Bipolar Affective Disorder Patients Research Articles

Comparative Study of Stigma and Its Correlates in Caregivers and Patients of Schizophrenia and Bipolar Affective Disorder

Abstract Objective: Stigma is very common among patients and caregivers of patients with severe mental disorders; however, there is a lack of comparative study data between schizophrenia and bipolar affective disorder in the Indian setting. Methods: For this, caregivers of patients with schizophrenia (n = 50) or bipolar affective disorder (n = 50) were assessed on the Affiliate Stigma Scale (ASS). Patients with schizophrenia (n = 50) or bipolar affective disorder (n = 50) were assessed on the Internalized Stigma of Mental Illness Scale (ISMIS). Results: Patients and caregivers of patients with schizophrenia have significantly higher mean scores on ISMIS and ASS, respectively, as compared to patients and caregivers of patients with bipolar affective disorder. Conclusion: This study suggests that patients with schizophrenia and their caregivers experience higher stigma than the caregivers of patients with bipolar affective disorder. Higher stigma is associated with higher psychological morbidity in the patients and caregivers. Therefore, clinicians managing patients with severe mental disorders must focus on stigma and psychological distress among the patients and caregivers and plan intervention strategies to reduce stigma.

COMPARATIVE STUDY ON NEUROCOGNITIVE DEFICITS IN PATIENTS OF SCHIZOPHRENIA AND BIPOLAR AFFECTIVE DISORDER

Objective: Cognitive impairments are central features of schizophrenia and are related to functional status and other aspects of the illness. Aim of this study is to assess and compare neurocognitive impairment in schizophrenia and bipolar affective disorder patients.
 Methods: It was a comparative study. 50 consecutive patients of schizophrenia and 50 consecutive patients of bipolar affective disorder were included. We used PANSS for schizophrenia patients and Hamilton Rating Scale for Depression (HRSD) and Young Mania Rating scale (YMRS) were administered for bipolar patients. Neuropsychological testing was used to compare the cognitive impairment of schizophrenia and bipolar affective disorder.
 Results: The mean age of schizophrenic patients was 37 y and the mean age of BPAD patients was 37.32 y The COWT mean score for schizophrenic patients was 6.98(SD±1.84) and for BPAD patients was 8.44(SD±2.61). The score for schizophrenic patients was-21.21(SD±8.83) and for BPAD patients was-25.43(SD±9.34). The score for schizophrenic patients was 27.10(SD±1.26) and for BPAD patients was 27.52(SD±1.43).
 Conclusion: Compared to bipolar patients, patients with schizophrenia had more cognitive dysfunction. Timely assessment and treatment of cognitive dysfunction should be part of standard management protocols in both schizophrenia and bipolar disorder.

Assessing Quality of Life: A Comparative Study among Patients with Schizophrenia, Bipolar Affective Disorder, and Healthy Control in a South Indian Tertiary Care Setting

Aim: To assess and compare the quality of life (QOL) of patients with schizophrenia, bipolar affective disorder (BPAD) patients and healthy control.
 Methods: This is an observational study carried out in MVJ Medical College and Research Hospital, Bengaluru, India. The WHOQOL-BREF questionnaire was administered to 139 patients with schizophrenia and 139 patients with BPAD that were diagnosed according to the ICD-10 diagnostic criteria, as well as 139 healthy subjects all of whom gave their informed consent. The data were analyzed using SAS 9.2 software.
 Results: On comparing the three groups, the schizophrenia group scored the least in the physical (53.51±19.36), psychological (51.32±21.37) and environmental health domains (55.59±17.78). The QOL of the BPAD group was comparable to that of the healthy control group and significantly better as compared to that of the schizophrenia group (P<0.0001).
 Conclusion: The study shows that patients with schizophrenia had significantly lower QOL than patients with BPAD and healthy subjects. Our study emphasizes the significance of addressing psychiatric patients' overall health and QOL in addition to symptom management.

