Neuropsychological aspects of bipolar disorder.

Bipolar disorder (BD) is a chronic condition with serious consequences on the health and functionality of patients who suffer from it, with a high heritability and segregation, and aprevalence of between 1% and 2%. Neuropsychological deficits have been implicated as a very important issue related to BD prognosis, so a review was conducted of these deficits, the related factors and their functional consequences. It has been determined that the presence of neuropsychological deficits can vary in patients with BD according to their mood state, with a great influence of depressive symptoms on the cognitive variability of patients with respect to the general population and differences with respect to patients in the manic phase. In euthymic patients, the most affected cognitive domains are those of memory, attention, and executive function, associated with a more severe disease, sociodemographic vulnerability factors, and stable over time. A relationship has been found between poor cognitive performance, especially executive dysfunction, and objective functional deficit. Furthermore, cognitive differences have been outlined between BD and other serious mental illnesses that are described in this review.

Aspectos neuropsicológicos del trastorno afectivo bipolar / Neuropsychological Aspects of Bipolar Disorder

RESUMEN El trastorno afectivo bipolar (TAB) es una entidad crónica con graves efectos para la salud y la funcionalidad de los pacientes que la sufren, con una alta carga de heredabilidad y segregabilidad y una prevalencia que oscila entre el 1 y el 2%. Las alteraciones neuropsicológicas son características importantes relacionadas con su pronóstico, por lo cual se hizo una revisión narrativa sobre estas alteraciones, los factores asociados y sus consecuencias funcionales. Se ha determinado que la presencia de alteraciones neuropsicológicas puede variar en los pacientes con TAB según la fase anímica en que se encuentren, con una gran influencia de los síntomas depresivos en la variabilidad cognitiva de los pacientes respecto a la población general y diferencias respecto a los pacientes en fase maniaca. En pacientes eutímicos, los dominios cognitivos más afectados son los de memoria, atención y función ejecutiva, asociados con una enfermedad más grave, factores sociodemográficos de vulne rabilidad y sin interacción con el tiempo de evolución. Se ha encontrado una relación entre el mal rendimiento cognitivo, especialmente la disfunción ejecutiva y el déficit funcional objetivo; además, se han perfilado diferencias cognitivas entre el TAB y otras enfermedades mentales graves que se describen en la revisión.

ABSTRACT Bipolar disorder (BD) is a chronic condition with serious consequences on the health and functionality of patients who suffer from it, with a high heritability and segregation, and a prevalence of between 1% and 2%. Neuropsychological deficits have been implicated as a very important issue related to BD prognosis, so a review was conducted of these deficits, the related factors and their functional consequences. It has been determined that the presence of neuropsychological deficits can vary in patients with BD according to their mood state, with a great influence of depressive symptoms on the cognitive variability of patients with respect to the general population and differences with respect to patients in the manic phase. In euthymic patients, the most affected cognitive domains are those of memory, attention, and executive function, associated with a more severe disease, sociodemographic vulnerability factors, and stable over time. A relationship has been found between poor cognitive performance, especially executive dysfunction, and objective functional deficit. Furthermore, cognitive differences have been outlined between BD and other serious mental illnesses that are described in the review.

Resting-state functional nuclear magnetic resonance imaging in patients with bipolar disorder: Beyond euthymia.

INTRODUCTION: Functional nuclear magnetic resonance imaging in the resting state (R-fMRI) allows the identification of complete functional connectivity networks and the possible neuronal correlations of psychiatric disorders. The literature on R-fMRI and bipolar disorder (BD) will be reviewed, emphasising the findings in the phases of mania, hypomania and depression. METHODS: It is a narrative review of the literature in which articles were searched in PubMed and Embase, with the key words in English "bipolar disorder" AND "resting state", without limit on the date of publication. RESULTS: The studies of BD patients in the mania and hypomania phases who underwent R-fMRI show concordant results in terms of decreased functional cerebral connectivity between the amygdala and some cortical regions, which indicates that this functional connection would have some implication in the normal affect regulation. Patients in the depressive phase show a decrease in functional brain connectivity, but as there are several anatomical structures involved and neural networks reported in the studies, it is not possible to compare them. CONCLUSIONS: There is a decrease in functional connectivity in patients with BD, but current evidence does not allow establishing specific changes in specific functional brain connectivity networks. However, there are already some findings that show correlation with the patients' symptoms.

Correlation between cognitive performance and structural neuroanatomy in patients with type I bipolar affective disorder treated with and without lithium.

