Manic Patients Research Articles

Alterations of Cognition and Cerebral Ventricle Volume in Manic and Euthymic Pediatric Bipolar Disorder.

Introduction: It remains unknown whether volumetric alterations of ventricles are similar or not in pediatric bipolar disorder (PBD) among different mood states. The present study aims to estimate ventricular volumetric alteration of PBD patients in manic and euthymic status, as well as the relationship between this alteration and cognitive changes.Methods: T1 magnetic resonance images were obtained from 20 manic PBD patients, 21 euthymic PBD patients, and 19 healthy controls (HCs). Ventricular volumes were automatically obtained via FreeSurfer 6.0 software. Ventricular volumes and cognitive indices were compared among the three groups, and the relationship between ventricular volumes and cognitive/clinical indices was analyzed.Results: In contrast to HCs, manic and euthymic PBD patients exhibited decreased cognitive scores of the Stroop color-word test and the digit span subtest. Manic PBD subjects presented enlarged volumes in the bilateral ventricles, third ventricle, and whole ventricles, and euthymic PBD participants displayed increased volumes in the third ventricle, fourth ventricle, and whole ventricles. No significant differences in cognitive performance and ventricular volumes were found between PBD groups. No significant correlation was discovered between ventricular volumes and cognitive/clinical indices in both manic and euthymic PBD patients.Conclusions: No significant differences in cognitive performance and ventricle volume were observed between euthymic and manic PBD groups, which may imply that the alterations are not specific to mood state. It may indicate structural and functional damage of corresponding brain circuits in euthymic PBD patients similar with that of manic PBD, which may provide clues to the diagnosis and treatment of euthymic PBD.

Cognitive subgroups in first episode bipolar I disorder: Relation to clinical and brain volumetric variables.

Distinct cognitive subgroups are seen in patients with long duration bipolar I disorder (BDI), possibly reflective of underlying pathophysiological differences. It is unknown whether such cognitive heterogeneity is present at illness onset. We applied latent class analysis (LCA) to cognitive test scores in first episode BDI patients. Exploratory analysis elucidated whether impaired subgroups were characterized by 'early neurodevelopmental' (low premorbid IQ and intracranial volume) versus 'later neurodevelopmental' (decline from premorbid to current IQ, changes in relative grey (GM)/white (WM) matter volumes) pathology. Recently recovered first manic episode BDI patients (n=91) and healthy controls (HC, n=63) comprised the study sample. LCA identified subgroups based on processing speed, verbal memory, non-verbal memory, executive functioning, attention and working memory scores. Subgroups were compared amongst each other and HC on premorbid/current IQ, intracranial (ICV), total brain and regional volumes. Three cognitive subgroups emerged: (i) globally impaired (GI, n=31), scoring 0.5-1 SD below demographically corrected norms across domains, (ii) selectively impaired (SI, n=47), with predominant processing speed deficits and (iii) high performing (HP, n=13), with above-average cognitive performance. GI patients showed a 'later neurodevelopmental' pattern, with normal ICV, significant decline from premorbid to current IQ, higher total GM and lower total WM (with respect to total brain volume) versus SI and HC (p=0.003). GI patients had higher left frontal pole GM versus HC (p<0.05, FWE corrected). A globally impaired patient subgroup is identifiable in first episode BDI, possibly characterized by unique neurodevelopmental pathologic processes proximal to illness onset.

