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Background: Given the importance of medication adherence among individuals with bipolar disorder (BD), this analysis from an ongoing randomized controlled trial (RCT) examined the relationship between BD symptoms, functioning and adherence in 69 poorly adherent adults with BD. Method: Study inclusion criteria included being ≥ 18 years old with BD Type 1 or 2, difficulties with medication adherence and actively symptomatic as measured by Brief Psychiatric Rating Scale (BPRS) score ≥ 36, Young Mania Rating Scale (YMRS) > 8 or Montgomery Asberg Depression Rating Scale (MADRS) > 8. Adherence was measured in 2 ways: 1) the self-reported Tablets Routine Questionnaire (TRQ) and 2) electronic pill container monitoring (eCap pillbox). BD symptoms and functioning were measured with the MADRS, YMRS, Clinical Global Impressions Scale (CGI), and Global Assessment of Functioning (GAF). Only screening and baseline data were examined. Results: Mean age was 42.32 (SD = 12.99) years, with 72.46% (n = 50) female and 43.48% (n = 30) non-white. Mean past 7-day percentage of days with missed BD medications using TRQ was 40.63% (SD = 32.61) and 30.30% (SD = 30.41) at screening and baseline, respectively. Baseline adherence using eCap was 42.16% (SD = 35.85) in those with available eCap data (n = 41). Worse adherence based on TRQ was significantly associated with higher MADRS (p = 0.04) and CGI (p = .03) but lower GAF (p = 0.02). eCAP measured adherence was not significantly associated with clinical variables. Conclusion: While depression and functioning were approximate markers of adherence, reliance on patient self-report or BD symptom presentation may give an incomplete picture of medication-taking behaviors.
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Transtorno Bipolar , Adesão à Medicação , Índice de Gravidade de Doença , Humanos , Transtorno Bipolar/tratamento farmacológico , Feminino , Adesão à Medicação/estatística & dados numéricos , Masculino , Adulto , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários , Escalas de Graduação PsiquiátricaRESUMO
Este artigo apresenta uma discussão sobre as repercussões do modo de funcionamento marcado pela pulsão oral como um elemento decisivo para que alcancemos as bases mais primordiais da psicose maníaco- depressiva. Entendemos que este estudo também pode auxiliar na elucidação da presença de estados melancoliformes e maniformes em configurações neuróticas de maior gravidade, ou ainda, em psicoses não desencadeadas. Nosso recorte temático será desenvolvido a partir do referencial freudiano, conferindo um espaço significativo às contribuições de Karl Abraham. Também contará com a exposição de novas colaborações da psicanálise pós-freudiana, com enfoque nos impactos da voracidade pulsional na vida humana e as consequências psicopatológicas desse tipo de fixação libidinal. Por fim, buscaremos alinhavar pontos levantados com o diferencial das teorizações de Jacques Lacan, resgatando sucintamente princípios de sua teoria da clínica como a relação ao grande Outro, a lógica fantasmática, o objeto a e o significante paterno.
Cet article présente une discussion sur les répercussions du mode de fonctionnement subjectif marqué par la pulsion orale comme un élément fondamental pour comprendre les bases les plus primordiales de la psychose maniaco-dépressive. Nous comprenons que cette étude peut également aider à élucider la présence d'états en format mélancolique et maniaque dans des configurations névrotiques de gravité plus élevée, ou encore, dans des psychoses non déclenchées. Notre découpage thématique sera développé à partir de la théorie freudienne, accordant un espace significatif aux contributions de Karl Abraham. Il inclura également l'exposition de nouvelles collaborations de la psychanalyse post-freudienne, en mettant l'accent sur les conséquences de la voracité pulsionnelle dans la vie humaine et les conséquences psychopathologiques de ce genre de fixation libidinale. Enfin, nous chercherons à relier les points relevés avec la spécificité des théorisations de Jacques Lacan, reprenant brièvement les principes de sa théorie clinique tels que la relation au grand Autre, la logique du fantasme, l'objet a et le signifiant paternel.
