scholarly journals Patterns of pharmacological maintenance treatment in a community mental health services bipolar disorder cohort study (SIN-DEPRES)

2013 ◽  
Vol 16 (3) ◽  
pp. 513-523 ◽  
Author(s):  
Iria Grande ◽  
Rosario de Arce ◽  
Miguel Ángel Jiménez-Arriero ◽  
Federico Guillermo Iglesias Lorenzo ◽  
Juan Ignacio Franch Valverde ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Clinical Features ◽  
Maintenance Treatment ◽  
Rating Scale ◽  
Community Mental Health Services ◽  
Residual Symptoms ◽  
Logistic Regression Models ◽  
Co Morbidity ◽  
Antidepressant Combination ◽  
Clinical Stability

Abstract Maintenance therapy in bipolar disorder (BD) is usually required to prevent relapses and improve residual symptoms. Therefore, in this study, we describe patterns of pharmacological maintenance treatment and identify associated clinical features. This prospective multicentre epidemiological study recruited a cohort of 739 consecutive out-patients with clinically stable BD. Clinical stability was assessed at baseline with the Clinical Global Impression scale for BD and depressive symptoms with the Hamilton Depression Rating Scale. Psychotropic medications were classified and analysed according to their mechanism as well as use. Logistic regression models were used to examine the associations between pharmacological strategies and clinical features. Longer time since last episode [odds ratio (OR) 1.002, p < 0.0001] and family history of psychiatric disorders (OR 1.911, p = 0.028) were associated with lithium in monotherapy; manic polarity of the most recent episode (OR 3.300, p = 0.006) and longer duration of clinical stability (OR 1.009, p = 0.034) with antipsychotic in monotherapy; depressive polarity of the most recent episode (OR 2.567, p = 0.003) and bipolar II disorder diagnosis (OR 2.278, p = 0.008) with antidepressant combination; no ongoing psychiatric co-morbidity (OR 0.230, p = 0.004) with lithium and anticonvulsant; manic polarity of the most recent episode (OR 3.774, p < 0.0001) with lithium and antipsychotic; manic polarity of the most recent episode (OR 2.907, p = 0.028) with lithium, anticonvulsant and antipsychotic. The pharmacological patterns followed published recommendations, except for the excessive use of antidepressants. This study reveals clinical factors closely related to prescription patterns.

Clinical features and co-morbidity of social phobics in Turkey

2001 ◽  
Vol 16 (2) ◽  
pp. 115-121 ◽  
Author(s):  
P.G. Gökalp ◽  
R. Tükel ◽  
D. Solmaz ◽  
T. Demir ◽  
E. Kiziltan ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Social Phobia ◽  
Clinical Features ◽  
Rating Scale ◽  
Clinical Sample ◽  
Clinical Interview ◽  
Avoidant Personality Disorder ◽  
Co Morbidity ◽  
Axis I ◽  
Hamilton Rating Scale

The aim of this study is to investigate the clinical features and frequency and importance of related co-morbid disorders of social phobia in a clinical sample. Eighty-seven patients meeting DSM-III-R diagnostic criteria for social phobia were studied. All patients were assessed by using a semi-structured socio-demographic form, the Structured Clinical Interview for DSM-III-R, Manual for the Structured Clinical Interview for DSM-III-R Personality Disorders, Liebowitz Social Anxiety Scale, Hamilton Rating Scale for Depression and Hamilton Rating Scale for Anxiety. Sixty-eight (78.2%) of the group were male, 19 (21.8%) were female. The ages varied between 16–58 years, with a mean of 26.2 years (SD = 8.5). Fifty-one point seven percent of the subjects were assessed as having a co-morbid axis I disorder, of which 12.6% consisted of panic disorder and 10.3% agoraphobia. An additional axis II disorder had been found in 67.8% of the subjects, and 54.0% of them had been diagnosed as having avoidant personality disorder. The frequency of co-morbid disorders in our social phobic sample is lower than most of the studies in the literature. The interface between social phobia and avoidant personality disorder needs to be studied and discussed further.

scholarly journals Methylene blue treatment for residual symptoms of bipolar disorder: Randomised crossover study

2017 ◽  
Vol 210 (1) ◽  
pp. 54-60 ◽  
Author(s):  
Martin Alda ◽  
Margaret McKinnon ◽  
Ryan Blagdon ◽  
Julie Garnham ◽  
Susan MacLellan ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Methylene Blue ◽  
Crossover Study ◽  
Rating Scale ◽  
Neuroprotective Effects ◽  
Double Blind ◽  
Residual Symptoms ◽  
Symptoms Of Depression ◽  
Hamilton Rating Scale ◽  
Active Dose

BackgroundResidual symptoms and cognitive impairment are among important sources of disability in patients with bipolar disorder. Methylene blue could improve such symptoms because of its potential neuroprotective effects.AimsWe conducted a double-blind crossover study of a low dose (15 mg, ‘placebo’) and an active dose (195 mg) of methylene blue in patients with bipolar disorder treated with lamotrigine.MethodThirty-seven participants were enrolled in a 6-month trial (trial registration: NCT00214877). The outcome measures included severity of depression, mania and anxiety, and cognitive functioning.ResultsThe active dose of methylene blue significantly improved symptoms of depression both on the Montgomery–Åsberg Depression Rating Scale and Hamilton Rating Scale for Depression (P = 0.02 and 0.05 in last-observation-carried-forward analysis). It also reduced the symptoms of anxiety measured by the Hamilton Rating Scale for Anxiety (P = 0.02). The symptoms of mania remained low and stable throughout the study. The effects of methylene blue on cognitive symptoms were not significant. The medication was well tolerated with transient and mild side-effects.ConclusionsMethylene blue used as an adjunctive medication improved residual symptoms of depression and anxiety in patients with bipolar disorder.

