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Trends in Psychiatry and Psychotherapy Dec 2022Based on studies of the biographies of artists and on research in which modern diagnostic criteria were applied, it has been suggested that there is a relationship...
INTRODUCTION
Based on studies of the biographies of artists and on research in which modern diagnostic criteria were applied, it has been suggested that there is a relationship between bipolar disorder (BD) and creativity. Objective: To investigate the relationship between BD and creativity and whether creative capacity varies depending on mood state.
METHOD
We conducted a systematic search of the scientific literature indexed on the PubMed, ISI Web of Science, PsycINFO, and SciELO databases using the terms "bipolar" OR "bipolar disorder" OR "mania" OR "manic" AND "creativ*". Original studies were selected that investigated samples of at least ten patients with BD using at least one psychometric instrument to assess creativity.
RESULTS
Twelve articles met the selection criteria. The results of comparisons of BD patients with control groups without BD were heterogeneous. BD was not associated with higher levels of creativity than other mental disorders. When comparing BD phases, depression was associated with worse performance on creativity tests and patients in mania (or hypomania) were not distinguished from euthymia patients.
CONCLUSION
It was not possible to corroborate the hypothesis that individuals with BD are more creative than individuals without psychiatric diagnoses or than patients suffering from other mental disorders, which may be related to the cross-sectional rather than longitudinal designs of virtually all of the clinical studies.
Topics: Humans; Cross-Sectional Studies; Creativity; Bipolar Disorder
PubMed: 34374271
DOI: 10.47626/2237-6089-2021-0196 -
Brain and Behavior Dec 2023Treatment of mood and cognitive symptoms of patients with bipolar disorder is associated with many complications and is generally not associated with therapeutic... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Treatment of mood and cognitive symptoms of patients with bipolar disorder is associated with many complications and is generally not associated with therapeutic satisfaction. In this clinical trial, we evaluated the effectiveness of spironolactone in controlling mood and cognitive symptoms, sleep quality, appetite, and body mass index in patients with bipolar disorder in manic episodes.
METHODS
Sixty inpatients with bipolar disorder in manic episodes were treated with spironolactone/placebo in an 8-week randomized, double-blind, placebo-controlled clinical trial. They were evaluated using the Young Mania Rating Scale (YMRS), mini-mental state examination (MMSE), Pittsburgh sleep quality index, Simplified Nutritional Appetite Questionnaire, and body mass index in weeks 1, 4, and 8.
RESULTS
For cognitive impairment (MMSE), there were significant interaction effects of group and time at week 8 (B = -1.60, SE = 0.69, t = -2.33, p = .021) such that individuals in the spironolactone group experienced more improvement in their cognitive performance. For manic symptoms (YMRS), there were no significant interaction effects of group and time at week 8 (B = -2.53, SE = 1.46, t = -1.73, p = .085).
CONCLUSIONS
Considering the promising findings in this clinical trial, further study of spironolactone as adjunctive therapy in bipolar disorder in manic episodes with larger sample sizes, multicenter settings, and longer follow-ups are recommended.
Topics: Humans; Bipolar Disorder; Double-Blind Method; Drug Therapy, Combination; Mania; Psychiatric Status Rating Scales; Spironolactone; Treatment Outcome; Valproic Acid
PubMed: 37933420
DOI: 10.1002/brb3.3313 -
Orthopaedics & Traumatology, Surgery &... Apr 2023Low-back pain requires comprehensive care using a biopsychosocial model. The psychologic dimension plays an important role, but the link between sagittal alignment and a...
INTRODUCTION
Low-back pain requires comprehensive care using a biopsychosocial model. The psychologic dimension plays an important role, but the link between sagittal alignment and a given psychopathological profile is little studied. The aim of this study was to analyze the psychopathological profiles and sagittal parameters of a population with low-back pain and to assess the link.
MATERIAL AND METHODS
205 patients, with a mean age of 49.6 years (range, 18-70 years), presenting chronic common low-back pain without radicular involvement, were included prospectively. Mood scores comprised: the self-administered "Hospital Anxiety and Depression Scale" (HAD), Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D) and Young Mania Rating Scale (YMRS). Radiological parameters, measured on lateral full-spine radiographs, included: L1-S1 lordosis, T1-T12 kyphosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA), T1 slope, and Roussouly type.
