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Register for the International Review of Psychosis and Bipolarity Conference

International Review of Psychosis & Bipolarity

Athens, Greece, 9-12 May 2014


Chair: Prof Konstantinos Fountoulakis

Co-Sponsored Scientific Meeting by the World Psychiatric Association  International Society of Neurobiology and Psychopharmacology  Hellenic Psychiatric Association
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Important Deadlines

Early Registration 1
31 December 2013

Oral Presentation Submissions
7th February 2014

Oral Presentation Approvals
23 February 2014

Early Registration 2
1st March 2014

Bursary Requests
7 March 2014

Bursary Approvals
21 March 2014

Final Posters
23 April 2014

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Most Recent Articles Published on Psychosis and Bipolarity:

Related Articles

Lung adenocarcinoma: a new bipolar masquerader.

BMJ Case Rep. 2013;2013

Authors: Alchakaki A, Kabach M, Alraiyes AH, Alraies MC

PMID: 24049089 [PubMed - indexed for MEDLINE]



Related Articles

Bipolar disorder, not so rare diagnosis: subtypes of different degrees of severity, diagnosis, therapy.

Rev Med Chir Soc Med Nat Iasi. 2014 Jan-Mar;118(1):111-5

Authors: Amih?esei IC

Abstract
Bipolar disorder is manifesting as a mood disorder, typically showing episodes of mania, alternating with depressive episodes. The subtypes are including bipolar I disorder (one or several manic episodes) and bipolar II disorder (hypomanic episodes and one or several major depressive episodes). Nevertheless, sub-threshold diagnosis criteria may include another 5.1, up to 6.4% of the population as having a bipolar spectrum disorder diagnosis. Anyone who received the diagnosis is not considered cured afterwards (just in remission). Diagnosis is considering the symptoms of mania, hypomania and depression. Therapy is based on lithium, anticonvulsants, for the manic symptoms, lamotrigine for the depressive episodes and antipsychotics. Under medication, most of the affected subjects are living a normal life; to a certain degree, medication may also prevent the relapses.

PMID: 24741786 [PubMed - in process]



Related Articles

Psychosocial Functioning in Depressive Patients: A Comparative Study between Major Depressive Disorder and Bipolar Affective Disorder.

Depress Res Treat. 2014;2014:302741

Authors: Mehta S, Mittal PK, Swami MK

Abstract
Introduction. Major depressive disorder (MDD) and bipolar affective disorder (BAD) are among the leading causes of disability. These are often associated with widespread impairments in all domains of functioning including relational, occupational, and social. The main aim of the study was to examine and compare nature and extent of psychosocial impairment of patients with MDD and BAD during depressive phase. Methodology. 96 patients (48 in MDD group and 48 in BAD group) were included in the study. Patients were recruited in depressive phase (moderate to severe depression). Patients having age outside 18-45 years, psychotic symptoms, mental retardation, and current comorbid medical or axis-1 psychiatric disorder were excluded. Psychosocial functioning was assessed using Range of Impaired Functioning Tool (LIFE-RIFT). Results. Domains of work, interpersonal relationship, life satisfaction, and recreation were all affected in both groups, but the groups showed significant difference in global psychosocial functioning score only (P = 0.031) with BAD group showing more severe impairment. Conclusion. Bipolar depression causes higher global psychosocial impairment than unipolar depression.

PMID: 24744917 [PubMed]



Related Articles

Distinctive trajectory groups of mental health functioning among assertive community treatment clients: an application of growth mixture modelling analysis.

Can J Psychiatry. 2013 Dec;58(12):670-8

Authors: Wilk P, Vingilis E, Bishop JE, He W, Braun J, Forchuk C, Seeley J, Mitchell B

Abstract
OBJECTIVE: Assertive community treatment (ACT) studies that have used conventional, statistical growth modelling methods have not examined different trajectories of outcomes or covariates that could influence different trajectories, even though heterogeneity in outcomes has been established in other research on severe mental illness. The purpose of our study was to examine the general trend in mental health functioning of ACT clients over a 2-year follow-up time period, to discover groups of ACT clients with distinctive longitudinal trajectories of mental health functioning, and to examine if some of the key sociodemographic and illness-related factors influence group membership.
METHOD: A 2-year, prospective, within-subjects study of 216 ACT clients within southern Ontario, collected functional outcome data at baseline and 12 and 24 months using the Colorado Client Assessment Record. Baseline covariates included sex, primary diagnosis, number of comorbidities, hospitalization history, and duration of illness. Growth mixture modelling (GMM) was used to examine trajectories.
RESULTS: Clinical staff assessments of ACT clients showed a statistically significant improvement in functioning and 84% achieved successful community tenure. GMM analysis identified 2 classes of ACT clients: class 1 (79.63% of clients) experienced lower and stable overall functioning, and class 2 (20.37%) showed a better baseline functioning score and improvement in the overall functioning over time. Class membership was predicted by the number of comorbidities and diagnosis.
CONCLUSIONS: Our study suggests general stability in overall functioning for the sampled ACT clients over 2 years, but significant heterogeneity in trajectories of functioning.

PMID: 24331286 [PubMed - indexed for MEDLINE]



Related Articles

Changes in mindfulness following repetitive transcranial magnetic stimulation for mood disorders.

