Bipolar Patient Research Articles

Hipersexuality in aripiprazole treatment : A case report

IntroductionAripiprazole is an antipsychotic that differs from the group in that it is a partial agonist of the D2 receptor, being also a partial agonist of 5HT1A and an antagonist of 5HT2A.Most antipsychotics cause a decrease in libido, affecting both sexual desire and function. According to the literature, D2 partial agonists can cause the appearance of compulsive behaviors as an adverse effect in 6-24% of patients. Among these behaviors you can find hypersexuality. In most cases, it subsides when treatment is stopped. We describe the case of a patient with bipolar disorder who develops hypersexual behaviors following the aripiprazole treatment. This is a 61-year-old bipolar patient receiving valproate and risperidone. It requires hospital admission due to manic symptoms where dysfunctional tremor is observed. Change from risperidone to aripiprazole. Subsequently, hypersexual behaviors appear, increased libido, obsession with sexual activities (compulsive masturbation with TV programs, mobile applications, cartoons) as well as delusional ideas about “receiving sexual gazes” with no other maniac symptomps.ObjectivesTo determine the possibility that hypersexuality was induced by treatment with aripiprazole.MethodsThe appearance in the time line of hypersexuality after the change of treatment would be indicative of causality.ResultsAfter switching back to risperidone, compulsive sexual behaviors disappear but not the delusional idea of being the focus of sexual gazes by everyone.ConclusionsAlthough it is not a common adverse effect, hypersexuality is listed in the literature as a rare adverse effect.DisclosureNo significant relationships.

Using polygenic scores and clinical data for bipolar disorder patient stratification and lithium response prediction: machine learning approach.

Response to lithium in patients with bipolar disorder is associated with clinical and transdiagnostic genetic factors. The predictive combination of these variables might help clinicians better predict which patients will respond to lithium treatment. To use a combination of transdiagnostic genetic and clinical factors to predict lithium response in patients with bipolar disorder. This study utilised genetic and clinical data (n = 1034) collected as part of the International Consortium on Lithium Genetics (ConLi+Gen) project. Polygenic risk scores (PRS) were computed for schizophrenia and major depressive disorder, and then combined with clinical variables using a cross-validated machine-learning regression approach. Unimodal, multimodal and genetically stratified models were trained and validated using ridge, elastic net and random forest regression on 692 patients with bipolar disorder from ten study sites using leave-site-out cross-validation. All models were then tested on an independent test set of 342 patients. The best performing models were then tested in a classification framework. The best performing linear model explained 5.1% (P = 0.0001) of variance in lithium response and was composed of clinical variables, PRS variables and interaction terms between them. The best performing non-linear model used only clinical variables and explained 8.1% (P = 0.0001) of variance in lithium response. A priori genomic stratification improved non-linear model performance to 13.7% (P = 0.0001) and improved the binary classification of lithium response. This model stratified patients based on their meta-polygenic loadings for major depressive disorder and schizophrenia and was then trained using clinical data. Using PRS to first stratify patients genetically and then train machine-learning models with clinical predictors led to large improvements in lithium response prediction. When used with other PRS and biological markers in the future this approach may help inform which patients are most likely to respond to lithium treatment.

Clinical considerations with use of psychotropic medications in COVID-19 patients

Clinical considerations with use of psychotropic medications in COVID-19 patients

Succesful ECT treatment of a treatment resistant manic bipolar patient with intracranial mass and pulmonary embolism history: Case report (eng)

Succesful ECT treatment of a treatment resistant manic bipolar patient with intracranial mass and pulmonary embolism history: Case report (eng)

Severe Hypothyroidism in a Hypomanic Patient With Sepsis.

Few cases of hypothyroidism in the setting of hypomania or mania have been documented. Moreover, infection and inflammation are risk factors that can precipitate mania. Here, read about a bipolar patient with hypomania, severe hypothyroidism, and sepsis.

