scholarly journals Manic Episode after Ventricular-Peritoneal Shunt Replacement in a Patient with Radiation-Induced Hydrocephalus: The Role of Lifetime Subthreshold Bipolar Features

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Antonio Callari ◽  
Valentina Mantua ◽  
Mario Miniati ◽  
Antonella Benvenuti ◽  
Mauro Mauri ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Case Reports ◽  
Manic Episode ◽  
Rapid Onset ◽  
D2 Receptors ◽  
Psychotic Symptoms ◽  
Bipolar Spectrum ◽  
Radiation Induced ◽  
Patient’S History

We present a case report of a woman hospitalized for a ventricular-peritoneal shunting replacement, who developed a manic episode with psychotic symptoms after hydrocephalus resolution. We have no knowledge of cases of manic episodes due to hydrocephalus resolution by ventricular-peritoneal shunt replacement, although previous case reports have suggested that hydrocephalus might induce rapid-onset affective episodes or mood cycles. The patient’s history revealed the lifetime presence of signs and features belonging to the subthreshold bipolar spectrum, in absence of previous full-blown episodes of a bipolar disorder. Our hypothesis is that such lifetime sub-threshold bipolar features represented precursors of the subsequent full-blown manic episode, triggered by an upregulated binding of striatum D2 receptors after the ventricular-peritoneal shunt replacement.

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.

Agenesis of the Corpus Callosum in A Patient With Bipolar Disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S493-S493
Author(s):  
J. Nogueira ◽  
R. Ribeiro ◽  
J. Vieira ◽  
R. Sousa ◽  
S. Mendes ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Corpus Callosum ◽  
Past History ◽  
Case Reports ◽  
Manic Episode ◽  
Psychotic Symptoms ◽  
Major Depressive ◽  
Mixed Features ◽  
Competing Interest ◽  
The Brain

BackgroundThe corpus callosum (CC) is the largest white matter structure in the brain, which plays a crucial role in interhemispheric communication. Agenesis of the CC is a rare development anomaly, with unknown cause. It could be asymptomatic or associated with mental retardation and neurologic symptoms. Some case reports, post-mortem studies and image studies have linked thickness reduction and agenesis of CC with psychotic symptoms, mainly in schizophrenia patients. Lately, anatomical abnormalities in the CC have been reported in patients with Bipolar Disorder (BD).Case reportA 52-year-old woman was brought to the emergency room by the authorities after being physically aggressive to her 13-year-old daughter and inappropriate behavior in public. At the emergency department her mood was elevated with emotional lability, dispersible attention, slight increase of motor activity, pressured and difficult to interrupt speech, grandious and self-referent delusional ideas.Her past history revealed hippomaniac episodes characterized by periods of excessive shopping and hyperphagia. In 2008, she had a major depressive episode.Head CT-SCAN revealed agenesia of CC. She received the diagnosis of Manic Episode with mixed features and was treated with valproic acid, flurazepam and olanzapine.ConclusionThis case reinforces the fact that changes in CC, probably due to deficiency in myelination, could have a crucial importance in the pathophysiology of Bipolar Disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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.

Looking for the Cyclothymic Temperament Within Major Depressive Patients: Under-recognising the Bipolar Spectrum?

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
M. Largueche ◽  
T. Ben Abla ◽  
M.F. M'Rad
Keyword(s):  
Bipolar Disorder ◽  
Family History ◽  
Antidepressant Treatment ◽  
Psychotic Symptoms ◽  
Bipolar Spectrum ◽  
Global Functioning ◽  
Major Depressive ◽  
Bipolar Spectrum Disorder ◽  
Significant Difference ◽  
Depressive Patients

Background:Under-recognised bipolar spectrum disorder is going to be one of the most important debates in new articles and researches. Recent data, enlarging bipolar criteria to temperament, family history and more, try to help clinicians in the recognition of the broader spectrum of bipolarity and so getting the most adequate therapeutic attitude.Methods:Consecutive 86 Tunisian patients who meet the DSM IV criteria for major depressive episode (MDE) were interviewed with the temperament evaluation of Memphis,Pisa,Paris and San Diego in order to assess the frequency of cyclothymic temperament (CT).Then we compared the distribution of bipolar criteria, as defined by Akiskal between cyclothymic depressive patients and non cyclothymic ones.Finally the evolution under antidepressants was studied using the GFE:the global functioning evaluation.Results:34.9% of patients meet the criteria of cyclothymic temperament and compared to the 65.1% who did not, they had significantly lower age of onset, higher recurrence of MDE, more atypical features and more suicidal attempts and comorbidities (anxious disorders and drug abuse).Family history of bipolar disorder was more frequently found within the cyclothymic group as well as psychotic symptoms but not with a significant difference. Finally 71.4% of the non cyclothymic patients improved under antidepressants (GFE score >= 70) compared to only 26.6% in the group of cyclothymic ones.Conclusion:If we consider the large criteria of bipolarity and the concept of an affective spectrum, the prevalence of bipolar disorder become higher than previously believed, making clinicians reconsider the relevance of the diagnostic of unipolar trouble and the pertinence of the antidepressant treatment.

