BACKGROUND Recently,a growing number of adolescents have been afflicted with mental disorders,with annual morbidity rates on the rise.This trend has been exacerbated by the global coronavirus disease 2019(COVID-19)pan...BACKGROUND Recently,a growing number of adolescents have been afflicted with mental disorders,with annual morbidity rates on the rise.This trend has been exacerbated by the global coronavirus disease 2019(COVID-19)pandemic,leading to a surge in suicide and self-harm rates among this demographic.AIM To investigate the impact of the COVID-19 pandemic on adolescent bipolar disorder(BD),along with the underlying factors contributing to heightened rates of suicide and self-harm among adolescents.METHODS A comprehensive statistical analysis was conducted utilizing clinical interviews and self-reports obtained from patients or their guardians.Diagnostic criteria for BDs were based on the Diagnostic and statistical manual of mental disorders,international classification of diseases-11,and the National institute of mental health research domain criteria.Statistical analyses were performed using SPSS 26.0 software,with significance set at P<0.05.RESULTS A cohort of 171 adolescents diagnosed with BD between January 1,2018,and December 31,2022,was included in the analysis.The gender distribution was 2.8:1(female to male),with ages ranging from 11 to 18 years old.Major factors contributing to adolescent BDs included familial influences,academic stress,genetic predisposition and exposure to school-related violence.Notably,a significant increase in suicide attempts and self-harm incidents was observed among adolescents with BD during the COVID-19 pandemic.Statistical analysis indicated that the pandemic exacerbated familial discord and heightened academic stress,thereby amplifying the prevalence of suicidal behavior and self-harm among adolescents.CONCLUSION The COVID-19 pandemic has exacerbated familial tensions and intensified the incidence of suicide and self-harm among adolescents diagnosed with BD.This study underscores the urgent need for societal,familial and educational support systems to prioritize the well-being of adolescents and offers valuable insights and guidelines for the prevention,diagnosis and treatment of adolescent BDs.展开更多
Rapid-cycling bipolar disorder(RCBD)is a phase of bipolar disorder defined by the presence of≥4 mood episodes in a year.It is a common phenomenon characterized by greater severity,a predominance of depression,higher ...Rapid-cycling bipolar disorder(RCBD)is a phase of bipolar disorder defined by the presence of≥4 mood episodes in a year.It is a common phenomenon characterized by greater severity,a predominance of depression,higher levels of disability,and poorer overall outcomes.It is resistant to treatment by conventional pharmacotherapy.The existing literature underlines the scarcity of evidence and the gaps in knowledge about the optimal treatment strategies for RCBD.However,most reviews have considered only pharmacological treatment options for RCBD.Given the treatment-refractory nature of RCBD,nonpharmacological interventions could augment medications but have not been adequately examined.This review carried out an updated and comprehensive search for evidence regarding the role of nonpharmacological therapies as adjuncts to medications in RCBD.We identified 83 reviews and meta-analyses concerning the treatment of RCBD.Additionally,we found 42 reports on adjunctive nonpharmacological treatments in RCBD.Most of the evidence favoured concomitant electroconvulsive therapy as an acute and maintenance treatment.There was preliminary evidence to suggest that chronotherapeutic treatments can provide better outcomes when combined with medications.The research on adjunctive psychotherapy was particularly scarce but suggested that psychoeducation,cognitive behavioural therapy,family interventions,and supportive psychotherapy may be helpful.The overall quality of evidence was poor and suffered from several methodological shortcomings.There is a need for more methodologically sound research in this area,although clinicians can use the existing evidence to select and individualize nonpharmacological treatment options for better management of RCBD.Patient summaries are included to highlight some of the issues concerning the implementation of adjunctive nonpharmacological treatments.展开更多
This paper is a systematic review of the treatment of bipolar disorder: a systematic Google Scholar search aimed at treatment guidelines and clinical trials. The search for treatment guidelines returned 375 papers and...This paper is a systematic review of the treatment of bipolar disorder: a systematic Google Scholar search aimed at treatment guidelines and clinical trials. The search for treatment guidelines returned 375 papers and was last performed from June 1, 2022 to August 30, 2022. The literature suggests that lithium helps control and alleviate severe mood episodes, and olanzapine is effective for acute manic or mixed episodes of bipolar I disorder. Achieving effectiveness or remission is better with Cariprazine. Lurasidone improves cognitive performance. Quetiapine improves sleep quality and co-morbid anxiety. Lamotrigine helps delay depression, mania, and mild manic episodes. Antidepressants are best used in conjunction with mood stabilizers. For co-morbid treatment, carbamazepine and lithium in combination are more effective in the treatment of psychotic mania. Co-morbid anxiety treatment considers adjunctive olanzapine or lamotrigine. Co-morbid bulimia treatment considers a mood stabilizer. Co-morbid fatigue treatment considers a dawn simulator. For diet, pay attention to a healthy diet, patients can ingest probiotics and pay attention to the balance of fatty acids.展开更多
Juvenile bipolar disorder can be a challenging diagnosis, given its atypical presentation and tendency to have other comorbid psychiatric disorders. In this case study, we describe a case of a young patient with some ...Juvenile bipolar disorder can be a challenging diagnosis, given its atypical presentation and tendency to have other comorbid psychiatric disorders. In this case study, we describe a case of a young patient with some atypical symptoms of early-onset bipolar disorder.展开更多
AIM To study if anxiety, depression and experience of stress are associated with gastrointestinal(GI) symptoms in patients with bipolar disorder.METHODS A total of 136 patients with bipolar disorder(mean age 49.9 year...AIM To study if anxiety, depression and experience of stress are associated with gastrointestinal(GI) symptoms in patients with bipolar disorder.METHODS A total of 136 patients with bipolar disorder(mean age 49.9 years; 61% women) and 136 controls from the general population(mean age 51.0 years; 60% women) were included in the study. GI symptoms were assessed with The Gastrointestinal Symptom Rating Scale-irritable bowel syndrome(GSRS-IBS), level of anxiety and depression with The Hospital Anxiety and Depression Scale(HADS) and stress-proneness with Perceived Stress Questionnaire. Over a ten year period, all visits in primary care were retrospectively recorded in order to identify functional GI disorders.RESULTS In subjects with low total HADS-score, there were no significant differences in GI-symptoms between patients and controls(GSRS-IBS 7.0 vs 6.5, P = 0.513). In the patients with bipolar disorder there were significant correlations between all GSRS and HADS subscores for all symptom clusters except for "constipation" and "reflux". Factors associated to GI symptoms in the patient group were female sex(adjusted OR = 2.37, 95%CI: 1.07-5.24) and high HADS-Depression score(adjusted OR = 3.64, 95%CI: 1.07-12.4). These patients had also significantly more visits for IBS than patients with low HADS-Depression scores(29% vs 8%, P = 0.008). However, there was no significant differences in consulting behaviour for functional GI disorders between patients and controls(25% vs 17%, P = 0.108).CONCLUSION Female patients and patients with high HADS depression score reported significantly more GI symptoms, whereas patients with low HADS scores did not differ from control subjects.展开更多
Most treatment guidelines emphasize the use of psychotropic drugs for both the acute and maintenance treatment of bipolar disorder(BD).However,relying only on psychotropics without adjunctive psychosocial intervention...Most treatment guidelines emphasize the use of psychotropic drugs for both the acute and maintenance treatment of bipolar disorder(BD).However,relying only on psychotropics without adjunctive psychosocial interventions may be insufficient in treating patients with BD.Given its unique view in the explanation of psychopathological states,metacognitive therapy(MCT)might be helpful for BD.Metacognitive theory posits that psychopathology is a result of the cognitive attentional syndrome(CAS)and that it is influenced and maintained by dysfunctional metacognitive beliefs,perseverative thinking,attentional biases,and dysfunctional coping strategies.In this review,literature data regarding these areas in BD are examined.Studies suggest that perseverative thinking might be among the emotion regulation strategies endorsed in individuals with BD.Regarding attentional biases,literature data show that state-dependent,moodchanging attentional biases and a ruminative self-focused attention are present.Studies also suggest that cognitive self-consciousness is higher in BD compared to controls.It is seen that maladaptive coping strategies are frequently reported in BD,and that these strategies are associated with depression severity,negative affect and relapse risk.Studies focusing on dysfunctional metacognitive beliefs in BD reported that individuals with BD had higher scores for negative metacognitive beliefs,self-consciousness,need to control thoughts,and a lack of cognitive confidence.Also,dysfunctional metacognitive beliefs were associated with depressive symptomatology.These findings suggest that the components of CAS and dysfunctional metacognitive beliefs are evident in BD.For a subgroup of patients with BD who fail to respond to evidence-based psychopharmacological and adjunctive psychotherapeutic interventions,MCT might be an alternative way to consider as a treatment option.In conclusion,taken the available data together,we propose a sequential treatment protocol for BD,mainly based on the MCT treatment plan of depressive disorders.展开更多
