bluuebunny/crossref_metadata_2025 huggingface dataset:
P01-226-Line item analysis in paediatric patients with bipolar I disorder treated with aripiprazole
Authors: Loze J.-Y. , Mankoski R. , Zhao J. , Carson W. , Youngstrom E. , Findling R. , Forbes R. , Landsberg W.
Published: May 2011

Introduction

Aripiprazole has demonstrated efficacy for the treatment of paediatric patients (10–17 years) with a manic or mixed episode associated with bipolar I disorder in a clinical trial that utilised the Young Mania Rating Scale (YMRS) Total score as the primary outcome measure.

Objectives/aim

This analysis evaluated the profile of discrete symptom response using the YMRS and other measures.

Methods

Post-hoc analysis of individual items of the YMRS and the parent or subject version of the General Behaviour Inventory (GBI) Mania and Depression scales using data from a 4-week, double-blind, randomised trial that compared aripiprazole (10 or 30 mg/day, n = 197) with placebo (n = 99).

Results

In total, 296 patients were randomised; 80% completed the study. Significant decreases at Week 4 (p < 0.05) were seen in eight YMRS items: elevated mood, increased motor activity/energy, need for sleep, irritability, speech (rate and amount), language/thought disorder, abnormal thought content and disruptive/aggressive behaviour. For the GBI, effect sizes for parent-reported mania items were medium to large (for example, 0.41 for ‘depressed but high energy’ to 0.78 for ‘rage combined with unusually happy’) but were consistently small on subject self-reported items of mania and depression and, for the overall scale, had the poorest agreement with clinician ratings.

Conclusions

Aripiprazole demonstrated improvements in some of the more troublesome symptoms of paediatric patients with bipolar I disorder experiencing an acute manic or mixed episode. Of note, irritability and aggression showed large treatment effects on both clinician and parent-reported measures, but less so for subject-reported measures.
P01-227-Implementing family psychoeducational intervention in bipolar i disorder: a randomized controlled trial
Authors: Luciano M. , Del Vecchio V. , Malangone C. , Giacco D. , De Rosa C. , Fiorillo A. , Maj M.
Published: May 2011

Introduction

Bipolar disorder is associated with high personal and social burden, impaired social functioning and high levels of disability. The psychoeducational family intervention, found to be effective in the treatment of schizophrenia, may be particularly useful for patients with bipolar disorder and their relatives.

Aims & methods

This study, funded by the Italian Ministry of Health, coordinated by the Department of Psychiatry of the University of Naples SUN and carried out in 11 randomly selected mental health centres, included the following phases

1) development of informative materials;

2) training of 2 mental health workers per center;

3) random selection of 16 families of patients with bipolar disorder for each center: 8 being randomly allocated to the experimental group and 8 to the control group.

Results

62 families have been recruited. Mental health workers reported several advantages in conducting the intervention, in particular in the relationship with patients and families. Significant improvements have been reported in professional skills and relationships with colleagues. The advantages tend to increase over time. The main reported difficulties are lack of time to run the intervention, identification of appropriate families, excessive workload and the need to integrate this intervention with other work commitments.

Conclusions

It is possible to provide psychoeducational family intervention for patients with bipolar I disorder and their families, after a relatively short period of training. In order to facilitate the dissemination of this intervention in routine conditions, a better planning of the activities of the mental health centers may be useful.
P01-228-Behcet's syndrome comorbid with bipolar disorder: A case report
Authors: Maner F. , Şahmelikoğlu Ö. , Hısım Ö. , Özhan H. , Sarıahmetoğlu H. , Tümay N. , Emin Ceylan M.
Published: May 2011

Introduction

Behcet's Syndrome is a chronic inflammatory disorder of unknown etiology, characterized by aphthous lesions and recurrent ulceration of the mouth, genitals and uveitis.

Objectives

The central nervous system is involved in about 20% of cases.

Aims

Only few reports deal with affective symptoms associated with Behcet's syndrome.

Methods

We report a case of a 43 year old male with Neuro-Behcet's Syndrome that presents with a psychotic manic attack. He developed Behcet's Syndrome at the age of 23, with recurrent uveitis and aphthous lesions in the mouth, painful ulcers in the genitalia and erythema nodosum. HLA-B 5 was positive.

Results

He was treated with azothioprine 150 mg/day for 13 years and prednole 100 mg/day during uveitis attacts for a week. At the age of 37 a sudden occurrence of right hemiparesia due to cerebrovascular accidence salicylic acid 100mg/day, siclosporine 150 mg/day, piracetame 1600mg/day were administered. He presented to psychiatry clinic in manic episode with euphoric mood, psychomotor agitation, talkativeness, decreased need for sleep, excessive buying and he had an unrealistical thought that he was a player of a famous soccer team. He was diagnosed as bipolar I disorder, according to DSM-IV. This was the patient's first admission and the symptoms which were continuing for 6 years exaggerated during uveitis attacks.Psychiatric examination releaved that increaced psychomotor activity, hypomaniac affect, amount and affect speed of speech affect, increased associations, grandiose delusions.

