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1.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(11): 108-115, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33340305

RESUMO

However, despite successful use of lithium in the treatment of affective disorders for almost 40 years, the mechanisms of its therapeutic action are still poorly understood. This review presents and summarizes the current literature about the use of lithium in treatment of affective disorders, as well as its effects on cellular physiology, with a separate description of the effect of this ion on the functioning of nerve tissue and ion-molecular mechanisms.


Assuntos
Transtorno Bipolar , Psicofarmacologia , Transtorno Bipolar/tratamento farmacológico , Humanos , Lítio/farmacologia , Lítio/uso terapêutico , Transtornos do Humor/tratamento farmacológico
2.
Psychiatr Danub ; 32(3-4): 351-358, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370732

RESUMO

BACKGROUND: Retina is considered as a window to the brain due to the similarities in terms of development and pathologies. Optical coherence tomography (OCT) can perform quantitative examinations in the retina. In this study, we aimed to investigate the effects of drugs used in schizophrenia and bipolar disorder (BD) on retinal nerve fiber layer (RNFL) and macular thickness. SUBJECTS AND METHODS: The study included schizophrenia (n=35) and euthymic BD (n=46) patients on various medications, and age, gender matched healthy control group (n=31). For retinal evaluation, measurements of RNFL and macula were performed with Optovue RTVue Premier OCT. RESULTS: In the schizophrenia group, chlorpromazine equivalent dose of antipsychotics was a statistically significant negative predictor of left RNFL nasal superior region thickness. In the BD group, serum valproate level was a significant positive predictor of thickness in the right macular inferior outer, left macular nasal outer region, right RNFL inferotemporal, left temporal and inferotemporal regions. CONCLUSION: Since the retina consists of neurons, morphological or functional examination of retina may be beneficial for the evaluation of the effects of psychopharmalogical treatments in schizophrenia and BD. The outcome of this study implies that valproate has neuroprotective effects on the optic nerve and macula, and this finding is consistent with the literature implying neurotrophic effects of valproate.


Assuntos
Transtorno Bipolar/diagnóstico por imagem , Transtorno Bipolar/tratamento farmacológico , Retina/efeitos dos fármacos , Retina/diagnóstico por imagem , Esquizofrenia/diagnóstico por imagem , Esquizofrenia/tratamento farmacológico , Tomografia de Coerência Óptica , Adulto , Feminino , Humanos , Macula Lutea/diagnóstico por imagem , Macula Lutea/efeitos dos fármacos , Masculino , Fibras Nervosas/efeitos dos fármacos
3.
Medicine (Baltimore) ; 99(42): e22823, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080761

RESUMO

INTRODUCTION/RATIONALE: Multiple sclerosis (MS) is associated with a higher prevalence of mood and psychiatric disorders, such as bipolar disorder (BD). While mania is most often associated with BD, MS can also induce manic symptoms. However, it is crucial to distinguish which condition is causing mania since medical management is different based on its etiology. Herein, we report a case of a manic episode in a middle-aged female with a prolonged history of BD who received a recent diagnosis of MS 1 year ago. PATIENT CONCERNS: A 56-year-old female presented with an episode of mania and psychosis while receiving a phenobarbital taper for chronic lorazepam use. She had a prolonged history of bipolar type 1 disorder and depression. She showed optic neuritis and was diagnosed with MS a year prior. DIAGNOSES: The patient was diagnosed with BD-induced mania based on the absence of increased demyelination compared to previous MRI and lack of new focal or lateralizing neurologic findings of MS. INTERVENTIONS: Lithium was given for mood stabilization and decreased dosage of prior antidepressant medication. Risperidone was given for ongoing delusions. OUTCOMES: After 8 days of hospitalization, patient's mania improved but demonstrated atypical features and ongoing delusions. She was discharged at her request to continue treatment in an outpatient setting. CONCLUSION/LESSON: In BD patients with an episode of mania, MS should be included in the differential, since both conditions can cause manic symptoms. The origin of mania should be delineated through a detailed neurological exam, neuroimaging, and thorough patient-family psychiatric history for appropriate clinical treatment.


