Affective Episodes In Bipolar Disorder Research Articles

Atypical antipsychotics in the treatment of depression in affective disorders and schizophrenia (using the aripiprazole model)

The review discusses aspects of the use of atypical antipsychotics in the treatment of depression in affective disorders and schizophrenia using the model of aripiprazole, a partial agonist of dopamine receptors. According to numerous studies, aripiprazole is the drug of choice for augmentative therapy of major depressive disorder, as well as for relieving and long-term maintenance monotherapy and combination therapy of various affective episodes of bipolar affective disorder and depression in schizophrenia.

Predictors of mood and activity instability in participants with newly diagnosed bipolar disorder – Exploratory findings from a prospective cohort study

BackgroundDaily variation in mood and activity between and within affective episodes in bipolar disorder has become a field of increasing interest. The present exploratory study aimed to identify predictors of mood and activity instability in participants with bipolar disorder (BD). MethodsA total of 258 participants with newly diagnosed BD type I and II were included as part of a longitudinal study (the Bipolar Illness Onset study (BIO)). The participants completed daily smartphone-based mood and activity ratings for a median [interquartile range] (IQR) of 109 days [40;240] and 106 days [40;243], respectively. Clinical evaluations and questionnaires were collected at the baseline visit. Backwards stepwise regression analysis was employed to identify predictors. ResultsPredictors of increased mood instability included childhood trauma (e.g., B = 0.006, 95 % CI 0.001;0.011, p = 0.031), increasing number of depressive episodes, antipsychotic medication, functional impairment, and impaired sleep quality. Predictors of increased activity instability included longer Illness duration, lower age at onset, number of depressive episodes, functional impairment, and impaired sleep quality (e.g., B = 0.089, 95 %CI=0.033;0.145, p = 0.002). LimitationsRisk of type 1 error due to the large number of analyses. ConclusionsIncreasing number of prior depressive episodes, functional impairment, and poor sleep quality were consistent predictors of subsequent increased mood and activity instability. Childhood trauma was a predictor of increased mood instability only, whereas age of onset was a predictor of increased activity instability only.

Influence of Attachment Behavior in Psychosis

Psychosis is a symptom of functional decline due to hallucinations, delusions, and the resulting behavior, and it appears in several psychiatric conditions including schizophrenia and severe mood episodes of bipolar affective disorder. Psychosis is influenced by environmental factors, including childhood stress, as well as genetic predisposition. People with psychosis are known to have more insecure attachments than the general population, and are particularly more likely to display dismissive attachment styles. Attachment behavior is related to stress-induced CRH secretion, CRH suppression by oxytocin, and dopamine release in the brain. Imbalances of CRH, oxytocin, and dopamine are expected in psychotic patients with unstable attachments, requiring tailored treatment for this condition. Therefore, this review intends to investigate the effects of insecure attachment in individuals with psychosis.

Gender approach to psychotherapeutic correction in complex treatment of depressive disorders

The importance and necessity of studying the gender specificity of mental disorders has been repeatedly emphasized. Significant differences in the mechanisms of formation of depressive disorders in men and women determine the specificity of clinical-psychopathological and pathopsychological manifestations and determine the need for the use of differentiated therapeutic and diagnostic approaches. 147 patients with depressive disorders (76 female and 71 male) were examined. Clinical-psychopathological, psychodiagnostic and catamnetic research methods were used. Based on the data obtained during the work, a personalized system of therapy for depressive disorders with differentiated use of psychopharmacotherapy, psychotherapy and psychoeducation methods was developed and tested. As a result of the study, we concluded that for the treatment of patients with a depressive episode, a program should be used, which includes: pharmacotherapy (selective serotonin reuptake inhibitor Sertraline, melatoninergic antidepressant Agomelatine, anxiolytics), gender-specific individual and group psychotherapy and psychoeducation. For the treatment of patients with recurrent depressive disorder, a program should be used, which includes: pharmacotherapy (anxiolytics, combined serotonin and norepinephrine reuptake inhibitors (Mirtazapine, Venlafaxine)), gender-specific individual and group psychotherapy and psychoeducation. For the treatment of patients with a depressive episode of bipolar affective disorder, a program should be used, which includes: pharmacotherapy (using valproate, Lamotrigine, selective serotonin reuptake inhibitor Sertraline); gender-specific individual and group psychotherapy and psychoeducation. Keywords: depressive disorders, gender differences, psychotherapy, psychoeducation, treatment.

