Childhood trauma and bipolar spectrum: a population-based sample of young adults

Abstract Introduction Childhood trauma has been suggested to be involved in susceptibility to bipolar disorder (BP). However, it remains unclear whether the occurrence of childhood trauma is differently distributed in subthreshold bipolar disorder (SBP). Objective To assess childhood trauma in young adults with SBP, as compared to young adults with BP and population controls (PC). Method This was a cross-sectional, population-based study. The Mini International Neuropsychiatric Interview (MINI) was used to define the groups with BP (subjects with a lifetime or current manic episode or lifetime or current hypomania with a history of a depressive episode), SBP (subjects with a history of hypomanic episode without lifetime or current depressive episode), and subjects without mood disorders (PC). Childhood trauma was assessed using de Childhood Trauma Questionnaire (CTQ). We investigated differences regarding childhood trauma across the three groups (BP, SBP and PC). Result Except for sexual abuse, all subtypes of childhood trauma remained associated with the BP group as compared to PC. Additionally, when we compared SBP and BP, significant differences were found only for emotional abuse. No significant differences were found in relation to childhood trauma between the SBP and PC groups after adjusting for confounding factors. Conclusion These findings suggest that investigating childhood trauma, with a particular focus on emotional abuse, could be considered a preventive measure and potentially improve the prognosis.

Trastorno Bipolar. Consideraciones clínicas y epidemiológicas / Bipolar disorder. Clinical and epidemiologic characteristics

RESUMEN El trastorno bipolar es un trastorno crónico y recurrente que se caracteriza por fluctuaciones patológicas del estado del ánimo. Las fases de la enfermedad incluyen episodios hipomaniacos, maniacos y depresivos. Estos episodios interfieren de forma significativa en la vida cotidiana del paciente y en su entorno, con importante repercusión en su salud y calidad de vida. Para los psiquiatras es de suma importancia el diagnóstico precoz de esta enfermedad para proporcionar un tratamiento oportuno a los pacientes, teniendo en cuenta la severidad de los síntomas y las complicaciones a las que lleva esta enfermedad. Ante esta realidad se decidió describir las características generales de este desorden mediante una revisión bibliográfica donde se exponen sus principales manifestaciones clínicas, clasificación, aspectos epidemiológicos, curso de la enfermedad, complicaciones y comorbilidad. Para ello se realizó una revisión de los trabajos más relevantes publicados y con ello contribuir al proceso de educación médica continuada para los profesionales de la salud.

ABSTRACT Bipolar disorder is a chronic and recurrent disorder characterized by pathological fluctuations of the mood states. The stages of the disease include hypomanic, maniac and depressive episodes. These episodes interfere in a significant way in the patient´s daily life and his surroundings, with an important repercussion on his health and life quality. For the psychiatrists, the precocious diagnosis of this disease is very important, in order to provide a timely treatment to patients, taking into account the severity of the symptoms and the complications of this disease. Due to this reality, the authors decided to describe the general characteristics of this disorder through a bibliographic review where they exposed the main clinical manifestations, classification, epidemiological aspects, the course of the disease, complications and co-morbidity. The most relevant published works were reviewed to contribute to the process of continued medical education of the health professionals.

Bipolar disorders: is there an influence of seasonality or photoperiod?

Objective: To increase understanding of the influence of photoperiod variation in patients with bipolar disorders. Methods: We followed a sample of Italian bipolar patients over a period of 24 months, focusing on inpatients. All patients admitted to the Psychiatric Inpatient Unit of San Luigi Gonzaga Hospital in Orbassano (Turin, Italy) between September 1, 2013 and August 31, 2015 were recruited. Sociodemographic and clinical data were collected. Results: Seven hundred and thirty patients were included. The admission rate for bipolar patients was significantly higher during May, June and July, when there was maximum sunlight exposure, although no seasonal pattern was found. Patients with (hypo)manic episodes were admitted more frequently during the spring and during longer photoperiods than those with major depressive episodes. Conclusions: Photoperiod is a key element in bipolar disorder, not only as an environmental factor but also as an important clinical parameter that should be considered during treatment.

