Antibiomania: A Case Report of a Manic Episode Potentially Induced by the Interaction of Clarithromycin and Amoxicillin during H. Pylori Eradication Therapy

Antibiomanic episodes, or as the DSM-5 refers to them, drug-induced manic episodes, pose a clinical challenge that is still poorly understood. There is insufficient information on the most common clinical presentation, patient profile, or underlying aetiopathogenic mechanisms. We present the clinical case of a 67-year-old woman who, after starting treatment (clarithromycin and amoxicillin) for the eradication of Helicobacter pylori, bacteria presented with a brief manic episode, which resolved after withdrawal of both drugs and with antipsychotic treatment. The possible interaction of both drugs, as GABA antagonists, in the generation of such episodes is discussed, and the clinical importance of such episodes in psychiatric emergency departments and liaison and interconsultation psychiatry, is highlighted. (AU)

Study on the Correlation between Hcy and Hs-CRP Levels and Cognitive Function in Patients with Bipolar Disorder and Borderline Personality Disorder

Objective: This study aims to explore the correlation and clinical significance of homocysteine and high-sensitivity C-reactive protein levels with cognitive function in patients with bipolar disorder (BD) and borderline personality disorder (BPD). Methods: Patients with BD admitted to our hospital from January 2022 to December 2022 were chosen retrospectively. BPD patients were categorized into comorbidity groups, while those without BPD were assigned to non-comorbidity groups, each consisting of 60 cases. Enzyme-linked immunosorbent assay (ELISA) was utilized to assess serum levels of homocysteine (Hcy) and high-sensitivity C-reactive protein (hs-CRP) in both patient groups. Clinical symptoms were evaluated by the Hamilton Depression Rating Scale (HAMD) and the Young Mania Rating Scale (YMRS). Cognitive function was evaluated and compared using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Pearson correlation analysis was performed on the correlation between patients' serum Hcy and hs-CRP levels and HAMD, YMRS, and RBANS scores. Results: In the comorbidity group, patients exhibited significantly elevated serum Hcy and hs-CRP levels compared to the non-comorbidity group (p < 0.05). Patients in the comorbidity group displayed higher HAMD and YMRS scores than those in the non-comorbidity group (p < 0.05). Additionally, attention, speech, visual span, immediate memory, and delayed memory in the comorbidity group were notably lower than in the non-comorbidity group (p < 0.05). The speech, visual span, and immediate memory of RBANS in bipolar depressive patients with comorbid BPD were lower than those in bipolar depressive patients without comorbid BPD (p < 0.05), the speech of RBANS in bipolar manic patients with comorbid BPD was lower than those in bipolar manic patients without comorbid BPD (p < 0.05). ... (AU)

Psychological Stress Analysis to Evaluate the Effects of Transcranial Magnetic Stimulation on Mood Regulation and Quality of Life in Patients with Bipolar Disorder

Objective: To explore the impact of transcranial magnetic stimulation on emotion regulation and quality of life in patients with bipolar disorder (BD) and to evaluate the effectiveness of the mental stress analyzer.Methods: Patients with BD admitted to our hospital from August 2022 to August 2023 were retrospectively selected. For the present study, 60 patients who received drug therapy served as the control group, and the other 60 patients who received repeated transcranial stimulation on this basis served as the observation group. The heart rate variability (HRV) of the two groups of patients was detected by a mental stress analyzer/HRV analysis system. Hamilton Depression Rating Scale (HAMD), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) were used to evaluate the mental state of the two groups of patients. The quality of life of the two groups was assessed using the Comprehensive Quality of Life Questionnaire 74 (GQOLI-74). Clinical effectiveness global rating scale-illness severity (CGI-SI) was used to evaluate the clinical symptoms of the two groups of patients, and the incidence of adverse reactions was calculated.Results: In comparison to the control group, the high-frequency power (HF) of the patients demonstrated an elevation in the observation group, and the low-frequency power (LF) and LF/HF were significantly reduced (p < 0.05). The standard deviation of NN intervals (SDNN), standard deviation of all five-minute NN intervals (SDANN), root mean square of successive differences (rMSSD), and percent RR intervals with a difference in duration higher than 50 ms (PNN50) of patients in the observation group showed a notable increase compared to the control group (p < 0.05). Compared with the control group, the HAMD, SAS, and SDS scores of the patients in the observation group demonstrated a substantial decline relative to the control group (p < 0.05). , ... Conclusions: ... (AU)

