Dissertations / Theses: 'Crime and Bipolar disorders'

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Maharaj, Avani. "A retrospective audit comparing state patients with schizophrenia and bipolar mood disorder who have committed violent crime admitted to the male forensic unit at Valkenberg Hospital." Master's thesis, Faculty of Health Sciences, 2018. http://hdl.handle.net/11427/31140.

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Background There is a consensus that psychosis confers a modest risk toward violent offending. Most research to date has shown that a statistical relationship does exist between schizophrenia and bipolar disorder, and violence and aggressive behavior In forensic mental health, state patients are rehabilitated in a general program regardless of diagnosis. It is not known whether different rehabilitation management strategies should be implemented on those with bipolar disorder as compared to those with schizophrenia. This study is an attempt to ascertain if there are differences between those diagnosed with schizophrenia and bipolar disorders, and if so, whether these have implications for their rehabilitation programs. Objectives The study aims to compare the demographic profiles and comorbidities (in terms of substance use and personality disorders) of state patients with bipolar disorder and schizophrenia who have offended violently. Methods This was a quantitative, cross sectional study. State patients who were diagnosed with schizophrenia and bipolar disorder and committed a violent crime were included in the study from the 1st January 2000 to 31st December 2014. The study population comprised a total of 93 male state patients. Of these 46 patients had a diagnosis of bipolar disorder and 47 patients had a diagnosis of schizophrenia. Results The results show that in general the differences between the schizophrenia group and the bipolar disorder group are marginal. A higher percentage of patients with schizophrenia committed murder at 17.02% and attempted murder at 12.77%. The bipolar disorder group had a significantly higher number of patients diagnosed with co morbid personality disorder at 59.57% (p value of 0.01.) Substance abuse was common in both groups. The mean age at admission was 31,23 years in schizophrenia and 36,85 years in bipolar disorder. This demonstrates an earlier onset of criminality in the group with schizophrenia. Patients with bipolar disorder were more likely to be married (13.04%), divorced (10.8%) or separated (2.17%). Conclusion There were no major differences elicited between the 2 groups of patients. Certain aspects such as therapeutic programs for personality disordered patients and social interventions in patients with poor social support would contribute to improving the quality of the rehabilitation programs currently used. The commonalities found in the 2 groups suggest that a common approach to rehabilitation would be adequate in this setting.

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Wittchen, Hans-Ulrich, Stephan Mühlig, and Lukas Pezawas. "Natural course and burden of bipolar disorders." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-117282.

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Despite an abundance of older and more recent retrospective and considerably fewer prospective-longitudinal studies in bipolar disorders I and II, there are still remarkable deficits with regard to our knowledge about the natural course and burden. The considerable general and diagnosis-specific challenges posed by the nature of bipolar disorders are specified, highlighting in particular problems in diagnostic and symptom assessment, shifts in diagnostic conventions and the broadening of the diagnostic concept by including bipolar spectrum disorders. As a consequence it still remains difficult to agree on several core features of bipolar disorders, such as when they begin, how many remit spontaneously and how many take a chronic course. On the basis of clinical and epidemiological findings this paper summarizes (i) a significant need to extend the study of the natural course of bipolar disorder in clinical samples beyond the snapshot of acute episodes to the study of the mid-term and long-term symptom course, associated comorbidities and the associated burden of the disease. (ii) In terms of epidemiological studies, that are also of key importance for resolving the critical issues of threshold definitions in the context of the bipolar spectrum concept, there is a clear need for identifying the most relevant risk factors for the first onset and those for the further illness progression in early stages. Since there are some indications that these critical processes might start as early as adolescence, such studies might concentrate on young cohorts and clearly before these prospective patients come to clinical attention. (iii) The value of both types of studies might be enhanced, if beyond the use of standardized diagnostic interview, special attempts are made to use prospective life- and episode-charting methods for bipolar illnesses.

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Jackson, Alison Margaret. "Day-to-day variability in bipolar disorders." Thesis, University of Glasgow, 2006. http://theses.gla.ac.uk/6326/.

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Background. Bipolar disorder is characterised by recurrent acute episodes of mania and depression with the common occurrence of subsyndromal symptoms between episodes. Episode recurrence and frequent inter-episode symptoms have made identification of the factors that influence relapse an important focus for research in bipolar disorder. Objective. To determine whether dysregulation in bipolar disorder would be exhibited, outwith acute mania, in day-to-day variability and whether variability was associated with risk of relapse. Design. A prospective daily monitoring study was conducted with bipolar disorder and general population samples. Twenty participants with a bipolar episode experienced in the previous two years were recruited from a Lithium Clinic. A control group often participants from the general population were recruited by opportunity sampling. Main outcome measures. Biological, behaviour, cognition, and affect measures included self-report measures of behavioural activation/inhibition, social rhythms, self esteem, positive affect, negative affect, elation, depression and objective actigraph estimation of the sleep-wake cycle and circadian rhythms. Results. Lower self esteem, lower positive affect, higher negative affect, higher depression levels and greater variability in self esteem, night waking and sleep efficiency across 14 days were evident in bipolar disorder. Survival analyses suggested greater variability in self esteem and sleep efficiency predicted earlier admission in bipolar disorder. Conclusions. Greater day-to-day variability in bipolar disorder was observed compared to the general population. Underlying disturbances in biological, cognition and affect measures were evident in bipolar disorder. Findings were clinically important since sleep and self esteem disturbances may be considered as potentially modifiable in reducing risk of relapse in bipolar disorder.

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Wittchen, Hans-Ulrich, Stephan Mühlig, and Lukas Pezawas. "Natural course and burden of bipolar disorders." Technische Universität Dresden, 2003. https://tud.qucosa.de/id/qucosa%3A27010.

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Despite an abundance of older and more recent retrospective and considerably fewer prospective-longitudinal studies in bipolar disorders I and II, there are still remarkable deficits with regard to our knowledge about the natural course and burden. The considerable general and diagnosis-specific challenges posed by the nature of bipolar disorders are specified, highlighting in particular problems in diagnostic and symptom assessment, shifts in diagnostic conventions and the broadening of the diagnostic concept by including bipolar spectrum disorders. As a consequence it still remains difficult to agree on several core features of bipolar disorders, such as when they begin, how many remit spontaneously and how many take a chronic course. On the basis of clinical and epidemiological findings this paper summarizes (i) a significant need to extend the study of the natural course of bipolar disorder in clinical samples beyond the snapshot of acute episodes to the study of the mid-term and long-term symptom course, associated comorbidities and the associated burden of the disease. (ii) In terms of epidemiological studies, that are also of key importance for resolving the critical issues of threshold definitions in the context of the bipolar spectrum concept, there is a clear need for identifying the most relevant risk factors for the first onset and those for the further illness progression in early stages. Since there are some indications that these critical processes might start as early as adolescence, such studies might concentrate on young cohorts and clearly before these prospective patients come to clinical attention. (iii) The value of both types of studies might be enhanced, if beyond the use of standardized diagnostic interview, special attempts are made to use prospective life- and episode-charting methods for bipolar illnesses.

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Sobczak, Sjacko. "Serotonin and bipolar disorders serotonergic vulnerability in first-degree relatives of patients with bipolar disorder /." [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Maastricht University [Host], 2002. http://arno.unimaas.nl/show.cgi?fid=7073.

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Tompkins, Season C. "Impulsivity : a link between bipolar and alcohol use disorders." Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/53773.

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There are many commonalities between bipolar and alcohol use disorders which suggest a common etiology, or vulnerability, for these disorders. Impulsivity is a shared feature of both disorders which may help to identify an underlying link between the disorders. The presented studies used an undergraduate sample to examine personality, behavioural, and electroencephalogram (EEG) measures which have previously been linked to either bipolar or alcohol use disorders, or to both disorders. The first study examined self-report impulsivity as a mediator of the relationship between hypomanic personality and alcohol use. Individuals from the first study were then invited to participate in a second study using delay discounting, a behavioural measure of impulsivity, and EEG measures, which have been related to bipolar and alcohol use disorders. In the first study, higher hypomanic personality was related to higher impulsivity and alcohol use. Impulsivity was also positively related to alcohol use. In this study, impulsivity mediated the relationship between hypomanic personality and various measures of alcohol use. Specifically, Sensation Seeking and Negative Urgency were the UPPS-P scales found to most often mediate the relationships between hypomanic personality and alcohol use. In the second study, hypomanic personality, Positive Urgency, and alcohol use were all positively correlated with delay discounting rates. However, Positive Urgency did not significantly mediate the relationship between hypomanic personality or alcohol use and delay discounting. With regard to EEG measures, there were some findings showing impulsivity, hypomanic personality, and alcohol use related to longer latencies of the P300 event-related potential, but not smaller amplitudes. This lack of EEG findings may be explained by the relatively healthy sample of undergraduate participants that did not endorse severe enough psychopathology to show the associations previously seen in clinical samples. Arts, Faculty of Psychology, Department of Graduate

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Pini, Stefano, Queiroz Valéria de, Daniel Pagnin, et al. "Prevalence and burden of bipolar disorders in European countries." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-110193.

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A literature search, supplemented by an expert survey and selected reanalyses of existing data from epidemiological studies was performed to determine the prevalence and associated burden of bipolar I and II disorder in EU countries. Only studies using established diagnostic instruments based on DSM-III-R or DSM-IV, or ICD-10 criteria were considered. Fourteen studies from a total of 10 countries were identified. The majority of studies reported 12-month estimates of approximately 1% (range 0.5–1.1%), with little evidence of a gender difference. The cumulative lifetime incidence (two prospective-longitudinal studies) is slightly higher (1.5–2%); and when the wider range of bipolar spectrum disorders is considered estimates increased to approximately 6%. Few studies have reported separate estimates for bipolar I and II disorders. Age of first onset of bipolar disorder is most frequently reported in late adolescence and early adulthood. A high degree of concurrent and sequential comorbidity with other mental disorders and physical illnesses is common. Most studies suggest equally high or even higher levels of impairments and disabilities of bipolar disorders as compared to major depression and schizophrenia. Few data are available on treatment and health care utilization.

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Pini, Stefano, Queiroz Valéria de, Daniel Pagnin, et al. "Prevalence and burden of bipolar disorders in European countries." Technische Universität Dresden, 2005. https://tud.qucosa.de/id/qucosa%3A26819.

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A literature search, supplemented by an expert survey and selected reanalyses of existing data from epidemiological studies was performed to determine the prevalence and associated burden of bipolar I and II disorder in EU countries. Only studies using established diagnostic instruments based on DSM-III-R or DSM-IV, or ICD-10 criteria were considered. Fourteen studies from a total of 10 countries were identified. The majority of studies reported 12-month estimates of approximately 1% (range 0.5–1.1%), with little evidence of a gender difference. The cumulative lifetime incidence (two prospective-longitudinal studies) is slightly higher (1.5–2%); and when the wider range of bipolar spectrum disorders is considered estimates increased to approximately 6%. Few studies have reported separate estimates for bipolar I and II disorders. Age of first onset of bipolar disorder is most frequently reported in late adolescence and early adulthood. A high degree of concurrent and sequential comorbidity with other mental disorders and physical illnesses is common. Most studies suggest equally high or even higher levels of impairments and disabilities of bipolar disorders as compared to major depression and schizophrenia. Few data are available on treatment and health care utilization.

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Ortiz-Dominguez, Tania Abigail. "Migraine comorbidity in bipolar disorder." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=116105.

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Introduction: Bipolar Disorder (BD) is a chronic mental illness associated with functional decline, mortality, and significant health care costs; furthermore, specific general medical conditions have been found to occur disproportionately within BD patient populations, among them, migraine is one of the most studied. Migraine has a global prevalence of 10%, and it is a disorder with elevated direct and indirect costs, the later mostly derived from its association with mood and anxiety disorders. Specifically, the reported prevalence of migraine in the BD population ranges from 24.8% to 39.8%, rates that are considerable higher than those found in the general population. Objective: To explore the prevalence and clinical characteristics of BD patients with and without migraine (Study 1), and to examine the psychiatric comorbidity in patients suffering from migraine (Study 2). Methods: 323 BD patients were studied, using SADS-L and SCID as diagnostic interviews, and ill-Migraine questionnaire to assess the presence of migraine. Statistical analyses were conducted using parametric analysis and the development of log-linear models. Additionally, 102 migraine patients were interviewed using SADS-L, and the descriptive characteristics of the sample were analyzed. Results: For Study 1, we found that 24.5% of BD patients suffer from migraine, and it is significantly associated with BD 2, suicidal behaviour, and a variety of anxiety disorders. As well, over 70% of migraine patients showed a lifetime psychiatric diagnosis, mainly within the spheres of mood and anxiety disorders; specifically, the prevalence of BD among migraine patients was 12.7%. Conclusions: Our study highlights the high prevalence of migraine among BD patients, and the elevated prevalence of psychiatric comorbidity among migraine sufferers. The study of this comorbidity will deepen our understanding of the mechanisms that underlie both disorders and provide a better framework for the developing of molecular techniques to further analyze the molecular physiopathology of Bipolar Disorder.

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Stratford, Hannah Joy. "Anxiety and bipolar spectrum disorders : psychological treatments and mental imagery." Thesis, University of Oxford, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.599903.

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Anxiety is a clinically significant feature of bipolar spectrum disorders [BP]. The. rate of anxiety symptoms and/or comorbid anxiety diagnoses is high, and it contributes to worse outcomes in a range of domains. There is an accumulation of evidence that psychological therapy is effective for anxiety, which is not so for BP. Mental imagery is implicated in the maintenance of anxiety and is a promising avenue of research in BP. A cognitive model of bipolar disorder posits that imagery is an emotional amplifier in mania and anxiety. Paper A presents a systematic review of the literature of psychological therapies for anxiety in BP. Twenty-two studies were identified, though no formal synthesis was possible. Preliminary data for CBT for obsessive compulsive disorder, generalised anxiety disorder, and post-traumatic stress disorder in a BP population are promising, and further research is warranted. Furthermore, the addition of an anxiety module to CBT for BP effectively reduces anxiety, and may have additional benefits in other domains. Pilot research applying other evidence-based CBT treatments for comorbid anxiety is indicated, as are RCTs for CBT for cyclothymia and rapid cycling BP. The addition of an anxiety module may Improve the effectiveness of psychological therapy for BP, further review and research is necessary to explore this. Paper B presents an empirical study, com paring imagery processes in adults with BP (currently euthymic), mixed anxiety disorders, and non-clinical controls. Genera imagery use, intrusive and deliberate prospective imagery, and characteristics of image ' during different mood states are explored. People with anxiety have high levels 0 general imagery use and intrusive prospective imagery. Unlike the clinical groups, the control group appears to have a bias against negative imagery in a deliberate prospective imagery task. Retrospective report of mental imagery during past low, anxious and high mood states gives partial support to the imagery as an emotional amplifier theory, and similarities between the clinical groups may illuminate the high rates of comorbidity. Future research is discussed.

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Hayel-Moghadam, Kamran, and Meredith K. Ginley. "The Interplay between Depression and Bipolar Disorders and OUD/SUD." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/etsu-works/8880.

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Slaughter, Mary E. "Examining Substance Use Disorders and Mental Health Comorbidities in Patients Hospitalized for Schizophrenia and Bipolar Disorders." Case Western Reserve University School of Graduate Studies / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=case1517851653320388.

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Ng, Roger Man Kin. "Does mental imagery act as an emotional amplifier in bipolar disorders?" Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:d327c209-9d56-4ac5-8c77-610a6d7de8b2.

