Mania Research Articles

Anti-manic and Antipsychotic Effects of Withania somnifera Extract in Rodent Model of Bipolar Disorder

Aim: The present study was to investigate the effects of WSE improve cognitive, behavioral and mood disorders in animal models of bipolar disorder. Materials: Animals were divided into six groups each group contain 6 wistar rats of either sex ,Behavioral and memory test were carried out followed by estimation of oxidative stress and neurotransmitters in rat brain using continuous sub anesthetic dose of Amph (1.5 mg/kg, i.p) with Withania somnifera extract (300 mg/kg, i.p) and Lithium chloride (100mg/kg, i.p.) administered daily for 21 days. Results: % Alternation was decreased in rat treated with WSE as compared to control indicating that it also improved spatial memory and learning. various oxidative parameters were estimated, oxidative stress was observed the levels of SOD and GSH reduced and increased in TBARS level compared to control groups, but reduced ion in oxidative stress upon administration of Withania somnifera extract and Lithium chloride indicates ameliorating effects of Withania somnifera extract in oxidative stress. Conclusion: We concluded that WSE showed improvement in learning and memory as animals treated with WSE spent more time in open arms as comapared to Amphetamine with Withania somnifera and Lithium chloridetreated rats. Overall, the findings of this work show that neurotransmitters get imbalance and change the mood and chemistry of the brain. Hence Withania somnifera extract improve neurotransmitter imbalance which is directly linked with mood, behavior, anxiety and manic episodes in an animal model of bipolar disorder

Gamma band VMPFC-PreCG.L connection variation after the onset of negative emotional stimuli can predict mania in depressive patients

ObjectiveBecause of the similar clinical symptoms, it is difficult to distinguish unipolar disorder (UD) from bipolar disorder (BD) in the depressive episode using the available clinical features, especially for those who meet the diagnostic criteria of UD, however, experience the manic episode during the follow-up (tBD). MethodsMagnetoencephalography recordings during a sad expression recognition task were obtained from 81 patients (27 BD, 24 tBD, 30 UD) and 26 healthy controls (HCs). Source analysis was applied to localize 64 regions of interest in the low gamma band (30–50 Hz). Regional functional connections (FCs) were constructed respectively within three time periods (early: 0–200 ms, middle: 200–400 ms, and post: 400–600 ms). The network-based statistic method was used to explore the abnormal connection patterns in tBD compared to UD and HC. BD was applied to explore whether such abnormality is still significant between every two groups of BD, tBD, UD, and HC. ResultsThe VMPFC-PreCG.L connection was found to be a significantly different connection between tBD and UD in the early time period and between tBD and BD in the middle time period. Furthermore, the middle/early time period ratio of FC value of VMPFC-PreCG.L connection was negatively correlated with the bipolarity index in tBD. ConclusionsThe VMPFC-PreCG.L connection in different time periods after the onset of sad facial stimuli may be a potential biomarker to distinguish the different states of BD. The FC ratio of VMPFC-PreCG.L connection may predict whether patients with depressive episodes subsequently develop mania.

Bipolar disorder in the International Classification of Diseases-Eleventh version: A review of the changes, their basis, and usefulness.

The World Health Organization's 11th revision of the International Classification of Diseases (ICD-11) including the chapter on mental disorders has come into effect this year. This review focuses on the "Bipolar or Related Disorders" section of the ICD-11 draft. It describes the benchmarks for the new version, particularly the foremost principle of clinical utility. The alterations made to the diagnosis of bipolar disorder (BD) are evaluated on their scientific basis and clinical utility. The change in the diagnostic requirements for manic and hypomanic episodes has been much debated. Whether the current criteria have achieved an optimum balance between sensitivity and specificity is still not clear. The ICD-11 definition of depressive episodes is substantially different, but the lack of empirical support for the changes has meant that the reliability and utility of bipolar depression are relatively low. Unlike the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), the ICD-11 has retained the category of mixed episodes. Although the concept of mixed episodes in the ICD-11 is not perfect, it appears to be more inclusive than the DSM-5 approach. Additionally, there are some uncertainties about the guidelines for the subtypes of BD and cyclothymic disorder. The initial results on the reliability and clinical utility of BD are promising, but the newly created diagnostic categories also appear to have some limitations. Although further improvement and research are needed, the focus should now be on facing the challenges of implementation, dissemination, and education and training in the use of these guidelines.

