Psychotic and affective symptoms of early-onset bipolar disorder: an observational study of patients in first manic episode

Objective: Presence of psychotic symptoms seems to be a commonplace in early-onset bipolar disorder (BD). However, few studies have examined their occurrence in adolescent-onset BD. We sought to investigate the frequency of affective and psychotic symptoms observed during the first manic episode in adolescents. Methods: Forty-nine adolescents with bipolar I disorder (DSM-IV criteria) were admitted to a psychiatric hospital during their first acute manic episode. Assessment for current psychiatric diagnosis was performed by direct clinical interview and the DSM-IV version of the Diagnostic Interview for Children and Adolescents (DICA). Results: Teenage inpatients with BD consistently exhibited typical manic features, such as euphoria, grandiosity, and psychomotor agitation. In addition, disorganization and psychotic symptoms were present in 82 and 55% of the total sample, respectively. There was no significant difference in symptoms between early- and late-adolescent subgroups. Remarkably, most patients (76%) reported previous depressive episode(s); of these, 47% had prominent psychotic features in the prior depressive period. Conclusion: These findings suggest that disorganization and psychotic symptoms during the first manic episode are salient features in adolescent-onset BD, and that psychotic depression frequently may precede psychotic mania. Nevertheless, differential diagnosis with schizophrenia should be routinely ruled out in cases of early-onset first psychotic episode.

Úlcera de Lipschütz: reporte de un caso y revisión bibliográfica / Lipschütz Ulcer: a case report and a literature review

Resumen: ANTECEDENTES: Las úlceras de Lipschütz son lesiones vulvovaginales dolorosas, de aparición aguda y desaparición espontánea en 2 a 6 semanas, no dejan secuelas ni son recurrentes a largo plazo. Su etiopatogenia es incierta, alrededor de 70% se consideran idiopáticas. En los estudios más recientes se ha demostrado su asociación con agentes infecciosos, sobre todo con el virus de Epstein-Barr. El diagnóstico se establece por exclusión y su tratamiento se basa en el control sintomático, cicatrizantes, analgésicos y antisépticos. CASO CLÍNICO: Paciente de 15 años, con úlceras vulvares de aparición súbita acompañadas de cuadro catarral. Se indicó tratamiento local con cicatrizante, antiséptico y antiinflamatorio; al cabo de tres semanas se observó la desaparición de las lesiones y la negatividad de las pruebas que descartó el origen infeccioso. Se estableció el diagnóstico de úlcera de Lipschütz. CONCLUSIONES: La úlcera de Lipschütz es infrecuente y los niños son quienes más la padecen. Debido al carácter de desaparición espontánea y a la juventud de las pacientes, es decisivo establecer el correcto diagnóstico diferencial.

Abstract: BACKGROUND: Lipschütz Ulcers are painful, acute onset and self-limiting vulvovaginal lesions that can frequently be associated with prodromal symptoms, disappearing in 2-6 weeks without any sequelae. 70% of cases present idiopathic etiopathogenesis, and are related to Epstein-Barr virus, among others. The diagnosis is made by exclusion and its treatment is based on symptomatic control and the promotion of correct healing, using analgesics, cicatrizers and antiseptics. CASE REPORT: A 15-year-old girl reported the acute apparition of ulcerative vulvar lesions coinciding with systemic catarrhal symptoms. Local treatment with healing, antiseptic and anti-inflammatory lotions was prescribed, and after three weeks, she was reevaluated, observing the disappearance of the lesions and the negativity of the tests to rule out infectious origin, for which she was diagnosed with a Lipschütz ulcer. CONCLUSIONS: Lipschütz ulcer is rare and children are the ones who suffer most from it. Due to the spontaneous disappearance character and the youthfulness of the patients, it is decisive to establish the correct differential diagnosis.

Biological and Clinical Markers in Panic Disorder

OBJECTIVE: Classifying mental disorders on the basis of objective makers might clarify their aetiology, help in making the diagnosis, identify “at risk” individuals, determine the severity of mental illness, and predict the course of the disorder. This study aims to review biological and clinical markers of panic disorder (PD). METHODS: A computerized search was carried out in PubMed and Science Direct using the key words: “marker/biomarker/clinical marker/neurobiology/staging” combined using Boolean AND operator with “panic.” In addition, the reference lists from existing reviews and from the articles retrieved were inspected. Only English language papers published in peer-reviewed journals were included. RESULTS: Structural changes in the amygdala, hippocampus, cerebral blood level in the left occipital cortex, serotonin 5-TH and noradrenergic systems activation, aberrant respiratory regulation, hearth rate variability, blood cells and peripheral blood stem cells, hypothalamic–pituitary–adrenal axis dysregulation were identified as potential candidate biomarkers of PD. Staging was identified as clinical marker of PD. According to the staging model, PD is described as follows: prodromal phase (stage 1); acute phase (stage 2); panic attacks (stage 3); chronic phase (stage 4). CONCLUSION: The clinical utility, sensitivity, specificity, and the predictive value of biomarkers for PD is still questionable. The staging model of PD might be a valid susceptibility, diagnostic, prognostic, and predictive marker of PD. A possible longitudinal model of biological and clinical markers of PD is proposed.

