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Most Recent Articles Published on Bipolar Disorder:

Aripiprazole: a drug with a novel mechanism of action and possible efficacy for alcohol dependence.

CNS Neurol Disord Drug Targets. 2010 Mar 1;9(1):50-4

Authors: Vergne DE, Anton RF

Alcohol dependence is a costly and socially devastating illness. The dopamine system has received increased attention due to the consensus that dopaminergic dysfunction is at the core of the addiction process. Agents that modulate this system might be beneficial in reducing craving, reward, and relapse. Aripiprazole is a 3(rd) generation atypical antipsychotic U.S. Food and Drug Administration-approved for the treatment of schizophrenia, bipolar disorder, and treatment-resistant major depression. Its principal mechanism of action appears to be associated with partial agonism at the D(2) dopamine receptor. Nevertheless, relatively recent pre-clinical data shows that aripiprazole might exert its action by way of agonism, partial agonism, and antagonism at both dopamine and serotonin receptors. In animal models of alcoholism aripiprazole produced an overall decrease in drinking behavior. Clinical trials with aripiprazole in alcoholics have shown some positive, but inconsistent, results. Given aripiprazole's putative activity on frontal-subcortical circuits subserving reward/craving and impulsive behavior, it might prove to be beneficial for neuropsychiatric conditions in which dysregulation of reward and impulsivity, among them alcoholism, are at the core of the syndrome. This article proposes a potential role for aripiprazole in alcoholism treatment, and suggests that more randomized controlled trials should be designed at appropriate doses to better understand aripiprazole's potential role as a treatment option. More options are needed to treat alcoholics that fall into different subgroups (e.g., those with impulsive disorders), or non-responsive to available treatments. Early results with aripiprazole are promising and warrant further exploration.

PMID: 20201815 [PubMed - in process]

TRPC Channels and their Implication in Neurological Diseases.

CNS Neurol Disord Drug Targets. 2010 Mar 1;9(1):94-104

Authors: Selvaraj S, Sun Y, Singh BB

Calcium is an essential intracellular messenger and serves critical cellular functions in both excitable and non-excitable cells. Most of the physiological functions in these cells are uniquely regulated by changes in cytosolic Ca(2+) levels ([Ca(2+)](i)), which are achieved via various mechanisms. One of these mechanism(s) is activated by the release of Ca(2+) from the endoplasmic reticulum (ER), followed by Ca(2+) influx across the plasma membrane (PM). Activation of PM Ca(2+) channel is essential for not only refilling of the ER Ca(2+) stores, but is also critical for maintaining [Ca(2+)](i) that regulates biological functions, such as neurosecretion, sensation, long term potentiation, synaptic plasticity, gene regulation, as well as cellular growth and differentiation. Alterations in Ca(2+) homeostasis have been suggested in the onset/progression of neurological diseases, such as Parkinson's, Alzheimer's, bipolar disorder, and Huntington's. Available data on transient receptor potential conical (TRPC) protein indicate that these proteins initiate Ca(2+) entry pathways and are essential in maintaining cytosolic, ER, and mitochondrial Ca(2+) levels. A number of biological functions have been assigned to these TRPC proteins. Silencing of TRPC1 and TRPC3 has been shown to inhibit neuronal proliferation and loss of TRPC1 is implicated in neurodegeneration. Thus, TRPC channels not only contribute towards normal physiological processes, but are also implicated in several human pathological conditions. Overall, it is suggested that these channels could be used as potential therapeutic targets for many of these neurological diseases. Thus, in this review we have focused on the functional implication of TRPC channels in neuronal cells along with the elucidation of their role in neurodegeneration.

PMID: 20201820 [PubMed - in process]

The strong relationship between bipolar and substance-use disorder.

