Bipolar Episodes Research Articles

Study on impulsivity and cognitive function in patients with manic episodes of bipolar I disorder

Objective To explore the role of impulsivity in manic episodes of bipolar I disorder and cognitive impairment. Methods Sixty-one patients with bipolar I manic-episode (study group) and 43 healthy volunteers (control group) were included in the study, and the cognitive function and impulsivity of the subjects were assessed using the MATRICS consensus cognitive battery (MCCB) and BIS-11 impulsivity scale (BIS-11). The differences in impulsivity and cognitive function between the study group and control group were compared.Partial correlation analysis was used to analyze the correlation between impulsivity and cognitive function in patients with bipolar I manic episode. Results (1)The scores of several cognitive function in study group, were significantly lower than those in healthy control group including information processing speed, attention alertness, word learning, visual learning, working memory, reasoning and problem solving (all P<0.01). (2)The total score, motor factor score and cognitive factor score of BIS-11 impulse scale in study group were significantly higher than those in control group (58.39±15.77 vs 48.02±11.16, 62.09±19.01 vs 44.24±21.09, 56.97±16.57 vs 50.06±13.87, all P<0.05). Increased overall scores on the bis-11 impulse inventory may be a risk factor for bipolar I episodes(OR=1.204, 95%CI=1.032-1.404). (3)In study group, the total score of BIS-11 was negatively correlated with the speed of information processing, working memory, word learning, reasoning and problem solving, and the total score of MCCB(r=-0.417, -0.360, -0.294, -0.348, -0.348, P<0.05). The score of unplanned factor was negatively correlated with the speed of information processing, word learning, the total score of MCCB(r=-0.397, -0.302, -0.358, P<0.05). The score of cognitive factor was negatively correlated with the speed of information processing, working memory, word learning, reasoning and problem solving, and the total score of MCCB(r=-0.327, -0.351, -0.374, -0.391, -0.463, P<0.05). The score of motor factor was negatively correlated with working memory and the total score of MCCB(r=0.370, r=0.389, P<0.05). Conclusion High impulsivity is a risk factor for manic episodes of bipolar I disorder and may be associated with cognitive impairment in patients with manic episodes of bipolar I disorder. Key words: Bipolar disorder; Manic episodes; Impulsivity; Cognitive function

Childhood factors associated with increased risk for mood episode recurrences in bipolar disorder-A systematic review.

Bipolar Disorder (BD) is a recurrent illness associated with high morbidity and mortality. The frequency of mood episode recurrence in BD is highly heterogeneous and significantly impacts the person's psychosocial functioning and well-being. Understanding the factors associated with mood recurrences could inform the prognosis and treatment. The objective of this review is to summarize the literature on factors, present during childhood, that influence recurrence. A systematic review of PubMed (1946-2017) and PsycINFO (1884-2017) databases was conducted to identify candidate studies. Search terms included bipolar disorder, episodes, predictors, recurrences, and course. Study characteristics, risk for bias, and factors associated with recurrence were coded by two raters according to predetermined criteria. Twenty child studies and 28 adult studies that retrospectively evaluated childhood variables associated with mood recurrences were included. Early age of onset, low socioeconomic status, comorbid disorders, inter-episode subsyndromal mood symptoms, BD-I/II subtypes, presence of stressors, and family history of BD were associated with higher number of recurrences. Risk factors and mood recurrences were assessed and defined in different ways, limiting generalizability. Multiple factors are associated with increased risk of mood episode recurrence in BD. Interventions targeting modifiable factors could reduce the impact of BD. For example, treatment of comorbid disorders and subsyndromal mood symptoms, coupled with appropriate cognitive behavioral and family-focused therapies could ameliorate risk related to many clinical factors. When coupled with social services to address environmental factors, the number of episodes could be reduced and the course of BD significantly improved.

