Number Of Manic Episodes Research Articles

Evolution of cognitive impairment in bipolar disorder: a systematic review of cross‐sectional evidence

The notion that sufferers of bipolar disorder achieve complete syndromal and functional recovery between illness episodes has been brought into question by evidence that a large proportion of patients fail to regain premorbid levels of functioning after the resolution of major affective symptoms. A growing body of evidence suggests that bipolar patients exhibit neuropsychological impairment that persists even during the euthymic state, which may be a contributory factor to poor psychosocial outcome. However, the aetiology of such impairment and its relation to progression of illness are not well understood. This review aims to consider evidence from studies investigating both the relationship between cognitive impairment and clinical outcome and studies of neurocognitive function in unaffected first-degree relatives (FDRs) of bipolar sufferers to address issues of the temporal evolution of cognitive impairment in bipolar disorder. Systematic literature review. The weight of evidence suggests that greater neuropsychological dysfunction in bipolar disorder is associated with a worse prior course of illness, particularly the number of manic episodes, hospitalizations and length of illness. The most consistent finding was a negative relationship between the number of manic episodes and verbal declarative memory performance. Impairment in unaffected FDRs was reported in verbal declarative memory and some facets of executive function. Cognitive impairment may be a trait vulnerability factor for bipolar disorder that is present before illness onset and worsens as the illness progresses. Further investigation into the causal relationship between cognitive impairment and illness course is essential.

Elevated serum nitric oxide and superoxide dismutase in euthymic bipolar patients: Impact of past episodes

Nitric oxide (NO) has been implicated to play a role in the pathogenesis of many neuropsychiatric disorders. NO level was found high in acute manic inpatients. In this study, we aimed to assess NO level and activity of the antioxidant enzyme, superoxide dismutase (SOD), in euthymic bipolar patients. Twenty-seven patients with bipolar disorder (BD) in euthymic phase, and 20 healthy volunteers were included in this study. A semi-structured form was used to note social, demographic and clinical parameters of the patients. NO level and SOD activity were studied in the serum samples obtained from the patients and controls. The mean serum NO level in BD was significantly higher than in controls. Mean serum SOD activity was found to be elevated in patients with BD compared to controls. Total number of the manic episodes correlated with NO levels, but not with SOD activity. In conclusion, the number of manic episodes is positively associated with NO levels. NO and SOD appear to have a pathophysiological role in BD, especially in Type I euthymic phase, and may be considered an available trait marker for BD.

Clinical features of antidepressant associated manic and hypomanic switches in bipolar disorder

The present study investigated possible clinical differences between bipolar patients with and without manic or hypomanic switch during antidepressant (AD) treatment. The authors undertook a retrospective assessment of 169 individuals affected by bipolar disorder type I (BP I: n=96) and II (BP II: n=73) who experienced at least one manic or hypomanic episode following depression without any interposed normothymic period (“manic switch”) during AD therapy. They were compared with a sex, age (±5 years), and ethnicity-matched group of 247 subjects, randomly selected from our pool of bipolar subjects who have never had manic switches. Only 2 of the 169 patients had had spontaneous switches before the AD-related one. Switched subjects were marginally older ( t=−2.65, df=414, P=.008) compared to not switched and less frequently delusional ( χ 2=13.86, P=.0002). Polarity of the onset episode was more frequently depressive in switched patients ( χ 2=21.93, P=.00002), which had also less previous manic episodes than not switched ( t=3.44, df=332, P=.0006). Those differences were more pronounced in the BP I subsample. Switched patients were more frequently BP I ( χ 2=29.66; P<.00001). Maintenance with mood stabilizers appears to be a strong protective factor; in fact, of the 124 individuals undertaking a mood stabilizer therapy, 21 had a switch and 103 had no switches ( χ 2=41.10, P<.000001). In conclusion, some clinical variables, such as the number of manic episodes, the presence of delusions, the polarity of onset episode, and the mood-stabilizing treatment, may be involved in AD-related switches. Further studies are required to investigate the causal relationships between those factors.

IV. CLINICAL ANALYSIS AND EVALUATION OF THE EFFECT OF LITHIUM THERAPY

SummaryA sample comprising 123 manic‐depressive patients, who had experienced at least one manic phase, was studied with respect to age of onset of symptoms, mode of onset, the character of the first and second episodes, and the effect of lithium treatment.The age of onset of all patients irrespective of the nature of the first phase was on average 33 years, median = 30 years. In 63 per cent of cases, the first episode of illness was depressive, in other cases manic.Regardless of whether the first episode was mania or depression the chances that the second episode would be manic or depressive were approximately equal.The clinical details of five manic patients who failed to improve after more than 9 days lithium treatment are presented. These patients had a symptom profile in common, characterized by severe manic symptoms, aggression, and marked flight of ideas with a confusional component in the clinical picture.Eighty‐five manic‐depressive patients received prophylactic lithium treatment for a varying time in an open investigation. The number and duration of manic and depressive episodes were calculated for a period which extended from and included the onset phase to thestart of the control period, for a control period without lithium treatment, and for a lithium treatment period immediately following the control period.A significant reduction in the number of both manic and depressive episodes per year was recorded in both sexes during the lithium period as compared with the control period. During the latter, the number of manic episodes in general was similar for men and women, while the number of depressive episodes was greater in the female patients. During the lithium period, the number of manic and depressive episodes for both men and women was reduced to the same level. During both the control and the lithium period higher rates were found for depression than for mania in both sexes.During the control period, the manic and depressive episodes lasted on average somewhat longer in male as compared with female patients. In comparison with the control period, a reduction in the length of the phases was observed during the lithium period.The proportion of time during which the patients were ill with mania or depression or both was reduced significantly, and to the same level, in both men and women during the lithium period as compared with the control period. During the latter period, the total duration of manic phases in male patients was slightly yet consistently longer than in females, while the sexes did not differ in respect of depression. During both periods, in both sexes, the depressive phases lasted overall for nearly twice as long as the manic phases.In the present investigation a definite prophylactic effect of lithium was demonstrated, by individual calculation in both male and female patients, for both the manic and depressive phases of manic‐depressive disease.