Impact of the COVID-19 pandemic and the lockdown period on the number of hospitalizations for acute mania

IntroductionCOVID-19 pandemic has affected social interaction and healthcare worldwide especially during the period of lockdown. As a result of this pandemic in Tunisia, the activity of hospital services and all non-emergency acts, in several specialties have been reduced. In psychiatry, such measures have not been taken. In the social zeitgeber hypothesis social rhythm disrupting life events such as eating, activity, and social patterns, may lead to the onset of manic episodes.ObjectivesThe objective of this study was to evaluate the impact of the COVID-19 pandemic on the frequency of acute mania in the context of bipolar disorder during the lockdown and post lockdown period compared to the same period during last year in a psychiatric department in Tunisia.MethodsWe assessed the number of hospitalizations in our department for acute mania in the context of bipolar disorder during the lockdown period in our country, (from March 1st and May 30, 2020) and during the two months following it. We compared this frequency to that of the previous year during the same periods.ResultsDuring the lockdown period, 17 patients were hospitalized for acute mania in the context of bipolar disorder. Sixty-seven patients were hospitalized in 2019 during the same period for acute mania. Nine hospitalizations for acute mania in the post lockdown period (between June and July 2020), were noted compared to 16 hospitalizations in the same period in 2019.ConclusionsLockdown seemed to have a protective effect from affective episodes in bipolar disorder. Perceiving increased connectedness among families may explain these findings.

Comparison of Formal Thought Disorder in the Acute Episode of Schizophrenia and Manic Episode of Bipolar Affective Disorder.

The aim of this study was to compare the formal thought disorder (FTD) in the acute episode of schizophrenia (SCHZ) and bipolar affective disorder (BPAD), and to determine the FTD dimensions associated with BPAD. The study included a total of 34 SCHZ patients not meeting the standardized remission criteria and 20 patients in BPAD manic episode. The patients completed the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression Scale (CGI), the Young Mania Rating Scale (YMRS), the Hamilton Depression Rating Scale (HAM-D) and the Thought and Language Disorder Scale (TALD) in order to assess FTD. The association of FTD with the diagnoses was analyzed by a logistic regression model including the TALD factors and the SCHZ and BPAD groups. Statistically significant differences were not determined between the demographic features, the CGI scores and the TALD objective positive factor scores of the SCHZ and BPAD groups. The objective negative and subjective negative factors (p<0.001 for all) were higher in SCHZ group and the subjective positive factor were significantly higher in BPAD group (p=0.028). In the logistic regression model, the TALD subjective positive factor was associated with BPAD diagnosis, and the objective negative factor was associated with SCHZ diagnosis. In the BPAD group, the TALD total score correlated positively with the manic episode severity, and the scores on the subjective negative and subjective positive factors correlated negatively with disease duration. The study results show that FTD is common to the acute episodes of both SCHZ and BPAD and that assessment of the subjective positive FTD symptoms and objective negative FTD symptoms may be useful to differentiate the acute episode of SCHZ from the BPAD manic episode.

The impact of the trajectory of bipolar disorder on global cognitive function: A one-year clinical prospective case-control study

