Bipolar Affective Disorder Research Articles

Eating disorder and bipolar mental illness through genome wide association studies

IntroductionBesides the role played by environmental factors and their epigenetic influences, scientific researchers showed that the susceptibility to develop an eating disorder among bipolar people is due to genetic factors.ObjectivesTo review the genetic factors behind eating disorders, highlight the role of genetics and epigenetics in the comorbidity of bipolar and eating disorders.Methods To delineate the role of genetics and epigenetics in eating disorders and bipolar disorders as two related mental illness, we comprehensively reviewed the scientific literature using GWAS (genome wide association studies) catalog databases to find genome-wide association studies carried out on patients with bipolar disorder EFO_0005203 and eating disorder comorbid condition (anorexia nervosa, binge eating, bulimia nervosa) EFO_0005203.Results GWAS of eating disorders were found in 33 studies with 324 associations whereas those of bipolar disorder were found in 114 studies with 1469 associations. GWAS of eating disorders within bipolar disorders revealed 182 and 134 associations, as well as 10 and 8 publications respectively. Only anorexia nervosa and binge eating were studied in association with bipolar disorders. The genetic variants were protein coding genes (CUBN, FAM228B, FXR1, etc.), non-coding RNA genes (SOX2-OT, MMADHC-DT, etc.), and pseudo-genes (RNU1-23P, CACYBPP2, etc.).ConclusionsAbout 300 genetic variants are associated with eating disorder as a comorbid condition of bipolar disorders. These variants may play a crucial role in the causes and mechanisms of eating disorders and should be more investigated towards more precise clinical and genetic entities.Disclosure of InterestNone Declared

Use of aripiprazole long-acting injectable release as a stabiliser. About a case

IntroductionA 56-year-old patient diagnosed with bipolar affective disorder type II, who remains stable, with no manifest episodes, thanks to aripiprazole 60mg daily.ObjectivesThe aim is to carry out a brief review of the use of the drug as the only stabiliser in bipolar affective disorder.MethodsA 56-year-old patient, who has been suffering from episodes of hypomania since the age of 40, with episodes of depression. After poor tolerance to the use of the usual stabilisers, and the impossibility of using antidepressants due to hypomanic swings, it was decided to start treatment with aripiprazole orally, up to a maximum of 60mg daily. Despite the fact that the patient, with this treatment, had no side effects and remained more stable psychopathologically, the patient did not comply adequately with the correct dosage, due to his rotating work shifts. This fact explained that although he acknowledged an improvement, he continued with episodes of depressive symptoms lasting several days followed by episodes of hypomanic characteristics.ResultsFor this reason, it was decided to change treatment to aripiprazole long-acting injectable, in order to ensure linear blood levels of the drug. Initially, it was decided to prescribe 400mg every 28 days. However, after the first administration, 20 days later, the patient began to show dysphoric mood, with marked emotional lability, living in an egodystonic manner. For this reason, the dose was increased to 600mg on a monthly basis. Since then, after a year and a half with the same treatment, the patient has been stable and in line. There has been no further decompensation of the underlying psychopathology and no side effects.ConclusionsAripiprazole in TAB is superior to placebo in type I patients, mainly affecting manic and mixed episodes, but not so much in depressive episodes. It has also been observed that it not only acts in the acute phases, but also has a stabilising function, preventing manic episodes.One study showed that up to 65% of patients on oral aripiprazole in whom it was replaced by AOM remained clinically stable. In the same study, approximately 50% of those who completed 52 weeks of follow-up were able to maintain clinical stability.Disclosure of InterestNone Declared

Long-Term Trends in Psychiatric Day Hospitalization: A Retrospective Study in Algarve, Portugal

