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1.
Cell Rep Med ; 3(1): 100499, 2022 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-35106511

RESUMO

Borna disease virus 1 (BoDV-1) causes rare but often fatal encephalitis in humans. Late diagnosis prohibits an experimental therapeutic approach. Here, we report a recent case of fatal BoDV-1 infection diagnosed on day 12 after hospitalization by detection of BoDV-1 RNA in the cerebrospinal fluid. In a retrospective analysis, we detect BoDV-1 RNA 1 day after hospital admission when the cell count in the cerebrospinal fluid is still normal. We develop a new ELISA using recombinant BoDV-1 nucleoprotein, phosphoprotein, and accessory protein X to detect seroconversion on day 12. Antibody responses are also shown in seven previously confirmed cases. The individual BoDV-1 antibody profiles show variability, but the usage of three different BoDV-1 antigens results in a more sensitive diagnostic tool. Our findings demonstrate that early detection of BoDV-1 RNA in cerebrospinal fluid and the presence of antibodies against at least two different viral antigens contribute to BoDV-1 diagnosis. Physicians in endemic regions should consider BoDV-1 infection in cases of unclear encephalopathy and initiate appropriate diagnostics at an early stage.


Assuntos
Anticorpos/imunologia , Doença de Borna/diagnóstico , Doença de Borna/imunologia , Vírus da Doença de Borna/fisiologia , Nucleoproteínas/imunologia , Fosfoproteínas/imunologia , Proteínas Virais/imunologia , Idoso , Animais , Chlorocebus aethiops , Humanos , Proteínas Recombinantes/imunologia , Células Vero
2.
Emerg Microbes Infect ; 11(1): 6-13, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34783638

RESUMO

In 2021, three encephalitis cases due to the Borna disease virus 1 (BoDV-1) were diagnosed in the north and east of Germany. The patients were from the states of Thuringia, Saxony-Anhalt, and Lower Saxony. All were residents of known endemic areas for animal Borna disease but without prior diagnosed human cases. Except for one recently detected case in the state of Brandenburg, all >30 notified cases had occurred in, or were linked to, the southern state of Bavaria. Of the three detected cases described here, two infections were acute, while one infection was diagnosed retrospectively from archived brain autopsy tissue samples. One of the acute cases survived, but is permanently disabled. The cases were diagnosed by various techniques (serology, molecular assays, and immunohistology) following a validated testing scheme and adhering to a proposed case definition. Two cases were classified as confirmed BoDV-1 encephalitis, while one case was a probable infection with positive serology and typical brain magnetic resonance imaging, but without molecular confirmation. Of the three cases, one full virus genome sequence could be recovered. Our report highlights the need for awareness of a BoDV-1 etiology in cryptic encephalitis cases in all areas with known animal Borna disease endemicity in Europe, including virus-endemic regions in Austria, Liechtenstein, and Switzerland. BoDV-1 should be actively tested for in acute encephalitis cases with residence or rural exposure history in known Borna disease-endemic areas.


Assuntos
Doença de Borna/diagnóstico , Vírus da Doença de Borna/isolamento & purificação , Encefalite Viral/diagnóstico , Idoso , Animais , Doença de Borna/epidemiologia , Doença de Borna/patologia , Doença de Borna/virologia , Vírus da Doença de Borna/classificação , Vírus da Doença de Borna/genética , Encéfalo/patologia , Encéfalo/virologia , Encefalite Viral/epidemiologia , Encefalite Viral/patologia , Encefalite Viral/virologia , Doenças Endêmicas , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia
4.
J Feline Med Surg ; 17(7): 614-6, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26101313

