Bipolar Affective Disorder Type Research Articles

Problems of Adaptation and Impairment of Social Functioning of Persons with Bipolar Affective Disorder Type II

The article presents an analysis of the main theoretical approaches to the violation of adaptation and social functioning of patients with bipolar disorder. The main approaches to socio-psychological adaptation in domestic and foreign psychology are presented. The concept of sustainability is disclosed as the ability to recover and grow positively after periods of impaired adaptation. The main areas of disruption of social functioning during the period of pathopsychological manifestations in patients with bipolar affective disorder are outlined: violations of interpersonal and social functioning, professional and educational activities, identity, self-image, emotional regulation, self-service ability. A study is presented that confirms the hypothesis of a decrease in adaptability and social functioning during periods of pathopsychological manifestations (21 people). The presented data can serve as a basis for effective support of patients with bipolar affective disorder.

Lamotrigine, a Miscreant in Toxic Epidermal Necrolysis: A Rare Case Report

This case report is about a rural 39 years old female of Asian origin and laborer by profession who developed Toxic Epidermal Necrolysis (TEN) with lamotrigine. She was a known case of Bipolar Affective Disorder Type 1 with psychosis on treatment with quetiapine, duloxetine, escitalopram, and etizolam for the last one and a half years and had no history of adverse effects with those drugs. Recently Lamotrigine was added to her regimen at a dose of 50 mg/day. She developed Stevens-Johnson syndrome (SJ syndrome) within two weeks of adding lamotrigine which progressed to Toxic Epidermal Necrolysis (TEN), SCORTEN scores 3, in the next 3-4 days. The sequence of events, reports of laboratory investigations, and management of TEN have been elaborated in this case report. On the Naranjo scale of causality, the suspected adverse drug reaction was established as ‘probable’ because the suspected culprit drug discontinuation led to improvement in the patient’s condition but a rechallenge was not tried.

Bipolar disorder type II - will the new classification help in setting an adequate diagnosis

IntroductionBipolar affective disorder type II is often misunderstood, neglected and rarely receives the attention it deserves and often remains undiagnosed. Despite its neglect and insufficient diagnosis, it is an important diagnostic entity because it causes significant suffering and functional impairment, a chronic course of the disease and a high suicide rate. Cognitive impairments and multiple comorbidities that significantly affect the course and outcome of the disease are common.ObjectivesThe purpose of this research was to determine the extent of the deficiency in diagnosing bipolar affective disorder type II in daily clinical work.MethodsA total of 82 adult psychiatric inpatients diagnosed with affective disorders (depressive disorders and bipolar affective disorders) and borderline disorders participated in this study. They completed HCL-32, MDQ and PHQ-9 questionairres. The average age of the sample is 43.9 years. A total of 76.8% were women in the sample.Results72.8% of respondents achieved a score above 14 on the HCL-32 questionnaire and thus met the criteria for possible hypomania. All three criteria for mania on the MDQ questionnaire were satisfied by 27.5% of respondents. 68% of respondents have moderate or severe symptoms of depression according to PHQ-9.ConclusionsThe results confirmed our assumption about the lack of recognition and diagnosis of bipolar affective disorder type II. Only 5 respondents (6.1%) were diagnosed with BAP II upon arrival. After the research, 73% of them met the criteria for diagnosing BAP II. As a correctly established diagnosis affects the selection of adequate therapy, we have tried to emphasize the importance of correct recognition of BAP II.Disclosure of InterestNone Declared

Variants in the zinc transporter-3 encoding gene (SLC30A3) in schizophrenia and bipolar disorder: Effects on brain glutamate-A pilot study.

Zinc transporter 3 (ZnT3) has been implicated in the aetiopathology of schizophrenia. In this pilot study, we tested the hypothesis that the presence of a minor allele of two variants in the gene encoding ZnT3 (SLC30A3) affects brain glutamate and cognitive activity in patients with schizophrenia and bipolar affective disorder. Fifteen patients with schizophrenia (SCZ), 15 with bipolar affective disorder type 2 (BD), and 14 healthy volunteers (HV) were genotyped for two SLC30A3 single nucleotide polymorphisms (rs11126936 and rs11126929). They also underwent structural and functional MRI (n-back) imaging as well as static (PRESS) and functional magnetic resonance spectroscopy (n-back) on a 3 Tesla MRI system. SCZ with at least one copy of the minor allele showed reductions in dorsal anterior cingulate cortex glutamate during the n-back task, whereas SCZ without the minor allele showed an increase in glutamate. BD with the minor allele had reduced glutamate in the anterior cingulate cortex (p < 0.05). There was no effect of SLC30A3 genotype on BOLD activation during n-back or on cortical brain volume. This study supports the further investigation of SLC30A3 and its role in glutamatergic neurotransmission and in the neuropathology of mental illness.