RESULTS
Mean HAM-A score was 16.1; 54% of patients had scores ≥14, indicating anxiety disorder. Mean HAM-D score was 10.8; 55% of patients had scores ≥10, indicating depressive disorder. Mean YMRS score was 2.6; only 1 patient had a score ≥20, indicating manic disorder. The 112 patients with HAM-A score >14 showed mean 51.6° L1-S1 lordosis (p=0.356), 48.3° T1-T12 kyphosis (p=0.590), -4.3mm C7 SVA (p=0.900), and 29.3° T1 slope (p=0.451). In case of HAM-A <14, there were no significant differences. The 113 patients with HAM-D score >10 showed significant differences in T1-T12 kyphosis (mean 49.0°; p<0.05) and T1 slope (30.2°; p<0.05); mean L1-S1 lordosis was 50.5° (p=0.861) and C7 SVA 1.6mm (p=0.462). In case of HAM-D <10, T1-T12 kyphosis was 45.5° (p<0.05) and T1 slope 26.2° (p<0.05); mean lordosis was 50.9° (p=0.861) and mean C7 SVA -7.1mm (p=0.259). Multivariate analysis found no significant link between Roussouly type and psychiatric scores: HAD (p=0.715), HAM-A (p=0.652), and HAM-D (p=0.902).
CONCLUSION
More than 50% of patients with common low-back pain presented a mood disorder. Depressive disorder was associated with greater T1-T12 kyphosis and T1 slope. There was no relationship between psychiatric scores and overall sagittal alignment.
LEVEL OF EVIDENCE
II.
Topics: Humans; Middle Aged; Lordosis; Cervical Vertebrae; Kyphosis; Low Back Pain; Mental Disorders; Lumbar Vertebrae
PubMed: 36347460
DOI: 10.1016/j.otsr.2022.103474 -
Acta Psychiatrica Scandinavica Nov 2022Previous research suggests that cognitive performance worsens during manic and depressed states in bipolar disorder (BD). However, studies have often relied upon...
OBJECTIVES
Previous research suggests that cognitive performance worsens during manic and depressed states in bipolar disorder (BD). However, studies have often relied upon between-subject, cross-sectional analyses and smaller sample sizes. The current study examined the relationship between mood symptoms and cognition in a within-subject, longitudinal study with a large sample.
METHODS
Seven hundred and seventy-three individuals with BD completed a neuropsychological battery and mood assessments at baseline and 1-year follow-up. The battery captured eight domains of cognition: fine motor dexterity, visual memory, auditory memory, emotion processing, and four aspects of executive functioning: verbal fluency and processing speed; conceptual reasoning and set shifting; processing speed with influence resolution; and inhibitory control. Structural equation modeling was conducted to examine the cross-sectional and longitudinal relationships between depressive symptoms, manic symptoms, and cognitive performance. Age and education were included as covariates. Eight models were run with the respective cognitive domains.
RESULTS
Baseline mood positively predicted 1-year mood, and baseline cognition positively predicted 1-year cognition. Mood and cognition were generally not related for the eight cognitive domains. Baseline mania was predictive in one of eight baseline domains (conceptual reasoning and set shifting); baseline cognition predicted 1-year symptoms (inhibitory control-depression symptoms, visual memory-manic symptoms).
CONCLUSIONS
In a large community sample of patients with bipolar spectrum disorder, cognitive performance appears to be largely unrelated to depressive and manic symptoms, suggesting that cognitive dysfunction is stable in BD and is not dependent on mood state in BD. Future work could examine how treatment affects relationship between cognition and mood.
SIGNIFICANT OUTCOMES
Cognitive dysfunction appears to be largely independent of mood symptoms in bipolar disorder.
LIMITATIONS
The sample was generally highly educated (M = 15.22), the majority of the subsample with elevated manic symptoms generally presented with concurrent depressive elevated symptoms, and the study did not stratify recruitment based on mood state.
Topics: Bipolar Disorder; Cognition; Cognition Disorders; Cross-Sectional Studies; Humans; Longitudinal Studies; Neuropsychological Tests
PubMed: 35426440
DOI: 10.1111/acps.13436 -
Annals of Medicine 2023Chronotherapeutic interventions for bipolar depression and mania are promising interventions associated with rapid response and benign side effect profiles. Filtering of...
INTRODUCTION
Chronotherapeutic interventions for bipolar depression and mania are promising interventions associated with rapid response and benign side effect profiles. Filtering of biologically active short wavelength (blue) light by orange tinted eyewear has been shown to induce antimanic and sleep promoting effects in inpatient mania. We here describe a study protocol assessing acute and long-term stabilizing effects of blue blocking (BB) glasses in outpatient treatment of bipolar disorder.
