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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 837-840, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018115

RESUMO

Gastric motility is in part coordinated by bio-electrical slow waves. The wavefront orientation of the slow wave contains vital physiological information about the motility condition of the gastrointestinal system. Dysmotility was shown to be associated with dysrhythmic propagation of the slow wave. The most commonly used method to detect wavefront orientation is computationally expensive because of the involvement of activation time identification. The information of local directionality contained in bipolar slow wave recordings could be used to detect the wavefront orientation. An algorithm called bipolar direction detection was developed to utilize the information contained in the bipolar slow wave recordings. Bipolar recordings were constructed by subtracting the unipolar in vivo recordings of directional electrode pairs. Then, time delay information was used to detect the wavefront direction. The algorithm was verified using synthetic data and validated using experimental data. Ten high-resolution in vivo slow wave signals from 5 pigs were recorded for a duration of 2 minutes. The performance was compared against the semi-automated approach, resulting in an average angle error of 20° for the experimental data. The algorithm was able to detect slow wave wavefront orientation with minimal errors rapidly.Clinical relevance-The ability to rapidly detect slow wave propagation direction will enable effective analysis of large data sets, through which we can obtain a better understanding of functional motility disorders and help with diagnosis and treatment.


Assuntos
Transtorno Bipolar , Estômago , Algoritmos , Animais , Transtorno Bipolar/diagnóstico , Eletrodos , Reprodução , Suínos
2.
Psychiatr Danub ; 32(Suppl 1): 58-63, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890364

RESUMO

INTRODUCTION: The present retrospective study investigated clinical correlates of the revolving door (RD) phenomenon in a population of subjects affected by Bipolar Disorders (BDs). SUBJECTS AND METHODS: Medical records of subjects with BDs admitted to a psychiatric inpatient unit over a 5-year period of time were retrospectively reviewed and clinical data were extracted into an electronic dataset. "Revolving Door Subjects" (RDS) were defined as those who presented three or more "Revolving Door Hospitalizations" (RDH) during twelve months. Features of RDH were compared with non-RDH in order to identify characteristics associated with RD phenomenon and possible risk factors for readmission. To explore predictors of RDH, a stepwise backword logistic regression model was built, including the variables that were significantly associated with RDH in the bivariate analyses. RESULTS: In our sample of 176 subjects affected by BDs, 53 (19.9%) RDH were identified. In the RDH group, a higher prevalence of mixed episodes (p=0.029) and medical co-morbidities (p=0.004) was detected. Subjects with repeated hospitalizations were more often committed to psychiatric residential facilities at discharge (p=0.002). Treatment features related to RDH were represented by a higher prescription rate of atypical antipsychotics (p=0.030), benzodiazepines (p=0.001) and antidepressants (p=0.048). CONCLUSIONS: Findings from the present study suggest that the early identification and treatment of medical comorbidities and specific clinical features of BDs may help reducing the RD phenomenon in this population of subjects.


Assuntos
Antipsicóticos , Transtorno Bipolar , Transtornos Mentais , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Hospitalização , Humanos , Pacientes Internados , Estudos Retrospectivos
3.
PLoS One ; 15(8): e0231995, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833958

RESUMO

Current practice of assessing mood episodes in affective disorders largely depends on subjective observations combined with semi-structured clinical rating scales. Motor activity is an objective observation of the inner physiological state expressed in behavior patterns. Alterations of motor activity are essential features of bipolar and unipolar depression. The aim was to investigate if objective measures of motor activity can aid existing diagnostic practice, by applying machine-learning techniques to analyze activity patterns in depressed patients and healthy controls. Random Forrest, Deep Neural Network and Convolutional Neural Network algorithms were used to analyze 14 days of actigraph recorded motor activity from 23 depressed patients and 32 healthy controls. Statistical features analyzed in the dataset were mean activity, standard deviation of mean activity and proportion of zero activity. Various techniques to handle data imbalance were applied, and to ensure generalizability and avoid overfitting a Leave-One-User-Out validation strategy was utilized. All outcomes reports as measures of accuracy for binary tests. A Deep Neural Network combined with SMOTE class balancing technique performed a cut above the rest with a true positive rate of 0.82 (sensitivity) and a true negative rate of 0.84 (specificity). Accuracy was 0.84 and the Matthews Correlation Coefficient 0.65. Misclassifications appear related to data overlapping among the classes, so an appropriate future approach will be to compare mood states intra-individualistically. In summary, machine-learning techniques present promising abilities in discriminating between depressed patients and healthy controls in motor activity time series.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Atividade Motora/fisiologia , Adulto , Algoritmos , Depressão/diagnóstico , Depressão/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Aprendizado de Máquina , Masculino , Transtornos do Humor/psicologia , Redes Neurais de Computação , Sensibilidade e Especificidade
4.
J Affect Disord ; 277: 337-340, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32858315

