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1.
BMC Psychiatry ; 22(1): 32, 2022 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-35012512

RESUMO

BACKGROUND: Long-acting injectable antipsychotics (LAIs) are an essential maintenance treatment option for individuals with schizophrenia or bipolar I disorder (BP-I). This report summarizes a roundtable discussion on the impact of COVID-19 on the mental healthcare landscape and use of LAIs for individuals with schizophrenia or BP-I. METHODS: Ten experts and stakeholders from diverse fields of healthcare participated in a roundtable discussion on the impact of the COVID-19 pandemic, treatment challenges, and gaps in healthcare for individuals with schizophrenia or BP-I, informed by a literature search. RESULTS: Individuals with schizophrenia or BP-I are at increased risk of COVID-19 infection and increased risk of mortality after COVID-19 diagnosis. LAI prescriptions decreased early on in the pandemic, driven by a decrease in face-to-face consultations. Mental healthcare services are adapting with increased use of telehealth and home-based treatment. Clinical workflows to provide consistent, in-person LAI services include screening for COVID-19 exposure and infection, minimizing contact, and ensuring mask-wearing by individuals and staff. The importance of continued in-person visits for LAIs needs to be discussed so that staff can share that information with patients, their caregivers, and families. A fully integrated, collaborative-care model is the most important aspect of care for individuals with schizophrenia or BP-I during and after the COVID-19 pandemic. CONCLUSIONS: The COVID-19 pandemic has highlighted the importance of a fully integrated collaborative-care model to ensure regular, routine healthcare contact and access to prescribed treatments and services for individuals with schizophrenia and BP-I.


Assuntos
Antipsicóticos , Transtorno Bipolar , COVID-19 , Esquizofrenia , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Teste para COVID-19 , Preparações de Ação Retardada/uso terapêutico , Humanos , Adesão à Medicação , Pandemias , SARS-CoV-2 , Esquizofrenia/tratamento farmacológico , Esquizofrenia/epidemiologia
2.
J Psychosoc Nurs Ment Health Serv ; 60(1): 6-9, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34978941

RESUMO

Bipolar disorder is a serious neuroprogressive disorder associated with structural and functional brain changes, multiple comorbidities, and heightened risk for suicide. Lithium has been a first-line treatment for bipolar disorder for more than 50 years and recent research suggests that early identification and treatment of bipolar disorder with lithium can alter the progression of the illness. The purpose of the current article is to review evidence for lithium's neurotrophic and neuroprotective actions and clinical guidelines for safe and effective use. [Journal of Psychosocial Nursing and Mental Health Services, 60(1), 6-9.].


Assuntos
Transtorno Bipolar , Profissionais de Enfermagem , Suicídio , Transtorno Bipolar/tratamento farmacológico , Encéfalo , Humanos , Lítio , Suicídio/prevenção & controle
3.
Psychiatr Prax ; 49(1): 51-53, 2022 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-34979577

RESUMO

We report the first manifestation of mania in an 85-year-old patient who had not previously received any psychiatric treatment. The patient had had Alzheimer's type dementia for 3 years. The COVID-19 infection took a mild course in accordance with the RKI guidelines. This was followed by a manic syndrome according to the ICD-10 with a clearly elevated mood, increased drive and behavior that occured for the first time in the patient's life.


Assuntos
Transtorno Bipolar , COVID-19 , Idoso de 80 Anos ou mais , Alemanha , Humanos , Mania , SARS-CoV-2
4.
Gene ; 809: 146021, 2022 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-34673206

