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Batra S, Anand A, Singh A, Verma S. Chronic Mania: Diagnostic Dilemma and the Need for Addition in Nosology. Cureus 2023; 15:e38703. [PMID: 37292529 PMCID: PMC10246484 DOI: 10.7759/cureus.38703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Chronic mania is a mental health disorder that has been described by various psychiatrists in the past but currently is not a part of nosology. Robust epidemiological data for chronic mania are lacking with regard to its prevalence and clinical features. The present case report is of a 48-year-old male with a six-year history of mood and psychotic symptoms, based on which differential diagnoses of schizoaffective disorder (manic type), schizophrenia, and mania with psychotic symptoms (with chronic course) were made. The diagnosis of chronic mania was confirmed considering the predominance of fluctuating mood symptoms along with psychotic symptoms, lack of remission, and chronic course of illness. Antipsychotics were initially started for six weeks, to which the patient demonstrated a minimal response. A mood stabilizer was added to the regimen, leading to significant improvement, and the patient was discharged. According to existing literature, patients with chronic mania present with severe illness, the presence of psychotic symptoms, and socio-occupational impairment, which was also noticed in this case. The prevalence of chronic mania among patients with bipolar disorder is approximately 13-15%, which constitutes a significant proportion of known mental illnesses. Therefore, chronic mania should be added as a distinct clinical entity in the existing nosological systems.
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Affiliation(s)
- Surbhi Batra
- Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, IND
- Psychiatry, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Abhinav Anand
- Covid Care, Central Jail Hospital, Mandoli Prison, New Delhi, IND
| | - Anmol Singh
- Psychiatry, Medanta Institute of Neurosciences, Gurugram, IND
- Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, IND
| | - Shrestha Verma
- Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, IND
- Psychiatry, St. Stephen's Hospital, New Delhi, IND
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Rumyantseva EB, Shevchenko OP, Oleichik IV, Sizov SV. [Features of the neurocognitive profile of patients with protracted and chronic endogenous manic and manic-delusional states]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:82-89. [PMID: 37655415 DOI: 10.17116/jnevro202312308182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To study the neurocognitive profile of patients with protracted and chronic endogenous manic and manic-delusional states (EMDS). MATERIAL AND METHODS Thirty-two female patients, aged 18 to 55 years (mean age 36.2±10.2 years), with protracted and chronic EMDS were studied. Based on the clinical typology of EMDS, patients were divided into 4 groups of 8 patients each: group 1 - «acute» subtype, group 2 - «chronified» subtype, group 3 - «developing» subtype and group 4 - subtype «double mania». Neuropsychological, clinical-psychopathological and statistical methods were used. RESULTS Disturbances of regulatory and executive functions and a decrease in neurodynamic indicators of mental activity in patients with EMDS are significantly more pronounced compared with the control group (p<0.05). The values of the index of severity of disturbances of regulatory and executive functions in patients with EMDS range from 0.95 points (group 1) to 1.14 points (group 4), without statistically significant differences between the groups. The highest severity of neurodynamic disorders is observed in group 1 (1.88 points), while in other groups the index values range from 0.88 points in group 2 to 1.09 in group 4 (p<0.05). Patients of group 1 have greater severity and wider spectrum of neurodynamic symptoms compared with group 2 (U=45.00; p<0.0021), group 3 (U=30.00; p<0.04), and group 4 (U=45.00; p<0.001). It should be noted that the cognitive impairments identified in patients with EMDS did not reach the level of dementia. CONCLUSION The most characteristic of EMBS are cognitive impairments associated with a decrease in the parameters of the neurodynamics of mental activity related to the first functional block, as well as with deficiency of executive functions, impaired planning and organization of cognitive activity, due to the weakness of the structures of the third functional block.
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Affiliation(s)
| | | | | | - S V Sizov
- Mental Health Research Center, Moscow, Russia
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Chakrabarti S, Singh N. Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review. World J Psychiatry 2022; 12:1204-1232. [PMID: 36186500 PMCID: PMC9521535 DOI: 10.5498/wjp.v12.i9.1204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/02/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder (BD) and can have an adverse effect on its course, outcome, and treatment. However, despite a considerable amount of research, the impact of psychotic symptoms on BD remains unclear, and there are very few systematic reviews on the subject.
AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.
METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021. Combinations of the relevant Medical Subject Headings terms were used to search for these studies. Articles were selected after a screening phase, followed by a review of the full texts of the articles. Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.
RESULTS This systematic review included 339 studies of patients with BD. Lifetime psychosis was found in more than a half to two-thirds of the patients, while current psychosis was found in a little less than half of them. Delusions were more common than hallucinations in all phases of BD. About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms, particularly during manic episodes. Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression. Although psychotic symptoms were not more severe in BD, the severity of the illness in psychotic BD was consistently greater. Psychosis was usually associated with poor insight and a higher frequency of agitation, anxiety, and hostility but not with psychiatric comorbidity. Psychosis was consistently linked with increased rates and the duration of hospitalizations, switching among patients with depression, and poorer outcomes with mood-incongruent symptoms. In contrast, psychosis was less likely to be accompanied by a rapid-cycling course, longer illness duration, and heightened suicidal risk. There was no significant impact of psychosis on the other parameters of course and outcome.