Evaluation of plasma agmatine level and its metabolic pathway in patients with bipolar disorder during manic episode and remission period

Objectives: Agmatine is a cationic amine resulting from the decarboxylation of l-arginine. Agmatine has neuroprotective, anti-inflammatory, anti-stress, and anti-depressant properties. In this study, plasma agmatine, arginine decarboxylase, and agmatinase levels were measured during manic episode and remission period in patients with bipolar disorder.Methods: Thirty healthy volunteers and 30 patients who meet Bipolar Disorder Manic Episode diagnostic criteria were included in the study. Additionally, the changes in the patient group between manic episode and remission period were examined. We evaluated the relationship between levels of l-arginine and arginine decarboxylase in the agmatine synthesis pathway, and level of agmatinase that degrades agmatine.Results: Levels of agmatine and l-arginine were significantly increased than control group during manic episode (p < .01). All parameters were increased during manic episode compared to remission period (p < .05). Agmatinase was significantly decreased both during manic episode (p < .01) and remission period (p < .05) in comparison to the control group. Arginine decarboxylase levels did not show a significant difference between the groups (p > .05).Conclusions: This study indicate that there may be a relationship between bipolar disorder and agmatine and its metabolic pathway. Nonetheless, we believe more comprehensive studies are needed in order to reveal the role of agmatine in etiology of bipolar disorder.Key pointsAgmantine, agmatinase, l-arginine and arginine decarboxylase levels in BD have not been explored before.Various neuro-chemical mechanisms act to increase agmatine in BD; however, agmatine could have elevated to compensate agmatine deficit prior to the manifestation of the disease as in schizophrenia.Elevated agmatine degradation resulting from excess expression of agmatinase which is suggested to be effective in pathogenesis of mood disorders was compensated by this way.Elevated agmatine may be one of the causes which play a role in mania development.Elevated agmatine levels are also suggested to trigger psychosis and be related with the etiology of manic episode and lead to BD.

A New Safety Scoring System for the Use of Psychotropic Drugs During Lactation.

Psychotropic drugs are frequently used to treat postpartum women with psychiatric diagnoses, especially psychotic disorder, major depression, and bipolar mood episodes. Pharmacotherapy in breastfeeding mothers is a major challenge. This article presents a new safety scoring system for the use of psychotropic drugs during lactation. The scoring system is based on the following 6 safety parameters: reported total sample, reported maximum relative infant dose, reported sample size for relative infant dose, infant plasma drug levels, prevalence of reported any adverse effect, and reported serious adverse effects. The total score ranges from 0 to 10. Higher scores represent a higher safety profile. According to this scoring system, sertraline and paroxetine, respectively, had the highest scores representing "very good safety profile." Citalopram, olanzapine, and midazolam were assigned to "good safety profile." Among drugs evaluated in this article, trifluoperazine, aripiprazole, amisulpride, clozapine, doxepin, zaleplon, and zolpidem are not recommended owing to safety scores ≤3. Most psychotropic drugs examined in this article have "moderate" or "low" safety profile.

Uses of Electroconvulsive Therapy in Conditions Other than Major Depressive Episode

The effectiveness of electroconvulsive therapy (ECT) in the treatment of unipolar and bipolar major depressive episodes (MDE) is well known, and the US Food and Drug Administration has recently reclassified ECT devices to a less restrictive category for treatment of MDE and catatonia. In this review, we look at the existing evidence supporting the use of ECT in conditions other than MDE, such as bipolar mania and mixed states, schizophrenia, catatonia, Parkinson's disease, agitation in dementia, and status epilepticus. [ Psychiatr Ann . 2019;49(4):157–163.]

Discussion on Patients with Bipolar Disorder and Depressive Episode by Ratio Low Frequency Amplitude Combined with Grey Matter Volume Analysis.

In order to explore the brain functional and structural imaging results of patients with bipolar disorder and depressive episode without taking medicine, and to further explore the disease mechanism of bipolar disorder by combining with clinical symptoms and cognitive function (neuropsychological test), DPABI (Data Processing and Analysis (Resting-State) For Brain Image) software is used to pre-process fMRI (functional magnetic resonance imaging) data and calculate fALFF (ratio low frequency fluctuation amplitude) index. In addition, SPM8 is applied for grey matter volume analysis based on voxel morphology. Pearson correlation model is used to analyze the relationship between functional and morphological changes and clinical symptoms and cognitive tests. DPABI software and SPSS 22.0 software are used to analyze the data. The results show that corresponding abnormal brain areas are found in both functional and structural aspects of patients with bipolar disorder and depression, involving LCSPT emotional circuits. More importantly, the superior frontal gyrus shows significant abnormalities in both functional and structural analysis.