A critical review of trials of transcranial direct current stimulation and trigeminal nerve stimulation for depression: the issue of treatment-emergent mania / Revisão crítica da literatura de ensaios clínicos em estimulação transcraniana por corrente contínua e estimulação de nervo trigêmeo para depressão: o problema da mania tratamento-emergente

Abstract Objective: This study is a critical review analyzing occurrence of treatment-emergent mania (TEM) related to transcranial direct current stimulation (tDCS) and trigeminal nerve stimulation (TNS). Method: We present a systematic review of the literature on TEM related to tDCS and TNS treatment for major depressive disorder (MDD), conducted in accordance with the recommendations from Cochrane Group and the PRISMA guidelines. Results: Our search identified few reported episodes of TEM in the literature. In fact, we found 11 trials focused on treatment of MDD (seven controlled trials of tDCS and four trials of TNS, three open label and one controlled). We highlight the need for safety assessment in clinical research settings to establish with precision and in larger samples the risks inherent to the technique under investigation. Conclusion: Safety assessment is of fundamental importance in clinical research. TEM is a very important safety issue in MDD trials. Further and larger controlled trials will help to clarify both the safety and the clinical effects of combinations of pharmacotherapy and tDCS or TNS in daily clinical practice.

Resumo Objetivo: O presente estudo consiste em uma revisão e análise crítica da ocorrência de mania tratamento-emergente (TEM) relacionada a estimulação transcraniana por corrente contínua (ETCC) e estimulação do nervo trigêmeo (TNS). Método: Apresentamos uma revisão sistemática de literatura sobre TEM relacionada a ETCC e TNS no tratamento de transtorno depressivo maior (TDM), conduzida de acordo com as recomendações do Grupo Cochrane e protocolo PRISMA. Resultados: A pesquisa identificou poucos relatos de TEM na literatura. Na verdade, foram encontrados 11 ensaios clínicos com foco no tratamento de TDM (sete estudos controlados de ETCC e quatro de TNS, sendo três abertos e um controlado). Destacamos a necessidade de avaliações de segurança em pesquisas clínicas para se estabelecer com maior precisão e em amostras maiores os riscos inerentes à técnica sob investigação. Conclusão: Avaliação de segurança é fundamental na pesquisa clínica. A TEM é um efeito adverso importante no tratamento do TDM. Maiores ensaios clínicos controlados ajudarão a esclarecer os efeitos clínicos e a segurança da combinação de psicotrópicos e ETCC ou TNS.

Simple markers for subclinical inflammation in the different phases of bipolar affective disorder

Abstract Background: Recently, a growing number of publications have suggested that the immune-inflammatory system may be involved in the etiology of bipolar disorder (BD). Objective: The aim of this study was to investigate neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red cell distribution width (RDW) in the three different phases of BD patients compared to each other and controls. Methods: One hundred eighty-seven bipolar patients (78 euthymic, 53 manic/hypomanic and 56 depressed), and 62 age and sex matched controls were enrolled. Sociodemographic variables and complete blood count parameters of the patients and the control group were recorded. Results: The groups did not differ from each other on the hematological parameters, except for NLR and RDW. Post-hoc analyses revealed that NLR values were significantly higher in the euthymic and manic/hypomanic bipolar groups compared to control group. In addition, post-hoc analyses revealed that RDW values were significantly higher in the manic/hypomanic bipolar group relative to the control group. Discussion: Longitudinal studies evaluating the levels of inflammatory markers in the early phases of the disorder, and their relationship with the development of different episodes and medical comorbidities may be useful to understand the role of inflammation in BD.

Clinical characteristics and influence of childhood trauma on the prodrome of bipolar disorder

Objectives: To describe the onset pattern, frequency, and severity of the signs and symptoms of the prodrome of the first hypomanic/manic episode and first depressive episode of bipolar disorder (BD) and to investigate the influence of a history of childhood maltreatment on the expression of prodromal symptoms. Methods: Using a semi-structured interview, the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R), information regarding prodromal symptoms was assessed from patients with a DSM-IV diagnosis of BD. History of childhood maltreatment was evaluated using the Childhood Trauma Questionnaire (CTQ). Results: Forty-three individuals with stable BD were included. On average, the prodrome of mania lasted 35.8±68.7 months and was predominantly subacute or insidious, with rare acute presentations. The prodrome of depression lasted 16.6±23.3 months and was also predominantly subacute or insidious, with few acute presentations. The prodromal symptoms most frequently reported prior to the first hypomanic or manic episode were mood lability, depressive mood, and impatience. A history of childhood abuse and neglect was reported by 81.4% of participants. Presence of childhood maltreatment was positively associated with prodromal symptoms, including social withdrawal, decreased functioning, and anhedonia. Conclusions: This study provides evidence of a long-lasting, symptomatic prodrome prior to first hypomanic/manic and depressive episode in BD and suggests that a history of childhood maltreatment influences the manifestations of this prodrome.

