Age-dependence of Schneiderian psychotic symptoms in bipolar patients.

Psychotic symptoms frequently occur in bipolar disorder, especially in younger patients. However, whether the association with younger age also extends to psychotic symptoms that have traditionally been associated with schizophrenia, such as Schneiderian first-rank symptoms (FRSs), is unclear. This study examined FRSs in bipolar I patients and their relationship to age and gender. The sample comprised 103 consecutive inpatients who met DSM IV criteria for bipolar disorder, manic or mixed. FRSs were rated with the Scale for the Assessment of Positive Symptoms (SAPS). Interaction between FRSs and gender and FRSs and age was assessed using logistic regression. A high rate of FRSs in manic and mixed patients was found with a higher frequency in men (31%) than in women (14%; P=0.038). A monotonic increase in the association between FRSs and younger age was apparent (odds ratios (OR) over five levels: 1.42; 1.00-2.01). These results confirm previous findings that FRSs are not specific to schizophrenia and suggest in addition that a dimension of nuclear psychotic experiences of developmental origin extends across categorically defined psychotic disorders.

Treatment of bipolar I rapid cycling patients during dysphoric mania with olanzapine.

The simultaneous presentation of manic and depressive symptoms in the same patient is fairly common. The terms and have been used as equivalents to mixed states. Pharmacotherapy is less effective in this group of patients. The aim of this study is to determine the effectiveness and safety of olanzapine as an add-on therapy in patients with bipolar disorder with a rapid cycling course during a dysphoric mania episode. Thirteen patients treated with mood stabilizers for at least 1 year and diagnosed with a mixed episode were included in an open trial. All had at least 4 episodes in the last year. Patients with organic diseases, including altered thyroid function, were excluded from the research. Patients were evaluated at inclusion and at day 28. Response was defined as a decrease of 50% in the Young Mania Rating Scale and the Hamilton Rating Scale for Depression concomitant with a Clinical Global Impression improvement of 1 or 2. All patients completed the study. The doses of olanzapine were 16.15 +/- 5.82 mg/day. There was a reduction in the manic and depressive symptoms in all patients. Ten of the 13 patients were considered to have responded to the treatment according to the response definition. Adverse effects included somnolence (23.08%) and weight gain (0.81 +/- 1.96 kg in women, 2.20 +/- 2.28 kg in men). Our results suggest that olanzapine combined with mood stabilizers is safe and effective in the treatment of the manic and the depressive symptoms of dysphoric mania with a rapid cycling course.

Use of olanzapine in dysphoric mania.

BACKGROUND: The simultaneous presentation of both manic and depressive symptoms has long been recognized. Nevertheless, a variable prevalence of dysphoric mania has been reported. The aim of this study was to estimate the prevalence of dysphoric mania among hospitalized patients and to assess the effectiveness of olanzapine in this type of patients. METHODS: Eighty-six patients who met DSM-IV criteria for mania were evaluated at admission with a protocol that included McElroy's criteria for dysphoric mania [Am. J. Psychiatry 149 (1992) 1633]. Treatment was administered according to clinical need, using mood stabilizers combined with antipsychotics. Sequential assessments were conducted throughout the study. RESULTS: Forty-four patients (51.2%) fulfilled McElroy's criteria for dysphoric mania. Fourteen of these dysphoric patients were treated with olanzapine in combination with mood-stabilizers. All patients improved in manic symptoms but patients treated with olanzapine improved significantly more than those treated with other antipsychotics in depressive symptoms. LIMITATIONS: The lack of randomization is a methodological limitation of this study, so these findings should be considered as preliminary. CONCLUSIONS: Dysphoric symptoms are common in this population of manic patients. Olanzapine in combination with mood-stabilizers may be effective in these patients. Additional controlled studies are needed to replicate these results.

Hospitalización contra la voluntad en primeros episodios psicóticos: factores asociados / Involuntary admission in first psychotic episodes: related factors

Introducción: La mayoría de los ingresos involuntarios en las unidades de agudos corresponden a pacientes con trastornos psiquiátricos graves. El objetivo de este trabajo es determinar las características y factores asociados a los ingresos involuntarios de primeros episodios psicóticos no debidos a enfermedad médica. Método: Se evalúan 61 primeros episodios psicóticos hospitalizados consecutivamente en una unidad de psiquiatría de un Hospital General. Se utilizó un protocolo que incluía la SCID, SCI-PANSS, citerios DSM-IV, historia clínica unificada, y las escalas PANSS y Phillips. Resultados: Dos tercios de los pacientes ingresaron con autorización judicial de ingreso. De las variables estudiadas sólo se asoció significativamente con el ingreso involuntario la puntuación en la subescala positiva de la PANSS. Conclusiones: Existe una alta proporción de ingresos involuntarios en pacientes con primer episodio psicótico. La involuntariedad de ingreso está en estrecha relación con la psicopatología, concretamente con los síntomas positivos (AU)

[Involuntary hospitalization in the first psychotic episodes: associated factors]. / Hospitalización contra la voluntad en primeros episodios psicóticos: factores asociados.

INTRODUCTION: The great majority of involuntary admissions at acute hospital units are related to severe psychiatric diseases. The aim of this study is to determine which are the characteristics and associated factors in first psychotic episodes not due to medical illness. METHOD: It had been evaluated, 61 first psychotic episodes hospitalised in a General Hospital Psychiatric Unit. It was used a protocol with the SCID, SCID-PANSS, DSM-IV criteria, unified clinical history, and PANSS, and Philips scales. RESULTS: 67.2% of the patients were committed to the hospital. Only the PANNS positive subscale was significantly associated with the involuntary admission. CONCLUSIONS: There is a high admission rate of involuntary inpatients with first psychotic episode. The involuntary admission is highly related to psychotic positive symptoms.