Lithium levels and lifestyle in patients with bipolar disorder: a new tool for self-management.

BACKGROUND: Patients should get actively involved in the management of their illness. The aim of this study was to assess the influence of lifestyle factors, including sleep, diet, and physical activity, on lithium levels in patients with bipolar disorder. METHODS: A multicenter study was performed. In total, 157 lithium measurements were done biweekly in a sample of 65 patients (35 women) over 6 weeks. Lifestyle, based on total sleep hours and physical activity, was assessed by actigraphy. Diet was evaluated using the Mediterranean Lifestyle Index (Medlife). RESULTS: 35.4% of patients had a normal weight. The mean Medlife score was 14.5 (± 2.5) (moderate-good adherence to Mediterranean diet). BMI, daily dose of lithium and intensity of physical activity had a combined effect on lithium levels, after adjustment for other variables. Patients who practiced intense physical exercise, who took lower doses and had a higher BMI exhibited lower levels of lithium. CONCLUSIONS: Higher physical activity and BMI contribute to lower lithium levels. Patients should be made aware of these relationships to improve their perception of control and self-management. Lifestyle-based interventions contribute to establishing a more personalized medicine.

Bilateral facial palsy with paresthesias, variant of Guillain-Barré syndrome following COVID-19 vaccine: A case series of 9 patients.

Several cases of Guillain-Barré Syndrome (GBS) associated with COVID-19 vaccination have been reported, including the rare subtype known as Bilateral Facial Palsy with paresthesias (BFP). To date, it is not known whether a causal relationship may exist between the two. We report 9 cases of BFP in patients vaccinated against COVID-19 in the previous month. Nerve conduction studies revealed demyelinating polyneuropathy in 4 patients, and 5 presented bilateral, focal facial nerve involvement, exclusively. Ganglioside antibody panel was positive in 4 patients (anti-GM1=2, anti-GD1a=1 and anti-sulfatide=1). Seven patients received intravenous immunoglobulin treatment, one plasma exchange, and one patient died from sudden cardiac arrest following arrhythmia before treatment could be administered. Rates of BFP following COVID-19 vaccination, did not differ from those reported in previous series. Epidemiological studies are essential to determine whether a causal relationship may exist between this rare form of GBS and COVID-19 vaccination.

Corpus callosum size by neurosonography in fetuses with congenital heart defect and relationship with expected pattern of brain oxygen supply.

OBJECTIVE: To evaluate corpus callosum (CC) size by neurosonography (NSG) in fetuses with an isolated major congenital heart defect (CHD) and explore the association of CC size with the expected pattern of in-utero oxygen supply to the brain. METHODS: A total of 56 fetuses with postnatally confirmed isolated major CHD and 56 gestational-age-matched controls were included. Fetuses with CHD were stratified into two categories according to the main expected pattern of cerebral arterial oxygen supply: Class A, moderately to severely reduced oxygen supply (left outflow tract obstruction and transposition of the great arteries) and Class B, near normal or mildly impaired oxygenated blood supply to the brain (other CHD). Transvaginal NSG was performed at 32-36 weeks in all fetuses to evaluate CC length, CC total area and areas of CC subdivisions in the midsagittal plane. RESULTS: CHD fetuses had a significantly smaller CC area as compared to controls (7.91 ± 1.30 vs 9.01 ± 1.44 mm2 ; P < 0.001), which was more pronounced in the most posterior part of the CC. There was a significant linear trend for reduced CC total area across the three clinical groups, with CHD Class-A cases showing more prominent changes (controls, 9.01 ± 1.44 vs CHD Class B, 8.18 ± 1.21 vs CHD Class A, 7.53 ± 1.33 mm2 ; P < 0.05). CONCLUSIONS: Fetuses with major CHD had a smaller CC compared with controls, and the difference was more marked in the CHD subgroup with expected poorer brain oxygenation. Sonographic CC size could be a clinically feasible marker of abnormal white matter development in CHD. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Q-switching bifurcation dynamics of passively mode-locked lasers.

We model Q-switched pulses in passively mode-locked lasers using the cubic-quintic complex Ginzburg-Landau equation (CGLE). We show that a wide set of parameters of this equation leads to Q-switched pulses of triangular shape that consist of a periodic sequence of evolving dissipative solitons. Bifurcation diagrams demonstrating various transformations of these pulses are calculated in terms of five major parameters of the CGLE. The diagrams show period doubling transformations as well as the transition to a chaotic evolution of the Q-switched pulses.

Concurrent Passive Mode-Locked and Self-Q-Switched Operation in Laser Systems.

