bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Double-Blind, Placebo-controlled Trial of Divalproex and Olanzapine in Bipolar I Disorder, Mixed Episode
Authors: Houston J. , Tohen M. , Degenhardt E. , Jamal H. , Liu L. , Ketter T. 
Published: March 2009

Aims:This unique study of treatment of the mixed state of bipolar I disorder using simultaneous depression and mania response criteria compared divalproex monotherapy versus olanzapine augmentation in a 6-week, randomized, double-blind trial.Methods:Patients (age 18-60 years) with 14-28 days of divalproex monotherapy (blood levels of 75-125 μg/mL) were randomized to augmentation with olanzapine 5-20 mg/day or placebo. Data collected included: Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Clinical Global Impression for Bipolar Illness (CGI-BP), hospitalizations, concomitant medications, and adverse events (AEs). Primary co-objectives were comparisons of baseline to endpoint changes in HDRS and YMRS. Secondary objectives included comparisons of times to onset (25% reduction) and response (50% reduction) in both HDRS and YMRS, change in CGI-BP, hospitalizations, and safety.Results:Patients were 59% female, 51% Caucasian, 33% African American, and 14% Hispanic with mean standard deviation (SD) HDRS and YMRS scores of 22.2 (4.5) and 20.9 (4.4). Mean standard error (SE) score changes for the olanzapine (n=100) or placebo (n=101) arms, respectively, were: HDRS, -9.37 (.55) and -7.69 (.54), p=.022; YMRS, -10.15 (.44) and -7.68 (.44), p< .001; and CGI-BP, -1.34 (.11) and -1.06 (.11), p=.056. Times-to-onset (median 7 vs 14 days) and response (median 25 vs 49 days) were significantly shorter for olanzapine augmentation. One olanzapine patient required hospitalization (p=1.0). Treatment-emergent AEs were consistent with previously-published rates.Conclusion:Six-week olanzapine treatment augmentation was associated with greater and earlier reduction of manic and depressive symptoms in mixed episode patients on divalproex treatment.
Substance Use and Physical Health in Patients with Bipolar Disorder Under Maintenance Treatment
Authors: Garcia-Portilla M.P. , Saiz P.A. , Florez G. , Bascaran M.T. , Al-Halabi S. , Bousoño M. , Bobes J. 
Published: March 2009

Background:To date, little is known about the impact of substance use on physical health of patients with bipolar disorder. This study provides data on the impact of tobacco, alcohol and cannabis upon weight, metabolic profile and cardiovascular risk in these patients.Methods:Naturalistic, cross-sectional, multicenter study conducted in Spain. Current use of tobacco, alcohol and cannabis was registered based on patient’ self-reports. Patients were evaluated for presence of metabolic syndrome (MetS) according to modified NCEP ATP III criteria, for cardiovascular risk using the Framinghan function (CHD) and the Systematic COronary Risk Evaluation (SCORE) function (CMR).Results:The mean age was 46.6 years and 49% were male. Fitty-one percent used tobacco, 13% alcohol and 12.5% cannabis. Mean body mass index (BMI) was 27.9 kg/m2, 22.4% had MetS and ten-year CHD and CMR risks were 7.6% and 1.8% respectively. Patients who used tobacco had significantly higher CHD risk (8.82 versus 5.74, p < 0.01), and used more antipsychotic (1.23 versus 1.04, p 0.002) and overall (3.18 versus 2.71, p 0.01) drugs for the treatment of their bipolar disorder. Patients who used cannabis had significantly lower BMI (26.0 versus 28.2, p < 0.05) and lower CMR (0.37 versus 1.99, p < 0.001), however, when controlling by age, severity of mania and presence of metabolic syndrome these associations disappear.Conclusions:Substance use, mainly tobacco, is high in patients with bipolar disorder. Use of tobacco is associated with higher cardiovascular risk and greater number of antipsychotic and overall drugs for the bipolar disorder.
Predictors of Mania in a Sample of Patients Treated with Antidepressants (Preliminary Results) [P01-190]
Authors: Amedei S. Gorini 
Published: March 2009