Ekbom’s syndrome in a bipolar disorder patient: a case report

Introduction: Ekbom syndrome is a rare condition in which the patient believes that his or her body is infested by worms or other parasites.This condition is associated to mental ilness in 81% of cases. There is not a final statement about the best psychofarmacological treatment of this condition. Objective: The present study presents a case report on which an elderly woman with bipolar disorder has shown Ekbom syndrome. Method: This study lists a case report of a 69 yerar-old woman with bipolar disorder. This patient had presented the belief that worms were walking under her skin during the past few months. She had a previous diagnosis of bipolar disorder. Depressive symptoms were intense. The patient was followed up in an outpatient psychiatric service for 120 days. Lurasidone was introduced and some drugs were discontinued. Result: One month after starting treatment with lurasidone, there was a significant improvement of delusional beliefs of Ekbom syndrome. Such improvement was associated with the improvement of the bipolar depressive condition in this case. Conclusion: Ekbom syndrome is a rare kind of delusion. Its etiology is not fully understood. We presented a case of an elderly woman with previous diagnosis of bipolar disorder with Ekbom syndrome. To our knowledge, there are no other case reports informing the use of lurasidone in bipolar depression associated with Ekbom syndrome.

Hubungan Terapi Kombinasi Mood Stabilizer dan Antipsikotik dengan Kemampuan Fungsional Pasien Gangguan Afektif Bipolar di Rumah Sakit Jiwa Grhasia Yogyakarta

Bipolar disorder is a mental illness that can affect the functional abilities of the patients. It is persistent even in a euthymic condition. There have been number of studies on the effectiveness of mood stabilizer and antipsychotic therapy in bipolar disorder, but there is still few studies related to the effect of the combination therapy of mood stabilizer and antipsychotics on bipolar patient’s functional ability. The objectives of this study is to determine the associatioin of valproate and lithium combined with antipsychotics on functional ability of bipolar disorder patients at Grhasia Mental Hospital Yogyakarta. The study design was cohort retrospective. The data was collected from medical record. The subjects were patients who were hospitalized and undergone therapy combination mood stabilizer and antipsychotics in January-December 2018. Total of 46 patients, 38 received valproate + antipsychotic and 8 patients received lithium + antipsychotic. There was no significant association between the combination therapy group on the patient’s functional abilities [ Odds Ratio (OR) = 1,71; 95% Confidence Interval (CI): 0,37-7,95 ; p = 0,963].

O manejo odontológico do paciente bipolar em litioterapia, com ênfase para a cárie dentária, no método clínico de intervenção : estudo de casos

The present work is a case study of 8 bipolar patients under lithium therapy, being all of them members of the lithium group of the Hospital de Clínicas de Porto Alegre. It describes the dental management of bipolar patients under lithium therapy, emphasizing dental caries and the clinical method of intervention. The work was divided into three phases, existing a ninety-day interval between each ofthem. In the first part ofthe research, dental examinations were carried out and the patients were interviewed with the special purpose of describing each one of them regarding his buccal health. They were also inquired about their experience in living with the bipolar disease, about the medication taken and its side effects. The patients received dental treatment according to the clinical method as they also attended health educational sessions destined to increase their autonomy up to the dental dismissal. In the second and third phases, the exams that had been carried out in the first phase were repeated in order to analyze the commitment of each bipolar patient to the proposed dental treatment. The questions about the relationship between the bipolar patient and the treatment of this disease were also repeated. It was concluded that the results of the dental exams were related to the degree of stabilization of the bipolar disease; the patients detaining the best results in the dental treatment were those who had the bipolar disease stabilized. It was concluded that, having in mind the occurrence frequency of bipolar disease, it would be plausible that a denfist who works in the Public Service sooner or later would attend bipolar patients; bipolar patients are a peculiar population group that need a specific dental program; the planning and scheduling of these specific odontological programs for bipolars should take into account the disruptions in the dental therapy, caused by the disease and it is also necessary to renegotiate with the bipolar, his responsibilities and his motivation for buccal self-care, which will result in more frequent dental visits.

Bipolar Patients and Bullous Pemphigoid after Risperidone Long-Acting Injectable: A Case Report and a Review of the Literature.

