Mania Research Articles

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AimTo evaluate the sociodemographic and clinical profile of patients with Bipolar affective disorder who received ECT during the period of 2016-2020.MethodologyThe ECT register of the department was used to screen the patients of Bipolar affective disorder who received ECT during the period of 2016 to 2020.Treatment records of patients were reviewed to evaluate the sociodemographic and clinical profile of patients with Bipolar affective disorder who received ECT. During the period of 2016 to 2020, 1187 patients received ECT, out of which 178 (15%) patients were diagnosed with Bipolar affective disorder. Out of 178 patients with Bipolar affective disorder, 113 (63.5%) had Bipolar depression and rest of the patients had manic or mixed episode. Out of 178 patients of Bipolar affective disorder who received ECT, 62 (34.8%) had psychotic symptoms. Majority of patients received 6-10 ECTs and showed satisfactory clinical response, very few patients developed complications.Conclusion:ECT is more often used for bipolar depression than manic episodes. ECT is effective in management of both the acute phases of illness in patients with bipolar disorder.

A rare case of partially empty sella with epileptiform discharges presenting with first episode of mania.

Sir, Busch described the condition empty sella syndrome (ESS) in 1951 where the sella turcica is filled with cerebrospinal fluid (CSF) causing displacement or flattening of the normal pituitary gland.[1] It is reported to occur in 5.5%–23.5% of the population[2] which is pathophysiologically characterized by either anatomic abnormalities in the diaphragma sellae (primary ESS) or damage to the pituitary by irradiation/surgery, or autoimmunity leading to the availability of “empty” space in the sella (secondary ESS).[1] The common signs and symptoms includes headache, papilledema due to raised intracranial pressure, leakage of CSF through nose and weight gain.[1] It can also present as decreased libido, galactorrhea, amenorrhea and secondary infertility.[3] Psychiatric manifestations of ESS are rare but can occur in the form of behavioral disturbances and psychotic symptoms.[4,5] A 25-year-old male presented to us with violent behavior towards family members, reduced need for sleep, elevated self-esteem and grandiose delusions claiming himself to be the prime minister of India. It was associated with one episode of tonic–clonic movements two nights back, with urinary incontinence. Patient also complained of jerky movements in his left arm occasionally about two to three times a day following this. All the symptoms started abruptly for past 10 days, this being his first such episode in his lifetime. There was no history of any febrile illness, head injury, substance abuse; blood parameters that included serum electrolytes, serum prolactin, vitamin B12 levels, and serum osmolality were all within normal limit. He was diagnosed to be in mania as per Diagnostic and Statistical Manual of Mental Disorders (DSM 5). Young’s Mania Rating Scale (YMRS) score was 24. The patient was subjected to magnetic resonance imaging (MRI) scan which revealed empty sella [Figure 1]. 10–20 electroencephalogram findings revealed generalized periodic epileptiform discharges (GPED). The patient was placed on sodium valproate 1000mg, haloperidol 10 mg and trihexyphenidyl 4 mg in divided dosages. The symptoms reduced in severity and YMRS score came 12 on day 5 of admission and EEG was normal. This was his first episode of mania that coexisted with first lifetime episode of seizure. GPEDs results in kindling of neuronal pathways, leading to psychiatric manifestations such as mania. Lateral hypothalamic kindling can induce manic-like behavior in a rat model.[5]Figure 1: MRI scan showing empty sellaThere are reports of atypical presentations of ESS in the form of acute psychosis, sinus bradycardia, herniation of anterior cerebral artery.[5–7] The presentation of empty sella as seizure episode has been reported rarely.[8] Moreover, it is even more rare to be presenting with both seizure episode and mania.[9] In one case report mania was precipitated by hyponatremia in a patient with ESS[10] whereas in our case sodium and other electrolytes level were in normal range. The possible mechanism of such is still a gray area.[9] Even there is also a dilemma of seizure precipitating mania or vice-versa. More sample based studies is needed to establish the neurochemical events leading to the same for better diagnosis and management. Ethical concerns Proper consent was taken from the patient regarding publication of the case without revealing patient’s identity Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Psychiatric Morbidity in Migraine and its Impact on Quality of Life: A Hospital-based Cross-sectional Study

