Recurrent Unipolar Manic Disorder in the Yoruba Nigerian: Further Evidence

1985 ◽  
Vol 147 (4) ◽  
pp. 434-437 ◽  
Author(s):  
Roger O. A. Makanjuola
Keyword(s):  
Bipolar Disorder ◽  
Clinical Presentation ◽  
Social Data ◽  
Manic Disorder ◽  
Western Countries ◽  
Bipolar Group ◽  
Female Sex ◽  
Depot Neuroleptics ◽  
Bipolar Patients

One hundred and four Yoruba Nigerian patients are described who presented with manic disorder over a five-year period; 55 could be classified as suffering from recurrent unipolar manic disorder, while 36 had suffered only one attack of mania. Only 13 patients suffered from bipolar disorder, in contrast to studies from Western societies, in which bipolar disorder is much more common than unipolar. The unipolar manic and bipolar patients could not be differentiated on the basis of clinical and social data, apart from a possible preponderance of the female sex in the bipolar group. The clinical presentation of mania was similar to that described from Western Countries. Long-term prophylaxis with depot neuroleptics may be advisable in such cases.

scholarly journals Response Processes to Looming Appetitive and Aversive Cues in Euthymic Bipolar Patients and Their First-Degree Relatives: An Exploratory Study

2020 ◽  
pp. 025371762097528
Author(s):  
Velprashanth Venkatesan ◽  
Christoday R J Khess ◽  
Umesh Shreekantiah ◽  
Nishant Goyal ◽  
K. K. Kshitiz
Keyword(s):  
Bipolar Disorder ◽  
Healthy Controls ◽  
Sensitivity To Reward ◽  
Bipolar Group ◽  
First Degree Relatives ◽  
Vulnerability Model ◽  
Increased Sensitivity ◽  
Appetitive Cues ◽  
Spectrum Disorders ◽  
Bipolar Patients

Background: Patients with bipolar disorder demonstrate increased sensitivity to appetitive/rewarding stimuli even during euthymia. On presentation of arousing pictures, they show a peculiar response, suggesting heightened vigilance. While responding to looming arousing cues, studies show subjects with anxiety spectrum disorders exhibit increased reaction time (RT), explained by the “looming-vulnerability model.” This study aimed to investigate the responses to looming arousing cues in euthymic bipolar patients and their first-degree relatives, as compared to healthy controls. Method: A looming appetitive and aversive cue paradigm was designed for assessing the RT of patients to process appetitive and aversive cues. The behavioral inhibition/activation and sensitivity to reward/punishment amongst the groups were also assessed. Results: The bipolar group showed significantly longer RT to process appetitive cues irrespective of the looming condition. Aversive cues elicited significantly longer RT in both the bipolar group and in first-degree relatives, but only when presented with the looming condition. Significant looming bias was elicited in the bipolar group which suggested a particular cognitive style to looming cues. A composite measure of RT along with sensitivity to reward/punishment distinguishes the bipolar group and their first-degree relatives from the healthy controls. Conclusion: The looming vulnerability model may provide important insights for future exploration of cognitive endophenotypes in bipolar disorder.

Treatment of Rapid-Cycling Bipolar Disorder

CNS Spectrums ◽  
2004 ◽  
Vol 9 (S2) ◽  
pp. 1-4
Author(s):  
Robert M. Post ◽  
Kiki D. Chang ◽  
Trisha Suppes ◽  
David L. Ginsberg
Keyword(s):  
Bipolar Disorder ◽  
Treatment Guidelines ◽  
Antidepressant Treatment ◽  
Rapid Cycling ◽  
Controlled Clinical Trials ◽  
Safety Considerations ◽  
Bipolar Patients ◽  
Patients Experience ◽  
Patient Use

