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Silva, Isabelle Salomão Teixeira, Jhonson Tizzo Godoy, Ana Paula Gouvêa de Barros, Iuri Carvalho Vieira, Isabella de Moura Magalhães, Manuela Pittella de Mattos, Raquel Carmo Araújo, Victório de Moura Magalhães, and Adriel Gustavo Lopes. "O uso da eletroconvulsoterapia (ECT) para o tratamento da depressão." Revista Eletrônica Acervo Saúde, no. 56 (August 13, 2020): e3926. http://dx.doi.org/10.25248/reas.e3926.2020.
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Objetivo: Avaliar a eficácia da eletroconvulsoterapia (ECT) no tratamento da depressão, considerando seusbenefícios e comparando sua eficácia entre depressão unipolar e bipolar. Além de também observar o riscode surgimento de episódios de mania após o uso da ECT. Revisão Bibliográfica: Atualmente, embora sejauma terapêutica muito promissora, o uso da ECT tem sido reservado para casos refratários ao tratamentomedicamentoso, em função de ainda ser uma ferramenta pouco disponível para uso na prática clínica. Deacordo com as evidências atuais quanto menor o tempo de duração da doença, maiores são as taxas deresposta e remissão dos sintomas com o uso da terapia eletroconvulsiva, sendo que alguns estudosafirmam que a taxa de resposta da depressão bipolar é maior que da depressão unipolar. Alguns efeitosadversos foram percebidos, entre eles o desenvolvimento de episódios maníacos em pacientes previamentedeprimidos. Considerações finais: Os estudos demonstraram melhora clínica dos pacientes comtranstorno depressivo bipolar e unipolar utilizando a ECT como tratamento, em especial na depressãobipolar. Foi observado a ocorrência de episódios de mania após o uso dessa terapêutica, como um efeitoadverso. No entanto, faz-se necessário mais pesquisas no intuito de diminuir o estigma e obter mais dados.
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Zegers, Otto Dörr. "Fenomenología de la intersubjetividad y su importancia para la comprensión de las enfermedades endógenas." Revista Psicopatologia Fenomenológica Contemporânea 2, no. 1 (October 17, 2013): 75–90. http://dx.doi.org/10.37067/rpfc.v2i1.1030.
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Um dos traços característicos dos transtornos endógenos é a alteração das relações interpessoais. Essa condição permite a realização, nesses estados patológicos, de uma fenomenologia da intersubjetividade, que revele as modificações das condições de possibilidade da presença do outro na esquizofrenia, depressão melancólica e mania. Após rever as contribuições fundamentais da psicopatologia fenomenológica nessa área, o autor propõe uma releitura da patologia da interpessoalidade a partir da fenomenologia da intersubjetividade de Edmund Husserl. A partir dos conceitos de apresentação/presentação e retentio/presentatio/protensio, sustenta que a mania é constituída por um fracasso de apresentação. Na depressão melancólica, por sua vez, a retentio invade a protentio e paralisa a apresentação. Examina a esquizofrenia por meio do conceito de intencionalidade, defendendo que a perda desta é típica da patologia.
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Cheniaux, Elie, Allan Dias, José Luiz M. Lessa, and Marcio Versiani. "A lamotrigina pode induzir virada maníaca?" Revista de Psiquiatria do Rio Grande do Sul 27, no. 2 (August 2005): 206–9. http://dx.doi.org/10.1590/s0101-81082005000200011.
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Em ensaios clínicos controlados com pacientes bipolares, a lamotrigina tem demonstrado eficácia no tratamento da fase aguda da depressão e, principalmente, na prevenção de novos episódios depressivos. É relatado o caso de um paciente bipolar tipo II, ciclador rápido, que, durante um episódio depressivo, fez uso dessa substância, em monoterapia, e passou a apresentar um quadro maníaco disfórico. Este remitiu logo após a retirada da medicação e foi sucedido por um novo episódio depressivo. Essa ocorrência foi bastante inesperada diante dos dados clínicos da literatura científica, os quais associam a lamotrigina a uma taxa muito baixa de virada para a mania.
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Silva, Rafael de Assis da, Daniel C. Mograbi, J. Landeira-Fernandez, and Elie Cheniaux. "O insight no transtorno bipolar: uma revisão sistemática." Jornal Brasileiro de Psiquiatria 63, no. 3 (September 2014): 242–54. http://dx.doi.org/10.1590/0047-2085000000032.
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Objetivos Realizar uma revisão sistemática para compreender que fatores estão relacionados a uma maior ou menor consciência de morbidade no transtorno bipolar (TB), como o insight varia em função do estado afetivo e estabelecer uma comparação com outros transtornos mentais. Métodos Realizou-se uma revisão sistemática da literatura científica sobre o insight em pacientes com TB. Foram buscados estudos clínicos originais sobre o tema nas bases de dados Medline, ISI e SciELO. Os termos de busca empregados foram: “insight” OR “awareness” AND “bipolar” OR “mania” OR “manic”. Resultados Foram selecionados 55 artigos. O insight no TB parece ser mais prejudicado do que na depressão unipolar, porém menos do que na esquizofrenia. Com relação ao TB, um menor nível de insight está relacionado à presença de sintomas psicóticos e de alterações cognitivas. Além disso, um comprometimento do insight está associado a uma menor adesão ao tratamento. Por outro lado, uma maior preservação do insight pode estar associada a maior ideação suicida. Finalmente, a fase maníaca cursa com um nível inferior de insight quando comparada à fase depressiva ou de eutimia. Conclusão No TB, o insight está significativamente prejudicado, especialmente na mania. Diversos fatores clínicos parecem influenciar o nível de insight.
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Bosaipo, Nayanne Beckmann, Vinícius Ferreira Borges, and Mario Francisco Juruena. "Bipolar disorder: a review of conceptual and clinical aspects." Medicina (Ribeirao Preto. Online) 50, supl1. (February 4, 2017): 72. http://dx.doi.org/10.11606/issn.2176-7262.v50isupl1.p72-84.
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Esta revisão tem o objetivo de introduzir aspectos históricos, epidemiológicos e etiológicos do transtorno bipolar, além de apresentar a caracterização e curso da doença e algumas questões relativas ao diagnóstico, tratamento e prognóstico. O Transtorno Bipolar (TB) é caracterizado por graves alterações de humor, que envolvem períodos de humor elevado e de depressão intercalados por períodos de remissão. O transtorno se diferencia em dois tipos principais: o Tipo I, em que ocorrem episódios de mania, e o Tipo II, em que a elevação do humor é mais branda e breve, caracterizando episódios de hipomania. O conceito de espectro bipolar amplia a classificação do TB, incluindo padrões clínicos e genéticos. O TB é uma doença comum, que atinge cerca de 30 milhões de pessoas no mundo, afetando homens e mulheres de modo diferente. As causas do TB incluem uma interação de fatores genéticos e ambientais, distinguindo-o como um transtorno complexo e multideterminado. O diagnóstico segundo os critérios do DSM-5 envolve a identificação de sintomas de mania ou hipomania e da avaliação do curso longitudinal da doença. A depressão é geralmente o quadro mais comum e persistente entre os pacientes bipolares. Embora não existam sintomas específicos que distinguem a depressão unipolar da depressão bipolar, foram encontradas características clínicas típicas de cada manifestação (e.g., perfil dos sintomas, história familiar, e curso da doença). O diagnóstico precoce e o tratamento dos episódios agudos de humor melhoram significativamente o prognóstico. O tratamento de primeira escolha é com medicamentos estabilizadores de humor, anticonvulsivantes e antipsicóticos atípicos. A combinação de medicamentos com intervenções psicossociais tem se mostrado efetiva. Não obstante, o uso de antidepressivos em monoterapia não é recomendado
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Alheira, Flávio Valdozende, and Marco Antônio Alves Brasil. "O papel dos glicocorticóides na expressão dos sintomas de humor: uma revisão." Revista de Psiquiatria do Rio Grande do Sul 27, no. 2 (August 2005): 177–86. http://dx.doi.org/10.1590/s0101-81082005000200008.
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O objetivo desta revisão é verificar, na literatura, uma relação entre níveis plasmáticos aumentados de corticosteróides e sintomas psiquiátricos, identificar as manifestações clínicas mais comuns e os tratamentos propostos. Alterações no eixo hipotálamo-hipófise-supra-renal levando a hipercortisolemia estariam associadas a distúrbios do humor, sobretudo depressão, enquanto que o uso de drogas glicocorticóides estaria relacionado ao aparecimento de sintomas psiquiátricos, como mania, depressão, labilidade afetiva e psicose. O levantamento bibliográfico foi realizado através dos indexadores Medline e Bireme no período de 1993 a 2003, em inglês, francês e espanhol, utilizando-se o cruzamento das seguintes palavras-chave: cortisol, corticosteróides, depressão, transtorno bipolar e psicose. Foram incluídos artigos originais (33) e de revisão (22) e excluídos relatos de caso. Alguns estudos sugerem que altas concentrações plasmáticas de cortisol, em longo prazo, podem levar à depressão, propondo que a utilização de drogas antiglicocorticóides teria efeito antidepressivo. Outros estudos, por outro lado, indicam não haver associação entre hipercortisolemia e episódios depressivos.
