Bipolar Affective Disorder Research Articles

Correlation and Inter-rater Agreement between Patient, Caregiver and Clinician-administrated Versions of WHODAS 2.0 among the Persons with Bipolar Affective Disorder: A Cross-sectional Study

Abstract Background: Bipolar affective disorders are dimensional illnesses in which patients experience, during the long-term course of illness, fluctuating levels of severity of manic and depressive symptoms interspersed with symptom-free periods. It is a highly exhausting and relapsing psychiatric disorder associated with significant morbidity and comorbidity. The World Health Organization Disability Assessment Schedule (WHODAS) is an International Classification of Functioning-based multidimensional instrument that was developed for measuring disability. Aim and Objective: The present study aimed to check the correlation and inter-rater agreement amongst the patient, caregiver, and clinician-administered version of the WHODAS 2.0 among persons with bipolar affective disorder. Materials and Methods: The study was cross-sectional in nature. Thirty samples of patients with bipolar affective disorder as per ICD-10 criteria were selected using a consecutive sampling technique. Patients above 18 years of age with a total duration of illness of at least more than 2 years were included and used self, proxy, and interviewer-administered versions of WHODAS 2.0. Results: The total score of WHODAS 2.0 shows that the interclass correlation coefficient between the patient and caregiver, caregiver and clinician, and patient and clinician was 0.655 (0.469–0.802), 0.599 (0.395–0.767), and 0.722 (0.586–0.820), respectively, indicative of moderate reliability. Caregivers showed a higher mean in cognition, 3.73 (3.13); mobility, 2.63 (1.73); and self-care, 0.867 (1.25), than other raters. Clinicians showed a higher mean (standard deviation) in getting along with people, 4.13 (1.69); life activities of the household, 5.46 (2.67); and participation in society, 10.70 (2.56), than other raters. Conclusion: People suffering from bipolar affective disorder are prone to disability albeit in the mild-to-moderate variety. The findings show that there was moderate reliability between the patient and caregiver, caregiver and clinician, and patient and clinician among the patient rated, caregiver rated on the overscore of WHODAS 2.0.

Integrated bipolar electrocoagulation and PVC-based ultrafiltration membrane process for palm oil mill effluent (POME) treatment

In this study, the effectiveness of integrating electrocoagulation (EC) and ultrafiltration (UF) membranes for palm oil mill effluent (POME) wastewater treatment was investigated. The impact of various parameters on contaminant removal efficiency, including electrode configuration (monopolar and bipolar), number of anodes, agitation rate, and current density, was studied. The findings demonstrated that using bipolar (BP) electrodes in the EC reactor improved coagulation efficiency. However, an increase in agitation rate led to a decrease in removal efficiency. The electrode configuration of 2A-2C–2B achieved high contaminant removal with a lower electrode consumption compared to the 4A-2C and 4A-2C–2B configurations. The removal efficiencies for total dissolved solids (TDS), total suspended solids (TSS), chemical oxygen demand (COD), and biological oxygen demand (BOD) were 59.1%, 99.9%, 96.8%, and 96%, respectively. The operating cost for the electrode configuration of 2A-2C–2B was estimated to be 2.71 US$ m−3 at an effluent capacity of 50 m3 d−1 and 20 h d−1 of operating time, while the energy requirement was 6.20 kWh m−3. An increase in operating time from 5 to 24 h d−1 raised the specific operating cost from 2.17 to 2.85 US$ m−3. This study provides valuable insights into optimizing EC and UF processes for POME wastewater treatment, which could have significant implications for sustainable industrial practices.

