Pain in the bipolar disorder: prevalence, characteristics and relationship with suicide risk / Dor no transtorno bipolar: prevalência, características e relação com risco de suicídio / Dolor en el trastorno bipolar: prevalencia, características y relación con el riesgo de suicidio

Objective: to know the prevalence and characteristics of pain, to verify how pain management has been carried out by the health services, and to correlate suicide risk with pain intensity in patients with bipolar disorder. Method: an observational study with a quantitative approach. The study included people with bipolar disorder assessed by the McGill-Reduced Pain Questionnaire, Body Diagram, Visual Numerical Scale, and the Suicidal Ideation Scale (Beck). Results: the sample of 60 participants was mainly composed of women with a mean age of 40 years old and a mean psychiatric treatment time of approximately 13 years. Of these, 83% reported feeling pain at the time of the interview. Half of the participants indicated that pain interferes with routine and 80% did not receive care in health institutions. The main descriptors that qualify the painful experience were as follows: painful, heavy and sensitive for the sensory descriptors, tiring and punishing in the affective category. Suicide attempt was reported by 57% of the participants. There was a correlation between suicide risk and pain intensity. Conclusion: pain presented a high prevalence. Suicide risk was identified in more than half of the participants. Pain intensity showed a significant correlation with suicide risk.

Objetivo: conhecer a prevalência e características da dor, verificar como o manejo da dor tem sido realizado pelos serviços de saúde e correlacionar o risco de suicídio com a intensidade da dor dos pacientes com transtorno bipolar. Método: estudo observacional com abordagem quantitativa. Participaram do estudo pessoas com transtorno bipolar avaliadas pelo Questionário de Dor McGill-reduzido, Diagrama Corporal, Escala Visual Numérica e a Escala de Ideação Suicida (Beck). Resultados: A amostra de 60 participantes foi composta principalmente por mulheres com idade média de 40 anos e tempo médio de tratamento psiquiátrico aproximado de 13 anos. Desses, 83% relataram sentir dor no momento da entrevista. Metade dos participantes indicou que a dor atrapalha a rotina e 80% não receberam cuidado nos equipamentos de saúde. Os principais descritores que qualificam a experiência dolorosa foram: dolorida, em peso e sensível para os descritores sensoriais, cansativo e castigante na categoria afetiva. A tentativa de suicídio foi relatada por 57% dos participantes. Foi observada correlação entre o risco de suicídio e a intensidade da dor. Conclusão: a dor apresentou prevalência elevada. O risco de suicídio foi identificado em mais da metade dos participantes. A intensidade da dor apresentou correlação significativa com o risco de suicídio.

Objetivo: conocer la prevalencia y las características del dolor, verificar cómo se ha realizado el manejo del dolor por parte de los servicios de salud y correlacionar el riesgo de suicidio con la intensidad del dolor en pacientes con trastorno bipolar. Método: se trata de un estudio observacional con abordaje cuantitativo. El estudio incluyó a personas con trastorno bipolar evaluadas mediante el Cuestionario de dolor de McGill - versión abreviada, el Diagrama Corporal, la Escala Visual Numérica y la Escala de Ideación Suicida (Beck). Resultados: la muestra de 60 participantes estuvo compuesta principalmente por mujeres con una edad promedio de 40 años y un tiempo promedio de tratamiento psiquiátrico de aproximadamente 13 años. El 83% de ellos manifestó sentir dolor en el momento de la entrevista. La mitad de los participantes indicó que el dolor interfiere en la rutina y el 80% no recibió atención en equipos de salud. Los principales descriptores que califican la experiencia dolorosa fueron: doloroso, pesadez y sensibilidad para los descriptores sensoriales, agotador y castigador en la categoría afectiva. El 57% de los participantes informó intento de suicidio. Se observó una correlación entre el riesgo de suicidio y la intensidad del dolor. Conclusión: el dolor tuvo una alta prevalencia. El riesgo de suicidio se identificó en más de la mitad de los participantes. La intensidad del dolor se correlacionó significativamente con el riesgo de suicidio.

Metacognição no transtorno bipolar: uma revisão sistemática / Metacognition in bipolar disorder: a systematic review

OBJETIVO: Realizar uma revisão sistemática investigando a metacognição no transtorno bipolar (TB). Os objetivos secundários incluem explorar os correlatos clínicos e sociodemográficos da metacognição no TB e como a metacognição varia de acordo com o estado afetivo, estabelecer uma comparação com outros transtornos mentais e investigar se as intervenções metacognitivas no TB são eficazes ou não. MÉTODOS: Realizou-se uma revisão sistemática da literatura científica sobre a metacognição em pacientes com TB. Foram buscados estudos clínicos originais sobre o tema nas bases de dados Medline, ISI, PsycINFO e SciELO. Os termos de busca empregados foram: "metacognition" OR "metacognitive" OR "metamemory" AND "bipolar" OR "mania" OR "manic". RESULTADOS: Foram selecionados nove artigos. A metacognição parece estar mais prejudicada no TB do que em controles e menos prejudicada do que na esquizofrenia. Por sua vez, parece não haver diferença entre bipolares e deprimidos unipolares quanto à capacidade metacognitiva. Maior nível educacional e maior duração da doença parecem estar associados a uma melhor capacidade metacognitiva, enquanto a maior gravidade dos sintomas de TB está associada a uma pior metacognição. O treinamento metacognitivo em pacientes com TB é uma perspectiva clínica promissora. CONCLUSÃO: Os estudos sobre metacognição no TB são escassos, mas a literatura existente indica possíveis fatores clínicos e sociodemográficos associados a pior metacognição no transtorno, sugerindo também que intervenções terapêuticas metacognitivas podem ser clinicamente relevantes para o manejo do TB.