Chronic Mania-A Case Report

Bipolar disorder is a phasic mental disorder characterized by the presence of (hypo) maniac, depressive and/or mixedepisodes during the course of the disease. A 70 year man, with no prior history of depressive episodes, began to suffera picture of manic characteristics as an adolescent. Despite the numerous drug treatments prescribed, there has beenno improvement, and the disorder has followed a torpid and chronic course. Chronic unipolar mania is a clinical entityappearing as a residual characteristic in the current psychiatric nosology. Its low prevalence makes it difficult to carryout research aimed at elucidating whether it has a subordinate or independent relationship with the bipolar disorder. Asystematic assessment of the effectiveness of electroconvulsive therapy is needed in these patients.

The concept of "metabolic jet lag" in the pathophysiology of bipolar disorder: implications for research and clinical care.

Bipolar disorder (BD) is a potentially chronic mental disorder marked by recurrent depressive and manic episodes, circadian rhythm disruption, and changes in energetic metabolism. "Metabolic jet lag" refers to a state of shift in circadian patterns of energy homeostasis, affecting neuroendocrine, immune, and adipose tissue function, expressed through behavioral changes such as irregularities in sleep and appetite. Risk factors include genetic variation, mitochondrial dysfunction, lifestyle factors, poor gut microbiome health and abnormalities in hunger, satiety, and hedonistic function. Evidence suggests metabolic jet lag is a core component of BD pathophysiology, as individuals with BD frequently exhibit irregular eating rhythms and circadian desynchronization of their energetic metabolism, which is associated with unfavorable clinical outcomes. Although current diagnostic criteria lack any assessment of eating rhythms, technological advancements including mobile phone applications and ecological momentary assessment allow for the reliable tracking of biological rhythms. Overall, methodological refinement of metabolic jet lag assessment will increase knowledge in this field and stimulate the development of interventions targeting metabolic rhythms, such as time-restricted eating.

Differential patterns of default mode network activity associated with negative and positive rumination in bipolar disorder

BackgroundPatients with bipolar disorder (BD) engage in both negative and positive rumination, defined as maladaptive self-focused thinking, and this tendency predicts depressive and manic episodes, respectively. Prior research in patients with major depression implicates regions of the default mode network (DMN) consistent with the self-focused nature of rumination. Little is known about the neural correlates of rumination in bipolar disorder. MethodsFifteen euthymic patients with BD (twelve with Type I) and 17 healthy controls (HC) performed negative and positive rumination induction tasks, as well as a distraction task, followed by a self-related trait judgment task while undergoing functional magnetic resonance imaging (fMRI). Participants also underwent resting state scans. We examined functional connectivity at rest and during the induction tasks, as well as task-based activation during the trait judgment task, in core regions of the DMN. ResultsCompared to HC, patients with BD showed greater functional connectivity between the posterior cingulate cortex (PCC) and medial prefrontal cortex (MPFC) at rest and during positive rumination, compared to distraction. They also showed greater activity in the PCC and MPFC during processing of positive traits, following positive rumination. At rest and during negative rumination compared to distraction, patients with BD showed greater functional connectivity between the PCC and inferior parietal lobule than HC. ConclusionsThese findings demonstrate that negative and positive rumination are subserved by different patterns of connectivity within the DMN in BD. Additionally, the PCC and MPFC are key regions involved in the processing of positive self-relevant traits following positive rumination.

