Manic-depressive illness — I: clinical characteristics of bipolar disorder subtypes

1992 ◽  
Vol 9 (1) ◽  
pp. 6-9 ◽  
Author(s):  
Patrick McKeon ◽  
Patrick Manley ◽  
Gregory Swanwick
Keyword(s):  
Bipolar Disorder ◽  
Family History ◽  
Age Of Onset ◽  
Rapid Cycling ◽  
Manic Depressive Illness ◽  
Bipolar Ii ◽  
History Of ◽  
Bipolar Patients ◽  
Depressive Episodes ◽  
Manic Patients

AbstractThe clinical and demographic features of 100 bipolar disorder patients, who were categorised into bipolar I, bipolar II, unipolar mania and rapid cycling groups, and who were further classified on the basis of the sequence of occurrence of the manic and depressive episodes within each cycle, are compared. Bipolar I (including unipolar manic) patients, 77% of whom had a sequence of moods where mania preceded depression (Mania-Depression – normothymic Interval: M.D.I.) constituted 69% of the total sample. Six per cent were classified as bipolar II and 25% has a rapid cycling disorder. Patients who had an M.D.I. sequence of moods, whether rapid or non-rapid cycling, had a younger age of onset, a higher male:female ratio and a stronger family history of bipolar disorder than patients whose depression preceded mania (D.M.I.). Unipolar manic patients, 12% of the sample, had a comparable age of onset, a greater family history of bipolarity and more frequent hospitalisations than the bipolar I-M.D.I. group. Rapid cycling patients had a lower mean serum thyroxine concentration than the non-rapid cycling bipolar disorder patients. This study supports the rationale for distinguishing bipolar patients with an M.D.I, sequence from those with a D.M.I, pattern and rapid cyclers from non-rapid cyclers.

scholarly journals Cognitive impact in bipolar disorder

2019 ◽  
pp. 052-058
Author(s):  
Bourin Michel
Keyword(s):  
Bipolar Disorder ◽  
Verbal Memory ◽  
Visual Memory ◽  
Age Of Onset ◽  
Cognitive Difficulties ◽  
Speed Of Information Processing ◽  
History Of ◽  
Bipolar Patients ◽  
Disability Severity ◽  
Depressive Episodes

It appears that bipolar patients suffer from cognitive difficulties whereas they are in period of thymic stability. These intercritical cognitive difficulties are fairly stable and their severity is correlated with the functional outcome of patients. Nevertheless, the profile of cognitive impairment varies significantly from study to study quantitatively and qualitatively. According to the studies, the authors find difficulties in terms of learning, verbal memory, visual memory, working memory, sustained attention, speed of information processing, functions executive. On the other hand, deficits of general intelligence, motor functions, selective attention, and language are not usually found. One of the reasons for the heterogeneity of results is the difficulty of exploring cognition in bipolar disorder. Many factors must be taken into account, such as the presence of residual mood symptoms, the longitudinal history of the disorder (age of onset, number of episodes due, among others, the neurotoxic impact of depressive episodes and deleterious cognitive effects). (length of hospitalization), level of disability severity, comorbidities (particularly addictive).

Manic-depressive illness — II: treatment outcome in bipolar disorder subtypes

1992 ◽  
Vol 9 (1) ◽  
pp. 9-12 ◽  
Author(s):  
Patrick McKeon ◽  
Patrick Manley ◽  
Gregory Swanwick
Keyword(s):  
Bipolar Disorder ◽  
Treatment Outcome ◽  
Antidepressant Drugs ◽  
Depressive Illness ◽  
Tricyclic Antidepressant ◽  
Rapid Cycling ◽  
Manic Depressive Illness ◽  
Mood Changes ◽  
Manic Depressive ◽  
Manic Patients

