Manic Patients Research Articles

No neuronal autoantibodies detected in plasma of patients with a bipolar I disorder

A subpopulation of patients with bipolar disorder type I (BD-I) might suffer from undiagnosed autoimmune encephalitis. We tested plasma of 104 BD-I patients with a current or recent manic episode in the past 2 years for the presence of neuronal autoantibodies using immunohistochemistry, immunocytochemistry and cell-based assay (CBA). Neuronal antibodies were not detected in any of the BD type I. This finding suggests that the frequency of an undiagnosed autoimmune encephalitis in patients with BD I is less than 1%. However, these findings need to be confirmed in cerebrospinal fluid and/or blood of acutely ill manic patients.

Clinical Manifestations of Mania in Patients With Bipolar I Disorder Based on the Primary Symptoms in DSM-5

Objective According to DSM-5, bipolar disorder is a condition in which the patient experiences one or several manic episodes and sometimes major depressive episodes too. The signs and symptoms of the disorders in DSM are generally influenced by cultural and ethnic factors. Therefore, the present study was aimed at identifying the clinical manifestations of mania in bipolar I disorder in Iranian population.Methods The present work is a cross-sectional study. The participants included 64 patients in the manic phase of bipolar I disorder who were selected from the Razi psychiatric hospital and the Taleghani Hospital, using a convenience sampling method. The study data were gathered using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Young Mania Rating Scale (YMRS).Results According to the findings, the most common signs and symptoms of mania in hospitalized patients with bipolar I disorder included reduced need for sleep (89.1), poor insight (87.5), elevated mood (85.9), talkativeness (79.7), and psychotic features (68.8). The major symptoms of the patients according to DSM-5 criteria included reduced need for sleep (89.1), talkativeness (79.7), and psychomotor agitation (40.6). According to t-test analysis, patients with and without a history of mental disorders did not have significantly different mania scores. The one-way analysis of variance (ANOVA) analysis indicated no significant difference in mania scores based on the age of onset of the disorder, marital status (single, married, divorced, or widow), education level, and number of hospitalizations. The chi-squared test revealed that patients with a lower education level showed more aggressive behaviors.Conclusion According to our results, since the response of a patient to a particular treatment is largely influenced by the symptoms of the disorder, clinicians should pay critical attention to the most common signs and symptoms of any mania.

P 127 Vigilance regulation in adult ADHD

Background Functional regulation of vigilance or wakefulness is crucial for interaction with the environment and can be described as a unique, situation-dependent characteristic. Disorders of wakefulness regulation manifest themselves as delayed or rash declines in vigilance under calm settings. The vigilance model of affective disorders and ADHS postulate that unstable regulation of vigilance (“CNS arousal”) is observed not only in overtired children, but also in patients with mania and ADHS. Moreover, sensation and novelty seeking, hyperactivity and impulsivity observed in such persons should be interpreted as an autoregulatory attempt to stabilise vigilance by creating a stimulus incentive environment. As in mania, also in ADHD several EEG-based studies indicate an unstable regulation of wakefulness. Using an EEG-based algorithm (Vigilance Algorithm Leipzig, VIGALL) to assess the transition from high wakefulness to drowsiness until sleep onset, paediatric ADHD as well as manic patients showed an unstable vigilance regulation with rapid declines to lower vigilance stages or sleep onset. We investigated whether the vigilance regulation in adult patients with ADHD is less stable than that of healthy controls by exploring the frequency of EEG-vigilance regulation patterns. Methods Resting EEG recordings of unmedicated adult ADHD patients and healthy controls were analysed. The diagnosis was provided based on the DSM-IV criteria. EEG recordings of 15 min under quiet rest with eyes closed were performed. The computer-based Vigilance Algorithm Leipzig (VIGALL) was used to classify 1-s EEG segments into stages on the continuum ranging from full wakefulness to sleep onset. Results/conclusions Patients with ADHD showed an unstable vigilance regulation and spent more time in the less vigilance stages compared to the healthy controls. The investigated vigilance regulation model in ADHD could establish new insights into the neurophysiology of ADHD in adulthood and should be the subject of further investigations. An additional pre-post-treatment investigation with view on the suitability of the vigilance regulation as a predictor for response after a treatment with psychostimulants appears also useful.