Schizophrenia and bipolar disorder are disabling psychiatric disorders with a worldwide prevalence of approximately 1%.Both disorders present chronic and deteriorating prognoses that impose a large burden,not only on ...Schizophrenia and bipolar disorder are disabling psychiatric disorders with a worldwide prevalence of approximately 1%.Both disorders present chronic and deteriorating prognoses that impose a large burden,not only on patients but also on society and health systems.These mental illnesses share several clinical and neurobiological traits;of these traits,oligodendroglial dysfunction and alterations to white matter(WM)tracts could underlie the disconnection between brain regions related to their symptomatic domains.WM is mainly composed of heavily myelinated axons and glial cells.Myelin internodes are discrete axon-wrapping membrane sheaths formed by oligodendrocyte processes.Myelin ensheathment allows fast and efficient conduction of nerve impulses through the nodes of Ranvier,improving the overall function of neuronal circuits.Rapid and precisely synchronized nerve impulse conduction through fibers that connect distant brain structures is crucial for higher-level functions,such as cognition,memory,mood,and language.Several cellular and subcellular anomalies related to myelin and oligodendrocytes have been found in postmortem samples from patients with schizophrenia or bipolar disorder,and neuroimaging techniques have revealed consistent alterations at the macroscale connectomic level in both disorders.In this work,evidence regarding these multilevel alterations in oligodendrocytes and myelinated tracts is discussed,and the involvement of proteins in key functions of the oligodendroglial lineage,such as oligodendrogenesis and myelination,is highlighted.The molecular components of the axo-myelin unit could be important targets for novel therapeutic approaches to schizophrenia and bipolar disorder.展开更多
The World Health Organization’s 11^(th)revision of the International Classification of Diseases(ICD-11)including the chapter on mental disorders has come into effect this year.This review focuses on the“Bipolar or R...The World Health Organization’s 11^(th)revision of the International Classification of Diseases(ICD-11)including the chapter on mental disorders has come into effect this year.This review focuses on the“Bipolar or Related Disorders”section of the ICD-11 draft.It describes the benchmarks for the new version,particularly the foremost principle of clinical utility.The alterations made to the diagnosis of bipolar disorder(BD)are evaluated on their scientific basis and clinical utility.The change in the diagnostic requirements for manic and hypomanic episodes has been much debated.Whether the current criteria have achieved an optimum balance between sensitivity and specificity is still not clear.The ICD-11 definition of depressive episodes is substantially different,but the lack of empirical support for the changes has meant that the reliability and utility of bipolar depression are relatively low.Unlike the Diagnostic and Statistical Manual of Mental Disorders,5th edition(DSM-5),the ICD-11 has retained the category of mixed episodes.Although the concept of mixed episodes in the ICD-11 is not perfect,it appears to be more inclusive than the DSM-5 approach.Additionally,there are some uncertainties about the guidelines for the subtypes of BD and cyclothymic disorder.The initial results on the reliability and clinical utility of BD are promising,but the newly created diagnostic categories also appear to have some limitations.Although further improvement and research are needed,the focus should now be on facing the challenges of implementation,dissemination,and education and training in the use of these guidelines.展开更多
[Objectives]To evaluate whether the level of serum uric acid in patients with bipolar disorder type I in their manic episode was different from that in healthy subjects,and to evaluate whether the level of serum uric ...[Objectives]To evaluate whether the level of serum uric acid in patients with bipolar disorder type I in their manic episode was different from that in healthy subjects,and to evaluate whether the level of serum uric acid is related to the severity of manic episode and the improvement of clinical symptoms.[Methods]A total of 70 patients with bipolar disorder type I in their manic episode were selected,their serum uric acid levels were measured at the beginning of the enrollment and at the end of the first,second and third week,and the clinical symptoms were evaluated with Young Mania Rating Scale(YMRS).65 healthy subjects were enrolled,and their serum uric acid levels were measured only at the beginning of the enrollment.[Results]The level of serum uric acid in patients with bipolar disorder type I in their manic episode was higher than that in healthy adults(t=8.153,p=0.039).At the end of the third week,the YMRS score and uric acid level of the patients were lower than those of the patients at the beginning of the enrollment(t=17.107,p=0.000;t=35.864,p=0.000).[Conclusions]The level of serum uric acid in patients with bipolar disorder type I in their manic episode was higher than that in healthy subjects,and the decrease of serum uric acid level may be related to the improvement of clinical symptoms.展开更多
BACKGROUND Recently,there has been a range of studies about smartphone-based interventions and monitoring for reducing symptoms of bipolar disorder(BD).However,their efficacy for BD remains unclear.AIM To compare the ...BACKGROUND Recently,there has been a range of studies about smartphone-based interventions and monitoring for reducing symptoms of bipolar disorder(BD).However,their efficacy for BD remains unclear.AIM To compare the effect of smartphone-based interventions and monitoring with control methods in treating patients with BD.METHODS A systematic literature search was performed on PubMed,Embase,Clinical trials,psycINFO,Web of Science,and Cochrane Library.Randomized clinical trials(RCTs)or single-group trials in which smartphone-based interventions and monitoring were compared with control methods or baseline in patients with symptoms of BD were included.Data were synthesized using a random-effects or a fixed-effects model to analyze the effects of psychological interventions and monitoring delivered via smartphone on psychiatric symptoms in patients with BD.The primary outcome measures were set for mania and depression symptoms.Subgroups were created to explore which aspects of smartphone interventions are relevant to the greater or lesser efficacy of treating symptoms.RESULTS We identified ten articles,including seven RCTs(985 participants)and three single-group trials(169 participants).Analysis of the between-group study showed that smartphone-based interventions were effective in reducing manic[g=-0.19,95%confidence interval(CI):-0.33 to-0.04,P=0.01]and depressive(g=-0.28,95%CI:-0.55 to-0.01,P<0.05)symptoms.In within-group analysis,smartphone-based interventions significantly reduced manic(g=0.17,95%CI:0.04 to 0.30,P<0.01)and depressive(g=0.48,95%CI:0.18 to 0.78)symptoms compared to the baseline.Nevertheless,smartphone-based monitoring systems significantly reduced manic(g=0.27,95%CI:0.02 to 0.51,P<0.05)but not depressive symptoms.Subgroup analysis indicated that the interventions with psychoeducation had positive effects on depressive(g=-0.62,95%CI:-0.81 to-0.43,P<0.01)and manic(g=-0.24,95%CI:-0.43 to-0.06,P=0.01)symptoms compared to the controlled conditions,while the interventions without psychoeducation did not(P>0.05).The contacts between therapists and patients that contributed to the implementation of psychological therapy reduced depression symptoms(g=-0.47,95%CI:-0.75 to-0.18,P=0.01).CONCLUSION Smartphone-based interventions and monitoring have a significant positive impact on depressive and manic symptoms of BD patients in between-group and within-group analysis.展开更多
BACKGROUND Bipolar disorder(BD)is a severe psychiatric disorder characterized by mood swings.Psychosocial interventions,such as psychoeducation,play an essential role in promoting social rehabilitation and improving p...BACKGROUND Bipolar disorder(BD)is a severe psychiatric disorder characterized by mood swings.Psychosocial interventions,such as psychoeducation,play an essential role in promoting social rehabilitation and improving pharmacological treatment.AIM To investigate the role of psychoeducation in BD.METHODS A systematic review of original studies regarding psychoeducation interventions in patients with BD and their relatives was developed.A systematic literature search was performed using the Medline,Scopus,and Lilacs databases.No review articles or qualitative studies were included in the analysis.There were no date restriction criteria,and studies published up to April 2021 were included.RESULTS A total of forty-seven studies were selected for this review.Thirty-eight studies included patients,and nine included family members.Psychoeducation of patients and family members was associated with a lower number of new mood episodes and a reduction in number and length of stay of hospitalizations.Psychoeducational interventions with patients are associated with improved adherence to drug treatment.The strategies studied in patients and family members do not interfere with the severity of symptoms of mania or depression or with the patient's quality of life or functionality.Psychoeducational interventions with family members do not alter patients'adherence to pharmacotherapy.CONCLUSION Psychoeducation as an adjunct strategy to pharmacotherapy in the treatment of BD leads to a reduction in the frequency of new mood episodes,length of hospital stay and adherence to drug therapy.展开更多
