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Sample records for bipolar disorder results

  1. Bipolar mixed features - Results from the comparative effectiveness for bipolar disorder (Bipolar CHOICE) study.

    Science.gov (United States)

    Tohen, Mauricio; Gold, Alexandra K; Sylvia, Louisa G; Montana, Rebecca E; McElroy, Susan L; Thase, Michael E; Rabideau, Dustin J; Nierenberg, Andrew A; Reilly-Harrington, Noreen A; Friedman, Edward S; Shelton, Richard C; Bowden, Charles L; Singh, Vivek; Deckersbach, Thilo; Ketter, Terence A; Calabrese, Joseph R; Bobo, William V; McInnis, Melvin G

    2017-08-01

    DSM-5 changed the criteria from DSM-IV for mixed features in mood disorder episodes to include non-overlapping symptoms of depression and hypomania/mania. It is unknown if, by changing these criteria, the same group would qualify for mixed features. We assessed how those meeting DSM-5 criteria for mixed features compare to those meeting DSM-IV criteria. We analyzed data from 482 adult bipolar patients in Bipolar CHOICE, a randomized comparative effectiveness trial. Bipolar diagnoses were confirmed through the MINI International Neuropsychiatric Interview (MINI). Presence and severity of mood symptoms were collected with the Bipolar Inventory of Symptoms Scale (BISS) and linked to DSM-5 and DSM-IV mixed features criteria. Baseline demographics and clinical variables were compared between mood episode groups using ANOVA for continuous variables and chi-square tests for categorical variables. At baseline, the frequency of DSM-IV mixed episodes diagnoses obtained with the MINI was 17% and with the BISS was 20%. Using DSM-5 criteria, 9% of participants met criteria for hypomania/mania with mixed features and 12% met criteria for a depressive episode with mixed features. Symptom severity was also associated with increased mixed features with a high rate of mixed features in patients with mania/hypomania (63.8%) relative to those with depression (8.0%). Data on mixed features were collected at baseline only and thus do not reflect potential patterns in mixed features within this sample across the study duration. The DSM-5 narrower, non-overlapping definition of mixed episodes resulted in fewer patients who met mixed criteria compared to DSM-IV. Copyright © 2017. Published by Elsevier B.V.

  2. Bipolar Disorder

    Science.gov (United States)

    Bipolar disorder is a serious mental illness. People who have it go through unusual mood changes. They go ... The down feeling is depression. The causes of bipolar disorder aren't always clear. It runs in families. ...

  3. Bipolar disorder

    Directory of Open Access Journals (Sweden)

    F Colin

    2013-08-01

    Full Text Available Bipolar disorder (BD presents in different phases over time and is oftencomplicated by comorbid conditions such as substance-use disordersand anxiety disorders. Treatment usually involves pharmacotherapywith combinations of different classes of medications and frequentmedication revisions.

  4. Cytokines in bipolar disorder

    DEFF Research Database (Denmark)

    Munkholm, Klaus; Vinberg, Maj; Vedel Kessing, Lars

    2012-01-01

    to affective state. METHODS: We conducted a systemtic review of studies measuring endogenous cytokine concentrations in patients with bipolar disorder and a meta-analysis, reporting results according to the PRISMA statement. RESULTS: Thirteen studies were included, comprising 556 bipolar disorder patients......BACKGROUND: Current research and hypothesis regarding the pathophysiology of bipolar disorder suggests the involvement of immune system dysfunction that is possibly related to disease activity. Our objective was to systematically review evidence of cytokine alterations in bipolar disorder according...

  5. Bipolar disorder

    Science.gov (United States)

    ... of pleasure in activities once enjoyed Loss of self-esteem Thoughts of death or suicide Trouble getting to ... other. This is called rapid cycling. Exams and Tests To diagnose bipolar disorder, the provider may do ...

  6. Risk factors for an anxiety disorder comorbidity among Thai patients with bipolar disorder: results from the Thai Bipolar Disorder Registry

    Directory of Open Access Journals (Sweden)

    Paholpak S

    2014-05-01

    Full Text Available Suchat Paholpak,1 Ronnachai Kongsakon,2 Wasana Pattanakumjorn,3 Roongsang Kanokvut,4 Wiroj Wongsuriyadech,5 Manit Srisurapanont6 On behalf of the Thai Bipolar Disorder Registry Study Group1Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, 2Department of Psychiatry, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 3Department of Psychiatry, Ratchaburi Hospital, Ratchaburi, 4Department of Psychiatry, Buddhachinaraj Hospital, Phitsanulok, 5Department of Psychiatry, Udonthani Hospital, Udonthani, 6Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Background: The aim of the study was to determine in a clinical setting the risk factors for current anxiety disorder (AD comorbidity among Thai patients with bipolar disorder (BD, being treated under the Thai Bipolar Disorder Registry Project (TBDR. Methods: The TBDR was a multisite naturalistic study conducted at 24 psychiatric units (ie, at university, provincial mental, and government general hospitals between February 2009 and January 2011. Participants were in- or out-patients over 18 years of age who were diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Instruments used in this study included the Thai Mini International Neuropsychiatric Interview version 5; Thai Montgomery–Åsberg Depression Rating Scale (MADRS; Thai Young Mania Rating Scale; Clinical Global Impression of Bipolar Disorder-Severity (CGI-BP-S, CGI-BP-S-mania, CGI-BP-S-depression, and CGI-BP-S-overall BP illness; and the Thai SF-36 quality of life questionnaire. Results: Among the 424 BD patients, 404 (95.3% had BD type I. The respective mean ± standard deviation of age of onset of mood disturbance, first diagnosis of BD, and first treatment of BD was 32.0±11.9, 36.1±12.2, and 36.2±12.2 years. The duration of illness was 10.7±9.0 years. Fifty-three (12.5% of the 424 participants had

  7. Bipolar Disorder (For Teens)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Bipolar Disorder KidsHealth / For Teens / Bipolar Disorder What's in this ... Disorder Print en español Trastorno bipolar What Is Bipolar Disorder? Bipolar disorders are one of several medical conditions ...

  8. What is Bipolar Disorder?

    Science.gov (United States)

    ... affect friends and family? For More Information Share Bipolar Disorder Download PDF Download ePub Order a free hardcopy ... brochure will give you more information. What is bipolar disorder? Bipolar disorder is a serious brain illness. It ...

  9. Bipolar disorder: an overview

    African Journals Online (AJOL)

    which is the reason that up to 69% of patients with BD are misdiagnosed.1 Bipolar ... Cyclothymic disorder. • Substance/medication induced bipolar and related disorder. • Bipolar and related disorder due to another medical condition ... patients. Keywords: bipolar disorder, mania, depression, pharmacological management.

  10. Types of Bipolar Disorder

    Science.gov (United States)

    ... many people have bipolar disorder along with another illness such as anxiety disorder, substance abuse, or an eating disorder. People with ... are sometimes misdiagnosed with schizophrenia. Anxiety and ADHD: ... such as bipolar disorder. Risk Factors Scientists are ...

  11. Bipolar Disorder in Children

    Science.gov (United States)

    2014-01-01

    Although bipolar disorder historically was thought to only occur rarely in children and adolescents, there has been a significant increase in children and adolescents who are receiving this diagnosis more recently (Carlson, 2005). Nonetheless, the applicability of the current bipolar disorder diagnostic criteria for children, particularly preschool children, remains unclear, even though much work has been focused on this area. As a result, more work needs to be done to further the understanding of bipolar symptoms in children. It is hoped that this paper can assist psychologists and other health service providers in gleaning a snapshot of the literature in this area so that they can gain an understanding of the diagnostic criteria and other behaviors that may be relevant and be informed about potential approaches for assessment and treatment with children who meet bipolar disorder criteria. First, the history of bipolar symptoms and current diagnostic criteria will be discussed. Next, assessment strategies that may prove helpful for identifying bipolar disorder will be discussed. Then, treatments that may have relevance to children and their families will be discussed. Finally, conclusions regarding work with children who may have a bipolar disorder diagnosis will be offered. PMID:24800202

  12. Bipolar Disorder in Children

    Directory of Open Access Journals (Sweden)

    Kimberly Renk

    2014-01-01

    Full Text Available Although bipolar disorder historically was thought to only occur rarely in children and adolescents, there has been a significant increase in children and adolescents who are receiving this diagnosis more recently (Carlson, 2005. Nonetheless, the applicability of the current bipolar disorder diagnostic criteria for children, particularly preschool children, remains unclear, even though much work has been focused on this area. As a result, more work needs to be done to further the understanding of bipolar symptoms in children. It is hoped that this paper can assist psychologists and other health service providers in gleaning a snapshot of the literature in this area so that they can gain an understanding of the diagnostic criteria and other behaviors that may be relevant and be informed about potential approaches for assessment and treatment with children who meet bipolar disorder criteria. First, the history of bipolar symptoms and current diagnostic criteria will be discussed. Next, assessment strategies that may prove helpful for identifying bipolar disorder will be discussed. Then, treatments that may have relevance to children and their families will be discussed. Finally, conclusions regarding work with children who may have a bipolar disorder diagnosis will be offered.

  13. Depressive and bipolar disorders

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Hansen, Hanne Vibe; Demyttenaere, Koen

    2005-01-01

    BACKGROUND: There is increasing evidence that attitudes and beliefs are important in predicting adherence to treatment and medication in depressive and bipolar disorders. However, these attitudes have received little study in patients whose disorders were sufficiently severe to require...... hospitalization. METHOD: The Antidepressant Compliance Questionnaire (ADCQ) was mailed to a large population of patients with depressive or bipolar disorder, representative of patients treated in hospital settings in Denmark. RESULTS: Of the 1005 recipients, 49.9% responded to the letter. A large proportion....... Moreover, their partners agreed on these negative views. Women had a more negative view of the doctor-patient relationship than men, and patients with a depressive disorder had a more negative view of antidepressants than patients with bipolar disorder. The number of psychiatric hospitalizations...

  14. Psychotic and Bipolar Disorders: Bipolar Disorder.

    Science.gov (United States)

    Holder, Sarah D

    2017-04-01

    Bipolar disorder is a severe chronic mental illness that affects a large number of individuals. This disorder is separated into two major types, bipolar I disorder, with mania and typically recurrent depression, and bipolar II disorder, with recurrent major depression and hypomania. Patients with bipolar disorder spend the majority of time experiencing depression, and this typically is the presenting symptom. Because outcomes are improved with earlier diagnosis and treatment, physicians should maintain a high index of suspicion for bipolar disorder. The most effective long-term treatments are lithium and valproic acid, although other drugs also are used. In addition to referral to a mental health subspecialist for initiation and management of drug treatment, patients with bipolar disorder should be provided with resources for psychotherapy. Several comorbidities commonly associated with bipolar disorder include other mental disorders, substance use disorders, migraine headaches, chronic pain, stroke, metabolic syndrome, and cardiovascular disease. Family physicians who care for patients with bipolar disorder should focus their efforts on prevention and management of comorbidities. These patients should be assessed continually for risk of suicide because they are at high risk and their suicide attempts tend to be successful. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  15. Early Intervention in Bipolar Disorder.

    Science.gov (United States)

    Vieta, Eduard; Salagre, Estela; Grande, Iria; Carvalho, André F; Fernandes, Brisa S; Berk, Michael; Birmaher, Boris; Tohen, Mauricio; Suppes, Trisha

    2018-01-24

    Bipolar disorder is a recurrent disorder that affects more than 1% of the world population and usually has its onset during youth. Its chronic course is associated with high rates of morbidity and mortality, making bipolar disorder one of the main causes of disability among young and working-age people. The implementation of early intervention strategies may help to change the outcome of the illness and avert potentially irreversible harm to patients with bipolar disorder, as early phases may be more responsive to treatment and may need less aggressive therapies. Early intervention in bipolar disorder is gaining momentum. Current evidence emerging from longitudinal studies indicates that parental early-onset bipolar disorder is the most consistent risk factor for bipolar disorder. Longitudinal studies also indicate that a full-blown manic episode is often preceded by a variety of prodromal symptoms, particularly subsyndromal manic symptoms, therefore supporting the existence of an at-risk state in bipolar disorder that could be targeted through early intervention. There are also identifiable risk factors that influence the course of bipolar disorder, some of them potentially modifiable. Valid biomarkers or diagnosis tools to help clinicians identify individuals at high risk of conversion to bipolar disorder are still lacking, although there are some promising early results. Pending more solid evidence on the best treatment strategy in early phases of bipolar disorder, physicians should carefully weigh the risks and benefits of each intervention. Further studies will provide the evidence needed to finish shaping the concept of early intervention.

  16. Bipolar Disorder

    Science.gov (United States)

    ... make treatment less successful. Examples include: Anxiety disorders Eating disorders Attention-deficit/hyperactivity disorder (ADHD) Alcohol or drug problems Physical health problems, such as heart disease, thyroid ...

  17. Perceptions and impact of bipolar disorder in Japan: results of an Internet survey

    Directory of Open Access Journals (Sweden)

    Watanabe K

    2016-11-01

    Full Text Available Koichiro Watanabe,1 Eiji Harada,2 Takeshi Inoue,3 Yuka Tanji,2 Toshiaki Kikuchi1 1Department of Neuropsychiatry, Kyorin University, School of Medicine, Tokyo, 2Medical Science, Medicines Development Unit-Japan, Eli Lilly Japan KK, Hyogo, 3Department of Psychiatry, Tokyo Medical University, Tokyo, Japan Abstract: Bipolar disorder is a recurrent and episodic illness. This survey study assessed experiences and identified clinical insights of individuals with bipolar disorder. An Internet-based monitor system database was screened for patients with bipolar disorder in Japan (February and March 2013. Of 1,050 patients, 457 completed surveys, and results were analyzed with descriptive statistics. Approximately one-fourth of respondents were diagnosed with bipolar disorder on their first visit to medical institutions, although the most common initial diagnosis was depression/depressive state (65%. Mean time lag between first-time visit to a medical institution and receipt of correct diagnosis of bipolar disorder was 4 years; one-third of patients experienced more than 5 years of lag time. Three perceived reasons for lapsed time before correct diagnosis were “(patients Did not consider manic symptoms as illness, and did not tell the doctor about them,” “I (patient did not know of bipolar disorder,” and “Lack of communication between my doctor and myself (patient.” Among participants who believed that they were initially incorrectly diagnosed and improperly treated, most experienced socioeconomic problems, such as having long-term inability to work or to study (65%. Sources of encouragement for participants included “To have someone to consult with” (41% followed by having “People around me treat me the same as before” (40%. Individuals with bipolar disorder reported a time lag of many years before accurate diagnosis, and substantial burden imposed by the illness. Encouragement should be provided for individuals to live positively

  18. Do Comorbid Anxiety Disorders Moderate the Effects of Psychotherapy for Bipolar Disorder? Results From STEP-BD

    Science.gov (United States)

    Deckersbach, Thilo; Peters, Amy T.; Sylvia, Louisa; Urdahl, Anna; Magalhães, Pedro V.S.; Otto, Michael W.; Frank, Ellen; Miklowitz, David J.; Berk, Michael; Kinrys, Gustavo; Nierenberg, Andrew

    2013-01-01

    Objective At least 50% of individuals with bipolar disorder have a lifetime anxiety disorder. Individuals with both bipolar disorder and a co-occurring anxiety disorder experience longer illness duration, greater illness severity, and poorer treatment response. The study explored whether comorbid lifetime anxiety in bipolar patients moderates psychotherapy treatment outcome. Method In the Systematic Treatment Enhancement Program randomized controlled trial of psychotherapy for bipolar depression, participants received up to 30 sessions of intensive psychotherapy (family-focused therapy, interpersonal and social rhythm therapy, or cognitive-behavioral therapy) or collaborative care, a three-session comparison treatment, plus pharmacotherapy. Using the number needed to treat, we computed effect sizes to analyze the relationship between lifetime anxiety disorders and rates of recovery across treatment groups after 1 year. Results A total of 269 patients (113 women) with a comorbid lifetime anxiety disorder (N=177) or without a comorbid lifetime anxiety disorder (N=92) were included in the analysis. Participants with a lifetime anxiety disorder were more likely to recover with psychotherapy than with collaborative care (66% compared with 49% recovered over 1 year; number needed to treat=5.88, small to medium effect). For patients without a lifetime anxiety disorder, there was no difference between rates of recovery in psychotherapy compared with collaborative care (64% compared with 62% recovered; number needed to treat=50, small effect). Participants with one lifetime anxiety disorder were likely to benefit from intensive psychotherapy compared with collaborative care (84% compared with 53% recovered; number needed to treat=3.22, medium to large effect), whereas patients with multiple anxiety disorders exhibited no difference in response to the two treatments (54% compared with 46% recovered; number needed to treat=12.5, small effect). Conclusions Depressed patients

  19. Do comorbid anxiety disorders moderate the effects of psychotherapy for bipolar disorder? Results from STEP-BD.

    Science.gov (United States)

    Deckersbach, Thilo; Peters, Amy T; Sylvia, Louisa; Urdahl, Anna; Magalhães, Pedro V S; Otto, Michael W; Frank, Ellen; Miklowitz, David J; Berk, Michael; Kinrys, Gustavo; Nierenberg, Andrew

    2014-02-01

    At least 50% of individuals with bipolar disorder have a lifetime anxiety disorder. Individuals with both bipolar disorder and a co-occurring anxiety disorder experience longer illness duration, greater illness severity, and poorer treatment response. The study explored whether comorbid lifetime anxiety in bipolar patients moderates psychotherapy treatment outcome. In the Systematic Treatment Enhancement Program randomized controlled trial of psychotherapy for bipolar depression, participants received up to 30 sessions of intensive psychotherapy (family-focused therapy, interpersonal and social rhythm therapy, or cognitive-behavioral therapy) or collaborative care, a three-session comparison treatment, plus pharmacotherapy. Using the number needed to treat, we computed effect sizes to analyze the relationship between lifetime anxiety disorders and rates of recovery across treatment groups after 1 year. A total of 269 patients (113 women) with a comorbid lifetime anxiety disorder (N=177) or without a comorbid lifetime anxiety disorder (N=92) were included in the analysis. Participants with a lifetime anxiety disorder were more likely to recover with psychotherapy than with collaborative care (66% compared with 49% recovered over 1 year; number needed to treat=5.88, small to medium effect). For patients without a lifetime anxiety disorder, there was no difference between rates of recovery in psychotherapy compared with collaborative care (64% compared with 62% recovered; number needed to treat=50, small effect). Participants with one lifetime anxiety disorder were likely to benefit from intensive psychotherapy compared with collaborative care (84% compared with 53% recovered; number needed to treat=3.22, medium to large effect), whereas patients with multiple anxiety disorders exhibited no difference in response to the two treatments (54% compared with 46% recovered; number needed to treat=12.5, small effect). Depressed patients with bipolar disorder and comorbid

  20. Bipolar Disorder and Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    Sermin Kesebir

    2010-04-01

    Full Text Available Comorbid endocrine and cardiovascular situations with bipolar disorder usually result from the bipolar disorder itself or as a consequence of its treatment. With habits and lifestyle, genetic tendency and side effects, this situation is becoming more striking. Subpopulations of bipolar disorders patients should be considered at high risk for diabetes mellitus. The prevalence of diabetes mellitus in bipolar disorder may be three times greater than in the general population. Comorbidity of diabetes causes a pathophysiological overlapping in the neurobiological webs of bipolar cases. Signal mechanisms of glycocorticoid/insulin and immunoinflammatory effector systems are junction points that point out the pathophysiology between bipolar disorder and general medical cases susceptible to stress. Glycogen synthetase kinase (GSK-3 is a serine/treonine kinase and inhibits the transport of glucose stimulated by insulin. It is affected in diabetes, cancer, inflammation, Alzheimer disease and bipolar disorder. Hypoglycemic effect of lithium occurs via inhibiting glycogen synthetase kinase. When comorbid with diabetes, the other disease -for example bipolar disorder, especially during its acute manic episodes-, causes a serious situation that presents its influences for a lifetime. Choosing pharmacological treatment and treatment adherence are another important interrelated areas. The aim of this article is to discuss and review the etiological, clinical and therapeutic properties of diabetes mellitus and bipolar disorder comorbidity.

  1. Scientific attitudes towards bipolar disorders

    Directory of Open Access Journals (Sweden)

    Mohammad-Hossein Biglu

    2014-02-01

    Full Text Available Introduction: Bipolar disorder is a psychiatric condition that is also called manic-depressive disease. It causes unusual changes in mood, energy, activity levels, and the ability to carry out day-to-day tasks. In the present study, 3 sets of data were considered and analyzed: first, all papers categorized under Bipolar Disorders in Science Citation Index Expanded (SCI-E database through 2001-2011; second, papers published by the international journal of Bipolar Disorders indexed in SCI-E during a period of 11 years; and third, all papers distributed by the international journal of Bipolar Disorders indexed in MEDLINE during the period of study. Methods: The SCI-E database was used to extract all papers indexed with the topic of Bipolar Disorders as well as all papers published by The International Journal of Bipolar Disorders. Extraction of data from MEDLINE was restricted to the journals name from setting menu. The Science of Science Tool was used to map the co-authorship network of papers published by The International Journal of Bipolar Disorders through 2009-2011. Results: Analysis of data showed that the majority of publications in the subject area of bipolar disorders indexed in SCI-E were published by The International Journal of Bipolar Disorders. Although journal articles consisted of 59% of the total publication type in SCI-E, 65% of publications distributed by The Journal of Bipolar Disorders were in the form of meetingabstracts. Journal articles consisted of only 23% of the total publications. USA was the leading country regarding sharing data in the field of bipolar disorders followed by England, Canada, and Germany. Conclusion: The editorial policy of The International Journal of Bipolar Disorders has been focused on new themes and new ways of researching in the subject area of bipolar disorder. Regarding the selection of papers for indexing, the SCI-E database selects data more comprehensively than MEDLINE. The number of papers

  2. [Creativity and bipolar disorder].

    Science.gov (United States)

    Maçkalı, Zeynep; Gülöksüz, Sinan; Oral, Timuçin

    2014-01-01

    The relationship between creativity and bipolar disorder has been an intriguing topic since ancient times. Early studies focused on describing characteristics of creative people. From the last quarter of the twentieth century, researchers began to focus on the relationship between mood disorders and creativity. Initially, the studies were based on biographical texts and the obtained results indicated a relationship between these two concepts. The limitations of the retrospective studies led the researchers to develop systematic investigations into this area. The systematic studies that have focused on artistic creativity have examined both the prevalence of mood disorders and the creative process. In addition, a group of researchers addressed the relationship in terms of affective temperaments. Through the end of the 90's, the scope of creativity was widened and the notion of everyday creativity was proposed. The emergence of this notion led researchers to investigate the associations of the creative process in ordinary (non-artist) individuals. In this review, the descriptions of creativity and creative process are mentioned. Also, the creative process is addressed with regards to bipolar disorder. Then, the relationship between creativity and bipolar disorder are evaluated in terms of aforementioned studies (biographical, systematic, psychobiographical, affective temperaments). In addition, a new model, the "Shared Vulnerability Model" which was developed to explain the relationship between creativity and psychopathology is introduced. Finally, the methodological limitations and the suggestions for resolving these limitations are included.

  3. Bipolar Disorder - Multiple Languages

    Science.gov (United States)

    ... MP3 Bipolar Disorder (An Introduction) - English MP4 Bipolar Disorder (An Introduction) - español (Spanish) MP4 Healthy Roads Media Characters not displaying correctly on this page? See language display issues . Return to the MedlinePlus Health Information ...

  4. Internet use by patients with bipolar disorder: Results from an international multisite survey.

    Science.gov (United States)

    Bauer, Rita; Conell, Jörn; Glenn, Tasha; Alda, Martin; Ardau, Raffaella; Baune, Bernhard T; Berk, Michael; Bersudsky, Yuly; Bilderbeck, Amy; Bocchetta, Alberto; Bossini, Letizia; Castro, Angela M Paredes; Cheung, Eric Yw; Chillotti, Caterina; Choppin, Sabine; Del Zompo, Maria; Dias, Rodrigo; Dodd, Seetal; Duffy, Anne; Etain, Bruno; Fagiolini, Andrea; Hernandez, Miryam Fernández; Garnham, Julie; Geddes, John; Gildebro, Jonas; Gonzalez-Pinto, Ana; Goodwin, Guy M; Grof, Paul; Harima, Hirohiko; Hassel, Stefanie; Henry, Chantal; Hidalgo-Mazzei, Diego; Kapur, Vaisnvy; Kunigiri, Girish; Lafer, Beny; Larsen, Erik R; Lewitzka, Ute; Licht, Rasmus W; Lund, Anne Hvenegaard; Misiak, Blazej; Monteith, Scott; Munoz, Rodrigo; Nakanotani, Takako; Nielsen, René E; O'Donovan, Claire; Okamura, Yasushi; Osher, Yamima; Piotrowski, Patryk; Reif, Andreas; Ritter, Philipp; Rybakowski, Janusz K; Sagduyu, Kemal; Sawchuk, Brett; Schwartz, Elon; Scippa, Ângela M; Slaney, Claire; Sulaiman, Ahmad H; Suominen, Kirsi; Suwalska, Aleksandra; Tam, Peter; Tatebayashi, Yoshitaka; Tondo, Leonardo; Vieta, Eduard; Vinberg, Maj; Viswanath, Biju; Volkert, Julia; Zetin, Mark; Whybrow, Peter C; Bauer, Michael

    2016-08-30

    There is considerable international interest in online education of patients with bipolar disorder, yet little understanding of how patients use the Internet and other sources to seek information. 1171 patients with a diagnosis of bipolar disorder in 17 countries completed a paper-based, anonymous survey. 81% of the patients used the Internet, a percentage similar to the general public. Older age, less education, and challenges in country telecommunications infrastructure and demographics decreased the odds of using the Internet. About 78% of the Internet users looked online for information on bipolar disorder or 63% of the total sample. More years of education in relation to the country mean, and feeling very confident about managing life decreased the odds of seeking information on bipolar disorder online, while having attended support groups increased the odds. Patients who looked online for information on bipolar disorder consulted medical professionals plus a mean of 2.3 other information sources such as books, physician handouts, and others with bipolar disorder. Patients not using the Internet consulted medical professionals plus a mean of 1.6 other information sources. The percentage of patients with bipolar disorder who use the Internet is about the same as the general public. Other information sources remain important. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Genetics of bipolar disorder

    OpenAIRE

    Kerner, Berit

    2014-01-01

    Berit Kerner Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA Abstract: Bipolar disorder is a common, complex genetic disorder, but the mode of transmission remains to be discovered. Many researchers assume that common genomic variants carry some risk for manifesting the disease. The research community has celebrated the first genome-wide significant associations between common single nucleotide polymorphisms (SNPs) and bipolar ...

  6. Update on quetiapine in the treatment of bipolar disorder: results from the BOLDER studies

    Directory of Open Access Journals (Sweden)

    Prashant Gajwani

    2007-01-01

    Full Text Available Prashant Gajwani1, David J Muzina2, David E Kemp3, Keming Gao1, Joseph R Calabrese11Case Western Reserve University (CWRU School of Medicine, 2Cleveland Clinic Lerner College of Medicine of CWRU, 3Case Western Reserve University, Cleveland OH, USAAbstract: The essential features of bipolar affective disorder involve the cyclical occurrence of high (manic or hypomanic episodes and low mood states. Depressive episodes in both bipolar I and II disorder are more numerous and last for longer duration than either manic or hypomanic episodes. In addition depressive episodes are associated with higher morbidity and mortality. While multiple agents, including all 5 atypical antipsychotics, have demonstrated efficacy and earned US FDA indication for manic phase of bipolar illness, the acute treatment of bipolar depression is less well-studied. The first treatment approved by the US FDA for acute bipolar depression was the combination of the atypical antipsychotic olanzapine and the antidepressant fluoxetine. Recently, quetiapine monotherapy has demonstrated efficacy in the treatment of depressive episodes associated with both bipolar I and II disorder and has earned US FDA indication for the same.Keywords: bipolar disorder, quetiapine, BOLDER studies

  7. [Antidepressants in bipolar disorder].

    Science.gov (United States)

    Courtet, P; Samalin, L; Olié, E

    2011-12-01

    Whereas mania defines the bipolar disorder, depression is the major challenge of treatment. In general, depressions are more frequent, longer, with a major prognostic impact in terms of disability and suicide. How should we treat a patient with bipolar depression? Antidepressants are the treatment of choice for depression, but not in the bipolar disorder. In this context, we have traditionally accepted that antidepressants are effective but they were inducing a significant risk of destabilization of the bipolar disorder, because of the transitions to mania and rapid cycling. Current data reconsider both the two aspects of this risk-benefit ratio. The effectiveness of antidepressants finally seems very limited, especially after the more recent studies with a robust methodology. Manic switches and rapid cycling may not be increased, particularly with new antidepressants and mood stabilizer combinations. The current literature reminds us that these course's modalities are inherent to the disease, with numerous risk factors, and among them, exposure to antidepressants. Who are the bipolar patients who only get the benefits of antidepressant treatment? Research will tell. They are in any case limited. How to navigate in our treatment strategies ? By choosing first drugs that demonstrated efficacy in bipolar depression. When the situation is more complex, "primum non nocere" should lead to support the prescription of the antidepressant in association with mood stabilizer. Copyright © 2011 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.

  8. Interpersonal and social rhythm therapy for adolescents with bipolar disorder: treatment development and results from an open trial.

    Science.gov (United States)

    Hlastala, Stefanie A; Kotler, Julie S; McClellan, Jon M; McCauley, Elizabeth A

    2010-05-01

    In adolescents and adults, bipolar disorder (BD) is associated with significant morbidity, mortality, and impairment in psychosocial and occupational functioning. IPSRT is an empirically supported adjunctive psychotherapy for adults with bipolar disorder, which has been shown to help delay relapse, speed recovery from a bipolar depressive episode, and increase occupational and psychosocial functioning in adults with BD. This study is designed to describe the adolescent-specific developmental adaptations made to IPSRT (i.e., IPSRT-A) and to report the results from an open trial of IPSRT-A with 12 adolescents with a bipolar spectrum disorder. Interpersonal and Social Rhythm Therapy was adapted to be developmentally relevant to adolescents with bipolar disorder. Twelve adolescents (mean age 16.5+/-1.3 years) diagnosed with a bipolar spectrum disorder participated in 16-18 sessions of adjunctive IPSRT-A over 20 weeks. Manic, depressive, and general symptoms and global functioning were measured at baseline, monthly during treatment, and at post-treatment. Adolescent satisfaction with treatment was also measured. Feasibility and acceptability of IPSRT-A were high; 11/12 participants completed treatment, 97% of sessions were attended, and adolescent-rated satisfaction scores were high. IPSRT-A participants experienced significant decreases in manic, depressive, and general psychiatric symptoms over the 20 weeks of treatment. Participants' global functioning increased significantly as well. Effect sizes ranged from medium-large to large. IPSRT-A appears to be a promising adjunctive treatment for adolescents with bipolar disorder. A current randomized controlled trial is underway to examine effects of adjunctive IPSRT-A on psychiatric symptoms and psychosocial functioning.

  9. Bipolar Affective Disorder and Migraine

    Directory of Open Access Journals (Sweden)

    Birk Engmann

    2012-01-01

    Full Text Available This paper consists of a case history and an overview of the relationship, aetiology, and treatment of comorbid bipolar disorder migraine patients. A MEDLINE literature search was used. Terms for the search were bipolar disorder bipolar depression, mania, migraine, mood stabilizer. Bipolar disorder and migraine cooccur at a relatively high rate. Bipolar II patients seem to have a higher risk of comorbid migraine than bipolar I patients have. The literature on the common roots of migraine and bipolar disorder, including both genetic and neuropathological approaches, is broadly discussed. Moreover, bipolar disorder and migraine are often combined with a variety of other affective disorders, and, furthermore, behavioural factors also play a role in the origin and course of the diseases. Approach to treatment options is also difficult. Several papers point out possible remedies, for example, valproate, topiramate, which acts on both diseases, but no first-choice treatments have been agreed upon yet.

  10. Genetics of bipolar disorder

    Directory of Open Access Journals (Sweden)

    Kerner B

    2014-02-01

    Full Text Available Berit Kerner Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA Abstract: Bipolar disorder is a common, complex genetic disorder, but the mode of transmission remains to be discovered. Many researchers assume that common genomic variants carry some risk for manifesting the disease. The research community has celebrated the first genome-wide significant associations between common single nucleotide polymorphisms (SNPs and bipolar disorder. Currently, attempts are under way to translate these findings into clinical practice, genetic counseling, and predictive testing. However, some experts remain cautious. After all, common variants explain only a very small percentage of the genetic risk, and functional consequences of the discovered SNPs are inconclusive. Furthermore, the associated SNPs are not disease specific, and the majority of individuals with a “risk” allele are healthy. On the other hand, population-based genome-wide studies in psychiatric disorders have rediscovered rare structural variants and mutations in genes, which were previously known to cause genetic syndromes and monogenic Mendelian disorders. In many Mendelian syndromes, psychiatric symptoms are prevalent. Although these conditions do not fit the classic description of any specific psychiatric disorder, they often show nonspecific psychiatric symptoms that cross diagnostic boundaries, including intellectual disability, behavioral abnormalities, mood disorders, anxiety disorders, attention deficit, impulse control deficit, and psychosis. Although testing for chromosomal disorders and monogenic Mendelian disorders is well established, testing for common variants is still controversial. The standard concept of genetic testing includes at least three broad criteria that need to be fulfilled before new genetic tests should be introduced: analytical validity, clinical validity, and clinical utility. These criteria are

  11. [Genetics of bipolar disorder].

    Science.gov (United States)

    Budde, M; Forstner, A J; Adorjan, K; Schaupp, S K; Nöthen, M M; Schulze, T G

    2017-07-01

    Bipolar disorder (BD) has a multifactorial etiology. Its development is influenced by genetic as well as environmental factors. Large genome-wide association studies (GWAS), in which genetic risk allelic variants for the disorder could be replicated for the first time, marked the breakthrough in the identification of the responsible risk genes. In addition to these common genetic variants with moderate effects identified by GWAS, rare variants with a higher penetrance are expected to play a role in disease development. The results of recent studies suggest that copy number variants might contribute to BD development, although to a lesser extent than in other psychiatric disorders, such as schizophrenia or autism. Results from the initial next generation sequencing studies indicate an enrichment of rare variants in pathways and genes that were previously found to be associated with BD. In the field of pharmacogenetics, a risk gene that influences the individual variance in the response to lithium treatment was identified for the first time in a recent large international GWAS. Currently the reported risk alleles do not sufficiently explain the phenotypic variance to be used for individual prediction of disease risk, disease course or response to medication. Future genetic research will provide important insights into the biological basis of BD by the identification of additional genes associated with BD. This knowledge of genetics will help identify potential etiological subgroups as well as cross-diagnostic disease mechanisms.

  12. Electronic monitoring in bipolar disorder.

    Science.gov (United States)

    Faurholt-Jepsen, Maria

    2018-03-01

    Major reasons for the insufficient effects of current treatment options in bipolar disorder include delayed intervention for prodromal depressive and manic symptoms and decreased adherence to psychopharmacological treatment. The reliance on subjective information and clinical evaluations when diagnosing and assessing the severity of depressive and manic symptoms calls for less biased and more objective markers. By using electronic devices, fine-grained data on complex psychopathological aspects of bipolar disorder can be evaluated unobtrusively over the long term. Moreover, electronic data could possibly represent candidate markers of diagnosis and illness activity in bipolar disorder and allow for early and individualized intervention for prodromal symptoms outside clinical settings. 
The present dissertation concerns the use of electronic monitoring as a marker and treatment intervention in bipolar disorder and investigated the scientific literature and body of evidence within the area, which includes ten original study reports and two systematic reviews, one of which included a meta-analysis, conducted by the author of the dissertation. 
Taken together, the literature presented in this dissertation illustrates that 1) smartphone-based electronic self-monitoring of mood seems to reflect clinically assessed depressive and manic symptoms and enables the long-term characterization of mood

instability in bipolar disorder; 2) preliminary results suggest that smartphone-based automatically generated data (e.g. the number of text messages sent/day; the number of incoming and outgoing calls/day; the number of changes in cell tower IDs/day; and voice features) seem to reflect clinically assessed depressive and manic symptoms in bipolar disorder; 3) smartphone-based electronic self-monitoring had no effects on the severity of depressive and manic symptoms in bipolar disorder, according to a randomized controlled trial; and 4) electronic monitoring of psychomotor

  13. [Spouses and bipolar disorder].

    Science.gov (United States)

    Ellouze, F; Ayedi, S; Cherif, W; Ben Abla, T; M'rad, M F

    2011-02-01

    To assess the quality of life of a population of spouses of bipolar patients compared with a control population. We conducted a cross-sectional study which included two groups: a group of 30 spouses of patients followed for bipolar I disorder according to DSM IV criteria and a second group of 30 subjects from the general population. Both groups were matched by age, sex, marital status and socioeconomic level. This device was designed to limit the differences between the two groups solely those of the bipolar illness. Evaluating the quality of life was achieved using the quality of life scale: SF-36. This is a scale that has already been translated and validated in dialect Arabic. Regarding sociodemographic variables, the two study groups differed only for: recreation, friendly relations and the couple relationship that included more and better skills among the control group. In the categorical approach, the quality of life was impaired in 60% of spouses and 40% of controls with a statistically significant difference. The following standardized dimensions: mental health (D4), limitation due to mental health (D5), life and relationship with others (D6) and perceived health (D8) and mental component (CM) were significantly altered in patients' spouses compared to controls. We found significant differences between the two groups for: overall average score (51.1 vs. 68.2), mental health (D4), limitation due to mental health (D5), life and relationship with others (D6), perceived health (D8) and perceived health (D8) standards. The impairment of quality of life of bipolar patients' spouses is related to the extra responsibility, stress, financial problems and health problems, stigma, and loss of security of the person loved. Considering the consequences that the appearance of bipolar disorder on the patient's spouse may have, certain measures must be proposed to improve their quality of life. Copyright © 2010 L'Encéphale, Paris. Published by Elsevier Masson SAS. All

  14. Genetics of bipolar disorder.

    Science.gov (United States)

    Kerner, Berit

    2014-01-01

    Bipolar disorder is a common, complex genetic disorder, but the mode of transmission remains to be discovered. Many researchers assume that common genomic variants carry some risk for manifesting the disease. The research community has celebrated the first genome-wide significant associations between common single nucleotide polymorphisms (SNPs) and bipolar disorder. Currently, attempts are under way to translate these findings into clinical practice, genetic counseling, and predictive testing. However, some experts remain cautious. After all, common variants explain only a very small percentage of the genetic risk, and functional consequences of the discovered SNPs are inconclusive. Furthermore, the associated SNPs are not disease specific, and the majority of individuals with a "risk" allele are healthy. On the other hand, population-based genome-wide studies in psychiatric disorders have rediscovered rare structural variants and mutations in genes, which were previously known to cause genetic syndromes and monogenic Mendelian disorders. In many Mendelian syndromes, psychiatric symptoms are prevalent. Although these conditions do not fit the classic description of any specific psychiatric disorder, they often show nonspecific psychiatric symptoms that cross diagnostic boundaries, including intellectual disability, behavioral abnormalities, mood disorders, anxiety disorders, attention deficit, impulse control deficit, and psychosis. Although testing for chromosomal disorders and monogenic Mendelian disorders is well established, testing for common variants is still controversial. The standard concept of genetic testing includes at least three broad criteria that need to be fulfilled before new genetic tests should be introduced: analytical validity, clinical validity, and clinical utility. These criteria are currently not fulfilled for common genomic variants in psychiatric disorders. Further work is clearly needed before genetic testing for common variants in

  15. Life expectancy in bipolar disorder

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Vradi, Eleni; Andersen, Per Kragh

    2015-01-01

    OBJECTIVE: Life expectancy in patients with bipolar disorder has been reported to be decreased by 11 to 20 years. These calculations are based on data for individuals at the age of 15 years. However, this may be misleading for patients with bipolar disorder in general as most patients have a later...... onset of illness. The aim of the present study was to calculate the remaining life expectancy for patients of different ages with a diagnosis of bipolar disorder. METHODS: Using nationwide registers of all inpatient and outpatient contacts to all psychiatric hospitals in Denmark from 1970 to 2012 we...... remaining life expectancy in bipolar disorder and that of the general population decreased with age, indicating that patients with bipolar disorder start losing life-years during early and mid-adulthood. CONCLUSIONS: Life expectancy in bipolar disorder is decreased substantially, but less so than previously...

  16. Bipolar Disorder and Obsessive Compulsive Disorder Comorbidity

    Directory of Open Access Journals (Sweden)

    Necla Keskin

    2014-08-01

    Full Text Available The comorbidity of bipolar disorder and anxiety disorders is a well known concept. Obsessive-compulsive disorder is the most commonly seen comorbid anxiety disorder in bipolar patients. Some genetic variants, neurotransmitters especially serotonergic systems and second-messenger systems are thought to be responsible for its etiology. Bipolar disorder alters the clinical aspects of obsessive compulsive disorder and is associated with poorer outcome. The determination of comorbidity between bipolar disorder and obsessive compulsive disorder is quite important for appropriate clinical management and treatment. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(4.000: 429-437

  17. Mathematical models of bipolar disorder

    Science.gov (United States)

    Daugherty, Darryl; Roque-Urrea, Tairi; Urrea-Roque, John; Troyer, Jessica; Wirkus, Stephen; Porter, Mason A.

    2009-07-01

    We use limit cycle oscillators to model bipolar II disorder, which is characterized by alternating hypomanic and depressive episodes and afflicts about 1% of the United States adult population. We consider two non-linear oscillator models of a single bipolar patient. In both frameworks, we begin with an untreated individual and examine the mathematical effects and resulting biological consequences of treatment. We also briefly consider the dynamics of interacting bipolar II individuals using weakly-coupled, weakly-damped harmonic oscillators. We discuss how the proposed models can be used as a framework for refined models that incorporate additional biological data. We conclude with a discussion of possible generalizations of our work, as there are several biologically-motivated extensions that can be readily incorporated into the series of models presented here.

  18. Diagnostic stability in pediatric bipolar disorder

    DEFF Research Database (Denmark)

    Vedel Kessing, Lars; Vradi, Eleni; Andersen, Per Kragh

    2015-01-01

    BACKGROUND: The diagnostic stability of pediatric bipolar disorder has not been investigated previously. The aim was to investigate the diagnostic stability of the ICD-10 diagnosis of pediatric mania/bipolar disorder.METHODS: All patients below 19 years of age who got a diagnosis of mania/bipolar...... disorder at least once in a period from 1994 to 2012 at psychiatric inpatient or outpatient contact in Denmark were identified in a nationwide register.RESULTS: Totally, 354 children and adolescents got a diagnosis of mania/bipolar disorder at least once; a minority, 144 patients (40.7%) got the diagnosis...... at the first contact whereas the remaining patients (210; 59.3%) got the diagnosis at later contacts before age 19. For the latter patients, the median time elapsed from first treatment contact with the psychiatric service system to the first diagnosis with a manic episode/bipolar disorder was nearly 1 year...

  19. Is recurrence in major depressive disorder related to bipolarity and mixed features? Results from the BRIDGE-II-Mix study.

    Science.gov (United States)

    Mazzarini, Lorenzo; Kotzalidis, Georgios D; Piacentino, Daria; Rizzato, Salvatore; Angst, Jules; Azorin, Jean-Michel; Bowden, Charles L; Mosolov, Sergey; Young, Allan H; Vieta, Eduard; Girardi, Paolo; Perugi, Giulio

    2018-03-15

    Current classifications separate Bipolar (BD) from Major Depressive Disorder (MDD) based on polarity rather than recurrence. We aimed to determine bipolar/mixed feature frequency in a large MDD multinational sample with (High-Rec) and without (Low-Rec) >3 recurrences, comparing the two subsamples. We measured frequency of bipolarity/hypomanic features during current depressive episodes (MDEs) in 2347 MDD patients from the BRIDGE-II-mix database, comparing High-Rec with Low-Rec. We used Bonferroni-corrected Student's t-test for continuous, and chi-squared test, for categorical variables. Logistic regression estimated the size of the association between clinical characteristics and High-Rec MDD. Compared to Low-Rec (n = 1084, 46.2%), High-Rec patients (n = 1263, 53.8%) were older, with earlier depressive onset, had more family history of BD, more atypical features, suicide attempts, hospitalisations, and treatment resistance and (hypo)manic switches when treated with antidepressants, higher comorbidity with borderline personality disorder, and more hypomanic symptoms during current MDE, resulting in higher rates of mixed depression according to both DSM-5 and research-based diagnostic (RBDC) criteria. Logistic regression showed age at first symptoms suicide attempts, treatment-resistance, antidepressant-induced swings, and atypical, mixed, or psychotic features during MDE to associate with High-Rec. Number of MDEs for defining recurrence was arbitrary; cross-sectionality did not allow assessment of conversion from MDD to BD. High-Rec MDD differed from Low-Rec group for several clinical/epidemiological variables, including bipolar/mixed features. Bipolarity specifier and RBDC were more sensitive than DSM-5 criteria in detecting bipolar and mixed features in MDD. Copyright © 2017. Published by Elsevier B.V.

  20. Differences in demographic composition and in work, social, and functional limitations among the populations with unipolar depression and bipolar disorder: results from a nationally representative sample

    Directory of Open Access Journals (Sweden)

    Williams Mark D

    2011-10-01

    Full Text Available Abstract Background Existing literature on mood disorders suggests that the demographic distribution of bipolar disorder may differ from that of unipolar depression, and also that bipolar disorder may be especially disruptive to personal functioning. Yet, few studies have directly compared the populations with unipolar depressive and bipolar disorders, whether in terms of demographic characteristics or personal limitations. Furthermore, studies have generally examined work-related costs, without fully investigating the extensive personal limitations associated with diagnoses of specific mood disorders. The purpose of the present study is to compare, at a national level, the demographic characteristics, work productivity, and personal limitations among individuals diagnosed with bipolar disorder versus those diagnosed with unipolar depressive disorders and no mood disorder. Methods The Medical Expenditure Panel Survey 2004-2006, a nationally representative survey of the civilian, non-institutionalized U.S. population, was used to identify individuals diagnosed with bipolar disorder and unipolar depressive disorders based on ICD-9 classifications. Outcomes of interest were indirect costs, including work productivity and personal limitations. Results Compared to those with depression and no mood disorder, higher proportions of the population with bipolar disorder were poor, living alone, and not married. Also, the bipolar disorder population had higher rates of unemployment and social, cognitive, work, and household limitations than the depressed population. In multivariate models, patients with bipolar disorder or depression were more likely to be unemployed, miss work, and have social, cognitive, physical, and household limitations than those with no mood disorder. Notably, findings indicated particularly high costs for bipolar disorder, even beyond depression, with especially large differences in odds ratios for non-employment (4.6 for bipolar

  1. Attention-deficit/hyperactivity disorder in adults with bipolar disorder or major depressive disorder: results from the international mood disorders collaborative project.

    Science.gov (United States)

    McIntyre, Roger S; Kennedy, Sidney H; Soczynska, Joanna K; Nguyen, Ha T T; Bilkey, Timothy S; Woldeyohannes, Hanna O; Nathanson, Jay A; Joshi, Shikha; Cheng, Jenny S H; Benson, Kathleen M; Muzina, David J

    2010-01-01

    Relatively few studies have evaluated the clinical implications of lifetime attention-deficit/hyperactivity disorder (ADHD) in adults with bipolar disorder or major depressive disorder (MDD). Herein, we sought to determine the prevalence as well as the demographic and clinical correlates of lifetime ADHD in persons with a mood disorder. The first 399 patients enrolled in the International Mood Disorders Collaborative Project (IMDCP) were evaluated for lifetime ADHD using the Mini-International Neuropsychiatric Interview-Plus (MINI-Plus) as the primary instrument to derive current and lifetime DSM-IV diagnoses. All analyses of variables of interest were conducted utilizing the MINI-Plus, the Adult ADHD Self-Report Scale-v1.1, and the Wender Utah Rating Scale-Short Form. The effect of ADHD on clinical presentation, course of illness variables, comorbidity, anamnesis, treatment, and outcome are reported. The IMDCP is a joint initiative of the Mood Disorders Psychopharmacology Unit at the University Health Network, University of Toronto, Toronto, Ontario, Canada, and the Cleveland Clinic Center for Mood Disorders Treatment and Research at Lutheran Hospital, Cleveland, Ohio. All data for this study were procured between January 2008 and January 2009. The percentages of subjects with MDD or bipolar disorder meeting the DSM-IV criteria for lifetime adult ADHD were 5.4% and 17.6% (P disorder populations was associated with earlier age at illness onset (MDD, P = .049; bipolar disorder, P = .005), a higher number of psychiatric comorbidities (eg, MDD and current panic disorder with agoraphobia [P = .002]; bipolar disorder and social phobia [P = .012]), and decreased quality of life (MDD, P = .018). The overarching findings herein are that the adult ADHD phenotype is commonly reported by individuals with MDD or bipolar disorder and is associated with a greater illness burden and complexity.

  2. Cytokines in bipolar disorder vs. healthy control subjects

    DEFF Research Database (Denmark)

    Munkholm, Klaus; Braüner, Julie Vestergaard; Kessing, Lars Vedel

    2013-01-01

    Bipolar disorder may be associated with peripheral immune system dysfunction; however, results in individual studies are conflicting. Our aim was to systematically review evidence of peripheral cytokine alterations in bipolar disorder integrating findings from various affective states....

  3. Bipolar Disorder and Alcoholism: Are They Related?

    Science.gov (United States)

    ... Is there a connection between bipolar disorder and alcoholism? Answers from Daniel K. Hall-Flavin, M.D. Bipolar disorder and alcoholism often occur together. Although the association between bipolar ...

  4. Results from an online survey of patient and caregiver perspectives on unmet needs in the treatment of bipolar disorder.

    Science.gov (United States)

    Masand, Prakash S; Tracy, Natasha

    2014-01-01

    To look at the manner in which patients and caregivers perceive the treatment of bipolar disorder compared with the evidence base for bipolar treatment. Between April 2013 and March 2014, 469 respondents took a 14-question online survey on demographics, medications taken, and perspectives on bipolar treatment and medications. Participants were recruited through social media outlets (Facebook and Twitter accounts) of Global Medical Education (New York, New York) and the blog Bipolar Burble, which has a primary audience of people with bipolar disorder. There were no exclusion criteria to participation, and both patients and health care professionals were encouraged to participate. Most respondents were taking ≥ 3 medications, and the greatest unmet need in treatment was for bipolar depression. In general, respondent perspectives on the effectiveness of individual medication treatments did not align with the available literature. Weight gain was the greatest side effect concern for both antipsychotics and mood stabilizers. Our survey demonstrates that there are still many unmet needs in the treatment of bipolar disorder. There is also a mismatch between the evidence base for treatments in bipolar disorder and patient perception of the relative efficacy of different medications. In order to achieve better outcomes, there is a need to provide patients and clinicians greater quality education with regard to the best evidence-based treatments for bipolar disorder.

  5. Work impairment in bipolar disorder patients--results from a two-year observational study (EMBLEM).

    Science.gov (United States)

    Reed, C; Goetz, I; Vieta, E; Bassi, M; Haro, J M

    2010-10-01

    To explore factors associated with work impairment at 2 years following an acute episode. European Mania in Bipolar disorder Longitudinal Evaluation of Medication (EMBLEM) is a prospective, observational study on the outcomes of patients with a manic/mixed episode. Work impairment was measured using a Longitudinal Interval Follow-up Evaluation (slice of LIFE) item and patients were categorised with either low or high work impairment at each observation. Baseline factors associated with work impairment at 2 years were assessed using multivariate modelling. At baseline (n=2289), 69% of patients had high work impairment. At 2 years (n=1393), high impairment reduced to 41%. Modelling identified rapid cycling as the strongest disease-related factor associated with high work impairment at 2 years, although high work impairment at baseline had the strongest association overall. Lower levels of education, recent admissions, CGI-BP overall severity in the 12 months prior to baseline and CGI-BP mania at baseline all predicted higher work impairment. Living together in a relationship and independent housing were both significantly associated with having low work impairment at 2 years. Work impairment in bipolar disorder is maintained over long periods, and is strongly associated with relationship status, living conditions and various disease-related factors. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  6. Asenapine for bipolar disorder

    Directory of Open Access Journals (Sweden)

    Scheidemantel T

    2015-12-01

    Full Text Available Thomas Scheidemantel,1 Irina Korobkova,2 Soham Rej,3,4 Martha Sajatovic1,2 1University Hospitals Case Medical Center, 2Case Western Reserve University School of Medicine, Cleveland, OH, USA; 3Department of Psychiatry, University of Toronto, Toronto, ON, 4Geri PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada Abstract: Asenapine (Saphris® is an atypical antipsychotic drug which has been approved by the US Food and Drug Administration for the treatment of schizophrenia in adults, as well as the treatment of acute manic or mixed episodes of bipolar I in both adult and pediatric populations. Asenapine is a tetracyclic drug with antidopaminergic and antiserotonergic activity with a unique sublingual route of administration. In this review, we examine and summarize the available literature on the safety, efficacy, and tolerability of asenapine in the treatment of bipolar disorder (BD. Data from randomized, double-blind trials comparing asenapine to placebo or olanzapine in the treatment of acute manic or mixed episodes showed asenapine to be an effective monotherapy treatment in clinical settings; asenapine outperformed placebo and showed noninferior performance to olanzapine based on improvement in the Young Mania Rating Scale scores. There are limited data available on the use of asenapine in the treatment of depressive symptoms of BD, or in the maintenance phase of BD. The available data are inconclusive, suggesting the need for more robust data from prospective trials in these clinical domains. The most commonly reported adverse effect associated with use of asenapine is somnolence. However, the somnolence associated with asenapine use did not cause significant rates of discontinuation. While asenapine was associated with weight gain when compared to placebo, it appeared to be modest when compared to other atypical antipsychotics, and its propensity to cause increases in hemoglobin A1c or serum lipid levels appeared to be

  7. Treatment patterns of youth with bipolar disorder: results from the National Comorbidity Survey-Adolescent Supplement (NCS-A).

    Science.gov (United States)

    Khazanov, Gabriela Kattan; Cui, Lihong; Merikangas, Kathleen Ries; Angst, Jules

    2015-02-01

    Despite growing evidence that bipolar disorder often emerges in adolescence, there are limited data regarding treatment patterns of youth with bipolar disorder in community samples. Our objective was to present the prevalence and clinical correlates of treatment utilization for a nationally representative sample of US adolescents with bipolar disorder. Analyses are based on data from the National Comorbidity Survey-Adolescent Supplement, a face-to-face survey of 10,123 adolescents (ages 13-18) identified in household and school settings. We found that of adolescents meeting DSM-IV criteria for bipolar I or II disorder (N = 250), 49 % were treated for depression or mania, 13 % were treated for conditions other than depression or mania, and 38 % did not report receiving treatment. Treatment for depression or mania was associated with increased rates of suicide attempts, as well as greater role disability and more comorbid alcohol use relative to those who had not received treatment. Treated adolescents had triple the rate of ADHD and double the rates of behavior disorders than those without treatment. Our findings demonstrate that a substantial proportion of youth with bipolar disorder do not receive treatment, and of those who do, many receive treatment for comorbid conditions rather than for their mood-related symptoms. Treatment was more common among youth with severe manifestations and consequences of bipolar disorder and those with behavior problems. These trends highlight the need to identify barriers to treatment for adolescents with bipolar disorder and demonstrate that those in treatment are not representative of youth with bipolar disorder in the general population.

  8. Epidemiology of DSM-5 bipolar I disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions - III.

    Science.gov (United States)

    Blanco, Carlos; Compton, Wilson M; Saha, Tulshi D; Goldstein, Benjamin I; Ruan, W June; Huang, Boji; Grant, Bridget F

    2017-01-01

    The objective of this study was to present 12-month and lifetime prevalence, correlates, comorbidity, treatment and disability of DSM-5 bipolar I disorder. Nationally representative U.S. adult sample (N = 36,309), the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions - III. Prevalences of 12-month and lifetime DSM-5 bipolar I disorder were 1.5% and 2.1% and did not differ between men (1.6% and 2.2%) and women (1.5% and 2.0%). Prevalences of bipolar I disorder were greater among Native Americans, and lower among Blacks, Hispanics and Asians/Pacific Islanders than whites. Rates were also lower among younger than older individuals, those previously married than currently married and with lower education and income relative to higher education and income. Bipolar I disorder was more strongly related to borderline and schizotypal personality disorders (adjusted odds ratios (AORS) = 2.2-4.7)), than to anxiety disorders (AORs = 1.3-2.9), and substance use disorders (AORs = 1.3-2.1) overall and among men and women. Quality of life was lower among individuals with bipolar I disorder relative to those without the disorder. Treatment rates among individuals with bipolar I disorder were low in the total sample (46%, SE = 2.63), among men (36.7%, SE = 3.82) and among women (55.8%, SE = 3.32). Bipolar I disorder continues to be common disabling and highly comorbid disorder among men and women, contributing substantially to low quality of life and burden of disease in our society. Copyright © 2016. Published by Elsevier Ltd.

  9. Modeling suicide in bipolar disorders.

    Science.gov (United States)

    Malhi, Gin S; Outhred, Tim; Das, Pritha; Morris, Grace; Hamilton, Amber; Mannie, Zola

    2018-02-19

    Suicide is a multicausal human behavior, with devastating and immensely distressing consequences. Its prevalence is estimated to be 20-30 times greater in patients with bipolar disorders than in the general population. The burden of suicide and its high prevalence in bipolar disorders make it imperative that our current understanding be improved to facilitate prediction of suicide and its prevention. In this review, we provide a new perspective on the process of suicide in bipolar disorder, in the form of a novel integrated model that is derived from extant knowledge and recent evidence. A literature search of articles on suicide in bipolar disorder was conducted in recognized databases such as Scopus, PubMed, and PsycINFO using the keywords "suicide", "suicide in bipolar disorders", "suicide process", "suicide risk", "neurobiology of suicide" and "suicide models". Bibliographies of identified articles were further scrutinized for papers and book chapters of relevance. Risk factors for suicide in bipolar disorders are well described, and provide a basis for a framework of epigenetic mechanisms, moderated by neurobiological substrates, neurocognitive functioning, and social inferences within the environment. Relevant models and theories include the diathesis-stress model, the bipolar model of suicide and the ideation-to-action models, the interpersonal theory of suicide, the integrated motivational-volitional model, and the three-step theory. Together, these models provide a basis for the generation of an integrated model that illuminates the suicidal process, from ideation to action. Suicide is complex, and it is evident that a multidimensional and integrated approach is required to reduce its prevalence. The proposed model exposes and provides access to components of the suicide process that are potentially measurable and may serve as novel and specific therapeutic targets for interventions in the context of bipolar disorder. Thus, this model is useful not only

  10. Sexual health and women with bipolar disorder.

    Science.gov (United States)

    McCandless, Fiona; Sladen, Claire

    2003-10-01

    The aim of this paper is to illustrate the importance of sexual health promotion strategies for women with bipolar disorder in order to stimulate interest and debate in this area of care. Sexual health promotion is an important aspect of holistic nursing care. However, the literature indicates that nurses are reluctant to discuss sexual health and sexual behaviour with their clients. People with bipolar disorder warrant special consideration with regards to sexual health because the nature of the manic, or hypomanic, mood state is associated in some cases with sexually risky behaviour. For women with bipolar disorder, the associated risks include the threat of unplanned pregnancy or sexually transmitted diseases. To ignore sexual health and sexual behaviour in mental health care increases the vulnerability of women who may already be at risk of sexual exploitation. CASE EXAMPLE: A brief case example is included to demonstrate how the sexual health of a young woman with bipolar disorder was promoted. The sexual health promotion that was incorporated into her care enabled her to make a choice about appropriate contraception, and also provided her with the opportunity to explore acceptable boundaries in different types of interpersonal relationships. As a result of the episodic nature of Bipolar disorder, it is impossible to state whether the positive outcomes from this strategy will be enduring or not. Consideration of sexual health is an essential element of the care of women with Bipolar disorder. To ignore it is to neglect an important sphere of human behaviour that can be affected by the condition.

  11. The role of sleep in bipolar disorder

    Directory of Open Access Journals (Sweden)

    Gold AK

    2016-06-01

    Full Text Available Alexandra K Gold,1 Louisa G Sylvia,1,2 1Department of Psychiatry, Massachusetts General Hospital, 2Harvard Medical School, Boston, MA, USA Abstract: Bipolar disorder is a serious mental illness characterized by alternating periods of elevated and depressed mood. Sleep disturbances in bipolar disorder are present during all stages of the condition and exert a negative impact on overall course, quality of life, and treatment outcomes. We examine the partnership between circadian system (process C functioning and sleep–wake homeostasis (process S on optimal sleep functioning and explore the role of disruptions in both systems on sleep disturbances in bipolar disorder. A convergence of evidence suggests that sleep problems in bipolar disorder result from dysregulation across both process C and process S systems. Biomarkers of depressive episodes include heightened fragmentation of rapid eye movement (REM sleep, reduced REM latency, increased REM density, and a greater percentage of awakenings, while biomarkers of manic episodes include reduced REM latency, greater percentage of stage I sleep, increased REM density, discontinuous sleep patterns, shortened total sleep time, and a greater time awake in bed. These findings highlight the importance of targeting novel treatments for sleep disturbance in bipolar disorder. Keywords: bipolar disorder, circadian rhythms, sleep–wake homeostasis

  12. Imunologia do transtorno bipolar Immunology of bipolar disorder

    Directory of Open Access Journals (Sweden)

    Izabela Guimarães Barbosa

    2009-01-01

    Full Text Available OBJETIVO: Pesquisas recentes têm implicado fatores imunes na patogênese de diversos transtornos neuropsiquiátricos. O objetivo do presente trabalho é revisar os trabalhos que investigaram a associação entre transtorno bipolar e alterações em parâmetros imunes. MÉTODOS: Artigos que incluíam as palavras-chave: "bipolar disorder", "mania", "immunology", "cytokines", "chemokines", "interleukins", "interferon" e "tumor necrosis factor" foram selecionados em uma revisão sistemática da literatura. As bases de dados avaliadas foram MedLine e Scopus, entre os anos de 1980 e 2008. RESULTADOS: Foram identificados 28 trabalhos que estudaram alterações imunes em pacientes com transtorno bipolar. Seis artigos investigaram genes relacionados à resposta imune; cinco, autoanticorpos; quatro, populações leucocitárias; 13, citocinas e/ou moléculas relacionadas à resposta imune e seis, leucócitos de pacientes in vitro. CONCLUSÕES: Embora haja evidências na literatura correlacionando o transtorno bipolar a alterações imunes, os dados não são conclusivos. O transtorno bipolar parece estar associado a níveis mais elevados de autoanticorpos circulantes, assim como à tendência à ativação imune com produção de citocinas pró-inflamatórias e redução de parâmetros anti-inflamatórios.OBJECTIVE: Emerging research has implicated immune factors in the pathogenesis of a variety of neuropsychiatric disorders. The objective of the present paper is to review the studies that investigated the association between bipolar disorder and immune parameters. METHODS: Papers that included the keywords "bipolar to disorder", "mania", "immunology", "cytokines", "chemokines", "interleukins", "interferon" and "tumor necrosis factor" were selected in a systematic review of the literature. The evaluated databases were MedLine and Scopus in the period between 1980 and 2008. RESULTS: Twenty eight works were found. Six studies investigated immune response

  13. Comorbidity bipolar disorder and personality disorders.

    Science.gov (United States)

    Latalova, Klara; Prasko, Jan; Kamaradova, Dana; Sedlackova, Jana; Ociskova, Marie

    2013-01-01

    Outcome in bipolar patients can be affected by comorbidity of other psychiatric disorders. Comorbid personality disorders are frequent and may complicate the course of bipolar illness. We have much information about treating patients with uncomplicated bipolar disorder (BD) but much less knowledge about possibilities for patients with the comorbidity of BD and personality disorder. We conducted a series of literature searches using, as key words or as items in indexed fields, bipolar disorder and personality disorder or personality traits. Articles were obtained by searching MEDLINE from 1970 to 2012. In addition, we used other papers cited in articles from these searches, or cited in articles used in our own work. Tests of personality traits indicated that euthymic bipolar patients have higher scores on harm avoidance, reward dependence, and novelty seeking than controls. Elevation of novelty seeking in bipolar patients is associated with substance abuse comorbidity. Comorbidity with personality disorders in BD patients is associated with a more difficult course of illness (such as longer episodes, shorter time euthymic, and earlier age at onset) and an increase in comorbid substance abuse, suicidality and aggression. These problems are particularly pronounced in comorbidity with borderline personality disorder. Comorbidity with antisocial personality disorder elicits a similar spectrum of difficulties; some of the antisocial behavior exhibited by patients with this comorbidity is mediated by increased impulsivity.

  14. [Drug Abuse Comorbidity in Bipolar Disorder].

    Science.gov (United States)

    Ortiz, Óscar Medina

    2012-06-01

    Drug use among patients with bipolar disorder is greater than the one observed in the general population; psychotic episodes are likely to occur after consumption. This has implications in the prevention, etiology, management, and treatment of the disease. Bipolar disorder pathology is likely to have positive response to pharmacological treatment. Therefore, identifying the strategies with better results to be applied in these patients is fundamental for psychiatrists and primary care physicians. Review literature in order to determine the prevalence and characteristics of drug abuse in patients with bipolar disorder and establish the pharmacological strategies that have produced better results. Literature review. A great variety of studies demonstrate the relationship between bipolar disorder and drug use disorder. These patients are hospitalized more frequently, have an earlier onset of the disease, and present a larger number of depressive episodes and suicide attempts which affect the course of the disease. The drug with better results in the treatment of these patients is Divalproate. Satisfactory results have been also obtained with other mood stabilizers such as carbamazepine, lamotrigine, and the antipsychotic aripiprazole. Substance abuse is present in a large number of patients with bipolar disorder. The Divalproate is the drug that has shown better results in the studies. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  15. Exercising control over bipolar disorder.

    Science.gov (United States)

    Malhi, Gin S; Byrow, Yulisha

    2016-11-01

    Following extensive research exercise has emerged as an effective treatment for major depressive disorder, and it is now a recognised therapy alongside other interventions. In contrast, there is a paucity of research examining the therapeutic effects of exercise for those with bipolar disorder. Given that dysfunctional reward processing is central to bipolar disorder, research suggests that exercise can perhaps be framed as a reward-related event that may have the potential to precipitate a manic episode. The behavioural activation system (BAS) is a neurobehavioural system that is associated with responding to reward and provides an appropriate framework to theoretically examine and better understand the effects of exercise treatment on bipolar disorder. This article discusses recent research findings and provides an overview of the extant literature related to the neurobiological underpinnings of BAS and exercise as they relate to bipolar disorder. This is important clinically because depending on mood state in bipolar disorder, we postulate that exercise could be either beneficial or deleterious with positive or negative effects on the illness. Clearly, this complicates the evaluation of exercise as a potential treatment in terms of identifying its optimal characteristics in this population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  16. The International Society for Bipolar Disorders (ISBD) Task Force Report on Antidepressant Use in Bipolar Disorders

    Science.gov (United States)

    Pacchiarotti, Isabella; Bond, David J.; Baldessarini, Ross J.; Nolen, Willem A.; Grunze, Heinz; Licht, Rasmus W.; Post, Robert M.; Berk, Michael; Goodwin, Guy M.; Sachs, Gary S.; Tondo, Leonardo; Findling, Robert L.; Youngstrom, Eric A.; Tohen, Mauricio; Undurraga, Juan; González-Pinto, Ana; Goldberg, Joseph F.; Yildiz, Ayşegül; Altshuler, Lori L.; Calabrese, Joseph R.; Mitchell, Philip B.; Thase, Michael E.; Koukopoulos, Athanasios; Colom, Francesc; Frye, Mark A.; Malhi, Gin S.; Fountoulakis, Konstantinos N.; Vázquez, Gustavo; Perlis, Roy H.; Ketter, Terence A.; Cassidy, Frederick; Akiskal, Hagop; Azorin, Jean-Michel; Valentí, Marc; Mazzei, Diego Hidalgo; Lafer, Beny; Kato, Tadafumi; Mazzarini, Lorenzo; Martínez-Aran, Anabel; Parker, Gordon; Souery, Daniel; Özerdem, Ayşegül; McElroy, Susan L.; Girardi, Paolo; Bauer, Michael; Yatham, Lakshmi N.; Zarate, Carlos A.; Nierenberg, Andrew A.; Birmaher, Boris; Kanba, Shigenobu; El-Mallakh, Rif S.; Serretti, Alessandro; Rihmer, Zoltan; Young, Allan H.; Kotzalidis, Georgios D.; MacQueen, Glenda M.; Bowden, Charles L.; Ghaemi, S. Nassir; Lopez-Jaramillo, Carlos; Rybakowski, Janusz; Ha, Kyooseob; Perugi, Giulio; Kasper, Siegfried; Amsterdam, Jay D.; Hirschfeld, Robert M.; Kapczinski, Flávio; Vieta, Eduard

    2014-01-01

    Objective The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders. Method An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. Results There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. Conclusions Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to mood-stabilizing medications

  17. Determining if Borderline Personality Disorder and Bipolar Disorder Are Alternative Expressions of the Same Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions.

