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.

scholarly journals The current state of benzodiazepines and Z-drugs use and their influences on bipolar disorder outcomes-A small sample analysis

2021 ◽  
Author(s):  
Yiming Chen ◽  
Fan Wang ◽  
Lvchun Cui ◽  
Haijing Huang ◽  
Shuqi Kong ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicide Attempt ◽  
Sleep Disturbance ◽  
Affective Disorder ◽  
Sleep Disturbances ◽  
Small Sample ◽  
Mood Stabilizers ◽  
Psychotic Symptoms ◽  
Psychiatric Drugs ◽  
Bipolar Patients

Abstract Background: Sleep disturbance and benzodiazepines (BZDs)/Z-drugs use are known to be common during affective episodes. Hence, we identified the probable outcomes of bipolar disorder that correlate with BZDs/Z-drugs use, aside from mood symptoms. We conducted an open-label, prospective study to describe the current use of BZDs and Z-drugs by patients with bipolar disorder during affective episodes. We evaluated the difference of characteristics between bipolar patients with sleep disturbance who chose BZDs/Z-drugs, and those who did not chose the drugs during and after affective disorder. The influences of BZDs/Z-drugs use on suicide attempt and psychotic symptoms during affective disorder were also investigated. Results: Seventy patients with current affective episodes were studied. Among them, 61 had sleep disturbances. The amount of mood stabilizers use in the BZDs/Z-drugs group was significantly greater than that in the no BZDs/Z-drugs group (p=0.038) during affective episodes. After affective episode, sleep disturbances, especially midnight wakes, became more improved in BZDs/Z-drugs group compared to the no BZDs/Z-drugs group. By contrast, attention and decisiveness became more improved in the no BZDs/Z-drugs group than in the BZDs/Z-drugs group. Furthermore, we observed that BZDs/Z-drugs had an OR of 4.338 (95% CI 1.068-17.623, p=0.040), and other psychiatric drugs had an OR of 1.835 (95% CI 1.105-3.047, p=0.019) in relation to suicide attempt. After nine months, we found that BZDs/Z-drugs use was of no significant effect to depressive or manic severity, or to recurrence rate.Conclusion: BZDs/Z-drugs use have no significant influence on variations in depressive or manic severity during the course of an affective episode. Nevertheless, BZDs/Z-drugs users took a greater amount of mood stabilizers than no BZDs/Z-drugs users. Finally, BZDs/Z-drugs or other psychiatric drugs polytherapy was regarded as a risk factor of suicide attempt during an affective episode.

Baseline and prodromal characteristics of first- versus multiple-episode mania in a French cohort of bipolar patients

2011 ◽  
Vol 27 (8) ◽  
pp. 557-562 ◽  
Author(s):  
J.-M. Azorin ◽  
A. Kaladjian ◽  
M. Adida ◽  
E. Fakra ◽  
E. Hantouche ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicide Attempts ◽  
Correct Diagnosis ◽  
Manic Episode ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Prodromal Phase ◽  
Multiple Episode ◽  
Patients At Risk ◽  
Bipolar Patients

AbstractObjective:To identify some of the main features of bipolar disorder for both first-episode (FE) mania and the preceding prodromal phase, in order to increase earlier recognition.Methods:One thousand and ninety manic patients (FE=81, multiple-episodes [ME]=1009) were assessed for clinical and temperamental characteristics.Results:Compared to ME, FE patients reported more psychotic and less depressive symptoms but were comparable with respect to temperamental measures and comorbid anxiety. The following independent variables were associated with FE mania: a shorter delay before correct diagnosis, greater substance use, being not divorced, greater stressors before current mania, a prior diagnosis of an anxiety disorder, lower levels of depression during index manic episode, and more suicide attempts in the past year.Conclusion:In FE patients, the diagnosis of mania may be overlooked, as they present with more psychotic symptoms than ME patients. The prodromal phase is characterised by high levels of stress, suicide attempts, anxiety disorders and alcohol or substance abuse. Data suggest to consider these prodromes as harmful consequences of temperamental predispositions to bipolar disorder that may concur to precipitate mania onset. Their occurrence should therefore incite clinicians to screen for the presence of such predispositions, in order to identify patients at risk of FE mania.

