Prodromes, coping strategies and course of illness in bipolar affective disorder – a naturalistic study

2001 ◽  
Vol 31 (8) ◽  
pp. 1397-1402 ◽  
Author(s):  
D. LAM ◽  
G. WONG ◽  
P. SHAM
Keyword(s):  
Coping Strategies ◽  
Bipolar Affective Disorder ◽  
Manic Episode ◽  
Psychosocial Interventions ◽  
Naturalistic Study ◽  
Prodromal Stage ◽  
Prodromal Symptoms ◽  
Course Of Illness ◽  
Manic Symptoms ◽  
Bipolar Patients

Background. Psychosocial interventions for bipolar patients often include teaching patients to recognize prodromal symptoms and tackle them early. This prospective study set out to investigate which bipolar prodromal symptoms were reported frequently and reliably over a period of 18 months. Furthermore, we have also investigated which types of coping strategies were related to good outcome.Method. Forty bipolar patients were interviewed for their bipolar prodromal symptoms and their coping strategies at recruitment and 18 months later. Patients were also assessed as to whether they had experienced relapses.Results. Bipolar patients were able to report bipolar prodromal symptoms reliably. Mania prodromal symptoms tended to be behavioural symptoms. A quarter of patients reported difficulties in detecting depression prodromes, which tended to be more diverse and consisted of a mix of behavioural, cognitive and somatic symptoms. Significantly fewer patients who reported the use of behavioural coping strategies to curb excessive behaviour during the mania prodromal stage experienced a manic episode. Similarly, significantly fewer patients who reported the use of behavioural coping strategies experienced depression relapses. How well patients coped with mania prodromes predicted bipolar episodes significantly when the mood levels at baseline were controlled. Ratings of how well subjects coped with mania prodromal symptoms also predicted manic symptoms significantly at T2 when manic symptom at T1 was controlled.Conclusion. Our study suggests that bipolar patients are able to report prodromal symptoms reliably. It is advisable to teach patients to monitor their moods systematically and to promote good coping strategies.

Treatment of bipolar patients in manic phase: A comparison between asenapine and aripiprazole

2016 ◽  
Vol 33 (S1) ◽  
pp. S331-S332
Author(s):  
L. Girardi ◽  
S. Gili ◽  
E. Gambaro ◽  
E. Di Tullio ◽  
E. Gattoni ◽  
...  
Keyword(s):  
Metabolic Profile ◽  
Blood Count ◽  
Complete Blood Count ◽  
Manic Episode ◽  
Acute Effects ◽  
Psychomotor Agitation ◽  
Specific Patient ◽  
Manic Symptoms ◽  
Competing Interest ◽  
Bipolar Patients

IntroductionAgitation is the most evident symptom in an acute manic episode. It can be defined as excessive motor or verbal activity that can degenerate into aggressive behaviour. Both aripiprazole and asenapine are indicated for the treatment of agitation in patients with manic episode.AimsTo retrospectively evaluate the acute effects of drug therapy on psychomotor agitation rated with the PANSS-EC, the change in manic symptoms through the YMRS, the QoL with the SF-36v2 and the cardiometabolic effects of the new oral APS.MethodsWe administered the following tests to 13 patients with DBI at T0 (baseline), T1 (after 1 week), T2 (after 4 weeks), T3 (after 12 weeks) and T4 (after 24 weeks): PANSS-EC, YMRS, SF-36v2, CGI-BD, CGI-S, HAM-D, BPRS. We also considered weight, height, BMI, ECG and complete blood count.ResultsPatients recruitment and statistical analyses are still in progress. Our preliminary results suggest that there is not a marked difference between the two drugs. We highlighted that there has been a noticeable decrease in results at PANSS as well as at YMRS from T0 to T4 and patients showed an improvement in QoL. Only one patient treated with asenapine showed an increase in the results of HAM-D.ConclusionsResults suggest the efficacy of the two new APS but further recruitment and data collection are needed to better understand their impact on agitation and QoL, including the metabolic profile, with the aim to help clinicians to make a more accurate choice of drug for each specific patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Chronic stressors and trauma: prospective influences on the course of bipolar disorder

2013 ◽  
Vol 43 (12) ◽  
pp. 2583-2592 ◽  
Author(s):  
A. Gershon ◽  
S. L. Johnson ◽  
I. Miller
Keyword(s):  
Bipolar Disorder ◽  
Support Groups ◽  
Life Stress ◽  
Bipolar I Disorder ◽  
Course Of Illness ◽  
College Life ◽  
Manic Symptoms ◽  
Chronic Stressors ◽  
Bipolar Patients ◽  
Exposure To Trauma

