The champion: Conquering the challenges of bipolar disorders

@#<p style="text-align: justify;">Bipolar Disorder has been one of the leading psychiatric conditions here in the Philippines. . It is characterized by mood swings from profound depression to extreme euphoria (mania), with intervening period of normal mood (euthymia). The frequency, duration, and severity of manic and/or depressive episodes varies and is unique to each individual (Haber, 1997). In general, there are five in every 100 Filipinos who are suffering from some form of depression, and other may have a different reaction such as hyperactivity or swinging from depression to euphoria, unable to function normally, and in real danger of hurting themselves and others. Sadly, many of those with bipolar illness are left undiagnosed and, consequently, untreated. This case study presents how nurses play a role in helping patients overcome the challenges of having a psychiatric illness particularly those with Bipolar Disorder. </p>

Mania/hipomania induzida por aripiprazol / Manic/hypomanic symptoms induced by aripiprazole

Aripiprazol é um antipsicótico atípico (AAt) frequentemente indicado para o tratamento agudo da mania, assim como para quadros mistos de transtorno bipolar (TB) tipo I e para o tratamento de manutenção do TB tipo I. A potencial ação antidepressiva dos AAts possibilita que medicamentos dessa classe aumentem as chances do aparecimento de mania em indivíduos suscetíveis. Com o objetivo de sumarizar evidência que possibilite a discussão técnica desse tópico, aqui relatamos três casos de pacientes com TB com mania induzida por aripiprazol. Pacientes tinham diagnósticos e comorbidades diferentes e estavam em regime terapêutico também diferente. Mania foi temporalmente associada à introdução de aripiprazol. Melhora considerável aconteceu após a retirada do fármaco. Sugerimos que o aripiprazol, por meio da sua ação antidepressiva, seja fator de risco para virada maníaca e hipomaníaca. Recomendamos o uso associado de estabilizador de humor com potencial antimaníaco para prevenir eventual inversão de fase. Sugere-se, ainda, a provável eficácia antidepressiva do aripiprazol.

Aripiprazole is an atypical antipsychotic often used as monotherapy or as add-on therapy in patients with manic episodes, as well as for bipolar disorders. The antidepressive effect of the atypical antipsychotic medications raises the possibility that these drugs may increase the risk of mania in susceptible individuals. With the aim of providing further evidence on this subject, herein we reported three patients with bipolar disorder and mania induced by aripiprazole. Patients had different final diagnosis as well as different comorbidities. Their therapeutic regimen was different as well. Onset of manias was temporarily associated with aripiprazole use and important improvement happened after the discontinuation of this drug. We suggest that aripiprazole, due to its antidepressant properties, is a risk factor for mania and hypomania. Mood stabilizer is recommended in certain individuals using this drug, in order to prevent phase switch. We also suggest the antidepressant efficacy of aripiprazole.

Antidepressant treatment-emergent affective switch in bipolar disorder: a prospective case-control study of outcome

OBJECTIVE: Treatment-emergent affective switch has been associated to cycle acceleration and poorer outcome, but there are few studies addressing this issue. The aim of this study was to prospectively compare the outcome of patients presenting treatment-emergent affective switch with patients with spontaneous mania, regarding presence and polarity of a new episode and time to relapse. METHOD: Twenty-four patients with bipolar disorder according to the DSM-IV were followed for 12 months. Twelve patients had treatment-emergent affective switch and twelve had spontaneous mania. Patients were evaluated weekly with the Young Mania Rating Scale and the Hamilton Depression Scale until remission of the index episode, and monthly until completion of the 12-month follow-up. RESULTS: Eleven patients with treatment-emergent affective switch had a recurrence on follow-up, all of them with major depressive episodes. In the group with spontaneous mania, six patients had a recurrence: two had a depressive episode, and four had a manic episode (p = 0.069 for new episode, p = 0.006 for polarity of the episode). Patients with treatment-emergent affective switch relapsed in a shorter period than patients with spontaneous mania (p = 0.016). CONCLUSIONS: In this first prospective study, treatment-emergent affective switch patients were at greater risk of relapses, especially depressive episodes, and presented a shorter duration of remission when compared with patients with spontaneous mania.

