Bipolar Affective Disorder Research Articles

Bipolar Disorder with History of Physical Abuse and Comorbid Polycythemia Vera: a Case Report

Introductions: Based on a 2015 United Nations Children’s Fund (UNICEF) report, violence against children is widespread in Indonesia; 40% of 13–15-year-old children reported being physically assaulted at least once a year, 26% reported being physically abused by a parent or caregiver, and 50% reported being bullied at school. Case: A 23-year-old female patient, Hindu, Balinese, unmarried, and unemployed, came alone to the psychiatric polyclinic of Wangaya Hospital. From history taking, there was dizziness, anhedonia, impaired attention, reduced self-esteem and confidence, guilt and uselessness, reference ideas, somatic delusions, relationship mood, logorrhea and flight of ideas, a history of mixed-type insomnia, and excessive energy. In a general examination, there were icteric sclera and palpable enlargement of the spleen (Schuffner 4). Neurological examination within normal limits. Discussion: The patient has bipolar disorder, caused by a traumatic experience in childhood. The patient was found to have a history of repeated treatment; she was initially diagnosed with bipolar disorder and received Depakote 250 mg and Clobazam 10 mg. Then, the patient came for treatment again at Wangaya Hospital on August 30, 2021, because of a headache and was diagnosed with bipolar affective disorder, with the current episode being moderately depressive with somatic symptoms. Conclusion: Traumatic childhood events are a risk factor for bipolar disorder. In addition to poor clinical presentation, the early onset of bipolar disorder is also an aggravating factor for symptom recurrence. Polycythemia vera can be a complicating factor in the recovery and relapse of bipolar disorder.

Graves Disease Presenting Psychosis: a Case Report

Introductions: Graves’ disease is the most common cause of hyperthyroidism. Neuropsychiatric manifestations may occur in thyroid disease. As the premier clinical manifestation of Graves disease, psychosis is highly uncommon; it was reported in 1% of cases. The major neuropsychiatric manifestations of hyperthyroidism are acute psychosis, dementia, apathy, agitation, mania, delusional behavior, and hallucinations, especially in older people. Psychosis is highly rare as the first clinical symptom of a grave disease. Case: A 48-year-old female with grave disease symptoms had been taken to the emergency department with psychotic manifestations. She had a three-month history of increasing irritability, increasing irrational talking, staying awake most of the night, muttering, night-time wandering, and poor personal hygiene. She was admitted to the hospital, and the laboratory investigations showed an elevated FT4 and a decreased thyroid-stimulating hormone (TSH). The patient was started on propanolol 3 x 10 mg, propylthiouracil 3 x 50 mg tab, risperidone 2x2mg, trihexylphenidil 2x2mg, lorazepam 1x2mg, and Zyprexa injection once, which showed improvement in psychotic symptoms. Conclusion: Graves’ disease can present with neuropsychiatric manifestations such as psychosis, mania, or a combination of both. A detailed medical history and physical and psychiatric evaluation are necessary for diagnosing and giving adequate treatment. A detailed clinical evaluation, including thyroid function tests, could be recommended for all patients who showed psychotic symptoms. More research is needed to comprehend the pathophysiology underlying psychosis due to Graves’ disease, so that it is expected that the management can be carried out properly.

Factors that can influence neurocognitive performance: a case study in a controlled environment

ABSTRACT This is a case study of a patient in her 50s who presents with severe malnutrition, alcohol dependence, and untreated Bipolar Affective Disorder. She was hospitalized multiple times and placed in a group home 1 year after symptom onset. Cognitive and functional improvements are observed over a 6-year period, as demonstrated by 3 comprehensive neuropsychological evaluations. Residing in a monitored and structured environment for 6 years, with stability in psychiatric medications, monitored nutrition and abstinence from alcohol are attributed to this improvement. This study provides unique evidence of the impact of balanced nutrition and improvements in psychiatric symptoms on cognition.

