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Bipolar Disorders Jun 2022Bipolar depression is the most prevalent phase of bipolar disorder (BD). There is a risk of inducing treatment-emergent affective switches (TEAS) with antidepressants... (Review)
Review
Bipolar depression is the most prevalent phase of bipolar disorder (BD). There is a risk of inducing treatment-emergent affective switches (TEAS) with antidepressants (ADs). Hence, clinical guidelines do not recommend their use in monotherapy. Cariprazine is a dopamine-serotonin partial agonist, with a recent FDA approval as a monotherapy for BD type 1 (BD-I) depression. To our knowledge, there is no significant evidence of cariprazine-induced TEAS in bipolar depression. We describe three clinical cases of patients admitted to our acute psychiatric ward who developed manic episodes after the introduction of low doses of cariprazine. Two of the patients met the DSM-5 criteria for BD-I, and one for schizoaffective disorder, bipolar type. All patients were initially treated with low doses of cariprazine (1.5 mg) during a depressive phase. All three cases were simultaneously treated with mood stabilizers, regardless of which they switched to a manic episode when cariprazine was initiated. In our review of previous studies assessing the efficacy and side effects profile of cariprazine in BD-I, TEAS have not been found to be significant. However, according to our experience, cariprazine may induce affective switches in BD-I patients. Patients and psychiatrists should receive information regarding early warning symptoms and monitor possible cariprazine-induced mood switching.
Topics: Antipsychotic Agents; Bipolar Disorder; Humans; Mania; Piperazines
PubMed: 34797609
DOI: 10.1111/bdi.13156 -
European Archives of Psychiatry and... Jun 2015In the classification of mood disorders, major depressive disorder is separate from bipolar disorders whereas mania is not. Studies on pure mania are therefore rare. Our... (Review)
Review
In the classification of mood disorders, major depressive disorder is separate from bipolar disorders whereas mania is not. Studies on pure mania are therefore rare. Our paper reviews the evidence for distinguishing pure mania (M) and mania with mild depression (Md) from bipolar disorder. Two large epidemiological studies found a prevalence of 1.7-1.8% of M/Md in adolescents and adults. Several clinical follow-up studies demonstrated good stability of the diagnosis after a previous history of three manic episodes. Compared to bipolar disorder, manic disorder is characterised by a weaker family history for depression, an earlier onset, fewer recurrences and better remission, and is less comorbid with anxiety disorders. In addition, mania is strongly associated with a hyperthymic temperament, manifests more psychotic symptoms and is more often treated with antipsychotics. Twin and family studies find mania to be more heritable than depression and show no significant transmission from depression to mania or from mania to depression. Cardiovascular mortality is elevated among patients with mood disorders generally and is highest among those with mania. In non-Western countries, mania and the manic episodes in bipolar disorder are reported to occur more frequently than in Western countries.
Topics: Bipolar Disorder; Diagnosis, Differential; Diagnostic and Statistical Manual of Mental Disorders; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Mood Disorders
PubMed: 25631618
DOI: 10.1007/s00406-015-0577-1 -
Journal of Affective Disorders Dec 2021To assess feasibility and clinical significance of tracking mania and depression in community college students before and after early identification and intervention.
OBJECTIVES
To assess feasibility and clinical significance of tracking mania and depression in community college students before and after early identification and intervention.
METHODS
From Affective Illness to Recovery: STudent Access to Rapid Treatment (FAIRSTART) is an early intervention program to provide diagnostic therapeutic consultation, short-term care, and community ongoing care referral for 18-28 year-old outpatient community college students (mean age 22.9±4.0 years) experiencing manic symptoms. Over three years, 54 FAIRSTART participants (70% with DSM-IV bipolar I/II/not otherwise specified disorder, BDI/II/NOS) were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation (ADE) and followed (range: one-time consult to 4.3±3.6 visits over 3-6 month follow-up) with the STEP-BD Clinical Monitoring Form.