A clinical case of type II bipolar affective disorder

This study presents a clinical case of bipolar affective disorder type II. Difficulties in differential diagnosis at the early disease stages are discussed. The considered clinical case reflects real psychiatric practice when the onset of the disease is identified in adolescence and associated with the impact of a traumatic situation. Disease manifestations are characterized by polymorphism and atypical affective symptoms, which require careful differential diagnosis, considering disorders of other nosological categories and pathological pubertal crisis. Early recognition of type II bipolar affective disorder is associated with difficulties in hypomanic episode identification that are not regarded by patients as painful in most cases and are not a reason for seeking psychiatric advice and care.

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BACKGROUNDBipolar disorder is an episodic psychiatric illness characterized by episodes of mania and hypomania. Presentation of bipolar disorder differs in women as compared to men, due to frequent occurrence of comorbidities like migraine, thyroid disorders, polycystic ovarian syndrome, etc. Migraine is one of the most disabling primary headaches and is more commonly seen in women with bipolar disorder. Women with migraine also tend to have more frequent mood episodes and greater psychosocial impairment. There are limited studies conducted on migraine and bipolar disorder in women in India.AIMS AND OBJECTIVESTo determine the co-occurrence of Migraine in women with Bipolar Affective DisorderMETHODOLOGYWomen with Bipolar Affective Disorder, who visited the Psychiatry Out Patient Department of a Tertiary Care Hospital in South India, were evaluated for the presence of migraine headache using the International Headache Society criteria for diagnosis.RESULTSOut of 80 subjects, 40% (N = 32) women with Bipolar Affective Disorder (BPAD) were also suffering from Migraine. 38.2% (N = 13) women with Type 1 BPAD had migraine; while 61.7% (N = 21) women with Type 2 BPAD had migraine.CONCLUSIONMigraine is a frequent complaint in women with bipolar disorder. It was more commonly seen in women with BPAD type 2. As the presence of migraine affects course and treatment response in women with bipolar disorder, it emphasizes on the importance of detailed evaluation and further research in the area.

Psychological Resilience and Suicide Attempt in Patients With Bipolar Disorder: An Exploratory Study.

Patients with bipolar affective disorder (BPAD) have a suicide risk of up to 30 times higher than the general population. There is increasing interest in analyzing the effects of resilience in psychiatric diseases and its relationship to other factors such as suicide risk. The main objective of this study was to analyze the relationship between psychological resilience and suicide attempts, along with other relevant clinical and sociodemographic variables in euthymic patients with BPAD. Eighty six outpatients, more than 18 years old, mostly men (60.5%) with BPAD type 1, 2, mixed, and unspecified, in euthymic phase receiving antidepressant and/or euthimizing treatment, participated in the study. Sociodemographic and clinical variables were assessed by means of a questionnaire and psychological resilience by means of Connor-Davidson's 10-item Resilience Scale. Patients with previous autolytic attempts scored significantly lower in resilience than those who had not attempted suicide (T = 3.30; p ≤ .001; 20.61 ± 6.58 vs. 26.52 ± 7.29). Patients diagnosed with BPAD scored significantly lower than other samples of university participants, workers, and the unemployed. The number of depressive episodes experienced was negatively and significantly associated with resilience scores (r = -.28; p < .01). Patients diagnosed with BPAD who had made autolytic attempts had lower resilience scores than those who had not made them and lower scores than other general nonpsychiatric samples. The promotion of resilience in patients diagnosed with BPAD would facilitate a more adaptive and positive coping with the disease and their recovery process.