CONCLUSION Though psychotic symptoms are very common in BD, they are not always associated with an adverse impact on BD and its course and outcome.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
| | - Navdeep Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
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4
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de Filippis R, Menculini G, D'Angelo M, Carbone EA, Tortorella A, De Fazio P, Steardo L. Internalized-stigma and dissociative experiences in bipolar disorder. Front Psychiatry 2022; 13:953621. [PMID: 35966460 PMCID: PMC9372275 DOI: 10.3389/fpsyt.2022.953621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Dissociative symptoms have been recently related to bipolar disorder (BD) symptomatology. Moreover, the disease burden carries on a share of perceived self-stigma that amplifies the BD impairment. Internalized stigma and dissociative symptoms often seem overlapping, leading toward common outcomes, with reduced treatment seeking and poor adherence. We hypothesize a potential relationship between dissociation and self-stigma in patients suffering from BD. MATERIALS AND METHODS In this cross-sectional study we enrolled a total of 120 adult clinically stable BD outpatients. All participants completed the Internalized Stigma of Mental Illness (ISMI), Dissociative Experiences Scale-II (DES-II), and Manchester Short Assessment of Quality of Life (MANSA). RESULTS Average age and age at BD (BD-I n = 66, 55%; BD-II n = 54, 45%) onset were 46.14 (±4.23), and 27.45 (±10.35) years, with mean disease duration of 18.56 (±13.08) years. Most participants were female (n = 71; 59.2%) and 40 (33%) of them experienced lifetime abuse, with an average of 1.05 (±0.78) suicide attempts. DES scores (mean 31.8, ±21.6) correlated with ISMI total-score, with significant association with spikes in Alienation (13.1, SD±3.1) (p < 0.001) and Stereotype (13.8, SD±3.9) (p < 0.001). Linear regression analysis has shown a significant association between DES total score and alienation (p < 0.001), stereotype (p < 0.001) and MANSA total-score (p < 0.001). DISCUSSION For the first time, our data suggests that self-stigma is associated to dissociative symptoms, reducing overall quality of life in BD. The early identification of at-risk patients with previous lifetime abuse and high perceived stigma could lead the way for an ever more precise tailoring of treatment management.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Martina D'Angelo
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Elvira Anna Carbone
- Psychiatry Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Steardo
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Maia da Silva MN, Porto FHDG, Lopes PMG, Sodré de Castro Prado C, Frota NAF, Alves CHL, Alves GS. Frontotemporal Dementia and Late-Onset Bipolar Disorder: The Many Directions of a Busy Road. Front Psychiatry 2021; 12:768722. [PMID: 34925096 PMCID: PMC8674641 DOI: 10.3389/fpsyt.2021.768722] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/13/2021] [Indexed: 12/18/2022] Open
Abstract
It is a common pathway for patients with the behavioral variant of frontotemporal dementia (bvFTD) to be first misdiagnosed with a primary psychiatric disorder, a considerable proportion of them being diagnosed with bipolar disorder (BD). Conversely, not rarely patients presenting in late life with a first episode of mania or atypically severe depression are initially considered to have dementia before the diagnosis of late-onset BD is reached. Beyond some shared features that make these conditions particularly prone to confusion, especially in the elderly, the relationship between bvFTD and BD is far from simple. Patients with BD often have cognitive complaints as part of their psychiatric disorder but are at an increased risk of developing dementia, including FTD. Likewise, apathy and disinhibition, common features of depression and mania, respectively, are among the core features of the bvFTD syndrome, not to mention that depression may coexist with dementia. In this article, we take advantage of the current knowledge on the neurobiology of these two nosologic entities to review their historical and conceptual interplay, highlighting the clinical, genetic and neuroimaging features that may be shared by both disorders or unique to each of them.
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Affiliation(s)
- Mari N Maia da Silva
- Geriatric Neuropsychiatry Outpatient Service, Nina Rodrigues Hospital, São Luís, Brazil
| | - Fábio Henrique de Gobbi Porto
- Laboratory of Psychiatric Neuroimaging (LIM-21) and Old Age Research Group (PROTER), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | - Norberto Anízio Ferreira Frota
- University of Fortaleza (UNIFOR) School of Medicine, Cognitive and Behavioral Neurology Service, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | | | - Gilberto Sousa Alves
- Geriatric Neuropsychiatry Outpatient Service, Nina Rodrigues Hospital, São Luís, Brazil.,Post Graduation in Psychiatry and Mental Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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6
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Abstract
Although chronic mania has been investigated, with several case reports and systematic retrospective cohort studies in the literature, it not a widely recognized entity. No specific definition for chronic mania is provided in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Furthermore, it is challenging to identify patients with chronic mania unless they come to the attention of the legal or medical system. We present the case of a manic patient who was hospitalized and subsequently found to have a YouTube channel that he had been using to promote his self-invented religion for over 2 years. Consent was obtained from the patient to review this YouTube channel for collateral information. From these videos, the patient was seen to be chronically circumstantial in his thought processes, grandiose in his ideas, highly energetic, distractible, preoccupied with religion, and talking with elaborate and rapid speech. A significant improvement in his symptoms was observed after administration of oral risperidone, with his scores on the Young Mania Rating Scale and Brief Psychiatric Rating Scale also showing improvement. To our knowledge, this is the first case in the literature in which an online video-sharing service was used longitudinally to facilitate diagnosis of a mental illness. We suggest that technology has great potential to improve our diagnostic tools, especially for disorders such as chronic mania the diagnosis of which relies primarily on self-report and collateral information.
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7
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Garakani A. Commentary on "Window to His World: Using a Patient's YouTube Channel to Help Diagnose Chronic Mania". J Psychiatr Pract 2020; 26:324-328. [PMID: 32692131 DOI: 10.1097/pra.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although chronic mania has been investigated, with several case reports and systematic retrospective cohort studies in the literature, it not a widely recognized entity. No specific definition for chronic mania is provided in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Furthermore, it is challenging to identify patients with chronic mania unless they come to the attention of the legal or medical system. We present the case of a manic patient who was hospitalized and subsequently found to have a YouTube channel that he had been using to promote his self-invented religion for over 2 years. Consent was obtained from the patient to review this YouTube channel for collateral information. From these videos, the patient was seen to be chronically circumstantial in his thought processes, grandiose in his ideas, highly energetic, distractible, preoccupied with religion, and talking with elaborate and rapid speech. A significant improvement in his symptoms was observed after administration of oral risperidone, with his scores on the Young Mania Rating Scale and Brief Psychiatric Rating Scale also showing improvement. To our knowledge, this is the first case in the literature in which an online video-sharing service was used longitudinally to facilitate diagnosis of a mental illness. We suggest that technology has great potential to improve our diagnostic tools, especially for disorders such as chronic mania the diagnosis of which relies primarily on self-report and collateral information.