Can J Psychiatry. 2013 Dec;58(12):687-91

Authors: Leong K, Chan P, Grabovac A, Wilkins-Ho M, Perri M

Abstract
OBJECTIVE: Mindfulness practices are associated with changes in different cortical regions, including the dorsolateral prefrontal cortices (DLPFCs). Our study sought to examine how an index course of repetitive transcranial magnetic stimulation (rTMS) over the DLPFC improved components of mindfulness as assessed by Baer's Five Facet Mindfulness Questionnaire (FFMQ) and the Experience Questionnaire (EQ).
METHOD: Our preliminary study is a retrospective chart review of 32 patients who had undergone an index course of rTMS for major depressive episode between 2009 and 2012. The following information was collected prior to rTMS: patient demographics, diagnosis, and age of onset of primary diagnosis. The following information was collected prior to and after rTMS: 21-item Hamilton Rating Scale for Depression (HRSD) scores, Patient-Health Questionnaire (PHQ-9) scores, Generalized Anxiety Disorder 7-item (GAD-7) scale scores, FFMQ scores, and EQ scores.
RESULTS: Following rTMS, results showed statistically significant decreases in HRSD, PHQ-9, and GAD-7 scores. There was significant improvement in the nonreactivity to inner experience subscale of the BFFMQ and in the decentring subscale of the EQ. Subgroup analysis between patients who did not improve on the HRSD by 50% or more following rTMS and those who did revealed no baseline difference in mindfulness. There was significant improvement in the decentring subscale of the EQ in both subgroups.
CONCLUSIONS: Our study provides preliminary data that rTMS may be associated with improvement in some components of mindfulness, independently of changes in depression.

PMID: 24331288 [PubMed - indexed for MEDLINE]



Formulary restrictions on atypical antipsychotics: impact on costs for patients with schizophrenia and bipolar disorder in Medicaid.

Am J Manag Care. 2014;20(2):e52-60

Authors: Seabury SA, Goldman DP, Kalsekar I, Sheehan JJ, Laubmeier K, Lakdawalla DN

Abstract
Objectives: To measure the impact of state Medicaid formulary policies on costs for patients with schizophrenia and bipolar disorder. Study Design: Retrospective analysis of medical and pharmacy claims for patients diagnosed with schizophrenia or bipolar disorder in 24 state Medicaid programs. Methods: We combined information on formulary restrictions in Medicaid with the medical and pharmacy claims of 117,908 patients with schizophrenia and 170,596 patients with bipolar disorder in Medicaid who were single-eligible, and newly prescribed a second-generation antipsychotic from 2001 to 2008. We tested the impact of formulary restrictions on the medical costs and utilization of patients in the 12 months after the index prescription. To capture social costs in addition to medical expenditures in Medicaid, we estimated the incremental costs of incarcerating patients with schizophrenia and bipolar disorder associated with formulary restrictions. Results: Patients with schizophrenia subject to formulary restrictions were more likely to be hospitalized (odds ratio 1.13, P <.001), had 23% higher inpatient costs (P <.001), and 16% higher total costs (P <.001). Similar effects were observed for patients with bipolar disorder. Our estimates suggest restrictive formulary policies in Medicaid increased the number of prisoners by 9920 and incarceration costs by $362 million nationwide in 2008. Conclusions: Applying formulary restrictions to atypical antipsychotics is associated with higher total medical expenditures for patients with schizophrenia and bipolar disorder in Medicaid. Combined with the other social costs such as an increase in incarceration rates, these formulary restrictions could increase state costs by $1 billion annually, enough to offset any savings in pharmacy costs.

PMID: 24738555 [PubMed - in process]



Lithium and autophagy.

ACS Chem Neurosci. 2014 Apr 16;

Authors: Motoi Y, Shimada K, Ishiguro K, Hattori N

Abstract
Lithium, a drug used to treat bipolar disorders, has a variety of neuroprotective mechanisms, including autophagy regulation, in various neuropsychiatric conditions. In neurodegenerative diseases, lithium enhances aggregate-prone protein, including mutated huntingtin, phosphorylated tau, and ?-synuclein, and causes damaged mitochondria to degrade, while in a mouse model of cerebral ischemia and Alzheimer's disease, autophagy downregulation by lithium is observed. The signaling pathway of lithium as an autophagy enhancer might be associated with the mammalian target of rapamycin (mTOR)-independent pathway, which is involved in myo-inositol-1,4,5-triphosphate (IP3) in Huntington's disease and Parkinson's disease. However, the mTOR-dependent pathway might be involved in inhibiting glycogen synthase kinase-3?(GSK-3?) in other diseases. Lithium's autophagy-enhancing property may contribute to the therapeutic benefit of patients with neuropsychiatric disorders.

PMID: 24738557 [PubMed - as supplied by publisher]



Cannabis use in first-treatment bipolar I disorder: relations to clinical characteristics.

Early Interv Psychiatry. 2014 Apr 17;

Authors: Kvitland LR, Melle I, Aminoff SR, Lagerberg TV, Andreassen OA, Ringen PA

Abstract
AIMS: The aim of this study was to investigate the associations between recent cannabis use, current symptomatology and age at onset of first manic, depressive and psychotic episodes in a large sample with first-treatment bipolar I disorder (BD I).
METHODS: One hundred one patients with first-treatment Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) bipolar I disorder were included as part of the Thematically Organized Psychosis study. The Structural Clinical Interview for DSM-IV was used for DSM-IV diagnosis and identification of episodes of illness. Earlier suicide attempts were recorded. Manic, depressive and psychotic symptoms were rated using the Young Mania Rating Scale, Inventory of Depressive Symptoms and Positive and Negative Syndrome Scale correspondingly. Cannabis use within the six last months was recorded.
RESULTS: After controlling for confounders, recent cannabis use was significantly associated with lower age at onset of first manic and psychotic episode, but not with onset of first depressive episode (both P?<?0.05). Recent use was also associated with more lifetime suicide attempts (P?<?0.01). No group differences were found on symptom levels.
CONCLUSIONS: The present study confirms earlier findings of an association between cannabis use and a lower age at onset. Recent cannabis use was also associated with more lifetime suicide attempts. The current findings suggest that recent cannabis use is associated with a more severe course of illness in the early phase of BD I.