scholarly journals T27. COGNITIVE RESERVE IN CHILD AND ADOLESCENT OFFSPRING OF PATIENTS DIANOSED WITH SCHIZOPHRENIA OR BIPOLAR DISORDER

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S241-S242
Author(s):  
Elena De la Serna ◽  
Patricia Camprodon-Boadas ◽  
Gisela Sugranyes ◽  
Carla Torrent ◽  
Brisa Sole ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
High Risk ◽  
Verbal Memory ◽  
Cognitive Reserve ◽  
Protective Factor ◽  
Rating Scale ◽  
Structured Interview ◽  
Psychotic Symptoms ◽  
Prodromal Symptoms ◽  
Neuropsychological Variables

Abstract Background Cognitive Reserve (CR) is defined as the ability of the brain to cope and deal with physiological or pathological brain injuries. In the field of psychiatry, higher levels of CR have been associated with lower levels of psychotic symptoms, higher psycho-social functioning and higher cognitive performance, suggesting that CR should be considered as a protective factor (Barnett et al., 2006; Amoretti et al., 2016). This study aims to compare CR levels in a sample of adolescents and young adult offspring of patients with schizophrenia or bipolar disorder who are at high risk of developing these disorders (HR) and compared them with a group of healthy controls (HC). We also assess the utility of CR in predicting clinical and cognitive variables. Methods Participants were 85 HR and 45 HC. A CR proxy was calculated based on premorbid IQ, socio-occupational attainment and social activities. Clinical assessment included: the Structured Interview for Prodromal Symptoms (SOPS), the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HDRS). Neuropsychological assessment included: Working Memory, Processing Speed, Verbal Memory, attention and executive functioning. A factorial analysis was conducted in order to obtain a single CR measure. Differences between groups in CR were assessed via MANCOVA and linear regressions were conducted to check the effectiveness of CR in predicting clinical and neuropsychological variables. Results No significant differences were observed in age or gender between HR and HC groups. Socioeconomic status was lower in HR subjects (F=8.100, p=0.005).CR was significantly lower in the HR group than in the HC group (F=17.522; p<0.001). Moreover, the CR proxy was able to correctly classify 72.7% of the sample as either HR or HC. Our proxy was able to predict the following clinical variables in the HR group: negative (F=9.269; p=0.002), and total (F=7.290; p=0.009) prodromal symptoms, the YMRS (F=11.597; P<0.001) and the HDRS (F=12.761; p<0.001). In terms of neuropsychological variables, RC predicted WM (F=9.738; p=0.003), PS (F=4.557; p=0.037) and verbal memory [immediate (F=6.999; p=0.010) and delayed recall (F=10.990; P=0.002)] in the HR sample. Discussion HR subjects have lower CR than controls. CR is associated with clinical and neuropsychological variables. To our knowledge no previous studies have assessed CR in high risk samples. Nevertheless, studies conducted in adult first episode psychotic samples have shown an association between CR and the severity of symptoms.

The Expanding Role of Antipsychotics

CNS Spectrums ◽  
2004 ◽  
Vol 9 (S1) ◽  
pp. 7-12
Author(s):  
Philip G. Janicak
Keyword(s):  
Bipolar Disorder ◽  
Manic Episode ◽  
Acute Mania ◽  
Psychotic Symptoms ◽  
Primary Therapy ◽  
Obsessive Compulsive ◽  
Stabilizing Agent ◽  
Compulsive Disorder ◽  
Bipolar Patients

Antipsychotics have been utilized in the treatment of bipolar disorder for many decades and were the mainstay of treatment before lithium was reintroduced in the late 1960s. Today, many bipolar patients who present with psychotic features are misdiagnosed and prescribed an antipsychotic for another disorder. Estimates of psychotic symptoms in bipolar disorder, particularly during a manic episode, are ≥50% by clinical assessment and even higher by individual reports. Thus, antipsychotics are frequently used: as first treatment for psychosis not recognized as bipolar disorder, and as an adjunct to a mood-stabilizing agent in bipolars with psychotic symptoms.Most recently, antipsychotics have been examined for their mood-stabilizing properties as well (Slide 9). One may conceptualize using a selective serotonin reuptake inhibitor (SSRI) antidepressant for disorders such as panic disorder or obsessive-compulsive disorder, and using an antiepileptic as a mood-stabilizing agent; however, it is more difficult to accept that an agent approved for treatment of psychosis can be a primary therapy for bipolar disorder. Data from the monotherapy trials suggest that second-generation antipsychotics (SGAs) are at least as effective as lithium and valproic acid for acute mania. There is a very large database indicating that SGAs can be utilized as monotherapy for acute mania. However, there is limited data on the role of these agents in prevention of relapse and recurrence and in their efficacy for depression in the context of bipolar disorder. More studies will be needed to clarify whether SGAs should be used as monotherapy or whether they would be best used as augmenting agents in severe and psychotically manic or depressed patients.