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Affiliation(s)
- Amir Garakani
- GARAKANI: Director of Education, Silver Hill Hospital, New Canaan, CT; Assistant Professor (Adjunct) of Psychiatry, Yale University School of Medicine, New Haven, CT; and Assistant Clinical Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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8
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Nebhinani N, Panda T, Saini V, Mahal P, Gupta T. Diagnostic dilemma and management difficulties in a case of chronic mania. JOURNAL OF MENTAL HEALTH AND HUMAN BEHAVIOUR 2020. [DOI: 10.4103/jmhhb.jmhhb_148_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Abstract
Bipolar disorder constitutes a challenge for clinicians in everyday clinical practice. Our knowledge concerning this clinical entity is incomplete, and contemporary classification systems are unable to reflect the complexity of this disorder. The concept of temperament, which was first described in antiquity, provides a helpful framework for synthesizing our knowledge on how the human body works and what determines human behavior. Although the concept of temperament originally included philosophical and sociocultural approaches, the biomedical model is dominant today. It is possible that specific temperaments might constitute vulnerability factors, determine the clinical picture, or modify the course of illness. Temperaments might even act as a bridge between genes and clinical manifestations, thus giving rise to the concept of the bipolar spectrum, with major implications for mental health research and treatment. More specifically, it has been reported that the hyperthymic and the depressive temperaments are related to the more "classic" bipolar disorder, whereas cyclothymic, anxious, and irritable temperaments are related to more complex manifestations and might predict poor response to treatment, violent or suicidal behavior, and high comorbidity. Incorporating of the concept of temperament and the bipolar spectrum into the standard training of psychiatric residents might well result in an improvement of everyday clinical practice.
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10
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Brotto LA, Klein C. Psychological factors involved in women’s sexual dysfunctions. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.09.67] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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11
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Overgenerality memory style for past and future events and emotions related in bipolar disorder. What are the links with problem solving and interpersonal relationships? Psychiatry Res 2013; 210:863-70. [PMID: 23978731 DOI: 10.1016/j.psychres.2013.06.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 06/07/2013] [Accepted: 06/15/2013] [Indexed: 11/21/2022]
Abstract
This study investigated patients with Bipolar Disorder's abilities to generate specific past and future events in response to positive and negative cues words as well as emotional intensity related to these ones. The relationships between the number of generated specific events cognitive functioning, interpersonal problems and the ability to problem solving were investigated. Nineteen BD and nineteen healthy controls completed a French version of the AMT to evaluate the past and future events recall, in function of their valence, and emotions related. Furthermore, they completed the Optional Thinking Test, the Inventory of Interpersonal Problems and the neuropsychological measures. Compared to healthy controls, BD recollected (1) fewer specific past negative events and (2) fewer future specific positive and negative events furthermore, (3) they felt more emotional intensity related to future events. These results were explained in the light of theoretical models. Finally, specific past memories deficits in BD were linked with issues in problem solving but not with levels of distress arising from interpersonal problems. In view of AM functions in everyday life, all types of deficits should be taken into consideration, and AM remediation envisaged.
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Azorin JM, Belzeaux R, Kaladjian A, Adida M, Hantouche E, Lancrenon S, Fakra E. Risks associated with gender differences in bipolar I disorder. J Affect Disord 2013; 151:1033-40. [PMID: 24060589 DOI: 10.1016/j.jad.2013.08.031] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/21/2013] [Accepted: 08/23/2013] [Indexed: 01/25/2023]
Abstract
BACKGROUND Previous studies have demonstrated that bipolar patients may differ in several features according to gender, but a number of the differences found remain controversial. METHODS The demographic, illness course, clinical, comorbidity and temperament characteristics of a total of 1090 consecutive DSM-IV bipolar I manic inpatients were compared according to gender. RESULTS Bipolar illness in women was characterised by the predominance of depression, as indicated by a depressive polarity at onset, higher rates of mixed mania, more suicidal behaviour, and a greater number of temperaments with depressive propensities. In contrast, the manic component was found to predominate in men. Men also had an earlier onset of their illness. Women displayed more comorbidities with eating, anxiety, and endocrine/metabolic disorders, whereas men were more comorbid with alcoholism and other forms of substance abuse, neurological, and cancer disorders. The following independent variables were associated with male gender: being single (+), depressive temperament (-), excessive alcohol use (+), cyclothymic temperament (-), excessive other substance use (+), mood congruent psychotic features (+), and manic polarity at onset (+). LIMITATIONS The retrospective design and the sample being potentially not representative of the bipolar disorder population are limitations. CONCLUSIONS Findings from this study tend to confirm most of the differences previously observed among bipolar men and women. Furthermore, these results draw attention to the risks that may be specifically linked to gender differences in bipolar I patients.
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Affiliation(s)
- Jean-Michel Azorin
- Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France.
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13
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Maddox Shaw AM, Rhoades GK, Allen ES, Stanley SM, Markman HJ. Predictors of extradyadic sexual involvement in unmarried opposite-sex relationships. JOURNAL OF SEX RESEARCH 2013; 50:598-610. [PMID: 22524318 PMCID: PMC3407304 DOI: 10.1080/00224499.2012.666816] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Using a sample of unmarried individuals in opposite-sex romantic relationships that was representative of the United States (N = 933), the current study prospectively evaluated predictors of extradyadic sexual involvement (ESI) over 20 months (from 2007-2010). Data were collected with self-report questionnaires via U.S. mail. Participants were 18 to 35 years old, and 34.9% were male. Variables tested as predictors included involved-partner factors such as demographic characteristics, sexual history, and mental health, as well as relationship-related factors including communication, sexual dynamics, and aspects of commitment. Future ESI was significantly predicted by lower baseline relationship satisfaction, negative communication, aggression, lower dedication, absence of plans to marry, suspicion of partners' ESI, and partners' ESI. It was not predicted by sexual frequency, sexual dissatisfaction, or cohabitation status. Although more problems with alcohol use, more previous sex partners, and having parents who never married one another predicted future ESI, there were many involved-partner demographic factors that did not predict later ESI (e.g., gender, age, education, religiosity, having divorced parents, and having children). None of the results were moderated by gender. These results suggest that compared to demographic characteristics, relationship dynamics and negative interactions are more strongly predictive of future ESI. Implications for future research are discussed.
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Affiliation(s)
- Amanda M Maddox Shaw
- Department of Psychology, University of Denver, 2155 S. Race St., Denver, CO 80208–3500, USA.