Ann N Y Acad Sci. 2010 Feb;1187:276-93

Authors: Swann AC

Bipolar disorder and substance-use disorders commonly occur in the same individual. In fact, bipolar disorder has a higher prevalence of substance-use disorders than any other psychiatric illness. Individuals with both disorders have a more severe course of bipolar disorder, including earlier onset, more frequent episodes, and more complications, including anxiety- and stress-related disorders, aggressive behavior, legal problems, and suicide. Bipolar and substance-use disorders share common mechanisms, including impulsivity, poor modulation of motivation and responses to rewarding stimuli, and susceptibility to behavioral sensitization. Studies of potential treatments for bipolar substance-use disorder have paid scant attention to the combined disorders. The most promising treatment strategies are those that address their shared mechanisms.

PMID: 20201858 [PubMed - in process]

Is perseveration uniquely characteristic of schizophrenia?

Schizophr Res. 2010 Mar 1;

Authors: Waford RN, Lewine R

Evidence for the existence of categorically distinct disorders such as schizophrenia, bipolar disorder, and major depression is mixed: neuropsychological impairments may be similar in schizophrenia and bipolar disorder; schizophrenia and major depression show similar neuropsychological and frontal lobe disturbances; and overlap in biochemical anomalies among the disorders has also been reported. Interestingly, there are very few studies that directly compare all diagnoses. The present study compares cognitive perseveration in these three diagnostic groups using the Wisconsin Card Sorting Task (WCST) to examine performance across patients with schizophrenia (n=143), bipolar disorder (n=25) and major depression (n=21). Individuals used in this sample were 18-45years old at time of testing to eliminate confounds of aging. Sex ratios within each diagnostic group are comparable to those of the national population. Univariate analyses examining diagnostic group and percent perseverative error revealed no significant differences in WCST performance across the diagnostic groups. Examination of clinical variables in the sample of individuals with schizophrenia revealed that perseveration is related to negative symptoms and depressive symptoms in young adults.

PMID: 20202795 [PubMed - as supplied by publisher]

Proxy and patients ratings on quality of life in patients with schizophrenia and bipolar disorder in Korea.

Qual Life Res. 2010 Mar 4;

Authors: Kim EJ, Song DH, Kim SJ, Park JY, Lee E, Seok JH, Jon DI, Cho HS

PURPOSE: This study aimed to assess the agreement between patient and proxy ratings of Quality of life (QoL) in patients with psychotic mental illnesses. METHODS: The abbreviated version of the WHO quality of life scale (WHOQOL-BREF) and 36-item short-form health survey (SF-36) were administered to patient-family proxy pairs of 81 schizophrenia patients with mild symptoms and 50 euthymic bipolar disorder patients. Paired t-tests and the intraclass correlation coefficient (ICC) were used to evaluate the level of agreement between patient and proxy ratings of QoL. RESULTS: At the group level, small standardized differences (0.0-0.3 for schizophrenia, 0.0-0.5 for bipolar disorder) between patient and proxy mean scores were found for most domains in both QoL measures. At the individual level, moderate to good agreement (ICC) was found (schizophrenia: ICC 0.4-0.7 on WHOQOL-BREF; 0.4-0.7 on SF-36; bipolar disorder: ICC 0.4-0.7 on WHOQOL-BREF; 0.6-0.7 on SF-36). The reported agreement was higher than that reported for similar measures in the psychiatric population. These results may be due to the fact that our subjects had mild clinical symptoms and frequent family interaction. CONCLUSION: These findings suggest that family proxy rating of patients' QoL can be used as a reasonable estimate of the patients' QoL for stable schizophrenia and bipolar patients in Korea.

PMID: 20204707 [PubMed - as supplied by publisher]

[Valproate induced hypoactive delirium in a bipolar disorder patient with psychotic features.]