BACKGROUND Believing or“credition”refers to psychological processes that integrate the cognitions and emotions that influence our behavior.In the credition model by Angel and Seitz,four parameters are postulated:pro...BACKGROUND Believing or“credition”refers to psychological processes that integrate the cognitions and emotions that influence our behavior.In the credition model by Angel and Seitz,four parameters are postulated:proposition,certainty,emotion and mightiness.It is assumed that believing processes are influenced by both the individual as well as socio-cultural factors and external circumstances.External or environmental circumstances can include threatening situations such as the ongoing pandemic.It has been hypothesized that believing processes related to the pandemic differ between individuals with bipolar disorder(BD)and healthy controls(HC).AIM To investigate credition in individuals with BD during the coronavirus disease 2019(COVID-19)pandemic.METHODS Psychiatrically stable individuals with BD(n=52)and age-and sex matched HC(n=52)participated in an online survey during the first lockdown of the COVID-19 pandemic.The survey took place between April 9^(th) and June 4^(th),2020,in Austria.Participants completed the Brief Symptom Inventory-18,the Beck Depression Inventory-Ⅱ,the Altman Self-Rating Mania Scale,the Pittsburgh Sleep Quality Index and a dedicated Believing Questionnaire assessing four parameters of credition(proposition,certainty,emotion and mightiness).The MAXQDA software was used to analyze the qualitative data.Statistical analyses included analyses of variance,a multivariate analysis of variance and a multivariate analysis of co-variance.RESULTS Individuals with BD reported significantly more negative propositions[F(1,102)=8.89,P=0.004,η2 p=0.08]and negative emotions[Welch´s F(1,82.46)=18.23,P<0.001,η2 p=0.18],while HC showed significantly more positive propositions[F(1,102)=7.78,P=0.006,η2 p=0.07]and emotions[F(1,102)=14.31,P<0.001,η2 p=0.12].In addition,individuals with BD showed a higher incongruence between their propositions and their emotions[F(1,102)=9.42,P=0.003,η2 p=0.08]and showed strong correlations between the parameters of the Believing Questionnaire and their psychiatric symptoms(r=0.51-0.77,all P<0.001).Positive as well as negative emotions and propositions were associated with scores measuring symptoms of depression,anxiety and sleep quality.CONCLUSION Believing parameters were associated with psychiatric symptoms in BD during the pandemic.Findings broaden knowledge about the susceptibility of believing processes for ambient challenges in individuals with BD.展开更多
BACKGROUND People with bipolar disorder(BD)frequently struggle with the recurrence of affective symptoms.However,the interplay between coping mechanism and positive mood state remains under-researched.AIM To explore t...BACKGROUND People with bipolar disorder(BD)frequently struggle with the recurrence of affective symptoms.However,the interplay between coping mechanism and positive mood state remains under-researched.AIM To explore the associations among behavioral approach system(BAS)sensitivity level,coping,and positive mood states among people with BD.METHODS Using a cross-sectional study design,90 participants with BD were presented with four BAS-activating life event scenarios and assessed with regard to their BAS trait sensitivity,coping flexibility,and mood states.A hierarchical clustering method was used to identify different groups with different styles of coping.Multiple hierarchical regression analyses were conducted to examine the mediating and moderating roles of different components of coping on mood states.RESULTS A three-cluster solution was found to best fit the present data set.The findings showed that a low mass of coping combined with low BAS sensitivity level protects people with BD from detrimentally accentuating mood states when they encounter BAS-activating life events.Moreover,coping flexibility is demonstrated to mediate and moderate the relationships between BAS sensitivity level and mood states.Specifically,subduing the perceived controllability and reducing the use of behavioral-activation/emotion-amplifying coping strategies could help buffer the effect of positive affect.CONCLUSION The judicious use of coping in emotion regulation for people with BD when encountering BAS-activating life events was indicated.Practical applications and theoretical implications are highlighted.展开更多
BACKGROUND Treatment alliance has an impact on several key patient outcomes in all psychiatric disorders,including bipolar disorder(BD).It has been suggested that the construct of treatment alliance is different among...BACKGROUND Treatment alliance has an impact on several key patient outcomes in all psychiatric disorders,including bipolar disorder(BD).It has been suggested that the construct of treatment alliance is different among patients from routine psychiatric settings compared to psychotherapeutic settings.However,research on the composition of treatment alliance in psychiatric disorders,such as BD,is relatively limited.AIM To determine whether a broader construct of treatment alliance was prevalent among outpatients with BD.METHODS This is a cross-sectional study,conducted in the psychiatric unit of a multispecialty hospital in north India over 12 mo(September 2018 to September 2019).A consecutive sample of 160 remitted adult outpatients with BD on mood stabilizers for at least a year were selected.The principal instrument to assess treatment alliance was the Working Alliance Inventory-client version(WAIClient).Other potential constituents of the alliance explored were perceived trust in clinicians assessed by the Trust in Physicians(TRIP)scale,perceived support from clinicians assessed by the Psychosocial Care by Physicians(PCP)scale,and perceived treatment satisfaction assessed by the Patient Satisfaction Questionnaire(PSQ).Associations between scores on all scales were determined by correlational and multiple regression analyses.Exploratory factor analysis of combined items of all scales was conducted using a principal components analysis.RESULTS Scores on all the three WAI-Client subscales were significantly correlated with each other(r=0.66-0.81;P<0.0001).The total TRIP scores were associated with the total WAI-Client scores(r=0.28;P<0.01).The total TRIP scores and the total PCP scores were also significantly associated with the WAI-Client scores on the Task subscale(r=0.28-0.29;P<0.01).The total TRIP scores were significantly associated with the total PSQ scores(r=0.45;P<0.0001).Factor analysis yielded two independent and coherent factors,which explained 69%of the variance in data.Factor-1(“alliance and support”),which explained about 41%of the variance,was comprised of a combined WAI-Client goal-task-bond component as well as the PCP support items.Factor-2(“trust and satisfaction”),which explained about 28%of the variance,consisted of all the TRIP trust and the PSQ treatment satisfaction items.CONCLUSION A broader construct of treatment alliance in BD was found.Apart from collaborative components,this construct included patients’perceptions regarding trust in clinicians,support from clinicians,and treatment satisfaction.展开更多
BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder(BD)and can have an adverse effect on its course,outcome,and treatment.However,despite a considerable amount of rese...BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder(BD)and can have an adverse effect on its course,outcome,and treatment.However,despite a considerable amount of research,the impact of psychotic symptoms on BD remains unclear,and there are very few systematic reviews on the subject.AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed.An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021.Combinations of the relevant Medical Subject Headings terms were used to search for these studies.Articles were selected after a screening phase,followed by a review of the full texts of the articles.Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.RESULTS This systematic review included 339 studies of patients with BD.Lifetime psychosis was found in more than a half to two-thirds of the patients,while current psychosis was found in a little less than half of them.Delusions were more common than hallucinations in all phases of BD.About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms,particularly during manic episodes.Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression.Although psychotic symptoms were not more severe in BD,the severity of the illness in psychotic BD was consistently greater.Psychosis was usually associated with poor insight and a higher frequency of agitation,anxiety,and hostility but not with psychiatric comorbidity.Psychosis was consistently linked with increased rates and the duration of hospitalizations,switching among patients with depression,and poorer outcomes with mood-incongruent symptoms.In contrast,psychosis was less likely to be accompanied by a rapid-cycling course,longer illness duration,and heightened suicidal risk.There was no significant impact of psychosis on the other parameters of course and outcome.CONCLUSION Though psychotic symptoms are very common in BD,they are not always associated with an adverse impact on BD and its course and outcome.展开更多
In this article, the present author, a research psychologist and measurement expert, evaluates the major clinical trials used to support the use of aripiprazole and the chemically almost identical cariprazine for trea...In this article, the present author, a research psychologist and measurement expert, evaluates the major clinical trials used to support the use of aripiprazole and the chemically almost identical cariprazine for treating bipolar disorder. The main problem with the trials is that they were conducted mainly with outpatients, who on average were only moderately manic in the mania studies and only moderately depressed in the depression studies. The effectiveness of aripiprazole and cariprazine in treating moderate mania, most likely hypomania, and moderate depression, was far from encouraging. Aripiprazole produced just 7% greater reduction of mania symptoms than did placebo treatment, and just 1% greater reduction of depression symptoms than did placebo treatment when administered, as is common practice, with an SSRI or SNRI antidepressant. Cariprazine proved to be not much better because at the high dosage level of 3.0 mg/day to 12.0 mg/day, cariprazine produced only 9% greater reduction of mania symptoms than did placebo treatment, and at the typical low dosage of 1.5 to 3.0 mg/day produced just 4% greater reduction of depression symptoms than did placebo treatment. Moreover, as the pharmaceutical industry has long suspected, there is a massive placebo effect associated with these two drugs, especially for depression. These findings imply that government regulatory authorities’ approval of aripiprazole and cariprazine as mood stabilizers for treating bipolar disorder is dubious. Nevertheless, the possibility remains that the purported mood-stabilizing mechanism of these two medicines is activated only with patients presently experiencing severe mania or severe depression, a possibility that requires an in-hospital clinical trial or, at the very least, a longitudinal analysis of bipolar patients’ treatment records. Furthermore, an appendix to the present article demonstrates that the measures used in the trials, the Young Mania Rating Scale and the Montgomery-Asberg Depression Rating Scale, are deficient and that a briefer combination measure focusing only on the core symptoms of bipolar disorder should be used.展开更多