A Stuttering Case Getting Well During Bipolar Disorder Manic Episode

Bipolar disorder; is a chronic disease with recurrent mania, hypomania and depression episodes. The cyclical progress of the disorder, with recovery and exacerbations, affects the individual physically and mentally and disturbs the patient’s professional and social harmony. Stuttering is defined as the disorder in which the individual's speech is not following his / her age due to fluency or timing. However, the etiology of shuttering has not yet understood. It is thought that, during the conversation, the thought of the negative reactions that the patient might encounter, affects the fluency of the speech. Researches on stuttering in bipolar disorder are limited. In this article, we discussed a case who has stuttering since childhood and whose stuttering got well during bipolar disorder manic episodes. It was observed that the patient's stuttering complaint was resumed when the patient had reached the euthymic state by the treatment.

A systematic review on sleep alterations anticipating the onset of bipolar disorder

BackgroundSleep alterations are frequent occurrence in Bipolar Disorder (BD), both in acute and interepisodic phases. Sleep alterations have been also described both long before BD onset, as aspecific risk syndromes, or as immediate prodromes of BD onset. The aim of the present study is to systematically review the relationship between sleep alterations anticipating for the full-blown onset of BD, both in general and according to specific polarities of onset. MethodsA systematic literature research according to PRISMA statement and considering: 1. prospective studies about BD patients’ offspring with sleep alterations who later developed BD. 2. prospective studies assessing patients with sleep disorders who later developed BD. 3. retrospective studies on BD patients where sleep alterations before BD onset of the disease were reported. ResultsA total of 16 studies were included in this review. Sleep disturbances may frequently appear 1 year before the onset of BD or more, often during childhood or adolescence. A decreased need for sleep may precede the onset of the illness, specially a manic episode, while insomnia appears to anticipate either a manic or a depressive episode. Hypersomnia seems to precede bipolar depressive episodes. ConclusionsSleep alterations frequently appear long before the onset of BD, and appear to be related specifically to the polarity of the index episode. The detection and treatment of sleep alterations in special high risk populations may help achieving an earlier detection of the illness.

Cross-sectional study of neutrophil-lymphocyte, platelet-lymphocyte and monocyte-lymphocyte ratios in mood disorders

ObjectiveNeutrophil-lymphocyte, monocyte-lymphocyte and platelet-lymphocyte ratio are inexpensive and reproducible biomarkers of inflammation found to be elevated in mood disorders. This study aimed to compare inflammatory ratios between bipolar disorder and major depressive disorder and between bipolar disorder manic episodes and bipolar disorder depressive episodes. MethodWe included 142 Caucasian patients (major depressive disorder: n = 36; bipolar disorder manic episode: n = 66; bipolar disorder depressive episode: n = 40). We measured white blood cells, neutrophils, lymphocytes, monocytes, platelets, glucose, and total cholesterol. Neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio were calculated. ResultsNeutrophil-lymphocyte ratio and monocyte-lymphocyte ratio were significantly higher in bipolar disorder manic episodes when compared to bipolar disorder depressive episodes and major depressive disorder episodes after adjustment for age, sex, body mass index, and smoking. ConclusionTo our knowledge, our study is the first one to compare inflammatory ratios between different bipolar disorder phases and major depressive disorder episodes. In accord with previous studies on other inflammatory mediators, we found higher neutrophil-lymphocyte and monocyte-lymphocyte ratios in bipolar manic episodes, suggesting that inflammatory changes occur especially during acute episodes of mania.