Turk Psikiyatri Derg. 2010;21(1):79-84

Authors: Ozen S, Bülbül I, Soyuçok E

Delirium may present with hyperactive, hypoactive or mixed clinical pictures. The signs of hypoactive delirium are lethargy, confusion, apathy, hypersomnia, muttering, difficulty in maintaining attention, and difficulty in understanding and performing commands. Valproate is commonly used for the treatment of epilepsy and bipolar disorders. It is also used for the management of alcohol withdrawal delirium and agitative-aggressive deliriums. However, few reports are available about the valproate-induced delirium. In this report, we present a 46 years-old woman with bipolar disorder for 14 years. During her last two hospital admissions, she had been diagnosed with manic episode with psychotic features and she had received valproate. She experienced three hypoactive delirium episodes lasting 2-3 days throughout the treatment period of first week. The patient predominantly had the following signs; vomiting, hypersalivation, confusion, drowsiness, dysphasia, and hypoactivity. At the first day of delirium episode, serum valproate level was found to be within the therapeutic range (98.4, 117.1, and 65.6 mug/ml; respectively). In addition, she had normal results of cranial MRI, complete blood count, urine analysis, electrocardiogram, ALT, AST, albumin, bilirubin, BUN, creatinine and electrolytes. The serum ammonia level of the patient could not been measured due to limitations of laboratory facilities. The patient's consciousness improved dramatically 2-3 days after cessation of valproate. In conclusion, valproate can induce delirium at therapeutic blood levels in some patients via various mechanisms and this side effect has to be considered during valproate use.

PMID: 20204907 [PubMed - in process]

Quetiapine Improves Sleep Disturbance in Acute Bipolar Disorder: A Case Series.

Pharmacopsychiatry. 2010 Mar 4;

Authors: Cohrs S, Gade K, Meier A, Jordan W, Falkai P, Rüther E, Rodenbeck A

PMID: 20205075 [PubMed - as supplied by publisher]

Clinical and medial temporal features in a family with mood disorders.

Neurosci Lett. 2010 Jan 4;468(2):93-7

Authors: Boccardi M, Almici M, Bresciani L, Caroli A, Bonetti M, Monchieri S, Gennarelli M, Frisoni GB

It is debated whether non-affected relatives of patients with affective disorders share a specific brain structure endophenotype. Aim of this work is to explore the medial temporal morphology in affected and non-affected members of a family with mood disorders. Hippocampi and amygdalae were manually traced from the 3D magnetic resonance imaging of five affected family members, 10 non-affected relatives, and 15 unrelated matched controls. Affected and non-affected relatives were characterized by larger left amygdalae (18%, p=0.030), smaller right hippocampus (up to 18%, p<0.0005), and reduced hippocampal asymmetry (p<0.001) than controls. Abnormal, albeit non significant, positive correlations of MTL volumes with age were observed, with the exception of smaller volume of the left hippocampus with advancing age (r=-0.76) in the affected relatives. These data add to the evidence that abnormal medial temporal structures may constitute an endophenotype for affective disorders.

PMID: 19874870 [PubMed - indexed for MEDLINE]

[Association between the tryptophan hydroxylase (TPH) gene polymorphic markers and endogenous psychoses]

Genetika. 2009 Dec;45(12):1668-73

Authors:

Tryptophan hydroxylase is one of the key enzymes involved in serotonergic metabolism. In many studies, an association between the TPH gene and human mentality, as well as mental disorder was demonstrated. This study was designed to analyze the association between three TPH gene polymorphisms (A218C, T3792A, and (CT)n(CA)n(CT)n) and endogenous psychoses. The patients included into investigation were represented by those with manic-depressive psychosis (93 individuals) and those with the schizophrenia spectrum disorders (307 individuals). An association between the A218C polymorphism with the disorders of the schizophrenia spectrum was demonstrated. These findings confirmed the data obtained earlier for other populations. In addition, an association between the (CT)n(CA)n(CT)n microsatellite repeats and bipolar disease was shown for the first time.

PMID: 20198979 [PubMed - in process]

Risk factors predicting onset and persistence of subthreshold expression of bipolar psychopathology among youth from the community.