scholarly journals Maintenance Treatment of Bipolar Disorder with Ziprasidone in Adjunctive Use with Lithium or Valproate

2012 ◽  
Vol 4 ◽  
pp. CMT.S7369 ◽  
Author(s):  
Steven L. Dubovsky ◽  
Amelia N. Dubovsky
Keyword(s):  
Bipolar Disorder ◽  
Antipsychotic Drugs ◽  
Mood Stabilizer ◽  
Manic Episode ◽  
Mood Stabilizers ◽  
Psychotic Symptoms ◽  
Comorbid Conditions ◽  
Recurrence Rates ◽  
Atypical Antipsychotic Drug ◽  
A Current

Ziprasidone is a second generation (“atypical”) antipsychotic drug that has been used alone and as an adjunct to standard mood stabilizers to reduce recurrence rates in bipolar disorder. Approval of ziprasidone as an adjunct to lithium or valproate in 2009 was based on an industry sponsored study of 584 outpatients with a current or recent manic episode; 240 of these subjects were randomized to adjunctive ziprasidone or placebo and 138 completed a six month trial. Patients enrolled in maintenance studies did not have refractory mood disorders, comorbid conditions or risk of dangerousness. Maintenance ziprasidone augmentation is an option for patients who do not respond to a single mood stabilizer rapidly, and possibly for those with residual psychotic symptoms, but there are insufficient data to prefer this approach to combinations of mood stabilizers or augmentation with other agents. Ziprasidone is generally well tolerated, with less sedation and weight gain than many other antipsychotic drugs; it should be taken with food. Primary interactions of concern are with other serotonergic medications, MAO inhibitors, and other medications that prolong the QT interval.

Use of amisulpride in clozapine-resistant schizophrenic patients: Three case reports

2011 ◽  
Vol 26 (S2) ◽  
pp. 1338-1338
Author(s):  
S.E. Ahlund ◽  
I. Gosai
Keyword(s):  
Side Effects ◽  
Treatment Option ◽  
Case Reports ◽  
Clinical Results ◽  
Psychotic Symptoms ◽  
Large Numbers ◽  
Second Generation Antipsychotics ◽  
Insufficient Response ◽  
Schizophrenic Patients

IntroductionIt is generally accepted that Clozapine is the gold standard treatment in patients with treatment resistant schizophrenia. Large numbers of patients treated with Clozapine discontinue treatment for various reasons including severe side-effects and insufficient response. There is limited literature supporting the next-step treatment option following the discontinuation of Clozapine.ObjectivesThe atypical antipsychotic Amisulpride as a next-step treatment option beyond Clozapine, is hypothesised to be useful in some patients due to its first pass metabolism which differs from other second generation antipsychotics. The authors present the clinical response from using Amisulpride in three Clozapine-resistant schizophrenic patients.AimsThe authors aim to demonstrate the role of Amisulpride monotherapy in patients with schizophrenia who are resistant to, Clozapine.MethodThree cases of individuals with residual psychotic symptoms despite Clozapine use and/ or with significant side effects precipitating discontinuation, are presented. They were changed to Amisulpiride and their response was evaluated by clinical assessment.ResultsPositive clinical results were obtained in all three patients, with improvement of psychotic symptoms and of some of the more common side effects of Clozapine.ConclusionThe findings from these cases suggest that Amisulpride can be of benefit in treating Clozapine-resistant schizophrenic patients. Further, more structured trials are needed to understand these findings.

Lamotrigine for the Treatment of Bipolar Disorder

2000 ◽  
Vol 34 (2) ◽  
pp. 258-262 ◽  
Author(s):  
Patricia M Engle ◽  
Amy M Heck
Keyword(s):  
Bipolar Disorder ◽  
Clinical Efficacy ◽  
Case Reports ◽  
Controlled Trial ◽  
Current Data ◽  
Stabilizing Agents ◽  
Treatment Refractory

OBJECTIVE: To describe the available data regarding the clinical efficacy of lamotrigine for the treatment of bipolar disorder. SUMMARY: Anticonvulsants have emerged as alternative mood-stabilizing agents for patients with bipolar disorder who do not respond to lithium. Data regarding the efficacy of lamotrigine have been generated primarily from case reports, small open trials, and one large, randomized, placebo-controlled trial. These reports suggest that lamotrigine may be effective for the management of bipolar disorder. CONCLUSIONS: Although current data are limited, treatment-refractory patients with bipolar disorder may benefit from lamotrigine therapy. Several studies are currently underway to determine the appropriate role of lamotrigine in the treatment of bipolar disorder.

