipolar disorder. However, the precise impact of semantic memory deficits on word comprehension, particularly across grammatical categories, has not been adequately investigated in these disorders. Furthermore, previous studies examining semantic memory have predominantly been designed so that most healthy controls perform at ceiling, questioning the validity of observed differences between patient and control groups. A new word definition task examined word comprehension across grammatical categories, i.e. nouns, verbs and adjectives, and was designed to overcome the ceiling effect. It was administered to 32 schizophrenia patients, 28 bipolar disorder patients and 32 matched healthy controls. Schizophrenia patients had a global impairment on the task but bipolar patients were only impaired on a recognition memory component. Word comprehension, however, across grammatical categories was comparable across groups.

  11. The addition of STEPPS in the treatment of patients with bipolar disorder and comorbid borderline personality features: a protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Bipolar disorder (BD) and borderline personality disorder (BPD) both are severe and chronic psychiatric disorders. Both disorders have overlapping symptoms, and current research shows that the presence of a BPD has an adverse effect on the course of BD. The limited research available shows an unfavorable illness course, a worse prognosis and response to medication, longer treatment duration, more frequent psychiatric admissions, higher drop-out, increased risk of substance abuse, increased risk of suicide, and more impairment of social and occupational functioning. However, there is no research available on the effect of specific psychotherapeutic treatment for this patients. Methods/Design This paper presents the protocol of a RCT to investigate the presence of borderline personality features in patients treated for BD (study part 1) and the effectiveness of STEPPS (Systems Training for Emotional Predictability and Problem Solving) added to treatment as usual (TAU) for BD compared to TAU in patients with BD and comorbid borderline personality features (study part 2). STEPPS is a validated and effective intervention for BPD. The study population consists of patients treated for BD at specialized outpatient clinics for BD in the Netherlands. At first the prevalence of comorbid borderline personality features in outpatients with BD is investigated. Inclusion criteria for study part 2 is defined as having three or more of the DSM-IV-TR diagnostic criteria of BPD, including impulsivity and anger bursts. Primary outcomes will be the frequency and severity of manic and depressive recurrences as well as severity, course and burden of borderline personality features. Secondary outcomes will be quality of life, utilizing mental healthcare and psychopathologic symptoms not primarily related to BD or BPD. Assessment will be at baseline, at the end of the intervention, and at 12 and 18 months follow-up. Discussion This will be the first randomized controlled trial

  12. Selective DNA methylation of BDNF promoter in bipolar disorder: differences among patients with BDI and BDII.

    PubMed

    D'Addario, Claudio; Dell'Osso, Bernardo; Palazzo, Maria Carlotta; Benatti, Beatrice; Lietti, Licia; Cattaneo, Elisabetta; Galimberti, Daniela; Fenoglio, Chiara; Cortini, Francesca; Scarpini, Elio; Arosio, Beatrice; Di Francesco, Andrea; Di Benedetto, Manuela; Romualdi, Patrizia; Candeletti, Sanzio; Mari, Daniela; Bergamaschini, Luigi; Bresolin, Nereo; Maccarrone, Mauro; Altamura, A Carlo

    2012-06-01

    The etiology of bipolar disorder (BD) is still poorly understood, involving genetic and epigenetic mechanisms as well as environmental contributions. This study aimed to investigate the degree of DNA methylation at the promoter region of the brain-derived neurotrophic factor (BDNF) gene, as one of the candidate genes associated with major psychoses, in peripheral blood mononuclear cells isolated from 94 patients with BD (BD I=49, BD II=45) and 52 healthy controls. A significant BDNF gene expression downregulation was observed in BD II 0.53±0.11%; P<0.05), but not in BD I (1.13±0.19%) patients compared with controls (CONT: 1±0.2%). Consistently, an hypermethylation of the BDNF promoter region was specifically found in BD II patients (CONT: 24.0±2.1%; BDI: 20.4±1.7%; BDII: 33.3±3.5%, P<0.05). Of note, higher levels of DNA methylation were observed in BD subjects on pharmacological treatment with mood stabilizers plus antidepressants (34.6±4.2%, predominantly BD II) compared with those exclusively on mood-stabilizing agents (21.7±1.8%; P<0.01, predominantly BD I). Moreover, among the different pharmacological therapies, lithium (20.1±3.8%, P<0.05) and valproate (23.6±2.9%, P<0.05) were associated with a significant reduction of DNA methylation compared with other drugs (35.6±4.6%). Present findings suggest selective changes in DNA methylation of BDNF promoter in subjects with BD type II and highlight the importance of epigenetic factors in mediating the onset and/or susceptibility to BD, providing new insight into the mechanisms of gene expression. Moreover, they shed light on possible mechanisms of action of mood-stabilizing compounds vs antidepressants in the treatment of BD, pointing out that BDNF regulation might be a key target for their effects.

  13. Catechol O-methyltransferase and monoamine oxidase A genotypes, and plasma catecholamine metabolites in bipolar and schizophrenic patients.

    PubMed

    Zumárraga, Mercedes; Dávila, Ricardo; Basterreche, Nieves; Arrue, Aurora; Goienetxea, Biotza; Zamalloa, María I; Erkoreka, Leire; Bustamante, Sonia; Inchausti, Lucía; González-Torres, Miguel A; Guimón, José

    2010-01-01

    Metabolites of dopamine and norepinephrine measured in the plasma have long been associated with symptomatic severity and response to treatment in schizophrenic, bipolar and other psychiatric patients. Plasma concentrations of catecholamine metabolites are genetically regulated. The genes encoding enzymes that are involved in the synthesis and degradation of these monoamines are candidate targets for this genetic regulation. We have studied the relationship between the Val158Met polymorphism in catechol O-methyltransferase gene, variable tandem repeat polymorphisms in the monoamine oxidase A gene promoter, and plasma concentrations of 3-methoxy-4-hydroxyphenylglycol, 3,4-dihydroxyphenylacetic acid and homovanillic acid in healthy control subjects as well as in untreated schizophrenic and bipolar patients. We found that the Val158Met substitution in catechol O-methyltransferase gene influences the plasma concentrations of homovanillic and 3,4-dihydroxyphenylacetic acids. Although higher concentrations of plasma homovanillic acid were found in the high-activity ValVal genotype, this mutation did not affect the plasma concentration of 3-methoxy-4-hydroxyphenylglycol. 3,4-dihydroxyphenylacetic acid concentrations were higher in the low-activity MetMet genotype. Interestingly, plasma values 3-methoxy-4-hydroxyphenylglycol were greater in schizophrenic patients and in bipolar patients than in healthy controls. Our results are compatible with the previously reported effect of the Val158Met polymorphism on catechol O-methyltransferase enzymatic activity. Thus, our results suggest that this polymorphism, alone or associated with other polymorphisms, could have an important role in the genetic control of monoamine concentration and its metabolites.

  14. Anticonvulsant Drugs for Nerve Pain, Bipolar Disorder and Fibromyalgia

    MedlinePlus

    Anticonvulsant Drugs for Nerve Pain, Bipolar Disorder &Fibromyalgia: Choosing What’sRight for You What are anticonvulsant drugs? Anticonvulsants are drugs used to treat seizures. They are also used to treat bipolar ...

  15. Functional brain organization in bipolar affective patients during manic phase and after recovery: a digit dichotic listening study.

    PubMed

    Kaprinis, G; Nimatoudis, J; Karavatos, A; Kandylis, D; Kaprinis, S

    1995-06-01

    To study the functional organization of the cerebral hemispheres in patients with bipolar psychosis using a verbal dichotic listening test for pairs of digits 26 patients were tested twice, during the acute expression of manic phase and after recovery. The patient group during the manic phase did not support the expected right-ear advantage of normal subjects on verbal dichotic tests but showed a statistically significant left-ear advantage, which shifted after recovery toward the typical normal asymmetry. Comparing patients during the manic phase and after recovery showed that the left-ear advantage as well as the shift in right-ear advantage after recovery was due to the reduction of left-ear performance. From the over-all neuropsychological findings for these patients mania may be hypothesized to be characterized by overactivation of the right hemisphere. This phaenomenon seems associated with acuteness of the symptoms of the psychotic disorder.

  16. Facial Emotion Processing in Acutely Ill and Euthymic Patients with Pediatric Bipolar Disorder

    ERIC Educational Resources Information Center

    Schenkel, Lindsay S.; Pavuluri, Mani N.; Herbener, Ellen S.; Harral, Erin M.; Sweeney, John A.

    2007-01-01

    Objective: Past investigations indicate facial emotion-processing abnormalities in pediatric bipolar disorder (PBD) subjects. However, the extent to which these deficits represent state- and trait-related factors is unclear. We investigated facial affect processing in acutely ill and clinically stabilized children with PBD and matched healthy…

  17. Attitudes towards bipolar disorder and predictive genetic testing among patients and providers.

    PubMed Central

    Smith, L B; Sapers, B; Reus, V I; Freimer, N B

    1996-01-01

    Attitudes about bipolar disorder (manic depressive disorder) and genetic testing were investigated. Three groups of subjects were surveyed including members of a manic depressive support group, medical students, and psychiatry residents. The questionnaire was intended to elicit impressions and attitudes about bipolar disorder (BP) from mental health consumers and health care providers with varying levels of personal and professional familiarity with the disorder. Attitudes towards prenatal testing and pregnancy termination were also assessed. The intention hypothetically to terminate a pregnancy was influenced by the likelihood of developing BP a well as the projected course and severity of illness. Nearly half of the total sample would terminate pregnancy if the fetus were definitely to develop an unspecified form of bipolar disorder. Presumed severity of illness was also found to be a modifying factor in the decision, with a low percentage of subjects electing to terminate for a mild course of bipolar disorder and a majority opting for termination in the case of an extremely severe presentation. Support group members were the least likely to terminate a hypothetical pregnancy in the case of a positive prenatal test and were the most likely to desire childhood testing in the absence of preventive or treatment options. The possible implications of these findings, as well as avenues of future research, are discussed. PMID:8818938

  18. An Integrated Risk Reduction Intervention can reduce body mass index in individuals being treated for bipolar I disorder: results from a randomized trial

    PubMed Central

    Frank, Ellen; Wallace, Meredith L; Hall, Martica; Hasler, Brant; Levenson, Jessica C; Janney, Carol A; Soreca, Isabella; Fleming, Matthew C; Buttenfield, Joan; Ritchey, Fiona C; Kupfer, David J

    2014-01-01

    Objectives We conducted a randomized, controlled trial comparing the efficacy of an Integrated Risk Reduction Intervention (IRRI) to a control condition with the objective of improving mood stability and psychosocial functioning by reducing cardiometabolic risk factors in overweight/obese patients with bipolar I disorder. Methods A total of 122 patients were recruited from our outpatient services and randomly allocated to IRRI (n = 61) or psychiatric care with medical monitoring (n = 61). Individuals allocated to IRRI received psychiatric treatment and assessment, medical monitoring by a nurse, and a healthy lifestyle program from a lifestyle coach. Those allocated to the control condition received psychiatric treatment and assessment and referral, if indicated, for medical problems. A mixed-effects model was used to examine the impact of the interventions on body mass index (BMI). Exploratory moderator analyses were used to characterize those individuals likely to benefit from each treatment approach. Results Analyses were conducted on the IRRI (n = 58) and control (n = 56) participants with ≥ 1 study visit. IRRI was associated with significantly greater rate of decrease in BMI (d = −0.51, 95% confidence interval: −0.91 to −0.14). Three variables (C-reactive protein, total cholesterol, and instability of total sleep time) contributed to a combined moderator of faster decrease in BMI with IRRI treatment. Conclusions Overweight/obese patients with bipolar disorder can make modest improvements in BMI, even when taking medications with known potential for weight gain. Our finding that a combination of three baseline variables provides a profile of patients likely to benefit from IRRI will need to be tested further to evaluate its utility in clinical practice. PMID:25495748

  19. Altered intrinsic functional connectivity in language-related brain regions in association with verbal memory performance in euthymic bipolar patients.

    PubMed

    Reinke, Britta; Ven, Vincent van de; Matura, Silke; Linden, David E J; Oertel-Knöchel, Viola

    2013-09-12

    Potential abnormalities in the structure and function of the temporal lobes have been studied much less in bipolar disorder than in schizophrenia. This may not be justified because language-related symptoms, such as pressured speech and flight of ideas, and cognitive deficits in the domain of verbal memory are amongst the hallmark of bipolar disorder (BD), and contribution of temporal lobe dysfunction is therefore likely. In the current study, we examined resting-state functional connectivity (FC) between the auditory cortex (Heschl's gyrus [HG], planum temporale [PT]) and whole brain using seed correlation analysis in n = 21 BD euthymic patients and n = 20 matched healthy controls and associated it with verbal memory performance. In comparison to controls BD patients showed decreased functional connectivity between Heschl's gyrus and planum temporale and the left superior and middle temporal gyrus. Additionally, fronto-temporal functional connectivity with the right inferior frontal/precentral gyrus and the insula was increased in patients. Verbal episodic memory deficits in the investigated sample of BD patients and language-related symptoms might therefore be associated with a diminished FC within the auditory/temporal gyrus and a compensatory fronto-temporal pathway.

  20. Bipolar Disorder.

    ERIC Educational Resources Information Center

    Spearing, Melissa

    Bipolar disorder, a brain disorder that causes unusual shifts in a person's mood, affects approximately one percent of the population. It commonly occurs in late adolescence and is often unrecognized. The diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and when possible, family history. Thoughts of suicide are…

  1. Bipolar disorder in general practice: challenges and opportunities.

    PubMed

    Piterman, Leon; Jones, Kay M; Castle, David J

    2010-08-16

    General practitioners are involved in the continuing care and shared care of patients with chronic mental illness, including bipolar disorder. Psychiatrists are particularly reliant on GPs to monitor and treat comorbidities as well as the psychiatric condition itself. Management of chronic mental illness is compromised by a number of factors, including problems with diagnosis, physical comorbidity, erratic attendance and poor compliance with treatment. Diagnosis of bipolar disorder is often delayed, and differential diagnoses to be considered include unipolar depression, anxiety disorder, drug and alcohol dependence, personality disorder, attention deficit hyperactivity disorder, and general medical and central nervous system diseases. New Medicare items have been introduced under the Better Access to Mental Health Care initiative. However, uptake for patients with chronic psychiatric illness, including bipolar disorder, is low. Patients with bipolar disorder may be prone to a range of comorbid psychological, social and physical problems, and GPs need to be vigilant to detect and manage comorbidity and social problems as part of the overall plan. This includes assistance with certification for sickness and unemployment benefits. GPs may become involved during crises affecting patients and this may pose significant problems for GPs who need to provide ongoing care following patient discharge from hospital. Despite these difficulties, opportunities exist for GPs to play a vital and ongoing role in the management of patients with bipolar disorder.

  2. Treatment of Bipolar Disorder in the University Student Population

    ERIC Educational Resources Information Center

    Federman, Russ

    2011-01-01

    University counseling centers are faced with the challenge of effectively treating bipolar students while also utilizing brief treatment frameworks and managing high patient volumes. Potential destabilization, particularly within the elevated mood phase, poses significant behavioral management issues for university clinicians and administrators,…

  3. Cariprazine for Schizophrenia and Bipolar Disorder

    PubMed Central

    2016-01-01

    Schizophrenia and bipolar disorder are associated with significant morbidity and mortality. Although atypical antipsychotics reduce positive and negative symptoms of schizophrenia as well as manic or mixed episodes of bipolar disorder, they are associated with varying degrees of metabolic adverse effects. This necessitates continued development of efficacious yet metabolically favorable treatments. Cariprazine was recently approved to treat adult patients with schizophrenia and manic or mixed episodes. It was well-tolerated and adverse reactions included akathisia, extrapyramidal symptoms, nausea, or constipation. Cariprazine is taken once daily without regard to food. The dose should be adjusted in patients who receive CYP450 inhibitors, and it should not be given to patients with severe hepatic or renal disease. This article reviews mechanisms of action, efficacy, tolerability (including adverse effects), dosing, and contraindications of cariprazine. PMID:27975000

  4. Complementary medicines in pediatric bipolar disorder.

    PubMed

    Bogarapu, S; Bishop, J R; Krueger, C D; Pavuluri, M N

    2008-02-01

    The increasing number and availability of various complementary and alternative medicines (CAM) has resulted in an exponentially growing utilization of these products for everything from minor aches and pains to the treatment of mental illness. Difficulties in treating mental illnesses in children, averseness to having children take psychiatric medications, and stigma all drive patients and their families to research alternative treatments. As a result, there has been an increased utilization of CAM in psychiatry, particularly for hard to treat conditions like pediatric BD. It is important for the health care providers to be aware of the alternative treatments by some of their patients. A review of studies investigating the utility of complementary and alternative medicines in bipolar patients was conducted and selected studies were included. Omega-3 fatty acids and lecithin/ choline have preliminary data indicating potential utility in the CAM treatment for bipolar disorder while S-adenosyl methionine (SAM-e) and inositol have some data supporting their efficacy in the treatment of depressive symptoms. Some data for CAM suggest they may be useful adjunctive treatments but only little data are available to support their use as stand-alone therapy. Thus, the conventional medicines remain the first choice in pediatric bipolar management. Healthcare providers need to routinely inquire about the utilization of these treatments by their patients and become familiar with the risks and benefits involved with their use in children.

  5. Thalidomide in Treating Patients With Myelodysplastic Syndrome

    ClinicalTrials.gov

    2013-01-23

    Chronic Myelomonocytic Leukemia; de Novo Myelodysplastic Syndromes; Previously Treated Myelodysplastic Syndromes; Refractory Anemia; Refractory Anemia With Excess Blasts; Refractory Anemia With Excess Blasts in Transformation; Refractory Anemia With Ringed Sideroblasts; Secondary Myelodysplastic Syndromes

  6. Prolactin-secreting pituitary adenoma in neuroleptic treated patients with psychotic disorder.

    PubMed

    Melkersson, K; Hulting, A L

    2000-01-01

    Three patients with psychoses and concomitant prolactin-secreting pituitary tumours are described. Patients A and B had bipolar and schizoaffective disorders, respectively. They had both been treated with neuroleptics for 20 years before the prolactinomas were revealed. Patient C developed a paranoid psychosis after two years of continuous bromocriptine treatment for a pituitary tumour. In patient A the prolactin level was successfully normalized and a good antipsychotic effect was maintained by combined therapy with haloperidol and quinagolide but not bromocriptine. In patient B the prolactinoma was removed by surgery, in view of the serious nature of the psychotic disorder, to avoid psychotic relapse by treatment with a dopamine agonist. In patient C a good result was obtained with the combination of clozapine and bromocriptine. These case reports support the view that neuroleptics being dopamine antagonists and dopamine agonistic agents which are the primary treatment of prolactinomas can cancel out each other's effects. The combination of clozapine and quinagolide is recommended as the treatment of choice for most patients.

  7. Demographic and clinical characteristics associated with comorbid cannabis use disorders (CUDs) in hospitalized patients with bipolar I disorder

    PubMed Central

    Weinstock, Lauren M.; Gaudiano, Brandon A.; Wenze, Susan J.; Epstein-Lubow, Gary; Miller, Ivan W.

    2015-01-01

    Background Published data suggest that cannabis use is associated with several negative consequences for individuals with bipolar disorder (BD), including new manic episode onset, psychosis, and functional disability. Yet much less is known about cannabis use disorders (CUDs) in this population, especially in more acutely symptomatic groups. Methods To evaluate correlates of CUD comorbidity in BD, a retrospective chart review was conducted for 230 adult patients with bipolar I disorder (BDI) who were admitted to a university-affiliated private psychiatric hospital. Using a computer algorithm, a hospital administrator extracted relevant demographic and clinical data from the electronic medical record for analysis. Results Thirty-six (16%) had a comorbid CUD. CUD comorbidity was significantly associated with younger age, manic/mixed episode polarity, presence of psychotic features, and comorbid nicotine dependence, alcohol use disorder (AUD), and other substance use disorders, but was associated with decreased likelihood of anxiety disorder comorbidity. With the exception of manic/mixed polarity and AUD comorbidity, results from multivariate analyses controlling for the presence of other SUDs were consistent with univariate findings. Conclusion Patients with BD and comorbid CUDs appear to be a complex population with need for enhanced clinical monitoring. Given increasing public acceptance of cannabis use, and the limited availability of evidenced-based interventions targeted toward CUDs in BD, psychoeducation and other treatment development efforts appear to be warranted. PMID:26773991

  8. Reversible Encephalopathy due to Valproic Acid Induced Hyperammonemia in a Patient with Bipolar I Disorder: A Cautionary Report

    PubMed Central

    Patel, Neel; Landry, Katherine B.; Fargason, Rachel E.; Birur, Badari

    2017-01-01

    Valproic acid (VPA) is an FDA-approved medication widely prescribed for seizures, migraines, and mixed or manic episodes in bipolar disorder. Hyperammonemia is a rare complication of VPA use, which can result in high morbidity and occasionally fatal encephalopathy. The scant literature on Valproate Induced Hyperammonemic Encephalopathy (VIHE) is characterized by acute onset of decreasing level of consciousness, drowsiness, lethargy which in rare instances can lead to seizures, stupor, coma, and persistent morbidity and cortical damage. Below we describe a case report of a patient with Bipolar I Disorder with no primary evidence of hepatic dysfunction that was initiated on VPA and olanzapine to address manic and psychotic symptoms. This patient subsequently developed elevated ammonia (NH4) levels that led to a reversible encephalopathy. This cautionary case report highlights the potential for a rare but serious complication from VPA, a medication increasingly used in both neurologic and neuropsychiatric settings. It is imperative that clinicians perform a thorough physical, neurological and diagnostic evaluation, routinely check NH4 and VPA levels when prescribing these agents and exercise caution when VPA is concomitantly prescribed with antipsychotics and cytochrome P450 inducing antiepileptic medications. PMID:28138203

  9. Genes involved in pruning and inflammation are enriched in a large mega-sample of patients affected by Schizophrenia and Bipolar Disorder and controls

    PubMed Central

    Marco, Calabrò; Antonio, Drago; Antonina, Sidoti; Alessandro, Serretti; Concetta, Crisafulli

    2015-01-01

    A molecular pathway analysis has been performed in order to complement previous genetic investigations on Schizophrenia. 4,486 Schizophrenic patients and 4,477 controls served as the investigation sample. 3,521 Bipolar patients and 3,195 controls served as replication sample. A molecular pathway associated with the neuronal pruning activity was found to be enriched in subjects with Schizophrenia compared to controls. HLA-C and HLA-DRA had more SNPs associated with both Schizophrenia and Bipolar Disorder than expected by chance. PMID:26160200

  10. Posttraumatic Stress Disorder, Depression, and Health-related Quality of Life in Patients with Bipolar Disorder: Review and New Data from a Multi-Site Community Clinic Sample

    PubMed Central

    Bajor, Laura A.; Lai, Zongshan; Goodrich, David E.; Miller, Christopher J.; Penfold, Robert B.; Kim, Hyungjin Myra; Kilbourne, Amy M.; Bauer, Mark S.

    2012-01-01

    Background Evidence suggests that patients with bipolar disorder have an elevated risk for comorbid posttraumatic stress disorder (PTSD) compared to those without a bipolar diagnosis. Although bipolar disorder is associated with decreased health-related quality of life (HRQOL), it is unclear whether comorbid PTSD interacts to affect HRQOL. Method Baseline data from a multi-site study of patients with bipolar disorder were analyzed. Patient surveys ascertained clinical and demographic information, including physical and mental HRQOL based on the SF-12, mood symptoms (PHQ-9, Internal State Scale), and self-reported co-occurring conditions including PTSD. Results Overall (N=384), 43.5% of patients self-reported co-occurring PTSD. Patients with PTSD had lower physical and mental HRQOL scores compared to those without PTSD (mean (SD) for those with and without PTSD, respectively): Mental Component Scale score 30.51 (8.22) and 32.86 (8.35); Physical Component Scale score 35.56 (7.77) and 37.21 (7.20). After adjusting for demographic and clinical factors including mood symptoms, multivariable linear regression analyses revealed that PTSD was no longer significantly associated with physical or mental HRQOL; however, depressive symptoms were independently associated with mental HRQOL (Beta −0.63, p<0.01). Conclusion Depressive symptoms may explain the association between PTSD and mental HRQOL. Clinicians working with these patients will want to emphasize treatment of depression as important towards improving HRQOL for this group. PMID:23021820

  11. Bipolar battery

    DOEpatents

    Kaun, Thomas D.

    1992-01-01

    A bipolar battery having a plurality of cells. The bipolar battery includes: a negative electrode; a positive electrode and a separator element disposed between the negative electrode and the positive electrode, the separator element electrically insulating the electrodes from one another; an electrolyte disposed within at least one of the negative electrode, the positive electrode and the separator element; and an electrode containment structure including a cup-like electrode holder.

  12. A Review of Bipolar Disorder in Adults

    PubMed Central

    Leamon, Martin H.; Lim, Russell F.; Kelly, Rosemary H.; Hales, Robert E.

    2006-01-01

    Objective: This article reviews the epidemiology, etiology, assessment, and management of bipolar disorder. Special attention is paid to factors that complicate treatment, including nonadherence, comorbid disorders, mixed mania, and depression. Methods: A Medline search was conducted from January of 1990 through December of 2005 using key terms of bipolar disorder, diagnosis, and treatment. Papers selected for further review included those published in English in peer-reviewed journals, with preference for articles based on randomized, controlled trials and consensus guidelines. Citations de-emphasized original mania trials as these are generally well known. Results: Bipolar disorder is a major public health problem, with diagnosis often occurring years after onset of the disorder. comorbid conditions are common and difficult to treat. Management includes a lifetime course of medication, usually more than one, and attention to psychosocial issues for patients and their families. Management of mania is well-established. Research is increasing regarding management of depressive, mixed and cycling episodes, as well as combination therapy. Conclusions: Bipolar disorder is a complex psychiatric disorder to manage, even for psychiatrists, because of its many episodes and comorbid disorders and nonadherence to treatment. PMID:20975827

  13. Adjunctive Psychosocial Intervention Following Hospital Discharge for Patients with Bipolar Disorder and Comorbid Substance Use: A Pilot Randomized Controlled Trial

    PubMed Central

    Wenze, Susan J.; Gaudiano, Brandon A.; Weinstock, Lauren M.; Tezanos, Katherine M.; Miller, Ivan W.

    2015-01-01

    Bipolar disorder and substance use disorders are highly debilitating conditions, and especially when co-occurring, are associated with a variety of negative outcomes. Surprisingly, there is a relative lack of research on feasible and effective psychosocial treatments for individuals with comorbid bipolar and substance use disorder (BD-SUD), and a dearth of literature examining interventions designed specifically to improve outcomes such as symptoms, functioning, and treatment engagement/adherence following psychiatric hospitalization in this population. In the current paper, we report results of a pilot randomized controlled trial (n = 30), comparing the recently developed Integrated Treatment Adherence Program, which includes individual and telephone sessions provided to patients and their significant others, versus Enhanced Assessment and Monitoring for those with BD-SUD. Participants who received the Integrated Treatment Adherence Program demonstrated significantly faster and greater improvements in depression, mania, functioning, and values-consistent living than participants randomized to Enhanced Assessment and Monitoring, and there was a trend for increased treatment adherence over time. Results are discussed in light of existing literature and study limitations, and suggestions for future research are proposed. PMID:26117247

  14. Fatty acid composition in the postmortem amygdala of patients with schizophrenia, bipolar disorder, and major depressive disorder.

    PubMed

    Hamazaki, Kei; Hamazaki, Tomohito; Inadera, Hidekuni

    2012-08-01

    Previous studies with postmortem brain tissues showed abnormalities in n-3 polyunsaturated fatty acids (PUFAs) in the orbitofrontal cortex of individuals with schizophrenia and mood disorders. However, in the hippocampus, we were not able to find any significant differences in PUFAs except for small differences in n-6 PUFAs. In the present study we investigated levels of PUFAs in the amygdala of postmortem brains from patients with schizophrenia, bipolar disorder, and major depressive disorder (MDD) compared with those of unaffected controls. Amygdala samples from patients with schizophrenia (n = 15), bipolar disorder (n = 15), or MDD (n = 15), and controls matched for age, sex, and five other confounding factors (n = 15) were analyzed for fatty acid composition by gas chromatography. In contrast to previous studies of the orbitofrontal cortex and hippocampus, we were unable to find any significant differences in major PUFAs. The relative compositions of docosahexaenoic acid (DHA), the major n-3 PUFA, were 10.0 ± 1.1%, 10.0 ± 1.3%, 9.3 ± 1.3%, and 9.7 ± 1.1%, respectively, in patients with schizophrenia, bipolar disorder, and MDD and unaffected controls (not significantly different). The corresponding relative compositions of arachidonic acid (AA), the major n-6 PUFA, were 9.0 ± 0.8%, 9.2 ± 0.5%, 9.4 ± 0.7%, and 9.4 ± 0.7%, respectively (not significantly different). Significant differences were found in some of the other fatty acids. In particular, we found a 6.5% increase in palmitic acid and 6.2% decrease in oleic acid in patients with MDD compared to controls. With regard to schizophrenia, there was an 8.0% decrease in docosatetraenoic acid compared to controls. In conclusion, the changes in DHA and/or AA seen in orbitofrontal cortex and hippocampus were not observed in amygdala. These changes may be specific to particular brain regions.

  15. Circulating T lymphocyte subsets, cytokines, and immune checkpoint inhibitors in patients with bipolar II or major depression: a preliminary study

    PubMed Central

    Wu, Wei; Zheng, Ya-li; Tian, Li-ping; Lai, Jian-bo; Hu, Chan-chan; Zhang, Peng; Chen, Jing-kai; Hu, Jian-bo; Huang, Man-li; Wei, Ning; Xu, Wei-juan; Zhou, Wei-hua; Lu, Shao-jia; Lu, Jing; Qi, Hong-li; Wang, Dan-dan; Zhou, Xiao-yi; Duan, Jin-feng; Xu, Yi; Hu, Shao-hua

    2017-01-01

    This study aimed to investigate the less known activation pattern of T lymphocyte populations and immune checkpoint inhibitors on immunocytes in patients with bipolar II disorder depression (BD) or major depression (MD). A total of 23 patients with BD, 22 patients with MD, and 20 healthy controls (HCs) were recruited. The blood cell count of T lymphocyte subsets and the plasma level of cytokines (IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ) were selectively investigated. The expression of T-cell immunoglobulin and mucin-domain containing-3 (TIM-3), programmed cell death protein 1 (PD-1) and its ligands, PD-L1 and PD-L2, on T lymphocytes and monocytes, was detected. In results, blood proportion of cytotoxic T cells significantly decreased in BD patients than in either MD patients or HCs. The plasma level of IL-6 increased in patients with BD and MD. The expression of TIM-3 on cytotoxic T cells significantly increased, whereas the expression of PD-L2 on monocytes significantly decreased in patients with BD than in HCs. These findings extended our knowledge of the immune dysfunction in patients with affective disorders. PMID:28074937

  16. Colorimetric determinations of lithium levels in drop-volumes of human plasma for monitoring patients with bipolar mood disorder.

    PubMed

    Qassem, M; Hickey, M; Kyriacou, P A

    2016-08-01

    Lithium preparations are considered the most reliable form of mood stabilizing medication for patients with Bipolar disorder. Nevertheless, lithium is a toxic element and its therapeutic range is extremely narrow, with levels of 0.61.0 mEq considered normal, whereas levels above 1.5 mEq are toxic. Thus unfortunately, many patients reach toxic levels that lead to unnecessary complications. It is believed that personal monitoring of blood lithium levels would benefit patients taking lithium medication. Therefore, our aim is to develop a personal lithium blood level analyzer for patients with bipolar mood disorder, and we report here our initial results of a colorimetric-based method used to test drop-volumes of human plasma that had been spiked with lithium. It was possible to validate results with standard flame photometry readings. Applying the Partial Least Squares (PLS) method on preprocessed spectra, therapeutic concentrations of lithium in a single drop can be predicted in a rapid manner, and furthermore, the calibration results were used to select effective wavelengths which were employed as inputs in Multiple Linear Regression (MLR). The simplified algorithms of this would prove useful when developing a personal lithium analyzer. Overall, both calibration methods gave high correlation and small error outputs with a R2= 0.99036 and RMSEC = 0.03778, and R2= 0.994148 and RMSEC= 0.0294404, for PLS and MLR methods, respectively. The results show that the spectrophotometric determination of blood lithium levels can be extended beyond laboratory applications and indicate the capability of this testing principle to be employed in a personal monitoring device. Future work will now focus on the technical development of a miniaturized system for measurement of lithium levels in blood with an acceptable level of accuracy and sensitivity.

  17. Bipolar disorder and multiple sclerosis.

    PubMed

    Ybarra, Mariana Inés; Moreira, Marcos Aurélio; Araújo, Carolina Reis; Lana-Peixoto, Marco Aurélio; Teixeira, Antonio Lucio

    2007-12-01

    Bipolar disorder may be overrepresented in multiple sclerosis (MS) patients. Although research in this area is limited, studies assessing the nature of this association have focused on genetic aspects, adverse reaction to drugs and brain demyelinating lesions. Herein we report three patients with MS that also presented bipolar disorder. The coexistence of neurological and psychiatric symptoms in most MS relapses highlights the relevance of biological factors in the emergence of mood disorders in these patients.

  18. Core principles in treating suicidal patients.

    PubMed

    Fowler, James Christopher

    2013-09-01

    The treatment of suicidal individuals requires special attention to therapist interventions that promote a viable treatment alliance in the context of shared responsibilities for patient safety. Three core principles in the treatment process (alliance building, enhancing curiosity about the function of suicidal thoughts and urges, as well as enhancing experience and expression of intense emotions) are articulated and brief case vignettes are used to illuminate the principles. Results from open trails and randomized control trials involving suicidal patients are examined to support the evidence-based practice of these principles. The overarching principle undergirding the utility of the principles is a collaborative joining with the patient to decrease isolation and alienation when facing intense and overwhelming emotions.

  19. Medium term outcome of bipolar plasma vaporization in prostate cancer patients – A palliative modality of preserving spontaneous voiding

    PubMed Central

    Geavlete, B; Moldoveanu, C; Niţă, G; Stănescu, F; Jecu, M; Geavlete, P

    2012-01-01

    Objectives:This retrospective analysis evaluated the efficiency, safety, and medium term postoperative results of bipolar plasma vaporization (BPV) in prostate cancer (PCa) cases associating complete urinary retention. Materials and Methods: A series of 40 patients diagnosed with locally advanced or metastatic PCa and complete urinary retention requiring a Foley catheter indwelling underwent BPV aiming to restore spontaneous voiding. A total of 35 patients completed the one year evaluation protocol consisting of International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum flow rate (Qmax) and post-voiding residual urinary volume (PVR), measured at 1, 3, 6 and 12 months after surgery. Results: BPV was successfully performed in all cases with satisfactory efficiency, as confirmed by the mean operation time (42.8 minutes) and hemoglobin drop (0.7 g/dl). A fast and safe postoperative recovery period was described in this series (hematuria rate – 7.5%; mean catheterization period – 36 hours; mean hospital stay – 2.5 days; early-irritative symptoms’ rate – 15%). At 1, 3, 6 and 12 months, satisfactory values were determined in terms of IPSS, Qmax, QoL and PVR. These parameters emphasized a stable evolution throughout the entire follow-up, as 88.6% of the patients maintained spontaneous voiding. Conclusions: The present trial confirmed the plasma-button vaporization as a promising therapeutic approach in PCa cases associating complete urinary retention. The technique displayed good efficacy, low perioperative morbidity, short convalescence, and satisfactory urodynamics and symptom score parameters during the one-year follow-up period. Abbreviations: BPV – bipolar plasma vaporization; PCa – prostate cancer; TURP – transurethral resection of the prostate; BPH – benign prostatic hyperplasia; BOO – bladder outlet obstruction; LUTS – lower urinary tract symptoms; IPSS – International Prostate Symptom Score; QoL – quality of life

  20. Abnormalities in the fatty acid composition of the postmortem entorhinal cortex of patients with schizophrenia, bipolar disorder, and major depressive disorder.

    PubMed

    Hamazaki, Kei; Hamazaki, Tomohito; Inadera, Hidekuni

    2013-11-30

    Previous studies of postmortem orbitofrontal cortex have shown abnormalities in levels of n-3 polyunsaturated fatty acids (PUFAs), especially docosahexaenoic acid (DHA), in individuals with schizophrenia, bipolar disorder, and major depressive disorder (MDD). We have previously measured PUFA levels in the postmortem hippocampus from patients with schizophrenia or bipolar disorder and control subjects; however, we found no significant differences between the groups except for small changes in n-6 PUFAs. Furthermore, our study of the postmortem amygdala showed no significant differences in major PUFAs in individuals with schizophrenia, bipolar disorder, or MDD in comparison with controls. In the present study, we investigated whether there were any changes in PUFAs in the entorhinal cortexes of patients with schizophrenia (n=15), bipolar disorder (n=15), or MDD (n=15) compared with unaffected controls (n=15) matched for characteristics including age and sex. In contrast to previous studies of the orbitofrontal cortex and hippocampus, we found no significant differences in major PUFAs. However, we found a 34.3% decrease in docosapentaenoic acid (DPA) (22:5n-3) in patients with MDD and an 8.7% decrease in docosatetraenoic acid (22:4n-6) in those with schizophrenia, compared with controls. Changes in PUFAs in patients with these psychiatric disorders may be specific to certain brain regions.

  1. Bipolar Disorder (For Teens)

    MedlinePlus

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Bipolar Disorder KidsHealth > For Teens > Bipolar Disorder A A A ... Bipolar Disorder en español Trastorno bipolar What Is Bipolar Disorder? Bipolar disorders are one of several medical conditions ...

