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Pinna M, Manchia M, Pillai G, Salis P, Minnai GP. Efficacy and safety of electroconvulsive therapy in the first trimester of pregnancy: a case of severe manic catatonia. Bipolar Disord 2015; 17:567-71. [PMID: 25854818 DOI: 10.1111/bdi.12297] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/04/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is an appropriate, albeit often neglected, option for managing severe or life-threatening psychiatric symptoms during pregnancy. We report on the rapid effectiveness and safety of ECT during the first trimester of pregnancy in a 28-year-old woman with severe catatonia. METHODS Catatonic symptoms were assessed using the Catatonia Rating Scale (CRS). The patient was treated with unilateral ECT using left anterior right temporal (LART) placement. Seizure quality and duration were monitored by a two-lead electroencephalograph (EEG) and by one-lead electromyography (EMG). During each ECT session, the fetal heart rate was monitored with electrocardiogram (ECG). RESULTS After the second ECT treatment (day 13 of hospitalization), we observed remission of the catatonic symptoms, as shown by the drop in the CRS score from 22 to 0. No cognitive abnormalities were reported and no gynecological complications were detected (e.g. vaginal bleeding, abdominal pain, or uterine contraction). The patient delivered at term a healthy male neonate who presented normal growth as well as normal psychomotor development. CONCLUSIONS This case highlights the effectiveness of ECT in treating severe catatonic mania during the first 3 months of pregnancy. In addition, ECT proved to be a safe therapeutic option, since neither mother nor infant experienced any adverse event. We suggest that ECT might be considered as a valid and safe option in the therapeutic decision-making process when catatonic symptoms manifest during pregnancy.
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Affiliation(s)
- Martina Pinna
- Psychiatry Unit, San Martino Hospital - Health Agency N. 5, Oristano, Italy
| | - Mirko Manchia
- Psychiatry Unit, Department of Public Health, Molecular and Clinical Medicine, University of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Gianluca Pillai
- Psychiatry Unit, San Martino Hospital - Health Agency N. 5, Oristano, Italy
| | - Piergiorgio Salis
- Psychiatry Unit, San Martino Hospital - Health Agency N. 5, Oristano, Italy
| | - Gian Paolo Minnai
- Psychiatry Unit, San Martino Hospital - Health Agency N. 5, Oristano, Italy
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Chakrabarty T, Kozicky JM, Torres IJ, Lam RW, Yatham LN. Verbal memory impairment in new onset bipolar disorder: Relationship with frontal and medial temporal morphology. World J Biol Psychiatry 2015; 16:249-60. [PMID: 25708742 DOI: 10.3109/15622975.2014.1000373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Verbal memory (VM) impairment is a trait feature of bipolar I disorder (BDI) that is present at illness onset and associated with functional outcome. However, little is known about the morphological abnormalities underlying this deficit early in the disease course. This study examined the neurobiological correlates of VM impairment in euthymic newly diagnosed patients, with attention to frontal and medial temporal (MT) structures known to contribute to VM. METHODS Euthymic patients with BDI recently recovered from their first episode of mania (n = 42) were compared with healthy subjects (n = 37) using measures of the California Verbal Learning Test (CVLT-II) associated with frontal and MT functioning. A subset of participants had 3T MRI scan (n = 31 patient group, n = 30 healthy subject group). Hippocampal and prefrontal volumes were analyzed using FreeSurfer 5.1 and correlated with their corresponding CVLT-II subscores. RESULTS Patients showed decreased performance in total learning as well as short and long delay verbal recall. Consistent with MT dysfunction, they also showed deficits in recognition discriminability and learning slope. In the patient group only, left hippocampal volumes were negatively correlated with these measures. CONCLUSIONS These results suggest that anomalous MT functioning is involved with VM impairment early in the course of BDI.