Depot aripiprazole as maintenance treatment in bipolar disorder: Report of a case

2016 ◽  
Vol 33 (S1) ◽  
pp. S332-S332
Author(s):  
C. Gómez Sánchez-Lafuente ◽  
R. Reina Gonzalez ◽  
A. De Severac Cano ◽  
I. Tilves Santiago ◽  
F. Moreno De Lara ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Maintenance Treatment ◽  
Oral Treatment ◽  
Manic Episode ◽  
Mood Stabilizers ◽  
Community Center ◽  
Psychotic Symptoms ◽  
Competing Interest ◽  
Long Acting

IntroductionRecently, depot aripiprazole was approved as a maintenance treatment for schizophrenia. However, long-acting antipsychotics has not been established efficacy in manic episode or maintenance treatment of bipolar disorder.AimsDescribe a clinical case of multiresistant bipolar disorder.MethodsThirty-nine years old male, diagnosed since 8 years ago with bipolar disorder, current episode manic with psychotic symptoms, admitted to Acute Psychiatrist Unit. It was his seventh internment. He was dysphoric, had insomnia, and showed many psychotic symptoms like grandiose delusions and delusions of reference. He thought he was a famous painter from nineteenth century.His disorder was refractory to mood stabilizers monotherapy and to many neuroleptic and, like olanzapine 30 mg/day, depot risperidone, zuclopenthixol, haloperidol, palmitate paliperidone, He was on treatment with lithium 1200 mg/day (lithemia 0.62 prior to admission) and oral aripiprazole 15 mg/day that he was not taking regularly. Poor compliance to oral treatment. No awareness of illness.Resultsduring the patient admission, we started long-acting aripiprazole 400 mg per 28–30 days. First 3 days he persisted dysphoric, hostile, and showing delusions of mind being read. From the fourth day, delusions disappeared and later he was calmer and more friendly, He was discharged 9 days later fully euthymic.For 6 months follow-up, the patient came once a month to community center for aripiprazole injection and he was taking lithium regularly. Last lithemia 0.65 mEQ/L.ConclusionLong-acting antipsychotics, like depot aripiprazole could be a useful alternative to oral medication, specially when there is no awareness of illness and there is low adherence to oral treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A case report of patient who had two manic episodes with psychotic features induced by nasal decongestant

2017 ◽  
Vol 41 (S1) ◽  
pp. S428-S428
Author(s):  
A. Kandeger ◽  
R. Tekdemir ◽  
B. Sen ◽  
Y. Selvi
Keyword(s):  
Bipolar Disorder ◽  
Case Reports ◽  
Nasal Congestion ◽  
Manic Episode ◽  
First Episode ◽  
Stimulant Effect ◽  
Sympathomimetic Drugs ◽  
The Central Nervous System ◽  
Competing Interest ◽  
Psychotic Features

ObjectivePhenylephrine, pseudoephedrine and ephedrine are the sympathomimetic drugs that have been used most commonly in oral preparations for the relief of nasal congestion. These drugs stimulate the central nervous system that is affected by the alpha and beta adrenergic agonism. Sympathomimetic agents used in the treatment of flu and common cold with ephedrine and pseudoephedrine are case reports. That the manic and psychotic episodes are triggered. In this article, we would like to present a bipolar manic disorder with two manic episodes and both of them triggered by influenza drugs.CaseA 25-year-old man patient was admitted to psychiatric outpatient clinic with increasing complaints such as increasing energy, speaking much, decreasing sleep, increasing the libido after using the flu drug that prescribed to him containing phenylephrine. Also, 2 years ago, he has manic attack triggered after the flu drug.DiscussionIn recent years the study of epilepsy and bipolar disorder in common suggests that bipolar disorder may affect the kindling phenomenon. In our case, two of reasons in the neurobiology of developing manic attacks the kindling phenomenon is likely to be effective. First, the possibility of using cold medicine containing ephedrine or pseudoephedrine in the first manic episode, in the second manic episode having spent the attack with FAQ stimulant effect of lower phenylephrine. Second, in the first episode after using the 5–6 tablets developing manic attacks. In the second attack to be triggered with just 2 doses may indicate the effect of kindling.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The role of electroconvulsive therapy in the treatment of bipolar disorder

2017 ◽  
Author(s):  
Roumen Milev
Keyword(s):  
Bipolar Disorder ◽  
Electroconvulsive Therapy ◽  
Case Reports ◽  
Bipolar Disorders ◽  
Seizure Threshold ◽  
Randomized Control Trials ◽  
Mixed States ◽  
Everyday Clinical Practice ◽  
Randomized Control

This chapter examines the use of electroconvulsive therapy (ECT) for treatment of patients with bipolar disorders. It briefly reviews the basics of ECT, stimulus parameters, placement of electrodes, and seizure threshold. The data for efficacy and tolerability of ECT for bipolar disorder, including mania, depression, mixed states, and across the lifespan is reviewed. Although there is a paucity of good-quality randomized studies, all available data, including case reports and naturalistic observations, support the use of ECT in this population, and reinforce the widespread use of ECT in everyday clinical practice. Good-quality randomized control trials are urgently needed to address numerous unanswered questions, in order to improve efficacy and reduce side-effect burden of one of the best treatments for bipolar disorder.

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