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Bipolar disorder is characterized by episodes of mania and depression and serious suicidal risks. Recent studies reported high mental imagery susceptibility (general use of imagery in daily life and emotional impact of prospective imagery) in euthymic bipolar patients. This thesis aims to: a) replicate these findings in patients at different phases of bipolar disorder and with varying degrees of bipolarity, and b) explore how mental imagery susceptibility, ruminative processing, and behavioural approach system (BAS) sensitivity interact to amplify mood symptoms. Chapter 1 provides an overview of current theories of mood amplification and recurrence in bipolar disorders. Chapter 2 details the local validation of scales used in the thesis. Chapter 3 (Study 1) investigated whether mental imagery susceptibility, positive rumination and BAS sensitivity were elevated in remitted bipolar I disorder compared with major depressive disorder and non-psychiatric controls. Results suggested that these cognitive variables were elevated in remitted bipolar I disorder. Positive rumination also interacted with positive prospective images to predict bipolarity. Chapter 4 (Study 2) found that these cognitive variables were elevated in bipolar I disorder during manic and euthymic phases, compared to major depression. Further, the number of positive prospective images predicted recovery status and manic symptom severity. Chapters 5, 6 and 7 report that, compared with people without bipolar spectrum conditions, these cognitive characteristics were elevated in sub-threshold bipolar disorder (Study 3), individuals with high bipolar risks based on a behavioural paradigm (Study 4), and individuals with high familial risk (Study 5). Studies 3-5 confirmed that positive and negative prospective images interacted with rumination to amplify hypomanic and depressive symptoms respectively. Chapter 8 (Study 6) showed that suicidal flash-forwards function as a psychological escape from perceived entrapment and defeat in suicidality. Based on these findings, Chapter 9 proposes novel imagery-based techniques for targeting problematic imagery in bipolar disorders.

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Padovan, Giordano B. "Psychoses, language and brain asymmetry: fMRI connectivity alterations in bipolar disorders." Doctoral thesis, Università degli studi di Padova, 2018. http://hdl.handle.net/11577/3423164.

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INTRODUCTION A mood characterised by alternating mania and depression have been matter of curiosity and attention since ancient times. According to T.J. Crow’s theory on psychosis, Schizophrenia is strictly linked to the development of the faculty of language (begun in hominids from 6 to 4.2 million years ago) which depends by (anatomical and functional) asymmetry observable between the two cerebral hemispheres (Crow 2004). Several data in the recent (and older) (Griesinger 1845) scientific literature support the hypothesis that schizophrenia and bipolar disorder are similar due to a large number of partially common features: symptomatology, genetics, cognitive features, neurobiology, connectivity alteration, etc.. A brief historical account about how often the classification of this disease changed across the last two centuries may suggest how the knowledge underling this diagnostic category is still fragile. AIM OF THE RESEARCH The goal of this paper is to study Functional Connectivity (FC) among bipolar patients and to test the compatibility of Crow’s paradigm with Bipolar Disorder, verifying the potential presence of hemispheric asymmetry alteration (left dominance deficit) through fMRI analysis. MATERIALS AND METHODS 18 outpatients of the Mood Disorders Unit at the Psychiatric Clinic of the University of Padua have been recruited. All subjects had a diagnosis of Bipolar Disorder type I or type II, according to the criteria of the DSM-IV-TR). 16 healthy individuals were chosen matched for age, sex and education. Clinical and psychological conditions at the time of the experiment were investigated through some psychometric scales widely used for the evaluation of mood, anxiety and other psychopathologic aspects. All subjects underwent a MRI scan both in resting state and while they were attending two tasks: a phonemic (verbal fluency) exercise and a visuo-spatial test (mental rotations). RESULTS From the neuropsychological point of view the phonemic task revealed no significant (p<0.05) differences between groups; on the contrary patients group showed decreased performance at the visuo-spatial task. MRI FC was analysed using two different techniques. Independent Component Analysis (ICA) showed mainly a volume within the Dorsal Attention Network located in left Precuneus (Brodmann Area 7) where patient group presented a reduction of FC compared to controls. Graph analysis brought to light a number of inter-hemispheric and left intra-hemispheric connections revealed to be significantly less active in patients compared to controls, on the contrary substantial conservation of indices at the Network Level was observed. INTRODUZIONE Un tono timico caratterizzato da un’alternanza di mania e depressione è stato oggetto di interesse e attenzione fin dai tempi antichi. Secondo La teoria di T.J. Crow sulla psicosi, la schizofrenia è strettamente legata allo sviluppo della facoltà del linguaggio (che ha avuto origine negli ominidi da 6 a 4,2 milioni di anni fa) che dipende dall'asimmetria (anatomica e funzionale) osservabile tra i due emisferi cerebrali (Crow 2004). Diversi dati nella letteratura scientifica recente (e più antica – Griesinger 1845) supportano l'ipotesi che la schizofrenia e il disturbo bipolare siano simili per un gran numero di caratteristiche parzialmente comuni: sintomatologia, genetica, cognitività, neurobiologia, alterazione della connettività, ecc. Un breve resoconto storico di quanto spesso la classificazione di questa malattia sia cambiata negli ultimi due secoli può suggerire come la conoscenza sottesa a questa categoria diagnostica sia ancora fragile. SCOPO DELLA RICERCA L'obiettivo di questo studio è quello di studiare la connettività funzionale (FC) tra i pazienti bipolari e testare la compatibilità del paradigma di Crow con il disturbo bipolare, verificando la potenziale presenza di alterazioni dell'asimmetria emisferica (deficit di dominanza sinistra) attraverso l'analisi fMRI (risonanza magnetica funzionale). MATERIALI E METODI Sono stati reclutati 18 pazienti ambulatoriali dell'Unità di Disturbi dell'Umore presso la Clinica Psichiatrica dell'Università di Padova. Tutti i soggetti avevano una diagnosi di disturbo bipolare di tipo I o di tipo II, secondo i criteri del DSM-IV-TR). Sono stati scelti 16 individui sani abbinati per età, sesso e istruzione. Le condizioni cliniche e psicologiche al momento dell'esperimento sono state studiate attraverso alcune scale psicometriche ampiamente utilizzate per la valutazione dell'umore, dell'ansia e di altri aspetti psicopatologici. Tutti i soggetti sono stati sottoposti a una risonanza magnetica sia in stato di riposo che durante l’esecuzione di due compiti: un esercizio fonemico (fluenza verbale) e un test visuo-spaziale (rotazioni mentali). RISULTATI Dal punto di vista neuropsicologico, il compito fonemico non ha rivelato differenze significative (p<0.05) tra i gruppi; al contrario, il gruppo di pazienti ha mostrato una riduzione delle prestazioni nel compito visuo-spaziale. I dati fMRI sono stati analizzati utilizzando due tecniche diverse. L'Independent Component Analysis (ICA) ha mostrato principalmente un volume all'interno della Dorsal Attention Network situato nel precuneo sinistro (area 7 di Brodmann) dove il gruppo di pazienti presentava una riduzione significativa della FC rispetto ai controlli. L'analisi dei grafi ha portato alla luce un numero di connessioni intra-emisferiche e intra-emisferiche di sinistra rivelate significativamente meno attive nei pazienti rispetto ai controlli, al contrario è stata osservata una sostanziale conservazione degli indici a livello di rete.

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Kwobah, Edith Wanjiku Kamaru. "Cardiovascular risk profile of adults with psychotic disorders in Eldoret, Kenya." Doctoral thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32715.

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Introduction: Cardiovascular disorders contribute significantly to mortality and morbidity amongst patient's psychotic disorders such as schizophrenia and bipolar mood disorders. In addition to conventional risk factors for cardiovascular disorders (smoking, alcohol use, inadequate physical activity, hypertension, diabetes, dyslipidaemia, obesity and metabolic syndrome, and non-modifiable factors such as sex, age and social-economic status) exposure to potentially traumatic events, psychological distress, comorbidity of other medical conditions, and use of antipsychotics may also increase cardiovascular risk in patients with psychosis. There is also evidence to suggest that intervention to mitigate such cardiovascular risk factors are suboptimal, hence contributing to poor outcomes. Despite growing interest in cardiovascular health, there remains a paucity of data on the prevalence of the various cardiovascular risk factors among patients with psychosis in low resource settings such as Sub-Saharan Africa. This is likely to differ from high resource contexts given social-cultural and economic differences as well as differences in the health systems. In order to design contextually relevant cardiovascular risk screening, treatment and prevention guidelines that can be integrated into routine care of the mentally ill patients in low- and middle-income countries (LMICs), further work in this setting is warranted. Objectives: The aim of this thesis was to establish the cardiovascular risk profile among patients treated for psychotic disorders at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Western Kenya. Specific objectives were as follows: 1. To conduct a literature review on the burden and etiological mechanisms of cardiovascular risk in patients with psychosis, with a focus on LMIC. 2. To compare the prevalence, as well as sociodemographic and clinical correlates, of conventional cardiovascular risk factors (smoking, alcohol intake, poor diet, and lack of exercise, diabetes mellitus, hypertension, obesity, dyslipidaemia and metabolic syndrome) in patients with psychosis versus matched controls. 3. To establish the prevalence and correlates of non-conventional risk factors; psychological distress, traumatic events (lifetime and childhood trauma) and comorbid medical disorders in patients with psychosis and controls, and to delineate how these risk factors contribute to the overall cardiovascular risk. 4. To describe current psychopharmacological treatments and explore potential associations with cardiovascular risk among patients with psychosis. 5. To explore the overall 10-year cardiovascular disease risk, as well as the social demographic and clinical correlates among patients and controls. 6 .To determine the proportion of untreated metabolic disorders (hypertension, diabetes mellitus, and dyslipidaemia) in patients with psychotic disorders and matched controls. Methods: This was a cross-sectional descriptive survey comparing 300 patients with psychosis and 300 controls at Moi Teaching and Referral Hospital, Western Kenya. A paper based researcher-administered questionnaire was used to collect data on demographic variables (age, sex, education level, and marital status), and risk factors (smoking, alcohol intake, diet, physical activity). We used the Composite International Diagnostic Interview (CIDI) to assess for presence of other chronic medical disorders. Data on childhood trauma were obtained using the Childhood Trauma Questionnaire (CTQ) while the Life Events Checklist (LEC) was used to obtain data on lifetime exposure to potentially traumatic events. Data on psychological distress among controls were obtained using the Kessler-10 questionnaire. Measurements of weight, height, abdominal circumference and blood pressure were taken from each of the participants. Blood was drawn for measurement of glucose level and lipid profile. Data analysis was undertaken using Stata version 15. T-tests were used to compare continuous variables while Pearson chi-squared tests was used for categorical variables. Regression modelling was undertaken to assess associations between sociodemographic and clinical predictor variables and the cardiovascular risk factors. Results: Data collection took place between July 2018 and March 2019. The mean age of patients was 33 years and of controls was 35 years. Compared to controls, patients were more likely to be unmarried (46% vs 33% p< 0.001), and were reduced among females (OR 0.41 p20). The estimated 10 year cardiovascular risk was significantly associated with female Sex (p=0.007), age (p <0.001), current tobacco smoking (p <0.001) and metabolic syndrome (P<0.001). Among the patients, 280 (94.3%) patients were on antipsychotics with the majority (86.5%) being treated with olanzapine. Of all the participants with diabetes 60% among patients and 22% among controls were not on treatment. Of the total number of participants with hypertension, 65% of patients and 47% controls were not on treatment. Conclusion: In the study setting of Eldoret, Western Kenya, patients with psychosis were found to have high levels of lifestyle cardiovascular risk factors such as smoking, inadequate intake of fruits and vegetables and inadequate physical activity. They were also found to have high rates of metabolic disorders such as hypertension, obesity, metabolic syndrome and dyslipidaemia. There was no evidence of increased cardiovascular risk among participants exposed to traumatic life events, with those experiencing psychological distress or those with other chronic medical disorders. The use of olanzapine was not significantly associated with increased cardiovascular risk in this setting. There was an identifiable gap in the treatment of cardiovascular risk factors in this setting. Given these findings, we recommend efforts to address these risk factors by development of protocols to ensure screening for these risk factors, adequate documentation and appropriate treatment.

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Hawke, Lisa. "Early maladaptive schemas as a cognitive vulnerability factor for bipolar spectrum disorders." Thesis, Université Laval, 2012. http://www.theses.ulaval.ca/2012/28817/28817.pdf.

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Päären, Aivar. "Long-Term Health Outcome of Adolescent Mood Disorders : Focus on Bipolar Disorder." Doctoral thesis, Uppsala universitet, Institutionen för neurovetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-239835.

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There has recently been an intense debate about the increased rate of bipolar disorders (BPD) in children and adolescents observed in clinical settings. Thus, there is great interest in child and adolescent symptoms of hypomania and whether these symptoms subsequently will develop into BPD. More knowledge about early signs could give insight into the development of the disorder. There are also concerns that hypomanic symptoms in adolescence indicate excess risk of other health conditions. It has been reported that patients with mood disorders have a high consumption of prescription drugs in different ATC classes. The primary objective of this thesis was to better understand the mental health outcome of adolescents with hypomania spectrum symptoms and to identify early risk factors for adult bipolar disorder among adolescents with mood disorders. In order to widen the scope and investigate health outcome of mood disorder in general psychopharmacological outcomes were included. A community sample of adolescents (N=2 300) in the town of Uppsala, Sweden, was screened for depressive symptoms. Both participants with positive screening and matched controls (in total 631) were diagnostically interviewed. Ninety participants reported hypomania spectrum episodes, while another 197 fulfilled the criteria for major depressive disorder (MDD) without a history of a hypomania spectrum episode. A follow-up after 15 years included a blinded diagnostic interview, a self-assessment of personality disorders, and national register data on prescription drugs and health services use. Adolescent mood symptoms, non-mood disorders, and family characteristics were assessed. Univariate and multivariate analyses were used. The results indicate that the phenomenology of the hypomania spectrum episodes during childhood and adolescence per se does not predict adult bipolar disorder. However, having both affective symptoms during adolescence and a family history of bipolar disorder increases the risk of developing bipolar disorders in adulthood. Disruptive disorder in childhood or adolescence as well as family histories of BPD emerged as significant risk factors that differentiated between the future development of BPD and MDD. Adolescents with hypomania spectrum episodes and adolescents with MDD do not differ substantially in health outcomes in adulthood. Both groups are at increased risk for subsequent mental health problems, high consumption of prescription drugs, and high health care use, compared with the control group. The high rates of prescription drugs in many ATC classes found among the former depressed females seem to indicate a series of co-morbid somatic illnesses. Thus, it is important to identify and treat children and adolescents with mood disorders, and carefully follow the continuing course. Characteristics such as disruptive disorders and family history warrant particular attention.

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Davenport, Kelly. "Exploring experiences and processes within psychological interventions for people with bipolar disorders." Thesis, University of Sheffield, 2017. http://etheses.whiterose.ac.uk/18030/.

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Sala, Cassola Regina. "Prevalence, clinical correlates and factors associated with course and outcome of anxiety disorders in youth with bipolar disorders." Doctoral thesis, Universitat de Barcelona, 2011. http://hdl.handle.net/10803/82142.