PMID: 24739233 [PubMed - as supplied by publisher]



Reliability and Validity the Brief Problem Monitor, an Abbreviated Form of the Child Behavior Checklist.

Psychiatry Clin Neurosci. 2014 Apr 16;

Authors: Piper BJ, Gray HM, Raber J, Birkett MA

Abstract
AIM: The parent form of the 113 item Child Behavior Checklist (CBCL) is widely utilized by child psychiatrists and psychologists. This report examines the reliability and validity of a recently developed abbreviated version of the CBCL, the Brief Problem Monitor (BPM).
METHODS: Caregivers (N=567) completed the CBCL online and the 19 BPM items were examined separately.
RESULTS: Internal consistency of the BPM was high (Cronbach's alpha=0.91) and satisfactory for the Internalizing (0.78), Externalizing (0.86), and Attention (0.87) scales. High correlations between the CBCL and BPM were identified for the total score (r=0.95) as well as the Internalizing (0.86), Externalizing (0.93), and Attention (0.97) scales. The BPM and scales were sensitive and identified significantly higher behavioral and emotional problems among children whose caregiver reported a psychiatric diagnosis of Attention Deficit Hyperactivity Disorder, bipolar, depression, anxiety, developmental disabilities, or Autism Spectrum Disorders relative to a comparison group that had not been diagnosed with these disorders. BPM ratings also differed by the socioeconomic status and education of the caregiver. Mothers with higher annual incomes rated their children as having 38.8% fewer total problems (Cohen's d=0.62) as well as 42.8% lower Internalizing (d=0.53), 44.1% less Externalizing (d=0.62), and 30.9% decreased Attention (d=0.39). A similar pattern was evident for maternal education (d=0.30 to 0.65).
CONCLUSION: Overall, these findings provide strong psychometric support for the BPM although the differences based on the characteristics of the parent indicates that additional information from other sources (e.g., teachers) should be obtained to complement parental reports.

PMID: 24735087 [PubMed - as supplied by publisher]



A comparison of decision making in patients with bipolar i disorder and schizophrenia.

Schizophr Res. 2014 Apr 12;

Authors: Martino DJ, Strejilevich SA

PMID: 24735784 [PubMed - as supplied by publisher]



Disturbance of the Glutamatergic System in Mood Disorders.

Exp Neurobiol. 2014 Mar;23(1):28-35

Authors: Jun C, Choi Y, Lim SM, Bae S, Hong YS, Kim JE, Lyoo IK

Abstract
The role of glutamatergic system in the neurobiology of mood disorders draws increasing attention, as disturbance of this system is consistently implicated in mood disorders including major depressive disorder and bipolar disorder. Thus, the glutamate hypothesis of mood disorders is expected to complement and improve the prevailing monoamine hypothesis, and may indicate novel therapeutic targets. Since the contribution of astrocytes is found to be crucial not only in the modulation of the glutamatergic system but also in the maintenance of brain energy metabolism, alterations in the astrocytic function and neuroenergetic environment are suggested as the potential neurobiological underpinnings of mood disorders. In the present review, the evidence of glutamatergic abnormalities in mood disorders based on postmortem and magnetic resonance spectroscopy (MRS) studies is presented, and disrupted energy metabolism involving astrocytic dysfunction is proposed as the underlying mechanism linking altered energy metabolism, perturbations in the glutamatergic system, and pathogenesis of mood disorders.

PMID: 24737937 [PubMed - as supplied by publisher]



Abnormal Early Gamma Responses to Emotional Faces Differentiate Unipolar from Bipolar Disorder Patients.

Biomed Res Int. 2014;2014:906104

Authors: Liu TY, Chen YS, Su TP, Hsieh JC, Chen LF

Abstract
This study investigates the cortical abnormalities of early emotion perception in patients with major depressive disorder (MDD) and bipolar disorder (BD) using gamma oscillations. Twenty-three MDD patients, twenty-five BD patients, and twenty-four normal controls were enrolled and their event-related magnetoencephalographic responses were recorded during implicit emotional tasks. Our results demonstrated abnormal gamma activity within 100?ms in the emotion-related regions (amygdala, orbitofrontal (OFC) cortex, anterior insula (AI), and superior temporal pole) in the MDD patients, suggesting that these patients may have dysfunctions or negativity biases in perceptual binding of emotional features at very early stage. Decreased left superior medial frontal cortex (smFC) responses to happy faces in the MDD patients were correlated with their serious level of depression symptoms, indicating that decreased smFC activity perhaps underlies irregular positive emotion processing in depressed patients. In the BD patients, we showed abnormal activation in visual regions (inferior/middle occipital and middle temporal cortices) which responded to emotional faces within 100?ms, supporting that the BD patients may hyperactively respond to emotional features in perceptual binding. The discriminant function of gamma activation in the left smFC, right medial OFC, right AI/inferior OFC, and the right precentral cortex accurately classified 89.6% of patients as unipolar/bipolar disorders.

PMID: 24738077 [PubMed - as supplied by publisher]



Related Articles

A qualitative study of undergraduates' conceptualizations of mental illness.

