Violent suicide attempt history in elderly patients with bipolar disorder: the role of sex, abdominal obesity, and verbal memory: results from the FACE-BD cohort (FondaMental Advanced center of Expertise for Bipolar Disorders)

This contribution provides a systematic review on recent developments in psychological interventions for bipolar disorder. The main focus of research to date has investigated the role of different psychotherapeutic approaches (cognitive behavioural therapy, family focused therapy, interpersonal and social rhythm therapy, psychoeducation) as an adjunct to pharmacotherapy for remission and relapse prevention. The review will assess efficacy and effectiveness of these interventions, their common ingredients, limitations and predictors of outcome. It will further explore the potential role of psychological interventions for primary prevention of bipolar disorders in high risk children and adolescents. Suggestions will be made for future work in these areas.

Download Full-text

Evaluation of the Role of ABCB1gene Polymorphic Variants on Psychiatric Disorders Predisposition in Macedonian Population

PRILOZI ◽

10.2478/prilozi-2018-0008 ◽

2017 ◽

Vol 38 (3) ◽

pp. 71-88

Author(s):

Zorica Naumovska ◽

Aleksandra K. Nestorovska ◽

Zoran Sterjev ◽

Ana Filipce ◽

Aleksandra Grozdanova ◽

...

Keyword(s):

Bipolar Disorder ◽

Psychiatric Disorders ◽

Psychiatric Illness ◽

Cell Activation ◽

Bipolar Disorders ◽

Control Group ◽

Microglia Cell ◽

Increased Risk ◽

And Function

Abstract The psychiatric and other CNS disorders are characterized with unregulated neuro-inflammatory processes and chronic microglia cell activation resulting with detrimental effect. ABCB1gene polymorphismsC1236T, G2677T/Aand C3435T are associated with P-glycoprotein expression and function andare linked with predisposition to psychiatric disorders such as schizophrenia and bipolar disorders. The relationship between mood disorders and glucocorticoids has been confirmed and ABCB1 SNPs influence the glucocorticoids access to the brain. The aim of the study is evaluation of the influence of the three most common ABCB1SNPs on predisposition to psychiatric disorders in Macedonian population. In the study 107 unrelated healthy Macedonians of both sexes were enrolled as a control group and patient population of 54 patients (22 to 65 years old) diagnosed with schizophrenia or bipolar disorder. ABCB1 for three polymorphisms were analyzed by Real-Time PCR in both groups. The results have confirmed the role of the ABCB1 gene in predisposition to psychiatric disorders and increased risk of developing bipolar disorder in carriers of the heterozygotes and mutant homozygotes for polymorphic variations in 1236 and 2677 in comparison to the normal genotype carriers. Three-fold higher risk was estimated for psychiatric illness in women that are 1236 and 2677 heterozygous carrier (heterozygous and mutant homozygous) compared to healthy control (men and women) population and four-fold higher risk in comparison only to healthy women population. Mutant allele carriers for 1236 and 2677 polymorphisms that are 35 years and below in patients population have almost three-fold higher risk for development of psychiatric illness.

Download Full-text

Immunological Indicators of Infl ammation in Late-Life Bipolar Disorder

Psychiatry ◽

10.30629/2618-6667-2021-19-3-22-33 ◽

2021 ◽

Vol 19 (3) ◽

pp. 22-33

Author(s):

L. V. Androsova ◽

E. S. Shipilova ◽

A. N. Simonov ◽

I. N. Otman ◽

T. P. Klyushnik ◽

...

Keyword(s):