The fast aging human population requires new approaches to reliable diagnosis and proper treatment of dementia in elderly patients with psychiatric disorders such as bipolar disorder (BD) and schizophrenia (SCZ). As c...The fast aging human population requires new approaches to reliable diagnosis and proper treatment of dementia in elderly patients with psychiatric disorders such as bipolar disorder (BD) and schizophrenia (SCZ). As compared to other psychiatric disorders, BD and SCZ are characterized by increased and similar risk for dementia as well as cerebrovascular (CVD) and Parkinson’s (PD) diseases independent of the patient’s age. There are reports in the literature suggesting BD and SCZ in older patients could cause dementia without contribution from the neurodegenerative diseases, including Alzheimer’s disease (AD), due to the absence of the known neuropathology associated with cognitive decline in such individuals. This view contradicts a plethora of data highlighting AD as a major cause of dementia in the elderly. This issue was addressed by examining postmortem cerebral pathology in an 83-year-old female diagnosed with BD, SCZ, and PD (D1) and comparing it to that of a second donor (D2), an age-matched male diagnosed with Lewy Body Dementia (LBD). Upon thorough histochemical and immunohistochemical examinations of both brains, the PD and LBD diagnoses in D1 and D2 were not confirmed. Instead, AD-related pathology was observed in both subjects with AD advancing to its clinical stage (mild to moderate) only in D1. Diffuse β-amyloid peptide 1-42 (Aβ1-42) staining, most likely reflecting a presence of the Aβ1-42 soluble form, was also detected in cerebellar neurons and cerebellar extracellular space in D1 and D2. Cerebrovascular pathology was pronounced and distinct in both brains and included amyloid angiopathy, hyaline atherosclerosis, microbleeds, and dilated Virchow Robin spaces in D1 as well as thick-walled blood vessels with microbleeds in D2. It was concluded that a mixed AD and cerebrovascular pathology could mimic Lewy Body Disease and potentially contribute to dementia development in elderly BD and SCZ patients.展开更多
Isotretinoin(Accutane) is a treatment for severe acne that is resistant to other forms of treatment, including antibiotics and topical treatments. The prescription of this drug has been controversial ever since its in...Isotretinoin(Accutane) is a treatment for severe acne that is resistant to other forms of treatment, including antibiotics and topical treatments. The prescription of this drug has been controversial ever since its initial marketing in 1982. It is the only non-psychotropic drug in the Food and Drug Administration top 10 drugs found to be associated with depression. Recently, Bremner et al published an extensive review(until 2010) of the evidence for the association of retinoic acid(RA) with depression and suicide. Some patients who are admitted in psychiatric hospitals report a history of present or past treatment with isotretinoin. Then, the imputability of the molecule in the occurrence of disorders represents necessarily an important question for both professionals and their patients. This paper aims to specify the links between the drug and specific psychiatric disorders. A review of the literature related to isotretinoin, RA, vitamin A, depression, suicide, anxiety, bipolar disorder, psychosis, schizophrenia was performed. Many studies demonstrated an increased risk of depression, attempted suicide and suicide following isotretinoin treatment. However, isotretinoin may have an antidepressant impact, according to some dermatological papers. They consider treating acne with this efficient treatment could improve selfimage and make the patient feel better. Several studies showed that patients with bipolar disorder had an increased risk for a clinical exacerbation of symptoms undergoing treatment with isotretinoin. A few studies also seem to suggest a possible link between isotretinoin and psychosis. Nonetheless, studies point out a link between retinoid dysregulation and schizophrenia through modulation of dopamine receptors. From this review, we propose guidelines for isotretinoin prescription to healthcare professionals.展开更多
AIM: To determine the prevalence of bipolar disorder(BD) and sub-threshold symptoms in children with attention deficit hyperactivity disorder(ADHD) through 14 years' follow-up, when participants were between 21-24...AIM: To determine the prevalence of bipolar disorder(BD) and sub-threshold symptoms in children with attention deficit hyperactivity disorder(ADHD) through 14 years' follow-up, when participants were between 21-24 years old.METHODS: First, we examined rates of BD type Ⅰ?and Ⅱ diagnoses in youth participating in the NIMH-funded Multimodal Treatment Study of ADHD(MTA). We used the diagnostic interview schedule for children(DISC), administered to both parents(DISC-P) and youth(DISCY). We compared the MTA study subjects with ADHD(n = 579) to a local normative comparison group(LNCG, n = 289) at 4 different assessment points: 6, 8, 12, and 14 years of follow-ups. To evaluate the bipolar variants, we compared total symptom counts(TSC) of DSM manic and hypomanic symptoms that were generated by DISC in ADHD and LNCG subjects. Then we sub-divided the TSC into pathognomonic manic(PM) and non-specific manic(NSM) symptoms. We compared the PM and NSM in ADHD and LNCG at each assessment point and over time. We also evaluated the irritability as category A2 manic symptom in both groups and over time. Finally, we studied the irritability symptom in correlation with PM and NSM in ADHD and LNCG subjects.RESULTS: DISC-generated BD diagnosis did not differ significantly in rates between ADHD(1.89%) and LNCG 1.38%). Interestingly, no participant met BD diagnosis more than once in the 4 assessment points in 14 years. However, on the symptom level, ADHD subjects reported significantly higher mean TSC scores: ADHD 3.0; LNCG 1.7; P < 0.001. ADHD status was associated with higher mean NSM: ADHD 2.0 vs LNCG 1.1; P < 0.0001. Also, ADHD subjects had higher PM symptoms than LNCG, with PM means over all time points of 1.3 ADHD; 0.9 LNCG; P = 0.0001. Examining both NSM and PM, ADHD status associated with greater NSM than PM. However, Over 14 years, the NSM symptoms declined and changed to PM over time(df 3, 2523; F = 20.1; P < 0.0001). Finally, Irritability(BD DSM criterion-A2) rates were significantly higher in ADHD than LNCG(χ2 = 122.2, P < 0.0001), but irritability was associated more strongly with NSM than PM(df 3, 2538; F = 43.2; P < 0.0001).CONCLUSION: Individuals with ADHD do not appear to be at significantly greater risk for developing BD, but do show higher rates of BD symptoms, especially NSM. The greater linkage of irritability to NSM than to PM suggests caution when making BD diagnoses based on irritability alone as one of 2(A-level) symptoms for BD diagnosis, particularly in view of its frequent presentation with other psychopathologies.展开更多
About half of the patients diagnosed with bipolar disorder(BD) become non-adherent during longterm treatment, a rate largely similar to other chronic illnesses and one that has remained unchanged over the years. Non-a...About half of the patients diagnosed with bipolar disorder(BD) become non-adherent during longterm treatment, a rate largely similar to other chronic illnesses and one that has remained unchanged over the years. Non-adherence in BD is a complex phenomenon determined by a multitude of influences. However, thereis considerable uncertainty about the key determinants of non-adherence in BD. Initial research on nonadherence in BD mostly limited itself to examining demographic, clinical and medication-related factors impacting adherence. However, because of inconsistent results and failure of these studies to address the complexities of adherence behaviour, demographic and illness-related factors were alone unable to explain or predict non-adherence in BD. This prompted a shift to a more patient-centred approach of viewing nonadherence. The central element of this approach includes an emphasis on patients' decisions regarding their own treatment based on their personal beliefs, life circumstances and their perceptions of benefits and disadvantages of treatment. Patients' decisionmaking processes are influenced by the nature of their relationship with clinicians and the health-care system and by people in their immediate environment. The primacy of the patient's perspective on non-adherence is in keeping with the current theoretical models and concordance-based approaches to adherence behaviour in BD. Research over the past two decades has further endorsed the critical role of patients' attitudes and beliefs regarding medications, the importance of a collaborative treatment-alliance, the influence of the family, and the significance of other patient-related factors such as knowledge, stigma, patient satisfaction and access to treatment in determining non-adherence in BD. Though simply moving from an illness-centred to a patientcentred approach is unlikely to solve the problem of nonadherence in BD, such an approach is more likely to lead to a better understanding of non-adherence and more likely to yield effective solutions to tackle this common and distressing problem afflicting patients with BD.展开更多
基金Local Special Projects in Major Health of Hubei Provincial Science and Technology Department,No.2022BCE054Key Scientific Research Projects of Hubei Polytechnic University,No.23xjz08A.
