Criteria For Bipolar Disorder Research Articles

Cognitive Function in Patients with Psychotic and Affective Disorders: Effects of Combining Pharmacotherapy with Cognitive Remediation.

Background: Cognitive impairment is a relevant problem in psychiatry and can be well assessed with a cross-diagnostic test such as the Screen for Cognitive Impairment in Psychiatry (SCIP). The aim of our pilot study is to assess cognitive impairment in acute psychiatric inpatients diagnosed with psychotic disorders, bipolar disorder and depression using the German version of the SCIP (SCIP-G). We also investigate whether cognitive dysfunction improves over the course of the inpatient treatment, where patients are offered a combination of pharmacological treatment and cognitive remediation. Methods: A total of 143 adult inpatients were included in the study. Cognitive testing was performed using two different forms of the SCIP-G. All patients received state-of-the-art pharmacotherapy and cognitive remediation using the COGPACK® software package version 6.06. Results: Based on the ICD-10 Criteria for Research, 54 patients were given an F2 diagnosis (schizophrenia and schizotypal and delusional disorders). Thirty-nine patients met the criteria for bipolar disorder (F30 and F31) and fifty for depression (F32 and F33). At baseline, a significant difference was observed between the SCIP total scores of the F2 and F32/33 patients (p < 0.001) and between the F2 and F30/31 groups (p = 0.022). At the second measurement time point, the SCIP total score showed significant improvement in all three groups (p < 0.001), and there was no statistically significant interaction between SCIP total score and diagnostic groups (p = 0.860). Conclusions: Cognitive dysfunction is present in psychiatric disorders and can be easily assessed during an inpatient hospital stay. In our sample, patients with a psychotic disorder were more cognitively impaired at baseline than patients with an affective disorder. Inpatient treatment, consisting of pharmacotherapy and cognitive remediation, improved cognitive deficits. Patients with psychotic disorders, bipolar disorder and depression showed similar improvements in cognitive performance.

Hypomania-Checklist-33: risk stratification and factor structure in a mixed psychiatric adolescent sample

BackgroundThe 33-item Hypomania Checklist (HCL-33) has been shown to distinguish between adolescent bipolar disorder (BD) and unipolar depression. To investigate the utility of the HCL-33 as a screening tool in routine diagnostics, the frequency and psychopathological characteristics of detected individuals in a mixed psychiatric sample necessitate more examination.MethodsThe HCL-33, Children’s Depression Inventory, Beck’s Anxiety Inventory, and Strengths and Difficulties Questionnaire were completed by 285 children and adolescents (12–18 years) in a mixed psychiatric sample. Applying the proposed HCL-33 cut-off score of ≥ 18, individuals with depressive symptoms were divided into at-risk or not at-risk for BD groups. The factorial structure, sum and factor score correlations with psychopathology, and impact on daily functioning were assessed.Results20.6% of the sample met at-risk criteria for BD. These individuals (n = 55) were older, more anxious, and showed more conduct problems vs the not at-risk group (n = 107). A two- and a three-factor model were pursued with the same Factor 1 (“active-elated”). Factor 2 (“risk-taking/irritable”) was separated into 2a (“irritable-erratic”) and 2b (“outgoing-disinhibited”) in the three-factor model. Whereas higher Factor 2 and 2a scores correlated with a broad range of more severe symptomatology (i.e., depression, anxiety, hyperactivity), higher Factor 1 and 2b scores correlated with more emotional and conduct problems, respectively. 51.7% of the sample reported a negative impact from hypomanic symptoms on daily functioning.LimitationsCross-sectional design and data collection in a single mental health service.ConclusionsThe HCL-33 may be a useful tool to improve diagnostics, especially in adolescents with depressive symptoms additionally presenting with anxious symptoms and conduct problems.

Polygenic scores for psychiatric disorders associate with year of first bipolar disorder diagnosis: A register-based study between 1972 and 2016

The diagnostic criteria of bipolar disorder (BD) have changed over time. To test if these changes are reflected in the polygenic profile in BD, we studied the association between first BD diagnosis year (during 1972–2016) and polygenic scores (PGS) for psychiatric disorders in BD patients (N = 3,818). We found significant associations between diagnosis year and PGS for BD, depression, and attention deficit hyperactivity disorder (ADHD). The PGS remained largely stable over time in BD type 1, while changes were observed in BD type 2. These findings bear significance not only for genetic research but also for clinical practise, as shifts in patient characteristics can influence treatment response.

