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

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 < 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 < 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.

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Baseline and prodromal characteristics of first- versus multiple-episode mania in a French cohort of bipolar patients

European Psychiatry ◽

10.1016/j.eurpsy.2010.11.001 ◽

2011 ◽

Vol 27 (8) ◽

pp. 557-562 ◽

Cited By ~ 8

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.

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Case Report: Severe Adolescent Major Depressive Syndrome Turns Out to Be an Unusual Case of Anti-NMDA Receptor Encephalitis

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.679996 ◽

2021 ◽

Vol 12 ◽

Author(s):

Alexander Moldavski ◽

Holger Wenz ◽

Bettina E. Lange ◽

Cathrin Rohleder ◽

F. Markus Leweke

Keyword(s):

Cognitive Deficits ◽

Psychiatric Symptoms ◽

Previous History ◽

Rapid Onset ◽

Depressive Syndrome ◽

Psychotic Symptoms ◽

Major Depressive ◽

Abnormal Movements ◽

Nmdar Encephalitis ◽

Initial Symptoms

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a neuroinflammatory condition mediated by autoantibodies against the GluN1 subunit of the receptor. Clinically, it is characterized by a complex neuropsychiatric presentation with rapidly progressive psychiatric symptoms, cognitive deficits, seizures, and abnormal movements. Isolated psychiatric manifestations of anti-NMDAR encephalitis are rare and usually dominated by psychotic symptoms. We present a case of an 18-year-old female high school student—without a previous history of psychiatric disorders—with a rapid onset severe depressive syndrome. Surprisingly, we found pleocytosis and anti-NMDAR autoantibodies in the cerebrospinal fluid (CSF), despite an otherwise unremarkable diagnostic workup, including blood test, clinical examination, and cranial magnetic resonance imaging (MRI). After intravenous immunoglobulins treatment, a complete remission of the initial symptoms was observed. In a follow-up 5 years later, the young woman did not experience any relapse or sequelae. Anti-NMDAR encephalitis can present in rare cases as an organic disorder with major depressive symptoms without distinct concomitant psychotic or neurological symptoms. A clinical presentation such as a rapid onset of symptoms, distinct disturbance in the thought process, restlessness, and cognitive deficits should prompt screening for NMDAR- and other neural autoantibodies to rule out this rare but debilitating pathology.

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Les manifestations psychiatriques dans la démence: perspective phénoménologique

The Canadian Journal of Psychiatry ◽

10.1177/070674379303801009 ◽

1993 ◽

Vol 38 (10) ◽

pp. 671-677 ◽

Cited By ~ 1

Author(s):

Isabelle Paquette

Keyword(s):

Major Depression ◽

Cognitive Deficits ◽

Clinical Characteristics ◽

Depressive Symptomatology ◽

Psychiatric Symptoms ◽

Memory Loss ◽

Psychotic Symptoms ◽

Neuropsychological Evaluations ◽

Operational Criteria ◽

Psychiatric Manifestations

The study of psychiatric manifestations in dementia has long been overshadowed by the more classical manifestations of the disease, such as memory loss and other cognitive deficits. In recent years, however, psychiatric symptoms as part of the demential process have attracted interest and research has become more specific. Clinicians are faced with diagnostic, treatment and management difficulties related to affective or psychotic symptoms, which account for much distress and morbidity. Several studies indicate that the prevalence of psychiatric manifestations in clinical populations of patients suffering from dementia is high: 15% to 30% for hallucinations, 15% to 30% for delusions, ten percent to 20% for major depression and 40% to 50% for depressed mood. These figures tend to confirm the hypothesis that psychiatric features in dementia are neither infrequent nor atypical. Thus, researchers have sought to link psychotic or depressive symptomatology with several clinical characteristics of dementia, namely stage, severity, prognosis or cognitive dysfunction. Some recent studies involving extensive neuropsychological evaluations indicate that subgroups of patients can be defined according to psychiatric criteria, as well as cognitive or neurological criteria. Unfortunately, results are inconsistent. Some of the contradictions in the literature are related to poorly defined terms and symptoms, a lack of reliable operational criteria, absence of validation of instruments and scales and heterogeneity of the populations studied. Ambiguous syndromes, such as pseudodementia, while illustrative of certain clinical situations, have not been helpful in categorizing demented patients. The author suggests that research focused on specific and clearly defined psychiatric symptoms in dementia will better serve our comprehension of mixed syndromes.

