Jonah Unbound

The Hebrew Bible is a compilation of literary ‘fictions’ and poetry that evoke ‘the truth of the human condition’ (Elena Ferrante). This article retells the story of the Book of Jonah from the first-person perspective of ‘Jonah’. The fictional narrative is rooted in the language and themes of the original biblical text. Jonah is still angry with God’s forgiveness of the Ninevites, and readers’ complicity in the always-recurring flight from taking responsibility to act against evil in the world. As Jonah tells his story, he regresses into a manic state that parallels chapter 2 of the biblical book. The narrative moves into reflections about humanity’s lack of compassion for the natural world, and Jonah’s fears about the forthcoming ‘ecocide’ of the planet.

Complexity and Variability Analyses of Motor Activity Distinguish Mood States in Bipolar Disorder

Aims Changes in motor activity are core symptoms of mood episodes in bipolar disorder. The manic state is characterized by increased variance, augmented complexity and irregular circadian rhythmicity when compared to healthy controls. The aim was to characterize differences in motor activity when comparing manic patients to their euthymic selves. Methods Motor activity was collected from 14 bipolar inpatients in mania and remission. 24-h recordings and 2-h time series in the morning and evening were analyzed for mean activity, variability and complexity. Lastly, the recordings were analyzed with the similarity graph algorithm and graph theory concepts such as edges, bridges, connected components and cliques. Results When compared to euthymia, over the duration of approximately one circadian cycle, the manic state presented reduced variability, displayed by decreased standard deviation (p = 0.013) and augmented complexity shown by increased sample entropy (p = 0.025). During mania there were also fewer edges (p = 0.039) and more bridges (p = 0.026). Similar changes in variability and complexity were observed in the 2-h morning and evening sequences, mainly in the estimates of the similarity graph algorithm. A comparison of morning and evening sequences within states revealed no significant change in estimates for mania. Contrarily, the euthymic state showed significant evening differences in variance and complexity, displayed by fewer edges (p = 0.010) and an increased number of connected components (p = 0.009). Conclusion The motor activity of mania is characterized by altered complexity, variability, and circadian rhythms when compared within-subject to euthymia.

Epidemiological profile of psychiatric illnesses in the province of Taza, Morocco: case of a study on a schizophrenic sub-population in the Ibn Baja Hospital

Aim The objective of this study is to assess the prevalence of major psychiatric disorders and to plot some characteristics of the schizophrenic sub-population in the study area. Methods We present the results of a retrospective study on psychiatric illnesses listed at the level of the psychiatric department at the Ibn Baja Hospital in the province of Taza (Morocco), involving a sample of 3803 patients aged 18 years and over between 2006 and 2016. Results The results obtained show that the average age of our sample is 33 ± 10.5 years and that schizophrenia is the most pronounced psychiatric disorder with a prevalence of 69.9%, followed by bipolar disorder (8.4%), manic state (8.3%), major depression (5.8%), epilepsy (3.7%), dementia (2.5%), and drug addiction (1.5%). The predominance of the workforce for all psychiatric disorders was significantly in favor of males (P = 0 .000) with an M/F sex ratio of 4.9. Most patients were from urban areas 77.1%, compared with 22.9% from rural areas, with a predominance of males (P<0.001). Schizophrenia disease is the most predominant in the region with a prevalence of 1.6% and affects 83% of men versus 17% of women with a M/F sex ratio value of 5.6 in favor of men (P = 0.000). Conclusion In our region of study, as everywhere else in the world, the prevalence of psychiatric diseases on the one hand, and schizophrenia on the other hand, seems to be worrying, thus requiring more vigilance on the part of public health workers in general and mental health workers.

The Cranial Rhythmic Impulse as a Measure in Patients With Bipolar Disorder: A Case Report

Bipolar disorder is a severe psychiatric illness associated with profound impairment in social and occupational functioning. Several conditions, including psychiatric disorders, have been associated with a decreased cranial rhythmic impulse (CRI). In this case report, a 20-year-old man with a recent manic episode is found to have a normal cranial rhythmic impulse, which is found to be decreased following resolution of the manic episode. This case illustrates the potential that a relative CRI increase in bipolar disorder may be a sign of an active manic state.

Diverse Pathophysiological Processes Converge on Network Disruption in Mania

BackgroundNeuroimaging of psychiatric disease is challenged by the difficulty of establishing the causal role of neuroimaging abnormalities. Lesions that cause mania present a unique opportunity to understand how brain network disruption may cause mania in both lesions and in bipolar disorder.MethodsA literature search revealed 23 case reports with imaged lesions that caused mania in patients without history of bipolar disorder. We traced these lesions and examined resting-state functional Magnetic Resonance Imaging (rsfMRI) connectivity to these lesions and control lesions to find networks that would be disrupted specifically by mania-causing lesions. The results were then used as regions-of-interest to examine rsfMRI connectivity in patients with bipolar disorder (n=16) who underwent imaging longitudinally across states of both mania and euthymia alongside a cohort of healthy participants scanned longitudinally. We then sought to replicate these results in independent cohorts of manic (n=26) and euthymic (n=21) participants with bipolar disorder.ResultsMania-inducing lesions overlap significantly in network connectivity. Mania-causing lesions selectively disrupt networks that include orbitofrontal cortex, dorsolateral prefrontal cortex, and temporal lobes. In bipolar disorder, the manic state was reflected in strong, significant, and specific disruption in network communication between these regions and regions implicated in bipolar pathophysiology: the amygdala and ventro-lateral prefrontal cortex.LimitationsThe was heterogeneity in the clinical characterization of mania causing lesions.ConclusionsLesions causing mania demonstrate shared and specific network disruptions. These disruptions are also observed in bipolar mania and suggest a convergence of multiple disorders on shared circuit dysfunction to cause mania.