J Prev Interv Community. 2013;41(4):231-43

Authors: Matteo E

Abstract
This qualitative study examined three stigma reduction interventions against mental illness stigma: education, video, and contact. Undergraduates (N = 69) in three introductory psychology classes from a small, Catholic, liberal arts university in the northeast United States participated. Responses to two open-ended questions revealed common negative and stereotypical themes associated with mental illness. The benefits of supplementing traditional social distance measures with a qualitative approach, as well as the importance of considering a social developmental approach to stigma education are discussed.

PMID: 24010560 [PubMed - indexed for MEDLINE]



How often and how consistently do symptoms directly precede criminal behavior among offenders with mental illness?

Law Hum Behav. 2014 Apr 14;

Authors: Peterson JK, Skeem J, Kennealy P, Bray B, Zvonkovic A

Abstract
Although offenders with mental illness are overrepresented in the criminal justice system, psychiatric symptoms relate weakly to criminal behavior at the group level. In this study of 143 offenders with mental illness, we use data from intensive interviews and record reviews to examine how often and how consistently symptoms lead directly to criminal behavior. First, crimes rarely were directly motivated by symptoms, particularly when the definition of symptoms excluded externalizing features that are not unique to Axis I illness. Specifically, of the 429 crimes coded, 4% related directly to psychosis, 3% related directly to depression, and 10% related directly to bipolar disorder (including impulsivity). Second, within offenders, crimes varied in the degree to which they were directly motivated by symptoms. These findings suggest that programs will be most effective in reducing recidivism if they expand beyond psychiatric symptoms to address strong variable risk factors for crime like antisocial traits. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

PMID: 24730388 [PubMed - as supplied by publisher]



Long-term lithium treatment reduces glucose metabolism in the cerebellum and hippocampus of non-demented older adults: an [18F]FDG-PET study.

ACS Chem Neurosci. 2014 Apr 14;

Authors: Forlenza OV, Coutinho AM, Aprahamian I, Prando S, Mendes LL, Diniz BS, Gattaz WF, Buchpiguel CA

Abstract
Lithium modulates several intracellular pathways related to neuroplasticity and resilience against neuronal injury. These properties have been consistently reported in experimental models, and involve the up-regulation of neurotrophic response and autophagy, and down-regulation of apoptosis, oxidative stress and inflammation. Clinical and epidemiological studies in bipolar disorder show that acute treatment with lithium increases plasma concentrations of brain-derived neurotrophic factor, and long term treatment lowers the risk of dementia. Neuroimaging studies indicate that lithium use is further associated with increased cortical thickness and larger hippocampal volumes. The objective of the present study was to evaluate whether these neurobiological properties of lithium reflect in increased regional brain glucose metabolism, as shown by [18F]FDG-PET. Participants (n=19) were non-demented older adults recruited at the endpoint of controlled trial addressing clinical and biological effects of lithium in a sample of patients with amnestic mild cognitive impairment. Twelve patients who had received low-dose lithium carbonate for 4 years were compared to seven matched controls. Chronic lithium treatment was not associated with any significant increase in brain glucose metabolism in the studied areas. Conversely, we found a significant reduction in glucose uptake in several clusters of the cerebellum and the in both hippocampi. These findings were not associated with any clinical evidence of toxicity. The clinical implications of the present findings need to be clarified by future controlled studies, particularly in the light of the potential use of lithium as a disease-modifying treatment approach for certain neurodegenerative disorders, namely Alzheimer's disease and amyotrophic lateral sclerosis.

PMID: 24730717 [PubMed - as supplied by publisher]



Response inhibition and psychopathology: A meta-analysis of go/no-go task performance.

J Abnorm Psychol. 2014 Apr 14;

Authors: Wright L, Lipszyc J, Dupuis A, Thayapararajah SW, Schachar R

Abstract
Response inhibition, defined as the ability to withhold a response, is considered to be a core deficit in various mental illnesses. Measures of response inhibition have been used to define functional deficits, as markers of genetic risk, in neuroimaging studies, and for diagnostic purposes in these disorders. However, the magnitude of the deficit across psychopathologies has not been systematically assessed. We conducted a systematic review and meta-analysis of performance on commonly used measures of the ability to withhold a response: go/no-go task, Conners' continuous performance task (CCPT), and sustained attention to response task (SART). The primary variable of interest in each of these tasks was commission errors (CE), which provides an index of one's ability to correctly withhold a response. In addition, we examined omission errors (OE) which are an index of sustained attention; and mean reaction time (RT; MRT). Three-hundred and 18 studies in 11 different psychiatric disorders met inclusion criteria. Weighted mean effect sizes (ESs) were calculated to measure the magnitude of the deficit. In general, we found low-to-medium ESs for commission errors ranging from g = -0.10 for anxiety disorder to medium ESs of g = 0.52 for bipolar disorder. Small-to-medium deficits in withholding were found in various disorders. Results indicate that deficits in withholding are insufficiently sensitive or specific to be used individually as a diagnostic measure or biomarker in most disorders. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

PMID: 24731074 [PubMed - as supplied by publisher]



Leukocyte telomerase activity and antidepressant efficacy in bipolar disorder.

