Bipolar Type Research Articles

Improved estimation of the risk of manic relapse by combining clinical and brain scan data

IntroductionEstimating the risk of manic relapse could help the psychiatrist individually adjust the treatment to the risk. Some authors have attempted to estimate this risk from baseline clinical data. Still, no studies have assessed whether the estimation could improve by adding structural magnetic resonance imaging (MRI) data. We aimed to evaluate it. Material and methodsWe followed a cohort of 78 patients with a manic episode without mixed symptoms (bipolar type I or schizoaffective disorder) at 2–4–6–9–12–15–18 months and up to 10 years. Within a cross-validation scheme, we created and evaluated a Cox lasso model to estimate the risk of manic relapse using both clinical and MRI data. ResultsThe model successfully estimated the risk of manic relapse (Cox regression of the time to relapse as a function of the estimated risk: hazard ratio (HR)=2.35, p=0.027; area under the curve (AUC)=0.65, expected calibration error (ECE)<0.2). The most relevant variables included in the model were the diagnosis of schizoaffective disorder, poor impulse control, unusual thought content, and cerebellum volume decrease. The estimations were poorer when we used clinical or MRI data separately. ConclusionCombining clinical and MRI data may improve the risk of manic relapse estimation after a manic episode. We provide a website that estimates the risk according to the model to facilitate replication by independent groups before translation to clinical settings.

Об антиэндоморфизмах группоидов

In this paper, we study the problem of element-by-element description of the set of all anti-endomorphisms of an arbitrary groupoid. In particular, the structure of the set of all anti-automorphisms of a groupoid is studied. It turned out that the set of all anti-endomorphisms of an arbitrary groupoid decomposes into a union of pairwise disjoint sets of transformations of a special form. These sets of transformations are referred to in this paper as basic sets of anti-endomorphisms. Each base set of anti-endomorphisms is parametrized by some mapping of the support set of the groupoid into a fixed set of two elements. These mappings are called the bipolar anti-endomorphism type. Since the base sets of anti-endomorphisms of various types have an empty intersection, each antiendomorphism can uniquely be associated with its bipolar type. This assignment leads to a bipolar classification of anti-endomorphisms of an arbitrary groupoid. In this paper, we study the semiheap (3-groupoid of a special form) of all anti-endomorphisms. A subsemiheap of anti-endomorphisms of the first type and a subsemiheap of anti-endomorphisms of the second type are constructed. These monotypic semiheaps can be expressed into empty sets for specific groupoids. A conjecture is made about a subsemiheap of a special type of anti-endomorphisms of mixed type. The main research method in this work is the use of internal left and right translations of the groupoid (left and right translations). Since an arbitrary groupoid is considered, the set of all left translations (similarly to right translations) need not be closed with respect to the composition of transformations of the support set of the groupoid.

Distinctive synaptic structural motifs link excitatory retinal interneurons to diverse postsynaptic partner types

Neurons make converging and diverging synaptic connections with distinct partner types. Whether synapses involving separate partners demonstrate similar or distinct structural motifs is not yet well understood. We thus used serial electron microscopy in mouse retina to map output synapses of cone bipolar cells (CBCs) and compare their structural arrangements across bipolar types and postsynaptic partners. Three presynaptic configurations emerge-single-ribbon, ribbonless, and multiribbon synapses. Each CBC type exploits these arrangements in a unique combination, a feature also found among rabbit ON CBCs. Though most synapses are dyads, monads and triads are also seen. Altogether, mouse CBCs exhibit at least six motifs, and each CBC type uses these in a stereotypic pattern. Moreover, synapses between CBCs and particular partner types appear biased toward certain motifs. Our observations reveal synaptic strategies that diversify the output within and across CBC types, potentially shaping the distinct functions of retinal microcircuits.

Two mechanisms for direction selectivity in a model of the primate starburst amacrine cell.

