ABSTRACT
OBJECTIVE: Mixed episodes have been described as more severe than manic episodes, especially due to their longer duration and their association with higher rates of suicide attempts, hospitalization and psychotic symptoms. The purpose of this study was to compare the severity between mixed and pure manic episodes according to DSM-IV criteria, through the evaluation of sociodemographic data and clinical characteristics. METHOD: Twenty-nine bipolar I patients presenting acute mixed episodes were compared to 20 bipolar I patients with acute manic episodes according to DSM-IV criteria. We analyzed (cross-sectionally) episode length, presence of psychotic symptoms, frequency of suicide attempts and hospitalization, Young Mania Rating Scale scores, Hamilton Depression Rating Scale scores and the Clinical Global Assessment Scale scores. RESULTS: Young Mania Rating Scale scores were higher in manic episodes than in mixed episodes. There were no differences in gender frequency, CGI scores and rates of hospitalization, suicide attempts and psychotic symptoms, when mixed and manic episodes where compared. Patients with mixed episodes were younger. CONCLUSION: In our sample, mixed states occurred at an earlier age than manic episodes. Contrary to previous reports, we did not find significant differences between manic and mixed episodes regarding severity of symptomatology, except for manic symptoms ratings, which were higher in acute manic patients. In part, this may be explained by the different criteria adopted on previous studies.
Subject(s)
Bipolar Disorder/psychology , Acute Disease , Adult , Bipolar Disorder/classification , Cross-Sectional Studies , Diagnostic and Statistical Manual of Mental Disorders , Female , Follow-Up Studies , Humans , Male , Psychiatric Status Rating Scales , Severity of Illness Index , Socioeconomic Factors , Statistics, NonparametricABSTRACT
OBJECTIVE: Mixed episodes have been described as more severe than manic episodes, especially due to their longer duration and their association with higher rates of suicide attempts, hospitalization and psychotic symptoms. The purpose of this study was to compare the severity between mixed and pure manic episodes according to DSM-IV criteria, through the evaluation of sociodemographic data and clinical characteristics. METHOD: Twenty-nine bipolar I patients presenting acute mixed episodes were compared to 20 bipolar I patients with acute manic episodes according to DSM-IV criteria. We analyzed (cross-sectionally) episode length, presence of psychotic symptoms, frequency of suicide attempts and hospitalization, Young Mania Rating Scale scores, Hamilton Depression Rating Scale scores and the Clinical Global Assessment Scale scores. RESULTS: Young Mania Rating Scale scores were higher in manic episodes than in mixed episodes. There were no differences in gender frequency, CGI scores and rates of hospitalization, suicide attempts and psychotic symptoms, when mixed and manic episodes where compared. Patients with mixed episodes were younger. CONCLUSION: In our sample, mixed states occurred at an earlier age than manic episodes. Contrary to previous reports, we did not find significant differences between manic and mixed episodes regarding severity of symptomatology, except for manic symptoms ratings, which were higher in acute manic patients. In part, this may be explained by the different criteria adopted on previous studies.
OBJETIVO: Estados mistos têm sido descritos como mais graves que episódios de mania, especialmente pela maior duração dos episódios, maiores taxas de suicídio, hospitalização e sintomas psicóticos. O objetivo deste estudo foi comparar a severidade entre episódios mistos e mania pura definidos segundo critérios do DSM-IV, avaliando-se características clínicas e sociodemográficas dos pacientes. MÉTODO: Vinte e nove pacientes bipolares do tipo I em estado misto foram comparados a 20 pacientes bipolares do tipo I em episódio de mania aguda de acordo com os critérios do DSM-IV. Analisou-se transversalmente a duração dos episódios, presença de sintomas psicóticos, tentativa de suicídio, hospitalização, escores da Escala de Sintomas de Mania de Young, escores da Escala de Depressão de Hamilton e Escala de Avaliação Clínica Global. RESULTADOS: As pontuações na escala de avaliação de mania de Young foram maiores nos episódios de mania quando comparadas às de episódios mistos. Não houve diferença estatisticamente significativa na freqüência de gêneros, nas pontuações da CGI, nas taxas de hospitalização, tentativa de suicídio e sintomas psicóticos entre episódios mistos e de mania. Pacientes com episódio agudo misto tinham idade menor que pacientes em episódio agudo de mania. CONCLUSÃO: Em nossa amostra, episódios mistos ocorreram em idade menor que em episódios de mania. Ao contrário da literatura, não houve diferenças significativas entre episódios de mania e mistos no que se refere à severidade da sintomatologia, exceto para a pontuação de sintomas de mania, que foi maior em pacientes em mania aguda. Isto pode ser explicado, em parte, pela diferença nos critérios adotados por estudos anteriores.
