Diagnosis Of Bipolar Type Research Articles

A transdiagnostic approach to negative symptoms: exploring factor structure and negative symptoms in bipolar disorders.

Negative symptoms are increasingly recognized as transdiagnostic phenomena, linked to reduced quality of life and functioning, and often caused or worsened by amendable external factors such as depression, social deprivation, side-effects of antipsychotics or substance use. The structure of negative symptoms fits into two dimensions: diminished expression and apathy. These may differ in association with external factors that influence their severity and may thus require different treatment approaches. The dimensions are comprehensively established in non-affective psychotic disorders but are understudied in bipolar disorders. We conducted exploratory and confirmatory factor analyses in a sample of 584 individuals with bipolar disorder to assess the latent factor structure of negative symptoms as measured by the Positive and Negative Syndrome Scale (PANSS), and performed correlational analyses and multiple hierarchical regression analyses to investigate links between the two dimensions of negative symptoms and clinical and sociodemographic correlates. The latent factor structure of negative symptoms fits into two dimensions, i.e., diminished expression and apathy. A diagnosis of bipolar type I or a history of psychotic episodes predicted more severe levels of diminished expression. Depressive symptoms were associated with more severe negative symptoms across dimensions, yet 26.3% of euthymic individuals still displayed at least one mild or more severe negative symptom (PANSS score ≥ 3). The two-dimensional structure of negative symptoms seen in non-affective psychotic disorders reproduces in bipolar disorders indicating similarities in their phenomenology. Diminished expression was associated with a history of psychotic episodes and a diagnosis of BD-I, which may infer closer connections to psychosis liability. We found significantly less severe negative symptoms in euthymic than depressed participants. Nevertheless, more than a quarter of the euthymic individuals had at least one mild negative symptom, demonstrating some degree of persistence beyond depressed states.

MISSED SEIZURE DURING ELECTROCONVULSIVE THERAPY

Background: Here, the authors reported two cases of electroconvulsive therapy with a missed seizure and present a literature review to explore the possible reasons and recommendations. To date, most authorities agreed seizure duration correlates to the effectiveness of the ECT, and a reason to a minimum of 25 seconds duration of seizure is defined as a good seizure. Many aspects of the seizures during the ECT are well researched and lots of data is available about the possible modifiers of seizures, indicators of an effective seizure, and ways to monitor an effective seizure but very few data reported missed seizures and strategies to follow in the events of no fits. In this case series, we described two cases of missed seizures which were identified and addressed appropriately with subsequent successful ECT sessions. We also presented the literature regarding the strategies to follow immediately post-event. Case 1: A 42-year-old married lady with a diagnosis of bipolar type I disorder, current episode manic, with psychotic symptoms (6A60.1) according to the ICD-11 diagnostic and classification system. Case 2: A middle-aged male with a diagnosis of severe depressive episodes with psychotic symptoms. Both cases had missed seizures during the 3rd session of the electroconvulsive therapy. Conclusion: Studies have shown that the phenomena of missed seizures are common but less reported and are caused by a number of factors including individual factors, the ECT technical parameters as well as concurrent use of pharmacological treatment and anesthetic agent which should be considered before every ECT session. There is a paucity of literature on the strategies to follow immediately after an event of no fits. Therefore, we tried to summarize some possible recommendations which need to be personalized according to a case-to-case basis.

Effects of ketamine treatment on suicidal ideation: a qualitative study of patients’ accounts following treatment for depression in a UK ketamine clinic

ObjectiveIt is recognised that ketamine treatment can reduce suicidal ideation (SI) in people with depression, at least in the short term. However, information is lacking on patients’ perspectives on such...