In a recent study, visual signals were recorded for the first time in starburst amacrine cells of the macaque retina, and, as for mouse and rabbit, a directional bias observed in calcium signals was recorded from near the dendritic tips. Stimulus motion from the soma toward the tip generated a larger calcium signal than motion from the tip toward the soma. Two mechanisms affecting the spatiotemporal summation of excitatory postsynaptic currents have been proposed to contribute to directional signaling at the dendritic tips of starbursts: (1) a "morphological" mechanism in which electrotonic propagation of excitatory synaptic currents along a dendrite sums bipolar cell inputs at the dendritic tip preferentially for stimulus motion in the centrifugal direction; (2) a "space-time" mechanism that relies on differences in the time-courses of proximal and distal bipolar cell inputs to favor centrifugal stimulus motion. To explore the contributions of these two mechanisms in the primate, we developed a realistic computational model based on connectomic reconstruction of a macaque starburst cell and the distribution of its synaptic inputs from sustained and transient bipolar cell types. Our model suggests that both mechanisms can initiate direction selectivity in starburst dendrites, but their contributions differ depending on the spatiotemporal properties of the stimulus. Specifically, the morphological mechanism dominates when small visual objects are moving at high velocities, and the space-time mechanism contributes most for large visual objects moving at low velocities.

Synthesis of component-controllable monolayer MoxW(1-x)S2ySe2(1-y) alloys with continuously tunable band gap and carrier type.

Alloying can effectively modify electronic and optical properties of two-dimensional (2D) transition metal dichalcogenides (TMDs). However, efficient and simple methods to synthesize atomically thin TMD alloys need to be further developed. In this study, we synthesized 25 monolayer MoxW(1-x)S2ySe2(1-y) alloys by using a new liquid phase edge epitaxy (LPEE) growth method with high controllability. This straightforward approach can be used to obtain monolayer materials and operates on a self-limiting growth mechanism. The process allows the liquid solution to come into contact with the two-dimensional grains only at their edges, resulting in epitaxy confined only along the in-plane direction, which produces exclusively monolayer epitaxy. By controlling the weight ratio of MoS2/WSe2 (MoSe2/WS2), 25 monolayer MoxW(1-x)S2ySe2(1-y) alloys with different atomic ratios can be obtained on sapphire substrates, with band gap ranging from WS2 (1.55 eV) to MoSe2 (1.99 eV) and a continuously broad spectrum ranging from 623 nm to 800 nm. By adjusting the alloy composition, the carrier type and carrier mobility of alloy-based field-effect transistors can be modulated. In particular, the adjustable conductivity of MoxW(1-x)S2ySe2(1-y) alloys from n-type to bipolar type is achieved for the first time. This general synthetic strategy provides a foundation for the development of monolayer TMD alloys with multiple components and various 2D materials.

Optimal Time Domain Reflectometry Penetrometer Design for Soil Water Content and Electrical Conductivity Profiling

Abstract Taiwan has a subtropics monsoon climate and frequently counters typhoons and rainfall, resulting in shallow landslides and landform changes. The significant quantities of soil yields affect the infrastructure safety and environment nearby. Among the influences of factors of safety of the soil slopes, the soil water content (WC) is crucial, and WC and electrical conductivity (EC) profilings of the soil slope assist early warning during a rainfall event. Thus, this study adapted time domain reflectometry (TDR) with the current bipolar type penetrometer to simultaneously measure the volumetric WC (VWC) and the EC in a case study at reservoir watersheds. TDR committed continuous monitoring but with apparent bias because of the insufficient sensing volume of the bipolar type penetrometer. Based on the field experience, this study applied numerical analysis to improve the TDR penetrometer into the dipole type by examining the electrical field, the electrical energy density, and the strain with external stress. After considering all the factors to obtain the optimal design, verifications were accomplished in a sandbox to retrieve measurement performance and the relationship between the soil VWC and the EC in different wetting and drying rates. Results denoted the adequate procedures for TDR on-site monitoring and corresponding calibration of soil VWC and EC for slope stability analysis.

Immunohistochemical characterization of bipolar cells in four distantly related avian species.

Visual (and probably also magnetic) signal processing starts at the first synapse, at which photoreceptors contact different types of bipolar cells, thereby feeding information into different processing channels. In the chicken retina, 15 and 22 different bipolar cell types have been identified based on serial electron microscopy and single-cell transcriptomics, respectively. However, immunohistochemical markers for avian bipolar cells were only anecdotally described so far. Here, we systematically tested 12 antibodies for their ability to label individual bipolar cells in the bird retina and compared the eight most suitable antibodies across distantly related species, namely domestic chicken, domestic pigeon, common buzzard, and European robin, and across retinal regions. While two markers (GNB3 and EGFR) labeled specifically ON bipolar cells, most markers labeled in addition to bipolar cells also other cell types in the avian retina. Staining pattern of four markers (CD15, PKCα, PKCβ, secretagogin) was species-specific. Two markers (calbindin and secretagogin) showed a different expression pattern in central and peripheral retina. For the chicken and European robin, we found slightly more ON bipolar cell somata in the inner nuclear layer than OFF bipolar cell somata. In contrast, OFF bipolar cells made more ribbon synapses than ON bipolar cells in the inner plexiform layer of these species. Finally, we also analyzed the photoreceptor connectivity of selected bipolar cell types in the European robin retina. In summary, we provide a catalog of bipolar cell markers for different bird species, which will greatly facilitate analyzing the retinal circuitry of birds on a larger scale.