Introduction: Migraine is a disabling headache disorder. Many psychiatric disorders co-exist with migrainous headache which largely remain undiagnosed leading to greater risk of morbidity and significantly impacts quality of life. Migraine patients are particularly at risk for mood and anxiety disorders which negatively impact the prognosis and poor headache outcome. Hence, defining the exact nature of underlying psychiatric conditions in migraine are relevant issues in the clinical practice. Aim: To find the association of psychiatric morbidity and quality of life in migrainous (with and without aura) and non-migrainous subjects and to assess the correlation between severity of migraine and quality of life. Materials and Methods: It was a hospital based cross-sectional study conducted amongst the patients and their healthy attendants visiting the Psychiatry OPD of Rajindra Hospital, Patiala from May 2018 to April 2019, after obtaining ethical clearance. A total of 392 subjects of both gender and in the age group 18-65 years, who gave informed consent were enrolled. Group 1 (n=196) consisted of cases i.e., migrainous patients as per International Classification of Headache Disorders 3rd Edition, β version (ICHD-3) criteria and Group 2 (n=196) consisted non-migrainous controls. Psychiatric morbidity was assessed using Mini International Neuropsychiatric Interview (MINI) and confirmed on International Classification of Diseases 10th edition (ICD-10). Severity of migraine was assessed on Migraine Disability Assessment Test (MIDAS) and its impact on quality of life (QOL) by using 36 Item Short Form questionnaire (SF-36 questionnaire). Variables were compared using the independent t-test and chi-square test. Pearson correlation was used to study the relationship between severity of migraine with QOL in subjects with and without psychiatric morbidity. Results: Psychiatric morbidity was found among 65.3% (n=128) and 19.9% (n=39) subject in Group 1 and Group 2, respectively. Major Depressive Disorder (37.2%, n=73) was the most common psychiatric morbidity, followed by Generalized Anxiety Disorder (8.7%, n=17), Manic episode and Panic disorder each (5.1%, n=10), Hypomanic episode & Obsessive Compulsive Disorder each (3.1%, n=6), Dysthymia (2%, n=4) and Post Traumatic Stress disorder (1%, n=2). Between groups, the association of migraine with Major Depressive Disorder (p≤0.001), General Anxiety Disorder (GAD) (p=0.024), Manic episode (p=0.005), Hypomanic episode (p=0.048) was statistically significant but more in migrainous patients than non-migrainous subjects. Migrainous patients had lower QOL in physical and psychological health domains of SF-36 than in non-migrainous subjects. Furthermore, migrainous patients with or without psychiatric morbidity had significantly negative correlation in all domains of SF-36. Conclusion: Psychiatric morbidity was significantly higher in migrainous patients than non-migrainous subjects with poor quality of life in migrainous patients causing significant disability with an increase in severity of migraine.

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BACKGROUNDBipolar disorder is an episodic psychiatric illness characterized by episodes of mania and hypomania. Presentation of bipolar disorder differs in women as compared to men, due to frequent occurrence of comorbidities like migraine, thyroid disorders, polycystic ovarian syndrome, etc. Migraine is one of the most disabling primary headaches and is more commonly seen in women with bipolar disorder. Women with migraine also tend to have more frequent mood episodes and greater psychosocial impairment. There are limited studies conducted on migraine and bipolar disorder in women in India.AIMS AND OBJECTIVESTo determine the co-occurrence of Migraine in women with Bipolar Affective DisorderMETHODOLOGYWomen with Bipolar Affective Disorder, who visited the Psychiatry Out Patient Department of a Tertiary Care Hospital in South India, were evaluated for the presence of migraine headache using the International Headache Society criteria for diagnosis.RESULTSOut of 80 subjects, 40% (N = 32) women with Bipolar Affective Disorder (BPAD) were also suffering from Migraine. 38.2% (N = 13) women with Type 1 BPAD had migraine; while 61.7% (N = 21) women with Type 2 BPAD had migraine.CONCLUSIONMigraine is a frequent complaint in women with bipolar disorder. It was more commonly seen in women with BPAD type 2. As the presence of migraine affects course and treatment response in women with bipolar disorder, it emphasizes on the importance of detailed evaluation and further research in the area.

Anti-NMDA-receptor encephalitis presenting as manic episode with catatonic features

Anti-NMDA-receptor encephalitis presenting as manic episode with catatonic features

Korean Medication Algorithm Project for Bipolar Disorder 2022: Manic Episode

Korean Medication Algorithm Project for Bipolar Disorder 2022: Manic Episode

A cross-sectional study of frequency, type, and lethality of deliberate self-harm in bipolar affective disorder patients presenting to tertiary care center