Chronic nicotine, but not suramin or resveratrol, partially remediates the mania-like profile of dopamine transporter knockdown mice

Bipolar disorder (BD) is a severe mental illness affecting 2% of the global population. Current pharmacotherapies provide incomplete symptom remediation, highlighting the need for novel therapeutics. BD is characterized by fluctuations between mania and depression, likely driven by shifts between hyperdopaminergia and hypercholinergia, respectively. Hyperdopaminergia may result from insufficient activity of the dopamine transporter (DAT), the primary mediator of synaptic dopamine clearance. The DAT knockdown (DAT KD) mouse recreates this mechanism and exhibits a highly reproducible hyperexploratory profile in the cross-species translatable Behavioral Pattern Monitor (BPM) that is: (a) consistent with that observed in BD mania patients; and (b) partially normalized by chronic lithium and valproate treatment. The DAT KD/BPM model of mania therefore exhibits high levels of face-, construct-, and predictive-validity for the pre-clinical assessment of putative anti-mania drugs. Three different drug regimens – chronic nicotine (nicotinic acetylcholine receptor (nAChR) agonist; 40 mg/kg/d, 26 d), subchronic suramin (anti-purinergic; 20 mg/kg, 1 × /wk, 4 wks), and subchronic resveratrol (striatal DAT upregulator; 20 mg/kg/d, 4 d) – were administered to separate cohorts of male and female DAT KD- and wildtype (WT) littermate mice, and exploration was assessed in the BPM. Throughout, DAT KD mice exhibited robust hyperexploratory profiles relative to WTs. Nicotine partially normalized this behavior. Resveratrol modestly upregulated DAT expression but did not normalize DAT KD behavior. These results support the mania-like profile of DAT KD mice, which may be partially remediated by nAChR agonists via restoration of disrupted catecholaminergic/cholinergic equilibrium. Delineating the precise mechanism of action of nicotine could identify more selective therapeutic targets.

Clozapine for Treatment-Refractory Aggressive Behavior.

Emergency psychiatry has the main role of resolving suicidal behavior and aggression. These severe psychiatric symptoms can be found in many psychiatric disorders such as schizophrenia, bipolar disorder, major depression, personality disorders, cognitive disorders, intellectual disability and substance abuse. Although indications for the use of antipsychotics are limited to a specific group of diseases, they are frequently used as rescue medication in high-risk or nonresponsive cases. Clozapine, the gold standard for TRS (treatment resistant schizophrenia) is effective in controlling aggression. The aim of the research was to identify the use of clozapine for treatment-refractory aggressive behavior in psychiatric emergency. A retrospective study based on the paper files of patients admitted between 2010 and 2019 in the Clinical Hospital of Psychiatry and Neurology of Brasov, Romania. Were included all the patients admitted as a psychiatric emergency and treated with clozapine for aggressive behavior. The hospital is an academic institution with 150 beds for acute patients, serving an area of over 600,000 inhabitants. It is the main public institution where patients with psychiatric emergencies are hospitalized. Off 19,000 patients admitted during the study period, 504 patients (2,4%) with a diagnosis other than schizophrenia or schizoaffective disorder received clozapine for aggressiveness (89.5%). The first four diagnoses identified were bipolar disorder (n = 172), intellectual disability (n = 128), cognitive impairment (n = 112), and personality disorder (n = 92). Other disorders identified but with a smaller number of cases were major depressive disorder (n = 3), adjustment disorders (n = 2), delusional disorder (n = 2), obsessive compulsive disorder (n = 2) and postpartum psychosis (n = 1). Clozapine was used as 3rd or 4th choice. The dose was greater for manic patients (350.29 ± 98.01mg/day) compared with all the other diagnoses. Clozapine was effective and safe in cases of patients with treatment-refractory aggressive behavior.

Physical therapy for reducing arousal and mechanical restraint among in-patients with mania

Background From 2003 to 2013 the number of patients exposed to mechanical restraint in Danish psychiatric hospitals was increased. Since, a great effort has been done to reduce mechanical restraint. Objectives The aim of this study was to assess whether physical therapy could lower the level of arousal and reduce mechanical restraint among patients with mania. Methods 170 patients admitted with mania at Aarhus University Hospital were offered physical therapy during the study period from 2017 to 2018. Patients reported their experienced level of arousal before and after physical therapy, rating feelings of tension, ability to be at rest, and feelings of irritability/aggression on Visual Analog Scales. Further, the number of manic patients exposed to mechanical restraint in this period was compared with the two previous years and with patients with other diagnoses. Results Patients’ level of arousal was significantly reduced after receiving physical therapy. Further, the study showed a significant reduction in mechanical restraint among patients with mania from 2015 to 2017. Conclusion The results indicate that physical therapy lowers the level of arousal and it is possible that physical therapy contributed to a reduction in mechanical restraint among manic patients. However, the study-design does not allow for confirming this causality.

