Bipolar Affective Disorder Patients Research Articles

Polycystic Ovary Syndrome in Bipolar Affective Disorder: A Hospital-based Study.

Background:Preliminary studies suggest a multidimensional relationship of mood pathology with endocrine disturbances. Studies have found an increased risk of mood disorders in polycystic ovary syndrome (PCOS), and conversely, many of the medications commonly used in the treatment of bipolar affective disorder (BPAD) can have deleterious effects on blood levels of reproductive hormones and consequently on the hypothalamic–pituitary–gonadal (HPG) axis and reproductive function. Furthermore, there is evidence of reproductive dysfunction in women with BPAD before treatment.Objectives:To assess the comorbidity of PCOS in patients of BPAD and to study risk factors associated with this comorbidity.Materials and Methods:Two hundred female patients with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition diagnosis of BPAD, between ages of 15 and 45 years, were evaluated by an endocrinologist. Patients reporting menstrual disturbances or having any stigmata of PCOS were further subjected to hormonal analysis, which included luteinizing hormone, follicle-stimulating hormone, prolactin, and testosterone, in the early follicular phase of menstrual cycle. Diagnosis of PCOS was made as per the NIH criteria.Results:Of 200 patients, 46 (23%) were diagnosed as having PCOS. Forty-five percent (n = 90) reported menstrual disturbances while 27% (n = 54) had polycystic ovaries on ultrasonography. 19.2% of the patients diagnosed as PCOS had a history of valproate intake while 27.90% patients had no such history (P = 0.15). No significant difference (P = 0.07) was found in the prevalence of PCOS among various drug groups (including group on multiple mood stabilizers).Conclusion:A higher prevalence of PCOS is seen in BPAD, irrespective of pharmacotherapy, suggesting a common link between the disorders which might be in the form of disturbance in HPG axis.

Disability in bipolar affective disorder patients in relation to the duration of illness and current affective state

Background: Bipolar affective disorder (BPAD) is an episodic illness in which episodes of depression/Mania/Mixed/Hypomania occur. BPAD has been found to be associated with the following types of disability: increased suicidal behavior, higher unemployment, higher dependence on public assistance, lower annual income, and increased work absenteeism owing to illness, decreased work productivity, poorer overall functioning, lower quality of life, and decreased lifespan. The two affective disorders, major depressive disorder, and bipolar disorders were associated with the large decrements in functioning. Bipolar disorder was particularly strongly associated with having missed time at work. Depressive disorders have been associated with a larger number of disability days and poorer role functioning than several common general medical diseases – arthritis, hypertension, and diabetes. Aims: This study aims to study the disability in bipolar patients in relation to the duration of their illness and current effective state. Methodology: Clinical and sociodemographic details of patients and caregivers were collected using a semi-structured pro forma. Indian Disability Evaluation and Assessment Scale is used to assess patients' disability. The diagnosis of BPAD is made in accordance with the International Classification of Disease-10 criteria. Results: Severe disability is seen where the duration of illness is Conclusions: Severe disability is seen where the duration of illness is

Comparison of the burdens of caregivers of patient with bipolar disorder-I and schizophrenia patient

Objective: This study aimed to compare the burden of caregivers of patients with bipolar disorder and schizo-phrenia, and its relationship with sociodemographic variables of the subjects and clinical features of the disorders. Methods: Sixty-two schizophrenia and 62 bipolar affective disorder-I patients with their caregivers who consulted Uludag University Medical Faculty outpatient clinic of Department of Psychiatry were enrolled to the study. Patients with schizophrenia were assessed on Positive and Negative Syndrome Scale, patients with bipolar affective disorder-I were assessed on Hamilton Depression Rating Scale (HDRS) and Young Mania Rat¬ing Scale. Global Assessment of Functioning (GAF) Scale, sociodemographic and Clinical Characteristics Data Form were applied to each patient. Caregivers of the patients were assessed on HDRS, Hamilton Anxiety Rating Scale (HARS), Zarit Caregiver Burden Scale (ZCBS) and Socio-demographic Characteristics Data Form. Results: It is found that the scores of ZCBS for schizophrenia patients’ caregivers were significantly higher than those bipolar affective disorder patients’ caregivers. Scores of HDRS and HARS were significantly correlated with the score of ZCBS in both care-giver groups. Conclusion: Caregivers of schizophrenia patients are more likely to be affected negatively than those of bipolar affective disorder patients, therefore psychological support should be considered for caregivers.