Neuropsychiatric disorders are found to be associated with bullous pemphigoid (BP), an autoimmune subepidermal blistering disease. Antipsychotics have emerged as possible inducing factors of BP. However, large sample studies concerning BP associated with antipsychotics, as well as with specific mental disorders, are still lacking. Our review retrieved a few clinical studies and case reports on the topic, producing controversial results. We report for the first time a bipolar patient case presenting BP following five-month therapy with risperidone long-acting injectable (LAI). We hypothesize that the dermatological event is associated with the medication administered. The issue emerged during psychiatric consultation and was confirmed by histological examination, direct and indirect immunofluorescence studies, plus positive plasma and cutaneous BP180 and BP230 IgG. Neurodegeneration or neuroinflammation might represent a primary process leading to a cross-reactive immune response between neural and cutaneous antigens and contributing to self-tolerance failure. Furthermore, the time sequence of the shared biological mechanisms leading to clinical manifestations of the neuropsychiatric disorder and BP remains undefined. BP comorbid with bipolar disorder might occasionally represent a serious health risk and affect patients’ physical and psychosocial quality of life. Thus, clinicians treating psychiatric patients should consider BP as a possible adverse effect of psychotropic medications.

530 - The effects of lithium and inflammation on the atherosclerosis of older bipolar patients at high risk for cardiovascular disease

Background:Atherosclerosis can result in serious cardiovascular disease (CVD) and is associated with inflammation and psychopharmacological treatment in bipolar disorder. We attempt to investigate the effects of lithium and inflammation on the atherosclerotic development in older bipolar adults at high risk for cardiovascular disease.Methods:The euthymic out-patients with bipolar I disorder aged over 45 years and concurrent endocrine or cardiovascular disease were recruited to measure their bilateral carotid intima media thickness (CIMT) and circulating levels of lithium, valproate, sTNF-R1, sIL-6R, and lipid profile. All clinical information were obtained by directly interviewing patients and reviewing all medical records.Results:Forty eight patients with mean 48.3 years old and mean 27.2 years of age at illness onset were recruited. After controlling for the body mass index, multivariate regression analyses showed that older age, lower lithium level, and higher plasma sTNF-R1 level were associated with higher CIMT and collectively accounting for 33.1% of the variance in CIMT. Blood level of low density lipid or valproate has none relationship with CIMT.Conclusion:Lithium treatment may protect older bipolar patient, even those at high risk for CVD, from atherosclerotic development. Furthermore, persistent inflammatory activation, particularly macrophage activation, may be associated with the accelerating development of atherosclerosis.

Lamotrigine induced Blepharospasm in a bipolar depression type-ii: A case report

The association of extrapyramidal side effects (EPS) with the use of conventional antipsychotics is well established, however, EPS can occur during treatment with anticonvulsant medications as well. There are several case reports of the development of involuntary movement disorders including chorea and tic disorder after lamotrigine (LTG) treatment. However, LTG-induced involuntary eyelid movement disorder is extremely rare. Most of this side effect was reported in patients with partial and generalized seizures, and only very few cases were in nonepileptic patients. In contrast, we present the case of 42 years old bipolar patient who developed blepharospasm during LTG therapy and again during re-challenge with the same agent. The focus of discussion will be on common side effects of this medication and previous reports of lamotrigine associated blepharospasm. We will also discuss a possible underlying mechanism.

Possible Antidepressant Effects of Memantine-Systematic Review with a Case Study.

The treatment of bipolar depression is hampered by the inadequate efficacy of antidepressants, moderate effect of mood stabilizers, and the side effects of some second-generation antipsychotics. There is limited evidence to date regarding the antidepressant effects of memantine in bipolar depression. The aim of the article was to provide a short review of preclinical and clinical studies on the antidepressant effect of memantine, and to present the case of a bipolar depression patient successfully treated with memantine. The described patient with bipolar disorder was unsuccessfully treated with two mood stabilizers. The addition of memantine at a dose of 20 mg/d to the treatment with lamotrigine and valproic acid resulted in a reduction in the severity of depression measured on the HDRS-17 scale by 35%, and by 47.1% after 7 weeks. The discussion presents experimental evidence for the antidepressant effect of memantine, as well as data from clinical trials in recurrent and bipolar depression. The presented case is the second report in the medical literature showing the antidepressant effect of memantine as an add-on treatment for bipolar depression. The described case and literature analysis indicate that memantine may be an effective and safe method of augmentation of mood stabilizing therapy in bipolar depression.

