A Cross Sectional Study on Sexual Dysfunction and Quality of Life in Patients with Bipolar Affective Disorder

Introduction: Sexual dysfunction is one of the leading causes of psychological distress in bipolar affective disorder patients. The current study aims to study the relationship between sexual dysfunction and quality of life in patients with Bipolar affective disorder in remission. Materials and methods: A cross-sectional study of purposively sampled bipolar patients in remission (N=60) was conducted in an OPD setting. After reinforcing confidentiality and privacy, data was collected and analyzed. Results: 73% with BD reported impaired sexual function. About 51.7% and 48.3% of male and female participants, respectively, had at least one form of sexual dysfunction. Better sexual function was associated with a higher degree of satisfaction with sexual life and higher QoL score. Conclusion: Sexual dysfunction is associated impaired quality of life, poor functioning and poor medication adherence. Hence, it should be made a routine practice to evaluate and address the problem of sexual dysfunction in patients with Bipolar affective disorder.

A cross-sectional comparative study of functioning in patients with bipolar depression and patients with unipolar depression

Background: Bipolar affective disorder is an episodic illness in which patient suffers from unexpected change in affect like elated mood episode (mania) followed by either depressed mood with period of inter episode euthymia. The disease in comparison to unipolar depression starts in early thirties, more severe symptoms and with more detriment in functioning and wellbeing. Aim and Objectives: The present study asses the level of global functioning of bipolar depressive patients in different domains and data compared with unipolar depressive patients. Materials and Methods: This study was done at a tertiary center in India. The study included 30 patients with bipolar depression in study group and 30 patients with unipolar depression included in control group. In all the patients of both groups, relevant scales, that is, back depression inventory and global assessment of functioning (GAF) were applied. These data were statistically analyzed by SPSS software. Results: On Comparison of global assessment of functioning scores between both groups the GAF score in bipolar depressive patients (SD ± 50.03 [4.75]) had significantly lower score as compared to unipolar depressive patients (62.37 [SD ± 11.50]), also patients show significant negative correlation. (?0.559) of GAF score and total Beck Depression Inventory score in case group (bipolar depressive patients). Conclusion: These findings of greater impairment in global functioning may be interpreted by understanding that life of patients with bipolar depression also complicated by having episode or episodes of manic symptoms in addition to their depressive episodes while patients with unipolar depression are experiencing depressive episodes only.

Resonancia magnética nuclear funcional en estado de reposo en pacientes con trastorno bipolar: más allá de la eutimia / Resting-state functional nuclear magnetic resonance imaging in patients with bipolar disorder: beyond euthymia

Resumen Introducción: La resonancia magnética funcional en estado de reposo (RMf-ER) permite identificar redes de conectividad funcional completas y los posibles correlatos neuronales de trastornos psiquiátricos. Se revisa la literatura sobre RMf-ER y trastorno bipolar (TB) haciendo énfasis en los hallazgos en las fases de manía, hipomanía y depresión. Métodos: Es una revisión narrativa de la literatura en la que se buscaron artículos en PubMed y EMBASE con las palabras clave en inglés "bipolar disorder" AND "resting state", sin límite en la fecha de publicación. Resultados: Los estudios de pacientes con TB en fases de manía e hipomanía sometidos a RMf-ER muestran resultados concordantes en cuanto a la disminución de la conectividad funcional cerebral entre la amígdala y algunas regiones corticales, lo cual indica que esta conexión funcional tendría alguna implicación en la regulación normal del afecto. Los pacientes en fase depresiva muestran disminución en la conectividad funcional cerebral, pero como son varias las estructuras anatómicas implicadas y las redes neuronales reportadas en los estudios, no es posible compararlos. Conclusiones: Hay disminución en la conectividad funcional en los pacientes con TB, pero la evidencia actual no permite establecer cambios específicos en redes de conectividad funcional cerebral puntuales. Sin embargo, ya hay algunos hallazgos que muestran correlación con la clínica de los pacientes.

ABSTRACT Introduction: imaging in the resting state (R-fMRI) Functional nuclear magnetic allows the identification of complete functional connectivity networks and the possible resonance neuronal correlations of psychiatric disorders. The literature on R-fMRI and bipolar disorder (BD) will be reviewed, emphasising the findings in the phases of mania, hypomania and depression. Methods: It is a narrative review of the literature in which articles were searched in PubMed and Embase, with the key words in English "bipolar disorder" AND "resting state", without limit on the date of publication. Results: The studies of BD patients in the mania and hypomania phases who underwent R-fMRI show concordant results in terms of decreased functional cerebral connectivity between the amygdala and some cortical regions, which indicates that this functional connection would have some implication in the normal affect regulation. Patients in the depressive phase show a decrease in functional brain connectivity, but as there are seve-ral anatomical structures involved and neural networks reported in the studies, it is not possible to compare them. Conclusions: There is a decrease in functional connectivity in patients with BD, but current evidence does not allow establishing specific changes in specific functional brain connectivity networks. However, there are already some findings that show correlation with the patients' symptoms.

