Bipolar Depressive Episodes Research Articles

Clinical Practice Guidelines for Management of Suicidal Behaviour.

Clinical Practice Guidelines for Management of Suicidal Behaviour.

Optimization of the Mood Disorder Questionnaire in identification of perinatal bipolar disorder

BACKGROUNDThe recognition of bipolar disorder during the perinatal period is often challenging because birthing people most commonly present in a depressive episode. The phenotypic expression of episodes of bipolar depression is difficult to differentiate from major depressive disorder and can lead to misdiagnosis and inappropriate treatment. The Mood Disorder Questionnaire is a readily available screening tool for bipolar disorder that has been validated in previous studies for use in the general and perinatal populations. However, the discriminatory capacity of the Mood Disorder Questionnaire for perinatal people who screen positive for depression in nonpsychiatric settings is still unclear. OBJECTIVEThis study aimed to evaluate the discriminatory capacity of the Mood Disorder Questionnaire to identify bipolar disorder in perinatal people who screen positive for depression on the Patient Health Questionnaire-9. STUDY DESIGNThis retrospective cohort study included individuals enrolled in the Collaborative Care Model for Perinatal Depression Support Services, a collaborative care program for perinatal mental health services implemented in a quaternary care setting, from January 2017 to April 2021. All individuals completed the Mood Disorder Questionnaire and psychiatric evaluation by a licensed clinical social worker. Clinical and sociodemographic characteristics were compared between those with and without a clinical diagnosis of bipolar disorder using bivariable analyses. The discriminatory capacity and test characteristics of the Mood Disorder Questionnaire were assessed at each score cutoff using the gold standard of a psychiatric clinical evaluation for comparison. RESULTSFrom January 2017 to April 2021, 1510 birthing people were enrolled in the Collaborative Care Model for Perinatal Depression Support Services and included in this study. Among this group, 62 (4.1%) were diagnosed with bipolar disorder by psychiatric clinical evaluation using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria. A score of ≥7 on question 1 is often used in the general population to identify bipolar disorder, which has a 60% sensitivity and 88% specificity in our perinatal sample with an area under the receiver operating characteristic curve of 0.74 (95% confidence interval, 0.72–0.76). Lowering the threshold to ≥4 improves sensitivity to 81% and the discriminatory capacity to an area under the receiver operating characteristic curve of 0.75 (95% confidence interval, 0.70–0.80), at the expense of a reduction in specificity to 69%. CONCLUSIONThe administration of the Mood Disorder Questionnaire in the perinatal period can help to identify which individuals who have screened positive for depression on the Patient Health Questionnaire-9 are at risk of a bipolar or unipolar disorder. In this context, lowering the Mood Disorder Questionnaire score threshold from that used in the nonperinatal population down to 4 improves test characteristics and reduces the risk of a missed diagnosis of bipolar disorder.

Executive dysfunction in affective disorders: differences in bipolar affective disorder and depressive episode

Aim. To identify the differences in executive function (inhibitory control, working memory, cognitive flexibility) between patients with bipolar affective disorder and depressive episode.Materials and methods. A total of 72 patients with affective disorders aged 20–40 years were examined. Of them, 30 patients had bipolar affective disorder, a current episode of mild or moderate depression, and 42 patients had a mild, moderate, and severe depressive episode without symptoms of psychosis. The executive function was evaluated using PsyToolkit, a set of software tools for programming psychological experiments. Computerized Go/ No–go tasks (assessment of inhibitory control and psychomotor functions), the Corsi block-tapping test (assessment of visual and spatial working memory capacities), and the Stroop Color and Word Test (assessment of cognitive flexibility) were used.Results. An intergroup comparison of patients revealed that patients with bipolar disorder significantly more often demonstrated false button press in the Go/No–go task (p = 0.043); however, they exhibited a greater working memory capacity in the Corsi block-tapping test (p = 0.049) compared with patients with a depressive episode.Conclusion. Important data were obtained regarding the specifics of executive dysfunction depending on the type of affective disorder. The presented data expand and supplement available information about the cognitive characteristics of patients with bipolar affective disorder and depressive episode, which may be useful in clinical practice and serve a focus of future research.

Seasonal Effects on Hospitalizations Due to Mood and Psychotic Disorders: A Nationwide 31-Year Register Study.

