Recurrent Psychiatric Disorders Research Articles

The importance of oxidative stress in the pathogenesis and treatment of bipolar affective disorder: a review of the literature

Introduction: Bipolar affective disorder (BD), also known as manic-depressive illness, is a chronic and recurrent psychiatric disorder characterised by significant mood disturbances. It is one of the leading causes of disability worldwide and is associated with a high risk of suicide. Recent studies highlight the role of oxidative stress (OS) in the pathogenesis of BD. The body's pro/antioxidant imbalance adversely affects cellular and molecular processes. Aim: The aim of this review is to synthesise the current state of knowledge on the role of OS in the aetiology and course of BD, including key biomarkers and potential therapeutic interventions. Methods: A review of the scientific literature was conducted, including articles published between 2000 and 2024. Searches were conducted in PubMed, Scopus and Web of Science databases, using the following keywords: 'bipolar disorder', 'oxidative stress', 'antioxidants', 'biomarkers', 'mitochondrial dysfunction', 'redox homeostasis', 'treatment'. Results: Results indicate that patients with BD have elevated levels of OS markers, including increased lipid peroxidation, altered antioxidant enzyme activity and impaired redox homeostasis. Treatment with lithium and other mood stabilisers may modulate levels of OS markers, which is one potential mechanism of drug action. However, inconclusive data suggest the need for further research to clarify the relationship between OS and BD. Conclusions: OS plays an important role in the pathophysiology of BD, offering potential directions for therapeutic interventions. Understanding the complex interactions between OS and BD may lead to the development of more targeted therapies aimed at reducing oxidative damage and improving patient health. Keywords: oxidative stress, bipolar affective disorder, redox, lipid peroxidation, protein damage, antioxidants, lithium

Ononin ameliorates depression-like behaviors by regulating BDNF-TrkB-CREB signaling in vitro and in vivo

Ethnopharmacological relevanceOnonin is a flavonoid compound found in several medicinal plants, including Astragalus membranaceus, Sophora flavescens, and Ononis spinosa. These plants have been traditionally used in various parts of the world for their medicinal properties, including anti-inflammatory, antioxidant, and antitumor effects. Major depression is a common, long-lasting, and recurrent psychiatric disorder with a high suicide rate. Naturally occurring flavonoids treat depression via poorly understood mechanisms. Aim of the studyThe present study aimed to determine whether ononin conferred an antidepressant-like effect in PC12 cell models and chronic mild stress (CMS)-induced depressive rat models and to explore its possible mechanisms. Materials and methodsDepression-related behaviors were measured using sucrose preference, tail suspension and open-field tests. Furthermore, to explore these mechanisms, we employed in vitro and in vivo assay methods, including neurite outgrowth, western blotting, quantitative RT-PCR, and staining methods. ResultsTreatment with ononin or BDNF significantly increased PC12 cells' neuronal growth and differentiation. Furthermore, ononin promotes the activation of TrkB and growth factors and upregulates the PI3K/Akt and BDNF/TrkB/CREB signaling pathways. The in vitro results were consistent with CMS-induced depressive rat models, in which ononin treatment significantly decreased depression-like behaviors and activated TrkB, growth factors, and BDNF/TrkB/CREB signaling pathways in the frontal cortex and hippocampus. Depression-induced microscopic alterations in the frontal cortex and hippocampus of rats with CMS-induced depression were also mitigated following ononin treatment. ConclusionBased on these findings, we suggest that ononin is a promising antidepressant candidate for treating depression.