This article presents a discussion about the repercussions of the predominance of the oral drive in subjective functioning as a decisive element to reach the primordial bases of manic-depressive psychosis. We understand that this study can also help enlighten the presence of melancholic and manic states in more severe neurotic configurations, or even in untriggered psychoses. Our thematic framework will be based on Freudian theory, giving significant space to the contributions of Karl Abraham. It will also include the exposition of new contributions from post-Freudian psychoanalysis, focusing on the impacts of drive eagerness in human life and the psychopathological consequences of this type of fixation of libido. Finally, we will seek to connect the issues raised with the uniqueness of Jacques Lacan's theorizations, briefly revisiting the principles of his clinical theory such as the relation to the Other, the phantasmatic logic, the object a, and the fatherly signifier.
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Psicanálise , Transtornos Psicóticos , Transtorno DepressivoRESUMO
BACKGROUND: Adenosinergic system has been implicated in the pathophysiology of bipolar disorder and drugs that affect adenosine neurotransmission have shown some efficacy as add-on therapy in manic patients. OBJECTIVE: Thus, the aim of the present study was to screen adenosinergic drugs for antimanic-like effect in methylphenidate (MPH)-induced hyperlocomotion in mice. METHODS: Male and female Swiss mice received a single allopurinol (50 and 200 mg/kg, ip), dipyridamole (20 mg/kg, ip), or inosine (50 mg/kg, ip) administration before an acute MPH challenge (5 mg/kg, sc). In experiments with repeated treatment, male mice received a daily administration of allopurinol (25 and 50 mg/kg, ip), dipyridamole (20 mg/kg, ip), or inosine (50 mg/kg, ip) for 14 days. Finally, pretreatment with aminophylline (2 mg/kg, sc), an unspecific adenosine receptor antagonist, was used to evaluate a putative adenosinergic mediation. Locomotor activity was measured in the automated activity chamber for 20 min. RESULTS: Acute and repeated dipyridamole reduced the increase in locomotor activity induced by MPH, while allopurinol and inosine had no effect. Aminophylline blocked the effect of dipyridamole in MPH-induced hyperlocomotion. CONCLUSION: The present results suggest that dipyridamole may have an antimanic-like effect through adenosine receptors and reinforce the proposal that the adenosine system may be an interesting target for new antimanic drugs.
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Mania is associated with disturbed dopaminergic transmission in frontotemporal regions. D-amphetamine (AMPH) causes increased extracellular DA levels, considered an acknowledged mania model in rodents. Doxycycline (DOXY) is a second-generation tetracycline with promising neuroprotective properties. Here, we tested the hypothesis that DOXY alone or combined with Lithium (Li) could reverse AMPH-induced mania-like behavioral alterations in mice by the modulation of monoamine levels in brain areas related to mood regulation, as well as cytoprotective and antioxidant effects in hippocampal neurons. Male Swiss mice received AMPH or saline intraperitoneal (IP) injections for 14 days. Between days 8-14, mice receive further IP doses of DOXY, Li, or their combination. For in vitro studies, we exposed hippocampal neurons to DOXY in the presence or absence of AMPH. DOXY alone or combined with Li reversed AMPH-induced risk-taking behavior and hyperlocomotion. DOXY also reversed AMPH-induced hippocampal and striatal hyperdopaminergia. In AMPH-exposed hippocampal neurons, DOXY alone and combined with Li presented cytoprotective and antioxidant effects, while DOXY+Li also increased the expression of phospho-Ser133-CREB. Our results add novel evidence for DOXY's ability to reverse mania-like features while revealing that antidopaminergic activity in some brain areas, such as the hippocampus and striatum, as well as hippocampal cytoprotective effects may account for this drug's antimanic action. This study provides additional rationale for designing clinical trials investigating its potential as a mood stabilizer agent.
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Antioxidantes , Doxiciclina , Hipocampo , Mania , Neurônios , Animais , Masculino , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Camundongos , Antioxidantes/farmacologia , Mania/induzido quimicamente , Mania/tratamento farmacológico , Doxiciclina/farmacologia , Comportamento Animal/efeitos dos fármacos , Células Cultivadas , Anfetamina/farmacologia , Anfetamina/toxicidade , Modelos Animais de Doenças , Estimulantes do Sistema Nervoso Central/toxicidade , Monoaminas Biogênicas/metabolismo , Dextroanfetamina/farmacologia , Dextroanfetamina/toxicidade , Antimaníacos/farmacologia , Fármacos Neuroprotetores/farmacologiaRESUMO
Resumo: Nas últimas décadas, observa-se a emergência de um debate a respeito do pouco avanço nas pesquisas sobre a mania em psicanálise. Este artigo examina duas hipóteses que elegem a nosografia como fator explicativo elementar para essa lacuna: a primeira concerne ao amplo assentimento da categoria da psicose maníaco-depressiva, ao passo que a segunda se refere à adoção indistinta de categorias divergentes pelos psicanalistas. Contrariamente a essas interpretações, mas ainda dentro do mesmo quadro de referência, pretende-se sustentar que o fator mais decisivo para tal estagnação da pesquisa situa-se nas concepções de curso do quadro incorporadas pela psicanálise. Argumenta-se que, se, por um lado, o sentido de defesa atribuído à posição invariavelmente secundária da mania na circulação com a melancolia contribuiu para a delimitação metapsicológica do quadro, por outro, ela conduziu ao estreitamento exagerado de sua psicopatologia e à correspondente redução das pesquisas sobre esses casos.