Eur Neuropsychopharmacol. 2014 Mar 27;

Authors: Soeiro-de-Souza MG, Teixeira AL, Mateo EC, Zanetti MV, Rodrigues FG, de Paula VJ, Bezerra JF, Moreno RA, Gattaz WF, Machado-Vieira R

Abstract
Telomeres are DNA-protein complexes that cap linear DNA strands, protecting DNA from damage. Recently, shorten telomeres length has been reported in bipolar disorder (BD) and depression. The enzyme telomerase regulates telomeres? length, which has been associated with cellular viability; however it is not clear how telomerase may be involved in the pathophysiology and therapeutics of BD. In the present study, leukocyte telomerase activity was assessed in 28 medication-free BD depressed individuals (DSM-IV-TR criteria) at baseline and after 6 weeks of lithium therapy (n=21) also matching with 23 healthy controls. There was no difference between telomerase activity in subjects with BD depression (before or after lithium) and controls. Improvement of depressive symptoms was negatively associated with telomerase activity after 6 weeks of lithium therapy. This is the first study describing telomerase activity in BD research. Overall, telomerase activity seems not directly involved in the pathophysiology of short-term BD. Lithium?s antidepressant effects may involve regulation at telomerase activity. Further studies with larger samples and long-term illness are also warranted.

PMID: 24731723 [PubMed - as supplied by publisher]



Associations of mental illness and substance use disorders with prescription contraception use among women veterans.

Contraception. 2014 Mar 6;

Authors: Callegari LS, Zhao X, Nelson KM, Lehavot K, Bradley KA, Borrero S

Abstract
OBJECTIVE: To investigate whether mental illness and substance use disorder (SUD) are associated with having a prescription contraceptive method among women veterans.
STUDY DESIGN: We conducted a retrospective analysis of National Veterans Administration (VA) administrative and clinical data for women veterans aged 18-45 years who made at least one primary care visit in 2008. We assessed associations between mental illness (depression, posttraumatic stress disorder, anxiety, bipolar disorder, schizophrenia and adjustment disorder) and SUD (drug/alcohol use disorder) with having a prescription contraceptive method from VA (pill, patch, ring, injection, implant and intrauterine device) using multivariable logistic regression with random effects for VA facility, adjusting for confounders.
RESULTS: Among 94,115 reproductive aged women, 36.5% had mental illness only, 0.6% had SUD only, 5.3% had both mental illness and SUD and 57.7% had neither diagnosis. In these groups, 22.1%, 14.6%, 18.2% and 17.7% (p<0.001), respectively, had documentation in 2008 of prescription contraception. After adjusting for potential confounders, women with mental illness only were as likely as women with neither diagnosis to have a prescription method and were more likely to use a highly effective prescription method (implant or intrauterine device) if using contraception [adjusted odds ratio (aOR) 1.17, 95% confidence interval (CI) = 1.08-1.27]. Women with SUD (with or without mental illness) were significantly less likely to have a prescription method than women with neither diagnosis (aOR 0.73, 95% CI = 0.57-0.95 and aOR 0.79, 95% CI = 0.73-0.86, respectively).
CONCLUSION: Women veterans with SUD are less likely to have prescription contraception compared to other women, which may increase their risk of unintended pregnancy.

PMID: 24731860 [PubMed - as supplied by publisher]



Bipolar Disorder in Primary Care: Clinical Characteristics of 740 Primary Care Patients With Bipolar Disorder.

Psychiatr Serv. 2014 Apr 15;

Authors: Cerimele JM, Chan YF, Chwastiak LA, Avery M, Katon W, Unützer J

Abstract
OBJECTIVE This study aimed to describe the characteristics of primary care patients with bipolar disorder enrolled in a statewide mental health integration program (MHIP). METHODS With the Composite International Diagnostic Interview (Version 3.0) and clinician diagnosis, 740 primary care patients with bipolar disorder were identified in Washington State between January 2008 and December 2011. Clinical rating scales were administered to patients at the time of enrollment and during treatment. Quality-of-care outcomes were obtained from a systematic review of the patient disease registry and compared with a previous study of patients with depressive symptoms in an MHIP. Descriptive analysis techniques were used to describe patients' clinical characteristics. RESULTS Primary care patients with bipolar disorder had high symptom severity on depression and anxiety measures: Patient Health Questionaire-9 (mean±SD score of 18.1±5.9 out of 27) and the seven-item Generalized Anxiety Disorder scale (15.7±4.7 out of 21). Psychosocial problems were common, with approximately 53% reporting concerns about housing, 15% reporting homelessness, and 22% reporting lack of a support person. Only 26% of patients were referred to specialty mental health treatment. Patients with bipolar disorder had a greater amount of contact with clinicians during treatment compared with patients with depressive symptoms from a prior study. CONCLUSIONS Primary care patients with bipolar disorder enrolled in MHIP had severe depression, symptoms of comorbid psychiatric illnesses, and multiple psychosocial problems. Patients with bipolar disorder received more intensive care compared with patients with depressive symptoms from a prior study. Referral to a community mental health center occurred infrequently even though most patients had persistent symptoms.

PMID: 24733084 [PubMed - as supplied by publisher]



Veterans' Perceptions of Behavioral Health Care in the Veterans Health Administration: A National Survey.

Psychiatr Serv. 2014 Apr 15;

Authors: Hepner KA, Paddock SM, Watkins KE, Solomon J, Blonigen DM, Pincus HA

Abstract
OBJECTIVE This study provided national estimates of perceptions of behavioral health care services among patients of the Veterans Health Administration (VHA) with a diagnosis of bipolar I disorder, major depression, posttraumatic stress disorder, schizophrenia, or substance use disorder. METHODS A stratified random sample of 6,190 patients completed telephone interviews from November 2008 through August 2009. Patients (N=5,185) who reported receiving VHA behavioral health care in the prior 12 months were asked about their need for housing and employment services, timeliness and recovery orientation of their care, satisfaction with care, and perceived improvement. RESULTS Half of patients reported always receiving routine appointments as soon as requested, and 42% were highly satisfied with their VHA mental health care. Approximately 74% of patients reported being helped by the treatment they received, yet only 32% reported that their symptoms had improved. After controlling for covariates, the analyses showed that patients with a substance use disorder reported lower satisfaction with care and perceived their treatment to be less helpful compared with patients without a substance use disorder. CONCLUSIONS Although matched sample comparison data were not available, the results showed that overall patient perceptions of VHA mental health care were favorable, but there was significant room for improvement across all areas of assessment. A majority reported being helped by treatment, but few reported symptom improvement. Variations in perceptions among patients with different disorders suggest the potential importance of psychiatric diagnosis, particularly substance use disorder, in assessing patient perceptions of care.

