Psychopathological and Therapeutic Trajectories of Inpatients Affected by Mixed States and Bipolar Spectrum Disorders.

In clinical practice, mental health professionals face diagnostic and therapeutic challenges daily. The diagnostic identification of mixed states allows the management of diagnostic and therapeutic trajectories appropriately. In our study, we evaluated 484 patients at a psychiatric rehabilitation center. The initial pre-admission diagnosis of the mixed state of 3.71% (at baseline) increased to 32.23%. The observation period was three years. The therapeutic efficacy of the pharmacological association of Antidepressants (Ads) or Second Generation Antipsychotics (SGAs) with a mood stabilizer (sodium valproate, lithium, lamotrigine, gabapentin, and pregabalin) was evaluated. An improvement in psychopathological symptoms was observed in different groups analyzed. The most significant differences were observed with the association SGAs + mood stabilizer [olanzapine + valproate sodium (p=0.005); risperidone + pregabalin (p=0.072)] and SSRIs + mood stabilizer [escitalopram + valproate sodium (p=0.005), vortioxetine + mood stabilizers (valproate or gabapentin). However, these are preliminary data and are under evaluation.

Depression, Mood Disorders and Bipolar Spectrum: One or Different Diseases?

The concept of mixity is the essential cognitive cornerstone for quantifying and understanding unstable mood and restlessness, which are components of all mood disorders, diseases that always present fluctuations in mood, from the depressive component to the restless one and to the hypomanic and manic one. The GT-MSRS Mixed States Rating Scale becomes an essential means for early diagnosis.

Nonlocality of mixtures of the ground and first excited states withinJ1-J2Heisenberg model.

We investigate both bipartite and multipartite nonlocality in theJ1-J2Heisenberg model. Bipartite nonlocality is measured by the Clauser-Horne-Shimony-Holt inequality, while multipartite nonlocality is explored through Bell-type inequalities. Our findings reveal that neither ground-state nor full thermal-state nonlocality reliably characterizes quantum phase transitions (QPTs). However, we uncover that the mixed-state nonlocality of the ground and first excited states exhibits distinctive characteristics applicable to both bipartite and multipartite scenarios. We also demonstrate how mixed-state quantum correlation behaviors depend on varying temperature regimes. In the bipartite case, we observe a phenomenon known as 'correlation reversal' with increasing temperature, a previously unreported occurrence in other models. For the multipartite case, the ability to signify phase transitions is significantly enhanced as the temperature rises. Furthermore, we discover a linear scaling effect that provides valuable insights for extrapolating QPTs in the thermodynamic limit asN→∞. Additionally, we identify the critical temperature at which mixed-state nonlocality becomes a reliable indicator of phase transitions.

Profiles and the impact of affective temperaments on alcohol use disorder: a cross-sectional study.

AIMS: This study aimed to explore the profiles and impact of affective temperaments, together with social and clinical backgrounds, including affective symptoms, in patients with alcohol use disorder (AUD). METHODS: This study included 314 low-risk drinkers and 257 patients with AUD. To assess affective temperament, we used the short version of the temperament evaluation of Memphis, Pisa, Paris, and San Diego. To evaluate depressive and mixed symptoms, the quick inventory of depressive symptomatology self-report Japanese version and 12-item questionnaire for the quantitative assessment of the depressive mixed state were used. We compared the profiles of affective temperaments as well as social and clinical backgrounds, including affective symptoms, between the two groups and further performed logistic regression analyses to explore the factors contributing to AUD. RESULTS: Our analysis showed higher cyclothymic, hyperthymic, and irritable temperament scores and lower depressive temperament scores in patients with AUD than that in nonclinical drinkers. Regarding other social and clinical backgrounds, patients with AUD were less educated and employed and more experienced depressive and mixed symptoms. Logistic regression analysis identified hyperthymic temperament as a positive contributor and depressive temperament as a negative contributor to AUD. CONCLUSIONS: Our findings indicated potential bipolarity in patients with AUD, as manifested by a more hyperthymic temperament in contrast to less depressive temperament. Despite their self-perceived adaptive temperament profiles, patients showed poorer social outcomes and more affective symptoms. This gap may be partly explained by a lack of insight unique to AUD psychology, which potentially disturbs problem recognition.