Влияние атипичных антипсихотиков на развитие сахарного диабета 2-го типа

Atypical antipsychotics (novell atypical generation antipsychotics) have entered clinical practice recently, but despite this, they have already managed to occupy one of the leading positions in modern therapy of mental disorders such as schizophrenia and bipolar affective disorder. It is known that treatment with antipsychotics of both generations is associated with a number of side effects. When using atypical antipsychotics, metabolic disorders, including carbohydrate metabolism, occupy a leading place. A number of scientific studies, the analysis of which we are conducting in this review, describe the mechanisms of development of such changes in glucose homeostasis as hyperglycemia and insulin resistance in patients receiving therapy with second-generation antipsychotics (atypical). Another proven side effect is an increase in appetite and an increase in body weight. It is obvious that such metabolic changes have the potential to lead to the development of type 2 diabetes mellitus in the long term. The relevance of the study lies in the fact that the use of atypical antipsychotics is not always among the causes of drug-induced diabetes mellitus. In this regard, not all internists, endocrinologists, general practitioners, and sometimes even psychiatrists consider patients receiving treatment with these drugs to be at increased risk. Consequently, primary and secondary prevention of diabetes mellitus among such patients may not be carried out or may be insufficient. In this review, through meta-analysis, we summarized data on the effect of the main representatives of atypical antipsychotics on the possibility of developing type 2 diabetes mellitus, and also examined in more depth the pathogenesis of carbohydrate metabolism disorders in patients receiving therapy with these drugs.

Evaluation of Chemotherapy-Related Mania in Cancer Patients

Objective: This study aims to evaluate chemotherapy-related mania in cancer patients. Methods: The mania status of 153 cancer patients who received chemotherapy was compared by applying the Young Mania Rating Scale before starting chemotherapy and after one session of the chemotherapy regimen. Results: When the mania total scores before and after treatment were compared according to the chemotherapeutic agents, it was seen that the post-treatment mania total scores increased in those using Fluorouracil-Folinic Acid-Oxaliplatin (Folfox) (p=0.014) and paclitaxel (p=0.036) chemotherapy regimens. In 8 (5.2%) patients who received the Folfox regimen, the mild mania score exceeded 20 points. Conclusions: Although the blood-brain barrier protects the central nervous system from the toxicity of many drugs, it is known that the stress of cancer diagnosis and some chemotherapeutics used in treatment cause disorders such as acute confusion, depression, and mania. In our study, as in case-based publications in the literature, a statistically significant increase in the total mania score was found in the Folfox regimen due to 5-fluorouracil's ability to cross the blood-brain barrier easily. According to published case reports in the literature, the possibility of mania symptoms appearing in the second, third, and sometimes subsequent sessions should be taken into consideration due to cumulative or delayed side effects of the drugs

The overlap across psychotic disorders: A functional network connectivity analysis

Functional network connectivity (FNC) has previously been shown to distinguish patient groups from healthy controls (HC). However, the overlap across psychiatric disorders such as schizophrenia (SZ), bipolar (BP), and schizoaffective disorder (SAD) is not evident yet. This study focuses on studying the overlap across these three psychotic disorders in both dynamic and static FNC (dFNC/sFNC). We used resting-state fMRI, demographics, and clinical information from the Bipolar–Schizophrenia Network on Intermediate Phenotypes cohort (BSNIP). The data includes three groups of patients with schizophrenia (SZ, N = 181), bipolar (BP, N = 163), and schizoaffective (SAD, N = 130) and HC (N = 238) groups. After estimating each individual's dFNC, we group them into three distinct states. We evaluated two dFNC features, including occupancy rate (OCR) and distance travelled over time. Finally, the extracted features, including both sFNC and dFNC, are tested statistically across patients and HC groups. In addition, we explored the link between the clinical scores and the extracted features. We evaluated the connectivity patterns and their overlap among SZ, BP, and SAD disorders (false discovery rate or FDR corrected p < 0.05). Results showed dFNC captured unique information about overlap across disorders where all disorder groups showed similar pattern of activity in state 2. Moreover, the results showed similar patterns between SZ and SAD in state 1 which was different than BP. Finally, the distance travelled feature of SZ (average R = 0.245, p < 0.01) and combined distance travelled from all disorders was predictive of the PANSS symptoms scores (average R = 0.147, p < 0.01).