Severe mental illness and symptoms of acute coronary syndrome in emergency calls

Abstract Background It can be lifesaving to act fast and correct when acute life-threatening diseases occur. This is, however, challenging in some patients with severe mental illness as they sometimes experience symptoms differently than patients without severe mental illness. This changed perception can affect the patients’ chances of receiving adequate help, as these patients are already stigmatized even by healthcare personnel. Purpose We aimed to determine whether patients with severe mental illness reported different symptoms of acute coronary syndrome (ACS) in emergency calls than patients without severe mental illness. Methods In this registry-based study, we analyzed symptoms of ACS in emergency calls made from 2014 to 2018 in the Capital Emergency Medical Services, including the Emergency Number (1-1-2) and the Out-of-hours Service (medical helpline). The study population comprised patients with severe mental illness (defined by schizophrenia, bipolar affective disorder, and depression) and a control group of patients without severe mental illness. Additionally, we investigated whether psychotropics (defined by antipsychotics, mood stabilizers, and antidepressants) were associated with altered symptom presentation of ACS. Furthermore, we determined the time from the emergency call to hospitalization. Analyses were performed by logistic regression adjusted for sex and age and t-tests. Results In total, 11,113 emergency calls were included; 917 were from patients with severe mental illness (45.4% were female, average age was 64.6 years), and 10,196 were from patients without severe mental illness (35.3% were female, average age was 67.7 years). Severe mental illness was associated with less frequent chest pain in ACS (odds ratio 0.80, 95%CI: 0.70-0.92, p=0.002). Furthermore, treatment with psychotropics was associated with less frequent chest pain in ACS (odds ratio 0.73, 95%CI: 0.64-0.82, p<0.001). The mean time difference from the emergency call to hospitalization was 17 minutes longer for patients with severe mental illness (1 hour 21 minutes vs. 1 hour 4 minutes, p=0.002) Conclusion Patients with severe mental illness presented less frequent chest pain in ACS in emergency calls than patients without severe mental illness and had increased time to hospitalization. This calls for increased awareness of symptom presentation in patients with severe mental illness to improve the identification and management of ACS.

Childhood cumulative trauma, social support and stress as predictors of illness outcomes and quality of life in bipolar disorder.

Trauma, social support and stress have been identified as factors which may be associated with the bipolar disorder illness course. However, these are yet to be examined in prospective studies as predictors of illness outcomes and overall quality of life in bipolar disorder. One hundred and fourteen participants (N = 97; 85.1% female) living with bipolar disorder I (41.2%) or II (58.8%) completed a semi-structured interview and a range of self-report measures assessing trauma history, social support, perceived stress, depression, anxiety, mania, suicidality, number of mood episodes and quality of life, at baseline and 6-month follow-up. Childhood cumulative trauma, social support and perceived stress accounted for a substantial and significant portion of the variance in quality of life (62%; 23.6%), anxiety severity (34.6%; 24.5%) and depression severity (49.6%; 26.7%), at both baseline and 6-month follow-up. Perceived stress made significant unique contributions to the prediction of all outcomes, and social support made significant unique contributions to depression and quality of life in bipolar disorder. Stress and social support play an important role in bipolar disorder and in quality of life for people living with this condition. Given that stress and social support are modifiable risk factors, this provides a promising direction for future intervention-based research.

Medication-Induced Hepatitis caused by Antipsychotic Drugs as a Revelation of Wilson's disease

Wilson's disease is an autosomal recessive genetic disorder that results from a mutation in the gene for a heavy metal transporter. This leads to a decrease or absence of copper transport in the bile and its accumulation in organs, particularly the brain. Affected patients have hepatic, neurological or psychiatric forms, and the diagnosis is based on clinical, biological, radiological and presumptive phenotypic arguments, as well as on associated molecular anomalies. Wilson's disease can result in behavioral disorders, depression, and psychosis: schizophrenia or manic depression. The diagnosis can be made if there is a combination of low ceruloplasmin, high cupremia, high cupruria, and a Kayser-Fleisher ring. In case of hemolysis, the cupremia may be elevated. On MRI, signal abnormalities of the basal ganglia, white matter and trunk are indicative of Wilson's disease. Genetic study is performed in case of family history. We present a clinical case of drug-induced hepatitis under antipsychotic drugs in the context of schizophrenia which was revealing of wilson's disease. Although rare, the onset of Wilson's disease can take the form of a late-onset adult psychosis, and is important to address in psychiatry. Is this a comorbidity of schizophrenia and wilson's disease, or is the psychiatric picture merely a consequence of neurological involvement with the disease?

Use of botulinum toxin A for depression symptoms in patients with treatment-resistant bipolar illness: A case series.

Use of botulinum toxin A for depression symptoms in patients with treatment-resistant bipolar illness: A case series.

Prescribing Trends ofAntiseizure Drugs inWomen Veterans With Epilepsy.

