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.

Bipolar fuzzy soft mappings with application to bipolar disorders

Bipolar disorder is a neurological disorder that consists of two main factors,i.e.mania and depression.There are two main drawbacks in clinical diagnosis of the bipolar disorder.First,bipolar disorder is mostly wrongly diagnosed as unipolar depression in clinical diagnosis.This is,because in clinical diagnosis,the first factor is often neglected due to its approach toward positivity.Consequently,the element of bipolarity vanishes and the disease becomes worse.Second,the types of bipolhr disorder are mostly misdiagnosed due to similar symptoms.To overcome these problems,the bipolar fuzzy soft set(BFS-set)and bipolar fuzzy soft mappings(BFS-mappings)are useful to tackle bipolarity and to construct a strong mathematical modeling process to diagnose this disease correctly.This technique is extensive but simple as compared to existing medical diagnosis methods.A chart(relation between different types and symptoms of bipolar disorder)is provided which contains different ranges over the interval[-1,1].A process of BFS-mappings is also provided to obtain correct diagnosis and to suggest the best treatment.Lastly,a generalized BFS-mapping is introduced which is helpful to keep patient's improvement record.The case study indicates the reliability,efficiency and capability of the achieved theoretical results.Further,it reveals that the connection of soft set with bipolar fuzzy set is fruitful to construct a connection between symptoms which minimize the complexity of the case study.

Neuroinflammation in bipolar disorders

Recent literature based on peripheral immunity findings speculated that neuroinflammation,with its connection to microglial activation,is linked to bipolar disorder.The endorsement of the neuroinflammatory hypotheses of bipolar disorder requires the demonstration of causality,which requires longitudinal studies.We aimed to review the evidence for neuroinflammation as a pathogenic mechanism of the bipolar disorder.We carried out a hyper inclusive PubMed search using all appropriate neuroinflammation-related terms and crossed them with bipolar disorder-related terms.The search produced 310 articles and the number rose to 350 after adding articles from other search engines and reference lists.Twenty papers were included that appropriately tackled the issue of the presence(but not of its pathophysiological role)of neuroinflammation in bipolar disorder.Of these,15 were postmortem and 5 were carried out in living humans.Most articles were consistent with the presence of neuroinflammation in bipolar disorder,but factors such as treatment may mask it.All studies were cross-sectional,preventing causality to be inferred.Thus,no inference can be currently made about the role of neuroinflammation in bipolar disorder,but a link is likely.The issue remains little investigated,despite an excess of reviews on this topic.

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.

Cognitive impairment in patients with bipolar disorder alone versus those with bipolar disorder comorbid with borderline personality disorder

BACKGROUND Bipolar disorder(BD)is a severe mental illness.BD often coexists with borderline personality disorders,making the condition more complex.AIM To explore the differences in cognitive impairment between patients with BD and those with BD comorbid with borderline personality disorder.METHODS Eighty patients with BD and comorbid borderline personality disorder and 80 patients with BD alone were included in groups A and B,respectively,and 80 healthy volunteers were included as controls.Cognitive function in each group was evaluated using the Chinese version of the repeatable battery for the assess-ment of neuropsychological status(RBANS),the Stroop color-word test,and the Wechsler intelligence scale-revised(WAIS-RC).RESULTS The indices of the RBANS,Stroop color-word test,and WAIS-RC in groups A and B were significantly lower than those of the control group(P<0.05).Group A had significantly longer Stroop color-word test times for single-character,single-color,double-character,and double-color,lower scores of immediate memory,visual breadth,verbal function dimensions and total score of the RBANS,as well as lower scores of verbal IQ,performance IQ,and overall IQ of the WAIS-RC compared with group B(P<0.05).Compared to group B,group A exhibited significantly longer single-character time,single-color time,double-character time,and double-color time in the Stroop color-word test(P<0.05).CONCLUSION The cognitive function of patients with BD complicated with borderline personality disorder is lower than that of patients with BD.

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.

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.

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.

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.

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.

Bipolar disorder in the International Classification of Diseases-Eleventh version:A review of the changes,their basis,and usefulness

The World Health Organization’s 11^(th)revision of the International Classification of Diseases(ICD-11)including the chapter on mental disorders has come into effect this year.This review focuses on the“Bipolar or Related Disorders”section of the ICD-11 draft.It describes the benchmarks for the new version,particularly the foremost principle of clinical utility.The alterations made to the diagnosis of bipolar disorder(BD)are evaluated on their scientific basis and clinical utility.The change in the diagnostic requirements for manic and hypomanic episodes has been much debated.Whether the current criteria have achieved an optimum balance between sensitivity and specificity is still not clear.The ICD-11 definition of depressive episodes is substantially different,but the lack of empirical support for the changes has meant that the reliability and utility of bipolar depression are relatively low.Unlike the Diagnostic and Statistical Manual of Mental Disorders,5th edition(DSM-5),the ICD-11 has retained the category of mixed episodes.Although the concept of mixed episodes in the ICD-11 is not perfect,it appears to be more inclusive than the DSM-5 approach.Additionally,there are some uncertainties about the guidelines for the subtypes of BD and cyclothymic disorder.The initial results on the reliability and clinical utility of BD are promising,but the newly created diagnostic categories also appear to have some limitations.Although further improvement and research are needed,the focus should now be on facing the challenges of implementation,dissemination,and education and training in the use of these guidelines.

