The impact of periventricular white matter lesions in patients with bipolar disorder type I

IntroductionWhite matter hyperintensities (WMHs) are one the most common neuroimaging findings in patients with bipolar disorder (BD). It has been suggested that WMHs are associated with impaired insight in schizophrenia and schizoaffective patients; however, the relationship between insight and WMHs in BD type I has not been directly investigated.MethodsPatients with BD-I (148) were recruited and underwent brain magnetic resonance imaging (MRI). Affective symptoms were assessed using Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS17); the presence of impaired insight was based on the corresponding items of YMRS and HDRS17.ResultsMultiple punctate periventricular WMHs (PWMHs) and deep WMHs (DWMHs) were observed in 49.3% and 39.9% of the cases, respectively. Subjects with lower insight for mania had significantly more PWMHs (54.6% vs 22.2%; p < 0.05) when compared to BD-I patients with higher insight for mania. The presence of PWMHs was independently associated with lower insight for mania: patients who denied illness according to the YMRS were 4 times more likely to have PWMHs (95% CI: 1.21/13.42) than other patients.ConclusionsImpaired insight in BD-I is associated with periventricular WMHs. The early identification of BD-I subjects with PWMHs and impaired insight may be crucial for clinicians.

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The impact of periventricular white matter lesions in patients with bipolar disorder type I – CORRIGENDUM

CNS Spectrums ◽

10.1017/s1092852914000121 ◽

2014 ◽

Vol 19 (4) ◽

pp. 355-355 ◽

Cited By ~ 1

Author(s):

G Serafini ◽

M Pompili ◽

M Innamorati ◽

Keyword(s):

Bipolar Disorder ◽

White Matter ◽

White Matter Lesions ◽

Periventricular White Matter ◽

Type I ◽

The Impact ◽

Disorder Type ◽

Periventricular White Matter Lesions

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Clinical Impact of Psychopathy on Bipolar Disorder

Medicina ◽

10.3390/medicina57020165 ◽

2021 ◽

Vol 57 (2) ◽

pp. 165

Author(s):

Giuseppina Calabrò ◽

Antonio Francesco Musolino ◽

Andrea Adolfo Filippo ◽

Renato de Filippis ◽

Elvira Anna Carbone ◽

...

Keyword(s):

Bipolar Disorder ◽

Personality Disorders ◽

Rating Scale ◽

Psychopathic Personality ◽

Type I ◽

Young Mania ◽

Manic Symptoms ◽

Affective Symptoms ◽

Group 3 ◽

Group 1

Background and Objectives. Bipolar disorder (BD) is associated with a significant burden due to affective symptoms and behavioral manifestations, but also cognitive and functional impairment. Comorbidity with other psychiatric conditions, including personality disorders, is frequent. The comorbidity with psychopathy deserves special consideration given that both disorders share some clinical characteristics, such as grandiosity, risky behavior or poor insight, among others, that can worsen the outcome of BD. Therefore, this study aimed to evaluate the prevalence of psychopathy in a sample of clinically stabilized patients with BD and its impact on the severity of BD. Materials and Methods. A sample of 111 patients with BD (38 type I and 73 type II) was studied. The Hamilton Depression Rating Scale (HAM-D) and the Young Mania Rating Scale (YMRS) served to assess the severity of BD. Psychopathy was measured by means of the Psychopathic Personality Inventory-Revised (PPI-R). Patients were divided into three groups according to the severity of psychopathy (Group 1: no psychopathy; Group 2: “psychopathic” trait; Group 3: clinical psychopathy). Other measures regarded impulsiveness (Barratt Impulsiveness Scale-11, BIS-11) and empathy (Empathy Quotient, EQ). Comparisons of mania, depression, impulsivity and empathy scores were run with MANOVA considering psychopathy and diagnosis as independent variables. Results. The prevalence of psychopathy was 5.4%. A significant association between the level of psychopathy and YMRS, attentional/cognitive impulsivity and motor impulsivity scores emerged. No interaction between psychopathy and BD diagnosis was found. Post hoc analysis demonstrated significantly higher YMRS scores in Group 3 than in Group 1; that is, patients with psychopathy have more manic symptoms. Conclusion. Psychopathy seems quite frequent among patients with BD. The association of psychopathy with BD results in higher impulsivity and manic symptoms. In light of this, psychopathy should be investigated when assessing patients with BD, regardless of the comorbidity of BD with other personality disorders.

