The Occurrence of Funeral Mania After Bereavement: A Case Report

Stressful or traumatic life events can lead to emergence of mood episodes. Events such as migration, relocation, job loss, bankruptcy, economic loss, divorce, natural disasters, accidental injury, or the loss of a loved one can trigger the first episode of bipolar disorder. After such life events, symptoms of depressive episodes often appear. Funeral mania, on the other hand, is defined as the emergence of manic episodes following the death of a close family member. Information on funeral mania, which occurs shortly after the loss of a loved one, is limited with a few case reports. In this study, a 26-year-old female patient who presented with the symptoms of a manic episode for the first time after her father’s death and who had no previous psychiatric disease or treatment history was presented in the light of findings in the literature. It is noteworthy that the patient, who was followed up with the diagnosis of bipolar disorder (mania period) according to DSM-5 diagnostic criteria, had a temporal closeness between her mood symptoms and her father’s death, and had not developed such a reaction to previous traumatic life events. Therefore, the diagnosis was evaluated as funeral mania. It should be kept in mind that, although rare, symptoms of mania can be seen among possible grief reactions

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Timing, quantity and quality of stressful life events in childhood and preceding the first episode of bipolar disorder

Journal of Affective Disorders ◽

10.1016/j.jad.2011.05.034 ◽

2011 ◽

Vol 134 (1-3) ◽

pp. 434-437 ◽

Cited By ~ 28

Author(s):

Netta Horesh ◽

Alan Apter ◽

Gil Zalsman

Keyword(s):

Bipolar Disorder ◽

Life Events ◽

Stressful Life Events ◽

Stressful Life ◽

First Episode

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Early clinical predictors and correlates of long-term morbidity in bipolar disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.480 ◽

2017 ◽

Vol 43 ◽

pp. 35-43 ◽

Cited By ~ 5

Author(s):

G. Serra ◽

A Koukopoulos ◽

L. De Chiara ◽

A.E. Koukopoulos ◽

G. Sani ◽

...

Keyword(s):

Bipolar Disorder ◽

Psychiatric Comorbidity ◽

First Episode ◽

Clinical Predictors ◽

Factors Associated ◽

Psychiatric Syndrome ◽

Linear Regression Modeling ◽

Depressive Episodes

AbstractObjectives:Identifying factors predictive of long-term morbidity should improve clinical planning limiting disability and mortality associated with bipolar disorder (BD).Methods:We analyzed factors associated with total, depressive and mania-related long-term morbidity and their ratio D/M, as %-time ill between a first-lifetime major affective episode and last follow-up of 207 BD subjects. Bivariate comparisons were followed by multivariable linear regression modeling.Results:Total % of months ill during follow-up was greater in 96 BD-II (40.2%) than 111 BD-I subjects (28.4%; P = 0.001). Time in depression averaged 26.1% in BD-II and 14.3% in BD-I, whereas mania-related morbidity was similar in both, averaging 13.9%. Their ratio D/M was 3.7-fold greater in BD-II than BD-I (5.74 vs. 1.96; P < 0.0001). Predictive factors independently associated with total %-time ill were: [a] BD-II diagnosis, [b] longer prodrome from antecedents to first affective episode, and [c] any psychiatric comorbidity. Associated with %-time depressed were: [a] BD-II diagnosis, [b] any antecedent psychiatric syndrome, [c] psychiatric comorbidity, and [d] agitated/psychotic depressive first affective episode. Associated with %-time in mania-like illness were: [a] fewer years ill and [b] (hypo)manic first affective episode. The long-term D/M morbidity ratio was associated with: [a] anxious temperament, [b] depressive first episode, and [c] BD-II diagnosis.Conclusions:Long-term depressive greatly exceeded mania-like morbidity in BD patients. BD-II subjects spent 42% more time ill overall, with a 3.7-times greater D/M morbidity ratio, than BD-I. More time depressed was predicted by agitated/psychotic initial depressive episodes, psychiatric comorbidity, and BD-II diagnosis. Longer prodrome and any antecedent psychiatric syndrome were respectively associated with total and depressive morbidity.

