Course of Bipolar Disorders

2020 ◽  
pp. 29-42
Author(s):  
Luis R. Patino Duran ◽  
Melissa P. DelBello
Keyword(s):  
Bipolar Disorder ◽  
Psychiatric Symptoms ◽  
Bipolar Disorders ◽  
Manic Episode ◽  
Premature Death ◽  
Medical Problems ◽  
Course Of Illness ◽  
Factors Affecting ◽  
Illness Onset ◽  
Disease Rates

Bipolar disorder is a lifelong condition in most individuals, with a complex and dynamic course of illness that consists of recurrent affective episodes complicated by other psychiatric and behavioral symptoms. Before illness onset, at-risk individuals demonstrate nonspecific psychiatric symptoms that evolve into, usually, depressive episodes and ultimately mania or hypomania during adolescence. Recovery after a first manic episode is typical, but recurrences are common, and with more episodes, the risk for recurrences increases. A number of clinical factors are associated with recurrences, including co-occurring psychiatric and medical problems. Suicide is a major concern in the course of illness, so understanding risk factors may help mollify the likelihood of this outcome. Similarly, cardiovascular disease rates are elevated and associated with premature death. This chapter provides a review of the factors affecting and associated with bipolar disorder across the life span.

Manic Mood Disorders

2010 ◽  
Author(s):  
Max Fink MD
Keyword(s):  
Bipolar Disorder ◽  
Severity Of Illness ◽  
Bipolar Disorders ◽  
Manic Episode ◽  
Depressive Illness ◽  
Manic Depressive Illness ◽  
Sleep Difficulty ◽  
Manic Depressive ◽  
Loss Of Appetite ◽  
Manic Patients

Patients suffering from mania are overactive, intrusive, excited, and belligerent. They may believe that they have special powers, are related to public figures, and can read the minds of others. They spend money lavishly. Voices on the radio or television are sometimes understood as personal communications. They speak rapidly, with illogical and confused thoughts, move constantly, and write page after page of nonsense. They typically sleep and eat poorly, have little interest in work, friends, or family, and often require restraint or seclusion. Suicide is a perpetual threat. Some manic patients are likable, while others are angry and frightening. Psychosis is a frequent feature. Manic patients believe that their parents are not their real parents, asserting that they have royal blood. They believe that they can predict the future. They know that others are watching or talking about them, and they hear voices when no one is present. Delusional mania requires more intensive treatment and almost always hospital care. In older classifications of psychiatric illnesses, these patients were considered to be suffering from a manic-depressive illness. In modern classification, this term has been discarded and the illness is now conceived as bipolar disorder for patients with manic and depressive features and major depression for those with depressive symptoms only. Bipolar disorders, ranging from mild to severe, are divided into numerous subtypes. The variety of symptoms that admit the diagnosis of bipolar disorder has led to a virtual epidemic of diagnoses of the condition. Many patients so labeled do not exhibit the sleep difficulty, loss of appetite, and loss of weight, or the severity of illness, that were the criteria for manic-depressive illness. In manic-depressive illness, the manic episode persists for hours, days, weeks, or months and interferes with normal living. Once the episode resolves, it may suddenly recur; or manic episodes may alternate with periods of depression, or occur as simultaneous mixed episodes of depression and mania. When the shift in mood from mania to depression takes place within one or a few days, the condition is labeled rapid cycling, a particularly malignant form of the illness. In manic-depressive illness, the manic episode persists for hours, days, weeks, or months and interferes with normal living.

Association Between HbA1c and Number of Episodes in Individuals with Bipolar Disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S115-S115
Author(s):  
F. Fellendorf
Keyword(s):  
Bipolar Disorder ◽  
Glucose Metabolism ◽  
Psychiatric Symptoms ◽  
Type Ii ◽  
Impaired Glucose Metabolism ◽  
Course Of Illness ◽  
Diabetes Mellitus Type Ii ◽  
Somatic Comorbidities ◽  
Competing Interest ◽  
Hba1c Levels

