Mania Research Articles

Manic episode after a brain tumor excision – a case report

Manic episode after a brain tumor excision – a case report

Comparison of NLR (neutrophil/lymphocyte ratio) and PLR (platelet/lymphocyte ratio) as inflammatory markers in 1st episode mania and bipolar mania: A preliminary study.

There are various factors including inflammation that have been studied in bipolar disorder. NLR (Neutrophil to lymphocyte ratio) and PLR (platelet to lymphocyte ratio) are one of them. Various psychotropic drugs can affect the inflammatory state. This study was planned to find NLR and PLR in bipolar disorder (mania) and psychotropic drug naïve 1st episode mania. Total of 120 subjects were chosen including, 40 bipolar mania, 40 drugs naïve 1st episode mania, and 40 healthy controls. The severity of mania was assessed by the Young Mania Rating Scale. Blood samples were collected in the morning hours in order to get blood counts. A significantly higher values of neutrophil counts and NLR, while the significant lower values of lymphocyte counts in both 1st episode and bipolar mania compared to healthy control were observed. The first episode mania group had significantly higher neutrophil counts and NLR in comparison to bipolar mania. Results suggest a possible inflammatory pathophysiology of mania. Psychotropic medicines may have an anti-inflammatory effect, signified by the fact that 1st episode mania group has a greater level of inflammation in comparison to bipolar mania.

Investigation of Electrocardiogram and Inflammation Parameters in Patients with First Episode Mania

Aim: This study examined inflammation markers and electrocardiogram data in patients with first-episode mania (FEM). It aimed to examine the inflammation processes in the early stages of the disease and the frontal QRS-T (fQRS-T) angle in bipolar disorder (BD). Materials and Methods: After exclusion criteria, 53 FEM patients and 59 healthy controls (HC) were included in the study. Sociodemographic, electrocardiogram (ECG) and lab data of the participants were evaluated. Results: Mean of age and gender distribution did not differ between the groups (p=.743, p=.294, respectively). The heart rate of the FEM group was significantly higher than the HC group (p<.001). fQRS-T was significantly wider in the FEM group than in healthy controls (p=.20). Albumin was significantly lower in the FEM group than in the HC group (p<.001). CRP and CAR values were significantly higher in the FEM group than in HC (p=.009 and p=.011, respectively). In the FEM group, HDL value was significantly lower than HC, while LDL value was significantly higher than HC (p=<.001 and p=.001, accordingly). MHR and AIP values were significantly greater in the FEM group than in HC (p=<.001 and p=.006, respectively). The fQRS-T angle in FEM patients was associated with MHR (r=.37). Conclusion: This study is unique in evaluating inflammatory markers, fQRS-T angle, and heart rate in FEM patients. In this study, we found significantly higher inflammatory markers of MHR, CRP, and CAR in FEM patients in the control group. We found that these findings were consistent with the literature. Since the fQRS-T angle was wider in the FEM group, the cardiovascular risk may be increased in the early stages of BD disease.

Clinical Practice Guidelines for the Use of Electroconvulsive Therapy.

Clinical Practice Guidelines for the Use of Electroconvulsive Therapy.

Pushing the Frontiers: Optogenetics for Illuminating the Neural Pathophysiology of Bipolar Disorder.

Bipolar disorder (BD), a disabling mental disorder, is featured by the oscillation between episodes of depression and mania, along with disturbance in the biological rhythms. It is on an urgent demand to identify the intricate mechanisms of BD pathophysiology. Based on the continuous progression of neural science techniques, the dysfunction of circuits in the central nervous system was currently thought to be tightly associated with BD development. Yet, challenge exists since it depends on techniques that can manipulate spatiotemporal dynamics of neuron activity. Notably, the emergence of optogenetics has empowered researchers with precise timing and local manipulation, providing a possible approach for deciphering the pathological underpinnings of mental disorders. Although the application of optogenetics in BD research remains preliminary due to the scarcity of valid animal models, this technique will advance the psychiatric research at neural circuit level. In this review, we summarized the crucial aberrant brain activity and function pertaining to emotion and rhythm abnormities, thereby elucidating the underlying neural substrates of BD, and highlighted the importance of optogenetics in the pursuit of BD research.

Predicting coercion during the course of psychiatric hospitalizations.