Characterizing the Impact of Stigma From the Perspective of Bipolar Disorder Patients: Results From a Social Listening Study

AbstractBackgroundBipolar disorder (BP) is a chronic and recurrent psychiatric disorder characterized by manic/hypomanic and depressive episodes with or without mixed features. Despite high levels of functional disability associated with BP, internal and external stigma can create barriers to successful recovery. This retrospective, observational social listening study was conducted to understand how stigma-related terms correlated with discussion of therapeutic interventions and psychosocial domains associated with functional recovery in unprompted, online conversations by self-identified bipolar disorder patients.MethodsA comprehensive search was performed for publicly available, online conversations posted on forums, blogs, message boards, and the social media platforms Facebook and YouTube between 1/1/2019 and 9/30/2021. Digital interactions of anonymous self-identified BP-diagnosed patients were analyzed to identify associations between common themes and sentiments related to BP and stigma. An index value (baseline=100) was calculated based on the expected correlation between the rate that a stigma-related concept was used in BP conversation versus general online conversation. An index value >100 indicated higher correlation than statistically expected; index values <100 indicated lower correlation than expected.ResultsA total of 257,964 conversations from 30,710 patients with BP were identified for analysis (mean, 8.4 BP-I posts per individual/year). The most prevalent stigma-related terms in patient conversations were guilt (6.9%), frustrated/discouraged (1.8%), shame (1.1%), and exhaustion (1.1%). Stigma-related terms over-indexed in conversations attributed to bipolar patients (e.g., guilt=708, denial=563, embarrassment=480); stigma-related terms were also over-indexed in relapse-related conversations (e.g., stressed=184, shame=141, and frustrated/discouraged=124). Social/familial topics (47.2%) were discussed as often as medical/psychological interventions (48.7%) and medication (42.8%). Medical intervention-related conversations were not highly correlated with stigma, except in areas of insurance/disability. Stigma-related terms were over-indexed in conversations related to social/familial relationships (e.g., isolation/loneliness=134, guilt=132), and jobs/school (e.g., embarrassment=190, stigma=184, overwhelmed=154, shame=142, isolation/loneliness=140).ConclusionThese analyses describe the pattern by which stigma appears in patient perceptions of psychosocial and medical/therapeutic domains. Stigma significantly associates with psychosocial domains related to functional recovery, but not with patient perceptions of therapeutic interventions. Thus, stigma may act as a barrier between symptomatic remission and functional recovery. The patient-provider therapeutic alliance represents a trusted channel and an opportunity through which patients should be supported in overcoming stigma-related barriers to functional recovery.FundingAbbVie

Chronic salmon calcitonin exerts an antidepressant effect via modulating the p38 MAPK signaling pathway.

Depression is a common recurrent psychiatric disorder with a high lifetime prevalence and suicide rate. At present, although several traditional clinical drugs such as fluoxetine and ketamine, are widely used, medications with a high efficiency and reduced side effects are of urgent need. Our group has recently reported that a single administration of salmon calcitonin (sCT) could ameliorate a depressive-like phenotype via the amylin signaling pathway in a mouse model established by chronic restraint stress (CRS). However, the molecular mechanism underlying the antidepressant effect needs to be addressed. In this study, we investigated the antidepressant potential of sCT applied chronically and its underlying mechanism. In addition, using transcriptomics, we found the MAPK signaling pathway was upregulated in the hippocampus of CRS-treated mice. Further phosphorylation levels of ERK/p38/JNK kinases were also enhanced, and sCT treatment was able only to downregulate the phosphorylation level of p38/JNK, with phosphorylated ERK level unaffected. Finally, we found that the antidepressant effect of sCT was blocked by p38 agonists rather than JNK agonists. These results provide a mechanistic explanation of the antidepressant effect of sCT, suggesting its potential for treating the depressive disorder in the clinic.