AbstractThe treatment outcome of 100 bipolar disorder patients (B.P.) was examined retrospectively to determine whether bipolar subtypes had a differential prophylactic response to lithium, carbamazepine, neuroleptics and antidepressant drugs when these treatments were given in a predetermined sequence. Sixty-eight per cent of 53 B.P.-I patients with a mania-depression-normothymic-interval (M.D.I.) sequence of mood changes had a good response to lithium, and all but one of the remainder responded with the addition of carbamazepine or an antidepressant. While only 17% of 12 unipolar manic patients achieved prophylaxis with lithium and a further 17% when carbamazepine was added, the other 66% remained normothymic when a neuroleptic was prescribed with lithium. Of the seven rapid cycling patients where depression preceded mania, 28% had a good prophylactic effect with lithium, a further 28% when a tricyclic antidepressant was added and 14% with lithium and carbamazepine. None of the 18 rapid cycling M.D.I. group had a good response to lithium, but 39% stabilised when carbamazepine was added to lithium. Twenty-eight per cent of this group failed completely to respond to any of the treatments used. Neuroleptics increased the severity and duration of depressive phases for all subtypes except the unipolar mania group.

Socio-Cultural Parameters in Yoruba Nigerian Patients with Affective Disorders

1989 ◽  
Vol 155 (3) ◽  
pp. 337-340 ◽  
Author(s):  
Roger O. A. Makanjuola
Keyword(s):  
Bipolar Disorder ◽  
Depressive Disorder ◽  
Affective Disorders ◽  
Educational Status ◽  
Major Depressive ◽  
Manic Disorder ◽  
Younger Age ◽  
History Of ◽  
Bipolar Patients ◽  
Manic Patients

One hundred and ten consecutive new patients presenting with major affective disorders were divided into five categories according to pattern of presentation: recurrent manic disorder, recurrent depressive disorder, bipolar disorder, single episodes of manic disorder, and single episodes of major depressive disorder. Manic patients predominated, and recurrent manic disorder was much more frequent than either recurrent depressive or bipolar disorder. The manic and bipolar patients were younger. Females predominanted in all five groups of patients. The two manic groups were less likely to be married, but this was probably a reflection of their younger age. No differences were demonstrated with regard to educational status or occupation. There were no significant differences with regard to sibship position, family size, or polygamous/monogamous parents. Manic patients were more likely to have suffered permanent separation from one or both parents before the age of 12 years. A relatively low proportion of the patients had a positive history of mental disorder among first- or second-degree relatives. Manic and bipolar patients tended to present in hospital relatively early in their illness.

From Obsessivity to Bipolarity and Vice Versa. A Literature Review

2016 ◽  
Vol 33 (S1) ◽  
pp. S494-S494
Author(s):  
P. Cano Ruiz ◽  
S. Cañas Fraile ◽  
A. Gómez Peinado ◽  
P. Sanmartin Salinas
Keyword(s):  
Bipolar Disorder ◽  
Depressive Illness ◽  
Bipolar Spectrum ◽  
Manic Depressive Illness ◽  
Bipolar Spectrum Disorders ◽  
Increased Risk ◽  
Spectrum Disorders ◽  
Competing Interest ◽  
Bipolar Patients ◽  
Depressive Episodes

IntroductionThe prevalence of obsessive symptoms in bipolar patients is currently under discussion. Last years, different cases of antidepressant-induced mania and hypomania in patients with OCD have been described.Several authors have reported that patients with OCD and bipolar disorder have more depressive episodes than patients with only OCD.ObjectiveTo know the relationship between OCD and other bipolar spectrum disorders.MethodBibliographical review on comorbidity between obsessive symptoms and bipolarity.ResultsSome longitudinal analysis have shown that patients firstly diagnosed with OCD have an increased risk for subsequent diagnosis of all other conditions, especially for bipolar and schizoaffective disorder, for those whose risk is of up to 13 times higher. The handling of a patient with bipolar disorder and OCD implies some difficulty, because of the main treatment of anxiety disorders, the antidepressants, alters the course of manic-depressive illness, accelerating cycles.ConclusionsOCD is etiologically related to bipolar spectrum disorders and schizophrenia. Therefore, it is necessary to continue the investigation of possible involved genes and approaches for clinical practice.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals The relationship between affective temperament and suicide attempt, clinical history and current subclinical symptoms in bipolar disorder