Psychotic versus non-psychotic bipolar disorder: Socio-demographic and clinical profiles in an Italian nationwide study

2019 ◽  
Vol 53 (8) ◽  
pp. 772-781 ◽  
Author(s):  
Alfredo Carlo Altamura ◽  
Massimiliano Buoli ◽  
Bruno Mario Cesana ◽  
Andrea Fagiolini ◽  
Andrea de Bartolomeis ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Confidence Interval ◽  
Clinical Features ◽  
Odds Ratio ◽  
Age At Onset ◽  
Psychotic Symptoms ◽  
Bipolar Type ◽  
Bipolar Patients ◽  
Depressive Episodes ◽  
First Diagnosis

Objective: Psychotic versus non-psychotic patients with bipolar disorder have been traditionally associated with different unfavorable clinical features. In this study on bipolar Italian patients, we aimed to compare clinical and demographic differences between psychotic and non-psychotic individuals, exploring clinical factors that may favor early diagnosis and personalized treatment. Methods: A total of 1671 patients (males: n = 712 and females: n = 959; bipolar type 1: n = 1038 and bipolar type 2: n = 633) from different psychiatric departments were compared according to the lifetime presence of psychotic symptoms in terms of socio-demographic and clinical variables. Chi-square tests for qualitative variables and Student’s t-tests for quantitative variables were performed for group comparison, and a multivariable logistic regression was performed, considering the lifetime psychotic symptoms as dependent variables and socio-demographic/clinical characteristics as independent variables. Results: Psychotic versus non-psychotic bipolar subjects resulted to: be more frequently unemployed ( p < 0.01) and never married/partnered ( p < 0.01); have an earlier age at onset ( p < 0.01); more frequently receive a first diagnosis different from a mood disorder ( p < 0.01); have a shorter duration of untreated illness ( p < 0.01); have a more frequently hypomanic/manic prevalent polarity ( p < 0.01) and a prevalent manic–depressive type of cycling ( p < 0.01); present a lower lifetime number of depressive episodes ( p < 0.01), but have more manic episodes ( p < 0.01); and less insight ( p < 0.01) and more hospitalizations in the last year ( p < 0.01). Multivariable regression analysis showed that psychotic versus non-psychotic bipolar patients received more frequently a first diagnosis different from bipolar disorder (odds ratio = 0.64, 95% confidence interval = [0.46, 0.90], p = 0.02) or major depressive disorder (odds ratio = 0.66, 95% confidence interval = [0.48, 0.91], p = 0.02), had more frequently a prevalent manic polarity (odds ratio = 1.84, 95% confidence interval = [1.14, 2.98], p < 0.01) and had a higher number of lifetime manic episodes (more than six) (odds ratio = 8.79, 95% confidence interval = [5.93, 13.05], p < 0.01). Conclusion: Lifetime psychotic symptoms in bipolar disorder are associated with unfavorable socio-demographic and clinical features as well as with a more frequent initial misdiagnosis.

scholarly journals Belief updating in bipolar disorder predicts time of recurrence

eLife ◽  
2020 ◽  
Vol 9 ◽  
Author(s):  
Paolo Ossola ◽  
Neil Garrett ◽  
Tali Sharot ◽  
Carlo Marchesi
Keyword(s):  
Bipolar Disorder ◽  
Sleep Disturbance ◽  
Clinical Manifestation ◽  
Negative Information ◽  
Belief Updating ◽  
Positive Information ◽  
Prodromal Symptoms ◽  
Learning Patterns ◽  
Dependent Learning ◽  
Bipolar Patients

