Bipolar Type Research Articles

The Causal Role of Thyroid Hormones in Bipolar Disorders: A Two-Sample Mendelian Randomization Study.

Bipolar disorder is a complex psychiatric condition with distinctions between clinical subtypes including Type 1 and 2 disorders. Several studies have proposed that thyroid hormones may be involved in the aetiology of bipolar disorders. This study employed a two-sample Mendelian randomization (MR) approach to investigate the causal relationships between six thyroid hormone metrics (TSH, FT4, FT3, TT3, FT3/FT4 and TT3/FT4) and bipolar disorder and Type 1 and 2 disorders, separately. Genome-wide association (GWAS) data from the ThyroidOmics Consortium (up to 271,040 individuals of European ancestry) were used for thyroid function metrics. Bipolar disorder GWAS data included 41,917 cases and 371,549 controls (25,060 Type 1 and 6,781 Type 2 cases). We applied inverse variance weighted (IVW) methods for primary MR analysis, with MR Egger, weighted median and weighted mode for sensitivity. Additional tests assessed horizontal pleiotropy and heterogeneity. Higher FT4 levels showed a protective causal effect against bipolar disorder (OR: 0.92, 95% CI: 0.86-0.97, p = 4.58 × 10-3) and a suggestive effect on Type 1 disorders (OR: 0.92, 95% CI: 0.86-0.99, p = 3.21 × 10-2). Elevated FT3 (OR: 1.18, 95% CI: 1.03-1.35, p = 1.55 × 10-2) and FT3/FT4 ratio (OR: 1.97, 95% CI: 1.02-3.82, p = 4.46 × 10-2) had suggestive harmful effects on Type 1 disorders. Sensitivity analyses showed consistent effects, with no significant horizontal pleiotropy or heterogeneity. These findings highlight the protective role of FT4 and the potentially harmful effect of elevated FT3 in Type 1 bipolar disorder, highlighting the need for further research on thyroid hormone levels as a potential treatment strategy for Type 1 bipolar disorder.

Seasonal variation in mood among individuals with and without bipolar disorder

IntroductionBipolar disorder is a disorder characterized by cyclic changes in mood, yet limited research has explored longitudinal patterns of seasonality on mood symptoms in this population. This study aimed to examine longitudinal mood symptoms in individuals with bipolar type I and II, and healthy controls to determine if seasonal patterns were present and to validate the Global Seasonality Score as a measure of seasonality. MethodsParticipants from the Prechter Longitudinal Study of Bipolar Disorder were included. Seasonal variations in mood were determined from the Patient Health Questionnaire, Altman Self-Rating Mania scale, and the Seasonal Pattern Assessment Questionnaire. Mixed effects models were utilized to examine the effects of season and diagnostic group on patterns of mood over time. ResultsAll groups exhibited significant seasonal effects on mood symptoms, with evidence of decreased depressive symptoms and increased mania symptoms in longer daylight months. The Global Seasonality Score showed significant differences between diagnostic groups, with bipolar I and II groups demonstrating higher seasonality than healthy controls. High seasonality was associated with greater variance in mood symptoms. ConclusionThe present study found evidence of seasonal patterns in mood symptoms in individuals with bipolar type I and II. These results highlight the need for consideration of seasonality in assessment and treatment in bipolar disorder and suggest that interventions such as light therapy during seasons of heightened risk could be beneficial. The validation of the Global Seasonality Score as a reliable measure further underscores the benefit of utilizing self-report measures to identify periods of vulnerability.

Diffusive Memristor with CuS Nanoparticles Embedded in Polymeric Film as Artificial Nociceptor.