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Affiliation(s)
- Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia , Vancouver, BC , Canada
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Kim HJ, Song W, Park JW. Differences in Trauma Experience Between Patients With Bipolar I Disorder, Patients With Major Depressive Disorder, and Healthy Controls. J Trauma Dissociation 2015; 16:419-27. [PMID: 26011123 DOI: 10.1080/15299732.2015.1016254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to compare differences in traumatic experiences between patients with bipolar I disorder, patients with major depressive disorder (MDD), and controls. The traumatic experiences (as measured by the Trauma Experience Questionnaire) of 40 participants with bipolar I disorder were compared with those of 38 participants with MDD and 92 controls. Participants with bipolar I disorder exhibited a significantly higher frequency of traumatic experiences and higher impact ratings when traumas did occur than did patients with MDD and controls. In addition, the present impact of past trauma for patients in the bipolar I disorder and MDD groups was significantly higher than for controls. The bipolar I disorder group reported more severe traumatic experiences than did both the MDD and control groups, and the MDD group in turn reported more severe traumatic experiences than did the control group.
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Affiliation(s)
- Hyun Joo Kim
- a Department of Couple and Family Counseling , Korea Counseling Graduate University , Seoul , Korea
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Galimberti D, Prunas C, Paoli RA, Dell'Osso B, Fenoglio C, Villa C, Palazzo C, Cigliobianco M, Camuri G, Serpente M, Scarpini E, Altamura AC. Progranulin gene variability influences the risk for bipolar I disorder, but not bipolar II disorder. Bipolar Disord 2014; 16:769-72. [PMID: 24499389 DOI: 10.1111/bdi.12180] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 10/16/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recent data have shown that genetic variability in the progranulin (GRN) gene may contribute to the susceptibility to developing bipolar disorder (BD). However, in regard to patients with BD, no information is available on the role of genetic variability and plasma progranulin levels in different types of this disorder. METHODS In this study, we performed an association analysis of GRN in an Italian population consisting of 134 patients with BD and 232 controls to evaluate progranulin plasma levels. RESULTS The presence of the polymorphic variant of the rs5848 single nucleotide polymorphism is protective for the development of bipolar I disorder (BD-I) (odds ratio = 0.55, 95% confidence interval: 0.33-0.93; p = 0.024) but not bipolar II disorder (BD-II) (p > 0.05). In addition, plasma progranulin levels are significantly decreased in BD [mean ± standard deviation (SD) 112 ± 35 versus 183 ± 93 ng/mL in controls; p < 0.001]. CONCLUSIONS Regarding the influence of GRN variability on BD susceptibility, the predisposing genetic background differs between BD-I and BD-II, possibly implying that pathogenic mechanisms differ between the two subtypes of BD.
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Affiliation(s)
- Daniela Galimberti
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Policlinico, Milan, Italy
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Akabaliev VH, Sivkov ST, Mantarkov MY. Minor physical anomalies in schizophrenia and bipolar I disorder and the neurodevelopmental continuum of psychosis. Bipolar Disord 2014; 16:633-41. [PMID: 24798215 DOI: 10.1111/bdi.12211] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 11/26/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Minor physical anomalies (MPAs) have been investigated by numerous studies in patients with schizophrenia in support of the neurodevelopmental hypothesis of the disorder, but have rarely been examined in patients with bipolar disorder or in direct comparisons between the two conditions. The main objective of the present study was to compare the prevalence of MPAs in psychiatrically healthy controls, patients with bipolar I disorder, and patients with schizophrenia. METHODS A slightly modified version of the Waldrop Physical Anomaly Scale was used to assess MPAs in psychiatrically healthy controls (n = 103), patients with bipolar I disorder (n = 61), and patients with schizophrenia (n = 128). RESULTS In five out of six topographic regions (mouth, feet, head, eyes, and ears) there was a pattern of lowest regional MPA scores in controls, intermediate in bipolar I disorder, and highest in schizophrenia. The cephalofacial composite score and the total MPA score showed the same pattern, with all between-group differences being statistically significant. Seven individual MPAs in the discriminant analysis model contributed independently to the prediction of the triple-dependent status of 'psychiatrically healthy control, bipolar I disorder patient, schizophrenia patient': high/arched palate, fine electric hair, large gap between first and second toes, third toe ≥ second toe, epicanthus, malformed ears, and furrowed tongue. CONCLUSIONS Our findings support the existence of a continuum of neurodevelopmental adversity within the clinical spectrum of psychosis, with bipolar I disorder occupying an intermediate position between psychiatric health and schizophrenia.