Bipolar disorder is a chronic relapsing condition in which mood episodes are interspersed with periods of wellbeing (euthymia). Shorter periods of euthymia are associated with poorer functioning, so it is crucial to identify predictors of relapse to facilitate treatment. Here, we test the hypothesis that specific valence-dependent learning patterns emerge prior to the clinical manifestation of a relapse, predicting its timing. The ability to update beliefs in response to positive and negative information was quantified in bipolar patients during euthymia, who were then monitored for 5 years. We found that reduced tendency to update beliefs in response to positive relative to negative information predicted earlier relapse. Less updating in response to positive information may generate pessimistic beliefs, which in turn can lead to more severe prodromal symptoms (e.g. sleep disturbance, irritability etc.). The results suggest that measuring valence-dependent belief updating could facilitate risk prediction in bipolar disorder.

scholarly journals Use of Dermatoglyphic Parameters as Possible Markers in Bipolar Affective Disorder

2021 ◽  
Vol 11 (7) ◽  
pp. 385-393
Author(s):  
Amit Kumar Pal ◽  
Sagarika Ray ◽  
Jishnu Bhattacharya
Keyword(s):  
Bipolar Disorder ◽  
Affective Disorder ◽  
Bipolar Affective Disorder ◽  
Control Group ◽  
Healthy Controls ◽  
Ridge Count ◽  
Primordial Prevention ◽  
And Gender ◽  
The Individual ◽  
Bipolar Patients

Background: Bipolar affective disorder is an episodic illness characterized by fluctuating mood states. Association of dermatoglyphic traits with bipolar affective disorder has been observed in various studies. This study was undertaken to evaluate epidermal ridge patterns in bipolar patients as compared to healthy controls attending a super speciality district hospital in West Bengal. Context and purpose of study: Establishing dermatoglyphic parameters as biomarkers for early diagnosis and consequently, prompt intervention in bipolar affective disorder will ensure a greater scope of recovery, and thus promote a better quality of life for the individual as well as lower the burden of disease for the society. Methods: Quantitative dermatoglyphic parameters namely, Total Finger Ridge Count (TFRC), Total A-B Ridge Count (TABRC), and ATD Angle of 100 bipolar patients were compared to 100 age and gender matched healthy controls. Results: Statistically significant differences were found on comparing the dermatoglyphic parameters between cases and controls. TFRC was found to be decreased while ATD angle was increased in bipolar cases, as compared to the control group. However, no significant change was observed in TABRC between the two groups. Conclusions: This study found a significant association between dermatoglyphic pattern anomalies and the development of bipolarity. This may offer a scope of primordial prevention of bipolar disorder in future. Key words: Dermatoglyphics, ridge pattern, bipolar disorder, Total Finger Ridge Count (TFRC), Total A-B Ridge Count (TABRC), ATD angle.

Exploratory Investigation of Biomarker Candidates for Suicide in Schizophrenia and Bipolar Disorder

Crisis ◽  
2015 ◽  
Vol 36 (1) ◽  
pp. 46-54 ◽  
Author(s):  
Nagy A. Youssef ◽  
Daniel W. Bradford ◽  
Jason D. Kilts ◽  
Steven T. Szabo ◽  
Jennifer C. Naylor ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Parietal Cortex ◽  
Gas Chromatography Mass Spectrometry ◽  
Individual Group ◽  
Posterior Cingulate ◽  
Completed Suicide ◽  
Exploratory Investigation ◽  
The Individual ◽  
Bipolar Patients ◽  
Post Hoc

Background: Clozapine and lithium increase neurosteroids in rodents, and both drugs demonstrate antisuicidal actions. We therefore hypothesized that neurosteroid levels may be reduced in patients with schizophrenia or bipolar disorder who completed suicide. Aims: To investigate neurosteroid levels in the parietal cortex and posterior cingulate in schizophrenia and bipolar patients who died by suicide, and compare them with patients with these disorders who died of other causes. Method: Neurosteroid levels were quantified by gas chromatography/mass spectrometry in the parietal cortex and posterior cingulate. Mann–Whitney analyses were conducted in exploratory post hoc analyses to investigate neurosteroids as possible biomarker candidates for suicide. Results: The study showed that pregnenolone was significantly decreased in the parietal cortex in the combined group of patients with schizophrenia or bipolar disorder who died by suicide (n = 13) compared with patients with these disorders who died of other causes (n = 17, p = .02). Pregnenolone levels were also lower in the parietal cortex in the individual group of schizophrenia patients who died by suicide (n = 4) compared with schizophrenia patients who died of other causes (n = 11) p = .04). Conclusion: Pregnenolone alterations may be relevant to the neurobiology of suicide in schizophrenia and bipolar disorder.