Contributions of animal models to the study of mood disorders

Mood disorders are a leading cause of morbidity and mortality, yet their underlying pathophysiology remains unclear. Animal models serve as a powerful tool for investigating the neurobiological mechanisms underlying psychiatric disorders; however, no animal model developed to date can fully mimic the “corresponding” human psychiatric disorder. In this scenario, the development of different animal models contributes to our understanding of the neurobiology of these disorders and provides the possibility of preclinical pharmacologic screening. The present review seeks to provide a comprehensive overview of traditional and recent animal models, recapitulating different features and the possible pathologic mechanisms of mood disorders emulated by these models.

The "selfish brain" hypothesis for metabolic abnormalities in bipolar disorder and schizophrenia / A hipótese do "cérebro egoísta" para alterações metabólicas no transtorno bipolar e na esquizofrenia

Metabolic abnormalities are frequent in patients with schizophrenia and bipolar disorder (BD), leading to a high prevalence of diabetes and metabolic syndrome in this population. Moreover, mortality rates among patients are higher than in the general population, especially due to cardiovascular diseases. Several neurobiological systems involved in energy metabolism have been shown to be altered in both illnesses; however, the cause of metabolic abnormalities and how they relate to schizophrenia and BD pathophysiology are still largely unknown. The "selfish brain" theory is a recent paradigm postulating that, in order to maintain its own energy supply stable, the brain modulates energy metabolism in the periphery by regulation of both allocation and intake of nutrients. We hypothesize that the metabolic alterations observed in these disorders are a result of an inefficient regulation of the brain energy supply and its compensatory mechanisms. The selfish brain theory can also expand our understanding of stress adaptation and neuroprogression in schizophrenia and BD, and, overall, can have important clinical implications for both illnesses (AU)

Alterações metabólicas são frequentes em pacientes com esquizofrenia e transtorno bipolar (TB), levando a uma alta prevalência de diabetes e síndrome metabólica nessa população. Além disso, as taxas de mortalidade entre pacientes são mais altas do que na população geral, especialmente em decorrência de doenças cardiovasculares. Vários sistemas neurobiológicos envolvidos no metabolismo energético têm demonstrado alterações nas duas doenças; no entanto, a causa das alterações metabólicas e a forma como elas se relacionam com a fisiopatologia da esquizofrenia e do TB ainda são arenas em grande parte desconhecidas. A teoria do "cérebro egoísta" é um paradigma recente que postula que, para manter estável seu próprio fornecimento de energia, o cérebro modula o metabolismo da energia na periferia regulando tanto a alocação quanto a ingestão de nutrientes. Apresentamos neste artigo a hipótese de que as alterações metabólicas observadas nesses transtornos são resultado de uma regulação ineficiente do fornecimento de energia do cérebro e seus mecanismos compensatórios. A teoria do cérebro egoísta também pode expandir nosso entendimento sobre a adaptação ao estresse e a neuroprogressão na esquizofrenia e no TB, e, acima de tudo, pode ter implicações clínicas importantes para as duas doenças (AU)

Abuso de cannabis em pacientes com transtornos psiquiátricos: atualização para uma antiga evidência: [revisão] / Cannabis abuse in patients with psychiatric disorders: an update to old evidence: [review]