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Berrios, German E. "Melancolia e depressão durante o século XIX: uma história conceitual." Revista Latinoamericana de Psicopatologia Fundamental 15, no. 3 (September 2012): 590–608. http://dx.doi.org/10.1590/s1415-47142012000300011.
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Este artigo analisa historicamente o background ideológico que tornou possível a transformação da noção de melancolia nos conceitos de depressão e transtorno bipolar, a partir das mudanças médicas e psicológicas ocorridas no decorrer do século XIX. A antiga noção de melancolia foi remodelada e sua transição para a doença depressiva foi facilitada pelo conceito de Iipemania de Esquirol, que, pela primeira vez, enfatizou a natureza afetiva primária da doença. Finalmente, uma vez obtidas as condições conceituais necessárias, a melancolia e a mania foram combinadas no conceito de insanidade alternante, periódica, circular, ou de forma dupla, seus rígidos padrões descritivos foram flexibilizados, tendo culminado este processo na sinopse de Kraepelin.
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MURPHY, F. C., B. J. SAHAKIAN, J. S. RUBINSZTEIN, A. MICHAEL, R. D. ROGERS, T. W. ROBBINS, and E. S. PAYKEL. "Emotional bias and inhibitory control processes in mania and depression." Psychological Medicine 29, no. 6 (November 1999): 1307–21. http://dx.doi.org/10.1017/s0033291799001233.
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Background. Despite markedly different clinical presentations, few studies have reported differences in neuropsychological functioning between mania and depression. The disinhibited behaviour characteristic of mania and evidence that subgenual prefrontal cortex is differentially activated in mania and depression both suggest that dissociable deficits will emerge on tasks that require inhibitory control and are subserved by ventromedial prefrontal cortex.Methods. Manic patients and controls undertook computerized neuropsychological tests of memory and planning ability. In addition, manic and depressed patients were directly compared with controls on a novel affective shifting task that requires inhibitory control over different components of cognitive and emotional processing.Results. Manic patients were impaired on tests of memory and planning. Importantly, affective shifting performance of manic patients differed from that of depressed patients. Manic patients were impaired in their ability to inhibit behavioural responses and focus attention, but depressed patients were impaired in their ability to shift the focus of attention. Depressed patients exhibited an affective bias for negative stimuli, and we believe this to be the first demonstration of an affective bias for positive stimuli in manic patients.Conclusions. Observed impairments on tests of memory and planning suggest a global pathology for mania consistent with previous profiles for this disorder and similar to established profiles for depression. The results on the affective shifting task demonstrate the presence of mood-congruent bias and dissociable components of inhibitory control in mania and depression. Against a background of memory and planning impairments in the two groups, these findings are consistent with a role for the ventromedial prefrontal cortex in mediating mood–cognition relationships.
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Noto, Mariane Nunes, Adiel Rios, and Mariana Pedrini. "Prodromal and at-risk states for bipolar disorder: opportunities for prevention." Revista Debates em Psiquiatria Ano 6 (October 1, 2016): 32–37. http://dx.doi.org/10.25118/2236-918x-6-5-4.
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O transtorno bipolar (TB) é uma doença psiquiátrica crônica e potencialmente grave. Nos últimos anos, pesquisas que focaram nas fases prodrômicas e iniciais do TB demonstraram que estratégias de detecção e intervenção precoces têm o potencial de atrasar, diminuir a severidade ou prevenir episódios completos do TB. Dessa forma, um novo caminho se apresenta para a clínica dos transtornos do humor, que passa não só a preocupar-se com o tratamento dos episódios de mania e depressão, como a buscar a detecção e o diagnóstico precoce e, fundamentalmente, a prevenção. O objetivo deste artigo é discutir dados da literatura sobre as fases iniciais do TB, os desafios da detecção precoce e as implicações desse enfoque para intervenções e manejo clínico antes ou logo após o desenvolvimento do primeiro episódio de mania, que marca, oficialmente, o início da doença.
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VARELA, ROGER BITENCOURT, WILSON RODRIGUES RESENDE, and JOÃO QUEVEDO. "ANIMAL MODEL OF MANIA INDUCED BY AMPHETAMINE AS A METHOD OF IDENTIFICATION OF NEW THERAPEUTIC TARGETS FOR BIPOLAR DISORDER." Revista Debates em Psiquiatria Ano 4 (April 1, 2014): 6–14. http://dx.doi.org/10.25118/2236-918x-4-2-1.
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O Transtorno Bipolar é um transtorno do humor grave com grande morbidade e mortalidade. É caracterizado por recorrentes episódios de mania e depressão. Pouco se sabe sobre a precisa neurobiologia do TB, que é essencial para o desenvolvimento de terapias específicas que funcionem rapidamente e sejam mais eficazes e toleráveis que as terapias existentes. Dadas as limitações das tecnologias não invasivas atuais para estudar o cérebro humano, os modelos animais de transtornos psiquiátricos são uma das ferramentas mais importantes para os estudos neurobiológicos. Nessa revisão são abordados alguns novos alvos terapêuticos para o tratamento do transtorno bipolar, descobertos através de estudo com modelos animais. Estudos com o modelo animal de mania induzido por anfetamina apresentam excelentes resultados apontando o envolvimento do estresse oxidativo, da Proteína Quinase C e das Histonas Deacetilases na fisiopatologia do transtorno bipolar, assim como seu potencial enquanto alvos terapêuticos, porém, esses alvos devem ser continuamente explorados nos transtornos de humor.
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Santos, Michaelle Geralda dos, Mayara Chaves Faria, Karina Braga Gomes Borges, Antônio Lúcio Teixeira, and Lirlândia Pires de Sousa. "Estudo da Inflamação no Transtorno Afetivo Bipolar:." Revista Neurociências 22, no. 1 (March 31, 2014): 134–43. http://dx.doi.org/10.34024/rnc.2014.v22.8124.
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Introdução. O processo inflamatório leva à liberação de diversos mediadores lipídicos e proteicos dentre os quais estão as citocinas. Estudos recentes têm relacionado a ação das citocinas com a fisiopatologia do Transtorno Bipolar (TB). Objetivo. Revisar a literatura acerca de estudos que realizaram dosagens dos níveis sistêmicos (séricos ou plasmáticos) de citocinas no TB. Método. Foram pesquisados artigosde 01/1980 a01/2013,nos idiomas inglês e português, nas bases de dados MedLine e Scielo, com as palavras-chave Inflammation, Cytokinese Bipolar Disorder. Foram excluídos artigos que avaliaram produção in vitro de citocinas, que não estratificaram os pacientes de acordo com a fase do transtorno bipolar (mania, depressão ou eutimia). Resultados. Foram identificados 25trabalhos que avaliaram os níveis séricos ou plasmáticos de citocinas em pacientes com TB. As citocinas avaliadas foram: IL-8, INF-γ, IL-1β, TGF-β, IL-12, IL-6, IL-4, IL-10, IL-2, IL-17, IL-5, TNF-α e seus receptores solúveis sTNFR1 e sTNFR2, além de sIL-6R e IL-1Ra. Embora os estudos apresentem resultados conflitantes quanto aos níveis de citocinas pró e anti-inflamatóriasno soro ou plasma de pacientes com TB, existeuma tendência para um perfil pró-inflamatório nos pacientes em fase de depressão e mania. Conclusão. O presente estudo sugere queos parâmetros imunológicos, representados por alterações nos níveis plasmáticos e/ou séricos de citocinas podem estar relacionados com a fisiopatologia do TB.
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Pieri, Giuliana Angeli, and Gustavo Bonini Castellana. "Transtorno de personalidade borderline ou transtorno afetivo bipolar? Contribuições da Psicopatologia Fenomenológica para o diagnóstico diferencial." Revista Psicopatologia Fenomenológica Contemporânea 5, no. 2 (October 17, 2016): 145–59. http://dx.doi.org/10.37067/rpfc.v5i2.994.
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O diagnóstico de Transtorno de personalidade borderline (TPB) tem sido defendido por alguns autores como um continuum do Transtorno Afetivo Bipolar (TAB). Entre esses autores, Akiskal afirma que tais quadros seriam manifestações sobrepostas de uma tendência comum à ciclotimia. Por outro lado, autores também contemporâneos, como Fuchs, Kimura, Stanghellini e Rosfort, de orientação fenomenológica, apoiam-se no estudo do “vivido” desses pacientes, para diferenciar os fenômenos dos sintomas listados. Conseguem, assim, demonstrar que a “depressão vazia” apresentada nos TPB é fenomenologicamente diferente da “depressão culpada”, característica dos melancólicos. O humor disfórico no TPB, por sua vez, diferencia-se da mania por sua força corporal primária, que fragmenta a estrutura intencional da corporeidade. A análise da temporalidade e identidade revela, ainda, que a divisão temporal do self e a fragmentação do self narrativo são as características essenciais do TPB. Esta exploração mostra, assim, como a psicopatologia fenomenológica contribui para o melhor diagnóstico clínico, dirimindo confusões oriundas dos critérios sintomatológicos atuais.