Bipolar Disorder ◽

Elderly Patients ◽

Blood Plasma ◽

Bipolar Disorders ◽

The Elderly ◽

Affective States ◽

Immune Markers ◽

Leukocyte Elastase ◽

Immunological Parameters ◽

Bipolar Affective Disorders

The aim of the study was to determine the immune markers of infl ammation in the blood plasma of the elderly patients with bipolar affective disorders (BD) in relation to the clinical specifi cities of the disease. Patients and methods: 134 blood samples from the elderly patients aged from 52 to 88 years old (mean age 66.7 ± 7.7 years) with diagnose of bipolar disorder were examined. Infl ammatory markers in the blood plasma were determined as follows: the enzymatic activity of leukocyte elastase (LE) and the functional activity of the D1-proteinase inhibitor (D1-PI), as well as the level of autoantibodies (aAB) to S100b and myelin basic protein (MBP), and the protease inhibitor index (PII), which was the ratio of LE and D1-PI activity and characterized the activity of the proteolytic system as the most important component of infl ammation. Cluster analysis was used to reveal immunotypes. Results and discussion: а signifi cant increase in D1-PI and the level of aAB to S100b was revealed in elderly patients diagnosed with bipolar disorders, as well as low proteolytic activity of infl ammation (according to PII). Immune markers of infl ammation in different types of affective episodes (depressions, manias, mixed affective states) and in therapeutic remission did not differ from each other. Immunological parameters in elderly patients with bipolar disorders depended on the severity degree of the affective disorder. A relationship was found between the severity of depression and the level of aAB to S100b; the difference between mania and hypomania in terms of LE and PII activity was shown; in mixed affective states immunological parameters differed from the control only in moderate disorders. Remission with residual symptoms differed from asymptomatic therapeutic remission in terms of LE and PII activity. The two identifi ed clusters (immunotypes) differed in the activity of LE and PII. Conclusion: the results indicated the participation of infl ammation in the pathogenesis of bipolar disorder, and the isolated immunotypes confi rmed the clinical diversity of the disease. The study of the pathogenetic signifi cance of infl ammation and the identifi cation of various immunotypes was aimed at search for new therapy targets, taking into account the contribution of infl ammation.

Download Full-text

The role of electroconvulsive therapy in the treatment of bipolar disorder

10.1093/med/9780198748625.003.0027 ◽

2017 ◽

Author(s):

Roumen Milev

Keyword(s):

Bipolar Disorder ◽

Electroconvulsive Therapy ◽

Case Reports ◽

Bipolar Disorders ◽

Seizure Threshold ◽

Randomized Control Trials ◽

Mixed States ◽

Everyday Clinical Practice ◽

Randomized Control

This chapter examines the use of electroconvulsive therapy (ECT) for treatment of patients with bipolar disorders. It briefly reviews the basics of ECT, stimulus parameters, placement of electrodes, and seizure threshold. The data for efficacy and tolerability of ECT for bipolar disorder, including mania, depression, mixed states, and across the lifespan is reviewed. Although there is a paucity of good-quality randomized studies, all available data, including case reports and naturalistic observations, support the use of ECT in this population, and reinforce the widespread use of ECT in everyday clinical practice. Good-quality randomized control trials are urgently needed to address numerous unanswered questions, in order to improve efficacy and reduce side-effect burden of one of the best treatments for bipolar disorder.

Download Full-text

Alternative treatment strategies for lithium in bipolar disorder

Acta Neuropsychiatrica ◽

10.1017/s0924270800033895 ◽

1993 ◽

Vol 5 (3) ◽

pp. 55-59

Author(s):

P.F. Bouvy

Keyword(s):

Bipolar Disorder ◽

Valproic Acid ◽

Adverse Effects ◽

Alternative Treatment ◽

Calcium Antagonists ◽

Treatment Strategies ◽

Bipolar Disorders ◽

Preventive Treatment ◽

Acute Mania

SummaryIndications for lithium in the treatment of bipolar disorders are acute mania, depression and preventive treatment. In the case of insufficient efficacy or adverse effects the first alternative for lithium in acute mania is carbamazepine. However, the role of carbamazepine in preventive treatment is still uncertain. Well designed prospective research is hardly done. Clearly positive reports on the efficacy of carbamazepine concern specific lithium-resistant groups such as the ‘rapid-cyclers’. Valproic acid has been found effective in a few studies in bipolar disorders, especially in acute mania. Clonazepam is sometimes mentioned as a possible alternative, however recent research seriously questions the efficacy of clonazepam in bipolar disorders. Calcium-antagonists, especially verapamil, may have some efficacy in the treatment of acute mania, their role is still very uncertain.