Conclusion

There are a few reports dealing with bipolar disorder as an entity related to Behcet's syndrome.
P01-229-Emotional incontinence or bipolar disorder?about a case report
Authors: Mnif L. , Masmoudi J. , Charfi N. , Baâti I. , Kolsi S. , Jaoua A.
Published: May 2011

Introduction

Post-stroke emotional incontinence and bipolar disorder are two disorders that involve the dysfunction of brain structures responsible of emotional regulation.

The objective of this work is to study the links between these disorders through a clinical case.

Case report

It was a 43 year old patient who consulted for an emotional incontinence appeared after an ischemic stroke with lenticulocapsular and right semioval center lesions.

Treatment with antidepressant was marked by the appearance of hypomania.

Discussion and conclusion

The appearance of a pharmacologically induced hypomania in this patient could suggest a link between emotional incontinence and bipolar disorder.

Especially that periventricular areas and deep subcortical structures, involved in emotional regulation, are affected in these disorders.

More attentiveness against antidepressant treatment is required, because of the potential risk of a pharmacological hypomania.
Quality of life in bipolar disorders compared to schizophrenia
Authors: Zouari L. , Abida I. , Walha M. , Masmoudi J. , Ben Thabet J. , Zouari N. , Maalej M.
Published: May 2011

Introduction

The classic opinion of a favorable prognosis of bipolar disorders, compared to schizophrenia, is refuted by modern conceptions.

Objectives

The aim of this study was to assess the quality of life (QOL) in bipolar patients compared to schizophrenic patients’, and to identify clinical and sociodemographic variables statistically associated to a poor QOL in bipolar disorder patients.

Methods

One hundred and twenty outpatients, 50 with bipolar disorder and 70 with schizophrenia, according to DSM-IV-TR criteria, were included in the study. The QOL has been assessed, in all patients, using the «36 item Short-Form Health Survey» (SF-36).

Results

Thirty-six percent of the bipolar patients had a poor QOL, versus 37% among the schizophrenic patients. The bipolar patients had the score of the standardized vitality subscale significantly lower than schizophrenic patients’ (p = 0.036); the latter had the standardized general health subscale score significantly lower (p = 0.03). There were no other statistically significant differences. The multivariate analyses showed three variables significantly correlated to a poor QOL in bipolar patients: age at the time of the study ≥ 40 years (p = 0.01), professional irregularity or inactivity (p = 0.005), age at onset ≥ 25 years (p = 0.004).

Conclusion

Our survey of the QOL in bipolar patients showed that it did not differ globally from the schizophrenic patients’, with the SF-36 scale. Results reported in the literature are not in agreement. Further longitudinal studies on several months, with other assessments, would permit to verify the validity of our results.
Group-based trajectory modeling a good model to explore sub-groups of recovery during acute bipolar mood episodes
Authors: M’bailara K. , Cosnefroy O. , Desage A. , Gard S. , Zanouy L. , Minois I. , Henry C.
Published: May 2011

Group-based trajectory modeling (GBTM) is a statistical method created to explore the heterogeneity of clinical groups based on their longitudinal outcomes by identifying distinct trajectories of change. This model can be applied to assess heterogeneity in responses to treatment. This pilot study explored the relevance of the GBTM associated with the dimensional evaluation of mood (MATHYS) to define trajectory of recovery in acute bipolar mood episodes on a short period of time during a naturalistic study.

Method

The sample consisted in 118 bipolar patients and all patients were recruited during an acute phase: 56% had a major depressive episode, 26% a manic or hypomanic episode, and 18% a mixed state using the DSM-IV criteria. Patients were assessed four times with MATHYS during a three weeks follow-up period. It is an observational study and treatment was prescribed as usual. We applied the GBTM method and MATHYS total score to define trajectories of recovery.

Results

This method allows identifying 4 trajectories of recovery. At Baseline, two of them started with a score of inhibition but with quite different evolutive profiles (stable inhibition versus improvement). The two others trajectories started with a score of activation (mild versus moderate) and showed a linear improvement of symptoms but with a more rapid recovery for the patients with the higher activation at baseline.

Conclusion

When considering the diagnosis of patients belonging in each trajectory, there model seems particular relevant to explore the high heterogeneity in response to treatment in bipolar patients during an acute depressive episode.
Treatment non-adherence amongst schizoaffective bipolar patients: An unsolved question
Authors: Murru A. , Bonnin C.M. , Nivoli A.M. , Pacchiarotti I. , Vieta E. , Colom F.
Published: May 2011

Introduction

Non adherence to treatment is especially common in patients with chronic relapsing disorders. Schizoaffective disorder is a chronic, severe and disabling illness consisting of the concurrent presentation of symptoms of schizophrenia and affective disorders. Its course and prognosis has been found to be intermediate to those two conditions.

Objectives

To evaluate treatment adherence in a schizoaffective sample and to which demographical and clinical variables it may be associated.

Methods

Adherence to treatment and its clinical correlates were assessed in 69 patients meeting DSM-IV-TR diagnosis of schizoaffective disorder, bipolar type, by means of adherence-focused interviews, measurements of plasma concentrations of mood stabilizers.

Adherent and poorly adherent patients were compared with respect to several clinical and treatment variables.