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Barroso, Sabrina Martins. "Instrumentos de avaliação em saúde mental." Jornal Brasileiro de Psiquiatria 65, no. 3 (September 2016): 304–5. http://dx.doi.org/10.1590/0047-2085000000136.
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RESUMO Existem muitas escalas e roteiros de entrevista potencialmente úteis para avaliar aspectos emocionais, cognitivos e psicopatológicos, mas não há uma “textoteca” que compile e disponibilize tais instrumentos para os profissionais e pesquisadores de saúde mental. Essa limitação torna difícil localizar instrumentos e conhecer suas características. Por esse motivo, o livro recém-lançado “Instrumentos de avaliação em saúde mental” poderá ser um grande facilitador do trabalho de clínicos e pesquisadores. Nesse livro diversos instrumentos de avaliação são apresentados, por tipo de construto avaliado. Por exemplo, instrumentos para avaliação de depressão, mania, sintomas psicóticos, entre outros. Além disso, são abordadas formas de construir e validar instrumentos.
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Uher, R., O. Mantere, K. Suominen, and E. Isometsä. "Typology of clinical course in bipolar disorder based on 18-month naturalistic follow-up." Psychological Medicine 43, no. 4 (July 18, 2012): 789–99. http://dx.doi.org/10.1017/s0033291712001523.
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BackgroundIndividual variation in the clinical course of bipolar disorder may have prognostic and therapeutic implications but is poorly reflected in current classifications. We aimed to establish a typology of the individual clinical trajectories based on detailed prospective medium-term follow-up.MethodLatent class analysis (LCA) of nine characteristics of clinical course (time depressed, severity of depression, stability of depression, time manic, severity of mania, stability of mania, mixed symptoms, mania-to-depression and depression-to-mania phase switching) derived from life charts prospectively tracking the onsets and offsets of (hypo)manic, depressive, mixed and subsyndromal episodes in a representative sample of 176 patients with bipolar disorder.ResultsThe best-fitting model separated patients with bipolar disorder into large classes of episodic bipolar (47%) and depressive type (32%), moderately sized classes characterized by prolonged hypomanias (10%) and mixed episodes (5%) and five small classes with unusual course characteristics including mania-to-depression and depression-to-mania transitions and chronic mixed affective symptoms. This empirical typology is relatively independent of the distinction between bipolar disorder type I and type II. Lifetime co-morbidity of alcohol use disorders is characteristic of the episodic bipolar course type.ConclusionsThere is potential for a new typology of clinical course based on medium-term naturalistic follow-up of a representative clinical sample of patients with bipolar disorder. Predictive validity and stability over longer follow-up periods remain to be established.
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Prakash, Om, Channaveerachari Naveen Kumar, P. T. Shivakumar, Srikala Bharath, and Mathew Varghese. "Clinical presentation of mania compared with depression: data from a geriatric clinic in India." International Psychogeriatrics 21, no. 4 (August 2009): 764–67. http://dx.doi.org/10.1017/s1041610209009466.
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ABSTRACTBackground: This retrospective chart review evaluated a comparison of the clinical profiles of older outpatients having mania and those with unipolar depression.Methods: The charts of elderly outpatients with mania and unipolar depression in tertiary care settings were reviewed and relevant information incorporated regarding clinical presentation, past and family history of affective disorder, treatment history and previous psychiatric and neurological history.Results: Charts for 30 patients with mania (23 men and 7 women with mean (±SD) age of 68.5(± 5.75 years) and 92 with depression (47 men and 45 women with mean (±SD) age of 68.18 (±6.0 years) were evaluated. Fifteen patients (50%) with manic episodes had psychotic symptoms in the form of delusions and hallucinations while only 33 (35.8%) depressed patients had psychotic symptoms. One-third of manic patients received mood stabilizers at index visit. More than half (n = 16; 53.3%) of the patients in the mania group were prescribed antipsychotic medications. On cognitive functions, patients with manic episodes scored poorly compared with those with depression.Conclusions: These findings suggest that mania in the elderly is a severe form of affective disorder with respect to psychotic and cognitive symptoms. Conclusions from this study are limited due to its retrospective design. Further studies in this area are warranted.
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Henry, Chantal, Joel Swendsen, Donatienne Van den Bulke, Frederic Sorbara, Jacques Demotes-Mainard, and Marion Leboyer. "Emotional hyper-reactivity as a fundamental mood characteristic of manic and mixed states." European Psychiatry 18, no. 3 (May 2003): 124–28. http://dx.doi.org/10.1016/s0924-9338(03)00041-5.
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AbstractBackgroundThe relationship between depression and mania remains poorly understood and is responsible for much of the confusion about mixed states. The difficulty in conceptualizing opposite states such as euphoric and depressive moods during the same episode may account for the considerable differences in reported frequencies of mixed states, among acutely manic patients. It is possible that the fundamental mood characteristic of mania is not tonality of mood (e.g. euphoric, irritable or depressed mood), but rather the intensity of emotions.MethodsWe interviewed 30 patients hospitalized for a manic episode, asking about their symptoms during the episode, using the list of symptoms for manic and depressive episode of the DSM-IV criteria. Emotional hyper-reactivity, defined as an increase in the intensity of all emotions, was assessed using the Hardy Scale. Manic symptoms were also assessed by a clinician using the Beck–Rafaelsen Mania Scale.ResultsThis study showed that most of the manic episodes presented many dysphoric symptoms, more particularly depressive mood (33%), irritability (53%), anxiety (76%), and recurrent thoughts of death or suicidal ideation (33%). However, only 10% of our sample met the criteria for mixed state. The other symptoms reported by patients and included in the DSM-IV criteria for depressive mood are common between depressive and manic episodes. All patients (100%) reported that they felt all their emotions with an unusual intensity.ConclusionsWe suggest that the most appropriate way to define mood in manic states is as a function of intensity, and not as a function of tonality. This definition circumvents the arbitrary dichotomy between mania and mixed state. With this definition, manic episodes can be described as being more or less dysphoric, with the actual characteristics of dysphoria encompassing irritability, anxiety, or depressive affect. This point could be extremely helpful in discriminating mixed state or dysphoric mania from depression.
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Van der Gucht, Emma, Richard Morriss, Gill Lancaster, Peter Kinderman, and Richard P. Bentall. "Psychological processes in bipolar affective disorder: negative cognitive style and reward processing." British Journal of Psychiatry 194, no. 2 (February 2009): 146–51. http://dx.doi.org/10.1192/bjp.bp.107.047894.
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BackgroundPsychological processes in bipolar disorder are of both clinical and theoretical importance.AimsTo examine depressogenic psychological processes and reward responsivity in relation to different mood episodes (mania, depression, remission) and bipolar symptomatology.MethodOne hundred and seven individuals with bipolar disorder (34 in a manic/hypomanic or mixed affective state; 30 in a depressed state and 43 who were euthymic) and 41 healthy controls were interviewed with Structured Clinical Interview for DSM–IV and completed a battery of self-rated and experimental measures assessing negative cognitive styles, coping response to negative affect, self-esteem stability and reward responsiveness.ResultsIndividuals in all episodes differed from controls on most depression-related and reward responsivity measures. However, correlational analyses revealed clear relationships between negative cognitive styles and depressive symptoms, and reward responsivity and manic symptoms.ConclusionsSeparate psychological processes are implicated in depression and mania, but cognitive vulnerability to depression is evident even in patients who are euthymic.
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Martino, Matteo, Paola Magioncalda, Zirui Huang, Benedetta Conio, Niccolò Piaggio, Niall W. Duncan, Giulio Rocchi, et al. "Contrasting variability patterns in the default mode and sensorimotor networks balance in bipolar depression and mania." Proceedings of the National Academy of Sciences 113, no. 17 (April 11, 2016): 4824–29. http://dx.doi.org/10.1073/pnas.1517558113.
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Depressive and manic phases in bipolar disorder show opposite constellations of affective, cognitive, and psychomotor symptoms. At a neural level, these may be related to topographical disbalance between large-scale networks, such as the default mode network (DMN) and sensorimotor network (SMN). We investigated topographical patterns of variability in the resting-state signal—measured by fractional SD (fSD) of the BOLD signal—of the DMN and SMN (and other networks) in two frequency bands (Slow5 and Slow4) with their ratio and clinical correlations in depressed (n = 20), manic (n = 20), euthymic (n = 20) patients, and healthy controls (n = 40). After controlling for global signal changes, the topographical balance between the DMN and SMN, specifically in the lowest frequency band, as calculated by the Slow5 fSD DMN/SMN ratio, was significantly increased in depression, whereas the same ratio was significantly decreased in mania. Additionally, Slow5 variability was increased in the DMN and decreased in the SMN in depressed patients, whereas the opposite topographical pattern was observed in mania. Finally, the Slow5 fSD DMN/SMN ratio correlated positively with clinical scores of depressive symptoms and negatively with those of mania. Results were replicated in a smaller independent bipolar disorder sample. We demonstrated topographical abnormalities in frequency-specific resting-state variability in the balance between DMN and SMN with opposing patterns in depression and mania. The Slow5 DMN/SMN ratio was tilted toward the DMN in depression but was shifted toward the SMN in mania. The Slow5 fSD DMN/SMN pattern could constitute a state-biomarker in diagnosis and therapy.
