Bipolar Disorder Patients Research Articles

Smartphone-based markers of social connectivity in schizophrenia and bipolar disorder

Social isolation and social impairment are hallmarks of progression as well as predictors of relapse in psychiatric disorders. We conducted a pilot study to assess the feasibility of sensing the social activity phenotype and loneliness using active and passive markers collected using a smartphone application. The study included 9 schizophrenia and bipolar disorder patients followed in the Bipolar Longitudinal study for at least 1 month and for whom mobile communication data was collected using the Beiwe smartphone application. Subjects completed daily surveys on digital and in-person social activity, and feelings of being outgoing or lonely. We described the level and variability of social activity features. We employed k-means clustering to identify “important contacts”. Further, we investigated whether social network-derived features of mobile communication are independent predictors of weekly counts of outgoing calls and text, weekly average self-reported digital social activity, and loneliness using mixed effect models and clustering with dynamic time warping distance. Subjects were followed between 5 and 208 weeks (number of days of observation = 2538). The k-means cluster analysis approach identified the number of “important contacts” among close friends and family members as reported in clinical interviews. The cluster analysis and longitudinal regression analysis indicate that the number of individuals a person communicates with on their phone is an independent predictor of perceived loneliness, with stronger evidence when “important contacts” only are included. This study provides preliminary evidence that the number of “important contacts” a person communicates with on their phone is a promising marker to capture subjects’ engagement in mobile communication activity and perceived loneliness.

B Cell-activating factor (BAFF): A promising trans-nosographic biomarker of inflammation and autoimmunity in bipolar disorder and schizophrenia

Immune dysregulation is an important aspect of schizophrenia (SZ) and bipolar disorders (BD) pathophysiology, including not only inflammatory but also autoimmune process reflective of abnormal humoral immune responses. Given that B cell-activating factor (BAFF) is an integral aspect of B lymphocyte regulation, the current study investigated BAFF in SZ and BD. 255 SZ patients, 407 BD patients and 185 healthy controls (HC) were investigated across three aspects of soluble BAFF (sBAFF) by (i) comparing sBAFF circulatory levels across SZ, BD and HC, (ii) determining potential correlations between the circulating levels of sBAFF and the genotype distribution of a functionally relevant polymorphism, namely the TNFSF13B 3′UTR insertion-deletion polymorphism (GCTGT>A), (iii) analyzing relationships between both sBAFF levels and 3′UTR insertion-deletion genotypes and disease risk, patients clinical characteristics and circulating levels of potent inflammatory molecules. In addition, in subsets of patients, we also searched for possible correlations between sBAFF levels and stigma of past infectious events as well as positivity for circulating systemic autoantibodies or those directed against central nervous system (CNS) structures. Studying blood derived serum and DNA, weobserved that circulating sBAFF levels were significantly higher in SZ and BD patients, versus HC (p = 5.3*10-10and p = 4.4*10-09). Patients experiencing acute episodes, versus stable patients, in between acute episodes, exhibited higher sBAFF levels (p = 0.017).In SZ patients, positive correlations were observed between elevated sBAFF levels and: (i) elevated positive psychotic symptoms (PANSS pos), (ii) history of childhood trauma (physical abuse), and (iii) low scores on global functioning (GAF) (p = 0.024, p = 0.024, and p = 0.041).We also found that the distribution of the BAFF Ins/Del genotypes was significantly correlated with circulating sBAFF levels in SZ and BD patients (p = 0.0004). Elevated sBAFF levels were also correlated with increased levels of pro-inflammatory markers in both SZ and BD cohorts (p < 0.001). Regarding infectious stigma, only patients seropositive, versus seronegative, for herpes simplex virus (HSV)1 immunoglobulin (Ig)G antibodies exhibited a significant association with high sBAFF levels (p = 0.013). In contrast, positivity for systemic or CNS autoantibodies was significantly associated with reduced sBAFF levels, compared to patients without autoantibodies (p = 0.0017). Overall, our findings indicate that BAFF may be a promising trans-nosographic biomarker of inflammation that is likely to offer predictive, diagnostic, and prognostic tools for the management of SZ and BD. The results therefore have practicable clinical utility given the availability of immunotherapeutic treatment options including targeted monoclonal antibodies against BAFF.