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First episode in bipolar disorder: misdiagnosis and psychotic symptoms

Journal of Affective Disorders ◽

10.1016/s0165-0327(98)00032-9 ◽

1998 ◽

Vol 50 (1) ◽

pp. 41-44 ◽

Cited By ~ 55

Author(s):

Ana Gonzalez-Pinto ◽

Miguel Gutierrez ◽

Fernando Mosquera ◽

Javier Ballesteros ◽

Purificacion Lopez ◽

...

Keyword(s):

Bipolar Disorder ◽

Psychotic Symptoms ◽

First Episode

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Study on risk factors of extrapyramidal symptoms induced by antipsychotics and its correlation with symptoms of schizophrenia

General Psychiatry ◽

10.1136/gpsych-2018-100026 ◽

2019 ◽

Vol 32 (1) ◽

pp. e100026 ◽

Cited By ~ 2

Author(s):

Jiajun Weng ◽

Yan Zhang ◽

Huafang Li ◽

Yifeng Shen ◽

Wenjuan Yu

Keyword(s):

Risk Factors ◽

Scale Score ◽

Atypical Antipsychotics ◽

Psychiatric Symptoms ◽

D2 Receptor ◽

Extrapyramidal Symptoms ◽

Chinese Patients ◽

Psychotic Symptoms ◽

Mood Symptoms ◽

Negative Score

BackgroundExtrapyramidal symptoms (EPS) are one of the most common and neglected side effects during the treatment of schizophrenia. The risk factors of EPS in Chinese patients with schizophrenia and its relationship with psychiatric symptoms and mood symptoms of schizophrenia remain unknown.AimsThe main objective of this study is to explore the risk factors of EPS caused by antipsychotics and the relationship between EPS and psychotic symptoms and mood symptoms of schizophrenia.MethodThis study included 679 patients with schizophrenia who have met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. Patients were divided into the EPS group and the non-EPS group according to the scale rating criteria and whether the anticholinergics have been used. The differences between demographic data and characters of drug intake were compared between the two groups, and the risk factors of EPS were selected between those factors. Correlation analysis was performed on the severity of schizophrenia (Positive and Negative Symptoms Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS) score) and EPS scale (Simpson-Angus Scale (SAS), Barnes Akathisia Rating Scale (BARS), Abnormal Involuntary Movement Scale (AIMS) score) in 679 patients. The differences between the PANSS subscale score and the CDSS score between the EPS group and the non-EPS group were compared.ResultCompared with the non-EPS group, the EPS group patients are older, and they have a longer duration since first prescribed antipsychotics. The EPS group patients have higher frequency of atypical antipsychotics polytherapy and typical and atypical antipsychotics polytherapy or combined treatments with mood stabilisers. Logistic regression analysis shows that antipsychotics with high D2 receptor antagonistic effect and illness duration are the risk factors of EPS. The SAS score was significantly correlated with PANSS negative score, PANSS general psychopathological score and PANSS total score. The BARS scale score was significantly correlated with PANSS positive score, PANSS general psychopathological score, PANSS total score and CDSS total score. The AIMS scale score was significantly correlated with PANSS negative score. Compared with the non-EPS group, the EPS group patients have significantly higher PANSS negative score, PANSS general psychopathological score, PANSS total score and CDSS total score.ConclusionAntipsychotic drugs with high D2 receptor antagonism and disease duration are risk factors of EPS in Chinese patients with schizophrenia. The severity of various types of EPS is significantly correlated with the psychiatric and mood symptoms of schizophrenia, and psychiatric symptoms and mood symptoms were significantly more severe in the EPS group. The occurrence of EPS is associated with poor treatment outcome of schizophrenia.