Serum osmolarity in male patients with bipolar disorder manic episode.

What is the central question of this study? The main goal of this study was, for the first time, to investigate the role of the serum osmolarity in bipolar disorder manic episode. What is the main finding and its importance? Our results demonstrate a diminished serum osmolarity in manic episode compared with healthy control subjects. This finding supports the hypothesis of a fluid and electrolyte imbalance during acute episodes. Decreased serum osmolarity might be a reflection of a relative haemodilution in mania. Imbalance of water and electrolyte homeostasis has been suggested to be associated with acute episodes of bipolar disorder. In this study, we aimed to investigate, for the first time, the serum osmolarity in bipolar disorder manic episode. A total of 68 bipolar inpatients in manic episode and 60 age- and sex-matched healthy control subjects were included in the study. Serum osmolarity was calculated from sodium (Na+ ), glucose and blood urea nitrogen (BUN) according to following formula: (2×Na+ )+(BUN/2.8)+(glucose/18). The significance level was accepted as P<0.05. The serum osmolarity of manic patients was 295.34±4.90mosmol/l and that of the control group was 298.46±5.33mosmol/l. The serum osmolarity of the manic group was significantly lower than that of control subjects (P <0.001). When we compared the components of serum osmolarity, a statistically significant difference was also observed between groups in terms of glucose (85.85±12.25mg/dl for manic, 92.95±20.77mg/dl for control subjects, P=0.019) and Na+ (140.73±2.06mmol/l for manic, 142.06±2.48mmol/l for control subjects, P=0.001). For BUN concentrations, there was no statistically significant difference between manic (25.50±9.85mg/dl) and control (26.61±6.64mg/dl) groups (P=0.461). Our results demonstrate a diminished serum osmolarity in manic episode compared with healthy control subjects. This finding supports the hypothesis of a fluid and electrolyte imbalance during acute episodes. Decreased serum osmolarity might be a reflection of a relative haemodilution in mania. However, exploration of the role of fluid and electrolyte homeostasis and mechanisms of related hormones may contribute to a better understanding of the aetiology of bipolar disorder.

Cortical inhibition in symptomatic and remitted mania compared to healthy subjects: A cross-sectional study.

Transcranial magnetic stimulation (TMS)-derived cortical reactivity studies provide a unique opportunity to non-invasively study gamma amino butyric acid (GABA)-mediated inhibitory neurotransmission in bipolar disorder (BD). Earlier studies were conducted in smaller samples and on patients who were on medications that can potentially confound the results. We aimed to study short-interval (SICI) and long-interval intracortical inhibition (LICI) in medication-naïve/free symptomatic (manic) BD patients (n=39), first episode mania (FEM) patients who had recently (≤6months) remitted with treatment (remitted FEM; n=28) and healthy subjects (HSs; n=45). Resting motor threshold (RMT), stimulation intensity to elicit a 1-mV motor evoked potential (MEP) (SI1mV ), SICI and LICI were measured in three groups using single- and paired-pulse TMS. Motor thresholds were higher in the manic BD and HS groups compared to the remitted FEM group (P<.001). SICI was lower (P=.026) but LICI was higher (P=.044) in the manic BD and remitted FEM groups compared to the HS group. Lower motor thresholds in remitted FEM perhaps reflect the effect of treatment, and could be studied as potential prognostic neuromarkers. Inverse findings for SICI (reduced) and LICI (increased) in BD indicate a possible differential involvement of the GABAA and GABAB subreceptor systems. These could be trait markers as they are impaired in both mania and euthymia.

Klotho dysfunction: A pathway linking the aging process to bipolar disorder?