Download Full-text

Evolution of the Elderly Admissions in an Acute Psychiatric Unit over the Last Decade

European Psychiatry ◽

10.1016/s0924-9338(09)71329-x ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

R. Touzon ◽

P. Rico-Villademoros ◽

E. Garnica

Keyword(s):

Bipolar Disorder ◽

Elderly Patients ◽

Medical Records ◽

Depressive Disorders ◽

Bipolar Disorders ◽

The Elderly ◽

Psychiatric Unit ◽

Population Pyramid

Aims:To describe and then compare the admissions of elderly in the last decade, to see if there have been significant changes regarding both the diagnosis and the number of admissions.Methods:Medical records of patients over 70 years admitted in an acute psychiatric unit in the course of 1997 and 2007 have been reviewed. the number of admissions in elderly patients is compared to the number of admissions in any age. Diagnosis in the elderly between 1997 and 2007 is also compared.Results:In the last decade the percentage of patients over 70 who enter our unit has increased. with regard to their diagnoses, depressive disorders and the "others" category have decreased, increasing, however, the bipolar disorder, dementia and other psychoses.Conclusions:Since the population pyramid tends towards older ages, it seems logical that the number of admissions in elderly patients increase, as it has been shown in our research.The fall in the diagnosis of “others” and the rise of diagnosis such as Dementia, Bipolar disorders and other psychosis might be due to a better diagnosis of these pathologies.

Download Full-text

The role of psychoeducation in the management of bipolar disorder

10.1093/med/9780198748625.003.0013 ◽

2017 ◽

Author(s):

Francesc Colom

Keyword(s):

Bipolar Disorder ◽

Bipolar Disorders ◽

Warning Signs ◽

Psychological Interventions ◽

Smartphone Applications ◽

Future Directions ◽

Preventive Efficacy

Psychological interventions play a major role in the prophylaxis of recurrences in bipolar disorders, always as an add-on to pharmacological care as none of them works in monotherapy. So far, the evidence for psychotherapy in the management of acute episodes is very limited so its use should be constrained to prevention. A common aspect of the majority of psychological interventions tested in bipolar disorder is that they are much more efficacious for patients with a low number of episodes prior to the treatment. Interestingly, all the psychological interventions showing preventive efficacy share psychoeducative ingredients including illness awareness, adherence enhancement, habits regularity, and warning signs identification. Future directions of psychoeducation should enhance its implementation worldwide, probably by using newer technologies such as smartphone applications. However, these need a proper testing before being included in clinical routines.

Download Full-text

Decision making in euthymic bipolar I and bipolar II disorders

Psychological Medicine ◽

10.1017/s0033291710001832 ◽

2010 ◽

Vol 41 (6) ◽

pp. 1319-1327 ◽

Cited By ~ 31

Author(s):

D. J. Martino ◽

S. A. Strejilevich ◽

T. Torralva ◽

F. Manes

Keyword(s):

Decision Making ◽

Bipolar Disorder ◽

Suicide Attempt ◽

Verbal Memory ◽

Iowa Gambling Task ◽

Large Population ◽

Healthy Controls ◽

Gambling Task ◽

Bipolar Ii ◽

History Of

BackgroundThe main aim of this study was to compare a large population of patients with bipolar disorder (BD) types I and II strictly defined as euthymic with healthy controls on measures of decision making. An additional aim was to compare performance on a decision-making task between patients with and without a history of suicide attempt.MethodEighty-five euthymic patients with BD-I or BD-II and 34 healthy controls were included. All subjects completed tests to assess verbal memory, attention and executive functions, and a decision-making paradigm (the Iowa Gambling Task, IGT).ResultsBoth groups of patients had worse performance than healthy controls on measures of verbal memory, attention and executive function. No significant differences were found between BD-I, BD-II and healthy controls on measures of decision making. By contrast, patients with a history of suicide attempt had lower performance in the IGT than patients without a history of suicide attempt.ConclusionsPatients with euthymic BD-I and BD-II had intact decision-making abilities, suggesting that this does not represent a reliable trait marker of the disorder. In addition, our results provide further evidence of an association between impairments in decision making and vulnerability to suicidal behavior.

Download Full-text

The Role of Kynurenines in Cognitive Dysfunction in Bipolar Disorder

Neuropsychobiology ◽

10.1159/000520152 ◽

2021 ◽

pp. 1-8

Author(s):

Kaat Hebbrecht ◽

Manuel Morrens ◽

Erik J. Giltay ◽

Alexander L.N. van Nuijs ◽

Bernard Sabbe ◽

...

