Chronotype in bipolar disorder: an 18-month prospective study

Objective: Circadian dysregulation plays an important role in the etiology of mood disorders. Evening chronotype is frequent in these patients. However, prospective studies about the influence of chronotype on mood symptoms have reached unclear conclusions in patients with bipolar disorder (BD). The objective of this study was to investigate relationship between chronotype and prognostic factors for BD. Methods: At the baseline, 80 euthymic BD patients answered a demographic questionnaire and clinical scales to evaluate anxiety, functioning and chronotype. Circadian preference was measured using the Morningness-Eveningness Questionnaire, in which lower scores indicate eveningness. Mood episodes and hospitalizations were evaluated monthly for 18 months. Results: Among the BD patients, 14 (17.5%) were definitely morning type, 35 (43.8%), moderately morning, 27 (33.7%) intermediate (neither) and 4 (5%) moderately evening. Eveningness was associated with obesity or overweight (p = 0.03), greater anxiety (p = 0.002) and better functioning (p = 0.01), as well as with mood episodes (p = 0.04), but not with psychiatric hospitalizations (p = 0.82). This group tended toward depressive episodes (p = 0.06), but not (hypo)mania (p = 0.56). Conclusion: This study indicated that evening chronotype predicts a poor prognostic for BD. It reinforces the relevance of treating rhythm disruptions even during euthymia to improve patient quality of life and prevent mood episodes.

Religiosity, depression, and quality of life in bipolar disorder: a two-year prospective study

Objective: Few quantitative studies have examined the effect of religious involvement on the course of bipolar disorder (BD). We investigated the effects of religious activity and coping behaviors on the course of depression, mania, and quality of life (QoL) in patients with BD. Methods: Two-year longitudinal study of 168 outpatients with BD. Linear regression was used to examine associations between religious predictors and outcome variables (manic symptoms, depression, QoL), controlling for sociodemographic variables. Results: Among the 158 patients reassessed after 2 years, positive religious coping at T1 predicted better QoL across all four domains: physical (β = 10.2, 95%CI 4.2 to 16.1), mental (β = 13.4, 95%CI 7.1 to 19.7), social (β = 10.5, 95%CI 3.6 to 17.33), and environmental (β = 11.1, 95%CI 6.2 to 16.1) at T2. Negative religious coping at T1 predicted worse mental (β = -28.1, 95%CI -52.06 to -4.2) and environmental (β = -20.4, 95%CI -39.3 to -1.6) QoL. Intrinsic religiosity at T1 predicted better environmental QoL (β = 9.56, 95%CI 2.76 to 16.36) at T2. Negative religious coping at T1 predicted manic symptoms (β = 4.1) at T2. Conclusion: Religiosity/spirituality (R/S) may influence the QoL of patients with BD over time, even among euthymic patients. Targeting R/S (especially positive and negative religious coping) in psychosocial interventions may enhance the quality of recovery in patients with BD.

Kraepelin's description of chronic mania: a clinical picture that meets the behavioral variant frontotemporal dementia phenotype / A descrição de Kraepelin de mania crônica: um quadro clínico que corresponde ao fenótipo da variante comportamental da demência fronto-temporal

ABSTRACT Chronic mania is an under-investigated condition and few reports have associated this disorder with an organic background. The present work examines Kraepelin’s reliable description of chronic mania from a current behavioral neurology viewpoint. Kraepelin had described a cluster of symptoms that are now recognized as core manifestations of the behavioral variant frontotemporal dementia (bvFTD) clinical phenotype. We also carried out additional reviews of original manuscripts from Kraepelin’s peers, in order to find any case reports that might fulfill the current diagnostic proposal for bvFTD. Even though we failed to find an ideal case, we found some scholars who seemed to agree that chronic mania should be considered a special form of dementia. The present work highlights, through historical data, the possible overlapping features between primary psychiatric disorders and neuropsychiatric symptoms secondary to neurodegenerative conditions.