Assuntos
Transtorno Bipolar/psicologia , Esclerose Múltipla/psicologia , Antimaníacos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Feminino , Humanos , Compostos de Lítio/uso terapêutico , Pessoa de Meia-Idade , Risperidona/uso terapêutico
4.
Artigo em Inglês | MEDLINE | ID: mdl-32942345

RESUMO

Background: There is a paucity of studies on treatment of childhood-onset bipolar disorder and its associated comorbidities, which leads to a wide diversity of opinion on choice and sequencing of treatment options. Methods: From December 2018 to January 2019, a graphic depiction of medications and weekly ratings of symptoms of mania, depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and oppositional behavior that parents had rated on their 9-year-old child over a period of several years was sent to experts in child and adult bipolar disorder. These responding medical doctors (MDs, 8 child and 18 adult psychiatrists) rated a comprehensive list of medications that they would choose (and with what priority) to treat the child's now improved mood (mania and depression) but continued mild to moderate symptoms of anxiety, ADHD, and oppositional behavior. Results: In the whole group, the drugs most highly endorsed were lamotrigine: 69%, lithium: 62%, lurasidone: 62%, quetiapine: 54%, aripiprazole: 46%, and valproate: 42%. Among the antidepressants, 38% endorsed a selective serotonin reuptake inhibitor, 12% a serotonin-norepinephrine reuptake inhibitor, and 27% bupropion. Of the child MDs, 75% suggested increasing the 1-mg dose of risperidone, while few adult MDs suggested this. Conversely, 56% of the adult MDs suggested using valproate, while only 1 child MD did so. There was little consensus on how to manage ADHD symptoms unresponsive to methylphenidate 36 mg/d. How these treatment options were sequenced also varied widely. Conclusions: There was wide variation in suggestions on to how to treat persistent symptoms of anxiety, ADHD, and oppositional behavior in a child whose mania and depression had been brought under good control. We surmise that this great diversity in recommendations among experts in child and adult bipolar disorder stems at least partially from inadequate literature on treatment and that a new emphasis on funding and conducting studies on efficacy and effectiveness is needed.


Assuntos
Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/tratamento farmacológico , Transtorno Bipolar/tratamento farmacológico , Psicotrópicos/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno Bipolar/terapia , Criança , Consenso , Feminino , Humanos , Prevenção Primária , Indução de Remissão
5.
Artigo em Inglês | MEDLINE | ID: mdl-32942346

RESUMO

Introduction: Bipolar disorder is a complex mood disorder characterized by a chronic and subtle course of fluctuating manic/hypomanic and depressive symptoms. Cariprazine, a dopamine D3-preferring D3/D2 receptor partial agonist with serotonin 5-HT1A receptor partial agonist and serotonin 5-HT2A antagonist properties, is approved to treat manic and depressive episodes of bipolar disorder. Post hoc analyses evaluated efficacy across symptoms in bipolar depression. Methods: Pooled data were analyzed from 3 phase 2 or 3, randomized, double-blind, placebo-controlled studies of adults with bipolar disorder and a major depressive episode. Mean change from baseline to week 6 in Montgomery-Asberg Depression Rating Scale (MADRS) total score and individual item scores were analyzed in individual dose groups (1.5 mg/d, 3 mg/d) and overall cariprazine (1.5-3 mg/d). Pooled safety was evaluated via adverse events. Results: A significantly greater difference in mean change from baseline in MADRS total score was seen for each cariprazine dose group versus placebo (least squares mean difference vs placebo: 1.5-3 mg/d = -2.6, 1.5 mg/d = -2.8, 3 mg/d = -2.4) (P < .001 all). Significant differences versus placebo were seen on all individual MADRS items except inner tension for the overall cariprazine group (P < .05). Cariprazine was generally well tolerated. Conclusions: Cariprazine demonstrated broad efficacy across symptoms of depression in bipolar disorder. In previous post hoc analyses, cariprazine also demonstrated broad efficacy across manic symptoms, suggesting that it is effective across the wide range of symptoms on the bipolar spectrum. A 1.5-mg/d starting dose and slow titration resulted in lower rates of some adverse events in the bipolar depression studies versus the mania studies. Trial Registration: ClinicalTrials.gov identifiers: NCT01396447, NCT02670538, NCT02670551.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Neurotransmissores/farmacologia , Piperazinas/farmacologia , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurotransmissores/administração & dosagem , Neurotransmissores/efeitos adversos , Piperazinas/administração & dosagem , Piperazinas/efeitos adversos , Resultado do Tratamento
6.
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
7.
Medicine (Baltimore) ; 99(38): e22280, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957382