Síndrome de Cotard, más allá del delirio nihilista: a propósito de un caso / Cotard's syndrome, beyond the nihilistic delusion: About a case

El presente artículo pretende ampliar la información clínica y de neuroimagen del síndrome de Cotard, presentar el abordaje terapéutico, así como las limitaciones en su práctica. Se presenta el caso de una paciente de 54 años con antecedente de trastorno bipolar que ingresó a una institución de salud mental, con una clínica depresiva con tendencia a la clinofilia, acompañado por delirio nihilista y de culpa. Se inició el tratamiento farmacológico con antipsicóticos, antidepresivos y un estabilizador del ánimo con la consecuente resolución del cuadro y mejora en la calidad de vida. En la actualidad, queda mucho por conocer acerca de esta entidad clínica. La neuroimagen funcional y la clínica, serán los pilares que nos permitan dilucidar las complejidades fisiopatológicas y lograr avances en su clasificación, diagnóstico y manejo integral. (AU)

The present article aims to expand the clinical and neuroimaging information of Cotard Syndrome, present therapeutic approaches, as well as the limitations in its practice. The case of a 54-year-old patient with a history of bipolar disorder who was admitted to a mental health institution with a depressive clinical presentation characterized by clinophilia, accompanied by nihilistic and guilt delusions, is presented. Pharmacological treatment was initiated with antipsychotics, antidepressants, and a mood stabilizer, resulting in the resolution of the condition and an improvement in the quality of life. Currently, much remains to be known about this clinical entity. Functional neuroimaging and clinical assessment will be the pillars that allow us to elucidate the physiopathological complexities and make advances in its classification, diagnosis, and comprehensive management. (AU)

Borderline personality disorder vs. mood disorders: clinical comparisons in young people treated within an “Early Intervention” service for first episode psychosis

Background and Objective Borderline Personality Disorder (BPD) is under-investigated in First Episode Psychosis (FEP). BPD psychotic manifestations and mood changes are also difficult to differentiate from first episode affective psychosis. The aim of this study was to compare sociodemographic and clinical features between FEP patients with BPD vs. Bipolar Disorder (BD) or Major Depressive Disorder (MDD) both at baseline and across a 2-year follow-up period. Methods 224 FEP participants (49 with BPD, 93 with BD and 82 with MDD) completed the Health of the Nation Outcome Scale (HoNOS), the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale. Psychiatric diagnosis was reformulated at the end of our follow-up. Inter-group comparisons were analyzed using the Kruskal-Wallis or the Chi-square test. A mixed-design ANOVA model was also performed to assess the temporal stability of clinical scores within and between the 3 subgroups. Results Compared to FEP/BD subjects at baseline, FEP/BPD patients showed higher depressive symptom severity and lower excitement severity. Compared to FEP/MDD at entry, they had a higher prevalence rate of substance abuse, a lower interpersonal impairment and a shorter DUP. Finally, they had a lower treatment response on HoNOS “Psychiatric Symptoms” subscale scores across the follow-up in comparison with both FEP/BD and FEP/MDD individuals. Conclusion BPD as categorical entity represents a FEP subgroup with specific clinical features and treatment response. Appropriate treatment guidelines for this FEP subgroup are thus needed. (AU)

Risk of developing avascular necrosis of the femoral head and neck among patients with bipolar disorder: A nationwide cohort study

Background and objectives The association between bipolar disorder (BD) and avascular necrosis of the femoral head and neck (AVNHNF) remains unclear. We aimed to investigate the risk of AVNHNF among different polarity of BD. Methods Between 2001 and 2010, patients with BD were selected from the Taiwan National Health Research Database. The controls were individuals without severe mental disorder who were matched for demographic, medical and psychiatric comorbidities. Cox regression analysis was used to estimate the risk of AVNHNF, with adjustments for demographics, comorbidities, exposure to corticosteroids, and all-cause clinical visits. Results A total of 84,721 patients with BD and 169,442 controls were included. Patients with BD demonstrated a 1.92-fold (95% of confidence interval: 1.21–3.04) higher risk of AVNHNF compared with the controls. The risk was increased to 7.91-fold (4.32–14.49) in patients with severe BD compared with the controls. Importantly, patients with severe bipolar depression were associated with a 14.23-fold higher risk of AVNHNF compared with the controls, while those with sever bipolar mania were associated with a 3.55-fold higher risk. Compared with the controls with alcohol use disorder (AUD), patients with BD and comorbid AUD were associated with a 2.0-fold higher risk of AVNHNF. Finally, long-term use of atypical antipsychotics was associated with a decreased risk of AVNHNF). Conclusion Clinicians should be aware of the increased risk of AVNHNF among patients with BD. This increased risk was associated with disorder severity, polarity, and comorbidity with AUD, and attenuated by long-term atypical antipsychotic treatment. (AU)

