Agenesis of the Corpus Callosum in A Patient With Bipolar Disorder

BackgroundThe corpus callosum (CC) is the largest white matter structure in the brain, which plays a crucial role in interhemispheric communication. Agenesis of the CC is a rare development anomaly, with unknown cause. It could be asymptomatic or associated with mental retardation and neurologic symptoms. Some case reports, post-mortem studies and image studies have linked thickness reduction and agenesis of CC with psychotic symptoms, mainly in schizophrenia patients. Lately, anatomical abnormalities in the CC have been reported in patients with Bipolar Disorder (BD).Case reportA 52-year-old woman was brought to the emergency room by the authorities after being physically aggressive to her 13-year-old daughter and inappropriate behavior in public. At the emergency department her mood was elevated with emotional lability, dispersible attention, slight increase of motor activity, pressured and difficult to interrupt speech, grandious and self-referent delusional ideas.Her past history revealed hippomaniac episodes characterized by periods of excessive shopping and hyperphagia. In 2008, she had a major depressive episode.Head CT-SCAN revealed agenesia of CC. She received the diagnosis of Manic Episode with mixed features and was treated with valproic acid, flurazepam and olanzapine.ConclusionThis case reinforces the fact that changes in CC, probably due to deficiency in myelination, could have a crucial importance in the pathophysiology of Bipolar Disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Depot aripiprazole as maintenance treatment in bipolar disorder: Report of a case

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1154 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S332-S332

Author(s):

C. Gómez Sánchez-Lafuente ◽

R. Reina Gonzalez ◽

A. De Severac Cano ◽

I. Tilves Santiago ◽

F. Moreno De Lara ◽

...

Keyword(s):

Bipolar Disorder ◽

Maintenance Treatment ◽

Oral Treatment ◽

Manic Episode ◽

Mood Stabilizers ◽

Community Center ◽

Psychotic Symptoms ◽

Competing Interest ◽

Long Acting

IntroductionRecently, depot aripiprazole was approved as a maintenance treatment for schizophrenia. However, long-acting antipsychotics has not been established efficacy in manic episode or maintenance treatment of bipolar disorder.AimsDescribe a clinical case of multiresistant bipolar disorder.MethodsThirty-nine years old male, diagnosed since 8 years ago with bipolar disorder, current episode manic with psychotic symptoms, admitted to Acute Psychiatrist Unit. It was his seventh internment. He was dysphoric, had insomnia, and showed many psychotic symptoms like grandiose delusions and delusions of reference. He thought he was a famous painter from nineteenth century.His disorder was refractory to mood stabilizers monotherapy and to many neuroleptic and, like olanzapine 30 mg/day, depot risperidone, zuclopenthixol, haloperidol, palmitate paliperidone, He was on treatment with lithium 1200 mg/day (lithemia 0.62 prior to admission) and oral aripiprazole 15 mg/day that he was not taking regularly. Poor compliance to oral treatment. No awareness of illness.Resultsduring the patient admission, we started long-acting aripiprazole 400 mg per 28–30 days. First 3 days he persisted dysphoric, hostile, and showing delusions of mind being read. From the fourth day, delusions disappeared and later he was calmer and more friendly, He was discharged 9 days later fully euthymic.For 6 months follow-up, the patient came once a month to community center for aripiprazole injection and he was taking lithium regularly. Last lithemia 0.65 mEQ/L.ConclusionLong-acting antipsychotics, like depot aripiprazole could be a useful alternative to oral medication, specially when there is no awareness of illness and there is low adherence to oral treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Misdiagnose bipolar disorder: About a case report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.393 ◽

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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A case report of patient who had two manic episodes with psychotic features induced by nasal decongestant

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.404 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S428-S428

Author(s):

A. Kandeger ◽

R. Tekdemir ◽

B. Sen ◽

Y. Selvi

Keyword(s):