Clinical and demographic profile of patients treated with electro convulsive therapy from a tertiary care psychiatry hospital in North India

Background: Electro-convulsive therapy (ECT) refers to the electrical stimulation of the brain to produce seizures for therapeutic purpose. This study was undertaken with the aim of exploring the clinical and demographic profile of patients treated with ECT from a tertiary care psychiatry hospital in north India.Methods: It was a retrospective descriptive study of patients who were treated with ECT after admission in the inpatient psychiatry unit of Institute of mental health and neurosciences Kashmir during a period of one year (March 2017 to February 2018).Results: A total of 70 patients received ECT during the course of one year. About 72.85% of the patients belonged to 20-39 years age group. Female patients constituted more than half of the subjects (55.71%). Review of diagnostic profile showed that majority of patients receiving ECT were suffering from Schizophrenia (35.71%), followed by bipolar affective disorder (28.57%), depressive disorder (28.57%), schizoaffective disorder (4.28%) and substance induced mood/psychotic disorders (2.85%). A significant majority of subjects (57.13%) received about 7-9 ECT sessions. No any major complications were noted during ECT treatment.Conclusions: This study suggests that ECT, use as a treatment modality is common in adults between 20 to 39 years of age and females with Schizophrenia being the most common indications.

Exploring the role of therapeutic drug monitoring and regular supervision in optimizing quality of life in patients of bipolar affective disorder receiving lithium therapy in a tertiary care teaching hospital: a prospective observational study

Background: Lithium is considered first line drug effective in treating manic and mixed episodes of bipolar affective disorders throughout the globe. But the chronic and heterogenous nature of disease, along with toxicity of lithium often make patients non-adherent to medication as well as diminished health related quality of life. Present study was done to find out the prospect of regular supervision and follow up with therapeutic drug monitoring in optimization of lithium therapy based on health-related quality of life outcomes.Methods: It was a prospective, non-randomized, observational study of a cohort of subjects who are suffering from bipolar affective disorders and on lithium therapy. Patients were regularly followed up with therapeutic drug monitoring and personalized interview with questionnaires like WHO Quality of Life Score (QOL-Bref), Montgomery-Asberg Depression Scale (MADRS) and Medication Adherence Rating Scale (MARS).Results: Results revealed there was significant improvement in health-related quality of life of patients who were monitored with therapeutic drug monitoring and prescribed lithium therapy.Conclusions: Hence to maintain patients’ quality of life improved throughout the cycle of bipolar disorder spectrum, regular follow-up visits with monitoring of serum levels of lithium is needed, so that adverse effects would be minimal and adherence to medication become optimal. These optimal dosing resulting in optimal benefit to patients can be achieved with the involvement of clinical pharmacological consultation.

Irritabilidad como síntoma transdiagnóstico / Irritability as a transdiagnostic Symptom

Resumen. La irritabilidad es un síntoma transdiagnóstico que atraviesa la barrera de las patologías internalizantes y externalizantes. Se define como un umbral bajo para experimentar la ira en respuesta a la frustración y es uno de los síntomas más comunes en niños y adolescentes. Las conductas relacionadas con la ira apropiadas para el desarrollo tienden a reflejar frustración en contextos esperados, mientras que la irritabilidad crónica es inapropiada para la situación. La presentación de la irritabilidad, crónica o episódica, es crucial para comprender su significado psicopatológico, en particular porque las estructuras de la irritabilidad episódica y crónica son separables y permanecen estables a lo largo del tiempo. Existen varios estudios acerca de la irritabilidad en patologías como trastorno afectivo bipolar y trastorno de desregulación disruptiva del estado del ánimo, en ambos casos es importante plantearse como punto de partida la identificación de la episodicidad. La irritabilidad también se encuentra presente en el trastorno de personalidad límite observándose dentro de una inestabilidad afectiva debida a una reactividad notable del estado de ánimo. Estas emociones tienen un correlato anatómico relacionado con deficiencias de los circuitos frontolímbicos. Para el manejo de la irritabilidad en las distintas patologías, la evidencia del tratamiento incluye terapia cognitivo conductual, intervención de los padres, mindfulness, pero existe una necesidad apremiante de investigación sobre el tratamiento farmacológico complementario.