Fitness to work decision for bipolar disorder patients : about 4 cases

IntroductionBipolar disorder or manic-depressive psychosis is a severe recurrent psychiatric disorder that, if left untreated, can lead to severe social harm, disability and neurotrophic changes in the brain. However, social and psychological factors play a key role in the onset and progression of the disorder. Therefore, a bio-psycho-social therapeutic approach in the form of an integrated model of “Collaborative Care” is recommended.ObjectivesDetermining the main factors interfering with the decision of fitness to work in bipolar disorders according to work requirements.MethodsClinical cases including health professionals (HP) was carried out. Cases were examinated at a specialized occupational health Clinics including HP between 2018 and 2022. Data was collected from medical records and by questioning patients directly in case of missing data.Results Four HP were included in the study. All suffering from bipolar disorder. The average age was 37 years [28,49]. All were women. Two were divorced and one single. Two anesthesia technicians, a nurse and a cleaner. Two were smokers. Two were transferred to another department because non psycho-education of colleagues at work, dealing with patients, verbal and physical agressivness and cognitive disorders. The two anesthesia technicians were judged unfit for work because of their work responsability and the need for the integrity of all cognitive faculties in the workplace.ConclusionsIn order to decide the fitness to work, occupational physician must consider both bipolar disorder impact and workplace exigency. The adequacy between disease stability and others security is iteratively revised.Disclosure of InterestNone Declared

MAD2B Blunts Chronic Unpredictable Stress and Corticosterone Stimulation-Induced Depression-Like Behaviors in Mice.

Depression is a prevalent and recurrent psychiatric disorder. Aberrant neural structure and activity play fundamental roles in the occurrence of depression. Mitotic arrest deficient protein (MAD2B) is highly expressed in neurons and may be implicated in synaptic plasticity in the central nervous system. However, the effect of MAD2B in depression, as well as the related molecular mechanism, is uncertain. Here, we employed mouse models of depression induced by chronic unpredictable stress exposure or corticosterone (CORT) stimulation. Depression-like behaviors in mice were evaluated by sucrose preference, forced swimming, and tail suspension tests. Hippocampal MAD2B overexpression was mediated by adeno-associated virus 8 containing enhanced green fluorescent protein. In vitro primary neuronal cells were obtained from the hippocampus of rat embryos and were treated with CORT, and MAD2B overexpression was performed using lentivirus. MAD2B and glutamate metabotropic receptor 4 (GRM4) levels were evaluated by western blots and quantitative PCR. Primary neuronal miR-29b-3p expression was detected by quantitative PCR. MAD2B expression was reduced in the hippocampus in mice exhibiting depressive-like behaviors. However, hippocampal MAD2B overexpression protected mice from developing either chronic unpredictable stress- or CORT-induced depression-like behaviors, an effect associated with reduced expression of GRM4, a presynaptic receptor involved in depression. Moreover, MAD2B overexpression in primary neuronal cells also decreased GRM4 expression while enhancing the level of miR-29b-3p; this phenomenon was also observed under CORT stimulation. Our results suggest an important role of neuronal MAD2B in the pathogenesis of depression via the miR-29b-3p/GRM4 signaling pathway. MAD2B could be a potential therapeutic target for depressive disorders.

Retrospective data analysis to determine the effectiveness of intravenous ketamine therapy on patients suffering from depression with suicidal ideation.

Depression is often a debilitating and recurrent psychiatric disorder. Depression with suicidal ideation, being a psychiatric emergency, often needs intensive intervention such as Electro-Convulsive Therapy (ECT). ECT may be refused because of stigma and perceived risk. Intravenous ketamine therapy, being an alternative to ECT for quick response compared to routine pharmaco-therapy, is analyzed to determine its effectiveness. Among patients suffering from depression with suicidal ideation, intravenous ketamine therapy is routinely offered as an alternative to ECT to the needy in the Department of Psychiatry affiliated with a teaching institute. There is a standard operative procedure laid down for ketamine therapy. Baseline and periodical assessment of depression by Hamilton Depression Rating Scale and suicidality by Columbia Suicide Severity Rating Scale is a part of it. Taking advantage of it, retrospective data analysis was done to determine the effectiveness of the therapy. Significant improvement of depression and suicidality found at all the evaluation points after intravenous ketamine therapy. Intravenous ketamine therapy is an effective alternative to ECT among patients suffering from depression with suicidal ideation.

