scholarly journals 508 - LATE ONSET BIPOLAR DISORDER: CASE REPORT AND LITERATURE REVIEW

2021 ◽  
Vol 33 (S1) ◽  
pp. 60-60
Author(s):  
Joana Regala ◽  
João Reis
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Electroconvulsive Therapy ◽  
Late Onset ◽  
Diffuse Axonal Injury ◽  
First Episode ◽  
Triggering Factors ◽  
History Of ◽  
Secondary Mania ◽  
Depressive Episodes

Background:Late-onset bipolar disorder (LOBD) remains an incompletely understood nosological entity, in reason of its complexity and the paucity of research in this issue. It is not yet clear whether LOBD is a “phenocopy” of the classic early-onset bipolar disorder (EOBD), sharing symptoms but having a different aetiology, or whether both have a common underlying vulnerability that interacts with age-specific triggering factors. Some authors have proposed that LOBD is a heterogeneous entity, comprising secondary mania (including organic brain disease), bipolarity in the context of dementia-like processes (BD type VI), and LOBD as expression of a lower vulnerability to bipolarity.Case Report:Female patient with previous medical history of hypertension and dyslipidaemia, and psychiatric history of recurrent severe depressive episodes since early age, with melancholic and psychotic features, had a first hypomanic episode at 76 years-old, under treatment with tricyclic antidepressant and electroconvulsive therapy. Meanwhile, she suffered a traumatic brain injury (TBI) complicated with subdural and subarachnoid hematoma, as well as intraventricular haemorrhage, which is an indirect sign of diffuse axonal injury (DAI). Later, at 79 years-old, she presented a mixed episode characterized by racing thoughts, flight of ideas, non-systematized persecutory and ruin delusions, hyposomnia, and ultradian alternation between dysphoric and depressive mood, psychomotor agitation and retardation, emotional lability, hypersyntonic contact and hostility. Medical conditions that could account for secondary mania were ruled out. This clinical picture subsided within few weeks under treatment with olanzapine and electroconvulsive therapy. After recovery memory deficits were noticed.Concluding remarks:This case illustrates a “latent” BD, in a patient with previous recurrent depressive disorder, manifesting the first episode of mania in late life. Several triggering factors may have contributed to this longitudinal evolution, lowering the threshold to manifest mania, namely cerebrovascular risk factors, a possible underlying degenerative process and DAI secondary to TBI, which through structural dysconnectivity also contributes to cognitive dysfunction. The deleterious effect of recurrent and severe depressive episodes on cognition is well documented. The question of whether some forms of LOBD could constitute a special risk factor for developing dementia deserves further investigation.

Electroconvulsive therapy for trichotillomania in a bipolar patient

2019 ◽  
Vol 83 (1) ◽  
pp. 97-104
Author(s):  
Leonardo F. Fontenelle ◽  
Samara dos Santos-Ribeiro ◽  
Juliana Kalaf ◽  
Murat Yücel
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Electroconvulsive Therapy ◽  
Specific Effect ◽  
Severe Depression ◽  
Bipolar Patient ◽  
Hair Pulling ◽  
Obsessive Compulsive ◽  
History Of

A recent review on the use of electroconvulsive therapy (ECT) in obsessive-compulsive–related disorders (OCRDs) identified reports of trichotillomania (TTM) in only three patients, but it did not describe the specific effect of ECT on hair-pulling behaviors. The authors present a case report of Mrs. A, a 77-year-old widowed housewife with a lifelong history of episodic TTM and bipolar disorder who was effectively treated with ECT. However, on each attempt to withdraw ECT, her condition deteriorated. Eventually, a decision was made to maintain ECT (one session every week), which resulted in no further relapse over the followup period. ECT shows some potential promise for reducing hair-pulling behaviors in the context of severe depression.