AbstractApproximately 40% of bipolar patients experience rapid cycling, and half of these suffer from ultra-rapid or ultradian cycling. These patterns are also common in children. Rapid-cycling bipolar disorder is difficult to bring to remission and often requires treatment with four or more classes of psychotropic medications. Lithium, even in combination with anticonvulsants or antidepressants, is often associated with residual episodic depressions. Concerns with adjunctive antidepressant treatment include their low response and remission rates and their tendency to cause switch into mania. Atypical antipsychotics and selected agents within the anticonvulsant class are becoming increasingly important in the treatment of rapid cycling. In the absence of clear treatment guidelines, the use and sequencing of drugs in complex combination treatment remains exploratory, but should be individualized based on careful prospective mood charting by the patient. Use of several drugs below their side-effect thresholds may prevent certain side effects. In children, long-term safety considerations are particularly important in the absence of a strong controlled clinical trials database.

Socio-Cultural Parameters in Yoruba Nigerian Patients with Affective Disorders

1989 ◽  
Vol 155 (3) ◽  
pp. 337-340 ◽  
Author(s):  
Roger O. A. Makanjuola
Keyword(s):  
Bipolar Disorder ◽  
Depressive Disorder ◽  
Affective Disorders ◽  
Educational Status ◽  
Major Depressive ◽  
Manic Disorder ◽  
Younger Age ◽  
History Of ◽  
Bipolar Patients ◽  
Manic Patients

One hundred and ten consecutive new patients presenting with major affective disorders were divided into five categories according to pattern of presentation: recurrent manic disorder, recurrent depressive disorder, bipolar disorder, single episodes of manic disorder, and single episodes of major depressive disorder. Manic patients predominated, and recurrent manic disorder was much more frequent than either recurrent depressive or bipolar disorder. The manic and bipolar patients were younger. Females predominanted in all five groups of patients. The two manic groups were less likely to be married, but this was probably a reflection of their younger age. No differences were demonstrated with regard to educational status or occupation. There were no significant differences with regard to sibship position, family size, or polygamous/monogamous parents. Manic patients were more likely to have suffered permanent separation from one or both parents before the age of 12 years. A relatively low proportion of the patients had a positive history of mental disorder among first- or second-degree relatives. Manic and bipolar patients tended to present in hospital relatively early in their illness.

Decreased leukocyte telomere length in male patients with chronic bipolar disorder: lack of effect of long-term lithium-treatment

2021 ◽  
pp. 1-25
Author(s):  
Ewa Ferensztajn-Rochowiak ◽  
Ewa Kurczewska ◽  
Błażej Rubiś ◽  
Michalina Lulkiewicz ◽  
Hanna Hołysz ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Telomere Length ◽  
Lithium Treatment ◽  
Quantitative Polymerase Chain Reaction ◽  
Accelerated Aging ◽  
Control Group ◽  
Duration Of Treatment ◽  
Control Male ◽  
Bipolar Patients

Abstract Objectives: Bipolar disorder (BD) may be connected with accelerated aging, the marker of this can be shorter telomere length (TL). Some data suggest that lithium may exert a protective effect against telomere shortening. The study aimed to compare the telomere length between patients with bipolar disorder and control subjects. The effect of long-term lithium treatment was also assessed. Methods: The study group comprised 41 patients with BD, including 29 patients treated longitudinally with lithium (mean 16.5 years) and 20 healthy people. Telomere length was assessed by the quantitative polymerase chain reaction (qPCR). Results: In the control group, the TL was significantly longer in males than in females. Male bipolar patients had significantly shorter TL compared with the control male group. In bipolar patients, there was no correlation between TL and duration of treatment. The TL was negatively correlated with age in male bipolar patients. Conclusion: The study did not confirm the lithium effect on TL in bipolar patients. TL showed gender differences, being shorter in BD males, compared to control males, and longer in healthy males, compared to control females.

scholarly journals Bupropion Maintenance Treatment in Refractory Bipolar Depression: A Case Report

