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World Journal of Psychiatry Dec 2014We review preclinical and clinical evidences strongly suggesting that memantine, an old drug currently approved for Alzheimer's dementia, is an effective treatment for... (Review)
Review
UNLABELLED
We review preclinical and clinical evidences strongly suggesting that memantine, an old drug currently approved for Alzheimer's dementia, is an effective treatment for acute mania and for the prevention of manic/hypomanic and depressive recurrences of manic-depressive illness. Lithium remains the first line for the treatment and prophylaxis of bipolar disorders, but currently available treatment alternatives for lithium resistant patients are of limited and/or questionable efficacy. Thus, research and development of more effective mood stabilizer drugs is a leading challenge for modern psychopharmacology. We have demonstrated that 21 d administration of imipramine causes a behavioural syndrome similar to a cycle of bipolar disorder, i.e., a mania followed by a depression, in rats. Indeed, such treatment causes a behavioural supersensitivity to dopamine D2 receptor agonists associated with an increase sexual activity and aggressivity (mania). The dopamine receptor sensitization is followed, after imipramine discontinuation, by an opposite phenomenon (dopamine receptor desensitization) and an increased immobility time (depression) in the forced swimming test of depression. Memantine blocks the development of the supersensitivity and the ensuing desensitization associated with the depressive like behavior. On the basis of these observations we have suggested the use of memantine in the treatment of mania and in the prophylaxis of bipolar disorders. To test this hypothesis we performed several naturalistic studies that showed an acute antimanic effect and a long-lasting and progressive mood-stabilizing action (at least 3 years), without clinically relevant side effects. To confirm the observations of our naturalistic trials we are now performing a randomized controlled clinical trial. Finally we described the studies reporting the efficacy of memantine in manic-like symptoms occurring in psychiatric disorders other than bipolar.
LIMITATIONS
A randomized controlled clinical trial is needed to confirm our naturalistic observations.
CONCLUSION
We believe that this review presents enough pharmacological and clinical information to consider the administration of memantine in the treatment of bipolar disorders that no respond to standard mood stabilizers.
PubMed: 25540723
DOI: 10.5498/wjp.v4.i4.80 -
Current Neuropharmacology 2023An increased risk of manic episodes has been reported in patients with neurodegenerative disorders, but the clinical features of bipolar disorder (BD) in different...
BACKGROUND
An increased risk of manic episodes has been reported in patients with neurodegenerative disorders, but the clinical features of bipolar disorder (BD) in different subtypes of dementia have not been thoroughly investigated.
OBJECTIVES
The main aim of this study is to systematically review clinical and therapeutic evidence about manic syndromes in patients with Alzheimer's disease (AD), vascular dementia (VaD), and frontotemporal dementia (FTD). Since manic-mixed episodes have been associated to negative outcomes in patients with dementia and often require medical intervention, we also critically summarized selected studies with relevance for the treatment of mania in patients with cognitive decline.
METHODS
A systematic review of the literature was conducted according to PRISMA guidelines. PubMed, Scopus, and Web of Science databases were searched up to February 2022. Sixty-one articles on patients with AD, VaD, or FTD and BD or (hypo) mania have been included.
RESULTS
Manic symptoms seem to be associated to disease progression in AD, have a greatly variable temporal relationship with cognitive decline in VaD, and frequently coincide with or precede cognitive impairment in FTD. Overall, mood stabilizers, and electroconvulsive therapy may be the most effective treatments, while the benefits of short-term treatment with antipsychotic agents must be balanced with the associated risks. Importantly, low-dose lithium salts may exert neuroprotective activity in patients with AD.
CONCLUSION
Prevalence, course, and characteristics of manic syndromes in patients with dementia may be differentially affected by the nature of the underlying neurodegenerative conditions.
Topics: Humans; Bipolar Disorder; Frontotemporal Dementia; Alzheimer Disease; Mania; Antipsychotic Agents; Antimanic Agents
PubMed: 35794767
DOI: 10.2174/1570159X20666220706110157 -
PloS One 2017Seasonal variation of manic and depressive symptoms is a controversial topic in bipolar disorder research. Several studies report seasonal patterns of hospital...
