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.

Bipolar Patients and Bullous Pemphigoid after Risperidone Long-Acting Injectable: A Case Report and a Review of the Literature

Neuropsychiatric disorders are found to be associated with bullous pemphigoid (BP), an autoimmune subepidermal blistering disease. Antipsychotics have emerged as possible inducing factors of BP. However, large sample studies concerning BP associated with antipsychotics, as well as with specific mental disorders, are still lacking. Our review retrieved a few clinical studies and case reports on the topic, producing controversial results. We report for the first time a bipolar patient case presenting BP following five-month therapy with risperidone long-acting injectable (LAI). We hypothesize that the dermatological event is associated with the medication administered. The issue emerged during psychiatric consultation and was confirmed by histological examination, direct and indirect immunofluorescence studies, plus positive plasma and cutaneous BP180 and BP230 IgG. Neurodegeneration or neuroinflammation might represent a primary process leading to a cross-reactive immune response between neural and cutaneous antigens and contributing to self-tolerance failure. Furthermore, the time sequence of the shared biological mechanisms leading to clinical manifestations of the neuropsychiatric disorder and BP remains undefined. BP comorbid with bipolar disorder might occasionally represent a serious health risk and affect patients’ physical and psychosocial quality of life. Thus, clinicians treating psychiatric patients should consider BP as a possible adverse effect of psychotropic medications.

MOOD DISORDER QUESTIONNAIRE-INA: PENGUJIAN KONSTRUK BERDASARKAN VALIDITAS BUTIR DENGAN METODE FACTOR ANALYSIS

Mood Disorder Questionnaire-INA (MDQ-INA) is one of the most popular screening tool that has been used around the world and it has been adapted into Bahasa Indonesia. This screening tool can be very useful because it helped professional by identifying mania or hypomania symptoms on bipolar patient. The purpose of this study is to find the proof of construct validity in MDQ-Ina by using Confirmatory Factor Analysis (CFA) approach. There are 13 items that has been tested and there are 209 subjects in this study. This study is using LISREL 9.30 student version to analyze CFA based on fitness of the model, item validity with P-value > .05; positive loading factor; and t-value > 1.96. The result of this study is MDQ-INA is having 13 valid items with positif loading factor. Conclusion of this study is MDQ-INA is screening tool that has a good construct validity and can be used in screening patient with bipolar and can also be use in further study or research about bipolar or screening tool. Mood Disorder Questionnaire-INA (MDQ-INA) merupakan salah satu alat ukur skrining gangguan bipolar yang paling sering digunakan di seluruh dunia dan telah di adaptasi ke dalam bahasa Indonesia. Alat ukur skrining ini dinilai sangat berguna karena membantu memastikan kemunculan gejala mania maupun hipomania pada pasien. Tujuan dari penelitian ini adalah untuk menguji konstruk MDQ-INA berdasarkan validitas butir menggunakan factor analysis, Confirmatory Factor Analysis (CFA). Jumlah butir tes sebanyak 13 butir, pengambilan data dilakukan kepada 209 subyek. Pengolahan data CFA menggunakan program LISREL 9.30 student, hasil pengujian berdasarkan model-fit dan validitas butir dengan P-Value > .05; factor loading positif; t-value > 1.96. Hasil pengujian menunjukkan bahwa MDQ-INA memiliki 13 butir valid dengan loading factor positif. Oleh karena itu, MDQ-INA merupakan alat ukur skrining bipolar dengan validitas konstruk yang baik. MDQ-INA dapat digunakan lebih lanjut untuk melakukan skrining pada pasien maupun untuk penelitian lebih lanjut mengenai alat ukur skrining ini.

530 - The effects of lithium and inflammation on the atherosclerosis of older bipolar patients at high risk for cardiovascular disease

Background:Atherosclerosis can result in serious cardiovascular disease (CVD) and is associated with inflammation and psychopharmacological treatment in bipolar disorder. We attempt to investigate the effects of lithium and inflammation on the atherosclerotic development in older bipolar adults at high risk for cardiovascular disease.Methods:The euthymic out-patients with bipolar I disorder aged over 45 years and concurrent endocrine or cardiovascular disease were recruited to measure their bilateral carotid intima media thickness (CIMT) and circulating levels of lithium, valproate, sTNF-R1, sIL-6R, and lipid profile. All clinical information were obtained by directly interviewing patients and reviewing all medical records.Results:Forty eight patients with mean 48.3 years old and mean 27.2 years of age at illness onset were recruited. After controlling for the body mass index, multivariate regression analyses showed that older age, lower lithium level, and higher plasma sTNF-R1 level were associated with higher CIMT and collectively accounting for 33.1% of the variance in CIMT. Blood level of low density lipid or valproate has none relationship with CIMT.Conclusion:Lithium treatment may protect older bipolar patient, even those at high risk for CVD, from atherosclerotic development. Furthermore, persistent inflammatory activation, particularly macrophage activation, may be associated with the accelerating development of atherosclerosis.