OBJECTIVE: To perform a systematic review investigating metacognition in bipolar disorder (BD). Secondary objectives include exploring clinical and sociodemographic correlates of metacognition in BD, how metacognition varies according to affective state, establishing a comparison with other mental disorders, and investigating whether metacognitive interventions in BD are effective or not. METHODS: A systematic review of the scientific literature on metacognition in BD patients was carried out. Original clinical studies on the subject were searched in the Medline, ISI, PsycINFO and SciELO databases. The search terms included were: "metacognition" OR "metacognitive" OR "metamemory" AND "bipolar" OR "mania" OR "manic". RESULTS: A total of nine articles were selected. Metacognition appears to be more impaired in BD than in controls, but less impaired than in schizophrenia. There seems to be no difference between bipolar and unipolar depression regarding metacognitive capacity. Higher educational level and longer duration of illness seem to be associated with better metacognitive capacity, while higher severity of BD symptoms is linked to worse metacognition. Metacognitive training in BD patients is a promising clinical perspective. CONCLUSION: Studies on metacognition in BD are scarce, but the existing literature indicates potential clinical and sociodemographic factors associated with poorer metacognition in the disorder, also suggesting that metacognitive therapeutic interventions may be clinically relevant for the management of BD.

Trastorno Bipolar. Consideraciones clínicas y epidemiológicas / Bipolar disorder. Clinical and epidemiologic characteristics

RESUMEN El trastorno bipolar es un trastorno crónico y recurrente que se caracteriza por fluctuaciones patológicas del estado del ánimo. Las fases de la enfermedad incluyen episodios hipomaniacos, maniacos y depresivos. Estos episodios interfieren de forma significativa en la vida cotidiana del paciente y en su entorno, con importante repercusión en su salud y calidad de vida. Para los psiquiatras es de suma importancia el diagnóstico precoz de esta enfermedad para proporcionar un tratamiento oportuno a los pacientes, teniendo en cuenta la severidad de los síntomas y las complicaciones a las que lleva esta enfermedad. Ante esta realidad se decidió describir las características generales de este desorden mediante una revisión bibliográfica donde se exponen sus principales manifestaciones clínicas, clasificación, aspectos epidemiológicos, curso de la enfermedad, complicaciones y comorbilidad. Para ello se realizó una revisión de los trabajos más relevantes publicados y con ello contribuir al proceso de educación médica continuada para los profesionales de la salud.

ABSTRACT Bipolar disorder is a chronic and recurrent disorder characterized by pathological fluctuations of the mood states. The stages of the disease include hypomanic, maniac and depressive episodes. These episodes interfere in a significant way in the patient´s daily life and his surroundings, with an important repercussion on his health and life quality. For the psychiatrists, the precocious diagnosis of this disease is very important, in order to provide a timely treatment to patients, taking into account the severity of the symptoms and the complications of this disease. Due to this reality, the authors decided to describe the general characteristics of this disorder through a bibliographic review where they exposed the main clinical manifestations, classification, epidemiological aspects, the course of the disease, complications and co-morbidity. The most relevant published works were reviewed to contribute to the process of continued medical education of the health professionals.

Viraje de fase maníaca a catatonía por noxa somática aguda / Manic phase shift to catatonia by acute somatic noxa

El síndrome catatónico como entidad neuropsiquiátrica ha sufrido cambios conceptuales a través de la historia, incluyendo tanto la clínica de su presentación como sus posibles causas. Éste último elemento cobra especial importancia, dado que la catatonía puede presentarse tanto por diversos cuadros médicos así como por patología psiquiátrica primaria. Se presenta el caso clínico de una paciente con antecedente de trastorno afectivo bipolar ingresada por un episodio maníaco con síntomas psicóticos asociados a un evento vital estresante. La paciente, durante una infección respiratoria baja, cambia su presentación clínica, objetivándose elementos propios de un estupor depresivo y síndrome catatónico. Una vez tratado el cuadro infeccioso y descartadas las causas neurológicas de la catatonía, se realizó tratamiento con benzodiacepinas, iniciándose luego fármacos para depresión bipolar, obteniéndose excelente respuesta clínica. Se pretende en este reporte dar a conocer la importancia de detectar elementos catatoniformes en pacientes psiquiátricos ingresados en unidades de corta estadía, así como buscar siempre posibles causas médicas relacionadas.