    Science.gov (United States)

    de la Rosa, Iris; Oquendo, María A; García, Gemma; Stanley, Barbara; González-Pinto, Ana; Liu, Shang-Min; Blanco, Carlos

    To examine whether bipolar disorder and borderline personality disorder represent 2 different disorders or alternative manifestations of the same disorder. The data were collected between January 1, 2004, and December 31, 2005. The analyses were conducted between December 21 and December 27, 2010. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed on 25 symptoms assessing depression, mania, and borderline personality disorder from the National Epidemiologic Survey on Alcohol and Related Conditions, a large nationally representative sample of the US adult population (N = 34,653). DSM-IV criteria were used for diagnosis of bipolar disorder and borderline personality disorder. A 3-factor solution provided an excellent fit in both the EFA (root mean square error of approximation [RMSEA] = 0.017, comparative fix index [CFI] = 0.997) and the CFA (RMSEA = 0.024, CFI = 0.993). Factor 1 (Borderline Personality Disorder) loaded on all 9 borderline personality disorder symptoms, factor 2 (Depression) loaded on 8 symptoms of depression, and factor 3 (Mania) loaded on 7 symptoms of mania plus the psychomotor agitation item of the depression section. The correlations between the Borderline Personality Disorder and Depression factors (r = 0.328) and between the Borderline Personality Disorder and Mania factors (r = 0.394) were lower than the correlation between Depression and Mania factors (r = 0.538). A model with 3 positively correlated factors provided an excellent fit for the latent structure of borderline personality disorder and bipolar disorder symptoms. The pattern of pairwise correlations between the 3 factors is consistent with the clinical presentation of 2 syndromes (depression and mania) that can be characterized as a unitary psychiatric entity (bipolar disorder) and a third syndrome (borderline personality disorder) that is often comorbid with bipolar disorder. The findings converge in suggesting that bipolar disorder and

  18. Dialectical behavior therapy for adolescents with bipolar disorder: results from a pilot randomized trial.

    Science.gov (United States)

    Goldstein, Tina R; Fersch-Podrat, Rachael K; Rivera, Maribel; Axelson, David A; Merranko, John; Yu, Haifeng; Brent, David A; Birmaher, Boris

    2015-03-01

    The purpose of this study was to conduct a pilot randomized trial of dialectical behavior therapy (DBT) versus psychosocial treatment as usual (TAU) for adolescents diagnosed with bipolar disorder (BP). We recruited participants 12-18 years of age with a primary BP diagnosis (I, II, or operationalized not otherwise specified [NOS] criteria) from a pediatric specialty clinic. Eligible patients were assigned using a 2:1 randomization structure to either DBT (n=14) or psychosocial TAU (n=6). All patients received medication management from a study-affiliated psychiatrist. DBT included 36 sessions (18 individual, 18 family skills training) over 1 year. TAU was an eclectic psychotherapy approach consisting of psychoeducational, supportive, and cognitive behavioral techniques. An independent evaluator, blind to treatment condition, assessed outcomes including affective symptoms, suicidal ideation and behavior, nonsuicidal self-injurious behavior, and emotional dysregulation, quarterly over 1 year. Adolescents receiving DBT attended significantly more therapy sessions over 1 year than did adolescents receiving TAU, possibly reflecting greater engagement and retention; both treatments were rated as highly acceptable by adolescents and parents. As compared with adolescents receiving TAU, adolescents receiving DBT demonstrated significantly less severe depressive symptoms over follow-up, and were nearly three times more likely to demonstrate improvement in suicidal ideation. Models indicate a large effect size, for more weeks being euthymic, over follow-up among adolescents receiving DBT. Although there were no between-group differences in manic symptoms or emotional dysregulation with treatment, adolescents receiving DBT, but not those receiving TAU, evidenced improvement from pre- to posttreatment in both manic symptoms and emotional dysregulation. DBT may offer promise as an adjunct to pharmacotherapy in the treatment of depressive symptoms and suicidal ideation for

  19. Bipolar Disorder in Children and Teens

    Science.gov (United States)

    ... I do? Share Bipolar Disorder in Children and Teens Download PDF Download ePub Order a free hardcopy ... Think about death or suicide Can children and teens with bipolar disorder have other problems? Young people ...

  20. Integrated neurobiology of bipolar disorder

    Directory of Open Access Journals (Sweden)

    Vladimir eMaletic

    2014-08-01

    Full Text Available From a neurobiological perspective there is no such thing as bipolar disorder. Rather, it is almost certainly the case that many somewhat similar, but subtly different, pathological conditions produce a disease state that we currently diagnose as bipolarity. This heterogeneity—reflected in the lack of synergy between our current diagnostic schema and our rapidly advancing scientific understanding of the condition—limits attempts to articulate an integrated perspective on bipolar disorder. However, despite these challenges, scientific findings in recent years are beginning to offer a provisional unified field theory of the disease. This theory sees bipolar disorder as a suite of related neurodevelopmental conditions with interconnected functional abnormalities that often appear early in life and worsen over time. In addition to accelerated loss of volume in brain areas known to be essential for mood regulation and cognitive function, consistent findings have emerged at a cellular level, providing evidence that bipolar disorder is reliably associated with dysregulation of glial-neuronal interactions. Among these glial elements are microglia—the brain’s primary immune elements, which appear to be overactive in the context of bipolarity. Multiple studies now indicate that inflammation is also increased in the periphery of the body in both the depressive and manic phases of the illness, with at least some return to normality in the euthymic state. These findings are consistent with changes in the HPA axis, which are known to drive inflammatory activation. In summary, the very fact that no single gene, pathway or brain abnormality is likely to ever account for the condition is itself an extremely important first step in better articulating an integrated perspective on both its ontological status and pathogenesis. Whether this perspective will translate into the discovery of innumerable more homogeneous forms of bipolarity is one of the great

  1. Systematic review of the prevalence of bipolar disorder and bipolar spectrum disorders in population-based studies.

    Science.gov (United States)

    Dell'Aglio, José Caetano; Basso, Lissia Ana; Argimon, Irani Iracema de Lima; Arteche, Adriane

    2013-01-01

    This paper describes the findings of a systematic literature review aimed at providing an overview of the lifetime prevalence of bipolar disorder and bipolar spectrum disorders in population-based studies. Databases MEDLINE, ProQuest, Psychnet, and Web of Science were browsed for papers published in English between 1999 and May 2012 using the following search string: bipolar disorders OR bipolar spectrum disorders AND prevalence OR cross-sectional OR epidemiology AND population-based OR non-clinical OR community based. The search yielded a total of 434 papers, but only those published in peer-reviewed journals and with samples aged ≥ 18 years were included, resulting in a final sample of 18 papers. Results revealed rather heterogeneous findings concerning the prevalence of bipolar disorders and bipolar spectrum disorders. Lifetime prevalence of bipolar disorder ranged from 0.1 to 7.5%, whereas lifetime prevalence of bipolar spectrum disorders ranged from 2.4 to 15.1%. Differences in the rates of bipolar disorder and bipolar spectrum disorders may be related to the consideration of subthreshold criteria upon diagnosis. Differences in the prevalence of different subtypes of the disorder are discussed in light of diagnostic criteria and instruments applied.

  2. Systematic review of the prevalence of bipolar disorder and bipolar spectrum disorders in population-based studies

    Directory of Open Access Journals (Sweden)

    José Caetano Dell'Aglio Jr.

    2013-01-01

    Full Text Available This paper describes the findings of a systematic literature review aimed at providing an overview of the lifetime prevalence of bipolar disorder and bipolar spectrum disorders in population-based studies. Databases MEDLINE, ProQuest, Psychnet, and Web of Science were browsed for papers published in English between 1999 and May 2012 using the following search string: bipolar disorders OR bipolar spectrum disorders AND prevalence OR cross-sectional OR epidemiology AND population-based OR non-clinical OR community based. The search yielded a total of 434 papers, but only those published in peer-reviewed journals and with samples aged ≥ 18 years were included, resulting in a final sample of 18 papers. Results revealed rather heterogeneous findings concerning the prevalence of bipolar disorders and bipolar spectrum disorders. Lifetime prevalence of bipolar disorder ranged from 0.1 to 7.5%, whereas lifetime prevalence of bipolar spectrum disorders ranged from 2.4 to 15.1%. Differences in the rates of bipolar disorder and bipolar spectrum disorders may be related to the consideration of subthreshold criteria upon diagnosis. Differences in the prevalence of different subtypes of the disorder are discussed in light of diagnostic criteria and instruments applied.

  3. Comorbidity of bipolar disorder and eating disorders.

    Science.gov (United States)

    Álvarez Ruiz, Eva M; Gutiérrez-Rojas, Luis

    2015-01-01

    The comorbidity of bipolar disorder and eating disorders has not been studied in depth. In addition, clinical implications involved in the appearance of both disorders are very important. A systematic literature review of MEDLINE published up to September 2013 was performed, analyzing all the articles that studied the comorbidity of both conditions (bipolar disorder and eating disorders) and others research that studied the efficacy of pharmacological treatment and psychotherapy to improve these illnesses. In this review we found a high comorbidity of bipolar disorder and eating disorders, especially of bulimia nervosa and binge eating disorder. Studies show that lithium and topiramate are 2 of the more effective pharmacological agents in the treatment of both disorders. There are a lot of studies that show evidence of comorbidity of bipolar disorder and eating disorders. However, further research is needed on assessment and treatment when these conditions co-exist, as well as study into the biopsychological aspects to determine the comorbid aetiology. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

  4. DeepBipolar: Identifying genomic mutations for bipolar disorder via deep learning.

    Science.gov (United States)

    Laksshman, Sundaram; Bhat, Rajendra Rana; Viswanath, Vivek; Li, Xiaolin

    2017-09-01

    Bipolar disorder, also known as manic depression, is a brain disorder that affects the brain structure of a patient. It results in extreme mood swings, severe states of depression, and overexcitement simultaneously. It is estimated that roughly 3% of the population of the United States (about 5.3 million adults) suffers from bipolar disorder. Recent research efforts like the Twin studies have demonstrated a high heritability factor for the disorder, making genomics a viable alternative for detecting and treating bipolar disorder, in addition to the conventional lengthy and costly postsymptom clinical diagnosis. Motivated by this study, leveraging several emerging deep learning algorithms, we design an end-to-end deep learning architecture (called DeepBipolar) to predict bipolar disorder based on limited genomic data. DeepBipolar adopts the Deep Convolutional Neural Network (DCNN) architecture that automatically extracts features from genotype information to predict the bipolar phenotype. We participated in the Critical Assessment of Genome Interpretation (CAGI) bipolar disorder challenge and DeepBipolar was considered the most successful by the independent assessor. In this work, we thoroughly evaluate the performance of DeepBipolar and analyze the type of signals we believe could have affected the classifier in distinguishing the case samples from the control set. © 2017 Wiley Periodicals, Inc.

  5. Family History in Patients with Bipolar Disorder.

    Science.gov (United States)

    Özdemir, Osman; Coşkun, Salih; Aktan Mutlu, Elif; Özdemir, Pınar Güzel; Atli, Abdullah; Yilmaz, Ekrem; Keskin, Sıddık

    2016-09-01

    In this study, we aimed to better understand the genetic transmission of bipolar disorder by examining the family history of patients. Sixty-three patients with bipolar disorder and their families were included. The final sample comprised 156 bipolar patients and their family members. An inclusion criterion was the presence of bipolar disorder history in the family. The diagnosis of other family members was confirmed by analyzing their files, hospital records, and by calling them to the hospital. Sixty-five patients were women (41.6%) and 91 were men (58.3%) (ratio of men/women: 1.40). When analyzing the results in terms of the transition of disease from the mother's or father's side, similar results were obtained: 25 patients were from the mother's side and 25 patients were from the father's side in 63 cases. The results of our study support the fact that a significant relationship exists between the degree of kinship and the heritability of bipolar disorder and, furthermore, that the effect of the maternal and paternal sides is similar on the transmission of genetic susceptibility.

  6. Bipolar disorder and neurophysiologic mechanisms

    Directory of Open Access Journals (Sweden)

    Simon M McCrea

    2008-11-01

    Full Text Available Simon M McCreaDepartments of Neurology and Neuroophthalmology, University of British Columbia, 2550 Willow Street, Vancouver, British Columbia, Canada V5Z 3N9Abstract: Recent studies have suggested that some variants of bipolar disorder (BD may be due to hyperconnectivity between orbitofrontal (OFC and temporal pole (TP structures in the dominant hemisphere. Some initial MRI studies noticed that there were corpus callosum abnormalities within specific regional areas and it was hypothesized that developmentally this could result in functional or effective connectivity changes within the orbitofrontal-basal ganglia-thalamocortical circuits. Recent diffusion tensor imaging (DTI white matter fiber tractography studies may well be superior to region of interest (ROI DTI in understanding BD. A “ventral semantic stream” has been discovered connecting the TP and OFC through the uncinate and inferior longitudinal fasciculi and the elusive TP is known to be involved in theory of mind and complex narrative understanding tasks. The OFC is involved in abstract valuation in goal and sub-goal structures and the TP may be critical in binding semantic memory with person–emotion linkages associated with narrative. BD patients have relative attenuation of performance on visuoconstructional praxis consistent with an atypical localization of cognitive functions. Multiple lines of evidence suggest that some BD alleles are being selected for which could explain the enhanced creativity in higher-ability probands. Associations between ROI’s that are not normally connected could explain the higher incidence of artistic aptitude, writing ability, and scientific achievements among some mood disorder subjects.Keywords: bipolar disorder, diffusion tensor imaging, white matter tractography, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, uncinate fasciculus, mood dysphoria, creativity, ventral semantic stream, writing ability, artistic aptitude

  7. Epidemiologia do transtorno bipolar Epidemiology of bipolar disorders

    Directory of Open Access Journals (Sweden)

    Maurício Silva de Lima

    2005-01-01

    surveys of psychiatric morbidity in adults have been conducted and as a result details on the frequency, risk factor, social disabilities, and service use rates of mental disorders are now available. Epidemiological findings on bipolar disorders are discussed on the light of results from recent large population-based surveys namely the Epidemiological Catchment Area Study (ECA, the National Comorbidity Survey (NCS, the OPCS Survey of Psychiatric Morbidity in Great Britain, the Brazilian Multicentric Study of Psychiatric Morbidity, and the longitudinal studies conducted in Zurich by Angst. Prevalence rates for bipolar disorder were generally low, regardless setting, the type of instrument used for generating psychiatric diagnosis, and the time periods by which prevalence is defined. Since the introduction of the concept of bipolar spectrum, broadening the boundaries of the disease, the estimate rates have been found to be substantially higher. Such rates still need to be validated by populational-based studies. Bipolar disorder is as prevalent in women as in men, more common among singles and separated or divorced people. Those affected by the disease are more likely to use medical services and to be hospitalized. The cost-effectiveness of treatments must be balanced with the high individual and social impact associated to the bipolar illness.

  8. Bipolar Disorder: What Can Psychotherapists Learn From the Cognitive Research?

    OpenAIRE

    Johnson, Sheri; Tran, Tanya

    2007-01-01

    Randomized controlled trials of psychological treatment, principally cognitive therapy, for bipolar disorder have yielded inconsistent results. Given the status of this evidentiary base, we provide a more fine-grained analysis of the cognitive profiles associated with bipolar disorder to inform clinical practice. In this practice-friendly review, we consider evidence that both negative and positive cognitive styles are related to bipolar disorder. Cross-sectional and prospective evidence sugg...

  9. Bipolar disorder, a precursor of Parkinson's disease?

    Directory of Open Access Journals (Sweden)

    Tânia M.S. Novaretti

    Full Text Available ABSTRACT Parkinson's disease is a neurodegenerative disorder predominantly resulting from dopamine depletion in the substantia nigra pars compacta. Some psychiatric disorders may have dopaminergic dysfunction as their substrate. We describe a well-documented case of Parkinson's disease associated with Bipolar Disorder. Although there is some knowledge about the association between these diseases, little is known about its pathophysiology and correlation. We believe that among various hypotheses, many neurotransmitters are linked to this pathophysiology.

  10. A YinYang bipolar fuzzy cognitive TOPSIS method to bipolar disorder diagnosis.

    Science.gov (United States)

    Han, Ying; Lu, Zhenyu; Du, Zhenguang; Luo, Qi; Chen, Sheng

    2018-05-01

    Bipolar disorder is often mis-diagnosed as unipolar depression in the clinical diagnosis. The main reason is that, different from other diseases, bipolarity is the norm rather than exception in bipolar disorder diagnosis. YinYang bipolar fuzzy set captures bipolarity and has been successfully used to construct a unified inference mathematical modeling method to bipolar disorder clinical diagnosis. Nevertheless, symptoms and their interrelationships are not considered in the existing method, circumventing its ability to describe complexity of bipolar disorder. Thus, in this paper, a YinYang bipolar fuzzy multi-criteria group decision making method to bipolar disorder clinical diagnosis is developed. Comparing with the existing method, the new one is more comprehensive. The merits of the new method are listed as follows: First of all, multi-criteria group decision making method is introduced into bipolar disorder diagnosis for considering different symptoms and multiple doctors' opinions. Secondly, the discreet diagnosis principle is adopted by the revised TOPSIS method. Last but not the least, YinYang bipolar fuzzy cognitive map is provided for the understanding of interrelations among symptoms. The illustrated case demonstrates the feasibility, validity, and necessity of the theoretical results obtained. Moreover, the comparison analysis demonstrates that the diagnosis result is more accurate, when interrelations about symptoms are considered in the proposed method. In a conclusion, the main contribution of this paper is to provide a comprehensive mathematical approach to improve the accuracy of bipolar disorder clinical diagnosis, in which both bipolarity and complexity are considered. Copyright © 2018 Elsevier B.V. All rights reserved.

  11. Mixed features in bipolar disorder.

    Science.gov (United States)

    Solé, Eva; Garriga, Marina; Valentí, Marc; Vieta, Eduard

    2017-04-01

    Mixed affective states, defined as the coexistence of depressive and manic symptoms, are complex presentations of manic-depressive illness that represent a challenge for clinicians at the levels of diagnosis, classification, and pharmacological treatment. The evidence shows that patients with bipolar disorder who have manic/hypomanic or depressive episodes with mixed features tend to have a more severe form of bipolar disorder along with a worse course of illness and higher rates of comorbid conditions than those with non-mixed presentations. In the updated Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5), the definition of "mixed episode" has been removed, and subthreshold nonoverlapping symptoms of the opposite pole are captured using a "with mixed features" specifier applied to manic, hypomanic, and major depressive episodes. However, the list of symptoms proposed in the DSM-5 specifier has been widely criticized, because it includes typical manic symptoms (such as elevated mood and grandiosity) that are rare among patients with mixed depression, while excluding symptoms (such as irritability, psychomotor agitation, and distractibility) that are frequently reported in these patients. With the new classification, mixed depressive episodes are three times more common in bipolar II compared with unipolar depression, which partly contributes to the increased risk of suicide observed in bipolar depression compared to unipolar depression. Therefore, a specific diagnostic category would imply an increased diagnostic sensitivity, would help to foster early identification of symptoms and ensure specific treatment, as well as play a role in suicide prevention in this population.

  12. [Bipolar disorders in DSM-5].

    Science.gov (United States)

    Severus, E; Bauer, M

    2014-05-01

    In spring 2013 the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) edited by the American Psychiatric Association was published. The DSM-5 has also brought some important changes regarding bipolar disorders. The goal of this manuscript is to review the novelties in DSM-5 and to evaluate the implications of these changes. The diagnostic criteria as well as the additional remarks provided in the running text of DSM-5 were carefully appraised. For the first time diagnostic criteria are provided for disorders which up to now have been considered as subthreshold bipolar disorders. Furthermore, mixed episodes were eliminated and instead a mixed specifier was introduced. An increase in goal-directed activity/energy is now one of the obligatory symptoms for a (hypo)manic episode. Diagnostic guidance is provided as to when a (hypo)manic episode that has developed during treatment with an antidepressant has to be judged to be causally related to antidepressants and when this episode has only occurred coincidentally with antidepressant use. While some of the novelties are clearly useful, e.g. addition of increased goal-directed activity/energy as obligatory symptom for (hypo)manic episodes, this remains to be demonstrated for others, such as the definition of various subthreshold bipolar disorders.

  13. Integrated Neurobiology of Bipolar Disorder

    Science.gov (United States)

    Maletic, Vladimir; Raison, Charles

    2014-01-01

    From a neurobiological perspective there is no such thing as bipolar disorder. Rather, it is almost certainly the case that many somewhat similar, but subtly different, pathological conditions produce a disease state that we currently diagnose as bipolarity. This heterogeneity – reflected in the lack of synergy between our current diagnostic schema and our rapidly advancing scientific understanding of the condition – limits attempts to articulate an integrated perspective on bipolar disorder. However, despite these challenges, scientific findings in recent years are beginning to offer a provisional “unified field theory” of the disease. This theory sees bipolar disorder as a suite of related neurodevelopmental conditions with interconnected functional abnormalities that often appear early in life and worsen over time. In addition to accelerated loss of volume in brain areas known to be essential for mood regulation and cognitive function, consistent findings have emerged at a cellular level, providing evidence that bipolar disorder is reliably associated with dysregulation of glial–neuronal interactions. Among these glial elements are microglia – the brain’s primary immune elements, which appear to be overactive in the context of bipolarity. Multiple studies now indicate that inflammation is also increased in the periphery of the body in both the depressive and manic phases of the illness, with at least some return to normality in the euthymic state. These findings are consistent with changes in the hypothalamic–pituitary–adrenal axis, which are known to drive inflammatory activation. In summary, the very fact that no single gene, pathway, or brain abnormality is likely to ever account for the condition is itself an extremely important first step in better articulating an integrated perspective on both its ontological status and pathogenesis. Whether this perspective will translate into the discovery of innumerable more homogeneous forms of

  14. Comparison of depressive episodes in bipolar disorder and in major depressive disorder within bipolar disorder pedigrees.

    Science.gov (United States)

    Mitchell, Philip B; Frankland, Andrew; Hadzi-Pavlovic, Dusan; Roberts, Gloria; Corry, Justine; Wright, Adam; Loo, Colleen K; Breakspear, Michael

    2011-10-01

    Although genetic epidemiological studies have confirmed increased rates of major depressive disorder among the relatives of people with bipolar affective disorder, no report has compared the clinical characteristics of depression between these two groups. To compare clinical features of depressive episodes across participants with major depressive disorder and bipolar disorder from within bipolar disorder pedigrees, and assess the utility of a recently proposed probabilistic approach to distinguishing bipolar from unipolar depression. A secondary aim was to identify subgroups within the relatives with major depression potentially indicative of 'genetic' and 'sporadic' subgroups. Patients with bipolar disorder types 1 and 2 (n = 246) and patients with major depressive disorder from bipolar pedigrees (n = 120) were assessed using the Diagnostic Interview for Genetic Studies. Logistic regression was used to identify distinguishing clinical features and assess the utility of the probabilistic approach. Hierarchical cluster analysis was used to identify subgroups within the major depressive disorder sample. Bipolar depression was characterised by significantly higher rates of psychomotor retardation, difficulty thinking, early morning awakening, morning worsening and psychotic features. Depending on the threshold employed, the probabilistic approach yielded a positive predictive value ranging from 74% to 82%. Two clusters within the major depressive disorder sample were found, one of which demonstrated features characteristic of bipolar depression, suggesting a possible 'genetic' subgroup. A number of previously identified clinical differences between unipolar and bipolar depression were confirmed among participants from within bipolar disorder pedigrees. Preliminary validation of the probabilistic approach in differentiating between unipolar and bipolar depression is consistent with dimensional distinctions between the two disorders and offers clinical utility in

  15. Bipolar disorder diagnosis: challenges and future directions

    Science.gov (United States)

    Phillips, Mary L; Kupfer, David J

    2018-01-01

    Bipolar disorder refers to a group of affective disorders, which together are characterised by depressive and manic or hypomanic episodes. These disorders include: bipolar disorder type I (depressive and manic episodes: this disorder can be diagnosed on the basis of one manic episode); bipolar disorder type II (depressive and hypomanic episodes); cyclothymic disorder (hypomanic and depressive symptoms that do not meet criteria for depressive episodes); and bipolar disorder not otherwise specified (depressive and hypomanic-like symptoms that do not meet the diagnostic criteria for any of the aforementioned disorders). Bipolar disorder type II is especially difficult to diagnose accurately because of the difficulty in differentiation of this disorder from recurrent unipolar depression (recurrent depressive episodes) in depressed patients. The identification of objective biomarkers that represent pathophysiologic processes that differ between bipolar disorder and unipolar depression can both inform bipolar disorder diagnosis and provide biological targets for the development of new and personalised treatments. Neuroimaging studies could help the identification of biomarkers that differentiate bipolar disorder from unipolar depression, but the problem in detection of a clear boundary between these disorders suggests that they might be better represented as a continuum of affective disorders. Innovative combinations of neuroimaging and pattern recognition approaches can identify individual patterns of neural structure and function that accurately ascertain where a patient might lie on a behavioural scale. Ultimately, an integrative approach, with several biological measurements using different scales, could yield patterns of biomarkers (biosignatures) to help identify biological targets for personalised and new treatments for all affective disorders. PMID:23663952

  16. [Comorbidity of eating disorders and bipolar affective disorders].

    Science.gov (United States)

    Kamińska, Katarzyna; Rybakowski, Filip

    2006-01-01

    Eating disorders--anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified (EDNOS) occur usually in young females. The significant pathogenic differences between patients who only restrict food, and patients with binge eating and compensatory behaviours, such as vomiting and purging were described. The prevalence of bipolar affective disorders--especially bipolar II and bipolar spectrum disorders (BS) may reach 5% in the general population. About half of the depressive episodes are associated with a "mild" bipolar disorder, and such a diagnosis is suggested by impulsivity and mood-instability. Previously, majority of research on the comorbidity between eating and affective disorders focused on depressive symptomatology, however difficulties in the reliable assessment of hypomania may obfuscate the estimation of the co-occurrence of eating disorders with BS. Epidemiological studies suggest the association between BS and eating disorders with binge episodes (bulimia nervosa, anorexia- bulimic type and EDNOS with binge episodes). Co-occurrence of such disorders with depressive symptoms probably suggests the diagnosis of BS, not recurrent depression. Bulimic behaviours, impulsivity and affective disorders might be related to the impairment of the serotonergic neurotransmission, which may result from the genetic vulnerability and early life trauma. Currently, the first-line pharmacological treatment of co-occurring eating disorders with binge episodes and BS are selective serotonin reuptake inhibitors. However in some cases, the use of mood-stabilising agents as monotherapy or in combination with serotonergic drugs may be helpful.

  17. Bipolar disorder and neurophysiologic mechanisms

    Science.gov (United States)

    McCrea, Simon M

    2008-01-01

    Recent studies have suggested that some variants of bipolar disorder (BD) may be due to hyperconnectivity between orbitofrontal (OFC) and temporal pole (TP) structures in the dominant hemisphere. Some initial MRI studies noticed that there were corpus callosum abnormalities within specific regional areas and it was hypothesized that developmentally this could result in functional or effective connectivity changes within the orbitofrontal-basal ganglia-thalamocortical circuits. Recent diffusion tensor imaging (DTI) white matter fiber tractography studies may well be superior to region of interest (ROI) DTI in understanding BD. A “ventral semantic stream” has been discovered connecting the TP and OFC through the uncinate and inferior longitudinal fasciculi and the elusive TP is known to be involved in theory of mind and complex narrative understanding tasks. The OFC is involved in abstract valuation in goal and sub-goal structures and the TP may be critical in binding semantic memory with person–emotion linkages associated with narrative. BD patients have relative attenuation of performance on visuoconstructional praxis consistent with an atypical localization of cognitive functions. Multiple lines of evidence suggest that some BD alleles are being selected for which could explain the enhanced creativity in higher-ability probands. Associations between ROI’s that are not normally connected could explain the higher incidence of artistic aptitude, writing ability, and scientific achievements among some mood disorder subjects. PMID:19337455

  18. A technology-enabled adherence enhancement system for people with bipolar disorder: results from a feasibility and patient acceptance analysis

    Directory of Open Access Journals (Sweden)

    Sajatovic M

    2015-06-01

    Full Text Available Martha Sajatovic,1 Michael S Davis,2 Kristin A Cassidy,3 Joseph Nestor,2 Johnny Sams,3 Edna Fuentes-Casiano3 1Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA; 2MedicaSafe, New York, NY, USA; 3Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA Objective: As poor medication adherence is common in bipolar disorder (BD, technology-assisted approaches may help to monitor and enhance adherence. This study evaluated preliminary feasibility, patient satisfaction and effects on adherence, BD knowledge, and BD symptoms associated with the use of a multicomponent technology-assisted adherence enhancement system. Methods: This prospective study tested the system in five BD patients over a 15-day period. System components included: 1 an automated pill cap with remote monitoring sensor; 2 a multimedia adherence enhancement program; and 3 a treatment incentive program. This study evaluated system usability, patient satisfaction and effects on adherence (Morisky scale, knowledge (treatment knowledge test [TKT], and symptoms (internal state scale [ISS]. Results: Mean age of the sample was 62 years, 4/5 (80% Caucasian, and 4/5 (80% single/divorced or widowed. Most participants (4/5, 80% were on a single BD medication. Participants had BD for an average of 21 years. Challenges included attaching the pill sensor to standard pharmacy bottles for individuals using very large pill containers or those with multiday pill boxes. Three of five (60% individuals completed the full 15-day period. Usability scores were high overall. Mean Morisky scores improved. Means on all four subscales of the ISS were all in the direction of improvement. On the TKT, there was a 40% increase in mean scores. Conclusion: A multicomponent technology-assisted BD

  19. Towards a blood-based diagnostic panel for bipolar disorder

    NARCIS (Netherlands)

    F. Haenisch (Frieder); J.D. Cooper (Jason); A. Reif (Andreas); S. Kittel-Schneider (Sarah); J. Steiner (Johann); F.M. Leweke (Marcus); M. Rothermundt (Matthias); N.J.M. van Beveren (Nico); B. Crespo-Facorro (Benedicto); D. Niebuhr (David); D. Cowan (David); N. Weber (Natalya); R.H. Yolken (Robert); B.W.J.H. Penninx (Brenda W.J.H.); S. Bahn (Sabine)

    2015-01-01

    markdownabstract_Background:_ Bipolar disorder (BD) is a costly, devastating and life shortening mental disorder that is often misdiagnosed, especially on initial presentation. Misdiagnosis frequently results in ineffective treatment. We investigated the utility of a biomarker panel as a diagnostic

  20. Swimming in Deep Water: Childhood Bipolar Disorder

    Science.gov (United States)

    Senokossoff, Gwyn W.; Stoddard, Kim

    2009-01-01

    The authors focused on one parent's struggles in finding a diagnosis and intervention for a child who had bipolar disorder. The authors explain the process of identification, diagnosis, and intervention of a child who had bipolar disorder. In addition to the personal story, the authors provide information on the disorder and outline strategies…

  1. Course of Subthreshold Bipolar Disorder in Youth: Diagnostic Progression from Bipolar Disorder Not Otherwise Specified

    Science.gov (United States)

    Axelson, David A.; Birmaher, Boris; Strober, Michael A.; Goldstein, Benjamin I.; Ha, Wonho; Gill, Mary Kay; Goldstein, Tina R.; Yen, Shirley; Hower, Heather; Hunt, Jeffrey I.; Liao, Fangzi; Iyengar, Satish; Dickstein, Daniel; Kim, Eunice; Ryan, Neal D.; Frankel, Erica; Keller, Martin B.

    2011-01-01

    Objective: To determine the rate of diagnostic conversion from an operationalized diagnosis of bipolar disorder not otherwise specified (BP-NOS) to bipolar I disorder (BP-I) or bipolar II disorder (BP-II) in youth over prospective follow-up and to identify factors associated with conversion. Method: Subjects were 140 children and adolescents…

  2. Genetic structure of personality factors and bipolar disorder in families segregating bipolar disorder.

    Science.gov (United States)

    Hare, Elizabeth; Contreras, Javier; Raventos, Henriette; Flores, Deborah; Jerez, Alvaro; Nicolini, Humberto; Ontiveros, Alfonso; Almasy, Laura; Escamilla, Michael

    2012-02-01

    Bipolar disorder (BPD) has been associated with variations in personality dimensions, but the nature of this relationship has been unclear. In this study, the heritabilities of BPD and the Big Five personality factors and the genetic correlations between BPD and personality factors are reported. The participants in this study were 1073 individuals from 172 families of Mexican or Central American ancestry. Heritabilities and genetic correlations were calculated under a polygenic model using the maximum-likelihood method of obtaining variance components implemented in the SOLAR software package. Heritabilities of 0.49, 0.43, and 0.43 were found for the narrowest phenotype (schizoaffective bipolar and bipolar I), the intermediate phenotype (schizoaffective bipolar, bipolar I, and bipolar II), and the broadest phenotype (schizoaffective bipolar, bipolar I, bipolar II, and recurrent depression), respectively. For the Big Five personality factors, heritabilities were 0.25 for agreeableness, 0.24 for conscientiousness, 0.24 for extraversion, 0.23 for neuroticism, and 0.32 for openness to experience. For the narrowest phenotype, a significant negative correlation (-0.32) with extraversion was found. For the broadest phenotype, negative correlations were found for agreeableness (-0.35), conscientiousness (-0.39), and extraversion (-0.44). A positive correlation (0.37) was found with neuroticism. It is not possible to determine whether aspects of personality are factors in the development of bipolar disorder or vice versa. The short form of the NEO does not provide the ability to examine in detail which facets of extraversion are most closely related to bipolar disorder or to compare our results with studies that have used the long version of the scale. This study establishes a partial genetic basis for the Big Five personality factors in this set of families, while the environmental variances demonstrate that non-genetic factors are also important in their influence on

  3. Genetic Relationships Between Schizophrenia, Bipolar Disorder, and Schizoaffective Disorder

    Science.gov (United States)

    Cardno, Alastair G.

    2014-01-01

    There is substantial evidence for partial overlap of genetic influences on schizophrenia and bipolar disorder, with family, twin, and adoption studies showing a genetic correlation between the disorders of around 0.6. Results of genome-wide association studies are consistent with commonly occurring genetic risk variants, contributing to both the shared and nonshared aspects, while studies of large, rare chromosomal structural variants, particularly copy number variants, show a stronger influence on schizophrenia than bipolar disorder to date. Schizoaffective disorder has been less investigated but shows substantial familial overlap with both schizophrenia and bipolar disorder. A twin analysis is consistent with genetic influences on schizoaffective episodes being entirely shared with genetic influences on schizophrenic and manic episodes, while association studies suggest the possibility of some relatively specific genetic influences on broadly defined schizoaffective disorder, bipolar subtype. Further insights into genetic relationships between these disorders are expected as studies continue to increase in sample size and in technical and analytical sophistication, information on phenotypes beyond clinical diagnoses are increasingly incorporated, and approaches such as next-generation sequencing identify additional types of genetic risk variant. PMID:24567502

  4. Thyroid Functions and Bipolar Affective Disorder

    Directory of Open Access Journals (Sweden)

    Subho Chakrabarti

    2011-01-01

    Full Text Available Accumulating evidence suggests that hypothalamo-pituitary-thyroid (HPT axis dysfunction is relevant to the pathophysiology and clinical course of bipolar affective disorder. Hypothyroidism, either overt or more commonly subclinical, appears to the commonest abnormality found in bipolar disorder. The prevalence of thyroid dysfunction is also likely to be greater among patients with rapid cycling and other refractory forms of the disorder. Lithium-treatment has potent antithyroid effects and can induce hypothyroidism or exacerbate a preexisting hypothyroid state. Even minor perturbations of the HPT axis may affect the outcome of bipolar disorder, necessitating careful monitoring of thyroid functions of patients on treatment. Supplementation with high dose thyroxine can be considered in some patients with treatment-refractory bipolar disorder. Neurotransmitter, neuroimaging, and genetic studies have begun to provide clues, which could lead to an improved understanding of the thyroid-bipolar disorder connection, and more optimal ways of managing this potentially disabling condition.

  5. Increased risk of hyperthyroidism among patients hospitalized with bipolar disorder

    DEFF Research Database (Denmark)

    Thomsen, Anders F; Kessing, Lars V

    2005-01-01

    . METHODS: We conducted a historical cohort study using the Danish register data. The observational period was 1977--99. Three study cohorts were identified: all patients with a first hospital admission with resulting index discharge diagnoses of depression, bipolar disorder, or osteoarthritis. The risks......OBJECTIVES: Hyperthyroidism has been associated with affective disorder in many cross-sectional studies, but longitudinal studies in this connection are scarce. We assessed whether hospitalization with depressive disorder or bipolar disorder was a risk factor for development of hyperthyroidism...... with depressive disorder did not have an increased risk of hyperthyroidism, whereas patients with bipolar disorder had an increased of risk on the margin of statistical significance, when compared to patients with osteoarthritis. Patients with bipolar disorder had a significantly increased risk of hyperthyroidism...

  6. Lithium in drinking water and the incidence of bipolar disorder

    DEFF Research Database (Denmark)

    Kessing, Lars V; Gerds, Thomas A; Knudsen, Nikoline N

    2017-01-01

    of bipolar disorder (primary prophylaxis). In a nation-wide population-based study, we investigated whether long-term exposure to micro levels of lithium in drinking water correlates with the incidence of bipolar disorder in the general population, hypothesizing an inverse association in which higher long......-term lithium exposure is associated with lower incidences of bipolar disorder. METHODS: We included longitudinal individual geographical data on municipality of residence, data from drinking water lithium measurements and time-specific data from all cases with a hospital contact with a diagnosis of mania/bipolar...... disorder from 1995 to 2013 (N=14 820) and 10 age- and gender-matched controls from the Danish population (N= 140 311). Average drinking water lithium exposure was estimated for all study individuals. RESULTS: The median of the average lithium exposure did not differ between cases with a diagnosis of mania/bipolar...

  7. Psychodynamics of hypersexuality in children and adolescents with bipolar disorder.

    Science.gov (United States)

    Adelson, Stewart

    2010-01-01

    It has recently become evident that bipolar disorder exists in children and adolescents. The criteria for making the diagnosis of juvenile bipolar disorder (JBD) are in the process of being proposed for the fifth edition of the Diagnostic and Statistical Manual (DSM-V). In adults, a criterion for bipolar disorder is excessive involvement in pleasurable activities including hypersexuality. Recently, some clinicians and researchers have suggested that hypersexuality be included as a criterion for JBD as well. Although abnormal sexuality has been reported to be present in some youth thought to have JBD, the reason for this association is not yet clear. Hypersexuality may be primary and intrinsic to bipolar disorder in youth, secondary and associated with it as the result of psychosocial influences or psychodynamic factors, or due to general aggression and disruptive behavior. Not only have developmental psychosocial factors that may influence sexuality in children and adolescence not been fully investigated, but psychodynamic influences have been omitted from modern etiological constructs as well. This report discusses the importance of psychosocial and psychodynamic influences on the sexual experience and activity of bipolar children. It is proposed that a developmental, psychodynamically informed model is helpful in understanding sexuality in children and adolescents with bipolar disorder. It is also suggested that assessment of psychosocial and psychodynamic influences on the sexuality of bipolar children is necessary in order to adequately assess whether hypersexuality should be a criterion of bipolar disorder in youth.

  8. Cognitive Behavioral Therapy in Bipolar Disorder

    Directory of Open Access Journals (Sweden)

    Zeynep Mackali

    2011-12-01

    Full Text Available Bipolar disorder is an early-onset, chronic disorder. It impairs occupational, social, and family functioning, which makes learning to adapt living with the disorder and its treatment critically important. Therefore, it has now become common knowledge that psychosocial interventions are also necessary in the treatment of bipolar disorder adjunctive to pharmacotherapy. Thus, whichever psychosocial interventions are more effective in bipolar disorder is a crucial research question. In this article, cognitive-behavioral therapy, which is applied adjunctive to pharmacotherapy, will be addressed and the findings of research about the effectiveness of these applications will be reviewed.

  9. Smartphone based treatment in bipolar disorder

    DEFF Research Database (Denmark)

    Faurholt-Jepsen, M; Frost, M.; Bardram, J.E.

    2016-01-01

    During this symposium, results from a randomized controlled trial investigating the effect of smartphone based electronic self-monitoring on the severity of depressive and manic symptoms will be presented and discussed.Further, we will present and discuss the use of automatically generated...... objective smartphone data on behavioral activities (eg social activities, mobility and physical activity) as electronic biomarkers of illness activity in bipolar disorder....

  10. Poorer sustained attention in bipolar I than bipolar II disorder

    Directory of Open Access Journals (Sweden)

    Chen Shih-Heng

    2010-02-01

    Full Text Available Abstract Background Nearly all information processing during cognitive processing takes place during periods of sustained attention. Sustained attention deficit is among the most commonly reported impairments in bipolar disorder (BP. The majority of previous studies have only focused on bipolar I disorder (BP I, owing to underdiagnosis or misdiagnosis of bipolar II disorder (BP II. With the refinement of the bipolar spectrum paradigm, the goal of this study was to compare the sustained attention of interepisode patients with BP I to those with BP II. Methods In all, 51 interepisode BP patients (22 with BP I and 29 with BP II and 20 healthy controls participated in this study. The severity of psychiatric symptoms was assessed by the 17-item Hamilton Depression Rating Scale and the Young Mania Rating Scale. All participants undertook Conners' Continuous Performance Test II (CPT-II to evaluate sustained attention. Results After controlling for the severity of symptoms, age and years of education, BP I patients had a significantly longer reaction times (F(2,68 = 7.648, P = 0.001, worse detectability (d' values (F(2,68 = 6.313, P = 0.003 and more commission errors (F(2,68 = 6.182, P = 0.004 than BP II patients and healthy controls. BP II patients and controls scored significantly higher than BP I patients for d' (F = 6.313, P = 0.003. No significant difference was found among the three groups in omission errors and no significant correlations were observed between CPT-II performance and clinical characteristics in the three groups. Conclusions These findings suggested that impairments in sustained attention might be more representative of BP I than BP II after controlling for the severity of symptoms, age, years of education and reaction time on the attentional test. A longitudinal follow-up study design with a larger sample size might be needed to provide more information on chronological sustained attention deficit in BP patients, and to illustrate

  11. Clinical status of comorbid bipolar disorder and borderline personality disorder.

    Science.gov (United States)

    Parker, Gordon; Bayes, Adam; McClure, Georgia; Del Moral, Yolanda Romàn Ruiz; Stevenson, Janine

    2016-09-01

    The status and differentiation of comorbid borderline personality disorder and bipolar disorder is worthy of clarification. To determine whether comorbid borderline personality disorder and bipolar disorder are interdependent or independent conditions. We interviewed patients diagnosed with either a borderline personality disorder and/or a bipolar condition. Analyses of participants grouped by DSM diagnoses established that those with comorbid conditions scored similarly to those with a borderline personality disorder alone on all key variables (i.e. gender, severity of borderline personality scores, developmental stressors, illness correlates, self-injurious behaviour rates) and differed from those with a bipolar disorder alone on nearly all non-bipolar item variables. Similar findings were returned for groups defined by clinical diagnoses. Comorbid bipolar disorder and borderline personality disorder is consistent with the formal definition of comorbidity in that, while coterminous, individuals meeting such criteria have features of two independent conditions. © The Royal College of Psychiatrists 2016.

  12. Obesity in bipolar disorder and major depressive disorder: results from a national community health survey on mental health and well-being.

    Science.gov (United States)

    McIntyre, Roger S; Konarski, Jakub Z; Wilkins, Kathryn; Soczynska, Joanna K; Kennedy, Sidney H

    2006-04-01

    We aimed to ascertain the prevalence of obesity in individuals with a mood disorder (MD) (that is, bipolar disorder or major depressive disorder), compared with the general population. We further aimed to examine the likelihood of an association between obesity and MD, while controlling for the influence of sociodemographic variables. The analysis was based on data from Statistics Canada's Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), conducted in 2002. The sample (n = 36 984; > or = aged 15 years) was drawn from the Canadian household-dwelling population. The CCHS used diagnostic criteria outlined in the DSM-IV to screen respondents. Individuals with a lifetime history of MD were more likely to be obese (body mass index [BMI] > 30) than were individuals without lifetime MD (19%, compared with 15%, respectively; P obesity in female respondents (95%CI, 1.03 to 1.46, odds ratio 1.22), but not in male respondents. Antipsychotic pharmacotherapy was also associated with obesity. This is the first Canadian epidemiologic investigation to specifically evaluate anthropometric indices and associated factors in people with MDs. The results herein supplement substantial clinical evidence documenting the association between MDs and stress-sensitive somatic disorders (for example, obesity). These data also underscore the metabolic consequences of some psychotropic agents.

  13. Using the mood disorder questionnaire and bipolar spectrum diagnostic scale to detect bipolar disorder and borderline personality disorder among eating disorder patients

    Science.gov (United States)

    2013-01-01

    Background Screening scales for bipolar disorder including the Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) have been plagued by high false positive rates confounded by presence of borderline personality disorder. This study examined the accuracy of these scales for detecting bipolar disorder among patients referred for eating disorders and explored the possibility of simultaneous assessment of co-morbid borderline personality disorder. Methods Participants were 78 consecutive female patients who were referred for evaluation of an eating disorder. All participants completed the mood and eating disorder sections of the SCID-I/P and the borderline personality disorder section of the SCID-II, in addition to the MDQ and BSDS. Predictive validity of the MDQ and BSDS was evaluated by Receiver Operating Characteristic analysis of the Area Under the Curve (AUC). Results Fifteen (19%) and twelve (15%) patients fulfilled criteria for bipolar II disorder and borderline personality disorder, respectively. The AUCs for bipolar II disorder were 0.78 (MDQ) and 0.78 (BDSD), and the AUCs for borderline personality disorder were 0.75 (MDQ) and 0.79 (BSDS). Conclusions Among patients being evaluated for eating disorders, the MDQ and BSDS show promise as screening questionnaires for both bipolar disorder and borderline personality disorder. PMID:23443034

  14. Can neuroimaging disentangle bipolar disorder?

    Science.gov (United States)

    Hozer, Franz; Houenou, Josselin

    2016-05-01

    Bipolar disorder heterogeneity is large, leading to difficulties in identifying neuropathophysiological and etiological mechanisms and hindering the formation of clinically homogeneous patient groups in clinical trials. Identifying markers of clinically more homogeneous groups would help disentangle BD heterogeneity. Neuroimaging may aid in identifying such groups by highlighting specific biomarkers of BD subtypes or clinical dimensions. We performed a systematic literature search of the neuroimaging literature assessing biomarkers of relevant BD phenotypes (type-I vs. II, presence vs. absence of psychotic features, suicidal behavior and impulsivity, rapid cycling, good vs. poor medication response, age at onset, cognitive performance and circadian abnormalities). Consistent biomarkers were associated with suicidal behavior, i.e. frontal/anterior alterations (prefrontal and cingulate grey matter, prefrontal white matter) in patients with a history of suicide attempts; and with cognitive performance, i.e. involvement of frontal and temporal regions, superior and inferior longitudinal fasciculus, right thalamic radiation, and corpus callosum in executive dysfunctions. For the other dimensions and sub-types studied, no consistent biomarkers were identified. Studies were heterogeneous both in methodology and outcome. Though theoretically promising, neuroimaging has not yet proven capable of disentangling subtypes and dimensions of bipolar disorder, due to high between-study heterogeneity. We issue recommendations for future studies. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. The bipolar II disorder personality traits, a true syndrome?

    Science.gov (United States)

    Gudmundsson, Einar

    2015-06-01

    The author was struck by the similarities and commonality of complaints, aside from mood swings, made by Bipolar II patients and started registrating these complaints. This registrational work eventually led to the development of The Bipolar II Syndome Checklist. The aim of this work was to understand how widely the Bipolar II disorder affects the personality, and what disturbing personality traits are the most common? Deliberately, no attempt was made to diagnose psychiatric comorbidities, in the hope that one would get a clearer view of what symptoms, if any, could be considered a natural part of the Bipolar II Disorder. As far as the author knows this is a novel approach. 105 Bipolar II patients completed the Bipolar II Syndrome Checklist. The answers to the 44 questions on the list are presented in tables. Symptoms like anxiety, low self esteem, paranoia, extreme hurtfulness, migraine, Post Partum Depression, obsessive traits, alcoholism in the family are amongst the findings which will be presented in greater detail. No control group. Bipolar I patients excluded. The Bipolar II Syndrome Checklist has not been systematically validated. The results show that Bipolar II Disorder causes multiple symptoms so commonly that it may be justified to describe it as a syndrome, The Bipolar II Syndrome. Also these disturbances commonly lie in families of Bipolar II patients and are in all likelihood, greatly underdiagnosed. The clinical relevance of this study lies in increasing our knowledge and understanding of the nature of the Bipolar II Disorder, which in all probability will increase the diagnostic and treatment accuracy, since clinicians are more likely to scan for other symptoms needing treatment. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. The relationship between borderline personality disorder and bipolar disorder

    Science.gov (United States)

    Zimmerman, Mark; Morgan, Theresa A.

    2013-01-01

    It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. Research considering whether BPD should be considered part of a bipolar spectrum reaches differing conclusions. We reviewed the most studied question on the relationship between BPD and bipolar disorder: their diagnostic concordance. Across studies, approximately 10% of patients with BPD had bipolar I disorder and another 10% had bipolar II disorder. Likewise, approximately 20% of bipolar II patients were diagnosed with BPD, though only 10% of bipolar I patients were diagnosed with BPD. While the comorbidity rates are substantial, each disorder is nontheless diagnosed in the absence of the other in the vast majority of cases (80% to 90%). In studies examining personality disorders broadly, other personality disorders were more commonly diagnosed in bipolar patients than was BPD. Likewise, the converse is also true: other axis I disorders such as major depression, substance abuse, and post-traumatic stress disorder are also more commonly diagnosed in patients with BPD than is bipolar disorder. These findings challenge the notion that BPD is part of the bipolar spectrum. PMID:24174890

  17. [Thinking organization and defense mechanisms in bipolar disorders. Clinical and psychopathological study on bipolar I and bipolar II].

    Science.gov (United States)

    Lo Baido, Rosa; Di Blasi, Marie; Alfano, Pietro; Audino, Palma; Bellavia, Carmela; Blando, Anna Antonia; Merendino, Adelaide; Messina, Rossana; Poma, Maria Luisa; La Grutta, Sabina

    2013-01-01

    The aim of this research is to explore the psychical functioning in bipolar I or bipolar II disorder people through the analysis and comparison of their thought styles and defense patterns. 29 bipolar I and bipolar II people afferent to Palermo University Policlinical Psychriatic Hospital Department were selected during the whole 2009-2010 year. The following tests were administred: Wechsler Adult Intelligent Scale-R (WAIS-R) in order to measure the general cognitive function; Defense Mechanisms Inventory (DMI) in order to measure defense patterns. Afterwards, the results of the two tests were analysed and compared. Bipolar disorder people use cognitive mechanisms and defense strategies that are very different from standard population. Bipolar I subjects show both wider and more serious cognitive deterioration and stricter defense mechanisms than bipolar II subjects. Generally bipolar patients show an immature personality based on archaic mechanisms that can be found in all the spheres of their personality: emotions, cognition, Ego-strength, adaptability to reality. The peculiar achieved cognitive and defense profile leads to important considerations about how psychological strategies can contribute to use "bespoke" treatments for these patients.

  18. Diagnostic Precursors to Bipolar Disorder among Offspring of Parents with Bipolar Disorder: A Longitudinal Study

    Science.gov (United States)

    Axelson, David; Goldstein, Benjamin; Goldstein, Tina; Monk, Kelly; Yu, Haifeng; Hickey, Mary Beth; Sakolsky, Dara; Diler, Rasim; Hafeman, Danella; Merranko, John; Iyengar, Satish; Brent, David; Kupfer, David; Birmaher, Boris

    2015-01-01

    Objective Identify diagnostic risk factors of mania/hypomania in the offspring of parents with bipolar disorder (“high-risk offspring”). Method High-risk offspring aged 6-18 years (n=391) and demographically-matched offspring (n=248) of community parents without bipolar disorder were assessed longitudinally with standardized diagnostic instruments by staff blind to parental diagnoses. Follow-up assessments were completed in 91% of the offspring (mean interval 2.5 years; mean duration 6.8 years). Results High-risk offspring, as compared to community offspring, had significantly higher rates of subthreshold (hypo)manic (13.3% vs. 1.2%, pattention-deficit hyperactivity (30.7% vs. 18.2%, p=.01), disruptive behavior (27.4% vs. 15.3%, p=.03), anxiety (39.9% vs. 21.8%, p=.0002), and substance use disorders (20.0% vs. 10.1%, p=.008), but not unipolar major depressive disorder (major depression with no bipolarity; 18.9% vs. 13.7%; p=.10). Multivariate Cox regressions in the high-risk offspring showed that subthreshold (hypo)manic episodes (Hazard Ratio 2.29, p=.03), major depressive episodes (Hazard Ratio 1.99, p=.05), and disruptive behavior disorders (Hazard Ratio 2.12, p=.03) were associated with subsequent mania/hypomania. Only subthreshold (hypo)manic episodes (Hazard Ratio 7.57, passociated when analyses were restricted to prospective data. Conclusions Subthreshold (hypo)manic episodes were a diagnostic risk factor for the development of mania/hypomania in the offspring of parents with bipolar disorder, and should be a target for clinical assessment and future treatment research. Major depressive episodes and disruptive behavior disorders are also indications for close clinical monitoring of emergent bipolarity in high-risk offspring. PMID:25734353

  19. Violence in schizophrenia and bipolar disorder.

    Science.gov (United States)

    Volavka, Jan

    2013-03-01

    Although most psychiatric patients are not violent, serious mental illness is associated with increased risk of violent behavior. Most of the evidence available pertains to schizophrenia and bipolar disorder. MEDLINE data base was searched for articles published between 1966 and November 2012 using the combination of key words 'schizophrenia' or 'bipolar disorder' with 'aggression' or 'violence'. For the treatment searches, generic names were used in combination with key words 'schizophrenia' or 'bipolar disorder' and 'aggression' No language constraint was applied. Only articles dealing with adults were included. The lists of references were searched manually to find additional articles. There were statistically significant increases of risk of violence in schizophrenia and in bipolar disorder in comparison with general population. The evidence suggests that the risk of violence is greater in bipolar disorder than in schizophrenia. Most of the violence in bipolar disorder occurs during the manic phase. The risk of violence in schizophrenia and bipolar disorder is increased by comorbid substance use disorder. Violence among adults with schizophrenia may follow at least two distinct pathways-one associated with antisocial conduct, and another associated with the acute psychopathology of schizophrenia. Clozapine is the most effective treatment of aggressive behavior in schizophrenia. Emerging evidence suggests that olanzapine may be the second line of treatment. Treatment adherence is of key importance. Non-pharmacological methods of treatment of aggression in schizophrenia and bipolar disorder are increasingly important. Cognitive behavioral approaches appear to be effective in cases where pharmacotherapy alone does not suffice. Violent behavior of patients with schizophrenia and bipolar disorder is a public health problem. Pharmacological and non-pharmacological approaches should be used to treat not only violent behavior, but also contributing comorbidities such

  20. Gene environment interactions in bipolar disorder.

    Science.gov (United States)

    Pregelj, Peter

    2011-09-01

    It has been estimated that the heritable component of bipolar disorder ranges between 80 and 90%. However, even genome-wide association studies explain only a fraction of phenotypic variability not resolving the problem of "lost heritability". Although direct evidence for epigenetic dysfunction in bipolar disorder is still limited, methodological technologies in epigenomic profiling have advanced, offering even single cell analysing and resolving the problem of cell heterogeneity in epigenetics research. Gene overlapping with other mental disorders represents another problem in identifying potential susceptibility genes in bipolar disorder. Better understanding of the interplay between multiple environmental and genetic factors involved in the patogenesis of bipolar disorder could provide relevant information for treatment of patients with this complex disorder. Future studies on the role of these factors in psychopathological conditions, subphenotypes and endophenotypes may greatly benefit by using more precise clinical data and a combined approach with multiple research tools incorporated into a single study.

  1. State-related alterations of gene expression in bipolar disorder

    DEFF Research Database (Denmark)

    Munkholm, Klaus; Vinberg, Maj; Berk, Michael

    2012-01-01

    on comprehensive database searches for studies on gene expression in patients with bipolar disorder in specific mood states, was conducted. We searched Medline, Embase, PsycINFO, and The Cochrane Library, supplemented by manually searching reference lists from retrieved publications. Results:  A total of 17......Munkholm K, Vinberg M, Berk M, Kessing LV. State-related alterations of gene expression in bipolar disorder: a systematic review. Bipolar Disord 2012: 14: 684-696. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objective:  Alterations in gene expression in bipolar disorder...... have been found in numerous studies. It is unclear whether such alterations are related to specific mood states. As a biphasic disorder, mood state-related alterations in gene expression have the potential to point to markers of disease activity, and trait-related alterations might indicate...

  2. Mortality and secular trend in the incidence of bipolar disorder

    DEFF Research Database (Denmark)

    Medici, Clara Reece; Videbech, Poul; Gustafsson, Lea Nørgreen

    2015-01-01

    BACKGROUND: The world-wide interest in bipolar disorder is illustrated by an exponential increase in publications on the disorder registered in Pubmed since 1990. This inspired an investigation of the epidemiology of bipolar disorder. METHODS: This was a register-based cohort study. All first......-ever diagnoses of bipolar disorder (International Classification of Diseases-10: F31) were identified in the nationwide Danish Psychiatric Central Research Register between 1995 and 2012. Causes of death were obtained from The Danish Register of Causes of Death. Age- and gender standardized incidence rates......, standardized mortality ratio (SMR) and Kaplan-Meier survival estimates were calculated. RESULTS: We identified 15,334 incident cases of bipolar disorder. The incidence rate increased from 18.5/100,000 person-years (PY) in 1995 to 28.4/100,000 PY in 2012. The mean age at time of diagnosis decreased...

  3. Thyroid Functions and Bipolar Affective Disorder

    OpenAIRE

    Chakrabarti, Subho

    2011-01-01

    Accumulating evidence suggests that hypothalamo-pituitary-thyroid (HPT) axis dysfunction is relevant to the pathophysiology and clinical course of bipolar affective disorder. Hypothyroidism, either overt or more commonly subclinical, appears to the commonest abnormality found in bipolar disorder. The prevalence of thyroid dysfunction is also likely to be greater among patients with rapid cycling and other refractory forms of the disorder. Lithium-treatment has potent antithyroid effects and c...

  4. Cognitive behavioral therapy for bipolar disorders

    OpenAIRE

    Lotufo Neto, Francisco

    2004-01-01

    Descrição dos objetivos e principais técnicas da terapia comportamental cognitiva usadas para a psicoterapia das pessoas com transtorno bipolar.Objectives and main techniques of cognitive behavior therapy for the treatment of bipolar disorder patients are described.

  5. Sexuality and Sexual Dysfunctions in Bipolar Disorder

    Directory of Open Access Journals (Sweden)

    Zeynep Namli

    2016-12-01

    Full Text Available In the clinical course of bipolar disorder, there is a reduction in sexual will during depressive episodes and inappopriate sexual experiences and hypersexuality occurs during manic episodes. Up to now, studies focused on sexual side effects of drugs. Sexual violence, sexually transmitted diseases, contraception methods, unplanned pregnancies need to be assessed carefully in bipolar disorder patients. This review focused on sexuality and sexual dysfunctions in the course of bipolar disorder. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(4.000: 309-320

  6. Is bipolar disorder specifically associated with aggression?

    Science.gov (United States)

    Ballester, Javier; Goldstein, Tina; Goldstein, Benjamin; Obreja, Mihaela; Axelson, David; Monk, Kelly; Hickey, MaryBeth; Iyengar, Satish; Farchione, Tiffany; Kupfer, David J; Brent, David; Birmaher, Boris

    2012-01-01

    Objective Several studies have suggested that bipolar disorder (BP) in adults is associated with aggressive behaviors. However, most studies have only included inpatients and have not taken possible confounding factors into consideration. The goal of this study was to compare the prevalence of aggression in subjects with BP compared to subjects with other non-BP psychopathology and healthy controls. Methods Subjects with bipolar I disorder (BP-I) and bipolar II disorder (BP-II) (n = 255), non-BP psychopathology (n = 85), and healthy controls (n = 84) were recruited. Aggression was measured using the Aggression Questionnaire (AQ). Group comparisons were adjusted for demographic and clinical differences (e.g., comorbid disorders) and multiple comparisons. The effects of the subtype of BP, current versus past episode, polarity of current episode, psychosis, the presence of irritable mania/hypomania only, and pharmacological treatment were examined. Results Subjects with BP showed significantly higher total and subscale AQ scores (raw and T-scores) when compared with subjects with non-BP psychopathology and healthy controls. Exclusion of subjects with current mood episodes and those with common comorbid disorders yielded similar results. There were no effects of BP subtype, polarity of the current episode, irritable manic/hypomanic episodes only, or current use of pharmacological treatments. Independent of the severity of BP and polarity of the episode, those in a current mood episode showed significantly higher AQ scores than those not in a current mood episode. Subjects with current psychosis showed significantly higher total AQ score, hostility, and anger than those without current psychosis. Conclusions Subjects with BP display greater rates of anger and aggressive behaviors, especially during acute and psychotic episodes. Early identification and management of these behaviors is warranted. PMID:22548901

  7. [Evaluating the missing heritability of bipolar disorder using the multifactorial liability threshold model].

    Science.gov (United States)

    Li, Kang; Xu, Ruihuan; Zhang, Hongde; Wang, Qian

    2014-09-01

    In order to evaluate the missing heritability of bipolar disorder, we queried the GWAS catalog of National Human Genome Research Institute, retrieve all the susceptible gene variation of bipolar disorder, and calculate the heritability explanation degree of each susceptibility variant using the multifactorial liability threshold model. The total heritability explanation degree of bipolar disorder was obtained through summing up the heritability explanation degree of each susceptibility variant. Then, we evaluated the missing heritability of bipolar disorder based on the total heritability explanation degree. The results showed that the total heritability explanation degree of bipolar disorder explained by known susceptible variants was 38.34%, and the other 61.66% of heritability can't be explained by known susceptibility variants, which belong to the missing heritability of bipolar disorder. The total heritability explanation degree of bipolar disorder in this study was significantly increased compared to earlier similar studies abroad. With constant discovery of new bipolar disorder susceptibility variants, the missing heritability of bipolar disorder has been greatly reduced, but the missing heritability of bipolar disorder still exists and occupies a large part of the bipolar disorder heritability, indicating that the molecular genetic mechanisms of bipolar disorder need to be further clarified.

  8. The relationship between borderline personality disorder and bipolar disorder

    OpenAIRE

    Zimmerman, Mark; Morgan, Theresa A.

    2013-01-01

    It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. Research considering whether BPD should be considered part of a bipolar spectrum reaches differing conclusions. We reviewed the most studied question on the relationship between BPD and bipolar disorder: their diagnostic concordance. Across studies, approximately 10% of patients with BPD had bi...

  9. Bipolar polygenic loading and bipolar spectrum features in major depressive disorder

    NARCIS (Netherlands)

    Wiste, Anna; Robinson, Elise B.; Milaneschi, Yuri; Meier, Sandra; Ripke, Stephan; Clements, Caitlin C.; Fitzmaurice, Garrett M.; Rietschel, Marcella; Penninx, Brenda W.; Smoller, Jordan W.; Perlis, Roy H.

    Objectives Family and genetic studies indicate overlapping liability for major depressive disorder and bipolar disorder. The purpose of the present study was to determine whether this shared genetic liability influences clinical presentation. Methods A polygenic risk score for bipolar disorder,

  10. Efficacy of Atypical Antipsychotics in the Management of Acute Agitation and Aggression in Hospitalized Patients with Schizophrenia or Bipolar Disorder: Results from a Systematic Review.

    Science.gov (United States)

    Yu, Xin; Correll, Christoph U; Xiang, Yu-Tao; Xu, Yifeng; Huang, Jizhong; Yang, Fude; Wang, Gang; Si, Tianmei; Kane, John M; Masand, Prakash

    2016-10-25

    Acute agitation and aggression are common symptoms in patients with bipolar disorder and schizophrenia. In this review, we discuss the prevalence, clinical assessment strategies, treatment options, and current Western and Chinese guidelines for the management of acute agitation and aggression in patients with bipolar disorder or schizophrenia. Among available approaches, we discuss in detail recent evidence supporting the use of intramuscular (IM) antipsychotics and some recently approved oral atypical antipsychotics for the management of acute aggression and agitation in hospitalized patients with bipolar disorder or schizophrenia presenting with acute agitation or aggression, highlighting some differences between individual antipsychotic agents.

  11. Gender differences in the phenomenology of bipolar disorder

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel

    2004-01-01

    OBJECTIVES: To investigate gender differences in the phenomenology of episodes in bipolar disorder as according to ICD-10. METHODS: All patients who got a diagnosis of a manic episode/bipolar disorder in a period from 1994 to 2002 at the first outpatient treatment ever or at the first discharge...... from psychiatric hospitalization ever in Denmark were identified in a nationwide register. RESULTS: Totally, 682 outpatients and 1037 inpatients got a diagnosis of a manic episode/bipolar disorder at the first contact ever. Significantly more women were treated as outpatients than as inpatients. Women...... patients treated during hospitalization more women than men presented with mixed episodes. CONCLUSIONS: Besides differences in the prevalence of mixed episodes and comorbid substance abuse few gender differences are found among patients presenting with a manic episode/bipolar disorder at first contact...

  12. Do young adults with bipolar disorder benefit from early intervention?

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Hansen, Hanne Vibe; Christensen, Ellen Margrethe

    2014-01-01

    BACKGROUND: It is unknown whether young adults with bipolar disorder are able to benefit from early intervention combining optimised pharmacological treatment and group psychoeducation. The aim of the present report was to compare the effects of early intervention among patients with bipolar...... disorder aged 18-25 years to that of patients aged 26 years or older. METHODS: Patients were randomised to early treatment in a specialised outpatient mood disorder clinic versus standard care. The primary outcome was risk of psychiatric re-hospitalisation. RESULTS: A total of 158 patients with mania/bipolar...... different, the observed differences of the point estimates was surprisingly larger for young adults suggesting that young adults with bipolar disorder may benefit even more than older adults from early intervention combining pharmacological treatment and group psychoeducation....

  13. The role of estrogen in bipolar disorder, a review

    DEFF Research Database (Denmark)

    Meinhard, Ninja; Kessing, Lars Vedel; Vinberg, Maj

    2014-01-01

    BACKGROUND: It appears that the female reproductive events and hormonal treatments may impact the course of bipolar disorder in women. In particular, childbirth is known to be associated with onset of affective episodes in women with bipolar disorder. During the female reproductive events the sex...... estrogen levels and women with bipolar disorder including studies of the anti manic effects of the selective estrogen receptor modulator tamoxifen. METHOD: A systematically literature search on PubMed was conducted: two studies regarding the connection between serum estrogen levels and women with bipolar...... disorder were identified. Furthermore, four studies were found concerning the antimanic effects of tamoxifen. RESULTS: Both studies in the estrogen studies showed very low levels of estrogen in women with postpartum psychosis and significant improvement of symptoms after treatment with estrogen. The four...