Quetiapine associated tics in a pediatric patient post overdose on re-initiation: An interesting clinical scenario

The COVID-19 pandemic has led to a multitude of new medical and psychiatric complications and new presentations that were either never seen before or not seen to the extent that they are presenting now. [1,2]. Increased number of suicide attempts and worsening severity of suicide attempts have been noted in the past year since the COVID-19 pandemic has started [1]. Psychotropic medications can often have lesser-known side effects and movement disorders, including tics, can be one of them [3]. Tics are recurrent, simple or complex behaviors that can be motor or phonic in nature [4,5]. Simple motor tics are often observed as rapid movements while complex motor tics are more synchronized and elaborate. Additionally, noises or brief sounds are examples of simple vocal tics, while speaking a string of words or syllables are more characteristic of a complex vocal tic [4]. The underlying pathogenesis of tics and tic disorders has not been well elucidated, dopaminergic hypothesis being the most widely accepted; however, multiple areas of the brain are speculated to be involved [4,6]. Common treatment options for tic disorders include alpha-2 agonists, clonidine and guanfacine, and antipsychotics [4,7]. Previous literature identifies two case reports that documented tics related to quetiapine. One report described a pediatric bipolar patient who developed tics proportional to quetiapine dose [8], and the other report identified an adult patient with schizophrenia who developed tics during quetiapine therapy [9]. In this article, we describe a pediatric patient who presented after overdosing on quetiapine, lamotrigine and sertraline and developed tics after re-initiation of quetiapine at a much lower dose. To the best of our knowledge, this is the first case of its kind where tics, which were previously absent, developed on re-initiation of quetiapine after an overdose.

DEMOGRAPHIC VARIABLES ASSOCIATED WITH DRUG USE IN BIPOLAR PATIENTS

Background: Substance Use is highly associated with bipolar affective disorder, however the reason for the co-occurrence is unknown. It was evident that if a bipolar patient use drug of abuse his outcome will be poor. Either it can directly trigger the affective symptoms, or may affect the treatment compliance indirectly. Aims: The objective of this study was to study the demographic correlates of drug abuse in patients with bi-polar affective disorder. Method: Cross-Sectional research design and non-probability consecutive sampling was used to collect data from a private clinic in Lahore. Data was comprised of 368 patients of bipolar disorder. Results: Out of a total of 368 bipolar patients, drug abuse was found in 147 patients that is 39.9%. The results showed that the mean age of the patients was 31.03 ±5.837; mean monthly income was 229597.82 ±164626.77 PKR. The mean duration of illness was 6.54 ±5.157. The mean number of drugs used was 2 ±0.875. The mean cost of drug was 29945.7 ±19068.8 PKR. The mean number of hospitalization was 2.47 ±1.694. Association between drug use and occupation of bipolar patients (0.006), factors leading to initiation of drug use (0.000), family history of drug use (0.001), current episode (0.000) and the type of drugs used (0.000) was statistically significant. Conclusion: The cause and effect relationship between drug use and bipolar disorder cannot be clearly identified. However occupation of the patient, reasons of initiating drugs, drug abuse in family, current episode as well as type of drugs used have significant association with drug abuse in bipolar patients .

Religious Behavior And Self-Defense Method: A Study Of Patient With Bipolar Disorder

Human life is dynamic in maintaining the balance of their soul. Life problems such as family conflict have an impact on mental balance. This study analyzed a bipolar patient, based on the result of observation, in-depth interviews, and relevant documents from one of the mental hospitals. Freud and Jung were chosen as a method for analyzing the concept of self-defense. The purpose of the study was to analyze bipolar psychiatric condition by finding the factors that influenced it. The findings revealed that life experience formed spirituality with zikir continually and practiced prayer despite the bipolar condition. Self-defense by continuing to maintain religious behavior as religious healing is one of the alternative solutions by involving the role of the family.