  2. "Why throw away something useful?": Attitudes and opinions of people treated for bipolar disorder and their relatives on organ and tissue donation.

    PubMed

    Padoan, Carolina S; Garcia, Lucas F; Rodrigues, Aline A; Patusco, Lucas M; Atz, Mariana V; Kapczinski, Flavio; Goldim, José R; Magalhães, Pedro V S

    2017-03-01

    In regard to mental illness, brain donation is essential for the biological investigation of central pathology. Nevertheless, little is known about the thoughts of people with mental disorders on tissue donation for research. Here, our objective was to understand the attitudes and opinions of people treated for bipolar disorder and their relatives regarding donation in general, and particularly donation for research. This is a qualitative study that used in-depth interviews to determine the thoughts of participants regarding tissue donation for research. Theoretical sampling was used as a recruitment method. Grounded theory was used as a framework for content analyses of the interviews. A semi-structured interview guide was applied with the topics: donation in general; donation for research; mental health and body organs; opinion regarding donation; feelings aroused by the topic. Although all participants were aware of organ donation for transplant, they were surprised that tissue could be donated for research. Nevertheless, once they understood the concept they were usually in favor of the idea. Although participants demonstrated a general lack of knowledge on donation for research, they were willing to learn more and viewed it as a good thing, with altruistic reasons often cited as a motive for donation. We speculate that bridging this knowledge gap may be a fundamental step towards a more ethical postmortem tissue donation process.

  3. Perceptions and impact of bipolar disorder in Japan: results of an Internet survey

    PubMed Central

    Watanabe, Koichiro; Harada, Eiji; Inoue, Takeshi; Tanji, Yuka; Kikuchi, Toshiaki

    2016-01-01

    Bipolar disorder is a recurrent and episodic illness. This survey study assessed experiences and identified clinical insights of individuals with bipolar disorder. An Internet-based monitor system database was screened for patients with bipolar disorder in Japan (February and March 2013). Of 1,050 patients, 457 completed surveys, and results were analyzed with descriptive statistics. Approximately one-fourth of respondents were diagnosed with bipolar disorder on their first visit to medical institutions, although the most common initial diagnosis was depression/depressive state (65%). Mean time lag between first-time visit to a medical institution and receipt of correct diagnosis of bipolar disorder was 4 years; one-third of patients experienced more than 5 years of lag time. Three perceived reasons for lapsed time before correct diagnosis were “(patients) Did not consider manic symptoms as illness, and did not tell the doctor about them,” “I (patient) did not know of bipolar disorder,” and “Lack of communication between my doctor and myself (patient).” Among participants who believed that they were initially incorrectly diagnosed and improperly treated, most experienced socioeconomic problems, such as having long-term inability to work or to study (65%). Sources of encouragement for participants included “To have someone to consult with” (41%) followed by having “People around me treat me the same as before” (40%). Individuals with bipolar disorder reported a time lag of many years before accurate diagnosis, and substantial burden imposed by the illness. Encouragement should be provided for individuals to live positively with bipolar disorder. PMID:27920534

  4. A comparison of neuropsychological dysfunction in first-episode psychosis patients with unipolar depression, bipolar disorder, and schizophrenia.

    PubMed

    Hill, S Kristian; Reilly, James L; Harris, Margret S H; Rosen, Cherise; Marvin, Robert W; Deleon, Ovidio; Sweeney, John A

    2009-09-01

    The severity and profile of cognitive dysfunction in first episode schizophrenia and psychotic affective disorders were compared before and after antipsychotic treatment. Parallel recruitment of consecutively admitted study-eligible first-episode psychotic patients (30 schizophrenia, 22 bipolar with psychosis, and 21 psychotic depression) reduced confounds of acute and chronic disease/medication effects as well as differential treatment and course. Patient groups completed a neuropsychological battery and were demographically similar to healthy controls (n=41) studied in parallel. Prior to treatment, schizophrenia patients displayed significant deficits in all cognitive domains. The two psychotic affective groups were also impaired overall, generally performing intermediate between the schizophrenia and healthy comparison groups. No profile differences in neuropsychological deficits were observed across patient groups. Following 6 weeks of treatment, no patient group improved more than practice effects seen in healthy individuals, and level of performance improvement was similar for affective psychosis and schizophrenia groups. Although less severe in psychotic affective disorders, similar profiles of generalized neuropsychological deficits were observed across patient groups. Recovery of cognitive function after clinical stabilization was similar in mood disorders and schizophrenia. To the extent that these findings are generalizable, neuropsychological deficits in psychotic affective disorders, like schizophrenia, may be trait-like deficits with persistent functional implications.

  5. Bipolar disorder

    PubMed Central

    Goodwin, Frederick K.; Ghaemi, S. Nassir

    1999-01-01

    Bipolar disorder's unique combination of three characteristics - clear genetic diathesis, distinctive clinical features, early availability of an effective treatment (lithium) - explains its special place in the history of psychiatry and its contribution to the current explosive growth of neuroscience. This article looks at the state of the art in bipolar disorder from the vantage point of: (i) genetics (possible linkages on chromosomes 18 and 21q, polygenic hypothesis, research into genetic markers); (ii) diagnosis (new focus on the subjective aspects of bipolar disorder to offset the current trend of underdiagnosis due to overreliance on standardized interviews and rating scales); (iii) outcome (increase in treatment-resistant forms signaling a change in the natural history of bipolar disorder); (iv) pathophysiology (research into circadian biological rhythms and the kindling hypothesis to explain recurrence); (v) treatment (emergence of the anticonvulsants, suggested role of chronic antidepressant treatment in the development of treatment resistance); (vi) neurobiology (evaluation of regulatory function in relation to affective disturbances, role of postsynaptic second-messenger mechanisms, advances in functional neuroimaging); and (vii) psychosocial research (shedding overly dualistic theories of the past to understand the mind and brain as an entity, thus emphasizing the importance of balancing the psychopharmacological and psychotherapeutic approaches). Future progress in the understanding and treatment of bipolar disorder will rely on successful integration of the biological and psychosocial lines of investigation. PMID:22033232

  6. Treating navicular syndrome in equine patients.

    PubMed

    Waguespack, R Wayne; Hanson, R Reid

    2011-01-01

    Navicular syndrome is a chronic, progressive condition affecting the navicular bone and bursa, deep digital flexor tendon (DDFT), and associated soft tissue structures composing the navicular apparatus. The treatment options for navicular syndrome are as varied as the proposed causes of the condition. The severity of clinical signs, intended use and workload of the horse, and owner compliance with therapy are important considerations in developing a treatment plan. Nonsurgical treatment of navicular syndrome consists of rest, hoof balance and corrective trimming/shoeing, and medical therapy, including administration of systemic antiinflammatories, hemorheologic medications, and intraarticular medications. While surgical therapy can include desmotomy of the collateral (suspensory) ligaments of the navicular bone, palmar digital neurectomy is more commonly performed when medical therapy is ineffective. Recently, adjunct therapies, such as acupuncture and extracorporeal shock wave therapy, have also been used to treat horses with navicular syndrome. Because of the wide range of pathologic changes and the lack of a definitive cure associated with navicular syndrome, treatment is directed toward the individual horse, focusing on the management of clinical signs to alleviate stress and retard degenerative changes of the navicular bursal and navicular regions.

  7. Hoarding Symptoms Respond to Treatment for Rapid Cycling Bipolar II Disorder.

    PubMed

    Laurito, Luana D; Fontenelle, Leonardo F; Kahn, David A

    2016-01-01

    Although some studies have reported a relationship between hoarding and bipolar disorder, we are unaware of any previous description of how they may interact with each other and how they should be managed appropriately. A 48-year-old male depressed patient with hoarding symptoms and obsessive-compulsive disorder (OCD) was diagnosed with bipolar II disorder after 2 hypomanic episodes. The patient was treated unsuccessfully with different high-dose serotonin reuptake inhibitors and atypical antipsychotics, maintaining a pattern of 6 to 8 discrete, but severe, depressive episodes each year, always in association with a drastic worsening of his OCD and hoarding symptoms. T.he patient did not improve until the dose of the serotonin reuptake inhibitor was decreased and a combination of lamotrigine and methylphenidate was initiated. On this treatment regimen, the patient did not show clinically significant levels of depression or hoarding or other OCD symptoms. This case suggests that, in some patients, (1) hoarding-related cognitions and behaviors may be a part of bipolar depression, (2) the episodic nature of rapid cycling bipolar II disorder may protect against the development of severe clutter, and (3) treatment focusing on bipolar depression (eg, lamotrigine plus methylphenidate) may result in an improvement of hoarding symptoms when these are present in patients with rapid cycling bipolar II disorder.

  8. Serum zinc levels in corticosteroid-treated asthmatic patients

    PubMed Central

    Ellul-Micallef, R.; Galdes, A.; Fenech, F. F.

    1976-01-01

    Serum zinc levels have been measured in twenty-four asthmatic patients, of whom sixteen were on long term corticosteroid therapy. They were carefully screened to exclude any concomitant disease. The non-steroid-treated asthmatics had normal serum zinc levels which ranged from 89 to 138 μg/ml. The corticosteroid-treated patients had a mean serum zinc level of 64 ± 9 μg/100 ml; this was significantly lower than normal (P = < 0·001). PMID:1264936

  9. Comparison of Sexual Experience and Behavior between Bipolar Outpatients and Outpatients without Mood Disorders

    PubMed Central

    Downey, Jennifer; Friedman, Richard C.; Haase, Elizabeth; Goldenberg, David; Bell, Robinette; Edsall, Sidney

    2016-01-01

    Sexual behavior over the past year of 32 outpatients with Bipolar disorder is compared to that of 44 Comparison patients that had never had an episode of affective illness. Subjects were outpatients treated with drugs and psychotherapy in routine office practice. Differences in sexual behavior between the two groups as a whole were minimal, but meaningful differences emerged when subgroups were compared. Compared to control men, Bipolar men had had more partners in the last year and were more likely to have had sex without condoms. Compared to Bipolar females, Bipolar males had more sex partners, had more sex with strangers, and were more likely to have engaged in homosexual behavior. Even so, some patients in the Comparison group also had engaged in risky sexual behavior. They had failed to use condoms and had had sex with strangers and prostitutes during the previous year. PMID:27190984

  10. Associations of serotonin receptor gene HTR3A, HTR3B, and HTR3A haplotypes with bipolar disorder in Chinese patients.

    PubMed

    Jian, J; Li, C; Xu, J; Qiao, D; Mi, G; Chen, X; Tang, M

    2016-09-16

    Single nucleotide polymorphisms (SNPs) in HTR3A and HTR3B have been reported to be associated with bipolar disorder in European and Japanese populations. We explored the roles of 21 tag SNPs in HTR3A and HTR3B in susceptibility to bipolar disorder in a Chinese cohort. Twenty-one Tag SNPs were genotyped in a study consisting of 130 patients with bipolar disorder, who visited Shandong Mental Health Center between June 2013 and May 2014, and 109 healthy individuals as controls. All of the tag SNPs were genotyped using Sequenom MassArray matrix-assisted laser desorption/ionization time of flight spectrometry. Plink 1.07, Haploview 4.2, and SPSS 20.0 were used for the analysis of the genotypes and the associations of the haplotypes with bipolar disorder. Association analyses of tag SNPs detected significant associations with the A allele in HTR3A rs1176719 (P = 0.030) and the C allele in HTR3A rs1176713 (P = 0.048). Haplotype-based association analyses indicated a statistically significant (P = 0.035) five-SNP haplotype (rs1062613:C, rs11604247:C, rs1176722:G, rs2276302:A, rs1176719:G) of linkage disequilibrium in block 3. Analysis of our small Chinese sample revealed a significant association of HTR3A with bipolar disorder, but yielded no evidence of an association between HTR3B and bipolar disorder. Furthermore, evidence for an association was found for a haplotype of HTR3A. Studies with larger Chinese samples are needed to verify our findings.

  11. Corpus callosum area in patients with bipolar disorder with and without psychotic features: an international multicentre study

    PubMed Central

    Sarrazin, Samuel; d’Albis, Marc-Antoine; McDonald, Colm; Linke, Julia; Wessa, Michèle; Phillips, Mary; Delavest, Marine; Emsell, Louise; Versace, Amelia; Almeida, Jorge; Mangin, Jean-François; Poupon, Cyril; Le Dudal, Katia; Daban, Claire; Hamdani, Nora; Leboyer, Marion; Houenou, Josselin

    2015-01-01

    Background Previous studies have reported MRI abnormalities of the corpus callosum (CC) in patients with bipolar disorder (BD), although only a few studies have directly compared callosal areas in psychotic versus nonpsychotic patients with this disorder. We sought to compare regional callosal areas in a large international multicentre sample of patients with BD and healthy controls. Methods We analyzed anatomic T1 MRI data of patients with BD-I and healthy controls recruited from 4 sites (France, Germany, Ireland and the United States). We obtained the mid-sagittal areas of 7 CC subregions using an automatic CC delineation. Differences in regional callosal areas between patients and controls were compared using linear mixed models (adjusting for age, sex, handedness, brain volume, history of alcohol abuse/dependence, lithium or antipsychotic medication status, symptomatic status and site) and multiple comparisons correction. We also compared regional areas of the CC between patients with BD with and without a history of psychotic features. Results We included 172 patients and 146 controls in our study. Patients with BD had smaller adjusted mid-sagittal CC areas than controls along the posterior body, the isthmus and the splenium of the CC. Patients with a positive history of psychotic features had greater adjusted area of the rostral CC region than those without a history of psychotic features. Limitations We found small to medium effect sizes, and there was no calibration technique among the sites. Conclusion Our results suggest that BD with psychosis is associated with a different pattern of interhemispheric connectivity than BD without psychosis and could be considered a relevant neuroimaging subtype of BD. PMID:26151452

  12. Prevalence of Circadian Rhythm Sleep-Wake Disorders and Associated Factors in Euthymic Patients with Bipolar Disorder

    PubMed Central

    Takaesu, Yoshikazu; Inoue, Yuichi; Murakoshi, Akiko; Komada, Yoko; Otsuka, Ayano; Futenma, Kunihiro; Inoue, Takeshi

    2016-01-01

    Recent studies have suggested that there are certain pathophysiological relationships between bipolar disorder (BD) and circadian rhythm dysfunction. However, apparently no studies have clarified the prevalence of circadian rhythm sleep-wake disorders (CRSWD) in patients with BD. This study was set out to investigate the prevalence of CRSWD and associated factors in patients with BD. One hundred four euthymic BD outpatients participated in this study. The subjects were asked to answer questionnaires including demographic variables, clinical course of BD, and family history of psychiatric disorders and suicide. Severity of BD was assessed by the Montgomery-Åsberg Depression Rating Scale and Young Mania Rating Scale. CRSWD was diagnosed by clinical interview, together with sleep logs, according to the International Classification of Sleep Disorders, third edition (ICSD-3). Thirty-five subjects (32.4%) met the criteria for CRSWD. The age at the time of investigation and that at the onset of BD were both lower in the CRSWD group than in the non-CRSWD group. The rates of family history of psychiatric disorders and suicide in the CRSWD group were higher than those in the non-CRSWD group. Multiple logistic regression analysis revealed that the presence of CRSWD was significantly associated with younger onset age of BD and family history of suicide. The prevalence of CRSWD could be quite high in BD patients. Younger onset age of BD and family history of suicide were associated with presence of CRSWD in BD patients. PMID:27442503

  13. Lack of influence of COMT and NET genes variants on executive functions in schizophrenic and bipolar patients, their first-degree relatives and controls.

    PubMed

    Szöke, A; Schürhoff, F; Méary, A; Mathieu, F; Chevalier, F; Trandafir, A; Alter, C; Roy, I; Bellivier, F; Leboyer, M

    2006-07-05

    Abnormal dopaminergic function in the prefrontal cortex (PFC) may be a key factor in the etiopathogeny of schizophrenia and bipolar disorder. Both schizophrenic and bipolar subjects have executive functions (EF) deficits, thought to reflect abnormal PFC function. The main inactivation pathways for dopamine in the PFC are enzymatic cleavage by the Carboxy-O-Methyl-Transferase (COMT) and reuptake by the nor-epinephrine transporter (NET). Our aim in this study was to replicate previous studies that investigated influence of the COMT genotype on EF in schizophrenic subjects, their relatives and controls and extend their scope by including bipolar patients, and their relatives and by exploring NET gene polymorphisms influence on executive performances. We investigated one functional polymorphism of the COMT gene and two polymorphisms of the NET gene. EF were assessed by means of the Trail Making Test (TMT) and the Wisconsin Card Sorting Test (WCST). We assessed the effect of each of the three genotypes on EF for the whole sample (N = 318) and separately in schizophrenic (N = 66), bipolar (N = 94) and healthy subjects (i.e., relatives and controls N = 158). Separate analyses were performed because of the presence, in patients samples, of potentially confounding factors, especially medication. Genotype had no significant effect on the cognitive measures in any of the analyses (for the two EF measures, the three polymorphisms, and the four groups). In our sample we found no evidence in favor of a major effect of COMT or NET polymorphisms on the two tests of EF.

  14. Distinct proteomic profiles in post-mortem pituitary glands from bipolar disorder and major depressive disorder patients.

    PubMed

    Stelzhammer, Viktoria; Alsaif, Murtada; Chan, Man K; Rahmoune, Hassan; Steeb, Hannah; Guest, Paul C; Bahn, Sabine

    2015-01-01

    Disturbances of the hypothalamic-pituitary-adrenal axis have been implicated in the pathophysiology of bipolar disorder (BD) and major depressive disorder (MDD). To examine this further, we carried out proteomic profiling of post-mortem pituitaries from 13 BD and 14 MDD patients, in comparison to 15 controls. Liquid chromatography-mass spectrometry (LC-MS(E)) analysis showed that BD patients had significantly increased levels of the major pituitary hormones pro-opiomelanocortin (POMC) and galanin. BD patients also showed changes in proteins associated with gene transcription, stress response, lipid metabolism and growth signalling. In contrast, LC-MS(E) profiling revealed that MDD patients had significantly decreased levels of the prohormone-converting enzyme carboxypeptidease E and follow-up enzymatic analysis showed decreased activity of prolyl-oligopeptidase convertase. This suggested that altered prohormone processing may occur in pituitaries of MDD patients. In addition, MDD patients had significant changes in proteins involved in intracellular transport and cytoskeletal signalling. Finally, we carried out selective reaction monitoring (SRM) mass spectrometry profiling for validation of protein changes in key biological pathways. This confirmed increased POMC levels in BD patients with no change in the levels of this prohormone in MDD. This study demonstrates that proteomic profiling analysis of the pituitary can lead to new insights into the pathophysiology of BD and MDD. Also, given that the pituitary directly releases a variety of bioactive molecules into the bloodstream, many of the proteins identified here could serve as focal points in the search for peripheral biomarkers in clinical or drug treatment studies of BD and MDD patients.

  15. The relationship between sensory processing patterns, alexithymia, traumatic childhood experiences, and quality of life among patients with unipolar and bipolar disorders.

    PubMed

    Serafini, Gianluca; Gonda, Xenia; Pompili, Maurizio; Rihmer, Zoltan; Amore, Mario; Engel-Yeger, Batya

    2016-12-01

    Several studies documented the involvement of sensory perception in emotional processes. The long-term consequences of traumatic experiences and alexithymia have been demonstrated as well. However, the role of extreme sensory processing patterns, traumatic childhood experiences, and alexithymia has not been thoroughly examined in major affective disorders. The present study aimed to: (1) compare unipolar/bipolar patients with regard to their sensory processing patterns, alexithymia, childhood traumatic experiences and quality of life; (2) examine the correlations between sensory processing patterns and childhood traumatic experiences; (3) investigate the relative contribution of diagnostic groups (unipolar/bipolar), sensory processing patterns, alexithymia, and childhood traumatic experiences in predicting quality of life. The sample included 336 participants, 197 with unipolar and 139 with bipolar disorder. All participants completed the Adolescent/Adult Sensory Profile (AASP), Toronto Alexithymia Scale, Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory (BDI)-II, and Short Form 12 Health Survey version 2 (SF-12). Bipolar patients showed significantly higher physical neglect, emotional abuse, and emotional neglect compared with unipolar patients. Both in unipolar and bipolar groups, lower registration of sensory input as well as hypersensitivity correlated with enhanced childhood trauma events. Reduced sensory sensitivity accounted for 11% of the variance in physical health composite score (PCS) of SF-12 whereas reduced depression accounted for 8% of the variance in mental health composite score (MCS). Furthermore, elevated MCS was predicted by depression, physical and emotional neglect. Sensory processing patterns and childhood traumatic experiences may specifically characterize individuals with major affective disorders and play a role in the prediction of their quality of life.

  16. Perturbational Profiling of Metabolites in Patient Fibroblasts Implicates α-Aminoadipate as a Potential Biomarker for Bipolar Disorder.

    PubMed

    Huang, Joanne H; Berkovitch, Shaunna S; Iaconelli, Jonathan; Watmuff, Bradley; Park, Hyoungjun; Chattopadhyay, Shrikanta; McPhie, Donna; Öngür, Dost; Cohen, Bruce M; Clish, Clary B; Karmacharya, Rakesh

    2016-07-01

    Many studies suggest the presence of aberrations in cellular metabolism in bipolar disorder. We studied the metabolome in bipolar disorder to gain insight into cellular pathways that may be dysregulated in bipolar disorder and to discover evidence of novel biomarkers. We measured polar and nonpolar metabolites in fibroblasts from subjects with bipolar I disorder and matched healthy control subjects, under normal conditions and with two physiologic perturbations: low-glucose media and exposure to the stress-mediating hormone dexamethasone. Metabolites that were significantly different between bipolar and control subjects showed distinct separation by principal components analysis methods. The most statistically significant findings were observed in the perturbation experiments. The metabolite with the lowest p value in both the low-glucose and dexamethasone experiments was α-aminoadipate, whose intracellular level was consistently lower in bipolar subjects. Our study implicates α-aminoadipate as a possible biomarker in bipolar disorder that manifests under cellular stress. This is an intriguing finding given the known role of α-aminoadipate in the modulation of kynurenic acid in the brain, especially as abnormal kynurenic acid levels have been implicated in bipolar disorder.

  17. [METABOLIC SYNDROME AND CARDIOVASCULAR RISK IN PATIENTS WITH SCHIZOPHRENIA, BIPOLAR DISORDER AND SCHIZOAFFECTIVE DISORDER].

    PubMed

    Muñoz-Calero Franco, Paloma; Sánchez Sánchez, Blanca; Rodríguez Criado, Natalia; Pinilla Santos, Berta; Bravo Herrero, Sandra; Cruz Fourcade, José Fernando; Martín Aragón, Rubén

    2015-12-01

    Introducción: los pacientes con patologías mentales graves como la esquizofrenia, el trastorno esquizoafectivo y el trastorno bipolar fallecen de media 20 años antes que la población general. La muerte por problemas cardiovasculares es la primera causa de fallecimiento, a pesar de la introducción de estrategias para el control de dichos factores de riesgo. Objetivos: analizar el porcentaje de pacientes con índice de masa corporal elevado, síndrome metabólico y riesgo cardiovascular diagnosticados según los criterios diagnósticos DSM-IV de esquizofrenia, trastorno bipolar y trastorno esquizoafectivo ingresados en la Unidad de Hospitalización Breve del Hospital Universitario de Móstoles de noviembre de 2014 a junio de 2015 por descompensación de su patología. Metodología: en 53 pacientes, 34 con diagnóstico de esquizofrenia, 16 con diagnóstico de trastorno bipolar y 3 con diagnóstico de trastorno esquizoafectivo se tomaron mediciones de peso, talla, perímetro abdominal y tensión arterial. Se realizó también analítica de ingreso, se incluyó determinación de glucosa en ayunas, triglicéridos, colesterol total y colesterol HDL. Se utilizó también la historia clínica para conocer los hábitos tóxicos de los pacientes y su estilo de vida, y se calculó el índice de masa corporal de los pacientes. Posteriormente fueron utilizados los criterios ATP III para síndrome metabólico y los de Framingham para calcular el riesgo cardiovascular a los diez años de los pacientes. Resultados: la muestra está compuesta por un 51% de varones y un 49% de mujeres, con una mediana de edad de 40 años. El 38% de los pacientes presentaron sobrepeso, el 22 % obesidad y el 4% obesidad mórbida. En cuanto a la presencia de síndrome metabólico, el 26% de los pacientes lo presentan según los criterios APT III; la mayoría de estos presentaban años de evolución de enfermedad y de tratamiento con psicofármacos. El 11% de los pacientes presenta un riesgo

  18. Effect of the methylenetetrahydrofolate reductase gene polymorphisms on homocysteine, folate and vitamin B12 in patients with bipolar disorder and relatives.

    PubMed

    Ozbek, Zeynep; Kucukali, Cem Ismail; Ozkok, Elif; Orhan, Nurcan; Aydin, Makbule; Kilic, Gamze; Sazci, Ali; Kara, Ihsan

    2008-07-01

    We investigated the effect of polymorphic variants of c.1298A>C (Glu429Ala) and c.677C>T (Ala222Val) in methylenetetrahydrofolate (MTHFR) gene on the total homocysteine (tHcy), folate and B12 levels in patients with bipolar disorder, first-degree relatives of patients, and controls. The c.677C>T and c.1298A>C polymorphisms in MTHFR were determined by polymerase chain reaction-restriction fragment length polymorphism in 197 bipolar patients, 278 relatives and 238 controls. tHcy and folate and vitamin B12 levels were measured by Fluorescence Polarization Immunoassay and Electrochemiluminescence, respectively. The tHcy was significantly increased in patients and relatives. In contrast, folate and B12 were significantly lower in patients and relatives. Gender was not considered as a significant determinant in the multivariate analysis. Genotypes of c.1298A>C and c.677C>T were correlated with tHcy, folate and B12. Patients and relatives carrying TT and/or AA and AC genotypes had elevated tHcy and reduced folate and B12 levels. High tHcy but low folate and vitamin B12 levels may be a risk factor for development of bipolar disorder.

  19. Stratifying Risk for Renal Insufficiency Among Lithium-Treated Patients: An Electronic Health Record Study.

    PubMed

    Castro, Victor M; Roberson, Ashlee M; McCoy, Thomas H; Wiste, Anna; Cagan, Andrew; Smoller, Jordan W; Rosenbaum, Jerrold F; Ostacher, Michael; Perlis, Roy H

    2016-03-01

    Although lithium preparations remain first-line treatment for bipolar disorder, risk for development of renal insufficiency may discourage their use. Estimating such risk could allow more informed decisions and facilitate development of prevention strategies. We utilized electronic health records from a large New England health-care system between 2006 and 2013 to identify patients aged 18 years or older with a lithium prescription. Renal insufficiency was identified using the presence of renal failure by ICD9 code or laboratory-confirmed glomerular filtration rate below 60 ml/min. Logistic regression was used to build a predictive model in a random two-thirds of the cohort, which was tested in the remaining one-third. Risks associated with aspects of pharmacotherapy were also examined in the full cohort. We identified 1445 adult lithium-treated patients with renal insufficiency, matched by risk set sampling 1 : 3 with 4306 lithium-exposed patients without renal insufficiency. In regression models, features associated with risk included older age, female sex, history of smoking, history of hypertension, overall burden of medical comorbidity, and diagnosis of schizophrenia or schizoaffective disorder (p<0.01 for all contrasts). The model yielded an area under the ROC curve exceeding 0.81 in an independent testing set, with 74% of renal insufficiency cases among the top two risk quintiles. Use of lithium more than once daily, lithium levels greater than 0.6 mEq/l, and use of first-generation antipsychotics were independently associated with risk. These results suggest the possibility of stratifying risk for renal failure among lithium-treated patients. Once-daily lithium dosing and maintaining lower lithium levels where possible may represent strategies for reducing risk.

  20. Stratifying Risk for Renal Insufficiency Among Lithium-Treated Patients: An Electronic Health Record Study

    PubMed Central

    Castro, Victor M; Roberson, Ashlee M; McCoy, Thomas H; Wiste, Anna; Cagan, Andrew; Smoller, Jordan W; Rosenbaum, Jerrold F; Ostacher, Michael; Perlis, Roy H

    2016-01-01

    Although lithium preparations remain first-line treatment for bipolar disorder, risk for development of renal insufficiency may discourage their use. Estimating such risk could allow more informed decisions and facilitate development of prevention strategies. We utilized electronic health records from a large New England health-care system between 2006 and 2013 to identify patients aged 18 years or older with a lithium prescription. Renal insufficiency was identified using the presence of renal failure by ICD9 code or laboratory-confirmed glomerular filtration rate below 60 ml/min. Logistic regression was used to build a predictive model in a random two-thirds of the cohort, which was tested in the remaining one-third. Risks associated with aspects of pharmacotherapy were also examined in the full cohort. We identified 1445 adult lithium-treated patients with renal insufficiency, matched by risk set sampling 1 : 3 with 4306 lithium-exposed patients without renal insufficiency. In regression models, features associated with risk included older age, female sex, history of smoking, history of hypertension, overall burden of medical comorbidity, and diagnosis of schizophrenia or schizoaffective disorder (p<0.01 for all contrasts). The model yielded an area under the ROC curve exceeding 0.81 in an independent testing set, with 74% of renal insufficiency cases among the top two risk quintiles. Use of lithium more than once daily, lithium levels greater than 0.6 mEq/l, and use of first-generation antipsychotics were independently associated with risk. These results suggest the possibility of stratifying risk for renal failure among lithium-treated patients. Once-daily lithium dosing and maintaining lower lithium levels where possible may represent strategies for reducing risk. PMID:26294109

  1. Comparably high retention and low relapse rates in different subpopulations of bipolar patients in a German non-interventional study

    PubMed Central

    2013-01-01

    Background Although a range of pharmacotherapeutical options are available for the treatment of bipolar disorder, patient non-adherence to prescribed treatment regimens and early treatment discontinuation remain among the primary obstacles to effective treatment. Therefore, this observational study assessed time on mood stabilizing medication and retention rates in patients with bipolar disorder (BD). Methods In an 18-month, prospective, multicenter, non-interventional study conducted in Germany 761 outpatients (≥18 years) with BD and on maintenance therapy were documented. For analysis, patients were stratified by baseline medication: monotherapy olanzapine (OM, N = 186), lithium (LM, N = 152), anticonvulsants (N = 216), other mood stabilizing medication (OMS, N = 44); combination therapy olanzapine/lithium (N = 47), olanzapine/anticonvulsant (N = 68), other combinations (OC, N = 48). Continuation on medication was assessed as retention rates with 95% confidence intervals. Time to discontinuation and relapse-free time were calculated by Kaplan-Meier analysis. A relapse was defined as increase to CGI-BP >3, worsening of CGI-BP by ≥2 points, hospitalization or death related to BD. A Cox regression was calculated for the discontinuation of mood stabilizing therapy (reference: OM). Logistic regression models with stepwise forward selection were used to explore possible predictors of maintenance of treatment and relapse. Results After 540 days (18 months), the overall retention rate of baseline medication was 87.7%, without notable differences between the cohorts. The overall mean time on mood stabilizing treatment was 444.7 days, with a range of 377.5 (OMS) to 481 (LM) by cohort. 74.0% of all patients were without relapse, with rates between the cohorts ranging from 58.4% (OC) to 80.2% (LM). Conclusions Retention rates exceeded controlled trial results in all treatment cohorts, in addition to other explanations possibly reflecting

  2. Antidepressant chronotherapeutics for bipolar depression

    PubMed Central

    Benedetti, Francesco

    2012-01-01

    Chronotherapeutics refers to treatments based on the principles of circadian rhythm organization and sleep physiology, which control the exposure to environmental stimuli that act on biological rhythms, in order to achieve therapeutic effects in the treatment of psychiatric conditions. It includes manipulations of the sleep-wake cycle such as sleep deprivation and sleep phase advance, and controlled exposure to light and dark. The antidepressant effects of chronotherapeutics are evident in difficult-to-treat conditions such as bipolar depression, which has been associated with extremely low success rates of antidepressant drugs in naturalistic settings and with stable antidepressant response to chronotherapeutics in more than half of the patients. Recent advances in the study of the effects of chronotherapeutics on neurotransmitter systems, and on the biological clock machinery, allow us to pinpoint its mechanism of action and to transform it from a neglected or “orphan” treatment to a powerful clinical instrument in everyday psychiatric practice. PMID:23393416

  3. Antidepressant chronotherapeutics for bipolar depression.

    PubMed

    Benedetti, Francesco

    2012-12-01

    Chronotherapeutics refers to treatments based on the principles of circadian rhythm organization and sleep physiology, which control the exposure to environmental stimuli that act on biological rhythms, in order to achieve therapeutic effects in the treatment of psychiatric conditions. It includes manipulations of the sleep-wake cycle such as sleep deprivation and sleep phase advance, and controlled exposure to light and dark. The antidepressant effects of chronotherapeutics are evident in difficult-to-treat conditions such as bipolar depression, which has been associated with extremely low success rates of antidepressant drugs in naturalistic settings and with stable antidepressant response to chronotherapeutics in more than half of the patients. Recent advances in the study of the effects of chronotherapeutics on neurotransmitter systems, and on the biological clock machinery, allow us to pinpoint its mechanism of action and to transform it from a neglected or "orphan" treatment to a powerful clinical instrument in everyday psychiatric practice.

  4. LURASIDONE IN THE LONG‐TERM TREATMENT OF PATIENTS WITH BIPOLAR DISORDER: A 24‐WEEK OPEN‐LABEL EXTENSION STUDY

    PubMed Central

    Sarma, Kaushik; Silva, Robert; Kroger, Hans; Cucchiaro, Josephine; Loebel, Antony

    2016-01-01

    Background The aim of this study was to evaluate the safety and tolerability of 6 months of open‐label, uncontrolled extension treatment with lurasidone in patients with a diagnosis of bipolar depression who completed 6 weeks of acute treatment. Methods Patients completing 6 weeks of double‐blind placebo‐controlled treatment with either lurasidone monotherapy (one study) or adjunctive therapy with lithium or valproate (two studies), were treated for 6 months with flexible doses of lurasidone, 20–120 mg/day, in an open‐label, uncontrolled extension study (N = 813; monotherapy, 38.9%; adjunctive therapy, 61.1%). Changes in safety parameters were calculated from double‐blind, acute‐phase baseline to month 6 of the extension phase, using a last observation carried forward (LOCF endpoint) analysis. Results Five hundred fifty‐nine of 817 (68.4%) patients completed the extension study. In the monotherapy and adjunctive therapy groups, 6.9 and 9.0%, respectively, discontinued due to an adverse event. For the monotherapy and adjunctive therapy groups, respectively, changes from double‐blind baseline to month 6 were +0.8 and +0.9 kg for weight (mean), 0.0 and +2.0 mg/dL for total cholesterol (median), +5.0 and +5.0 mg/dL for triglycerides (median), −1.0 and 0.0 mg/dL for glucose (median); −22.6 and −21.7 for Montgomery‐Asberg Depression Rating Scale (MADRS; mean); whereas change from open‐label baseline to month 6 were +0.85 and +0.88 kg for weight (mean), and −6.9 and −6.5 for MADRS (mean). Conclusions Six months of treatment with open‐label lurasidone was safe and well tolerated with minimal effect on weight and metabolic parameters; continued improvement in depressive symptoms was observed. PMID:26918425

  5. AN UNTARGETED METABOLOMICS ANALYSIS OF ANTIPSYCHOTIC USE IN BIPOLAR DISORDER

    PubMed Central

    Burghardt, Kyle J.; Evans, Simon J.; Wiese, Kristen M.; Ellingrod, Vicki L.

    2015-01-01

    Background Second generation antipsychotic (SGA) use in bipolar disorder is common and has proven effective in short-term trials. There continues to be a lack of understanding of the mechanisms underlying many of their positive and negative effects in bipolar disorder. This study aimed to describe the metabolite profiles of bipolar subjects treated with SGAs by comparing to metabolite profiles of bipolar subjects treated with lithium, and schizophrenia subjects treated with SGAs. Methods Cross-sectional, fasting untargeted serum metabolomic profiling was conducted in 82 subjects diagnosed with bipolar I disorder (n=30 on SGAs and n=32 on lithium) or schizophrenia (n=20). Metabolomic profiles of bipolar subjects treated with SGAs were compared to bipolar subjects treated with lithium and schizophrenia subjects treated with SGAs using multivariate methods. Results Partial lease square discriminant analysis (PLS-DA) plots showed separation between bipolar subjects treated with SGAs, bipolar subjects treated with lithium, or schizophrenia subjects treated with SGAs. Top influential metabolite features were associated with several pathways including that of polyunsaturated fatty acids, pyruvate, glucose and branched chain amino acids. Conclusions The findings from this study require further validation in pre and post treated bipolar and schizophrenia subjects, but suggest that the pharmacometabolome may be diagnosis specific. PMID:26314700

  6. [Major depression: features indicative of bipolarity?].

    PubMed

    Azorin, J-M

    2011-12-01

    Several recent studies have shown that bipolar disorder is underdiagnosed in patients with major depression. Missing the diagnosis of a bipolar disorder may have serious and even occasionally fatal consequences for a patient with the disease. Moreover misdiagnosis may lead to inappropriate treatment and therefore contribute to worsening medical and functional prognosis. Although there are no pathognomonic characteristics of bipolar depression compared to unipolar depression, evidence-based findings suggest that some features may be indicative of bipolarity, in patients with depression. These features are related to clinical picture of depressive state, course of episode and illness, response to treatment, family history, comorbid conditions, as well as demographic and temperamental characteristics. Based on such features, some authors have proposed operationalized criteria or a diagnostic specific for bipolarity, to identify bipolar depression. Screening instruments may also be used, to facilitate early recognition. Validation studies of these diagnostic features and instruments are underway.