Factor analysis of lifetime psychopathology and its brain morphometric and genetic correlates in a transdiagnostic sample

There is a lack of knowledge regarding the relationship between proneness to dimensional psychopathological syndromes and the underlying pathogenesis across major psychiatric disorders, i.e., Major Depressive Disorder (MDD), Bipolar Disorder (BD), Schizoaffective Disorder (SZA), and Schizophrenia (SZ). Lifetime psychopathology was assessed using the OPerational CRITeria (OPCRIT) system in 1,038 patients meeting DSM-IV-TR criteria for MDD, BD, SZ, or SZA. The cohort was split into two samples for exploratory and confirmatory factor analyses. All patients were scanned with 3-T MRI, and data was analyzed with the CAT-12 toolbox in SPM12. Psychopathological factor scores were correlated with gray matter volume (GMV) and cortical thickness (CT). Finally, factor scores were used for exploratory genetic analyses including genome-wide association studies (GWAS) and polygenic risk score (PRS) association analyses. Three factors (paranoid-hallucinatory syndrome, PHS; mania, MA; depression, DEP) were identified and cross-validated. PHS was negatively correlated with four GMV clusters comprising parts of the hippocampus, amygdala, angular, middle occipital, and middle frontal gyri. PHS was also negatively associated with the bilateral superior temporal, left parietal operculum, and right angular gyrus CT. No significant brain correlates were observed for the two other psychopathological factors. We identified genome-wide significant associations for MA and DEP. PRS for MDD and SZ showed a positive effect on PHS, while PRS for BD showed a positive effect on all three factors. This study investigated the relationship of lifetime psychopathological factors and brain morphometric and genetic markers. Results highlight the need for dimensional approaches, overcoming the limitations of the current psychiatric nosology.

COVID-19 pandemic amplified mortality rates among adolescents with bipolar disorder through family-related factors.

Recently, a growing number of adolescents have been afflicted with mental disorders, with annual morbidity rates on the rise. This trend has been exacerbated by the global coronavirus disease 2019 (COVID-19) pandemic, leading to a surge in suicide and self-harm rates among this demographic. To investigate the impact of the COVID-19 pandemic on adolescent bipolar disorder (BD), along with the underlying factors contributing to heightened rates of suicide and self-harm among adolescents. A comprehensive statistical analysis was conducted utilizing clinical interviews and self-reports obtained from patients or their guardians. Diagnostic criteria for BDs were based on the Diagnostic and statistical manual of mental disorders, international classification of diseases-11, and the National institute of mental health research domain criteria. Statistical analyses were performed using SPSS 26.0 software, with significance set at P < 0.05. A cohort of 171 adolescents diagnosed with BD between January 1, 2018, and December 31, 2022, was included in the analysis. The gender distribution was 2.8:1 (female to male), with ages ranging from 11 to 18 years old. Major factors contributing to adolescent BDs included familial influences, academic stress, genetic predisposition and exposure to school-related violence. Notably, a significant increase in suicide attempts and self-harm incidents was observed among adolescents with BD during the COVID-19 pandemic. Statistical analysis indicated that the pandemic exacerbated familial discord and heightened academic stress, thereby amplifying the prevalence of suicidal behavior and self-harm among adolescents. The COVID-19 pandemic has exacerbated familial tensions and intensified the incidence of suicide and self-harm among adolescents diagnosed with BD. This study underscores the urgent need for societal, familial and educational support systems to prioritize the well-being of adolescents and offers valuable insights and guidelines for the prevention, diagnosis and treatment of adolescent BDs.