The economic burden of bipolar disorder: a case study in Southern Iran

BackgroundBipolar Disorder (BD) imposes considerable economic and social burdens on the community. Therefore, the present study aimed to determine the economic burden of bipolar disorder in patients referred to single-specialty psychiatric hospitals at the secondary and tertiary care level in 2022.MethodsThis partial economic evaluation was conducted as a cross-sectional study in the south of Iran in 2022, and 916 patients were selected through the census method. The prevalence-based and bottom-up approaches were used to collect cost information and calculate the costs, respectively. The data on Direct Medical Costs (DMC), Direct Non-Medical Costs (DNMC), and Indirect costs (IC) were obtained using the information from the patients’ medical records and bills as well as the self-reports by the patients or their companions. The human capital approach was also used to calculate IC.Findings: The results showed that in 2022, the annual cost of bipolar disorder was $4,227 per patient. The largest share of the costs was that of DMC (77.66%), with hoteling and ordinary beds accounting for the highest expenses (55.40%). The shares of DNMC and IC were 6.37% and 15.97%, respectively, and the economic burden of the disease in the country was estimated at $2,799,787,266 as well.ConclusionIn general, the costs of bipolar disorder treatment could impose a heavy economic burden on the community, the health system, the insurance system, and the patients themselves. Considering the high costs of hoteling and ordinary beds, it is suggested that hospitalization of BD patients be reduced by managing treatment solutions along with prevention methods to reduce the economic burden of this disease. Furthermore, in order to reduce the costs, proper and fair distribution of psychiatrists and psychiatric beds as well as expansion of home care services and use of the Internet and virtual technologies to follow up the treatment of these patients are recommended.

Evaluating psychological distress associated with life events under the traumatic experience threshold in patients with major depressive and bipolar disorder

Patients with bipolar disorder (BD) and major depressive disorder (MDD) experience psychological distress associated with daily events that do not meet the threshold for traumatic experiences, referred to as event-related psychological distress (ERPD). Recently, we developed an assessment tool for ERPD, the ERPD-24. This tool considers four factors of ERPD: feelings of revenge, rumination, self-denial, and mental paralysis. We conducted a cross-sectional study between March 2021 and October 2022 to identify the differences and clinical features of ERPD among patients with MDD and BD and healthy subjects who did not experience traumatic events. Specifically, we assessed ERPD using the ERPD-24 and anxiety-related symptoms with the State-Trait Anxiety Inventory, Liebowitz Social Anxiety Scale, and anxious-depressive attack. Regarding the ERPD-24 scores among the groups, as the data did not rigorously follow the test of normality, the Kruskal–Wallis test was used to compare the differences among the groups, followed by the Dunn–Bonferroni adjusted post-hoc test. Non-remitted MDD patients and BD patients, regardless of remission/non-remission, presented more severe ERPD than healthy subjects. This study also demonstrated the relationships between all anxiety-related symptoms, including social phobia and anxious-depressive attack and ERPD, in both BD and MDD patients and in healthy subjects. In conclusion, patients with non-remitted MDD and with BD regardless of remission/non-remission experience severe ERPD related to anxiety-related symptoms.