Case Report on Bipolar Affecting Disorder with Hypertension

Introduction: Bipolar disorder (BD) is one of the foremost frequent chronic disorders in populations where depression is usually present; however, in chronic cases, it can raise the danger of death. Bipolar major Affective Disorder (BPAD) may be a common and recurrent psychiatric disorder that affects people everywhere on the planet. Tt's characterized by episodes of mania, hypomania, hyperactivity, and depression.
 Findings of Clinical: A 45-year-old woman from Chandrapur is admitted to the (AVBRH) Archarya Vinoba Bhave Rural Hospital Sawangi Meghe (Wardha), in a mental health ward(Psychiatric ward) with a known case of Bipolar major Affective Disorder. Her relatives brought her to AVBRH, where she is admitted with the chief complaint of low mood, muttering to herself, violent and abusive behavior. A case of bipolar major affective disorder is been identified. Both manic and hypomanic episodes are feasible. Bouncy, jumpy, or wired unusually. Increased activity, excitement, or energy. Feelings of satisfaction and self-assurance that are exaggerated (euphoria). Thyroid function testing and urine analyses were done with a A/B testing A simple randomized controlled experiment was done. A variety of procedures is used, including (CBC) complete blood count, (MRI)Magnetic Resonance Imaging, (CT) scan Computed Tomography, Mental Status Examination, and (ECT)Electroconvulsive Therapy with Psychotherapy.
 Therapeutic Intervention: Olanzapine, sodium valproate, capacitance, and cloze, chlorpromazine are examples of pharmacological therapy given. 
 Conclusion: After treatment, the patient's manic episodes stop and her symptoms began to fade.

Prevalence of Depression in Patients with Visual Impairment in Cataract: A Systematic Literature Review

Introduction. Depression is a chronic and often recurrent psychiatric disorder among older people, and its association with cataracts has not been well defined. Several studies have shown that depression is a prevalent mental health problem in ophthalmological practice and is often unrecognized or untreated. A systematic review was conducted to investigate the prevalence of depression in patients with visual impairment in cataracts.Methods. A literature search was performed on PubMed and Medline in the last 10 years (2011 to 2021). The search strategy used the following terms: (prevalence) and (visual impairment or blindness) and (cataract) and (depression or depressive symptoms). Of the 544 electronics, 226 articles were selected in free full text and 10 studies were identified as being possibly relevant. Results. Depression was associated with visual impairment in all studies. The prevalence of depression is higher in patients with eye disease.Conclusion. The prevalence of depression among eye disease patients was higher than that in healthy people. Cataract surgery is associated with an improvement in depressive symptomatology. More research is needed to identify effective strategies for the prevention and management of depression in patients with cataracts or visual impairment.

Temporal Lobe Epilepsy and Psychiatric Comorbidity.

Most focal seizures originate in the temporal lobe and are commonly divided into mesial and lateral temporal epilepsy, depending upon the neuronal circuitry involved. The hallmark features of the mesial temporal epilepsy are aura, unconsciousness, and automatisms. Symptoms often overlap with the lateral temporal epilepsy. However, the latter present a less evident psychomotor arrest, frequent clones and dystonic postures, and common focal to bilateral tonic–clonic seizures. Sclerosis of the hippocampus is the most frequent cause of temporal lobe epilepsy (TLE). TLE is among all epilepsies the most frequently associated with psychiatric comorbidity. Anxiety, depression, and interictal dysphoria are recurrent psychiatric disorders in pediatric patients with TLE. In addition, these alterations are often combined with cognitive, learning, and behavioral impairment. These comorbidities occur more frequently in TLE with hippocampal sclerosis and with pharmacoresistance. According to the bidirectional hypothesis, the close relationship between TLE and psychiatric features should lead to considering common pathophysiology underlying these disorders. Psychiatric comorbidities considerably reduce the quality of life of these children and their families. Thus, early detection and appropriate management and therapeutic strategies could improve the prognosis of these patients. The aim of this review is to analyze TLE correlation with psychiatric disorders and its underlying conditions.

