Creatine kinase levels in patients with bipolar disorder: depressive, manic, and euthymic phases

OBJECTIVE: Bipolar disorder is a severe, recurrent, and often chronic psychiatric illness associated with significant functional impairment, morbidity, and mortality. Creatine kinase is an important enzyme, particularly for cells with high and fluctuating energy requirements, such as neurons, and is a potential marker of brain injury. The aim of the present study was to compare serum creatine kinase levels between bipolar disorder patients, in the various phases (depressive, manic, and euthymic), and healthy volunteers. METHOD: Forty-eight bipolar patients were recruited: 18 in the euthymic phase; 17 in the manic phase; and 13 in the depressive phase. The control group comprised 41 healthy volunteers. The phases of bipolar disorder were defined as follows: euthymic-not meeting the DSM-IV criteria for a mood episode and scoring < 8 on the Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS); manic-scoring < 7 on the HDRS and > 7 on the YMRS; depressive-scoring > 7 on the HDRS and < 7 on the YMRS. Patients in mixed phases were excluded. Blood samples were collected from all participants. RESULTS: Creatine kinase levels were higher in the manic patients than in the controls. However, we observed no significant difference between euthymic and depressive patients in terms of the creatine kinase level. CONCLUSION: Our results suggest that the clinical differences among the depressive, manic, and euthymic phases of bipolar disorder are paralleled by contrasting levels of creatine kinase. However, further studies are needed in order to understand the state-dependent differences observed in serum creatine kinase activity.

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Comparison of efficacy between risperidone and aripiprazole in combination with sodium valproate in patients with acute manic or mixed episodes

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1390 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S749-S749

Author(s):

N. Amanat ◽

A. Nazeri Astane ◽

B. Dieji ◽

O. Rezaie ◽

A. Biglarian

Keyword(s):

Weight Gain ◽

Sodium Valproate ◽

Rating Scale ◽

Analysis Of Covariance ◽

Young Mania ◽

Double Blind ◽

Measurement Evaluation ◽

Significant Difference ◽

Competing Interest ◽

Bipolar Patients

Today, despite of the improvement in the psychological therapeutic approach, mania still remains as a challenging problem for health system. The aim of this study is comparison efficacy of risperidone and aripiprazole in combination with sodium valproate in bipolar patients with acute manic or mixed episodes who hospitalized in Razi psychiatric hospital in Tehran. This study was conducted as a double blind randomized clinical trial in two groups of bipolar disorder patients with manic or mixed episodes (18–65 age). Patients randomly set in two groups who received valproate with aripiprazole or risperidone. Clinical response was assessed with young mania rating scale (YMRS) and weight gain at 3 and 6 weeks. Data was analyzed with Chi2 test, paired t-test and analysis of covariance and repeated measurement. Evaluation of treatment response after 3 and 6 weeks (50% reduction in Young's scale) in both groups did not show any significant difference between the two therapeutic combinations. The combination of sodium valproate and risperidone showed higher weight gain in comparison with the combination of valproate and aripiprazole at the end of week 6 (P < 0.001). The mentioned combination in bipolar I disorder with manic or mixed episode has similar therapeutic effect, so that both of them are effective and usable. There was no difference in their efficacy, and both treatments can be used. Due to the less weight gain, the combination of valproate and aripiprazole in patients who prone to weight gain, this approach is recommended as more safe and effective therapy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Adjunctive Treatment with Gabapentin in Bipolar Patients during Acute Mania

The International Journal of Psychiatry in Medicine ◽

10.2190/pm.43.3.e ◽

2012 ◽

Vol 43 (3) ◽

pp. 261-271 ◽

Cited By ~ 4

Author(s):

Ali Nazeri Astaneh ◽

Omid Rezaei

Keyword(s):

Bipolar Disorder ◽

Rating Scale ◽

Age Groups ◽

Acute Mania ◽

Adjunctive Treatment ◽

Control Group ◽

Case Group ◽

Final Score ◽

Bipolar Patients ◽

And Control

Objective: In this clinical trial, we studied the effects of adjunctive treatment with gabapentin in controlling the symptoms of acute mania in patients admitted with bipolar disorder. Method: Sixty patients with bipolar disorder (30 men and 30 women) admitted in the acute phase of mania were categorized as case and control groups, each holding 30 patients. Both groups were treated with lithium for 6 weeks and the case group received an adjunctive treatment with 900 mg gabapentin simultaneously. All patients were evaluated at the beginning and the end of the trial using Young's Mania Rating Scale (YMRS), and two groups were compared for improvement in acute symptoms. Findings: The final score of YMRS was significantly improved in the case group compared to the control group ( p = 0.00). The improvement of YMRS score was not significantly different between men and women and between different age groups. Conclusion: Adjunctive treatment with gabapentin is effective for controlling symptoms of acute mania.