The catatonic syndrome as a neuropsychiatric entity has undergone conceptual changes throughout history, including both the clinical presentation and its possible causes. This last element is particularly important, given that catatonia can occur both in different medical situations as well as in primary psychiatric pathology. We present the clinical case of a patient with a history of bipolar affective disorder, hospitalized because of a manic episode with psychotic symptoms associated with a stressful life event. The patient, during a low respiratory infection, changes its clinical presentation, with elements of a depressive stupor and catatonic syndrome. Once the infectious symptoms were treated and the neurological causes of catatonia were ruled out, treatment with benzodiazepines was carried out, and then drugs for bipolar depression were started, obtaining an excellent clinical response. The aim of this report is to make known the importance of detecting catatoniform elements in psychiatric patients admitted to short-stay units, as well as to look for possible related medical causes.

Early trauma, attachment experiences and comorbidities in schizophrenia / Relação entre traumas precoces, experiências de apego e comorbidades na esquizofrenia

Abstract Objective To evaluate attachment patterns in subjects with schizophrenia and their relationships to early traumatic events, psychotic symptoms and comorbidities. Methods Twenty patients diagnosed with schizophrenia according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) underwent retrospective symptom assessment and careful assessment of the number and manner of childhood caregiver changes. The Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD) was used to assess symptoms related to schizophrenia (positive and negative symptoms), depression and mania. Anxiety disorder comorbidities were assessed by the Liebowitz Social Anxiety Scale (LSAS), Yale-Brown Obsessions and Compulsions Scale (Y-BOCS) and Panic and Schizophrenia Interview (PaSI). Experience in Close Relationships - Relationship Structures (ECR-RS) and Early Trauma Inventory Self Report-Short Form (ETISR-SF) were used to assess attachment patterns and traumatic history, respectively. Results Moderate and significant correlations between attachment patterns and early trauma showed that greater severity of anxious attachment was predicted by a higher frequency of total early traumas (Spearman ρ = 0.446, p = 0.04), mainly general traumas (ρ = 0.526, p = 0.017; including parental illness and separation, as well as natural disaster and serious accidents). Among the correlations between early trauma and comorbid symptoms, panic attacks occurring before the onset of schizophrenia showed significant and positive correlations with ETISR-SF total scores and the sexual trauma subscale. Conclusion Children with an unstable early emotional life are more vulnerable to the development of psychopathology, such as panic anxiety symptoms. Traumatic events may also predict later schizophrenia.

Resumo Objetivos Avaliar o padrão de apego em portadores de esquizofrenia e discutir a relação que tais padrões apresentam com a sintomatologia psicótica e as comorbidades dos pacientes investigados. Métodos Vinte pacientes diagnosticados com esquizofrenia de acordo com os critérios do Manual Diagnóstico e Estatístico de Transtornos Mentais, 5ª edição (DSM-5) foram submetidos a avaliação de sintomas retrospectivos e avaliação cuidadosa do número e modo de mudança de cuidador da infância. A Entrevista Diagnóstica para Psicoses e Transtornos Afetivos (DI-PAD) foi utilizada para avaliar sintomas relacionados à esquizofrenia (sintomas positivos e negativos), depressão e mania. As comorbidades de transtorno de ansiedade foram avaliadas pela Escala de Ansiedade Social de Liebowitz (LSAS), Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS) e Entrevista de Pânico e Esquizofrenia (PaSI). Os instrumentos Questionário das Experiências nas Relações Próximas-Estruturas Relacionais (ECR-RS) e Inventário de Autorrelato de Trauma Precoce - Forma Curta (ETISR-SF) foram utilizados para avaliar padrões de apego e histórico traumático, respectivamente. Resultados Foram identificadas correlações significativas entre a ocorrência de traumas precoces e o apego do tipo ansioso. Também foi verificada a relação entre traumas gerais e sintomas de pânico, constatando-se que as crises de pânico antecipam surtos quando predominam sintomas ansiosos, somáticos, alucinações e ideias delirantes. Foi observado que a ocorrência de traumas precoces contribui para o pânico, elevando o risco de episódios psicóticos. Conclusão . Os resultados indicam que as adversidades ambientais na infância estão associadas com o risco de desenvolvimento de esquizofrenia e de outras psicoses mais tarde na vida.

Cardiovascular risk and bipolar disorder: factors associated with a positive coronary calcium score in patients with bipolar disorder type 1

Objective: Cardiovascular disease is the leading cause of death in patients with bipolar disorder. The aim of this study was to evaluate the factors associated with positive coronary calcium score (CCS) in individuals with bipolar disorder type 1. Methods: Patients from the Bipolar Disorder Program at Hospital de Clínicas de Porto Alegre, Brazil, underwent computed tomography scanning for calcium score measurement. Clinical and sociodemographic variables were compared between patients according to their CCS status: negative (CCS = 0) or positive (CCS > 0). Poisson regression analysis was used to examine the association of CCS with number of psychiatric hospitalizations. Results: Out of 41 patients evaluated, only 10 had a positive CCS. Individuals in the CCS-positive group were older (55.2±4.2 vs. 43.1±10.0 years; p = 0.001) and had more psychiatric hospitalizations (4.7±3.0 vs. 2.6±2.5; p = 0.04) when compared with CCS- negative subjects. The number of previous psychiatric hospitalizations correlated positively with CCS (p < 0.001). Conclusion: Age and number of psychiatric hospitalizations were significantly associated with higher CCS, which might be a potential method for diagnosis and stratification of cardiovascular disease in bipolar patients. There is a need for increased awareness of risk assessment in this population.

