Bipolar Affective Disorder Research Articles

Steroid-induced mania in a patient with previously well-controlled organic bipolar 1-like affective disorder secondary to acquired brain injury: case report and literature review

Steroid-induced neuropsychiatric sequelae are common, and pose significant risks to people usually receiving glucocorticoids in the context of physical illness. Steroid-induced mania and hypomania are the most common of the acute complications, yet despite great progress in understandings in neurophysiology there are no recent studies which review the factors which might predict who will experience this severe complication, nor are there consensus guidelines on management. We report the unusual case of a woman in her 50s admitted to a psychiatric unit with steroid-induced mania despite compliance with two mood stabilisers, several days after the administration of a Dexamethasone and Docetaxel chemotherapy regime adjunctive to lumpectomy for breast cancer. She had previously been diagnosed with an organic affective disorder (with classical bipolar 1 pattern) following severe ventriculitis related to ventricular drain insertion for obstructive hydrocephalus secondary to a colloid cyst. She had no psychiatric illness before this brain injury, but has a maternal history of idiopathic bipolar 1 affective disorder. Her episode of steroid-induced mania resolved following use of sedative medications, continuation of her existing mood stabilisers, and reductions of the steroid dosing in collaboration with her oncology team, which also protected her from further manic relapses during continued chemotherapy. Established mental illness, a family history, and acquired brain injury may reflect risk factors for steroid-induced mania through currently unclear pathways. Future epidemiological studies could better confirm these observations, and basic neuroscience may look to further explore the role of extrinsic glucocorticoids in the pathophysiology of affective disorders.

Cognitive and inflammatory heterogeneity in severe mental illness: Translating findings from blood to brain

Recent findings link cognitive impairment and inflammatory-immune dysregulation in schizophrenia (SZ) and bipolar (BD) spectrum disorders. However, heterogeneity and translation between the periphery and central (blood-to-brain) mechanisms remains a challenge. Starting with a large SZ, BD and healthy control cohort (n = 1235), we aimed to i) identify candidate peripheral markers (n = 25) associated with cognitive domains (n = 9) and elucidate heterogenous immune-cognitive patterns, ii) evaluate the regulation of candidate markers using human induced pluripotent stem cell (iPSC)-derived astrocytes and neural progenitor cells (n = 10), and iii) evaluate candidate marker messenger RNA expression in leukocytes using microarray in available data from a subsample of the main cohort (n = 776), and in available RNA-sequencing deconvolution analysis of postmortem brain samples (n = 474) from the CommonMind Consortium (CMC). We identified transdiagnostic subgroups based on covariance between cognitive domains (measures of speed and verbal learning) and peripheral markers reflecting inflammatory response (CRP, sTNFR1, YKL-40), innate immune activation (MIF) and extracellular matrix remodelling (YKL-40, CatS). Of the candidate markers there was considerable variance in secretion of YKL-40 in iPSC-derived astrocytes and neural progenitor cells in SZ compared to HC. Further, we provide evidence of dysregulated RNA expression of genes encoding YKL-40 and related signalling pathways in a high neuroinflammatory subgroup in the postmortem brain samples. Our findings suggest a relationship between peripheral inflammatory-immune activity and cognitive impairment, and highlight YKL-40 as a potential marker of cognitive functioning in a subgroup of individuals with severe mental illness.

Toxoplasma gondii infection associated with inflammasome activation and neuronal injury

