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1.
Psychiatr Danub ; 31(Suppl 3): 554-560, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488790

RESUMO

Bipolar depression (BD) is among the most severe psychiatric disorders. A significant number of patients do not achieve an entirely symptom-free state and experience residual sub-syndromal depression. Most of the treatment options approved for bipolar depression give no rapid symptom improvement. Ketamine is an anaesthetic medication that acts as an antagonist of the NMDA receptor and has antidepressant potential. Due to its unique way of action, ketamine seems to be crucial for the treatment of anhedonia. This review paper aims to provide an overview of the efficacy of ketamine infusions in bipolar depression with a focus on anhedonia Literature suggests that intravenous ketamine 0.5 mg/kg over 40 min weekly could be useful in the treatment of bipolar depression with prominent anhedonia, but there is still a small number of studies that examine the efficacy of ketamine infusions in BD. In conclusion, ketamine should be considered as a valuable treatment option for patients with BD and anhedonia.


Assuntos
Anedonia/efeitos dos fármacos , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/psicologia , Depressão/complicações , Depressão/tratamento farmacológico , Ketamina/farmacologia , Ketamina/uso terapêutico , Antidepressivos/farmacologia , Antidepressivos/uso terapêutico , Transtorno Bipolar/complicações , Humanos
2.
Psychiatr Danub ; 31(Suppl 3): 591-594, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488796

RESUMO

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a rare monogenic disorder caused by mutations in the NOTCH3 gene. The clinical features are primarily neurological, which include recurrent transient ischaemic attacks, strokes, and migraines. However, psychiatric manifestations which mainly include mood disturbances have also been reported in CADASIL. Manic symptoms and bipolar disorders are rarely documented in CADASIL and existing reports generally lack detailed descriptions of the psychiatric evaluation. We discuss a case of Bipolar Affective Disorder (BD) in a British woman with a family history of CADASIL. This case provides insight into the diagnosis and management of BD as well as the possible underlying aetiologies that should be considered. The similarities between BD and CADASIL in terms of imaging, genetic, and therapeutic aspects raise the possibility of common dysfunctional pathways. BD in CADASIL may warrant greater consideration by both psychiatrists as well as non-psychiatric specialists and further studies are required to understand the pathological significance.


Assuntos
Transtorno Bipolar/complicações , CADASIL/complicações , Transtorno Bipolar/genética , Transtorno Bipolar/fisiopatologia , Transtorno Bipolar/psicologia , CADASIL/genética , CADASIL/fisiopatologia , CADASIL/psicologia , Feminino , Humanos , Transtornos de Enxaqueca/complicações , Transtornos do Humor/complicações , Mutação , Receptor Notch3/genética , Reino Unido
3.
Medicina (Kaunas) ; 55(8)2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31344941

RESUMO

Bipolar disorders (BDs) are prevalent mental health illnesses that affect about 1-5% of the total population, have a chronic course and are associated with a markedly elevated premature mortality. One of the contributors for the decreased life expectancy in BD is suicide. Accordingly, the rate of suicide among BD patients is approximately 10-30 times higher than the corresponding rate in the general population. Extant research found that up to 20% of (mostly untreated) BD subjects end their life by suicide, and 20-60% of them attempt suicide at least one in their lifetime. In our paper we briefly recapitulate the current knowledge on the epidemiological aspects of suicide in BD as well as factors associated with suicidal risk in BD. Furthermore, we also discuss concisely the possible means of suicide prevention in BD.


Assuntos
Transtorno Bipolar/complicações , Suicídio/psicologia , Adulto , Transtorno Bipolar/psicologia , Feminino , Humanos , Lítio/normas , Lítio/uso terapêutico , Compostos de Lítio/normas , Compostos de Lítio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Suicídio/estatística & dados numéricos
4.
Medicina (Kaunas) ; 55(7)2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31331102