PurposeTo examine seasonal patterns of hospital admissions due to mood and psychotic disorders and to investigate whether the admission rates show variation according to the seasonal daylength (photoperiods).Patients and MethodsA retrospective nationwide register-based cohort of all psychiatric admissions (N=978,079) during 1987–2017 in Finland was utilized. The smoothed time-series of adjusted ratio of observed and expected (O/E) daily counts were estimated to examine seasonal variation. The mean O/E with 95% confidence intervals (CI) was used to study the admission rates by photoperiods. The calendar days were classified into the 71-day photoperiods based on the daylength (long/summer, short/winter, equal/spring, equal/fall) and the pace of change in daylength (slowly/rapidly increasing/decreasing daylength).ResultsManic episodes peaked in summer during the long (mean O/E=1.10, 95% CI=1.06–1.13) and slowly decreasing (1.09, 1.06–1.13) photoperiods and had a nadir in winter during the slowly increasing (0.93, 0.89–0.98) photoperiod. Admissions for unipolar depressive (UPD) episodes peaked in autumn and in spring at the end of the rapidly decreasing (1.03, 1.02–1.04) and increasing (1.03, 1.01–1.04) photoperiod, and dropped in summer during the long and slowly decreasing (0.95, 0.94–0.96) photoperiods. Bipolar depressive (BPD) and mixed episodes signaled excess admissions in autumn and in spring. Admissions for schizophrenia were higher than expected from summer to early-autumn, during the long and slowly decreasing photoperiods (1.02, 1.02–1.03), and lower than expected in other seasons, especially in mid-spring during the rapidly increasing photoperiod (0.98, 0.98–0.99).ConclusionThe study indicates the seasonality and photoperiodicity of mental disorders, especially for manic episodes. The seasonal pattern is similar between schizophrenia and manic episodes, and between UPD, BPD, and mixed episodes.

Efficacy and safety of daily home-based transcranial direct current stimulation as adjunct treatment for bipolar depressive episodes: Double-blind sham-controlled randomized clinical trial.

BackgroundAlthough transcranial direct current stimulation (tDCS) is known to be a promising therapeutic modality for unipolar depression, the efficacy and safety of tDCS for bipolar depressive episodes (BD) are still unknown and clinical trials of home-based tDCS treatment are scarce. As a result, we set out to investigate the efficacy and safety of home-based tDCS for the treatment BD.MethodsParticipants (n = 64), diagnosed as bipolar disorder as per the diagnostic and statistical manual of mental disorders (DSM-5), were randomly assigned to receive tDCS. Hamilton Depression Rating Scale (HDRS-17) scores were measured at the baseline, week 2, 4, and 6, and home-based tDCS (for 30 min with 2 mA) was self-administered daily.ResultsOf the 64 patients (15.6% bipolar disorder I, 84.4% bipolar disorder II), 41 patients completed the entire assessment. In the intention-to-treat analysis, time-group interaction for the HDRS-17 [F(3, 146.36) = 2.060; p = 0.108] and adverse effect differences between two groups were not statistically significant, except the pain score, which was higher in the active group than the sham group (week 0–2: p < 0.01, week 2–4: p < 0.05, and week 4–6: p < 0.01).ConclusionEven though we found no evidence for the efficacy of home-based tDCS for patients with BD, this tool was found to be a safe and tolerable treatment modality for BD.Clinical trial registration[https://clinicaltrials.gov/show/NCT03974815], identifier [NCT03974815].

The Efficacy and Safety of Transcranial Magnetic Stimulation in Treatment-Resistant Bipolar Depression.

The aim of the current study is to investigate the efficacy and safety of Transcranial magnetic stimulation (TMS) treatment, a non-invasive brain stimulation technique, on depressive symptoms in treatment-resistant bipolar depression (TRBD). The study included 29 patients between the ages of 18-65, with bipolar disorder depressive episode according to DSM-5 and with the decision of non-response to treatment according to the Canadian Mood and Anxiety Treatment Network (CANMAT). Patients were divided into two groups double-blind-randomly, 20 sessions of TMS and 20 sessions of sham TMS were applied crossover. Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory (BDI), Young Mania Rating Scale (YMRS) and TMS Side Effect Questionnaire were applied to the patients before the treatment, at the 2nd week which is the crossover phase, and at the end of the treatment at 4th week. In both groups, the severity of depression was decreased significantly according to HAM-D and BDI scores after the procedure. As well as active stimulation, some positive placebo effects were observed with sham stimulation. But the decreases seen in HAM-D and BDI scores and response to the treatment were higher during the weeks when the groups received active stimulation (respectively p=0.000, p=0.001, p=0.005). At the end of the study, according to HAM-D, 55.7% of the patients showed response to the treatment, 24.13% partial response. According to BDI, 41.37% of the patients showed response to the treatment, and 31.03% partial response. No associations were found between TMS response and sociodemographic - clinical features, or type of the disease (p>0.05). During the study, no serious adverse effects such as seizures or manic / hypomanic switches were observed. The results of our study showed that TMS treatment is an effective and safe treatment for patients with treatment-resistant bipolar depression.