RESULTS
38/54 patients (70%) had BDI/II/NOS, 11 unipolar depression (20%), 1 psychosis spectrum disorder (2%), 2 dysthymia/persistent depressive disorder (4%), and 2 incomplete intake with mood disorder diagnosis undetermined (4%). Average illness duration was 9.1±5.3 years. Among the 38 BD I/II/NOS patients, depression (SUM-D, t(30)=6.5; p<0.001) and mania (SUM-M, t(30)=4.7; p<0.001) scores improved significantly from baseline to last visit, with 17 (44.7%) reporting recovery by time transitioned from FAIRSTART to community care (after 4.3±3.6 visits).
CONCLUSIONS
Short-term, early intervention in community college students with mood symptoms appeared feasible and yielded significant improvements in depression and mania scores. However, additional studies, with longer-term follow-ups, larger sample sizes, and comparison to current care standards, are needed to determine this early intervention program's impact on trajectory of mania symptoms in transitional age young adult populations.
Topics: Adolescent; Adult; Affect; Bipolar Disorder; Diagnostic and Statistical Manual of Mental Disorders; Humans; Longitudinal Studies; Mood Disorders; Young Adult
PubMed: 34391959
DOI: 10.1016/j.jad.2021.08.001 -
Advances in Clinical Chemistry 2018Major depressive disorder (MDD) and bipolar disorder (BD) are the most common mood disorders. They are etiologically related, but clinically distinct psychiatric... (Review)
Review
Major depressive disorder (MDD) and bipolar disorder (BD) are the most common mood disorders. They are etiologically related, but clinically distinct psychiatric illnesses. Their shared clinical features result in high rates of misdiagnosis due to a lack of biomarkers that allow their differentiation. BD is more frequently misdiagnosed as MDD because of overlapping symptomology, often later onset of mania, and frequent occurrence of depressive episodes in patients with BD. Misdiagnosis is also increased when patients with BD present symptoms indicative of a clinically significant depressive episode, but are premorbid for manic symptoms, or previous manic states not recognized. Therefore, the development of specific biomarkers for these disorders would be invaluable for establishing the correct diagnosis and treatment of MDD and BD. This chapter presents an overview and future perspective of the identification of biomarkers for mood disorders using metabolomics.
Topics: Animals; Biomarkers; Bipolar Disorder; Brain; Depressive Disorder, Major; Humans; Metabolic Networks and Pathways; Metabolome; Metabolomics
PubMed: 29478517
DOI: 10.1016/bs.acc.2017.12.005 -
Journal of Psychiatric Practice Sep 2023Patients may present with manic symptoms in medical settings such as emergency rooms and on inpatient medical floors, leading to psychiatric consultation to try to...
Patients may present with manic symptoms in medical settings such as emergency rooms and on inpatient medical floors, leading to psychiatric consultation to try to determine the etiology of the symptoms. It is crucial to clarify whether the mania is secondary to a medical illness or whether the patient's symptoms are from a primary bipolar disorder. In this issue, we publish 2 case reports of patients presenting with manic symptoms in medical settings. The first case involves polymicrogyria in the frontal lobe of the brain as a cause of secondary mania. The second case involves a patient who was previously diagnosed with bipolar disorder and subsequently developed symptoms of Behçet's disease. In this case, it appears likely that the bipolar disorder was primary, and that the Behçet disease and the bipolar disorder may have exacerbated each other. Given the complexities involved in assessing and treating patients, especially in acute or emergency settings, it is important for primary medical and psychiatric providers to collaborate and communicate well in assuring that they obtain a thorough history of their patients' symptoms and that patients receive a comprehensive medical evaluation before psychiatric treatment is started.
Topics: Humans; Mania; Bipolar Disorder; Brain; Inpatients; Emergency Service, Hospital
PubMed: 37678372
DOI: 10.1097/PRA.0000000000000731 -
Journal of Affective Disorders Aug 2014Cannabis is the most commonly abused drug among patients with bipolar disorder. Available data has shown that the risk of psychotic disorders increases with the... (Review)
Review
BACKGROUND
Cannabis is the most commonly abused drug among patients with bipolar disorder. Available data has shown that the risk of psychotic disorders increases with the frequency and intensity of cannabis abuse. The present purpose was to review relevant studies to investigate whether cannabis use can be linked to the onset of mania in bipolar disorder.
METHODS
Articles published between 1972 and December 2013 were searched on Medline and PsychInfo using the following keywords: first manic episode, or onset mania, or bipolar disorder and cannabis. Relevant papers cited in the references of selected articles were further considered for inclusion into the review.