RESUMO

Background and Objectives: Suicide is the leading cause of death in patients with Bipolar Disorder (BD). In particular, the high mortality rate is due to violent suicide attempts. Several risk factors associated with suicide attempts in patients with BD have been identified. Affective temperaments are associated with suicidal risk, but their predictive role is still understudied. The aim of this study is to assess the relationship between affective temperaments and personal history of violent suicide attempts. Materials and Methods: 74 patients with Bipolar Disorder type I (BD-I) or II (BD-II) were included. All patients filled in the short version of Munster Temperament Evaluation of the Memphis, Pisa, Paris and San Diego (short TEMPS-M) and the Temperament and Character Inventory, revised version (TCI-R). The sample was divided into two groups on the basis of a positive history for suicidal attempts and the suicidal group was further divided into two subgroups according to violent suicide attempts. Results: Violent suicide attempts were positively associated with the cyclothymic temperament and inversely to the hyperthymic one. BD-I patients and patients with a clinical history of rapid cycling were significantly more represented in the group of patients with a history of violent suicide attempts. Conclusions: Our study highlights that several clinical and temperamental characteristics are associated with violent suicide attempts, suggesting the importance of affective temperaments in the clinical management of patients with BPI.


Assuntos
Transtorno Bipolar/complicações , Tentativa de Suicídio/psicologia , Temperamento , Adulto , Agressão/psicologia , Transtorno Bipolar/psicologia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Tentativa de Suicídio/prevenção & controle
5.
Expert Opin Drug Metab Toxicol ; 15(8): 619-631, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31271537

RESUMO

Introduction: The comorbidity between obsessive-compulsive disorder (OCD) and bipolar disorders (BDs) is a frequent and severe condition characterized by a chronic course, high suicidal risk and tendency towards chronicity and treatment non-response. It represents a real challenge to psychiatrists, while requiring a careful and appropriate therapeutic management consisting in the combination of serotonergic antidepressants (ADs), such as serotonin reuptake inhibitors (SRIs), with mood stabilizers. This combination, like any other, raises the problems related to drug interactions that may lead to pharmacokinetic and pharmacodynamic changes, resulting in the modification of the pharmacologic effect and safety profile of a given compound. Areas covered: The aim of the present paper was to review the literature on the pharmacokinetic and pharmacodynamic changes resulting from the interactions of the different drugs prescribed in the OCD-BD comorbidity. Expert opinion: The literature data on pharmacokinetic and pharmacodynamic changes due to interactions of drugs commonly prescribed in the treatment of the OCD-BD comorbidity are extremely limited, and the information is inferred by findings gathered in psychiatric patients suffering from other disorders. This represents a gap in psychopharmacology that should be filled by specific studies on this important topic.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Antimaníacos/administração & dosagem , Antimaníacos/farmacocinética , Antimaníacos/farmacologia , Antipsicóticos/administração & dosagem , Antipsicóticos/farmacocinética , Antipsicóticos/farmacologia , Transtorno Bipolar/complicações , Interações de Medicamentos , Humanos , Transtorno Obsessivo-Compulsivo/complicações , Inibidores de Captação de Serotonina/administração & dosagem , Inibidores de Captação de Serotonina/farmacocinética , Inibidores de Captação de Serotonina/farmacologia
6.
Geriatr Psychol Neuropsychiatr Vieil ; 17(2): 179-188, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31162118

RESUMO

Bipolar disorder is a severe, recurrent mood disorder, associated with a higher rate of morbidity and mortality. A new population of aging bipolar patients is emerging for which specific studies are scarce. There seem to be an association between bipolar disorder and major cognitive disorder, significantly affecting patients' psychosocial outcomes. Though the neuropathological mecanisms underlying such an evolution have yet to be found, there are three paradigms that can help us understand the clinical heterogeneity within the aging bipolar group. First, there seem to be different cognitive endophenotypes within the bipolar spectrum, related to different neurodevelopmental abnormalities. Each of these endophenotypes will interact with the normal cognitive aging process which is associated with a decline in certain cognitive domains while others remain stable. Nevertheless this cognitive decline will be variable from one patient to another. This can be explained by cognitive reserve which reflects the brain's capacity to endure neuropathology, and minimize clinical manifestations. The second hypothesis is the neuroprogression paradigm that offers an explanation on how a cyclic disorder such as bipolar disorder could evolve progressively into a major cognitive disorder. According to this paradigm, each manic and depressive episode is associated to an allostatic load, a systemic response associated with the secretion of neuroinflammatory factors which will secondarily alter the brain's connectivity. The third paradigm suggests that bipolar patients may develop either vascular dementia which is coherent with their increased vascular risk factor or another neurodegenerative disease. All three paradigms are not exclusive, and many other factors are to be taken into account such as medication, sensory impairment, health related changes and residual mood symptoms, which can alter cognitive functions.