Seasonal variation of manic and depressive symptoms is a controversial topic in bipolar disorder research. Several studies report seasonal patterns of hospital admissions for depression and mania and variation in symptoms that appear to follow a seasonal pattern, whereas others fail to report such patterns. Differences in research methodologies, data analysis strategies, and temporal resolution of data may partly explain the variation in findings between studies. The current study adds a novel perspective to the literature by investigating specific meteorological factors such as atmospheric pressure, hours of sunshine, relative humidity, and daily maximum and minimum temperatures as more proximal predictors of self-reported daily mood change in people diagnosed with bipolar disorder. The results showed that daily maximum temperature was the only meteorological variable to predict clinically-relevant mood change, with increases in temperature associated with greater odds of a transition into manic mood states. The mediating effects of sleep and activity were also investigated and suggest at least partial influence on the prospective relationship between maximum temperature and mood. Limitations include the small sample size and the fact that the number and valence of social interactions and exposure to natural light were not investigated as potentially important mediators of relationships between meteorological factors and mood. The current data make an important contribution to the literature, serving to clarify the specific meteorological factors that influence mood change in bipolar disorder. From a clinical perspective, greater understanding of seasonal patterns of symptoms in bipolar disorder will help mood episode prophylaxis in vulnerable individuals.
Topics: Affect; Atmospheric Pressure; Bipolar Disorder; Female; Humans; Humidity; Male; Meteorological Concepts; Middle Aged; Sleep; Temperature; Weather
PubMed: 28278268
DOI: 10.1371/journal.pone.0173431 -
Molecules and Cells Jul 2017Mammalian physiology and behavior are regulated by an internal time-keeping system, referred to as circadian rhythm. The circadian timing system has a hierarchical... (Review)
Review
Mammalian physiology and behavior are regulated by an internal time-keeping system, referred to as circadian rhythm. The circadian timing system has a hierarchical organization composed of the master clock in the suprachiasmatic nucleus (SCN) and local clocks in extra-SCN brain regions and peripheral organs. The circadian clock molecular mechanism involves a network of transcription-translation feedback loops. In addition to the clinical association between circadian rhythm disruption and mood disorders, recent studies have suggested a molecular link between mood regulation and circadian rhythm. Specifically, genetic deletion of the circadian nuclear receptor induces mania-like behavior caused by increased midbrain dopaminergic (DAergic) tone at dusk. The association between circadian rhythm and emotion-related behaviors can be applied to pathological conditions, including neurodegenerative diseases. In Parkinson's disease (PD), DAergic neurons in the substantia nigra pars compacta progressively degenerate leading to motor dysfunction. Patients with PD also exhibit non-motor symptoms, including sleep disorder and neuropsychiatric disorders. Thus, it is important to understand the mechanisms that link the molecular circadian clock and brain machinery in the regulation of emotional behaviors and related midbrain DAergic neuronal circuits in healthy and pathological states. This review summarizes the current literature regarding the association between circadian rhythm and mood regulation from a chronobiological perspective, and may provide insight into therapeutic approaches to target psychiatric symptoms in neurodegenerative diseases involving circadian rhythm dysfunction.
Topics: Affect; Animals; Circadian Rhythm; Dopamine; Humans; Models, Biological; Mood Disorders; Parkinson Disease
PubMed: 28780783
DOI: 10.14348/molcells.2017.0065 -
Trends in Psychiatry and Psychotherapy Feb 2023Bipolar disorder (BD) in DSM-III and DSM-IV is classified as a mood disorder and requires the presence of a mood change, i.e., euphoria or irritability. Differently,...
INTRODUCTION
Bipolar disorder (BD) in DSM-III and DSM-IV is classified as a mood disorder and requires the presence of a mood change, i.e., euphoria or irritability. Differently, DSM-5 states that there must be some increase in energy or motor activity in addition to the mood change.
OBJECTIVE
Our aim was to identify which types of symptoms (i.e., mood- or energy/activity-related symptoms) are the most informative in a manic episode.