Bipolar Disorder

Bipolar disorder (BD), previously known as “manic depressive illness,” is a recurrent chronic disorder characterised by mood and energy-state fluctuations. People who have BD comprise more than 1% of the world’s population from all nationalities, ethnic origins, and socioeconomic statuses. There are four different types of bipolar-related disorders: bipolar disorder I, bipolar disorder II, cyclothymic disorder, and unspecified BD, which are classified by different patterns of manic, hypomanic, and depressive episodes. Where manic and hypomanic episodes are both states of increased activity, energy, or agitation, hypomanic episodes only last around four consecutive days and are less severe compared to manic episodes, which last around one week. Depressive episodes are characterised by feelings of despair and a loss of interest in previously enjoyed activities. Like many other psychological disorders, BD is often difficult to diagnose accurately in clinical practice due to large variations in individual symptoms, symptom overlap, or lack of approved biomarkers. Additionally, because many patients with BD only seek treatment for depressive episodes, many BD patients are initially misdiagnosed. Two studies conducted in 1999 and 2000 found that nearly 40% of patients with BD are initially diagnosed with unipolar depression. Previous diagnosis criteria for the types of BD were also overly restrictive. For example, according to the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-4) criteria, bipolar disorder II requires an episode of mania or hypomania lasting four days, even though many experts believe that the average duration of the hypomanic state ranges between one to three days. Moreover, it is often difficult to elicit a past history of hypomanic episodes from patients because of its milder presentation. For many patients, the increased energy and activity experienced during hypomanic episodes may not even be considered negative, and thus will go unreported. Currently, the DSM-5 contains the most widely acknowledged diagnostic classifications for bipolar disorder.

Family environment of youth with first episode Mania.

The purpose is to compare youth- and caregiver-reported characteristics of family environment, within and between families with a child experiencing a first manic episode of bipolar disorder (BPD), and families without a child with BPD or familial history of psychiatric disorders (HF). Family environment of 61 families with a child with BPD and 44 HF were assessed with Family Environment Scale (FES). We compared FES subscale scores between families with BPD and HF, and caregiver- and youth-rated scores. Families with BPD differed significantly from HF on 8/10 FES subscales scores. Youth differed significantly from their caregivers on 7/10 subscales. An interaction effect was observed such that youth with BPD reported lower cohesion and organization, and higher conflict than their caregivers; however, HF did not differ significantly on these domains. Our results suggest that families with BPD have higher conflict and lower cohesion and organization compared to HF. Results also indicate differences between youth and caregiver perspectives in both groups, which may contribute to family discord. Interventions targeting areas of cohesion, organization, and conflict may be beneficial for youth with BPD and their families, specifically those that identify and bridge perceptual divides.

The Effect of Intravenous Ketamine on Suicidal Ideation in Depressed Patients: A Randomized Clinical Trial

Background: Major depressive disorder (MDD) generally occurs together with depression in patients with no history of manic, mixed, or hypomanic episodes. The suicidal ideation in MDD patients is very common and can potentially be considered an emergency circumstance in many cases. Among the developed drugs and medicines, ketamine (KET) is a potential option to treat patients with MDD. This study aims at investigating the effect of KET on the treatment of suicidal ideation and the reduction of the intensity of symptoms in patients suffering from MDD. Materials and Methods: This randomized double-blind clinical trial was performed on 30 patients who suffered from MDD and had suicidal ideation at Ibn Sina Hospital, Bandar Abbas, Iran, during 2016-2017. The patients were divided into two groups: the KET group which received 0.5 mg/kg of intravenous (IV) KET diluted in 500 mL of normal saline over 30 minutes and the control group which received 500 mL of normal saline without KET over 30 minutes. Results: According to the statistical analysis, 24 hours after the intervention, suicidal ideation score reached 2.53 and 20.6 in the KET and control groups, respectively. In fact, KET caused a significant reduction in the score of the suicidal ideation (SSI) (SSI<4) in comparison with the control group (P<0.001). Conclusion: It was observed that KET can play a key role in the treatment of depression disorders, especially severe and life-threatening forms that require immediate intervention, such as the use of electroconvulsive therapy.