Subject(s)
Adult , Female , Humans , Male , Bipolar Disorder/psychology , Acute Disease , Bipolar Disorder/classification , Cross-Sectional Studies , Diagnostic and Statistical Manual of Mental Disorders , Follow-Up Studies , Psychiatric Status Rating Scales , Severity of Illness Index , Socioeconomic Factors , Statistics, NonparametricABSTRACT
INTRODUCTION: The anterior cingulate region has been implicated in the pathophysiology of mood disorders. Studies have reported anatomical and functional abnormalities in this region in bipolar disorder patients. Few neurochemical studies have evaluated this region, especially on medicated bipolar patients. Lithium has been reported to increase NAA levels but not by all studies. We used proton magnetic spectroscopy ((1)HMRS) to measure the levels of N-acetyl-L-aspartate (NAA) and choline (Cho) relative to creatine (Cr) in the anterior cingulate of euthymic medicated bipolar subjects. METHODS: (1)HMRS was performed using a GE Signa 1.5 Tesla scanner in 13 euthymic bipolar patients who were taking lithium for at least four weeks before the scan and in 15 normal controls. The (1)HMRS signal was collected from an 8 cm(3) voxel placed in the anterior cingulate. Data analysis was performed with the automated PROBE/SV quantification tool. RESULTS: NAA/Cr and Cho/Cr ratios were not significantly different between patients and controls (NAA/Cr: 1.60 +/- 0.34 in patients, 1.68 +/- 0.34 in controls; Cho/Cr: 1.13 +/- 0.13 in patients, 1.11 +/- 0.20 in controls). CONCLUSIONS: We did not find a significant difference in the NAA/Cr and Cho/Cr ratio between bipolar patients and healthy controls. Chronic administration of psychotropic drugs could have had an effect on NAA/Cr levels of bipolar patients.
Subject(s)
Bipolar Disorder/metabolism , Gyrus Cinguli/metabolism , Adult , Aspartic Acid/analogs & derivatives , Aspartic Acid/analysis , Bipolar Disorder/drug therapy , Choline/analysis , Creatine/analysis , Female , Humans , Lithium/therapeutic use , Magnetic Resonance Spectroscopy , Male , Middle AgedABSTRACT
OBJECTIVES: To review the literature on antidepressant-induced mania, its incidence, clinical presentation, risk factors and treatment. METHODS: A Medline search of studies published between 1970 and 2001 was carried out. Open and controlled studies as well as case series with data from more than five patients were included. RESULTS: Antidepressant induced mania may differ clinically from spontaneous mania with a milder severity and shorter duration. The risk factors have not been established. CONCLUSION: A very limited number of prospective and controlled studies on antidepressant-induced mania have been published. Antidepressants have been associated with an increased risk of inducing mania. This risk may vary according to the drug utilized. Therefore antidepressants should be used in bipolar patients based on clinical efficacy as well as the potential effects on the course of the illness.
Subject(s)
Antidepressive Agents/adverse effects , Bipolar Disorder/chemically induced , Bipolar Disorder/drug therapy , Humans , Severity of Illness IndexABSTRACT
OBJETIVOS: Realizar uma revisão da literatura sobre a mania induzida por antidepressivos, sua incidência, quadro clínico, fatores de risco e tratamento. MÉTODOS: Foi realizado um levantamento no Medline dos artigos publicados entre 1970 e 2001. Foram incluídos estudos abertos e controlados bem como relatos de caso com casuística maior que cinco pacientes. RESULTADOS: Mania induzida e mania espontânea parecem ter apresentações clínicas distintas, sendo a mania induzida mais leve e breve. Os fatores de risco para mania induzida ainda não estão bem estabelecidos. CONCLUSÃO: Existe um número muito limitado de estudos controlados e prospectivos sobre a mania induzida. Os antidepressivos estão associados a um aumento no risco de indução de mania. Este risco pode variar dependendo da droga utilizada. Portanto, os antidepressivos devem ser utilizados em pacientes bipolares considerado-se tanto a eficácia clínica como os potenciais efeitos sobre o curso da doença
