Platelet and Plasmatic Lipidic Profile as Potential Marker of Bipolar Disorders: Preliminary Findings

IntroductionAlthough the diagnosis of bipolar disorder is currently based on clinical criteria, preliminary studies showed that palmitic and arachidonic acid levels are able to discriminate adult patients with major depressive disorder (MDD) from those with bipolar disorder (BD).ObjectivesTo replicate and to expand previous findings by investigating the relation between mood disorders and platelet and plasmatic fatty levels.AimsTo compare the lipidic profile of individuals with different mood disorder (MDD vs. BD) and to investigate the relation with specific clinical features (duration of illness, attempted suicide, psychotic symptoms).MethodsPotential participants were recruited from the outpatient and inpatient psychiatric units of the university hospital of Palermo (Italy). Diagnosis of DSM IV mood disorders was made using the MINI. Symptom severity was assessed using the HAM-D rating scale and the YMRS. Fatty acid profile was analyzed using mass spectrometry.ResultsPreliminary analyses were performed on 8 patients with MDD and 6 with BD. Groups were similar in terms of demographic variables. Patients with MDD showed highest levels of platelet palmitic acid, stearic acid, and arachidonic acid. Furthermore, plasmatic docosahexaenoic acid was negatively related with manic symptoms severity (Rho = –0.697; P = 0.025) and platelet alpha linolenic acid was positively related with illness duration (Rho = 0.845; P = 0.040).ConclusionsThese preliminary findings suggest that platelet fatty acids may be possible biological markers to improve the diagnosis of BD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Psychotic symptoms in bipolar disorder: Two years’ retrospective study

Health Renaissance ◽

10.3126/hren.v13i1.17947 ◽

2017 ◽

Vol 13 (1) ◽

pp. 49-57

Author(s):

Baikuntha Raj Adhikari ◽

S Mishra ◽

S Nepal ◽

N Sapkota

Keyword(s):

Bipolar Disorder ◽

Retrospective Study ◽

Bipolar Depression ◽

Bipolar Disorders ◽

Unipolar Depression ◽

Common Type ◽

Psychotic Symptoms ◽

Mixed Episode ◽

Auditory Verbal Hallucinations ◽

Primary Substance

Background: Psychosis in bipolar disorder is common but still not well understood. There is paucity of literature from our country and none from this institute which serves the eastern part of Nepal.Objective: To describe the hallucinations and delusions in bipolar disorders in our place.Methods: Patients-record files of bipolar disorders with psychosis discharged in two years’ time from 2012 to 2014 were analysed. Patients with unipolar depression, recurrent depressive disorder, serious organic illness, and primary substance use disorders were excluded. Information was collected in a structured performa. Association of delusion and hallucination was observed.Results: During the study period, ninety-five patients with bipolardisorder had psychosis. Hallucination was present in 29 (30.5%) cases, and out of these 23 (79.3%) were cases of mania. In 26 (89.7%) patients, the hallucinations were mood congruent. The median duration of appearance of hallucination was 10 days and appeared early in mania. Among hallucinations, auditory verbal hallucinations were present in all 29 patients. Delusions were present in 77 (81.1%) of patients, and grandiose delusions were the most common. Grandiose delusions tended to occur even in the absence of hallucinations. Conclusion: Psychosis is common in bipolar disorder. Grandiose delusions are the most common delusion and are relatively independent of hallucination. The auditory verbal hallucinations are the most common type of hallucination. Hallucinations in mania tend to manifest earlier than in bipolar depression and mixed episode, and most of the hallucinations in bipolar disorder are mood congruent. Health Renaissance 2015;13 (1): 49-57

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Introduction to mood disorders

New Oxford Textbook of Psychiatry ◽

10.1093/med/9780199696758.003.0083 ◽

2012 ◽

pp. 629-632

Author(s):

John R. Geddes

Keyword(s):

Bipolar Disorder ◽

Mood Disorders ◽

Subsequent Development ◽

Bipolar Disorders ◽

Early History ◽

Diagnostic Systems ◽

Psychiatric Nosology ◽

Future Developments ◽

Mood Depression

The concept of mood is difficult to define. In psychiatry, it has come to mean a pervasive emotional tone varying along an axis from happiness to sadness—and perhaps anxiety. The boundaries between normal and abnormal mood are equally difficult to define. Nonetheless, there is usually no doubt about the most extreme manifestations of low mood, depression, or elevated mood, mania. This chapter begins by discussing the early history and subsequent development of modern psychiatric nosology. It then covers the distinction between unipolar and bipolar disorders, modern diagnostic systems and the birth of diagnostic criteria, subgroups of unipolar and bipolar disorder, and likely future developments in the classification of mood disorders.