Bipolarity in Older individuals Living without Drugs (BOLD): Protocol and preliminary findings

IntroductionAlthough clinical guidelines regard prophylactic medication as the cornerstone of treatment, it is estimated almost half of patients with bipolar disorder (BD) live without medication. This group is underrepresented in research but can provide indispensable knowledge on natural course, resilience and self-management strategies. We aim to describe the clinical phenotype of patients diagnosed with BD who have discontinued maintenance treatment. MethodsThe mixed-methods BOLD study included 58 individuals aged 50 years and over with BD that did not use maintenance medication in the past 5 years. A preliminary, quantitative comparison of clinical characteristics between BOLD and our pre-existing cohort of >220 older BD outpatients with medication (Dutch Older Bipolars, DOBi) was performed. ResultsBD-I, psychiatric comorbidities, number of mood episodes and lifetime psychotic features were more prevalent in BOLD compared to DOBi. BOLD participants had a younger age at onset and reported more childhood trauma. BOLD participants reported fewer current mood symptoms and higher cognitive, social, and global functioning. LimitationsOur findings may not be generalizable to all individuals diagnosed with BD living without maintenance medication due to selection-bias. ConclusionA group of individuals exists that meets diagnostic criteria of BD and is living without maintenance medication. They appear to be relatively successful in terms of psychosocial functioning, although they do not have a milder clinical course than those on maintenance medication. The high prevalence of childhood trauma warrants further investigation. Future analyses will examine differences between BOLD and DOBi per domain (e.g. cognition, physical health, psychosocial functioning, coping).

MALADAPTIVE PARENTING AND PEER GROUP BULLYING AS PATHOLOGICAL PATHWAYS TO BORDERLINE PERSONALITY DISORDER SYMPTOMS IN EARLY ADULT: CASE REPORT

Introduction – Maladaptive experiences during adolescene have been consistently linked with borderline personality disorder. BPD is a serious mental illness characterized by pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image. Tthere was an interrelated relationship between parenting experiences and the development of BPD symptoms. Children who reported chronic bullying had a fivefold increase in the likelihood of developing BPD symptoms. Methods – Presented the case of patient, 20 years old young male with symptoms of borderline personality disorder turned out to have maladaptive parenting and history of became victim by peer group bullying since childhood. Data were taken from interviews and mental status examinations in psychiatric clinics, then a literature review was carried out. Results – The development of borderline personality disorder in adult linked with report of low care parenting, involves coldness, indifference, and rejection. BPD is also inevitable from hereditary risk factors. Discuss – There is a direct significant association between being victim of bullying and development of BPD. Empathy is one important aspect of social behavior that may not function in BPD. Atypical depressed patients with affective dysregulation first diagnosed with borderline personality disorder if do not meet the diagnostic criteria for bipolar disorder. Conclusion – Borderline personality disorder (BPD) is very prone to occur in young adults. Starting from affect dysregulation, inability to impulse control, unstable interpersonal relationships, and unstable self-image that begin to develop in children and adolescents when exposed to environmental risk factors. Risk factors that are very often influencing are family and peer group relationships. BPD is also an entry point for developing into bipolar disorder. Therefore, effective interventions should be targeted, early preventing the development of affect dysregulation in the development of the borderline personality disorder by reducing exposure to environmental risk factors. Keywords: borderline personality disorder, maladaptive parenting, bullying.

What does it mean to age well with bipolar disorder? A qualitative study using photo elicitation.

The objective of this study is to explore what ageing well means to older adults with bipolar disorder. Older adults with bipolar disorder took photographs of aspects of their lives that they felt represented ageing well. They then completed audio-recorded photo elicitation interviews to explore what it meant to age well with bipolar disorder in detail. Data were analysed using reflexive thematic analysis. Seventeen participants met the criteria for bipolar disorder I or II. The analysis resulted in four key themes to ageing well with bipolar disorder: (1) Lifelong learning - referring to how participants accumulated a wealth of knowledge about bipolar disorder and used this to maintain stability in later life; (2) Finding where you belong - relating to how participants prioritised finding new communities, utilised family support and refined their support networks over time to age well; (3) Recognising your value and worth - which involved participants using their strengths and experiences to support others; and (4) Continuity of support - older adults with bipolar disorder highlighted the benefits of continuous support that allowed them to be actively involved in their treatment. Participants ageing with bipolar disorder identified unique challenges indicating that services require adaptation to meet their needs and support them to age well. Findings suggested that services should provide continuous care that allows this group to actively engage with their treatment, build upon their strengths, and develop meaningful connections with professionals and peers. This approach may enhance support for older adults with bipolar disorder and reduce the inequalities they experience.

