bluuebunny/crossref_metadata_2025 huggingface dataset:
Biological support to distinguish between congruent and incongruent symptoms in psychotic bipolar i patients
Authors: Basterreche N. , Zumárraga M. , Dávila W. , Dávila R. , Guimón J. , Arrue A. , Gordo E.
Published: May 2011

Introduction

Many authors support the idea that Mood Incongruent Psychosis is a subtype of affective illness, although no clear definition or etiopathogenic basis of the congruent or incongruent subtype has been found.

Aims

In this study we intend to evaluate clinical and biological differences between Psychotic Bipolar I patients who have mood congruent or mood incongruent psychotic symptoms.

Methods

The study has been carried out in 80 Psychotic Bipolar I Patients before, and after, four weeks of treatment with Olanzapine plus Lithium. We studied the correlation between the plasma concentration, before treatment, of the dopamine metabolite 3,4 Dihydroxyphenylacetic acid (DOPAC) and the clinical response to treatment.

Results

The most remarkable result found was that Clinical Improvement after 28 days of treatment correlated positively with the initial concentration of DOPAC, but ONLY in the subgroup of patients with congruent psychotic symptoms.

Conclusions

From our results it seems that the Congruence and Incongruence of psychosis in bipolar I patients can provide a basis to objectively divide these patients. Both groups can be distinguished based on the relationship established between their concentration of DOPAC before treatment and their clinical response to the pharmacological treatment.

Supported by

Universidad del País Vasco Grant N° EHU 09/21 and Fondo de Investigación Sanitaria and Feder Founds Grant N° 09/01760.
Change in mood instability (MI) with time and treatment
Authors: Bowen R. , Mahmood Y. , Milani A. , Baetz M.
Published: May 2011

Introduction

The literature indicates that most patients with Major Depression mention sudden short “mood swings” (MI) when asked. MI is known to be distressing but little is known about the treatment.

Objectives

To determine whether MI changes with community treatment of depression.

Aim

To study changes in MI with 3-6 months of treatment for depression in patients with Major Depression and complaints of MI.

Methods

34 patients with Major Depression and complaints of “mood swings” were recruited from 4 psychiatric practices. They were interviewed with the MINI diagnostic interview and the Mood Disorders Questionnaire. They completed the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory Trait Form (STAI-T), and Visual Analogue Scales for Depressed Mood (VAS) and Anxious Mood twice a day for a week. The Mean Square Successive Difference Statistic (MSSD) was calculated from the VAS readings. The BDI, STAI-T, and VAS were repeated after 6 months of treatment.

Results

25/34 patients reported past hypomania. Most patients were treated with a combination of antidepressants and mood stabilizers. The BDI and STAI-T scores improved with treatment. There was no overall change in depressed and anxious MI. Change in Depressed MI and Anxiety MI correlates with change in BDI from T1 to T2

Conclusions

Anxiety and depression improved with treatment as expected. Change in MI is inconsistent. Research into medications and psychosocial treatments that improve MI is needed and this will probably improve depression treatment outcome.
Driving ability in bipolar patients receiving lithium or lamotrigine
Authors: Brunnauer A. , Segmiller F. , Hermisson I. , Seemüller F. , Riedel M. , Laux G. , Engel R. , Möller H.-J.
Published: May 2011

Objectives

Driving is a daily activity for most people in developed countries and is important in maintaining independence. Bipolar patients may have an impaired driving behavior because of the pathology itself, with psychomotor and cognitive disturbances. Additionally, adverse effects of pharmacologic treatment may be detrimental.

Methods

24 remitted bipolar outpatients diagnosed according to ICD-10 criteria were enrolled in the study, receiving either lithium (n = 12) or lamotrigine (n = 12). Participants were investigated under steady state plasma level conditions. According to the German Guidelines for road and traffic safety data were collected with the Wiener Testsystem (WTS) measuring visual perception, reactivity, stress tolerance, concentration and vigilance.

Psychopathologic symptoms were rated with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Young Mania Rating Scale - Clinician rated (YMRS-C).

Results

About 40% of patients were without clinically relevant psychomotor disturbances. In 40% of cases mild to moderate impairments could be seen, and 20% of the patients were considered as severely impaired. Data show that patients under lamotrigine had an altogether better test performance than patients treated with lithium. Especially in visual perception and stress tolerance differences were most pronounced.

Conclusions

About 20% of remitted bipolar outpatients treated with lithium or lamotrigine must be considered unfit to drive. In 40% of the cases it seems justified to counsel patients individually, taking into account compensational factors. Analysis of our data point to an advantage for bipolar patients treated with lamotrigine when compared with lithium. However causal relationships can not be drawn from our data.
The two faces of the blade: Stigmatization and internalized stigmatization
Authors: Cam M.O. , Cuhadar D.
Published: May 2011

Stigmatization is a serious problem that felt by 54.6% of bipolar patients. The most dramatic deterministic about attidues of bipolar patients towards their illness is decreased self esteem that occur result of illness. Stigma and internalized stigma experiences of a patient with bipolar disorder will be transferred in this case report.

