Dimensions of mania: differences between mixed and pure episodes

2004 ◽  
Vol 19 (5) ◽  
pp. 307-310 ◽  
Author(s):  
Ana González-Pinto ◽  
Ana Aldama ◽  
Asunción González Pinto ◽  
Fernando Mosquera ◽  
José Luis Pérez de Heredia ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Clinical Trials ◽  
Depressive Symptoms ◽  
Factorial Analysis ◽  
Mixed States ◽  
Varimax Rotation ◽  
Factor Solution ◽  
Bipolar I Disorder ◽  
Five Dimensions ◽  
Dsm Iv

AbstractObjectiveThe presence of at least five dimensions in mania has recently been established. This study extends previous findings by comparing the dimensions of pure vs. mixed mania.Materials and methodOne hundred and three inpatients with bipolar I disorder, manic or mixed (DSM IV), were assessed with SCID-I, YMRS and HDRS-21. The five-factor solution found after applying factorial analysis with Varimax rotation was compared between manic and mixed patients.ResultsThere were differences between pure mania and mixed states on factor 1 (depression) and factor 3 (hedonism). There was a tendency to present higher values on factor 5 (activation) in the pure manic group. No differences were found in factor 2 (dysphoria) and factor 4 (psychosis).DiscussionHedonism and activation dimensions are present to a lesser degree in mixed states. Although the principal difference between mixed and pure bipolar disorder is the existence of depressive symptoms, the depressive dimension is strongly present in patients with pure mania.ConclusionsThere is need to search for core depressive symptoms in all patients suffering from mania and to evaluate their outcome in clinical trials.

The treatment of mixed states and the risk of switching to depression

2005 ◽  
Vol 20 (2) ◽  
pp. 96-100 ◽  
Author(s):  
Eduard Vieta
Keyword(s):  
Clinical Trials ◽  
Depressive Symptoms ◽  
Mixed State ◽  
Atypical Antipsychotics ◽  
Randomized Clinical Trials ◽  
Mixed States ◽  
Conventional Antipsychotics

AbstractThere are few controlled studies evaluating the treatment of bipolar mixed states. Evidence suggests that mixed states may be more responsive to some anticonvulsants than to lithium. Olanzapine alone or in combination with divalproate or lithium has been adequately evaluated in randomized clinical trials involving mixed-state patients, whereas risperidone and quetiapine have not. There is also some evidence demonstrating the efficacy of ziprasidone and aripiprazole. The risk of switching to depression is high in mixed states. Conventional antipsychotics, such as haloperidol, may be less efficacious at protecting against a switch to depression than atypical antipsychotics, divalproate or lithium. When choosing drugs for the treatment of mania, and especially for the treatment of mixed states, their efficacy against manic and depressive symptoms, and their safety in terms of the risk of switching to depression should be taken into account.

scholarly journals Using Extended-Release Injectable Aripiprazole for the Successful Treatment of Depressive Symptoms in Bipolar I Disorder

2020 ◽  
Vol 2020 ◽  
pp. 1-2
Author(s):  
Joseph Kuo ◽  
Shih-Ku Lin
Keyword(s):  
Clinical Trials ◽  
Depressive Symptoms ◽  
Successful Treatment ◽  
Placebo Effect ◽  
Extended Release ◽  
Bipolar Depression ◽  
Dropout Rate ◽  
Bipolar I Disorder ◽  
High Dropout Rate ◽  
High Doses

Extended-release injectable (ERI) aripiprazole is indicated for schizophrenia and maintenance monotherapy of bipolar I disorder. Clinical trials of aripiprazole failed to exhibit efficacy in the treatment of bipolar depression. It has been suggested that relatively high doses, rapid titration of dose, a high dropout rate, and a high placebo effect might be the reasons of its ineffectiveness. Here, we report a case of a 39-year-old woman with bipolar depression who was successfully treated with ERI aripiprazole.