Transition of self-passivation and semiconductor property of titanium in the simulated environments of proton exchange membrane fuel cells

In this work, the passivation behaviors of titanium at various solution acidities are investigated in the simulated environments of proton exchange membrane fuel cells. The results show that there is a critical pH value to initiate the self-passivation of titanium, and a mathematic method based on the potentiodynamic polarization curve analysis is proposed to verify this value. The semiconductor type of the passive film changes from n-type to bipolar type, then to p-type as the pH increases, which can be explained by an n/p junction model. In addition, the relationship of the passive film thickness and pH is consistent with the prediction of point defect model.

ADHD in adults with major depressive or bipolar disorder: does it affect clinical features, comorbidity, quality of life, and global functioning?

BackgroundThis study compared clinical characteristics, concurrent disorders, level of function, and quality of life in adults with bipolar (BD) or major depressive disorder (MDD) in those with/without adult attention defici1t hyperactivity disorder (AADHD).MethodsThe participants were recruited among adult inpatients and outpatients with MDD or BD in their current partial remission in a psychiatric hospital. They were evaluated using the interview for adults with ADHD (DIVA-5), Conners’ Adult ADHD Rating Scales–Self-Report-Screening Version (CAARS-SR-SV), Structured Clinical Interview for DSM-V (SCID-5), Beck Depression Inventory-II and Young Mania Rating Scale, Global Assessment of Functioning (GAF) and World Health Organization Quality of Life Scale-Brief (WHOQoL-BREF).ResultsIn those with MDD (n = 105) and BD (n = 103), AADHD was detected as 13.3% and 16.5%, respectively. The inattentive presentation was the most prevalent type among patients with AADHD. Compared to the patients without AADHD, the results regarding the prevalence of comorbidities, suicidal attempts, severity of affective episodes, the early emergence of the affective disorders, and level of quality of life and global functioning were poorer in the group with AADHD (p < 0.05).LimitationsThe participants were individuals with major depressive or bipolar type I disorder with a mostly manic episode, chosen among the referrals to a tertiary psychiatric hospital with high comorbidity and more severe psychopathology. This may limit the generalizability of the findings.ConclusionADHD was common in adults with MDD and BD, along with high psychiatric comorbidity and negative consequences. Clinicians are suggested to screen adults with mood disorders for the symptoms of ADHD for a more precise and comprehensive diagnosis and to provide a more appropriate therapeutic intervention.

A bipolar three-way decision model and its application in analyzing incomplete data

The theory of three-way decision has contributed to data science in many topics, such as three-way classification, three-way clustering, and three-way feature selection. Most three-way decision models are formulated based on evaluation functions that commonly consider two opposite aspects of positive and negative, alliance and conflict, etc. This idea coincides with the concept of bipolarity, which studies the two opposite poles of positive and negative. However, the connections between bipolarity and three-way decision models have not been well investigated, despite the fact that they share many common features. Therefore, this work explores their relationships and proposes a new bipolar three-way decision model. Firstly, we examine the connections between the polarity theory, including the concepts of unipolarity and bipolarity, and decision models, including the two-way and three-way decision models. The examination suggests a lack of a three-way decision model corresponding to certain types of bipolarity. Thus, secondly, we propose a new bipolar three-way decision model 3WD-(ep,en)2, which considers a pair of a positive evaluation function ep and a negative evaluation function en and applies a pair of thresholds on each function. Finally, we illustrate the usefulness and effectiveness of 3WD-(ep,en)2 in data science through its application in analyzing incomplete data. In particular, we present a computational formulation based on similarity classes and a conceptual formulation based on a conjunctive description language. The two formulations together provide a multi-view understanding of the approach.

