[Length of psychiatric hospitalizations: a clinical and socio-demographic characterization]. / Duración de las internaciones psiquiátricas: una caracterización clínica y socio-demográfica.

AIM: The aim of this study was to determine the clinical, socio-demographic, and therapeutic variables associated with the length of hospitalization in a psychiatric emergency hospital in Buenos Aires City. METHOD: The present retrospective analytical study included 350 consecutively admitted patients aged 18-65, from June 2013 until December 2017 in a public psychiatric hospital in Buenos Aires City. Data collected included socio-demographic, clinical and discharge conditions. RESULTS: Variables that predicted the length of hospitalization were: diagnosis of psychosis, the use of lithium and anticonvulsants, unemployment, no economic autonomy, not have formed a family and have modified the living support group during the hospitalization. CONCLUSION: The representative of social and economic vulnerability variables were associated with the utilization of psychiatric inpatient beds. Public policies are requested to interrupt the relationship between poverty and mental pathology.

Sexual risk behaviors among women with bipolar disorder.

The aim of this study was to investigate sexual health and sexual risk behaviors for sexually transmitted infections (STI) among women with bipolar disorder (BDW). Sixty-three euthymic women diagnosed with bipolar disorder type I, II or not otherwise specified were included and matched with a control group of 63 healthy women. Demographic and clinical data, structured sexual health measures and extensive assessment of sexual risk behavior were obtained and compared between groups. BDW had casual partners, were in non-monogamous sexual partnerships and had sex with partners with unknown HIV condition more frequently than healthy control women. History of two or more STI was more frequent among BDW. Inclusion of sexual behavior risk assessment among BDW in treatment is necessary to better identify those women with higher risk for STI and to take measures to improve their sexual health.

Unplanned pregnancies and reproductive health among women with bipolar disorder.

BACKGROUND: The aim of this study was to investigate reproductive health and level of planning of pregnancies among women with bipolar disorder (BDW). METHODS: 63 euthymic women, with bipolar disorder type I, II or not otherwise specified diagnosis, were included and were matched with a control group of 63 healthy women. Demographic and clinical data, structured reproductive health measures and planning level of pregnancies were obtained and compared between groups. RESULTS: Lower level of planning of pregnancies and higher frequency of unplanned pregnancies were found among BDW. Women with bipolar disorder reported history of voluntary interruption of pregnancies more frequent than women from control group. Current reproductive health care showed no differences between groups. LIMITATIONS: Data based on self-report of participants and retrospective nature of some collected measures may be affected by information bias. The pregnancy planning measure has not been validated in this population before. Demographic and clinical characteristics of the sample study limit generalization of these findings. CONCLUSIONS: Adverse reproductive events, as unplanned pregnancies and elective interruption of pregnancies, may be more frequent among BDW. Clinician must be aware of the reproductive health during treatment of young BDW and take measures to improve better family planning access.

Relationship between neurocognitive functioning and episode recurrences in bipolar disorder.

BACKGROUND: The relationship between neurocognitive impairment and clinical course in bipolar disorder (BD) is inconclusive. The aim of this study was to compare time to recurrence between patients with and without clinically significant cognitive impairment. METHODS: Seventy euthymic patients with BD were included. Based on baseline neurocognitive performance, patients were divided into those with (n=49) and those without (n=21) clinically significant cognitive impairment. Both groups of patients were prospectivelly assessed by a modified life chart method during a mean of 16.3 months. RESULTS: Patients with some cognitive domain compromised had an increased risk of suffering any recurrence (HR: 3.13; CI 95%: 1.64-5.96), hypo/manic episodes (HR: 2.42; CI 95%: 1.13-5.19), or depressive episodes (HR: 3.84, CI 95%: 1.66-8.84) compared with those patients without clinically significant cognitive impairment. These associations remained significant after adjusting for several potential counfounders such as number of previous episodes, time since last episode, clinical subtype of BD, exposure to antipsychotics, and subclinical symptoms. LIMITATIONS: We classified patients as with or without clinically significant cognitive impairment, although deficits in different cognitive domains may not be equivalent in terms of risk of recurrence. CONCLUSIONS: The results did not support the hypothesis that the experience of successive episodes is related to a progressive neurocognitive decline. On the contrary, cognitive impairment could be the cause more than the consequence of poorer clinical course. Alternatively, a specific subgroup of patients with clinically significant cognitive impairment and a progressive illness in terms of counts of recurrence and shortening of wellness intervals might explain the association showed in this study.