RESUMO A mania crônica constitui uma condição subinvestigada e alguns trabalhos têm associado esta desordem a um substrato orgânico. O presente manuscrito analisa a descrição fidedigna de Kraepelin de mania crônica a partir de um ponto de vista atual da neurologia comportamental. Concebemos que ele havia descrito um conjunto de sintomas que atualmente é reconhecido como manifestações centrais do fenótipo clínico da variante comportamental da demência frontotemporal (bvFTD). Também realizamos uma revisão adicional de manuscritos originais de pares contemporâneos de Kraepelin, a fim de procurar por um único relato de caso que poderia preencher critério diagnóstico atual de bvFTD. Mesmo que não tenhamos conseguido encontrar um caso perfeitamente exemplar, identificamos que alguns estudiosos da época pareciam concordar que a mania crônica devesse ser considerada uma forma especial de demência. O presente trabalho destaca por meio de dados históricos a sobreposição entre transtornos psiquiátricos primários e sintomas neuropsiquiátricos secundários a doenças neurodegenerativas.

Sensory processing patterns, coping strategies, and quality of life among patients with unipolar and bipolar disorders

Objective: To compare sensory processing, coping strategies, and quality of life (QoL) in unipolar and bipolar patients; to examine correlations between sensory processing and QoL; and to investigate the relative contribution of sociodemographic characteristics, sensory processing, and coping strategies to the prediction of QoL. Methods: Two hundred sixty-seven participants, aged 16-85 years (53.6±15.7), of whom 157 had a diagnosis of unipolar major depressive disorder and 110 had bipolar disorder type I and type II, completed the Adolescent/Adult Sensory Profile, Coping Orientations to Problems Experienced, and 12-item Short-Form Health Survey version 2. The two groups were compared with multivariate analyses. Results: The unipolar and bipolar groups did not differ concerning sensory processing, coping strategies, or QoL. Sensory processing patterns correlated with QoL independently of mediation by coping strategies. Correlations between low registration, sensory sensitivity, sensation avoidance, and reduced QoL were found more frequently in unipolar patients than bipolar patients. Higher physical QoL was mainly predicted by lower age and lower sensory sensitivity, whereas higher mental QoL was mainly predicted by coping strategies. Conclusion: While age may predict physical QoL, coping strategies predict mental QoL. Future studies should further investigate the impact of sensory processing and coping strategies on patients’ QoL in order to enhance adaptive and functional behaviors related to affective disturbances.

Homocysteine and other markers of cardiovascular risk during a manic episode in patients with bipolar disorder

Objective: To evaluate serum levels of different biomarkers associated with cardiovascular disease in patients with bipolar disorder (BD). Patients were prospectively evaluated in two separate instances: during acute mania and after remission of manic symptoms. All measurements were compared with those of healthy controls. Methods: The study included 30 patients with BD and 30 healthy controls, matched for gender and age. Biochemical parameters evaluated included homocysteine (Hcy), folic acid, vitamin B12, ferritin, creatine kinase (CK) and C-reactive protein (CRP). Results: Hcy levels were significantly higher in the BD patients, both during mania and after achieving euthymia. When Hcy was adjusted for body mass index, there was no significant difference between patients and controls. Ferritin was the only marker that showed a significant decrease during mania when compared to both euthymic patients and controls. There were no significant differences for folate, vitamin B12, CK and CRP. Conclusions: These findings do not show an association between alterations of markers of cardiovascular risk during manic episodes. Further studies are necessary to determine factors and mechanisms associated with cardiovascular risk in patients with BD. .