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14
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Abstract
Chronic mania (defined as the presence of manic symptoms for more than 2 years without remission) poses significant problems in diagnosis and management. Generally it denotes poor outcome, though contrary reports are available. We present a case of chronic mania and discuss the clinical features of chronic mania reported in the literature, which are useful in distinguishing chronic mania from acute mania.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
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15
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Azorin JM, Kaladjian A, Adida M, Fakra E. Late-onset bipolar illness: the geriatric bipolar type VI. CNS Neurosci Ther 2011; 18:208-13. [PMID: 22070456 DOI: 10.1111/j.1755-5949.2011.00255.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
In parallel to considerable progress in understanding and treatment of bipolarity and despite growing interest in old age psychiatry, late-onset bipolar illness (LOBI) has remained relatively understudied so far, probably in reason of its complexity. To update available data, a systematic review was conducted, focusing on the main issues addressed in literature in regard to this topic. In addition to data on epidemiology, clinical features and treatment, five main issues could be identified: LOBI as secondary disorder, LOBI as expression of a lower vulnerability to the disease, LOBI as subform of pseudodementia, LOBI as risk factor for developing dementia, and LOBI as bipolar type VI (bipolarity in the context of dementia like processes). Levels of available evidence were found to vary according to the addressed issue. Although the concept of bipolar type VI could be criticized for subsuming under one single heading all the four other issues, this concept may be of pragmatic value in helping clinicians to orientate both diagnosis process and treatment decisions. Among others, the question as to whether some forms of bipolar type VI could constitute a special risk factor for developing dementia deserves further investigation. More studies are also needed to better disentangle the effects of age at onset from those of age itself.
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Affiliation(s)
- Jean-Michel Azorin
- Pôle Universitaire de Psychiatrie-Solaris, Hôpital Sainte-Marguerite, Cedex, France.
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16
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The need to consider mood disorders, and especially chronic mania, in cases of Diogenes syndrome (squalor syndrome). Int Psychogeriatr 2011; 23:505-7. [PMID: 20836916 DOI: 10.1017/s1041610210001663] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report the case of a 69 year-old female patient who was hospitalized for Diogenes syndrome, defined by marked self-neglect, social withdrawal and excessive hoarding, leading to squalor. Somatic causes were eliminated. Her personal history showed an eight-year depressive episode followed by a 20-year hypomanic episode without remission, followed by a persistent manic episode associated with Diogenes syndrome for four years. The Diogenes syndrome was successfully treated with mood stabilizers. Mood disorders - in particular chronic mania (i.e. a manic episode lasting more than two years) - should be considered in cases of Diogenes syndrome and in current classifications.
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Joshi G, Wozniak J, Petty C, Vivas F, Yorks D, Biederman J, Geller D. Clinical characteristics of comorbid obsessive-compulsive disorder and bipolar disorder in children and adolescents. Bipolar Disord 2010; 12:185-95. [PMID: 20402711 PMCID: PMC2864069 DOI: 10.1111/j.1399-5618.2010.00795.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore bidirectional comorbidity between bipolar disorder (BPD) and obsessive-compulsive disorder (OCD) in youth and to examine the symptom profile and clinical correlates of both disorders in the context of reciprocal comorbidity and ascertainment status. METHODS Two samples of consecutively referred youth (ages 6-17 years) ascertained contemporaneously for respective studies of BPD and OCD were compared using clinical and scalar assessment and structured diagnostic interviews. RESULTS A total of 21% (17/82) of the BPD subjects and 15% (19/125) of the OCD subjects met DSM-III-R diagnostic criteria for both disorders. In the presence of BPD, youth with OCD more frequently experienced hoarding/saving obsessions and compulsions along with a clinical profile of greater comorbidity, poorer global functioning, and higher rate of hospitalization that is characteristic of BPD. Multiple anxiety disorders (> or = 3), especially generalized anxiety disorder and social phobia, were present at a higher frequency when OCD and BPD were comorbid than otherwise. In subjects with comorbid OCD and BPD, the primary disorder of ascertainment was associated with an earlier onset and more severe impairment. CONCLUSIONS An unexpectedly high rate of comorbidity between BPD and OCD was observed in youth irrespective of primary ascertainment diagnosis. In youth with comorbid OCD and BPD, the clinical characteristics of each disorder run true and are analogues to their clinical presentation in youth without reciprocal comorbidity, with the exception of increased risk for obsessions and compulsions of hoarding/saving and comorbidity with other anxiety disorders.
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Affiliation(s)
- Gagan Joshi
- Pediatric Psychopharmacology Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
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18
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Peters TJ, Beveridge A. The madness of King George III: a psychiatric re-assessment. HISTORY OF PSYCHIATRY 2010; 21:20-37. [PMID: 21877428 DOI: 10.1177/0957154x09343825] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This research, based on a study of King George III's medical records and of contemporary diaries of his courtiers and equerries, further confirms the considerable doubt on the claim of Richard Hunter and Ida Macalpine that the King suffered from recurrent attacks of acute porphyria.The present study examines the above records from a psychiatric viewpoint, together with some additional reports, to re-assess the nature of the King's maladies. It concludes that he suffered from recurrent mania (four episodes), with chronic mania and possibly a degree of fatuity during the last decade of his life.This is in agreement with previous reports that he suffered from manic-depressive psychosis.
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Affiliation(s)
- Timothy J Peters
- Institute of Archaeology and Antiquity, University of Birmingham.
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19
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Aldana LL, Miguel PSS, López MR, Raya MLS, Martínez GP, Sanjaime PR, Moreno LR. Bipolar patients in community mental health centers and specialized units. Could they be pooled? REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2009; 2:128-132. [PMID: 23034311 DOI: 10.1016/s1888-9891(09)72403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 06/12/2009] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Bipolar patients recruited for studies are usually picked from Bipolar Disorder Units, which only contain a fraction of the total population of patients with bipolar disorder. The purpose of this study was to determine whether the course of the illness is comparable in patients from a Community Mental Health Center (CMHC) and those from a Bipolar Disorder Unit (BDU). METHODS This study was carried out at the La Fe Teaching Hospital BDU and two CMCH. Data were collected from the patients' clinical records and were completed by a face-toface interview. When the latter was not possible, a telephone interview was carried out. Demographic, clinical and course-of-illness variables were gathered. RESULTS There were no differences in demographic characteristics between the two patient groups. Differences were found in clinical data: BDU patients were younger at illness onset (p<0.005), were admitted more frequently (p<0.05), and stayed longer in the hospital (p<0.005). CONCLUSIONS Bipolar patients treated at a CMHC show clear differences compared with those from a BDU. Consequently, care should be exercised when generalizing the clinical course of bipolar patients using BDU samples. These patients are not representative of the total bipolar patient population, as their clinical course is more complicated.