Affective disorders in patients with epilepsy: primary process or consequence of paroxysmal activity?

The high prevalence of primary affective disorders in patients with epilepsy is beyond doubt. However, patients in this group are often identified as suffering from mood disorders that do not fulfil the criteria for primary mood disorders, such as recurrent depressive disorder and bipolar affective disorder. The aim of this paper is to analyze the classification and clinical picture of affective disorders in patients with epilepsy and differential diagnostic approaches to identify primary affective disorders and secondary affective disorders in epilepsy. A set of diagnostic signs for the differential assessment of affective disorders in patients with epilepsy is presented. Research of affective pathology in patients with epilepsy and the development of strategies for its successful treatment are still needed.

Effectiveness of Evidence-Based Psychosocial Interventions on Recurrence of Symptoms in Adolescents with Bipolar Spectrum Disorders: A Systematic Review Study

Introduction: Considering the problems of emotion regulation and social skills in adolescents with bipolar spectrum disorders, one of the methods that can help these adolescents is psychosocial intervention. Therefore, the aim of the present study was to investigate the effectiveness of evidence-based psychosocial interventions on the recurrence of symptoms in adolescents with bipolar spectrum disorders. Methods: In the present study, keywords like psychosocial intervention, recurrence, bipolar disorder, bipolar and related disorders, and adolescence were selected based on the database of medical subject headings (MeSH) and searched on English databases such as Scopus, PsycINFO, PubMed, Web of Science, and Google Scholar in the period of 2008 (from March) to 2023 (until December). In this study, the PRISMA systematic review study reporting guide was used. Results: The results of the conducted research indicated the existence of problems in the sleep schedule, emotion regulation, social functioning, and problem-solving skills of these adolescents. Although drug interventions were the front line of mania treatment, psychosocial interventions using models such as psychoeducation, cognitive-behavioral therapy focused on children and families, dialectical behavior therapy, and interpersonal as well as social rhythm therapy has helped the process of treatment stability and effectively prevent the symptoms of the disorder from returning. Conclusion: Early psychosocial treatment, along with pharmacotherapy intervention, can reduce the negative impact of symptoms and lead to improved short-term and long-term outcomes by equipping adolescents and their families with knowledge and skills to improve understanding and management of the disorder.

Comparative Study of Stigma and Its Correlates in Caregivers and Patients of Schizophrenia and Bipolar Affective Disorder

Abstract Objective: Stigma is very common among patients and caregivers of patients with severe mental disorders; however, there is a lack of comparative study data between schizophrenia and bipolar affective disorder in the Indian setting. Methods: For this, caregivers of patients with schizophrenia (n = 50) or bipolar affective disorder (n = 50) were assessed on the Affiliate Stigma Scale (ASS). Patients with schizophrenia (n = 50) or bipolar affective disorder (n = 50) were assessed on the Internalized Stigma of Mental Illness Scale (ISMIS). Results: Patients and caregivers of patients with schizophrenia have significantly higher mean scores on ISMIS and ASS, respectively, as compared to patients and caregivers of patients with bipolar affective disorder. Conclusion: This study suggests that patients with schizophrenia and their caregivers experience higher stigma than the caregivers of patients with bipolar affective disorder. Higher stigma is associated with higher psychological morbidity in the patients and caregivers. Therefore, clinicians managing patients with severe mental disorders must focus on stigma and psychological distress among the patients and caregivers and plan intervention strategies to reduce stigma.