Assuntos
Transtorno Bipolar/psicologia , Envelhecimento Cognitivo , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtorno Bipolar/complicações , Transtorno Bipolar/terapia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Progressão da Doença , Humanos , Pessoa de Meia-Idade
7.
J Coll Physicians Surg Pak ; 29(6): S56-S58, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31142424

RESUMO

Erotomania is a delusional phenomenon in which patient believes that some celebrity is in love with her. It is associated with various psychiatric illnesses. We herein present a report of a young woman with erotomanic delusion diagnosed with recurrent depression, current episode being severe with psychotic features. A 22-year woman, previously treated for a depressive episode three years ago, was brought by the mother for evaluation. The woman presented with symptoms of depression for the past six months along with the delusion that famous singer SY is in love with her for the past two months. This has resulted in a gross decline in social and academic functioning. Psychometrics revealed Beck's depression inventory (BDI) score of 36 and brief psychiatric rating scale (BPRS) score of 41. A diagnosis of recurrent depression with current severe episode with psychotic features, was made at our psychiatric facility. This case report highlights that psychotic depression can present with a rare mood incongruent delusion of erotomanic content and accurate diagnosis and management require adequate knowledge about this phenomenon.


Assuntos
Transtorno Bipolar/complicações , Delusões/diagnóstico , Depressão/diagnóstico , Transtorno Depressivo/diagnóstico , Transtornos Psicóticos/complicações , Delusões/etiologia , Delusões/psicologia , Depressão/tratamento farmacológico , Depressão/psicologia , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/psicologia , Emoções , Feminino , Fluoxetina/administração & dosagem , Fluoxetina/uso terapêutico , Humanos , Amor , Olanzapina/administração & dosagem , Olanzapina/uso terapêutico , Transtornos Psicóticos/psicologia , Adulto Jovem
8.
BMJ Case Rep ; 12(5)2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31133548

RESUMO

A 72-year-old woman with suicidal ideations for the first time was seen for a follow-up medical visit. Patient diagnosed with bipolar disorder II, chronic complex pain and other complex medical issues. Patient was on long-standing chronic opioid agonist therapy. Patient was prescribed oral hydromorphone to supplement her chronic opioid regimen. Within 24 hours, the patient reported no further suicidal ideations and there were no reported complications. The case provides impetus for further study as to what interventions work best for patients who present with acute suicidal ideations. The case acknowledges cultural issues and implicit biases that can influence medical care and perceptions thereof. Implicit biases may be particularly apparent as they relate to mental health concerns and the use of substances that are susceptible to abuse. The most important clinical lesson reminder may be the importance of adequate documentation and discussion be provided when one prescribes an opioid in a novel way in a special clinical context.


Assuntos
Transtorno Bipolar/psicologia , Dor Crônica/tratamento farmacológico , Hidromorfona/efeitos adversos , Tentativa de Suicídio/prevenção & controle , Idoso , Transtorno Bipolar/complicações , Transtorno Bipolar/diagnóstico , Dor Crônica/complicações , Dor Crônica/psicologia , Depressão/tratamento farmacológico , Depressão/psicologia , Feminino , Humanos , Hidromorfona/administração & dosagem , Hidromorfona/uso terapêutico , Entorpecentes/efeitos adversos , Ideação Suicida , Tentativa de Suicídio/psicologia , Resultado do Tratamento
10.
Lancet Psychiatry ; 6(5): 379-390, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30975539