Antiseizure medications (ASMs) are frequently used for other indications, such as migraine, pain syndromes, and psychiatric disorders. Possible teratogenic effects are therefore of wide concern and the risks imposed by the medications must be weighed against the risk with the disorder treated. It is our objective to update family practitioners on the implications of starting ASM for women with epilepsy during childbearing age. We hypothesized that clinicians would prescribe ASM based on avoiding teratogenesis and treating associated comorbidities simultaneously. The study cohort was derived from women veterans with epilepsy (WVWE) prescribed ASM who received Veterans Health Administration care for at least 3 years in Veterans Health Administration between fiscal years (FY)01 and FY19. Regimens were classified as monotherapy or polytherapy. Multivariant logistic regression examined the association between demographics, military characteristics, physical/psychiatric comorbidities, neurological care, and use of each ASM. Among 2,283 WVWE, in ages between 17 and 45, the majority (61%) received monotherapy in FY19. Commonly prescribed ASM included 29% gabapentin, 27% topiramate, 20% lamotrigine, 16% levetiracetam, and 8% valproate (VPA). Comorbid diagnosis of headache predicted use of topiramate and VPA, bipolar disease predicted use of LMT and VPA, pain predicted gabapentin, and schizophrenia was associated with VPAs use. Women receiving levetiracetam and lamotrigine were significantly more likely to receive neurology care previously. The presence of medical comorbidities influences the selection of ASM. VPAs use in WVWE during childbearing age continues, despite the high teratogenic risk, especially in women with bipolar disorder and headaches. Multidisciplinary care integrating family practice doctors, mental health, and neurology can prevent the enduring problem of teratogenesis in women taking ASM.

Childhood trauma and bipolar affective disorder: Is there a linkage?

Bipolar affective disorder (BPAD) is a major psychiatric illness impairing the quality of life. The etiology of BPAD is influenced by different factors possibly related to gene-environment interactions. Approximately 30% to 50% of individuals with BPAD have experienced some traumatic event in childhood. Serious adverse experiences that children may suffer early in life are often described as childhood trauma (CT). It includes physical, emotional, and sexual abuse and physical and emotional neglect. CT is linked with an elevated risk of developing BPAD. Childhood adversities play a role in modulating the early onset of illness, increased number of depressive episodes, increased suicide attempts, and other clinical severity of BPAD. Hospital-based studies comprising heterogeneous populations had researched the specific role of each trauma subtype as a predisposing factor for BPAD. Identifying and addressing CT through early intervention methods may prevent the future development of chronic disorders like BPAD. This review article is an attempt to explore and highlight the existing literature regarding the association of different subtypes of CT with BPAD.

What is associated with caregiver burden for adults with bipolar affective disorder: Illness severity or financial well being?

Background: Persons with bipolar affective disorder (BPAD) need long-term care and support. As most of the expenses for this are met personally by the caregivers, it will have financial implications for them. However, we do not know how much financial well-being is associated with the caregivers' burden as compared to the illness severity. Aim: This study aimed to examine the association between financial well-being and illness severity with the caregivers' burden in the context of BPAD. Materials and Methods: This study adopted a cross-sectional descriptive design. The first 50 consenting caregivers of persons with an International Classification of Diseases (ICD)-10 diagnosis of BPAD, who visited the National Institute of Mental Health and Neurosciences (NIMHANS) within 2019–2021, were included in the study. The patients were assessed on the Clinical Global Impression (CGI) and the Global Assessment of Functioning (GAF) for the severity of the symptoms and the current level of functioning, respectively. Caregivers were assessed on the Personal Finance Well-Being Scale. Results: In this study, the majority of caregivers were males (62%), with a median, monthly household income of Rs. 24,000, and expenditure of Rs. 12,000. The median cost of medicine was Rs. 1000 per month. The majority (64%) of patients did not have any health insurance. A total of 28 (56%) caregivers reported the cost of damage due to illness behavior. It was found that the severity of illness and current level of functioning had a significant negative correlation with caregivers' burden. The financial well-being as reflected through income and health expenditure did not have a significant correlation with the caregivers' burden. Conclusions: Caregivers of persons with BPAD meet the treatment expenditure out of their pocket. Though they have the financial burden, it is the illness severity and functioning capacities that are associated with caregivers' burden. These findings have implications for mental health care in persons with BPAD.