Concurrent passive mode-locked and self-Q-switched operation of laser devices is modeled using the complex cubic-quintic Ginzburg-Landau equation. Experimental observations use a passively mode-locked fiber ring laser with a waveguide array as a fast saturable absorber. The shape of each individual self-Q-switched pulse and the periodic trains of pairs of such pulses are in a good qualitative agreement with the numerical results.

Diel patterns of microphytobenthic primary production in intertidal sediments: the role of photoperiod on the vertical migration circadian rhythm.

Diel primary production patterns of intertidal microphytobenthos (MPB) have been attributed to short-term physiological changes in the photosynthetic apparatus or to diel changes in the photoautotrophic biomass in the sediment photic layer due to vertical migration. Diel changes in primary production and vertical migration are entrained by external factors like photoperiod and tides. However, the role of photoperiod and tides has not been experimentally separated to date. Here, we performed laboratory experiments with sediment cores kept in immersion, in the absence of tides, with photoperiod or under continuous light. Measurements of net production, made with O2 microsensors, and of spectral reflectance at the sediment surface showed that, in intertidal sediments, the photoperiod signal was the major driver of the diel patterns of net primary production and sediment oxygen availability through the vertical migration of the MPB photoautotrophic biomass. Vertical migration was controlled by an endogenous circadian rhythm entrained by photoperiod in the absence of tides. The pattern progressively disappeared after 3 days in continuous light but was immediately reset by photoperiod. Even though a potential contribution of a subjective in situ tidal signal cannot be completely discarded, Fourier and cross spectral analysis of temporal patterns indicated that the photosynthetic circadian rhythm was mainly characterized by light/dark migratory cycles.

Dissipative solitons with extreme spikes in the normal and anomalous dispersion regimes.

Prigogine's ideas of systems far from equilibrium and self-organization (Prigogine & Lefever. 1968 J. Chem. Phys.48, 1695-1700 (doi:10.1063/1.1668896); Glansdorff & Prigogine. 1971 Thermodynamic theory of structures, stability and fluctuations New York, NY/London, UK: Wiley) deeply influenced physics, and soliton science in particular. These ideas allowed the notion of solitons to be extended from purely integrable cases to the concept of dissipative solitons. The latter are qualitatively different from the solitons in integrable and Hamiltonian systems. The variety in their forms is huge. In this paper, one recent example is considered-dissipative solitons with extreme spikes (DSESs). It was found that DSESs exist in large regions of the parameter space of the complex cubic-quintic Ginzburg-Landau equation. A continuous variation in any of its parameters results in a rich structure of bifurcations.This article is part of the theme issue 'Dissipative structures in matter out of equilibrium: from chemistry, photonics and biology (part 1)'.

Factors associated with poor functional outcome in bipolar disorder: sociodemographic, clinical, and neurocognitive variables.

OBJECTIVE: The current investigation aimed at studying the sociodemographic, clinical, and neuropsychological variables related to functional outcome in a sample of euthymic patients with bipolar disorder(BD) presenting moderate-severe levels of functional impairment. METHODS: Two-hundred and thirty-nine participants with BD disorders and with Functioning Assessment Short Test(FAST) scores equal or above 18 were administered a clinical and diagnostic interview, and the administration of mood measure scales and a comprehensive neuropsychological battery. Analyses involved preliminary Pearson bivariate correlations to identify sociodemographic and clinical variables associated with the FAST total score. Regarding neuropsychological variables, a principal component analysis (PCA) was performed to group the variables in orthogonal factors. Finally, a hierarchical multiple regression was run. RESULTS: The best fitting model for the variables associated with functioning was a linear combination of gender, age, estimated IQ, Hamilton Depression Rating Scale (HAM-D), number of previous manic episodes, Factor 1 and Factor 2 extracted from the PCA. The model, including all these previous variables, explained up to 29.4% of the observed variance. CONCLUSIONS: Male gender, older age, lower premorbid IQ, subdepressive symptoms, higher number of manic episodes, and lower performance in verbal memory, working memory, verbal fluency, and processing speed were associated with lower functioning in patients with BD.

Breather turbulence versus soliton turbulence: Rogue waves, probability density functions, and spectral features.

Turbulence in integrable systems exhibits a noticeable scientific advantage: it can be expressed in terms of the nonlinear modes of these systems. Whether the majority of the excitations in the system are breathers or solitons defines the properties of the turbulent state. In the two extreme cases we can call such states "breather turbulence" or "soliton turbulence." The number of rogue waves, the probability density functions of the chaotic wave fields, and their physical spectra are all specific for each of these two situations. Understanding these extreme cases also helps in studies of mixed turbulent states when the wave field contains both solitons and breathers, thus revealing intermediate characteristics.