Estudio descriptivo sobre patrones de salud sexual y reproductiva en mujeres con diagnóstico de trastorno bipolar en tratamiento / Descriptive study of sexual and reproductive health in women diagnosed with bipolar disorder in treatment

INTRODUCCION: Las personas afectadas por trastornos bipolares (TB) son consideradas como un grupo de riesgo para adquirir enfermedades de transmisión sexual (ETS) y tener embarazos no planificados (ENP). Sin embargo, la salud sexual y reproductiva de las mujeres con TB no ha sido debidamente estudiada.OBJETIVO: Estudiar aspectos de la salud reproductiva y sexual de mujeres con diagnóstico de TB en condiciones usuales de tratamiento y analizar su relación con variables clínicas.METODOS: El estudio incluyó 60 mujeres con diagnóstico de TB tipo I, II y no especificado, en condiciones de eutimia, y 60 mujeres sanas como grupo control (GC). Se relevó información demográfica y clínica del TB, así como medidas de salud sexual y reproductiva en eutimia, y se comparó con el GC. Entre las mujeres con TB, se evaluaron retrospectivamente las conductas sexuales durante los episodios de la enfermedad.RESULTADOS: No se encontraron diferencias en la frecuencia de uso del método anticonceptivo (X2= 1,274; p= 0,279) ni en la frecuencia de controles ginecológicos durante la eutimia (X2= 2,521; p= 0,472). No hubo diferencias en la prevalencia de ETS a lo largo de la vida (TB= 36,2% vs. GC= 31,66%; X2= 0,271; p= 0,607). La prevalencia de ENP a lo largo de la vida fue significativamente mayor (TB= 36,84% vs. GC= 9,23%; X2= 24,302, p< 0,001). La prevalencia de mujeres con TB que habían interrumpido voluntariamente al menos un embarazo fue significativamente mayor (41,38% vs. 12,90%; X2=6,213; p= 0,013). Se encontraron conductas de mayor riesgo en los episodios de TB.CONCLUSIONES: los eventos reproductivos adversos son más prevalentes entre las mujeres con TB, por lo que la salud sexual y reproductiva de esta población merece mayor atención.

INTRODUCTION: People with bipolar disorder (BD) are considered a group at risk for the acquisition of sexually transmitted diseases (STD) and unplanned pregnancies (UP). However, the sexual and reproductive health of women with BD has not been systematically studied.OBJECTIVE: To investigate the reproductive and sexual health of women with BD diagnosis in usual treatment condition and the relation with clinical variables.METHODS: 60 euthymic women, with BD type I, II or not otherwise specified diagnosis, were included in the study and matched with a control group (CG) of 60 healthy women. Demographic and clinical data and structured sexual and reproductive measures during the euthymic period were obtained and compared with control group. The sexual behaviours during affective episodes were collected retrospectively.RESULTS: No differences were found in reported current contraceptive use (X2= 1.274; p= 0.279) or in frequency of gynecological visits during euthymia (X2= 2.521; p= 0.472). The lifetime prevalence of STD were similar between groups (BD= 36.2% vs. CG= 31.66%; X2= 0.271; p= 0.607). UP prevalence during life was significantly higher (BD= 36.84% vs. CG= 9.23%; X2= 24.302, p< 0.001). Prevalence of women with history of abortion was significantly higher (41.38% vs. 12.90%; X2=6.213; p= 0.013). More sexual risky behaviors were found during depressive and manic/hyponic episodes.CONCLUSIONS: Adverse reproductive and sexual health events are more prevalent for women affected by BD. The sexual and reproductive health of this population needs more attention.