Prevalence and factors associated with fatigue in patients with major depressive disorder or bipolar disorder

AimsTo study the prevalence of fatigue and factors associated with fatigue in patients with major depressive disorder (MDD) or bipolar disorder (BD). MethodsTwo hundred fifty-three outpatients with MDD or BD at the initial assessment were used to study the prevalence of fatigue and relationship between fatigue and other clinical correlates. The severity of fatigue was measured with Iowa Fatigue Scale (IFS), and depression and anxiety symptom-severity were measured with the QIDS-16-SR (the 16-item Quick Inventory of Depressive Symptomatology – Self-Report) and Zung-SAS (Zung Self-Rating Anxiety Scale). Correlation between IFS and QIDS-16-SR total scores, QIDS-16-SR item scores or Zung-SAS total scores, and independent factors associated with fatigue was assessed with simple or multiple linear regression analysis. ResultsOverall, 28.4 % of MDD and 29.8 % of BD patients did not have fatigue, but 41.2 % of MDD and 45.0 % of BD patients had fatigue, and 30.4 % of MDD and 25.2 % of BD patients had severe fatigue. Depression/anxiety severity was significantly correlated with fatigue. However, after controlling current psychiatric comorbidities, demographics, some social factors, and psychotropic use, only QIDS-16-SR scores were still significantly and positively correlated with IFS scores in both MDD and BD. Differential correlations between IFS scores and item scores of QIDS-16-SR in MDD and BD were observed. LimitationCross-sectional. ConclusionsIn this outpatient sample, fatigue was highly prevalent in patients with MDD or BD. The independent association of depressive severity with the severity of fatigue highlights the importance of complete resolution of depressive symptoms in treating MDD and BD.

A bipolar disorder-associated missense variant alters adenylyl cyclase 2 activity and promotes mania-like behavior.

The single nucleotide polymorphism rs13166360, causing a substitution of valine (Val) 147 to leucine (Leu) in the adenylyl cyclase 2 (ADCY2), has previously been associated with bipolar disorder (BD). Here we show that the disease-associated ADCY2 missense mutation diminishes the enzyme´s capacity to generate the second messenger 3',5'-cylicadenosine monophosphate (cAMP) by altering its subcellular localization. We established mice specifically carrying the Val to Leu substitution using CRISPR/Cas9-based gene editing. Mice homozygous for the Leu variant display symptoms of a mania-like state accompanied by cognitive impairments. Mutant animals show additional characteristic signs of rodent mania models, i.e., they are hypersensitive to amphetamine, the observed mania-like behaviors are responsive to lithium treatment and the Val to Leu substitution results in a shifted excitatory/inhibitory synaptic balance towards more excitation. Exposure to chronic social defeat stress switches homozygous Leu variant carriers from a mania- to a depressive-like state, a transition which is reminiscent of the alternations characterizing the symptomatology in BD patients. Single-cell RNA-seq (scRNA-seq) revealed widespread Adcy2 mRNA expression in numerous hippocampal cell types. Differentially expressed genes particularly identified from glutamatergic CA1 neurons point towards ADCY2 variant-dependent alterations in multiple biological processes including cAMP-related signaling pathways. These results validate ADCY2 as a BD risk gene, provide insights into underlying disease mechanisms, and potentially open novel avenues for therapeutic intervention strategies.

Understanding Internalized Stigma's Role in Sex-Specific Suicidal Ideation among Individuals with Bipolar Disorder.

Background: The experience of stigma can exert a profound impact on the mental health and well-being of individuals with bipolar disorder (BD). Our study explores which factors of internalized stigma are associated with suicidal ideation and how they differ between the two sexes in a clinical sample of BD patients. Methods: The study follows a cross-sectional study design, employing the Clinical Global Impression for Bipolar Patients (CGI-BP) to evaluate the overall severity of illness and the alteration in patients affected by bipolar disorder, the Internalized Stigma of Mental Illness (ISMI) assessing self-stigma among individuals experiencing mental disorders, and the Columbia Suicide Severity Rating Scale (C-SSRS) identifying and assessing individuals vulnerable to suicide. Descriptive analyses, analysis of variance (ANOVA), and logistic regression analysis were conducted, and 344 BD subjects were recruited. Results: Our ANOVA results revealed a significant association between sex and suicide across ISMI sub-items (p = 0.000). Logistic regression analysis comprised three phases: Discrimination was consistently significant across all phases (p < 0.001), while Alienation and Stereotype emerged as additional predictors of suicide in later phases of the analysis (p < 0.001). Conclusions: Our study contributes to the growing body of literature on internalized stigma, sex, and suicidality among individuals with bipolar disorder. Early intervention programs and prevention strategies are needed.

