COVID-19 pandemic amplified mortality rates among adolescents with bipolar disorder through family-related factors

BACKGROUND Recently,a growing number of adolescents have been afflicted with mental disorders,with annual morbidity rates on the rise.This trend has been exacerbated by the global coronavirus disease 2019(COVID-19)pandemic,leading to a surge in suicide and self-harm rates among this demographic.AIM To investigate the impact of the COVID-19 pandemic on adolescent bipolar disorder(BD),along with the underlying factors contributing to heightened rates of suicide and self-harm among adolescents.METHODS A comprehensive statistical analysis was conducted utilizing clinical interviews and self-reports obtained from patients or their guardians.Diagnostic criteria for BDs were based on the Diagnostic and statistical manual of mental disorders,international classification of diseases-11,and the National institute of mental health research domain criteria.Statistical analyses were performed using SPSS 26.0 software,with significance set at P<0.05.RESULTS A cohort of 171 adolescents diagnosed with BD between January 1,2018,and December 31,2022,was included in the analysis.The gender distribution was 2.8:1(female to male),with ages ranging from 11 to 18 years old.Major factors contributing to adolescent BDs included familial influences,academic stress,genetic predisposition and exposure to school-related violence.Notably,a significant increase in suicide attempts and self-harm incidents was observed among adolescents with BD during the COVID-19 pandemic.Statistical analysis indicated that the pandemic exacerbated familial discord and heightened academic stress,thereby amplifying the prevalence of suicidal behavior and self-harm among adolescents.CONCLUSION The COVID-19 pandemic has exacerbated familial tensions and intensified the incidence of suicide and self-harm among adolescents diagnosed with BD.This study underscores the urgent need for societal,familial and educational support systems to prioritize the well-being of adolescents and offers valuable insights and guidelines for the prevention,diagnosis and treatment of adolescent BDs.

MicroRNAs as potential diagnostic biomarkers for bipolar disorder

Abnormal expression of microRNAs is connected to brain development and disease and could provide novel biomarkers for the diagnosis and prognosis of bipolar disorder. We performed a PubMed search for microRNA biomarkers in bipolar disorder and found 18 original research articles on studies performed with human patients and published from January 2011 to June 2023. These studies included microRNA profiling in bloodand brain-based materials. From the studies that had validated the preliminary findings,potential candidate biomarkers for bipolar disorder in adults could be miR-140-3p,-30d-5p,-330-5p,-378a-5p,-21-3p,-330-3p,-345-5p in whole blood, miR-19b-3p,-1180-3p,-125a-5p, let-7e-5p in blood plasma, and miR-7-5p,-23b-5p,-142-3p,-221-5p,-370-3p in the blood serum. Two of the studies had investigated the changes in microRNA expression of patients with bipolar disorder receiving treatment. One showed a significant increase in plasma miR-134 compared to baseline after 4 weeks of treatment which included typical antipsychotics, atypical antipsychotics, and benzodiazepines. The other study had assessed the effects of prescribed medications which included neurotransmitter receptorsite binders(drug class B) and sedatives, hypnotics, anticonvulsants, and analgesics(drug class C) on microRNA results. The combined effects of the two drug classes increased the significance of the results for miR-219 and-29c with miR-30e-3p and-526b* acquiring significance. MicroRNAs were tested to see if they could serve as biomarkers of bipolar disorder at different clinical states of mania, depression, and euthymia. One study showed that upregulation in whole blood of miR-9-5p,-29a-3p,-106a-5p,-106b-5p,-107,-125a-3p,-125b-5p and of miR-107,-125a-3p occurred in manic and euthymic patients compared to controls, respectively, and that upregulation of miR-106a-5p,-107 was found for manic compared to euthymic patients. In two other studies using blood plasma,downregulation of miR-134 was observed in manic patients compared to controls, and dysregulation of miR-134,-152,-607,-633,-652,-155 occurred in euthymic patients compared to controls. Finally, microRNAs such as miR-34a,-34b,-34c,-137, and-140-3p,-21-3p,-30d-5p,-330-5p,-378a-5p,-134,-19b-3p were shown to have diagnostic potential in distinguishing bipolar disorder patients from schizophrenia or major depressive disorder patients, respectively. Further studies are warranted with adolescents and young adults having bipolar disorder and consideration should be given to using animal models of the disorder to investigate the effects of suppressing or overexpressing specific microRNAs.