Frontal meningioma and bipolar disorder: Etiopathogenic link or co-morbidity? A case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S678-S678
Author(s):  
I. Chaari ◽  
H. Ben Ammar ◽  
R. Nefzi ◽  
N. Mhedhbi ◽  
E. Khelifa ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Suicide Attempts ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Manic Episode ◽  
Atypical Symptoms ◽  
Co Morbidity ◽  
Major Depressive Episodes ◽  
Depressive Episodes

IntroductionFrontal meningiomas are benign brain tumours known for their late onset. They may be presented by only psychiatric symptoms. Thus, the diagnosis at early stages can be missed or overlooked until the tumour causes neurological deficit.Case reportWe report the case of a 61-year-old man, receiving a treatment and a follow-up for bipolar disorder for 11 years. He has history of 3 major depressive episodes, 2 suicide attempts and a manic episode. The symptoms were initially well controlled by medication. Since 6 months, the patient started to experience atypical symptoms: he had presented disinhibited and aggressive behaviour, psychomotor instability, pyromania and self-neglect. The patient did not respond to treatment despite repeated adjustments. A frontal syndrome was suspected. Cerebral CT scan revealed an unexpected mass measuring 6.8 cm × 5.6 cm at the right frontal area, suggestive of a giant meningioma (Fig 1).ConclusionsGenerally, once diagnosed, psychiatric disorders are rarely revised. Consequently, “silent” tumours such as frontal meningiomas can be overlooked. Neuroimaging should be considered in case of new-onset psychiatric symptoms, atypical or change in clinical presentation.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.

scholarly journals Affective disorders and risk of developing dementia: systematic review

2013 ◽  
Vol 202 (3) ◽  
pp. 177-186 ◽  
Author(s):  
Joaquim da Silva ◽  
Manuel Gonçalves-Pereira ◽  
Miguel Xavier ◽  
Elizabeta B. Mukaetova-Ladinska
Keyword(s):  
Systematic Review ◽  
Bipolar Disorder ◽  
Affective Disorders ◽  
Late Onset ◽  
Demographic Variables ◽  
Future Research ◽  
Increased Risk ◽  
Cognitive Disturbances ◽  
History Of ◽  
Depressive Episodes

BackgroundAffective disorders are associated with cognitive disturbances but their role as risk factors for dementia is still not fully investigated.AimsTo evaluate the risk of developing dementia in individuals with a history of affective disorder.MethodWe conducted a systematic review of case-control and cohort studies addressing the risk of developing dementia in people with affective disorders. To the best of our knowledge, this is the first systematic review that has included studies evaluating this risk specifically in people with bipolar disorder.ResultsFifty-one studies were included. Most of the studies found an increased risk for developing dementia in individuals with depression. Greater frequency and severity of depressive episodes seem to increase this risk. The evidence is contradictory regarding whether there is a difference in risk in people with early- or late-onset depression. The few available risk estimates for dementia in people with bipolar disorder suggest an even higher risk than for those with depression.ConclusionsAffective disorders appear to be associated with an increased risk of developing dementia, and one that is dependent on clinical and demographic variables. Depression may be both a prodrome and a risk factor for dementia. Future research should aim to elucidate the mechanisms that mediate these links.

scholarly journals Catatonia Development in a Patient with Bipolar Disorder Following Electroconvulsive Therapy: A Case Report

2019 ◽  
Author(s):  
Azadeh Mashayekhi ◽  
Alireza Ghayoumi
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Electroconvulsive Therapy ◽  
Case Reports ◽  
Precipitating Factors ◽  
Psychotic Feature ◽  
History Of ◽  
B12 Deficiency ◽  
Major Treatment ◽  
Long Acting

Objective: Electroconvulsive therapy (ECT) is a major treatment of catatonia; and catatonia development during electroconvulsive therapy is a highly surprising phenomenon. We present a patient with bipolar disorder who developed catatonia during ECT. Case Reports: A 21-year-old woman, with a known case of bipolar disorder in manic phase without psychotic feature, history of long acting antipsychotic use, and severe B12 deficiency, was treated with ECT. Full catatonia syndrome developed after the fifth session of ECT. Conclusion: In rare cases, catatonia can develop during ECT course in the presence of some precipitating factors. Thus, these precipitating factors should be eliminated as much as possible before the start of ECT course to prevent catatonia development.