INTRODUCTION: Lithium treatment of bipolar disorder (BD) has been associated with less cognitive impairment and fewer changes in structural brain anatomy compared to other treatments. However, the studies are heterogeneous and few assess whether these effects are related. The objective of this study was to evaluate and relate cognitive performance and structural neuroanatomy in patients treated with and without lithium. METHODS: Cross-sectional study that included 48 subjects with BD-I, of which 22 were treated with lithium and 26 without lithium. Performance was assessed on Wechsler III (WAIS III), TMT A and B (Trial Making Test) neuropsychological tests, California verbal learning test (CVLT), Rey complex figure test and Wisconsin card sorting test. Brain structures obtained by magnetic resonance imaging (MRI) were evaluated. The standardised mean difference (SMD) between both groups was calculated, adjusted for confounding variables using a propensity score, and the Spearman correlation coefficient (ρ) was used to assess the relationship between cognitive performance and neuroanatomical regions. RESULTS: Compared to the group without lithium, the group with lithium had fewer perseverative errors in the Wisconsin test (SMD = -0.69) and greater left and right cortical areas (SMD = 0.85; SMD = 0.92); greater surface area in the left anterior cingulate (SMD = 1.32), right medial orbitofrontal cortex (SMD = 1.17), right superior frontal gyrus (SMD = 0.82), and right and left precentral gyrus (SMD = 1.33; SMD = 0.98); greater volume of the right amygdala (SMD = 0.57), right hippocampus (SMD = 0.66), right putamen (SMD = 0.87) and right thalamus (SMD = .67). In the lithium group, a correlation was found with these errors and the thickness of the left precentral gyrus (ρ = -0.78), the volume of the right thalamus (ρ = -0.44), and the right amygdala (ρ = 0.6). CONCLUSIONS: The lithium group had better cognitive flexibility and greater dimension in some frontal and subcortical cortical regions. Furthermore, there was a moderate to high correlation between performance in this executive function and the thickness of the right precentral gyrus, and the volumes of the thalamus and the right amygdala. These findings could suggest a neuroprotective effect of lithium.

Correlación entre el desempeño cognitivo y la neuroanatomía estructural en pacientes con trastorno afectivo bipolar tipo I tratados con y sin litio / Correlation Between Cognitive Performance and Structural Neuroanatomy in Patients with Type I Bipolar Affective Disorder Treated with and Without Lithium

RESUMEN Introducción: El tratamiento del trastorno afectivo bipolar (TAB) con litio se ha relacionado con menos deterioro cognitivo y menores cambios en la anatomía estructural cerebral comparado con otros tratamientos. Sin embargo, los estudios son heterogéneos y son pocos los que evalúan si estos efectos están relacionados. El objetivo de este estudio es evaluar y relacionar el desempeno cognitivo y la neuroanatomía estructural en pacientes tratados con y sin litio. Métodos: Estudio de corte trasversal que incluyó a 48 sujetos con TAB I: 22 tratados con litio y 26 sin litio. Se evaluó el desempeno en las pruebas neuropsicológicas Wechsler III (WAIS III), TMTAyB (Trial Making Test), prueba de aprendizaje verbal de California (TAVEC), prueba de Figura compleja de Rey y prueba de clasificación de tarjetas de Wisconsin. Se evaluaron estructuras cerebrales obtenidas por resonancia magnétiva (RM) cerebral. Se calculó la diferencia de medias estandarizada (DME) entre ambos grupos, con ajuste por variables de confusión mediante puntuación de propensión, y se empleó el coeficiente de correlación de Spearman (p) para evaluar la relación existente entre el desempeno cognitivo y las regiones neuroanatómicas. Resultados: Respecto al grupo sin litio, el grupo con litio tuvo menos errores perseverativos en el Wisconsin (DME = -0,69) y mayores áreas corticales derecha e izquierda (DME = 0,85 y DME = 0,92); mayor superficie en el cíngulo anterior izquierdo (DME = 1,32), la corteza orbi-tofrontal medial derecha (DME = 1,17), el giro frontal superior derecho (DME = 0,82), los giros precentrales derecho e izquierdo (DME = 1,33 y DME = 0,98); mayor volumen de la amígdala derecha (DME = 0,57), el hipocampo derecho (DME = 0,66), el putamen derecho (DME = 0,87) y el tálamo derecho (DME = 0,67). En el grupo con litio, se encontró una correlación con dichos errores y el espesor del giro precentral izquierdo (p = -0,78), el volumen del tálamo derecho (p = -0,44) y la amígdala derecha (p = 0,6). Conclusiones: El grupo con litio tuvo mejor flexibilidad cognitiva y mayor dimensión en algunas regiones corticales frontales y subcorticales. Además, hubo correlación moderada a alta entre el desempeno en esta función ejecutiva y el espesor del giro precentral derecho, y los volúmenes del tálamo y la amígdala derecha. Estos hallazgos podrían indicar un efecto neuroprotector del litio

ABSTRACT Introduction: Lithium treatment of bipolar disorder (BD) has been associated with less impairment and fewer changes in structural brain anatomy compared to other treatments. However, the studies are heterogeneous and few assess whether these effects are related. The objective of this study was to evaluate and relate cognitive performance and structural neuroanatomy in patients treated with and without lithium. Methods: Cross-sectional study that included 48 subjects with BD-I, of which 22 were treated with lithium and 26 without lithium. Performance was assessed on Wechsler III (WAIS III), TMT A and B (Trial Making Test) neuropsychological tests, California verbal learning test (CVLT), Rey complex figure test and Wisconsin card sorting test. Brain structures obtained by magnetic resonance imaging (MRI) were evaluated. The standardised mean difference (SMD) between both groups was calculated, adjusted for confounding variables using a propen-sity score, and the Spearman correlation coefficient (p) was used to assess the relationship between cognitive performance and neuroanatomical regions. Results: Compared to the group without lithium, the group with lithium had fewer perse-verative errors in the Wisconsin test (SMD = -0.69) and greater left and right cortical areas (SMD = 0.85; SMD = 0.92); greater surface area in the left anterior cingulate (SMD = 1.32), right medial orbitofrontal cortex (SMD = 1.17), right superior frontal gyrus (SMD = 0.82), and right and left precentral gyrus (SMD = 1.33; SMD = 0.98); greater volume of the right amyg-dala (SMD = 0.57), right hippocampus (SMD = 0.66), right putamen (SMD = 0.87) and right thalamus (SMD=.67). In the lithium group, a correlation was found with these errors and the thickness of the left precentral gyrus (p = -0.78), the volume of the right thalamus (p =-0.44), and the right amygdala (p = 0.6). Conclusions: Thelithium group had better cognitive flexibility and greater dimension in some frontal and subcortical cortical regions. Furthermore, there was a moderate to high correlation between performance in this executive function and the thickness of the right precentral gyrus, and the volumes of the thalamus and the right amygdala. These findings could suggest a neuroprotective effect of lithium.