A STUDY ON BIPOLAR AFFECTIVE DISORDER SUBJECTS UNDER REMISSION – QUALITY OF SLEEP AND QUALITY OF LIFE

Aims and Objectives: People affected with bipolar disorder experience sleep disturbances which precedes an episode of depression or mania. The aim of the present study was to assess the quality of sleep and quality of life (QOL) in subjects with euthymic bipolar disorder. Methods: This was a case–control study conducted between April 2015 and September 2015. All subjects in the age of 18–60 years with bipolar affective disorder (BPAD) under remission for at least 6 months were included as cases and healthy volunteers as controls. Mini-international neuropsychiatric interview plus brief interview, Hamilton depression rating scale and young mania rating scale were used to quantify remission. Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale were used to assess quality of sleep and the WHO quality of life brief version (WHOQOL-BREF) scale was used to assess QOL. Descriptive data were given in summary statistics, Student’s t-test to compare means, one-way ANOVA to compare means with variables, Pearson’s test for correlation and Chi-square test for qualitative variables were used. p<0.05 was considered significant. Results: Fifty patients and 51 volunteers were included in the study. The mean age was 39.62±11.68 years, males and females were equal, most were married (82.17%), 34.65% had completed high school, 47.52% were unskilled workers and 73.27% were in upper lower socioeconomic status. About 95.05% did not had family history of psychiatric illness. Euthymic BPAD patients were more unmarried (p=0.033), more unemployed (p=0.0003), less full-time employees (p=0.0001), had more PSQI global score (p=0.0003) and more Epworth sleepiness scale (p=0.0004) than controls. As the duration of remission increased, sleep dysfunction improved (p=0.009). WHOQOL scores were lower in BPAD patients and overall perception of health was lower (p=0.044). BPAD patients had poor sleep hygiene and watched more television in bed, had more cigarettes and had more coffee than tea. Conclusion: Patients with BPAD even when in remission had significant sleep disturbances. Sleep hygiene factors have to be modified to improve sleep dysfunction. Psychosocial interventions are needed to achieve better QOL.

DETERMINING THE RISK OF CARDIOVASCULAR DISEASE IN PATIENTS DIAGNOSED WITH SCHIZOPHRENIA AND BIPOLAR AFFECTIVE DISORDER.

In Schizophrenia (SCZ) and Bipolar Affective Disorder (BAD) patients using the Framingham Heart Risk Scoring (FHRS), we aimed to investigate the possible cardiac arrhythmia risk by calculating electrocardiogram (ECG) parameters (QT, QTc, Tpe, and TPE/QTc ratios), which are ventricular repolarization markers. A total of 140 BAD and 253 SCZ patients were included in the study. Age, blood test results (fasting blood glucose, LDL-HDL-TC levels, hemogram values), blood pressure and heart rate, smoking status, antihypertensive drug use, and FHRS were calculated from the patient files, and sociodemographic information was recorded. In addition, ECG calculations were performed, and QT, QTc, TPe, TPe/QTc ratios and heart rate were measured. When we evaluated the cardiac risk indexes of SCZ and BAD patients, we detected that FHRS was higher in smokers, female patients, and those with other medical diseases such as diabetes mellitus (DM) (p<0.05). In addition, we found that QTc rates, markers of ventricular repolarization, were associated with FHRS, the number of antipsychotics used, patient age, disease duration, and the number of hospitalizations. TPe and QT rates were found to increase in parallel with FHRS. In addition, a positive correlation was found between QTc rates in females, patients with DM, and those using additional medical drugs. (p<0.05) In BAD and SCZ patients, diabetes diagnosis, other medical drug use, a high Framingham heart score, the number of antipsychotics, the disease duration, the patient&apos;s age, and an increased number of hospitalizations may increase the risk of cardiac arrhythmia. Therefore, possible cardiac risk should be considered in patients with chronic drug use, such as BAD and SCZ. Regulating the treatment and follow-up of this group of patients against possible cardiac risks will reduce cardiac mortality and morbidity

Profile of sleep disturbances in patients with recurrent depressive disorder or bipolar affective disorder in a tertiary sleep disorders service