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OBJECTIVE: Anxiety disorders are among the most common comorbid conditions in youth with bipolar disorder (BP). We aimed to examine the prevalence, correlates, persistence (>50% of the follow-up time), and the onset of new anxiety disorders in youth with comorbid anxiety disorders and BP. METHODS: As part of the Course and Outcome of Bipolar Youth study (COBY), 446 youth ages 7 to 17, who met DSM-IV criteria for BP-I (n=260), BP-II (n=32) or operationalized criteria for BP not otherwise specified (BP-NOS; n=154) were included. Subjects were evaluated for current and lifetime Axis-I psychiatric disorders at intake using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children–Present and Lifetime version (K-SADS-PL), and standardized instruments to assess functioning and family history. Subjects were followed on average 5 years using the Longitudinal Interval Follow-up Evaluation. RESULTS: Forty-four percent (n=194) of the sample met DSM-IV criteria for at least one lifetime anxiety disorder, most commonly separation anxiety (24%) and generalized anxiety disorders (16%). Nearly 20% met criteria for two or more anxiety disorders. Overall, anxiety disorders predated the onset of BP. BP-II subjects were more likely than BP-I or BP-NOS subjects to have a comorbid anxiety disorder. After adjusting for confounding factors, BP youth with anxiety were more likely to have BP-II, longer duration of mood symptoms, more severe ratings of depression, and family history of depression, hopelessness and somatic complaints during their worst lifetime depressive episode than those without anxiety. Of the 170 youth who had anxiety at intake, 80.6% had an anxiety disorder at any time during the follow-up. Most of the anxiety disorders during the follow-up were of the same type as those present at intake. About 50% of the youth had persistent anxiety, particularly Generalized Anxiety Disorder (GAD). Persistence was associated with multiple anxiety disorders, less follow-up time in euthymia, less conduct disorder, and less treatment with antimanic and antidepressant medications (all p-values≤0.05). Twenty-five percent of the sample who did not have an anxiety disorder at intake developed new anxiety disorders during follow-up, most commonly GAD. New onsets were significantly associated with being female, lower socioeconomic status, presence of attention-deficit/hyperactivity disorder and substance use disorder and more follow-up time with manic or hypomanic symptoms (all p-values≤0.05) CONCLUSIONS: Comorbid anxiety disorders are common in youth with BP, and most often predate BP onset. BP-II, a family history of depression, and more severe lifetime depressive episodes distinguish BP youth with comorbid anxiety disorders from those without. In addition, anxiety disorders in youth with BP tend to persist and new anxiety disorders onset in a substantial proportion of the sample. Careful consideration should be given to the assessment of comorbid anxiety in BP youth. Furthermore, early identification of factors associated with the persistence and onset of new anxiety disorders may enable the development of strategies for treatment and prevention. OBJECTIUS: Els trastorns d'ansietat són les condicions comòrbides més comuns en nens i adolescents amb trastorn bipolar (TB), però fins on sabem, cap estudi ha examinat l'evolució dels trastorns d'ansietat en joves i adults amb TB. L'objectiu de l'estudi va ser examinar els factors associats amb la persistència (>50% del temps de seguiment) i l'aparició de nous trastorns d'ansietat en nens i adolescents amb TB. MÈTODE: Com a part de l’estudi Course and Outcome of Bipolar Youth (COBY), 413 nens i adolescents entre 7 i 17 anys que complien els criteris per el Manual Diagnòstic i Estadístic IV (DSM-IV) pel TB-I (n=244), TB-II (n=28) o el criteri operacionalitzat pel TB no especificat (TB-NOS; n=154) van ser reclutats principalment de consultoris d'atenció ambulatòria. Els subjectes van ser seguits de mitjana durant 5 anys utilitzant el Longitudinal Interval Follow-up Evaluation. RESULTATS: Dels 170 nens i adolescents que presentaven ansietat a l'inici de l’estudi, el 80.6% tenia un trastorn d'ansietat en qualsevol moment durant el seguiment. La majoria dels trastorns d'ansietat durant el seguiment van ser del mateix tipus que els presents a l'inici de l'estudi. Al voltant del 50% dels joves tenien persistència d'ansietat, sobretot trastorn d'ansietat generalitzada (TAG). La persistència es va associar amb trastorns d'ansietat múltiple, menys temps de seguiment en eutimia, menys trastorn de conducta i menor tractament amb medicaments antidepressius i antimaníacs. Vint-cinc per cent de la mostra que no tenien un trastorn d'ansietat a l'inici, va desenvolupar nous trastorns d'ansietat durant el seguiment, en general TAG. L'inici de nous trastorns d'ansietat es va associar significativament amb ser dona, baix nivell socioeconòmic, presència del trastorn per dèficit d'atenció i hiperactivitat, trastorn per consum de substàncies i més temps de seguiment amb símptomes maníacs o hipomaníacs. CONCLUSIONS: Els trastorns d'ansietat en nens i adolescents amb TB tendeixen a persistir i l'ansietat de nou inici apareix en una proporció substancial de la mostra. S'ha de prestar atenció a l'avaluació de l'ansietat comòrbida en nens i adolescents amb TB i la identificació precoç dels factors associats amb la persistència i l'aparició de nous trastorns d'ansietat poden permetre el desenvolupament d'estratègies pel tractament i la seva prevenció.

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20

Hatton, Sean Nicholas. "Neuroanatomical correlates of psychiatric symptoms and cognitive deficits in emerging mental health disorders." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/12741.

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The purpose of this thesis was to determine how neuroanatomical changes in the early stages of mental illness are associated with behavioural and cognitive symptoms. Situated at the University of Sydney’s Brain and Mind Research Institute, young people with mental health disorders were recruited from the Youth Mental Health program between 2011 and 2013. Participants underwent magnetic resonance imaging (MRI) to characterise neuroanatomical structures, a clinical interview and self-report assessment to determine clinical symptom severity, and a battery of neuropsychological tests to assess cognitive performance. Chapter 1 introduces different models used to categorise psychiatric disorders to aid the characterisation and treatment of clinical symptoms and cognitive deficits. This is followed by a discussion of the normal neuroanatomical changes that occur from childhood through to early adulthood, essential for emotional regulation and higher cognitive capabilities, and the major mechanisms that underpin healthy brain maturation. This chapter continues by reviewing the neuroanatomical changes reported in the early stages of psychosis as determined by MRI, and how these changes are associated with positive and negative symptoms and cognition. The aims of this thesis and the structure of Chapters 2 to 4 conclude this section. Chapter 2 (Hatton et al., 2012) examines how differences in anterior insula gray matter volume are correlated with symptoms and cognition in a group of young people seeking mental health services. We report that young people with mental health disorders have reduced gray matter in the left anterior insula associated with impaired attention, and that increases or decreases in right anterior insula gray matter are associated with increased positive symptoms. Next, we chose to investigate two disorders that are characterised by positive symptoms and cognitive deficits, namely psychosis and bipolar disorder. Chapter 3 (Hatton et al., 2013) investigates how reductions in cortical thickness relate to cognitive deficits in psychosis and bipolar disorder subjects compared to healthy counterparts. Compared to healthy counterparts, bipolar and psychosis subjects showed reduced cortical thickness within the bilateral insula-temperoparietal regions that was associated with cognitive deficits in visual sustained attention, semantic verbal fluency, verbal learning and verbal memory. Importantly, regions of shared cortical reductions between psychosis and bipolar disorder subjects were associated with the same cognitive deficits demonstrating that these two different diagnoses shared common neuroanatomical changes in the insula-temperoparietal regions and gave rise to the same cognitive deficits and clinical needs. Subsequently, we sought to understand how these regions of reduced cortical thickness are structurally connected by underlying white matter pathways in early psychosis. In Chapter 4 (Hatton et al., 2014b) we use a new analysis technique to demonstrate that long association white matter tracts subserving the left temperoparietal regions are disorganised in young psychosis subjects compared to controls, yet the uncinate fasciculus connecting the insula to the temporal lobe was not significantly different. Relative to healthy controls, psychosis subjects had white matter disruptions in the forceps major (associated with worse depression and symptom severity), left inferior longitudinal fasciculus (associated with worse depression and symptom severity) and left superior longitudinal fasciculus (associated with worse distress, verbal fluency and attention). Importantly, this paper demonstrated that the changes within these tracts are associated with alterations in axon cohesion at this early stage of illness, which is in contrast to reports of myelin loss that is characteristic of chronic psychosis. Considering our findings of gray matter volume changes in the left insula, as well as reduced cortical thickness and abnormalities in long white matter tracts subserving the left insula-temperoparietal region, we examined more closely the short white matter tracts connecting these regions. In Chapter 5 (Hatton et al., 2014a) we build an atlas of the gray matter volumes, white matter volumes and short association tracts comprising the left insula-temperoparietal junction. Compared to controls, adolescent-onset psychosis subjects showed pronounced white matter abnormalities in the fibres connecting the left superior and middle temporal gyri, and adult-onset psychosis subjects had increased white matter in the left Heschl’s gyrus that was associated with worse attention shifting and executive functioning. Furthermore, we show that there are white matter abnormalities in the fibres connecting the left superior temporal gyrus to Heschl’s gyrus in adolescent-onset psychosis subjects compared to adult-onset subjects. This last publication integrated the techniques of volumetric analysis, cortical parcellation and tractography to highlight how subtle neuroanatomical changes in the early course of a severe mental health disorder are associated with common clinical and cognitive symptoms. This thesis concludes in Chapter 6 with a discussion of the culmination of these four papers. A brief overview of key findings is provided followed by a discussion of mechanisms that could explain the neuroanatomical changes observed and how such changes relate to symptoms and cognitive deficits in emerging mental health disorders. The thesis closes with suggestions to improve the clinical and research utility of structural neuroimaging to provide better outcomes for young people with mental health disorders. The studies reported in this thesis are consistent with the view that the structural brain changes in the early phase of major psychiatric disorders are associated with the common symptoms and cognitive impairments seen in young people seeking mental health services. Critically, these early neuroanatomical changes differ both from normal brain maturation during adolescence and early adulthood as well as neuroanatomical changes reported in older chronic subjects with major psychiatric disorders. In conclusion, this thesis highlights the need to address neuroanatomical changes and their associated symptoms and cognitive deficits within the context of normal brain maturation and the clinical stage of psychiatric illness progression.

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Teixeira, Eduardo Henrique 1969. "Delirio e delito : estudo caso-controle de homens delirantes que cometeram atos criminosos com violência comparados com delirantes que não cometeram atos criminosos." [s.n.], 2007. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311621.

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Orientador: Paulo Dalgalarrondo Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Medicas Made available in DSpace on 2018-08-08T11:26:57Z (GMT). No. of bitstreams: 1 Teixeira_EduardoHenrique_M.pdf: 2378711 bytes, checksum: 73d59583c19a26a22f8da5b55f2524c8 (MD5) Previous issue date: 2007 Resumo: IntroduÃ§Ã£o: Aspectos da psicopatologia do delÃrio e do perfil dos pacientes delirantes parecem relacionados Ã ocorrÃªncia de crime violento. Objetivo: Descrever o perfil sÃ³cio-demogrÃ¡fico e psicopatolÃ³gico de sujeitos delirantes que cometeram crimes violentos. MÃ©todos: Estudo retrospectivo do tipo caso-controle, comparando dois grupos de trinta pacientes delirantes. Todos pacientes apresentaram transtorno psicÃ³tico com atividade delirante definida. Os pacientes do grupo caso cometeram crimes violentos e foram selecionados da Casa de CustÃ³dia do municÃpio de Franco da Rocha-SP, nos anos de 2004 a 2006. Os pacientes do grupo controle foram selecionados de enfermaria psiquiÃ¡trica do Hospital das ClÃnicas da Unicamp, do Hospital e Maternidade Celso Pierro (Puc-Campinas) e do Instituto AmÃ©rico Bairral do municÃpio de Itapira-SP. Foram utilizadas as escalas PANSS (Escala das SÃndromes Positiva e Negativa), MINI (Entrevista NeuropsiquiÃ¡trica Mini-Internacional) e MMDAS (Escala de AvaliaÃ§Ã£o de DelÃrio Macarthur-Maudsley). Resultados: Os dois grupos foram muito parecidos em relaÃ§Ã£o ao perfil sÃ³cio-demogrÃ¡fico, histÃ³ria da doenÃ§a, comorbidade de substÃ¢ncias psicoativas e conteÃºdo do delÃrio. Os pacientes do grupo caso apresentaram mais antecedentes criminais, embora tenham cometido menos freqÃ¼entemente agressÃµes leves. As vÃtimas dos crimes foram com mais frequÃªncia parentes ou conhecidos. Em relaÃ§Ã£o Ã s dimensÃµes do delÃrio, o grupo caso teve menor pontuaÃ§Ã£o em â?¿inibiÃ§Ã£o de aÃ§Ã£oâ?? e â?¿afeto negativoâ??. ConclusÃµes: Fatores intrÃnsecos do delÃrio parecem ser mais relevantes do que o perfil sÃ³cio-demogrÃ¡fico nos sujeitos delirantes que cometem crimes. DelÃrios que induzem a inibiÃ§Ã£o de aÃ§Ãµes aparentemente tambÃ©m reduzem o potencial de aÃ§Ãµes violentas. Ao contrÃ¡rio do que se afirma correntemente, pacientes delirantes assustados e com outros afetos negativos associados ao delÃrio parecem cometer menos atos violentos Abstract: Introduction: Some aspects of the psychopathology of delusion and the profile of the delirious patients seem to be related to the occurrence of violent crime. Objective: To describe the social-demographic and psychopathologic profile of delirious patients who have committed violent crimes. Methods: Retrospective case-control study, comparing two groups of thirty delusional patients. All patients had presented psychotic disorders with definite delusion activity. The patients of the case group had committed violent crimes and have been selected out of the criminal-psychiatric ward Franco da Rocha-SP, from 2004 to 2006. The patients of the control group have been selected out of psychiatric ward of the Hospital das ClÃnicas da Unicamp, of the Hospital e Maternidade Celso Pierro (PUC-Campinas) and of the Instituto AmÃ©rico Bairral of the city of Itapira-SP. Scales PANSS (Positive and Negative Syndrome Scale), MINI (Mini International Neuropsychiatric Interview) and MMDAS (Macarthur-Maudsley Delusion Assessment Scale) have been used. Results: The two groups were very similar as far as social-demographic profile, history of the illnesses, substance abuse and content of the delusion. The patients of the case group had greater criminal records, although a smaller frequency of light aggressions. The victims of the crimes had been more often acquaintances or relatives. In relation to the dimensions of the delusion, the patients in the study group scored less in "action inhibition" and "negative affection". Conclusions: Intrinsic factors of the delusion seem to be more relevant than social-demographic profile in the delusional patients who commit crimes. Delusions that induce action inhibition apparently also reduce the potential for violent actions. In contrast to what is commonly said, delusional patients with fear and other negative affection associated to the delusion seem to commit less violent acts Mestrado Saude Mental Mestre em Ciências Médicas

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Molz, Adams Ashleigh. "NATURE OF AND RISK FOR EXPERIENCING MIXED STATES IN RECENT-ONSET BIPOLAR SPECTRUM SAMPLE." Diss., Temple University Libraries, 2015. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/341168.