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Mothers with and without bipolar disorder and their infants: group differences in mother-infant interaction patterns at three months postpartum

BMC Psychiatry ◽

10.1186/s12888-019-2275-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Teija M. S. Anke ◽

Kari Slinning ◽

Vibeke Moe ◽

Cathrine Brunborg ◽

Torill S. Siqveland ◽

...

Keyword(s):

Bipolar Disorder ◽

Rating Scale ◽

Depressive Symptomatology ◽

Group Differences ◽

Maternal Behaviour ◽

Interaction Patterns ◽

Young Mania ◽

Significant Group ◽

Interaction Quality ◽

Affective Symptoms

Abstract Background Women with bipolar disorder (BD) have a high risk of illness relapse postpartum. The risk coincides with the period when mother-infant interactions are evolving. We compared mother-infant interactions in dyads where the mothers have BD with dyads where the mothers have no mental disorder. The association between concurrent affective symptoms of BD mothers and interaction quality was investigated. Methods Twenty-six women with BD and 30 comparison women with infants were included. The Parent-Child Early Relational Assessment (PCERA) was used to assess maternal behaviour, infant behaviour and dyadic coordination in interactions at 3 months postpartum. The Inventory of Depressive Symptomatology and Young Mania Rating Scale were used to assess affective symptoms of BD mothers at the time of interaction. Results There were significant group differences with medium to large effect sizes (0.73–1.32) on five of six subscales within the three interactional domains. Most interactional concerns were identified in dyadic coordination. No significant associations were found between maternal symptom load and interaction quality within the BD sample. Forty-six percent of the BD mothers experienced a mood episode within 0–3 months postpartum. Conclusions The present study identified challenges for mothers with BD and their infants in “finding” each other in interaction at 3 months postpartum. If sustained, this interaction pattern may have a long-term impact on children’s development. We suggest interventions specifically focusing on sensitising and supporting mothers to read infants’ cues on a micro-level. This may help them to respond contingently and improve dyadic coordination and synchronicity.

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Does the efficacy of asenapine in bipolar disorder increase in the presence of comorbidity with a substance use disorder? A naturalistic study

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125316674698 ◽

2016 ◽

Vol 7 (2) ◽

pp. 67-77 ◽

Cited By ~ 8

Author(s):

Sergio De Filippis ◽

Ilaria Cuomo ◽

Georgios D. Kotzalidis ◽

Daniela Pucci ◽

Pietro Zingaretti ◽

...

Keyword(s):

Bipolar Disorder ◽

Substance Use ◽

Substance Use Disorder ◽

Repeated Measures ◽

Rating Scale ◽

Type I ◽

Open Label ◽

Young Mania ◽

Psychiatric Rating ◽

Psychiatric Rating Scale

Background: Asenapine is a second-generation antipsychotic approved in Europe for treating moderate-to-severe manic episodes in adults affected by type I bipolar disorder (BD-I). We aimed to compare its efficacy in psychiatric inpatients with BD-I, with or without substance use disorder (SUD). Methods: We administered flexible asenapine doses ranging from 5–20 mg/day to 119 voluntarily hospitalized patients with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) BD-I diagnosis, with or without SUD. Patients were assessed with clinician-rated questionnaires [i.e. Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and Global Assessment of Functioning (GAF)]. Assessments were carried out at baseline (T0, prior to treatment), and 3 (T1), 7 (T2), 15 (T3), and 30 days (T4) after starting treatment for all clinical scales and at T0 and T4 for the GAF. Results: Patients improved on all scales ( p < 0.001) across all timepoints, as shown both by paired-sample comparisons and by applying a repeated-measures, generalized linear model (GLM). Patients without comorbid SUD showed greater reductions in BPRS scores at T2 and T3, greater reduction in YMRS scores at T3, and lower HARS scores at all timepoints. HDRS scores did not differ between the two groups at any timepoint. However, the reduction in HARS scores in the comorbid group was stronger than in the BD-I only group, albeit not significantly. Side effects were few and mild-to-moderate. Conclusions: The open-label design and the relatively short observation period may expose to both type I and type II statistical errors (false positive and false negatives). Asenapine showed effectiveness and safety in hospitalized BD-I patients. Its effect was stronger in patients without comorbid SUD.