AimAlthough accelerated aging profile has been described in bipolar disorder (BD), the biology linking BD and aging is still largely unknown. Reduced levels and/or activity of a protein named Klotho is associated with decreased life span, premature aging and occurrence of age-related diseases. Therefore, this study was designed to evaluate plasma levels of Klotho in BD patients and controls. MethodsForty patients with type 1 BD and 30 controls were enrolled in this study. After clinical evaluation, peripheral blood samples were drawn and plasma levels of Klotho were measured using enzyme-linked immunosorbent assay. ResultsPatients with BD and controls presented similar age and sex distribution. The mean ± SD length of illness was 24.00 ± 12.75 years. BD patients presented increased frequency of clinical comorbidities in comparison with controls, mainly arterial hypertension, diabetes mellitus, and hypothyroidism. Both patients with BD in remission and in mania exhibited increased plasma levels of Klotho in comparison with controls. There was no significant difference between patients in mania and patients in remission regarding the levels of Klotho. ConclusionKlotho-related pathway is altered in BD. Contrary to our original hypothesis, our sample of patients with BD presented increased plasma levels of Klotho in comparison with controls. Elevated levels of Klotho in long-term BD patients may be associated with the disorder progression. Further studies are needed to better understand the role of Klotho in BD and other mood disorders.

Alcohol use and bipolar disorders: Risk factors associated with their co-occurrence and sequence of onsets

BackgroundLittle is known about the sequence of onsets in patients affected by comorbid alcohol use and bipolar disorder. This study examines the risk factors associated with their co-occurrence and order of onset. MethodThe demographic, clinical, and temperament characteristics as well as the course of illness were analyzed within our sample of 1090 DSM-IV bipolar I manic patients. Our sample was categorized according to the presence of comorbid alcohol use disorder and the sequence of onsets of bipolar and alcohol use disorders i.e., alcohol first (AUD-BD) and bipolar first (BD-AUD). ResultsRegression analyses revealed that alcohol use disorder (52.5%) was associated with the male gender, additional substance use disorders, as well as an irritable and a hyperthymic temperament. The AUD-BD group (6.6%) was older than the BD-AUD group (45.8%) and showed higher rates of comorbid sedative use, organic, and anxiety disorders with higher levels of irritable temperament, and a bipolar subtype characterized by depressive polarity at onset. The BD-AUD group had high levels of hyperthymic temperament with higher rates of comorbid stimulant use disorder and a manic polarity at onset. ConclusionsIn the AUD-BD group, alcohol might have been used to reduce stress and tension caused by the presence of an irritable temperament as well as anxious and organic disorders, leading to first depressive episode. In the BD-AUD group, stimulant use might have triggered the first manic episode, and alcohol abuse result from mania severity.

Telomere length and hTERT in mania and subsequent remission.

Objective:The findings of telomere length (TL) studies in bipolar disorder (BD) are controversial. The aim of the present study was to detect TL, human telomerase reverse transcriptase (hTERT), and brain derived neurotrophic factor (BDNF) in severe mania and subsequent remission.Methods:Twenty-one medication-free male patients and 20 age and gender matched controls were recruited. The patients were followed in the inpatient clinic, and comparisons were made between the same patients in their remission state and controls. Patients received lithium plus antipsychotics during the follow-up period. Quantitative real-time polymerase chain reaction was performed to verify leukocyte TL and whole blood hTERT gene expression levels. Serum BDNF levels were verified by enzyme-linked immunosorbent assay (ELISA).Results:Compared to controls, manic patients presented shorter telomeres (p < 0.001) whose length increased with treatment (p = 0.001). Patients in the late stages showed shorter TL than those in the early stages and controls (p < 0.001). hTERT gene expression levels were up-regulated in mania and remission compared to controls (p = 0.03 and p = 0.01, respectively). BDNF changes did not reach statistically significant levels.Conclusions:TL and hTERT gene expression might reflect a novel aspect of BD pathophysiology and TL might represent a novel biomarker for BD staging.

Complex psychotropic polypharmacy in bipolar disorder across varying mood polarities: A prospective cohort study of 2712 inpatients