IntroductionCurrent healthcare policies encourage the investment in transition units between hospitalization and outpatient care. Psychiatry day hospitals (DH) serve as partial hospitalization structures that facilitate this transition. The DH at the Faro Unit of the Centro Hospitalar Universitário do Algarve (CHUA), began its activity in 2008, is situated in southern Portugal and provides support to the entire eastern Algarve region (approximately 300,000 people). Its focus is on rehabilitating individuals with severe mental illnesses necessitating multidisciplinary care, with personalized therapeutic plans.ObjectivesWe aimed to categorize patients based on diagnoses (primary psychotic disorder, depressive disorder, and others) according to the International Classification of Diseases (ICD-11) and to characterize and compare sociodemographic and clinical data among these three groups.MethodsA retrospective study spanning from May 2008 to June 2023 was conducted. We assessed sociodemographic, clinical, and epidemiological data of patients undergoing treatment at CHUA Faro Unit’s DH.ResultsOver this period, 541 treatment cycles were carried out to 433 distinct patients, between 18 and 78 years old. Of the total treatments, 38% were for Primary Psychotic Disorder (PPD), 24% for Depressive Disorder (DD) and among the others (39%) the diagnosis of Bipolar Affective Disorder and Personality Disorder predominated . Statistically significant differences were identified among these three groups. The PPD group exhibited a male predominance, whereas DD and others were largely female. Patients in the PPD group were significantly younger (average age of 36 in PPD, 40 in others, and 48 in DD), more likely to be single, and a majority were unemployed (with several patients retired due to disability). No significant differences were noted regarding dropouts, expulsions, or the duration of DH treatment. These results are preliminary, and additional relevant data are being collected and processed.ConclusionsThe diagnostic group’s consideration revealed differences in the social, demographic, and clinical characteristics of patients. These findings offer insights into patient details, enabling the future adaptation of intervention strategies in a more personalized manner.Disclosure of InterestNone Declared

Influence of genetic background on the clinical picture of bipolar affective disorder in a population of children and adolescents

IntroductionBipolar disorder in children is characterized by a different course than in adults, which is a diagnostic difficulty. DAT-1 is a dopamine transporter gene that regulates dopaminergic neurotransmission through the mechanism of active reuptake of this neurotransmitter from the synapse. Polymorphisms within the described gene can result in changes in dopamine levels, which may have implications for the development of bipolar disorder.Objectives The aim of the project was to analyze the relationship between single nucleotide polymorphisms (SNPs) within the dopamine transporter gene DAT-1 and the risk of development of bipolar disorder in a population of children and adolescents.Methods21 healthy controls (12 females, 9 males) have been recruited into the study and 13 patients (9 girls, 4 boys) with bipolar disorder diagnosis from Department of Psychiatry and outpatient clinic, were recruited for the study group. Questionnaires such as the KSADS-PL were carried out and blood was taken for laboratory tests of four SNPs within the DAT-1 transporter. PQStat, Microsoft Excel 2013 and StatSoft STATISTICA were used to perform the statistical analysis.ResultsSNPs within the dopamine transporter gene and environmental risk factors influenced the risk of developing bipolar disorder in the population of children and adolescents.ConclusionsThe ambiguity in results emphasizes the necessity for further investigations into correlation between genetic factors in bipolar disorder etiology. Future research should involve more participants. The results of this project are likely to make a significant and valuable contribution to the current knowledge of bipolar disorder and to the development of innovative diagnostic methods, making a significant contribution to the advancement of science.Disclosure of InterestNone Declared

Comparison of Staging Methods for Treatment-Resistant Depression: Chart Review

IntroductionTreatment-resistant depression (TRD) lacks a universally consistent definition due to varied interpretations despite attempts to define it based on inadequate response or remission despite sufficient antidepressant treatment. There’s a crucial demand for a uniform definition and staging to streamline its effective management amid diverse treatment options and the complex nature of resistance. Five methods have emerged to define and classify treatment resistance reliably.Objectives The aim of this study is to compare the five staging methods (Thase&Rush SM (T&R), European Staging Method (ESM), Maudsley Staging Method (MSM), Massachusetts General Hospital Staging Method (MHG-s), Conway Staging Method(Conway)) in assessing treatment resistance within a single sample.Methods Retrospective analysis involved medical records of inpatient psychiatry clinic admissions at Hacettepe University between October 2012 and October 2014. Patients with a primary diagnosis of bipolar affective disorder, schizophrenia, other chronic psychotic disorders, dementia or cognitive disorders, alcohol and substance use disorders, and those with missing data were excluded.ResultsInitial screening yielded a total of 115 patients. 64 patients were included in the study, 13 patients were excluded due to missing data, and 38 patients were excluded due to comorbidity.CharacteristicTotal (N=64) Last Episode CharacteristicsTotal (N=64)Female - N(%)44 (69)Episode duration – month (mean ± SD)13.75 ± 16.09Age – yr (mean ± SD)48.39 ± 18.81Psychotic symptoms – N(%)20 (31)Married – N(%)41 (64)Anxiety symptoms – N(%)24 (38)Secondary school and over – N(%)38 (59)Suicidal attempt – N(%)19 (30)Employed – N(%)16 (25)TRD definition and staging method (N=55) T&R ESM MSM MGH-S ConwayNot resistant by this method26 (47.3)45 (81.8)0 (0)27 (49.1)43 (78.2)Identified by this method29 (52.7)10 (18.2)55 (100)28 (50.9)12 (21.8)Exclusively identified by this method0 (0)0 (0)21 (38.2)0 (0)0 (0)By this and one other method27 (49.1)0 (0)11 (20)5 (9.1)0 (0)By all methods10 (18.2)10 (18.2)10 (18.2)10 (18.2)10 (18.2)Identified as TRDAge of onset (mean ± SD)40.28 ± 17.4235.6 ± 18.2740.44 ±18.3840.07 ± 17.938.17 ± 17.71ATHF score (mean ± SD)7.55 ± 5.4612.1 ± 6.514.93 ± 4.987.43 ± 5.6911.08 ± 6.47Last episode duration (month) (mean ± SD)17.11 ± 17.2522.10 ± 20.9614.22 ± 17.0816.33 ± 17.6620.83 ± 19.25Conclusions There is no universally agreed-upon definition for treatment resistance. In this sample, different definition and staging methods were employed to examine the similarities and differences in the clinical and treatment related characteristics of groups with TRD identified with each. The reasons and possible implication of concurrence and discordance between the methods will be discussed.Disclosure of InterestNone Declared