Daily estimates of clinical severity of symptoms in bipolar disorder from smartphone-based self-assessments

Currently, the golden standard for assessing the severity of depressive and manic symptoms in patients with bipolar disorder (BD) is clinical evaluations using validated rating scales such as the Hamilton Depression Rating Scale 17-items (HDRS) and the Young Mania Rating Scale (YMRS). Frequent automatic estimation of symptom severity could potentially help support monitoring of illness activity and allow for early treatment intervention between outpatient visits. The present study aimed (1) to assess the feasibility of producing daily estimates of clinical rating scores based on smartphone-based self-assessments of symptoms collected from a group of patients with BD; (2) to demonstrate how these estimates can be utilized to compute individual daily risk of relapse scores. Based on a total of 280 clinical ratings collected from 84 patients with BD along with daily smartphone-based self-assessments, we applied a hierarchical Bayesian modelling approach capable of providing individual estimates while learning characteristics of the patient population. The proposed method was compared to common baseline methods. The model concerning depression severity achieved a mean predicted R2 of 0.57 (SD = 0.10) and RMSE of 3.85 (SD = 0.47) on the HDRS, while the model concerning mania severity achieved a mean predicted R2 of 0.16 (SD = 0.25) and RMSE of 3.68 (SD = 0.54) on the YMRS. In both cases, smartphone-based self-reported mood was the most important predictor variable. The present study shows that daily smartphone-based self-assessments can be utilized to automatically estimate clinical ratings of severity of depression and mania in patients with BD and assist in identifying individuals with high risk of relapse.

Combination Regimen With Lithium and Antipsychotic in Bipolar Manic Episodes: Impact on Adult Hospitalization Length of Stay

ObjectiveTo discern the demographic predictors in bipolar disorder (BD) manic patients receiving combination regimen, that is, lithium and antipsychotic, and to study the impact of a combination regimen on hospitalization length of stay (LOS) and total charges.MethodsWe used the nationwide inpatient sample (NIS) and included 1,435 adult inpatients with BD, manic episodes, and receiving lithium. Independent sample T-test with equality measures was used for LOS and total charges. Logistic regression model was used to find the odds ratio (OR) for the combination regimen to estimate the predictors with 95% CI.ResultsAmong the inpatient sample, 34.5% received a combination regimen. There was statistically no significant difference between the combination regimen versus non-combination regimen cohorts by age and sex. A higher proportion of inpatients receiving combination regimen were from high-income families above 75th percentile (56.4%) and covered by private insurance (47.5%). Blacks (OR 2.00, 95% CI 1.43-2.82) and hispanic (OR 2.31, 95% CI 1.49-3.57) had higher odds of receiving a combination regimen compared to whites. The combination regimen significantly reduced LOS for BD, manic episode management by 2.8 days (95% CI 1.13-4.53 days, P < 0.001). There was statistically no significant mean difference in total charges (P = 0.495).ConclusionA combination regimen with lithium and antipsychotics significantly reduced LOS for BD manic episodes by 2.8 days compared to inpatients receiving lithium monotherapy. So, starting the combination regimen from the initial day of hospitalization should be considered as an effective model for faster response.

Mirror Readmission Study of the Association of Electroconvulsive Therapy With 1-Year Mood Disorder Readmissions in a Tertiary Mood Disorder Unit.