Polygenic scores for psychiatric disorders associate with year of first bipolar disorder diagnosis: A register-based study between 1972 and 2016

The diagnostic criteria of bipolar disorder (BD) have changed over time. To test if these changes are reflected in the polygenic profile in BD, we studied the association between first BD diagnosis year (during 1972–2016) and polygenic scores (PGS) for psychiatric disorders in BD patients (N = 3,818). We found significant associations between diagnosis year and PGS for BD, depression, and attention deficit hyperactivity disorder (ADHD). The PGS remained largely stable over time in BD type 1, while changes were observed in BD type 2. These findings bear significance not only for genetic research but also for clinical practise, as shifts in patient characteristics can influence treatment response.

Mitochondrial Biomarkers and Metabolic Syndrome in Bipolar Disorder

The object of this study is test whether mitochondrial blood-based biomarkers are associated with markers of metabolic syndrome in bipolar disorder, hypothesizing higher lactate but unchanged cell-free circulating mitochondrial DNA levels in bipolar disorder patients with metabolic syndrome. In a cohort study, primary testing from the FondaMental Advanced Centers of Expertise for bipolar disorder (FACE-BD) was conducted, including 837 stable bipolar disorder patients. The I-GIVE validation cohort consists of 237 participants: stable and acute bipolar patients, non-psychiatric controls, and acute schizophrenia patients. Multivariable regression analyses show significant lactate association with triglycerides, fasting glucose and systolic and diastolic blood pressure. Significantly higher levels of lactate were associated with presence of metabolic syndrome after adjusting for potential confounding factors. Mitochondrial-targeted metabolomics identified distinct metabolite profiles in patients with lactate presence and metabolic syndrome, differing from those without lactate changes but with metabolic syndrome. Circulating cell-free mitochondrial DNA was not associated with metabolic syndrome. This thorough analysis mitochondrial biomarkers indicate the associations with lactate and metabolic syndrome, while showing the mitochondrial metabolites can further stratify metabolic profiles in patients with BD. This study is relevant to improve the identification and stratification of bipolar patients with metabolic syndrome and provide potential personalized-therapeutic opportunities.

Fibroblasts as an in vitro model of circadian genetic and genomic studies

Bipolar disorder (BD) is a heritable disorder characterized by shifts in mood that manifest in manic or depressive episodes. Clinical studies have identified abnormalities of the circadian system in BD patients as a hallmark of underlying pathophysiology. Fibroblasts are a well-established in vitro model for measuring circadian patterns. We set out to examine the underlying genetic architecture of circadian rhythm in fibroblasts, with the goal to assess its contribution to the polygenic nature of BD disease risk. We collected, from primary cell lines of 6 healthy individuals, temporal genomic features over a 48 h period from transcriptomic data (RNA-seq) and open chromatin data (ATAC-seq). The RNA-seq data showed that only a limited number of genes, primarily the known core clock genes such as ARNTL, CRY1, PER3, NR1D2 and TEF display circadian patterns of expression consistently across cell cultures. The ATAC-seq data identified that distinct transcription factor families, like those with the basic helix-loop-helix motif, were associated with regions that were increasing in accessibility over time. Whereas known glucocorticoid receptor target motifs were identified in those regions that were decreasing in accessibility. Further evaluation of these regions using stratified linkage disequilibrium score regression analysis failed to identify a significant presence of them in the known genetic architecture of BD, and other psychiatric disorders or neurobehavioral traits in which the circadian rhythm is affected. In this study, we characterize the biological pathways that are activated in this in vitro circadian model, evaluating the relevance of these processes in the context of the genetic architecture of BD and other disorders, highlighting its limitations and future applications for circadian genomic studies.

