Mania Research Articles

Predictors of Employment Status for Persons with Bipolar Disorder.

Bipolar disorder is characterized by manic and depressive episodes and can be a lifetime condition. Bipolar disorder has been found to be associated with various types of disabilities, including low employment rate and high dependence on public aid. The purpose of this study is to identify factors related to being employed for persons with bipolar disorder. Nine thousand eight hundred and eighty-six subjects with bipolar disorder were collected between July of 2012 and November of 2013 and retrieved from Taiwan national disability database on May of 2014. The mean age of the sample is 45.41 (SD = 10.5), with 64% as female. Logistic regression was used to examine the log odds of the predictive variables on outcome of employment. A Receiver Operating Characteristics analysis was applied to locate the cutoff score of World Health Organization Disability Assessment Schedule 2.0 for being employed. All demographic variables were found to be significantly correlated with employment status among subjects. The Receiver Operating Characteristics results revealed that those subjects whose scores were below 33.57 had about a four-fold higher probability of being in employment than those whose scores were above 33.57. The result provides insights into future research effort and intervention design aimed at helping persons with bipolar disorder to obtain gainful employment.

Risk factors for Deliberate Self Harm in Bipolar Affective Disorder patients presenting to Tertiary care center- A cross-sectional study

Abstract:-
 Background: Deliberate Self Harm (DSH) is a complex event, associated with psychosomatic, biological, social factors and psychiatric disorders. Current literature shows that, there is rise in DSH in psychiatric disorders and it has been recognised as major public health problem in India. So, objective of this study was to assess the underlying risk factors for DSH in patients with Bipolar Affective Disorder (BPAD).
 Methods:
 This cross-sectional study was conducted on 150 patients diagnosed with BPAD as per International Classification of Diseases; tenth revision (ICD-10). Semi-structured socio-demographic proforma was used to record basic profile. Deliberate self harm inventory (DSHI) was administered to assess the type of DSH. Young Mania Rating scale and Beck Depression Inventory were used to assess severity of symptoms.
 Results:
 Prevalence of DSH in present study was 33%. In socio-demographic profile, younger age group, lower education levels and being single were significant risk factors for DSH (p- value <.001, .016 and <.001 respectively) and among clinical variables, early years of disorder, severe mania, moderate and severe depressive episode in presence of medium to high suicidal intent, family history of mood disorders and co-morbid substance use and medical disorder were significant risk factors for DSH in BPAD with statistical significance (p<.0001).
 Conclusion:
 DSH is considered to be the significant predictor of suicide. BPAD is associated with high risk of DSH, which can be present in either depressive or manic episode. Patients with BPAD in early years of illness, should be evaluated thoroughly for risk factors, so that DSH risk can be minimised

Dysfunction of the Purinergic System in Bipolar Disorder

Objective: To verify the purinergic hypothesis of bipolar disorder (BD), we assessed the concentration of various components of the purinergic system in manic and depressed bipolar patients. Methods: Sixty-two patients (19 male and 43 female), aged 22–69 (49 ± 14) years, with BD were studied. Twenty-three patients (9 male and 14 female) were assessed during a manic episode and subsequent remission, and 39 patients (10 male and 29 female) were investigated in a depressive episode and the following remission. Twenty-two healthy subjects (8 male and 14 female), aged 19–70 (41 ± 14) years, served as the control group (CG). The severity of symptoms was evaluated using the Hamilton Depression Rating Scale (HDRS) and the Young Mania Rating Scale (YMRS). The concentrations of uric acid (UA) were estimated by the uricase-based method, whereas xanthine dehydrogenase (XDH), adenosine (Ado), and adenosine deaminase (ADA) by ELISA. Results: The mean score in the acute episode was 32 ± 8 points in the YMRS for mania and 31 ± 8 in the HDRS for depression. UA levels were significantly higher in female bipolar patients compared to the females in the CG. The concentrations of XDH, Ado, and ADA were significantly lower in bipolar patients both during an acute episode and remission compared to CG. Conclusions: A significant dysfunction of the purinergic system in patients with BD was observed. In most instances, the disturbances were not different in the acute episode than in remission what qualifies them as trait dependent. The results may confirm the role of the purinergic system in the pathogenesis of BD.