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Cariprazine Use in Early Psychosis: Three Case Reports

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.788281 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ricardo Coentre ◽

Rodrigo Saraiva ◽

Carolina Sereijo ◽

Pedro Levy

Keyword(s):

Atypical Antipsychotic ◽

Negative Symptoms ◽

Case Reports ◽

First Episode Psychosis ◽

Early Psychosis ◽

First Episode ◽

Low Doses ◽

Bipolar I Disorder ◽

Episode Psychosis ◽

Depressive Episodes

Objective: Cariprazine is a new atypical antipsychotic approved for the acute and maintenance treatment of schizophrenia (1, 2) and for the treatment of manic or mixed episodes associated with bipolar I disorder (1). Recently, cariprazine also got extended FDA-approval for the treatment of depressive episodes in adults with bipolar I disorder (3). The use of low doses of atypical antipsychotics is an essential component of early intervention in psychosis. For its particular performance and tolerability, cariprazine is becoming an important option for the treatment of first-episode psychosis.Method: Three patients experiencing first-episode psychosis (FEP) were successfully treated with cariprazine. Two patients were in their first months of the disease, and the third patient was in his third year after the FEP.Results: The three patients had a diagnosis of non-affective FEP, which includes schizophrenia, delusional disorder, and schizoaffective disorder. One of them was in their third year after the FEP with a predominance of negative symptoms at this stage of the disorder. All the patients were treated with cariprazine with a target dose of 3–4.5 mg/day. The three patients showed improvements in their psychosis, including a decrease in negative symptoms. No significant side effects were reported.Conclusion: Our three case reports indicate that cariprazine is an atypical antipsychotic beneficial in the treatment of early psychosis. Treatment with low doses of cariprazine could be effective and tolerable in this phase of the disorder. Future studies with longer follow-up of FEP patients are recommended to confirm these positive results of cariprazine in the early phases of psychosis.

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

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.404 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S428-S428

Author(s):

A. Kandeger ◽

R. Tekdemir ◽

B. Sen ◽

Y. Selvi

Keyword(s):

Bipolar Disorder ◽

Case Reports ◽

Nasal Congestion ◽

Manic Episode ◽

First Episode ◽

Stimulant Effect ◽

Sympathomimetic Drugs ◽

The Central Nervous System ◽

Competing Interest ◽

Psychotic Features

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

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Prevalence of Traumatic Life Events and Posttraumatic Stress Disorder in the Severe Mental Illness

European Psychiatry ◽

10.1016/s0924-9338(09)71347-1 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

M.J. Alvarez ◽

A. Osés ◽

Q. Foguet ◽

J.M. Santos ◽

P. Roura ◽

...

Keyword(s):

Bipolar Disorder ◽

Posttraumatic Stress Disorder ◽

Mental Illness ◽

Sexual Abuse ◽

Posttraumatic Stress ◽

Life Events ◽

Schizoaffective Disorder ◽

Rating Scale ◽

Stress Disorder ◽

Traumatic Life Events

Aims:In some different studies, a high prevalence of interpersonal trauma especially childhood abuse as well as posttraumatic stress disorder (PTSD) has been found in patients with several mental illness (SMI): schizophrenia, schizoaffective and bipolar disorder.The aim of this study was to determine the prevalence of the traumatic life events and PTSD in a sample with SMI.Methods:We enrolled adults patients with schizophrenia, schizoaffective disorder or bipolar I disorder. We excluded patients who score 3 or more in conceptual disorganization, hallucinations and/or unusual contents of the Brief Psychiatric Rating Scale (BPRS) and 4 or more in another item of this scale. Interventions: sociodemographic date and Traumatic Life Events Questionnaire and Distressing Event Questionnaire.Results:78 patients (52.6% men) with a mean age of 40 years. Diagnostic of the sample: 47.5% schizophrenia, 41% bipolar disorder and 11.5% schizoaffective disorder. Traumatic life events in the childhood: physical abuse, 22.1% (22.5% males and 21.8% females); psychological abuse, 26.9% (14.6% males and 40.5% females, p< 0.05); sexual abuse, 28.2% (21.9% males and 35.1% females).Some abuse in childhood, 48.0% (38.1% males and 62.2% women, p< 0.05).Sexual abuse in adulthood: 25.6% (43.24% females and 9.7% men, p=0'05).PTSD, 12.9% (8.3% males and 20.7% females).Conclusions:Almost the half of the patients have biographical history of traumatic life events in the childhood. These traumatic events are significantly more prevalent in females. in adulthood, almost half of women had suffered sexual abuse.A fifth part of the women with SMI have comorbidity with PTSD.