Abstract: Recent decades saw the emergence of a debate regarding the halt in research on mania in psychoanalysis. This article examines two explanatory hypotheses for this gap based on nosography: the first concerns the broad endorsement of manic-depressive psychosis as a category, whereas the second refers to the indistinct adoption of divergent categories by psychoanalysts. Contrary to these interpretations, but within the same framework, we claim that the most decisive factor for such stagnation lies in the conceptions of mania assumed by psychoanalysis. If, on the one hand, the meaning attributed to the invariably secondary position of mania alongside melancholia as a defense contributed to the metapsychological delimitation of the clinical picture, on the other, it led to the exaggerated restriction of its psychopathology and the corresponding decrease in research on these cases.
Résumé : Au cours des dernières décennies, un débat a émergé sur le faible progrès dans la recherche sur la manie en psychanalyse. Cet article examine deux hypothèses qui privilégient la nosographie comme facteur explicatif élémentaire de cette lacune : la première concerne l'acceptation générale de la catégorie de psychose maniaco-dépressive, tandis que la seconde se réfère à l'adoption indistincte de catégories divergentes par les psychanalystes. Contrairement à ces interprétations, mais toujours dans le même cadre de référence, nous soutenons que le facteur le plus décisif de cette stagnation réside dans les conceptions de l'évolution de la manie incorporées par la psychanalyse. Si, d'une part, le sens la défense attribué à la position invariablement secondaire de la manie en circulation avec la mélancolie a contribué à la délimitation métapsychologique du tableau clinique, d'autre part, il a conduit à un rétrécissement exagéré de sa psychopathologie et à une réduction correspondante de la recherche.
Resumen: En las últimas décadas ha surgido un debate sobre la falta de avances en la investigación sobre la manía en psicoanálisis. Este artículo examina dos hipótesis que eligen a la nosografía como factor explicativo elemental de esta brecha: La primera se refiere a la amplia adhesión a la categoría de psicosis maníaco-depresiva, mientras que la segunda alude a la adopción indistinta de categorías divergentes por parte de los psicoanalistas. Contrariamente a estas interpretaciones, pero dentro del mismo marco, se sostiene que el factor determinante para el estancamiento de esta investigación reside en las concepciones del curso de la manía asumidas por el psicoanálisis. Por un lado, se argumenta que el sentido de defensa atribuido a la posición invariablemente secundaria de la manía en circulación con la melancolía contribuyó a la delimitación metapsicológica del cuadro clínico; por otro, esta ha llevado a una restricción de su psicopatología y disminución de los estudios sobre estos casos.
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Humanos , Defesa Perceptiva , Psicanálise , Psicopatologia , Transtorno Bipolar , Mania , Transtorno DepressivoRESUMO
Background: There is evidence suggesting racial disparities in diagnosis and treatment in bipolar disorder (BD) and schizophrenia (SZ). The purpose of this study is to compare psychiatric diagnoses and psychotropic use preceding a first episode of mania (FEM) or psychosis (FEP) in racially diverse patients. Methods: Using a comprehensive medical records linkage system (Rochester Epidemiology Project, REP), we retrospectively identified individuals diagnosed with BD or SZ and a documented first episode of mania or psychosis. Illness trajectory before FEP/FEM were characterized as the time from first visit for a mental health complaint to incident case. Pathways to care and clinical events preceding FEP/FEM were compared based on subsequent incident case diagnosis (BD or SZ) and self-reported race (White vs. non-White). Results: A total of 205 (FEM = 74; FEP = 131) incident cases were identified in the REP. Duration of psychiatric antecedents was significantly shorter in non-White patients, compared to White patients (2.2 ± 4.3 vs. 7.4 ± 6.6 years; p < 0.001) with an older age at time of first visit for a mental health complaint (15.7 ± 6.3 vs. 11.1 ± 6.0 years; p = 0.005). There were no significant differences by race in FEM pathway to care or age of first seeking mental health. Overall non-White patients had lower rates of psychotropic use. Conclusion: These data are unable to ascertain reasons for shorter duration of psychiatric antecedents and later age of seeking care, and more broadly first age of initial symptom presentation. If symptoms are confirmed to be earlier than first time seeking care in both groups, it would be important to identify barriers that racial minorities face to access timely psychiatric care and optimize early intervention strategies.