Aperiodic dynamical quantum phase transition in multi-band Bloch Hamiltonian and its origin.

We investigate the dynamical quantum phase transition (DQPT) in the multi-band Bloch Hamiltonian of the one-dimensional periodic Kitaev model, focusing on quenches from a Bloch band. By analyzing the dynamical free energy and Pancharatnam geometric phase (PGP), we show that the critical times of DQPTs deviate from periodic spacing due to the multi-band effect, contrasting with results from two-band models. We propose a geometric interpretation to explain this non-uniform spacing. Additionally, we clarify the conditions needed for DQPT occurrence in the multi-band Bloch Hamiltonian, highlighting that a DQPT only arises when the quench from the Bloch states collapses the band gap at the critical point. Moreover, we establish that the dynamical topological order parameter, defined by the winding number of the PGP, is not quantized but still exhibits discontinuous jumps at DQPT critical times due to periodic modulation. Additionally, we extend our analysis to mixed-state DQPT and find its absence at non-zero temperatures.

Can daily actigraphic profiles distinguish between different mood states in inpatients with bipolar disorder? An observational study.

Background: Criterion A changes for bipolar disorder (BD) in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition yield new difficulties in diagnosis. Actigraphy has been used to capture the activity features of patients with BD. However, it remains unclear whether long-term actigraphic data could distinguish between different mood states in hospitalized patients with BD. Methods: In this observational study, 30 hospitalized patients with BD were included. Wrist-worn actigraphs were used to monitor motor activity. The patients were divided into bipolar disorder-depression (BD-D), bipolar disorder-mania (BD-M), and bipolar disorder-mixed state (BD-MS) groups. Motor activity differences were estimated using non-parametric analyses between and within the three groups. Results: The mean 24 h activity level differed between the groups. In the between-group analysis, the intra-individual fluctuation and minute-to-minute variability in the morning and the mean activity level and minute-to-minute variability in the evening significantly differed between the BD-M and BD-MS groups. In the within-group analysis, the BD-M group showed a disrupted rhythm and reduced activity complexity at night. Both the BD-D and BD-MS groups demonstrated significant differences between several parameters obtained in the morning and evening. Conclusion: The mean activity levels during the relatively long monitoring period and the intra-day variation within the groups could reflect the differences in motor activity. Sustained activity monitoring may clarify the emotional states and provide information for clinical diagnosis.

Treatment of Bipolar Disorders in Older Adults: A Review.

Background: Old age bipolar disorder has been an orphan of psychiatric research for a long time despite the fact that bipolar disorder (BD)-I and II together may affect 0.5-1.0% of the elderly. It is also unclear whether aetiology, course of illness and treatment should differ in patients with a first manifestation in older age and patients suffering from a recurrence of a BD known for decades. This narrative review will summarize the current state of knowledge about the epidemiology, clinical features, and treatment of BD in the elderly. Methods: We conducted a Medline literature search from 1970 to 2021 using MeSH terms "Bipolar Disorder" × "Aged" or "Geriatric" or "Elderly". Search results were complemented by additional literature retrieved from examining cross references and by hand search in text books. Summary of findings: Varying cut-off ages have been applied to differentiate old age from adult age BD. Within old age BD, there is a reasonable agreement of distinct entities, early and late-onset BD. They differ to some extent in clinical symptoms, course of illness, and some co-morbidities. Point prevalence of BD in older adults appears slightly lower than in working-age adults, with polarity of episodes shifting towards depression. Psychopharmacological treatment needs to take into account the special aspects of somatic gerontology and the age-related change of pharmacokinetic and pharmacodynamic characteristics. The evidence for commonly used treatments such as lithium, moodstabilizing antiepileptics, antipsychotics, and antidepressants remains sparse. Preliminary results support a role of ECT as well as psychotherapy and psychosocial interventions in old age BD. Conclusions: There is an obvious need of further research for all treatment modalities of BD in old age. The focus should be pharmacological and psychosocial approaches, as well as their combination, and the role of physical treatment modalities such as ECT.Appeared originally in Ann Gen Psychiatry 2021; 20:1.