  7. Effects of cognitive remediation on cognitive dysfunction in partially or fully remitted patients with bipolar disorder: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background A large proportion of patients with bipolar disorder experience persistent cognitive dysfunction, such as memory, attention and planning difficulties, even during periods of full remission. The aim of this trial is to investigate whether cognitive remediation, a new psychological treatment, improves cognitive function and, in turn, psychosocial function in patients with bipolar disorder in partial or full remission. Methods/Design The trial has an evaluator-blind, randomized, between-groups design. Forty patients with bipolar disorder in full or partial remission, aged 18 to 50 years, who report moderate to severe cognitive difficulties, are recruited. Patients are randomized to receive weekly group-based cognitive remediation treatment over 12 weeks in addition to standard treatment or standard treatment alone. Both groups undergo neurocognitive testing and functional magnetic resonance imaging (fMRI) at baseline, post-treatment (week 12) and follow-up (week 26). The primary outcome is improved verbal memory, as measured with the Rey Auditory Verbal Learning Test (RAVLT) from baseline to post-treatment. With inclusion of 40 patients we obtain 86% power to detect a clinically relevant difference in verbal memory between groups. Secondary outcomes are improved attention, executive function and psychosocial function, as measured with the Rapid Visual Information Processing test, the Trail Making Test part B and the Functional Assessment Short Test (FAST), respectively. Tertiary outcomes are improved scores for additional neuropsychological tests of memory, attention, executive function and facial expression recognition, as well as in questionnaires measuring subjective cognitive difficulties, stress, coping strategies, personality traits, depressive symptoms and quality of life. Discussion This is the first randomized controlled trial to evaluate the effects of cognitive remediation on cognitive function in patients with bipolar disorder who experience

  8. Intrahepatic Flow Redistribution in Patients Treated with Radioembolization

    SciTech Connect

    Spreafico, Carlo Morosi, Carlo; Maccauro, Marco; Romito, Raffaele; Lanocita, Rodolfo Civelli, Enrico M.; Sposito, Carlo Bhoori, Sherrie; Chiesa, Carlo; Frigerio, Laura F.; Lorenzoni, Alice; Cascella, Tommaso Marchianò, Alfonso; Mazzaferro, Vincenzo

    2015-04-15

    IntroductionIn planning Yttrium-90 ({sup 90}Y)-radioembolizations, strategy problems arise in tumours with multiple arterial supplies. We aim to demonstrate that tumours can be treated via one main feeding artery achieving flow redistribution by embolizing accessory vessels.MethodsOne hundred {sup 90}Y-radioembolizations were performed on 90 patients using glass microspheres. In 19 lesions/17 patients, accessory branches were found feeding a minor tumour portion and embolized. In all 17 patients, the assessment of the complete perfusion was obtained by angiography and single photon emission computerized tomography–computerized tomography (SPECT–CT). Dosimetry, toxicity, and tumor response rate of the patients treated after flow redistribution were compared with the 83 standard-treated patients. Seventeen lesions in 15 patients with flow redistribution were chosen as target lesions and evaluated according to mRECIST criteria.ResultsIn all patients, the complete tumor perfusion was assessed immediately before radioembolization by angiography in all patients and after the {sup 90}Y-infusion by SPECT–CT in 15 of 17 patients. In the 15 assessable patients, the response rate in their 17 lesions was 3 CR, 8 PR, and 6 SD. Dosimetric and toxicity data, as well tumour response rate, were comparable with the 83 patients with regular vasculature.ConclusionsAll embolization procedures were performed successfully with no complications, and the flow redistribution was obtained in all cases. Results in term of toxicity, median dose administered, and radiological response were comparable with standard radioembolizations. Our findings confirmed the intratumoral flow redistribution after embolizing the accessory arteries, which makes it possible to treat the tumour through its single main feeding artery.

  9. Development of psychosis in patients with epilepsy treated with lamotrigine: report of six cases and review of the literature.

    PubMed

    Brandt, Christian; Fueratsch, Nora; Boehme, Volker; Kramme, Corinna; Pieridou, Maria; Villagran, Antonia; Woermann, Friedrich; Pohlmann-Eden, Bernd

    2007-08-01

    Lamotrigine (LTG) is a generally well-tolerated antiepileptic drug (AED) with broad-spectrum efficacy in several forms of partial and generalized epilepsy and is also licensed for use in bipolar disorder in several countries. We describe six patients who developed a psychotic disorder--in most, but not all, cases schizophrenia-like in character--under treatment with LTG, within a group of about 1400 patients treated with this drug in our center. This indicates that psychosis is a rare adverse event under LTG treatment. On the background of available drug serum levels, we suggest, in particular, an intrinsic or toxic psychotogenic effect of LTG. Possible risk factors seem to be psychiatric comorbidity and temporal lobe pathology. The described phenomenon is discussed within the context of possible psychotogenic effects of other AEDs.

  10. Hair cortisol measurement in mitotane-treated adrenocortical cancer patients.

    PubMed

    Manenschijn, L; Quinkler, M; van Rossum, E F C

    2014-04-01

    The only approved drug for the treatment of adrenocortical cancer (ACC) is mitotane. Mitotane is adrenolytic and therefore, hydrocortisone replacement therapy is necessary. Since mitotane increases cortisol binding globulin (CBG) and induces CYP3A4 activity, high doses of hydrocortisone are thought to be required. Evaluation of hydrocortisone therapy in mitotane-treated patients has been difficult since there is no good marker to evaluate hydrocortisone therapy. Measurement of cortisol in scalp hair is a novel method that offers the opportunity to measure long-term cortisol levels. Our aim was to evaluate whether hair cortisol measurements could be useful in evaluating recent hydrocortisone treatment in mitotane-treated ACC patients. Hair cortisol levels were measured in 15 mitotane-treated ACC patients on hydrocortisone substitution and 96 healthy individuals. Cortisol levels were measured in 3 cm hair segments, corresponding to a period of 3 months. Hair cortisol levels were higher in ACC patients compared to healthy individuals (p<0.0001). Seven ACC patients (47%) had hair cortisol levels above the reference range. None of the patients had hair cortisol levels below normal. In contrast to hydrocortisone doses (β=0.03, p=0.93), hair cortisol levels were associated with BMI (β=0.53, p=0.042). There was no correlation between hair cortisol levels and hydrocortisone doses (β=0.41, p=0.13). Almost half of the ACC patients had high hair cortisol levels, suggesting long-term over-substitution of hydrocortisone in some of the patients, whereas none of the patients was under-substituted. Hair cortisol measurements might be useful in long-term monitoring hydrocortisone treatment in mitotane-treated ACC patients.

  11. Effects of mood state on divided attention in patients with bipolar disorder: evidence for beneficial effects of subclinical manic symptoms.

    PubMed

    Koenders, Manja A; Spijker, Annet T; Hoencamp, Erik; Haffmans, Judith P M; Zitman, Frans G; Giltay, Erik J

    2014-12-15

    A relatively small number of studies have been dedicated to the differential effects of the current mood state on cognition in patients with a bipolar disorder (BD). The aim of the current study was to investigate the effect of current mood state on divided attention (DA) performance, and specifically examine possible beneficial effects of the (hypo-) manic state. Over a maximum period of 24 months, medication use, divided attention test (a subtest of the Test for Attentional Performance (TAP)) was assessed every 6 months in 189 outpatients with BD. Data were analyzed with multilevel regression analysis (i.e. linear mixed models). DA performance varied considerable over time within patients. Corrected for psychotropic medication a significant quadratic relationship between manic symptoms and DA performance was found, with mild hypomanic symptoms having a positive influence on divided attention scores and moderate to severe manic symptoms having a negative influence. No association between depressive symptoms and DA performance was found. In future research on mania and cognition as well as in the clinical practice both the beneficial and negative effects of mania should be taken into account.

  12. The Characteristics of Treated Pulmonary Arterial Hypertension Patients in Ontario

    PubMed Central

    Vaid, Haris M.; Camacho, Ximena; Granton, John T.; Mamdani, Muhammad M.; Yao, Zhan; Singh, Samantha; Juurlink, David N.; Gomes, Tara

    2016-01-01

    Background. There are no Canadian prevalence studies on pulmonary arterial hypertension (PAH) to date. We described the characteristics of treated PAH patients and the healthcare utilization and costs associated with PAH in a population of public drug plan beneficiaries in Ontario, Canada. Methods. A retrospective cross-sectional analysis was conducted between April 2010 and March 2011 to identify treated PAH patients using population-based health administrative databases. We investigated demographic and clinical characteristics of treated PAH patients and conducted a cohort study to determine treatment patterns, healthcare utilization, and associated costs, over a one-year follow-up period (March 2012). Results. We identified 326 treated PAH cases in Ontario's publicly funded drug plan. Overall mean age was 59.4 years (±20.3 years) and over 77% of cases were women (n = 251). Combination therapy was used to treat 22.9% (n = 69) of cases, costing an average of $4,569 (SD $1,544) per month. Median monthly healthcare costs were $264 (IQR $96–$747) for those who survived and $2,021 (IQR $993–$6,399) for those who died over a one-year period, respectively (p < 0.01). Conclusions. PAH care in Ontario is complex and has high healthcare costs. This data may help guide towards improved patient management. PMID:27445555

  13. Maintenance Treatment With Varenicline for Smoking Cessation in Patients With Schizophrenia and Bipolar Disorder

    PubMed Central

    Evins, A. Eden; Cather, Corinne; Pratt, Sarah A.; Pachas, Gladys N.; Hoeppner, Susanne S.; Goff, Donald C.; Achtyes, Eric D.; Ayer, David; Schoenfeld, David A.

    2014-01-01

    Importance It is estimated that more than half of those with serious mental illness smoke tobacco regularly. Standard courses of pharmacotherapeutic cessation aids improve short-term abstinence, but most who attain abstinence relapse rapidly after discontinuation of pharmacotherapy. Objective To determine whether smokers diagnosed with schizophrenia and bipolar disease have higher rates of prolonged tobacco abstinence with maintenance pharmacotherapy than with standard treatment. Design, Setting, and Participants Randomized, double-blind, placebo-controlled, parallel-group, relapse-prevention clinical trial conducted in 10 community mental-health centers. Of 247 smokers with schizophrenia or bipolar disease recruited from March 2008-April 2012, 203 received 12-weeks' open-label varenicline and cognitive behavioral therapy and 87 met abstinence criteria to enter the relapse prevention intervention. Interventions Participants who had 2 weeks or more of continuous abstinence at week 12 of open treatment were randomly assigned to receive cognitive behavioral therapy and double-blind varenicline (1 mg, 2 per day) or placebo from weeks 12 to 52. Participants then discontinued study treatment and were followed up to week 76. Main Outcomes and Measures Seven-day rate of continuous abstinence at study week 52, the end of the relapse-prevention phase, confirmed by exhaled carbon monoxide. Secondary outcomes were continuous abstinence rates for weeks 12 through 64 based on biochemically verified abstinence and weeks 12 through 76, based on self-reported smoking behavior. Results Sixty-one participants completed the relapse-prevention phase; 26 discontinued participation (7 varenicline, 19 placebo) and were considered to have relapsed for the analyses; 18 of these had relapsed prior to dropout. At week 52, point-prevalence abstinence rates were 60% in the varenicline group (24 of 40) vs 19% (9 of 47) in the placebo group (odds ratio [OR], 6.2; 95% CI, 2.2-19.2; P < .001). From

  14. [Unipolar versus bipolar depression: clues toward predicting bipolarity disorder].

    PubMed

    Ben Abla, T; Ellouze, F; Amri, H; Krid, G; Zouari, A; M'Rad, M F

    2006-01-01

    Bipolar and unipolar disorders share a common depressive clinical manifestation. It is important to distinguish between these two forms of depression for several reasons. First, prescribing antidepressors in monotherapy indubitably worsens the prognosis of bipolarity disorders. Second, postponing the prescription of a mood stabilizer reduces the efficacy of the treatment and multiplies the suicidal risks by two. The object of this study is to reveal the factors that distinguish between unipolar and bipolar depression. This is a retrospective study on patients' files. It includes 186 patients divided according to DSM IV criteria into two groups: patients with bipolar disorder type I or II with a recent depressive episode (123 patients) and patients with recurrent depressive disorder (63 patients). A medical record card was filled-in for every patient. It included socio-demographic data, information about the disorder, family antecedents, CGI score (global clinical impressions), physical comorbidity, substance abuse and personality disorder. In order to sort out the categorization variables, the two groups were compared using chi2 test or Fischer's test. With regard to the quantitative variables, the two groups were compared using Krostal Wallis's test or Ancova. Our study has revealed that bipolar disorder differs significantly from unipolar disorder in the following respects: bipolar disorder is prevalent among men (sex-ratio 2) while unipolar disorder is prevailing among women (sex-ratio 0.8); patients with bipolar disorder are younger than patients with unipolar disorder (38.1 +/- 5 years vs. 49.7 +/- years); the age at the onset of bipolar disorder is earlier than that of unipolar disorder (20.8 +/- 2 years vs. 38.7 +/- 5 years); family antecedents are more important in bipolar patients than in unipolar patients (51.1% vs. 33%). More importantly, bipolar disorder differs from unipolar disorder in the following aspects: The number of suicidal attempts (25.3% vs

  15. Insulin-like Growth Factor 1 Differentially Affects Lithium Sensitivity of Lymphoblastoid Cell Lines from Lithium Responder and Non-responder Bipolar Disorder Patients.

    PubMed

    Milanesi, Elena; Hadar, Adva; Maffioletti, Elisabetta; Werner, Haim; Shomron, Noam; Gennarelli, Massimo; Schulze, Thomas G; Costa, Marta; Del Zompo, Maria; Squassina, Alessio; Gurwitz, David

    2015-07-01

    Bipolar disorder (BD) is a chronic psychiatric illness with an unknown etiology. Lithium is considered the cornerstone in the management of BD, though about 50-60 % of patients do not respond sufficiently to chronic treatment. Insulin-like growth factor 1 (IGF1) has been identified as a candidate gene for BD susceptibility, and its low expression has been suggested as a putative biomarker for lithium unresponsiveness. In this study, we examined the in vitro effects of insulin-like growth factor 1 (IGF-1) on lithium sensitivity in lymphoblastoid cell lines (LCLs) from lithium responder (R) and non-responder (NR) bipolar patients. Moreover, we evaluated levels of microRNA let-7c, a small RNA predicted to target IGF1. We found that exogenous IGF-1 added to serum-free media increased lithium sensitivity selectively in LCLs from NR BD patients. However, no significant differences were observed when comparing let-7c expression in LCLs from R vs. NR BD patients. Our data support a key role for IGF-1 in lithium resistance/response in the treatment of bipolar disorder.

  16. What is Bipolar Disorder?

    MedlinePlus

    ... affect friends and family? For More Information Share Bipolar Disorder Download PDF Download ePub Order a free hardcopy ... brochure will give you more information. What is bipolar disorder? Bipolar disorder is a serious brain illness. It ...

  17. The changing face of HIV/AIDS in treated patients.

    PubMed

    Llibre, Josep M; Falco, Vicenç; Tural, Cristina; Negredo, Eugenia; Pineda, Juan A; Muñoz, Jose; Ortega, Enrique; Videla, Sebastia; Sirera, Guillem; Martinez, Esteban; Miralles, Celia; Iribarren, Josean; Galindo, Maria J; Domingo, Pere; d'Arminio-Monforte, Antonella; Miro, Jose M; Clotet, Bonaventura

    2009-07-01

    The spectrum of complications emerging in successfully treated HIV-infected patients has dramatically changed since the advent of HAART. Typical AIDS-defining illnesses have been substituted by new comorbid conditions that threaten even those patients who maintain virologic suppression. Proper management of cardiovascular risk, and early diagnosis of AIDS-related and, particularly, non-AIDS-related malignancies (including papilomavirus-related neoplasms) must be introduced into the routine of care. Hot areas of investigation include HIV-associated neurocognitive disorders, hepatitis B and C coinfection, non-alcoholic fatty liver disease, progressive multifocal leukoencephalopathy and tuberculosis. Bone and kidney long-term toxicities and lipoatrophy remain as issues of paramount importance. The identification and early treatment of immune reconstitution disease is also of major interest, specially in those patients starting their antiretroviral treatment with severe CD4 cell depletion. The present review focuses on these twelve areas of increasing interest for physicians currently facing successfully treated HIV+ patients.

  18. Use of clozapine alongside chemotherapy in a treatment-resistant bipolar disorder patient with ovarian carcinoma: A case report and brief review

    PubMed Central

    Pakhre, Ashish; Krishnan, Aarya; Pattanayak, Raman Deep; Khandelwal, Sudhir K.

    2016-01-01

    Regular monitoring of blood counts ensures the safety of clozapine use; however, certain clinical situations may pose a dilemma for management such as use of clozapine in the presence of myelosuppressive chemotherapy. Further, there is very limited literature to guide such decisions. We report a case of a clozapine-stabilized, treatment-resistant bipolar disorder patient with ovarian carcinoma requiring chemotherapy. The clinical challenges are discussed in light of a brief review of the available reports. PMID:28197007

  19. Genetics Home Reference: bipolar disorder

    MedlinePlus

    ... Me Understand Genetics Home Health Conditions bipolar disorder bipolar disorder Enable Javascript to view the expand/collapse boxes. ... bipolar affective psychosis bipolar spectrum disorder depression, bipolar manic depressive illness Related Information How are genetic conditions and genes ...

  20. [Comorbid autoimmune pathology in patients treated with disease modifying drugs].

    PubMed

    Goncharova, Z A; Sizyakina, L P; Belovolova, R A; Megeryan, V A

    2016-01-01

    Because of intensive growth of the prevalence of multiple sclerosis (MS) and other autoimmune diseases (AID) during the last years, the comorbidity of MS and AID is not a rarity. In this literature review, the development of comorbid AID in patients with MS is considered to be the probable complication of disease modifying therapy with drugs of different groups. The authors present the own data on the prevalence of comorbid autoimmune pathology in patients with MS treated with disease modifying drugs.

  1. Analysis of polyglutamine-coding repeats in the TATA-binding protein in different human populations and in patients with schizophrenia an bipolar affective disorder

    SciTech Connect

    Rubinsztein, D.C.; Leggo, J.; Crow, T.J.

    1996-09-20

    A new class of disease (including Huntington disease, Kennedy disease, and spinocerebellar ataxias types 1 and 3) results from abnormal expansions of CAG trinucleotides in the coding regions of genes. In all of these diseases the CAG repeats are thought to be translated into polyglutamine tracts. There is accumulating evidence arguing for CAG trinucleotide expansions as one of the causative disease mutations in schizophrenia and bipolar affective disorder. We and others believe that the TATA-binding protein (TBP) is an important candidate to investigate in these diseases as it contains a highly polymorphic stretch of glutamine codons, which are close to the threshold length where the polyglutamine tracts start to be associated with disease. Thus, we examined the lengths of this polyglutamine repeat in normal unrelated East Anglians, South African Blacks, sub-Saharan Africans mainly from Nigeria, and Asian Indians. We also examined 43 bipolar affective disorder patients and 65 schizophrenic patients. The range of polyglutamine tract-lengths that we found in humans was from 26-42 codons. No patients with bipolar affective disorder and schizophrenia had abnormal expansions at this locus. 22 refs., 1 tab.

  2. The Diagnosis and Treatment of Bipolar Disorder: Decision-Making in Primary Care

    PubMed Central

    2014-01-01

    Bipolar disorder is a chronic episodic illness, characterized by recurrent episodes of manic or depressive symptoms. Patients with bipolar disorder frequently present first to primary care, but the diversity of the potential symptoms and a low index of suspicion among physicians can lead to misdiagnosis in many patients. Frequently, co-occurring psychiatric and medical conditions further complicate the differential diagnosis. A thorough diagnostic evaluation at clinical interview, combined with supportive case-finding tools, is essential to reach an accurate diagnosis. When treating bipolar patients, the primary care physician has an integral role in coordinating the multidisciplinary network. Pharmacologic treatment underpins both short- and long-term management of bipolar disorder. Maintenance treatment to prevent relapse is frequently founded on the same pharmacologic approaches that were effective in treating the acute symptoms. Regardless of the treatment approach that is selected, monitoring over the long term is essential to ensure continued symptom relief, functioning, safety, adherence, and general medical health. This article describes key decision-making steps in the management of bipolar disorder from the primary care perspective: from initial clinical suspicion to confirmation of the diagnosis to decision-making in acute and longer-term management and the importance of patient monitoring. PMID:25317368

  3. Ofuji's disease in an immunocompetent patient successfully treated with dapsone

    PubMed Central

    Anjaneyan, Gopikrishnan; Manne, Sindhura; Panicker, Vinitha Varghese; Eapen, Malini

    2016-01-01

    Eosinophilic pustular folliculitis or Ofuji's disease is a non-infectious eosinophilic infiltration of hair follicles, which usually presents with itchy papules and pustules in a circinate configuration. We report this case of an immunocompetent patient with erythematous papules and plaques without macropustules diagnosed as eosinophilic pustular folliculitis—a rarely reported entity outside Japan. He was successfully treated with oral dapsone. PMID:27730038

  4. Psychiatrists' Perceptions and Practices in Treating Patients' Obesity

    ERIC Educational Resources Information Center

    Lichwala-Zyla, Christine; Price, James H.; Dake, Joseph A.; Jordan, Timothy; Price, Joy Ann

    2009-01-01

    Objective: This study identified psychiatrists' perceptions and practices regarding advising and treating obese patients. Methods: Questionnaires were mailed to a national random sample of 500 members of APA. A three-wave mailing was used to maximize the return rate. The questionnaire contained items on weight control based on the Stages of Change…

  5. Silent venous thromboembolism in multiple myeloma patients treated with lenalidomide.

    PubMed

    Isoda, Atsushi; Sato, Naru; Miyazawa, Yuri; Matsumoto, Yoshinobu; Koumoto, Mina; Ookawa, Masahito; Sawamura, Morio; Matsumoto, Morio

    2015-09-01

    Lenalidomide treatment in combination with dexamethasone and/or chemotherapy is associated with a significant risk of venous thromboembolism (VTE) in patients with multiple myeloma (MM). However, the incidence of asymptomatic VTE in lenalidomide-treated MM patients remains unclear. A total of 80 relapsed and refractory MM patients treated with lenalidomide-containing regimens in a single institution between July 2010 and July 2014 were retrospectively analyzed. Of these, eight patients had asymptomatic VTE before starting lenalidomide. The remaining 72 patients received thromboprophylaxis with low-dose aspirin (100 mg daily) and monitoring of plasma D-dimer levels on each visit. During the median follow-up time of 7.3 months (range 1.0-43.5 months), 29 patients (40.3 %) showed an elevation of D-dimer (≥2.5 μg/mL), and 13 (18.1 %) showed asymptomatic VTE in a lower extremity. Median time to asymptomatic VTE events from initiation of lenalidomide treatment was 3.0 months (range 1.0-13.1 months). All patients having an asymptomatic VTE continued lenalidomide treatment on warfarinization (target international normalized ratio 1.5-2.5), and none of them developed symptomatic VTE. In conclusion, an asymptomatic VTE event occurred in 18 % of Japanese MM patients receiving lenalidomide-containing therapy despite aspirin prophylaxis. Serial monitoring of plasma D-dimer levels and early intervention may help to prevent symptomatic or lethal VTE events.

  6. Physical Activity in Patients Treated With Peritoneal Dialysis

    PubMed Central

    Thangarasa, Tharshika; Imtiaz, Rameez; Hiremath, Swapnil; Zimmerman, Deborah

    2017-01-01

    Background: Patients with chronic diseases are known to benefit from exercise. Despite a lack of compelling evidence, patients with end-stage kidney disease treated with peritoneal dialysis are often discouraged from participating in exercise programs that include resistance training due to concerns about the development of hernias and leaks. The actual effects of physical activity with or without structured exercise programs for these patients remain unclear. The purpose of this study is to more completely define the risks and benefits of physical activity in the end-stage kidney disease population treated with peritoneal dialysis. Methods/design: We will conduct a systematic review examining the effects of physical activity on end-stage kidney disease patients treated with peritoneal dialysis. For the purposes of this review, exercise will be considered a purposive subcategory of physical activity. The primary objective is to determine if physical activity in this patient population is associated with improvements in mental health, physical functioning, fatigue and quality of life and if there is an increase in adverse outcomes. With the help of a skilled librarian, we will search MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials for randomized trials and observational studies. We will include adult end-stage kidney disease patients treated with peritoneal dialysis that have participated in an exercise training program or had their level of physical activity assessed directly or by self-report. The study must include an assessment of the association between physical activity and one of our primary or secondary outcomes measures. We will report study quality using the Cochrane Risk of Bias Assessment Tool for randomized controlled trials and the Newcastle–Ottawa Scale for observational studies. Quality across studies will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The

  7. Transcriptomic Analysis of Induced Pluripotent Stem Cells Derived from Patients with Bipolar Disorder from an Old Order Amish Pedigree

    PubMed Central

    Kim, Kwi Hye; Liu, Jiangang; Sells Galvin, Rachelle J.; Dage, Jeffrey L.; Egeland, Janice A.; Smith, Rosamund C.; Merchant, Kalpana M.; Paul, Steven M.

    2015-01-01

    Fibroblasts from patients with Type I bipolar disorder (BPD) and their unaffected siblings were obtained from an Old Order Amish pedigree with a high incidence of BPD and reprogrammed to induced pluripotent stem cells (iPSCs). Established iPSCs were subsequently differentiated into neuroprogenitors (NPs) and then to neurons. Transcriptomic microarray analysis was conducted on RNA samples from iPSCs, NPs and neurons matured in culture for either 2 weeks (termed early neurons, E) or 4 weeks (termed late neurons, L). Global RNA profiling indicated that BPD and control iPSCs differentiated into NPs and neurons at a similar rate, enabling studies of differentially expressed genes in neurons from controls and BPD cases. Significant disease-associated differences in gene expression were observed only in L neurons. Specifically, 328 genes were differentially expressed between BPD and control L neurons including GAD1, glutamate decarboxylase 1 (2.5 fold) and SCN4B, the voltage gated type IV sodium channel beta subunit (-14.6 fold). Quantitative RT-PCR confirmed the up-regulation of GAD1 in BPD compared to control L neurons. Gene Ontology, GeneGo and Ingenuity Pathway Analysis of differentially regulated genes in L neurons suggest that alterations in RNA biosynthesis and metabolism, protein trafficking as well as receptor signaling pathways may play an important role in the pathophysiology of BPD. PMID:26554713

  8. Psychiatric diagnoses in patients who screen positive on the Mood Disorder Questionnaire: Implications for using the scale as a case-finding instrument for bipolar disorder.

    PubMed

    Zimmerman, Mark; Galione, Janine N; Chelminski, Iwona; Young, Diane; Dalrymple, Kristy

    2011-02-28

    Bipolar disorder is prone to being overlooked because its diagnosis is more often based on retrospective report than cross-sectional assessment. Recommendations for improving the detection of bipolar disorder include the use of screening questionnaires. The Mood Disorder Questionnaire (MDQ) is the most widely studied self-report screening scale that has been developed to improve the detection of bipolar disorder. Although developed as a screening scale, the MDQ has also been used as a case-finding measure. However, studies of the MDQ in psychiatric patients have found high false positive rates, though no study has determined the psychiatric diagnoses associated with false positive results on the MDQ. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to identify the psychiatric disorders associated with increased false positive rates on the MDQ. Four hundred eighty psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV (SCID) and completed the MDQ. After excluding the 52 patients diagnosed with a lifetime history of bipolar disorder we compared diagnostic frequencies in patients who did and did not screen positive on the MDQ. Based on the Hirschfeld et al. scoring guidelines of the MDQ, 15.2% (n=65) of the 428 nonbipolar patients screened positive on MDQ. Compared to patients who screened negative, the patients who screened positive were significantly more likely have a current and lifetime diagnosis of specific phobia, posttraumatic stress disorder, alcohol and drug use disorders, any eating disorder, any impulse control disorder, and attention deficit disorder. Results were similar using a less restrictive threshold to identify MDQ cases. That is, MDQ caseness was associated with significantly elevated rates of anxiety, impulse control, substance use, and attention deficit disorders. Studies using the MDQ as a stand-alone proxy for the diagnosis of

  9. Repeated Assessment of Exploration and Novelty Seeking in the Human Behavioral Pattern Monitor in Bipolar Disorder Patients and Healthy Individuals

    PubMed Central

    Minassian, Arpi; Henry, Brook L.; Young, Jared W.; Masten, Virginia; Geyer, Mark A.; Perry, William

    2011-01-01

    Background Exploration and novelty seeking are cross-species adaptive behaviors that are dysregulated in bipolar disorder (BD) and are critical features of the illness. While these behaviors have been extensively quantified in animals, multivariate human paradigms of exploration are lacking. The human Behavioral Pattern Monitor (hBPM), a human version of the animal open field, identified a signature pattern of hyper-exploration in manic BD patients, but whether exploratory behavior changes with treatment is unknown. The objective of this study was to assess the sensitivity of the hBPM to changes in manic symptoms, a necessary step towards elucidating the neurobiology underlying BD. Methodology and Principal Findings Twelve acutely hospitalized manic BD subjects and 21 healthy volunteers were tested in the hBPM over three sessions; all subjects were retested one week after their first session and two weeks after their second session. Motor activity, spatial and entropic (degree of unpredictability) patterns of exploration, and interactions with novel objects were quantified. Manic BD patients demonstrated greater motor activity, extensive and more unpredictable patterns of exploration, and more object interactions than healthy volunteers during all three sessions. Exploration and novelty-seeking slightly decreased in manic BD subjects over the three sessions as their symptoms responded to treatment, but never to the level of healthy volunteers. Among healthy volunteers, exploration did not significantly decrease over time, and hBPM measures were highly correlated between sessions. Conclusions/Significance Manic BD patients showed a modest reduction in symptoms yet still demonstrated hyper-exploration and novelty seeking in the hBPM, suggesting that these illness features may be enduring characteristics of BD. Furthermore, behavior in the hBPM is not subject to marked habituation effects. The hBPM can be reliably used in a repeated-measures design to characterize

  10. A feasibility study of expert patient and community mental health team led bipolar psychoeducation groups: implementing an evidence based practice

    PubMed Central

    2013-01-01

    Background Group psychoeducation is a cost effective intervention which reduces relapse and improves functioning in bipolar disorder but is rarely implemented. The aim of this study was to identify the acceptability and feasibility of a group psychoeducation programme delivered by community mental health teams (CMHTs) and peer specialist (PS) facilitators. Organisational learning was used to identify and address systematically barriers and enablers, at organisational, health professional and patient levels, to its implementation into a routine service. Methods A systematic examination of barriers and enablers to a three day training process informed the delivery of a first treatment group and a similar process informed the delivery of the second treatment group. Triangulation of research methods improved its internal validity: direct observation of training, self-rated surveys of participant experiences, group discussion, and thematically analysed individual participant and facilitator interviews were employed. Results Barriers and enablers were identified at organisational, educational, treatment content, facilitator and patient levels. All barriers under the control of the research team were addressed with subsequent improvements in patient knowledge about the condition and about local service. In addition, self-management, agency and altruism were enhanced. Barriers that could not be addressed required senior clinical and education leadership outside the research team’s control. PS and professional facilitators were successfully trained and worked together to deliver groups which were generally reported as being beneficial. Conclusion Psychoeducation groups involving CMHT and PS facilitators is acceptable and feasible but their sustainment requires senior leadership within and outside the organisation that control finance and education services. PMID:24215655

  11. Genetic and clinical factors predict lithium's effects on PER2 gene expression rhythms in cells from bipolar disorder patients.

    PubMed

    McCarthy, M J; Wei, H; Marnoy, Z; Darvish, R M; McPhie, D L; Cohen, B M; Welsh, D K

    2013-10-22

    Bipolar disorder (BD) is associated with abnormal circadian rhythms. In treatment responsive BD patients, lithium (Li) stabilizes mood and reduces suicide risk. Li also affects circadian rhythms and expression of 'clock genes' that control them. However, the extent to which BD, Li and the circadian clock share common biological mechanisms is unknown, and there have been few direct measurements of clock gene function in samples from BD patients. Hence, the role of clock genes in BD and Li treatment remains unclear. Skin fibroblasts from BD patients (N=19) or healthy controls (N=19) were transduced with Per2::luc, a rhythmically expressed, bioluminescent circadian clock reporter gene, and rhythms were measured for 5 consecutive days. Rhythm amplitude and period were compared between BD cases and controls with and without Li. Baseline period was longer in BD cases than in controls. Li 1 mM increased amplitude in controls by 36%, but failed to do so in BD cases. Li 10 mM lengthened period in both BD cases and controls. Analysis of clock gene variants revealed that PER3 and RORA genotype predicted period lengthening by Li, whereas GSK3β genotype predicted rhythm effects of Li, specifically among BD cases. Analysis of BD cases by clinical history revealed that cells from past suicide attempters were more likely to show period lengthening with Li 1 mM. Finally, Li enhanced the resynchronization of damped rhythms, suggesting a mechanism by which Li could act therapeutically in BD. Our work suggests that the circadian clock's response to Li may be relevant to molecular pathology of BD.

  12. Severe hyponatraemia in an amiloride/hydrochlorothiazide-treated patient.

    PubMed

    van Assen, S; Mudde, A H

    1999-03-01

    A 85-year-old woman treated with, among other drugs, a thiazide diuretic presented with a severe hyponatraemia. She met several of the criteria for SIADH and, besides drugs, no cause for SIADH was found. After stopping the thiazide diuretic and restricting fluid intake the patient recovered fully. It was later proved that the thiazide was the cause of the water intoxication by rechallenging the patient with a single dose of amiloride/hydrochlorothiazide 5/50 mg. This "thiazide provocation test" showed its usefulness in the differential diagnosis of suspected SIADH. Moreover, the test demonstrated the paradoxal effect of thiazide diuretics to cause water retention in susceptible patients.

  13. Diagnosis and treatment of postpartum bipolar depression.

    PubMed

    Kelly, Erin; Sharma, Verinder

    2010-07-01

    The postpartum period is a time of increased risk of new-onset psychiatric illness, hospital admissions and out-patient psychiatric care for new mothers. Research into postpartum mood disorders has focused primarily on major depressive disorder, and has overlooked the study of bipolar disorder, particularly bipolar II disorder and bipolar disorder not otherwise specified. Failure to properly diagnose postpartum bipolar disorder may delay the initiation of appropriate treatment, lead to inappropriate treatment - thereby precipitating (hypo)mania, rapid cycling or a mixed episode - or result in polypharmacy and treatment refractoriness. The most serious consequence, however, is the high risk of infanticide and suicide among women with postpartum bipolar disorder. While no specific screening tools have been validated for postpartum mania or bipolar depression, symptoms of hypomania, atypical depression, a family history of bipolar disorder and a rapid onset of depressive symptoms following delivery may suggest a bipolar diathesis. In the absence of any pharmacological or psychotherapeutic treatments to guide clinical decision-making, it is recommended that the treatment of postpartum bipolar depression follow the same guidelines as the treatment of non-postpartum bipolar depression, using medications that are compatible with lactation.

  14. Accumulation of guanylate binding proteins in patients treated with interferons.

    PubMed

    Cheng, Y S; Becker-Manley, M F; Rucker, R G; Borden, E C

    1988-06-01

    We have previously described an interferon (IFN)-induced protein with a molecular weight of 67,000. This protein has an affinity to guanylates and is thus called guanylate binding protein (GBP). The synthesis of GBP is inducible by IFNs in all human diploid fibroblast cell lines that we studied. To determine whether or not the GBP synthesis is IFN-inducible in humans as well as in cultured cells, we have studied the levels of GBP in the peripheral blood leukocytes (PBL) of patients treated with either type I or type II IFN. An increased GBP level was found the day immediately after treatment with either type of IFN, and the elevated GBP levels were maintained for at least 8 days. Among the patients studied, we found a higher level GBP accumulation (2.3x) in patients treated with IFN-beta than in those treated with IFN-gamma (1.6x). The increase of GBP in patients receiving IFN-gamma correlated with increases in class II histocompatibility antigens, HLA-DR and HLA-DQ in monocytes. Thus, the levels of GBP in peripheral blood leukocytes may be used as a parameter for the study of IFN responses in patients.

