Early stages of bipolar disorder: characterization and strategies for early intervention

Objective: To characterize the early stages of bipolar disorder (BD), defined as the clinical prodrome/subsyndromal stage and first-episode phase, and strategies for their respective treatment. Methods: A selective literature search of the PubMed, Embase, PsycINFO, and ISI databases from inception until March 2014 was performed. Included in this review were articles that a) characterized prodromal and first-episode stages of BD or b) detailed efficacy and safety/tolerability of interventions in patients considered prodromal for BD or those with only one episode of mania/hypomania. Results: As research has only recently focused on characterization of the early phase of BD, there is little evidence for the effectiveness of any treatment option in the early phase of BD. Case management; individual, group, and family therapy; supportive therapy; and group psychoeducation programs have been proposed. Most evidence-based treatment guidelines for BD do not address treatment specifically in the context of the early stages of illness. Evidence for pharmacotherapy is usually presented in relation to illness polarity (i.e., manic/mixed or depressed) or treatment phase. Conclusions: Although early recognition and treatment are critical to preventing unfavorable outcomes, there is currently little evidence for interventions in these stages of BD.

Reporte de caso clínico: depresión, estrés y pica, ¿un nexo serotoninérgico? / Case report. Depressive illness, stress and pica: a serotoninergic link?

Tanto el CIE-10 como el DSM-IV coinciden en que la pica es la ingestión persistente de sustancias no nutritivas. Cabe señalar que ambos sistemas de clasificación incluyen a la pica dentro de los trastornos que ocurren en la infancia. Nosotros describimos el caso de una mujer de 47 años de edad sin antecedentes psiquiátricos, quien luego de una serie de eventos estresantes, presentó síntomas depresivos y ansiosos, que configuraron un diagnóstico de episodio depresivo mayor. Dentro de los exámenes realizados destaca un hemograma con alteraciones compatibles con una anemia ferropénica, por lo que se indicó el tratamiento respectivo. En los controles sucesivos, la paciente tuvo una evolución tórpida de su cuadro depresivo, y además se sumó otro fenómeno, el cual consistió en ingesta de hielo. Comiendo promedio, entre 6 a 8 cubetas de hielo diarios. Esto último se inició de manera brusca y por primera vez en su historia de vida. A pesar de la existencia de anemia en esta paciente, creemos que este hecho no explica en forma satisfactoria lo ocurrido en este caso, por lo que se intenta dar una hipótesis neurobiológica que involucra al sistema serotoninérgico. Es importante destacar que tanto la ocurrencia de pica en un adulto como la asociación de ésta con un episodio depresivo, son hechos escasamente descritos.

The ICD-10 as well as the DSM-IV, coincide in the fact that pica is the persistent eating of non nutritive substances. It should be noted. That both classification systems include pica under the disorders that occur on infancy and early childhood. We describe the case of a woman of 47 years old, without psychiatric past history that presented a depressive illness after a series of stressful events. Within the laboratory test, there was an altered cell blood count that showed an iron deficiency anemia, the reason why respective treatment was indicated. The patient had a torpid evolution of her depression and also another phenomenon appeared, she began to eat 6 to 8 ice buckets daily in average (more than 200 ice cubes) this behavior started abruptly and for the fist time in her life history. Despite the presence of anemia, we believe that this fact does not explain satisfactorily what happens in this case. That is why we try to give a neurobiological hypothesis that includes the serotonergic system. It is noteworthy that the presence of pica in an adult and its assoc8iation with a depressive illness is rarely reported.

FVC, FEV1 and FEV1/FVC% in Patients with Depressive Illness and their Relationships with the level of Depression.

Background: Depressive illness is a common psychological disorder which affects various organs including lungs. Many studies have reflected decreased lung functions in patients with depressive illness. Objective: The present study was undertaken to measure some pulmonary function parameters in diagnosed female patients with depressive illness to evaluate their lung functions status. Methods: This cross-sectional study was carried out in the Department of Physiology, SSMC, Mitford, Dhaka, from 1st July 2009 to 30th June 2010 on 30 female patients with depressive illness, age ranged from 20- 40 years. Depressed patients (study group) were divided into patients with minor depressive illness (group-B1) and patients with major depressive illness (group- B2). For comparison, 30 age and BMI matched apparently healthy subjects (control group-A) were also studied. The study groups were selected from the Out Patient Department of Psychiatry, SSMC, Mitford, Dhaka and the control group was selected by personal contact. Pulmonary function parameters like FVC, FEV1, FEV1/FVC%, of all subjects were measured by digital spirometer. Statistical analysis was done by using appropriate method as applicable. Results: All the pulmonary function parameters except FEV1/FVC% were significantly (p<0.001) lower in patients with depressive illness in comparison to those of control. Again, pulmonary function parameters like FVC (p<0.01), FEV1 (p<0.05) showed significant negative correlation with the level of depression in patients with major depressive illness. Conclusion: This study reveals that some pulmonary functions may be reduced in patients with depressive illness especially in major depressive patients which is negatively related with level of depression.

A Case of Thyrotoxicosis During Lithium Therapy / 대한내분비학회지

Lithium has been established as a drug useful for the treatment of manic depressive disorder. It is now well recognized that long-term administration of this drug is associated with various antithyroid effects such as goiter, and subclinical and overt hypothyroidism. However, it has been associated less commonly with thyrotoxicosis. Recently we experienced a case of thyroitoxicosis during lithium therapy. A 24-year-old man treated with lithium carbonate 900 mg-1,200 mg/day for manic-depressive illness for four weeks. He then complained of nervousness, palpitation, tremor, heat intolerance, and sweating. Neck pain was not noted. At that time the results of thyroid function test were consistent with hyperthyroidism: T3 568.8 ng/dL, TSH 0.01 mU/mL, FT4 6.0 ng/dL, but 24 hr radioiodine uptake was 0.3%. We suspected this case as lithium induced thyrotoxicosis and discontinued lithium administration. After discontinuation of lithium thyrotoxic symptoms were subsided. One month later, thyroid hormon levels became normalized: T 100.2 ng/dL, TSH 0.06 mU/mL, FT4 0.97 ng/dL and 24hr radioiodine uptake was 16%. We report this case with review of literatures.

Effect of Yi'nao Jieyu Formula on Brain Evoked Potential in Primary Depressive Illness Patients / 中医杂志

Objective To study the spatial distribution character of brain evoked potential(BEP)in primary depressive illness(PDI)patients and the effect of Yi'nao Jieyu Formula.Methods Case control study and self-control study in Chinese herbal treatment group were conducted.Brain-stem auditory evoked potential(BAEP)and visual evoked potential(VEP)of 60 PDI patients and 45 healthy controllers were recorded by BEP apparatus made in Italy.BAEP and VEP of 30 patients of PDI group were detected again after taking Yi'nao Jieyu Formula for 6 weeks.Results Latencies of whole waves in BAEP and VEP prolonged significantly in PDI group(P