Resonancia magnética nuclear funcional en estado de reposo en pacientes con trastorno bipolar: más allá de la eutimia / Resting-state functional nuclear magnetic resonance imaging in patients with bipolar disorder: beyond euthymia

Resumen Introducción: La resonancia magnética funcional en estado de reposo (RMf-ER) permite identificar redes de conectividad funcional completas y los posibles correlatos neuronales de trastornos psiquiátricos. Se revisa la literatura sobre RMf-ER y trastorno bipolar (TB) haciendo énfasis en los hallazgos en las fases de manía, hipomanía y depresión. Métodos: Es una revisión narrativa de la literatura en la que se buscaron artículos en PubMed y EMBASE con las palabras clave en inglés "bipolar disorder" AND "resting state", sin límite en la fecha de publicación. Resultados: Los estudios de pacientes con TB en fases de manía e hipomanía sometidos a RMf-ER muestran resultados concordantes en cuanto a la disminución de la conectividad funcional cerebral entre la amígdala y algunas regiones corticales, lo cual indica que esta conexión funcional tendría alguna implicación en la regulación normal del afecto. Los pacientes en fase depresiva muestran disminución en la conectividad funcional cerebral, pero como son varias las estructuras anatómicas implicadas y las redes neuronales reportadas en los estudios, no es posible compararlos. Conclusiones: Hay disminución en la conectividad funcional en los pacientes con TB, pero la evidencia actual no permite establecer cambios específicos en redes de conectividad funcional cerebral puntuales. Sin embargo, ya hay algunos hallazgos que muestran correlación con la clínica de los pacientes.

ABSTRACT Introduction: imaging in the resting state (R-fMRI) Functional nuclear magnetic allows the identification of complete functional connectivity networks and the possible resonance neuronal correlations of psychiatric disorders. The literature on R-fMRI and bipolar disorder (BD) will be reviewed, emphasising the findings in the phases of mania, hypomania and depression. Methods: It is a narrative review of the literature in which articles were searched in PubMed and Embase, with the key words in English "bipolar disorder" AND "resting state", without limit on the date of publication. Results: The studies of BD patients in the mania and hypomania phases who underwent R-fMRI show concordant results in terms of decreased functional cerebral connectivity between the amygdala and some cortical regions, which indicates that this functional connection would have some implication in the normal affect regulation. Patients in the depressive phase show a decrease in functional brain connectivity, but as there are seve-ral anatomical structures involved and neural networks reported in the studies, it is not possible to compare them. Conclusions: There is a decrease in functional connectivity in patients with BD, but current evidence does not allow establishing specific changes in specific functional brain connectivity networks. However, there are already some findings that show correlation with the patients' symptoms.

Psychotic disorders in the diagnostic stability of a Portuguese ward - Diagnostic retrospective analysis / Trastornos psicóticos en la estabilidad diagnóstica de un barrio portugués - Análisis retrospectivo diagnóstico

ABSTRACT Objectives: Psychiatric diagnosis is based on clinical manifestations, resulting from patients' internal state, their life situation, the evolution of their condition and the response to our interventions. There are currently few objective data which help to establish the diagnosis which is why this is based on diagnostic criteria such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM defines entities by their diagnostic stability, however there are several causes of variability as categorised by Spritzer et al. (1987): subjects variance (changing in patients), occasions variance (different episodes), information variance (new information) and observation variance (different interpretations). This paper aims to determine the diagnostic stability of patients with Psychotic Disorders among patients readmitted to our Psychiatric Unit. Methods: Retrospective analysis of the diagnoses of patients with Psychotic Disorders who had been readmitted to our unit. We analysed data from the last 12 years - 5422 admission episodes with 507 patients with a relevant diagnosis in this period. Results: Psychiatric diagnosis does evolve over time, nevertheless some diagnostic groups show a relatively significant stability over time - Bipolar Disorder and Schizophrenia with 69% and 77% stability, respectively. Diagnosis such as Depressive Psychosis and Drug-induced psychosis show a significantly lower stability (8% and 21%, respectively). Conclusions: Knowing our own reality can make us aware that a cross-sectional view of patients can be insufficient and only time can determine a clear diagnosis. This study may help us to understand how psychotic disorders evolve.