Toxoplasma gondii (TOXO) infection typically results in chronic latency due to its ability to form cysts in the brain and other organs. Latent toxoplasmosis could promote innate immune responses and impact brain function. A large body of evidence has linked TOXO infection to severe mental illness (SMI). We hypothesized that TOXO immunoglobulin G (IgG) seropositivity, reflecting previous infection and current latency, is associated with increased circulating neuron-specific enolase (NSE), a marker of brain damage, and interleukin-18 (IL-18), an innate immune marker, mainly in SMI. We included 735 patients with SMI (schizophrenia or bipolar spectrum) (mean age 32 years, 47% women), and 518 healthy controls (HC) (mean age 33 years, 43% women). TOXO IgG, expressed as seropositivity/seronegativity, NSE and IL-18 were measured with immunoassays. We searched for main and interaction effects of TOXO, patient/control status and sex on NSE and IL-18. In the whole sample as well as among patients and HC separately, IL-18 and NSE concentrations were positively correlated (p < 0.001). TOXO seropositive participants had significantly higher NSE (3713 vs. 2200 pg/ml, p < 0.001) and IL-18 levels (1068 vs. 674 pg/ml, p < 0.001) than seronegative participants, and evaluation within patients and HC separately showed similar results. Post-hoc analysis on cytomegalovirus and herpes simplex virus 1 IgG status showed no associations with NSE or IL-18 which may suggest TOXO specificity. These results may indicate ongoing inflammasome activation and neuronal injury in people with TOXO infections unrelated to diagnosis.

Bipolar Disorder in Adolescents: Early Detection and Intervention Strategies

As a severe mental condition marked by extreme mood swings, with the development of science and technology, adolescent bipolar disorder’s detection and therapy have been increasingly valued by research workers. This article explores the complex issue of adolescent bipolar disorder, highlighting the part played by genetic predisposition and neurological factors in determining how the condition develops, providing directions for further study and likely targeted treatments with a literature review approach. Meanwhile, this review highlights the crucial need for early detection and therapeutic techniques. With the examination of early detection measures and discussion of the value of screening instruments, prodromal symptom recognition, and community and school collaboration. The knowledge gained from this research offers a thorough framework for comprehending and treating adolescent bipolar disease, with the ultimate goal of increasing diagnostic precision, informing therapies, and eventually enhancing the long-term well-being of those who experience it. This review sheds light on the current landscape of early detection and intervention of adolescents’ bipolar disorders.

Factors associated with satisfaction and perceived helpfulness of mental healthcare: a World Mental Health Surveys report

BackgroundMental health service providers are increasingly interested in patient perspectives. We examined rates and predictors of patient-reported satisfaction and perceived helpfulness in a cross-national general population survey of adults with 12-month DSM-IV disorders who saw a provider for help with their mental health.MethodsData were obtained from epidemiological surveys in the World Mental Health Survey Initiative. Respondents were asked about satisfaction with treatments received from up to 11 different types of providers (very satisfied, satisfied, neither satisfied nor dissatisfied, somewhat dissatisfied, very dissatisfied) and helpfulness of the provider (a lot, some, a little, not at all). We modelled predictors of satisfaction and helpfulness using a dataset of patient-provider observations (n = 5,248).ResultsMost treatment was provided by general medical providers (37.4%), psychiatrists (18.4%) and psychologists (12.7%). Most patients were satisfied or very satisfied (65.9-87.5%, across provider) and helped a lot or some (64.4-90.3%). Spiritual advisors and healers were most often rated satisfactory and helpful. Social workers in human services settings were rated lowest on both dimensions. Patients also reported comparatively low satisfaction with general medical doctors and psychiatrists/psychologists and found general medical doctors less helpful than other providers. Men and students reported lower levels of satisfaction than women and nonstudents. Respondents with high education reported higher satisfaction and helpfulness than those with lower education. Type of mental disorder was unrelated to satisfaction but in some cases (depression, bipolar spectrum disorder, social phobia) was associated with low perceived helpfulness. Insurance was unrelated to either satisfaction or perceived helpfulness but in some cases was associated with elevated perceived helpfulness for a given level of satisfaction.ConclusionsSatisfaction with and perceived helpfulness of treatment varied as a function of type of provider, service setting, mental status, and socio-demographic variables. Invariably, caution is needed in combining data from multiple countries where there are cultural and service delivery variations. Even so, our findings underscore the utility of patient perspectives in treatment evaluation and may also be relevant in efforts to match patients to treatments.