Psychosocial Traumatic Environments: A Clinical Case of Childhood Abuse

Traumatic psychosocial environments directly impact adult life. Compromised self-esteem, emotional self-regulation, and interpersonal relationships are observed, and a predisposition to the presence of mental and personality disorders is exacerbated in cases of sexual abuse. Science has presented quantitative and statistical studies on child abuse and a limited number of studies that have investigated the consequences and long-term impacts on the lives of individuals who suffered maltreatment in childhood and did not have access to forms of protection or social support after the identification of child abuse, especially in Brazil. Therefore, this case report is a qualitative study of an ideographic nature which aims to evaluate the “particular” form of abuse repercussions in the life of a 60-year-old woman, giving voice to the victim of child abuse through the process of the investigation and complex analysis of her life history and family relationships. The psychological assessment protocol included a semi-structured interview, active listening, a genogram, and a mental status examination. The results reveal the coexistence of a rigid and violent environment with the presence of physical punishment and child sexual abuse. Self-injurious episodes and suicide attempts began in adolescence. Changes in mood, changes in remote memory, negative thoughts, self-injurious behavior, suicidal ideation and attempts, clinical comorbidities, a lack of interest in romantic relationships, and the repetition of behaviors that perpetuate the cycle of abuse and violence (physical, psychological, and patrimonial) were identified. The diagnostic criteria for bipolar disorder with dependent and borderline personality traits have been established. The case requires a multi-disciplinary follow-up with the use of medication to control and remit the symptoms.

The economic and humanistic burden of bipolar disorder in adults in the United States

BackgroundBipolar disorder is associated with functional impairment and diminished health-related quality of life (HRQoL). The purpose of this study was to estimate the annual per patient direct healthcare costs, indirect costs, and HRQoL of patients with bipolar disorder by depressive symptom severity and overall compared to the general population in the US.MethodsThis cross-sectional study used self-reported data from the 2020 US National Health and Wellness Survey. Adult respondents who reported bipolar disorder symptoms in the past 12 months and/or a diagnosis of bipolar disorder were identified (bipolar disorder cohort) and were further classified by depressive symptom severity based on Patient Health Questionnaire (PHQ-9) scores (none/mild = 0–9, moderate = 10–14, severe = 15–27). Annualized direct healthcare costs and indirect costs were calculated from 6-month healthcare resource utilization and work productivity, respectively. A general population cohort was constructed using 2:1 propensity score matching. Multivariate regression models of all-cause hospitalizations in the past 6 months, annualized direct healthcare costs, annualized indirect costs, and HRQoL (eg, EuroQol 5-Dimension Health Questionnaire (EQ-5D)) controlled for confounders (demographic and clinical characteristics).ResultsOf 3583 adults meeting pre-specified criteria for bipolar disorder, 1401 (39.1%) reported none/mild, 889 (24.8%) moderate, and 1293 (36.1%) severe depressive symptom severity. Additionally, 3285 (91.7%) were matched to 6570 adults in the general population. Compared to the general population, adjusted mean hospitalizations (0.53 vs. 0.30), annualized per patient direct healthcare costs ($20,846 vs. $11,391), and indirect costs ($14,795 vs. $9274) were significantly greater for the bipolar disorder cohort (all p < 0.001); adjusted HRQoL (EQ-5D: 0.69 vs. 0.79) was significantly worse (p < 0.001). By depressive symptom severity, adjusted mean hospitalizations (none/mild = 0.30, moderate = 0.50, severe = 0.46), direct healthcare costs ($14,389, $22,302, $21,341), and indirect costs ($10,799, $17,109, $18,470) were significantly greater for moderate and severe compared to none/mild depressive symptom severity (all p < 0.01); adjusted HRQoL (EQ-5D: 0.77, 0.67, 0.59) was significantly worse (p < 0.001).ConclusionsAmong respondents with bipolar disorder, those with moderate to severe depression had greater direct healthcare costs and indirect costs as well as worse HRQoL than those with mild or no depressive symptoms. Treatment targeting reduction in depressive symptoms may reduce the economic and humanistic burden of bipolar disorder.