RESUMEN Objetivos: El diagnóstico psiquiátrico se basa en las manifestaciones clínicas, consecuencia del estado interno del paciente, de su situación vivencial, de la evolución de su enfermedad y de la respuesta a nuestras intervenciones. Actualmente, existen pocos datos objetivos que ayudan a establecer el diagnóstico por lo que éste se basa en criterios diagnósticos como el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM). La DSM define diagnósticos por su estabilidad, sin embargo, existen varias causas de variabilidad caracterizadas por Spritzer et al. (1987): variación en el sujeto (cambio en el paciente), variación ocasional (diferentes episodios), variación en la información (nueva información) y variación en la observación (diferentes interpretaciones). Este trabajo pretende evaluar la estabilidad diagnóstica de los pacientes con Trastornos Psicóticos reinternados en nuestro internamiento psiquiátrico. Métodos: Análisis retrospectivo de los diagnósticos de los pacientes con Trastornos Psicóticos con reingresos en nuestro servicio. Se analizaron datos de los últimos 12 anos - 5422 admisiones con 507 pacientes con diagnóstico de interés en ese período. Resultados: El diagnóstico psiquiátrico se altera con el tiempo, sin embargo, algunos grupos revelan una mayor estabilidad a lo largo del tiempo - Perturbación Afectiva Bipolar y Esquizofrenia con el 69% y el 77%, respectivamente. Los diagnósticos como la depresión psicótica y la psicosis tóxica, revelan una estabilidad significativamente menor (8% y 21% respectivamente). Conclusiones: Conocer nuestra realidad nos hace conscientes de que una mirada transversal a los enfermos puede ser insuficiente y sólo el tiempo puede determinar un diagnóstico claro. Este trabajo puede ayudarnos a entender cómo evolucionan las enfermedades psicóticas.

Psychotic disorders in the diagnostic stability of a Portuguese ward - Diagnostic retrospective analysis.

OBJECTIVES: Psychiatric diagnosis is based on clinical manifestations, resulting from patients' internal state, their life situation, the evolution of their condition and the response to our interventions. There are currently few objective data which help to establish the diagnosis which is why this is based on diagnostic criteria such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM defines entities by their diagnostic stability, however there are several causes of variability as categorised by Spritzer et al. (1987): subjects variance (changing in patients), occasions variance (different episodes), information variance (new information) and observation variance (different interpretations). This paper aims to determine the diagnostic stability of patients with Psychotic Disorders among patients readmitted to our Psychiatric Unit. METHODS: Retrospective analysis of the diagnoses of patients with Psychotic Disorders who had been readmitted to our unit. We analysed data from the last 12 years - 5422 admission episodes with 507 patients with a relevant diagnosis in this period. RESULTS: Psychiatric diagnosis does evolve over time, nevertheless some diagnostic groups show a relatively significant stability over time - Bipolar Disorder and Schizophrenia with 69% and 77% stability, respectively. Diagnosis such as Depressive Psychosis and Drug-induced psychosis show a significantly lower stability (8% and 21%, respectively). CONCLUSIONS: Knowing our own reality can make us aware that a cross-sectional view of patients can be insufficient and only time can determine a clear diagnosis. This study may help us to understand how psychotic disorders evolve.

Polidipsia psicógena e hiponatremia severa en trastorno afectivo bipolar: informe de caso / Psychogenic polydipsia and severe hyponatremia in bipolar affective disorder: case report

La polidipsia psicógena, polidipsia primaria o potomaníaes un trastorno de origen multifactorial que se asocia con unamorbilidad y mortalidad sustancial. Se presenta frecuentemente en pacientes con enfermedades psiquiátricas, particularmente aquellos con esquizofrenia, sin embargo, no es exclusiva de esta, ya que se ha notificado en menor proporción enpacientes con trastornos de ansiedad y trastornos del estadode ánimo. Peso a todo lo anterior, continúa siendo una afección poco comprendida y por ende subdiagnosticada.Es fundamental reconocer esta entidad clínica de manera oportuna, debido a sus complicaciones potencialmentegraves como la hiponatremia sintomática que puede derivaren coma y muerte si no se detecta y se maneja tempranamente. Además, se debe recalcar la importancia de una elección acertada de los psicofármacos, ya que la mayoría delos estabilizantes del afecto y algunos inhibidores selectivosde la recaptación de serotonina, pueden causar y/o agravardicho trastorno hidroelectrolítico, lo cual implica un desafíoadicional para el especialista al momento de establecer laterapia de mantenimiento.Son escasos los reportes en la literatura sobre polidipsiapsicógena documentada en trastornos del estado de ánimo,con este propósito, exponemos el caso de una paciente contrastorno afectivo bipolar que desarrolló hiponatremia severa secundaria a polidipsia primaria. (AU)

Psychogenic polydipsia, primary polydipsia or potomaniais a disorder of multifactorial etiology which is associatedwith substantial morbidity and mortality. It occurs frequently in patients with psychiatric diseases, particularly thosewith schizophrenia, however, it is not exclusive, it has beenreported in a lower proportion in patients with anxiety disorders and mood disorders. Although, is still poorly understoodand therefore underdiagnosed condition.It is essential to recognize this clinical entity opportunely,due to its potentially serious complications, such as symptomatic hyponatremia that can lead to coma and death if notdetected and managed early. Furthermore, the importanceof a correct choice of psychotropic medications should beemphasized, since most of the mood stabilizers and someselective serotonin reuptake inhibitors can cause and / oraggravate the hydroelectrolytic disorder, which implies anadditional challenge for the specialist in establishing maintenance therapy.There are few reports in the literature on documentedpsychogenic polydipsia in mood disorders, for this purpose, we present the case of a patient with bipolar affectivedisorder suffering from severe hyponatremia secondary toprimary polydipsia. (AU)

Neuropsychological Aspects of Bipolar Disorder. / Aspectos neuropsicológicos del trastorno afectivo bipolar.