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Huang, Yu-Jui, Shang-Ying Tsai, Kuo-Hsuan Chung, Pao-Huan Chen, Shou-Hung Huang, and Chian-Jue Kuo. "State-dependent alterations of lipid profiles in patients with bipolar disorder." International Journal of Psychiatry in Medicine 53, no. 4 (December 27, 2017): 273–81. http://dx.doi.org/10.1177/0091217417749786.
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Objective Serum lipid levels may be associated with the affective severity of bipolar disorder, but data on lipid profiles in Asian patients with bipolar disorder and the lipid alterations in different states of opposite polarities are scant. We investigated the lipid profiles of patients in the acute affective, partial, and full remission state in bipolar mania and depression. Methods The physically healthy patients aged between 18 and 45 years with bipolar I disorder, as well as age-matched healthy normal controls were enrolled. We compared the fasting blood levels of glucose, cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein of manic or depressed patients in the acute phase and subsequent partial and full remission with those of their normal controls. Results A total of 32 bipolar manic patients (12 women and 20 men), 32 bipolar depressed participants (18 women and 14 men), and 64 healthy control participants took part in this study. The mean cholesterol level in acute mania was significantly lower than that in acute depression (p < 0.025). The lowest rate of dyslipidemia (hypertriglyceridemia or low high-density lipoprotein cholesterol) was observed in acute bipolar mania. Conclusion Circulating lipid profiles may be easily affected by affective states. The acute manic state may be accompanied by state-dependent lower cholesterol and triglyceride levels relative to that in other mood states.
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MURPHY, F. C., J. S. RUBINSZTEIN, A. MICHAEL, R. D. ROGERS, T. W. ROBBINS, E. S. PAYKEL, and B. J. SAHAKIAN. "Decision-making cognition in mania and depression." Psychological Medicine 31, no. 4 (May 2001): 679–93. http://dx.doi.org/10.1017/s0033291701003804.
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Background. Despite markedly different clinical presentations, few studies have reported differences in neuropsychological functioning between mania and depression. Recent work has suggested that differences may emerge on cognitive tasks requiring affective processing, such as decision-making. The present study sought to compare decision-making cognition in mania and depression in order to clarify the current profiles of impairment for these disorders and to contribute to our more general understanding of the relationship between mood and cognition.Methods. Medicated manic patients, depressed patients, and normal healthy controls completed a computerized decision-making task. All subjects were asked to win as many points as possible by choosing outcomes based on variably-weighted probabilities and by placing ‘bets’ on each decision.Results. Both patient groups were impaired on this task, as evidenced by slower deliberation times, a failure to accumulate as many points as controls and suboptimal betting strategies. Manic, but not depressed, patients made suboptimal decisions – an impairment that correlated with the severity of their illness.Conclusions. These findings are consistent with a growing consensus that manic and depressed patients are characterized by significant impairments in cognitive and particularly executive, functioning. Furthermore, the distinct patterns of observed impairment in manic and depressed patients suggests that the nature and extent of cognitive impairment differ between these two groups. Viewed in the context of other recent studies, these findings are consistent with a role for the ventromedial prefrontal cortex in mediating mood–cognition relationships.
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Silva, Rafael de Assis da, Daniel C. Mograbi, Luciana Angélica Silva Silveira, Ana Letícia Santos Nunes, Fernanda Demôro Novis, Paola Anaquim Cavaco, J. Landeira-Fernandez, and Elie Cheniaux. "Mood self-assessment in bipolar disorder: a comparison between patients in mania, depression, and euthymia." Trends in Psychiatry and Psychotherapy 35, no. 2 (2013): 141–45. http://dx.doi.org/10.1590/s2237-60892013000200008.
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BACKGROUND: Some studies indicate that mood self-assessment is more severely impaired in patients with bipolar disorder in a manic episode than in depression. OBJECTIVES: To investigate variations in mood self-assessment in relation to current affective state in a group of individuals with bipolar disorder. METHODS: A total of 165 patients with a diagnosis of bipolar disorder type I or type II had their affective state assessed using the Clinical Global Impressions Scale for use in bipolar illness (CGI-BP), the Positive and Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF). In addition, participants completed a self-report visual analog mood scale (VAMS). Patients were divided into three groups (euthymia, mania, and depression) and compared with regard to VAMS results. RESULTS: Manic patients rated their mood similarly to patients in euthymia in 14 out of 16 items in the VAMS. By contrast, depressed patients rated only two items similarly to euthymic patients. CONCLUSION: Patients with bipolar disorder in mania, but not those in depression, poorly evaluate their affective state, reinforcing the occurrence of insight impairment in the manic syndrome.
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Previdelli, Marina Brito, Amanda Oliva Spaziani, Talita Costa Barbosa, Júlia Groto Rico, Iasmim Alves De Lima Custódio, Ariany Aparecida Bonfim Simioni, Raissa Silva Frota, et al. "Transtorno afetivo bipolar em paciente gestante com trágico desfecho fetal: relato de caso." ARCHIVES OF HEALTH INVESTIGATION 10, no. 1 (October 7, 2020): 38–41. http://dx.doi.org/10.21270/archi.v10i1.4844.
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O Transtorno Afetivo Bipolar (TAB) envolve a psicose, depressão e mania caracterizado por períodos de bom humor e irritação ou depressão, podendo trazer prejuízos para as relações afetivas. No caso de TAB em gestação o tratamento torna-se complicado, pois a escassez de estudos faz com que a terapêutica farmacológica seja suspensa. Sexo feminino, 37 anos. Em tratamento para transtorno afetivo bipolar há 7 anos. Paciente engravidou em 2018 em uso de: Risperidona; Citalopram; Biperideno; Carbonato de lítio; Clorpromazina; Propanolol; Brometazina; Clonazepam. Devido a gestação, descoberta com 20 semanas gestacionais, alterou-se a medicação. Fazia uso de: Clonazepam, Prometazina, Carbonato de Lítio, Haloperidol e Clorpromazina. Com 26 semanas gestacionais, ultrassom gestacional apresentava polidrâmnio. Com 30 semanas gestacionais apresentou dor abdominal de grande intensidade e foi internada. Na manhã seguinte apresentava melhora do quadro álgico, porém tinha 9 polpas digitais de dilatação, colo fino e anterior. Encaminhada para o centro cirúrgico para realização de cesárea com recém-nascido bradicardico e hipotônico que evoluiu com óbito seis dias após. A prescrição e uso de medicamentos na gestação, merece especial cuidado. Os trabalhos na área com gestantes são bastantes escassos, uma vez que estudos nesta fase da vida vão de encontro a princípios da bioética.
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Sanches, Rafael Faria, and João Mazzoncini de Azevedo Marques. "Cannabis e humor." Revista Brasileira de Psiquiatria 32, no. 2 (June 2010): 173–80. http://dx.doi.org/10.1590/s1516-44462010000200014.
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OBJETIVO: Avaliar as relações entre o uso agudo e crônico de cannabis e alterações do humor. MÉTODO: Os artigos foram selecionados por meio de busca eletrônica no indexador PubMed. Capítulos de livros e as listas de referências dos artigos selecionados também foram revisados. RESULTADOS: Observam-se elevados índices de comorbidade entre abuso/dependência de cannabis e transtornos afetivos em estudos transversais e em amostras clínicas. Estudos longitudinais indicam que, em longo prazo, o uso mais intenso de cannabis está relacionado com um risco maior de desenvolvimento de doença bipolar e, talvez, depressão maior em indivíduos inicialmente sem quadros afetivos; porém, os mesmos não encontraram maior risco de uso de cannabis entre aqueles com mania ou depressão sem esta comorbidade. Outra importante observação é que o uso de substâncias psicoativas em bipolares pode estar associado a uma série de características negativas, como dificuldade na recuperação dos sintomas afetivos, maior número de internações, piora na adesão ao tratamento, risco aumentado de suicídio, agressividade e a uma pobre resposta ao lítio. Tratamentos psicossociais e farmacológicos são indicados para o manejo da comorbidade entre cannabis e transtornos afetivos. CONCLUSÃO: As relações entre o uso de cannabis e alterações do humor são observadas tanto epidemiologicamente quanto nos contextos clínicos.
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Previdelli, Marina Brito, Amanda Oliva Spaziani, Talita Costa Barbosa, Júlia Groto Rico, Iasmim Alves De Lima Custódio, Ariany Aparecida Bonfim Simioni, Raissa Silva Frota, et al. "Transtorno afetivo bipolar em paciente gestante com trágico desfecho fetal: relato de caso." ARCHIVES OF HEALTH INVESTIGATION 10, no. 1 (October 7, 2020): 38–41. http://dx.doi.org/10.21270/archi.v10i1.4844.