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Objectives: Electroconvulsive therapy (ECT) is commonly indicated for refractory psychiatric disorders. However, little research has compared response across diagnoses. Here, we aimed to evaluate the relative impact of diagnosis and clinical staging as response predictors in a cross-diagnostic sample. Methods: In a retrospective cohort of adult inpatients (n=287) who underwent at least six sessions of ECT, we investigated predictors of complete response (a clinical global impression of 1) to ECT. We use adjusted regression models to estimate the impact of clinical diagnosis and staging on complete response and dominance analysis to assess the relative importance of these predictors. Results: Those for whom a depressive episode was a primary indication for treatment were the most likely to have complete improvement, while those with psychosis were the least likely; clinical stage had a significant influence on outcome in all diagnoses. A diagnosis of psychosis was the strongest predictor of non-response. Conclusions: A diagnosis of psychosis (mainly schizophrenia) was the strongest predictor of non-response. We also found that clinical staging can aggregate information on ECT response that is independent of clinical diagnosis.
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OBJECTIVE: Electroconvulsive therapy (ECT) is commonly indicated for refractory psychiatric disorders. However, response comparison across diagnoses is scantly investigated. Here, we aimed to evaluate the relative impact of diagnosis and clinical staging as response predictors in a cross-diagnostic sample. METHODS: We investigate, in a retrospective cohort of adult inpatients (N=287) who underwent at least six sessions of ECT, predictors of complete response (a clinical global impression of 1) to ECT. We use adjusted regression models to estimate the impact of clinical diagnosis and staging on complete response and dominance analysis to assess the relative importance of these predictors. RESULTS: Those with a depressive episode as a primary indication for treatment were more likely than all the other groups to have complete improvement, while those with psychosis were the least likely; clinical stage had a significant influence on outcome in all diagnoses. A diagnosis of psychosis stood as the strongest predictor of non-response. CONCLUSION: An indication of ECT for psychosis (mostly schizophrenia) had a dominant impact in our cohort, indicating a worse chance of response. We also demonstrate that clinical staging can aggregate information on response to electroconvulsive therapy that is independent of clinical diagnosis.
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BACKGROUND: Bipolar disorder (BD) is a complex and severe mental disorder that affects 1-3 % of the world population. Studies have suggested the involvement of oxidative stress in the physiopathology of this psychiatry disorder. Folic acid (FA), a vitamin from the B complex, is a nutraceutical that has recently been researched as a possible treatment for BD since folate is reduced in patients with the disorder. The present study aimed to evaluate the effects of lithium (Li) and FA on behavioral changes and oxidative stress parameters in an animal model of mania induced by ouabain (OUA). METHODS: Wistar rats received a single intracerebroventricular (ICV) injection of OUA or artificial cerebrospinal fluid (aCSF). From the day following ICV injection, the rats were treated for seven days with gavage injections of Li (47.5 mg/kg/mL), FA (50 mg/kg/mL), or water (1 mL/kg). On the 7th day after OUA injection, locomotor activity was measured using the open-field test. In addition, the oxidative stress parameters were evaluated in rats' frontal cortex, striatum, and hippocampus. RESULTS: OUA induced mania-like behavior and oxidative stress in rats' brains, but Li could reverse these alterations. FA did not affect behavior parameters; however, it presents an antioxidant effect on the brain structures evaluated. LIMITATIONS: The study was only evaluated male rats and ICV injection is an invasive procedure. CONCLUSION: These results indicate that even though FA has an effect against the oxidative stress induced by OUA, this effect was not strong enough to interfere with behavior parameters.