Electroconvulsive therapy (ECT) is one of the most effective treatments for severe mood disorders and may reduce psychiatric readmissions. However, the effect on ECT on mood disorder readmissions in Asia is unclear. We embarked to assess the relationship between inpatient ECT and 1-year psychiatric readmissions for patients with mood disorders. A retrospective database analysis of patients admitted to a tertiary Mood Disorders Unit in a developed Asian city was analyzed to investigate the association of inpatient ECT with psychiatric readmission using a 1-year mirror-image method with major depressive disorder and bipolar mania patients acting as their own controls. Covariates of age, sex, number of outpatient visits, and outpatient ECT were analyzed to account for confounders. t Tests were done to compare number and duration of psychiatric admissions and significance set at P < 0.05. Patients with major depressive disorder and bipolar mania (N = 121) receiving inpatient ECT had a 35% mean reduction from the baseline mean of number of admissions in the 1-year after ECT. Maintenance ECT (between 30 days and 1 year after discharge) was associated with the protective effect (β = -0.116, t = -2.044, P = 0.043). In major depressive disorder, there was a trend association between the number of 1-year postdischarge outpatient visits and decreased 1-year readmissions with an opposite association seen in bipolar mania. Electroconvulsive therapy may be associated with decreased 1-year readmissions for mood disorders in Asia, and this effect may be mediated by maintenance ECT.

Platelet mass index as an indicator of platelet activation in manic episode

BackgroundDiscovering the biological basis of bipolar disorder has been the focus of studies in recent years. Alterations in platelet parameters were found to be associated with episodes of bipolar disorder. This study aimed to compare the differences in platelet parameters especially the platelet mass index as an inflammation marker between the patients with bipolar mania and healthy controls. Methods68 male inpatients with manic episodes and 60 age-gender matched healthy controls were included in the study. Platelet mass index, mean platelet volume and platelet counts were compared between controls and manic patients. ResultsPlatelet mass index of manic group was significantly higher than the controls (p = 0.002). Statistically significant difference was also observed between groups in terms of mean platelet volume (p = 0.012). For platelet counts; there was no statistically significant difference between manic and control groups (p = 0.171). LimitationThe limitations of this study is that, platelet mass index was not measured in manic patients after manic episodes subsided. Other limitations are relatively small sample size, cross-sectional nature and lacking the data about other inflammation and cardiovascular marker, and lack of the longitudinal outcomes of multiple drugs and effects of lifestyle factors. ConclusionPlatelet mass index reflects platelet functionality and is thought to be a useful parameter for plaque formation capacity of platelets. In our study, we have shown an increment in platelet activation in manic episode compared to healthy controls; which may reflect the inflammation process and cardiovascular status in bipolar disorder.