Effectiviness and safety of antidepresants in bipolar depression

IntroductionDepressive episodes are associated with higher morbidity, mortality (mostly suicidality. Despite the high prevalence and the devastating impact of this condition, there is a long‐standing debate about its treatment, particularly about the use of antidepressants. International guidelines and expert consensus recommend to avoid AD for bipolar depression, or to use AD with caution and as second line treatment only if the depressive episode shows poor response to mood stabilizers (MS) and to some second generation antipsychotics (SGA) (cariprazine, lurasidone, quetiapine and olanzapine combined with fluoxetine) in monotherapy and in combination. Contrary to the advice of guidelines and experts, 50%–80% of acute bipolar depressive episodes are treated with AD in everyday clinical practice.ObjectivesTo evaluate the effectiveness and the safety of AD acute treatment in patients with bipolar depressionMethodsLiterature review (PubMed)ResultsShort‐term safety, switching and suicidality did not differ significantly, and no suicide attempt was observed. Concerning long‐term safety, patients with bipolar depression had a significant reduction of depressive and total recurrences during the first year.ConclusionsAcute AD treatment of bipolar depression is effective in the short term and safe in the short‐ and long‐termDisclosureNo significant relationships.

Role of MAOI drugs as triggers of manic episodes in bipolar disorders: A case report and a narrative review

IntroductionUse of Monoamine Oxidase Inhibitors (MAOIs) has experimented an important reduction in recent years, being replaced by other antidepressant drugs (ADs) associated with a better safety profile. Its use has been restricted to instructed professionals treating resistant and atypical depression. Thus, treatment-emergent affective switch (TEAS) induced by MAOIs is a rare event nowadays.ObjectivesTo describe a manic episode associated to a one-year-long treatment with phenelzine, a MAOI agent.MethodsWe present the case of a 47-year-old man hospitalized in our acute psychiatric unit after presenting compatible clinical symptoms with a manic episode. He showed severe irritability, decreased need for sleep, pressured speech, increased energy and goal-directed activities. The patient had started phenelzine a year ago for the treatment of major depressive episode resistant to previous pharmacological essayed treatments. No previous history of TEAS was reported, although he had already taken other ADs and mood-stabilizer treatments in the past.ResultsSeveral studies reported the effectiveness of MAOIs for the treatment of monopolar depressive episodes resistant to other ADs, especially when atypical symptoms were observed. Data on the use of MAOIs for the treatment of drug-resistant bipolar depressive episodes is scarce. Few studies have described a good response without showing and increased risk of TEAS.ConclusionsAs MAOIs have fallen out of favour with modern psychiatry, there is scarce evidence on the prevalence of TEAS in patients undergoing treatment with these drugs. Further research is needed in order to accurately define these complex relationships.DisclosureNo significant relationships.

UNIPOLAR DEPRESSION TO BIPOLAR DISORDER CONVERSION

Bipolar disorder cases have increased compared to a decade ago. It is thought that this increase is the result of a high number of bipolar patients who were not recognized early on because bipolar and unipolar depression is difficult to distinguish from one another. In addition, this problem also gave rise to the hypothesis that unipolar depression could develop into bipolar disorder. Therefore, the diagnosis conversion of unipolar depresion into bipolar disorder and its predictor needs to be studied further. Literature review by using several literatures between 2011-2021 that discuss about unipolar depresion, bipolar disorder, diagnosis conversion, and factors that influence the conversion of unipolar depression diagnosis into bipolar disorder. Diagnosis of unipolar depression can turn into bipolar disorder. This may be due to failure to differentiate unipolar and bipolar depressive episodes, strict diagnostic criteria, failure to recognize history of hypomania/mania, or due to the genuine progression of the disorders. This problem leads to the provision of inappropriate therapy for patients that trigger disease progression and worsen the prognosis. One of the anticipations that can be done is to explore the presence of conversion predictor factor. It includes the age of onset &lt;25 years, bipolar family history, patient’s course of depression (high recurrence, short duration, moderate to severe depression, hypersomnia, psychomotor retardation, psychosis symptoms, postpartum depression), resistance to antidepressants, antidepressant-induced hypomania/mania, and the presence of subthreshold mania. If these factors are found, the patient should be closely monitored and therapy adjustment may be required. Keywords: bipolar disorder, conversion, predictor, unipolar depression.