RESUMO

The GABA receptors represent the main inhibitory system in the central nervous system that ensure synaptogenesis, neurogenesis, and the regulation of neuronal plasticity and learning. GABAA receptors are pentameric in structure and belong to the Cys-loop superfamily. The GABRB2 gene, located on chromosome 5q34, encodes the ß2 subunit that combines with the α and γ subunits to form the major subtype of GABAA receptors, which account for 43% of all GABAA receptors in the mammalian brain. Each subunit probably consists of an extracellular N-terminal domain, four membrane-spanning segments, a large intracellular loop between TM3 and TM4, and an extracellular C-terminal domain. Alternative splicing of the RNA transcript of the GABRB2 gene gives rise at least to four long and short isoforms with dissimilar electrophysiological properties. Furthermore, GABRB2 is imprinted and subjected to epigenetic regulation and positive selection. It has been associated with schizophrenia first in Han Chinese, and subsequently validated in other populations. Gabrb2 knockout mice also exhibited schizophrenia-like behavior and neuroinflammation that were ameliorated by the antipsychotic drug risperidone. GABRB2 was also associated with other neuropsychiatric disorders including bipolar disorder, epilepsy, autism spectrum disorder, Alzheimer's disease, frontotemporal dementia, substance dependence, depression, internet gaming disorder, and premenstrual dysphoric disorder. Recently, it has been postulated that GABRB2 might be a potential marker for different cancer types. As GABRB2 has a pivotal role in the central nervous system and is increasingly recognized to contribute to human diseases, further understanding of its structure and function may expedite the generation of new therapeutic approaches.


Assuntos
Transtornos Mentais/genética , Doenças do Sistema Nervoso/genética , Doenças Neurodegenerativas/genética , Receptores de GABA-A/fisiologia , Animais , Transtorno do Espectro Autista/genética , Transtorno Bipolar/genética , Epilepsia/genética , Predisposição Genética para Doença , Humanos , Camundongos Knockout , Neoplasias/genética , Receptores de GABA-A/química , Receptores de GABA-A/genética , Receptores de GABA-A/metabolismo , Esquizofrenia/genética
5.
Int Clin Psychopharmacol ; 37(1): 25-28, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34686643

RESUMO

Lithium, a mood stabilizer used in the treatment of bipolar disorder is known for its anti-inflammatory properties with the discussion of its potential use in COVID-19 infection. The SARS-CoV-2 virus causing COVID-19 infection is known to enter the target cells through angiotensin converting enzyme-2 receptors present in abundance in the lung and renal tissue. Recent research supports the evidence for direct renal injury by viral proteins. Here we report two patients with bipolar disorder presenting with lithium toxicity in the presence of COVID-19 infection. Two patients with bipolar disorder, maintaining remission on lithium prophylaxis, presented to the psychiatric emergency with recent-onset fever and altered sensorium. Both the patient's investigations revealed lithium toxicity, elevated serum creatinine, urea and inflammatory markers. Hypernatremia, hyperkalaemia, and hyperchloremia were seen in one patient. Lithium and other psychotropic medications were stopped immediately, and COVID-19 treatment was initiated. Patient with clinical signs of lithium toxicity, hypernatremia, hyperkalaemia, and hyperchloremia developed ventricular tachycardia. He survived and regained consciousness after 2 weeks of aggressive conservative management. However, another patient died of acute respiratory failure on day 3. Possible direct infection of the kidney by SARS-CoV-2 viral proteins can manifest with acute kidney injury and lithium toxicity among patients on long-term lithium therapy. Health professionals treating COVID-19 infection among individuals on lithium therapy should be aware of the possibility of lithium toxicity in the background of renal injury.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Antimaníacos/efeitos adversos , COVID-19/complicações , Compostos de Lítio/efeitos adversos , Antimaníacos/uso terapêutico , Transtorno Bipolar/complicações , Transtorno Bipolar/tratamento farmacológico , Creatinina/sangue , Evolução Fatal , Humanos , Hiperpotassemia/induzido quimicamente , Hipernatremia/induzido quimicamente , Compostos de Lítio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Insuficiência Respiratória/induzido quimicamente , Taquicardia Ventricular/induzido quimicamente , Ureia/sangue
6.
Lancet Psychiatry ; 9(1): 21-22, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34921793
7.
Biol Psychiatry ; 91(1): 102-117, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34099189