Ayurveda Management of Bipolar Affective Disorder – A Case Report

Bipolar affective disorder (BPAD) often refers to as bipolar disorder which characterized by depressive and manic or hypomanic episodes. These disorders include: Bipolar disorder type I and bipolar disorder type II. The prevalence rate is approximately 1% across all populations and is typically treated with mood stabilizers, antipsychotics, and therapy. However, limitations include potential side effects, individual response variations, and the challenge of finding the right medication combination. Ayurvedic treatments are observed as beneficial in bipolar disorders. Few studies are only reported in this condition. The present article deals with a diagnosed case of BPAD, with current episode of depression. The Ayurvedic diagnosis was Kapha-Pittaja unmada and assessments were done before and after treatment, with HAM D Scale. Patient showed improvement in depressed mood, appearance and restlessness. Sodhana and Samana Karma play a key role in the management of BPAD. Ayurvedic treatment helps to stabilize the mood and improves the quality of life in BPAD.

Predictive efficiency of phoenixin, spexin and kisspeptin neuropeptides concentration levels in diagnosis of bipolar disorder in paediatric population.

The aim of the study was to assess concentrations of the following neuropeptides: phoenixin, spexin and kisspeptin in venous blood serum of children and adolescents suffering from bipolar disorder, and by this their predictive efficiency in this disorder. The study covered 75 individuals with a mean age of 15.26 years (95% CI: 14.86-15.67), of which the study group comprised of 57 individuals diagnosed with bipolar affective disorder and the control group - 18 individuals with no psychiatric diagnosis and no pharmacological treatment. Phoenixin, spexin and kisspeptin levels were determined in the peripheral venous blood serum. Neuropeptide concentrations were measured with the enzyme-linked immunosorbent assay (ELISA). The mean phoenixin concentration in the studied group equalled 1.57 ng/ml (95% CI: 1.35-1.79), while in the control group - 2.69 ng/ml (95% CI: 2.38-3; U Mann-Whitney test p-value < 0.05). For spexin, these results were 639.65 pg/ml (95% CI: 558.86-720.44) in the studied group, and 354.28 pg/ml (95% CI: 310.33-398.22; U Mann-Whitney test p-value < 0.05) in the control group. The observed differences were statistically significant. The mean concentration of kisspeptin levels in the studied group was 126.02 pg/ml (95% CI: 39.82-212.23; median: 59.85), while in the control group - 54.83 pg/ml (95% CI: 39.23-70.43; median: 51.3; U Mann-Whitney test p-value = 0.29), and the observed difference was not statistically significant. The occurrence of bipolar disorder symptoms is statistically significantly linked with a decreased phoenixin concentration and to a small degree - with an increased spexin concentration in blood serum of patients. However, it is not linked with the kisspeptin concentration.

Penatalaksanaan Gangguan Afektif Bipolar Episode Kini Depresif Berat tanpa Gejala Psikotik melalui Pendekatan Kedokteran Keluarga

Bipolar disorder is a group of affective or mood disorders characterized by depressive and manic or hypomanic periods. The prevalence of bipolar disorder is estimated to be around 10-15 per 100,000 individuals annually in the human population, with higher rates in women, which can reach up to 30 per 100,000. Comprehensive management with a family medicine approach is necessary to improve the quality of life of patients. Service activities are conducted using counseling/support for patients with bipolar affective disorder experiencing severe depressive episodes without psychotic symptoms, reviewed through self-report, collateral history, mental status examination, home visits, and secondary data obtained from patient medical records with the application of a holistic and comprehensive family medicine approach. The goal of counseling/support for patients is to increase disease awareness and improve the patient's quality of life. The results of service activities show better understanding of the disease by patients and medication adherence levels that impact therapy success. Holistic management with a family medicine approach is necessary to identify problems in various aspects and support therapy success as well as improve patient quality of life.

Skin Diseases in Patients With Primary Psychiatric Conditions in Northern India: A Cross-Sectional Study.