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Van Riel WG, Vieta E, Martinez-Aran A, Haro JM, Bertsch J, Reed C, Van Os J, For The Emblem Advisory Board. Chronic mania revisited: factors associated with treatment non-response during prospective follow-up of a large European cohort (EMBLEM). World J Biol Psychiatry 2009; 9:313-20. [PMID: 18949649 DOI: 10.1080/15622970701805491] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe the course and outcome of patients with prospectively defined chronic mania and to identify predictors of treatment non-response. METHOD EMBLEM is a 2-year prospective, observational study of bipolar disorder treatment outcomes conducted in 14 European countries. Patients with a manic/mixed episode were assessed and prospectively followed for 1 year. Clinical scales (Clinical Global Impressions-Bipolar Disorder (CGI-BP) overall, mania, and depression; Young Mania Rating Scale (YMRS); and five-item Hamilton Depression Rating Scale (HAM-D-5)) and medication taken were systemically recorded. Treatment adherence and outcome measures were also captured. Chronic mania (non-response) was defined as not achieving more than one point improvement on CGI-BP mania scale during up to 12-month follow-up. The analysis was conducted with 3373 patients who had at least two CGI-BP mania ratings available. RESULTS A total of 15% of patients fulfilled criteria for chronic mania. Compared to those who responded to treatment, chronic mania was associated with lower severity of mania symptoms at baseline (OR = 0.44, 95% CI 0.37-0.52), shorter duration of current episode before treatment start (OR = 0.71, 95% CI 0.52-0.96), more delusions/hallucinations at baseline (OR = 1.12, 95% CI 1.03-1.22), less socially active (OR = 0.52, 95% CI 0.39-0.70) and greater occupational impairment (OR = 1.54, 95% CI 1.01-2.35) by multivariate statistical analysis. CONCLUSIONS Rather than severity or duration of manic symptoms, factors associated with chronicity in mania are the presence of psychotic symptoms and issues related to social and occupational functioning.
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Affiliation(s)
- Willemijn G Van Riel
- Bipolar Disorders Program, Hospital Clinic, University of Barcelona IDIBAPS, CIBER-SAM, Barcelona, Spain
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Långström N, Hanson RK. High rates of sexual behavior in the general population: correlates and predictors. ARCHIVES OF SEXUAL BEHAVIOR 2006; 35:37-52. [PMID: 16502152 DOI: 10.1007/s10508-006-8993-y] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2004] [Revised: 09/14/2004] [Accepted: 11/16/2004] [Indexed: 05/06/2023]
Abstract
We studied 2450, 18-60-year-old men and women from a 1996 national survey of sexuality and health in Sweden to identify risk factors and correlates of elevated rates of sexual behavior (hypersexuality) in a representative, non-clinical population. Interviews and questionnaires measured various sexual behaviors, developmental risk factors, behavioral problems, and health indicators. The results suggested that correlates of high rates of intercourse were mostly positive, whereas the correlates of high rates of masturbation and impersonal sex were typically undesirable. For both men and women, high rates of impersonal sex were related to separation from parents during childhood, relationship instability, sexually transmitted disease, tobacco smoking, substance abuse, and dissatisfaction with life in general. The association between hypersexuality and paraphilic sexual interests (exhibitionism, voyeurism, masochism/sadism) was particularly and equally strong for both genders (odds ratios of 4.6-25.6). The results held, with a few exceptions, when controlling for age, being in a stable relationship, living in a major city, and same-sex sexual orientation. We conclude that elevated rates of impersonal sex are associated with a range of negative health indicators in the general population.
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Affiliation(s)
- Niklas Långström
- Centre for Violence Prevention, Karolinska Institutet, Stockholm, Sweden.
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Angst J, Gamma A, Endrass J, Hantouche E, Goodwin R, Ajdacic V, Eich D, Rössler W. Obsessive-compulsive syndromes and disorders: significance of comorbidity with bipolar and anxiety syndromes. Eur Arch Psychiatry Clin Neurosci 2005; 255:65-71. [PMID: 15711895 DOI: 10.1007/s00406-005-0576-8] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2004] [Accepted: 12/06/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the prevalence and clinical characteristics of comorbid obsessive compulsive disorders and syndromes (OCD/OCS), compared with pure OCD/OCS among adults in the community. METHOD Data were drawn from the Zurich Study, a longitudinal cohort study of 591 adults in the canton of Zurich. Comorbid OCD/OCS was compared with pure OCD/OCS groups in terms of distress, impairment, family history, suicide behavior and treatment using multivariable logistic regression analyses. RESULTS OCD was significantly comorbid with bipolar I/II and minor bipolar disorders, anxiety states (GAD, repeated panic attacks) and social phobia, whereas there was no clear association between OCD and major depressive disorder or phobias other than social phobia. Results suggest that comorbid OCD/OCS is common among adults in the community, with the majority of those with OCD/OCS having at least one comorbid mood or anxiety disorder with a prevalence of 7.4% compared to 4.8% of remaining OCD/OCS. Comorbidity of OCD/OCS and anxiety states was more common among women (85.6 %) and comorbidity with bipolar spectrum was more common among men (69.6%). Comorbid OCD/OCS was associated with significantly higher levels of treatment seeking, impairment,distress and suicidality compared with pure OCD/OCS. Comorbidity with bipolar disorders significantly increased the risk for alcohol abuse/dependence. CONCLUSION Comorbidity of OCD/OCS with bipolar disorder and bipolar spectrum disorders is common and very probably explains the association between OCD and depression found in other studies. The early recognition of bipolar/cyclothymic OCD/OCS may help to prevent the abuse of/dependence on alcohol.
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Affiliation(s)
- Jules Angst
- Zurich University Psychiatric Hospital, Lenggstrasse 31, P. O. Box 68, 8029 Zurich, Switzerland.
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Berk M, Malhi GS, Mitchell PB, Cahill CM, Carman AC, Hadzi-Pavlovic D, Hawkins MT, Tohen M. Scale matters: the need for a Bipolar Depression Rating Scale (BDRS). Acta Psychiatr Scand 2004:39-45. [PMID: 15330937 DOI: 10.1111/j.1600-0447.2004.00412.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To briefly review the clinical and biological distinctions between unipolar and bipolar depression critiquing in particular currently available depression rating scales and discuss the need for a new observer-rated scale tailored to bipolar depression. METHOD Relevant literature pertaining to the symptomatic differences between bipolar disorder and unipolar disorder as well as their measurement using existing assessment scales was identified by computerized searches and reviews of scientific journals known to the authors. RESULTS Bipolar depression is distinct from unipolar depression in terms of phenomenology and clinical characteristics. These distinguishing features can be used to identify bipolarity in patients that present with recurrent depressive episodes. This is important because current self-report and observer-rated scales are optimized for unipolar depression, and hence limited in their ability to accurately assess bipolar depression. CONCLUSION The development of a specific bipolar depression rating scale will improve the assessment of bipolar depression in both research and clinical settings and assist the development of better treatments and interventions.