BackgroundIt is common for patients with bipolar disorder (BP) to receive multiple psychotropics, but few studies have assessed demographic and clinical features associated with risk for receiving complex psychotropic polypharmacy. MethodsThis longitudinal cohort study examined 2712 inpatients with a DSM-IV clinical diagnosis of BP to assess associations between complex polypharmacy (defined as ≥4 psychotropics) and demographic and clinical features; associations with risk of rehospitalization were also examined. Logistic regressions were performed with the sample as a whole and with each of four DSM-IV BP subtypes individually. ResultsComplex polypharmacy was present in 21.0%. BP-I depressed patients were more likely to receive complex regimens than BP-I manic, BP-I mixed or BP-II patients. In the sample as a whole, variables significantly associated with complex polypharmacy included female, white, psychotic features and a co-diagnosis of borderline personality, post-traumatic stress or another anxiety disorder. The only examined medication not significantly associated with complex polypharmacy was lithium, although only in BP-I depressed and BP-I mixed. Complex polypharmacy was associated with rehospitalization in BP-I mania within 15 and 30days post index hospitalization. LimitationsAll data were from one clinical facility; results may not generalize to other settings and patient populations. ConclusionsBP-I depression may pose a greater treatment challenge than the other BP subtypes. Lithium may confer an overall advantage compared to other medications in BP-I depressed and BP-I mixed. Further research is needed to guide pharmacotherapy decisions in BP patients.

Effect of Oxcarbazepine on Serum Brain Derived Neurotrophic Factor in Bipolar Mania: An Exploratory Study.

ObjectiveIn bipolar disorder, serum brain-derived neurotrophic factor (BDNF) level decreases leading to dysfunctions of critical neurotrophic, cellular plasticity and neuroprotective processes. The present study was conducted to evaluate the change in serum BDNF level with oxcarbazepine monotherapy in bipolar mania.MethodsThe present study is a prospective, interventional, open label clinical study conducted on 25 patients of bipolar mania and 25 healthy controls. Detailed history, clinical evaluation including Young Mania Rating Scale (YMRS) scoring and serum BDNF were assessed at baseline for all 50 subjects. The bipolar patients were prescribed tablet oxcarbazepine and followed up after 4 weeks for clinical evaluation and re-estimation of serum BDNF and YMRS scoring.ResultsThe serum BDNF level in bipolar manic patients were compared with healthy controls at baseline and results revealed that there is a significant reduction (p=0.002) in serum BDNF level in bipolar patients. At follow-up after 4 weeks, the mean change in serum BDNF in bipolar group who were on oxcarbazepine monotherapy was found statistically significant (p=0.02) in comparison to healthy controls. In bipolar group, the YMRS score and serum BDNF at baseline have an inverse relation(r=−0.59) whereas change of the YMRS score had a positive correlation (r=0.67) with the change of serum BDNF over 4 weeks.ConclusionIn bipolar mania serum BDNF level is low and it is found to be increased with short term monotherapy with oxcarbazepine.

The influence of current mood state, number of previous affective episodes and predominant polarity on insight in bipolar disorder

Background: Although many studies have explored the effect of current affective episodes on insight into bipolar disorder, the potential interaction between current mood state and previous affective episodes has not been consistently investigated.Objective: To explore the influence of dominant polarity, number of previous affective episodes and current affective state on insight in bipolar disorder patients in euthymia or mania.Methods: A total of 101 patients with bipolar disorder were recruited for the study, including 58 patients in euthymia (30 with no defined predominant polarity and 28 with manic predominant polarity) and 43 in mania (26 with no defined predominant polarity and 17 with manic predominant polarity). Patients underwent a clinical assessment and insight was evaluated through the Insight Scale for Affective Disorders.Results: Bipolar disorder patients in mania had worse insight than those in euthymia, with no effect of dominant polarity. In addition, positive psychotic symptoms showed a significant effect on insight and its inclusion as a covariate eliminated differences related to mood state. Finally, the number of previous manic or depressive episodes did not correlate with insight level.Conclusions: Mania is a predictor of loss of insight into bipolar disorder. However, it is possible that its contribution is linked to the more frequent presence of psychotic symptoms in this state. Dominant polarity and number/type of previous affective episodes have a limited impact on insight.

Too Fast or Too Slow? Time and Neuronal Variability in Bipolar Disorder-A Combined Theoretical and Empirical Investigation.