Comparison of effectiveness between Haloperidol and Quetiapine in acute manic episode.

This study was conducted to compare the response rate of Quetiapine and Haloperidol in patients with acute manic episodes. A total of 120 patients with acute episode of mania with baseline Young Mania Rating Scale (YMRS) of more than 20 were included and randomly allocated to either Quetiapine (Group A) or Haloperidol (Group B). Each patient was assessed at baseline. YMRS was administered at the start and at follow-up visit after six weeks. Comparison of response rate (>50% reduction in YMRS) was not statistically significant between the two groups (70% vs. 71.7%; p=0.410) after six weeks in acute manic episode. Quetiapine and Haloperidol emerged as equally effective pharmacological strategies for the treatment of bipolar mania. Quetiapine may be used as an alternative to conventional antipsychotics; Haloperidol can be used as replacement of Quetiapine as well, as it is of low cost.

The prevalence and clinical correlates of medical disorders comorbidities in patients with bipolar disorder

ObjectiveMedical disorders in patients with bipolar disorder (BD) have attracted more and more attention. So far, there is still a lack of studies on this issue utilizing large sample sizes in the Chinese sample. Therefore, we conducted this study to explore the clinical characteristics of BD patients comorbid medical disorders in a relatively large Chinese sample.MethodsThis was a cross-sectional study including 1,393 BD patients (882 patients with medical disorders and 511 patients without medical disorders). Their demographic and clinical characteristics were obtained by the Hospital Information System and self-designed questionnaires.ResultsThe comorbidity rate of medical disorders in BD was 63.32%. The average number of medical disorders for a BD patient was 2.69. The top five comorbid medical disorders in BD patients were circulatory system diseases (19%), nervous system diseases (18%), endocrine and metabolic diseases (17%), digestive system diseases (16%), and respiratory system diseases (8%). BD patients with comorbid medical disorders had an older average age, lower education level, longer illness course, later onset age, lower ratio of psychotic features, more admission numbers, higher ratio of smoking and drinking alcohol, more number of manic episodes (All P < 0.05). Smoking, numbers of depressive episode, onset age, and illness course were independent risk factors of comorbidities in BD patients (All P < 0.05).ConclusionsMedical disorders in Chinese BD patients are highly prevalent. The smoking, number of depressive episodes, onset age, illness course, are correlated with BD patients comorbid medical disorders. Clinicians should pay attention to the medical disorders comorbidities in BD patients, and take effective measures to improve treatment outcome and reduce the suffering. The integrative approach should be the imperative in clinical practice.

Effect of nighttime bedroom light exposure on mood episode relapses in bipolar disorder.

A previous cross-sectional study reported that nighttime light is associated with increased occurrence of manic symptoms in bipolar disorder; however, the longitudinal association between nighttime light and subsequent mood episode relapses remains unclear. We determined whether bedroom nighttime light was associated with mood episode relapses in patients with bipolar disorder. This prospective cohort study included 172 outpatients with bipolar disorder who participated in an Association between the Pathology of Bipolar Disorder and Light Exposure in Daily Life (APPLE) cohort study. A portable photometer was used to measure illuminance in the bedroom from bedtime to rising time during 7 consecutive nights for baseline assessment. Then, the participants were assessed at a 2-year follow-up for mood episode relapses. Of the 172 participants, 157 (91%) completed the 2-year follow-up, and 39 (22%) experienced manic or hypomanic episodes (with or without mixed features), during that time. In the Cox proportional-hazards model, the hazard ratio (HR) for manic/hypomanic episode relapses was significantly higher when the average nighttime illuminance was ≥3lux (n=71) than when it was <3lux (n=101; HR, 2.54; 95% confidence interval (CI), 1.33-4.84). In the multivariable model adjusted for a propensity score in relation to nighttime light, the relationship remained significant (HR, 2.17; 95% CI, 1.04-4.52). The association between nighttime light and depressive episode relapses was not significantly different. Keeping the bedroom dark at night may prevent hypomanic and manic episodes.

C-Reactive Protein in Bipolar Disorder and Unipolar Depression.