STUDY OF THE ASSOCIATION OF CHILDHOOD TRAUMA WITH SCHIZOPHRENIA AND BIPOLAR DISORDER IN A SAMPLE OF ADULT PATIENTS

Schizophrenia is a clinical syndrome of variable, but profoundly disruptive, psychopathology that involves cognition, emotion, perception, and other aspects of behavior. The hallmark symptom of schizophrenia is psychosis, such as experiencing auditory hallucinations (voices) and delusions (fixed false beliefs).It carries a lifetime risk of around 1%, and its early onset and tendency to chronicity mean that its prevalence is relatively high.(1) In the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV), bipolar disorder constitutes a spectrum of mood disorders that includes BPI (bipolar affective disorder type I), BPII (bipolar affective disorder type II), cyclothymia and are thought to be a “bridge” between schizophrenia spectrum disorders and depressive disorders in terms of the symptomology, family history and genetics.Childhood trauma is considered as a risk factor for psychiatric disorders across diagnostic boundaries. Childhood trauma is most likely interacting with genetic factors in the development of psychiatric disorders.

[Mental disorders in type 2 diabetes].

To assess the prevalence of mental disorders in patients with type 2 diabetes mellitus (DM2) and their relationship with laboratory findings, somatic comorbidities and psychosocial consequences. In the frames of the INTERPRET-DD multicenter 200 T2DM patients from primary care (47 men and 153 women) from the Russian sample were studied. The psychometric assessment included MINI-6, HAMD-17, PHQ-9, PAID, WHO-5. One hundred and seventeen patients (58.5%) have mental disorders. Current mental disorders were diagnosed in 93 (46.5%) of patients. Depression (depressive episode, recurrent depressive disorder, bipolar affective disorder type II) was identified in 34 (17.0%), dysthymia in 26 (13.0%), and anxiety spectrum disorders in 39 (19.5%). In about half of the cases, anxiety disorders were combined with depression. The most severe problems were observed in the patients with depression and dysthymia. Patients with social phobia had significantly higher levels of glycated hemoglobin compared to patients without mental disorders. The significant decrease of systolic arterial pressure and body mass index was observed in patients with agoraphobia compared to patients without mental disorders. In addition, there was an increased prevalence of chronic ischemic heart disease in recurrent depression, dysthymia and generalized anxiety disorder, higher prevalence of neuropathy in depressive episode and recurrent depression and nephropathy in panic disorder. Depressive and anxiety disorders, as well as severe psychosocial problems, are consistently associated with T2DM. At the same time, concomitant somatic disorders and complications of DM2 are not just by chance comorbid to various forms of mental disorders, which allows for a new look at the problem of comorbidity/multimorbidity in T2DM.

THE BIPOLAR AFFECTIVE DISORDER TYPE II

The article presents review of modern publications concerning studies of bipolar affective disorder type II. The materials are summing up concerning national and international studies of characteristics of clinical course of depressions and hypo-maniacal states within the framework of bipolar affective disorder type II, problems of differential diagnostic of bipolar affective disorder within spectrum of affective pathology. The significance of studying of pre-morbid background in case of bipolar affective disorder type II, co-morbid states for prognosis of course of disease is demonstrated. The screening, diagnostic and estimated scales and questionnaires are considered including principles of their application as an add-on to actual international diagnostic systems ICD-10, DSM-IV-TR, DSM-V.

Prevalence of Metabolic Syndrome amongst Bipolar Patients on Lithium and Sodium Valproate Monotherapy

There is a growing body of evidence on metabolic syndrome associated with antipsychotic medications. However, very limited data exist on metabolic syndrome and commonly prescribed mood stabilizers such as Lithium, Valproic acid and Carbamazepine. Method: This paper is a cross sectional survey of metabolic syndrome in a group of patients diagnosed with bipolar affective disorder (BPAD). The study completed a data on 32 patients, 19 females and 13 males. These patients were diagnostically stratified using ICD 10 into BPAD type 1(10) and BPAD type 2 (22). The groups were further divided into two according to their treatment with 19 patients receiving Lithium monotherapy and 13 Valproic acid monotherapy. The International Diabetic Federation (IDF) was used to screen all the patients for metabolic syndrome. Result: The result shows that Lithium has low prevalence of metabolic syndrome (10%) while Valproic acid possessed significant risk with a prevalence rate of 30%. Conclusion: It is therefore important to extend metabolic monitoring beyond antipsychotics to cover mood stabilizing agents especially Valproic acid. Limitation: Small sample size. However, it is very difficult to find bipolar patients on a monotherapy of mood stabilizer.