Bipolar Disorder ◽

Case Reports ◽

Nasal Congestion ◽

Manic Episode ◽

First Episode ◽

Stimulant Effect ◽

Sympathomimetic Drugs ◽

The Central Nervous System ◽

Competing Interest ◽

Psychotic Features

ObjectivePhenylephrine, pseudoephedrine and ephedrine are the sympathomimetic drugs that have been used most commonly in oral preparations for the relief of nasal congestion. These drugs stimulate the central nervous system that is affected by the alpha and beta adrenergic agonism. Sympathomimetic agents used in the treatment of flu and common cold with ephedrine and pseudoephedrine are case reports. That the manic and psychotic episodes are triggered. In this article, we would like to present a bipolar manic disorder with two manic episodes and both of them triggered by influenza drugs.CaseA 25-year-old man patient was admitted to psychiatric outpatient clinic with increasing complaints such as increasing energy, speaking much, decreasing sleep, increasing the libido after using the flu drug that prescribed to him containing phenylephrine. Also, 2 years ago, he has manic attack triggered after the flu drug.DiscussionIn recent years the study of epilepsy and bipolar disorder in common suggests that bipolar disorder may affect the kindling phenomenon. In our case, two of reasons in the neurobiology of developing manic attacks the kindling phenomenon is likely to be effective. First, the possibility of using cold medicine containing ephedrine or pseudoephedrine in the first manic episode, in the second manic episode having spent the attack with FAQ stimulant effect of lower phenylephrine. Second, in the first episode after using the 5–6 tablets developing manic attacks. In the second attack to be triggered with just 2 doses may indicate the effect of kindling.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Manic Episode after Ventricular-Peritoneal Shunt Replacement in a Patient with Radiation-Induced Hydrocephalus: The Role of Lifetime Subthreshold Bipolar Features

Case Reports in Psychiatry ◽

10.1155/2014/953728 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

Antonio Callari ◽

Valentina Mantua ◽

Mario Miniati ◽

Antonella Benvenuti ◽

Mauro Mauri ◽

...

Keyword(s):

Bipolar Disorder ◽

Case Reports ◽

Manic Episode ◽

Rapid Onset ◽

D2 Receptors ◽

Psychotic Symptoms ◽

Bipolar Spectrum ◽

Radiation Induced ◽

Patient’S History

We present a case report of a woman hospitalized for a ventricular-peritoneal shunting replacement, who developed a manic episode with psychotic symptoms after hydrocephalus resolution. We have no knowledge of cases of manic episodes due to hydrocephalus resolution by ventricular-peritoneal shunt replacement, although previous case reports have suggested that hydrocephalus might induce rapid-onset affective episodes or mood cycles. The patient’s history revealed the lifetime presence of signs and features belonging to the subthreshold bipolar spectrum, in absence of previous full-blown episodes of a bipolar disorder. Our hypothesis is that such lifetime sub-threshold bipolar features represented precursors of the subsequent full-blown manic episode, triggered by an upregulated binding of striatum D2 receptors after the ventricular-peritoneal shunt replacement.

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Mixed features: evolution of the concept, past and current definitions, and future prospects

CNS Spectrums ◽

10.1017/s1092852916000882 ◽

2017 ◽

Vol 22 (2) ◽

pp. 161-169 ◽

Cited By ~ 8

Author(s):

Alan C. Swann

Keyword(s):

Bipolar Disorder ◽

Affective Disorders ◽

Depressive Disorders ◽

Manic Episode ◽

Severe Illness ◽

Mixed States ◽

Major Depressive ◽

Mixed Features ◽

The 19Th Century ◽

Depressive Episodes

Mixed states address the relationships between episodes and the course of an illness, presenting significant clinical challenges. Recurrent affective disorders were described thousands of years ago as dimensional disturbances of the basic elements of behavior, combining the characteristics of what we would now consider manic and depressive episodes. It was recognized from the beginning that combinations of depressive and manic features are associated with a severe illness course, including increased suicide risk. Early descriptions of affective disorders formulated them as systemic illnesses, a concept supported by more recent data. Descriptions of affective disorders and their course, including mixed states, became more systematic during the 19th century. Structured criteria achieved importance with evidence that, in addition to early onset, frequent recurrence, and comorbid problems, mixed states had worse treatment outcomes than other episodes. In contrast to 2000 years of literature on recurrent affective episodes and mixed states, the unipolar–bipolar disorder distinction was formalized in the mid-20th century. Mixed-state criteria, initially developed for bipolar disorder, ranged from fully combined depression and mania to the DSM–5 criteria, no longer limited to bipolar disorder, of a primary depressive or manic episode with at least three symptoms of the other episode type. The challenges involved in understanding and identifying mixed states center largely on what drives them, including (1) their formulation as either categorical or dimensional constructs, (2) the specificity of their relationships to depressive or manic episodes, and (3) specificity for bipolar versus major depressive disorder. Their existence challenges the distinction between bipolar and major depressive disorders. The challenges involved in identifying the underlying physiological mechanisms go to the heart of these questions.