Bidirectional relationship between sleep disturbances and affective disorders is increasingly recognised, but its underlying mechanisms are far from clear, and there is a scarcity of studies that report on sleep disturbances in recurrent depressive disorder (RDD) and bipolar affective disorder (BPAD). To address this, we conducted a retrospective study of polysomnographic and clinical records of patients presenting to a tertiary sleep disorders clinic with affective disorders. Sixty-three BPAD patients (32 female; mean age ± S.D.: 41.8 ± 12.4 years) and 126 age- and gender-matched RDD patients (62 female; 41.5 ± 12.8) were studied. Whilst no significant differences were observed in sleep macrostructure parameters between BPAD and RDD patients, major differences were observed in comorbid sleep and physical disorders, both of which were higher in BPAD patients. Two most prevalent sleep disorders, namely obstructive sleep apnoea (OSA) (BPAD 50.8.0% vs RDD 29.3%, P = 0.006) and insomnia (BPAD 34.9% vs RDD 15.0%, P = 0.005) were found to be strongly linked with BPAD. In summary, in our tertiary sleep clinic cohort, no overt differences in the sleep macrostructure between BPAD and RDD patients were demonstrated. However, OSA and insomnia, two most prevalent sleep disorders, were found significantly more prevalent in patients with BPAD, by comparison to RDD patients. Also, BPAD patients presented with significantly more severe OSA, and with higher overall physical co-morbidity. Thus, our findings suggest an unmet/hidden need for earlier diagnosis of those with BPAD.

IMPACT OF SCHIZOPHRENIA AND BIPOLAR AFFECTIVE DISORDER ON MARITAL SATISFACTION – A COMPARATIVE STUDY

Objectives: To compare marital satisfaction among patients with Schizophrenia and bipolar affective disorder. Methods: A cross-sectional study was conducted for 1 month. The sample was chosen by using purposive random sampling, 60 married patients with Schizophrenia and Bipolar Affective Disorder who fulfilled the ICD 10 criteria for Schizophrenia and Bipolar Affective Disorder, respectively, under remission with Clinical Global Impression-Severity Scale (CGI-S) score ≤2, and were assessed for Marital Satisfaction with The Couples Satisfaction Index (CSI) and its relationship with forgiveness is studied with the Marital Offence-Specific Forgiveness Scale (MOFS). Results: Compared to patients with Bipolar Affective Disorder, patients with Schizophrenia reported poor marital satisfaction. Conclusion: It is the first study in India to compare marital satisfaction in patients with Schizophrenia and Bipolar Affective Disorder. The present study suggests that marital satisfaction is more impaired in Schizophrenia patients compared to bipolar affective disorder patients.

A cross-sectional study of frequency, type, and lethality of deliberate self-harm in bipolar affective disorder patients presenting to tertiary care center

Introduction: Deliberate self-harm (DSH) is one of the leading causes of death and a major public health problem worldwide. According to the World Health Organization, DSH has increased by 60% over the past 50 years, of which 90% of victims had a psychiatric disorder. Aims and Objectives: The aim is to analyze the frequency, type, and lethality of DSH in bipolar affective disorder (BPAD) patients. Materials and Methods: This study included 150 patients diagnosed to have BPAD. Specially designed sociodemographic pro forma was used to record basic profile. DSH inventory was administered on BPAD patients who presented with DSH to analyze the type and lethality. Diagnosis of BPAD was made according to the International Classification of Diseases, tenth revision. Data were recorded, compiled, and analyzed using frequency and percentage with the IBM SPSS Statistics for Windows, Version 24.0. Results: The frequency of DSH was found to be 33%, out of which 38 (35%) patients had manic episode and 11 (30%) patients had depressive episode. The most common type of DSH was found to be cutting self with sharp or blunt objects and consumption of poison with frequency of 12 (24.5%) each. The second most common DSH was banging head, which was present in (11) 22.4% of patients. Conclusion: BPAD is associated with increased risk of DSH compared to the general population. The most common type of DSH was cutting self with sharp objects followed by consumption of poison. Patients who presented with DSH in depressive episode and severe mania had more lethal modes of DSH.

Self-reported Medication Adherence in Schizophrenia and Bipolar Disorder Patients during COVID-19 Pandemic in a COVID Care Hospital: A Cross-sectional Study