RESUMO

BACKGROUND: Sex differences in incidence and/or presentation of schizophrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BIP) are pervasive. Previous evidence for shared genetic risk and sex differences in brain abnormalities across disorders suggest possible shared sex-dependent genetic risk. METHODS: We conducted the largest to date genome-wide genotype-by-sex (G×S) interaction of risk for these disorders using 85,735 cases (33,403 SCZ, 19,924 BIP, and 32,408 MDD) and 109,946 controls from the PGC (Psychiatric Genomics Consortium) and iPSYCH. RESULTS: Across disorders, genome-wide significant single nucleotide polymorphism-by-sex interaction was detected for a locus encompassing NKAIN2 (rs117780815, p = 3.2 × 10-8), which interacts with sodium/potassium-transporting ATPase (adenosine triphosphatase) enzymes, implicating neuronal excitability. Three additional loci showed evidence (p < 1 × 10-6) for cross-disorder G×S interaction (rs7302529, p = 1.6 × 10-7; rs73033497, p = 8.8 × 10-7; rs7914279, p = 6.4 × 10-7), implicating various functions. Gene-based analyses identified G×S interaction across disorders (p = 8.97 × 10-7) with transcriptional inhibitor SLTM. Most significant in SCZ was a MOCOS gene locus (rs11665282, p = 1.5 × 10-7), implicating vascular endothelial cells. Secondary analysis of the PGC-SCZ dataset detected an interaction (rs13265509, p = 1.1 × 10-7) in a locus containing IDO2, a kynurenine pathway enzyme with immunoregulatory functions implicated in SCZ, BIP, and MDD. Pathway enrichment analysis detected significant G×S interaction of genes regulating vascular endothelial growth factor receptor signaling in MDD (false discovery rate-corrected p < .05). CONCLUSIONS: In the largest genome-wide G×S analysis of mood and psychotic disorders to date, there was substantial genetic overlap between the sexes. However, significant sex-dependent effects were enriched for genes related to neuronal development and immune and vascular functions across and within SCZ, BIP, and MDD at the variant, gene, and pathway levels.


Assuntos
Transtorno Bipolar/genética , Transtorno Depressivo Maior , Transtornos Psicóticos , Esquizofrenia/genética , Caracteres Sexuais , Transtorno Depressivo Maior/genética , Células Endoteliais , Feminino , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Humanos , Masculino , Polimorfismo de Nucleotídeo Único , Transtornos Psicóticos/genética , Receptores de Fatores de Crescimento do Endotélio Vascular , Sulfurtransferases
8.
PLoS One ; 16(12): e0261170, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34914762

RESUMO

OBJECTIVE: We have used long-read single molecule, real-time (SMRT) sequencing to fully characterize a ~12Mb genomic region on chromosome Xq24-q27, significantly linked to bipolar disorder (BD) in an extended family from a genetic sub-isolate. This family segregates BD in at least four generations with 24 affected individuals. METHODS: We selected 16 family members for targeted sequencing. The selected individuals either carried the disease haplotype, were non-carriers of the disease haplotype, or served as married-in controls. We designed hybrid capture probes enriching for 5-9Kb fragments spanning the entire 12Mb region that were then sequenced to screen for candidate structural variants (SVs) that could explain the increased risk for BD in this extended family. RESULTS: Altogether, 201 variants were detected in the critically linked region. Although most of these represented common variants, three variants emerged that showed near-perfect segregation among all BD type I affected individuals. Two of the SVs were identified in or near genes belonging to the RNA Binding Motif Protein, X-Linked (RBMX) gene family-a 330bp Alu (subfamily AluYa5) deletion in intron 3 of the RBMX2 gene and an intergenic 27bp tandem repeat deletion between the RBMX and G protein-coupled receptor 101 (GPR101) genes. The third SV was a 50bp tandem repeat insertion in intron 1 of the Coagulation Factor IX (F9) gene. CONCLUSIONS: Among the three genetically linked SVs, additional evidence supported the Alu element deletion in RBMX2 as the leading candidate for contributing directly to the disease development of BD type I in this extended family.