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Absence and size of massa intermedia in patients with schizophrenia and bipolar disorder

Acta Neuropsychiatrica ◽

10.1111/j.1601-5215.2008.00296.x ◽

2008 ◽

Vol 20 (4) ◽

pp. 193-198 ◽

Cited By ~ 9

Author(s):

Meltem Ceyhan ◽

Baki Adapınar ◽

Gokay Aksaray ◽

Figen Ozdemir ◽

Ertugrul Colak

Keyword(s):

Bipolar Disorder ◽

Magnetic Resonance ◽

Gender Difference ◽

Sagittal Plane ◽

Magnetic Resonance Images ◽

Control Group ◽

Healthy Controls ◽

Significant Difference ◽

Specific Alteration ◽

Bipolar Patients

Objective:To evaluate the absence and size of massa intermedia (MI), a midline thalamic structure, and its gender-specific alteration in patients with schizophrenia and bipolar disorder.Methods:Thirty-five patients with schizophrenia (17 females and 18 males), 21 patients with bipolar disorder (15 females and 6 males) and 89 healthy controls (50 females and 39 males) were evaluated by magnetic resonance imaging. Thin-slice magnetic resonance images of the brain were evaluated. MI was determined in coronal and sagittal images, and area of the MI was measured on the sagittal plane.Results:Females had a significantly lower incidence of absent MI compared with males in the healthy control group. The absence of MI in schizophrenia and bipolar patients was not higher than the incidence in healthy controls. The size of MI showed a gender difference. The mean MI area size was smaller in female schizophrenia patients than in female controls, while no significant difference was observed between male schizophrenia patients and their controls.Conclusions:The size of MI, a gender difference midline structure, is smaller in females with schizophrenia, and the results of this study support other studies of structural aberration of the thalamus and other midline structures in the brains of patients with schizophrenia.

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Psychosocial functioning impairment in euthymic patients with bipolar disorder II: The role of clinical factors

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1164 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S333-S333

Author(s):

R.S. Ilhan ◽

V. Senturk-Cankorur

Keyword(s):

Bipolar Disorder ◽

Psychosocial Functioning ◽

Rating Scale ◽

Healthy Individuals ◽

Young Mania ◽

Clinical Variables ◽

Hamilton Anxiety Rating Scale ◽

Short Test ◽

Competing Interest ◽

Bipolar Patients

IntroductionGrowing body of evidence have showed that euthymic bipolar patients have poor psychosocial functioning. Most of the studies have focused on the psychosocial functioning in euthymic bipolar disorder (BD)-I patients. On the contrary, there have been limited researches investigating psychosocial functioning in euthymic BD-II patients. Moreover, the factors associated with psychosocial functioning in euthymic patients with BD II have been also understudied.Objectives/aimsAim of our study was to investigate the association between clinical variables and poor psychosocial functioning in euthymic BD-II patients. Hypothesis of this study was that euthymic BD-II patients would have low level of psychosocial functioning compared with healthy individuals.MethodsBD-II (n = 37) and healthy subjects (n = 35) were compared in terms of their psychosocial functioning which were assessed by Functional Assessment Short Test (FAST). The euthymic state was confirmed by low scores both on the Hamilton Depression Rating Scale (HDRS) and the Young Mania Rating Scale (YMRS). Anxiety symptoms were also assessed by Hamilton Anxiety Rating Scale (HARS) in both groups. Clinical variables were taken as independent variables and FAST scores were taken as dependent variable in order to run correlation analysis in BD-II group.ResultsNo socio-demographic differences were found between two groups. Euthymic BD-II patients had significantly higher FAST, HARS, HDRS YMRS scores compared with healthy individuals. Only HDRS scores correlated with FAST scores of BD-II patients.ConclusionsThis study indicated that euthymic BD-II patients had poorer psychosocial functioning. And subclinical depressive symptoms were associated with poor psychosocial functioning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Normal levels of prepulse inhibition in the euthymic phase of bipolar disorder