  14. The role of estrogen in bipolar disorder, a review

    DEFF Research Database (Denmark)

    Meinhard, Ninja; Kessing, Lars Vedel; Vinberg, Maj

    2014-01-01

    Background: It appears that the female reproductive events and hormonal treatments may impact the course of bipolar disorder in women. In particular, childbirth is known to be associated with onset of affective episodes in women with bipolar disorder. During the female reproductive events the sex...... estrogen levels and women with bipolar disorder including studies of the anti manic effects of the selective estrogen receptor modulator tamoxifen. Method: A systematically literature search on PubMed was conducted: two studies regarding the connection between serum estrogen levels and women with bipolar...... disorder were identified. Furthermore, four studies were found concerning the antimanic effects of tamoxifen. Results: Both studies in the estrogen studies showed very low levels of estrogen in women with postpartum psychosis and significant improvement of symptoms after treatment with estrogen. The four...

  15. Are rates of pediatric bipolar disorder increasing?

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Vradi, Eleni; Andersen, Per Kragh

    2014-01-01

    Studies from the USA suggest that rates of pediatric bipolar disorder have increased since the mid-90s, but no study outside the USA has been published on the rates of pediatric bipolar disorder. Further, it is unclear whether an increase in rates reflects a true increase in the illness or more...... diagnostic attention. Using nationwide registers of all inpatients and outpatients contacts to all psychiatric hospitals in Denmark, we investigated (1) gender-specific rates of incident pediatric mania/bipolar disorder during a period from 1995 to 2012, (2) whether age and other characteristics...... for pediatric mania/bipolar disorder changed during the calendar period (1995 to 2003 versus 2004 to 2012), and (3) whether the diagnosis is more often made at first psychiatric contact in recent time compared to earlier according to gender. Totally, 346 patients got a main diagnosis of a manic episode (F30...

  16. Internet use by patients with bipolar disorder

    DEFF Research Database (Denmark)

    Bauer, Rita; Conell, Jörn; Glenn, Tasha

    2016-01-01

    There is considerable international interest in online education of patients with bipolar disorder, yet little understanding of how patients use the Internet and other sources to seek information. 1171 patients with a diagnosis of bipolar disorder in 17 countries completed a paper-based, anonymous...... survey. 81% of the patients used the Internet, a percentage similar to the general public. Older age, less education, and challenges in country telecommunications infrastructure and demographics decreased the odds of using the Internet. About 78% of the Internet users looked online for information...... for information on bipolar disorder consulted medical professionals plus a mean of 2.3 other information sources such as books, physician handouts, and others with bipolar disorder. Patients not using the Internet consulted medical professionals plus a mean of 1.6 other information sources. The percentage...

  17. Bipolar Disorder and Early Affective Trauma.

    Science.gov (United States)

    de Codt, Aloise; Monhonval, Pauline; Bongaerts, Xavier; Belkacemi, Ikram; Tecco, Juan Martin

    2016-09-01

    Bipolar disorder is a chronic psychiatric disease with a high prevalence and is a major psychosocial and medical burden. The exact etiological pathways of bipolar disorder are not fully understood. Genetic factors are known to play an important role in the etiology of bipolar disorder. However, high rates of discordance among identical twins and a growing body of evidence that environmental factors such as early stress can influence the onset and course of psychiatric diseases underline the importance of additional etiological mechanisms of bipolar disorders. There has been little investigation about early trauma in bipolar disorder. The aim of this study was to review the literature on the association between early traumatic interactions like child neglect, mistreatment, abuse or early parental separation and the occurrence of bipolar disorder in adulthood or impact on the course of the disease. Studies investigating associations between child neglect, mistreatment, abuse or early parental separation and occurrence of bipolar disorder in adulthood or impact on the course of the disease were searched in the Pubmed database. More than 700 articles were sorted independently by two of the authors using predefined criteria. Only research articles, reviews and meta-analyses were selected for this review. 53 articles met the inclusion criteria. To date, four systematic reviews partially addressed our research question. Early trauma is more frequently found in the past of bipolar patients than in the general population. Studies support a harmful effect of childhood trauma on the course of bipolar disease, with more anxious, depressive or psychotic symptoms, an early age of onset and a worse prognosis. Early trauma is more often found in the past of bipolar adult patients than the general population and studies support a harmful effect of childhood trauma on the course of bipolar disease, with more anxious, depressive or psychotic symptoms, an early age of onset and a

  18. [Circadian markers and genes in bipolar disorder].

    Science.gov (United States)

    Yeim, S; Boudebesse, C; Etain, B; Belliviera, F

    2015-09-01

    Bipolar disorder is a severe and complex multifactorial disease, characterized by alternance of acute episodes of depression and mania/hypomania, interspaced by euthymic periods. The etiological determinants of bipolar disorder yet, are still poorly understood. For the last 30 years, chronobiology is an important field of investigation to better understand the pathophysiology of bipolar disorder. We conducted a review using Medline, ISI Database, EMBase, PsyInfo up to January 2015, using the following keywords combinations: "mood disorder", "bipolar disorder", "depression", "unipolar disorder", "major depressive disorder", "affective disorder", for psychiatric conditions; and "circadian rhythms", "circadian markers", "circadian gene", "clock gene", "melatonin" for circadian rhythms. The search critera was presence of word in any field of the article. Quantitative and qualitative circadian abnormalities are associated with bipolar disorders both during acute episodes and euthymic periods, suggesting that these altered circadian rhythms may represent biological trait markers of the disorder. These circadian dysfunctions were assessed by various validated tools including polysomnography, actigraphy, sleep diaries, chronotype assessments and blood melatonin/cortisol measures. Other altered endogenous circadian activities have also been reported in bipolar patients, such as hormones secretion, core body temperature or fibroblasts activity. Moreover, these markers were also altered in healthy relatives of bipolar patients, suggesting a degree of heritability. Several genetic association studies have also showed associations between multiple circadian genes and bipolar disorder, such as CLOCK, ARTNL1, GSK3β, PER3, NPAS2, NR1D1, TIMELESS, RORA, RORB, and CSNK1ε. Thus, these circadian gene variants may contribute to the genetic susceptibility of the disease. Furthermore, the study of the clock system may help to better understand some phenotypic aspects like the

  19. Bipolar disorders and Wilson’s disease

    Directory of Open Access Journals (Sweden)

    Carta Mauro

    2012-05-01

    Full Text Available Abstract Background The aim of this study was to determine the risk for Bipolar Disorder (BD in Wilson’s disease (WD and to measure the impaired Quality of Life (QL in BD with WD using standardized psychiatric diagnostic tools and a case control design. Methods This was a case control study. The cases were 23 consecutive patients with WD treated at the University Hospital in Cagliari, Italy, and the controls were 92 sex- and age-matched subjects with no diagnosis of WD who were randomly selected from a database used previously for an epidemiological study. Psychiatric diagnoses according to DSM-IV criteria were determined by physicians using structured interview tools (ANTAS-SCID. QL was measured by means of SF-12. Results Compared to controls, WD patients had lower scores on the SF-12 and higher lifetime prevalence of DSM-IV major depressive disorders (OR = 5.7, 95% CI 2.4–17.3 and bipolar disorders (OR = 12.9, 95% CI 3.6–46.3. BD was associated with lower SF-12 in WD patients. Conclusions This study was the first to show an association between BD and WD using standardized diagnostic tools and a case control design. Reports in the literature about increased schizophrenia-like psychosis in WD and a lack of association with bipolar disorders may thus have been based on a more inclusive diagnosis of schizophrenia in the past. Our findings may explain the frequent reports of loss of emotional control, hyperactivity, loss of sexual inhibition, and irritability in WD patients. This study was limited by a small sample size.

  20. Classification of cognitive performance in bipolar disorder.

    Science.gov (United States)

    Sparding, Timea; Silander, Katja; Pålsson, Erik; Östlind, Josefin; Ekman, Carl Johan; Sellgren, Carl M; Joas, Erik; Hansen, Stefan; Landén, Mikael

    2017-09-01

    To understand the etiology of cognitive impairment associated with bipolar disorder, we need to clarify potential heterogeneity in cognitive functioning. To this end, we used multivariate techniques to study if the correlation structure of cognitive abilities differs between persons with bipolar disorder and controls. Clinically stable patients with bipolar disorder (type I: n = 64; type II: n = 44) and healthy controls (n = 86) were assessed with a wide range of cognitive tests measuring executive function, speed, memory, and verbal skills. Data were analysed with multivariate techniques. A distinct subgroup (∼30%) could be identified that performed significantly poorer on tests concerning memory function. This cognitive phenotype subgroup did not differ from the majority of bipolar disorder patients with respect to other demographic or clinical characteristics. Whereas the majority of patients performed similar to controls, a subgroup of patients with bipolar disorder differed substantially from healthy controls in the correlation pattern of low-level cognitive abilities. This suggests that cognitive impairment is not a general trait in bipolar disorder but characteristic of a cognitive subgroup. This has important clinical implications for cognitive rehabilitation and remediation.

  1. Corpus callosum changes in euthymic bipolar affective disorder.

    Science.gov (United States)

    Lloyd, Adrian J; Ali, Heba E; Nesbitt, David; Moore, P Brian; Young, Allan H; Ferrier, I Nicol

    2014-02-01

    Changes in corpus callosum area and thickness have been reported in bipolar disorder. Imaging and limited neuropathological data suggest possible abnormalities in myelination and/or glial function. To compare corpus callosum area, thickness and magnetic resonance imaging (MRI) T1 signal intensity in patients with bipolar disorder and healthy controls. A total of 48 patients with euthymic bipolar disorder and 46 healthy controls underwent MRI analysis of callosal midsagittal area, callosal thickness and T1 signal intensity. The bipolar group had smaller overall and subregional callosal areas and correspondingly reduced callosal width than the control group. Age correlated negatively with callosal area in the control group but not in the bipolar group. Signal intensity was higher in women than in men in both groups. Signal intensity was reduced in women, but not in men, in the bipolar group. Observed differences probably relate to diagnosis rather than mood state and bipolar disorder appears to result in morphometric change that overrides changes seen in normal ageing. Intensity changes are consistent with possible altered myelination or glial function. A gender-dependent factor appears to operate and to interact with diagnosis.

  2. Efficacy of Atypical Antipsychotics in the Management of Acute Agitation and Aggression in Hospitalized Patients with Schizophrenia or Bipolar Disorder: Results from a Systematic Review

    OpenAIRE

    ,; CORRELL, Christoph U.; ,; ,; ,; ,; ,; ,; KANE, John M.; MASAND, Prakash

    2016-01-01

    Summary Acute agitation and aggression are common symptoms in patients with bipolar disorder and schizophrenia. In this review, we discuss the prevalence, clinical assessment strategies, treatment options, and current Western and Chinese guidelines for the management of acute agitation and aggression in patients with bipolar disorder or schizophrenia. Among available approaches, we discuss in detail recent evidence supporting the use of intramuscular (IM) antipsychotics and some recently appr...

  3. Bipolar (spectrum) disorder and mood stabilization: standing at the crossroads?

    OpenAIRE

    De Fruyt, Jurgen; Demyttenaere, Koen

    2007-01-01

    Diagnosis and treatment of bipolar disorder has long been a neglected discipline. Recent years have shown an upsurge in bipolar research. When compared to major depressive disorder, bipolar research still remains limited and more expert based than evidence based. In bipolar diagnosis the focus is shifting from classic mania to bipolar depression and hypomania. There is a search for bipolar signatures in symptoms and course of major depressive episodes. The criteria for hypomania are softened,...

  4. Prevalence and impact of comorbid anxiety and bipolar disorder.

    Science.gov (United States)

    Keller, Martin B

    2006-01-01

    Comorbid conditions pose a serious risk to patients with bipolar disorder, but anxiety comorbidity poses a specific hazard due to the increased negative impact of anxiety on illness course and treatment. Anxiety comorbidity appears to be highly prevalent and is associated with intensified symptoms of bipolar disorder and additional comorbid disorders, resulting in a negative impact on the patient and on the course of the illness. The presence of anxiety in bipolar patients is also associated with a lowered age at onset, hampered patient response to treatment such as lithium, increased rates of suicide and substance abuse, and decreased quality of life. Patients can experience work, family, and social impairment and be made to contend with increased health care costs and strains on family support. Studies are few and have a limited scope, and many have failed to consider the clinical significance of comorbid anxiety and bipolar disorder. Because the degree to which anxiety impacts patients with bipolar disorder is not fully known, more information is needed about the relationship between bipolar disorder and anxiety.

  5. Urbanicity during upbringing and bipolar affective disorders in Denmark

    DEFF Research Database (Denmark)

    Pedersen, Carsten Bøcker; Mortensen, Preben Bo

    2006-01-01

    It has been suggested that known or suspected risk factors for schizophrenia may also be of importance for other psychoses, but the empirical evidence regarding this is limited. Urbanicity of place of birth and during upbringing has been shown to be related to the risk of schizophrenia. Few studies...... of urbanicity in relation to bipolar affective disorder exist. Objective: To investigate the potential association between urbanicity at birth and during upbringing and the risk of bipolar affective disorder. Method: Using data from the Danish Civil Registration System, we established a population-based cohort...... of 2.04 million people born in Denmark during 1956-1986, which included information on place of residence during upbringing. Bipolar affective disorder in cohort members was identified by linkage with the Danish Psychiatric Central Register. Results: Overall, 2232 people developed bipolar affective...

  6. Big data for bipolar disorder.

    Science.gov (United States)

    Monteith, Scott; Glenn, Tasha; Geddes, John; Whybrow, Peter C; Bauer, Michael

    2016-12-01

    The delivery of psychiatric care is changing with a new emphasis on integrated care, preventative measures, population health, and the biological basis of disease. Fundamental to this transformation are big data and advances in the ability to analyze these data. The impact of big data on the routine treatment of bipolar disorder today and in the near future is discussed, with examples that relate to health policy, the discovery of new associations, and the study of rare events. The primary sources of big data today are electronic medical records (EMR), claims, and registry data from providers and payers. In the near future, data created by patients from active monitoring, passive monitoring of Internet and smartphone activities, and from sensors may be integrated with the EMR. Diverse data sources from outside of medicine, such as government financial data, will be linked for research. Over the long term, genetic and imaging data will be integrated with the EMR, and there will be more emphasis on predictive models. Many technical challenges remain when analyzing big data that relates to size, heterogeneity, complexity, and unstructured text data in the EMR. Human judgement and subject matter expertise are critical parts of big data analysis, and the active participation of psychiatrists is needed throughout the analytical process.

  7. Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder: Part I of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder

    Science.gov (United States)

    Schaffer, Ayal; Isometsä, Erkki T; Tondo, Leonardo; Moreno, Doris H; Sinyor, Mark; Kessing, Lars Vedel; Turecki, Gustavo; Weizman, Abraham; Azorin, Jean-Michel; Ha, Kyooseob; Reis, Catherine; Cassidy, Frederick; Goldstein, Tina; Rihmer, Zoltán; Beautrais, Annette; Chou, Yuan-Hwa; Diazgranados, Nancy; Levitt, Anthony J; Zarate, Carlos A; Yatham, Lakshmi

    2016-01-01

    Objectives Bipolar disorder is associated with elevated risk of suicide attempts and deaths. Key aims of the International Society for Bipolar Disorders Task Force on Suicide included examining the extant literature on epidemiology, neurobiology and pharmacotherapy related to suicide attempts and deaths in bipolar disorder. Methods Systematic review of studies from 1 January 1980 to 30 May 2014 examining suicide attempts or deaths in bipolar disorder, with a specific focus on the incidence and characterization of suicide attempts and deaths, genetic and non-genetic biological studies and pharmacotherapy studies specific to bipolar disorder. We conducted pooled, weighted analyses of suicide rates. Results The pooled suicide rate in bipolar disorder is 164 per 100,000 person-years (95% confidence interval = [5, 324]). Sex-specific data on suicide rates identified a 1.7:1 ratio in men compared to women. People with bipolar disorder account for 3.4–14% of all suicide deaths, with self-poisoning and hanging being the most common methods. Epidemiological studies report that 23–26% of people with bipolar disorder attempt suicide, with higher rates in clinical samples. There are numerous genetic associations with suicide attempts and deaths in bipolar disorder, but few replication studies. Data on treatment with lithium or anticonvulsants are strongly suggestive for prevention of suicide attempts and deaths, but additional data are required before relative anti-suicide effects can be confirmed. There were limited data on potential anti-suicide effects of treatment with antipsychotics or antidepressants. Conclusion This analysis identified a lower estimated suicide rate in bipolar disorder than what was previously published. Understanding the overall risk of suicide deaths and attempts, and the most common methods, are important building blocks to greater awareness and improved interventions for suicide prevention in bipolar disorder. Replication of genetic findings and

  8. The Mood Disorder Questionnaire improves recognition of bipolar disorder in psychiatric care

    Directory of Open Access Journals (Sweden)

    Leppämäki Sami

    2003-07-01

    Full Text Available Abstract Background We investigated our translation of The Mood Disorder Questionnaire (MDQ as a screening instrument for bipolar disorder in a psychiatric setting in Finland. Methods In a pilot study for the Jorvi Bipolar Study (JoBS, 109 consecutive non-schizophrenic psychiatric out- and inpatients in Espoo, Finland, were screened for bipolar disorder using the Finnish translation of the MDQ, and 38 of them diagnostically interviewed with the SCID. Results Forty subjects (37% were positive in the MDQ screen. In the SCID interview, twenty patients were found to suffer from bipolar disorder, of whom seven (70% of ten patients with bipolar I but only two (20% of ten with bipolar II disorder had been previously clinically correctly diagnosed. The translated MDQ was found internally consistent (alpha 0.79 and a feasible screening tool. Conclusions Bipolar disorder, particularly type II, remains commonly unrecognized in psychiatric settings. The Mood Disorder Questionnaire is a feasible screen for bipolar disorder, which could well be integrated into psychiatric routine practice.

  9. Satisfaction with treatment among patients with depressive and bipolar disorders

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Hansen, Hanne Vibe; Ruggeri, Mirella

    2006-01-01

    , the Verona Service Satisfaction Scale-Affective, was mailed to a large population of patients with depressive or bipolar disorders representative of outpatients treated at their first contact to hospital settings in Denmark. RESULTS: Among the 1,005 recipients, 49.9% responded to the letter. Overall....... There was no difference in satisfaction between genders or between patients with depressive disorder and patients with bipolar disorder. CONCLUSION: There is a need to strengthen outpatient treatment for patients discharged from a psychiatric hospital diagnosed of having affective disorders, focusing more on information...

  10. Obsessive-Compulsive-Bipolar Disorder Comorbidity: A Case Report

    Directory of Open Access Journals (Sweden)

    João Pedro Ribeiro

    2013-12-01

    Full Text Available Anxiety disorders have been described as features of Bipolar Disorder (BD, and Obsessive-compulsive-bipolar disorder (OCBD may occur in as many as 56% of obsessive-compulsive patients. Mania in Obsessive-Compulsive Disorder (OCD can occur either as an independent comorbidity or as a result of an antidepressant-induced switch. We report the case of a 38-year-old male with a 3 year diagnosis of OCD treated with antidepressants, admitted due to a manic episode, and describe diagnostic and treatment challenges of this comorbidity.

  11. The functional neuroanatomy of bipolar disorder: a consensus model

    Science.gov (United States)

    Strakowski, Stephen M; Adler, Caleb M; Almeida, Jorge; Altshuler, Lori L; Blumberg, Hilary P; Chang, Kiki D; DelBello, Melissa P; Frangou, Sophia; McIntosh, Andrew; Phillips, Mary L; Sussman, Jessika E; Townsend, Jennifer D

    2013-01-01

    Objectives Functional neuroimaging methods have proliferated in recent years, such that functional magnetic resonance imaging, in particular, is now widely used to study bipolar disorder. However, discrepant findings are common. A workgroup was organized by the Department of Psychiatry, University of Cincinnati (Cincinnati, OH, USA) to develop a consensus functional neuroanatomic model of bipolar I disorder based upon the participants’ work as well as that of others. Methods Representatives from several leading bipolar disorder neuroimaging groups were organized to present an overview of their areas of expertise as well as focused reviews of existing data. The workgroup then developed a consensus model of the functional neuroanatomy of bipolar disorder based upon these data. Results Among the participants, a general consensus emerged that bipolar I disorder arises from abnormalities in the structure and function of key emotional control networks in the human brain. Namely, disruption in early development (e.g., white matter connectivity, prefrontal pruning) within brain networks that modulate emotional behavior leads to decreased connectivity among ventral prefrontal networks and limbic brain regions, especially amygdala. This developmental failure to establish healthy ventral prefrontal–limbic modulation underlies the onset of mania and ultimately, with progressive changes throughout these networks over time and with affective episodes, a bipolar course of illness. Conclusions This model provides a potential substrate to guide future investigations and areas needing additional focus are identified. PMID:22631617

  12. Climatic factors and bipolar affective disorder

    DEFF Research Database (Denmark)

    Christensen, Ellen Margrethe; Larsen, Jens Knud; Gjerris, Annette

    2008-01-01

    In bipolar disorder, the factors provoking a new episode are unknown. As a seasonal variation has been noticed, it has been suggested that weather conditions may play a role. The aim of the study was to elucidate whether meteorological parameters influence the development of new bipolar phases....... A group of patients with at least three previous hospitalizations for bipolar disorder was examined every 3 months for up to 3 years. At each examination an evaluation of the affective phase was made according to the Hamilton Depression Scale (HAM-D(17)), and the Bech-Rafaelsen Mania Rating Scale (MAS......). In the same period, daily recordings from the Danish Meteorological Institute were received. We found no correlations between onset of bipolar episodes [defined as MAS score of 11 or more (mania) and as HAM-D(17) score of 12 or more (depression)] and any meteorological parameters. We found a statistical...

  13. Attention-deficit hyperactivity disorder in bipolar disorder

    OpenAIRE

    Rydén, Eleonore

    2010-01-01

    Attention-deficit hyperactivity disorder (ADHD) is a developmental disorder, i.e., it is by definition present from childhood. The main features characterizing ADHD are the difficulties to regulate attention, activity level, and impulses. The hallmark of bipolar disorder is episodic mood alterations with restitution between episodes. Although debut in childhood may occur, bipolar disorder typically debuts in late adolescence or early adulthood. The overarching aim with this ...

  14. Comorbid medical illness in bipolar disorder.

    Science.gov (United States)

    Forty, Liz; Ulanova, Anna; Jones, Lisa; Jones, Ian; Gordon-Smith, Katherine; Fraser, Christine; Farmer, Anne; McGuffin, Peter; Lewis, Cathryn M; Hosang, Georgina M; Rivera, Margarita; Craddock, Nick

    2014-12-01

    Individuals with a mental health disorder appear to be at increased risk of medical illness. To examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden. Participants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria. We found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset. Bipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role. Royal College of Psychiatrists.

  15. Assessing neural tuning for object perception in schizophrenia and bipolar disorder with multivariate pattern analysis of fMRI data

    Directory of Open Access Journals (Sweden)

    Eric A. Reavis

    2017-01-01

    Conclusions: The results show for the first time MVPA can be used successfully to classify individual perceptual stimuli in schizophrenia and bipolar disorder. However, the results do not provide evidence of abnormal neural tuning in schizophrenia and bipolar disorder.

  16. Early maladaptive schemas in bipolar disorder.

    Science.gov (United States)

    Ak, Mehmet; Lapsekili, Nergis; Haciomeroglu, Bikem; Sutcigil, Levent; Turkcapar, Hakan

    2012-09-01

    According to the cognitive model of depression, negative schemas, formed in early life, increase susceptibility to depression. The objective of this study was to investigate schemas that are proposed to increase susceptibility of depression in bipolar disorder patients who have had depressive episodes. Eighteen patients diagnosed with bipolar disorder according to DSM-IV and a healthy control group (N= 20) constituted the sample of the study. The Beck Depression Inventory, Young Mania Rating Scale, and Young Schema Scale were applied to patients in order to determine the level of symptoms and schemas. When the scores obtained from Young Schema Scale were compared between groups, significant differences were observed between bipolar patients and control group on all the schemas except abandonment, emotional deprivation, defectiveness, vulnerability to harm or illness, and approval seeking. The negative schema scores of bipolar patients were significantly higher than those of the control group. Of all schemas included in the Young Schema Scale, the scores of bipolar group were higher than the scores of the control group. These findings suggest that, in cognitive-based psychotherapeutic approaches for patients with bipolar disorder, it would be more effective to focus on schemas related to the perception and allowance of feelings at the proper time and the instability of self-perceptions. © 2011 The British Psychological Society.

  17. Rumination in bipolar disorder: evidence for an unquiet mind

    OpenAIRE

    Ghaznavi, Sharmin; Deckersbach, Thilo

    2012-01-01

    Abstract Depression in bipolar disorder has long been thought to be a state characterized by mental inactivity. However, recent research demonstrates that patients with bipolar disorder engage in rumination, a form of self-focused repetitive cognitive activity, in depressed as well as in manic states. While rumination has long been associated with depressed states in major depressive disorder, the finding that patients with bipolar disorder ruminate in manic states is unique to bipolar disord...

  18. Dealing with bipolar disorder in general practice | Rodseth | South ...

    African Journals Online (AJOL)

    ... it is in the general realm of specialist diagnosis and care, general practitioners can play an important role in early identification of the disorder and long-term management, in shared care with the psychiatrist. Keywords: bipolar disorder, mania, hypomania, depression, DSM-IV criteria, bipolar I disorder, bipolar II disorder ...

  19. The use of antidepressants in bipolar disorder patients with depression.

    Science.gov (United States)

    Bowden, Charles L; Singh, Vivek

    2016-01-01

    The proportion of time that bipolar patients experience depressive symptoms and clinical states, with associated psychosocial impairment and elevated risk of suicide, is significantly greater than the time spent in manic/hypomanic forms of bipolar disorders. Yet, manic states and symptoms have been the focus and interest of most clinical research over the past quarter century. Not a single antidepressant approved for treatment of major depressive disorder, as monotherapy, has received regulatory approval for treatment of bipolar depression as monotherapy, despite their common use in bipolar depression. We reviewed randomized studies, particularly ones initially intended for registration purposes, and systematic treatment guidelines, in development of this guide to treatment decision and implementation of interventions for depression in bipolar disorders. The Expert Opinion section emphasizes strategies, not individual agents. The efficacious performance of mood stabilizers and second-generation antipsychotics as a component of the strategy is strongly supported by published studies. However, this section relies largely on secondary publications and our combined clinical experience, as few randomized, blinded studies have had, as their focus, the comparison of combined regimens for depression. This article summarizes the design features and results of studies dealing with depressive features and intervention strategies for bipolar disorders. The emphasis of the recommendations is on pragmatic treatment decisions that clinicians can make to enhance the probability of both short and long term benefits for patients.

  20. Heart rate variability in bipolar disorder

    DEFF Research Database (Denmark)

    Faurholt-Jepsen, Maria; Kessing, Lars Vedel; Munkholm, Klaus

    2017-01-01

    Background Heart rate variability (HRV) has been suggested reduced in bipolar disorder (BD) compared with healthy individuals (HC). This meta-analysis investigated: HRV differences in BD compared with HC, major depressive disorder or schizophrenia; HRV differences between affective states; HRV...

  1. Obesity and bipolar disorder: synergistic neurotoxic effects?

    Science.gov (United States)

    Liu, Celina S; Carvalho, André F; Mansur, Rodrigo B; McIntyre, Roger S

    2013-11-01

    Bipolar disorder (BD) is a disabling and chronic neuropsychiatric disorder that is typified by a complex illness presentation, episode recurrence and by its frequent association with psychiatric and medical comorbidities. Over the past decade, obesity has emerged as one of many comorbidities generating substantial concern in the BD population due to important prognostic implications. This comprehensive review details the bidirectional relationship between obesity and BD as evidenced by alterations in the structure and function of the central nervous system, in addition to greater depressive recurrence, cognitive dysfunction and risk of suicidality. Drawing on current research results, this article presents several putative mechanisms underlying the synergistic toxic effects and provides a framework for future treatment options for the obesity-BD comorbidity. There is a need for more large-scale prospective studies to investigate the bidirectional relationships between obesity and BD.

  2. Excess mortality of acute and transient psychotic disorders: comparison with bipolar affective disorder and schizophrenia

    DEFF Research Database (Denmark)

    Castagnini, Augusto; Foldager, Leslie; Bertelsen, Aksel

    2013-01-01

    Objective: To investigate mortality and causes of death of short-lived psychotic disorders, by carrying out a comparison with bipolar disorder and schizophrenia. Method: Record linkage study to the official register of causes of death of all cases aged 15–64 years who were listed for the first time...... in the Danish Psychiatric Register between 1995 and 2008 with an ICD-10 diagnosis of ‘acute and transient psychotic disorders’ (ATPDs; n = 4157), bipolar disorder (n = 3200) and schizophrenia (n = 4576). Results: A total of 232 patients (5.6%) with ATPDs, 172 (5.4%) with bipolar disorder and 233 (5...

  3. Bipolar disorder and age-related functional impairment Prejuízo funcional associado à idade e transtorno bipolar

    Directory of Open Access Journals (Sweden)

    Alice Aita Cacilhas

    2009-12-01

    Full Text Available OBJECTIVE: Although bipolar disorder is a major contributor to functional impairment worldwide, an independent impact of bipolar disorder and ageing on functioning has yet to be demonstrated. The objective of the present study was to evaluate the effect of bipolar disorder on age-related functional status using matched controls as a standard. METHOD: One-hundred patients with bipolar disorder and matched controls were evaluated for disability. Age-related effects controlled for confounders were cross-sectionally evaluated. RESULTS: Patients were significantly more impaired than controls. Regression showed effects for aging in both groups. The effect, size, however, was significantly stronger in patients. CONCLUSION: Bipolar disorder was an important effect modifier of the age impact on functioning. While a longitudinal design is needed to effectively demonstrate this different impact, this study further depicts bipolar disorder as a chronic and progressively impairing illness.OBJETIVO: O transtorno bipolar é responsável por importante parcela do prejuízo funcional ao redor do mundo. Um efeito independente do transtorno bipolar e da idade no funcionamento ainda não foi demonstrado. O presente estudo tem o objetivo de avaliar o efeito do transtorno bipolar no prejuízo funcional relacionado à idade, com controles pareados como padrão. MÉTODO: Cem pacientes com transtorno bipolar e controles pareados foram avaliados para incapacidade. Efeitos relacionados à idade, com controle para confundidores, foram investigados. RESULTADOS: Pacientes tiveram significativamente mais prejuízo que controles. A regressão mostrou efeito para a idade em ambos os grupos, e o efeito foi significativamente mais forte nos pacientes. CONCLUSÃO: O transtorno bipolar foi um importante modificador de efeito no impacto da idade no funcionamento. Enquanto um desenho de estudo longitudinal é necessário para efetivamente demonstrar este impacto diferencial, este

  4. Individuals with bipolar disorder and their relationship with the criminal justice system: a critical review.

    Science.gov (United States)

    Fovet, Thomas; Geoffroy, Pierre Alexis; Vaiva, Guillaume; Adins, Catherine; Thomas, Pierre; Amad, Ali

    2015-04-01

    Bipolar disorder is a severe and prevalent psychiatric disease. Poor outcomes include a high frequency of criminal acts, imprisonments, and repeat offenses. This critical review of the international literature examined several aspects of the complex relationship between individuals with bipolar disorder and the criminal justice system: risk factors for criminal acts, features of bipolar patients' incarceration, and their postrelease trajectories. Publications were obtained from the PubMed and Google Scholar electronic databases by using the following MeSH headings: prison, forensic psychiatry, criminal law, crime, and bipolar disorder. Among patients with bipolar disorder, the frequency of violent criminal acts is higher than in the general population (odds ratio [OR]=2.8, 95% confidence interval [CI]=1.8-4.3). The frequency is higher among patients with bipolar disorder and a comorbid substance use disorder than among those without either disorder (OR=10.1, CI=5.3-19.2). As a result, the prevalence of bipolar disorder among prisoners is high (2%-7%). In prison, patients' bipolar disorder symptoms can complicate their relationship with prison administrators, leading to an increased risk of multiple incarcerations. Moreover, the risk of suicide increases for these prisoners. Criminal acts are common among patients with bipolar disorder and are often associated with problems such as addiction. Thus it is important to improve the diagnosis and treatment of inmates with bipolar disorder.

  5. Bipolar disorder: an update | Outhoff | South African Family Practice

    African Journals Online (AJOL)

    Bipolar disorder, characterised by alternating discrete episodes of (hypo)mania and depression, provides unique diagnostic and treatment challenges. Updated diagnostic (DSM-5) and current pharmacological treatment recommendations are briefly reviewed here. Keywords: bipolar disorder; diagnosis; evidence-based ...

  6. Assessment of subjective and objective cognitive function in bipolar disorder

    DEFF Research Database (Denmark)

    Demant, Kirsa M; Vinberg, Maj; Kessing, Lars V

    2015-01-01

    Cognitive dysfunction is prevalent in bipolar disorder (BD). However, the evidence regarding the association between subjective cognitive complaints, objective cognitive performance and psychosocial function is sparse and inconsistent. Seventy seven patients with bipolar disorder who presented...

  7. BIPOLAR DISORDER AND METABOLIC SYNDROME: COMORBIDITY OR SIDE EFFECTS OF TREATMENT OF BIPOLAR DISORDER

    OpenAIRE

    Babić, Dragan; Maslov, Boris; Nikolić, Katica; Martinac, Marko; Uzun, Suzana; Kozumplik, Oliver

    2010-01-01

    Objective: There is evidence that people with mental disorders are more likely to suffer from metabolic syndrome. In the last decades there has been an increase in interest for researching metabolic syndrome in psychiatric patients and plenty of evidence about their association. However, investigations on the prevalence of metabolic syndrome in patients with bipolar disorder are still surprisingly rare. The aim of this paper is to analyze comorbidity of bipolar disorder and metabolic syndrome...

  8. Rate and predictors of conversion from unipolar to bipolar disorder

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Willer, Inge; Andersen, Per Kragh

    2017-01-01

    OBJECTIVES: For the first time to present a systematic review and meta-analysis of the conversion rate and predictors of conversion from unipolar disorder to bipolar disorder. METHODS: A systematic literature search up to October 2016 was performed. For the meta-analysis, we only included studies...... that used survival analysis to estimate the conversion rate. RESULTS: A total of 31 studies were identified, among which 11 used survival analyses, including two register-based studies. The yearly rate of conversion to bipolar disorder decreased with time from 3.9% in the first year after study entry......, the prevalence of psychotic depression, the prevalence of chronic depression, and severity of depression. It was not possible to identify risk factors that were consistently or mainly confirmed to predict conversion across studies. CONCLUSIONS: The conversion rate from unipolar to bipolar disorder decreases...

  9. Biological dysrhythm in remitted bipolar I disorder.

    Science.gov (United States)

    Iyer, Aishwarya; Palaniappan, Pradeep

    2017-12-01

    Recent treatment guidelines support treatment of biological rhythm abnormalities as a part of treatment of bipolar disorder, but still, literature examining various domains (Sleep, Activity, Social, and Eating) of biological rhythm and its clinical predictors are less. The main aim of our study is to compare various domains of biological rhythm among remitted bipolar I subjects and healthy controls. We also explored for any association between clinical variables and biological rhythm among bipolar subjects. 40 subjects with Bipolar I disorder and 40 healthy controls who met inclusion and exclusion criteria were recruited for the study. Diagnoses were ascertained by a qualified psychiatrist using MINI 5.0. Sociodemographic details, biological rhythm (BRIAN-Biological Rhythm Interview of assessment in Neuropsychiatry) and Sleep functioning (PSQI- Pittsburgh Sleep Quality Index) were assessed in all subjects. Mean age of the Bipolar subjects and controls were 41.25±11.84years and 38.25±11.25 years respectively. Bipolar subjects experienced more biological rhythm disturbance when compared to healthy controls (total BRIAN score being 34.25±9.36 vs 28.2±6.53) (p=0.002). Subsyndromal depressive symptoms (HDRS) had significant positive correlation with BRIAN global scores(r=0.368, p=0.02). Linear regression analysis showed that number of episodes which required hospitalization (β=0.601, t=3.106, P=0.004), PSQI (β=0.394, t=2.609, p=0.014), HDRS (β=0.376, t=2.34, t=0.036) explained 31% of variance in BRIAN scores in remitted bipolar subjects. Biological rhythm disturbances seem to persist even after clinical remission of bipolar illness. More studies to look into the impact of subsyndromal depressive symptoms on biological rhythm are needed. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Clinical, Demographic, and Familial Correlates of Bipolar Spectrum Disorders among Offspring of Parents with Bipolar Disorder

    Science.gov (United States)

    Goldstein, Benjamin I.; Shamseddeen, Wael; Axelson, David A.; Kalas, Cathy; Monk, Kelly; Brent, David A.; Kupfer, David J.; Birmaher, Boris

    2010-01-01

    Objective: Despite increased risk, most offspring of parents with bipolar disorder (BP) do not manifest BP. The identification of risk factors for BP among offspring could improve preventive and treatment strategies. We examined this topic in the Pittsburgh Bipolar Offspring Study (BIOS). Method: Subjects included 388 offspring, ages 7-17 years,…

  11. Transcultural aspects of bipolar disorder

    OpenAIRE

    Sanches, Marsal; Jorge, Miguel Roberto

    2004-01-01

    Considerando-se que existem diferenças importantes na maneira como as emoções são vivenciadas e expressas em diferentes culturas, a apresentação e o manejo do transtorno afetivo bipolar sofrem influência de fatores culturais. O presente artigo realiza uma breve revisão da evidência referente aos aspectos transculturais do transtorno bipolar.Cultural variations in the expression of emotions have been described. Consequently, there are cross-cultural influences on the diagnosis and management o...

  12. Patients With Co-Occurring Bipolar Disorder and Posttraumatic Stress Disorder: A Rapid Review of the Literature.

    Science.gov (United States)

    Cerimele, Joseph M; Bauer, Amy M; Fortney, John C; Bauer, Mark S

    2017-05-01

    To summarize the current literature on epidemiology, clinical correlates, and treatment of individuals with co-occurring bipolar disorder and posttraumatic stress disorder (PTSD). We conducted a focused, time-sensitive review called "rapid review" in November 2015, using keyword searches (including keywords bipolar disorder, post-traumatic stress disorder, PTSD, and others) in PubMed for studies of adults with co-occurring bipolar disorder and PTSD. Results were sorted and systematically searched. An article was excluded if it did not describe adult patients with co-occurring PTSD and bipolar disorder or did not report original data on epidemiology, clinical correlates, or treatment. Information on study characteristics including population studied and key findings were extracted onto a data collection tool. Thirty-two articles were included. Over two-thirds of articles reported epidemiology of co-occurring bipolar disorder and PTSD. Prevalence of PTSD among individuals with bipolar disorder ranged from 4% to 40%, with women and those with bipolar I versus bipolar II disorder experiencing higher prevalence of PTSD. Prevalence of bipolar disorder among individuals with PTSD ranged from 6% to 55%. Baseline PTSD or bipolar disorder was associated with incidence of the other illness. Individuals with co-occurring bipolar disorder and PTSD experienced high symptom burden and low quality of life. No studies evaluated prospective treatment of patients with co-occurring bipolar disorder and PTSD. Bipolar disorder and PTSD commonly co-occur and result in greater symptom burden than either condition alone. Few published treatment strategies exist for patients with both conditions. © Copyright 2017 Physicians Postgraduate Press, Inc.

  13. Bipolar disorder and the pseudoautosomal region: An association study

    Energy Technology Data Exchange (ETDEWEB)

    Parsian, A.; Todd, R.D. [Washington Univ. School of Medicine, St. Louis, MO (United States)

    1994-03-15

    From family, adoption, and twin studies it is clear that genetic factors play an important role in the etiology of bipolar disorder (McGuffin and Katz: The Biology of Depression, Gaskell, London, 1986). Recently Yoneda et al. reported an association between an allele (A4) of a VNTR marker (DXYS20) for the pseudoautosomal region and bipolar disorder in a Japanese population. In order to test for this association in a Caucasian population, we have typed a sample of 52 subjects with bipolar disorder and 61 normal controls. The bipolar subjects are probands of multiple incidence families. The normal controls are an epidemiologically ascertained sample of middle-aged, unrelated individuals. The two groups were matched for sex and ethnic background. There were no significant differences in the allele or genotype frequencies of DXYS20 between the two groups. In particular, there was no significant difference in the frequency of the A4 allele in normal controls and bipolar patients (0.377 vs. 0.317, respectively). The prevalence of the A4 allele in bipolar patients and normal controls was 0.567 and 0.622, respectively. We were not able to replicate the results of the 1992 Yoneda et al. study. 15 refs., 2 tabs.

  14. Hypersexuality and couple relationships in bipolar disorder: A review.

    Science.gov (United States)

    Kopeykina, Irina; Kim, Hae-Joon; Khatun, Tasnia; Boland, Jennifer; Haeri, Sophia; Cohen, Lisa J; Galynker, Igor I

    2016-05-01

    with comorbid substance use as well as inpatient, outpatient, symptomatic and euthymic patients, may limit the generalizability of results. Although bipolar patients experience disease-specific sexual problems of mania-induced hypersexuality and specific effects of mood cycling on couple relationships, the existing literature is mostly outdated and lacks a consistent definition of hypersexuality. Novel research is needed to address sexual symptomatology in bipolar disorder within the context of current sexual, cultural and gender norms. Copyright © 2016. Published by Elsevier B.V.

  15. Correlates of current suicide risk among Thai patients with bipolar I disorder: findings from the Thai Bipolar Disorder Registry

    Directory of Open Access Journals (Sweden)

    Suttajit S

    2013-11-01

    Full Text Available Sirijit Suttajit,1 Suchat Paholpak,2 Somrak Choovanicvong,3 Khanogwan Kittiwattanagul,4 Wetid Pratoomsri,5 Manit Srisurapanont1On behalf of the Thai Bipolar Registry Group1Department of Psychiatry, Chiang Mai University, Chiang Mai, 2Department of Psychiatry, Khon Kaen University, Khon Kaen, 3Srithanya Hospital, Nonthaburi, 4Khon Kaen Rajanagarindra Psychiatric Hospital, Khon Kaen, 5Chachoengsao Hospital, Chachoengsao, ThailandBackground: The Thai Bipolar Disorder Registry was a prospective, multisite, naturalistic study conducted in 24 hospitals across Thailand. This study aimed to examine the correlates of current suicide risk in Thai patients with bipolar I disorder.Methods: Participants were adult inpatients or outpatients with bipolar disorder, based on the Diagnosis and Statistical Manual of Mental Disorders, fourth edition. All were assessed by using the Mini International Neuropsychiatric Interview (MINI, version 5. The severity of current suicide risk was determined by using the total score of the MINI suicidality module. Mood symptoms were assessed by using the Young Mania Rating Scale and the Montgomery Asberg Depression Rating Scale.Results: The data of 383 bipolar I disorder patients were included in the analyses. Of these, 363 (94.8% were outpatients. The mean (standard deviation of the MINI suicide risk score was 1.88 (5.0. The demographic/clinical variables significantly associated with the MINI suicide risk scores included age, number of overall previous episodes, the Young Mania Rating Scale score, the Montgomery Asberg Depression Rating Scale scores, and the Clinical Global Impression Severity of Illness Scale for Bipolar Disorder mania score, depression score, and overall score. The variables affecting the differences of suicide risk scores between or among groups were type of first mood episode, a history of rapid cycling, anxiety disorders, and alcohol use disorders. The stepwise multiple linear regression model revealed

  16. Family Functioning and the Course of Adolescent Bipolar Disorder

    Science.gov (United States)

    Sullivan, Aimee E.; Judd, Charles M.; Axelson, David A.; Miklowitz, David J.

    2012-01-01

    The symptoms of bipolar disorder affect and are affected by the functioning of family environments. Little is known, however, about the stability of family functioning among youth with bipolar disorder as they cycle in and out of mood episodes. This study examined family functioning and its relationship to symptoms of adolescent bipolar disorder,…

  17. Sexual behavior in women with bipolar disorder.

    Science.gov (United States)

    Mazza, Marianna; Harnic, Desiree; Catalano, Valeria; Di Nicola, Marco; Bruschi, Angelo; Bria, Pietro; Daniele, Antonio; Mazza, Salvatore

    2011-06-01

    There is a lack of studies regarding sexuality and sexual behavior in women with bipolar disorder. The aim of this study is to investigate sexual behavior in women affected by bipolar disorder in order to stimulate interest and debate in this area of care. Sixty women (30 BD I and 30 BD II) consent to participate in the study and were included in the sample. Moreover, sixty female healthy subjects without histories of psychiatric disorders were recruited as normal controls. Patients and healthy subjects were given the Sexual Interest and Sexual Performance Questionnaire, a questionnaire devised to explore various aspects of sexual behavior. The results of the present study suggest an increase of sexual interest in patients with BD I as compared both with BD II patients and healthy controls. In women with BD I such increase of interest was detected on some items of section I of the Sexual Interest and Sexual Performance Questionnaire, in particular "Actual Value of Sexuality" and "Implicit Sexual Interest", which implicitly explore sexual interest without overtly focusing upon sexual problems. Moreover, we observed a higher desired frequency of intercourse in women with BD I than BD II and a higher occurrence of repeated sexual intercourse in women with BD I than BD II. The main finding of the present study was an increase of sexual interest in BD I as compared with BD II female patients and normal controls. This result was detected when sexual interest was explored implicitly. Our study is limited by the small size of our subject groups. Further investigations on larger subject samples are needed to better clarify particular aspects of sexual behavior of BD patients. Copyright © 2010 Elsevier B.V. All rights reserved.

  18. Family Care giving in Bipolar disorder: Experiences of Stigma.

    Directory of Open Access Journals (Sweden)

    Farshid Shamsaei

    2013-12-01

    Full Text Available Stigma is a serious impediment to the well-being of those who experience it. Many family- caregivers are challenged by the stereotypes and prejudice that result from misconceptions about bipolar disorder.The purpose of this study was to explore the stigma experienced by family caregivers of patients with bipolar disorder.This was a qualitative and phenomenological study. In this study, we selected the family caregivers of patients with bipolar disorder in a psychiatric hospital (Iran using purposive sampling in 2011. By reaching data saturation, the number of participant was 12. Data were gathered through in-depth interviews and analyzed by the "Collaizi" method.Stigma was a pervasive concern to almost all participants. Family caregivers of patients with Bipolar disorders reported feelings and experiences of stigma and were most affected by them. Analysis of the interviews revealed 3 themes: Negative judgment, Shame, Stigmatization and Social Isolation.For a person with bipolar disorder, this illness is associated with the following problems: worse recovery, difficulty accessing health services, receiving poor treatment and support, and difficulty gaining community acceptance. Rejection of people with mental illness might also affect their family caregivers at various levels.

  19. Personality disorder symptom severity predicts onset of mood episodes and conversion to bipolar I disorder in individuals with bipolar spectrum disorder.

    Science.gov (United States)

    Ng, Tommy H; Burke, Taylor A; Stange, Jonathan P; Walshaw, Patricia D; Weiss, Rachel B; Urosevic, Snezana; Abramson, Lyn Y; Alloy, Lauren B

    2017-04-01

    Although personality disorders (PDs) are highly comorbid with bipolar spectrum disorders (BSDs), little longitudinal research has been conducted to examine the prospective impact of PD symptoms on the course of BSDs. The aim of this study is to examine whether PD symptom severity predicts shorter time to onset of bipolar mood episodes and conversion to bipolar I disorder over time among individuals with less severe BSDs. Participants (n = 166) with bipolar II disorder, cyclothymia, or bipolar disorder not otherwise specified completed diagnostic interview assessments of PD symptoms and self-report measures of mood symptoms at baseline. They were followed prospectively with diagnostic interviews every 4 months for an average of 3.02 years. Cox proportional hazard regression analyses indicated that overall PD symptom severity significantly predicted shorter time to onset of hypomanic (hazard ratio [HR] = 1.42; p conversion to bipolar I disorder (HR = 2.51; p conversion to bipolar I disorder (HR = 2.77; p < .001), whereas cluster C severity (HR = 1.56; p < .001) predicted shorter time to onset of major depressive episodes. These results support predisposition models in suggesting that PD symptoms may act as a risk factor for a more severe course of BSDs. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  20. Antisocial personality and bipolar disorder: interactions in impulsivity and course of illness

    Science.gov (United States)

    Swann, Alan C

    2011-01-01

    SUMMARY Antisocial personality disorder (ASPD) and bipolar disorder are both characterized by impulsive behavior, increased incarceration or arrest, addictive disorders and suicidal behavior. These characteristics appear more severe in the combined disorders. Individuals with ASPD who also have bipolar disorder have higher rates of addictive disorders and suicidal behavior and are more impulsive, as measured by questionnaires or behavioral laboratory tests. Those with bipolar disorder who have ASPD have higher rates of addictive, criminal and suicidal behavior, earlier onset of bipolar disorder with a more recurrent and predominately manic course and increased laboratory-measured, but not questionnaire-rated, impulsivity. These characteristics may result in part from differential impulsivity mechanisms in the two disorders, with bipolar disorder driven more by excessive catecholamine sensitivity and ASPD by deficient serotonergic function. PMID:22235235

  1. Systematic review of the prevalence of bipolar disorder and bipolar spectrum disorders in population-based studies

    OpenAIRE

    Dell'Aglio Jr.,José Caetano; Basso,Lissia Ana; Argimon,Irani Iracema de Lima; Arteche,Adriane

    2013-01-01

    This paper describes the findings of a systematic literature review aimed at providing an overview of the lifetime prevalence of bipolar disorder and bipolar spectrum disorders in population-based studies. Databases MEDLINE, ProQuest, Psychnet, and Web of Science were browsed for papers published in English between 1999 and May 2012 using the following search string: bipolar disorders OR bipolar spectrum disorders AND prevalence OR cross-sectional OR epidemiology AND population-based OR non-c...

  2. Unblending Borderline Personality and Bipolar Disorders.

    Science.gov (United States)

    di Giacomo, Ester; Aspesi, Flora; Fotiadou, Maria; Arntz, Arnoud; Aguglia, Eugenio; Barone, Lavinia; Bellino, Silvio; Carpiniello, Bernardo; Colmegna, Fabrizia; Lazzari, Marina; Lorettu, Liliana; Pinna, Federica; Sicaro, Aldo; Signorelli, Maria Salvina; Clerici, Massimo

    2017-08-01

    Borderline Personality (BPD) and Bipolar (BP) disorders stimulate an academic debate between their distinction and the inclusion of Borderline in the Bipolar spectrum. Opponents to this inclusion attribute the important differences and possible diagnostic incomprehension to overlapping symptoms. We tested 248 Borderline and 113 Bipolar patients, consecutively admitted to the Psychiatric Unit, through DSM-IV Axis I and II Disorders (SCID-I/II), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Young Mania Rating Scale (YMRS) and Borderline Personality Disorder Severity Index-IV (BPDSI-IV). All the tests statistically discriminated the disorders (p Borderline patients with manic features offer a privileged point of view for a deeper analysis. This allows for the possibility of a more precise examination of the nature and load of each symptom. Borderline Personality and Bipolar Disorders can be distinguished with high precision using common and time-sparing tests. The importance of discriminating these clinical features may benefit from this evidence. Copyright © 2017. Published by Elsevier Ltd.

  3. Concurrent hypokalemic periodic paralysis and bipolar disorder

    Directory of Open Access Journals (Sweden)

    Chia-Lin Lin

    2015-01-01

    Full Text Available Primary periodic paralysis is a rare autosomal dominant disorder of ion-channel dysfunction, manifested by episodic flaccid paresis secondary to abnormal sarcolemma excitability. Membrane destabilization involving Na, K-ATPase has been hypothesized to be a biological etiology of the bipolar disorder (BD and the mechanisms underlying lithium therapy have been linked to it. To date, there has been only one reported case of BD comorbid with periodic paralysis. Herein, we reported another case of concurrent bipolar mania and hypokalemic periodic paralysis (HPP, one special form of periodic paralysis. Consistent with the previous case, our patient responded well to lithium treatment for both bipolar mania and HPP. This might provide some support to the hypothesis that the therapeutic effects of lithium in both BD and HPP could be due to the correction of the underlying common pathophysiology.

  4. Improving the Recognition of Borderline Personality Disorder in a Bipolar World.

    Science.gov (United States)

    Zimmerman, Mark

    2016-06-01

    Both bipolar disorder and borderline personality disorder (BPD) are serious mental health disorders resulting in significant psychosocial morbidity, reduced health-related quality of life, and excess mortality. Yet research on BPD has received much less funding from the National Institute of Health (NIH) than has bipolar disorder during the past 25 years. Why hasn't the level of NIH research funding for BPD been commensurate with the level of psychosocial morbidity, mortality, and health expenditures associated with the disorder? In the present article, the author illustrates how the bipolar disorder research community has done a superior job of "marketing" their disorder. Studies of underdiagnosis, screening, diagnostic spectra, and economics are reviewed for both bipolar disorder and BPD. Researchers of bipolar disorder have conducted multiple studies highlighting the problem with underdiagnosis, developed and promoted several screening scales, published numerous studies of the operating characteristics of these screening measures, attempted to broaden the definition of bipolar disorder by advancing the concept of the bipolar spectrum, and repeatedly demonstrated the economic costs and public health significance of bipolar disorder. In contrast, researchers of BPD have almost completely ignored each of these four issues and research efforts. Although BPD is as frequent as (if not more frequent than) bipolar disorder, as impairing as (if not more impairing than) bipolar disorder, and as lethal as (if not more lethal than) bipolar disorder, it has received less than one-tenth the level of funding from the NIH and has been the focus of many fewer publications in the most prestigious psychiatric journals. The researchers of BPD should consider adopting the strategy taken by researchers of bipolar disorder before the diagnosis is eliminated in a future iteration of the DSM or the ICD.

  5. [Disease mongering and bipolar disorder in Japan].

    Science.gov (United States)

    Ihara, Hiroshi

    2011-01-01

    Frequently used in a pejorative sense, "disease mongering" connotes a widening of the diagnostic boundaries of illness. Pharmaceutical companies conduct disease awareness campaigns on the pretext of educating the public about the prevention of illness or the promotion of health. Encouraged by disease awareness advertisements, people gradually become filled with concern that they are ill and need medical treatment. As a result, pharmacotherapy is increasingly being applied to ever-milder conditions, leading to potentially unnecessary medication, wasted resources, and even adverse side effects. Among all fields of clinical medicine, psychiatry is undoubtedly the most vulnerable to the danger of disease mongering. In Japan, depression provides the most drastic example of the impact of disease awareness campaigns on the number of patients seeking treatment. Until the late 1990s, Japanese psychiatrists focused almost exclusively on psychosis and endogenous depression, the latter being severe enough to require conventional forms of antidepressants, known as tricyclic antidepressants, and even hospitalization. At this time, people's attitude toward depression was generally unfavorable. Indeed, the Japanese word for clinical depression, utubyo, has a negative connotation, implying severe mental illness. This situation, however, changed immediately after fluvoxiamine (Luvox-Fujisawa, Depromel-Meiji Seika), the first selective serotonin re-uptake inhibitor (SSRI) to receive approval in Japan, was introduced in 1999. In order to aid the drug's acceptance by the Japanese public, pharmaceutical companies began using the catchphrase kokoro no kaze, which literally means "a cold of the soul". Thus armed with this phrase, the pharmaceutical industry embarked on a campaign to lessen the stigma surrounding depression. According to national data from the Ministry of Health and Welfare, the number of patients with a diagnosis of mood disorder increased from 327,000 in 1999 to 591

  6. The bipolarity of light and dark: A review on Bipolar Disorder and circadian cycles.

    Science.gov (United States)

    Abreu, T; Bragança, M

    2015-10-01

    Bipolar Disorder is characterized by episodes running the full mood spectrum, from mania to depression. Between mood episodes, residual symptoms remain, as sleep alterations, circadian cycle disturbances, emotional deregulation, cognitive impairment and increased risk for comorbidities. The present review intends to reflect about the most recent and relevant information concerning the biunivocal relation between bipolar disorder and circadian cycles. It was conducted a literature search on PubMed database using the search terms "bipolar", "circadian", "melatonin", "cortisol", "body temperature", "Clock gene", "Bmal1 gene", "Per gene", "Cry gene", "GSK3β", "chronotype", "light therapy", "dark therapy", "sleep deprivation", "lithum" and "agomelatine". Search results were manually reviewed, and pertinent studies were selected for inclusion as appropriate. Several studies support the relationship between bipolar disorder and circadian cycles, discussing alterations in melatonin, body temperature and cortisol rhythms; disruption of sleep/wake cycle; variations of clock genes; and chronotype. Some therapeutics for bipolar disorder directed to the circadian cycles disturbances are also discussed, including lithium carbonate, agomelatine, light therapy, dark therapy, sleep deprivation and interpersonal and social rhythm therapy. This review provides a summary of an extensive research for the relevant literature on this theme, not a patient-wise meta-analysis. In the future, it is essential to achieve a better understanding of the relation between bipolar disorder and the circadian system. It is required to establish new treatment protocols, combining psychotherapy, therapies targeting the circadian rhythms and the latest drugs, in order to reduce the risk of relapse and improve affective behaviour. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Resistant bipolar affective disorder treated by stereotactic subcaudate tractotomy.

    Science.gov (United States)

    Poynton, A; Bridges, P K; Bartlett, J R

    1988-03-01

    The results of stereotactic subcaudate tractotomy in nine patients with resistant bipolar affective disorder are presented in the form of a single case study with a summary of the other eight cases. Follow-up studies at 2-4 years showed substantial improvement in five patients and amelioration of symptoms in a further four patients, with a tendency for a greater improvement in the manic than in the depressive episodes. These preliminary results suggest that there is a place for this operation in the management of severe bipolar affective disorders which are not responding to any other treatment, although decisive recovery occurs less often than with unipolar depression.

  8. A report on older-age bipolar disorder from the International Society for Bipolar Disorders Task Force

    DEFF Research Database (Denmark)

    Sajatovic, Martha; Strejilevich, Sergio A; Gildengers, Ariel G

    2015-01-01

    OBJECTIVES: In the coming generation, older adults with bipolar disorder (BD) will increase in absolute numbers as well as proportion of the general population. This is the first report of the International Society for Bipolar Disorder (ISBD) Task Force on Older-Age Bipolar Disorder (OABD). METHO...

  9. Schizoaffective disorder merges schizophrenia and bipolar disorders as one disease--there is no schizoaffective disorder.

    Science.gov (United States)

    Lake, Charles Ray; Hurwitz, Nathaniel

    2007-07-01

    Schizoaffective disorder was named as a compromise diagnosis in 1933, and remains popular as judged by its place in the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders, its frequent use in clinical practice, and its extensive discussion in the literature. Some, however, have questioned the validity of schizoaffective disorder as separate from psychotic mood disorder. We examined the literature to assess the rationale for the continuation of schizoaffective disorder as a legitimate diagnostic category. The diagnosis of schizoaffective disorder depends on the disease specificity of the diagnostic criteria for schizophrenia; however, the psychotic symptoms for schizophrenia, traditionally held as specific, can be accounted for by psychotic bipolar. Further, the interrater reliability for diagnosing schizoaffective disorder is very low. A recent and expanding body of comparative evidence from a wide range of clinical and basic science studies, especially genetic, reveals multiple similarities between schizoaffective disorder, schizophrenia and psychotic bipolar. Schizoaffective disorder unifies schizophrenia and bipolar, blurring the zones of rarity between them and suggesting that schizoaffective disorder is not a separate, 'bona-fide' disease. Patients diagnosed with schizoaffective disorder likely suffer from a psychotic mood disorder. The diagnosis of schizoaffective disorder, which can result in substandard treatment, should be eliminated from the diagnostic nomenclature.

  10. Bipolar polygenic loading and bipolar spectrum features in major depressive disorder.

    Science.gov (United States)

    Wiste, Anna; Robinson, Elise B; Milaneschi, Yuri; Meier, Sandra; Ripke, Stephan; Clements, Caitlin C; Fitzmaurice, Garrett M; Rietschel, Marcella; Penninx, Brenda W; Smoller, Jordan W; Perlis, Roy H

    2014-09-01

    Family and genetic studies indicate overlapping liability for major depressive disorder and bipolar disorder. The purpose of the present study was to determine whether this shared genetic liability influences clinical presentation. A polygenic risk score for bipolar disorder, derived from a large genome-wide association meta-analysis, was generated for each subject of European-American ancestry (n = 1,274) in the Sequential Treatment Alternatives to Relieve Depression study (STAR*D) outpatient major depressive disorder cohort. A hypothesis-driven approach was used to test for association between bipolar disorder risk score and features of depression associated with bipolar disorder in the literature. Follow-up analyses were performed in two additional cohorts. A generalized linear mixed model including seven features hypothesized to be associated with bipolar spectrum illness was significantly associated with bipolar polygenic risk score [F = 2.07, degrees of freedom (df) = 7, p = 0.04]. Features included early onset, suicide attempt, recurrent depression, atypical depression, subclinical mania, subclinical psychosis, and severity. Post-hoc univariate analyses demonstrated that the major contributors to this omnibus association were onset of illness at age ≤ 18 years [odds ratio (OR) = 1.2, p = 0.003], history of suicide attempt (OR = 1.21, p = 0.03), and presence of at least one manic symptom (OR = 1.16, p = 0.02). The maximal variance in these traits explained by polygenic score ranged from 0.8% to 1.1%. However, analyses in two replication cohorts testing a five-feature model did not support this association. Bipolar genetic loading appeared to be associated with bipolar-like presentation in major depressive disorder in the primary analysis. However, the results were at most inconclusive because of lack of replication. Replication efforts were challenged by different ascertainment and assessment strategies in the different cohorts. The methodological approach

  11. Assessing and addressing cognitive impairment in bipolar disorder

    DEFF Research Database (Denmark)

    Miskowiak, K W; Burdick, K E; Martinez-Aran, A

    2018-01-01

    OBJECTIVES: Cognition is a new treatment target to aid functional recovery and enhance quality of life for patients with bipolar disorder. The International Society for Bipolar Disorders (ISBD) Targeting Cognition Task Force aimed to develop consensus-based clinical recommendations on whether, when...... through these exchanges with no need for formal consensus methods. RESULTS: The identified questions were: (I) Should cognitive screening assessments be routinely conducted in clinical settings? (II) What are the most feasible screening tools? (III) What are the implications if cognitive impairment...... in Bipolar Disorder Rating Assessment, and (III) evaluate the impact of medication and comorbidity, refer patients for comprehensive neuropsychological evaluation when clinically indicated, and encourage patients to build cognitive reserve. Regarding question (IV), there is limited evidence for current...

  12. Peripheral blood brain-derived neurotrophic factor in bipolar disorder

    DEFF Research Database (Denmark)

    Munkholm, K; Vinberg, M; Kessing, L V

    2016-01-01

    subjects and between affective states in bipolar disorder patients, including assessment of the effect of treatment of acute episodes on BDNF levels. A systematic review of English language studies without considering publication status was conducted in PubMed (January 1950-November 2014), Embase (1974......Peripheral blood brain-derived neurotrophic factor (BDNF) has been proposed as a potential biomarker related to disease activity and neuroprogression in bipolar disorder, speculated to mirror alterations in brain expression of BDNF. The research area is rapidly evolving; however, recent...... investigations have yielded conflicting results with substantial variation in outcomes, highlighting the need to critically assess the state of current evidence. The aims of the study were to investigate differences in peripheral blood BDNF concentrations between bipolar disorder patients and healthy control...

  13. Diagnostic subtypes of bipolar disorder in older versus younger adults

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel

    2006-01-01

    OBJECTIVE: To investigate differences in diagnostic subtypes of bipolar disorder as according to ICD-10 between patients whose first contact with psychiatric health care occurs late in life (over 50 years of age) and patients who have first contact earlier in life (50 years of age or below......). METHODS: From 1994 to 2002 all patients who received a diagnosis of a manic episode or bipolar disorder at initial contact with the mental healthcare system, whether outpatient or inpatient, were identified in Denmark's nationwide register. RESULTS: A total of 852 (49.6%) patients, who were over age 50......, and 867 patients, who were 50 or below, received a diagnosis of a manic episode or bipolar disorder at the first contact ever. Older inpatients presented with psychotic symptoms (35.4%) significantly less than younger inpatients (42.6%) due specifically to a lower prevalence of manic episodes...

  14. Two methylenetetrahydrofolate reductase gene (MTHFR) polymorphisms, schizophrenia and bipolar disorder

    DEFF Research Database (Denmark)

    Jönsson, Erik G; Larsson, Kristina; Vares, Maria

    2008-01-01

    disorder. In a replication attempt the MTHFR C677T and A1298C SNPs were analyzed in three Scandinavian schizophrenia case-control samples. In addition, Norwegian patients with bipolar disorder were investigated. There were no statistically significant allele or genotype case-control differences....... The present Scandinavian results do not verify previous associations between the putative functional MTHFR gene polymorphisms and schizophrenia or bipolar disorder. However, when combined with previous studies in meta-analyses there is still evidence for association between the MTHFR C677T polymorphism......Recent meta-analyses of the methylenetetrahydrofolate reductase gene (MTHFR) have suggested association between two of its functional single gene polymorphisms (SNPs; C677T and A1298C) and schizophrenia. Studies have also suggested association between MTHFR C677T and A1298C variation and bipolar...

  15. Two methylenetetrahydrofolate reductase gene (MTHFR) polymorphisms, schizophrenia and bipolar disorder

    DEFF Research Database (Denmark)

    Jönsson, Erik G; Larsson, Kristina; Vares, Maria

    2008-01-01

    Recent meta-analyses of the methylenetetrahydrofolate reductase gene (MTHFR) have suggested association between two of its functional single gene polymorphisms (SNPs; C677T and A1298C) and schizophrenia. Studies have also suggested association between MTHFR C677T and A1298C variation and bipolar...... disorder. In a replication attempt the MTHFR C677T and A1298C SNPs were analyzed in three Scandinavian schizophrenia case-control samples. In addition, Norwegian patients with bipolar disorder were investigated. There were no statistically significant allele or genotype case-control differences....... The present Scandinavian results do not verify previous associations between the putative functional MTHFR gene polymorphisms and schizophrenia or bipolar disorder. However, when combined with previous studies in meta-analyses there is still evidence for association between the MTHFR C677T polymorphism...

  16. Post-stroke emotional incontinence or bipolar disorder?

    Directory of Open Access Journals (Sweden)

    Mnif L

    2016-07-01

    Full Text Available Leila Mnif,1 Rim Sellami,2 Jawaher Masmoudi2 1Department of Psychiatry “D”, Razi University hospital, Tunis, 2Department of Psychiatry “A”, Hédi Chaker University Hospital, Sfax, Tunisia Introduction: Post-stroke emotional incontinence and bipolar disorder are two disorders that involve the dysfunction of brain structures responsible for emotional regulation. The objective of this work is to study the links between these disorders through a clinical case. Case report: We present the case of a 43-year-old man without previous psychiatric history who experienced emotional incontinence after cerebrovascular events. He reacted promptly to selective serotonin reuptake inhibitor treatment. However, he experienced his first episode of hypomania after 6 months of antidepressant therapy. Adjunctive therapy with valproic acid and low-dose paroxetine was eventually added, resulting in complete improvement of both emotional incontinence and hypomania after 4 additional months of treatment. Conclusion: The clinician should carefully explore any history of premorbid bipolar disorder, personality disorder characterized by mood instability, and family history of bipolar disorder. Keywords: stroke, emotional incontinence, bipolar disorder

  17. Social skills knowledge and performance among adolescents with bipolar disorder.

    Science.gov (United States)

    Goldstein, Tina R; Miklowitz, David J; Mullen, Kimberley L

    2006-08-01

    This study investigated social skills deficits among adolescents with bipolar disorder. Adolescents with DMS-IV bipolar disorder (n = 18) and their parents completed social skills assessments when they were experiencing minimal mood symptoms. The control group (n = 18) consisted of adolescents with no history of psychiatric disorders. Participants and their parents rated the adolescents' social performance using the Matson Evaluation of Social Skills with Youngsters. We measured the adolescents' knowledge of appropriate social skills using the Interpersonal Negotiation Strategy Interview. Raters 'blind' to psychiatric status rated the adolescents' responses and their social interactions with an examiner during the assessment. Adolescents with bipolar disorder displayed significantly more social skills performance deficits than controls. No significant differences emerged between the groups in social skills knowledge. Ratings of social interactions with the examiner failed to distinguish bipolar from control teens, but raters were successful in guessing the psychiatric status of the participants. These findings indicate that bipolar adolescents lag behind their peers in social skills performance, but not social skills knowledge. Results support the hypothesis that difficulties with emotion regulation interfere with the consistent exhibition of appropriate social behaviors.