Distractibility, anxiety, irritability, and agitation symptoms are associated with the severity of depressive and manic symptoms in mixed depression.

OBJECTIVE: To explore whether there is an association between distractibility, anxiety, irritability, and agitation (DAIA) symptoms and the severity of depressive and manic symptoms. METHODS: Patients with unipolar and bipolar disorder (I and II) and mixed depression were evaluated. DAIA symptoms were assessed using previously described definitions. RESULTS: The full analysis set comprised 100 patients. The severity of depressive symptoms in mixed depression, assessed by Montgomery-Åsberg Depression Rating Scale (MADRS), was significantly associated with the presence of two or more DAIA symptoms in the bipolar sample, influenced mainly by anxiety. The severity of manic symptoms in mixed depression, assessed by Young Mania Rating Scale (YMRS), was significantly associated with the presence of two or more DAIA symptoms in the bipolar sample and three or four DAIA symptoms in the unipolar sample. CONCLUSION: DAIA symptoms were associated with greater severity of manic symptoms in mixed depression. DAIA symptoms must be evaluated in all patients with mixed features and are associated with the severity of depressive and manic symptoms in mixed depression.

Distractibility, anxiety, irritability, and agitation symptoms are associated with the severity of depressive and manic symptoms in mixed depression

Objective: To explore whether there is an association between distractibility, anxiety, irritability, and agitation (DAIA) symptoms and the severity of depressive and manic symptoms. Methods: Patients with unipolar and bipolar disorder (I and II) and mixed depression were evaluated. DAIA symptoms were assessed using previously described definitions. Results: The full analysis set comprised 100 patients. The severity of depressive symptoms in mixed depression, assessed by Montgomery-Åsberg Depression Rating Scale (MADRS), was significantly associated with the presence of two or more DAIA symptoms in the bipolar sample, influenced mainly by anxiety. The severity of manic symptoms in mixed depression, assessed by Young Mania Rating Scale (YMRS), was significantly associated with the presence of two or more DAIA symptoms in the bipolar sample and three or four DAIA symptoms in the unipolar sample. Conclusion: DAIA symptoms were associated with greater severity of manic symptoms in mixed depression. DAIA symptoms must be evaluated in all patients with mixed features and are associated with the severity of depressive and manic symptoms in mixed depression. Clinical trial registration: ClinicalTrials.gov (NCT04123301).

Set-Valued Control to COVID-19 Spread with Treatment and Limitation of Vaccination Resources.

In this paper, we consider an SEIR model that describes the dynamics of the COVID-19 pandemic. Subject to this model with vaccination and treatment as controls, we formulate a control problem that aims to reduce the number of infectious individuals to zero. The novelty of this work consists of considering a more realistic control problem by adding mixed constraints to take into account the limited vaccines supply. Furthermore, to solve this problem, we use a set-valued approach combining a Lyapunov function defined in the sense of viability theory with some results from the set-valued analysis. The expressions of the control variables are given via continuous selection of an adequately designed feedback map. The main result of our study shows that even though there are limits of vaccination resources, the combination of treatment and vaccination strategies can significantly reduce the number of exposed and infectious individuals. Some numerical simulations are proposed to show the efficiency of our set-valued approach and to validate our theoretical results.

Analysis of Seasonal Clinical Characteristics in Patients With Bipolar or Unipolar Depression.