Bipolar Disorder

Bipolar disorder (BD), previously known as “manic depressive illness,” is a recurrent chronic disorder characterised by mood and energy-state fluctuations. People who have BD comprise more than 1% of the world’s population from all nationalities, ethnic origins, and socioeconomic statuses. There are four different types of bipolar-related disorders: bipolar disorder I, bipolar disorder II, cyclothymic disorder, and unspecified BD, which are classified by different patterns of manic, hypomanic, and depressive episodes. Where manic and hypomanic episodes are both states of increased activity, energy, or agitation, hypomanic episodes only last around four consecutive days and are less severe compared to manic episodes, which last around one week. Depressive episodes are characterised by feelings of despair and a loss of interest in previously enjoyed activities. Like many other psychological disorders, BD is often difficult to diagnose accurately in clinical practice due to large variations in individual symptoms, symptom overlap, or lack of approved biomarkers. Additionally, because many patients with BD only seek treatment for depressive episodes, many BD patients are initially misdiagnosed. Two studies conducted in 1999 and 2000 found that nearly 40% of patients with BD are initially diagnosed with unipolar depression. Previous diagnosis criteria for the types of BD were also overly restrictive. For example, according to the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-4) criteria, bipolar disorder II requires an episode of mania or hypomania lasting four days, even though many experts believe that the average duration of the hypomanic state ranges between one to three days. Moreover, it is often difficult to elicit a past history of hypomanic episodes from patients because of its milder presentation. For many patients, the increased energy and activity experienced during hypomanic episodes may not even be considered negative, and thus will go unreported. Currently, the DSM-5 contains the most widely acknowledged diagnostic classifications for bipolar disorder.

Current Problems of Psychological Counterfeit of Negative Information Influences on Personality and Ways to Overcome Them

the purpose. Theessence of the social situation that has occurred in the world is that the importance of the psychological factor of personal existence in the formation and functioning of the process are caused by the pandemic. The purpose of the study is to reveal the current problems of psychological counter-feit of negative influences on personality and to find ways to overcome them. methods of the research. Achieving the goal and solving the tasks of our research comprises the use of a number of methods of theoretical scientific re-search: analysis of the education system in the field of psychology; generaliza-tion of conceptual principles of professional education; comparison of educa-tional and professional programs; systematization of the main principles of edu-cational and professional training; modeling of the structural and logical scheme of educational and professional training in establishments of higher education.the results of the research. The results of monitoring the neurointerface of cognitive-emotional reactions of young people of normative and deviant behav-ior before and during the COVID-19 pandemic are presented. During quarantine, changes were observed both at the level of the individual’s psyche and at the macro-social level.conclusions. It is a certain mania of persecution and observance of certain rules of protection, which has become a manic state in society. The mania of per-secution becomes the dominant unit. The second point is the illogicality of thin-king, which is manifested in an inadequate attitude to the world as a whole, and to themselves, to relatives, friends.... And this is a specific form of bifurcation of consciousness. When there are rather incomprehensible paradoxical aggressive and depressive syndromes, on the one hand, it is aggression, and on the other hand, it is the fear of everyone around.Constant transformational processes in society and serious challenges of today such as digitalization, robotics, armed conflicts, economic downturn, pandemic COVID-19, environmental problems force people to constantly adapt to new realities. However, the intensity and dynamics of these changes cause psy-chological maladaptation in young people, which is manifested by behavioral deviations: high aggression, intolerance, addictions, suicidal behavior and sexual deviations. In general, the scale of deviant behavior threatens the na-tional security of many countries. Therefore, now it is more necessary than ever to find effective solutions to overcome the psychological consequences of the COVID-19 pandemic and prepare for such situations. However, it is necessary to know how the cognitive and emotional reactions of young people to psychologi-cal events before and during quarantine have changed. It is these data from the longitudinal study that will make it possible to build adequate programs for the prevention of deviations among young people caused by being in natural and man-made emergencies

