First bipolar episode and functionality: Relation with depressive symptoms and inflammation levels

2016 ◽  
Vol 33 (S1) ◽  
pp. S122-S123 ◽  
Author(s):  
M. Martinez-cengotitabengoa ◽  
C. Bermudez-ampudia ◽  
M.P. Lopez ◽  
A. Garcia-alocen ◽  
I. Gonzalez-ortega ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Depressive Symptoms ◽  
Manic Episode ◽  
Inflammatory Factors ◽  
First Episode ◽  
Illness Onset ◽  
Inflammatory Parameters ◽  
General Functioning ◽  
Competing Interest ◽  
One Year

IntroductionIt is important to make an early and effective intervention from the first bipolar episode. The presence of depressive symptoms in the course of a manic episode could influence negatively the evolution and the prognosis of the patient. Inflammation and oxidative stress are also related with functionality.ObjectivesTo explore the relationship between depressive symptoms during a first episode of mania, inflammatory parameters and patient functionality during the follow-up.MethodWe included in the study 92 are patients with a first manic episode and 92 matched healthy controls. We compared 13 inflammatory/oxidative stress parameters measured at baseline (TFNα, IL6, PGE2, MCP1, TBARS, NO2, SOD, CAT, GSHTOT, GSSG, GSHfree, GPx, TAS) between both groups. Between patients, 46 presented pure mania (PM) (no depressive symptoms) and 46 mixed mania (MM) (with depressive symptoms). We explored the influence of inflammatory factors in functionality, exploring differences between PM and MM. To measure patients’ general functioning one year after illness onset, we used the Functional Assessment Short Test (FAST).ResultsWe found significant differences in TFNα, MCP1 and TBARS (higher in patients) and in SOD, GSHtot, GSSG, GSHfree, GPx and TAS levels (lower in patients). Only In MM group, there was a significant influence of SOD and GSHfree in FAST scores suggesting that a higher antioxidant levels at baseline the patient functionality improves one year after.ConclusionsSome parameters of oxidative stress at baseline are related with patient's functionality one year after the first episode of mania, but only when mania debuts with depressive symptons simultaneously.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Evolution of inflammatory dysregulation and oxidative stress in patients with first episode of mania

2016 ◽  
Vol 33 (S1) ◽  
pp. S331-S331
Author(s):  
S. García ◽  
P. López Peña ◽  
I. Zorrilla ◽  
A. García-Alocen ◽  
M. Martínez-Cengotitabengoa ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Plasma Concentrations ◽  
First Episode ◽  
Healthy Controls ◽  
Illness Onset ◽  
Inflammatory Parameters ◽  
Tnf Α ◽  
Assessment Time ◽  
Competing Interest ◽  
And Oxidative Stress

IntroductionRecent studies have focused on the imbalance in inflammatory and antioxidant pathways as possible causes of the underlying neurodegenerative processes in bipolar disorder. Thus, the study of these pathways in first episodes of mania (FEM) can increase knowledge about this issue.AimTo compare plasma concentrations of pro-inflammatory (MCP-1, PGE2, TNFα) and oxidative parameters (TAS, NO2 and TBARS) between controls and FEM patients and to analyze the evolution of these parameters in patients from baseline to 6 months assessment time.MethodsThis study included 44 FEM patients and 79 healthy controls, aged 18 to 40. Blood samples were available for controls at baseline and for patients at baseline and 6 months after. TAS and TBARS were measured using non-EIA assay kits, N02 was measured with Griess method and PGE2, MCP-1 and TNFα with ELISA kits.ResultsAt baseline, TAS was significantly lower in patients than in controls and TBARS, MCP-1 and TNFα were significantly higher in patients. Among patients, TAS and MCP1 were lower at 6 months than at the illness onset and PGE2 and NO2 were significantly higher than at baseline.ConclusionPatients presented an increased oxidative damage and also a higher activation of pro-inflammatory pathways than healthy controls at baseline. After 6 months their level of oxidative stress continue increased. Pro-inflammatory parameters decreased overtime (MCP-1 and TNF α) but PGE2, increased surprisingly. This can be due to the fact that antipsychotics are not able to completely reverse baseline inflammation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Five-year Course of Bipolar Disorder Following Treatment of First Manic Episode with Risperidone Versus Olanzapine: A Retrospective Review

2017 ◽  
Vol 41 (S1) ◽  
pp. S206-S206
Author(s):  
K. Kulkarni ◽  
G. Devasthali ◽  
A. Purty ◽  
M. Kesavan ◽  
J. Reddy ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Retrospective Chart Review ◽  
Mood Stabilizer ◽  
Manic Episode ◽  
Complete Recovery ◽  
Mood Stabilizers ◽  
First Episode ◽  
Second Generation Antipsychotics ◽  
Icd 10 ◽  
Competing Interest