Forensic mental health intellectual and developmental disability service: an analysis of referral patterns and comparison with community mental health intellectual disability (MHID) services in Ireland

PurposeThe purpose of this study is to analyse the characteristics of all the referrals to the forensic MHIDD service over the past five years and to compare these characteristics to the cohort of service users attending the three general MHID services based in Dublin which are Service 1, Service 2 and Service 3.Design/methodology/approachThis is a cross-sectional study of adults attending the three generic MHID services and the national forensic MHIDD service. The medical files of service users attending the MHID services were reviewed, and data such as age, gender, level of intellectual disability and psychiatric diagnoses were extracted and compiled into a database. The forensic MHIDD service has since its inception maintained a database of all referrals received and reviewed. The characteristics data needed were extracted from the forensic MHIDD database. All these data were then analysed using the Statistical Package for Social Sciences (SPSS).FindingsThe majority of the three MHID service users were in the moderate to profound range of intellectual disability, while the majority of the cases assessed by forensic MHIDD had normal IQ, borderline IQ and mild intellectual disability with 66.1%. The prevalence of neurodevelopmental disorder, schizophrenia and emotionally unstable personality disorder in the forensic MHIDD is comparable to the three MHID services. The prevalence of depression, bipolar affective disorder (BPAD), anxiety disorder and obsessive-compulsive disorder (OCD) is higher in the three MHID services than in the forensic MHIDD service.Originality/valueThe FHMIDD received referrals at a greater level of overall ability, with two-thirds of the service users having mild intellectual disability to normal IQ. The prevalence of neurodevelopmental disorder such as ASD and schizophrenia is comparable between the forensic MHIDD and the three MHID services. There is a higher prevalence of depression, BPAD, anxiety disorder and OCD in the three MHID services as compared to the forensic MHIDD service.

Reshaping the diagnostic borders: Historical analysis of the diagnostic changes following the introduction of the schizophrenia concept

BackgroundAlthough the concept of schizophrenia is still widely presented as having replaced that of dementia praecox, studies have shown that the former was broader than the latter, resulting in a more complex diagnostic redistribution. However, this is poorly documented by quantitative approaches. AimsWe sought to test the hypothesis that the use of the concept of schizophrenia had caused a diagnostic redistribution and to quantify it. MethodA retrospective study, based on admission register archives of the Strasbourg University Clinic of Psychiatry was conducted. The frequency of diagnoses given to patients were examined at two key time periods: one before (TP1) and one after (TP2) the introduction of the schizophrenia concept (established between 1926 and 1928). Eight main diagnoses related to schizophrenia were considered. ResultsPatients diagnosed with schizophrenia at TP2 mainly received the diagnoses of dementia praecox but also depression, hebephrenia, manic depressive illness, hysteria, paraphrenia, catatonia and mania at TP1. Dementia praecox and hebephrenia were the most relayed by schizophrenia. Bayesian sensitivity analyses confirmed the robustness of our data against distinct scenarios challenging our hypothesis. ConclusionsOur results confirm the broadening of the concept of schizophrenia compared to that of dementia praecox but also qualify the different concepts supposed to have been impacted. They provide unique quantitative data that define the contours of the diagnostic redistribution thus provoked. They also give relevant input in the current context where the need to rethink the DSM/ICD concept of schizophrenia is still debated.

(141) Acute Mania: A Rare Adverse Effect in a Patient Undergoing Ifosfamide-Based Chemotherapy

(141) Acute Mania: A Rare Adverse Effect in a Patient Undergoing Ifosfamide-Based Chemotherapy

Sex-Based Differences and Risk Factors for Comorbid Nonalcoholic Fatty Liver Disease in Patients with Bipolar Disorder: A Cross-Sectional Retrospective Study.