Evaluating Pharmacological and Rehabilitation Strategies for Effective Management of Bipolar Disorder: A Comprehensive Clinical Study

Bipolar disorder presents significant challenges in clinical management, characterized by recurrent episodes of depression and mania often accompanied by impairment in functioning. This study investigates the efficacy of pharmacological interventions and rehabilitation strategies to improve patient outcomes and quality of life. Utilizing a randomized controlled trial with multiple treatment arms, participants will receive pharmacotherapy, polypharmacotherapy, rehabilitation interventions, or combination treatments. Outcome measures will be assessed using standardized scales, including the Hamilton Depression Scale, Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and Mania Scale. Preliminary data suggest improvements in symptom severity and functional outcomes with combination treatments. This research aims to inform clinical practice, guide treatment decisions, and ultimately enhance the quality of care for individuals living with bipolar disorder. Findings will be disseminated through peer-reviewed journals and scientific conferences to advance knowledge in this field.

From Signals to Solutions: Exploring Early Detection of Neuropsychiatric and Neurodevelopment Disorders through Biomarkers

In 2013, the percentage of children ranging from 5 to 17 years who reported being diagnosed with autism surged to 1.2% from 0.1% in 1997 [1]. Alongside this increase in the incidence of autism in children, there were findings of a 21% increase in children who displayed behavioral and conduct problems from 2019 to 2020 [2]. Early detection of neuropsychiatric and neurodevelopmental disorders in children is critical for timely intervention and improved long-term outcomes. With early intervention, there is better aptitude to support healthy development and give proper treatment to attain a better quality of life. This paper explores studies aimed at enhancing the early detection of these disorders through the use of biomarkers with the aim of creating a bridge between the worlds of research and clinical practice. The disorders in this paper specifically discussed are Major Depressive Disorder, Bipolar Disorder, and Autism Spectrum Disorder. With this bridge, we can foster collaborations and encourage further advancement in the field of early detection and intervention.

Role of adjunctive nonpharmacological strategies for treatment of rapid-cycling bipolar disorder

Rapid-cycling bipolar disorder(RCBD)is a phase of bipolar disorder defined by the presence of≥4 mood episodes in a year.It is a common phenomenon characterized by greater severity,a predominance of depression,higher levels of disability,and poorer overall outcomes.It is resistant to treatment by conventional pharmacotherapy.The existing literature underlines the scarcity of evidence and the gaps in knowledge about the optimal treatment strategies for RCBD.However,most reviews have considered only pharmacological treatment options for RCBD.Given the treatment-refractory nature of RCBD,nonpharmacological interventions could augment medications but have not been adequately examined.This review carried out an updated and comprehensive search for evidence regarding the role of nonpharmacological therapies as adjuncts to medications in RCBD.We identified 83 reviews and meta-analyses concerning the treatment of RCBD.Additionally,we found 42 reports on adjunctive nonpharmacological treatments in RCBD.Most of the evidence favoured concomitant electroconvulsive therapy as an acute and maintenance treatment.There was preliminary evidence to suggest that chronotherapeutic treatments can provide better outcomes when combined with medications.The research on adjunctive psychotherapy was particularly scarce but suggested that psychoeducation,cognitive behavioural therapy,family interventions,and supportive psychotherapy may be helpful.The overall quality of evidence was poor and suffered from several methodological shortcomings.There is a need for more methodologically sound research in this area,although clinicians can use the existing evidence to select and individualize nonpharmacological treatment options for better management of RCBD.Patient summaries are included to highlight some of the issues concerning the implementation of adjunctive nonpharmacological treatments.