Irritability is a transdiagnostic symptom that crosses the barrier between internalizing and externalizing pathologies. It is defined as a low threshold to experience anger in response to frustration and it is one of the most common symptoms in children and adolescents. Behaviors related to appropriate developmental anger tend to reflect frustration in expected contexts, while chronic irritability is inappropriate to the situation. The presentation of irritability, chronic or episodic, is crucial to understanding its psychopathological meaning, particularly because the structures of episodic and chronic irritability are separable and remain stable over time. There are several studies about irritability in pathologies such as bipolar affective disorder and disruptive mood dysregulation disorder, in both cases it is important to consider the identification of episodicity as a starting point. Irritability is also present in borderline personality disorder, where it is expressed as an affective instability due to a remarkable reactivity of the state of mind. These emotions have been anatomically related to deficiencies of the frontolimbic circuits. For the management of irritability in different patholo-gies, the evidence includes cognitive behavioral therapy, parental intervention, mindfulness, but there still is a pressing need for research on complementary pharmacological treatment.

Increased levels of plasma IL-1b and BDNF can predict resistant depression patients

SUMMARY BACKGROUND: There is no strong evidence on the link between inflammatory profile and pattern of drug treatment response in depressive patients that could result in Coronary Artery Disease occurrence. OBJECTIVE: This study aimed to compare the subclinical atherosclerosis markers, inflammatory profile, and BDNF production in Resistant Depression (RD) or Bipolar Affective Disorder (BAD) patients under conventional treatment. METHODS: The population evaluated was comprised of 34 RD, 43 BAD, and 41 controls. Subclinical atherosclerosis markers were evaluated using ultrasonography, tomography, and exercise stress test. Plasma concentrations of TNFα, IL-1β, IL-6, and BDNF were measured using Luminex100™. The usCRP concentration was measured using turbidimetric immunoassay. IL1B, IL6, and TNFA expression were determined using TaqMan®. For the statistical analysis, the significance level was established at p<0.05. RESULTS: Concerning subclinical atherosclerosis markers, only O2 consumption was reduced in the BAD group (p = 0.001). Although no differences were found in gene expression, BDNF and IL-1β plasma concentration was increased in the RD group (p = 0.002 and p = 0.005, respectively) even with an antidepressant treatment, which suggests that these drugs have no effect in IL-1β secretion and that the inflammasome may play a role in therapy response. CONCLUSION: Taken together, both BDNF and IL-1β plasma concentrations could be used to the early identification of RD patients.

RESUMO FUNDAMENTAÇÃO: Não há fortes evidências sobre a associação entre o perfil inflamatório e o padrão de resposta ao tratamento medicamentoso em pacientes depressivos que podem resultar em ocorrência de doença coronariana. OBJETIVO: O objetivo deste estudo foi comparar os marcadores de aterosclerose subclínica, o perfil inflamatório e a produção de BDNF em pacientes com Depressão Resistente (DR) ou Transtorno Afetivo Bipolar (BAD) sob tratamento convencional. MÉTODOS: A população avaliada incluiu 34 RD, 43 BAD e 41 controles. Os marcadores de aterosclerose subclínica foram avaliados por ultrassonografia, tomografia e teste de esforço. As concentrações plasmáticas de TNFα, IL-1β, IL-6 e BDNF foram medidas utilizando Luminex100TM. A concentração de usCRP foi medida por imunoensaio turbidimétrico. A expressão de IL1B, IL6 e TNFA foi determinada usando TaqMan®. Para as análises estatísticas, foi estabelecido o nível de significância de p < 0,05. RESULTADOS: Quanto aos marcadores de aterosclerose subclínica, apenas o consumo de O2 foi reduzido no grupo BAD (p = 0,001). Embora não tenham sido encontradas diferenças na expressão gênica, a concentração plasmática de BDNF e IL-1β foi aumentada no grupo RD (p = 0,002 e p = 0,005, respectivamente) mesmo sob tratamento antidepressivo, o que sugere que esses medicamentos não têm efeito na secreção de IL-1β e que o inflamassomo pode desempenhar um papel na resposta terapêutica. CONCLUSÃO: Juntas, as concentrações BDNF e IL-1β poderiam ser usadas para a identificação precoce de pacientes com DR.