Neuroretinal Alterations in Schizophrenia and Bipolar Disorder: An Updated Meta-analysis.

Schizophrenia (SZ) and bipolar disorder (BD) are characterized by major symptomatic, cognitive, and neuroanatomical changes. Recent studies have used optical coherence tomography (OCT) to investigate retinal changes in SZ and BD, but their unique and shared changes require further evaluation. Articles were identified using PubMed and Google Scholar. 39 studies met the inclusion criteria. Diagnostic groups were proband (SZ/BD combined), SZ, BD, and healthy control (HC) eyes. Meta-analyses utilized fixed and random effects models when appropriate, and publication bias was corrected using trim-and-fill analysis ("meta" package in R). Results are reported as standardized mean differences with 95% CIs. Data from 3145 patient eyes (1956 SZ, 1189 BD) and 3135 HC eyes were included. Studies identified thinning of the peripapillary retinal nerve fiber layer (pRNFL, overall and in 2 subregions), m-Retina (overall and all subregions), mGCL-IPL, mIPL, and mRPE in SZ patients. BD showed thinning of the pRNFL (overall and in each subregion), pGCC, and macular Retina (in 5 subregions), but no changes in thickness or volume for the total retina. Neither SZ nor BD patients demonstrated significant changes in the fovea, mRNFL, mGCL, mGCC, mINL, mOPL, mONL, or choroid thicknesses. Moderating effects of age, illness duration, and smoking on retinal structures were identified. This meta-analysis builds upon previous literature in this field by incorporating recent OCT studies and examining both peripapillary and macular retinal regions with respect to psychotic disorders. Overall, this meta-analysis demonstrated both peripapillary and macular structural retinal abnormalities in people with SZ or BD compared with HCs.

Assessment of Cognitive Functions Among Remitted Patients of Schizophrenia and Bipolar Disorder: A Comparative Study.

Introduction Bipolar disorder and schizophrenia exhibit different patterns of cognitive impairment, with schizophrenia demonstrating more profound deficiencies in verbal memory and bipolar disorder in social cognition. Understanding these patterns may guide the development of interventions to enhance cognition in these disorders. Aim This study aims to assess and compare the cognitive abilities of persons diagnosed with bipolar illness and schizophrenia. Methodology A facility-based cross-sectional study was done from December 2016 to June 2017 among 30 schizophrenia and 30 bipolar disorder patients aged 18-45 years, in remission selected after screening throughHamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), orPositive and Negative Syndrome Scale (PANSS). Exclusions included schizoaffective disorder, systemic illness, brain/neurological conditions, and substance abuse. After collecting the baseline demographic and clinical profile of the selected patients, the cognitive domains were assessed such as attention (digit span), verbal memory (Rey's Auditory Verbal Learning Test (RAVLT)), visual memory (Rey Complex Figure), verbal fluency (Animal Naming), and executive functions (Stroop and Trail Making). The data was analyzed using the IBM SPSS Statistics for Windows, Version 16 (Released 2007; IBM Corp., Armonk, New York, United States)using standard descriptive and inferential statistics. Results Sociodemographic and clinical characteristics were largely similar between groups. Schizophrenia patients showed poorer attention, working memory, and visual attention/task-switching compared to bipolar patients. Bipolar patients demonstrated relatively preserved abilities in these domains but exhibited more impairments in visual and verbal memory. Distinct patterns highlight unique neurobiological underpinnings, showing association of more generalized cognitive deficits in schizophrenia and more localized impairments in memory functionsin bipolar disorder. Conclusion The study findings explain these disorders' unique neurobiological mechanisms and may help develop targeted cognitive remediation and pharmacological interventions to improve functional outcomes and quality of life.