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Antimaníacos , Ouabaína , Masculino , Ratos , Animais , Antimaníacos/farmacologia , Antimaníacos/uso terapêutico , Ouabaína/farmacologia , Mania/tratamento farmacológico , Mania/patologia , Ratos Wistar , Ácido Fólico/farmacologia , Ácido Fólico/uso terapêutico , Modelos Animais de Doenças , Encéfalo , Estresse Oxidativo , Lítio/farmacologia , Comportamento AnimalRESUMO
Objectives: Bipolar disorder type 1 (BD1) and behavioral-variant frontotemporal dementia (bvFTD) share similar behavioral and cognitive symptoms, rendering the differential diagnosis between them a clinical challenge. We investigated the accuracy of social cognition (SC) measures to differentiate bvFTD from BD. Methods: We included three groups of participants: early-onset BD1 (in remission, n=20), bvFTD (n=18), and cognitively healthy controls (HC) (n=40), matched for age, schooling, and sex. All participants underwent cognitive assessment, including the Facial Emotion Recognition (FER) and Modified Faux-Pas (mFP) tests, which assess mentalizing. Results: Compared to HC, BD1 and bvFTD patients underperformed on both SC measures. BD1 and bvFTD did not differ regarding FER or mFP total scores, although patients with bvFTD had significantly higher difficulties than those in the BD1 group to detect social faux-pas (p < 0.001, d = 1.35). Conclusion: BD1 and bvFTD share deficits in the core SC functions. These findings should be considered in the development of tasks aiming to improve clinical differentiation between the two disorders.
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INTRODUCTION: Bipolar disorder (BD) in DSM-III and DSM-IV is classified as a mood disorder and requires the presence of a mood change, i.e., euphoria or irritability. Differently, DSM-5 states that there must be some increase in energy or motor activity in addition to the mood change. OBJECTIVE: Our aim was to identify which types of symptoms (i.e., mood- or energy/activity-related symptoms) are the most informative in a manic episode. METHOD: Symptoms of manic episodes in 106 outpatients with BD were assessed through the Young Mania Rating Scale between November 2002 and November 2015 in a naturalistic study. The items of the scale were divided into three groups according to clinical criteria: mood, energy/activity, and other. The Samejima Graded Response Model of the Item Response Theory was computed as well as the Test Information Function for comparisons between groups. Chi-squared tests were used to verify the association between the groups of symptoms by comparing the area under the curve of the TIF results. RESULTS: The information accounted for energy/activity represents 77% of the proportion of the total TIF; about 23% is related to mood and other groups of symptoms. Both proportions are statistically different (X2(1) = 30.42, p < 0.001). CONCLUSION: On average, changes in energy/activity tend to be more informative than mood changes during the manic phases of BD.
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OBJECTIVES: Bipolar disorder type 1 (BD1) and behavioral-variant frontotemporal dementia (bvFTD) share similar behavioral and cognitive symptoms, rendering the differential diagnosis between them a clinical challenge. We investigated the accuracy of social cognition (SC) measures to differentiate bvFTD from BD. METHODS: We included three groups of participants: early-onset BD1 (in remission, n=20), bvFTD (n=18), and cognitively healthy controls (HC) (n=40), matched for age, schooling, and sex. All participants underwent cognitive assessment, including the Facial Emotion Recognition (FER) and Modified Faux-Pas (mFP) tests, which assess mentalizing. RESULTS: Compared to HC, BD1 and bvFTD patients underperformed on both SC measures. BD1 and bvFTD did not differ regarding FER or mFP total scores, although patients with bvFTD had significantly higher difficulties than those in the BD1 group to detect social faux-pas (p < 0.001, d = 1.35). CONCLUSION: BD1 and bvFTD share deficits in the core SC functions. These findings should be considered in the development of tasks aiming to improve clinical differentiation between the two disorders.