Avaliação da eficácia da psicoeducação domiciliar individual em relação à psicoeducação em grupo para pacientes com transtorno afetivo bipolar / Evaluation of effectiveness of individual psychoeducation household compared to the psychoeducation group therapy for patients with bipolar affective disorder

Introdução: Vários ensaios clínicos têm demonstrado a alta eficácia de programas para a prevenção de recaídas com base na psicoeducação, estando esta intervenção psicossocial entre as mais amplamente estudadas. Trata-se de uma intervenção bastante útil para o sistema de saúde público brasileiro, considerando sua curta duração, baixo custo e fácil execução por profissionais de saúde. Evidências indicam o formato de grupo com boa aplicabilidade, porém há uma carência de estudos que comprovem a eficácia da psicoeducação em visitas domiciliares. Objetivo: Avaliar a eficácia da Psicoeducação Domiciliar na recuperação sintomática, funcional e na adesão ao tratamento de indivíduos com TAB de médio e longo prazo, em comparação com a Psicoeducação Grupal. Metodologia: Estudo follow up, randomizado, controlado, com 45 pacientes portadores de TAB tipo I ou II, de acordo com os critérios do DSM-V TR; com pontuação <=17 na Escala de Depressão de Hamilton (HAM-D) e <=15 na Escala de Mania de Young (YOUNG). A distribuição dos sujeitos em três grupos foi feita por meio de randomização estratificada. O grupo de Intervenção Domiciliar (ID), composto por 15 pacientes, recebeu, além do tratamento farmacológico, visitas domiciliares com intervenção psicoeducacional. O grupo de Intervenção em Grupo (IG), composto por 15 pacientes, recebeu, além do tratamento farmacológico, abordagem psicoeducacional em formato de grupo realizada no serviço de saúde mental. O Grupo Controle (GC), composto por 15 pacientes, recebeu apenas o tratamento farmacológico padrão, sem intervenção psicoeducacional. Os instrumentos de avaliação utilizados foram a escala de HAM-D para sintomas de depressão, e YOUNG para sintomas de mania. A escala para avaliar a recuperação funcional foi a WHOQOL-brief. Para avaliação de níveis de estresse percebido, foi utilizada a Escala de Estresse Percebido (EEP). Além disso, utilizou-se, para avaliar a adesão medicamentosa, a Escala de Medida de Adesão ao Tratamento (MAT) e avaliação dos níveis plasmáticos de medicamentos. Resultados: Ao final do estudo, o grupo de intervenção domiciliar apresentou melhores taxas de adesão medicamentosa, quando comparado aos outros grupos do estudo (p=0,02). O efeito da psicoeducação, na ID e na IG, com relação à diminuição das taxas de recaídas, foi altamente notável no seguimento de 12 meses quando comparados ao GC (p=0,03 e p=0,02 respectivamente). ID e IG apresentaram elevação dos escores de qualidade de vida com significância estatística, enquanto o GC apresentou queda significativa dos escores do início do estudo e após 12 meses de seguimento. Conclusão: A Psicoeducação Domiciliar apresentou-se mais eficaz na adesão medicamentosa que a Psicoeducação Grupal e o tratamento usual. Ainda, o presente estudo evidenciou que a Psicoeducação em seu formato domiciliar individual e em seu formato de grupo, realizado no serviço de saúde mental, apresenta eficácia na prevenção de recaídas e recorrências, na melhora da qualidade de vida e na melhora da adesão medicamentosa em pacientes com TAB, em comparação com o Grupo Controle

Introduction: Several clinical trials have demonstrated the high effectiveness of psychoeducation-based programs designed to prevent relapse, this being the psychosocial intervention more widely studied. This is a very useful intervention for the Brazilian public health system, considering its short duration, low cost and easy execution by health professionals. Signs indicate that the group format has good applicability, however there is a lack of studies that prove the effectiveness of psychoeducation in home visits. Aim: To evaluate the effectiveness of Domiciliary Psychoeducation in symptomatic, functional recovery, and adherence to the treatment of individuals with Bipolar Affective Disorder in medium and long term, compared to psychoeducation group therapy performed in the mental health service. Methodology: This is a randomized, controlled, follow up study, with 45 patients with bipolar I or II, according to the DSM-V TR; with score <=17 on the Hamilton Depression Scale (HAMD) and <=15 on the Young Mania Scale (YOUNG). The distribution of patients in three groups was made by using of stratified randomization. The Domiciliary Intervention group (DI), consisting of 15 patients who received in addition to pharmacological treatment, home visits with psychoeducational intervention. The Intervention Group (IG), composed of 15 patients who received in addition to the pharmacological treatment, a psychoeducational approach in a group format, performed in mental health service. The Control Group (CG), composed of 15 patients who received only standard pharmacological treatment, without psychoeducational intervention. The assessment instruments used were the HAM-D scale for depression symptoms, and the YOUNG scale for mania symptoms. The WHOQOL-Brief scale was used to assess functional recovery. Perceived Stress Scale (PSS) was used to measure perceived stress levels. To evaluate drug adherence, the Treatment Adherence Instrument (MAT) was used as measure the evaluation of plasma levels of medications. Results: At the end of the study, the DI had better rates of drug adherence when compared to the other study groups (p = 0.02). The effect of psychoeducation on DI and IG in relation to decreased relapse rates was highly evident at 12 months follow up, when compared to CG (p = 0.03 and p = 0.02, respectively). The DI and IG presented an increase in quality of life scores with statistical significance, while the CG showed an expressive decrease in the scores at the beginning of the study and after 12 months of follow-up. Conclusion: The Domiciliary Psychoeducation was more effective in drug adherence than group psychoeducation and treatment as usual. Furthermore, the present study showed that Psychoeducation in its individual domiciliary format and in its group format, carried out in mental health service, presents effectiveness in prevention of relapses and recurrences, as well as in the improvement of quality of life and in the improvement of medication adherence in patients with bipolar affective disorder, when compared to the Control Group