Case

31 years old, married, female patient. She is having bipolar disorder treatment for three years. About her diseases she said that “ıt is the worst illness among all of the illness, because mind is the organizatör of the human body, if you loss your mind you can not move your hand or arm”.About public stigma she told that “people afraid because of harming by us, when they see us on street they enter their home, they don’t give permission to touch their child and run away from us. My brothers wife saying me afraid from me and don’t want to be alone with me.” Also patient said that “I’m not having a talk with my neighbour because I feel they won’t take seriously me. I stayed in hospital for 28 day because illness after discharged I didn’t told anyone about staying in psychiatry clinic. In the past I done eveything but now I’m doing nothing. I feel all of the weight of the world on me. I feel myself weak both as physical and mental”

Conclusion

Stigmatized people believe that others will devalue and reject the people with mental illness and experiencing negative outcomes such as demoralization, decreased self esteem, impaired social adaptaion, unemployment, decreased psychiatric treatment adherence.
Case report: Scream of the mother whose daughter is bipolar
Authors: Cam M.O. , Cuhadar D.
Published: May 2011

50-90% percent of patients with mentall ilness live with their relatives after the acute treatment. Giving care brings important burden to family. Experinence of a mother whose daughter is bipolar will be transferred in this case.

Case

46 years old, housewife. Her daughter disease occured seven years ago in pospartum period. Mother said “three months after birth my daughter came to me with her child. she gave up the child on my arms and said “look after this baby, I want to be free and I’m going”, I didn’t understand what is happening and felt afraid. At the same time her self care was very bad, also there was only a diaper on baby. Before ilness my daughter was working in a factory because of the illness she gave up working. Now she wants to work but if she has an episod when working and says again “I want to go”, what can I do. When she is with me I can control her but out I can’t.When she is good or when she is worse isn’t clear, if something happen to her. My daughter is pure, if someone around her want to utilieze from her what will be happen. I often follow her, she knows this and get angry to me, but it is beyond my power. She have to use drug for a long time, drugs are expensive and although using drugs her illness show recurrence. It is a very difficult condition, knowing ever will be fully recovered thouth me every efforts are unnecessarily”.
Identify of family caregiver needs of patients with bipolar disorder
Authors: Cheraghi F. , Shamsaei F.
Published: May 2011

Introduction

Today's, families of individuals with bipolar disorders are actively participating in the care of their relative. Successful management of bipolar disorder in the community relies significantly on family caregivers. The need and experiences of such caregivers have been little studies with respect to bipolar disorder.

Objective

The aim of the study was to identify of family caregivers needs of patients with bipolar disorder.

Methods

In a qualitative research of phenomenological methodology, the family member’s caregivers of bipolar disorder in farshian psychiatric hospital in Hamedanl were selected by purposive sampling in the year 2010. By reaching data saturation the number of participant was 12. Data were gathered through in-depth interviews and analyzed by “Van manen” method.

Results

Five main themes were identified in this study analysis: educational needs, consult needs, economical needs, care and nursing needs and supports needs.

Conclusion

Identified the need of family member caregiver with bipolar disorder patient for mental health services to be helped and to identify the specific caring interventions that are effective in helping to sustain family caregiving.
Euthymic bipolar disorder: Are there cognitive dysfunctions?
Authors: Da Ponte G. , Neves T. , Lobo M.
Published: May 2011

Introduction

The presence of cognitive dysfunction in bipolar disorder is well established, but in the euthymic phase appear a few studies that point to the absence of cognitive deficits.

Objectives

Alert to cases of euthymic bipolar disorder with no cognitive dysfunction.

Methods

Review of relevant literature and description of a clinical case with psychological tests that assess memory and executive functions.

Results

Description of a clinical case: FP is a middle age woman, early retired, with a bipolar disorder type 2, which begins at age 30.

Her disease has several depressive episodes, and in the last 10 years, she spent most of the days lying in bed and repeatedly resorted to the emergency department for excessive voluntary drug intoxication or simply because she “wanted” to be hospitalized; her husband could not stand this situation. In September of 2009, in addition to the medical and psychological consultations, she starts attending group therapy; over the next 6 months her medication was changed and finally her disease goes into remission.

The psychological tests, made at euthymic phase, show’s no significant deficits in verbal memory and executive functions.

Conclusions

This patient has a disease with prolonged course and multiple hospitalizations and drug treatments, but don’t present relevant cognitive deficits, which may point to the fact that cognitive impairment is determined by biological factors.
Antiepileptics as mood stabilizers
Authors: Danevski G.
Published: May 2011

The field of bipolar affective disorders research now immence methodological challenges, some of which have only recently become obvious.

It has become more clear that bipolar affective disorder should be viewed longitudinally rather than in terms of individual episodes. As result of these methodological challenges, more have been far a few mood stabilizers approwed for use in bipolar disorder. Lithium was the gold standard of treatment for bipolar disorder, but a number of studies over the past several decades shown that many drugs with antiepileptic properties are effective in the treatment of some patients with bipolar affective disorder, especially for those whose disorder inadequately responds to lithium, and those who are intolerant of treatment with lithium. These antiepileptic agents include two generations of drugs: cabamazepin and valproate as first generation, and lamotrigine, gabapentine and topiramate as second generation of mood stabilising antiepileptic agents. In this article are rewiew the pharmacological properties and their efficacy in the treatment of bipolar disorder.