2017 ◽  
Vol 13 (1) ◽  
pp. 43-48
Author(s):  
Julia Dehning ◽  
Heinz Grunze ◽  
Armand Hausmann
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Maintenance Treatment ◽  
Bipolar Depression ◽  
Antidepressant Treatment ◽  
Mood Stabilizer ◽  
Obvious Benefit ◽  
Insufficient Response ◽  
Bipolar Patients

Background:The optimal duration of antidepressant treatment in bipolar depression appears to be controversial due to a lack of quality evidence, and guideline recommendations are either vague or contradictive. This is especially true for second line treatments such as bupropion that had not been subject to rigourous long term studies in Bipolar Disorder.Case presentation:We report the case of a 75 year old woman who presented with treatment refractory bipolar depression. Because of insufficient response to previous mood stabilizer treatment and refractory depressive symptoms, bupropion was added to venlafaxine and lamotrigine. From there onwards, the patient improved continuously without experiencing deterioration of depression or a switch into hypomania. Our patient being on antidepressants for allmost four years experienced an obvious benefit from longterm antidepressant administration.Conclusion:Noradrenergic/dopaminergic mechanisms of action may play a more prominent role in bipolar depression, and may still be underused as a therapeutic strategy in the acute phase as well as in long-term maintenance in at least a subgroup of bipolar patients. There is still a lack of evidence from RCTs, but this case report further supports antidepressant long-term continuation and the usefulness of a noradrenergic/dopaminergic antidepressant in the acute and maintenance treatment of bipolar disorder.

scholarly journals Perception of Burden and Stigma by Caretaker of Schizophrenia and Bipolar Disorder: a Comparative Study

2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Nandaniya KiritKumar L
Keyword(s):  
Bipolar Disorder ◽  
Education Level ◽  
Burden Of Care ◽  
Subjective Burden ◽  
Manic Disorder ◽  
Perceived Burden ◽  
Significant Difference ◽  
Objective Burden ◽  
Bipolar Patients ◽  
Test Correlation

Background burden of care can be conceptualized into two distinct components (objective and subjective). Objective burden of care is meant to indicate its effects on the household such as taking care of daily tasks, whereas subjective burden indicates the extent to which the caregivers perceived the burden of care. Aim of the present study was to assess level of burden and stigma on caretaker of schizophrenia and bipolar patients. Method researcher took N=80 samples from the population of schizophrenia and bipolar disorder. Researcher used ‘t’ test, ‘f’ test, correlation test, degree of freedom test to analyzed the data. Results researcher found that caretaker perceived higher stigma and burden, there will be no significant difference in education level. Twenty two (50.0 %) caretaker of schizophrenia perceived moderate to severe burden comparatively 9 (25.0 %) BMD (bipolar manic disorder) perceived moderate to severe burden. Researcher concluded that caretaker of schizophrenia and bipolar both perceived burden and stigma.

Impact of psychotic features on morbidity and course of illness in patients with bipolar disorder

2010 ◽  
Vol 25 (1) ◽  
pp. 47-51 ◽  
Author(s):  
İ. Özyıldırım ◽  
S. Çakır ◽  
O. Yazıcı
Keyword(s):  
Bipolar Disorder ◽  
Clinical Features ◽  
Psychotic Episode ◽  
Response Patterns ◽  
Course Of Illness ◽  
Comparison Groups ◽  
Bipolar Patients ◽  
Psychotic Features ◽  
Depressive Episodes