RESUMO

OVERVIEW: Borna disease virus (BDV) has a broad host range, affecting primarily horses and sheep, but also cattle, ostriches, cats and dogs. In cats, BDV may cause a non-suppurative meningoencephalomyelitis ('staggering disease'). INFECTION: The mode of transmission is not completely elucidated. Direct and indirect virus transmission is postulated, but BDV is not readily transmitted between cats. Vectors such as ticks may play a role and shrews have been identified as a potential reservoir host. Access to forested areas has been reported to be an important risk factor for staggering disease. DISEASE SIGNS: It is postulated that BDV may infect nerve endings in the oropharynx and spread via olfactory nerve cells to the central nervous system. A strong T-cell response may contribute to the development of clinical disease. Affected cats develop gait disturbances, ataxia, pain in the lower back and behavioural changes. DIAGNOSIS: For diagnostic purposes, detection of viral RNA by reverse transcription PCR in samples collected from cats with clinical signs of Borna disease can be considered diagnostic. Serology is of little value; cats without signs of Borna disease may be seropositive and yet not every cat with BDV infection has detectable levels of antibodies. HUMAN INFECTION: A hypothesis that BDV infection may be involved in the development of selected neurological disorders in man could not be confirmed. A research group within the German Robert Koch Institute studied the potential health threat of BDV to humans and concluded that BDV was not involved in the aetiology of human psychiatric diseases.


Assuntos
Bem-Estar do Animal/normas , Doença de Borna/prevenção & controle , Vírus da Doença de Borna/isolamento & purificação , Doenças do Gato/prevenção & controle , Abrigo para Animais/normas , Zoonoses/virologia , Animais , Anticorpos Antivirais/sangue , Doença de Borna/diagnóstico , Doenças do Gato/diagnóstico , Doenças do Gato/virologia , Gatos , Humanos , Masculino , Guias de Prática Clínica como Assunto , Medicina Veterinária/normas
5.
Virol J ; 12: 39, 2015 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-25888756

RESUMO

BACKGROUND: Human Borna disease virus (BDV) infections have recently been reported in China. BDV causes cognitive and behavioural disturbances in animals. The impact on human mental disorders is subject to debate, but previous studies worldwide have found neuropsychiatric patients more frequently infected than healthy controls. A few isolates were recovered from severely depressed patients, but contagiousness of BDV strain remains unknown. METHOD: We addressed the risk of infection in health care settings at the first affiliated hospital of Chongqing Medical University (CQMU), located in downtown Chongqing, a megacity in Southwest China. Between February 2012 and March 2013, we enrolled 1529 participants, of whom 534 were outpatients with major depressive disorder (MDD), 615 were hospital personnel, and 380 were healthy controls who underwent a health check. Infection was determined through BDV-specific circulating immune complexes (CIC), RNA, and selective antibodies (blood). RESULTS: One-fifth of the hospital staff (21.8%) were found to be infected (CIC positive), with the highest prevalence among psychiatry and oncology personnel, which is twice as many as were detected in the healthy control group (11.1%), and exceeds the prevalence detected in MDD patients (18.2%). CONCLUSION: BDV circulates unnoticed in hospital settings in China, putting medical staff at risk and warranting clarification of infection modes and introduction of prevention measures.


Assuntos
Doença de Borna/virologia , Vírus da Doença de Borna/isolamento & purificação , Transtorno Depressivo Maior/virologia , Pessoal de Saúde/estatística & dados numéricos , Doenças Profissionais/virologia , Adolescente , Adulto , Idoso , Anticorpos Antivirais/sangue , Doença de Borna/sangue , Doença de Borna/diagnóstico , Doença de Borna/epidemiologia , Vírus da Doença de Borna/imunologia , Estudos de Casos e Controles , China/epidemiologia , Transtorno Depressivo Maior/sangue , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/sangue , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Exposição Ocupacional/estatística & dados numéricos , Adulto Jovem
6.
J Vet Diagn Invest ; 27(2): 150-8, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25701023

RESUMO

The present study compares diagnosis of avian Borna disease virus (ABV) infection of psittacine birds by Western blot of bornaviral proteins in dried feather stems with the detection of anti-bornaviral protein antibodies to bornaviral proteins in plasma by enzyme-linked immunosorbent assay (ELISA). The detection of ABV proteins P40 and P24 in feather calami by Western blotting was possible even after storage of the dried feathers for several years at ambient temperature. Serological identification of anti-bornaviral antibodies may fail (e.g., in young birds, hatched from infected parents), whereas bornaviral P40 and P24 proteins were detected in feather stems. This failure can last at least 10 months after the birds are hatched. In some older birds (>5 years), ABV protein was only detectable in the brain, but not in some peripheral tissues, suggesting that the immune system had succeeded in removing the infecting ABV from tissues outside the brain. These results show that a combination of feather stem analysis for the presence of bornaviral proteins by Western blot combined with serological detection of anti-bornaviral antibodies by ELISA is the most reliable procedure for the detection of a bornaviral infection.