Bipolar disorder (BD) is a chronic condition with serious consequences on the health and functionality of patients who suffer from it, with a high heritability and segregation, and a prevalence of between 1% and 2%. Neuropsychological deficits have been implicated as a very important issue related to BD prognosis, so a review was conducted of these deficits, the related factors and their functional consequences. It has been determined that the presence of neuropsychological deficits can vary in patients with BD according to their mood state, with a great influence of depressive symptoms on the cognitive variability of patients with respect to the general population and differences with respect to patients in the manic phase. In euthymic patients, the most affected cognitive domains are those of memory, attention, and executive function, associated with a more severe disease, sociodemographic vulnerability factors, and stable over time. A relationship has been found between poor cognitive performance, especially executive dysfunction, and objective functional deficit. Furthermore, cognitive differences have been outlined between BD and other serious mental illnesses that are described in the review.

Correlation Between Cognitive Performance and Structural Neuroanatomy in Patients with Type I Bipolar Affective Disorder Treated with and Without Lithium. / Correlación entre el desempeño cognitivo y la neuroanatomía estructural en pacientes con trastorno afectivo bipolar tipo I tratados con y sin litio.

INTRODUCTION: Lithium treatment of bipolar disorder (BD) has been associated with less cognitive impairment and fewer changes in structural brain anatomy compared to other treatments. However, the studies are heterogeneous and few assess whether these effects are related. The objective of this study was to evaluate and relate cognitive performance and structural neuroanatomy in patients treated with and without lithium. METHODS: Cross-sectional study that included 48 subjects with BD-I, of which 22 were treated with lithium and 26 without lithium. Performance was assessed on Wechsler III (WAIS III), TMT A and B (Trial Making Test) neuropsychological tests, California verbal learning test (CVLT), Rey complex figure test and Wisconsin card sorting test. Brain structures obtained by magnetic resonance imaging (MRI) were evaluated. The standardised mean difference (SMD) between both groups was calculated, adjusted for confounding variables using a propensity score, and the Spearman correlation coefficient (ρ) was used to assess the relationship between cognitive performance and neuroanatomical regions. RESULTS: Compared to the group without lithium, the group with lithium had fewer perseverative errors in the Wisconsin test (SMD = -0.69) and greater left and right cortical areas (SMD = 0.85; SMD = 0.92); greater surface area in the left anterior cingulate (SMD = 1.32), right medial orbitofrontal cortex (SMD = 1.17), right superior frontal gyrus (SMD = 0.82), and right and left precentral gyrus (SMD = 1.33; SMD = 0.98); greater volume of the right amygdala (SMD = 0.57), right hippocampus (SMD = 0.66), right putamen (SMD = 0.87) and right thalamus (SMD=.67). In the lithium group, a correlation was found with these errors and the thickness of the left precentral gyrus (ρ = -0.78), the volume of the right thalamus (ρ =-0.44), and the right amygdala (ρ = 0.6). CONCLUSIONS: The lithium group had better cognitive flexibility and greater dimension in some frontal and subcortical cortical regions. Furthermore, there was a moderate to high correlation between performance in this executive function and the thickness of the right precentral gyrus, and the volumes of the thalamus and the right amygdala. These findings could suggest a neuroprotective effect of lithium.

Consumo de alcohol y diagnóstico de trastorno afectivo bipolar en población adulta colombiana / Alcohol Consumption and Bipolar Disorder in a Colombian Population Sample

RESUMEN Introducción: El trastorno afectivo bipolar (TAB) es el trastorno mental reportado con mayor comorbilidad con el trastorno de abuso de sustancias (TAUS). Específicamente se han encontrado trastornos asociados con el consumo de alcohol (TACDA) en más de la mitad de los pacientes con TAB. Material y métodos: Se realizó un análisis secundario en una muestra poblacional de adultos en Colombia, con el objetivo de identificar la presencia de comorbilidad y los factores relacionados con el uso de alcohol en personas con TAB. El diagnóstico de TAB de los participantes se realizó a través del Entrevista Diagnóstica Internacional Compuesta (CIDI-CAPI) y el patrón de consumo de alcohol en el último año se determinó con la escala AUDIT C. Resultados: Se encontró que todos los pacientes con diagnóstico de TAB tenían algún patrón desadaptativo de consumo de alcohol. Entre las mujeres con TAB de esta muestra, se encontró un mayor riesgo de consumo de tipo dependencia, también mayor riesgo de consumo de nicotina y marihuana; entre quienes viven en centros urbanos, una mayor frecuencia de ideas suicidas y menor riesgo entre aquellos en una relación de pareja estable. Discusión: Se identificaron factores asociados novedosos respecto a publicaciones previas y otros ya descritos en estudios similares. Conclusiones: Estos hallazgos indican la necesidad de evaluar, en el abordaje de los pacientes con TAB, el tipo de consumo de alcohol y otras sustancias, dada su relevancia en el manejo y el pronóstico de esta población.