RESUMO

BACKGROUND: In December 2019, the novel coronavirus (SARS-CoV-2) infection was first reported in Wuhan city, central China, which has spread rapidly. The common clinical features of patients with SARS-CoV-2 infection included fever, fatigue, and damage to the respiratory or digestive system. However, it is still unclear whether SARS-CoV-2 infection could cause damage to the central nervous system (CNS) inducing psychiatric symptoms. CASE REPORT: Herein, we present the first case of SARS-CoV-2 infection with manic-like symptoms and describe the diagnosis, clinical course, and treatment of the case, focusing on the identifications of SARS-CoV-2 in the specimen of cerebrospinal fluid (CSF). The patient developed manic-like symptoms when his vital signs recovered on illness day 17. After manic-like attack, the detection of SARS-CoV-2 specific IgG antibody in CSF was positive, while the reverse transcriptase-polymerase chain reaction (RT-PCR) on CSF for the SARS-CoV-2 was negative. The patient received Olanzapine for treatment and his mood problems concurrently improved as indicated by scores of Young Manic Rating Scale (YMRS). LIMITATION: This is a single case report only, and the RT-PCR test for SARS-CoV-2 in CSF was not performed simultaneously when SARS-CoV-2 was positive in samples of sputum and stool. CONCLUSION: This first case of COVID-19 patient with manic-like symptoms highlights the importance of evaluation of mental health status and may contribute to our understanding of potential risk of CNS impairments by SARS-CoV-2 infection.


Assuntos
Transtorno Bipolar/etiologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Anticorpos Antivirais/líquido cefalorraquidiano , Antipsicóticos/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus , Transtorno Bipolar/líquido cefalorraquidiano , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Encéfalo/diagnóstico por imagem , Dor no Peito , China , Técnicas de Laboratório Clínico , Cobicistat/uso terapêutico , Infecções por Coronavirus/líquido cefalorraquidiano , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Darunavir/uso terapêutico , Dispneia , Febre , Glucocorticoides/uso terapêutico , Humanos , Indóis/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Moxifloxacina/uso terapêutico , Olanzapina/uso terapêutico , Pandemias , Faringite , Pneumonia Viral/líquido cefalorraquidiano , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Reação em Cadeia da Polimerase Via Transcriptase Reversa
5.
Epidemiol Psychiatr Sci ; 29: e144, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32684190

RESUMO

AIMS: Establishing the minimum clinically important difference (MCID) in functioning and cognition is essential to the interpretation of the research and clinical work conducted in bipolar disorders (BD). The present study aimed to estimate the MCID for the Functioning Assessment Short Test (FAST) and a battery of neuropsychological tests in BD. METHODS: Anchor-based and distributive methods were used to estimate the MCID for the FAST and cognition using data from a large, multicentre, observational cohort of individuals with BD. The FAST and cognition were linked with the Clinical Global Impressions Scale-Severity (CGI-S) and Global Assessment of Functioning (GAF) using an equipercentile method. The magnitude of the standard error measurement (s.e.m.) provided another estimate of the MCID. RESULTS: In total, 570 participants were followed for 2 years. Cross-sectional CGI-S and GAF scores were linked to a threshold ⩽7 on the FAST for functional remission. The MCID for the FAST equalled 8- or 9-points change from baseline using the CGI-S and GAF. One s.e.m. on the FAST corresponded to 7.6-points change from baseline. Cognitive variables insufficiently correlated with anchor variables (all ρ <0.3). One s.e.m. for cognitive variables corresponded to a range of 0.45 to 0.93-s.d. change from baseline. CONCLUSIONS: These findings support the value of the estimated MCID for the FAST and cognition and may be a useful tool to evaluate cognitive and functional remediation effects and improve patient functional outcomes in BD. The CGI-S and GAF were inappropriate anchors for cognition. Further studies may use performance-based measures of functioning instead.