The Screen for Cognitive Impairment in Psychiatry (German version, SCIP-G): Validation, dimensionality analysis and practical application in inpatient psychiatric treatment

IntroductionPsychiatric disorders are often characterised by cognitive impairment. The Screen for Cognitive Impairment in Psychiatry (SCIP) was developed for routine screening of psychiatric patients and is available in several languages.ObjectivesUsing the German version (SCIP-G), 3 studies were conducted: 1. feasibility, reliability, and validity of the SCIP-G were investigated [Sachs et al. Schizophr. Res. Cogn. 2021: 25, 100197], 2. a confirmatory factor analysis was performed [Sachs et al. Schizophr. Res. Cogn. 2022: 29, 100259], and 3. patients with psychotic, bipolar affective, and depressive disorders were assessed before and after standard inpatient treatment including cognitive remediation.MethodsStudy 1 included patients with schizophrenia or schizoaffective psychosis and thirty healthy controls matched for sex, age, and education. Data were collected at the Medical University of Vienna, Department of Psychiatry and Psychotherapy. In studies 2 and 3, patients from the Klinik Hietzing, 1st Department of Psychiatry and Psychotherapeutic Medicine, Vienna, Austria, were studied. In study 3, all patients received modern pharmacotherapy plus cognitive remediation using the COGPACK® software package version 6.06; based on the ICD-10 criteria for research, 54 patients received an F2 diagnosis (schizophrenia, schizotypal, and delusional disorders), 39 patients met criteria for bipolar disorder (F30 and F31), and 50 for depression (F32 and F33).ResultsIn Study 1, significant differences in cognitive performance were found between patients and healthy controls on both versions of the SCIP. The SCIP effectively discriminated between patients and the control group. In Study 2, a two-factor solution in which the Verbal Learning Test-Immediate Recall subtests, Delayed Recall Test of the VLT, and Working Memory Test loaded on the first factor and the Verbal Fluency Test and Psychomotor Speed Test subtests loaded on the second factor yielded good model fit (χ² = 6.7, df = 3, p = .08, χ²/df = 2.2). In Study 3, SCIP total score showed significant improvement after treatment in all three diagnostic groups (p &lt; .001), with no statistically significant interaction between SCIP total score and diagnostic groups (p = .860).ConclusionsOur data indicate that the SCIP-G is a valid and reliable instrument for assessing cognitive impairment. Good model fit can be achieved with a two-factor solution for the SCIP. Our study is the first to perform a confirmatory factor analysis with the German SCIP version and to test its dimensional structure with a hypothesis-testing approach. Inpatient treatment consisting of pharmacotherapy and cognitive remediation improved cognitive deficits. This improvement in cognitive performance was observed to a similar extent in patients with psychotic disorders, bipolar disorder, and depression.Disclosure of InterestNone Declared

State of illness-dependent associations of neuro-cognition and psychopathological syndromes in a large transdiagnostic cohort

BackgroundThere is a lack of knowledge regarding the relationship between dimensional psychopathological syndromes and neurocognitive functions, particularly across the major psychiatric disorders (i.e., Major Depressive Disorder (MDD), Bipolar Disorder (BD), and Schizophrenia (SZ)). MethodSANS, SAPS, HAMA, HAM-D, and YMRS were assessed in 1064 patients meeting DSM-IV-TR criteria for MDD, BD, SZ or schizoaffective disorder (SZA). In addition, a comprehensive neuropsychological test battery was administered. Psychopathological syndromes derived from factor analysis and present state of illness were used to explore psychopathology-cognition relationships. Correlational analyses were corrected for age, sex, verbal IQ, years of education, and DSM-IV-TR diagnosis. Age of onset and total duration of hospitalizations as proxies for illness severity were tested as moderators on the cognition – psychopathology relationship. ResultsThe negative syndrome, positive formal thought disorder as well as the paranoid-hallucinatory syndrome exhibited associations with neuro-cognition in an illness state-dependent manner, while the psychopathological factors depression and increased appetite only showed weak associations. Illness severity showed moderating effects on the neurocognitive-psychopathology relationship only for the negative syndrome and positive formal thought disorder. LimitationsNo healthy control subjects were entered into the analyses because of lack of variance in psychopathological symptoms, which prevents from drawing conclusions regarding the relative level of potential cognitive impairments. ConclusionsThis study suggests the relationship of neuro-cognition and psychopathology to be highly state of illness-dependent across affective and psychotic disorders. Results hint at the moderating effects of illness severity on psychopathological factors that might be more treatment resistant.

Course of subthreshold manic symptoms and related risk factors in the general population: A three-year follow-up study.