METHOD
Symptoms of manic episodes in 106 outpatients with BD were assessed through the Young Mania Rating Scale between November 2002 and November 2015 in a naturalistic study. The items of the scale were divided into three groups according to clinical criteria: mood, energy/activity, and other. The Samejima Graded Response Model of the Item Response Theory was computed as well as the Test Information Function for comparisons between groups. Chi-squared tests were used to verify the association between the groups of symptoms by comparing the area under the curve of the TIF results.
RESULTS
The information accounted for energy/activity represents 77% of the proportion of the total TIF; about 23% is related to mood and other groups of symptoms. Both proportions are statistically different (X2(1) = 30.42, p < 0.001).
CONCLUSION
On average, changes in energy/activity tend to be more informative than mood changes during the manic phases of BD.
PubMed: 36745539
DOI: 10.47626/2237-6089-2022-0551 -
Brain and Behavior Mar 2021The aim of this study is to explore mania as a network of its symptoms, inspired by the network approach to mental disorders.
OBJECTIVES
The aim of this study is to explore mania as a network of its symptoms, inspired by the network approach to mental disorders.
METHODS
Network structures of both cross-sectional and temporal effects were measured at three time points (admission, middle of hospital stay, and discharge) in a sample of 100 involuntarily committed patients diagnosed with bipolar I disorder with severe manic features and hospitalized in a specialized psychiatric ward.
RESULTS
Elevated mood is the most interconnected symptom in the network on admission, while aggressive behavior and irritability are highly predictive of each other, as well as language-thought disorder and "content" (the presence of abnormal ideas or delusions). Elevated mood is influenced by many symptoms in the temporal network.
CONCLUSIONS
The investigation of manic symptoms with network analysis allows for identifying important symptoms that are better connected to other symptoms at a given moment and over time. The connectivity of the manic symptoms evolves over time. Central symptoms could be considered as targets for clinical intervention when treating severe mania.
Topics: Bipolar Disorder; Cross-Sectional Studies; Humans; Psychiatric Status Rating Scales
PubMed: 33452874
DOI: 10.1002/brb3.2010 -
Experimental & Molecular Medicine Apr 2018Bipolar disorder (BD) is a common psychiatric disorder characterized by recurrent mood swings between depression and mania, and is associated with high treatment costs.... (Review)
Review
Bipolar disorder (BD) is a common psychiatric disorder characterized by recurrent mood swings between depression and mania, and is associated with high treatment costs. The existence of manic episodes is the defining feature of BD, during which period, patients experience extreme elevation in activity, energy, and mood, with changes in sleep patterns that together severely impair their ability to function in daily life. Despite some limitations in recapitulating the complex features of human disease, several rodent models of mania have been generated and characterized, which have provided important insights toward understanding its underlying pathogenic mechanisms. Among the mechanisms, neuronal excitatory and inhibitory (E/I) synaptic dysfunction in some brain regions, including the frontal cortex, hippocampus, and striatum, is an emerging hypothesis explaining mania. In this review, we highlight recent studies of rodent manic models having impairments in the E/I synaptic development and function. We also summarize the molecular and functional changes of E/I synapses by some mood stabilizers that may contribute to the therapeutic efficacy of drugs. Furthermore, we discuss potential future directions in the study of this emerging hypothesis to better connect the outcomes of basic research to the treatment of patients with this devastating mental illness.
Topics: Affect; Animals; Animals, Genetically Modified; Antipsychotic Agents; Biomarkers; Bipolar Disorder; Disease Models, Animal; Gene Expression Regulation; Humans; Neurons; Synapses
PubMed: 29628501
DOI: 10.1038/s12276-018-0028-y -
Current Neuropharmacology Apr 2017Beyond both being biphasic/bidirectional disorders (hypo)mania and essential hypertension share a surprising number of similarities and an overlap between their... (Review)
Review
Beyond both being biphasic/bidirectional disorders (hypo)mania and essential hypertension share a surprising number of similarities and an overlap between their genetics, biological background, underlying personality and temperamental factors, precipitating factors, comorbidity and response to treatment, indicating a possibly partially shared biological background. Based on theoretical knowledge, similarities related to characteristics, manifestation and course, and the results of pharmacological studies related to the effects and side effects of pharmacotherapies used in the treatment of these two distinct disorders, the authors outline a hypothesis discussing the similar origins of these two phenomena and thus mania being the hypertension of mood in memory of Athanasios Koukopoulos, one of the greatest researchers and theoreticists of mania of all time.