A series of 32 patients with bipolar affective disorder was reported. All patients were supervized in the Emergency psychiatry service in Psychiatric Hospital Skopje, as the greatest and most important psychiatric institution in Macedonia. We also summarise use of these agents in combination with other psychotropics.
Selective DNA methylation of BDNF promoter and nociceptin gene in bipolar disorder
Authors: dell’Osso B. , d’Addario C. , Palazzo M. , Cattaneo E. , Galimberti D. , Scarpini E. , Bresolin N. , Arosio B. , Bergamaschini L. , Candeletti S. , Romualdi P. , Altamura A.C.
Published: May 2011

Introduction

The etiology of bipolar disorder (BD) is still poorly understood and it has been proposed that altered expression of multiple mRNAs, affecting neurotransmission, in psychotic subjects may be due to epigenetic mechanisms (e.g., DNA methylation or histone modification).

Aims

The present collaborative study was aimed to investigate, in subjects with BD, dysregulation of DNA methylation, in the brain-derived neurotrophic factor (BDNF), previously associated with psychosis and linked to epigenetic changes at promoter regions, and in the nociceptin gene (N/OFQ), a new proposed target in psychiatric disorders.

Methods

DNA was isolated from blood of patients diagnosed with BD (either type I [n = 19] or II [n = 20]) according to DSM-IV criteria, and from healthy controls (n = 20) and, thereafter, bisulfite conversion was performed. Real-Time Methylation Specific PCR (MSP) was used for the quantification of the methylated promoters in all samples.

Results

A hypermethylation of BDNF promoter region was observed in BD II patients (but not in BD I) compared to controls (CONT: 19.0 ± 3.2%; BD I: 27.2 ± 4.0%; BD II: 36.3 ± 6.2% * P = 0.0167; ANOVA F = 3.464; P = 0.0384; Bonferroni’s post hoc test). No significant differences were found for DNA methylation of N/OFQ promoter.

Conclusions

Present preliminary findings suggest selective changes in DNA methylation of BDNF promoter in type II bipolar patients and highlight the importance of epigenetic factors in mediating the onset and/or susceptibility to BD, providing new insight into the mechanisms of gene expression.
P01-200-Validation of the french version of the affective disorder evaluation (ADE)
Authors: Delmas C. , Bourgeois V. , Haouzir S. , Bretel F. , Campion D. , Guillin O.
Published: May 2011

Objective

Despite the number of rating scales for mood disorder and semi-structured interview in psychiatry, they are few evaluations focused on bipolar disorder. Here, we report the validation of the French version of the ADE used in STEP-BD (Systematic Treatment Enhancement Program for Bipolar Disorder) studies.

Method

A total of 63 bipolar patients completed the ADE and French version of the DIGS (Diagnostic Interview for Genetic Studies). We compared the results between the two evaluations.

Results

There was a very good concordance between the two interview for the diagnosis of the type of bipolar diagnosis (κ = 1) and non-significative difference between the age at onset. The concordance coefficient was weak for addictions: alcohol (κ = 0.22) and cannabis (κ = 0.16), for anxiety disorder: panic attacks (κ = 0.35), phobia (κ = 0.36), obsessive-compulsive disorder (κ = 0) and anorexia (κ = 0.04), but stronger for psychosis: delusion (κ = 0.78), hallucinations (κ = 0.69), suicidal attempts (κ = 0.97), violence (κ = 0.47) and bulimia (κ = 0.47).

Conclusions

The affective disorder evaluation seems to be a useful instrument in clinical practice and in psychopharmacological studies, but not when the diagnosis of comorbities is necessary.
P01-202-Assessement of relationship between affective temperaments, trait impusivity and emotional response inhibition in euthymic state of bipolar disorder
Authors: Novak T. , Dolenc B. , Sprah L. , Dernovsek M.
Published: May 2011

Introduction

Several cognitive and behavioural disturbances persist in interepisodic bipolar disorder (BD). Affective temperaments may influence impairments as they contribute to the predisposition to BD and may share a common neurobiological basis with elevated trait impulsivity.

Aims

We aimed to assess a relationship between temperamental traits and impulsivity as a trait and state dependent behaviour among euthymic bipolar outpatients and healthy volunteers.

Methods

38 euthymic bipolar outpatients and 24 healthy volunteers completed TEMPS-A and BIS-11. Computerised picture- based affective go/no-go task was applied to examine emotional response inhibition as an indicator of state dependent impulsivity.

Results

Clinical group scored significantly higher than healthy volunteers on trait impulsivity and affective temperaments scales, and displayed poorer control of emotional response inhibition (Table 1). Correlation patterns were similar in both groups, with strong associations between the majority of affective temperaments and trait impulsivity components, while correlations between state dependent impulsivity measures appeared weak.

Conclusions

During euthymia, distinctive temperament profile, elevated trait impulsivity and impaired emotional inhibition, prevailed among bipolar outpatients. This is consistent with data suggesting persistent abnormalities within specific areas of the prefrontal cortex and limbic structures which may underlie the emotional, cognitive and behavioural disturbances observed in all phases of BD.
P01-203-Motivational systems and trait impulsivity in euthymic outpatients with bipolar mood disorder and healthy volunteers
Authors: Dolenc B. , Sprah L. , Dernovsek M.
Published: May 2011

Objectives

Although previous studies have suggested that bipolar disorder symptoms could result from increased impulsivity and vulnerability of the Behavioural Activation System (BAS), the association of the Behavioural Inhibition System (BIS) with the disorder remains unclear.