ObjectiveContemporary treatment guidelines recommend use of second-generation antipsychotics (SGAs) either as mono therapy or in combination with mood stabilizers as first-line treatment. While these drugs have been established to have superior efficacy compared to placebo, there is very less data comparing these antipsychotics with one another. We sought to study differences in the five-year outcome of first episode of mania (FEM) treated with olanzapine or risperidone, either alone or in combination with mood stabilizer.MethodsWe conducted a retrospective chart review of patients diagnosed with FEM (ICD-10) in the year 2008 (n = 88) at our centre. We selected the data of patients prescribed either olanzapine or risperidone for the purpose of this analysis. We extracted data about time to recovery and recurrence after FEM, total episodes, drug compliance and response, and number of follow-up visits from 2008 to 2013. The study was approved by the Institute Ethics Committee.ResultsA total of 88 patients received diagnosis of FEM in the year 2008, of which 50 (56.8%) received risperidone and 35 (39.8%) received olanzapine. The two groups were comparable in socio-demographic and clinical symptomatology of FEM (all P > 0.08). Complete recovery was significantly more in the olanzapine group than the risperidone group (χ2 = 4.84, P < 0.05).ConclusionOur study indicates that risperidone and olanzapine, either alone or in combination with mood stabilizers have a similar impact on the five-year course of BD following a first manic episode. However, olanzapine is associated with more complete recovery from FEM than risperidone.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Kleine-Levin syndrome: interface between neurology and psychiatry

2007 ◽  
Vol 65 (1) ◽  
pp. 150-152 ◽  
Author(s):  
Luís Pereira Justo ◽  
Helena Maria Calil ◽  
Sílvia A. Prado-Bolognani ◽  
Mauro Muszkat
Keyword(s):  
Clinical Features ◽  
Manic Episode ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Neuropsychological Evaluation ◽  
Pharmacologic Treatment ◽  
Behavioral Disturbances ◽  
Illness Onset ◽  
Sexual Disinhibition ◽  
Polysomnographic Recording

We report the first episode of Kleine-Levin (KLS) syndrome in a 17-year-old male. The illness onset, clinical features, neuropsychological evaluation and polysomnographic recording are described. Typical symptoms hypersomnia, hyperphagia and sexual disinhibition were observed besides behavioral disturbances, polysonographic and neuropsychological alterations. Behavioral disturbances similar to a manic episode including psychotic symptoms were relevant. The pharmacologic treatment included lithium, methylphenidate and risperidone. The introduction of risperidone aimed the control of psychotic symptoms and the persistent manifestations of hypersexuality after sleepness control and to the best of our knowledge there are no other report regarding risperidone use for KLS in the literature.

Depression in the active phase of paranoid schizophrenia in relation to age of onset and sex

2016 ◽  
Vol 33 (S1) ◽  
pp. s263-s263
Author(s):  
M. Skokou ◽  
P. Gourzis
Keyword(s):  
Depressive Symptoms ◽  
Depressive Symptomatology ◽  
Age Of Onset ◽  
Late Onset ◽  
Paranoid Schizophrenia ◽  
Depression Scale ◽  
Active Phase ◽  
Young Onset ◽  
Illness Onset ◽  
Competing Interest

IntroductionDepression is often observed in schizophrenia, in all phases of the disorder. Age of illness onset and sex have been found to correlate with depressive symptomatology in many but not all studies.AimsIn the present work the relation between depressive symptoms and age of onset and sex was investigated, in a sample of patients with paranoid schizophrenia.MethodsEighty-eight (88) patients with paranoid schizophrenia according to DSM-IV-TR criteria were examined, 21 of which became ill at ≥35 years of age (late onset), whereas 60 had age of onset < 30 years (young onset). During the active phase the Calgary Depression Scale for Schizophrenia (CDSS) was applied. Comparisons were performed by using the two-tailed Wilcoxon rank-sum and Chi-squared tests.ResultsThe percentage of patients with depression (CDSS > 6) in the whole sample was 27.2%. There was a trend for higher scores in early awakening in late onset patients (P = 0.060). In men, there was a trend for heavier depression in late onset patients, and higher scores in early awakening (P = 0.082, 0.019, respectively). In young onset patients, there was a trend for heavier symptomatology in women compared with men, and heavier pathological guilt (P = 0.073, 0.007, respectively), whereas in late onset patients, there was a trend for heavier self depreciation in men (P = 0.072).ConclusionsAlthough the frequency of depression does not seem to be influenced by age of onset or sex, more subtle differences are found in the severity of certain depressive symptoms, in relation to these factors, possibly warranting further investigation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Depressive symptoms in first episode psychosis: a one-year follow-up study