The threshold behavior and the ion diffusion dynamics in diffusive volatile memristors have a very uncanny resemblance to the transduction process of biological nociceptors. Hence, the diffusive memristors are considered the most suited for making artificial nociceptive systems. To facilitate their widespread adoption, it is imperative to develop polymeric or organic-inorganic hybrid material-based diffusive memristors that are economical, biocompatible, and easily processable. In this study, we present a cluster-type polymeric diffusive memristor where copper is used as the active top electrode. The switching medium comprises copper(II) sulfide (CuS) nanoparticles embedded in poly(ethylene oxide) (PEO). The devices show electrochemical metalization (ECM)-type and bidirectional diffusive volatile memory with high nonlinearity (104) and turn-on slope (5.6 mV/dec). They reliably remain diffusive volatile with up to 10 wt % CuS in PEO and for a wide range of compliance (10-6 to 10-2 A) without transitioning to the bipolar nonvolatile type. The low reduction potential of CuS and optimal segmental dynamics of PEO work synergistically to ensure stable and reproducible diffusive memory. The CuS nanoparticles act as bipolar electrodes, undergoing local oxidation and reduction under the influence of the bias. The switching of resistance states in the CuS-PEO memristors is attributed to the formation of cluster-type filaments between CuS nanoparticles within the PEO matrix supported by the participation of copper ions from the top Cu electrode. The observation of low filament temperature and the independence of on-state resistance with respect to the device area and temperature further corroborate the cluster-type filament in CuS-PEO memristors. Using a 5 wt % CuS-based device, an artificial nociceptor is realized, which successfully mimics most of the nociceptive plasticities such as threshold, relaxation, no adaptation, and sensitization.

Care burden and associated factors among caregivers of patients with bipolar type I disorder

BackgroundFamily caregivers play a significant role in providing care for these people at home and need new evidence on the outcomes of their caregiving. Caregiving for people with chronic psychiatric disorders, especially Bipolar type I Disorder (BD-I), is a major challenge in the healthcare system. This study aimed to examine the relationship between caregiver burden, resilience and optimism in family caregivers of patients with BD-I.MethodsThis study used a cross-sectional design and involved 209 family caregivers of people with BD-I by convenience sampling method. Data were collected using the Zarit Burden Inventory (ZBI), Connor-Davidson Resilience Scale (CD-RISC), and Revised Life Orientation Test (LOT-R). The participants were selected from the list of family caregivers covered by the Ibn Sina Hospital’s health clinic in Mashhad, Iran. The data were analyzed using descriptive statistics and multiple regression analysis with a significance level of 0.05.ResultsThe average ages of the caregivers and their patients were 45.43 (13.34) and 36.7 (14.05), respectively. The average caregiver burden score was 41.92 (19.18), which was moderate (31 to 60). The predictors of caregiver burden in this study were caregiver-related factors such as optimism (p < 0.001, β = 0.25) and employment status (housewife: p = 0.038, β = 0.43; self-employed: p = 0.007, β = 0.12; retired: p < 0.001, β = 0.23), and patient-related factors such as the presence of psychotic symptoms (p < 0.001, β = 0.33), daily caregiving hours (p < 0.001, β = 0.16), history of suicide attempts (p = 0.035, β = 0.43), and alcohol consumption (p < 0.001, β = 0.85). These variables explained 58.3% of the variance in caregiver burden scores.ConclusionThe study concluded that family caregivers of people with BD-I had moderate levels of caregiver burden and low resilience, influenced by various factors related to themselves and their patients. Psychological education interventions within the framework of mental health support systems are recommended to reduce caregiver burden in these people.

Prevalence and correlates of non-suicidal self-injury among patients with bipolar disorder: A multicenter study across China

BackgroundNon-suicidal self-injury (NSSI) is increasingly prevalent among patients with bipolar disorder (BD), raising concerns in psychology and mental health. Investigating the incidence and factors associated with NSSI is crucial for developing prevention and intervention strategies. MethodsNSSI behaviors were identified using the Ottawa Self-injury Inventory. The Clinically Useful Depression Outcome Scale supplemented with questions for the DSM-5 specifier of mixed features (CUDOS-M) and the Mini International Neuropsychiatric Interview (Hypo-)Manic Episode with Mixed Features-DSM-5 Module (MINI-M) were used to evaluate clinical symptoms. Non-parametric tests, chi-square tests, point-biserial correlation and logistic regression analyses were employed for the purposes of data analysis. ResultsThe enrolled sample comprised 1044 patients with BD from 20 research centers across China. Out of 1044 individuals, 446 exhibited NSSI behaviors, with 101 of them being adolescents, leading to a prevalence of 78.3 % among adolescent patients. The most common methods for females and males were “cutting” (41.2 %) and “hitting” (34.7 %), respectively. By binary logistic regression analysis, young age, female, bipolar type II disorder, with suicidal ideation and mixed states, depressive symptoms and without family history of mental disorder were correlates of NSSI in patients with BD (P < 0.05). LimitationsAs a cross-sectional study, causality between NSSI behaviors and associated factors cannot be established. Reporting and recall biases may occur due to self-rating scales and retrospective reports. ConclusionOur study indicates a concerning prevalence of NSSI, particularly among young patients with BD in China. Future research should focus on understanding NSSI behaviors in this population and developing effective interventions.