This study was to investigate the characteristics of seasonal symptoms and non-enzymatic oxidative stress in the first hospitalized patients with bipolar and unipolar depression, aiming to differentiate bipolar depression from unipolar depression and reduce their misdiagnosis. A total of 450 patients with bipolar depression and 855 patients with depression were included in the present study. According to the season when the patients were admitted to the hospital due to the acute onset of depression, they were further divided into spring, summer, autumn and winter groups. According to the characteristics of symptoms of bipolar disorder in the DSM-5, the characteristic symptoms of bipolar disorder were collected from the medical record information, and clinical biochemical indicators that can reflect the oxidative stress were also recorded. The seasonal risk factors in patients with bipolar or unipolar depression were analyzed. The relationship of age and gender with the bipolar or unipolar depression which attacked in winter was explored. There were significant differences between groups in the melancholic features, atypical features and conjugated bilirubin in spring. In summer, there were significant differences between groups in the melancholic features, uric acid and conjugated bilirubin. In autumn, there were marked differences between groups in melancholic features, anxiety and pain, atypical features, uric acid, total bilirubin, conjugated bilirubin and albumin. In winter, the conjugated bilirubin and prealbumin were significantly different between two groups. The melancholic features and uric acid that in summer as well as melancholic features, uric acid and total bilirubin in autumn were the seasonal independent risk factors for the unipolar depression as compared to bipolar depression. In winter, significant difference was noted in the age between two groups. In conclusion, compared with patients with unipolar depression, patients with bipolar depression have seasonal characteristics. Clinical symptoms and indicators of oxidative stress may become factors for the differentiation of seasonal unipolar depression from bipolar depression. Young subjects aged 15-35 years are more likely to develop bipolar depression in winter.

Increasing Quantum Correlations Based on Measurement-Induced Disturbance via a Swapping Procedure with Two-Qubit Mixed States.

In this paper, quantum correlation (QC) swapping for certain separable two-qubit mixed states is treated. A QC quantifier, measurement-induced disturbance (MID) (Luo in Phys Rev A 77:022301, 2008), is employed to characterize and quantify QCs in the relevant states. Properties of all QCs in the swapping process are revealed. Particularly, it is found that MID can be increased through QC swapping for certain separable two-qubit mixed states.

Treatment of bipolar disorders in older adults: a review.

BACKGROUND: Old age bipolar disorder has been an orphan of psychiatric research for a long time despite the fact that bipolar disorder (BD)-I and II together may affect 0.5-1.0% of the elderly. It is also unclear whether aetiology, course of illness and treatment should differ in patients with a first manifestation in older age and patients suffering from a recurrence of a BD known for decades. This narrative review will summarize the current state of knowledge about the epidemiology, clinical features, and treatment of BD in the elderly. METHODS: We conducted a Medline literature search from 1970 to 2021 using MeSH terms "Bipolar Disorder" × "Aged" or "Geriatric" or "Elderly". Search results were complemented by additional literature retrieved from examining cross references and by hand search in text books. Varying cut-off ages have been applied to differentiate old age from adult age BD. Within old age BD, there is a reasonable agreement of distinct entities, early and late-onset BD. They differ to some extent in clinical symptoms, course of illness, and some co-morbidities. Point prevalence of BD in older adults appears slightly lower than in working-age adults, with polarity of episodes shifting towards depression. Psychopharmacological treatment needs to take into account the special aspects of somatic gerontology and the age-related change of pharmacokinetic and pharmacodynamic characteristics. The evidence for commonly used treatments such as lithium, mood-stabilizing antiepileptics, antipsychotics, and antidepressants remains sparse. Preliminary results support a role of ECT as well as psychotherapy and psychosocial interventions in old age BD. CONCLUSIONS: There is an obvious need of further research for all treatment modalities of BD in old age. The focus should be pharmacological and psychosocial approaches, as well as their combination, and the role of physical treatment modalities such as ECT.

Old Age Bipolar Disorder-Epidemiology, Aetiology and Treatment.