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O Transtorno Afetivo Bipolar (TAB) envolve a psicose, depressão e mania caracterizado por períodos de bom humor e irritação ou depressão, podendo trazer prejuízos para as relações afetivas. No caso de TAB em gestação o tratamento torna-se complicado, pois a escassez de estudos faz com que a terapêutica farmacológica seja suspensa. Sexo feminino, 37 anos. Em tratamento para transtorno afetivo bipolar há 7 anos. Paciente engravidou em 2018 em uso de: Risperidona; Citalopram; Biperideno; Carbonato de lítio; Clorpromazina; Propanolol; Brometazina; Clonazepam. Devido a gestação, descoberta com 20 semanas gestacionais, alterou-se a medicação. Fazia uso de: Clonazepam, Prometazina, Carbonato de Lítio, Haloperidol e Clorpromazina. Com 26 semanas gestacionais, ultrassom gestacional apresentava polidrâmnio. Com 30 semanas gestacionais apresentou dor abdominal de grande intensidade e foi internada. Na manhã seguinte apresentava melhora do quadro álgico, porém tinha 9 polpas digitais de dilatação, colo fino e anterior. Encaminhada para o centro cirúrgico para realização de cesárea com recém-nascido bradicardico e hipotônico que evoluiu com óbito seis dias após. A prescrição e uso de medicamentos na gestação, merece especial cuidado. Os trabalhos na área com gestantes são bastantes escassos, uma vez que estudos nesta fase da vida vão de encontro a princípios da bioética.
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Pedroso, Vinicius Sousa Pietra, Leonardo Cruz de Souza, and Antônio Lúcio Teixeira. "Síndromes neuropsiquiátricas associadas a acidentes vasculares encefálicos: revisão de literatura." Jornal Brasileiro de Psiquiatria 63, no. 2 (July 2014): 165–76. http://dx.doi.org/10.1590/0047-2085000000021.
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Objetivo Revisar as principais síndromes neuropsiquiátricas associadas ao acidente vascular encefálico (AVE), suas características clínicas, impacto sobre a recuperação dos pacientes, tratamento, suas possíveis relações com a fisiopatologia dos AVE e, quando possível, contextualizá-las à realidade brasileira. Métodos Foram realizadas buscas nas bases de dados PubMed/MedLine e SciELO/Lilacs com os termos “stroke” e “cerebrovascular disease” em combinações com “neuropsychiatry”, “neuropsychiatric disorders”, “psychiatry”, “psychiatric disorders”, “depression”, “anxiety” e “dementia”, com ênfase nos últimos dez anos. Resultados Foram revisadas as síndromes neuropsiquiátricas pós-AVE, incluindo depressão, ansiedade, transtorno da expressão emocional involuntária, labilidade emocional, irritabilidade, raiva, reação catastrófica, apatia, demência, mania e psicose, de acordo com os objetivos propostos. Conclusão É notória a escassez de informações sobre o manejo terapêutico das complicações neuropsiquiátricas secundárias aos AVE, especialmente diante do impacto em saúde pública representado pelas doenças cerebrovasculares. Com a evolução da abordagem precoce a esses pacientes e o consequente aumento de sua sobrevida, o aprofundamento do conhecimento sobre o desenvolvimento e o tratamento dos transtornos neuropsiquiátricos parece ter maior potencial para melhorar o desfecho e a qualidade de vida dos indivíduos que sofreram AVE.
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Kwok, Cecilia Sze Nga, and Leslie Eng Choon Lim. "Mania following antidepressant discontinuation in depression: two case reports." Australasian Psychiatry 25, no. 6 (October 4, 2017): 617–21. http://dx.doi.org/10.1177/1039856217732470.
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Objective: Antidepressant-induced mania and an antidepressant discontinuation syndrome are well documented, whereas mania occurring after antidepressant cessation has been infrequently reported. Method: We describe antidepressant discontinuation-related mania in two Chinese patients, as well as a review of the literature on this phenomenon in unipolar depression. Results: A 72-year-old man and a 65-year-old woman had late-onset depression with vascular risk factors, but no personal or family history of mood disorders. Manic symptoms started after stopping escitalopram and venlafaxine during depressive relapse, and resolved with the initiation of olanzapine and valproate. In the literature, 29 episodes of antidepressant discontinuation-related mania were reported. Tricyclic antidepressants were most frequently implicated, followed by selective serotonin reuptake inhibitors. There was spontaneous resolution of manic symptoms in half of the cases. Conclusion: This is the first report of antidepressant discontinuation-related mania in an Asian population, in the setting of late-onset depression. This phenomenon is rare and is amenable to standard treatment.
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Raes, Filip, Ine Ghesquière, and Dinska Van Gucht. "Cognitive Reactivity to Success and Failure Relate Uniquely to Manic and Depression Tendencies and Combine in Bipolar Tendencies." Depression Research and Treatment 2012 (2012): 1–4. http://dx.doi.org/10.1155/2012/753946.
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The present study examined simultaneously the relations between cognitive reactivity to success and failure, on the one hand, and depression, manic, and bipolar tendencies, on the other hand. Participants (161 students) completed measures of success and failure reactivity, current manic and depressive symptoms, and tendencies towards depression, mania, and bipolarity. Results showed that respondents with a greater tendency towards depression evidenced greater (negative) reactivity to failure, whereas those with a greater tendency toward mania evidenced greater (positive) reactivity to success. Depression vulnerability was unrelated to success reactivity, and manic vulnerability was unrelated to failure reactivity. Tendencies toward bipolarity correlated significantly withbothfailure and success reactivity in a negative and positive manner, respectively. These findings add to the growing body of literature, suggesting that different features or cognitive tendencies are related to depression vulnerability versus manic vulnerability and imply that these “mirrored” cognitive features both form part of vulnerability to bipolar disorder.
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Russo, Daniel, Matteo Martino, Paola Magioncalda, Matilde Inglese, Mario Amore, and Georg Northoff. "Opposing Changes in the Functional Architecture of Large-Scale Networks in Bipolar Mania and Depression." Schizophrenia Bulletin 46, no. 4 (February 12, 2020): 971–80. http://dx.doi.org/10.1093/schbul/sbaa004.
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Abstract Objective Manic and depressive phases of bipolar disorder (BD) show opposite symptoms in psychomotor, thought, and affective dimensions. Neuronally, these may depend on distinct patterns of alterations in the functional architecture of brain intrinsic activity. Therefore, the study aimed to characterize the spatial and temporal changes of resting-state activity in mania and depression, by investigating the regional homogeneity (ReHo) and degree of centrality (DC), in different frequency bands. Methods Using resting-state functional magnetic resonance imaging (fMRI), voxel-wise ReHo and DC were calculated—in the standard frequency band (SFB: 0.01–0.10 Hz), as well as in Slow5 (0.01–0.027 Hz) and Slow4 (0.027–0.073 Hz)—and compared between manic (n = 36), depressed (n = 43), euthymic (n = 29) patients, and healthy controls (n = 112). Finally, clinical correlations were investigated. Results Mania was mainly characterized by decreased ReHo and DC in Slow4 in the medial prefrontal cortex (as part of the default-mode network [DMN]), which in turn correlated with manic symptomatology. Conversely, depression was mainly characterized by decreased ReHo in SFB in the primary sensory-motor cortex (as part of the sensorimotor network [SMN]), which in turn correlated with depressive symptomatology. Conclusions Our data show a functional reconfiguration of the spatiotemporal structure of intrinsic brain activity to occur in BD. Mania might be characterized by a predominance of sensorimotor over associative networks, possibly driven by a deficit of the DMN (reflecting in internal thought deficit). Conversely, depression might be characterized by a predominance of associative over sensorimotor networks, possibly driven by a deficit of the SMN (reflecting in psychomotor inhibition).
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Chang, Ping-Tsun, and Cheng-Ta Li. "Mania induced by varenicline." F1000Research 2 (September 13, 2013): 183. http://dx.doi.org/10.12688/f1000research.2-183.v1.
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Varenicline is sometimes used in the treatment of smoking addiction. Side effects such as nausea, vomiting, and headaches have been well documented. In addition, depressed mood and suicidal thoughts relating to varenicline usage have been previously reported. We report a case of mania in a patient with refractory depression whose first manic episode developed under the use of varenicline in combination with original antidepressant medications.
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Lester, David. "Comment on “Manic—Depressiveness and its Correlates”." Psychological Reports 85, no. 3 (December 1999): 1057–58. http://dx.doi.org/10.2466/pr0.1999.85.3.1057.
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Data from a sample of 612 college students showed that the Depression subscale of the Manic–Depressiveness Scale had greater internal reliability than the Mania subscale. Furthermore, correlates of the total scale score did nor appear to provide as useful information as use of the Depression and Mania subscales separately.
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Wadi, Yonissa Marmitt, and Diego Luiz Dos Santos. "“O que é normal e o que é louco?” A vida com transtorno bipolar na autobiografia em quadrinhos Parafusos de Ellen Forney." Revista Eletrônica da ANPHLAC, no. 24 (July 11, 2018): 281–318. http://dx.doi.org/10.46752/anphlac.24.2018.2948.