RESUMO

BACKGROUND: People with severe mental illnesses such as schizophrenia are three times more likely to smoke than the wider population, contributing to widening health inequalities. Smoking remains the largest modifiable risk factor for this health inequality, but people with severe mental illness have not historically engaged with smoking cessation services. We aimed to test the effectiveness of a combined behavioural and pharmacological smoking cessation intervention targeted specifically at people with severe mental illness. METHODS: In the smoking cessation intervention for severe mental illness (SCIMITAR+) trial, a pragmatic, randomised controlled study, we recruited heavy smokers with bipolar disorder or schizophrenia from 16 primary care and 21 community-based mental health sites in the UK. Participants were eligible if they were aged 18 years or older, and smoked at least five cigarettes per day. Exclusion criteria included substantial comorbid drug or alcohol problems and people who lacked capacity to consent at the time of recruitment. Using computer-generated random numbers, participants were randomly assigned (1:1) to a bespoke smoking cessation intervention or to usual care. Participants, mental health specialists, and primary care physicians were unmasked to assignment. The bespoke smoking cessation intervention consisted of behavioural support from a mental health smoking cessation practitioner and pharmacological aids for smoking cessation, with adaptations for people with severe mental illness-such as, extended pre-quit sessions, cut down to quit, and home visits. Access to pharmacotherapy was via primary care after discussion with the smoking cessation specialist. Under usual care participants were offered access to local smoking cessation services not specifically designed for people with severe mental illnesses. The primary endpoint was smoking cessation at 12 months ascertained via carbon monoxide measurements below 10 parts per million and self-reported cessation for the past 7 days. Secondary endpoints were biologically verified smoking cessation at 6 months; number of cigarettes smoked per day, Fagerström Test for Nicotine Dependence (FTND) and Motivation to Quit (MTQ) questionnaire; general and mental health functioning determined via the Patient Health Questionnaire-9 (PHQ-9), the Generalised Anxiety Disorder-7 (GAD-7) questionnaire, and 12-Item Short Form Health Survey (SF-12); and body-mass index (BMI). This trial was registerd with the ISRCTN registry, number ISRCTN72955454, and is complete. FINDINGS: Between Oct 7, 2015, and Dec 16, 2016, 526 eligible patients were randomly assigned to the bespoke smoking cessation intervention (n=265) or usual care (n=261). 309 (59%) participants were male, median age was 47·2 years (IQR 36·3-54·5), with high nicotine dependence (mean 24 cigarettes per day [SD 13·2]), and the most common severe mental disorders were schizophrenia or other psychotic illness (n=343 [65%]), bipolar disorder (n=115 [22%]), and schizoaffective disorder (n=66 [13%]). 234 (88%) of intervention participants engaged with the treatment programme and attended 6·4 (SD 3·5) quit smoking sessions, with an average duration of 39 min (SD 17; median 35 min, range 5-120). Verified quit data at 12 months were available for 219 (84%) of 261 usual care and 223 (84%) of 265 intervention participants. The proportion of participants who had quit at 12 months was higher in the intervention group than in the usual care group, but non-significantly (34 [15%] of 223 [13% of those assigned to group] vs 22 [10%] of 219 [8% of those assigned to group], risk difference 5·2%, 95% CI -1·0 to 11·4; odds ratio [OR] 1·6, 95% CI 0·9 to 2·9; p=0·10). The proportion of participants who quit at 6 months was significantly higher in the intervention group than in the usual care group (32 [14%] of 226 vs 14 [6%] of 217; risk difference 7·7%, 95% CI 2·1 to 13·3; OR 2·4, 95% CI 1·2 to 4·6; p=0·010). The incidence rate ratio for number of cigarettes smoked per day at 6 months was 0·90 (95% CI 0·80 to 1·01; p=0·079), and at 12 months was 1·00 (0·89 to 1·13; p=0·95). At both 6 months and 12 months, the intervention group was non-significantly favoured in the FTND (adjusted mean difference 6 months -0·18, 95% CI -0·53 to 0·17, p=0·32; and 12 months -0·01, -0·39 to 0·38, p=0·97) and MTQ questionnaire (adjusted mean difference 0·58, -0·01 to 1·17, p=0·056; and 12 months 0·64, 0·04 to 1·24, p=0·038). The PHQ-9 showed no difference between the groups (adjusted mean difference at 6 months 0·20, 95% CI -0·85 to 1·24 vs 12 months -0·12, -1·18 to 0·94). For the SF-12 survey, we saw evidence of improvement in physical health in the intervention group at 6 months (adjusted mean difference 1·75, 95% CI 0·21 to 3·28), but this difference was not evident at 12 months (0·59, -1·07 to 2·26); and we saw no difference in mental health between the groups at 6 or 12 months (adjusted mean difference at 6 months -0·73, 95% CI -2·82 to 1·36, and 12 months -0·41, -2·35 to 1·53). The GAD-7 questionnaire showed no difference between the groups (adjusted mean difference at 6 months -0·32 95% CI -1·26 to 0·62 vs 12 months -0·10, -1·05 to 0·86). No difference in BMI was seen between the groups (adjusted mean difference 6 months 0·16, 95% CI -0·54 to 0·85; 12 months 0·25, -0·62 to 1·13). INTERPRETATION: This bespoke intervention is a candidate model of smoking cessation for clinicians and policy makers to address high prevalence of smoking. The incidence of quitting at 6 months shows that smoking cessation can be achieved, but the waning of this effect by 12 months means more effort is needed for sustained quitting. FUNDING: National Institute for Health Research Health Technology Assessment Programme.