BackgroundThe relationship between cognitive function and relapse of affective episodes in bipolar disorder (BD) is rarely studied. The aim of this prospective, longitudinal, case-control study was to assess the trajectory of cognitive function and mood occilations within a one-year period in patients with BD relative to healthy control (HC) individuals. MethodsThe sample included 86 outpatients with BD in euthymia, and 44 gender-and-age-matched HC. All participants were evaluated with clinical assessement and neuropsychological testing at baseline and during euthymia after a year. Further patients with BD were reevaluated if they developed a new affective episode during follow-up. The patients´ affective states were recorded on a weekly basis as asymptomatic, subthreshold level, major depression or (hypo)mania. Cognitive changes over time were measured for a global cognitive score and for the four cognitive domains: ‘working memory and executive skills’, ‘psychomotor speed’, ‘sustained attention’, and ‘verbal learning and memory’ in patients and HC. ResultsThe study showed that cognitive performance in patients with BD was unaltered compared to baseline when they stabilised in euthymia following an affective episode and, at the one-year follow-up. Cognitive performance showed practice effect, thus improved within a year across patients with BD and HC. Furthermore, cognitive functions were not related to clinical subtypes BDI/II, prior psychosis, the polarity of the relapse and week-to-week mood fluctuations during follow-up. Functioning correlated weakly to moderately with week-to-week mood fluctuations. LimitationsModest sample size. ConclusionA one-year trajectory of BD seems to have no direct negative impact on cognitive function.

Cognitive impairment in patients with a primary episode of bipolar affective disorder

An increasing number of studies on cognitive impairment associated with bipolar disorder indicate the relevance of the topic in psychiatry. The aim of the study was to investigate the features of cognitive functioning of patients with primary episode of bipolar disorder, taking into account sex and clinical variant. According to the method of «Remembering the Ten Words», 153 patients were examined: with prevalence of depressive symptoms (44 men and 75 women), with prevalence of manic symptoms (15 men and 8 women) and with simultaneous presence of depressive and manic symptoms or with rapid change of phases (6 men and 5 women). Statistical analysis was performed using the non-parametric Mann-Whitney test. It was found that in the depressive variant, the memorization curve was characterized by difficulties of fixing information and difficulty in holding it: 4.2±1.2 words, 4.6±1.4 words, 5.9±1.8 words, 5.8±1.4 words, 4.4±1.3 words, 2.6±1.4 words (in men – 4.2±1.4 words, 4.6±1.5 words, 6.1±1.9 words, 5.7±1.5 words, 4.4±1.3 words, 2.6±1.4 words, in women – 4.2±1.1 words, 4.5±1.4 words, 5,9±1.7 words, 5.8±1.3 words, 4.4±1.3 words, 2.5±1.3 words); at manic – rapid rise with subsequent decrease and the lowest reproduction rates in an hour: 4.7±1.3 words, 7.5±1.3 words, 7.2±1.3 words, 6.7±1.8 words , 4.7±1.0 words, 2.0±1.0 words (in men – 4.9±1.3 words, 7.3±1.3 words, 7.1±1.2 words, 6, 3±1.7 words, 4.7±0.9 words, 1.9±0.9 words, in women – 4.3±1.4 words, 7.9±1.4 words, 7.5±1,5 words, 7.5±1.7 words, 4.6±1.3 words, 2.3±1.2 words); when mixed – combined fixation difficulties and low reproduction rates: 4.5±0.9 words, 5.1±1.3 words, 5.9±1.1 words, 5.6±0.8 words, 4.2±1.1 words, 2.4±0.9 words (in men – 4.5±0.8 words, 5.5±1.0 words, 5.8±1.0 words, 5.8±0, 8 words, 4.5±1.0 words, 2.0±0.9 words, in women – 4.6±1.1 words, 4.6±1.5 words, 6.0±1.4 words, 5.4±0.9 words, 3.8±1.1 words, 2.8±0.8 words). Certain differences in cognitive impairment were found depending on the clinical version of the primary episode; however, the differences between men and women are insignificant. Further prospects are related to the improvement of methods for predicting and treating cognitive impairment in bipolar disorders.

Features of cognitive disorders in patients with primary episodes of bipolar affective disorder