RESULTS
Lifetime use of cannabis among bipolar patients appears to be around 70% and approximately 30% of patients with a bipolar disorder present a comorbidity of cannabis abuse or dependence. Cannabis use is associated with younger age at onset of first mania and with more frequent depressive or manic episodes, although the evidence is somewhat inconsistent. Likewise cannabis consumption is related to poorer outcome and an increased risk of rapid cycling or mixed episodes. In contrast, neuro-cognitive functioning seems to be positively affected in patients with psychiatric comorbidity. While cannabis use often precedes first manic episodes, the causal direction remains to be determined.
LIMITATIONS
Variations in definition of cannabis use/dependence. Lack of controlled studies limiting definite conclusions about a putative causal relationship between cannabis and onset of mania.
CONCLUSIONS
Further investigations are needed to clarify the relationships between cannabis use and first manic episode.
Topics: Adult; Aged; Bipolar Disorder; Cannabis; Female; Humans; Male; Marijuana Abuse; Middle Aged
PubMed: 24882185
DOI: 10.1016/j.jad.2014.04.038 -
Psychiatrike = Psychiatriki 2020The clinical and diagnostic debate circulating pediatric bipolar disorder (PBD) has been highlighted as one of the most controversial themes in child psychiatry. With... (Review)
Review
The clinical and diagnostic debate circulating pediatric bipolar disorder (PBD) has been highlighted as one of the most controversial themes in child psychiatry. With atypical symptomatic expression, constituting its predominant diagnostic discrepancy, PBD is manifested through prolonged manic episodes and affective storms, lacking the symptomatic cycling and episodic nature presented in adult BD. Apart from its unique clinical presentation, the substantial symptomatic overlap with attention deficit hyperactivity disorder (ADHD) indicate an important diagnostic challenge in PBD. Specifically, both disorders share core characteristics such as irritability, hyperactivity, excessive talking and distractibility. Against this background of findings on the overlapping symptomatology between PBD and ADHD, current research guidelines highlight the need of exploring non-symptomatic markers as potential clinical phenotypes. Especially in disorders with distinctive biologic underpinnings, both clinicians and researchers have shown increased interest in establishing neuropsychological profiles. Recent neuropsychological studies indicated the distinct nature of neurocognitive deficits in PBD, describing impairments in various cognitive skills during acute episodes phases, while this severe deterioration of cognitive deficits appears to persist even during euthymic states. Regarding neuropsychological assessment in AHD, recent findings suggested dysfunctions in the domains of working memory, verbal memory and response inhibition. Furthermore, neuroimaging studies are fast becoming a key instrument to establish distinct neuropsychological profiles for PBD and ADHD. A large number of neuroimaging studies have indicated abnormalities in limbic, cortical and subcortical brain systems, while meta-analytic findings of voxel based morphometric studies highlight abnormalities in dorsolateral and lateral orbitofrontal-temporal areas in PBD. In recent neuroimaging findings with focus on neurocognitive performance during an emotional Stroop task, patients diagnosed with ADHD indicated activation on higher cortical centres associated with processing speed and significantly decreased role of sustained attention. Furthermore, these findings suggest emotional regulation and inhibitory control are moderately intercorrelated, adding more complexity to the theme of neurocognitive deficits in ADHD. These observations on the neurobiological mechanisms of cognitive impairments in PBD appear to provide robust evidence on a potential specific neuropsychological profile of PBD, the relationship between mood states and neuropsychological functioning, and the link between emotion generation and regulation in children with PBD.
Topics: Adolescent; Attention Deficit Disorder with Hyperactivity; Bipolar Disorder; Child; Child Psychiatry; Humans; Neuroimaging; Neuropsychological Tests; Psychiatric Status Rating Scales
PubMed: 33361063
DOI: 10.22365/jpsych.2020.314.332 -
Psychopathology 2021Cycle patterns of bipolar disorders (BDs) have been previously shown to be associated with clinical characteristics and response to lithium salts. Here, we evaluated the...