Psychological Medicine ◽

10.1017/s0033291705005702 ◽

2005 ◽

Vol 35 (12) ◽

pp. 1737-1746 ◽

Cited By ~ 28

Author(s):

SUZANNE LUCIA BARRETT ◽

CHRISTOPHER KELLY ◽

DAVID ROBERT WATSON ◽

ROBERT BELL ◽

DAVID JOHN KING

Keyword(s):

Bipolar Disorder ◽

Prepulse Inhibition ◽

Startle Response ◽

Rating Scale ◽

Acoustic Startle ◽

High Risk Group ◽

Schizophrenia Spectrum Disorders ◽

Young Mania ◽

Stimulus Interval ◽

Bipolar Patients

Background. Deficits in prepulse inhibition (PPI) of the acoustic startle response have been suggested as a potentially useful endophenotype for schizophrenia spectrum disorders and may explain certain symptoms and cognitive deficits observed in the psychoses. PPI deficits have also been found in mania, but it remains to be confirmed whether this dysfunction is present in the euthymic phase of bipolar disorder.Method. Twenty-three adult patients with DSM-IV bipolar disorder were compared to 20 controls on tests of acoustic startle reactivity and PPI of the startle response. Sociodemographic and treatment variables were recorded and symptom scores assessed using the Hamilton Depression Inventory and the Young Mania Rating Scale.Results. Overall, the patient and control groups demonstrated similar levels of startle reactivity and PPI, although there was a trend for the inter-stimulus interval to differentially affect levels of PPI in the two groups.Conclusions. In contrast to bipolar patients experiencing a manic episode, general levels of PPI were normal in this euthymic sample. Further studies are required to confirm this finding and to determine the mechanisms by which this potential disruption/normalization occurs. It is suggested that an examination of PPI in a high-risk group is required to fully discount dysfunctional PPI as a potentially useful endophenotype for bipolar disorder.

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Celecoxib added to mood stabilizer for treating acute mania in bipolar disorder: A randomized, double -blind, placebo-controlled trial in IRAN

10.21203/rs.3.rs-237985/v1 ◽

2021 ◽

Author(s):

Farhad Faridhosseini ◽

Ali Talaei ◽

Najmeh Shahini ◽

Mahbobeh Eslamzadeh ◽

Samira Ahrari ◽

...

Keyword(s):

Repeated Measures ◽

Rating Scale ◽

Controlled Trial ◽

Acute Mania ◽

Control Group ◽

Young Mania ◽

Double Blind ◽

Double Blind Placebo ◽

Valproate Sodium ◽

Significant Difference

Abstract Background: Inflammatory processes in the brain contribute to the aetiopathogenesis of acute mania. Cyclooxygenase-2 (COX-2) inhibitors, such as Celecoxib, reduce the production of pro-inflammatory cytokines. The purpose of the present investigation was to assess the efficacy of Celecoxib in the treatment of acute mania.Methods: We conducted a double-blind, placebo-controlled trial at the Specialty in-patient Clinic of Ibn-e-Sina Hospital [Mashhad University of Medical Sciences, Iran] from March 2017 to August 2017. The study involved 58 patients who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria for acute mania screening to participate in the trial were used for the study. Twenty-three patients were assigned to a study group and were given Valproate Sodium 200 mg /BD plus Celecoxib 400 mg/day (200 mg BID). The control group included 22 patients who were given Valproate Sodium 200 mg /BD plus placebo. Patients were assessed by Young Mania Rating Scale (YMRS) at baseline 0, after 9, 18, and 28 days after the medication started. Data were analyzed by using Statistical Package for Social Sciences (SPSS) 11.5., two-way repeated measures analysis of variance, Fisher’s exact test, and T-Test. P≤0.05 was considered to be statistically significant.Results: A total of 58 patients were screened and 45 were randomized. Most of participations in celecoxib group were male (55%) and in placebo group were female (75%). There were no statistically significant differences between the groups regarding number of episode. sex, marital status, past medical history, past psychiatry history and family history P value ≥0.05. A significant difference was observed in the change of scores on Young Mania Rating Scale (YMRS) at week 4 as compared to the baseline in patient groups P: 0.04.Conclusion: This study suggested that Celecoxib can be an effective adjuvant agent in managing patients with acute mania and anti-inflammatory therapies should further be investigated in these patients.Trial registration: Iran clinical trial register: IRCT20200306046708N1