BIPOLAR AFFECTIVE DISORDER;

Introduction: Bipolar Affective Disorder is a chronic, recurring illness. There is evidenced relationship between life events (particularly adverse interpersonal events) and the onset of bipolar episodes. Objective: To determine the association of different Psychosocial risk factors for relapse in patients with Bipolar Affective Disorder. Study Design: Descriptive cross-sectional study. Setting: Psychiatry Outpatient Department (OPD) of Jinnah Post Graduate Medical Centre (JPMC), Karachi. Period: January 2016 to July 2016). Subjects and Method: Total 146 patients of both genders aged between 18 to 60 years were enrolled in study. Diagnosis of Bipolar Affective Disorder was based on diagnostic criteria of International Classification of Diseases 10th version [ICD-10]. For the identification of psychosocial factors Holmes and Rahe stress scale was used. Results: A total of 146 patients of both genders with average age of 31.44 ± 10.40 years. Among 146 cases, 97 (66.40%) were males and 49(33.60%) were females. Out of 146, 79(54.10%) were married, 61(41.80) were single. Among 146 patients the psychosocial factors were identified individually. The death of spouse, recent marriage, marital separation and death of close family member or friend, pregnancy were the psychosocial factors associated with relapse with p-value of less than 0.05. Conclusion: The psychosocial factors or adverse life events do trigger the course of Bipolar Affective Disorder. The major negative life events such as death of spouse or close family member or friend, the marital issues are predominant.

Prescribing practices of Indian psychiatrists in the treatment of bipolar disorder.

The treatment of bipolar disorder is challenging because of its clinical complexity and availability of multiple treatment options, none of which are ideal mood stabilizers. This survey studies prescription practices of psychiatrists in India and their adherence to guidelines. In total, 500 psychiatrists randomly selected from the Indian Psychiatric Society membership directory were administered a face-to-face 22-item questionnaire pertaining to the management of bipolar disorder. For acute mania, most practitioners preferred a combination of a mood stabilizer and an atypical antipsychotic to monotherapy. For acute depression, there was a preference for a combination of an antidepressant and a mood stabilizer over other alternatives. Electroconvulsive therapy was preferred in the treatment of severe episodes and to hasten the process of recovery. Approximately, 50% of psychiatrists prescribe maintenance treatment after the first bipolar episode, but maintenance therapy was rarely offered lifelong. While the majority (85%) of psychiatrists acknowledged referring to various clinical guidelines, their ultimate choice of treatment was also significantly determined by personal experience and reference to textbooks. The study did not study actual prescriptions. Hence, the responses to queries in the survey are indirect measures from which we have tried to understand the actual practices, and of course, these are susceptible to self-report and social-desirability biases. This was a cross-sectional study; therefore, temporal changes in responses could not be considered. Overall, Indian psychiatrists seemed to broadly adhere to recommendations of clinical practice guidelines, but with some notable exceptions. The preference for antidepressants in treating depression is contrary to general restraint recommended by most guidelines. Therefore, the efficacy of antidepressants in treating bipolar depression in the context of Indian psychiatrists' practice needs to be studied systematically. Not initiating maintenance treatment early in the course of illness may have serious implications on the long-term outcome of bipolar disorder.

Compulsory Psychiatric Admissions in an Italian Urban Setting: Are They Actually Compliant to the Need for Treatment Criteria or Arranged for Dangerous Not Clinical Condition?

Background: Italy was one of the first European countries adopting the need for treatment criteria for compulsory admission (CA). The aim of the present study was to confirm whether CA in an urban setting in Italy was compliant with the requested clinical criteria.Methods: In this retrospective observational study, we retrieved all collected information regarding CA in Turin (Italy) from January 2006 to December 2013. All content and data reported in the CA forms, including diagnosis and clinical details, were gathered and analyzed. Comparisons between CA with and without a diagnosis of DSM-IV psychiatric disorders and between different diagnoses were performed using either parametric or non-parametric tests, depending on variable distribution.Results: Three hundred and two (10.5%) of 2,870 consecutive CAs made in Turin during a lag time of 8 years were due to unknown psychiatric diagnoses (113; 3.9%) or to psychomotor agitation (189; 6.6%). The most prevalent psychiatric disorders leading to CA were schizophrenia (729; 25.4%), brief psychotic disorder (627; 21.8%), bipolar disorder episode (396; 13.8%), delusional disorder (292; 10.2%), and personality disorder (237; 8.3%). The CAs due to psychiatric disorder were longer (U = 328,875.0; p < 0.001) and involved patients who were more likely to be compulsorily admitted during the study period (U = 357,012.5; p = 0.003), to have had prior contact with a psychiatrist [ = 28.34; p < 0.001], to have had previous admissions to a psychiatric ward [ = 33.06; p < 0.001], to be under the care of psychiatric services [ = 87.01; p < 0.001], and not to have concurrent alcohol [ = 23.06; p < 0.001] and/or drug use [ = 12.97; p < 0.001] than those due to psychomotor agitation/unspecified diagnoses.Conclusion: Despite a history of 35 years of CA made according to a strict need for treatment criteria, the evaluation of CA records shows that a certain proportion of CAs appears to have been due to brief, not psychiatric, alcohol/drug related behavioral conditions. Further studies should confirm the need for law reform leading to the integration between the need for treatment and the danger criteria for CAs.