Acta Psychiatr Scand. 2010 Feb 25;

Authors: Tijssen MJ, Van Os J, Wittchen HU, Lieb R, Beesdo K, Wichers M

Tijssen MJA, Van Os J, Wittchen HU, Lieb R, Beesdo K, Wichers M. Risk factors predicting onset and persistence of subthreshold expression of bipolar psychopathology among youth from the community Objective: To examine factors increasing the risk for onset and persistence of subthreshold mania and depression. Method: In a prospective cohort community study, the association between risk factors [a family history of mood disorders, trauma, substance use, attention-deficit/hyperactivity disorder (ADHD) and temperamental/personality traits] and onset of manic/depressive symptoms was determined in 705 adolescents. The interaction between baseline risk factors and baseline symptoms in predicting 8-year follow-up symptoms was used to model the impact of risk factors on persistence. Results: Onset of manic symptoms was associated with cannabis use and novelty seeking (NS), but NS predicted a transitory course. Onset of depressive symptoms was associated with a family history of depression. ADHD and harm avoidance (HA) were associated with persistence of depressive symptoms, while trauma and a family history of depression predicted a transitory course. Conclusion: Different risk factors may operate during onset and persistence of subthreshold mania and depression. The differential associations found for mania and depression dimensions suggest partly different underlying mechanisms.

PMID: 20199490 [PubMed - as supplied by publisher]

[Bipolar disorders as co-morbidity in childhood and adolescence - underdiagnosed or overinterpreted? Therapy of a 14-year-old boy with Hyperkinetic Conduct Disorder and hypomania.]

Z Kinder Jugendpsychiatr Psychother. 2010 Mar;38(2):123-30

Authors: Rothermel B, Poustka L, Banaschewski T, Becker K

Objective: Considerable debate exists regarding differing prevalence rates of co-morbid bipolar disorder in children and adolescents with ADHD in Germany as compared to the US. Methods: Described in this case report are the assessment of and treatment procedure for a 14-year old boy with hyperkinetic conduct disorder and co-morbid hypomanic episode, as well as different possible interpretations of symptoms. Conclusions: Further studies of children and adolescents with ADHD and coexisting impulsive-aggressive behaviour are needed. Important in practice is a precise differentiation of symptoms with regard to co-morbid bipolar disorder.

PMID: 20200829 [PubMed - in process]

Functional polymorphism of matrix metalloproteinase-9 (MMP-9) gene in alcohol dependence: Family and case control study.

Brain Res. 2010 Feb 27;

Authors: Samochowiec A, Grzywacz A, Kaczmarek L, Bienkowski P, Samochowiec J, Mierzejewski P, Preuss UW, Grochans E, Ciechanowicz A

AIM: Matrix metalloproteinases (MMP) are extracellularly acting endopeptidases, whose substrates are extracellular matrix and adhesion proteins. In the gene polymorphism studies MMP-9 has been suggested to be involved in the pathogenesis of heart disease, cancer, bipolar disorder, and schizophrenia. In animal models MMP-9 has been shown to play a key role in a variety of neuronal plasticity phenomena, including learning and memory as well as drug addiction. METHOD: We studied 139 families, Caucasians, with no history of psychiatric disorder of ICD-10 other than alcohol or nicotine dependence. The control subjects were 136 unrelated individuals, matched for ethnicity and gender, with no mental disorder. Alcohol and family history of alcoholism were assessed by means of a structured interview, based on the Polish version of SSAGA (Semi-Structured Assessment on Genetics in Alcoholism). RESULTS: We found a statistically significant preferential transmission of the T allele (known to produce higher gene transcriptional activity) from parents to alcoholics (59%, p=0.046). In case-control study genotype TT and T alleles were significantly more frequent in the alcoholics than in the controls (OR=2.6). CONCLUSION: Our results suggest that the MMP-9 gene may play a role in the pathogenesis of alcohol dependence.

PMID: 20197064 [PubMed - as supplied by publisher]

Screening for bipolar disorder during pregnancy and the postpartum period.

Arch Womens Ment Health. 2010 Mar 3;

Authors: Chessick CA, Dimidjian S

Bipolar disorder is a significant mental health problem among perinatal women; however, little attention has been devoted to methods of screening for bipolar disorder during this phase of women's life cycle. There is a need for reliable and valid screening instruments for perinatal women. This paper presents a review of 11 self-report measures used to screen bipolar disorder in the general population and discusses their applicability to screening among perinatal women. Published psychometric data, including reliability, sensitivity, specificity, and positive predictive value of each self-report instrument, is presented and critiqued. We make recommendations for screening in clinical practice and highlights priorities for future research. The need for more research in this area is emphasized.