BackgroundExposure to life stress is known to adversely impact the course of bipolar disorder. Few studies have disentangled the effects of multiple types of stressors on the longitudinal course of bipolar I disorder. This study examines whether severity of chronic stressors and exposure to trauma are prospectively associated with course of illness among bipolar patients.MethodOne hundred and thirty-one participants diagnosed with bipolar I disorder were recruited through treatment centers, support groups and community advertisements. Severity of chronic stressors and exposure to trauma were assessed at study entry with in-person interviews using the Bedford College Life Event and Difficulty Schedule (LEDS). Course of illness was assessed by monthly interviews conducted over the course of 24 months (over 3000 assessments).ResultsTrauma exposure was related to more severe interpersonal chronic stressors. Multiple regression models provided evidence that severity of overall chronic stressors predicted depressive but not manic symptoms, accounting for 7.5% of explained variance.ConclusionsOverall chronic stressors seem to be an important determinant of depressive symptoms within bipolar disorder, highlighting the importance of studying multiple forms of life stress.

A Comparison Between Manic Patients With or Without Antipsychotic Continuation Treatment: Data from a 12-months Follow-up Study at Mood Disorder Unit of San Raffaele–Turro Hospital

2017 ◽  
Vol 41 (S1) ◽  
pp. S119-S120
Author(s):  
S. Brioschi ◽  
D. Delmonte ◽  
C. Locatelli ◽  
L. Franchini ◽  
B. Barbini ◽  
...  
Keyword(s):  
Mood Stabilizer ◽  
Manic Episode ◽  
Mood Stabilizers ◽  
Antipsychotic Therapy ◽  
Course Of Illness ◽  
Long Term Treatment ◽  
Continuation Treatment ◽  
Bipolar Patients

IntroductionSeveral studies suggest that in severe bipolars there is a long-term benefit in continuing antipsychotic therapy plus a mood stabilizer also after remission from a manic episode. Nevertheless, the long-term use of antipsychotics is associated with significant side effects which can interfere with patient global functioning. In this sense, antipsychotics should not be continued unless the benefits outweight the risks.ObjectivesThe present study describes the course of illness between bipolar patients remitted from a manic episode, in continuation treatment with or without antipsychotic therapy during a 12-months follow-up period.MethodsCinquante-six bipolars (22 male and 44 female) remitted (Young < 12) from a severe manic episode were observed during a 12-months follow-up. According to clinical judge, as continuation treatment, 21/56 (37.5%) took antipsychotic plus mood stabilizer (AP + MS); 35/56 (62.5%) took mood stabilizers monotherapy (MS). During follow-up period YMRS and HAM-D were administered at 6th and 12th month to verify remission.ResultsAt the end of follow-up up, 33/56 patients (58.9%) maintained remission, 23/56 (41.1%) relapsed (56.5% depressive, 31.4% manic). The greater number of relapses occurred within 6th month: 16/56 (28.8%). In AP + MS group 12/21 patients relapsed (57.14%); in MS group 11/35 patients relapsed (31.4%). No statistical difference between the two continuation treatment strategies was observed (Chi-square = 3.586; P = 0.06).ConclusionsOur data confirm the efficacy of mood stabilizers monotherapy in long-term treatment of our severe (psychotic features, revolving-doors) bipolar patients. In fact, once the remission was obtained, the clinical choice of discontinuing antipsychotic therapy did not worsen the course of illness without a higher risk of relapse.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Prodromal Symptoms to Relapse in Bipolar Disorder

2007 ◽  
Vol 41 (5) ◽  
pp. 385-391 ◽  
Author(s):  
Pilar Sierra ◽  
Lorenzo Livianos ◽  
Sergio Arques ◽  
Javier Castelló ◽  
Luis Rojo
Keyword(s):  
Bipolar Disorder ◽  
Coping Strategies ◽  
Sleep Disturbances ◽  
Psychotic Symptoms ◽  
Prodromal Symptoms ◽  
Hand Search ◽  
Mood Changes ◽  
The Individual ◽  
Bipolar Patients ◽  
Psychomotor Symptoms

In a cyclical and recurring illness such as bipolar disorder, prodrome detection is of vital importance. This paper describes manic and depressive prodromal symptoms to relapse, methods used in their detection, problems inherent in their assessment, and patients’ coping strategies. A review of the literature on the issue was performed using MEDLINE and EMBASE databases (1965–May 2006). ‘Bipolar disorder’, ‘prodromes’, ‘early symptoms’, ‘coping’, ‘manic’ and ‘depression’ were entered as key words. A hand search was conducted simultaneously and the references of the articles found were used to locate additional articles. The most common depressive prodromes are mood changes, psychomotor symptoms and increased anxiety; the most frequent manic prodromes are sleep disturbances, psychotic symptoms and mood changes. The manic prodromes also last longer. Certain psychological interventions, both at the individual and psychoeducational group level, have proven effective, especially in preventing manic episodes. Bipolar patients are highly capable of detecting prodromal symptoms to relapse, although they do find the depressive ones harder to identify. Learning detection, coping strategies and idiosyncratic prodromes are elements that should be incorporated into daily clinical practice with bipolar patients.