Glial Cell-Targeted Treatments for Bipolar Disorder: A Systematic Review of Available Data and Clinical Perspectives

This paper is a systematic review of the treatment of bipolar disorder: a systematic Google Scholar search aimed at treatment guidelines and clinical trials. The search for treatment guidelines returned 375 papers and was last performed from June 1, 2022 to August 30, 2022. The literature suggests that lithium helps control and alleviate severe mood episodes, and olanzapine is effective for acute manic or mixed episodes of bipolar I disorder. Achieving effectiveness or remission is better with Cariprazine. Lurasidone improves cognitive performance. Quetiapine improves sleep quality and co-morbid anxiety. Lamotrigine helps delay depression, mania, and mild manic episodes. Antidepressants are best used in conjunction with mood stabilizers. For co-morbid treatment, carbamazepine and lithium in combination are more effective in the treatment of psychotic mania. Co-morbid anxiety treatment considers adjunctive olanzapine or lamotrigine. Co-morbid bulimia treatment considers a mood stabilizer. Co-morbid fatigue treatment considers a dawn simulator. For diet, pay attention to a healthy diet, patients can ingest probiotics and pay attention to the balance of fatty acids.

双相Ⅰ型障碍和双相Ⅱ型患者人口学和临床特征的比较

目的:比较双相Ⅰ型障碍和双相Ⅱ型障碍患者的人口学特征、临床特征、治疗特征和生理指标。方法:选取符合美国精神障碍诊断与统计手册第5版(DSM-5)双相障碍的患者381例,其中Ⅰ型302例(79.27%),Ⅱ型74例(19.42%),其他特定及相关障碍5例(1.31%)。用自编临床资料访谈表收集人口学资料及临床特征数据。采用多因素logistic回归和多重线性回归分析方法进行因素分析。结果:与双相II型障碍相比,双相I型障碍患者更容易伴有精神病性特征(OR=5.75,95%CI:2.82~11.76),病程更长,接受重复经颅磁刺激治疗较多(OR=3.09,95%CI:1.02~9.35),尿酸、总胆固醇、高密度脂蛋白浓度更高,汉族更常见(OR=11.50,95%CI:1.76~75.30)、受教育程度更低(OR=10.22,95%CI:1.16~89.77),更少有精神病家族史(OR=2.34,95%CI:1.01~5.42)。结论:双相Ⅰ型障碍和双相Ⅱ型障碍的人口学特征、临床特征、治疗情况和生理指标有差异,可为探讨双相障碍的发病机制提供线索。

Inter-relationships between isotretinoin treatment and psychiatric disorders: Depression, bipolar disorder, anxiety, psychosis and suicide risks

Isotretinoin(Accutane) is a treatment for severe acne that is resistant to other forms of treatment, including antibiotics and topical treatments. The prescription of this drug has been controversial ever since its initial marketing in 1982. It is the only non-psychotropic drug in the Food and Drug Administration top 10 drugs found to be associated with depression. Recently, Bremner et al published an extensive review(until 2010) of the evidence for the association of retinoic acid(RA) with depression and suicide. Some patients who are admitted in psychiatric hospitals report a history of present or past treatment with isotretinoin. Then, the imputability of the molecule in the occurrence of disorders represents necessarily an important question for both professionals and their patients. This paper aims to specify the links between the drug and specific psychiatric disorders. A review of the literature related to isotretinoin, RA, vitamin A, depression, suicide, anxiety, bipolar disorder, psychosis, schizophrenia was performed. Many studies demonstrated an increased risk of depression, attempted suicide and suicide following isotretinoin treatment. However, isotretinoin may have an antidepressant impact, according to some dermatological papers. They consider treating acne with this efficient treatment could improve selfimage and make the patient feel better. Several studies showed that patients with bipolar disorder had an increased risk for a clinical exacerbation of symptoms undergoing treatment with isotretinoin. A few studies also seem to suggest a possible link between isotretinoin and psychosis. Nonetheless, studies point out a link between retinoid dysregulation and schizophrenia through modulation of dopamine receptors. From this review, we propose guidelines for isotretinoin prescription to healthcare professionals.