Topics: Affect; Age of Onset; Bipolar Disorder; Comorbidity; History, 20th Century; History, 21st Century; Humans; Hypertension; Temperature
PubMed: 28503115
DOI: 10.2174/1570159X14666160902145635 -
The Journal of Clinical Psychiatry Jul 2022To estimate overall prevalence of bipolar disorder (BD) and the prevalence and timing of bipolar-spectrum mood episodes in perinatal women. Databases (PubMed, Scopus,... (Meta-Analysis)
Meta-Analysis
To estimate overall prevalence of bipolar disorder (BD) and the prevalence and timing of bipolar-spectrum mood episodes in perinatal women. Databases (PubMed, Scopus, PsycINFO, CINAHL, Cochrane, ClincalTrials.gov) were searched from inception to March 2020. Included studies were original research in English that had (1) populations of perinatal participants (pregnant or within 12 months postpartum), aged ≥ 18 years, and (2) a screening/diagnostic tool for BD. Search terms described the population (eg, ), illness (eg, ), and detection (eg, , ). Study design data, rates, and timing of positive screens/diagnoses and mood episodes were extracted by 3 independent reviewers. Pooled prevalences were estimated using random-effects meta-analyses. Twenty-two articles were included in qualitative review and 12 in the meta-analysis. In women with no known psychiatric illness preceding the perinatal period, pooled prevalence of BD was 2.6% (95% CI, 1.2%-4.5%) and prevalence of bipolar-spectrum mood episodes (including depressed, hypomanic/manic, mixed) during pregnancy and the postpartum period was 20.1% (95% CI, 16.0%-24.5%). In women with a prior BD diagnosis, 54.9% (95% CI, 39.2%-70.2%) were found to have at least one bipolar-spectrum mood episode occurrence in the perinatal period. Our review suggests that the perinatal period is associated with high rates of bipolar-spectrum mood episodes and that pregnant and postpartum women represent a special risk population. This review may help to inform clinical care recommendations, thus helping to identify those who may have.
Topics: Affect; Bipolar Disorder; Female; Humans; Postpartum Period; Pregnancy; Prevalence; Risk Factors
PubMed: 35830616
DOI: 10.4088/JCP.21r14045 -
Current Neuropharmacology Apr 2017Pediatric Bipolar Disorder (BD) is a highly morbid pediatric psychiatric disease, consistently associated with family psychiatric history of mood disorders and... (Review)
Review
Pediatric Bipolar Disorder (BD) is a highly morbid pediatric psychiatric disease, consistently associated with family psychiatric history of mood disorders and associated with high levels of morbidity and disability and with a great risk of suicide. While there is a general consensus on the symptomatology of depression in childhood, the phenomenology of pediatric mania is still highly debated and the course and long-term outcome of pediatric BD still need to be clarified. We reviewed the available studies on the phenomenology of pediatric mania with the aim of summarizing the prevalence, demographics, clinical correlates and course of these two types of pediatric mania. Eighteen studies reported the number of subjects presenting with either irritable or elated mood during mania. Irritability has been reported to be the most frequent clinical feature of pediatric mania reaching a sensitivity of 95-100% in several samples. Only half the studies reviewed reported on number of episodes or cycling patterns and the described course was mostly chronic and ultra-rapid whereas the classical episodic presentation was less common. Few long-term outcome studies have reported a diagnostic stability of mania from childhood to young adult age. Future research should focus on the heterogeneity of irritability aiming at differentiating distinct subtypes of pediatric psychiatric disorders with distinct phenomenology, course, outcome and biomarkers. Longitudinal studies of samples attending to mood presentation, irritable versus elated, and course, chronic versus episodic, may help clarify whether these are meaningful distinctions in the course, treatment and outcome of pediatric onset bipolar disorder.
Topics: Adolescent; Bipolar Disorder; Child; Diagnosis, Differential; Euphoria; Humans; Irritable Mood; Suicide
PubMed: 28503110
DOI: 10.2174/1570159X14666160607100403