Estudio descriptivo sobre patrones de salud sexual y reproductiva en mujeres con diagnóstico de trastorno bipolar en tratamiento / Descriptive study of sexual and reproductive health in women diagnosed with bipolar disorder in treatment

INTRODUCCION: Las personas afectadas por trastornos bipolares (TB) son consideradas como un grupo de riesgo para adquirir enfermedades de transmisión sexual (ETS) y tener embarazos no planificados (ENP). Sin embargo, la salud sexual y reproductiva de las mujeres con TB no ha sido debidamente estudiada.OBJETIVO: Estudiar aspectos de la salud reproductiva y sexual de mujeres con diagnóstico de TB en condiciones usuales de tratamiento y analizar su relación con variables clínicas.METODOS: El estudio incluyó 60 mujeres con diagnóstico de TB tipo I, II y no especificado, en condiciones de eutimia, y 60 mujeres sanas como grupo control (GC). Se relevó información demográfica y clínica del TB, así como medidas de salud sexual y reproductiva en eutimia, y se comparó con el GC. Entre las mujeres con TB, se evaluaron retrospectivamente las conductas sexuales durante los episodios de la enfermedad.RESULTADOS: No se encontraron diferencias en la frecuencia de uso del método anticonceptivo (X2= 1,274; p= 0,279) ni en la frecuencia de controles ginecológicos durante la eutimia (X2= 2,521; p= 0,472). No hubo diferencias en la prevalencia de ETS a lo largo de la vida (TB= 36,2% vs. GC= 31,66%; X2= 0,271; p= 0,607). La prevalencia de ENP a lo largo de la vida fue significativamente mayor (TB= 36,84% vs. GC= 9,23%; X2= 24,302, p< 0,001). La prevalencia de mujeres con TB que habían interrumpido voluntariamente al menos un embarazo fue significativamente mayor (41,38% vs. 12,90%; X2=6,213; p= 0,013). Se encontraron conductas de mayor riesgo en los episodios de TB.CONCLUSIONES: los eventos reproductivos adversos son más prevalentes entre las mujeres con TB, por lo que la salud sexual y reproductiva de esta población merece mayor atención.

INTRODUCTION: People with bipolar disorder (BD) are considered a group at risk for the acquisition of sexually transmitted diseases (STD) and unplanned pregnancies (UP). However, the sexual and reproductive health of women with BD has not been systematically studied.OBJECTIVE: To investigate the reproductive and sexual health of women with BD diagnosis in usual treatment condition and the relation with clinical variables.METHODS: 60 euthymic women, with BD type I, II or not otherwise specified diagnosis, were included in the study and matched with a control group (CG) of 60 healthy women. Demographic and clinical data and structured sexual and reproductive measures during the euthymic period were obtained and compared with control group. The sexual behaviours during affective episodes were collected retrospectively.RESULTS: No differences were found in reported current contraceptive use (X2= 1.274; p= 0.279) or in frequency of gynecological visits during euthymia (X2= 2.521; p= 0.472). The lifetime prevalence of STD were similar between groups (BD= 36.2% vs. CG= 31.66%; X2= 0.271; p= 0.607). UP prevalence during life was significantly higher (BD= 36.84% vs. CG= 9.23%; X2= 24.302, p< 0.001). Prevalence of women with history of abortion was significantly higher (41.38% vs. 12.90%; X2=6.213; p= 0.013). More sexual risky behaviors were found during depressive and manic/hyponic episodes.CONCLUSIONS: Adverse reproductive and sexual health events are more prevalent for women affected by BD. The sexual and reproductive health of this population needs more attention.

[Clinical concepts associated with lithium underutilization in the treatment of bipolar disorder]. / Conceptos clínicos asociados a la subestimación del litio en el tratamiento del Trastorno Bipolar.