Electronic structure of silicon oxynitride films grown by plasma-enhanced chemical vapor deposition for memristor application

The electronic structure and optical properties of SiOxNy:H films enriched with silicon obtained by plasma-enhanced chemical deposition are studied. It is shown, that with the plasma generator power growth, the content of silicon (amorphous silicon clusters) and oxygen decreases, whereas the nitrogen content increases. Thus, the SiOxNy:H film composition can be effectively varied both by changing the gas flow ratio in the growth chamber and by changing the plasma generator power. The electronic stricture of SiOxNy of various x and y values is calculated from the first principles for the model structures, and the energy diagram, as well as the bandgap dependence on the oxygen content, is obtained. It is found that p+-Si/SiOxNy:H/Ni structures, have the properties of memristor bipolar type: they are reversibly switched between high and low resistance states. These memristors are forming-free: the initial state has a close resistance to the low resistance state.

Neuroinflammation and neuroprogression produced by oxidative stress in euthymic bipolar patients with different onset disease times

Bipolar disorder (BD) is associated with systemic toxicity, represented by changes in biomarkers associated with mood episodes, leading to neurological damage, which may reflect cognitive functions and functionality and the progression of the disease. We aimed to analyze the effect of four biomarkers, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), and thiobarbituric acid reactive substances (TBA-RS), related to oxidative stress in BD and to correlate them with cognitive functions and functionality. We studied 50 bipolar types I/II patients in the euthymic phase, which was divided into two subgroups with 25 patients each (≤ 3 years and ≥ 10 years of diagnosis, from the first episode of mania) and 25 control patients. To analyze frontal cognitive functions and functionality, we used the Frontal Assessment Battery (FAB) and Functioning Assessment Short Test (FAST) tests, respectively. The scores of the FAST and FAB tests showed an increase and decrease respectively, in both bipolar groups, when compared to the control group, demonstrating impairment in cognitive functions and functionality since the disease onset. In addition, changes occurred in all six domains of the FAST test, and in four domains of the FAB test in bipolar patients when compared to the control group. Regarding oxidative stress biomarkers, we did not find changes in SOD and GSH-Px activities; however, a significant increase in CAT activity and lipid peroxidation was observed in both groups, although the patients were euthymic and medicated. These results allow us to raise the hypothesis that since the beginning of the disease, the euthymic bipolar patient has presented a level of oxidative stress, which gets worse with the evolution of the disease, promoting impairments in the frontal cognitive functions and functionality gradually.

Center-surround interactions underlie bipolar cell motion sensitivity in the mouse retina.

Motion sensing is a critical aspect of vision. We studied the representation of motion in mouse retinal bipolar cells and found that some bipolar cells are radially direction selective, preferring the origin of small object motion trajectories. Using a glutamate sensor, we directly observed bipolar cells synaptic output and found that there are radial direction selective and non-selective bipolar cell types, the majority being selective, and that radial direction selectivity relies on properties of the center-surround receptive field. We used these bipolar cell receptive fields along with connectomics to design biophysical models of downstream cells. The models and additional experiments demonstrated that bipolar cells pass radial direction selective excitation to starburst amacrine cells, which contributes to their directional tuning. As bipolar cells provide excitation to most amacrine and ganglion cells, their radial direction selectivity may contribute to motion processing throughout the visual system.

Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review.

BACKGROUNDLifetime psychotic symptoms are present in over half of the patients with bipolar disorder (BD) and can have an adverse effect on its course, outcome, and treatment. However, despite a considerable amount of research, the impact of psychotic symptoms on BD remains unclear, and there are very few systematic reviews on the subject.AIMTo examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.METHODSThe Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021. Combinations of the relevant Medical Subject Headings terms were used to search for these studies. Articles were selected after a screening phase, followed by a review of the full texts of the articles. Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.RESULTSThis systematic review included 339 studies of patients with BD. Lifetime psychosis was found in more than a half to two-thirds of the patients, while current psychosis was found in a little less than half of them. Delusions were more common than hallucinations in all phases of BD. About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms, particularly during manic episodes. Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression. Although psychotic symptoms were not more severe in BD, the severity of the illness in psychotic BD was consistently greater. Psychosis was usually associated with poor insight and a higher frequency of agitation, anxiety, and hostility but not with psychiatric comorbidity. Psychosis was consistently linked with increased rates and the duration of hospitalizations, switching among patients with depression, and poorer outcomes with mood-incongruent symptoms. In contrast, psychosis was less likely to be accompanied by a rapid-cycling course, longer illness duration, and heightened suicidal risk. There was no significant impact of psychosis on the other parameters of course and outcome.CONCLUSIONThough psychotic symptoms are very common in BD, they are not always associated with an adverse impact on BD and its course and outcome.