Encefalopatía posterior reversible: una complicación de la intoxicación por litio / Posterior reversible encephalopathy: a complication of lithium toxicity

Las intoxicaciones en nuestro medio se presenta con una incidencia de 45.1 por cada 100,000 habitantes. Una de las principales causas son las intoxicaciones por psicofármacos dentro de las cuales esta el litio. Este medicamento es utilizado para el manejo del trastorno afectivo bipolar. En la literatura existen diferentes factores de riesgo para la intoxicación por litio como: condiciones que favorezcan la hipovolemia, uso de diuréticos, antihipertensivos, hiponatremia , interacciones medicamentosas y ajuste de dosis. Alrededor del 75 a 90% de los pacientes tratados crónicamente con litio pueden tener niveles tóxicos durante su tratamiento. Como tal la intoxicación puede cursar con diferentes complicaciones renales, cardiovasculares y neurológicas, dentro de estas últimas ésta la encefalopatía. Presentamos el caso de una paciente que ingresa con toxicidad crónica y presenta como complicación neurológica una encefalopatía posterior reversible. El objetivo de este reporte es sensibilizar al personal medico sobre esta complicación poco frecuente pero asociada a gran morbimortalidad. (AU)

Intoxications in our enviroment has an incidence of 45.1 for each 100.000 habitants. One of the main causes are psychopharmaceuticals, one of which is lithium. This drug is used in the management of bipolar disorder. There are several risk factors depicted on literature for this intoxication, such as: conditions that favor hipovolemia, diurethic and antihypertensive use, hiponatremia, drug interactions and lithium dose adjustment. About 75 to 90% of patients chronically treated with lithium can reach toxic levels during their treatment. Lithium intoxication can present with complications affecting different systems such as renal, cardiovascular and nervious, last one includying encephalopathy. We will discuss the case of a patient that presents with chronic lithuim toxicity and develops posterior reversible encephalopathy as a neurologic complication. The goal of this case report is to sensitize medical staff with this unfrequent but dangerous complication. (AU)

Patients with severe mental illness and hepatitis C virus infection benefit from new pangenotypic direct-acting antivirals: Results of a literature review / Los beneficios de los nuevos antivirales pangenotípicos de acción directa en pacientes con enfermedad mental grave e infección por el virus de la hepatitis C: resultados de una revisión bibliográfica

Introduction: Hepatitis C virus (HCV) infection is a global health problem that can results in cirrhosis, hepatocellular carcinoma and even death. HCV infection is 3–20-fold more prevalent among patients with versus without severe mental illness (SMI), such as major depressive disorder, personality disorder, bipolar disorder and schizophrenia. Treatment options for HCV were formerly based on pegylated interferon alpha, which is associated with neuropsychiatric adverse events, and this contributed to the exclusion of patients with SMI from HCV treatment, elimination programmes, and clinical trials. Moreover, the assumption of poor adherence, scant access to healthcare and the stigma and vulnerability of this population emerged as barriers and contributed to the low rates of treatment and efficacy. Methods: This paper reviews the literature published between December 2010 and December 2020 exploring the epidemiology of HCV in patients with SMI, and vice versa, the effect of HCV infection, barriers to the management of illness in these patients, and benefits of new therapeutic options with pangenotypic direct antiviral agents (DAAs). Results: The approval of DAAs has changed the paradigm of HCV infection treatment. DAAs have proven to be an equally efficacious and safe option that improves quality of life (QoL) in patients SMI. Conclusions: Knowledge of the consequences of the HCV infection and the benefits of treatment with new pangenotypic DAAs among psychiatrists can increase screening, referral and treatment of HCV infection in patients with SMI.(AU)