Complementary optical rogue waves in parametric three-wave mixing.

We investigate the resonant interaction of two optical pulses of the same group velocity with a pump pulse of different velocity in a weakly dispersive quadratic medium and report on the complementary rogue wave dynamics which are unique to such a parametric three-wave mixing. Analytic rogue wave solutions up to the second order are explicitly presented and their robustness is confirmed by numerical simulations, in spite of the onset of modulation instability activated by quantum noise.

Integrable Turbulence and Rogue Waves: Breathers or Solitons?

Turbulence in dynamical systems is one of the most intriguing phenomena of modern science. Integrable systems offer the possibility to understand, to some extent, turbulence. Recent numerical and experimental data suggest that the probability of the appearance of rogue waves in a chaotic wave state in such systems increases when the initial state is a random function of sufficiently high amplitude. We provide explanations for this effect.

Functional remediation in bipolar disorder: 1-year follow-up of neurocognitive and functional outcome.

BACKGROUND: Few randomised clinical trials have examined the efficacy of an intervention aimed at improving psychosocial functioning in bipolar disorder. AIMS: To examine changes in psychosocial functioning in a group that has been enrolled in a functional remediation programme 1 year after baseline. METHOD: This was a multicentre, randomised, rater-masked clinical trial comparing three patient groups: functional remediation, psychoeducation and treatment as usual over 1-year follow-up. The primary outcome was change in psychosocial functioning measured by means of the Functioning Assessment Short Test (FAST). Group×time effects for overall psychosocial functioning were examined using repeated-measures ANOVA (trial registration NCT01370668). RESULTS: There was a significant group×time interaction for overall psychosocial functioning, favouring patients in the functional remediation group (F = 3.071, d.f. = 2, P = 0.049). CONCLUSIONS: Improvement in psychosocial functioning is maintained after 1-year follow-up in patients with bipolar disorder receiving functional remediation.

Effects of functional remediation on neurocognitively impaired bipolar patients: enhancement of verbal memory.

BACKGROUND: Functional remediation is a novel intervention with demonstrated efficacy at improving functional outcome in euthymic bipolar patients. However, in a previous trial no significant changes in neurocognitive measures were detected. The objective of the present analysis was to test the efficacy of this therapy in the enhancement of neuropsychological functions in a subgroup of neurocognitively impaired bipolar patients. METHOD: A total of 188 out of 239 DSM-IV euthymic bipolar patients performing below two standard deviations from the mean of normative data in any neurocognitive test were included in this subanalysis. Repeated-measures analyses of variance were conducted to assess the impact of the treatment arms [functional remediation, psychoeducation, or treatment as usual (TAU)] on participants' neurocognitive and functional outcomes in the subgroup of neurocognitively impaired patients. RESULTS: Patients receiving functional remediation (n = 56) showed an improvement on delayed free recall when compared with the TAU (n = 63) and psychoeducation (n = 69) groups as shown by the group × time interaction at 6-month follow-up [F 2,158 = 3.37, degrees of freedom (df) = 2, p = 0.037]. However, Tukey post-hoc analyses revealed that functional remediation was only superior when compared with TAU (p = 0.04), but not with psychoeducation (p = 0.10). Finally, the patients in the functional remediation group also benefited from the treatment in terms of functional outcome (F 2,158 = 4.26, df = 2, p = 0.016). CONCLUSIONS: Functional remediation is effective at improving verbal memory and psychosocial functioning in a sample of neurocognitively impaired bipolar patients at 6-month follow-up. Neurocognitive enhancement may be one of the active ingredients of this novel intervention, and, specifically, verbal memory appears to be the most sensitive function that improves with functional remediation.

Rogue waves of the Sasa-Satsuma equation in a chaotic wave field.

We study the properties of the chaotic wave fields generated in the frame of the Sasa-Satsuma equation (SSE). Modulation instability results in a chaotic pattern of small-scale filaments with a free parameter-the propagation constant k. The average velocity of the filaments is approximately given by the group velocity calculated from the dispersion relation for the plane-wave solution. Remarkably, our results reveal the reason for the skewed profile of the exact SSE rogue-wave solutions, which was one of their distinctive unexplained features. We have also calculated the probability density functions for various values of the propagation constant k, showing that probability of appearance of rogue waves depends on k.

Risk factors for suicide in schizophrenia: systematic review and clinical recommendations.