S82. REINFORCEMENT LEARNING IMPAIRMENT IN PATIENTS WITH EARLY-STAGE PSYCHOTIC BIPOLAR DISORDER

BackgroundAbnormal reward sensitivity is a biosignature to mood disorders spectrum. Recent data suggested either elevated or preserved positive but impaired negative reinforcement learning in patients with bipolar disorder. Functional MRI studies provided extra evidence on heightened reward sensitivity in manic patients. Of note, these investigations mostly rest on chronically ill samples, conditions of whom may have been confounded by prolonged exposure to medications. This study aims to examine reinforcement learning performance and its relationship with symptomology in patients with early-stage psychotic bipolar disorder (BDP).MethodsThis study is based on 38 patients with early-stage BDP (defined by having received psychiatric treatment for first-episode BDP within 3 years since service entry) who have been euthymic for at least eight weeks and 40 demographically-matched controls. Reinforcement learning performance was evaluated using Gain-vs-Loss-Avoidance Task (GLAT), which measured the correct responses in both gain and loss-avoidance pairs with reinforcement probability at either 90% or 80% across four blocks in the training phase and one block in the test/transfer phase. Comparison analyses on reinforcement learning performance were conducted on two groups. Associations of reinforcement learning measures with symptom scores, cognitive functions and functioning measures were also tested.ResultsThere was no group difference in gender, age or education level. Repeated-measures analysis of variance (ANOVA) showed significant main effects of group (F=6.52, p=0.013), block (F=43.71, p<0.001), probability (F= 5.58, p<0.001), and block x group (F=2.87, p=0.040) interaction. Post-hoc tests revealed that controls performed better than patients across blocks (p<0.05). Patients also showed a lower lose-shift rate (t= 2.21, p=0.03) and punishment-driven learning accuracy rates (t=2.42, p=0.018) than controls. Marginally significant main effect of stimulus pair (F=3.98, p=0.05) was revealed in the test phase, with controls showing a significantly higher preference in Frequent Winner vs Frequent Loser (FWFL) pair than patients (t=-2.25, p=0.028). No significant correlations between learning measures and any of the symptom dimensions in patient sample.DiscussionOur preliminary findings provided a brief evidence on the negative reinforcement learning impairment in early-stage BDP patients. Further investigation is required to verify and confirm our results of impaired negative reinforcement learning in the initial course of bipolar disorder.

Cortical source localization during facial emotion recognition in bipolar mania: An ERP study.

Facial emotion recognition has enormous value for humans in social cognition and thereby day to day functioning. Disturbances in the processing of emotional cues are seen in all the three phases of bipolar disorder and have been proposed as an etiology in the development of bipolar disorder. 30 consented patients with bipolar mania with psychotic symptoms and 30 age and sex matched healthy controls were taken for the study. Facial emotion ecognition task containing four basic emotions namely happy, sad, anger and fear were used. Sixty four (64) channel ERP recordings were done for all the subjects. Source localization was done using sLORETA selecting the window for late positive potentials (LPP). Statistically significant and reduced cortical sources were noted in the right insula (p = 0.004) at the peak of LPP during response to anger facial emotions in bipolar mania patients. Hypoactivation of right insular cortex during response to anger emotion may be due to the aberrant activation and possible failure of interoceptive prediction system during acute manic phase are discussed.

Neuroserpin in Bipolar Disorder.

Neuroserpin is a serine protease inhibitor predominantly expressed in the nervous system functioning mainly in neuronal migration and axonal growth. Neuroprotective effects of neuroserpin were shown in animal models of stroke, brain, and spinal cord injury. Postmortem studies confirmed the involvement of neuroserpin in Alzheimer's disease. Since altered adult neurogenesis was postulated as an aetiological mechanism for bipolar disorder, the possible effect of neuroserpin gene expression in the disorder was evaluated. Neuroserpin mRNA expression levels were examined in the peripheral blood of bipolar disorder type I manic and euthymic patients and healthy controls using the polymerase chain reaction method. The sample comprised of 60 physically healthy, middle-aged men as participants who had no substance use disorder. The gene expression levels of neuroserpin were found lower in the bipolar disorder patients than the healthy controls (p=0.000). The neuroserpin levels did not differ between mania and euthymia (both 96% down-regulated compared to the controls). Since we detected differences between the patients and the controls, not the disease states, the dysregulation in the neuroserpin gene could be interpreted as a result of the disease itself.

Are existing self-ratings of acute manic symptoms in adults reliable and valid?-A systematic review.