PATIENTS AND METHODS
A total of 150 outpatients with bipolar disorder and current symptoms of (hypo)-mania will be randomized 1:1 to wear glasses with either high (99%) (intervention group) or low (15%) (control group) filtration of short wavelength light (<500 nm). Following a baseline assessment including ratings of manic and depressive symptoms, sleep questionnaires, pupillometric evaluation and 48-h actigraphy, participants will wear the glasses from 6 PM to 8 AM for 7 consecutive days. The primary outcome is the between group difference in change in Young Mania Rating Scale scores after 7 days of intervention (day 9). Following the initial treatment period, the long-term stabilizing effects on mood and sleep will be explored in a 3-month treatment paradigm, where the period of BB treatment is tailored to the current symptomatology using a 14-h antimanic schedule during (hypo-) manic episodes (BB glasses or dark bedroom from 6 PM to 8 AM) and a 2-h maintenance schedule (BB glasses on two hours prior to bedtime/dark bedroom) during euthymic and depressive states.The assessments will be repeated at follow-up visits after 1 and 3 months. Throughout the 3-month study period, participants will perform continuous daily self-monitoring of mood, sleep and activity in a smartphone-based app. Secondary outcomes include between-group differences in actigraphic sleep parameters on day 9 and in day-to-day instability in mood, sleep and activity, general functioning and objective sleep markers (actigraphy) at weeks 5 and 15.
TRIAL REGISTRATION
The trial will be registered at www.clinicaltrials.gov prior to initiation and has not yet received a trial reference.
ADMINISTRATIVE INFORMATION
The current paper is based on protocol version 1.0_31.07.23. : Lars Vedel Kessing.
Topics: Humans; Bipolar Disorder; Antimanic Agents; Mania; Sleep; Ambulatory Care; Randomized Controlled Trials as Topic
PubMed: 38109922
DOI: 10.1080/07853890.2023.2292250 -
Ugeskrift For Laeger Apr 2022This narrative review addresses the challenges of how to identify and treat bipolar depression. Bipolar depression, i.e. depressive episode(s) as part of bipolar... (Review)
Review
This narrative review addresses the challenges of how to identify and treat bipolar depression. Bipolar depression, i.e. depressive episode(s) as part of bipolar disorder, can be differentiated from unipolar depression only through the previous course of illness. A correct diagnosis therefore may be delayed. The pharmacotherapy of bipolar depression differs from that of unipolar depression due to a high risk of recurrence of either hypomanic/manic or depressive episodes or mood instability. Therefore, long periods of specialized treatment will often be required. Both bipolar and unipolar depression will often benefit from adjunctive social and psychological interventions.
Topics: Bipolar Disorder; Depressive Disorder; Diagnostic and Statistical Manual of Mental Disorders; Humans
PubMed: 35410656
DOI: No ID Found -
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 -
Journal of Affective Disorders Jan 2022Bipolar disorder (BD) is highly recurrent and prevention of relapse and illness onset is an urgent treatment priority. This systematic review examined whether cognitive... (Review)
Review
BACKGROUND
Bipolar disorder (BD) is highly recurrent and prevention of relapse and illness onset is an urgent treatment priority. This systematic review examined whether cognitive assessments can aid prediction of recurrence in patients with BD and/or illness onset in individuals at familial risk.
METHODS
The review included longitudinal studies of patients with BD or individuals at familial risk of mood disorder that examined the association between cognitive functions and subsequent relapse or illness onset, respectively. We followed the procedures of the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) 2020 statement. Searches were conducted on PubMed/MEDLINE, EMBASE and PsychInfo databases from inception up until May 10th 2021.
RESULTS
We identified 19 eligible studies; 12 studies investigated cognitive predictors of recurrence in BD (N = 36-76) and seven investigated cognitive predictors of illness onset in at-risk individuals (N = 84-234). In BD, general cognitive impairment, poorer verbal memory and executive function and positive bias were associated with subsequent (hypo)manic relapse -but with not depressive relapse or mood episodes in general. In first-degree relatives, impairments in attention, verbal memory and executive functions and positive bias were associated with subsequent illness onset.
LIMITATIONS
The findings should be considered preliminary given the small-to-moderate sample sizes and scarcity of studies.
CONCLUSIONS
Subject to replication, the associations between cognitive impairment and (hypo)mania relapse and illness onset may provide a platform for personalised treatment and prophylactic strategies.
Topics: Affect; Bipolar Disorder; Cognition; Cognition Disorders; Humans; Mood Disorders
PubMed: 34699850
DOI: 10.1016/j.jad.2021.10.044 -
BMJ Mental Health Feb 2023Are antipsychotic dose equivalents between acute mania and schizophrenia the same? (Meta-Analysis)
Meta-Analysis
QUESTION
Are antipsychotic dose equivalents between acute mania and schizophrenia the same?