Genealogy Study of Three Generations of Patients with Bipolar Mood Disorder Type I.

Introduction:The purpose of this research is genealogy examination of three generation of bipolar mood disorder Type I patients.Methods:Patients selected using Poisson sampling method from 100 patients with bipolar mood disorder Type I, referring to a psychiatric center of Amir Kabir Hospital of Arak, Iran. Examine issues such as physical ailments, psychological review of living and deceased family members of each patient, drawn family pedigree using pedigree chart, check the relationship of the different pattern of the autosomal dominant and recessive disease, sex-linked dominant and recessive and linked to Y chromosome have been performed on patients. Different methods used in this study are pedigree chart and young mania rating scale and SPSS and Pearson's correlation test for analyzing the data collected.Results:Among the studied inheritance patterns, the most common inheritance pattern was autosomal recessive. There was a significant relationship between age, number of generation, and inheritance patterns with physical ailments in families of patients with bipolar mood disorder (P < 0.05), but there was no significant association with mental illness (P > 0.05). Furthermore, there was a significant relation between generation and skin, gastrointestinal, ovarian, lung, coronary heart disease, diabetes mellitus, hypertension, Cerebrovascular accident (CVA), hyperlipidemia, cardiomyopathy, hypothyroidism, and kidney disease in patients with bipolar affective disorder Type I (P < 0.05).Conclusion:The results showed that autosomal recessive was the most pattern of inheritance and there is a significant relationship between generation and some physical disorders in patients with bipolar mood disorder Type I.

[Daily dynamics of time perception in bipolar II disorder patients with redarted or anxious depression].

It is known affective disorders are changing the perception of time. The study of time perception in patients with affective disorders enables researchers to make early diagnostic criteria for these conditions, as well as to shed light on possible mechanisms for the development of affective disorders. 20 patients with bipolar affective disorder type II in accordance with the DSM-5 criteria (10 patients with a predominance of anxiety and 10 patients with a predominance of psychomotor retardation) and 10 healthy subjects were recruited to the study. Test for measuring minute was conducted from 7 hours to 21 hours with an interval of 2 hours. Patients were distributed into two experimental groups in accordance with the severity ratio of psychomotor retardation and anxiety. All patients were on monotherapy with agomelatine in a single dose 25-50 mg/day. Duration of individual minute, was significantly shorter in the experimental groups compared with the control group and did not differ within experimental groups. In the group of healthy volunteers length of individual minutes was close to «AIM: minute, i.e. 60 seconds, in groups of patients with prevalence of anxiety and a predominance of psychomotor retardation length of individual minutes was set to about 40 seconds and did not differ significantly in patients groups. In patients with retarded depression distribution of a minute duration peaks was shifted for 2 hours late (13-17 h) comparing to controls, in anxious depresssion the distribution was bimodal with peaks in 10 and 18 hours. There were no singnificant differences between groups. Shorter duration of individual minute in patients with recurrent depressive episodes, may be an early sign of a new depressive episode.

Cognitive functions in euthymic patients with bipolar II disorder and their correlation with the clinical profile

Deficits in neurocognitive functions can hinder the functional recovery and the quality of life of psychiatric patients, especially those with bipolar disorder. Numerous reports consistently demonstrated cognitive deficits in euthymic patients with bipolar disorder; however, their relation to the clinical profile remains unclear. The aim of this study was to demonstrate the range of neuropsychological deficits in euthymic patients with bipolar II disorder and to correlate these neuropsychological deficits with their illness characteristics. Thirty bipolar affective disorder type II patients in their euthymic state were assessed by the Structured Clinical Interview for DSM-IV, the Hamilton Rating Scale for Depression, the Young Mania Rating Scale, the Wechsler Adult Intelligence Scale, the Wechsler Memory Scale, the Continuous Performance Test, and the Wisconsin Card Sorting Test. Patients’ cognitive functions were compared with a matched control group. The performance on most domains of the Wechsler Adult Intelligence Scale was associated with the total number of episodes, the number of depressive episodes, the age of onset, and the average duration of an episode in months. The performance on the Wechsler Memory Scale was significantly associated across most domains with the total number of episodes, the number of depressive episodes, the age in years, the average duration of an episode in months, and the average duration of illness in years. The performance deficits on the Wisconsin Card Sorting Test were significantly associated with the total number of episodes, the number of depressive episodes, family history, and the average duration of illness in years. Bipolar II euthymic patients showed persistent cognitive deficits in some aspects of general intellectual capacity, executive and memory functions, and the ability for sustained attention, which are correlated with some clinical variables. Bipolar II patients should be routinely assessed for deficits in cognitive functions to enable early intervention and rehabilitation.

