Bipolar Affective Disorder in Adolescence: A 10-Year Study

A descriptive study of bipolar affective disorder in adolescent patients, conducted over a 10-year period, is presented. The diagnosis of 30 subjects referred to an adolescent treatment facility of a major teaching hospital was reviewed using DSM-III criteria, and antecedent symptomatology and signs were documented. Common diagnostic features included schizophreniform phenomenology, motoric and vegetative changes, suicidal and inappropriate sexual behaviour and a stormy first year of illness. A positive family history was frequently noted, as was the relevance of various forms of loss as a precipitant of the first episode. Timely recognition and multidisciplinary management, including the use of lithium, are discussed. It appears that the prognosis of bipolar affective disorder in adolescence is better than was previously believed, probably as a result of earlier diagnosis and more frequent recognition.

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Features of depressive and anxiety manifestations in the first episode of bipolar affective disorder

Archives of psychiatry ◽

10.37822/2410-7484.2019.25.3.142-146 ◽

2019 ◽

Vol 25 (3) ◽

pp. 142-146

Author(s):

Yu. I. Mysula

Keyword(s):

Affective Disorder ◽

Bipolar Affective Disorder ◽

First Episode ◽

Depression And Anxiety ◽

Men And Women ◽

Treatment And Prevention ◽

The Mean ◽

Gender Factor ◽

The Impact ◽

Mixed Variant

Background. The study of depression and anxiety in the first episode of BAR is important for the timely detection, treatment and prevention of poor diagnosis of the disease. Objective – the study of the features of depressive and anxiety symptoms of the first episode of bipolar affective disorder, taking into account the gender factor and the clinical type. Materials and methods. We have clinically examined 65 men and 88 women diagnosed with first episode (FE) of bipolar affective disorder (BAD). Results. In patients with depressive FE of BAD, all indicators, with the exception of the undifferentiated depression indicator, in men are slightly higher than in women: the overall indicator (respectively 22.55±3.61 points and 22.16±3.03 points); adynamic depression (17.41±2.62 points and 16.76±2.48 points); pervasive depression (9.75±3.13 points and 9.69±2.66 points); depression with fear (9.34±2.55 points and 9.51±2.27 points); undifferentiated depression (4.89±0.95 points and 5.01±1.22 points); in patients with the mixed variant are not significantly different: accordingly 15,83±2,64 points and 17,00±3,32 points; 11.00±1.67 points and 11.80±1.64 points; 6.67±1.63 points and 6.60±2.07 points; 7.33±1.21 points and 8.00±1.87 points; 3.67±1.03 points and 3.40±1.14 points; in patients with a manic type there are no signs of depression. The indicators of anxiety in men and women do not differ significantly: in the depressive variant, the total indicator was accordingly 21.41±7.01 points and 23.36±7.01 points; psychic anxiety – 13.25±3.86 points and 14.35±3.87 points; somatic anxiety – 8.16±4.05 points and 9.01±4.10 points; when mixed, accordingly, 20,00±4,52 points and 22,00±4,90 points; 13.33±3.27 points and 15.20±2.39 points; 6.67±3.27 points and 6.80±3.70 points; the manic variant showed no signs of anxiety. The mean Zung score for the depressed variant was 68.82±8.30 points and 65.97±8.41 points, accordingly, for the mixed one, 44.00±5.55 points and 50.40±5.32 points, accordingly, at a manic variant 2.13±1.64 points and 2.50±1.60 points. Conclusions. Differences in manifestations of depression and anxiety in the first episode of bipolar affective disorder are determined by the clinical option; the impact of gender on these manifestations is insignificant.

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Incidence of bipolar affective disorder in three UK cities

The British Journal of Psychiatry ◽

10.1192/bjp.186.2.126 ◽

2005 ◽

Vol 186 (2) ◽

pp. 126-131 ◽

Cited By ~ 45

Author(s):

Tuhina Lloyd ◽

Noel Kennedy ◽

Paul Fearon ◽

James Kirkbride ◽

Rosemarie Mallett ◽

...