Depression research historically uses both self- and clinician ratings of symptoms with significant and substantial correlations. It is often assumed that manic patients lack insight and cannot accurately report their symptoms. This delayed the development of self-rating scales for mania, but several scales now exist and are used in research. Our objective is to systematically review the literature to identify existing self-ratings of symptoms of (hypo)mania and to evaluate their psychometric properties. PubMed, Web of Knowledge, and Ovid were searched up until June 2018 using the keywords: "(hypo)mania," "self-report," and"mood disorder" to identify papers which included data on the validity and reliability of self-rating scales for (hypo)mania in samples including patients with bipolar disorder. We identified 55 papers reporting on 16 different self-rating scales claiming to assess (hypo)manic symptoms or states. This included single item scales, but also some with over 40 items. Three of the scales, the Internal State Scale (ISS), Altman Self-Rating Mania Scale (ASRM), and Self-Report Manic Inventory (SRMI), provided data about reliability and/or validity in more than three independent studies. Validity was mostly assessed by comparing group means from individuals in different mood states and sometimes by correlation to clinician ratings of mania. ASRM, ISS, and SRMI are promising self-rating tools for (hypo)mania to be used in clinical contexts. Future studies are, however, needed to further validate these measures; for example, their associations between each other and sensitivity to change, especially if they are meant to be outcome measures in studies.

Comorbid personality disorders in manic bipolar I disorder patients is associated with increased use of long-acting injectable antipsychotic treatment and higher rates of rehospitalization.

Personality disorder comorbidity is considered a poor prognostic factor among bipolar disorder patients. However, an evidence-based pharmacological treatment for this sub-population is lacking, and only few studies investigated the impact of personality disorder on bipolar disorder-I course. Here, we studied the effect of comorbid personality disorder on the administrated psychopharmacotherapy and rehospitalization risk among manic bipolar disorder-I patients. A sample of 340 patients with bipolar disorder-I, who were hospitalized with acute manic episode between 2005 and 2013, were retrospectively followed for a mean duration of 1129 days. Drug treatment at discharge and rehospitalization rates during follow-up time were compared between bipolar disorder-I patients with (n = 55) or without (n = 285) personality disorder comorbidity. Multivariate survival analyses adjusted for covariates were conducted. During the study period, 39.4% of bipolar disorder-I patients were rehospitalized due to a mood episode. Comorbid personality disorder was significantly associated with higher rates of long-acting injectable antipsychotics administration at discharge from hospitalization (adjusted odds ratio 2.66, 95% confidence interval: 1.19-5.94, P = 0.017). Comorbid personality disorder significantly increased the adjusted risk of rehospitalization due to a mood episode (hazard ratio = 2.04, 95% confidence interval: 1.29-3.23, P = 0.002). In conclusion, comorbid personality disorder in manic bipolar disorder-I patients is associated with increased use of long-acting injectable antipsychotics and higher rates of rehospitalization.

A Humoral Recognition-Behavioral Stress-Coping Glycolipid Considered As another Biomarker of Psychotic Symptoms of Schizophrenia

Background: Mammalians have the recognition-behavioral stress-coping system regulated via the neuronal modules followed by some humoral glycolipids. A sulfated Galbeta1-4GlcNAc-lipid which promotes the serotonergic module, keeps physical strength by regulating emotional behaviors. GalNAcalpha1-3GalNAc-lipid which promotes the adrenergic module, induces stress-coping behaviors. A sulfated Fucalpha1-2Gal-lipid protects the cholinergic module maintaining stress-coping memories from the ischemic stress. Sialalpha2-3Gal-lipid which promotes the dopaminergic module, integrates these recognition-behaviors. It is considered stresses are closely related to onset of schizophrenia, and the psychotic symptoms are not necessarily deleted after long-time medication. Schizophrenic patients might abnormally produce the humoral recognition-behavioral stress-coping glycolipids even under medication. Materials and Methods: I examined the humoral stress-coping glycolipids of medicated schizophrenic patients and those of medicated manic patients without psychotic symptoms for comparison. Results: The medicated manic patients increased sulfated Galbeta1-4GlcNAc-lipid production. The medicated schizophrenic patients increased sulfated Galbeta1-4GlcNAc-lipid production, and remarkably produced Sialalpha2- 3Gal-lipid. These indicate the manic patients and the schizophrenic patients had a stress to be coped with the serotonergic module activity, and psychotic symptoms of the schizophrenic patients would be induced via stress-coping Sialalpha2-3Gal-lipid production. Conclusion: The stressors are not clear, however, I understood humoral Sialalpha2-3Gal-lipid would be considered as another biomarker of psychotic symptoms of schizophrenia.