  15. Do Comorbid Anxiety Disorders Moderate the Effects of Psychotherapy for Bipolar Disorder? Results From STEP-BD

    PubMed Central

    Deckersbach, Thilo; Peters, Amy T.; Sylvia, Louisa; Urdahl, Anna; Magalhães, Pedro V.S.; Otto, Michael W.; Frank, Ellen; Miklowitz, David J.; Berk, Michael; Kinrys, Gustavo; Nierenberg, Andrew

    2013-01-01

    Objective At least 50% of individuals with bipolar disorder have a lifetime anxiety disorder. Individuals with both bipolar disorder and a co-occurring anxiety disorder experience longer illness duration, greater illness severity, and poorer treatment response. The study explored whether comorbid lifetime anxiety in bipolar patients moderates psychotherapy treatment outcome. Method In the Systematic Treatment Enhancement Program randomized controlled trial of psychotherapy for bipolar depression, participants received up to 30 sessions of intensive psychotherapy (family-focused therapy, interpersonal and social rhythm therapy, or cognitive-behavioral therapy) or collaborative care, a three-session comparison treatment, plus pharmacotherapy. Using the number needed to treat, we computed effect sizes to analyze the relationship between lifetime anxiety disorders and rates of recovery across treatment groups after 1 year. Results A total of 269 patients (113 women) with a comorbid lifetime anxiety disorder (N=177) or without a comorbid lifetime anxiety disorder (N=92) were included in the analysis. Participants with a lifetime anxiety disorder were more likely to recover with psychotherapy than with collaborative care (66% compared with 49% recovered over 1 year; number needed to treat=5.88, small to medium effect). For patients without a lifetime anxiety disorder, there was no difference between rates of recovery in psychotherapy compared with collaborative care (64% compared with 62% recovered; number needed to treat=50, small effect). Participants with one lifetime anxiety disorder were likely to benefit from intensive psychotherapy compared with collaborative care (84% compared with 53% recovered; number needed to treat=3.22, medium to large effect), whereas patients with multiple anxiety disorders exhibited no difference in response to the two treatments (54% compared with 46% recovered; number needed to treat=12.5, small effect). Conclusions Depressed patients

  16. Fluoroscopy-guided Bipolar Radiofrequency Thermocoagulation Treatment for Discogenic Low Back Pain

    PubMed Central

    Zhang, Li; Ding, Xin-Li; Zhao, Xu-Li; Wang, Jun-Nan; Li, Yan-Ping; Tian, Ming

    2016-01-01

    Background: The efficacy of percutaneous intradiscal radiofrequency thermocoagulation (PIRFT) for the treatment of discogenic low back pain (LBP) remains controversial. However, all the PIRFT studies utilized monopolar radiofrequency thermocoagulation (RFTC). The aim of this study was to investigate the safety and efficacy of bipolar RFTC for the treatment of discogenic LBP. Methods: A total of 23 patients with discogenic LBP were treated with single-level bipolar RFTC. The patients were assessed before the procedure and at 1 week, 1 month, 3 months, 6 months, and 1 year after the procedure. The primary outcome included the visual analog scale (VAS) score and the Oswestry Disability Index (ODI) score. The secondary outcome included pain relief, reduction of analgesic dose, and patient satisfaction. Results: The VAS and ODI scores were significantly decreased after bipolar RFTC treatment at all time points of follow-up (P < 0.05). Bipolar RFTC treatment also resulted in a significant change in all secondary measures, such as pain relief, reduction of analgesic dose, and patient satisfaction. No serious complications or neurological sequelae were observed in any of the patients. Conclusions: Bipolar RFTC treatment can significantly attenuate pain and improve the function of patients with discogenic LBP. PMID:27647190

  17. Hearing Loss in Patients with Shunt-Treated Hydrocephalus.

    PubMed

    Panova, Margarita V; Geneva, Ina E; Madjarova, Kalina I; Bosheva, Miroslava N

    2015-01-01

    Hearing loss is a common manifestation of the long-term complications in patients with shunt treated hydrocephalus along with motor development disturbance, cognitive and visual impairment, epilepsy and endocrine disorders. The aim of the present study was to investigate the alterations of hearing in patients with shunt treated hydrocephalus of non-tumor etiology and at least one year after implantation of ventriculo-peritoneal shunt, as well as their impact on the quality of life of patients. The study included 70 patients (age range 1.25 years - 21.25 years) with shunted non-tumor hydrocephalus and at least one year after placement of the shunt system. Hearing alterations were proved by measuring the brainstem auditory evoked potentials (BAEP) for children up to 5 years of age and children with mental retardation; audiograms was used for children older than 5 years with normal neuro-psychological development (NPD). Of the 70 studied patients 17 (24%) had hearing loss (10 bilateral and 7-unilateral) and all of them had sensorineural hearing loss, which is associated with low weight at birth, posthemorrhagic hydrocephalus and brainstem symptoms at the time of diagnosis of hydrocephalus. Hearing pathology was found more often in shunt-treated patients with NPD retardation, poor functional status and low quality of life. Children with shunt-treated hydrocephalus have hearing loss of sensorineural type. Children with brain stem symptomatology at diagnosing hydrocephalus and children with post-hemorrhagic hydrocephalus show higher risk of hearing loss. Children with shunted hydrocephalus and hearing loss show lower NPD, lower quality of life and lower functional status.

  18. Cabergoline can induce mania with psychotic features in bipolar I disorder: a case report.

    PubMed

    Rovera, Chiara; Cremaschi, Laura; Thanju, Amod; Fiorentini, Alessio; Mauri, Massimo Carlo; Serati, Marta; Lindenmayer, Jean Pierre; Altamura, A Carlo

    2016-08-01

    Up to date, only a small evidence of psychosis induced by cabergoline is available in literature. Herein, the case of a 34-year-old bipolar patient treated with cabergoline has been described. Cabergoline is generally a safe and effective method of reducing prolactin levels and it may be associated with psychiatric side effects, including psychotic features.

  19. Multiple Meningioma in a Patient of Bipolar Disorder: The Dilemma of Detecting Structural Brain Lesions in the Backdrop of a Long Standing Psychiatric Illness

    PubMed Central

    Sood, Mamta; Khandelwal, Sudhir Kumar

    2016-01-01

    Multiple meningioma often can be clinically silent and may present with only psychiatric symptoms. We report a case of 43-year-old, right handed woman with a 23 year history of long standing bipolar affective disorder, who presented with a mixed episode with psychotic symptoms which did not respond to usual treatment and was further complicated with a different set of symptomatology. MRI brain revealed multiple dural based mass lesions identified to be multiple meningiomas. Patient’s symptoms improved after gamma knife stereotactic radiosurgery for the multiple meningioma. Our finding illustrates the need to assess for brain lesions in presence of atypical symptoms, along with unresponsiveness to traditional management with psychotropic medications in patients with bipolar affective disorders. PMID:27656537

  20. Activation of kynurenine pathway in ex vivo fibroblasts from patients with bipolar disorder or schizophrenia: cytokine challenge increases production of 3-hydroxykynurenine.

    PubMed

    Johansson, Anne-Sofie; Owe-Larsson, Björn; Asp, Linnéa; Kocki, Tomasz; Adler, Mats; Hetta, Jerker; Gardner, Renee; Lundkvist, Gabriella B S; Urbanska, Ewa M; Karlsson, Håkan

    2013-11-01

    Accumulating data suggest a causative link between immune stimulation, disturbed metabolism of tryptophan, and pathogenesis of bipolar disorder and schizophrenia. The goal of this study was to examine the production of kynurenic acid (KYNA), 3-hydroxykynurenine (3-HK) and the expression of kynurenine pathway enzymes involved in their synthesis and metabolism in cultured skin fibroblasts obtained from patients with bipolar disorder, schizophrenia or from healthy control individuals. The assessment was performed under basal conditions or following treatment with interferon (IFN)-γ, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, or their combinations, in cells exposed to exogenous kynurenine. In both groups of patients, the baseline production of KYNA and 3-HK was increased, as compared to control subjects. Case-treatment analyses revealed significant interactions between bipolar case status and IL-1β, IL-6, IFN-γ + TNF-α, or IFN-γ + IL-1β, as well as between schizophrenia case status and IL-1β, IFN-γ + TNF-α, or IFN-γ + IL-1β, in terms of higher 3-HK. Noteworthy, no case-treatment interactions in terms of KYNA production were found. Observed changes did not appear to correlate with the expression of genes encoding kynurenine aminotransferases (KATs), kynureninase (KYNU) or kynurenine-3-monooxygenase (KMO). The single nucleotide polymorphisms (SNPs), rs1053230 and rs2275163, in KMO influenced KYNA levels yet did not explain the case-treatment discrepancies. In conclusion, our present findings indicate the utility of skin-derived fibroblasts for kynurenines research and support the concept of kynurenine pathway alterations in bipolar disorder and schizophrenia. The increase in ratio between neurotoxic 3-HK and neuroinhibitory/neuroprotective KYNA following exposure to cytokines may account for altered neurogenesis and structural abnormalities characteristic for both diseases.

  1. Treatment of bipolar disorder in the Netherlands and concordance with treatment guidelines: study protocol of an observational, longitudinal study on naturalistic treatment of bipolar disorder in everyday clinical practice

    PubMed Central

    2014-01-01

    Background While various guidelines on the treatment of bipolar disorder have been published over the last decades, adherence to guidelines has been reported to be low. In this article we describe the protocol of a nationwide, multicenter, longitudinal, non-intervention study on the treatment of bipolar disorder in the Netherlands. Study aims are to provide information on the nature and content of outpatient treatment of bipolar disorder, to determine to what extent treatment is in concordance with the Dutch guideline for the treatment of bipolar disorder (2008), and to investigate the relationship of guideline concordance with symptomatic and functional outcome. Methods/Design Between December 2009 and February 2010, all psychiatrists registered as member of the Dutch Psychiatric Association received a questionnaire with questions about their treatment setting, and whether they would be willing to participate in further research. Psychiatrists treating adult outpatients with bipolar disorder were invited to participate. Consenting psychiatrist subsequently approached all their patients with bipolar disorder. The study is performed with written patient and caregiver surveys at baseline and after 12 months, including data on demographics, illness characteristics, organization of care, treatments received, symptomatic and functional outcome, quality of life, and burden of care for informal caregivers. Discussion This study will provide information on the naturalistic treatment of bipolar disorder in the Netherlands, as well as degree of concordance of this treatment with the Dutch guideline, and its relationship with symptomatic and functional outcome. Limitations of a survey-based study are discussed. PMID:24576061

  2. Pharmacotherapy of depression and mixed states in bipolar disorder.

    PubMed

    Montgomery, S A; Schatzberg, A F; Guelfi, J D; Kasper, S; Nemeroff, C; Swann, A; Zajecka, J

    2000-09-01

    The treatment of bipolar depression requires the resolution of depression and the establishment of mood stability. A basic problem is that the treatments used in treating bipolar depression were developed and proven effective for other disease states: antidepressants for unipolar depression, and mood stabilizers for mania. The panel addressed four unresolved questions regarding depression in relation to bipolar disorder: (1) the relative effectiveness of different antidepressant treatments; (2) the relative likelihood of mood destabilization with different antidepressant treatments; (3) the effectiveness and role of mood-stabilizing medicines as antidepressants; and (4) the optimal approach to mixed states. The selection of an antidepressant depends both on its relative lack of mania- or hypomania-provoking potential and on its effectiveness against bipolar depression. There is little definitive evidence distinguishing effectiveness of the major groups of antidepressive agents, so side-effect profiles and pharmacokinetics are major considerations. The underlying bipolar disorder should be treated with mood stabilizers started simultaneously with any antidepressive treatments. Lithium, divalproex sodium and carbamazepine have all been found to be helpful, to some extent, in treating bipolar depressive episodes as well as for long-term mood stabilization. There is little evidence for long-term benefits of antidepressive agents in bipolar disorder, and some evidence that they may destabilize the disorder. Therefore, in contrast to the long-term use of mood-stabilizers, antidepressant use is recommended on a temporary basis. The duration of antidepressant treatment is determined by past history in terms of liability for mood destabilization, and by the ability of the patient to tolerate gradual antidepressant discontinuation without return of depression. Mixed states, where symptoms of depression and mania coexist, are regarded as a predictor of relatively poor

  3. Short-term clinical stability and lack of insight are associated with a negative attitude towards antipsychotic treatment at discharge in patients with schizophrenia and bipolar disorder

    PubMed Central

    Medina, Esteban; Salvà, Joan; Ampudia, Rubén; Maurino, Jorge; Larumbe, Juan

    2012-01-01

    Purpose The primary aim of this study was to assess the range of attitudes towards antipsychotic treatment at hospital discharge in patients with schizophrenia and bipolar disorder. The secondary aim was to analyze the relationship between patients’ attitudes and sociodemographic and clinical parameters. Patients and methods A cross-sectional study with a sample of patients admitted due to acute exacerbation of schizophrenia or a manic episode was conducted. Attitude towards pharmacological treatment at discharge was assessed with the 10-item Drug Attitude Inventory (DAI-10). Logistic regression was used to determine significant variables associated with attitude to medication. Results Eighty-six patients were included in the study. The mean age was 43.1 years (standard deviation [SD] 12.1), and 55.8% were males. Twenty-six percent of the patients presented a negative attitude towards antipsychotic treatment (mean DAI-10 score of −4.7, SD 2.7). Most of them had a diagnosis of schizophrenia. Multivariate analysis showed that poor insight into illness and a greater number of previous acute episodes was significantly associated with a negative attitude towards medication at discharge (odds ratio 1.68 and 1.18, respectively). Conclusion Insight and clinical stability prior to admission were related to patients’ attitude towards antipsychotic treatment at hospital discharge among patients with schizophrenia and bipolar disorder. The identification of factors related to the attitude towards medication would offer an improved opportunity for clinicians to select patients eligible for prophylactic adherence-focused interventions. PMID:22969293

  4. Virginia Woolf, neuroprogression, and bipolar disorder.

    PubMed

    Boeira, Manuela V; Berni, Gabriela de Á; Passos, Ives C; Kauer-Sant'Anna, Márcia; Kapczinski, Flávio

    2017-01-01

    Family history and traumatic experiences are factors linked to bipolar disorder. It is known that the lifetime risk of bipolar disorder in relatives of a bipolar proband are 5-10% for first degree relatives and 40-70% for monozygotic co-twins. It is also known that patients with early childhood trauma present earlier onset of bipolar disorder, increased number of manic episodes, and more suicide attempts. We have recently reported that childhood trauma partly mediates the effect of family history on bipolar disorder diagnosis. In light of these findings from the scientific literature, we reviewed the work of British writer Virginia Woolf, who allegedly suffered from bipolar disorder. Her disorder was strongly related to her family background. Moreover, Virginia Woolf was sexually molested by her half siblings for nine years. Her bipolar disorder symptoms presented a pernicious course, associated with hospitalizations, suicidal behavioral, and functional impairment. The concept of neuroprogression has been used to explain the clinical deterioration that takes places in a subgroup of bipolar disorder patients. The examination of Virgina Woolf's biography and art can provide clinicians with important insights about the course of bipolar disorder.

  5. Neurocognitive function in patients with recurrent glioblastoma treated with bevacizumab

    PubMed Central

    Wefel, Jeffrey S.; Cloughesy, Timothy; Zazzali, James L.; Zheng, Maoxia; Prados, Michael; Wen, Patrick Y.; Mikkelsen, Tom; Schiff, David; Abrey, Lauren E.; Yung, W.K. Alfred; Paleologos, Nina; Nicholas, Martin K.; Jensen, Randy; Vredenburgh, James; Das, Asha; Friedman, Henry S.

    2011-01-01

    Neurocognitive decline is a frequent adverse effect of glioblastoma. Antitumor therapies that are efficacious, as measured by traditional endpoints such as objective response (OR) and progression-free survival (PFS), and have beneficial effects on neurocognitive function (NCF) are of clinical benefit to these patients. We evaluated neurocognitive changes across time in 167 patients with recurrent glioblastoma treated with bevacizumab-based therapy in BRAIN, a phase II, randomized, multicenter trial. All patients underwent MRI and neurocognitive testing at baseline and every 6 weeks thereafter. Memory, visuomotor scanning speed, and executive function were evaluated using the Hopkins Verbal Learning Test–Revised, the Trail Making Test, and the Controlled Oral Word Association test, respectively. NCF relative to baseline for patients with an OR, PFS >6 months, or disease progression was evaluated at time of OR, 24 weeks, and time of progression, respectively. For patients with an OR or PFS >6 months, median standardized test scores were examined from baseline to week 24. Most patients with an OR or PFS >6 months had poorer NCF performance compared to the general population at baseline and had improved or stable NCF at the time of response or at the 24-week assessment, respectively; most patients with progressive disease had neurocognitive decline at the time of progression. For patients with an OR or PFS >6 months, median standardized test scores were largely stable across the first 24 weeks on study. Neurocognitive testing was an objective, valid, and feasible method of monitoring NCF in patients with recurrent glioblastoma. PMID:21558074

  6. The relationship between bipolar disorder and type 2 diabetes: more than just co-morbid disorders.

    PubMed

    Calkin, Cynthia V; Gardner, David M; Ransom, Thomas; Alda, Martin

    2013-03-01

    Type 2 diabetes mellitus (T2DM) rates are three times higher in patients with bipolar disorder (BD), compared to the general population. This is a major contributing factor to the elevated risk of cardiovascular mortality, the leading cause of death in bipolar patients. There may be shared pathophysiology linking the two disorders, including hypothalamic-pituitary-adrenal and mitochondrial dysfunction, common genetic links, and epigenetic interactions. Life-style, phenomenology of bipolar symptoms, and adverse effects of pharmacotherapy may be contributing factors. Patients with BD and T2DM have a more severe course of illness and are more refractory to treatment. Control of their diabetes is poorer when compared to diabetics without BD, and an existing disparity in medical care may be partly responsible. Glucose abnormalities in bipolar patients need to be screened for and treated. Metformin appears to have the best benefit/risk ratio, and the dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists and analogues also appear promising, although these agents have not been specifically studied in populations with mood disorders. Physicians need to be aware of the increased risk for T2DM and cardiovascular disease in bipolar patients, and appropriate prevention, screening, case finding, and treatment is recommended.

  7. Cardiovascular considerations in patients treated with HIV protease inhibitors.

    PubMed

    Colagreco, Joseph P

    2004-01-01

    Highly active antiretroviral therapy (HAART) has dramatically reduced mortality from HIV infection, transforming it in many cases to a chronic condition. However, protease inhibitors (PIs), which are integral components of most HAART regimens, are commonly associated with a host of metabolic disturbances that may increase the risk of cardiovascular disease in patients with HIV infection, potentially counteracting some of the positive health effects of PIs. Dyslipidemia is of particular concern. The Adult AIDS Clinical Trials Group has established preliminary guidelines to evaluate and treat PI-associated dyslipidemia. A number of strategies exist for the management of PI-based dyslipidemia in HAART recipients; their advantages and disadvantages should be considered when treating patients with HIV infection.

  8. Dyspnoea management in acute coronary syndrome patients treated with ticagrelor

    PubMed Central

    Parodi, Guido; Storey, Robert F

    2015-01-01

    The occurrence of dyspnoea in acute coronary syndrome (ACS) patients has always been considered a challenging diagnostic and therapeutic clinical scenario. P2Y12 platelet receptor inhibitors (i.e., clopidogrel, prasugrel and ticagrelor) are currently the cornerstone of treatment of ACS patients. Thus, in the last few years, the potential association between ACS and dyspnoea has also become more challenging with the increasing use of ticagrelor in these patients due to its beneficial effects on ischaemic event prevention and mortality, since ticagrelor can induce dyspnoea as a side effect. The present article is intended to review the current literature regarding dyspnoea occurrence in ACS patients, especially those treated with ticagrelor, and to propose ticagrelor-associated dyspnoea management recommendations based on current knowledge. PMID:25267878

  9. Treating a transgender patient: overview of the guidelines.

    PubMed

    Wilczynski, Cory; Emanuele, Mary Ann

    2014-11-01

    Transgenderism and gender dysphoria are becoming more prevalent diagnoses and the patient population is increasing. Primary care practitioners, endocrinologists, and mental health professionals are all part of the medical care team that treats these patients, but family and internal medicine physicians continue to deliver the care in the long term. Transgender medicine is not a strong part of the medical curriculum, and recent studies have shown there is anxiety in new physicians in taking care of these patients. There are many aspects to transgender care that involve different specialities, including, but not limited to, mental health, primary care, endocrinology, surgery, and obstetrics and gynecology. This article gives an overview of the current guidelines for standards of care of transgender patients as delineated by the World Professional Association for Transgender Health and the Endocrine Society.

  10. Isolated hypomagnesemia in a patient treated with capecitabine.

    PubMed

    Rajapakse, Senaka; Rodrigo, Chaturaka; Rajapakse, Anoja C

    2013-09-01

    Hypomagnesemia is known to occur for a variety of renal, gastrointestinal and other causes, and is often associated with other electrolyte and metabolic disturbances. We present a case of isolated hypomagnesemia in a patient who had been treated with the chemotherapy agent capecitabine. The approach to diagnosis and treatment is discussed. We postulate that capecitabine may cause isolated hypomagnesemia, possibly due to renal magnesium loss.

  11. Who Treats Patients with Diabetes and Compensated Cirrhosis

    PubMed Central

    Barritt IV, A. Sidney; Weinberger, Morris; Paul, John E.; Fried, Bruce; Trogdon, Justin G.

    2016-01-01

    Background Increasingly, patients with multiple chronic conditions are being managed in patient-centered medical homes (PCMH) that coordinate primary and specialty care. However, little is known about the types of providers treating complex patients with diabetes and compensated cirrhosis. Objective We examined the mix of physician specialties who see patients dually-diagnosed with diabetes and compensated cirrhosis. Design Retrospective cross-sectional study using 2000–2013 MarketScan® Commercial Claims and Encounters and Medicare Supplemental Databases. Patients We identified 22,516 adults (≥ 18 years) dually-diagnosed with diabetes and compensated cirrhosis. Patients with decompensated cirrhosis, HIV/AIDS, or liver transplantation prior to dual diagnosis were excluded. Main Measures Physician mix categories: patients were assigned to one of four physician mix categories: primary care physicians (PCP) with no gastroenterologists (GI) or endocrinologists (ENDO); GI/ENDO with no PCP; PCP and GI/ENDO; and neither PCP nor GI/ENDO. Health care utilization: annual physician visits and health care expenditures were assessed by four physician mix categories. Key Results Throughout the 14 years of study, 92% of patients visited PCPs (54% with GI/ENDO and 39% with no GI/ENDO). The percentage who visited PCPs without GI/ENDO decreased 22% (from 63% to 49%), while patients who also visited GI/ENDO increased 71% (from 25% to 42%). Conclusions This is the first large nationally representative study to document the types of physicians seen by patients dually-diagnosed with diabetes and cirrhosis. A large proportion of these complex patients only visited PCPs, but there was a trend toward greater specialty care. The trend toward co-management by both PCPs and GI/ENDOs suggests that PCMH initiatives will be important for these complex patients. Documenting patterns of primary and specialty care is the first step toward improved care coordination. PMID:27783702

  12. Comparisons of the tolerability and sensitivity of quetiapine-XR in the acute treatment of schizophrenia, bipolar mania, bipolar depression, major depressive disorder, and generalized anxiety disorder

    PubMed Central

    Wang, Zuowei; Kemp, David E.; Chan, Philip K.; Fang, Yiru; Ganocy, Stephen J.; Calabrese, Joseph R.; Gao, Keming

    2012-01-01

    Quetiapine extended-release (quetiapine-XR) has been studied in patients with schizophrenia, bipolar mania, bipolar depression, major depressive disorder (MDD), and generalized anxiety disorder (GAD). The purpose of this study was to compare the tolerability and sensitivity of quetiapine-XR among these psychiatric conditions. The discontinuation due to adverse events (DAEs) and reported somnolence in randomized, double-blind, placebo-controlled studies of quetiapine-XR in these psychiatric conditions were examined. The absolute risk reduction or increase and the number needed to treat to benefit (NNTB) or harm (NNTH) for DAEs and reported somnolence of quetiapine-XR ≥300 mg/d relative to placebo were estimated. Data from one study in schizophrenia (n=465), one in mania (n=316), one in bipolar depression (n=280), two in refractory MDD (n=624), two in MDD (n=669) and three in GAD (n=1109) were available. The risk for DAEs of quetiapine-XR relative to placebo was significantly increased in bipolar depression (NNTH=9), refractory MDD (NNTH=8), MDD (NNTH=9), and GAD (NNTH=5), but not in schizophrenia and mania. The risk for reported somnolence of quetiapine-XR relative to placebo was significantly increased in schizophrenia (600 mg/d NNTH=15 and 800 mg/d NNTH=11), mania (NNTH=8), bipolar depression (NNTH=4), refractory MDD (NNTH=5), MDD (NNTH=5) and GAD (NNTH=5). These results suggest that patients with GAD had the poorest tolerability during treatment with quetiapine-XR, but they had a similar sensitivity as those with bipolar depression and MDD. Patients with schizophrenia or mania had a higher tolerability and a lower sensitivity than those with bipolar depression, MDD, or GAD. PMID:20875219

  13. [Pneumatic dilatation of achalasia: local experience in treating 41 patients].

    PubMed

    Honein, Khalil; Slim, Rita; Yaghi, César; Kheir, Bahaa; Bou Jaoudé, Joseph; Sayegh, Raymond

    2007-01-01

    L'achalasia is the best known primary motor disorder of the esophagus in which the lower esophageal sphincter (LES) has abnormally high resting pressure and incomplete relaxation with swallowing. Pneumatic dilatation (PD) remains the first choice of treatment. Our aim was to report, in a retrospective way, our experience in treating with pneumatic dilatation 41 achalasia patients admitted to the gastroenterology unit at Hôtel-Dieu de France (HDF) hospital between 1994 and 2004. A total of 46 dilatations were performed in 41 patients with achalasia [20 males and 21 females, the mean age was 46.8 years (range, 15-90)]. All patients underwent an initial dilatation by inflating a 35 mm balloon to 7 psi three times successively under fluoroscopic control. The need for subsequent dilatation with the same technique or for surgical treatment was based on symptom assessment. The mean follow-up period was 36.7 months (3 mo-7 years). Among the patients whose follow-up information was available, a satisfactory result was achieved in 29 patients (80.5%) after only one or two sessions of pneumatic dilatation. Esophageal perforation as a short-term complication was observed in one patient (2.17%). Seven patients were referred for surgery (one for esophageal perforation and six for persistent or recurrent symptoms). In conclusion, performing balloon dilatation under fluoroscopic observation is simple, safe and efficacious for treating patients with achalasia. Referral to repeated PD or to surgical myotomy should be discussed in case of no response to a first session of PD.

  14. Are critically ill older patients treated differently than similarly ill younger patients?

    PubMed Central

    Stillman, A E; Braitman, L E; Grant, R J

    1998-01-01

    Our goal was to determine whether critically ill older patients are treated differently than middle-aged patients. If so, what factors besides age contribute to that difference? Internal medicine residents (n = 46) and practicing internists (n = 41) received 8 clinical vignettes of 4 critically ill 85-year-old patients and 4 critically ill 50-year-old patients. Each patient had a distinct premorbid mental and physical state. Each respondent selected from 4 levels of therapeutic aggressiveness for each patient. The main outcome measure was the proportion of physicians who intended to treat the older of each matched pair of patients less aggressively than the younger one (that is, downgraded for age). Eight physicians (9%) treated a previously unimpaired 85-year-old patient less aggressively than a comparable 50-year-old patient. When the matched patients were either premorbidly mentally or physically impaired (but not both), about 20% of physicians downgraded for age. Most downgraded for age in matched patients who were premorbidly both mentally and physically impaired. We conclude that age alone does not engender much therapeutic bias against older patients as long as they are physically and mentally intact before the onset of their acute illness. As premorbid disabilities multiply, older patients may be treated less aggressively than younger ones with similar impairments and clinical presentations. PMID:9771155

  15. Aquaporin-4 antibody titration in NMO patients treated with rituximab

    PubMed Central

    Marnetto, Fabiana; Granieri, Letizia; Capobianco, Marco; Bertolotto, Antonio

    2016-01-01

    Objective: We undertook an observational retrospective study to investigate the usefulness of aquaporin-4 (AQP4) antibodies (Ab) titration in the management of patients with neuromyelitis optica (NMO) treated with rituximab (RTX) by studying (1) the correlation between AQP4-Ab titer and disease activity, (2) the influence of RTX on antibody levels, and (3) the association between AQP4-Ab levels and responsiveness to RTX. Methods: A cell-based assay was used for AQP4-Ab titration in 322 serum samples from 7 patients with NMO treated with RTX (median follow-up 65 months), according to a treatment-to-target approach. Serum samples were collected every month following standardized procedures. Results: (1) In group analysis, AQP4-Ab titers correlated with the disease activity, showing higher titers during and preceding relapses than during remission. However, in individual analysis, an increase in AQP4-Ab titers and CD19+ B cells did not always precede a relapse. (2) A reduction of AQP4-Ab titers in the short-term and long-term period was observed during RTX treatment. (3) Reduction of AQP4-Ab titers was observed in responder patients both 3 months after RTX infusion and in the long-term follow-up. In one nonresponder patient, AQP4-Ab levels never decreased during the treatment period. Conclusions: Titration of AQP4-Abs could be useful in the clinical management of patients with NMO treated with RTX: titration before each reinfusion and 3 months after each reinfusion may provide information about responsiveness to RTX. Although a relationship among AQP4-Ab levels, disease activity, and response to RTX was observed, the usefulness of AQP4-Ab titration to predict relapses is limited. PMID:28054001

  16. Altered functional connectivity during self- and close other-reflection in patients with bipolar disorder with past psychosis and patients with schizophrenia.

    PubMed

    Zhang, Liwen; Vander Meer, Lisette; Opmeer, Esther M; Marsman, Jan-Bernard C; Ruhé, Henricus G; Aleman, André

    2016-12-01

    Disturbances in implicit self-processing have been reported both in psychotic patients with bipolar disorder (BD) and schizophrenia. It remains unclear whether these two psychotic disorders show disturbed functional connectivity during explicit self-reflection, which is associated with social functioning and illness symptoms. Therefore, we investigated functional connectivity during explicit self-reflection in BD with past psychosis and schizophrenia. Twenty-three BD-patients, 17 schizophrenia-patients and 21 health controls (HC) performed a self-reflection task, including the conditions self-reflection, close other-reflection and semantic control. Functional connectivity was investigated with generalized psycho-physiological interaction (gPPI). During self-reflection compared to semantic, BD-patients had decreased connectivity between several cortical-midline structures (CMS) nodes (i.e., anterior cingulate cortex, ventromedial prefrontal cortex), the insula and the head of the caudate while HC showed increased connectivities. Schizophrenia-patients, during close other-reflection compared to semantic, demonstrated reduced ventral-anterior insula-precuneus/posterior cingulate cortex (PCC) functional connectivity, whereas this was increased in HC. There were no differences between BD and schizophrenia during self- and close other-reflection. We propose that decreased functional connectivity between the CMS nodes/insula and head of the caudate in BD-patients may imply a reduced involvement of the motivational system during self-reflection; and the reduced functional connectivity between the ventral-anterior insula and precuneus/PCC during close other-reflection in schizophrenia-patients may subserve difficulties in information integration of autobiographical memory and emotional awareness in relation to close others. These distinctive impaired patterns of functional connectivity in BD and schizophrenia (compared to HC) deserve further investigation to determine their

  17. Transition to Mania During Treatment of Bipolar Depression

    PubMed Central

    Perlis, Roy H; Ostacher, Michael J; Goldberg, Joseph F; Miklowitz, David J; Friedman, Edward; Calabrese, Joseph; Thase, Michael E; Sachs, Gary S

    2010-01-01

    Some individuals with bipolar disorder transition directly from major depressive episodes to manic, hypomanic, or mixed states during treatment, even in the absence of antidepressant treatment. Prevalence and risk factors associated with such transitions in clinical populations are not well established, and were examined in the Systematic Treatment Enhancement Program for Bipolar Disorder study, a longitudinal cohort study. Survival analysis was used to examine time to transition to mania, hypomania, or mixed state among 2166 bipolar I and II individuals in a major depressive episode. Cox regression was used to examine baseline clinical and sociodemographic features associated with hazard for such a direct transition. These features were also examined for interactive effects with antidepressant treatment. In total, 461/2166 subjects in a major depressive episode (21.3%) transitioned to a manic/hypomanic or mixed state before remission, including 289/1475 (19.6%) of those treated with antidepressants during the episode. Among the clinical features associated with greatest transition hazard were greater number of past depressive episodes, recent or lifetime rapid cycling, alcohol use disorder, previous suicide attempt, and history of switch while treated with antidepressants. Greater manic symptom severity was also associated with risk for manic transition among both antidepressant-treated and antidepressant-untreated individuals. Three features, history of suicide attempt, younger onset age, and bipolar subtype, exhibited differential effects between individuals treated with antidepressants and those who were not. These results indicate that certain clinical features may be associated with greater risk of transition from depression to manic or mixed states, but the majority of them are not specific to antidepressant-treated patients. PMID:20827274

  18. Bipolar dislocation of the forearm (floating forearm).

    PubMed

    Aşkar, Hüseyin; Ertürk, Cemil; Altay, Mehmet Akif; Akif Altay, Mehmet; Bilge, Ali

    2014-01-01

    Bipolar dislocation of the forearm (floating forearm) is an unusual injury and is therefore often overlooked. We report a 28-year-old male patient who presented at another center with a history of a fall while climbing a tree. The patient's left elbow was treated with closed reduction and immobilization with a long-arm cast brace due to elbow dislocation. However, the patient was admitted with pain and swelling of the wrist to our emergency department the following day. Physical and radiological examination revealed dorsal trans-scaphoid perilunate dislocation. A dorsal incision was performed for open reduction and internal fixation to provide wide surgical exposure. Concomitant occurrence of elbow dislocation and fracture-dislocation of the perilunate is infrequent. Therefore, physicians should be aware of possible additional injuries and current recommended treatment methods.

  19. Treating Pain in Addicted Patients: Recommendations from an Expert Panel

    PubMed Central

    Cheatle, Martin; Wunsch, Martha; Skoufalos, Alexis; Reddy, Yeshwant

    2014-01-01

    Abstract Clinicians may face pragmatic, ethical, and legal issues when treating addicted patients. Equal pressures exist for clinicians to always address the health care needs of these patients in addition to their addiction. Although controversial, mainly because of the lack of evidence regarding their long-term efficacy, the use of opioids for the treatment of chronic pain management is widespread. Their use for pain management in the addicted population can present even more challenges, especially when evaluating the likelihood of drug-seeking behavior. As the misuse and abuse of opioids continues to burgeon, clinicians must be particularly vigilant when prescribing chronic opioid therapy. The purpose of this article is to summarize recommendations from a recent meeting of experts convened to recommend how primary care physicians should approach treatment of chronic pain for addicted patients when an addiction specialist is not available for a referral. As there is a significant gap in guidelines and recommendations in this specific area of care, this article serves to create a foundation for expanding chronic pain guidelines in the area of treating the addicted population. This summary is designed to be a practical how-to guide for primary care physicians, discussing risk assessment, patient stratification, and recommended therapeutic approaches. (Population Health Management 2014;17:79–89) PMID:24138341

  20. Toxic Epidermal Necrolysis in Polymedicated Patient Treated With Radiotherapy

    PubMed Central

    Pérez-Calderón, Remedios; Corrales-Vargas, Silvia; Jiménez-Ferrera, Gloria; Rodríguez-Nevado, Isabel; Díaz-Delgado, Mario

    2015-01-01

    Temozolomide is an oral alkylating agent indicated for the treatment of patients with glioblastoma multiforme concomitantly with radiotherapy and subsequently as monotherapy treatment. We report the case of a patient who developed toxic epidermal necrolysis (TEN) while she was being treated with chemoradiotherapy and several drugs. Cutaneous tests were performed with the drugs involved with negative result. Although the occurrence of TEN contraindicates suspected drug readministration, we based the decision to perform the controlled administration of temozolomide on the following reasons: (1) the poor prognosis of the underlying disease, (2) the lack of therapeutic alternatives, (3) the suspicion that other drugs taken by the patient simultaneously may be responsible (as anticonvulsants and trimethoprim sulfamethoxazole [TMP-SMX]), and (4) temozolomide was the first choice for treating the patient's disease. The administration of a cumulative dose of 60 mg of temozolomide caused a slight skin reaction. Given this result, we conducted controlled administration of other drugs involved. Dexamethasone, codeine, omeprazole and levetiracetam were well tolerated. However, TMP-SMX produced a similar reaction to that caused by temozolomide. In conclusion, we present the first case of TEN induced by temozolomide and TMP-SMX associated with cranial radiotherapy confirmed by controlled administration. Radiotherapy in combination with these drugs could have favored TEN, as some authors have postulated, but we cannot prove this. PMID:25729629

  1. [Lithium and anticonvulsants in bipolar depression].

    PubMed

    Samalin, L; Nourry, A; Llorca, P-M

    2011-12-01

    For decades, lithium and anticonvulsants have been widely used in the treatment of bipolar disorder. Their efficacy in the treatment of mania is recognized. These drugs have been initially evaluated in old and methodologically heterogeneous studies. Their efficacy in bipolar depression has not always been confirmed in more recent and methodologically more reliable studies. Thus, lithium's efficacy as monotherapy was challenged by the study of Young (2008) that showed a lack of efficacy compared with placebo in the treatment of bipolar depression. In two recent meta-analyses, valproate has shown a modest efficacy in the treatment of bipolar depression. As for lithium, valproate appeared to have a larger antimanic effect for acute phase and prophylaxis of bipolar disorder. In contrast, lamotrigine is more effective on the depressive pole of bipolar disorder with better evidence for the prevention of depressive recurrences. The guidelines include these recent studies and recommend lamotrigine as a first-line treatment of bipolar depression and for maintenance treatment. Because of more discordant data concerning lithium and valproate, these two drugs are placed either as first or as second line treatment of bipolar depression. The different safety/efficacy ratios of mood stabilizers underlie the complementarity and the importance of combination between them, or with some second-generation antipsychotics, in the treatment of patients with bipolar disorder.

  2. Evidence for association between structural variants in lissencephaly-related genes and executive deficits in schizophrenia or bipolar patients from a Spanish isolate population.

    PubMed

    Tabarés-Seisdedos, Rafael; Mata, Ignacio; Escámez, Teresa; Vieta, Eduard; López-Ilundain, Jose M; Salazar, Jose; Selva, Gabriel; Balanzá, Vicente; Rubio, Cristina; Martínez-Arán, Anabel; Valdés-Sánchez, Lourdes; Geijo-Barrientos, Emilio; Martínez, Salvador

    2008-12-01

    There is evidence for an association between structural variants in genes for lissencephaly, which are involved in neuronal migration, and prefrontal cognitive deficits in schizophrenia and bipolar patients. On the basis of these intriguing findings, we analyzed 16 markers located in the lissencephaly critical region (LCR in chromosome 17p13.3) in 124 schizophrenic, 56 bipolar, and 141 healthy individuals. All recruits were from a Spanish population isolate of Basque origin that is characterized by low genetic heterogeneity. In addition, we examined whether structural genomic variations in the LCR were associated with executive cognition. Twenty-three patients (12.8%), but none of the controls, showed structural variants (deletions and insertions) in either of two markers related with lissencephaly (D17S1566 on tumor suppressor gene TP53: tumor protein p53 and D17S22 on SMG6 gene: Smg-6 homolog, nonsense mediated mRNA decay factor- Caenorhabditis elegans). These patients performed significantly worse in the Wisconsin Card Sorting Test-Categories in comparison with patients without such variations in lissencephaly-related genes. The presence of structural variants was related to completed categories, and accounted for 10.7% of the variance (P=0.001). Finally, logistic regression showed that poor Wisconsin Card Sorting Test-Categories performance was the only predictor of belonging to the positive LCR variations group. These new findings provide further evidence for the association between some lissencephaly-related genes and both schizophrenia and bipolar disorder, and influence on frontal executive functioning.