Clinical Factors as Predictors on Functional Impairment in Bipolar Disorder

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Rosa ◽  
M. Reinares ◽  
C. Franco ◽  
M. Comes ◽  
C. Torrent ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Interpersonal Relationships ◽  
Functional Impairment ◽  
Severe Illness ◽  
Clinical Factors ◽  
Short Test ◽  
Dsm Iv ◽  
Bipolar Patients ◽  
Financial Issues

Introduction:Recent studies have suggested that functional impairment in bipolar disorder may be strongly associated with residual depressive symptoms. However, there is a notable disparity between functional recovery and symptomatic recovery. This study was carried out to investigate clinical factors as potential predictors on functional impairment in a well defined euthymic bipolar sample.Methods:Seventy-one patients were recruited from the Bipolar Disorder Program at the Clinic Hospital of Barcelona. A Structured Clinical Interview for DSM-IV-TR, HAM-D and YMRS were used to diagnostic assessment and euthymia criteria. The Functioning Assessment Short Test (FAST) was employed to assess functional impairment. The FAST is a reliable and valid, interview-administered scale, rapid and easy to apply (3-6 min). It consists of 24 items which allow to assess six specific areas of functioning such as autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time.Results:The sample comprised 36 (51%) men, aged 48±13.56 years. Several clinical variables were associated with poor functioning on a linear regression model, such as age, depressive symptoms, number of previous mixed episodes and number of previous hospitalizations. This model explained 44% of the variance (F=12.54, df=58, p< 0.001).Discussion:In this study, specific clinical and socio-demographic characteristics were identified as predictors of functional impairment in remitted bipolar patients. Poor functioning was identified in patients with older age and more severe illness course.

scholarly journals Perceived stigma and depression among caregivers of patients with bipolar disorder

2007 ◽  
Vol 190 (6) ◽  
pp. 535-536 ◽  
Author(s):  
Deborah A. Perlick ◽  
David J. Miklowitz ◽  
Bruce G. Link ◽  
Elmer Struening ◽  
Richard Kaczynski ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Perceived Stigma ◽  
Patient Status ◽  
Coping Effectiveness ◽  
Clinical And Functional Status ◽  
Dsm Iv ◽  
Socio Demographic Factors ◽  
And Coping ◽  
The Relationship

SummaryThis study investigates the associations between perceived stigma, depressive symptoms and coping among caregivers of people with bipolar disorder. Caregivers of 500 people with DSM–IV bipolar disorder responded to measures of these constructs at study entry Patients' clinical and functional status were evaluated within 30 days of the caregiver assessment. Perceived stigma was positively associated with caregiver depressive symptoms, controlling for patient status and socio-demographic factors. Social support and avoidance coping accounted for 63% of the relationship between caregiver stigma and depression. Results suggest that caregivers' perceptions of stigma may negatively affect their mental health by reducing their coping effectiveness.

Scope and Characteristics of Suicide Attempts Among Manic Patients With Bipolar Disorder

Crisis ◽  
2018 ◽  
Vol 39 (6) ◽  
pp. 489-492
Author(s):  
Marnina Swartz-Vanetik ◽  
Mark Zeevin ◽  
Yoram Barak
Keyword(s):  
Bipolar Disorder ◽  
Suicide Risk ◽  
Suicide Attempts ◽  
Clinical Severity ◽  
Mixed States ◽  
Retrospective Design ◽  
Raising Awareness ◽  
Increased Risk ◽  
Dsm Iv ◽  
Manic Patients

Abstract. Background: Suicide is often associated with depression in patients suffering from bipolar disorder (BD) and less is known about its relation to mania. Available data suggest that patients in the manic phase of BD may be at risk of suicide. Aim: We characterized suicide attempts in a cohort of patients with BD in manic and mixed phases. Method: We focused on the scope, rate, and characteristics of suicide attempts among BD patients during manic or mixed states. Associations between suicide as well as clinical and sociodemographic variables were analyzed using computerized medical chart data from 209 adult inpatients diagnosed (DSM-IV) as experiencing manic and mixed BD episodes. Results: The rate of recent suicide attempts among BD inpatients with manic and mixed episodes was 10.5%. Married patients had a decreased rate of suicide attempts. Comorbid alcohol or substance abuse were correlated with an increased risk of suicide attempts. Presence of suicidal ideation increased suicide risk while older age was linked to a decrease in the rate of suicide attempts. Limitations: The retrospective design of the study and overrepresentation of the clinical severity of BD were limitations. Conclusion: The rate of suicide attempts in the manic and mixed phases of BD is substantial and calls for raising awareness among psychiatrists.

scholarly journals Electroconvulsive Therapy (ECT) in Bipolar Disorder Patients with Ultra-Rapid Cycling and Unstable Mixed States