Cardiovascular risk factors in outpatients with bipolar disorder: a report from the Brazilian Research Network in Bipolar Disorder

Objective: Bipolar disorder (BD) is associated with significant morbidity and mortality due to comorbid general medical conditions, particularly cardiovascular disease. This study is the first report of the Brazilian Research Network in Bipolar Disorder (BRN-BD) that aims to evaluate the prevalence and clinical correlates of cardiovascular risk factors among Brazilian patients with BD. Methods: A cross-sectional study of 159 patients with DSM-IV BD, 18 years or older, consecutively recruited from the Bipolar Research Program (PROMAN) in São Paulo and the Bipolar Disorder Program (PROTAHBI) in Porto Alegre. Clinical, demographic, anthropometric, and metabolic variables were systematically assessed. Results: High rates of smoking (27%), physical inactivity (64.9%), alcohol use disorders (20.8%), elevated fasting glucose (26.4%), diabetes (13.2%), hypertension (38.4%), hypertriglyceridemia (25.8%), low HDL-cholesterol (27.7%), general (38.4%) and abdominal obesity (59.1%) were found in the sample. Male patients were more likely to have alcohol use disorders, diabetes, and hypertriglyceridemia, whereas female patients showed higher prevalence of abdominal obesity. Variables such as medication use pattern, alcohol use disorder, and physical activity were associated with selected cardiovascular risk factors in the multivariable analysis. Conclusion: This report of the BRN-BD provides new data regarding prevalence rates and associated cardiovascular risk factors in Brazilian outpatients with BD. There is a need for increasing both awareness and recognition about metabolic and cardiovascular diseases in this patient population. .

Bipolar disorder and age-related functional impairment / Prejuízo funcional associado à idade e transtorno bipolar

OBJECTIVE: Although bipolar disorder is a major contributor to functional impairment worldwide, an independent impact of bipolar disorder and ageing on functioning has yet to be demonstrated. The objective of the present study was to evaluate the effect of bipolar disorder on age-related functional status using matched controls as a standard. METHOD: One-hundred patients with bipolar disorder and matched controls were evaluated for disability. Age-related effects controlled for confounders were cross-sectionally evaluated. RESULTS: Patients were significantly more impaired than controls. Regression showed effects for aging in both groups. The effect, size, however, was significantly stronger in patients. CONCLUSION: Bipolar disorder was an important effect modifier of the age impact on functioning. While a longitudinal design is needed to effectively demonstrate this different impact, this study further depicts bipolar disorder as a chronic and progressively impairing illness.

OBJETIVO: O transtorno bipolar é responsável por importante parcela do prejuízo funcional ao redor do mundo. Um efeito independente do transtorno bipolar e da idade no funcionamento ainda não foi demonstrado. O presente estudo tem o objetivo de avaliar o efeito do transtorno bipolar no prejuízo funcional relacionado à idade, com controles pareados como padrão. MÉTODO: Cem pacientes com transtorno bipolar e controles pareados foram avaliados para incapacidade. Efeitos relacionados à idade, com controle para confundidores, foram investigados. RESULTADOS: Pacientes tiveram significativamente mais prejuízo que controles. A regressão mostrou efeito para a idade em ambos os grupos, e o efeito foi significativamente mais forte nos pacientes. CONCLUSÃO: O transtorno bipolar foi um importante modificador de efeito no impacto da idade no funcionamento. Enquanto um desenho de estudo longitudinal é necessário para efetivamente demonstrar este impacto diferencial, este estudo caracteriza o transtorno bipolar como uma doença crônica e incapacitante.

Clinical expression of obsessive-compulsive disorder in women with bipolar disorder

