Neurocognitive functioning in first-episode Bipolar Disorder: Relationship with functional status.

BACKGROUND: The aim of this study was to assess if an association between neurocognitive deficits and psychosocial functioning exists in first-episode BD patients. METHODS: Twenty-five euthymic first-episode BD patients and thirty-seven healthy controls were recruited. History of suicide attempts, psychiatric comorbidities, pharmacological exposure, and previous depressive episodes were investigated. Performances on neurocognitive domains (verbal memory, attention, processing speed, and executive functions) as well as a measure of psychosocial functioning were used as outcomes. RESULTS: First-episode BD patients showed medium-to-large size deficits on measures of attention, processing speed, and executive functions. A significant association between verbal memory and psychosocial functioning at the moment of BD diagnosis was detected (beta coefficient -3.9, IC 95% -6.7 to -1.2, p < 0.01). CONCLUSIONS: A relationship between cognitive performance at the moment of BD diagnosis and psychosocial functioning was detected. Possible therapeutic implications of this finding are discussed.

Neuropsychological profiles of major depressive disorder and bipolar disorder during euthymia. A systematic literature review of comparative studies.

Bipolar disorder and major depressive disorder have been shown to be associated with neurocognitive abnormalities during periods of clinical remission. However, at present, there is no consensus on whether these disorders have distinctive cognitive profiles. The aim of this study was to provide an updated systematic review of studies comparing neuropsychological functioning between bipolar disorder and major depressive disorder during remission. Main findings included the following: 1) no differences regarding performances in measures of attention and processing speed, executive functions and theory of mind were found between both patient groups and 2) regarding verbal memory, preliminary evidence points towards a more defective performance in patients with bipolar disorder than those with major depressive disorder. However, several variables with negative impact on cognition (medication status, age at onset, premorbid IQ, bipolar subtype, among others) were not adequately controlled in most studies. In conclusion, evidence from studies exploring neuropsychological profiles in bipolar disorder and major depressive disorder could not provide clues to differentiate these mood disorders. Larger studies with adequate control of confounding variables would be necessary to elucidate if the finding of more defective verbal memory performance in bipolar disorder is truly explained by distinct underlying mechanisms.

[ATTENUATED PSYCHOSIS SYNDROME: A LITERATURE REVIEW]. / Sindrome de psicosis atenuada. Revisión bibliográfica.

Despite recent findings on the treatment of schizophrenia, it is an illness still associated with high morbidity and incapacity in social and work domains. There is a growing interest in examining the phases prior to the development of the illness so as to make early interventions that would potentially change its devastating course. The attenuated psychosis syndrome was included in the section III of the last version of the Diagnostic and Statistical Manual of Mental Disorders as a condition in which a patient exhibits mild psychotic symptoms, an intact reality testing and certain degree of social or occupational impairment. The present work is a review of the available literature on this subject. The main findings were: the risk of conversion to a psychotic disorder is relatively low and there are some variables (social withdrawal, negative symptoms, neurocognitive impairment, poor global functioning and certain neuroimaging findings) that increase this risk. Those people diagnosed with attenuated psychosis syndrome had one or more other current psychiatric comorbid conditions and these are the main reason to warrant medical attention. Regarding to the treatment of this condition, there are available evidence on atypical antipsychotics, cognitive-behavioral therapy and omega 3 fatty acid.

Suicidality in clozapine-treated patients with schizophrenia: role of obsessive-compulsive symptoms.

Patients with schizophrenia have an increased lifetime risk of comorbid obsessive-compulsive symptoms. Up to 30% of these patients experience such symptoms and 12% may be diagnosed with obsessive-compulsive disorder. The presence of these symptoms in schizophrenia seems to be associated with poor outcomes including a greater suicidal risk. A subgroup of patients develops this symptomatology after the initiation with Second Generation Antipsychotics (SGA). Also, there is evidence of a causal relationship for this association, particularly for clozapine. The primary aim of this study was to investigate the association of this comorbidity with suicidality in a population of clozapine-medicated schizophrenic and schizoaffective patients (N=65). The prevalence of obsessive-compulsive symptoms in our sample was 29.2% (N=19) and the prevalence of obsessive-compulsive disorder was 13.8% (N=9). Significant positive correlations between suicidality and total Y-BOCS score and between Y- BOCS score and depressive symptoms were found. Further analysis indicated that a Y-BOCS score greater or equal than 8 was an independent predictor of suicide attempt during clozapine treatment. Routine screening for this adverse event should be warranted for this population.

Switch to mania after ayahuasca consumption in a man with bipolar disorder: a case report.

BACKGROUND: There is an increasing use of ayahuasca for recreational purposes. Furthermore, there is a growing evidence for the antidepressant properties of its components. However, there are no reports on the effects of this substance in the psychiatric setting. Harmaline, one of the main components of ayahuasca, is a selective and reversible MAO-A inhibitor and a serotonin reuptake inhibitor. CASE REPORT: We present the case of a man with bipolar disorder who had a manic episode after an ayahuasca consumption ritual. This patient had had at least one hypomanic episode in the past and is currently depressed. We discuss the diagnostic repercussion of this manic episode. CONCLUSION: There is lack of specificity in the diagnosis of substance-induced mental disorder. The knowledge of the pharmacodynamic properties of ayahuasca consumption allows a more physiopathological approach to the diagnosis of the patient.