This study aimed to explore the role of C-reactive protein (CRP) in the pathological mechanism and differential diagnoses of bipolar disorder (BD) and unipolar depression (UD). We tested serum CRP levels of 176 BD and 86 UD patients, and 82 healthy controls (HCs), at acute and remission phases. In the acute phase, CRP levels were higher in BD than in UD patients and HC, and lower in UD patients than in HC. The CRP levels of BD patients in a manic episode were higher than those of HC; in a depressive or mixed episode, they were comparable to those of HC. The CRP levels of BD and UD patients during an acute depressive episode yielded an area under the curve of 0.676. CRP may be a state marker of acute manic episodes in BD and acute depressive episodes in UD, and a biomarker for distinguishing BD and UD.

Precision Nomothetic Medicine in Depression Research: A New Depression Model, and New Endophenotype Classes and Pathway Phenotypes, and A Digital Self.

Machine learning approaches, such as soft independent modeling of class analogy (SIMCA) and pathway analysis, were introduced in depression research in the 1990s (Maes et al.) to construct neuroimmune endophenotype classes. The goal of this paper is to examine the promise of precision psychiatry to use information about a depressed person’s own pan-omics, environmental, and lifestyle data, or to tailor preventative measures and medical treatments to endophenotype subgroups of depressed patients in order to achieve the best clinical outcome for each individual. Three steps are emerging in precision medicine: (1) the optimization and refining of classical models and constructing digital twins; (2) the use of precision medicine to construct endophenotype classes and pathway phenotypes, and (3) constructing a digital self of each patient. The root cause of why precision psychiatry cannot develop into true sciences is that there is no correct (cross-validated and reliable) model of clinical depression as a serious medical disorder discriminating it from a normal emotional distress response including sadness, grief and demoralization. Here, we explain how we used (un)supervised machine learning such as partial least squares path analysis, SIMCA and factor analysis to construct (a) a new precision depression model; (b) a new endophenotype class, namely major dysmood disorder (MDMD), which is a nosological class defined by severe symptoms and neuro-oxidative toxicity; and a new pathway phenotype, namely the reoccurrence of illness (ROI) index, which is a latent vector extracted from staging characteristics (number of depression and manic episodes and suicide attempts), and (c) an ideocratic profile with personalized scores based on all MDMD features.

A pilot trial of quetiapine, lithium, or placebo added to divalproex sodium for hypomanic or manic episodes in ambulatory adults with bipolar I disorder

BackgroundMany patients with bipolar I disorder do not respond to monotherapy treatment with mood-stabilizing medications, and combination regimens are commonly used in both inpatient and outpatient settings for the acute and maintenance treatment of bipolar disorder. We studied whether combination therapy is more effective than monotherapy for the acute treatment of subjects with bipolar I disorder currently experiencing manic symptoms. The primary hypothesis was that combination treatments would be associated with greater reductions in symptoms of mania and hypomania than monotherapy alone. The secondary hypothesis was that combination therapies would be associated with lower depression levels than monotherapy alone. Last, a post-hoc exploratory aim was used to examine whether the effect of side effect severity on risk-of-dropout would be greater in combination therapies than in monotherapy alone.ResultsIn this 12-week, double-blind, placebo-controlled ambulatory pilot trial, participants (n = 75) with bipolar I disorder were randomly assigned to: (1) monotherapy divalproex plus placebo (DVP + PBO), (2) combination therapy of divalproex plus blinded lithium (DVP + Li) or (3) divalproex plus blinded quetiapine (DVP + QTP). Combination therapies (vs. monotherapy) were not associated with improved symptoms of mania, hypomania or depression. The effect of side effect severity on study retention did not differ between combination therapies and monotherapy. However, the risk-of-dropout was significantly greater in the DVP + Li arm versus the DVP + PBO arm.ConclusionsNo longitudinal differences in mania, hypomania or depression were found between combination therapies and monotherapy. The effect of side effect severity on study retention did not differ between groups. Due to the small sample size and differential rates of attrition between treatment arms, results of this pilot trial must be interpreted with caution.Trial registration ClinicalTrials.gov identifier: NCT00183443

Acute safety assessment of lithium bioacummulated in mycelial biomass of Ganoderma lucidum