Aims

Given that motivational systems, especially BAS, and impulsivity are closely intertwined, we aimed to assess the associations between BIS and BAS and impulsivity among healthy volunteers and remitted bipolar outpatients.

Methods

70 euthymic bipolar outpatients and 70 healthy controls were self assessed with the BIS/BAS Scale and the Barratt Impulsivity Scale.

Results

Our data revealed elevated BIS and BAS sensitivity (Figure 1a) as well as impulsivity (Figure 1b) in the group of bipolar outpatients. Both motivational systems seem to be unrelated to the trait impulsivity.

Conclusions

Our results indicate that BIS/BAS sensitivity and impulsivity represent a distinct trait. Furthermore, elevated BIS and BAS sensitivity and impulsivity in the euthymic phase of the disorder could represent an indicator of relatively stable personal traits which persist throughout all phases of the illness, thus signifying a vulnerability factor that could be relevant in the early diagnostic picture of affective disorders.
P01-204-Predictors of recurrence of bipolar disorder during pregnancy and postpartum period in a sample of egyptian women
Authors: Abd El-Hay M.A. , El Sawy H.F. , Badawy A.A.
Published: May 2011

Introduction

Pregnancy and the postpartum are times of increased risk for women with bipolar disorder to develop new episodes.

Objective

To evaluate factors that are supposed to be associated with recurrence of bipolar I disorder among euthymic women with a history of bipolar I disorder, which could be used as a predictors of bipolar I disorder in that period.

Method

Eighty-three pregnant women with history of bipolar I disorder were followed through pregnancy and post-partum periods for possible recurrence of a new episode. All women were assessed using the MINI International Neuropsychiatric Interview. Factors that may contribute to recurrence were assessed prospectively; these included age of patients, age of onset of bipolar disorder, duration of illness, number of previous attacks, number of previous pregnancies, prior episodes in pregnancy or postpartum, complications during pregnancy and labor, pregnancy type, prior hospitalization, prior suicidal attempts, time since last episode in months, and continuation of medications.

Results

Sixty five % of euthymic bipolar females had recurrence of a new episode, either during pregnancy (33.73%) or 4 weeks postpartum (31.32%). Discontinuation of medications, longer duration of illness, more number of previous attacks, more number of previous pregnancies, more prior episodes in pregnancy, more complication during pregnancy, more complication during labor, unplanned pregnancy type, prior hospitalization, were associated with recurrence of bipolar disorder during pregnancy and postpartum.

Conclusions

Multiple factors were associated with risk of recurrence of bipolar I disorder during pregnancy and postpartum, which should be while planning treatment for such women.
P01-205-Standing in the shoulders of kraeplin's excited depression: evidences that suport “treating” depressive mixed state(s) as an official nosologic entity
Authors: Fernandes J.L. , Jorge J.C.
Published: May 2011

Introduction

Kraepelin described in “manic-depressive insanity” (1899/1913) co-ocurrence of opposite polarity symptoms in mania, hypomania, and depression. A full opposite polarity syndrome was not required to diagnose mixed state(s). Actually, mixed state(s) in the official nosology - ICD-1o and DSM-IV - is essentially limited to fullblown mixed state(s) with concomitant syndromal mania and depression. Nevertheless in the past 35 years contributions of Akiskal, Benazzi, and others followed a time of opposition to Krapelin's concept of mixed states - on the part of proeminent psychiatrists, namely: Karl Jaspers and Kurt Scheneider.

Objective

To review knowledge about depressive mixed state(s) and its importance in clinical practice.

Aim

To emphasize recent evidence supporting clinical and treatment implications of depressive mixed state(s) in both unipolar and bipolar depressed patients.

Methods

Sciencedirect and Pubmed search of English-language papers published between January 2000 e September 2010 using and cross-listing key words: bipolar mixed states, depressive mixed state/s, mixed depression, excited depression, agitated depression and suicide.

Discussion

Recently depressive mixed state(s) was “redefined” and validated as a major depressive episode with some concurrent hypomanic symptoms, its diagnostic validity supported by familiar history and its utility supported by treatment response (negative effects of antidepressants).

No response, worsening and suicidality observed in some depressed patients on antidepressants may reflect the inadequacy of our current oficial nosology which fails to recognize patients for whom antidepressant therapy unprotected by mood stabilizing agents and/or atypical antipsychotics appears to be inappropriate.
P01-206-Validation of two scales of depression in mixed mania
Authors: Fernandez M. , Ugarte A. , Ruiz de Azua S. , Saenz M. , Karim Haidar M. , Ron S. , Besga A. , Gonzalez-Pinto A.M.
Published: May 2011

Introduction

There are manic disorders with depressive symptoms in mixed mania that do not reach the threshold for the diagnosis of mixed episode.Mania and hypomania are evaluated with scales that do not detect the depressive symptoms of patients in manic episode.

Objectives

To determine the usefulness of HAMD-5 and MES depression scales in patients with bipolar disorder type I and II who have a manic or hypomanic episode with depressive symptoms. These scales were compared with the HAMD-21 and the MADRS scales respectively.

Methods

100 subjects between 18 and 65 years old were included. All patients met the DSM-IV-TR criteria for bipolar disorder with manic or hypomanic symptoms and major depression.All patients were evaluated at baseline and at 3 and 4 weeks during the follow-up.