Síndromes psicóticos / Psychotic syndromes: clinical case summary

Paciente de 47 años, casada, con 3 hijos. Antecedentes de patología psiquiátrica en madre y hermano. Sin antecedentes psiquiátricos previos. Ingresa hace 4 años al Servicio. Con síntomas polimorfos, varios diagnósticos desde el ingreso, pero con respuesta al tratamiento y con periodos de estabilidad psicopatológica demás de un año. Conocida en varios dispositivos del servicio. Diagnósticos: Trastorno Delirante, Obs. Trastorno Afectivo Bipolar, Trastorno Esquizoafectivo

Patient 47 years old, married, with 3 children. History of psychiatric pathology in mother and brother. No previous psychiatric history. Enter the Service 4 years ago. With polymorphic symptoms, several diagnoses from admission, but with response to treatment and with periods of psychopathological stability over a year. Known in several service devices. Diagnoses: Delusional Disorder, Obs. Bipolar Affective Disorder, Schizoaffective Disorder

Enfermedad de Darier white: Reporte de caso y relación con enfermedades neuropsiquiátricas / Darier white disease: Case report and relationship with neuropsychiatric diseases

La enfermedad de Darier White es una enfermedad autosómica dominante, de penetrancia completa con expresividad variable que afecta al cromosoma 12q23-24.1. Se caracteriza por manifestaciones dermatológicas como: placas o pápulas no foliculares en zonas seborreicas, que tienen un olor característico. La presente investigación busca presentar reportes de casos de dos pacientes, en un Hospital Universitario en Bogotá-Colombia y la relación que existe con enfermedades psiquiátricas, tales como: trastorno afectivo bipolar y retraso mental. Se realizó una historia clínica y examen físico completo. Posteriormente, se firmó un consentimiento informado para toma de fotos y uso de las mismas, con fines educativos. Con estos elementos, se buscó información en las bases de datos más requeridas hoy en día, como: Pubmed, Science Direct, Embase y Scielo utilizando búsquedas con palabras claves, relacionando enfermedad de Darier White y enfermedades psiquiátricas en general. Consecutivamente, se buscó información de trastorno afectivo bipolar y retraso mental. En definitiva se enfocó cada uno de los casos descritos, como enfermedad de Darier con la asociación clínica de enfermedades psiquiátricas, en relación con el trastorno afectivo bipolar y retraso mental, con los que esta enfermedad muestra una relación estrecha.

Darier White or dyskeratosis follicularis disease is a genetic disorder of autosomal dominant trait, affecting chromosome 12q23-24.1. It starts at first or second decade of life, it is characterized by cutaneous manifestations due to several hyperkeratotic papules that affect seborrheic areas such as head, neck and thorax. This article seeks to present reports of cases of two patients in a Hospital in Bogotá-Colombia and their relationship with psychiatric illnesses such as bipolar affective disorder and mental retardation. A complete clinical history was made, the patients were examined, and informed consent was signed for taking pictures and using them for educational purposes. With this information, we proceeded to look for bibliography in the most recognized databases such as: Pubmed, Science Direct, Embase using advanced searches with key words, related words like Darier White disease and its relationship with psychiatric illnesses in general. Finally, each of the cases described as Darier's disease was approached with the clinical association of psychiatric illnesses such as bipolar affective disorder and mental retardation, with which this disease shows a close relationship in relation to the percentages of presentation.