Lithium is a first-line treatment for bipolar disorder, a disorder that is characterized by alternating manic and depressive episodes. However, because of its narrow therapeutic index, lithium can cause adverse effects. The association of lithium with more complex molecules, such as proteins and polysaccharides, may help control the release of lithium throughout the digestive system, thereby reducing the doses that are used by patients and consequently reducing adverse effects. The present study evaluated the acute oral toxicity of lithium bioaccumulated in mycelial biomass of Ganoderma lucidum, a research step that precedes preclinical efficacy studies. The study followed Organization for Economic Cooperation and Development guideline. Male Wistar rats (n = 6) were acutely treated by gavage with fixed doses (300 and 2000 mg/kg) of lithium bioaccumulated in mycelial biomass of G. lucidum. Changes in clinical signs, body mass, relative organ mass, biochemical parameters, blood count, leukocytes, and histopathological changes were evaluated. A group of animals that were treated with vehicle (n = 6) served as the basal group. No signs of toxicity were observed in any of the investigated parameters. Lithium bioaccumulation in mycelial biomass of G. lucidum did not induce signs of toxicity in rats that were acutely orally treated.

The bipolarity of Alberto Santos-Dumont: flights and falls of the “Father of Aviation”

ABSTRACT Objective: Discussing the psychiatric diagnosis of Alberto Santos-Dumont, considered in Brazil to be the inventor of the airplane, who was admitted to psychiatric institutions several times and committed suicide. Methods: A narrative review was carried out on the psychopathological manifestations he presented, based on some of the most important biographies about the aviator. No scientific article on the topic was found. Results: Depressive episodes were well characterized. Behavioral changes that suggest manic episodes have also been reported. Conclusion: He probably suffered from bipolar disorder.

Association of depression and exacerbation of manic episodes with covid-19 in patients with bipolar disorder. Literature review

Justė Teišerskytė1, Justė Straševičiūtė1, Viltė Urbonavičiūtė1, Karolina Laurinaitienė2 1Lithuanian University of Health Sciences 2Lithuanian University of Health Sciences, Department of Psychiatry Abstract: Bipolar affective disorder is an affective disorder characterized by changes in mood, thinking, behaviour and energy. The level of anxiety, stress, and psychological distress experienced by subjects with bipolar disorder during the pandemic […]

Prodromal phase: Differences in prodromal symptoms, risk factors and markers of vulnerability in first episode mania versus first episode psychosis with onset in late adolescence or adulthood.

ObjectiveThis study was aimed at identifying differences in the prodromal symptoms and their duration, risk factors and markers of vulnerability in patients presenting a first episode mania (FEM) or psychosis (FEP) with onset in late adolescence or adulthood in order to guide tailored treatment strategies.MethodsPatients with a FEM or FEP underwent a clinical assessment. Prodromes were evaluated with the Bipolar Prodrome Symptom Scale‐Retrospective (BPSS‐R). Chi‐squared tests were conducted to assess specific prodromal symptoms, risk factors or markers of vulnerability between groups. Significant prodromal symptoms were entered in a stepwise forward logistic regression model. The probabilities of a gradual versus rapid onset pattern of the prodromes were computed with logistic regression models.ResultsThe total sample included 108 patients (FEM = 72, FEP = 36). Social isolation was associated with the prodromal stage of a FEP whilst Increased energy or goal‐directed activity with the prodrome to a FEM. Physically slowed down presented the most gradual onset whilst Increased energy presented the most rapid. The presence of obstetric complications and difficulties in writing and reading during childhood were risk factors for FEP. As for markers of vulnerability, impairment in premorbid adjustment was characteristic of FEP patients. No specific risk factor or marker of vulnerability was identified for FEM.ConclusionEarly characteristics differentiating FEP from FEM were identified. These findings might help shape early identification and preventive intervention programmes.