  3. Cognitive therapy in bipolar disorder.

    PubMed

    Scott, Jan

    2002-07-01

    Stress-vulnerability models are increasingly viewed as plausible explanations of recurrence in severe affective disorders. This has promoted greater interest in the application of evidence-based psychological treatments, such as cognitive therapy, as an adjunct to medication for patients with bipolar disorder. This paper reviews the results from outcome studies of combined treatment approaches. Preliminary findings indicate that cognitive therapy reduces symptoms, enhances social adjustment and functioning and reduces relapses and hospitalizations in patients with bipolar disorder. However, the lack of published data from large scale randomized controlled trials and the absence of an adequate psychological model of manic relapse means that the role of cognitive therapy in bipolar disorders will be the subject of intense debate for some time to come.

  4. Different outcomes of never-treated and treated patients with schizophrenia: 14-year follow-up study in rural China

    PubMed Central

    Ran, Mao-Sheng; Weng, Xue; Chan, Cecilia Lai-Wan; Chen, Eric Yu-Hai; Tang, Cui-Ping; Lin, Fu-Rong; Mao, Wen-Jun; Hu, Shi-Hui; Huang, Yue-Qin; Xiang, Meng-Ze

    2015-01-01

    Background The long-term outcome of never-treated patients with schizophrenia is unclear. Aims To compare the 14-year outcomes of never-treated and treated patients with schizophrenia and to establish predictors for never being treated. Method All participants with schizophrenia (n = 510) in Xinjin, Chengdu, China were identified in an epidemiological investigation of 123 572 people and followed up from 1994 to 2008. Results The results showed that there were 30.6%, 25.0% and 20.4% of patients who received no antipsychotic medication in 1994, 2004 and 2008 respectively. Compared with treated patients, those who were never treated in 2008 were significantly older, had significantly fewer family members, had higher rates of homelessness, death from other causes, being unmarried, living alone, being without a caregiver and poor family attitudes. Partial and complete remission in treated patients (57.3%) was significantly higher than that in the never-treated group (29.8%). Predictors of being in the never-treated group in 2008 encompassed baseline never-treated status, being without a caregiver and poor mental health status in 1994. Conclusions Many patients with schizophrenia still do not receive antipsychotic medication in rural areas of China. The 14-year follow-up showed that outcomes for the untreated group were worse. Community-based mental healthcare, health insurance and family intervention are crucial for earlier diagnosis, treatment and rehabilitation in the community. PMID:26382951

  5. [The use of plasmapheresis in treating urology patients].

    PubMed

    Neĭmark, A I; Astakhov, Iu I; Davydov, A V; Mazyrko, A V; Iakovets, Ia V

    1993-01-01

    The paper presents the results of plasmapheresis inclusion into a combined therapy of pyelonephritis. Out of 79 patients treated, 42 had urosepsis, 25 developed pyelonephritis in pregnancy, 12 had complicating chronic renal failure. Uroseptic patients were examined for hemostasis, the rest for immune status. There were symptoms of DIC syndrome in the former and immunity suppression in the latter. After the combined therapy with plasmapheresis, latent hypercoagulation and intoxication disappeared, uroseptic manifestations reduced. The above treatment of pregnancy pyelonephritis stopped inflammation, promoted activation of the immune system. In patients with chronic renal failure adjuvant plasmapheresis enhanced cellular and humoral immunity, neutrophil function, the number of middle-size molecules in the blood diminished. The latter improved renal function in decreasing uremia.

  6. Family history of psychiatric disorders and alcohol and substance misuse in patients with bipolar I disorder, substance use disorder, or both.

    PubMed

    Sbrana, Alfredo; Bizzarri, Jacopo V; Rucci, Paola; Gonnelli, Chiara; Massei, Jacopo G; Ravani, Laura; Endicott, Jean; Maser, Jack D; Cassano, Giovanni B

    2007-01-01

    Family history data were collected on first-degree relatives of 78 patients with bipolar I disorder (BD) and substance use disorder (SUD), 47 with BD only, and 35 with SUD only. The prevalence of psychiatric disorders was significantly higher in first-degree relatives of patients with BD + SUD (64%) and BD (61%) compared with first-degree relatives of SUD patients (20%). The prevalence of alcohol misuse was significantly higher in first-degree relatives of patients with BD + SUD (23.1%) and SUD alone (28.6%) compared to first-degree relatives of patients with BD (4.3%). Our findings suggest that BD and SUD do not share familial risk factors.

  7. Italian Bipolar II vs I patients have better individual functioning, in spite of overall similar illness severity.

    PubMed

    Dell'Osso, Bernardo; Dobrea, Cristina; Cremaschi, Laura; Buoli, Massimiliano; Miller, Shefali; Ketter, Terence A; Altamura, A Carlo

    2016-02-24

    Introduction Bipolar disorders (BDs) comprise different variants of chronic, comorbid, and disabling conditions, with relevant suicide and suicide attempt rates. The hypothesis that BD types I (BDI) and II (BDII) represent more and less severe forms of illness, respectively, has been increasingly questioned over recent years, justifying additional investigation to better characterize related sociodemographic and clinical profiles.

  8. A Meta-Analysis of Neuropsychological Functioning in Patients with Early Onset Schizophrenia and Pediatric Bipolar Disorder

    ERIC Educational Resources Information Center

    Nieto, Rebeca Garcia; Castellanos, F. Xavier

    2011-01-01

    Despite the nosological distinction between bipolar disorder and schizophrenia, there is increasing evidence that these conditions share phenomenological characteristics. To examine the similarities in their patterns of cognitive impairment, we conducted a meta-analysis from 12 studies of Early Onset Schizophrenia (EOS) and 12 studies of Pediatric…

  9. Effective desynchronization with bipolar double-pulse stimulation

    NASA Astrophysics Data System (ADS)

    Tass, Peter A.

    2002-09-01

    This paper is devoted to the desynchronizing effects of bipolar stimuli on a synchronized cluster of globally coupled phase oscillators. The bipolar pulses considered here are symmetrical and consist of a positive and a negative monopolar pulse. A bipolar single pulse with the right intensity and duration desynchronizes a synchronized cluster provided the stimulus is administered at a vulnerable initial phase of the cluster's order parameter. A considerably more effective desynchronization is achieved with a bipolar double pulse consisting of two qualitatively different bipolar pulses. The first bipolar pulse is stronger and resets the cluster, so that the second bipolar pulse, which follows after a constant delay, hits the cluster in a vulnerable state and desynchronizes it. A bipolar double pulse desynchronizes the cluster independently of the cluster's dynamical state at the beginning of the stimulation. The dynamics of the order parameter during a bipolar single pulse or a bipolar double pulse is different from the dynamics during a monopolar single pulse or a monopolar double pulse. Nevertheless, concerning their desynchronizing effects the monopolar and the bipolar stimuli are comparable, respectively. This is significant for applications where bipolar stimulation is required. For example, in medicine and physiology charge-balanced stimulation is typically necessary in order to avoid tissue damage. Based on the results presented here, demand-controlled bipolar double-pulse stimulation is suggested as a milder and more efficient therapy compared to the standard permanent high-frequency deep brain stimulation in neurological patients.

  10. Coping with a life event in bipolar disorder: ambulatory measurement, signalling and early treatment.

    PubMed

    Knapen, Stefan E; Riemersma-van der Lek, Rixt F; Haarman, Bartholomeus C M; Schoevers, Robert A

    2016-10-13

    Disruption of the biological rhythm in patients with bipolar disorder is a known risk factor for a switch in mood. This case study describes how modern techniques using ambulatory assessment of sleep parameters can help in signalling a mood switch and start early treatment. We studied a 40-year-old woman with bipolar disorder experiencing a life event while wearing an actigraph to measure sleep-wake parameters. The night after the life event the woman had sleep later and shorter sleep duration. Adequate response of both the woman and the treating psychiatrist resulted in two normal nights with the use of 1 mg lorazepam, possibly preventing further mood disturbances. Ambulatory assessment of the biological rhythm can function as an add-on to regular signalling plans for prevention of episodes in patients with bipolar disorder. More research should be conducted to validate clinical applicability, proper protocols and to understand underlying mechanisms.

  11. A Case in the Bipolar Spectrum

    PubMed Central

    KOÇBIYIK, Sibel; BATMAZ, Sedat; TURHAN, Levent

    2016-01-01

    It has been reported that the correct diagnosis and treatment are delayed when subsyndromal bipolar mood disorder symptoms are overlooked. Patients in this spectrum are reported to have a diminished level of functioning, and these patients fail to accept their diagnosis; therefore, there is a low level of treatment adherence. This case report focuses on the diagnosis and treatment of a patient in the bipolar spectrum. PMID:28360771

  12. Immunotherapy and patients treated for cancer with microsatellite instability.

    PubMed

    Colle, Raphaël; Cohen, Romain; Cochereau, Delphine; Duval, Alex; Lascols, Olivier; Lopez-Trabada, Daniel; Afchain, Pauline; Trouilloud, Isabelle; Parc, Yann; Lefevre, Jérémie H; Fléjou, Jean-François; Svrcek, Magali; André, Thierry

    2017-01-01

    Microsatellite instability (MSI) is a tumor phenotype linked to somatic or germline (Lynch syndrome) inactivating alterations of DNA mismatch repair genes. A broad spectrum of neoplasms exhibits MSI phenotype, mainly colorectal cancer, endometrial cancer, and gastric cancer. MSI tumors are characterized by dense immune infiltration and high load of tumor neo-antigens. Growing evidence is accumulating on the efficacy of immune checkpoint inhibition for patients treated for MSI solid tumors. We present a comprehensive overview of MSI phenotype, its biological landscape and current diagnostic methods. Then we focus on MSI as a predictive biomarker of response to immune checkpoint inhibition in the context of colorectal cancer and non-colorectal tumors.

  13. Hepatic lesions in patients treated with synthetic anabolic steriods.

    PubMed

    Sweeney, E C; Evans, D J

    1976-07-01

    Hepatic abnormalities are described in three patients who received synthetic anabolic steroids. A child with Franconi's anaemia was treated for four years and at necropsy the liver showed generalized hyperplasia, hyperplastic nodules, and a benign hepatoma. Two adults received only three months' therapy with synthetic androgens; in one there was generalized hepatic hyperplasia and in the other widespread nodular hyperplasia. It is suggested that anabolic steroids may induce tumours through intermediate hyperplastic lesions, a sequence similar to that seen during tumour induction by carcinogens in experimental animals.

  14. Hepatic lesions in patients treated with synthetic anabolic steriods.

    PubMed Central

    Sweeney, E C; Evans, D J

    1976-01-01

    Hepatic abnormalities are described in three patients who received synthetic anabolic steroids. A child with Franconi's anaemia was treated for four years and at necropsy the liver showed generalized hyperplasia, hyperplastic nodules, and a benign hepatoma. Two adults received only three months' therapy with synthetic androgens; in one there was generalized hepatic hyperplasia and in the other widespread nodular hyperplasia. It is suggested that anabolic steroids may induce tumours through intermediate hyperplastic lesions, a sequence similar to that seen during tumour induction by carcinogens in experimental animals. Images PMID:185239

  15. Opportunistic infections in patients treated with immunotherapy for cancer.

    PubMed

    Kyi, Chrisann; Hellmann, Matthew D; Wolchok, Jedd D; Chapman, Paul B; Postow, Michael A

    2014-01-01

    Immunomodulatory antibodies that enhance the immune system to fight cancer are revolutionizing the treatment of patients with an expanding variety of malignancies. There is a unique spectrum of side effects associated with immunomodulatory antibodies, termed immune-related adverse events (irAEs), which include colitis and hepatitis among others. The treatment of refractory or severe irAEs can occasionally require significant immunosuppression, involving steroids or tumor necrosis factor-alpha antagonists, placing these patients at risk for infections. We present the first reported case to our knowledge of an opportunistic infection in a patient treated with an immunomodulatory antibody. As the use of immunomodulatory antibodies expands and more patients develop irAEs that require treatment with immunosuppression, recognition of the potential for opportunistic infections in this emerging patient population will be critical. Prospective trials are needed to define the optimal immunosuppressive management of irAEs and determine whether prophylactic antiviral, antibacterial, or antifungal therapies are beneficial in this unique population.

  16. Hypothyroidism in patients with colorectal carcinoma treated with fluoropyrimidines.

    PubMed

    Fujiwara, Yutaka; Chayahara, Naoko; Mukohara, Toru; Kiyota, Naomi; Tomioka, Hideo; Funakoshi, Yohei; Minami, Hironobu

    2013-10-01

    Targeted therapy with tyrosine kinase inhibitors, including vascular endothelial growth factor receptors, has been demonstrated to induce hypothyroidism and thyroid dysfunction. Cancer patients with thyroid dysfunction may be underdiagnosed and undertreated. Thyroid function in colorectal cancer patients receiving fluoropyrimidine-based chemotherapy with or without bevacizumab was evaluated at baseline and monthly. In the present study, 3 of 27 (11.1%) patients who received fluoropyrimidine-based chemotherapy developed a thyroid-stimulating hormone (TSH) level >10 µU/ml, and 13 (48.1%) developed an elevation above the upper limit of the normal range. No difference in TSH elevation was noted between the bevacizumab and chemotherapy-alone group (50 vs. 45%; P=1.00, respectively). Three (11.1%) patients developed a TSH level >10 µU/ml and 2 with hypothyroidism were treated with thyroid hormone replacement therapy. We demonstrated that bevacizumab does not affect thyroid function but fluoropyrimidines may induce thyroid dysfunction in patients with colorectal cancer. Further investigation is required to clarify the mechanism of fluoropyrimidine-induced thyroid dysfunction.

  17. Exploratory analysis of the French version of the beliefs about medicines questionnaire in patients with severe mental disorders: Factorial structure and reliability in specific populations of schizophrenic, bipolar and depressive patients

    PubMed Central

    Samalin, Ludovic; de Chazeron, Ingrid; Belzeaux, Raoul; Llorca, Pierre-Michel

    2017-01-01

    Objectives The aims of our study were to explore the factor structure and psychometric properties of the French version of the Beliefs about Medicines Questionnaire (BMQ) in patients with severe mental illness and in specific populations of patients with schizophrenia, bipolar disorder and major depressive disorder. Methods A cross-sectional study including patients with schizophrenia, bipolar disorder and major depressive disorder was conducted (n = 150). Principal component analysis (PCA), reliability and validity of the French version of the BMQ were performed. Results PCA revealed a two-factor structure similar to the original structure for the BMQ-Specific scale but only a one-component solution for the BMQ-General scale in both the total sample and the three subgroups. These subscales have satisfactory internal consistency. Validity was supported by the significant correlations of all BMQ subscales with the Drug Attitude Inventory. Conclusion The French version of the BMQ appears as a three-dimensional scale and presents satisfactory psychometric properties for use in patients with severe mental illness as well as specific populations of patients with schizophrenia, bipolar disorder and major depressive disorder. PMID:28257447

  18. Recurrence rates of bipolar disorder during the postpartum period: a study on 276 medication-free Italian women.

    PubMed

    Maina, Giuseppe; Rosso, Gianluca; Aguglia, Andrea; Bogetto, Filippo

    2014-10-01

    The postpartum period is considered a time of heightened vulnerability to bipolar disorder. The primary goal of this study was to examine the frequency and the polarity of postpartum episodes in a clinical sample of women with bipolar disorder who were medication-free during their pregnancies. In addition, we sought to examine whether there are differences in terms of clinical features of bipolar disorder between women with and without postpartum episodes. Lastly, we analyzed the potential relationship between polarity of the postpartum episodes and clinical features of bipolar disorder. The presence/absence of postpartum episodes and their characteristics were obtained from medical records of 276 women with bipolar disorder who were medication-free during their pregnancies. Two hundred seven women (75.0 %) had a history of one or more postpartum mood episodes: depressive (79.7 %), (hypo)manic (16.4 %), or mixed episodes (3.9 %). Psychotic symptoms during postpartum episodes were associated with depression in 37 (22.4 %) patients, with mania in 19 (67.8 %) patients, and with mixed episodes in 7 (87.5 %) patients. Postpartum manic and mixed episodes were significantly associated with type I disorder and with psychotic features. Our findings indicate high risk of clinically ascertained mood episodes during postpartum period in bipolar women who are not treated during pregnancy.

  19. Prefronto–cerebellar transcranial direct current stimulation improves visuospatial memory, executive functions, and neurological soft signs in patients with euthymic bipolar disorder

    PubMed Central

    Minichino, Amedeo; Bersani, Francesco Saverio; Bernabei, Laura; Spagnoli, Francesco; Vergnani, Lucilla; Corrado, Alessandra; Taddei, Ines; Biondi, Massimo; Delle Chiaie, Roberto

    2015-01-01

    Objective The aim of the study was to improve neuropsychological functioning of euthymic patients with bipolar disorder (BD) using transcranial direct current stimulation (tDCS) applied to cerebellar and prefrontal cortices. Methods Twenty-five BD outpatients underwent prefrontal (anodal) and cerebellar (cathodal) tDCS for 3 consecutive weeks. All participants were assessed through the Rey Complex Figure Test delay and copy and the Neurological Examination Scale at baseline and after therapy with tDCS. Results After tDCS treatment, patients showed significant improvements in visuospatial memory tasks. Patients with worse baseline cognitive performances also showed a significant improvement in executive functioning tasks. Neurological Examination Scale total score and motor coordination subscale significantly improved. Conclusion Prefrontal-excitatory and cerebellar-inhibitory stimulations in euthymic BD patients may lead to better neurocognitive performances. This improvement could result from the modulation of prefronto–thalamic–cerebellar circuit activity pattern, which can be disrupted in BD. PMID:26356034

  20. Olanzapine approved for the acute treatment of schizophrenia or manic/mixed episodes associated with bipolar I disorder in adolescent patients

    PubMed Central

    Maloney, Ann E; Sikich, Linmarie

    2010-01-01

    Background Severe and persistent mental illnesses in children and adolescents, such as early- onset schizophrenia spectrum (EOSS) disorders and pediatric bipolar disorder (pedBP), are increasingly recognized. Few treatments have demonstrated efficacy in rigorous clinical trials. Enduring response to current medications appears limited. Recently, olanzapine was approved for the treatment of adolescents with schizophrenia or acute manic/mixed episodes in pedBP. Methods PubMed searches were conducted for olanzapine combined with pharmacology, schizophrenia, or bipolar disorder. Searches related to schizophrenia and bipolar disorder were limited to children and adolescents. The bibliographies of the retrieved articles were hand-checked for additional relevant studies. The epidemiology, phenomenology, and treatment of EOSS and pedBP, and olanzapine’s pharmacology are reviewed. Studies of olanzapine treatment in youth with EOSS and pedBP are examined. Results Olanzapine is efficacious for EOSS and pedBP. However, olanzapine is not more efficacious than risperidone, molindone, or haloperidol in EOSS and is less efficacious than clozapine in treatment-resistant EOSS. No comparative trials have been done in pedBP. Olanzapine is associated with weight gain, dyslipidemia, and transaminase elevations in youth. Extrapyramidal symptoms, neuroleptic malignant syndrome, and blood dyscrasias have also been reported but appear rare. Conclusions The authors conclude that olanzapine should be considered a second-line agent in EOSS and pedBP due to its risks for significant weight gain and lipid dysregulation. Awareness of the consistent weight and metabolic changes observed in olanzapine-treated youth focused attention on the potential long-term risks of atypical antipsychotics in youth. PMID:21127693

  1. Sleep Disturbances and Nightmares in a Patient Treated with Prazosin.

    PubMed

    Kosari, Sam; Naunton, Mark

    2016-04-15

    Prazosin is increasingly being used off-label to treat nightmares in patients with posttraumatic stress disorder. The literature about the psychiatric adverse effects of prazosin is very limited. We present a case in which low-dose prazosin was associated with nightmares and sleep disturbances in an elderly patient without previously diagnosed mental illness or coexisting environmental risk factors for nightmares. Insomnia and hallucinations are listed as some of the rare side effects of prazosin by the manufacturer. Prazosin could be associated with rare psychiatric adverse effects and sleep disturbances. Particular attention is required in identifying these adverse effects, which can be difficult to distinguish from other drug-related side effects in the elderly particularly because they are often using multiple medications.

  2. Neurotrophic Tyrosine Kinase Receptor Type 2 (NTRK2) Gene Associated with Treatment Response to Mood Stabilizers in Patients with Bipolar I Disorder

    PubMed Central

    Fan, Jinbo; Gao, Keming; Li, Zezhi; Yi, Zhenghui; Wang, Lingxiao; Huang, Jia; Yuan, Chengmei; Hong, Wu; Yu, Shunying

    2013-01-01

    There is increasing evidence supporting the relationship between bipolar disorder (BP) and neurotrophin. The present study investigated the relationship between neurotrophic tyrosine kinase receptor type 2 (NTRK2) gene polymorphisms and bipolar I disorder (BP I) susceptibility and treatment response to mood stabilizers (lithium or valproate). Two-hundred eighty-four patients who met the DSM-IV criteria for BP I and 295 matched healthy controls were enrolled into this study. TaqMan® SNP genotyping assays were applied to genotype three NTRK2 gene polymorphisms (rs2769605, rs1565445, rs1387923). Our study showed a significant allelic association between NTRK2 gene polymorphism rs2769605 and treatment response to mood stabilizers in BP I patients (t=−2.53, P=0.01). However, no significant association between NTRK2 gene polymorphisms and BP I susceptibility was observed after correcting for multiple comparisons. The results suggest that the NTRK2 gene polymorphism likely plays an essential role in treatment response to mood stabilizers in Han Chinese BP I patients. PMID:23315174

  3. The number of past manic episodes is the best predictor of antidepressant-emergent manic switch in a cohort of bipolar depressed patients.

    PubMed

    Gorwood, Philip; Richard-Devantoy, Stéphane; Sentissi, Othman; Le Strat, Yann; Olié, Jean Pierre

    2016-06-30

    The present study sought to identify factors associated with the onset of a manic or hypomanic episode during the month following a new antidepressant therapy in depressed bipolar patients. Patients receiving mood stabilizers for ≥3 months were screened from 400 French centers and were assessed for a 4-week period following prescription of a first or a new antidepressant. Of the 1242 included participants, 4.8% (n=60) experienced antidepressant-emergent manic switch (AEMS). AEMS was more frequently associated with lifetime manic, depressive, and total mood episodes, and with past AEMS. A higher score at two items of the Montgomery-Åsberg Depression Rating Scale (pessimistic and suicidal thoughts) were significantly associated with AEMS. Logistic regression analysis showed that the number of lifetime manic episodes and past AEMS were the two most factors associated with an AEMS. Having more than four past manic episodes was associated with a 2.84 fold increased risk of AEMS. Cumulative number of past mood episodes seems to be the most important factor for switching to a manic episode following antidepressants in patients with bipolar disorder. Longer-term studies are required to further delineate antidepressant causality from natural disease course.

  4. [Validation of the Spanish version of the Mood Disorder Questionnaire to detect bipolar disorder type II in patients with major depression disorder].

    PubMed

    González, Alfonso; Arias, Astrid; Mata, Salvador; Lima, Lucimney

    2009-06-01

    The Mood Disorder Questionnaire (MDQ) is an inventory used to detect bipolar disorder type II (BD II) and it has been validated in several countries, other than Venezuela. For this reason, the authors tried to determine the criterion validity of the Venezuelan version of the MDQ in Venezuelan patients. The study was carried out in two stages at the Psychiatric Department of the Hospital Vargas of Caracas, Venezuela, which is a general teaching hospital. A group of 199 adult outpatients, who had been previously diagnosed as suffering from major depression disorder--single episode or recurrent--were evaluated. Initially, they were diagnosed using the Structured Clinical Interview for DSM-IV for Axis I Disorders (SCID-I). Afterwards, they were asked to answer the MDQ using a cut-off point > or = 7/13. The protocol was approved by the institutional review board of the Hospital Vargas of Caracas. A total of 78.4% of the subjects were female. The mean age was 43.60 years for males (SD = 14.19) and 43.94 years for females (SD = 12.06). The frequency of false unipolar patients was 28.1% (23.6% bipolar disorder type I and 4.5% BD II). While comparing the results of the SCID-I and the MDQ, a sensibility of 100.0% (95% CI: 0.66-1.00) and a specificity of 61.1% (95% CI: 0.53-0.68) were found for the diagnosis of BD II. According to our results, the MDQ with a cut-off point > or = 7/13 is a valid instrument to detect the bipolar disorder type II in Venezuelan depressed outpatients.

  5. How Childhood Maltreatment Is Related to Suicidality, Bipolarity and Central Serotonergic Activity in Patients with Major Depressive Disorder: A Cross-Sectional Pilot Study

    PubMed Central

    Lee, Bun-Hee

    2016-01-01

    Objective The aims of this study were to determine whether childhood maltreatment contributes to the occurrence of major depressive disorder (MDD) with bipolarity, and whether there is a relationship between central serotonergic activity, as assessed using loudness dependence of auditory evoked potentials (LDAEP), and childhood maltreatment. Methods Thirty-five MDD patients were stratified according to the presence or absence of childhood trauma into two subgroups, childhood trauma (CT) and no childhood trauma (NCT), using the Korean version of the Childhood Trauma Questionnaire (K-CTQ). The CT group was subjected to further analysis. Several psychometric ratings were also applied. In addition, auditory processing for the loudness dependence of auditory evoked potentials (LDAEP), which was used as a marker of serotonergic activity, was measured before beginning medication. Results There was a significant difference in total Korean Bipolar Spectrum Disorder Scale score between the CT and NCT groups (t=-2.14, p=0.04). The total K-CTQ score was positively correlated with the total Beck Scale for Suicidal Ideation (BSS) score (r=0.36, p=0.036). In particular, emotional abuse was positively correlated with the total Barratt Impulsiveness Scale (r=0.38, p=0.026), BSS (r=0.38, p=0.025), and Hamilton Depression Rating Scale (HAMD) (r=0.36, p=0.035) scores. There was also a positive correlation between LDAEP and total Hypomania Personality Scale (r=0.49, p=0.02) and HAMD (r=0.58, p=0.004) scores within CT group. Conclusion The findings of this study support that there is a relationship between childhood maltreatment and bipolarity in patients with MDD. PMID:27081379

  6. Mathematical models of bipolar disorder

    NASA Astrophysics Data System (ADS)

    Daugherty, Darryl; Roque-Urrea, Tairi; Urrea-Roque, John; Troyer, Jessica; Wirkus, Stephen; Porter, Mason A.

    2009-07-01

    We use limit cycle oscillators to model bipolar II disorder, which is characterized by alternating hypomanic and depressive episodes and afflicts about 1% of the United States adult population. We consider two non-linear oscillator models of a single bipolar patient. In both frameworks, we begin with an untreated individual and examine the mathematical effects and resulting biological consequences of treatment. We also briefly consider the dynamics of interacting bipolar II individuals using weakly-coupled, weakly-damped harmonic oscillators. We discuss how the proposed models can be used as a framework for refined models that incorporate additional biological data. We conclude with a discussion of possible generalizations of our work, as there are several biologically-motivated extensions that can be readily incorporated into the series of models presented here.

  7. Case of glioblastoma patient treated with tumor treating fields therapy at recurrence degenerating to sarcoma.

    PubMed

    Majd, Pejman; O'Connell, Daniel E; Kim, Ronald C; Bota, Daniela A; Carrillo, Jose A

    2017-03-17

    Optune(®) treatment is a US FDA-approved treatment for glioblastoma (GBM) that employs alternating electric fields. Tumor treating field (TTF) therapy can exert its effects on GBM via cell cycle mitosis disruption and cytokinesis. We describe a patient with recurrent GBM who had disease progression following standard surgical treatment and concomitant chemoradiotherapy, and was found to have sarcomatous transformation after initiation of TTF therapy with bevacizumab. Upon tumor progression, repeat surgical resection revealed transformation into a GFAP-negative, reticulin-positive sarcoma with rhabdomyoid features. The possibility of a causal connection between TTF therapy and sarcomatous transformation needs to be further evaluated. No such case of apparent sarcoma formation in the CNS following chemoradiotherapy and/or TTF treatment for GBM has been reported.

  8. How I treat patients with advanced systemic mastocytosis.

    PubMed

    Valent, Peter; Sperr, Wolfgang R; Akin, Cem

    2010-12-23

    Advanced systemic mastocytosis (SM) is a rare myeloid neoplasm characterized by uncontrolled accumulation of neoplastic mast cells (MCs) in various organs with consecutive impairment of organ function, drug resistance, and a poor prognosis. Advanced SM may present as smoldering or slowly progressing neoplasm but may also present as rapidly progressing aggressive SM or even as MC leukemia. Approximately half of the patients have an associated hematologic non-MC-lineage disease (SM-AHNMD) or develop an AHNMD over time. Drug resistance may not only result from the KIT mutant D816V that is found in most patients, but also from KIT-independent pro-oncogenic signaling pathways that play a role in disease evolution. In patients with slow progression, advanced SM can often be kept under control for months with interferon-α or 2CdA. By contrast, in rapidly progressing aggressive SM and MC leukemia, even polychemotherapy and hematopoietic stem cell transplantation may fail, which points to the need to develop new drugs and treatment concepts for these patients. In SM-AHNMD, separate treatment plans should be established for the SM component and the AHNMD component of the disease, with recognition that the AHNMD often has to be managed and treated as a secondary and thus a high-risk neoplasm.

  9. Venetoclax in patients with previously treated chronic lymphocytic leukemia.

    PubMed

    Roberts, Andrew W; Stilgenbauer, Stephan; Seymour, John F; Huang, David C S

    2017-01-18

    Venetoclax is the first BCL2 inhibitor to enter routine clinical practice. It is an orally bioavailable small molecule that binds BCL2 very specifically. Acting as a pharmacological mimic of the proteins that initiate apoptosis (a so-called BH3-mimetic), venetoclax rapidly induces apoptosis in chronic lymphocytic leukemia (CLL) cells which express high levels of BCL2 and rely on it to maintain their survival. As a single agent, daily venetoclax treatment induced durable responses in 79% of patients with relapsed or refractory CLL or small lymphocytic lymphoma in a Phase 1 study, including complete remissions in 20% of patients. Its use was approved by the FDA in April 2016 for patients with previously treated del(17p) CLL on the basis of a single arm Phase 2 trial demonstrating a 79% response rate and an estimated 1 year progression-free survival of 72% with 400mg/day continuous therapy. This review focuses on venetoclax, its mechanism-of-action, pharmacology and clinical trial data, and seeks to place it in the context of rapid advances in therapy for patients with relapsed CLL, especially those with del(17p) CLL.

  10. New bipolar tissue ligator combines constant tissue compression and temperature guidance: histologic study and implications for treatment of hemorrhoids

    PubMed Central

    Piskun, Gregory; Tucker, Robert

    2012-01-01

    Background Several minimally invasive technologies are available to treat common soft tissue lesions including symptomatic hemorrhoids. The use of energy to deliver heat and coagulate target lesions is commonly practiced. This study compares the histologic effects produced on intestinal tissues by two energy-based systems which employ different approaches of heat delivery. Methods Two heat delivery systems were evaluated in vivo in a single porcine subject: infrared coagulator and bipolar tissue ligator utilizing constant tissue compression and temperature guidance. Eighteen treatment sites divided into three groups of six were assessed. Treatment site temperature was measured and the effects of thermal treatment in the mucosa, submucosa, submucosal vessels, and muscularis layer were scored. Lateral thermal spread beyond the energy application site was also assessed. Results Treatment site temperatures were much lower in the bipolar ligator group than in the infrared coagulator group. The mucosal and submucosal tissue changes observed in tissues treated with infrared energy and bipolar energy at 55°C were similar. Both the mucosal and submucosal tissue changes with bipolar energy at 50°C were significantly less. Conclusion Both devices achieved similar histologic results. However, the unique design of the bipolar ligator, which allows consistent capture, constant compression, and temperature monitoring of target tissue, accomplished the desired histologic changes with less muscular damage at much lower temperatures than the infrared coagulator. The use of bipolar ligation could offer clinical advantages such as reduced patient pain and a minimized chance of heat-related collateral tissue damage. PMID:23152714

  11. Neurons derived from patients with bipolar disorder divide into intrinsically different sub-populations of neurons, predicting the patients' responsiveness to lithium.

    PubMed

    Stern, S; Santos, R; Marchetto, M C; Mendes, A P D; Rouleau, G A; Biesmans, S; Wang, Q-W; Yao, J; Charnay, P; Bang, A G; Alda, M; Gage, F H

    2017-02-28

    Bipolar disorder (BD) is a progressive psychiatric disorder with more than 3% prevalence worldwide. Affected individuals experience recurrent episodes of depression and mania, disrupting normal life and increasing the risk of suicide greatly. The complexity and genetic heterogeneity of psychiatric disorders have challenged the development of animal and cellular models. We recently reported that hippocampal dentate gyrus (DG) neurons differentiated from induced pluripotent stem cell (iPSC)-derived fibroblasts of BD patients are electrophysiologically hyperexcitable. Here we used iPSCs derived from Epstein-Barr virus-immortalized B-lymphocytes to verify that the hyperexcitability of DG-like neurons is reproduced in this different cohort of patients and cells. Lymphocytes are readily available for research with a large number of banked lines with associated patient clinical description. We used whole-cell patch-clamp recordings of over 460 neurons to characterize neurons derived from control individuals and BD patients. Extensive functional analysis showed that intrinsic cell parameters are very different between the two groups of BD neurons, those derived from lithium (Li)-responsive (LR) patients and those derived from Li-non-responsive (NR) patients, which led us to partition our BD neurons into two sub-populations of cells and suggested two different subdisorders. Training a Naïve Bayes classifier with the electrophysiological features of patients whose responses to Li are known allows for accurate classification with more than 92% success rate for a new patient whose response to Li is unknown. Despite their very different functional profiles, both populations of neurons share a large, fast after-hyperpolarization (AHP). We therefore suggest that the large, fast AHP is a key feature of BD and a main contributor to the fast, sustained spiking abilities of BD neurons. Confirming our previous report with fibroblast-derived DG neurons, chronic Li treatment reduced

  12. The changing characteristics of atrial fibrillation patients treated with warfarin.

    PubMed

    Putnam, Andrew; Gu, Xiaokui; Haymart, Brian; Kline-Rogers, Eva; Almany, Steve; Kozlowski, Jay; Krol, Gregory D; Kaatz, Scott; Froehlich, James B; Barnes, Geoffrey D

    2015-11-01

    It has been suggested that direct oral anticoagulants are being preferentially used in low risk atrial fibrillation (AF) patients. Understanding the changing risk profile of new AF patients treated with warfarin is important for interpreting the quality of warfarin delivery through an anticoagulation clinic. Six anticoagulation clinics participating in the Michigan Anticoagulation Quality Improvement Initiative enrolled 1293 AF patients between 2010 and 2014 as an inception cohort. Abstracted data included demographics, comorbidities, medication use and all INR values. Risk scores including CHADS2, CHA2DS2-VASc, HAS-BLED, SAMe-TT2R2, and Charlson comorbidity index (CCI) were calculated for each patient at the time of warfarin initiation. The quality of anticoagulation was assessed using the Rosendaal time in the therapeutic range (TTR) during the first 6 months of treatment. Between 2010 and 2014, patients initiating warfarin therapy for AF had an increasing mean CHADS2 (2.0 ± 1.1 to 2.2 ± 1.4, p = 0.02) and CCI (4.7 ± 1.8 to 5.1 ± 2.0, p = 0.03), and a trend towards increasing mean CHA2DS2-VASc, HAS-BLED, and SAMe-TT2R2 scores. The actual TTR remained unchanged over the study period (62.6 ± 18.2 to 62.7 ± 17.0, p = 0.98), and the number of INR checks did not change (18.9 ± 5.2 to 18.5 ± 5.1, p = 0.06). Between 2010 and 2014, AF patients newly starting warfarin had mild increases in risk for stroke and death with sustained quality of warfarin therapy.

  13. The changing characteristics of atrial fibrillation patients treated with warfarin

    PubMed Central

    Gu, Xiaokui; Haymart, Brian; Kline-Rogers, Eva; Almany, Steve; Kozlowski, Jay; Krol, Gregory D.; Kaatz, Scott; Froehlich, James B.; Barnes, Geoffrey D.