A Comparative Study of Internalized Stigma in Patients with Schizophrenia and Bipolar Affective Disorder in Remission

Background: Internalized stigma experienced by individuals with schizophrenia and bipolar affective disorder dramatically affects their overall quality of life. While several studies have explored this topic, there remains a scarcity of research comparing internalized stigma across both these illnesses. We investigated and compared how internalized stigma is associated with different socio-demographic factors among individuals diagnosed with schizophrenia and bipolar affective disorder in remission. Aim: To carry out a comparative study of the internalized stigma experienced by patients with schizophrenia and bipolar affective disorder in remission. Materials and Methods: A total of 106 patients with schizophrenia and 53 with bipolar affective disorder (BPAD) in remission underwent assessment using the Internalized Stigma of Mental Illness Scale (ISMIS), Positive and Negative Syndrome Scale (PANSS), and Young Mania Rating Scale (YMRS). Results: The study revealed that internalized stigma was significantly more ( p value = .0001) in patients with schizophrenia (84.84 ± 6.02) compared to those with BPAD (78.55 ± 6.07). Further analysis of the ISMIS domains revealed significant correlations between internalized stigma and stereotype endorsement ( p value = .005), stigma resistance ( p value = .009), social withdrawal ( p value = .0001), and alienation ( p value = .0001). Conclusion: The study suggests that individuals with schizophrenia experience higher levels of internalized stigma in comparison to those with BPAD.

Cortico-striatal differences in the epigenome in attention-deficit/ hyperactivity disorder

While epigenetic modifications have been implicated in ADHD through studies of peripheral tissue, to date there has been no examination of the epigenome of the brain in the disorder. To address this gap, we mapped the methylome of the caudate nucleus and anterior cingulate cortex in post-mortem tissue from fifty-eight individuals with or without ADHD. While no single probe showed adjusted significance in differential methylation, several differentially methylated regions emerged. These regions implicated genes involved in developmental processes including neurogenesis and the differentiation of oligodendrocytes and glial cells. We demonstrate a significant association between differentially methylated genes in the caudate and genes implicated by GWAS not only in ADHD but also in autistic spectrum, obsessive compulsive and bipolar affective disorders through GWAS. Using transcriptomic data available on the same subjects, we found modest correlations between the methylation and expression of genes. In conclusion, this study of the cortico-striatal methylome points to gene and gene pathways involved in neurodevelopment, consistent with studies of common and rare genetic variation, as well as the post-mortem transcriptome in ADHD.

Effects of yoga on impulsivity in patients with and without mental disorders: a systematic review

BackgroundYoga can be used as a complementary intervention to conventional treatments, whether pharmacological or non-pharmacological. Sustained practice of yoga can generate a series of benefits for individuals' quality of life and improve their physical fitness.ObjectiveTo investigate the potential effects of yoga as an adjunct intervention in conditions involving impulse control issues, such as attention deficit hyperactivity disorder (ADHD), borderline personality disorder, bipolar affective disorder, and substance use disorders.MethodsWe performed a systematic review of placebo-controlled, randomized trials of yoga in patients with impulsivity. PubMed, Web of Science, and Science Direct databases were searched for trials published up to January, 2023. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations.ResultsOut of 277 database results, 6 RCT were included in this systematic review. To assess the level of attention and impulsiveness, the following scales were analyzed: Barratt Impulsiveness, UPPS-P Impulsive Behavior scale, Conners’ Continuous Performance Test IIª and Conners’ Parent Rating Scale–Revised: Long.ConclusionsYoga didn’t have a significant improvement in impulsivity when compared to placebo. There are many tools to assess impulsivity, but they mean different concepts and domains consisting in a weakness on comparison of yoga effects.PROSPERO registrationCRD42023389088.

Vulnerability to risky sexual behavior among patients with severe mental illness in Uganda

