Case Report: Paliperidone Palmitate in the Management of Bipolar I Disorder With Non-compliance

Background: Medication non-adherence is prevalent in patients with bipolar disorder (BD). Long-acting injectable antipsychotics (LAIAs) are widely used to improve compliance with treatment. This study aimed to illustrate the effectiveness, compliance, and safety profile of once-monthly paliperidone palmitate (PP1M), a novel therapeutic LAIA, in the management of bipolar I disorder (BDI).Method: A prospective follow-up was arranged to 11 BDI patients who were prescribed PP1M as monotherapy or adjunctive treatment. Severity of symptoms, disturbing behavior, status of employment, 17-item Hamilton Depression Rating Scale (HAMD-17), and Young Mania Rating Scale (YMRS) were evaluated at the baseline and the endpoint of follow-up. Clinical Global Impression—Bipolar Disorder—Severity of Illness Scale (CGI-BP) and Treatment Emergent Symptom Scale (TESS) were measured at each injection of PP1M. Compliance, relapse or switch, and new hospitalization were monitored through the period of follow-up.Results: The median duration of treatment was 14 months, ranging from 5 to 22 months. The scores (mean ± standard deviation) of HAMD-17, YMRS, and CGI-BP generally decreased from the baseline (16.1 ± 10.3, 30.9 ± 12.6, 5.3 ± 0.7) to the endpoint (7.4 ± 5.7, 3.7 ± 3.2, 2.3 ± 0.7). No disturbing behavior was detected at the endpoint. Neither new hospitalization nor manic/mixed episode occurred during treatment, whereas mild to moderate depressive episodes were reported in three cases. The status of employment of 10 participants (90.9%) was improved, and no new safety concern was detected.Conclusion: PP1M might offer a new valid treatment option in the long-term management of BDI, especially for those with poor compliance with oral medication. However, more studies are needed to further justify such role.

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Comparisons of Narrative Psychotherapy to Conventional CBT for the Psychotherapy of Psychosis and Bipolar Disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1480 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s779-s779

Author(s):

L. Mehl-Madrona ◽

B. Mainguy

Keyword(s):

Bipolar Disorder ◽

Narrative Therapy ◽

Rating Scales ◽

Psychotic Disorders ◽

Rating Scale ◽

Therapy Group ◽

Well Being ◽

Outcome Data ◽

Symptom Scale ◽

Young Mania

IntroductionThere is ongoing debate about about both the value of psychotherapy in psychotic disorders and the best type of psychotherapy to use if necessary.MethodsWe conducted narrative psychotherapy with 18 adults, all diagnosed as having bipolar disorder with psychotic features and/or schizo-affective disorder. Outcome data consisted of the Positive and Negative Symptom Scale, the Clinical Global Impressions Scale, the Young Mania Rating Scale, the Hamilton Anxiety and Depression Scales, the My Medical Outcome Profile, Version 2(MYMOP2), and the Outcome Rating Scales of Duncan and Miller. We compare the outcomes of our patients to those of a matched comparison group receiving conventional psycho-education and cognitive behavioural therapy. Patients were seen for a minimum of 16 weeks over an average of 22 weeks. Average age was 31.5 years with a standard deviation of 8.1 years.ResultsThe narrative therapy group showed statistically significant reductions in all outcome measures compared to the conventional treatment group. They continued treatment significantly longer and had fewer re-hospitalizations. They were less distressed by voices.ConclusionsA narrative psychotherapy approach using dialogical theory and therapy ideas is a reasonable approach for the psychotherapy of psychosis. Review of psychotherapy notes showed that narrative approaches allowed the therapist to align with the patient as collaborator in considering the story presented and was therefore less productive of defensiveness and self-criticism than conventional approaches. The therapy included techniques for negotiating changes in illness narratives, identity narratives, and treatment narratives that were more conducive of well-being and recovery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Reduced Plasma Dopamine-β-Hydroxylase Activity Is Associated With the Severity of Bipolar Disorder: A Pilot Study

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.566091 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zuoli Sun ◽

Qijing Bo ◽

Zhen Mao ◽

Feng Li ◽

Fan He ◽

...