2018 ◽  
Vol 9 (3) ◽  
pp. 65
Author(s):  
Rafael Assis Da Silva ◽  
Daniel Mograbi ◽  
Luiza Nogueira Amadeo ◽  
Cristina MT Santana ◽  
Jesus Landeira-Fernandez ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicide Attempt ◽  
Clinical Course ◽  
Depressive Mood ◽  
First Episode ◽  
Hamilton Depression Scale ◽  
Affective Temperament ◽  
History Of ◽  
Bipolar Patients ◽  
Depressive Episodes

Background: Affective temperament may strongly influence psychopathological characteristics in mood disorders such as clinical course of major or minor affective episodes, predominant polarity, clinical symptoms, long term clinical course, suicidality, and response/adherence to medication.Objective: The objective of this work is evaluate the association between affective temperament and clinical characteristics in bipolar disorder (BD) patients.Method: 88 euthymic bipolar patients were evaluated through Hamilton Depression Scale (HAM-D), Young Mania Rating Scale (YMRS), Clinical Global Impressions Scale for use in bipolar illness (CGI-BP), and TEMPS-Rio de Janeiro. Identification, sociodemographic data, and clinical information as age on disease onset, number of manic episodes, number of depressive episodes, polarity of first affective episode, and history of suicidal attempts, if any, from each patient were collected.Results: Our results founded that high scores in cyclothymic, irritable, depressive and anxious temperaments were associated with at least one suicide attempt. Higher scores of anxious temperament were associated with depressive polarity in the first episode of the disease as well as higher amount of manic episodes. Higher scores of hyperthymic temperament were associated with manic polarity in the first episode of the disease. Higher scores of depressive temperament were associated with higher scores in total HAM-D and specifically with higher scores in items 1 and 2 of HAM-D, i.e., depressive mood and guilt. No correlation was found between temperament and intensity of subsyndromal manic symptoms.Conclusion: We concluded that affective temperaments in BD are associated with history of suicide attempts, seem to influence polarity of first episode and that depressive temperament seems to relate to more intense subsyndromal depressive symptoms, especially depressive mood and guilt.

Cognitive impairments in patients with bipolar disorder during different phases of illness

2011 ◽  
Vol 26 (S2) ◽  
pp. 412-412
Author(s):  
M. Buoli ◽  
E. Caletti ◽  
R.A. Paoli ◽  
M. Serati ◽  
A.C. Altamura
Keyword(s):  
Bipolar Disorder ◽  
Executive Functioning ◽  
Neuropsychological Tests ◽  
Verbal Learning ◽  
Semantic Knowledge ◽  
Attention And Memory ◽  
Bipolar Patients ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Manic Patients

IntroductionSeveral studies have reported that Bipolar Disorder (BD) is characterized by neuropsychological deficits both during affective episodes and euthymic phases; in particular, bipolar patients (BPs) show psychomotor slowing and impairment of memory during Major Depressive Episodes and frontal-executive deficits in Hypomania.AimsThe aim of the present study is to compare possible differences in cognitive performances of BPs during euthymia or during an affective episode.Methods22 BPs with an affective episode (depressive = 7, mixed = 7, manic = 8) and 5 euthymic patients underwent neuropsychological tests, after assessing the diagnosis by SCID-I. The cognitive abilities tested by raters included attention, verbal abilities, memory, abstract reasoning, executive functioning and semantic knowledge. One-way ANOVAs were performed on mean total scores of neuropsychological tests comparing euthymics versus BPs in the different phases of illness.ResultsThe 20% of euthymic patients showed attentive, verbal and memory deficits; the 40% showed perceptual and executive functioning deficits. Depressed (p = 0.03) and manic (p = 0.01) patients showed worse scores at Trail Making Test A (TMT-A) than euthymics. Manic patients presented the most severe deficits in memory as showed by the scores of Corsi's test (F = 4.96, p = 0.01), Recall of Prose (F = 4.06, p = 0.02) and California Verbal Learning Test (F = 3.67, p = 0.03).ConclusionsEuthymic patients showed deficits in several cognitive domains. Manic patients had more severe deficits in attention and memory in comparison with depressed, mixed and euthymic patients. Controlled studies with larger samples are needed to confirm these data.