INTRODUCTION
Cycle patterns of bipolar disorders (BDs) have been previously shown to be associated with clinical characteristics and response to lithium salts. Here, we evaluated the distribution of different types of manic-depressive cycles in a large sample of patients with BD. The associations between a mania-depression-interval (MDI) course and depression-mania-interval (DMI) course with sociodemographic/clinical factors were also assessed in order to define specific clinical profiles.
METHODS
In this cross-sectional study, 806 patients with BD admitted to the Psychiatric Unit of San Luigi Gonzaga Hospital in Orbassano and Molinette Hospital in Turin, Italy, were recruited. Patients were grouped according to the following course patterns: MDI, DMI, continuous cycling (CC, <4 episodes/year without intervals), rapid cycling (RC, ≥4 episodes/year), and irregular (IRR) cycling. We compared several sociodemographic and clinical variables in an MDI versus DMI course by means of ANOVA and Pearson χ2 with Bonferroni correction.
RESULTS
Bipolar cycles were distributed as follows: 50.2% IRR course, 31.5% MDI course, 16% DMI course, 1.2% CC, and 1% RC. Compared to DMI course, patients with an MDI course were more often men, younger, with an earlier onset, a manic polarity onset, and more lifetime compulsory admissions. They were more frequently treated with lithium and antipsychotics. Patients with a DMI course had older age at diagnosis and at first mood-stabilizer treatment and were more often misdiagnosed with a major depressive disorder. These patients were more commonly treated with anticonvulsants, and they had more frequently failed treatment trials with lithium salts in the past.
CONCLUSION
This study supports the utility of classifying BD according to their course patterns. This classification holds prognostic as well as therapeutic implications.
Topics: Bipolar Disorder; Cross-Sectional Studies; Depressive Disorder, Major; Female; Humans; Male; Middle Aged
PubMed: 33626525
DOI: 10.1159/000513314 -
The Journal of Neuropsychiatry and... 2020Previous studies have documented manic and hypomanic symptoms in behavioral variant frontotemporal dementia (bvFTD), suggesting a relationship between bipolar disorder... (Review)
Review
OBJECTIVE
Previous studies have documented manic and hypomanic symptoms in behavioral variant frontotemporal dementia (bvFTD), suggesting a relationship between bipolar disorder and bvFTD.
METHODS
The investigators conducted a literature review as well as a review of the psychiatric histories of 137 patients with bvFTD, and patients with a prior diagnosis of bipolar disorder were identified. The clinical characteristics of patients' bipolar disorder diagnosis, family history, features of bvFTD, and results from fluorodeoxyglucose positron emission tomography (FDG-PET), as well as autopsy findings, were evaluated.
RESULTS
Among the 137 patients, 14 (10.2%) had a psychiatric diagnosis of bipolar disorder, eight of whom met criteria for bipolar disorder (type I, N=6; type II, N=2) 6-12 years preceding onset of classic symptoms of progressive bvFTD. Seven of the eight patients with bipolar disorder had a family history of mood disorders, four had bitemporal predominant hypometabolism on FDG-PET, and two had a tauopathy involving temporal lobes on autopsy. Three additional patients with late-onset bipolar I disorder proved to have a nonprogressive disorder mimicking bvFTD. The remaining three patients with bvFTD had prior psychiatric symptoms that did not meet criteria for a diagnosis of bipolar disorder. The literature review and the findings for one patient further suggested a shared genetic mutation in some patients.
CONCLUSIONS
Manic or hypomanic episodes years before other symptoms of bvFTD may be a prodrome of this dementia, possibly indicating anterior temporal involvement in bvFTD. Other patients with late-onset bipolar disorder exhibit the nonprogressive frontotemporal dementia phenocopy syndrome. Finally, a few patients with bvFTD have a genetic predisposition for both disorders.
Topics: Adult; Age of Onset; Aged; Bipolar Disorder; Female; Frontotemporal Dementia; Humans; Magnetic Resonance Imaging; Male; Mania; Middle Aged; Positron-Emission Tomography; Prodromal Symptoms; Retrospective Studies
PubMed: 32498603
DOI: 10.1176/appi.neuropsych.20010003 -
The Primary Care Companion For CNS... May 2021
Topics: Bipolar Disorder; Humans; Ketamine; Mania
PubMed: 34000155
DOI: 10.4088/PCC.20l02811