The aim of the work was to study the features of cognitive disorders in the primary episode of bipolar affective disorder, taking into account the gender factor and clinical variant. Materials and methods. 153 patients with primary episode of bipolar affective disorder: with prevalence of depressive symptomatology (44 men and 75 women), with prevalence of manic symptoms (15 men and 8 women) and with simultaneous presence of depressive and manic symptomatology or with rapid or severe manic symptoms and 5 women) were examined using the Stroop test. Results and discussion. In patients with the depressed primary episode variant, a general slowdown in the performance of all four subtests of the Stroop test was detected: reading time of the names of colors printed in black font (TNFb) in all patients 63.7±8.1 sec., in men 65.0±9.6 sec., in women 63.0±7.0 sec.; names of colors (NС) were respectively 96.6±9.2 sec, 96.5±9.1 sec and 96.6±9.3; reading time of color names where the font color is different from the word value (TNCd) – respectively 153.5±20.3 sec., 153.8±23.3 sec., 153.3±18.6 sec.; name of the word color where the font color is different from the word value (NCWd) – 62.6±7.9 sec., 63.8±9.3 sec. and 61.9±6.9 sec. In patients with a manic variant, the time to perform the Strup test is the smallest of all groups: TNFb – 44.3±4.0 sec., 44.5±4.1 sec. and 43.8±4.1 sec.; NC – 62.7±4.9 sec., 61.7±5.5 sec. and 64.6±3.2 sec.; TNCd – 116.2±9.5 sec., 118.0±10.5 sec. and 112.9±6.4 sec.; NCWd – 43.3±4.0 sec., 43.5±4.1 sec. and 42.8±4.1 sec, respectively. In patients with mixed variant indicators occupy an intermediate position: TNFb – 59,8±16,1 sec., 57,3±14,6 sec. and 62.8±19.0 sec.; NC – 79.1±10.1 sec., 76.5±10.3 sec. and 82.2±10.0 sec.; TNCd – 124.3±22.5 sec., 120.7±18.9 sec. and 128.6±27.7 sec.; NCWd – 58.5±15.7 sec., 56.2±14.3 sec. and 61.4±18.5 sec. in accordance. Gender differences in Stroop test performance are not significant. Conclusions. The primary episode of BAD is characterized by the presence of cognitive impairment, the structure and expressiveness of which is determined by the clinical variant. In the depressive variant revealed the greatest overall slowdown in the execution of the Stroop test with a significant number of errors, with manic - deterioration of attention, behavioral inhibition and maximal impulse control when mixed - a marked slowdown in the performance of the Stroop test with a significant number of errors. Gender differences in cognitive impairment are insignificant

Some characteristics of disorders of cognitive functions in the primary episode of bipolar affective disorder

Some characteristics of disorders of cognitive functions in the primary episode of bipolar affective disorder

Structure of cognitive disorders in patients with primary episode of bipolar affective disorder

Structure of cognitive disorders in patients with primary episode of bipolar affective disorder

Comprehensive assessment of the quality of life in primary episode of bipolar affective disorder

A study of quality of life in 153 patients with a primary episode of bipolar aff ective disorder found a signifi cantly lower quality of life score in women in individual areas and in general, these differences were most pronounced in manic and depressive variant of primary episode of bipolar affective disorder. The clinical variant of primary episode of BD had a decisive influence on the self-esteem of quality of life in patients: patients with the depressive variant had low quality of life indicators, with manic — high, and with mixed — medium ones. When comparing quality of life self-assessment data, a tendency was found for the quality of life to decrease in all key areas in the depressive variant, and a tendency for overestimation — in the manic one. In the mixed version, the self-esteem indicators of quality of life did not have significant differences from the qualification score by a specialist psychiatrist. The identifi ed patterns should be taken into account when determining treatment and rehabilitation measures. Keywords: bipolar affective disorder, primary episode, quality of life

PRIMARY EPISODE OF BIPOLAR AFFECTIVE DISORDER

Background. Bipolar affective disorder (BAD) is a topical issue of contemporary psychiatry. The features of the primary episode (PE) of the disease are extremely important for prognosis, treatment and rehabilitation measures of BAD. Individual psychological features of the patients with PE of BAD are still unexplored that complicates development of new methods of prediction, treatment and prevention of BAD. Objective. The aim of the study was to investigate individual psychological features of the patients with a primary episode of bipolar affective disorder, taking into account the gender factor and clinical variant of the BAD debut. Methods. 153 patients (65 men and 88 women) with a primary episode of bipolar affective disorder were examined. The patients were divided into three groups according to the clinical variant of the course of PE of BAD: depressive variant, manic variant and mixed variant. The examination was carried out using the Standardized multifactor method of personality research (SMMPR). Statistical processing of the data was performed using the non-parametric Mann-Whitney test. Results. The most significant differences in the quantitative indicators of SMMPR were found when comparing depressive and manic, as well as depressive and mixed variants of PE of BAD, and lesser – when comparing manic and mixed variants. Most of all, these differences were expressed in terms of pessimism, impulsiveness, individualism and optimism. Conclusions. Some peculiar features of male and female patients with depressive, manic and mixed variants of PE of BAD promoting to search for new methods of prediction, treatment and prevention of BAD have been defined.