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T27. COGNITIVE RESERVE IN CHILD AND ADOLESCENT OFFSPRING OF PATIENTS DIANOSED WITH SCHIZOPHRENIA OR BIPOLAR DISORDER

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa029.587 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S241-S242

Author(s):

Elena De la Serna ◽

Patricia Camprodon-Boadas ◽

Gisela Sugranyes ◽

Carla Torrent ◽

Brisa Sole ◽

...

Keyword(s):

Bipolar Disorder ◽

High Risk ◽

Verbal Memory ◽

Cognitive Reserve ◽

Protective Factor ◽

Rating Scale ◽

Structured Interview ◽

Psychotic Symptoms ◽

Prodromal Symptoms ◽

Neuropsychological Variables

Abstract Background Cognitive Reserve (CR) is defined as the ability of the brain to cope and deal with physiological or pathological brain injuries. In the field of psychiatry, higher levels of CR have been associated with lower levels of psychotic symptoms, higher psycho-social functioning and higher cognitive performance, suggesting that CR should be considered as a protective factor (Barnett et al., 2006; Amoretti et al., 2016). This study aims to compare CR levels in a sample of adolescents and young adult offspring of patients with schizophrenia or bipolar disorder who are at high risk of developing these disorders (HR) and compared them with a group of healthy controls (HC). We also assess the utility of CR in predicting clinical and cognitive variables. Methods Participants were 85 HR and 45 HC. A CR proxy was calculated based on premorbid IQ, socio-occupational attainment and social activities. Clinical assessment included: the Structured Interview for Prodromal Symptoms (SOPS), the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HDRS). Neuropsychological assessment included: Working Memory, Processing Speed, Verbal Memory, attention and executive functioning. A factorial analysis was conducted in order to obtain a single CR measure. Differences between groups in CR were assessed via MANCOVA and linear regressions were conducted to check the effectiveness of CR in predicting clinical and neuropsychological variables. Results No significant differences were observed in age or gender between HR and HC groups. Socioeconomic status was lower in HR subjects (F=8.100, p=0.005).CR was significantly lower in the HR group than in the HC group (F=17.522; p<0.001). Moreover, the CR proxy was able to correctly classify 72.7% of the sample as either HR or HC. Our proxy was able to predict the following clinical variables in the HR group: negative (F=9.269; p=0.002), and total (F=7.290; p=0.009) prodromal symptoms, the YMRS (F=11.597; P<0.001) and the HDRS (F=12.761; p<0.001). In terms of neuropsychological variables, RC predicted WM (F=9.738; p=0.003), PS (F=4.557; p=0.037) and verbal memory [immediate (F=6.999; p=0.010) and delayed recall (F=10.990; P=0.002)] in the HR sample. Discussion HR subjects have lower CR than controls. CR is associated with clinical and neuropsychological variables. To our knowledge no previous studies have assessed CR in high risk samples. Nevertheless, studies conducted in adult first episode psychotic samples have shown an association between CR and the severity of symptoms.

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The Use of Antiepileptic Drugs in Bipolar Disorders: A Review Based on Evidence From Controlled Trials

CNS Spectrums ◽

10.1017/s1092852900014917 ◽

2006 ◽

Vol 11 (10) ◽

pp. 788-799 ◽

Cited By ~ 19

Author(s):

Richard H. Weisler ◽

Andrew J. Cutler ◽

James C. Ballenger ◽

Robert M. Post ◽

Terence A. Ketter

Keyword(s):

Bipolar Disorder ◽

Mood Disorders ◽

Antiepileptic Drugs ◽

Bipolar Disorders ◽

Acute Mania ◽

Controlled Trials ◽

Rapid Cycling ◽

Comorbid Conditions ◽

United States Food ◽

States Food

ABSTRACTAntiepileptic drugs (AEDs) have diverse psychotropic profiles. Some AEDs have proven to be efficacious in the treatment of mood disorders, especially bipolar disorder. Others are ineffective as primary treatments but may be useful adjuncts for mood disorders or comorbid conditions. Valproate (acute mania and mixed episodes), carbamazepine (acute mania and mixed episodes), and lamotrigine (maintenance to delay recurrence) have United States Food and Drug Administration indications for the treatment of bipolar disorder. This article provides an overview of data on the use of AEDs in bipolar disorder, including acute mania and depression, prophylaxis, and rapid cycling.