Assuntos
Transtorno Bipolar/complicações , Esquizofrenia/complicações , Abandono do Hábito de Fumar/métodos , Fumar/terapia , Adulto , Transtorno Bipolar/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Fumar/psicologia , Resultado do Tratamento , Reino Unido
11.
Neurobiol Learn Mem ; 161: 158-168, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31004802

RESUMO

Episodic memories, when reactivated, can be modified or updated by new learning. Since such dynamic memory processes remain largely unexplored in psychiatric disorders, we examined the impact of depression on episodic memory updating. Unipolar and bipolar depression patients, and age/education matched controls, first learned a set of objects (List-1). Two days later, participants in all three groups were either reminded of the first learning session or not followed by the learning of a new set of objects (List-2). Forty-eight hours later, List-1 recall was impaired in unipolar and bipolar patients compared to control participants. Further, as expected, control participants who received a reminder spontaneously recalled items from List-2 during recall of List-1, indicative of an updated List-1 memory. Such spontaneous intrusions were also seen in the unipolar and bipolar patients that received the reminder, suggesting that memory updating was unaffected in these two patient groups despite impaired recall of List 1. Unexpectedly, we observed a trend towards higher intrusions, albeit statistically insignificant, not only in the reminder but also in the no-reminder subgroups of bipolar patients. We probed this further in a second cohort by testing recall of List-2, which was also impaired in both depression groups. Again bipolar patients showed intrusions, but this time in the reverse order from List-1 into List-2, independent of a reminder. Taken together, despite impaired recall, updating of episodic memories was intact and unidirectional in unipolar depression. In contrast, indiscriminate updating, as evidenced by bidirectional interference between episodic memories, was seen in bipolar depression. These findings reveal a novel distinction between unipolar versus bipolar depression using a reactivation-dependent memory updating paradigm.


Assuntos
Transtorno Bipolar/fisiopatologia , Transtorno Depressivo/fisiopatologia , Transtornos da Memória/fisiopatologia , Memória Episódica , Rememoração Mental/fisiologia , Adolescente , Adulto , Transtorno Bipolar/complicações , Estudos de Coortes , Transtorno Depressivo/complicações , Feminino , Humanos , Masculino , Transtornos da Memória/etiologia , Pessoa de Meia-Idade , Adulto Jovem
13.
Medicine (Baltimore) ; 98(17): e15287, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027088

RESUMO

RATIONALE: Topiramate is a novel antiepileptic drug that is used as an adjunctive in the treatment of partial and secondary generalized seizures. In recent years, psychiatrists have paid more attention to topiramate as a mood stabilizer and as an agent for treating eating disorders, especially in binge eating disorder (BED) and bulimia nervosa. PATIENT CONCERNS AND DIAGNOSES: Herein, we report a case of topiramate precipitating a manic episode in a bipolar patient comorbid with BED, who complained of emotional instability and binge-eating behaviors. DIAGNOSES: In this patient, acute manic episode was induced by topiramate treatment at a daily dose of 75 mg for three days. INTERVENTIONS: The dose of topiramate was decreased to 25 mg per day promptly, and the patient gradually became calm but the BED symptoms recurred, then the dose of topiramate was increased to 50 mg per day again. Meanwhile, the dosage of quetiapine was escalated up to 500 mg per night to stabilize her mood. OUTCOMES: With a combination of quetiapine 500 mg per night and topiramate 50 mg per day, the emotion and eating problems of this patient concurrently improved. LESSONS: These findings indicated that patients with a history of bipolar disorder and comorbid BED have a tendency to develop manic episode when taking topiramate. Careful monitoring of mood alterations after topiramate supplement to mood stabilizers is necessary in this population.