Bipolar Disorder: Clinical Perspectives and Implications with Cognitive Dysfunction and Dementia

Introduction. Cognitive dysfunction as a core feature in the course of bipolar affective disorder (BPD) is a current subject of debate and represents an important source of psychosocial and functional burden. Objectives. To stand out the connection and clinical implications between cognitive dysfunction, dementia, and BPD. Methods. A nonsystematic review of all English language PubMed articles published between 1995 and 2011 using the terms “bipolar disorder,” “cognitive dysfunction,” and “dementia”. Discussion. As a manifestation of an affective trait or stage, both in the acute phases and in remission, the domains affected include attention, executive function, and verbal memory. The likely evolution or overlap with the behavioural symptoms of an organic dementia allows it to be considered as a dementia specific to BPD. This is named by some authors, as BPD type VI, but others consider it a form of frontotemporal dementia. It is still not known if this process is neurodevelopmental or neurodegenerative in nature, or both simultaneously. The assessment should consider the iatrogenic effects of medication, the affective symptoms, and a neurocognitive evaluation. Conclusion. More specific neuropsychological tests and functional imaging studies are needed and will assume an important role in the near future for diagnosis and treatment.

Effect of Acute Posttrauma Propranolol on PTSD Outcome and Physiological Responses During Script‐Driven Imagery

Animal and human research suggests that the development of posttraumatic stress disorder (PTSD) may involve the overconsolidation of memories of a traumatic experience. Previous studies have attempted to use pharmaceutical agents, especially the β-adrenergic blocker propranolol, to reduce this overconsolidation. In this randomized, placebo-controlled study of the efficacy of propranolol in reducing the development of PTSD, we optimized dosages and conducted both psychophysiological and clinical assessments 1 and 3 months after the traumatic event. Forty-one emergency department patients who had experienced a qualifying acute psychological trauma were randomized to receive up to 240 mg/day of propranolol or placebo for 19 days. At 4 and 12 weeks post-trauma, PTSD symptoms were assessed. One week later, participants engaged in script-driven imagery of their traumatic event while psychophysiological responses were measured. Physiological reactivity during script-driven traumatic imagery, severity of PTSD symptoms, and the rate of the PTSD diagnostic outcome were not significantly different between the two groups. However, post hoc subgroup analyses showed that in participants with high drug adherence, at the 5-week posttrauma assessment, physiological reactivity was significantly lower during script-driven imagery in the propranolol than in the placebo subjects. The physiological results provide some limited support for a model of PTSD in which a traumatic conditioned response is reduced by posttrauma propranolol. However, the clinical results from this study do not support the preventive use of propranolol in the acute aftermath of a traumatic event.

Support for tryptophan hydroxylase-2 as a susceptibility gene for bipolar affective disorder

Bipolar affective disorder (BPAD) is a highly inherited genetic disorder and may be caused in part by deficits in serotonergic neurotransmission. We investigated whether variants within the tryptophan hydroxylase-2 (TPH2) gene, which is required for the synthesis of serotonin (5-HT), are associated with susceptibility to developing BPAD. Thirteen single nucleotide polymorphisms (SNPs) within TPH2 were genotyped in a collection of 151 Irish BPAD type I trios and were tested for association using the transmission disequilibrium test. SNPs rs1386482 and rs1386486, which are in very strong linkage disequilibrium, were associated with BPAD (P=0.006). The association retained significance after a correction for multiple testing. The associated SNPs are in perfect linkage disequilibrium with SNPs previously associated with BPAD (rs4290270) and impulsivity (rs1386483), a core trait of BPAD. These results strongly support a role for TPH2 in the aetiology of BPAD.