Sex-based differences in patients with bipolar disorders (BD) are well recognized, and it is well known that the prevalence and severity of nonalcoholic fatty liver disease (NAFLD) are both higher in men than in women. Although metabolic disorders such as NAFLD are common in patients with BD, sex differences and risk factors for NAFLD comorbidity in these patients have not been thoroughly explored. This study aimed to investigate sex differences in patients with comorbid NAFLD and BD and associated risk factors. This retrospective cross-sectional study included 710 patients with BD. Clinical data of patients with BD, including information on fasting glucose, liver function-related enzymes, relevant lipid data, uric acid, the triglyceride-glucose index (TyG), and demographics, were derived from the hospital electronic medical record system from June 2020 to July 2022. We performed logistic regression analysis and calculated the odds ratios with 95% confidence intervals of factors using t-tests, χ²-tests, and receiver operating characteristic. NAFLD was diagnosed using liver ultrasonography. The prevalence of NAFLD was higher in male patients with BD than in female patients (50.9% vs 38.5%), and there were significant differences in the years of education and marital status (all P<0.05). Regression analysis showed that the risk factors for comorbidities were the body mass index (BMI), fasting glucose, and apolipoprotein B levels in male patients and the BMI, bipolar disease course, glutamine transpeptidase levels, and the TyG in female patients. Sex-based differences exist in risk factors and in the prevalence of comorbid NAFLD among patients with BD. BMI is a sex-independent risk factor, and clinical attention should be targeted to risk factors associated with comorbid NAFLD related to sex, especially in female patients with BD who presenting a high TyG index.

Epidemiological profile of involuntary admission in the Psychiatry Service of the University Hospital of Gran Canaria Doctor Negrín

IntroductionInvoluntary admissions due to mental disorders occur with relative regularity in hospital admission units in our country. This work will study the socio-demographic and clinical characteristics found in relation to these type of patients, in order to have more information, both clinical and legal, with which to work and perform a better function, administration of resources, and development of necessary skills in these situations. Material and methodsRetrospective descriptive observational study, in which different variables will be analyzed, previously selected, present in the population of psychiatric patients involuntarily admitted to the Doctor Negrín Hospital in a period of 2 years, 2019 and 2020, thus determining, the degree of prevalence of each of them. ResultsAmong the variables most associated with involuntary admission are, being a man, in the fourth decade of life, single, without children, or employment, with a diagnosis of major psychotic or affective disorder who has most likely abandoned treatment. DiscussionIt would be advisable to carry out a special follow-up of patients who meet the profile described above in order to minimize involuntary occurrence. It is necessary to develop educational, follow-up, and adherence programs within the reach of the population of psychiatric patients in order to minimize the need for involuntary admissions in our environment.

Tobacco smoking related to childhood trauma mediated by cognitive control and impulsiveness in severe mental disorders.

People with severe mental disorders (SMDs) show an increased prevalence of tobacco smoking compared to the general population. Tobacco smoking and other adult adverse health behaviors have been associated with traumatic experiences in childhood. In the present study we investigated the relationship between childhood trauma and tobacco smoking in people with SMDs, including the possible mediating role of cognitive- and personality characteristics, i.e. cognitive control, impulsiveness, affective lability and self-esteem. Enrolled in the study were 871 participants with schizophrenia (SCZ, N=484) and bipolar (BD, N=387) spectrum disorders. We assessed tobacco smoking behavior (yes/no and amount), and history of childhood trauma with the Childhood Trauma Questionnaire. Data on cognitive control, impulsiveness, affective lability, and self-esteem were available in subsamples. We performed linear and logistic regressions, and conducted mediation analyses in PROCESS. All analyses were as standard adjusted for age, sex, and diagnostic group. Experience of one or more subtypes of childhood trauma was significantly associated with smoking tobacco in SMDs (p=0.002). There were no significant associations between childhood trauma and amount of tobacco smoking. Cognitive control and impulsiveness were significant mediators between childhood trauma and tobacco smoking. These findings indicate the experience of childhood trauma as a predisposing factor for tobacco smoking in SMDs. Cognitive control and impulsiveness were suggested as mediating mechanisms, indicating the importance of considering inhibition related self-regulatory aspects in efforts to improve health behavior in individuals with SMDs and childhood trauma.