Characteristics of platelet-associated parameters and their predictive values in Chinese patients with affective disorders

ObjectivePlatelets are increasingly considered to play an important role in inflammation and are being regarded as a putative bridge linking mental diseases and inflammatory response. Platelet-associated haematological parameters including mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), systemic immune-inflammation index (SII), platelet to lymphocyte ratio (PLR), platelet to albumin ratio (PAR) and red blood cell distribution width (RDW) to platelet ratio (RPR), have been recently investigated as simple, easily available, and inexpensive inflammatory markers. In this study, we aimed is to use large-scale clinical data to study platelet parameters in patients with affective disorders, to further investigate the predictive power of platelet parameters for major depressive disorder (MDD) and bipolar disorder (BD).MethodsThe retrospective, naturalistic, cross-sectional study analysed the data of 14,007 Chinese affective disorder patients, including 4,801 patients with first-episode MDD, 4,098 patients with recurrent MDD, 3,444 patients with BD manic episodes and 1,664 patients with BD depressive episodes. Meanwhile, 6,847 healthy subjects were served as the control group. The differences in the MPV, PDW, PCT, SII, PLR, PAR, RPR and albumin among different groups were compared, and the contributing factors for the occurrence of MDD or BD were analysed.ResultsThere were significant differences in MPV, PDW, PCT, SII, PLR, RPR and albumin values among the study groups. In the subjects, patients experiencing BD manic episodes had the highest mean values of MPV and SII, patients experiencing BD depressive episodes had the lowest mean values of platelet counts and PAR, and patients with MDD had the highest mean values of PLR and RDW. The levels of MPV, PDW and albumin were independently correlated with MDD and BD, and they are important predictors for differentiating patients with MDD or BD from healthy controls.ConclusionsOur study demonstrated that different affective disorders have unique platelet parameter variation patterns, highlighting the role of platelet parameters and systemic inflammation in the pathophysiology of MDD and BD.

Latent subtypes of manic and/or irritable episode symptoms in two population-based cohorts - ERRATUM.

Latent subtypes of manic and/or irritable episode symptoms in two population-based cohorts - ERRATUM.

Faecal microbiota transplantation for bipolar disorder: A detailed case study.

Faecal microbiota transplantation for bipolar disorder: A detailed case study.

Depressive and Anxious Temperaments as Predictors of Late Onset Bipolar Disorder? Preliminary Results of a "Real World" Exploratory Study.

IntroductionBipolar disorder (BD) onset typically occurs between 15 and 30 years, being diagnosed under the age of 50 in 90% of cases, named “non-late onset BD” (non-LOBD). However, clinical observation of late-onset BD (LOBD) raised some concern regarding a differential psychopathological pattern, outcomes and treatment, including a specific affective temperament vulnerability. Therefore, an exploratory study in the “real world” was carried out by investigating psychopathological and temperamental features of a psychogeriatric cohort of LOBD and non-LOBD subjects.MethodsA total of 180 patients affected with BD-I, BD-II, and Cyclothymic Disorder were screened in a Mood Disorder Outpatient Service, during the timeframe January 2019-August 2021. Out of 78 enrolled outpatients, 66 (33 non-LOBD, 33 LOBD) were recruited, by the retrospective collection of sociodemographic, cognitive, psychopathological and clinical assessment, including the short-version of the Temperament Evaluation of Memphis, Pisa, and San Diego (TEMPS-M).ResultsLOBD is significantly associated with higher rates of BD-II diagnosis (χ2 = 27.692, p < 0.001), depressive episodes (p = 0.025), mixed states (p = 0.009), predominant depressive and anxious affective temperaments (p < 0.001). Non-LOBD is significantly associated with higher endocrinological (χ2 = 6.988, p = 0.008) and metabolic comorbidity (χ2 = 5.987, p = 0.014), a diagnosis of BD-I, manic episodes, and predominant hyperthymic affective temperaments (p = 0.001). GDS (p < 0.001) and MSRS (p = 0.005) scores were significantly higher in LOBD.ConclusionFurther longitudinal studies with larger sample sizes and a control group are needed to determine whether LOBD may represent a distinct psychopathological entity from non-LOBD and evaluate differences (if any) in terms of prognosis and treatment between non-LOBD and LOBD.

Brain Neural Activity Patterns in an Animal Model of Antidepressant-Induced Manic Episodes.