An Obscure Colon Dilatation and its Underlying Cause: Case Report and Literature Review

2020 ◽  
pp. 1-5
Author(s):  
Anton Stift ◽  
Kerstin Wimmer ◽  
Felix Harpain ◽  
Katharina Wöran ◽  
Thomas Mang ◽  
...  
Keyword(s):  
Case Report ◽  
Sigmoid Colon ◽  
Immunohistochemical Staining ◽  
Late Onset ◽  
Hirschsprung Disease ◽  
Endoscopic Examination ◽  
Case Presentation ◽  
Idiopathic Megacolon ◽  
History Of ◽  
Cells Of Cajal

Introduction: Congenital as well as acquired diseases may be responsible for the development of a megacolon. In adult patients, Clostridium difficile associated infection as well as late-onset of Morbus Hirschsprung disease are known to cause a megacolon. In addition, malignant as well as benign colorectal strictures may lead to intestinal dilatation. In case of an idiopathic megacolon, the underlying cause remains unclear. Case Presentation: We describe the case of a 44-year-old male patient suffering from a long history of chronic constipation. He presented himself with an obscurely dilated large intestine with bowel loops up to 17 centimeters in diameter. Radiological as well as endoscopic examination gave evidence of a spastic process in the sigmoid colon. The patient was treated with a subtotal colectomy and the intraoperative findings revealed a stenotic stricture in the sigmoid colon. Since the histological examination did not find a conclusive reason for the functional stenosis, an immunohistochemical staining was advised. This showed a decrease in interstitial cells of Cajal (ICC) in the stenotic part of the sigmoid colon. Discussion: This case report describes a patient with an idiopathic megacolon, where the underlying cause remained unclear until an immunohistochemical staining of the stenotic colon showed a substantial decrease of ICCs. Various pathologies leading to a megacolon are reviewed and discussed.

scholarly journals Catatonia Associated With Late Paraphrenia Successfully Treated With Lithium: A Case Report

2020 ◽  
Author(s):  
Hiroko Sugawara ◽  
Junpei Takamatsu ◽  
Mamoru Hashimoto ◽  
Manabu Ikeda
Keyword(s):  
Case Report ◽  
Mood Disorders ◽  
Electroconvulsive Therapy ◽  
Late Onset ◽  
Treatment Strategies ◽  
Psychotic Symptoms ◽  
Case Presentation ◽  
Limited Efficacy ◽  
Cumulative Evidence ◽  
The Brain

Abstract Background: Catatonia is a psychomotor syndrome that presents various symptoms ranging from stupor to agitation, with prominent disturbances of volition. Its pathogenesis is poorly understood. Benzodiazepines and electroconvulsive therapy (ECT) are safe and effective standard treatments for catatonia; however, alternative treatment strategies have not been established in cases where these treatments are either ineffective or unavailable. Here, we report a case of catatonia associated with late paraphrenia classified as very-late-onset schizophrenia-like psychosis, which was successfully treated with lithium. Case presentation: A 66-year-old single man with hearing impairment developed hallucination and delusions and presented with catatonic stupor after a fall. He initially responded to benzodiazepine therapy; however, his psychotic symptoms became clinically evident and benzodiazepine provided limited efficacy. Blonanserin was ineffective, and ECT was unavailable. His catatonic and psychotic symptoms were finally relieved by lithium monotherapy.Conclusions: Catatonic symptoms are common in patients with mood disorders, suggesting that lithium may be effective in these cases. Moreover, lithium may be effective for both catatonic and psychotic symptoms, as it normalizes imbalances of excitatory and inhibitory systems in the brain, which underlies major psychosis. Cumulative evidence from further cases is needed to validate our findings.

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).

