Longitudinal hair cortisol in bipolar disorder and a mechanism based on HPA dynamics.

Bipolar disorder (BD) is marked by fluctuating mood states over months to years, often with elevated cortisol levels. Elevated cortisol can also trigger mood episodes. Here, we combine longitudinal hair cortisol and mood measurements with mathematical modeling to provide a potential mechanistic link between cortisol and mood timescales in BD. Using 12 cm hair samples, representing a year of growth, we found enhanced year-scale cortisol fluctuations whose amplitude averaged 4-fold higher in BD (n = 26) participants than controls (n = 59). The proximal 2 cm of hair correlated with recent mood scores. Depression (n = 266) and mania (n = 273) scores from a longitudinal study of BD showed similar frequency spectra. These results suggest a mechanism for BD in which high emotional reactivity excites the slow timescales in the hypothalamic-pituitary-adrenal (HPA) axis to generate elevated months-scale cortisol fluctuations, triggering cortisol-induced mood episodes.

[THE PATIENT AND THERAPIST`S EXPERIENCE IN PSYCHIATRIC HOSPITALIZATION].

INTRODUCTION: As part of the psychiatric hospitalization, the patients who face severe mental illness, suffer from considerable emotional distress, extreme behavioral changes, and at times are in danger to themselves and others. By virtue of the Law for the Treatment of the Mentally Ill, psychiatric treatment is sometimes given under coercion. This abnormal situation produces complex conflicts in the therapeutic relationship. In this article I will try to draw a line between a case study of a person suffering from schizophrenia who was hospitalized under coercion in the closed-door ward, and the concept of the "Uncanny" presented by Freud in his article "Das Unheimliche" - from 1919 in order to convey the unique emotional experience which accompanies the therapeutic alliance in the ward.

Author Correction: Listening to the Patient Perspective: Psychiatric Inpatients' Attitudes Towards Physical Restraint.

The original version of this article unfortunately contained a mistake in the author group section. The correct name of the second author is "Saed Maree" and the third author is "Aviv Segev."

Listening to the Patient Perspective: Psychiatric Inpatients' Attitudes Towards Physical Restraint.

When other options fail, physical restraint is used in inpatient psychiatric units as a means to control violent behavior of agitated inpatients and to prevent them from harm. The professional and social discourse regarding the use of restrictive measures and the absence of the inpatients' attitudes towards these measures is notable. Our research therefore tries to fill this gap by interviewing inpatients about these issues. To assess the subjective experience and attitudes of inpatients who have undergone physical restraint. Forty inpatients diagnosed with psychiatric disorders were interviewed by way of a structured questionnaire. Descriptive statistics were conducted via use of SPSS statistical software. 1.Inpatients reported that physical restraint evoked an experience of loneliness (77.5%) and loss of autonomy (82.5%). 2.Staff visits during times of physical restraint were reported as beneficial according to 73.6% of the inpatients interviewed. 3.Two thirds of the inpatients viewed the use of physical restraints as justified when an inpatient was dangerous. 4.Two thirds of the inpatients regarded physical restraint as the most aversive experience of their hospitalization. Our pilot study explored the subjective experience and attitudes of psychiatric inpatients towards the use of physical restraint. Inpatients viewed physical restraint as a practice that was sometimes justified but at the same time evoked negative subjective feelings. We conclude that listening to inpatients' perspectives can help caregivers to evaluate these measures.