  18. Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder

    DEFF Research Database (Denmark)

    Schaffer, Ayal; Isometsä, Erkki T; Tondo, Leonardo

    2015-01-01

    and pharmacotherapy studies specific to bipolar disorder. We conducted pooled, weighted analyses of suicide rates. RESULTS: The pooled suicide rate in bipolar disorder is 164 per 100,000 person-years (95% confidence interval = [5, 324]). Sex-specific data on suicide rates identified a 1.7:1 ratio in men compared......OBJECTIVES: Bipolar disorder is associated with elevated risk of suicide attempts and deaths. Key aims of the International Society for Bipolar Disorders Task Force on Suicide included examining the extant literature on epidemiology, neurobiology and pharmacotherapy related to suicide attempts...... and deaths in bipolar disorder. METHODS: Systematic review of studies from 1 January 1980 to 30 May 2014 examining suicide attempts or deaths in bipolar disorder, with a specific focus on the incidence and characterization of suicide attempts and deaths, genetic and non-genetic biological studies...

  19. Deep brain stimulation for bipolar disorder-review and outlook.

    Science.gov (United States)

    Gippert, Sabrina M; Switala, Christina; Bewernick, Bettina H; Kayser, Sarah; Bräuer, Alena; Coenen, Volker A; Schlaepfer, Thomas E

    2017-06-01

    Research on deep brain stimulation (DBS) for treatment-resistant psychiatric disorders has established preliminary efficacy signals for treatment-resistant depression. There are only few studies on DBS that included patients suffering from bipolar disorder. This article gives an overview of these studies concerning DBS targets, antidepressant efficacy, and the occurrence of manic/hypomanic symptoms under stimulation. First, promising results show that all patients experienced significant improvement in depressive symptomatology. In a single case, hypomanic symptoms occurred, but they could be resolved by adjusting stimulation parameters. Furthermore, this article highlights important clinical differences between unipolar and bipolar depression that have to be considered throughout the course of treatment.

  20. Genetics Home Reference: bipolar disorder

    Science.gov (United States)

    ... often occurs with other mental health conditions, including anxiety disorders (such as panic attacks), behavioral disorders (such as ... disorder is a common form of mental illness. At some point during their lifetime, 2.4 ...

  1. Co-morbid disorders and sexual risk behavior in Nigerian adolescents with bipolar disorder

    Directory of Open Access Journals (Sweden)

    Bakare Muideen O

    2009-06-01

    Full Text Available Abstract Background Adolescent onset bipolar disorder often presents with co-morbid disorders of which psychoactive substance use disorders are notable. Mania symptoms and co-morbid psychoactive substance use disorders prone adolescents with bipolar disorder to impulsivity, impaired judgment, and risk taking behavior which often includes sexual risk behavior. There are dearth of information on pattern of co-morbid disorders and sexual risk behavior in adolescent onset bipolar disorder in Nigeria. This study assessed the prevalence and pattern of co-morbid disorders and determined associated factors of sexual risk behavior among adolescents with bipolar disorder. Methods Socio-demographic information was obtained from the adolescents using socio-demographic questionnaire. Clinical interview, physical examination and laboratory investigations were employed to establish co-morbid disorders in these adolescents during the outpatient follow up visits over a one year period. Results A total of forty six (46 adolescents with bipolar disorder were followed up over a one year period. Twenty two (47.8% of the adolescents had co-morbid disorders with cannabis use disorders, alcohol use disorders, conduct disorder with or without other psychoactive substance use accounting for 23.9%, 8.7%, 13.0% respectively and HIV infection, though a chance finding accounting for 2.2%. Twenty one (45.7% of the adolescents had positive history of sexual risk behavior, which was significantly associated with presence of co-morbid disorders (p = 0.003, level of religion activities in the adolescents (p = 0.000, and marital status of the parents (p = 0.021. Conclusion When planning interventions for children and adolescents with bipolar disorder, special attention may need to be focused on group of adolescents with co-morbid disorders and propensity towards impulsivity and sexual risk behavior. This may help in improving long term outcome in this group of adolescents.

  2. Impulse control disorder comorbidity among patients with bipolar I disorder.

    Science.gov (United States)

    Karakus, Gonca; Tamam, Lut

    2011-01-01

    Impulsivity is associated with mood instability, behavioral problems, and action without planning in patients with bipolar disorder. Increased impulsivity levels are reported at all types of mood episodes. This association suggests a high comorbidity between impulse control disorders (ICDs) and bipolar disorder. The aim of this study is to compare the prevalence of ICDs and associated clinical and sociodemographic variables in euthymic bipolar I patients. A total of 124 consecutive bipolar I patients who were recruited from regular attendees from the outpatient clinic of our Bipolar Disorder Unit were included in the study. All patients were symptomatically in remission. Diagnosis of bipolar disorder was confirmed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Impulse control disorders were investigated using the modified version of the Minnesota Impulsive Disorders Interview. Impulsivity was measured with the Barratt Impulsiveness Scale Version 11. Furthermore, all patients completed the Zuckerman Sensation-Seeking Scale Form V. The prevalence rate of all comorbid ICDs in our sample was 27.4% (n = 34). The most common ICD subtype was pathologic skin picking, followed by compulsive buying, intermittent explosive disorder, and trichotillomania. There were no instances of pyromania or compulsive sexual behavior. There was no statistically significant difference between the sociodemographic characteristics of bipolar patients with and without ICDs with regard to age, sex, education level, or marital status. Comorbidity of alcohol/substance abuse and number of suicide attempts were higher in the ICD(+) group than the ICD(-) group. Length of time between mood episodes was higher in the ICD(-) group than the ICD(+) group. There was a statistically significant difference between the total number of mood episodes between the 2 groups, but the number of depressive episodes was higher in the ICD(+) patients

  3. An Integrated Risk Reduction Intervention can reduce body mass index in individuals being treated for bipolar I disorder: results from a randomized trial

    Science.gov (United States)

    Frank, Ellen; Wallace, Meredith L; Hall, Martica; Hasler, Brant; Levenson, Jessica C; Janney, Carol A; Soreca, Isabella; Fleming, Matthew C; Buttenfield, Joan; Ritchey, Fiona C; Kupfer, David J

    2014-01-01

    Objectives We conducted a randomized, controlled trial comparing the efficacy of an Integrated Risk Reduction Intervention (IRRI) to a control condition with the objective of improving mood stability and psychosocial functioning by reducing cardiometabolic risk factors in overweight/obese patients with bipolar I disorder. Methods A total of 122 patients were recruited from our outpatient services and randomly allocated to IRRI (n = 61) or psychiatric care with medical monitoring (n = 61). Individuals allocated to IRRI received psychiatric treatment and assessment, medical monitoring by a nurse, and a healthy lifestyle program from a lifestyle coach. Those allocated to the control condition received psychiatric treatment and assessment and referral, if indicated, for medical problems. A mixed-effects model was used to examine the impact of the interventions on body mass index (BMI). Exploratory moderator analyses were used to characterize those individuals likely to benefit from each treatment approach. Results Analyses were conducted on the IRRI (n = 58) and control (n = 56) participants with ≥ 1 study visit. IRRI was associated with significantly greater rate of decrease in BMI (d = −0.51, 95% confidence interval: −0.91 to −0.14). Three variables (C-reactive protein, total cholesterol, and instability of total sleep time) contributed to a combined moderator of faster decrease in BMI with IRRI treatment. Conclusions Overweight/obese patients with bipolar disorder can make modest improvements in BMI, even when taking medications with known potential for weight gain. Our finding that a combination of three baseline variables provides a profile of patients likely to benefit from IRRI will need to be tested further to evaluate its utility in clinical practice. PMID:25495748

  4. Clinical phenotype of bipolar disorder with comorbid binge eating disorder

    Science.gov (United States)

    McElroy, Susan L.; Crow, Scott; Biernacka, Joanna M.; Winham, Stacey; Geske, Jennifer; Cuellar Barboza, Alfredo B.; Prieto, Miguel L.; Chauhan, Mohit; Seymour, Lisa R.; Mori, Nicole; Frye, Mark A.

    2017-01-01

    Background To explore the relationship between binge eating disorder (BED) and obesity in patients with bipolar disorder (BP). Methods 717 patients participating in the Mayo Clinic Bipolar Biobank completed structured diagnostic interviews and questionnaires for demographic and illness-related variables. They also had weight and height measured to determine body mass index (BMI). The effects of BED and obesity (BMI≥30 kg/m2), as well as their interaction, were assessed on one measure of general medical burden and six proxies of psychiatric illness burden. Results 9.5% of patients received a clinical diagnosis of BED and 42.8% were obese. BED was associated with a significantly elevated BMI. Both BED and obesity were associated with greater psychiatric and general illness burden, but illness burden profiles differed. After controlling for obesity, BED was associated with suicidality, psychosis, mood instability, anxiety disorder comorbidity, and substance abuse comorbidity. After controlling for BED status, obesity was associated with greater general medical comorbidity, but lower substance abuse comorbidity. There were no significant interaction effects between obesity and BED, or BMI and BED, on any illness burden outcome. Limitations There may have been insufficient power to detect interactions between BED and obesity. Conclusions: Among patients with BP, BED and obesity are highly prevalent and correlated, but associated with different profiles of enhanced illness burden. As the association of BED with greater psychiatric illness burden remained significant even after accounting for the effect of obesity, BP with BED may represent a clinically important sub-phenotype. PMID:23742827

  5. Cardiovascular risk factors in outpatients with bipolar disorder

    NARCIS (Netherlands)

    Klumpers, U.M.H.; Boom, K.; Janssen, F.M.G.; Tulen, J.H.M.; Loonen, Anton J. M.

    2004-01-01

    Background: The mortality due to cardiovascular diseases in bipolar patients is much higher than in the general population. It is unclear whether lithium treatment contributes to this cardiovascular morbidity. Methods: The cardiovascular risk factors in outpatients with bipolar disorder on

  6. [Emotional and impulsive dimensions in bipolar disorder and borderline personality disorder].

    Science.gov (United States)

    Leblanc, A; Jarroir, M; Vorspan, F; Bellivier, F; Leveillee, S; Romo, L

    2017-05-01

    Studies have shown that patients with borderline personality disorder are often misdiagnosed to have bipolar disorder and conversely. Indeed, a number of characteristics common to both disorders could explain this problem: emotional instability as well as impulsivity represent confounding factors and contribute to the risk of misdiagnosis. However, it appears that these characteristics manifest themselves in different ways according to the pathology. The aim of the study is to show differences between affective lability, emotional intensity and impulsivity dimensions. The clinical aim is to refine bipolar disorder and borderline personality disorder diagnosis, to improve psychological care for these patients in the long-term. We compared the emotional and impulsive dimensions in two groups of patients: a group of 21 patients with bipolar disorder and a group of 19 patients with borderline personality disorder. Tools: ALS, a self-report questionnaire to evaluate affective lability, AIM, a self-report questionnaire to see affective intensity, and UPPS, a self-report questionnaire to measure impulsivity according to several dimensions. The results indicate that borderline patients scored significantly higher than bipolar patients at the ALS and AIM scales. Regarding the UPPS, borderline patients scored significantly higher than bipolar patients for the dimensions "lack of premeditation" and "lack of perseverance"; however, bipolar patients had significantly higher scores than borderline patients for the dimension "negative emergency". This study shows that bipolar disorder and borderline personality can be differentiated thanks to emotional dimensions as well as different dimensions of impulsivity: borderline patients appear to have an affective lability and intensity more important than bipolar patients; it also appears that impulsivity manifests itself differently according to the disorder. Copyright © 2016 L'Encéphale, Paris. Published by Elsevier Masson SAS. All

  7. Cardiovascular risk factors in outpatients with bipolar disorder: a report from the Brazilian Research Network in Bipolar Disorder

    Directory of Open Access Journals (Sweden)

    Fabiano A. Gomes

    2013-06-01

    Full Text Available Objective: Bipolar disorder (BD is associated with significant morbidity and mortality due to comorbid general medical conditions, particularly cardiovascular disease. This study is the first report of the Brazilian Research Network in Bipolar Disorder (BRN-BD that aims to evaluate the prevalence and clinical correlates of cardiovascular risk factors among Brazilian patients with BD. Methods: A cross-sectional study of 159 patients with DSM-IV BD, 18 years or older, consecutively recruited from the Bipolar Research Program (PROMAN in São Paulo and the Bipolar Disorder Program (PROTAHBI in Porto Alegre. Clinical, demographic, anthropometric, and metabolic variables were systematically assessed. Results: High rates of smoking (27%, physical inactivity (64.9%, alcohol use disorders (20.8%, elevated fasting glucose (26.4%, diabetes (13.2%, hypertension (38.4%, hypertriglyceridemia (25.8%, low HDL-cholesterol (27.7%, general (38.4% and abdominal obesity (59.1% were found in the sample. Male patients were more likely to have alcohol use disorders, diabetes, and hypertriglyceridemia, whereas female patients showed higher prevalence of abdominal obesity. Variables such as medication use pattern, alcohol use disorder, and physical activity were associated with selected cardiovascular risk factors in the multivariable analysis. Conclusion: This report of the BRN-BD provides new data regarding prevalence rates and associated cardiovascular risk factors in Brazilian outpatients with BD. There is a need for increasing both awareness and recognition about metabolic and cardiovascular diseases in this patient population.

  8. Atypical depression is associated with suicide attempt in bipolar disorder.

    Science.gov (United States)

    Sánchez-Gistau, V; Colom, F; Mané, A; Romero, S; Sugranyes, G; Vieta, E

    2009-07-01

    There is a dearth of research focusing on factors associated with suicide attempts. High rates of atypical depression have been reported in studies including unipolar and bipolar II patients. In this study, the association between suicide attempt and atypical depression, in addition to other major risk factors, was evaluated in 390 bipolar I and II out-patients. Variables were defined according to DSM-IV criteria, and assessed with a Structured Interview for DSM-IV (axis I and II). History of suicide attempt was obtained through interviews with patients and relatives. Attempters and non-attempters were compared using univariate and multivariate analysis. Attempters showed significantly higher rates of atypical depression, family history of completed suicide, depression at index episode and cluster B personality disorder. Our results highlight the relevance of atypical depression in bipolar disorder. A more accurate identification of potential attempters may contribute to the development of effective preventive treatment strategies.

  9. Comorbidity and Phenomenology of Bipolar Disorder in Children with ADHD

    Science.gov (United States)

    Serrano, Eduardo; Ezpeleta, Lourdes; Castro-Fornieles, Josefina

    2013-01-01

    Objective: To assess the comorbidity of bipolar disorder (BPD) in children with ADHD and to study the psychopathological profile of ADHD children with and without mania. Method: A total of 100 children with ADHD were assessed with a semistructured diagnostic interview and questionnaires of mania, ADHD, and general psychopathology. Results: 8% of…

  10. Facial affect recognition deficits in bipolar disorder.

    Science.gov (United States)

    Getz, Glen E; Shear, Paula K; Strakowski, Stephen M

    2003-05-01

    Patients diagnosed with bipolar disorder (BPD), by definition, have problems with emotional regulation. However, it remains uncertain whether these patients are also deficient at processing other people's emotions, particularly while manic. The present study examined the ability of 25 manic bipolar patients and 25 healthy participants on tasks of facial recognition and facial affect recognition at three different presentation durations: 500 ms, 750 ms, and 1000 ms. The groups did not differ in terms of age, education, sex, ethnicity, or estimated IQ. The groups did not differ significantly on either a novel computerized facial recognition task or the Benton Facial Recognition Test. In contrast, the bipolar group performed significantly more poorly than did the comparison group on a novel facial affect labeling task. Although the patient group had slower reaction times on all 3 computerized tasks, the presentation duration did not have an effect on performance in the patients. This study suggests that patients with bipolar disorder are able to recognize faces, but have difficulty processing facial affective cues.

  11. [BIPOLAR DISORDER AS A MULTI-SYSTEM ILLNESS].

    Science.gov (United States)

    Fenchel, Daphna; Levkovitz, Yechiel; Kotler, Moshe

    2017-12-01

    Bipolar disorder is a chronic condition, characterized by high distress in patients and high suicide rates (30%). Most patients suffer from medical and other psychiatric comorbidities, which worsen the psychiatric symptoms and decrease the likelihood of remission. More than 70% of bipolar patients have cardio-metabolic symptoms, with higher rates compared to other psychiatric disorders. Cardiovascular disease is the major cause of high mortality rates in these patients, with 1.5-2 fold increased risk of mortality, compared to the general population without psychiatric symptoms. The rates of cardiovascular risk factors and their resulting increased mortality rates are similar to those found in schizophrenia. In addition to cardio-metabolic conditions, 50% of patients with bipolar disorder suffer from other medical symptoms, which are also associated with worse outcomes. Therefore, the current perspective is that bipolar disorder is not only a psychiatric disorder, but rather a multi-system illness, affecting the entire body. The optimal treatment for these patients should include diagnosis, monitoring and treatment of both psychiatric and physical symptoms, which would improve their prognosis.

  12. A gender-focused perspective on health service utilization in comorbid bipolar I disorder and alcohol use disorders: results from the national epidemiologic survey on alcohol and related conditions.

    Science.gov (United States)

    Goldstein, Benjamin I; Levitt, Anthony J

    2006-06-01

    This study compares health service utilization by individuals with comorbid lifetime bipolar I disorder and lifetime alcohol use disorders (AUD) to that of individuals with either diagnosis alone, using nationally representative data. The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions was used to identify respondents with bipolar I disorder only (BD-only; N = 636), AUD only (N = 11,068), and comorbid bipolar I disorder and AUD (BD-AUD; N = 775). Diagnoses were generated using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. The 3 groups were compared with respect to self-reported health service utilization. For both men and women, respondents in the BD-AUD group were significantly more likely than AUD-only respondents to report any alcohol-related service utilization (p disorder-related hospital admissions as compared with BD-only respondents among males only (p = .009). Within the BD-AUD group, males reported significantly greater utilization of AUD treatment only (p disorder treatment only (p disorder services. As expected, individuals with comorbid bipolar I disorder and AUD utilize significantly more mental health services than individuals with either disorder alone. The primary original finding is that among those with comorbid bipolar I disorder and AUD, bipolar I disorder is more likely to go untreated among males and AUD is more likely to go untreated among females. Gender may be an important factor to consider in future health service planning for comorbid bipolar I disorder and AUD.

  13. Neural Correlates of Irritability in Disruptive Mood Dysregulation and Bipolar Disorders.

    Science.gov (United States)

    Wiggins, Jillian Lee; Brotman, Melissa A; Adleman, Nancy E; Kim, Pilyoung; Oakes, Allison H; Reynolds, Richard C; Chen, Gang; Pine, Daniel S; Leibenluft, Ellen

    2016-07-01

    Bipolar disorder and disruptive mood dysregulation disorder (DMDD) are clinically and pathophysiologically distinct, yet irritability can be a clinical feature of both illnesses. The authors examine whether the neural mechanisms mediating irritability differ between bipolar disorder and DMDD, using a face emotion labeling paradigm because such labeling is deficient in both patient groups. The authors hypothesized that during face emotion labeling, irritability would be associated with dysfunctional activation in the amygdala and other temporal and prefrontal regions in both disorders, but that the nature of these associations would differ between DMDD and bipolar disorder. During functional MRI acquisition, 71 youths (25 with DMDD, 24 with bipolar disorder, and 22 healthy youths) performed a labeling task with happy, fearful, and angry faces of varying emotional intensity. Participants with DMDD and bipolar disorder showed similar levels of irritability and did not differ from each other or from healthy youths in face emotion labeling accuracy. Irritability correlated with amygdala activity across all intensities for all emotions in the DMDD group; such correlation was present in the bipolar disorder group only for fearful faces. In the ventral visual stream, associations between neural activity and irritability were found more consistently in the DMDD group than in the bipolar disorder group, especially in response to ambiguous angry faces. These results suggest diagnostic specificity in the neural correlates of irritability, a symptom of both DMDD and bipolar disorder. Such evidence of distinct neural correlates suggests the need to evaluate different approaches to treating irritability in the two disorders.

  14. A genetic deconstruction of neurocognitive traits in schizophrenia and bipolar disorder.

    Directory of Open Access Journals (Sweden)

    Carla P D Fernandes

    Full Text Available Impairments in cognitive functions are common in patients suffering from psychiatric disorders, such as schizophrenia and bipolar disorder. Cognitive traits have been proposed as useful for understanding the biological and genetic mechanisms implicated in cognitive function in healthy individuals and in the dysfunction observed in psychiatric disorders.Sets of genes associated with a range of cognitive functions often impaired in schizophrenia and bipolar disorder were generated from a genome-wide association study (GWAS on a sample comprising 670 healthy Norwegian adults who were phenotyped for a broad battery of cognitive tests. These gene sets were then tested for enrichment of association in GWASs of schizophrenia and bipolar disorder. The GWAS data was derived from three independent single-centre schizophrenia samples, three independent single-centre bipolar disorder samples, and the multi-centre schizophrenia and bipolar disorder samples from the Psychiatric Genomics Consortium.The strongest enrichments were observed for visuospatial attention and verbal abilities sets in bipolar disorder. Delayed verbal memory was also enriched in one sample of bipolar disorder. For schizophrenia, the strongest evidence of enrichment was observed for the sets of genes associated with performance in a colour-word interference test and for sets associated with memory learning slope.Our results are consistent with the increasing evidence that cognitive functions share genetic factors with schizophrenia and bipolar disorder. Our data provides evidence that genetic studies using polygenic and pleiotropic models can be used to link specific cognitive functions with psychiatric disorders.

  15. Cognitive Impairment in Euthymic Pediatric Bipolar Disorder

    DEFF Research Database (Denmark)

    Elias, Liana R.; Miskowiak, Kamilla W.; Vale, Antônio M. O.

    2017-01-01

    OBJECTIVE: To perform a systematic review and meta-analysis of studies investigating neurocognition in euthymic youths with bipolar disorder (BD) compared to healthy controls (HCs). METHOD: A systematic literature search was conducted in the PubMed/MEDLINE, PsycINFO, and EMBASE databases from...... learning and memory. We also found evidence for other potential sources of heterogeneity in several ES estimates including co-occurring attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders, and the use of medications. In addition, the use of different neuropsychological tests appeared...

  16. Sleep study in Disruptive Mood Dysregulation Disorder and Bipolar children.

    Science.gov (United States)

    Estrada-Prat, Xavier; Álvarez-Guerrico, Ion; Bleda-Hernández, María J; Camprodon-Rosanas, Ester; Batlle-Vila, Santiago; Pujals-Altes, Elena; Nascimento-Osorio, María T; Martín-López, Luís M; Álvarez-Martínez, Enric; Pérez-Solá, Víctor; Romero-Cela, Soledad

    2017-01-01

    Decreased need for sleep has been proposed as a core symptom of mania and it has been associated with the pathogenesis of Bipolar Disorder. The emergence of Disruptive Mood Dysregulation Disorder (DMDD) as a new diagnostic has been controversial and much has been speculated about its relationship with the bipolar spectrum. REM sleep fragmentation could be a biomarker of affective disorders and it would help us to differentiate them from other disorders. Polysomnographic cross-sectional study of children with DMDD, bipolar disorder and Attention Deficit Hyperactivity Disorder (ADHD). All participants underwent a psychiatric semi-structured interview to obtain the diagnosis, comorbidities and primary sleep disorders. DMDD’s sample was performed following DSM5 criteria. Perform polysomnography in a sample of bipolar, DMDD and ADHD children and compare their profiles to provide more evidence about the differences or similarities between bipolar disorder and DMDD. Bipolar group had the highest REM density values while ADHD had the lowest. REM density was not statiscally different between bipolar phenotypes. REM density was associated with antidepressant treatment, episodes of REM and their interaction. REM latency was associated with antipsychotic treatment and school performance. Bipolar patients had higher scores on the depression scale than DMDD and ADHD groups. No significant differences between the two compared affective disorders were found. However there were differences in REM density between bipolar and ADHD groups. REM sleep study could provide a new theoretical framework to better understand the pathogenesis of pediatric bipolar disorder.

  17. Tratamento do transtorno bipolar: eutimia Bipolar disorder treatment: euthymia

    Directory of Open Access Journals (Sweden)

    Fábio Gomes de Matos e Souza

    2005-01-01

    Full Text Available O transtorno bipolar é um quadro complexo caracterizado por episódios de depressão, mania ou hipomania e fases assintomáticas. O tratamento visa ao controle de episódios agudos e prevenção de novos episódios. O tratamento farmacológico iniciou-se com o lítio. Até o momento, o lítio permanece como o tratamento com mais evidências favoráveis na fase de manutenção. Outros tratamentos demonstram eficácia nessa fase, como o valproato, a carbamazepina e os antipsicóticos atípicos. Dos antipsicóticos atípicos o mais estudado nesta fase do tratamento é a olanzapina. Mais estudos prospectivos são necessários para confirmar a ação profilática de novos agentes.Bipolar disorder is a complex disorder characterized by depression episodes, mania or hypomania and asymptomatic phases. The treatment aims at the control of acute episodes and prevention of new episodes. The pharmacological treatment was inaugurated with lithium. Until the moment, lithium remains as the treatment with more favorable evidences in the maintenance phase. Other treatments demonstrate efficacy in this phase, as valproate, carbamazepine and atypical antipsychotics. Of the atypical antipsychotics, the most studied in this phase of treatment is olanzapine. More prospective studies are necessary to confirm prophylactic action of new agents.

  18. Bipolar Disorder in Children: Implications for Speech-Language Pathologists

    Science.gov (United States)

    Quattlebaum, Patricia D.; Grier, Betsy C.; Klubnik, Cynthia

    2012-01-01

    In the United States, bipolar disorder is an increasingly common diagnosis in children, and these children can present with severe behavior problems and emotionality. Many studies have documented the frequent coexistence of behavior disorders and speech-language disorders. Like other children with behavior disorders, children with bipolar disorder…

  19. Contextual social cognition impairments in schizophrenia and bipolar disorder.

    Science.gov (United States)

    Baez, Sandra; Herrera, Eduar; Villarin, Lilian; Theil, Donna; Gonzalez-Gadea, María Luz; Gomez, Pedro; Mosquera, Marcela; Huepe, David; Strejilevich, Sergio; Vigliecca, Nora Silvana; Matthäus, Franziska; Decety, Jean; Manes, Facundo; Ibañez, Agustín M

    2013-01-01

    The ability to integrate contextual information with social cues to generate social meaning is a key aspect of social cognition. It is widely accepted that patients with schizophrenia and bipolar disorders have deficits in social cognition; however, previous studies on these disorders did not use tasks that replicate everyday situations. This study evaluates the performance of patients with schizophrenia and bipolar disorders on social cognition tasks (emotional processing, empathy, and social norms knowledge) that incorporate different levels of contextual dependence and involvement of real-life scenarios. Furthermore, we explored the association between social cognition measures, clinical symptoms and executive functions. Using a logistic regression analysis, we explored whether the involvement of more basic skills in emotional processing predicted performance on empathy tasks. The results showed that both patient groups exhibited deficits in social cognition tasks with greater context sensitivity and involvement of real-life scenarios. These deficits were more severe in schizophrenic than in bipolar patients. Patients did not differ from controls in tasks involving explicit knowledge. Moreover, schizophrenic patients' depression levels were negatively correlated with performance on empathy tasks. Overall performance on emotion recognition predicted performance on intentionality attribution during the more ambiguous situations of the empathy task. These results suggest that social cognition deficits could be related to a general impairment in the capacity to implicitly integrate contextual cues. Important implications for the assessment and treatment of individuals with schizophrenia and bipolar disorders, as well as for neurocognitive models of these pathologies are discussed.

  20. Bipolar disorder and substance use disorders. Madrid study on the prevalence of dual disorders/pathology.

    Science.gov (United States)

    Arias, Francisco; Szerman, Nestor; Vega, Pablo; Mesías, Beatriz; Basurte, Ignacio; Rentero, David

    2017-06-28

    Given its prevalence and impact on public health, the comorbidity of bipolar and substance use disorders is one of the most relevant of dual diagnoses. The objective was to evaluate the characteristics of patients from community mental health and substance abuse centres in Madrid. The sample consisted of 837 outpatients from mental health and substance abuse centres. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate axis I and II disorders. Of these patients, 174 had a lifetime bipolar disorder, 83 had bipolar disorder type I and 91 had type II. Most patients had dual pathology. Of the 208 participants from the mental health centres, 21 had bipolar disorder and 13 (61.9%) were considered dually-diagnosed patients, while 33.2% of non-bipolar patients had a dual diagnoses (p = 0.03). Of the 629 participants from the substance abuse centres, 153 patients (24.3%) had a bipolar diagnosis. Bipolar dual patients had higher rates of alcohol and cocaine dependence than non-bipolar patients. Moreover, age at onset of alcohol use was earlier in bipolar duallydiagnosed patients than in other alcoholics. Bipolar dually-diagnosed patients had higher personality and anxiety disorder comorbidities and greater suicide risk. Thus, alcohol and cocaine are the drugs most associated with bipolar disorder. Given the nature of the study, the type of relationship between these disorders cannot be determined.

  1. Bias in emerging biomarkers for bipolar disorder

    DEFF Research Database (Denmark)

    Carvalho, A F; Köhler, C A; Fernandes, B S

    2016-01-01

    BACKGROUND: To date no comprehensive evaluation has appraised the likelihood of bias or the strength of the evidence of peripheral biomarkers for bipolar disorder (BD). Here we performed an umbrella review of meta-analyses of peripheral non-genetic biomarkers for BD. METHOD: The Pubmed/Medline, E......BACKGROUND: To date no comprehensive evaluation has appraised the likelihood of bias or the strength of the evidence of peripheral biomarkers for bipolar disorder (BD). Here we performed an umbrella review of meta-analyses of peripheral non-genetic biomarkers for BD. METHOD: The Pubmed....../Medline, EMBASE and PsycInfo electronic databases were searched up to May 2015. Two independent authors conducted searches, examined references for eligibility, and extracted data. Meta-analyses in any language examining peripheral non-genetic biomarkers in participants with BD (across different mood states...

  2. Attention deficit hyperactivity disorder and bipolar mood disorder in ...

    African Journals Online (AJOL)

    Attention deficit hyperactivity disorder and bipolar mood disorder in children and adolescents. L Scribante. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4102/sajpsychiatry.v15i2.205 · AJOL African Journals ...

  3. Service utilization and associated direct costs for bipolar disorder in 2004: an analysis in managed care.

    Science.gov (United States)

    Stensland, Michael D; Jacobson, Jennie G; Nyhuis, Allen

    2007-08-01

    Bipolar disorder is a chronic and costly condition. This analysis examines health care costs associated with bipolar disorder in 2004 and contrasts them with those for depression, a better understood mental illness. Health care costs associated with bipolar disorder and non-bipolar depression were determined using private payer administrative claims. Individuals having 2 claims with a primary ICD-9-CM code for bipolar disorder or depression were categorized as bipolar disorder or non-bipolar depression patients, respectively. Comparisons between patient groups were adjusted for demographic differences and comorbid diagnoses. On average, bipolar patients (n=6072) used significantly more psychiatric resources per person than depression patients (n=60,643), and had more mean psychiatric hospital days, psychiatric and medical emergency room visits, and psychiatric office visits (p<.001 for all). Bipolar patients were slightly less likely to be treated with antidepressants, but substantially more likely to be treated with antipsychotics, anticonvulsants, lithium, and benzodiazepines (p<.001 for all). Mean direct per-patient costs were $10,402 for bipolar patients and $7494 for depression patients (p<.001), with the primary differences observed for psychiatric medication ($1641 vs. $507) and psychiatric hospitalization ($1187 vs. $241). Patients were categorized based on diagnostic codes in administrative claims data, which may not always be accurate. Results may not generalize beyond private payer populations in the US. Bipolar disorder is associated with significantly greater per-patient total annual health care costs than non-bipolar depression, as well as significantly greater psychiatric costs. Bipolar disorder, a chronic condition often suboptimally treated, may represent a good target for disease-management programs.

  4. Circadian Phase Preference in Pediatric Bipolar Disorder

    OpenAIRE

    Kerri L. Kim; Alexandra B. Weissman; Megan E. Puzia; Grace K. Cushman; Karen E. Seymour; Ezra Wegbreit; Mary A. Carskadon; Daniel P. Dickstein

    2014-01-01

    Pediatric bipolar disorder (BD) rates have notably increased over the past three decades. Given the significant morbidity and mortality associated with BD, efforts are needed to identify factors useful in earlier detection to help address this serious public health concern. Sleep is particularly important to consider given the sequelae of disrupted sleep on normative functioning and that sleep is included in diagnostic criteria for both Major Depressive and Manic Episodes. Here, we examine on...

  5. Family Functionality and Coping Attitudes of Patients with Bipolar Disorder.

    Science.gov (United States)

    Çuhadar, Döndü; Savaş, Haluk Asuman; Ünal, Ahmet; Gökpınar, Fatma

    2015-10-01

    The coping of patients with prodromal syndromes prevents relapses, and the differences in coping strategies affect the results of bipolar disorder. The various functionality levels of bipolar disorder patients such as work, marital relations, parental abilities and social presentation are significantly related with how well they cope. The objective of this study was to determine the family functionality and coping attitudes of bipolar disorder patients. The study planned as a descriptive one was carried with 81 bipolar disorder patients. Personal description form, family assessment device and Coping Attitudes Scale were used as data acquisition tools. It was determined that the adaptive coping attitudes used most frequently by the patients were religious coping, positive reinterpretation, active coping, problem-focused coping and emotional focused coping, beneficial social support use, emotional social support use, planning, suppression of competing activities and restraint coping; maladaptive coping attitudes used most frequently by the patients were "focusing on the problem and venting of emotions and mental disengagement." It was determined that family functions affected the coping attitudes of patients and that the patients who evaluated family functions in a healthy manner made use of adaptive coping strategies more at a statistically significant level.

  6. Historical Underpinnings of Bipolar Disorder Diagnostic Criteria

    Directory of Open Access Journals (Sweden)

    Brittany L. Mason

    2016-07-01

    Full Text Available Mood is the changing expression of emotion and can be described as a spectrum. The outermost ends of this spectrum highlight two states, the lowest low, melancholia, and the highest high, mania. These mood extremes have been documented repeatedly in human history, being first systematically described by Hippocrates. Nineteenth century contemporaries Falret and Baillarger described two forms of an extreme mood disorder, with the validity and accuracy of both debated. Regardless, the concept of a cycling mood disease was accepted before the end of the 19th century. Kraepelin then described “manic depressive insanity” and presented his description of a full spectrum of mood dysfunction which could be exhibited through single episodes of mania or depression or a complement of many episodes of each. It was this concept which was incorporated into the first DSM and carried out until DSM-III, in which the description of episodic mood dysfunction was used to build a diagnosis of bipolar disorder. Criticism of this approach is explored through discussion of the bipolar spectrum concept and some recent examinations of the clinical validity of these DSM diagnoses are presented. The concept of bipolar disorder in children is also explored.

  7. Bipolar disorder: Evidence for a major locus

    Energy Technology Data Exchange (ETDEWEB)

    Spence, M.A.; Flodman, P.L. [Univ. of California, Irvine, CA (United States); Sadovnick, A.D.; Ameli, H. [Univ. of British Columbia, Vancouver (Canada)] [and others

    1995-10-09

    Complex segregation analyses were conducted on families of bipolar I and bipolar II probands to delineate the mode of inheritance. The probands were ascertained from consecutive referrals to the Mood Disorder Service, University Hospital, University of British Columbia and diagnosed by DSM-III-R and Research Diagnostic Criteria. Data were available on over 1,500 first-degree relatives of the 186 Caucasian probands. The purpose of the analyses was to determine if, after correcting for age and birth cohort, there was evidence for a single major locus. Five models were fit to the data using the statistical package SAGE: (1) dominant, (2) recessive, (3) arbitrary mendelian inheritance, (4) environmental, and (5) no major effects. A single dominant, mendelian major locus was the best fitting of these models for the sample of bipolar I and II probands when only bipolar relatives were defined as affected (polygenic inheritance could not be tested). Adding recurrent major depression to the diagnosis {open_quotes}affected{close_quotes} for relatives reduced the evidence for a major locus effect. Our findings support the undertaking of linkage studies and are consistent with the analyses of the National Institutes of Mental Health (NIMH) Collaborative Study data by Rice et al. and Blangero and Elston. 39 refs., 4 tabs.

  8. Chronic obstructive pulmonary disease associated with increased risk of bipolar disorder.

    Science.gov (United States)

    Su, Vincent Yi-Fong; Hu, Li-Yu; Yeh, Chiu-Mei; Chiang, Huey-Ling; Shen, Cheng-Che; Chou, Kun-Ta; Chen, Tzeng-Ji; Lu, Ti; Tzeng, Cheng-Hwai; Liu, Chia-Jen

    2017-05-01

    Epidemiological studies have identified a trend in the development of depressive and anxiety disorders following a diagnosis of chronic obstructive pulmonary disease (COPD). However, the relationship between COPD and subsequent bipolar disorder remains unclear. From January 1, 2000, we identified adult patients with COPD from the Taiwan National Health Insurance Research Database. A nationwide population-based study was conducted; 46,778 COPD patients and 46,778 age-, sex-, and comorbidity-matched subjects between 2000 and 2011 were enrolled. The two cohorts were followed up till December 31, 2011 and observed for occurrence of bipolar disorder. We observed the COPD and comparison cohorts for 263,020 and 267,895 person-years, respectively, from 2000 to 2011. The incidence rate for bipolar disorder was 1.6/1000 person-years in the COPD cohort and 1.2/1000 person-years in the comparison cohort ( p bipolar disorder among the COPD patients was 1.42 (95% confidence interval [CI], 1.22-1.64; p bipolar disorder development (HR = 1.83, 95% CI = 1.25-2.69, p = 0.002). Other COPD medications were not associated with the risk of bipolar disorder development. The study results indicate that COPD may be an independent risk factor for the development of bipolar disorder. The regular use of SABAs might increase the risk of bipolar disorder in COPD patients.

  9. O transtorno bipolar na mulher Bipolar disorder in women

    Directory of Open Access Journals (Sweden)

    Alexandro de Borja Gonçalves Guerra

    2005-01-01

    Full Text Available Diferenças sexuais, descritas em vários transtornos psiquiátricos, também parecem estar presentes no transtorno afetivo bipolar (TAB. A prevalência do TAB tipo I se distribui igualmente entre mulheres e homens. Mulheres parecem estar sujeitas a um risco maior de ciclagem rápida e mania mista, condições que fariam do TAB um transtorno com curso mais prejudicial no sexo feminino. Uma diátese depressiva mais marcante, uso excessivo de antidepressivos e diferenças hormonais surgem como hipóteses para explicar essas diferenças fenomenológicas, apesar das quais, mulheres e homens parecem responder igualmente ao tratamento medicamentoso. A indicação de anticonvulsivantes como primeira escolha em mulheres é controversa, a não ser para o tratamento da mania mista e, talvez, da ciclagem rápida. O tratamento do TAB na gravidez deve levar em conta tanto os riscos de exposição aos medicamentos quanto à doença materna. A profilaxia do TAB no puerpério está fortemente indicada em decorrência do grande risco de recorrência da doença nesse período. Embora, de modo geral, as medicações psicotrópicas estejam contra-indicadas durante a amamentação, entre os estabilizadores do humor, a carbamazepina e o valproato são mais seguros do que o lítio. Mais estudos são necessários para a confirmação das diferenças de curso do TAB entre mulheres e homens e a investigação de possíveis diferenças na efetividade dos tratamentos.Gender differences, described in several psychiatric disorders, seem to be also present in bipolar disorder (BD. The prevalence of bipolar I disorder is equally distributed between women and men. Women seem to be at higher risk for rapid cycling and mixed mania, conditions that could make BD a disorder with a more severe course in the female sex. A marked depressive diathesis among women, greatest use of antidepressants and hormonal differences have been mentioned as hypotheses to explain these

  10. The relationship between bipolar disorder and biological rhythms.

    Science.gov (United States)

    Gonzalez, Robert

    2014-04-01

    Rhythm disruption is a core feature of bipolar disorder and it has been hypothesized that disturbances of the circadian timing system play a fundamental role in the etiology of the disorder. We sought to investigate (1) theoretical models for biological rhythm disruptions in bipolar disorder, (2) physiological disturbances of biological rhythms in bipolar disorder, (3) clinical and therapeutic implications of biological rhythm disturbances in bipolar disorder, and (4) associations between circadian gene variations and bipolar disorder. PubMed database was searched systematically for articles that were published on or before May 5, 2013, and were written in English using the terms bipolar disorder, clock genes, endogenous clock, molecular clock, biological rhythms, circadian, suprachiasmatic nucleus, circadian rhythm, melatonin, and sleep. Seventy-four articles highlighting the objectives were included in the review. Data regarding exploring the association between bipolar disorder and circadian and chronobiological phenomena were reviewed and findings summarized. The literature reviewed suggests that circadian rhythm disturbance may be a feature of bipolar disorder. In toto, the literature suggests that circadian rhythm disturbances may be a feature of bipolar disorder. This area of research has received theoretical consideration as playing a significant role in the pathophysiology of the illness but has been understudied to this point. Further research in the field is warranted. © Copyright 2014 Physicians Postgraduate Press, Inc.

  11. No association of mutations and mRNA expression of WFS1/wolframin with bipolar disorder in humans.

    Science.gov (United States)

    Kato, Tadafumi; Iwamoto, Kazuya; Washizuka, Shinsuke; Mori, Kanako; Tajima, Osamu; Akiyama, Tsuyoshi; Nanko, Shinichiro; Kunugi, Hiroshi; Kato, Nobumasa

    2003-02-20

    Association of WFS1 (wolframin) and bipolar disorder has been suggested by psychiatric manifestations in patients or non-symptomatic carriers of Wolfram disease and linkage of bipolar disorder with 4p16, the locus of WFS1. Five studies of WFS1 in bipolar disorder did not support this association, although possible association of several missense mutations has not been excluded yet. In this study, four such mutations were genotyped in 184 patients with bipolar disorder and 207 controls. None had the A559T and A602V mutations, and no association of G576S and H611R with bipolar disorder was found. We also quantified the expression levels of WFS1 mRNA in the postmortem brains of patients with bipolar disorder, depression, schizophrenia, and controls. There was no significant difference of the expression levels. These results did not support the pathophysiological significance of WFS1 in bipolar disorder. Copyright 2002 Elsevier Science Ireland Ltd.

  12. Unexplored areas of psychotherapy in bipolar disorder.

    Science.gov (United States)

    Popovic, Dina; Yildiz, Ayşegül; Murphy, Paula; Colom, Francesc

    2014-01-01

    Several psychological interventions-including group psychoeducation, family-focused psychoeducation, and interpersonal social-rhythm therapy-have demonstrated prophylactic efficacy as an adjunct to medication in bipolar disorders (BDs). The field of psychological interventions for BD has experienced impressive progress over the last 15 years. Certain unexplored areas, however, require further research in order to establish the full potential of psychological interventions for BD. Such research should focus, among other things, on cognitive impairment associated with BD, BD in the elderly, comorbid anxiety disorders and other comorbidities, the treatment of BD in pregnant women, and the improvement of patients' overall physical health.

  13. Increased sensitivity to positive social stimuli in monozygotic twins at risk of bipolar vs. unipolar disorder

    DEFF Research Database (Denmark)

    Kærsgaard, S; Meluken, I; Kessing, L V

    2018-01-01

    BACKGROUND: Abnormalities in affective cognition are putative endophenotypes for bipolar and unipolar disorders but it is unclear whether some abnormalities are disorder-specific. We therefore investigated affective cognition in monozygotic twins at familial risk of bipolar disorder relative...... to those at risk of unipolar disorder and to low-risk twins. METHODS: Seventy monozygotic twins with a co-twin history of bipolar disorder (n = 11), of unipolar disorder (n = 38) or without co-twin history of affective disorder (n = 21) were included. Variables of interest were recognition of and vigilance...... to emotional faces, emotional reactivity and -regulation in social scenarios and non-affective cognition. RESULTS: Twins at familial risk of bipolar disorder showed increased recognition of low to moderate intensity of happy facial expressions relative to both unipolar disorder high-risk twins and low...

  14. Identifying Potential Regions of Copy Number Variation for Bipolar Disorder

    Directory of Open Access Journals (Sweden)

    Yi-Hsuan Chen

    2014-02-01

    Full Text Available Bipolar disorder is a complex psychiatric disorder with high heritability, but its genetic determinants are still largely unknown. Copy number variation (CNV is one of the sources to explain part of the heritability. However, it is a challenge to estimate discrete values of the copy numbers using continuous signals calling from a set of markers, and to simultaneously perform association testing between CNVs and phenotypic outcomes. The goal of the present study is to perform a series of data filtering and analysis procedures using a DNA pooling strategy to identify potential CNV regions that are related to bipolar disorder. A total of 200 normal controls and 200 clinically diagnosed bipolar patients were recruited in this study, and were randomly divided into eight control and eight case pools. Genome-wide genotyping was employed using Illumina Human Omni1-Quad array with approximately one million markers for CNV calling. We aimed at setting a series of criteria to filter out the signal noise of marker data and to reduce the chance of false-positive findings for CNV regions. We first defined CNV regions for each pool. Potential CNV regions were reported based on the different patterns of CNV status between cases and controls. Genes that were mapped into the potential CNV regions were examined with association testing, Gene Ontology enrichment analysis, and checked with existing literature for their associations with bipolar disorder. We reported several CNV regions that are related to bipolar disorder. Two CNV regions on chromosome 11 and 22 showed significant signal differences between cases and controls (p < 0.05. Another five CNV regions on chromosome 6, 9, and 19 were overlapped with results in previous CNV studies. Experimental validation of two CNV regions lent some support to our reported findings. Further experimental and replication studies could be designed for these selected regions.

  15. Differences in the ICD-10 diagnostic subtype of depression in bipolar disorder compared to recurrent depressive disorder

    DEFF Research Database (Denmark)

    Jensen, H.M.; Christensen, E.M.; Kessing, Lars Vedel

    2008-01-01

    Background: The aim of the study was to investigate whether patients with bipolar depression and patients with recurrent depressive disorder present with different subtypes of depressive episode as according to ICD-10. Sampling and Methods: All patients who got a diagnosis of bipolar affective......: Totally, 389 patients got a diagnosis of bipolar disorder, current episode of depression, and 5.391 patients got a diagnosis of recurrent depressive disorder, current episode of depression, at first contact. Compared with patients with a diagnosis of recurrent depressive disorder, patients with bipolar...... for patients with bipolar disorder, current episode of depression, compared with patients with a current depression as part of a recurrent depressive disorder (HR = 1.50, 95% CI = 1.20-1.86). Conclusions: The results consistently indicate that a depressive episode is severer and/or more often associated...

  16. Pediatric Bipolar Disorder: Evidence for Prodromal States and Early Markers

    Science.gov (United States)

    Luby, Joan L.; Navsaria, Neha

    2010-01-01

    Background: Childhood bipolar disorder remains a controversial but increasingly diagnosed disorder that is associated with significant impairment, chronic course and treatment resistance. Therefore, the search for prodromes or early markers of risk for later childhood bipolar disorder may be of great importance for prevention and/or early…

  17. Comorbid bipolar disorder and borderline personality disorder and history of suicide attempts.

    Science.gov (United States)

    Zimmerman, Mark; Martinez, Jennifer; Young, Diane; Chelminski, Iwona; Morgan, Theresa A; Dalrymple, Kristy

    2014-06-01

    Both bipolar disorder and borderline personality disorder are associated with elevated rates of attempted suicide; however, no studies have examined whether there is an independent, additive risk for suicide attempts in patients diagnosed with both disorders. In the present study from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, 3,465 psychiatric outpatients were interviewed with semistructured interviews. Compared to the bipolar patients without borderline personality disorder, the patients diagnosed with both bipolar and borderline personality disorder were significantly more likely to have made a prior suicide attempt. The patients with borderline personality disorder and bipolar disorder were nonsignificantly more likely than the borderline patients without bipolar disorder to have made a prior suicide attempt. Bipolar disorder and borderline personality disorder were each associated with an increased rate of suicide attempts. The co-occurrence of these disorders conferred an additive risk, although the influence of borderline personality disorder was greater than that of bipolar disorder.

  18. Social cognition and functional capacity in bipolar disorder and schizophrenia.

    Science.gov (United States)

    Thaler, Nicholas S; Sutton, Griffin P; Allen, Daniel N

    2014-12-15

    Social cognition is a functionally relevant predictor of capacity in schizophrenia (SZ), though research concerning its value for bipolar disorder (BD) is limited. The current investigation examined the relationship between two social cognitive factors and functional capacity in bipolar disorder. This study included 48 individuals with bipolar disorder (24 with psychotic features) and 30 patients with schizophrenia. Multiple regression controlling for estimated IQ scores was used to assess the predictive value of social cognitive factors on the UCSD Performance-Based Functional Skills Assessment (UPSA). Results found that for the bipolar with psychosis and schizophrenia groups, the social/emotion processing factor predicted the UPSA. The theory of mind factor only predicted the UPSA for the schizophrenia group.. Findings support the clinical utility of evaluating emotion processing in individuals with a history of psychosis. For BD, theory of mind may be better explained by a generalized cognitive deficit. In contrast, social/emotion processing may be linked to distinct neurobiological processes associated with psychosis. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Bariatric surgery in patients with bipolar spectrum disorders: Selection factors, post-operative visit attendance, and weight outcomes

    Science.gov (United States)

    Friedman, Kelli E.; Applegate, Katherine; Portenier, Dana; McVay, Megan

    2017-01-01

    Background As many of 3% of bariatric surgery candidates are diagnosed with a bipolar spectrum disorder. Objectives 1) To describe differences between patients with bipolar spectrum disorders who are approved and not approved for surgery by the mental health evaluator. 2) To examine surgical outcomes of patients with bipolar spectrum disorders. Setting Academic medical center, United States. Methods A retrospective record review was conducted of consecutive patients who applied for bariatric surgery between 2004 and 2009. Patients diagnosed with bipolar spectrum disorders who were approved for surgery (n=42) were compared with patients with a bipolar spectrum disorder who were not approved (n=31) and to matched control surgical patients without a bipolar spectrum diagnosis (n=29) on a variety of characteristics and surgical outcomes. Results Of bariatric surgery candidates diagnosed with a bipolar spectrum disorder who applied for surgery, 57% were approved by the psychologist and 48% ultimately had surgery. Patients with a bipolar spectrum disorder who were approved for surgery were less likely to have had a previous psychiatric hospitalizations than those who were not approved for surgery. Bariatric surgery patients diagnosed with a bipolar spectrum disorder were less likely to attend follow-up care appointments 2 or more years post-surgery compared to matched patients without bipolar disorder. Among patients with available data, those with a bipolar spectrum disorder and matched patients had similar weight loss at 12 months (n=21 for bipolar, n=24 for matched controls) and at 2 or more years (mean=51 months; n=11 for bipolar, n=20 for matched controls). Conclusions Patients diagnosed with a bipolar spectrum disorder have a high rate of delay/denial for bariatric surgery based on the psychosocial evaluation and are less likely to attend medical follow-up care 2 or more years post-surgery. Carefully screened patients with bipolar disorder who engage in long

  20. Lower switch rate in depressed patients with bipolar II than bipolar I disorder treated adjunctively with second-generation antidepressants

    NARCIS (Netherlands)

    Altshuler, LL; Suppes, T; Nolen, WA; Leverich, G; Keck, PE; Frye, MA; Kupka, R; McElroy, SL; Grunze, H; Kitchen, CMR; Post, R; Black, D.O.

    Objectives: The authors compared the switch rate into hypomania/mania in depressed patients treated with second-generation antidepressants who had either bipolar I or bipolar II disorder. Method: In a 10-week trial, 184 outpatients with bipolar depression (134 with bipolar I disorder, 48 with

  1. Prevalence and correlates of eating disorders in 875 patients with bipolar disorder

    NARCIS (Netherlands)

    McElroy, Susan L.; Frye, Mark A.; Hellemann, Gerhard; Altshuler, Lori; Leverich, Gabriele S.; Suppes, Trisha; Keck, Paul E.; Nolen, Willem A.; Kupka, Ralph; Post, Robert M.

    Objective: Relatively little is known about the co-occurrence of bipolar and eating disorders. We therefore assessed the prevalence and clinical correlates of eating disorders in 875 patients with bipolar disorder. Method: 875 outpatients with DSM-IV bipolar I or II disorder were evaluated with

  2. Creativity and Bipolar Disorder: Igniting a Dialogue.

    Science.gov (United States)

    Johnson, Sheri L; Moezpoor, Michelle; Murray, Greg; Hole, Rachelle; Barnes, Steven J; Michalak, Erin E

    2016-01-01

    Bipolar disorder (BD) has been related to heightened creativity, yet core questions remain unaddressed about this association. We used qualitative methods to investigate how highly creative individuals with BD understand the role of symptoms and treatment in their creativity, and possible mechanisms underpinning this link. Twenty-two individuals self-identified as highly creative and living with BD took part in focus groups and completed quantitative measures of symptoms, quality of life (QoL), and creativity. Using thematic analysis, five themes emerged: the pros and cons of mania for creativity, benefits of altered thinking, the relationship between creativity and medication, creativity as central to one's identity, and creativity's importance in stigma reduction and treatment. Despite reliance on a small sample who self-identified as having BD, findings shed light on previously mixed results regarding the influence of mania and treatment and suggest new directions for the study of mechanisms driving the creative advantage in BD. © The Author(s) 2015.

  3. Neurocognitive features in subgroups of bipolar disorder

    Science.gov (United States)

    Aminoff, Sofie Ragnhild; Hellvin, Tone; Lagerberg, Trine Vik; Berg, Akiah Ottesen; Andreassen, Ole A; Melle, Ingrid

    2013-01-01

    Objective To examine which subgroups of DSM-IV bipolar disorder (BD) [BD type I (BD-I) or BD type II (BD-II), and subgroups based on history of psychosis, presenting polarity, and age at onset] differentiate best regarding neurocognitive measures. Methods A total of 199 patients with BD were characterized by clinical and neurocognitive features. The distribution of subgroups in this sample was: BD-I, 64% and BD-II, 36%; 60% had a history of psychosis; 57% had depression as the presenting polarity; 61% had an early onset of BD, 25% had a mid onset, and 14% had a late onset. We used multivariate regression analyses to assess relationships between neurocognitive variables and clinical subgroups. Results Both BD-I diagnosis and elevated presenting polarity were related to impairments in verbal memory, with elevated presenting polarity explaining more of the variance in this cognitive domain (22.5%). History of psychosis and BD-I diagnosis were both related to impairment in semantic fluency, with history of psychosis explaining more of the variance (11.6%). Conclusion Poor performance in verbal memory appears to be associated with an elevated presenting polarity, and poor performance in semantic fluency appears to be associated with a lifetime history of psychosis. PMID:23521608

  4. A Test of the Bidirectional Association Between Sleep and Mood in Bipolar Disorder and Insomnia

    Science.gov (United States)

    Talbot, Lisa S.; Stone, Susan; Gruber, June; Hairston, Ilana S.; Eidelman, Polina; Harvey, Allison G.

    2012-01-01

    The present study investigates sleep, mood, and the proposed bidirectional relationship between the two in psychiatric disorders. Participants with interepisode bipolar disorder (n = 49), insomnia (n = 34), and no psychiatric history (n = 52) completed seven consecutive days of sleep diaries and mood measures. The interepisode bipolar and insomnia participants exhibited greater sleep disturbance than the healthy control individuals. Negative mood was equally heightened in both interepisode bipolar disorder and insomnia, and there were no differences between the three groups in positive mood. Total wake time was associated with next morning negative mood in bipolar disorder, whereas evening negative mood was associated with subsequent total wake time in both bipolar disorder and insomnia. Additionally, positive mood was associated with subsequent total wake time for the insomnia group. Results support the theory that disruptions in nighttime sleep and daytime mood may be mutually maintaining and suggest the potential importance of transdiagnostic or universal processes. PMID:21842957

  5. Ethnicity and suicide attempt: analysis in bipolar disorder and schizophrenia.

    Science.gov (United States)

    Bani-Fatemi, Ali; Polsinelli, Gina; Kennedy, James L; De Luca, Vincenzo

    2013-10-08

    Evidence is mixed as to whether White Europeans are at a higher risk for suicide attempts or completions compared to other ethnic groups. The present analysis assessed whether risk for suicide attempt was associated with White European ethnicity in 907 subjects with schizophrenia or bipolar disorder. Subjects were diagnosed using the Structured Clinical Interview for DSM-IV, and ethnicity was determined by self-report. Subjects were recruited from psychiatric care centers in Toronto, Canada. Logistic regression correcting for clinical covariates like age, gender and diagnosis, was used in this study. We found no difference in suicide attempter status in white and non-white subjects who were diagnosed with schizophrenia and bipolar disorder. Our study does not support the evidence that White-European patients in North America are at higher risk for suicide attempt compared to non-European descent subjects. However, this result has to be replicated in larger studies in patients with these disorders.

  6. Effectiveness of olanzapine monotherapy and olanzapine combination treatment in the long term following acute mania--results of a two year observational study in bipolar disorder (EMBLEM).

    Science.gov (United States)

    Gonzalez-Pinto, Ana; Vieta, Eduard; Reed, Catherine; Novick, Diego; Barraco, Alessandra; Aguado, Jaume; Haro, Josep Maria

    2011-06-01

    This study compared the 2-year outcomes of patients with a manic/mixed episode of bipolar disorder taking olanzapine monotherapy or olanzapine in combination with other agents. EMBLEM (European Mania in Bipolar Longitudinal Evaluation of Medication) is a 2-year, prospective, observational study of clinical and functional outcomes of bipolar patients with an index manic/mixed episode. The study consisted of two phases: acute (12 weeks) and maintenance (follow-up over 2 years). The longitudinal outcome measure was the Clinical Global Impression-Bipolar Disorder scale. Cox regression models compared outcomes of both therapy groups using intention-to-treat and switching medication analysis. Treatment-emergent adverse events were also assessed. 1076 patients were included in this analysis. 29% took olanzapine as monotherapy (n = 313) and 71% as combination (n = 763) at 12-weeks post-baseline (end of study acute phase). After adjusting for patient characteristics using switching medication analysis, only relapse rates differed (p = 0.01) in favour of monotherapy-treated patients. There was no significant difference in rates of improvement, remission, and recovery. Patients treated with combination therapy reported more tremor (OR 2.37, 95%CI 1.44-3.89) and polyuria (OR 3.08, 95%CI 1.45-6.54) treatment-emergent events than monotherapy, although weight change was greater in the monotherapy group. Unknown confounding and potential selection bias may differentially impact treatment outcomes. EMBLEM patients benefitted from the selected therapy to a similar extent. Differences in patient characteristics between those prescribed monotherapy and combination therapy appear to be clinically relevant in the treatment decision. Physicians must balance the benefits and risks when determining appropriate treatment for individual patients. Copyright © 2010 Elsevier B.V. All rights reserved.

  7. A different perspective on bipolar disorder? : epidemiology, consequences, concept, and recognition of bipolar spectrum disorder in the general population

    NARCIS (Netherlands)

    Regeer, Eline Janet

    2008-01-01

    Bipolar disorder, or manic-depressive illness, is a mood disorder in which episodes of mania, hypomania and depression occur in alternation with intervals of normal mood. Bipolar disorder is typically a recurrent illness and may have serious consequences such as poor social and occupational

  8. Life events and bipolar disorder : The influence of life events on the onset and course of bipolar disorder

    NARCIS (Netherlands)

    Kemner, Sanne

    2017-01-01

    In the Netherlands, bipolar disorder (also known as manic-depressive illness) is diagnosed in approximately 2% of the population. The disorder is characterized by alternating periods of raised activity and (manic) mood and periods of reduced activity with lowered (depressed) mood. Bipolar disorder

  9. Cardiovascular risk and bipolar disorder: factors associated with a positive coronary calcium score in patients with bipolar disorder type 1

    Directory of Open Access Journals (Sweden)

    Aline R. Wageck

    2017-10-01

    Full Text Available Objective: Cardiovascular disease is the leading cause of death in patients with bipolar disorder. The aim of this study was to evaluate the factors associated with positive coronary calcium score (CCS in individuals with bipolar disorder type 1. Methods: Patients from the Bipolar Disorder Program at Hospital de Clínicas de Porto Alegre, Brazil, underwent computed tomography scanning for calcium score measurement. Clinical and sociodemographic variables were compared between patients according to their CCS status: negative (CCS = 0 or positive (CCS > 0. Poisson regression analysis was used to examine the association of CCS with number of psychiatric hospitalizations. Results: Out of 41 patients evaluated, only 10 had a positive CCS. Individuals in the CCS-positive group were older (55.2±4.2 vs. 43.1±10.0 years; p = 0.001 and had more psychiatric hospitalizations (4.7±3.0 vs. 2.6±2.5; p = 0.04 when compared with CCS- negative subjects. The number of previous psychiatric hospitalizations correlated positively with CCS (p < 0.001. Conclusion: Age and number of psychiatric hospitalizations were significantly associated with higher CCS, which might be a potential method for diagnosis and stratification of cardiovascular disease in bipolar patients. There is a need for increased awareness of risk assessment in this population.

  10. Posttraumatic stress disorder and bipolar mood disorder

    OpenAIRE

    Machado Vieira, Rodrigo; Gauer, Gabriel J C

    2003-01-01

    O Transtorno Bipolar (THB) não é somente uma condição endógena. Severos eventos negativos durante a vida influenciam o desenvolvimento do primeiro episódio e alteram o curso do THB durante a vida. O Transtorno de Estresse Pós-Traumático (TEPT) é uma severa e incapacitante doença mental que afeta uma significativa parcela da população, em algum momento de suas vidas. A presença concomitante de TEPT e THB parece mais freqüente que anteriormente sugerido, e pacientes psicóticos com história de t...

  11. A review of factors associated with greater likelihood of suicide attempts and suicide deaths in bipolar disorder: Part II of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder

    Science.gov (United States)

    Schaffer, Ayal; Isometsä, Erkki T; Azorin, Jean-Michel; Cassidy, Frederick; Goldstein, Tina; Rihmer, Zoltán; Sinyor, Mark; Tondo, Leonardo; Moreno, Doris H; Turecki, Gustavo; Reis, Catherine; Kessing, Lars Vedel; Ha, Kyooseob; Weizman, Abraham; Beautrais, Annette; Chou, Yuan-Hwa; Diazgranados, Nancy; Levitt, Anthony J; Zarate, Carlos A; Yatham, Lakshmi

    2018-01-01

    Objectives Many factors influence the likelihood of suicide attempts or deaths in persons with bipolar disorder. One key aim of the International Society for Bipolar Disorders Task Force on Suicide was to summarize the available literature on the presence and magnitude of effect of these factors. Methods A systematic review of studies published from 1 January 1980 to 30 May 2014 identified using keywords ‘bipolar disorder’ and ‘suicide attempts or suicide’. This specific paper examined all reports on factors putatively associated with suicide attempts or suicide deaths in bipolar disorder samples. Factors were subcategorized into: (1) sociodemographics, (2) clinical characteristics of bipolar disorder, (3) comorbidities, and (4) other clinical variables. Results We identified 141 studies that examined how 20 specific factors influenced the likelihood of suicide attempts or deaths. While the level of evidence and degree of confluence varied across factors, there was at least one study that found an effect for each of the following factors: sex, age, race, marital status, religious affiliation, age of illness onset, duration of illness, bipolar disorder subtype, polarity of first episode, polarity of current/recent episode, predominant polarity, mood episode characteristics, psychosis, psychiatric comorbidity, personality characteristics, sexual dysfunction, first-degree family history of suicide or mood disorders, past suicide attempts, early life trauma, and psychosocial precipitants. Conclusion There is a wealth of data on factors that influence the likelihood of suicide attempts and suicide deaths in people with bipolar disorder. Given the heterogeneity of study samples and designs, further research is needed to replicate and determine the magnitude of effect of most of these factors. This approach can ultimately lead to enhanced risk stratification for patients with bipolar disorder. PMID:26175498

  12. Precursors in adolescence of adult-onset bipolar disorder.

    Science.gov (United States)

    Hiyoshi, Ayako; Sabet, Julia A; Sjöqvist, Hugo; Melinder, Carren; Brummer, Robert J; Montgomery, Scott

    2017-08-15

    Although the estimated contribution of genetic factors is high in bipolar disorder, environmental factors may also play a role. This Swedish register-based cohort study of men examined if physical and psychological characteristics in late adolescence, including factors previously linked with bipolar disorder (body mass index, asthma and allergy), are associated with subsequent bipolar disorder in adulthood. Unipolar depression and anxiety are analysed as additional outcomes to identify bipolar disorder-specific associations. A total of 213,693 men born between 1952 and 1956, who participated in compulsory military conscription assessments in late adolescence were followed up to 2009, excluding men with any psychiatric diagnoses at baseline. Cox regression estimated risk of bipolar disorder, depression and anxiety in adulthood associated with body mass index, asthma, allergy, muscular strength stress resilience and cognitive function in adolescence. BMI, asthma and allergy were not associated with bipolar disorder. Higher grip strength, cognitive function and stress resilience were associated with a reduced risk of bipolar disorder and the other disease outcomes. The sample consisted only of men; even though the characteristics in adolescence pre-dated disease onset, they may have been the consequence of prodromal disease. Associations with body mass index and asthma found by previous studies may be consequences of bipolar disorder or its treatment rather than risk factors. Inverse associations with all the outcome diagnoses for stress resilience, muscular strength and cognitive function may reflect general risks for these psychiatric disorders or intermediary factors. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. [Search association between cannabis abuse and bipolar disorder: A study on a sample of patients hospitalized for bipolar disorder].

    Science.gov (United States)

    Kazour, F; Awaida, C; Souaiby, L; Richa, S

    2018-02-01

    . Compared to non-users, cannabis users were found to be younger (33.6 vs. 43.0 years old), more commonly male (77.8 % vs. 49.3 %), and were symptomatic at a younger age (24.6 vs. 30.8 years old). Cannabis users had more hospital admissions in total (6.0 vs. 3.7), and per year (0.73 vs. 0.44) as well as higher socio-economical state. There was a linear relationship between the monthly income per household and cannabis consumption with an OR increasing with the monthly income. Consumers presented more often in a manic state (59.3 %) than in a depressed state (11.1 %). The respective scores of consumers and non-consumers were: YMRS (30.3 vs. 32.1), MADRS (38 vs. 39.5), SAPS (22.7 vs. 23.2). Among cannabis users, 55.6 % and 33.3 % represent the respective percentages of cannabis abuse and dependence. The mean CAST score in these patients was 13.4. Compared to the results in the literature, cannabis use in bipolar disorder was found to be lower in our sample. Cannabis use was also associated with an earlier onset of the bipolar disorder as well as a higher number of hospitalizations per year. The age at the diagnosis of the bipolar disorder was 6.2 years lower among cannabis users. Cannabis users had scores of depression, mania and psychotic symptoms statistically similar to those of the non-consumers. Copyright © 2016 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  14. Loopy: The Political Ontology of Bipolar Disorder

    Directory of Open Access Journals (Sweden)

    RACHEL JANE LIEBERT

    2013-01-01

    Full Text Available This essay is at once a critical analysis, an experiment in form, and – with some irony – a cautionary tale. Triggered by the inclusion of prodromal diagnoses in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, and the recent call by the United States’ (U.S. Obama administration for increased mental health screening, I argue that shifts toward identifying and intervening on one’s potential madness, or risk, circulate with/in the contemporary U.S. climate of intensified discipline and terror, and use Bipolar Disorder as a site to critically explore how and with what implications this circulation occurs. Specifically, I weave Massumi’s ‘political ontology of threat’ with the narrative of a woman diagnosed with Bipolar Disorder in order to trace the pre-emptive politics and affective logic of a risk-based approach to madness. I contend that the diagnosing and drugging of potential is a self-perpetuating loop that is personally and politically harmful, and consider alternatives to this burgeoning practice.