PMID: 24733444 [PubMed - as supplied by publisher]



Adolescent Risperidone treatment alters protein expression associated with protein trafficking and cellular metabolism in the adult rat prefrontal cortex.

Proteomics. 2014 Apr 14;

Authors: Farrelly LA, Dicker P, Wynne K, English J, Cagney G, Föcking M, Cotter DR

Abstract
The prefrontal cortex is associated with mental health illnesses including schizophrenia, depression, bipolar disorder and autism spectrum disorders. It richly expresses neuroreceptors which are the target for antipsychotics. However as the precise mechanism of action of antipsychotic medications are not known, proteomic studies of the effects of antipsychotic drugs on the brain are warranted. In the current study we aimed to characterise protein expression in the adult rodent prefrontal cortex (n = 5 per group) following low dose treatment with Risperidone or saline in adolescence (postnatal-days 34-47). The prefrontal cortex was examined by triplicate one hour runs of label-free LC-MS/MS. The raw mass spectral data were analyzed with the MaxQuant(TM) software. Statistical analysis was carried out using SAS® Version 9.1. Pathway and functional analysis was performed with IngenuityPathway Analysis and in the Database for Annotation, Visualization and Integrated Discovery (DAVID) respectively, the most implicated pathways were found to be related to mitochondrial function, protein-trafficking and the cytoskeleton. This report adds to the current repertoire of data available concerning the effects of antipsychotic drugs on the brain and sheds light on their biological mechanisms. The mass spectrometry data has been deposited with the ProteomeXchange Consortium with dataset identifier PXD000480. This article is protected by copyright. All rights reserved.

PMID: 24733778 [PubMed - as supplied by publisher]



Clinical Reasoning: Acute-onset homonymous hemianopia with hyperglycemia: Seeing is believing.

Neurology. 2014 Apr 15;82(15):e129-33

Authors: Strowd RE, Wabnitz A, Balakrishnan N, Craig J, Tegeler CH

Abstract
A 32-year-old woman with a history of bipolar disorder, polycystic ovarian syndrome, and hypertension and a 4-year history of uncontrolled type 2 diabetes mellitus (DM) presented with bifrontal headache, elevated blood sugars (>500 mg/dL), and abrupt-onset left homonymous hemianopia upon awakening. Vital signs included temperature 98.0°F, blood pressure 160/89 mm Hg, and heart rate 67 bpm. Neurologic examination showed dense left homonymous hemianopia with macular sparing and without other focal findings.

PMID: 24733863 [PubMed - in process]



Related Articles

Test-retest stability of the Onset of Depression Inventory.

Psychopathology. 2014;47(1):45-50

Authors: Strauss M, Mergl R, Sander C, Doehring C, Schönknecht P, Angst J, Hegerl U

Abstract
BACKGROUND: The 'Onset of Depression Inventory' (ODI) is a patient interview developed for systematically registering the speed of onset of depression. The ODI might contribute to the detection of hidden bipolarity because in previous studies a more rapid depression onset was found in patients with bipolar compared to unipolar depression. The aim of this study was to evaluate the test-retest stability of the ODI. Patients were asked concerning the speed of onset at the time of hospitalization and again before discharge.
SAMPLING AND METHODS: Test-retest stability of the ODI was investigated in 37 patients with a depressive episode. Each patient was interviewed concerning his present depressive episode by the same person at two different time points. Severity of depression at the different time points was assessed using the Hamilton Depression Rating Scale (HAMD-17) and the Inventory of Depressive Symptomatology (IDS-C).
RESULTS: The speed of onset as assessed with the ODI showed good test-retest stability (rho = 0.83, p < 0.001). This parameter was not influenced by changes in depression severity.
CONCLUSIONS: The ODI allows reliable assessment of the speed of onset of depressive episodes. The instrument might be useful for the detection of hidden bipolarity.

PMID: 23548734 [PubMed - indexed for MEDLINE]



A psychometric evaluation of the Swedish version of the Responses to Positive Affect questionnaire.

Nord J Psychiatry. 2014 Apr 14;

Authors: Olofsson ME, Boersma K, Engh J, Wurm M

Abstract
Background: Previous research mainly focused on responses to negative affect in relation to depression, and less on responses to positive affect. Cognitive responses to positive affect are interesting in the context of emotion regulation and emotion disorders: positive rumination is associated to hypomania risk and bipolar disorder. There is to date no questionnaire in Swedish that captures the phenomena of cognitive response styles. Aims: The aim of this study was to investigate the replicability of the Responses to Positive Affect questionnaire (RPA) in a newly translated Swedish version and to test its psychometric properties. Methods: Swedish undergraduates (n = 111) completed a set of self-report questionnaires in a fixed order. Results: The hypothesized three-factor model was largely replicated in the subscales Self-focused positive rumination, Emotion-focused positive rumination and Dampening. The two positive rumination subscales were strongly associated with each other and current positive affect. The subscales showed acceptable convergent and incremental validity with concurrent measures of depression, hypomania, anxiety, repetitive negative thinking, and positive and negative affect. The model explained 25% of the variance in hypomania, but fell short in the explanation of depression. Conclusions: The Swedish version of the RPA shows satisfactory reliability and initial findings from a student sample indicate that it is a valid measure comparable with the original RPA questionnaire. Results give emphasis to the importance of further exploration of cognitive response styles in relation to psychopathology.