Introducción: La infección por el virus de la hepatitis C (VHC) es un problema de salud mundial que puede provocar cirrosis, carcinoma hepatocelular e incluso la muerte. La infección por el VHC es de 3 a 20 veces más prevalente entre los pacientes con enfermedades mentales graves (EMG), como el trastorno depresivo mayor, el trastorno de personalidad, el trastorno bipolar y la esquizofrenia. Las opciones de tratamiento para el VHC se basaban anteriormente en el interferón pegilado alfa, que se asocia con efectos adversos neuropsiquiátricos, y esto contribuyó a la exclusión de los pacientes con EMG del tratamiento del VHC, tanto de los programas de eliminación como de los ensayos clínicos. Además, la mala adherencia terapéutica, el escaso acceso de los pacientes a la asistencia sanitaria y el estigma y la vulnerabilidad de esta población surgieron como barreras y contribuyeron a las bajas tasas de tratamiento y eficacia. Métodos: En este trabajo se revisa la literatura publicada entre diciembre de 2010 y diciembre de 2020 en la que se explora la epidemiología del VHC en pacientes con EMG, y vice versa, el efecto de la infección por VHC, las barreras para el manejo de la enfermedad en estos pacientes y los beneficios de las nuevas opciones terapéuticas con agentes antivirales directos pangenotípicos (AAD). Resultados: La aprobación de los AAD ha cambiado el paradigma del tratamiento de la infección por VHC. Los AAD han demostrado ser una opción igualmente eficaz y segura que mejora la calidad de vida (QoL) en los pacientes SMI. Conclusiones: El conocimiento de las consecuencias de la infección por el VHC y los beneficios del tratamiento con los nuevos AAD pangenotípicos entre los psiquiatras puede aumentar el cribado, la derivación y el tratamiento de la infección por el VHC en pacientes con EMG.(AU)

COMT rs4680 and DRD2 rs6275 variants and their association with YMRS scores in children with early-onset bipolar disorder

Background and objectives: Bipolar disorder (BD) is a clinical status with at least one manic, hypomanic or mixed attacks. Genetic factors take part significantly in early-onset BD (EOBD). Dopamine receptors (DRD) act in neurological mechanisms like motivation, learning, memory, and, control of neuroendocrine signaling. DRD2 receptor has been reported to influence the stability of DRD2 transcript. Catechol-O-Methyl transferase (COMT) inactivates catecholamines and Val158Met variation on COMT has effects on COMT activity. This study aims to explore DRD2 and COMT variants in the clinical development of EOBD.MethodsIn this case-control study, 102 EOBD patients and 168 healthy control subjects were used. DRD2 rs6275 and COMT Val158Met variations were detected by real-time polymerase chain reaction (RT-PCR). Young Mania Rating Scale (YMRS) was utilized to determine the EOBD severity.ResultsFor DRD2 rs6275 and COMT Val158Met polymorphisms, no significant relationship was observed in the genotype and allele frequencies between patient and control groups. Nevertheless, TT genotype carriers of DRD2 rs6275 polymorphism demonstrated significantly increased YMRS scores when compared with CC and CT genotype carriers (p = 0.039). Nevertheless, no significant difference was observed between COMT Val158Met genotypes and YMRS scores.ConclusionsWe suggest that the DRD2 rs6275 TT variant can be associated with symptom severity in children with EOBD and can have a clinical significance in EOBD pathogenesis. However, these results need to be confirmed with larger samples of patient and control groups. (AU)

The relationship between objective and subjective cognitive performance to clinical features in bipolar disorder: A 6 years follow-up study

There is a consensus in the literature indicating that patients with Bipolar Disorder (BD) show cognitive impairments, especially in executive function, during both acute episodes and euthymia.1 An emerging body of knowledge indicates the importance of promoting functional recovery and improving cognitive deficits to achieve an adequate treatment of BD. However, the trajectories of cognitive deficits are still unclear. The neuroprogression hypothesis suggests that BD may present a progressive course with cognitive and functioning decline, which may be associated with mood episodes, length of the illness, early trauma,2 and biological rhythms disturbance, which may be a feature of BD.3 However, most of the evidence in this field came from cross-sectional studies, and the few existing longitudinal studies bring contrary results.4 A small number of studies assess the patient's perception of their cognitive function, which might be highly relevant to their everyday life.5 Therefore, the ideal study to assess the progression of cognition in BD might include objective as well as subjective measures from a longitudinal perspective.Thus, the purpose of the present study was to evaluate longitudinal cognitive performance in a sample of individuals with BD at baseline and after six years. All patients were in a depressive episode at baseline and euthymic at follow-up. We assessed subjective and objective cognitive difficulties in both points. We also investigated the relationship between psychosocial functioning, biological rhythms, and childhood trauma to cognition and the course of the illness. As far as we know, this is the first report using specific instruments to measure the relationship between these aspects to objective and subjective cognitive difficulties in a longitudinal BD sample. (AU)

Servicio de indicación farmacéutica a pacientes tratados con medicamentos de estrecho margen terapéutico / Minor ailment service for patients treated with narrow therapeutic index drug