ABSTRACT Background: Bipolar disorder (BD) is reported to be the mental disorder with the highest rate of comorbidity with substance use disorders (SUD). More than half of patients with BD have been found to have disorders associated with alcohol use. Methods: A secondary analysis was performed in a population sample of Colombian adults. The aim was to identify bipolar-alcohol comorbidity and factors related to the use of alcohol in people with BD. The diagnosis of BD among participants was made with the "Composite International Diagnostic Interview" (CIDI-CAPI) and the pattern of alcohol consumption in the last year was evaluated with the AUDIT C screening tool. Results: It was found that all patients with BD had some type of problematic alcohol consumption pattern. Women with BD were at greater risk of having a dependence-type pattern, using nicotine and marijuana and, among those living in urban areas, had higher rates of suicidal ideation, although that risk was lower if they were in a stable relationship. Discussion: Some of the related factors we identified are new with respect to previous publications and others have already been described in similar studies. Conclusions: Given the importance of such factors in the management of this population and their prognosis, these findings highlight the need to determine consumption patterns of alcohol and other substances in patients with BD.

Alcohol Consumption and Bipolar Disorder in a Colombian Population Sample. / Consumo de alcohol y diagnóstico de trastorno afectivo bipolar en población adulta colombiana.

BACKGROUND: Bipolar disorder (BD) is reported to be the mental disorder with the highest rate of comorbidity with substance use disorders (SUD). More than half of patients with BD have been found to have disorders associated with alcohol use. METHODS: A secondary analysis was performed in a population sample of Colombian adults. The aim was to identify bipolar-alcohol comorbidity and factors related to the use of alcohol in people with BD. The diagnosis of BD among participants was made with the "Composite International Diagnostic Interview" (CIDI-CAPI) and the pattern of alcohol consumption in the last year was evaluated with the AUDIT C screening tool. RESULTS: It was found that all patients with BD had some type of problematic alcohol consumption pattern. Women with BD were at greater risk of having a dependence-type pattern, using nicotine and marijuana and, among those living in urban areas, had higher rates of suicidal ideation, although that risk was lower if they were in a stable relationship. DISCUSSION: Some of the related factors we identified are new with respect to previous publications and others have already been described in similar studies. CONCLUSIONS: Given the importance of such factors in the management of this population and their prognosis, these findings highlight the need to determine consumption patterns of alcohol and other substances in patients with BD.

"Psychotic Disorders in the Diagnostic Stability of a Portuguese Ward - Diagnostic Retrospective Analysis".

OBJECTIVES: Psychiatric diagnosis is based on clinical manifestations, resulting from patients' internal state, their life situation, the evolution of their condition and the response to our interventions. There are currently few objective data which help to establish the diagnosis which is why this is based on diagnostic criteria such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM defines entities by their diagnostic stability, however there are several causes of variability as categorised by Spritzer et al. (1987): subjects variance (changing in patients), occasions variance (different episodes), information variance (new information) and observation variance (different interpretations). This paper aims to determine the diagnostic stability of patients with Psychotic Disorders among patients readmitted to our Psychiatric Unit. METHODS: Retrospective analysis of the diagnoses of patients with Psychotic Disorders who had been readmitted to our unit. We analysed data from the last 12 years - 5422 admission episodes with 507 patients with a relevant diagnosis in this period. RESULTS: Psychiatric diagnosis does evolve over time, nevertheless some diagnostic groups show a relatively significant stability over time - Bipolar Disorder and Schizophrenia with 69% and 77% stability, respectively. Diagnosis such as Depressive Psychosis and Drug-induced psychosis show a significantly lower stability (8% and 21%, respectively). CONCLUSIONS: Knowing our own reality can make us aware that a cross-sectional view of patients can be insufficient and only time can determine a clear diagnosis. This study may help us to understand how psychotic disorders evolve.

Resting-state functional nuclear magnetic resonance imaging in patients with bipolar disorder: beyond euthymia. / Resonancia magnética nuclear funcional en estado de reposo en pacientes con trastorno bipolar: más allá de la eutimia.

INTRODUCTION: Functional nuclear magnetic resonance imaging in the resting state (R-fMRI) allows the identification of complete functional connectivity networks and the possible neuronal correlations of psychiatric disorders. The literature on R-fMRI and bipolar disorder (BD) will be reviewed, emphasising the findings in the phases of mania, hypomania and depression. METHODS: It is a narrative review of the literature in which articles were searched in PubMed and Embase, with the key words in English "bipolar disorder" AND "resting state", without limit on the date of publication. RESULTS: The studies of BD patients in the mania and hypomania phases who underwent R-fMRI show concordant results in terms of decreased functional cerebral connectivity between the amygdala and some cortical regions, which indicates that this functional connection would have some implication in the normal affect regulation. Patients in the depressive phase show a decrease in functional brain connectivity, but as there are several anatomical structures involved and neural networks reported in the studies, it is not possible to compare them. CONCLUSIONS: There is a decrease in functional connectivity in patients with BD, but current evidence does not allow establishing specific changes in specific functional brain connectivity networks. However, there are already some findings that show correlation with the patients' symptoms.