Suicidal ideation and ECT, ECT and suicidal ideation: A register study.

ObjectiveAlthough electroconvulsive therapy (ECT) is anti‐suicidal, it is not known whether the presence of suicidal ideation (SI) at baseline predicts response and remission after ECT. The aim of the study was to analyze the impact of baseline SI on response and remission following ECT treatment in a large sample of patients with depression and to assess SI before and after ECT.MethodsThis population‐based register study used data from the Swedish National Quality Register for ECT and the Swedish Patient Register. Patients aged 18 years or older who had received ECT for a unipolar or bipolar depressive episode between 2011 and 2018 were included in the study. SI was defined as a score of ≥4 on the last item of the Montgomery–Åsberg Depression Rating Scale – Self Assessment (MADRS‐S). Using a logistic regression model, SI at baseline was used to predict response and remission following ECT, while controlling for depression severity, psychotic symptoms, presence of a comorbid personality disorder, age, sex, electrode position, unipolar or bipolar disorder, and number of previous suicide attempts at baseline.ResultsIn patients who exhibited SI at baseline, 53.7% (N = 632) of cases showed a response to ECT, whereas 68.4% (N = 690) of patients without SI showed a response. In addition, 27.2% (N = 320) of cases with SI achieved remission, whereas 48.5% (N = 489) of cases without SI achieved remission. The odds of achieving response and remission for patients with SI were 0.75 and 0.58 times, respectively, those for patients without SI. Of the 1178 patients with pre‐treatment SI, 75.64% (N = 891) exhibited no SI at the end of treatment. Moreover, in this subgroup, the presence of a personality disorder, higher MADRS‐S‐score, and younger age were associated with persistent SI.ConclusionThe presence of SI was associated with lower ECT response and remission rates. Nevertheless, depressive symptoms and SI were reduced in a large proportion of patients across both patient groups. Clinicians should be aware of the lower likelihood of achieving a successful outcome following ECT in younger patients who present with a non‐psychotic depressive episode, SI, and (suspected) personality disorders. More research is warranted regarding if these patients can achieve similar or better results with other treatments.

Modafinil in the treatment of selected mental disorders

Modafinil belongs to a class of wakefulness promoting agents. It is widely used in the treatment of sleep disorders. Although narcolepsy is the main indication for its use, hypersomnia from obstructive sleep apnoea and shift work sleep disorder are also indications in some countries. Due to its efficacy in the treatment of hypersomnia, the drug has also been clinically assessed in patients with mental disorders to reduce the severity of symptoms such as fatigue, hypersomnolence and cognitive impairment. The aim of this paper is to present the potential clinical applications of modafinil in the treatment of selected mental disorders. The use of modafinil in depressive disorders to enhance the treatment applied may improve mood, anhedonia and apathy, fatigue, hypersomnolence and executive cognitive impairment. In severe episodes of bipolar depression, modafinil may improve depressive symptoms, fatigue, and hypersomnia. Despite the potential risk of manic symptoms during modafinil treatment, recent studies show no increased risk of switching from depressive to manic phase. In schizophrenia, there is no evidence for the beneficial effect of modafinil on the negative symptoms, but improvement in selected cognitive functions accompanied by exacerbation of psychotic symptoms was observed in some patients. Furthermore, modafinil is used as an alternative to standard therapy in attention-deficit/hyperactivity disorder. Despite lacking evidence for the efficacy of modafinil in cocaine addiction, an analysis of selected studies indicates a potential benefit in the form of maintained abstinence. Modafinil is well tolerated and safe in most cases. The risk of dependence is lower than with other psychostimulants.

Ketamine and other glutamate receptor modulators for depression in adults with bipolar disorder.