文摘BACKGROUND Recently,a growing number of adolescents have been afflicted with mental disorders,with annual morbidity rates on the rise.This trend has been exacerbated by the global coronavirus disease 2019(COVID-19)pandemic,leading to a surge in suicide and self-harm rates among this demographic.AIM To investigate the impact of the COVID-19 pandemic on adolescent bipolar disorder(BD),along with the underlying factors contributing to heightened rates of suicide and self-harm among adolescents.METHODS A comprehensive statistical analysis was conducted utilizing clinical interviews and self-reports obtained from patients or their guardians.Diagnostic criteria for BDs were based on the Diagnostic and statistical manual of mental disorders,international classification of diseases-11,and the National institute of mental health research domain criteria.Statistical analyses were performed using SPSS 26.0 software,with significance set at P<0.05.RESULTS A cohort of 171 adolescents diagnosed with BD between January 1,2018,and December 31,2022,was included in the analysis.The gender distribution was 2.8:1(female to male),with ages ranging from 11 to 18 years old.Major factors contributing to adolescent BDs included familial influences,academic stress,genetic predisposition and exposure to school-related violence.Notably,a significant increase in suicide attempts and self-harm incidents was observed among adolescents with BD during the COVID-19 pandemic.Statistical analysis indicated that the pandemic exacerbated familial discord and heightened academic stress,thereby amplifying the prevalence of suicidal behavior and self-harm among adolescents.CONCLUSION The COVID-19 pandemic has exacerbated familial tensions and intensified the incidence of suicide and self-harm among adolescents diagnosed with BD.This study underscores the urgent need for societal,familial and educational support systems to prioritize the well-being of adolescents and offers valuable insights and guidelines for the prevention,diagnosis and treatment of adolescent BDs.
文摘Rapid-cycling bipolar disorder(RCBD)is a phase of bipolar disorder defined by the presence of≥4 mood episodes in a year.It is a common phenomenon characterized by greater severity,a predominance of depression,higher levels of disability,and poorer overall outcomes.It is resistant to treatment by conventional pharmacotherapy.The existing literature underlines the scarcity of evidence and the gaps in knowledge about the optimal treatment strategies for RCBD.However,most reviews have considered only pharmacological treatment options for RCBD.Given the treatment-refractory nature of RCBD,nonpharmacological interventions could augment medications but have not been adequately examined.This review carried out an updated and comprehensive search for evidence regarding the role of nonpharmacological therapies as adjuncts to medications in RCBD.We identified 83 reviews and meta-analyses concerning the treatment of RCBD.Additionally,we found 42 reports on adjunctive nonpharmacological treatments in RCBD.Most of the evidence favoured concomitant electroconvulsive therapy as an acute and maintenance treatment.There was preliminary evidence to suggest that chronotherapeutic treatments can provide better outcomes when combined with medications.The research on adjunctive psychotherapy was particularly scarce but suggested that psychoeducation,cognitive behavioural therapy,family interventions,and supportive psychotherapy may be helpful.The overall quality of evidence was poor and suffered from several methodological shortcomings.There is a need for more methodologically sound research in this area,although clinicians can use the existing evidence to select and individualize nonpharmacological treatment options for better management of RCBD.Patient summaries are included to highlight some of the issues concerning the implementation of adjunctive nonpharmacological treatments.
文摘This paper is a systematic review of the treatment of bipolar disorder: a systematic Google Scholar search aimed at treatment guidelines and clinical trials. The search for treatment guidelines returned 375 papers and was last performed from June 1, 2022 to August 30, 2022. The literature suggests that lithium helps control and alleviate severe mood episodes, and olanzapine is effective for acute manic or mixed episodes of bipolar I disorder. Achieving effectiveness or remission is better with Cariprazine. Lurasidone improves cognitive performance. Quetiapine improves sleep quality and co-morbid anxiety. Lamotrigine helps delay depression, mania, and mild manic episodes. Antidepressants are best used in conjunction with mood stabilizers. For co-morbid treatment, carbamazepine and lithium in combination are more effective in the treatment of psychotic mania. Co-morbid anxiety treatment considers adjunctive olanzapine or lamotrigine. Co-morbid bulimia treatment considers a mood stabilizer. Co-morbid fatigue treatment considers a dawn simulator. For diet, pay attention to a healthy diet, patients can ingest probiotics and pay attention to the balance of fatty acids.
文摘Juvenile bipolar disorder can be a challenging diagnosis, given its atypical presentation and tendency to have other comorbid psychiatric disorders. In this case study, we describe a case of a young patient with some atypical symptoms of early-onset bipolar disorder.
文摘AIM To study if anxiety, depression and experience of stress are associated with gastrointestinal(GI) symptoms in patients with bipolar disorder.METHODS A total of 136 patients with bipolar disorder(mean age 49.9 years; 61% women) and 136 controls from the general population(mean age 51.0 years; 60% women) were included in the study. GI symptoms were assessed with The Gastrointestinal Symptom Rating Scale-irritable bowel syndrome(GSRS-IBS), level of anxiety and depression with The Hospital Anxiety and Depression Scale(HADS) and stress-proneness with Perceived Stress Questionnaire. Over a ten year period, all visits in primary care were retrospectively recorded in order to identify functional GI disorders.RESULTS In subjects with low total HADS-score, there were no significant differences in GI-symptoms between patients and controls(GSRS-IBS 7.0 vs 6.5, P = 0.513). In the patients with bipolar disorder there were significant correlations between all GSRS and HADS subscores for all symptom clusters except for "constipation" and "reflux". Factors associated to GI symptoms in the patient group were female sex(adjusted OR = 2.37, 95%CI: 1.07-5.24) and high HADS-Depression score(adjusted OR = 3.64, 95%CI: 1.07-12.4). These patients had also significantly more visits for IBS than patients with low HADS-Depression scores(29% vs 8%, P = 0.008). However, there was no significant differences in consulting behaviour for functional GI disorders between patients and controls(25% vs 17%, P = 0.108).CONCLUSION Female patients and patients with high HADS depression score reported significantly more GI symptoms, whereas patients with low HADS scores did not differ from control subjects.