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Early Schizophrenia and Bipolar Disorder Patients Display Reduced Neural Prepulse Inhibition

Brain Sciences ◽

10.3390/brainsci12010093 ◽

2022 ◽

Vol 12 (1) ◽

pp. 93

Author(s):

Rodrigo San-Martin ◽

Maria Zimiani ◽

Milton de Ávila ◽

Rosana Shuhama ◽

Cristina Del-Ben ◽

...

Keyword(s):

Bipolar Disorder ◽

Prepulse Inhibition ◽

Rating Scale ◽

Acoustic Startle ◽

Acoustic Startle Response ◽

Population Based ◽

Simultaneous Recording ◽

First Episode ◽

Control Group ◽

Young Mania

Background: Altered sensorimotor gating has been demonstrated by Prepulse Inhibition (PPI) tests in patients with psychosis. Recent advances in signal processing methods allow assessment of neural PPI through electroencephalogram (EEG) recording during acoustic startle response measures (classic muscular PPI). Simultaneous measurements of muscular (eye-blink) and neural gating phenomena during PPI test may help to better understand sensorial processing dysfunctions in psychosis. In this study, we aimed to assess simultaneously muscular and neural PPI in early bipolar disorder and schizophrenia patients. Method: Participants were recruited from a population-based case-control study of first episode psychosis. PPI was measured using electromyography (EMG) and EEG in pulse alone and prepulse + pulse with intervals of 30, 60, and 120 ms in early bipolar disorder (n = 18) and schizophrenia (n = 11) patients. As control group, 15 socio-economically matched healthy subjects were recruited. All subjects were evaluated with Rating Scale, Hamilton Rating Scale for Depression, and Young Mania Rating Scale questionnaires at recruitment and just before PPI test. Wilcoxon ranked sum tests were used to compare PPI test results between groups. Results: In comparison to healthy participants, neural PPI was significantly reduced in PPI 30 and PPI60 among bipolar and schizophrenia patients, while muscular PPI was reduced in PPI60 and PPI120 intervals only among patients with schizophrenia. Conclusion: The combination of muscular and neural PPI evaluations suggested distinct impairment patterns among schizophrenia and bipolar disorder patients. Simultaneous recording may contribute with novel information in sensory gating investigations.

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Lovastatin as an Adjuvant to Lithium for Treating Manic Phase of Bipolar Disorder: A 4-Week, Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Depression Research and Treatment ◽

10.1155/2014/730505 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Ahmad Ghanizadeh ◽

Motahhar OmraniSigaroodi ◽

Ali Javadpour ◽

Mohammad Hossein Dabbaghmanesh ◽

Sara Shafiee

Keyword(s):

Clinical Trial ◽

Bipolar Disorder ◽

Placebo Group ◽

Adverse Effects ◽

Rating Scale ◽

Clinical Symptoms ◽

Controlled Clinical Trial ◽

Young Mania ◽

Double Blind ◽

Significant Difference

Objectives. Many patients with bipolar disorder suffer from metabolic disorder. Lovastatin is effective for treating major depression. This double-blind randomized placebo controlled clinical trial investigates whether lovastatin is a useful adjuvant to lithium for treating mania.Methods. Fifty-four patients with bipolar disorder-manic phase were randomly allocated into lovastatin or placebo group. The clinical symptoms were assessed at baseline, week 2, and week 4 using Young Mania Rating Scale. Adverse effects were checked.Results. Forty-six out of 54 patients completed this trial. The mania score in the lovastatin group decreased from 40.6 (11.1) at baseline to 12.9 (8.7) and 4.1 (5.4) at weeks 2 and 4, respectively. The score in the placebo group decreased from 41.0 (11.2) at baseline to 12.8 (8.07) and 5.8 (4.6) at weeks 2 and 4, respectively. However, there was no significant difference between groups at week 2 and week 4. The adverse effects rates were comparable between the two groups. No serious adverse effect was found. Tremor and nausea were the most common adverse effects.Conclusions. Lovastatin neither exacerbated nor decreased the symptoms of mania in patients with bipolar disorder. Current results support that the combination of lovastatin with lithium is tolerated well in bipolar disorder. The trial was registered with the Iranian Clinical Trials Registry (IRCT201302203930N18).