RESUMO

BACKGROUND: Nowadays, there are some randomized controlled trials (RCTs) to explore the effectiveness of drug therapy for bipolar disorder with anxiety disorders. However, due to lack of sufficient data, there are currently no good treatment recommendations. The purpose of this network meta-analysis is to compare the efficacy and safety of different drugs for bipolar disorder complicated with anxiety disorders to provide evidence to support clinical practice and guidelines development. METHODS: A systematic literature search will be performed in the Cochrane Library, PubMed, EMBASE, and Web of Science from inception to July 2020. RCTs that compared the efficacy and safety of different drugs for bipolar disorder complicated with anxiety disorders will be included. Two reviewers will independently search and select the studies, extract the data, and assess the risk of bias. We will assess the risk of bias of included RCTs using the Cochrane risk of bias tool. The WinBUGS 1.4.3 software will be used to perform the network meta-analysis, and the result figures will be generated by STATA 15.0 software. In addition, we will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the quality of evidence. RESULTS: This study will systematically compare the efficacy and safety of different drugs for bipolar disorder complicated with anxiety disorders. The results of this network meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION: Our study will provide evidence for the drug therapy of patients with bipolar disorder complicated with anxiety disorders, and provide suggestions for clinical practice or guidelines. INPLASY REGISTRATION NUMBER: INPLASY202070132.


Assuntos
Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Transtornos de Ansiedade/complicações , Transtorno Bipolar/complicações , Transtorno Bipolar/tratamento farmacológico , Metanálise em Rede , Revisões Sistemáticas como Assunto , Transtorno Bipolar/psicologia , Humanos
8.
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
9.
Psychiatr Danub ; 32(2): 205-209, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32796785

RESUMO

BACKGROUND: The aim of this study was to evaluate the association of bruxism and treatment regimens among remitted bipolar patients. SUBJECTS AND METHODS: The total case group included 222 adult patients with BD. Diagnosis of bruxism was based upon the on 'self-reports' plus the outcome from the clinical examinations. RESULTS: The sample consisted of 112 (50.5%) bipolar patients with bruxism and 110 (49.5%) without bruxism. Remitted bipolar patients who were on mood stabilizer plus atypical antipsychotic treatment had lower bruxism rates than patients on other than bipolar patients on mood stabilizer treatment regimen (p=0.04) and bipolar patients on polypharmacy (p=0.01). CONCLUSION: Our findings have supported the existence of psychotropic drug-bruxism relation and atypical antipsychotic related therapeutic effect among bipolar patients.


Assuntos
Antipsicóticos , Transtorno Bipolar , Bruxismo , Adulto , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Humanos , Psicotrópicos
10.
Psiquiatr. biol. (Internet) ; 27(2): 71-73, mayo-ago. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193250

RESUMO

OBJETIVO: El objetivo de este artículo es analizar la utilidad de clozapina como tratamiento farmacológico en el trastorno bipolar refractario, a través de un caso clínico. CASO CLÍNICO: Se presenta el caso de un varón de 32 años, con inicio maníaco de la enfermedad a los 20 años. Tras varias ciclaciones e ingresos hospitalarios, logra la estabilidad clínica gracias al tratamiento de mantenimiento con valproato. En el último ingreso, el paciente experimenta reagudización psicótica con tendencia a delirio de tipo emotivo. Tras la introducción de clozapina durante el ingreso, se logra remisión de la clínica y la estabilización. RESULTADOS: La clozapina es un fármaco ampliamente utilizado en Asia con esta indicación, aunque en Europa no está aprobado oficialmente para su uso. CONCLUSIONES: Existe suficiente evidencia científica para afirmar que clozapina es un fármaco eficaz y seguro en el tratamiento del trastorno bipolar resistente a tratamiento