Antidepressants for bipolar disorder A meta-analysis of randomized, double-blind, controlled trials

OBJECTIVE： To examine the efficacy and safety of short-term and long-term use of antidepres- sants in the treatment of bipolar disorder. DATA SOURCES： A literature search of randomized, double-blind, controlled trials published until December 2012 was performed using the PubMed, ISI Web of Science, Medline and Cochrane Central Register of Controlled Trials databases. The keywords ＂bipolar disorder, bipolar I disorder, bipolar II disorder, bipolar mania, bipolar depression, cyclothymia, mixed mania and depression, rapid cycling and bipolar disorder＂, AND ＂antidepressant agent, antidepressive agents second- generation, antidepressive agents tricyclic, monoamine oxidase inhibitor, noradrenaline uptake in- hibitor, serotonin uptake inhibitor, and tricyclic antidepressant agent＂ were used. The studies that were listed in the reference list of the published papers but were not retrieved in the above-mentioned databases were supplemented. STUDY SELECTION： Studies selected were double-blind randomized controlled trials assessing the efficacy and safety of antidepressants in patients with bipolar disorder. All participants were aged 18 years or older, and were diagnosed as having primary bipolar disorder. Antidepressants or antidepressants combined with mood stabilizers were used in experimental interventions. Placebos, mood stabilizers, antipsychotics and other antide pressants were used in the control interventions. Studies that were quasi-randomized studies, or used antidepressants in combination with antipsy- chotics in the experimental group were excluded. All analyses were conducted using Review Man- ager 5.1 provided by the Cochrane Collaboration.

Risk for emerging bipolar disorder, variants, and symptoms in children with attention deficit hyperactivity disorder, now grown up

AIM: To determine the prevalence of bipolar disorder(BD) and sub-threshold symptoms in children with attention deficit hyperactivity disorder(ADHD) through 14 years' follow-up, when participants were between 21-24 years old.METHODS: First, we examined rates of BD type Ⅰ?and Ⅱ diagnoses in youth participating in the NIMH-funded Multimodal Treatment Study of ADHD(MTA). We used the diagnostic interview schedule for children(DISC), administered to both parents(DISC-P) and youth(DISCY). We compared the MTA study subjects with ADHD(n = 579) to a local normative comparison group(LNCG, n = 289) at 4 different assessment points: 6, 8, 12, and 14 years of follow-ups. To evaluate the bipolar variants, we compared total symptom counts(TSC) of DSM manic and hypomanic symptoms that were generated by DISC in ADHD and LNCG subjects. Then we sub-divided the TSC into pathognomonic manic(PM) and non-specific manic(NSM) symptoms. We compared the PM and NSM in ADHD and LNCG at each assessment point and over time. We also evaluated the irritability as category A2 manic symptom in both groups and over time. Finally, we studied the irritability symptom in correlation with PM and NSM in ADHD and LNCG subjects.RESULTS: DISC-generated BD diagnosis did not differ significantly in rates between ADHD(1.89%) and LNCG 1.38%). Interestingly, no participant met BD diagnosis more than once in the 4 assessment points in 14 years. However, on the symptom level, ADHD subjects reported significantly higher mean TSC scores: ADHD 3.0; LNCG 1.7; P < 0.001. ADHD status was associated with higher mean NSM: ADHD 2.0 vs LNCG 1.1; P < 0.0001. Also, ADHD subjects had higher PM symptoms than LNCG, with PM means over all time points of 1.3 ADHD; 0.9 LNCG; P = 0.0001. Examining both NSM and PM, ADHD status associated with greater NSM than PM. However, Over 14 years, the NSM symptoms declined and changed to PM over time(df 3, 2523; F = 20.1; P < 0.0001). Finally, Irritability(BD DSM criterion-A2) rates were significantly higher in ADHD than LNCG(χ2 = 122.2, P < 0.0001), but irritability was associated more strongly with NSM than PM(df 3, 2538; F = 43.2; P < 0.0001).CONCLUSION: Individuals with ADHD do not appear to be at significantly greater risk for developing BD, but do show higher rates of BD symptoms, especially NSM. The greater linkage of irritability to NSM than to PM suggests caution when making BD diagnoses based on irritability alone as one of 2(A-level) symptoms for BD diagnosis, particularly in view of its frequent presentation with other psychopathologies.