(149) Use of Intravenous Valproic Acid Loading in the Emergency Department for Acute Mania: Case Report and Literature Review

(149) Use of Intravenous Valproic Acid Loading in the Emergency Department for Acute Mania: Case Report and Literature Review

Studi Kasus: Pengaruh Cognitive Behavior Therapy (CBT) pada Klien dengan Diagnosa Gangguan Afektif Bipolar

This study aims to explore how the cognitive behavioural therapy affected a client with bipolar affective disorder. Participant was a 25-years-old woman (SM) who is diagnosed with bipolar disorder specify current or most recent episode: manic, depressed (F31.6). Before beginning the therapy session, the participant completed a series of assessment, including interview (autoanamnesa and alloanamnesa), observation, graphic tests (BAUM, DAP, HTP Wartegg) and Sack’s Sentence Completion Test (SSCT) to evaluate the participant’s personality, and Standard Progressive Matrices (SPM) to assess cognitive ability. Therapy was conducted in 5 sessions (1 session each week) with additional daily task to track the thoughts and behaviors pattern. The result shows a decrease in depression scores (BDI-II) and also SUDS (Subjective Unit Disturbance Scale). Qualitatively, CBT helps the participant to select her own automatic negative thoughts and form more adaptive thinking pattern by her own. Participant also shows an increasing score in GAF (Global Assesment Functioning) after completing the whole therapy sessions

Evolutionary aspects of bipolar affective illness.

Bipolar affective illness (bipolar disorder - BD), also known as manic-depressive illness, is characterized by periodic opposite states of mood, activity, and motivation (mania and depression) sometimes of extreme intensity. The development and maintenance of such states in evolution can betoken a possibility of their adaptive character, enabling adaptation to an unfavorable external situation (depression) and a mobilization to using resources when available (mania). In the article, the main focus is put on the evolutionary aspect of "bipolarity" and manic/hypomanic states. Molecular-genetic studies show that in evolution, the genes connected with a predisposition to BD have been conserved. In the paper, the evolutionary adaptive concepts connected with the functioning of Homo sapiens during the middle and late Pleistocene periods were discussed as well as the "mismatch" theories associated with not befitting brain functioning to contemporary conditions. The benefits of mania and hypomania, also in the context of their link to depression were delineated, indicating their relationship to the increase in reproductive success. They result from such features of mania/hypomania as increased exploratory, psychomotor and sexual activity, and prompt risk-taking. The reproductive success can be connected with hyperthymic and cyclothymic temperaments, most frequently occurring in subjects with BD. The hyperthymic temperament often leads to increased social status and a tendency to leadership, and the cyclothymic temperament can increase creativity. Examples of the relationship between manic/hypomanic states and the phenomenon of emigration as well as the advancement of American society are provided.

BD research hub to offer new treatments, clinical options

A national research grant totaling more than $6 million to fund this country's first bipolar disorder (BD) patient and research hub will address the limited treatment options for some of the millions of Americans living with the condition and will make it easier for patients to find new treatments and clinical trials, research officials said.

Opportunities to engage in positive activities during the COVID-19 pandemic: Perspectives of individuals with mood disorders

BackgroundDespite cross-sectional population and clinical studies finding individuals with existing mood disorders being adversely impacted by the COVID-19 pandemic, longitudinal studies have not shown a worsening of psychiatric symptoms. In response to these findings, we explored opportunities to engage in positive activities during the pandemic from the perspectives of individuals with mood disorders. MethodsA bespoke survey, containing closed and open questions, was sent to participants with mood disorders who were part of the UK Bipolar Disorder Research Network (BDRN). Questions related to experiences of positive impacts of the pandemic, levels of engagement in positive activities and coping strategies. ResultsResponse rate was 46.4 % (N = 1688). 61.9 % reported positive life changes during the pandemic, with slower pace of life reported most frequently (52.8 %). 47.3 % reported no adverse impact of the pandemic on implementing their usual coping strategies. Activities that respondents most commonly reported the same or greater level of engagement in compared to before the pandemic were avoiding known mood triggers (82.3 %), relaxation techniques (78.8 %) and the ability to maintain set routines (69.4 %). LimitationsResponder bias may be present and experiences during the pandemic are likely to differ among other clinical and research mood disorders cohorts. ConclusionsOur findings may help to explain why longitudinal studies have not found a worsening of mental health symptoms during the COVID-19 pandemic. Identifying potential facilitators to maintaining mental health have wider applicability, and may help to inform future evidence-based psychoeducation and self-management programmes for mood disorders.