Assuntos
Transtorno Bipolar/diagnóstico , Transtornos Cognitivos/diagnóstico , Cognição/fisiologia , Testes Neuropsicológicos/estatística & dados numéricos , Transtorno Bipolar/psicologia , Transtornos Cognitivos/psicologia , Estudos Transversais , Função Executiva , Feminino , Humanos , Masculino , Memória de Curto Prazo , Avaliação de Resultados em Cuidados de Saúde , Tempo de Reação , Comportamento Social
6.
J Clin Psychiatry ; 81(4)2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32526106

RESUMO

OBJECTIVE: To evaluate the prevalence and the predictors of depressive switch in patients with bipolar I disorder (BD-I) requiring the initiation or change (but not a dose change) of treatment with oral antipsychotics or mood stabilizers for mania or mixed-mania. METHODS: This was a 3-month, prospective, noninterventional study conducted in 34 Italian psychiatric centers from April 2012 to April 2013. The study sample comprised 234 patients aged 18 years or older presenting with a manic episode according to DSM-IV-TR criteria. Patients were assessed at baseline and at follow-up visits by a variety of measures, including the Clinical Global Impressions scale for use in bipolar illness (CGI-BP). The primary outcome measure was depressive switch, which was defined a posteriori on the basis of a Montgomery-Åsberg Depression Rating Scale total score ≥ 15 and a Young Mania Rating Scale total score < 10 at week 12. A stepwise backward logistic regression model was used to explore the effect of clinical variables on the occurrence of depressive switch. RESULTS: According to the definition used in this study, 26 (11.1%) of 234 patients switched to depression. The variables associated with a depressive switch were prescription of both first- and second-generation antipsychotics (P = .017), depressive-predominant polarity (P = .012), CGI-BP total score at baseline evaluation (P = .024), depressive temperament (P = .063), and age at evaluation (P = .020). CONCLUSIONS: Depressive switch was observed in about 1 of 10 of the BD-I patients. Our results suggest an association between the depressive switch and treatment with both first- and second-generation antipsychotics, depressive-predominant polarity, greater severity of the symptomatology, and older age at evaluation. Further randomized controlled studies are needed to confirm possible predictors of a depressive switch during mania.


Assuntos
Transtorno Bipolar/diagnóstico , Depressão/epidemiologia , Adolescente , Adulto , Fatores Etários , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
7.
PLoS One ; 15(5): e0232459, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32442169

RESUMO

BACKGROUND: The association between temperament characteristics and mood disorders has gained much attention in recent years. The Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A) is a self-rating scale measuring 5 affective temperament dimensions. In this study, we aimed to clarify whether each affective temperament of TEMPS-A is a differentiating factor between major depressive disorder (MDD), bipolar I disorder (BD-I), and bipolar II disorder (BD-II), and analyzed the utility of TEMPS-A in their differential diagnosis in a clinical setting. METHODS: A total of 346 patients (MDD, n = 176; BD-II, n = 112; BD-I, n = 58) filled out TEMPS-A. To assess the patients' mood state at the time of temperament assessment, Patient Health Questionnaire-9 (PHQ-9) and Young Mania Rating Scale (YMRS) were also conducted. RESULTS: Multivariate logistic regression analysis demonstrated that cyclothymic and anxious temperament scores were significant factors differentiating the diagnosis of BD-I and BD-II from the diagnosis of MDD, and hyperthymic temperament score was a specific factor for the differential diagnosis of BD-I versus the diagnosis of BD-II. LIMITATIONS: All of the patients included in our study received treatment in large general hospitals. Because the nature of the present study was cross-sectional, some MDD subjects in this study might have unrecognized BD-I/BD-II. CONCLUSIONS: Cyclothymic and anxious temperament scores assessed by TEMPS-A might enable differentiation between MDD and BD, and hyperthymic temperament score on TEMPS-A might be useful in distinguishing between BD-I and BD-II.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Inventário de Personalidade , Temperamento , Adulto , Afeto , Ansiedade , Transtorno Bipolar/classificação , Transtorno Bipolar/psicologia , Estudos Transversais , Transtorno Depressivo Maior/psicologia , Diagnóstico Diferencial , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Autorrelato
8.
J Fr Ophtalmol ; 43(5): e157-e166, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32381369