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Psychology Ph.D. Clinicians and researchers have identified a pattern of "mixed" symptoms that are sometimes exhibited by individuals with bipolar spectrum disorders (BSDs). However, the criteria for these mixed states as outlined by the American Psychological Association have been criticized for being too stringent for most individuals that experience impairing episodes of mixed symptomatology (e.g., Akiskal, 1996). Mixed states are associated with a more impairing course of illness and suicidality. More research is needed on mixed states, and there is particularly little evidence for risk factors in recent-onset samples. The aims of this study were to 1) examine the prevalence of mixed states in a sample of individuals with recent-onset bipolar spectrum disorders, 2) examine the symptom structure of hypomanic and depressive episodes, and 3) examine some of the risk factors associated with mixed states. Participants in sample 1 were adolescents, initially aged 14-19, selected for exhibiting either moderate or high Behavioral Approach System (BAS) risk for first onset of BSDs. Participants in sample 2 were 18-24 year old undergraduates from Temple University recruited for having a bipolar spectrum diagnosis. Mixed states captured 37.10% of all episodes examined in sample 1, yet only 13 (10.48%) of these episodes met available research criteria for mixed mood episodes. Factor analysis yielded two adequate models that fit the data; one model had two factors that aligned with traditional depressive and hypomanic symptomatology, and another model had three factors that aligned with hypothesized overactivity, inhibited depression, and irritable risk taking components of bipolar disorder. Latent class analysis allowed for examining observed patterns of responses within individuals, and then grouping heterogeneous groups of individuals into classes based on similarities on dimensions of interest, performance within dimensions, or both (Nylund, Bellmore, Nishina, & Graham, 2007). The latent class analysis showed that three classes best defined bipolar spectrum individuals in sample 1: low impulsivity, aggressive, and substance problems classes were obtained. The `aggressive' class was significantly more likely than the `low impulsivity' class to experience any mixed symptomatology, although a continuous measure of mixed symptoms did not yield significant differences between classes. Overall, the results from the current study support findings suggesting that mixed mood states are more commonly experienced than originally believed. These results extend previous studies to include individuals with bipolar spectrum disorders, not solely bipolar I and II disorders. These findings also suggest that non-treatment-seeking samples may have different types of mixed mood states than those seeking treatment. These findings add support to the literature that individuals with BSDs and comorbid substance use diagnoses are at increased risk for chronic illness, and show that these individuals are also more likely to experience mixed mood states than those without comorbid substance use diagnosis. Treatment providers should be aware of the complications that are inherent in bipolar individuals with comorbid substance diagnoses, as they are more likely to experience more episodes as well as mixed symptoms. Temple University--Theses

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McCabe, Patrick J. "Cannabis Use and Bipolar Disorder: Bipolar Disorder Case Identification and Cannabis Use Risk Assessment: A Dissertation." eScholarship@UMMS, 2011. https://escholarship.umassmed.edu/gsbs_diss/584.

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Bipolar disorders (BD) are characterized by symptoms of grandiosity, decreased need for sleep, pressure to keep talking, flight of ideas, distractibility, increased goal-directed activities, psychomotor agitation, and excessive involvement in pleasurable activities. Those with a bipolar disorder have a high degree of psychiatric comorbidity including substance use disorders, and they also experience increased mortality. Despite the widespread recognition of BD as an important psychiatric condition, available population-based estimates for BD prevalence differs across data sources. Cannabis is one of the most widely-used illicit substances. Evidence supports it as a risk factor for psychotic symptoms and disorders. Because populations with psychotic disorders and populations with bipolar disorder share genetic characteristics, cannabis may increase risk for bipolar disorders through the same pathways as it does with psychotic disorders. Limited and conflicting evidence regarding the association of cannabis use and bipolar disorder is currently available. This dissertation investigates cannabis use as a risk factor for incident manic symptoms and bipolar disorders in a large nationally representative longitudinal cohort. The first aim of this dissertation is to evaluate the implications for manic, hypomanic and major depressive episode prevalence estimates arising from the different approaches to assessing DSM-IV criterion between two national surveys. Differences in the assessment of impairment strongly influence manic or hypomanic classification within the NESARC. Compared to multiple imputation estimates (19.7% [95% CI: 19.3-20.1]) which treat depressed mood and anhedonia as separate symptoms, symptom assessment in the NESARC substantially underestimates major depressive episode prevalence (16.9% [95% CI: 16.1-17.6]). The second research objective examined self-reported cannabis use as a risk factor for incident manic symptoms, bipolar spectrum disorders (including manic and hypomanic episodes) and SCID-based recalibrated BD I and II. Cannabis use risk was assessed in the population as a whole and in sub-populations defined by age, substance abuse/dependence status, and family history. Among those reporting no lifetime major depressive or manic symptoms at baseline, self-reported past-year cannabis use was associated with increased odds of an incident week of extremely elevated or irritable mood accompanied by at least two manic episode criterion B symptoms (adj. OR 1.69, 95% CI: 1.08-2.65, p=.02) over the three year follow-up period. Among adults (ages 26 to 45) >=1 reported use(s) of cannabis per week was associated with incident manic or hypomanic episodes (adjusted OR 2.52, 95% CI: 1.32-4.80, p=.006). Among those endorsing no major depressive symptoms, substance abuse/dependence, or anti-social traits in their first degree relatives, past year cannabis use is associated with increased risk for incident bipolar spectrum disorders (adjusted OR 2.27, 95% CI: 1.01-5.10, p=.05) and CIDI recalibrated BD I and II (adjusted OR 5.49, 95% CI: 1.38-21.9, p=.02). Past year cannabis use risk for DSM-IV manic or hypomanic episodes among those aged 26 to 45 is concentrated in those with a baseline history of a substance use disorder (adj. OR 2.00, 95% CI: 1.10-3.66, p=.02) as compared to those with no such history (adj. OR 1.87, 95% CI: 0.49-7.21, p=.36). The third research objective of this dissertation was a sensitivity analysis using externally-predicted categorized exposures and continuous cannabis use propensities. The sensitivity analysis found evidence of exposure misclassification. Exposures defined by external propensity scores had improved cross-sectional association with bipolar spectrum disorders compared to reported use when both were compared to an external standard. No significant risk estimates were found for categorized predicted cannabis use among groups that were previously found to have significant risk from reported exposure. However, among adults 18 to 45 years of age with no manic or major depressive symptoms at baseline, past year cannabis use propensity (as a log transformed continuous measure) was associated with incident manic or hypomanic episodes (adj. OR 1.49, 95% CI: 1.10-2.03, p=.01). Elevated risk for high cannabis use propensity (>=1 use/week in the past year) was also found in this same group (adj. OR 1.33, 95% CI: 1.03-1.72, p=.03). Among those with no reported history of depression, substance abuse/dependence, or anti-social traits among their first-degree relatives, propensity for past year cannabis use (adj. OR 1.61, 95% CI: 1.11-2.32, p=.01) and propensity for >=1 use/week of cannabis in the past year (adj. OR 1.38, 95% CI: 1.03-1.85, p=.03) were associated with incident manic or hypomanic episodes. Among those without a substance use history at baseline, propensity for past year cannabis use (adj. OR 1.63, 95% CI: 1.33-1.55, p=1 use/week of cannabis in the past year (adj. OR 1.54, 95% CI: 1.26-1.88, p The findings of the first aim support the conclusion that the AUDADIS substantially under-estimated lifetime major depressive episode prevalence compared to an imputed estimate that treated anhedonia and depressed mood as separate and concurrent MDE symptoms. The operationalization of impairment for manic disorders in both the AUDADIS and CIDI strongly influences case identification, with the CIDI having suppressed manic and hypomanic prevalence estimates. Evidence was found supporting the conclusion that self-reported cannabis use is a significant risk factor for incident bipolar spectrum outcomes within subpopulations in a nationally representative cohort. A sensitivity analysis finds evidence that supports the conclusion that increasing cannabis use propensity is associated with increased risk of bipolar spectrum outcomes within population subgroups, with the greatest increased risk among those with the lowest innate risk. Under-reporting of illicit substance use is a major limitation in this dissertation; further study is needed with improved exposure measures.

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Levin, Alexandra. "Writing Out Your Feelings: Linguistics, Creativity, & Mood Disorders." Scholarship @ Claremont, 2017. http://scholarship.claremont.edu/scripps_theses/963.

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The purpose of this study proposal is to examine the potential relationship between linguistic creativity and mood disorders, specifically depression and bipolar disorder. Participants will be approximately 67 adults who have either bipolar disorder, major depressive disorder, or serve as a healthy control group. Participants will complete prompts in order to measure linguistic creativity and then fill out several questionnaires relating to depressed mood, mania, general creativity, and rumination levels. It is predicted that bipolar disorder will have higher levels of certain types of linguistic creativity, such as lexical and semantic creativity, whereas depression will have more syntactic creativity. Furthermore, it is anticipated that higher rumination levels in the depressed group will be associated with higher levels of linguistic creativity, as opposed to participants in the depressed group with lower levels of rumination. Lastly, it is predicted that the type of writing prompt will influence the amount of creativity exhibited by each participant group. The proposed study has implications for therapeutic benefits, the emergence of a new area of research in two separate fields, and a new way of analyzing shifts in speech patterns of those with mood disorders.

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Pina, Cesar. "Barriers to Medication Acceptance in Patients Diagnosed With Bipolar Disorder." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5116.

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The problem addressed in this project was poor medication acceptance among patients with bipolar disorder in an outpatient psychiatric clinic. The practice-focused question asked about the factors that contribute to medication nonacceptance in patients with bipolar disorders and further sought to determine strategies that promote medication acceptance. The project took place in an outpatient psychiatric clinic in the southern United States. The Iowa model and the Orem self-care deficit nursing theory were used to guide the project. Deidentified data from 55 patients in an outpatient mental health clinic formed the basis of the project. The data included a survey made up of 6 open-ended questions asking about reasons for not taking prescribed medications. A second source of deidentified data was the results of the medication adherence questionnaire, a Likert-style questionnaire that asked about the level of adherence to medications. Qualitative data were examined by manually coding the results, and the quantitative questions were analyzed for frequencies and percentages. Results from the analyses indicated that 70% of patients with bipolar disorder had missed doses of medications and were not adherent to their prescribed medications. Results of the project were then used to develop recommendations for addressing medication nonadherence among patients with bipolar disorder. Recommendations included education for nursing staff on how to teach patients and their families the advantages of medication adherence and to promote self-care consistent with Orem's model of self-care. Positive social change is possible as a result of this project as patients with bipolar disorders learn self-care strategies for medication adherence.

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Grierson, Ashlee Brooke. "Optimising Sleep-Wake And Circadian Rhythm Interventions For Youth With Mood Disorders." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17574.

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Mood disorders are ranked as the most burdensome disorders for youth worldwide. The consequences for this age group are serious, including exacerbated symptoms, persistent syndromes, and suicide. A treatment target of interest is sleep-wake and circadian rhythm disturbances, as disruptions in these phenomena trigger and prolong mood symptoms. However, efficacious sleep-wake and circadian rhythm interventions for youth with mood disorders are limited, potentially owing to a lack of youth-specific programs and inadequate assessment of sleep-wake and circadian rhythms as outcome measures. A second treatment target of interest is maladaptive rumination. Maladaptive rumination has been shown to predict depression onset, maintenance, and relapse in youth with mood disorders. Importantly, rumination shares bidirectional links with sleep-wake disturbance in youth. However, the commonalities between these phenomena remain unclear, where shared dimensions may represent valuable intervention targets that could optimise future sleep-wake and circadian rhythm interventions for youth. This thesis aimed to address these potentially significant gaps through a series of empirical and review studies examining sleep-wake and circadian rhythm disturbance, rumination, and the treatment of youth with mood disorders. Within this thesis, five empirical and review studies were conducted: 1) a review of non-pharmacological and psychological interventions targeting sleep-wake and circadian rhythm disturbance in youth with mood disorders; 2) a cross-sectional analysis of circadian rhythm disturbances in youth with mood disorders; 3) a pilot of a novel youth-specific sleep-wake and circadian rhythm intervention for youth with mood disorders; 4) a review of rumination as a key biomarker for mental disorders in youth and as a modifiable treatment target; and 5) a longitudinal examination of common dimensions between sleep-wake disturbance and rumination as trans-diagnostic predictors of illness trajectories in at-risk youth. These findings provide the foundation for an optimised sleep-wake and circadian intervention for youth with mood disorders, and bring to light the necessary dual inclusion of rumination and sleep-wake and circadian rhythms as intervention targets for this patient population.

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Mantere, Outi. "Recognition, comorbidity, and outcome of DSM-IV bipolar I and II disorders in psychiatric care." Helsinki University of Helsinki, 2007. http://urn.fi/URN:ISBN:978-951-740-694-9.

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Diss. Tiivistelmäosa. - University of Helsinki, Faculty of Medicine, Institute of Clinical Medicine, Department of Psychiatry, Department of Mental Health and Alcohol Research, National Public Health Institute. Myös paperimuodossa (ISBN 978-951-740-693-2).

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Zonta, Filippo. "Hippocampal volumes in patients with bipolar-schizophrenic spectrum disorders and their unaffected first-degree relatives." Doctoral thesis, Università degli studi di Padova, 2013. http://hdl.handle.net/11577/3423015.