Data regarding older age bipolar disorder (OABD) are sparse. Two major groups are classified as patients with first occurrence of mania in old age, the so called "late onset" patients (LOBD), and the elder patients with a long-standing clinical history, the so called "early onset" patients (EOBD). The aim of the present literature review is to provide more information on specific issues concerning OABD, such as epidemiology, aetiology and treatments outcomes. We conducted a Medline literature search from 1970-2021 using the MeSH terms "bipolar disorder" and "aged" or "geriatric" or "elderly". The additional literature was retrieved by examining cross references and by a hand search in textbooks. With sparse data on the treatment of OABD, current guidelines concluded that first-line treatment of OABD should be similar to that for working-age bipolar disorder, with specific attention to side effects, somatic comorbidities and specific risks of OABD. With constant monitoring and awareness of the possible toxic drug interactions, lithium is a safe drug for OABD patients, both in mania and maintenance. Lamotrigine and lurasidone could be considered in bipolar depression. Mood stabilizers, rather than second generation antipsychotics, are the treatment of choice for maintenance. If medication fails, electroconvulsive therapy is recommended for mania, mixed states and depression, and can also be offered for continuation and maintenance treatment. Preliminary results also support a role of psychotherapy and psychosocial interventions in old age BD. The recommended treatments for OABD include lithium and antiepileptics such as valproic acid and lamotrigine, and lurasidone for bipolar depression, although the evidence is still weak. Combined psychosocial and pharmacological treatments also appear to be a treatment of choice for OABD. More research is needed on the optimal pharmacological and psychosocial approaches to OABD, as well as their combination and ranking in an evidence-based therapy algorithm.

Not Only Mania or Depression: Mixed States/Mixed Features in Paediatric Bipolar Disorders.

Background: early onset is frequent in Bipolar Disorders (BDs), and it is characterised by the occurrence of mixed states (or mixed features). In this systematic review, we aimed to confirm and extend these observations by providing the prevalence rates of mixed states/features and data on associated clinical, pharmacological and psychopathological features. Methods: following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched from inception to 9 February 2021 for all studies investigating mixed states/mixed features in paediatric BD. Data were independently extracted by multiple observers. The prevalence rates of mixed states/features for each study were calculated. Results: eleven studies were included in our review, involving a total patient population of 1365 individuals. Overall, of the patients with paediatric age BD, 55.2% had mixed states/features (95% CI 40.1-70.3). Children with mixed states/features presented with high rates of comorbidities, in particular, with Attention Deficit Hyperactivity Disorder (ADHD). Evidences regarding the psychopathology and treatment response of mixed states/features are currently insufficient. Conclusions: our findings suggested that mixed states/features are extremely frequent in children and adolescents with BD and are characterised by high levels of comorbidity. Future investigations should focus on the relationship between mixed states/features and psychopathological dimensions as well as on the response to pharmacological treatment.

Unambiguous State Discrimination with Intrinsic Coherence.

We investigate the discrimination of pure-mixed (quantum filtering) and mixed-mixed states and compare their optimal success probability with the one for discriminating other pairs of pure states superposed by the vectors included in the mixed states. We prove that under the equal-fidelity condition, the pure-pure state discrimination scheme is superior to the pure-mixed (mixed-mixed) one. With respect to quantum filtering, the coherence exists only in one pure state and is detrimental to the state discrimination for lower dimensional systems; while it is the opposite for the mixed-mixed case with symmetrically distributed coherence. Making an extension to infinite-dimensional systems, we find that the coherence which is detrimental to state discrimination may become helpful and vice versa.

Association of treatment facets, severity of manic symptoms, psychomotor disturbances and psychotic features with response to electroconvulsive therapy in bipolar depression.

OBJECTIVES: Clinically useful predictors of response to electroconvulsive therapy (ECT) are warranted, especially in the case of bipolar depression. The aim of this study was to explore the associations between response and its known and putative correlates. METHODS: Six hundred seventy bipolar depressive patients treated with ECT were included in the study. The association between response (CGI-I ≤ 2) and mean seizure duration, number of treatments, age, sex, bipolar subtype, episode duration, HAM-D and YMRS scores, psychomotor disturbances and psychotic symptoms assessed through BPRS-EV were evaluated by means of univariate and multivariate logistic regression models, including quadratic and/or linear effects of continuous variables. RESULTS: Four hundred eighty three patients (72%) were responders. Among known correlates of response, significant quadratic effects were found for seizure duration and number of treatments, while a linear association was confirmed for episode duration. Among putative correlates, severe motor retardation, tension or agitation, hyperactivity and delusions of guilt were significantly associated with response (p<.01) and a significant quadratic effect was found for YMRS score (p<.01). CONCLUSION: Bipolar depressive patients with severe psychomotor disturbances, mood-congruent delusions and severe mixed features are highly responsive to ECT. A significant improvement in response prediction is expected when considering those clinical characteristics.