Keyword(s):

Bipolar Disorder ◽

Cognitive Functioning ◽

Processing Speed ◽

Verbal Memory ◽

Large Scale ◽

Bipolar Depression ◽

Low Grade ◽

Therapeutic Implications ◽

Depression Group

Introduction: Chronic low-grade inflammation is suggested to play a pathophysiological role in bipolar disorder (BD) and its related cognitive dysfunctions. Although kynurenine (KYN) pathway metabolites are key inflammatory mediators, studies investigating the association between KYN metabolism and cognition in BD are scarce. We aimed to explore the relationship between KYN metabolism and cognitive functioning across different mood states in BD. Methods: Sixty-seven patients with BD (35 depressed and 32 [hypo] manic) and 29 healthy controls were included. Cognitive functioning was assessed at 3 time intervals (baseline, 4, and 8 months) assessing processing speed, sustained attention, verbal memory, working memory, and response inhibition. Plasma samples for quantification of 3-hydroxykynurenine, quinolinic acid, and kynurenic acid (KYNA) were concurrently provided. Linear mixed models were used for statistical analysis. Results: The manic group showed deficits in all assessed cognitive domains with the exception of verbal memory at all test moments. The bipolar depression group showed deficits in the processing speed at all test moments. Throughout the whole follow-up period, KYNA was significantly lower in both patient groups than in controls. Only in the bipolar depression group, low KYNA was associated with worse global cognitive functioning (B = 0.114, p = 0.02) and slower processing speed in particular (B = 0.139, p = 0.03). Conclusion: Only in the bipolar depression group, lower KYNA was associated with worse cognitive functioning. Future large-scale longitudinal studies are warranted to confirm the role of KYN metabolites in cognitive impairment in patients with BD and the possible therapeutic implications of this relationship.

Download Full-text

High BDNF serum levels are associated to good cognitive functioning in bipolar disorder

European Psychiatry ◽

10.1016/j.eurpsy.2019.02.006 ◽

2019 ◽

Vol 60 ◽

pp. 97-107 ◽

Cited By ~ 11

Author(s):

Ester Mora ◽

Maria J. Portella ◽

Gerard Piñol-Ripoll ◽

Ricard López ◽

Daniel Cuadras ◽

...

Keyword(s):

Oxidative Stress ◽

Bipolar Disorder ◽

Cognitive Functioning ◽

Verbal Memory ◽

Cognitive Outcome ◽

Oxidative Stress Markers ◽

Stress Markers ◽

Bipolar Patients ◽

And Oxidative Stress

AbstractBackground:Neurotrophins such as brain-derived neurotrophic factor (BDNF), inflammation and oxidative damage may contribute to the pathophysiology of bipolar disorder (BD) in terms of illness activity. To date, there is a lack of studies linking the cognitive impairment observed in BD with these neurobiological mechanisms. This study aimed to investigate the role of these neurobiological factors in clinical and cognitive outcomes in a sample of bipolar individuals.Methods:We measured serum BDNF, cytokines and oxidative stress markers in a sample of 133 individuals: 52 euthymic bipolar patients, 32 manic patients and 49 healthy controls. They were all assessed with a comprehensive cognitive battery. Sociodemographic and clinical data were collected. Multiple linear regression models were built to study associations of neurotrophins and inflammatory and oxidative measures with cognitive functioning.Results:BDNF levels were decreased in euthymic (p = 0.039) and manic (p < 0.001) individuals. Conversely, inflammatory (interleukin 6 (IL-6)) (p = 0.019) and oxidative stress (p = 0.003) measures were increased in bipolar individuals compared to controls. BDNF levels were associated with executive functioning (β = 0.01, p = 0.02) and verbal memory (β = 0.013, p = 0.005), together with other demographic variables. In particular, verbal memory was also associated with obesity (β=-0.04, p = 0.005). Neither inflammatory markers, oxidative stress markers nor other relevant clinical variables showed any association with cognitive outcome.Conclusions:Of all the peripheral neurobiological factors analysed, BDNF was the only one significantly associated with cognitive dysfunction in bipolar disorder individuals. This study emphasizes the role of BDNF not only across mood phases but also in cognitive functioning.

Download Full-text