Depressão e transtorno afetivo bipolar ­ existe associação com a periodontite? / Depression and bipolar affective disorder ­ is there an association with periodontitis? - literature review

Estudos epidemiológicos sugerem que a depressão pode alterar a instalação e a progressão da doença periodontal. O processo inflamatório, induzido pela depressão e o biofilme dentário, podem atuar sinergicamente estimulando uma intensa resposta do sistema imunológico, influenciando a progressão das doenças periodontais. O objetivo do presente trabalho é revisar a literatura em relação aos principais trabalhos que investigaram a possível correlação entre a depressão e a doença periodontal. Concluiu-se que a maioria dos estudos publicados até o momento sugerem que a depressão pode alterar significativamente a resposta do hospedeiro, tanto no nível comportamental quanto imunológico. Em relação ao transtorno afetivo bipolar e a periodontite, a maioria dos estudos publicados, até o momento, não apresentam estratégias metodológicas que avaliem corretamente a possível associação entre a doença periodontal e o transtorno bipolar especificamente. São necessários maiores estudos com metodologias que envolvam as características epidemiológicas, microbiológicas e imunológicas dessa possível associação, propiciando um melhor entendimento da doença.

Epidemiological studies suggest that depression can after the onset and progression of periodontal disease. The inflammatory process induced depression and biofilm can synergistically stimulate an intense immune response influencing the progression of periodontal diseases. The aim of this paper is to review the literature on the main studies that investigated the possible correlation between depression and periodontal disease. It was concluded that most studies published suggests that depression can significantly alter the host response at both the behavioral and immune aspects. In relation to bipolar affective disorder and periodontitis, most of the studies published do not present methodological strategies that correctly evaluate the possible association between periodontal disease and bipolar disorder specifically. More studies are needed with methodologies that involve the epidemiological, microbiological and immunological characteristics of this possible association, providing a better understanding of for a possible association.

Management of recurrent Aphthous Stomatitis major in a bipolar affective disorder patient with food allergy

@#This is the case of a 35-year-old female diagnosed by medical and psychiatric examinations as suffering from bipolar affective disorder and food allergy. Evident characteristic included mood swings. Her main complaint was extensive painful ulcer on the palate and lower lip. Current condition had caused her weight loss. Management included anamnesis, clinical and laboratory examinations, psychometrics, and referral to a psychiatrist. The dentist played an important role in identifying recurrent aphthous stomatitis and in the optimal and comprehensive treatment of the patient through multidisciplinary assessment.

Paraoxonase (PON1) L55M and Q192R polymorphisms in major depression and bipolar affective disorder

Abstract Background Oxidative and nitrosative stress pathways, along with immune-inflammatory response, might play an important role in the pathogenic mechanisms underlying major depression and bipolar disorder. Objective The aim of the present study is to investigate paraoxonase 1 polymorphisms and its correlations with disease parameters in patients with major depression and bipolar affective disorder. Methods PON1 L55M and Q192R single nucleotide polymorphisms were analyzed in a group consisted of 100 patients with major depression, and 100 patients with bipolar affective disorder and 96 healthy controls. Polymorphisms were analyzed by using polymerase chain reaction. Results Our findings reported no association between Q192R and L55M polymorphisms of PON1 and major depression and bipolar disorder. Additionally, there was no association between the PON1 genotypes and disease variables in both depressed and bipolar patients. Discussion Evaluating the different stages of patients with affective disorders and and investigating the connection between PON1 polymorphisms and treatment outcomes will help us to clarify the relationship between PON1 and mood disorders.

Efficacy of Sodium Valproate and Olanzapine in treating bipolar affective disorder 'mania' at a tertiary care hospital in Nepal: A comparative study

Background and Objectives: Bipolar affective disorder, mania is the mood of an abnormally elevated arousal energy level or a state of heightened overall activation with enhanced affective expression together with lability of affect. The objective of the study was to compare the efficacy of sodium valproate and olanzapine in bipolar affective disorder, mania patients at a tertiary care hospital in NepalMaterial and Methods: A randomized observational prospective open label study was conducted for one and half year at College of Medical Sciences-Teaching Hospital (CMS-TH), Bharatpur, Nepal in the Psychiatry Department. Sixty patients diagnosed with bipolar affective disorder, mania were enrolled. 30 patients received sodium valproate and 30 patients received olanzapine. Patients were monitored and evaluated on baseline (day 0), day 7 and day 30 and compared to the baseline for the severity of illness using the 11-item Young Mania Rating Scale (YMRS).Results: The mean baseline YMRS score for all cases on sodium valproate (n=30) on day 0 was 38.87 ± 3.73, while it was reduced to 13.90 ± 1.95 (p < 0.001) on day 30. Similarly, the mean baseline YMRS score for all cases on olanzapine (n=30) on day 0was 40.83 ± 6.50, while it was reduced to 14.47 ± 2.83 (p < 0.001) on day 30.The mean decrease in YMRS score by sodium valproate was 64.24% and by olanzapine was 64.56%.Conclusion: Treatment with sodium valproate and olanzapine significantly improves the mean mania ratings score and there is no statistically significant difference in efficacy of both the drugs in patients diagnosed with bipolar affective disorder, mania.