Assuntos
Anticonvulsivantes/efeitos adversos , Transtorno da Compulsão Alimentar/complicações , Transtorno Bipolar/complicações , Progressão da Doença , Topiramato/efeitos adversos , Feminino , Humanos , Adulto Jovem
14.
Int J Soc Psychiatry ; 65(4): 300-304, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30977426

RESUMO

BACKGROUND: Occupational functioning is severely impaired in patients with bipolar disorder (BD). Work motivation (WM), defined as the psychological processes that determine the direction, intensity, and persistence of action within the work, is an essential component of work-related functioning. AIM: To assess whether WM is affected in patients with BD and which clinical and sociodemographic factors are related to low WM. METHODS: In all, 95 euthymic BD patients were invited to answer the Motivation for Work Questionnaire and the Rating Scale on Subjective Cognitive Deficits in Bipolar Disorder (COBRA). RESULTS: A total of 49.5% ( n = 47) of the patients were classified in the Low Motivated (LM) group. Unemployment and the report of more subjective cognitive complaints were predictors of poor WM in this sample ((OR) = 3.01 and 7.10, respectively). CONCLUSIONS: Perceived cognitive deficits related to the disorder and current unemployment negatively impact WM in patients with BD. In addition to symptomatic recovery, the need of the inclusion of personal and occupational areas in the comprehensive treatment of patients with BD is necessary.


Assuntos
Transtorno Bipolar/complicações , Transtornos Cognitivos/complicações , Emprego/psicologia , Motivação , Adulto , Transtorno Bipolar/psicologia , Transtornos Cognitivos/psicologia , Feminino , Humanos , Satisfação no Emprego , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Testes Neuropsicológicos , Inquéritos e Questionários
15.
Med Sci Monit ; 25: 1760-1768, 2019 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-30846676

RESUMO

BACKGROUND There have been few studies published on the prevalence of severe depressive episode in people with type 2 diabetes (T2DM) or its role in adherence to dietary recommendations. We examined the Polish National Health Fund (NFZ) database estimates of all medical visits from 2010 to 2017 to determine the trend and the epidemiology of severe depressive episode in T2DM. MATERIAL AND METHODS The NFZ database was used. We defined the T2DM group diagnosed with both T2DM and severe depressive episode according to the ICD-10 codes. The annual prevalence of severe depressive episode was estimated according to the T2DM diagnosis status, and the age groups were stratified into 8 groups. RESULTS Relative risk for depression (regardless of severity of symptoms) in T2DM is 1.347 [95%CI: 1.342-1.353]. The frequency trend of severe depressive episode with or without psychotic symptoms remains relatively stable. In the case of mild and moderate depressive episode, a downward trend was noted, but they are still the most frequent mood disorders diagnosed. Patients with T2DM aged 20 to 40, for whom the peak of coexistence of these illnesses was noted, are the group particularly vulnerable to depression. Depression also remains on a relatively high but stable level for patients over 60 years of age. CONCLUSIONS The coexistence of depressive episodes in T2DM is a key challenge for medicine and public health. Measures aimed at early identification of patients with T2DM prone to depression need to be taken. Creating multidisciplinary care teams in diabetes management is also necessary.