Comprehensive Characterization of a Subfamily of Ca2+-Binding Proteins in Mouse and Human Retinal Neurons at Single-Cell Resolution.

Ca2+-binding proteins (CaBPs; CaBP1-5) are a subfamily of neuronal Ca2+ sensors with high homology to calmodulin. Notably, CaBP4, which is exclusively expressed in rod and cone photoreceptors, is crucial for maintaining normal retinal functions. However, the functional roles of CaBP1, CaBP2, and CaBP5 in the retina remain elusive, primarily due to limited understanding of their expression patterns within inner retinal neurons. In this study, we conducted a comprehensive transcript analysis using single-cell RNA sequencing datasets to investigate the gene expression profiles of CaBPs in mouse and human retinal neurons. Our findings revealed notable similarities in the overall expression patterns of CaBPs across both species. Specifically, nearly all amacrine cell, ganglion cell, and horizontal cell types exclusively expressed CaBP1. In contrast, the majority of bipolar cell types, including rod bipolar (RB) cells, expressed distinct combinations of CaBP1, CaBP2, and CaBP5, rather than a single CaBP as previously hypothesized. Remarkably, mouse rods and human cones exclusively expressed CaBP4, whereas mouse cones and human rods coexpressed both CaBP4 and CaBP5. Our single-cell reverse transcription polymerase chain reaction analysis confirmed the coexpression CaBP1 and CaBP5 in individual RBs from mice of either sex. Additionally, all three splice variants of CaBP1, primarily L-CaBP1, were detected in mouse RBs. Taken together, our study offers a comprehensive overview of the distribution of CaBPs in mouse and human retinal neurons, providing valuable insights into their roles in visual functions.

Species–specific circuitry of double cone photoreceptors in two avian retinas

In most avian retinas, double cones (consisting of a principal and accessory member) outnumber other photoreceptor types and have been associated with various functions, such as encoding luminance, sensing polarized light, and magnetoreception. However, their down-stream circuitry is poorly understood, particularly across bird species. Analysing species differences is important to understand changes in circuitry driven by ecological adaptations. We compare the ultrastructure of double cones and their postsynaptic bipolar cells between a night-migratory European robin and non-migratory chicken. We discover four previously unidentified bipolar cell types in the European robin retina, including midget-like bipolar cells mainly connected to one principal member. A downstream ganglion cell reveals a complete midget-like circuit similar to a circuit in the peripheral primate retina. Additionally, we identify a selective circuit transmitting information from a specific subset of accessory members. Our data highlight species-specific differences in double cone to bipolar cell connectivity, potentially reflecting ecological adaptations.

Distressing memories: A continuum from wellness to PTSD

BackgroundExposure to traumatic events is a frequent source of distress, provoking isolated symptoms such as distressing memories (DM) to full-blown post-traumatic stress disorder (PTSD). We aimed to assess the continuum theory using DM as an isolated symptom, and to examine trauma consequences in a exposed to traumatic events. MethodsUsing data from the National Epidemiologic Study of Alcohol and Related Conditions III, we assessed the prevalence of DM in a trauma exposed sample, and examined their sociodemographic and lifetime psychiatric correlates, comparing three groups: (i) controls (no DM, no PTSD); (ii) participants with isolated DM without PTSD; (iii) participants with PTSD. We estimated the sensitivity and specificity of DM for PTSD diagnosis. ResultsIn our sample of 17,505 participants exposed to trauma, 13 % had PTSD and 42 % had DM without PTSD. The sensitivity of DM for the diagnosis of PTSD was 95.14 %, specificity was 51.91 %. Participants with DM and those with PTSD shared the same socio-demographic correlates. Participants with DM reported more lifetime psychiatric disorders (mood disorders - mainly depressive disorders and bipolar type 1 disorder; anxiety disorders - mainly social anxiety disorder, substance use disorders - mainly opioid use disorder and cannabis disorder; eating disorders - mainly binge eating disorder; personality disorders - mainly borderline personality disorder- and suicidality) than controls, but less than participants with PTSD. ConclusionDM represent an intermediate state between well-being and post-traumatic stress disorder; DM is also associated with other psychiatric disorders. It should be considered as a transdiagnostic psychiatric symptom useful for clinicians in identifying psychiatric vulnerability.