Burden and Expressed Emotion in Caregivers of Schizophrenia and Bipolar Affective Disorder Patients: A Comparative Study

Background: Caregiver burden and expressed emotion have been studied in patients with schizophrenia but literature is less regarding these in bipolar affective disorder (BPAD). No study could be found which compared the caregiver burden and expressed emotion in these two patient groups. Hence, the study is conducted to investigate and compare the caregiver burden and expressed emotion in caregivers of patients with schizophrenia and BPAD. Materials and Methods: Data were collected from outpatient department of psychiatry, Institute of Mental Health and Hospital, Agra regarding sociodemographic characteristics (e.g., age, gender, domicile), followed by burden assessment schedule, family emotional involvement and criticism scale, positive and negative syndrome scale, Young mania rating scale, and hamilton depression rating scale (HDRS) from patients of schizophrenia and BPAD and their caregivers. Descriptive statistics such as mean and standard deviation (SD) and unpaired t test were applied for continuous data and chi square for categorical data. Spearman correlation was used to find correlation. Results: No statistically significant difference between the sociodemographic variable of either patient of schizophrenia and bipolar disorder or their caregivers was observed. Significantly higher total burden (P = 0.01) with mean value of 82.8 (SD = 8.8) in caregivers of patients with schizophrenia compared to BPAD with mean value of 76.7 (SD = 12.3) was noted. Emotional over-involvement was significantly more in patients with BPAD compared to patients with schizophrenia (P = 0.0007). Spearman correlation shows positive correlation among age of caregivers, education, and burden of care in both the groups (P

Assessing Caregiver Burden in Caregivers of Patients with Schizophrenia and Bipolar Affective Disorder in Kathmandu Medical College.

Schizophrenia and bipolar affective disorder are chronic psychiatric illness that requires long term care. This study tends to measure psychological burden and factors associated with it among caregivers of these two illnesses. This is a cross- sectional study that included participants by purposive sampling method. Self designed performa was used to collect the socio-demographic details of the caregivers. Modified caregiver strain index was used to assess the overall stress. Beck`s depression inventory and Beck`s anxiety inventory was used to assess depression and anxiety respectively. Hundred caregivers, 50 each of schizophrenia and bipolar affective disorder were enrolled. Seventy-two percent of caregivers were found to have higher level of stress. Twenty-five percent had depression and 29% anxiety related problems. Stress was found to be significantly associated with being in debt, longer duration of illness, education level, marital status, subjective feeling of psychological stress and self- acknowledgement of need of professional help. Caregivers of both group experienced similar level of stress. Psychological burden is seen to be high in caregivers of patients of Schizophrenia and Bipolar Affective Disorder.

Standards of Lithium Treatment Monitoring In a Teaching Hospital in South India among Bipolar Affective Disorder

Background: Lithium is a commonly used drug with a narrow therapeutic index, it has significant adverse effects on kidney and thyroid, and is life threatening during intoxication. Maudsley guidelines on managing bipolar affective disorder patients (BPAD) with lithium recommends checking weight at baseline and every 3rd month, serum lithium after 7th day thereafter 3 months once, renal function test and serum thyroid stimulating hormone (TSH) at baseline and 6 months once. Aim: To evaluate whether Pre-Lithium workup and monitoring is done in Bipolar affective disorder (BPAD) patients initiated on Lithium as per Maudsley prescribing guidelines in psychiatry. Method: Retrospective audit conducted in a tertiary care hospital on lithium monitoring in BPAD patients treated with lithium atleast for six months compared against Maudsley prescribing guidelines. Results: Among medical records of 114 bipolar patients fulfilling study criteria, weight and serum lithium at baseline was checked in 100% of patients; serum creatinine and TSH at baseline along with lithium at 3rd month was done in 83.3%, 78.9% and 68.4% of patients respectively. Maudsley guidelines for serum creatinine, TSH and lithium level at 6th month were met only in 43.8%, 43.8% and 72.8% of patients respectively. Conclusion: The quality of lithium monitoring in bipolar patients falls well short of accepted standards; Hence addressing the issues in monitoring and following a standard protocol can improve the effectiveness of treatment and quality of life of patients.