OBJECTIVE: The aim of this article is to analyse the usefulness of clozapine in treatment-resistant bipolar disorder, by using a case study. CASE REPORT: The case is presented of a 32 year-old male, who started with a manic episode when he was 20 years-old. After some maniac/depressive episodes and a few hospital admissions, the patient remains stable. In the last hospital admission, the patient started with psychotic symptoms and emotional delirium. Clozapine treatment was started, and the patient experienced great clinical improvement. RESULTS: Clozapine is a usual treatment in Asia for this kind of condition, although it has not been officially approved in Europe. CONCLUSIONS: There is sufficient scientific evidence to show that using clozapine in treatment-resistant bipolar disorder is effective and safe


Assuntos
Humanos , Masculino , Adulto , Transtorno Bipolar/tratamento farmacológico , Clozapina/uso terapêutico , Antipsicóticos/uso terapêutico , Resultado do Tratamento
12.
Sci Rep ; 10(1): 12239, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32699220

RESUMO

Lithium (Li) is the cornerstone maintenance treatment for bipolar disorders (BD), but response rates are highly variable. To date, no clinical or biological marker is available to reliably define eligibility criteria for a maintenance treatment with Li. We examined whether the prophylactic response to Li (assessed retrospectively) is associated with distinct blood DNA methylation profiles. Bisulfite-treated total blood DNA samples from individuals with BD type 1 (15 excellent-responders (LiERs) versus 11 non-responders (LiNRs)) were used for targeted enrichment of CpG rich genomic regions followed by high-resolution next-generation sequencing to identify differentially methylated regions (DMRs). After controlling for potential confounders we identified 111 DMRs that significantly differ between LiERs and LiNRs with a significant enrichment in neuronal cell components. Logistic regression and receiver operating curves identified a combination of 7 DMRs with a good discriminatory power for response to Li (Area Under the Curve 0.806). Annotated genes associated with these DMRs include Eukaryotic Translation Initiation Factor 2B Subunit Epsilon (EIF2B5), Von Willebrand Factor A Domain Containing 5B2 (VWA5B2), Ral GTPase Activating Protein Catalytic Alpha Subunit 1 (RALGAPA1). Although preliminary and deserving replication, these results suggest that biomarkers of response to Li may be identified through peripheral epigenetic measures.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/genética , Metilação de DNA/efeitos dos fármacos , Metilação de DNA/genética , Lítio/uso terapêutico , Biomarcadores/metabolismo , Ilhas de CpG/efeitos dos fármacos , Ilhas de CpG/genética , DNA/genética , Epigênese Genética/efeitos dos fármacos , Epigênese Genética/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Acta Med Port ; 33(10): 693-702, 2020 Oct 01.
Artigo em Português | MEDLINE | ID: mdl-32705981

RESUMO

INTRODUCTION: The COVID-19 pandemic is a particularly relevant threat to mentally ill patients, and it constitutes a new challenge for health care providers. To the best of our knowledge, there is not any embracing published review about the use of psychotropic drugs during the COVID-19 pandemic. MATERIALS AND METHODS: Non-systematic literature review. A search in the PubMed database was performed, with the terms 'psychotropic drugs', 'COVID-19', 'psychiatry' and 'pandemic'. Consensus and clinical guidelines about psychotropic drugs and COVID-19 approach, published by scientific societies, governmental entities and drug regulatory agencies were included. RESULTS AND DISCUSSION: We present the recommendations about the use of psychotropic drugs during the COVID-19 pandemic, in the outpatient and inpatient settings. The treatment of affective bipolar disorder and schizophrenia have now added increased difficulties. Some psychotropic drugs interfere with the pathophysiology of the novel coronavirus infection and they could interact with the drugs used in the treatment of COVID-19. Some patients will need pharmacological interventions due to the presence of delirium. Smoking cessation changes the serum levels of some psychotropic drugs and may influence their use. CONCLUSION: The COVID-19 pandemic has created new challenges in clinical practice. Psychiatric patients are a vulnerable population and often a careful clinical, laboratorial and electrocardiographic evaluation may be needed, particularly in those diagnosed with COVID-19. The regular treatment of mentally ill patients with COVID-19 presents increased complexity.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transtornos Mentais/tratamento farmacológico , Pneumonia Viral/epidemiologia , Psicotrópicos/uso terapêutico , Antivirais/uso terapêutico , Benzodiazepinas/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Regulação da Temperatura Corporal/efeitos dos fármacos , Regulação da Temperatura Corporal/fisiologia , Buprenorfina/efeitos adversos , Buprenorfina/uso terapêutico , Clozapina/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Preparações de Ação Retardada/uso terapêutico , Interações Medicamentosas , Hospitalização , Humanos , Compostos de Lítio/uso terapêutico , Transtornos Mentais/complicações , Metadona/efeitos adversos , Metadona/uso terapêutico , Antagonistas de Entorpecentes/efeitos adversos , Antagonistas de Entorpecentes/uso terapêutico , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Agentes de Cessação do Hábito de Fumar/uso terapêutico , Ácido Valproico/uso terapêutico
14.
BMC Psychiatry ; 20(1): 349, 2020 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-32620087