OBJECTIVE: To identify risk factors associated with suicide of patients with schizophrenia and provide clinical recommendations, which integrate research findings into a consensus based on clinical experience and evidence. METHOD: A task force formed of experts and clinicians iteratively developed consensus through serial revisions using the Delphi method. Initial survey items were based on systematic literature review published up to June 2013. RESULTS: Various risk factors were reported to be implicated in suicide in schizophrenia. Our findings indicate that suicide risk in schizophrenia is mainly related to affective symptoms, history of a suicide attempt and number of psychiatric admissions. Other risk factors identified are given by younger age, closeness to illness onset, older age at illness onset, male sex, substance abuse and period during or following psychiatric discharge. Integrating the evidence and the experience of the task force members, a consensus was reached on 14 clinical recommendations. CONCLUSION: Identification of risk factors for suicide in individuals diagnosed with schizophrenia is imperative to improve clinical management and develop strategies to reduce the incidence of suicide in this population. This study provides the critical overview of available data and clinical recommendations on recognition and management of the above-mentioned risk factors.

Dark- and bright-rogue-wave solutions for media with long-wave-short-wave resonance.

Exact explicit rogue-wave solutions of intricate structures are presented for the long-wave-short-wave resonance equation. These vector parametric solutions feature coupled dark- and bright-field counterparts of the Peregrine soliton. Numerical simulations show the robustness of dark and bright rogue waves in spite of the onset of modulational instability. Dark fields originate from the complex interplay between anomalous dispersion and the nonlinearity driven by the coupled long wave. This unusual mechanism, not available in scalar nonlinear wave equation models, can provide a route to the experimental realization of dark rogue waves in, for instance, negative index media or with capillary-gravity waves.

Dissipative shock waves in all-normal-dispersion mode-locked fiber lasers.

We propose an interpretation of the pronounced "M" spectral shape that is a recurrent feature in all-normal-dispersion mode-locked fiber laser dynamics. Our interpretation involves shock wave formation regularized by dissipation, modeled by a modified Burgers equation. The large fringes appearing at the edges of the spectrum result from discontinuities in the spectral phase.

Prenatal diagnosis of chromosomal abnormalities in fetuses with abnormal cardiac ultrasound findings: evaluation of chromosomal microarray-based analysis.

OBJECTIVES: To assess the frequency of karyotype abnormalities and chromosome 22q11.2 deletion syndrome among fetuses with abnormal cardiac ultrasound findings, and to evaluate the clinical value of chromosomal microarray-based analysis (CMA) in the study of such pregnancies. METHODS: First, we carried out retrospective analysis of karyotype abnormalities and 22q11.2 deletion syndrome cases diagnosed between January 2009 and December 2011 in our center among fetuses with abnormal cardiac ultrasound findings (n = 276). Second, CMA was performed in 51 of the fetuses with such findings, normal karyotype and negative or no 22q11.2 deletion syndrome study, and in the only fetus with a heart defect and an apparently balanced de novo chromosomal rearrangement. RESULTS: Out of the 276 pregnancies with abnormal cardiac ultrasound findings, karyotyping revealed a chromosomal abnormality in 44 (15.9%). Of fetuses with normal karyotype in which 22q11.2 deletion syndrome studies were performed, 6.4% (5/78) had this microdeletion syndrome. Among fetuses with abnormal cardiac findings, normal karyotype and negative or no 22q11.2 deletion syndrome study that underwent CMA, the detection rate of pathogenic copy number variants not detected by conventional cytogenetics was 2.0% (1/51), and no variants of uncertain clinical significance were found. In the fetus with a heart defect and an apparently balanced de novo chromosomal rearrangement, CMA revealed that the rearrangement was not truly balanced. CONCLUSIONS: In the assessment of genetic abnormalities in pregnancies with abnormal cardiac ultrasound findings, the diagnostic yield may be increased by 2% if CMA is used as a complementary tool to conventional cytogenetics. Our results suggest that CMA could be a good alternative to karyotyping in these pregnancies.

Dissipative rogue waves generated by chaotic pulse bunching in a mode-locked laser.

Rare events of extremely high optical intensity are experimentally recorded at the output of a mode-locked fiber laser that operates in a strongly dissipative regime of chaotic multiple-pulse generation. The probability distribution of these intensity fluctuations, which highly depend on the cavity parameters, features a long-tailed distribution. Recorded intensity fluctuations result from the ceaseless relative motion and nonlinear interaction of pulses within a temporally localized multisoliton phase.

Dissipative rogue waves: extreme pulses generated by passively mode-locked lasers.

We study numerically rogue waves in dissipative systems, taking as an example a unidirectional fiber laser in a nonstationary regime of operation. The choice of specific set of parameters allows the laser to generate a chaotic sequence of pulses with a random distribution of peak amplitudes. The probability density function for the intensity maxima has an elevated tail at higher intensities. We have found that the probability of producing extreme pulses in this setup is higher than in any other system considered so far.