The relationship between skin diseases and psychiatric illnesses is bi-directional and is manifested as cause and effect. Psychiatric disorders such as stress, anxiety, and depression are seen to be instrumental in the development and progression of dermatological diseases on one hand, while on the other hand, cosmetic disfigurement caused by dermatological diseases is responsible for psychological distress in patients. The present study was conducted to investigate the spectrum of dermatological disorders in psychiatric patients to offer them holistic treatment andprovide them with a better quality of life. This cross-sectional, observational study wasconducted at a tertiary medical care center. A total of 170 psychiatric patients referred to the dermatology department for different dermatological manifestations were enrolled in the study. A demographic profile of the patients was done, and an association between dermatological diseases and psychiatric illnesses was done. Out of 170 study participants, 88 (51.8%) were females, and the rest (82, 48.2%) were males.A total of 13 major types of dermatological conditions were noted; among them, fungal infection (43, 25.3%) was the most common, followed by eczema (18, 10.6%), parasitic infestation (17, 10.0%), pigmentary disorder (13, 7.6%), acne (11, 6.5%), bacterial infection (11, 6.5%), pruritic disorder (11, 6.5%), hair disorder (9, 5.3%), drug reaction (9, 5.3%), papulosquamous disorder (7, 4.1%), and viral infection (6, 3.5%). Skin conditions other than the above-mentioned were present in 15 (8.8%) patients.The most common psychiatric illness in the present study was major depressive disorder (41, 24.1%), followed by generalized anxiety disorder (38, 22.4%) and psychosis not otherwise specified (34, 20.0%). Other psychiatric illnesses included in the study were bipolar affective disorder (22, 12.9%), schizophrenia (18, 10.6%), obsessive-compulsive disorder (12, 7.1%), and mixed anxiety depressive disorder (5, 2.9%). The findings of the present study depict that psychiatric patients with dermatological manifestations show a spectrum of dermatological conditions, primarily of infectious (fungal, parasitic, or viral) nature. This might be associated with a relatively poor hygienic status of psychiatric patients and thus their increased susceptibility to these disorders. Most of the time, the susceptibility to these skin conditions seemed to be opportunistic and unaffected by the type, duration, and level of control of psychiatric illness.

Prescribing Patterns of Psychotropic Medications for Common Psychiatric Disorders in a Mental Health Hospital in Tabuk.

Mental health disorders are often chronic and disabling conditions that impact different populations, irrespective of age, cultural background, or socioeconomic status. This study aimed to describe the prescribing pattern of psychotropic medications in patients with psychiatric disorders. This research was a retrospective investigation of psychotropic medication prescribing patterns and conducted at Eradah Mental Health Hospital at Tabuk City, SaudiArabia. The data were extracted from the electronic medical database of adult patients presenting to the outpatient and inpatient clinics of a mental health hospital between 2020 and 2023. The diagnosis of psychiatric disorders was identified using the International Classification of Diseases 10th Revision (ICD-10) codes version 2019 for mental and behavioral disorders (F00 to F99). The electronic medication records of 526 patients were reviewed, of whom 510 (97%) were Saudi nationals, 368 (69.9%) were males, 235 (44.7%) were between 31 and 40 years of age, and 233 (44.3%) were outpatients. The most common psychiatric diagnoses were schizophrenia (33.3%), followed by bipolar affective disorder (16.9%). A total of 2,153 medication orders for psychotropic medications were quantified. Second-generation antipsychotics (SGAs) and first-generation antipsychotics (FGAs) were the top prescribed medication classes (1,290, 60%), followed by mood stabilizers (324, 15%). More than one-half of the patients (282, 53.6%) received a combination of antipsychotic and mood stabilizers, and 155 (29.5%) received a combination of antipsychotic and antidepressant medications.No significant differences were observed in prescribing for males and females. Schizophrenia was highly prevalent among adult patients who sought mental healthcare. Polypharmacy of psychotropic medication was common depending on the symptoms' severity and comorbid psychiatric diseases.

The psychopathology among the offspring of schizophrenia and bipolar I disorder patients in an Egyptian sample: A comparative study.

