جستجوی مقالات مرتبط با کلیدواژه « Bipolar Disorder » در نشریات گروه « پزشکی »

Manic and mixed episodes of bipolar disorder are important episodes of this disorder. The aim of the current study was to assess serum vitamin D (SVD) levels in patients with mania and mixed bipolar disorder, compared to healthy subjects.

The current cross-sectional study was conducted on 75 subjects, including healthy subjects (n = 25), patients with acute-phase mania (n = 25), and patients with mixed bipolar disorder (n = 25). The SVD levels were measured in all of the enrolled subjects. The Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), and Clinical Global Impression- Severity (CGI-S) were used to assess disease activity in patient groups. Data analysis was performed using SPSS version 18. For statistical analysis, analysis of variance (ANOVA), independent-sample t test, Pearson correlation, and Chi-square tests were utilized. P-values < 0.05 were considered statistically significant.

The results showed that the mean of SVD was significantly lower in mania and mixed bipolar patients compared to healthy subjects (P < 0.05). In addition, the number of subjects with SVD ≥ 20 ng/ml was higher in the healthy group compared to the patient groups (P < 0.05). Also, SVD was negatively correlated with the CGI-S (r = -0.311; P = 0.028), YMRS (r = -0.464; P = 0.001), and HDRS (r = -0.393; P = 0.005) in the total patient subjects.

Prevalence of low SVD was considerably high in mania and mixed bipolar patients compared to healthy subjects. Additionally, meaningful negative correlations were found between SVD and disease activity-related variables including the HDRS, YMRS, and CGI-S.

Treatment adherence, the key to therapy success and patients’ quality of life, can be influenced by many factors in psychiatric patients, including self-stigma, alongside insight, illness duration, social support, health beliefs, personality, substance abuse, side effects, and life circumstances.

This study aims to identify factors, particularly self-stigma, affecting treatment adherence in stable psychiatric outpatients.

A sample of 200 adult mental health patients in Arak, Iran, diagnosed with schizophrenia, bipolar disorder, major depressive disorder, or anxiety disorders, participated in this study. Self-stigma was assessed using the Internalized Stigma of Mental Illness (ISMI) scale, and treatment adherence was measured using the Drug Attitude Inventory (DAI-10). Data were analyzed using descriptive statistics, correlation, regression, and chi-square tests.

Among the 200 participants (73 men and 127 women, with an average age of 35.1 years), the average stigma score was 62.8. The mean DAI-10 score was 4.8, with 172 showing positive medication attitudes. Younger, smoking, and alcohol-consuming patients showed lower treatment adherence. Higher self-stigma correlated with lower adherence, but there were no significant associations with gender, marital status, diagnosis, or diagnosis duration.

This study highlights the importance of addressing self-stigma as a barrier to treatment adherence in individuals with mental illnesses. Strategies to reduce self-stigma may improve treatment outcomes, especially among younger patients and those with substance use disorders. Further research is warranted to develop effective interventions for enhancing medication adherence in stable psychiatric outpatients.

On 11 March 2020, the World Health Organization (WHO) announced the detection of a new virus epidemic in Wuhan, China. Many studies have shown that the SARS-CoV-2 virus can cause mental disorders, such as anxiety, depression, and bipolar disorder. Here, we presented a case without a history of psychiatric illness. After contracting COVID-19

A 40-year-old woman was hospitalized for ten days and then discharged. However, on the fourth day following her discharge, the patient exhibited talkative, energetic, and distractible behavior. She believed herself to be God’s daughter with the ability to cure COVID-19, leading to abnormal behaviors and necessitating readmission. Treatment was started with haloperidol 5 mg, sodium valproate 500 g, and clonazepam 2 mg. By the 17th day, the patient’s mania rating scale score had decreased.

This case report underscores the significance of viral diseases as triggering and exacerbating factors in bipolar disorder. It also emphasizes the importance of considering viral infections as potential causes of psychiatric symptoms in individuals with COVID-19.