Daily ratings of mood and sleep duration over 3.3 years are associated with the lunar illumination cycle in a rapid cycling bipolar patient.

Previous reports from a single research group have described changes in mood in rapid cycling bipolar patients that are associated with the lunar cycle. In many cases, there is more positive mood around the time of the full moon, and more negative mood around the time of the new moon, in accordance with the lunar illumination cycle period of ~29.5 days (the equivalent of two spring-neap cycles).

That’s not my family: The undercover bipolar patient

IntroductionBipolar disorder is a serious psychiatric condition based on depressive, manic, and mixed phases. Bipolar disorder has been usually divided into type I (manic phases and depressive phases) and type II (hypomanic and depressive phases). Furthermore, subsequent classifications have been developed based on subtypes complexity.ObjectivesA case of a 52-year-old man is presented. The patient had suffered depressive symptoms and self-destructive ideation. He had sold his house to pay for drugs and prostitution, even though he was in quarantine for COVID-19. The patient had a history of depressive episodes with milder manic episodes which had been treated with antidepressants.MethodsAnalytical and imaging tests were performed without findings. Mood stabilizing treatment was started based on lithium salts. He became perplexed and suspicious of the medication. Auditory hallucinations appeared congruent with the mood and he began to think that his relatives were dead; the patient started to communicate via telephone with actors. A treatment based on olanzapine 30mg/d was started.ResultsThe clinic was resolved with antipsychotic treatment. The diagnosis of Bipolar Disorder has been made in youth; however, some patients symptoms could be camouflaged and allow a functional life. Depressive episodes could present with psychotic symptoms and predispose more to suicide attempts than manic phases.ConclusionsThe early-stage diagnosis should play a key role on bipolar disorder control. More public and clinic efforts are needed to prevent non-easily distinguishable cases which could derived on serious social and health problems.DisclosureNo significant relationships.

Quetiapine associated tics in a pediatric patient post overdose on re-initiation: An interesting clinical scenario

The COVID-19 pandemic has led to a multitude of new medical and psychiatric complications and new presentations that were either never seen before or not seen to the extent that they are presenting now. [1,2]. Increased number of suicide attempts and worsening severity of suicide attempts have been noted in the past year since the COVID-19 pandemic has started [1]. Psychotropic medications can often have lesser-known side effects and movement disorders, including tics, can be one of them [3]. Tics are recurrent, simple or complex behaviors that can be motor or phonic in nature [4,5]. Simple motor tics are often observed as rapid movements while complex motor tics are more synchronized and elaborate. Additionally, noises or brief sounds are examples of simple vocal tics, while speaking a string of words or syllables are more characteristic of a complex vocal tic [4]. The underlying pathogenesis of tics and tic disorders has not been well elucidated, dopaminergic hypothesis being the most widely accepted; however, multiple areas of the brain are speculated to be involved [4,6]. Common treatment options for tic disorders include alpha-2 agonists, clonidine and guanfacine, and antipsychotics [4,7]. Previous literature identifies two case reports that documented tics related to quetiapine. One report described a pediatric bipolar patient who developed tics proportional to quetiapine dose [8], and the other report identified an adult patient with schizophrenia who developed tics during quetiapine therapy [9]. In this article, we describe a pediatric patient who presented after overdosing on quetiapine, lamotrigine and sertraline and developed tics after re-initiation of quetiapine at a much lower dose. To the best of our knowledge, this is the first case of its kind where tics, which were previously absent, developed on re-initiation of quetiapine after an overdose.

Odour identification impairment is a trait but not a disease-specific marker for bipolar disorders: Comparisons of bipolar disorder with different episodes, major depressive disorder and schizophrenia.