Assuntos
Doenças das Aves/diagnóstico , Doença de Borna/diagnóstico , Vírus da Doença de Borna/isolamento & purificação , Psittaciformes , Animais , Anticorpos Antivirais/sangue , Vírus da Doença de Borna/genética , Calamus/virologia , Ensaio de Imunoadsorção Enzimática/veterinária , Plumas/virologia , Feminino , Masculino
7.
Virol J ; 11: 161, 2014 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-25186971

RESUMO

BACKGROUND: Borna disease virus (BDV) is an evolutionary old RNA virus, which infects brain and blood cells of humans, their primate ancestors, and other mammals. Human infection has been correlated to mood disorders and schizophrenia, but the impact of BDV on mental-health still remains controversial due to poor methodological and cross-national comparability. METHOD: This first report from the Middle East aimed to determine BDV infection prevalence in Iranian acute psychiatric disorder patients and healthy controls through circulating immune complexes (CIC), antibodies (Ab) and antigen (pAg) in blood plasma using a standardized triple enzyme immune assay (EIA). Samples of 314 subjects (114 psychiatric cases, 69 blood donors, and 131 healthy controls) were assayed and data analyzed quantitatively and qualitatively. RESULTS: CICs revealed a BDV prevalence of one third (29.5%) in healthy Iranian controls (27.5% controls; 33.3% blood donors). In psychiatric patients CIC prevalence was higher than in controls (40.4%) and significantly correlating with bipolar patients exhibiting overt clinical symptoms (p = 0.005, OR = 1.65). CIC values were significantly elevated in bipolar (p = 0.001) and major depressive disorder (p = 0.029) patients as compared to controls, and in females compared to males (p = 0.031). CONCLUSION: This study supports a similarly high prevalence of subclinical human BDV infections in Iran as reported for central Europe, and provides again an indication for the correlation of BDV infection and mood disorders. Further studies should address the morbidity risk for healthy carriers and those with elevated CIC levels, along with gender disparities.


Assuntos
Transtorno Bipolar/complicações , Doença de Borna/diagnóstico , Vírus da Doença de Borna/isolamento & purificação , Transtorno Depressivo Maior/complicações , Adolescente , Adulto , Idoso , Transtorno Bipolar/epidemiologia , Doadores de Sangue , Doença de Borna/epidemiologia , Doença de Borna/virologia , Estudos de Casos e Controles , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
8.
Arch Virol ; 159(8): 1941-9, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24573218

RESUMO

Borna disease virus (BDV) is a non-cytolytic, neurotropic RNA virus that can infect many vertebrate species, including humans. To date, BDV infection has been reported in a range of animal species across a broad global geographic distribution. However, a systematic epidemiological survey of BDV infection in domesticated animals in China has yet to be performed. In current study, BDV RNA and antibodies in 2353 blood samples from apparently healthy animals of eight species (horse, donkey, dog, pig, rabbit, cattle, goat, sheep) from three areas in western China (Xinjiang province, Chongqing municipality, and Ningxia province) were assayed using reverse transcription qPCR (RT-qPCR) and ELISA assay. Brain tissue samples from a portion of the BDV RNA- and/or antibody-positive animals were subjected to RT-qPCR and western blotting. As a result, varying prevalence of BDV antibodies and/or RNA was demonstrated in various animal species from three areas, ranging from 4.4 % to 20.0 %. Detection of BDV RNA and/or antibodies in Chongqing pigs (9.2 %) provided the first known evidence of BDV infection in this species. Not all brain tissue samples from animals whose blood was BDV RNA and/or antibody positive contained BDV RNA and protein. This study provides evidence that BDV infection among healthy domestic animal species is more widespread in western China than previously believed.