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The relationship between affective temperament and suicide attempt, clinical history and current subclinical symptoms in bipolar disorder

DIVERSITATES International Journal ◽

10.53357/cpav4969 ◽

2018 ◽

Vol 9 (3) ◽

pp. 65

Author(s):

Rafael Assis Da Silva ◽

Daniel Mograbi ◽

Luiza Nogueira Amadeo ◽

Cristina MT Santana ◽

Jesus Landeira-Fernandez ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicide Attempt ◽

Clinical Course ◽

Depressive Mood ◽

First Episode ◽

Hamilton Depression Scale ◽

Affective Temperament ◽

History Of ◽

Bipolar Patients ◽

Depressive Episodes

Background: Affective temperament may strongly influence psychopathological characteristics in mood disorders such as clinical course of major or minor affective episodes, predominant polarity, clinical symptoms, long term clinical course, suicidality, and response/adherence to medication.Objective: The objective of this work is evaluate the association between affective temperament and clinical characteristics in bipolar disorder (BD) patients.Method: 88 euthymic bipolar patients were evaluated through Hamilton Depression Scale (HAM-D), Young Mania Rating Scale (YMRS), Clinical Global Impressions Scale for use in bipolar illness (CGI-BP), and TEMPS-Rio de Janeiro. Identification, sociodemographic data, and clinical information as age on disease onset, number of manic episodes, number of depressive episodes, polarity of first affective episode, and history of suicidal attempts, if any, from each patient were collected.Results: Our results founded that high scores in cyclothymic, irritable, depressive and anxious temperaments were associated with at least one suicide attempt. Higher scores of anxious temperament were associated with depressive polarity in the first episode of the disease as well as higher amount of manic episodes. Higher scores of hyperthymic temperament were associated with manic polarity in the first episode of the disease. Higher scores of depressive temperament were associated with higher scores in total HAM-D and specifically with higher scores in items 1 and 2 of HAM-D, i.e., depressive mood and guilt. No correlation was found between temperament and intensity of subsyndromal manic symptoms.Conclusion: We concluded that affective temperaments in BD are associated with history of suicide attempts, seem to influence polarity of first episode and that depressive temperament seems to relate to more intense subsyndromal depressive symptoms, especially depressive mood and guilt.

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Stress in Bipolar Disorder

The Oxford Handbook of Stress and Mental Health ◽

10.1093/oxfordhb/9780190681777.013.6 ◽

2018 ◽

pp. 126-154

Author(s):

Lauren B. Alloy ◽

Madison K. Titone ◽

Tommy H. Ng ◽

Corinne P. Bart

Keyword(s):

Bipolar Disorder ◽

Life Events ◽

Life Stress ◽

Future Research ◽

Bipolar Spectrum ◽

Bipolar Spectrum Disorders ◽

Different Types ◽

Spectrum Disorders ◽

Depressive Episodes

Environmental experiences play an important part in the development and maintenance of bipolar spectrum disorders (BSDs). Consequently, in this chapter, we review evidence on the role of life stress in the onset and course of BSDs. We begin with methodological issues relevant to demonstrating life stress’s role in the development and course of BSDs. We consider the effects of exposure both to recent life events and childhood stressors, as well as whether the influence of stressor exposure changes over the course of BSDs. We also address whether the effects of different types of life event exposure depend on mood episode polarity (hypomanic/manic versus depressive episodes) and whether there are specific theoretically relevant types of life events that are particularly likely to trigger bipolar episodes or symptoms. We end with suggestions for future research that may lead to a more complete understanding of the bipolar disorder–stress association.

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The progression of 102 Brazilian patients with bipolar disorder: outcome of first 12 months of prospective follow-up

Trends in Psychiatry and Psychotherapy ◽

10.1590/2237-6089-2012-0048 ◽

2014 ◽

Vol 36 (1) ◽

pp. 16-22 ◽

Cited By ~ 2

Author(s):

Fernanda Novis ◽

Patricia Cirillo ◽

Rafael Assis da Silva ◽

Ana Letícia Santos ◽

Luciana Angélica Silva Silveira ◽

...