OBJECTIVES: Bipolar Disorders are among the ten leading causes of morbity and lithium is considered first-line treatment and the most cost-effective. Nevertheless, its use takes a back seat to other treatment options less effective, safe and more expensive; and the reasons for this remains unclear. The present study investigates clinical concepts related to its underutilization. METHOD: An anonymous questionnaire concerning different aspects of lithium clinical use (compared efficacy, adverse effects, practical aspects regarding its use, use in special populations) was administered during the XXV Congress of the Argentinean Psychiatrist Association. RESULTS: 164 questionnaires were analyzed. Less than one-third of the sample referred lithium as their most frequent treatment option, although almost 60% qualified it as effective. Almost two-thirds considered its utilization as more complex and ill-ascribed adverse effects to it. One third referred not to use it in youth and senior populations. CONCLUSIONS: Contrary to current recommendations, lithium is under utilized. This is the first report on the possible causes leading to such phenomena, which can be related to ill concepts regarding its safety, clinical use and adverse effects; although not to its effectiveness.

Long-term worsening of bipolar disorder related with frequency of antidepressant exposure.

BACKGROUND: The aim of this study of 53 persons with bipolar disorder (BD) was to evaluate the relationship between history of exposure to antidepressants (AD) and mood stabilizers (MS) and the percentage of time spent ill. METHODS: BD outpatients with more than 12 months of prospective follow-up were included. Outcome was documented using a life charting technique. Current and previous exposure to AD and MS were assessed using a scale that provides a quantitative measure of exposure to psychotropic medications. Regression models were used to correct for possible confounders. RESULTS: Previous treatment with AD was an independent predictor of polarity changes (P < .001) and mixed symptoms (P = .01). In contrast, "years of exposure to MS" was an independent predictor of time spent asymptomatic (P = .019). The ratio between exposure to AD vs MS was associated with less weeks asymptomatic (P = .03), more mixed symptomatology (P = .019), and more polarity changes (P = .001). CONCLUSIONS: Antidepressant exposure was a major predictor of mood instability in the long-term outcome of BD. The ratio used of previous exposure to AD vs MS was associated with poor outcomes, suggesting that the harmful effect of AD may be additive and related to how much they are used.

Theory of mind and facial emotion recognition in euthymic bipolar I and bipolar II disorders.

The main aim of this study was to compare patients with euthymic bipolar I (BDI) and bipolar II (BDII) disorders and healthy controls in measures of social cognition. Additional aims were to explore the association between social cognition performance with neurocognitive impairments and psychosocial functioning. Eighty one euthymic patients with BDI or BDII and 34 healthy controls were included. All subjects completed tests to assess verbal memory, attention, and executive functions. Additionally theory of mind (ToM) and facial emotion recognition measures were included. Psychosocial functioning was assessed with the GAF. Both groups of patients had lower performance than healthy controls in ToM, and a lower recognition of fear facial expression. When neurocognitive impairments and exposure to medications were controlled, performance in ToM and recognition of fear facial expression did not allow predicting if a subject was patient or healthy control. Social cognition measures not enhance variance beyond explained by neurocognitive impairments and they were not independent predictors of psychosocial functioning. Impairments in facial emotion recognition and ToM are mediated, at least partly, by attention-executive functions deficits and exposure to psychotropic medications. Likewise, social cognition measures did not contribute to variance beyond neurocognitive impairments.

[Valproate-induced hyperammonemic encephalopathy. Review of cases in the psychiatric setting]. / Encefalopatía hiperamonémica asociada al uso de ácido valproico. Revisión de casos en psiquiatría.

Valproate-induced hyperammonemic encephalopathy is a rare but severe and potentially fatal adverse event. Frequently, the use of valproic acid produces an elevation of ammonia levels. In some people, this is associated with the development of encephalopathy without evidence of liver failure, usually reversible with discontinuation or dose reduction. Although there is important evidence about this adverse event in patients with neurologic disorders, the data in the psychiatric setting is scarce. We review the available studies and case reports about valproate-induced hyperammonemic encephalopathy in people treated with valproic acid for psychiatric disorders. We describe the clinical and therapeutic characteristics, and the physiology of this adverse event.