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Doença de Alzheimer , Transtorno Bipolar , Demência Frontotemporal , Humanos , Transtorno Bipolar/diagnóstico , Demência Frontotemporal/diagnóstico , Demência Frontotemporal/psicologia , Cognição Social , Testes Neuropsicológicos , Cognição , Doença de Alzheimer/diagnósticoRESUMO
OBJECTIVES: To describe the theoretical procedures employed in the process of cross-cultural adaptation (CCA) for Brazil of the Child Mania Rating Scale - Parent Version (CMRS-P). METHODS: Seven steps were carried out: (1) translations and synthesis; (2) Committee of Judges-I; (3) grammatical review; (4) Committee of Judges-II; (5) semantic analysis (pre-test); (6) back-translation; and (7) discussion with the authors of the original instrument. Participants were two professional translators, 14 experts, a grammar proofreader, and 21 parents/guardians, representatives of the target population. The results were analyzed in terms of the percentage of agreement between evaluators and the content validity coefficient (CVC) and by analysis of comments and suggestions. RESULTS: Grammatical and cultural adjustments were made, in addition to substitution and/or inclusion of words and examples. Adequacy agreement indexes exceeding 86% were achieved and the CVC result for the total scale was excellent (0.95). The pre-test indicated good acceptance and understanding by participants. CONCLUSION: The proposed version proved to be promising for use in the Brazilian context, although further psychometric studies are still needed to prove the scale's validity and reliability.
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Comparação Transcultural , Mania , Humanos , Criança , Brasil , Reprodutibilidade dos Testes , Traduções , Pais , Inquéritos e QuestionáriosRESUMO
Abstract Objectives To describe the theoretical procedures employed in the process of cross-cultural adaptation (CCA) for Brazil of the Child Mania Rating Scale - Parent Version (CMRS-P). Methods Seven steps were carried out: (1) translations and synthesis; (2) Committee of Judges-I; (3) grammatical review; (4) Committee of Judges-II; (5) semantic analysis (pre-test); (6) back-translation; and (7) discussion with the authors of the original instrument. Participants were two professional translators, 14 experts, a grammar proofreader, and 21 parents/guardians, representatives of the target population. The results were analyzed in terms of the percentage of agreement between evaluators and the content validity coefficient (CVC) and by analysis of comments and suggestions. Results Grammatical and cultural adjustments were made, in addition to substitution and/or inclusion of words and examples. Adequacy agreement indexes exceeding 86% were achieved and the CVC result for the total scale was excellent (0.95). The pre-test indicated good acceptance and understanding by participants. Conclusion The proposed version proved to be promising for use in the Brazilian context, although further psychometric studies are still needed to prove the scale's validity and reliability.
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Bipolar disorder (BD) is a chronic condition with serious consequences on the health and functionality of patients who suffer from it, with a high heritability and segregation, and aprevalence of between 1% and 2%. Neuropsychological deficits have been implicated as a very important issue related to BD prognosis, so a review was conducted of these deficits, the related factors and their functional consequences. It has been determined that the presence of neuropsychological deficits can vary in patients with BD according to their mood state, with a great influence of depressive symptoms on the cognitive variability of patients with respect to the general population and differences with respect to patients in the manic phase. In euthymic patients, the most affected cognitive domains are those of memory, attention, and executive function, associated with a more severe disease, sociodemographic vulnerability factors, and stable over time. A relationship has been found between poor cognitive performance, especially executive dysfunction, and objective functional deficit. Furthermore, cognitive differences have been outlined between BD and other serious mental illnesses that are described in this review.
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Transtorno Bipolar , Disfunção Cognitiva , Atenção , Transtorno Bipolar/epidemiologia , Disfunção Cognitiva/complicações , Humanos , Testes NeuropsicológicosRESUMO
RESUMEN El trastorno afectivo bipolar (TAB) es una entidad crónica con graves efectos para la salud y la funcionalidad de los pacientes que la sufren, con una alta carga de heredabilidad y segregabilidad y una prevalencia que oscila entre el 1 y el 2%. Las alteraciones neuropsicológicas son características importantes relacionadas con su pronóstico, por lo cual se hizo una revisión narrativa sobre estas alteraciones, los factores asociados y sus consecuencias funcionales. Se ha determinado que la presencia de alteraciones neuropsicológicas puede variar en los pacientes con TAB según la fase anímica en que se encuentren, con una gran influencia de los síntomas depresivos en la variabilidad cognitiva de los pacientes respecto a la población general y diferencias respecto a los pacientes en fase maniaca. En pacientes eutímicos, los dominios cognitivos más afectados son los de memoria, atención y función ejecutiva, asociados con una enfermedad más grave, factores sociodemográficos de vulne rabilidad y sin interacción con el tiempo de evolución. Se ha encontrado una relación entre el mal rendimiento cognitivo, especialmente la disfunción ejecutiva y el déficit funcional objetivo; además, se han perfilado diferencias cognitivas entre el TAB y otras enfermedades mentales graves que se describen en la revisión.