Ketamine and other glutamate receptor modulators for depression in adults with bipolar disorder.

DEPRESSION’S WAY OF EXPRESSION IN THE CASE OF A PARANOID-SCHIZOTYPAL PERSONALITY STRUCTURE

Motivation: A psychiatric patient should be looked at in the longitudinal dynamics of their life because it is possible that during youth, mental suffering has a certain tone to it, which is later erased, transformed or moved, through a greater or lesser contact with the ideas or the affect. Objective: We want to present the life history and dynamics of a subject whose first episode of mental illness of a depressive nature was around the age of 20, and to emphasize how over the years, this nature has faded. Currently, there is an absence of connection between the symptoms and the possible causalities. Material and methods: psychiatric and psychoanalytic interviews in dynamics, analysis of the life map, interpretations, the symptom’s evolution under medication, social support, identification of positive and negative prognostic factors, differential diagnoses, performing the diagnostic tree. Results: The patient presented a first depressive episode in youth with a trigger related to an important emotional relationship; the episode overlapping with childhood difficulties (a father with a penal past, absence of parental Superego, attempts to build a shield through divinity). There follows a period of well-being, over which, about ten years ago, a hypochondriac pathology occurs, which associates the significant change of in a bizarre psychotic sense, with homelessness, delusional interpretation and completed with suicide attempt, so that the last episode is predominantly psychotic, but with a mystical and guilt theme and sin, with important changes, which also highlights the paranoid personality background of the person in question. Conclusion: The personality structure along with social functioning are important milestones of clinical evolution, beyond the main diagnosis of axis I, which in this case remained of recurrent depressive disorder, major depressive episode with psychotic phenomena, with the first two differential diagnoses: Bipolar disorder or schizophrenia depressive episode

Repetitive transcranial magnetic stimulation (rTMS) in bipolar disorder: A systematic review.

Repetitive transcranial magnetic stimulation (rTMS) is commonly used in unipolar depression; yet, its evidence in bipolar disorder (BD) is limited. We sought to review the evidence on the use of rTMS across the different stages of BD. MEDLINE database was systematically searched using the PubMed interface following the PRISMA guidelines. Inclusion criteria were as follows: (i) randomized clinical trials (RCTs), open-label studies, and case series; (ii) specific evaluation of the treatment outcomes using psychometric scales; (iii) clinical studies in adults; and (iv) articles in the English language. The systematic review has been registered on PROSPERO (CRD42020192788). Thirty-one papers were included in the review. Most studies included participants diagnosed with a bipolar depressive episode (N=24), have yielded mixed findings, and have yet to reach a consensus on the most effective rTMS protocol. Few studies examined the effect of rTMS during manic (N=5) or mixed episode (N=1), or as maintenance treatment (N=1). The limited data thus far suggest rTMS to be relatively safe and well tolerated. Small sample sizes, heterogeneity among study designs, patients and control groups recruited, rTMS parameters, and outcome measures are among the most significant limitations to these studies. The current data regarding the application of rTMS in BD patients remain limited. More adequately powered sham-controlled studies are required to verify its efficacy. Large-scale clinical trials are needed to also determine whether its effects extend to manic and mixed episodes, as well as its role in mood stabilization and amelioration of suicidal behavior.

Neutrophil-to-Lymphocyte Ratio, a Novel Inflammatory Marker, as a Predictor of Bipolar Type in Depressed Patients: A Quest for Biological Markers.

(1) Background: Recent research suggests inflammation as a factor involved in the pathophysiology of mood disorders. Neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte (PLR), and systemic immune-inflammatory (SII) index ratios have been studied as peripheral markers of inflammation in bipolar and major depressive disorders. The purpose of this study is to comparatively analyze these inflammatory ratios among manic episodes of bipolar disorder, bipolar depression and unipolar depression. (2) Methods: 182 patients were retrospectively included in the study and divided into three groups: 65 manic patients, 34 patients with bipolar depression, and 83 unipolar depressive patients. White blood cells, neutrophils, monocytes, lymphocytes, and platelets were retrieved from the patients’ database. NLR, MLR, PLR, and SII index were calculated using these parameters. (3) Results: Patients with manic episodes had elevated NLR (p < 0.001), MLR (p < 0.01), PLR (p < 0.05), and SII index (p < 0.001) compared to unipolar depression and increased NLR (p < 0.05) and SII index (p < 0.05) when compared to bipolar depression. NLR (p < 0.01) and SII index (p < 0.05) were higher in the bipolar depression than unipolar depression. NLR is an independent predictor of the bipolar type of depression in depressive patients. (4) Conclusions: The results confirm the role of inflammation in the pathophysiology of mood disorders and suggest the ability of NLR as a marker for the differentiation of bipolar from unipolar depression.