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BACKGROUND: schizophrenic and bipolar disorders are complex and disabling psychiatric diseases whose classical nosography and classification are still under challenging debate aiming to overcome the traditional “Kraepelinian Dichotomy”. For the past hundred years most clinical work and research in psychiatry has proceeded under the assumption that schizophrenia and bipolar disorderaredistinctentities with separate underlying disease processes and treatments. In more recent years there has been increasing evidence for phenomenological, biological and genetic overlap between the two disorders (Potash and Bienvenu 2009). Nowadays, the categorical approach to psychiatric nosography is in contrast with the recent neurobiological, neuropsychological and genetic findings in affective and schizophrenic disorders. Further, symptoms and signs constituting bipolar and schizophrenic disorders are continuously, not dichotomously, distributed; there may be no point of “real cleavage” (Phelps et al. 2008). This recognition has led some clinicians and researchers to call for a diagnostic model that, moving to a “dimensional perspective”, formally recognizes a continuous spectrum from schizophrenic to bipolar (and recurrent depressive) disorders. Kelsoe argued that the existing data coming from various fields of research in bipolar and schizophrenic disorders may best fit a model in which different set of genes predispose to overlapping phenotypes in a continuum. Given the apparent overlap of regions of the genome implicated in bipolar disorder with those for schizophrenia (Kelsoe 1999; Berrettini 2000), the data suggest the possibility that a common polygenic background predisposes to both bipolar disorder and schizophrenia, according to the so-called “multiple threshold model” (Kelsoe 2003). As highlighted by Craddock and Owen, the recent findings are compatible with a model of functional psychosis in which susceptibility to a spectrum of clinical phenotypes is under the influence of overlapping sets of genes, which, together with environmental and epigenetic factors, determine an individual’s expression of illness (Craddock and Owen 2005). A lot of interest is focusing on brain structural abnormalities in patients suffering from schizophrenia and bipolar disorder. A huge amount of neuroimaging studies has been published so far, however the literature is heterogeneous and there is still some degree of uncertainty concerning what key regions are involved in the pathogenesis of such disorders. Schizophrenia and Bipolar Disorder have a number of overlapping symptoms and risk factors, but it is not yet clear if the disorders are characterized by similar deviations in brain morphometry or whether any such deviations reflect the impact of shared susceptibility genes on brain structure. To date there is no consensus about whether, and to what extent, gray matter loss in Schizophrenia is mirrored in Bipolar Disorder and what is the effect of medication or other confounding factors. Studies in family members of patients, who share the risk of the disease but not the confounding factors, may help elucidate whether abnormalities in brain structures are shared by both illnesses. AIM OF THE STUDY: to investigate hippocampal gray matter volume differences in a group of patients with bipolar-schizophrenic spectrum disorders, a group of their unaffected first-degree relatives, and a group of healthy control subjects. METHODS: a total of 104 subjects - 36 schizophrenic or schizoaffective (SZ), 27 bipolar (BP), 2 major depression, 8 unaffected relatives (UR), and 31 healthy controls (HC) - underwent 1,5 T MRI scanning, with volumetric T1 3D acquisition protocol, at the Neuroradiology Unit of Conegliano Hospital. We calculate bilateral hippocampal gray matter volume (HV) and total cerebral volume (TCV) in a sample of 31 SZ, 27 BP, 8 UR and 26 HC, with a stereological method using ANALYZE 10.0 software. RESULTS: we found statistically significant reductions in bilateral HV in the BP-SZ patients compared to HC; the direct comparison between patient groups identified statistically significant reduction in the right HV of SZ, but no significant differences for left HV or TCV (however statistical significance was lost after normalization); statistically significant reduction in the left HV and a trend towards statistical significance for right HV in the UR compared to HC (a trend towards statistically significant reduction in bilateral HV persisted after normalization). CONCLUSION: it might be speculated that the alterations of the gray matter volume in the hippocampus highlighted in our study could be interpreted as a possible structural “biological marker” in the schizophrenic-bipolar spectrum. INTRODUZIONE: schizofrenia e disturbo bipolare sono malattie psichiatriche complesse e invalidanti, il cui inquadramento nosografico è oggetto di continuo dibattito nel superamento della classica “dicotomia Kraepeliniana” tra Dementia Praecox e Malattia Maniaco-Depressiva. Negli ultimi cento anni, buona parte della pratica clinica e della ricerca in psichiatria sono state basate sull’assunto che schizofrenia e disturbo bipolare fossero entità categorialmente distinte, separate da distinti meccanismi patologici e trattamenti. In anni più recenti invece, si sono accumulate numerose evidenze a supporto di una parziale sovrapposizione fenomenologica, biologica e genetica tra questi disturbi (Potash e Bienvenu 2009). Attualmente, l’approccio nosografico “categoriale” nei disturbi affettivi e schizofrenici è in contrasto con le più recenti scoperte in ambito neurobiologico, neuropsicologico e genetico. Inoltre è stato evidenziato come, nemmeno dal punto di vista clinico vi sia un reale punto di “separazione” tra i due disturbi, che presentano segni e sintomi comuni e sovrapponibili (Phelps et al. 2008). Tale consapevolezza ha portato clinici e ricercatori a orientarsi verso un modello diagnostico che, spostandosi in una prospettiva “dimensionale”, formalmente riconosce l’esistenza di uno spettro tra disturbi schizofrenici e bipolari. Kelsoe afferma che i dati provenienti dai vari filoni di ricerca nei disturbi bipolari e schizofrenici potrebbero essere meglio spiegati da un modello in cui differenti set di geni predispongono a fenotipi clinici che si sovrappongono in un continuum. Data la documentata sovrapposizione fra regioni genomiche implicate nel disturbo bipolare con quelle della schizofrenia (Kelsoe 1999; Berrettini 2000), le evidenze suggeriscono la possibilità che un substrato poligenico comune possa conferire una predisposizione a entrambi i disturbi, secondo il cosiddetto modello delle “soglie multiple” (Kelsoe 2003). Come sottolineato da Craddock e Owen, le più recenti scoperte in tale ambito sono compatibili con un modello di psicosi funzionale, nel quale la suscettibilità ad uno spettro di fenotipi clinici è sotto l’influenza di un set di geni condivisi, che, insieme a fattori ambientali ed epigenetici, determina l’espressione di malattia in ciascun individuo (Craddock e Owen 2005). Notevole interesse si sta inoltre focalizzando sulle alterazioni strutturali cerebrali in pazienti affetti da schizofrenia e disturbo bipolare. Nonostante l’ingente mole di studi di neuroimaging finora pubblicati, la letteratura sull’argomento è molto eterogenea ed esiste ancora notevole incertezza su quali siano le specifiche regioni cerebrali coinvolte nella patogenesi di tali disturbi. Schizofrenia e Disturbo Bipolare condividono una serie di sintomi e fattori di rischio, ma non è ancora stato chiarito se questi disturbi siano caratterizzati da comuni modificazioni morfometriche cerebrali e se tali alterazioni riflettano l’impatto di geni comuni di suscettibilità sulla morfologia del cervello. Ad oggi, non è stato definitivamente chiarito se, e fino a che punto, la documentata perdita di sostanza grigia nella Schizofrenia si rifletta anche nel Disturbo Bipolare e su quali siano gli effetti della farmacoterapia o di altri fattori di confondimento. Gli studi sui membri non affetti di pazienti schizofrenici e bipolari, che condividono la predisposizione genetica ai disturbi, ma non i fattori di confondimento, posso rivelarsi utili nel verificare se le varie anomalie cerebrali siano condivise nelle due patologie. SCOPO DELLO STUDIO: analizzare eventuali differenze volumetriche nella sostanza grigia ippocampale in un gruppo di pazienti dello spettro bipolare-schizofrenico, un gruppo di familiari di primo grado non affetti e un gruppo di soggetti sani di controllo. MATERIALI E METODI: un totale di 104 sogetti - 36 pazienti con disturbo schizofrenico o schizoaffettivo (SZ), 27 pazienti con disturbo bipolare (BP), 2 pazienti affetti da depressione maggiore ricorrente, 8 familiari di primo grado non affetti (UR) e 31 controlli sani (HC) sono stati sottoposti ad una procedura di Risonanza Magnetica cerebrale ad 1,5 Tesla, secondo un protocollo di acquisizione di sequenze T1 3D volumetriche, presso l’Unità Operativa di Neuroradiologia del Presidio Ospedaliero di Conegliano. Mediante l’utilizzo del Software ANALYZE 10.0, sono stati calcolati, con un metodo stereologico, i volumi bilaterali della sostanza grigia ippocampale (HV) ed il volume cerebrale totale (TCV) in un campione di 31 SZ, 27 BP, 8 UR e 26 HC. RISULTATI: sono state riscontrate riduzioni volumetriche statisticamente significative della sostanza grigia di ippocampo destro e sinistro tra i gruppi di pazienti dello spettro bipolare-schizofrenico rispetto ai controlli; nel confronto diretto tra il gruppo di pazienti schizofrenici e quello dei bipolari è stata identificata una riduzione statisticamente significativa del volume della sostanza grigia dell’ippocampo destro (tale significatività non persiste in seguito a normalizzazione) e nessuna significativa differenza nei volumi della sostanza grigia dell’ippocampo sinistro o nel volume cerebrale totale; nel confronto tra il gruppo di familiari di primo grado non affetti rispetto al gruppo di soggetti sani di controllo è stata evidenziata una significativa riduzione volumetrica della sostanza grigia dell’ippocampo sinistro e un trend verso la significatività statistica per l’ippocampo destro (tali riduzioni volumetriche della grigia ippocampale mantenevano bilateralmente tale trend verso la significatività statistica anche dopo la normalizzazione). CONCLUSIONE: la alterazione volumetrica della sostanza grigia ippocampale evidenziata nel nostro studio potrebbe essere interpretata come un possibile “marker biologico” strutturale nei disturbi dello spettro schizofrenico-bipolare.

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Starling, Jean. "The clinical, cognitive and connectivity features of early onset psychotic disorders." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/13505.

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This thesis is about an overlooked area in psychiatry: psychotic disorders in the very young. It examines psychosis in 42 children and young adolescents in three ways – phenomenologically, cognitively and biologically - using a group with a mean age of 13.2 years (SD 2.3 years, range 7-16 years). The diagnoses made were 36% schizophrenia spectrum, 43% bipolar disorder and 21% psychosis not otherwise specified. There was a high prevalence of pre-existing abnormalities, including developmental, social and mood symptoms. Symptoms were similar to those of older first episode psychosis (FEP) samples; with 90% having auditory hallucinations and 50% visual hallucinations. Affective and non-affective psychoses had similar severity of presentation and levels of impairment. Those with a trauma history, 47% of the group, had more disturbed behaviours, particularly self-harm and aggression, and a more difficult treatment course. There were extensive deficits in neurocognition and social cognition, ranging from 0.56 to 1.37 SD below the control mean, a magnitude similar to other FEP populations. The greatest impairments were in attention/vigilance (z= -1.37), verbal learning (z= -1.34), reasoning and problem solving (z= -1.11), and visual learning (z= -1.01). Working memory impairment (z= -0.57) was correlated with poorer role functioning and negative symptoms. A biological measure of connectivity, gamma synchrony, was increased both at baseline and during an auditory oddball task compared to controls, suggesting an integrative system overloaded at rest, with a corresponding inability to respond to cognitive tasks. In summary, this thesis makes several original contributions to the literature. The first is the age of the group, with a mean age of 13.2 years, substantially younger than previous FEP studies. The second are the wide-ranging measures, which include an exploration of phenomenology, cognitive deficits and electroencephalographic (EEG) measures. Finally, this is the first time that gamma synchrony, an EEG measure well validated in older FEP samples, has been studied in psychotic disorders in this age group. These findings provide a credible explanation for the poor level of functioning seen in other studies of children with psychotic disorders.

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Campos, Rodolfo Nunes. "Ocorrência e correlatos do espectro bipolar em pacientes com transtornos alimentares atendidos em serviço terciário: projeto ESPECTRA." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/5/5142/tde-26012012-092127/.

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Pacientes com transtornos alimentares freqüentemente apresentam comorbidades com outros transtornos psiquiátricos, em especial com os transtornos de humor. Apesar de estudos recentes sugerirem uma íntima relação com o transtorno bipolar, o estudo do espectro bipolar em suas formas abrangentes ainda não foi realizado nesta população. O presente trabalho estudou, em pacientes com transtornos alimentares atendidos em serviço terciário, a ocorrência do espectro bipolar e os correlatos de impulsividade, imagem corporal, sintomas de humor ao longo da vida, adequação social e qualidade de vida. Avaliou sessenta e nove pacientes com diagnóstico de anorexia nervosa, bulimia nervosa ou transtorno alimentar sem outra especificação e, como grupo comparativo, sessenta e nove mulheres sem diagnóstico de transtornos alimentares ou transtorno bipolar. A avaliação foi constituída pela Entrevista Clínica Estruturada para Transtornos do Eixo I do DSM IV, avaliação clínica dos critérios de Zurich para diagnóstico do espectro bipolar, a Escala de Impulsividade de Barrat, o Questionário de Imagem Corporal, a Escala de Auto-avaliação de Hipomania, a Entrevista Clínica Estruturada para o Espectro do Humor, Escala de Hamilton para Avaliação de Depressão, Escala de Young para Avaliação de Mania, a Escala de Adequação Social e a Escala de Avaliação da Qualidade de Vida. As comparações das médias das variáveis contínuas foram realizadas por meio dos testes de Kruskal- Wallis e Mann-Whitney. A associação entre as variáveis categóricas e os grupos foi descrita através de tabelas de contingência e analisadas através do teste Chi- Quadrado de Pearson ou Exato de Fisher. A análise multivariada pelo método de stepwise foi realizada para verificar o efeito das variáveis sobre a imagem corporal, adequação social e qualidade de vida. O nível de significância alfa foi estabelecido em 5%. Os resultados mostraram que 68,1% das pacientes apresentaram comorbidade com espectro bipolar e isto esteve associado à maior renda familiar, proporção de pessoas casadas, comorbidade com uso de substâncias e mais sintomas maníacos/hipomaníacos ao longo da vida. Tanto o grupo com e sem comorbidade com espectro bipolar apresentaram maiores níveis de gravidade em todos os desfechos avaliados em relação ao grupo comparativo. No grupo de pacientes com comorbidade com espectro bipolar a qualidade de vida, impulsividade e comportamento suicida influenciaram a imagem corporal. Estes resultados mostraram que o espectro bipolar é uma comorbidade comum em pacientes com transtornos alimentares e está associado a correlatos de importância clínica, notadamente a comorbidade com uso de substâncias. Devido ao padrão de semelhança entre os grupos com e sem comorbidade com o espectro bipolar em relação a diversos desfechos avaliados a identificação da comorbidade pode ser difícil. Entretanto, o diagnóstico preciso e a identificação criteriosa de correlatos clínicos pode contribuir para futuros avanços no tratamento destas condições Eating disorder patients often have comorbidities with other psychiatric disorders, especially with mood disorders. Although recent studies suggest an intimate relationship with bipolar disorder, the study of bipolar spectrum broader definition has not been done in this population. This work studied the occurrence of bipolar spectrum and correlates of impulsivity, body image, mood symptoms throughout life, social adjustment and quality of life in eating disorders patients of a tertiary service. Sixty-nine female patients diagnosed with anorexia nervosa, bulimia nervosa or eating disorder not otherwise specified and, as a comparative group, sixty-nine women without a diagnosis of eating disorder or bipolar disorder were evaluated. The evaluation comprised the Structured Clinical Interview for DSM IV Axis I Disorders, clinical criteria for diagnosis of Zurich bipolar spectrum, Barratt Impulsiveness Scale, the Body Shape Questionnaire, the Hypomania Checklist-32, the Structured Clinical Interview for Mood Spectrum, Hamilton Depression Rating Scale, Young Mania Rating Scale, Social Adjustment Scale and the World Health Organizations Quality of Life Questionnaire. Kruskall-Wallis and Mann-Whitney tests compared means of continuous variables. The association between categorical variables and the groups were described using contingency tables and analyzed using the chi-squared or Fisher exact test. Multivariate analysis using the stepwise method was performed to verify the effect of variables on body image, social adjustment and quality of life. The level of significance alpha was set at 5%. The results showed that 68,1% of patients had comorbidity with bipolar spectrum and this was associated with higher family income, proportion of married people, comorbidity with substance use and more manic/hypomanic symptoms throughout life. The groups with or without comorbidity with bipolar spectrum showed more severity in all outcomes compared with the comparison group. In patients with comorbid bipolar spectrum, quality of life, impulsivity and suicidal behavior influenced the body image. These results showed that the bipolar spectrum is a common comorbidity in patients with eating disorders and is associated with correlates of clinical importance, notably the comorbidity with substance use. Due to the pattern of similarity between the groups with and without comorbid bipolar spectrum in relation to various outcomes evaluated the identification of comorbidity can be difficult. However, the precise diagnosis and careful identification of clinical correlates may contribute to future advances in treating these conditions

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Stroppa, André Lúcio Pinto Coelho. "Religiosidade e espiritualidade no transtorno bipolar do humor." Universidade Federal de Juiz de Fora (UFJF), 2011. https://repositorio.ufjf.br/jspui/handle/ufjf/4934.

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Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-06-14T12:24:26Z No. of bitstreams: 1 andreluciopintocoelhostroppa.pdf: 17748362 bytes, checksum: 19a0925c34309dbb1712aed625ee5121 (MD5) Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-06-29T12:06:43Z (GMT) No. of bitstreams: 1 andreluciopintocoelhostroppa.pdf: 17748362 bytes, checksum: 19a0925c34309dbb1712aed625ee5121 (MD5) Made available in DSpace on 2017-06-29T12:06:43Z (GMT). No. of bitstreams: 1 andreluciopintocoelhostroppa.pdf: 17748362 bytes, checksum: 19a0925c34309dbb1712aed625ee5121 (MD5) Previous issue date: 2011-09-14 Objetivos: Investigar a relação entre Religiosidade/Espiritualidade (R/E) e o estado de humor, qualidade de vida, ocorrência de internações hospitalares e tentativas graves de suicídio entre pacientes bipolares. Métodos: Em um estudo transversal com pacientes bipolares em tratamento ambulatorial (n=168) foram avaliados sintomas de Mania (YMRS) e Depressão (MADRS), Religiosidade (Duke Religious índex), Coping Religioso-Espiritual (Brief RCOPE) e Qualidade de Vida (WHOQOL-BREF). Dados sociodemográficos, número tentativas de suicídio e internações foram obtidos através da entrevista com o indivíduo e análise do prontuário médico. Foram realizadas regressões logísticas e lineares das associações entre os indicadores de R/E e as variáveis clinicas, controlando para variáveis sociodemográficas. Resultados: Referiram alguma filiação religiosa 148 (88,1%) indivíduos. Religiosidade Intrínseca e mais estratégias de Coping Religioso-Espiritual (CRE) positivo associaram-se a menos sintomas depressivos, respectivamente (OR) 0.19, (Cl) 0.06 — 0.57, (p) 0.003 e (OR) 0.25, (Cl) 0.09 — 0.71, (p) 0.01. Qualidade de vida associou-se a Religiosidade Organizacional (B) 0.188, (p) 0.019, Religiosidade Intrínseca (B) 0.306, (p) <0,001 e CRE positivo (B) 0.264, (p) 0.001. CRE negativo associou-se a pior qualidade de vida (B) — 0.253, (p) 0.001. Conclusões: Religiosidade intrínseca e CRE positivo associaram-se a menor ocorrência de depressão e melhor qualidade de vida de forma significativa. Estudos longitudinais serão úteis na investigação de relações causais. Aims: To investigate the relationship between Religiousness/Spirituality (R/S) and mood, quality of life, hospitalizations and severe suicide attempts among bipolar patients. Methods: In a transversal study among bipolar patients under ambulatory care (n=168), symptoms of Mania (YMRS) and Depression (MADRS), Religiousness (Duke Religious Index), Religious Coping (Brief RCOPE) and Quality of Life (WHOQOL-BREF) were assessed. Socio-demographic data, number of suicide attempts and hospitalizations were obtained through an interview with the individual and analysis of medical records. Logistical and linear regressions of the association between the Religious indicators and clinical variables were carried out, controlling for socio-demographic variables. Results: 148 individuals mentioned some kind of religious affiliation (88.1%). Intrinsic Religiousness (IR) and Positive Religious Coping (RC) strategies associated to less depressive symptoms [respectively odds ratio (OR) = 0.19, 95% confidence interval (Cl) = 0.06 - 0.57, p=0.003 and OR= 0.25; Cl = 0.09 - 0.71, p=0.01]. Quality of life inversely associated with negative RC ([3= - 0.253, p=0.001) and directly associated with Organizational Religiousness (13= 0.188, p=0.019), Intrinsic Religiousness (13= 0.306, =p <0,001) and positive RC (13- 0.264, p= 0.001). Conclusions: Intrinsic Religiousness and positive RC are strongly associated with less depressive symptoms and better quality of life. Negative RC associated to worse quality of life. Religiousness is a relevant aspect which must be taken into consideration by physicians when assessing and guiding

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Giannuli, Maria Michael. "Mood-affective and anxiety disorders in female juvenile offenders : prediction of crime indexes /." The Ohio State University, 2001. http://rave.ohiolink.edu/etdc/view?acc_num=osu1486398195325394.