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 624
Author(s):  
Sergey Mosolov ◽  
Christoph Born ◽  
Heinz Grunze
Keyword(s):  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Electroconvulsive Therapy ◽  
Mood Stabilizer ◽  
Rapid Cycling ◽  
Mixed States ◽  
Limited Effectiveness ◽  
Bipolar Patients ◽  
Depressive Episodes

Background and Objectives: Unstable mixed episodes or rapid switching between opposite affective poles within the scope of short cycles was first characterized in 1967 by S. Mentzos as complex polymorphous states with chaotic overlap of manic and depressive symptoms. Well-known examples include antidepressant-induced mania/hypomania and rapid/ultra-rapid/ultradian cycling, when clinicians observe an almost continuous mixed state with a constant change of preponderance of manic or depressive symptoms. Achieving stable remission in these cases is challenging with almost no data on evidence-based treatment. When mood stabilizers are ineffective, electroconvulsive therapy (ECT) has been suggested. Objectives: After reviewing the evidence from available literature, this article presents our own clinical experience of ECT efficacy and tolerability in patients with ultra-rapid cycling bipolar disorder (BD) and unstable mixed states. Materials and Methods: We conducted an open, one-year observational prospective study with a “mirror image” design, including 30 patients with rapid and ultra-rapid cycling BD on long-term mood stabilizer treatment (18 received lithium carbonate, 6 on valproate and 6 on carbamazepine) with limited effectiveness. A bilateral ECT course (5–10 sessions) was prescribed for regaining mood stability. Results: ECT was very effective in 12 patients (40%) with a history of ineffective mood stabilizer treatment who achieved and maintained remission; all of them received lithium except for 1 patient who received carbamazepine and 2 with valproate. Nine patients (30%) showed partial response (one on carbamazepine and two on valproate) and nine patients (30%) had no improvement at all (four on carbamazepine and two on valproate). For the whole sample, the duration of affective episodes was significantly reduced from 36.05 ± 4.32 weeks in the year prior to ECT to 21.74 ± 12.14 weeks in the year post-ECT (p < 0.001). Depressive episodes with mixed and/or catatonic features according to DSM-5 specifiers were associated with a better acute ECT response and/or long-term mood stabilizer treatment outcome after ECT. Conclusions: ECT could be considered as a useful option for getting mood instability under control in rapid and ultra-rapid cycling bipolar patients. Further randomized trials are needed to confirm these results.

scholarly journals 156 The Broad Efficacy of Cariprazine Across Symptoms in Patients with Bipolar I Disorder: Post Hoc Analysis of Randomized, Placebo-Controlled Trials

CNS Spectrums ◽  
2020 ◽  
Vol 25 (2) ◽  
pp. 300-300
Author(s):  
Lakshmi N. Yatham ◽  
Eduard Vieta ◽  
Roger S. McIntyre ◽  
Rakesh Jain ◽  
Willie R. Earley ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Rating Scale ◽  
Bipolar Depression ◽  
Partial Agonist ◽  
Controlled Trials ◽  
Bipolar I Disorder ◽  
Manic Symptoms ◽  
Bipolar Mania ◽  
Post Hoc