Pregnancy and postpartum psychiatric episodes in fathers: A population-based study on treatment incidence and prevalence

BackgroundFor women, the perinatal period confers an increased risk of severe psychiatric disorders, but similar evidence for fathers is lacking. We examined rates of first-time and recurrent psychiatric disorders in men before and after becoming fathers. MethodsA descriptive prospective study design was applied using information from the Danish National registers. Perinatal psychiatric episodes were assessed as incidence of first-time and prevalence (including recurrence) of recorded in- or outpatient admissions for any mental disorder and redeemed prescriptions for psychotropic medication in fathers to children born from January 1, 1998 until December 31, 2015. ResultsWe identified 929,415 births and 543,555 unique fathers. Incidence and prevalence proportions for paternal psychiatric in- and outpatient episodes showed an increasing trend over the perinatal period and were marginally higher postpartum compared to pregnancy; e.g., median incidence proportion for inpatient treatment during pregnancy was 0.07 (95% CI: 0.04; 0.07) and 0.10 (95% CI: 0.08; 0.11) postpartum per 1000 births. No difference between the periods was found for incidence of prescriptions for psychotropic medication. Psychiatric disorders in expecting and new fathers were mainly treated in primary care with cumulative incidence of prescriptions for psychotropic medication of 14.56 per 1000 births during the first year of fatherhood. LimitationsWe only capture fathers who actively sought and received treatment, and we consequently underestimate milder psychiatric episodes in expecting and new fathers. ConclusionBecoming a father did not appear to trigger a substantially increased risk of severe psychiatric disorders, as it has been observed for new mothers.

Blueberry extract as a potential pharmacological tool for preventing depressive-like behavior and neurochemical dysfunctions in mice exposed to lipopolysaccharide

ABSTRACT Objective: Major depressive disorder is a debilitating and recurrent psychiatric disorder. Blueberries have several biological properties, including neuroprotective effects, through antioxidant and anti-inflammatory actions. The aim of this study was to evaluate the effect of blueberry extract on depressive-like behavior and lipopolysaccharide (LPS)-induced neurochemical changes. Methods: Mice were pretreated with vehicle, fluoxetine (20 mg/kg) or blueberry extract (100 or 200 mg/kg) intragastrically for seven days before intraperitoneal LPS (0.83 mg/kg) injection. Twenty-four hours after LPS administration, mice were submitted to behavioral tests. Oxidative stress and neuroinflammatory parameters were evaluated in the cerebral cortex, hippocampus, and striatum. Results: Our data showed that blueberry extract or fluoxetine treatment protected against LPS-induced depressive-like behavior in tail suspension and splash tests (P < 0.05), without changes in locomotor activity (P > 0.05). LPS induced an increase in the levels of reactive oxygen species (P < 0.001), nitrite (P < 0.05) and thiobarbituric acid reactive substances (P < 0.01), as well as a reduction in total sulfhydryl content (P < 0.05) and catalase activity (P < 0.05) in brain structures; blueberry extract restored these alterations (P < 0.05). In addition, blueberry extract attenuated the increase in tumor necrosis factor-alpha (TNF-α) levels induced by LPS administration (P < 0.05). Conclusion: This study showed that blueberry extract exerted antidepressant-like effects, protected the brain against oxidative damage, and modulated TNF-α levels induced by LPS.

Impulsivity and Suicidal Behavior.