Results

Poorly adherent patients were 40% of the total sample. Demographic variables (i.e.: gender, marital status, cultural level, employment) were not associated to treatment adherence, nor were clinical variables (age at onset, polarity of the first episode, lifetime history of seasonal pattern, rapid cycling, atypical depression, melancholia, catatonia) or family history for generic psychiatric, affective disorders and suicide. No pharmacological treatment (atypical antipsychotic, mood stabilizer and antidepressant) was associated to adherence in our sample.

Conclusions

Clinical and demographical factors are not related to medication adherence in our sample. Coherently with the general severity of this condition, and since there does not seem to be any clinical predictor of poor adherence, in clinical practice all schizoaffective patients should be monitored and treated as potentially non-adherent.
Lithium and valproate combination: Therapeutic strategies in a sample of patients with bipolar disorder
Authors: Muti M. , Pergentini I. , Corsi M. , Viaggi C. , Caramelli A. , Musetti L. , Corsini G.U. , Dell’Osso L.
Published: May 2011

Introduction

Lithium is the agent that has shown more efficacy for the treatment of Bipolar Disorder (BD), anyway a single agent isn’t effective to control all aspects of the syndrome.

The mood-stabilizer frequently used, in combination with Lithium, is Valproate which presents different methabolism and side effects. Further both molecules are glycogen synthase kinase-3 (GSK-3b) inhibitors and have synergistic neuroprotective action.

Objectives

We underline the need to better investigate Lithium and Valproate combination therapy in BD.

Aims

Observation of Lithium and Valproate combination therapy in a sample of patients with BD, considering doses and serum levels.

Methods

56 patients with BD (mean age 38 ± 0,02), followed at the day hospital of the Psychiatric Clinic, University of Pisa, were studied. Serum levels evaluated at the Section of Pharmacology, Department of Neuroscience, University of Pisa.

Results

We identified 5 comparison groups depending on the dose intake of Lithium (11 subjects: 300 mg /die, 9: 450 mg/die, 19: 600 mg/die, 7: 750 mg/die, 10: 900 mg/die) with increased serum levels of the medication (0.27 mEq/l, 0.37 mEq/l, 0.50 mEq/l, 0.52 mEq/l, 0,70 mEq/l). There are not significant differences between groups related to both, the mean dose intake of Valproate (772 mg/die, 744.4 mg/die, 867.5 mg/die, 821.4 mg/die, 845 mg/die) and its serum levels (45.2 mg/L, 46.6 mg/L, 53.2 mg/L, 47.4 mg/L, 48.4 mg/L).

Conclusions

This study aims to identify the effective dose of Lithium in combination with Valproate able to determine the prevention of relapse in BD patients. The use of the lower dose of Lithium maintaining therapeutic effectivness, means reducing side effects, toxicity and the need for constant monitoring.
Bipolar disorder and heroin addiction-case report
Authors: Nikic M. , Alcaz S. , Vucetic-Arsic S. , Popadic G.
Published: May 2011

Background

It was estimated that in general adult population represented in 2–3% co-occurring mental and substance use disorders.

In our case we represented the patient who is a long-time heroin addict with a dual diagnosis of bipolar disorder. Special attention was payed to influence of the primary psychiatric disorder to a course and treatment of substance abuse.

Methods

Patient is observed during the five years from March 2005 to March 2010. In the evaluation of the case we used History of illness, MINI, HAMD. and psychological tests battery (MMPI 202, Drawing Human Figure, EGO Perception and EGO Ideal Test).

Results

During the observation we have noticed that the patient was started treatment in periods of depression decompensation, because of heroin relapse. In that moment HAMD score was between 20 and 24 points. After detoxification, the patient was experiencing a switch in hippomanic state, which resulted in drop-out in the first month of treatment. This course of disease was repeated five times during our observation. Because the patient retained in treatment, we were able to progress. Now, the patient has been in abstinence for eight months, and he is in acceptable affective stability.

Conclusion

Bipolar Disorder is increased risk for frequent heroin relapses and continuity in the therapeutic treatment. This influence may involve direct effects of drugs on the initiation of affective symptoms and indirect effects on treatment compliance. When symptoms are controlled through these psychiatric medications, patients will benefit from therapeutic treatment of their substance abuse.
Lithium therapy and the risk of acute hemolysis in G6PD deficient bipolar patients
Authors: Olari M. , Bourgeois V. , Haouzir S. , Guillin O.
Published: May 2011

Introduction

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme deficiency worldwide. In this condition acute hemolysis is caused by exposure to an oxidative stressor in the form of an oxidative drug, an infection or aliments. G6PD deficiency can be associated to different psychiatric conditions, but little is known about the risk of acute hemolysis in G6PD deficient patients that are treated with antipsychotics and mood stabilizers.

Aims

A clinical description is presented in order to illustrate the possible risk of acute hemolysis with Lithium therapy in a G6PD patient.

Methods

A 33 years old male of hispanic origin and a G6PD enzyme deficiency was admitted presenting a first episode of mania. Lithium treatment was initiated.

The patient was clinically examined daily. Extensive laboratory evaluation was performed, including complete blood cell count, liver, renal and thyroid function tests, serum electrolytes and glucose levels, urinalysis, lithium blood dosage. Neuroimaging studies were also performed excluding secondary causes of mania.