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

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.

Symptom-specific self-referential cognitive processes in bipolar disorder: a longitudinal analysis

2012 ◽  
Vol 43 (9) ◽  
pp. 1895-1907 ◽  
Author(s):  
H. Pavlickova ◽  
F. Varese ◽  
O. Turnbull ◽  
J. Scott ◽  
R. Morriss ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Multilevel Models ◽  
Rating Scale ◽  
Self Esteem ◽  
Dysfunctional Attitudes ◽  
Psychological Processes ◽  
Co Morbidity ◽  
Clinical Measures ◽  
Specific Symptoms ◽  
Over Time

BackgroundAlthough depression and mania are often assumed to be polar opposites, studies have shown that, in patients with bipolar disorder, they are weakly positively correlated and vary somewhat independently over time. Thus, when investigating relationships between specific psychological processes and specific symptoms (mania and depression), co-morbidity between the symptoms and changes over time must be taken into account.MethodA total of 253 bipolar disorder patients were assessed every 24 weeks for 18 months using the Hamilton Rating Scale for Depression (HAMD), the Bech–Rafaelsen Mania Assessment Scale (MAS), the Rosenberg Self-Esteem Questionnaire (RSEQ), the Dysfunctional Attitudes Scale (DAS), the Internal, Personal and Situational Attributions Questionnaire (IPSAQ) and the Personal Qualities Questionnaire (PQQ). We calculated multilevel models using the xtreg module of Stata 9.1, with psychological and clinical measures nested within each participant.ResultsMania and depression were weakly, yet significantly, associated; each was related to distinct psychological processes. Cross-sectionally, self-esteem showed the most robust associations with depression and mania: depression was associated with low positive and high negative self-esteem, and mania with high positive self-esteem. Depression was significantly associated with most of the other self-referential measures, whereas mania was weakly associated only with the externalizing bias of the IPSAQ and the achievement scale of the DAS. Prospectively, low self-esteem predicted future depression.ConclusionsThe associations between different self-referential thinking processes and different phases of bipolar disorder, and the presence of the negative self-concept in both depression and mania, have implications for therapeutic management, and also for future directions of research.

scholarly journals Prevalence of anxiety symptoms among the clients maintained in methadone maintenance treatment programme at Tribhuvan University Teaching Hospital

2012 ◽  
Vol 1 (1) ◽  
pp. 15-19
Author(s):  
Naba Raj Koirala ◽  
Sharma Vidya Dev ◽  
Saroj Prasad Ojha ◽  
Nishita Pathak
Keyword(s):  
Methadone Maintenance Treatment ◽  
Maintenance Treatment ◽  
Rating Scale ◽  
Methadone Maintenance ◽  
Cross Sectional Study ◽  
Anxiety Symptoms ◽  
University Teaching ◽  
Cross Sectional ◽  
Methadone Dosage ◽  
Co Morbidity

Background: The symptoms of anxiety are widely prevalent among the former opioid addicts in methadone maintenance treatment (MMT). It is clinically important to be aware of the severity of the co-morbidity as it plays a crucial role in the methadone dosage, length of time in treatment and the relapse rate and the co-existence of co-morbidity has been described as the factor which worsens the prognosis. Aim: to study the prevalence of the symptoms of anxiety among MMT clients Methods: a descriptive, survey and a cross- sectional study, 60 MMT clients were selected who had been attending the MMTP for more than 2 months and were given with semistructured proforma specifically designed for this study only. Then after, they were evaluated for the anxiety symptoms with Beck Anxiety Inventory (BAI). Finally, the information obtained from the demographic profile and the rating scale were analyzed with the help of computer program SPSS. Results: The study showed around 41.7 % of the patients had symptoms of anxiety with varying severity. Correlates of presence of anxiety symptom among MMT client in the present study showed higher prevalence among age group 20-29(88%), 66% were separated and 64% were unmarried, 50% were Buddhist, majority of the case were chhetri (70%), 75% had primary level education, 67% were unemployed, and 65% from middle class socioeconomic status. Limitation: The study was a cross sectional, which showed only the symptoms of anxiety not the disorder and the drug use, withdrawals itself, could distort evaluation and lead to misdiagnosis of anxiety. Conclusion: The major risk factor for was male gender, separated, primary education level, students and middle socio-economic status.DOI: http://dx.doi.org/10.3126/jonmc.v1i1.7283 Journal of Nobel Medical College Vol.1(1) 2011 15-19