Coercive measures (such as seclusion, mechanical restraint, and forced medication) during psychiatric inpatient treatment should be avoided whenever possible. Different interventions were already developed to reduce coercion, but for their effective application, it is crucial to know the risk factors of individuals and clinical situations that might be associated with coercion. Since the results of previous studies differ considerably the current study aims to fill this gap by evaluating the course of the exertion of coercion in detail. In this study, we analyzed clinical, procedural, and sociodemographic data from patients (n=16,607 cases) who were treated as inpatients in Switzerland's largest psychiatric institution with 320 beds during the years 2017 to 2020. We used regression models to identify predictors for the exertion of coercion, the number of coercive measures during a treatment episode and time until exertion of the first and last coercive measure. Coercive measures are mostly used during the first days of treatment. We identified clinical parameters such as manic or psychotic episodes to be the most relevant predictors for the exertion of coercion. Cases with those disorders also received coercion more often and earlier in their treatment course than other diagnostic groups. Other promoting factors for frequency and early application of coercion were involuntary admission and factors of chronicity and clinical severity. Knowing the risk factors may help to target preventive strategies for those at highest risk. In particular, interventions should focus on the critical timeframe at the beginning of treatment.

A paper-based colorimetric method for monitoring of lithium therapeutic levels.

Lithium remains the "gold standard" for both acute and maintenance treatment of bipolar disorder (BD), a serious life-long condition characterised by recurrent episodes of depressed and manic mood states. However, lithium has a very narrow therapeutic range (0.4-1.2 mmol L-1) and despite its effectiveness in preventing and reducing mood swings and suicidality, it is a potentially hazardous drug. While it is crucial to carefully monitor lithium plasma levels, the current techniques of lithium monitoring are cumbersome and require frequent blood tests with the consequent discomfort which results in patients evading treatment. Therefore, development of low-cost and facile lithium detection techniques that can be translated into point-of-care devices for personal monitoring will be a major advance in the management of BD. In the current study, we present colorimetric determination of lithium therapeutic levels utilizing test paper strips, based on its reaction with the chromogenic agent Quinizarin. Exposure of Quinizarin-dipped test papers to samples of interstitial fluid (ISF) or dH2O spiked with therapeutic concentrations of lithium resulted in colour changes that were monitored using optical spectroscopy. The acquired spectra from the test papers show spectral variations which are related to lithium concentrations in spiked samples of dh2O and artificial ISF with a coefficient of determination (R2) of 0.9 and 0.8, respectively. Altogether, the spectrophotometric and colorimetric analyses demonstrated strong correlations between the observed colour changes and the concentrations of lithium present in the sample. Therefore, this study has demonstrated that Quinizarin-treated cellulose-based papers are suitable for the precise detection of changes in lithium therapeutic levels. This method is simple and very convenient and serves as a foundation for the future development of a paper-based colorimetric sensor for monitoring of lithium therapeutic levels in ISF and other non-invasive biological fluids.

First episode of mania associated with self-prescribed acetyl-l-carnitine in a man with no prior psychiatric history

First episode of mania associated with self-prescribed acetyl-l-carnitine in a man with no prior psychiatric history

Glial-Neuronal Interaction in Synapses: A Possible Mechanism of the Pathophysiology of Bipolar Disorder.

Bipolar disorder (BD) is a severe and chronic psychiatric disorder that affects approximately 1-4% of the world population and is characterized by recurrent episodes of mania or hypomania and depression. BD is also associated with illnesses marked by immune activation, such as metabolic syndrome, obesity, type 2 diabetes mellitus, and cardiovascular diseases. Indeed, a connection has been suggested between neuroinflammation and peripheral inflammatory markers in the pathophysiology of BD, which can be associated with the modulation of many dysfunctional processes, including synaptic plasticity, neurotransmission, neurogenesis, neuronal survival, apoptosis, and even cognitive/behavioral functioning. Rising evidence suggests that synaptic dysregulations, especially glutamatergic system dysfunction, are directly involved in mood disorders. It is becoming clear that dysregulations in connection and structural changes of glial cells play a central role in the BD pathophysiology. This book chapter highlighted the latest findings that support the theory of synaptic dysfunction in BD, providing an overview of the alterations in neurotransmitters release, astrocytic uptake, and receptor signaling, as well as the role of inflammation on glial cells in mood disorders. Particular emphasis is given to the alterations in presynaptic and postsynaptic neurons and glial cells, all cellular elements of the "tripartite synapse," compromising the neurotransmitters system, excitatory-inhibitory balance, and neurotrophic states of local networks in mood disorders. Together, these studies provide a foundation of knowledge about the exact role of the glial-neuronal interaction in mood disorders.

Our anesthesia management in a bipolar pregnant case in third trimester

Bipolar disorder is one of the most common psychiatric disorders during pregnancy. Electroconvulsive therapy (ECT) is a potent treatment option for pregnant bipolar cases who do not respond to medical treatment and have a high risk of suicide. In this report, we aimed to present the anesthesia management of a 34-week pregnant woman with bipolar disorder who underwent ECT due to the increase in the frequency of manic episodes despite medical treatment. Induction of labor remains an important risk in the application of ECT in third-trimester pregnant women. Further large-scale randomized controlled studies using different anesthetic agents are needed.