Intrinsic brain activity of subcortical-cortical sensorimotor system and psychomotor alterations in schizophrenia and bipolar disorder: A preliminary study

ObjectiveAlterations in psychomotor dimension cut across different psychiatric disorders, such as schizophrenia (SCZ) and bipolar disorder (BD). This preliminary study aimed to investigate the organization of intrinsic brain activity in the subcortical-cortical sensorimotor system in SCZ (and BD) as characterized according to psychomotor dimension. MethodIn this resting-state functional magnetic resonance imaging (fMRI) study, functional connectivity (FC) between thalamus and sensorimotor network (SMN), along with FC from substantia nigra (SN) and raphe nuclei (RN) to basal ganglia (BG) and thalamic regions, were investigated by using an a-priori-driven and dimensional approach. This was done in two datasets: SCZ patients showing inhibited psychomotricity (n = 18) vs. controls (n = 19); SCZ patients showing excited psychomotricity (n = 20) vs. controls (n = 108). Data from a third dataset of BD in inhibited depressive or manic phases (reflecting inhibited or excited psychomotricity) were used as control. ResultsSCZ patients suffering from psychomotor inhibition showed decreased thalamus-SMN FC toward around-zero values paralleled by a concomitant reduction of SN-BG/thalamus FC and RN-BG/thalamus FC (as BD patients in inhibited depression). By contrast, SCZ patients suffering from psychomotor excitation exhibited increased thalamus-SMN FC toward positive values paralleled by a concomitant reduction of RN-BG/thalamus FC (as BD patients in mania). ConclusionsThese findings suggest that patients exhibiting low or high levels of psychomotor activity show distinct patterns of thalamus-SMN coupling, which could be traced to specific deficit in SN- or RN-related connectivity. Notably, this was independent from the diagnosis of SCZ or BD, supporting an RDoC-like dimensional approach to psychomotricity.

Lower serum nicotinamide N-methyltransferase levels in patients with bipolar disorder during acute episodes compared to healthy controls: a cross-sectional study

BackgroundNicotinamide N-methyltransferase (NNMT) has been implicated in the pathogenesis of neuropsychiatric diseases. Bipolar disorder (BD) is associated with metabolic abnormalities and NNMT regulates energy metabolism and may also exert a causal role in metabolic disorders. The present study aimed to determine serum NNMT levels in patients with BD and compared the results with that of healthy controls, to explore the correlation between NNMT and clinical and metabolic characteristics.MethodsThe NNMT levels of 80 patients having a manic episode of BD and 65 non-psychiatric control individuals were measured using enzyme-linked immunosorbent assay. Metabolic parameters were evaluated using standard laboratory methods.ResultsThe serum NNMT levels of bipolar mania patients were significantly lower than that of non-psychiatric controls. Furthermore, the serum levels of NNMT were found to be negatively correlated with Young Mania Rating Scale (YMRS) scores and the duration of the illness. Moreover, lower NNMT serum levels were found in patients with a history of antipsychotic medication and dyslipidemia. Our results also demonstrated the different patterns of correlation that exist between the study groups. Serum NNMT levels were found to be negatively correlated with triglyceride, cholesterol, and apolipoprotein B levels in the BD group, while the same was found to be negatively associated only with high-density lipoprotein cholesterol in the control group.ConclusionsThese findings support the suggestion that lower NNMT serum levels are significantly associated with BD and that serum NNMT has the potential to regulate lipid metabolism in BD patients.