Bipolar Disorder in Pregnancy: A Challenging Case Managed with Maintenance Electroconvulsive Therapy

IntroductionPregnancy is a high-risk period for major affective disorders and can lead to a destabilizing period for our patients. Standard pharmacological strategies must be carefully evaluated due to potential teratogenic or side effects. We present a case of bipolar disorder type I with challenging-to-control maniac episodes during pregnancy, which has required Electroconvulsive Therapy for its management.ObjectivesPresenting maintenance electroconvulsive therapy (ECT) as a safe and effective therapeutic strategy during pregnancy, with the presentation of a case in which it has been administered every 3 weeks from the second trimester until the baby’s birth at 37 weeksMethodsThis concerns a 28-year-old immigrant woman, married, with a 10-year-old child. She was diagnosed with bipolar disorder type I at the age of 16 when she experienced her first manic episode in her country of origin. Subsequently, during her first pregnancy, she required hospitalization for electroconvulsive therapy (ECT) treatment, with a positive response after a single session. She remained stable for several years without maintenance pharmacological treatment or follow-up until the ninth week of her second pregnancy when she experienced a manic episode requiring hospitalization.ResultsShe was initially treated with Olanzapine and Lorazepam with a positive response, but three weeks later, she was readmitted with a similar episode. These decompensations occurred almost monthly, leading to the consideration of introducing mood stabilizers after the first trimester. However, due to the patient’s severe hyperemesis gravidarum, this stabilizing treatment was ruled out due to the difficulty in controlling its blood levels and the associated risk of intoxication. During the fifth admission at the 20th week of gestation, the decision was made to initiate ECT treatment, which yielded an excellent response and subsequent maintenance.ConclusionsThe indications for electroconvulsive therapy (ECT) during pregnancy are the same as in the rest of adult patients. In individuals with a psychiatric history, it is possible for a relapse of mental illness to occur during pregnancy, although the risk is considerably higher during the postpartum period. ECT is considered an effective and safe treatment option in all three trimesters of pregnancy and the postpartum period. During the informed consent process, patients should be informed about the potential impact of ECT as well as alternative treatment options.Disclosure of InterestNone Declared

Korean Medication Algorithm for Bipolar Disorder: changes in preferred medications for mania over 20 years

Introduction Majority of international guidelines for bipolar disorders are based on evidences from clinical trials. In contrast, the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed to adopt an expert-consensus paradigm which was more practical and specific to the atmosphere in Korea.ObjectivesIn this study, preferred medication strategies for acute mania over six consecutively published KMAP-BP (2002, 2006, 2010, 2014, 2018, and 2022) were investigated.MethodsA written survey using a nine-point scale was asked to Korean experts about the appropriateness of various treatment strategies and treatment agents. A written survey asked about the appropriateness of various treatment strategies and treatment agents commonly used by clinicians as the first-line.ResultsThe most preferred option for the initial treatment of mania was a combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP) in every edition. Preference for combined treatment for euphoric mania increased, peaked in KMAP-BP 2010, and declined slightly. Either MS or AAP monotherapy was also considered a first-line strategy for mania, but not for all types of episodes, including mixed/psychotic mania. Among MSs, lithium and valproate are almost equally preferred except in the mixed subtype where valproate is the most recommended MS. The preference of valproate showed reverse U-shaped curve. This preference change of valproate may indicate the concern about teratotoxicity in women. Quetiapine, aripiprazole, and olanzapine were the preferred AAP for acute mania since 2014. This change might depend on the recent evidences and safety profile. In cases of unsatisfactory response to initial medications, switching or adding another first-line agent was recommended. The most notable changes over time included the increasing preference for AAPs.ConclusionsThe Korean experts have been increasingly convinced of the effectiveness of a combination therapy for acute mania. There have been evident preference changes: increased for AAP and decreased for carbamazepine.Disclosure of InterestNone Declared