ABSTRACT Bipolar disorder (BD) is a chronic condition with serious consequences on the health and functionality of patients who suffer from it, with a high heritability and segregation, and a prevalence of between 1% and 2%. Neuropsychological deficits have been implicated as a very important issue related to BD prognosis, so a review was conducted of these deficits, the related factors and their functional consequences. It has been determined that the presence of neuropsychological deficits can vary in patients with BD according to their mood state, with a great influence of depressive symptoms on the cognitive variability of patients with respect to the general population and differences with respect to patients in the manic phase. In euthymic patients, the most affected cognitive domains are those of memory, attention, and executive function, associated with a more severe disease, sociodemographic vulnerability factors, and stable over time. A relationship has been found between poor cognitive performance, especially executive dysfunction, and objective functional deficit. Furthermore, cognitive differences have been outlined between BD and other serious mental illnesses that are described in the review.
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The Third Argentine Consensus on the management of bipolar disorders (TB) is an initiative of the Argentine Association of Biological Psychiatry (AAPB). As a reference document, this consensus pursues two main objectives: on the one hand, to summarize and systematize the best available evidence on the comprehensive management of this pathology; on the other, to provide a useful, up-to-date instrument for psychiatrists, multidisciplinary teams dedicated to mental health, and government agencies. During a period of approximately six months of work -that is, from May to October 2022- a committee of experts made up of 18 professionals and representatives of the three most important Psychiatry and Mental Health associations in Argentina (that is, the AAPB, the Argentine Association of Psychiatrists, AAP, and the Association of Argentine Psychiatrists, APSA) have focused on updating the information regarding TB. Finally, this document was prepared as a result of an exhaustive review of the bibliography published to date, which was strategically divided into three parts: the first deals with the generalities of TB; the second deals with the comprehensive treatment of the pathology; finally, the third analyzes TB in the context of special situations.
El Tercer Consenso Argentino sobre el manejo de los Trastornos Bipolares (TB) es una iniciativa de la Asociación Argentina de Psiquiatría Biológica (AAPB). Como documento de referencia, este consenso persigue dos objetivos principales: por un lado, resumir y sistematizar la mejor evidencia disponible sobre el manejo integral de esta patología; por el otro, proporcionar un instrumento útil y actualizado a psiquiatras, a equipos multidisciplinarios abocados a la salud mental y a organismos gubernamentales. Durante un período de aproximadamente seis meses de trabajo -desde mayo a octubre de 2022- un comité de expertos integrado por 18 profesionales y por representantes de las tres asociaciones de Psiquiatría y Salud Mental más importantes de la Argentina: la AAPB, la Asociación Argentina de Psiquiatras, (AAP) y la Asociación de Psiquiatras Argentinos (APSA), se abocaron a actualizar la información respecto de los TB. Finalmente, y como resultado de una exhaustiva revisión de la bibliográfica publicada hasta la actualidad, se confeccionó este documento que fue dividido estratégicamente en tres partes: la primera versa acerca de las generalidades del TB; la segunda aborda el tratamiento integral de la patología; y, por último, la tercera analiza los TB en el contexto de situaciones especiales.
Assuntos
Antipsicóticos , Transtorno Bipolar , Humanos , Transtorno Bipolar/tratamento farmacológico , Antipsicóticos/uso terapêutico , Consenso , ArgentinaRESUMO
Resumen Introducción: La manía unipolar (MU) es un trastorno que se comporta de manera distinta al trastorno bipolar-I (TB-I), sin embargo, no es considerado como una entidad independiente por los manuales diagnósticos vigentes, sino que es incluido dentro del diagnóstico de TB-I. Caso clínico: Hombre de 21 años presenta cuadro clínico de 3 meses de evolución caracterizado por ánimo exaltado y síntomas psicóticos congruentes al estado de ánimo. El paciente niega episodios depresivos previos. Se instaura tratamiento con litio y aripiprazol que resulta satisfactorio, sin presentar recurrencias tras 5 años de seguimiento. Revisión de la literatura y discusión: Los manuales diagnósticos describen que para diagnosticar TB-I no se requiere la presencia de un episodio depresivo mayor, lo que implica que pacientes con MU quedan dentro de la misma categoría diagnóstica que pacientes con TB-I. Diferencias entre MU y TB-I han sido demostradas en estudios epidemiológicos, clínicos y genéticos, por lo tanto, incluir pacientes heterogéneos dentro de la misma categoría podría dificultar la interpretación de estudios y limitar los avances en el conocimiento de ambos trastornos. Conclusión: De la revisión de la literatura se sugiere que la MU debe ser reconocida como un diagnóstico independiente. A pesar de su baja prevalencia, al validarlo como tal, en un futuro podríamos contar con mayor cantidad y mejor calidad de datos sobre este. De esta forma se podrá definir de manera más concreta sus características distintivas, y por consiguiente mejorar el abordaje clínico de estos pacientes.