PMID: 24724927 [PubMed - as supplied by publisher]



Association of obesity and treated hypertension and diabetes with cognitive ability in bipolar disorder and schizophrenia.

Bipolar Disord. 2014 Apr 12;

Authors: Depp CA, Strassnig M, Mausbach BT, Bowie CR, Wolyniec P, Thornquist MH, Luke JR, McGrath JA, Pulver AE, Patterson TL, Harvey PD

Abstract
OBJECTIVES: People with bipolar disorder or schizophrenia are at greater risk for obesity and other cardio-metabolic risk factors, and several prior studies have linked these risk factors to poorer cognitive ability. In a large ethnically homogenous outpatient sample, we examined associations among variables related to obesity, treated hypertension and/or diabetes and cognitive abilities in these two patient populations.
METHODS: In a study cohort of outpatients with either bipolar disorder (n = 341) or schizophrenia (n = 417), we investigated the association of self-reported body mass index and current use of medications for hypertension or diabetes with performance on a comprehensive neurocognitive battery. We examined sociodemographic and clinical factors as potential covariates.
RESULTS: Patients with bipolar disorder were less likely to be overweight or obese than patients with schizophrenia, and also less likely to be prescribed medication for hypertension or diabetes. However, obesity and treated hypertension were associated with worse global cognitive ability in bipolar disorder (as well as with poorer performance on individual tests of processing speed, reasoning/problem-solving, and sustained attention), with no such relationships observed in schizophrenia. Obesity was not associated with symptom severity in either group.
CONCLUSIONS: Although less prevalent in bipolar disorder compared to schizophrenia, obesity was associated with substantially worse cognitive performance in bipolar disorder. This association was independent of symptom severity and not present in schizophrenia. Better understanding of the mechanisms and management of obesity may aid in efforts to preserve cognitive health in bipolar disorder.

PMID: 24725166 [PubMed - as supplied by publisher]



Bipolar polygenic loading and bipolar spectrum features in major depressive disorder.

Bipolar Disord. 2014 Apr 12;

Authors: Wiste A, Robinson EB, Milaneschi Y, Meier S, Ripke S, Clements CC, Fitzmaurice GM, Rietschel M, Penninx BW, Smoller JW, Perlis RH

Abstract
OBJECTIVES: Family and genetic studies indicate overlapping liability for major depressive disorder and bipolar disorder. The purpose of the present study was to determine whether this shared genetic liability influences clinical presentation.
METHODS: A polygenic risk score for bipolar disorder, derived from a large genome-wide association meta-analysis, was generated for each subject of European-American ancestry (n = 1,274) in the Sequential Treatment Alternatives to Relieve Depression study (STAR*D) outpatient major depressive disorder cohort. A hypothesis-driven approach was used to test for association between bipolar disorder risk score and features of depression associated with bipolar disorder in the literature. Follow-up analyses were performed in two additional cohorts.
RESULTS: A generalized linear mixed model including seven features hypothesized to be associated with bipolar spectrum illness was significantly associated with bipolar polygenic risk score [F = 2.07, degrees of freedom (df) = 7, p = 0.04]. Features included early onset, suicide attempt, recurrent depression, atypical depression, subclinical mania, subclinical psychosis, and severity. Post-hoc univariate analyses demonstrated that the major contributors to this omnibus association were onset of illness at age ? 18 years [odds ratio (OR) = 1.2, p = 0.003], history of suicide attempt (OR = 1.21, p = 0.03), and presence of at least one manic symptom (OR = 1.16, p = 0.02). The maximal variance in these traits explained by polygenic score ranged from 0.8% to 1.1%. However, analyses in two replication cohorts testing a five-feature model did not support this association.
CONCLUSIONS: Bipolar genetic loading appeared to be associated with bipolar-like presentation in major depressive disorder in the primary analysis. However, the results were at most inconclusive because of lack of replication. Replication efforts were challenged by different ascertainment and assessment strategies in the different cohorts. The methodological approach described here may prove useful in applying genetic data to clarify psychiatric nosology in future studies.

PMID: 24725193 [PubMed - as supplied by publisher]



Increased temporo-insular engagement in unmedicated bipolar II disorder: an exploratory resting state study using independent component analysis.

Bipolar Disord. 2014 Apr 12;

Authors: Yip SW, Mackay CE, Goodwin GM

Abstract
OBJECTIVES: Despite numerous structural and functional magnetic resonance imaging studies, the neurobiology of bipolar disorder (BD) is still incompletely understood. Resting-state functional magnetic resonance imaging (rsFMRI) allows for the study of intrinsic functional connections between brain areas, which may reflect the pathophysiology of BD. Most previous rsFMRI studies conducted in BD have included a majority of medicated patients, making simple interpretation with respect to pathophysiology difficult.
METHODS: Participants were 15 antipsychotic agent- and mood-stabilizer-naïve young adults with bipolar II disorder (BD-II), and 20 healthy controls group-matched for gender, age, and cognitive ability. Independent component analysis (ICA) was used to identify eight commonly studied resting-state networks (RSNs). Between-group comparisons were conducted using dual regression and corrected for family-wise error (FWE) across space and the number of components (pFWE < 0.05).
RESULTS: In comparison to controls, participants with BD-II had increased coherence across several brain regions, including the bilateral insula and putamen, across a temporo-insular network. No between-group differences in engagement of the default mode network were found.
CONCLUSIONS: This was the first ICA-based rsFMRI study conducted among unmedicated individuals with BD. Given the young age (mean = 23 years) and antipsychotic agent- and mood-stabilizer-naïve status of our participants with BD-II, temporo-insular functional connectivity is a candidate vulnerability marker for BD. Further work is needed to relate resting-state differences to detailed understanding of pathophysiology.