Results

At baseline the HAMD-5 and the MES had high reliability (α = 0.88 and α = 0,74 respectively)The test-retest reliability between the 3rd and the 4th week was great for both scales (HAMD-5: r = 0,89; p < 0,001; MES: r = 0,77; p < 0,001).The convergent validity had an acceptable level for the HAMD-5 (HAMD-21/HAMD-5 = 0,73; 95% CI 0,599–0,873) and for the MES (MADRS/MES = 0,79; 95% CI 0,766–0,894)Regarding the discriminant validity, the values for the HAMD-5 and MES were higher than for the HAMD-21 and MADRS respectively (HAM-5: AUC = 0,92, 95% CI: 0,892–0,980; MES: AUC = 0,86, 95% CI: 0,786–0,934).

Conclusions

Both scales showed an adequate correlation with the HAMD-21 and MADRS and a high capacity of detection of mixed, pure and other symptoms as their remission.
„Sms-the subjective mania scale“
Authors: Freidl M. , Friedrich F. , Kaiser G. , Wancata J.
Published: May 2011

Introduction

Non-adherence of medication still is a major problem among patients suffering from bipolar disorders.

Objectives

Previous studies focused mainly on possible side-effects, attitudes and subjective well-being. Most scales concerning this issue have been developed by psychiatric experts and based on their knowledge not on the patients points of view.

Aims

The purpose of this study was to find out what kind of drug effects the patients themselves want.

Methods

2 focus-groups with 13 patients and In-depth interviews with 15 mania patients were conducted to collect information about subjective burden and symptoms of the illness. Content analyses of the transcriptions were performed and the results were used to develop a first draft of the questionnaire.

Results

The final German test version consists of 32 items and is called “The Subjective Mania Scale”. The study of content-validity showed that all SMS items were considered to be important by more than 50% of the sample. Test-retest reliability and sensitivity to change were evaluated. All SMS-items showed a significant change between time-point 1 and 3.

Conclusion

The SMS-rating scale is a feasible, reliable and valid instrument for clinical trials among mania patients.
P01-208-Prevalence of hypomania in patients with diagnosis of affective disorder
Authors: Garcia Del Castillo I. , Fernandez Mayo L. , Carmona Camacho R. , Martin Calvo M.J. , Serrano Drozdowskyj E. , Ovejero García S. , Baca García E.
Published: May 2011

Introduction

Recent epidemiological studies suggest that the prevalence of bipolar disorder might be misdiagnosed initially as unipolar depression due to the difficulty to detect episodes of hypomania. The Hypomania Checklist (HCL-32), validated in Spanish, is a self-report questionnaire with 32 hypomania items designed to screen for hypomanic episodes.

Objectives

To examine the prevalence of hypomania in patients with unipolar depression. Corroborate the efficacy of the HCL-32 to detect symptoms of hypomania.

Methods

The presence of hypomanic symptoms was assessed by the HCL-32 in a sample of 128 subjects diagnosed with bipolar I disorder (n = 30), bipolar II disorder (n = 1), unipolar depression (n = 57), and anxiety disorder (n = 15) according to DSM-IV-TR criteria. A control group of healthy subjects was selected (n = 25).

Results

The discriminative capacity was analyzed by the ROC curve. The AUC was 0.65 which did not indicate a good capacity. The sensitivity (S), specificity (E) and prevalence (P) of hypomania in unipolar patients for the following cut-off points were :14: S = 81.6%,95%CI(69.8, 93.5); E = 30.1%,95%CI(19.7,40.6); P = 74.1%; 15: S = 77.6%,95%CI(64.9,90.3); E = 37.4%,95%CI(26.3,48.4); P = 67.2%; 16: S = 59.2%,95%CI(44.4,73.9); E = 55.4%,95%CI(44.1,74.0); P = 51.7%; 17: S = 55.1%,95%CI(40.2,70.1); E = 57.8%,95%CI(46.6,69.1); P = 48.3%.

Conclusions

The HCL-32 has a high sensitivity but a low specificity as screening instrument. This might explain the high proportion of hypomania found in this study. The difference with previous studies is that our sample was heterogeneous, unstable and serious. This suggests that the HCL-32 is not valid for any psychiatric sample. Future research should develop more specific instruments with better external validity.
P01-209-The comparison between manic and mixed episodes
Authors: Ghaffarinejad A. , Mirghiasi A.
Published: May 2011

This study was designed for comparing between manic and mixed episodes and the relationship between these episodes and special scores were evaluated.

This analytical - observational study was performed in Kerman Beheshti hospital / Kerman / Iran : one hundred and eighty six bipolar inpatients with diagnosis of manic and mixed episodes were included in study. They were assessed with the Young mania and Beck Depression Inventory.

Frequency of pure mania was 22.6%. The mean of age of onsent was lower in mixed type (P = 0.02). Young score was higher in pure mania (p = 0.026).

Spearman's correlation coefficient show strong relationship between duration of hospitalization and young score (p = 0.0001).

These is significant relationship between Beck score and family history of bipolar disorder (p < 0.05). and there was significant relationship between Beck score and patient’s insight overlay,comorbidity of personality disorder was 26.3 was similar in both groups.There were significant relationships between age of onset of illness and positive familial history of bipolar disorder and major depressive disorder,and between suicidal attept and panic disorder and social phobia,however rapid cycling was higher in mixed patients significantly (p = 0.009).