  15. Cognitive dysfunction in bipolar disorder and schizophrenia

    DEFF Research Database (Denmark)

    Bortolato, Beatrice; Miskowiak, Kamilla W; Köhler, Cristiano A

    2015-01-01

    Cognitive impairment is a core feature of schizophrenia (SZ) and bipolar disorder (BD). A neurocognitive profile characterized by widespread cognitive deficits across multiple domains in the context of substantial intellectual impairment, which appears to antedate illness onset, is a replicated...... deterioration in either SZ or BD, some findings point to more severe cognitive deficits in patients with early illness onset across both disorders. A compromised pattern of cognitive functioning in individuals at familiar and/or clinical risk to psychosis as well as in first-degree relatives of BD patients...... suggests that early neurodevelopmental factors may play a role in the emergence of cognitive deficits in both disorders. Premorbid intellectual impairment in SZ and at least in a subgroup of patients with BD may be related to a shared genetically determined influence on neurodevelopment....

  16. The underlying neurobiology of bipolar disorder

    Science.gov (United States)

    MANJI, HUSSEINI K; QUIROZ, JORGE A; PAYNE, JENNIFER L; SINGH, JASKARAN; LOPES, BARBARA P; VIEGAS, JENILEE S; ZARATE, CARLOS A

    2003-01-01

    Clinical studies over the past decades have attempted to uncover the biological factors mediating the pathophysiology of bipolar disorder (BD) utilizing a variety of biochemical and neuroendocrine strategies. Indeed, assessments of cerebrospinal fluid chemistry, neuroendocrine responses to pharmacological challenge, and neuroreceptor and transporter binding have demonstrated a number of abnormalities in the amine neurotransmitter systems in this disorder. However, recent studies have also implicated critical signal transduction pathways as being integral to the pathophysiology and treatment of BD, in addition to a growing body of data suggesting that impairments of neuroplasticity and cellular resilience may also underlie the pathophysiology of the disorder. It is thus noteworthy that mood stabilizers and antidepressants indirectly regulate a number of factors involved in cell survival pathways - including MAP kinases, CREB, BDNF and bcl-2 protein - and may thus bring about some of their delayed long-term beneficial effects via underappreciated neurotrophic effects. PMID:16946919

  17. Cognitive enhancement treatments for bipolar disorder

    DEFF Research Database (Denmark)

    Miskowiak, Kamilla W; Carvalho, André F; Vieta, Eduard

    2016-01-01

    Cognitive dysfunction is an emerging treatment target in bipolar disorder (BD). Several trials have assessed the efficacy of novel pharmacological and psychological treatments on cognition in BD but the findings are contradictory and unclear. A systematic search following the PRISMA guidelines...... was conducted on PubMed and PsychInfo. Eligible articles reported randomized, controlled or open-label trials investigating pharmacological or psychological treatments targeting cognitive dysfunction in BD. The quality of the identified randomized controlled trials (RCTs) was evaluated with the Cochrane...

  18. Obesity in bipolar disorder: an overview.

    Science.gov (United States)

    McElroy, Susan L; Keck, Paul E

    2012-12-01

    Bipolar disorder (BD) is associated with obesity, overweight, and abdominal obesity, and BD individuals with obesity have a greater illness burden. Factors related to BD, its treatment, and the individual may all contribute to BD's association with obesity. Management strategies for the obese BD patient include use of medications with better metabolic profiles, lifestyle interventions, and adjunctive pharmacotherapy for weight loss. Obesity-related psychiatric and medical comorbidities should also be assessed and managed. Bariatric surgery may be an option for carefully selected patients. Greater research into the theoretical underpinnings and clinical management of the BD-obesity connection is needed.

  19. Personality disorders in euthymic bipolar patients: a systematic review

    Directory of Open Access Journals (Sweden)

    Severino Bezerra-Filho

    2015-06-01

    Full Text Available Objective:To identify, by means of a systematic review, the frequency with which comorbid personality disorders (PDs have been assessed in studies of euthymic bipolar patients.Methods:PubMed, ciELO and PsychINFO databases were searched for eligible articles published between 1997 and 2013. After screening 1,249 empirical papers, two independent reviewers identified three articles evaluating the frequency of PDs in patients with bipolar disorders assessed in a state of euthymia.Results:The total sample comprised 376 euthymic bipolar patients, of whom 155 (41.2% had at least one comorbid PD. Among them, we found 87 (23.1% in cluster B, 55 (14.6% in cluster C, and 25 (6.6% in cluster A. The frequencies of PD subtypes were: borderline, 38 (10.1%; histrionic, 29 (7.7%; obsessive-compulsive, 28 (7.4%; dependent, 19 (5%; narcissistic, 17 (4.5%; schizoid, schizotypal, and avoidant, 11 patients each (2.95%; paranoid, five (1.3%; and antisocial, three (0.79%.Conclusion:The frequency of comorbid PD was high across the spectrum of euthymic bipolar patients. In this population, the most common PDs were those in cluster B, and the most frequent PD subtype was borderline, followed by histrionic and obsessive-compulsive.

  20. Can bipolar disorder be viewed as a multi-system inflammatory disease?

    Science.gov (United States)

    Leboyer, Marion; Soreca, Isabella; Scott, Jan; Frye, Mark; Henry, Chantal; Tamouza, Ryad; Kupfer, David J.

    2012-01-01

    Background Patients with bipolar disorder are known to be at high risk of premature death. Comorbid cardio-vascular diseases are a leading cause of excess mortality, well above the risk associated with suicide. In this review, we explore comorbid medical disorders, highlighting evidence that bipolar disorder can be effectively conceptualized as a multi-systemic inflammatory disease. Methods We conducted a systematic PubMed search of all English-language articles recently published with bipolar disorder cross-referenced with the following terms: mortality and morbidity, cardio-vascular, diabetes, obesity, metabolic syndrome, inflammation, auto-antibody, retro-virus, stress, sleep and circadian rhythm. Results Evidence gathered so far suggests that the multi-system involvement is present from the early stages, and therefore requires proactive screening and diagnostic procedures, as well as comprehensive treatment to reduce progression and premature mortality. Exploring the biological pathways that could account for the observed link show that dysregulated inflammatory background could be a common factor underlying cardio-vascular and bipolar disorders. Viewing bipolar disorder as a multi-system disorder should help us to re-conceptualize disorders of the mind as “disorders of the brain and the body”. Limitations The current literature substantially lacks longitudinal and mechanistic studies, as well as comparison studies to explore the magnitude of the medical burden in bipolar disorder compared to major mood disorders as well as psychotic disorders. It is also necessary to look for subgroups of bipolar disorder based on their rates of comorbid disorders. Conclusions Comorbid medical illnesses in bipolar disorder might be viewed not only as the consequence of health behaviors and of psychotropic medications, but rather as an early manifestation of a multi-systemic disorder. Medical monitoring is thus a critical component of case assessment. Exploring common

  1. Exploring the association between bipolar disorder and uric acid: A mediation analysis.

    Science.gov (United States)

    Bartoli, Francesco; Crocamo, Cristina; Gennaro, Giulia Maria; Castagna, Gloria; Trotta, Giulia; Clerici, Massimo; Carrà, Giuseppe

    2016-05-01

    Recent evidence shows that bipolar disorder might be associated with a purinergic system dysfunction. This study aimed at (i) testing the association between bipolar disorder and uric acid serum levels, and (ii) clarifying whether this relationship is mediated by metabolic syndrome and other relevant metabolic parameters. Patients consecutively admitted to a Mental Health Inpatient Unit, with a diagnosis of bipolar disorder or other severe mental disorders, and an appropriate healthy control sample, were included in this cross-sectional, exploratory study. We performed linear regression analyses, to explore factors associated with uric acid levels, and formal tests of mediation to assess mediating effect of candidate variables. 176 individuals with mental disorders and 89 healthy controls met inclusion criteria. Bipolar disorder was the only diagnostic subgroup significantly associated with increased uric acid levels. Furthermore, male gender, metabolic syndrome, as well as abdominal circumference and triglycerides levels, had a significant effect on uric acid. Relevant mediation analyses showed that the estimated effect between bipolar disorder and uric acid levels was only partially mediated by metabolic abnormalities. This study suggests a direct association between bipolar disorder and uric acid levels, only partially mediated by metabolic abnormalities. It seems consistent with results of previous studies highlighting a purinergic dysfunction in bipolar disorder and the role that purinergic modulators, lowering uric acid levels, could have in clinical practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. The prevalence and illness characteristics of DSM-5-defined "mixed feature specifier" in adults with major depressive disorder and bipolar disorder: Results from the International Mood Disorders Collaborative Project.

    Science.gov (United States)

    McIntyre, Roger S; Soczynska, Joanna K; Cha, Danielle S; Woldeyohannes, Hanna O; Dale, Roman S; Alsuwaidan, Mohammad T; Gallaugher, Laura Ashley; Mansur, Rodrigo B; Muzina, David J; Carvalho, Andre; Kennedy, Sidney H

    2015-02-01

    A substantial proportion of individuals with mood disorders present with sub-syndromal hypo/manic features. The objective of this analysis was to evaluate the prevalence and illness characteristics of the Diagnostic and Statistical Manual Version-5 (DSM-5) - defined mixed features specifier (MFS) in adults with major depressive disorder (MDD) and bipolar disorder (BD). Data from participants who met criteria for a current mood episode as part of MDD (n=506) or BD (BD-I: n=216, BD-II: n=130) were included in this post-hoc analysis. All participants were enrolled in the International Mood Disorders Collaborative Project (IMDCP): a collaborative research platform at the Mood Disorders Psychopharmacology Unit, University of Toronto and the Cleveland Clinic, Cleveland, Ohio. Mixed features specifier was operationalized as a score ≥ 1 on 3 or more select items on the Young Mania Rating Scale (YMRS) or ≥ 1 on 3 select items of the Montgomery Åsberg Depression Rating Scale (MADRS) or Hamilton Depression Rating Scale (HAMD-17) during an index major depressive episode (MDE) or hypo/manic episode, respectively. A total of 26.0% (n=149), 34.0% (n=65), and 33.8% (n=49) of individuals met criteria for MFS during an index MDE as part of MDD, BD-I and BD-II, respectively. Mixed features specifier during a hypo/manic episode was identified in 20.4% (n=52) and 5.1% (n=8) in BD-I and BD-II participants, respectively. Individuals with MDE-MFS as part of BD or MDD exhibited a more severe depressive phenotype (p=0.0002 and pdefined MFS is common during an MDE as part of MDD and BD. The presence of MFS identifies a subgroup of individuals with greater illness complexity and possibly a higher rate of cardiovascular comorbidity. The results herein underscore the common occurrence of MFS in adults with either BD or MDD. Moreover, the results of our analysis indicate that adults with mood disorders and MFS have distinct clinical characteristics and comorbidity patterns. Copyright

  3. Class effect of pharmacotherapy in bipolar disorder: fact or misbelief?

    Directory of Open Access Journals (Sweden)

    Vieta Eduard

    2011-03-01

    Full Text Available Abstract Background Anecdotal reports suggests that most clinicians treat medications as belonging to a class with regard to all therapeutic indications; this means that the whole 'class' of drugs is considered to possesses a specific therapeutic action. The present article explores the possible existence of a true 'class effect' for agents available for the treatment of bipolar disorder. Methods We reviewed the available treatment data from randomized controlled trials (RCTs and explored 16 'agent class'/'treatment issue' cases for bipolar disorder. Four classes of agents were examined: first-generation antipsychotics (FGAs, second-generation antipsychotics (SGAs, antiepileptics and antidepressants, with respect to their efficacy on four treatment issues of bipolar disorder (BD (acute mania, acute bipolar depression, maintenance against mania, maintenance against depression. Results From the 16 'agent class'/' treatment issue' cases, only 3 possible class effects were detected, and they all concerned acute mania and antipsychotics. Four effect cases have not been adequately studied (FGAs against acute bipolar depression and in maintenance protection from depression, and antidepressants against acute mania and protection from mania and they all concern treatment cases with a high risk of switching to the opposite pole, thus research in these areas is poor. There is no 'class effect' at all concerning antiepileptics. Conclusions The available data suggest that a 'class effect' is the exception rather than the rule in the treatment of BD. However, the possible presence of a 'class effect' concept discourages clinicians from continued scientific training and reading. Focused educational intervention might be necessary to change this attitude.

  4. Risperidone Mono - Therapy as Prophylaxis in Bipolar Affective Disorders

    OpenAIRE

    Trivedi, Mohit; Pinto, Denzil; Safeekh, A.T.

    2004-01-01

    Risperidone has been found to be useful in the treatment of acute bipolar disorders. This is a case report where risperidone mono therapy has been found to be effective in prophylaxis of bipolar affective disorder. The pharmacological and clinical implications of risperidone in the management of BPAD are discussed

  5. Neurocognitive and Neuroimaging Predictors of Clinical Outcome in Bipolar Disorder

    OpenAIRE

    Bearden, Carrie E.; Woogen, Michelle; Glahn, David C.

    2010-01-01

    Historically, bipolar disorder has been conceptualized as a disease involving episodic rather than chronic dysfunction. However, increasing evidence indicates that bipolar disorder is associated with substantial inter-episode psychosocial and vocational impairment. Here we review the contributions of neurocognitive deficits and structural and functional neuroanatomic alterations to the observed functional impairments. In particular, compelling evidence now suggests that neurocognitive impairm...

  6. Olfactocentric Paralimbic Cortex Morphology in Adolescents with Bipolar Disorder

    Science.gov (United States)

    Wang, Fei; Kalmar, Jessica H.; Womer, Fay Y.; Edmiston, Erin E.; Chepenik, Lara G.; Chen, Rachel; Spencer, Linda; Blumberg, Hilary P.

    2011-01-01

    The olfactocentric paralimbic cortex plays a critical role in the regulation of emotional and neurovegetative functions that are disrupted in core features of bipolar disorder. Adolescence is thought to be a critical period in both the maturation of the olfactocentric paralimbic cortex and in the emergence of bipolar disorder pathology. Together,…

  7. The Enigma of Bipolar Disorder in Children and Adolescents

    Science.gov (United States)

    Hatchett, Gregory T.

    2009-01-01

    In the past decade, there has been a proliferation in the number of children and adolescents diagnosed with bipolar disorder. Except in rare cases, the young people who receive this diagnosis do not meet the strict diagnostic criteria for bipolar disorder I or II in the DSM-IV-TR. Many pediatric psychiatrists insist there are important development…

  8. Major Ups and Downs: Bipolar Disorder Brings Extreme Mood Swings

    Science.gov (United States)

    ... are severe—making it hard for you to sleep, stay focused or go to work—it may be a sign of bipolar disorder. Not only can bipolar disorder damage relationships, affect your grades and make it hard to keep a job; ...

  9. Premorbid intelligence and educational level in bipolar and unipolar disorders

    DEFF Research Database (Denmark)

    Sørensen, Holger Jelling; Sæbye, Ditte; Urfer-Parnas, Annick

    2012-01-01

    Registry-based studies have found no or weak associations between premorbid intelligence and the broad entity of affective spectrum disorder, but none of the studies compared bipolar/unipolar subgroups.......Registry-based studies have found no or weak associations between premorbid intelligence and the broad entity of affective spectrum disorder, but none of the studies compared bipolar/unipolar subgroups....

  10. Bipolar Disorder: not only in the Brain - immunological aspects

    NARCIS (Netherlands)

    E.M. Knijff (Esther)

    2006-01-01

    textabstractThe main objective of this thesis was to obtain more insight in the role of the immune system in the pathogenesis of bipolar disorder by investigating various aberrancies in the immune system of patients with bipolar disorder. In Chapter 1 some general concepts, important for the

  11. Study of Attention Deficit in Patients with Schizophrenia and Bipolar Disorder

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    SM Kafi

    2013-05-01

    Full Text Available Abstract Background & aim: Attention deficit has significant effect on the life of patients suffering from schizophrenia and bipolar disorder. The aim of this study was to assess the attention deficit in patients with schizophrenia. Methods: In the present post-hoc study, 132 patients with schizophrenia and bipolar disorder were selected via non-randomized sampling at Shafa Hospital (Rasht, Iran and then divided into four equal groups: chronic schizophrenia patients, first-episode patients, chronic bipolar patients, and first-episode bipolar patients. Thirty-three healthy individuals were selected as the control group. Subjects were evaluated by Stroop color-word test. The gathered Data were analyzed by one-way ANOVA. Results: Attention deficit among chronic schizophrenics and patients suffering from bipolar disease was higher than the control group (p <1. Chronic schizophrenic patients compared with schizophrenia bipolar disease and first round schizophrenia showed more attention deficit. There was no significant difference among the first bipolar disease and schizophrenia, bipolar disorder, as well as the first round schizophrenia (p<0.05. Conclusion: Attention deficit is more severe in schizophrenic patients than bipolar disorder, and chronicity is more effective in schizophrenic patients. Key words: Attention, Schizophrenia, Chronicity

  12. Compare of Executive Function in Bipolar I Disorder and Schizophrenia

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    Mohammad Reza khodaei-Ardakani

    2013-10-01

    Full Text Available Objective: There is evidence for differential executive function in Bipolar I Disorder (BID and schizophrenia that may tend different cognitive deficits and abnormalities. The objective of this sudsy was to compare the executive function of BID and schizophrenic patients. Materials & Methods: We studied 50 patients with BID, and 50 with schizophrenia participants in outpatients' clinic of Rouzbeh hospital. All participants completed the Wisconsin Card Sorting Test (WCST the Persian version. The participants were mach in three basic variables which had most contributions in cognitive conditions in patients. They were Age, educational status and period of illness. Results: The two patient groups had compared performance on the WCST in compared with general population (P<0/05. In the WCST, schizophrenic patients showed impairment executive function than BID patients (P<0/05. Conclusion: findings indicated that schizophrenic patients had more dysfunctions executive function than the Bipolar disorder I patients. Although, both disorders may show impairment in executive function, but the dysfunction in schizophrenia greater than Bipolar I Disorder patients.

  13. Mitochondrial variants in schizophrenia, bipolar disorder, and major depressive disorder.

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    Brandi Rollins

    Full Text Available Mitochondria provide most of the energy for brain cells by the process of oxidative phosphorylation. Mitochondrial abnormalities and deficiencies in oxidative phosphorylation have been reported in individuals with schizophrenia (SZ, bipolar disorder (BD, and major depressive disorder (MDD in transcriptomic, proteomic, and metabolomic studies. Several mutations in mitochondrial DNA (mtDNA sequence have been reported in SZ and BD patients.Dorsolateral prefrontal cortex (DLPFC from a cohort of 77 SZ, BD, and MDD subjects and age-matched controls (C was studied for mtDNA sequence variations and heteroplasmy levels using Affymetrix mtDNA resequencing arrays. Heteroplasmy levels by microarray were compared to levels obtained with SNaPshot and allele specific real-time PCR. This study examined the association between brain pH and mtDNA alleles. The microarray resequencing of mtDNA was 100% concordant with conventional sequencing results for 103 mtDNA variants. The rate of synonymous base pair substitutions in the coding regions of the mtDNA genome was 22% higher (p = 0.0017 in DLPFC of individuals with SZ compared to controls. The association of brain pH and super haplogroup (U, K, UK was significant (p = 0.004 and independent of postmortem interval time.Focusing on haplogroup and individual susceptibility factors in psychiatric disorders by considering mtDNA variants may lead to innovative treatments to improve mitochondrial health and brain function.

  14. Combinations of genetic variants associated with bipolar disorder

    DEFF Research Database (Denmark)

    Mellerup, Erling; Andreassen, Ole A.; Bennike, Bente

    2017-01-01

    The main objective of the study was to find genetic variants that in combination are significantly associated with bipolar disorder. In previous studies of bipolar disorder, combinations of three and four single nucleotide polymorphisms (SNP) genotypes taken from 803 SNPs were analyzed, and five...... clusters of combinations were found to be significantly associated with bipolar disorder. In the present study, combinations of ten SNP genotypes taken from the same 803 SNPs were analyzed, and one cluster of combinations was found to be significantly associated with bipolar disorder. Combinations from......, heterozygote or variant homozygote. In the combinations containing 10 SNP genotypes almost all the genotypes were the normal homozygote. Such a finding may indicate that accumulation in the genome of combinations containing few SNP genotypes may be a risk factor for bipolar disorder when those combinations...

  15. Bipolar disorder and diabetes mellitus: evidence for disease-modifying effects and treatment implications.

    Science.gov (United States)

    Charles, Ellen F; Lambert, Christophe G; Kerner, Berit

    2016-12-01

    Bipolar disorder refers to a group of chronic psychiatric disorders of mood and energy levels. While dramatic psychiatric symptoms dominate the acute phase of the diseases, the chronic course is often determined by an increasing burden of co-occurring medical conditions. High rates of diabetes mellitus in patients with bipolar disorder are particularly striking, yet unexplained. Treatment and lifestyle factors could play a significant role, and some studies also suggest shared pathophysiology and risk factors. In this systematic literature review, we explored data around the relationship between bipolar disorder and diabetes mellitus in recently published population-based cohort studies with special focus on the elderly. A systematic search in the PubMed database for the combined terms "bipolar disorder" AND "elderly" AND "diabetes" in papers published between January 2009 and December 2015 revealed 117 publications; 7 studies were large cohort studies, and therefore, were included in our review. We found that age- and gender- adjusted risk for diabetes mellitus was increased in patients with bipolar disorder and vice versa (odds ratio range between 1.7 and 3.2). Our results in large population-based cohort studies are consistent with the results of smaller studies and chart reviews. Even though it is likely that heterogeneous risk factors may play a role in diabetes mellitus and in bipolar disorder, growing evidence from cell culture experiments and animal studies suggests shared disease mechanisms. Furthermore, disease-modifying effects of bipolar disorder and diabetes mellitus on each other appear to be substantial, impacting both treatment response and outcomes. The risk of diabetes mellitus in patients with bipolar disorder is increased. Our findings add to the growing literature on this topic. Increasing evidence for shared disease mechanisms suggests new disease models that could explain the results of our study. A better understanding of the complex

  16. Redox Dysregulation in the Pathophysiology of Schizophrenia and Bipolar Disorder

    DEFF Research Database (Denmark)

    Kulak, Anita; Steullet, Pascal; Cabungcal, Jan-Harry

    2013-01-01

    Abstract Significance: Schizophrenia (SZ) and bipolar disorder (BD) are classified as two distinct diseases. However, accumulating evidence shows that both disorders share genetic, pathological, and epidemiological characteristics. Based on genetic and functional findings, redox dysregulation due...

  17. The Dysregulated Brain : A psychoimmunological approach to bipolar disorder

    NARCIS (Netherlands)

    Haarman, Bartholomeus Cornelius Maria

    2017-01-01

    An important problem with psychiatric disorders is that much remains unknown about the underlying disease mechanisms, thereby delaying sometimes for many years the diagnosis bipolar disorder, with significant implications for treatment. In recent years, the neuroinflammation theory, which assumes

  18. Season of birth is associated with adult body mass index in patients with bipolar disorder.

    Science.gov (United States)

    Soreca, Isabella; Cheng, Yu; Frank, Ellen; Fagiolini, Andrea; Kupfer, David J

    2013-05-01

    Cardiovascular risk factors, such as abdominal obesity and obesity in general, are very prevalent among patients with bipolar disorder (BD). Although long-term use of psychotropic medications is an important determinant of these risk factors, other evidence suggests that early development may interact with the mood disorder diathesis to exponentially increase the risk of obesity. The goal of our study was to test whether season of birth is associated with adult body mass index (BMI) and abdominal obesity in individuals with bipolar disorder. We compared season of birth effects on BMI in 375 adult patients with bipolar disorder and 196 adult patients with unipolar major depression. We found a significant season of birth effect on BMI in patients with bipolar disorder, but not unipolar. In patients with bipolar disorder, season of birth was also associated with waist circumference, with a stronger effect in males. Season of birth affects adult BMI and waist circumference in patients with bipolar disorder, but not in patients with unipolar depression. Our results suggest that early environmental factors, yet to be identified, interact with specific neurobiological features of bipolar disorder to determine stable traits and disease risk factors in adult life.

  19. Bipolar Disorder and Cognitive Dysfunction: A Complex Link.

    Science.gov (United States)

    Cipriani, Gabriele; Danti, Sabrina; Carlesi, Cecilia; Cammisuli, Davide Maria; Di Fiorino, Mario

    2017-10-01

    The aim of this article was to describe the current evidence regarding phenomenon of cognitive functioning and dementia in bipolar disorder (BD). Cochrane Library and PubMed searches were conducted for relevant articles, chapters, and books published before 2016. Search terms used included "bipolar disorder," "cognitive dysfunction," and "dementia." At the end of the selection process, 159 studies were included in our qualitative synthesis. As result, cognitive impairments in BD have been previously considered as infrequent and limited to the affective episodes. Nowadays, there is evidence of stable and lasting cognitive dysfunctions in all phases of BD, including remission phase, particularly in the following domains: attention, memory, and executive functions. The cause of cognitive impairment in BD raises the question if it subtends a neurodevelopmental or a neurodegenerative process. Impaired cognitive functioning associated with BD may contribute significantly to functional disability, in addition to the distorted affective component usually emphasized.

  20. Depression and Mania in Bipolar Disorder.

    Science.gov (United States)

    Tondo, Leonardo; Vázquez, Gustavo H; Baldessarini, Ross J

    2017-04-01

    Episode duration, recurrence rates, and time spent in manic and depressive phases of bipolar disorder (BD) is not well defined for subtypes of the disorder. We reviewed the course, timing, and duration of episodes of mania and depression among 1130 clinically treated DSM-IV-TR BD patients of various types, and compared duration and rates as well as total proportion of time in depressive versus manic episodes during 16.7 average years at risk. As expected, episodes of depressions were much longer than manias, but episode-duration did not differ among BD diagnostic types: I, II, with mainly mixed-episodes (BD-Mx), or with psychotic features (BD-P). Recurrence rates (episodes/year) and proportion of time in depression and their ratios to mania were highest in BD-II and BD-Mx subjects, with more manias/year in psychotic and BD-I subjects. In most BD-subtypes, except with psychotic features, there was more time in depressive than manic morbidity, owing mainly to longer depressive than manic episodes. The proportion of time in depression was highest among those who followed a predominant DMI course, whereas total time in mania was greatest in BD with psychotic features and BD-I. and with an MDI course. Subtypes of BD patients differed little in episode-duration, which was consistently much longer for depression. The findings underscore the limited control of bipolar depression with available treatments.

  1. Terapia comportamental cognitiva para pessoas com transtorno bipolar Cognitive behavioral therapy for bipolar disorders

    Directory of Open Access Journals (Sweden)

    Francisco Lotufo Neto

    2004-10-01

    Full Text Available Descrição dos objetivos e principais técnicas da terapia comportamental cognitiva usadas para a psicoterapia das pessoas com transtorno bipolar.Objectives and main techniques of cognitive behavior therapy for the treatment of bipolar disorder patients are described.

  2. [Artistic creativity and bipolar mood disorder].

    Science.gov (United States)

    Janka, Zoltán

    2004-08-15

    Several studies and theories propose a connection between psychopathology and artistic creativity i.e. madness and genius characters share common roots. Employing scientific research data, the objective of this review is to elucidate the frequency of psychopathological alterations among writers and artists and to analyse the possible influence of bipolar mood disorder spectrum on the artistic creativity. Reviewing studies a) on retrospective investigations, based on biographies of famous persons with high creative achievements, b) on psychiatric examinations of living writers and artists, c) on individual examples of geniuses in the light of their mental status and work output correlations, and d) on creative traits and skills of diagnosed psychiatric patient populations. Beyond the practical experiences and impressions being held for ages from ancient times, the scientific observations and surveys indicate that psychopathological symptoms, especially those belonging to the bipolar mood disorder (bipolar I and II), major depression and cyclothymia categories occur more frequently among writers, poets, visual artists and composers, compared to the rates in the general population. Self-reports of writers and artists describe symptoms in their intensively creative periods which are reminiscent and characteristic of hypomanic states. Further, cognitive styles of hypomania (e.g. overinclusive thinking, richness of associations) and originality-prone creativity share many common as indicated by several authors. Among the eminent artists showing most probably manic-depressive or cyclothymic symptoms were: E. Dickinson, E. Hemingway, N. Gogol, A. Strindberg, V. Woolf, Lord Byron (G. Gordon), J. W. Goethe, V. van Gogh, F. Goya, G. Donizetti, G. F. Händel, O. Klemperer, G. Mahler, R. Schumann, and H. Wolf. Based on biographies and other studies, brief descriptions are given in the present article on the personality character of Gogol; Strindberg, Van Gogh, H

  3. Preliminary findings regarding overweight and obesity in pediatric bipolar disorder.

    Science.gov (United States)

    Goldstein, Benjamin I; Birmaher, Boris; Axelson, David A; Goldstein, Tina R; Esposito-Smythers, Christianne; Strober, Michael A; Hunt, Jeffrey; Leonard, Henrietta; Gill, Mary Kay; Iyengar, Satish; Grimm, Colleen; Yang, Mei; Ryan, Neal D; Keller, Martin B

    2008-12-01

    Overweight/obesity is highly prevalent among adults with bipolar disorder and has been associated with illness severity. Little is known regarding overweight/obesity among youth with bipolar disorder. Subjects were 348 youths aged 7 to 17 years who met DSM-IV criteria for bipolar I or bipolar II disorder or study-operationalized criteria for bipolar disorder not otherwise specified and were enrolled in the Course and Outcome of Bipolar Illness in Youth study. Age- and sex-adjusted body mass index was computed according to International Obesity Task Force cut points, based on self- and parent-reported height and weight, to determine overweight/obesity. The study was conducted from October 2000 to July 2006. Overweight/obesity was prevalent among 42% of subjects. The most robust predictors of overweight/obesity in a logistic regression model were younger age, nonwhite race, lifetime physical abuse, substance use disorders, psychiatric hospitalizations, and exposure to ≥ 2 medication classes associated with weight gain. The prevalence of overweight/obesity among youth with bipolar disorder may be modestly greater than in the general population. Moreover, similar to adults, overweight/obesity among youth with bipolar disorder may be associated with increased psychiatric burden. These preliminary findings underscore the importance of early identification of overweight/obesity among youth with bipolar disorder. Future studies are needed to clarify the direction of the associations between overweight/obesity and the identified predictors and to compare the prevalence of overweight/obesity among youth with bipolar disorder versus other psychiatric disorders. Copyright 2008 Physicians Postgraduate Press, Inc.

  4. The miRNome of bipolar disorder.

    Science.gov (United States)

    Fries, Gabriel R; Carvalho, Andre F; Quevedo, Joao

    2018-06-01

    Epigenetic mechanisms have been suggested to play a key role in the pathophysiology of bipolar disorder (BD), among which microRNAs (miRNAs) may be of particular significance according to recent studies. We aimed to summarize miRNA studies in BD to identify consistent findings, limitations, and future directions of this emerging field. We performed a comprehensive search on PUBMED and Medline for studies investigating an association between BD and miRNAs. The included studies report miRNA alterations in postmortem brain tissues and in the periphery, cell culture and preclinical findings, genetic associations, and the effects of medications. Several studies report changes in miRNA expression levels in postmortem brain and in the periphery of patients, although most of the results so far have not been replicated and are not concordant between different populations. Genetic studies also suggest that miRNA genes are located within susceptibility loci of BD, and also a putative role of miRNAs in modulating genes previously shown to confer risk of BD. We did not perform a systematic review of the literature, and miRNAs represent only one facet of the plethora of epigenetic mechanisms that might be involved in BD's pathophysiology. miRNA findings in BD significantly vary between studies, but are consistent to suggest a key role for these molecules in BD's pathophysiology and treatment, particularly miR-34a and miR-137. Accordingly, miRNA might represent important biomarkers of illness to be used in the clinical settings, and potentially also for the development of novel therapeutics for BD in the near future. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Circadian Phase Preference in Pediatric Bipolar Disorder

    Directory of Open Access Journals (Sweden)

    Kerri L. Kim

    2014-03-01

    Full Text Available Pediatric bipolar disorder (BD rates have notably increased over the past three decades. Given the significant morbidity and mortality associated with BD, efforts are needed to identify factors useful in earlier detection to help address this serious public health concern. Sleep is particularly important to consider given the sequelae of disrupted sleep on normative functioning and that sleep is included in diagnostic criteria for both Major Depressive and Manic Episodes. Here, we examine one component of sleep—i.e., circadian phase preference with the behavioral construct of morningness/eveningness (M/E. In comparing 30 BD and 45 typically developing control (TDC participants, ages 7–17 years, on the Morningness-Eveningness Scale for Children (MESC, no between-group differences emerged. Similar results were found when comparing three groups (BD−ADHD; BD+ADHD; TDC. Consistent with data available on circadian phase preference in adults with BD, however, we found that BD adolescents, ages 13 years and older, endorsed significantly greater eveningness compared to their TDC peers. While the current findings are limited by reliance on subjective report and the high-rate of comorbid ADHD among the BD group, this finding that BD teens demonstrate an exaggerated shift towards eveningness than would be developmentally expected is important. Future studies should compare the circadian rhythms across the lifespan for individuals diagnosed with BD, as well as identify the point at which BD youth part ways with their healthy peers in terms of phase preference. In addition, given our BD sample was overall euthymic, it may be that M/E is more state vs. trait specific in latency age youth. Further work would benefit from assessing circadian functioning using a combination of rating forms and laboratory-based measures. Improved understanding of sleep in BD may identify behavioral targets for inclusion in prevention and intervention protocols.

  6. Diagnostic Precursors to Bipolar Disorder in Offspring of Parents With Bipolar Disorder: A Longitudinal Study.

    Science.gov (United States)

    Axelson, David; Goldstein, Benjamin; Goldstein, Tina; Monk, Kelly; Yu, Haifeng; Hickey, Mary Beth; Sakolsky, Dara; Diler, Rasim; Hafeman, Danella; Merranko, John; Iyengar, Satish; Brent, David; Kupfer, David; Birmaher, Boris

    2015-07-01

    The authors sought to identify diagnostic risk factors of manic, mixed, or hypomanic episodes in the offspring of parents with bipolar disorder ("high-risk offspring"). High-risk offspring 6-18 years old (N=391) and demographically matched offspring (N=248) of community parents without bipolar disorder were assessed longitudinally with standardized diagnostic instruments by staff blind to parental diagnoses. Follow-up assessments were completed in 91% of the offspring (mean follow-up interval, 2.5 years; mean follow-up duration, 6.8 years). Compared with community offspring, high-risk offspring had significantly higher rates of subthreshold mania or hypomania (13.3% compared with 1.2%), manic, mixed, or hypomanic episodes (9.2% compared with 0.8%), and major depressive episodes (32.0% compared with 14.9%). They also had higher rates of attention deficit hyperactivity disorder (30.7% compared with 18.1%), disruptive behavior disorders (27.4% compared with 15.3%), anxiety disorders (39.9% compared with 21.8%), and substance use disorders (19.9% compared with 10.1%), but not unipolar major depressive disorder (major depression with no bipolarity; 18.9% compared with 13.7%). Multivariate Cox regressions showed that in the high-risk offspring, subthreshold manic or hypomanic episodes (hazard ratio=2.29), major depressive episodes (hazard ratio=1.99), and disruptive behavior disorders (hazard ratio=2.12) were associated with subsequent manic, mixed, or hypomanic episodes. Only subthreshold manic or hypomanic episodes (hazard ratio=7.57) were associated when analyses were restricted to prospective data. Subthreshold manic or hypomanic episodes were a diagnostic risk factor for the development of manic, mixed, or hypomanic episodes in the offspring of parents with bipolar disorder and should be a target for clinical assessment and treatment research. Major depressive episodes and disruptive behavior disorders are also indications for close clinical monitoring of emergent

  7. Contextual Social Cognition Impairments in Schizophrenia and Bipolar Disorder

    Science.gov (United States)

    Villarin, Lilian; Theil, Donna; Gonzalez-Gadea, María Luz; Gomez, Pedro; Mosquera, Marcela; Huepe, David; Strejilevich, Sergio; Vigliecca, Nora Silvana; Matthäus, Franziska; Decety, Jean; Manes, Facundo; Ibañez, Agustín M.

    2013-01-01

    Background The ability to integrate contextual information with social cues to generate social meaning is a key aspect of social cognition. It is widely accepted that patients with schizophrenia and bipolar disorders have deficits in social cognition; however, previous studies on these disorders did not use tasks that replicate everyday situations. Methodology/Principal Findings This study evaluates the performance of patients with schizophrenia and bipolar disorders on social cognition tasks (emotional processing, empathy, and social norms knowledge) that incorporate different levels of contextual dependence and involvement of real-life scenarios. Furthermore, we explored the association between social cognition measures, clinical symptoms and executive functions. Using a logistic regression analysis, we explored whether the involvement of more basic skills in emotional processing predicted performance on empathy tasks. The results showed that both patient groups exhibited deficits in social cognition tasks with greater context sensitivity and involvement of real-life scenarios. These deficits were more severe in schizophrenic than in bipolar patients. Patients did not differ from controls in tasks involving explicit knowledge. Moreover, schizophrenic patients’ depression levels were negatively correlated with performance on empathy tasks. Conclusions/Significance Overall performance on emotion recognition predicted performance on intentionality attribution during the more ambiguous situations of the empathy task. These results suggest that social cognition deficits could be related to a general impairment in the capacity to implicitly integrate contextual cues. Important implications for the assessment and treatment of individuals with schizophrenia and bipolar disorders, as well as for neurocognitive models of these pathologies are discussed. PMID:23520477

  8. Contextual social cognition impairments in schizophrenia and bipolar disorder.

    Directory of Open Access Journals (Sweden)

    Sandra Baez

    Full Text Available BACKGROUND: The ability to integrate contextual information with social cues to generate social meaning is a key aspect of social cognition. It is widely accepted that patients with schizophrenia and bipolar disorders have deficits in social cognition; however, previous studies on these disorders did not use tasks that replicate everyday situations. METHODOLOGY/PRINCIPAL FINDINGS: This study evaluates the performance of patients with schizophrenia and bipolar disorders on social cognition tasks (emotional processing, empathy, and social norms knowledge that incorporate different levels of contextual dependence and involvement of real-life scenarios. Furthermore, we explored the association between social cognition measures, clinical symptoms and executive functions. Using a logistic regression analysis, we explored whether the involvement of more basic skills in emotional processing predicted performance on empathy tasks. The results showed that both patient groups exhibited deficits in social cognition tasks with greater context sensitivity and involvement of real-life scenarios. These deficits were more severe in schizophrenic than in bipolar patients. Patients did not differ from controls in tasks involving explicit knowledge. Moreover, schizophrenic patients' depression levels were negatively correlated with performance on empathy tasks. CONCLUSIONS/SIGNIFICANCE: Overall performance on emotion recognition predicted performance on intentionality attribution during the more ambiguous situations of the empathy task. These results suggest that social cognition deficits could be related to a general impairment in the capacity to implicitly integrate contextual cues. Important implications for the assessment and treatment of individuals with schizophrenia and bipolar disorders, as well as for neurocognitive models of these pathologies are discussed.

  9. Bipolar disorder and metabolic syndrome: a systematic review

    Directory of Open Access Journals (Sweden)

    Letícia Czepielewski

    2013-03-01

    Full Text Available OBJECTIVE: Summarize data on metabolic syndrome (MS in bipolar disorder (BD. METHODS: A systematic review of the literature was conducted using the Medline, Embase and PsycInfo databases, using the keywords "metabolic syndrome", "insulin resistance" and "metabolic X syndrome" and cross-referencing them with "bipolar disorder" or "mania". The following types of publications were candidates for review: (i clinical trials, (ii studies involving patients diagnosed with bipolar disorder or (iii data about metabolic syndrome. A 5-point quality scale was used to assess the methodological weight of the studies. RESULTS: Thirty-nine articles were selected. None of studies reached the maximum quality score of 5 points. The prevalence of MS was significantly higher in BD individuals when compared to a control group. The analysis of MS subcomponents showed that abdominal obesity was heterogeneous. Individuals with BD had significantly higher rates of hypertriglyceridemia than healthy controls. When compared to the general population, there were no significant differences in the prevalence of low HDL-c in individuals with BD. Data on hypertension were also inconclusive. Rates of hyperglycemia were significantly greater in patients with BD compared to the general population. CONCLUSIONS: The overall results point to the presence of an association between BD and MS, as well as between their subcomponents.

  10. Efficacy of Electroconvulsive Therapy in Bipolar Disorder with Mixed Features

    Directory of Open Access Journals (Sweden)

    Miguel Palma

    2016-01-01

    Full Text Available Introduction. Mixed states represent a frequent presentation of bipolar disorder, associated with higher resistance to psychopharmacology. Limited evidence supports the use of ECT in these patients. We aim to report our experience on treating bipolar mixed states with ECT. Methods. Retrospective data were collected from all bipolar patients submitted to acute ECT treatment, between June 2006 and June 2011. Three groups were created in terms of affective polarity of the episode. CGI rating was used to establish clinical remission and demographic and clinical variables were compared among groups. Long-term outcome was assessed through readmission measures, considering the use of continuation or maintenance ECT. Results. During the study time frame, a total of 50 ECT course treatments were performed on 41 bipolar patients. All affective episodes, except one mixed state, showed a positive clinical response. Patients with mixed state presentation tended to be younger and have an earlier first hospitalization than depressed patients. No differences were found in terms of ECT sessions performed, length of hospital admission, referral to continuation ECT treatment, number of readmissions, and time until next readmission. Conclusions. Our results support the effectiveness of ECT in patients experiencing a mixed affective state.

  11. Atypical features in depression: Association with obesity and bipolar disorder.

    Science.gov (United States)

    Łojko, Dorota; Buzuk, Grzegorz; Owecki, Maciej; Ruchała, Marek; Rybakowski, Janusz K

    2015-10-01

    Depression with atypical features amounts to a significant proportion of depressed patients. Studies have shown its association with bipolarity and, recently, with obesity. In this study, we investigated atypical features of depression in relation to overweight/obesity in three diagnostic categories: unipolar depression, bipolar depression and dysthymia. Out of 512 depressed patients screened, we recruited 182 research subjects, consisting of 91 pairs, matched by age, gender and diagnosis, in which one member of the pair was within the normal weight range (BMI≤25) and the other was either overweight or obese (BMI>25). There were 35 pairs with unipolar depression, 27 with bipolar depression and 29 with dysthymia. Symptoms of atypical depression, such as increased appetite, hypersomnia, leaden paralysis, longstanding pattern of interpersonal rejection sensitivity, and, a significant weight gain in the past 3 months, were assessed. All the symptoms of atypical depression were significantly more pronounced in those depressed patients with a BMI>25, compared with depressed subjects with a normal weight. Except for hypersomnia, these symptoms scored significantly higher in women compared to men. Among the diagnostic categories, symptoms of atypical depression were significantly higher in patients with bipolar disorder compared with both major depressive disorder and dysthymia. The preponderance of women, the assessment of atypical depression by adaptation of the DSM criteria, entirely Polish population, specificity of selection criteria. The results demonstrated a higher intensity of atypical depression's symptoms in overweight/obese depressed patients. They also confirm the association between obesity and bipolarity. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. Early Maladaptive Schemas among patients diagnosed with bipolar disorder.

    Science.gov (United States)

    Hawke, Lisa D; Provencher, Martin D

    2012-02-01

    Bipolar disorder is associated with a variety of cognitive features that seem to play a role in affective symptoms. Schema theory may serve as a unifying theory that would explain many of these features. This study is an exploratory investigation of schema theory's Early Maladaptive Schemas (EMSs) among individuals diagnosed with bipolar disorder. A sample of 74 participants with bipolar disorder and 99 mixed clinical controls (46 with unipolar depression and 53 with anxiety disorders) completed the Young Schema Questionnaire and comparison measures. Associations were investigated using univariate and multivariate analyses. Mean scores were compared with previously established benchmarks. Participants with bipolar disorder demonstrate elevated scores on most EMSs, many at an intermediate position between nonclinical and mixed clinical control groups. When controlling for depression, participants with bipolar disorder exceed those with unipolar depression on Approval-Seeking/Recognition-Seeking and Entitlement/Grandiosity. Bipolar group membership is predicted by high scores on Approval-Seeking/Recognition-Seeking and low scores on Emotional Inhibition and Abandonment. Women were overrepresented. Axis II traits were not assessed, nor were manic symptoms in the mixed clinical sample. Bipolar disorder is associated with a general activation of the EMSs. Approval-Seeking/Recognition-Seeking and Entitlement/Grandiosity seem to be particularly high, while Emotional Inhibition and Abandonment seem to be typically low. These EMS are highly consistent with characteristics of the bipolar spectrum. By demonstrating the activation of the EMSs, this study suggests that the EMS component of schema theory may be applied to bipolar disorder. Future research should explore how EMSs might interact with life events to trigger affective symptoms and, ultimately, the applicability of schema therapy to bipolar disorder. Copyright © 2011 Elsevier B.V. All rights reserved.

  13. International Society for Bipolar Disorders Task Force on Suicide

    DEFF Research Database (Denmark)

    Schaffer, Ayal; Isometsä, Erkki T; Tondo, Leonardo

    2015-01-01

    significantly associated with suicide attempts were: female gender, younger age at illness onset, depressive polarity of first illness episode, depressive polarity of current or most recent episode, comorbid anxiety disorder, any comorbid substance use disorder, alcohol use disorder, any illicit substance use......OBJECTIVES: Bipolar disorder is associated with a high risk of suicide attempts and suicide death. The main objective of the present study was to identify and quantify the demographic and clinical correlates of attempted and completed suicide in people with bipolar disorder. METHODS: Within...... the framework of the International Society for Bipolar Disorders Task Force on Suicide, a systematic review of articles published since 1980, characterized by the key terms bipolar disorder and 'suicide attempts' or 'suicide', was conducted, and data extracted for analysis from all eligible articles...

  14. Clinical, demographic, and familial correlates of bipolar spectrum disorders among offspring of parents with bipolar disorder.

    Science.gov (United States)

    Goldstein, Benjamin I; Shamseddeen, Wael; Axelson, David A; Kalas, Cathy; Monk, Kelly; Brent, David A; Kupfer, David J; Birmaher, Boris

    2010-04-01

    Despite increased risk, most offspring of parents with bipolar disorder (BP) do not manifest BP. The identification of risk factors for BP among offspring could improve preventive and treatment strategies. We examined this topic in the Pittsburgh Bipolar Offspring Study (BIOS). Subjects included 388 offspring, ages 7-17 years, of 233 parents with BP-I or BP-II (via the Structured Clinical Interview for DSM-IV). Offspring diagnoses were determined using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Present and Lifetime version (KSADS-PL). Analyses focused on the 41 offspring who were diagnosed with BP-I (N = 9), BP-II (N = 5), or BP-NOS (N = 27). Offspring with BP had proband parents who were significantly younger at the time of their birth, were more likely to be female, and had lower socio-economic status, versus proband parents of offspring without BP. Parental clinical variables and obstetric variables were not significantly associated with BP among offspring. History of physical and/or sexual abuse, exposure to antidepressants, and exposure to stimulants was significantly greater among offspring with versus without BP. There was significantly greater prevalence of attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, oppositional defiant disorder/conduct disorder (ODD/CD), and exposure to stimulants and antidepressants among offspring with versus without BP. Variables significantly associated with BP among offspring in regression analyses were as follows: older offspring age, younger parent age at birth, offspring anxiety disorders and ODD/CD, and biological coparent with BP. History of anxiety and/or disruptive behavior disorders, as well as presence of bi-lineal parental BP, is associated with elevated risk of bipolar spectrum disorders among offspring. If replicated prospectively, these findings could have implications for the diagnosis and treatment of psychopathology among BP offspring.

  15. Starting lithium prophylaxis early v. late in bipolar disorder

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Vradi, Eleni; Andersen, Per Kragh

    2014-01-01

    BACKGROUND: No study has investigated when preventive treatment with lithium should be initiated in bipolar disorder. AIMS: To compare response rates among patients with bipolar disorder starting treatment with lithium early v. late. METHOD: Nationwide registers were used to identify all patients...... with a diagnosis of bipolar disorder in psychiatric hospital settings who were prescribed lithium during the period 1995-2012 in Denmark (n = 4714). Lithium responders were defined as patients who, following a stabilisation lithium start-up period of 6 months, continued lithium monotherapy without being admitted......-response to lithium compared with the rate for patients starting lithium later (adjusted analyses: first v. later contact: Pbipolar disorder: P

  16. Access to Pharmacotherapy Amongst Women with Bipolar Disorder during Pregnancy: a Preliminary Study.

    Science.gov (United States)

    Byatt, Nancy; Cox, Lucille; Moore Simas, Tiffany A; Biebel, Kathleen; Sankaran, Padma; Swartz, Holly A; Weinreb, Linda

    2018-03-01

    Bipolar disorder among pregnant women has deleterious effects on birth and child outcomes and is currently under-detected, not addressed effectively, or exacerbated through inappropriate treatment. The goal of this study was to identify perspectives of pregnant and postpartum women with bipolar disorder on barriers and facilitators to psychiatric treatment during pregnancy. In-depth interviews were conducted with pregnant and postpartum women who scored ≥ 10 on the Edinburgh Postnatal Depression Scale and met DSM-IV criteria for bipolar disorder I, II or not otherwise specified using the Mini International Neuropsychiatric Interview version 5.0. Interviews were transcribed, and resulting data were analyzed using a grounded theory approach to identify barriers and facilitators to bipolar disorder treatment access in pregnancy. Participant identified barriers included perception that psychiatric providers lack training and experience in the treatment of psychiatric illness during pregnancy, are reluctant to treat bipolar disorder among pregnant women, and believe that pharmacotherapy is not needed for psychiatric illness during pregnancy. Facilitators included participants' perception that providers' acknowledge risks associated with untreated or undertreated psychiatric illness during pregnancy and provide psycho-education about the risks, benefits and alternatives to pharmacotherapy. Psychiatric providers are critically important to the treatment of bipolar disorder and need knowledge and skills necessary to provide care during the perinatal period. Advancing psychiatric providers' knowledge/skills may improve access to pharmacotherapy for pregnant women with bipolar disorder.

  17. International multi-site survey on the use of online support groups in bipolar disorder.

    Science.gov (United States)

    Bauer, Rita; Conell, Jörn; Glenn, Tasha; Alda, Martin; Ardau, Raffaella; Baune, Bernhard T; Berk, Michael; Bersudsky, Yuly; Bilderbeck, Amy; Bocchetta, Alberto; Bossini, Letizia; Castro, Angela M Paredes; Cheung, Eric Y W; Chillotti, Caterina; Choppin, Sabine; Zompo, Maria Del; Dias, Rodrigo; Dodd, Seetal; Duffy, Anne; Etain, Bruno; Fagiolini, Andrea; Hernandez, Miryam Fernández; Garnham, Julie; Geddes, John; Gildebro, Jonas; Gonzalez-Pinto, Ana; Goodwin, Guy M; Grof, Paul; Harima, Hirohiko; Hassel, Stefanie; Henry, Chantal; Hidalgo-Mazzei, Diego; Kapur, Vaisnvy; Kunigiri, Girish; Lafer, Beny; Larsen, Erik R; Lewitzka, Ute; Licht, Rasmus W; Hvenegaard Lund, Anne; Misiak, Blazej; Piotrowski, Patryk; Monteith, Scott; Munoz, Rodrigo; Nakanotani, Takako; Nielsen, René E; O'donovan, Claire; Okamura, Yasushi; Osher, Yamima; Reif, Andreas; Ritter, Philipp; Rybakowski, Janusz K; Sagduyu, Kemal; Sawchuk, Brett; Schwartz, Elon; Scippa, Ângela M; Slaney, Claire; Sulaiman, Ahmad H; Suominen, Kirsi; Suwalska, Aleksandra; Tam, Peter; Tatebayashi, Yoshitaka; Tondo, Leonardo; Vieta, Eduard; Vinberg, Maj; Viswanath, Biju; Volkert, Julia; Zetin, Mark; Whybrow, Peter C; Bauer, Michael

    2017-08-01

    Peer support is an established component of recovery from bipolar disorder, and online support groups may offer opportunities to expand the use of peer support at the patient's convenience. Prior research in bipolar disorder has reported value from online support groups. To understand the use of online support groups by patients with bipolar disorder as part of a larger project about information seeking. The results are based on a one-time, paper-based anonymous survey about information seeking by patients with bipolar disorder, which was translated into 12 languages. The survey was completed between March 2014 and January 2016 and included questions on the use of online support groups. All patients were diagnosed by a psychiatrist. Analysis included descriptive statistics and general estimating equations to account for correlated data. The survey was completed by 1222 patients in 17 countries. The patients used the Internet at a percentage similar to the general public. Of the Internet users who looked online for information about bipolar disorder, only 21.0% read or participated in support groups, chats, or forums for bipolar disorder (12.8% of the total sample). Given the benefits reported in prior research, clarification of the role of online support groups in bipolar disorder is needed. With only a minority of patients using online support groups, there are analytical challenges for future studies.

  18. [Attention deficit hyperactivity disorder and/or bipolar disorder?].

    Science.gov (United States)

    Da Fonseca, D; Adida, M; Belzeaux, R; Azorin, J-M

    2014-12-01

    The attention deficit disorder and the bipolar disorder maintain a complex relation. Indeed, these two syndromes share numerous symptoms that engender numerous diagnostic difficulties. According to several studies, it seems that these two disorders are really different with significant differences at the functional and anatomical level. However, there are common cognitive deficits as well as relatively frequent co-morbidity which is necessary to know in order to adjust the treatment. Copyright © 2014 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.

  19. Social and nonsocial cognition in bipolar disorder and schizophrenia: relative levels of impairment.

    Science.gov (United States)

    Lee, Junghee; Altshuler, Lori; Glahn, David C; Miklowitz, David J; Ochsner, Kevin; Green, Michael F

    2013-03-01

    This study aimed to determine the relative extent of impairment in social and nonsocial cognitive domains in patients with bipolar disorder compared with schizophrenia patients and healthy comparison subjects. Sixty-eight clinically stable outpatients with bipolar disorder, 38 clinically stable outpatients with schizophrenia, and 36 healthy comparison subjects completed a range of social (facial affect perception, emotional regulation, empathic accuracy, mental state attribution, and self-referential memory) and nonsocial (speed of processing, attention/vigilance, working memory, verbal memory, visual memory, and reasoning/problem solving) cognitive tasks. For each social cognitive task, patients with bipolar disorder did not differ significantly from comparison subjects, and both groups performed better than schizophrenia patients. Within the bipolar group, clinical features and medication status were not related to social cognitive performance. Bipolar patients showed performance patterns across tasks (i.e., profiles) that were similar to those of comparison subjects on both social and nonsocial cognitive domains, whereas both groups differed from schizophrenia patients for both domains. Regarding relative impairment across the two cognitive domains, results revealed a significant group-by-domain interaction in which bipolar patients showed less impaired social than nonsocial cognition, while schizophrenia patients showed the opposite pattern. Bipolar patients showed less impairment on social relative to nonsocial cognitive performance, whereas schizophrenia patients showed more impairment on social relative to nonsocial cognitive performance. These results suggest that these two cognitive domains play different roles in bipolar disorder compared with in schizophrenia.

  20. A genome-wide association study of bipolar disorder with comorbid eating disorder replicates the SOX2-OT region.

    Science.gov (United States)

    Liu, Xiaohua; Kelsoe, John R; Greenwood, Tiffany A

    2016-01-01

    Bipolar disorder is a heterogeneous mood disorder associated with several important clinical comorbidities, such as eating disorders. This clinical heterogeneity complicates the identification of genetic variants contributing to bipolar susceptibility. Here we investigate comorbidity of eating disorders as a subphenotype of bipolar disorder to identify genetic variation that is common and unique to both disorders. We performed a genome-wide association analysis contrasting 184 bipolar subjects with eating disorder comorbidity against both 1370 controls and 2006 subjects with bipolar disorder only from the Bipolar Genome Study (BiGS). The most significant genome-wide finding was observed bipolar with comorbid eating disorder vs. controls within SOX2-OT (p=8.9×10(-8) for rs4854912) with a secondary peak in the adjacent FXR1 gene (p=1.2×10(-6) for rs1805576) on chromosome 3q26.33. This region was also the most prominent finding in the case-only analysis (p=3.5×10(-7) and 4.3×10(-6), respectively). Several regions of interest containing genes involved in neurodevelopment and neuroprotection processes were also identified. While our primary finding did not quite reach genome-wide significance, likely due to the relatively limited sample size, these results can be viewed as a replication of a recent study of eating disorders in a large cohort. These findings replicate the prior association of SOX2-OT with eating disorders and broadly support the involvement of neurodevelopmental/neuroprotective mechanisms in the pathophysiology of both disorders. They further suggest that different clinical manifestations of bipolar disorder may reflect differential genetic contributions and argue for the utility of clinical subphenotypes in identifying additional molecular pathways leading to illness. Copyright © 2015 Elsevier B.V. All rights reserved.

  1. Processamento cognitivo "Teoria da Mente" no transtorno bipolar Cognitive "Theory of Mind" processing in bipolar disorder

    Directory of Open Access Journals (Sweden)

    Hélio Anderson Tonelli

    2009-12-01

    Full Text Available OBJETIVO: O transtorno afetivo bipolar está associado ao comprometimento funcional persistente. Apesar de muitas pesquisas demonstrarem que bipolares podem apresentar déficits cognitivos, um número menor de trabalhos avaliou o papel de prejuízos no processamento cognitivo social, a Teoria da Mente (relacionado à capacidade de inferir estados mentais, no aparecimento de sintomas e complicações sociais em bipolares. O objetivo deste trabalho é o de revisar sistemática e criticamente a literatura sobre possíveis alterações do processamento Teoria da Mente no transtorno afetivo bipolar. MÉTODO: Foi realizada uma busca na base de dados Medline por trabalhos publicados em língua inglesa, alemã, espanhola ou portuguesa nos últimos 20 anos, utilizando a frase de busca "Bipolar Disorder"[Mesh] AND "Theory of Mind". Foram procurados por estudos clínicos envolvendo indivíduos bipolares e que empregaram uma ou mais tarefas cognitivas desenvolvidas para a avaliação de habilidades Teoria da Mente. Foram excluídos os relatos de caso e cartas ao editor. A busca inicial resultou em cinco artigos, sendo selecionados quatro. Outros quatro foram também selecionados a partir da leitura dos artigos acima. DISCUSSÃO: Os artigos selecionados avaliaram populações de bipolares adultos e pediátricos, incluindo indivíduos eutímicos, maníacos e deprimidos. A maioria dos trabalhos avaliados sugere que existam prejuízos no processamento Teoria da Mente em portadores de transtorno afetivo bipolar e que estes podem estar por trás dos sintomas e dos déficits funcionais do transtorno afetivo bipolar. CONCLUSÃO: Pesquisas futuras a respeito do tema em questão poderão esclarecer muito acerca do papel das alterações sociocognitivas no surgimento dos sintomas do transtorno afetivo bipolar, bem como ajudar no desenvolvimento de estratégias preventivas e terapêuticas do mesmo.OBJECTIVE: Bipolar disorder is associated to persistent functional

  2. Mental imagery as an emotional amplifier: application to bipolar disorder.

    Science.gov (United States)

    Holmes, Emily A; Geddes, John R; Colom, Francesc; Goodwin, Guy M

    2008-12-01

    Cognitions in the form of mental images have a more powerful impact on emotion than their verbal counterparts. This review synthesizes the cognitive science of imagery and emotion with transdiagnostic clinical research, yielding novel predictions for the basis of emotional volatility in bipolar disorder. Anxiety is extremely common in patients with bipolar disorder and is associated with increased dysfunction and suicidality, yet it is poorly understood and rarely treated. Mental imagery is a neglected aspect of bipolar anxiety although in anxiety disorders such as posttraumatic stress disorder and social phobia focusing on imagery has been crucial for the development of cognitive behavior therapy (CBT). In this review we present a cognitive model of imagery and emotion applied to bipolar disorder. Within this model mental imagery amplifies emotion, drawing on Clark's cyclical panic model [(1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461-470]. We (1) emphasise imagery's amplification of anxiety (cycle one); (2) suggest that imagery amplifies the defining (hypo-) mania of bipolar disorder (cycle two), whereby the overly positive misinterpretation of triggers leads to mood elevation (escalated by imagery), increasing associated beliefs, goals, and action likelihood (all strengthened by imagery). Imagery suggests a unifying explanation for key unexplained features of bipolar disorder: ubiquitous anxiety, mood instability and creativity. Introducing imagery has novel implications for bipolar treatment innovation--an area where CBT improvements are much-needed.

  3. Diagnostic stability in bipolar disorder in clinical practise as according to ICD-10

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel

    2005-01-01

    BACKGROUND: The diagnostic stability of the ICD-10 diagnosis of mania/bipolar disorder has not been investigated in clinical practice. METHODS: All patients who got a diagnosis of mania/bipolar disorder at least once in a period from 1994 to 2002 at outpatient treatment or at discharge from...... psychiatric hospitalisation in Denmark were identified in a nationwide register. RESULTS: Totally, 4116 patients got a diagnosis of mania/bipolar disorder at least once; among these, 2315 patients (56.2%) got the diagnosis at the first contact, whereas the remaining patients (43.8%) got the diagnosis at later...... contacts. Approximately 30% of patients with an initial diagnosis of mania/bipolar disorder eventually changed diagnosis during follow-up. A substantial proportion of patients initially presented with prodromal syndromes such as transient psychosis, reaction to stress/adjustment disorder or mental...

  4. A report on older-age bipolar disorder from the International Society for Bipolar Disorders Task Force

    Science.gov (United States)

    Sajatovic, Martha; Strejilevich, Sergio A; Gildengers, Ariel G; Dols, Annemiek; Al Jurdi, Rayan K; Forester, Brent P; Kessing, Lars Vedel; Beyer, John; Manes, Facundo; Rej, Soham; Rosa, Adriane R; Schouws, Sigfried NTM; Tsai, Shang-Ying; Young, Robert C; Shulman, Kenneth I

    2015-01-01

    Objectives In the coming generation, older adults with bipolar disorder (BD) will increase in absolute numbers as well as proportion of the general population. This is the first report of the International Society for Bipolar Disorder (ISBD) Task Force on Older-Age Bipolar Disorder (OABD). Methods This task force report addresses the unique aspects of OABD including epidemiology and clinical features, neuropathology and biomarkers, physical health, cognition, and care approaches. Results The report describes an expert consensus summary on OABD that is intended to advance the care of patients, and shed light on issues of relevance to BD research across the lifespan. Although there is still a dearth of research and health efforts focused on older adults with BD, emerging data has brought some answers, innovative questions, and novel perspectives related to the notion of late onset, medical comorbidity, and the vexing issue of cognitive impairment and decline. Conclusions Improving our understanding of the biological, clinical, and social underpinnings relevant to OABD is an indispensable step in building a complete map of BD across the lifespan. PMID:26384588

  5. Hypothyroidism and Bipolar Affective Disorder: Is There a Connection?

    OpenAIRE

    Menon, Bindu

    2014-01-01

    Context: Hypothalamic-pituitary-thyroid axis dysfunction in the pathophysiology of bipolar disorder has received less attention as compared with that in depressive disorder. Aims: To study the prevalence of hypothyroidism in patients diagnosed with bipolar disorder and compare it with a population norm. Settings and Design: The setting was the psychiatry inpatient unit of a tertiary care hospital. The design was retrospective and observational. Subjects and Methods: A retrospective observatio...

  6. The relationship between bipolar disorder and cannabis use in daily life: an experience sampling study.

    Science.gov (United States)

    Tyler, Elizabeth; Jones, Steven; Black, Nancy; Carter, Lesley-Anne; Barrowclough, Christine

    2015-01-01

    Although cannabis use is common in bipolar disorder and may contribute to worse clinical outcomes, little is understood about the relationship between this drug and bipolar disorder over the course of daily life. The aim of study was to examine the effect of cannabis on affect and bipolar symptoms in a group of individuals with bipolar disorder. Twenty-four participants with bipolar disorder type I or type II completed diaries for 6 days using Experience Sampling Methodology to investigate the temporal associations between cannabis, affect and bipolar disorder symptoms. The results indicated that higher levels of positive affect increase the odds of using cannabis (OR:1.25 ,CI:1.06-1.47, P=0.008). However, neither negative affect, manic nor depressive symptoms predicted the use of cannabis. Cannabis use was associated with subsequent increases in positive affect (β=0.35, CI:0.20-0.51, P=0.000), manic symptoms (β=0.20,CI:0.05-0.34, P=0.009) and depressive symptoms (β= 0.17,CI:0.04-0.29, P=0.008). The findings indicate that cannabis use is associated with a number of subsequent psychological effects. However there was no evidence that individuals with BD were using cannabis to self-medicate minor fluctuations in negative affect or bipolar disorder symptoms over the course of daily life. The findings in relation to existing literature and clinical implications are discussed.

  7. Antisocial Personality Disorder and Borderline Symptoms are Differentially Related to Impulsivity and Course of Illness in Bipolar Disorder

    Science.gov (United States)

    Swann, Alan C.; Lijffijt, Marijn; Lane, Scott D.; Steinberg, Joel L.; Moeller, F. Gerard

    2012-01-01

    Background Interactions between characteristics of bipolar and Axis II cluster B disorders are clinically and diagnostically challenging. Characteristics associated with personality disorders may be dimensional aspects of bipolar disorder. We investigated relationships among antisocial personality disorder (ASPD) or borderline personality disorder symptoms, impulsivity, and course of illness in bipolar disorder. Methods Subjects with bipolar disorder were recruited from the community. Diagnosis was by Structured Clinical Interview for DSM-IV (SCID-I and –II), psychiatric symptom assessment by the Change version of the Schedule for Affective Disorders and Schizophrenia (SADS-C), severity of axis II symptoms by ASPD and borderline personality disorder SCID-II symptoms, and impulsivity by the Barratt Impulsiveness Scale (BIS-11). Results ASPD and borderline symptoms were not related to clinical state or affective symptoms. Borderline symptoms correlated with BIS-11 impulsivity scores, and predicted history of suicide attempts independently of the relationship to impulsivity. ASPD symptoms were more strongly related to course of illness, including early onset, frequent episodes, and substance-related disorders. These effects persisted after allowance for gender and substance-use disorder history. Conclusions Personality disorder symptoms appear to be dimensional, trait-like characteristics of bipolar disorder. ASPD and Borderline symptoms are differentially related to impulsivity and course of illness. PMID:22835849

  8. Risk Factors of Attempted Suicide in Bipolar Disorder

    Science.gov (United States)

    Cassidy, Frederick

    2011-01-01

    Suicide rates of bipolar patients are among the highest of any psychiatric disorder, and improved identification of risk factors for attempted and completed suicide translates into improved clinical outcome. Factors that may be predictive of suicidality in an exclusively bipolar population are examined. White race, family suicide history, and…

  9. Seasonal changes, sleep length and circadian preference among twins with bipolar disorder

    Directory of Open Access Journals (Sweden)

    Koskenvuo Markku

    2003-06-01

    Full Text Available Abstract Background We aimed at studying the seasonal changes in mood and behaviour, the distribution of hospital admissions by season, and the persistence of the circadian type in twins with bipolar disorder and their healthy co-twins. Methods All Finnish like-sex twins born from 1940 to 1969 were screened for a diagnosis of bipolar type I disorder. The diagnosis was assessed with a structured research interview, and the study subjects (n = 67 filled in the Seasonal Pattern Assessment Questionnaire (SPAQ and the Morningness-Eveningness Questionnaire (MEQ. For studying the persistence of the habitual sleep length and circadian type, we used data derived from the Finnish Twin Cohort Questionnaire (FTCQ. Bipolar twins were compared with their healthy co-twins. Results Bipolar twins had greater seasonal changes in sleep length (p = 0.01 and mood (p = 0.01, and higher global seasonality scores (p = 0.03 as compared with their co-twins with no mental disorder. Sunny days (p = 0.03 had a greater positive effect on wellbeing in the bipolar than healthy co-twins. Conclusions Our results support the view that bipolar disorder is sensitive to the environmental influence in general and to the seasonal effect in specific. Exposure to natural light appears to have a substantial effect on wellbeing in twins with bipolar disorder.