Assuntos
Elementos Alu , Transtorno Bipolar/genética , Genes Ligados ao Cromossomo X , Predisposição Genética para Doença , Feminino , Humanos , Masculino , Linhagem
10.
Neuropsychopharmacol Hung ; 23(4): 347-362, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34971399

RESUMO

Objective: Medication adherence in bipolar disorder (BD) may be influenced by 6 selfreported dimensions: 1) high/low psychological reactance, 2) high/low internal healthlocus of control (HLOC), 3) high/low doctor HLOC, 4) pharmacophobia, 5) pharmacophilia, and 6) skepticism about a specific medication. This study in Spain, Argentina, and Venezuela included 142 outpatients with BD prescribed 320 psychiatric medications and 1230 other psychiatric outpatients prescribed 2134 medications. Methods: Logistic regression models included adherence for each psychiatric medication, measured by the Sidorkiewicz Adherence Tool as the dependent variable. The models provided adjusted odds ratios (ORs) of dichotomous independent variables: clinical variables and 6 self-reported dimensions. Results: ORs significant in both groups were: 1) high doctor HLOC (OR=1.87 in BD, OR=1.25 in other patients), 2) high psychological reactance (respectively OR=0.572, OR=0.798), 3) pharmacophobia (respectively OR=0.361, OR=0.614), and 4) skepticism about a specific medication (respectively OR=0.300, OR=0.556). Two ORs were only significant in BD patients: medication duration > 1 year (OR=0.449), and extreme polypharmacy (OR=2.49). The study included 104 BD patients prescribed 122 mood stabilizers and 136 other patients prescribed 140 mood stabilizers. Two ORs were significant for mood stabilizer adherence only in BD patients: high doctor HLOC and skepticism (respective ORs=2.38, OR=0.390). The study included 87 BD patients prescribed 97 antipsychotics and 417 other patients prescribed 458 antipsychotics. Four ORs were significant for antipsychotic adherence only in the BD group. Conclusions: Future studies of adherence to all/specific medications should explore the specific city/commonality of these dimensions, particularly doctor HLOC, in BD versus other psychiatric patients. (Neuropsychopharmacol Hung 2021; 23(4): 347-362).


Assuntos
Antipsicóticos , Transtorno Bipolar , Transtornos Mentais , Psiquiatria , Adulto , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Humanos , Adesão à Medicação , Transtornos Mentais/tratamento farmacológico
11.
Neuropsychopharmacol Hung ; 23(4): 363-373, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34971494

RESUMO

Findings of three articles reporting results in 1372 stabilized outpatients taking 2454 medications in Spain, Argentina, and Venezuela were combined. Prevalence of good adherence was not obviously different across diagnoses: 69.5% (N=212) for schizophrenia, 66.3% (N=142) for bipolar disorder, and 69.8% (N=521) for depression. Besides the focus on stabilized outpatients, other study biases included use of a research sample; limited to oral medications, ignoring long-acting injectable antipsychotics; and lack of data on active substance abuse, clinical severity, and insight. Logistic regression models explored predictors of good vs. poor adherence. The six self-reported variables studied were pharmacophobia, pharmacophilia, high psychological reactance, high internal health locus of control (LOC), high doctor LOC, and skepticism concerning specific medications. ORs were significant in 56% (47/84) of the statistical tests vs. 24% (23/98) of ORs significant in case of 7 demographic/clinical variables (p=0.001). At least 2/3 of the ORs for pharmacophobia, pharmacophilia and skepticism were significantly associated with adherence in cases and controls, indicating their independence from diagnoses. In need of replication, three other self-reported measures had differential effects on adherence across diagnoses. High psychological reactance was associated with decreased adherence to antidepressant medications in general, or for patients with mood disorders. High internal LOC as associated with poor adherence may reflect the distrust patients with schizophrenia or severe bipolar disorder have of other people. High doctor LOC was significantly associated with increased adherence only in patients with bipolar disorder, but was significant for all medications, mood stabilizers and antipsychotics, indicating the relevance of the patient-psychiatrist relationship in these patients. (Neuropsychopharmacol Hung 2021; 23(4): 363-373).