Results

At J7 of lithium therapy the patient presented with jaundice and a blood count revealed a drop in the number of red blood cell (from 3,42 T/L to 2,42 T/L) with an increase of bilirubin (87,2 umol/l) which revealed an episode of acute hemolysis. Lithium therapy was discontinued immediately. Red blood cell count continued to drop for another 7 days and returned to normal after 2 weeks of discontinuation of Lihium therapy.

Conclusions

Lithium might be a trigger of acute hemolysis in bipolar patients with G6PD deficiency associated.
The effects of childhood trauma on psychotic symptoms in bipolar disorder
Authors: Ozkose M.M. , Guclu O. , Guloksuz S. , Karaca O. , Yildirim B. , Ince B. , Erkmen H.
Published: May 2011

Introduction

Although history of childhood trauma is present in nearly 50% of bipolar patients, the effects of childhood trauma on the course of bipolar disorder are rarely investigated. Thus, we aimed to investigate the effects of childhood trauma on psychotic symptoms seen in patients with bipolar disorder.

Methods

One-hundred DSM-IV-TR diagnosed bipolar patients who were either manic or depressive were recruited from inpatient units of Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery. Patients were initially evaluated by Young Mania Rating Scale (YMRS), Montgomery-Asperg Depression Rating Scale (MADRS), Scales for Assessment of Positive Symptoms. Patients were also evaluated by Childhood Trauma Questionnaire (CTQ) and Dissociative Experiences Scale in euthymia which was defined by scores of < 7 in YMRS, < 4 in MADRAS

Results

There were no differences between the patients with and without a history of psychotic episode in terms of age at onset, duration of illness and episode characteristics. Patients with a history of psychotic episode were hospitalized more. CTQ physical abuse scores were higher in male comparing to female. CTQ sexual abuse scores were higher in female comparing to male. CTQ emotional abuse, physical neglect, physical abuse and total scores were higher in patients who had at least one psychotic episode in lifetime than in patients without a history of psychotic episode.

Conclusion

The history of childhood trauma should be investigated and therapeutic interventions for childhood trauma should be added to the standard treatment plan of bipolar patients.
Pharmacological treatment prescribed to the hospitable discharge in the patients with diagnosis of two-pole disorder, current maniacal episode con/without psychotic symptoms
Authors: Paez M.I.N.
Published: May 2011

Introduction

The two-pole disorder is one of the diagnoses more prevalent to the hospitable revenue of the patients in the UHSM-HUSC. Nowadays there is scanty the knowledge of the pat physiology of this disease. Therefore, in the last years an advance has taken place in the different pharmacological therapies used for this disorder, being variable the current available evidence.

Aims

To analyze the prescription to the hospitable discharge of lithium, anti-epileptic, antipsychotic atypical medicaments and antipsychotic typical in patients.

Methods

We realize a descriptive retrospective study of the prescribed treatments. The different alternatives of treatment analyzed are: antipsychotic atypical medicament, antipsychotic typical medicament, lithium and anti-epileptic in monotherapy or mixed. We use as sample all the patients’ income that have the criteria of two-pole Disorder, current maniacal episode con/without psychotic symptoms according to the CIE-10 that have taken place in the triennium in the UHSM-HUSC of Granada. The obtained information was submitted to statistical analysis(SPSS v.16.0)

Results

The medicaments prescribed with more frequency are the lithium in monotherapy or partner to antipsychotic atypical being the trend the use of the acid valproico in monotherapy or from concomitant form to antipsychotic atypical. The medicaments fewer employees are the acid valproico and the antipsychotic atypical ones in monotherapy.

Conclusions

It was prescribed as treatment to the hospitable discharge in patients during the triennium principally lithium or acid valproico partners to antipsychotic atypical being the trend the use of acid valproico associated to antipsychotic atypical. The use of antipsychotic typical was more limited.
Bipolar disorder in childhood and adolescence
Authors: Paixão L. , Avelino M.J. , Barroso C.
Published: May 2011

Introduction

The diagnosis of Bipolar Disorder (BD) is still controversial in the early stages of life, not only because of its difficulty, but also because of the precaution of professionals with this diagnosis, since it is a chronic illness.

Aims

To review and synthesize available information about paediatric BD.

Methods

The authors consulted, selected and reviewed information concerning the theme, mainly searched on-line articles.

Results

It is difficult to diagnose BD in youths, considering the fewer specific symptoms and the high co-morbidity.