Postpartum psychosis: Revisiting the phenomenology, nosology, and treatment

• The heterogeneity of postpartum psychosis poses diagnostic challenges. • Although generally considered a rare entity, more than 16% of women with bipolar disorder have a manic, mixed or psychotic episode after childbirth. • There is paucity of data on the identification of women at risk of having postpartum psychosis. • Managing the predisposing, precipitating, perpetuating, and protective factors has the potential to improve the short- and long-term prognosis of postpartum psychosis. To review the phenomenology, nosology, and treatment of postpartum psychosis. Using the keywords postpartum, puerperal, psychosis, bipolar, mania, depression, classification, nosology, phenomenology, diagnosis, suicide, infanticide, and treatment, four electronic databases, MEDLINE/PubMed (1966–2020), PsycINFO (1806–2020), EMBASE (1980–2020), and the Cochrane Database of Systematic Reviews were searched. We also searched the reference lists of articles identified to find articles of interest. There is a lack of consensus about the diagnostic criteria. Although it is usually considered a rare entity, as many as 16% of women with bipolar I disorder have mood or psychotic episodes that meet the contemporary definition of postpartum psychosis. There is a paucity of data on the identification of women at risk of having postpartum psychosis. Atypical antipsychotics and lithium are commonly recommended for acute treatment of postpartum psychosis, however, there are no randomised trials of drugs in the acute treatment of manic/mixed or depressive episodes with psychosis in the postpartum period. This is not a systematic review but rather a selective appraisal of the literature. Controversies surrounding its phenomenology and nosology have probably prevented consensus about its management. Accurate diagnosis of postpartum psychosis is crucial for suicide risk assessment and prediction, and treatment planning. As much as possible clinicians should consider applying the DSM-5 nomenclature to characterize disorders subsumed under the umbrella of postpartum psychosis. A nuanced approach that takes into consideration the predisposing, precipitating, perpetuating, and protective factors could potentially improve the short- and long-term prognosis of postpartum psychosis.

Psychopharmacological Treatment Algorithms of Manic/Mixed and Depressed Episodes in Pediatric Bipolar Disorder.

Introduction: Pediatric bipolar disorder (PBD) is a severe psychiatric illness diagnosed before the age of 18, which is associated with extreme shifts in mood characterized by manic and depressive episodes. In 2005, AACAP published algorithms to guide pharmacological treatment of manic/mixed episodes associated with PBD. At that time, lithium was the only Food and Drug Administration (FDA)-approved treatment for pediatric bipolar manic/mixed episodes. The goal of this article is to review evidence that has emerged since the AACAP algorithm in 2005. Methods: Literature searches were conducted through PubMed and limited to studies published between 2005 and 2021, using keywords that focused on randomized controlled trials (RCTs) for available psychopharmacological medications. In addition, the authors conducted in-depth searches for articles providing evidence for agents included in the 2005 AACAP algorithm. Results: Since the publication of the AACAP algorithm in 2005, multiple RCTs have been conducted in PBD, leading to FDA approval of five medications (aripiprazole, asenapine, olanzapine, quetiapine, and risperidone) for the treatment of manic/mixed episodes and two medications (lurasidone and olanzapine-fluoxetine combination) for the treatment of depressed episodes. Divalproex sodium and oxcarbazepine were studied in pediatric RCTs and failed to separate from placebo. Conclusions: We offer an update to the 2005 AACAP algorithms for the treatment of pediatric bipolar mixed/manic episodes and added an evidence-based algorithm for the treatment of depression in PBD. In addition to treatment algorithms, we review current evidence for efficacy of agents proposed in the AACAP algorithm and provide tables summarizing medication side effects and efficacy.

Korean Medication Algorithm Project for Bipolar Disorder 2022, Fifth Revision: An Executive Summary

We revised the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP), first published in 2002 and revised in 2006, 2010, 2014, and 2018, to reflect recent progress in the treatment of bipolar disorder. The questionnaires consisted of 56 items for adult patients and 7 items for child/adolescent patients, and were used to obtain the consensus of experts regarding pharmacological treatment strategies for various phases of bipolar disorder. The review committee included 87 Korean psychiatrists and 40 child and adolescent psychiatry experts. For treatment of manic episodes, a combination of a mood stabilizer (MS) and atypical antipsychotics (AAP), or monotherapy with MS or AAP were recommended as first-line treatments. Combinations of MS and AAP, or AAP and lamotrigine (LMT) were recommended as first-line treatments for depressive episodes regardless of the severity. Monotherapy with MS, AAP, or LMT were also first-line treatments for mild to moderate depressive episodes. For mixed features, a combination of MS and AAP, or monotherapy with AAP or MS were recommended as first-line treatments, and a combination of AAP and LMT, or MS and LMT were the first-line treatments for depressive mixed state. The recommendations of the KMAP-BP 2022 have changed from the previous version, to reflect the evolution of the social culture and healthcare system in Korea and recent evidence regarding pharmacotherapy of bipolar disorder. The KMAP-BP 2022 provides clinicians with a wealth of information regarding appropriate strategies to treat patients with bipolar disorder.