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Affiliation(s)
- M Berk
- Barwon Health and The Geelong Clinic, Geelong, Australia.
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Negash A, Kebede D, Alem A, Melaku Z, Deyessa N, Shibire T, Fekadu A, Fekadu D, Jacobsson L, Kullgren G. Neurological soft signs in bipolar I disorder patients. J Affect Disord 2004; 80:221-30. [PMID: 15207935 DOI: 10.1016/s0165-0327(03)00116-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2002] [Revised: 05/06/2003] [Accepted: 05/06/2003] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neurological soft signs (NSS) have been reported to be more prevalent in patients with schizophrenia compared to other psychiatric and non-psychiatric controls. However, this issue in bipolar I disorder seems to be understudied. AIMS The aims of the study were to examine the extent to which NSS are associated with bipolar I disorder cases compared to healthy controls, to assess the possible relationship between NSS and clinical dimensions of the disorder, and to explore the association of sociodemographic characteristics with the occurrence of NSS in cases with this disorder. METHODS Predominantly treatment naïve cases of bipolar I disorder from rural communities were assessed for NSS using the Neurological Evaluation Scale (NES). RESULTS This study showed that patients with bipolar I disorder performed significantly worse on two NES items from the sensory integration subscale, on one item from motor coordination and on four items from the 'others' subscale, the highest difference in performance being in items under the sequencing of complex motor acts subscale. Clinical dimensions and sociodemographic characteristics appeared to have no relationship with NES total score. CONCLUSIONS Bipolar I disorder patients seem to have more neurological dysfunction compared to healthy controls particularly in the area of sequencing of complex motor acts. In addition, the finding suggests that NSS in bipolar I disorder are stable neurological abnormalities established at its onset or may be essential characteristic features of the disorder representing stable disease process that existed long before its onset.
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Affiliation(s)
- A Negash
- Department of Community Health, Addis Ababa University, Addis Ababa, Ethiopia
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Abstract
Bipolar disorder continues to be underrecognized, despite being known for 2000 years. Mania, the fullest expression of the disease affects approximately 1% of the population; the less-than-manic forms of the disease dominated by depressive episodes have recently been found to be more common, affecting 4-5% of the population. In reviewing the international literature on this broadened bipolar spectrum, this paper pays particular tribute to the French EPIDEP and EPIMAN studies and Italo-American collaboration which have generated the largest set of systematic data on the new clinical portrait of bipolar disorders. Early detection is crucial, because untreated bipolar disorder has a high mortality rate. A review of the diagnostic criteria for the various subtypes of bipolar disorder has identified several factors that interfere with making an accurate diagnosis. These include age at onset, ethnic differences, co-morbidity (particularly substance abuse and alcoholism), and the broad range of clinical presentations. Moreover, symptoms frequently overlap with those of other psychiatric disorders including schizophrenia, attention-deficit disorder and personality disorders. Misdiagnosis is a major factor leading to a poor outcome for patients. Accurate identification and diagnosis of the different forms of mania can lead to specific treatment choices that may improve prognosis. Particularly important are recent data indicating reduced mortality with a variety of psychopharmacologic agents including, but not limited to, lithium and valproate.
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Affiliation(s)
- P Thomas
- Department of Psychiatry, School of Medicine, University of Lille ll, Centre Hospitalier Regional and Universitaire, 6 Rue de Pr Laguesse, Lille, France.
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Abstract
OBJECTIVE There are many nuances of elevated mood states. At times, it becomes very difficult to diagnose a case of mania because of personality style of the patient superimposed on a cyclothymic or hyperthymic temperament. Such cases may become chronic if timely intervention is not received. We describe a case of chronic mania of 48 years of duration. METHOD A case report. RESULTS A 65-year-old male was admitted with history of mania for around five decades. The illness commenced at prepubertal age and was continuous without any residual symptoms of note. During the course of illness, he got involved in many devastating socio-politico-legal complications. He showed good response to treatment and is currently maintained well without medication. In this case we also described some psychosocial features that may have been responsible for the chronicity of the illness. CONCLUSION We highlighted the need for correctly identifying chronic mania, early intervention and increasing treatment awareness. This case was not treatment resistant, suggesting that chronicity per se should not denote poor outcome.
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Affiliation(s)
- D N Mendhekar
- Psychiatry Department, G.B. Pant Hospital, New Delhi, India.
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Abstract
Among the elderly, bipolar disorder is a significant public health problem, often leading to functional impairment and substantial use of health care resources. There has been a growing awareness regarding the manifestations of bipolar disorder among older adults owing to both changes in national demographics and developing sophistication in the treatment of bipolar illness. Bipolar disorder accounts for 5% to 19% of mood disorder presentations in the elderly, although a clear picture of the exact prevalence of bipolar disorder among older adults in the community is still lacking. Data from treatment centers give a somewhat unreliable picture of the true prevalence and manifestations of bipolar disorder in the general population as elderly patients tend to underuse mental health systems, under-report psychiatric symptoms, and are often treated in nonhospital/clinic settings, such as nursing homes. Factors of particular relevance in late-life bipolar disorder include age of onset, symptom presentation/recognition, secondary mania, psychiatric and medical comorbidity, and response to treatment. Future mental health services research must further explore these issues to optimize care for older adults with bipolar disorder.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
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Wozniak J, Biederman J, Monuteaux MC, Richards J, Faraone SV. Parsing the comorbidity between bipolar disorder and anxiety disorders: a familial risk analysis. J Child Adolesc Psychopharmacol 2003; 12:101-11. [PMID: 12188979 DOI: 10.1089/104454602760219144] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A growing literature suggests that anxiety disorders (ANX) co-occur with bipolar disorder (BPD), but the nature of this overlap is unknown. Thus, we investigated the familial association between BPD and ANX among the first-degree relatives of children with BPD with and without comorbid ANX. METHODS We compared relatives of four proband groups defined by the presence or absence of BPD and ANX in the proband: (1) BPD + ANX (n = 23 probands, 74 relatives), (2) BPD without ANX (n = 11 probands, 38 relatives), (3) ANX without BPD (n = 48 probands, 167 relatives), and (4) controls without BPD or ANX (n = 118 probands, 385 relatives). All subjects were evaluated with structured diagnostic interviews. Diagnoses of relatives were made blind to the diagnoses of probands. RESULTS The results show high rates of both BPD and ANX in relatives of children with BPD + ANX. Moreover, BPD and ANX cosegregated among the relatives of children with BPD + ANX. Although relatives of both ANX proband groups (with and without BPD) had high rates of ANX, and relatives of both BPD proband groups (with and without ANX) had high rates of BPD, the combined condition BPD + ANX was the predominant form of BPD among relatives of probands with BPD + ANX. CONCLUSIONS These family-genetic findings suggest that the comorbid condition BPD+ANX may be a distinct clinical entity. More work is needed to evaluate whether the presence of comorbid ANX may be a marker of very early onset BPD.