Mortality from cardiovascular causes, including pulmonary embolism (PE), is the second most common cause of mortality in psychiatric patients. Signs and symptoms that are specific to PE include tachycardia and dyspnea. It rarely manifests as acute psychosis and other unspecific signs and symptoms. Many common treatment modalities for psychiatric disorders increase the risk of coagulopathies and conditions, such as catatonia are associated with an increased incidence of venous thromboembolism (VTE). PE is a preventable cause of death for psychiatric patients. Therefore, we present this case to emphasize the importance of VTE complications in psychiatric patients.

A 56-year-old woman was hospitalized a week before admission due to aggression, restlessness, and disturbance. She was hospitalized more than 6 times with the diagnosis of “bipolar spectrum”. Based on available information, a diagnosis of “unspecified and related bipolar disorder” with akathisia (possibly doxepin and selective serotonin reuptake inhibitor [SSRI] induced) was considered. Doxepin, citalopram, and olanzapine were tapered. Also, sodium valproate tablet 200 mg/qid and propranolol tablet 20 mg/bid were added to her drugs. After two weeks, with no progress in relieving symptoms, tachycardia was detected. Therefore, consultation with an internal medicine specialist and more evaluation was requested. With a high level of D-dimer, and low saturation, we considered thromboembolism, the patient was sent to a general hospital, and then the diagnosis of VTE was confirmed.

One of the vital causes of death in psychiatric wards is VTE. It is difficult to diagnose VTE in a psychiatric patient; therefore, it can increase the risk of mortality. Therefore, psychiatrists must perform essential assessments for patients with clinical suspicion. We publish this case to raise awareness of thromboembolic complications in psychiatric patients, especially hospitalized patients.

This study aimed to assess the effects of Liothyronine supplementation on memory performance in patients diagnosed with mood disorders (major depressive or bipolar disorder). This double-blind controlled clinical trial was conducted on patients with major depression and bipolar disorder. The participants were randomly assigned to either the intervention group receiving Liothyronine or the placebo group, with 33 patients in each group, for a duration of one month. Memory performance was assessed before the first, fourth, and final ECT sessions, as well as one month after the last session using the Wechsler Memory Scale-Revised (WMS-R). Data analysis was performed using independent-samples Chi-square test and the Greenhouse-Geisser correction factor. Liothyronine significantly enhanced communicative learning and visual memory in patients with major depression and bipolar disorder one month after the final ECT session. Additionally, a positive effect of Liothyronine on immediate recall was observed before the last ECT session. Liothyronine supplementation improves ECT-induced cognitive impairment in patients with major depression and bipolar disorder. Further research is necessary to fully comprehend the potential of Liothyronine as an adjunctive treatment for major depression and bipolar disorder.

Many patients with bipolar disorder (BD) experience sleep problems. Sleep abnormalities are associated with immune dysfunction, which may be reflected by hematological indices.

This study aimed to investigate the association between sleep quality and the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in patients with BD.   

This cross-sectional study was performed at Imam Hossein Hospital, Tehran, Iran, from March to September 2023. Hospitalized patients newly diagnosed with BD were interviewed to complete questionnaires. Sleep quality and manic and depressive symptoms of the participants were assessed using the Pittsburg Sleep Quality Index (PSQI), the Young Mania Rating Scale (YMRS), and the Hamilton Depression Rating Scale (HDRS), respectively. Furthermore, blood samples were taken from each patient to investigate hematological indices. Continuous and categorical variables were compared between groups using an independent-sample t test and chi-square/Fisher's exact tests, respectively. The Poisson regression model was also used to investigate predictors of the PSQI score.  

Of 305 patients included in the study, 78.7% and 21.3% were experiencing manic and depressive episodes, and 90.20% had poor sleep quality. The prevalence of poor sleep quality was significantly higher in depressed patients than in manic patients (100% vs. 87.5%; P = 0.003). Depressed patients had significantly higher platelet counts (mean difference [MD], 34.09 [95% CI, 9.35-58.83]; P = 0.007) and PLR (MD, 38.14 [95%CI, 10.25-66.02]; P = 0.008) and lower lymphocyte counts (MD, 266.04 [95% CI, [14.41-517.67]; P = 0.038) compared with manic patients. The Poisson regression model with adjustment revealed that men (risk ratio [RR], 1.113; P = 0.025), those with lower educational levels (RR, 1.164; P = 0.001), and those with higher HDRS scores (RR, 1.370; P < 0.001) had significantly deteriorated sleep quality.  