Effects of In Utero Exposure to AEDs on Morphology and Neurodevelopment

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S5) ◽  
pp. 9-10
Author(s):  
Martha J. Morrell
Keyword(s):  
Bipolar Disorder ◽  
Clinical Information ◽  
Mood Stabilizer ◽  
Mood Stabilizers ◽  
Antipsychotic Treatment ◽  
Close Monitoring ◽  
History Of ◽  
Major Congenital Malformations ◽  
Major Depressive Episodes ◽  
Depressive Episodes

AbstractThe presentations and clinical courses of patients with bipolar disorder differ greatly by gender. In addition, medical therapy must be tailored differently for men and women because of emerging safety concerns unique to the female reproductive system. In November 2005, these topics were explored by a panel of experts in psychiatry, neurology, and reproductive health at a closed roundtable meeting in Dallas, Texas. This clinical information monograph summarizes the highlights of that meeting.Compared to men with bipolar disorder, women have more pervasive depressive symptoms and experience more major depressive episodes. They are also at higher risk for obesity and certain other medical and psychiatric comorbidities. Mood changes across the menstrual cycle are common, although the severity, timing, and type of changes are variable. Bipolar disorder is frequently associated with menstrual abnormalities and ovarian dysfunction, including polycystic ovarian syndrome. Although some cases of menstrual disturbance precede the treatment of bipolar disorder, it is possible that valproate and/or antipsychotic treatment may play a contributory role in young women.Pregnancy does not protect against mood episodes in untreated women. Maintenance of euthymia during pregnancy is critical because relapse during this period strongly predicts a difficult postpartum course. Suspending therapy in the first months of pregnancy may be an option for some women with mild-to-moderate illness, or those with a long history of euthymia during pre-pregnancy treatment. However, a mood stabilizer should be reintroduced either in the later stages of pregnancy or in the immediate postpartum period. Preliminary data suggest that fetal exposure to some mood stabilizers may raise the risk of major congenital malformations and neurodevelopmental delays. For women planning to become pregnant, clinicians may consider switching to other drugs before conception. The value and drawbacks of breastfeeding during treatment must be considered in partnership with the patient, with close monitoring of nursing infants thereafter. The risks and benefits of medical treatment for women with bipolar disorder should be carefully reconsidered at each stage of their reproductive lives, with a flexible approach that is responsive to the changing needs of patients and their families.

Risk of bipolar disorder and psychotic features in patients initially hospitalised with severe depression

2014 ◽  
Vol 27 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Kimiya Nakamura ◽  
Junichi Iga ◽  
Naoki Matsumoto ◽  
Tetsuro Ohmori
Keyword(s):  
Bipolar Disorder ◽  
Severe Depression ◽  
Psychotic Symptoms ◽  
Primary Disorder ◽  
Icd 10 ◽  
History Of ◽  
Physical Diseases ◽  
The Stability ◽  
Psychotic Features ◽  
Depressive Episodes

ObjectiveSevere depression may be a risk factor for diagnostic conversion into bipolar disorder (BD), and psychotic depression (PD) has been consistently associated with BD. The aims of the present study were to investigate the stability of the diagnosis of severe depression and the differences between PD and non-psychotic severe depression (non-PD), as well as to assess the effectiveness of electroconvulsive therapy (ECT).MethodsPatients who were hospitalised for severe depression (diagnosed according to ICD-10) both with and without psychotic symptoms (n=89; mean age=55.6 years, SD=13.9) from 2001 to 2010 were retrospectively assessed.ResultsBy the 75th month of follow-up assessments, 11(12.4%) patients had developed BD. Among these 11 converters, nine had developed BD within 1 year after admission. Only sub-threshold hypomanic symptoms were significantly related to developing BD. The number of depressive episodes and history of physical diseases were significantly increased in non-PD compared with PD patients, whereas ECT was significantly increased in PD compared with non-PD patients. There was a significant association between length of stay at the hospital and the number of days between admission and ECT.ConclusionSub-threshold hypomanic symptoms may represent a prodrome of BD or an indicator of an already manifest phenotype, especially in older patients, which suggests cautious use of antidepressants. In severe depression, non-PD may often occur secondary to physical diseases and patients may experience increased recurrences compared with PD patients, which may be a more ‘primary’ disorder and often requires ECT treatments. ECT is effective for severe depression regardless of the presence of any psychotic feature; the earlier ECT is introduced, the better the expected treatment outcome.

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