AbstractObjectiveIn this study, we aimed to compare the clinical features and response patterns to the long-term prophylaxis of bipolar patients with or without psychotic features.MethodThe life charts of patients with bipolar I disorder were evaluated. Two hundred and eighty-one patients who suffer with bipolar disorder for at least 4 years and who had at least three mood episodes were included to the study. The patients whose all episodes are psychotic (psychotic group) and the patients who never experienced psychotic episode (non-psychotic group) were assigned as comparison groups. The clinical features and the response to long-term prophylaxis were compared across the groups.ResultsThe psychotic group consists of 43 patients; non-psychotic group consists of 54 patients. The history of bipolar disorder among the first-degree relatives was remarkably more prevalent in non-psychotic group (p = 0.032). The predominance of manic/hypomanic episodes was significantly higher in psychotic group than non-psychotic group; and the rate of depressive episodes were higher in non-psychotic group than psychotic group (p = 0.013). Episodes were more severe (p < 0.001) and hospitalization rates were higher (p = 0.023) in psychotic group. The response to lithium monotherapy was better in non-psychotic group (p < 0.001).ConclusionThe well identified psychotic subtype of bipolar patients may give important predictions about long term course and prophylaxis of bipolar disorder.

scholarly journals 162 Post-lithium Delirious Mania in Patients with Bipolar Disorder

CNS Spectrums ◽  
2020 ◽  
Vol 25 (2) ◽  
pp. 303-304
Author(s):  
Muhammad Zaidi ◽  
Michael Champ ◽  
Aquanette Brown ◽  
Tzvetelina Dimitrova
Keyword(s):  
Bipolar Disorder ◽  
Meta Analysis ◽  
Definitive Treatment ◽  
Term Therapy ◽  
Relative Reduction ◽  
List Type ◽  
Increased Risk ◽  
Long Term Treatment ◽  
Bipolar Patients

Abstract:Delirious mania is a life-threatening condition, presenting with symptoms of acute delirium and psychotic mania as a complication of medical or psychiatric condition. It is not recognized as a diagnosis in DSM-V and is under recognized in clinical practice. It was first described by Calmeil (Calmeil, 1832). In 1849 Luther Bell described 40 cases with an associated 75% mortality rate. More recently, Jacobowski et al (2013) compiled a comprehensive review of clinical characteristics, diagnostic work up, and treatment recommendations for delirious mania. In addition to acute onset, clinical course is frequently worsened by psychosis and catatonia. Delirium leads to disequilibrium of neurotransmitters, particularly depletion of acetylcholine and elevation of dopamine.Lithium has been used for the treatment of mania for many decades. Suppes et al performed a meta-analysis of 14 studies including 257 patients with Bipolar I disorder and concluded that patients relapsed 28 times more when stopping lithium compared to those who continued this medication. Baldessarini et al (1999) completed analysis of 227 patients with Bipolar I and II disorders, dividing the sample into “abrupt” (1-14 days) and “gradual” (15-30 days) discontinuation groups and concluded that the frequency of relapse following “abrupt” cessation was four times higher compared to following “gradual” cessation. In a study of 450 bipolar patients, Baldessarini et al (2003) reviewed the long-term treatment of lithium as monotherapy (86 % of the study’s population) in the context of lithium maintenance population morbidity. Greater pretreatment morbidity lead to larger relative reduction in morbidity as a result of treatment with lithium. A subgroup of bipolar patients with “abrupt” discontinuation became refractory when re-challenged with lithium.Describing three clinical cases of delirious mania following conclusions can be derived:•Patients with bipolar disorder and comorbid chronic kidney injury currently or formerly receiving long-term therapy with lithium are at increased risk for delirious mania.•Abrupt lithium discontinuation in patients with bipolar disorder and comorbid chronic medical conditions (especially chronic kidney disease) increases risk for mania refractory to conventional treatment with medications.•In such patients, definitive treatment is ECT.

Does psychoeducatioanal Approach Could Reach the Target Patients with Bipolar Disorder?