Assuntos
Depressão/epidemiologia , Depressão/psicologia , Diabetes Mellitus Tipo 2/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtorno Bipolar/complicações , Transtorno Bipolar/psicologia , Criança , Depressão/complicações , Transtorno Depressivo/complicações , Transtorno Depressivo/psicologia , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Polônia , Prevalência , Transtornos Psicóticos/complicações , Transtornos Psicóticos/psicologia , Estudos Retrospectivos , Adulto Jovem
16.
Curr Psychiatry Rep ; 21(3): 14, 2019 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-30826893

RESUMO

PURPOSE OF REVIEW: Disruptions in circadian rhythms are believed to underlie the illness course of bipolar disorder (BD). This review evaluates recent studies on the treatment of circadian dysfunction in BD. RECENT FINDINGS: Targeted social rhythm therapy may be useful for bipolar depression though some studies suggest that a non-targeted psychosocial or pharmacological intervention may be just as efficacious. Lithium holds potential for addressing circadian dysfunction in BD. Blue-blocking therapy may be useful for mania and midday bright light therapy may relieve depression. CONCLUSIONS: Psychosocial, pharmacological, and light-based approaches are promising avenues for treating circadian dysfunction in BD.


Assuntos
Transtorno Bipolar/fisiopatologia , Transtorno Bipolar/terapia , Ritmo Circadiano/efeitos dos fármacos , Ritmo Circadiano/efeitos da radiação , Transtorno Bipolar/complicações , Transtorno Bipolar/psicologia , Depressão/complicações , Depressão/fisiopatologia , Depressão/terapia , Transtorno Depressivo/complicações , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/terapia , Humanos , Compostos de Lítio/uso terapêutico , Fototerapia
17.
Eat Behav ; 33: 30-33, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30852343

RESUMO

PURPOSE: To examine the potential factor structure of the Eating Disorder Diagnostic Scale (EDDS) in a sample of individuals with bipolar disorder. METHOD: Exploratory common factor analyses were conducted in a sample of 1031 people with bipolar disorder as defined by the Structured Clinical Interview for DSM-IV-TR. RESULTS: Approximately 27% of participants had a comorbid eating disorder. Exploratory factor analysis yielded a 3 factor solution (i.e., shape/weight concerns; binge eating behaviors, compensatory behavior). CONCLUSIONS: The 3-factor solution of the EDDS in a bipolar disorder sample is consistent with major eating disorder symptom domains. Future research is necessary to replicate these findings in eating disorder samples with diverse comorbid psychopathology.


Assuntos
Anorexia Nervosa/psicologia , Transtorno da Compulsão Alimentar/psicologia , Transtorno Bipolar/psicologia , Bulimia Nervosa/psicologia , Comportamento Alimentar/psicologia , Adulto , Anorexia Nervosa/complicações , Anorexia Nervosa/epidemiologia , Transtorno da Compulsão Alimentar/complicações , Transtorno da Compulsão Alimentar/epidemiologia , Transtorno Bipolar/complicações , Bulimia Nervosa/complicações , Bulimia Nervosa/epidemiologia , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicopatologia
18.
J Affect Disord ; 249: 262-269, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30784723

RESUMO

BACKGROUND: Bipolar disorder is a chronic, episodic mental illness, affecting around 2.4% of the population worldwide. Psychological and/or physiological comorbidities are a common consequence, and osteoporosis is one such possible comorbidity. Thus, this systematic review aimed to collate, evaluate, and discuss the literature examining the link between bipolar disorder and bone health. METHODS: We conducted an e-search of PubMed/OVID/MEDLINE, PsychINFO and CINAHL to identify studies that investigated associations between bipolar disorder and bone in adults aged ≥18. Two reviewers determined eligibility according to pre-determined criteria, and methodological quality was assessed using a previously published methodological scoring system. Due to heterogeneity, a best-evidence synthesis was performed. RESULTS: Our search yielded 1409 articles, of which three (all cohorts) met predetermined criteria. The studies from Taiwan and the United States of America analysed administrative data, albeit spanning different years, and comprised a total of 344,497 participants. No studies investigating bone quantity or quality were identified. Bipolar disorder was associated with an increased risk of fracture (range 20-80%); and fracture-free survival time for those with bipolar disorder decreased substantially with advancing age, and for women (10-30% shorter than men). Fracture incidence per 1000 person years (py) was 21.4 and 10.8 in those with and without bipolar disorder, respectively. LIMITATIONS: Limited data and marked methodological heterogeneity prevented the pooling of these data for a numerical synthesis. CONCLUSIONS: Increased fracture risk was observed in individuals with bipolar disorder, independent of older age, sex, comorbidities and medication use. The operative mechanisms, risk and treatment factors warrant further enquiry.