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Parafusos: Mania, Depressão, Michelangelo e Eu, escrito e desenhado pela quadrinista estadunidense Ellen Forney, é uma autobiografia em quadrinhos na qual a autora narrou sua vida após ser diagnosticada com transtorno bipolar. A maior parte do enredo se passa entre 1998, ano do diagnóstico, e 2002, quando afirma ter alcançado “equilíbrio emocional”. O objetivo deste texto, inserido no campo da história da loucura e da psiquiatria, foi problematizar a narrativa de Ellen, no sentido de compreender suas próprias problematizações sobre a experiência com a loucura, especialmente a classificação de sua subjetividade pelo diagnóstico, sua busca por alternativas ao tratamento psiquiátrico medicamentoso, sua aceitação deste e a relação entre loucura e criatividade artística. Concluímos que a quadrinista teve uma dupla intenção ao transformar sua experiência em livro: uma de caráter pedagógico, que visou oferecer informações e companhia aos leitores que conviviam com o sofrimento; outra, de caráter terapêutico, que contribuiu para lidar com seu próprio sofrimento, construindo, assim, um novo sentido para seu presente.
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Del Porto, José Alberto. "Evolução do conceito e controvérsias atuais sobre o transtorno bipolar do humor." Revista Brasileira de Psiquiatria 26, suppl 3 (October 2004): 3–6. http://dx.doi.org/10.1590/s1516-44462004000700002.
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O autor revê o conceito de transtorno bipolar como um processo em evolução. Suas raízes podem ser encontradas no trabalho de Araeteus da Capadócia, que assumia serem a melancolia e a mania duas formas da mesma doença. A compreensão atual da doença bipolar começou na França, através dos trabalhos de Falret (1851) e Baillarguer (1854). Os conceitos fundamentais de Kraepelin mudaram as bases da nosologia psiquiátrica, e o conceito unitário de Kraepelin sobre a insanidade maníaco-depressiva passou a ser amplamente aceito. Depois de Kraepelin, no entanto, as idéias de Kleist e Leonhard, na Alemanha, e o trabalho subseqüente de Angst, Perris e Winokur enfatizaram a distinção entre as formas monopolares e bipolares da depressão. Mais recentemente a ênfase mudou novamente para o espectro bipolar, que em suas formas leves expande-se às bordas dos temperamentos normais. Finalizando, o autor sumariza os aspectos polêmicos da nosologia da doença bipolar e seus limites com as esquizofrenias, a doença esquizoafetiva e as psicoses ciclóides.
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Machado-Vieira, Rodrigo, Alexandre Willi Schwartzhaupt, Benício Noronha Frey, Joyce Jacini Lenadro, Keila Maria Mendes Ceresér, Liege Neto da Silveira, Lino Marcos Zanatta, et al. "Neurobiologia do transtorno de humor bipolar e tomada de decisão na abordagem psicofarmacológica." Revista de Psiquiatria do Rio Grande do Sul 25, suppl 1 (April 2003): 88–105. http://dx.doi.org/10.1590/s0101-81082003000400010.
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O Transtorno do Humor Bipolar (THB) caracteriza-se por oscilações do humor que causam prejuízos significativos no âmbito biopsicossocial. O interesse da comunidade científica por este transtorno vem aumentando nos últimos cinco anos em função de sua crescente prevalência associada ao refinamento diagnóstico, à ampliação do arsenal terapêutico e ao conhecimento dos avanços nas pesquisas da neurobiologia do transtorno. A presente revisão aborda questões diagnosticas e terapêuticas aplicadas à neurobiologia dos THB, relacionando-as diretamente à terapêutica dos quadros de mania, hipomania, estados mistos, depressão bipolar e ciclagem rápida, da infância à idade adulta. São revisados criticamente importantes estudos realizados com diferentes fármacos potencialmente eficazes como estabilizadores do humor, nos diversos subdiagnósticos do THB. São analisados fármacos, tais como o lítio, anticonvulsivantes, antipsicóticos, benzodiazepínicos, bloqueadores dos canais de cálcio e hormônio tireoideo, bem como as possíveis bases biológicas para seus efeitos terapêuticos. Em síntese, este trabalho aborda os avanços da psicofarmacologia cuja eficácia é comprovada nos subtipos do THB, procurando relacioná-los com a neurobiologia deste transtorno.
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Alves, Gilberto Sousa, Felipe Kenji Sudo, Lucas Briand, and Johannes Pantel. "Treatment of bipolar disorder in the elderly: a review of the literature." Revista Debates em Psiquiatria Ano 7 (December 1, 2017): 26–36. http://dx.doi.org/10.25118/2236-918x-7-6-3.
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O transtorno afetivo bipolar (TAB) é uma condição potencialmente grave, caracterizada por mudanças de humor e disfunção cognitiva e funcional. O presente artigo revisa as evidências atualizadas das intervenções farmacológicas e não medicamentosas direcionadas ao TAB em idosos. Diretrizes baseadas em evidências, embora sejam úteis na promoção de uma terapia racional e eficaz, ainda são relativamente reduzidas no TAB em idosos. As recomendações atuais para mania aguda incluem o uso de antipsicóticos atípicos (por exemplo, risperidona, quetiapina, olanzapina), lítio (de maneira criteriosa) e a eleição de valproato como terapia padrão ouro. Na depressão aguda do TAB, os agentes de primeira linha em monoterapia podem incluir lítio, lamotrigina, quetiapina e quetiapina de liberação prolongada. No que se refere à escolha do estabilizador de humor ideal, o maior potencial de efeitos colaterais relacionados ao lítio vem desestimulando sua prescrição em indivíduos idosos. A eletroconvulsoterapia, embora limitada pela evidência, pode ser uma opção para casos graves/refratários.
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Bressi, C., M. Porcellana, P. M. Marinaccio, E. P. Nocito, M. Ciabatti, L. Magri, and A. C. Altamura. "The association between insight and symptoms in bipolar inpatients: An Italian prospective study." European Psychiatry 27, no. 8 (November 30, 2011): 619–24. http://dx.doi.org/10.1016/j.eurpsy.2011.09.002.
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AbstractObjectiveTo evaluate potential differences in insight among bipolar manic, mixed and bipolar depressed inpatients and assess the role of clinical and demographic characteristics as possible predictors.MethodOne hundred and twenty consecutive inpatients divided into three diagnostic groups were studied on admission (T0), at discharge (T1) and at 18weeks after hospitalization (T2). The Young Mania Rating Scale (YMRS), the Hamilton Rating Scale for Depression (HAMD) and the Scale to Assess Unawareness of Mental Disorder (SUMD) were used.ResultsPatients with mixed mania showed highest scores on the SUMD than patients with mania or bipolar depression. It was found a significant relationship between improvements in mania and in the insight. The level of insight at baseline was the only predictor of awareness in social consequences, moreover clinical and demographic characteristics were predictors of insight into mental illness. For what concerns insight about therapy benefits it was influenced by level of mania at baseline.ConclusionThe three general dimensions of insight revealed significant differences among the three groups. Regression models suggest that insight is a multidimensional concept in which some aspects are state-related, associated with psychopathology, whereas others are trait-like qualities, not directly associated with symptoms and predicted only by level at baseline.
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Stahl, Stephen M., Sarah Laredo, and Debbi Ann Morrissette. "Cariprazine as a treatment across the bipolar I spectrum from depression to mania: mechanism of action and review of clinical data." Therapeutic Advances in Psychopharmacology 10 (January 2020): 204512532090575. http://dx.doi.org/10.1177/2045125320905752.
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Cariprazine is one of the newest dopamine-serotonin partial agonists, also known as ‘atypical’ second generation antipsychotics. Originally approved for acute and maintenance treatment of schizophrenia as well as for acute mania and mixed mania/depression, cariprazine has now been approved for bipolar I depression. Additionally, post hoc analyses of bipolar I depressed subjects show that both those with and those without concurrent manic features were improved following treatment with cariprazine. Maintenance studies are in progress in bipolar disorder, as are studies to augment antidepressants in unipolar major depressive episodes insufficiently responsive to treatment. Here, we review specifically the efficacy and safety data of cariprazine in bipolar I disorder and discuss the hypothesized mechanism of action of cariprazine and how it could theoretically be linked to caprazine’s broad therapeutic actions across the mood disorder spectrum.
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McKeon, Patrick, Patrick Manley, and Gregory Swanwick. "Manic-depressive illness — I: clinical characteristics of bipolar disorder subtypes." Irish Journal of Psychological Medicine 9, no. 1 (May 1992): 6–9. http://dx.doi.org/10.1017/s0790966700013823.