RESUMO

Major depressive disorder, bipolar disorder and schizophrenia are currently among the most common psychiatric disorders, known to constitute a serious public health issue in terms of morbidity, mortality and functional handicap. Their pathophysiology is still unclear, but there is now increasing evidence supporting the existence of abnormalities of neurotransmission. As the retina is an extension of the central nervous system, it may be an interesting site of study which might provide a better understanding of the pathophysiology of psychiatric disorders. Several studies have demonstrated retinal abnormalities, with abnormal cone and rod responses on electroretinography (ERG), suggesting a process of functional neuronal loss, structurally supported by a decrease in the retinal nerve fiber layer thickness (RNFL) on optical coherence tomography (OCT), which suggests involvement of the molecular signal pathways of neurotransmission. These tests could be useful tools for diagnosing and monitoring psychiatric disorders. This article is an overview of the literature on retinal abnormalities observed in patients with major depressive disorder, bipolar disorder or schizophrenia, and discusses how they could be pathophysiologic markers.


Assuntos
Transtorno Bipolar/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Retina/diagnóstico por imagem , Retina/patologia , Retina/fisiopatologia , Esquizofrenia/fisiopatologia , Transtorno Bipolar/complicações , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Eletrorretinografia , Humanos , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Transmissão Sináptica/fisiologia , Tomografia de Coerência Óptica
9.
BMC Psychiatry ; 20(1): 207, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32380965

RESUMO

BACKGROUND: Affective disorders, such as major depressive (MDD), bipolar I (BD I) and II (BD II) disorders, are overlapped at a continuum, but their exact loci are not clear. The self-reports from patients with affective disorders might help to clarify this issue. METHODS: We invited 738 healthy volunteers, 207 individuals with BD I, 265 BD II, and 192 MDD to answer a 79 item-MATRIX about on-going affective states. RESULTS: In study 1, all 1402 participants were divided random-evenly and gender-balanced into two subsamples; one subsample was used for exploratory factor analysis, and another for confirmatory factor analysis. A structure-validated inventory with six domains of Overactivation, Psychomotor Acceleration, Distraction/ Impulsivity, Hopelessness, Retardation, and Suicide Tendency, was developed. In study 2, among the four groups, MDD scored the highest on Retardation, Hopelessness and Suicide Tendency, whereas BD I on Distraction/ Impulsivity and Overactivation. CONCLUSION: Our patients confirmed the affective continuum from Suicide Tendency to Overactivation, and described the different loci of MDD, BD I and BD II on this continuum.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Inquéritos Epidemiológicos/normas , Ideação Suicida , Adolescente , Adulto , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto Jovem
10.
Int J Med Inform ; 138: 104131, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32305023

RESUMO

BACKGROUND: Bipolar disorder (BD) is a chronic illness with a high recurrence rate. Smartphones can be a useful tool for detecting prodromal symptoms of episode recurrence (through real-time monitoring) and providing options for early intervention between outpatient visits. AIMS: The aim of this systematic review is to overview and discuss the studies on the smartphone-based systems that monitor or detect the phase change in BD. We also discuss the challenges concerning predictive modelling. METHODS: Published studies were identified through searching the electronic databases. Predictive attributes reflecting illness activity were evaluated including data from patients' self-assessment ratings and objectively measured data collected via smartphone. Articles were reviewed according to PRISMA guidelines. RESULTS: Objective data automatically collected using smartphones (voice data from phone calls and smartphone-usage data reflecting social and physical activities) are valid markers of a mood state. The articles surveyed reported accuracies in the range of 67% to 97% in predicting mood status. Various machine learning approaches have been analyzed, however, there is no clear evidence about the superiority of any of the approach. CONCLUSIONS: The management of BD could be significantly improved by monitoring of illness activity via smartphone.