The 12-Item Self-Rating Questionnaire for Depressive Mixed State (DMX-12) for Screening of Mixed Depression and Mixed Features.

For simultaneous screening of mixed features (MF) by DSM-5 and mixed depression (MD) by Benazzi, useful symptoms were extracted from our 12-item dimensional scale for depressive mixed state (DMX-12). Subjects were 190 consecutive cases with major depressive episode (MDE) who visited our clinic. Associations between symptomatological combinations of the DMX-12 and MF or MD were analyzed using receiver operating characteristic (ROC). The rate of MF was 4.2% while that of MD was 22.6%. Eight symptoms (overreactivity, inner tension, racing/crowded thought, impulsivity, irritability, aggression, risk-taking behavior, and dysphoria) with their AUC > 0.6 for ROC curves were specially focused on distinguishing patients with MF or MD from non-mixed patients. By using these 8 symptoms, 40.5% of the overall patients were screened as positive at the same cut-off value (≥13) for both MD and MF. The AUC of ROC curve and sensitivity/specificity were well balanced together with sufficient negative predictive values. The abovementioned 8 symptoms seem to be helpful for primary screening and negative check of DMX with considerable severity during MDE.

Proximity effect in [Nb(1.5 nm)/Fe(x)]10/Nb(50 nm) superconductor/ferromagnet heterostructures.

We have investigated the structural, magnetic and superconduction properties of [Nb(1.5 nm)/Fe(x)]10 superlattices deposited on a thick Nb(50 nm) layer. Our investigation showed that the Nb(50 nm) layer grows epitaxially at 800 °C on the Al2O3(1-102) substrate. Samples grown at this condition possess a high residual resistivity ratio of 15-20. By using neutron reflectometry we show that Fe/Nb superlattices with x < 4 nm form a depth-modulated FeNb alloy with concentration of iron varying between 60% and 90%. This alloy has weak ferromagnetic properties. The proximity of this weak ferromagnetic layer to a thick superconductor leads to an intermediate phase that is characterized by a suppressed but still finite resistance of structure in a temperature interval of about 1 K below the superconducting transition of thick Nb. By increasing the thickness of the Fe layer to x = 4 nm the intermediate phase disappears. We attribute the intermediate state to proximity induced non-homogeneous superconductivity in the structure.

Naturalistic follow-up in bipolar patients after successful electroconvulsive therapy.

BACKGROUND: Electroconvulsive therapy (ECT) is an effective treatment for acute depression, mania and mixed states. We evaluated the long-term outcome of patients with bipolar depression or mixed state, responsive to ECT. METHODS: this observational follow-up study was conducted in 70 patients with Bipolar Disorder: 36 patients met DSM-IV-TR criteria for a major depressive episode (MDE) and 34 for a mixed episode (MXE). During the follow-up after ECT, the relapse rates and the duration of response and remission periods were recorded. RESULTS: the mean duration of the follow-up was 57 weeks. 93% of the patients maintained at least a partial therapeutic response for more than 90% of the follow-up period. 73% of patients fulfilled the criteria for a full remission, 33% showed a depressive relapse and 10% a mixed relapse. No manic relapses occurred but almost 1/3 of the sample presented hypomanic episodes. MDE patients presented higher rates of remission compared to MXE ones. Patients with anxiety disorders reported earlier relapses than those without this comorbidity. Relapsed-patients showed higher functional impairment at baseline evaluation, compared to non-relapsed ones. LIMITATIONS: nonrandom allocation, limited sample size, possible influence of psychopharmacological treatment. CONCLUSIONS: Given several methodological limitations, this study cannot draw definite conclusions but could suggest that in treatment-resistant bipolar patients with severe depression or mixed state, ECT may represent a useful treatment option. Patients with mixed features, comorbid anxiety disorders and higher functional impairment present less favorable outcome. Future research on long-term efficacy of ECT and on clinical predictors of relapse is needed.