Characterization of depressed bipolar patients with current suicidal ideation

2020 ◽  
pp. 000486742096374
Author(s):  
Bénédicte Nobile ◽  
Jonathan Dubois ◽  
Bruno Aouizerate ◽  
Valerie Aubin ◽  
Joséphine Loftus ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicidal Ideation ◽  
Clinical Features ◽  
Rating Scale ◽  
Depressive Symptomatology ◽  
Self Report ◽  
Depressed Patients ◽  
Scale Total Score ◽  
Suicidal Patients

Objective: Bipolar disorder is one of the most frequent psychiatric disorders among suicidal patients. A large part of patients with bipolar disorder (30–50%) will attempt suicide. Suicidal ideation being a major risk factor of suicidal act, it is crucial to better characterize patients with suicidal bipolar depression (i.e. depression with current suicidal ideation). The aim of this study was to characterize suicidal bipolar depressed patients in comparison with non-suicidal depressed patients in terms of clinical characteristics, evolution of depression and suicidal ideation course over time, and risk of suicide attempt during follow-up. Methods: Among patients with bipolar disorder recruited from the network of FondaMental expert centres for bipolar disorder between 2009 and 2017, we selected patients with at least mild depression (Montgomery–Åsberg Depression Rating Scale total score >11) and without current manic symptomatology (Young Mania Rating Scale total score <7) at baseline ( N = 938). Suicidal depression was defined by a baseline score ⩾2 for item 12 of the Quick Inventory of Depressive Symptomatology–Self Report ( N = 271, 28.9%). Non-suicidal depression was defined by a baseline item 12 of the Quick Inventory of Depressive Symptomatology–Self Report score <2 ( N = 667, 71.1%). A subsample of about 300 patients (with or without suicidal ideation at baseline) was followed up for 2 years. Results: Baseline clinical features (e.g. depression severity, childhood trauma, global functioning) were more severe in patients with than without suicidal depression. Suicidal patients tended to remain more suicidal throughout the follow-up than patients without suicidal ideation at baseline (3.4-fold higher risk of persistent suicidal ideation at the 2-year visit despite an improvement in depressive symptomatology). Conclusions: Depressed bipolar disorder patients reporting suicidal ideation had more severe clinical features at baseline and were more prone to report persistent suicidal ideation during the follow-up, independently of thymic state. Clinicians should closely monitor this subgroup of patients.

Acute Colonic Diverticulitis: Diagnostic Evidence, Demographic and Clinical Features in ree Practice Settings

2014 ◽  
Vol 23 (4) ◽  
pp. 379-386 ◽  
Author(s):  
Rajan Iyer ◽  
George F. Longstreth ◽  
Li-Hao Chu ◽  
Wansu Chen ◽  
Linnette Yen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Clinical Features ◽  
Clinical Characteristics ◽  
Past History ◽  
Colonic Diverticulitis ◽  
Co Morbidity ◽  
Objective Evidence ◽  
Multiple Variables ◽  
Acute Colonic Diverticulitis

Background & Aims: Diverticulitis is often diagnosed in outpatients, yet little evidence exists on diagnostic evidence and demographic/clinical features in various practice settings. We assessed variation in clinical characteristics and diagnostic evidence in inpatients, outpatients, and emergency department cases and effects of demographic and clinical variables on presentation features.Methods: In a retrospective cohort study of 1749 patients in an integrated health care system, we compared presenting features and computed tomography findings by practice setting and assessed independent effects of demographic and clinical factors on presenting features.Results: Inpatients were older and more often underweight/normal weight and lacked a diverticulitis past history and had more comorbidities than other patients. Outpatients were most often Hispanic/Latino. The classical triad (abdominal pain, fever, leukocytosis) occurred in 78 (38.6%) inpatients, 29 (5.2%) outpatients and 34 (10.7%) emergency department cases. Computed tomography was performed on 196 (94.4%) inpatients, 110 (9.2%) outpatients and 296 (87.6%) emergency department cases and was diagnostic in 153 (78.6%) inpatients, 62 (56.4%) outpatients and 243 (82.1%) emergency department cases. Multiple variables affected presenting features. Notably, female sex had lower odds for the presence of the triad features (odds ratio [95% CI], 0.65 [0.45-0.94], P<0.05) and increased odds of vomiting (1.78 [1.26-2.53], P<0.01). Patients in age group 56 to 65 and 66 or older had decreased odds of fever (0.67 [0.46-0.98], P<0.05) and 0.46 [0.26-0.81], P<0.01), respectively, while ≥1 co-morbidity increased the odds of observing the triad (1.88 [1.26-2.81], P<0.01).Conclusion: There was little objective evidence for physician-diagnosed diverticulitis in most outpatients. Demographic and clinical characteristics vary among settings and independently affect presenting features.Abbreviations: AD: acute colonic diverticulitis; BMI: body mass index; CT: computed tomography; ED: emergency department; IBS: irritable bowel syndrome; ICD-9-CM: International Classification of Diseases, 9th Revision, Clinical Modification; IP: inpatient; KPSC: Kaiser Permanente Southern California; OP: outpatient.

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

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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