Aims:From 35% to 60% of cases the initial presentation of illness in bipolar disorder is different from mania or hypomania. So far the studies that have investigated predictors of (hypo)mania have been concentrated on samples suffering from depression. On one hand is well known that antidepressant drugs are commonly prescribed in a broad spectrum of disorders other than depression. On the other hand there are strong connections within bipolar disorder and anxiety disorders that have been reported to be a possible clinical onset of a subsequent bipolar disorder.In all these cases patients are likely to be treated with antidepressants drugs, the effects of which has been associated with a worsened course of bipolar illness, from switching to mania to a rapid cycling course. This is the reason that led to perform a research on predictors of bipolar evolution on an antidepressant treated sample of outpatients irrespective of the diagnosis.This study examines clinical features at the first presentation of the illness that can be considered predictive of the subsequent bipolar course of illness.Method:A sample of outpatients treated for the first time in their life with antidepressant drugs has been prospectively evaluated in order to assess the clinical features associated with the later onset of bipolar disorder.
Recognizing the Similarities and Differences Between Pediactric Bipolar Disorder (PBPD) and Autistic Spectrum Disorders (ASD)
Authors: Greenberg R. 
Published: March 2009

Recent studies have indicated a significant increase in the number of children diagnosed with psychiatric disorders. This is especially true for pediatric bipolar disorder and autistic spectrum disorders this includes autism, Asperger's and pervasive developmental disorder not otherwise specified. The purpose of this presentation is to define these two disorders and help elucidate the overlap and the differences between them, as well as help elucidate when a youngsters has both.On the surface these two diagnoses can look quite similar. In both the child can show signs of inappropriate and an excessive of response to frustration, overreaction to sensory stimuli, and rigid behavior with difficulty accepting change and transitions, as well as an intense and obsessional interest in certain topics. Sleep difficulties, limited eating repetitore, problems with inattention, poor social skills etc. are also common to both disorders. The number of children that have both disorders is still unknown but clinically appears more common than previously believed. The importance of recognizing the coexistence of both disorders can have a major effect on the approach to treatment and the individual's resultant level of functioning.This presentation will address the following question:1.How are BPD and ASD identified?2.What are the differences between adult and pediatric bipolar disorder?3.In what ways do the symptoms of PBPD and ASD overlap?4.How does one separate the two disorders?5.When should both diagnoses be given?6.How does having both affect the approach to treatment?
Metabolic Syndrome in Bipolar Illness: Patient Concepts and Screening Effectivity
Authors: Guerreiro D. , Navarro R. , Telles D. , Carvalho M. , Martins P. , Trigo E. , Silva M. , Gois C. , Figueira L. 
Published: March 2009

Introduction:Metabolic Syndrome (MS) is constituted by a set of specific metabolic alterations being postulated that the main dysfunction is insulin resistance. Estimates point to higher prevalence of MS in bipolar patients, between 30 to 35%. Cost-effective screening methods, not recurring to blood test, have been researched.Objectives:Analyse knowledge and importance given to MS in bipolar patients. Test the viability of MS screening without blood tests.Methodology:Observational, cross-sectional study. Random sample of 15 adult bipolar patients, in euthymic phase. Semi-structured interview, YMRS, HAMD were applied. MS diagnosis investigated according to the International Diabetes Federation (IDF) criteria. MS screening was defined positive if blood pressure ≥ 130/85 or anti-hypertensive medication and abdominal perimeter > 90 in males or > 80 in females. A questionnaire about knowledge, attitudes and concerns on MS was applied.Main results:14 patients completed the investigation protocol. Five (36%) met IDF criteria for metabolic syndrome. Screening sensitivity was 80% and specificity 78%. Twelve patients (80%) were overweigh or obese. Mean IMC in patients that met IDF criteria for MS was 30 while in the other group mean IMC was 26. Only 3 (20%) have ever heard about MS, but the majority of the patients were concerned, in decreasing order, about weight gain, blood pressure cholesterol and hyperglycemia control.Conclusions:Although limited by small sample size, this study strengthens the idea that MS screening can be effective in clinical practice, it also indicates the need to educate BP patients about MS and to prevent overweight.
No Association Between Catecholamine-O-Methyltransferase Gene Polymorphism and Bipolar Disorder and it Subtypes
Authors: Leszczyńska-Rodziewicz A. , Dmitrzak-Weglarz M. , Skibinska M. , Rybakowski J. , Hauser J. 
Published: March 2009