Assuntos
Transtorno Bipolar/fisiopatologia , Densidade Óssea , Fraturas Ósseas/etiologia , Osteoporose/complicações , Adulto , Transtorno Bipolar/complicações , Osso e Ossos/fisiopatologia , Comorbidade , Feminino , Humanos , Masculino
19.
J Clin Psychiatry ; 80(2)2019 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-30786180

RESUMO

OBJECTIVE: This post hoc analysis of the BRIDGE-II-MIX study is aimed at evaluating affective lability (AL) as a possible clinical feature of mixed depression and assessing the relationship with atypical depressive features, particularly mood reactivity (MR). METHODS: In the BRIDGE-II-MIX multicenter, cross-sectional study, 2,811 individuals suffering from a major depressive episode (MDE; DSM-IV-TR criteria), in the context of bipolar I or II disorder (BD-I, BD-II, respectively) or major depressive disorder, were enrolled between June 2009 and July 2010. Patients with (MDE-AL, n = 694) and without (MDE-noAL, n = 1,883) AL and with (MDE-MR, n = 1,035) or without (MDE-noMR, n = 1,542) MR were compared through χ² test or Student t test. Stepwise backward logistic regression models, respectively testing AL and MR as the dependent variable, were performed to differentiate the 2 clinical constructs. RESULTS: AL was positively associated with BD-I (P < .001) and BD-II (P < .001), with DSM-5 mixed (DSM-5-MXS) (P < .001) and atypical (DSM-5-AD) features (P < .001) and negatively associated with MDD (P < .001). In the logistic regression models, MR was the variable most significantly associated with AL and vice versa (P < .001 for both). AL was positively associated with severity of mania and DSM-5-MXS and negatively correlated with severity of depression, while MR was better predicted by atypical symptoms such as hyperphagia, hypersomnia, and leaden paralysis and correlated with both comorbid anxiety disorders and DSM-5-MXS. CONCLUSIONS: Mixed and atypical depression may lie on the same continuum. MR and AL could represent the underlying matrix, bridging the gap between mixed and atypical depression.


Assuntos
Transtorno Bipolar/psicologia , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Adulto , Transtorno Bipolar/complicações , Estudos Transversais , Depressão/complicações , Transtorno Depressivo Maior/complicações , Feminino , Humanos , Masculino
20.
Bipolar Disord ; 21(5): 428-436, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30729637

RESUMO

OBJECTIVES: Lithium and quetiapine are known to be effective treatments for bipolar disorder. However, little information is available to inform prediction of response to these medications. Machine-learning methods can identify predictors of response by examining variables simultaneously. Further evaluation of models on a test sample can estimate how well these models would generalize to other samples. METHODS: Data (N = 482) were drawn from a randomized clinical trial of outpatients with bipolar I or II disorder who received adjunctive personalized treatment plus either lithium or quetiapine. Elastic net regularization (ENR) was used to generate models for lithium and quetiapine; these models were evaluated on a test set. RESULTS: Predictions from the lithium model explained 17.4% of the variance in actual observed scores of patients who received lithium in the test set, while predictions from the quetiapine model explained 32.1% of the variance of patients that received quetiapine. Of the baseline variables selected, those with the largest parameter estimates were: severity of mania; attention-deficit/hyperactivity disorder (ADHD) comorbidity; nonsuicidal self-injurious behavior; employment; and comorbidity with each of two anxiety disorders (social phobia/society anxiety and agoraphobia). Predictive accuracy of the ENR model outperformed the simple and basic theoretical models. CONCLUSION: ENR is an effective approach for building optimal and generalizable models. Variables identified through this methodology can inform future research on predictors of response to lithium and quetiapine, as well as future modeling efforts of treatment choice in bipolar disorder.


Assuntos
Antipsicóticos/administração & dosagem , Transtorno Bipolar/tratamento farmacológico , Compostos de Lítio/administração & dosagem , Modelos Biológicos , Fumarato de Quetiapina/administração & dosagem , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno Bipolar/complicações , Comorbidade , Feminino , Humanos , Aprendizado de Máquina , Masculino , Medicina de Precisão , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
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