Neurochemical metabolites in the medial prefrontal cortex in bipolar disorder A proton magnetic resonance spectroscopy study

The aim of this study was to investigate proton magnetic resonance spectroscopy metabolite values in the medial prefrontal cortex of individuals with euthymic bipolar disorder. The subjects consisted of 15 patients with euthymic bipolar disorder type I and 15 healthy controls. We performed proton magnetic resonance spectroscopy of the bilateral medial prefrontal cortex and measured levels of N-acetyl aspartate, choline and creatine. Levels of these three metabolites in the medial prefrontal cortex were found to be lower in patients with bipolar disorder compared with healthy controls. A positive correlation was found between illness duration and choline levels in the right medial prefrontal cortex. Our study suggests that during the euthymic period, there are abnormalities in cellular energy and membrane phospholipid metabolism in the medial prefrontal cortex, and that this may impair neuronal activity and integrity.

Comorbidity of bipolar and anxiety disorders:An overview of trends in research

Over the last three decades burgeoning research has shown that anxiety disorder comorbidity is not only highly prevalent in bipolar disorder(BD),but it also adversely impacts the course,outcome,and treatment of BD.The present review provides an overview of the current trends in research on comorbid anxiety and BDs based on prior reviews and meta-analyses(n=103),epidemiological surveys,and large-scale clinical studies.The results reiterated the fact that at least half of those with BD are likely to develop an anxiety disorder in their lifetimes and a third of them will manifest an anxiety disorder at any point of time.All types of anxiety disorders were equally common in BD.However,there was a wide variation in rates across different sources,with most of this discrepancy being accounted for by methodological differences between reports.Comorbid anxiety disorders negatively impacted the presentation and course of BD.This unfavourable clinical profile led to poorer outcome and functioning and impeded treatment of BD.Despite the extensive body of research there was paucity of data on aetiology and treatment of anxiety disorder comorbidity in BD.Nevertheless,the substantial burden and unique characteristics of this comorbidity has important clinical and research implications.

Treatment alliance and adherence in bipolar disorder

The clinician patient relationship lies at the core of psychiatric practice and delivery of mental health care services. The concept of treatment alliance in psychiatry has its origins in psychotherapy, but has also been influenced by several other constructs such as patientcentred care(PCC) and shared decision-making(SDM). Similarly, there has been a shift in conceptualization of treatment-adherence in psychiatric disorders including bipolar disorder(BD) from illness-centred and clinician-centred approaches to patient-centred ones. Moreover, the traditional compliance based models are being replaced by those based on concordance between clinicians and patients. Newer theories of adherence in BD place considerable emphasis on patient related factors and the clinician patient alliance is considered to be one of the principal determinants of treatment-adherence in BD. Likewise, current notions of treatment alliance in BD also stress the importance of equal and collaborative relationships, sensitivity to patients' viewpoints, sharing of knowledge, and mutual responsibility and agreement regarding decisions related to treatment. Accumulated evidence from quantitative research, descriptive accounts, qualitative studies and trials of psychosocial interventions indicates that efficacious treatment alliances have a positive influence on adherence in BD. Then again, research on the alliance-adherence link in BD lags behind the existing literature on the subject in other medical and psychiatric conditions in terms of the size and quality of the evidence, the consistency of its findings and clarity about underlying processes mediating this link. Nevertheless, the elements of an effective alliance which could have a positive impact on adherence in BD are reasonably clear and include PCC, collaborative relationships, SDM, open communication, trust, support, and stability and continuity of the relationship. Therefore, clinicians involved in the care of BD would do well to follow these principles and improve their interpersonal and communication skills in order to build productive alliances with their patients. This could go a long way in confronting the ubiquitous problem of nonadherence in BD. The role of future research in firmly establishing the alliance-adherence connection and uncovering the processes underlying this association will also be vital in devising effective ways to manage nonadherence in BD.

