Beneficial effect of lithium in female patient with bipolar affective illness and psoriasis

Objectives. Psoriasis makes a relative contraindication for lithium treatment which can exacerbate its symptoms or induce it itself. On the other hand, lithium exerts immuno-modulatory activity. Case study. In this paper, a case of a female patient is presented. The patient has been treated since 2012 for bipolar affective illness (bipolar disorder – BD) and psori­asis, which occurred for the first time during a depress­ive episode. Despite intensive pharmacological treatment, both as inpatient and outpatient, a satisfactory improvement of affective illness has not been obtained. After the introduction of lithium, a remission of BD was achieved as well as a reduction of psoriatic changes, which have been maintained until now (2021). Conclusion. The remission of Bipolar Disorder (BD) on lithium can suggest that the patient belongs to the group of the so-called excellent lithium responders. In the presen­ted case remission of psoriasis was observed during lithium treatment. This case report must be treated with caution because remission could be spontaneous and the patient needs further observation.

In search of sex-related mediators of affective illness

Sex differences in the rates of affective disorders have been recognized for decades. Studies of physiologic sex-related differences in animals and humans, however, have generally yielded little in terms of explaining these differences. Furthermore, the significance of these findings is difficult to interpret given the dynamic, integrative, and highly context-dependent nature of human physiology. In this article, we provide an overview of the current literature on sex differences as they relate to mood disorders, organizing existing findings into five levels at which sex differences conceivably influence physiology relevant to affective states. These levels include the following: brain structure, network connectivity, signal transduction, transcription/translation, and epigenesis. We then evaluate the importance and limitations of this body of work, as well as offer perspectives on the future of research into sex differences. In creating this overview, we attempt to bring perspective to a body of research that is complex, poorly synthesized, and far from complete, as well as provide a theoretical framework for thinking about the role that sex differences ultimately play in affective regulation. Despite the overall gaps regarding both the underlying pathogenesis of affective illness and the role of sex-related factors in the development of affective disorders, it is evident that sex should be considered as an important contributor to alterations in neural function giving rise to susceptibility to and expression of depression.

Seasonal Affective Illness

Seasonal affective illness is seen as part of the seasonality of affective illness, not as a separate disease. All human beings are sensitive to light; the impact of light is hardwired in neuroanatomy. The body has intricate circadian rhythms that are regulated by the interaction of light with this neuroanatomy. Thus, everyone is affected by light, or its absence. Manic and depressive states, when part of the disease of manic-depressive illness, can have a seasonal pattern, with depression more prevalent in the fall/winter and mania in the spring/summer. The high prevalence of suicide in the spring likely relates to mixed manic states. Treatment with light boxes can be helpful symptomatically. Available studies are summarized. Importantly, light precautions, which involve behavioral interventions to increase or decrease light exposure, can prevent seasonal mood episodes.

Other Agents (Glutamate Antagonists, Antihistamines, Melatonin Agonists, and Others)

A final drug class of other agents includes glutamate antagonists, antihistamines, and melatonin agonists. These agents have a range of clinical uses, but most are used symptomatically to produce sedation or reduce anxiety or for other symptoms. The clinical pharmacology of specific agents within each class, including their efficacy and side effects, is explored. Specific phenomena surveyed include the inefficacy of novel anticonvulsants for mood: clinicians and researchers have been excited about novel anticonvulsants, most of which have either anti-glutamate or pro-GABA effects. None have proven effective for affective illness or for any important psychiatric use, except perhaps for some mild anxiolytic effects for the GABAergic agents. The purported benefits of ketamine are also investigated.

Clinical Cases

Seventeen case reports are provided applying the principles described in this volume, including the following triad of principles: 1. Treat diseases, not symptoms. 2. Do not use DSM-based diagnoses. 3. Focus on the course of the illness, not just its symptoms, when you are making diagnoses. In addition, specific pharmacological aspects of medications as used in practice are explored in the context of specific cases—mood illnesses; PTSD; personality states; purported ADD; seasonality in affective illness; stopping antidepressants for “depression”; first depression in a young adult; pre-adolescent depression versus bipolar illness; when benzodiazepines are preferable to SRIs for anxiety; hyperthymia misdiagnosed as treatment-resistant depression; premenstrual mood dysphoric disorder; low-dose divalproex for misdiagnosed narcissistic personality disorder; suicidality and antidepressants in borderline personality—and more.

Comparison of Sexual Experience and Behavior between Bipolar Outpatients and Outpatients without Mood Disorders

Sexual behavior over the past year of 32 outpatients with Bipolar disorder is compared to that of 44 Comparison patients that had never had an episode of affective illness. Subjects were outpatients treated with drugs and psychotherapy in routine office practice. Differences in sexual behavior between the two groups as a whole were minimal, but meaningful differences emerged when subgroups were compared. Compared to control men, Bipolar men had had more partners in the last year and were more likely to have had sex without condoms. Compared to Bipolar females, Bipolar males had more sex partners, had more sex with strangers, and were more likely to have engaged in homosexual behavior. Even so, some patients in the Comparison group also had engaged in risky sexual behavior. They had failed to use condoms and had had sex with strangers and prostitutes during the previous year.