Evaluation and Treatment of Cognitive Dysfunctions in Schizophrenia and Bipolar Disorder

Cognitive dysfunction is the most important determinant for the recovery in schizophrenia and bipolar disorder. Cognitive dysfunction serves as an endophenotype although it may be a consequence of drug treatments. In schizophrenia starting from the first episode, pronounced cognitive defects such as cognitive flexibility, inhibition, verbal fluency, verbal memory and visual-motor processing are observable. These cognitive defects remain stable in the chronic phase of schizophrenia. On the other hand, cognitive dysfunctions in bipolar disorder patients have a heterogeneous pattern. One group of patients show no evidence of cognitive dysfunction while one group has limited dysfunction (of processing speed, attention, verbal learning and social cognition) and another one has wide spread dysfunctions as seen in schizophrenia. Despite its importance, no satisfactory results have been achieved in the treatment of cognitive dysfunctions in schizophrenia and bipolar disorder. In this article, the evaluation and treatment of the most frequent cognitive dysfunctions of schizophrenia and bipolar disorder are reviewed.

Comparison of the Effectiveness of Family-Focused Therapy and Social Cognition and Interaction Training in Preventing Relapse in Bipolar Disorder and Enhancing Patients' Social Functioning and Interpersonal Relationships

Background: Bipolar disorder type I (BD-I) is marked by periodic mood swings, including episodes of mania and depression. Factors such as family stress and cognitive impairments are crucial in the relapse of this disorder. Objectives: This study aims to evaluate the effectiveness of family-focused therapy (FFT) and social cognition and interaction training (SCIT) in preventing relapses of BD-I and enhancing patients' interpersonal relationships and social functioning. Methods: This experimental study featured a controlled, pretest-posttest design with a three-month follow-up, conducted from 2019 to 2020. Sixty primary caregivers of patients with BD-I in Zahedan, Iran, were purposively selected and randomly assigned to three groups. The SCIT group (only patients) and the FFT group (patients with primary caregivers) each underwent 15 sessions of group interventions. Research tools were administered before and after the intervention, as well as in the follow-up. Baseline differences in outcomes were assessed using independent samples t-tests for completers vs. non-completers and analysis of variance (ANOVA) for the three intervention groups. Results: Results indicate that both SCIT and FFT significantly improved relapse prevention and enhanced social functioning, except in the domain of interpersonal relationships. Here, SCIT proved more effective than FFT in post-tests (β = 3, P = 0.034) and follow-up (β = 5.043, P = 0.001). Conclusions: Given that FFT is an evidence-based treatment for BD-I, integrating SCIT can further enhance intervention effectiveness, particularly in improving interpersonal relationships and social functioning by addressing environmental factors and social cognitive deficits.

Optical coherence tomography angiography in patients with bipolar disorder and major depressive disorder

BackgroundCerebral microvascular dysfunction is a promising area for research into the pathogenesis of major depressive disorder (MDD) and bipolar disorder (BD). Despite the scientific and clinical potential of studying microvascular dysfunction, progress in this area has long been hampered by the lack of methods to study microvessels intravitally. AimsThe aim of the present study was to search for potential optical coherence tomography (OCT) and OCT-angiography (OCTA) biomarkers of BD and MDD. MethodsOne hundred and five consecutive patients with a current depressive episode were enrolled in the study (39 – BD and 66 – MDD). In addition, forty-one generally healthy subjects were enrolled as a control group. Only the right eye was examined in all subjects. Structural OCT and OCTA scans with signal strength ≥7 were included. ResultsStructural OCT measurements showed no significant differences between the groups. OCTA measurements of foveal avascular zone (FAZ), area and skeleton density showed a decrease in the retinal capillary bed in BD patients, whereas OCTA values in MDD patients did not differ from the control group. Several significant differences were found between the BD and control groups. In the BD group, the FAZ of the deep capillary plexus was increased, reflecting a reduction in capillary perfusion in the central subfield of this plexus. ConclusionsOCTA measurements of FAZ, area and skeleton density showed a decrease in the retinal capillary bed in BD patients, whereas OCTA values in MDD patients did not differ from the control group.