Experiencia clínica de la terapia electroconvulsiva con anestesia y relajación en la Clínica Universidad de La Sabana: 2009-2017

IntroductionElectroconvulsive therapy is an effective and safe procedure, which is indicated mainly in patients with both unipolar and bipolar depressive episodes, mania and schizophrenia, when they do not respond to other treatments. ObjectiveTo describe the demographic, social and clinical properties of a group of patients treated with electroconvulsive therapy (ECT) with anaesthetic and muscular relaxant at the Universidad de La Sabana Clinic for a period of 8 years. MethodsThe databases and records of the procedures were reviewed from 1 January 2009 to 31 December 2017. An analysis was performed with descriptive statistics. ResultsIn this period, 1,322 procedures were performed on 143 patients (54.5% women) with an associated diagnosis of major depression in 57%. The number of treatments per person was 9.2 and complications occurred in 3.8%, without any of them requiring invasive management. ConclusionsElectroconvulsive therapy is performed safely in patients and with different parameters in terms of age, gender and diagnosis, in comparison to other countries in Latin America and the world. It is important to join efforts in research that allow a more complete overview of the characteristics of its application in the country.

Bipolar disorder, pregnancy, COVID-19: Electroconvulsive therapy is needed!

IntroductionTreating pregnant women with bipolar disorder is among the most challenging clinical endeavors. Patients and clinicians are faced with difficult choices at every turn, and no approach is without risk. Many primary mood stabilizers have been associated with risk of congenital malformations. In the last 15 years, there has been an increase of antepartum use of atypical antipsychotic drugs, many of which could be viable alternatives to mood stabilizers. Electroconvulsive therapy has been recommended as a safe and efficacious treatment of bipolar depressive and manic episodes in pregnant women.ObjectivesThis case presents a 24-year-old woman, with COVID-19 infection, that underwent an acute manic episode at her 20-weeks-pregnancy. The goal was to stabilize the patient by the use of electroconvulsive therapy.MethodsThe patient was admitted in isolation in the psychiatric ward. Treatment was started with olanzapine 20mg/d and lorazepam 4mg/d. The patient maintained psychotic agitation that required higher dosage, while on the second week of isolation the PCR test was negative. After six weeks of treatment severe manic symptoms continued and electroconvulsive therapy was started.ResultsShe received 10 electroconvulsive therapy sessions. The patient showed a substantial clinical improvement after the seventh administration. She gave birth at 37 weeks, with no complications during labor (Apgar 9/10).ConclusionsElectroconvulsive therapy has been shown as a suitable option for patients with severe psychiatric disorders in the pregnancy period, either medication resistant illness and psychotic agitation.DisclosureNo significant relationships.

Quetiapine for Bipolar Depressive Episode in Obsessive-Compulsive Disorder Patients Maintained on Selective Serotonin Reuptake Inhibitor Treatment.

A meaningful proportion of patients with obsessive-compulsive disorder (OCD) develop symptoms of bipolar depression (BP-D). In the present investigation, we aimed to determine whether quetiapine is efficacious in OCD patients who despite continuous treatment with a selective serotonin reuptake inhibitor developed an acute episode of BP-D. We analyzed 68 charts of Diagnostic and Statistical Manual of Mental Disorders Fifth Edition OCD patients from our outpatient clinic and identified 15 patients who in addition met Diagnostic and Statistical Manual of Mental Disorders Fifth Edition criteria for bipolar II disorder, depressive episode. Eleven (7 men and 4 women, aged 24-54 years) patients for whom quetiapine was added to treat the index episode of BP-D were included. Treatment response was assessed retrospectively and defined as a score of "much improved" or "very much improved" on the Clinical Global Impression-Improvement scale. Quetiapine was added for treatment of BP-D in a dose range of 150 to 400 mg (mean, 273 mg). Eight (73%) of the 11 study patients fulfilled the criterion of response, that is a score of "much improve" (4 patients) and "very much improved" (4 patients) on the Clinical Global Impression-Improvement scale. Notably, quetiapine was associated with additional improvement of OCD symptoms in 6 of 8 study responders. Quetiapine was well tolerated. The most frequently detected side effects were drowsiness (5 patients), constipation (4 patients), and orthostatic hypotension (2 patients). The revealed beneficial effect of quetiapine addition for acute episode of BP-D in OCD patients maintained on selective serotonin reuptake inhibitor treatment merits further controlled investigation.