Aims:The catecholamine hypothesis of affective disorders suggests that depression is associated with a functional decrease of catecholamines. There is consistent evidence that COMT gene would be a candidate gene for studies of bipolar disorder.Methods:The study was performed on patients with bipolar disorder n=298 (male n=126, female n=172). Control subjects were blood donors n=336 (male n=130, female n=206), who were not psychiatrically assessed. The subgroup of patients with psychotic features not congruent with mood contained n=88 patients, males n=41, females n=47. The subgroup of patients with psychotic features congruent with mood contained n=89 patients, males n=47, females n=42. The subgroup of patients with melancholic depression contained n=197 patients, males n=76, females n= 121. A polymorphism was analysed by PCR-RFLP method.Results:There were no differences in the frequency of genotypes, alleles between patients and controls in the whole group (p=0,286 for genotypes, p= 0,652 for alleles). Dividing the patients according to the gender, no differences in the frequency of either genotypes or alleles were found (p=0,298 for genotype males, p=0,456 for genotypes females). We did not find the association in the subgroup of patients with psychotic features congruent (p=0,828 for genotypes, p= 0,866 for alleles), or not congruent with mood (p=0,116 for genotypes, p= 0,673 for alleles) and with the subgroup of patients with depression with melancholic features (p= 0,758 for genotypes, p= 0,849 for alleles).Conclusion:Results of our study suggest that the polymorphism of COMT gene is not associated with the susceptibility to bipolar disorder.
All Available Treatments of Bipolar Disorders
Authors: Misic P. , Arandjelovic D. , Stanojkovic S. , Vladejic S. , Mladenovic J. 
Published: March 2009

Bipolar disorder is a treatable brain disorder that causes changes in person’s mood, thought, energy and behaviour.All available resources were searched and combined with the experince from everyday practice in Specialized Psychiatric Hospital “Gornja Toponica” and this is a rewiev of the various treatments that are currently available for the treatment of bipolar disorders.Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time. In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidality, Electroconvulsive therapy (ECT), Transcranial Magnetic Stimulation (TMS), Vagus Nerve Stimulation (VNS), Magnetic Stimulation Therapy (MST) and even herbal or natural supplements may be considered.Lithium, the first mood-stabilizing medication is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.Anticonvulsant medications, such as valproate or carbamazepine, also can have mood-stabilizing effects.Newer anticonvulsant medications, including lamotrigine, gabapentin, and topiramate, are also very effective in stabilizing mood cycles.Atypical antipsychotic medications, including clozapine, olanzapine, risperidone, quetiapine, and ziprasidone, are are also used for bipolar disorder treatment.If insomnia is a problem, a high-potency benzodiazepine medication such as clonazepam or lorazepam may be helpful to promote better sleep. However, since these medications may be habit-forming, they are best prescribed on a short-term basis. Other types of sedative medications, such as zolpidem, are sometimes used instead.
Group Cognitive Behaviour Therapy for Depression - Does it Help Bipolar Patients Too?
Authors: Moore L. , Gibson J. , Carr A. 
Published: March 2009

Aims:To compare the effectiveness of a manualised group cognitive behaviour therapy (CBT) programme for people with bipolar disorder (BPD) and major depressive disorder (MDD).Method:In addition to treatment as usual (TAU), 17 people with BPD and 17 matched controls with MDD completed 8 or 12 sessions of twice weekly group CBT, followed by 6 booster sessions, held at monthly intervals. Participants completed the Structured Clinical Interview for DSM-IV Axis 1 Disorders, Clinician Version (SCID-1) and the University of Rhode Island Change Assessment (URICA) prior to therapy. They completed the Beck Depression Inventory - II (BDI), the Beck Anxiety Inventory (BAI), the Clinical Outcomes in Routine Evaluation (CORE), the World Health Organisation Quality of Life Brief Version (WHOQoL - BREF) and the Dysfunctional Attitudes Scale (DAS) before and after therapy and at the final follow-up session. The BDI and BAI were also completed at each group session.Results:Both groups showed statistically and clinically significant improvement on the BDI and BAI after treatment and at follow-up. Both groups showed a significant improvement on the psychological health sub-scale on the WHOQoL-BREF.Conclusions:Manualised group CBT leads to a reduction in the symptoms of depression and anxiety in people with both BPD and MDD and helps improve their perceived quality of life.Declaration of interest:None.
Cardiovascular and Respiratory Comorbidities in Patients with Bipolar Disorder: A Systematic Review
Authors: Montes J.M. , Mostaza J. , Rico-Villademoros F. , Saiz-Ruiz J. , Bobes J. , Vieta E. 
Published: March 2009