Suicide is the leading cause of injury mortality in the United States and the second-leading cause of death in people aged 10-34years. While many long-term risk factors are known, the short-term prediction of suicidal behavior remains elusive. Many characteristics of suicidal behavior cut across diagnoses, but suicide is increased in recurrent psychiatric disorders, addictive disorders, and trauma-related disorders. Suicide results from the interaction of short-term and long-term behavioral regulation. The shorter the time-course of the mechanism, the closer it is to actual suicidal behavior, and the harder it is to prevent. We will discuss the manner in which impulsivity, a major determinant of short-term suicide risk, interacts with longer-term risk factors, especially sensitization to addictive or traumatic stimuli. Impulsivity predisposes to sensitization; in turn, impulsivity is a prominent component of sensitized behavior. Impulsivity can be described as a general pattern of behavior ("trait" impulsivity), as responses that are not conformed to their context (action-impulsivity), or as inability to delay reward or to take future consequences into account (choice-impulsivity). Each of these contributes to suicidal behavior. The neural mechanisms of impulsivity and sensitization are analogous, and sensitization can produce rapidly fluctuating patterns of impulsive behavior, arousal, and anhedonia. In order to recognize and prevent suicidal behavior, it is necessary to identify factors associated with susceptibility to bouts of impulsive behavior in people at elevated long-term risk.

Evidence-Based Psychotherapies for Bipolar Disorder.

Bipolar disorder is a recurrent psychiatric disorder marked by waxing and waning affective symptoms and impairment in functioning. Some of the morbidity and mortality associated with the illness may be reduced with evidence-based psychotherapies (EBPs) along with pharmacotherapy. To enhance clinicians' understanding of which therapy modalities have evidence supporting their use, the authors conducted a systematic literature review to identify randomized controlled trials (RCTs) of psychotherapy for adults with bipolar disorder. A strong evidence base exists for psychoeducation, cognitive-behavioral therapy, family-focused therapy, interpersonal and social rhythm therapy, and peer-support programs. Promising modalities include functional remediation, mindfulness-based cognitive therapy, illness management and recovery, and technology-assisted strategies. RCTs demonstrate a consistent advantage of these psychotherapies plus pharmacotherapy, compared with the use of pharmacotherapy alone. Adjunctive EBPs hasten time to remission, delay time to recurrence, and improve functional outcomes. EBPs play an important role in helping individuals develop skills needed to manage the persistent and lifelong psychosocial, neurocognitive, vocational, and interpersonal consequences of bipolar disorder. Continued efforts to improve the effectiveness of EBPs for adults with bipolar disorder are warranted.

CDK5-mediated phosphorylation of Sirt2 contributes to depressive-like behavior induced by social defeat stress

Major depressive disorder (MDD) is a common, severe and recurrent psychiatric disorder worldwide; however, the underlying neuropathological mechanisms remain elusive. Histone deacetylases (HDACs) appear to play an essential role in depression. As the class III HDACs, Sirt1 and Sirt2 have attracted the most interest in the nervous system. Indeed, chronic stress decreased Sirt1 activity and down-regulated Sirt1 gene expression in MDD. Nevertheless, there is a paucity of literature on the role of Sirt2. To study the role of Sirt2 we established a MDD mouse model in wild type and Sirt2 knockout C57BL/6 mice using social defeat stress (SDS). We found that a lack of Sirt2 blocked the development of SDS-induced depressive-like behavior. Moreover, SDS led to Sirt2 phosphorylation in the amygdala without changing total Sirt2 levels, and blocking the phosphorylation of Sirt2 by CDK5 at serine residues 368 and 372 prevented SDS-induced depressive-like behavior and Sirt2 nuclear import. We also discovered that SDS-induced Sirt2 phosphorylation was involved in VTA-amygdala modulation using TetTag-pharmacogenetic method. These results suggest that CDK5 mediates phosphorylation of Sirt2 in the amygdala and contributes to the depressive-like behavior induced by SDS. This study highlights that inhibiting CDK5-dependent phosphorylation of Sirt2 at serine residues 368 and 372 by myristoylated membrane-permeabilising peptide (Sirt2-p), rather than using non-specific sirtuin inhibitors, may be a novel strategy for treating depression.