Olfactory deficits have been reported in bipolar disorder, but this finding is controversial. This study investigated whether olfactory deficit can serve as a specific marker for bipolar disorder by comparing olfactory function in different mood episodes of bipolar disorder. We also compared olfactory function in bipolar disorder and other mental disorders - namely, major depressive disorder and schizophrenia. The study consisted of two experiments. Experiment 1 enrolled 175 bipolar disorder patients (70 depressed subgroup, 70 manic subgroup and 35 euthymic subgroup) and 47 controls. Experiment 2 enrolled the participants from Experiment 1, along with 85 major depressive disorder and 90 schizophrenia patients. The Sniffin' Sticks test was used to evaluate odour identification ability and odour threshold (as a measure of odour sensitivity). The Hamilton Depression Rating Scale and Young Mania Rating Scale were used to assess depressive symptoms in all subjects and manic symptoms in bipolar disorder patients, respectively. We also used the Positive and Negative Syndrome Scale to assess clinical symptoms in schizophrenia patients. All three bipolar disorder patient subgroups (depressed, manic and euthymic subgroup) showed reduced odour identification ability compared to controls; however, only patients in the acute phase of a mood episode (depressed, and manic subgroup) showed impaired odour sensitivity. Clinical symptoms were negatively correlated with odour sensitivity but not odour identification ability. Bipolar disorder and major depressive disorder patients showed less odour identification and sensitivity impairment than schizophrenia patients. Odour sensitivity is a potential dopaminergic marker for distinguishing between bipolar disorder patients in acute phase vs remission, while odour identification is a trait but a nonspecific marker of bipolar disorder.

DEMOGRAPHIC VARIABLES ASSOCIATED WITH DRUG USE IN BIPOLAR PATIENTS

Background: Substance Use is highly associated with bipolar affective disorder, however the reason for the co-occurrence is unknown. It was evident that if a bipolar patient use drug of abuse his outcome will be poor. Either it can directly trigger the affective symptoms, or may affect the treatment compliance indirectly.
 Aims: The objective of this study was to study the demographic correlates of drug abuse in patients with bi-polar affective disorder.
 Method: Cross-Sectional research design and non-probability consecutive sampling was used to collect data from a private clinic in Lahore. Data was comprised of 368 patients of bipolar disorder.
 Results: Out of a total of 368 bipolar patients, drug abuse was found in 147 patients that is 39.9%. The results showed that the mean age of the patients was 31.03 ±5.837; mean monthly income was 229597.82 ±164626.77 PKR. The mean duration of illness was 6.54 ±5.157. The mean number of drugs used was 2 ±0.875. The mean cost of drug was 29945.7 ±19068.8 PKR. The mean number of hospitalization was 2.47 ±1.694. Association between drug use and occupation of bipolar patients (0.006), factors leading to initiation of drug use (0.000), family history of drug use (0.001), current episode (0.000) and the type of drugs used (0.000) was statistically significant.
 Conclusion: The cause and effect relationship between drug use and bipolar disorder cannot be clearly identified. However occupation of the patient, reasons of initiating drugs, drug abuse in family, current episode as well as type of drugs used have significant association with drug abuse in bipolar patients .

Religious Behavior And Self-Defense Method: A Study Of Patient With Bipolar Disorder

Human life is dynamic in maintaining the balance of their soul. Life problems such as family conflict have an impact on mental balance. This study analyzed a bipolar patient, based on the result of observation, in-depth interviews, and relevant documents from one of the mental hospitals. Freud and Jung were chosen as a method for analyzing the concept of self-defense. The purpose of the study was to analyze bipolar psychiatric condition by finding the factors that influenced it. The findings revealed that life experience formed spirituality with zikir continually and practiced prayer despite the bipolar condition. Self-defense by continuing to maintain religious behavior as religious healing is one of the alternative solutions by involving the role of the family.

Lithium: The best current treatment for the well-informed bipolar patient.