IntroductionBipolar disorder (BD) is associated with an impaired glucose metabolism (IGM) leading to diabetes mellitus Type II (DM). DM influences the medical state of BD individuals and leads to increased mortality. However, there is evidence that IGM is associated with psychiatric symptoms, as well.AimThe study aimed to investigate the association between IGM and number of episodes and their ratio in individuals with BD, separated for gender.MethodsHbA1c levels from fasting blood were measured of 162 individuals (46% females) with BD. Furthermore, clinical parameters e.g. number of depressive and (hypo)manic episodes were gathered.ResultsAfter adjustment for illness duration and BMI there was a positive correlation in male individuals between HbA1c and number of depressive (M = 13.86, SD = 14.67; r = .308, P < 0.05) as well as (hypo)manic episodes (M = 17.23, SD = 24.24; r = 0.263, P < 0.05). There was no association in females as well as between HbA1c levels and ratio of episodes.ConclusionAssociations between HbA1c and number of episodes in male individuals with BD were found. As there are correlations between IGM and somatic comorbidities as well as the course of illness the treatment of glucose metabolism is important in BD. However, number of episodes might have an impact on the glucose metabolism due to inflammation processes, but further investigations have to focus on the direction of the found correlation. As gender differences are known in different pathways, they should be considered in research, diagnosis and therapy.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

scholarly journals The Impact of Mutations in Wolframin on Psychiatric Disorders

2021 ◽  
Vol 9 ◽  
Author(s):  
Saira Munshani ◽  
Eiman Y. Ibrahim ◽  
Ilaria Domenicano ◽  
Barbara E. Ehrlich
Keyword(s):  
Bipolar Disorder ◽  
Cell Function ◽  
Psychiatric Symptoms ◽  
Bipolar Disorders ◽  
Wolfram Syndrome ◽  
Published Data ◽  
Behavioral Alterations ◽  
C Terminus ◽  
Heterozygous Carriers ◽  
The Impact

Wolfram Syndrome is a rare autosomal recessive disease characterized by early-onset diabetes mellitus, neurodegeneration, and psychological disorders. Mutations in the gene WFS1, coding for the protein wolframin, cause Wolfram Syndrome and are associated with bipolar disorder and schizophrenia. This report aims to connect WFS1 mutations to their impact on protein expression and structure, which ultimately translates to altered cell function and behavioral alterations of an individual.Methods: Published data were used to compile WFS1 mutations associated with psychiatric symptoms, both in homozygous patients and heterozygous carriers of WFS1 mutations. These mutations were evaluated in silico using SNAP2, PolyPhen-2, and PROVEAN to predict the effects of sequence variants. Statistical analysis was performed to assess the correlation between the locations of the mutations and the damage prediction scores.Results: Several mutations, clustering in the center and C-terminus of the WFS1 polypeptide, such as A559T and R558C, are found in individuals with psychiatric diseases and appear particularly impactful on protein structure. Our analysis showed that mutations in all regions of wolframin were present in patients with schizophrenia whereas only cytoplasmic and ER luminal mutations were reported in patients with manic episodes and bipolar disorders. According to Poly-Phen-2 predictions, 82.4% of the ER lumen mutations and 85.7% of the membrane mutations are damaging.Conclusion: We propose mood disorders in Wolfram Syndrome and heterozygous carriers of WFS1 mutations are the consequence of specific mutations in WFS1 that alter the structure of wolframin, resulting in intracellular calcium dysregulations and impaired cell signaling, Understanding the effect of WFS1 mutations on bipolar disorder and schizoprenia is integral to designing clinically targeted treatments for both diseases, which need more specialized treatments.

Misdiagnose bipolar disorder: About a case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S425-S425
Author(s):  
C. Novais ◽  
M. Marinho ◽  
M. Mota Oliveira ◽  
M. Bragança ◽  
A. Côrte-Real ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Psychiatric Inpatient ◽  
Bipolar Disorders ◽  
Manic Episode ◽  
Inpatient Unit ◽  
Cranial Computed Tomography ◽  
Major Depressive ◽  
Competing Interest

IntroductionEarly stages of bipolar disorder are sometimes misdiagnosed as depressive disorders. This symptomatology can lead to misinterpretation and under diagnosis of bipolar disorders.Objectives/aimsTo describe a patient with a new diagnosis of bipolar disorder after 23 years of psychiatric care.MethodsWe report a case of a 66-year-old man, with a previous psychiatric diagnosis of recurrent depressive disorder for the last 23 years, after a hospitalization in a psychiatric inpatient unit because of a major depressive episode. In subsequent years, he was regularly followed in psychiatric consultation with description of recurrent long periods of depressed mood requiring therapeutic setting, alternating with brief remarks of not valued slightly maladjusted behaviour. At 65, he came to the emergency room presenting with observable expansive and elevated mood, disinhibited behaviour, grandiose ideas and overspending, leading to his hospitalization with the diagnosis of a manic episode. In the inpatient unit care, we performed blood tests, cranial-computed tomography (CT) and a cognitive assessment. His medication has also been adjusted.ResultsLaboratory investigations were unremarkable. Cranial-CT showed some subcortical atrophy of frontotemporal predominance, without corroboration by the neuropsychological evaluation. The patient was posteriorly transferred to a residential unit for stabilization, where he evolved with major depressive symptoms that needed new therapeutic adjustment. Later he was discharged with the diagnosis of bipolar disorder.ConclusionsOur case elucidates the importance of ruling out bipolar disorder in patients presenting with depressive symptoms alternating with non-specific maladjusted behaviour, which sometimes can be a challenging task.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Longitudinal research on bipolar disorders