Assuntos
Algoritmos , Transtorno Bipolar/diagnóstico , Aprendizado de Máquina , Smartphone , Análise de Dados , Feminino , Humanos , Masculino , Monitorização Fisiológica , Inquéritos e Questionários
11.
Nervenarzt ; 91(3): 207-215, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32125440

RESUMO

BACKGROUND: Bipolar disorder (BD) is a relevant psychiatric disorder, which requires early identification and treatment. OBJECTIVE: What are the guideline-concordant diagnostic and early recognition procedures regarding BD? RESULTS: The current German S3 guidelines on BD are based on the ICD-10. The multiaxial and dimensional description should include disorder-relevant somatic, psychological and social factors as well as the level of functional impairment. A BD can be diagnosed when at least two affective episodes have occurred, of which at least one must have been hypomanic, manic or mixed. In people considered at increased risk for BD, (subsyndromal) symptoms should be identified via the patient history and screening tools, e.g. the hypomania checklist 32 (HCL-32) and the mood disorder questionnaire (MDQ). The differential diagnosis of BD should exclude unipolar depression, dysthymia, cyclothymia, schizophrenia, schizoaffective disorders and substance-induced or organically related BD. The risk of comorbid psychiatric disorders is increased 8-13-fold in BD. The most common somatic disorders include obesity, cardiovascular diseases, metabolic syndrome, diabetes, musculoskeletal disorders and migraine. Observation of the course by the clinician and the patient (e.g. mood charting) as well as examinations before and during pharmacological treatment should be part of the treatment plan. Early recognition of BD during a so-called prodromal stage is currently not reliably possible. In the case of a clinical suspicion, e.g. due to subsyndromal (hypo)manic symptoms, comorbid conditions should be addressed and symptom-based psychotherapeutic interventions should be considered. CONCLUSION: Early recognition and accurate diagnosis of BD, which enables adequate and timely treatment, can improve outcomes.


Assuntos
Transtorno Bipolar , Diagnóstico Precoce , Transtorno Bipolar/diagnóstico , Diagnóstico Diferencial , Alemanha , Humanos , Inquéritos e Questionários/normas
12.
PLoS One ; 15(3): e0230674, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32218598

RESUMO

BACKGROUND: To estimate the potential gain in life expectancy from addressing modifiable risk factors for all-cause mortality (excluding suicide and deaths from accidents or violence) across specific serious mental illness (SMI) subgroups, namely schizophrenia, schizoaffective disorders, and bipolar disorders in a Western population. METHODS: We have used relative risks from recent meta-analyses to estimate the population attribution fraction (PAF) due to specific modifiable risk factors known to be associated with all-cause mortality within SMI. The potential gain in life expectancy at birth, age 50 and age 65 years were assessed by estimating the combined effect of modifiable risk factors from different contextual levels (behavioural, healthcare, social) and accounting for the effectiveness of existing interventions tackling these factors. Projections for annual gain in life expectancy at birth during a two-decade was estimated using the Annual Percentage Change (APC) formula. The predicted estimates were based on mortality rates for year 2014-2015. RESULTS: Based on the effectiveness of existing interventions targeting these modifiable risk factors, we estimated potential gain in life expectancy at birth of four (bipolar disorders), six (schizoaffective disorders), or seven years (schizophrenia). The gain in life expectancy at age 50 years was three (bipolar disorders) or five (schizophrenia and schizoaffective disorders) years. The projected gain in life expectancy at age 65 years was three (bipolar disorders) or four (schizophrenia and schizoaffective disorders) years. CONCLUSIONS: The implementation of existing interventions targeting modifiable risk factors could narrow the current mortality gap between the general and the SMI populations by 24% (men) to 28% (women). These projections represent ideal circumstances and without the limitation of overestimation which often comes with PAFs.


Assuntos
Transtorno Bipolar/diagnóstico , Expectativa de Vida , Transtornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Idoso , Transtorno Bipolar/mortalidade , Transtorno Bipolar/patologia , Bases de Dados Factuais , Feminino , Humanos , Estilo de Vida , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Transtornos Psicóticos/mortalidade , Transtornos Psicóticos/patologia , Fatores de Risco , Esquizofrenia/mortalidade , Esquizofrenia/patologia , Índice de Gravidade de Doença , Taxa de Sobrevida , Reino Unido
13.
Nervenarzt ; 91(3): 193-206, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32076760

RESUMO

Since the first publication of the guideline in 2012, which included critically reviewed evidence up to 2010, several hundred articles with new evidence were published and some topics of the clinical consensus needed to be reconsidered. Therefore, it was urgently necessary to revise the guideline to bring them up to date. In this article important revisions and updates are presented and the chances and limitations of the development of the guidelines and their implementation are discussed.