A variety of psychiatric illnesses can develop in children of parents who suffer from bipolar affective disorder. The purpose of the research was to investigate, among the offsprings of patients diagnosed with schizophrenia and bipolar disorder type I, the prevalence of a variety of psychiatric diseases as well as a range of behavioral abnormalities. This was a cross-sectional observational comparative study. The outpatient psychiatric clinics at Shebin Elkom Mental Health Hospital, Menofia Governorate, Egypt 500 offspring (there were 250 offspring of parents both diagnosed with schizophrenia and 250 offsprings born to parents with bipolar affective disorder). Statistically significant association of male gender with somatic complaints, social problems, and attention problems in the bipolar offspring group. In addition, there was a statistically significant association between female gender and anxiety or depression in the bipolar offspring group. Moreover, there was a statistically significant association between male gender and thought problems and aggressive behavior in the schizophrenia group. Assessment of psychiatric symptoms using K-SADS in relation to gender revealed a statistically significant association of male gender with affective disorder, behavioral disorder, and substance use disorder in the bipolar offspring group. Moreover, there was a statistically significant association between female gender and psychotic disorder in the schizophrenia group. We concluded that offspring with bipolar illness had a significant association with somatic symptoms, anxiety/depressive disorder, social issues, attention problems, and aggressive behavior. Schizophrenia offspring were strongly related to thought issues.

A good life with psychosis: rate of positive outcomes in first-episode psychosis at 10-year follow-up.

More knowledge about positive outcomes for people with first-episode psychosis (FEP) is needed. An FEP 10-year follow-up study investigated the rate of personal recovery, emotional wellbeing, and clinical recovery in the total sample and between psychotic bipolar spectrum disorders (BD) and schizophrenia spectrum disorders (SZ); and how these positive outcomes overlap. FEP participants (n = 128) were re-assessed with structured clinical interviews at 10-year follow-up. Personal recovery was self-rated with the Questionnaire about the Process of Recovery-15-item scale (total score ⩾45). Emotional wellbeing was self-rated with the Life Satisfaction Scale (score ⩾5) and the Temporal Experience of Pleasure Scale (total score ⩾72). Clinical recovery was clinician-rated symptom-remission and adequate functioning (duration minimum 1 year). In FEP, rates of personal recovery (50.8%), life satisfaction (60.9%), and pleasure (57.5%) were higher than clinical recovery (33.6%). Despite lower rates of clinical recovery in SZ compared to BD, they had equal rates of personal recovery and emotional wellbeing. Personal recovery overlapped more with emotional wellbeing than with clinical recovery (χ2). Each participant was assigned to one of eight possible outcome groups depending on the combination of positive outcomes fulfilled. The eight groups collapsed into three equal-sized main outcome groups: 33.6% clinical recovery with personal recovery and/or emotional wellbeing; 34.4% personal recovery and/or emotional wellbeing only; and 32.0% none. In FEP, 68% had minimum one positive outcome after 10 years, suggesting a good life with psychosis. This knowledge must be shared to instill hope and underlines that subjective and objective positive outcomes must be assessed and targeted in treatment.

Correlates to Improvement in Sleep Duration in Acute Mania and Depression.

Correlates to Improvement in Sleep Duration in Acute Mania and Depression.

Negative impact of comorbidities on all-cause mortality of patients with psoriasis is partially alleviated by biologic treatment: A real-world case-control study