Validity and reliability of the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) in Brazilian bipolar patients / Validade e fidedignidade da Escala de Disfunções Cognitivas no Transtorno Bipolar (COBRA) em pacientes bipolares brasileiros

Abstract Introduction: In Brazil, there is no valid instrument to measure subjective cognitive dysfunction in bipolar disorder. The present study analyzed the psychometric properties of the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) in Brazilian bipolar patients. We further investigated the relationship between the COBRA, objective cognitive measures, and illness course variables. Methods: The total sample (N=150) included 85 bipolar disorder patients and 65 healthy controls. The psychometric properties of the COBRA (e.g., internal consistency, concurrent validity, discriminative validity, factor analyses, ROC curve, and feasibility) were analyzed. Results: The COBRA showed a one-factor structure with very high internal consistency (Cronbach's alpha=0.890). Concurrent validity was indicated by a strong correlation with the cognitive domain of the FAST (r=0.811, p<0.001). Bipolar patients experienced greater cognitive complaints (mean=14.69; standard deviation [SD]=10.03) than healthy controls (mean=6.78; SD=5.49; p<0.001), suggesting discriminative validity of the instrument. No significant correlations were found between the COBRA and objective cognitive measures. Furthermore, higher COBRA scores were associated with residual depressive (r=0.448; p<0.001) and manic (r=0.376; p<0.001) symptoms, number of depressive episodes (r=0.306; p=0.011), number of total episodes (r=0.256; p=0.038), and suicide attempts (r=0.356; p=0.003). Conclusion: The COBRA is a valid instrument to assess cognitive complaints, and the combined use of subjective-objective cognitive measures enables the correct identification of cognitive dysfunctions in bipolar disorder.

Resumo Introdução: No Brasil, não existem instrumentos válidos para medir a disfunção cognitiva subjetiva no transtorno bipolar. O presente estudo analisou as propriedades psicométricas da Escala de Disfunções Cognitivas no Transtorno Bipolar (COBRA) em uma amostra brasileira de pacientes bipolares. Adicionalmente, investigamos a relação entre a COBRA, medidas cognitivas objetivas e curso da doença. Métodos: A amostra total (n=150) incluiu 85 pacientes com transtorno bipolar e 65 controles saudáveis. As propriedades psicométricas da COBRA (consistência interna, validade concorrente, validade discriminativa, análise fatorial, curva ROC e fidedignidade) foram analisadas. Resultados: A COBRA apresentou estrutura de um fator com alta consistência interna (alfa de Cronbach=0,890). A validade concorrente ficou demonstrada pela forte correlação com o domínio cognitivo da FAST (r=0,811, p<0,001). Pacientes bipolares tiveram mais queixas cognitivas [média=14,69; desvio padrão (DP)=10,03] que os controles (média=6,78; DP=5,49; p<0,001), sugerindo a validade discriminativa do instrumento. Não houve correlação significativa entre a COBRA e medidas cognitivas objetivas. Além disso, escores mais altos na COBRA estiveram associados com sintomas residuais depressivos (r=0,448; p<0,001) e maníacos (r=0,376; p<0,001), número de episódios depressivos (r=0,306; p=0,011), número de episódios totais (r=0.256; p=0.038) e tentativas de suicídio (r=0,356; p=0,003). Conclusão: A COBRA é um instrumento válido para avaliar queixas cognitivas, e o uso combinado das medidas cognitivas subjetivas-objetivas possibilita a correta identificação das disfunções cognitivas no transtorno bipolar.

Clinical and familial profile of bipolar disorder with and without obsessive-compulsive disorder: an Indian study / Perfil clínico e familiar do transtorno bipolar com e sem transtorno obsessivo-compulsivo: estudo indiano

Abstract Introduction Comorbid obsessive-compulsive disorder (OCD) is common in bipolar disorder (BD). Clinical characteristics, functionality and familial pattern of this comorbidity are largely understudied. Objective To assess clinical profile, familial loading of psychiatric disorders and level of functioning in remitted BD patients who have comorbid OCD and to compare results with those of remitted BD patients without OCD. Methods Remitted BD-I subjects were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders, Global Assessment of Functioning Scale (GAF), Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Family Interview for Genetic Studies (FIGS). BD patients with and without OCD were compared. Group differences were analyzed using the chi-square test and the independent samples t test. Values <0.05 were considered statistically significant. Results Of the 90 remitted BD-I patients, 35.5% (n=32) had obsessive-compulsive symptoms/OCD. The BD-OCD group showed significantly lower GAF scores, higher rates of suicidal attempts, hospitalizations, manic and depressive episodes compared to the group with BD only (p<0.05). In addition, first and second-degree relatives had higher rates of BD-OCD and OCD, but not of BD. Conclusions BD-OCD is characterized by more severe BD, more dysfunction and higher familial loading of BD-OCD and OCD. Larger studies involving relatives of probands will help to confirm our findings and to delineate nosological status of BD-OCD comorbidity.