文摘Most treatment guidelines emphasize the use of psychotropic drugs for both the acute and maintenance treatment of bipolar disorder(BD).However,relying only on psychotropics without adjunctive psychosocial interventions may be insufficient in treating patients with BD.Given its unique view in the explanation of psychopathological states,metacognitive therapy(MCT)might be helpful for BD.Metacognitive theory posits that psychopathology is a result of the cognitive attentional syndrome(CAS)and that it is influenced and maintained by dysfunctional metacognitive beliefs,perseverative thinking,attentional biases,and dysfunctional coping strategies.In this review,literature data regarding these areas in BD are examined.Studies suggest that perseverative thinking might be among the emotion regulation strategies endorsed in individuals with BD.Regarding attentional biases,literature data show that state-dependent,moodchanging attentional biases and a ruminative self-focused attention are present.Studies also suggest that cognitive self-consciousness is higher in BD compared to controls.It is seen that maladaptive coping strategies are frequently reported in BD,and that these strategies are associated with depression severity,negative affect and relapse risk.Studies focusing on dysfunctional metacognitive beliefs in BD reported that individuals with BD had higher scores for negative metacognitive beliefs,self-consciousness,need to control thoughts,and a lack of cognitive confidence.Also,dysfunctional metacognitive beliefs were associated with depressive symptomatology.These findings suggest that the components of CAS and dysfunctional metacognitive beliefs are evident in BD.For a subgroup of patients with BD who fail to respond to evidence-based psychopharmacological and adjunctive psychotherapeutic interventions,MCT might be an alternative way to consider as a treatment option.In conclusion,taken the available data together,we propose a sequential treatment protocol for BD,mainly based on the MCT treatment plan of depressive disorders.
基金Supported by Fondo Sectorial de Investigación para la Educación(FSIE SEP/CONACyT)to MV-T,No.287115Fondo Sectorial de Investigación en Salud y Seguridad Social(FOSISS SS/IMSS/ISSSTE-CONACyT)to BC,No.261459.
文摘Schizophrenia and bipolar disorder are disabling psychiatric disorders with a worldwide prevalence of approximately 1%.Both disorders present chronic and deteriorating prognoses that impose a large burden,not only on patients but also on society and health systems.These mental illnesses share several clinical and neurobiological traits;of these traits,oligodendroglial dysfunction and alterations to white matter(WM)tracts could underlie the disconnection between brain regions related to their symptomatic domains.WM is mainly composed of heavily myelinated axons and glial cells.Myelin internodes are discrete axon-wrapping membrane sheaths formed by oligodendrocyte processes.Myelin ensheathment allows fast and efficient conduction of nerve impulses through the nodes of Ranvier,improving the overall function of neuronal circuits.Rapid and precisely synchronized nerve impulse conduction through fibers that connect distant brain structures is crucial for higher-level functions,such as cognition,memory,mood,and language.Several cellular and subcellular anomalies related to myelin and oligodendrocytes have been found in postmortem samples from patients with schizophrenia or bipolar disorder,and neuroimaging techniques have revealed consistent alterations at the macroscale connectomic level in both disorders.In this work,evidence regarding these multilevel alterations in oligodendrocytes and myelinated tracts is discussed,and the involvement of proteins in key functions of the oligodendroglial lineage,such as oligodendrogenesis and myelination,is highlighted.The molecular components of the axo-myelin unit could be important targets for novel therapeutic approaches to schizophrenia and bipolar disorder.
文摘The World Health Organization’s 11^(th)revision of the International Classification of Diseases(ICD-11)including the chapter on mental disorders has come into effect this year.This review focuses on the“Bipolar or Related Disorders”section of the ICD-11 draft.It describes the benchmarks for the new version,particularly the foremost principle of clinical utility.The alterations made to the diagnosis of bipolar disorder(BD)are evaluated on their scientific basis and clinical utility.The change in the diagnostic requirements for manic and hypomanic episodes has been much debated.Whether the current criteria have achieved an optimum balance between sensitivity and specificity is still not clear.The ICD-11 definition of depressive episodes is substantially different,but the lack of empirical support for the changes has meant that the reliability and utility of bipolar depression are relatively low.Unlike the Diagnostic and Statistical Manual of Mental Disorders,5th edition(DSM-5),the ICD-11 has retained the category of mixed episodes.Although the concept of mixed episodes in the ICD-11 is not perfect,it appears to be more inclusive than the DSM-5 approach.Additionally,there are some uncertainties about the guidelines for the subtypes of BD and cyclothymic disorder.The initial results on the reliability and clinical utility of BD are promising,but the newly created diagnostic categories also appear to have some limitations.Although further improvement and research are needed,the focus should now be on facing the challenges of implementation,dissemination,and education and training in the use of these guidelines.
文摘[Objectives]To evaluate whether the level of serum uric acid in patients with bipolar disorder type I in their manic episode was different from that in healthy subjects,and to evaluate whether the level of serum uric acid is related to the severity of manic episode and the improvement of clinical symptoms.[Methods]A total of 70 patients with bipolar disorder type I in their manic episode were selected,their serum uric acid levels were measured at the beginning of the enrollment and at the end of the first,second and third week,and the clinical symptoms were evaluated with Young Mania Rating Scale(YMRS).65 healthy subjects were enrolled,and their serum uric acid levels were measured only at the beginning of the enrollment.[Results]The level of serum uric acid in patients with bipolar disorder type I in their manic episode was higher than that in healthy adults(t=8.153,p=0.039).At the end of the third week,the YMRS score and uric acid level of the patients were lower than those of the patients at the beginning of the enrollment(t=17.107,p=0.000;t=35.864,p=0.000).[Conclusions]The level of serum uric acid in patients with bipolar disorder type I in their manic episode was higher than that in healthy subjects,and the decrease of serum uric acid level may be related to the improvement of clinical symptoms.
基金Supported by The Anhui Natural Science Foundation,No.1808085MH291The Project of Human Social Science of Anhui Province,No.SK2016A047Grants for Scientific Research of BSKY from Anhui Medical University,No.XJ201826.
文摘BACKGROUND Recently,there has been a range of studies about smartphone-based interventions and monitoring for reducing symptoms of bipolar disorder(BD).However,their efficacy for BD remains unclear.AIM To compare the effect of smartphone-based interventions and monitoring with control methods in treating patients with BD.METHODS A systematic literature search was performed on PubMed,Embase,Clinical trials,psycINFO,Web of Science,and Cochrane Library.Randomized clinical trials(RCTs)or single-group trials in which smartphone-based interventions and monitoring were compared with control methods or baseline in patients with symptoms of BD were included.Data were synthesized using a random-effects or a fixed-effects model to analyze the effects of psychological interventions and monitoring delivered via smartphone on psychiatric symptoms in patients with BD.The primary outcome measures were set for mania and depression symptoms.Subgroups were created to explore which aspects of smartphone interventions are relevant to the greater or lesser efficacy of treating symptoms.RESULTS We identified ten articles,including seven RCTs(985 participants)and three single-group trials(169 participants).Analysis of the between-group study showed that smartphone-based interventions were effective in reducing manic[g=-0.19,95%confidence interval(CI):-0.33 to-0.04,P=0.01]and depressive(g=-0.28,95%CI:-0.55 to-0.01,P<0.05)symptoms.In within-group analysis,smartphone-based interventions significantly reduced manic(g=0.17,95%CI:0.04 to 0.30,P<0.01)and depressive(g=0.48,95%CI:0.18 to 0.78)symptoms compared to the baseline.Nevertheless,smartphone-based monitoring systems significantly reduced manic(g=0.27,95%CI:0.02 to 0.51,P<0.05)but not depressive symptoms.Subgroup analysis indicated that the interventions with psychoeducation had positive effects on depressive(g=-0.62,95%CI:-0.81 to-0.43,P<0.01)and manic(g=-0.24,95%CI:-0.43 to-0.06,P=0.01)symptoms compared to the controlled conditions,while the interventions without psychoeducation did not(P>0.05).The contacts between therapists and patients that contributed to the implementation of psychological therapy reduced depression symptoms(g=-0.47,95%CI:-0.75 to-0.18,P=0.01).CONCLUSION Smartphone-based interventions and monitoring have a significant positive impact on depressive and manic symptoms of BD patients in between-group and within-group analysis.
文摘BACKGROUND Bipolar disorder(BD)is a severe psychiatric disorder characterized by mood swings.Psychosocial interventions,such as psychoeducation,play an essential role in promoting social rehabilitation and improving pharmacological treatment.AIM To investigate the role of psychoeducation in BD.METHODS A systematic review of original studies regarding psychoeducation interventions in patients with BD and their relatives was developed.A systematic literature search was performed using the Medline,Scopus,and Lilacs databases.No review articles or qualitative studies were included in the analysis.There were no date restriction criteria,and studies published up to April 2021 were included.RESULTS A total of forty-seven studies were selected for this review.Thirty-eight studies included patients,and nine included family members.Psychoeducation of patients and family members was associated with a lower number of new mood episodes and a reduction in number and length of stay of hospitalizations.Psychoeducational interventions with patients are associated with improved adherence to drug treatment.The strategies studied in patients and family members do not interfere with the severity of symptoms of mania or depression or with the patient's quality of life or functionality.Psychoeducational interventions with family members do not alter patients'adherence to pharmacotherapy.CONCLUSION Psychoeducation as an adjunct strategy to pharmacotherapy in the treatment of BD leads to a reduction in the frequency of new mood episodes,length of hospital stay and adherence to drug therapy.