  10. Comorbidity of Bipolar Disorder and Multiple Sclerosis: A Case Report

    Directory of Open Access Journals (Sweden)

    Necla Keskin

    2013-08-01

    Full Text Available Multiple sclerosis is a chronic demyelinating disease of a central nervous system. Neuropsychiatric symptoms are common in multiple sclerosis and bipolar disorder is one of the most common psychiatric disorders that coexist with multiple sclerosis. Manic episodes may be the first presenting symptom of multiple sclerosis as comorbid pathology or as an adverse effect of pharmacotherapies used in multiple sclerosis. The comorbidity of bipolar disorder and multiple sclerosis is well-proven but its etiology is not known and investigated accurately. Recent studies support a common genetic susceptibility. Management of bipolar disorder in multiple sclerosis is based on evidence provided by case reports and treatment should be individualized. In this report, the association between bipolar disorder and multiple sclerosis, epidemiology, ethiology and treatment is discussed through a case had diagnosed as multiple sclerosis and had a manic episode with psychotic features. [Cukurova Med J 2013; 38(4.000: 832-836

  11. Is increased sexual behavior a symptom of bipolar disorder in children and adolescents?

    Science.gov (United States)

    Adelson, Stewart; Bell, Robinette; Graff, Adam; Goldenberg, David; Haase, Elizabeth; Downey, Jennifer I; Friedman, Richard C

    2013-01-01

    While there is consensus that bipolar disorder exists in children and adolescents, its diagnostic criteria are debated. Excessive sexual behavior has been reported in youth who may have juvenile bipolar disorder (JBD), and has been termed "hypersexuality." Although there is no universal definition of this term, this observation has led to a hypothesis that increased sexual behavior characterizes the bipolar syndrome in children and adolescents, and differentiates it from attention deficit hyperactivity disorder. Although this hypothesis is plausible, evidence for it is incomplete, because testing it definitively would require both establishing a standard definition of hypersexuality in children and adolescents, and also reaching consensus about the other nonsexual criteria for pediatric bipolar disorder. In addition, studies to test it would need to control factors other than JBD that are known to increase sexual behavior in children and adolescents. These include sexual abuse and related posttraumatic stress disorder, excessive exposure to sexual stimuli, psychiatric illness in general, and social variables such as family chaos and social stress. Some of these factors might increase sexual behavior in youth with bipolar disorder through psychodynamic mechanisms rather than as a result of the illness itself. Therefore, further research is needed to determine whether increased sexual behavior can serve as a diagnostically valuable criterion for bipolar disorder in children and adolescents, and whether it differentiates the disorder from other conditions known to be associated with increased sexual behavior in youth.

  12. Implicit motives and cognitive variables: specific links to vulnerability for unipolar or bipolar disorder.

    Science.gov (United States)

    Fuhr, Kristina; Hautzinger, Martin; Meyer, Thomas Daniel

    2014-01-30

    Cognitive variables contribute to the etiology of affective disorders. With the differentiation between explicit and implicit measures some studies have indicated underlying depressogenic schemata even in bipolar disorders. We tested for differences in implicit motives and cognitive variables between patients with remitted unipolar and bipolar disorder compared to controls and in a high-risk sample. Additionally we investigated whether affective symptoms relate to those variables. We cross-sectionally examined N=164 participants (53 with bipolar disorder, 58 with major depression, and 53 without affective disorders) and a high-risk sample (N=49) of adolescent children of either parents with unipolar or bipolar disorder or of healthy parents. The Multi-Motive-Grid was used to measure the implicit motives achievement, affiliation, and power, in addition to the cognitive measures of self-esteem, dysfunctional attitudes, and perfectionism. Unipolar and bipolar groups did not differ from healthy controls in implicit motives but showed higher scores in the cognitive factors. Adolescents at high risk for unipolar disorder showed lower scores in the power and achievement motives compared to adolescents at low risk. Subsyndromal depressive symptoms were related to the cognitive variables in both samples. Our results underline the importance of cognitive-behavioral treatment for both unipolar and bipolar disorder. © 2013 Published by Elsevier Ireland Ltd.

  13. Rethinking emotion: cognitive reappraisal is an effective positive and negative emotion regulation strategy in bipolar disorder.

    Science.gov (United States)

    Gruber, June; Hay, Aleena C; Gross, James J

    2014-04-01

    Bipolar disorder involves difficulties with emotion regulation, yet the precise nature of these emotion regulatory difficulties is unclear. The current study examined whether individuals with remitted bipolar I disorder (n = 23) and healthy controls (n = 23) differ in their ability to use one effective and common form of emotion regulation, cognitive reappraisal. Positive, negative, and neutral films were used to elicit emotion, and participants were cued to watch the film carefully (i.e., uninstructed condition) or reappraise while measures of affect, behavior, and psychophysiology were obtained. Results showed that reappraisal was associated with reductions in emotion reactivity across subjective (i.e., positive and negative affect), behavioral (i.e., positive facial displays), and physiological (i.e., skin conductance) response domains across all participants. Results suggest that reappraisal may be an effective regulation strategy for both negative and positive emotion across both healthy adults and individuals with bipolar disorder. Discussion focuses on clinical and treatment implications for bipolar disorder.

  14. International multi-site survey on the use of online support groups in bipolar disorder

    DEFF Research Database (Denmark)

    Bauer, Rita; Conell, Jörn; Glenn, Tasha

    2017-01-01

    BACKGROUND: Peer support is an established component of recovery from bipolar disorder, and online support groups may offer opportunities to expand the use of peer support at the patient's convenience. Prior research in bipolar disorder has reported value from online support groups. AIMS......: To understand the use of online support groups by patients with bipolar disorder as part of a larger project about information seeking. METHODS: The results are based on a one-time, paper-based anonymous survey about information seeking by patients with bipolar disorder, which was translated into 12 languages....... The survey was completed between March 2014 and January 2016 and included questions on the use of online support groups. All patients were diagnosed by a psychiatrist. Analysis included descriptive statistics and general estimating equations to account for correlated data. RESULTS AND CONCLUSIONS: The survey...

  15. Coping and personality in older patients with bipolar disorder.

    Science.gov (United States)

    Schouws, Sigfried N T M; Paans, Nadine P G; Comijs, Hannie C; Dols, Annemiek; Stek, Max L

    2015-09-15

    Little is known about coping styles and personality traits in older bipolar patients. Adult bipolar patients show a passive coping style and higher neuroticism scores compared to the general population. Our aim is to investigate personality traits and coping in older bipolar patients and the relationship between coping and personality. 75 Older patients (age > 60) with bipolar I or II disorder in a euthymic mood completed the Utrecht Coping List and the NEO Personality Inventory FFI and were compared to normative data. Older bipolar patients show more passive coping styles compared to healthy elderly. Their personality traits are predominated by openness, in contrast conscientiousness and altruism are relatively sparse. Neuroticism was related to passive coping styles, whereas conscientiousness was related to an active coping style. Older bipolar patients have more passive coping styles. Their personality is characterized by openness and relatively low conscientiousness and altruism. Our sample represents a survival cohort; this may explain the differences in personality traits between older patients in this study and in adult bipolar patients in other studies. The association between coping styles and personality traits is comparable to reports of younger adult patients with bipolar disorder. Longitudinal studies are warranted to explore if coping and personality change with ageing in bipolar patients and to determine which coping style is most effective in preventing mood episodes. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. The Reciprocal Relationship between Bipolar Disorder and Social Interaction: A Qualitative Investigation.

    Science.gov (United States)

    Owen, Rebecca; Gooding, Patricia; Dempsey, Robert; Jones, Steven

    2017-07-01

    Evidence suggests that social support can influence relapse rates, functioning and various clinical outcomes in people with bipolar disorder. Yet 'social support' is a poorly defined construct, and the mechanisms by which it affects illness course in bipolar disorder remain largely unknown. Key aims of this study were to ascertain which facets of social interaction affect mood management in bipolar disorder, and how symptoms of bipolar disorder can influence the level of support received. Semi-structured qualitative interviews were conducted with 20 individuals with bipolar disorder. Questions were designed to elicit: the effects of social interaction upon the management and course of bipolar disorder; and the impact of bipolar disorder upon social relationships. An inductive thematic analysis was used to analyse the data. Empathy and understanding from another person can make it easier to cope with bipolar disorder. Social interaction can also provide opportunities to challenge negative ruminative thoughts and prevent the onset of a major mood episode. The loss of social support, particularly through bereavement, creates a loss of control and can trigger mania or depression. Hypomanic symptoms can facilitate new social connections, whereas disinhibited and risky behaviour exhibited during mania can cause the breakdown of vital relationships. An in-depth clinical formulation of an individual's perceptions of how their illness affects and is affected by social interaction is crucial to understanding psychosocial factors which influence mood management. These results have clear application in interventions which aim to promote improved wellbeing and social functioning in bipolar disorder. Copyright © 2016 John Wiley & Sons, Ltd. The relationship between bipolar-related experiences and social interaction is complex and multi-faceted. Bipolar disorder can damage social relationships and create a loss of social control via extreme mood states, but it can also offer a

  17. Aberrant cerebellar connectivity in bipolar disorder with psychosis.

    Science.gov (United States)

    Shinn, Ann K; Roh, Youkyung S; Ravichandran, Caitlin T; Baker, Justin T; Öngür, Dost; Cohen, Bruce M

    2017-07-01

    The cerebellum, which modulates affect and cognition in addition to motor functions, may contribute substantially to the pathophysiology of mood and psychotic disorders, such as bipolar disorder. A growing literature points to cerebellar abnormalities in bipolar disorder. However, no studies have investigated the topographic representations of resting state cerebellar networks in bipolar disorder, specifically their functional connectivity to cerebral cortical networks. Using a well-defined cerebral cortical parcellation scheme as functional connectivity seeds, we compared ten cerebellar resting state networks in 49 patients with bipolar disorder and a lifetime history of psychotic features and 55 healthy control participants matched for age, sex, and image signal-to-noise ratio. Patients with psychotic bipolar disorder showed reduced cerebro-cerebellar functional connectivity in somatomotor A, ventral attention, salience, and frontoparietal control A and B networks relative to healthy control participants. These findings were not significantly correlated with current symptoms. Patients with psychotic bipolar disorder showed evidence of cerebro-cerebellar dysconnectivity in selective networks. These disease-related changes were substantial and not explained by medication exposure or substance use. Therefore, they may be mechanistically relevant to the underlying susceptibility to mood dysregulation and psychosis. Cerebellar mechanisms deserve further exploration in psychiatric conditions, and this study's findings may have value in guiding future studies on pathophysiology and treatment of mood and psychotic disorders, in particular.

  18. Identifying early indicators in bipolar disorder: a qualitative study.

    Science.gov (United States)

    Benti, Liliane; Manicavasagar, Vijaya; Proudfoot, Judy; Parker, Gordon

    2014-06-01

    The identification of early markers has become a focus for early intervention in bipolar disorder. Using a retrospective, qualitative methodology, the present study compares the early experiences of participants with bipolar disorder to those with unipolar depression up until their first diagnosed episode. The study focuses on differences in early home and school environments as well as putative differences in personality characteristics between the two groups. Finally we a compare and contrast prodromal symptoms in these two populations. Thirty-nine participants, 20 diagnosed with unipolar depression and 19 diagnosed with bipolar disorder, took part in the study. A semi-structured interview was developed to elicit information about participants' experiences prior to their first episode. Participants with bipolar disorder reported disruptive home environments, driven personality features, greater emotion dysregulation and adverse experiences during the school years, whereas participants with depression tended to describe more supportive home environments, and more compliant and introvert personality traits. Retrospective data collection and no corroborative evidence from other family members. No distinction was made between bipolar I and bipolar II disorder nor between melancholic and non-melancholic depression in the sample. Finally the study spanned over a 12-month period which does not allow for the possibility of diagnostic reassignment of some of the bipolar participants to the unipolar condition. These findings indicate that there may be benefits in combining both proximal and distal indicators in identifying a bipolar disorder phenotype which, in turn, may be relevant to the development of early intervention programs for young people with bipolar disorder.

  19. Risperidone treatment for ADHD in children and adolescents with bipolar disorder

    Directory of Open Access Journals (Sweden)

    Joseph Biederman

    2008-03-01

    Full Text Available Joseph Biederman, Paul Hammerness, Robert Doyle, Gagan Joshi, Megan Aleardi, Eric MickPediatric Psychopharmacology Research Department, Massachusetts General Hospital, Boston, MA, USAObjective: Children and adolescents with bipolar disorder are also at high risk of having comorbid attention-deficit hyperactivity disorder (ADHD. The objective of this study was to estimate improvement in ADHD symptoms in children with bipolar disorder.Methods: This was an open-label, study of risperidone monotherapy for the treatment of pediatric bipolar disorder. Thirty-one children and adolescents 4–15 years of age (7.2 ± 2.8 years of both sexes (71%, N = 22 male with pediatric bipolar disorder (YMRS score = 32.9 ± 8.8 and ADHD (ADHD-RS score = 37.9 ± 8.9 were included in these analyses.Results: Improvement in ADHD symptoms was contingent on improvement in manic symptoms. Although both hyperactive/impulsive (−7.5 ± 5.5.6, p < 0.05 and inattentive (−6.8 ± 5.0, p < 0.05 ADHD symptoms were significantly improved with risperidone, improvement was modest, and only 29% of subjects (N = 6 showed a 30% reduction in ADHD rating scale scores and had a CGI-I ≤ 2.Conclusions: These results suggest that that treatment with risperidone is associated with tangible but generally modest improvement of symptoms of ADHD in children with bipolar disorder.Keywords: ADHD, bipolar disorder, children, risperidone

  20. Bipolar disorder and dementia: where is the link?

    Science.gov (United States)

    Masouy, Anaïs; Chopard, Gilles; Vandel, Pierre; Magnin, Eloi; Rumbach, Lucien; Sechter, Daniel; Haffen, Emmanuel

    2011-03-01

    Cognitive disorders appearing in the course of bipolar disease have been identified, and recent studies have defined the neuropsychological characteristics of this pathology, which includes attention, executive function, memory and language disorders. However, questions remain concerning the appearance of dementia symptoms over the course of bipolar disorder in certain patients: is it a chance association or is there a connection between bipolar disorders and dementia? If the latter hypothesis is considered, what is the nature of the dementia, which might be considered as a dementia specific to bipolar disorder? Current clinical, neuropsychological and cerebral imaging data are inconclusive, but similarities with frontotemporal dementia might be highlighted. Functional imaging studies might provide answers as well as more specific tests in neuropsychology. The cause of cognitive damage in bipolar disease also raises questions concerning a neurodevelopmental or neurodegenerative process, because several factors seem to influence cognition and these two processes might occur simultaneously. Long-term studies are necessary to determine whether cognitive deterioration in bipolar disease is stable or progressive. There might also be different neurobiological subgroups of patients with bipolar disease. © 2011 The Authors. Psychogeriatrics © 2011 Japanese Psychogeriatric Society.

  1. Using Smartphones to Monitor Bipolar Disorder Symptoms: A Pilot Study.

    Science.gov (United States)

    Beiwinkel, Till; Kindermann, Sally; Maier, Andreas; Kerl, Christopher; Moock, Jörn; Barbian, Guido; Rössler, Wulf

    2016-01-06

    Relapse prevention in bipolar disorder can be improved by monitoring symptoms in patients' daily life. Smartphone apps are easy-to-use, low-cost tools that can be used to assess this information. To date, few studies have examined the usefulness of smartphone data for monitoring symptoms in bipolar disorder. We present results from a pilot test of a smartphone-based monitoring system, Social Information Monitoring for Patients with Bipolar Affective Disorder (SIMBA), that tracked daily mood, physical activity, and social communication in 13 patients. The objective of this study was to investigate whether smartphone measurements predicted clinical symptoms levels and clinical symptom change. The hypotheses that smartphone measurements are (1) negatively related to clinical depressive symptoms and (2) positively related to clinical manic symptoms were tested. Clinical rating scales were administered to assess clinical depressive and manic symptoms. Patients used a smartphone with the monitoring app for up to 12 months. Random-coefficient multilevel models were computed to analyze the relationship between smartphone data and externally rated manic and depressive symptoms. Overall clinical symptom levels and clinical symptom changes were predicted by separating between-patient and within-patient effects. Using established clinical thresholds from the literature, marginal effect plots displayed clinical relevance of smartphone data. Overall symptom levels and change in clinical symptoms were related to smartphone measures. Higher overall levels of clinical depressive symptoms were predicted by lower self-reported mood measured by the smartphone (beta=-.56, Psmartphone (ie, cell tower movements: beta=-.11, P=.03). Higher overall levels of clinical manic symptoms were predicted by lower physical activity on the smartphone (ie, distance travelled: beta=-.37, Psmartphone (beta=-.17, Psmartphone measurements, but not all smartphone measures predicted the occurrence of

  2. Progression along the Bipolar Spectrum: A Longitudinal Study of Predictors of Conversion from Bipolar Spectrum Conditions to Bipolar I and II Disorders

    Science.gov (United States)

    Alloy, Lauren B.; Urošević, Snežana; Abramson, Lyn Y.; Jager-Hyman, Shari; Nusslock, Robin; Whitehouse, Wayne G.; Hogan, Michael

    2011-01-01

    Little longitudinal research has examined progression to more severe bipolar disorders in individuals with “soft” bipolar spectrum conditions. We examine rates and predictors of progression to bipolar I and II diagnoses in a non-patient sample of college-age participants (n = 201) with high General Behavior Inventory scores and childhood or adolescent onset of “soft” bipolar spectrum disorders followed longitudinally for 4.5 years from the Longitudinal Investigation of Bipolar Spectrum (LIBS) project. Of 57 individuals with initial cyclothymia or bipolar disorder not otherwise specified (BiNOS) diagnoses, 42.1% progressed to a bipolar II diagnosis and 10.5% progressed to a bipolar I diagnosis. Of 144 individuals with initial bipolar II diagnoses, 17.4% progressed to a bipolar I diagnosis. Consistent with hypotheses derived from the clinical literature and the Behavioral Approach System (BAS) model of bipolar disorder, and controlling for relevant variables (length of follow-up, initial depressive and hypomanic symptoms, treatment-seeking, and family history), high BAS sensitivity (especially BAS Fun Seeking) predicted a greater likelihood of progression to bipolar II disorder, whereas early age of onset and high impulsivity predicted a greater likelihood of progression to bipolar I (high BAS sensitivity and Fun-Seeking also predicted progression to bipolar I when family history was not controlled). The interaction of high BAS and high Behavioral Inhibition System (BIS) sensitivities also predicted greater likelihood of progression to bipolar I. We discuss implications of the findings for the bipolar spectrum concept, the BAS model of bipolar disorder, and early intervention efforts. PMID:21668080

  3. Toward a complex system understanding of bipolar disorder: A chaotic model of abnormal circadian activity rhythms in euthymic bipolar disorder.

    Science.gov (United States)

    Hadaeghi, Fatemeh; Hashemi Golpayegani, Mohammad Reza; Jafari, Sajad; Murray, Greg

    2016-08-01

    In the absence of a comprehensive neural model to explain the underlying mechanisms of disturbed circadian function in bipolar disorder, mathematical modeling is a helpful tool. Here, circadian activity as a response to exogenous daily cycles is proposed to be the product of interactions between neuronal networks in cortical (cognitive processing) and subcortical (pacemaker) areas of the brain. To investigate the dynamical aspects of the link between disturbed circadian activity rhythms and abnormalities of neurotransmitter functioning in frontal areas of the brain, we developed a novel mathematical model of a chaotic system which represents fluctuations in circadian activity in bipolar disorder as changes in the model's parameters. A novel map-based chaotic system was developed to capture disturbances in circadian activity across the two extreme mood states of bipolar disorder. The model uses chaos theory to characterize interplay between neurotransmitter functions and rhythm generation; it aims to illuminate key activity phenomenology in bipolar disorder, including prolonged sleep intervals, decreased total activity and attenuated amplitude of the diurnal activity rhythm. To test our new cortical-circadian mathematical model of bipolar disorder, we utilized previously collected locomotor activity data recorded from normal subjects and bipolar patients by wrist-worn actigraphs. All control parameters in the proposed model have an important role in replicating the different aspects of circadian activity rhythm generation in the brain. The model can successfully replicate deviations in sleep/wake time intervals corresponding to manic and depressive episodes of bipolar disorder, in which one of the excitatory or inhibitory pathways is abnormally dominant. Although neuroimaging research has strongly implicated a reciprocal interaction between cortical and subcortical regions as pathogenic in bipolar disorder, this is the first model to mathematically represent this

  4. Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis

    DEFF Research Database (Denmark)

    Starzer, Marie Stefanie Kejser; Nordentoft, Merete; Hjorthøj, Carsten

    2017-01-01

    OBJECTIVE: The authors investigated the rates of conversion to schizophrenia and bipolar disorder after a substance-induced psychosis, as well as risk factors for conversion. METHOD: All patient information was extracted from the Danish Civil Registration System and the Psychiatric Central Research...... to obtain cumulative probabilities for the conversion from a substance-induced psychosis to schizophrenia or bipolar disorder. Cox proportional hazards regression models were used to calculate hazard ratios for all covariates. RESULTS: Overall, 32.2% (95% CI=29.7-34.9) of patients with a substance......-induced psychosis converted to either bipolar or schizophrenia-spectrum disorders. The highest conversion rate was found for cannabis-induced psychosis, with 47.4% (95% CI=42.7-52.3) converting to either schizophrenia or bipolar disorder. Young age was associated with a higher risk of converting to schizophrenia...

  5. Late onset bipolar disorder and frontotemporal dementia with mutation in progranulin gene: a case report.

    Science.gov (United States)

    Rubino, Elisa; Vacca, Alessandro; Gallone, Salvatore; Govone, Flora; Zucca, Milena; Gai, Annalisa; Ferrero, Patrizia; Fenoglio, Pierpaola; Giordana, Maria Teresa; Rainero, Innocenzo

    2017-11-01

    Bipolar disorder is a chronic psychiatric illness characterised by fluctuation in mood state, with a relapsing and remitting course. Frontotemporal dementia (FTD) is a clinically and genetically heterogeneous syndrome, with the most frequent phenotype being behavioural variant frontotemporal dementia (bvFTD). Here, we report the case of an Italian male presenting with late-onset bipolar disorder that developed into bvFTD over time, carrying a mutation in the GRN gene. Interestingly, the patient carried the c.1639 C > T variant in the GRN gene, resulting in a R547C substitution. Our case report further corroborates the notion that, in addition to FTD, progranulin may be involved in the neurobiology of bipolar disorder type 1, and suggests to screen patients with late-onset bipolar disorder for GRN mutations.

  6. As bases neurobiológicas do transtorno bipolar Neurobiological basis of bipolar disorder

    Directory of Open Access Journals (Sweden)

    Rodrigo Machado-Vieira

    2005-01-01

    the biology of bipolarity. The authors emphasize that bipolar disorder has been shown to be directly associated with dysfunctions on neural adaptative mechanisms, promoting neural stress. The resulted stress, even that do not lead to cell death, may limit the neuroplasticity and neurotrophism in neurons and glia, which in turn may facilitate the arousal of this pervasive illness.

  7. Methodological recommendations for cognition trials in bipolar disorder by the International Society for Bipolar Disorders Targeting Cognition Task Force

    DEFF Research Database (Denmark)

    Miskowiak, K W; Burdick, K E; Martinez-Aran, A

    2017-01-01

    OBJECTIVES: To aid the development of treatment for cognitive impairment in bipolar disorder, the International Society for Bipolar Disorders (ISBD) convened a task force to create a consensus-based guidance paper for the methodology and design of cognition trials in bipolar disorder. METHODS...... of treatments to illness stage and using a multimodal approach. CONCLUSIONS: This ISBD task force guidance paper provides the first consensus-based recommendations for cognition trials in bipolar disorder. Adherence to these recommendations will likely improve the sensitivity in detecting treatment efficacy...... or partly remitted patients. It is strongly encouraged that trials exclude patients with current substance or alcohol use disorders, neurological disease or unstable medical illness, and keep non-study medications stable. Additional methodological considerations include neuroimaging assessments, targeting...

  8. Personality traits in bipolar disorder and influence on outcome.

    Science.gov (United States)

    Sparding, Timea; Pålsson, Erik; Joas, Erik; Hansen, Stefan; Landén, Mikael

    2017-05-03

    The aim was to investigate the personality profile of bipolar disorder I and II, and healthy controls, and to study whether personality influences the course of bipolar disorder. One hundred ten patients with bipolar disorder I, 85 patients with bipolar disorder II, and 86 healthy individuals had their personality profile assessed using the Swedish universities Scales of Personality (SSP), an instrument developed to explore personality-related vulnerabilities and correlates of psychiatric disorders. Patients were followed prospectively for 2 years. To assess the impact of Neuroticism, Aggressiveness, and Disinhibition on illness course, we performed logistic regressions with the outcome variables mood episodes (depressive, hypo/manic, mixed), suicide attempts, violence, and the number of sick leave days. Bipolar disorder I and II demonstrated higher global measures of Neuroticism, Aggressiveness, and Disinhibition as compared with healthy controls. A third of the patients scored ≥1 SD above the population-based normative mean on the global neuroticism measure. The two subtypes of bipolar disorder were, however, undistinguishable on all of the personality traits. In the unadjusted model, higher neuroticism at baseline predicted future depressive episodes and suicide attempts/violent behavior, but this association disappeared when adjusting for baseline depressive symptoms as assessed with MADRS. A significant minority of the patients scored ≥1 SD above the population mean on the global measures of Neuroticism, Aggressiveness and Disinhibition; scores this high are usually evident clinically. Yet, the personality profile does not seem to have prognostic value over a 2-year period.

  9. Positive aspects of mental illness: a review in bipolar disorder.

    Science.gov (United States)

    Galvez, Juan Francisco; Thommi, Sairah; Ghaemi, S Nassir

    2011-02-01

    There is growing interest to understand the role of positive psychological features on the outcomes of medical illnesses. Unfortunately this topic is less studied in relation to mental health, and almost completely neglected in relation to one of the most common severe psychiatric illnesses, bipolar disorder. Certain specific psychological characteristics, that are generally viewed as valuable and beneficial morally or socially, may grow out of the experience of having this affective disorder. We describe the sources, research and impact of these positive psychological traits in the lives of persons with bipolar disorder based on the few published literature available to date. These include, but are not limited to: spirituality, empathy, creativity, realism, and resilience. After an extensive search in the literature, we found 81 articles that involve descriptions of positive psychological characteristics of bipolar disorder. We found evidence for enhancement of the five above positive psychological traits in persons with bipolar disorder. Bipolar disorder is associated with the positive psychological traits of spirituality, empathy, creativity, realism, and resilience. Clinical and research attention to preserving and enhancing these traits may improve outcomes in bipolar disorder. © 2010 Elsevier B.V. All rights reserved.

  10. Discrete neurocognitive subgroups in fully or partially remitted bipolar disorder

    DEFF Research Database (Denmark)

    Jensen, Johan Høy; Knorr, Ulla; Vinberg, Maj

    2016-01-01

    controls. Hierarchical cluster analysis was conducted to determine whether there are discrete neurocognitive subgroups in bipolar disorder. The pattern of the cognitive deficits and the characteristics of patients in these neurocognitive subgroups were examined with analyses of covariance and least......BACKGROUND: Neurocognitive impairment in remitted patients with bipolar disorder contributes to functional disabilities. However, the pattern and impact of these deficits are unclear. METHODS: We pooled data from 193 fully or partially remitted patients with bipolar disorder and 110 healthy...... was cross-sectional which limits inferences regarding the causality of the findings. CONCLUSION: Globally and selectively impaired bipolar disorder patients displayed more functional disabilities than those who were cognitively intact. The present findings highlight a clinical need to systematically screen...

  11. Combinations of SNPs Related to Signal Transduction in Bipolar Disorder

    DEFF Research Database (Denmark)

    Koefoed, Pernille; Andreassen, Ole A; Bennike, Bente

    2011-01-01

    of complex diseases, it may be useful to look at combinations of genotypes. Genes related to signal transmission, e.g., ion channel genes, may be of interest in this respect in the context of bipolar disorder. In the present study, we analysed 803 SNPs in 55 genes related to aspects of signal transmission...... and calculated all combinations of three genotypes from the 3×803 SNP genotypes for 1355 controls and 607 patients with bipolar disorder. Four clusters of patient-specific combinations were identified. Permutation tests indicated that some of these combinations might be related to bipolar disorder. The WTCCC...... in the clusters in the two datasets. The present analyses of the combinations of SNP genotypes support a role for both genetic heterogeneity and interactions in the genetic architecture of bipolar disorder....

  12. Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies

    Science.gov (United States)

    Solé, Brisa; Jiménez, Esther; Torrent, Carla; Reinares, Maria; Bonnin, Caterina del Mar; Torres, Imma; Varo, Cristina; Grande, Iria; Valls, Elia; Salagre, Estela; Sanchez-Moreno, Jose; Martinez-Aran, Anabel; Carvalho, André F

    2017-01-01

    Abstract Over the last decade, there has been a growing appreciation of the importance of identifying and treating cognitive impairment associated with bipolar disorder, since it persists in remission periods. Evidence indicates that neurocognitive dysfunction may significantly influence patients’ psychosocial outcomes. An ever-increasing body of research seeks to achieve a better understanding of potential moderators contributing to cognitive impairment in bipolar disorder in order to develop prevention strategies and effective treatments. This review provides an overview of the available data from studies examining treatments for cognitive dysfunction in bipolar disorder as well as potential novel treatments, from both pharmacological and psychological perspectives. All these data encourage the development of further studies to find effective strategies to prevent and treat cognitive impairment associated with bipolar disorder. These efforts may ultimately lead to an improvement of psychosocial functioning in these patients. PMID:28498954

  13. Prospective longitudinal course of aggression among adults with bipolar disorder

    Science.gov (United States)

    Ballester, Javier; Goldstein, Benjamin; Goldstein, Tina R; Yu, Haifeng; Axelson, David; Monk, Kelly; Hickey, Mary Beth; Diler, Rasim S; Sakolsky, Dara J; Sparks, Garrett; Iyengar, Satish; Kupfer, David J; Brent, David A; Birmaher, Boris

    2014-01-01

    Objectives Bipolar disorder (BP) has been associated with increased aggressive behaviors. However, all existing studies are cross-sectional and include forensic or inpatient populations and many do not take into account the effects of comorbid conditions. The goal of this study was to evaluate the longitudinal course of aggression among adult outpatients with BP compared with non-BP patients and healthy controls. Methods Subjects with bipolar I disorder (BP-I)/bipolar II disorder (BP-II) (n = 255), non-BP psychopathology (n = 85), and healthy controls (n = 84) (average 38.9 years, 78.7% female, and 84.9% Caucasian) were evaluated at intake and after two- and four-years of follow-up. Aggression was self-rated using the Aggression Questionnaire (AQ). Comparisons were adjusted for any significant demographic and clinical differences and for multiple comparisons. For subjects with BP, associations of AQ with subtype of BP, current versus past mood episodes, polarity and severity of the current episode, psychosis, and current pharmacological treatment were evaluated. Results In comparison with subjects with non-BP psychiatric disorders and healthy controls, subjects with BP showed persistently higher total and subscale AQ scores (raw and T-scores) during the four-year follow-up. There were no effects of BP subtype, severity or polarity of the current episode, psychosis, and current pharmacological treatments. Subjects in an acute mood episode showed significantly higher AQ scores than euthymic subjects. Conclusions BP, particularly during acute episodes, is associated with increased self-reported verbal and physical aggression, anger, and hostility. These results provide further evidence for the need of treatments to prevent mood recurrences and prompt treatment of acute mood episodes in subjects with BP. PMID:24372913

  14. Detecting allocentric and egocentric navigation deficits in patients with schizophrenia and bipolar disorder using virtual reality.

    Science.gov (United States)

    Mohammadi, Alireza; Hesami, Ehsan; Kargar, Mahmoud; Shams, Jamal

    2018-04-01

    Present evidence suggests that the use of virtual reality has great advantages in evaluating visuospatial navigation and memory for the diagnosis of psychiatric or other neurological disorders. There are a few virtual reality studies on allocentric and egocentric memories in schizophrenia, but studies on both memories in bipolar disorder are lacking. The objective of this study was to compare the performance of allocentric and egocentric memories in patients with schizophrenia and bipolar disorder. For this resolve, an advanced virtual reality navigation task (VRNT) was presented to distinguish the navigational performances of these patients. Twenty subjects with schizophrenia and 20 bipolar disorder patients were compared with 20 healthy-matched controls on the newly developed VRNT consisting of a virtual neighbourhood (allocentric memory) and a virtual maze (egocentric memory). The results demonstrated that schizophrenia patients were significantly impaired on all allocentric, egocentric, visual, and verbal memory tasks compared with patients with bipolar disorder and normal subjects. Dissimilarly, the performance of patients with bipolar disorder was slightly lower than that of control subjects in all these abilities, but no significant differences were observed. It was concluded that allocentric and egocentric navigation deficits are detectable in patients with schizophrenia and bipolar disorder using VRNT, and this task along with RAVLT and ROCFT can be used as a valid clinical tool for distinguishing these patients from normal subjects.

  15. Neuregulin 3 is associated with attention deficits in schizophrenia and bipolar disorder.

    Science.gov (United States)

    Meier, Sandra; Strohmaier, Jana; Breuer, Rene; Mattheisen, Manuel; Degenhardt, Franziska; Mühleisen, Thomas W; Schulze, Thomas G; Nöthen, Markus M; Cichon, Sven; Rietschel, Marcella; Wüst, Stefan

    2013-04-01

    Linkage and fine mapping studies have established that the neuregulin 3 gene (NRG3) is a susceptibility locus for schizophrenia. Association studies of this disorder have implicated NRG3 variants in both psychotic symptoms and attention performance. Psychotic symptoms and cognitive deficits are also frequent features of bipolar disorder. The aims of the present study were to extend analysis of the association between NRG3 and psychotic symptoms and attention in schizophrenia and to determine whether these associations also apply to bipolar disorder. A total of 358 patients with schizophrenia and 111 patients with bipolar disorder were included. Psychotic symptoms were evaluated using the Operational Criteria Checklist for Psychotic Illness (OPCRIT) and attention performance was assessed using the Trail Making Test (TMT). Symptoms and performance scores were then tested for association with the NRG3 variant rs6584400. A significant association was found between the number of rs6584400 minor alleles and the total OPCRIT score for psychotic symptoms in patients with schizophrenia. Moreover, in both schizophrenia and bipolar disorder patients, minor allele carriers of rs6584400 outperformed homozygous major allele carriers in the TMT. The results suggest that rs6584400 is associated with psychotic symptoms and attention performance in schizophrenia. The finding of a significant association between rs6584400 and attention performance in bipolar disorder supports the hypothesis that this NRG3 variant confers genetic susceptibility to cognitive deficits in both schizophrenia and bipolar disorder.

  16. Genetic association between NRG1 and schizophrenia, major depressive disorder, bipolar disorder in Han Chinese population.

    Science.gov (United States)

    Wen, Zujia; Chen, Jianhua; Khan, Raja Amjad Waheed; Song, Zhijian; Wang, Meng; Li, Zhiqiang; Shen, Jiawei; Li, Wenjin; Shi, Yongyong

    2016-04-01

    Schizophrenia, major depressive disorder, and bipolar disorder are three major psychiatric disorders affecting around 0.66%, 3.3%, and 1.5% of the Han Chinese population respectively. Several genetic linkage analyses and genome wide association studies identified NRG1 as a susceptibility gene of schizophrenia, which was validated by its role in neurodevelopment, glutamate, and other neurotransmitter receptor expression regulation. To further investigate whether NRG1 is a shared risk gene for major depressive disorder, bipolar disorder as well as schizophrenia, we performed an association study among 1,248 schizophrenia cases, 1,056 major depression cases, 1,344 bipolar disorder cases, and 1,248 controls. Totally 15 tag SNPs were genotyped and analyzed, and no population stratification was found in our sample set. Among the sites, rs4236710 (corrected Pgenotye  = 0.015) and rs4512342 (Pallele  = 0.03, Pgenotye  = 0.045 after correction) were associated with schizophrenia, and rs2919375 (corrected Pgenotye  = 0.004) was associated with major depressive disorder. The haplotype rs4512342-rs6982890 showed association with schizophrenia (P = 0.03 for haplotype "TC" after correction), and haplotype rs4531002-rs11989919 proved to be a shared risk factor for both major depressive disorder ("CC": corrected P = 0.009) and bipolar disorder ("CT": corrected P = 0.003). Our results confirmed that NRG1 was a shared common susceptibility gene for major mental disorders in Han Chinese population. © 2016 Wiley Periodicals, Inc.

  17. Religiosidade e espiritualidade no transtorno bipolar do humor Religiosity and spirituality in bipolar disorder

    Directory of Open Access Journals (Sweden)

    André Stroppa

    2009-01-01

    articles published between 1957 and 2008. RESULTS: The studies indicate that bipolar patients have a greater religious/spiritual concern and involvement, more reports of conversion, experiences of salvation and a more frequent use of spiritual/religious coping, than people with other mental disorders. It also indicates a frequent and significant relationship between manic symptoms and mystical experiences, and changes in the intensity of faith after the onset of the disorder. The most relevant studies in the literature were distributed by subjects: mystical delusions, religiosity and spirituality, spiritual-religious coping, community resources and traditional communities. CONCLUSION: The number of studies about healthy religious practices, spirituality, and coping among bipolar patients should be expanded, as soon as its relation to accession, compliance with treatment and recurrences of the disease. Greater attention should be given to investigate the relationships between religiosity, religious coping, psychotherapeutic interventions, and based-spiritual psychoeducation.

  18. [Differential diagnosis between borderline personality disorder and bipolar disorder].

    Science.gov (United States)

    Herbst, Luis

    2010-01-01

    The relationship between bipolar disorder and borderline personality disorder remains controversial since in both conditions there are overlapping and similar symptomatic dimensions. Symptomatic dimensions suitable to subserve differential diagnosis are: mood, mood variability mode, and personal and family history. Characteristics of psychotic symptoms may also be useful in the differentiation. On the other hand, anxiety symptoms, neuropsychological profiles, neuro-imaging procedures and biomarkers seem not to contribute to differentiate between both diseases. The presentation of nonsuicidal self mutilation behavior can offer some differences between bipolar and borderline personality disorders, but both can coexist in clinical comorbid forms and do not significantly contribute to the differential diagnosis. Differential diagnosis is complicated by the fact that a low percentage of patients can experience comorbidity of both conditions. In this work we review all these issues, and particularly emphasize the importance of sitematically take into account the patient background, the course that follows his or her disorder, together with the outcome in response to medical decisions.

  19. Borderline personality disorder in transition age youth with bipolar disorder.

    Science.gov (United States)

    Yen, S; Frazier, E; Hower, H; Weinstock, L M; Topor, D R; Hunt, J; Goldstein, T R; Goldstein, B I; Gill, M K; Ryan, N D; Strober, M; Birmaher, B; Keller, M B

    2015-10-01

    To determine the longitudinal impact of borderline personality disorder (BPD) on the course and outcome of bipolar disorder (BP) in a pediatric BP sample. Participants (N = 271) and parents from the Course and Outcome of Bipolar Youth (COBY) study were administered structured clinical interviews and self-reports on average every 8.7 months over a mean of 93 months starting at age 13.0 ± 3.1 years. The structured interview for DSM-IV personality disorders (SIDP-IV) was administered at the first follow-up after age 18 to assess for symptoms of BPD. BPD operationalized at the disorder, factor, and symptom level, was examined as a predictor of poor clinical course of BP using all years of follow-up data. The number of BPD symptoms was significantly associated with poor clinical course of BP, above and beyond BP characteristics. Affective dysregulation was most strongly associated with poor course at the factor level; the individual symptoms most strongly associated with poor course were dissociation/stress-related paranoid ideation, impulsivity, and affective instability. BPD severity adds significantly to the burden of BP illness and is significantly associated with a more chronic and severe course and outcome beyond what can be attributable to BP characteristics. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Bipolar Disorder in Pregnancy: A Review of Pregnancy Outcomes.

    Science.gov (United States)

    Scrandis, Debra A

    2017-11-01

    Women with bipolar disorder may benefit from continuation of their medications during pregnancy, but there may be risks to the fetus associated with some of these medications. This article examines the evidence relating to the effect of bipolar disorder and pharmacologic treatments for bipolar disorder on pregnancy outcomes. MEDLINE, CINAHL, ProQuest Dissertation & Theses, and the Cochrane Database of Systematic Reviews were searched for English-language studies published between 2000 and 2017, excluding case reports and integrative reviews. Twenty articles that met inclusion criteria were included in this review. Women with bipolar disorder have a higher risk for pregnancy complications and congenital abnormalities than do women without bipolar disorder. In addition, illness relapse can occur if psychotropic medications are discontinued. There are limited data to recommend discontinuing lithium, lamotrigine, or carbamazepine during pregnancy. Valproic acid is not recommended during pregnancy due to increased odds of neural tube defects associated with its use. Atypical antipsychotics are used more frequently during pregnancy, with mixed evidence regarding an association between these agents and congenital malformations or preterm birth. The knowledge of benefits and risks of bipolar disorder and its treatment can help women and health care providers make individualized decisions. Prenatal care providers can discuss the evidence about safety of medications used to treat bipolar disorder with women in collaboration with their mental health care providers. In addition, women being treated for bipolar disorder require close monitoring for depressive and manic/hypomanic episodes that impact pregnancy outcomes. © 2017 by the American College of Nurse-Midwives.

  1. Evidence for clinical progression of unipolar and bipolar disorders

    DEFF Research Database (Denmark)

    Kessing, L. V.; Andersen, P. K.

    2017-01-01

    ) the risk of recurrence of episodes, (ii) probability of recovery from episodes, (iii) severity of episodes, (iv) the threshold for developing episodes, and (v) progression of cognitive deficits in unipolar and bipolar disorders. Method: A systematic review comprising an extensive literature search...... severity of episodes, (iv) decreasing threshold for developing episodes, and (v) increasing risk of developing dementia. Conclusion: Although the course of illness is heterogeneous, there is evidence for clinical progression of unipolar and bipolar disorders....

  2. Transtorno afetivo bipolar: um enfoque transcultural Transcultural aspects of bipolar disorder

    Directory of Open Access Journals (Sweden)

    Marsal Sanches

    2004-10-01

    Full Text Available Considerando-se que existem diferenças importantes na maneira como as emoções são vivenciadas e expressas em diferentes culturas, a apresentação e o manejo do transtorno afetivo bipolar sofrem influência de fatores culturais. O presente artigo realiza uma breve revisão da evidência referente aos aspectos transculturais do transtorno bipolar.Cultural variations in the expression of emotions have been described. Consequently, there are cross-cultural influences on the diagnosis and management of bipolar disorder. This article provides a review of the evidence regarding the main aspects of transcultural psychiatry and bipolar disorder.

  3. The seroprevalence of antithyroid peroxidase antibodies in bipolar families and bipolar twins: results from two longitudinal studies.

    Science.gov (United States)

    Snijders, G; de Witte, L; Mesman, E; Kemner, S; Vonk, R; Brouwer, R; Nolen, W A; Drexhage, H A; Hillegers, M H J

    2017-12-01

    Previous studies of our group among bipolar offspring and bipolar twins showed significant higher prevalence's and levels of antithyroid peroxidase antibodies (TPO-Abs) in offspring and co-twins (without a mood disorder) compared to controls, suggesting that TPO-Abs might be considered as vulnerability factor (trait marker) for BD development. Here we elucidate, in the same cohorts, but now after 12- and 6-year follow-up, whether TPO-abs should be considered as a 'trait' marker for BD. The present study aims to investigate whether TPO-Abs (1) are stable over time, (2) are associated with lithium-exposure, (3) share a common genetic background with BD and are related to psychopathology. In bipolar offspring and twins, the prevalence of TPO-Abs is stable over time (r s  = .72 p bipolar offspring (10,4% versus 4%) and higher TPO-abs titers were still present in co-twins of bipolar cases compared to control twins [mean 1.06 IU/ml (SD .82) versus mean .82 IU/ml (SD .67)], although statistical significance was lost. Although our results show a trend toward an increased inherited risk of the co-occurrence of BD and thyroid autoimmunity, large-scale studies can only draw final conclusions. Nationwide epidemiological and GWAS studies reach such numbers and support the view of a possible common (autoimmune) etiology of severe mood disorders and chronic recurrent infections and autoimmunity, including thyroid autoimmunity.

  4. Adverse effects of obesity on cognitive functions in individuals at ultra high risk for bipolar disorder: Results from the global mood and brain science initiative.

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    McIntyre, Roger S; Mansur, Rodrigo B; Lee, Yena; Japiassú, Letícia; Chen, Kun; Lu, Rui; Lu, Weicong; Chen, Xiaodong; Li, Ting; Xu, Guiyun; Lin, Kangguang

    2017-03-01

    The burden of illness associated with bipolar disorder (BD) warrants early pre-emption/prevention. Prediction models limited to psychiatric phenomenology have insufficient predictive power. Herein, we aimed to evaluate whether the presence of overweight/obesity is associated with greater cognitive decline in individuals at high risk (HR) or ultra high risk (UHR) for BD. We conducted a retrospective analysis to investigate the moderational role of body mass index (BMI) on measures of cognitive function. Subjects between the ages of 8 and 28 years with a positive family history of BD were compared to age-matched controls with a negative family history of BD. Subjects with at least one biological parent with bipolar I/II disorder were further stratified into UHR or HR status by the presence or absence, respectively, of subthreshold hypomanic, major depressive, attenuated psychotic, and/or attention-deficit/hyperactivity disorder symptoms. A total of 36 individuals at HR for BD, 33 individuals at UHR for BD, and 48 age-matched controls were included in the analysis. Higher BMI was significantly associated with lower performance on measures of processing speed (i.e. Brief Assessment of Cognition in Schizophrenia-symbol coding: r=-.186, P=.047) and attention/vigilance (i.e. Continuous Performance Test-Identical Pairs: r=-.257, P=.006). There were trends for negative correlations between BMI and measures of working memory (i.e. Wechsler Memory Scale-III Spatial Span: r=-0.177, P=.059) and overall cognitive function (i.e. Measurement and Treatment Research to Improve Cognition in Schizophrenia composite score: r=-.157, P=.097). Negative associations between BMI and cognitive performance were significantly stronger in the UHR group than in the HR group, when compared to controls. Individuals at varying degrees of risk for BD exhibit greater cognitive impairment as a function of co-existing overweight/obesity. Prediction models for BD may be substantively informed by

  5. Early maladaptive schemas in patients with bipolar and unipolar disorder.

    Science.gov (United States)

    Özdin, Selçuk; Sarisoy, Gökhan; Şahin, Ahmet Rıfat; Arik, Ali Cezmi; Özyıldız Güz, Hatice; Böke, Ömer; Karabekiroğlu, Aytül

    2018-06-01

    The aim of our study is to determine the difference between the bipolar disorder, unipolar disorder and control groups in terms of maladaptive schemes and childhood trauma. Two groups of patients under monitoring with a diagnosis of bipolar or unipolar disorder and one group of healthy controls were enrolled in this study. Each group consisted of 60 subjects. The Young Mania Rating Scale and Beck Depression Inventory were used to confirm that patients were in remission. The Childhood Trauma Questionnaire and Young Schema Questionnaire-Short Form 3 were used to identify childhood traumas and early maladaptive schemas. In bipolar disorder, a positive, low power correlation was observed between the vulnerability to threats schema and emotional, physical and sexual abuse. In the unipolar disorder group, there was a positive, low power correlation between the emotional inhibition, failure, approval seeking, dependence, abandonment and defectiveness schemas and social isolation, and a positive, moderate correlation between social isolation and emotional abuse. Individuals with bipolar disorder suffered greater childhood trauma compared to subjects with unipolar disorder and healthy individuals. Greater maladaptive schema activation were present in individuals with bipolar disorder compared to those with unipolar disorder and healthy individuals.

  6. A genome-wide meta-analysis identifies novel loci associated with schizophrenia and bipolar disorder.

    Science.gov (United States)

    Wang, Ke-Sheng; Liu, Xue-Feng; Aragam, Nagesh

    2010-12-01

    Schizophrenia and bipolar disorder both have strong inherited components. Recent studies have indicated that schizophrenia and bipolar disorder may share more than half of their genetic determinants. In this study, we performed a meta-analysis (combined analysis) for genome-wide association data of the Affymetrix Genome-Wide Human SNP array 6.0 to detect genetic variants influencing both schizophrenia and bipolar disorder using European-American samples (653 bipolar cases and 1034 controls, 1172 schizophrenia cases and 1379 controls). The best associated SNP rs11789399 was located at 9q33.1 (p=2.38 × 10(-6), 5.74 × 10(-4), and 5.56 × 10(-9), for schizophrenia, bipolar disorder and meta-analysis of schizophrenia and bipolar disorder, respectively), where one flanking gene, ASTN2 (220kb away) has been associated with attention deficit/hyperactivity disorder and schizophrenia. The next best SNP was rs12201676 located at 6q15 (p=2.67 × 10(-4), 2.12 × 10(-5), 3.88 × 10(-8) for schizophrenia, bipolar disorder and meta-analysis, respectively), near two flanking genes, GABRR1 and GABRR2 (15 and 17kb away, respectively). The third interesting SNP rs802568 was at 7q35 within CNTNAP2 (p=8.92 × 10(-4), 1.38 × 10(-5), and 1.62 × 10(-7) for schizophrenia, bipolar disorder and meta-analysis, respectively). Through meta-analysis, we found two additional associated genes NALCN (the top SNP is rs2044117, p=4.57 × 10(-7)) and NAP5 (the top SNP is rs10496702, p=7.15 × 10(-7)). Haplotype analyses of above five loci further supported the associations with schizophrenia and bipolar disorder. These results provide evidence of common genetic variants influencing schizophrenia and bipolar disorder. These findings will serve as a resource for replication in other populations to elucidate the potential role of these genetic variants in schizophrenia and bipolar disorder. Copyright © 2010 Elsevier B.V. All rights reserved.

  7. Marital adjustment of patients with substance dependence, schizophrenia and bipolar affective disorder

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    Shital S Muke

    2014-01-01

    Full Text Available Background: Marital adjustment is considered as a part of social well-being. Disturbed marital relationship can directly affect the disease adjustment and the way they face disease outcomes and complications. It may adversely affect physical health, mental health, the quality-of-life and even economic status of individuals. Aim: The aim of this study was to compare the marital adjustment among patients with substance dependence, schizophrenia and bipolar affective disorder. Materials and Methods: The sample consisted of each 30 patients with substance dependence, bipolar affective disorder and schizophrenia, diagnosed as per international classification of diseases-10 diagnostic criteria for research with a minimum duration of illness of 1 year were evaluated using marital adjustment questionnaire. The data was analyzed using parametric and non-parametric statistics. Results: Prevalence of poor marital adjustment in patients with schizophrenia, bipolar affective disorder and substance dependence was 60%, 70% and 50% respectively. There was a significant difference on overall marital adjustment among substance dependence and bipolar affective disorder patients. There was no significant difference on overall marital adjustment among patients with substance dependence and schizophrenia as well as among patients with schizophrenia and bipolar affective disorder. On marital adjustment domains, schizophrenia patients had significantly poor sexual adjustment than substance dependence patients while bipolar affective disorder patients had significantly poor sexual and social adjustment compared with substance dependence patients. Conclusion: Patients with substance dependence have significant better overall marital adjustment compared with bipolar affective disorder patients. Patients with substance dependence have significantly better social and sexual adjustment than patients with bipolar affective disorder as well as significantly better sexual

  8. Relationship between structural abnormalities in the cerebellum and dementia, posttraumatic stress disorder and bipolar disorder

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    Leonardo Baldaçara

    Full Text Available ABSTRACT. New evidence suggests that the cerebellum has structural and functional abnormalities in psychiatric disorders. Objective: In this research, the goal was to measure the volume of the cerebellum and its subregions in individuals with psychiatric disorders and to relate these findings to their symptoms. Methods: Patients with different degrees of cognitive impairment (Epidemiology of the Elderly - UNIFESP and patients with post-traumatic stress disorder (PTSD from population studies were analyzed. Also, patients with bipolar disorder from an outpatient clinic (Center for the Study of Mood and Anxiety Disorders, Universidade Federal da Bahia were recruited for this study. All subjects underwent a 1.5T structural magnetic resonance scan. Volumetric measures and symptom measurements, by psychometric scales, were performed and compared between patients and controls. Results: The cerebellum volume was reduced in patients with cognitive impairment without dementia and with dementia, in patients with PTSD, and in patients with bipolar disorder compared to controls. In dementia and PTSD, the left cerebellar hemisphere and vermis volume were reduced. In bipolar disorder, volumes of both hemispheres and the vermis were reduced. In the first two studies, these cerebellar volumetric reductions correlated with symptoms of the disease. Conclusion: The exact nature of cerebellar involvement in mental processes is still not fully understood. However, abnormalities in cerebellar structure and its functions have been reported in some of these diseases. Future studies with larger samples are needed to clarify these findings and investigate whether they are important for treatment and prognosis.

  9. Pharmacotherapy of bipolar disorder in children and adolescents: an update

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    Tatiana Lauxen Peruzzolo

    2013-12-01

    Full Text Available Objective: To review the options for acute and maintenance pharmacological treatment of bipolar disorder in children and adolescents, including the treatment of bipolar depression and comorbid attention deficit/hyperactivity disorder (ADHD. Methods: Narrative review of randomized clinical trials and open-label studies published from 2000 to 2012. The PubMed and PsycINFO websites were queried. Case series were included when a higher level of evidence was not available. Results: Published data from randomized controlled trials (RCTs in acute mania/hypomania with significant responses are available for lithium, topiramate, risperidone, olanzapine, and aripiprazole. Open trials of lithium and lamotrigine show that these drugs may be effective in the treatment of depressive episodes. No trials of selective serotonin reuptake inhibitors (SSRIs have been conducted. In the treatment of comorbid ADHD, there are encouraging findings with mixed amphetamine salts and atomoxetine; conflicting results are observed with methylphenidate. Conclusions: Published RCTs of traditional mood stabilizers are scarce, but the best available evidence (results from meta-analytic regression suggests that second-generation antipsychotics (SGAs as a group are more effective in reducing manic symptoms. Risperidone was the only one included in head-to-head comparisons (vs. lithium and divalproex, showing superiority in terms of efficacy, but with more metabolic side effects, which were also more common in most of the SGAs. There are few studies addressing the treatment of ADHD and depression. Brazilian guidelines for the treatment of pediatric bipolar disorder should also include some SGAs (especially risperidone and aripiprazole as first-line treatment, and these drugs should be provided by the public health services.

  10. Comparing Mental Health of School-Age Children of Parents With/Without Bipolar Disorders: A Case Control Study

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    Shamsaei

    2015-05-01

    Full Text Available Background Children of parents with bipolar disorder appear to have an increased risk of early-onset Bipolar Disorder (BP, mood disorders and other psychiatric disorders. Objectives The aim of this study was to compare the mental health of school-age children of parents, with/without bipolar disorder. Materials and Methods This case-control study included one hundred children aged six to twelve years, who had parents with bipolar disorder and 200 children of 163 demographically-matched control parents. Parents with bipolar disorder were recruited from Farshchian Psychiatric Hospital of Hamadan, Iran, during year 2014. The parent version of the Child Symptom Inventory-4 questionnaire was used to measure mental health. Mean comparisons were performed using Student’s t test while effect sizes were estimated by Cohen’s d coefficient. The Chi-square test was used to assess significant differences between frequency distribution of demographic variables in both groups. The significance level was considered less than 0.05. Results There were statistically significant differences between children of parents with and those without bipolar disorder regarding attention deficit hyperactivity disorder, oppositional defiant disorder, conduct, generalized anxiety disorder, schizophrenia, major depression, separation anxiety (P< 0.001 and social phobia (P < 0.05. Children of parents with BP are at high risk for psychiatric disorders. Conclusions These findings support that the careful evaluation and prospective following of the psychopathology of children of parents with bipolar disorder are critical for early identification and treatment.

  11. Comparison of metabolic syndrome prevalence in patients with schizophrenia and bipolar I disorder.

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    Nayerifard, Razieh; Bureng, Majid Akbari; Zahiroddin, Alireza; Namjoo, Massood; Rajezi, Sepideh

    2017-11-01

    Research has shown that the metabolic syndrome is more prevalent among patients with schizophrenia or bipolar I disorder. Given the scarcity of research on the disorders, this paper aims to compare the prevalence of the syndrome among the two groups of patients. A total of 120 individuals participated in this cross sectional study: 60 patients with schizophrenia (26 males and 34 females) and 60 patients with bipolar I disorder (32 males and 28 females). The psychological disorders were diagnosed by some experienced psychiatrists according to the DSM-V. Furthermore, metabolic syndrome was diagnosed according to ATP III guidelines. Metabolic syndrome prevalence among schizophrenic and bipolar I patients was 28 and 36 percent, respectively; the disparity in prevalence is not significant. According to the results, compared to their male counterparts, females were more prone significant to metabolic syndrome. Moreover, diastolic blood pressure was significantly higher among bipolar I patients. On the other hand, schizophrenic males were observed to have higher fasting blood sugar levels in comparison to bipolar I males patients. Age, consumption of second generation antipsychotics or antidepressants, and the duration of the disorder were found to be related to metabolic syndrome. This study showed that metabolic syndrome is not more prevalent among bipolar I patients, compared to those with schizophrenia. Also, women are more likely to be affected by the syndrome. A number of factors such as age, consumption of medication, and duration of the disorder are associated with the likelihood of the syndrome. Copyright © 2017. Published by Elsevier Ltd.

  12. Differential brain network activity across mood states in bipolar disorder.

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    Brady, Roscoe O; Tandon, Neeraj; Masters, Grace A; Margolis, Allison; Cohen, Bruce M; Keshavan, Matcheri; Öngür, Dost

    2017-01-01

    This study aimed to identify how the activity of large-scale brain networks differs between mood states in bipolar disorder. The authors measured spontaneous brain activity in subjects with bipolar disorder in mania and euthymia and compared these states to a healthy comparison population. 23 subjects with bipolar disorder type I in a manic episode, 24 euthymic bipolar I subjects, and 23 matched healthy comparison (HC) subjects underwent resting state fMRI scans. Using an existing parcellation of the whole brain, we measured functional connectivity between brain regions and identified significant differences between groups. In unbiased whole-brain analyses, functional connectivity between parietal, occipital, and frontal nodes within the dorsal attention network (DAN) were significantly greater in mania than euthymia or HC subjects. In the default mode network (DMN), connectivity between dorsal frontal nodes and the rest of the DMN differentiated both mood state and diagnosis. The bipolar groups were separate cohorts rather than subjects imaged longitudinally across mood states. Bipolar mood states are associated with highly significant alterations in connectivity in two large-scale brain networks. These same networks also differentiate bipolar mania and euthymia from a HC population. State related changes in DAN and DMN connectivity suggest a circuit based pathology underlying cognitive dysfunction as well as activity/reactivity in bipolar mania. Altered activities in neural networks may be biomarkers of bipolar disorder diagnosis and mood state that are accessible to neuromodulation and are promising novel targets for scientific investigation and possible clinical intervention. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Bipolar disorder and metabolic syndrome: an international perspective.

    Science.gov (United States)

    McIntyre, Roger S; Danilewitz, Marlon; Liauw, Samantha S; Kemp, David E; Nguyen, Ha T T; Kahn, Linda S; Kucyi, Aaron; Soczynska, Joanna K; Woldeyohannes, Hanna O; Lachowski, Angela; Kim, Byungsu; Nathanson, Jay; Alsuwaidan, Mohammad; Taylor, Valerie H

    2010-11-01

    The ubiquity and hazards posed by abnormal body composition and metabolic parameters in the bipolar population are a priority research and clinical issue. Herein, we summarize and synthesize international studies describing the rate of US National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATP III])- and International Diabetes Federation (IDF)-defined metabolic syndrome and its criterion components in individuals with bipolar disorder. We conducted a PubMed search of all English-language articles published between January 2005 and July 2009 with the following search terms: metabolic syndrome and bipolar disorder, mania and manic-depression. Articles selected for review were based on adequacy of sample size, the use of standardized experimental procedures, validated assessment measures, and overall manuscript quality. The rate of metabolic syndrome in individuals with bipolar disorder is increased relative to the general population. Disparate estimates are reported ranging from comparability to approximately twofold greater than the general population. The increased hazard for metabolic syndrome amongst bipolar individuals is now documented in twelve countries from Europe, Australia, Asia, North and South America. The co-occurrence of metabolic syndrome in the bipolar population is associated with a more complex illness presentation, less favourable response to treatment, and adverse course and outcome. The association between metabolic syndrome and bipolar disorder is mediated/moderated by both iatrogenic and non-iatrogenic factors. The increased hazard for metabolic syndrome in bipolar populations is due to the clustering of traditional (and emerging) risk factors as well as iatrogenic and health systems factors. Extant data support recommendations for prioritizing, surveillance, prevention, diagnosis and management of metabolic syndrome as routine care

  14. Revisiting the wandering womb: Oxytocin in endometriosis and bipolar disorder.

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    Dinsdale, Natalie L; Crespi, Bernard J

    2017-11-01

    Hippocrates attributed women's high emotionality - hysteria - to a 'wandering womb'. Although hysteria diagnoses were abandoned along with the notion that displaced wombs cause emotional disturbance, recent research suggests that elevated levels of oxytocin occur in both bipolar disorder and endometriosis, a gynecological condition involving migration of endometrial tissue beyond the uterus. We propose and evaluate the hypothesis that elevated oxytocinergic system activity jointly contributes to bipolar disorder and endometriosis. First, we provide relevant background on endometriosis and bipolar disorder, and then we examine evidence for comorbidity between these conditions. We next: (1) review oxytocin's associations with personality traits, especially extraversion and openness, and how they overlap with bipolar spectrum traits; (2) describe evidence for higher oxytocinergic activity in both endometriosis and bipolar disorder; (3) examine altered hypothalamic-pituitary-gonadal axis functioning in both conditions; (4) describe data showing that medications that treat one condition can improve symptoms of the other; (5) discuss fitness-related impacts of endometriosis and bipolar disorder; and (6) review a pair of conditions, polycystic ovary syndrome and autism, that show evidence of involving reduced oxytocinergic activity, in direct contrast to endometriosis and bipolar disorder. Considered together, the bipolar spectrum and endometriosis appear to involve dysregulated high extremes of normally adaptive pleiotropy in the female oxytocin system, whereby elevated levels of oxytocinergic activity coordinate outgoing sociality with heightened fertility, apparently characterizing, overall, a faster life history. These findings should prompt a re-examination of how mind-body interactions, and the pleiotropic endocrine systems that underlie them, contribute to health and disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Comparison of Subjective and Objective Sleep Estimations in Patients with Bipolar Disorder and Healthy Control Subjects

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    Philipp S. Ritter

    2016-01-01

    Full Text Available Background. Several studies have described but not formally tested discrepancies between subjective and objective measures of sleep. Study Objectives. To test the hypothesis that patients with bipolar disorder display a systematic bias to underestimate sleep duration and overestimate sleep latency. Methods. Actimetry was used to assess sleep latency and duration in 49 euthymic participants (bipolar = 21; healthy controls = 28 for 5–7 days. Participants simultaneously recorded estimated sleep duration and sleep latency on a daily basis via an online sleep diary. Group differences in the discrepancy between subjective and objective parameters were calculated using t-tests and corrected for multiple comparisons. Results. Patients with bipolar disorder significantly underestimated their sleep duration but did not overestimate their sleep latency compared to healthy controls. Conclusions. Studies utilizing diaries or questionnaires alone in patients with bipolar disorders may systematically underestimate sleep duration compared to healthy controls. The additional use of objective assessment methods such as actimetry is advisable.

  16. Resting state EEG power, intra-hemisphere and inter-hemisphere coherence in bipolar disorder

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    Handayani, Nita; Khotimah, S. N.; Haryanto, F.; Arif, I.; Taruno, Warsito P.

    2017-02-01

    This paper examines the differences of EEG power and coherence between bipolar disorder patients and healthy subjects in the resting state. Observations are focused on the prefrontal cortex area by calculating intra-hemisphere and inter-hemisphere coherence. EEG data acquisition are conducted by using wireless Emotiv Epoc on AF3, AF4, FC5, FC6, F7 and F8 channels. The power spectral analysis shows that in bipolar disoder there is an increase of power in the delta, theta and beta frequencies, and power decrease in the alpha frequency. The coherence test results show that both intra-hemisphere and inter-hemisphere coherence in bipolar disorder patients are lower than healthy subjects. This shows the lack of brain synchronization in bipolar disorder patients.

  17. Valuing happiness is associated with bipolar disorder.

    Science.gov (United States)

    Ford, Brett Q; Mauss, Iris B; Gruber, June

    2015-04-01

    Although people who experience happiness tend to have better psychological health, people who value happiness to an extreme tend to have worse psychological health, including more depression. We propose that the extreme valuing of happiness may be a general risk factor for mood disturbances, both depressive and manic. To test this hypothesis, we examined the relationship between the extreme valuing of happiness and risk for, diagnosis of, and illness course for bipolar disorder (BD). Supporting our hypothesis, the extreme valuing of happiness was associated with a measure of increased risk for developing BD (Studies 1 and 2), increased likelihood of past diagnosis of BD (Studies 2 and 3), and worse prospective illness course in BD (Study 3), even when controlling for current mood symptoms (Studies 1-3). These findings indicate that the extreme valuing of happiness is associated with and even predicts BD. Taken together with previous evidence, these findings suggest that the extreme valuing of happiness is a general risk factor for mood disturbances. More broadly, what emotions people strive to feel may play a critical role in psychological health. (c) 2015 APA, all rights reserved).

  18. Three times more days depressed than manic or hypomanic in both bipolar I and bipolar II disorder

    NARCIS (Netherlands)

    Kupka, Ralph W.; Altshuler, Lori L.; Nolen, Willem A.; Suppes, Trisha; Luckenbaugh, David A.; Leverich, Gabriele S.; Frye, Mark A.; Keck, Paul E.; McElroy, Susan L.; Grunze, Heinz; Post, Robert M.

    Objectives: To assess the proportion of time spent in mania, depression and euthymia in a large cohort of bipolar subjects studied longitudinally, and to investigate depression/mania ratios in patients with bipolar I versus bipolar II disorder. Methods: Clinician-adjusted self-ratings of mood were

  19. Interactions between bipolar disorder and antisocial personality disorder in trait impulsivity and severity of illness.

    Science.gov (United States)

    Swann, A C; Lijffijt, M; Lane, S D; Steinberg, J L; Moeller, F G

    2010-06-01

    We investigated trait impulsivity in bipolar disorder and antisocial personality disorder (ASPD) with respect to severity and course of illness. Subjects included 78 controls, 34 ASPD, 61 bipolar disorder without Axis II disorder, and 24 bipolar disorder with ASPD, by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (SCID-I and -II). Data were analyzed using general linear model and probit analysis. Barratt Impulsiveness Scale (BIS-11) scores were higher in ASPD (effect sizes 0.5-0.8) or bipolar disorder (effect size 1.45) than in controls. Subjects with both had more suicide attempts and previous episodes than bipolar disorder alone, and more substance-use disorders and suicide attempts than ASPD alone. BIS-11 scores were not related to severity of crimes. Impulsivity was higher in bipolar disorder with or without ASPD than in ASPD alone, and higher in ASPD than in controls. Adverse effects of bipolar disorder in ASPD, but not of ASPD in bipolar disorder, were accounted for by increased impulsivity.