Background: In the treatment of patients with bipolar disorder (BP), antidepressant-induced mania is usually observed. The rate of phase switching (from depressive to manic) in these patients exceeds 22%. The exploration of brain activity patterns during an antidepressant-induced manic phase may aid the development of strategies to reduce the phase-switching rate. The use of a murine model to explore brain activity patterns in depressive and manic phases can help us to understandthe pathological features of BP. The novel object recognition preference ratio is used to assess cognitive ability in such models.Objective: To investigate brain Ca2+ activity and behavioral expression in the depressive and manic phases in the same murine model, to aid understanding of brain activity patterns in phase switching in BP.Methods: In vivo two-photon imaging was used to observe brain activity alterations in a murine model in which induce depressive-like and manic-like behaviors were induced sequentially. The immobility time was used to assess depressive-like symptoms and the total distance traveled was used to assess manic-like symptoms.Results: In vivo two-photon imaging revealed significantly reduced brain Ca2+ activity in temporal cortex pyramidal neurons in the depressive phase in mice exposed to chronic unpredictable mild stress compared with naïve controls. The brain Ca2+ activity correlated negatively with the novel object recognition preference ratio within the immobility time. Significantly increased brain Ca2+ activity was observed in the ketamine-induced manic phase. However, this activity did not correlate with the total distance traveled. The novel object recognition preference ratio correlated negatively with the total distance traveled in the manic phase.

Identifying Recent Manic Symptoms by Newly Discharged Patients with Bipolar Disorder.

Background: Bipolar disorder type I is a chronic and recurrent disease and is considered as the ninth nonfatal disease. Identifying the symptoms of the manic episode, which are more likely detected by patients, increases the ability of psychiatrists in diagnosing this disorder. Methods: In this cross-sectional study, a total of 96 patients with bipolar disorder were enrolled from 2 academic psychiatric centers. Then, using the patients’ medical records, demographic data were collected. Further, both the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) interview and the Young mania rating scale (Y-MRS) scale were also performed. Then, about 27 to 33 days after discharge, the patients were contacted by phone and the SCID-I interview was conducted again. Meanwhile, to make the patients focus on the period from which they have recently improved, the phrase "the recent period of hospitalization" was added to the interview questions and the symptoms were checked. Results: At the beginning of the hospitalization, the most common symptom in the total population was irritable mood (89.5%): in the male population decreased need for sleep (98.2%), and in the female population irritable mood (97.5%). In addition, in the evaluation, about 1 month later, irritable mood (69.7%) and decreased need for sleep (67.7%) were the most common symptoms detected by the patients. In terms of the predictive value of each symptom to the diagnosis of that symptom by the psychiatrist, the highest positive predictive value was related to the symptoms of irritable mood (95.5%), decreased need for sleep (95.4%), and talkativeness (95.2%). However, the highest negative predictive value was related to the symptom of elevated mood (87.5%). Conclusion: The patients who have passed manic episodes are more able to detect some symptoms of this episode. Despite some limitations, it seems that using these statistical findings in practice may promote clinical assessment and diagnosis of bipolar disorder type I by psychiatrists.

Undetermined predominant polarity in a cohort of bipolar disorder patients: Prevalent, severe, and overlooked

ObjectivesPredominant polarity (PP) is a concept used to define patients with bipolar disorder (BD) as presenting a tendency to manifest depressive (DPP) or manic (MPP) episodes. Still, the high percentage of patients with an undetermined PP (UPP), has been overlooked in most studies. Thus, we aimed to study UPP and outline its socio-demographic, clinical, and treatment-related features. MethodsPatients were recruited from a BD specialized unit. The sample was divided into three groups according to PP and socio‐demographic and clinical variables were compared. Significant variables at univariate comparisons were included in multivariate logistic regression with UPP as the dependent variable. ResultsA total of 708 BD patients were included, of which 437 with UPP (61.7%). UPP was associated with a higher number of affective relapses, when compared with DPP or MPP (χ2= 28.704, p<0.001). Mixed episodes (OR=1.398; CI=1.118–1.749), aggressive behaviour (OR=1.861; CI=1.190–2.913), seasonality (OR=2.025; CI= 1.289–3.501) and treatment with lamotrigine (OR= 2.101; CI=1.244–3.550) were significantly associated with UPP at the logistic regression. LimitationsRecall bias may have occurred due to mixed episode diagnostic criteria change over the years. No data on the patients’ follow-up has been reported on predominant polarity changes. ConclusionsUPP is associated with a higher number of relapses, and different clinical variables related to a severe course of illness. Considering PP in patients with BD may guide the choice for differential treatment approaches having an impact on BD course of illness and patients' prognosis and recovery.