The SLC6A1 Mutation Schizophrenia case — A Comprehensive Case Study With iPSC Generation

IntroductionThe main finding of a large-scale collaborative study (Rees et al. Nat Neurosci 2020;23(2) 179-184), which focused on de novo mutations in schizophrenia, was the discovery of an enrichment of these mutations in the SLC6A1 gene. This gene encodes the gamma-aminobutyric acid (GABA) transporter GAT1, thereby encouraging further research into novel schizophrenia targets within the GABA pathway. However, the gene was not highlighted in recent schizophrenia genetic studies, while typically pathogenic SLC6A1 mutations result in epilepsy, motor dysfunction, autistic spectrum disorder (ASD) and developmental delay. The absence of genetic replication for SLC6A1’s involvement in schizophrenia and the differing clinical spectrum for SLC6A1 mutations led us to study in depth one of the only three original probands from the Rees et al. 2020 study.ObjectivesIn our comprehensive case study, we delved deep into the relationship between the SLC6A1 mutation and schizophrenia.MethodsOur subject, a patient who first presented with acute mania symptoms at age 15 and was later diagnosed with schizophrenia, carried the SLC6A1 Arg211Cys mutation. Over a detailed 25-year follow-up, we conducted an array of assessments and tests, including cognitive testing, personality assessments, EEG, and 1H-MRS.ResultsNotably, we discovered abnormal GABA levels, potentially indicating a dysfunction in GABA reuptake, adding a new layer of complexity to our understanding. Further analysis revealed a significant correlation between the patient’s clinical picture and a polygenic background, rather than the SLC6A1 mutation. Despite having a high polygenic risk score for bipolar disorder, the dominant features of his condition were more representative of schizophrenia. Interestingly, neither the patient nor his father, who also showed a higher BP PRS, had a diagnosis of bipolar disorder. The pathogenic significance of the mutation warrants investigation in cells of neuronal origin. We generated induced pluripotent stem cells (iPSC) from the patient and his parents. This approach provides us with a platform for future investigations into the pathogenic significance of the mutation in neuronal cells. The Human Pluripotent Stem Cell Registry accession numbers of those cells are MHRCCGi001-A (patient), MHRCCGi005-A (mother) and MHRCCGi004-A (father).ConclusionsIn the presented case the clinical picture is rather explained by the polygenic background than by the SLC6A1 Arg211Cys mutation. The study is supported by Russian Science Foundation, grant 21-15-00124 (https://rscf.ru/project/21-15-00124)Disclosure of InterestNone Declared

The hierarchical taxonomy of psychopathology in clinical high risk for psychosis: Validation and extension.

The Hierarchical Taxonomy of Psychopathology (HiTOP) consortium's transdiagnostic dimensional model of psychopathology has considerable support; however, this model has been underresearched in individuals at clinical high risk for psychosis (CHR-P), a population that may advance the model. CHR-P individuals not only have attenuated psychotic symptoms that vary in severity, but also have many comorbid diagnoses and varied clinical outcomes, including disorders with uncertain relations to HiTOP (e.g., obsessive-compulsive disorder). The present study used self-report and interview data from North American Prodrome Longitudinal Study-3 (710 CHR, 96 controls) to replicate the HiTOP model and test specific hypotheses regarding disorders with uncertain relations to its dimensions. Additionally, the present study examined the HiTOP model in relation to childhood trauma, declines in social functioning, and development of full psychosis. Confirmatory factor analysis indicated that the HiTOP model's fit was nearly adequate (e.g., comparative fit index = .89), though several theory-relevant modifications were indicated. Additionally, specific tests were conducted to gain a more fine-grained perspective on how disorders with less clear prior evidence were related to the HiTOP model. Notable findings from these analyses include bipolar spectrum disorders relating to the psychosis super spectrum (i.e., .39 loading), and obsessive-compulsive disorder showing a complex pattern of loadings (e.g., internalizing and psychosis). The final model parsimoniously accounted for childhood trauma (e.g., super spectra rs = .22-.32), associations with current functioning, and predicted future conversion to a psychotic disorder (e.g., super spectra R² = .13). Overall, these results inform the HiTOP model and suggest its promise for CHR-P research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Factors influencing delays in the diagnosis and treatment of bipolar disorder in adolescents and young adults: A systematic scoping review.