Objective:To synthesize the available knowledge on cardiovascular and respiratory comorbidities in patients with bipolar disorder (BD).Methods:Relevant studies were identified by a MEDLINE search from 1966 to January 2008, and supplemented by a manual review of reference lists of the articles identified and previous review articles. When available, priority was given to comparative studies.Results:We identified 21 studies, 15 (71%) comparative. As compared to the general population, two studies reported higher point-prevalence rates of hypertension (28-60.8% vs 11.9-43%), two studies lower point-prevalence rates (10.4-34.8% vs 14.9-36.8%), one study a higher lifetime-prevalence rate (28.7% vs 14.8%), and one study a significantly increased incidence rate ratio (1.24 females and 1.34 for males). In addition, two studies reported higher point-prevalence rates of hypertension than in medical samples (4.6-18.1% vs 2.2-9.2%) and one study reported a higher risk than in patients with schizophrenia (OR 1.13, 95%CI 1.01-1.26). Point-prevalence rate of stroke was not different than in the general population (n=1, 1.7 vs 2.1, p=0.063); four studies evaluating the risk of stroke as compared to clinical samples provide contradictory results. Point-prevalence rates (n=2, 15.9-17% vs 8.3-10%) and lifetime-prevalence rate (n=1, 16.7% vs 9.7%) of asthma were higher than in the general population. Point-prevalence rates of COPD were also higher than in the general population (n=1, 10.6% vs 9.4%) and in clinical samples (n=3, 1-12.9% vs 0.6-3.6%).Conclusion:BD seems to be associated with increased rates of hypertension, asthma and COPD. Available data do not support the association between BD and stroke.
Nutritional, Metabolic and Endocrine Disorders in Patients with Bipolar Disorder: A Systematic Review
Authors: Vieta E. , Mostaza J. , Bobes J. , Saiz-Ruiz J. , Rico-Villademoros F. , Montes J.M. 
Published: March 2009

Objective:To evaluate the frequency of nutritional, metabolic and endocrine disorders in patients with bipolar disorder (BD).Methods:A Medline search (up to January 2008) in and manual review of reference lists of relevant primary articles and review articles. All studies in Spanish or English, all study designs, BD diagnosis by any criteria, with a sample size of ≥ 30 patients, and which reported any measure of frequency measure or association.Results:Thirty studies were identified: 18 (60%) cross-sectional and 12 (40%) retrospective cohort; 2 (6.7%) population- based; and 2 (6.7%) random sampling. The frequency of obesity in patients with BD was higher than that of the general population (n=4, 19-53% vs 9-14%), of other medical populations (n=1, 4.6% vs 1.1%) and of patients with schizophrenia (n=1, 11.6% vs 9.9%). The frequency of diabetes in patients with BD was higher than (n=5, 6-26% vs 2-16%) or similar to (n=2, 3.5-4.3% vs 3.4-4.8%) that of the general population; higher than that of other medical samples (n=2, 1.8-4.4% vs 0.6-2.2%) and similar to that in of patients with schizophrenia (n=1, 17.7% vs 17.6%). The frequency of dyslipidaemia was higher than that found in a medical sample (n=1, 0.9% vs 0.3%) and in patients with schizophrenia (n=1, 27% vs 23%). The frequency of hypothyroidism was higher than that of a medical sample (n=1, 10% vs 3%).Conclusion:BD appears to be associated with obesity. It may also be associated with dyslipidaemia and hypothyroidism. Data on the association between BD and diabetes are inconclusive.
Protocadherin Alpha Gene Polymorphisms in Bipolar Disorder. Results from the Czech Cohort
Authors: Novak T. , Stopkova P. , Pedrosa E. , Lachman H. 
Published: March 2009