    2016-01-01

    It has been suggested that direct oral anticoagulants are being preferentially used in low risk atrial fibrillation (AF) patients. Understanding the changing risk profile of new AF patients treated with warfarin is important for interpreting the quality of warfarin delivery through an anticoagulation clinic. Six anticoagulation clinics participating in the Michigan Anticoagulation Quality Improvement Initiative enrolled 1293 AF patients between 2010 and 2014 as an inception cohort. Abstracted data included demographics, comorbidities, medication use and all INR values. Risk scores including CHADS2, CHA2DS2-VASc, HAS-BLED, SAMe-TT2R2, and Charlson comorbidity index (CCI) were calculated for each patient at the time of warfarin initiation. The quality of anticoagulation was assessed using the Rosendaal time in the therapeutic range (TTR) during the first 6 months of treatment. Between 2010 and 2014, patients initiating warfarin therapy for AF had an increasing mean CHADS2 (2.0 ± 1.1 to 2.2 ± 1.4, p = 0.02) and CCI (4.7 ± 1.8 to 5.1 ± 2.0, p = 0.03), and a trend towards increasing mean CHA2DS2-VASc, HAS-BLED, and SAMe-TT2R2 scores. The actual TTR remained unchanged over the study period (62.6 ± 18.2 to 62.7 ± 17.0, p = 0.98), and the number of INR checks did not change (18.9 ± 5.2 to 18.5 ± 5.1, p = 0.06). Between 2010 and 2014, AF patients newly starting warfarin had mild increases in risk for stroke and death with sustained quality of warfarin therapy. PMID:26130229

  14. The relationship between borderline personality disorder and bipolar disorder.

    PubMed

    Zimmerman, Mark; Morgan, Theresa A

    2013-06-01

    It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. Research considering whether BPD should be considered part of a bipolar spectrum reaches differing conclusions. We reviewed the most studied question on the relationship between BPD and bipolar disorder: their diagnostic concordance. Across studies, approximately 10% of patients with BPD had bipolar I disorder and another 10% had bipolar II disorder. Likewise, approximately 20% of bipolar II patients were diagnosed with BPD, though only 10% of bipolar I patients were diagnosed with BPD. While the comorbidity rates are substantial, each disorder is nontheless diagnosed in the absence of the other in the vast majority of cases (80% to 90%). In studies examining personality disorders broadly, other personality disorders were more commonly diagnosed in bipolar patients than was BPD. Likewise, the converse is also true: other axis I disorders such as major depression, substance abuse, and post-traumatic stress disorder are also more commonly diagnosed in patients with BPD than is bipolar disorder. These findings challenge the notion that BPD is part of the bipolar spectrum.

  15. Bipolar disorder in women

    PubMed Central

    Parial, Sonia

    2015-01-01

    Bipolar affective disorder in women is a challenging disorder to treat. It is unique in its presentation in women and characterized by later age of onset, seasonality, atypical presentation, and a higher degree of mixed episodes. Medical and psychiatric co-morbidity adversely affects recovery from the bipolar disorder (BD) more often in women. Co-morbidity, particularly thyroid disease, migraine, obesity, and anxiety disorders occur more frequently in women while substance use disorders are more common in men. Treatment of women during pregnancy and lactation is challenging. Pregnancy neither protects nor exacerbates BD, and many women require continuation of medication during the pregnancy. The postpartum period is a time of high risk for onset and recurrence of BD in women. Prophylaxis with mood stabilizers might be needed. Individualized risk/benefits assessments of pregnant and postpartum women with BD are required to promote the health of the women and to avoid or limit exposure of the fetus or infant to potential adverse effects of medication. PMID:26330643

  16. The differences in temperament–character traits, suicide attempts, impulsivity, and functionality levels of patients with bipolar disorder I and II

    PubMed Central

    Izci, Filiz; Fındıklı, Ebru Kanmaz; Zincir, Serkan; Zincir, Selma Bozkurt; Koc, Merve Iris

    2016-01-01

    Background The primary aim of this study was to compare the differences in temperament–character traits, suicide attempts, impulsivity, and functionality levels of patients with bipolar disorder I (BD-I) and bipolar disorder II (BD-II). Methods Fifty-two BD-I patients and 49 BD-II patients admitted to Erenköy Mental and Neurological Disease Training and Research Hospital psychiatry clinic and fifty age- and sex-matched healthy control subjects were enrolled in this study. A structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I Disorders, Temperament and Character Inventory, Barrett Impulsiveness Scale-11 (BIS-11), Hamilton Depression Inventory Scale, Young Mania Rating Scale, and Bipolar Disorder Functioning Questionnaire (BDFQ) were administered to patients and to control group. Results No statistically significant difference in sociodemographic features existed between the patient and control groups (P>0.05). Thirty-eight subjects (37.62%) in the patient group had a suicide attempt. Twenty-three of these subjects (60.52%) had BD-I, and 15 of these subjects (39.47%) had BD-II. Suicide attempt rates in BD-I and II patients were 60.52% and 39.47%, respectively (P<0.05). Comparison of BD-I and II patients with healthy control subjects revealed that cooperativeness (C), self-directedness (Sdi), and self-transcendence (ST) scores were lower and novelty seeking (NS1 and NS2), harm avoidance (HA4), and reward dependence (RD2) subscale scores were higher in patients with BD-I. When BD-I patients were compared with BD-II patients, BIS-11 (attention) scores were higher in patients with BD-II and BIS-11 (motor and nonplanning impulsivity) scores were higher in patients with BD-I. According to BDFQ, relations with friends, participation in social activities, daily activities and hobbies, and occupation subscale scores were lower and taking initiative subscale scores were higher in patients with BD-I. Social withdrawal

  17. Grey matter volume abnormalities in patients with bipolar I depressive disorder and unipolar depressive disorder: a voxel-based morphometry study.

    PubMed

    Cai, Yi; Liu, Jun; Zhang, Li; Liao, Mei; Zhang, Yan; Wang, Lifeng; Peng, Hongjun; He, Zhong; Li, Zexuan; Li, Weihui; Lu, Shaojia; Ding, Yuqiang; Li, Lingjiang

    2015-02-01

    Bipolar disorder and unipolar depressive disorder (UD) may be different in brain structure. In the present study, we performed voxel-based morphometry (VBM) to quantify the grey matter volumes in 23 patients with bipolar I depressive disorder (BP1) and 23 patients with UD, and 23 age-, gender-, and education-matched healthy controls (HCs) using magnetic resonance imaging. We found that compared with the HC and UD groups, the BP1 group showed reduced grey matter volumes in the right inferior frontal gyrus and middle cingulate gyrus, while the UD group showed reduced volume in the right inferior frontal gyrus compared to HCs. In addition, correlation analyses revealed that the grey matter volumes of these regions were negatively correlated with the Hamilton depression rating scores. Taken together, the results of our study suggest that decreased grey matter volume of the right inferior frontal gyrus is a common abnormality in BP1 and UD, and decreased grey matter volume in the right middle cingulate gyrus may be specific to BP1.

  18. Mixed features in bipolar disorder.

    PubMed

    Solé, Eva; Garriga, Marina; Valentí, Marc; Vieta, Eduard

    2016-12-29

    Mixed affective states, defined as the coexistence of depressive and manic symptoms, are complex presentations of manic-depressive illness that represent a challenge for clinicians at the levels of diagnosis, classification, and pharmacological treatment. The evidence shows that patients with bipolar disorder who have manic/hypomanic or depressive episodes with mixed features tend to have a more severe form of bipolar disorder along with a worse course of illness and higher rates of comorbid conditions than those with non-mixed presentations. In the updated Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5), the definition of "mixed episode" has been removed, and subthreshold nonoverlapping symptoms of the opposite pole are captured using a "with mixed features" specifier applied to manic, hypomanic, and major depressive episodes. However, the list of symptoms proposed in the DSM-5 specifier has been widely criticized, because it includes typical manic symptoms (such as elevated mood and grandiosity) that are rare among patients with mixed depression, while excluding symptoms (such as irritability, psychomotor agitation, and distractibility) that are frequently reported in these patients. With the new classification, mixed depressive episodes are three times more common in bipolar II compared with unipolar depression, which partly contributes to the increased risk of suicide observed in bipolar depression compared to unipolar depression. Therefore, a specific diagnostic category would imply an increased diagnostic sensitivity, would help to foster early identification of symptoms and ensure specific treatment, as well as play a role in suicide prevention in this population.

  19. Polarity index of pharmacological agents used for maintenance treatment of bipolar disorder.

    PubMed

    Popovic, Dina; Reinares, Maria; Goikolea, Jose Manuel; Bonnin, Caterina Mar; Gonzalez-Pinto, Ana; Vieta, Eduard

    2012-05-01

    Over one half of bipolar patients have been reported to be more prone to either depressive or manic relapses. This study aimed to define profiles of drugs used for maintenance treatment of bipolar disorder (BD) by the means of Polarity Index. Polarity Index is a new metric indicating the relative antimanic versus antidepressive preventive efficacy of drugs. Polarity Index was retrieved by calculating Number Needed to Treat (NNT) for prevention of depression and NNT for prevention of mania ratio, as emerging from the results of randomized placebo-controlled trials. Included trials were randomized and double blind, with a minimal duration of 24 weeks, assessing effectiveness of a mood stabilizer or antipsychotic drug alone or in combination with a mood stabilizing agent versus a placebo comparator in BD maintenance treatment. Polarity Index value above 1.0 indicates a relative greater antimanic prophylactic efficacy, number below 1.0 a relative greater antidepressive efficacy. The polarity index for the drugs used in maintenance therapy for bipolar disorder was 12.09 for risperidone, 4.38 for aripiprazole, 3.91 for ziprasidone, 2.98 for olanzapine, 1.39 for lithium, 1.14 for quetiapine, and 0.40 for lamotrigine. Polarity index of valproate and oxcarbazepine may not be reliable due to the failure of their maintenance trials. The polarity index provides a measure of how much antidepressant versus antimanic a drug is in bipolar disorder prophylaxis, and may guide the choice of maintenance therapy in bipolar patients.

  20. Scurvy in an alcoholic patient treated with intravenous vitamins.

    PubMed

    Ong, John; Randhawa, Rabinder

    2014-04-11

    Vitamin C deficiency is rare in developed countries but there is an increased prevalence in chronic alcohol abusers. In the UK, it is common practice to treat patients with chronic alcoholism who are admitted to hospital with intravenous vitamins B1, B2, B3, B6 and C for 2-3 days, followed by oral thiamine and vitamin B-compound tablets. This is a case of a 57-year-old man with a history of chronic alcoholism and chronic obstructive lung disease who was admitted to the intensive care unit for pneumonia requiring ventilatory support. He was given high doses of intravenous vitamins B1, B2, B3, B6 and C for 3 days then oral thiamine and vitamin B compound tablets but developed scurvy 4 days later. He was restarted on oral vitamin C supplementation and showed signs of improvement within 3 days of treatment.

  1. Severe hypercalcemia and hypernatremia in a patient treated with canagliflozin

    PubMed Central

    Winters, Stephen J

    2015-01-01

    Summary Drugs that inhibit the sodium-glucose co-transporter-2 (SGLT2) are an exciting novel, insulin-independent treatment for diabetes that block glucose reabsorption from the proximal tubules of the kidney, leading to increased glucose excretion and lower blood glucose levels. Inhibition of SGLT2 activity also reduces sodium reabsorption, which together with glycosuria produces a mild diuretic effect with the potential for dehydration and hyperkalemia. We report on a 60-year-old man with uncontrolled type 2 diabetes treated with insulin, glimepiride, metformin and canagliflozin, who was admitted with altered mental status after a syncopal episode. He had a 1-week history of ingestion of Tums for heartburn followed by poor appetite and lethargy. Laboratory work-up showed acute kidney injury, diabetic ketoacidosis (DKA), and parathyroid hormone-independent severe hypercalcemia of 17.4 mg/dl. DKA resolved with insulin treatment, and saline hydration led to improvement in hypercalcemia and renal function over 48 h, but was accompanied by a rapid increase in the serum sodium concentration from 129 to 162 mmol/l despite changing fluids to 0.45% saline. Urine studies were consistent with osmotic diuresis. Hypernatremia was slowly corrected with hypotonic fluids, with improvement in his mental status over the next 2 days. This is the first report of hypercalcemia associated with the use of a SLGT2 inhibitor. Although the exact mechanism is unknown, canagliflozin may predispose to hypercalcemia in patients ingesting excessive calcium because of dehydration from osmotic diuresis, with reduced calcium excretion and possible increased intestinal calcium absorption. Saline therapy and osmotic diuresis may lead to hypernatremia from electrolyte-free water loss. Learning points Canagliflozin, an SGLT2 inhibitor, may cause hypercalcemia in susceptible patients.Although the exact mechanisms are unknown, dehydration from osmotic diuresis and increased intestinal calcium

  2. Transdiagnostic Treatment of Bipolar Disorder and Comorbid Anxiety with the Unified Protocol: A Clinical Replication Series

    PubMed Central

    Ellard, Kristen K.; Deckersbach, Thilo; Sylvia, Louisa G.; Nierenberg, Andrew A.; Barlow, David H.

    2013-01-01

    Bipolar disorder (BD) is a chronic, debilitating disorder with recurrent manic and depressive episodes. Over 75% of bipolar patients have a current or lifetime diagnosis of a comorbid anxiety disorder. Comorbid anxiety in BD is associated with greater illness severity, greater functional impairment, and poorer illness-related outcomes. Effectively treating comorbid anxiety in individuals with BD has been recognized as one of the biggest unmet needs in the field of bipolar disorder. Recently, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was developed to be applicable to the full range of anxiety and mood disorders, based upon converging evidence from genetics, cognitive and affective neuroscience, and behavioral research suggesting common, core emotion-related pathology. Here, we present a preliminary evaluation of the efficacy of the UP for the treatment of BD with comorbid anxiety, in a clinical replication series consisting of three cases. PMID:22822175

  3. Bipolar II disorder family history using the family history screen: findings and clinical implications.

    PubMed

    Benazzi, Franco

    2004-01-01

    Psychiatric family history of bipolar II disorder is understudied. The aims of the current study were to find the psychiatric family history of bipolar II patients using a new structured interview, the Family History Screen by Weissman et al (2000), and to find bipolar disorders family history predicting power for the diagnosis of bipolar II. One hundred sixty-four consecutive unipolar major depressive disorder (MDD) and 241 consecutive bipolar II major depressive episode (MDE) outpatients were interviewed with the Structured Clinical Interview for DSM-IV (SCID). The Family History Screen was used. Sensitivity and specificity of predictors of the diagnosis of bipolar II (bipolar [type I and II] family history, bipolar II family history, atypical depression, depressive mixed state, many MDE recurrences, early onset) were studied. Bipolar II subjects had significantly more bipolar I, more bipolar II (50.7%), more MDE, and more social phobia in first-degree relatives than did unipolar subjects. Bipolar II subjects had many more first-degree relatives with bipolar II than with bipolar I. Among the predictors of the diagnosis of bipolar II, bipolar II family history had the highest specificity (82.8%), while early onset had the highest sensitivity. Discriminant analysis of predictor variables found that bipolar II family history and early onset were highly significant predictors. In conclusion, bipolar II family history was common in bipolar II patients, and it had high specificity for predicting bipolar II. If detected, it could reduce bipolar II misdiagnosis by inducing careful probing for a history of hypomania.

  4. Varicella-Zoster Virus Infections in Patients Treated With Fingolimod

    PubMed Central

    Arvin, Ann M.; Wolinsky, Jerry S.; Kappos, Ludwig; Morris, Michele I.; Reder, Anthony T.; Tornatore, Carlo; Gershon, Anne; Gershon, Michael; Levin, Myron J.; Bezuidenhoudt, Mauritz; Putzki, Norman

    2017-01-01

    IMPORTANCE Varicella-zoster virus (VZV) infections increasingly are reported in patients with multiple sclerosis (MS) and constitute an area of significant concern, especially with the advent of more disease-modifying treatments in MS that affect T-cell-mediated immunity. OBJECTIVE To assess the incidence, risk factors, and clinical characteristics of VZV infections in fingolimod-treated patients and provide recommendations for prevention and management. DESIGN, SETTING, AND PARTICIPANTS Rates of VZV infections in fingolimod clinical trials are based on pooled data from the completed controlled phases 2 and 3 studies (3916 participants) and ongoing uncontrolled extension phases (3553 participants). Male and female patients aged 18 through 55 years (18–60 years for the phase 2 studies) and diagnosed as having relapsing-remitting MS were eligible to participate in these studies. In the postmarketing setting, reporting rates since 2010 were evaluated. INTERVENTIONS In clinical trials, patients received fingolimod at a dosage of 0.5 or 1.25 mg/d, interferon beta-1a, or placebo. In the postmarketing setting, all patients received fingolimod, 0.5 mg/d (total exposure of 54 000 patient-years at the time of analysis). MAIN OUTCOMES AND MEASURES Calculation of the incidence rate of VZV infection per 1000 patient-years was based on the reporting of adverse events in the trials and the postmarketing setting. RESULTS Overall, in clinical trials, VZV rates of infection were low but higher with fingolimod compared with placebo (11 vs 6 per 1000 patient-years). A similar rate was confirmed in the ongoing extension studies. Rates reported in the postmarketing settings were comparable (7 per 1000 patient-years) and remained stable over time. Disproportionality in reporting herpes zoster infection was higher for patients receiving fingolimod compared with those receiving other disease-modifying treatments (empirical Bayes geometric mean, 2.57 [90% CI, 2.26–2.91]); the proportion

  5. Current issues: women and bipolar disorder

    PubMed Central

    Marangell, Lauren B.

    2008-01-01

    While the treatment of bipolar disorder (BD) is typically complex, the treatment of women with bipolar disorder is even more challenging because clinicians must also individualize treatment based on the potential for pregnancy, drug interactions with oral contraceptives, and an increased risk of endocrine diseases that can either impact the course of illness or become manifest with some treatments. Women with BD should be checked for hypothyroidism, and if prescribed antidepressants, carefully watched for rapid cycling or a mood switch to mania, hypomania, or a mixed state. Several medications interact with oral contraceptives or increase the risk of developing polycystic ovary syndrome. Consideration of possible pregnancy is essential, and should be planned in advance whenever possible. Rates of recurrence have been shown to be equal in pregnant and nonpregnant women with BD. Risks of medication to the fetus at various points of development must be balanced against the risks of not treating, which is also detrimental to both fetus and mother. The postpartum period is a time of especially high risk; as many as 40% to 67% of women with BD report experiencing a postpartum mania or depression. The decision to breastfeed must also take into account the adverse impact of sleep deprivation in triggering mood episodes. In order to best address these issues, clinicians must be familiar with the data and collaborate with the patient to assess risks and benefits for the individual women and her family. PMID:18689292

  6. Bimodal response sensitivity and bias in a test of sustained attention contrasting patients with schizophrenia and bipolar disorder to normal comparison group.

    PubMed

    Baerwald, Jeffrey P; Tryon, Warren W; Sandford, Joseph

    2005-01-01

    This study examined response discrimination (d') and bias (likelihood ratio) differentials in a computer-generated test of auditory and visual attention functioning. Patients with bipolar disorder (n=42) and schizophrenia (n=47) were contrasted to a normal comparison group (n=89) in two conditions: (a) simple modal responsivity (auditory and visual stimuli) and (b) ipsimodal (auditory/auditory and visual/visual) and crossmodal (auditory/visual and visual/auditory) responding. The results of this study indicated that in the simple modal condition both subject groups showed differential modal preferences but in opposite directions. The schizophrenic group showed a significant visual over auditory preference, committing more auditory commission and omission errors than visual errors. The bipolar group displayed a distinct auditory over visual response preference, committing significantly higher number of visual omission errors. Response bias analysis indicates that both diagnostic groups adopted a more liberal response bias, whereas the comparison group assumed a more conservative approach. For all groups response sensitivity improved as response bias became more neutral. The modal switching results indicated that all three groups tended to commit more commission errors (false alarms) in the auditory crossmodal switching condition (visual/auditory) by comparison with the other switching conditions. Between group comparisons for this condition showed that the schizophrenic group committed significantly more commission errors than the other groups. No significant medication effects were detected.

  7. Nigerian dental students' willingness to treat HIV-positive patients.

    PubMed

    Azodo, Clement Chinedu; Ehigiator, Osarobo; Oboro, Helen Oziofu; Ehizele, Adebola Oluyemisi; Umoh, Agnes; Ezeja, Ejike Bartholomew; Omili, Michael; Ehigiator, Laura

    2010-04-01

    Dental care of HIV-positive individuals plays a vital role in improving their nutritional intake, medication tolerance and effectiveness, treatment success rate, and quality of life. It is therefore important to ensure optimal dental care of this group of people, especially since more of them, with or without knowledge of their serologic status, are now utilizing dental services. The objective of this study was to assess Nigerian dental students' willingness to treat HIV-positive individuals. A descriptive cross-sectional survey of all seventy-six final-year dental students of the University of Benin, Nigeria, was conducted in December 2007 using a self-administered questionnaire that elicited information on the students' demography, self-rated knowledge on HIV/AIDS, attitude towards homosexuals, infection control practices, occupational risk perception, and willingness to provide care for HIV-positive individuals. The response rate was 76.3 percent. Over 77 percent of the respondents were in the twenty-five to thirty years age group. The male-female ratio was approximately 1.6:1. HIV-related knowledge was reported as high by only 31 percent of the respondents. Eighty-one percent showed great interest in HIV-related information, while about half (53.4 percent) exhibited significant worry about occupational contagion. Forty-eight (82.7 percent) desired more knowledge about safety precautions during treatment of HIV patients. Fifty respondents (86.2 percent) reported good infection control practices. About three-fourths (74.2 percent) rated the risk of HIV contagion from patients high, while only one-fourth (25.8 percent) reported having an unsympathetic attitude towards homosexuals. Almost all respondents (98.3 percent) agreed that oral care for HIV-positive individuals improves their quality of life, but only 58.8 percent expressed a willingness to treat HIV-positive patients and only 46.5 percent said they will render volunteer dental services in HIV centers. HIV

  8. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013.

    PubMed

    Yatham, Lakshmi N; Kennedy, Sidney H; Parikh, Sagar V; Schaffer, Ayal; Beaulieu, Serge; Alda, Martin; O'Donovan, Claire; Macqueen, Glenda; McIntyre, Roger S; Sharma, Verinder; Ravindran, Arun; Young, L Trevor; Milev, Roumen; Bond, David J; Frey, Benicio N; Goldstein, Benjamin I; Lafer, Beny; Birmaher, Boris; Ha, Kyooseob; Nolen, Willem A; Berk, Michael

    2013-02-01

    The Canadian Network for Mood and Anxiety Treatments published guidelines for the management of bipolar disorder in 2005, with updates in 2007 and 2009. This third update, in conjunction with the International Society for Bipolar Disorders, reviews new evidence and is designed to be used in conjunction with the previous publications.The recommendations for the management of acute mania remain largely unchanged. Lithium, valproate, and several atypical antipsychotic agents continue to be first-line treatments for acute mania. Monotherapy with asenapine, paliperidone extended release (ER), and divalproex ER, as well as adjunctive asenapine, have been added as first-line options.For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, as well as olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. Lurasidone monotherapy and the combination of lurasidone or lamotrigine plus lithium or divalproex have been added as a second-line options. Ziprasidone alone or as adjunctive therapy, and adjunctive levetiracetam have been added as not-recommended options for the treatment of bipolar depression. Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone long-acting injection, and adjunctive ziprasidone continue to be first-line options for maintenance treatment of bipolar disorder. Asenapine alone or as adjunctive therapy have been added as third-line options.

  9. Clinical variables and implications of the personality on the outcome of bipolar illness: a pilot study

    PubMed Central

    Casas-Barquero, Nieves; García-López, Olga; Fernández-Argüelles, Pedro; Camacho-Laraña, Manuel

    2007-01-01

    Outcome in bipolar patients is affected by comorbidity. Comorbid personality disorders are frequent and may complicate the course of bipolar illness. This pilot study examined a series of 40 euthymic bipolar patients (DSM-IV criteria) (bipolar I disorder 31, bipolar II disorder 9) to assess the effect of clinical variables and the influence of comorbid personality on the clinical course of bipolar illness. Bipolar patients with a diagnosis of comorbid personality disorder (n = 30) were compared with “pure” bipolar patients (n = 10) with regard to demographic, clinical, and course of illness variables. Comorbid personality disorder was diagnosed in 75% of patients according to ICD-10 criteria, with obsessive-compulsive personality disorder being the most frequent type. Sixty-three per cent of subjects had more than one comorbid personality disorder. Bipolar patients with and without comorbid personality disorder showed no significant differences regarding features of the bipolar illness, although the group with comorbid personality disorder showed a younger age at onset, more depressive episodes, and longer duration of bipolar illness. In subjects with comorbid personality disorders, the number of hospitalizations correlated significantly with depressive episodes and there was an inverse correlation between age at the first episode and duration of bipolar illness. These findings, however, should be interpreted taking into account the preliminary nature of a pilot study and the contamination of the sample with too many bipolar II patients. PMID:19300559

  10. [Antidepressant-resistant depression and the bipolar spectrum -- diagnostic and therapeutic considerations].

    PubMed

    Rihmer, Zoltán; Gonda, Xénia; Rihmer, Annamária; Döme, Péter

    2016-01-01

    According to the results of epidemiological studies mood disorders with unipolar (major and minor depressive disorder; dysthymia) or bipolar features are among the most prevalent psychiatric disorders. These disorders with their frequent comorbidities (alcohol and/or drug use disorders, smoking, suicide, cardiovascular disorders) pose great public health challenge and cause substantial individual and familar burdens as well. Since SSRIs and other new antidepressant agents entered the market the possibilities to treat depression improved substantially but 25-35 percent of major depressives do not respond even to the second antidepressant trial but the rate of patients who are resistant after the third and fourth adequate antidepressant trial are around only 15-25 and 10 percent, respectively. Pharmacotherapy-resistant depression is a multicausal phenomenon. Along with its well-known risk-factors investigations of the past decade have revealed that unrecognised or hidden (subsyndromal or subthreshold) bipolarity is one of the most frequent causes of treatment resistance. In the case of bipolar depression (either as a part of syndromal bipolar I or II disorder or a subsyndromal manifestation) antidepressant monotherapy should be avoided and, instead of it, the administration of a mood stabilizer (primarily lithium and lamotrigine) or some atypical antipsychotics (preferably quetiapine) are recommended. If antidepressant is inevitably necessary in bipolar depression, we should use it always in combination with mood stabilizers or atypical antipsychotics.

  11. Cutaneous adverse events in multiple sclerosis patients treated with daclizumab

    PubMed Central

    Cortese, Irene; Ohayon, Joan; Fenton, Kaylan; Lee, Chyi-Chia; Raffeld, Mark; Cowen, Edward W.; DiGiovanna, John J.

    2016-01-01

    Objective: To analyze the spectrum and mechanisms of cutaneous adverse events (AEs) in patients with multiple sclerosis treated with daclizumab high-yield process (DAC-HYP). Methods: A total of 31 participants in an institutional review board–approved open-label phase I study of DAC-HYP (NCT01143441) were prospectively evaluated over 42 months for development of cutaneous AEs. Participants provided written informed consent. Fifteen participants were naive to anti-CD25 therapy (cohort B), while 16 had received daclizumab (Zenapax; Hoffmann-La Roche) IV for 4–9 years (mean 5.8 years) prior to enrollment (cohort A). Immunohistochemistry was performed on pretreatment and posttreatment skin biopsies of normal-appearing skin (cohort B only) and on lesional biopsies in participants presenting with rash (both cohorts). Results: Cutaneous AEs occurred in 77% of patients, the majority presenting with patches of eczema requiring no treatment. Moderate to severe rash developed in 6 participants (19%) and required discontinuation of DAC-HYP in 4 (13%). More severe rashes presented psoriasiform phenotype, but lesional biopsies lacked features of either psoriasis or drug hypersensitivity eruptions. Instead, irrespective of clinical severity, lesional biopsies showed nonspecific features of eczematous dermatitis, but with prominent CD56+ lymphocytic infiltrates. Pretreatment and posttreatment biopsies of normal-appearing skin demonstrated no histopathologic changes. Conclusions: Observed cutaneous AEs are likely related to the immunomodulatory effects DAC-HYP exerts on innate lymphoid cells, including natural killer cells. Vigilance and timely management of skin reactions may prevent treatment discontinuation in participants with severe rash. PMID:26843560

  12. Quality of life of oropharyngeal cancer patients treated with brachytherapy.

    PubMed

    Teguh, David N; Levendag, Peter C; Kolkman-Deurloo, Inger-Karine; van Rooij, Peter; Schmitz, Paul I M

    2009-03-01

    Brachytherapy (BT) is a highly conformal (accurate clinical target volume delineation, no planning target volume margin) radiotherapy technique; the radioactive source, guided by afterloading catheters, is implanted into the heart of the tumor. The localized high dose of radiation enables high tumor control rates and, because of rapid dose fall-off, sparing of the adjacent normal tissues. At the Erasmus Medical Center, excellent results were observed: 5-year local regional control of 84%, 5-year disease-free survival of 59%, and 5-year overall survival of 64%. Therefore, in the case of moderately sized tumors, for well-trained, skillful physicians, BT is the therapy of choice (if technically feasible). However, side effects are not totally negligible, partly because of the cumulative dose of BT and the first series of 46/2 Gy. However, patients treated with BT still have a better swallowing-related quality of life, which might improve further if summation of BT and the first series of 46/2 Gy, as well as autocontouring of the neck levels, are realized. So far, there is no significant relationship between the -quality index of the BT implants and local control/overall survival and/or quality of life.

  13. Effects on weight and outcome of long-term olanzapine-topiramate combination treatment in bipolar disorder.

    PubMed

    Vieta, Eduard; Sánchez-Moreno, Jose; Goikolea, José Manuel; Colom, Francesc; Martínez-Arán, Anabel; Benabarre, Antonio; Corbella, Bàrbara; Torrent, Carla; Comes, Mercè; Reinares, María; Brugue, Esteve

    2004-08-01

    Olanzapine is an effective drug for the long-term treatment of bipolar disorder but is associated with burdensome weight gain. Topiramate is a novel anticonvulsant that may induce weight loss in some patients. This is the first study to address the long-term efficacy and impact on weight of the combination of olanzapine and topiramate in bipolar patients. Twenty-six Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition bipolar spectrum patients received olanzapine plus topiramate cotherapy for treatment of their manic (n = 14), hypomanic (n = 6), depressive (n = 2), and mixed (n = 1) symptoms for 1 year. Three rapid cycling patients were also enrolled despite being euthymic. Efficacy was assessed with the Young Mania Rating Scale, the Hamilton Depression Rating Scale, and the Modified Clinical Global Impressions for Bipolar Disorder. Weight, body mass index, and side effects were collected at every visit. Thirteen (50%) patients completed the 1-year follow-up. By intent-to-treat, patients significantly improved from baseline in Young Mania Rating Scale scores (P < 0.0001), Hamilton Depression Rating Scale (P < 0.05), and Modified Clinical Global Impressions for Bipolar Disorder subscales (mania P < 0.0001, depression P < 0.05, overall P < 0.0001). Most patients gained weight during the first month of combined treatment (mean weight gain 0.7 +/- 0.6 kg), but at the 12-month endpoint, the mean weight change was -0.5 +/- 1.1 kg. The combination of olanzapine and topiramate was efficacious for the long-term treatment of bipolar patients and appeared to carry some benefits for controlling weight gain. Given the limitations of the open, uncontrolled design, further trials are warranted with this combination.

  14. Treatment Guidelines for Children and Adolescents with Bipolar Disorder

    ERIC Educational Resources Information Center

    Kowatch, Robert A.; Fristad, Mary; Birmaher, Boris; Wagner, Karen Dineen; Findling, Robert L.; Hellander, Martha

    2005-01-01

    Clinicians who treat children and adolescents with bipolar disorder desperately need current treatment guidelines. These guidelines were developed by expert consensus and a review of the extant literature about the diagnosis and treatment of pediatric bipolar disorders. The four sections of these guidelines include diagnosis, comorbidity, acute…

  15. Sleep architecture and cognitive changes in olanzapine-treated patients with depression: A double blind randomized placebo controlled trial

    PubMed Central

    2014-01-01

    Background Disturbance in sleep quality is a symptom of Major Depressive Disorder (MDD) and Bipolar Disorder (BD) and thus improving quality of sleep is an important aspect of successful treatment. Here, a prospective, double-blind, randomized, placebo-controlled study examined the effect of olanzapine (an atypical antipsychotic) augmentation therapy on sleep architecture, specifically slow wave sleep (SWS), in the treatment of depression. The effect of olanzapine augmentation therapy on other features of sleep (e.g., sleep continuity) and depression (e.g., illness severity and cognitive function) were also determined. Methods Patients currently experiencing a major depressive episode and who were on a stable medication were included. Sleep architecture was measured by overnight ambulatory polysomnography. Illness severity was determined using the Montgomery-Asberg Depression Rating Scale (MADRS). Cognitive function was examined using Cambridge Neuropsychological Test Automated Battery (CANTAB): Spatial Working Memory (SWM), Spatial Span (SSP), and Reaction Time (RTI) tasks. Polysomnographs, clinical measures and cognitive tests were administered at baseline, after 2–4 days of treatment and after 28–31 days of treatment. Twenty-five patients participated in the study (N = 10, N = 15 for placebo and olanzapine treated groups respectively). Results The primary objective of the study was to assess the objective (polysomnographic) changes in sleep quality, defined as changes in SWS, following olanzapine treatment for depression. Latency to but not duration of SWS was found to significantly differ between olanzapine- and placebo-treated participants (Hedge’s g: 0.97, 0.13 respectively). A significant improvement in olanzapine-treated participants over placebo-treated participants was observed in secondary outcome measures, including sleep efficiency, total sleep time, and sleep latency. Secondary objectives assessed the subjective changes in sleep quality

  16. Pharmacogenomics of bipolar disorder.

    PubMed

    Severino, Giovanni; Squassina, Alessio; Costa, Marta; Pisanu, Claudia; Calza, Stefano; Alda, Martin; Del Zompo, Maria; Manchia, Mirko

    2013-04-01

    Bipolar disorder (BD) is a lifelong severe psychiatric condition with high morbidity, disability and excess mortality. The longitudinal clinical trajectory of BD is significantly modified by pharmacological treatment(s), both in acute and in long-term stages. However, a large proportion of BD patients have inadequate response to pharmacological treatments. Pharmacogenomic research may lead to the identification of molecular predictors of treatment response. When integrated with clinical information, pharmacogenomic findings may be used in the future to determine the probability of response/nonresponse to treatment on an individual basis. Here we present a selective review of pharmacogenomic findings in BD. In light of the evidence suggesting a genetic effect of lithium reponse in BD, we focused particularly on the pharmacogenomic literature relevant to this trait. The article contributes a detailed overview of the current status of pharmacogenomics in BD and offers a perspective on the challenges that can hinder its transition to personalized healthcare.

  17. Adjunctive Methylphenidate in the Treatment of Bulimia Nervosa Co-occurring with Bipolar Disorder and Substance Dependence

    PubMed Central

    McElroy, Susan L.

    2013-01-01

    Bulimia nervosa is associated with bipolar disorder, substance dependence, attention-deficit hyperactivity disorder, and anxiety disorders. Few reports, however, have addressed the treatment of patients with all of these conditions. We describe a young woman with bulimia nervosa, bipolar I disorder, cocaine and alcohol dependence, attention-deficit hyperactivity disorder, and panic disorder who achieved a sustained (>1 year) remission of her bulimia nervosa symptoms and significant improvement of her attention-deficit hyperactivity disorder symptoms with adjunctive methylphenidate after her bipolar, substance use, and panic disorders were successfully treated with hospitalization, intensive psychotherapy, quetiapine, and lamotrigine. Further research into the use of stimulants in bulimia nervosa, including in patients with complex comorbidity, is required. PMID:23556140

  18. Study of bipolar batteries

    NASA Astrophysics Data System (ADS)

    Clifford, J. E.

    1984-06-01

    The status of development of bipolar batteries with an aqueous electrolyte was determined. Included in the study were lead-acid, nickel-cadmium, nickel-zinc, nickel-iron, and nickel-hydrogen batteries. The technical and patent literature is reviewed and a bibliography covering the past 15 years is presented. Literature data are supplemented by a survey of organizations. The principal interest was in bipolar lead-acid batteries and more recently in bipolar nickel-hydrogen batteries for space applications.

  19. The International Society for Bipolar Disorders (ISBD) Task Force Report on Antidepressant Use in Bipolar Disorders

    PubMed Central

    Pacchiarotti, Isabella; Bond, David J.; Baldessarini, Ross J.; Nolen, Willem A.; Grunze, Heinz; Licht, Rasmus W.; Post, Robert M.; Berk, Michael; Goodwin, Guy M.; Sachs, Gary S.; Tondo, Leonardo; Findling, Robert L.; Youngstrom, Eric A.; Tohen, Mauricio; Undurraga, Juan; González-Pinto, Ana; Goldberg, Joseph F.; Yildiz, Ayşegül; Altshuler, Lori L.; Calabrese, Joseph R.; Mitchell, Philip B.; Thase, Michael E.; Koukopoulos, Athanasios; Colom, Francesc; Frye, Mark A.; Malhi, Gin S.; Fountoulakis, Konstantinos N.; Vázquez, Gustavo; Perlis, Roy H.; Ketter, Terence A.; Cassidy, Frederick; Akiskal, Hagop; Azorin, Jean-Michel; Valentí, Marc; Mazzei, Diego Hidalgo; Lafer, Beny; Kato, Tadafumi; Mazzarini, Lorenzo; Martínez-Aran, Anabel; Parker, Gordon; Souery, Daniel; Özerdem, Ayşegül; McElroy, Susan L.; Girardi, Paolo; Bauer, Michael; Yatham, Lakshmi N.; Zarate, Carlos A.; Nierenberg, Andrew A.; Birmaher, Boris; Kanba, Shigenobu; El-Mallakh, Rif S.; Serretti, Alessandro; Rihmer, Zoltan; Young, Allan H.; Kotzalidis, Georgios D.; MacQueen, Glenda M.; Bowden, Charles L.; Ghaemi, S. Nassir; Lopez-Jaramillo, Carlos; Rybakowski, Janusz; Ha, Kyooseob; Perugi, Giulio; Kasper, Siegfried; Amsterdam, Jay D.; Hirschfeld, Robert M.; Kapczinski, Flávio; Vieta, Eduard

    2014-01-01

    Objective The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders. Method An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. Results There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. Conclusions Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to mood-stabilizing medications

  20. Objective and subjective sleep quality: Melatonin versus placebo add-on treatment in patients with schizophrenia or bipolar disorder withdrawing from long-term benzodiazepine use.