Most bipolar patients have poor sleep quality, particularly those with depressive episodes. Depressed patients had significantly higher platelet counts and PLR. Also, depressed patients with male sex, lower educational levels, and more severe depressive symptoms had poorer sleep quality.

Paying attention to the needs of patients with psychiatric disorders has recently come into focus. Failure to meet the needs of patients can affect their quality of life. This study aimed to determine the main areas of the needs of patients with severe psychiatric disorders and evaluate their relationship with the quality of life.  

In this cross-sectional study, 174 patients with severe mental illness who were referred to Iran Psychiatric Hospital for hospitalization or outpatient treatment were enrolled in this study (68 with schizophrenia and schizoaffective disorder, 106 with bipolar disorder type 1). A qualified psychiatry resident conducted interviews with each patient to determine their needs using the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) and the severity of their illness using the Hamilton Depression Rating Scale (HAM-D), Positive and Negative Syndrome Scale (PANSS), and Young Mania Rating Scale. A checklist for demographic data and the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire was completed by patients. Data were analyzed using descriptive statistics. Since the number of needs distribution was not normal, we used the Mann-Whitney, Kruskal-Wallis, and chi-square tests for qualitative variables.  

The total number of patient needs was 9 (mean = 9.1, SD = 3.7). The most unmet needs were intimate relationships (69.5%), sexual expression (65.5%), and information on condition and treatment (51.1%). Unmet needs showed a negative correlation with the quality of life (P < 0.001) and a positive correlation with the severity of depression (P = 0.045), negative symptoms (P = 0.001), and general psychopathology (P < 0.001).   

A higher number of unmet needs of severe psychiatric patients is associated with lower quality of life and more severe disorders.

Family-focused therapy (FFT) has been developed to address the significant impairments in psychosocial functioning among individuals with bipolar disorder (BD).

This study investigated the effectiveness of FFT combined with drug therapy in patient support in managing this disorder.

In this randomized controlled trial, 50 patients and their caregivers were randomly divided into 2 groups: A drug therapy group that only received medication and a family therapy group that received 15 one-hour sessions of FFT with their caregivers in addition to medication. The Expressed Emotion Questionnaire (EEQ), a modified version of the standard internal label questionnaire for the mentally ill, and theWorld Health Organization Quality of Life–Brief (WHOQOL-BREF) were used in the present study. Data were analyzed using the t-test.

Expressed emotion (EE) significantly decreased in the family therapy group (P = 0.001). Also, mental health and social health were better in the family therapy group than in the drug therapy group (P = 0.001). Nevertheless, no significant change was observed in the dimensions of physical and environmental health in both groups. The results of the study were relatively stable in all measurements in follow-up, except for the stigma.

Significant improvements were observed in EE and quality of life (QOL) in the family therapy group. This difference was not statistically significant in the stigma score despite the difference in the means of the 2 groups.

 Bipolar II disorder (BD-II) is a chronic mental illness with recurrent episodes of depression that causes emotional disorders in patients.

 The present study aimed to investigate the effects of Emotional Schema Therapy (EST) and Dialectical Behavior Therapy (DBT) on psychological distress and cognitive-behavioral avoidance in patients with BD-II.

 This study was carried out using a quasi-experimental pretest-posttest design with a control group. The study population consisted of all patients with BD-II visiting the counseling centers in Dezful, Iran, in 2021, and the research sample included 45 eligible individuals selected using purposive sampling. The patients were randomly assigned to two intervention groups and one control group (n = 15 per group). The participants in the first and second intervention groups attended eleven 90-minute sessions of EST and DBT, respectively. However, those in the control group were placed on the waiting list. The research instruments included the Kessler Psychological Distress Scale (K10) and the Cognitive-Behavioral Avoidance Scale. The data were analyzed using analysis of covariance (ANCOVA) and Bonferroni post hoc test in SPSS software (version 26).