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
S. Cakir ◽  
R. Bensusan ◽  
Z. Akca ◽  
O. Yazici
Keyword(s):  
Bipolar Disorder ◽  
Participation Rate ◽  
Poor Response ◽  
Term Treatment ◽  
Recruitment Rate ◽  
Mood Stabilizers ◽  
Blood Levels ◽  
Long Term Treatment ◽  
Bipolar Patients

The recurrent nature of bipolar disorder needs an optimum compliance with long term pharmacotherapy, however the poor adherence is common. Adjunctive psychoeducation seems favorable effects on adherence during the long term pharmacotherapy. Even strong benefits were showed, setting a psychoeducation in clinical practice is still novel and recruiting the patients with long history of bipolar disorder may not be feasible. In literature, recruitment rate, motivation and attitudes of patients for participation in psychoeducation is not studied. The present study was conducted to clarify the intends of patients with bipolar disorder to participate in psychoeducation and the factors that contribute.The euthymic patients with diagnosis of bipolar disorder I or II, were invited to the 6 week psychoeducation program in prospective study. The demographic and clinical data were obtained from life charts and updated with a clinical interview. The blood levels of mood stabilizers, adherence, response to prophylactic treatment, relapses and hospitalization rates between the participants and non-participants were compared.84 patients were attended the program, 71 patients were considered as unwilling to attend. The motivation of patients to attend a psychoeducation is limited. The participation rate was only 54.2%. The patients who refused attending to this program have fewer adherences to medication and irregular follow up visits, insufficient blood levels of mood stabilizers, poor response to long term treatment, more likely have mood episodes. Education level between attendees and non-attendees were not different.Optimum methods are required for recruitment of bipolar patients to a psychoeducation program.

scholarly journals Electroconvulsive Therapy (ECT) in Bipolar Disorder Patients with Ultra-Rapid Cycling and Unstable Mixed States

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 624
Author(s):  
Sergey Mosolov ◽  
Christoph Born ◽  
Heinz Grunze
Keyword(s):  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Electroconvulsive Therapy ◽  
Mood Stabilizer ◽  
Rapid Cycling ◽  
Mixed States ◽  
Limited Effectiveness ◽  
Bipolar Patients ◽  
Depressive Episodes

Background and Objectives: Unstable mixed episodes or rapid switching between opposite affective poles within the scope of short cycles was first characterized in 1967 by S. Mentzos as complex polymorphous states with chaotic overlap of manic and depressive symptoms. Well-known examples include antidepressant-induced mania/hypomania and rapid/ultra-rapid/ultradian cycling, when clinicians observe an almost continuous mixed state with a constant change of preponderance of manic or depressive symptoms. Achieving stable remission in these cases is challenging with almost no data on evidence-based treatment. When mood stabilizers are ineffective, electroconvulsive therapy (ECT) has been suggested. Objectives: After reviewing the evidence from available literature, this article presents our own clinical experience of ECT efficacy and tolerability in patients with ultra-rapid cycling bipolar disorder (BD) and unstable mixed states. Materials and Methods: We conducted an open, one-year observational prospective study with a “mirror image” design, including 30 patients with rapid and ultra-rapid cycling BD on long-term mood stabilizer treatment (18 received lithium carbonate, 6 on valproate and 6 on carbamazepine) with limited effectiveness. A bilateral ECT course (5–10 sessions) was prescribed for regaining mood stability. Results: ECT was very effective in 12 patients (40%) with a history of ineffective mood stabilizer treatment who achieved and maintained remission; all of them received lithium except for 1 patient who received carbamazepine and 2 with valproate. Nine patients (30%) showed partial response (one on carbamazepine and two on valproate) and nine patients (30%) had no improvement at all (four on carbamazepine and two on valproate). For the whole sample, the duration of affective episodes was significantly reduced from 36.05 ± 4.32 weeks in the year prior to ECT to 21.74 ± 12.14 weeks in the year post-ECT (p < 0.001). Depressive episodes with mixed and/or catatonic features according to DSM-5 specifiers were associated with a better acute ECT response and/or long-term mood stabilizer treatment outcome after ECT. Conclusions: ECT could be considered as a useful option for getting mood instability under control in rapid and ultra-rapid cycling bipolar patients. Further randomized trials are needed to confirm these results.

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