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Torres CV, Ezquiaga E, Navas M, de Sola RG. Deep brain stimulation of the subcallosal cingulate for medication-resistant type I bipolar depression: case report. Bipolar Disord 2013; 15:719-21. [PMID: 23930934 DOI: 10.1111/bdi.12102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/13/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Cristina V Torres
- Division of Neurosurgery; Department of Surgery; University Hospital La Princesa; Madrid; Spain
| | - Elena Ezquiaga
- Department of Psychiatry; University Hospital La Princesa; Madrid; Spain
| | - Marta Navas
- Division of Neurosurgery; Department of Surgery; University Hospital La Princesa; Madrid; Spain
| | - Rafael G. de Sola
- Division of Neurosurgery; Department of Surgery; University Hospital La Princesa; Madrid; Spain
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Chen W, Deveaugh-Geiss AM, Palmer L, Princic N, Chen YT. Patterns of atypical antipsychotic therapy use in adults with bipolar I disorder in the USA. Hum Psychopharmacol 2013; 28:428-37. [PMID: 23861367 DOI: 10.1002/hup.2326] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 04/28/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study aims to describe the utilization patterns of atypical antipsychotics (AA) among insured patients with bipolar I disorder in the USA. METHODS We studied patients with bipolar I disorder who newly initiated an oral AA between 2002 and 2008. Utilization measures included adherence [medication possession ratio (MPR) ≥80%], persistence (gaps ≤15 days between refills and an absence of ≥30 days of continuous concomitant non-index AA use), non-compliance (16-29 day gaps with no evidence of switch/augmentation), and discontinuation of the index AA (≥30 days without index AA, no evidence of switch/augmentation). RESULTS The study included 16 807 patients: mean age 43.3 years, 67.7% female. Overall, adherence to the index AA was low (8.3%; mean MPR = 0.2). Only 10.5% of the patients were persistent to index AA, another 13.6% were non-compliant, and 63.4% discontinued index AA with an average time to discontinuation of 66 days. A majority (69.5%) of the discontinued patients did not resume any antipsychotic therapy. Results were similar across insurance types and index AA. CONCLUSION Adherence to and persistence with AA treatment were low in new users with bipolar I disorder. Most patients discontinued the index AA and did not restart any antipsychotic treatment. Future study should distinguish physician-directed discontinuation versus patient non-adherence.
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Affiliation(s)
- Wenjia Chen
- Department of Pharmacy Practice and Administration, Rutgers University, Piscataway, New Jersey, USA; Merck & Co., Inc, Whitehouse Station, New Jersey, USA; Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
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Akhter A, Fiedorowicz JG, Zhang T, Potash JB, Cavanaugh J, Solomon DA, Coryell WH. Seasonal variation of manic and depressive symptoms in bipolar disorder. Bipolar Disord 2013; 15:377-84. [PMID: 23621686 PMCID: PMC3731411 DOI: 10.1111/bdi.12072] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 01/13/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Analyses of seasonal variation of manic and depressive symptoms in bipolar disorder in retrospective studies examining admission data have yielded conflicting results. We examined seasonal variation of mood symptoms in a prospective cohort with long-term follow-up: the Collaborative Depression Study (CDS). METHODS The CDS included participants from five academic centers with a prospective diagnosis of bipolar I or II disorder. The sample was limited to those who were followed for at least 10 years of annual or semi-annual assessments. Time series analyses and autoregressive integrated moving average (ARIMA) models were used to assess seasonal patterns of manic and depressive symptoms. RESULTS A total of 314 individuals were analyzed (bipolar I disorder, n = 202; bipolar II disorder, n = 112), with both disorders exhibiting the lowest frequency of depressive symptoms in summer and the highest around the winter solstice, though the winter peak in symptoms was statistically significant only with bipolar I disorder. Variation of manic symptoms was more pronounced in bipolar II disorder, with a significant peak in hypomanic symptomatology in the months surrounding the fall equinox. CONCLUSIONS Significant seasonal variation exists in bipolar disorder, with manic/hypomanic symptoms peaking around the fall equinox and depressive symptoms peaking in the months surrounding the winter solstice in bipolar I disorder.