Comparison of the complete blood count-derived inflammatory markers in bipolar patients with manic and mixed episodes

We aimed to compare altered inflammatory status between patients with bipolar manic and mixed episodes through neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) levels. NLR, PLR, and MLR are systemic inflammation biomarkers that have recently studied in bipolar disorder (BD) manic and depressive episodes. Immunological biomarker signature of mixed episodes and MLR levels in BD have less been studied. Our study included 48 bipolar patients in a mood episode (28 manic, 20 mixed) and 32 controls. Study-specific form including sociodemographic and clinical variables with laboratory findings were filled for all participants. Red cell distribution width (RDW), mean platelet volume (MPV) neutrophil, lymphocyte and platelet count, NLR, PLR, and MLR were recorded. PLR and MLR were found significantly higher in bipolar patients compared to controls while NLR and MLR were significantly higher in manic patients than in mixed patients. RDW was found higher in mixed episode compared to controls. One can interpret these findings as MLR would be considered as a novel state biomarker for bipolar mood episodes and greater inflammatory activation may be involved in mania rather than mixed episode (Tab. 2, Fig. 1, Ref. 35).

Examination of Neutrophil, Platelet, Monocyte-Lymphocyte Ratios in Adolescents with Bipolar Disorder-Manic Episode and Depression

Examination of Neutrophil, Platelet, Monocyte-Lymphocyte Ratios in Adolescents with Bipolar Disorder-Manic Episode and Depression

Lexical Cohesion in Sadegh Hedayat's Letters: The Effect of Bipolar Mood Disorder

This paper makes an attempt to investigate the effect of bipolar mood disorder on the basis of using the lexical cohesion elements (that is, repetition, synonymy, antonymy, hyponymy, and collocation) in a case study approach based on the fact that approximately one percent of people suffer from this kind of affective disorder. Specifically, a large number of artists are afflicted by the very disorder presumably due to their creativity. The private letters of Sadegh Hedayat, mostly known as an Iranian eminent writer suffering from bipolar mood disorder, to Shahid Nourai, one of his friends, are selected as the material of the study. The addressee is kept fixed noticeably to remove the effective linguistic features. Sadegh Hedayat’s letters have been studied regarding mentioned linguistic elements in terms of two major bipolar mood disorder episodes (that is to say, hypomanic and depressive). In the study, all the letters related to hypomanic and depressive episodes are investigated using the elements of lexical cohesion. Furthermore, all the words on the basis of the elements with respect to various ties, i.e. immediate, mediate, and remote, are counted and the averages are evaluated using SPSS with the aim of finding any noteworthy result to discover whether specific psychological mood affects the use of certain lexical cohesion elements or not. Moreover, it explores whether there is any significant difference between bipolar mood disorder and schizophrenia on the basis of previous studies. The statistical analysis shows a highly significant difference concerning antonymy and hyponymy between hypomania and depression. No significant difference is found with respect to repetition, synonymy, and collocation. In addition, the results suggest that the text analyzed in the research is cohesive as regards bipolar mood disorder in contrast to those studies conducted related to schizophrenia.