Se estudian los casos de dos pacientes que demandan nuestro servicio de indicación farmacéutica porque presentan sintomatología digestiva inespecífica. Ambos están siendo tratados con fármacos de estrecho margen terapéutico (carbonato de litio y digoxina, respectivamente). Durante la indicación, el análisis de la medicación revela la posibilidad de que la clínica que ambos manifiestan guarde relación con estos tratamientos en distinta medida: en el caso del carbonato de litio, por tratarse de una reacción adversa frecuente en tratamientos prolongados, y en el de la digoxina, porque la sintomatología va acompañada de bradicardia. En consecuencia, se proponen dos intervenciones, siendo una de ellas la derivación urgente al médico de atención primaria. El análisis de los tratamientos farmacológicos crónicos prescritos a los pacientes, especialmente aquellos de estrecho margen terapéutico, durante el proceso de indicación, es un punto clave para discriminar entre clínica debida exclusivamente a síntomas menores y otras situaciones que pueden incluso comprometer la vida. (AU)

La valoración de dependencia y su baja demanda tras los primeros episodios agudos en salud mental / Dependencyassessment and its low demand after the first acute episodes in mental health

Introducción: Dentro de los problemas de salud mental, los trastornos mentales graves cronificados en el tiempo han evidenciado una falta de función ocupacional en los componentes volitivos, de habituación y ejecutivo. Sin embargo, tras el primer episodio agudo y posterior rehabilitación y estabilización, quizá por las expectativas puestas en ellos y en el intentar devolverles a una independencia pre-prodrómica inalcanzable, se han visto abocados a unas exigencias de autonomía personal que no pueden cumplir. El bajo porcentaje de los procesos de valoración del grado de dependencia de personas con trastorno mental grave en los dos a tres primeros años desde el primer episodio agudo han evidenciado que hay una barrera para el acceso y es necesario poner en marcha este derecho universal y subjetivo de la persona con problemas de salud mental. Métodos: la idea es analizar como la Ley de promoción de la autonomía personal y atención a la dependencia, Ley de dependencia y el baremo de valoración que desarrolla esta ley ha enmarcado los criterios para considerar con dependencia a una persona y por tanto dar acceso a unas prestaciones en forma de servicios o prestaciones económicas, y qué procesos internos han hecho que la propia persona y su entorno más cercano, familiar y profesional, impidan y limiten el acceso a este derecho. Discusión: De esta manera podremos entender los porqués de esta situación desventajosa. (AU)

Introduction: Among mental health problems, serious chronic mental health disorders have shown a lack of occupational function in the volitional, habituation and executive components. However, after the first acute episode and subsequent rehabilitation and stabilization process, patients find it difficult, when not impossible, to to meet the demands of their personal autonomy due to the high expectations placed on them, and the wish to make the patients achieve the unattainable level of independence that they had before the prodromal phase. The low percentage of dependency assessments made to people with severe mental disorders in the first two or three years from the first acute episode have shown that there is a barrier to access and to exercise an universal and subjective right of the person with mental illness. Methods: Our goal is to analyze how the Spanish “Ley de Dependencia'' (Law of Dependency)and the assessment scale developed specifically to implement this law has shaped the criteria to consider a person dependent or independent, and therefore to make them entitled to benefits such as care services or financial assistance. We also want to understand what internal processes may have prevented or limited patients the exercise of this right in relation with their closest family or professional environment. Discussion: So that we can better understand the reasons for this disadvantaged situation. (AU)

Ciclación Rápida en el Trastorno Bipolar: una Metarevisión / Rapid cycling in bipolar disorder: a meta-review

El descriptor evolutivo "Ciclación Rápida" (CR) en el Trastorno Bipolar constituye uno de los retos más importantes a la hora de realizar un plan terapéutico. Sin embargo, a pesar de su uso habitual en la clínica y los libros generalistas, existe poca bibliografía original y escasas publicaciones de investigación sobre el tema. La presente metarevisión analiza los datos más recientes al respecto, enfatizando especialmente los aspectos etiopatogénicos, evolutivos y de tratamiento. Para ello, hemos utilizado las revisiones y artículos recogidos en las bases de datos PubMed y Psychinfo en los últimos 10 años (entre abril del 2011 y abril del 2021), publicadas en inglés o castellano. Después de descartar duplicados, por consenso pudimos seleccionar 76 publicaciones que cumplían los criterios de inclusión. Como principales resultados, destacan los estudios que relacionan la futura aparición de CR con un inicio más precoz del trastorno bipolar, la comorbilidad con el trastorno límite de la personalidad y con el consumo de sustancias. Entre los factores biológicos favorecedores, estarían las alteraciones tiroideas, la obesidad, las alteraciones de los ritmos circadianos, la migraña y otros factores inflamatorios y (quizás) los tratamientos antidepresivos continuados. Entre los aspectos terapéuticos, destacan los bajos niveles de recomendación y de evidencia entre las pautas propuestas en las diferentes revisiones y guías terapéuticas, lo cual se corresponde también con las dificultades de tratamiento en la práctica clínica. Por otra parte, se evidencia la falta de ensayos clínicos y estudios randomizados adecuados y específicos para poder extraer mejores conclusiones al respecto.(AU)