2007 ◽  
Vol 16 (2) ◽  
pp. 109-117 ◽  
Author(s):  
Paola Salvatore ◽  
Mauricio Tohen ◽  
Hari-Mandir Kaur Khalsa ◽  
Christopher Baethge ◽  
Leonardo Tondo ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Psychotic Disorders ◽  
Longitudinal Research ◽  
Bipolar Disorders ◽  
First Episode ◽  
Longitudinal Assessment ◽  
Bipolar I Disorder ◽  
Illness Onset ◽  
Large Numbers ◽  
Very High

AbstractLongitudinal assessment of the course of major psychiatric disorders has been advanced by studies from onset, but only rarely have large numbers of patients with a range of psychotic and major affective disorders been studied simultaneously and systematically from illness-onset. The decade-long McLean-Harvard First Episode Project & International Consortium for Bipolar Disorder Research has systematically followed-up large numbers of patients with DSM-IV bipolar or psychotic disorders from first hospitalization. Major findings among patients with bipolar I disorder include: [a] full functional recovery from initial episodes was uncommon, and full symptomatic recovery, much slower than early syndromal recovery; [b] risks of relapse, recurrence, and switching were very high in the first two years; [c] most early morbidity was depressive-dysphoric, as reported in mid-course; [d] initial depression or mixed-states predicted more later depressive and overall morbidity, whereas initial mania or psychosis predicted later mania and a better prognosis; [e] based on within-subject modeling, most patients did not show progressive cycling over time, and illness-course was rather chaotic within and among patients; [f] treatment-latency or episode-counts were unassociated with responsiveness to long-term mood-stabilizing treatment; [g] very high rates of suicidal behavior and accidents occurred early; [h] early substance-use comorbidity associated with anxiety; [i] factor-analysis of prodromal symptoms predicted bipolar disorder much better than non-affective psychotic disorders. Project findings indicate that the course of bipolar I disorder is much less favorable than had been believed formerly, despite clinical treatment with modern mood-stabilizing and other treatments.

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.

Bipolar disorders diagnostics in ambulatory medico-psychological service

2017 ◽  
Vol 41 (S1) ◽  
pp. S424-S424
Author(s):  
N. Kornetov ◽  
E. Larionova
Keyword(s):  
Bipolar Disorder ◽  
Schizoaffective Disorder ◽  
Bipolar Disorders ◽  
Manic Episode ◽  
Primary Diagnosis ◽  
Type I ◽  
Dsm 5 ◽  
Psychological Service ◽  
Depressive Episodes ◽  
Disorder Type

IntroductionThe difficulties of diagnosis and clinical differentiation of bipolar disorders, schizophrenia and schizoaffective disorder have been repeatedly noted both foreign and Russian authors.ObjectivesFull medico-psychological service clinical documentation research, including bipolar disorder patient records.AimsDetermination of bipolar disorders in accordance with the DSM-5 criteria among psychiatric outpatients.MethodsA group of 142 patients with established according to ICD-10 diagnoses: schizophrenia, schizoaffective disorder 137 (96.5%); the average patient's age 50 ± 13 and bipolar disorder and mania episode 5 (3.5%) – 55.4 ± 14.4 has been investigated.ResultsIt was found that 18 (12.7%) of all patients meet the DSM-5 bipolar disorder criteria compared with the primary diagnosis (3.5%). Structure of the diagnosis of bipolar disorder was represented as follows: bipolar disorder type I – 11 (61.2%), bipolar disorder type II – 7 (38.8%). Consequently, due to formal application DSM-5 bipolar disorder criteria BD determination 3.5 times more.ConclusionTraditionally, the diagnosis of schizophrenia is preferred over bipolar disorder. Manic episode in bipolar disorder can be evidently regarded as an acute schizophrenia manifestation. The diagnostic criteria for DSM-5 are convenient in diagnostics of manic and depressive episodes in case of their combination in I type bipolar disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Risk of dementia and death in community-dwelling older men with bipolar disorder

2016 ◽  
Vol 209 (2) ◽  
pp. 121-126 ◽  
Author(s):  
Osvaldo P. Almeida ◽  
Kieran McCaul ◽  
Graeme J. Hankey ◽  
Bu B. Yeap ◽  
Jonathan Golledge ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Record Linkage ◽  
Digestive System ◽  
Premature Death ◽  
Later Life ◽  
Electronic Record ◽  
Community Dwelling ◽  
Illness Onset ◽  
Increased Risk ◽  
History Of