BackgroundThe relationship between severe mental illness and risky sexual behaviors, defined as acts associated with a higher risk level is notably significant in sub-Saharan Africa. In Uganda, mental disorders have been substantially correlated with unsafe sexual practices, contributing to the global burden of risky sexual behaviors. The consequential outcomes, such as sexually transmitted diseases, has resulted into a significant challenge in managing severe mental illness and potentially increased risky sexual behaviour. There is an urgent need to identify and understand factors specific to Uganda that amplify the vulnerability of severe mental illness patients to risky sexual behaviors. This study aimed to understand the vulnerability factors to risky sexual behaviour in severe mental illness in central and south-western Uganda, seeking to inform the development of tailored and effective intervention strategies to address this critical issue.MethodsThis was a qualitative descriptive study that was carried out at Butabika and Masaka hospitals in Uganda, involving a varied group of 32 individuals, comprising 12 persons with diagnosed Severe Mental Illness (Schizophrenia, Bipolar Affective Disorder, or Recurrent Major Depressive Disorder) and to risky sexual behaviors, 8 caregivers (who had patients with severe mental illness and to risky sexual behaviors) and 12 mental health specialists, (who had treated these participants). Purposive sampling was done by intentionally selecting participants based on specific attributes relevant to the research question and the objective of the study which was to explore the factors contributing vulnerability to risky sexual behaviour in severe mental illness in central and south-western Uganda. The interviews were conducted, centered on personal experiences and influences on risky sexual behaviors for the persons with severe mental illness, targeting insights into the nuanced interplay of severe mental illness and sexual behavior. For caregivers and mental health specialists, the interviews were conducted to gain a comprehensive understanding of the unique challenges, perspectives, and experiences they encounter in providing support and treatment respectively. The interviews were tape-recorded and transcribed verbatim. Framework analysis of transcribed interviews, using NVivo11 software that helped to systematically organize and code data within the predetermined and emergent thematic framework, we were able to identify patterns and themes to address the research question and objective.ResultsThe study findings underscored a pervasive pattern of engaging in risky sexual behavior among individuals coping with severe mental illness, a growing concern traditionally associated with sexually transmitted infections like HIV and AIDS, unwanted pregnancies, and sexual encounters with strangers. This problem was largely attributed to factors such as compromised judgment due to underlying morbidity, abnormally high libido, poverty, desperation, and inadequate social support. Additionally, sexual deprivation, often a result of stigma, discrimination, and prolonged periods of hospitalization, was found to contribute to irresponsible and risky sexual acts. Respondents also highlighted certain practices and structural weaknesses within hospital environments, such as stripping patients naked when going to seclusion rooms and inadequate patient monitoring.ConclusionsThe findings underscore the need for targeted interventions addressing both individual and structural factors to alleviate the risks associated with sexual behavior among individuals with severe mental illness.

Foliar-Applied Lithium And Its Effect On Morpho-Physiological Behavior And The Elemental Composition Of Lettuce

ABSTRACT Lithium (Li) intake is insufficient in many countries of the world. Low dietary intake of Li is associated with many psycho-behavioral disorders (e.g., increased suicide and homicide rates, aggressive behaviors, unipolar/bipolar disorders, and acute mania). Agronomic biofortification is a good strategy to increase Li intake in the human diet. This study aims to evaluate the effect of Li foliar application on the biofortification of two lettuce cultivars, as well as its influence on morpho-physiological characteristics and elemental composition. The experiment was carried out in a randomized complete block design in a 2 × 5 factorial scheme with four replicates. Two curly lettuce cultivars (SVR 2005 and Solaris) were treated with five levels of Li (0, 16, 32, 48, and 64 g ha−1) applied via foliar under semi-controlled conditions. Both cultivars showed higher Li content and accumulation with the application of 64 g ha−1of Li. For the Solaris cultivar, the supply of 37 g ha−1of Li guarantees the consumption of approximately 30% of the daily Li recommendation. The morpho-physiological characteristics of the Solaris and SVR 2005 cultivars presented positive results with the application of between 20 and 41 g ha−1of Li. The content of potassium (K), calcium (Ca), magnesium (Mg), iron (Fe), manganese (Mn), and zinc (Zn) was altered by the foliar application of Li. The results obtained in this study show that the application of Li via leaves, under semi-controlled conditions, is an efficient strategy to biofortify lettuce and provide Li in the human diet. However, attention must be paid to the contents of macro and micronutrients in lettuce.