Irritabilidad como síntoma transdiagnóstico / Irritability as a transdiagnostic Symptom

Resumen. La irritabilidad es un síntoma transdiagnóstico que atraviesa la barrera de las patologías internalizantes y externalizantes. Se define como un umbral bajo para experimentar la ira en respuesta a la frustración y es uno de los síntomas más comunes en niños y adolescentes. Las conductas relacionadas con la ira apropiadas para el desarrollo tienden a reflejar frustración en contextos esperados, mientras que la irritabilidad crónica es inapropiada para la situación. La presentación de la irritabilidad, crónica o episódica, es crucial para comprender su significado psicopatológico, en particular porque las estructuras de la irritabilidad episódica y crónica son separables y permanecen estables a lo largo del tiempo. Existen varios estudios acerca de la irritabilidad en patologías como trastorno afectivo bipolar y trastorno de desregulación disruptiva del estado del ánimo, en ambos casos es importante plantearse como punto de partida la identificación de la episodicidad. La irritabilidad también se encuentra presente en el trastorno de personalidad límite observándose dentro de una inestabilidad afectiva debida a una reactividad notable del estado de ánimo. Estas emociones tienen un correlato anatómico relacionado con deficiencias de los circuitos frontolímbicos. Para el manejo de la irritabilidad en las distintas patologías, la evidencia del tratamiento incluye terapia cognitivo conductual, intervención de los padres, mindfulness, pero existe una necesidad apremiante de investigación sobre el tratamiento farmacológico complementario.

Irritability is a transdiagnostic symptom that crosses the barrier between internalizing and externalizing pathologies. It is defined as a low threshold to experience anger in response to frustration and it is one of the most common symptoms in children and adolescents. Behaviors related to appropriate developmental anger tend to reflect frustration in expected contexts, while chronic irritability is inappropriate to the situation. The presentation of irritability, chronic or episodic, is crucial to understanding its psychopathological meaning, particularly because the structures of episodic and chronic irritability are separable and remain stable over time. There are several studies about irritability in pathologies such as bipolar affective disorder and disruptive mood dysregulation disorder, in both cases it is important to consider the identification of episodicity as a starting point. Irritability is also present in borderline personality disorder, where it is expressed as an affective instability due to a remarkable reactivity of the state of mind. These emotions have been anatomically related to deficiencies of the frontolimbic circuits. For the management of irritability in different patholo-gies, the evidence includes cognitive behavioral therapy, parental intervention, mindfulness, but there still is a pressing need for research on complementary pharmacological treatment.

Viraje de fase maníaca a catatonía por noxa somática aguda / Manic phase shift to catatonia by acute somatic noxa

El síndrome catatónico como entidad neuropsiquiátrica ha sufrido cambios conceptuales a través de la historia, incluyendo tanto la clínica de su presentación como sus posibles causas. Éste último elemento cobra especial importancia, dado que la catatonía puede presentarse tanto por diversos cuadros médicos así como por patología psiquiátrica primaria. Se presenta el caso clínico de una paciente con antecedente de trastorno afectivo bipolar ingresada por un episodio maníaco con síntomas psicóticos asociados a un evento vital estresante. La paciente, durante una infección respiratoria baja, cambia su presentación clínica, objetivándose elementos propios de un estupor depresivo y síndrome catatónico. Una vez tratado el cuadro infeccioso y descartadas las causas neurológicas de la catatonía, se realizó tratamiento con benzodiacepinas, iniciándose luego fármacos para depresión bipolar, obteniéndose excelente respuesta clínica. Se pretende en este reporte dar a conocer la importancia de detectar elementos catatoniformes en pacientes psiquiátricos ingresados en unidades de corta estadía, así como buscar siempre posibles causas médicas relacionadas.

The catatonic syndrome as a neuropsychiatric entity has undergone conceptual changes throughout history, including both the clinical presentation and its possible causes. This last element is particularly important, given that catatonia can occur both in different medical situations as well as in primary psychiatric pathology. We present the clinical case of a patient with a history of bipolar affective disorder, hospitalized because of a manic episode with psychotic symptoms associated with a stressful life event. The patient, during a low respiratory infection, changes its clinical presentation, with elements of a depressive stupor and catatonic syndrome. Once the infectious symptoms were treated and the neurological causes of catatonia were ruled out, treatment with benzodiazepines was carried out, and then drugs for bipolar depression were started, obtaining an excellent clinical response. The aim of this report is to make known the importance of detecting catatoniform elements in psychiatric patients admitted to short-stay units, as well as to look for possible related medical causes.

Síndromes psicóticos / Psychotic syndromes: clinical case summary

Paciente de 47 años, casada, con 3 hijos. Antecedentes de patología psiquiátrica en madre y hermano. Sin antecedentes psiquiátricos previos. Ingresa hace 4 años al Servicio. Con síntomas polimorfos, varios diagnósticos desde el ingreso, pero con respuesta al tratamiento y con periodos de estabilidad psicopatológica demás de un año. Conocida en varios dispositivos del servicio. Diagnósticos: Trastorno Delirante, Obs. Trastorno Afectivo Bipolar, Trastorno Esquizoafectivo

Patient 47 years old, married, with 3 children. History of psychiatric pathology in mother and brother. No previous psychiatric history. Enter the Service 4 years ago. With polymorphic symptoms, several diagnoses from admission, but with response to treatment and with periods of psychopathological stability over a year. Known in several service devices. Diagnoses: Delusional Disorder, Obs. Bipolar Affective Disorder, Schizoaffective Disorder

Estudio comparativo sobre las causas de mortalidad entre personas con trastorno bipolar y una muestra control en Costa Rica entre 1995 y 2005 / Comparative study of mortality causes between subjects with bipolar disorder and a control sample between 1995 and 2005