Time is an essential feature in bipolar disorder (BP). Manic and depressed BP patients perceive the speed of time as either too fast or too slow. The present article combines theoretical and empirical approaches to integrate phenomenological, psychological, and neuroscientific accounts of abnormal time perception in BP. Phenomenology distinguishes between perception of inner time, ie, self-time, and outer time, ie, world-time, that desynchronize or dissociate from each other in BP: inner time speed is abnormally slow (as in depression) or fast (as in mania) and, by taking on the role as default-mode function, impacts and modulates the perception of outer time speed in an opposite way, ie, as too fast in depression and too slow in mania. Complementing, psychological investigation show opposite results in time perception, ie, time estimation and reproduction, in manic and depressed BP. Neuronally, time speed can be indexed by neuronal variability, ie, SD. Our own empirical data show opposite changes in manic and depressed BP (and major depressive disorder [MDD]) with abnormal SD balance, ie, SD ratio, between somatomotor and sensory networks that can be associated with inner and outer time. Taken together, our combined theoretical-empirical approach demonstrates that desynchronization or dissociation between inner and outer time in BP can be traced to opposite neuronal variability patterns in somatomotor and sensory networks. This opens the door for individualized therapeutic "normalization" of neuronal variability pattern in somatomotor and sensory networks by stimulation with TMS and/or tDCS.

Inhibitory Control for Emotional and Neutral Scenes in Competition: An Eye-Tracking Study in Bipolar Disorder

This study examined the inhibitory control of attention to social scenes in manic, depressive, and euthymic episodes of bipolar disorder (BD). Two scenes were simultaneously presented (happy/threatening/neutral [target] versus control). Participants were asked either to look at the emotional pictures (i.e., attend-to-emotional block) or to avoid looking at the emotional pictures (i.e., attend-to-neutral block) while their eye movements were recorded. The initial orienting (latency and percentage of first fixation) and subsequent attentional engagement (gaze duration) were computed. Manic patients showed a higher percentage of initial fixations on happy scenes than on the other scenes, regardless of the instructions. However, in the attend-to-neutral block, their gaze durations were longest for threatening scenes. Inhibitory control was not modulated by the scene's emotional salience in the other groups. Thus, manic patients had difficulties voluntarily ignoring emotional information – this was characterized by a happy-related bias during initial orienting, but a threat-related bias during attentional engagement.

Affective disorders, psychosis and lipid levels: Is there a connection? Linking psychopathology, clinical exams and neurobiology

IntroductionPublished research regarding the relationship between lipid levels in affective disorders has been contradictory. Additionally, most studies correlating psychosis to lipid serum concentrations only concern schizophrenic patients.ObjectiveTo access the relationship between serum lipid levels with the diagnosis and pathophysiology of affective disorders.MethodsDiagnostic data (ICD–10: F31–32), including mood and psychotic features, were prospectively collected for all patients admitted at the affective disorder ward at Centro Hospitalar Psiquiátrico de Lisboa (Portugal), during the third trimester of 2016. Serum concentrations of triglycerides and total/HDL/LDL cholesterol were evaluated using standard laboratory tests. Statistical analysis was performed for possible correlations between serum lipid levels and:– different stages of bipolar disorder (BD);– elevated versus depressive mood (unipolar and bipolar);– depressive mood (BD versus non-BD);– psychotic features.ResultsSixty-three patients admitted were enrolled in this study: 47 presented with BD (32 manic, 10 depressives and 5 mixed episodes) and 16 presented depressive disorders. Statistical analysis (R software) revealed that depressed bipolar patients had significantly higher triglyceride (P = 0.026), total and LDL cholesterol (P = 0.525) levels than other states; mixed episodes presented higher HDL levels (P = 0.542). Although not significant, manic patients’ HDL levels were consistently elevated compared to depressive ones, whom presented with lower values overall. Finally, when adjusted for age, psychotic patients showed lower levels of total (P = 0.031) and LDL cholesterol (P = 0.052) compared to non-psychotic patients.ConclusionsThere is a potential link between serum lipid levels and diagnosis/psychopathology of affective disorders. Further research is needed to characterize its pathophysiologic relevance.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Antidepressants induced mania in patients with diagnosed unipolar depression: Case report and literature discussion

The association of antidepressant therapy with mania in people being treated for unipolar depression reinforces the importance of further clarification of this effect, since it has a huge implication in treatment approach and outcome. With this main objective, authors propose to make retrospective sociodemographic and clinical characterization of a group of patients with antidepressant induced mania in diagnosed unipolar depression, admitted in inpatient unit of Psychiatry and Mental Health Department of Centro Hospitalar de Trás-os-Montes e Alto Douro. Authors also aim to identify features that may increase the risk for mania or hypomania in people who present with an episode of depression, which can guide clinical orientation and improve outcome.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A comparison between manic patients with or without antipsychotic continuation treatment: Data from a 12-months follow-up study at mood disorder unit of San Raffaele–Turro hospital