Waning waves of mood: The declining trend of hospitalized patients with affective disorders in Germany

IntroductionAffective disorders profoundly affect individuals' emotional well-being and quality of life. This study investigates the epidemiology of affective disorders in Germany from 2011 to 2021, focusing on incidence rates, age- and sex-standardized rates, and developmental trends. MethodsUsing nationwide data of ICD-10 diagnosis codes from 2011 to 2021, this cross-sectional study analyzed inpatient cases of affective disorders in individuals aged 20 years or older. Age- and sex-standardized incidence rates were calculated based on the population size of each birth cohort in the 16 German federal states. Incidence rate ratios (IRRs) for 2011 to 2021 and 2019 to 2021 were compared with a two-sample z-test. ResultsBetween 2011 and 2021, F30 (manic episode) showed a decline of 42.8 % to an incidence of 4.9 per 100,000 inhabitants, even though not statistically significant (p = 0.322). F31 (bipolar affective disorder) remained relatively stable with a reduction of 15.3 % to an incidence of 13.6 per 100,000 inhabitants in 2021 (p = 0.653). F32 (depressive episode) decreased statistically significant by 25.7 % to an incidence of 64.1 per 100,000 inhabitants (p = 0.072). F33 (recurrent depressive disorder) slightly increased by 18.3 % to an incidence of 94.6 per 100,000 inhabitants (p = 0.267). No statistically significant differences were found when comparing the COVID-19 pandemic year 2021 to 2019 incidences (p ≥ 0.529). ConclusionThe study provides valuable insights into the changing landscape of affective disorders in Germany over the past decade. The observed decline in incidence rates underscores the importance of continued efforts to promote mental health awareness and access to care.

Implementation of an Electronic Clinical Decision Support System for the Early Recognition and Management of Dysglycemia in an Inpatient Mental Health Setting Using CogStack: Protocol for a Pilot Hybrid Type 3 Effectiveness-Implementation Randomized Controlled Cluster Trial.

Severe mental illnesses (SMIs), including schizophrenia, bipolar affective disorder, and major depressive disorder, are associated with an increased risk of physical health comorbidities and premature mortality from conditions including cardiovascular disease and diabetes. Digital technologies such as electronic clinical decision support systems (eCDSSs) could play a crucial role in improving the clinician-led management of conditions such as dysglycemia (deranged blood sugar levels) and associated conditions such as diabetes in people with a diagnosis of SMI in mental health settings. We have developed a real-time eCDSS using CogStack, an information retrieval and extraction platform, to automatically alert clinicians with National Health Service Trust-approved, guideline-based recommendations for dysglycemia monitoring and management in secondary mental health care. This novel system aims to improve the management of dysglycemia and associated conditions, such as diabetes, in SMI. This protocol describes a pilot study to explore the acceptability, feasibility, and evaluation of its implementation in a mental health inpatient setting. This will be a pilot hybrid type 3 effectiveness-implementation randomized controlled cluster trial in inpatient mental health wards. A ward will be the unit of recruitment, where it will be randomly allocated to receive either access to the eCDSS plus usual care or usual care alone over a 4-month period. We will measure implementation outcomes, including the feasibility and acceptability of the eCDSS to clinicians, as primary outcomes, alongside secondary outcomes relating to the process of care measures such as dysglycemia screening rates. An evaluation of other implementation outcomes relating to the eCDSS will be conducted, identifying facilitators and barriers based on established implementation science frameworks. Enrollment of wards began in April 2022, after which clinical staff were recruited to take part in surveys and interviews. The intervention period of the trial began in February 2023, and subsequent data collection was completed in August 2023. Data are currently being analyzed, and results are expected to be available in June 2024. An eCDSS can have the potential to improve clinician-led management of dysglycemia in inpatient mental health settings. If found to be feasible and acceptable, then, in combination with the results of the implementation evaluation, the system can be refined and improved to support future successful implementation. A larger and more definitive effectiveness trial should then be conducted to assess its impact on clinical outcomes and to inform scalability and application to other conditions in wider mental health care settings. ClinicalTrials.gov NCT04792268; https://clinicaltrials.gov/study/NCT04792268. DERR1-10.2196/49548.