Resumo Introdução Transtorno obsessivo-compulsivo (TOC) comórbido é comum no transtorno bipolar (TB). Características clínicas, funcionalidade e história familiar dessa comorbidade são pouco estudadas. Objetivo Avaliar o perfil clínico, a carga familiar de transtornos psiquiátricos e o nível de funcionalidade em pacientes com TB em remissão que apresentam TOC comórbido e comparar os resultados com aqueles obtidos em pacientes com TB em remissão sem TOC. Métodos Indivíduos com TB-I em remissão foram avaliados usando a Entrevista Clínica Estruturada para o DSM-IV- Transtornos do Eixo I, Escala de Avaliação Global do Funcionamento, Escala de Depressão de Hamilton, Escala de Mania de Young, Escala Obsessivo-Compulsiva de Yale-Brown e Entrevista Familiar para Estudos Genéticos. Pacientes com TB com e sem TOC foram comparados. Diferenças entre os grupos foram analisadas usando o teste do qui-quadrado e o teste t para amostras independentes. Valores <0,05 foram considerados estatisticamente significativos. Resultados Dos 90 pacientes com TB-I em remissão, 35,5% (n=32) tinham sintomas obsessivo-compulsivos/TOC. O grupo com TB-TOC mostrou escores significativamente mais baixos na Escala de Avaliação Global do Funcionamento, maiores taxas de tentativas de suicídio, hospitalizações, episódios maníacos e depressivos quando comparado ao grupo com apenas TB (p<0,05). Além disso, familiares de primeiro e segundo grau mostraram maiores níveis de TB-TOC e TOC, mas não de TB. Conclusões TB-TOC se caracteriza por TB de maior gravidade, mais disfunção e maior carga familiar de TB-TOC e TOC. Estudos maiores envolvendo familiares de probandos ajudarão a confirmar nossos achados e a delinear o status nosológico de TB-TOC comórbidos.

Complicaciones endocrinológicas de psicofármacos en psiquiatría infantil / Endocrinological complications of psychoactive drugs in childhood psychiatry

El uso de psicofármacos en el ejercicio de la psiquiatría infantil es cada vez mayor en los últimos años. Su correcto uso requiere que el psiquiatra desarrolle a partir del diagnóstico, un tratamiento que incluya una monitorización adecuada en el caso de uso de psicofármacos, ya que esto nos permitirá tener los mejores resultados con menores efectos adversos, como también la mejor adhesión al tratamiento que se haya propuesto (1). En esta revisión encontraremos varios fármacos de uso común en el ejercicio de la profesión, asociado a efectos adversos endocrinológicos que se han descrito en la literatura, seguido de recomendaciones de manejo y seguimiento.

The use of psychotropic drugs in child psychiatry has increased in recent years. Its correct use requires that the psychiatrist develops from starting point of a diagnosis, a treatment that includes an appropriate monitoring of the use of psychotropic drug, since this will allow the patient to have the best results with fewest adverse effects, as well as the better adherence to the treatment (1). In this review we will discuss several drugs commonly used in the practice of the profession, associated with adverse endocrine effects that have been described in the literature, followed by recommendations for management and monitoring.

Neural correlates of hallucinations in bipolar disorder

Objective: Approximately one-half of all patients affected by bipolar disorder present with psychotic features on at least one occasion. Several studies have found that alterations in the activity of mesolimbic and prefrontal regions are related to aberrant salience in psychotic patients. The aim of the present study was to investigate the structural correlates of a history of hallucinations in a sample of euthymic patients with bipolar I disorder (BD-I). Methods: The sample consisted of 21 euthymic patients with BD-I and no comorbid axis I DSM-IV-TR disorders. Voxel based morphometry (VBM) was used to compare patients with and without a lifetime history of hallucinations. Preprocessing was performed using the Diffeomorphic Anatomical Registration through Exponentiated Lie Algebra (DARTEL) algorithm for VBM in SPM8. Images were processed using optimized VBM. Results: The main finding of the present study was a reduction in gray matter volume in the right posterior insular cortex of patients with BD-I and a lifetime history of hallucinations, as compared to subjects with the same diagnosis but no history of hallucinations. Conclusions: This finding supports the presence of abnormalities in the salience network in BD patients with a lifetime history of hallucinations. These alterations may be associated with an aberrant assignment of salience to the elements of one’s own experience, which could result in psychotic symptoms.