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has made it difficult for patients with Schizophrenia and Bipolar Affective Disorder (BPAD) to receive ongoing care, which has led to non adherence to medication and undesirable health outcomes. Lower treatment adherence in severe mental illness might lead to symptom exacerbation and relapses and might cause a strain on the health system during COVID-19 pandemic. Aim: To assess the treatment adherence in Schizophrenia and BPAD patients during prevailing COVID-19 situation in India. Materials and Methods: This cross-sectional study was conducted among 92 patients with Schizophrenia and BPAD through a questionnaire between January to September 2021 in a COVID-19 care hospital Government Medical College Palakkad/District hospital Palakkad, Kerala, India. Demographic and clinical data, adherence to treatment, along with Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Hamilton Rating Scale for Depression (HAM-D). Clinical Global impression (CGI S&amp;I), Work and Social Adjustment Scale (WSAS), Modified COVID Threat Scale (CTS) and Medication Adherence Rating Scale (MARS) were collected. The outcomes included adherence to medication, deterioration of the psychopathology, improvement in severity, social functioning. Descriptive statistics was used to define the sample characteristics and presented as mean and standard deviation and frequency and percentages. Spearman’s Correlation coefficient was used to find the correlation between MARS and other variables: CTS, BPRS, YMRS, HAM-D, CGI and WSAS. Results: A total of 92 patients were interviewed which comprised of 43 patients with Schizophrenia and 49 patients with Bipolar disorder. As assessed by MARS rating scale 19 patients (20.65%) had a MARS score less than six suggesting poor adherence and 73 (79.35%) had MARS score 6 and greater suggesting better adherence to the treatment. This was supported by negative correlation with BPRS, YMRS, HAM-D and CGI-S and CGI-I scales which implies that the COVID-19 pandemic did not hinder the patients to take the medication. The mean MARS score was 7.31±2.11. A total of 37 (40.2%) patients had acute exacerbation of the illness during the COVID-19 related lockdown and 37 (40.2%) had exacerbation during the six months prior to COVID-19 lockdown. There was negative correlation between MARS scores and the CTS but was not statistically significant. Conclusion: Despite the COVID-19 pandemic related restriction, patients with Schizophrenia and BPAD were adherent to the medication and the number of relapses during COVID19 pandemic was similar to the period before the pandemic. COVID-19 related anxiety didn’t have an impact on medication adherence and relapse in this study.

РОЛЬ ИМПУЛЬСИВНОСТИ И ЕЁ ТИПОВ В СТРУКТУРЕ БИПОЛЯРНОГО АФФЕКТИВНОГО РАССТРОЙСТВА

Elevated levels of impulsivity often characterize patients with bipolar affective disorder (BD). However, it remains unclear whether the characteristics of impulsivity and its types depend on the solid phase of the disease and the severity of symptoms, as well as comorbid conditions and psychopharmacotherapy. Fifty-one patients diagnosed with BD and 61 respondents without psychiatric characteristics were assessed, including impulsivity with the Barratt Self-Interview Survey (BIS-11) and temperament with the Cloninger Temperament and Character Inventory (TCI). Statistical data processing included comparing means, analysis of variance with posterior tests, and correlation analysis. BD patients were characterized by an increased level of impulsivity regardless of the actual phase of the disease (t (76.2) = 7.04; p &lt; 0.001). Euthymia patients were significantly more impulsive compared to the control group (t (107) = 3.95; p &lt; 0.001), whereas patients were characterized by increases in all types of impulsivity (F (3) = 19.0; p &lt; 0.001). There were associations of the impulsivity level with the severity of depressive (r = 0.502; p &lt; 0.001) and manic symptoms (rho = 0.302; p = 0.035) as well as temperament traits such as reward dependence (r = -0.312; p = 0.029) and novelty seeker (r = 0.525; p &lt; 0.001). Impulsivity assessment can serve as an essential diagnostic tool in the clinical evaluation of a patient with suspected BD.

Beyond pharmacotherapy for bipolar disorder– a group psychotherapeutic intervention for bipolar affective disorder patients: a treatment protocol and research proposal

Beyond pharmacotherapy for bipolar disorder– a group psychotherapeutic intervention for bipolar affective disorder patients: a treatment protocol and research proposal

Low α-N-acetylgalactosaminidase plasma concentration correlates with the presence and severity of the bipolar affective disorder

Objectives Believing that a neurodevelopmental pathology may cause bipolar affective disorder (BAD), we aimed to measure the concentrations of α-N-acetylgalactosaminidase (α-NAGAL), a lysosomal enzyme. Methods The study included 32 patients with BAD and 32 healthy controls. The Young Mania Rating Scale was used to measure the severity of the disease. Serum α-N-acetylgalactosaminidase concentrations were measured in all blood samples using the human α-N-acetylgalactosaminidase ELISA Kit. Results A statistically significant difference was found in the α-NAGAL values between the groups. The mean α-NAGAL values of BAD patients are lower than the mean α-NAGAL values of the control group. A strong negative and statistically significant relationship was found between the α-NAGAL values of patients with BAD and their Young Mania Rating Scale scores. And a positive strong correlation was found between the age of onset of the disease and α-NAGAL levels. Conclusions Low α-N-acetylgalactosaminidase concentrations may cause the accumulation of some glycoproteins in the lysosomes in the brain during the gestational period, producing the clinical symptoms of BAD. α-N-acetylgalactosaminidase deficiency may not be the only cause of BAD, but it may be an important factor in the aetiology of this disease.