    PubMed

    Baandrup, Lone; Glenthøj, Birte Yding; Jennum, Poul Jørgen

    2016-06-30

    Benzodiazepines are frequently long-term prescribed for the treatment of patients with severe mental illness. This prescribing practice is problematic because of well-described side effects including risk of dependence. We examined the efficacy of prolonged-release melatonin on objective and subjective sleep quality during benzodiazepine discontinuation and whether sleep variables were associated with benzodiazepine withdrawal. Eligible patients included adults with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder and long-term use of benzodiazepines in combination with antipsychotics. All participants gradually tapered the use of benzodiazepines after randomization to add-on treatment with melatonin versus placebo. Here we report a subsample of 23 patients undergoing sleep recordings (one-night polysomnography) and 55 patients participating in subjective sleep quality ratings. Melatonin had no effect on objective sleep efficiency, but significantly improved self-reported sleep quality. Reduced benzodiazepine dosage at the 24-week follow-up was associated with a significantly decreased proportion of stage 2 sleep. These results indicate that prolonged-release melatonin has some efficacy for self-reported sleep quality after gradual benzodiazepine dose reduction, and that benzodiazepine discontinuation is not associated with rebound insomnia in medicated patients with severe mental illness. However, these findings were limited by a small sample size and a low retention rate.

  1. Association of Jacobsen syndrome and bipolar affective disorder in a patient with a de novo 11q terminal deletion.

    PubMed

    Böhm, D; Hoffmann, K; Laccone, F; Wilken, B; Dechent, P; Frahm, J; Bartels, I; Bohlander, S K

    2006-02-15

    We report on a young woman with Jacobsen syndrome (JBS) who was admitted to our psychiatric department because of a bipolar affective disorder (BPAD). Chromosome analysis was performed due to the fact that she had mental retardation, short stature, and subtle facial anomalies. A deletion of the distal long arm of chromosome 11 was found. A detailed mapping of the deletion breakpoint by quantitative real time PCR revealed a true terminal 11q deletion of approximately 8 Mb corresponding to the karyotype 46,XX,del(11)(q24.2). Polymorphic DNA marker analysis showed that the deletion is located on the paternal chromosome. Additionally, laboratory investigations revealed a low platelet count and magnetic resonance imaging of the brain showed white matter T2 hyperintensities in frontotemporal regions, which are unlikely to result from a demyelinating process as indicated by localized proton magnetic resonance spectroscopy. To our knowledge, this is the first report describing a BPAD in a case with JBS.

  2. Are Uric Acid Levels Different from Healthy Subjects in Bipolar Affective Disorder and Schizophrenia?: Relationship Between Clinical Improvement and Episode Severity in Male Patients

    PubMed Central

    GÜLTEKİN, Bülent Kadri; KESEBİR, Sermin; KABAK, Sevgi Gül; ERGÜN, Ferzan Fikret; TATLIDİL YAYLACI, Elif

    2014-01-01

    Introduction Purinergic system dysfunction has been shown both in patients with bipolar disorder (BD) and those with schizophrenia. The aim of this study was to evaluate whether uric acid levels in male BD patients with manic episode and schizophrenia patients with psychotic relapse differ from healthy male subjects. Secondly to assess whether uric acid levels in both patient groups correlate with episode severity and if a decrease in uric acid levels correlate with clinical improvement. Method A total of 55 BD patients with manic episode and 59 schizophrenic patients with psychotic relapse were evaluated at baseline and at weeks 1, 2, 3 using the Young Mania Rating Scale (YMRS) and the Positive and Negative Syndrome Scale (PANSS), and their plasma uric acid levels were measured. 60 age-matched healthy males without history of any previous or current psychiatric diagnosis and treatment constituted the control group. In order to determine plasma uric acid levels, blood samples were centrifuged at 3000 × g for 15 minutes, stored at −80°C and measured in milligrams per deciliter. Results Uric acid levels in both patient groups with manic episode and psychotic relapse were found higher than in healthy controls (f=6.122, p=.027). The difference between repeated measurements of uric acid levels in BD patient group was found to be between baseline and first week measurements (after Bonferroni correction) (p<.001). No correlation was found between YMRS and PANSS scores and uric acid levels at 4 assessment times. Conclusion Uric acid levels in male BD and schizophrenia patients with manic episode and psychotic relapse were similar with each other, and higher than in healthy males. No correlation was found between uric acid levels and episode severity in both groups. However, for patients with BD, a decrease in uric acid levels between baseline and first week seems to be correlated with clinical improvement.

  3. Association and linkage studies of candidate genes involved in GABAergic neurotransmission in lithium-responsive bipolar disorder.

    PubMed Central

    Duffy, A; Turecki, G; Grof, P; Cavazzoni, P; Grof, E; Joober, R; Ahrens, B; Berghöfer, A; Müller-Oerlinghausen, B; Dvoráková, M; Libigerová, E; Vojtĕchovský, M; Zvolský, P; Nilsson, A; Licht, R W; Rasmussen, N A; Schou, M; Vestergaard, P; Holzinger, A; Schumann, C; Thau, K; Robertson, C; Rouleau, G A; Alda, M

    2000-01-01

    OBJECTIVE: To test for genetic linkage and association with GABAergic candidate genes in lithium-responsive bipolar disorder. DESIGN: Polymorphisms located in genes that code for GABRA3, GABRA5 and GABRB3 subunits of the GABAA receptor were investigated using association and linkage strategies. PARTICIPANTS: A total of 138 patients with bipolar 1 disorder with a clear response to lithium prophylaxis, selected from specialized lithium clinics in Canada and Europe that are part of the International Group for the Study of Lithium-Treated Patients, and 108 psychiatrically healthy controls. Families of 24 probands were suitable for linkage analysis. OUTCOME MEASURES: The association between the candidate genes and patients with bipolar disorder versus that of controls and genetic linkage within families. RESULTS: There was no significant association or linkage found between lithium-responsive bipolar disorder and the GABAergic candidate genes investigated. CONCLUSIONS: This study does not support a major role for the GABAergic candidate genes tested in lithium-responsive bipolar disorder. PMID:11022400

  4. Lithium prophylaxis during pregnancy and the postpartum period in women with lithium-responsive bipolar I disorder.

    PubMed

    Rosso, Gianluca; Albert, Umberto; Di Salvo, Gabriele; Scatà, Manuela; Todros, Tullia; Maina, Giuseppe

    2016-04-01

    The aim of this study was to evaluate the efficacy of lithium prophylaxis during the peripartum period in women with lithium-responsive bipolar I disorder. Seventeen lithium-treated patients were selected and underwent preconception counseling that included both a psychiatric and an obstetric evaluation. Treatment was continued with flexible-doses of lithium combined with supportive psychotherapy throughout the pregnancy and the postpartum period. The results support the prophylaxis efficacy of lithium in lithium-responder bipolar women who have a high risk of severe peripartum recurrences.

  5. Continuum of depressive and manic mixed states in patients with bipolar disorder: quantitative measurement and clinical features.

    PubMed

    Swann, Alan C; Steinberg, Joel L; Lijffijt, Marijn; Moeller, Gerard F

    2009-10-01

    Bipolar mixed states combine depressive and manic features, presenting diagnostic and treatment challenges and reflecting a severe form of the illness. DSM-IV criteria for a mixed state require combined depressive and manic syndromes, but a range of mixed states has been described clinically. A unified definition of mixed states would be valuable in understanding their diagnosis, mechanism and treatment implications. We investigated the manner in which depressive and manic features combine to produce a continuum of mixed states. In 88 subjects with bipolar disorder (DSM-IV), we evaluated symptoms and clinical characteristics, and compared depression-based, mania-based, and other published definitions of mixed states. We developed an index of the extent to which symptoms were mixed (Mixed State Index, MSI) and characterized its relationship to clinical state. Predominately manic and depressive mixed states using criteria from recent literature, as well as Kraepelinian mixed states, had similar symptoms and MSI scores. Anxiety correlated significantly with depression scores in manic subjects and with mania scores in depressed subjects. Discriminant function analysis associated mixed states with symptoms of hyperactivity and negative cognitions, but not subjective depressive or elevated mood. High MSI scores were associated with severe course of illness. For depressive or manic episodes, characteristics of mixed states emerged with two symptoms of the opposite polarity. This was a cross-sectional study. Mixed states appear to be a continuum. An index of the degree to which depressive and manic symptoms combine appears useful in identifying and characterizing mixed states. We propose a depressive or manic episode with three or more symptoms of the opposite polarity as a parsimonious definition of a mixed state.

  6. Diagnosing and treating renal disease in cirrhotic patients.

    PubMed

    Wong, Florence

    2016-09-01

    Renal dysfunction in cirrhosis is mostly related to the development of acute kidney injury (AKI), precipitated by either an acute disturbance of hemodynamics, or acute structural damage to the kidneys. The incidence of chronic renal failure is rising, due to increasing prevalence of conditions such as diabetes, viral hepatitis, which can be associated with renal damage. AKI is defined as a rise in serum creatinine of 0.3 mg/dL in <48 hours or by 50% from baseline within the past 3 months without setting a threshold for the final serum creatinine. Stages 1, 2, and 3 of AKI are defined as 150%, 200% and 300% of baseline serum creatinine respectively, which allows for assessment of AKI progression. Chronic kidney disease (CKD) is defined as an estimated glomerular filtration rate of <60 mL/min for >3 months. Treatment of AKI consists of removal of precipitating factors and replenishment of the intravascular volume using colloids such as albumin. Frequently, AKI can be reversed using these measures alone. Non-responders to removal of precipitating factors and volume challenge can receive vasoconstrictors such as terlipressin or norepinephrine together with albumin. Midodrine is inferior in efficacy as a vasoconstrictor when compared to terlipressin. Liver transplantation is the definitive treatment for type 1 hepatorenal syndrome with liver failure. Delay in receiving a liver transplant can result in non-recovery of renal function post transplant. Treatment of CKD in cirrhosis is unsatisfactory, mostly aimed at optimizing management of comorbid conditions, or treating the underlying refractory ascites in patients with type 2 hepatorenal syndrome.

  7. Characterisation of genetic variation in ST8SIA2 and its interaction region in NCAM1 in patients with bipolar disorder.

    PubMed

    Shaw, Alex D; Tiwari, Yash; Kaplan, Warren; Heath, Anna; Mitchell, Philip B; Schofield, Peter R; Fullerton, Janice M

    2014-01-01

    Alpha-2,8-sialyltransferase 2 (ST8SIA2) is an enzyme responsible for the transfer of polysialic acid (PSA) to glycoproteins, principally the neuronal cell adhesion molecule (NCAM1), and is involved in neuronal plasticity. Variants within ST8SIA2 have previously shown association with bipolar disorder, schizophrenia and autism. In addition, altered PSA-NCAM expression in brains of patients with schizophrenia or bipolar disorder indicates a functional dysregulation of glycosylation in mental illness. To explore the role of sequence variation affecting PSA-NCAM formation, we conducted a targeted re-sequencing study of a ∼ 100 kb region--including the entire ST8SIA2 gene and its region of interaction with NCAM1--in 48 Caucasian cases with bipolar disorder using the Roche 454 platform. We identified over 400 DNA variants, including 47 putative novel variants not described in dbSNP. Validation of a subset of variants via Sequenom showed high reliability of Roche 454 genotype calls (97% genotype concordance, with 80% of novel variants independently verified). We did not observe major loss-of-function mutations that would affect PSA-NCAM formation, either by ablating ST8SIA2 function or by affecting the ability of NCAM1 to be glycosylated. However, we identified 13 SNPs in the UTRs of ST8SIA2, a synonymous coding SNP in exon 5 (rs2305561, P207P) and many additional non-coding variants that may influence splicing or regulation of ST8SIA2 expression. We calculated nucleotide diversity within ST8SIA2 on specific haplotypes, finding that the diversity on the specific "risk" and "protective" haplotypes was lower than other non-disease-associated haplotypes, suggesting that putative functional variation may have arisen on a spectrum of haplotypes. We have identified common and novel variants (rs11074064, rs722645, 15:92961050) that exist on a spectrum of haplotypes, yet are plausible candidates for conferring the effect of risk and protective haplotypes via multiple enhancer

  8. Early- versus late-onset bipolar II disorder.

    PubMed Central

    Benazzi, F

    2000-01-01

    OBJECTIVE: To compare the clinical features and the outcome between patients with early- and late-onset bipolar II disorder. DESIGN: Case series. SETTING: Outpatient private practice. PATIENTS: One hundred and seventy-nine consecutive outpatients with bipolar II disorder presenting for treatment of a major depressive episode. OUTCOME MEASURES: Duration of illness, severity of depression, recurrences, psychosis, chronicity, atypical features and comorbidity. RESULTS: Patients with early-onset (before 20, 25 or 30 years of age) bipolar II disorder had a significantly longer duration of illness and more recurrences compared with patients with late-onset (after 20, 25 or 30 years of age) bipolar II disorder. All other variables were not significantly different between the 2 groups. CONCLUSIONS: Indicators of worse outcome (severity of depression, psychosis, chronicity, comorbidity) were not significantly different between patients with early- and late-onset bipolar II disorder. PMID:10721685

  9. Clinical usefulness of the screen for cognitive impairment in psychiatry (SCIP-S) scale in patients with type I bipolar disorder

    PubMed Central

    Guilera, Georgina; Pino, Oscar; Gómez-Benito, Juana; Rojo, J Emilio; Vieta, Eduard; Tabarés-Seisdedos, Rafael; Segarra, Nuria; Martínez-Arán, Anabel; Franco, Manuel; Cuesta, Manuel J; Crespo-Facorro, Benedicto; Bernardo, Miguel; Purdon, Scot E; Díez, Teresa; Rejas, Javier

    2009-01-01

    Background The relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD. Methods After short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects. Results Feasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbach's alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity. Limitations The sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored. Conclusion With minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients. PMID:19338661

  10. Is the brain arachidonic acid cascade a common target of drugs used to manage bipolar disorder?

    PubMed

    Bazinet, Richard P

    2009-10-01

    Although lithium has been used therapeutically to treat patients with bipolar disorder for over 50 years, its mechanism of action, as well as that of other drugs used to treat bipolar disorder, is not agreed upon. In the present paper, I review studies in unanaesthetized rats using a neuropharmacological approach, combined with kinetic, biochemical and molecular biology techniques, demonstrating that chronic administration of three commonly used mood stabilizers (lithium, valproic acid and carbamazepine), at therapeutically relevant doses, selectively target the brain arachidonic acid cascade. Upon chronic administration, lithium and carbamazepine decrease the binding activity of activator protein-2 and, in turn, the transcription, translation and activity of its arachidonic acid-selective calcium-dependent phospholipase A(2) gene product, whereas chronic valproic acid non-competitively inhibits long-chain acyl-CoA synthetase. The net overlapping effects of the three mood stabilizers are decreased turnover of arachidonic acid, but not of docosahexaenoic acid, in rat brain phospholipids, as well as decreased brain cyclo-oxygenase-2 and prostaglandin E(2). As an extension of this theory, drugs that are thought to induce switching to mania, especially when administered during bipolar depression (fluoxetine and imipramine), up-regulate enzymes of the arachidonic acid cascade and turnover of arachidonic acid in rat brain phospholipids. Future basic and clinical studies on the arachidonic acid hypothesis of bipolar disorder are warranted.

  11. Thermal chondroplasty: effect of bipolar and monopolar radio frequency energy

    NASA Astrophysics Data System (ADS)

    Edwards, Ryland B.; Lu, Yan; Cole, Brian J.; Markel, Mark D.

    2001-06-01

    Cartilage fibrillation is commonly associated with injury and long-term degeneration. Contouring the articular surface with radiofrequency energy (RFE) may stabilize the surface, and improve clinical function, but subchondral bone injury has been reported in some patients. The purpose of this research was to document the effects of bipolar and monopolar RFE on articular cartilage. Bipolar RFE and monopolar RFE treatment of abraded bovine cartilage was investigated in an in vitro model. Bipolar RFE caused greater chondrocyte death than monopolar RFE, (bipolar RFE: 1700-mm; monopolar RFE: 800-mm) (p<0.05). Both bipolar RFE and monopolar RFE contoured the articular surface but the depth of chondrocyte death raised concerns regarding the clinical application of RFE. Further work investigated the arthroscopic application of bipolar RFE and monopolar RFE on human chondromalacic cartilage in vitro. Both devices smoothed the fibrillated surface, but bipolar RFE caused increased depth of chondrocyte death compared to monopolar RFE (bipolar RFE 2100-mm; monopolar RFE 620-mm (p<0.05). Fluoroptic thermometry has demonstrated cartilage matrix temperatures exceeding 70° C 2-mm below the articular surface during the application of bipolar RFE. The clinical use of the bipolar RFE systems available to date will likely result in unacceptable chondrocyte death and subchondral injury. While RFE demonstrates some promise for the management of cartilage injury, further work must be completed to define the parameters for its application.

  12. [Treating mentally wounded patients within the French armed forces].

    PubMed

    Raffray, Pierre; Rio, Anaïck; Lahutte, Bertrand; Boisseaux, Humbert

    2012-12-01

    The French army has put in place a doctrine aimed at treating mentally wounded soldiers. A real treatment pathway comprising different specialised medical staff, places and time frames supports the soldier from the theatre of operations to France.

  13. Bipolar disorder and substance use disorders. Madrid study on the prevalence of dual disorders/pathology.

    PubMed

    Arias, Francisco; Szerman, Nestor; Vega, Pablo; Mesías, Beatriz; Basurte, Ignacio; Rentero, David

    2016-03-02

    Given its prevalence and impact on public health, the comorbidity of bipolar and substance use disorders is one of the most relevant of dual diagnoses. The objective was to evaluate the characteristics of patients from community mental health and substance abuse centres in Madrid. The sample consisted of 837 outpatients from mental health and substance abuse centres. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate axis I and II disorders. Of these patients, 174 had a lifetime bipolar disorder, 83 had bipolar disorder type I and 91 had type II. Most patients had dual pathology. Of the 208 participants from the mental health centres, 21 had bipolar disorder and 13 (61.9%) were considered dually-diagnosed patients, while 33.2% of non-bipolar patients had a dual diagnoses (p = 0.03). Of the 629 participants from the substance abuse centres, 153 patients (24.3%) had a bipolar diagnosis. Bipolar dual patients had higher rates of alcohol and cocaine dependence than non-bipolar patients. Moreover, age at onset of alcohol use was earlier in bipolar duallydiagnosed patients than in other alcoholics. Bipolar dually-diagnosed patients had higher personality and anxiety disorder comorbidities and greater suicide risk. Thus, alcohol and cocaine are the drugs most associated with bipolar disorder. Given the nature of the study, the type of relationship between these disorders cannot be determined.

  14. Types of Bipolar Disorder

    MedlinePlus

    ... problems, or perform poorly in school or at work. Family, friends and people experiencing symptoms may not recognize these problems as signs of a major mental illness such as bipolar disorder. Risk Factors Scientists are studying the possible causes of bipolar disorder. Most agree ...

  15. Personality Disorders in Substance Abusers: A Comparison of Patients Treated in a Prison Unit and Patients Treated in Inpatient Treatment

    ERIC Educational Resources Information Center

    Stefansson, Ragnar; Hesse, Morten

    2008-01-01

    A large body of literature has shown a high prevalence of personality disorders in substance abusers. We compared a sample of substance abusers treated in a prison setting with substance abusers treated in a non-prison inpatient setting rated with the Millon Clinical Multiaxial Inventory-III. Base-rate scores indicated a prevalence of 95% of…

  16. Neurocognitive Functioning in Overweight and Obese Patients With Bipolar Disorder: Data From the Systematic Treatment Optimization Program for Early Mania (STOP-EM)

    PubMed Central

    Silveira, Leonardo E; Kozicky, Jan-Marie; Muralidharan, Kesavan; Bücker, Joana; Torres, Ivan J; Bond, David J; Kapczinski, Flavio; Kauer-Sant’Anna, Marcia; Lam, Raymond W; Yatham, Lakshmi N

    2014-01-01

    Objective Obesity is frequent in people with bipolar I disorder (BD I) and has a major impact on the course of the illness. Although obesity negatively influences cognitive function in patients with BD, its impact in the early phase of the disorder is unknown. We investigated the impact of overweight and obesity on cognitive functioning in clinically stable patients with BD recently recovered from their first manic episode. Method: Sixty-five patients with BD (25 overweight or obese and 40 normal weight) recently remitted from a first episode of mania and 37 age- and sex-matched healthy control subjects (9 overweight or obese and 28 normal weight) were included in this analysis from the Systematic Treatment Optimization Program for Early Mania (commonly referred to as STOP-EM). All subjects had their cognitive function assessed using a standard neurocognitive battery. We compared cognitive function between normal weight patients, overweight–obese patients, and normal weight healthy control subjects. Results: There was a negative affect of BD diagnosis on the domains of attention, verbal memory, nonverbal memory, working memory, and executive function, but we were unable to find an additional effect of weight on cognitive functioning in patients. There was a trend for a negative correlation between body mass index and nonverbal memory in the patient group. Conclusions: These data suggest that overweight–obesity does not negatively influence cognitive function early in the course of BD. Given that there is evidence for a negative impact of obesity later in the course of illness, there may be an opportunity to address obesity early in the course of BD. PMID:25702364

  17. A Therapeutic Confrontation Approach to Treating Patients with Factitious Illness

    ERIC Educational Resources Information Center

    Wedel, Kenneth R.

    1971-01-01

    Patients suffering from factitious illness present complex problems for themselves and hospital personnel. This article describes a multidisciplinary intervention through confrontation approach that has proved to be successful with such patients. (Author)

  18. Prefrontocerebellar transcranial direct current stimulation increases amplitude and decreases latency of P3b component in patients with euthymic bipolar disorder

    PubMed Central

    Bersani, Francesco Saverio; Minichino, Amedeo; Fattapposta, Francesco; Bernabei, Laura; Spagnoli, Francesco; Mannarelli, Daniela; Francesconi, Marta; Pauletti, Caterina; Corrado, Alessandra; Vergnani, Lucilla; Taddei, Ines; Biondi, Massimo; Delle Chiaie, Roberto

    2015-01-01

    Introduction Neurocognitive impairments have been observed in patients with bipolar disorder (BD) even during the euthymic phase of the disease, potentially representing trait-associated rather than state-associated characteristics of the disorder. In the present study, we used transcranial direct current stimulation (tDCS) applied to cerebellar and prefrontal cortices to improve the neurophysiological performances of patients with euthymic BD. Methods Twenty-five outpatients with BD underwent open-label prefrontocerebellar tDCS for 3 consecutive weeks. Neurophysiological performances were assessed through the examination of the P3b and P3a subcomponents of P300 event-related potential at baseline and after stimulation. Results Compared to baseline, P3b component after tDCS showed significantly higher amplitude and shorter latency (latency: Fz P=0.02, Cz P=0.03, and Pz P=0.04; amplitude: Fz P=0.24, Cz P=0.02, and Pz P=0.35). Conclusion In our sample of patients with euthymic BD, concomitant prefrontoexcitatory and cerebellar-inhibitory modulations led to improved brain information processing stream. This improvement may at least partially result from neuroplastic modulation of prefrontocerebellar circuitry activity. PMID:26640377

  19. Antipsychotic Medicines for Schizophrenia and Bipolar Disorder: What You Should Know

    MedlinePlus

    Antipsychotic Drugs for Schizophrenia and Bipolar Disorder: What You Should Know What are antipsychotic drugs? Antipsychotics are prescription drugs used to treat schizophrenia. They can also be used— ...

  20. [Non pharmacological treatment for bipolar disorder].

    PubMed

    Mirabel-Sarron, Christine; Giachetti, Raphaël

    2012-12-01

    Bipolar disorder is a chronic and recurring disorder associated with significant psychosocial impairment. A number of psychosocial interventions have been developed to address impairment. The consensus makes mood stabilizer the treatment of bipolar disorder. However, numerous patients are not in complete remission despite a controlled observance. Every patient can follow a psycho educational program. What this paper adds. The review identifies that a range of interventions have demonstrated efficacy in extended periods of euthymia, improved social and occupational functioning and alleviation of subsyndromal symptoms. Adjunctive, short-term psychotherapies have been shown to offer fairly consistent benefits to bipolar disorder patients. Cognitive-behavioural therapy, family-focused therapy, and psychoeducation offer the most robust efficacy in regard to relapse prevention. The most complex situations including comorbidities can be helped by behavioral and cognitive therapy for bipolar disorder. Evaluations emphasize positive impact. The psychosocial interventions reviewed provide mental health nurses with evidence-based approaches to improving mental health care for patients with bipolar disorder. There is a need for mental health nurses to conduct high quality trials of the clinical effectiveness of these interventions.

  1. Classification of schizophrenia and bipolar patients using static and dynamic resting-state fMRI brain connectivity.

    PubMed

    Rashid, Barnaly; Arbabshirani, Mohammad R; Damaraju, Eswar; Cetin, Mustafa S; Miller, Robyn; Pearlson, Godfrey D; Calhoun, Vince D

    2016-07-01

    Recently, functional network connectivity (FNC, defined as the temporal correlation among spatially distant brain networks) has been used to examine the functional organization of brain networks in various psychiatric illnesses. Dynamic FNC is a recent extension of the conventional FNC analysis that takes into account FNC changes over short periods of time. While such dynamic FNC measures may be more informative about various aspects of connectivity, there has been no detailed head-to-head comparison of the ability of static and dynamic FNC to perform classification in complex mental illnesses. This paper proposes a framework for automatic classification of schizophrenia, bipolar and healthy subjects based on their static and dynamic FNC features. Also, we compare cross-validated classification performance between static and dynamic FNC. Results show that the dynamic FNC significantly outperforms the static FNC in terms of predictive accuracy, indicating that features from dynamic FNC have distinct advantages over static FNC for classification purposes. Moreover, combining static and dynamic FNC features does not significantly improve the classification performance over the dynamic FNC features alone, suggesting that static FNC does not add any significant information when combined with dynamic FNC for classification purposes. A three-way classification methodology based on static and dynamic FNC features discriminates individual subjects into appropriate diagnostic groups with high accuracy. Our proposed classification framework is potentially applicable to additional mental disorders.

  2. Optimize patient health by treating literacy and language barriers.

    PubMed

    Dreger, Vicki; Tremback, Tom

    2002-02-01

    More than 90 million Americans have limited literacy skills. Almost two million US residents cannot speak English, and millions more speak it poorly. The stigma of illiteracy or the inability to speak a country's predominant language keep patients from disclosing their limitations. Recognizing these facts is an important first step in improving health education for this vulnerable population. By adapting teaching techniques to patients' special needs, nurses can ensure that patients understand their health problems and plan of care. Statistics dramatically demonstrate the high cost of neglecting these needs. Patients who do not understand their plan of care do not comply with instructions and, therefore, suffer unnecessary complications. Health care providers who can communicate with their patients through multilingual, low literacy patient education materials and with the use of qualified interpreters markedly improve the quality of care for their patients and the resulting outcomes.

  3. Antipsychotic drugs attenuate aberrant DNA methylation of DTNBP1 (dysbindin) promoter in saliva and post-mortem brain of patients with schizophrenia and Psychotic bipolar disorder.

    PubMed

    Abdolmaleky, Hamid M; Pajouhanfar, Sara; Faghankhani, Masoomeh; Joghataei, Mohammad Taghi; Mostafavi, Ashraf; Thiagalingam, Sam

    2015-12-01

    Due to the lack of genetic association between individual genes and schizophrenia (SCZ) pathogenesis, the current consensus is to consider both genetic and epigenetic alterations. Here, we report the examination of DNA methylation status of DTNBP1 promoter region, one of the most credible candidate genes affected in SCZ, assayed in saliva and post-mortem brain samples. The Illumina DNA methylation profiling and bisulfite sequencing of representative samples were used to identify methylation status of the DTNBP1 promoter region. Quantitative methylation specific PCR (qMSP) was employed to assess methylation of DTNBP1 promoter CpGs flanking a SP1 binding site in the saliva of SCZ patients, their first-degree relatives and control subjects (30, 15, and 30/group, respectively) as well as in post-mortem brains of patients with SCZ and bipolar disorder (BD) versus controls (35/group). qRT-PCR was used to assess DTNBP1 expression. We found DNA hypermethylation of DTNBP1 promoter in the saliva of SCZ patients (∼12.5%, P = 0.036), particularly in drug-naïve patients (∼20%, P = 0.011), and a trend toward hypermethylation in their first-degree relatives (P = 0.085) versus controls. Analysis of post-mortem brain samples revealed an inverse correlation between DTNBP1 methylation and expression, and normalization of this epigenetic change by classic antipsychotic drugs. Additionally, BD patients with psychotic depression exhibited higher degree of methylation versus other BD patients (∼80%, P = 0.025). DTNBP1 promoter DNA methylation may become a key element in a panel of biomarkers for diagnosis, prevention, or therapy in SCZ and at risk individuals pending confirmatory studies with larger sample sizes to attain a higher degree of significance.

  4. A randomized, double-blind, placebo-controlled trial of quetiapine in patients with bipolar disorder, mixed or depressed phase, and alcohol dependence

    PubMed Central

    Brown, E. Sherwood; Domingo Davila, S.; Nakamura, Alyson; Carmody, Thomas J.; Rush, A. John; Lo, Alexander; Holmes, Traci; Adinoff, Bryon; Caetano, Raul; Swann, Alan C; Sunderajan, Prabha; Bret, Mary E.

    2014-01-01

    Background Alcohol dependence is common in bipolar disorder (BPD) and associated with treatment non-adherence, violence, and hospitalization. Quetiapine is a standard treatment for BPD. We previously reported improvement in depressive symptoms, but not alcohol use, with quetiapine in BPD and alcohol dependence. However, mean alcohol use was low and a larger effect size on alcohol-related measures was observed in those with higher levels of alcohol consumption. In this study, efficacy of quetiapine in patients with BPD and alcohol dependence was examined in patients with higher mean baseline alcohol use than in the prior study. Methods Ninety outpatients with bipolar I or II disorders, depressed or mixed mood state, and current alcohol dependence were randomized to 12 weeks of sustained release quetiapine (to 600 mg/day) add-on therapy or placebo. Drinking was quantified using the Timeline Follow Back method. Additional assessment tools included the Hamilton Rating Scale for Depression (HRSD17), Inventory of Depressive Symptomatology–Self-Report (IDS-SR30), Young Mania Rating Scale (YMRS), Penn Alcohol Craving Scale (PACS), liver enzymes, and side effects. Alcohol use and mood were analyzed using a declining-effects random-regression model. Results Baseline and demographic characteristics in the two groups were similar. No significant between-group differences were observed on the primary outcome measure of drinks/day or other alcohol-related or mood measures (p>.05). Overall side effect burden, glucose and cholesterol were similar in the two groups. However, a significant weight increase was observed with quetiapine at week 6 (+2.9 lbs [SE 1.4] quetiapine vs. −2.0 lbs [SE 1.4], p=.03), but not at week 12. Scores on the Barnes Akathisia Scale increased significantly more (p=.04) with quetiapine (+0.40 (SE 0.3)) than placebo (−0.52 (SE 0.3)) at week 6 but not week 12. Retention (survival) in the study was similar in the groups. Conclusions Findings suggest that

  5. Biologic basis of bipolar disorder in children and adolescents.

    PubMed

    Kloos, Angelica; Weller, Elizabeth B; Weller, Ronald A

    2008-04-01

    Bipolar disorder is a serious and difficult-to-treat condition in any age group. In childhood and adolescence, diagnosis and treatment present specific challenges, as the disorder often manifests in atypical presentations, such as marked irritability and frequent alterations of mood states not typically seen in adults. The lack of double-blind, placebo-controlled studies in pediatric populations also leads to many difficult pharmacologic challenges. In this paper, we review available studies in neuroanatomy, neurochemistry, neurocognitive functioning, and genetics to further explore the underlying neurobiologic mechanisms of child and adolescent bipolar disorder. Future investigation should elicit distinct mechanisms for diagnosing and treating bipolar disorder from a neurobiologic perspective.

  6. Genetic susceptibility for bipolar disorder and response to antidepressants in major depressive disorder.

    PubMed

    Tansey, Katherine E; Guipponi, Michel; Domenici, Enrico; Lewis, Glyn; Malafosse, Alain; O'Donovan, Michael; Wendland, Jens R; Lewis, Cathryn M; McGuffin, Peter; Uher, Rudolf

    2014-01-01

    The high heterogeneity of response to antidepressant treatment in major depressive disorder (MDD) makes individual treatment outcomes currently unpredictable. It has been suggested that resistance to antidepressant treatment might be due to undiagnosed bipolar disorder or bipolar spectrum features. Here, we investigate the relationship between genetic susceptibility for bipolar disorder and response to treatment with antidepressants in MDD. Polygenic scores indexing risk for bipolar disorder were derived from the Psychiatric Genomics Consortium Bipolar Disorder whole genome association study. Linear regressions tested the effect of polygenic risk scores for bipolar disorder on proportional reduction in depression severity in two large samples of individuals with MDD, treated with antidepressants, NEWMEDS (n=1,791) and STAR*D (n=1,107). There was no significant association between polygenic scores for bipolar disorder and response to treatment with antidepressants. Our data indicate that molecular measure of genetic susceptibility to bipolar disorder does not aid in understanding non-response to antidepressants.

  7. Tardive dyskinesia in 2 patients treated with ziprasidone

    PubMed Central

    Ananth, Jambur; Burgoyne, Karl S.; Niz, David; Smith, Michael

    2004-01-01

    Ziprasidone is an atypical antipsychotic drug that is believed to have a low propensity for inducing extrapyramidal symptoms, including tardive dyskinesia (TD). Two of our patients developed TD after 23 months and 34 months of ziprasidone monotherapy, respectively. One of the patients had had earlier exposure to typical antipsychotic drugs, but no other predisposing factors for TD were noted. Therefore, patients on long-term therapy with atypical antipsychotic drugs should be screened periodically for TD. PMID:15644988

  8. [Personality and emesis in the patient treated with antineoplastic chemotherapy].

    PubMed

    Llorca, G; Martín, T; Derecho, J; Gómez, M J

    1991-01-01

    A sample of twenty cancer patients following chemotherapy realize MMPI questionnaire, and another one for valuation of emetic and anticipatory phenomena in relation to said therapy. The authors came to the conclusion that 36.8% of the sample had anticipatory nausea and vomiting, 63.6% anticipatory dysphoria, and 66% emetic incidents after chemotherapy. The conclusion, through comparison of personality variables, is that all patients showed neuroticism and depression scales increased, in relation to healthy population. Depression variable increased especially in patients that didn't present anticipatory nausea and vomiting. Likewise, patients with anticipatory symptoms or emetic incidents after chemotherapy present an increased social introversion variable.

  9. Ixabepilone in Treating Young Patients With Refractory Solid Tumors

    ClinicalTrials.gov

    2014-11-13

    Adult Rhabdomyosarcoma; Adult Synovial Sarcoma; Alveolar Childhood Rhabdomyosarcoma; Childhood Synovial Sarcoma; Embryonal Childhood Rhabdomyosarcoma; Previously Treated Childhood Rhabdomyosarcoma; Recurrent Adult Soft Tissue Sarcoma; Recurrent Childhood Rhabdomyosarcoma; Recurrent Childhood Soft Tissue Sarcoma; Recurrent Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Recurrent Neuroblastoma; Recurrent Osteosarcoma; Recurrent Wilms Tumor and Other Childhood Kidney Tumors

  10. Cixutumumab in Treating Patients With Relapsed or Refractory Solid Tumors

    ClinicalTrials.gov

    2015-03-18

    Adult Rhabdomyosarcoma; Adult Synovial Sarcoma; Childhood Hepatoblastoma; Childhood Synovial Sarcoma; Previously Treated Childhood Rhabdomyosarcoma; Recurrent Adrenocortical Carcinoma; Recurrent Adult Soft Tissue Sarcoma; Recurrent Childhood Liver Cancer; Recurrent Childhood Rhabdomyosarcoma; Recurrent Childhood Soft Tissue Sarcoma; Recurrent Ewing Sarcoma/Peripheral Primitive; Neuroectodermal Tumor; Recurrent Neuroblastoma; Recurrent Osteosarcoma; Recurrent Retinoblastoma; Recurrent Wilms Tumor and Other Childhood Kidney Tumors

  11. Willingness of Health-Professions Students to Treat Patients with AIDS.

    ERIC Educational Resources Information Center

    Currey, Charles J.; And Others

    1990-01-01

    This 1988-89 survey of 319 students in the medical, dental, nursing, and allied health-care professions revealed that over one-third had reservations about treating AIDS (Acquired Immune Deficiency Syndrome) patients. Unwillingness to treat AIDS patients was strongly associated with homophobic attitudes. Education should emphasize methods for the…

  12. Metabolic alterations in medication-free patients with bipolar disorder: a 3T CSF-corrected magnetic resonance spectroscopic imaging study.

    PubMed

    Port, John D; Unal, Sencan S; Mrazek, David A; Marcus, Susan M

    2008-02-28

    The objective of this study was to determine whether cerebrospinal fluid(CSF)-corrected concentrations of N-acetylaspartate are lower in several brain regions of drug- and medication-free subjects with bipolar disorder as compared with matched healthy controls. Bipolar subjects (n=21) and age- and sex-matched healthy control (n=21) were studied using proton magnetic resonance spectroscopic imaging on a 3T magnetic resonance (MR) scanner. Spectra were quantified using the LCModel, and metabolite values were CSF-corrected to yield metabolite concentrations. Fourteen regions of interest and five metabolite concentrations in each subject were selected for statistical analysis. We found that bipolar subjects had significantly decreased N-acetylaspartate concentrations in both caudate heads and the left lentiform nucleus. Choline and creatine in the head of the right caudate were also significantly decreased in bipolar subjects. Significantly increased myo-inositol was found in the left caudate head in bipolar subjects. Bipolar subjects showed significantly decreased glutamate/glutamine concentrations in the frontal white matter bilaterally and in the right lentiform nucleus. No differences were found for other metabolites examined. These preliminary findings suggest decreased neuronal density or viability in the basal ganglia and neurometabolic abnormalities in the frontal lobes of subjects with bipolar disorder.

