scholarly journals Clinical characteristic of prodromal symptoms between bipolar I and II disorder among Chinese patients: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qian Zhao ◽  
Tong Guo ◽  
Yang Li ◽  
Lei Zhang ◽  
Nan Lyu ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Manic Episode ◽  
Chinese Patients ◽  
Psychotic Symptoms ◽  
Type I ◽  
Structured Interviews ◽  
Symptom Scale ◽  
Prodromal Phase ◽  
Prodromal Symptoms ◽  
Clinical Characteristic

Abstract Background This study aimed to identify the clinical characteristic of prodromal symptoms in Chinese patients with bipolar disorder (BD), prior to the first affective episode. It further aimed to characterize the prodromal traits between bipolar disorder type I (BD-I) and type II (BD-II). Methods 120 individuals with BD-I (n = 92) and BD- II (n = 28) were recruited to the study. Semi-structured interviews were then administered to evaluate prodromal symptoms in patients, within 3 years of BD onset, by using the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R). Results In the prodromal phase of the first depressive episode, patients with BD-II experienced more prodromal symptoms (p = 0.0028) compared to BD-I. Additionally, more frequent predictors were reported in patients with BD-II than BD-I including educational and occupational dysfunction (p = 0.0023), social isolation (p < 0.001), difficulty making decisions (p = 0.0012), oppositionality (p = 0.012), and suspiciousness/persecutory ideas (p = 0.017). There were also differences in the duration of the precursors. The duration of “weight loss or decrease in appetite” (p = 0.016) lasted longer in patients with BD-I, while “obsessions and compulsions” (p = 0.023) started earlier in patients with BD-II and occurred during the pre-depressive period. The prevalence and duration of each reported prodrome, preceding a first (hypo) manic episode, showed no difference between patients with BD-I and BD-II. Conclusions Specific affective, general, or psychotic symptoms occurred prior to both affective episodes. The characteristic of prodromal symptoms were key predictors for later episodes of BD including attenuated mania-like symptoms, subthreshold depressed mood, mood swings/lability, and anxiety. In the pre-depressive state, when compared to BD-II, BD-I presented with more prodromal symptoms in nonspecific dimensions, which indicated the substantial burden of BD-II. In conclusion, this study extends the understanding of the characteristics of prodromes of BD-I and BD-II.

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.

Algorithm-Driven Pharmacological Management of Bipolar Disorder in Connecticut Prisons

2011 ◽  
Vol 57 (2) ◽  
pp. 251-264 ◽  
Author(s):  
Jayesh Kamath ◽  
Wanli Zhang ◽  
Karen Kesten ◽  
Sara Wakai ◽  
Deborah Shelton ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Outcome Measures ◽  
Clinical Status ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Type I ◽  
Symptom Scale ◽  
Pharmacological Management ◽  
Correctional Setting ◽  
Disorder Symptom

The objective of this study was to assess adaptation of the Texas Implementation of Medication Algorithm (TIMA) for bipolar disorder (BD) in the Connecticut Department of Correction. A nonrandomized sample of 20 males and 20 females, with diagnoses of BD Type I or II, was enrolled in the study. Two TIMA-trained psychiatrists treated the participants over a 12-week period following the TIMA protocol. The primary outcome measure was the Bipolar Disorder Symptom Scale. Secondary outcome measures evaluated global clinical status, comorbid symptomatology, and quality of life. Significant improvement was seen with the primary and secondary outcome measures ( p < .001). Subanalyses showed differences in outcomes based on gender and whether a manic or depression algorithm was used. Antidepressant and antipsychotic medication use decreased, with increase in anticonvulsant and anxiolytic medication usage. This pilot study confirmed the effectiveness and benefits of TIMA for BD adaptation in the correctional setting.

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&lt;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&lt;0.001) and the HDRS (F=12.761; p&lt;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.

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.

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.