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Affiliation(s)
- Janet Wozniak
- Pediatric Psychopharmacology Unit of the Child Psychiatry Service, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
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Akiskal HS, Azorin JM, Hantouche EG. Proposed multidimensional structure of mania: beyond the euphoric-dysphoric dichotomy. J Affect Disord 2003; 73:7-18. [PMID: 12507733 DOI: 10.1016/s0165-0327(02)00318-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although the construct of depression has been subjected to numerous factor analytic studies and phenomenological subtypes of clinical relevance have been delineated, this is not the case for mania. The few available studies have reported at least two factors, which consist of euphoric versus dysphoric-hostile subtypes. Our objective was to replicate and further enrich this literature. METHODS In the EPIMAN French National Study we systematically evaluated 104 DSM-IV hospitalized manic patients in four university centers in different regions of France. Psychiatrists completed the Beigel-Murphy Manic State Rating Scale (MSRS), as well as the HAM-D(17), affective temperament scales, and the GAF Axis V from DSM-IV. Categorization of patients into pure versus dysphoric mania was made on the basis of clinical diagnosis, independent from psychometric measures. RESULTS On principal component analysis of the MSRS, three factors explained the largest variance: a global manic (23.3% variance), paranoid-hostile (14.8% variance), and psychotic (9.1% variance). After varimax rotation, we obtained seven independent factors: F1 Disinhibition-instability, F2 Paranoia-hostility, F3 Deficit, F4 Grandiosity-psychosis, F5 Elation-euphoria, F6 Depression, and F7 (Hyper)sexuality. We could not demonstrate significant correlations between the individual factors and impaired functioning on GAF. However, depressive and, to some extent, cyclothymic temperaments correlated with F6 Depression. Finally, intergroup comparisons between pure versus dysphoric mania diagnosed clinically showed high levels of F3 Deficit and F5 Elation in the pure, and of F6 Depression in dysphoric, mania; F2 Paranoia-hostility did not discriminate these two clinical forms of mania. LIMITATIONS Although the present analyses on the Beigel-Murphy represent the largest sample studied to date, they are still underpowered and do not guarantee a stable factorial structure. Our findings are cross-sectional and require prospective validation. CONCLUSIONS Our data suggest that 'dysphoria' as used in the literature to qualify mania is insufficiently precise, and is best further specified as 'depressive' versus 'irritable.' Moreover, our data extend the rich multidimensional phenomenology of mania beyond the existing literature: we submit that disinhibition-instability (a core 'activation' component) can, on the one hand, be associated with distinct emotional presentations (euphoric, depressive, or irritable-hostile), as well as psychotic and deficit symptomatology on the other.
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Affiliation(s)
- H S Akiskal
- International Mood Center, University of California at San Diego, La Jolla, CA, USA.
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de Zelicourt M, Dardennes R, Verdoux H, Gandhi G, Khoshnood B, Chomette E, Papatheodorou ML, Edgell ET, Even C, Fagnani F. Frequency of hospitalisations and inpatient care costs of manic episodes: in patients with bipolar I disorder in France. PHARMACOECONOMICS 2003; 21:1081-1090. [PMID: 14596627 DOI: 10.2165/00019053-200321150-00002] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Bipolar disorder is a chronic illness that may involve multiple relapses and result in substantial psychosocial impairment. However, very few recent studies have investigated the economic burden of the disease. OBJECTIVE To assess the frequency of hospitalisation and the inpatient care costs associated with manic episodes in patients with bipolar I disorder in France. METHOD A cost-of-illness study was conducted based on available data using a hospital payer perspective. The lifetime prevalence of manic episodes was estimated from published epidemiological data using a random-effects meta-analysis. Data were obtained by a computerised literature search using the main scientific and medical databases. Additional epidemiological references were identified from published studies and textbooks. Data on frequency of hospitalisation and length of stay were collected from a large psychiatric university hospital. Data on unit costs for inpatient care were obtained from the accounting system of the largest hospital group in Paris, France for the year 1999. RESULTS Extrapolating from international data on the average prevalence of bipolar I disorder, the proportion of rapid cycling patients and the average cycle duration, we estimated the annual number of manic episodes in patients with bipolar I disorder to be around 265,000 in France. Based on hospital data in Paris, the proportion of manic episodes that require hospitalisation was estimated to be around 63%. The average length of stay was 32.4 days and the hospitalisation-related costs were estimated to be around 8.8 billion French francs (Euro 3 billion) [1999 values]. CONCLUSION Our study highlights the lack of medical and economic data on the frequency and hospitalisation-related costs of manic episodes in patients with bipolar I disorder in France. As the lifetime prevalence of bipolar I disorder may be as high as 3% among adults, further studies are required in order to provide representative national data and to allow economic evaluations of costs related to bipolar I disorder in France.
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Affiliation(s)
- Marie de Zelicourt
- Cemka-Eval, 43 Boulevard de maréchal Joffre, 92340, Bourg-la-Reine, France.
