Cognitive impairment in patients with a primary episode of bipolar affective disorder

An increasing number of studies on cognitive impairment associated with bipolar disorder indicate the relevance of the topic in psychiatry. The aim of the study was to investigate the features of cognitive functioning of patients with primary episode of bipolar disorder, taking into account sex and clinical variant. According to the method of «Remembering the Ten Words», 153 patients were examined: with prevalence of depressive symptoms (44 men and 75 women), with prevalence of manic symptoms (15 men and 8 women) and with simultaneous presence of depressive and manic symptoms or with rapid change of phases (6 men and 5 women). Statistical analysis was performed using the non-parametric Mann-Whitney test. It was found that in the depressive variant, the memorization curve was characterized by difficulties of fixing information and difficulty in holding it: 4.2±1.2 words, 4.6±1.4 words, 5.9±1.8 words, 5.8±1.4 words, 4.4±1.3 words, 2.6±1.4 words (in men – 4.2±1.4 words, 4.6±1.5 words, 6.1±1.9 words, 5.7±1.5 words, 4.4±1.3 words, 2.6±1.4 words, in women – 4.2±1.1 words, 4.5±1.4 words, 5,9±1.7 words, 5.8±1.3 words, 4.4±1.3 words, 2.5±1.3 words); at manic – rapid rise with subsequent decrease and the lowest reproduction rates in an hour: 4.7±1.3 words, 7.5±1.3 words, 7.2±1.3 words, 6.7±1.8 words , 4.7±1.0 words, 2.0±1.0 words (in men – 4.9±1.3 words, 7.3±1.3 words, 7.1±1.2 words, 6, 3±1.7 words, 4.7±0.9 words, 1.9±0.9 words, in women – 4.3±1.4 words, 7.9±1.4 words, 7.5±1,5 words, 7.5±1.7 words, 4.6±1.3 words, 2.3±1.2 words); when mixed – combined fixation difficulties and low reproduction rates: 4.5±0.9 words, 5.1±1.3 words, 5.9±1.1 words, 5.6±0.8 words, 4.2±1.1 words, 2.4±0.9 words (in men – 4.5±0.8 words, 5.5±1.0 words, 5.8±1.0 words, 5.8±0, 8 words, 4.5±1.0 words, 2.0±0.9 words, in women – 4.6±1.1 words, 4.6±1.5 words, 6.0±1.4 words, 5.4±0.9 words, 3.8±1.1 words, 2.8±0.8 words). Certain differences in cognitive impairment were found depending on the clinical version of the primary episode; however, the differences between men and women are insignificant. Further prospects are related to the improvement of methods for predicting and treating cognitive impairment in bipolar disorders.

A double blind randomized clinical trial of buprenorphine augmentation for treatment of psychotic symptoms in opioid addicted bipolar patients

Objective: To assess the efficacy of buprenorphine augmentation in treatment of psychotic symptoms in bipolar disorder type I.Design: Bipolar type I patients with manic or depressive episodes and psychotic feature and with opioid dependency comorbidity were randomly included and allocated. Both groups of buprenorphine (4 or 6 mg/d) and placebo were also treated with enough dosages of sodium valproate and risperidone. Psychosis as primary outcome and depressive and manic symptoms as secondary outcome were assessed at baseline and after 1 and 2 weeks. Data were analyzed through t test and repeated measure ANOVA.Results: Twenty-four patients remained in each group. Both groups displayed significant reduction in psychotic, depressive, and manic symptoms during the 2 weeks of study, although there was not any significant difference between them. Conclusions: Buprenorphine did not add any efficacy to usual treatment of psychotic episodes of bipolar, although did not aggravate psychiatric symptoms.

The effect of smartphone-based monitoring on illness activity in bipolar disorder: the MONARCA II randomized controlled single-blinded trial

BackgroundRecently, the MONARCA I randomized controlled trial (RCT) was the first to investigate the effect of smartphone-based monitoring in bipolar disorder (BD). Findings suggested that smartphone-based monitoring sustained depressive but reduced manic symptoms. The present RCT investigated the effect of a new smartphone-based system on the severity of depressive and manic symptoms in BD.MethodsRandomized controlled single-blind parallel-group trial. Patients with BD, previously treated at The Copenhagen Clinic for Affective Disorder, Denmark and currently treated at community psychiatric centres, private psychiatrists or GPs were randomized to the use of a smartphone-based system or to standard treatment for 9 months. Primary outcomes: differences in depressive and manic symptoms between the groups.ResultsA total of 129 patients with BD (ICD-10) were included. Intention-to-treat analyses showed no statistically significant effect of smartphone-based monitoring on depressive (B = 0.61, 95% CI −0.77 to 2.00, p = 0.38) and manic (B = −0.25, 95% CI −1.1 to 0.59, p = 0.56) symptoms. The intervention group reported higher quality of life and lower perceived stress compared with the control group. In sub-analyses, the intervention group had higher risk of depressive episodes, but lower risk of manic episodes compared with the control group.ConclusionsThere was no effect of smartphone-based monitoring. In patient-reported outcomes, patients in the intervention group reported improved quality of life and reduced perceived stress. Patients in the intervention group had higher risk of depressive episodes and reduced risk of manic episodes. Despite the widespread use and excitement of electronic monitoring, few studies have investigated possible effects. Further studies are needed.