Lithium is the gold standard in the maintenance treatment of bipolar disorders. When used properly, lithium can bring about dramatic improvements in the course of this disease, with, in general, good tolerability, also in comparison with other approved treatment options. However, it's not a panacea for every individual patient at every stage of the disease. There is a significant number of patients who do not respond to or do not tolerate the usually recommended therapeutic serum concentrations of 0.6 - 0.8 mmol/l. Given its potential toxicity, lithium is a drug for the informed cooperating patient, who has developed an acceptance regarding his illness and the need for long-term medication and regular check-ups. High-quality group psychoeducation may greatly help for the majority of patients for successful long-term treatment with lithium, based on "shared decision making" with an openness to flexible patient-centered solutions with regard to dosage issues, side effect management and stand-by add-on/combination treatment. Under the above conditions, lithium should be offered and recommended to every patient with bipolar disorders early in the course of the disease as the mainstay of long-term treatment. Against this background, lithium should also be used more often in the acute treatment of manic episodes, if needed in combination with other mood stabilizing drugs that are approved for this purpose and may have a more rapid onset of action, in order to facilitate the path to successful long-term treatment with lithium.

Bariatrik Cerrahi Sonrasında Lityum Düzeyi Etkilenir mi?

Giriş: Kronik hastalık sebebiyle ilaç kullanımı olan hastalarda, bariatrik cerrahi sonrasında ilaç dozları ayarlanmalıdır. Bariatrik cerrahi sonrası oral alınan ilaçların farmakokinetiği ile ilgili çalışmalar sınırlıdır. Biz de bariatrik cerrahi sonrasında lityum kullanımına devam etmesi gereken genç bipolar erkek obez hastamızı sunacağız. Olgu: 26 yaşında erkek hasta son 1 yılda 20 kilo alımı sebebiyle başvurdu. Hasta 2 yıldır bipolar bozukluk (BPB) tanısıyla, risperidon 2 mg 1x1 tablet ve lityum 1x3 kapsül kullanıyordu. Astım tanısı olan hastanın düzenli inhaler kullanımı yoktu. Fizik bakıda; vücut ağırlığı: 195 kg, boy: 184 cm, vücut kütle indeksi: 57.5 kg/m2 ve vital bulgular stabil saptandı. Akciğer muayenesinde ronkuslar saptandı; diğer sistem muayeneleri normal sınırlardaydı. Laboratuar bulgularında; glukoz: 480 mg/dL, kreatinin: 0.9 mg/dL, ALT: 65 U/L, AST: 28 U/L, Na: 143 mmol/L, K: 4 mmol/L, HDL: 26 mg/dL, LDL: 165 mg/dL, Trigliserid: 200 mg/dL, HbA1c: %8.5 saptandı. Tip 2 diyabet tanısıyla, eksenatid 5 mcg 2x1 subkütan ve metformin 1000 mg 2x1 tb başlandı ve kan şekeri regülasyonu sağlandı. Psikiyatri tarafından değerlendirilen hasta BPB açısından stabil seyretti ve serum lityum düzeyi: 0.5 mEq/L saptandı. Bariatrik cerrahi konseyinde değerlendirildi ve laparoskopik Roux-n-Y gastrik bypass (RYGB) cerrahisi planlandı. Postoperatif pulmoner komplikasyonları azaltmak için perioperatif beta2 agonist inhaler tedavi başlandı. RYGB uygulanan hastaya postoperatif dönemde metformin veya eksenatid verilmedi. Bariatrik cerrahi diyeti verilen hastanın kan şekeri regülasyonu antidiyabetik bir ajana ihtiyaç duyulmadan sağlandı. Hasta postoperatif dönemde lityum ve risperidonu tolere edemedi ve bu sebeple hastaya sublingual olanzapin 10 mg başlandı. Daha sonra postoperatif 1.ayda risperidon im 25 mg 2 haftada bir uygulanmaya başlandı. İntolerans sebebiyle postoperatif 6. aya kadar lityum verilmedi. Postoperatif 6. ayda lityum 1x1 kapsül başlandı, doz haftada bir tedricen 1x3 kapsüle çıkıldı. Tedavinin 1. ayında bakılan lityum düzeyi 0.21 mEq/L, 6. ayında 0.129 mEq/L ölçüldü. Efektif lityum düzeyi sağlanamadı. Sonuç: Bulantı sebebiyle postoperatif lityum kullanımı zorlaşmaktadır. Hastamızda postoperatif 6. aydan sonra lityum düzenli verilebildi ancak serum lityum düzeyi referans aralığına ulaşmadı. BPB’de bariatrik cerrahi sonrasında lityum kullanımı ile ilgili geniş çalışmalara ihtiyaç vardır.