PMID: 20198393 [PubMed - as supplied by publisher]

Electroconvulsive therapy in a cochlear implant patient.

Otol Neurotol. 2010 Jan;31(1):64-6

Authors: Labadie RF, Clark NK, Cobb CM, Benningfield MM, Fuchs DC

OBJECTIVE: To report the first use of electroconvulsive therapy (ECT) in a patient with a cochlear implant (CI). STUDY DESIGN: Clinical Capsule Report. SETTING: University hospital. PATIENT:: A 17-year-old boy who underwent Nucleus 22 cochlear implantation in 1995 presented with delirious mania in 2009. Aggressive pharmacologic management was ineffective, and ECT was recommended due to the potentially lethal nature of his psychiatric illness. INTERVENTIONS: After careful consideration by a multidisciplinary team, unilateral ECT on the side opposite the CI without removal of the device was recommended. Electroconvulsive therapy was performed on hospital Days 20 and 21. Integrity testing of the CI was performed on hospital Day 38. MAIN OUTCOME MEASURES: Subjective and objective assessment of cochlear implant functioning and response to ECT. RESULTS: Electroconvulsive therapy was well tolerated and contributed to alleviation of presenting symptoms. The patient used his CI without subjective degradation of performance. Integrity testing of the CI after ECT confirmed proper functioning of the device. CONCLUSION: This is the first report of ECT in a patient with CI. Unilateral ECT was performed contralateral to the CI without subjective or objective decline in performance. This Clinical Report motivates further study regarding the use of ECT in CI patients.

PMID: 19816223 [PubMed - indexed for MEDLINE]

Perceived treatment effectiveness, medication compliance, and complementary and alternative medicine use among veterans with bipolar disorder.

J Altern Complement Med. 2010 Mar;16(3):251-5

Authors: Jarman CN, Perron BE, Kilbourne AM, Teh CF

Abstract Objectives: Recent research shows a high rate of complementary and alternative medicine (CAM) use among persons with mental disorders, although correlates and patterns of CAM use are relatively unknown. This study tested whether CAM use is associated with perceived effectiveness of conventional treatment (i.e., psychotropic medication and psychotherapy) and medication compliance among persons with bipolar disorder. Design: Patients with bipolar disorder (n = 435) were included as part of a naturalistic cohort study. Measures of CAM utilization, medication compliance, and perceptions of the effectiveness of psychotropic medications and psychotherapy were based on previously established questionnaires. Associations were tested using bivariate and multivariate analyses. Results: Bivariate analyses showed that patients who did not perceive psychotherapy as effective at improving social, family, or job functioning reported greater CAM use. However, medication compliance was not significantly associated with use of CAM. Patients who used oral (e.g., herbal therapies) or cognitive (e.g., meditation) CAM were more likely to report that their medications were not effective at relieving manic or depressive symptoms. Users of cognitive CAM were more likely to report that their medications did not help with social, job, or family functioning, and that they did not prevent recurrences of manic or depressive episodes. None of the bivariate associations remained significant in multivariate analyses. Conclusions: Prior research has suggested that persons who are dissatisfied with treatment for medical conditions are more likely to use CAM therapies. However, the results of this study do not show CAM therapies to be associated with perceived effectiveness of treatments for mental health problems among this sample of persons with serious mental illnesses. This suggests that motivations for CAM use may vary by population and condition. Because few correlates of CAM use among persons with serious mental illnesses are known, providers should conduct routine assessments of CAM use.

PMID: 20192909 [PubMed - in process]

Course and impact of bipolar disorder in young patients.

J Clin Psychiatry. 2010 Feb;71(2):e05

Authors: Chang KD

The presentation of bipolar disorder in children and adolescents may vary from its presentation in adults. Rage, irritability, and long episodes are common manifestations of mania in young people with bipolar disorder. Frequent comorbid disorders in young patients include ADHD and anxiety disorders. Prodromal and subsyndromal states of bipolar disorder, such as bipolar disorder NOS, present opportunities for early intervention and prevention. Early recognition and intervention are crucial, because untreated pediatric bipolar disorder becomes chronic, has a high incidence of relapse, and has a poor prognosis.