Subthreshold manic symptoms (subM) are a risk factor for the onset and recurrence of bipolar disorder (BD). Individuals with subM may benefit from preventive interventions, however, their development is hampered by a lack of knowledge on subM prevalence and subsequent course. This study examines subM characteristics, course, and risk factors for an unfavourable course. In a Dutch representative, population-based sample aged 18-64 (N= 4618), we assessed subM, defined as the occurrence of manic core symptoms (elation/irritability), without meeting full DSM-IV criteria for BD I or II in the past 3 years. Comparison groups had either no manic symptoms (noM) or hypomania/mania in the context of BD (mBD) in the past 3 years. Furthermore, we differentiated a mild and moderate type of subM, based on the number of manic symptoms. A subsequent three-year course was assessed prospectively. SubM had a three-year prevalence of 4.9%. Its prevalence, characteristics, and course were in between noM and mBD, and there were few differences between mild and moderate subM. Over the 3-year follow-up, 25.0% of individuals with subM had persistent subM and another 6.1% transitioned to mBD. Eleven significant risk factors for this unfavourable course were found. The most important were a history of depression/dysthymia (OR 3.75, p≤ 0.001), living alone (OR 2.61, p≤ 0.01) and elevated neuroticism score (OR 1.21, p≤ 0.001). This study supports the validity and clinical relevance of subM as a BD prodrome. It demonstrates that subM symptoms often persist or increase during follow-up and identifies 11 risk factors that are associated with an unfavourable course.

Association of current and remitted bipolar disorders with health-related quality of life: Findings from a nationally representative sample in the US

BackgroundThe associations of current and remitted bipolar disorder (BD) with health-related quality of life (HRQOL) have been under-studied, and we aim to address these gaps. MethodsThe 2012–2013 National Epidemiological Survey on Alcohol and Related Conditions III (NESARC III) surveyed a nationally representative sample of non-institutionalized adults in the US. Using DSM-5 criteria, three groups were operationalized as: 1) adults who met criteria for BD in the past year (i.e., current BD; n = 566 unweighted); and 2) adults who met criteria for BD previously but not in the past year (i.e., BD in remission; n = 187); and 3) adults with no BD in their lifetime (n = 35,556). HRQOL and quality-adjusted life years (QALYs) were compared by these groups. Multivariable-adjusted regression analyses were used to adjust for and examine the role of covariates. ResultsOverall, 1.5 % of the study sample, representing 3.6 million adults nationwide, met criteria for current BD, and 0.5 %, representing 1.3 million adults, met criteria for BD in remission. Adults with current BD and BD in remission had lower mental HRQOL and QALYs, as compared to adults who never had BD. However, these differences were no longer significant when adjusted for behavioral co-morbidities (e.g., psychiatric and substance use disorders). ConclusionBoth current BD and BD in remission were adversely associated with HRQOL and QALYs, while these associations were not independent of behavioral co-morbidities. Because behavioral co-morbidities are common in individuals with current BD or those with BD in remission, they should be treated together to improve HRQOL.

Clinical features and management of manic episodes in adolescents. A case review

IntroductionAssessment and management of bipolar disorder, and particularly manic episodes in adolescents means a challenge. The presence of comorbid disorders, and divergent interpretations of manic symptoms in the context of the adolescent natural inmaturity, can make diagnosis and treatment hard goals to achieve. The existence of juvenile specific criteria for bipolar disorder is a debate topic. This concept emerged from an attempt to solve diagnosis issues and involves a wide range of definitions for mania.ObjectivesLiterature review concerning bipolar disorder in young population: Main comorbidities, psychosocial problems, prognosis. Clinical presentation: Shared and specific features compared to adult population. Available treatment options. Issues related to safety and tolerability.MethodsWe present a case of a 16 year old woman diagnosed with bipolar II disorder, hospitalised in an inpatient adolescent unit in 2021. Review of the literature available (clinical guidelines, PubMed).ResultsPatient initially oriented as a Bipolar II disorder, after depressive episodes followed by hypomanic symptoms in the past years. The following clinical course was conditioned by personality traits. Emotional disregulation and a complex family environment made affective symptoms difficult to evaluate, leading to a diagnostic hypothesis of personality-related disorder. After a period of outpatient treatment in a day hospital, she debuted with a clinical picture of manic symptoms, mixed features and rapid mood cycling.ConclusionsAfter an initial trial, stabilization was achieved with aripiprazole and asenapine. Combination therapy might be necessary in longer-term treatment, according to existing evidence. Diagnosis and treatment concerns are interfered by the limited number of trials.DisclosureNo significant relationships.