As far as we know This is the first study regarding relationship between bipolar subtypes and severity of mood disorders in Iran. This study is a part of a larger study including several provinces in Iran.We believed the prevalence of mixed state is not well known and in many cases it could be underdiagnosed.
P01-210-Bipolar affective disorder and dissociation – comparison with healthy controls
Authors: Latalova K. , Prasko J. , Kamaradova D. , Kovacsova A. , Grambal A. , Diveky T. , Jelenova D. , Mainerova B. , Vrbova K.
Published: May 2011

Introduction

According to recent findings, certain clinical symptoms of the patients suffering from affective and anxiety disorder can be related to dissociation. The aim of our study is to examine if the level of dissociation in bipolar affective disorder differ from the level of dissociation in healthy volunteers.

Methods

41 patients suffering from bipolar disorder (51.2% females), and 198 healthy controls (71.2% females) were included in the study. The patients with bipolar affective disorder in remission of the illness were recruited from the Outpatient psychiatric department of Psychiatry Clinic of University hospital Olomouc. Patients were psychiatrically assessed and the state of the disorder was evaluated by experienced psychiatrist. Only patients in remission of the disorder, evaluated as 1 or 2 points of clinical global impression - severity scale, were included into the study. All participants were assessed with the Dissociative Experiences Scale (DES).

Results

The groups didn’t differ in demographic variables like age, gender and education. Patients had significantly higher mean score on the DES and pathological DES than healthy controls.

Conclusion

Our results suggest that the level of psychological dissociation in bipolar affective patients is higher than in healthy controls.

Supported by grant IGA MZ ČR NT11047
Incongruent psychosis in bipolar i disorder: heritability and importance for genetic association studies
Authors: Grigoroiu-Serbanescu M. , Elston R.C.
Published: May 2011

Introduction

Phenotype homogeneity and heritability are important conditions for identifying the genetic basis of bipolar I disorder (BPI) in association studies. Our objective was to study the heritability of mood-incongruent psychosis (MIP) in BPI in a sample of 504 families ascertained through BPI probands (294 females; 210 males) recruited from consecutive hospital admissions.

Method

There were 402 families with a psychotic proband and 275 families with a proband with MIP. All probands were directly interviewed as well as 79.55% first-degree and 22.59% second-degree relatives. The narrow and the broad sense heritability (h2) of MIP and the effect of sex and age were estimated using S.A.G.E.v.6.01-software (2009).

Results

There was no sex difference for the psychosis prevalence in probands but MIP was two times more frequent in females than in males. In families with MIP probands the narrow-sense h2 for MIP was 0.14 (SE = 0.02, P = 0.002) and the broad-sense h2 was 0.20 (SE = 0.014, P = 0.0000). Significant but lower heritabilities were found in families with a psychotic proband (narrow-sense h2 = 0.12; broad-sense h2 = 0.13). In the total sample the narrow-sense h2 was 0.06 (P < 0.005) and the broad-sense h2 was 0.10 (P < 0.00001). The female sex was more prone to incongruency (χ2 = 33.32, P = 0.0000).

Conclusion

The heritability of MIP was significant but not high in families ascertained through BPI probands regardless of familial psychopathology. These finding is in line with GWAS-studies showing that the polygenic score fails to differentiate psychotic BPI from non-psychotic BPI. Is therefore incongruent psychosis a useful dimension for association studies?
Burn-out indexes in mental health services employees and satisfaction in patients with a diagnosis of bipolar disorder
Authors: Harnic D. , Cardella A. , Mazza M. , Catalano V. , Bruschi A. , Janiri L. , Romano C. , Callea A.
Published: May 2011

Objectives

The aim of our study is the investigation of burn-out indexes in public mental health services employees (psychiatrists, psychologists, nursing staff, care providers) working with patients affected by Bipolar Disorder in order to correlate them with patients’ indexes of satisfaction about received treatment and care.

Methods

A sample of 20 employees of mental health services (psychiatrists, psychologists, nurses) and one consisting of 22 patients with a diagnosis of Bipolar Disorder have been recruited at the Bipolar Disorders Unit of the Day Hospital of Psychiatry of the A. Gemelli Hospital in Rome. Operators have been submitted the Maslach Burnout Inventory (Emotional distress, Depersonalization, Personal satisfaction/achievement/fulfilment) while patients have been submitted the Questionnaire on Satisfaction of patient (QS)

Results

By calculating the Spearman Correlation Coefficient the Depersonalization dimension proves highly correlated with the three subscales of QS: Doctor-Patient relationship quality (-.51); Information Quality and Doctor's therapeutic competence (-.48); Efficiency of service organization (-.58)

Conclusions

In our sample high levels of Depersonalization are correlated to a low satisfaction of patients. We therefore expect low levels of Depersonalization to be correlated with a higher satisfaction of the patient. Although it is not possible to generalize these results we can hypothesize that burn out negatively influences patients’ satisfaction.
Is theory of mind impairment a trait-marker in bipolar disorder?
Authors: Ioannidi N. , Konstantakopoulos G. , Patrikelis P. , Economou A. , Sakkas D. , Ploumpidis D. , Oulis P.
Published: May 2011

Objectives

Previous studies have provided evidence for Theory of Mind (ToM) impairment in bipolar disorder (BD). The aim of the study was to determine whether ToM impairment can be considered as a trait- marker or a state characteristic of BD.