Treatment-adherence in bipolar disorder: A patient-centred approach

About half of the patients diagnosed with bipolar disorder(BD) become non-adherent during longterm treatment, a rate largely similar to other chronic illnesses and one that has remained unchanged over the years. Non-adherence in BD is a complex phenomenon determined by a multitude of influences. However, thereis considerable uncertainty about the key determinants of non-adherence in BD. Initial research on nonadherence in BD mostly limited itself to examining demographic, clinical and medication-related factors impacting adherence. However, because of inconsistent results and failure of these studies to address the complexities of adherence behaviour, demographic and illness-related factors were alone unable to explain or predict non-adherence in BD. This prompted a shift to a more patient-centred approach of viewing nonadherence. The central element of this approach includes an emphasis on patients' decisions regarding their own treatment based on their personal beliefs, life circumstances and their perceptions of benefits and disadvantages of treatment. Patients' decisionmaking processes are influenced by the nature of their relationship with clinicians and the health-care system and by people in their immediate environment. The primacy of the patient's perspective on non-adherence is in keeping with the current theoretical models and concordance-based approaches to adherence behaviour in BD. Research over the past two decades has further endorsed the critical role of patients' attitudes and beliefs regarding medications, the importance of a collaborative treatment-alliance, the influence of the family, and the significance of other patient-related factors such as knowledge, stigma, patient satisfaction and access to treatment in determining non-adherence in BD. Though simply moving from an illness-centred to a patientcentred approach is unlikely to solve the problem of nonadherence in BD, such an approach is more likely to lead to a better understanding of non-adherence and more likely to yield effective solutions to tackle this common and distressing problem afflicting patients with BD.

缓解期双相情感障碍Ⅰ型患者白质纤维结构异常的扩散张量成像研究

目的:探讨缓解期双相情感障碍(BD)Ⅰ型患者脑白质神经纤维束的改变,及患者认知功能与脑白质病变的关系。方法:采用汉密尔顿抑郁量表(HAMD),杨氏躁狂量表(YMRS)和重复性成套神经心理状态量表(RBANS)对患者进行入组的筛查与认知评估。应用3.0T磁共振仪对76例缓解期BD-Ⅰ型患者以及66例年龄、性别相匹配的健康志愿者(对照组)行DTI扫描,使用PANDA软件包提取全脑白质纤维束的各向异性分数(FA)和平均扩散率(MD),采用独立样本t检验进行组间差异比较,及Pearson相关分析探讨BD组中各纤维束的FA与临床可重复神经心理状态测验(RBANS)评分间的相关性。结果:相较于对照组,BD-Ⅰ型组的左、右侧钩束、右侧上纵束、右侧下额枕束及左侧毯束的FA值降低,MD值升高,差异均具有统计学意义(P<0.01)。BD-Ⅰ型组的左、右侧钩束、右侧上纵束和右侧下额枕束的FA值与RBANS量表评估的总分及即刻记忆、延迟记忆、视觉广度和注意力四项因子的评分均具有正相关关系(r=0.32~0.44,P均<0.05)。结论:缓解期双相障碍BD I型患者多个脑白质神经纤维束微观结构受损,且与认知功能改变相关。