Characteristics of verbal fluency in patients with a primary episode of bipolar affective disorder

A study was conducted using the verbal fluency test of 153 patients with a primary episode of bipolar affective disorder: with prevalence of depressive symptoms (44 men and 75 women), with prevalence of manic symptoms (15 men and 8 women), and with simultaneous presence of depressive symptoms and manic symptoms phase change (6 men and 5 women). Significant impairment of test performance in patients with depression with respect to phonetic and semantic verbal fluency was revealed: the average number of words per letter "K" per 60 sec. in all patients 14,1±2,7 words, in men – 13,8±3,1 words, in women - 14,3±2,4 words, on the letter "P" – 12,5±2,8 respectively words, 12.3±3.2 words, 12.6±2.6 words, "Male Names" – 13.1±2.6 words respectively, 12.8±3.0 words, 13.3±2,4 words; "Fruits / furniture" – 12.0±2.4 words, 11.9±2.8 words, 12.1±2.1 words. Deterioration in the performance of semantic and phonemic verbal fluency test reflects the state of bradypsychism inherent in patients with depressive variant, which manifests a slow thinking rate, difficulty concentrating attention, motor inhibition, deterioration of operational capacity, rapid exhaustion. In patients with a maniacal variant, the high speed of the test is offset by a large number of errors due to the chaotic mental activity, instability and scattering of attention, the difficulty of maintaining focus of attention: the indicators were respectively 21.7±5.7 words, 22.5±5.7 words, 20,3±6.0 words; 20.3±5.6 words, 21.1±5.5 words, 19.0±5.9 words; 20.5±5.4 words, 21.2±5.2 words, 19.1±5.7 words; 19.5±5.4 words, 20.2±5.2 words, 18.1±5.7 words. In patients with mixed variants, the indicators of verbal fluency are reduced due to the influence of complex polymorphic symptoms with rapid change of state: respectively 16.5±5.6 words, 18.2±6.1 words, 14.4±4.8 words; 14.5±5.4 words, 16.2±5.7 words, 12.4±4.8 words; 15.4±5.4 words, 17.0±5.8 words, 13.4±4.8 words; 13.9±5.0 words, 15.5±5.3 words, 12.0±4.3 words. The differences in scores across all subtests in all groups between men and women are statistically insignificant (p&gt;0.05).

Биполярное аффективное расстройство. Клинические аспекты и коморбидность с другими расстройствами

The review of the literature describes the clinical features of bipolar affective disorder (BAD). Difficulties in diagnosing BAD due to the complex clinical picture that cause untimely diagnosis and the formation of an unfavorable course of the disease are examined in detail. The data on mental disorders it is necessary to differentiate BAD from are presented. The characteristics of the course of BAD are described in detail, including unfavorable forms and mixed bipolar conditions, which are difficult to diagnose and treat, and present a negative prognostic factor. The data on the deterioration of the cognitive abilities of patients with an increase in the number of episodes of BAD, which can occur even during euthymy, are considered. Particular attention is paid to the consideration of forms of mental and somatic pathology, comorbid BAD associated with a decrease in the quality of life, poor prognosis, increased disability, and premature mortality.