Reconfiguration of the visual code and retinal cell type complement in closely related diurnal and nocturnal mice.

How does evolution act on neuronal populations to match computational characteristics to functional demands? We address this problem by comparing visual code and retinal cell composition in closely related murid species with different behaviours. Rhabdomys pumilio are diurnal and have substantially thicker inner retina and larger visual thalamus than nocturnal Mus musculus. High-density electrophysiological recordings of visual response features in the dorsal lateral geniculate nucleus (dLGN) reveals that Rhabdomys attains higher spatiotemporal acuity both by denser coverage of the visual scene and a selective expansion of elements of the code characterised by non-linear spatiotemporal summation. Comparative analysis of single cell transcriptomic cell atlases reveals that realignment of the visual code is associated with increased relative abundance of bipolar and ganglion cell types supporting OFF and ON-OFF responses. These findings demonstrate how changes in retinal cell complement can reconfigure the coding of visual information to match changes in visual needs.

Unveiling childhood onset bipolar disorder: A hidden diagnosis behind posttraumatic stress disorder

Abstract: Childhood-onset bipolar disorder (BD) presents significant challenges in diagnosis and management, compounded by a lack of extensive research into its early precursors and comorbidities. Delayed recognition and treatment of BD are linked to a higher frequency of depressive episodes and poor long-term outcomes. This case report describes an adolescent misdiagnosed with posttraumatic stress disorder after her father’s death, presenting with mood dysregulation, self-harm, suicidal tendencies, and school dropout, with a history of sexual abuse. Upon further evaluation, Bipolar type I disorder, current episode mixed, was diagnosed. The case highlighted the need for comprehensive pharmacological, psychosocial, and psychoeducational interventions to improve treatment outcomes in childhood-onset BD.

A novel bipolar coil structure with high interoperability performance for electric vehicle wireless charging systems

SummaryThe magnetic couplers play an important role in electric vehicle (EV) wireless power transfer (WPT) systems. Conversational coupling structures are mainly based on unipolar, bipolar, and quadrupole coils, and the interoperability among them cannot be achieved. To solve the interoperability problem in the coupling structure, a novel bipolar coil structure is proposed in this paper. Energy transfer with unipolar and bipolar coils is achieved by interconnecting unipolar and bipolar types crosswise in the same plane and combining them with the corresponding topologies. They are connected in series on the dc side. An experimental prototype is built to verify the interoperability performance of the proposed novel bipolar coil structure. The proposed novel bipolar coil structure can be compatible with unipolar, bipolar, and quadrupole coils and achieve a maximum dc‐dc efficiency of more than 85%.

Computational evaluation of PEMFC performance based on bipolar plate material types

Materials used in bipolar plates are essential for addressing the challenges associated with the large-scale commercialization of Proton Exchange Membrane Fuel Cells (PEMFCs). Therefore, it is necessary to develop effective performance evaluation approaches to evaluate the performance of materials. This work has presented a high-fidelity mathematical model that includes electrochemical, fluid flow, energy, species transport, water formation, and transport aspects to simulate the conditions in a PEMFC system and to theoretically assess the performances of commercial bipolar plate materials. Accordingly, the effects of metallic (aluminum) and carbon-based (graphite and graphite composite) bipolar plate materials on the current collection performance, thermal management, water management, and overall efficiency of PEMFCs are analyzed. The findings suggest that the current density, power density, and operating voltage of each PEMFC are greatly affected by the bipolar plate material used. When compared to graphite bipolar plates, the aluminum and graphite composite bipolar plates have exhibited 16.5 % and 7.5 % higher power densities, respectively. The change in operating conditions and thermal environments caused by a change of bipolar plate materials gives rise to distinct water transport phenomena according to their respective capabilities in the balancing of liquid water movements across the membrane, which in turn affects the species distribution pattern. Specifically, the high imbalance between the electro-osmotic drag and back diffusion in the case of aluminum bipolar plate leads to a severe membrane dry-out on the anode side, limiting the hydrogen concentration in the region.