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Magnetic resonance spectroscopic measurement of cerebral gamma-aminobutyric acid concentrations in patients with bipolar disorders

Acta Neuropsychiatrica ◽

10.1111/j.1601-5215.2006.00132.x ◽

2006 ◽

Vol 18 (2) ◽

pp. 120-126 ◽

Cited By ~ 21

Author(s):

Po W. Wang ◽

Napapon Sailasuta ◽

Rebecca A. Chandler ◽

Terence A. Ketter

Keyword(s):

Bipolar Disorder ◽

Magnetic Resonance ◽

Mood Disorders ◽

Bipolar Disorders ◽

Occipital Lobe ◽

Gabaergic Neurotransmission ◽

Control Subjects ◽

Bipolar Ii ◽

Healthy Control ◽

Cr Concentration

Background:Animal models of depression and psychopharmacological mechanisms of action suggest the importance of the gamma-amino butyric acid (GABA) system in the pathophysiology of mood disorders. Mood stabilizers have overlapping effects on GABAergic neurotransmission, and antidepressant use has been associated with alterations in GABAB receptor function. Magnetic resonance spectroscopy (MRS) provides an opportunity to noninvasively assess cerebral GABA concentrations in anterior paralimbic circuits that have been implicated in mood disorders.Methods:In bipolar disorder patients and healthy control subjects, we used MRS with a modified GABA-edited point resolved spectroscopy sequence (TE 68 ms, TR 1500 ms, 512 averages, total scan time 26 min) to assess GABA in an 18-cm3 occipital voxel. In addition, in another cohort of bipolar disorder patients and healthy control subjects, we similarly assessed GABA in a 12.5-cm3 medial prefrontal/anterior cingulate (MPF/AC) voxel. The concentration of GABA was referenced to creatine (Cr) from unedited spectra.Results:In bipolar patients and controls, we consistently detected 3.0 p.p.m. GABA peaks in occipital lobe and MPF/AC. In 16 bipolar (nine bipolar I and seven bipolar II) disorder patients, compared with six healthy control subjects, mean occipital GABA/Cr concentration was 61% higher. In addition, in 15 bipolar (five bipolar I, nine bipolar II, and one bipolar not otherwise specified) disorder patients, compared with six healthy control subjects, mean MPF/AC GABA/Cr concentration tended to be 41% higher.Conclusions:Patients with bipolar disorders may have increased cerebral GABA concentrations. Although this was more evident in the occipital lobe, MPC/AC GABA disturbance may be of greater potential interest in view the more established role of MPF/AC in affective processing. Additional studies are warranted to assess changes in GABAergic neurotransmission and the influences of diagnosis, mood state, and medication status in bipolar disorder patients.

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Association between childhood dimensions of attention deficit hyperactivity disorder and adulthood clinical severity of bipolar disorders

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867416642021 ◽

2016 ◽

Vol 51 (4) ◽

pp. 382-392 ◽

Cited By ~ 4

Author(s):

Bruno Etain ◽

M Lajnef ◽

J Loftus ◽

C Henry ◽

A Raust ◽

...

Keyword(s):

Bipolar Disorder ◽

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Rating Scale ◽

Age At Onset ◽

Bipolar Disorders ◽

Clinical Severity ◽

Factorial Structure ◽

Hyperactivity Disorder ◽

Wender Utah Rating Scale

Background: Clinical features of attention deficit hyperactivity disorder can be frequently observed in cases with bipolar disorders and associated with greater severity of bipolar disorders. Although designed as a screening tool for attention deficit hyperactivity disorder, the Wender Utah Rating Scale could, given its factorial structure, be useful in investigating the early history of impulsive, inattentive or mood-related symptoms among patients with bipolar disorders. Methods: We rated the Wender Utah Rating Scale in 276 adult bipolar disorder cases and 228 healthy controls and tested its factorial structure and any associations with bipolar disorder phenomenology. Results: We confirmed a three-factor structure for the Wender Utah Rating Scale (‘ impulsivity/temper’, ‘ inattentiveness’ and ‘ mood/self-esteem’). Cases and controls differed significantly on Wender Utah Rating Scale total score and sub-scale scores ( p-values < 10−5). About 23% of bipolar disorder cases versus 5% of controls were classified as ‘ WURS positive’ (odds ratio = 5.21 [2.73–9.95]). In bipolar disorders, higher Wender Utah Rating Scale score was associated with earlier age at onset, severity of suicidal behaviors and polysubstance misuse; multivariate analyses, controlling for age and gender, confirmed the associations with age at onset ( p = 0.001) and alcohol and substance misuse ( p = 0.001). Conclusion: Adults with bipolar disorders who reported higher levels of childhood symptoms on the Wender Utah Rating Scale presented a more severe expression of bipolar disorders in terms of age at onset and comorbidity. The Wender Utah Rating Scale could be employed to screen for attention deficit hyperactivity disorder but also for ‘ at-risk behaviors’ in adult bipolar disorder cases and possibly for prodromal signs of early onset in high-risk subjects.