Conclusions

Despite some disagreement on this diagnosis, BD is a valid clinical entity in children and adolescents.
P01-242-Composer robert schumann not a bipolar. New sources
Authors: Peters U.H.
Published: May 2011

According to new findings the name of Robert Schumann has to be striked off the list of famous people with bipolar disorder. The author has reviewed hundreds of hitherto unknown sources, daily notes of his psychiatrists, letters, diaries, among others. Schumann turned out to have been an alcoholic, who suffered from delirium tremens, 4 days, misdiagnosed as madness by his physicians. The famous suicidal attempt by jumping into the Rhine was just a floating rumour, not reality. Schumann was admitted to a privately owned madhouse. In spite of all his painstaking he could not free himself. His wife did not want him back. Finally he died from malnutrition and pneumonia. – Schumann always worked as easy as Mozart, according to the financial needs of his fast growing family. Attributing this to a manic state is erroneous. Already in young age Schumann had trained his “inner hearing”, he just wrote down, what he had heart. Only once in his life Schumann said himself to have been a melancholic, but that was for making up a plausible excuse for an intimate relationship to an other girl, pretending medical advice against melancholia. – All of these scattered sources are available only in German language. In two books I have written lengthy quotations in order to ease the access. However, there is no English translation available.
P01-244-Mood-dependent changes of serum lithium concentration in a rapid cycling patient maintained on stable doses of lithium carbonate
Authors: Rittmannsberger H. , Malsiner-Walli G.
Published: May 2011

Introduction

Serum concentration of lithium may change according to mood states in bipolar patients, leading to reduced serum levels of lithium during manic periods.

Objective/aims

Documentation of mood states and serum lithium levels in a rapid cycling patient

Methods

We report about a 58 year old female patient with rapid cycling disorder whose mood altered every 20 to 30 days. No treatment has been effective until now. The patient is treated with a stable combination of clozapine 200mg, valproate 1500mg and lithium carbonate 450mg. Noncompliance can be ruled out since intake of medication is supervised. For 13 months a mood diary was performed by a relative using a simple scale for mood which rated neutral mood with 0, mania with +1, +2 and +3 (highest mania) and depression from -1 to -3 (deepest depression). Lithium levels were obtained first on a monthly, later on a weekly to two-weekly basis.

Results

Over a period of 13 months 7 depressive and 6 manic phases could be observed. The patient spent 230 (48%) days in depression (8 lithium samples obtained), 137 (29%) in mania (11 samples) and was euthymic on 68 (16%) days (2 samples). Mean lithium serum levels were 0.68mmol/l in depressive states, 0.37 mmol/l in manic states (p = .001, t-test). The lowest value was 0.13 mmol/l (in mania) and the highest 0.93 mmol/l (in depression).

Conclusions

In this patient mood-dependent changes of serum lithium levels during constant medication could be demonstrated. The reasons for this phenomenon are yet to be elucidated.
P01-245-Substance related disorder among bipolar patients
Authors: Samimi Ardestani S.M. , Razjouyan K. , Ramezani F.
Published: May 2011

Introduction

Bipolar disorder (BPD) is a common, severe, and persistent psychiatric illness affecting 1.3% to 1.7% of the population. Substance use disorders (SUDs) are also common. A community-based study found a lifetime prevalence of 17% for alcohol abuse or dependence and 6% for other substances. BPD and SUDs occur together more frequently than would be expected by chance alone.

Objectives

This study was conducted to determine the pattern of substance abuse among Iranian bipolar disorder inpatients.

Aims

We reviewed the history of patients who admitted with bipolar diagnosis in any phase to determine types of substance usage.

Methods and materials

This descriptive-analytical cross-sectional study on existing data, conducted among 322 patients with bipolar disorder attending to Imam-Hossein Hospital. The clinical records of each patient was assessed for any type of substance or alcohol related disorders.

Results

84 patients (26.1%) had substance use disorders. 40.5% were using opioids, 6% mood-elevators, 7.1% alcohol, and 46.4% were using multiple substances. The mean duration of substance abuse was 104 months plus 23 days.

Conclusions

Totally, it may be concluded that substance abuse frequency among patients with bipolar disorder is high and may lead to deteriorated prognosis. Substances can also distort the clinical feature and course of the disorder and may create difficulties in correct diagnosis
P01-246-3Q29 case-control association study of co-morbid migraine in bipolar affective disorder
Authors: Schmoeger M. , Cohen-Woods S. , Hosang G. , Schloegelhofer M. , Craig I. , Farmer A.E. , McGuffin P. , Aschauer H.N. , Schosser A.
Published: May 2011

According to Oedegaard et al. (2010) the co-morbidity of migraine and bipolar disorder (BPD) is well documented in numerous epidemiological and clinical studies, and there are clear pathophysiological similarities. Interestingly, in a genome-wide scan, Lea et al. (2005) identified a susceptibility locus for a severe heritable form of common migraine on chromosome 3q29. With respect to BPD, a susceptibility region on chromosome 3q29 was identified in a genome-wide linkage scan (Bailer et al. 2002) and follow-up linkage analysis (Schosser et al. 2004). These findings were also supported by further fine-mapping of this region (Schosser et al. 2007). Since 3q29 is among the chromosomal regions implicated in migraine and bipolar linkage studies, the aim of the current study is to test for 3q29 association of migraine in sample of patients with BPD. The sample consists of 463 patients with a diagnosis of BPD (34.63% men, 65.37% women; mean age ± SD: 48.01 ± 11.26), as defined by the Diagnostic and Statistical Manual 4th edition operational criteria (DSM-IV) and the International Classification of Diseases 10th edition operational criteria (ICD-10), derived from the Bipolar Affective Disorder Case Control Study (BACCS). A total of 51 SNPs in the region of the 3q29 were genotyped using Sequenom MassARRAY® iPLEX Gold and tested for association with migraine. The results of this association study investigating the 3q29 region in a sample of patients with BPD will be presented.
P01-249-Weight change and metabolic effects of asenapine in placebo- or olanzapine-controlled studies
Authors: Zhao J. , Cazorla P. , Schoemaker J. , Mackle M. , Panagides J. , Karson C. , Szegedi A.
Published: May 2011

Introduction

Weight change and metabolic effects of atypical antipsychotics vary considerably.