Benson relaxation technique to address sleep quality and aggression among patients with bipolar type I disorder: A randomized clinical trial study

PurposeThe present research was conducted to assess the effect of the Benson relaxation technique on sleep quality and aggression among patients with bipolar type I disorder. MethodsThis study was conducted using a randomized clinical trial design with the participation of 60 patients with bipolar type I disorder (30 participants in each group) in Mashhad, Iran (IRCT20220108053659N1). The intervention group received the Benson relaxation technique for 21 days in a row, twice a day (in the morning and evening), under the supervision of an expert psychiatric nurse (On the first day, instruction was given on implementing BRT. In the subsequent days of the intervention, the nurse stayed by the patient's bedside for the entire relaxation process). Aggression and sleep quality were assessed using the Buss-Perry Aggression Questionnaire and Pittsburgh Sleep Quality Index, respectively, before and one week after the completion of the intervention. Data were analyzed using descriptive and inferential statistics (Chi-squared, Fisher's exact test, independent sample t-test, and analysis of covariance). ResultsThe participants in the present study were individuals of both genders aged 18 and above. Based on the results, both groups were homogeneous regarding demographic characteristics. Prior to the intervention, the two groups of control and intervention were not significantly different from each other in terms of sleep quality (p = 0.870) and aggression (p = 0.961). After the intervention, in an intergroup comparison, a significant difference was observed between the two groups in terms of the mean difference of aggression (p < 0.001) and sleep quality scores (p < 0.001). ConclusionDespite the favorable effect of this intervention, it is necessary to conduct more studies considering the broader aspects of interventions and related variables before including these interventions in the care plan of patients with bipolar type I disorder.

Ancient origin of the rod bipolar cell pathway in the vertebrate retina.

Vertebrates rely on rod photoreceptors for vision in low-light conditions. The specialized downstream circuit for rod signalling, called the primary rod pathway, is well characterized in mammals, but circuitry for rod signalling in non-mammals is largely unknown. Here we demonstrate that the mammalian primary rod pathway is conserved in zebrafish, which diverged from extant mammals ~400 million years ago. Using single-cell RNA sequencing, we identified two bipolar cell types in zebrafish that are related to mammalian rod bipolar cell (RBCs), the only bipolar type that directly carries rod signals from the outer to the inner retina in the primary rod pathway. By combining electrophysiology, histology and ultrastructural reconstruction of the zebrafish RBCs, we found that, similar to mammalian RBCs, both zebrafish RBC types connect with all rods in their dendritic territory and provide output largely onto amacrine cells. The wiring pattern of the amacrine cells postsynaptic to one RBC type is strikingly similar to that of mammalian RBCs and their amacrine partners, suggesting that the cell types and circuit design of the primary rod pathway emerged before the divergence of teleost fish and mammals. The second RBC type, which forms separate pathways, was either lost in mammals or emerged in fish.

Subcellular pathways through VGluT3-expressing mouse amacrine cells provide locally tuned object-motion-selective signals in the retina

VGluT3-expressing mouse retinal amacrine cells (VG3s) respond to small-object motion and connect to multiple types of bipolar cells (inputs) and retinal ganglion cells (RGCs, outputs). Because these input and output connections are intermixed on the same dendrites, making sense of VG3 circuitry requires comparing the distribution of synapses across their arbors to the subcellular flow of signals. Here, we combine subcellular calcium imaging and electron microscopic connectomic reconstruction to analyze how VG3s integrate and transmit visual information. VG3s receive inputs from all nearby bipolar cell types but exhibit a strong preference for the fast type 3a bipolar cells. By comparing input distributions to VG3 dendrite responses, we show that VG3 dendrites have a short functional length constant that likely depends on inhibitory shunting. This model predicts that RGCs that extend dendrites into the middle layers of the inner plexiform encounter VG3 dendrites whose responses vary according to the local bipolar cell response type.