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Perugi G, Maremmani I, Toni C, Madaro D, Mata B, Akiskal HS. The contrasting influence of depressive and hyperthymic temperaments on psychometrically derived manic subtypes. Psychiatry Res 2001; 101:249-58. [PMID: 11311928 DOI: 10.1016/s0165-1781(01)00232-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The present investigation focused on symptomatological subtypes of mania and their relationships with affective temperaments and other clinical features of bipolar disorder. In 153 inpatients with mania diagnosed according to DSM-III-R, symptomatological subtypes have been investigated by means of principal component factor analysis of 18 selected items of the Comprehensive Psychopathological Rating Scale (CPRS). We compared other clinical features, depressive and hyperthymic temperamental attributes, and first degree-family history for mood disorders among the various manic subtypes on the basis of the highest z-scores obtained on each CPRS factor (dominant CPRS factor groups). Five factors--Depressive, Irritable-Agitated, Euphoric-Grandiose, Accelerated-Sleepless, Paranoid-Anxious--emerged, accounting for 59.8% of the total variance. When the factor-based groups were compared, significant differences emerged in terms of the duration of the current episodes, rates of chronicity and incongruent psychotic features--being highest in the 'Depressive' and 'Paranoid-Anxious' dominant groups. The patients with highest z-scores for the 'Euphoric-Grandiose', 'Paranoid-Anxious' and 'Accelerated-Sleepless' factors were those most likely to belong to the hyperthymic temperament, while the 'Depressive' dominant group had the highest rate of depressive temperament. Finally, it is noteworthy that the 'Irritable-Agitated' group was high for both temperaments. The foregoing multidimensional structure of mania--revealing five factors--is generally concordant with the emerging literature. Consistently with our original hypothesis, a hyperthymic temperament seems to underlie the most extreme manic excitement with euphoric-accelerated-paranoid phenomenology. By contrast, the depressive temperament seemed to mute the expression of mania into a depressive-manic phenomenology.
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Affiliation(s)
- G Perugi
- Department of Psychiatry, University of Pisa, Via Roma 67, 56100, Pisa, Italy.
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Strakowski SM, Williams JR, Sax KW, Fleck DE, DelBello MP, Bourne ML. Is impaired outcome following a first manic episode due to mood-incongruent psychosis? J Affect Disord 2000; 61:87-94. [PMID: 11099745 DOI: 10.1016/s0165-0327(99)00192-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mood-incongruent psychosis during the course of bipolar disorder has been associated with poor outcome. However, it remains unknown whether this is secondary to persistent affective or psychotic symptoms or both. METHOD Fifty patients with bipolar disorder between the ages of 16 and 45 years were recruited during their first psychiatric hospitalization for mania. These patients were evaluated using structured and semi-structured clinical instruments then followed longitudinally. Outcomes during the first eight months of follow-up were compared between patients with mood-incongruent psychosis and those without (i.e., patients with mood-congruent psychosis or no psychosis) during the index manic episode. Specifically, ratings of the percent of weeks during follow-up with psychosis and affective syndromes and symptoms, as well as ratings of global outcome (GAF), were compared. RESULTS Patients with mood-incongruent psychosis at the index hospitalization exhibited significantly more weeks during follow-up with both mood-incongruent and mood-congruent psychotic symptoms than patients without mood-incongruent psychosis. Mood-incongruent psychosis was also associated with poorer overall functioning during the outcome interval. The groups did not differ in the percent of weeks with affective syndromes or symptoms. Treatment during follow-up did not differ between groups and was not associated with outcome variables in general. CONCLUSION Mood-incongruent psychosis that occurs during the first manic episode appears to predict an increased likelihood of persistent psychotic symptoms during the subsequent eight months. This persistence of psychosis is associated with a worse overall course of illness as compared to patients without mood-incongruent psychosis. LIMITATIONS These results apply to a relatively short outcome period and are from a single center.
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Affiliation(s)
- S M Strakowski
- Bipolar and Psychotic Disorders Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, 45267-0559, Cincinnati, OH, USA.
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Cassano GB, McElroy SL, Brady K, Nolen WA, Placidi GF. Current issues in the identification and management of bipolar spectrum disorders in 'special populations'. J Affect Disord 2000; 59 Suppl 1:S69-S79. [PMID: 11121828 DOI: 10.1016/s0165-0327(00)00180-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bipolar disorder is a common, lifelong condition that can present during childhood, adolescence, adulthood or later in life. It may occur alone but, more frequently, is complicated by comorbid psychiatric and medical disorders. As such, bipolar disorder presents in many different special populations, each of which warrants specific considerations of diagnosis, treatment and management. This review summarizes common issues concerning recognition of bipolar disorder, particularly in younger patients, discusses the prevalence and treatment of anxious disorder and addictive comorbidity, and considers bipolar disorder in the institutionalized and forensic populations. Treatment options and the supporting evidence are discussed.
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Affiliation(s)
- G B Cassano
- DPNFB, Università degli di Pisa, Via Rome 67, 561 00, Pisa, Italy
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Perugi G, Micheli C, Akiskal HS, Madaro D, Socci C, Quilici C, Musetti L. Polarity of the first episode, clinical characteristics, and course of manic depressive illness: a systematic retrospective investigation of 320 bipolar I patients. Compr Psychiatry 2000; 41:13-8. [PMID: 10646613 DOI: 10.1016/s0010-440x(00)90125-1] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In 320 patients with established bipolar I disorder, we examined the past course on the basis of polarity at onset (depressive, mixed, and manic). Despite the obvious limitations of retrospective methodology, information on course parameters in a large sample of affective disorders is most practically obtained by such methodology. We believe that our systematic interview of patients and their relatives--as well as the systematic study of their records--minimized potential biases. Depressive onsets were the most common, accounting for 50%, followed by mixed and manic onsets in about equal proportion. In general, the polarity of episodes over time reflected polarity at onset. Those with depressive onset had significantly higher levels of rapid cycling, as well as suicide attempts, but were significantly less likely to develop psychotic symptoms. Mixed onsets, too, had high rates of suicide attempts, but differed from depressive onsets in having significantly more chronicity yet negligible rates of rapid cycling at follow-up evaluation. Because cases with depressive onset had received significantly higher rates of psychopharmacologic treatment, our data are compatible with the hypothesis that antidepressants may play a role in the induction of rapid cycling. Overall, our data support the existence of distinct longitudinal patterns within bipolar I disorder, which in turn appear correlated with the polarity at onset. In particular, rapid cycling and mixed states emerge as distinct psychopathologic processes.
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Affiliation(s)
- G Perugi
- Institute of Psychiatry, University of Pisa, Italy
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