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AbstractThe clinical and demographic features of 100 bipolar disorder patients, who were categorised into bipolar I, bipolar II, unipolar mania and rapid cycling groups, and who were further classified on the basis of the sequence of occurrence of the manic and depressive episodes within each cycle, are compared. Bipolar I (including unipolar manic) patients, 77% of whom had a sequence of moods where mania preceded depression (Mania-Depression – normothymic Interval: M.D.I.) constituted 69% of the total sample. Six per cent were classified as bipolar II and 25% has a rapid cycling disorder. Patients who had an M.D.I. sequence of moods, whether rapid or non-rapid cycling, had a younger age of onset, a higher male:female ratio and a stronger family history of bipolar disorder than patients whose depression preceded mania (D.M.I.). Unipolar manic patients, 12% of the sample, had a comparable age of onset, a greater family history of bipolarity and more frequent hospitalisations than the bipolar I-M.D.I. group. Rapid cycling patients had a lower mean serum thyroxine concentration than the non-rapid cycling bipolar disorder patients. This study supports the rationale for distinguishing bipolar patients with an M.D.I, sequence from those with a D.M.I, pattern and rapid cyclers from non-rapid cyclers.
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Koukopoulos, Athanasios, and S. Nassir Ghaemi. "The primacy of mania: A reconsideration of mood disorders." European Psychiatry 24, no. 2 (March 2009): 125–34. http://dx.doi.org/10.1016/j.eurpsy.2008.07.006.
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AbstractIn contemporary psychiatry, depression and mania are conceived as different entities. They may occur together, as in bipolar disorder, or they may occur separately, as in unipolar depression. This view is partly based on a narrow definition of mania and a rather broad definition of depression. Generally, depression is seen as more prominent, common, and problematic; while mania appears uncommon and treatment-responsive. We suggest a reversal: mania viewed broadly, not as simply episodic euphoria plus hyperactivity, but a wide range of excitatory behaviors; and depression seen more narrowly. Further, using pharmacological and clinical evidence, and in contrast to previous theories of mania interpreted as a flight from depression, we propose the primacy of mania hypothesis (PM): depression is a consequence of the excitatory processes of mania. If correct, current treatment of depressive illness needs revision. Rather than directly lifting mood with antidepressants, the aim would be to suppress manic-like excitation, with depression being secondarily prevented. Potential objections to, and empirical tests of, the PM hypothesis are discussed.
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Sclare, Paul, and Francis Creed. "Life Events and the Onset of Mania." British Journal of Psychiatry 156, no. 4 (April 1990): 508–14. http://dx.doi.org/10.1192/bjp.156.4.508.
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Thirty manic in-patients were interviewed in hospital using the LEDS, and 24 were re-interviewed 6–12 months after discharge. Data for life events were analysed by: comparing events before onset of mania and before re-interview; and comparing these manic patients with patients in other studies which examined life events and the onset of schizophrenia and depression. No relationship was found between life events and the onset of mania in this preliminary study. Previous studies reporting a link between events and the onset of mania have serious methodological flaws, and definitive data have yet to be produced.
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Weisberg, Robert W. "Genius and Madness?: A Quasi-Experimental Test of the Hypothesis That Manic-Depression Increases Creativity." Psychological Science 5, no. 6 (November 1994): 361–67. http://dx.doi.org/10.1111/j.1467-9280.1994.tb00286.x.
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Much evidence has been adduced to support the view, originally proposed by Kraepelin, that mania increases creativity Examples of supporting evidence are findings of similarity in thought between creative persons and manic-depressives and high creativity in normal relatives of manic-depressives However, such data are correlational and are therefore equivocal concerning the hypothesis that mania is a cause of increased creativity The present study analyzed the relationship between mood and productivity in the career of composer Robert Schumann, who has been diagnosed as bipolar Schumann's positive mood was related to increased quantity of his work but not to increased quality, indicating that mania did not increase creativity of thought processes
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Chatterton, Mary Lou, Emily Stockings, Michael Berk, Jan J. Barendregt, Rob Carter, and Cathrine Mihalopoulos. "Psychosocial therapies for the adjunctive treatment of bipolar disorder in adults: Network meta-analysis." British Journal of Psychiatry 210, no. 5 (May 2017): 333–41. http://dx.doi.org/10.1192/bjp.bp.116.195321.
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BackgroundFew trials have compared psychosocial therapies for people with bipolar affective disorder, and conventional meta-analyses provided limited comparisons between therapies.AimsTo combine evidence for the efficacy of psychosocial interventions used as adjunctive treatment of bipolar disorder in adults, using network meta-analysis (NMA).MethodSystematic review identified studies and NMA was used to pool data on relapse to mania or depression, medication adherence, and symptom scales for mania, depression and Global Assessment of Functioning (GAF).ResultsCarer-focused interventions significantly reduced the risk of depressive or manic relapse. Psychoeducation alone and in combination with cognitive–behavioural therapy (CBT) significantly reduced medication non-adherence. Psychoeducation plus CBT significantly reduced manic symptoms and increased GAF. No intervention was associated with a significant reduction in depression symptom scale scores.ConclusionsOnly interventions for family members affected relapse rates. Psychoeducation plus CBT reduced medication non-adherence, improved mania symptoms and GAF. Novel methods for addressing depressive symptoms are required.
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Bauer, Mark S., Gregory E. Simon, Evette Ludman, and Jurgen Unützer. "‘Bipolarity’ in bipolar disorder: Distribution of manic and depressive symptoms in a treated population." British Journal of Psychiatry 187, no. 1 (July 2005): 87–88. http://dx.doi.org/10.1192/bjp.187.1.87.
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SummaryCross-sectional analysis of 441 individuals with bipolar disorder treated at a US health maintenance organisation investigated the distribution of manic and depressive symptoms in that illness. Clinically significant depressive symptoms occurred in 94.1% of those with (hypo)mania, while70.1% inadepressive episode had clinically significant manic symptoms. DSM-unrecognised depression-plus-hypomania was over twice as prevalent as DSM-recognised mixed episodes. Depressive symptoms were unimodally distributed in (hypo)mania. Depressive and manic symptoms were positively, not inversely correlated, and their co-occurrence was associated with worse quality of life. Implications for the DSM and ICD nosological systems are discussed.
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Loze, J. Y., R. Mankoski, J. Zhao, W. Carson, E. Youngstrom, R. Findling, R. Forbes, and W. Landsberg. "P01-226-Line item analysis in paediatric patients with bipolar I disorder treated with aripiprazole." European Psychiatry 26, S2 (March 2011): 227. http://dx.doi.org/10.1016/s0924-9338(11)71937-x.
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IntroductionAripiprazole has demonstrated efficacy for the treatment of paediatric patients (10–17 years) with a manic or mixed episode associated with bipolar I disorder in a clinical trial that utilised the Young Mania Rating Scale (YMRS) Total score as the primary outcome measure.Objectives/aimThis analysis evaluated the profile of discrete symptom response using the YMRS and other measures.MethodsPost-hoc analysis of individual items of the YMRS and the parent or subject version of the General Behaviour Inventory (GBI) Mania and Depression scales using data from a 4-week, double-blind, randomised trial that compared aripiprazole (10 or 30 mg/day, n = 197) with placebo (n = 99).ResultsIn total, 296 patients were randomised; 80% completed the study. Significant decreases at Week 4 (p < 0.05) were seen in eight YMRS items: elevated mood, increased motor activity/energy, need for sleep, irritability, speech (rate and amount), language/thought disorder, abnormal thought content and disruptive/aggressive behaviour. For the GBI, effect sizes for parent-reported mania items were medium to large (for example, 0.41 for ‘depressed but high energy’ to 0.78 for ‘rage combined with unusually happy’) but were consistently small on subject self-reported items of mania and depression and, for the overall scale, had the poorest agreement with clinician ratings.ConclusionsAripiprazole demonstrated improvements in some of the more troublesome symptoms of paediatric patients with bipolar I disorder experiencing an acute manic or mixed episode. Of note, irritability and aggression showed large treatment effects on both clinician and parent-reported measures, but less so for subject-reported measures.
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Finucane, Lucy, Gabriele Jordan, and Thomas D. Meyer. "Risk for Mania and its Relationship to Implicit and Explicit Achievement Motivation." Journal of Individual Differences 34, no. 4 (January 1, 2013): 214–21. http://dx.doi.org/10.1027/1614-0001/a000117.
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There is evidence that bipolar disorders are associated with achievement-related cognitions such as setting high goals. A psychodynamic model, the manic defense hypothesis, postulates that a threat to fragile self-esteem triggers grandiosity and manic behaviors in vulnerable people. Vulnerability to bipolar disorders should therefore be positively associated with indicators of explicit hope of success (HS) and implicit fear of failure (FF). Using an online sample (n = 252), we tested these hypotheses using the well-validated Hypomanic Personality Scale as risk indicator for mania, the Multi-Motive Grid for achievement motivation, controlling for current and lifetime depression. Contrary to expectations, we found that vulnerability for mania was significantly and positively related to implicit HS but not to FF after controlling for depression. All measures were self-report tools. Our results contradict the Manic Defense Hypothesis, but they are in line with the idea that achievement-related cognitions are of relevance to vulnerability in bipolar disorders. This is in line with research focusing on the role of the Behavioral Activation System in relation to vulnerability for mania.
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Goren, Jessica L., and Gary M. Levin. "Mania with Bupropion: A Dose-Related Phenomenon?" Annals of Pharmacotherapy 34, no. 5 (May 2000): 619–21. http://dx.doi.org/10.1345/aph.19313.