Assuntos
Antipsicóticos , Transtorno Bipolar , Transtorno Depressivo Maior , Esquizofrenia , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Depressão , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/epidemiologia , Humanos , Adesão à Medicação , Esquizofrenia/tratamento farmacológico
12.
BMJ Case Rep ; 14(11)2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34789530

RESUMO

Lithium is a medication with a variety of medical usage for various diseases including bipolar mood disorder. As the therapeutic window of lithium is narrow, its usage is commonly associated with toxicity. Lithium toxicity affects multiple systems especially the central nervous system, leading to neuropsychiatric complications. Haemodialysis is an effective method for lithium removal especially in severe lithium toxicity such as neurotoxicity with electroencephalogram changes. We describe a case of lithium neurotoxicity with electroencephalographic abnormalities which was reversed following haemodialysis.


Assuntos
Transtorno Bipolar , Síndromes Neurotóxicas , Transtorno Bipolar/tratamento farmacológico , Eletroencefalografia , Humanos , Lítio/toxicidade , Síndromes Neurotóxicas/diagnóstico , Síndromes Neurotóxicas/etiologia , Diálise Renal
14.
Vertex ; XXXII(152): 24-28, 2021 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-34783792

RESUMO

Children are more prone to adverse effects of selective serotonin reuptake inhibitors than adults. The aim of this study is to review the bibliography on mania and hypomania induced by these antidepressants. Most of the young people diagnosed with bipolar disorder had been exposed to this type of drug. The hypomania associated with these antidepressants in children with anxiety disorders is as relevant as that of those who had previously received a diagnosis of depression. As a limitation, in the selected papers, the activation syndrome could or could not include (hypo) mania. When indicating an antidepressant, we must be extremely prudent and place special emphasis on the risk-benefit analysis. It is essential to conduct a thorough search of family history of bipolar disorder together with a personal history investigation and a meticulous analysis of the semiology of our patients due to the risks of (hypo) mania.


Assuntos
Transtorno Bipolar , Mania , Adolescente , Adulto , Antidepressivos/efeitos adversos , Transtorno Bipolar/induzido quimicamente , Transtorno Bipolar/tratamento farmacológico , Criança , Humanos , Inibidores de Captação de Serotonina/uso terapêutico
15.
Asian J Psychiatr ; 66: 102884, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34740125

RESUMO

Lithium therapy is a common treatment for affective disorders and is widely regarded as a lifesaving drug. However, because its elimination is almost wholly unchanged via the kidneys, both acute and long-term adverse effects relating to toxicity may occur, including declining renal function and nephrogenic diabetes insipidus (DI). DI may be difficult to detect and is frequently preceded by dehydration and which, in our patient, was discovered by chance. We describe a case of an elderly woman on chronic lithium therapy for bipolar affective disorder who initially presented with dehydration from vomiting but possibly developed extra-pontine myelinolysis (EPM) after over-zealous correction of hyponatraemia. Steroids administered appeared to have prevented further progression but a persisting hyperosmolar state then alerted us to the presence of nephrogenic DI. Although both conditions were later successfully reversed with no obvious chronic sequelae, the recovery of the patient was protracted. Clinicians should be vigilant for complications of managing dehydration states in people prescribed with lithium.


Assuntos
Transtorno Bipolar , Diabetes Insípido Nefrogênico , Diabetes Mellitus , Idoso , Transtorno Bipolar/tratamento farmacológico , Diabetes Insípido Nefrogênico/induzido quimicamente , Feminino , Humanos , Lítio/efeitos adversos , Efeitos Adversos de Longa Duração , Transtornos do Humor
16.
Rev Colomb Psiquiatr (Engl Ed) ; 50(4): 273-284, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34815013