Analysis of Misdiagnosis of Bipolar Disorder in An Outpatient Setting

背景:双相情感障碍是一种高误诊率的精神疾病,常被误诊为抑郁症、精神分裂症、焦虑症、强迫症和人格障碍等精神疾病,导致临床症状不能有效控制,病情呈反复发作趋势,故近年来双相情感障碍的误诊问题越来越引起精神科医生的重视。目的:了解双相情感障碍在门诊的误诊情况,并分析其误诊原因,指导临床医师加强对双相情感障碍的识别,尽量避免或减少其误诊和漏诊。方法:纳入专家门诊确诊为双相情感障碍的患者,了解其在门诊的就诊及误诊和漏诊情况,通过比较误诊组(包含漏诊者)和确诊组的临床资料进一步分析导致误诊和漏诊的可能原因。结果:双相情感障碍在专家门诊就诊患者中占31.5%。符合本研究入组标准的共有177例,其中误诊组136例(76.8%),确诊组41例(23.2%),误诊为抑郁症者最多(70.6%)。误诊组患者首次发作更多的表现为抑郁发作(χ~2=5.206,p=0.023),并且病程中抑郁发作次数更多(Z=-2.268,p=0.023);误诊组起病至首次治疗的时间较短(Z=-2.612,p=0.009)、而起病至确诊时间更长(Z=-3.685,p<0.001),总病程更长(Z=-3.274,p=0.001),并且住院治疗的患者更多(χ~2=4.539,p=0.033),住院次数也更多(Z=-2.164,p=0.031);误诊组伴有精神病性症状更多(χ~2=11.74,p=0.001),尤其抑郁发作时(χ~2=7.63,p=0.006),共病的发生率更高(χ~2=5.23,p=0.022);误诊组HCL-32评分更低(t=-2.564,p=0.011)。误诊组诊断为其他特定的双相及相关障碍的患者较确诊组多(11.0%v.4.9%),并且误诊组最近发作情况表现为抑郁发作的患者较多(78.7%v.65.9%)。结论:门诊双相情感障碍患者的误诊率高,常被误诊为抑郁症。误诊组患者首次发作更多的表现为抑郁发作,病程中抑郁发作次数更多,伴有精神病性症状更多,共病的发生率更高,并且患者对自身躁狂或轻躁狂发作情况明显认识不足,导致早期难以明确诊断,确诊所需时间更长,住院比率更高,住院次数更多。临床医生应提高对双相情感障碍的识别,避免或减少双相情感障碍的误诊和漏诊。

Aripiprazole augmentation in treating comorbid bipolar disorder and obsessive-compulsive disorder

Obsessive-compulsive disorder(OCD) is one of the most difficult additional diagnoses to manage in patients with bipolar disorder(BD) since the gold standard treatment for one disease(antidepressants for OCD) can worsen the other. This case report describes the efficacy of aripiprazole augmentation as maintenance therapy in a young patient with comorbid BD-OCD. Our patient presented complete remission of affective and obsessivecompulsive symptoms with remarkable improvement in social and occupational functioning for 24 months.Adverse drug reactions were not severe enough to result in drug discontinuation. In consideration of the important nosological, clinical and therapeutic implications, future research efforts may lead to more grounded guidelines,which are greatly needed in patients with comorbid BDOCD.

Association between gastrointestinal symptoms and affectivity in patients with bipolar disorder

AIM To study if anxiety, depression and experience of stress are associated with gastrointestinal(GI) symptoms in patients with bipolar disorder.METHODS A total of 136 patients with bipolar disorder(mean age 49.9 years; 61% women) and 136 controls from the general population(mean age 51.0 years; 60% women) were included in the study. GI symptoms were assessed with The Gastrointestinal Symptom Rating Scale-irritable bowel syndrome(GSRS-IBS), level of anxiety and depression with The Hospital Anxiety and Depression Scale(HADS) and stress-proneness with Perceived Stress Questionnaire. Over a ten year period, all visits in primary care were retrospectively recorded in order to identify functional GI disorders.RESULTS In subjects with low total HADS-score, there were no significant differences in GI-symptoms between patients and controls(GSRS-IBS 7.0 vs 6.5, P = 0.513). In the patients with bipolar disorder there were significant correlations between all GSRS and HADS subscores for all symptom clusters except for "constipation" and "reflux". Factors associated to GI symptoms in the patient group were female sex(adjusted OR = 2.37, 95%CI: 1.07-5.24) and high HADS-Depression score(adjusted OR = 3.64, 95%CI: 1.07-12.4). These patients had also significantly more visits for IBS than patients with low HADS-Depression scores(29% vs 8%, P = 0.008). However, there was no significant differences in consulting behaviour for functional GI disorders between patients and controls(25% vs 17%, P = 0.108).CONCLUSION Female patients and patients with high HADS depression score reported significantly more GI symptoms, whereas patients with low HADS scores did not differ from control subjects.