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33

Maripuu, Martin. "Hypocortisolism in recurrent affective disorders." Doctoral thesis, Umeå universitet, Psykiatri, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-112824.

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Bipolar disorders and recurrent depressions are two common psychiatric disorders with a life time prevalence of approximately 1% and 8%, respectively. Despite treatment these patients suffer from affective symptoms up to 50% of the time, resulting in lower well-being. The average life length is also reduced with 10-15 years, mainly attributable to suicide and cardiovascular disease. Increased stress is one of many factors that have been shown to be linked to an increased risk for developing affective disorders and some comorbid somatic conditions such as metabolic disturbances and cardiovascular disease. An increased stress level is known to cause hyperactivity of the hypothalamic-pituitary-adrenal-axis (HPA-axis) with increased cortisol secretion. Hyperactivity of the HPA-axis (or hypercortisolism) is one of the most replicated neurobiological finding in depression. In other stress related disorders it has however been shown that prolonged stress over long periods of time can lead to a state of low HPA-axis activity, hypocortisolism. Since persons with recurrent affective disorders such as bipolar disorder and recurrent depression are exposed to a high degree of recurrent and chronic stress it could be expected that in addition to hypercortisolism, a state of hypocortisolism could also develop in these disorders, potentially exerting an influence upon the psychological and somatic wellbeing among these patients. The major aim of this thesis was to evaluate whether hypocortisolism is related to relevant psychiatric and somatic phenotypes in recurrent affective disorders. In bipolar disorder, individuals with hypocortisolism exhibited a higher degree of depression and low quality of life compared to patients with normal HPA-axis activity. In recurrent depression, individuals with hypocortisolism exhibited shorter leukocyte telomere length than patients with normal or high HPA-axis activity, which is an indication of an accelerated aging process. In a sample of both bipolar and recurrent depression patients, hypocortisolism was associated with an increased proportion of obesity, dyslipidemia and metabolic syndrome compared with patients with normal or high HPA-axis activity. Patients with recurrent depression showed a higher occurrence of hypocortisolism than the control sample representative of the general population. Patients with bipolar disorder showed a similar occurrence of hypocortisolism as the control sample. Among bipolar disorder patients with a low degree of lifetime with lithium prophylaxis, there was an inverse correlation between age and HPA-axis activity. In contrast, among patients with a higher degree of lifetime with lithium prophylaxis as well as among the controls, there was no correlation between age and HPA-axis activity. Accordingly, hypocortisolism was most common among older patients with a low degree of lifetime with lithium prophylaxis. In conclusion, hypocortisolism in both recurrent depression and bipolar disorder was associated with multiple clinically-relevant phenotypes. Additionally it was shown for bipolar disorder patients that increasing age was a risk factor for hypocortisolism and that prophylactic lithium treatment was a protective factor. It is argued that the protective effect of lithium towards the HPA-axis is attributable to its mood-stabilizing effect, which in turn reduces the chronic stress level. These results provide new insight into the role of hypocortisolism and chronic stress in recurrent affective disorders warranting further studies and hopefully providing clues to improved treatment strategies.

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Johnson, Lars. "Affective disorders in a stress-vulnerability perspective : a clinical, biological and psycho-social study /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-396-1/.

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35

Decoline, Marie Denise. "Predictors of HIV Testing Among Individuals Diagnosed With Bipolar Disorder." ScholarWorks, 2014. https://scholarworks.waldenu.edu/dissertations/487.

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Research on rates of HIV testing among individuals diagnosed with Bipolar Disorder (BPD) is limited, while HIV infection continues to rise among BPD individuals. The problem is that BPD individuals are at high risk for HIV infection due to non-adherence to treatment for bipolar disorder and manic episodes that can lead to high-risk behaviors. The goal of the study was to examine the association between selected demographic variables, having a bipolar diagnosis, engaging in high-risk behaviors, inability to afford treatment for bipolar disorder, non-adherence to treatment for bipolar disorder, and substance abuse, and their relationship to obtaining an HIV test (the dependent variable) for individuals with BPD. The epidemiologic triangle model served as the theoretical model to assist with interpreting findings. Data collected from 383 BPD diagnosed individuals from the 2007 National Health Interview Study were analyzed using binary logistic regression, chi-square, and multiple logistic regression methods. The results indicated that all 5 behavioral independent variables were significantly associated (p=.000) with obtaining an HIV test. Significant associations were also found for demographic variables (race, gender, and homelessness) as confounding factors that influenced HIV testing among BPD individuals. Implications for positive social change are increased education on the risks of HIV infection and the need for appropriate HIV testing among BPD diagnosed individuals in an effort to protect the health and welfare of this vulnerable population.

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Walther, Andreas, Marlene Penz, Daniela Ijacic, and Timothy R. Rice. "Bipolar Spectrum Disorders in Male Youth: The Interplay between Symptom Severity, Inflammation, Steroid Secretion, and Body Composition." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2018. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-231804.

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The morbidity and societal burden of youth bipolar spectrum disorders (BSD) are high. These disorders are multisystemic in that adult populations there are clear interactions with inflammatory processes and steroidal physiological systems. There are much less data concerning these areas of study in youth populations with BSD. This is surprising given the association of youth-onset BSD with puberty and its associated physiological changes. In this mini-review, we overview the theoretical role of inflammatory processes and steroidal physiological systems in youth BSD, describe the greater literature in adult populations, detail the literature in youth populations when available, and overview current proposed molecular mechanistic pathways and interaction effects based on the available data. We also attend to the interplay of this complex system with body composition and weight gain, an especially important consideration in relation to the role of second generation antipsychotics as the first line treatment for youth with BSD in major clinical guidelines. A developmental model of early onset BSD for boys is hypothesized with pubertal hormonal changes increasing risk for first (hypo-)manic/depressive episode. The dramatic androgen rise during puberty might be relevant for first onset of BSD in boys. A shift from general hypercortisolism driven by glucocorticoid resistance to hypocortisolism with further disease progression is assumed, while increased levels of inflammation are functionally associated with endocrine dysregulation. The interacting role of overweight body habitus and obesity in youth with BSD further indicates leptin resistance to be a central moderator of the dynamic neurobiology of BSD in youth. The intent of this mini-review is to advance our knowledge of youth BSD as multisystemic disorders with important contributions from endocrinology and immunology based on a developmental perspective. This knowledge can influence current clinical care and more importantly inform future research.

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Walther, Andreas, Marlene Penz, Daniela Ijacic, and Timothy R. Rice. "Bipolar Spectrum Disorders in Male Youth: The Interplay between Symptom Severity, Inflammation, Steroid Secretion, and Body Composition." Frontiers Research Foundation, 2017. https://tud.qucosa.de/id/qucosa%3A30703.

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The morbidity and societal burden of youth bipolar spectrum disorders (BSD) are high. These disorders are multisystemic in that adult populations there are clear interactions with inflammatory processes and steroidal physiological systems. There are much less data concerning these areas of study in youth populations with BSD. This is surprising given the association of youth-onset BSD with puberty and its associated physiological changes. In this mini-review, we overview the theoretical role of inflammatory processes and steroidal physiological systems in youth BSD, describe the greater literature in adult populations, detail the literature in youth populations when available, and overview current proposed molecular mechanistic pathways and interaction effects based on the available data. We also attend to the interplay of this complex system with body composition and weight gain, an especially important consideration in relation to the role of second generation antipsychotics as the first line treatment for youth with BSD in major clinical guidelines. A developmental model of early onset BSD for boys is hypothesized with pubertal hormonal changes increasing risk for first (hypo-)manic/depressive episode. The dramatic androgen rise during puberty might be relevant for first onset of BSD in boys. A shift from general hypercortisolism driven by glucocorticoid resistance to hypocortisolism with further disease progression is assumed, while increased levels of inflammation are functionally associated with endocrine dysregulation. The interacting role of overweight body habitus and obesity in youth with BSD further indicates leptin resistance to be a central moderator of the dynamic neurobiology of BSD in youth. The intent of this mini-review is to advance our knowledge of youth BSD as multisystemic disorders with important contributions from endocrinology and immunology based on a developmental perspective. This knowledge can influence current clinical care and more importantly inform future research.

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Verdolini, Norma. "Self and Hetero-Aggression: Clinical Implications in Bipolar Disorder and Mixed States." Doctoral thesis, Universitat de Barcelona, 2018. http://hdl.handle.net/10803/665442.

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The poorest outcomes in bipolar disorder are represented by self-aggressive (i.e. deliberate self-harm, attempted or completed suicide) and hetero-aggressive violent behaviors. A better understanding of the clinical factors associated with both the risk of criminal behavior and the risk of self-injurious behaviors among individuals suffering from bipolar disorder may improve the course of illness and the risk management. The main objective of this doctoral thesis was to evaluate the psychiatric correlates of self- or hetero-aggression in the context of bipolar disorder, particularly in those patients presenting mixed features. The five published articles included in this thesis had different study designs: Study I. A meta-analysis including studies on the association between bipolar disorder and violent criminal behaviors; Study II. A cross-sectional study assessing clinical correlates of deliberate self-harm and suicide attempts in prisoners, particularly mood disorders and bipolar disorder; Study III. A post-hoc analysis of the Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE)-II-MIX multicentric study aimed at evaluating hetero-aggression as a mixed feature during a major depressive episode and its relationship with other clinical variables, such as the lifetime history of suicide attempts. Study IV. Another post-hoc analysis of the BRIDGE-II-Mix study focused on the clinical relevance of the intertwined association between affective lability and mood reactivity and their correlation with other mixed symptoms, particularly verbal or physical hetero-aggression and suicide attempts. Study V. A critical systematic review of guidelines on the treatment of mixed states with a methodological quantitative quality assessment of included articles and a specific focus on challenging aspects such as hetero- and self-aggression. One every fourteen patients suffering from bipolar disorder reported violent criminal behavior. Even though the association with violent criminality was not significant when patients suffering from bipolar disorder were compared with patients suffering from any other psychiatric disorder, the chance of committing violent criminal behavior was smaller in patients with bipolar disorder than in those suffering from psychotic disorders but higher in comparison with patients with depressive disorders. In meta-regression analyses, no significant moderators emerged. The associations for violent criminal behaviors in bipolar disorder in comparison with patients suffering from anxiety, alcohol and drug abuse/dependence and personality disorders were not significant. Mood disorders as well as psychoses, borderline personality disorder and poly-drug use were the most relevant clinical predictors of deliberate self-harm in prison. In the sample of affective patients evaluated during a major depressive episode, the presence of aggressive behaviors was mainly related with bipolarity and the most relevant clinical variable associated with aggression was the presence of mixed features. A significant increase of the risk for aggressive behaviors associated with the presence of lifetime suicide attempts has been observed. As for the association between affective lability with other mixed symptoms, irritable mood and impulsivity were directly significantly associated with affective lability. These two clinical features are two of the most important mediators of self-aggressive behaviors. Despite this, affective lability was not correlated with a higher rate of suicide attempts. The identification of self- and hetero-aggressive behaviors represented the target of a tailored treatment strategy in the subgroup of bipolar disorder patients characterized by a shared psychopathological “aggressive” dimension and mixed characteristics. in conclusion, the self- and hetero-aggressive components of bipolar disorder have been investigated in this doctoral thesis, leading to a better and broader knowledge on the topic, with important implications for the every-day clinical practice and in terms of treatment strategies, both in psychiatric and in correctional settings. El objetivo principal de esta tesis doctoral fue evaluar los correlatos clínicos de auto o hetero-agresiones, en el contexto del trastorno bipolar, con especial foco en aquellos pacientes que presentan características clínicas mixtas. Los cinco artículos incluidos tenían diseños de estudio diferentes: I. Meta-análisis de estudios sobre la asociación entre trastorno bipolar y conductas criminales violentas; II. Estudio transversal que evalúa los correlatos clínicos de autolesiones e intentos de suicidio en presos, en particular trastornos afectivos y trastorno bipolar; III. Análisis post-hoc del estudio BRIDGE-II-MIX, con el objetivo de evaluar la hetero-agresión considerada como característica mixta durante un episodio depresivo, y su relación con otras variables clínicas, como la historia de intentos de suicidio; IV. Análisis post-hoc del estudio de BRIDGE-II-MIX, enfocado en la importancia clínica de la asociación entrelazada entre la labilidad afectiva y la reactividad de humor y su correlación con otros síntomas mixtos, en particular la hetero-agresión verbal o física; V. Revisión crítica sistemática de guías clínicas sobre el tratamiento de estados mixtos con una evaluación cuantitativa de la calidad metodológica de los artículos incluidos. Uno cada catorce pacientes que padecen de trastorno bipolar presentó una conducta criminal violenta. La posibilidad de cometer una conducta criminal violenta era menor en pacientes con trastorno bipolar que en aquellos que padecen de trastornos psicóticos, pero mayor en comparación con pacientes con trastornos depresivos. Los análisis de meta-regresión no detectaron moderadores significativos. Los trastornos afectivos así como las psicosis, el trastorno límite de personalidad y el consumo de diferentes tóxicos eran los factores clínicos de riesgo más relevantes de autolesiones en la cárcel. En la muestra de pacientes afectivos evaluados durante un episodio depresivo, la presencia de comportamientos agresivos principalmente fue relacionada con la bipolaridad y la variable más relevante clínica asociada con agresión, fue la presencia de características mixtas. Se observó además un aumento significativo del riesgo para comportamientos agresivos asociados con la presencia de intentos suicidas previos. La identificación de comportamientos auto y hetero-agresivos representa el objetivo de una estrategia de tratamiento adaptada en el subgrupo de pacientes con trastorno bipolar, caracterizado por una dimensión psicopatológica "agresiva" compartida.

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McAulay, Claire Elise. "Eating Disorder Features in Bipolar Disorder: Course, Psychological Correlates, and Relationship with Quality of Life." Thesis, The University of Sydney, 2019. https://hdl.handle.net/2123/21943.