Keyword(s):

Bipolar Disorder ◽

Rating Scale ◽

Bipolar Depression ◽

Depression Scale ◽

Hamilton Depression Scale ◽

Cognitive Assessments ◽

Young Mania ◽

Neuropsychological Status ◽

Patient Health ◽

Depressive Episodes

Dopamine-β-hydroxylase (DβH) is an enzyme converting dopamine to norepinephrine, a key neurotransmitter in mood disorders, such as major depressive disorder (MDD) and bipolar disorder (BD). Due to overlapping symptomology of unipolar and bipolar depression, the present study attempted to explorer if the plasma DβH activity could discriminate the depressive episodes of BD from MDD. The aim of this study was to compare the plasma DβH activity among MDD patients (n = 104), BD patients (n = 101), and healthy controls (n = 160). Clinical characteristics and cognitive function were assessed using the Young Mania Rating Scale (YMRS), Hamilton Depression Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), Patient Health Questionnaire-9 (PHQ-9), and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Our data showed a lower plasma DβH activity in patients with BD, not MDD, than that in controls. For the BD patients, the plasma DβH activities were negatively correlated with HAM-D scores and HAM-A scores. However, there was no significant correlation between plasma DβH activity and severity of depressive symptoms in MDD patients. No significant correlation between DβH activities and cognitive assessments neither in BD nor in MDD patients. The present study provides evidence that BD is associated with decreased circulating DβH activity.

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Clinical and familial profile of bipolar disorder with and without obsessive-compulsive disorder: an Indian study

Trends in Psychiatry and Psychotherapy ◽

10.1590/2237-6089-2017-0061 ◽

2017 ◽

Vol 39 (4) ◽

pp. 270-275 ◽

Cited By ~ 2

Author(s):

Firoz Kazhungil ◽

Ajitha Cholakottil ◽

Shihab Kattukulathil ◽

Abdurazak Kottelassal ◽

Rajeesh Vazhakalayil

Keyword(s):

Bipolar Disorder ◽

Obsessive Compulsive Disorder ◽

Rating Scale ◽

Obsessive Compulsive ◽

Young Mania ◽

Chi Square ◽

Compulsive Disorder ◽

Chi Square Test ◽

Axis I ◽

Depressive Episodes

Abstract Introduction Comorbid obsessive-compulsive disorder (OCD) is common in bipolar disorder (BD). Clinical characteristics, functionality and familial pattern of this comorbidity are largely understudied. Objective To assess clinical profile, familial loading of psychiatric disorders and level of functioning in remitted BD patients who have comorbid OCD and to compare results with those of remitted BD patients without OCD. Methods Remitted BD-I subjects were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders, Global Assessment of Functioning Scale (GAF), Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Family Interview for Genetic Studies (FIGS). BD patients with and without OCD were compared. Group differences were analyzed using the chi-square test and the independent samples t test. Values <0.05 were considered statistically significant. Results Of the 90 remitted BD-I patients, 35.5% (n=32) had obsessive-compulsive symptoms/OCD. The BD-OCD group showed significantly lower GAF scores, higher rates of suicidal attempts, hospitalizations, manic and depressive episodes compared to the group with BD only (p<0.05). In addition, first and second-degree relatives had higher rates of BD-OCD and OCD, but not of BD. Conclusions BD-OCD is characterized by more severe BD, more dysfunction and higher familial loading of BD-OCD and OCD. Larger studies involving relatives of probands will help to confirm our findings and to delineate nosological status of BD-OCD comorbidity.

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Affective dimensions as a diagnostic tool for bipolar disorder in first psychotic episodes

European Psychiatry ◽

10.1016/j.eurpsy.2013.07.005 ◽

2014 ◽

Vol 29 (7) ◽

pp. 424-430 ◽

Cited By ~ 5

Author(s):

M. Arrasate ◽

I. González-Ortega ◽

S. Alberich ◽

M. Gutierrez ◽

M. Martínez-Cengotitabengoa ◽

...