Family Interaction Pattern and Quality Of Life of Caregivers Having Violent Patients with Bipolar Affective Disorder (Current Episode Mania)

Background: Bipolar affective disorder (BAD) is a multi-factorial disorder with various clinical presentations. ‘The manic episodes are manifestated by decreased sleep, irritability, aggression, dramatic fluctuation in mood or emotions caused to violent acts’. The clinical importance of hostility is in its close association with violence and non-adherence to treatment. BAD symptoms can result in damaged relationships, poor job or school performance that can seriously affect the lives of patients and their families. All caregivers share a similar fate; and they take responsibility for their mentally ill family members. Aim and Objectives: Aim was to examine the family interaction pattern and quality of life of caregivers having violent patients with bipolar affective disorder (current episode mania). Methodology: The Present study was a cross sectional hospital based and approved by ethical committee. Total 858 family members/caregiver interviewed for history of violence with diagnosed patient with BAD current episode mania (age 21 – 45 years) fulfilling ICD-10 criteria selected using probability sampling, when they brought patient in OPD. Total thirty (n=30) adult persons with BAD patient’s caregivers sample were recruited as per inclusion, exclusion-criteria for data collection tools such as Semi-structured socio-demographic data sheet, Family Violence Scale (Bhatti et al., 1985), Family interaction pattern scale (Bhatti et al., 1986) and WHO-Quality of Life Scale (WHO-QoL-BREF, 1998). Results: There was no significant difference found in all domains of the Family Violence Scale. In correlation Physical violence domain positively correlated with Family Interaction Pattern’s domain of Leadership pattern at 0.05 level and Emotional violence positively correlated with Communication at 0.05 level and with Leadership pattern at 0.01 level. As well as Social violence positively correlated with the domain Leadership at 0.05 level. Also total score of family violence positively correlated with Leadership pattern at 0.01 level of the Family Interaction Pattern Scale. With QoL family violence domain emotional violence negatively correlated with the Psychological health, Social relationship and Environmental/Financial at 0.05 level and with Total score of QoL at 0.01 level. As well as total score of the family violence negatively correlated with the domain Social relationship at 0.05 level of the WHO – Quality of life Scale. Conclusion: It is very important for the mental health professionals to identify the needs of the family caregivers. Finding out areas need attention and strategies to restore the wellbeing of an individual and caregiver requires knowledge and skill based comprehensive assessment. Mental health issues need multidimensional approaches to bring fruitful outcomes. Engagement and implementation strategies, as well as the interventions themselves, must be tailored to local and cultural characteristics.

Impact of Pharmacist-Psychiatrist Collaborative Patient Education on Medication Adherence and Quality of Life (QOL) of Bipolar Affective Disorder (BPAD) Patients.

Background: Bipolar Affective Disorder (BPAD) is one of the leading causes of disability globally. Medication non-adherence and low quality of life (QOL) are the major challenges associated with the treatment of BPAD patients.Objective: Aim of this study was to assess the impact of pharmacist–psychiatrist collaborative patient education on medication adherence and QOL of BPAD patients.Methodology: A prospective randomized control study was conducted in the psychiatry outpatient department in a tertiary care setting. The eligible patients were enrolled and randomized into test (collaborative care) and control (usual care) groups. Patient education was provided by pharmacists to the test group patients, along with the usual care provided to all the patients. Patients were followed for three follow-ups of nearly 1 month intervals. Medication adherence and QOL were assessed by Medication Adherence Rating Scale and WHOQOL-BREF questionnaire, respectively. T-test was used and P-values < 0.05 were considered statistically significant.Results: Out of 75 patients enrolled, 73 patients were followed for all the three follow-ups and completed the study. Thirty-eight patients belonged to test and 35 were in control group. The mean age of patients was 34.21 ± 10.91 years. Forty-eight (65.75%) patients belonged to age group of 18–39 years. There were 41 males (56.16%) and 32 female patients (43.83%) in the study. Mean improvement in medication adherence and QOL of the test and control groups were found to be 2.06 ± 0.15 (<0.001) and 13.8 ± 10.5 (<0.05), respectively.Conclusion: This study concluded that pharmacist–psychiatrist collaborative patient education can significantly improve the medication adherence and QOL of the BPAD patients. Statistically significant results indicating improved patient care and outcomes were possible when pharmacists worked as a team with psychiatrists.