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Mood Stabilizers: Implementing Combined Treatment Regimens in Bipolar Disorder

10.2310/psych.13066 ◽

2018 ◽

Author(s):

Charles Bowden ◽

Melissa Martinez

Keyword(s):

Bipolar Disorder ◽

Treatment Planning ◽

Rating Scale ◽

Bipolar Depression ◽

Combined Treatment ◽

Bipolar Disorders ◽

Maintenance Phase ◽

Mood Stabilizers ◽

Outcome Analysis ◽

Treatment Regimens

Patients with bipolar disorders spend a greater proportion of their illness in a depressed or mixed state rather than experiencing either mania or hypomania. Over the past 20 years, most major pharmaceutical companies have either reduced or abandoned the research and development of novel psychiatric drugs, exiting the development of new, safe, efficacious, and tolerable treatment regimens for bipolar disorder. Therefore, optimizing the current treatments available is critical. We review studies of the last 15 years that provide guidance relevant to managing the maintenance phase of bipolar disorders. Based on these data, we provide recommendations for effective treatment planning and implementation, principally for the maintenance phase care of persons with bipolar disorder. We also discuss strategies for implementing medication regimens, differentiating strategies for maintenance phase treatment from those of acute phase treatment. Assessing key symptoms that are sensitive to change is critical for longitudinal assessments and treatment planning for patients with bipolar disorders. In most studies, only a subset of rating scale items differentiate patients with good responses from those without. Identified symptoms include racing thoughts, less need for sleep, hyperactivity, increased activity, and increased energy. We developed a procedure for using Multistate Outcome Analysis of Treatment (MOAT) in bipolar disorders. MOAT integrates efficacy and tolerability data during studies to provide information about the quantity and quality of time spent in distinct mood states. The protocol developed will be useful for assessing treatment strategies in bipolar disorder. This review contains 4 figures, 7 tables and 32 references Key words: bipolar, depression, lithium, mania, mixed, mood stabilizer, survival analysis, symptom domains, valproate

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Increased risk of hospital admission for mood disorders following admission for epilepsy

Neurology ◽

10.1212/01.wnl.0000542492.00605.9d ◽

2018 ◽

Vol 91 (9) ◽

pp. e800-e810 ◽

Cited By ~ 6

Author(s):

Anna M. Kim ◽

Kyle C. Rossi ◽

Nathalie Jetté ◽

Ji Yeoun Yoo ◽

Kenneth Hung ◽

...

Keyword(s):

Bipolar Disorder ◽

Hospital Admission ◽

Mood Disorders ◽

Cox Regression ◽

Bipolar Disorders ◽

Medical Group ◽

Index Hospitalization ◽

Increased Risk ◽

Stroke Group ◽

Nationally Representative

ObjectiveTo determine if epilepsy admissions, compared to admissions for other medical causes, are associated with a higher readmission risk for mood disorders.MethodsThe Nationwide Readmissions Database is a nationally representative dataset comprising 49% of US hospitalizations in 2013. In this retrospective cohort study, we used ICD-9-CM codes to identify medical conditions. Index admissions for epilepsy (n = 58,278) were compared against index admissions for stroke (n = 215,821) and common medical causes (n = 973,078). Readmission rates (per 100,000 index admissions) for depression or bipolar disorders within 90 days from discharge for index hospitalization were calculated. Cox regression was used to test for associations between admission type (defined in 3 categories as above) and readmission for depression or bipolar disorder up to 1 year after index admission, in univariate models and adjusted for age, sex, psychiatric history, drug abuse, income quartile of patient's zip code, and index hospitalization characteristics.ResultsThe adjusted hazard ratio (HR) for readmission for depression in the epilepsy group was elevated at 2.80 compared to the stroke group (95% confidence interval [CI] 2.39–3.27, p < 2 × 10−16), and 2.09 compared to the medical group (95% CI 1.88–2.32, p < 2 × 10−16). The adjusted HR for readmission for bipolar disorder in the epilepsy group was elevated at 5.84 compared to the stroke group (95% CI 4.56–7.48, p < 2 × 10−16), and 2.46 compared to the medical group (95% CI 2.16–2.81, p < 2 × 10−16).ConclusionAdmission for epilepsy was independently associated with subsequent hospital readmission for mood disorders. The magnitude of elevated risk in this population suggests that patients admitted with epilepsy may warrant targeted psychiatric screening during their hospital admission.