Evaluation of systemic immune inflammation index and neutrophil-to-lymphocyte ratio in schizophrenia, bipolar disorder and depression.

Numerous studies consistently report on the frequent presence of low-grade systemic inflammation in individuals with schizophrenia, bipolar disorder (BD), and depression. Neutrophil-to-lymphocyte ratio (NLR) and arecently established marker, systemic immune inflammation index (SII), are markers used to assess systemic inflammation and immune response. In this study, NLR and SII index values were examined and compared across patients diagnosed with major psychiatric disorders and healthy controls. The study included, totaling 129 patients, encompassed individuals who were diagnosed with schizophrenia in remission or BD in the euthymic period, and those undergoing treatment for major depressive disorder (MDD). The control group consisted of 62 healthy individuals. White blood cell (WBC), neutrophil, lymphocyte, platelet, and monocyte counts obtained retrospectively from complete blood profiles served as the basis for calculating NLR and SII values. In this study, higher WBC, neutrophil counts, NLR, and SII values were observed in schizophrenia and BD patients compared to the control group. In patients with MDD, no significant difference was found in terms of inflammatory blood cell markers compared to healthy controls. Higher NLR and Sİİ values were found in patients with schizophrenia and BD compared to patients with MDD. The results of the study indicate that the significant difference in NLR and SII values persists after treatment in patients with schizophrenia and BD, and that the abnormal inflammatory response continues during the treatment process (Tab. 2, Ref. 41).

Face-brain correlates as potential sex-specific biomarkers for schizophrenia and bipolar disorder

Given the shared ectodermal origin and integrated development of the face and the brain, facial biomarkers emerge as potential candidates to assess vulnerability for disorders in which neurodevelopment is compromised, such as schizophrenia (SZ) and bipolar disorder (BD).The sample comprised 188 individuals (67 SZ patients, 46 BD patients and 75 healthy controls (HC)). Using a landmark-based approach on 3D facial reconstructions, we quantified global and local facial shape differences between SZ/BD patients and HC using geometric morphometrics. We also assessed correlations between facial and brain cortical measures. All analyses were performed separately by sex.Diagnosis explained 4.1 % - 5.9 % of global facial shape variance in males and females with SZ, and 4.5 % - 4.1 % in BD. Regarding local facial shape, we detected 43.2 % of significantly different distances in males and 47.4 % in females with SZ as compared to HC, whereas in BD the percentages decreased to 35.8 % and 26.8 %, respectively. We detected that brain area and volume significantly explained 2.2 % and 2 % of facial shape variance in the male SZ - HC sample.Our results support facial shape as a neurodevelopmental marker for SZ and BD and reveal sex-specific pathophysiological mechanisms modulating the interplay between the brain and the face.

Physical comorbidities of older age bipolar disorder (OABD) patients: A global replication analysis of prevalence and sex differences

ObjectivesTo compare the prevalence of physical morbidities between older aged patients with bipolar disorder (OABD) and non-psychiatric comparisons (NC), and to analyze sex differences in prevalence. MethodsOABD was defined as bipolar disorder among adults aged ≥50 years. Outcomes analyzed were the prevalence of diseases affecting the cardiovascular, respiratory, gastrointestinal, genitourinary, renal, musculoskeletal, and endocrine systems. The analysis used cross-sectional data of OABD participants (n = 878; mean age 60.9 ± 8.0 years, n = 496 (56%) women) from the collaborative Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) dataset and NC participants recruited at the same sites (n = 355; mean age 64.4 ± 9.7 years, n = 215 (61%) women). ResultsAfter controlling for sex, age, education, and smoking history, the OABD group had more cardiovascular (odds ratio [95% confidence interval]: 2.12 [1.38–3.30]), renal (5.97 [1.31–43.16]), musculoskeletal (2.09 [1.30–3.43]) and endocrine (1.90 [1.20–3.05]) diseases than NC. Women with OABD had more gastrointestinal (1.56 [0.99–2.49]), genitourinary (1.72 [1.02–2.92]), musculoskeletal (2.64 [1.66–4.37]) and endocrine (1.71 [1.08–2.73]) comorbidities than men with OABD, when age, education, smoking history, and study site were controlled. ConclusionsThis replication GAGE-BD study confirms previous findings indicating that OABD present more physical morbidities than matched comparison participants, and that this health burden is significantly greater among women.