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Co-morbid Obsessive-compulsive Disorder and Bipolar Disorder in Highly Endogamous Population: Which Came First?

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1910 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S119-S119

Author(s):

A. Bener

Keyword(s):

Bipolar Disorder ◽

Obsessive Compulsive Disorder ◽

Rating Scale ◽

Obsessive Compulsive ◽

Young Mania ◽

Compulsive Disorder ◽

Oppositional Defiant ◽

Co Morbidity ◽

Endogamous Population ◽

The Impact

The aim of this study was to determine the prevalence of co-morbidity with obsessive-compulsive disorder (OCD) among bipolar disorder (BD) patients in order to assess the impact of OCD on the socio-demographic and clinical features of patients in a highly endogamous population. A cohort study was carried out on 396 patients enrolled between November 2011 to October 2013. We employed the WHO Composite International Diagnostic Interview (WHO-CIDI) and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-IV/Clinical Version for diagnoses, the Yale-Brown Obsessive Compulsive Scale Symptom Checklist for scoring OCD. Patients were grouped in BD patients with OCD (BD-OCD) and BD patients without OCD.Groups were compared for socio-demographic and clinical variables. There were no significant differences for age, gender, BMI, and marital status, between BD patients with and without OCD. We found significant differences in level of education (P = 0.022), occupation status (P = 0.025), household income, (P = 0.049), cigarette smoking (P = 0.038), sheesha smoking (P = 0.007), and prevalence of consanguinity (P = 0.036) among these groups. Number of hospitalizations and Young Mania Rating Scale score were not different among BD patients with or without OCD whereas there were significant differences in Hamilton-Depression score, Clinical Global Impression-BD Score, duration of illnesses, and Global Assessment of Functioning (GAF). Also specific phobia, somatization, depression, mania, any mood disorder, oppositional defiant disorder, ADHD and personality disorder were more common in BD than OCD–BD group. This study confirms that BD-OCD is a common co-morbidity, largely under-recognized in clinical practice, which may significantly change BD presentation and outcome.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

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Cerebral white matter lesions in bipolar affective disorder: relationship to outcome

The British Journal of Psychiatry ◽

10.1192/bjp.178.2.172 ◽

2001 ◽

Vol 178 (2) ◽

pp. 172-176 ◽

Cited By ~ 95

Author(s):

P. Brian Moore ◽

Debra J. Shepherd ◽

Donald Eccleston ◽

Iain C. Macmillan ◽

Uptal Goswami ◽

...

Keyword(s):

Bipolar Disorder ◽

White Matter ◽

Affective Disorder ◽

Bipolar Affective Disorder ◽

White Matter Lesions ◽

Periventricular White Matter ◽

White Matter Abnormalities ◽

Good Outcome ◽

Poor Outcome ◽

Outcome Group

BackgroundTwenty per cent of patients with bipolar affective disorder suffer an illness that responds inadequately to treatment and has a poor outcome. Many patients, but not all, with bipolar disorder show white matter abnormalities on T2-weighted magnetic resonance imaging (MRI).AimsTo explore the hypothesis that white matter abnormalities on MRI are seen more frequently in subjects whose illness has a poor outcome compared with those with a good outcome or controls.MethodTwo groups of age- and gender-matched patients with bipolar disorder (14 with a good outcome and 15 with a poor outcome) and 15 controls, aged 20–65 years, were studied. Axial T2-weighted MRI scans were examined for the presence and severity of white matter abnormalities.ResultsSignificantly more poor outcome group members had deep subcortical punctate, but not periventricular, white matter hyperintensities than the good outcome group (P=0.035) or controls (P=0.003) and these abnormalities were of greater severity (P=0.030 and P < 0.014, respectively).ConclusionsSubcortical white matter lesions are associated with poor outcome bipolar disorder.