Psychoeducation in bipolar disorder: A systematic review

BACKGROUND Bipolar disorder(BD)is a severe psychiatric disorder characterized by mood swings.Psychosocial interventions,such as psychoeducation,play an essential role in promoting social rehabilitation and improving pharmacological treatment.AIM To investigate the role of psychoeducation in BD.METHODS A systematic review of original studies regarding psychoeducation interventions in patients with BD and their relatives was developed.A systematic literature search was performed using the Medline,Scopus,and Lilacs databases.No review articles or qualitative studies were included in the analysis.There were no date restriction criteria,and studies published up to April 2021 were included.RESULTS A total of forty-seven studies were selected for this review.Thirty-eight studies included patients,and nine included family members.Psychoeducation of patients and family members was associated with a lower number of new mood episodes and a reduction in number and length of stay of hospitalizations.Psychoeducational interventions with patients are associated with improved adherence to drug treatment.The strategies studied in patients and family members do not interfere with the severity of symptoms of mania or depression or with the patient's quality of life or functionality.Psychoeducational interventions with family members do not alter patients'adherence to pharmacotherapy.CONCLUSION Psychoeducation as an adjunct strategy to pharmacotherapy in the treatment of BD leads to a reduction in the frequency of new mood episodes,length of hospital stay and adherence to drug therapy.

Cognitive attentional syndrome and metacognitive beliefs as potential treatment targets for metacognitive therapy in bipolar disorder

Most treatment guidelines emphasize the use of psychotropic drugs for both the acute and maintenance treatment of bipolar disorder(BD).However,relying only on psychotropics without adjunctive psychosocial interventions may be insufficient in treating patients with BD.Given its unique view in the explanation of psychopathological states,metacognitive therapy(MCT)might be helpful for BD.Metacognitive theory posits that psychopathology is a result of the cognitive attentional syndrome(CAS)and that it is influenced and maintained by dysfunctional metacognitive beliefs,perseverative thinking,attentional biases,and dysfunctional coping strategies.In this review,literature data regarding these areas in BD are examined.Studies suggest that perseverative thinking might be among the emotion regulation strategies endorsed in individuals with BD.Regarding attentional biases,literature data show that state-dependent,moodchanging attentional biases and a ruminative self-focused attention are present.Studies also suggest that cognitive self-consciousness is higher in BD compared to controls.It is seen that maladaptive coping strategies are frequently reported in BD,and that these strategies are associated with depression severity,negative affect and relapse risk.Studies focusing on dysfunctional metacognitive beliefs in BD reported that individuals with BD had higher scores for negative metacognitive beliefs,self-consciousness,need to control thoughts,and a lack of cognitive confidence.Also,dysfunctional metacognitive beliefs were associated with depressive symptomatology.These findings suggest that the components of CAS and dysfunctional metacognitive beliefs are evident in BD.For a subgroup of patients with BD who fail to respond to evidence-based psychopharmacological and adjunctive psychotherapeutic interventions,MCT might be an alternative way to consider as a treatment option.In conclusion,taken the available data together,we propose a sequential treatment protocol for BD,mainly based on the MCT treatment plan of depressive disorders.

Differential aberrant connectivity of precuneus and anterior insula may underpin the diagnosis of schizophrenia and mood disorders

BACKGROUND Over the past decade,resting-state functional magnetic resonance imaging(rsfMRI)has concentrated on brain networks such as the default mode network(DMN),the salience network(SN),and the central executive network(CEN),allowing for a better understanding of cognitive deficits observed in mental disorders,as well as other characteristic psychopathological phenomena such as thought and behavior disorganization.AIM To investigate differential patterns of effective connectivity across distributed brain networks involved in schizophrenia(SCH)and mood disorders.METHODS The sample comprised 58 patients with either paranoid syndrome in the context of SCH(n=26)or depressive syndrome(Ds)(n=32),in the context of major depressive disorder or bipolar disorder.The methods used include rs-fMRI and subsequent dynamic causal modeling to determine the direction and strength of connections to and from various nodes in the DMN,SN and CEN.RESULTS A significant excitatory connection from the dorsal anterior cingulate cortex to the anterior insula(aI)was observed in the SCH patient group,whereas inhibitory connections from the precuneus to the ventrolateral prefrontal cortex and from the aI to the precuneus were observed in the Ds group.CONCLUSION The results delineate specific patterns associated with SCH and Ds and offer a better explanation of the underlying mechanisms of these disorders,and inform differential diagnosis and precise treatment targeting.