Aspectos epidemiológicos, clínicos e microbiológicos da associação entre o transtorno afetivo bipolar e periodontite / Epidemiological, clinical and microbiological aspects of the association between bipolar affective disorder and periodontitis

As doenças periodontais reúnem um grupo de doenças infecciosas, que resultam da interação entre os biofilmes, supra e subgengival, e a resposta imuno-inflamatória gerada pelo hospedeiro. Diversos fatores e variáveis de risco podem interferir e modular a relação entre o desafio microbiano e a resposta do hospedeiro. O transtorno afetivo bipolar (TABP) é uma síndrome psiquiátrica clássica, caracterizada por períodos oscilatórios entre os estados mentais de normalidade e equilíbrio (eutmia), estado de ânimo anormalmente baixo (depressão) e estado anormalmente alto (mania). Embora pouco investigado e com dados conflitantes, o transtorno afetivo bipolar (TABP) é um fator comportamental associado à doença periodontal. Adicionalmente, pouco se conhece sobre a sua interferência na resposta microbiana, e imunológica, frente à periodontite. Este estudo objetivou determinar as condições periodontais, perfil epidemiológico e microbiológico entre indivíduos com TABP. Especificamente objetivou-se: a) determinar a prevalência de periodontite em uma população com diagnóstico de TABP; b) verificar a influência de variáveis de risco na associação entre o TABP e periodontite; c) determinar a frequência de periodontopatógenos do complexo vermelho (Treponema denticola, Tannerella forsythia e Porphyromonas gingivalis), da espécie Aggregatibacter actinomycetemcomitans e a carga total bacteriana, em indivíduos com TABP com periodontite. O estudo foi composto por uma amostra de conveniência de 156 indivíduos com TABP, selecionados no Hospital de Saúde Mental, anexo ao Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG). Os indivíduos foram avaliados através de parâmetros clínicos periodontais, variáveis de risco sociais/demográficas e coleta microbiológica, analisada por meio de qPCR (Reação em Cadeia da Polimerase em Tempo Real). Os resultados demostraram uma prevalência de 59% de periodontite entre os indivíduos com TABP. Destes, 90,2% apresentavam periodontite crônica moderada e 9,8% a forma avançada. Quanto à extensão de periodontite, em 81,5% a doença apresentou-se na forma localizada e em 18,5% na generalizada. Observou-se uma forte associação significativa entre periodontite e uso de drogas ilícitas, onde não usuários apresentaram 56,8% de periodontite e usuários 100% de periodontite. A fase de depressão, nos indivíduos com TABP, foi fortemente associada à ocorrência de periodontite (p<0.001). Os indivíduos com TABP e periodontite tiveram uma contagem das bactérias do complexo vermelho, 7 da espécie Aggregatibacter actinomycetemcomitans e carga total bacteriana significativamente maior do que os sem periodontite. Adicionalmente, foi verificado que o grupo de indivíduos com periodontite avançada, e generalizada, apresentou contagens microbianas significativamente superiores, quando comparado com o grupo de indivíduos com periodontite moderada e localizada, em relação às bactérias do complexo vermelho em conjunto, e quando analisadas individualmente. O modelo multivariado final de regressão logística revelou que a probabilidade de um indivíduo ter periodontite foi maior na fase de depressão (OR = 28,94; 95% IC = 4,44 - 177,27; p<0.001), em relação aos indivíduos na fase de mania e na presença de maior contagem de carga total bacteriana (OR = 1,91; 95% IC = 1,00 - 1,99; p<0.01). Concluiu-se que indivíduos com TABP apresentaram uma alta prevalência de periodontite e esta foi significativamente associada a maiores contagens dos periodontopatógenos estudados, confirmando a importância da prevenção, diagnóstico e tratamento desta doença, e sinalizando que a periodontite pode ser considerada como mais uma comorbidade associada a esta doença psiquiátrica

Periodontal diseases comprise a group of infectious diseases, resulting from the interaction between the supra and subgingival biofilms and immuno-inflammatory response generated by the host. Several risk factors and variables may interfere and modulate the relation between microbial challenge and the host response. Bipolar affective disorder (BAD) is a classic psychiatric syndrome characterized by oscillatory periods between mental states of normality and balance (euthymia), abnormally low mood (depression) and abnormally high state (mania). Although little investigated and with conflicting data, bipolar affective disorder is a behavioral factor associated to the periodontal disease. In addition, little is known about its interference with the microbial response and immunological, to periodontitis. This study aimed to determine the periodontal conditions, epidemiological and microbiological profile of individuals with BAD. Specifically it aimed to: a) determine the prevalence of periodontitis in a population diagnosed with BAD; b) check the influence of risk variables on the association between BAD and periodontitis; c) determine the frequency of periodontopathogens of the red complex (Treponema denticola, Tannerella forsythia and Porphyromonas gingivalis), the Aggregatibacter actinomycetemcomitans species and the total bacterial load in individuals with BAD with periodontitis. The study consisted of a convenience sample of 156 individuals with BAD selected in the Mental Health Hospital, attached to the Hospital of the Federal University of Minas Gerais (HC-UFMG). Subjects were assessed through clinical periodontal parameters, social risk variables / demographic and microbiological collection, analyzed by qPCR (Reaction Polymerase Chain in Real Time). The results showed a prevalence of 59% of periodontitis among individuals with BAD. Of these, 90.2% had moderate chronic periodontitis and 9.8% the advanced one. As to the extent of periodontitis, in 81.5% the disease presented itself as localized and 18.5% as general. It was observed a strong significant association between periodontitis and the use of illicit drugs, in which nonusers showed 56.8% of periodontitis and users 100% of periodontitis. The phase of depression in individuals with BAD, was strongly associated with the occurrence of periodontitis (p <0.001). Individuals with BAD and periodontitis had a bacteria count of the red complex, Aggregatibacter actinomycetemcomitans species and total bacterial load, significantly higher than those without periodontitis. Additionally, it was found that the group of individuals with advanced and generalized periodontitis presented significantly higher microbial counts compared to the group of individuals with moderate and localized periodontitis in relation to the bacteria of the red complex together and when analyzed individually. The final multivariate logistic regression model showed that the probability of an individual having periodontitis was higher in depression phases (OR = 28,94, 95% CI = 4,44-177,27; p<0.001) compared to individuals in 9 mania stage and in the presence of higher total bacterial load count (OR = 1,91; 95% CI = 1,00 - 1,99; p<0.01). It was concluded that individuals with BAD showed a high prevalence of periodontitis and this was significantly associated with higher scores of studied periodontal periodontopathogens, confirming the importance of prevention, diagnosis and treatment of this disease, and signaling that periodontitis can be considered as an additional comorbidity associated to this psychiatric disorder