Assuntos
Animais Domésticos/virologia , Doença de Borna/virologia , Vírus da Doença de Borna/fisiologia , Animais , Anticorpos Antivirais/sangue , Doença de Borna/sangue , Doença de Borna/diagnóstico , Doença de Borna/epidemiologia , Vírus da Doença de Borna/genética , Vírus da Doença de Borna/imunologia , Vírus da Doença de Borna/isolamento & purificação , Bovinos , China/epidemiologia , Cães , Equidae , Cabras , Cavalos , Coelhos , Ovinos , Suínos
9.
Vet J ; 201(2): 142-9, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24480411

RESUMO

Bornaviruses are known to cause neurological disorders in a number of animal species. Avian Bornavirus (ABV) causes proventricular dilatation disease (PDD) in birds and Borna disease virus (BDV) causes Borna disease in horses and sheep. BDV also causes staggering disease in cats, characterised by ataxia, behavioural changes and loss of postural reactions. BDV-infection markers in cats have been reported throughout the world. This review summarizes the current knowledge of Borna disease viruses in cats, including etiological agent, clinical signs, pathogenesis, epidemiology and diagnostics, with comparisons to Bornavirus infections in other species.


Assuntos
Doença de Borna , Vírus da Doença de Borna/fisiologia , Doenças do Gato , Animais , Doença de Borna/diagnóstico , Doença de Borna/epidemiologia , Doença de Borna/terapia , Doença de Borna/virologia , Doenças do Gato/diagnóstico , Doenças do Gato/epidemiologia , Doenças do Gato/terapia , Doenças do Gato/virologia , Gatos
10.
J Feline Med Surg ; 14(8): 573-82, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22553310

RESUMO

Borna disease virus (BDV) is a RNA-virus causing neurological disorders in a wide range of mammals. In cats, BDV infection may cause staggering disease. Presently, staggering disease is a tentative clinical diagnosis, only confirmed at necropsy. In this study, cats with staggering disease were investigated to study markers of BDV infection aiming for improvement of current diagnostics. Nineteen cats fulfilled the inclusion criteria based on neurological signs and pathological findings. In 17/19 cats, BDV infection markers (BDV-specific antibodies and/or BDV-RNA) were found, and antibodies in serum (13/16, 81%) were the most common marker. BDV-RNA was found in 11/19 cats (58%). In a reference population without neurological signs, 4/25 cats were seropositive (16%). The clinical history and neurological signs in combination with presence of BDV infection markers, where serology and rRT-PCR on blood can be helpful tools, improve the diagnostic accuracy in the living cat.


Assuntos
Anticorpos Antivirais/sangue , Doença de Borna/diagnóstico , Doença de Borna/virologia , Vírus da Doença de Borna/isolamento & purificação , Doenças do Gato/diagnóstico , Doenças do Gato/virologia , Animais , Ataxia/veterinária , Ataxia/virologia , Biomarcadores/sangue , Doença de Borna/imunologia , Doenças do Gato/imunologia , Gatos , Feminino , Masculino , Paresia/veterinária , Paresia/virologia
11.
Virus Res ; 162(1-2): 162-72, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21968299

RESUMO

The occasion of Brian Mahy's retirement as editor of Virus Research provides an opportunity to reflect on the work that led one of the authors (Lipkin) to meet him shortly after the molecular discovery and characterization of Borna disease virus in the late 1980s, and work with authors Briese and Hornig to investigate mechanisms of pathogenesis and its potential role in human disease. This article reviews the history, molecular biology, epidemiology, and pathobiology of bornaviruses.