PMID: 24725219 [PubMed - as supplied by publisher]



Family-focused therapy for individuals at clinical high risk for psychosis: treatment fidelity within a multisite randomized trial.

Early Interv Psychiatry. 2014 Apr 11;

Authors: Marvin SE, Miklowitz DJ, O'Brien MP, Cannon TD

Abstract
AIM: Family psychoeducation is an effective adjunct to pharmacotherapy in delaying relapse among patients with schizophrenia and bipolar disorder. This study tested the treatment adherence and competence of newly trained clinicians to an adaptation of family-focused therapy for individuals at clinical high risk for psychosis (FFT-CHR).
METHODS: The sample included 103 youth or young adults (ages 12-30 years) who had attenuated positive symptoms of psychosis. Families participated in a randomized trial comparing two psychosocial interventions: FFT-CHR (18 sessions over 6 months) and enhanced care (EC; 3 sessions over 1 month). Following a 1.5-day training seminar, 24 clinicians from eight study sites received teleconference supervision in both treatment protocols for the 2-year study period. Treatment fidelity was rated with the 13-item Therapy Competence and Adherence Scales, Revised.
RESULTS: Supervisors classified 90% of treatment sessions as above acceptable fidelity thresholds (ratings of 5 or better on a 1-7 scale of overall fidelity). As expected, fidelity ratings indicated that FFT-CHR included a greater emphasis on communication and problem-solving skills training than EC, but ratings of non-specific clinician skills, such as maintaining rapport and appropriately pacing sessions, did not differ between conditions. Treatment fidelity was not related to the severity of symptoms or family conflict at study entry.
CONCLUSIONS: FFT-CHR can be administered with high levels of fidelity by clinicians who receive training and supervision. Future studies should examine whether there are more cost-effective methods for training, supervising and monitoring the fidelity of FFT-CHR.

PMID: 24725329 [PubMed - as supplied by publisher]



Valproic acid triggers increased mitochondrial biogenesis in POLG-deficient fibroblasts.

Mol Genet Metab. 2014 Mar 28;

Authors: Sitarz KS, Elliott HR, Karaman BS, Relton C, Chinnery PF, Horvath R

Abstract
Valproic acid (VPA) is a widely used antiepileptic drug and also prescribed to treat migraine, chronic headache and bipolar disorder. Although it is usually well tolerated, a severe hepatotoxic reaction has been repeatedly reported after VPA administration. A profound toxic reaction on administration of VPA has been observed in several patients carrying POLG mutations, and heterozygous genetic variation in POLG has been strongly associated with VPA-induced liver toxicity. Here we studied the effect of VPA in fibroblasts of five patients carrying pathogenic mutations in the POLG gene. VPA administration caused a significant increase in the expression of POLG and several regulators of mitochondrial biogenesis. It was further supported by elevated mtDNA copy numbers. The effect of VPA on mitochondrial biogenesis was observed in both control and patient cell lines, but the capacity of mutant POLG to increase the expression of mitochondrial genes and to increase mtDNA copy numbers was less effective. No evidence of substantive differences in DNA methylation across the genome was observed between POLG mutated patients and controls. Given the marked perturbation of gene expression observed in the cell lines studied, we conclude that altered DNA methylation is unlikely to make a major contribution to POLG-mediated VPA toxicity. Our data provide experimental evidence that VPA triggers increased mitochondrial biogenesis by altering the expression of several mitochondrial genes; however, the capacity of POLG-deficient liver cells to address the increased metabolic rate caused by VPA administration is significantly impaired.

PMID: 24725338 [PubMed - as supplied by publisher]



Multimodal Emotion Integration in Bipolar Disorder: An Investigation of Involuntary Cross-Modal Influences between Facial and Prosodic Channels.

J Int Neuropsychol Soc. 2014 Apr 11;:1-9

Authors: Van Rheenen TE, Rossell SL

Abstract
The ability to integrate information from different sensory channels is a vital process that serves to facilitate perceptual decoding in times of unimodal ambiguity. Despite its relevance to psychosocial functioning, multimodal integration of emotional information across facial and prosodic modes has not been addressed in bipolar disorder (BD). In light of this paucity of research we investigated multimodal processing in a BD cohort using a focused attention paradigm. Fifty BD patients and 52 healthy controls completed a task assessing the cross-modal influence of emotional prosody on facial emotion recognition across congruent and incongruent facial and prosodic conditions, where attention was directed to the facial channel. There were no differences in multi-modal integration between groups at the level of accuracy, but differences were evident at the level of response time; emotional prosody biased facial recognition latencies in the control group only, where a fourfold increase in response times was evident between congruent and incongruent conditions relative to patients. The results of this study indicate that the automatic process of integrating multimodal information from facial and prosodic sensory channels is delayed in BD. Given that interpersonal communication usually occurs in real time, these results have implications for social functioning in the disorder. (JINS, 2014, 20, 1-9).

PMID: 24725656 [PubMed - as supplied by publisher]





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