MODERN APPROACHES TO THE TREATMENT OF PATIENTS WITH A PRIMARY EPISODE OF BIPOLAR AFFECTIVE DISORDER

A comprehensive system of treatment and rehabilitation measures for the initial episode of bipolar affective disorder is proposed, which is implemented in three interrelated stages: a psychodiagnostic stage, which provides a comprehensive clinical and psychodiagnostic analysis to determine the clinical option; the stage of complex therapy, which involves the combination of psychopharmacology with normotymics, antidepressants, atypical neuroleptics with psychoeducation, compliance therapy, family therapy, work with comorbid mental and narcological pathology; and the stage of psychosocial rehabilitation and prevention, which includes supportive psychopharmacological therapy and psychosocial therapy and rehabilitation activities. We conducted a clinical psychodiagnostic examination of 88 patients with a primary episode of Bipolar Affective Disorder (PE BAD) who were treated at the Ternopil Regional Psychoneurological Hospital during the period 2011-2016 in compliance with the principles of biomedical ethics. The following groups were formed from them: 1) 34 patients with depressed variant of PE BAD, who received treatment according to the proposed scheme; 2) 33 patients with depressive variant of PE BAD who received treatment according to the traditional scheme; 3) 11 patients with a manic variant of PE BAD who received treatment according to the proposed scheme; 4) 10 patients with a manic variant of PE BAD who received treatment according to the traditional scheme. The results were compared in pairs in each of the clinical groups according to the clinical version of PE BAD. The evaluation was performed before the start of treatment and 6 months after the start of treatment in three main areas: dynamics of mental state (complete clinical remission, significant improvement of mental state, improvement of mental state, slight improvement of mental state); dynamics of changes in psycho-emotional state based on the results of evaluation using standardized psychodiagnostic tools (M. Hamilton Depression and Anxiety Scales, The Zung self-Rating Depression Scale, Bipolar Diagnostic Scale); the dynamics of quality of life indicators according to the Scale of Quality of Life Mezzich et al. in the adaptation of N.O. Maruta. The comparative analysis showed a higher effectiveness of the proposed therapy compared to the traditional relative clinical effect, normalization of the affective sphere and improvement of the quality of life of patients.

Features of changes in the cognitive sphere of patients with a primary episode of bipolar affective disorder

153 patients with primary episode of bipolar affective disorder were divided to three groups: with prevalence of depressive symptomatology (44 men and 75 women), with prevalence of manic symptoms (15 men and 8 women) and with simultaneous presence of depressive and manic symptomatology or with rapid or severe manic symptoms (6 men and 5 women) and were examined using the Rey–Osterrieth test. It was found that they had impaired cognitive functioning whose structure and severity were related to the clinical type of the primary episode. In patients with depressive variant revealed approximately equal deterioration of test performance across all assessment vectors, while reproduction (immediate and delayed) observed synchronous deterioration of indicators, with the degree of deterioration of characteristics between copying and immediate and retarded reproduction. In the manic variant the performance of test is significantly different from the depressive variant. Patients with a manic variant showed the lowest indicators in the presence of individual elements of the figure, accuracy and diligence. At the same time, indicators for most estimation vectors are unstable, varying with immediate and delayed reproduction without some systematicity. Such features reflect on the cognitive functions of the maniac state with its acceleration of the speed of thinking, its chaos, instability of attention, difficulties of concentration and inability to productive activity. In patients with mixed episode, the Ray–Osterrieth test scores reflect complex contradictory tendencies of changes in the affective area, related to the rapid phase change and the presence of opposite affective manifestations. Quantitative values of indicators in patients of this group has an intermediate position between indicators of patients with depressive and manic variants. Common disorders inherent in patients of all groups were distortion of the integrity and symmetry of the figure, contamination of the elements of the figure and the omission of minor details. The differences in the structure and severity of cognitive impairment between men and women are not statistically significant.

Some predictors of bipolarity in a primary episode of bipolar aff ective disorder

Clinical-psychodiagnostic examination of 153 patients with primary episode of bipolar aff ective disorder (BAD) found the highest diagnostic potential of the bipolar spectrum diagnostic scale in patients with depressive, manic and mixed variants of primary episode of BAD, and less predictive potential of the Mood Disorder Questionnaire (MDQ) and Hypomania Checklist-32 (HCL-32), which revealed pathological aff ective symptomatology of the bipolar spectrum in patients with manic and mixed type of the primary episode of BAD, but were insensitive with depressive form. Using the bipolar spectrum scale to detect signs of bipolarity in the primary episode of BAD, it should be kept in mind that the quantitative indicators of it are lower compared with the patients with clinically formed BAD, which should be taken into account during the diagnosis. Keywords: bipolar aff ective disorder, primary episode, prognosis