Internalized stigma and its impact in Indian outpatients with bipolar disorder

Patients with many psychiatric disorders have considerable internalized stigma. The current study intended to examine the level and impact of internalized stigma in patients with bipolar affective disorder (BPAD). 60 patients with BPAD, 33 patients with schizophrenia and 30 patients with anxiety disorders were compared on Internalized Stigma of Mental Illness scale and The Stigma Scale. The patients with BPAD were assessed using Rosenberg Self-Esteem Scale (RSES), Participation scale (PS) and World Health Organization Quality Of Life - Brief Version – Hindi (WHOQOL-bref). Significant differences were found in all domains of self-stigma measures among the three groups. Using appropriate covariates, it was found that the differences were significant and independent of the effect of the covariates. In patients of BPAD, stigma and its domains were significantly correlated with the measures on monthly income, education, socio-occupational functioning, RSES, PS and WHOQOL-bref. Patients with BPAD experience substantial stigma, which was intermediate between that experienced by patients with schizophrenia (higher) and that experienced by patients with anxiety disorder (lower). Internalized stigma has significant impact on self-esteem, socio-occupational participation and functioning, and quality of life in patients with BPAD. Small sample size, sample of convenience, and cross-sectional design, limit the generalizability of the results.

PMH41 - Impact of Collaborative Coustomized Patient Education in Psychiatric Diseases

: To study the impact of Pharmacist-Psychiatrist Collaborative customized Patient Education in patients with depression, Bipolar Affective Disorder (BPAD), Schizophrenia and alcohol dependent Syndrome(ADS) in an Ambulatory Care Setting A prospective randomized control study was conducted in the psychiatry out-patient department of a tertiary care hospital for a period of 9 months. Eligible patients (225) were randomized into test group and control groups by simple randomization in each disease and followed for a period of six months. Customized patient education was provided to the test group with the help of patient education materials while the control group was on usual care. The medication adherence and quality of life (QOL) of both the groups were assessed and compared once in every two months by using Medication Adherence Rating Scale (MARS) and World Health Organization Quality of Life (WHOQOL) – BREF questionnaire respectively Among the study population 210 completed all the follow-ups out of which 100 were in control group and 110 in test group. Mean age was found to be 38.07 ± 11.60. Majority [n=75 (35.71%)] of patients were diagnosed to have had depression followed by BPAD [n=73 (34.76%)]. A statistically significant increase in the mean medication adherence score of test group was observed in all the follow-ups. The mean medication adherence scores was high in BPAD (1.4) and depression (1.4) compared to schizophrenia and ADS. Upon the analysis QOL, the difference in the overall mean score between test group and control was 8.45 which was statistically significant. Comparison of mean medication adherence scores of all patients in each disease showed that BPAD patients had a mean increase of 2.04 than depression, 1.36 than ADS and 2.01 than schizophrenia patients. Provision of customized patient education by pharmacist and psychiatrist improved the patient medication adherence and QOL.

Prevalence and Sociodemographic Profile of Lithium-induced Cutaneous Side Effects in Bipolar Affective Disorder Patients: A 1-year Prospective Observational Study in South India.