IntroductionBipolar Disorder (BD) is a complex psychiatric condition that typically manifests during late adolescence and early adulthood. Over the past two decades, international studies have reported that BD often goes unrecognized and untreated for several years, which can lead to negative clinical and functional outcomes. However, the components of delay in the diagnosis and treatment of BD in adolescents and young adults and various factors influencing those components have not been systematically explored.ObjectivesTo determine the known factors that contribute to delays in the treatment of BD in adolescents and young adults and identify current knowledge gaps.MethodsA conceptual framework based on the Model of Pathways to Treatment by Scott and colleagues was used as a foundation for our search and extraction strategy to ensure all components of delay and potential factors influencing each component are explored. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline (PRISMA-ScR) to systematically search the electronic databases of MEDLINE (OVID), EMBASE, PsycINFO and CINAHL for peer-reviewed original research articles published from January 01, 2000 through March 29, 2023. Inclusion was restricted to studies with quantitative or qualitative data on individuals diagnosed with bipolar spectrum disorders with symptomatic onset or study participation between the ages of 13-24. Grey literature and studies not published in English were excluded due to resource limitations. Two independent reviewers screened the references retrieved by the literature search based on our inclusion criteria. The findings of included studies were summarized in a narrative and tabular form according to component of delay.ResultsOur search yielded 5180 unique citations, of which 44 articles met our inclusion criteria. We present findings on the patient, illness, and healthcare provider/mental health system factors contributing to the delays in illness appraisal, help-seeking, diagnosis, and treatment.ConclusionsTo the best of our knowledge, this is the first systematic scoping review to explore the potential factors that influence delays in the treatment of BD in adolescents and young adults. Findings from this review will inform clinical practice and policy. We also demonstrate the utility of a systematic approach to identifying the components of delay, from symptom recognition through treatment, as a methodology to help identify knowledge gaps to inform future research.Disclosure of InterestNone Declared

Centering prayer in the treatment of bipolar disorder

Bipolar Disorder (BD), formerly manic-depressive illness or manic depression, is a lifelong mood disorder and mental health condition that causes intense shifts in mood, energy levels, thinking patterns, and behavior. These shifts can last for hours, days, weeks, or months, interrupting the ability to carry out daily tasks. The condition is manageable with medications, talk therapy, lifestyle changes, and other treatments, but the therapy results are unreliable in many patients. Most faith traditions have two forms of prayer: discursive and contemplative. Most believers practice discursive prayer. Medical research has shown the statistical healing effects of discursive prayer, but there is considerably less research on contemplative prayer. Hesse reports a method of teaching CP by asking a volunteer to help demonstrate the analogy between human and Divine relationships in the following quoted phases., Therefore, we hypothesize that CP might produce a significant depression improvement in BP patients. Two neurologists double-blind diagnosed five patients complaining of BD and five normal subjects. All cases expressed their belief in God, so CP is prayer, not non-theistic meditation. Patients will be free of medication and selected during depressive episodes. Among the trait markers are frontal alpha asymmetry,55,56, and changes in frontal qEEG cordance. A very stable QEEG pattern, consisting of frontal alpha asymmetry, was observed in all five patients. Hence, this pattern was used to compare QEEG before and after CP. Our main result showed that the focal left frontal Alpha increment disappeared after CP. Conclusion: CP is a promising tool for treating depression, organizing the function interplay among brain networks that subserve Cognition-emotion interactions in the prefrontal cortex.

Self-Stigma in Patients with Endogenous Mental Disorders: A Cross-Sectional Comparative Study.