Simple markers for subclinical inflammation in the different phases of bipolar affective disorder

Abstract Background: Recently, a growing number of publications have suggested that the immune-inflammatory system may be involved in the etiology of bipolar disorder (BD). Objective: The aim of this study was to investigate neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red cell distribution width (RDW) in the three different phases of BD patients compared to each other and controls. Methods: One hundred eighty-seven bipolar patients (78 euthymic, 53 manic/hypomanic and 56 depressed), and 62 age and sex matched controls were enrolled. Sociodemographic variables and complete blood count parameters of the patients and the control group were recorded. Results: The groups did not differ from each other on the hematological parameters, except for NLR and RDW. Post-hoc analyses revealed that NLR values were significantly higher in the euthymic and manic/hypomanic bipolar groups compared to control group. In addition, post-hoc analyses revealed that RDW values were significantly higher in the manic/hypomanic bipolar group relative to the control group. Discussion: Longitudinal studies evaluating the levels of inflammatory markers in the early phases of the disorder, and their relationship with the development of different episodes and medical comorbidities may be useful to understand the role of inflammation in BD.

Psicofarmacología del suicidio II parte: Estabilizadores del ánimo y suicidio / Mood stabilizers and suicide: Part II

Lithium and anticonvulsants have been widely used as mood stabilizers (MS) in bipolar affective disorder (BAD), showing a reduction of suicide risk, even more, the anti-suicidal effect of lithium would be independent of its stabilizer property. The action mechanisms of the drug are not completely known and clinical research is hampered due to the heterogeneity of the studied samples, however, some mechanisms related to neurotransmitters metabolism and neurotrophic and neuroprotective factors have been proposed in order to explain its effect. Despite the current decline in the use of lithium as a MS it remains as the anti-suicidal drug of choice in bipolar patients.

El litio y los anticonvulsivantes han sido ampliamente empleados como estabilizadores del ánimo (EA) en el trastorno afectivo bipolar (TAB), demostrando además una reducción del riesgo de suicidio. En el caso particular del litio, dicho efecto sería independiente de su acción estabilizadora. Si bien los mecanismos de acción de la droga no son completamente conocidos y la investigación clínica se ve dificultada debido a la heterogeneidad de las muestras estudiadas, se han propuesto distintas vías que explicarían su efecto, relacionadas con el metabolismo de los neurotransmisores y con factores neurotróficos y neuroprotectores. Pese a la disminución actual en el uso del litio como EA, continúa siendo el fármaco antisuicida de elección en pacientes bipolares.

Oral rehabilitation in a patient with bipolar affective disorder: clinical case report

Objective: This study, through a literature review, aimed to present the key aspects found in Bipolar Affective Disorder (BAD), as well as present a case report of a patient who received dental care in the Discipline of Dentistry for Patients with Special Needs of PUCPR. Case report:Female patient, 30 years of age, leukoderma, diagnosed by medical and psychological exams as suffering from BAD and slight mental retardation. The most evident characteristics inherent to the primary illness included swings in mood and affection as well as bipolar or manic depressions. The special school where she studied and worked referred her to receive dental care in the Discipline of Dentistry for Patients with Special Needs of PUCPR. Her main complaint was the lack of upper front teeth and the esthetic. The treatment plan included adequacy of oral environment through basic periodontal therapy and production of removable partial dentures. Conclusion: People with BAD requires extra care with regard to behavioral management.

A patient with a long history of relapsing psychosis and mania presenting with anti-NMDA receptor encephalitis ten years after first episode / Paciente com longo curso de psicose e mania recorrentes apresentando encefalite antirreceptor NMDA dez anos após o primeiro episódio

Anti-N-methyl- D-aspartate receptor (NMDAR) encephalitis is a recently discovered autoimmune disorder, in which antibodies target NMDARs in the brain, leading to their removal from synapses. Early in the disease course, patients often present with marked psychosis and mood disturbances (i.e. mania, depression), explaining why most of these patients are first seen by psychiatrists. Hence, autoimmune encephalitis is receiving growing attention from psychiatry, mainly owing to concerns over misdiagnosing immunomediated and potentially curable disorders as primary psychiatric disorders, such as schizophrenia or major depressive disorder. Although anti-NMDAR encephalitis occurs in the context of new-onset psychiatric symptoms, there is a lack of information on differential diagnosis and treatment of this disorder after a long-term diagnostic history of functional psychiatric disorders. We report a case of a patient with a long history of bipolar affective disorder evolving with anti-NMDAR encephalitis, initially misdiagnosed as non-organic psychosis.