The significance of sleep quality in euthymic bipolar patients from Nigeria.

BackgroundBipolar disorder is highly under-researched in Africa. Existing studies show that racial/ethnic disparities exist for sleep quality. Poor sleep quality in bipolar disorder causes significant morbidity and mortality even during periods of euthymia.AimThis study aimed to assess sleep quality and its correlates amongst euthymic patients with bipolar I disorder from Nigeria.SettingThe study was carried out in a teaching hospital, and state hospital, in Ibadan, Nigeria.MethodThis cross-sectional study was conducted amongst 76 euthymic bipolar patients aged between 18 and 60 years, meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria for bipolar disorder. Euthymia was defined as having a score of ≤ 5 on the Young Mania Rating Scale and < 8 on the Hamilton Depression Rating Scale. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI).ResultsA total of 37 (48.7%) participants had poor quality sleep. Sleep quality was associated with marital status (p = 0.013) and suicide plan (p = 0.047). Participants with good sleep quality had higher total sleep duration, lower time to fall asleep (sleep latency), better subjective quality of sleep, were less likely to use sleep medications and had less daytime dysfunction than participants with poor sleep quality. All p-values were < 0.05. Subjective quality of sleep, ongoing use of sleep medication, daytime dysfunction were independently associated with poor sleep quality.ConclusionPoor sleep quality frequently persists during euthymic periods in patients with bipolar disorder. The correlates identified can be targeted for intervention during treatment.

Which mixed depression model? A comparison between DSM-5-defined mixed features and Koukopoulos' criteria.

The criteria of the Diagnostic and Statistical Manual of Mental Disorders 5th edition "with mixed features specifier" (DSM-5 MFS) are considered controversial since they include only typical manic symptoms. By contrast, Koukopoulos developed an alternative model of mixed depression (MxD) focusing primarily on the excitatory component. To compare DSM-5 MFS and Koukopoulos' MxD (KMxD) in terms of prevalence, associated clinical variables, and discriminative capacity for bipolar depression in patients with major depressive episode (MDE). A total of 300 patients with MDE-155 with major depressive disorder and 145 with bipolar disorder (BD)-were recruited. The discriminative capacity of DSM-5 MFS and KMxD criteria for BD was estimated using the area under the curves of receiver operating characteristic (ROC_AUC). The clinical variables associated with these two diagnostic constructs were assessed by performing a logistic regression. A total of 44 and 165 patients met the DSM-5 MFS and KMxD criteria, respectively. The ROC_AUCs and their confidence intervals for BD according to DSM-5 MFS and KMxD were 77.0% (72.0%-82.1%) and 71.9% (66.2%-77.7%), respectively. The optimal thresholds (combining sensitivity and specificity measures) for BD diagnosis were ≥1 (77%/68%) for DSM-5 MFS and ≥3symptoms (78%/66%) for KMxD. However, considering the DSM-5 MFS cut-off (≥3symptoms), the specificity (97%) increased at the expense of sensitivity (26%). KMxD and DSM-5-MFS showed an overlapping discriminative capacity for bipolar depression. The current diagnostic threshold of DSM-5 MFS did not prove to be very inclusive, if compared with the greater diagnostic sensitivity of KMxD, which also yielded better association with clinical variables related to mixedness.

Transitioning to bipolar disorder: A systematic review of prospective high-risk studies.

Bipolar disorder is a highly heritable condition, which can progress from an asymptomatic period in at-risk individuals to a potentially debilitating illness. Identifying individuals who are at a high risk of developing bipolar disorder may provide an opportunity for early intervention to improve outcomes. The main objective of this systematic review is to provide an overview of prospective studies that evaluated the incidence and predictors of transitioning to bipolar disorder among high-risk individuals. Twenty-three publications from 16 cohorts were included in the final review. Most studies focused on familial high-risk groups, while others either used clinical or a combination of clinical and genetic risk factors. The follow-up length was from 1 to 21 years and the rate of conversion to bipolar disorder was between 8 and 25% among different studies. Overall, the results suggest that a combination of genetic and clinical risk factors; namely, subthreshold (hypo)manic symptoms and elevated depressive symptoms, may be required to optimally predict conversion to bipolar disorder. The concept of high-risk for bipolar disorder is still in its infancy. Further discussions are needed to work towards an expert consensus on the high-risk criteria for bipolar disorder, taking into account both clinical and genetic risk factors.