scholarly journals Executive dysfunction and memory impairment in schizoaffective disorder: a comparison with bipolar disorder, schizophrenia and healthy controls

2012 ◽  
Vol 42 (10) ◽  
pp. 2127-2135 ◽  
Author(s):  
B. Amann ◽  
J. J. Gomar ◽  
J. Ortiz-Gil ◽  
P. McKenna ◽  
B. Sans-Sansa ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Executive Function ◽  
Schizoaffective Disorder ◽  
Executive Dysfunction ◽  
Psychotic Symptoms ◽  
Similar Degree ◽  
Healthy Controls ◽  
Patient Groups ◽  
Bipolar Patients ◽  
Manic Patients

BackgroundDeficits in memory and executive performance are well-established features of bipolar disorder and schizophrenia. By contrast, data on cognitive impairment in schizoaffective disorder are scarce and the findings are conflicting.MethodWe used the Wechsler Memory Scale (WMS-III) and the Behavioural Assessment of the Dysexecutive Syndrome (BADS) to test memory and executive function in 45 schizophrenic patients, 26 schizomanic patients and 51 manic bipolar patients in comparison to 65 healthy controls. The patients were tested when acutely ill.ResultsAll three patient groups performed significantly more poorly than the controls on global measures of memory and executive functioning, but there were no differences among the patient groups. There were few differences in memory and executive function subtest scores within the patient groups. There were no differences in any test scores between manic patients with and without psychotic symptoms.ConclusionsSchizophrenic, schizomanic and manic patients show a broadly similar degree of executive and memory deficits in the acute phase of illness. Our results do not support a categorical differentiation across different psychotic categories with regard to neuropsychological deficits.

Safety, Efficacy, and Patient Acceptability of Aripiprazole in the Maintenance Treatment of Bipolar Disorder

2012 ◽  
Vol 4 ◽  
pp. CMT.S7388
Author(s):  
Maria Paola Rapagnani
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics ◽  
Early Adulthood ◽  
Similar Efficacy ◽  
Psychotic Symptoms ◽  
Patient Acceptability ◽  
Specific Patient ◽  
Central Nervous System Activity ◽  
The Individual ◽  
Depressive Episodes

Background Bipolar disorder (manic depression) is a serious, long-term mental illness that affects about 1% of adults at some time during their life. It usually develops in late adolescence or early adulthood and affects men and women from all backgrounds. People with bipolar disorder experience wild mood swings that interfere with daily life and damage relationships. They can also have psychotic symptoms: they may see or hear things that are not there. During depressive episodes, affected individuals may feel helpless, worthless, and suicidal. Treatments for bipolar disorder include drugs to stabilize mood swings (for example, lithium and anticonvulsant medications), antide-pressants to treat depressive episodes and antipsychotic drugs to treat manic episodes. The development of second-generation atypical antipsychotics (SGAs) has increased the hopes of psychiatrists. SGAs, however, cannot be considered a unique pharmacological class since each SGA has many complex pharmacologic actions, only some of which are shared with other SGAs. Even though, many antipsychotics have similar efficacy on average, prescribers may be able to achieve better than average results by considering differences in selecting a specific drug for a specific patient. Clinicians know that each patient is unique and in order to achieve best outcomes for the individual patient, the better therapy is the therapy tailored for the single patient. Objectives With this article we provide information on a relatively new antipsychotic aripiprazole released in 2002 by Bristol-Myers Squibb for the treatment of schizophrenia; for acute manic and mixed episodes associated with bipolar disorder in 2004; as an adjunct for major depressive disorder on November 2007; and to treat irritability in children with autism on 2009. Compared with other first line atypical antipsychotics aripiprazole has a unique profile due to partial agonism at dopamine D2 and D3 and serotonin 5-HT1A receptors, and antagonism at 5-HT2A receptors. This paper describes the development of aripiprazole, its unique properties and its metabolically-friendly profile including its receptor binding affinities, pharmacokinetics, central nervous system activity results of clinical efficacy and relevant clinical trials, in particular safety, efficacy and patient acceptability are also examined. The available literature on aripiprazole of the last six years is reviewed.

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