Introduction: Deliberate self-harm (DSH) is one of the leading causes of death and a major public health problem worldwide. According to the World Health Organization, DSH has increased by 60% over the past 50 years, of which 90% of victims had a psychiatric disorder. Aims and Objectives: The aim is to analyze the frequency, type, and lethality of DSH in bipolar affective disorder (BPAD) patients. Materials and Methods: This study included 150 patients diagnosed to have BPAD. Specially designed sociodemographic pro forma was used to record basic profile. DSH inventory was administered on BPAD patients who presented with DSH to analyze the type and lethality. Diagnosis of BPAD was made according to the International Classification of Diseases, tenth revision. Data were recorded, compiled, and analyzed using frequency and percentage with the IBM SPSS Statistics for Windows, Version 24.0. Results: The frequency of DSH was found to be 33%, out of which 38 (35%) patients had manic episode and 11 (30%) patients had depressive episode. The most common type of DSH was found to be cutting self with sharp or blunt objects and consumption of poison with frequency of 12 (24.5%) each. The second most common DSH was banging head, which was present in (11) 22.4% of patients. Conclusion: BPAD is associated with increased risk of DSH compared to the general population. The most common type of DSH was cutting self with sharp objects followed by consumption of poison. Patients who presented with DSH in depressive episode and severe mania had more lethal modes of DSH.

Altered caudate activity in reinforcement learning during a manic episode

Altered caudate activity in reinforcement learning during a manic episode

New onset of mania in COVID-19 infection: A report of two cases

Background: Those who have infected with coronavirus disease 2019 (COVID-19), experience a range of symptoms, from mild and self-resolving respiratory illnesses to severe respiratory complications, as well as a range of the emotional symptoms of fear, guilt, anger, or anxiety due to the need of quarantine isolation. Clinical cases with a new onset of psychiatric symptoms in the acute stage or aftermath of COVID-19 have also been described in the literature. The impact of COVID-19 on psychological health across all stages of illness has become an area of interest in psychiatry. Methods: We at Johor Bahru, Malaysia, would like to report two patients without any history of any known psychiatric illness, who had their first manic episodes during the acute stage of COVID-19 infection. Results: Patient A was a 29-year-old married female patient, had a COVID-19 infection which were treated smoothly. But unfortunately, the devastating news of her husband's hospitalization for COVID-19 infection and the death of her sister-in-law due to the deadly virus came on the day of her discharge. Since she developed a picture of a manic episode with as elated mood, irritability, talkativeness, increased energy, decreased need for sleep, spending spree, reckless driving, excessive ideas concerning COVID-19 infection, and excessive sexual drive. She subsequently responded to treatment and was discharged with daily 600 mg of oral lithium carbonate, 200 mg of oral chlorpromazine, and 1,000 mg of sodium valproate Chrono. Patient B was a 31-year-old married homemaker and she presented herself to the emergency department for stage COVID-19 infection and witnessed resuscitation and eventual deaths of several patients diagnosed with COVID-19 infection. She was so frightened that she had become easily distracted, increasingly irritable, and talkative. Having reduced need for sleep at night, she would repeatedly call her friends and family around the clock to check if they had COVID-19 infection. She claimed to have the power to heal bone fractures with naked eyes. Furthermore, she started to see supernatural creatures around her at home. She subsequently responded to daily 750 mg of lithium carbonate and 1,000 mg of amisulpride during a 14-day inpatient stay. Conclusion: We content that our two patients had a new onset of manic episode after COVID-19 infection. We suggest that manic symptoms may have been triggered through an episode of COVID-19.

Abstract- Poster

Lithium remains the mainstay for treatment of acute and maintenance therapy of mania in bipolar disorder. The effectiveness of lithium should be weighed against its side effect profile. The cutaneous effects of lithium may occur at normal therapeutic serum lithium levels. Types of skin reactions associated with lithium include acne conglobata, hidradenitis suppurativa, folliculitis, alopecia, thinning of hair, macular/maculopapular rashes, and diffuse, erythematous, pruritic, maculopapular eruption.A 28 year old female patient, was admitted in our hospital with symptoms of irritability, decreased sleep, talking excessively, overfamiliarity, increased energy levels, increased sexual desire. Total duration of illness being 2 months. No past treatment history. Mental status examination shows overfamiliarity, overdressed, increased psychomotor activity, pressurized speech, flight of ideas and increased self esteem. She was diagnosed as first episode mania and was given tablet sodium valproate 1500 mg and tablet olanzapine 10mg in divided doses. Later lithium 300mg was added. 4 days after starting lithium patient developed maculopapular rash over both forearms, ventral aspect and nape of neck. There were no complaints of itching or any signs of systemic infection. Rash subsided completely within 5 days after stopping lithium.Clinicians should monitor cutaneous symptoms during lithium treatment, as lithium is associated cutaneous side effects, these may result in suboptimal adherence by the patients.

How do you treat a first episode mania? Antipsychotic, mood stabiliser or both?

How do you treat a first episode mania? Antipsychotic, mood stabiliser or both?