BackgroundCardiovascular comorbidities are believed to cause higher mortality in psoriasis patients. Conversely, systemic therapy may improve overall survival. ObjectiveTo evaluate the impact of different comorbidities and therapy on mortality risk of psoriasis patients in the entire population of Alberta, Canada (population 4.37 million). MethodsCohorts of psoriasis cases (n=18,618) and controls (ambulatory patients matched 1:3 by by age, and sex) were retrieved from Alberta Health Services Data Repository of Reporting database within the period 2012-2019. Cases were stratified according to Charlson Comorbidity Index (CCI), and the type of therapy. ResultsMortality in psoriasis cohort was significantly higher than in the controls (median age of death 72.0 years vs 74.4 years, respectively). CCI and comorbidities were strong predictors of mortality, in particular drug induced liver injury (hazard ratio [HR] 1.8, affective bipolar disease, HR 1.6, and major cardiovascular diseases. Mortality was lower in patients treated with biologics (HR 0.54). LimitationsSome factors (psoriasis type and severity, response to treatment, smoking, alcohol intake) could not be measured. ConclusionsHepatic injury, psychiatric affective disorders and cardiovascular disease were major determinants of overall survival in psoriasis. Biologic therapy was associated with a reduced mortality risk.

Childhood trauma in bipolar affective disorder: A case control study.

The etiology of Bipolar Affective Disorder (BPAD) is influenced by a variety of factors, possibly related to gene-environment interactions. Childhood trauma (CT) has been associated with an increased risk of developing BPAD. It also impacts the course of illness. The association of subcomponents of CT with BPAD and its various characteristics has not been studied in detail. This study was conducted to evaluate the association of CT with BPAD and compare it with age and sex-matched healthy controls. Fifty cases of BPAD diagnosed as per International Classification Diseases 10 (Diagnostic Criteria for Research) and 50 years age and sex-matched healthy control were studied. The required sample size was 38. Assessment of CT was done using the Childhood Trauma Questionnaire and statistical methods were applied. Among all cases of BPAD, 38 (76%) cases had experienced moderate to severe CT as compared to 10 (20%) of controls. This was statistically significant. All subtypes of CT were significantly associated with BPAD as compared to healthy controls. Among subtypes, emotional abuse had the highest association with BPAD (odds ratio 7.37, confidence interval 1.98-27.31). CT is significantly associated with BPAD. All subtypes of CT are associated with BPAD and among them, emotional abuse appeared to exert the biggest impact. A multicentric study with larger sample sizes will further substantiate this finding regarding subtypes.

Postpartum Depression and Inflammatory Biomarkers of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, and Monocyte-Lymphocyte Ratio: A Prospective Observational Study

Objectives: Postpartum depression (PPD) is a severe mental health disorder affecting a significant proportion of mothers, often undiagnosed and untreated, with potential long-term effects. While numerous studies have identified risk factors for PPD, the relationship between inflammatory markers and PPD remains unknown. This study aimed to investigate the potential correlation between indirect inflammatory markers, specifically neutrophil-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR), and the risk of developing PPD, assessed by the Edinburgh Postnatal Depression Scale (EPDS). Design: This was a prospective observational study conducted in a second-level university hospital, from December 2019 to February 2021. Participants: A total of 211 full-term pregnant women were enrolled. Exclusion criteria included specific psychiatric diagnoses, such as severe intellectual disability, schizophrenia, schizoaffective disorder, delusional disorder, bipolar or other unspecified psychotic spectrum disorders. Additionally, pregnancies affected by gestational and pregestational diabetes, chronic hypertension, gestational hypertension, preeclampsia/eclampsia, intrauterine fetal growth restriction, preterm delivery, multiple pregnancies, and fetal abnormalities detected prenatally were excluded. Methods: Socio-demographic and clinical data were recorded. Blood samples for complete blood count were obtained at hospital admission, focusing on NLR, PLR, and MLR. Analyses were conducted in our laboratory using standard techniques. The postpartum PPD evaluation was conducted 3 days after delivery, with the EPDS Italian version. Statistical analyses included descriptive statistics, group comparisons using t tests or Wilcoxon rank-sum tests for continuous variables, and Pearson χ2 or Fisher’s exact tests for categorical variables. Correlation analyses employed Pearson correlation or Spearman’s rank correlation tests. Simple logistic regression models, adjusted for various baseline patient characteristics, explored the correlation between inflammatory markers (PLR, NLR, MLR) and postpartum depressive symptoms. Version 4.1.3 of RStudio statistical software was utilized. Results: Overall, 211 pregnant women enrolled were categorized into two groups based on the EPDS scores: <10 (176 patients) and ≥10 (35 patients). The two groups demonstrated homogeneity in different socio-demographic factors. Stepwise regression analysis indicated that PLR, NLR, and MLR were not significantly associated with these variables. The scatterplot of PLR, NLR, and MLR on EPDS was stratified for EPDS groups. The Wilcoxon rank-sum test applied to PLR, NLR, and MLR values and EPDS groups did not reveal a statistical relationship. Additional analyses were conducted using the estimated odds ratios of the logistic regression model on EPDS groups, considering both continuous and binary values of indirect inflammatory markers (PLR, NLR, MLR). The results indicated the absence of a statistical relationship. Limitations: Our evaluation was restricted to the postpartum period, and data for the first and second trimesters of pregnancy are lacking. Conclusions: Our findings did not evidence a correlation between indirect inflammatory markers (NLR, PLR, and MPL) and PPD. This novel finding prompts further evaluation of the role of indirect inflammatory markers in PPD, highlighting the need for additional research to clarify the complex relationship between inflammation and psychological health in the postpartum period.