Prevalence of suicidal behavior in bipolar type 1 patients

IntroductionThe prevalence of suicidal behavior in individuals diagnosed with Bipolar Disorder Type 1 is a topic of great concern within the field of psychiatry and mental health research. Bipolar Disorder Type 1 is characterized by extreme mood fluctuations that can contribute to a heightened risk of suicidal ideation, attempts, and completions in affected individuals.Objectives-To examine the socio-demographic and clinical profiles of Bipolar Type 1 patients admitted to the “C” psychiatry department at Hedi Chaker Hospital in Sfax, Tunisia.-To identify and understand the factors associated with suicidal behavior in this population. MethodsWe conducted a retrospective descriptive and analytic study of hospitalized patients suffering from bipolar disorder type 1 in the psychiatry department “C”, Hedi Chaker Hospital, Sfax Tunisia from 2021 to 2023. Socioeconomic data and clinical profiles of patients were collected from archived files.Results The total number of patients was 98, with an average age of 36.74 ± 12.3 years. The majority were single (67%), living with their families (76.5%), jobless (45.9%), and receiving family support (94.9%). In terms of psychoactive substance use, 81.6% have used tobacco, 46.9% have used alcohol, and 34.7% have used cannabis.Concerning family history, 55% of patients had at least one family member being treated for a mood disorder. Among them, 7.1% had attempted suicide, and 6.1% had died by suicide.Concerning the clinical profile of the study population, 28.6% had a personal somatic history. The diagnosis of bipolar disorder was made at the age of 27.52±8.6 years. 11.2% had a comorbid personality disorder with bipolar disorder.The majority of patients were on antipsychotics (95.9%), 84.7% were using mood stabilizers, 33.7% were prescribed anxiolytics, and only 4.1% were on antidepressants. Treatment compliance was poor in 61.2% of cases and 63.3% of patients had a poor insight.Ten percent of these patients had attempted suicide, 50% during a depressive episode, 50% occurring during a depressive episode, 30% during a manic episode, and 40% of attempts were related to discontinuation of treatment. 3.1% had used hanging, and 3.1% had engaged in voluntary drug ingestion as a method of self-harm. None of the suicide attempts necessitated intensive care hospitalization, but 60% of the individuals were admitted to psychiatric care. There was a statistically significant correlation between suicide attempts and a family history of suicide (p=0.049).ConclusionsBipolar patients face a heightened risk of suicide, which is closely tied to the distinctive attributes of the disorder, including biological factors, thymic decompensation, and psychological aspects. Consequently, managing their condition necessitates a tailored approach, demanding ongoing vigilance for individuals diagnosed with bipolar disorder.Disclosure of InterestNone Declared

Differences in the dynamics of schizophrenia with the formation of episodic and persistent apathetic depressions

IntroductionApathy in endogenous depressions is a complex mental phenomenon (it is characterized by indifference and loss of interests, reduced incentives and motivation, decreased mental and physical activity). Apathy becomes the cause of pronounced social maladaptation and untimely seeking medical help. Different depressions vary in psychopathological features of apathy, in addition, there are also different dimensions of the general dynamics of endogenous disease.ObjectivesStudy of the features of the course of schizophrenia, in which apathetic depressions develop with episodic and persistent type of dynamicsMethodsThe study included 36 patients (15 men, 21 women, average age 34.9 years) with schizophrenia. In 17 cases, apathetic depressions occurred as short-term episodes, in 19 cases, depression took a persistent (close to chronic) course.Results Schizophrenia with an episodic type of dynamics of apathetic depressions was characterized by: the predominance of cases with early onset of the disease; alternation of apathetic and other type depressions; equal occurrence of mono- and bipolar types of desease; low severity of negative symptoms and slight changes in social and labor functioning. Apathy has always been present during the whole lenght of depression, its picture was dominated by a motivational decline. The studied cases were prognostically favorable. The features of the course of schizophrenia with chronic apathetic depression were: hyperthymic (10 out of 19 observations) and sensitive schizoid (6 out of 19 observations) premorbid personality; bipolar forms of the disease (94.7%, p &lt; 0.05); the predominance of apathetic depression over other depression types, atypical form of depression; short duration of remissions; frequent course of the disease with the presence of only apathetic depressions (12 out of 19, 63.1%, p &lt; 0.05); significant severity of negative symptoms. Apathy occupied only as a part of the duration of the state, as a rule, after anxiety depression. The picture of apathy was dominated by a decrease in initiative or motivation. This clinical group is the most prognostically unfavorable.ConclusionsSchizophrenia, occurring with the presence of persistent forms of apathetic depression, has a greater impact on the functioning of patients and has a less favorable prognosis.Disclosure of InterestNone Declared

Abstract P321: Clinical Correlates of Medication Adherence to Antihypertensives and Bipolar Medications in Individuals With Hypertension and Bipolar Disorder