Psychological impact of the COVID-19 pandemic on individuals with serious mental disorders: A systematic review of the literature

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic is having a great impact on individuals from all over the world,particularly on individuals with mental disorders.Several studies found more pronounced psychiatric symptoms,notably symptoms of depression and anxiety.AIM To assess the situation of patients with serious mental illness(SMI:Affective disorders and schizophrenia)regarding their mental health outcome during the pandemic.METHODS A systematic search using the databases PubMed and MEDLINE was conducted,employing the key words“COVID-19”,“SARS-CoV-2”,“psychiatric/mental disorder/illness”,“affective/mood disorder”,“bipolar disorder”,“(major)depression”,“schizoaffective disorder”,and“schizophrenia”.Studies that had been published up until January 9,2021 were included.Information of studies in languages other than English and German was mostly taken from their English abstracts.RESULTS The literature search concluded in the finding of 36 studies containing relevant clinical data.A general impairment of the mental health of individuals with SMI could be detected,particularly in individuals with affective disorders,as compared to those with schizophrenia.Compared to healthy controls,symptoms of anxiety,depression,and stress were more pronounced in individuals with SMI.Relevant factors found that impacted their mental health were age,resilience,and socioeconomic environment,especially the shortage of mental health services,lack of social support,and inadequate information about COVID-19.CONCLUSION In light of these results,mental health services should be reinforced,notably the use of telemental health services.Furthermore,supplying individuals with SMI with adequate information about the COVID-19 pandemic and increasing their resilience is important.When researching the impact of the COVID-19 pandemic on individuals with SMI,standardization as well as follow-up studies are needed to enable better comparability and understanding.

Psychotic symptoms in bipolar disorder and their impact on the illness:A systematic review

BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder(BD)and can have an adverse effect on its course,outcome,and treatment.However,despite a considerable amount of research,the impact of psychotic symptoms on BD remains unclear,and there are very few systematic reviews on the subject.AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed.An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021.Combinations of the relevant Medical Subject Headings terms were used to search for these studies.Articles were selected after a screening phase,followed by a review of the full texts of the articles.Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.RESULTS This systematic review included 339 studies of patients with BD.Lifetime psychosis was found in more than a half to two-thirds of the patients,while current psychosis was found in a little less than half of them.Delusions were more common than hallucinations in all phases of BD.About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms,particularly during manic episodes.Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression.Although psychotic symptoms were not more severe in BD,the severity of the illness in psychotic BD was consistently greater.Psychosis was usually associated with poor insight and a higher frequency of agitation,anxiety,and hostility but not with psychiatric comorbidity.Psychosis was consistently linked with increased rates and the duration of hospitalizations,switching among patients with depression,and poorer outcomes with mood-incongruent symptoms.In contrast,psychosis was less likely to be accompanied by a rapid-cycling course,longer illness duration,and heightened suicidal risk.There was no significant impact of psychosis on the other parameters of course and outcome.CONCLUSION Though psychotic symptoms are very common in BD,they are not always associated with an adverse impact on BD and its course and outcome.

Relationship between Serum Uric Acid Level and Clinical Symptom Improvement in Patients with Bipolar Disorder Type I in Their Manic Episode

[Objectives]To evaluate whether the level of serum uric acid in patients with bipolar disorder type I in their manic episode was different from that in healthy subjects,and to evaluate whether the level of serum uric acid is related to the severity of manic episode and the improvement of clinical symptoms.[Methods]A total of 70 patients with bipolar disorder type I in their manic episode were selected,their serum uric acid levels were measured at the beginning of the enrollment and at the end of the first,second and third week,and the clinical symptoms were evaluated with Young Mania Rating Scale(YMRS).65 healthy subjects were enrolled,and their serum uric acid levels were measured only at the beginning of the enrollment.[Results]The level of serum uric acid in patients with bipolar disorder type I in their manic episode was higher than that in healthy adults(t=8.153,p=0.039).At the end of the third week,the YMRS score and uric acid level of the patients were lower than those of the patients at the beginning of the enrollment(t=17.107,p=0.000;t=35.864,p=0.000).[Conclusions]The level of serum uric acid in patients with bipolar disorder type I in their manic episode was higher than that in healthy subjects,and the decrease of serum uric acid level may be related to the improvement of clinical symptoms.