Keyword(s):

Bipolar Disorder ◽

Depressive Symptoms ◽

Rating Scale ◽

Depression Scale ◽

First Episode ◽

First Year ◽

International Studies ◽

Hamilton Depression Scale ◽

Adequate Treatment ◽

Depressive Episodes

INTRODUCTION: Prospective studies have shown that the course of bipolar disorder (BD) is characterized by the persistence of symptoms, predominantly depression, along most of the time. However, to our knowledge, no studies in Latin America have investigated it. OBJECTIVES: To replicate international studies using a Brazilian sample to prospectively analyze treatment outcomes in the first year and to determine potential chronicity factors. METHODS: We followed up 102 patients with BD for 12 months and evaluated the number of months with affective episodes and the intensity of manic and depressive symptoms using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAM-D17). Sociodemographic and retrospective clinical data were examined to determine possible predictors of outcome. RESULTS: Almost 50% of the patients had symptoms about half of the time, and there was a predominance of depressive episodes. Disease duration and number of depressive episodes were predictors of chronicity. Depressive polarity of the first episode and a higher number of depressive episodes predicted the occurrence of new depressive episodes. CONCLUSION: In general, BD outcome seems to be poor in the first year of monitoring, despite adequate treatment. There is a predominance of depressive symptoms, and previous depressive episodes are a predictor of new depressive episodes and worse outcome.

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508 - LATE ONSET BIPOLAR DISORDER: CASE REPORT AND LITERATURE REVIEW

International Psychogeriatrics ◽

10.1017/s1041610221002039 ◽

2021 ◽

Vol 33 (S1) ◽

pp. 60-60

Author(s):

Joana Regala ◽

João Reis

Keyword(s):

Bipolar Disorder ◽

Case Report ◽

Electroconvulsive Therapy ◽

Late Onset ◽

Diffuse Axonal Injury ◽

First Episode ◽

Triggering Factors ◽

History Of ◽

Secondary Mania ◽

Depressive Episodes

Background:Late-onset bipolar disorder (LOBD) remains an incompletely understood nosological entity, in reason of its complexity and the paucity of research in this issue. It is not yet clear whether LOBD is a “phenocopy” of the classic early-onset bipolar disorder (EOBD), sharing symptoms but having a different aetiology, or whether both have a common underlying vulnerability that interacts with age-specific triggering factors. Some authors have proposed that LOBD is a heterogeneous entity, comprising secondary mania (including organic brain disease), bipolarity in the context of dementia-like processes (BD type VI), and LOBD as expression of a lower vulnerability to bipolarity.Case Report:Female patient with previous medical history of hypertension and dyslipidaemia, and psychiatric history of recurrent severe depressive episodes since early age, with melancholic and psychotic features, had a first hypomanic episode at 76 years-old, under treatment with tricyclic antidepressant and electroconvulsive therapy. Meanwhile, she suffered a traumatic brain injury (TBI) complicated with subdural and subarachnoid hematoma, as well as intraventricular haemorrhage, which is an indirect sign of diffuse axonal injury (DAI). Later, at 79 years-old, she presented a mixed episode characterized by racing thoughts, flight of ideas, non-systematized persecutory and ruin delusions, hyposomnia, and ultradian alternation between dysphoric and depressive mood, psychomotor agitation and retardation, emotional lability, hypersyntonic contact and hostility. Medical conditions that could account for secondary mania were ruled out. This clinical picture subsided within few weeks under treatment with olanzapine and electroconvulsive therapy. After recovery memory deficits were noticed.Concluding remarks:This case illustrates a “latent” BD, in a patient with previous recurrent depressive disorder, manifesting the first episode of mania in late life. Several triggering factors may have contributed to this longitudinal evolution, lowering the threshold to manifest mania, namely cerebrovascular risk factors, a possible underlying degenerative process and DAI secondary to TBI, which through structural dysconnectivity also contributes to cognitive dysfunction. The deleterious effect of recurrent and severe depressive episodes on cognition is well documented. The question of whether some forms of LOBD could constitute a special risk factor for developing dementia deserves further investigation.

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