Assuntos
Doença de Borna/virologia , Vírus da Doença de Borna/genética , Encéfalo/virologia , Doenças dos Bovinos/virologia , Genoma Viral , Doenças dos Cavalos/virologia , Esquizofrenia/virologia , Doenças dos Ovinos/virologia , Animais , Doença de Borna/complicações , Doença de Borna/diagnóstico , Doença de Borna/epidemiologia , Doença de Borna/patologia , Encéfalo/patologia , Bovinos , Doenças dos Bovinos/diagnóstico , Doenças dos Bovinos/patologia , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/patologia , Cavalos , Humanos , RNA Viral/genética , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Esquizofrenia/etiologia , Esquizofrenia/patologia , Ovinos , Doenças dos Ovinos/diagnóstico , Doenças dos Ovinos/patologia , Estados Unidos/epidemiologia , Vírion/química , Vírion/genética , Replicação Viral
13.
J Comp Pathol ; 143(2-3): 203-8, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20153871

RESUMO

Borna disease (BD) was diagnosed in a 2-year-old male alpaca with a history of chronic suppressed sexual desire and acute stretching convulsions. Microscopical examination of the central nervous system revealed non-purulent meningoencephalitis with mononuclear perivascular cuffing. The diagnosis was confirmed by immunohistochemistry, in-situ hybridization, polymerase chain reaction (PCR) and sequencing of PCR products and alignment with known Borna disease virus sequences. Serological screening of the herd was performed. This is the first detailed report of naturally occurring BD in alpacas.


Assuntos
Doença de Borna/diagnóstico , Vírus da Doença de Borna/isolamento & purificação , Camelídeos Americanos/virologia , Animais , Doença de Borna/patologia , Vírus da Doença de Borna/genética , Vírus da Doença de Borna/imunologia , Encéfalo/patologia , Encéfalo/virologia , Evolução Fatal , Alemanha , Masculino , Meningoencefalite/patologia , RNA Viral/genética , Análise de Sequência de RNA
14.
Vet Microbiol ; 143(2-4): 196-201, 2010 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-20036080

RESUMO

Avian Borna virus (ABV) has recently been shown to be the causal agent of proventricular dilatation disease (PDD) a lethal neurologic disease of captive psittacines and other birds. An immunoblot assay was used to detect the presence of antibodies against avian Borna virus in the serum of affected birds. A lysate from ABV-infected duck embryo fibroblasts served as a source of antigen. The assay was used to test for the presence of antibodies to ABV in 117 birds. Thirty of these birds had biopsy or necropsy-confirmed proventricular dilatation disease (PDD), while the remaining 87 birds were apparently healthy or were suffering from diseases other than PDD. Sera from 27 of the 30 PDD cases (90%) contained antibodies to ABV. Seventy-three (84%) of the apparently "healthy" birds were seronegative. Additionally, sera from seven macaws and one parrot trapped in the Peruvian Amazon were seronegative. Positive sera recognized the bornaviral nucleoprotein (N-protein). While the presence of antibodies to ABV largely corresponded with the development of clinical PDD, 14 apparently healthy normal birds possessed detectable antibodies to ABV. The existence of a carrier state was confirmed when 13 of 15 apparently healthy cockatiels were shown by PCR to have detectable ABV RNA in their feces. Western blot assays may be of significant assistance in diagnosing proventricular dilatation disease. Many apparently healthy birds may however be seronegative while, at the same time, shedding ABV in their feces.


Assuntos
Anticorpos Antivirais/sangue , Western Blotting/veterinária , Doença de Borna/diagnóstico , Vírus da Doença de Borna/imunologia , Psittaciformes , Animais , Doenças das Aves/sangue , Doenças das Aves/imunologia , Doenças das Aves/virologia , Doença de Borna/sangue , Sensibilidade e Especificidade , Testes Sorológicos/veterinária
15.
J Vet Med Sci ; 71(8): 1009-15, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19721351

RESUMO

We have examined the seroprevalence of BDV in wild Raccoons (Procyon lotor) in Hokkaido, Japan. Serum samples from raccoons were examined using ELISA and Western blot assays to detect the presence of serum antibodies that react specifically to BDV antigens. Among 549 investigated individuals, eleven (2.0%) showed a positive reaction to BDV antigens. Brain tissue samples from five individuals were subjected to RT-PCR, which detected BDV sequences in three of them. Sequence analysis revealed a high degree of genetic conservation between BDV sequences derived from raccoons and previously published sequences derived from other animal species.