Early Detection and Intervention of Autism Spectrum Disorder / 한양의대학술지

Autism spectrum disorder (ASD) is a neurodevelopmental disorder typically identified in early toddlerhood. Both retrospective and prospective follow up studies of high risk infants reveal early risk signs of ASD at 12-24 months of age. The most frequently replicated early signs of ASD are atypical visual tracking and coordination, lack of social reciprocity, abnormal social communication and unusual patterns of manipulating objects, atypical sensory exploration, expressed as uncoordinated eye contact, unresponsiveness to naming, lack of social smile, delayed development of nonverbal communication and joint attention, less sharing interest, and unusually repetitive use of objects. Early intervention, before 2 years of age, appears to change the underlying developmental trajectories of the brain in individuals with ASD. In this review, the early risk signs of ASD in infancy and toddlerhood, along with early intervention and their implications, are discussed.

EARLY DETECTION AND TREATMENT：AN EXAMINATION OF PRODROMAL SYMPTOMS OF POST OPERATIVE DELIRIUMIN ELDERLY PATIENTS

ntroduction: The development of postoperative delirium is a mental disorder common among those aged 70 and over in the wake of the surgery. The impact of postoperative delirium can be severe and result in withdrawal and deterioration in patients’ quality of life. The purpose of this study was to identity the prodromal symptoms perceived by veteran nurses to reflect onset of postoperative delirium among elderly patients in Japan. Methods: Participants A total of 300 nurses, each with over five years’ of nursing experience and over three years of clinical nursing experience on surgical wards, participated in this research.Consent and investigative cooperation was obtained from the nursing director of each hospital who was then sent copies of the questionnaire. Each director was requested to distribute the questionnaires among nurses in the surgical wards Participants. That met the inclusion criteria of this study. Questionnaires were returned by post in accordance with a three-week deadline. Results: The following items were to be most characteristic of postoperative delirium onset: “Has been refrain,” “patient’s mood is dark,” “patient complains of wound pain,” “patient refuses to roll over,” “patient complains of urgency,” “patient experiences a constant urge to have a bowel movement, the wrong time, patient refuses to adhere to their diet, and patient is unable to effectively use the nurses call. Conclusions: The results of this research revealed that prodromal symptoms identified by clinical nurses can be categorized into six distinct areas: behavior, confusion, negative symptoms, sleep, delusion, and excretion.

Translation and adaptation of the Bipolar Prodrome Symptom Scale-Retrospective: Patient Version to Brazilian portuguese / Tradução e adaptação da Bipolar Prodrome Symptom Scale-Retrospective: Patient Version para português brasileiro

BACKGROUND: Bipolar disorder (BD) is a chronic and often severe mental disease, associated with a significant burden in affected individuals. The characterization of a premorbid (prodromal) period and possible development of preventive interventions are recent advances in this field. Attempts to characterize high-risk stages in BD, identifying symptoms prior to the emergence of a first manic/hypomanic episode, have been limited by a lack of standardized criteria and instruments for assessment. The Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R), developed by Correll and collaborators, retrospectively evaluates symptoms that occur prior to a first full mood episode in individuals with BD. OBJECTIVE: To describe the translation and adaptation process of the BPSS-R to Brazilian Portuguese. METHOD: Translation was conducted as follows: 1) translation of the scale from English to Brazilian Portuguese by authors who have Portuguese as their first language; 2) merging of the two versions by a committee of specialists; 3) back-translation to English by a translator who is an English native speaker; 4) correction of the new version in English by the author of the original scale; 5) finalization of the new version in Brazilian Portuguese. RESULTS: All the steps of the translation process were successfully accomplished, resulting in a final version of the instrument. CONCLUSIONS: The Brazilian Portuguese version of the BPSS-R is a potentially useful instrument to investigate prodromal period of BD in Brazil

INTRODUÇÃO: O transtorno bipolar (TB) é um transtorno mental crônico e muitas vezes grave, associado a um significativo prejuízo psicossocial nos indivíduos afetados. A caracterização de um período pré-mórbido (prodrômico) e o possível desenvolvimento de intervenções preventivas são avanços recentes na área. Tentativas de caracterizar estágios de alto risco para o TB, através da identificação de sintomas antes do aparecimento de um primeiro episódio maníaco/hipomaníaco, têm sido limitadas pela falta de critérios padronizados e instrumentos de avaliação. A Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R), desenvolvida por Correll e colaboradores, avalia retrospectivamente os sintomas que ocorrem antes de um episódio sindrômico de humor em indivíduos com TB. OBJETIVO: Descrever o processo de tradução e adaptação da BPSS-R para português brasileiro. MÉTODO: A tradução foi conduzida como segue: 1) tradução da escala de inglês para português brasileiro por autores que têm o português como língua materna; 2) junção das duas versões por um comitê de especialistas; 3) retrotradução para inglês por um tradutor que tem inglês como língua materna; 4) correção da nova versão em inglês pelo autor do instrumento original; 5) finalização da nova versão em português brasileiro. RESULTADOS: Todos os passos do processo de tradução foram completados com sucesso, resultando em uma versão final do instrumento. CONCLUSÕES: A versão da BPSS-R em português brasileiro é um instrumento potencialmente útil para investigar o período prodrômico do TB no Brasil