Electroconvulsive Therapy for Bipolar Depression in Older Adults.

Electroconvulsive therapy (ECT) is a well-established treatment for mood disorders in younger adults and has been consistently shown to be safe and effective in unipolar depression in older adults. However, data on this treatment in older adults with bipolar disorder are limited. In this retrospective study, we report outcomes from all cases of older adults with bipolar depression who received ECT from a large academic institution over a 7-year period. We retrospectively identified all patients 65 years and older with bipolar depression who were treated with ECT over a 7-year period. Patients receiving ECT for an episode of bipolar depression were included in the study based on chart review and availability of documented outcome measures. Primary outcomes were changes in Montreal Cognitive Assessment and Clinical Global Impressions scores. We identified 34 patients meeting inclusion criteria. Collectively, patients had statistically significant improvement in Montreal Cognitive Assessment scores and reductions in Clinical Global Impressions severity scores after treatment. Pre- and posttreatment Montgomery-Asberg Depression Rating Scale scores were also available for a subset of 20 patients and demonstrated a similarly significant reduction in severity with treatment. There were no serious adverse effects of treatment, and no patients discontinued treatment. Electroconvulsive therapy was well tolerated and effective in treating bipolar depression in older adults. Importantly, these findings challenge commonly held worries about cognitive decline in older adults receiving ECT. It should be a regular consideration for management of this challenging illness in a population that may otherwise not respond to pharmacotherapy.

Differences in Demographic and Clinical Characteristics of Patients With Depressive vs. Manic First Episode of Bipolar Disorder.

Background: Bipolar disorder is a serious mental disease marked by episodes of depression, mania, hypomania, or mixed states. Patients with bipolar disorder may present with different symptoms at first onset. The aim of this study is to compare demographic and clinical variables based on a patient's first episode of bipolar disorder, including risk of recurrence over a 2-year period.Methods: A large cohort (N = 742) of patients with bipolar disorder in China was analyzed. Patients were divided into two groups according to their first episode of bipolar disorder, either depression or mania. Patients in mixed state first episode were classified based on predominant symptoms. Three hundred eighteen patients of the cohort had a first episode of mania and 424 patients had initial symptoms of depression. Demographic and clinical data were collected. All patients were followed up for 24 months. Data on compliance with follow-up appointments and recurrence of symptoms after 6, 12, 18, and 24 months were collected. Clinical characteristics (course of disease, age of onset, psychiatric family history, etc.) were compared between the mania group and depression groups.Results: More patients with bipolar disorder had a first episode of depression than mania (57.14 vs. 42.86%). Compared with the depression group, the mania group had later age of diagnosis of bipolar disorder [(38.64 ± 13.50) vs. (36.34 ± 14.94), P = 0.028], lower education level [(9.37 ± 4.34) vs. (10.17 ± 4.81), P = 0.017] and longer latency between an initial episode of psychiatric symptoms and formal bipolar diagnosis [(10.80 ± 10.76) vs. (8.85 ± 9.90), P = 0.012]. More patients in the mania group were male and without psychotic symptoms (all P < 0.05). In comparison with the mania group, more patients in the depression group were female, with higher frequency of a reported precipitating event before first mood episode (all P < 0.05). Compared with the depression group, the mania group had more recurrences of illness at the end of 12 months (Z =-2.156, P = 0.031), 18 months (Z =-2.192, P = 0.028), and 24 months (Z = −2.364, P = 0.018).Conclusions: In our study, there are a number of differences in demographic and clinical characteristics of patients with different onset syndromes of bipolar disorder. These differences include gender, education level, diagnosis age, the rate of recurrences, and others. These data of a cohort of Chinese patients add to the growing international literature on the relationship between index episode of bipolar disorder and clinical variables and outcomes. These results and further study may allow clinicians to offer patients and families more reliable prognostic information at the onset of disease.