The clinical descriptor “Rapid Cycling” (RC) in Bipolar Disorder is one of the most important challenges in designing a therapeutic plan. However, despite its usual use in medical practice and in general books, there is little original literature and few publications related to it. This umbrella review analyses most recent publications referred to Rapid Cycling, emphasizing specially in their etiology, outcomes and treatment aspects. Reviews from the databases PubMed and Psychinfo have been collected, including the ones from the last 10 years (between April 2011 and April 2021), published in English or Spanish. After discharging duplicates, we applied a consensus to finally recruit 76 publications that fulfilled the inclusion criteria.As main results it must be mentioned the studies that relate RC to early age of onset, the ones that relate it with Borderline Personality Disorder comorbidity and finally the ones with Substance Abuse. Biological factors considered for the etiology of RC would be thyroidal disorders, obesity, circadian rhythms disorders and other inflammatory factors, migraine and (maybe) the maintained antidepressant treatments. Among the therapeutic aspects, the low level of recommendation and evidence in the different therapeutic guidelines stands out. This corresponds with the treatment difficulties observed in the clinical practice. Finally, it is important to mention the lack of clinical trials and randomized studies that are necessary to obtain better conclusions in the area.(AU)

Endocrine biomarkers related to sleep-wake cycle and sleep disturbances in patients with bipolar disorder: A systematic review

Background and objectives: Sleep and circadian disturbances have been widely studied in patients with bipolar disorder. However, there is no clear evidence about the role of peripheral biomarkers of the circadian cycle in this population. This systematic review aims to identify potential endocrine blood biomarkers of circadian rhythms and study their relationship with sleep problems in these patients.MethodsAn electronic search was performed of PubMed and PsycINFO databases. It included articles about the topic from 1991 through 2021. The search strategy was: ("peripheral biomarkers" OR "biological markers" OR biomarker OR cortisol OR melatonin OR orexin OR hypocretin) AND (blood OR serum OR plasma) AND (“sleep-wake” OR "circadian rhythm" OR sleep OR insomnia) AND "bipolar."ResultsAfter excluding duplicates, 92 records were obtained. Only 5 studies met the inclusion criteria (n=499; bipolar disorder=125; unipolar depression=148; schizophrenia=80; controls=146). The endocrine parameters analyzed were: cortisol (3 studies), melatonin (1 study), and orexin-A (1 study). Overall, no significant associations were detected between these biomarkers and sleep disturbances, assessed with subjective (psychometric evaluation) and/or objective (polysomnography) measures.ConclusionThis review highlights the lack of studies exploring the role of endocrine biomarkers related to circadian function in the pathophysiology of sleep disturbances in bipolar disorder. (AU)

Uso de cariprazina en el trastorno bipolar: una revisión sistemática y aspectos prácticos / Use of cariprazine in bipolar disorder: A systematic review and practical considerations

Cariprazina es un antipsicótico de nueva generación que actúa como agonista parcial de los receptores de la dopamina D2 y D3, y de los receptores de serotonina 5HT1A. Actualmente, la cariprazina está aprobada por la Asociación Española del Medicamento para el tratamiento de la esquizofrenia, y por la Food and Drug Administration para el tratamiento de las fases maníacas, depresivas y mixtas asociadas al trastorno bipolar. La evidencia científica disponible, así como varias guías clínicas internacionales, acreditan la eficacia, seguridad y tolerabilidad de este fármaco y avalan su uso en cualquier tipo de episodio agudo del TB, con o sin síntomas mixtos. Los efectos adversos más frecuentes son los síntomas extrapiramidales, especialmente la acatisia. En dichos estudios se propone individualizar la dosis de cariprazina en función del tipo y la gravedad del episodio, así como de la tolerabilidad del paciente. Los estudios más recientes parecen indicar también un potencial beneficio para la prevención de recaídas en la fase de eutimia, y actualmente se están llevando a cabo ensayos clínicos para evaluar tanto este aspecto como el impacto del fármaco en la esfera cognitiva y en la funcionalidad de los pacientes. En conclusión, el uso de cariprazina en el TB está plenamente justificado desde un punto de vista científico, con unos beneficios globales que sobrepasan ampliamente el perfil de efectos adversos. (AU)