 According to the results, there was a significant reduction in levels of psychological distress and cognitive-behavioral avoidance among the participants of the EST and DBT groups, compared to those in the control group (P < 0.001).

 Emotional Schema Therapy and Dialectical Behavior Therapy reduced psychological distress and cognitive-behavioral avoidance in patients with BD-II. Therefore, therapists and health professionals can use EST and DBT interventions, along with other effective therapeutic approaches, to reduce psychological distress and cognitive-behavioral avoidance in patients with BD-II.

 Patients with bipolar disorder suffer from different problems, including emotional disorders, e.g., the loss of emotional self-regulation.

 This study aimed to investigate the effects of emotional schema therapy and dialectical behavior therapy on emotional self-regulation in patients with bipolar II disorder (BP-II).

 This was an experimental study with a pretest-posttest design and a control group. The research population comprised patients with BP-II who visited the counseling and psychology centers of Dezful (Iran) in 2022. A sample of 45 eligible patients was purposively selected and randomly allocated to three groups. Each of the two experimental groups received twelve 90-minute sessions of emotional schema therapy and eleven 90-minute sessions of dialectical behavior therapy, while the control group was on the waiting list. The data were collected using the Cognitive Emotion Regulation Questionnaire (CERQ) and analyzed using the analysis of covariance with the Bonferroni post-hoc test in SPSS v. 26.

 In the emotional schema therapy group, the mean ± standard deviation (SD) of the post-test scores of adaptive and maladaptive emotional self-regulation were 20.60 ± 2.99 and 12.66 ± 2.22, respectively. Moreover, in the dialectical behavior therapy group, the mean ± SD of the post-test scores of adaptive and maladaptive emotional self-regulation were 21.60 ± 3.33 and 14.13 ± 2.35, respectively. Both interventions significantly reduced maladaptive emotional self-regulation and significantly increased adaptive emotional self-regulation in the patients with BP-II, compared to the control group (P < 0.001).

 Emotional schema therapy and dialectical behavior therapy improved emotional self-regulation in patients with BP-II. Therapists and healthcare professionals can thus administer both methods and other effective methods to improve health-related traits, especially self-regulation, in patients with BP-II.

As glutamatergic system dysfunction is involved in bipolar depression pathophysiology, the glutamate receptor modulators such as Ketamine have been applied as complementary medication for mood stabilizers. While the treatment is currently just the intravenous injection of a single dose, and there is no robust conclusion on Ketamine effectiveness or its side effects in bipolar patients, this study aimed to consider single- and double-dose intravenous injections of Ketamine in bipolar patients compared to the placebo.

In a randomized, double-blind controlled clinical trial, 30 patients diagnosed with bipolar I and II disorders according to DSM-IV-TR (SCID-I) were randomly divided into three groups: the first group received an intravenous injection of Ketamine (0.5 mg/kg) and placebo with a three-day interval, the second group received two doses of Ketamine (0.5 mg/kg) in the same interval, and the third group received two placebo injections. Patients were assessed for depression, anxiety, and mania at various time points, including before the injection, 60 minutes after the injection, on the first, third, fifth, seventh, and 14th day, as well as at the end of the first month using the Hamilton Depression Rating Scale, Beck Anxiety Inventory, and Young Mania Scale, respectively. Data were analyzed using ANOVA and Repeated measure tests.

The mean age of patients was 36.8 ± 7.9 years, with 18 females (60%) and 12 (40%) males. Depression and anxiety showed significant differences in both the single- and double-dose Ketamine groups over time (P < 0.01). Moreover, mania displayed significant changes during the study time in the single- and double-dose Ketamine groups, as well as the in the control group. However, during the study time, there were no significant differences observed in depression, anxiety, and mania among the three groups (P = 0.198, P = 0.416, and P = 0.540, respectively). Patients did not indicate any side effects during the study.

Intravenous Ketamine administration may relieve depressive manifestations in bipolar patients. The findings suggest that a double dose of Ketamine does not lead to greater improvement than a single dose.