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Validity and characteristics of patient-evaluated adherence to medication via smartphones in patients with bipolar disorder: exploratory reanalyses on pooled data from the MONARCA I and II trials

Evidence-Based Mental Health ◽

10.1136/ebmental-2019-300106 ◽

2020 ◽

Vol 23 (1) ◽

pp. 2-7 ◽

Cited By ~ 2

Author(s):

Maria Faurholt-Jepsen ◽

Mads Frost ◽

Ellen Margrethe Christensen ◽

Jakob Eyvind Bardram ◽

Maj Vinberg ◽

...

Keyword(s):

Bipolar Disorder ◽

Rating Scale ◽

Young Mania ◽

Illness Duration ◽

Link Type ◽

Adherence To Medication ◽

Affective Symptoms ◽

Younger Age ◽

Increased Risk ◽

Patient Reported

BackgroundNon-adherence to medication is associated with increased risk of relapse in patients with bipolar disorder (BD).ObjectivesTo (1) validate patient-evaluated adherence to medication measured via smartphones against validated adherence questionnaire; and (2) investigate characteristics for adherence to medication measured via smartphones.MethodsPatients with BD (n=117) evaluated adherence to medication daily for 6–9 months via smartphones. The Medication Adherence Rating Scale (MARS) and the Rogers’ Empowerment questionnaires were filled out. The 17-item Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Functional Assessment Short Test were clinically rated. Data were collected multiple times per patient. The present study represents exploratory pooled reanalyses of data collected as part of two randomised controlled trials.FindingsDuring the study 90.50% of the days were evaluated as ‘medication taken’, 6.91% as ‘medication taken with changes’ and 2.59% as ‘medication not taken’. Adherence to medication measured via smartphones was valid compared with the MARS (B: −0.049, 95% CI −0.095 to −0.003, p=0.033). Younger age and longer illness duration were significant predictors for non-adherence to medication (model concerning age: B: 0.0039, 95% CI 0.00019 to 0.0076, p=0.040). Decreased affective symptoms measured with smartphone-based patient-reported mood and clinical ratings as well as decreased empowerment were associated with non-adherence.ConclusionsSmartphone-based monitoring of adherence to medication was valid compared with validated adherence questionnaire. Younger age and longer illness duration were predictors for non-adherence. Increased empowerment was associated with adherence.Clinical implicationsUsing smartphones for empowerment of adherence using patient-reported measures may be helpful in everyday clinical settings.Trial registration numberNCT01446406 and NCT02221336.

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Cognitive reserve lessens the burden of white matter lesions on executive functions in bipolar disorder

Psychological Medicine ◽

10.1017/s0033291716001641 ◽

2016 ◽

Vol 46 (15) ◽

pp. 3095-3104 ◽

Cited By ~ 6

Author(s):

S. Rolstad ◽

C. Abé ◽

E. Olsson ◽

C. Eckerström ◽

M. Landén

Keyword(s):

Bipolar Disorder ◽

White Matter ◽

Executive Functions ◽

Cognitive Reserve ◽

White Matter Lesions ◽

Brain Pathology ◽

Linear Regression Models ◽

Brain Volumes ◽

Interaction Terms ◽

The Impact

BackgroundThe concept of cognitive reserve (CR) hypothesizes that intellectually stimulating activities provide resilience against brain pathology/disease. Whereas brain abnormalities and cognitive impairment are frequently reported in bipolar disorder (BD), it is unknown whether the impact of brain alterations can be lessened by higher CR in BD.MethodWe tested if higher CR would reduce the influence of total volumes of deep white matter hypointensities (WMH), ventricular cerebrospinal fluid (CSF), and prefrontal cortex on memory, executive, and attention/speed functions in patients with BD (n = 75). Linear regression models with interaction terms for CR and brain volumes were applied to directly test if CR reduces the influence of brain pathology on cognitive domains.ResultsCR reduced the influence of total volumes of deep WMH (β = −0.38, Q = 0.003) and ventricular CSF (β = −41, Q = 006) on executive functions.ConclusionsThe interactions between CR and total volumes of deep WMH/ventricular CSF appear to account for executive functioning in BD. The results suggest that the concept of CR is applicable in BD. Higher reserve capacity in BD alters the relationship between brain pathology and clinical presentation.