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Clustering of hypertension, dyslipidemia and diabetes mellitus in bipolar disorder: A case-control study of chinese patients

European Psychiatry ◽

10.1016/s0924-9338(11)72580-9 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 875-875

Author(s):

E. Lee ◽

C.M. Leung

Keyword(s):

Diabetes Mellitus ◽

Bipolar Disorder ◽

Clinical Characteristics ◽

Mood Stabilizer ◽

University Teaching ◽

Chinese Patients ◽

Psychiatric Outpatient Clinic ◽

Patients With Diabetes ◽

The Mean ◽

Control Study

IntroductionPatients with bipolar disorder are at risk of obesity, metabolic syndrome and diabetes mellitus. Little was known about the association of clinical characteristics of bipolar disorder and diabetes mellitus.ObjectivesInvestigate the clinical characteristics of patients with bipolar disorder and diabetes mellitus.AimsIdentify the risk factors of medical comorbidity.MethodsPatients suffering from bipolar disorder, according to DSM-IV classification, with and without diabetes mellitus were retrieved from computer database in a university teaching hospital psychiatric outpatient clinic. Patients with diabetes mellitus were compared with patients without diabetes mellitus after matching with sex and age.ResultsOne hundred and fifty patients with bipolar disorder (30 with diabetes mellitus and 120 without diabetes mellitus) were collected. All patients were Chinese and 86.7% were female. For patients with and without diabetes mellitus, the mean (SD) age were 49.9 (9.3) years and 49.4 (8.9) years respectively. Their mean (SD) duration of mental illness were 18.1 (10.9) years and 16.8 (10.6) years and the mean number of admissions were 3.4 (4.2) and 3.2 (4.3) for patients with and without diabetes mellitus respectively. The use of antipsychotics and mood stabilizer were similar between patients with and without diabetes mellitus. Hypertension and dyslipidemia were statistically significant factors associated with diabetes mellitus among patients with bipolar disorder.ConclusionsHypertension and dyslipidemia are associated with diabetes mellitus among Chinese patients with bipolar disorder. Psychiatrists should be alerted to screen and monitor for hypertension, dyslipidemia and diabetes mellitus among patients with bipolar disorder.

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Psychosis and Schizencephaly – A Case Report and Systematic Review

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1035 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S-S

Author(s):

S. Gunturu ◽

L. Schmalz ◽

J. Zebelian ◽

L. Gonzalez ◽

C. Drazinic ◽

...

Keyword(s):

Systematic Review ◽

Grey Matter ◽

Psychiatric Symptoms ◽

Psychiatric Service ◽

Psychotic Symptoms ◽

First Episode ◽

Neurodevelopmental Outcomes ◽

Episode Psychosis ◽

Competing Interest ◽

The Brain

Psychotic symptoms have been reported in association with a wide array of brain abnormalities. Few published reports have examined the association between schizencephaly and psychiatric illness. Originally defined by Wilmarth and later by Yakolev and Wadsworth – Schizencephaly is an uncommon congenital disorder of cerebral cortical development, defined as a grey matter-lined cleft extending from the pial surface to the ventricle. The nosology is based on neuroradiologic findings and confirmed by neuropathology when available. The Clinical presentation and neurodevelopmental outcomes of the disorder vary and are usually related to the extent/areas of the brain involved. In this article we review the medical literature around Schizencephaly paying particular attention to the pathophysiology, etiology and diagnosis of such patients. We then present a case of Schizencephaly and first episode psychosis in a 16-year-old adolescent who was admitted to our inpatient psychiatric service. Lastly, we present the findings of a systematic review from PubMed whereby we summarize 10 cases of Schizencephaly with associated psychiatric symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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

European Psychiatry ◽

10.1016/j.eurpsy.2016.09.009 ◽

2016 ◽

Vol 41 (1) ◽

pp. 85-94 ◽

Cited By ~ 13

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.