Methods

ToM was assessed in 29 patients with bipolar-I during an episode and in remission as well as in 29 pair-matched for age, gender and education level healthy controls. Three different ToM tests were used (multilevel assessment): First Order False Belief Stories, Hinting Test, Faux Pas Recognition Test. Attention, memory, verbal learning ability, visuospatial ability, executive functions were also assessed using WAIS – Vocabulary, Block design, and Digit span, Stroop Test, Rey Auditory Verbal Learning Test, Trail Making Test, Wisconsin Card Sorting Test. Paired t-test was used to compare patients’ neuropsychological performance in episode and euthimic states and one-way ANOVA with post hoc Bonferroni corrections for the between groups comparisons.

Results

Patients showed significant impairments on ToM tasks in the acute phase compared to the control group. ToM deficits did not persist beyond mood episode, except patients’ poor performance on Faux Pas. Dysfunction in verbal learning, working memory, visospatial ability was found during both the acute and the euthymic phases in relation to the comparison group. Poorer performance in attention, immediate verbal memory and executive function tasks was observed only in the acute phase of the illness.

Conclusions

Impairments in social cognition might reflect underlying general cognitive deficits and residual symptoms rather than representing a specific trait-marker in BD.
P01-216-Frontopolar cortical inefficiency underpins both “hot” and “cold” cognitive dysfunction in bipolar disorder
Authors: Jogia J. , Dima D. , Kumari V. , Frangou S.
Published: May 2011

Introduction

Emotional dysregulation in Bipolar Disorder (BD) is thought to be linked with prefrontal cortex (PFC) dysfunction associated with cognitive control coupled with increased or aberrant activation within regions associated with emotional processing.

Objectives

To determine the common and distinct patterns of functional brain abnormalities during affective and emotionally neutral cognitive processing in BD.

Aims

Current models of BD emphasise the relationship between mood dysregulation and fronto-limbic dysfunction during affective or “hot” processing. However, they do not account for deficits in emotionally neutral or “cold” tasks of memory and executive function which are also present in BD. Therefore the purpose of this study was to examine the neural correlates of affective decision making and working memory in BD.

Methods

Participants were 36 euthymic BD patients and 37 healthy controls matched for age, gender and IQ. FMRI was conducted during the Iowa Gambling Task (IGT) and the n-back working memory task as respective exemplars of “hot” and “cold” processing.

Results

There were no group differences in performance on either task. BD patients demonstrated a pattern of inefficient engagement within the ventral frontopolar PFC in both the IGT and n-back. These abnormalities showed task-related segregation along the medial-lateral dimension for “hot” and “cold” processing respectively. Patients also showed greater activation in the anterior cingulate cortex during the IGT and in the insula during the n-back. These regions are thought to respond to markers of autonomic arousal.

Conclusions

These data demonstrate ventral frontopolar PFC inefficiency as a shared abnormality underpinning both “hot” and “cold” processing deficits in BD.
Therapeutic effect and tolerability of quetiapine XR in patients with manic episode, bipolar disorder I
Authors: Ladea M. , Grosu L.S. , Sinca M.C. , Sarpe M.C.
Published: May 2011

Introduction

Agitation and aggressive behavior are common symptoms in patients with an acute relapse of bipolar mania.

Objectives

Quetiapine XR is an effective treatment in agitated patients with an acute relapse of bipolar disorder.

Aims

The aim of this study was to assess the efficacy and tolerability of Quetiapine XR in patients with manic episode.

Methods

This naturalistic, observational study evaluated 45 patients diagnosed with manic episode, bipolar disorder I (DSM IV-TR) for a period of 4 weeks, during which the patients received Quetiapine XR, in doses between 800 mg and 1000 mg per day, using a rapid titration scheme.

Efficacy of the treatment was measured using Young Mania Rating Scale (YMRS) and Clinical Global Impression Scale (CGI), performed at baseline, and then weekly. The Overt Aggression Scale-Modified (OAS-M) was used daily until day 4 and then once per week. Extrapyramidal symptoms were assessed with Barnes Akathisia Rating Scale and Abnormal Involuntary Movement Scale.

Results

Important improvement of OAS-M total score was observed from the second day of treatment. After 4 weeks, more than a half of the patients presented a decrease of YMRS score with more than 50%. The CGI score also significantly improved. The treatment was well tolerated, mild to moderated adverse reactions being registered, without extrapyramidal symptoms.

Conclusions

These results confirm that Quetiapine XR is an effective and safe treatment for patients with an acute relapse of bipolar disorder I, the rapid titration scheme of the doses leading to a good control of aggressive behavior.
Autonomic nervous system in euthymic patients with bipolar affective disorder
Authors: Latalova K. , Diveky T. , Grambal A. , Kamaradova D. , Velartova H. , Prasko J.
Published: May 2011

Background

Autonomic nervous system (ANS) dysfunction and reduced heart rate variability (HRV) have been reported in a wide variety of psychiatric disorders, but have not been well characterized in bipolar patiens in remission. We recorded cardiac activity and assessed HRV in bipolar outpatients in remission.