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Executive Functions Influence on Memory Process in Patients with Paranoid Schizophrenia and Bipolar Disorders with and without Psychotic Symptoms. A Pilot Study

The Spanish Journal of Psychology ◽

10.1017/sjp.2021.38 ◽

2021 ◽

Vol 24 ◽

Author(s):

Eduardo García-Laredo ◽

Miguel Ángel Castellanos ◽

Esperanza Badaya ◽

Nuria Paúl ◽

Raquel Yubero ◽

...

Keyword(s):

Bipolar Disorder ◽

Declarative Memory ◽

Memory Performance ◽

Paranoid Schizophrenia ◽

Bipolar Disorders ◽

Psychotic Symptoms ◽

Control Group ◽

Immediate Recall ◽

Trail Making ◽

Neuropsychological Assessment Battery

Abstract The objective of the present study was to evaluate whether declarative memory deficits are related to executive function deficits (EF), since they could be a consequence of a poor organization of the material to memorize. This interaction between both cognitive processes can be studied simultaneously in a single task such as the Test of Memory Strategies (TSM). 23 patients with paranoid schizophrenic disorder, 11 with bipolar disorder with psychotic symptoms, 13 with bipolar disorder without psychotic symptoms and 15 healthy subjects were evaluated with the TSM; with the memory test Texts A and B (subtest of the Barcelona neuropsychological assessment battery), which assesses short-term and immediate recall without the influence of EF; and with the Trail Making Test (TMT): Part A (sustained attention) and Part B (executive control). The patients groups and the control group showed an improvement in memory performance across each of the TSM conditions. However, this facilitating effect of the strategies differed among the groups (the patients with higher EF deficits showed less improvement). Regarding these results, we conclude that this cognitive process cannot be independent of EF. However, due to the pilot nature of this study, it would be recommended to replicate these findings in new studies.

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Executive deficits in psychotic and bipolar disorders – Implications for our understanding of schizoaffective disorder

European Psychiatry ◽

10.1016/j.eurpsy.2007.10.006 ◽

2008 ◽

Vol 23 (1) ◽

pp. 20-25 ◽

Cited By ~ 51

Author(s):

Andrei Szoke ◽

Alexandre Meary ◽

Anca Trandafir ◽

Frank Bellivier ◽

Isabelle Roy ◽

...

Keyword(s):

Bipolar Disorder ◽

Schizoaffective Disorder ◽

Bipolar Disorders ◽

Life Time ◽

Wisconsin Card Sorting Test ◽

Psychotic Symptoms ◽

Card Sorting ◽

Perseverative Errors ◽

Trail Making ◽

Sorting Test

AbstractObjectiveSchizoaffective disorder could be considered as a form of schizophrenia, a form of bipolar disorder, an independent disorder or a disorder intermediate between bipolar disorder and schizophrenia, within a psychotic continuum. The study of cognitive deficits in subjects with those diagnoses could help differentiate between these possibilities.MethodsWe compared cognitive performances of schizoaffective (SZAff) subjects with those of subjects with schizophrenia (SZ), bipolar disorder with psychotic symptoms (life-time) (BDP), bipolar disorder without life-time occurrence of psychotic symptoms (BD) and normal controls (NC). We used two tests of executive functions – the Wisconsin Card Sorting Test (WCST) and the Trail-making Test (TMT) – that are known to be impaired in those disorders.ResultsThe number of perseverative errors on WCST was highest in SZ subjects and gradually decreased in SZAff, BDP and, finally in BD subjects. By contrast, SZ and SZAff subjects obtained similar scores in the TMT, as did BD and BDP patients.ConclusionsThese results suggest that, for some deficits, there may be a continuum between SZ, SZAff and affective disorders, whereas SZAff patients most closely resemble SZ patients for other deficits. This implies that different conceptual views about schizoaffective disorder should be seen as complementary, rather than mutually exclusive.

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