Health-care needs of remitted patients with bipolar disorder: A comparison with schizophrenia

AIM To investigate health-care needs and their correlates among patients with remitted bipolar disorder(BD) compared to patients with remitted schizophrenia. METHODS Outpatients with BD(n = 150) and schizophrenia(n = 75) meeting clearly defined remission criteria were included in the study along with their relatives. Diagnostic ascertainment was carried out using the Mini International Neuropsychiatric Interview. Demographic and clinical details were recorded using structured formats. Residual symptoms were assessed using standardized scales. Health-care needs were assessed on two separate scales. The principal instrument employed to assess health-care needs was the Camberwell Assessment of Need-Research version(CAN-R). To further evaluate health-care needs we felt that an additional instrument, which was more relevant for Indian patients and treatment-settings and designed to cover those areas of needs not specifically covered by the CAN-R was required. This instrument with a structure and scoring pattern similar to the CAN-R was used for additional evaluation of needs. Patients' level offunctioning was assessed using the Global Assessment of Functioning Scale and their quality of life(QOL) using the World Health Organization Quality Of Life-BREF version in Hindi.RESULTS An average of 6-7 needs was reported by patients with BD as well as their relatives. Commonly reported needs were in the areas of economic and welfare needs, informational needs, social needs and the need for treatment. According to the CAN-R, both patients and relatives reported that more than 60% of the total needs were being met. However, over 90% of the needs covered by the additional evaluation were unmet according to patients and relatives. Needs in the areas of economic and welfare-benefits, information, company, daytime activities and physical health-care were largely unmet according to patients and relatives. Total, met and unmet needs were significantly higher for schizophrenia, but the most common types of needs were quite similar to BD. Relatives reported more needs than patients with certain differences in the types of needs reported. Level of patients' functioning was the principal correlate of greater total and unmet needs in both groups. Significant associations were also obtained with residual symptoms and QOL.CONCLUSION The presence of unmet needs in remitted patients with BD was an additional marker of the enduring psychosocial impairment characteristic of the remitted phase of BD.

Insights into myelin dysfunction in schizophrenia and bipolar disorder

Schizophrenia and bipolar disorder are disabling psychiatric disorders with a worldwide prevalence of approximately 1%.Both disorders present chronic and deteriorating prognoses that impose a large burden,not only on patients but also on society and health systems.These mental illnesses share several clinical and neurobiological traits;of these traits,oligodendroglial dysfunction and alterations to white matter(WM)tracts could underlie the disconnection between brain regions related to their symptomatic domains.WM is mainly composed of heavily myelinated axons and glial cells.Myelin internodes are discrete axon-wrapping membrane sheaths formed by oligodendrocyte processes.Myelin ensheathment allows fast and efficient conduction of nerve impulses through the nodes of Ranvier,improving the overall function of neuronal circuits.Rapid and precisely synchronized nerve impulse conduction through fibers that connect distant brain structures is crucial for higher-level functions,such as cognition,memory,mood,and language.Several cellular and subcellular anomalies related to myelin and oligodendrocytes have been found in postmortem samples from patients with schizophrenia or bipolar disorder,and neuroimaging techniques have revealed consistent alterations at the macroscale connectomic level in both disorders.In this work,evidence regarding these multilevel alterations in oligodendrocytes and myelinated tracts is discussed,and the involvement of proteins in key functions of the oligodendroglial lineage,such as oligodendrogenesis and myelination,is highlighted.The molecular components of the axo-myelin unit could be important targets for novel therapeutic approaches to schizophrenia and bipolar disorder.