OBJETIVO: Realizar uma atualização sobre o abuso de cannabis em pacientes com transtornos psiquiátricos. MÉTODO: Busca de artigos nas bases de dados eletrônicas Medline, The Cochrane Library Database, Lilacs, PubMed e SciELO, utilizando os descritores "marijuana abuse", "cannabis abuse", "psychiatric disorders" AND "mental disorders"; incluindo artigos que avaliaram ambas as exposições para abuso e dependência de cannabis e qualquer outro transtorno psiquiátrico. Foi considerado o período até dezembro de 2009. RESULTADOS: Observou-se que o abuso frequente de cannabis pode aumentar o risco para o desenvolvimento de esquizofrenia e de sintomas psicóticos crônicos, embora estes achados ainda careçam de comprovação. A cannabis parece ser uma das drogas de escolha de portadores de transtorno afetivo bipolar, sendo que é descrito que estados maníacos podem ser induzidos pelo seu consumo. O abuso de maconha também frequentemente co-ocorre em indivíduos com transtornos ansiosos, sendo que a relação de cronicidade destas condições e o consumo de maconha ainda é incerta. Para depressão ainda não existem evidências claras que apontem que o consumo de cannabis ocorre como forma de automedicação. Em indivíduos com transtornos psiquiátricos, há relatos de que o uso da cannabis pode exacerbar sintomas positivos, somar efeitos negativos no curso do transtorno, contribuir para pior adesão ao tratamento e levar a maior número de hospitalizações. CONCLUSÃO: O abuso de cannabis em pacientes com transtornos psiquiátricos como esquizofrenia, transtornos do humor e ansiosos tem impacto negativo tanto na fase aguda quanto em fases mais avançadas destas condições, embora futuros estudos avaliando estas associações ainda sejam necessários.

OBJECTIVE: To perform an update on cannabis abuse by patients with psychiatric disorders. METHOD: A search was performed in the electronic databases Medline, The Cochrane Library Database, Lilacs, PubMed, and SciELO, using the keywords 'marijuana abuse', 'cannabis abuse', 'psychiatric disorders', and 'mental disorders'. Articles published until December 2009, dealing with cannabis abuse and dependence in association with other psychiatric disorders were included. RESULTS: Cannabis abuse was found to be associated with increased risk for the onset of schizophrenia and chronic psychotic symptoms, although these findings require confirmation from additional research. Cannabis seems to be one of the drugs of choice of individuals with bipolar disorder, despite evidence that manic states can be induced by its use. Cannabis abuse also occurs frequently in individuals with anxiety disorders, but the relationship between the chronic nature of these conditions and the use of marijuana remains uncertain. In respect to depression, there is no clear evidence to date that depressive patients use cannabis as a form of self-medication. In individuals with psychiatric disorders, the use of cannabis has been associated with increased positive symptoms, additional negative symptoms in the course of illness, impaired treatment compliance, and more hospitalizations. CONCLUSION: The abuse of cannabis by patients with psychiatric disorders such as schizophrenia and mood and anxious disorders has a negative impact both in the acute and advanced stages of these conditions, although further investigation on this association is still necessary.

Hypersexuality following subthalamic nucleus stimulation for Parkinson's disease.

Subthalamic nucleus (STN) stimulation is an established surgical treatment for Parkinson's disease (PD). Though the motor benefits of STN stimulation are well understood, its cognitive and behavioral effects are still not fully understood. Manic psychosis, hypersexuality, pathological gambling and mood swings are associated with advanced PD. There have been reports to suggest improvement or worsening in these symptoms following STN deep brain stimulation (DBS). We report two cases as the sole behavioral side-effects of STN stimulation despite good clinical improvement on long-term follow-up. These patients and literature review suggests the complex role of STN stimulation in motor and behavioral control.

Outcome of Bipolar I (mania) disorders, In Relation with Personality Profile.

This prospective semi structured study evaluated the relations of symptomatology and outcome of bipolar manic patients with personality vulnerability. Methods: 52 patients of bipolar (mania) disorder, out of total 430 admitted patients in psychiatry ward, from January 10, to July 9, 2005 were included in the study. The patients with organic diseases or on any drugs for last two weeks were excluded from the study. All the patients were diagnosed as per ICD-10 diagnostic criteria. Patients of bipolar mania were administered Young Mania Rating Scale (YMRS) to assess the severity of mania. The personality traits and disorders were assessed by the help of ICD-10 module of International Personality Disorder Examination (IPDE). The stress in preceding one month was evaluated by using 41 items Presumptive Stressful Life Event Scale. Initial response to lorazepam was monitored to determine outcome categories. Results: The clinical and demographic variables of the study sample were analyzed with initial response to IV lorazepam as quick responder (grade-I), moderate and poor responders (grade II, III). Sociodemographic variables like marital status (x2 = 1.62, df = 2, NS) and education status (X2 = 4.57, df = 2, NS) did not approach to statistical significance in outcome. However, the outcome of the low income group patients was significantly better ( X2 = 16.84, df = 2, p < 0.001). Out of 14 (26.92%) patients of first manic episode, only 3 patients showed good response to initial lorazepam treatment (Grade I) and 9 and 2 patients assigned outcome category II and III respectively. Patients with history of multiple episodes had shown better response (X2=11.59, df=1, p<0.001, highly significant). Presence of stressful life events was positively correlated with better response to lorazepam treatment (x2==6.73, df=1, p<0.01 significant). Anxious (avoidant) or dependent traits alone or in combination with emotionally unstable personality traits in manic patients significantly determined better episode recovery with lorazepam at one hand proneness for relapses on the other hand.