Symposium

Symposium

Hassle Faced with Induced Mania in Elderly Female While Treating for Obsessive-Compulsive Symptoms

Obsessive-compulsive disorder (OCD) is one of the most frequently associated comorbidities in bipolar disorder. While this presents a challenge in understanding the phenomenology and also the treatment aspect of cooccurrence of mania with OCD. The index case is of an elderly female who presented with obsessive-compulsive (OC) symptoms and while on treatment had mania episodes. The mania episodes presented challenges while managing underlying OC symptoms. The common neurobiological mechanism for the comorbid illness and treatment lacunae are discussed.

Management of Psychiatric Disorders in Patients with Stroke and Traumatic Brain Injury.

Management of Psychiatric Disorders in Patients with Stroke and Traumatic Brain Injury.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Implementation of Educational-Interactive-Psychiatric Management Software for Patients with Bipolar Disorder

Background: Bipolar disorder is considered a psychiatric disease without any effective screening questionnaire to monitor and manage Iranian patients. This study aims to implement a researcher-made questionnaire in the form of educational interactive software for better management of patients with bipolar disorder and prevent further complications. Methods: The present cross-sectional study evaluated the efficacy of psychoeducational-interactive-therapeutic software for patients with bipolar disorder, which is a network-based software providing a researcher-made questionnaire in a planned manner. This software can predict the occurrence of future bipolar episodes for each patient by using artificial intelligence algorithms after the occurrence of two mood episodes as the training phase. The patients with bipolar disorder were asked to use the software for a year and their mood episodes were compared before and after using the software. We evaluate the reliability of the questionnaires in the software with internal consistency using alpha Cronbach test and test-retest analysis. Face validity and content validity were also evaluated. Results: The content validity index of the instrument was 93%, and the Cronbach's alpha coefficient of the whole questionnaire was 0.955. Also, the ICC coefficient for this questionnaire is above 0.70, and the correlation coefficient of the answers in all constructs of the questionnaire is more than 0.8. Thirty male patients with bipolar disorder who experienced four episodes of mood swings per year experienced an average of 2 mood episodes per year following the use of this software. Conclusion: Our Psychoeducational-interactive-therapeutic software is the first Persian language software based on artificial intelligence to monitor clinical symptoms in patients with bipolar disorder, which uses a standard questionnaire to predict the incidence of episodes of depression and mania in these patients.

Bipolar disorder detection over social media

Bipolar disorder is a mental illness characterized by manic and depressive episodes. The inability to track the patient at different stages of the disease, the patient’s concealment of information, and the difficulty in obtaining and paying for a psychologist are all weaknesses in traditional diagnosis procedures. In this regard, computer researchers have developed automated prediction algorithms in response to issues involved in using traditional ways of diagnosing bipolar disorder. Although these automated approaches have eliminated many problems that plagued previous systems, there are still many challenges to tackle. Discovering a mechanism to track changes in user behavior and aggregating various features into a cohesive model are the most critical issues in this context. To address these concerns, this research proposes a novel approach for detecting bipolar disorder among Twitter users.

Intravenous valproic acid for the treatment of inpatients with bipolar disorder experiencing manic or depressive episodes with mixed features

Intravenous valproic acid for the treatment of inpatients with bipolar disorder experiencing manic or depressive episodes with mixed features

Biomarker potential of hsa-miR-145-5p in peripheral whole blood of manic bipolar I patients

Objective:Bipolar I disorder (BD-I) is a type of bipolar spectrum disorder characterized by manic or mixed episodes. Detecting microRNA regulations as epigenetic actors in BD-I is important to elucidate the pathogenesis of the disease and reveal the potential of microRNAs (miRNAs) as biomarkers.Methods:We evaluated the expression profile of six candidate miRNAs (hsa-miR-145-5p, hsa-miR-376a-3p, hsa-miR-3680-5p, hsa-miR-4253-5p, hsa-miR-4482-3p, and hsa-miR-4725) in patients with BD-I and in healthy controls (aged 11-50 years). We also determined the potential target genes of these miRNAs through in silico analysis. The diagnostic values of the miRNAs were calculated through receiver operating characteristic curve analysis.Results:Four miRNAs were upregulated (hsa-miR-376a-3p, hsa-miR-3680-5p, hsa-miR-4253-5p, hsa-miR-4482-3p) and hsa-miR-145-5p was downregulated in patients (p < 0.001). The target gene analyses showed that hsa-miR-145-5p specifically targets the dopamine decarboxylase (DDC) gene. The area under the curve of hsa-miR-145-5p was 0.987.Conclusion:Differential expression of five miRNAs in peripheral blood may be associated with the pathogenesis of BD-I, and hsa-miR-145-5p has potential as a BD-I biomarker. This miRNA can be used in dopamine-serotonin regulation and dose adjustment in drug therapy via the DDC gene.

Variations in bioenergetic response to effort between manic and euthymic states in bipolar disorder type I

Variations in bioenergetic response to effort between manic and euthymic states in bipolar disorder type I