A study on resilience and social support in bipolar affective disorder patients in remission visiting a tertiary care centre

Introduction: Bipolar affective disorder is one of the most complex psychiatric conditions characterized by recurrent mood episodes and longitudinally varied courses. It affects at least 1% of the population. Even though it is an episodic illness patients face many challenges during inter episodic period. The study aims to investigate social support by BPAD patients in remission and how it affect the resilience in them.Methodology: Cross sectional study.275 BPAD patients in remission were evaluated using semi-structured socio demographic perfoma, Connor-Davidson Resilience 25 item scale and Multidimensional Scale of Perceived Social Support Result: Study showed majority of the patients had moderate resilience. Patients had highest support from family and lowest support from friends.There was significant association between perceived social support and resilience in. the patients of BPAD.Conclusion: Higher perceived social support enhance resilience in patients of bipolar affective disorder.

Positive and Negative Symptoms Are Associated with Distinct Effects on Predictive Saccades.

The predictive saccade task is a motor learning paradigm requiring saccades to track a visual target moving in a predictable pattern. Previous research has explored extensively anti-saccade deficits observed across psychosis, but less is known about predictive saccade-related mechanisms. The dataset analysed came from the studies of Crawford et al, published in 1995, where neuroleptically medicated schizophrenia and bipolar affective disorder patients were compared with non-medicated patients and control participants using a predictive saccade paradigm. The participant groups consisted of medicated schizophrenia patients (n = 40), non-medicated schizophrenia patients (n = 18), medicated bipolar disorder patients (n = 14), non-medicated bipolar disorder patients (n = 18), and controls (n = 31). The current analyses explore relationships between predictive saccades and symptomatology, and the potential interaction of medication. Analyses revealed that the schizophrenia and bipolar disorder diagnostic categories are indistinguishable in patterns of predictive control across several saccadic parameters, supporting a dimensional hypothesis. Once collapsed into predominantly high-/low- negative/positive symptoms, regardless of diagnosis, differences were revealed, with significant hypometria and lower gain in those with more negative symptoms. This illustrates how the presentation of the deficits is homogeneous across diagnosis, but heterogeneous when surveyed by symptomatology; attesting that a diagnostic label is less informative than symptomatology when exploring predictive saccades.

Risk factors for Deliberate Self Harm in Bipolar Affective Disorder patients presenting to Tertiary care center- A cross-sectional study

Abstract:-&#x0D; Background: Deliberate Self Harm (DSH) is a complex event, associated with psychosomatic, biological, social factors and psychiatric disorders. Current literature shows that, there is rise in DSH in psychiatric disorders and it has been recognised as major public health problem in India. So, objective of this study was to assess the underlying risk factors for DSH in patients with Bipolar Affective Disorder (BPAD).&#x0D; Methods:&#x0D; This cross-sectional study was conducted on 150 patients diagnosed with BPAD as per International Classification of Diseases; tenth revision (ICD-10). Semi-structured socio-demographic proforma was used to record basic profile. Deliberate self harm inventory (DSHI) was administered to assess the type of DSH. Young Mania Rating scale and Beck Depression Inventory were used to assess severity of symptoms.&#x0D; Results:&#x0D; Prevalence of DSH in present study was 33%. In socio-demographic profile, younger age group, lower education levels and being single were significant risk factors for DSH (p- value &lt;.001, .016 and &lt;.001 respectively) and among clinical variables, early years of disorder, severe mania, moderate and severe depressive episode in presence of medium to high suicidal intent, family history of mood disorders and co-morbid substance use and medical disorder were significant risk factors for DSH in BPAD with statistical significance (p&lt;.0001).&#x0D; Conclusion:&#x0D; DSH is considered to be the significant predictor of suicide. BPAD is associated with high risk of DSH, which can be present in either depressive or manic episode. Patients with BPAD in early years of illness, should be evaluated thoroughly for risk factors, so that DSH risk can be minimised

Sleep quality impairments in schizophrenia and bipolar affective disorder patients continue during periods of remission: a case-controlled study.