Self-stigma remains one of the most vexing issues in psychiatry. It complicates the treatment and social functioning of patients with endogenous psychiatric disorders. Identifying the specific features of self-stigma depending on the type and duration of the endogenous mental illness can help solve this problem. The aim of this study was to establish the level and specific features of self-stigma in patients with various types of chronic endogenous psychiatric disorders at different disease stages and to establish the correlation between the level of self-stigma and the attitude of the patient to his/her disease and treatment. Clinical psychopathology assessment, psychometric scales and questionnaires: "Positive and Negative Syndrome Scale" (PANSS), "Questionnaire for Self-Stigma Assessment in Mentally Ill Patients", and Russian versions of the "Insight Scale for Psychosis" (ISP), and "Drug Attitude Inventory" (DAI-10). The cross-sectional study included 86 patients with endogenous mental illnesses (bipolar affective disorder and schizophrenia spectrum disorders. The analysis of the results of the "Questionnaire for Self-Stigma Assessment in Mentally Ill Patients" showed that at the initial disease stages the highest level of self-stigma is observed in patients with bipolar affective disorder (M±σ=1.22±0.73; Me [Q1; Q3]=1.10 [0.83; 1.60]), while the lowest level was observed in patients with schizophrenia spectrum disorders (M±σ=0.86±0.53; Me [Q1; Q3]=0.77 [0.31; 1.25]). Patients with schizophrenia and schizoaffective disorder and a disease duration more than five years participating in a long-term comprehensive psychosocial rehabilitation program also demonstrated high rates of self-stigma (M±σ=1.20±0.57, Me [Q1; Q3]=1.26 [0.89; 1.47]). The study groups showed differences in terms of the structure of components of self-stigma and their severity; significant correlations were uncovered between the self-stigma parameters and the attitude of patients to their disease and therapy. The results of this study contribute to a better understanding of the specific features of self-stigma in patients with various endogenous disorders at different stages of the disease. These data can be used as part of a comprehensive psychosocial treatment program for this patient cohort, as well as for future research.

Sarcopenia prevalence between obese and morbid obese patients in an obesity center

Background/Aim: Sarcopenia and obesity are independent diseases that result in decreased muscle strength and function. Few studies have been conducted on the association of sarcopenia and obesity, especially in women. This study aims to measure the possibility of sarcopenic obesity in women with obesity. Methods: Our study was organized using a prospective cross-sectional study in Turkey. A total of 135 volunteer were included in the study. Inclusion criteria required the patients to have a BMI >35 kg/m2 or BMI >40 kg/m2 and no current comorbid disease. The exclusion criteria included: age (<18 and >70 years were excluded), history of muscle disease, malignancy, psychiatric disorders such as bipolar disease and psychosis, malnutrition, and recent corticosteroid (CS) use (within the last three months). Probable sarcopenia is determined by low skeletal muscle strength, and confirmed sarcopenia is defined if there is both low skeletal muscle mass and low skeletal muscle quality. Muscle strength was measured with isometric dynamometry using the handgrip method. A six-minute walk test (6MWT), in which we measured walking speed, was performed to determine the physical performance of the patients. We adjusted appendicular skeletal muscle (ASM) using height squared (ASM/height2) bioelectrical impedance analysis (BIA) to measure the muscle mass. Results: Patients’ mean age was 43 (11.4) (20-69) years. Of the total participants, 64.6% were in the age range of 40-59; 19.2% of patients were defined as possible sarcopenia; and 2.2% had confirmed sarcopenia. A total of 78.5% of patients did not meet any of the sarcopenia criteria. We determined that there was no difference in anthropometric measurements between sarcopenic and non-sarcopenic patients (P>0.05), except for waist and hip circumferences. However, we did observe a noteworthy distinction in waist and hip circumference measurements between the two groups, with sarcopenic patients exhibiting larger circumferences (P=0.05 and P=0.032, respectively). Our study revealed a significant disparity in the results of the six-minute walk test and handgrip strength values between sarcopenic and non-sarcopenic patients (P<0.001). Specifically, non-sarcopenic patients demonstrated higher values in both tests.. Conclusion: Obesity and sarcopenic obesity will continue to be a public health problem in the future among middle-aged women. It should be considered that the prevalence of decreased muscle strength was high in our study group, and physical performance decreased due to muscle strength. We concluded that as success in the six-minute walk test and handgrip values increased, the diagnosis of sarcopenia decreased, and each increase in platelet count increased the risk of sarcopenia in obese female patients.

The association between personal stigma and adherence to treatment in patients diagnosed with bipolar mood disorder, attention deficit/ hyperactivity disorder and schizophrenia

Research has highlighted that some types of mental disorders are associated with widespread discrimination and stigma, phenomena that negatively affect adherence. The aim of the present study was to examine the association between stigma and adherence to pharmacological treatment in patients diagnosed with bipolar mood disorder (BD), attention deficit hyperactivity disorder (ADHD) and schizophrenia (SZ). A total of 112 patients (age range: 20-68 years, Median age = 42.08; SD age = 12.02) from Brazil (38.4% ADHD, 34.8% SZ, and 26.8% TB) participated in the study. Treatment adherence was measured using the Medication Adherence Questionnaire, personal stigma by means of the Internalized Stigma of Mental Illness, Stigma Scale, and Perceived Devaluation and Discrimination Scale, and self-esteem with Rosenberg’s Self-Esteem Scale. Results showed an association between personal stigma and treatment adherence for all three types of disorder. The lower the personal stigma, the higher the adherence to treatment. The study highlights the role of stigma and self-esteem in relation to treatment adherence, with possible implications for future psychotherapy for these disorders.