Evaluation of thyroid function in lithium-naive bipolar patients

1999 ◽  
Vol 14 (6) ◽  
pp. 341-345 ◽  
Author(s):  
J. Valle ◽  
J.L. Ayuso-Gutierrez ◽  
A. Abril ◽  
J.L. Ayuso-Mateos
Keyword(s):  
Thyroid Function ◽  
Bipolar Affective Disorder ◽  
Rapid Cycling ◽  
Course Of Illness ◽  
Duration Of Illness ◽  
Bipolar Ii ◽  
Significant Difference ◽  
High Prevalence ◽  
Bipolar Patients ◽  
Tsh Levels

SummaryA high prevalence of thyroid hypofunction has been found in bipolar patients. However, the samples used in previous studies included a high percentage of patients in treatment with lithium and carbamazepine. Since the use of these drugs may explain the high prevalence of thyroid disturbances found in bipolar patients, we designed the present study to assess thyroid function in a sample of bipolar patients who had not been treated previously with lithium or carbamazepine. Patients included in the sample met Research Diagnostic Criteria for bipolar affective disorder. Assessment included determination of serum levels for total tyroxine (T4), total triiodothyronine (T3), and thyrotropin both basally and in response to infusion of 500 mg of Protilerin. The rate of thyroid hypofunction in the total sample (9.2%) was considerably lower than that reported in other studies with bipolar patients undergoing lithium therapy. Five patients (9.2%) showed some thyroid hyperfuncion parameter. Our results do not show significant differences in thyroid function indices between long-term and short-term duration of illness, between outpatients and inpatients, between high and low number of episodes, and between rapid- and non-rapid-cycling cases. Comparison between bipolar I and bipolar II patients shows a statistically significant difference in the values of TSH levels, with the bipolar II group having a higher mean value. Our data suggest that thyroid dysfunction is not related to gender, duration of illness, number of episodes, or rapid-cycling course of illness. The higher TRH-stimulated TSH levels in the bipolar II group could be considered a differential biological feature.

Psychoeducation in Bipolar Disorder: A Clinical Perspective

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
L.C. Castro ◽  
T. Rodrigues ◽  
J. Pereira ◽  
I. Coelho ◽  
H. Maia ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Disorders ◽  
Psychosocial Interventions ◽  
Clinical Perspective ◽  
Prodromal Symptoms ◽  
Disorder Treatment ◽  
Bipolar Patients ◽  
The Impact ◽  
Relapse Rates

Background:Bipolar disorder is a chronic, recurrent and debilitating mood disorder with a major impact on several aspects of everyday life. Although pharmacotherapy plays a central role in bipolar disorder treatment, psychosocial interventions are essential to a more complete and successful treatment.Aims:To present a psychoeducation program for bipolar patients runned in a Portuguese psychiatric hospital - Hospital de Magalhães Lemos, Oporto. To review the impact of psychoeducative measures on bipolar patients.Methods:A psychoeducative program for bipolar patients was developed and adapted, based on the Barcelona Bipolar Disorders Program"s experience. The psychoeducative program was applied to bipolar patients as an adjuvant of maintenance treatment.Results:Fifteen sessions were runned during 15 weeks. Twelve patients were recruited to integrate the psychoeducative group. The sessions addressed several topics including information about the illness, early detection of prodromal symptoms and symptoms management, stress management and the importance of maintaining routines.Conclusions:The best treatment available for patients with bipolar disorder includes, along with the pharmacological treatment, psychosocial interventions aimed to target issues as early identification of prodromal symptoms, coping skills, medication adherence and understanding of the disorder. This broader approach of bipolar disorder treatment has proved to be efficient in reducing relapse rates, and improving patients’ feelings of self-efficacy and quality of life.