ObjectiveBipolar disorder (BD) and schizophrenia are chronic psychiatric disorders in which sleep disorders are commonly seen. In mental disorders, residual symptoms may persist even if symptoms are greatly reduced overall. The aim of this study was to compare the sleep quality of schizophrenia and BD patients in remission with that of healthy controls.MethodsForty-three patients with schizophrenia, 46 BD patients in remission for at least 3 months, and 51 healthy controls were included the study. The Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Young Mania Rating Scale (YMRS) and Pittsburgh Sleep Quality Index (PSQI) were administered to all participants and the Positive and Negative Syndrome Scale (PANSS) was administered to patients with schizophrenia.ResultsPoor sleep quality was more frequent in the patient groups than the control group (p=0.009). PSQI score was positively correlated with duration of disease (r=0.236; p=0.026), number of cigarettes smoked per day (r=0.430; p<0.001), body mass index (r=0.189; p=0.025), and negatively correlated with duration of remission (r=-0.224; p=0.0359).ConclusionSchizophrenia and BD patients in remission had worse sleep quality than a control group. Sleep quality was worst in the patients with schizophrenia. The severity of sleep disorder symptoms was positively associated with disease duration and negatively associated with duration of remission. Schizophrenia and BD patients should be carefully evaluated for symptoms of sleep disorders even when they are in clinical remission and should be offered additional treatment for sleep disorder symptoms when necessary.

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AimTo evaluate the sociodemographic and clinical profile of patients with Bipolar affective disorder who received ECT during the period of 2016-2020.MethodologyThe ECT register of the department was used to screen the patients of Bipolar affective disorder who received ECT during the period of 2016 to 2020.Treatment records of patients were reviewed to evaluate the sociodemographic and clinical profile of patients with Bipolar affective disorder who received ECT. During the period of 2016 to 2020, 1187 patients received ECT, out of which 178 (15%) patients were diagnosed with Bipolar affective disorder. Out of 178 patients with Bipolar affective disorder, 113 (63.5%) had Bipolar depression and rest of the patients had manic or mixed episode. Out of 178 patients of Bipolar affective disorder who received ECT, 62 (34.8%) had psychotic symptoms. Majority of patients received 6-10 ECTs and showed satisfactory clinical response, very few patients developed complications.Conclusion:ECT is more often used for bipolar depression than manic episodes. ECT is effective in management of both the acute phases of illness in patients with bipolar disorder.

Relationship Between Lithium Dose, Serum Concentration and Duration of Lithium Therapy with Cutaneous Side-effects in Bipolar Affective Disorder Patients

Introduction: Lithium has been used in the treatment of mood disorders for more than five decades. Despite a few studies focusing on the relationship between the dose of lithium, serum lithium levels, duration of therapy, and cutaneous side-effects, results remain inconclusive. Lithium is known to cause multiple cutaneous side-effects like acneiform eruptions, psoriasiform eruption, seborrheic dermatitis, and follicular keratitis. Aim: To evaluate the relationship between cutaneous side-effects of lithium with the serum lithium levels, dosage and duration of lithium therapy in bipolar affective disorder patients. Materials and Methods: An ambispective observational study conducted among 52 bipolar affective disorder patients on lithium therapy recruited by convenient sampling methods from both Inpatients and Outpatient Psychiatry Units of PSG Institute of medical sciences and research, Coimbatore, Tamil Nadu, India, June 2014 to August 2014. The patients with bipolar affective disorder who are either newly started on lithium or already on lithium therapy were included in the study. They were followedup to assess the effect of lithium dosage, duration of lithium and serum lithium level with skin lesions, once a month for six months and once in two months for one year. Kaplan-Meier survival analysis was done with varying lithium dosages and serum lithium levels. Association between the lithium dose and serum lithium levels with the cutaneous side-effects were calculated using the survival analysis with the p-value of &lt;0.01. Results: Out of the total, 59.6 % of the participants were in the age group less than 40 years and 34.6 % were in the age group 40-60 years. There was almost equal distribution of males and females, 51.9% and 48.1%, respectively. Overall, 38.46% participants had cutaneous lesions. Various lithium dosage and serum lithium levels did not correlate statistically with skin reactions upto one year. Survival analysis at the end of 10 years revealed that participants with higher dosage and serum levels had higher prevalence of skin lesions (40% vs 4%: 47.1% vs 6.6% respectively, p-value &lt;0.001). The cumulative proportion of skin lesions at the end of three, five, seven and 10 years for higher dose (&gt;800 mg/day) was 38%, 46.9%, 52.2%, 59% and for higher lithium levels (&gt;0.8 mEq/L) was 41%, 58.2%, 65.2%, 73.9%. Conclusion: The patients who were treated with lower dosage and who had lower serum lithium level had reduced risk for cutaneous lesions. Lithium continued to exert its mood stabilisation property even when the serum level was maintained less than 0.8 mEq/L. This resulted in better compliance