Cariprazine is a new generation antipsychotic that acts as a partial agonist of dopamine D2 and D3 receptors and serotonin 5HT1A receptors.Cariprazine has now been approved by the Spanish Medicines Association (Asociación Española del Medicamento (AEM)) for the treatment of schizophrenia, and by the Food and Drug Administration (FDA) for the treatment of the manic, depressive, and mixed states associated with bipolar disorder (BD). The available scientific evidence, and several international guidelines attest to the efficacy, safety, and tolerability of this drug and endorse its use in any type of acute BD episode, with or without mixed symptoms.The most frequent adverse effects are extrapyramidal symptoms, especially akithisia. Studies propose individualising the dose of cariprazine to the type and severity of the episode, and the patient’s tolerability. The most recent studies also seem to indicate a potential benefit in the prevention of relapse in the euthymia phase, and clinical trials are currently underway to evaluate this and the impact of the drug on patients’ cognitive sphere and functionality. To conclude, the use of cariprazine in bipolar disorder is fully justified from a scientific perspective, with overall benefits that far outweigh the adverse effects profile. (AU)

Evolución longitudinal y cambios de función cerebral entre fases del trastorno bipolar / Longitudinal evolution and changes in brain function between phases of bipolar disorder

Mediante resonancia magnética funcional (fMRI) se han señalado alteraciones en el sistema límbico y en el lóbulo prefrontal del cerebro de los pacientes bipolares sobre todo durante episodios de manía y depresivos, aunque también en la eutimia. La relación entre cambios funcionales cerebrales y las distintas fases del trastorno bipolar (TB) es menos clara y la manera ideal de investigarlos es examinar a los mismos pacientes en fases distintas de la enfermedad. Se presentan los resultados de dos estudios longitudinales que examinaron mediante fMRI las activaciones y desactivaciones cerebrales durante una tarea de memoria de trabajo (n-back) en pacientes durante un episodio afectivo agudo que luego alcanzaron la eutimia. Entre otros hallazgos, la corteza dorsal prefrontal (dlPFC) se mostró hipoactivada durante el episodio de manía y se normalizaba durante la eutimia, mientras que el área ventromedial de la corteza prefrontal (vmPFC) mostró un fracaso en la desactivación durante la tarea n-back, tanto durante la manía y la depresión, como en la eutimia. Teniendo en cuenta que el área vmPFC es uno de los nodos principales de la red neuronal por defecto, los resultados sugieren una disfunción de esta red neuronal más como rasgo que como marcador de estado en el TB (AU)

Functional magnetic resonance imaging (fMRI) has revealed alterations in the limbic system and the prefrontal lobe of the brain in bipolar patients, especially during episodes of mania and depression, but also in euthymia. The relationship between functional brain changes and the different phases of bipolar disorder (BD) is less clear and the ideal way to investigate them is to examine the same patients in different phases of the illness. We present the results of two longitudinal studies that examined by fMRI the brain activations and deactivations during a working memory task (n-back) in patients during an affective acute episode who later reached euthymia. Among other findings, during the manic episode the dorsal prefrontal cortex (dlPFC) showed hypoactivation during the task, but it normalised during the euthymia, while the ventromedial prefrontal cortex (vmPFC) showed a failure to deactivate both during mania and depression, as well as in euthymia. Considering that the vmPFC area is one of the main nodes of the default neural network (DMN), the results suggest dysfunction of this neural network more as a trait than as a state marker in TB (AU)

Efecto antisuicida del litio a dosis infraterapéutica, a propósito de un caso / Anti-suicidal effect of lithium at sub-therapeutic doses, a case report