Relationship between cognitive functioning and 6-month clinical and functional outcome in patients with first manic episode bipolar I disorder

2010 ◽  
Vol 41 (5) ◽  
pp. 971-982 ◽  
Author(s):  
I. J. Torres ◽  
C. M. DeFreitas ◽  
V. G. DeFreitas ◽  
D. J. Bond ◽  
M. Kunz ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Clinical Outcome ◽  
Cognitive Functioning ◽  
Functional Outcome ◽  
Verbal Learning ◽  
Manic Episode ◽  
Type I ◽  
Co Morbidity ◽  
Dsm Iv ◽  
The Impact

BackgroundAlthough cognitive deficits in bipolar disorder have been associated with diminished functional outcome, this relationship has been studied primarily through cross-sectional designs, and has not been studied in patients early in the course of illness. The purpose of this study was to evaluate the impact of cognitive functioning on longitudinal 6-month functional and clinical outcome in recently diagnosed clinically stable patients with bipolar disorder.MethodA total of 53 recently diagnosed patients with DSM-IV bipolar disorder type I were assessed within 3 months of their first manic episode using a neuropsychological battery measuring verbal/pre-morbid intellectual functioning, learning/memory, spatial/non-verbal reasoning, attention/processing speed and executive function. Functional outcome was assessed at baseline and 6 months using the Multidimensional Scale of Independent Functioning (MSIF) and DSM-IV Global Assessment of Functioning Scale (GAF). Clinical outcome was assessed with symptom ratings and by monitoring onset of new mood episodes.ResultsMemory, particularly verbal learning/memory, was robustly associated with 6-month functional outcome on the MSIF, even after partialling out the influence of mood symptoms and substance abuse co-morbidity. Depression ratings at 6 months, but not cognitive variables, were associated with 6-month GAF scores. Cognitive functioning was not associated with 6-month clinical outcome.ConclusionsMemory was associated with 6-month longitudinal functional but not clinical outcome in recently diagnosed patients with bipolar disorder. These data further support the distinction between clinical and functional outcome, and emphasize the need for identification of, and development of treatments for, cognitive impairments early in the course of bipolar disorder.

scholarly journals Differences in Demographic and Clinical Characteristics of Patients With Depressive vs. Manic First Episode of Bipolar Disorder

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhonggang Wang ◽  
Yuying Cao ◽  
Yaya Zhu ◽  
Kunkun Li ◽  
Xianfei Jiang ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Clinical Characteristics ◽  
Psychiatric Symptoms ◽  
Education Level ◽  
Chinese Patients ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Clinical Variables ◽  
Depression Group ◽  
Initial Symptoms

Background: Bipolar disorder is a serious mental disease marked by episodes of depression, mania, hypomania, or mixed states. Patients with bipolar disorder may present with different symptoms at first onset. The aim of this study is to compare demographic and clinical variables based on a patient's first episode of bipolar disorder, including risk of recurrence over a 2-year period.Methods: A large cohort (N = 742) of patients with bipolar disorder in China was analyzed. Patients were divided into two groups according to their first episode of bipolar disorder, either depression or mania. Patients in mixed state first episode were classified based on predominant symptoms. Three hundred eighteen patients of the cohort had a first episode of mania and 424 patients had initial symptoms of depression. Demographic and clinical data were collected. All patients were followed up for 24 months. Data on compliance with follow-up appointments and recurrence of symptoms after 6, 12, 18, and 24 months were collected. Clinical characteristics (course of disease, age of onset, psychiatric family history, etc.) were compared between the mania group and depression groups.Results: More patients with bipolar disorder had a first episode of depression than mania (57.14 vs. 42.86%). Compared with the depression group, the mania group had later age of diagnosis of bipolar disorder [(38.64 ± 13.50) vs. (36.34 ± 14.94), P = 0.028], lower education level [(9.37 ± 4.34) vs. (10.17 ± 4.81), P = 0.017] and longer latency between an initial episode of psychiatric symptoms and formal bipolar diagnosis [(10.80 ± 10.76) vs. (8.85 ± 9.90), P = 0.012]. More patients in the mania group were male and without psychotic symptoms (all P &lt; 0.05). In comparison with the mania group, more patients in the depression group were female, with higher frequency of a reported precipitating event before first mood episode (all P &lt; 0.05). Compared with the depression group, the mania group had more recurrences of illness at the end of 12 months (Z =-2.156, P = 0.031), 18 months (Z =-2.192, P = 0.028), and 24 months (Z = −2.364, P = 0.018).Conclusions: In our study, there are a number of differences in demographic and clinical characteristics of patients with different onset syndromes of bipolar disorder. These differences include gender, education level, diagnosis age, the rate of recurrences, and others. These data of a cohort of Chinese patients add to the growing international literature on the relationship between index episode of bipolar disorder and clinical variables and outcomes. These results and further study may allow clinicians to offer patients and families more reliable prognostic information at the onset of disease.