A encefalite antirreceptor N-metil-D-aspartato (NMDA) é uma doença autoimmune recentemente descoberta, na qual anticorpos têm como alvo os receptors NMDA no cérebro, levando à sua remoção da sinapse. Os pacientes frequentemente desenvolvem psicose e distúrbios de humor proeminentes nas fases iniciais da doença (i.e: mania e depressão), o que explica o fato de que a maioria destes pacientes seja vista primeiramente por psiquiatras. Consequentemente, as encefalites autoimunes têm recebido atenção crescente pela psiquiatria, principalmente pela preocupação de erroneamente diagnosticar doenças imunomediadas e potencialmente tratáveis como doenças psiquiátricas primárias, como esquizofrenia ou transtorno depressivo maior. Embora a encefalite antirreceptor NMDA ocorra no contexto de sintomas psiquiátricos de início recente, há carência de informações sobre o diagnóstico diferencial e tratamento desta doença após o diagnóstico de doenças psiquiátricas funcionais de longa data. Aqui, nós apresentamos o caso de uma paciente com diagnóstico de transtorno afetivo bipolar de longa data evoluindo com encefalite antirreceptor NMDA, inicialmente diagnosticada erroneamente como uma psicose não-orgânica.

Occurrences of thrombocytopenia with valproic acid used for psychiatric indication.

Background: The main aim of this study is to find out the effect of valproic acid on platelet count and to know the possible risk factors for thrombocytopenia in patients taking valproate (VPA). Methods: On 72 patients having psychiatric indication, a longitudinal observational study was designed and conducted from February 2012 to July 2013 at Department of Psychiatry (out-patient department) of Pt. Jawahar Lal Nehru Memorial Medical College and Dr. Bhim Rao Ambedkar Memorial Hospital, Jail Road, Raipur, Chhattisgarh. Platelet count was monitored and determined using an automatic coulter analyzer. The patients were followed up to 6 months. Statistical tool standard deviation ± was used for statistical analysis. p<0.05 is considered as statistically significant. Results: Total percentage of thrombocytopenia was found to be 12.5%; among that males constitute 9.8% and females 19.04%. The maximum number of cases falls in the age group between 51 and 60 years (55.5%). The major diagnostic group was reported to be consisted of mania (40.4%), followed by resistant cases of schizophrenia (25%) and then bipolar affective disorder (23.6%). The study indicated that maximum patients suffered from mild thrombocytopenia (11.1%) and (1.4%) patients have moderate thrombocytopenia. The mean time from exposure to VPA therapy to the first episode of thrombocytopenia was reported 92 days. Conclusions: Our findings underlined the importance of monitoring platelet counts in patients treated with VPA. This monitoring should be continued indefinitely on monthly basis. The studies indicate that the demands of more vigilant monitoring of patients should occur in age of 50-60 years, and result of entire studies indicates that females were found to be subjected to incidences of thrombocytopenia especially.

Correlation of serum lithium levels and thyroid function tests in subjects of bipolar affective disorder: a prospective hospital-based study.

Background: Lithium is used in the prophylaxis of long-term therapy of bipolar affective disorder (BPAD) as a mood-stabilizing agent. Thyroid function abnormality is very commonly seen adverse effect, more common in females than males. This study aimed to correlate lithium levels and thyroid function abnormalities associated with it. Methods: Evaluation of medical records of 150 patients in Father Muller Medical College with BPAD, who were treated for 6 months with lithium, carried out from February, 12 2014 to July, 20 2014. Serum lithium levels done by ion selective electrode method in ilyte analyzer and thyroid function test (TFT) by electrochemiluminescence. Data are analyzed by Karl Pearson correlation coeffi cient. Results: Correlation of lithium levels and TFT in BPAD patients according to Karl Pearson correlation coeffi cient was negative with signifi cant p<0.002. Among 150 enrolled candidates, 52 (34.67%) were females and 98 (65.4%) were males, 4% (6) patients (3 males and 3 females) had thyroid stimulating hormone (TSH) value <0.27 with an average lithium value of 1.35 mEq/L, 6% (9) patients (5 males and 4 females) had TSH value >4.2 with an average lithium levels of 0.44 mEq/L and 90% of the patients with an average lithium levels 0.66 mEq/L had no thyroid function abnormalities. Conclusions: As already known, Lithium is a drug of narrow therapeutic index and females are more prone for thyroid function abnormalities. Appropriate monitoring of serum lithium levels will aid in necessary dose adjustment and ensure proper utilization of drug.