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OBJECTIVE: To report a case in which bipolar depression was resistant to usual therapies, requiring dosages of bupropion >450 mg/d and to review the literature on mania associated with bupropion and propose a potential theory of a dose-related threshold associated with bupropion and mania. CASE SUMMARY: A 44-year-old white man with a 25-year history of bipolar affective disorder presented with depression resistant to usual therapies. Bupropion therapy was initiated and the dosage was titrated to 600 mg/d. After exceeding the maximum recommended daily dose (450 mg/d), he experienced a manic episode attrib uted to high-dose bupropion. DISCUSSION: Due to increased risk of seizures, current prescribing guidelines state that the total daily dose of bupropion is not to exceed 450 mg/d. Since bupropion is the agent least likely to cause a manic switch in bipolar disorder, this agent seemed a logical choice to treat the patient's depression. Due to a lack of response, the bupropion dosage was titrated to a maximum of 600 mg/d. Since the patient did not switch into mania until the dosage exceeded 450 mg/d, we speculate that this adverse reaction is a dose-related phenomenon. Scientific literature supports this theory. CONCLUSIONS: A switch into mania is a potential risk associated with antidepressant drug use in bipolar affective disorder. Bupropion is believed to be associated with a decreased risk compared with other antidepressant therapies. However, our case report as well as others support the theory that this decreased risk may be due to dosages not exceeding the recommended daily dose (450 mg/d). Doses of bupropion >450 mg/d should be used with caution in depressed patients with bipolar affective disorder.
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Cheniaux, Elie. "O tratamento farmacológico do transtorno bipolar: uma revisão sistemática e crítica dos aspectos metodológicos dos estudos clínicos modernos." Revista Brasileira de Psiquiatria 33, no. 1 (March 2011): 72–80. http://dx.doi.org/10.1590/s1516-44462011000100015.
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OBJETIVO: Revisar sistematicamente os principais estudos clínicos sobre o tratamento farmacológico do transtorno bipolar e fazer uma análise crítica de seus aspectos metodológicos. MÉTODO: Realizou-se uma busca nas bases de dados Medline, ISI e PsycINFO, utilizando-se os seguintes termos de busca: "bipolar", "randomized", "placebo" e "controlled". Foram selecionados estudos clínicos randomizados, duplo-cegos e controlados por placebo sobre o tratamento farmacológico do transtorno bipolar. Além disso, de acordo com os nossos critérios, as amostras deveriam ser de no mínimo 100 pacientes e a substância testada deveria ser usada como monoterapia. RESULTADOS: 34 artigos se adequaram aos critérios de seleção. Todas as substâncias atualmente indicadas para mania, depressão bipolar e para o tratamento de manutenção foram mais eficazes que o placebo em pelo menos um estudo. Todavia, esses estudos tiveram amostras altamente selecionadas, altas taxas de abandono e baixas taxas de resposta clínica. CONCLUSÃO: Os modernos estudos clínicos sobre o tratamento farmacológico do transtorno bipolar apresentam algumas importantes limitações metodológicas. Assim, seus resultados devem ser considerados com cautela.
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Zimmerman, Mark. "Measures of the DSM–5 mixed-features specifier of major depressive disorder." CNS Spectrums 22, no. 2 (January 12, 2017): 196–202. http://dx.doi.org/10.1017/s1092852916000857.
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During the past two decades, a number of studies have found that depressed patients frequently have manic symptoms intermixed with depressive symptoms. While the frequency of mixed syndromes are more common in bipolar than in unipolar depressives, mixed states are also common in patients with major depressive disorder. The admixture of symptoms may be evident when depressed patients present for treatment, or they may emerge during ongoing treatment. In some patients, treatment with antidepressant medication might precipitate the emergence of mixed states. It would therefore be useful to systematically inquire into the presence of manic/hypomanic symptoms in depressed patients. We can anticipate that increased attention will likely be given to mixed depression because of changes in the DSM–5. In the present article, I review instruments that have been utilized to assess the presence and severity of manic symptoms and therefore could be potentially used to identify the DSM–5 mixed-features specifier in depressed patients and to evaluate the course and outcome of treatment. In choosing which measure to use, clinicians and researchers should consider whether the measure assesses both depression and mania/hypomania, assesses all or only some of the DSM–5 criteria for the mixed-features specifier, or assesses manic/hypomanic symptoms that are not part of the DSM–5 definition. Feasibility, more so than reliability and validity, will likely determine whether these measures are incorporated into routine clinical practice.
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Silverstone, Trevor, Sarah Romans, Neil Hunt, and Heather McPherson. "Is There a Seasonal Pattern of Relapse in Bipolar Affective Disorders? a Dual Northern and Southern Hemisphere Cohort Study." British Journal of Psychiatry 167, no. 1 (July 1995): 58–60. http://dx.doi.org/10.1192/bjp.167.1.58.
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BackgroundAdmission statistics for mania frequently show an increase in the summer. The present two-centre study was designed to test the hypothesis, in a representative sample of bipolar patients, that manic and depressive relapses show a seasonal pattern.MethodTwo cohorts of bipolar I patients, one in London, England (n = 86), the other in Dunedin, New Zealand (n = 58), were tracked retrospectively during 1985–88 and prospectively during 1989–91, with the onset of all relapses being carefully dated.ResultsIn the London cohort there were 221 episodes of mania and 76 of depression; in the Dunedin cohort there were 201 of mania and 61 of depression. No consistent seasonal pattern of mania was detected in either centre. There was an autumn preponderance of depressive episodes in both centres.ConclusionsRelapse of bipolar depression, but not of mania, appears to be determined in part by seasonal factors.
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Rittmannsberger, H., and G. Malsiner-Walli. "P01-244-Mood-dependent changes of serum lithium concentration in a rapid cycling patient maintained on stable doses of lithium carbonate." European Psychiatry 26, S2 (March 2011): 245. http://dx.doi.org/10.1016/s0924-9338(11)71955-1.
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IntroductionSerum concentration of lithium may change according to mood states in bipolar patients, leading to reduced serum levels of lithium during manic periods.Objective/aimsDocumentation of mood states and serum lithium levels in a rapid cycling patientMethodsWe report about a 58 year old female patient with rapid cycling disorder whose mood altered every 20 to 30 days. No treatment has been effective until now. The patient is treated with a stable combination of clozapine 200mg, valproate 1500mg and lithium carbonate 450mg. Noncompliance can be ruled out since intake of medication is supervised. For 13 months a mood diary was performed by a relative using a simple scale for mood which rated neutral mood with 0, mania with +1, +2 and +3 (highest mania) and depression from -1 to -3 (deepest depression). Lithium levels were obtained first on a monthly, later on a weekly to two-weekly basis.ResultsOver a period of 13 months 7 depressive and 6 manic phases could be observed. The patient spent 230 (48%) days in depression (8 lithium samples obtained), 137 (29%) in mania (11 samples) and was euthymic on 68 (16%) days (2 samples). Mean lithium serum levels were 0.68mmol/l in depressive states, 0.37 mmol/l in manic states (p = .001, t-test). The lowest value was 0.13 mmol/l (in mania) and the highest 0.93 mmol/l (in depression).ConclusionsIn this patient mood-dependent changes of serum lithium levels during constant medication could be demonstrated. The reasons for this phenomenon are yet to be elucidated.
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Fusar-Poli, Laura, Andrea Amerio, Patriciu Cimpoesu, Pietro Grimaldi Filioli, Antimo Natale, Guendalina Zappa, Eugenio Aguglia, Mario Amore, Gianluca Serafini, and Andrea Aguglia. "Gender Differences in Complete Blood Count and Inflammatory Ratios among Patients with Bipolar Disorder." Brain Sciences 11, no. 3 (March 12, 2021): 363. http://dx.doi.org/10.3390/brainsci11030363.
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Background: Evidence suggested that inflammation may be involved in the etiopathogenesis of bipolar disorder (BD), a chronic psychiatric condition affecting around 2–3% of the general population. However, little is known regarding potential gender differences in peripheral biomarkers of BD, such as neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and monocyte-to-lymphocyte (MLR) ratios. Methods: In total, 197 females and 174 males with BD in different phases (i.e., (hypo)mania, depression, euthymia) were recruited. A blood sample was drawn to perform a complete blood count (CBC). NLR, PLR, and MLR were subsequently calculated, and differences were computed according to the illness phase and gender. Results: PLR was consistently higher in (hypo)manic than depressed patients, in both males and females. No significant gender differences in PLR value were found when considering only (hypo)mania. Conversely, NLR was increased in (hypo)mania only among males, and gender differences were retrieved in the (hypo)manic subgroup. The findings related to MLR were only marginally significant. Higher platelets values were associated with (hypo)mania only in the female group. Basophils and eosinophils appeared gender- but not state-dependent. Conclusions: Our findings provide further evidence that increased PLR levels may be associated with (hypo)mania in bipolar patients, regardless of gender. Moreover, the usefulness of NLR as a peripheral biomarker of BD appeared limited to males while the role of platelets to females. As CBC represents a low-cost and easily accessible test, researchers should investigate in-depth its potential usefulness as a biomarker of BD and other psychiatric disorders.