Specific alterations in plasma proteins during depressed, manic, and euthymic states of bipolar disorder

Bipolar disorder (BD) is a common psychiatric mood disorder affecting more than 1-2% of the general population of different European countries. Unfortunately, there is no objective laboratory-based test to aid BD diagnosis or monitor its progression, and little is known about the molecular basis of BD. Here, we performed a comparative proteomic study to identify differentially expressed plasma proteins in various BD mood states (depressed BD, manic BD, and euthymic BD) relative to healthy controls. A total of 10 euthymic BD, 20 depressed BD, 15 manic BD, and 20 demographically matched healthy control subjects were recruited. Seven high-abundance proteins were immunodepleted in plasma samples from the 4 experimental groups, which were then subjected to proteome-wide expression profiling by two-dimensional electrophoresis and matrix-assisted laser desorption/ionization-time-of-flight/time-of-flight tandem mass spectrometry. Proteomic results were validated by immunoblotting and bioinformatically analyzed using MetaCore. From a total of 32 proteins identified with 1.5-fold changes in expression compared with healthy controls, 16 proteins were perturbed in BD independent of mood state, while 16 proteins were specifically associated with particular BD mood states. Two mood-independent differential proteins, apolipoprotein (Apo) A1 and Apo L1, suggest that BD pathophysiology may be associated with early perturbations in lipid metabolism. Moreover, down-regulation of one mood-dependent protein, carbonic anhydrase 1 (CA-1), suggests it may be involved in the pathophysiology of depressive episodes in BD. Thus, BD pathophysiology may be associated with early perturbations in lipid metabolism that are independent of mood state, while CA-1 may be involved in the pathophysiology of depressive episodes.

Where does her mood come from? An organic approach to a once functional patient / De onde vem seu humor? Uma abordagem orgânica para um paciente previamente funcional

Objective: To report the rare development of manic symptoms in a patient with schizophrenia and discuss its differential diagnosis. Case description: Diagnostic criteria were based on the International Classification of Diseases, 10th edition (ICD-10). A 63-year-old female (diagnosed with schizophrenia since she was 28) was brought to the emergency room with symptoms consistent with manic episode and physical examination suggestive of thyrotoxicosis. Graves' disease was confirmed by subsequent laboratory tests. She was treated successfully with radioiodine ablation, leading to full remission of manic symptoms. Comments: Schizophrenia is a chronic disease that affects about 1% of the population worldwide. The main symptoms of the disorder are altered affection, delusions, and hallucinations. Graves' disease is an autoimmune condition in which antibodies increase the production and release of thyroid hormones. There are reports about the development of mood symptoms in patients with Graves' disease that remit with adequate treatment. .

Objetivo: Relatar um caso raro de desenvolvimento de sintomas maníacos em uma paciente com esquizofrenia e discutir o diagnóstico diferencial desses sintomas. Descrição do caso: Foram utilizados como base os critérios diagnósticos da Classificação Internacional de Doenças, 10ª edição (CID-10). Paciente de 63 anos do sexo feminino e com diagnóstico de esquizofrenia desde os 28 anos foi levada a emergência com sintomas compatíveis com episódio de mania e exame físico sugestivo de tireotoxicose. Doença de Graves foi confirmada por exames subsequentes. A paciente foi tratada com sucesso com ablação por iodo radioativo, levando à remissão dos sintomas maníacos. Comentários: A esquizofrenia é uma doença crônica que afeta cerca de 1% da população mundial. Os principais sintomas do transtorno são o embotamento afetivo, alucinações e delírios. A doença de Graves é uma doença autoimune em que o estímulo humoral aumenta a produção e liberação de hormônios pela tireoide. Há relatos na literatura sobre o desenvolvimento de sintomas maníacos em pacientes com doença de Graves, os quais remitem mediante tratamento adequado. .