The Mood and Resilience in Offspring (MARIO) project: a longitudinal cohort study among offspring of parents with and without a mood disorder

BackgroundOne of the most robust risk factors for developing a mood disorder is having a parent with a mood disorder. Unfortunately, mechanisms explaining the transmission of mood disorders from one generation to the next remain largely elusive. Since timely intervention is associated with a better outcome and prognosis, early detection of intergenerational transmission of mood disorders is of paramount importance. Here, we describe the design of the Mood and Resilience in Offspring (MARIO) cohort study in which we investigate: 1. differences in clinical, biological and environmental (e.g., psychosocial factors, substance use or stressful life events) risk and resilience factors in children of parents with and without mood disorders, and 2. mechanisms of intergenerational transmission of mood disorders via clinical, biological and environmental risk and resilience factors.MethodsMARIO is an observational, longitudinal cohort study that aims to include 450 offspring of parents with a mood disorder (uni- or bipolar mood disorders) and 100-150 offspring of parents without a mood disorder aged 10-25 years. Power analyses indicate that this sample size is sufficient to detect small to medium sized effects. Offspring are recruited via existing Dutch studies involving patients with a mood disorder and healthy controls, for which detailed clinical, environmental and biological data of the index-parent (i.e., the initially identified parent with or without a mood disorder) is available. Over a period of three years, four assessments will take place, in which extensive clinical, biological and environmental data and data on risk and resilience are collected through e.g., blood sampling, face-to-face interviews, online questionnaires, actigraphy and Experience Sampling Method assessment. For co-parents, information on demographics, mental disorder status and a DNA-sample are collected.DiscussionThe MARIO cohort study is a large longitudinal cohort study among offspring of parents with and without mood disorders. A unique aspect is the collection of granular data on clinical, biological and environmental risk and resilience factors in offspring, in addition to available parental data on many similar factors. We aim to investigate the mechanisms underlying intergenerational transmission of mood disorders, which will ultimately lead to better outcomes for offspring at high familial risk.

The Contribution of Tonic Inhibition to Cognitive Deficits in a Mouse Model of Bipolar Disease

The Contribution of Tonic Inhibition to Cognitive Deficits in a Mouse Model of Bipolar Disease

Exploring the Role of Serum Hydrogen Sulphide (H2S) Levels in Manic Depressive Psychosis in Terms of Its Association, Diagnostic Ability, and Severity Prediction: Findings From a Tertiary Care Center in North Bengal.

Manic depressive psychosis (MDP) or bipolar disorder, a prevalent psychiatric condition globally and in the Indian population, has been attributed to various pathological mechanisms. Hydrogen sulphide (H2S), a member of the gasotransmitter family, may be linked to the development of bipolar disorder because it plays a crucial role in maintaining proper neuronal function in terms of excitability, plasticity, and homeostatic functions. There is very little data regarding the role of the gasotransmitter H2S in MDP in terms of its association, diagnostic ability, and severity prediction, which led us to conduct this study among MDP patients in the Sub-Himalayan region of West Bengal. This was an observational case-control study performed in the Department of Biochemistry, North Bengal Medical College and Hospital, Siliguri, West Bengal, India, from January 2022 to December 2022. Fifty diagnosed MDP patients and 50 healthy age- and sex-matched control subjects satisfying the inclusion and exclusion criteria were studied. The H2S level in the blood was assayed using the standardised spectrophotometric methylene blue method. The severity of depression was assessed by Hamilton Depression Rating Scale (HAM-D) scoring. Of the 50 MDP patients, 45 (90%) were in the depressive phase, and five (10%) were in the manic phase. Of the 45 depressive patients, eight (17.8%) had mild depression, 12 (26.7%) had moderate depression, 19 (42.2%) had severe depression, and six (13.3%) had very severe depression. The mean H2S level in MDP patients (41.98±18.88 μmol/l) was significantly (P<0.05) lower than that in control subjects (99.20± 15.20 μmol/l). It was also observed that the mean H2S level in MDP patients decreased with the duration of the disease but was not statistically significant. The mean H2S levels in the different depression severity groups were found to be significantly different (P<0.001). Receiver operating characteristic (ROC) curve analysis revealed that a cut-off value of H2S <78.5 μmol/l was associated with MDP, with a sensitivity of 96%and a specificity of 88%,and a cut-off value of H2S < 53 μmol/lpredicted the severity of depression with a sensitivity of 89.3% and a specificity of 76.5%. The significant association of the gasotransmitter H2S in MDP patients and its role as a diagnostic and severity predictive marker can help us to employ proper measures for better management of MDP and improving quality of life.