OBJETIVO: A ciclagem para mania associada ao antidepressivo tem sido relacionada à aceleração do ciclo e pior evolução, mas há poucos estudos na literatura sobre este assunto. O objetivo deste estudo foi comparar prospectivamente a evolução de pacientes com mania associada a antidepressivo com pacientes com mania espontânea, em relação a tempo para recaída e polaridade do novo episódio. MÉTODO: Vinte e quatro pacientes com transtorno bipolar, de acordo com os critérios diagnósticos do DSM-IV, foram seguidos por 12 meses: 12 pacientes com mania associada a antidepressivo e 12 pacientes com mania espontânea. Os pacientes foram avaliados semanalmente com a Escala para Mania de Young e a Escala para Depressão de Hamilton até remissão do episódio inicial e, mensalmente, até completar o período de seguimento de 12 meses. RESULTADOS: Onze pacientes com mania associada ao antidepressivo tiveram uma recorrência no seguimento, sendo todos os episódios depressivos. No grupo de mania espontânea, seis pacientes apresentaram recorrência, sendo dois episódios depressivos, e quatro episódios de mania (p = 0,069 para novo episódio e p = 0,006 para polaridade do episódio). Pacientes com mania associada a antidepressivo recaíram em um menor período de tempo que os pacientes com mania espontânea (p = 0,016). CONCLUSÕES: Neste estudo prospectivo, os pacientes com mania associada a antidepressivo apresentaram maior risco de recorrência, especialmente episódios depressivos, e com menor duração de remissão quando comparados aos pacientes com mania espontânea.

Neurodynamic organization of cognitive processes and EEG correlates of endogenous asthenia-like disrorders

The EEG of 58 young endogenous psychiatric patients (male, aged 16 - 25) with atypical subdepressive and depressive states (defined in the literature as "asthenic juvenile deficiency") was analyzed by means of period (interval-amplitude) and factor analyses. Characteristic neurodynamic imbalance was revealed in subgroup of 24 patients of sluggish schizophrenia with prominent "asthenia-like" symptomatology characterized by predominant mild thought disorders with difficulty in attention concentration. These patients diffrend from control normal subjects, cyclothymic patients and the patients of sluggish schizophrenia without well-defined asthenic disorders in significantly higher values of EEG Factor related to the index (temporal percentage), frequency and regularity of low-amplitude beta-waves as well as in the reduced values of the other EEG Factor connected with the mean period of alpha-waves and with the theta-index. According to previous series of EEG study of cognitive activity in norm, this can probably be considered as abundance of processes of "cortical excitation" and deficit of "active selective inhibition". The revealed imbalance of such process proved to be opposed to their normal balance revealed during voluntary attention concentration and some other processes of mental selectivity in normal subjects

Personalidad premórbida en los trastornos del ánimo y en la esquizofrenia: un estudio empírico / Pre-morbid personality in mood disorders and schizophrenia: an empirical study

Numerosos autores han asociado ciertos rasgos de la personalidad a las diferentes formas de trastorno mental. Las depresiones unipolares han sido asociadas a una estructura de personalidad premórbida rígida, fijada al rol y al orden e intolerante a la ambigüedad. Los trastornos bipolares a estructuras cambiantes, flexibles, creativas y sociables y los trastornos esquizofrénicos a rasgos introvertidos. Este trabajo analiza empíricamente las características e interacciones entre algunos constructos de la personalidad premórbida y los trastornos de ánimo y esquizofrénicos. 20 pacientes bipolares, 27 depresivos unipolares y 17 esquizofrénicos, diagnósticados de acuerdo al DSM-III R e ICD-10 y hospitalizados en la Clínica Psiquiátrica de la Universidad de Chile, junto a un grupo control, fueron comparados psicométricamente mediante escalas F, MP-T y de Intolerancia a la ambigüedad de Kischkel, todas de autoevaluación, junto a la escala MP-T de evaluación externa. Los pacientes debieron completar las escalas al momento del alta, encontrándose asintomáticos. El análisis de covarianza de los resultados demostró mayores índices de rígidez e intolerancia a la ambigüedad para el grupo depresivo unipolar, mayores valores de rasgos ciclotímicos como flexibilidad, creatividad y sociabilidad para el grupo bipolar y menores índices de extroversión para el grupo esquizofrénico. Los resultados confirman hallazgos previos registrados en Alemania y Japón, corroborando la hipótesis de que esas formas de personalidad son independientes de las influencias culturales. Finalmente se discute el significado de estos hallazgos para la comprensión de la patogénesis, la psicopatología, las formas de evolución y el adecuado tratamiento de estos trastornos

El subtipo bipolar II de la enfermedad maníaco depresiva / The II bipolar subtype of the maniac-depressive disease

En el subtipo bipolar II, mD, existen episodioa de depresión y leves fases hipomaníacas. Su reconocimiento permite diagnosticar correctamente la enfermedad bipolar, puesto que con frecuencia en este subgrupo pasan desapercibidos los episodios hipomaníacos, lo que lleva erróneamente al diagnóstico de depresión monopolar. El diagnóstico bipolar II está en la línea conceptual de espectro bipolar