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Assessment of psychotic symptoms in bipolar disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.376 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S419-S419

Author(s):

F. Cazan ◽

R. Paunescu ◽

A. Tamas

Keyword(s):

Bipolar Disorder ◽

Rating Scale ◽

Psychotic Symptoms ◽

Young Mania ◽

Affective Symptoms ◽

Number Of Patients ◽

General Functioning ◽

Competing Interest ◽

Bipolar Patients ◽

Manic Patients

IntroductionBipolar disorder is a disabling condition characterized by the presence of manic, depressive, hypomanic or mixed episodes, affective symptoms that may coexist with several types of psychotic features.ObjectivesThe purpose is to evaluate the frequency of psychotic symptoms among bipolar disorder.MethodThe study included 55 bipolar patients admitted in the Psychiatry Clinical Hospital from January 2012 until May 2013. Inclusion criteria were represented by diagnosis of bipolar disorder, manic or depressive episode, according to DSM-IV-TR and ICD 10 criteria. Clinical instruments used to assess the severity of the current affective episode were Young Mania Rating Scale (YMRS) for manic patients and Hamilton Depression Rating Scale-17 items – (HDRS) for the depressive ones. Psychotic symptoms were evaluated with the Brief Psychiatric Rating Scale-18 items – (BPRS).ResultsOut of the 55 patients, 32 had psychotic symptoms upon admission to the hospital. BPRS results showed delusions of guilt, inutility, hypochondriac and nihilistic delusions for the depressed patients. Delusions of grandiosity and megalomania accounted for most of psychotic symptoms in manic patients. A smaller number of patients showed delusions of invention and reform. Perception disturbances such as auditory hallucinations were present in both diagnosis categories but in a higher percentage in depressive bipolar patients.ConclusionsEven if less frequently than in schizophrenia or schizoaffective disorder, psychotic symptoms are present in bipolar disorder. They influence the general functioning and the outcome of patients diagnosed with this illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The functional impairment of different subtypes and occupational states in euthymic patients with bipolar disorder

BMC Psychiatry ◽

10.1186/s12888-021-03242-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xinyu Liu ◽

Xiaojuan Ma ◽

Wenchen Wang ◽

Jian Zhang ◽

Xia Sun ◽

...

Keyword(s):

Bipolar Disorder ◽

Social Functioning ◽

Rating Scale ◽

Verbal Learning ◽

Occupational Status ◽

Learning Performance ◽

Neurocognitive Functioning ◽

Type I ◽

Speed Of Processing ◽

Occupational Functioning

Abstract Background The aim was to explore the associations between clinical symptoms, demographic variables, social and neurocognitive functioning in euthymic patients with bipolar disorder (BD) stratified by subgroups of DSM-IV BD (type I (BD-I) and type II (BD-II)) and occupational status (employed/unemployed), and to highlight the significance of occupational status when assessing social and neurocognitive functioning in euthymic BD patients. Methods A total of 81 euthymic BD patients were participated in the study. The severity of the depressive and manic/hypomanic symptoms was measured using the 17-item Hamilton Depression Rating Scale (HDRS-17) and the Young Mania Rating Scale (YMRS), respectively. Social functioning and neurocognitive functioning were evaluated by the Functioning Assessment Short Test (FAST) and neurocognitive measures, respectively. Results Employed BD patients displayed greater social functioning (autonomy, occupational functioning, interpersonal relationship domain) and better verbal learning performance and speed of processing than unemployed BD patients. The correlation between neurocognitive functioning and social functioning was stronger in the employed group than in the unemployed group. There were no significant differences in neurocognitive and social functioning between the BD-I and BD-II groups, and the correlation between neurocognitive functioning and social functioning was similar between the BD-I and BD-II groups. Conclusion Employed BD patients may present greater occupational functioning and interpersonal relationships, as well as better verbal learning performance and speed of processing.

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