Keyword(s):

Bipolar Disorder ◽

Rating Scale ◽

Diagnostic Value ◽

First Episode Psychosis ◽

First Episode ◽

Young Mania ◽

Dimension Score ◽

Episode Psychosis ◽

Affective Dimensions

AbstractObjectiveTo examine the predictive diagnostic value of affective symptomatology in a first-episode psychosis (FEP) sample with 5 years’ follow-up.MethodAffective dimensions (depressive, manic, activation, dysphoric) were measured at baseline and 5 years in 112 FEP patients based on a factor structure analysis using the Young Mania Rating Scale and Hamilton Depression Rating Scale. Patients were classified as having a diagnosis of bipolar disorder at baseline (BDi), bipolar disorder at 5 years (BDf), or “other psychosis”. The ability of affective dimensions to discriminate between these diagnostic groups and to predict a bipolar disorder diagnosis was analysed.ResultsManic dimension score was higher in BDi vs. BDf, and both groups had higher manic and activation scores vs. “other psychosis”. Activation dimension predicted a bipolar diagnosis at 5 years (odds ratio = 1.383; 95% confidence interval, 1.205–1.587; P = 0.000), and showed high levels of sensitivity (86.2%), specificity (71.7%), positive (57.8%) and negative predictive value (90.5%). Absence of the manic dimension and presence of the depressive dimension were both significant predictors of an early misdiagnosis.ConclusionThe activation dimension is a diagnostic predictor for bipolar disorder in FEP. The manic dimension contributes to a bipolar diagnosis and its absence can lead to early misdiagnosis.

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Delusions in a Sample of Patients with Schizophrenia and Bipolar Disorder: The same or different?

QJM ◽

10.1093/qjmed/hcaa054.025 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

H M E Azzam ◽

M A Hamed ◽

Y A Elhawary ◽

A H A Mohammed

Keyword(s):

Bipolar Disorder ◽

Negative Symptoms ◽

Rating Scale ◽

Psychotic Symptoms ◽

University Hospitals ◽

Young Mania ◽

Syndrome Scale ◽

Psychotic Features ◽

Negative Syndrome ◽

Depressive Episodes

Abstract Background Growing evidences indicate that there is overlapping between schizophrenia (SCZ) and bipolar disorder (BP) in neurobiology, phenomenology or even in changing of diagnosis from schizophrenia to bipolar disorder or vice versa. Psychotic symptoms can be observed during manic or depressive episodes in bipolar disorder. While manic or depressive episodes can be observed between or during psychotic episodes in schizophrenia. Aim of the work To describe delusional types present in both groups of study sample: a group of patients with schizophrenia and a group of patients with bipolar disorder accompanied by psychotic features. Also to compare between types of delusions in patients with schizophrenia and patients with bipolar disorder accompanied by psychotic features. Patients and Methods total 80 patients (40 in group of Schizophrenia and 40 in group of bipolar disorder accompanied by psychotic features) were selected as convenient sampling from patients during the first two weeks of their admission in the Institute of Psychiatry, Ain Shams University Hospitals. Nature and types of the delusions were assessed by using Scale for the Assessment of Negative Symptoms (SANS), Positive and Negative Syndrome Scale (PANSS) and Young Mania Rating Scale (YMRS) in study period from 1st of October 2017 till 1st of April 2018. Results Delusion of persecution is the commonest delusion in group of SCZ (37.5%), while delusion of grandiosity is the commonest delusion in group of BP accompanied by psychotic features (32.5%). Monothematic delusions are doubling frequent in group of BP accompanied by psychotic features (75%) if it compared to group of SCZ (35%). Non systematized delusions are the dominant in group of SCZ (45%) while most delusions in other group are some systematized (45%). Delusions of most patients in group of SCZ are incongruent with mood (77.5%). While delusions of most patients in group of BP accompanied by psychotic features are congruent with mood (65%). The presence of delusion is positively correlated to higher score of: SANS (in both groups), PANSS (in both groups) and YMRS (in BP accompanied by psychotic features). Conclusion delusions of schizophrenia are different in nature and types when it compared to delusions of bipolar disorder.