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Baseline and prodromal characteristics of first- versus multiple-episode mania in a French cohort of bipolar patients

European Psychiatry ◽

10.1016/j.eurpsy.2010.11.001 ◽

2011 ◽

Vol 27 (8) ◽

pp. 557-562 ◽

Cited By ~ 8

Author(s):

J.-M. Azorin ◽

A. Kaladjian ◽

M. Adida ◽

E. Fakra ◽

E. Hantouche ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicide Attempts ◽

Correct Diagnosis ◽

Manic Episode ◽

Psychotic Symptoms ◽

First Episode ◽

Prodromal Phase ◽

Multiple Episode ◽

Patients At Risk ◽

Bipolar Patients

AbstractObjective:To identify some of the main features of bipolar disorder for both first-episode (FE) mania and the preceding prodromal phase, in order to increase earlier recognition.Methods:One thousand and ninety manic patients (FE=81, multiple-episodes [ME]=1009) were assessed for clinical and temperamental characteristics.Results:Compared to ME, FE patients reported more psychotic and less depressive symptoms but were comparable with respect to temperamental measures and comorbid anxiety. The following independent variables were associated with FE mania: a shorter delay before correct diagnosis, greater substance use, being not divorced, greater stressors before current mania, a prior diagnosis of an anxiety disorder, lower levels of depression during index manic episode, and more suicide attempts in the past year.Conclusion:In FE patients, the diagnosis of mania may be overlooked, as they present with more psychotic symptoms than ME patients. The prodromal phase is characterised by high levels of stress, suicide attempts, anxiety disorders and alcohol or substance abuse. Data suggest to consider these prodromes as harmful consequences of temperamental predispositions to bipolar disorder that may concur to precipitate mania onset. Their occurrence should therefore incite clinicians to screen for the presence of such predispositions, in order to identify patients at risk of FE mania.

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The Expanding Role of Antipsychotics

CNS Spectrums ◽

10.1017/s1092852900027140 ◽

2004 ◽

Vol 9 (S1) ◽

pp. 7-12

Author(s):

Philip G. Janicak

Keyword(s):

Bipolar Disorder ◽

Manic Episode ◽

Acute Mania ◽

Psychotic Symptoms ◽

Primary Therapy ◽

Obsessive Compulsive ◽

Stabilizing Agent ◽

Compulsive Disorder ◽

Bipolar Patients

Antipsychotics have been utilized in the treatment of bipolar disorder for many decades and were the mainstay of treatment before lithium was reintroduced in the late 1960s. Today, many bipolar patients who present with psychotic features are misdiagnosed and prescribed an antipsychotic for another disorder. Estimates of psychotic symptoms in bipolar disorder, particularly during a manic episode, are ≥50% by clinical assessment and even higher by individual reports. Thus, antipsychotics are frequently used: as first treatment for psychosis not recognized as bipolar disorder, and as an adjunct to a mood-stabilizing agent in bipolars with psychotic symptoms.Most recently, antipsychotics have been examined for their mood-stabilizing properties as well (Slide 9). One may conceptualize using a selective serotonin reuptake inhibitor (SSRI) antidepressant for disorders such as panic disorder or obsessive-compulsive disorder, and using an antiepileptic as a mood-stabilizing agent; however, it is more difficult to accept that an agent approved for treatment of psychosis can be a primary therapy for bipolar disorder. Data from the monotherapy trials suggest that second-generation antipsychotics (SGAs) are at least as effective as lithium and valproic acid for acute mania. There is a very large database indicating that SGAs can be utilized as monotherapy for acute mania. However, there is limited data on the role of these agents in prevention of relapse and recurrence and in their efficacy for depression in the context of bipolar disorder. More studies will be needed to clarify whether SGAs should be used as monotherapy or whether they would be best used as augmenting agents in severe and psychotically manic or depressed patients.

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Interhemispheric functional disconnection because of abnormal corpus callosum integrity in bipolar disorder type II

BJPsych Open ◽

10.1192/bjpo.bp.116.002683 ◽

2016 ◽

Vol 2 (6) ◽

pp. 335-340 ◽

Cited By ~ 7

Author(s):

Fumihiko Yasuno ◽

Takashi Kudo ◽

Kiwamu Matsuoka ◽

Akihide Yamamoto ◽

Masato Takahashi ◽

...