Abstract:Study Objective:Patients with bipolar disorder experience a wide range of depressive and manic symptoms. Only 2 drugs are FDA-approved to treat episodes of both mania and depression in patients with bipolar disorder, highlighting the need for treatments with proven efficacy at opposite poles of the bipolar spectrum. Cariprazine, a dopamine D3-preferring D3/D2 receptor partial agonist and serotonin 5-HT1A receptor partial agonist, is approved in the US for the treatment of both bipolar depression and manic and mixed episodes associated with bipolar I disorder. Cariprazine has previously demonstrated broad efficacy in patients with bipolar mania, with significantly greater improvement in favor of cariprazine vs placebo (PBO) across all individual symptom domains (P<.001) measured by the Young Mania Rating Scale (YMRS). Additionally, cariprazine has demonstrated efficacy vs PBO in 3 phase II/III clinical studies in patients with depressive episodes associated with bipolar I disorder (NCT01396447, NCT02670538, NCT02670551). To further assess the broad efficacy of cariprazine in patients with bipolar I disorder, we performed post hoc analyses to evaluate the range of depressive symptoms comprising the individual items of the Montgomery-Åsberg Depression Rating Scale (MADRS) in patients from the bipolar depression studies.Methods:Data from the 3 randomized, double-blind, PBO-controlled trials in patients with bipolar depression were pooled. Least squares (LS) mean change from baseline to week 6 in MADRS individual items was assessed in the pooled cariprazine 1.5 and 3 mg/d groups vs PBO using a mixed-effects model for repeated measures in the intent-to-treat (ITT) population.Results:There were 1383 patients in the ITT population (placebo=460; cariprazine 1.5-3 mg/d=923). At week 6, LS mean change from baseline was significantly greater for cariprazine 1.5-3 mg/d vs PBO on 9 of 10 individual MADRS items: Apparent Sadness (-2.0 vs -1.6, P<.0001); Reported Sadness (-2.0 vs -1.6, P<.0001); Reduced Sleep (-1.6 vs -1.4, P=.0357); Reduced Appetite (-1.2 vs -1.0, P=.0001); Concentration Difficulties (-1.5 vs -1.2, P=.0002); Lassitude (-1.7 vs -1.4, P=.0003); Inability To Feel (-1.7 vs -1.5, P=.0009); Pessimistic Thoughts (-1.4 vs -1.2, P=.0054) and Suicidal Thoughts (-0.3 vs -0.2, P=.0383); differences between cariprazine and PBO on the Inner Tension item were not significant.Conclusions:Significant improvement in most MADRS single items suggests broad efficacy in depressive symptoms for cariprazine 1.5-3 mg/d vs PBO in patients with bipolar depression. Coupled with broad efficacy in manic symptoms as demonstrated by significant improvement in all YMRS individual items in patients with bipolar mania or mixed episodes, cariprazine appears be effective across the range of symptoms that affect patients with bipolar disorder.Funding Acknowledgements:Supported by Allergan plc.

scholarly journals Mixed states in bipolar disorder: modelling, measuring and managing

2018 ◽  
Vol 27 (1) ◽  
pp. 69-71 ◽  
Author(s):  
Gordon Parker ◽  
Tahlia Ricciardi
Keyword(s):  
Bipolar Disorder ◽  
Treatment Guidelines ◽  
Antidepressant Medication ◽  
Mixed States ◽  
Limited Evidence ◽  
Best Management ◽  
Dsm 5 ◽  
Dsm Iv ◽  
Second Generation Antipsychotic ◽  
Definition Of

Objective: To consider whether consensus exists in recommendations for managing bipolar mixed states published in recent reviews and treatment guidelines, and to summarise what might be their best management. Conclusion: Limitations to and changes in the definition of mixed states compromise diagnosis and management. The striking comparison between DSM-IV and DSM-5 criteria sets risks under-diagnosis and over-diagnosis. Current reviews and guidelines offer limited evidence to guide treatment; however, management should involve addressing the contribution of any antidepressant medication, and the introduction of a second-generation antipsychotic medication to stabilise the condition.

scholarly journals Quality of life of people with schizophrenia, bipolar disorder and other psychotic disorders

2010 ◽  
Vol 197 (5) ◽  
pp. 386-394 ◽  
Author(s):  
Samuli I. Saarni ◽  
Satu Viertiö ◽  
Jonna Perälä ◽  
Seppo Koskinen ◽  
Jouko Lönnqvist ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Psychotic Disorders ◽  
Health Utility ◽  
Health Related Quality ◽  
Bipolar I Disorder ◽  
Related Quality ◽  
Health Related ◽  
Dsm Iv

BackgroundHealth utility and quality of life (QoL) are increasingly important outcome measures in healthcare and health economics.AimsTo compare the loss of subjective QoL and utility-based health-related quality of life (HRQoL) associated with psychotic disorders.MethodA representative sample of 8028 Finns was screened for psychotic disorders and bipolar I disorder. Lifetime psychotic disorders were diagnosed using the Structured Clinical Interview for DSM–IV and/or case records. Health-related quality of life was measured with EQ–5D and 15D, and QoL was measured with a 10-point scale.ResultsSchizoaffective disorder was associated with the largest losses of QoL and HRQoL, with bipolar I disorder associated with similar or smaller losses than schizophrenia. Current depressive symptoms explained most of the losses.ConclusionsDepressive symptoms are the strongest predictors of poor QoL/HRQoL in psychotic disorders. Subjective loss of QoL associated with psychotic disorders may be smaller than objective loss of functioning suggests. The EQ–5D is problematic as an outcome measure in psychotic disorders.Declarations of interestNone.

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