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Nasrettin Sönmez ◽  
Kristin Lie Romm ◽  
Ole A Andreasssen ◽  
Ingrid Melle ◽  
Jan Ivar Røssberg
Keyword(s):  
Depressive Symptoms ◽  
First Episode Psychosis ◽  
First Episode ◽  
Follow Up Study ◽  
Episode Psychosis ◽  
One Year

Lack of differential long-term metabolic profile of aripiprazole, quetapine and ziprasidone in first episode of psychosis

2017 ◽  
Vol 41 (S1) ◽  
pp. S388-S388
Author(s):  
J. Vázquez Bourgon ◽  
R. Pérez-Iglesias ◽  
V. Ortiz-García de la Foz ◽  
B. Crespo-Facorro
Keyword(s):  
Metabolic Profile ◽  
Metabolic Parameters ◽  
First Episode ◽  
Short Term ◽  
Treatment Groups ◽  
Long Term Follow Up ◽  
Drug Naïve ◽  
Competing Interest ◽  
One Year

IntroductionThe use of second-generation antipsychotic (SGA) treatments in psychosis has been associated with metabolic changes. However, there are differences in metabolic profile between SGAs. In a previous study conducted in our sample of first episode psychosis patients, we observed that the ziprasidone had a more benign metabolic profile compare to aripiprazole and quetiapine, at short-term (12 weeks). However, to detect clinically-relevant impairment in metabolic parameters a long-term follow-up is preferred.ObjectivesThe aim of this study was to investigate if the differentiated metabolic profile of aripiprazole, ziprasidone and quetiapine observed at short-term is maintained after 1 year of treatment in a sample of drug-naïve patients with a first episode of psychosis.MethodsOne hundred and sixty-eight, drug-naïve patients, suffering from a non-affective first episode of psychosis, were included in the present study. Patients were randomly assigned to receive quetiapine, ziprasidone or aripiprazole. Weight and glucemic/lipid parameters were recorded at baseline and after 1 year of treatment. Other clinical and socio-demographic variables were recorded to eliminate potential confounding effects.ResultsNo significant differences between antipsychotic groups (all F < 2.61; P > 0.05) were found in any of the metabolic parameters studied after one year of treatment.ConclusionsDespite the metabolic profile differences observed at short-term in our previous studies, we did not find significant differences in the metabolic and weight parameters studied between treatment groups after one year of treatment, concluding that they present similar metabolic profiles at long-term. Other clinical individual interventions (e.g.: diet, exercise), not here controlled, may have influenced possible differences in long-term metabolic outcomes.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neutrophin signalling in first-episode psychosis: relationship with treatment response 1 year after the illness onset

2016 ◽  
Vol 33 (S1) ◽  
pp. s258-s258
Author(s):  
M. Martinez-cengotitabengoa ◽  
K. Macdowell ◽  
S. Alberich ◽  
M. Parellada ◽  
P. Saiz ◽  
...  
Keyword(s):  
First Episode ◽  
Severe Illness ◽  
Antipsychotic Treatment ◽  
Illness Onset ◽  
Episode Psychosis ◽  
Confounding Variables ◽  
Inflammatory Processes ◽  
Competing Interest ◽  
Antipsychotic Drug Treatment

IntroductionPro/antiinflammatory imbalance has been found in first-episode psychotic (FEP) patients, even 12 months later. Current research is every time more focused in the need to find biomarkers to understand the underlying pathophysiological mechanisms of this severe illness.ObjectivesTo assess peripherical levels of neurotrophins and their receptors and their correlation with inflammation, clinical symptomatology and response to antipsychotic treatment, over the time.MethodologyNinety-four FEP patients and 80 matched healthy controls were included. Blood samples were taken at baseline to measure BDNF and NGF and their receptor levels (TrkB-full, TrkB-truncated and TrkA) and pro/antiinflammatory parameters (NFkB, COX-2, iNOS, PPARgamma, 15d-PG12). Patients were followed-up during 12 months.ResultsBDNF TrkB-full receptor and NFG TrkA receptor levels increased during the follow-up whereas BDNF TrkB-truncated form receptor decreased. After adjusting for confounding variables, baseline levels of proinflamatory variables were significantly related to TrkB-full/TrkB-truncated ratio (FL/T), suggesting that a higher proinflammatory status is related to a higher FL/T ratio expression. Furthermore, baseline FL/T ratio could have a predictor role of patient's functionality 1 year after the illness onset, depending on whether patient is treated or not with antipsychotic drugs.ConclusionInflammatory processes, neurotrophic pathways and functional status of FEP patients seem to be related which is of great traslational relevance. Specific, the expression of the 2 isoforms of BDNF receptor should be taken into account before starting an antipsychotic drug treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Case Report: Three Years of Refractory Atypical Depression Successfully Treated With“Old School” Moclobemide (maoi-r)