The Effect of BDNF Gene on Bipolar Disorder

BDNF (brain-derived neurotrophic factor) is a kind of neurotrophic protein, widely distributed in the brain and spinal cord. BDNF is engaged in regulating the growth and migration of neurons, and can promote the repair of damaged neurons. While disorders of BDNF expression can lead to mental diseases such as bipolar disorder. The main way in which the BDNF gene affects bipolar disorder is through BDNF's interaction with TrkB receptors. In addition, BDNF also causes bipolar disorder by affecting the amygdala and hippocampus, promoting neuronal regeneration, and participating in synaptic plasticity. At present, there are still some questions in the field of bipolar disorder and BDNF gene research. The pathological mechanism of bipolar disorder is still unclear, and the clinical application of BDNF has many difficulties. This article reviews the BDNF gene influences the role and mechanism of bipolar disorder and the evidence that BDNF gene causes bipolar disorder, hoping to provide a new direction for the treatment of bipolar disorder.

An initial test of the contrast avoidance model in bipolar spectrum disorders

The Contrast Avoidance Model suggests that individuals sensitive to negative emotional shifts use prior increases in negative affect to prevent further escalation in response to adverse situations, while the heightened negative affect amplifies positive emotional contrasts when encountering unexpected positive events. Individuals with bipolar spectrum disorders (BSDs), characterized by shifts between (hypo)manic and depressive episodes, may undergo more salient emotional contrasts. Drawing from the Contrast Avoidance Model, the shifts from depression to (hypo)mania can be conceptualized as positive emotional contrasts, potentially heightening the perceived pleasure during (hypo)manic episodes. On the other hand, the shifts from (hypo)manic to depressive episodes can be viewed as negative emotional contrasts, contributing to the challenges associated with depressive states. Despite the intriguing potential of this interplay, the link between the Contrast Avoidance Model and BSDs has never been empirically tested. Our study addressed this gap by examining group differences in contrast avoidance traits between individuals with BSDs, unipolar depression, and healthy controls in a large cohort study (N = 536). Results indicated that individuals with BSDs exhibited significantly higher scores in the total, and Discomfort with Negative Emotional Shifts and Avoidance of Negative Emotional Contrasts/Enhancement of Positive Emotional Contrasts factors, as well as separate item scores on the Contrast Avoidance Questionnaire-General Emotion (CAQ-GE), compared to those with unipolar depression and healthy controls. Although marginal, the BD II subtype demonstrated a stronger inclination to avoid negative emotional contrasts compared to BD I. These findings suggest that contrast avoidance may be a psychological mechanism implicated in BSDs.

Association Between Mood Disorder Severity, Treatment Response and Systemic Inflammatory Markers: Exploring the Role of NLR, PLR, MLR, and SII.

In this study, the relationship between treatment response, clinical features of episodes such as psychosis, suicidal behavior, and agitation, duration of hospitalization, and systemic inflammation markers Systemic Inflammatory Index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) in bipolar affective disorder manic episode (BAD-M), bipolar affective disorder-depressive episode (BAD-D), and major depressive disorder (MDD) were investigated. TheNLR, MLR, PLR, and log SII were measured using parameters from a complete blood count. Admission and discharge Young Mania Rating Scale and Hamilton Depression Rating Scale scores were evaluated. This is a retrospective study conducted with a total of 451 inpatients, 122 (27.10%) of whom were diagnosed with BAD-M, 60 (13.20%) with BAD-D, and 269 (56.60%) with MDD. The patients with manic episodes have higher levels of NLR (P = .019), MLR (P = .002), and log SII (P = .007). In the bipolar depression and mania groups, the patients with and without treatment responses did not differ in terms of inflammation markers; the log PLR value was found to be higher in the unipolar depression group in the patients who did not reach remission (P = .048). This study reveals associations between inflammation markers and different types of mood episodes. Higher NLR, MLR, and log SII levels in bipolar mania and lower NLR levels in agitated unipolar depression provide clues about changes in inflammation across different episodes. Studies with larger samples are needed to evaluate the relationship between inflammatory markers, the severity of mania and depression, and the response to treatment.