Pretreatment Thyroid Profile and its Relationship with Response to Treatment with Lithium in Bipolar Mood Disorder: A Longitudinal Study from Northeast India

Abstract Background: The thyroid hormone’s significant impact on the treatment of depressive and other mood disorders is well documented. Even minor hypothyroidism can modify the progression and treatment results of major depressive disorder. This research aims to explore the correlation between initial thyroid levels and the treatment outcome in bipolar mood disorder using lithium, a well-established treatment method. Methodology: The study involved 45 bipolar mood disorder patients diagnosed according to the Diagnostic and Statistical Manual 5 criteria and admitted to a tertiary care teaching institute in Northeast India. The patients received lithium treatment, with injectable lorazepam used for immediate agitation control when necessary. On the 1st day, a semi-structured questionnaire and Brief Psychiatric Rating Scale (BPRS) 24-item scale were used to evaluate symptoms, and samples were collected for a thyroid profile, including T3, T4, FT3, FT4, and thyroid-stimulating hormone (TSH). The BPRS scale was used again on the 30th day to assess treatment response. Results: The BPRS subscale showed the highest treatment response for grandiosity and the lowest for depression. Factors such as age, illness duration, substance use, and family history of mood disorder were inversely correlated with the BPRS score’s decrease. Initial thyroid levels were identified as a predictor of treatment response, with baseline T4 levels showing a significant positive correlation with treatment response, while baseline TSH levels showed a negative correlation. Conclusion: Lithium proved to be an effective treatment for bipolar mood disorder, particularly for the manic subtype. Initial T4 and TSH levels were found to significantly predict treatment response, with T4 showing a positive correlation and TSH showing a negative correlation.

Bipolar disorder, Deafness and Culturality in Psychiatric Home Hospitalization: A Clinical Case

IntroductionMental health in the deaf community is a complex issue. Challenges in diagnosis and treatment arise from a lack of experienced interpreters and difficulties in translating Sign Language to spoken language. Deaf individuals, due to auditory limitations, are more vulnerable to abuse, increasing their risk of mental health disorders, including bipolar affective disorder (BPAD). BPAD is a prevalent, debilitating condition with varied prevalence estimates. Managing it is tough due to its lifelong, unpredictable nature. A new approach called Psychiatric Home Hospitalization Unit aims to provide acute mental health care at home as an alternative to hospitalization.ObjectivesTo show the management of severe bipolar disorder with comorbidity from a Psychiatric Home Hospitalization UnitMethodsA clinical case of bipolar disorder with deafness attended at the Psychiatric Home Hospitalization Unit of our hospital is presented.ResultsA 24-year-old deaf woman borned in Pakistan and later moving to Catalonia, she faced educational challenges but ultimately completed her studies with sign language support. Afterward, she struggled to find suitable employment, and her family had a history of bipolar disorder.She exhibited a sudden change in behavior, characterized by irritability, paranoia, and distrust. Communication was challenging due to her speech difficulties, but assessments using sign language and observation were conducted. Her physical examination was normal, but her speech was disorganized and pressured, suggesting possible auditory hallucinations and thought disturbances. She was hospitalized and diagnosed with bipolar disorder with psychotic features.During her initial hospitalization, she received lithium, olanzapine, clotiapine and benzodiacepines. After discharge, she continued treatment through a home hospitalization service during almost 4 month. During follow-up she presented a course with high affective instability, rapid cycling alternating brief periods of stability with other presenting manic and mixed features with high disorganization.Due to the rapid cycling pattern Valproic acid was considered. Valproic acid was introduced up to 700 mg/d (97.1 mcg/mL). Treatment with lithium carbonate 800 mg/d (0.91 mEq/L) was maintained. Previous antipsychotic regimen was changed to quetiapine 400mg/d, olanzapine 5mg/d. Her condition improved significantly with the adjusted treatment regimen. She was discharged to an outpatient service.ConclusionsDiagnosing and treating bipolar affective disorder (BPAD) in a deaf and mute patient posed unique challenges. The rapid mood cycling pattern and complexity of her case made treatment challenging. Family information and interpreter support were vital. Cultural factors were considered, and home hospitalization was crucial in managing symptoms that lasted over four months.Disclosure of InterestNone Declared

Case Series: The use of Lithium in Bipolar Affective Disorder and End-Stage Renal Disease