Keyword(s):

Bipolar Disorder ◽

Affective Disorder ◽

Ethnic Groups ◽

Bipolar Affective Disorder ◽

Incidence Rates ◽

First Episode ◽

Minority Ethnic Groups ◽

Incidence Studies ◽

Significant Difference ◽

Minority Ethnic

BackgroundThere has been a relative dearth of epidemiological research into bipolar affective disorder. Furthermore, incidence studies of bipolar disorder have been predominantly retrospective and most only included hospital admission cases.AimsTo determine the incidence of operationally defined bipolar disorder in three areas of the UK and to investigate any differences in gender and ethnicity.MethodAll patients who contacted mental health services with first-episode psychosis or non-psychotic mania between September 1997 and August 1999 were identified and diagnosed according to ICD–10 criteria. Incidence rates of bipolar affective disorder were standardised for age and stratified by gender and ethnic group across the three areas.ResultsThe incidence rate per 100 000 per year in south-east London was over twice that in Nottingham and Bristol. There was no significant difference in the rates of disorder in men and women. Incidence rates of bipolar disorder in the combined Black and minority ethnic groups in all three areas were significantly higher than those of the comparison White groups.ConclusionsThe incidence of bipolar disorder was higher in south-east London than in the other two areas, and was higher among Black and minority ethnic groups than in the White population.

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Prolactin ordering patterns in psychiatric inpatients and the impact this has on patient management

Australasian Psychiatry ◽

10.1177/1039856220934326 ◽

2020 ◽

pp. 103985622093432

Author(s):

Annabel S Jones ◽

Shoshana Sztal-Mazer ◽

Ilan Rauchberger ◽

Peter Shane Hamblin

Keyword(s):

Affective Disorder ◽

Clinical Management ◽

Bipolar Affective Disorder ◽

Clinical History ◽

First Episode ◽

Antipsychotic Treatment ◽

Asymptomatic Patients ◽

Episode Psychosis ◽

Alfred Hospital ◽

The Impact

Objective: Guidelines stipulate that baseline prolactin be ordered prior to commencing antipsychotic treatment to facilitate investigation of any subsequent hyperprolactinaemic symptoms. The aim was to observe when and why prolactin levels are ordered for psychiatry inpatients commencing or continuing antipsychotics and how this alters clinical management. Methods: Psychiatry inpatients admitted to the Alfred Hospital, Melbourne, Australia, in 2018 with the diagnoses of psychosis, schizophrenia, schizo-affective disorder or bipolar affective disorder were retrospectively analysed. Results and clinical history data were collected in patients in whom prolactin was ordered during or within 12 months of the relevant admission. Results: Of 592 patients admitted during this period, 90 had prolactin ordered. Eight (8.9%) of the 90 tests were for hyperprolactinaemic symptoms, while the remainder were routine blood work. The results altered clinical management in 10 of the 90 (11.1%) patients. Of these 10, 8 were symptomatic. In the six patients with first episode psychosis, only one had prolactin ordered prior to antipsychotic commencement. Conclusions: Adherence to guideline recommendations of baseline prolactin testing was poor. When established on antipsychotics, measuring prolactin rarely changed management in asymptomatic patients; however, it did in those with hyperprolactinaemic symptoms. Measuring prolactin in asymptomatic patients on antipsychotics appears unhelpful.

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Lithium and recurrence in a long-term follow-up of bipolar affective disorder

Psychological Medicine ◽

10.1017/s0033291796004461 ◽

1997 ◽

Vol 27 (2) ◽

pp. 281-289 ◽

Cited By ~ 29

Author(s):

W. CORYELL ◽

G. WINOKUR ◽

D. SOLOMON ◽

T. SHEA ◽

A. LEON ◽

...

Keyword(s):

Affective Disorder ◽

Bipolar Affective Disorder ◽

Treatment Decisions ◽

First Year ◽

Drug Status ◽

Prophylactic Effect ◽

Long Term Follow Up ◽

Physiological Differences

Background. Though previous studies have clearly shown that lithium affords prophylaxis in bipolar affective disorder, these studies have not demonstrated the persistence of this prophylactic effect beyond the first year of recovery.Methods. One hundred and eighty-one patients with bipolar affective disorder recovered during 5 years of semi-annual follow-up. After 8 weeks of recovery, 139 were taking lithium prophylaxis and 42 were not. Analyses used drug status (lithium v. no-lithium) as a censoring variable to compare these two groups by interval-specific probabilities of recurrence.Results. Recurrence was initially less likely in the lithium group but interval-specific probabilities of recurrence did not consistently favour either group after the first 32 weeks of recovery.Conclusions. Biases in treatment decisions may have both reduced the size and altered the specificity of the lithium effects seen here. Nevertheless, the apparent transience of lithium prophylactic effects is unexplained and may reflect important, physiological differences between relapse and recurrence. This possibility invites a controlled lithium discontinuation study, with gradual taper, of patients who have had at least 8 months of sustained euthymia.

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