Recidivism with opiate addicted patients on buprenorphine substitution treatment: Case report

Introduction: Opiate dependence is a serious, chronic and recurrent psychiatric disorder, whose prevalence reach epidemic proportions. This also contributes to a significant increase in mortality, associated with overdose with opiates, as well as the rise in other health and social problems of the society. The methods and availability of treatment do not correspond to increased treatment needs, and treatment success is limited by the characteristics of the disorder, or numerous risk factors, which contribute to a high percentage of recidivism. Good clinical practice guidelines have defined treatment recommendations that include high and low-demanding programs. The personalized and integrative approaches are emphasized. Case report: The patient aged 41 years, intravenous-use opiate addict from his adolescences, with numerous psychological, health and social complications of addiction, is a participant in institutional treatment, following a court order as a measure of obligatory treatment, due to criminal offenses related to addiction. The history of the disease refers to numerous unsuccessful attempts to heal and short-term abstinence in the past, mainly in penal institutions. The patient meets all the criteria defined by the guidelines for inclusion in the buprenorphine maintenance program started in the year 2013. During the four-year treatment, the doses of the drug were adapted as needed; two heroin relapses and many in-risk situations for relapse were registered. The treatment continued with close monitoring of the patient's condition and, with appropriate psychosocial interventions, contribute to keeping the patient in treatment and preventing the development of new complications of addiction, as well an improving the quality of his life. Discussion: Pharmacological treatment of opioid dependence relies on agents belonging to groups of antagonists, agonists and partial agonists of opiate receptors. The earlier programs with abstinence as a treatment goal have significantly allocated the place to 'harm reduction' programs, where the therapeutic goals are less demanding and defined as the harm-reduction of opiate dependence on the individual and the society. Treatment guidelines define the principles and types of treatment regimens with agonists and partial agonists of opiate receptors and most commonly used are methadone and buprenorphine. The high risk of relapses despite treatment is defined and a comprehensive approaches and inclusion of Cognitive Behavior Therapy /CBT/, family and social therapy are needed. Conclusion: Defining opioid addiction as severe, chronic and recurrent disease, with high prevalence and mortality rate, forces a therapeutic approach similar to the other chronic and widespread diseases in the population. First of all this implies changing treatment goals, in terms of controlling and reducing harm to individuals and society, and then increasing the availability of treatment at the level of primary care outside the hospital and psychiatric institutions. In addition to pharmacological approach maintenance programs, psychosocial programs are also needed to contribute to the better treatment outcome.

Peripartum management plan for patients with mental illnesses : Strategies to reduce the risk of postpartum relapse

Transition to parenthood is challenging but for women with a history of recurrent psychiatric disorders becoming a mother has a number of additional issues. Women with a history of mood disorders or psychoses are at increased risk for exacerbation in the vulnerable postpartum period and fear the potential risk of medication during pregnancy for the unborn child as much as they fear a relapse. In these difficult situations women and their families seek advice and support from mental health providers and obstetricians. Based on the treatment of 420 mentally ill women with a desire to have children and pregnancy and prospective documentation of 196 pregnancies over the last 10years (2006-2016) the authors developed the Bonn concept of peripartum management (BKPM). The plan was designed to reduce the incidence and severity of postpartum relapses in women suffering from psychiatric disorders. Factors to be considered include antenatal and postpartum medication as well as reduction of stress and stimuli, sleep preservation, social support and help from the partner in caring for the baby. Of the 196 women in the BKPM only 4.6 % (n= 9) experienced a severe postpartum relapse with hospitalization. Additionally, the informed consent discussion with patient and partner as part of the peripartum management plan showed positive effects on how women and their families experienced autonomy and safety during pregnancy and postpartum. Careful planning and monitoring with a structured perinatal management plan can reduce the risk of relapse in the perinatal period and thus support women with a history of mental disorder in the transition to motherhood. Therefore, the management concept employed in Bonn contributes to the major goal of current peripartum psychiatric care in developing effective prevention strategies for women at high risk.