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Impact of modification to DSM-5 criterion A for hypomania/mania in newly diagnosed bipolar patients: findings from the prospective BIO study

International Journal of Bipolar Disorders ◽

10.1186/s40345-020-00219-9 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Mette U. Fredskild ◽

Sharleny Stanislaus ◽

Klara Coello ◽

Sigurd A. Melbye ◽

Hanne Lie Kjærstad ◽

...

Keyword(s):

Rating Scale ◽

Newly Diagnosed ◽

Young Mania ◽

Dsm 5 ◽

Criterion A ◽

Number Of Patients ◽

Bipolar Type ◽

Dsm Iv ◽

Bipolar Patients

Abstract Background DSM-IV states that criterion A for diagnosing hypomania/mania is mood change. The revised DSM-5 now states that increased energy or activity must be present alongside mood changes to diagnose hypomania/mania, thus raising energy/activity to criterion A. We set out to investigate how the change in criterion A affects the diagnosis of hypomanic/manic visits in patients with a newly diagnosed bipolar disorder. Results In this prospective cohort study, 373 patients were included (median age = 32; IQR, 27–40). Women constituted 66% (n = 245) of the cohort and 68% of the cohort (n = 253) met criteria for bipolar type II, the remaining patients were diagnosed bipolar type I. Median number of contributed visits was 2 per subject (IQR, 1–3) and median follow-up time was 3 years (IQR, 2–4). During follow-up, 127 patients had at least one visit with fulfilled DSM-IV criterion A. Applying DSM-5 criterion A reduced the number of patients experiencing a hypomanic/manic visit by 62% at baseline and by 50% during longitudinal follow-up, compared with DSM-IV criterion A. Fulfilling DSM-5 criterion A during follow-up was associated with higher modified young mania rating scale score (OR = 1.51, CL [1.34, 1.71], p < 0.0001) and increased number of visits contributed (OR = 1.86, CL [1.52, 2.29], p < 0.0001). Conclusion Applying the stricter DSM-5 criterion A in a cohort of newly diagnosed bipolar patients reduced the number of patients experiencing a hypomanic/manic visit substantially, and was associated with higher overall young mania rating scale scores, compared with DSM-IV criterion A. Consequently, fewer hypomanic/manic visits may be detected in newly diagnosed bipolar patients with applied DSM-5 criterion A, and the upcoming ICD-11, which may possibly result in longer diagnostic delay of BD as compared with the DSM-IV.

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Treatment of bipolar depression with supraphysiologic doses of levothyroxine: a randomized, placebo-controlled study of comorbid anxiety symptoms

International Journal of Bipolar Disorders ◽

10.1186/s40345-019-0155-y ◽

2019 ◽

Vol 7 (1) ◽

Author(s):

Maximilian Pilhatsch ◽

Thomas J Stamm ◽

Petra Stahl ◽

Ute Lewitzka ◽

Anne Berghöfer ◽

...

Keyword(s):