Assuntos
Transtorno Bipolar , Guias como Assunto , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/terapia , Alemanha , Guias como Assunto/normas , Humanos
14.
PLoS One ; 15(2): e0229539, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32107501

RESUMO

BACKGROUND: Bipolar disorder (BPD) is a major mental disorder which not only affects the personal and social functioning of an individual, but also inflicts a huge economic burden on the family. Yet, the study of BPD in Bangladesh is rare and poorly documented. Responding to the dire need, we conducted a new study to determine the prevalence of, and detect the associated factors of, BPD among married women in Rajshahi City, Bangladesh. METHODS: We conducted a cross-sectional study, selecting households in Rajshahi City using a multi-stage random sampling design. The data consisted of 279 married women, who were screened for BPD using the bipolar spectrum diagnostic scale (BSDS). Frequency distribution, chi-square test and binary logistic regression model were used respectively to determine the prevalence, identify the associated factors and quantify their effects on BPD. RESULTS: The prevalence of BPD among married women in Rajshahi City was 2.5%, with an additional 7.2% classified as probable BPD. A binary logistic regression analysis established the following six main factors of BPD: (1) comorbid mental disorder [AOR = 8.232, 95% CI = (1.397, 50.000), p<0.05]; (2) poor relationship with husband [AOR = 11.775, 95% CI = (2.070, 66.667), p<0.01]; (3) poverty [AOR = 1.600, 95% CI = (2.086, 122.709), p<0.01]; (4) high educational level [AOR = 0.177, 95% CI = (0.037, 0.843), p<0.05]; (5) lack of immediate treatment if sick [AOR = 2.941, 95% CI = (1.259, 6.871), p<0.05]; and (6) death of beloved one/s [AOR = 2.768, 95% CI = (1.130, 6.777), p<0.05]. LIMITATIONS: Our survey involved self-reporting, which is typically affected by differing levels of understanding and bias. Also, a cross-sectional, observational study cannot establish an actual cause-and-effect relationship. Some other potentially important factors such as environment, lifestyle, familial customs, effects of drugs, treatment options and outcomes, etc. were not studied. Also, save mental disorder, all other comorbidities remained undocumented. CONCLUSION: This study laid down the foundation for conducting further research on identifying different factors affecting BPD, and for studying other issues related to BPD among married women in Bangladesh. Among such factors are familial environment and culture, comorbidities, treatment options, treatment outcomes, biochemical feature, environmental factors, etc. This study also recommends that, while treating BPD patients, health professionals should focus on comorbidities and family matters.


Assuntos
Transtorno Bipolar/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bangladesh/epidemiologia , Transtorno Bipolar/diagnóstico , Cidades , Comorbidade , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Casamento , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Cônjuges , Inquéritos e Questionários , Adulto Jovem
15.
Actas esp. psiquiatr ; 48(1): 28-35, ene.-feb. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-188330

RESUMO

INTRODUCCIÓN: La estabilidad de un diagnóstico psiquiátrico en el tiempo representa la mejor prueba para validarlo y es útil para predecir el curso de un trastorno. El diagnóstico de Trastorno Bipolar presenta gran variabilidad a lo largo del tiempo y son pocas las investigaciones que han evaluado el impacto de la estabilidad diagnóstica vs su cambio. MATERIAL Y MÉTODOS: Se realizó una revisión sistemática mediante búsqueda bibliográfica en Pubmed, Medline y Web of Science de artículos publicados en los últimos diez años (2008-2018), utilizando las siguientes palabras clave: stability diagnosis, bipolar disorders y mood disorders. Se seleccionaron aquellos estudios realizados en pacientes que presentaban un cuadro afectivo y/o psicótico y en los que se estudiaba la estabilidad temporal del diagnóstico. RESULTADOS: La búsqueda inicial mostró un total de 140 artículos, de los cuales 13 cumplieron los CRITERIOS DE INCLUSIÓN: Hemos encontrado que, en comparación con otros trastornos mentales, en el Trastorno Bipolar se observa una mayor validez de constructo y estabilidad a largo plazo. CONCLUSIONES: El Trastorno Bipolar en su fase inicial constituye un desafío diagnóstico y terapéutico. Pese a ello, se considera junto con la esquizofrenia una de las categorías diagnósticas más estables (el 60% de los pacientes que reciben este diagnóstico inicial se mantiene en el tiempo). La ausencia de instrumentos fiables y válidos para el diagnóstico es considerada una limitación, por lo que sería conveniente que en sucesivas clasificaciones de los trastornos mentales sigan esforzándose en que las entidades nosológicas tengan la mayor validez de constructo posible