OBJETIVO: Estudar características clínicas e psicopatológicas do transtorno obsessivo-compulsivo (TOC) em mulheres com transtorno de humor bipolar (THB). MÉTODOS: Foram estudadas, retrospectivamente, 15 pacientes ambulatoriais com diagnósticos simultâneos de transtorno de humor bipolar I (80,0%) ou II (20,0%) e transtorno obsessivo-compulsivo. A maioria havia buscado tratamento para transtorno de humor bipolar (80,0%). A avaliação constou da Entrevista Clínica Estruturada para o DSM-IV (SCID/P), de entrevistas semi-estruturadas para pesquisa de obsessões, compulsões e fenômenos sensoriais que podem preceder as compulsões e de módulo adicional para diagnóstico de tiques motores e vocais crônicos. A gravidade dos sintomas foi investigada através das seguintes escalas: Escala Yale-Brown para Sintomas Obsessivo-Compulsivos, Escala de Avaliação para Depressão de Hamilton e Escala de Avaliação de Mania de Young. RESULTADOS: O transtorno obsessivo-compulsivo teve início precoce em nove (60%) casos, instalou-se antes do transtorno de humor bipolar em 10 (66,7%) e teve curso crônico flutuante em 13 (86,7%). Houve ampla superposição de tipos de sintomas obsessivo-compulsivos e todas as pacientes apresentaram fenômenos sensoriais precedendo as compulsões. Não houve padrão definido no impacto dos episódios depressivos e maníacos na intensidade dos sintomas obsessivo-compulsivos. Estes aumentaram na depressão e diminuíram na mania em 40,0% dos casos; tiveram o comportamento inverso em 26,7% das pacientes e oscilaram de forma inconsistente nas demais. Diagnosticou-se comorbidade com transtorno de tiques em cinco (33,3%) casos. CONCLUSÕES: Nossos resultados sugerem que, em mulheres com comorbidade de transtorno de humor bipolar e transtorno obsessivo-compulsivo, este último apresente características que talvez sejam específicas da associação dos dois transtornos, tais como instalação precoce e presença de fenômenos sensoriais antecedendo as compulsões. A confirmação destas observações em pesquisa prospectiva controlada é necessária, em função de algumas limitações do estudo: casuística reduzida e restrita ao sexo feminino, alguma heterogeneidade da amostra quanto ao tipo de transtorno de humor bipolar e com relação ao transtorno que determinou procura de tratamento, ausência de grupo controle e coleta de dados retrospectiva.

Fisiopatologia do transtorno afetivo bipolar: o que mudou nos últimos 10 anos? / Physiopathology of bipolar disorders: what have changed in the last 10 years?

Apesar dos crescentes esforços para o entendimento da neurobiologia do transtorno afetivo bipolar (TAB), sua exata fisiopatologia permanece indeterminada. Inicialmente, a pesquisa estava voltada para o estudo das aminas biogênicas, devido aos efeitos dos diversos agentes psicofarmacológicos. Mais recentemente, evidências apontam que disfunções nos sistemas de sinalização intracelular e de expressão gênica podem estar associadas ao TAB. Estas alterações podem estar associadas a interrupções nos circuitos reguladores do humor, como sistema límbico, estriado e córtex pré-frontal, sendo que os efeitos neuroprotetores do uso crônico dos estabilizadores de humor podem reverter este processo patológico. Este artigo tem como objetivo trazer uma atualização dos achados recentes sobre a neuroquímica do TAB.

Depressoes crônicas / Chronic depression

O autor, de início, focaliza aspectos conceptuais e certos dados estatísticos, presentes na literatura mundial, a respeito do assunto. A seguir, apresenta e discute a classificaçäo de depressäo crônica, proposta por H.S. AKISKAL (1983). Expöes, entäo, os resultados obtidos, através de levantamento de casuística de sua clientela particular, referentes ao período de 5 anos (1981/1985), de 100 pacientes, que preencheram os critérios de inclusäo do DSM III, para os grupos de Depressäo Maior, distúrbios distímicos e ciclotímicos. Comenta o percentual de depressäo crônica encontrado, de acordo com os critérios da "Task dorce of Nomenclature and Statistics of the American Psychiatric Association", entre pacientes observados durante um prazo mínimo de 6 meses e máximo de 24 anos (21%) e com duraçäo da doença de forma contínua ou com leve atenuaçäo da sintomatologia, ao longo de um período mínimo de 2 anos. Em seguida, distribui sua casuística em 5 grupos diagnósticos, passiveis de serem condensados em 3. Finaliza com consideraçöes gerais acerca de seus achados