RESUMO

BACKGROUND: Megalencephalic leukoencephalopathy with subcortical cysts (MLC), or Van der Knaap disease, is a rare spongiform leukodystrophy that is characterized by macrocephaly, progressive motor dysfunction, and mild mental retardation. It is very rare for mental illness such as psychotic disorders, affective disorders and anxiety disorders to occur in MLC. CASE PRESENTATION: A 17-year-old boy was admitted to our hospital after he developed symptoms of depressive state with catatonia after being diagnosed as having MLC with confirmed MLC1 mutation. His catatonic symptoms were improved with administration of olanzapine and sertraline and he was discharged after 4 months. Several months later, he became hypomanic. He was diagnosed with bipolar II disorder. Mood swings were controlled with the administration of carbamazepine. CONCLUSIONS: This case is the first report of bipolar disorder during the clinical course of MLC. This case indicate the possibility that MLC influences the development of bipolar disorder in MLC, however, further studies involving more patients are required to clarify this.


Assuntos
Transtorno Bipolar/diagnóstico , Encéfalo/diagnóstico por imagem , Catatonia/complicações , Cistos , Depressão/complicações , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central , Adolescente , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/genética , Catatonia/diagnóstico , Cistos/diagnóstico , Cistos/genética , Depressão/diagnóstico , Feminino , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central/diagnóstico , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central/genética , Humanos , Imagem por Ressonância Magnética , Megalencefalia
15.
Ann Biol Clin (Paris) ; 78(4): 449-453, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32618565

RESUMO

Nephrogenic diabetes insipidus due to the inability of the kidneys to concentrate urine is frequently observed during lithium therapy. Lithium concentrates into principal cells in collecting ducts in the kidney and downregulates aquaporin 2 expression, which reduces renal reabsorption of water. This disease is characterized by polyuria - polydipsia leading to intracellular dehydration and hypernatremia. Water deprivation test is performed to confirm insipidus diabetes. The desmopressin permits to distinguish nephrogenic from cranial insipidus diabetes. We report the case of a 64 years old women who presented with global dehydration and severe hypernatremia. Four years ago, she was hospitalized for nephrogenic diabetes insipidus related to a self-induced lithium intoxication. Persistent nephrogenic insipidus diabetes after cessation of lithium therapy are described in literature, and this hypothesis may be consistent with this case report.


Assuntos
Diabetes Insípido Nefrogênico/induzido quimicamente , Compostos de Lítio/efeitos adversos , Sódio/efeitos adversos , Água/efeitos adversos , Transtorno Bipolar/tratamento farmacológico , Desidratação/diagnóstico , Desidratação/etiologia , Feminino , Humanos , Compostos de Lítio/envenenamento , Compostos de Lítio/uso terapêutico , Pessoa de Meia-Idade , Intoxicação por Água/complicações , Intoxicação por Água/diagnóstico
16.
Medicine (Baltimore) ; 99(28): e21122, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664138