  13. The microtubular cytoskeleton of olfactory neurons derived from patients with schizophrenia or with bipolar disorder: Implications for biomarker characterization, neuronal physiology and pharmacological screening.

    PubMed

    Benítez-King, G; Valdés-Tovar, M; Trueta, C; Galván-Arrieta, T; Argueta, J; Alarcón, S; Lora-Castellanos, A; Solís-Chagoyán, H

    2016-06-01

    Schizophrenia (SZ) and Bipolar Disorder (BD) are highly inheritable chronic mental disorders with a worldwide prevalence of around 1%. Despite that many efforts had been made to characterize biomarkers in order to allow for biological testing for their diagnoses, these disorders are currently detected and classified only by clinical appraisal based on the Diagnostic and Statistical Manual of Mental Disorders. Olfactory neuroepithelium-derived neuronal precursors have been recently proposed as a model for biomarker characterization. Because of their peripheral localization, they are amenable to collection and suitable for being cultured and propagated in vitro. Olfactory neuroepithelial cells can be obtained by a non-invasive brush-exfoliation technique from neuropsychiatric patients and healthy subjects. Neuronal precursors isolated from these samples undergo in vitro the cytoskeletal reorganization inherent to the neurodevelopment process which has been described as one important feature in the etiology of both diseases. In this paper, we will review the current knowledge on microtubular organization in olfactory neurons of patients with SZ and with BD that may constitute specific cytoskeletal endophenotypes and their relation with alterations in L-type voltage-activated Ca(2+) currents. Finally, the potential usefulness of neuronal precursors for pharmacological screening will be discussed.

  14. Diagnostic criteria for bipolarity based on an international sample of 5,635 patients with DSM-IV major depressive episodes.

    PubMed

    Angst, J; Gamma, A; Bowden, C L; Azorin, J M; Perugi, G; Vieta, E; Young, A H

    2012-02-01

    To assess the clinical validity of individual DSM-IV criteria for hypomania. In an international sample of 5,635 patients with major depressive episodes (Bridge Study), DSM-IV criteria for hypomania (stem questions, number and quality of symptoms, duration and exclusion criteria) were systematically assessed and their validity analysed on the basis of clinical data including family history, course, and other clinical characteristics. Three stem questions for hypomania, irritability, elevated mood and the added question of increased activity, showed comparable validity. The results support the current DSM-IV requirement for a higher symptom threshold (4 of 7 hypomanic symptoms) in cases of irritable mood. Longer durations of hypomanic episodes were associated with higher scores on all validators. The results did not support the DSM-IV durational requirements for hypomanic episodes (4 days) and manic episodes (7 days). Brief hypomanic episodes of 1, 2 or 3 days were valid and would meet validity criteria for inclusion. The three exclusion criteria in DSM-IV (hypomania due to the use of antidepressants or of other substances, or to other medical conditions) were found to exclude patients with bipolar depression and should therefore not be retained. These results support several revisions of the DSM-IV concept of hypomanic episodes: specifically, the inclusion of increased activity as a gate question, the inclusion of 1 or 2 to 3-day episodes and the elimination of all exclusion criteria.

  15. Comorbid bipolar disorder and borderline personality disorder and history of suicide attempts.

    PubMed

    Zimmerman, Mark; Martinez, Jennifer; Young, Diane; Chelminski, Iwona; Morgan, Theresa A; Dalrymple, Kristy

    2014-06-01

    Both bipolar disorder and borderline personality disorder are associated with elevated rates of attempted suicide; however, no studies have examined whether there is an independent, additive risk for suicide attempts in patients diagnosed with both disorders. In the present study from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, 3,465 psychiatric outpatients were interviewed with semistructured interviews. Compared to the bipolar patients without borderline personality disorder, the patients diagnosed with both bipolar and borderline personality disorder were significantly more likely to have made a prior suicide attempt. The patients with borderline personality disorder and bipolar disorder were nonsignificantly more likely than the borderline patients without bipolar disorder to have made a prior suicide attempt. Bipolar disorder and borderline personality disorder were each associated with an increased rate of suicide attempts. The co-occurrence of these disorders conferred an additive risk, although the influence of borderline personality disorder was greater than that of bipolar disorder.

  16. A Study on the Association of Interleukin-1 Cluster with Genetic Risk in Bipolar I Disorder in Iranian Patients: A Case-control Study.

    PubMed

    Talaei, Ali; Tavakkol Afshari, Jalil; Fayyazi Bordbar, Mohammad Reza; Pouryousof, Hamidreza; Faridhosseini, Farhad; Saghebi, Ali; Rezaei Ardani, Amir; Talaei, Andisheh; Tehrani, Mohsen

    2016-12-01

    The pathogenesis of Bipolar I Disorder (BP-I) involves immune-mediated mechanisms, especially an imbalance in pro-inflammatory/anti-inflammatory cytokines in plasma or cerebrospinal fluid. Interleukin-1 (IL-1) gene cluster, coding some of these pro-inflammatory cytokines, might play a role in various neuropathologies related to neuron inflammation. The aim of the present study was to investigate the possible role of IL-1 gene cluster polymorphisms in determining the susceptibility to BP-I in Iranian population. 48 patients with BP-I in Mashhad (in north-eastern Iran), diagnosed by two psychiatrists using SCID (structured clinical interview for DSM disorders) were selected through convenient sampling and were compared with 47 healthy controls, voluntarily enrolled in the study. Patients with non-Persian ethnicity, history of immunoallergic disorders, endocrinopathies, neurologic disorders, and substance-induced mood disorders were excluded from both case and control groups. Genotyping of IL-1 gene cluster polymorphisms, including IL-1a-889, IL-1b +3954, IL-1b-511, and IL-1RN (VNTR) were carried out using Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and compared by SPSS using Fisher's exact and chi-square tests. The frequency of IL-1b-511 CC genotype and C/T allelic frequency were significantly different between BMD patients and healthy controls (p=0.04 and p=0.02, respectively). Among patients, -511 T allele was significantly more frequent in those with a positive history of major depression. Moreover, +3954 T allele was significantly more frequent in early onset BMD patients. The results suggest a positive association between IL-1 gene cluster variation and BP-I. This polymorphism may contribute to genetic vulnerability through its possible role in neuron inflammation.

  17. Secondary hemorrhage after bipolar transurethral resection and vaporization of prostate

    PubMed Central

    Yee, Chi-Hang; Wong, Joseph Hon-Ming; Chiu, Peter Ka-Fung; Teoh, Jeremy Yuen-Chun; Chan, Chi-Kwok; Chan, Eddie Shu-Yin; Hou, See-Ming; Ng, Chi-Fai

    2016-01-01

    Introduction: We evaluated the factors associated with secondary hemorrhage after bipolar transurethral resection of prostate (TURP) and vaporization of prostate. Materials and Methods: The perioperative data of patients undergoing endoscopic surgery for benign prostatic hyperplasia (BPH) were prospectively collected. Procedures involved included bipolar TURP, bipolar vaporization of prostate, and hybrid bipolar TURP/vaporization of prostate. Secondary hemorrhage was defined as bleeding between 48 h and 30 days postsurgery requiring hospital attendance with or without admission. Risk factors for secondary hemorrhage were analyzed. Results: From 2010 to 2013, 316 patients underwent bipolar surgery for BPH. Bipolar TURP accounted for 48.1% of the procedures, bipolar vaporization accounted for 20.3% of the procedures, and the rest were hybrid TURP/vaporization of prostate. Among this cohort of patients, fifty patients had secondary hemorrhage with hospital attendance. Consumption of platelet aggregation inhibitors (PAIs) was found to be associated with secondary hemorrhage (P < 0.0005). Age, prostate volume, operation type, the use of 5-alpha reductase inhibitors, and being with a urethral catheter before operation were not found to be statistically significant risk factors for secondary hemorrhage. Conclusions: Secondary hemorrhage after bipolar surgery for BPH is a common event. Consumption of PAI is a risk factor for such complication. PMID:28057992

  18. Risk Factors of Attempted Suicide in Bipolar Disorder

    ERIC Educational Resources Information Center

    Cassidy, Frederick

    2011-01-01

    Suicide rates of bipolar patients are among the highest of any psychiatric disorder, and improved identification of risk factors for attempted and completed suicide translates into improved clinical outcome. Factors that may be predictive of suicidality in an exclusively bipolar population are examined. White race, family suicide history, and…

  19. Cognitive-Behavioral Therapy for Rapid Cycling Bipolar Disorder

    ERIC Educational Resources Information Center

    Reilly-Harrington, Noreen A.; Knauz, Robert O.

    2005-01-01

    This article describes the application of cognitive-behavioral therapy (CBT) to the treatment of rapid cycling bipolar disorder. Between 10% and 24% of bipolar patients experience a rapid cycling course, with 4 or more mood episodes occurring per year. Characterized by nonresponse to standard mood-stabilizing medications, rapid cyclers are…

  20. Diagnosis, Epidemiology and Management of Mixed States in Bipolar Disorder.

    PubMed

    Fagiolini, Andrea; Coluccia, Anna; Maina, Giuseppe; Forgione, Rocco N; Goracci, Arianna; Cuomo, Alessandro; Young, Allan H

    2015-09-01

    Approximately 40% of patients with bipolar disorder experience mixed episodes, defined as a manic state with depressive features, or manic symptoms in a patient with bipolar depression. Compared with bipolar patients without mixed features, patients with bipolar mixed states generally have more severe symptomatology, more lifetime episodes of illness, worse clinical outcomes and higher rates of comorbidities, and thus present a significant clinical challenge. Most clinical trials have investigated second-generation neuroleptic monotherapy, monotherapy with anticonvulsants or lithium, combination therapy, and electroconvulsive therapy (ECT). Neuroleptic drugs are often used alone or in combination with anticonvulsants or lithium for preventive treatment, and ECT is an effective treatment for mixed manic episodes in situations where medication fails or cannot be used. Common antidepressants have been shown to worsen mania symptoms during mixed episodes without necessarily improving depressive symptoms; thus, they are not recommended during mixed episodes. A greater understanding of pathophysiological processes in bipolar disorder is now required to provide a more accurate diagnosis and new personalised treatment approaches. Targeted, specific treatments developed through a greater understanding of bipolar disorder pathophysiology, capable of affecting the underlying disease processes, could well prove to be more effective, faster acting, and better tolerated than existing therapies, therefore providing better outcomes for individuals affected by bipolar disorder. Until such time as targeted agents are available, second-generation neuroleptics are emerging as the treatment of choice in the management of mixed states in bipolar disorder.

  1. Challenges in Treating Older Patients with Acute Myeloid Leukemia

    PubMed Central

    Eleni, Lagadinou D.; Nicholas, Zoumbos C.; Alexandros, Spyridonidis

    2010-01-01

    Whereas in younger patients diagnosed with acute myeloid leukemia (AML) treatment is straightforward and the goal is cure, the optimal treatment decision for older adults remains highly controversial. Physicians need to determine whether palliation, “something” beyond palliation, intensive therapy, or an investigational therapy is the most appropriate treatment option. This requires understanding of the biology and risk profile of the AML, clinical judgment in evaluating the functional status of the patient, communication skills in understanding the patient's wishes and social background, and medical expertise in available therapies. The physician has to accurately inform the patient about (a) the unique biological considerations of his leukemia and his prognosis; (b) the risks and benefits of all available treatment options; (c) novel therapeutic approaches and how the patient can get access to these treatments. Last but not least, he has to recommend a treatment. This paper tries to discuss each of these issues. PMID:20628485

  2. Laser radiation of blood in treating patients with postinfarction heart

    NASA Astrophysics Data System (ADS)

    Tashchuk, V.; Polyanskaya, O.; Chaplinsky, R.; Ilashchuk, I.; Kulyk, T.

    1999-11-01

    168 patients on the postclinical stage of treatment of acute myocardial infarction were examined by means of the use of basic antiischemic therapy and intravenous laser radiation of blood (LRB). All patients were studied with the help of transesophageal electrocardiostimulation, bicycle ergometry, echocardiography and Holter ECG monitoring in the dynamics of prolonged observation and treatment. The analysis of efficiency of the LRB has shown that the most minimal degree of myocardial ischemization was marked in patients after intravenous LRB. The patients before LRB had the greater reduction of coronary reserve. The use of LRB has given the possibility to the optimization of therapy in patients on the stage of the forming of `the postinfarction heart'.

  3. Bipolar fuel cell

    DOEpatents

    McElroy, James F.

    1989-01-01

    The present invention discloses an improved fuel cell utilizing an ion transporting membrane having a catalytic anode and a catalytic cathode bonded to opposite sides of the membrane, a wet-proofed carbon sheet in contact with the cathode surface opposite that bonded to the membrane and a bipolar separator positioned in electrical contact with the carbon sheet and the anode of the adjacent fuel cell. Said bipolar separator and carbon sheet forming an oxidant flowpath, wherein the improvement comprises an electrically conductive screen between and in contact with the wet-proofed carbon sheet and the bipolar separator improving the product water removal system of the fuel cell.

  4. How I treat influenza in patients with hematologic malignancies

    PubMed Central

    Casper, Corey; Englund, Janet

    2010-01-01

    The 2009 H1N1 influenza pandemic has heightened the interest of clinicians for options in the prevention and management of influenza virus infection in immunocompromised patients. Even before the emergence of the novel 2009 H1N1 strain, influenza disease was a serious complication in patients with hematologic malignancies receiving chemotherapy or undergoing hematopoietic cell transplantation. Here we review the clinical manifestations of seasonal and 2009 H1N1 influenza and discuss current diagnosis, antiviral treatment, and prophylaxis options. We also summarize infection control and vaccination strategies for patients, family members, and caregivers. PMID:20009037

  5. American brain tumor patients treated with BNCT in Japan

    SciTech Connect

    Laramore, G.E.; Griffin, B.R.; Spence, A.

    1995-11-01

    The purpose of this work is to establish and maintain a database for patients from the United States who have received BNCT in Japan for malignant gliomas of the brain. This database will serve as a resource for the DOE to aid in decisions relating to BNCT research in the United States, as well as assisting the design and implementation of clinical trials of BNCT for brain cancer patients in this country. The database will also serve as an information resource for patients with brain tumors and their families who are considering this form of therapy.

  6. [Lithium can be given to patients on haemodialysis treatment].

    PubMed

    Kancir, Anne Sophie Pinholt; Viftrup, Jens Emil; Pedersen, Erling Bjerregaard

    2015-01-26

    Lithium-induced nephropathy is a known complication of lithium treatment in bipolar disorder. Treatment with lithium should be discontinued, if there is evidence of lithium-induced nephropathy. However, lithium can be given to patients with end-stage-renal-disease on haemodialysis treatment, if there is no other way to control the bipolar disorder. We report one patient who was successfully treated with lithium in parallel with haemodialysis.

  7. Benefits of treating highly disabled migraine patients with zolmitriptan while pain is mild.

    PubMed

    Klapper, J; Lucas, C; Røsjø, Ø; Charlesworth, B

    2004-11-01

    Clinical trials of migraine therapy often require treatment when migraine pain intensity is moderate or severe, but many physicians find this practice artificial and patients often prefer to treat while pain is mild. This randomized, placebo-controlled study assessed the efficacy of zolmitriptan 2.5 mg in treating migraine while pain is mild, in patients who typically experience migraine attacks that are initially mild, but progress to moderate or severe. The intent-to-treat population comprised 280 patients (138 zolmitriptan; 148 placebo), with mean MIDAS grades of 29.6 (zolmitriptan) and 27.6 (placebo). Zolmitriptan 2.5 mg provided a significantly higher pain-free rate at 2 h (43.4% vs. 18.4% placebo; P < 0.0001). Significantly fewer zolmitriptan patients reported progression of headache pain to moderate or severe intensity 2 h postdose (53.7% vs. 70.4% placebo; P < 0.01), or required further medication within 24 h (46.4% vs. 71.1% placebo; P < 0.0001). The efficacy of zolmitriptan was more pronounced in patients treating during the first 15 min following pain onset. Adverse events were reported in 31.2% of patients treated with zolmitriptan (vs. 11.3% for placebo), and the incidence was lower in patients who treated early after attack onset. Zolmitriptan provides high efficacy when treating migraine while pain is mild, with the clinical benefits being more pronounced when treating early after migraine onset.

  8. Patient heal thyself: modeling and treating neurological disorders using patient-derived stem cells.

    PubMed

    Ess, Kevin C

    2013-03-01

    Disorders of the brain and spinal cord are common worldwide problems but have remained very difficult to treat. As a group they have diverse etiologies and can be due to trauma, infection, tumors, genetic mutations and environmental insults. Though distinct in etiology, neurological disorders share an overall intractability as current therapies are largely limited to treatment of symptoms. Improved outcomes are further constrained by the minimal endogenous capacity of the brain and spinal cord for repair. Spectacular recent scientific advances, however, suggest that new stem cell-based approaches may change this undesirable situation. In this review, I will broadly outline the challenges of studying and treating disorders of the brain and spinal cord. I will review ongoing attempts to use stem cell-based therapies to both model and treat neurological disorders. While this field is in its infancy, expected advances and needed breakthroughs point to a future where patient-derived stem cells will be the basis for the emerging discipline of regenerative neurology.

  9. Patient heal thyself: modeling and treating neurological disorders using patient-derived stem cells

    PubMed Central

    Ess, Kevin C

    2013-01-01

    Disorders of the brain and spinal cord are common worldwide problems but have remained very difficult to treat. As a group they have diverse etiologies and can be due to trauma, infection, tumors, genetic mutations and environmental insults. Though distinct in etiology, neurological disorders share an overall intractability as current therapies are largely limited to treatment of symptoms. Improved outcomes are further constrained by the minimal endogenous capacity of the brain and spinal cord for repair. Spectacular recent scientific advances, however, suggest that new stem cell-based approaches may change this undesirable situation. In this review, I will broadly outline the challenges of studying and treating disorders of the brain and spinal cord. I will review ongoing attempts to use stem cell-based therapies to both model and treat neurological disorders. While this field is in its infancy, expected advances and needed breakthroughs point to a future where patient-derived stem cells will be the basis for the emerging discipline of regenerative neurology. PMID:23598977

  10. Administering ziconotide and monitoring patients treated with ziconotide: expert opinions.

    PubMed

    Mitchell, Alisia A; Sapienza-Crawford, Anne J; Hanley, Kari L; Lokey, Kristi J; Wells, Linda; McDowell, Gladstone C; Stanton-Hicks, Michael

    2013-09-01

    Some patients with chronic pain who are intolerant of or refractory to treatment with systemic analgesics may benefit from intrathecal therapy. Ziconotide is the first nonopioid analgesic approved by the United States Food and Drug Administration for intrathecal administration. Several randomized, double-blind, placebo-controlled clinical trials have demonstrated the efficacy and safety of ziconotide. However, the maximum recommended dosing and titration schedule provided in the prescribing information may be too aggressive for some patients, and experience has demonstrated that ziconotide is better tolerated with slower titration to a lower maximum dose. Efficacy can be assessed by an evaluation of changes in pain, functionality, and quality of life. Cognitive adverse events may be subtle; therefore, it is important that health care professionals not only monitor patients for signs and symptoms of cognitive adverse events, but also teach family members how to do the same. Careful patient assessment and monitoring can help optimize the potential benefit from treatment with ziconotide.

  11. Serial thyroid iodine content in hyperthyroid patients treated with radioiodine

    SciTech Connect

    Lee, G.S.; Sandler, M.P.; Patton, J.A.; Brill, A.B.

    1986-02-01

    X-ray fluorescent scanning was used to measure initial thyroidal iodine content in 64 patients diagnosed as being hyperthyroid and selected for I-131 therapy, and serially in 48 of these patients after therapy in an attempt to determine those patients that were at high risk of becoming hypothyroid. Iodine content fell rapidly after therapy, reaching a nadir at about three months. Based on the population studied, the chance of early hypothyroidism (within 12 months) is about 80% if the iodine content measured at three months is less than 2 mg. If the iodine content is greater than 2 mg, the chance is only about 14%. The serial measurement of thyroidal iodine content (with x-ray fluorescent scanning) may allow early identification of those patients at high risk of developing permanent hypothyroidism following a therapeutic dose of I-131.

  12. Treating Patients with High-Risk Smoldering Myeloma

    Cancer.gov

    In this phase III clinical trial, patients with smoldering myeloma classified as high risk for progression will be randomly assigned to undergo standard observation or six 4-week courses of treatment with the drug lenalidomide.

  13. Choline-containing compounds detected by proton magnetic resonance spectroscopy in the basal ganglia in bipolar disorder.

    PubMed Central

    Kato, T; Hamakawa, H; Shioiri, T; Murashita, J; Takahashi, Y; Takahashi, S; Inubushi, T

    1996-01-01

    Choline-containing compounds (Cho) were examined by proton magnetic resonance spectroscopy (1H-MRS) in the left subcortical region, including basal ganglia, in 19 euthymic patients with bipolar disorder and 19 age-matched normal controls. Ten of the patients were treated with lithium; the remaining 9 were not treated with lithium for at least 30 d. The Cho to creatine + phosphocreatine (Cr) peak ratio in the bipolar patients (0.75 +/- 0.38 [mean +/- SD]) was higher than that in the normal controls (0.52 +/- 0.26, P < 0.05). There was no significant difference in the Cho:Cr peak ratio between patients treated with lithium (0.63 +/- 0.36) and without lithium (0.89 +/- 0.35). These results do not support the hypothesis that lithium increases the brain choline-containing compounds, but rather imply that membrane breakdown may occur in the basal ganglia of patients with bipolar disorder. Images Figure 1 PMID:8754593

  14. Metabolic syndrome - the consequence of lifelong treatment of bipolar affective disorder.

    PubMed

    Dadić-Hero, Elizabeta; Ruzić, Klementina; Grahovac, Tanja; Petranović, Duska; Graovac, Mirjana; Palijan, Tija Zarković

    2010-06-01

    Mood disturbances are characteristic and dominant feature of Mood disorders. Bipolar Affective Disorder (BAD) is a mood disorder which occurs equally in both sexes. BAD may occur in co morbidity with other mental diseases and disorders such as: Anorexia Nervosa, Bulimia Nervosa, Attention Deficit, Panic Disorder and Social Phobia. However, medical disorders (one or more) can also coexist with BAD. Metabolic syndrome is a combination of metabolic disorders that increase the risk of developing cardiovascular disease. A 61-year old female patient has been receiving continuous and systematic psychiatric treatment for Bipolar Affective Disorder for the last 39 years. The first episode was a depressive one and it occurred after a child delivery. Seventeen years ago the patient developed diabetes (diabetes type II), and twelve years ago arterial hypertension was diagnosed. High cholesterol and triglyceride levels as well as weight gain were objective findings. During the last nine years she has been treated for lower leg ulcer. Since metabolic syndrome includes abdominal obesity, hypertension, diabetes mellitus, increased cholesterol and serum triglyceride levels, the aforesaid patient can be diagnosed with Metabolic Syndrome. When treating Bipolar Affective Disorder, the antipsychotic drug choice should be careful and aware of its side-effects in order to avoid the development or aggravation of metabolic syndrome.

  15. Fusing Functional MRI and Diffusion Tensor Imaging Measures of Brain Function and Structure to Predict Working Memory and Processing Speed Performance among Inter-episode Bipolar Patients.

    PubMed

    McKenna, Benjamin S; Theilmann, Rebecca J; Sutherland, Ashley N; Eyler, Lisa T

    2015-05-01

    Evidence for abnormal brain function as measured with diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) and cognitive dysfunction have been observed in inter-episode bipolar disorder (BD) patients. We aimed to create a joint statistical model of white matter integrity and functional response measures in explaining differences in working memory and processing speed among BD patients. Medicated inter-episode BD (n=26; age=45.2±10.1 years) and healthy comparison (HC; n=36; age=46.3±11.5 years) participants completed 51-direction DTI and fMRI while performing a working memory task. Participants also completed a processing speed test. Tract-based spatial statistics identified common white matter tracts where fractional anisotropy was calculated from atlas-defined regions of interest. Brain responses within regions of interest activation clusters were also calculated. Least angle regression was used to fuse fMRI and DTI data to select the best joint neuroimaging predictors of cognitive performance for each group. While there was overlap between groups in which regions were most related to cognitive performance, some relationships differed between groups. For working memory accuracy, BD-specific predictors included bilateral dorsolateral prefrontal cortex from fMRI, splenium of the corpus callosum, left uncinate fasciculus, and bilateral superior longitudinal fasciculi from DTI. For processing speed, the genu and splenium of the corpus callosum and right superior longitudinal fasciculus from DTI were significant predictors of cognitive performance selectively for BD patients. BD patients demonstrated unique brain-cognition relationships compared to HC. These findings are a first step in discovering how interactions of structural and functional brain abnormalities contribute to cognitive impairments in BD.

  16. DNA-methyltransferase1 (DNMT1) binding to CpG rich GABAergic and BDNF promoters is increased in the brain of schizophrenia and bipolar disorder patients.

    PubMed

    Dong, E; Ruzicka, W B; Grayson, D R; Guidotti, A

    2015-09-01

    The down regulation of glutamic acid decarboxylase67 (GAD1), reelin (RELN), and BDNF expression in brain of schizophrenia (SZ) and bipolar (BP) disorder patients is associated with overexpression of DNA methyltransferase1 (DNMT1) and ten-eleven translocase methylcytosine dioxygenase1 (TET1). DNMT1 and TET1 belong to families of enzymes that methylate and hydroxymethylate cytosines located proximal to and within cytosine phosphodiester guanine (CpG) islands of many gene promoters, respectively. Altered promoter methylation may be one mechanism underlying the down-regulation of GABAergic and glutamatergic gene expression. However, recent reports suggest that both DNMT1 and TET1 directly bind to unmethylated CpG rich promoters through their respective Zinc Finger (ZF-CXXC) domains. We report here, that the binding of DNMT1 to GABAergic (GAD1, RELN) and glutamatergic (BDNF-IX) promoters is increased in SZ and BP disorder patients and this increase does not necessarily correlate with enrichment in promoter methylation. The increased DNMT1 binding to these promoter regions is detected in the cortex but not in the cerebellum of SZ and BP disorder patients, suggesting a brain region and neuron specific dependent mechanism. Increased binding of DNMT1 positively correlates with increased expression of DNMT1 and with increased binding of MBD2. In contrast, the binding of TET1 to RELN, GAD1 and BDNF-IX promoters failed to change. These data are consistent with the hypothesis that the down-regulation of specific GABAergic and glutamatergic genes in SZ and BP disorder patients may be mediated, at least in part, by a brain region specific and neuronal-activity dependent DNMT1 action that is likely independent of its DNA methylation activity.

  17. Response to lithium in bipolar disorder: clinical and genetic findings.

    PubMed

    Rybakowski, Janusz K

    2014-06-18

    The use of lithium is a cornerstone for preventing recurrences in bipolar disorder (BD). The response of patients with bipolar disorder to lithium has different levels of magnitude. About one-third of lithium-treated patients are excellent lithium responders (ELR), showing total prevention of the episodes. A number of clinical characteristics were delineated in patients with favorable response to lithium as regards to clinical course, family history of mood disorders, and psychiatric comorbidity. We have also demonstrated that temperamental features of hypomania (a hyperthymic temperament) and a lack of cognitive disorganization predict the best results of lithium prophylaxis. A degree of prevention against manic and depressive episodes has been regarded as an endophenotype for pharmacogenetic studies. The majority of data have been gathered from so-called "candidate" gene studies. The candidates were selected on the basis of neurobiology of bipolar disorder and mechanisms of lithium action including, among others, neurotransmission, intracellular signaling, neuroprotection or circadian rhythms. We demonstrated that response to lithium has been connected with the genotype of BDNF gene and serum BDNF levels and have shown that ELR have normal cognitive functions and serum BDNF levels, even after long-term duration of the illness. A number of genome-wide association studies (GWAS) of BD have been also performed in recent years, some of which also focused on lithium response. The Consortium on Lithium Genetics (ConLiGen) has established the large sample for performing the genome-wide association study (GWAS) of lithium response in BD, and the first results have already been published.

  18. Endotracheal Intubation in Patients Treated for Prehospital Status Epilepticus

    PubMed Central

    Miller, Joseph B.; Nicholas, Katherine S.; Varelas, Panayiotis N.; Harsh, Donna M.; Durkalski, Valerie; Silbergleit, Robert; Wang, Henry E.

    2015-01-01

    Introduction Limited data describe the frequency, timing, or indications for endotracheal intubation (ETI) in patients with status epilepticus. A better understanding of the characteristics of patients with status epilepticus requiring airway interventions could inform clinical care. We sought to characterize ETI use in patients with prehospital status epilepticus. Methods This study was a secondary analysis of the Rapid Anticonvulsant Medication Prior to Arrival Trial, a multi-center, randomized trial comparing intravenous lorazepam to intramuscular midazolam for prehospital status epilepticus treatment. Subjects received ETI in the prehospital, Emergency Department (ED), or inpatient setting at the discretion of caregivers. Results Of 1023 enrollments, 218 (21 %) received ETI. 204 (93.6 %) of the ETIs were performed in the hospital and 14 (6.4 %) in the prehospital setting. Intubated patients were older (52 vs 41 years, p < 0.001), and men underwent ETI more than women (26 vs 21 %, p = 0.047). Patients with ongoing seizures on ED arrival had a higher rate of ETI (32 vs 16 %, p < 0.001), as did those who received rescue anti-seizure medication (29 vs 20 %, p = 0.004). Mortality was higher for intubated patients (7 vs 0.4 %, p < 0.001). Most ETI (n = 133, 62 %) occurred early (prior to or within 30 min after ED arrival), and late ETI was associated with higher mortality (14 vs 3 %, p = 0.002) than early ETI. Conclusions ETI is common in patients with status epilepticus, particularly among the elderly or those with refractory seizures. Any ETI and late ETI are both associated with higher mortality. PMID:25623785

  19. Differential pattern of semantic memory organization between bipolar I and II disorders.

    PubMed

    Chang, Jae Seung; Choi, Sungwon; Ha, Kyooseob; Ha, Tae Hyon; Cho, Hyun Sang; Choi, Jung Eun; Cha, Boseok; Moon, Eunsoo

    2011-06-01

    Semantic cognition is one of the key factors in psychosocial functioning. The aim of this study was to explore the differences in pattern of semantic memory organization between euthymic patients with bipolar I and II disorders using the category fluency task. Study participants included 23 euthymic subjects with bipolar I disorder, 23 matched euthymic subjects with bipolar II disorder and 23 matched control subjects. All participants were assessed for verbal learning, recall, learning strategies, and fluency. The combined methods of hierarchical clustering and multidimensional scaling were used to compare the pattern of semantic memory organization among the three groups. Quantitative measures of verbal learning, recall, learning strategies, and fluency did not differ between the three groups. A two-cluster structure of semantic memory organization was identified for the three groups. Semantic structure was more disorganized in the bipolar I disorder group compared to the bipolar II disorder. In addition, patients with bipolar II disorder used less elaborate strategies of semantic memory organization than those of controls. Compared to healthy controls, strategies for categorization in semantic memory appear to be less knowledge-based in patients with bipolar disorders. A differential pattern of semantic memory organization between bipolar I and II disorders indicates a higher risk of cognitive abnormalities in patients with bipolar I disorder compared to patients with bipolar II disorder. Exploring qualitative nature of neuropsychological domains may provide an explanatory insight into the characteristic behaviors of patients with bipolar disorders.

  20. Use of NSAIDs in treating patients with arthritis

    PubMed Central

    2013-01-01

    Patients with rheumatic diseases, including rheumatoid arthritis and osteoarthritis, almost universally describe pain and stiffness as important contributors to reduced health-related quality of life. Of the treatment options available, NSAIDs are the most widely used agents for symptomatic treatment. NSAIDs are effective anti-inflammatory and analgesic drugs by virtue of their ability to inhibit biosynthesis of prostaglandins at the level of the cyclooxygenase enzyme. However, many of the adverse effects of NSAIDs are also related to inhibition of prostaglandin production, making their use problematic in some patient populations. For the clinician, understanding the biology of prostaglandin as it relates to gastrointestinal, renal, and cardiovascular physiology and the pharmacologic properties of specific NSAIDs is key to using these drugs safely. Of particular importance is the recognition of co-morbid conditions and concomitant drugs that may increase the risk of NSAIDs in particular patients. In patients with risk factors for NSAID toxicity, using the lowest dose of a drug with a short half-life only when it is needed is likely to be the safest treatment option. For those patients whose symptoms cannot be managed with intermittent treatment, using protective strategies is essential. PMID:24267197

  1. Muscle function in rheumatic disease patients treated with corticosteroids.

    PubMed

    Rothstein, J M; Delitto, A; Sinacore, D R; Rose, S J

    1983-02-01

    Clinical and experimental data indicate that long-term corticosteroid use leads to atrophy of the type 2 muscle fibers. The purpose of this study was to characterize and quantify the nature of muscle function in rheumatic disease patients who have been on long-term corticosteroid therapy. Quadriceps function (i.e., peak torque and power) in 19 patients (11 with rheumatoid arthritis, five with systemic lupus erythematosis, and 3 other) and 11 age- and activity-matched normal controls was measured with an isokinetic dynamometer (Cybex II), during four constant velocity movements. Power was significantly lower for the patients at all speeds. At the higher speeds the patients' deficit in power production increased as indicated by a difference in the slopes of power-velocity regression lines. Measures of peak torque could not be consistently used to differentiate the groups. Patients with rheumatic diseases receiving corticosteroids have a decreased ability to generate muscle power. The method described allows for quantification of these deficits in a clinical setting.

  2. Identifying and treating pregnant patients at risk from alcohol.

    PubMed Central

    Rosett, H. L.; Weiner, L.

    1981-01-01

    Heavy alcohol consumption during pregnancy has been associated with retardation of fetal growth and abnormal fetal development. Pregnant women whose offspring are at risk because of alcohol abuse can be identified and counselled by health professional providing prenatal care. Offspring born to women who had been drinking heavily and subsequently abstained from or reduced their intake of alcohol before the third trimester demonstrated improvements in growth and in regulation of sleep-awake states. The existing health care delivery system can be modified in a cost-effective manner to treat pregnant women who are problem drinkers. Physicians' attitudes and behaviour are critical for the success of this strategy. PMID:7272865

  3. Bipolar disorder (image)

    MedlinePlus

    Bipolar disorder is a mood disorder characterized by episodes of mania and major depression. Treatment with lithium or mood stabilizers may be effective, but medication regimens are sometimes difficult to tolerate ...

  4. Genetics of bipolar disorder.

    PubMed

    Escamilla, Michael A; Zavala, Juan M

    2008-01-01

    Bipolar disorder especially the most severe type (type I), has a strong genetic component. Family studies suggest that a small number of genes of modest effect are involved in this disorder. Family-based studies have identified a number of chromosomal regions linked to bipolar disorder, and progress is currently being made in identifying positional candidate genes within those regions. A number of candidate genes have also shown evidence of association with bipolar disorder, and genome-wide association studies are now under way, using dense genetic maps. Replication studies in larger or combined datasets are needed to definitively assign a role for specific genes in this disorder. This review covers our current knowledge of the genetics of bipolar disorder, and provides a commentary on current approaches used to identify the genes involved in this complex behavioral disorder.

  5. Comorbid medical illness in bipolar disorder

    PubMed Central

    Forty, Liz; Ulanova, Anna; Jones, Lisa; Jones, Ian; Gordon-Smith, Katherine; Fraser, Christine; Farmer, Anne; McGuffin, Peter; Lewis, Cathryn M.; Hosang, Georgina M.; Rivera, Margarita; Craddock, Nick

    2014-01-01

    Background Individuals with a mental health disorder appear to be at increased risk of medical illness. Aims To examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden. Method Participants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria. Results We found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset. Conclusions Bipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role. PMID:25359927

  6. Neutrophil activation in ivermectin-treated onchocerciasis patients.

    PubMed Central

    Njoo, F L; Hack, C E; Oosting, J; Stilma, J S; Kijlstra, A

    1993-01-01

    Ivermectin is a safe and effective drug for onchocerciasis treatment. In certain individuals, however, therapy is accompanied by adverse reactions. The mechanisms underlying these reactions are not yet known. The aim of the present study was to investigate whether neutrophils are involved in the development of these adverse reactions. Elastase and lactoferrin, two markers for the release of neutrophil azurophilic and specific granule contents respectively, were measured by radioimmunoassays in plasma of onchocerciasis patients with varying degrees of side effects, as well as in control subjects before and 1 and 2 days after ivermectin treatment. A considerable increase of elastase levels after treatment was observed, whereas lactoferrin levels did not change. The percentage of patients with elevated elastase levels was significantly correlated with the degree of side effects. These findings suggest that neutrophil activation may be involved in the development of adverse reactions in these patients. PMID:8222324

  7. St John's Wort treating patients with autistic disorder.

    PubMed

    Niederhofer, Helmut

    2009-11-01

    Problems of eye contact and expressive language limit the effectiveness of educational and behavioral interventions in patients suffering from pervasive developmental disorders. For that reason, additive psychopharmacological interventions are sometimes needed to improve symptomatology. In our preliminary open trial, three male patients with autistic disorder, diagnosed by ICD-10 criteria, completed an open trial of St John's Wort. Subjects were included in the study if their eye contact and expressive language was inadaequate for their developmental level and if they had not tolerated or responded to other psychopharmacologic treatments (methy