Objectives:Objective in our study is i) To assess the prevalence and sociodemographic profile of cutaneous side effects in bipolar affective disorder patients (BPAD) on lithium. ii) To assess the course of pre-existing skin reactions, when patient is initiated on lithium therapy.Methods:Lithium induced cutaneous side effects were assessed at baseline and monthly for 6 months followed by every 2 months over a year. Dermatologist opinion obtained to diagnose and treat for each patient who developed cutaneous side effects. Data were analyzed in percentage.Results:The prevalence of lithium induced cutaneous side effects in our study is 38.46%. On analyzing the individual subtype of cutaneous lesions, acneiform eruption and hairfall were most common. The cutaneous adverse reactions on lithium are more common in early adulthood than in the late adulthood and geriatric age group and among the subtypes of skin lesion acneiform eruptions are more common among males than in females. On analyzing the course of pre-existing lesions, severe alopecia developed with pre-existing systemic lupus erythematosis.Conclusion:These novel finding indicate that prevalence of lithium induced cutaneous side effects continues to be high. Hence, clinician should educate the patients before initiating lithium to improve attrition rate.

Incidence of Hepatitis B and C Infections in Patients of Mental Disorders

Ojective: It is estimated that Hepatitis B (HBV) and Hepatitis C (HCV) diseases have high morbidity, affecting more than 400 million people in the world. Turkey is considered as a semi-pandemic region for these infections. Methods: In this study, our aim is to determine the seroprevalance of HBV and HCV in psychiatric hospitalized patients which is thought to be the risk group and to support the literature in terms of protective precautions in the progressed stages. Our study was performed between February-2014 and January 2015 in Diyarbakir Selahaddin Eyyubi State Hospital psychiatry clinic. The patient’s files were investigated retrospectively, the results of serological tests (HBsAg, AntiHBS and AntiHCV) and socio-demographical data (age, sex, diagnoses and living areas) were used. Results: HBSAg positivity was 1.7% in schizophrenia patients, 0,8% in bipolar affective disorder patients, 0.4% in retarded patients and 0,3% in depression patients. A statistically significant relationship was found between schizophrenia and HBSAg. Conclusion: Similar precautions against viral hepatitis with high transmission rates should be applied in the chronic, disabled psychiatric patients just like the normal population. Active immunization will be useful in the schizophrenia group patients having relatively more risk. Extensive studies should be performed to obtain detailed and accurate data.

Evaluation of Oxidative Status in Patients Treated with Electroconvulsive Therapy.

ObjectiveElectroconvulsive therapy (ECT) is used in the treatment of many psychiatric diseases and this therapy may be effective on antioxidant defence system. In this study, we aimed to evaluate the effects of ECT on oxidative stress.MethodsFourteen major depression, 11 schizophrenia and 8 bipolar affective disorder patients diagnosed and received ECT treatment, and 37 healthy volunteers enrolled in the study. ECT was applied to all patients. Before ECT, after the first and last ECTs, serum samples were obtained. Serum total antioxidant status (TAS), total oxidant status (TOS), and calculated oxidative stress index (OSI) were measured in patients before and after ECTs.ResultsTOS values before ECT were higher in major depression (p=0.005) and schizophrenia (p=0.001) groups compared to the control group. TAS values were lower in major depression (p=0.0001), schizophrenia (p=0.004), bipolar affective disorder (p=0.004) groups compared to the controls. Also OSI values were higher in major depression (p=0.0001), schizophrenia (p=0.001), bipolar affective disorder (p=0.009) groups compared to healthy group. After the last ECT, TOS values were significantly lower compared to TOS values before ECT in major depression (p=0.004) and schizophrenia patients (p=0.004). TAS values after the first ECT were higher compared to values before ECT in major depression patients (p=0.004). After last ECT, OSI values were significantly lower compared to before ECT in schizophrenia patients (p=0.006).ConclusionAs a result, it can be said that ECT did not increase oxidative stress. However, further studies with more patients are needed.

Adverse Drug Events in Patients with Mental Disorder in an Ambulatory Setting.