Evaluation of Family Dysfunction in Patients with Schizophrenia and Bipolar I Disorder

Introduction: Schizophrenia and bipolar I disorder are very common disorders in hospitalized patients. Considering that family problems are one of the factors in the appearance and persistence of schizophrenia and bipolar I disorder, in this study, we decided to investigate and compare the family functioning between these two groups of patients. Methods: The sample consisted of 50 patients with schizophrenia and 50 patients with bipolar I disorder. The third group was the control group which consisted of 50 normal different professions such as teachers, workers, housekeepers and others. Then the Family Functioning Scale (FAD-I) was used and the final results of the three groups were compared by SPSS V21 software. Results: In the schizophrenia group, 88.9% percent of patients had family functioning scores less than 109.81 which showed that they had severe family dysfunction but in the bipolar I disorder group, 11.1% and all participants in the control group, had scores higher than 109.81.Conclusion: Family dysfunction was seen in schizophrenic patients rather than in the other two groups.

Healthy individuals vs patients with bipolar or unipolar depression in gray matter volume

BACKGROUND Previous studies using voxel-based morphometry(VBM)revealed changes in gray matter volume(GMV)of patients with depression,but the differences between patients with bipolar disorder(BD)and unipolar depression(UD)are less known.AIM To analyze the whole-brain GMV data of patients with untreated UD and BD compared with healthy controls.METHODS Fourteen patients with BD and 20 with UD were recruited from the Mental Health Center of Shantou University between August 2014 and July 2015,and 20 nondepressive controls were recruited.After routine three-plane positioning,axial T2WI scanning was performed.The connecting line between the anterior and posterior commissures was used as the scanning baseline.The scanning range extended from the cranial apex to the foramen magnum.Categorical data are presented as frequencies and were analyzed using the Fisher exact test.RESULTS There were no significant intergroup differences in gender,age,or years of education.Disease course,age at the first episode,and Hamilton depression rating scale scores were similar between patients with UD and those with BD.Compared with the non-depressive controls,patients with BD showed smaller GMVs in the right inferior temporal gyrus,left middle temporal gyrus,right middle occipital gyrus,and right superior parietal gyrus and larger GMVs in the midbrain,left superior frontal gyrus,and right cerebellum.In contrast,UD patients showed smaller GMVs than the controls in the right fusiform gyrus,left inferior occipital gyrus,left paracentral lobule,right superior and inferior temporal gyri,and the right posterior lobe of the cerebellum,and larger GMVs than the controls in the left posterior central gyrus and left middle frontal gyrus.There was no difference in GMV between patients with BD and UD.CONCLUSION Using VBM,the present study revealed that patients with UD and BD have different patterns of changes in GMV when compared with healthy controls.

Effects of smartphone-based interventions and monitoring on bipolar disorder:A systematic review and meta-analysis

BACKGROUND Recently,there has been a range of studies about smartphone-based interventions and monitoring for reducing symptoms of bipolar disorder(BD).However,their efficacy for BD remains unclear.AIM To compare the effect of smartphone-based interventions and monitoring with control methods in treating patients with BD.METHODS A systematic literature search was performed on PubMed,Embase,Clinical trials,psycINFO,Web of Science,and Cochrane Library.Randomized clinical trials(RCTs)or single-group trials in which smartphone-based interventions and monitoring were compared with control methods or baseline in patients with symptoms of BD were included.Data were synthesized using a random-effects or a fixed-effects model to analyze the effects of psychological interventions and monitoring delivered via smartphone on psychiatric symptoms in patients with BD.The primary outcome measures were set for mania and depression symptoms.Subgroups were created to explore which aspects of smartphone interventions are relevant to the greater or lesser efficacy of treating symptoms.RESULTS We identified ten articles,including seven RCTs(985 participants)and three single-group trials(169 participants).Analysis of the between-group study showed that smartphone-based interventions were effective in reducing manic[g=-0.19,95%confidence interval(CI):-0.33 to-0.04,P=0.01]and depressive(g=-0.28,95%CI:-0.55 to-0.01,P<0.05)symptoms.In within-group analysis,smartphone-based interventions significantly reduced manic(g=0.17,95%CI:0.04 to 0.30,P<0.01)and depressive(g=0.48,95%CI:0.18 to 0.78)symptoms compared to the baseline.Nevertheless,smartphone-based monitoring systems significantly reduced manic(g=0.27,95%CI:0.02 to 0.51,P<0.05)but not depressive symptoms.Subgroup analysis indicated that the interventions with psychoeducation had positive effects on depressive(g=-0.62,95%CI:-0.81 to-0.43,P<0.01)and manic(g=-0.24,95%CI:-0.43 to-0.06,P=0.01)symptoms compared to the controlled conditions,while the interventions without psychoeducation did not(P>0.05).The contacts between therapists and patients that contributed to the implementation of psychological therapy reduced depression symptoms(g=-0.47,95%CI:-0.75 to-0.18,P=0.01).CONCLUSION Smartphone-based interventions and monitoring have a significant positive impact on depressive and manic symptoms of BD patients in between-group and within-group analysis.