Keyword(s):

Bipolar Disorder ◽

Corpus Callosum ◽

Emotional Dysregulation ◽

Cerebral Hemispheres ◽

Type Ii ◽

Emotional Information ◽

Major Depressive ◽

Insula Cortex ◽

Disorder Type ◽

Ventral Prefrontal Cortex

BackgroundA significantly lower fractional anisotropy (FA) value has been shown in anterior parts of the corpus callosum in patients with bipolar disorder.AimsWe investigated the association between abnormal corpus callosum integrity and interhemispheric functional connectivity (IFC) in patients with bipolar disorder.MethodsWe examined the association between FA values in the corpus callosum (CC-FA) and the IFC between homotopic regions in the anterior cortical structures of bipolar disorder (n=16) and major depressive disorder (n=22) patients with depressed or euthymic states.ResultsWe found a positive correlation between the CC-FA and IFC values between homotopic regions of the ventral prefrontal cortex and insula cortex, and significantly lower IFC between these regions in bipolar disorder patients.ConclusionsThe abnormal corpus callosum integrity in bipolar disorder patients is relevant to the IFC between homotopic regions, possibly disturbing the exchange of emotional information between the cerebral hemispheres resulting in emotional dysregulation.

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Fatty acid composition of the postmortem corpus callosum of patients with schizophrenia, bipolar disorder, or major depressive disorder

European Psychiatry ◽

10.1016/j.eurpsy.2016.05.007 ◽

2017 ◽

Vol 39 ◽

pp. 51-56 ◽

Cited By ~ 9

Author(s):

K. Hamazaki ◽

M. Maekawa ◽

T. Toyota ◽

B. Dean ◽

T. Hamazaki ◽

...

Keyword(s):

Fatty Acids ◽

Bipolar Disorder ◽

Major Depressive Disorder ◽

Fatty Acid ◽

White Matter ◽

Corpus Callosum ◽

Depressive Disorder ◽

Psychiatric Disorders ◽

Postmortem Brain ◽

Major Depressive

AbstractBackgroundStudies investigating the relationship between n-3 polyunsaturated fatty acid (PUFA) levels and psychiatric disorders have thus far focused mainly on analyzing gray matter, rather than white matter, in the postmortem brain. In this study, we investigated whether PUFA levels showed abnormalities in the corpus callosum, the largest area of white matter, in the postmortem brain tissue of patients with schizophrenia, bipolar disorder, or major depressive disorder.MethodsFatty acids in the phospholipids of the postmortem corpus callosum were evaluated by thin-layer chromatography and gas chromatography. Specimens were evaluated for patients with schizophrenia (n = 15), bipolar disorder (n = 15), or major depressive disorder (n = 15) and compared with unaffected controls (n = 15).ResultsIn contrast to some previous studies, no significant differences were found in the levels of PUFAs or other fatty acids in the corpus callosum between patients and controls. A subanalysis by sex gave the same results. No significant differences were found in any PUFAs between suicide completers and non-suicide cases regardless of psychiatric disorder diagnosis.ConclusionsPatients with psychiatric disorders did not exhibit n-3 PUFAs deficits in the postmortem corpus callosum relative to the unaffected controls, and the corpus callosum might not be involved in abnormalities of PUFA metabolism. This area of research is still at an early stage and requires further investigation.

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Manic episode associated with interferon alpha therapy: A case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1156 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S332-S332 ◽

Cited By ~ 1

Author(s):

L. González ◽

C. Gomis ◽

V. Rodriguez ◽

C. Gomez ◽

E. tercelan ◽

...

Keyword(s):

Malignant Melanoma ◽

Interferon Alpha ◽

Neuropsychiatric Symptoms ◽

Manic Episode ◽

Chronic Fatigue ◽

Psychotic Symptoms ◽

Entire Family ◽

Urine Drug ◽

Competing Interest ◽

Urine Drug Test

Interferon alpha is a cytokine with antiviral and antineoplastic action, which is commonly used for treatment of Hepatitis C and B, malignant melanoma, Kaposi's sarcoma, kidney cancer and certain hematologic diseases. It is well-known some of its neuropsychiatric symptoms such as depressive symptoms, cognitive impairment, chronic fatigue, dysphoria and anxiety, but there are also other less common like mania, psychotic symptoms and suicide risk that have been reported. These symptoms interfere in the quality of life very significantly, which at the end can affect treatment adherence.We report a case of a 33-year-old man who was taken to the emergency department by his family referring nervousness, irritability, verbose, and insomnia during the last 5 days. The patient had not psychiatric history. He was diagnosed with a malignant melanoma stage III A a year ago which required to start interferon alpha treatment.Patient and family tell that symptoms began after forgetting last interferon dose. In the psychopathology exploration, we could observe mood lability, delusion ideas of prosecution, which includes his entire family and autorreferentiality. In the emergency room the blood test, urine drug test and CT were normal.During the admission, and in collaboration with the Oncology service, it was agreed the reintroduction and maintenance of interferon combined with olanzapine up to 30 mg/day and clonazepam up to 6 mg/day, which resulted in the resolution of symptoms in two weeks.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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