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Clinical overlap between behavioral variant of frontotemporal dementia and bipolar disorder: A case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1173 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S335-S336 ◽

Cited By ~ 1

Author(s):

P. Oliveira ◽

C. Roque ◽

V. Santos ◽

N. Madeira

Keyword(s):

Bipolar Disorder ◽

Frontotemporal Dementia ◽

Psychiatric Symptoms ◽

Late Onset ◽

Single Photon ◽

Photon Emission ◽

Interpersonal Behavior ◽

Psychotic Symptoms ◽

Emission Computed Tomography ◽

Global Pattern

The behavioral variant of frontotemporal dementia (FTD) often begins with psychiatric symptoms, including changes in personal conduct and/or interpersonal behavior. Prior to developing cognitive impairment, differentiating FTD from primary psychiatric disorders might be challenging.This work presents a case of a manic episode with psychotic features in a 61-year-old man, whom personality changes and daily life difficulties arouse and persist after optimal management of the active manic and psychotic symptoms. Neuropsychological assessment detailed severe deficits among visuospatial and planning performances. Structural neuroimaging (CT-scan) primary revealed a global pattern of brain volume reduction. Severe perfusion deficits on frontal and both parietal lobes were shown on 99mTc-HMPAO single-photon emission computed tomography (SPECT). The hypothesis of probable FTD (behavioral variant) was established.The present case highlights how putative atypical and late-onset forms of bipolar disorder (BD) might instead progress to FTD. Several links are being advanced between the BD and FTD, for instance the close involvement of the C9ORF72 gene in a group of BD patients which progresses to dementia. These relations have actually been on focus recently. The field is however still relatively unexplored.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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M240. THE RELATIONSHIP OF TREATMENT DELAY WITH PERSONALITY TRAIT AND FAMILY COHESION IN PATIENTS WITH FIRST-EPISODE SCHIZOPHRENIA SPECTRUM DISORDER

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa030.552 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S227-S227

Author(s):

Anna Jo ◽

Sung-Wan Kim ◽

Yeonghyeok Kim ◽

Jung Jin Kim ◽

Young-Chul Chung ◽

...

Keyword(s):

Personality Trait ◽

Family Relationships ◽

Family Cohesion ◽

Treatment Delay ◽

Psychotic Symptoms ◽

First Episode ◽

Antipsychotic Treatment ◽

Initial Symptoms ◽

The Family ◽

First Episode Schizophrenia

Abstract Background Duration of Untreated Psychosis (DUP) is one of the important factors that affect the prognosis of schizophrenia. This study aimed to investigate the effects of personality trait and family relationships on delayed treatment of schizophrenia. Methods The subjects were 169 patients diagnosed with first-episode schizophrenia. It is a prospective study examined the socio-demographic factors with positive and negative syndrome (PANSS) and social occupational function (SOFAS). Personality trait was investigated with the Big Five Inventory (BFI-10) and family cohesion was investigated with the Family Adaptability and Cohesion Evaluation Scales-III (FACES-III). The DUP was defined as the time period from the appearance of the first psychotic symptoms for more than several days to the time when antipsychotic treatment began. Groups were divided according to the median value of the DUP. Results The average DUP was 12.0 months and the median value was 3.0 months. In long DUP group, age is significantly older, the PANSS score was significantly higher and the SOFAS score was significantly lower. Logistic regression analysis showed that long DUP was associated with the conscientiousness of the BFI-10 (OR = 2.175, p = 0.004) and lower level of family cohesion of FACES-III (OR = 0.930, p = 0.025). Discussion As a result of the study, treatment delay of psychosis was associated with lower cohesion and adaptability of family function and the tendency of the personality with conscientiousness. These suggest that the role of the family in accessing mental health services is important when the initial symptoms of schizophrenia develop.

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