IntroductionSeveral studies suggest that in severe bipolars there is a long-term benefit in continuing antipsychotic therapy plus a mood stabilizer also after remission from a manic episode. Nevertheless, the long-term use of antipsychotics is associated with significant side effects which can interfere with patient global functioning. In this sense, antipsychotics should not be continued unless the benefits outweight the risks.ObjectivesThe present study describes the course of illness between bipolar patients remitted from a manic episode, in continuation treatment with or without antipsychotic therapy during a 12-months follow-up period.MethodsCinquante-six bipolars (22 male and 44 female) remitted (Young &lt; 12) from a severe manic episode were observed during a 12-months follow-up. According to clinical judge, as continuation treatment, 21/56 (37.5%) took antipsychotic plus mood stabilizer (AP + MS); 35/56 (62.5%) took mood stabilizers monotherapy (MS). During follow-up period YMRS and HAM-D were administered at 6th and 12th month to verify remission.ResultsAt the end of follow-up up, 33/56 patients (58.9%) maintained remission, 23/56 (41.1%) relapsed (56.5% depressive, 31.4% manic). The greater number of relapses occurred within 6th month: 16/56 (28.8%). In AP + MS group 12/21 patients relapsed (57.14%); in MS group 11/35 patients relapsed (31.4%). No statistical difference between the two continuation treatment strategies was observed (Chi-square = 3.586; P = 0.06).ConclusionsOur data confirm the efficacy of mood stabilizers monotherapy in long-term treatment of our severe (psychotic features, revolving-doors) bipolar patients. In fact, once the remission was obtained, the clinical choice of discontinuing antipsychotic therapy did not worsen the course of illness without a higher risk of relapse.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Assessment of psychotic symptoms in bipolar disorder

IntroductionBipolar disorder is a disabling condition characterized by the presence of manic, depressive, hypomanic or mixed episodes, affective symptoms that may coexist with several types of psychotic features.ObjectivesThe purpose is to evaluate the frequency of psychotic symptoms among bipolar disorder.MethodThe study included 55 bipolar patients admitted in the Psychiatry Clinical Hospital from January 2012 until May 2013. Inclusion criteria were represented by diagnosis of bipolar disorder, manic or depressive episode, according to DSM-IV-TR and ICD 10 criteria. Clinical instruments used to assess the severity of the current affective episode were Young Mania Rating Scale (YMRS) for manic patients and Hamilton Depression Rating Scale-17 items – (HDRS) for the depressive ones. Psychotic symptoms were evaluated with the Brief Psychiatric Rating Scale-18 items – (BPRS).ResultsOut of the 55 patients, 32 had psychotic symptoms upon admission to the hospital. BPRS results showed delusions of guilt, inutility, hypochondriac and nihilistic delusions for the depressed patients. Delusions of grandiosity and megalomania accounted for most of psychotic symptoms in manic patients. A smaller number of patients showed delusions of invention and reform. Perception disturbances such as auditory hallucinations were present in both diagnosis categories but in a higher percentage in depressive bipolar patients.ConclusionsEven if less frequently than in schizophrenia or schizoaffective disorder, psychotic symptoms are present in bipolar disorder. They influence the general functioning and the outcome of patients diagnosed with this illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Treatment with risperidone vs. olanzapine in naturalistic study of bipolar manic inpatients