Bipolar Disorder ◽

Rating Scale ◽

Bipolar Depression ◽

Phenotypic Expression ◽

Anxiety Symptoms ◽

Controlled Study ◽

Double Blind ◽

Comorbid Anxiety ◽

Depressed Patients ◽

Depressive Episodes

Abstract Background Symptoms of anxiety co-occur in a variety of disorders including in depressive episodes of bipolar disorder and in patients with thyrotoxicosis. Treatment of refractory bipolar disorder with supraphysiologic doses of levothyroxine (L-T4) has been shown to improve the phenotypic expression of the disorder and is associated with an increase of circulating thyroid hormones. However, it might be associated with somatic and mental adverse effects. Here we report the investigation of the influence of treatment with supraphysiologic doses of L-T4 on symptoms of anxiety in patients with refractory bipolar depression. Methods Post-hoc analysis from a 6-week, multi-center, randomized, double-blind, placebo-controlled study of the effects of supraphysiologic L-T4 treatment on anxiety symptoms in bipolar depression. Anxiety symptoms were measured weekly with the Hamilton anxiety/somatization factor (HASF) score of the Hamilton Depression Rating Scale (HAMD) and the State- and Trait Anxiety Inventory (STAI). Results Treatment of both groups was associated with a significant reduction in anxiety symptoms (p < 0.001) with no statistical difference between groups (LT-4: from 5.9 (SD = 2.0) at baseline to 3.7 (SD = 2.4) at study end; placebo: from 6.1 (SD = 2.4) at baseline to 4.4 (SD = 2.8) at study end; p = 0.717). Severity of anxiety at baseline did not show a statistically significant correlation to the antidepressive effect of treatment with supraphysiologic doses of L-T4 (p = 0.811). Gender did not show an influence on the reduction of anxiety symptoms (females: from 5.6 (SD = 1.7) at baseline to 3.5 (SD = 2.4) at study end; males: from 6.1 (SD = 2.3) at baseline to 4.0 (SD = 2.4) at study end; p = 0.877). Conclusions This study failed to detect a difference in change of anxiety between bipolar depressed patients treated with supraphysiologic doses of L-T4 or placebo. Comorbid anxiety symptoms should not be considered a limitation for the administration of supraphysiologic doses of L-T4 refractory bipolar depressed patients. Trial registration ClinicalTrials, ClinicalTrials.gov identifier: NCT01528839. Registered 2 June 2012—Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT01528839

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Recovery and its correlates among patients with bipolar disorder: A study from a tertiary care centre in North India

International Journal of Social Psychiatry ◽

10.1177/0020764016676214 ◽

2016 ◽

Vol 62 (8) ◽

pp. 726-736 ◽

Cited By ~ 5

Author(s):

Sandeep Grover ◽

Nandita Hazari ◽

Jitender Aneja ◽

Subho Chakrabarti ◽

Sunil Sharma ◽

...

Keyword(s):

Bipolar Disorder ◽

Mental Illness ◽

Depressive Symptoms ◽

Rating Scale ◽

Tertiary Care ◽

North India ◽

Personal Recovery ◽

Tertiary Care Centre ◽

Young Mania ◽

Level Of Functioning

Background and Aim: The goal of treatment in mental illness has evolved from a symptom-based approach to a personal recovery–based approach. The aim of this study was to evaluate the predictors of personal recovery among patients with bipolar disorder. Methodology: A total of 185 patients with bipolar disorder, currently in remission, were evaluated on Recovery Assessment Scale (RAS), Internalized Stigma of Mental Illness Scale (ISMIS), Brief Religious coping scale (RCOPE), Duke University Religiosity Index (DUREL), Religiousness Measures Scale, Hamilton depression rating scale (HDRS), Young Mania rating scale (YMRS) and Global Assessment of Functioning (GAF) scale. Results: The mean age of the sample was 40.5 (standard deviation (SD), 11.26) years. Majority of the participants were male, married, working, Hindu by religion and belonged to extended/joint families of urban background. In the regression analysis, RAS scores were predicted significantly by discrimination experience, stereotype endorsement and alienation domains of ISMIS, level of functioning as assessed by GAF, residual depressive symptoms as assessed by HDRS and occupational status. The level of variance explained for total RAS score and various RAS domains ranged from 36.2% to 46.9%. Conclusion: This study suggests that personal recovery among patients with bipolar disorder is affected by stigma, level of functioning, residual depressive symptoms and employment status of patients with bipolar disorder.

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Living With Bipolar Disorder in the Time of Covid-19: Biorhythms During the Severe Lockdown in Cagliari, Italy, and the Moderate Lockdown in Tunis, Tunisia

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.634765 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mauro Giovanni Carta ◽

Uta Ouali ◽

Alessandra Perra ◽

Azza Ben Cheikh Ahmed ◽

Laura Boe ◽

...