Validación de la escala para cribar alteración cognitiva en psiquiatría (SCIP-S) en pacientes con trastorno bipolar / Validation of the Cognitive Impairment in Psychiatry (SCIP-S) Screen Scale in Patients with Bipolar Disorder I

Introducción: La versión española de la escala para cribar alteración cognitiva en psiquiatría se ha desarrollado en respuesta a las necesidades que se presentan en la práctica clínica durante la evaluación de pacientes con enfermedad mental, pero no se conoce cómo es su comportamiento en la población colombiana con trastorno bipolar I. El presente trabajo busca establecer la validez de constructo y la estabilidad de la escala en pacientes con trastorno bipolar I de la ciudad de Manizales. Métodos: Se estimó la validez de constructo comparando la medición en dos grupos divergentes, grupo control y grupo con trastorno bipolar I; se comparó con una batería neuropsicológica que medía los mismos dominios de la escala; se evaluó la correlación entre cada una de las subpruebas de la escala y la estabilidad a través de la confiabilidad test-retest en el grupo con trastorno bipolar I. Resultados: La escala mostró capacidad discriminatoria del funcionamiento cognitivo entre el grupo control y el grupo con trastorno bipolar I. La correlación con la batería neuropsicológica se estimó por medio de la prueba de Spearman, que mostró resultados entre 0,36 y 0,77, y la correlación entre las subpruebas de la escala mostró correlaciones entre 0,39 y 0,72. La prueba test-retest se midió con el coeficiente de correlación intraclase y su valores fueron entre 0,77 y 0,91. Conclusiones: La versión española de la escala para criba de alteración cognitiva en psiquiatría muestra validez y confiabilidad aceptables como instrumento de medición en la practica clínica psiquiátrica.

Background: The Spanish version of the cognitive impairment in psychiatry scale screening scale has been developed as a response to the needs arising in clinical practice during the evaluation of mental illness patients, but the performance is not known in the Colombian population with bipolar disorder I. This paper tries to establish construct validity and stability of the scale in patients with bipolar disorder I in the city of Manizales. Methods: Construct validity was estimated by comparing the measurement in two divergent groups, a control group and a group with bipolar disorder I. It was also compared to a Neuropsychological battery measuring the same scale domains. The correlation between each one of the sub-tests of the scale and stability was evaluated through the reliability test-retest in the group with bipolar disorder I. Results: The scale showed discriminatory capacity in cognitive functioning between the control group and the group with bipolar disorder I. The correlation with the neuropsycho logical battery was estimated by the Spearman test showing results between 0.36 and 0.77, and the correlation between each sub-test of the scale showed correlations between 0.39 and 0.72. Test-retest was measured with the intraclass correlation coefficient (ICC) and their values were between 0.77 and 0.91. Conclusions: The Spanish version of screening scale in the cognitive disorder in psychiatry shows acceptable validity and reliability as a measurement tool in clinical psychiatric practice.

Riesgo de trastorno bipolar en estudiantes universitarios con sintomatología depresiva elevada / [Risk of bipolar disorder of universitary students with high depressive symptomatology].

INTRODUCTION: This research aims to determine if there is a relation between high depressive symptoms and the risk of suffering from bipolar disorder in university students, as well as describing demographic variables and career preferences association with these variables. METHODS: A self-survey was carried out with 823 students who were asked to fill out the Beck Depression Inventory and the Bipolar Spectrum Disorder Scale. RESULTS: 12.7

of the population showed symptoms related to clinical depression while 1.9

presented either moderated or high bipolar disorder risk. The 22.4

of those who suffered from clinical depression showed high and moderated bipolar disorder risk. The 43.8

of those who showed high probability of suffering from bipolar disorder risk received psychopharmacological treatment and 87.5

of them were studying an artistic career. CONCLUSION: The percentage of college students at high risk of bipolar disorder is similar to what have been found in the international literature. In people with high levels of depression symptomatology the risk increases being one in four of them at risk for bipolar disorder.

Cardiovascular risk factors in outpatients with bipolar disorder: a report from the Brazilian Research Network in Bipolar Disorder

Objective: Bipolar disorder (BD) is associated with significant morbidity and mortality due to comorbid general medical conditions, particularly cardiovascular disease. This study is the first report of the Brazilian Research Network in Bipolar Disorder (BRN-BD) that aims to evaluate the prevalence and clinical correlates of cardiovascular risk factors among Brazilian patients with BD. Methods: A cross-sectional study of 159 patients with DSM-IV BD, 18 years or older, consecutively recruited from the Bipolar Research Program (PROMAN) in São Paulo and the Bipolar Disorder Program (PROTAHBI) in Porto Alegre. Clinical, demographic, anthropometric, and metabolic variables were systematically assessed. Results: High rates of smoking (27%), physical inactivity (64.9%), alcohol use disorders (20.8%), elevated fasting glucose (26.4%), diabetes (13.2%), hypertension (38.4%), hypertriglyceridemia (25.8%), low HDL-cholesterol (27.7%), general (38.4%) and abdominal obesity (59.1%) were found in the sample. Male patients were more likely to have alcohol use disorders, diabetes, and hypertriglyceridemia, whereas female patients showed higher prevalence of abdominal obesity. Variables such as medication use pattern, alcohol use disorder, and physical activity were associated with selected cardiovascular risk factors in the multivariable analysis. Conclusion: This report of the BRN-BD provides new data regarding prevalence rates and associated cardiovascular risk factors in Brazilian outpatients with BD. There is a need for increasing both awareness and recognition about metabolic and cardiovascular diseases in this patient population. .