scholarly journals Structural and metabolic differentiation between bipolar disorder with psychosis and substance-induced psychosis: An integrated MRI/PET study

2016 ◽  
Vol 41 (1) ◽  
pp. 85-94 ◽  
Author(s):  
A.C. Altamura ◽  
G. Delvecchio ◽  
G. Marotta ◽  
L. Oldani ◽  
A. Pigoni ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Substance Abuse ◽  
Prefrontal Cortex ◽  
Cerebral Metabolism ◽  
Anterior Cingulate ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Type I ◽  
Healthy Controls ◽  
Posterior Cingulate

AbstractBackgroundBipolar disorder (BD) may be characterized by the presence of psychotic symptoms and comorbid substance abuse. In this context, structural and metabolic dysfunctions have been reported in both BD with psychosis and addiction, separately. In this study, we aimed at identifying neural substrates differentiating psychotic BD, with or without substance abuse, versus substance-induced psychosis (SIP) by coupling, for the first time, magnetic resonance imaging (MRI) and positron emission tomography (PET).MethodsTwenty-seven BD type I psychotic patients with (n = 10) or without (n = 17) substance abuse, 16 SIP patients and 54 healthy controls were enrolled in this study. 3T MRI and 18-FDG-PET scanning were acquired.ResultsGray matter (GM) volume and cerebral metabolism reductions in temporal cortices were observed in all patients compared to healthy controls. Moreover, a distinct pattern of fronto-limbic alterations were found in patients with substance abuse. Specifically, BD patients with substance abuse showed volume reductions in ventrolateral prefrontal cortex, anterior cingulate, insula and thalamus, whereas SIP patients in dorsolateral prefrontal cortex and posterior cingulate. Common alterations in cerebellum, parahippocampus and posterior cingulate were found in both BD with substance abuse and SIP. Finally, a unique pattern of GM volumes reduction, with concomitant increased of striatal metabolism, were observed in SIP patients.ConclusionsThese findings contribute to shed light on the identification of common and distinct neural markers associated with bipolar psychosis and substance abuse. Future longitudinal studies should explore the effect of single substances of abuse in patients at the first-episode of BD and substance-induced psychosis.

The characteristics of psychotic features in bipolar disorder

2018 ◽  
Vol 49 (12) ◽  
pp. 2036-2048 ◽  
Author(s):  
Annet H. van Bergen ◽  
Sanne Verkooijen ◽  
Annabel Vreeker ◽  
Lucija Abramovic ◽  
Manon H. Hillegers ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Childhood Maltreatment ◽  
Linear Models ◽  
Disease Onset ◽  
Cross Sectional Study ◽  
Psychotic Symptoms ◽  
Type I ◽  
Cross Sectional ◽  
History Of ◽  
Psychotic Features

AbstractBackgroundIn a large and comprehensively assessed sample of patients with bipolar disorder type I (BDI), we investigated the prevalence of psychotic features and their relationship with life course, demographic, clinical, and cognitive characteristics. We hypothesized that groups of psychotic symptoms (Schneiderian, mood incongruent, thought disorder, delusions, and hallucinations) have distinct relations to risk factors.MethodsIn a cross-sectional study of 1342 BDI patients, comprehensive demographical and clinical characteristics were assessed using the Structured Clinical Interview for DSM-IV (SCID-I) interview. In addition, levels of childhood maltreatment and intelligence quotient (IQ) were assessed. The relationships between these characteristics and psychotic symptoms were analyzed using multiple general linear models.ResultsA lifetime history of psychotic symptoms was present in 73.8% of BDI patients and included delusions in 68.9% of patients and hallucinations in 42.6%. Patients with psychotic symptoms showed a significant younger age of disease onset (β = −0.09, t = −3.38, p = 0.001) and a higher number of hospitalizations for manic episodes (F11 338 = 56.53, p < 0.001). Total IQ was comparable between groups. Patients with hallucinations had significant higher levels of childhood maltreatment (β = 0.09, t = 3.04, p = 0.002).ConclusionsIn this large cohort of BDI patients, the vast majority of patients had experienced psychotic symptoms. Psychotic symptoms in BDI were associated with an earlier disease onset and more frequent hospitalizations particularly for manic episodes. The study emphasizes the strength of the relation between childhood maltreatment and hallucinations but did not identify distinct subgroups based on psychotic features and instead reported of a large heterogeneity of psychotic symptoms in BD.

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