STUDY SELECTION AND ANALYSIS
Six databases were systematically searched (from inception to 17 September 2022) to identify blinded randomised controlled trials (RCTs) that used a flexible-dose oral antipsychotic drug for patients with acute mania. The mean and SD of the effective dose and the pre-post changes in manic symptoms were extracted. A network meta-analysis (NMA) under a frequentist framework was performed to examine the comparative efficacy between the antipsychotics. A classic mean dose method (sample size weighted) was used to calculate each antipsychotic dose equivalent to 1 mg/day olanzapine for acute mania. The antipsychotic dose equivalents of acute mania were compared with published data for schizophrenia.
FINDINGS
We included 42 RCTs which enrolled 11 396 participants with acute mania. The NMA showed that risperidone was superior to olanzapine (reported standardised mean difference: -022, 95% CI -0.41 to -0.02), while brexpiprazole was inferior to olanzapine (standardised mean difference: 0.36, 95% CI 0.08 to 0.64). The dose equivalents to olanzapine (with SD) were 0.68 (0.23) for haloperidol, 0.32 (0.07) for risperidone, 0.60 (0.11) for paliperidone, 8.00 (1.41) for ziprasidone, 41.46 (5.98) for quetiapine, 1.65 (0.32) for aripiprazole, 1.23 (0.20) for asenapine, 0.53 (0.14) for cariprazine and 0.22 (0.03) for brexpiprazole. Compared with the olanzapine dose equivalents for schizophrenia, those of acute mania were higher for quetiapine (p<0.001, 28.5%) and aripiprazole (p<0.001, 17.0%), but lower for haloperidol (p<0.001, -8.1%) and risperidone (p<0.001, -15.8%).
CONCLUSIONS
Antipsychotic drugs have been considered first-line treatment for acute mania, warranting specific dose equivalence for scientific and clinical purposes.
Topics: Humans; Antipsychotic Agents; Olanzapine; Risperidone; Aripiprazole; Quetiapine Fumarate; Haloperidol; Bipolar Disorder; Mania; Schizophrenia; Randomized Controlled Trials as Topic
PubMed: 36789916
DOI: 10.1136/bmjment-2022-300546 -
World Journal of Psychiatry Jun 2021Panic disorders frequently occur with affective disorders, particularly bipolar disorder. Patients with panic disorder and bipolar disorder are more likely to present...
BACKGROUND
Panic disorders frequently occur with affective disorders, particularly bipolar disorder. Patients with panic disorder and bipolar disorder are more likely to present with severe symptoms, such as high rates of suicidal behavior, poor symptomatic and functional recovery, and poor drug responses.
AIM
To investigate the psychological characteristics of panic disorder patients related to bipolarity.
METHODS
A total of 254 patients (136 men and 118 women, mean age = 33.48 ± 3.2 years) who were diagnosed with panic disorder were included in the study. Panic disorder with bipolarity (BP+) was defined as a score of ≥ 7 on the Korean version of the Mood Disorder Questionnaire (K-MDQ), and a score lower than 7 was considered as a panic disorder without bipolarity (BP-). Self-report questionnaires were analyzed to examine their association with bipolarity. Psychological tests used in the study were the Mood Disorder Questionnaire (MDQ), Panic Disorder Severity Scale, Beck Depression Inventory, State-Trait Anxiety Inventory (STAI), Temperament and Character Inventory (TCI), and Minnesota Multiphasic Personality Inventory (MMPI). Statistical analyses were performed to evaluate the correlation between bipolarity of panic disorder patients and various psychological test results indicative of psychological characteristics.
RESULTS
Patients with a K-MDQ score of 7 or more were considered to have a history of manic or hypomanic episodes (BP+ group, = 128), while patients with K-MDQ scores below 7 were defined as those without bipolarity (BP- group, = 126). The BP+ group were more likely to be unmarried (single 56.2% 44.4%, = 0.008) and younger (30.78 ± 0.59 37.11 ± 3.21, 0.001). Additionally, the BP+ group had significantly higher scores on psychological assessment scales, such as the hypochondriasis, psychopathic deviate, masculinity-femininity, psychasthenia, schizophrenia, and hypomania (Ma) in MMPI, and novelty seeking, harm avoidance and self-transcendence in TCI, and STAI (state and trait) compared to the BP- group. In logistic regression analysis, depression in MMPI, self-directedness in TCI, and age were negatively associated with MDQ score, meanwhile, Ma in MMPI and STAI (trait) were positively associated with MDQ score.
CONCLUSION
The result of this study suggests that almost 50% of patients with panic disorder are likely to have hypomanic or manic symptoms, and certain psychological factors are associated bipolarity in panic disorder.
PubMed: 34168971
DOI: 10.5498/wjp.v11.i6.242