RESUMO

Bipolar disorder (BD) has a large hereditary component. It is a disorder that begins in early adulthood, but about which it has been described a premorbid period preceding the onset of BD. During this herald expression psychiatric disorders and symptoms, such as depressive, manic, psychotic, anxious and others, may appear. OBJECTIVE: To determine the psychopathological profile of a Bipolar Offspring (BO) group compared with the Community Control Offspring (CCO) group, and its evolution over time, including subthreshold symptoms and mental disorders. METHODS: We conducted an observational mixed cohort study, with a prospective design. We included subjects from six to 30 years of age, from the region of Antioquia, Colombia. A total of 131 subjects from the risk group BO and 150 subjects from the CCO group were evaluated through validated psychiatric diagnostic interviews (K-SADS-PL and DIGS) at baseline and at 4 years follow up. All interviews were carried out by a staff blind to parent diagnoses. Follow-up assessment were complete in 72% of the offspring. Forty-two subjects were excluded as they surpassed the age of 30 years, and only 46 subjects were not followed (change of address or did not consent to participate). RESULTS: Compared with the CCO group, the BO group had a higher frequency of affective disorder, psychotic disorder, externalizing disorders and use of the psychoactive substances during both assessments at time 1 and 2. The magnitude of the differences between the groups increased when they reach time 2. The BO group had a greater risk for presenting subthreshold symptoms and definitive psychiatric disorders, such as affective disorders, psychotic disorders and externalizing disorders. In addition, the BO group had a younger age of onset for psychoactive substances consumption. CONCLUSION: During the follow-up period, the BO group had a higher risk of presenting mental disorders compared with the CCO group. The most relevant symptoms and disorders that could precede the onset of BD were depressive, bipolar not otherwise specified, psychotic and substance use.


Assuntos
Transtorno Bipolar , Filho de Pais Incapacitados , Transtornos Mentais , Adulto , Transtorno Bipolar/epidemiologia , Estudos de Coortes , Humanos , Transtornos Mentais/epidemiologia , Estudos Prospectivos
17.
Medicina (Kaunas) ; 57(11)2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34833431

RESUMO

The German concept of a trialogue in medicine is at its best a cooperation between patients, relatives, and professionals as partners on equal footing. Prerequisites, and also the aim of the trialogue, are mutual respect, an open attitude from professionals, and self-confidence from patients and relatives. The expertise of each of these groups is to be strengthened through the trialogue and should benefit all. Trialogue cooperation brings about a change of perspective and promotes mutual understanding. By establishing a therapeutic relationship on equal footing with the patient with involvement of their relatives, individual and family resources can be better utilized, professional assistance can be designed to better meet the patient's needs, and acceptance of and commitment to treatment can be increased. In addition, early symptoms and new phases of the disease can be recognized earlier and adequate treatment can be initiated more quickly. A favorable course of the disease is thus more likely, and relapses are less likely to present. The use of peers has proven to be quite helpful. The consistently trialogue structure within the German Society for Bipolar Disorder (Deutsche Gesellschaft für Bipolare Störungen e.V./DGBS: Heinrich-Hoffmann-Straße 10, 60528 Frankfurt am Main) as a medical society enables further development of the trialogue on many levels, for example, the drafting and updating of the German guidelines for bipolar disorder with the trialogue in mind.


Assuntos
Transtorno Bipolar , Transtorno Bipolar/tratamento farmacológico , Alemanha , Humanos , Sociedades Médicas
18.
Medicina (Kaunas) ; 57(11)2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34833474

RESUMO

Substance use disorders (SUD) are highly prevalent in bipolar disorder (BD) and significantly affect clinical outcomes. Incidence and management of illicit drug use differ from alcohol use disorders, nicotine use of behavioral addictions. It is not yet clear why people with bipolar disorder are at higher risk of addictive disorders, but recent data suggest common neurobiological and genetic underpinnings and epigenetic alterations. In the absence of specific diagnostic instruments, the clinical interview is conducive for the diagnosis. Treating SUD in bipolar disorder requires a comprehensive and multidisciplinary approach. Most treatment trials focus on single drugs, such as cannabis alone or in combination with alcohol, cocaine, or amphetamines. Synopsis of data provides limited evidence that lithium and valproate are effective for the treatment of mood symptoms in cannabis users and may reduce substance use. Furthermore, the neuroprotective agent citicoline may reduce cocaine consumption in BD subjects. However, many of the available studies had an open-label design and were of modest to small sample size. The very few available psychotherapeutic trials indicate no significant differences in outcomes between BD with or without SUD. Although SUD is one of the most important comorbidities in BD with a significant influence on clinical outcome, there is still a lack both of basic research and clinical trials, allowing for evidence-based and specific best practices.