Does schizophrenia exist?

Criteria- based international classificatory systems like the lCD and DSM have ensured greater reliability for the diagnosis of schizophrenia. These, however, are an index of reliability, rather than validity. There is an accumulating evidence for shared genetic/ environmental risk factors and neurobiological abnormalities between schizophrenia and bipolar disorder. Much of the evidence accumulated over the past twenty years points to a significant overlap and commonality of genetic heritage between schizo- phrenia and bipolar disorder. This article attempts to present an overview of the problems in delineating schizophrenia from bipolar, affective disorder and suggest some alternatives

Reporte de un caso de manía en paciente VIH positivo / Case report fo mania in HIV positive patient

Se describe el caso clínico de un paciente hospitalizado por un cuadro maniacal, cuyo su estudio clínico permitió el diagnóstico de VIH. Se comenta la existencia de síntomas psiquiátricos en pacientes infectados por VIH, aún antes de la etapa de SIDA, y su riesgo aumentado de presentar cuadros anímicos. Se citan cifras de prevalencia de manía tanto en pacientes seropositivos como inmunosuprimidos. Se muestran las interrelaciones existentes en pacientes con manía y VIH, ya sea en episodios bipolares o en los secundarios al virus. Se destaca que la presencia de VIH es uno de los factores más frecuentes de manías orgánicas. Se presenta la información bibliográfica sobre la elección de psicofármacos en estos casos. Se muestra la relevancia de reconocer esta comorbilidad, sus implicancias epidemiológicas, clínicas, farmacológicas y psicológicas.

Transtorno bipolar de início tardio: uma variedade orgânica do transtorno de humor? / Bipolar disorder with late onset: an organic variety of mood disorder?

Transtorno bipolar (TB) é comumente associado à fase final da adolescência ou idade adulta jovem, embora em uma proporção substancial dos pacientes a doença comece em fases mais tardias da vida. Os resultados de várias investigações clínicas sugerem que casos de transtorno bipolar com início tardio têm, mais freqüentemente, uma "causa orgânica" e que isso justificaria a subdivisão do transtorno bipolar entre "início precoce" e "início tardio". Este artigo revê a literatura sobre a hipótese orgânica do transtorno bipolar de início tardio e conclui que essa subdivisão é artificial e carece de suporte clínico e epidemiológico.

Depressão e doença bipolar na infância e adolescência / Bipolar disorder and depression in childhood and adolescence

OBJETIVOS: Este estudo buscou a revisão da história, conceitos, categorias diagnósticas, epidemiologia, fatores genéticos e neurobiológicos, assim como fatores predisponentes e modalidades de tratamento desses transtornos. FONTES DOS DADOS: Foi realizada uma revisão extensa da literatura sobre depressão infantil e transtorno bipolar. SíNTESE DOS DADOS: A depressão infantil e o transtorno bipolar estão associados a fatores genéticos, temperamento, eventos adversos da vida, divórcio, problemas acadêmicos, abuso físico e sexual e fatores neurobiológicos. O tratamento pode ser realizado, na maioria das vezes, com medicações e psicoterapia. CONCLUSÕES: São transtornos importantes, muitas vezes de difícil diagnóstico, que, uma vez reconhecidos e tratados, irão minorar o sofrimento de crianças e adolescentes. O pediatra poderá intervir orientando a família nos casos leves, mas deve ficar atento àqueles que necessitam de outros tipos de tratamento.