Features of depressive and anxiety manifestations in the first episode of bipolar affective disorder

Background. The study of depression and anxiety in the first episode of BAR is important for the timely detection, treatment and prevention of poor diagnosis of the disease.&#x0D; Objective – the study of the features of depressive and anxiety symptoms of the first episode of bipolar affective disorder, taking into account the gender factor and the clinical type.&#x0D; Materials and methods. We have clinically examined 65 men and 88 women diagnosed with first episode (FE) of bipolar affective disorder (BAD).&#x0D; Results. In patients with depressive FE of BAD, all indicators, with the exception of the undifferentiated depression indicator, in men are slightly higher than in women: the overall indicator (respectively 22.55±3.61 points and 22.16±3.03 points); adynamic depression (17.41±2.62 points and 16.76±2.48 points); pervasive depression (9.75±3.13 points and 9.69±2.66 points); depression with fear (9.34±2.55 points and 9.51±2.27 points); undifferentiated depression (4.89±0.95 points and 5.01±1.22 points); in patients with the mixed variant are not significantly different: accordingly 15,83±2,64 points and 17,00±3,32 points; 11.00±1.67 points and 11.80±1.64 points; 6.67±1.63 points and 6.60±2.07 points; 7.33±1.21 points and 8.00±1.87 points; 3.67±1.03 points and 3.40±1.14 points; in patients with a manic type there are no signs of depression. The indicators of anxiety in men and women do not differ significantly: in the depressive variant, the total indicator was accordingly 21.41±7.01 points and 23.36±7.01 points; psychic anxiety – 13.25±3.86 points and 14.35±3.87 points; somatic anxiety – 8.16±4.05 points and 9.01±4.10 points; when mixed, accordingly, 20,00±4,52 points and 22,00±4,90 points; 13.33±3.27 points and 15.20±2.39 points; 6.67±3.27 points and 6.80±3.70 points; the manic variant showed no signs of anxiety. The mean Zung score for the depressed variant was 68.82±8.30 points and 65.97±8.41 points, accordingly, for the mixed one, 44.00±5.55 points and 50.40±5.32 points, accordingly, at a manic variant 2.13±1.64 points and 2.50±1.60 points.&#x0D; Conclusions. Differences in manifestations of depression and anxiety in the first episode of bipolar affective disorder are determined by the clinical option; the impact of gender on these manifestations is insignificant.

Features of the cognitive sphere in patients with a mixed episode of bipolar affective disorder

Background. Data of various meta-analyzes confirm that the majority of patients with bipolar affective disorder (BAD) have neurocognitive dysfunction, even during remission. According to the latest research, disturbed domains with moderate to pronounced changes are attention, verbal learning and memory, as well as executive functions, whereas premorbid intelligence may remain unchanged. The main body of research is devoted to the study of cognitive impairment in the first episode of BAD, in manic, depressive episodes and euthymia. At the same time, the features of cognitive dysfunction in mixed forms of biologically active substances remain insufficiently studied.&#x0D; Objective – to study the characteristics of the cognitive sphere in patients with a mixed episode of BAD.&#x0D; Materials and methods. With the help of battery tests (a test to memorize ten unrelated words; Rey-Osterreith Complex Figure Test; Verbal Fluency Test Digit Symbol Substitution Test; Trail making test), the cognitive functions of 25 patients with mixed episodes, 16 patients with manic episodes, and 15 patients with depressive episode of BAD.&#x0D; Results. Cognitive impairments were identified in all patients, regardless of the type of affective symptoms, in the form of a wide range of psychopathological phenomena, which are more pronounced in patients with a mixed episode BAD. The peculiarities of the phenomenological structure of cognitive impairment in patients with mixed phase BAD manifest themselves in the form of: a more pronounced deterioration of verbal memory, speed of information processing; more pronounced violations of spatial representations, impairment of visual memory, verbal associative performance and executive functions; reduction of attention and violations of its distribution.&#x0D; Conclusions. The findings suggest that the presence of depressive symptoms in the structure of mixed affect plays a dominant role in the formation of these disorders.