Insomnia in the context of affective disorders

The article analyzes the current literature on the relationship of insomnia with affective disorders, in particular with depression and anxiety. Research shows that there is a strong multi-channel relationship between insomnia, depression, and anxiety, with insomnia being considered a risk factor for mood disorders more often than vice versa. The so-called insomnia paradox of bipolar disorder is described, the essence of which is that in manic episodes the frequency of insomnia is higher than in depressive episodes. The data of a network meta-analysis, which found an evidence base for the use of a variety of drugs used for the pharmacological treatment of insomnia in adults, are presented. Efficiency and convenience in taking the drug Valocordin-Doxylamine are noted.

Depressive predominant polarity in bipolar disorder – a retrospective study in a sample of patients hospitalized for a manic episode

Depressive predominant polarity in bipolar disorder – a retrospective study in a sample of patients hospitalized for a manic episode

The levels of advanced glycation end product in pre- and post-treatment patients with diagnosed manic episode

The levels of advanced glycation end product in pre- and post-treatment patients with diagnosed manic episode

Effect of Hypertension on Blood Lithium Level and its Concentration to Dose Ratio in Manic Episode Patients

Effect of Hypertension on Blood Lithium Level and its Concentration to Dose Ratio in Manic Episode Patients

Characterization of manic episodes with psychotic symptoms: is psychosis synonymous with severity?

Characterization of manic episodes with psychotic symptoms: is psychosis synonymous with severity?

Incidence of hyperthyroidism in patients with bipolar or schizoaffective disorder with or without lithium: 21-year follow-up from the LiSIE retrospective cohort study.

Lithium-associated hyperthyroidism is much rarer than lithium-associated hypothyroidism. Yet, it may be of substantial clinical significance for affected individuals. For instance, lithium-associated hyperthyroidism could destabilise mood, mimic manic episodes and impact physical health. Only few studies have explored incidence rates of lithium-associated hyperthyroidism. Even fewer studies have compared incidence rates according to lithium exposure history. To determine the impact of lithium treatment on the incidence rate of hyperthyroidism in patients with bipolar or schizoaffective disorder and assess its aetiology. This study is part of the LiSIE (Lithium - Study into Effects and Side Effects) retrospective cohort study. Between 1997 and 2017, patients in the Swedish region of Norrbotten with a diagnosis of bipolar or schizoaffective disorder were screened for all episodes of overt hyperthyroidism in form of thyrotoxicosis or thyroiditis. Incidence rates of episodes of hyperthyroidism per 1000 person-years (PY) were compared in relation to lithium exposure; concurrent, previous, or no exposure ever (lithium-naïve patients). In 1562 patients, we identified 16 episodes of hyperthyroidism corresponding to an incidence rate of 0.88 episodes per 1000 PY. Ninety-four percent of episodes had occurred in women. Patients who had concurrently been exposed to lithium, had an incidence rate of 1.35 episodes per 1000 PY. Patients who had previously been exposed to lithium had an incidence rate of 0.79 per 1000 PY. Patients who had never been exposed to lithium had an incidence rate of 0.47 per 1000 PY. There were no significant differences in the risk ratios for patients with concurrent or previous exposure compared with lithium-naïve patients, neither for hyperthyroidism overall, thyrotoxicosis, or thyroiditis. Lithium-associated hyperthyroidism seems uncommon. The risk of hyperthyroidism does not seem significantly higher in patients with current or previous lithium exposure than in lithium-naïve patients.

Prevalence and characteristics of unipolar mania in a low-income country setting: population-based data from the Butajira cohort, rural Ethiopia

PurposePrevious research suggests unipolar mania, i.e., bipolar disorder without depression, to be more common in low-income countries. However, longitudinal population-based studies on unipolar mania from low-income countries are lacking. This study therefore examined unipolar mania, in Butajira, Ethiopia, and associations with possible determinants.MethodsKey informants and 68,378 screenings with the Composite International Diagnostic Interviews (CIDI 2.1) identified suspected cases of bipolar disorder. Diagnosis was confirmed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1) (n = 2,285). 315 participants with bipolar disorder were recruited and followed up for an average of 2.5 years. Unipolar mania was defined when illness episodes consisted of at least two manic relapses. 240 cases had sufficient data to ascertain course of disorder.Results41.7% (100 of 240 cases) of participants had unipolar mania. Unipolar mania was associated with less suicidal ideation (0% vs. 26.4%, p < 0.001), less suicidal thoughts (occasionally/often: 1%/3% vs. 19.6%/21%, p < 0.001), and less history of suicide attempt (2% vs. 11.6%, p = 0.01). The participants with unipolar mania tended to have better social functioning (OR = 2.05, p = 0.07) and less alcohol use (20.8% vs. 31.4%, p = 0.07). The study was partly based on retrospective data liable to recall bias. Some cases defined as unipolar mania in our study may later develop depression.ConclusionPrevious cross-sectional studies finding high proportions of unipolar mania in low-income countries appear supported. Unipolar mania trended towards better social functioning and was associated with lower suicidality. Future unipolar mania specifications could inform treatment and prognostic estimates of bipolar disorder.