Keyword(s):

Bipolar Disorder ◽

Depressive Symptoms ◽

Rating Scale ◽

Biological Rhythms ◽

Short Term ◽

Female Age ◽

Future Studies ◽

Restrictive Measures ◽

Depressive Episodes ◽

Hamilton Rating Scale

Background: Restrictions during Covid-19 pandemic lockdown, in which rhythms of life have been compromised, can influence the course of bipolar disorder (BD). This study follows patients with bipolar disorder living in two geographically close cities (Cagliari and Tunis), but with different lockdown conditions: less severe in Tunis.Methods: Two cohorts were evaluated during lockdown (April 2020, t0) and 2 months later with lockdown lifted for a month (t1). Individuals were: over 18 years old without gender exclusion, BD I or II, in care for at least 1 year, received a clinical interview in the month before the start of the lockdown, stable clinically before the lockdown. The assessment was conducted by telephone by a psychiatrist or psychologist with good knowledge of patients. Diagnoses were made according to DSM-5 criteria. Depressive symptoms were collected through the Hamilton Rating Scale for Depression; cut-off 14 indicative of depressive episode. Circadian rhythms were measured using the BRIAN scale.Results: Forty individuals in Cagliari (70%female, age 48.57 ± 11.64) and 30 in Tunis (53.3% Female, age 41.8 ± 13.22) were recruited. In Cagliari at t0 45% had depressive episodes against none in Tunis, a similar difference appeared at t1. At t0 and t1 the Cagliari sample had more dysfunctional scores in the overall BRIAN scale and in the areas of sleep, activities and social rhythms; no differences were found in nutrition, both samples had predominantly nocturnal rhythm. In Cagliari at t0 and t1, the depressive sub-group showed more dysfunctional scores in the BRIAN areas sleep, activity, and nutrition. However, the differences in biological rhythms resulted, through ANCOVA analysis, independent of the co-presence of depressive symptoms.Discussion: A rigid lockdown could expose people with BD to depressive relapse through dysregulation of biological rhythms. The return to more functional rhythms did not appear 1 month after lockdown. The rekindling of the pandemic and the restoration of new restrictive measures will prevent, at least in the short term, the beneficial effect of a return to normality of the two cohorts.This was a limited exploratory study; future studies with larger samples and longer observational time are needed to verify the hypothesis.

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Case Report: Clinical and Pharmacokinetic Profile of Lithium Monotherapy in Exclusive Breastfeeding. A Follow-Up Case Series

Frontiers in Pharmacology ◽

10.3389/fphar.2021.647414 ◽

2021 ◽

Vol 12 ◽

Author(s):

Maria Luisa Imaz ◽

Dolors Soy ◽

Mercé Torra ◽

Llüisa García-Esteve ◽

Cristina Soler ◽

...

Keyword(s):

Exclusive Breastfeeding ◽

Rating Scale ◽

Venous Blood ◽

Case Series ◽

Late Pregnancy ◽

Structured Interview ◽

Pharmacokinetic Data ◽

Close Monitoring ◽

Young Mania

Background: Most guidelines advise that women taking lithium should not breastfeed. The variation in transfer is just one reason behind this advice.Objectives: To present clinical and pharmacokinetic data of nine mother–infant pairs exposed to lithium monotherapy during late pregnancy and exclusive breastfeeding at the Perinatal Psychiatric Unit (2006–2018).Methods: We obtained sociodemographic data, medical risk factors, obstetric variables, and family and personal psychiatric history by semi-structured interview, and assessed maternal psychopathology with the Hamilton Depression Rating Scale and Young Mania Rating Scale. A senior neonatologist reviewed neonatal outcomes at birth using the Peripartum Events Scale. Paired maternal and cord blood and infant venous blood samples were collected. During the breastfeeding period, we monitored serum lithium and creatinine concentrations in mother–infant pairs at delivery, and at days 1–5, 7–11, 30, and 60 postpartum, and monthly until 6-months.Results: Lithium equilibrated completely across the placenta [1.13 (0.10), range (1.02–1.30)]. No women presented symptoms of postpartum lithium intoxication, two of the neonates presented transient hypotonia (22%). Lithium exposure was significantly less during breastfeeding than during late pregnancy, and serum lithium concentrations decreased up to 44% overtime from delivery to the first-month, and up to 60% to the third-month postpartum. There was no growth or developmental delay in the follow-up period. One woman had a manic episode with psychotic features at 45 days postpartum.Conclusions: In carefully selected women with bipolar disorder, lithium therapy when breastfeeding can be an appropriate option if coupled with close monitoring of the mother-infant pair.

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