Management of bipolar disorder in South Africa: National Department of Health essential medicine selection and treatment algorithms

Background. Bipolar disorder (BD) is a severe mental illness associated with multimorbidity, psychosocial disability and significant public health issues. However, guideline heterogeneity clouds therapeutic decisions, particularly in relapse prevention. Polypharmacy and poor health outcomes are common. For low- and middle-income countries, deciding which medicines to procure and how to treat BD in an integrated manner remains elusive. Although South Africa (SA) is committed to universal health coverage, the estimated treatment gap for mental disorders in the public health sector is 91%. An Essential Medicines List (EML) enables equitable access to medicines, while Standard Treatment Guidelines (STGs) facilitate rational prescribing and quality care. Objectives. To describe the medicine selection process for the treatment of BD in the SA public health sector, and the treatment algorithms developed to guide integrated care. Methods. Evidence-based medicine principles, stakeholder consultation and consensus decision-making were used. The existing (2015) BD guideline and stakeholder comments were reviewed by a ministerially appointed expert review committee, following which a research question with eligibility criteria was formed, and rapid systematic evidence synthesis conducted. PubMed and Cochrane databases were searched for systematic reviews of randomised controlled trials and observational studies of acute and maintenance treatment in BD, with an additional PubMed search for primary research. Quality of the systematic reviews was appraised using the 11-item assessment of multiple systematic reviews. After costing to ensure affordability, final recommendations were made to the National EML Committee (NEMLC) using the strength of recommendation taxonomy classification. Following approval by the NEMLC, proposed medicines were incorporated into the 2019 National Department of Health Adult Hospital STGs. As the STGs are updated every 3 years, stakeholder input was sought in 2021 and 2023, with no changes to the medicine selection. Results. Seven systematic reviews and one observational study were included in the evidence synthesis. Six medicines were selected as essential for maintenance treatment: lithium, valproate, lamotrigine, olanzapine, quetiapine and clozapine. While risperidone and benzodiazepines were retained for acute mania, carbamazepine and fluoxetine were removed from acute depression. Treatment algorithms for predominantly manic and depressive courses of illness were constructed to encourage person-centred care, aiming for euthymia, individual functioning and relapse prevention. Conclusion. Evidence-based medicine principles enabled the NEMLC to select a range of essential medicines for the management of BD in a middle-income country. Local monitoring and evaluation are needed to inform future editions of the STGs and EML.