Assuntos
Alcoolismo , Transtorno Bipolar , Transtornos Relacionados ao Uso de Substâncias , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/epidemiologia , Comorbidade , Humanos , Psicotrópicos/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
19.
Asian J Psychiatr ; 66: 102895, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34741883

RESUMO

Hashimoto's encephalopathy is a rare autoimmune disease the presentation of which can include a variety of neurological signs and psychiatric symptoms. Here we present a 53-year-old woman with a history of bipolar disorder who experienced catatonia, consciousness disturbance, and general weakness after the aggravation of symptoms depression. After laboratory data revealed increased blood anti-thyroid peroxidase antibodies, the patient was diagnosed as having Hashimoto's encephalopathy, and her neuropsychiatric symptoms resolved soon after she received steroid pulse therapy. Hashimoto's encephalopathy rarely presents as catatonia, but the symptoms might mimic the manifestation of a previous mental illness. Clinicians should therefore consider Hashimoto's encephalopathy an underlying cause of catatonia.


Assuntos
Transtorno Bipolar , Encefalopatias , Catatonia , Doença de Hashimoto , Transtorno Bipolar/complicações , Transtorno Bipolar/tratamento farmacológico , Encefalopatias/complicações , Catatonia/diagnóstico , Catatonia/tratamento farmacológico , Catatonia/etiologia , Encefalite , Feminino , Doença de Hashimoto/complicações , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/tratamento farmacológico , Humanos , Pessoa de Meia-Idade
20.
J Med Internet Res ; 23(11): e29749, 2021 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-34806996

RESUMO

BACKGROUND: Bipolar disorder (BD) is the 10th most common cause of frailty in young individuals and has triggered morbidity and mortality worldwide. Patients with BD have a life expectancy 9 to 17 years lower than that of normal people. BD is a predominant mental disorder, but it can be misdiagnosed as depressive disorder, which leads to difficulties in treating affected patients. Approximately 60% of patients with BD are treated for depression. However, machine learning provides advanced skills and techniques for better diagnosis of BD. OBJECTIVE: This review aims to explore the machine learning algorithms used for the detection and diagnosis of bipolar disorder and its subtypes. METHODS: The study protocol adopted the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We explored 3 databases, namely Google Scholar, ScienceDirect, and PubMed. To enhance the search, we performed backward screening of all the references of the included studies. Based on the predefined selection criteria, 2 levels of screening were performed: title and abstract review, and full review of the articles that met the inclusion criteria. Data extraction was performed independently by all investigators. To synthesize the extracted data, a narrative synthesis approach was followed. RESULTS: We retrieved 573 potential articles were from the 3 databases. After preprocessing and screening, only 33 articles that met our inclusion criteria were identified. The most commonly used data belonged to the clinical category (19, 58%). We identified different machine learning models used in the selected studies, including classification models (18, 55%), regression models (5, 16%), model-based clustering methods (2, 6%), natural language processing (1, 3%), clustering algorithms (1, 3%), and deep learning-based models (3, 9%). Magnetic resonance imaging data were most commonly used for classifying bipolar patients compared to other groups (11, 34%), whereas microarray expression data sets and genomic data were the least commonly used. The maximum ratio of accuracy was 98%, whereas the minimum accuracy range was 64%. CONCLUSIONS: This scoping review provides an overview of recent studies based on machine learning models used to diagnose patients with BD regardless of their demographics or if they were compared to patients with psychiatric diagnoses. Further research can be conducted to provide clinical decision support in the health industry.


Assuntos
Transtorno Bipolar , Algoritmos , Transtorno Bipolar/diagnóstico , Gerenciamento de Dados , Humanos , Aprendizado de Máquina , Processamento de Linguagem Natural
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