Objective

Assess weight and metabolic effects of asenapine in adults.

Aim

Demonstrate that asenapine marketed doses are well tolerated compared with placebo or olanzapine.

Methods

Data were from pooled asenapine trials that used placebo (1748 patients; duration: 1−6 wk) and/or olanzapine (3430 patients; duration, 3−>100 wk) controls. Asenapine doses were 5 or 10 mg BID (2–20 mg BID in 2 studies); olanzapine doses were 5–20 mg QD. Post hoc inferential analyses based on ANOVA assessed change from baseline weight, body mass index, and fasting lipid and glucose levels.

Results

Table 1 summarizes the results.

[Change From Baseline Weight and Metabolic Paramete]

Discussion

These post hoc pooled analyses support published reports and suggest asenapine was associated with moderate weight gain and increased fasting triglyceride and glucose levels vs placebo, but lower propensity for weight gain or increased serum lipids (ie, triglycerides, low-density lipoprotein, and cholesterol) vs olanzapine.
Meta-analyses of the efficacy of asenapine vs placebo in bipolar I disorder as monotherapy and adjunct therapy compared with other atypical antipsychotics
Authors: Fennema H. , Slaap B. , Karson C. , Szegedi A.
Published: May 2011

Introduction

Superiority of asenapine vs placebo, as monotherapy or adjunctive therapy to lithium or valproate, for acute bipolar mania has previously been reported.

Objective

Present meta-analyses of asenapine compared with atypical antipsychotics based on placebo-controlled trials.

Aim

Further demonstrate the efficacy of asenapine for acute bipolar mania.

Methods

The primary endpoint was change from baseline vs placebo on Young Mania Rating Scale (YMRS) total score at treatment week 3. Data for asenapine (5 or 10 mg BID) and comparators were obtained from all monotherapy (n = 20) or adjunctive treatment trials in patients showing incomplete response to lithium or valproate monotherapy (n = 10) published at the time of the analysis. Meta-analyses used a random-effects model described by DerSimonian and Laird (Control Clin Trials 1986;7:177–188).

Results

Treatment effects varied substantially across agents and for individual agents across trials. For monotherapy, the change from baseline in YMRS total score with asenapine exceeded placebo by 4.5 points (95% CI, 2.5–6.4; p < 0.0001); this was comparable to the treatment effect of all comparators vs placebo (4.9 points; 95% CI, 3.8–6.0). The treatment effect for adjunctive asenapine exceeded placebo by 2.4 points (95% CI, 0.5–4.3); this was also comparable to the overall treatment effect for the combined comparators (2.7 points; 95% CI, 2.0–3.3).

Discussion

These meta-analyses demonstrate statistical superiority of asenapine over placebo, as monotherapy or adjunctive therapy, for acute bipolar mania. Further, they reveal that the efficacy of asenapine is similar to that of other atypical antipsychotics used as monotherapy or adjunctive therapy.
The temperaments: Its knowledge is a crucial way in early diagnosis of bipolar disorders
Authors: Tavormina G.T.
Published: May 2011

Background

An observational study of the diagnosis of 300 consecutive new patients in a period of four years led to the main observation of a high percentage of bipolar spectrum diagnosis (4), followed to a new classification of “the bipolar spectrum” (ten sub-types of bipolar spectrum mood).

Inside these sub-types also the temperaments have been inserted, even if they are only sub-clinical aspects of the bipolar spectrum (sub-threshold forms).

Methods

With the same method (the diagnostic method was based on an analysis of clinical interviews and personal history of the illness) and with the same aims, others 123 consecutive new patients have been valued for the other subsequential two years; then, all the 423 patients of the six years evaluation have been revalued to put in evidence the presence of their temperaments, emerging from their personal anamnesis.

Results

It appears clear that significantly more patients within the series appear to have a soft bipolar illness than a major unipolar depression; the depressive episodes are now considered as only one phase of bipolar spectrum. Besides, every patient with bipolar spectrum disorder already presented in their personal history of the illness a sub-clinical evidence of one temperament (hyperthymic temper.: 35%; cyclothymic temper.: 49%; depressive temper.: 16%).

Conclusions

The subthreshold presence of the temperaments in the history of the patients with bipolar spectrum disorders allow us to consider this crucial way for early diagnosis of bipolar spectrum mood disorders.
Screening of bipolarity in a depressed population
Authors: Touhami M. , Ouriaghli F. , Manoudi F. , Asri F.
Published: May 2011

Introduction

It's not always evident to diagnose a bipolar disorder.The difficulties of diagnosis have been demonstrated by several studies, some of which have shown that one out of two bipolars consulted at least three health professionals before receiving a proper diagnosis, with an average period of 10 years evolution prior to diagnosis. hypomania is often experienced by patients as a pleasant experience and not a pathological one, rarely have they reported this phenomenon spontaneously. Thus, the diagnosis of hypomania or BP-II disorder is not established in 50% of cases.