Aims

Ascertain if ANS decrease with the age of the patient; ascertain relation between activity of ANS and level of dissociation, and other components (age of patients, and age of disorder, dosage of psychotropic medication)

Methods

Autonomic nervous system (ANS) has been evaluated during orthostatic change in three positions (1- lie down 5 minutes, 2 – stand up 5 minutes, 3 – lie down 5 minutes). The functioning of the ANS has been measured by the diagnostic systems that are using the power spectral analysis which quantifies the heart rate variability (HRV) was assessed using time domain, frequency domain, and nonlinear analyses in 23 bipolar patients in remission.

Results

We found highly statistically significant negative correlations between level of dissociation measured by DES and most of parameters of ANS. We found negative correlations between the age of the patient and activity of ANS, and negative correlations between activity of ANS and duration and onset of disorder.

Conclusions

Autonomic dysregulation is associated with bipolar disorder in remission and has relation to level of dissociation and probably to age of patiens and age of onset and duration of disorder.

Supported by grant IGA MZ ČR NT11047
P01-222-Prospective memory performance in Chinese patients with bipolar affective disorder
Authors: Lee E. , Xiang Y.T. , Au R.W.C. , Shum D. , Tang W.K. , Ungvari G.S.
Published: May 2011

Introduction

Persons suffering from bipolar affective disorder have a wide range of cognitive deficits, but there have been limited understanding of prospective memory performance. Time-based prospective memory is remembering to perform an action at a specific time, whereas event-based prospective memory is remembering to perform an action when an external cue appears.

Objectives

Assess the time-based and event-based prospective memory performance in Chinese persons diagnosed with bipolar affective disorder.

Aims

Identify factors associated with prospective memory performance.

Methods

A sample of 40 persons diagnosed with bipolar affective disorder were recruited from a psychiatric outpatient clinic. All participants completed the Cambridge Prospective Memory Test, Rivermead Behavioral Memory Test, Test of Nonverbal Intelligence - Third Edition, the Young Mania Rating Scale and Hamilton Rating Scale for Depression.

Results

The mean total score of the Cambridge Prospective Memory Test of persons diagnosed with bipolar affective disorder was 24.4 ± 7.0. Time-based prospective memory performance was worse than event-based PM task. The Cambridge Prospective Memory Test total score was associated with the Hamilton Rating Scale for Depression score and Rivermead Behavioral Memory Test score. The performance of time-based prospective memory tasks was associated with the Hamilton Rating Scale for Depression score, and the performance of event-based prospective memory tasks was associated with the Rivermead Behavioral Memory Test total score.

Conclusions

Persons diagnosed with bipolar affective disorder are found to have worse time-based than event-based prospective memory performance. The importance for everyday functioning and independent living needs to be explored in future studies.
P01-224-Diagnosis and misdiagnosis of bipolar disorder: decision making of Austrian psychiatrists
Authors: Lex C. , Rados C. , Meyer T.D.
Published: May 2011

Introduction

Studies show that bipolar disorder is often misdiagnosed. One reason for misdiagnosis may be that psychiatrists do not rely strictly on ICD or DSM criteria but consider some symptoms, e.g., „decreased need for sleep”, as more critical than others. Another reason could be that the diagnosis of bipolar disorder is associated with the total number of reported symptoms.

Objectives

Firstly, we investigate if an individual is more likely to be diagnosed with bipolar disorder if he/she reports a „decreased need for sleep”. Secondly, we explore if a high number of reported relevant symptoms increases the likelihood of a bipolar diagnosis.

Method

Five case vignettes that varied in respect to the relevant information were sent to 400 randomly selected Austrian psychiatrists. The vignettes contained all information that is required to diagnose a bipolar disorder according to ICD-10 or DSM-IV. The psychiatrists were asked to return a questionnaire that collected data on their diagnostic decision making.

Results

Preliminary data will be reported and discussed.
P01-225-A case of unipolar mania
Authors: Lopes R. , Azevedo J. , Curral R. , Esteves M. , Coelho R. , Roma-Torres A.
Published: May 2011

Introduction

The concept of unipolar mania has been raised, rejected and resurrected by a number of authors, and its true position within bipolar affective disorders is still a subject of debate.

Clinical case

A 52-year-old Caucasian woman was presented to the emergency room accompanied by family members because she had seven days without sleeping, exaggerated self-confidence and was engaged in multiple activities.

Discussion

At the mental examination she presented irritability, agitation, elation of mood, verbiage, sexual disinhibition, delusional activity of persecutory content, absence of insight. She had three manic episodes earlier and she didn’t have therapeutic adherence. The patient maintained an optimal level of performance functioning between maniac episodes, and also had no earlier depressive episodes. She described herself as a very creative, original, friendly, outgoing, sociable, responsible person. She had no family history of bipolar disease or other psychiatric disorder. An hemogram, basic biochemical investigations, cerebral TC, ilicits drugs screen and EEG were preformed showing no relevant alterations. She was admitted at an acute care psychiatric unit for 16 days. She had a good response to risperidone 2 mg and 1000 mg of divalproex sodium and to cognitive behavioural treatment.

Conclusion

Due to her previous 3 and her current manic episodes, without history of depressive symptoms, we concluded by the diagnosis of unipolar mania. Although there are certain sociodemographic and clinical variables that overlap, there does seem to be recent evidence concerning clinical, psychopathological and treatment features indicating a nosological separation of unipolar mania from bipolar mania.