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Affiliation(s)
- Ahmed Akhter
- Department of Psychiatry, The University of Iowa, Iowa City, IA
| | - Jess G. Fiedorowicz
- Department of Psychiatry, The University of Iowa, Iowa City, IA,Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA,Department of Epidemiology, The University of Iowa, Iowa City, IA
| | - Tao Zhang
- Department of Biostatistics, College of Public Health, The University of Iowa, Iowa City, IA
| | - James B. Potash
- Department of Psychiatry, The University of Iowa, Iowa City, IA
| | - Joseph Cavanaugh
- Department of Biostatistics, College of Public Health, The University of Iowa, Iowa City, IA
| | - David A. Solomon
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Abstract
OBJECTIVES The Phenomenology and Course of Pediatric Bipolar Disorders study, a National Institute of Mental Health-funded study of child bipolar I disorder (BP-I) begun in 1995, is a prospective follow-up study that included collecting pharmacological and non-drug treatment data. METHODS There were 115 first-episode subjects who fit full DSM-IV criteria for BP-I, mixed or manic phase, with severity scores in the clinically impaired range, ascertained by consecutive new case ascertainment. Subjects were assessed with the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS), given separately to parents about their children and to children about themselves. All treatment was provided by the subjects' own community practitioners, exactly as if they had not been in the research study. Thus, families were only seen for research assessments, and research staff were not at all involved in their treatment. Data on type, dose, and duration of pharmacological and non-drug treatment were collected. During follow-up, 93.9% (n = 108) were assessed at each of the nine assessment times. RESULTS During the eight years, only 62.6% received any antimanic medication (antipsychotic, anticonvulsant, lithium) at any time. Percents who received non-antimanic medication included 77.4% medication for attention-deficit hyperactivity disorder and 64.3% antidepressants. A total of 67.8% of subjects were taking two or more concurrent medication classes. Subjects ascertained from psychiatric versus pediatric sites received antimanics significantly more frequently (p = 0.006). Earlier recovery during eight-year follow-up was predicted by greater percent of weeks on lithium (p = 0.017). CONCLUSIONS Given these findings, and the poor prognosis from prospective follow-up of this sample reported elsewhere, there is a need for further research that informs the development of effective treatment strategies.
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Affiliation(s)
- Barbara Geller
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO 63110-1093, USA.
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Abstract
Asenapine is a new atypical antipsychotic agent currently under development for the treatment of schizophrenia and bipolar disorder. It has high affinity for various receptors including antagonism at 5HT(2A), 5HT(2B), 5HT(2C), 5HT(6) and 5HT(7) serotonergic receptor subtypes, alpha(1A), alpha(2A), alpha(2B) and alpha(2C) adrenergic and D(3) and D(4) dopaminergic receptors. As with other atypicals, asenapine exhibits a high 5HT(2A):D(2) affinity ratio. Although similar to clozapine in its multi-target profile, it shows no appreciable affinity for muscarinic receptors. Asenapine has shown efficacy in alleviating both positive and negative symptoms of schizophrenia compared with placebo. Although promising, further studies are required in order to determine whether it has advantages over placebo and other antipsychotics in alleviating cognitive impairment associated with schizophrenia. It has also shown long-term efficacy comparable with olanzapine in bipolar I disorder. Asenapine is generally well tolerated and appears to be metabolically neutral. It has low propensity to cause weight gain and prolactin elevation. There were no concerns in the studies about its effects on the cardiovascular system and QTc prolongation. The incidence of extrapyramidal symptoms with asenapine however has been found to be higher than that with olanzapine. It may be a useful alternative to aripiprazole in schizophrenia and bipolar disorder in patients who are at high risk of metabolic abnormalities.
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Affiliation(s)
- Delia Bishara
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK.
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