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Despite growing interest in eating disorders (EDs) comorbid with bipolar disorder (BD), little research has considered the nature of ED features and their association with physical health and psychosocial outcomes. The current research aimed to assess ED features in people with BD and their association with BMI and psychological factors. People with BD (Aus=73, Netherlands=109) completed online questionnaires and 9 Australian participants with the comorbidity participated in a qualitative interview. In total, 31 (19%) were identified as having a probable ED, most commonly binge eating disorder (45%). Only one reported a formally-diagnosed ED. Comorbid EDs were associated with significantly poorer emotion regulation ability, reduced quality of life (QoL), and higher distress, but not impulsivity. Greater depressive symptoms and more frequent hospital admissions for depression were also reported. The most common ED features were weight/shape overvaluation (36%) and objective binge eating episodes (OBEs; 21%). OBEs and restriction uniquely contributed to poorer QoL in a regression model. Positive beliefs about the function of binge eating, but not OBEs, predicted higher body mass index (BMI). Interviews revealed that BD illness episodes often correlated with changes in eating and BMI. Most participants connected their experience of an ED and BD to traumatic experiences. None felt that concerns with their eating, weight gain and physical health had been adequately addressed. Results suggest that this double diagnosis and even subthreshold EDs in BD are associated with elevated ED cognitions and heightened difficulties with emotion regulation. Clinicians and researchers alike should consider more proactive screening for this comorbidity as a significant contributing factor to disability. Future interventions for this under-supported group could consider targeting cognitive processes, emotion regulation difficulties and comorbid traumatic stress disorders.

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Follador, Halima. "DTI study of the frontal lobes, hippocampus, amygdala and neurocognitive assessment in patients with bipolar-schizophrenic spectrum disorders." Doctoral thesis, Università degli studi di Padova, 2015. http://hdl.handle.net/11577/3423972.

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Schizophrenic and bipolar disorders are complex and disabling psychiatric diseases whose recent neurobiological, neuropsychological and genetic findings is in contrast with the traditional categorical approach of psychiatric nosography. The multiple threshold model describes the complex relationship between the shared genetic background and the wide phenotypic expression in the various disorders ascribed to the bipolar schizophrenic spectrum. This model assumes that common genes are involved in a spectrum of disorders ranging from major depression, to bipolar and schizophrenia and that their effect is additive along a continuum of risk: when a certain threshold is exceeded the quantitative difference becomes a qualitative difference that manifests itself as a different disorder (eg. switching from major depression to bipolar disorder to schizo-affective disorder than schizophrenic) (Kelsoe 2003). A field of great interest in neuroscience and psychiatric research is finding evidence of shared clinical features and pathophysiological pathways between these disorders. Genetics, histopathological and MRI in vivo studies have consistently revealed abnormalities in brain neural networks among these disorders. The Diffusion tensor imaging (DTI) is a fundamental brain imaging technique to investigate white matter‘s structural connectivity, despite its relative recently introduction in clinical practice and research. AIM OF THE STUDY: to investigate the DTI measures of WM integrity in specific brain regions and the cognitive performances in a group of patients with the bipolar-schizophrenic spectrum disorders and a group of healthy control subjects. In order to verify or exclude specific diagnosis-related differences, we performed cross-sectional comparisons between the sub group of bipolar patients, schizophrenic patients and healthy controls. METHODS: 64 patients -32 schizophrenic (SZ), 25 bipolars (BP)-, and 31 healthy controls underwent 1,5 T MRI scanning, comprehending DTI acquisitions and volumetric T1 3D with a specifically designed acquisition protocol, at the Neuroradiology Unit of Conegliano Hospital. Then we calculate DTI indices of bilateral frontal lobes, hippocampus and amygdala using ANALYZE 10.0 software, all recruited subjects underwent clinical and standardized, thorough neurocognitive assessment (ENB, Mondini et al; WCST). RESULTS: we found statistically significant alterations of the DTI indicies for the regions of interest (ROIs), that pointed out shared abnormalities among the patients with bipolar schizophrenic-spectrum disorder regarding frontal lobes with respect to healthy control subjects; more interesting, we find a complex pattern of alterations among the hippocampal region and amygdala between the patients and the control group and also comparing the schizophrenic with the bipolar patients. Moreover we found out a significant impairment on the performances during the neurocognitive and neuro psychological assessment across all tests in the patients opposed to healthy controls. We also pointed out some interesting correlations between the scores of the battery test administrated (ENB, Mondini et al; WCST) and the FA and ADC indices for the frontal lobes, as expected from the abundant current literature, but also for the hippocampus and amygdala. This approach could help to the understand some aspects of the complexity of the Bipolar-schizophrenic spectrum disorders CONCLUSION: in this study we highlighted shared tracts among the spectrum disorders such as the common neurocognitive and neuropsychological impairment, the compromised structural integrity of the white matter in the frontal regions and probably, in some degree, even of the right hippocampus, implying that these two disorders may share some common pathophysiological mechanisms, further demonstrating how alterations in the cerebral white matter networks, involving the frontal regions and also subcortical structures, such as the hippocampus and amygdala, contribute to the pathophysiological process of schizophrenia and bipolar disorder. Our findings also bring out differences among the two groups of patients, with the bipolars showing a most prominent alteration of the left amygdala and the schizophrenics a predominant deficit on the right hippocampus and amygdala. In the bipolar-schizophrenic spectrum disorders it might be speculated that the alteration and disruption of white matter connectivity, and their correlation with neurocognitive performances, could be interpreted as a possible “biological marker”. This might help to specifically define the common and the different aspects of these disorders in order to better understand their complex pathophysiological mechanisms, jet to be clearly defined. Schizofrenia e disturbo bipolare sono malattie psichiatriche complesse e invalidanti, nelle quali il tradizionale approccio categoriale della nosografia psichiatrica entra in continuo dibattito in relazione alle più recenti scoperte nei campi della neurobiologia, della genetica, della neuropsicologia e del brain imaging. Il modello delle soglie multiple descrive le complesse relazioni tra l’assetto genetico e l’ampia espressione fenotipica nei vari disturbi appartenenti allo spettro. Esso parte dal presupposto che i geni comuni siano coinvolti in tali disturbi lungo uno spettro che va da dalla depressione maggiore al disturbo bipolare alla schizofrenia e che il loro effetto sia additivo lungo un continuum di rischio: quando una determinata soglia è superata, la differenza ‘quantitativa’ diventa ‘qualitativa’ e si manifesta come un disturbo diverso. Un campo di grande interesse nell’ambito delle neuroscienze e della ricerca in psichiatria è quello di scoprire caratteristiche cliniche e pattern psicopatologici condivisi tra questi disturbi. Studi istopatologici, di genetica e di neuroimaging hanno evidenziato in modo rilevante alterazioni a livello dei network neuronali di questi disturbi, tramite diverse metodiche. In particolare tra gli studi di brain imaging in risonanza magnetica, la tecnica non convenzionale di DTI si è rilevata, fin dalla sua introduzione, uno strumento estremamente promettente per gettare luce in particolare sulla complesse proprietà della sostanza bianca cerebrale e l’analisi dell’integrità dei fasci assonali. SCOPO DELLO STUDIO: investigare, tramite metodica DTI e calcolo degli indici di diffusione l’integrità della sostanza bianca in specifiche regioni cerebrali, e valutare le alterazioni neurocognitive in due gruppi di pazienti appartenenti allo spettro bipolare-schizofrenico (rispettivamente schizofrenici e bipolari) e un gruppo di soggetti sani. MATERIALI E METODI: 64 pazienti (32 SZ-25 BP) e 31 controlli sani sono stati sottoposti ad una procedura di Risonanza Magnetica cerebrale ad 1,5 Tesla, secondo un protocollo di acquisizione di acquisizione dedicato, comprendente sequenze T1 3D volumetriche e DTI, presso l’Unità Operativa di Neuroradiologia del Presidio Ospedaliero di Conegliano. Mediante l’utilizzo del Software ANALYZE 10.0, sono stati calcolati gli indici di diffusione DTI, in specifiche regioni regioni cerebrali con metodo di delineamento delle ROIs, in particolare soffermandoci sui lobi frontali e sul complesso amigdala-ippocampo. Tutti i soggetti sono stati sottoposti a valutazione neurocognitiva tramite la somministrazioone di una batteria di test tratti dall’esame neuropsicologico breve (ENB) e al Wisconsin Card Sorting Test (WSCT) RISULTATI: sono state riscontrate alterazioni statisticamente significative degli indici di diffusione per le regioni di interesse (ROIs) che hanno evidenziato anormalità degli indici di diffusione nelle regioni frontali nei pazienti dello spettro (e condivise tra bipolari e schizofrenici) rispetto ai controlli sani. È stato evidenziato un pattern complesso di alterazioni degli indici di diffusione a livello dell’ippocampo e dell’amigdala tra i due gruppi di pazienti e i controlli sani. Oltre a questo, è stato riscontrato un peggiore funzionamento cognitivo e delle prestazioni al WSCT nei pazienti rispetto ai controlli sani. Si sono inoltre evidenziate alcune correlazioni tra i punteggi ottenuti ai test e gli indici di diffusione, in particolare per le regioni frontali condivise tra pazienti schizofrenici e bipolari. CONCLUSIONI: I pazienti dello spettro schizofrenico-bipolare condividono le ridotte prestazioni ai test neuropsicologici, le alterazioni degli indici FA e ADC a livello dei lobi frontali e di ADC dell’ippocampo di sinistra, ma gli schizofrenici, rispetto ai bipolari hanno un pattern differente di alterazioni a livello della formazione ippocampale di destra dell’amigdala sinistra. La disconnettività appare quindi avere un ruolo centrale nella patogenesi dei disturbi dello spettro. L’identificazione di alterazioni degli indici di diffusione di specifiche regioni cerebrali potrebbe rappresentare un passo cruciale nell’individuare un correlato neurobiologico presente nei disturbi dello spettro bipolare-schizofrenico.

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Papmeyer, Martina. "Structural brain imaging and cognitive function in individuals at high familial risk of mood disorders." Thesis, University of Edinburgh, 2015. http://hdl.handle.net/1842/15915.

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Bipolar disorder (BD) and major depressive disorder (MDD) are characterised by a fundamental disturbance of mood, with strong support for overlapping causal pathways. Structural brain and neurocognitive abnormalities have been associated with mood disorders, but it is unknown whether these reflect early adverse effects predisposing to mood disorders or emerge as a consequence of illness onset. The Bipolar Family Study is well-suited to examine the origin of structural brain and neuropsychological abnormalities in mood disorders further. The volumes of subcortical brain regions, cortical thickness and surface area measures of frontal and temporal regions of interest and neuropsychological performance over a two-year time interval was compared at baseline and longitudinally between three groups: young individuals at high risk of mood disorders who subsequently developed MDD during the follow-up period (HR-MDD), individuals at high risk of mood disorders who remained well (HR-well), and healthy control subjects (HC). The longitudinal analysis of cortical thickness revealed significant group effects for the right parahippocampal and right fusiform gyrus. Cortical thickness in both of these brain regions across the two time points was reduced in both high-risk groups relative to controls, with the HR-MDD group displaying a thinner parahippocampus gyrus than the HR-well group. Moreover, a significant interaction effect was observed for the left inferior frontal and left precentral gyrus. The HR-well subjects had progressive thickness reductions in these brain regions relative to controls, while the HR-MDD group showed cortical thickening of these areas. Finally, longitudinal analyses of neuropsychological performance revealed a significant group effect for long delay verbal memory and extradimensional set-shifting performance. Reduced neurocognitive performance during both tasks across the two time points was found in the HR-well group relative to controls, with the HR-MDD group displaying decreased extradimensional set-shifting abilities as compared to the HC group only. These findings indicate, that reduced left parahippocampal and fusiform thickness constitute a familial trait marker for vulnerability to mood disorders and may thus form potential neuroanatomic endophenotypes. Particularly strong thickness reductions of the parahippocampal gyrus appear be linked to an onset of MDD. Moreover, progressive thickness reductions in the left inferior frontal and precentral gyrus in early adulthood form a familial trait marker for vulnerability to mood disorders, potentially reflecting early neurodegenerative processes. By contrast, an absence of cortical thinning of these brain regions in early adulthood appears to be linked to the onset of MDD, potentially reflecting a lack or delay of normal synaptic pruning processes. Reduced long delay verbal memory and extradimensional set-shifting performance across time constitute a familial trait marker for vulnerability to mood disorders, likely representing disturbances of normal brain development predisposing to illness. These findings advance our understanding of the origin of structural brain and neurocognitive abnormalities in mood disorders.

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Clevenger, Wesley Arnold. "A case study exploration of placement in a therapeutic day school as an educational intervention package for children and adolescents with bipolar disorders." Diss., University of Iowa, 2010. https://ir.uiowa.edu/etd/789.

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The number of children and adolescents diagnosed with bipolar disorders has increased dramatically since the mid-1990s, while the treatment literature has failed to keep pace. Few studies have explored any aspect of the educational functioning of this population, and no empirically supported educational interventions have been identified. As a result, school psychologists have little guidance regarding how to effectively serve these students. In this study, case study methodology was utilized to explore the effectiveness of placement in a therapeutic day school as an educational intervention package for eleven (n=11) children and adolescents diagnosed with bipolar disorders. Both quantitative and qualitative data were utilized, and within- and cross-case analyses were conducted. Academic performance was examined in the areas of reading, mathematics, writing, science, and social studies. Behavioral/social-emotional performance was explored in the areas of on task/work completion, compliant (i.e., following instructions), and physically aggressive behaviors, as well as social skills and coping skills. Results indicated that a majority of students with bipolar disorders at least sustained performance in areas of relative academic and behavioral/social-emotional strength, improved performance in areas of relative academic and behavioral/social-emotional weakness, achieved positive immediate educational outcomes (e.g., upper levels of school's behavior modification level system, re-integration into home schools), and ameliorated referral concerns. Interestingly, all students in this study exhibited relative weaknesses in social and coping skills. Nearly all students demonstrated a relative weakness in mathematics. Another important finding of this study was the identification of two distinct patterns of physically aggressive behavior: a "spike" pattern and a "low levels" pattern. All students exhibited one of these two patterns, either in full or emerging form. In general, placement in a therapeutic day school was determined to be an effective educational intervention package for students with bipolar disorders. However, degrees, rates, and patterns of success were variable. Future studies should attempt to parse out the treatments that comprised this study's intervention package in an effort to find effective treatments for children and adolescents with bipolar disorders.

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Duff, Barbara Jane. "Cognition in t(1;11) translocation carriers and patients with psychotic disorders." Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/28826.