Background:Although adverse drug events (ADEs) among inpatients occur frequently and are widely studied, few data are available on ADEs among outpatients with mental disorders.Aims:To determine the rates, types, and severity of ADEs in patients with mental disorder.Materials and Methods:Cross-sectional survey of patients with mental disorder attending outpatient department. Data were collected over a period of 6 months.Results:A total of 400 patients (217 schizophrenia patients, 127 bipolar affective disorder patients, and 56 patients of depression) with a mean age of 32.1 ± 9.7(±standard deviation) participated in the study. Patients suffering from schizophrenia and all nonadherent patients reported significantly more ADEs (P < 0.05). Out of 343 patients (86%) who reported at least one ADE, majority (87%) reported central nervous system ADEs followed by weight gain (48%), gastro-intestinal (28%), skin (4%), cardiovascular (1%), and sexual dysfunctions (0.3%). Out of 673 ADEs reported, sedation (41%) and weight gain (25%) were reported most commonly. Most ADEs reported (76%) were mild; however, there were no life-threatening, fatal, or serious ADEs. The medication classes most frequently involved in ADEs were antipsychotics (72%) followed by sedatives (44%), antimanic drugs (32%), and antidepressants (27%). Patients on atypical antipsychotic drugs reported significantly more body weight gain (P < 0.05). More than three drugs were prescribed in 49% of patients who reported ADEs.Conclusion:The study data indicate high prevalence of ADEs in the outpatients on psychotropic medications.

Association of executive dysfunctions and symptoms in a sample of bipolar affective disorder patients

Background Executive functions are defined as the higher-level cognitive functions that are necessary to plan and execute goal-directed behaviors and may include cognitive flexibility, creativity, planning ability, abstract thinking, concept formation, and response inhibition. Recently, it has been shown that those with schizophrenia, as well as those with bipolar disorder, exhibit deficits in executive functions relative to controls. Executive function capability is an important predictor of the treatment, prognosis, and functional outcomes of these disorders.Patients and methods This cross-sectional study was carried out in Suez Canal University Outpatient Psychiatric Clinic. It included 60 patients with bipolar disorder type 1 (male and female). All studied patients were subjected to assessment of the manic symptoms using the total scores of Young’s Mania Rating Scale and the depressive symptoms using the total scores of the Hamilton Depression Rating scale by researcher. Assessment of cognitive functions was carried out by an expert psychologist using the Wechsler Adult intelligence Scale, Wechsler Memory Scale-III-Revised Hayling Sentence Completion Test, Trail Making Test, and the Wisconsin Card-Sorting Test.Result The results showed worsening in the executive function associated with manic than with depressive symptoms.Conclusion Manic symptoms had a significant effect on cognitive functions.

NON PITTING TYPE PEDAL EDEMA WITH LITHIUM: A CASE REPORT

&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To report a case of lithium induced bilateral nonpitting pedal edema.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The clinical data of a bipolar affective disorder patient with current episode of mania and psychotic symptoms who experienced bilateral non pitting pedal edema with lithium.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The patient was a 29 yr old female who developed bilateral non-pitting type pedal edema with lithium therapy with normal plasma lithium level (0.72mEq/l). She is a known case of bipolar affective disorder (BPAD) was admitted to psychiatry department with episode of mania with psychotic symptoms. She had history of drug induced hypersensitivity reaction with eosinophilia and systemic symptoms (DRESS) with oxcarbazepine and so the drug was discontinued and was started on tablet lithium 400 mg twice daily. On admission here, the dose of lithium was increased to 1200 mg/day. The patient gradually improved but she developed bilateral non-pitting pedal edema. Serum lithium concentration was normal and there were no other early symptoms of lithium toxicity. But as the patient's distress further increased with increasing pedal edema, it was decided to stop lithium altogether and to maintain the patient on tablet quetiapine 800 mg therapy for BPAD. Within one week of stopping lithium the edema on both her feet decreased significantly. Causality was assessed by naranjo causality assessment scale and a probable relationship was obtained between lithium and pedal edema with a score of 6.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This case emphasises that regular physical examination and laboratory investigations are important for patients who are on lithium therapy. Clinicians should always be careful while initiating lithium treatment in a patient with respect to the initial dose and dose escalation even after a period of successful therapy with lithium, as minor dose escalation can cause major changes in the serum lithium concentration and thereby the patient’s tolerability to lithium.&lt;/p&gt;

Cognitive Analytic Therapy for Bipolar Disorder: A Pilot Randomized Controlled Trial.

Treating BD with CAT appears feasible and safe. Retaining fidelity to the reformulation, recognition and revision structure of CAT appears useful. Participants stated that across the phases of CAT, focussing on patterns of mood variability was consistently helpful.

