O manejo odontológico do paciente bipolar em litioterapia, com ênfase para a cárie dentária, no método clínico de intervenção : estudo de casos

The present work is a case study of 8 bipolar patients under lithium therapy, being all of them members of the lithium group of the Hospital de Clínicas de Porto Alegre. It describes the dental management of bipolar patients under lithium therapy, emphasizing dental caries and the clinical method of intervention. The work was divided into three phases, existing a ninety-day interval between each ofthem. In the first part ofthe research, dental examinations were carried out and the patients were interviewed with the special purpose of describing each one of them regarding his buccal health. They were also inquired about their experience in living with the bipolar disease, about the medication taken and its side effects. The patients received dental treatment according to the clinical method as they also attended health educational sessions destined to increase their autonomy up to the dental dismissal. In the second and third phases, the exams that had been carried out in the first phase were repeated in order to analyze the commitment of each bipolar patient to the proposed dental treatment. The questions about the relationship between the bipolar patient and the treatment of this disease were also repeated. It was concluded that the results of the dental exams were related to the degree of stabilization of the bipolar disease; the patients detaining the best results in the dental treatment were those who had the bipolar disease stabilized. It was concluded that, having in mind the occurrence frequency of bipolar disease, it would be plausible that a denfist who works in the Public Service sooner or later would attend bipolar patients; bipolar patients are a peculiar population group that need a specific dental program; the planning and scheduling of these specific odontological programs for bipolars should take into account the disruptions in the dental therapy, caused by the disease and it is also necessary to renegotiate with the bipolar, his responsibilities and his motivation for buccal self-care, which will result in more frequent dental visits.

433 - A possible link between Bipolar Disease and Frontotemporal Dementia

Background:Both neurological and psychiatric symptoms are observed among mental disorders and represent a challenge for the differential diagnosis, specially in old adults presenting behavioral changes. Investigations have documented manic/hypomanic symptoms from behavioral variant frontotemporal dementia(bvFTD), suggesting a relationship of bipolar disease (BD) with bvFTD.Research objective:This work aims to determine the relationship between patients with bipolar disease and behavioral variant frontotemporal dementia.Method:A non-systematic review of the literature is presented. Bibliographic selection was carried out through keyword research in MEDLINE and Google Scholar.Results:An early stage of bvFTD often displays a mix of behavioral disturbances and personality changes. Also, BP is associated with a higher risk of dementia in older adults and with cognitive impairment, where a subset of patients presents a neuroprogressive pattern during the disease course. It was shown a specific type of post-BD dementia with clinical features of bvFTD and cases of patients with marked manic symptoms for the first time in their life had subsequent diagnosis of FTD. Mutations in the progranulin gene (GRN) were the most frequent causes of autosomal dominant FTD and have also been reported in sporadic FTD. Genetic polymorphisms in this gene are also associated with schizophrenia and BD. An hypothetical model of shared mechanisms between bvFTD and BD was proposed, including specific mendelian mutations associated with genetic predisposition (e.g. brain-derived neurotrophic factor-BDNF gene) and environmental factors with an effect on cellular homeostasis (e.g. increased cell deaths, decreased synthesis of synaptic proteins) and an influence over behavioural and cognitive symptoms. Nevertheless, comparison of the executive functions, social cognition profiles and structural neuroimaging of bvFTD and elderly patients with BD showed difference in patterns.Discussion:Although BD is principally considered a neurodevelopment disorder, while FTD is a neurodegenerative disorder, follow-up studies of cognitive deficits, imaging, and genetics in BD patients could elucidate the possible correlation between these major diseases and may have implications for pathogenesis, as well as for treatment.

Na+, K+-ATPase α Isoforms and Endogenous Cardiac Steroids in Prefrontal Cortex of Bipolar Patients and Controls

Bipolar disorder is a chronic multifactorial psychiatric illness that affects the mood, cognition, and functioning of about 1–2% of the world’s population. Its biological basis is unknown, and its treatment is unsatisfactory. The α1, α2, and α3 isoforms of the Na+, K+-ATPase, an essential membrane transporter, are vital for neuronal and glial function. The enzyme and its regulators, endogenous cardiac steroids like ouabain and marinobufagenin, are implicated in neuropsychiatric disorders, bipolar disorder in particular. Here, we address the hypothesis that the α isoforms of the Na+, K+-ATPase and its regulators are altered in the prefrontal cortex of bipolar disease patients. The α isoforms were determined by Western blot and ouabain and marinobufagenin by specific and sensitive immunoassays. We found that the α2 and α3 isoforms were significantly higher and marinobufagenin levels were significantly lower in the prefrontal cortex of the bipolar disease patients compared with those in the control. A positive correlation was found between the levels of the three α isoforms in all samples and between the α1 isoform and ouabain levels in the controls. These results are in accordance with the notion that the Na+, K+-ATPase-endogenous cardiac steroids system is involved in bipolar disease and suggest that it may be used as a target for drug development.

Characterization CYP1A2, CYP2C9, CYP2C19 and CYP2D6 Polymorphisms Using HRMA in Psychiatry Patients with Schizophrenia and Bipolar Disease for Personalized Medicine

Background: The interindividual genetic variations in drug metabolizing enzymes effects the impact and toxicity in plenty of drugs. Objective: CYP1A2, CYP2C9, CYP2C19 and CYP2D6 gene polymorphisms were characterized using high resolution melting analysis (HRMA) in follow-up patients in psychiatry clinic as a preliminary preparation for personalized medicine. Method: Genotyping of CYP1A2*1F, CYP2C9 *2, *3, CYP2C19 *2, *3 and *17 and CYP2D6 *3, *4 was conducted in 101 patients using HRMA. Genotype and allele frequencies of the CYP variants were found to be in equilibrium with the Hardy-Weinberg equation. Results: The frequency of the CYP1A2*1F allele in schizophrenia and bipolar disease was 0.694 and 0.255, respectively. The CYP2C9 allele frequencies were 0.087 (CYP2C9*2), and 0.549 (CYP2C9*3) for bipolar; 0.278 (CYP2C9*2) and 0.648 (CYP2C9*3) in schizophrenias. The CYP2C19*2 and *17 allele frequencies was 0.111 and 0.185 in schizophrenia and variant *2 was 0.117 and variant *17 was 0.255 in bipolar group. The frequency of the CYP2D6*3 allele was 0.027 in schizophrenias. The frequencies for the CYP2D6*4 variant were 0.092 and 0.096 in schizophrenia and bipolar groups, respectively. Conclusion: The knowledge in pharmacogenomic and also the developments in molecular genetics are growing rapidly. In future, this can be expected to provide new methodologies in the prediction of the activity in drug metabolizing enzymes. The HRMA is a rapid and useful technique to identify the genotypes for drug dosage adjustment before therapy in psychiatry patients.