Assuntos
Vírus da Doença de Borna/isolamento & purificação , Guaxinins/virologia , Animais , Anticorpos Antivirais/sangue , Doença de Borna/diagnóstico , Doença de Borna/epidemiologia , Vírus da Doença de Borna/genética , Encéfalo/virologia , Primers do DNA , Feminino , Japão , Masculino , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Estudos Soroepidemiológicos
18.
APMIS Suppl ; (124): 40-3, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18771095

RESUMO

Borna Disease Virus (BDV) is a unique RNA virus, whose organs of manifestation are the brain and blood of animals as well as humans. The infection disrupts certain cell functions, but does not damage the cell structure. The infection with BDV can exist without associated clinical symptoms. Furthermore the majority of natural BDV-infections occur unnoticed without causing symptoms particularly those in connection with only a slight BDV-infection. BDV-infected horses can be detected by an extremely practicable ELISA based on blood samples and developed by the Berlin Working Group under guidance of Ludwig and Bode. All three serological Borna-Disease (BD) parameters antigen-, immune complex- and antibody-titer can be measured with this ELISA. However a single testing can not lead to a final evaluation of the infection so that progressive investigations are unavoidable. Blood tests in intervals of 4-6 weeks show the course of infection and help to adjust the specific treatment. After an infection an examination of the antigen- and immune complex-titer will show whether this occurrence is acute and activated or not. Therefore we examined 3481 blood samples of different horses by ELISA. 1841 (50%) were BDV-infected. Approximately 40% of the infected horses were clinically healthy and approximately 43% were clinically ill. The relatively high infection rate could be justified by the fact that these subjects had more or less direct contact with clinically ill horses. Furthermore, it is possible that the highly Borna positive, but not clinically ill horses were tested shortly before the symptoms of disease would appear. Moreover there were also horses that have had a high BDV-titer without showing any sign of the BDV-disease. These animals were thus able to live with the infection. Our investigations focused on highly seropositive BDV-infected horses (1) (Fig. 1). The results can not be linked to BD typical endemic regions due to the fact of today's far more sophisticated testing methods. Horses are more than ever used for leisure activity and become subjects to a worldwide marketing and movement. Any stress situation, especially in competitions as shown in long-term monitoring of sick horses, leads to worsening of symptoms. In this context it should be noted that a test for activated BDV-infection is still not common. EU-wide regulations should therefore be considered.


Assuntos
Amantadina/uso terapêutico , Antivirais/uso terapêutico , Doença de Borna/diagnóstico , Doença de Borna/tratamento farmacológico , Vírus da Doença de Borna/imunologia , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/tratamento farmacológico , Animais , Anticorpos Antivirais/sangue , Complexo Antígeno-Anticorpo/sangue , Antígenos Virais/sangue , Doença de Borna/sangue , Portador Sadio , Diagnóstico Diferencial , Ensaio de Imunoadsorção Enzimática , Alemanha , Doenças dos Cavalos/sangue , Cavalos
20.
APMIS Suppl ; (124): 66-9, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18771102

RESUMO

A description of Bipolar Disorder and its treatment costs. The prevalence of various psychiatric disorders in the United States in which Borna Disease Virus (BDV) may play a role. My personal history of Bipolar Disorder including: diagnoses and treatment of Borna Disease Virus infection.


Assuntos
Amantadina/uso terapêutico , Transtorno Bipolar/complicações , Transtorno Bipolar/tratamento farmacológico , Doença de Borna/complicações , Doença de Borna/tratamento farmacológico , Adulto , Amantadina/administração & dosagem , Antidepressivos/uso terapêutico , Transtorno Bipolar/diagnóstico , Doença de Borna/diagnóstico , Esquema de Medicação , Quimioterapia Combinada , Cloridrato de Duloxetina , Humanos , Masculino , Anamnese , Tiofenos/uso terapêutico , Estados Unidos
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