HLA-E circulating and genetic determinants in schizophrenia and bipolar disorder

Schizophrenia (SZ) and bipolar disorders (BD) are severe mental illnesses that lack reliable biomarkers to guide diagnosis and management. As immune dysregulation is associated with these disorders, we utilized the immunoregulatory functions of the natural killer cell inhibitory HLA-E locus to investigate the relationships between HLA-E genetic and expression diversities with SZ and BD risk and severity. Four hundred and forty-four patients meeting DSM-IV criteria for SZ (N = 161) or BD (N = 283) were compared to 160 heathy controls (HC). Circulating levels of the soluble isoform of HLA-E molecules (sHLA-E) were measured and HLA-E*01:01 and HLA-E*01:03 variants genotyped in the whole sample. sHLA-E circulating levels were significantly higher in both SZ and in BD patients compared to HC (pc < 0.0001 and pc = 0.0007 for SZ and BD, respectively). High sHLA-E levels were also observed in stable SZ patients and in acute BD patients experiencing depressive episodes when comparisons were made between the acute and stable subgroups of each disorder. sHLA-E levels linearly increased along HLA-E genotypes (p = 0.0036). In conclusion, HLA-E variants and level may have utility as diagnostic biomarkers of SZ and BD. The possible roles of HLA diversity in SZ and BD etiology and pathophysiology are discussed.

43.2 Youth Receiving Opioid Agonist Treatment: Exploring Differences and Similarities to Adult Patients in a Canadian Study

There continues to be an underutilization of opioid agonist treatment (OAT) in youth younger than 25 years. Understanding unique characteristics of this population may inform the treatment goals and supports required to improve treatment for youth with opioid use disorder (OUD). We explored characteristics of youth (ages 16-25 years) enrolled in OAT compared to adults (>25 years). Data were collected from 261 youth and 3184 adults receiving OAT at 36 outpatient clinics in Ontario, Canada. Cross-sectional data on sociodemographic, treatment, and substance use characteristics were obtained at study entry. The Mini-International Neuropsychiatric Interview was administered to patients recruited from 2013 to 2016, including 66 youths and 617 adults, to identify mental illness comorbidity. We used logistic regression to explore characteristics associated with youth compared to adults enrolled in OAT. The mean age was 22.5 years (SD = 1.7) for youth and 40 years (SD = 10.2) for adults. Most youth (83%) and adults (87%) were treated with methadone. Compared to adults, youth were more likely to be female (OR = 1.67; 95% CI, 1.25-2.23) and less likely to have finished high school (OR = 0.53; 95% CI, 0.39-0.71). Youth were more likely to use drugs intravenously (OR = 1.47; 95% CI, 1.08-2.01) and to use cannabis (OR 1.78; 95% CI, 1.32-2.39); they were less likely to have started opioid use following a physician prescription (OR = 0.19; 95% CI, 0.13-0.29). Youth were enrolled in treatment for less time than adults (OR = 0.76; 95% CI, 0.71-0.82) but were more likely to be abstinent from opioids as measured by urine drug screen (UDS) before study entry (OR = 1.65; 95% CI, 1.22-2.22). Youth were more likely to meet the criteria for bipolar disorder (OR = 2.41; 95% CI, 1.20-4.83) and anxiety disorders (OR = 1.85; 95% CI, 1.08-3.17); they did not differ from adults for depression (OR = 1.15; 95% CI, 0.62-2.15), psychotic disorders (OR = 0.31; 95% CI, 0.04-2.44), or eating disorders (OR = 1.06; 95% CI, 0.12-9.45). Youth enrolled in OAT differ from adults on a number of dimensions: demographic characteristics, substance use, and mental illness comorbidity. These findings suggest areas of attention for clinical programs treating youth with OUD, including educational supports and management of co-occurring mental health disorders.