Ha sido bien documentado un efecto antisuicida entratamientos prolongados con Litio, con evidencias dealta calidad en trastorno bipolar y depresión unipolar,demostrado significativamente superior al de otros estabilizadores del ánimo, con reducción del riesgo suicidaen un 50-80%.Presentamos el caso de un varón de 70 años que ingresa en nuestra unidad por intento de ahorcamiento trassuspensión del tratamiento con Litio debido a detecciónde daño renal. Se había mantenido estabilidad clínica desde el debut de la enfermedad con dosis de 1200 mg/d, decidiéndose entonces reducción hasta 600 mg/d, obteniéndose litemias mantenidas en niveles infraterapéuticos de0,32-0,34 mEq/L, persistiendo estabilidad psicopatológicavarios años más. Posteriormente, se realiza retirada progresiva de Litio en un periodo de 6 meses, produciéndoseaproximadamente al mes de la retirada completa descompensación depresiva con delirio de perjuicio, sin mejoríacon pauta antidepresiva y antipsicótica; que culmina en elgesto autolítico mencionado.A pesar de un evidente efecto estabilizador del ánimo,antisuicida y del hecho de que un tercio de pacientes contrastorno bipolar se consideran excelentes respondedoresa Litio en monoterapia, con remisión completa de recaídasafectivas; su uso ha declinado en distintos países durantelas últimas décadas, en favor de otros fármacos con efectoestabilizador del ánimo. (AU)

An antisuicidal effect has been well documented in prolonged Lithium treatments, with high-quality evidence inbipolar disorder and unipolar depression, shown to be significantly superior to other mood stabilizers, with a 50-80%of reduction in suicide risk.We present the case of a 70-year-old man who was admitted to our unit for attempted suicide by hanging afterdiscontinuation of Lithium treatment due to detection ofkidney damage. Clinical stability had been maintained sincethe onset of the disease with a dose of 1200 mg/d, decidingthen to reduce it to 600 mg/d, obtaining maintained infratherapeutic levels of Lithium of 0.32-0.34 mEq/L, persistingpsychopathological stability for several more years.Subsequently, progressive lithium withdrawal is performed over a 6-month period, occurring approximately onemonth after complete withdrawal, depressive decompensation with delusion of harm, without improvement with antidepressant and antipsychotic regimen; culminating in theattempted suicide.Despite an evident mood stabilizing, antisuicidal effectand the fact that one third of patients with bipolar disorderare considered excellent responders to Lithium monotherapy,with complete remission of affective relapses; its use has declined in different countries during the last decades, in favorof other drugs with a mood stabilizing effect. (AU)

Resilience moderates the associations between bipolar disorder mood episodes and mental health / La resiliencia modera la asociación entre los episodios anímicos del trastorno bipolar y la salud mental

Resilience could moderate the impact of bipolar disorder (BD) on patients’ quality of life (QoL) and psychosocial functioning. This study aimed to (1) explore the relationships between bipolar disorder mood episodes (depression, [hypo]mania, and euthymia) and mental health outcomes of QoL, personal recovery, impaired work, and psychosocial functioning in individuals with BD; and (2) determine whether resilience domains were moderators of these associations. A clinical adult sample of 97 individuals diagnosed with BD (63.90% female, mean age = 45.02 years) completed a battery of BD-specific measures of resilience and mental health-related variables. Multiple regression showed that self-management of BD resilience domain moderated the negative relationship between (hypo)manic episode and personal recovery. Furthermore, self-confidence moderated the positive relationships between (hypo)manic and depressive episodes and impaired functioning. We suggest that BD patients experiencing (hypo)manic or depressive episodes may improve their mental health and wellbeing through interventions that promote disorder-specific resilience factors. (AU)

La resiliencia podría moderar el impacto del trastorno bipolar (TB) en la calidad de vida (CV) y funcionamiento psicosocial de los pacientes. Los objetivos del presente estudio fueron: (1) explorar la asociación entre los episodios anímicos bipolares (depresión, [hipo]manía y eutimia) y los resultados de la CV en cuanto a salud mental, la recuperación personal y el deterioro del funcionamiento laboral y psicosocial de personas con TB y (2) determinar si los dominios de resiliencia moderaban esta asociación. Una muestra clínica de 97 personas adultas diagnosticadas de TB (63.90% mujeres, edad media = 45.02) cumplimentaron una batería de medidas específicas de TB sobre resiliencia y variables relacionadas con la salud mental. La regresión múltiple mostró que el dominio de la resiliencia de autogestión del TB moderó la relación negativa entre el episodio (hipo)maníaco y la recuperación personal. Además, la confianza en uno mismo moderó la asociación positiva entre los episodios (hipo)maníacos y depresivos y el deterioro del funcionamiento. Se sugiere que la salud mental y bienestar de los pacientes con TB en episodios (hipo)maníacos o depresivos podrían mejorar mediante intervenciones que desarrollen aspectos de resiliencia específicos de este trastorno mental. (AU)