Associations Between Self-Report of Emotional State and the EEG Patterns in Affective Disorders Patients

2010 ◽  
Vol 24 (1) ◽  
pp. 33-40 ◽  
Author(s):  
Miroslaw Wyczesany ◽  
Jan Kaiser ◽  
Anton M. L. Coenen
Keyword(s):  
State Energy ◽  
Emotional State ◽  
Spectral Power ◽  
Bipolar Affective Disorder ◽  
Affective State ◽  
Manic Episode ◽  
High Energy ◽  
Self Report ◽  
Major Depressive ◽  
High Tension

The study determines the associations between self-report of ongoing emotional state and EEG patterns. A group of 31 hospitalized patients were enrolled with three types of diagnosis: major depressive disorder, manic episode of bipolar affective disorder, and nonaffective patients. The Thayer ADACL checklist, which yields two subjective dimensions, was used for the assessment of affective state: Energy Tiredness (ET) and Tension Calmness (TC). Quantitative analysis of EEG was based on EEG spectral power and laterality coefficient (LC). Only the ET scale showed relationships with the laterality coefficient. The high-energy group showed right shift of activity in frontocentral and posterior areas visible in alpha and beta range, respectively. No effect of ET estimation on prefrontal asymmetry was observed. For the TC scale, an estimation of high tension was related to right prefrontal dominance and right posterior activation in beta1 band. Also, decrease of alpha2 power together with increase of beta2 power was observed over the entire scalp.

scholarly journals Cognitive errors assessed by observer ratings in bipolar affective disorder: relationship with symptoms and therapeutic alliance

2009 ◽  
Vol 2 (2) ◽  
pp. 92-105 ◽  
Author(s):  
Ueli Kramer ◽  
Guy Bodenmann ◽  
Martin Drapeau
Keyword(s):  
Cognitive Therapy ◽  
Affective Disorder ◽  
Mood Disorders ◽  
Bipolar Affective Disorder ◽  
Cognitive Model ◽  
Control Group ◽  
Cognitive Errors ◽  
Manic Symptoms ◽  
Observer Ratings ◽  
Depressive Patients

AbstractThe construct of cognitive errors is clinically relevant for cognitive therapy of mood disorders. Beck's universality hypothesis postulates the relevance of negative cognitions in all subtypes of mood disorders, as well as positive cognitions for manic states. This hypothesis has rarely been empirically addressed for patients presenting bipolar affective disorder (BD). In-patients (n= 30) presenting with BD were interviewed, as were 30 participants of a matched control group. Valid and reliable observer-rater methodology for cognitive errors was applied to the session transcripts. Overall, patients make more cognitive errors than controls. When manic and depressive patients were compared, parts of the universality hypothesis were confirmed. Manic symptoms are related to positive and negative cognitive errors. These results are discussed with regard to the main assumptions of the cognitive model for depression; thus adding an argument for extending it to the BD diagnostic group, taking into consideration specificities in terms of cognitive errors. Clinical implications for cognitive therapy of BD are suggested.

Mania with Bupropion: A Dose-Related Phenomenon?

2000 ◽  
Vol 34 (5) ◽  
pp. 619-621 ◽  
Author(s):  
Jessica L Goren ◽  
Gary M Levin
Keyword(s):  
Affective Disorder ◽  
Bipolar Depression ◽  
Bipolar Affective Disorder ◽  
Antidepressant Drug ◽  
Manic Episode ◽  
Total Daily Dose ◽  
High Dose ◽  
Related Phenomenon ◽  
Increased Risk ◽  
Daily Dose

OBJECTIVE: To report a case in which bipolar depression was resistant to usual therapies, requiring dosages of bupropion >450 mg/d and to review the literature on mania associated with bupropion and propose a potential theory of a dose-related threshold associated with bupropion and mania. CASE SUMMARY: A 44-year-old white man with a 25-year history of bipolar affective disorder presented with depression resistant to usual therapies. Bupropion therapy was initiated and the dosage was titrated to 600 mg/d. After exceeding the maximum recommended daily dose (450 mg/d), he experienced a manic episode attrib uted to high-dose bupropion. DISCUSSION: Due to increased risk of seizures, current prescribing guidelines state that the total daily dose of bupropion is not to exceed 450 mg/d. Since bupropion is the agent least likely to cause a manic switch in bipolar disorder, this agent seemed a logical choice to treat the patient's depression. Due to a lack of response, the bupropion dosage was titrated to a maximum of 600 mg/d. Since the patient did not switch into mania until the dosage exceeded 450 mg/d, we speculate that this adverse reaction is a dose-related phenomenon. Scientific literature supports this theory. CONCLUSIONS: A switch into mania is a potential risk associated with antidepressant drug use in bipolar affective disorder. Bupropion is believed to be associated with a decreased risk compared with other antidepressant therapies. However, our case report as well as others support the theory that this decreased risk may be due to dosages not exceeding the recommended daily dose (450 mg/d). Doses of bupropion >450 mg/d should be used with caution in depressed patients with bipolar affective disorder.

Sign in / Sign up

Export Citation Format

Share Document