Obesity and Obstetric Complications are Associated with Rapid-cycling in Italian Patients with Bipolar Disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S74-S74
Author(s):  
A. Caldiroli ◽  
M. Buoli ◽  
B. Dell’Osso ◽  
G.S. Carnevali ◽  
M. Serati ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bipolar Disorder ◽  
Antidepressant Treatment ◽  
Age At Onset ◽  
Obstetric Complications ◽  
Psychotic Symptoms ◽  
Rapid Cycling ◽  
Clinical Variables ◽  
History Of ◽  
Bipolar Patients

IntroductionRapid cycling (RC) worsens the course of bipolar disorder (BD) being associated with poor response to pharmacotherapy. Previous results about clinical variables potentially associated with RCBD were discordant or unreplicated.ObjectivesAn early diagnosis should be the goal to properly treat RCBD patients.AimsTo compare clinical variables between RC and non-RC bipolar patients and to identify related risk factors.MethodsA sample of 238 bipolar patients was enrolled from three different community mental health centers. Descriptive analyses were performed on total sample and patients were compared in terms of sociodemographic and clinical variables according to the presence of RC by multivariate analyses of variance (MANOVAs, continuous variables) or χ2 tests (qualitative variables). Binary logistic regression was performed to calculate odds ratios.ResultsOverall, 28 patients (11.8%) had RC. The two groups were not different in terms of age, age at onset, gender distribution, type of family history, type of substance use disorder, history of antidepressant therapy, main antidepressant, psychotic symptoms, comorbid anxiety disorders, suicide attempts, thyroid diseases, diabetes, type of BD, duration of untreated illness, illness duration, duration of antidepressant treatment and GAF scores. In contrast, RC patients had more often a history of obstetric complications (P < 0.05), obesity (P < 0.05) and a trend to hypercholesterolemia (P = 0.08). In addition, RC bipolar patients presented more frequently lifetime MDMA misuse (P < 0.05) than patients without RC.ConclusionsObesity and obstetric complications are risk factors for the development of RC in BD. Lifetime MDMA misuse may be more frequent in RC bipolar patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Electroconvulsive Therapy (ECT) in Bipolar Disorder Patients with Ultra-Rapid Cycling and Unstable Mixed States

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 624
Author(s):  
Sergey Mosolov ◽  
Christoph Born ◽  
Heinz Grunze
Keyword(s):  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Electroconvulsive Therapy ◽  
Mood Stabilizer ◽  
Rapid Cycling ◽  
Mixed States ◽  
Limited Effectiveness ◽  
Bipolar Patients ◽  
Depressive Episodes

Background and Objectives: Unstable mixed episodes or rapid switching between opposite affective poles within the scope of short cycles was first characterized in 1967 by S. Mentzos as complex polymorphous states with chaotic overlap of manic and depressive symptoms. Well-known examples include antidepressant-induced mania/hypomania and rapid/ultra-rapid/ultradian cycling, when clinicians observe an almost continuous mixed state with a constant change of preponderance of manic or depressive symptoms. Achieving stable remission in these cases is challenging with almost no data on evidence-based treatment. When mood stabilizers are ineffective, electroconvulsive therapy (ECT) has been suggested. Objectives: After reviewing the evidence from available literature, this article presents our own clinical experience of ECT efficacy and tolerability in patients with ultra-rapid cycling bipolar disorder (BD) and unstable mixed states. Materials and Methods: We conducted an open, one-year observational prospective study with a “mirror image” design, including 30 patients with rapid and ultra-rapid cycling BD on long-term mood stabilizer treatment (18 received lithium carbonate, 6 on valproate and 6 on carbamazepine) with limited effectiveness. A bilateral ECT course (5–10 sessions) was prescribed for regaining mood stability. Results: ECT was very effective in 12 patients (40%) with a history of ineffective mood stabilizer treatment who achieved and maintained remission; all of them received lithium except for 1 patient who received carbamazepine and 2 with valproate. Nine patients (30%) showed partial response (one on carbamazepine and two on valproate) and nine patients (30%) had no improvement at all (four on carbamazepine and two on valproate). For the whole sample, the duration of affective episodes was significantly reduced from 36.05 ± 4.32 weeks in the year prior to ECT to 21.74 ± 12.14 weeks in the year post-ECT (p < 0.001). Depressive episodes with mixed and/or catatonic features according to DSM-5 specifiers were associated with a better acute ECT response and/or long-term mood stabilizer treatment outcome after ECT. Conclusions: ECT could be considered as a useful option for getting mood instability under control in rapid and ultra-rapid cycling bipolar patients. Further randomized trials are needed to confirm these results.