RESUMO

RATIONALE: Lithium is the first-line medication for bipolar disorder, given a narrow therapeutic window of 0.8 to 1.2 mEq/L. Change of lithium pharmacokinetics following bariatric surgery may lead to lithium toxicity, which is particularly concerned. PATIENT CONCERNS: We presented a 39-year-old man with morbid obesity and bipolar affective disorder for 20 years, who was treated with lithium. He developed serious lithium toxicity following sleeve gastrectomy and prolonged neurologic sequelae. DIAGNOSES: He suffered from persistent watery diarrhea, general weakness, and then drowsy consciousness. Lithium level was checked immediately to be 3.42 mEq/L and lithium toxicity was diagnosed. INTERVENTIONS: After 3 courses of hemodialysis, his serum lithium level subsequently declined to 0.63 mEq/L, while his consciousness returned normal. Lithium was replaced by lamotrigine. OUTCOMES: The patient was discharged thirty-five days after admission, while his serum lithium declined to 0.06 mEq/L. Neurologic sequelae were noted by muscle weakness and pain sensation in both feet. The nerve conduction test revealed sensorimotor polyneuropathy with conduction block. He was advised to keep a passive range of motion exercise. LESSONS: Although the consensus guideline remains lacking, our report reviewed cases of relevance in the literature and highlighted the awareness of the potential risk of lithium toxicity following bariatric surgery. We suggest close monitoring of the lithium levels and perhaps a dosage adjustment for the postoperative period.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Gastrectomia/efeitos adversos , Carbonato de Lítio/efeitos adversos , Obesidade Mórbida/cirurgia , Polineuropatias/induzido quimicamente , Complicações Pós-Operatórias , Adulto , Antidepressivos/efeitos adversos , Antidepressivos/farmacocinética , Transtorno Bipolar/complicações , Transtorno Bipolar/metabolismo , Humanos , Laparoscopia/efeitos adversos , Lítio , Carbonato de Lítio/farmacocinética , Masculino , Obesidade Mórbida/complicações
18.
Neuron ; 106(5): 715-726, 2020 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-32497508

RESUMO

Ketamine exerts rapid antidepressant action in depressed and treatment-resistant depressed patients within hours. At the same time, ketamine elicits a unique form of functional synaptic plasticity that shares several attributes and molecular mechanisms with well-characterized forms of homeostatic synaptic scaling. Lithium is a widely used mood stabilizer also proposed to act via synaptic scaling for its antimanic effects. Several studies to date have identified specific forms of homeostatic synaptic plasticity that are elicited by these drugs used to treat neuropsychiatric disorders. In the last two decades, extensive work on homeostatic synaptic plasticity mechanisms have shown that they diverge from classical synaptic plasticity mechanisms that process and store information and thus present a novel avenue for synaptic regulation with limited direct interference with cognitive processes. In this review, we discuss the intersection of the findings from neuropsychiatric treatments and homeostatic plasticity studies to highlight a potentially wider paradigm for treatment advance.


Assuntos
Antimaníacos/farmacologia , Transtorno Bipolar/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Antagonistas de Aminoácidos Excitatórios/farmacologia , Homeostase/efeitos dos fármacos , Ketamina/farmacologia , Compostos de Lítio/farmacologia , Plasticidade Neuronal/efeitos dos fármacos , Animais , Antimaníacos/uso terapêutico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Humanos , Ketamina/uso terapêutico , Compostos de Lítio/uso terapêutico , Transtornos do Humor/tratamento farmacológico , Sinapses/efeitos dos fármacos
19.
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
20.
J Clin Psychiatry ; 81(4)2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32558403

RESUMO

People with bipolar I disorder experience an illness course marked by potentially disastrous manic episodes, disabling depressive episodes, and functional impairment. A frequent obstacle to wellness in these individuals is nonadherence to treatment. Long-acting injectable (LAI) antipsychotics have the potential to address nonadherence and thereby increase patients' chances at sustained recovery and normal psychosocial functioning. LAI formulations of 2 second-generation antipsychotics-aripiprazole monohydrate and risperidone-have received approval from the US Food and Drug Administration as monotherapy or adjunctive therapy to lithium or valproate for the maintenance treatment of bipolar I disorder in adult patients. In a recent roundtable meeting, a panel of 4 experts discussed the use of these medications in bipolar I disorder. This Academic Highlights summarizes their discussion, which included the impact of functional impairment, the potential benefits of employing an LAI antipsychotic at earlier stages of bipolar illness, and the characteristics of patients who may be good candidates for treatment with an LAI antipsychotic.


Assuntos
Antipsicóticos/administração & dosagem , Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Seleção de Pacientes , Risperidona/uso terapêutico , Aripiprazol/administração & dosagem , Análise Custo-Benefício , Preparações de Ação Retardada/uso terapêutico , Humanos , Injeções , Injeções Intramusculares , Adesão à Medicação , Guias de Prática Clínica como Assunto , Risperidona/administração & dosagem
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