IntroductionLithium is a highly effective treatment in the management of Bipolar Affective Disorder (BPAD) however it is associated with increased risk of developing chronic kidney disease. There is a lack of clear guidance on alternative approaches to managing those individuals that require cessation of lithium due to progression to end stage renal disease (ESRD).ObjectivesWe discuss two patients with BPAD on lithium therapy who have developed ESRD. In both cases, lithium was discontinued due to ESRD, with alternatives trialled. In one case, the patient continues to be managed without lithium, whereas in the second, a decision was made to recommence lithium at a low dose. We reviewed the literature to provide meaningful context to the cases.MethodsCase 1 This patient with a long history of BPAD and multiple medical co-morbidities experienced progressive decline in renal function. A decision was made to cease lithium therapy with close monitoring for signs of affective relapse. The patient was stabilised using a combination of sodium valproate and quetiapine. Since cessation of lithium, the patient has required a significant increase in support from the CMHT and more frequent admissions to manage mood and anxiety symptoms that cause significant subjective distress.Results Case 2 This patient had a long history of stable BPAD, with no episodes of illness for over 30 years. Unfortunately they developed CKD and despite a significant reduction in lithium over time, they developed ESRD requiring haemodialysis. Lithium was discontinued leading to a manic relapse of BPAD requiring a prolonged admission and a combination of carbamezapine, olanzapine, escitalopram and clonazepam to stabilise their mental state. Following discharge home, their mental state failed to reach baseline and they reported significant anxiety symptoms and memory impairment. Following protracted assessment and support they were deemed unfit for renal transplant and a decision was then made by the patient, their family, nephrology and psychiatry to recommence lithium therapy whilst on haemodialysis. Their anxiety and functioning improved significantly following the reintroduction of low dose lithium, allowing the withdrawal of other neuroleptics.ConclusionsBoth cases required an individual approach to balance physical and mental health considerations. There are no clear markers to predict if a patient will respond to alternative mood stabilisers, nor is there a guarantee that kidney function will improve or stop declining when lithium is discontinued. Decisions should reflect patient preference and balance risks associated with relapse and of declining ESRD.Disclosure of InterestNone Declared

Role of Expressed Emotions and Its Impact on Relapse in Bipolar Affective Disorder

Abstract Background: The role of expressed emotions (EEs) in relapse is poorly understood in bipolar affective disorder (BPAD). Understanding the association between EE and relapse will be useful in predicting further relapse and improving the prognosis. Aims and Objectives: The present study was conducted with the objectives of assessing the relationship between EEs of caregivers and relapse of the illness in patients with BPAD on regular medication and to assess the relationship between severity of illness and EEs. Materials and Methods: Fifty consecutive bipolar disorder patients diagnosed as per the International Classification of Diseases-10 criteria, who were admitted into the department of psychiatry with relapse while on regular medication, and their caregivers were recruited into the study. Data were collected using a semi-structured pro forma designed for the study. Clinical details of illness were obtained from the informant and the records. The severity of the current episode was assessed with the rating scales (Young Mania Rating Scale and Hamilton Depression Rating Scale). The Expressed emotions(EE) among the caregivers were assessed using the Family Attitude Scale, association between EE and relapses as well as the severity of illness was analyzed with appropriate tests. Results: The mean age of the patients was 43.8 ± 15.4. Majority of them were male and married (68% and 68%). The mean age of the caregivers was 47.1 ± 10.5. The majority of the caregivers were female (60%). Sixty-four percent of the caregivers had high EEs. The mean age of onset of illness was 26.2 ± 4.6, and the number of previous episodes was 3.9 ± 2.5. The total duration of illness was 17.7 ± 13.4 years, and the number of previous admissions was 3.3 ± 2.2. Among clinical variables of patients and caregivers with high EEs, a significant association was found between duration of illness (Chi-square test: 11.82, P = 0.003), previous episodes (Chi-square test: 12.26, P &lt; 0.01), and the number of previous admissions (Chi-square test: 9.79, P = 0.002). Conclusion: There was a significant association between high EE and relapse.