Introduction: Individuals with bipolar disorder (BD) have high rates of suboptimal medication adherence, medical illness, and premature mortality largely from cardiovascular causes. In the current analysis, we examined screening and baseline data from an ongoing randomized controlled trial and assessed clinical correlates of adherence to antihypertensives and BD medications in 55 patients with bipolar disorder and hypertension. Hypothesis: We assessed the hypothesis that adherence to antihypertensives would correlate with systolic blood pressure (SBP) and adherence to BD medication would correlate with psychiatric symptoms. Method: Inclusion criteria were a BD Type 1 or 2 diagnosis, being prescribed antihypertensives, and uncontrolled hypertension (SBP ≥130mmHg). Adherence was measured for the prior week with 1) self-reported Tablets Routine Questionnaire for antihypertensives (TRQ-HTN) and BD (TRQ-BD) with higher percentage reflecting worse adherence and 2) objective electronic monitoring using an eCAP © for one antihypertensive medication. Average SBP was calculated from 12 readings over one week. Symptoms of BD were measured with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Brief Psychiatric Rating Scale (BPRS). Results: Mean age of the sample (N=55) was 53.91±9.97, a majority female (61.8%), 49.1% Black and 45.5% White. Mean years of education was 14.09 ±2.83 and 95% had Bipolar Type I. At screen, TRQ-HTN was 35.80% ± 21.78 (N=55); at baseline, mean TRQ-HTN was 12.94 ± 16.88%. At screen, TRQ-BD was 29.61% ±28.02 (N=55); at baseline, TRQ-BD was 19.43% ±28.54 (N=50). At baseline, eCAP (N=43) was 39.53 ± 35.11%. There was a significant improvement in TRQ-HTN from screen to baseline (t(52) = -6.75 r &lt;0.001) and a trend for TRQ-HTN (t(49) = 1.80, p = 0.078). There was a significant correlation between TRQ-HTN and eCAP at baseline (rs=0.307, p&lt;.05, N= 43) yet eCAP reported more missed days than TRQ-HTN (Mean = -25.581 t(42) = -4.903 p&lt;0.001). TRQ-BD was significantly correlated with BPRS ( r = 0.313, p &lt;.05, N = 50) but not with MADRS. Neither TRQ-HTN nor eCAP were correlated with SBP. SBP significantly decreased from screen to baseline (t(53) = 2.357 p&lt;.05). Conclusion: In conclusion, adherence levels vary widely and objective measurement identified rates of missed medications that were approximately 26% higher than self-report. Self-reported BD adherence was related to global psychiatric symptoms but not depression while antihypertensive adherence did not relate to SBP. Greater BD symptom severity may be a clinical indicator to assess for adherence problems and medication and BP monitoring alone may improve adherence and SBP.

A case report of LAI two injection start in a 16-year-old adolescent with severe manic episode and comorbid cannabinoid use disorder

There is a lack of randomized clinical trials and few studies regarding long-acting injectable antipsychotics (LAIs) in adolescents. Non-adherence, aggressiveness, comorbid substance use disorder and lack of insight may represent the main reasons for starting LAIs. Hereby we describe a 16-year-old male adolescent subject with bipolar type I disorder and comorbid cannabinoid use disorder, successfully treated with two-injection start regimen of LAI aripiprazole. Two-injection start regime of aripiprazole could represent an effective and safe therapeutic option for adolescents with early onset bipolar disorder.

Distributed feature representations of natural stimuli across parallel retinal pathways

How sensory systems extract salient features from natural environments and organize them across neural pathways is unclear. Combining single-cell and population two-photon calcium imaging in mice, we discover that retinal ON bipolar cells (second-order neurons of the visual system) are divided into two blocks of four types. The two blocks distribute temporal and spatial information encoding, respectively. ON bipolar cell axons co-stratify within each block, but separate laminarly between them (upper block: diverse temporal, uniform spatial tuning; lower block: diverse spatial, uniform temporal tuning). ON bipolar cells extract temporal and spatial features similarly from artificial and naturalistic stimuli. In addition, they differ in sensitivity to coherent motion in naturalistic movies. Motion information is distributed across ON bipolar cells in the upper and the lower blocks, multiplexed with temporal and spatial contrast, independent features of natural scenes. Comparing the responses of different boutons within the same arbor, we find that axons of all ON bipolar cell types function as computational units. Thus, our results provide insights into the visual feature extraction from naturalistic stimuli and reveal how structural and functional organization cooperate to generate parallel ON pathways for temporal and spatial information in the mammalian retina.