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Assessment of psychotic symptoms in bipolar disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.376 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S419-S419

Author(s):

F. Cazan ◽

R. Paunescu ◽

A. Tamas

Keyword(s):

Bipolar Disorder ◽

Rating Scale ◽

Psychotic Symptoms ◽

Young Mania ◽

Affective Symptoms ◽

Number Of Patients ◽

General Functioning ◽

Competing Interest ◽

Bipolar Patients ◽

Manic Patients

IntroductionBipolar disorder is a disabling condition characterized by the presence of manic, depressive, hypomanic or mixed episodes, affective symptoms that may coexist with several types of psychotic features.ObjectivesThe purpose is to evaluate the frequency of psychotic symptoms among bipolar disorder.MethodThe study included 55 bipolar patients admitted in the Psychiatry Clinical Hospital from January 2012 until May 2013. Inclusion criteria were represented by diagnosis of bipolar disorder, manic or depressive episode, according to DSM-IV-TR and ICD 10 criteria. Clinical instruments used to assess the severity of the current affective episode were Young Mania Rating Scale (YMRS) for manic patients and Hamilton Depression Rating Scale-17 items – (HDRS) for the depressive ones. Psychotic symptoms were evaluated with the Brief Psychiatric Rating Scale-18 items – (BPRS).ResultsOut of the 55 patients, 32 had psychotic symptoms upon admission to the hospital. BPRS results showed delusions of guilt, inutility, hypochondriac and nihilistic delusions for the depressed patients. Delusions of grandiosity and megalomania accounted for most of psychotic symptoms in manic patients. A smaller number of patients showed delusions of invention and reform. Perception disturbances such as auditory hallucinations were present in both diagnosis categories but in a higher percentage in depressive bipolar patients.ConclusionsEven if less frequently than in schizophrenia or schizoaffective disorder, psychotic symptoms are present in bipolar disorder. They influence the general functioning and the outcome of patients diagnosed with this illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Prepulse inhibition in euthymic bipolar disorder patients in comparison with control subjects

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.170 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S126-S126

Author(s):

J.L. Santos ◽

J. Mateo ◽

A. Aparicio ◽

E.M. Sánchez-Morla

Keyword(s):

Bipolar Disorder ◽

Social Cognition ◽

Prepulse Inhibition ◽

Rating Scale ◽

Smoking Status ◽

Sensorimotor Gating ◽

Cognitive Measures ◽

Young Mania ◽

Control Subjects ◽

Bipolar Patients

IntroductionDeficient prepulse inhibition (PPI) of the startle response, indicating sensorimotor gating deficits, has been reported in schizophrenia and other neuropsychiatric disorders.Objectives and aimsThe present study aimed to assess sensorimotor gating deficits in euthymic bipolar patients. Furthermore, we analysed the relationships between PPI and clinical and cognitive measures.MethodPPI was measured in 64 euthymic bipolar patients and in 64 control subjects matched for age, gender, education level and smoking status. Clinical characteristics and level of functioning were assessed in all participants using the Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS) and Functioning Assessment Short Test (FAST). Cognition was evaluated using the MATRICS Consensus Cognitive Battery (MCCB) and the Stroop Test as an additional measure of executive function.ResultsCompared with controls, patients with bipolar disorder exhibited PPI deficits at 60- and 120-milliseconds prepulse-pulse intervals. Among patients with bipolar disorder, PPI was correlated with the social cognition domain of the MCCB. PPI was not significantly correlated with other clinical or neurocognitive variables in either group.ConclusionsOur data suggest that PPI deficit is a neurobiological marker in euthymic bipolar disorder, which is associated with social cognition but not with other clinical, functional or cognitive measures.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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