  20. Attention Deficit Hyperactivity Disorder Erroneously Diagnosed and Treated as Bipolar Disorder

    Science.gov (United States)

    Atmaca, Murad; Ozler, Sinan; Topuz, Mehtap; Goldstein, Sam

    2009-01-01

    Objective: There is a dearth of literature on patients erroneously diagnosed and treated for bipolar disorder. Method: The authors report a case of an adult with attention deficit hyperactivity disorder erroneously diagnosed and treated for bipolar disorder for 6 years. At that point, methylphenidate was initiated. The patient was judged to be a…

  1. "Is it menopause or bipolar?": a qualitative study of the experience of menopause for women with bipolar disorder.

    Science.gov (United States)

    Perich, Tania; Ussher, Jane; Parton, Chloe

    2017-11-16

    Menopause can be a time of change for women and may be marked by disturbances in mood. For women living with a mental illness, such as bipolar disorder, little is known about how they experience mood changes during menopause. This study aimed to explore how women with bipolar disorder constructed mood changes during menopause and how this impacted on treatment decisions. Semi-structured interviews were undertaken with fifteen women who reported they had been diagnosed with bipolar disorder. Data was analysed using thematic analysis guided by a social constructionist framework. Themes identified included 'Constructions of mood change: menopause or bipolar disorder?',' Life events, bipolar disorder and menopause coming together'; 'Treatment choices for mood change during menopause'. The accounts suggested that women related to the experience of mood changes during menopause through the lens of their existing framework of bipolar disorder, with implications for understanding of self and treatment choices.

  2. TO DETERMINE THE PERSONALITY TRAITS, CLINICAL CHARACTERISTICS AND COGNITIVE FUNCTIONS IN BIPOLAR DISORDER PATIENTS WITH COMORBID ALCOHOL USE DISORDERS

    Directory of Open Access Journals (Sweden)

    Ahalya Thinaharan

    2016-12-01

    Full Text Available BACKGROUND Comorbidity of bipolar disorder and substance use disorder is common. It is difficult to treat bipolar disorder patients with comorbid alcohol use disorder since the disease course is more severe and they have greater difficulties in cognitive functions than those without alcohol use. Whether alcohol negatively affects specific cognitive functions or the deficits are more diffuse in nature is unclear. Alcoholic bipolar patients present with high scores in openness to experience and neuroticism personality traits. Personality to an extent mediates the co-occurrence of substance use in bipolar disorder. Thus, identifying these personality traits in bipolar or substance use disorder patients, will help us to prevent the co-occurrence of the second disorder. The aim of the study is to evaluate the clinical characteristics, personality traits and cognitive functions of patients with bipolar and comorbid alcohol use disorders. MATERIALS AND METHODS A sample of 100 patients, 50 with bipolar and alcohol use disorder (cases and 50 with bipolar disorder (controls attending tertiary care hospital outpatient department at Chennai was selected. Alcohol status was assessed using AUDIT (alcohol use disorder identification test and SADQ (severity of alcohol dependence questionnaire. Personality was assessed using NEO-five factor inventory. Cognition was assessed using frontal lobe assessment battery, Stroop test, DSST (digit symbol substitution test and verbal N back test. RESULTS The cases group had more number of hospitalisations and mixed episodes than control group. They also performed poorer on frontal lobe assessment battery, Stroop test and digit symbol substitution test. Duration of alcohol use was associated positively with total number of hospitalisations and number of episodes. The cases group scored significantly higher on the personality traits of neuroticism and openness to experience. CONCLUSION The study confirmed the higher

  3. Bipolar and related disorders in DSM-5 and ICD-10.

    Science.gov (United States)

    Kaltenboeck, Alexander; Winkler, Dietmar; Kasper, Siegfried

    2016-08-01

    Bipolar disorders are a group of psychiatric disorders with profound negative impact on affected patients. Even if their symptomatology has long been recognized, diagnostic criteria have changed over time and diagnosis often remains difficult. The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), issued in May 2013, comprises several changes regarding the diagnosis of bipolar disorders compared to the previous edition. Diagnostic categories and criteria for bipolar disorders show some concordance with the internationally also widely used Tenth Edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). However, there are also major differences that are worth highlighting. The aim of the following text is to depict and discuss those.

  4. The role of psychological factors in bipolar disorder: prospective relationships between cognitive style, coping style and symptom expression.

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    Fletcher, Kathryn; Parker, Gordon; Manicavasagar, Vijaya

    2014-04-01

    Psychological factors contribute to bipolar disorder illness course, representing targets for psychological intervention. Research to date has focused on bipolar I disorder, extrapolating results to bipolar II disorder. The current study addresses this discrepancy by exploring cognitive and coping styles in patients diagnosed with bipolar I or II disorder. Participants were recruited from the Sydney-based Black Dog Institute. Diagnoses were derived via the MINI International Neuropsychiatric Interview. Baseline cognitive and coping style measures were completed, and mood symptoms assessed over a 6-month period. Clinician-rated mood status was assessed at follow-up to determine the predictive utility of cognitive and coping styles. The follow-up sample comprised 151 participants. Differential relationships between cognitive style, coping styles and mood symptoms emerged across the bipolar sub-types. Some key differences were that a broader set of negative cognitive styles were associated with bipolar II depression symptoms; while few relationships were observed between coping styles and bipolar II symptoms. Differences in cognitive and coping style relationships with symptom expression across bipolar I and II disorder may provide clinicians with fruitful guides for directing treatment interventions when relevant maladaptive styles are observed. Further exploration of differences in cognitive and coping styles in bipolar I and II disorder is warranted.

  5. Cross-Disorder Genomewide Analysis of Schizophrenia, Bipolar Disorder, and Depression

    Science.gov (United States)

    Huang, Jie; Perlis, Roy H.; Lee, Phil H.; Rush, A John; Fava, Maurizio; Sachs, Gary S.; Lieberman, Jeffrey; Hamilton, Steven P.; Sullivan, Patrick; Sklar, Pamela; Purcell, Shaun; Smoller, Jordan W.

    2013-01-01

    Background Family and twin studies indicate substantial overlap of genetic influences on psychotic and mood disorders. Linkage and candidate gene studies have also suggested overlap across schizophrenia (SCZ), bipolar disorder (BPD), and major depressive disorder (MDD). The objective of this study was to apply genomewide association study (GWAS) analysis to address the specificity of genetic effects on these disorders. Method We combined GWAS data from three large effectiveness studies of SCZ (CATIE, genotyped n = 741), BPD (STEP-BD, n = 1575) and MDD (STAR*D, n= 1938) and psychiatrically-screened controls (NIMH-GI controls, n = 1204). We applied a two-stage analytic procedure involving an omnibus test of allele frequency differences among case and control groups followed by a model selection step to identify the best-fitting model of allelic effects across disorders. Results The strongest result was seen for a single nucleotide polymorphism near the adrenomedullin (ADM) gene (rs6484218, p = 3.93 × 10−8), with the best-fitting model indicating that the effect is specific to bipolar II disorder. We also observed evidence suggesting that several genes may have effects that transcend clinical diagnostic boundaries including variants in NPAS3 that showed pleiotropic effects across SCZ, BPD, and MDD. Conclusions This study provides the first genomewide significant evidence implicating variants near the ADM gene on chromosome 11p15 in psychopathology, with effects that appear to be specific to bipolar II disorder. Although we do not detect genomewide significant evidence of cross-disorder effects, our study provides evidence that there are both pleiotropic and disorder-specific effects on major mental illness and illustrates an approach to dissecting the genetic basis of mood and psychotic disorders that can inform future large-scale cross-disorder GWAS analyses. PMID:20713499

  6. Update on schizophrenia and bipolar disorder: focus on cariprazine

    Directory of Open Access Journals (Sweden)

    Roberts RJ

    2016-07-01

    Full Text Available Rona Jeannie Roberts,1 Lillian Jan Findlay,2 Peggy L El-Mallakh,2 Rif S El-Mallakh1 1Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, 2School of Nursing, University of Kentucky, Lexington, KY, USA Abstract: Schizophrenia and bipolar disorder are severe psychiatric disorders that are frequently associated with persistent symptoms and significant dysfunction. While there are a multitude of psychopharmacologic agents are available for treatment of these illnesses, suboptimal response and significant adverse consequences limit their utility. Cariprazine is a new, novel antipsychotic medication with dopamine D2 and D3 partial agonist effects. Its safety and efficacy have been investigated in acute psychosis of schizophrenia, bipolar mania, bipolar depression, and unipolar depression. Efficacy has been demonstrated in schizophrenia and mania. It is unclear if cariprazine is effective in depression associated with unipolar or bipolar illness. Adverse consequences include extrapyramidal symptoms including akathisia, and various gastrointestinal symptoms. The US Food and Drug Administration (FDA has recently approved cariprazine. This review will provide clinicians with basic information regarding the research program of cariprazine. Keywords: cariprazine, dopamine D3 receptor, dopamine D2 receptor, bipolar disorder, mania, bipolar depression, schizophrenia

  7. Toward constructing an endophenotype strategy for bipolar disorders.

    Science.gov (United States)

    Hasler, Gregor; Drevets, Wayne C; Gould, Todd D; Gottesman, Irving I; Manji, Husseini K

    2006-07-15

    Research aimed at elucidating the underlying neurobiology and genetics of bipolar disorder, and factors associated with treatment response, have been limited by a heterogeneous clinical phenotype and lack of knowledge about its underlying diathesis. We used a survey of clinical, epidemiological, neurobiological, and genetic studies to select and evaluate candidate endophenotypes for bipolar disorder. Numerous findings regarding brain function, brain structure, and response to pharmacological challenge in bipolar patients and their relatives deserve further investigation. Candidate brain function endophenotypes include attention deficits, deficits in verbal learning and memory, cognitive deficits after tryptophan depletion, circadian rhythm instability, and dysmodulation of motivation and reward. We selected reduced anterior cingulate volume and early-onset white matter abnormalities as candidate brain structure endophenotypes. Symptom provocation endophenotypes might be based on bipolar patients' sensitivity to sleep deprivation, psychostimulants, and cholinergic drugs. Phenotypic heterogeneity is a major impediment to the elucidation of the neurobiology and genetics of bipolar disorder. We present a strategy constructed to improve the phenotypic definition of bipolar disorder by elucidating candidate endophenotypes. Studies to evaluate candidate endophenotypes with respect to specificity, heritability, temporal stability, and prevalence in unaffected relatives are encouraged.

  8. Associations between health risk behaviors and symptoms of schizophrenia and bipolar disorder: a systematic review

    Science.gov (United States)

    Katon, Wayne J.

    2012-01-01

    Objective To systematically review the literature to determine if health risk behaviors in patients with schizophrenia or bipolar disorder are associated with subsequent symptom burden or level of functioning. Method Using the PRISMA systematic review method we searched PubMed, Cochrane, PsychInfo and EMBASE databases with key words: health risk behaviors, diet, obesity, overweight, BMI, smoking, tobacco use, cigarette use, sedentary lifestyle, sedentary behaviors, physical inactivity, activity level, fitness, sitting AND schizophrenia, bipolar disorder, bipolar illness, schizoaffective disorder, severe and persistent mental illness, and psychotic to identify prospective, controlled studies of greater than 6 months duration. Included studies examined associations between sedentary lifestyle, smoking, obesity, physical inactivity and subsequent symptom severity or functional impairment in patients with schizophrenia or bipolar disorder. Results Eight of the 2130 articles identified met inclusion criteria and included 508 patients with a health risk behavior and 825 controls. Six studies examined tobacco use and two studies examined weight gain/obesity. Seven studies found that patients with schizophrenia or bipolar illness and at least one health risk behavior had more severe subsequent psychiatric symptoms and/or decreased level of functioning. Conclusion Tobacco use and weight gain/obesity may be associated with increased severity of symptoms of schizophrenia and bipolar disorder or decreased level of functioning. PMID:23044246

  9. Autoimmune diseases, bipolar disorder, and non-affective psychosis.

    Science.gov (United States)

    Eaton, William W; Pedersen, Marianne G; Nielsen, Philip R; Mortensen, Preben Bo

    2010-09-01

    Clinic-based studies of immune function, as well as comorbidity of autoimmune diseases, bipolar disorder, and schizophrenia, suggest a possible autoimmune etiology. Studies of non-affective psychosis and schizophrenia suggest common etiologies. The objective was to determine the degree to which 30 different autoimmune diseases are antecedent risk factors for bipolar disorder, schizophrenia, and non-affective psychosis. A cohort of 3.57 million births in Denmark was linked to the Psychiatric Case Register and the National Hospital Register. There were 20,317 cases of schizophrenia, 39,076 cases of non-affective psychosis, and 9,920 cases of bipolar disorder. As in prior studies, there was a range of autoimmune diseases which predicted raised risk of schizophrenia in individuals who had a history of autoimmune diseases, and also raised risk in persons whose first-degree relatives had an onset of autoimmune disease prior to onset of schizophrenia in the case. These relationships also existed for the broader category of non-affective psychosis. Only pernicious anemia in the family was associated with raised risk for bipolar disorder (relative risk: 1.7), suggesting a small role for genetic linkage. A history of Guillain-Barré syndrome, Crohn's disease, and autoimmune hepatitis in the individual was associated with raised risk of bipolar disorder. The familial relationship of schizophrenia to a range of autoimmune diseases extends to non-affective psychosis, but not to bipolar disorder. The data suggest that autoimmune processes precede onset of schizophrenia, but also non-affective psychosis and bipolar disorder. © 2010 John Wiley and Sons A/S.

  10. Visual sensory processing deficits in patients with bipolar disorder revealed through high-density electrical mapping.

    LENUS (Irish Health Repository)

    Yeap, Sherlyn

    2009-11-01

    BACKGROUND: Etiological commonalities are apparent between bipolar disorder and schizophrenia. For example, it is becoming clear that both populations show similar electrophysiological deficits in the auditory domain. Recent studies have also shown robust visual sensory processing deficits in patients with schizophrenia using the event-related potential technique, but this has not been formally tested in those with bipolar disorder. Our goal here was to assess whether early visual sensory processing in patients with bipolar disorder, as indexed by decreased amplitude of the P1 component of the visual evoked potential (VEP), would show a similar deficit to that seen in those with schizophrenia. Since the P1 deficit has already been established as an endophenotype in schizophrenia, a finding of commonality between disorders would raise the possibility that it represents a measure of common genetic liability. METHODS: We visually presented isolated-check stimuli to euthymic patients with a diagnosis of bipolar disorder and age-matched healthy controls within a simple go\\/no-go task and recorded VEPs using high-density (72-channel) electroencephalography. RESULTS: The P1 VEP amplitude was substantially reduced in patients with bipolar disorder, with an effect size of f = 0.56 (large according to Cohen\\'s criteria). LIMITATIONS: Our sample size was relatively small and as such, did not allow for an examination of potential relations between the physiologic measures and clinical measures. CONCLUSION: This reduction in P1 amplitude among patients with bipolar disorder represents a dysfunction in early visual processing that is highly similar to that found repeatedly in patients with schizophrenia and their healthy first-degree relatives. Since the P1 deficit has been related to susceptibility genes for schizophrenia, our results raise the possibility that the deficit may in fact be more broadly related to the development of psychosis and that it merits further

  11. Toward the Definition of a Bipolar Prodrome: Dimensional Predictors of Bipolar Spectrum Disorders in At-Risk Youths.

    Science.gov (United States)

    Hafeman, Danella M; Merranko, John; Axelson, David; Goldstein, Benjamin I; Goldstein, Tina; Monk, Kelly; Hickey, Mary Beth; Sakolsky, Dara; Diler, Rasim; Iyengar, Satish; Brent, David; Kupfer, David; Birmaher, Boris

    2016-07-01

    The authors sought to assess dimensional symptomatic predictors of new-onset bipolar spectrum disorders in youths at familial risk of bipolar disorder ("at-risk" youths). Offspring 6-18 years old of parents with bipolar I or II disorder (N=359) and community comparison offspring (N=220) were recruited. At baseline, 8.4% of the offspring of bipolar parents had a bipolar spectrum disorder. Over 8 years, 14.7% of offspring for whom follow-up data were available (44/299) developed a new-onset bipolar spectrum disorder (15 with bipolar I or II disorder). Measures collected at baseline and follow-up were reduced using factor analyses, and factors (both at baseline and at the visit prior to conversion or last contact) were assessed as predictors of new-onset bipolar spectrum disorders. Relative to comparison offspring, at-risk and bipolar offspring had higher baseline levels of anxiety/depression, inattention/disinhibition, externalizing, subsyndromal manic, and affective lability symptoms. The strongest predictors of new-onset bipolar spectrum disorders were baseline anxiety/depression, baseline and proximal affective lability, and proximal subsyndromal manic symptoms (prisk of conversion. While youths without anxiety/depression, affective lability, and mania (and with a parent with older age at mood disorder onset) had a 2% predicted chance of conversion to a bipolar spectrum disorder, those with all risk factors had a 49% predicted chance of conversion. Dimensional measures of anxiety/depression, affective lability, and mania are important predictors of new-onset bipolar spectrum disorders in at-risk youths. These symptoms emerged from among numerous other candidates, underscoring the potential clinical and research utility of these findings.

  12. Basic Principles of Interpersonal Social Rhythm Therapy in Bipolar Disorder

    Directory of Open Access Journals (Sweden)

    Gokben Hizli Sayar

    2014-08-01

    Full Text Available Interpersonal Social Rhythm Therapy is a psychotherapy modality that helps the patient recognize the relationship between disruptions in social rhythms and the onset of previous episodes of psychiatric disorders. It uses psychoeducation and behavioral techniques to maintain social rhythm and sleep/wake regularity. It is closely related to and ldquo;social zeitgeber theory and rdquo; that emphasizes the importance that social rhythm regularity may play in synchronization of circadian rhythms in individuals with or at risk for bipolar spectrum disorders. Interpersonal and social rhythm therapy have been shown to stabilize social rhythms and enhance course and outcome in bipolar disorder. This review focuses on the theoretical principles and the basic steps of interpersonal and social rhythm therapy as a psychotherapy approach in bipolar disorder. PubMed, Scopus, Google Scholar databases were searched without temporal restriction. Search terms included interpersonal social rhythm therapy, bipolar, mood disorders. Abstracts were reviewed for relevance, and randomized controlled trials of interpersonal and social rhythm therapy in bipolar disorder selected. These researches also summarized on the final part of this review. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(4.000: 438-446

  13. Rapid cycling bipolar disorder: clinical characteristics and treatment options.

    Science.gov (United States)

    Coryell, William

    2005-01-01

    Approximately one of six patients who seek treatment for bipolar disorder present with a rapid cycling pattern. In comparison with other patients who have bipolar disorder, these individuals experience more affective morbidity in both the immediate and distant future and are more likely to experience recurrences despite treatment with lithium or anticonvulsants. Particular care should be given to distinguishing rapid cycling bipolar disorder from attention-deficit hyperactivity disorder in children or adolescents and from borderline personality disorder in adults. Perhaps four of five cases of rapid cycling resolve within a year, but the pattern may persist for many years in the remaining patients. As with bipolar disorder in general, depressive symptoms produce the most morbidity over time. Controlled studies have not established that antidepressants provoke switching or rapid cycling, but neither have they been shown consistently to have benefits in bipolar illness. Successful management will often require a sequence of trials with mood stabilizer drugs, beginning with lithium in treatment-naive patients. Efforts to minimise adverse effects, and the recognition that full benefits may not be apparent for several months, will make the premature abandonment of a potentially helpful treatment less likely. Placebo-controlled studies so far provide the most support for the use of lithium and lamotrigine as prophylactic agents. The combination of lithium and carbamazepine, valproate or lamotrigine for maintenance has some support from controlled studies, as does the adjunctive use of olanzapine.

  14. Bipolar Disorder and Heart Transplantation: A Case Report.

    Science.gov (United States)

    Ramírez-Giraldo, Ana María; Restrepo, Diana

    Bipolar disorder is a chronic and recurrent mood disease that includes symptoms that fluctuate from euphoria to depression. As a mood disorder, itis one of the main contraindications for transplantation procedures. The case is presented of a patient with bipolar disorder who had a heart transplant after a cardiac arrest. Heart transplantation is the treatment of choice in patients with heart failure and arrhythmias that do not respond to conventional treatment. Case report and narrative review of literature. A 34-year-old woman with bipolar disorder diagnosed when she was 13, treated with lithium and aripiprazole. She required a heart transplant as the only therapeutic option, after presenting with ventricular tachycardia refractory to conventional treatment. The patient did not suffer an emotional decompensation with the removal of the lithium and aripiprazole that were associated with prolonged QTc interval, and remained eurhythmic throughout the process. Heart transplantation can be performed safely and successfully in patients with bipolar disorder, when suitably followed-up by a liaison psychiatry group. Bipolar disorder should not be considered as an absolute contraindication for heart transplantation. Copyright © 2017 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  15. Matricídio e transtorno bipolar Matricide and bipolar disorder

    Directory of Open Access Journals (Sweden)

    Alexandre Martins Valença

    2009-01-01

    Full Text Available CONTEXTO: Matricídio é o assassinato de uma mãe pelo filho ou filha, uma forma de homicídio raramente vista na prática psiquiátrica. Estudos de casos de matricídio têm revelado a presença de transtornos mentais, tais como esquizofrenia, transtorno bipolar, transtornos de personalidade e alcoolismo, assim como casos em que não há evidência de transtorno mental. OBJETIVO: Tem-se como objetivo relatar o caso de uma mulher com transtorno bipolar que assassinou a sua genitora e que foi avaliada em perícia psiquiátrica para avaliação da responsabilidade penal. MÉTODOS: Foi realizada entrevista psiquiátrica, sendo o diagnóstico psiquiátrico estabelecido com base na entrevista e observação dos registros periciais e hospitalares, utilizando-se os critérios diagnósticos DSM-IV-TR. RESULTADOS: A examinanda foi considerada inimputável, em virtude da presença de doença mental que afetou inteiramente o seu entendimento e determinação em relação ao delito praticado. Ela cumpre medida de segurança em Hospital de Custódia e Tratamento Psiquiátrico há dois anos. CONCLUSÃO: É importante que psiquiatras e outros profissionais da saúde mental estejam atentos para risco de comportamento violento em pacientes que apresentam história de doença mental de longa duração, com episódios de violência durante a fase aguda, ameaças contra familiares ou amigos e falta de tratamento psiquiátrico regular.BACKGROUND: Matricide is the killing of one's own mother, and a type of homicide rarely seen on psychiatric practice. Matricide cases studies have shown the presence of mental disorders, such as schizophrenia, bipolar disorder, personality disorders and alcoholism, and have also found cases where there is no evidence of mental disorders. OBJECTIVE: We aim to report a case of a woman with bipolar disorder that murdered her own mother and had a psychiatric forensic evaluation to ascertain her penal imputability. METHODS: Psychiatric

  16. Bifurcation analysis of parametrically excited bipolar disorder model

    Science.gov (United States)

    Nana, Laurent

    2009-02-01

    Bipolar II disorder is characterized by alternating hypomanic and major depressive episode. We model the periodic mood variations of a bipolar II patient with a negatively damped harmonic oscillator. The medications administrated to the patient are modeled via a forcing function that is capable of stabilizing the mood variations and of varying their amplitude. We analyze analytically, using perturbation method, the amplitude and stability of limit cycles and check this analysis with numerical simulations.

  17. a study of emotions in dreams in bipolar disorder

    OpenAIRE

    Chae, Woo Ri

    2017-01-01

    Bipolar disorders are characterized by fluctuation of mood states with serious consequences for several aspects of the lives of those affected. According to the Continuity Hypothesis of Dreaming the content of dreams is largely continuous with waking concepts and emotional concerns of the dreamer. Therefore, if a clear relationship exists between mood and dream content, qualitative changes in dreams of bipolar patients should be evident. Ernest Hartmann proposed a theory called Contemporary T...

  18. A Comparison of Brain/Behavioral Systems, and Quality of Life among Patients with Schizophrenia and Bipolar Disorder

    Directory of Open Access Journals (Sweden)

    Mahmoud Najafi

    2014-09-01

    Full Text Available Background: The aim of the research was to compare brain/behavioral systems, and quality of life among people with schizophrenia, people with bipolar disorder, and normal people. Materials and Methods: In this causal-comparative research, 90 people consisting of people with schizophrenia, people with bipolar disorder, and normal people were selected using access sampling method, and they completed the Gray-Wilson Personality Questionnaire and Quality of Life Scale. Results: The findings suggested that there is a significant difference in behavioral inhibition and activation inhibition between normal people and people with bipolar disorder, as well as in sub-scales from quality of life of normal people and people with schizophrenia and bipolar disorder. Conclusion: Impairment in brain/behavioral systems and low quality of life provides explanations for schizophrenia and bipolar disorder.

  19. General health and well-being in outpatients with depressive and bipolar disorders

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Hansen, Hanne Vibe; Bech, Per

    2006-01-01

    Prior studies have found contradictory results regarding the association between course of illness and quality of life among patients with depressive disorder or bipolar disorder. Questionnaires about quality of life and affective symptoms (the EQ-5D, EQ-5D-VAS, WHO (Five) well-being index......-VAS) and well-being (WHO (Five) well-being index) and more depressive and anxiety symptoms compared with bipolar disorder. Similarly, more psychiatric admissions were associated with poorer general health and well-being and more depressive and anxiety symptoms. However, when adjusting for the effect...... and the BDI-42) were mailed to a large population of outpatients with depressive or bipolar disorder representative of patients treated in hospital settings in Denmark. Among the 1005 recipients, 49.9% responded to the letter. Depressive disorder was associated with poorer general health (EQ-5D, EQ-5D...

  20. Differences in clinical presentation between bipolar I and II disorders in the early stages of bipolar disorder

    DEFF Research Database (Denmark)

    Vinberg, Maj; Mikkelsen, Rie Lambaek; Kirkegaard, Thomas

    2017-01-01

    AIM: In a naturalistic clinical study of patients in the early stages of bipolar disorders the aim was to assess differences between patients with bipolar I (BD I) and bipolar II (BD II) disorders on clinical characteristics including affective symptoms, subjective cognitive complaints, functional...... level, the presence of comorbid personality disorders and coping strategies. METHODS: Diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Disorders. Clinical symptoms were rated with the Young Mania Rating Scale and the Hamilton Depression Rating Scale, and functional status...... using the Functional Assessment Short Test. Cognitive complaints were assessed using the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire, the presence of comorbid personality disorders using the Standardized Assessment of Personality - Abbreviated Scale and coping style...

  1. Visual sensory processing deficits in patients with bipolar disorder revealed through high-density electrical mapping.

    Science.gov (United States)

    Yeap, Sherlyn; Kelly, Simon P; Reilly, Richard B; Thakore, Jogin H; Foxe, John J

    2009-11-01

    Etiological commonalities are apparent between bipolar disorder and schizophrenia. For example, it is becoming clear that both populations show similar electrophysiological deficits in the auditory domain. Recent studies have also shown robust visual sensory processing deficits in patients with schizophrenia using the event-related potential technique, but this has not been formally tested in those with bipolar disorder. Our goal here was to assess whether early visual sensory processing in patients with bipolar disorder, as indexed by decreased amplitude of the P1 component of the visual evoked potential (VEP), would show a similar deficit to that seen in those with schizophrenia. Since the P1 deficit has already been established as an endophenotype in schizophrenia, a finding of commonality between disorders would raise the possibility that it represents a measure of common genetic liability. We visually presented isolated-check stimuli to euthymic patients with a diagnosis of bipolar disorder and age-matched healthy controls within a simple go/no-go task and recorded VEPs using high-density (72-channel) electroencephalography. The P1 VEP amplitude was substantially reduced in patients with bipolar disorder, with an effect size of f = 0.56 (large according to Cohen's criteria). Our sample size was relatively small and as such, did not allow for an examination of potential relations between the physiologic measures and clinical measures. This reduction in P1 amplitude among patients with bipolar disorder represents a dysfunction in early visual processing that is highly similar to that found repeatedly in patients with schizophrenia and their healthy first-degree relatives. Since the P1 deficit has been related to susceptibility genes for schizophrenia, our results raise the possibility that the deficit may in fact be more broadly related to the development of psychosis and that it merits further investigation as a candidate endophenotype for bipolar disorder.

  2. Homer1a protein expression in schizophrenia, bipolar disorder, and major depression.

    Science.gov (United States)

    Leber, Stefan L; Llenos, Ida C; Miller, Christine L; Dulay, Jeannette R; Haybaeck, Johannes; Weis, Serge

    2017-10-01

    In recent years, there was growing interest in postsynaptic density proteins in the central nervous system. Of the most important candidates of this specialized region are proteins belonging to the Homer protein family. This family of scaffolding proteins is suspected to participate in the pathogenesis of a variety of diseases. The present study aims to compare Homer1a expression in the hippocampus and cingulate gyrus of patients with major psychiatric disorders including schizophrenia, bipolar disorder and major depression. Immunohistochemistry was used to analyze changes of Homer1a protein expression in the hippocampal formation and the cingulate gyrus from the respective disease groups. Glial cells of the cingulate gyrus gray matter showed decreased Homer1a levels in bipolar disorder when compared to controls. The same results were seen when comparing cingulate gyrus gray matter glial cells in bipolar disorder with major depression. Stratum oriens glial cells of the hippocampus showed decreased Homer1a levels in bipolar disorder when compared to controls and major depression. Stratum lacunosum glial cells showed decreased Homer1a levels in bipolar disorder when compared to major depression. In stratum oriens interneurons Homer1a levels were increased in all disease groups when compared to controls. Stratum lucidum axons showed decreased Homer1a levels in bipolar disorder when compared to controls. Our data demonstrate altered Homer1a levels in specific brain regions and cell types of patients suffering from schizophrenia, bipolar disorder and major depression. These findings support the role of Homer proteins as interesting candidates in neuropsychiatric pathophysiology and treatment.

  3. Smartphone-based objective monitoring in bipolar disorder

    DEFF Research Database (Denmark)

    Faurholt-Jepsen, Maria; Bauer, Michael; Kessing, Lars Vedel

    2018-01-01

    In 2001, the WHO stated that: "The use of mobile and wireless technologies to support the achievement of health objectives (mHealth) has the potential to transform the face of health service delivery across the globe". Within mental health, interventions and monitoring systems for depression......, anxiety, substance abuse, eating disorder, schizophrenia and bipolar disorder have been developed and used. The present paper presents the status and findings from studies using automatically generated objective smartphone data in the monitoring of bipolar disorder, and addresses considerations...

  4. Subcortical volumetric abnormalities in bipolar disorder.

    Science.gov (United States)

    Hibar, D P; Westlye, L T; van Erp, T G M; Rasmussen, J; Leonardo, C D; Faskowitz, J; Haukvik, U K; Hartberg, C B; Doan, N T; Agartz, I; Dale, A M; Gruber, O; Krämer, B; Trost, S; Liberg, B; Abé, C; Ekman, C J; Ingvar, M; Landén, M; Fears, S C; Freimer, N B; Bearden, C E; Sprooten, E; Glahn, D C; Pearlson, G D; Emsell, L; Kenney, J; Scanlon, C; McDonald, C; Cannon, D M; Almeida, J; Versace, A; Caseras, X; Lawrence, N S; Phillips, M L; Dima, D; Delvecchio, G; Frangou, S; Satterthwaite, T D; Wolf, D; Houenou, J; Henry, C; Malt, U F; Bøen, E; Elvsåshagen, T; Young, A H; Lloyd, A J; Goodwin, G M; Mackay, C E; Bourne, C; Bilderbeck, A; Abramovic, L; Boks, M P; van Haren, N E M; Ophoff, R A; Kahn, R S; Bauer, M; Pfennig, A; Alda, M; Hajek, T; Mwangi, B; Soares, J C; Nickson, T; Dimitrova, R; Sussmann, J E; Hagenaars, S; Whalley, H C; McIntosh, A M; Thompson, P M; Andreassen, O A

    2016-12-01

    Considerable uncertainty exists about the defining brain changes associated with bipolar disorder (BD). Understanding and quantifying the sources of uncertainty can help generate novel clinical hypotheses about etiology and assist in the development of biomarkers for indexing disease progression and prognosis. Here we were interested in quantifying case-control differences in intracranial volume (ICV) and each of eight subcortical brain measures: nucleus accumbens, amygdala, caudate, hippocampus, globus pallidus, putamen, thalamus, lateral ventricles. In a large study of 1710 BD patients and 2594 healthy controls, we found consistent volumetric reductions in BD patients for mean hippocampus (Cohen's d=-0.232; P=3.50 × 10 -7 ) and thalamus (d=-0.148; P=4.27 × 10 -3 ) and enlarged lateral ventricles (d=-0.260; P=3.93 × 10 -5 ) in patients. No significant effect of age at illness onset was detected. Stratifying patients based on clinical subtype (BD type I or type II) revealed that BDI patients had significantly larger lateral ventricles and smaller hippocampus and amygdala than controls. However, when comparing BDI and BDII patients directly, we did not detect any significant differences in brain volume. This likely represents similar etiology between BD subtype classifications. Exploratory analyses revealed significantly larger thalamic volumes in patients taking lithium compared with patients not taking lithium. We detected no significant differences between BDII patients and controls in the largest such comparison to date. Findings in this study should be interpreted with caution and with careful consideration of the limitations inherent to meta-analyzed neuroimaging comparisons.

  5. A brief review of exercise, bipolar disorder, and mechanistic pathways

    Science.gov (United States)

    Thomson, Daniel; Turner, Alyna; Lauder, Sue; Gigler, Margaret E.; Berk, Lesley; Singh, Ajeet B.; Pasco, Julie A.; Berk, Michael; Sylvia, Louisa

    2015-01-01

    Despite evidence that exercise has been found to be effective in the treatment of depression, it is unclear whether these data can be extrapolated to bipolar disorder. Available evidence for bipolar disorder is scant, with no existing randomized controlled trials having tested the impact of exercise on depressive, manic or hypomanic symptomatology. Although exercise is often recommended in bipolar disorder, this is based on extrapolation from the unipolar literature, theory and clinical expertise and not empirical evidence. In addition, there are currently no available empirical data on program variables, with practical implications on frequency, intensity and type of exercise derived from unipolar depression studies. The aim of the current paper is to explore the relationship between exercise and bipolar disorder and potential mechanistic pathways. Given the high rate of medical co-morbidities experienced by people with bipolar disorder, it is possible that exercise is a potentially useful and important intervention with regard to general health benefits; however, further research is required to elucidate the impact of exercise on mood symptomology. PMID:25788889

  6. A brief review of exercise, bipolar disorder and mechanistic pathways

    Directory of Open Access Journals (Sweden)

    Daniel eThomson

    2015-03-01

    Full Text Available Despite evidence that exercise has been found to be effective in the treatment of depression, it is unclear whether these data can be extrapolated to bipolar disorder. Available evidence for bipolar disorder is scant, with no existing randomised controlled trials having tested the impact of exercise on depressive, manic or hypomanic symptomatology. Although exercise is often recommended in bipolar disorder, this is based on extrapolation from the unipolar literature, theory and clinical expertise and not empirical evidence. In addition, there are currently no available empirical data on program variables, with practical implications on frequency, intensity and type of exercise derived from unipolar depression studies. The aim of the current paper is to explore the relationship between exercise and bipolar disorder and potential mechanistic pathways. Given the high rate of medical co-morbidities experienced by people with bipolar disorder, it is possible that exercise is a potentially useful and important intervention with regard to general health benefits; however, further research is required to elucidate the impact of exercise on mood symptomology.

  7. Attitudes toward antipsychotic treatment among patients with bipolar disorders and their clinicians: a systematic review

    Directory of Open Access Journals (Sweden)

    Sajatovic M

    2017-08-01

    Full Text Available Martha Sajatovic,1 Faith DiBiasi,2 Susan N Legacy3 1Departments of Psychiatry and Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA; 2US Medical Affairs, Neuroscience, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD, USA; 3US Medical Affairs, Neuroscience, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA Introduction: Antipsychotics are recommended as first-line therapy for acute mania and maintenance treatment of bipolar disorder; however, published literature suggests their real-world use remains limited. Understanding attitudes toward these medications may help identify barriers and inform personalized therapy. This literature review evaluated patient and clinician attitudes toward the use of antipsychotics for treating bipolar disorder. Materials and methods: A systematic search of the Cochrane Library, Ovid MEDLINE, Embase, and BIOSIS Previews identified English language articles published between January 1, 2000, and June 15, 2016, that reported attitudinal data from patients, health care professionals, or caregivers; treatment decision-making; or patient characteristics that predicted antipsychotic use for bipolar disorder. Results were analyzed descriptively. Results: Of the 209 references identified, 11 met the inclusion criteria and were evaluated. These articles provided attitudinal information from 1,418 patients with bipolar disorder and 1,282 treating clinicians. Patients’ attitudes toward antipsychotics were generally positive. Longer duration of clinical stability was associated with positive attitudes. Implementation of psychoeducational and adherence enhancement strategies could improve patient attitudes. Limited data suggest clinicians’ perceptions of antipsychotic efficacy and tolerability may have the greatest impact on their prescribing patterns. Because the current real-world evidence base is inadequate, clinician attitudes

  8. An update on adjunctive treatment options for bipolar disorder.

    Science.gov (United States)

    Dean, Olivia M; Gliddon, Emma; Van Rheenen, Tamsyn E; Giorlando, Francesco; Davidson, Sandra K; Kaur, Manreena; Ngo, Trung T; Williams, Lana J

    2018-03-01

    Bipolar disorder is a complex illness often requiring combinations of therapies to successfully treat symptoms. In recent years, there have been significant advancements in a number of therapies for bipolar disorder. It is therefore timely to provide an overview of current adjunctive therapeutic options to help treating clinicians to inform their patients and work towards optimal outcomes. Publications were identified from PubMed searches on bipolar disorder and pharmacotherapy, nutraceuticals, hormone therapy, psychoeducation, interpersonal and social rhythm therapy, cognitive remediation, mindfulness, e-Health and brain stimulation techniques. Relevant articles in these areas were selected for further review. This paper provides a narrative review of adjunctive treatment options and is not a systematic review of the literature. A number of pharmacotherapeutic, psychological and neuromodulation treatment options are available. These have varying efficacy but all have shown benefit to people with bipolar disorder. Due to the complex nature of treating the disorder, combination treatments are often required. Adjunctive treatments to traditional pharmacological and psychological therapies are proving useful in closing the gap between initial symptom remission and full functional recovery. Given that response to monotherapy is often inadequate, combination regimens for bipolar disorder are typical. Correspondingly, psychiatric research is working towards a better understanding of the disorder's underlying biology. Therefore, treatment options are changing and adjunctive therapies are being increasingly recognized as providing significant tools to improve patient outcomes. Towards this end, this paper provides an overview of novel treatments that may improve clinical outcomes for people with bipolar disorder. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Association between childhood dimensions of attention deficit hyperactivity disorder and adulthood clinical severity of bipolar disorders.

    Science.gov (United States)

    Etain, Bruno; Lajnef, M; Loftus, J; Henry, C; Raust, A; Gard, S; Kahn, J P; Leboyer, M; Scott, J; Bellivier, F

    2017-04-01

    Clinical features of attention deficit hyperactivity disorder can be frequently observed in cases with bipolar disorders and associated with greater severity of bipolar disorders. Although designed as a screening tool for attention deficit hyperactivity disorder, the Wender Utah Rating Scale could, given its factorial structure, be useful in investigating the early history of impulsive, inattentive or mood-related symptoms among patients with bipolar disorders. We rated the Wender Utah Rating Scale in 276 adult bipolar disorder cases and 228 healthy controls and tested its factorial structure and any associations with bipolar disorder phenomenology. We confirmed a three-factor structure for the Wender Utah Rating Scale (' impulsivity/temper', ' inattentiveness' and ' mood/self-esteem'). Cases and controls differed significantly on Wender Utah Rating Scale total score and sub-scale scores ( p-values bipolar disorder cases versus 5% of controls were classified as ' WURS positive' (odds ratio = 5.21 [2.73-9.95]). In bipolar disorders, higher Wender Utah Rating Scale score was associated with earlier age at onset, severity of suicidal behaviors and polysubstance misuse; multivariate analyses, controlling for age and gender, confirmed the associations with age at onset ( p = 0.001) and alcohol and substance misuse ( p = 0.001). Adults with bipolar disorders who reported higher levels of childhood symptoms on the Wender Utah Rating Scale presented a more severe expression of bipolar disorders in terms of age at onset and comorbidity. The Wender Utah Rating Scale could be employed to screen for attention deficit hyperactivity disorder but also for ' at-risk behaviors' in adult bipolar disorder cases and possibly for prodromal signs of early onset in high-risk subjects.

  10. Bipolar disorder: an overview | Bronkhorst | South African Family ...

    African Journals Online (AJOL)

    Bipolar disorder (BD) is a chronic disorder characterised by abnormal mood changes and fluctuation in energy levels. The disease is characterised by a depressive episode, which can last up to a few months, and include low energy levels, hypersomnia, cognitive impairments, decreased sexual desire, carbohydrate ...

  11. [Psychoeducation and interpersonal and social rhythm therapy for bipolar disorder].

    Science.gov (United States)

    Mizushima, Hiroko

    2011-01-01

    In treating bipolar disorder, specific psychotherapies in adjunct to pharmacotherapy have been shown to be effective in preventing new episodes and treating depressive episodes. Among those, interpersonal and social rhythm therapy (IPSRT) developed by Frank, amalgamation of interpersonal psychotherapy (IPT) with behavioral therapy focused on social rhythm has been shown to be an efficacious adjunct to mediation in preventing new episodes in bipolar I patients and in treating depression in bipolar I arid II disorder. IPSRT has also been shown to enhance total functioning, relationship functioning and life satisfaction among patients with bipolar disorder, even after pretreatment functioning and concurrent depression were covaried. IPSRT was designed to directly address the major pathways to recurrence in bipolar disorder, namely medication nonadherence, stressful life events, and disruptions in social rhythms. IPT, originated by Klerman et al., is a strategic time-limited psychotherapy focused on one or two of four current interpersonal problem areas (ie, grief, interpersonal role disputes, role transitions, and interpersonal dificits). In IPSRT, the fifth problem area "grief for the lost healthy self" has been added in order to promote acceptance of the diagnosis and the need for life-long treatment. Social rhythm therapy is a behavioral approach aiming at increasing regularity of social rhythms using the Social Rhythm Metric (SRM), a chart to record daily social activities including how stimulating they were, developed from observation that disruptions in social rhythms often trigger affective episodes in patients with bipolar disorder. IPSRT also appears to be a promising intervention for a subset of individuals with bipolar II depression as monotherapy for the acute treatment.

  12. Clinical phenotype of bipolar disorder with comorbid binge eating disorder.

    Science.gov (United States)

    McElroy, Susan L; Crow, Scott; Biernacka, Joanna M; Winham, Stacey; Geske, Jennifer; Cuellar Barboza, Alfredo B; Prieto, Miguel L; Chauhan, Mohit; Seymour, Lisa R; Mori, Nicole; Frye, Mark A

    2013-09-25

    To explore the relationship between binge eating disorder (BED) and obesity in patients with bipolar disorder (BP). 717 patients participating in the Mayo Clinic Bipolar Biobank completed structured diagnostic interviews and questionnaires for demographic and illness-related variables. They also had weight and height measured to determine body mass index (BMI). The effects of BED and obesity (BMI≥30 kg/m(2)), as well as their interaction, were assessed on one measure of general medical burden and six proxies of psychiatric illness burden. 9.5% of patients received a clinical diagnosis of BED and 42.8% were obese. BED was associated with a significantly elevated BMI. Both BED and obesity were associated with greater psychiatric and general illness burden, but illness burden profiles differed. After controlling for obesity, BED was associated with suicidality, psychosis, mood instability, anxiety disorder comorbidity, and substance abuse comorbidity. After controlling for BED status, obesity was associated with greater general medical comorbidity, but lower substance abuse comorbidity. There were no significant interaction effects between obesity and BED, or BMI and BED, on any illness burden outcome. There may have been insufficient power to detect interactions between BED and obesity. Among patients with BP, BED and obesity are highly prevalent and correlated, but associated with different profiles of enhanced illness burden. As the association of BED with greater psychiatric illness burden remained significant even after accounting for the effect of obesity, BP with BED may represent a clinically important sub-phenotype. © 2013 Elsevier B.V. All rights reserved.

  13. Psychosis in bipolar disorder: Does it represent a more "severe" illness?

    Science.gov (United States)

    Burton, Cynthia Z; Ryan, Kelly A; Kamali, Masoud; Marshall, David F; Harrington, Gloria; McInnis, Melvin G; Tso, Ivy F

    2018-02-01

    Although there is a common clinical assumption that bipolar disorder with psychotic features reflects greater severity than bipolar disorder without psychosis, the existing empirical literature is mixed. This study investigated the phenomenology of psychosis as well as demographic, clinical, functional, and neuropsychological features in a large, cross-sectional sample of participants with bipolar disorder divided by history of psychosis. In a large single study, 168 affective-only bipolar disorder (BP-A) participants and 213 bipolar disorder with a history of psychosis (BP-P) participants completed a comprehensive clinical diagnostic interview and neuropsychological testing. t tests, chi-square tests, and Bayes factors were used to investigate group differences or lack thereof. The prevalence of psychosis in this sample (53%) was similar to published reports. Nearly half of BP-P participants experienced grandiose delusions, and relatively few endorsed "first-rank" hallucinations of running commentary or two or more voices conversing. There were no demographic or neuropsychological differences between groups. BP-A participants experienced greater chronicity of affective symptoms and a greater degree of rapid cycling than BP-P participants; there were no other clinical differences between groups. Overall, these results contradict the conventional notion that bipolar disorder with psychotic features represents a more severe illness than bipolar disorder without a history of psychosis. The presence of psychosis does not appear to be associated with poorer clinical/functional outcome or suggest a greater degree of neuropsychological impairment; conversely, the absence of psychosis was associated with affective chronicity and rapid cycling. Nosological and treatment implications are discussed. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Impulsivity in bipolar disorder: relationships with neurocognitive dysfunction and substance use history

    Science.gov (United States)

    Powers, Robyn L; Russo, Manuela; Mahon, Katie; Brand, Jesse; Braga, Raphael J; Malhotra, Anil K; Burdick, Katherine E

    2013-01-01

    Objectives Impulsivity is a core feature in bipolar disorder. Although mood symptoms exacerbate impulsivity, self-reports of impulsivity are elevated even during euthymia. Neurocognitive processes linked to impulsivity (e.g., attention, inhibition) are also impaired in patients with bipolar disorder and a high frequency of comorbidities associated with impulsivity, such as substance use disorders, further highlight the clinical relevance of this dimension of the illness. Our objective was to assess the relationship between impulsivity and cognition in bipolar disorder. Methods We evaluated impulsivity in 98 patients with bipolar disorder and its relationship with symptoms, cognition, and substance use history. We assessed self reports of trait-impulsivity [Barrett Impulsiveness Scale (BIS)] and impulsive behaviors on the Iowa Gambling Task (IGT). A comprehensive clinical and neurocognitive battery was also completed. Patients were compared with 95 healthy controls. Results Patients with bipolar disorder had higher scores versus healthy controls on all BIS scales. Performance on the IGT was significantly impaired and patients showed a tendency toward more erratic choices. Depressive symptoms were positively correlated with trait-impulsivity and with an increased tendency to attend more readily to losses versus gains on the IGT. We found no significant associations between impulsivity and neurocognition in the full bipolar sample; however, when sub-grouped based on substance abuse history, significant relationships were revealed only in subjects without a substance abuse history. Discussion Our data support prior reports of increased trait-impulsivity and impairment on behavioral tasks of impulsiveness in bipolar disorder and suggest a differential relationship between these illness features that is dependent upon history of substance abuse. PMID:24028391

  15. The effect of bariatric surgery on psychiatric course among patients with bipolar disorder.

    Science.gov (United States)

    Ahmed, Ameena T; Warton, E Margaret; Schaefer, Catherine A; Shen, Ling; McIntyre, Roger S

    2013-11-01

    Bariatric surgery is the most effective therapy for severe obesity. People with bipolar disorder have increased risk of obesity, yet are sometimes considered ineligible for bariatric surgery due to their bipolar disorder diagnosis. This study aimed to determine if bariatric surgery alters psychiatric course among stable patients with bipolar disorder. A matched cohort study (2006-2009) with mean follow-up of 2.17 years was conducted within Kaiser Permanente Northern California, a group practice integrated health services delivery organization that provides medical and psychiatric care to 3.3 million people. Participants were 144 severely obese patients with bipolar disorder who underwent bariatric surgery, and 1,440 control patients with bipolar disorder, matched for gender, medical center, and contemporaneous health plan membership. Controls met referral criteria for bariatric surgery. Hazard ratio for psychiatric hospitalization, and change in rate of outpatient psychiatric utilization from baseline to Years 1 and 2, were compared between groups. A total of 13 bariatric surgery patients (9.0%) and 153 unexposed to surgery (10.6%) had psychiatric hospitalization during follow-up. In multivariate Cox models adjusting for potential confounding factors, the hazard ratio of psychiatric hospitalization associated with bariatric surgery was 1.03 [95% confidence interval (CI): 0.83-1.23]. In fully saturated multivariate general linear models, change in outpatient psychiatric utilization was not significantly different for surgery patients versus controls, from baseline to Year 1 (-0.4 visits/year, 95% CI: -0.5 to 0.4) or baseline to Year 2 (0.4 visits/year, 95% CI: -0.1 to 1.0). Bariatric surgery did not affect psychiatric course among stable patients with bipolar disorder. The results of this study suggest that patients with bipolar disorder who have been evaluated as stable can be considered for bariatric surgery. © 2013 John Wiley & Sons A/S. Published by John

  16. Lithium and suicide prevention in bipolar disorder.

    Science.gov (United States)

    Benard, V; Vaiva, G; Masson, M; Geoffroy, P A

    2016-06-01

    Bipolar 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. We 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". As 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

  17. Association of brain-derived neurotrophic factor (BDNF) Val66Met polymorphism with early-onset bipolar disorder.

    Science.gov (United States)

    Nassan, Malik; Croarkin, Paul E; Luby, Joan L; Veldic, Marin; Joshi, Paramjit T; McElroy, Susan L; Post, Robert M; Walkup, John T; Cercy, Kelly; Geske, Jennifer R; Wagner, Karen D; Cuellar-Barboza, Alfredo B; Casuto, Leah; Lavebratt, Catharina; Schalling, Martin; Jensen, Peter S; Biernacka, Joanna M; Frye, Mark A

    2015-09-01

    Brain-derived neurotrophic factor (BDNF) Val66Met (rs6265) functional polymorphism has been implicated in early-onset bipolar disorder. However, results of studies are inconsistent. We aimed to further explore this association. DNA samples from the Treatment of Early Age Mania (TEAM) and Mayo Clinic Bipolar Disorder Biobank were investigated for association of rs6265 with early-onset bipolar disorder. Bipolar cases were classified as early onset if the first manic or depressive episode occurred at age ≤19 years (versus adult-onset cases at age >19 years). After quality control, 69 TEAM early-onset bipolar disorder cases, 725 Mayo Clinic bipolar disorder cases (including 189 early-onset cases), and 764 controls were included in the analysis of association, assessed with logistic regression assuming log-additive allele effects. Comparison of TEAM cases with controls suggested association of early-onset bipolar disorder with the rs6265 minor allele [odds ratio (OR) = 1.55, p = 0.04]. Although comparison of early-onset adult bipolar disorder cases from the Mayo Clinic versus controls was not statistically significant, the OR estimate indicated the same direction of effect (OR = 1.21, p = 0.19). When the early-onset TEAM and Mayo Clinic early-onset adult groups were combined and compared with the control group, the association of the minor allele rs6265 was statistically significant (OR = 1.30, p = 0.04). These preliminary analyses of a relatively small sample with early-onset bipolar disorder are suggestive that functional variation in BDNF is implicated in bipolar disorder risk and may have a more significant role in early-onset expression of the disorder. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Prevalence and correlates of bipolar disorders in patients with eating disorders.

    Science.gov (United States)

    Tseng, Mei-Chih Meg; Chang, Chin-Hao; Chen, Kuan-Yu; Liao, Shih-Cheng; Chen, Hsi-Chung

    2016-01-15

    To investigate the prevalence and correlates of bipolar disorders in patients with eating disorders (EDs), and to examine differences in effects between major depressive disorder and bipolar disorder on these patients. Sequential attendees were invited to participate in a two-phase survey for EDs at the general psychiatric outpatient clinics. Patients diagnosed with EDs (n=288) and controls of comparable age, sex, and educational level (n=81) were invited to receive structured interviews for psychiatric co-morbidities, suicide risks, and functional level. All participants also completed several self-administered questionnaires assessing general and eating-related pathology and impulsivity. Characteristics were compared between the control, ED-only, ED with major depressive disorder, and ED with bipolar disorder groups. Patients with all ED subtypes had significantly higher rates of major depressive disorder (range, 41.3-66.7%) and bipolar disorder (range, 16.7-49.3%) than controls did. Compared to patients with only EDs, patients with comorbid bipolar disorder and those with comorbid major depressive disorder had significantly increased suicidality and functional impairments. Moreover, the group with comorbid bipolar disorder had increased risks of weight dysregulation, more impulsive behaviors, and higher rates of psychiatric comorbidities. Participants were selected in a tertiary center of a non-Western country and the sample size of individuals with bipolar disorder in some ED subtypes was small. Bipolar disorders were common in patients with EDs. Careful differentiation between bipolar disorder and major depressive disorder in patients with EDs may help predict associated psychopathology and provide accurate treatment. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Abordagens psicoterápicas no transtorno bipolar Psychoterapeutic approach in bipolar disorder

    Directory of Open Access Journals (Sweden)

    Paulo Knapp

    2005-01-01

    Full Text Available Embora o tratamento farmacológico seja essencial para o tratamento do transtorno bipolar, apenas 40% de todos os pacientes que aderem às medicações permanecem assintomáticos durante o período de seguimento, o que tem levado ao desenvolvimento de intervenções psicoterápicas associadas. O objetivo deste artigo é examinar as evidências atuais da eficácia de intervenções psicoterápicas no tratamento do transtorno bipolar. Foi realizada uma pesquisa bibliográfica por meio do MedLine, PsychoINFO, Lilacs e Cochrane Data Bank, até o ano de 2004, em que foram procurados artigos originais e revisões sobre as abordagens psicoterápicas utilizadas no tratamento do transtorno bipolar. Há várias abordagens que podem se mostrar úteis no tratamento do transtorno bipolar. A psicoeducação e a terapia cognitivo-comportamental apresentam as evidências mais consistentes e são as técnicas mais amplamente estudadas. As intervenções envolvendo familiares e a terapia interpessoal e de ritmo social se mostram tratamentos eficazes em determinadas situações. Há alguns estudos empregando a terapia psicodinâmica no transtorno bipolar, mas são estudos com limitações metodológicas. Apesar de haver evidências demonstrando a eficácia de determinadas abordagens psicoterápicas no transtorno bipolar, ainda é necessária a realização de estudos posteriores que comprovem tais dados e que desenvolvam tratamentos baseados em modelos etiológicos e que identifiquem tratamentos específicos para as diferentes fases e tipos de transtorno bipolar.Although pharmacological treatment is essential for treating bipolar disorder, less than half of all medication compliant patients are non-symptomatic during follow-up, which has led to developments of adjunctive psychosocial interventions. This paper examines the current evidence for effectiveness of psychotherapeutic interventions in the treatment of bipolar disorder. Searches were undertaken through Med

  20. Enrichment of deleterious variants of mitochondrial DNA polymerase gene (POLG1) in bipolar disorder.

    Science.gov (United States)

    Kasahara, Takaoki; Ishiwata, Mizuho; Kakiuchi, Chihiro; Fuke, Satoshi; Iwata, Nakao; Ozaki, Norio; Kunugi, Hiroshi; Minabe, Yoshio; Nakamura, Kazuhiko; Iwata, Yasuhide; Fujii, Kumiko; Kanba, Shigenobu; Ujike, Hiroshi; Kusumi, Ichiro; Kataoka, Muneko; Matoba, Nana; Takata, Atsushi; Iwamoto, Kazuya; Yoshikawa, Takeo; Kato, Tadafumi

    2017-08-01

    Rare missense variants, which likely account for a substantial portion of the genetic 'dark matter' for a common complex disease, are challenging because the impacts of variants on disease development are difficult to substantiate. This study aimed to examine the impacts of amino acid substitution variants in the POLG1 found in bipolar disorder, as an example and proof of concept, in three different modalities of assessment: in silico predictions, in vitro biochemical assays, and clinical evaluation. We then tested whether deleterious variants in POLG1 contributed to the genetics of bipolar disorder. We searched for variants in the POLG1 gene in 796 Japanese patients with bipolar disorder and 767 controls and comprehensively investigated all 23 identified variants in the three modalities of assessment. POLG1 encodes mitochondrial DNA polymerase and is one of the causative genes for a Mendelian-inheritance mitochondrial disease, which is occasionally accompanied by mood disorders. The healthy control data from the Tohoku Medical Megabank Organization were also employed. Although the frequency of carriers of deleterious variants varied from one method to another, every assessment achieved the same conclusion that deleterious POLG1 variants were significantly enriched in the variants identified in patients with bipolar disorder compared to those in controls. Together with mitochondrial dysfunction in bipolar disorder, the present results suggested deleterious POLG1 variants as a credible risk for the multifactorial disease. © 2016 The Authors. Psychiatry and Clinical Neurosciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.

  1. How genes and environmental factors determine the different neurodevelopmental trajectories of schizophrenia and bipolar disorder.

    Science.gov (United States)

    Demjaha, Arsime; MacCabe, James H; Murray, Robin M

    2012-03-01

    The debate endures as to whether schizophrenia and bipolar disorder are separate entities or different manifestations of a single underlying pathological process. Here, we argue that this sterile argument obscures the fact that the truth lies somewhere in between. Thus, recent studies support a model whereby, on a background of some shared genetic liability for both disorders, patients with schizophrenia have been subject to additional genetic and/or environmental factors that impair neurodevelopment; for example, copy number variants and obstetric complications are associated with schizophrenia but not with bipolar disorder. As a result, children destined to develop schizophrenia show an excess of neuromotor delays and cognitive difficulties while those who later develop bipolar disorder perform at least as well as the general population. In keeping with this model, cognitive impairments and brain structural abnormalities are present at first onset of schizophrenia but not in the early stages of bipolar disorder. However, with repeated episodes of illness, cognitive and brain structural abnormalities accumulate in both schizophrenia and bipolar disorder, thus clouding the picture.

  2. Treating nonspecific anxiety and anxiety disorders in patients with bipolar disorder: a review.

    Science.gov (United States)

    Rakofsky, Jeffrey J; Dunlop, Boadie W

    2011-01-01

    To review the evidence for treating anxiety in patients with bipolar disorder. A literature search from 1950 to week 1 of August 2009 was conducted via OVID and the National Institutes of Health's clinical trials online databases. Search terms included anxiety, anxiety disorders, bipolar disorder, panic disorder, generalized anxiety disorder, social phobia, social anxiety, obsessive compulsive disorder, specific phobia, posttraumatic stress disorder, and treatment. Reference lists of identified articles were also searched. Fourteen treatment studies that included patients with bipolar disorder with either a syndrome-defined anxiety disorder or nonspecific anxiety were selected. Sample size, bipolar disorder subtype, comorbid anxiety disorders, baseline anxiety, treatment interventions, and outcome measurements were extracted. The majority of studies focus on treating anxiety disorders and nonspecific anxiety occurring during bipolar mood episodes. Studies of syndrome-defined anxiety disorders reveal that risperidone monotherapy did not separate from placebo and that olanzapine was superior to lamotrigine when used to augment lithium treatment. A study using open-label divalproex sodium and an uncontrolled study of group cognitive-behavioral therapy both suggest some benefit from these treatments in patients with bipolar disorder with panic disorder. Studies of nonspecific anxiety reveal some benefit for divalproex, quetiapine, olanzapine, and olanzapine-fluoxetine combination. Weaker evidence supports the use of Mindfulness-Based Cognitive Therapy, and observational studies suggest potential efficacy for gabapentin and valproate. Nonspecific anxiety symptoms occurring during a mood episode improve with treatment of the mood disturbance, though divalproex may be the mood stabilizer of choice for anxious patients with bipolar disorder. Given their reduced risk for manic induction and episode cycling, psychotherapy, benzodiazepines, and certain atypical antipsychotics

  3. Conversion (dissociative) symptoms as a presenting feature in early onset bipolar disorder: a case series

    OpenAIRE

    Ghosal, Malay Kumar; Guha, Prathama; Sinha, Mausumi; Majumdar, Debabrata; Sengupta, Payel

    2009-01-01

    We present three cases of early onset bipolar disorder where dissociative (conversion) symptoms preceded the onset of mania. This case series underscores the significance of dissociative/conversion symptoms as an early atypical presentation in juvenile bipolar disorder.

  4. Menopause and illness course in bipolar disorder: A systematic review.

    Science.gov (United States)

    Perich, Tania; Ussher, Jane; Meade, Tanya

    2017-09-01

    Menopause may be a time of increased mood symptoms for some women. This systematic review aimed to examine the severity of symptoms and prevalence of mood changes in women with bipolar disorder during peri-menopause and post-menopause. A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The two primary outcomes assessed were relapse rates and symptom severity during menopause. Databases searched were MEDLINE, EMBASE, PsychInfo, CINAHL and SCOPUS from January 1980 until December 2016. Nine studies, including a total of 273 participants diagnosed with bipolar disorder and who reported menopause, were included in the narrative synthesis. Menopause was reported to be associated with increased symptoms overall, and with depression in particular (range of 46%-91%). The collection of self-reported retrospective data was the most commonly used method to record menopause status. The impact of menopause on illness course for women with bipolar disorder is largely under-explored. Preliminary evidence suggests that it may be associated with increased bipolar symptoms. Further work is needed to explore how menopause may interact with bipolar disorder over time and the nature of these symptom changes, and if and how menopause may differ from other reproductive stages. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Validity and reliability of the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) in Japanese patients with bipolar disorder.

    Science.gov (United States)

    Toyoshima, Kuniyoshi; Fujii, Yutaka; Mitsui, Nobuyuki; Kako, Yuki; Asakura, Satoshi; Martinez-Aran, Anabel; Vieta, Eduard; Kusumi, Ichiro

    2017-08-01

    In Japan, there are currently no reliable rating scales for the evaluation of subjective cognitive impairment in patients with bipolar disorder. We studied the relationship between the Japanese version of the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) and objective cognitive assessments in patients with bipolar disorder. We further assessed the reliability and validity of the COBRA. Forty-one patients, aged 16-64, in a remission period of bipolar disorder were recruited from Hokkaido University Hospital in Sapporo, Japan. The COBRA (Japanese version) and Frankfurt Complaint Questionnaire (FCQ), the gold standard in subjective cognitive assessment, were administered. A battery of neuropsychological tests was employed to measure objective cognitive impairment. Correlations among the COBRA, FCQ, and neuropsychological tests were determined using Spearman's correlation coefficient. The Japanese version of the COBRA had high internal consistency, good retest reliability, and concurrent validity-as indicated by a strong correlation with the FCQ. A significant correlation was also observed between the COBRA and objective cognitive measurements of processing speed. These findings are the first to demonstrate that the Japanese version of the COBRA may be clinically useful as a subjective cognitive impairment rating scale in Japanese patients with bipolar disorder. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  6. Cortical complexity in bipolar disorder applying a spherical harmonics approach.

    Science.gov (United States)

    Nenadic, Igor; Yotter, Rachel A; Dietzek, Maren; Langbein, Kerstin; Sauer, Heinrich; Gaser, Christian

    2017-05-30

    Recent studies using surface-based morphometry of structural magnetic resonance imaging data have suggested that some changes in bipolar disorder (BP) might be neurodevelopmental in origin. We applied a novel analysis of cortical complexity based on fractal dimensions in high-resolution structural MRI scans of 18 bipolar disorder patients and 26 healthy controls. Our region-of-interest based analysis revealed increases in fractal dimensions (in patients relative to controls) in left lateral orbitofrontal cortex and right precuneus, and decreases in right caudal middle frontal, entorhinal cortex, and right pars orbitalis, and left fusiform and posterior cingulate cortices. While our analysis is preliminary, it suggests that early neurodevelopmental pathologies might contribute to bipolar disorder, possibly through genetic mechanisms. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  7. Visuospatial planning in unmedicated major depressive disorder and bipolar disorder : distinct and common neural correlates

    NARCIS (Netherlands)

    Rive, M. M.; Koeter, M. W. J.; Veltman, D. J.; Schene, A. H.; Ruhe, H. G.

    Background Cognitive impairments are an important feature of both remitted and depressed major depressive disorder (MDD) and bipolar disorder (BD). In particular, deficits in executive functioning may hamper everyday functioning. Identifying the neural substrates of impaired executive functioning

  8. Factor analysis of temperament and personality traits in bipolar patients: Correlates with comorbidity and disorder severity.

    Science.gov (United States)

    Qiu, Frank; Akiskal, Hagop S; Kelsoe, John R; Greenwood, Tiffany A

    2017-01-01

    Temperament and personality traits have been suggested as endophenotypes for bipolar disorder based on several lines of evidence, including heritability. Previous work suggested an anxious-reactive factor identified across temperament and personality inventories that produced significant group discrimination and could potentially be useful in genetic analyses. We have attempted to further characterize this factor structure in a sample of bipolar patients. A sample of 1195 subjects with bipolar I disorder was evaluated, all with complete data available. Dimension reduction across two inventories identified 18 factors explaining 39% of the variance. The two largest factors reflected affective instability and general anxiety/worry, respectively. Subsequent analyses of the clinical features associated with bipolar disorder revealed specificity for the factors in a predictable pattern. Cluster analysis of the factors identified a subgroup defined by a strong lack of general anxiety and low affective instability represented by the first two factors. The remaining subjects could be distinguished into two clusters by the presence of either more positive characteristics, including persistence/drive, spirituality, expressivity, and humor, or more negative characteristics of depression and anxiety. These analyses involved bipolar I subjects only and must be extended to other bipolar spectrum diagnoses, unaffected relatives, and individuals at risk. These results suggest that temperament and personality measures access latent traits associated with important clinical features of bipolar disorder. By translating clinical variables into quantitative traits, we may identify subgroups of bipolar patients with distinct clinical profiles, thereby facilitating both individual treatment strategies and genetic analyses. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. Depression diagnoses following the identification of bipolar disorder: costly incongruent diagnoses

    Directory of Open Access Journals (Sweden)

    Schultz Jennifer F

    2010-06-01

    Full Text Available Abstract Background Previous research has documented that the symptoms of bipolar disorder are often mistaken for unipolar depression prior to a patient's first bipolar diagnosis. The assumption has been that once a patient receives a bipolar diagnosis they will no longer be given a misdiagnosis of depression. The objectives of this study were 1 to assess the rate of subsequent unipolar depression diagnosis in individuals with a history of bipolar disorder and 2 to assess the increased cost associated with this potential misdiagnosis. Methods This study utilized a retrospective cohort design using administrative claims data from 2002 and 2003. Patient inclusion criteria for the study were 1 at least 2 bipolar diagnoses in 2002, 2 continuous enrollment during 2002 and 2003, 3 a pharmacy benefit, and 4 age 18 to 64. Patients with at least 2 unipolar depression diagnoses in 2003 were categorized as having an incongruent diagnosis of unipolar depression. We used propensity scoring to control for selection bias. Utilization was evaluated using negative binomial models. We evaluated cost differences between patient cohorts using generalized linear models. Results Of the 7981 patients who met all inclusion criteria for the analysis, 17.5% (1400 had an incongruent depression diagnosis (IDD. After controlling for background differences, individuals who received an IDD had higher rates of inpatient and outpatient psychiatric utilization and cost, on average, an additional $1641 per year compared to individuals without an IDD. Conclusions A strikingly high proportion of bipolar patients are given the differential diagnosis of unipolar depression after being identified as having bipolar disorder. Individuals with an IDD had increased acute psychiatric care services, suggesting higher levels of relapses, and were at risk for inappropriate treatment, as antidepressant therapy without a concomitant mood-stabilizing medication is contraindicated in bipolar

  10. GABAergic neuroactive steroids: a new frontier in bipolar disorders?

    Directory of Open Access Journals (Sweden)

    Carta Mauro Giovanni

    2012-12-01

    Full Text Available Abstract Neurosteroids are synthesized in the brain and modulate brain excitability. There is increasing evidence of their sedative, anesthetic and antiseizure properties, as well as their influence on mood. Currently neurosteroids are classified as pregnane neurosteroids (allopregnanolone and allotetrahydrodeoxycorticosterone, androstane neurosteroids (androstanediol and etiocholanone or sulfated neurosteroids (pregnenolone sulfate and dehydroepiandrosterone sulfate. Both preclinical and clinical findings indicate that progesterone derivative neurosteroids such as allopregnanolone and allotetrahydrodeoxycorticosterone play a role in mood disorders. Clozapine and olanzapine, which were shown to be effective in stabilizing bipolar disorder, elevate pregnenolone levels in rat hippocampus, cerebral cortex, and serum. In lithium-treated mice, the blood levels of allopregnanolone and pregnenolone were elevated compared to control levels. Women diagnosed with bipolar disorder typically show symptomatic exacerbation in relation to the menstrual cycle, and show vulnerability to the onset or recurrence of mood disorders immediately after giving birth, when the levels of neurosteroid derivatives of progesterone drop. Whereas in women who had recovered from bipolar disorder, the plasma concentration of allopregnanolone was elevated compared to either healthy controls or women with major depressive disorder during the premenstrual period. During depressive episodes, blood level of allopregnanolone is low. Treatment with fluoxetine tends to stabilize the levels of neurosteroids in depression. These findings converge to suggest that these steroids have significant mood-stabilizing effect. This hypothesis is consistent with the observation that a number of anticonvulsants are effective therapies for bipolar disorder, a finding also consistent with the antiseizure properties of neurosteroids. Further exploration of action of neuroactive steroids is likely to

  11. Self Stigma Among People with Bipolar-I Disorder in Iran

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    Gita Sadighi

    2015-03-01

    Full Text Available Objectives: Psychiatric stigma refers to systemic and internalized stereotypical negative attitudes against individual with mental illness. This article describes the level of self stigma, stereotype endorsement and perceived discrimination experienced by patients with Bipolar-I disorder in Tehran. Methods: Data were collected from a total of 126 patients with Bipolar-I disorder who responded to acute phase treatment using the Internalized Stigma of Mental Illness scale. The ISMI scale has five subscales: Alienation, Stereotype Endorsement, Perceived Discrimination, Social Withdrawal and Stigma Resistance. Results: In this study 26.7% of participants reported moderate to high levels of self stigma, 57.49% moderate to high levels of stigma resistance and 18.3% moderate to high levels of Perceived discrimination. Discussion: The results suggest that, self stigma appears in over one fifth of individuals with Bipolar-I disorder in Iran. The symptoms of Bipolar-I disorder has profound impacts on the quality of life of affected patients. Psychosocial functioning and self-esteem is impaired in people with Bipolar-I disorder. Interventions are required to reduce the negative effects of internalized stigma in this group.