First Clinical Signs of the Bipolar Prodrome

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
G. Juckel
Keyword(s):  
Bipolar Disorder ◽  
Family History ◽  
Positive Family History ◽  
Clinical Signs ◽  
Structured Interview ◽  
Psychotic Episode ◽  
Affective Temperament ◽  
History Of ◽  
Bipolar Patients

Temperament and mood swings are promising indicator for the characterization of mood-spectrum vulnerability. The aim of this study was to investigate the relationship between affective temperament and mood swings in bipolar disorder. We explored these clinical features retrospectively. Patients who met the criteria for Bipolar I disorder were enrolled in the study. Exclusion criteria were partial remittance and a full affective or psychotic episode. Data concerning illness and family history, mood swings (semi-structured interview) and depression (BDI) were obtained. We examined premorbid temperament with TEMPS-A, and with the validated German version TEMPS-M. Patients with and without mood swings were compared with respect to the dominant temperament. Out of 20 bipolar patients, 6 subjects reported mood swings prior to the onset of affective disorder. Subjects with mood swings significantly correlated with a positive family history of affective disorders. Concerning cyclothymic, irritable, and hyperthymic temperament, bipolar affective patients with mood swings had higher scores. No differences were found between males and females. Our findings support the assumption that mood swings, as represented by the cyclothymic temperament, could be prodromes of bipolar disorder. These traits may represent vulnerability markers and could presumably be used to identify individuals at high risk for developing bipolar disorder in order to prevent this illness or to modify its course. A further retrospective study with a larger sample size was started to deepen knowledge about putative prodromal symptoms of bipolar disorder.

Clinical and dimensional characteristics of euthymic bipolar patients with or without suicidal behavior

2011 ◽  
Vol 27 (8) ◽  
pp. 570-576 ◽  
Author(s):  
C. Parmentier ◽  
B. Etain ◽  
L. Yon ◽  
H. Misson ◽  
F. Mathieu ◽  
...  
Keyword(s):  
Suicidal Behaviour ◽  
Alcohol Misuse ◽  
Age At Onset ◽  
Diagnostic Interview ◽  
Rapid Cycling ◽  
Replication Sample ◽  
History Of ◽  
Bipolar Patients ◽  
Affective Lability ◽  
Depressive Episodes

AbstractBackgroundThe clinical and dimensional features associated with suicidal behaviour in bipolar patients during euthymic states are not well characterised.MethodsIn a sample of 652 euthymic bipolar patients, we assessed clinical features with the Diagnostic Interview for Genetics Studies (DIGS) and dimensional characteristics with questionnaires measuring impulsivity/hostility and affective lability/intensity. Bipolar patients with and without suicidal behaviour were compared for these clinical and dimensional variables.ResultsOf the 652 subjects, 42.9% had experienced at least one suicide attempt. Lifetime history of suicidal behaviour was associated with being a woman, a history of head injury, tobacco misuse and indicators of severity of bipolar disorder including early age at onset, high number of depressive episodes, positive history of rapid cycling, alcohol misuse and social phobia. Indirect hostility and irritability were dimensional characteristics associated with suicidal behaviour in bipolar patients, whereas impulsivity and affective lability/intensity were not associated with suicidal behaviour.LimitationsThis study had a retrospective design with no replication sample.ConclusionsBipolar patients with earlier onset, mood instability (large number of depressive episodes, rapid cycling) and/or particular addictive and anxiety comorbid disorders might be at high risk of suicidal behaviour. In addition, hostility dimensions (indirect hostility and irritability), may be trait components associated with suicidal behaviour in euthymic bipolar patients.

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