文摘BACKGROUND Believing or“credition”refers to psychological processes that integrate the cognitions and emotions that influence our behavior.In the credition model by Angel and Seitz,four parameters are postulated:proposition,certainty,emotion and mightiness.It is assumed that believing processes are influenced by both the individual as well as socio-cultural factors and external circumstances.External or environmental circumstances can include threatening situations such as the ongoing pandemic.It has been hypothesized that believing processes related to the pandemic differ between individuals with bipolar disorder(BD)and healthy controls(HC).AIM To investigate credition in individuals with BD during the coronavirus disease 2019(COVID-19)pandemic.METHODS Psychiatrically stable individuals with BD(n=52)and age-and sex matched HC(n=52)participated in an online survey during the first lockdown of the COVID-19 pandemic.The survey took place between April 9^(th) and June 4^(th),2020,in Austria.Participants completed the Brief Symptom Inventory-18,the Beck Depression Inventory-Ⅱ,the Altman Self-Rating Mania Scale,the Pittsburgh Sleep Quality Index and a dedicated Believing Questionnaire assessing four parameters of credition(proposition,certainty,emotion and mightiness).The MAXQDA software was used to analyze the qualitative data.Statistical analyses included analyses of variance,a multivariate analysis of variance and a multivariate analysis of co-variance.RESULTS Individuals with BD reported significantly more negative propositions[F(1,102)=8.89,P=0.004,η2 p=0.08]and negative emotions[Welch´s F(1,82.46)=18.23,P<0.001,η2 p=0.18],while HC showed significantly more positive propositions[F(1,102)=7.78,P=0.006,η2 p=0.07]and emotions[F(1,102)=14.31,P<0.001,η2 p=0.12].In addition,individuals with BD showed a higher incongruence between their propositions and their emotions[F(1,102)=9.42,P=0.003,η2 p=0.08]and showed strong correlations between the parameters of the Believing Questionnaire and their psychiatric symptoms(r=0.51-0.77,all P<0.001).Positive as well as negative emotions and propositions were associated with scores measuring symptoms of depression,anxiety and sleep quality.CONCLUSION Believing parameters were associated with psychiatric symptoms in BD during the pandemic.Findings broaden knowledge about the susceptibility of believing processes for ambient challenges in individuals with BD.
文摘BACKGROUND People with bipolar disorder(BD)frequently struggle with the recurrence of affective symptoms.However,the interplay between coping mechanism and positive mood state remains under-researched.AIM To explore the associations among behavioral approach system(BAS)sensitivity level,coping,and positive mood states among people with BD.METHODS Using a cross-sectional study design,90 participants with BD were presented with four BAS-activating life event scenarios and assessed with regard to their BAS trait sensitivity,coping flexibility,and mood states.A hierarchical clustering method was used to identify different groups with different styles of coping.Multiple hierarchical regression analyses were conducted to examine the mediating and moderating roles of different components of coping on mood states.RESULTS A three-cluster solution was found to best fit the present data set.The findings showed that a low mass of coping combined with low BAS sensitivity level protects people with BD from detrimentally accentuating mood states when they encounter BAS-activating life events.Moreover,coping flexibility is demonstrated to mediate and moderate the relationships between BAS sensitivity level and mood states.Specifically,subduing the perceived controllability and reducing the use of behavioral-activation/emotion-amplifying coping strategies could help buffer the effect of positive affect.CONCLUSION The judicious use of coping in emotion regulation for people with BD when encountering BAS-activating life events was indicated.Practical applications and theoretical implications are highlighted.
文摘BACKGROUND Treatment alliance has an impact on several key patient outcomes in all psychiatric disorders,including bipolar disorder(BD).It has been suggested that the construct of treatment alliance is different among patients from routine psychiatric settings compared to psychotherapeutic settings.However,research on the composition of treatment alliance in psychiatric disorders,such as BD,is relatively limited.AIM To determine whether a broader construct of treatment alliance was prevalent among outpatients with BD.METHODS This is a cross-sectional study,conducted in the psychiatric unit of a multispecialty hospital in north India over 12 mo(September 2018 to September 2019).A consecutive sample of 160 remitted adult outpatients with BD on mood stabilizers for at least a year were selected.The principal instrument to assess treatment alliance was the Working Alliance Inventory-client version(WAIClient).Other potential constituents of the alliance explored were perceived trust in clinicians assessed by the Trust in Physicians(TRIP)scale,perceived support from clinicians assessed by the Psychosocial Care by Physicians(PCP)scale,and perceived treatment satisfaction assessed by the Patient Satisfaction Questionnaire(PSQ).Associations between scores on all scales were determined by correlational and multiple regression analyses.Exploratory factor analysis of combined items of all scales was conducted using a principal components analysis.RESULTS Scores on all the three WAI-Client subscales were significantly correlated with each other(r=0.66-0.81;P<0.0001).The total TRIP scores were associated with the total WAI-Client scores(r=0.28;P<0.01).The total TRIP scores and the total PCP scores were also significantly associated with the WAI-Client scores on the Task subscale(r=0.28-0.29;P<0.01).The total TRIP scores were significantly associated with the total PSQ scores(r=0.45;P<0.0001).Factor analysis yielded two independent and coherent factors,which explained 69%of the variance in data.Factor-1(“alliance and support”),which explained about 41%of the variance,was comprised of a combined WAI-Client goal-task-bond component as well as the PCP support items.Factor-2(“trust and satisfaction”),which explained about 28%of the variance,consisted of all the TRIP trust and the PSQ treatment satisfaction items.CONCLUSION A broader construct of treatment alliance in BD was found.Apart from collaborative components,this construct included patients’perceptions regarding trust in clinicians,support from clinicians,and treatment satisfaction.
文摘BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder(BD)and can have an adverse effect on its course,outcome,and treatment.However,despite a considerable amount of research,the impact of psychotic symptoms on BD remains unclear,and there are very few systematic reviews on the subject.AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed.An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021.Combinations of the relevant Medical Subject Headings terms were used to search for these studies.Articles were selected after a screening phase,followed by a review of the full texts of the articles.Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.RESULTS This systematic review included 339 studies of patients with BD.Lifetime psychosis was found in more than a half to two-thirds of the patients,while current psychosis was found in a little less than half of them.Delusions were more common than hallucinations in all phases of BD.About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms,particularly during manic episodes.Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression.Although psychotic symptoms were not more severe in BD,the severity of the illness in psychotic BD was consistently greater.Psychosis was usually associated with poor insight and a higher frequency of agitation,anxiety,and hostility but not with psychiatric comorbidity.Psychosis was consistently linked with increased rates and the duration of hospitalizations,switching among patients with depression,and poorer outcomes with mood-incongruent symptoms.In contrast,psychosis was less likely to be accompanied by a rapid-cycling course,longer illness duration,and heightened suicidal risk.There was no significant impact of psychosis on the other parameters of course and outcome.CONCLUSION Though psychotic symptoms are very common in BD,they are not always associated with an adverse impact on BD and its course and outcome.