Genetic Liabilities Differentiating Bipolar Disorder, Schizophrenia, and Major Depressive Disorder, and Phenotypic Heterogeneity in Bipolar Disorder

Understanding the origins of clinical heterogeneity in bipolar disorder (BD) will inform new approaches to stratification and studies of underlying mechanisms. To identify components of genetic liability that are shared between BD, schizophrenia, and major depressive disorder (MDD) and those that differentiate each disorder from the others and to examine associations between heterogeneity for key BD symptoms and each component. Using data from the Bipolar Disorder Research Network in the United Kingdom, components of liability were identified by applying genomic structural equation modeling to genome-wide association studies of schizophrenia, BD, and MDD. Polygenic risk scores (PRS) representing each component were tested for association with symptoms in an independent BD data set. Adults with DSM-IV BD or schizoaffective disorder, bipolar type, were included. Data were collected from January 2000 to December 2013, and data were analyzed from June 2020 to February 2022. PRS representing the components of liability were tested for association with mania and depression, psychosis, and mood incongruence of psychosis in participants with BD, measured using the Bipolar Affective Disorder Dimensional Scale. Of 4429 included participants, 3012 (68.0%) were female, and the mean (SD) age was 46.2 (12.3) years. Mania and psychosis were associated with the shared liability component (mania β = 0.29; 95% CI, 0.23-0.34; P = 3.04 × 10-25; psychosis β = 0.05; 95% CI, 0.04-0.07; P = 2.33 × 10-13) and the components that differentiate each of schizophrenia (mania β = 0.08; 95% CI, 0.03-0.14; P = .002; psychosis β = 0.03; 95% CI, 0.01-0.04; P = 1.0 × 10-4) and BD (mania β = 0.14; 95% CI, 0.09-0.20; P = 1.99 × 10-7; psychosis β = 0.02; 95% CI, 0.01-0.03; P = .006) from the other disorders. The BD differentiating component was associated with mania independently of effects on psychosis (β = 0.14; 95% CI, 0.08-0.20; P = 4.32 × 10-6) but not with psychosis independently of mania. Conversely, the schizophrenia differentiating component was associated with psychosis independently of effects on mania (β = 0.01; 95% CI, 0.003-0.03; P = .02), but not with mania independently of psychosis. Mood incongruence of psychosis was associated only with the schizophrenia differentiating component (β = 0.03; 95% CI, 0.01-0.05; P = .005). Depression was associated with higher MDD differentiating component (β = 0.07; 95% CI, 0.01-0.12; P = .01) but lower BD differentiating component (β = -0.11; 95% CI, -0.17 to -0.06; P = 7.06 × 10-5). In this study of BD, clinical heterogeneity reflected the burden of liability to BD and the contribution of alleles that have differentiating effects on risk for other disorders; mania, psychosis, and depression were associated with the components of genetic liability differentiating BD, MDD, and schizophrenia, respectively. Understanding the basis of this etiological heterogeneity will be critical for identifying the different pathophysiological processes underlying BD, stratifying patients, and developing precision therapeutics.

Contraction of axonal and dendritic fields in Sox5-deficient cone bipolar cells is accompanied by axonal sprouting and dendritic hyper-innervation of pedicles.