Aims

to find the prevalence of bipolar disorder type II in a population of depressed people in order to highlight the role of scales in the early identification of this disease often under-diagnosed.

Methods

a prospective study of screening for a history of hypomania in a population of patients hospitalized for consultants or major depressive episode or recurrent depressive disorder; over a period of three months

The diagnoses of MDE and RDD were prepared according to the DSM-IV.TR.

The screening tool is the Hypomania Checklist (HCL French version) which was completed by patients or by the psychiatrist of illiterate patients after its translation into Arabic dialect

Results:

Sample of 35 patients: 20 women and 15 men, average age: 34 years; Composed of 25 RDD and 10 MED

15 patients answered “yes” to 10 or more items of the HCL-20, hypomanic history was confirmed by a clinical interview in 13 of them
Meanings of life experiences during manic episodes as reported by outpatients in remission in the Southeast Brazil: A clinical-qualitative study
Authors: Bin L.C.P. , Santos A. , Carvalho A. , Turato E.R.
Published: May 2011

Background

Psychosocial representations about the manic episode may constitute personal difficulty factors in dealing with the disorder, to relate socially and compromise satisfactory adherence to clinical treatments. It was elected to recall the experiences of manic episode due to its social and individual stigma.

Purpose

To discuss the meanings of life experiences regarding manic episodes as reported by outpatients with bipolar affective disorder in remission.

Method

Research methodology from the Humanities employed to health settings, using clinical-qualitative method, with the technique of semi-directed interview with open-ended questions. The sample was closed by the criterion of theoretical saturation of information. Eight interviews were conducted in a university psychiatric clinic. Data were treated through the qualitative content analysis, with free-floating readings of the corpus - the set of the transcribed interviews - in order to categorization in core's discussion.

Results

Patients whom experienced manic episodes use unique adaptive mechanisms to deal with their psychosocial experiences and emotions. The highlights were the recognized strategies of bargaining, denial, rationalization and escaping when facing the experienced problems.

Conclusion

The recognition of the management of patients’ experiences of mental disorder by the healthcare team can better harmonize the professional-patient relationship and develop strategies for greater adherence to the therapeutic and preventive measures for recurrence of the episodes.
Misdiagnosis and psychotic symptoms in bipolar disorder
Authors: Ugarte A. , Fernández M. , González I. , Peciña J.R. , Villamor A. , Zuhaitz E. , García B. , García J. , González-Pinto A.
Published: May 2011

Introduction

Early onset forms of bipolar disorder may be difficult to distinguish from schizophrenia. Although operational criteria have become more precise, and there are more diagnostic systems to catalogue a psychotic adolescent, the clinicians continue having difficulties.

Objective

To know the stability of the diagnosis of definitively bipolar patients with psychotic symptoms during the episodes, and factors that can influence other psychotic diagnoses in the first episode of the illness.

Method

140 bipolar patients of Araba, (Basque country) were included during 2 years. Patients were divided into two groups: unstable diagnoses (UD)(bipolar patients with an initial diagnosis of other psychosis) and stable diagnoses (SD) of bipolar disorder. Clinical and sociodemographic data were obtained.

Results

The mean age at onset was significantly lower in the UD group (p = 0.004). It was rare to have an unstable diagnosis when the first psychotic episode occurred after age 38 (p = 0.008). There were more singles in the UD group (p = 0.010).

The presence of mood incongruent psychotic symptoms was more frequent in the UD group (p < 0.001).

Mood incongruent psychotic symptoms variable was the only independent factor significantly associated with an unstable diagnosis in the multivariate analysis (p = 0.036).

Discussion

One third of the patients have been previously diagnosed with other psychotic illness.

This study suggests that the most important factor is the clinical picture, especially the presence of mood-incongruent psychotic symptoms. A correct diagnosis is important because patients who are prescribed mood stabilizers have lower rates of rehospitalisation than those who are not treated with mood stabilizers.
Perception of disease and pathways to care in bipolar disorder
Authors: Vargas-Huicochea I. , Berenzon-Gorn S. , Becerra C. , Huicochea-Gomez L. , Berlanga C.
Published: May 2011

Introduction

Bipolar disorder (BD) is a major psychiatric disorder that has important consequences for those who live with it. Day by day new contributions for diagnosis and treatment appear thanks to a continuous research advance. However there are many challenges to defeat such as the pathways to care that bipolar patients choose, and the different factors that have an impact on seeking for treatment.

Objective

To describe the role that perception of disease has on the selection of pathways to care in patients with BD.

Aims

To generate information to augment the available data for specific interventions in bipolar patients.

Methods

We studied perception of disease in six patients with BD through focused interviews. The results were analyzed from a qualitative approach.

Results

We found that even when the main type of health care practices reported by these patients had to do with the allopathic form, usually they combine and try different health care forms. This allows each patient to build their own pathway to care in order to meet their needs and their suffering from living with BD.