Cognitive functions in a mixed episode of bipolar affective disorder

Summary. According to various meta-analyzes, most patients with bipolar affective disorder have neurocognitive dysfunction even in remission. In recent studies, moderate to severe impairments have been found in attention, verbal learning and memory, and executive function. Whereas premorbid intelligence remains unchanged. The main body of research is devoted to the study of cognitive impairment in the first episode of bipolar affective disorder, in manic, depressive episodes, and euthymia. At the same time, the features of cognitive dysfunction in mixed forms of bipolar affective disorder remain poorly understood. The aim of the study was to study the characteristics of cognitive functions in patients with a mixed episode of bipolar affective disorder. Materials and methods. With the help of a battery of tests (a test for remembering ten unrelated words; a Ray-Osterritz test; a verbal speed test; a digital character substitution test; a symbol linking test), the cognitive features of 25 patients with a mixed episode, 16 patients with a manic episode, and 15 patients with a depressive episode of bipolar affective disorder. Results and conclusions. Deviations in cognitive function were found in all patients regardless of the type of affective symptomatology. In the form of a wide range of psychopathological phenomena which manifested themselves to a greater extent in patients with a mixed episode of bipolar affective disorder. The peculiarities of the phenomenological structure of cognitive impairment in patients with mixed phase of bipolar affective disorder are manifested in the form of a more pronounced deterioration of verbal memory, information processing speed; more pronounced violations of spatial representations, deterioration of visual memory, verbal associative performance and executive functions; a decrease in attention and a violation of its distribution. The findings suggest that the leading role in the formation of these disorders is played by the presence of depressive symptoms in the clinical structure of affective disorders.

The actigraphic monitoring of bipolar disorder manic episode

The actigraphic monitoring of bipolar disorder manic episode

1000. Jen

1000. Jen Jennifer Tennant (bio) I have an excellent memory. Somewhat encyclopedic. Friends have joked that I remember things that have happened in their lives but they have since forgotten. Remembering is important and comforting to me. It keeps things alive, it affirms, it is a way for me to see myself and truly see others. An act of care for others, a way for current me to care for younger me. But I have no recollection of the day my mom told me that my dad did not, in fact, die in a hiking accident. That he had jumped off the Golden Gate Bridge. The walkway of the Golden Gate Bridge is about 250 feet above the water. The railings are easily scaled and there are no suicide barriers, even though more than 1700 people have died there since the bridge opened in 1937. A barrier wasn't even approved until 2008, but the Bridge board formally delayed the project until 2017. The first bids came in at more than double the original $76 million estimate, threatening to delay construction even further. Construction finally began in April 2017, with a price tag of $200 million. The rationale for no barriers was an aesthetic one. Many people oppose nets and safety barriers because they don't want to obstruct the view. Even if it saves lives, people often don't want a visual representation of human suffering and despair. There might be subconscious cost-benefit analysis at play, as well. A false yet common judgement about suicide victims is that they are lost causes. That expensive barriers are futile, delaying the inevitable. However, in 2016 alone, bystanders helped prevent 200 suicides from taking place at the Golden Gate Bridge—more than one every other day. After jumping, it takes 4 seconds to hit the water. At the moment of impact, a body is falling at 86 miles per hour. The Center for Suicide Prevention in Calgary states that out of the more than 1700 who have jumped off the Golden Gate Bridge over the years, only 25 have survived. The rest die from internal injuries and broken bones, drown in the frigid tumultuous waters that straddle the San Francisco Bay and the Pacific Ocean, or succumb to hypothermia. As we say in my family, it's not the fall that kills you, it's the sudden stop. My dad was 6'3", slender and beautiful, almost all legs. His legs would have scaled the railings very easily. What did his last moments on that June day look like? Did he walk with purpose and go right over the edge in one continuous, unstoppable movement? Did he pace back and forth, convincing himself that this is what he needed to do for himself, for us? Or did he pause and hang on to the railings for a bit before he willed himself to let go? Often when someone takes his or her own life by way of some sharp object, there are hesitation wounds. One of my greatest worries is that someone saw this happen. That someone tried or didn't try to intervene and had to witness terrifying pain. Does this image haunt them still? Do my dad's hesitation wounds mark their bodies? [End Page 74] A couple of days before he died, my dad checked himself into a psychiatric facility in Marin County. Since his teen years, he had dealt with severe bipolar episodes. I don't know what was going on in that particular moment – why this moment seemed more unlivable than others. He had a dentist appointment set for the following week. Why would he have made a dentist appointment – both a mundane task and an act of self-care – if he didn't plan on being alive to go to it? His death couldn't have been completely planned – there must have been an impulsive part of it. A horrible impulse that could never be taken back. Since he checked himself in, he was allowed to check himself out. When he left the facility, he left his will on his bed. On it, he wrote, "Cath can keep the kids." My parents had divorced a...