Resumen Justificación: el trastorno afectivo bipolar afecta entre un 1 % y un 2 % de la población mundial. Se ha descrito que se acompaña de un aumento en la mortalidad por causas tanto violentas como no violentas. Existen pocos estudios en el país acerca de las causas de muerte en esta población. Este estudio tiene como objetivo analizar las causas de muerte de personas con trastorno afectivo bipolar y compararlas con las de controles sanos. Métodos: de los sujetos con trastorno afectivo bipolar previamente reclutados para estudios genéticos del Centro de Investigación en Biología Celular y Molecular de la UCR, se seleccionó a las 154 personas que habían fallecido entre 1993 y 2005. Se eligieron 154 controles apareados por sexo, que hubiesen nacido y fallecido en el mismo periodo que el sujeto, con una diferencia no mayor a tres meses. El análisis estadístico consistió en una prueba exacta de Fisher con 1000 simulaciones del valor de p con Monte Carlo. Resultados: de los 154 sujetos, un 50 % (n=77) fueron mujeres. No hubo diferencia en la causa de muerte entre sexos. Se encontró diferencia significativa en las principales causas de muerte entre casos y controles (p<0,05). Se observó una diferencia significativa en las categorías de "lesiones autoinflingidas" (χ2 (1)=11.0, p<0,05) y "cáncer" (χ2(1)= 4,1, p= 0,04). No se documentó diferencia en enfermedad cardiovascular (χ2(1)=0,3, p= 0,61), neumonía (χ2(1)=3,1, p= 0,07) y accidentes (χ2(1)= 2,0, p= 0,16). Conclusión: como se ha documentado en bibliografía internacional, las lesiones autoinfligidas son la causa de muerte de mayor importancia en la población afectada con trastorno afectivo bipolar.

Abstract Background: Bipolar disorder affects 1% to 2% of the world population. It has been described that it is accompanied by an increase in mortality from both violent and non-violent causes. Few studies have been published in our country about causes of death in this particular population. The objective of our study is to analyze the causes of death of subjects with bipolar disorder and compare them to healthy controls. Methods: From the pool of subjects with bipolar disorder previously recruited for genetic studies conducted at the Cellular and Molecular Biology Research Centre of the UCR, we recruited the 154 subjects who had died between 1993 and 2005. Controls of the same sex who were born and died in the same period as the subject, with a difference no greater than three months, were selected. For the statistical analysis we ran a Fisher's exact test with 1000 simulations of the p-value with Monte Carlo. Results: Of 154 subjects, 50% (n=77) were women. We found no difference in the cause of death between sexes among the cases. A significant difference in the main causes of death was found between cases and controls (p<0.05). A significant difference was observed in the categories of "self-inflicted lesions" (χ2 (1)=11.0, p<0.05) and "cancer" (χ2(1)= 4.1, p= 0.04). No difference was documented in cardiovascular disease, (χ2(1)=0.3, p= 0.61), pneumonia (χ2(1)=3.1, p= 0.07) nor accidents (χ2(1)= 2.0, p= 0.16). Conclusion: Self-inflicted lesions, as has been documented in international literature, are a cause of death of major importance in the population affected with bipolar disorder.

Enfermedad de Darier white: Reporte de caso y relación con enfermedades neuropsiquiátricas / Darier white disease: Case report and relationship with neuropsychiatric diseases

La enfermedad de Darier White es una enfermedad autosómica dominante, de penetrancia completa con expresividad variable que afecta al cromosoma 12q23-24.1. Se caracteriza por manifestaciones dermatológicas como: placas o pápulas no foliculares en zonas seborreicas, que tienen un olor característico. La presente investigación busca presentar reportes de casos de dos pacientes, en un Hospital Universitario en Bogotá-Colombia y la relación que existe con enfermedades psiquiátricas, tales como: trastorno afectivo bipolar y retraso mental. Se realizó una historia clínica y examen físico completo. Posteriormente, se firmó un consentimiento informado para toma de fotos y uso de las mismas, con fines educativos. Con estos elementos, se buscó información en las bases de datos más requeridas hoy en día, como: Pubmed, Science Direct, Embase y Scielo utilizando búsquedas con palabras claves, relacionando enfermedad de Darier White y enfermedades psiquiátricas en general. Consecutivamente, se buscó información de trastorno afectivo bipolar y retraso mental. En definitiva se enfocó cada uno de los casos descritos, como enfermedad de Darier con la asociación clínica de enfermedades psiquiátricas, en relación con el trastorno afectivo bipolar y retraso mental, con los que esta enfermedad muestra una relación estrecha.

Darier White or dyskeratosis follicularis disease is a genetic disorder of autosomal dominant trait, affecting chromosome 12q23-24.1. It starts at first or second decade of life, it is characterized by cutaneous manifestations due to several hyperkeratotic papules that affect seborrheic areas such as head, neck and thorax. This article seeks to present reports of cases of two patients in a Hospital in Bogotá-Colombia and their relationship with psychiatric illnesses such as bipolar affective disorder and mental retardation. A complete clinical history was made, the patients were examined, and informed consent was signed for taking pictures and using them for educational purposes. With this information, we proceeded to look for bibliography in the most recognized databases such as: Pubmed, Science Direct, Embase using advanced searches with key words, related words like Darier White disease and its relationship with psychiatric illnesses in general. Finally, each of the cases described as Darier's disease was approached with the clinical association of psychiatric illnesses such as bipolar affective disorder and mental retardation, with which this disease shows a close relationship in relation to the percentages of presentation.