[Correlations between clinical features of bipolar affective disorder and serum concentrations of ANKRD12 gene product, coagulation factor XIII, and cadherin 5].

To determine the serum concentrations of some proteins identified in the blood serum of patients with bipolar affective disorder (BD) and to evaluate the relationship of their concentrations with clinical characteristics of BD. Protein concentrations of cadherin 5, coagulation factor XIII and ANKRD12 gene product in the blood serum of patients with BD and healthy individuals were determined using commercial ELISA kits. The severity of current depression and the main clinical manifestations of BD were assessed by SIGH-SAD and CGI upon admission to the hospital before the prescription of therapy. Data analysis was carried out using the Kruskal-Wallis and Mann-Whitney tests. Comparison between subgroups of BD patients, selected in accordance with the current affective episode (hypomanic, manic, depressive and mixed), and control group by the Kruskal-Wallis test has shown the significant difference in ANKRD12 protein product concentration (p=0.0448). When comparing pairwise each subgroup with the control group, the significant difference in ANKRD12 product concentration was found only in the case of a subgroup of BD patients with current depressive episode (Mann-Whitney test, p=0.006). Pairwise comparison of the ANKRD12 product concentrations in subgroups of BD patients with different disease duration (<5 years, 6-10 years, and >11 years) and in the control group by the Mann-Whitney test has revealed significant differences (p=0.04, p=0.01, p=0.02, respectively), the maximum protein concentration was found in patients with disease duration >11 years. Significant negative correlation of cadherin 5 concentration with the severity of atypical depressive symptoms assessed by SIGH-SAD (r=-0.69, p=0.038) and the decrease in cadherin 5 concentration in BD patients with greater severity of the current depressive episode were revealed. Significant negative correlation was found between factor XIII concentration and CGI scores (r=-0.62, p=0.032). The results indicate a possible link of the studied proteins with BD pathogenesis. Further study of these proteins may contribute to the development of new therapeutic and diagnostic techniques.

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BACKGROUND:Negative symptoms are characterized by a reduction of normal functions. They have been appreciated as core features of schizophrenia but remain under-recognized and poorly treated. They include – affective flattening, alogia, avolition, apathy, anhedonia, asociality, and impairment of attention. Initially thought to be specific to schizophrenia, they are also seen in other disorders – schizoaffective disorder, neuropsychiatric disorders, and bipolar affective disorder.AIMS:To assess various negative symptoms in Schizophrenia and Bipolar affective disorder patients in remission.METHODS:100 patients in symptomatic remission were included in this cross sectional study. Remission was assessed using the Clinical Global Impression Scale (CGI). The Scale for assessment of Negative Symptoms (SANS) was used to evaluate negative symptoms.RESULTS:Negative symptoms were present in 84% of patients in the schizophrenia group and 56% in the bipolar affective disorder group. The overall negative symptom frequency and severity was higher in the schizophrenia group.The mean SANS summary score was 7.38±4.46 in the schizophrenia group, which was higher than the BPAD group(4.80±2.69) and the difference was statistically significant (p=0.005). Affective flattening, alogia, and attentional impairment were significantly impaired in patients with Schizophrenia. Although mean scores were higher on the Anhedonia and avolition domains, the difference was statistically insignificant.CONCLUSION:Residual negative symptoms are frequently present in bipolar disorder and schizophrenia patients in remission and need to be addressed as important treatment goals for better functional recovery and outcome.