Lithium and suicide prevention in bipolar disorder

IntroductionBipolar disorder (BD) is a severe and recurrent psychiatric disorder. The severity of prognosis in BD is mainly linked to the high rate of suicide in this population. Indeed, patients with BD commit suicide 20 to 30 times more frequently than the general population, and half of the BD population with an early age of onset have a history of suicide attempt. International therapeutic guidelines recommend lithium (Li) as the first-line treatment in BD for its prophylactic action on depressive or manic episodes. In addition, Li is the only mood stabilizer that has demonstrated efficacy in suicide prevention. This effect of Li is unfortunately often unknown to psychiatrists. Thus, this review aims to highlight evidence about the preventive action of Li on suicide in BD populations. MethodsWe conducted a literature search between April 1968 and August 2014 in PubMed database using the following terms: “lithium” AND “suicide” OR “suicidality” OR “suicide attempt”. ResultsAs confirmed by a recent meta-analysis, many studies show that Li has a significant effect on the reduction of suicide attempts and deaths by suicide in comparison to antidepressants or other mood-stabilisers in BD populations. Studies have demonstrated that long-term treatment with Li reduces suicide attempts by about 10% and deaths by suicide by about 20%. The combination of Li and an antidepressant could reduce suicidal behaviours by reducing suicidal ideation prior to depressive symptoms. It appears crucial for Li efficacy in suicide prevention to maintain the Li blood concentrations in the efficient therapeutic zone and to instate long-term Li treatment. The “impulsive-aggressive” endophenotype is associated with suicide in BD. The specific action of Li on the 5-HT serotoninergic system could explain the specific anti-suicidal effects of Li via the modulation of impulsiveness and aggressiveness. Furthermore, genetic variants of the glycogen synthase kinase 3α/β (GSK3α and β; proteins inhibited by Li) seem to be associated with more impulsiveness in BD populations. ConclusionThe anti-suicidal effect of Li has been very well demonstrated. By its specific action on the serotoninergic system, treatment with Li significantly reduces “impulsive-aggressive” behaviour which is a vulnerability factor common to suicide and BD. Long-term appropriately modulated treatment with Li seems to have considerable impact on the reduction of suicidal behaviours, suicidal ideation and death by suicide in the BD population.

Applied public mental health: bridging the gap between evidence and clinical practice.

Applied public mental health: bridging the gap between evidence and clinical practice.

Role of perinatal long-chain omega-3 fatty acids in cortical circuit maturation: Mechanisms and implications for psychopathology.

Accumulating translational evidence suggests that the long-chain omega-3 fatty acid docosahexaenoic acid (DHA) plays a role in the maturation and stability of cortical circuits that are impaired in different recurrent psychiatric disorders. Specifically, rodent and cell culture studies find that DHA preferentially accumulates in synaptic and growth cone membranes and promotes neurite outgrowth, dendritic spine stability, and synaptogenesis. Additional evidence suggests that DHA may play a role in microglia-mediated synaptic pruning, as well as myelin development and resilience. In non-human primates n-3 fatty acid insufficiency during perinatal development leads to widespread deficits in functional connectivity in adult frontal cortical networks compared to primates raised on DHA-fortified diet. Preterm delivery in non-human primates and humans is associated with early deficits in cortical DHA accrual. Human preterm birth is associated with long-standing deficits in myelin integrity and cortical circuit connectivity and increased risk for attention deficit/hyperactivity disorder (ADHD), mood, and psychotic disorders. In general, ADHD and mood and psychotic disorders initially emerge during rapid periods of cortical circuit maturation and are characterized by DHA deficits, myelin pathology, and impaired cortical circuit connectivity. Together these associations suggest that early and uncorrected deficits in fetal brain DHA accrual may represent a modifiable risk factor for cortical circuit maturation deficits in psychiatric disorders, and could therefore have significant implications for informing early intervention and prevention strategies.