Aims:Protocadherins (PCHD) are cell adhesion proteins with an important role in neuronal migration, differentiation and synaptogenesis. The linkage studies suggest that the 5q31-linked protocadherin family locus should be considered as potential candidate locus in schizophrenia and bipolar disorder. In this study, we focused particularly on single-nucleotide polymorphisms (SNPs) located in PCHDα enhancer. Results from the Czech cohort of patients with bipolar disorder (BD) will be presented.Methods:Unrelated inpatients and outpatients with BD based on Schedule for Affective Disorders and Schizophrenia - Lifetime (n=167) and blood bank donors as control subjects (n=211) were recruited in the study. Four SNPs posted in dbSNP (rs31745, rs10036519, rs3756337 and rs59497) in the PCDHα gene enhancer were analyzed. The data sets were analysed using a case control design.Results:In case of SNP, rs31745, a significant increase in homozygosity for the minor allele (T) was detected in patients with BD; 5% had this genotype, but no controls (p=0.001). The distribution of allels did not differ between patients and controls. No significant differences were found in allele or genotype distribution for three other SNPs.Conclusions:The findings suggest that the PCHDα is an interesting gene family to consider in BD susceptibility.
Bipolar Disorder Treatment in an Acute Inpatient Unit
Authors: Torres C. , Nunes P. , Cunha S. , Viana M. 
Published: March 2009

Bipolar disorder is a chronic, debilitating psychiatric disease. The management of this disorder involves treating current episodes and preventing their long-term recurrence.Many patients with Bipolar Disorder are hospitalized at some point in the course of their illness. Although most bipolar patients do not require extended inpatient psychiatric hospitalizations, short-term hospitalizations may be necessary during acute or potential crises.Hospitalization is among the most expensive treatment options available, and it is therefore offered sparingly and generally only when no other treatment options will prove sufficient to ensure patient safety.A hospital setting should be considered when safety is in question due to suicidal, homicidal, or aggressive impulses or actions, as well as inability to care for self. Other clear indications for hospital admission are the need for diagnostic procedures, history of rapidly progressive symptoms (especially psychotic phenomena), the rupture of patient"s usual support systems and a patient"s grossly reduced ability to take care of themselves.The aim of this study is to characterize the inpatient treatment of bipolar patients admitted in the Hospital São João's Psychiatry Department. Data were collected from clinical files using an investigation protocol especially developed for this purpose. This protocol includes sociodemographic information, the referral source, the admission path, reason for hospitalization, current phase of disease, voluntary versus involuntary status, number of previous admissions, prescribed medications and length of stay.
Metabolic Syndrome in Patients with Bipolar Disorders (BD): Findings from the BIMET study
Authors: González-Pinto A. , Vieta E. , Montes J.M. , Rejas-Gutiérrez J. , Mesa F. 
Published: March 2009

Purpose:To evaluate the 12-months prospective evolution of metabolic and cardiovascular risk factors in patients with types I or II Bipolar Disorder (BD) in Spain.Methods:The BIMET study is a 12-month, prospective, multicentre, naturalistic study which enrolled patients with type I or II BD according to DSM-IV TR criteria. Fasting blood levels of glucose, total, HDL, LDL cholesterol and triglycerides as well as weight, height, waist circumference and blood pressure were recorded. The National Cholesterol Educational Program (NCEP)-ATP III definition was applied to consider presence of metabolic syndrome (MS).Results:A total of 524 patients were enrolled; 73% type I and 27% type II. 61.9% women, mean age 46.3 years. 28.4% of subjects work regularly. Smokers were 42.2%, 15.1% had a substance abuse history, 34.2% were obese according with WHO criteria (obesity class I; 23.2%, class II; 7.5%, and class III; 3.5%) and overweight was found in 37.4% of sample. Prevalence of diabetes was 7.3%, hypertension was present in 24.7%, 18.5% had cholesterol ≥240 mg/dL and 36.2% had triglycerides ≥150 mg/dL. Overall prevalence of MS was 27.0% (95% CI: 22.7%-31.3%), with 27.3% (22.2%-32.3%) in type I BD and 27.1% (19.0%-36.6%) in type II (p=0.973).Conclusions:The prevalence of metabolic syndrome in type I / II BD patients was considerably higher than in the general population. As an excess of mortality due to metabolic and cardiovascular reasons pointed out in these patients, it is recommended a close clinical monitoring of such parameters in the routine medical practice.