Effects of filling painting on attention function of bipolar affective disorder patients

Objective To explore the effects and correlative factors of filling painting on attention function of bipolar affective disorder (BAD) patients. Methods The random number table was used to selected 70 BAD patients who admitted our hospital from January to December 2014, and they were randomly divided into experimental group and control group on average. The patients of control group underwent medicine treatment and health education, while the patients of experimental group, based on the interventions of control group, received filling painting training, which utilized numerical span, trail marking test A (TMT-A), digit symbol test, Stroop color word test (including Stroop-word, Stroop-color, Stroop color word detection) etc. sub-test to compare attention function before and 6 weeks after interventions, so as to further analyze the correlation between attention function and age, disease process, educational years, symptom. Results Six weeks after interventions, the scores difference of numerical span test in experimental group had no statistical significance difference (P>0.05); but the scores of experimental group were better than that of control group in digit symbol test, Stroop-word, Stroop-color, Stroop color word detection (P<0.05); the time consumed shorter in experimental group compared with that of control group (P<0.05); except numerical span, the other program of attention function effects had correlation with patient′s age, disease process, educational level and symptom. Conclusions Filling painting can facilitate attention function of BAD patients and be benefit rehabilitation of cognitive function; attention function may impact by age, disease process, educational level, symptom, and other factors. Key words: Filling painting; Bipolar affective disorder; Attention function; Rehabilitation effects

Role of traditional healers in the pathway to care of patients with bipolar disorder in Egypt

Background A large number of mentally ill patients prefer to visit non-medical practitioners such as traditional healers because of the confidence in the system, affordability and accessibility of the service. This may lead to delay in seeking psychiatric services and has prognostic impact. Aim To assess the rate of bipolar affective disorder (BAD) patients seeking traditional healers, the sociodemographic and clinical correlates of those patients. Methods We assessed 350 patients with BAD after confirmation of diagnosis with Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I) research version and assessment of functioning with Global Assessment of Functioning scale. They were assessed for percent, rate and timing of seeking traditional healers. Results In all, 40.8% sought traditional healers, with 34.9% more than four times. Of those, 62.2% were before seeking psychiatric services and 37.8% after. Lower educational level, less impairment of functioning and presence of hallucinations were significant correlates. Conclusion This study shows that most of the patients suffering from mental illness prefer to approach faith healers first, which may delay entry to psychiatric care and thereby negatively impact the prognosis of BAD. This highlights the importance of mental health education and developing a positive collaborative relationship with traditional healers.

Distressing cutaneous lesion among bipolar affective disorder patients on lithium therapy: A retrospective cross-sectional study.

Aim:To assess the incidence of cutaneous lesion in bipolar affective disorder (BPAD) patients on lithium therapy. To evaluate the relationship between duration of lithium therapy, dosage of lithium, serum lithium level, and cutaneous lesions. To assess whether reduction/stoppage of dose of lithium has any change in the course of cutaneous side effects. To look for a relationship between addition of isotretinoin and the course of mood disorder.Methodology:We retrospectively collected hospital case records of 125 consecutive BPAD patients initiated lithium therapy, assessed with inclusion and exclusion criteria. We follow up them for 2½ years for the assessment of above said aims.Results:The prevalence of skin reaction in BPAD patients with lithium therapy was 19.8%. Among patients on lithium therapy, cutaneous lesion emerged in initial 6 months and later after 1 year of treatment. Nearly 55% of patients on higher doses of lithium (1200 mg) had a cutaneous lesion. Patient on therapeutic serum level of lithium had a higher incidence of skin lesion. Out of six patients in whom dosage of lithium was reduced, three of them had reduced lesions (P = 0.6), in two patients, skin lesion increased, and one patient had no change. Among 11 patients treated with isotretinoin, only two patients had emergence of depressive symptoms.Conclusion:Lithium continues to increase the incidence of multiple cutaneous lesions among BPAD patients on lithium therapy. Incidence of cutaneous side effects directly correlates with the dose of lithium and therapeutic range of serum lithium level. Altering the dose of lithium does not statistically influence the cutaneous lesion.