Cariprazine (Vraylar)


 CADTH recommends that Vraylar should not be reimbursed by public drug plans for use as monotherapy for the acute management of manic or mixed episodes associated with bipolar I disorder (bipolar mania), and acute management of depressive episodes associated with bipolar I disorder (bipolar depression).
 Despite results from 6 clinical trials that showed treatment with Vraylar may improve manic and depressive symptoms associated with bipolar mania and bipolar depression, it is unclear if patients treated with Vraylar in clinical practice would experience the same magnitude of improvement, as patients in the cariprazine studies may not represent the population of patients who will use cariprazine in Canada.
 Although the results for the 1.5 mg dose of Vraylar suggested an improvement in depressive symptoms, the results for the 3 mg dose of Vraylar were inconsistent across studies; therefore, the CADTH Canadian Drug Expert Committee (CDEC) was not confident that Vraylar would fill a treatment gap.
 The potential benefit of Vraylar compared to other treatments for bipolar I disorder are unknown. There were no studies directly comparing Vraylar with any other treatments, and the indirect comparative evidence reviewed had many limitations.

Predictors of illicit substance abuse/dependence during young adulthood: A machine learning approach

Prior studies have found an especially high prevalence of illicit substance use among adolescents and young adults in Brazil. The current study aimed to employ machine learning techniques to identify predictors of illicit substance abuse/dependence among a large community sample of young adults followed for 5 years. This prospective, population-based cohort study included a sample of young adults between the ages of 18–24 years from Pelotas, Brazil at baseline (T1). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was used to assess illicit substance abuse/dependence. A clinical interview was conducted to collect data on sociodemographic characteristics and psychopathology. Elastic net was used to generate a regularized linear model for the machine learning component of this study, which followed standard machine learning protocols. A total of 1560 young adults were assessed at T1, while 1244 were reassessed at the 5-year follow-up period (T2). The strongest predictors of illicit substance abuse/dependence at baseline (AUC of 0.83) were alcohol abuse/dependence, tobacco abuse/dependence, being in a current major depressive episode, history of a lifetime manic episode, current suicide risk, and male sex. The strongest predictors for illicit substance abuse/dependence at the 5-year follow-up (AUC: 0.79) were tobacco abuse/dependence at T1, history of a lifetime manic episode at T1, male sex, alcohol abuse/dependence at T1, and current suicide risk at T1. Our findings indicate that machine learning techniques hold the potential to predict illicit substance abuse/dependence among young adults using sociodemographic/clinical characteristics, with relatively high accuracy.

Increased cortical surface area but not altered cortical thickness or gyrification in bipolar disorder following stabilisation from a first episode of mania

BackgroundDespite reports of altered brain morphology in established bipolar disorder (BD), there is limited understanding of when these morphological abnormalities emerge. Assessment of patients during the early course of illness can help to address this gap, but few studies have examined surface-based brain morphology in patients at this illness stage. MethodsWe completed a secondary analysis of baseline data from a randomised control trial of BD individuals stabilised after their first episode of mania (FEM). The magnetic resonance imaging scans of n = 35 FEM patients and n = 29 age-matched healthy controls were analysed. Group differences in cortical thickness, surface area and gyrification were assessed at each vertex of the cortical surface using general linear models. Significant results were identified at p < 0.05 using cluster-wise correction. ResultsThe FEM group did not differ from healthy controls with regards to cortical thickness or gyrification. However, there were two clusters of increased surface area in the left hemisphere of FEM patients, with peak coordinates falling within the lateral occipital cortex and pars triangularis. ConclusionsCortical thickness and gyrification appear to be intact in the aftermath of a first manic episode, whilst cortical surface area in the inferior/middle prefrontal and occipitoparietal cortex is increased compared to age-matched controls. It is possible that increased surface area in the FEM group is the outcome of abnormalities in a premorbidly occurring process. In contrast, the findings raise the hypothesis that cortical thickness reductions seen in past studies of individuals with more established BD may be more attributable to post-onset factors.