Introduction: Unipolar mania (UM) is a disorder that behaves differently from bipolar-I disorder (BP-I), however, it is not considered an independent entity by current diagnostic manuals, but rather included within the diagnosis of BP-I. Case report: A 21-year-old man presented a 3-month-long episode characterized by exalted mood and mood-congruent psychotic symptoms. The patient denies previous depressive episodes. Treatment with lithium and aripiprazole was established, which was satisfactory, not showing recurrence after 5 years of follow-up. Literature review and discussion: Diagnostic manuals describe that to diagnose BP-I the presence of a major depressive episode is not required, which implies that patients with UM fall into the same diagnostic category as patients with BP-I. Differences between UM and BP-I have been demonstrated in epidemiological, clinical, and genetic studies, therefore, including heterogeneous patients within the same category could hinder the interpretation of studies and limit advances in the knowledge of both disorders. Conclusion: Based on the literature review, it is suggested that UM should be recognized as an independent diagnosis. Despite its low prevalence, by validating it as such, in the future we could have more and better-quality data about this diagnosis. In this way, its distinctive characteristics can be defined more concretely, and therefore improve the clinical approach of these patients.
Assuntos
Humanos , Masculino , Adulto , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/classificação , Transtorno Bipolar/tratamento farmacológico , Aripiprazol/uso terapêutico , Lítio/uso terapêuticoRESUMO
Children are more prone to adverse effects of selective serotonin reuptake inhibitors than adults. The aim of this study is to review the bibliography on mania and hypomania induced by these antidepressants. Most of the young people diagnosed with bipolar disorder had been exposed to this type of drug. The hypomania associated with these antidepressants in children with anxiety disorders is as relevant as that of those who had previously received a diagnosis of depression. As a limitation, in the selected papers, the activation syndrome could or could not include (hypo) mania. When indicating an antidepressant, we must be extremely prudent and place special emphasis on the risk-benefit analysis. It is essential to conduct a thorough search of family history of bipolar disorder together with a personal history investigation and a meticulous analysis of the semiology of our patients due to the risks of (hypo) mania.
Assuntos
Transtorno Bipolar , Mania , Adolescente , Adulto , Antidepressivos/efeitos adversos , Transtorno Bipolar/induzido quimicamente , Transtorno Bipolar/tratamento farmacológico , Criança , Humanos , Inibidores Seletivos de Recaptação de Serotonina/uso terapêuticoRESUMO
Bipolar disorder (BD) is a complex psychiatric disease characterized by mood swings that include episodes of mania and depression. Given its cyclical nature, BD is especially hard to model; however, the standard practice has been to mimic manic episodes in animal models. Despite scientific advances, the pathophysiology of BD is not fully understood, and treatment remains limited. In the last years, natural products have emerged as potential neuroprotective agents for the treatment of psychiatric diseases. Thus, the aim of this review was to explore the therapeutic potential of natural compounds and derivatives against BD, taking into account preclinical and clinical studies. Reliable articles indexed in databases such as PubMed, Web of Science and Science Direct were used. In clinical studies, treatment with herbal plants extracts, omega-3, inositol, n-acetylcysteine and vitamin D has been associated with a clinical improvement in symptoms of mania and depression in BD patients. In animal models, it has been shown that red fruits extracts, curcumin, quercetin, gallic acid, alpha-lipoic acid and carvone can modulate many neurochemical pathways involved in the pathophysiology of manic episodes. Thus, this review appointed the advances in the consumption of natural compounds and derivatives as an important therapeutic strategy to mitigate the symptoms of BD.