  12. The prevalence of bipolar spectrum disorder in elderly patients with recurrent depression

    Science.gov (United States)

    Lee, Chang-In; Jung, Young-Eun; Kim, Moon-Doo; Hong, Seong-Chul; Bahk, Won-Myong; Yoon, Bo-Hyun

    2014-01-01

    Purpose Despite a growing body of knowledge on bipolar spectrum disorder (BSD), relatively little is known about the clinical characteristics of BSD in elderly people. We investigated the prevalence of BSD in elderly patients with recurrent depression. Patients and methods A total of 65 elderly outpatients (≥60 years of age) who met the Diagnostic and Statistical Manual of Mental Disorders IV criteria for recurrent major depressive disorder participated in the study. BSD was diagnosed according to the criteria developed by Ghaemi et al and the Mood Disorder Questionnaire (MDQ) was used to assess bipolarity. Results Of 65 subjects, eleven (16.9%) and 54 (83.1%) were diagnosed with BSD and unipolar depression, respectively. A total of 32.3% (n=22) had a positive screen for bipolar disorder, and we found a significant association between the BSD criteria and the criteria for a positive MDQ (Ppersonality (P=0.001), and atypical depression (P=0.030) were highly associated with MDQ-positive patients. Conclusion Our results indicate that many depressed elderly patients have bipolar-related illness; moreover, some features of the depression are associated with bipolarity. PMID:24855364

  13. Mapping vulnerability to bipolar disorder: a systematic review and meta-analysis of neuroimaging studies

    Science.gov (United States)

    Fusar-Poli, Paolo; Howes, Oliver; Bechdolf, Andreas; Borgwardt, Stefan

    2012-01-01

    Background Although early interventions in individuals with bipolar disorder may reduce the associated personal and economic burden, the neurobiologic markers of enhanced risk are unknown. Methods Neuroimaging studies involving individuals at enhanced genetic risk for bipolar disorder (HR) were included in a systematic review. We then performed a region of interest (ROI) analysis and a whole-brain meta-analysis combined with a formal effect-sizes meta-analysis in a subset of studies. Results There were 37 studies included in our systematic review. The overall sample for the systematic review included 1258 controls and 996 HR individuals. No significant differences were detected between HR individuals and controls in the selected ROIs: striatum, amygdala, hippocampus, pituitary and frontal lobe. The HR group showed increased grey matter volume compared with patients with established bipolar disorder. The HR individuals showed increased neural response in the left superior frontal gyrus, medial frontal gyrus and left insula compared with controls, independent from the functional magnetic resonance imaging task used. There were no publication biases. Sensitivity analysis confirmed the robustness of these results. Limitations As the included studies were cross-sectional, it remains to be determined whether the observed neurofunctional and structural alterations represent risk factors that can be clinically used in preventive interventions for prodromal bipolar disorder. Conclusion Accumulating structural and functional imaging evidence supports the existence of neurobiologic trait abnormalities in individuals at genetic risk for bipolar disorder at various scales of investigation. PMID:22297067

  14. Sustained Attention and Executive Functioning among Remitted Adolescents with Bipolar Disorder.

    Science.gov (United States)

    Maqbool, Masood; Sinha, Vinod Kumar; Vikas

    2015-01-01

    Neuro-cognitive functions have not been extensively studied among young bipolar disorder patients. Researchers have found cognitive deficits in bipolar disorder and many have found such deficits even in euthymic states of the disorder but results are still inconclusive. To study sustained attention and executive functioning in remitted adolescents with bipolar disorder. Present study was a hospital-based cross-sectional study. Twenty adolescents, aged 14-17 years with bipolar disorder, were selected for the study. Subjects were euthymic for at least 2 months. The performance of patients was matched with normal controls. Sustained attention was primarily measured by Letter Cancellation Test (LCT) and Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT) and Stroop Colour Word Test were used to assess executive functions. Two groups differed significantly on level of education and thus multivariate linear model was used and education was put as a covariate. Results revealed that patients preformed less well than control. Significant poor performance was reported on LCT (omission scores), TMT, Stroop and WCST. The study confirmed previous findings stating that cognitive deficits like sustained attention and executive functions continue to be present in adolescent bipolar patients even in euthymic states.

  15. Nationwide and population-based prescription patterns in bipolar disorder

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Vradi, Eleni; Andersen, Per Kragh

    2016-01-01

    OBJECTIVES: The aim of the present study was to describe prescription patterns and changes in these patterns over the last decade for patients diagnosed with bipolar disorder in mental healthcare, using population-based and nationwide data, and to relate the findings to recommendations from...... international guidelines. METHODS: A population-based, nationwide study was carried out. It included register-based longitudinal data on all patients with a first-ever contact with mental healthcare with a diagnosis of mania/bipolar disorder from the entire Danish population, and all prescription data...

  16. Synchronization of chaotic and nonchaotic oscillators: Application to bipolar disorder

    International Nuclear Information System (INIS)

    Nono Dueyou Buckjohn, C.; Siewe Siewe, M.; Tchawoua, C.; Kofane, T.C.

    2010-01-01

    In this Letter, we use a synchronization scheme on two bipolar disorder models consisting of a strong nonlinear system with multiplicative excitation and a nonlinear oscillator without parametric harmonic forcing. The stability condition following our control function is analytically demonstrated using the Lyapunov theory and Routh-Hurwitz criteria, we then have the condition for the existence of a feedback gain matrix. A convenient demonstration of the accuracy of the method is complemented by the numerical simulations from which we illustrate the synchronized dynamics between the two non-identical bipolar disorder patients.

  17. Synchronization of chaotic and nonchaotic oscillators: Application to bipolar disorder

    Science.gov (United States)

    Nono Dueyou Buckjohn, C.; Siewe Siewe, M.; Tchawoua, C.; Kofane, T. C.

    2010-08-01

    In this Letter, we use a synchronization scheme on two bipolar disorder models consisting of a strong nonlinear system with multiplicative excitation and a nonlinear oscillator without parametric harmonic forcing. The stability condition following our control function is analytically demonstrated using the Lyapunov theory and Routh-Hurwitz criteria, we then have the condition for the existence of a feedback gain matrix. A convenient demonstration of the accuracy of the method is complemented by the numerical simulations from which we illustrate the synchronized dynamics between the two non-identical bipolar disorder patients.

  18. Cortical Volume Alterations in Conduct Disordered Adolescents with and without Bipolar Disorder

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    Rene L. Olvera

    2014-04-01

    Full Text Available Background: There is increasing evidence that bipolar disorder (BD and conduct disorder (CD are co-occurring disorders. Magnetic resonance imaging has revealed differences in the structure and function of the frontal cortex in these disorders when studied separately; however, the impact of BD comorbidity on brain structure in adolescents with CD has not yet been examined. Method: We conducted an optimized voxel based morphometry (VBM study of juvenile offenders with the following diagnoses: conduct disorder with comorbid bipolar disorder (CD-BD; n = 24, conduct disorder without bipolar disorder (CD; n = 24 and healthy controls (HC, n = 24. Participants were 13–17 years of age, in a residential treatment facility for repeat offenders. The three groups in this study were similar in age, gender, socioeconomic status and ethnicity. Results: We found CD-BD subjects had decreased volume relative to controls at the voxel level in the right medial prefrontal cortex (PFC. Using a Threshold-Free Cluster Enhancement (TFCE technique, the CD-BD subjects had significantly decreased volumes of the right medial prefrontal cortex and portions of the superior and inferior frontal gyrus, anterior cingulate and temporal gyrus. The CD subjects did not have differences in brain volume compared to control subjects or CD-BD subjects. Conclusions: Our findings suggest the comorbidity between CD and BD is associated with neurobiological impact namely volumetric differences from healthy controls. Furthermore subjects with this comorbidity had poorer lifetime functioning, more mood and attentional dysfunction, and more medication exposure than subjects with CD who were not BD.

  19. Disruptive mood dysregulation disorder and its effect on bipolar disorder.

    Science.gov (United States)

    Faheem, Shama; Petti, Victoria; Mellos, George

    2017-05-01

    In the last few decades, a noticeable increase in the diagnosis of bipolar disorder (BD) in youth has raised concerns, particularly because of a consequent increase in the use of psychotropic medications with adverse side effects. After observing the development of those youth into adulthood, clinicians and researchers have questioned the notion of expanding the diagnostic boundaries of BD to encapsulate these youth. Our research is aimed at gleaning further information on disruptive mood dysregulation disorder (DMDD) and to observe whether its introduction has affected the rates of BD in children and adolescents. In a retrospective study, we calculated the frequencies of patients with BD admitted to a pediatric psychiatric hospital both before and after the introduction of DSM-5. We also observed age, sex, comorbid disorders, and management of DMDD. We found a decrease in the diagnosis of BD with the introduction of DMDD in DSM-5, without much change in treatment interventions utilized. Research on DMDD is limited so far. Further studies are needed to put together evidence-based guidelines and practice parameters for its management.

  20. Risk of bipolar disorder and schizophrenia in relatives of people with attention-deficit hyperactivity disorder.

    Science.gov (United States)

    Larsson, Henrik; Rydén, Eleonore; Boman, Marcus; Långström, Niklas; Lichtenstein, Paul; Landén, Mikael

    2013-08-01

    Attention-deficit hyperactivity disorder (ADHD) is associated with bipolar disorder and schizophrenia, and it has been suggested that combined bipolar disorder and ADHD is aetiologically distinct from the pure disorders. To clarify whether ADHD shares genetic and environmental factors with bipolar disorder and schizophrenia. By linking longitudinal Swedish national registers, we identified 61 187 persons with ADHD (the proband group) and their first- and second-degree relatives, and matched them with a control group of people without ADHD and their corresponding relatives. Conditional logistic regression was used to determine the risks of bipolar disorder and schizophrenia in the relatives of the two groups. First-degree relatives of the ADHD proband group were at increased risk of both bipolar disorder (odds ratio (OR) = 1.84-2.54 for parents, offspring and full siblings) and schizophrenia (OR = 1.71-2.22 for parents, offspring and full siblings). The risks of bipolar disorder and schizophrenia among second-degree relatives were substantially lower than among full siblings. These findings suggest that the co-occurrence of ADHD and bipolar disorder as well as ADHD and schizophrenia is due to shared genetic factors, rather than representing completely aetiologically distinct subsyndromes.

  1. Family Intervention with a Case of Bipolar I Disorder with Family Conflict

    Science.gov (United States)

    Sahu, Kamlesh Kumar

    2013-01-01

    Bipolar disorder is a major mental illness. Inherited treatment of bipolar disorder has been focused on pharmacological treatments. Though, psychosocial variables appear to be important antecedents of bipolar disorder, poor drug compliance, expressed emotion or faulty communication and life events play a vital role in relapse. Conflict is commonly…

  2. Coping strategies and real-world functioning in bipolar disorder.

    Science.gov (United States)

    Nitzburg, George C; Russo, Manuela; Cuesta-Diaz, Armando; Ospina, Luz; Shanahan, Megan; Perez-Rodriguez, Mercedes; McGrath, Meaghan; Burdick, Katherine E

    2016-07-01

    Bipolar disorder (BD) patients encounter significant life adversity, which has contributed to bipolar disorder being a leading cause of disability worldwide. Studies suggest BD patients have more maladaptive coping strategies, some of which can impact their illness course. Yet research on which coping strategies most influence disability is lacking. Such research could inform cognitive-behavioral targets to improve functional outcomes. Thus, we sought to identify relations between coping strategies and real-world function in BD. In 92 affectively-stable BD outpatients, we measured coping strategies via the Brief COPE, real-world disability via the World Health Organization Disability Assessment Schedule, current symptoms, illness chronicity, and neurocognitive functioning via the MATRICS. Multiple regression analysis served to identify the neurocognitive domains predictive of disability for entry into subsequent analyses. Multiple regressions assessed how adaptive and maladaptive coping strategies influenced disability. Only one neurocognitive domain, verbal learning, significantly predicted disability and was included in subsequent analyses. Maladaptive coping significantly predicted disability while adaptive coping did not. Behavioral disengagement (giving up) and self-blame were the only remaining predictors of disability, after controlling for age, sex, illness chronicity, current symptoms, and neurocognitive functioning. The study was limited by the use of a self-report disability measure and a brief-form coping scale. Results suggest that giving up and self-blame are significant predictors of real-world functioning beyond sub-threshold depressive symptoms. Our results in BD expand upon recent schizophrenia studies suggesting that defeatist beliefs negatively influence functional outcomes across the range of major psychiatric disorders. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. Neuroleptic-induced deficit syndrome in bipolar disorder with psychosis

    Directory of Open Access Journals (Sweden)

    Ueda S

    2016-02-01

    Full Text Available Satoshi Ueda,1 Takeshi Sakayori,1 Ataru Omori,2 Hajime Fukuta,3 Takashi Kobayashi,3 Kousuke Ishizaka,1 Tomoyuki Saijo,4 Yoshiro Okubo1 1Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan; 2Tamachuo Hospital, Tokyo, Japan; 3Kurumegaoka Hospital, Tokyo, Japan; 4Saijo Clinic, Tokyo, Japan Abstract: Neuroleptics can induce not only physical adverse effects but also mental effects that produce deficit status in thought, affect, cognition, and behavior. This condition is known as neuroleptic-induced deficit syndrome (NIDS, which includes apathy, lack of initiative, anhedonia, indifference, blunted affect, and reduced insight into disease. Although this old concept now appears almost forgotten, neuroleptics, whether typical or atypical, can make depression or bipolar disorder resemble other more refractory conditions, readily leading to mistaken diagnosis and inappropriate treatment. The authors describe three cases of NIDS superimposed on depressive phase in bipolar disorder with psychosis, where the attending psychiatrist’s failure to recognize NIDS prevented patients from receiving effective treatment and achieving remission. All cases achieved remission after reduction of neuroleptics and intensive therapy, including electroconvulsive therapy, for bipolar depression. The concept of NIDS was originally introduced for schizophrenia, and it has rarely been highlighted in other diseases. In recent years, however, atypical antipsychotics are being more often administered to patients with bipolar disorder. Psychiatrists, therefore, should also remember and exercise caution regarding NIDS in the pharmacotherapy of bipolar disorder with and without psychosis. The authors believe that the concept of NIDS needs to be reappraised in current psychiatry. Keywords: neuroleptic-induced deficit syndrome (NIDS, bipolar disorder, psychosis, atypical antipsychotics, electroconvulsive therapy

  4. Meta-Analysis of Amygdala Volumes in Children and Adolescents with Bipolar Disorder

    Science.gov (United States)

    Pfeifer, Jonathan C.; Welge, Jeffrey; Strakowski. Stephen M.; Adler, Caleb M.; Delbello, Melissa P.

    2008-01-01

    The size of amygdala of bipolar youths and adults is investigated using neuroimaging studies. Findings showed that smaller volumes of amygdala were observed in youths with bipolar youths compared with children and adolescents without bipolar disorder. The structural amygdala abnormalities in bipolar youths are examined further.

  5. Influence of birth cohort on age of onset cluster analysis in bipolar I disorder

    DEFF Research Database (Denmark)

    Bauer, M.; Glenn, T.; Alda, M.

    2015-01-01

    Purpose: Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset......, using a large, international database. Methods: The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth...... for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups. Conclusion: These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based...

  6. Mood self-assessment in bipolar disorder: a comparison between patients in mania, depression, and euthymia

    Directory of Open Access Journals (Sweden)

    Rafael de Assis da Silva

    2013-01-01

    Full Text Available BACKGROUND: Some studies indicate that mood self-assessment is more severely impaired in patients with bipolar disorder in a manic episode than in depression. OBJECTIVES: To investigate variations in mood self-assessment in relation to current affective state in a group of individuals with bipolar disorder. METHODS: A total of 165 patients with a diagnosis of bipolar disorder type I or type II had their affective state assessed using the Clinical Global Impressions Scale for use in bipolar illness (CGI-BP, the Positive and Negative Syndrome Scale (PANSS, and the Global Assessment of Functioning (GAF. In addition, participants completed a self-report visual analog mood scale (VAMS. Patients were divided into three groups (euthymia, mania, and depression and compared with regard to VAMS results. RESULTS: Manic patients rated their mood similarly to patients in euthymia in 14 out of 16 items in the VAMS. By contrast, depressed patients rated only two items similarly to euthymic patients. CONCLUSION: Patients with bipolar disorder in mania, but not those in depression, poorly evaluate their affective state, reinforcing the occurrence of insight impairment in the manic syndrome.

  7. Can structural MRI aid in clinical classification? A machine learning study in two independent samples of patients with schizophrenia, bipolar disorder and healthy subjects.

    Science.gov (United States)

    Schnack, Hugo G; Nieuwenhuis, Mireille; van Haren, Neeltje E M; Abramovic, Lucija; Scheewe, Thomas W; Brouwer, Rachel M; Hulshoff Pol, Hilleke E; Kahn, René S

    2014-01-01

    Although structural magnetic resonance imaging (MRI) has revealed partly non-overlapping brain abnormalities in schizophrenia and bipolar disorder, it is unknown whether structural MRI scans can be used to separate individuals with schizophrenia from those with bipolar disorder. An algorithm capable of discriminating between these two disorders could become a diagnostic aid for psychiatrists. Here, we scanned 66 schizophrenia patients, 66 patients with bipolar disorder and 66 healthy subjects on a 1.5T MRI scanner. Three support vector machines were trained to separate patients with schizophrenia from healthy subjects, patients with schizophrenia from those with bipolar disorder, and patients with bipolar disorder from healthy subjects, respectively, based on their gray matter density images. The predictive power of the models was tested using cross-validation and in an independent validation set of 46 schizophrenia patients, 47 patients with bipolar disorder and 43 healthy subjects scanned on a 3T MRI scanner. Schizophrenia patients could be separated from healthy subjects with an average accuracy of 90%. Additionally, schizophrenia patients and patients with bipolar disorder could be distinguished with an average accuracy of 88%.The model delineating bipolar patients from healthy subjects was less accurate, correctly classifying 67% of the healthy subjects and only 53% of the patients with bipolar disorder. In the latter group, lithium and antipsychotics use had no influence on the classification results. Application of the 1.5T models on the 3T validation set yielded average classification accuracies of 76% (healthy vs schizophrenia), 66% (bipolar vs schizophrenia) and 61% (healthy vs bipolar). In conclusion, the accurate separation of schizophrenia from bipolar patients on the basis of structural MRI scans, as demonstrated here, could be of added value in the differential diagnosis of these two disorders. The results also suggest that gray matter pathology in

  8. Atypical antipsychotics in bipolar disorder: systematic review of randomised trials

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    Moore R Andrew

    2007-08-01

    Full Text Available Abstract Background Atypical antipsychotics are increasingly used for treatment of mental illnesses like schizophrenia and bipolar disorder, and considered to have fewer extrapyramidal effects than older antipsychotics. Methods We examined efficacy in randomised trials of bipolar disorder where the presenting episode was either depression, or manic/mixed, comparing atypical antipsychotic with placebo or active comparator, examined withdrawals for any cause, or due to lack of efficacy or adverse events, and combined all phases for adverse event analysis. Studies were found through systematic search (PubMed, EMBASE, Cochrane Library, and data combined for analysis where there was clinical homogeneity, with especial reference to trial duration. Results In five trials (2,206 patients participants presented with a depressive episode, and in 25 trials (6,174 patients the presenting episode was manic or mixed. In 8-week studies presenting with depression, quetiapine and olanzapine produced significantly better rates of response and symptomatic remission than placebo, with NNTs of 5–6, but more adverse event withdrawals (NNH 12. With mania or mixed presentation atypical antipsychotics produced significantly better rates of response and symptomatic remission than placebo, with NNTs of about 5 up to six weeks, and 4 at 6–12 weeks, but more adverse event withdrawals (NNH of about 22 in studies of 6–12 weeks. In comparisons with established treatments, atypical antipsychotics had similar efficacy, but significantly fewer adverse event withdrawals (NNT to prevent one withdrawal about 10. In maintenance trials atypical antipsychotics had significantly fewer relapses to depression or mania than placebo or active comparator. In placebo-controlled trials, atypical antipsychotics were associated with higher rates of weight gain of ≥7% (mainly olanzapine trials, somnolence, and extrapyramidal symptoms. In active controlled trials, atypical antipsychotics

  9. Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Hansen, Hanne Vibe; Hvenegaard, Anne

    2013-01-01

    BACKGROUND: Little is known about whether treatment in a specialised out-patient mood disorder clinic improves long-term prognosis for patients discharged from initial psychiatric hospital admissions for bipolar disorder. AIMS: To assess the effect of treatment in a specialised out-patient mood...... disorder clinic v. standard decentralised psychiatric treatment among patients discharged from one of their first three psychiatric hospital admissions for bipolar disorder. METHOD: Patients discharged from their first, second or third hospital admission with a single manic episode or bipolar disorder were...... randomised to treatment in a specialised out-patient mood disorder clinic or standard care (ClinicalTrials.gov: NCT00253071). The primary outcome measure was readmission to hospital, which was obtained from the Danish Psychiatric Central Register. RESULTS: A total of 158 patients with mania/bipolar disorder...

  10. Parental death and bipolar disorder: a robust association was found in early maternal suicide

    DEFF Research Database (Denmark)

    Tsuchiya, Kenji; Agerbo, Esben; Mortensen, Preben Bo

    2005-01-01

    of a conditional logistic regression analysis. RESULTS: Among 947 subjects with bipolar disorder and 47,350 controls, those having experienced the parental suicide were significantly associated with an increased risk for BPD (incidence rate ratios: 1.83 [95% confidence interval: 1.07 to 3.12] for paternal suicide......BACKGROUND: Previous studies have suggested that early parental death may be associated with the emergence of bipolar disorder in later life. However, it remains unknown whether this association applies specifically to parental death due to suicide or only to early parental death. The present study...... were born in 1960 or later and were first admitted to or had first contact with Danish psychiatric facilities between 1981 and 1998 with a diagnosis of bipolar disorder, and fifty age-matched controls per case were extracted. The effects of the deaths of relatives were estimated by means...

  11. Causes of decreased life expectancy over the life span in bipolar disorder

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Vradi, Eleni; McIntyre, Roger S

    2015-01-01

    BACKGROUND: Accelerated aging has been proposed as a mechanism explaining the increased prevalence of comorbid general medical illnesses in bipolar disorder. AIMS: To test the hypothesis that lost life years due to natural causes starts in early and mid-adulthood, supporting the hypothesis...... of accelerated aging. METHODS: Using individual data from nationwide registers of patient with a diagnosis of bipolar disorder we calculated remaining life expectancies before age 90 years for values of age 15, 25, 35…75 years among all individuals alive in year 2000. Further, we estimated the reduction in life...... expectancy due to natural causes (physical illnesses) and unnatural causes (suicide and accidents) in relation to age. RESULTS: A total of 22,635 patients with bipolar disorder were included in the study in addition to data from the entire Danish general population of 5.4 million people. At age 15 years...

  12. Similar familial underpinnings for full and subsyndromal pediatric bipolar disorder: A familial risk analysis.

    Science.gov (United States)

    Wozniak, Janet; Uchida, Mai; Faraone, Stephen V; Fitzgerald, Maura; Vaudreuil, Carrie; Carrellas, Nicholas; Davis, Jacqueline; Wolenski, Rebecca; Biederman, Joseph

    2017-05-01

    To examine the validity of subthreshold pediatric bipolar I disorder (BP-I), we compared the familial risk for BP-I in the child probands who had either full BP-I, subthreshold BP-I, ADHD, or were controls that neither had ADHD nor bipolar disorder. BP-I probands were youth aged 6-17 years meeting criteria for BP-I, full (N=239) or subthreshold (N=43), and also included were their first-degree relatives (N=687 and N=120, respectively). Comparators were youth with ADHD (N=162), controls without ADHD or bipolar disorder (N=136), and their first-degree relatives (N=511 and N=411, respectively). We randomly selected 162 non-bipolar ADHD probands and 136 non-bipolar, non-ADHD control probands of similar age and sex distribution to the BP-I probands from our case-control ADHD family studies. Psychiatric assessments were made by trained psychometricians using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Epidemiological Version (KSADS-E) and Structured Clinical Interview for DSM-IV (SCID) structured diagnostic interviews. We analyzed rates of bipolar disorder using multinomial logistic regression. Rates of full BP-I significantly differed between the four groups (χ 2 3 =32.72, Pdisorder compared to relatives of control probands. Our results showed that youth with subthreshold BP-I had similarly elevated risk for BP-I and major depressive disorder in first-degree relatives as youth with full BP-I. These findings support the diagnostic continuity between subsyndromal and fully syndromatic states of pediatric BP-I disorder. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Transcription factor SP4 is a susceptibility gene for bipolar disorder.

    Directory of Open Access Journals (Sweden)

    Xianjin Zhou

    Full Text Available The Sp4 transcription factor plays a critical role for both development and function of mouse hippocampus. Reduced expression of the mouse Sp4 gene results in a variety of behavioral abnormalities relevant to human psychiatric disorders. The human SP4 gene is therefore examined for its association with both bipolar disorder and schizophrenia in European Caucasian and Chinese populations respectively. Out of ten SNPs selected from human SP4 genomic locus, four displayed significant association with bipolar disorder in European Caucasian families (rs12668354, p = 0.022; rs12673091, p = 0.0005; rs3735440, p = 0.019; rs11974306, p = 0.018. To replicate the genetic association, the same set of SNPs was examined in a Chinese bipolar case control sample. Four SNPs displayed significant association (rs40245, p = 0.009; rs12673091, p = 0.002; rs1018954, p = 0.001; rs3735440, p = 0.029, and two of them (rs12673091, rs3735440 were shared with positive SNPs from European Caucasian families. Considering the genetic overlap between bipolar disorder and schizophrenia, we extended our studies in Chinese trios families for schizophrenia. The SNP7 (rs12673091, p = 0.012 also displayed a significant association. The SNP7 (rs12673091 was therefore significantly associated in all three samples, and shared the same susceptibility allele (A across all three samples. On the other hand, we found a gene dosage effect for mouse Sp4 gene in the modulation of sensorimotor gating, a putative endophenotype for both schizophrenia and bipolar disorder. The deficient sensorimotor gating in Sp4 hypomorphic mice was partially reversed by the administration of dopamine D2 antagonist or mood stabilizers. Both human genetic and mouse pharmacogenetic studies support Sp4 gene as a susceptibility gene for bipolar disorder or schizophrenia. The studies on the role of Sp4 gene in hippocampal development may provide novel insights for the contribution of hippocampal abnormalities in these

  14. Cognitive behavioral therapy for insomnia in euthymic bipolar disorder: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Steinan, Mette Kvisten; Krane-Gartiser, Karoline; Langsrud, Knut; Sand, Trond; Kallestad, Håvard; Morken, Gunnar

    2014-01-16

    Patients with bipolar disorder experience sleep disturbance, even in euthymic phases. Changes in sleep pattern are frequent signs of a new episode of (hypo)mania or depression. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for primary insomnia, but there are no published results on the effects of CBT-I in patients with bipolar disorder. In this randomized controlled trial, we wish to compare CBT-I and treatment as usual with treatment as usual alone to determine its effect in improving quality of sleep, stabilizing minor mood variations and preventing new mood episodes in euthymic patients with bipolar disorder and comorbid insomnia. Patients with euthymic bipolar I or II disorder and insomnia, as verified by the Structured Clinical Interview for DSM Disorders (SCID-1) assessment, will be included. The patients enter a three-week run-in phase in which they complete a sleep diary and a mood diary, are monitored for seven consecutive days with an actigraph and on two of these nights with polysomnography in addition before randomization to an eight-week treatment trial. Treatment as usual consists of pharmacological and supportive psychosocial treatment. In this trial, CBT-I will consist of sleep restriction, psychoeducation about sleep, stabilization of the circadian rhythm, and challenging and correcting sleep state misperception, in three to eight sessions. This trial could document a new treatment for insomnia in bipolar disorder with possible effects on sleep and on stability of mood. In addition, more precise information can be obtained about the character of sleep disturbance in bipolar disorder. ClinicalTrials.gov: NCT01704352.

  15. Pediatric Bipolar Disorder: Diagnostic Challenges in Identifying Symptoms and Course of Illness

    OpenAIRE

    Singh, Tanvir

    2008-01-01

    Based on available literature, this article reviews the challenges associated with diagnosing pediatric bipolar disorder. The article also reviews and provides discussion on the assessment tools, complex mood cycling, and clinical symptoms of pediatric bipolar disorder. The challenge of differentiating common comorbid disorders like attention deficit hyperactivity disorder and conduct disorder from pediatric bipolar disorder is presented and discussed. A discussion of the validity of diagnosi...

  16. Creativity and bipolar disorder: Touched by fire or burning with questions?☆

    Science.gov (United States)

    Johnson, Sheri L.; Murray, Greg; Fredrickson, Barbara; Youngstrom, Eric A.; Hinshaw, Stephen; Bass, Julie Malbrancq; Deckersbach, Thilo; Schooler, Jonathan; Salloum, Ihsan

    2012-01-01

    Substantial literature has linked bipolar disorder with creative accomplishment. Much of the thinking in this area has been inspired by biographical accounts of poets, musicians, and other highly accomplished groups, which frequently document signs of bipolar disorder in these samples. A smaller literature has examined quantitative measures of creativity among people with bipolar disorder or at risk for the disorder. In this paper, we provide a critical review of such evidence. We then consider putative mechanisms related to the link of bipolar disorder with creativity, by drawing on literature outside of bipolar disorder on personality, motivational, and affective predictors of creativity. Because so little research has directly evaluated whether these factors could help explain the elevations of creativity in bipolar disorder, we conclude with an agenda for future research on the theoretically and clinically compelling topic of creativity in bipolar disorder. PMID:22088366

  17. Bipolar disorder and co-occurring cannabis use disorders: characteristics, co-morbidities and clinical correlates.

    Science.gov (United States)

    Lev-Ran, Shaul; Le Foll, Bernard; McKenzie, Kwame; George, Tony P; Rehm, Jürgen

    2013-10-30

    This study examines rates of co-morbid mental disorders and indicators of the course of illness among individuals with bipolar disorder and cannabis use disorders (CUD). Data were drawn from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC Wave 1, 2001-2002), a nationally representative sample of adults living in the United States. Among individuals with lifetime prevalence of bipolar disorder (N=1905) rates of CUD in the past 12 months were 7.2%, compared to 1.2% in the general population. Logistic regression models adjusting for sociodemographic variables indicated that individuals with bipolar disorder and co-occurring CUD were at increased risk for nicotine dependence (Adjusted Odds Ratio (AOR)=3.8), alcohol (AOR=6.6) and drug (AOR=11.9) use disorders, as well as antisocial personality disorder (AOR=2.8) compared to those without CUD. Among individuals with co-occurring CUD, age of onset of bipolar disorder was significantly lower and median number of manic, hypomanic and depressive episodes per year was significantly greater compared to individuals without CUD. Co-occurring CUD is associated with significant co-morbidities and a more severe course of illness among individuals with bipolar disorder. Comprehensive evaluation of patients with bipolar disorder should include a systematic assessment of CUD. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  18. Pharmacological Approaches for Treatment-resistant Bipolar Disorder

    Science.gov (United States)

    Poon, Shi Hui; Sim, Kang; Baldessarini, Ross J.

    2015-01-01

    Bipolar disorder is prevalent, with high risks of disability, substance abuse and premature mortality. Treatment responses typically are incomplete, especially for depressive components, so that many cases can be considered “treatment resistant.” We reviewed reports on experimental treatments for such patients: there is a striking paucity of such research, mainly involving small incompletely controlled trials of add-on treatment, and findings remain preliminary. Encouraging results have been reported by adding aripiprazole, bupropion, clozapine, ketamine, memantine, pramipexole, pregabalin, and perhaps tri-iodothyronine in resistant manic or depressive phases. The urgency of incomplete responses in such a severe illness underscores the need for more systematic, simpler, and better controlled studies in more homogeneous samples of patients. PMID:26467409

  19. Systematic assessment of environmental risk factors for bipolar disorder

    DEFF Research Database (Denmark)

    Bortolato, Beatrice; Köhler, Cristiano A.; Evangelou, Evangelos

    2017-01-01

    Objectives: The pathophysiology of bipolar disorder is likely to involve both genetic and environmental risk factors. In our study, we aimed to perform a systematic search of environmental risk factors for BD. In addition, we assessed possible hints of bias in this literature, and identified risk...... factors supported by high epidemiological credibility. Methods: We searched the Pubmed/MEDLINE, EMBASE and PsycInfo databases up to 7 October 2016 to identify systematic reviews and meta-analyses of observational studies that assessed associations between putative environmental risk factors and BD....... For each meta-analysis, we estimated its summary effect size by means of both random- and fixed-effects models, 95% confidence intervals (CIs), the 95% prediction interval, and heterogeneity. Evidence of small-study effects and excess of significance bias was also assessed. Results: Sixteen publications...

  20. Smartphone data as objective measures of bipolar disorder symptoms

    DEFF Research Database (Denmark)

    Faurholt-Jepsen, Maria; Frost, Mads; Vinberg, Maj

    2014-01-01

    The daily electronic self-monitoring Smartphone software "MONARCA" was used by 17 patients with bipolar disorder for 3 consecutive months. Patients were rated fortnightly using Hamilton Depression rating Scale 17 items (HDRS-17) and Young Mania rating Scale (YMRS) (102 ratings) with blinding...

  1. The relationship between brain volumes and intelligence in bipolar disorder

    NARCIS (Netherlands)

    Vreeker, Annabel; Abramovic, Lucija; Boks, Marco P.M.; Verkooijen, Sanne; van Bergen, Annet H.; Ophoff, Roel A.; Kahn, René S.; van Haren, Neeltje E.M.

    2017-01-01

    Objectives Bipolar disorder type-I (BD-I) patients show a lower Intelligence Quotient (IQ) and smaller brain volumes as compared with healthy controls. Considering that in healthy individuals lower IQ is related to smaller total brain volume, it is of interest to investigate whether IQ deficits in

  2. Schizophrenia and bipolar disorder: no recovery without suicide prevention.

    Science.gov (United States)

    Foster, Tom

    2015-11-01

    Suicide prevention for people with schizophrenia or bipolar disorder warrants an evidence-based approach to service design as well as clinical practice. The issue of personal responsibility (diminished when mental capacity is impaired) contributing to reduction of suicide risk has, arguably, been neglected. © The Royal College of Psychiatrists 2015.

  3. Parenting among Mothers with Bipolar Disorder: Children's Perspectives

    Science.gov (United States)

    Venkataraman, Meenakshi

    2011-01-01

    Four children from three families in which the mother had a bipolar disorder were interviewed to understand their perspectives on their mothers' parenting. Children identified strengths in their mother's parenting, such as helping them with homework and moods and providing for their wants. They also identified challenges, such as mothers sleeping…

  4. Peer Relationship Difficulties in Adolescents with Bipolar Disorder

    Science.gov (United States)

    Siegel, Rebecca S.; Freeman, Andrew J.; La Greca, Annette M.; Youngstrom, Eric A.

    2015-01-01

    Background: Pediatric bipolar disorder (PBD) is associated with psychosocial impairment, but few studies have examined peer relationship functioning and PBD. Adolescence is a crucial developmental period when peers become increasingly salient. Objective: This study compared perceived friendship quality and peer victimization in adolescents with…

  5. Reward Processing in Adolescents with Bipolar I Disorder

    Science.gov (United States)

    Singh, Manpreet K.; Chang, Kiki D.; Kelley, Ryan G.; Cui, Xu; Sherdell, Lindsey; Howe, Meghan E.; Gotlib, Ian H.; Reiss, Allan L.

    2013-01-01

    Objective: Bipolar disorder (BD) is a debilitating psychiatric condition that commonly begins in adolescence, a developmental period that has been associated with increased reward seeking. Because youth with BD are especially vulnerable to negative risk-taking behaviors, understanding the neural mechanisms by which dysregulated affect interacts…

  6. Information Processing in Adolescents with Bipolar I Disorder

    Science.gov (United States)

    Whitney, Jane; Joormann, Jutta; Gotlib, Ian H.; Kelley, Ryan G.; Acquaye, Tenah; Howe, Meghan; Chang, Kiki D.; Singh, Manpreet K.

    2012-01-01

    Background: Cognitive models of bipolar I disorder (BD) may aid in identification of children who are especially vulnerable to chronic mood dysregulation. Information-processing biases related to memory and attention likely play a role in the development and persistence of BD among adolescents; however, these biases have not been extensively…

  7. Early Onset Bipolar Spectrum Disorder: Psychopharmacological, Psychological, and Educational Management

    Science.gov (United States)

    McIntosh, David E.; Trotter, Jeffrey S.

    2006-01-01

    Although published research continues to advocate medication as the first line of treatment for early onset bipolar spectrum disorder (EOBSD; N. Lofthouse & M.A. Fristad, 2004), preliminary research demonstrating the utility of cognitive, cognitive-behavioral, and psychoeducational therapies is promising. It appears as if future treatment of EOBSD…

  8. Early Onset Bipolar Disorder: Clinical and Research Considerations

    Science.gov (United States)

    Carlson, Gabrielle A.

    2005-01-01

    This article examined some of the reasons for confusion and controversy surrounding the frequency of diagnosis of bipolar disorder, especially in prepubertal children. Four case vignettes are used to articulate questions surrounding manifestations of euphoria and grandiosity, informant variance, diagnostic implications of medication-induced…

  9. Bipolar disorder, childhood bereavement, and the return of the dead ...

    African Journals Online (AJOL)

    Upon its head, with red extended mouth and solitary eye of fire, sat the hideous beast whose craft had seduced me into murder ...' From 'The Black Cat', written c. age 35 (Poe 1975:230). Keywords: Edgar Allan Poe; bipolar disorder, childhood bereavement, and the return of the dead; literary criticism; American poetry; ...

  10. 7. Bipolar disorder in child psychiatric practice.cdr

    African Journals Online (AJOL)

    ESEM

    old Memory's sister diagnosed with bipolar I disorder and generalized ... Memory was dressed provocatively, in a bright shirt and her skirt painted with colored ink. While talking she was absent-minded, inattentive, it was clear that it took efforts to keep the attention on the ... The girl denies auditory or visual hallucinations and.

  11. Connection between Genetic and Clinical Data in Bipolar Disorder

    DEFF Research Database (Denmark)

    Mellerup, Erling; Andreassen, Ole; Bennike, Bente

    2012-01-01

    Complex diseases may be associated with combinations of changes in DNA, where the single change has little impact alone. In a previous study of patients with bipolar disorder and controls combinations of SNP genotypes were analyzed, and four large clusters of combinations were found to be signifi...

  12. No association between serum cholesterol and death by suicide in patients with schizophrenia, bipolar affective disorder, or major depressive disorder.

    Science.gov (United States)

    Park, Subin; Yi, Ki Kyoung; Na, Riji; Lim, Ahyoung; Hong, Jin Pyo

    2013-12-05

    Previous research on serum total cholesterol and suicidality has yielded conflicting results. Several studies have reported a link between low serum total cholesterol and suicidality, whereas others have failed to replicate these findings, particularly in patients with major affective disorders. These discordant findings may reflect the fact that studies often do not distinguish between patients with bipolar and unipolar depression; moreover, definitions and classification schemes for suicide attempts in the literature vary widely. Subjects were patients with one of the three major psychiatric disorders commonly associated with suicide: schizophrenia, bipolar affective disorder, and major depressive disorder (MDD). We compared serum lipid levels in patients who died by suicide (82 schizophrenia, 23 bipolar affective disorder, and 67 MDD) and non-suicide controls (200 schizophrenia, 49 bipolar affective disorder, and 175 MDD). Serum lipid profiles did not differ between patients who died by suicide and control patients in any diagnostic group. Our results do not support the use of biological indicators such as serum total cholesterol to predict suicide risk among patients with a major psychiatric disorder.

  13. STUDY ON EXECUTIVE DYSFUNCTION IN EUTHYMIC PHASE OF PATIENTS WITH BIPOLAR AFFECTIVE DISORDER

    Directory of Open Access Journals (Sweden)

    Shijin Ammanamveetil Ummar

    2016-07-01

    Full Text Available BACKGROUND: Although classically conceptualised as a disorder of mood, a consensus is emerging that patients with bipolar disorder show cognitive deficits both during the acute phase of illness and during remission (Savitz et al., 2005. The cognitive dysfunction seen in bipolar disorder may also be a key to longterm disability, which in turn is likely to adversely affect psychosocial functioning, insight and treatment adherence. AIM To assess the executive functions in euthymic phase of bipolar affective disorder subjects and study the relationship between cognitive functions and illness variables. MATERIALS AND METHODS 30 BPAD patients were assessed in the euthymic phase for executive dysfunction on four tests- verbal fluency, Trail making tests, Stroop colour word tests and Wisconsin card sorting tests and compared with controls. An intragroup analysis was then done to determine the effect of illness variables. Statistical analysis of the data has been done using the Statistical Package for Social Sciences. RESULTS Executive function was significantly impaired in the bipolar group when compared to normal controls. On analysing the relation of executive dysfunction with illness variables, only number of episodes had a significant effect, that too on a subtest of Stroop. CONCLUSION The presence of executive dysfunction may be a trait marker of bipolar illness and its relation with progression of illness need to be assessed.

  14. Alteration of complex negative emotions induced by music in euthymic patients with bipolar disorder.

    Science.gov (United States)

    Choppin, Sabine; Trost, Wiebke; Dondaine, Thibaut; Millet, Bruno; Drapier, Dominique; Vérin, Marc; Robert, Gabriel; Grandjean, Didier

    2016-02-01

    Research has shown bipolar disorder to be characterized by dysregulation of emotion processing, including biases in facial expression recognition that is most prevalent during depressive and manic states. Very few studies have examined induced emotions when patients are in a euthymic phase, and there has been no research on complex emotions. We therefore set out to test emotional hyperreactivity in response to musical excerpts inducing complex emotions in bipolar disorder during euthymia. We recruited 21 patients with bipolar disorder (BD) in a euthymic phase and 21 matched healthy controls. Participants first rated their emotional reactivity on two validated self-report scales (ERS and MAThyS). They then rated their music-induced emotions on nine continuous scales. The targeted emotions were wonder, power, melancholy and tension. We used a specific generalized linear mixed model to analyze the behavioral data. We found that participants in the euthymic bipolar group experienced more intense complex negative emotions than controls when the musical excerpts induced wonder. Moreover, patients exhibited greater emotional reactivity in daily life (ERS). Finally, a greater experience of tension while listening to positive music seemed to be mediated by greater emotional reactivity and a deficit in executive functions. The heterogeneity of the BD group in terms of clinical characteristics may have influenced the results. Euthymic patients with bipolar disorder exhibit more complex negative emotions than controls in response to positive music. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Metabolomics of Major Depressive Disorder and Bipolar Disorder: Overview and Future Perspective.

    Science.gov (United States)

    Hashimoto, Kenji

    2018-01-01

    Major depressive disorder (MDD) and bipolar disorder (BD) are the most common mood disorders. They are etiologically related, but clinically distinct psychiatric illnesses. Their shared clinical features result in high rates of misdiagnosis due to a lack of biomarkers that allow their differentiation. BD is more frequently misdiagnosed as MDD because of overlapping symptomology, often later onset of mania, and frequent occurrence of depressive episodes in patients with BD. Misdiagnosis is also increased when patients with BD present symptoms indicative of a clinically significant depressive episode, but are premorbid for manic symptoms, or previous manic states not recognized. Therefore, the development of specific biomarkers for these disorders would be invaluable for establishing the correct diagnosis and treatment of MDD and BD. This chapter presents an overview and future perspective of the identification of biomarkers for mood disorders using metabolomics. © 2018 Elsevier Inc. All rights reserved.

  16. Bipolar Disorder and/or Creative Bipolarity: Robert Schumann's Exemplary Psychopathology - Combining Symptomatological and Psychosocial Perspectives with Creativity Research.

    Science.gov (United States)

    Holm-Hadulla, Rainer Matthias; Koutsoukou-Argyraki, Asimina

    2017-01-01

    The psychopathological condition of Robert Schumann has been a prominent object of study in psychiatry since his hospitalization in 1854. Renowned psychiatrists have diagnosed Schumann with syphilis, schizophrenia, and bipolar and personality disorders. Until today, these analyses of his symptomatology have led to contradictory results. Recent discussion has suggested that his hospitalization was due to professional failure and separation wishes on the part of his wife, her family, and her friends. In line with this hypothesis is the opinion that the separation insisted upon by Clara Schumann was reinforced by the economic interests of the psychiatrist who kept Schumann in custody for 2 years until his death in 1856. In this article, we trace the complex interaction of bipolar vulnerability and pathogenic life events with hypersensitive talent and "creative bipolarity," defined as the capacity, motivation, and resilience to transform emotional stress and cognitive inconsistency into coherent artistic products. Finally, we present our conclusions about comprehensive psychiatric and psychotherapeutic treatment with respect to "creative bipolarity." © 2017 S. Karger AG, Basel.

  17. [Bipolar disorders and comorbid anxiety: prognostic impact and therapeutic challenges].

    Science.gov (United States)

    Cazard, F; Ferreri, F

    2013-02-01

    Anxiety disorders are among the main psychiatric conditions co-occuring with bipolar disorders. Many clinical and epidemiological studies have found much higher prevalence rates of generalized anxiety disorder, social phobia, obsessive-compulsive disorder, panic disorder and post-traumatic stress disorder in bipolar patients than in the general population, regardless of age. In the National Comorbidity Survey for instance, the diagnosis of at least one anxiety disorder was made for nearly 90% of bipolar subjects. Several issues arise from this high comorbidity, such as the way anxiety disorders alter the course and prognosis of the mood disorder, and challenge typical therapeutic strategies. This article reviews data on clinical and therapeutical significance of such comorbidity. Many studies point out the poorer outcome for bipolar patients with co-occurring anxiety symptoms: apart from the alarming increase of suicidal ideas and suicide attempts, authors have found a shorter duration of euthymia, more comorbid addictions, mixed states and rapid cycling, and lower response to treatments. This is the reason why monitoring the suicidal risk in those bipolar patients with co-occurring anxiety disorders is of critical importance. From a physiopathological standpoint, the precise links between both pathologies remains unclear. The frequency of this comorbidity and its significance on long term prognosis stands in sharp contrast with the very few therapeutic studies conducted in this indication so far. Pharmacological approaches are strongly limited by the risk of mood switching under antidepressants and drug dependence on anxiolytics such as benzodiazepines. Nevertheless, there is emerging evidence of the interest of atypical antipsychotics such as olanzapine and mood stabilisers such as lamotrigine to control anxiety symptoms in bipolar patients. There is weaker evidence for other molecules. Taking into account other therapeutic approaches than the pharmacological

  18. A combined analysis of genome-wide expression profiling of bipolar disorder in human prefrontal cortex.

    Science.gov (United States)

    Wang, Jinglu; Qu, Susu; Wang, Weixiao; Guo, Liyuan; Zhang, Kunlin; Chang, Suhua; Wang, Jing

    2016-11-01

    Numbers of gene expression profiling studies of bipolar disorder have been published. Besides different array chips and tissues, variety of the data processes in different cohorts aggravated the inconsistency of results of these genome-wide gene expression profiling studies. By searching the gene expression databases, we obtained six data sets for prefrontal cortex (PFC) of bipolar disorder with raw data and combinable platforms. We used standardized pre-processing and quality control procedures to analyze each data set separately and then combined them into a large gene expression matrix with 101 bipolar disorder subjects and 106 controls. A standard linear mixed-effects model was used to calculate the differentially expressed genes (DEGs). Multiple levels of sensitivity analyses and cross validation with genetic data were conducted. Functional and network analyses were carried out on basis of the DEGs. In the result, we identified 198 unique differentially expressed genes in the PFC of bipolar disorder and control. Among them, 115 DEGs were robust to at least three leave-one-out tests or different pre-processing methods; 51 DEGs were validated with genetic association signals. Pathway enrichment analysis showed these DEGs were related with regulation of neurological system, cell death and apoptosis, and several basic binding processes. Protein-protein interaction network further identified one key hub gene. We have contributed the most comprehensive integrated analysis of bipolar disorder expression profiling studies in PFC to date. The DEGs, especially those with multiple validations, may denote a common signature of bipolar disorder and contribute to the pathogenesis of disease. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. The Risk of Treatment-Emergent Mania With Methylphenidate in Bipolar Disorder.

    Science.gov (United States)

    Viktorin, Alexander; Rydén, Eleonore; Thase, Michael E; Chang, Zheng; Lundholm, Cecilia; D'Onofrio, Brian M; Almqvist, Catarina; Magnusson, Patrik K E; Lichtenstein, Paul; Larsson, Henrik; Landén, Mikael

    2017-04-01

    The authors sought to determine the risk of treatment-emergent mania associated with methylphenidate, used in monotherapy or with a concomitant mood-stabilizing medication, in patients with bipolar disorder. Using linked Swedish national registries, the authors identified 2,307 adults with bipolar disorder who initiated therapy with methylphenidate between 2006 and 2014. The cohort was divided into two groups: those with and those without concomitant mood-stabilizing treatment. To adjust for individual-specific confounders, including disorder severity, genetic makeup, and early environmental factors, Cox regression analyses were used, conditioning on individual to compare the rate of mania (defined as hospitalization for mania or a new dispensation of stabilizing medication) 0-3 months and 3-6 months after medication start following nontreated periods. Patients on methylphenidate monotherapy displayed an increased rate of manic episodes within 3 months of medication initiation (hazard ratio=6.7, 95% CI=2.0-22.4), with similar results for the subsequent 3 months. By contrast, for patients taking mood stabilizers, the risk of mania was lower after starting methylphenidate (hazard ratio=0.6, 95% CI=0.4-0.9). Comparable results were observed when only hospitalizations for mania were counted. No evidence was found for a positive association between methylphenidate and treatment-emergent mania among patients with bipolar disorder who were concomitantly receiving a mood-stabilizing medication. This is clinically important given that up to 20% of people with bipolar disorder suffer from comorbid ADHD. Given the markedly increased hazard ratio of mania following methylphenidate initiation in bipolar patients not taking mood stabilizers, careful assessment to rule out bipolar disorder is indicated before initiating monotherapy with psychostimulants.

  20. Perceived stigma and depression among caregivers of patients with bipolar disorder.

    Science.gov (United States)

    Perlick, Deborah A; Miklowitz, David J; Link, Bruce G; Struening, Elmer; Kaczynski, Richard; Gonzalez, Jodi; Manning, Lauren N; Wolff, Nancy; Rosenheck, Robert A

    2007-06-01

    This study investigates the associations between perceived stigma, depressive symptoms and coping among caregivers of people with bipolar disorder. Caregivers of 500 people with DSM-IV bipolar disorder responded to measures of these constructs at study entry. Patients' clinical and functional status were evaluated within 30 days of the caregiver assessment. Perceived stigma was positively associated with caregiver depressive symptoms, controlling for patient status and socio-demographic factors. Social support and avoidance coping accounted for 63% of the relationship between caregiver stigma and depression. Results suggest that caregivers' perceptions of stigma may negatively affect their mental health by reducing their coping effectiveness.

  1. Model endophenotype for bipolar disorder: Qualitative Analysis, etiological factors, and research areas

    Directory of Open Access Journals (Sweden)

    Naraiana de Oliveira Tavares

    2014-12-01

    Full Text Available The aim of this study is to present an updated view of the writings on the endophenotype model for bipolar disorder using analytical methodologies. A review and analysis of networks was performed through descriptors and keywords that characterize the composition of the endophenotype model as a model of health. Information was collected from between 1992 and 2014, and the main thematic areas covered in the articles were identified. We discuss the results and question their cohesion, emphasizing the need to strengthen and identify the points of connection between etiological factors and characteristics that make up the model of endophenotypes for bipolar disorder.

  2. Correlates of impulsive and hostile behavior in patients with borderline personality disorder and bipolar II disorder

    Directory of Open Access Journals (Sweden)

    Ali Reza Shafiee-Kandjani

    2017-03-01

    Full Text Available Introduction: Patients with borderline personality disorder (BPD suffer from a higher degree of impulsive and hostile behavior, compared with other psychiatric disorders. On the other hand, the impulsive behavior in these patients is different from the patients with type II bipolar disorder (BMD II. This study aimed to investigate the differences between patients with BPD and patients with bipolar disorder in the aggressiveness and impulsivity scales. Methods: A descriptive-analytical study through a convenience sampling method was conducted on 117 patients with BPD (30 patients and BMD II (87 patients who completed the Buss and Perry’s Aggression Questionnaire as well as the Barratt Impulsiveness Scale. The obtained data was analyzed in SPSS using Student’s t-test, and its results were considered significant at P < 0.05 level. Results: The two groups were significantly different in terms of attention and cognitive complexity of Barratt Impulsiveness Scales, hostility, physical aggression, as well as in the total score of Buss and Perry’s aggression and hostility questionnaire, in which the scores in patients with BMD in the above-mentioned scales were higher, compared with the BPD and finally, the marital status variable was significantly correlated with age, physical aggression, anger, anxiety, cognitive complexity, and perseverance.Conclusion: The patients with BMD II experienced a higher degree of excitement in terms of hostility, violence and impulsivity measures; it is also different from the patients with borderline disorder in terms of type of aggressiveness.

  3. The societal cost of bipolar disorder in Sweden.

    Science.gov (United States)

    Ekman, Mattias; Granström, Ola; Omérov, Sead; Jacob, Johanna; Landén, Mikael

    2013-10-01

    There is a lack of comprehensive cost-of-illness studies in bipolar disorder, in particular studies based on patient-level data. The purpose of this study was to estimate the societal cost of bipolar disorder and to relate costs to disease severity, depressive episodes, hospitalisation and patient functioning. Retrospective resource use data in inpatient and outpatient care during 2006-2008, as well as ICD-10 diagnoses and Global Assessment of Functioning (GAF) scores, were obtained from the Northern Stockholm psychiatric clinic with a catchment area including 47% of the adult inhabitants in Stockholm. This dataset was combined with national register data on prescription pharmaceuticals and sick leave to estimate the societal cost of bipolar disorder. The study was conducted from a societal perspective, with indirect costs valued according to the human capital method. The average annual cost per patient was 28,011 in 2008 (n = 1,846). Indirect costs due to sick leave and early retirement represented 75%, inpatient costs 13%, outpatient costs 8%, pharmaceuticals 2% and community care another 2% of the total cost. Total costs were considerably higher during mood episodes (six times higher than in remission), for hospitalised patients (55,500 vs. 22,200) and for patients with low GAF scores. The high cost of bipolar disorder is driven primarily by indirect costs. Costs were strongly associated with mood episodes, hospitalisations and low GAF scores. This suggests that treatment that reduces the risk for relapses and hospitalizations and improve functioning may decrease both the societal cost of bipolar disorder and patient suffering.

  4. Brain functional effects of psychopharmacological treatments in bipolar disorder.

    Science.gov (United States)

    Laidi, Charles; Houenou, Josselin

    2016-11-01

    Functional magnetic resonance imaging (fMRI) studies have contributed to the understanding of bipolar disorder. However the effect of medication on brain activation remains poorly understood. We conducted an extensive literature review on PubMed and ScienceDirect to investigate the influence of medication in fMRI studies, including both longitudinal and cross-sectional studies, which aimed at assessing this influence. Although we reported all reviewed studies, we gave greater emphasis to studies with the most robust methodology. One hundred and forty studies matched our inclusion criteria and forty-seven studies demonstrated an effect of pharmacological treatment on fMRI blood oxygen level dependent (BOLD) signal in adults and children with bipolar disorder. Out of these studies, nineteen were longitudinal. Most of cross-sectional studies suffered from methodological bias, due to post-hoc analyses performed on a limited number of patients and did not find any effect of medication. However, both longitudinal and cross-sectional studies showing an impact of treatment tend to suggest that medication prescribed to patients with bipolar disorder mostly influenced brain activation in prefrontal regions, when measured by tasks involving emotional regulation and processing as well as non-emotional cognitive tasks. FMRI promises to elucidate potential new biomarkers in bipolar disorder and could be used to evaluate the effect of new therapeutic compounds. Further research is needed to disentangle the effect of medication and the influence of the changes in mood state on brain activation in patients with bipolar disorder. Copyright © 2016 Elsevier B.V. and ECNP. All rights reserved.

  5. Psychotropic drug prescription patterns among patients with bipolar I disorder.

    Science.gov (United States)

    Levine, J; Chengappa, K N; Brar, J S; Gershon, S; Yablonsky, E; Stapf, D; Kupfer, D J

    2000-06-01

    Combination treatment, rather than monotherapy, is prevalent in the treatment of subjects with bipolar disorder, probably due to the complex and phasic nature of the illness. In general, prescription patterns may be influenced by the demographic characteristics of patients as well. We evaluated prescription patterns and the influence of demographic variables on these patterns in a voluntary registry of subjects with bipolar disorder. A subset of data from a larger voluntary registry was extracted for demographic variables and psychotropic medication use that had been reported in the month prior to registration by ambulatory, non-hospitalized subjects with bipolar I disorder in 1995/96 (n = 457). Among the thymoleptic agents, lithium was prescribed in over 50% of subjects, valproate in approximately 40%, and carbamazepine in 11% of subjects. Eighteen percent of subjects had no prescription for thymoleptic agents. Nearly one-third of all subjects were receiving antipsychotic agents, of whom two-thirds were receiving the traditional neuroleptic agents. More than half of all subjects were receiving concomitant antidepressants, of whom nearly 50% received the SSRI antidepressants and nearly 25% received buproprion. Approximately 40% of subjects received benzodiazepines. Only 18% of subjects received monotherapy, and nearly 50% received three or more psychotropic agents. In general, no associations were noted between demographic parameters including age, gender, marital or educational status, and psychotropic prescriptions. Consistent with the anecdotal reports, these data confirm that combination treatment is far more common than monotherapy. Demography appears to have a minimal impact on cross-sectional prescription patterns in subjects with bipolar disorder. Given that combination treatments are the rule rather than the exception, we should strive to achieve rational, yet pragmatic, treatment guidelines and algorithms to minimize the risks while maximizing the

  6. re:Mind - A mobile application for bipolar disorder patients

    DEFF Research Database (Denmark)

    Corradini, Andrea; Lyck Festersen, Pia

    2014-01-01

    Several personal healthcare monitoring systems have been proposed to target somatic diseases and specific mental illness. This paper reports on the re:Mind system, which is a helpful tool that supports the treatment of people diagnosed with bipolar disorder. We developed the system as a hybrid...... mobile application to help bipolar patients self-monitor a set of parameters that are known to affect their illness while also allowing them to communicate with their physician. Based on data collected from medical personnel, clinicians, patients, patients’ relatives and persons akin to them, we created...

  7. Effectiveness of the Dader Method for Pharmaceutical Care on Patients with Bipolar I Disorder: Results from the EMDADER-TAB Study.

    Science.gov (United States)

    Salazar-Ospina, Andrea; Amariles, Pedro; Hincapié-García, Jaime A; González-Avendaño, Sebastián; Benjumea, Dora M; Faus, Maria José; Rodriguez, Luis F

    2017-01-01

    Bipolar I disorder (BD-I) is a chronic illness characterized by relapses alternating with periods of remission. Pharmacists can contribute to improved health outcomes in these patients through pharmaceutical care in association with a multidisciplinary health team; however, more evidence derived from randomized controlled trials (RCTs) is needed to demonstrate the effect of pharmaceutical care on patients with BD-I. To assess the effectiveness of a pharmaceutical intervention using the Dader Method on patients with BD-I, measured by the decrease in the number of hospitalizations, emergency service consultations, and unscheduled outpatient visits from baseline through 1 year of follow-up. This study is based on the EMDADER-TAB trial, which was an RCT designed to compare pharmaceutical care with the usual care given to outpatients with BD-I in a psychiatric clinic. The main outcome was the use of health care services, using Kaplan-Meier methods and Cox regression. The trial protocol was registered in ClinicalTrials.gov (Identifier NCT01750255). 92 patients were included in the EMDADER-TAB study: 43 pharmaceutical care patients (intervention group) and 49 usual care patients (control group). At baseline, no significant differences in demographic and clinical characteristics were found across the 2 groups. After 1 year of follow-up, the risk of hospitalizations and emergencies was higher for the control group than for the intervention group (HR = 9.03, P = 0.042; HR = 3.38, P = 0.034, respectively); however, the risk of unscheduled outpatient visits was higher for the intervention group (HR = 4.18, P = 0.028). There was no "placebo" treatment, and patients in the control group might have produced positive outcomes and reduced the magnitude of differences compared with the intervention group. Compared with usual care, pharmaceutical care significantly reduced hospitalizations and emergency service consultations by outpatients with BD-I. This study received funding from

  8. ESPECTRA: Searching the Bipolar Spectrum in Eating Disorder patients

    Directory of Open Access Journals (Sweden)

    Moreno Ricardo A

    2011-04-01

    Full Text Available Abstract Background Bipolar Disorder (BD is a chronic, recurrent and highly prevalent illness. Despite the need for correct diagnosis to allow proper treatment, studies have shown that reaching a diagnosis can take up to ten years due to the lack of recognition of the broader presentations of BD. Frequent comorbidities with other psychiatric disorders are a major cause of misdiagnosis and warrant thorough evaluation. Methods/Design ESPECTRA (Occurrence of Bipolar Spectrum Disorders in Eating Disorder Patients is a single-site cross-sectional study involving a comparison group, designed to evaluate the prevalence of bipolar spectrum in an eating disorder sample. Women aged 18-45 years will be evaluated using the SCID-P and Zurich criteria for diagnosis and the HAM-D, YOUNG, SCI-MOODS, HCL-32, BIS-11, BSQ, WHOQoL and EAS instruments for rating symptoms and measuring clinical correlates. Discussion The classificatory systems in psychiatry are based on categorical models that have been criticized for simplifying the diagnosis and leading to an increase in comorbidities. Some dimensional approaches have been proposed aimed at improving the validity and reliability of psychiatric disorder assessments, especially in conditions with high rates of comorbidity such as BD and Eating Disorder (ED. The Bipolar Spectrum (BS remains under-recognized in clinical practice and its definition is not well established in current diagnostic guidelines. Broader evaluation of psychiatric disorders combining categorical and dimensional views could contribute to a more realistic understanding of comorbidities and help toward establishing a prognosis.

  9. Cognitive deficits in bipolar disorders: Implications for emotion.

    Science.gov (United States)

    Lima, Isabela M M; Peckham, Andrew D; Johnson, Sheri L

    2018-02-01

    Prominent cognitive deficits have been documented in bipolar disorder, and multiple studies suggest that these deficits can be observed among non-affected first-degree relatives of those with bipolar disorder. Although there is variability in the degree of cognitive deficits, these deficits are robustly relevant for functional outcomes. A separate literature documents clear difficulties in emotionality, emotion regulation, and emotion-relevant impulsivity within bipolar disorder, and demonstrates that these emotion-relevant variables are also central to outcome. Although cognitive and emotion domains are typically studied independently, basic research and emergent findings in bipolar disorder suggest that there are important ties between cognitive deficits and the emotion disturbances observed in bipolar disorder. Understanding these relationships has relevance for fostering more integrative research, for clarifying relevant aspects related to functionality and vulnerability within bipolar disorder, and for the development of novel treatment interventions. Bipolar disorder (BD) is a severe psychiatric illness that has been ranked as one of the 20 leading medical causes of disability (WHO, 2011). BD has been shown to be the psychiatric disorder with the highest rates of completed suicide across two major cohort studies (Ilgen et al., 2010; Nordentoft, Mortensen, & Pedersen, 2011). In a cross-national representative sample, one in four persons diagnosed with bipolar I disorder reported a suicide attempt (Merikangas et al., 2011). Rates of relapse remain high despite available treatments (Gitlin, Swendsen, Heller, & Hammen, 1995), and in the year after hospitalization for manic episode, two-thirds of patients do not return to work (Strakowski et al., 1998). Poverty, homelessness, and incarceration are all too common (Copeland et al., 2009). Despite the often poor outcomes, there is also evidence for outstanding accomplishments and creativity among those with milder

  10. Heritability and linkage analysis of personality in bipolar disorder.

    Science.gov (United States)

    Greenwood, Tiffany A; Badner, Judith A; Byerley, William; Keck, Paul E; McElroy, Susan L; Remick, Ronald A; Dessa Sadovnick, A; Kelsoe, John R

    2013-11-01

    The many attempts that have been made to identify genes for bipolar disorder (BD) have met with limited success, which may reflect an inadequacy of diagnosis as an informative and biologically relevant phenotype for genetic studies. Here we have explored aspects of personality as quantitative phenotypes for bipolar disorder through the use of the Temperament and Character Inventory (TCI), which assesses personality in seven dimensions. Four temperament dimensions are assessed: novelty seeking (NS), harm avoidance (HA), reward dependence (RD), and persistence (PS). Three character dimensions are also included: self-directedness (SD), cooperativeness (CO), and self-transcendence (ST). We compared personality scores between diagnostic groups and assessed heritability in a sample of 101 families collected for genetic studies of BD. A genome-wide SNP linkage analysis was then performed in the subset of 51 families for which genetic data was available. Significant group differences were observed between BD subjects, their first-degree relatives, and independent controls for all but RD and PS, and all but HA and