IntroductionThere are very few comparative controlled trials of risperidone versus olanzapine in manic patients. No previous naturalistic study has compared the efficacy of these two antipsychotics in the natural environment of manic inpatients.ObjectiveThe aim of this retrospective and naturalistic study was to evaluate the efficacy of acute treatment with risperidone vs. olanzapine in Bipolar I manic inpatients.Methods(1) Patients: the study includes all the inpatients diagnosed with bipolar I manic episode (DSM-IV) who were admitted during the years 2009 to 2014. Patients treated with risperidone and olanzapine concomitantly (n = 6) and patients not treated with risperidone or olanzapine (n = 129) were excluded.The patients finally included (n = 183) were separated in two groups:– treated with risperidone (n = 89);– treated with olanzapine (n = 94).(2) The Student-T test was used to compare, between the groups, the mean of scores in YMRS and CGI-S scales and the mean of length of stay.ResultsBaseline characteristics were similar between the groups. The majority of patients were also treated with mood stabilizers (46% with lithium and 45% with valproate).The mean decrease in CGI-S scores from baseline to the day of discharge was significantly (P &lt; 0.003) higher in the risperidone group (−2.81 vs. −2.36). The length of stay was significantly (P &lt; 0.004) lower in the olanzapine group (mean of 23.03 days vs. mean of 30.3).Conclusions(1) The CGI-S scores in manic patients treated with risperidone decreased more than in patients treated with olanzapine during admission. (2) The length of stay was significantly lower in patients treated with olanzapine.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cortical inhibition in symptomatic and remitted mania compared to healthy subjects: A paired-pulse TMS study

IntroductionCortical inhibition (CI) is a neurophysiological outcome of the interaction between GABA inhibitory interneurons and other excitatory neurons. Transcranial magnetic stimulation (TMS) measures of CI deficits have been documented in both symptomatic and remitted bipolar disorder (BD) suggesting it could be a trait marker. The effects of medications and duration of illness may contribute to these findings.ObjectiveTo study CI in BD.AimsTo compare CI across early-course medication-naive BD-mania, remitted first episode mania (FEM) and healthy subjects (HS).MethodsSymptomatic BD subjects having &lt; 3 episodes, currently in mania and medication-naive (n = 27), remitted FEM (n = 27; YMRS &lt; 12 and HDRS &lt; 8) and 45 HS, matched for age and gender, were investigated. Resting motor threshold (RMT) and 1-millivolt motor threshold (MT1) were estimated from the right first dorsal interosseous muscle. Paired-pulse TMS measures of short (SICI; 3ms) and long interval intracortical inhibition (LICI; 100ms) were acquired. Group differences in measures of CI were examined using ANOVA.ResultsTable 1.ConclusionsSymptomatic mania patients had the highest motor thresholds and the maximum LICI indicating a state of an excessive GABA-B neurotransmitter tone. Remitted mania patients had deficits in SICI indicating reduced GABA-A neurotransmitter tone. Putative changes in GABA-A neurotransmitter system activity with treatment may be investigated in future studies. CI has received less attention in BD as compared to schizophrenia and is a potential avenue for future research in this area.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Serum of bipolar patients induces pro-inflammatory activation of macrophages

IntroductionEvidence has suggested that immune imbalance is involved with bipolar disorder (BD); however, its precise mechanism is poorly understood.ObjectiveThis study investigated whether biochemical changes in the serum from BD patients could modulate the phenotype of macrophages.MethodsEighteen subjects with BD and healthy individuals (n = 5) were included in this study. The human monocyte cell line U-937 was activated with PMA (phorbol 12-myristate 13-acetate) and polarization was induced with RPMI-1640 media supplemented with 10% serum from each patient for 24 h. Gene expression of selected M1 and M2 markers was assessed by qPCR.ResultsMacrophages exposed to serum of manic and depressive BD patients displayed an increase of IL-1β (6.40 ± 3.47 and 9.04 ± 5.84 versus 0.23 ± 0.11; P &lt; 0.05) and TNF-α (2.23 ± 0.91 and 2.03 ± 0.45 versus 0.62 ± 0.24; P = 0.002 and P = 0.004, respectively) compared to remitted group. In parallel, U-937 macrophages treated with serum of patients in acute episode displayed a down-regulation of CXCL9 (0.29 ± 0.20 versus 1.86 ± 1.61; P = 0.006) and CXCL10 expression (0.36 ± 0.15 and 0.86 ± 0.24 versus 1.83 ± 0.88; P &lt; 0.000 and P = 0.04) compared to remitters.ConclusionsOur results are consistent with previous studies showing that changes in peripheral blood markers could modulate M1/M2 polarization in BD. The evidence of macrophages as source of inflammatory cytokines might be helpful to unravel how the mononuclear phagocyte system can be involved in the etiology of BD.Disclosure of interestThe authors have not supplied their declaration of competing interest.