Neuropsychological performance facilitates emotion recognition in bipolar disorder

Aim of the studyIn bipolar disorder (BD), evidence for both cognitive impairment and deficit in emotion recognition has been found. Several investigations indicate that cognition and face processing can be interrelated. In this study, we assessed the correlations between cognitive functioning and emotion recognition (face expression) in patients with BD during an acute manic and depressive episode as well as in remission using a large battery of neurocognitive tests.Subject or material and methodsTwenty-four manic subjects, 21 with bipolar depression, and 22 euthymics, age-, sex-, and education-matched were included. Cognitive functions were assessed by the Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT, Stroop Color-Word Interference Test (SCWT), California Verbal Learning Test (CVLT), Benton Visual Memory Test (BVRT), Rey-Osterreich Complex Figure Test (ROFT), d2 test and Verbal Fluency Test (VFT). For emotion recognition, the Penn Emotion Recognition Test and Penn Emotion Discrimination Test were employed.ResultsIn mania, performances on selected measures of the WCST, TMT, SCWT, CVLT, ROFT, d2 test, and VFT, achieved 19 positive correlations with better recognition of happiness. In depression, conducting these tests obtained 20 correlations with finer recognition of sadness. In remission, such performances acquired 18 correlations with greater identification of sadness (10 replicated those obtained in depression).DiscussionBetter emotion recognition in manic patients concerns mostly happiness, while in depression and remission, mainly sadness.ConclusionsBetter neuropsychological performance can facilitate emotion recognition. We hypothesize that the identification of sadness could be considered a biological marker of mood disorders.

Associations between emotional and non-emotional cognition and subsequent mood episodes in recently diagnosed patients with bipolar disorder: A 16-month follow-up study

BackgroundBipolar disorder (BD) is associated with impairments in both emotional and non-emotional cognition. Recently, cognitive impairments have attracted increasing research interest as markers of prognosis and possible treatment targets in patients with BD. However, there is a paucity of studies investigating cognitive predictors of prognosis in BD. MethodsWe assessed 148 recently diagnosed, symptomatically stable patients with BD with a battery of emotional and non-emotional cognitive tests and followed them up over 16 months as part of an ongoing cohort study. Multiple linear regression analyses were conducted to examine the associations between cognitive performance at baseline and the recurrence and duration of (hypo)manic and depressive episodes, respectively, with adjustment for age, sex, subsyndromal symptoms and time between assessments. ResultsPoorer recognition of negative facial expressions and more negative emotions in neutral daily life scenarios were associated with greater frequency (ps ≤ .04) and longer duration (ps ≤ .03) of subsequent (hypo)manic episodes over the 16-month follow-up period. In addition, poorer global cognition, attention and psychomotor speed, and verbal fluency were associated with more (hypo)manic episodes (ps ≤ .04). Finally, more difficulty down-regulating emotion in negative social scenarios was associated with depressive relapse (p = .007).It was a limitation that patients had a delayed diagnosis of seven years from their first mood episode despite being recently diagnosed. ConclusionTrait-related cognitive impairments influence the early course in recently diagnosed patients with BD, particularly (hypo)manic relapse. Early prophylactic strategies targeting cognitive impairments may increase resilience and the course of illness in recently diagnosed patients with BD.

Brain stimulation treatment for bipolar disorder.

Bipolar disorders are clinically complex, chronic and recurrent disorders. Few treatment options are effective across hypomanic, manic, depressive and mixed states and as continuation or maintenance treatment after initial symptom remission. The aim of this review was to provide an up-to-date overview of research on the efficacy, tolerability and cognitive effects of electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), magnetic seizure therapy (MST), deep brain stimulation (DBS) and vagus nerve stimulation (VNS). References included in this review were identified through multiple searches of the Embase, PubMed/MEDLINE and APA PsycINFO electronic databases for articles published from inception until February 2022. Published reviews, meta-analyses, randomised controlled trials and recent studies were prioritised to provide a comprehensive and up-to-date overview of research on brain stimulation in patients with bipolar disorders. The evidence base for brain stimulation as an add-on or alternative to pharmacological and psychological treatments in patients with bipolar disorders is limited but rapidly expanding. Brain stimulation treatments represent an opportunity to treat all bipolar disorder states, including cognitive dysfunction during euthymic periods. Whilst findings to date have been encouraging, larger randomised controlled trials with long-term follow-up are needed to clarify important questions regarding treatment efficacy and tolerability, the frequency of treatment-emergent affective switches and effects on cognitive function.