INTRODUCTION: Stability of a diagnosis over time rep-resents the best evidence to validate psychiatric diagnoses and helps to predict the course of a disorder. The diagnosis of bipolar disorder shows large variability over time and only a few numbers of investigations have evaluated the impact of the diagnostic stability vs the change. MATERIAL AND METHODS: A systematic review was made through a literature search in Pubmed, Medline and Web of Science of the articles published in the last 10 years (2008-2018). We used the following key words; "stability diagno-sis", AND "bipolar disorders", AND "mood disorders". We selected those studies conducted in patients who presented affective and/or psychotic clinic where the stability of the diagnosis was studied over time. RESULTS: The initial search showed a total of 140 articles, 13 of which met inclusion criteria. In this review we have found that, compared to other mental disorders, Bipolar Disorder has in its favor a greater construct validity and long-term stability. CONCLUSIONS: Initial phases of Bipolar Disorder consti-tute a real diagnostic and therapeutic challenge. Despite this, it is considered, added to schizophrenia as one of the most stable diagnostic categories (60% of patients who receive this initial diagnosis remain it during time). The absence of reliable and valid instruments for diagnosis is considered as a limitation so it would be convenient that in the next classifications of mental disorders they continue striv-ing so that the nosological entities have greater construct validity posible


Assuntos
Humanos , Transtorno Bipolar/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Técnicas e Procedimentos Diagnósticos
17.
Psychiatry Res ; 284: 112781, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31986357

RESUMO

BACKGROUND: Vascular Endothelial Growth Factor (VEGF) has been implicated in the neurotrophic model of depression. We explored the potential role of VEGF in the pathophysiology of bipolar depression and potential utility as a diagnostic or outcome predictive biomarker. METHODS: In a double-blind study, treatment-resistant bipolar depressed patients received Escitalopram and were randomized to receive add-on Celecoxib (26 participants) or Placebo (21 participants). There were 32 healthy controls. Plasma levels of VEGF were determined at three timepoints over eight weeks. RESULTS: Bipolar patients had significantly higher VEGF levels at baseline compared to healthy controls. Logistic regression analysis revealed that the AUC is 0.67 and the VEGF cut point is 8.21. At all timepoints, patients receiving Celecoxib had comparable VEGF levels to those receiving Placebo. VEGF levels did not change significantly over time. Baseline VEGF was a poor predictor of treatment response with an AUC of 0.53. CONCLUSIONS: The increased VEGF in bipolar depression agrees with similar findings in major depressive disorder. A high VEGF level tended to accurately predict bipolar disorder, with apparent differential VEGF expression. Baseline VEGF did not predict treatment response, and levels did not change with treatment. Plasma VEGF may have diagnostic utility and guide personalized treatment.


Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Transtorno Bipolar/sangue , Transtorno Bipolar/tratamento farmacológico , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Fator A de Crescimento do Endotélio Vascular/sangue , Adulto , Idoso , Biomarcadores/sangue , Transtorno Bipolar/diagnóstico , Celecoxib/uso terapêutico , Citalopram/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Resultado do Tratamento , Adulto Jovem
18.
Nord J Psychiatry ; 74(5): 340-345, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31900022