PMID: 20193644 [PubMed - as supplied by publisher]

Benzodiazepine use and risk of recurrence in bipolar disorder: a STEP-BD report.

J Clin Psychiatry. 2010 Feb;71(2):194-200

Authors: Perlis RH, Ostacher MJ, Miklowitz DJ, Smoller JW, Dennehy EB, Cowperthwait C, Nierenberg AA, Thase ME, Sachs GS

OBJECTIVE: Benzodiazepines are widely prescribed to patients with bipolar disorder, but their impact on relapse and recurrence has not been examined. METHOD: We examined prospective data from a cohort of DSM-IV bipolar I and II patients who achieved remission during evidence-guided naturalistic treatment in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study (conducted in the United States between 1999 and 2005). Risk for recurrence among individuals who did or did not receive benzodiazepine treatment was examined using survival analysis. Cox regression was used to adjust for clinical and sociodemographic covariates. Propensity score analysis was used in a confirmatory analysis to address the possible impact of confounding variables. RESULTS: Of 1,365 subjects, 349 (25.6%) were prescribed a benzodiazepine at time of remission from a mood episode. After adjusting for potential confounding variables, the hazard ratio for mood episode recurrence among benzodiazepine-treated patients was 1.21 (95% CI, 1.01-1.45). The effects of benzodiazepine treatment on relapse remained significant after excluding relapses occurring within 90 days of recovery, or stratifying the sample by propensity score, a summary measure of likelihood of receiving benzodiazepine treatment. In an independent cohort of 721 subjects already in remission at study entry, effects of similar magnitude were observed. CONCLUSION: Benzodiazepine use may be associated with greater risk for recurrence of a mood episode among patients with bipolar I and II disorder. The prescribing of benzodiazepines, at a minimum, appears to be a marker for a more severe course of illness.

PMID: 20193647 [PubMed - as supplied by publisher]

Antidepressants in bipolar disorder: caveats in interpreting and applying the findings of Altshuler et al.

J Clin Psychiatry. 2010 Feb;71(2):211-2

Authors: Sparhawk R

PMID: 20193651 [PubMed - in process]

Rapid-cycling bipolar disorder: cross-national community study.

Br J Psychiatry. 2010 Mar;196:217-25

Authors: Lee S, Tsang A, Kessler RC, Jin R, Sampson N, Andrade L, Karam EG, Mora ME, Merikangas K, Nakane Y, Popovici DG, Posada-Villa J, Sagar R, Wells JE, Zarkov Z, Petukhova M

BACKGROUND: The epidemiology of rapid-cycling bipolar disorder in the community is largely unknown. AIMS: To investigate the epidemiological characteristics of rapid-cycling and non-rapid-cycling bipolar disorder in a large cross-national community sample. METHOD: The Composite International Diagnostic Interview (CIDI version 3.0) was used to examine the prevalence, severity, comorbidity, impairment, suicidality, sociodemographics, childhood adversity and treatment of rapid-cycling and non-rapid-cycling bipolar disorder in ten countries (n = 54 257). RESULTS: The 12-month prevalence of rapid-cycling bipolar disorder was 0.3%. Roughly a third and two-fifths of participants with lifetime and 12-month bipolar disorder respectively met criteria for rapid cycling. Compared with the non-rapid-cycling, rapid-cycling bipolar disorder was associated with younger age at onset, higher persistence, more severe depressive symptoms, greater impairment from depressive symptoms, more out-of-role days from mania/hypomania, more anxiety disorders and an increased likelihood of using health services. Associations regarding childhood, family and other sociodemographic correlates were less clear cut. CONCLUSIONS: The community epidemiological profile of rapid-cycling bipolar disorder confirms most but not all current clinically based knowledge about the illness.

PMID: 20194545 [PubMed - in process]

Structural brain abnormalities in bipolar disorder: what meta-analyses tell us.

Br J Psychiatry. 2010 Mar;196:245-6

Authors: Vita A, De Peri L, Sacchetti E

PMID: 20194550 [PubMed - in process]