LAMOTRIGINE-INDUCED MANICEPISODEINA PATIENT WITH COMORBID BIPOLAR DISORDER AND OBSESSIVE-COMPULSIVE DISORDER: CASE REPORT

The coexistence of obsessive-compulsive disorderand bipolar disorder is a prevalent issue in psychiatry.Population studies have found lifetime prevalence rates of comorbid obsessive-compulsive disorderin bipolar disorder patients ranging between 11.1% and 21%. The primary treatmentforobsessive-compulsive disorder, serotonin reuptake inhibitors, can induce manic episodes in bipolar disorder patients. This article presents a case of a 54-year-old woman with bipolar disorder and obsessive-compulsive disorder comorbidity, who experienced a manic shift after the introduction of lamotrigine, a drug commonly used for bipolar disorder and known for its mood-stabilizing properties. Although lamotrigine has been recommended, especially for patients predisposed to depressive bouts, its potential to induce manic or hypomanic states remains controversial. The presented patients reaction to lamotrigine suggests a possible link between the drug and the onset of manic episodes, especially in those with a history of bipolar disorder and obsessive-compulsive disorder. Furthermore, while lamotrigine offers benefits for bipolar depression, healthcare professionals need to exercise caution due to its potential to initiate manic or hypomanic states, especially in patients with complex clinical backgrounds. Comprehensive research and careful post-marketing observations are crucial to better understand the risk-benefit profile of lamotrigine.

Neuroanatomical alterations in brain disorder: A magnetic resonance imaging analysis

Background: Bipolar disorder is a serious mental disorder caused by strong mood fluctuations, affecting 2% of the world's population. People with bipolar disorder experience both manic and depressive episodes, which can lead to suicidal thoughts and changes in appetite, activity, and focus. There are different subtypes of bipolar disorder, with cyclothymic disorder being the milder of the two. Bipolar I is characterized by manic periods, while bipolar II is marked by hypomanic and significant depressive episodes. Bipolar disorder is a biological, genetic, and environmental condition that can affect anyone at any age. Methods: In this study, we enrolled a total of 49 bipolar disorder (BD) participants to 44 healthy control (HC) subjects. Bipolar disorder patients were enlisted with their consent using web portals, medical facilities, and local marketing. MRI contraindications, medical history, self-reported using a mood-altering medication, inadequate vision, and left-handedness were among the exclusion criteria. The various tissue structures which are: the gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) were examined using voxel-based morphometry (VBM) to ascertain these changes. We employed statistical parametric mapping (SPM) for both image processing and statistical analysis. Results: Our findings demonstrate that individuals with bipolar disorder showed a substantial volume decrease in both gray matter (GM) and white matter (WM), with gray matter (GM) and white matter (WM) volume decreases being more noticeable in the frontal, temporal, parietal, and occipital lobes. Additionally, individuals with bipolar disorder showed no CSF volume in any of the brain regions. Conclusion: Our VBM research backs up earlier studies that link changes in brain structure, particularly gray matter and white matter, to bipolar disorder. These discoveries shed more information on the neurology of bipolar disorder and could guide the creation of more potent diagnostic and treatment modalities.