Bipolar disorders and narcissism: Diagnostic concerns, conceptual commonalities and potential antecedents.

Narcissistic personality disorder (NPD) and the manic and hypomanic episodes found in the bipolar disorders are characterized by grandiosity. It is possible that this shared grandiosity is a 'homologous structure' or reflects a superficial similarity between two disparate conditions. It is, however, possible that NPD and the bipolar disorders are more closely related than implied by their segregation into the separate superordinate categories of personality disorders and mood disorders. Whereas narcissism is considered to be a life-course, stable trait and the bipolar disorders are characterized by episodes of mania and depression, there is considerable research indicating that narcissism may be linked to mood instability (including depression) and bipolar disorder may have a pervasive personality component (i.e., hypomanic personality). Utilizing dimensional models of psychopathology, the current review examined the evidence linking narcissism and the bipolar disorders and suggests that considerable overlap may exist in the domains associated with reward-seeking, harm avoidance and social functioning.

Chemical Element Profiling in the Sera and Brain of Bipolar Disorders Patients and Healthy Controls.

Bipolar Disorder (BD) is a severe recurrent affective mood disorder characterized by a wide range of lifelong mood swings, varying between depressive and manic states. BD affects more than 1% of the world's population irrespective of nationality, ethnic origin, or socioeconomic status and is one of the main causes of disability among young people, leading to cognitive and functional impairment and raised mortality, particularly death by suicide. Trace elements play a vital role in many biochemical and physiological processes. Compelling evidence shows that element toxicity might play a crucial role in the onset and progression of neurodegenerative disorders, but their involvement in mood disorders has been scarcely studied. In the present investigation, we determined the concentration of 26 elements in the serum of BD patients before and after treatment and in postmortem brain samples from BD patients and compared them with matched controls. The only element that was reduced significantly in the serum following treatment was vanadium (V). Furthermore, the concentration of Al, B, Cu, K, Mg and V were significantly lower in the pre-frontal cortex of BD patients compared with those of the controls. A comparison of Spearman's rank correlation coefficients between the elements in the serum and brain of BD patients and control groups pointed to boron and aluminum as being involved in the disease. These results suggest that there is a disturbance in the elements' homeostasis and the inter-elements' relationship in the brain of BD patients and advocate a thorough examination of the possible involvement of chemical elements in different stages of the disease.

Risk of Mania After Methylphenidate in Patients With Bipolar Disorder.

Bipolar disorder and attention-deficit/hyperactivity disorder are common comorbidities. Attention-deficit/hyperactivity disorder is commonly treated with stimulants (eg, methylphenidate), which, however, have been suggested to cause treatment-emergent mania in patients with bipolar disorder. Here, we assessed the risk of mania, depressive episodes, and psychiatric admissions after initiation of methylphenidate treatment in patients with bipolar disorder. Using Danish health registries, we identified all individuals registered with a diagnosis of bipolar disorder from January 1, 2000, to January 1, 2018, who were treated with methylphenidate. We applied a 1-year mirror-image model to compare the occurrence of mania, depression, and psychiatric admissions in the period leading up to and after methylphenidate treatment initiation. We furthermore assessed the trend in these outcomes from 4 years before to 1 year after initiation of methylphenidate treatment. A total of 1043 patients with bipolar disorder initiated treatment with methylphenidate. The number of manic episodes decreased by 48% after methylphenidate treatment initiation (P = 0.01), both among patients using mood stabilizers (-50%) and among patients not using mood stabilizers (-45%). The number of manic episodes, however, peaked approximately 6 months before methylphenidate. The results were similar for the secondary outcomes. Initiation of methylphenidate treatment was not associated with an increased risk of mania in patients with bipolar disorder. A decrease in mania, depressive episodes, and psychiatric admissions was observed after methylphenidate. However, these decreases seemed to be driven by regression to the mean after clinical deterioration preceding methylphenidate treatment, rather than by the methylphenidate treatment itself.