文摘In this article, the present author, a research psychologist and measurement expert, evaluates the major clinical trials used to support the use of aripiprazole and the chemically almost identical cariprazine for treating bipolar disorder. The main problem with the trials is that they were conducted mainly with outpatients, who on average were only moderately manic in the mania studies and only moderately depressed in the depression studies. The effectiveness of aripiprazole and cariprazine in treating moderate mania, most likely hypomania, and moderate depression, was far from encouraging. Aripiprazole produced just 7% greater reduction of mania symptoms than did placebo treatment, and just 1% greater reduction of depression symptoms than did placebo treatment when administered, as is common practice, with an SSRI or SNRI antidepressant. Cariprazine proved to be not much better because at the high dosage level of 3.0 mg/day to 12.0 mg/day, cariprazine produced only 9% greater reduction of mania symptoms than did placebo treatment, and at the typical low dosage of 1.5 to 3.0 mg/day produced just 4% greater reduction of depression symptoms than did placebo treatment. Moreover, as the pharmaceutical industry has long suspected, there is a massive placebo effect associated with these two drugs, especially for depression. These findings imply that government regulatory authorities’ approval of aripiprazole and cariprazine as mood stabilizers for treating bipolar disorder is dubious. Nevertheless, the possibility remains that the purported mood-stabilizing mechanism of these two medicines is activated only with patients presently experiencing severe mania or severe depression, a possibility that requires an in-hospital clinical trial or, at the very least, a longitudinal analysis of bipolar patients’ treatment records. Furthermore, an appendix to the present article demonstrates that the measures used in the trials, the Young Mania Rating Scale and the Montgomery-Asberg Depression Rating Scale, are deficient and that a briefer combination measure focusing only on the core symptoms of bipolar disorder should be used.
文摘The fast aging human population requires new approaches to reliable diagnosis and proper treatment of dementia in elderly patients with psychiatric disorders such as bipolar disorder (BD) and schizophrenia (SCZ). As compared to other psychiatric disorders, BD and SCZ are characterized by increased and similar risk for dementia as well as cerebrovascular (CVD) and Parkinson’s (PD) diseases independent of the patient’s age. There are reports in the literature suggesting BD and SCZ in older patients could cause dementia without contribution from the neurodegenerative diseases, including Alzheimer’s disease (AD), due to the absence of the known neuropathology associated with cognitive decline in such individuals. This view contradicts a plethora of data highlighting AD as a major cause of dementia in the elderly. This issue was addressed by examining postmortem cerebral pathology in an 83-year-old female diagnosed with BD, SCZ, and PD (D1) and comparing it to that of a second donor (D2), an age-matched male diagnosed with Lewy Body Dementia (LBD). Upon thorough histochemical and immunohistochemical examinations of both brains, the PD and LBD diagnoses in D1 and D2 were not confirmed. Instead, AD-related pathology was observed in both subjects with AD advancing to its clinical stage (mild to moderate) only in D1. Diffuse β-amyloid peptide 1-42 (Aβ1-42) staining, most likely reflecting a presence of the Aβ1-42 soluble form, was also detected in cerebellar neurons and cerebellar extracellular space in D1 and D2. Cerebrovascular pathology was pronounced and distinct in both brains and included amyloid angiopathy, hyaline atherosclerosis, microbleeds, and dilated Virchow Robin spaces in D1 as well as thick-walled blood vessels with microbleeds in D2. It was concluded that a mixed AD and cerebrovascular pathology could mimic Lewy Body Disease and potentially contribute to dementia development in elderly BD and SCZ patients.
文摘Isotretinoin(Accutane) is a treatment for severe acne that is resistant to other forms of treatment, including antibiotics and topical treatments. The prescription of this drug has been controversial ever since its initial marketing in 1982. It is the only non-psychotropic drug in the Food and Drug Administration top 10 drugs found to be associated with depression. Recently, Bremner et al published an extensive review(until 2010) of the evidence for the association of retinoic acid(RA) with depression and suicide. Some patients who are admitted in psychiatric hospitals report a history of present or past treatment with isotretinoin. Then, the imputability of the molecule in the occurrence of disorders represents necessarily an important question for both professionals and their patients. This paper aims to specify the links between the drug and specific psychiatric disorders. A review of the literature related to isotretinoin, RA, vitamin A, depression, suicide, anxiety, bipolar disorder, psychosis, schizophrenia was performed. Many studies demonstrated an increased risk of depression, attempted suicide and suicide following isotretinoin treatment. However, isotretinoin may have an antidepressant impact, according to some dermatological papers. They consider treating acne with this efficient treatment could improve selfimage and make the patient feel better. Several studies showed that patients with bipolar disorder had an increased risk for a clinical exacerbation of symptoms undergoing treatment with isotretinoin. A few studies also seem to suggest a possible link between isotretinoin and psychosis. Nonetheless, studies point out a link between retinoid dysregulation and schizophrenia through modulation of dopamine receptors. From this review, we propose guidelines for isotretinoin prescription to healthcare professionals.
文摘AIM: To determine the prevalence of bipolar disorder(BD) and sub-threshold symptoms in children with attention deficit hyperactivity disorder(ADHD) through 14 years' follow-up, when participants were between 21-24 years old.METHODS: First, we examined rates of BD type Ⅰ?and Ⅱ diagnoses in youth participating in the NIMH-funded Multimodal Treatment Study of ADHD(MTA). We used the diagnostic interview schedule for children(DISC), administered to both parents(DISC-P) and youth(DISCY). We compared the MTA study subjects with ADHD(n = 579) to a local normative comparison group(LNCG, n = 289) at 4 different assessment points: 6, 8, 12, and 14 years of follow-ups. To evaluate the bipolar variants, we compared total symptom counts(TSC) of DSM manic and hypomanic symptoms that were generated by DISC in ADHD and LNCG subjects. Then we sub-divided the TSC into pathognomonic manic(PM) and non-specific manic(NSM) symptoms. We compared the PM and NSM in ADHD and LNCG at each assessment point and over time. We also evaluated the irritability as category A2 manic symptom in both groups and over time. Finally, we studied the irritability symptom in correlation with PM and NSM in ADHD and LNCG subjects.RESULTS: DISC-generated BD diagnosis did not differ significantly in rates between ADHD(1.89%) and LNCG 1.38%). Interestingly, no participant met BD diagnosis more than once in the 4 assessment points in 14 years. However, on the symptom level, ADHD subjects reported significantly higher mean TSC scores: ADHD 3.0; LNCG 1.7; P < 0.001. ADHD status was associated with higher mean NSM: ADHD 2.0 vs LNCG 1.1; P < 0.0001. Also, ADHD subjects had higher PM symptoms than LNCG, with PM means over all time points of 1.3 ADHD; 0.9 LNCG; P = 0.0001. Examining both NSM and PM, ADHD status associated with greater NSM than PM. However, Over 14 years, the NSM symptoms declined and changed to PM over time(df 3, 2523; F = 20.1; P < 0.0001). Finally, Irritability(BD DSM criterion-A2) rates were significantly higher in ADHD than LNCG(χ2 = 122.2, P < 0.0001), but irritability was associated more strongly with NSM than PM(df 3, 2538; F = 43.2; P < 0.0001).CONCLUSION: Individuals with ADHD do not appear to be at significantly greater risk for developing BD, but do show higher rates of BD symptoms, especially NSM. The greater linkage of irritability to NSM than to PM suggests caution when making BD diagnoses based on irritability alone as one of 2(A-level) symptoms for BD diagnosis, particularly in view of its frequent presentation with other psychopathologies.
文摘About half of the patients diagnosed with bipolar disorder(BD) become non-adherent during longterm treatment, a rate largely similar to other chronic illnesses and one that has remained unchanged over the years. Non-adherence in BD is a complex phenomenon determined by a multitude of influences. However, thereis considerable uncertainty about the key determinants of non-adherence in BD. Initial research on nonadherence in BD mostly limited itself to examining demographic, clinical and medication-related factors impacting adherence. However, because of inconsistent results and failure of these studies to address the complexities of adherence behaviour, demographic and illness-related factors were alone unable to explain or predict non-adherence in BD. This prompted a shift to a more patient-centred approach of viewing nonadherence. The central element of this approach includes an emphasis on patients' decisions regarding their own treatment based on their personal beliefs, life circumstances and their perceptions of benefits and disadvantages of treatment. Patients' decisionmaking processes are influenced by the nature of their relationship with clinicians and the health-care system and by people in their immediate environment. The primacy of the patient's perspective on non-adherence is in keeping with the current theoretical models and concordance-based approaches to adherence behaviour in BD. Research over the past two decades has further endorsed the critical role of patients' attitudes and beliefs regarding medications, the importance of a collaborative treatment-alliance, the influence of the family, and the significance of other patient-related factors such as knowledge, stigma, patient satisfaction and access to treatment in determining non-adherence in BD. Though simply moving from an illness-centred to a patientcentred approach is unlikely to solve the problem of nonadherence in BD, such an approach is more likely to lead to a better understanding of non-adherence and more likely to yield effective solutions to tackle this common and distressing problem afflicting patients with BD.