Prevalence and risk factors for metabolic syndrome in schizophrenia, schizoaffective, and bipolar disorder

Background Metabolic Syndrome (MetS) is a risk for developing cardiovascular diseases and its prevalence is especially high in psychiatric patients. To date, there is limited data from the United Arab Emirates (UAE) on the prevalence of MetS. Therefore, we aimed to investigate its prevalence and possible risk factors in a large sample of psychiatric patients in the UAE. Methods A cross-sectional study was conducted at Al-Ain Hospital, in Al-Ain City, UAE. We collected demographic and clinical data on patients diagnosed with schizophrenia, schizoaffective, and bipolar affective disorder in the period between January 2017 and December 2020. This included their secondary diagnosis (psychiatric or medical), vital signs (heart rate, systolic and diastolic blood pressure, Body Mass Index [BMI]), metabolic parameters (fasting blood glucose, cholesterol, triglycerides, low-density lipoprotein, high-density lipoproteins), and prescribed medications. We used the American Association of Clinical Endocrinology (AACE) criteria to diagnose MetS. Results We included 889 subjects and of these, 79.8% (N = 709) had a BMI ≥25 kg/m2 and 9.8% (N = 87) had no abnormal metabolic parameters. Overall, 28.1% (N = 250) had MetS with no statistical difference between the three groups. Fasting blood glucose levels and abnormally elevated triglycerides were significant predictors for MetS. Conclusion Our study found that around one in three patients had MetS irrespective of the three diagnoses. Some variables were significant predictors for MetS. Our findings were consistent with other studies and warrant the need for regular screening and management of abnormal metabolic parameters.

To study childhood trauma in patients with bipolar affective disorder and its association with leucocyte telomere length

BackgroundChildhood traumatic (CT) events are more frequent in Bipolar Affective Disorder (BD) than in healthy individuals. As per existing studies, telomere shortening might be associated with psychiatric illnesses and aging-related disorders. One basis could be CT in BD aiding in telomere shortening. Methods100 BD patients and 100 healthy controls (HC) were matched for age and sex. All the participants were administered Childhood Trauma Questionnaire (CTQ). Subsequently, Quantitative Polymerase Chain Reaction (q-PCR) was performed in order to verify leukocyte telomere length (LTL) for both cases and controls. ResultsPresence of subtypes of moderate to severe CT among cases revealed emotional abuse in 35%, physical abuse in 16%, and sexual abuse in 15%. BD patients had significantly shorter telomeres in comparison to HC. BD patients with CT had significantly shorter LTL as compared to healthy controls with CT. The association between CT and LTL was not statistically significant in cases as well as in controls. ConclusionsOur study revealed presence of CT (moderate to severe) in 46% of BD patients and 12% in age and sex-matched healthy controls. All CT subtypes except sexual abuse were significantly higher among cases than in healthy controls. Mean score of LTL among cases including that with CT was significantly lower than the healthy controls.

The clinical picture of bipolar affective disorders in children and adolescents hospitalized at the psychiatric ward in Sosnowiec.

To determine the clinical picture of bipolar affective disorders (BD) in children and adolescents hospitalized at the Clinical Ward of Developmental Age Psychiatry and Psychotherapy (DAPP) in Sosnowiec, Poland. Documentation analysis of 288 BD patients below 18 years of age. Detailed clinical and demographic data were collected and symptoms present during hospitalization were assessed. The mean age of illness onset was 13.6 ± 1.7 years. A total of 86.5% of the studied individuals received a first diagnosis different from BD/mania, and the average time until the proper diagnosis was 16.9 months. In 45.5% the first episode was depression with varied severity, in 29.2% a mixed episode and in 25.3% mania/hypomania. In 48.6% comorbid disorders were present. The most frequent reason for hospitalization was a mixed episode (47.6%). Among the symptoms, irritability was observed in over 80% of patients with mania or mixed episodes, but also in 60% of patients with depression. Suicidal thoughts were experienced by almost all the depression patients, 84.7% in the mixed episode and also 52.6% in mania/hypomania episode. Anxiety was mostly present in depression (40.7%) and mixed episode (22.6%), while moodcongruent delusions in depression and mania (around 20% of cases). Aggressive behaviours were manifested in around half of patients with mania and a mixed episode. In the studied population of children and adolescents, BD usually started with a depression episode accompanied by a high rate of comorbid disorders and in most cases there was an original misdiagnosis. Study results also point to a significant frequency of some pathological symptoms in this population.