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Deficits in a number of cognitive domains have been associated with core symptoms of schizophrenia, including working memory, attention, motor skills, reaction time, episodic memory and executive function. Bipolar Disorder is also associated with cognitive impairment; however the level of impairment appears to be less severe than that seen in schizophrenia. A translocation (t(1;11)) containing the Disrupted-in-Schizophrenia 1 (DISC1) gene has been found to be highly associated with schizophrenia, bipolar disorder and major depressive disorder. As such, this gene has been the focus of much research and to date DISC1 has been found to be associated with brain development, brain structure and the glutamate system - all key factors in current models of schizophrenia and affective disorders. The aim of this PhD is to identify cognitive domains that are differentially impaired or unimpaired in a large Scottish family, some of whom carry this rare DISC1 variant, a balanced translocation (t (1;11) (q 42; q14.3)), that segregates with schizophrenia and affective disorders, as well as psychiatric patients with schizophrenia and bipolar disorder and healthy control subjects. All participants have undergone standardised cognitive assessments to measure premorbid I.Q. (NART), current I.Q. (WASI) verbal memory, working memory, verbal fluency, processing speed, motor skills, executive function (BACS) and selected CANTAB tasks to assess simple and five-choice reaction time. Polygenic risk profile scores and self-report questionnaire data have also been investigated. Results indicate an impact of the DISC1 t(1;11) translocation on general intelligence and attention and processing speed. Significant differences were also identified between DISC1 t(1;11) carriers and non-carriers on self-report questionnaire data. Mean scores for polygenic risk for bipolar disorder were significantly different between DISC1 t(1;11) carriers and non-carriers and polygenic risk for schizophrenia was significantly associated with symptom severity, as measured by the Positive and Negative Symptom Scale (PANSS). Within the patient groups, a measure of processing speed (the token motor task) was found to be significantly different between those with schizophrenia and bipolar disorder and there was also a trend for attention and processing speed. As expected, I.Q. was significantly different between patients and control participants. Clinical ratings were significantly associated with neuropsychological and self-report measures. Polygenic risk for major depressive disorder was found to be significantly associated with impaired general intelligence (current IQ) and slowed reaction time in patients who were not currently depressed, suggesting there may be genetic risk markers in this population which impact on cognition. This is a novel finding and further suggests the possibility of a biological component related to the genetics of depression. In conclusion, and in line with the literature, psychosis has a negative impact on cognition with reduced performance across several neuropsychological tasks between patient groups, with schizophrenia patients performing worse than patients with bipolar disorder and both patient groups performing worse than healthy control participants. Cognition is markedly more impaired in DISC1 t(1;11) translocation carriers and especially in those with psychosis. The DISC1 t(1;11) translocation and psychosis may therefore confer a “double hit” on cognition - in addition to psychosis itself - which is known to impair cognitive function, significantly increasing the level of cognitive impairment and increasing the risk for psychosis in general.

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Reyes, Amanda Neumann. "Functional impairment and cognitive performance in mood disorders : a young community sample." Universidade Catolica de Pelotas, 2014. http://tede.ucpel.edu.br:8080/jspui/handle/tede/476.

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Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2016-08-01T12:24:32Z No. of bitstreams: 1 amanda reyesvolume final - 23-07-15.pdf: 348695 bytes, checksum: 2ee5f76444cb295f170acae0bec93565 (MD5) Made available in DSpace on 2016-08-01T12:24:32Z (GMT). No. of bitstreams: 1 amanda reyesvolume final - 23-07-15.pdf: 348695 bytes, checksum: 2ee5f76444cb295f170acae0bec93565 (MD5) Previous issue date: 2014-11-25 . Objetivo Geral • Comparar o desempenho cognitivo e o funcionamento global entre adultos jovens com e sem o diagnóstico de Transtorno Bipolar, bem como correlacionar estas medidas nos sujeitos com Transtorno Bipolar. 2.2 Objetivos Específicos • Comparar o funcionamento global de adultos jovens com e sem diagnóstico de TB; • Comparar o desempenho cognitivo de adultos jovens com e sem diagnóstico de TB; • Correlacionar o desempenho cognitivo e o funcionamento em uma amostra populacional de adultos jovens; • Correlacionar o desempenho cognitivo e o funcionamento nos adultos jovens com Transtorno Bipolar; • Correlacionar a severidade dos sintomas maníacos e depressivos com o desempenho cognitivo e o funcionamento dos jovens com TB.

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Fekadu, Abebaw. "Studies on affective disorders in rural Ethiopia." Doctoral thesis, Umeå universitet, Psykiatri, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-37813.

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Background Affective disorders are poorly defined and studied in sub-Saharan Africa despite their substantial public health impact. Objectives Overall objective: To describe the epidemiology of selected affective disorders in rural Ethiopia. Specific objectives 1. To describe the validity and utility of the concept of minor depressive disorder (mD). 2. To describe the manifestation, prevalence and the short-term clinical and functional course and outcome of bipolar disorder. Subjects and methods Population: Zay community residents (age ≥16), and residents of Butajira (ages 15-49), in Southern Ethiopia. Study design: Population-based cross-sectional and longitudinal studies Case identification: For the identification of cases with bipolar disorder, a two stage process was employed. An initial screen used key informants and interview with the Composite International Diagnostic Interview (CIDI) to identify cases with probable bipolar disorder. A second confirmatory diagnostic assessment stage employed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). For the identification of cases with mD, data from the CIDI was used. Follow-up: 312 cases with bipolar disorder from Butajira were followed up for a mean of 2.5 years (ranging 1-4 years) through monthly clinical assessments and annual symptom and functional ratings. Results The CIDI was administered to 1714 adults among the Zay and to 68, 378 adults among the Butajira residents. The prevalence of mD among the Zay and Butajira was 20.5% and 2.2% respectively. Up to 80% of cases with mD had used services for their symptoms, while a third to a half of cases had thought about self harm. Up to a sixth of cases had attempted suicide. Age, marital status, education and somatic symptoms were independently associated with mD. The prevalence of bipolar disorder among the Zay was 1.8%. During a 2.5-year follow-up of 312 cases with bipolar disorder from Butajira, 65.9% relapsed (47.8% manic, 44.3% depressive and 7.7% mixed episodes) while 31.1% experienced persistent illness. Female gender predicted depressive relapse whereas male gender predicted manic relapse. Only being on psychotropic medication predicted remission (OR=3.42; 95% CI=1.82, 6.45). Disability was much worse among bipolar patients than in the general population and was predicted by symptom se3verity. Conclusions This is the largest study on mD and bipolar disorder in Africa. mD appears to have potential clinical utility in this setting given its association with service use and risk. The identified risk factors for mD also suggest potential aetiological continuity with major depression. The relatively high prevalence of bipolar disorder among the Zay may be related to genetic predisposition perhaps mediated through a founder effect, but other factors need exploring. In relation to the outcome of bipolar disorder, this study indicates that, contrary to previous assumptions, the course of bipolar disorder is characterised by both manic and depressive relapses in a relatively proportionate fashion. Bipolar disorder also leads to significant levels of disability. This is the only prospective outcome study of bipolar disorder in Africa where cases were monitored systematically at short assessment intervals. Therefore, findings are likely to be more robust than previous reports.

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Feiger, Jeremy A. "The Impact of Mild Traumatic Brain Injury, Schizophrenia Spectrum Disorders, and Neurocognitive Deficits on Violent Crime." Thesis, California State University, Long Beach, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10838803.

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Mild traumatic brain injury (mTBI) and schizophrenia spectrum disorders (SSD) are conditions characterized by frontal lobe deficits. Past research has shown increased violent and aggressive behavior in both conditions; however, few studies have examined the mechanisms driving this relationship, particularly in non-athlete or non-veteran populations. The current study examined the neurodegenerative effects of repeated mTBI over time on cognitive flexibility and stability deficits in a homeless population. Additionally, we investigated the mediating effects of these deficits on the impact of both repeated lifetime mTBI and presence of an SSD on violent crime. Consistent with expectations, the number of lifetime mTBIs positively predicted violence levels across multiple measures of violent crime, however cognitive flexibility and stability deficits did not mediate this relationship. Furthermore, comorbidity of mTBI and SSD increased the frequency of violent crimes greater than either condition alone. Implications for risk assessment, intervention strategies and violence reduction are discussed.

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Branco, Jerônimo Costa. "ATIVIDADE FÍSICA E TRANSTORNO DE HUMOR EM JOVENS: DEPRESSÃO TRANSTORNO BIPOLAR." Universidade Catolica de Pelotas, 2011. http://tede.ucpel.edu.br:8080/jspui/handle/tede/139.

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Made available in DSpace on 2016-03-22T17:26:30Z (GMT). No. of bitstreams: 1 Jeronimo Branco MESTRE.pdf: 335739 bytes, checksum: 594c32865f53fb0dc9840bef11e87515 (MD5) Previous issue date: 2011-01-18 Mood disorders are characterized by affective manifestations considered unsuitable in terms of intensity, frequency and duration. According to the previous description, this study intends to investigate the prevalence of physical activity among patients who have bipolar disorder or depression compared to population controls. This transversal study selected 211 young people of a population-based study which surveyed 1,560 youths aged 18 to 24 years. The instruments used were a Questionnaire of Habitual Physical Activity and the Semi-Structured Clinical Interview (SCID) for the DSM-IV, conducted by psychologists in the research laboratory of the University Hospital San Francisco de Paula. The data were analyzed by descriptive statistics, chi-square and Poisson s regression with the use of the software STATA 9.0. The study was approved by the Ethics Search the Catholic University of Pelotas, obtaining the following scores mean physical activity: 12.74 ± 8.43 in control population; 8.75 ± 8.07 in Depression; and 11.95 ± 7.31 in Bipolar. Factors associated with higher prevalence of physical inactivity/ sedentariness in the studied sample was being female (p = 0.010) and have a clinical diagnosis of depression (p <0.001). We can conclude that sedentariness is more likely to occur to young people with depression than to those with bipolar disorder or those in the control group Os transtornos de humor caracterizam-se por manifestações afetivas consideradas inadequadas em termos de intensidade, freqüência e duração. De acordo com a descrição anterior, o presente estudo tem como objetivo investigar a prevalência da prática de atividade física entre portadores de transtorno bipolar ou depressão comparados a controles populacionais. Este estudo transversal selecionou 211 jovens de um estudo de base populacional que entrevistou 1560 jovens de 18 a 24 anos. Os instrumentos utilizados foram um Questionário de Atividade Física Habitual e a Entrevista Clínica Semi-Estruturada (SCID) para o DSM-IV, realizada por psicólogas no laboratório de pesquisa do Hospital Universitário São Francisco de Paula. Os dados foram analisados por meio de estatística descritiva, teste do qui-quadrado e regressão de Poisson no programa STATA 9.0. O estudo foi aprovado pelo comitê de Ética em Pesquisa da Universidade Católica de Pelotas. Obtiveram-se os seguintes escores médios de atividade física: 12,74±8,43 no controle populacional; 8,75±8,07 na Depressão e 11,95±7,31 no Transtorno Bipolar. Os fatores associados à maior prevalência de inatividade física/sedentarismo na amostra estudada, foi ser do sexo feminino (p=0,010) e ter o diagnóstico clínico de depressão (p<0,001). Conclui-se que os jovens com depressão estão mais propensos a ocorrência de sedentarismo do que os jovens com transtorno bipolar ou aqueles do grupo controle

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Healey, Christine. "The reasons for alcohol and substance use in dual diagnosis bipolar disorder and substance use disorders : a qualitative study." Thesis, University of Liverpool, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.548767.

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Vesco, Anthony Thomas. "Examining the Course of Cyclothymic Disorder and Comparing it to Dysthymic Disorder and Other Bipolar Spectrum Disorders in Children." The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1364907946.

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Silva, Luiz Fernando de Almeida Lima e. 1980. "Avaliação da resposta terapêutica no tratamento de manutenção com lítio em pacientes com transtorno afetivo bipolar." [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312553.

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Orientadores: Cláudio Eduardo Muller Banzato , Clarissa de Rosalmeida Dantas Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Made available in DSpace on 2018-08-27T15:11:19Z (GMT). No. of bitstreams: 1 Silva_LuizFernandodeAlmeidaLimae_M.pdf: 4787027 bytes, checksum: 41b58615628a8ce9c086589e9db94ca8 (MD5) Previous issue date: 2015 Resumo: O transtorno afetivo bipolar (TAB) é uma morbidade mental crônica e grave, que habitualmente se manifesta na adolescência ou início da vida adulta. Sua forma mais prevalente de apresentação é a de episódios maníacos ou hipomaníacos, intercalados por episódios depressivos ou períodos de eutimia. Modernamente, uma miríade de medicações possuem aprovação para o tratamento do TAB, porém o lítio ainda é considerado um dos fármacos de primeira linha no tratamento de manutenção do transtorno. Como a resposta ao lítio não é uniforme, a tentativa de identificar possíveis preditores de resposta terapêutica vem sendo alvo de diversos estudos. Neste contexto, um grande desafio é avaliação da melhora clínica de pacientes tratados fora de um protocolo estrito de pesquisa. Para contornar este problema, a escala ALDA vem se mostrando como um valioso instrumento nos trabalhos publicados na literatura. OBJETIVOS: estudar a confiabilidade da escala ALDA, avaliar de forma padronizada a resposta terapêutica ao lítio no tratamento de manutenção do TAB e identificar possíveis preditores clínicos e epidemiológicos de resposta. MÉTODOS: quarenta pacientes em tratamento ambulatorial com diagnostico confirmado de TAB e história de uso de lítio foram avaliados, com revisão minuciosa dos prontuários médicos. Um instrumento padronizado (a escala ALDA), que se baseia em informações clínicas obtidas de forma retrospectiva, foi usado para avaliar a melhora clínica global e possíveis fatores confundidores. Foram também coletados dados acerca de variáveis clínicas e sociodemográficas, para avaliar possíveis fatores preditores de resposta ao tratamento. Também aferimos a confiabilidade interavaliadores para o escore total e para cada um dos itens da escala ALDA, por meio do Coeficiente de Correlação Intraclasse (ICC), entre dois pesquisadores que realizaram suas avaliações de modo independente. RESULTADOS: nosso estudo encontrou uma relação inversa entre o número de episódios de humor com sintomas psicóticos e melhor desfecho no tratamento com lítio (PE -1,24241). Também constatamos a relação direta entre uso atual ou prévio de tabaco e melhora clínica com lítio (PE 7,66608). Com relação ao estudo de ICC nos diferentes itens da escala ALDA, encontramos valores que variaram de 0,610 a 0,833. CONCLUSÃO: nossos achados apontam que a escala ALDA pode ser uma ferramenta útil e confiável para a avaliação padronizada da resposta terapêutica em pacientes com TAB. Os resultados obtidos reforçam a hipótese que o lítio parece ser menos eficaz em pacientes que manifestam sintomas psicóticos, além de nos levarem a questionar o papel do tabaco no prognóstico de pacientes com transtorno bipolar Abstract: Bipolar disorder (BD) is a chronic and severe mental illness, that usually manifest its first symptoms in early adulthood. The most prevalent clinical form of the disorder is the occurrence of episodes of mania or hypomania, interspersed with episodes of depression and periods of euthymia. Currently, a myriad of drugs have approval for treating BD, nevertheless lithium still stands as a gold standard in the prophylactic treatment of the disorder. Since lithium response is not uniform between patients, different studies have been trying to identify possible predictors of response to the treatment. In this scenario, accessing clinical improvement in patients not treated following a strict research protocol is a great challenge. To solve this issue, the ALDA scale appeared as a valuable tool in different published studies. OBJECTIVES: to study the reliability of the ALDA scale, to systematically access the response of prophylactic lithium treatment in BD and to identify possible clinical and epidemiological predictors of lithium response. METHODS: forty outpatients in treatment for confirmed clinical diagnose of BD, and with history of lithium use, were accessed with a thorough review of their medical charts. A standardized instrument (the ALDA scale), which is based on clinical information obtained retrospectively, was used to evaluate clinical improvement and possible confounding factors. In this process, we have obtained other clinical and sociodemographic data, to investigate possible predictive variables to treatment response. We have also used the Interclass Correlation Coefficient (ICC) to determine the inter-rater reliability between two independent researchers, for the ALDA scale total score and each of its sub items. RESULTS: our study found an inverse relation between the number of mood episodes with psychotic symptoms and improvement with lithium therapy (PE -1,24241). We have also found a direct relation between current or previous tobacco use and clinical improvement with lithium (PE 7,66608). Concerning the ICC for each of the ALDA scale sub items, we found values ranging between 0,610 and 0,833. CONCLUSION: our findings suggest that the ALDA scale can be a useful and trustworthy instrument in the standardized evaluation of clinical response in patients with BD. Our results also reinforce the hypothesis that lithium treatment seems to be less efficacious in patients with psychosis, and lead us to speculate the role of tobacco use in the outcome of patients with bipolar disorder Mestrado Saude Mental Mestre em Ciências Médicas

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Dissertations / Theses on the topic 'Crime and Bipolar disorders'

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