Conclusions

Pathways to care in BD are composed of a combination of health care practices, this situation happens because the patient needs to look for the possibility to get a stock of potential alternatives of treatment which allow to maximize his/her curative resources. Beside this, having a variety of treatment modalities helps bipolar people to deal with the different issues that are part of the experience of living with BD.
Bipolar disorder therapy in daily clinical practice: Analysis of retrospective data from a large multinational longitudinal study (WAVE-BD)
Authors: Vieta E. , Figueira M.L. , Bellivier F. , Souery D. , Blasco-Colmenares E. , Medina E. , Langosch J. ,   on behalf of the WAVE-bd Study Group
Published: May 2011

Introduction

The Wide AmbispectiVE study of clinical management and burden of bipolar disorder (BD) (WAVE-bd; NCT01062607) is ongoing to address limitations of longitudinal BD studies to-date focused on single disease phases or treatment.

Aim/Objective

To understand current treatment approaches for patients with BD in daily clinical practice.

Methods

Multinational, multicentre, non-interventional, longitudinal study of patients diagnosed with BD-I or BD-II with ≥1 mood event in the preceding 12 months, followed-up for 12-27 months (including retrospective and prospective phases). Site and patient selection provided a sample representative of bipolar populations. The study includes descriptive analyses of demographics, diagnosis, medical history and clinical management. Medication use during the retrospective phase will be presented.

Results

Preliminary results (based on data availability at time of submission) are presented from 2829 patients recruited March-September 2010. During the retrospective period, 94.3% (94.2% BD-I, 94.6% BD-II) of patients received BD therapy. Among BD-I and BD-II patients, respectively, the most common number of prescribed drugs was two (29.5%, 31.5%); 17.6% and 18.1% were prescribed one drug, and 11.5% and 9.8% were prescribed five or more. Drug classes most commonly used (BD-I, BD-II, respectively) were atypical antipsychotics (64.5%, 48.9%) anticonvulsants (58.0%, 54.3%), antidepressants (39.6%, 66.7%) and lithium (31.2%, 17.3%). Electroconvulsive therapy was used in 12 (0.4%) patients (9 BD-I, 3 BD-II). Average treatment duration with atypical antipsychotics, anticonvulsants and antidepressants was 165.0, 199.7 and 169.7 days, respectively.

Conclusions

This ongoing study provides a multinational perspective on BD patient management practices in a large sample population. Financial support: AstraZeneca
A comparative study of the phenomenological features of bipolar depression versus unipolar major depression in chinese patients in a regional hospital in hong kong
Authors: Wong S.M.Q.
Published: May 2011

Objectives

To determine the characteristics and time course of diagnostic conversion from unipolar depression to bipolar depression in a retrospective cohort of psychiatric outpatients, and to compare the clinical and sociodemographic profiles of the bipolar switch group against a matched group without conversion.

Method

This is a retrospective case-control study in which outpatients newly diagnosed of unipolar depression from 1st January 1994 to 31st December 1999 were reviewed. Those with conversion to bipolar depression were identified and controls were matched.

Multivariate conditional logistic regression was carried out to identify predictors of bipolar switch.

Results

88 patients out of 823 were identified with bipolar switch. The mean age at switch was 37.58 years old. The mean time interval from presentation to conversion was 58.13 months. Sodium valproate was most commonly used after switch. Bipolar switch was associated with male sex (OR 2.601, 95% CI 1.279 – 5.291, p = 0.008), an earlier age at presentation of depression of < 37 years old (OR 2.238, 95% CI 1.136 – 4.409, p = 0.020), family history of bipolar affective disorder (OR 5.684, 95% CI 1.149 – 28.124, p = 0.033) and use of 3 or above different antidepressants in the first five years after presentation (OR 2.105, 95% CI 1.082 – 4.098, p = 0.028).

Conclusion

The incidence of bipolar switch found in this study was 10.7%. Family history of bipolar affective disorder and frequent switch of antidepressants in depressive patients presenting at a young age can be helpful guidance for identification of those at high risk for a bipolar course.
Manic-depressive illness and the artistic temperament
Authors: Zaman R. , Agius M. , Hankir A.
Published: May 2011

Introduction

A notion exists of a special kind of relationship between poets and being “crazy”. A possible correlation between madness and genius is one of the oldest and most persistent and controvertialof cultural concepts. We decided to investigate the relationship between manic-depressive illness and the artistic temperament.

Method

A review was conducted on Professor Kay Redfield Jamison's treatise Touched with Fire, Manic-depressive Illness and the Artistic Temperament.

Results

Research strongly suggests that, compared with the general population, writers and artists show a vastly disproportionate rate of the affective disorders manic-depressive and depressive illness. Research employing systematic biographical methodology has also given strong support to a much higher rate of mood disorders in artistic populations than could be expected from chance alone. A British study revealed many overlapping mood, cognitive, and behavioral changes between hypomania and intense creative states. Many of the changes in mood, thinking, and perception that characterize the mildly manic states are highly characteristic of creative thought as well. Although it seems counterintuitive at first, melancholy has also been reported to be associated with artistic inspiration and productivity.

Discussion

Not all (not even most) writers and artists suffer from major mood disorders. Likewise, most of those who have a major mood disorder are not writers or artists. However despite this, research does strongly suggest that there is a correlation between manic-depressive illness and the artistic temperament. The major resistance to an association between psychopathology, or mental illness, and creativity seems to revolve around a few central points.