RESUMO

Purpose: Higher homocysteine (HHcy) levels have been detected in bipolar disorder (BD) patients, and BD patients show circadian rhythm disorders even during remission. Here, we determined the homocysteine (Hcy) levels and chronotype of patients with BD during remission and investigated whether this was related to the clinical course of the disease. Materials and methods: In total, 80 BD outpatients were included. Clinical evaluation was conducted using the Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Pittsburgh Sleep Quality Index (PSQI) and the Morningness-Eveningness Questionnaire (MEQ). Hcy, folic acid, vitamin B12 levels and protein consumption the day before clinical evaluation were measured.Results and conclusions: HHcy was found in 11 patients (8.8%), most of whom were males (n = 8, 72.7%). During the course of BD, patients with HHcy had significantly more mixed episodes than patients without HHcy (p = .007, z = -2696). In addition, patients with HHcy had significantly lower MEQ scores than patients without HHcy (p = .04, t = 2018). There was no significant difference in chronotype between patients with and without HHcy. The HHcy group had significantly lower levels of vitamin B12 (p = .003, t = 2870). There were no statistically significant differences in daily protein intake and folic acid levels between HHcy and non-HHcy groups. Our study showed a significant relationship between the number of mixed episodes and HHcy. In terms of potential confounds, patients who abused alcohol were excluded, but alcohol consumption was not evaluated. This result should be considered in BD and should be evaluated in larger samples of BD patients.


Assuntos
Transtorno Bipolar/sangue , Transtorno Bipolar/diagnóstico , Ritmo Circadiano/fisiologia , Homocisteína/sangue , Escalas de Graduação Psiquiátrica , Adulto , Biomarcadores/sangue , Transtorno Bipolar/psicologia , Feminino , Ácido Fólico/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica/normas , Estudos Retrospectivos , Inquéritos e Questionários/normas , Vitamina B 12/sangue , Adulto Jovem
19.
J Nerv Ment Dis ; 208(2): 118-126, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985560

RESUMO

This study investigated the seroprevalence of Toxoplasma gondii in a cohort of 101 Italian inpatients affected by mood or schizophrenia-spectrum disorders and compared clinical features between seronegative and seropositive subjects. Patients diagnosed according to DSM-5 criteria underwent clinical assessments and blood collection to test parasite-specific IgG/IgM serum levels. Twenty-eight patients (27.7%) had IgG anti-T. gondii, and none had IgM antibodies. We found higher prevalence rate in patients aged 40 years or older, as compared with younger. No significant association was detected between T. gondii and a specific diagnostic category; however, bipolar disorder (BD)-II showed the highest positivity rate (40.9%). The seropositive status was significantly associated with a lower presence of psychotic symptoms, higher number of total episodes of predominant excitatory polarity, longer illness duration, and lower severity of current episode, particularly anxiety, depressive, and withdrawal/retardation symptoms. These preliminary results seem to point out an association between chronic toxoplasmosis and a specific subtype of BD.


Assuntos
Transtorno Bipolar/diagnóstico , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Toxoplasmose/diagnóstico , Toxoplasmose/psicologia , Adulto , Idoso , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/psicologia , Doença Crônica , Estudos de Coortes , Comorbidade , Correlação de Dados , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Esquizofrenia/epidemiologia , Estudos Soroepidemiológicos , Toxoplasmose/epidemiologia , Adulto Jovem
20.
Emotion ; 20(1): 37-42, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31961175

RESUMO

The current article addresses the consequences of emotion regulation (ER) for mental health. A large body of research has shown that alterations in ER are related to psychological disorders across different diagnostic categories. Because of the apparent ubiquity of ER difficulties in psychopathology, several authors have proposed that ER should be regarded as a transdiagnostic process. This article critically examines evidence regarding alterations in the use of cognitive ER strategies as a transdiagnostic process. Cognitive ER strategies are examined as 1 example of several possible ER-related processes that could be involved in psychopathology. There is consistent evidence showing that a reduced use of cognitive reappraisal and an increased use of negative rumination are present across a number of disorders, whereas increased levels of positive rumination appear to be confined to bipolar disorder. However, there is only preliminary evidence from prospective and/or experimental studies on the causal nature of altered ER strategy use in the development or maintenance of psychopathology. The article concludes by discussing future directions, including methodological and design issues, as well as implications for assessment and treatment when studying alterations in ER from a transdiagnostic perspective. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Assuntos
Regulação Emocional/fisiologia , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Humanos , Estudos Prospectivos , Psicopatologia , Ruminação Cognitiva
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