2017 ◽  
Vol 41 (S1) ◽  
pp. s239-s239
Author(s):  
S. Latorre ◽  
I. Moreno ◽  
M.J. Gordillo
Keyword(s):  
Rating Scale ◽  
Manic Episode ◽  
Psychotic Symptoms ◽  
Specific Response ◽  
Good Tolerability ◽  
Atypical Depression ◽  
Competing Interest ◽  
Clinical Description ◽  
One Year ◽  
Amino Oxidase

BackgroundAtypical depression is linked to bipolarity and specific response to mono amino oxidase inhibitors (MAOI), treatments not commonly used due to their complex handling. We describe a successfully treated case.MethodologyClinical description. Depression severity is assessed with Montgomery Asberg depression rating scale (MADRS).Clinical caseFemale, 54-year-old. Major depression, since 2011, refractory to venlafaxine/aripiprazol and escitalopram 20 mg/day. Manic episode with psychotic symptoms after potentiation with duloxetine. Diagnose of schizoaffective disorder was made, treated with aripiprazol 10 mg/day, with established chronical depressive symptoms, despite addition of valproate and venlafaxine, and partial response to pramipexole up to 1 mg/day.– Decision of cleaning up aripiprazol during 8 days and switch to moclobemide monotherapy was made due to atypical features. Baseline MADRS: 31. At week 2, there is change in mood, expression, psychomotor features and speech formal and content alterations. At week 4, activity increases, and biorythms normalize. At week 8 (with 600 mg/day increased dose), full response is obtained, including drive, and anxiety, with MADRS 12.– After one year of treatment, she has kept stability with no manic or psychotic symptoms emergence. Reduction in dose are linked to depression relapses. She still struggles with psychosocial recovery.– Tolerance has been good in all moment, except for headache crisis, not linked to high blood pressure or diet.ConclusionsMAOI still has a role in affective disorders treatment, given its effectiveness, unique mechanism of action and good tolerability. Targeted psychopharmacological and phenomenology knowledge can be the key to a recovery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Misdiagnose bipolar disorder: About a case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S425-S425
Author(s):  
C. Novais ◽  
M. Marinho ◽  
M. Mota Oliveira ◽  
M. Bragança ◽  
A. Côrte-Real ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Psychiatric Inpatient ◽  
Bipolar Disorders ◽  
Manic Episode ◽  
Inpatient Unit ◽  
Cranial Computed Tomography ◽  
Major Depressive ◽  
Competing Interest

IntroductionEarly stages of bipolar disorder are sometimes misdiagnosed as depressive disorders. This symptomatology can lead to misinterpretation and under diagnosis of bipolar disorders.Objectives/aimsTo describe a patient with a new diagnosis of bipolar disorder after 23 years of psychiatric care.MethodsWe report a case of a 66-year-old man, with a previous psychiatric diagnosis of recurrent depressive disorder for the last 23 years, after a hospitalization in a psychiatric inpatient unit because of a major depressive episode. In subsequent years, he was regularly followed in psychiatric consultation with description of recurrent long periods of depressed mood requiring therapeutic setting, alternating with brief remarks of not valued slightly maladjusted behaviour. At 65, he came to the emergency room presenting with observable expansive and elevated mood, disinhibited behaviour, grandiose ideas and overspending, leading to his hospitalization with the diagnosis of a manic episode. In the inpatient unit care, we performed blood tests, cranial-computed tomography (CT) and a cognitive assessment. His medication has also been adjusted.ResultsLaboratory investigations were unremarkable. Cranial-CT showed some subcortical atrophy of frontotemporal predominance, without corroboration by the neuropsychological evaluation. The patient was posteriorly transferred to a residential unit for stabilization, where he evolved with major depressive symptoms that needed new therapeutic adjustment. Later he was discharged with the diagnosis of bipolar disorder.ConclusionsOur case elucidates the importance of ruling out bipolar disorder in patients presenting with depressive symptoms alternating with non-specific maladjusted behaviour, which sometimes can be a challenging task.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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