BackgroundBipolar disorder has been associated with cognitive decline, but confirmatory evidence from a community-derived sample of older people is lacking.AimsTo investigate the 13-year risk of dementia and death in older adults with bipolar disorder.MethodCohort study of 37 768 men aged 65–85 years. Dementia (primary) and death (secondary), as recorded by electronic record linkage, were the outcomes of interest.ResultsBipolar disorder was associated with increased adjusted hazard ratio (HR) of dementia (HR = 2.30, 95% CI 1.80–2.94). The risk of dementia was greatest among those with <5 years of history of bipolar disorder or who had had illness onset after 70 years of age. Bipolar disorder was also associated with increased mortality (HR = 1.51, 95% CI 1.28–1.77). Competing risk regression showed that bipolar disorder was associated with increased hazard of death by suicide, accidents, pneumonia or influenza, and diseases of the liver and digestive system.ConclusionsBipolar disorder in later life is associated with increased risk of dementia and premature death.

scholarly journals Course of illness in depressive and bipolar disorders

2004 ◽  
Vol 185 (5) ◽  
pp. 372-377 ◽  
Author(s):  
Lars Vedel Kessing ◽  
Mette Gerster Hansen ◽  
Per Kragh Andersen
Keyword(s):  
Bipolar Disorder ◽  
Depressive Disorder ◽  
Affective Disorders ◽  
Hospital Admissions ◽  
Bipolar Disorders ◽  
Case Register ◽  
Course Of Illness ◽  
Longitudinal Course ◽  
The Past ◽  
New Treatments

BackgroundNewer antidepressants have increasingly been used during the past decade. These drugs may increase compliance and reduce the risk of cycle acceleration in affective disorders.AimsTo investigate the naturalistic longitudinal course of illness in patients with depressive or bipolar disorder following the use of recently introduced drugs.MethodThe rates of relapse leading to hospitalisation after successive episodes were calculated in a case register study including all hospital admissions of patients with primary affective disorder in Denmark during 1994–1999. Altogether, 9417 patients had a diagnosis of depressive disorder and 1106 patients had a diagnosis of mania or bipolar disorder, at first-ever discharge.ResultsThe rate of relapse leading to hospitalisation increased with the number of previous episodes in both depressive and bipolar disorders. However, the effect of episodes was not significant for men. The rate of relapse did not decline during the study period.ConclusionsThe course of severe depressive and bipolar disorders has remained roughly the same despite introduction of new treatments.

scholarly journals Aberrant cognition in newly diagnosed patients with bipolar disorder and their unaffected relatives

2019 ◽  
Vol 50 (11) ◽  
pp. 1808-1819 ◽  
Author(s):  
Hanne Lie Kjærstad ◽  
Nicolaj Mistarz ◽  
Klara Coello ◽  
Sharleny Stanislaus ◽  
Sigurd Arne Melbye ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Cognitive Function ◽  
Emotional Reactivity ◽  
Emotion Processing ◽  
Newly Diagnosed ◽  
Neurocognitive Deficits ◽  
Cross Sectional ◽  
Course Of Illness ◽  
Illness Onset ◽  
Illness Progression

AbstractBackgroundPatients with bipolar disorder (BD) experience persistent impairments in both affective and non-affective cognitive function, which is associated with a worse course of illness and poor functional outcomes. Nevertheless, the temporal progression of cognitive dysfunction in BD remains unclear and the identification of objective endophenotypes can inform the aetiology of BD.MethodsThe present study is a cross-sectional investigation of cognitive baseline data from the longitudinal Bipolar Illness Onset-study. One hundred seventy-two remitted patients newly diagnosed with BD, 52 of their unaffected relatives (UR), and 110 healthy controls (HC) were compared on a large battery of behavioural cognitive tasks tapping into non-affective (i.e. neurocognitive) and affective (i.e. emotion processing and regulation) cognition.ResultsRelative to HCs, patients with BD exhibited global neurocognitive deficits (ps < 0.001), as well as aberrant emotion processing and regulation (ps ⩽ 0.011); including decreased emotional reactivity to positive social scenarios, impaired ability to down-regulate positive emotion, as well as a specific deficit in the ability to recognise surprised facial expressions. Their URs also showed a trend towards difficulties identifying surprised faces (p = 0.075). No other differences in cognitive function were found for URs compared to HCs.ConclusionsNeurocognitive deficits and impairments within emotion processing and regulation may be illness-related deficits of BD that present after illness-onset, whereas processing of emotional faces may represent an early risk marker of BD. However, longitudinal studies are needed to examine the association between cognitive impairments and illness progression in BD.

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