Multiple factors regulate the differentiation of neuronal morphology during development, including interactions with afferents, targets, and homotypic neighbors, as well as cell-intrinsic transcriptional regulation. Retinal bipolar cells provide an exemplary model system for studying the control of these processes, as there are 15 transcriptionally and morphologically distinct types, each extending their dendritic and axonal arbors in respective strata within the synaptic layers of the retina. Here we have examined the role of the transcription factor Sox5 in the control of the morphological differentiation of one type of cone bipolar cell (CBC), the Type 7 cell. We confirm selective expression of SOX5 in this single bipolar cell type, emerging at the close of the first post-natal week, prior to morphological differentiation. Conditional knockout mice were generated by crossing a bipolar cell-specific cre-expressing line with mice carrying floxed Sox5 alleles, as well as the Gustducin-gfp reporter which labels Type 7 CBCs. Loss of SOX5 was confirmed in the bipolar cell stratum, in GFP+ Type 7 cells. Such SOX5-deficient Type 7 cells differentiate axonal and dendritic arbors that are each reduced in areal extent. The axonal arbors exhibit sprouting in the inner plexiform layer (IPL), thereby extending their overall radial extent, while the dendritic arbors connect with fewer cone pedicles in the outer plexiform layer, showing an increase in the average number of dendritic contacts at each pedicle. SOX5-deficient Type 7 CBCs should therefore exhibit smaller receptive fields derived from fewer if now hyper-innervated pedicles, transmitting their signals across a broader depth through the IPL.

The effect of mindfulness-based cognitive therapy on rumination and a task-based measure of intrusive thoughts in patients with bipolar disorder

BackgroundPreliminary evidence suggests that Mindfulness-Based Cognitive Therapy (MBCT) is a promising treatment for bipolar disorder (BD). A proposed working mechanism of MBCT in attenuating depressive symptoms is reducing depressive rumination. The primary aim of this study was to investigate the effect of MBCT on self-reported trait depressive rumination and an experimental state measure of negative intrusive thoughts in BD patients. Exploratively, we investigated the effect of MBCT on positive rumination and positive intrusive thoughts.MethodsThe study population consisted of a subsample of bipolar type I or II patients participating in a multicenter randomized controlled trial comparing MBCT + treatment as usual (TAU) (N = 25) to TAU alone (N = 24). Trait depressive rumination (RRS brooding subscale) and intrusive thoughts (breathing focus task (BFT)) were assessed at baseline (full subsample) and post-treatment (MBCT + TAU; n = 15, TAU; n = 15). During the BFT, participants were asked to report negative, positive and neutral intrusive thoughts while focusing on their breathing.ResultsCompared to TAU alone, MBCT + TAU resulted in a significant pre- to post-treatment reduction of trait depressive rumination (R2 = .16, F(1, 27) = 5.15, p = 0.031; medium effect size (f2 = 0.19)) and negative intrusive thoughts on the BFT (R2 = .15, F(1, 28) = 4.88, p = 0.036; medium effect size (f2 = 0.17)). MBCT did not significantly change positive rumination or positive intrusive thoughts.ConclusionsMBCT might be a helpful additional intervention to reduce depressive rumination in BD which might reduce risk of depressive relapse or recurrence. Considering the preliminary nature of our findings, future research should replicate our findings and explore whether this reduction in rumination following MBCT indeed mediates a reduction in depressive symptoms and relapse or recurrence in BD.

The counterphobic matrix of cuckolding and troilism: The psychopathological origin of sexual sharing paraphilias

Background and aims: Based on the concept of “cuckolding” and “troilism”, it was hypothesized that underlying this paraphilia is a counterphobic attitude that positively reinforced produces the establishment of behavioural addiction. The purpose of this study is to confirm this hypothesis. Materials and methods: Clinical interview, based on narrative-anamnestic and documentary evidence and the basis of the Perrotta Human Emotions Model (PHEM) concerning their emotional and perceptual-reactive experience, and administration of the battery of psychometric tests published in international scientific journals by the author of this work: 1) Perrotta Integrative Clinical Interviews (PICI-2), to investigate functional and dysfunctional personality traits; 2) Perrotta Individual Sexual Matrix Questionnaire (PSM-Q), to investigate the individual sexual matrix; 3) Perrotta Affective Dependence Questionnaire (PAD-Q), to investigate the profiles of affective and relational dependence; 4) Perrotta Human Defense Mechanisms Questionnaire (PDM-Q), to investigate the defence mechanisms of the Ego. Results: In a population sample of 108 subjects (98 males and 10 females), the totality was found to exhibit at least 5 dysfunctional personality traits of the manic, borderline, narcissistic covert, masochistic, and dependent types, with secondary traits of the neurotic, bipolar, histrionic, and paranoid types. Always the totality of the sample shows the marked dysfunctionality of a sexual nature (especially in relational profiles) and the activation of defense mechanisms typical of psychopathological processes; in particular, at the PSM-Q the totality of the sample stated that the basis of their paraphilia is the establishment of a traumatic event of an affective, sentimental or sexual nature related to adolescence and adulthood that has generated in the person distrust in the relationship. Conclusions: At the origin of cuckolding and troilism, it is reasonable to deduce that there is a traumatic event of an affective, sentimental or sexual nature, occurring mainly in youth or early adulthood, which has negatively impacted the subject’s perception of the relational sphere. Such an event, capable of generating negative feelings of distressing origin, was then reworked and sublimated by the subject using a counterphobic attitude (the fear of being betrayed is replaced by the idea that granting the partner sexual freedom, after sharing, is sufficient to avoid the reoccurrence of the primary traumatizing event); the repetition of avoidant experiences of the danger of the primary phobia (betrayal) then generates in the subject the belief in the functioning of the mechanism, which therefore is repeated according to a cognitive-behavioural pattern of positive reinforcement, capable of establishing over time the behavioural dependence that underlies the paraphiliac disorder. Such a fear-prone psychopathological pattern, moreover, could be the same one that favours polygamous relational choice (at the expense of monogamous relational choice), net of environmental and social conditioning (e.g., Islamic contexts) that might naturally favour such choice. This counterphobic mechanism reinforced by positive reinforcement may underlie the onset of paraphilias and deserves further investigation.