Serum zonulin and claudin-5 levels in patients with bipolar disorder

The etiology in bipolar disorder has not been fully understanding. There are limited data regarding the relationship between the permeability of intestinal and blood-brain barrier (BBB), and bipolar disorder etiology. Zonulin is regarded as a non-invasive biomarker for intestinal permeability. Claudin-5 is an important part of BBB permeability. In this study, we assumed that there may be a deterioration in serum zonulin and claudin-5 levels in patients with bipolar disorder and this may affect the severity of the disease. Forty-one bipolar disorder patients (21 patients in remission and 20 patients with manic episodes) and 41 healthy controls were included in this study. The patients were administered Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS) to determine the severity of manic and depressive symptoms, respectively. Venous blood samples were collected, and serum zonulin and claudin-5 levels were measured. The mean serum zonulin and claudin-5 levels in patients were significantly higher than healthy controls. There is no difference zonulin and claudın-5 levels between patients with manic episodes and patients in remission. This study's small sample size limits the generalization of these outcomes to a larger population. Also, a major limitation of our study is lack of evaluations of gut microbiota in patients with bipolar disorder and controls. In conclusion, the current research indicates that zonulin and claudin-5 are increased in patients with bipolar disorder and this finding may contribute to the role of intestinal permeability or BBB in the pathogenesis of bipolar disorder.

Blue-blocking glasses as additive treatment for mania: Effects on actigraphy-derived sleep parameters.

Improvement of sleep is a central treatment goal for patients in a manic state. Blue-blocking (BB) glasses as adjunctive treatment hasten overall recovery from mania. This method is an evolvement from dark therapy and builds on the discovery of the blue-light-sensitive retinal ganglion cell that signals daytime to the brain. We report effects of adjunctive BB glasses on actigraphy-derived sleep parameters for manic inpatients as compared to placebo. Hospitalized patients with bipolar disorder in a manic state aged 18-70years were recruited from five clinics in Norway from February 2012 to February 2015. The participants were randomly allocated to wearing BB glasses or placebo (clear glasses) as an adjunctive treatment from 18:00 to 08:00hours for seven consecutive nights. Sleep and wake were monitored by actigraphy. From 32 eligible patients, 10 patients in each group qualified for the group analyses. The BB group's mean sleep efficiency was significantly higher at night 5 as compared to the placebo group (92.6% vs. 83.1%, p=.027). The 95% confidence interval (CI) was 89.4%-95.8% in the BB group and 75.9%-90.3% in the placebo group. There were fewer nights of interrupted sleep in the BB group: 29.6% versus 43.8% in the placebo group. The BB group received less-intensive sleep-promoting pharmacological treatment and showed significantly higher sleep efficiency and more consolidated sleep as compared to the placebo group. Our findings suggest sleep-promoting effects through deactivating mechanisms. Adjunctive BB glasses seem to be useful for improving sleep for manic patients in the hospital setting.

Trajectory of insight on various dimensions among bipolar disorder in-patients.

Background:Insight is awareness of one's symptoms, illness, and need for treatment. In bipolar disorder, insight is better in bipolar depression and nonpsychotic depression when compared with mania and psychotic depression. Insight impacts on medication adherence. In our study, we measured and compared with various clinical parameters of insight. The aim of this study is to assess various dimensions of insight recovery prospectively in bipolar affective disorder patients with treatment and drug compliance.Materials and Methods:Patient's insight was assessed using Mood Disorder Insight Scale (MDIS) at baseline, 1st, 3rd, and 6th months. Their insight was then compared with various sociodemographic profiles and correlated with number of mood episodes, family history of mental illness, and 6-month MDIS scores.Results:Depression patients scored better in insight components (P = 0.001). The good compliance group attributed their symptoms to their illness than the poor compliance group (P = 0.013). The MDIS scores were gradually improving from baseline to 6 months (P ≤ 0.001). There was no relationship between insight and the number of episodes (P = 0.788).Conclusion:Depressive episode patients had better insight during the baseline, which improved during 6 months follow-up compared with manic patients. Among various components of insight, insight on the attribution of symptoms was a predictor of good compliance. Progression of insight was steady and proportionate to the duration of treatment in depressive episode patients.