Candidate gene analysis of 21q22: Support for S100B as a susceptibility gene for bipolar affective disorder with psychosis

A genome-wide scan in 60 bipolar affective disorder (BPAD) affected sib-pairs (ASPs) identified linkage on chromosome 21 at 21q22 (D21S1446, NPL = 1.42, P = 0.08), a BPAD susceptibility locus supported by multiple studies. Although this linkage only approaches significance, the peak marker is located 12 Kb upstream of S100B, a neurotrophic factor implicated in the pathology of psychiatric disorders, including BPAD and schizophrenia. We hypothesized that the linkage signal at 21q22 may result from pathogenic disease variants within S100B and performed an association analysis of this gene in a collection of 125 BPAD type I trios. S100B single nucleotide polymorphisms (SNPs) rs2839350 (P = 0.022) and rs3788266 (P = 0.031) were significantly associated with BPAD. Since variants within S100B have also been associated with schizophrenia susceptibility, we reanalyzed the data in trios with a history of psychosis, a phenotype in common between the two disorders. SNPs rs2339350 (P = 0.016) and rs3788266 (P = 0.009) were more significantly associated in the psychotic subset. Increased significance was also obtained at the haplotype level. Interestingly, SNP rs3788266 is located within a consensus-binding site for Six-family transcription factors suggesting that this variant may directly affect S100B gene expression. Fine-mapping analyses of 21q22 have previously identified transient receptor potential gene melastatin 2 (TRPM2), which is 2 Mb upstream of S100B, as a possible BPAD susceptibility gene at 21q22. We also performed a family-based association analysis of TRPM2 which did not reveal any evidence for association of this gene with BPAD. Overall, our findings suggest that variants within the S100B gene predispose to a psychotic subtype of BPAD, possibly via alteration of gene expression.

Bipolar 1 disorder is not associated with the RGS4, PRODH, COMT and GRK3 genes

Although current psychiatric nosology separates bipolar disorder and schizophrenia into non-overlapping categories, there is growing evidence of a partial aetiological overlap between them from linkage, genetic epidemiology and molecular genetics studies. Thus, it is important to determine whether genes implicated in the aetiology of schizophrenia play a role in bipolar disorder, and vice versa. In this study we investigated a total of 15 single nucleotide polymorphisms (SNPs), and all possible haplotypes, of genes that have been previously implicated in schizophrenia or bipolar disorder - RGS4, PRODH, COMT and GRK3 - in a sample of 213 cases with bipolar affective disorder type 1 and 197 controls from Scotland. We analysed the polymorphisms allele-wise, genotype-wise and, for each gene, haplotype-wise but obtained no result that reached nominal significance (p<0.05) for an association with the disease status. In conclusion, we could not find evidence of association between RGS4, PRODH, COMT and GRK3 genes and bipolar affective disorder 1 in the Scottish population.

Genome-wide scan for genes involved in bipolar affective disorder in 70 European families ascertained through a bipolar type I early-onset proband: supportive evidence for linkage at 3p14

Preliminary studies suggested that age at onset (AAO) may help to define homogeneous bipolar affective disorder (BPAD) subtypes. This candidate symptom approach might be useful to identify vulnerability genes. Thus, the probability of detecting major disease-causing genes might be increased by focusing on families with early-onset BPAD type I probands. This study was conducted as part of the European Collaborative Study of Early Onset BPAD (France, Germany, Ireland, Scotland, Switzerland, England, Slovenia). We performed a genome-wide search with 384 microsatellite markers using non-parametric linkage analysis in 87 sib-pairs ascertained through an early-onset BPAD type I proband (AAO of 21 years or below). Non-parametric multipoint analysis suggested eight regions of linkage with P-values<0.01 (2p21, 2q14.3, 3p14, 5q33, 7q36, 10q23, 16q23 and 20p12). The 3p14 region showed the most significant linkage (genome-wide P-value estimated over 10 000 simulated replicates of 0.015 [0.01-0.02]). After genome-wide search analysis, we performed additional linkage analyses with increased marker density using markers in four regions suggestive for linkage and having an information contents lower than 75% (3p14, 10q23, 16q23 and 20p12). For these regions, the information content improved by about 10%. In chromosome 3, the non-parametric linkage score increased from 3.51 to 3.83. This study is the first to use early-onset bipolar type I probands in an attempt to increase sample homogeneity. These preliminary findings require confirmation in independent panels of families.