A Web-Based Intervention for Relatives of People Experiencing Psychosis or Bipolar Disorder: Design Study Using a User-Centered Approach

BackgroundRelatives of people experiencing bipolar mood episodes or psychosis face a multitude of challenges (eg, social isolation, limited coping strategies, and issues with maintaining relationships). Despite this, there is limited informational and emotional support for people who find themselves in supporting or caring roles. Digital technologies provide us with an opportunity to offer accessible tools, which can be used flexibly to provide evidence-based information and support, allowing relatives to build their understanding of mental health problems and learn from others who have similar experiences. However, to design tools that are useful to relatives, we first need to understand their needs.ObjectiveThe aim of this study was to use a user-centered design approach to develop an accessible Web-based intervention, based on the Relatives Education And Coping Toolkit (REACT) booklet, to support the informational and emotional needs of relatives of people experiencing psychosis or bipolar disorder.MethodsWe engaged relatives of people with experiences of bipolar disorder or psychosis in workshops to identify their needs and design requirements for developing a Web-based version of a paper-based toolkit. We used a 2-phase qualitative approach to explore relatives’ views on content, design, and functionalities, which are considered to be engaging and useful in a Web-based intervention. In phase 1, we consulted 24 relatives in 2 workshops to better understand their existing support infrastructure, their barriers for accessing support, unmet needs, and relatives’ views on online support. On the basis of the results of these workshops, we developed a set of design considerations to be explored in a smaller workshop. Workshop 3 then involved working with 2 digitally literate relatives to design a usable and acceptable interface for our Web-based toolkit. Finally, in phase 2, we conducted a heuristic evaluation to assess the usability of the toolkit.ResultsOur findings indicated that relatives require technologies that (1) they can place their trust in, particularly when discussing a highly sensitive topic, (2) enable learning from the lived experiences of others while retaining confidentiality, and (3) they can work through at their own pace in a personalized manner.ConclusionsOur study highlights the need for providing a trustworthy, supportive tool where relatives can engage with people who have similar experiences to their own. Our heuristic evaluation showed promise in terms of perceived usability of the REACT Web-based intervention. Through this work, we emphasize the need to involve stakeholders with various characteristics, including users with limited computer literacy or experience in online support.

Bright Light Therapy in the Morning or at Mid-Day in the Treatment of Non-Seasonal Bipolar Depressive Episodes (LuBi): Study Protocol for a Dose Research Phase I / II Trial.

ObjectiveThis study protocol aims to determine, using a rigorous approach in patients with bipolar disorder (BD) and non-seasonal major depressive episode (MDE), the characteristics of bright light therapy (BLT) administration (duration, escalation, morning and mid-day exposures) depending on the tolerance (hypomanic symptoms). MethodsPatients with BD I or II and treated by a mood stabilizer are eligible. After 1 week of placebo, patients are randomized between either morning or mid-day exposure for 10 weeks of active BLT with glasses using a dose escalation at 7.5, 10, 15, 30 and 45 minutes/day. A further follow-up visit is planned 6 months after inclusion. Patients will be included by cohorts of 3, with at least 3 days of delay between them, and 1 week between cohorts. If none meet a dose limiting toxicity (DLT; i.e hypomanic symptoms), the initiation dose of the next cohort will be increased. If one patient meet a DLT, an additionnal cohort will start at the same dose. If 2 or 3 patients meet a DLT, from the same cohort or from two cohorts at the same dose initiation, the maximum tolerated dose is defined. This dose escalation will also take into account DLTs observed during the intra-subject escalation on previous cohorts, with a “Target Ceiling Dose” defined if 2 DLTs occured at a dose. DiscussionUsing an innovative and more ergonomic device in the form of glasses, this study aims to better codify the use of BLT in BD to ensure a good initiation and tolerance. Trial registrationClinicalTrials.gov Identifier: NCT03396744.