Effectiveness and Tolerability of Lurasidone for Bipolar Types I and II and Other Specified Bipolar Depression: A 12-Week Observational Study.

There are few guidelines on the management of depressive episodes in patients with bipolar type II (BDII) and related disorders (other specified bipolar and related disorders [OSBD]). Lurasidone is a potential option for treating depressive episodes in BDII/OSBD. This retrospective chart review study aimed to examine the effectiveness and tolerability of lurasidone for use in patients with bipolar depression. We reviewed 66 consecutive outpatients with bipolar depression who were prescribed lurasidone between June 2020 and January 2021 and examined 12-week outcomes. Fourteen patients were diagnosed with BDI, and 52 patients were diagnosed with BDII/OSBD (42 BDII and 10 OSBD). Depressive symptoms were evaluated by the Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR) at baseline and 2, 4, and 12 weeks. Tolerability was assessed throughout the study period by the incidence of adverse events, such as akathisia, nausea, and manic/hypomanic switch, as well as the lurasidone dropout rate due to adverse events. The total QIDS-SR score at 2 ( P < 0.001), 4 ( P < 0.001), and 12 weeks ( P < 0.001) was significantly lower than that measured at baseline. Remission rate during study period was 29.1%. Of the 66 participants, 47 (71.2%) continued taking lurasidone and 27 (40.9%) and 16 (24.2%) reported adverse events and akathisia, respectively. No significant difference in total QIDS-SR score, dropout rate due to adverse events, rate of adverse events, or rate of akathisia was found between the BDII/OSBD and BDI groups. Lurasidone is tolerated and could be effective for managing depressive episodes in patients with BDII/OSBD and BDI.

Early Manifestation of Clozapine-Induced Cardiotoxicity: Detection, Pathophysiology, and Management

Schizoaffective disorder, bipolar type is a chronic mental health disorder that may manifest as mania. Clozapine is effective in treating acute mania and in achieving mood stabilization. However, on rare occasions, the use of clozapine has been associated with cardiotoxicity. Here, we present a case of a 31-year-old man who at baseline is known to have schizoaffective disorder, bipolar type, and cannabis dependence and was admitted to our hospital with a psychotic relapse. He was treated with clozapine, uptitrated to a maximum daily dose of 200mg twice daily by day 10. Thereafter he became febrile and experienced malaise, myalgias, and chest pain. He was noted on electrocardiogram to have sinus tachycardia without ischemic changes. In this context, he had a troponin leak, increased white blood cell count, serologies and cultures were negative and chest x-ray revealed no acute disease of the chest. Due to the suspicion of clozapine-induced cardiotoxicity, a transthoracic echocardiogram was done, which revealed mildly depressed left ventricular (LV) systolic function without pericardial effusion. Thereafter, clozapine was withdrawn and switched to lithium. Additionally, the cardioselective, metoprolol tartrate was initiated. Within 36-48 hours, he had resolution of symptoms and remained cardiovascularly stable. Clozapine uncommonly causes cardiotoxicity and early features may be non-specific. Awareness of this and recognizing early features aids in reducing the associated cardiovascular morbidity and mortality.