BIPOLAR DISORDER – FROM ENDOPHENOTYPES TO TREATMENT

Introduction: There are a lot of unresolved issues associated with the classification, diagnosis, clinical management and understanding of the underlying pathogenic mechanisms of bipolar affective disorder. Aim: To search for discrete endophenotypes in BAD. Subjects and methods: We studied various bipolar I and II and recurrent depression patient samples and healthy controls using descriptive data, self and clinician-rated scales for neurological and psychopathological symptoms, neurocognitive instruments, and inventories for temperamental and characterological features. We also looked into the efficacy, tolerability and cost/benefit ratio of sodium valproate in the treatment of acute mania. Results: BAD patients display deficits in the domains of memory, selective attention, working memory and psychomotor speed. Sensory, motor and complex neurological soft signs can be considered part and parcel of the symptomatology of BAD. The evidence linking hyperthymic temperament to the bipolar spectrum is not supported, while cyclothymia seems to be a marker of vulnerability to affective psychopathology. In contrast to others, we found significantly lower self-transcendence in BAD patients compared to controls. Early age of onset, abrupt onset, lability of mood and energy with late-day brightening and activation, discriminate bipolar from unipolar depression. Sodium valproate (especially if started intravenously) is a highly efficacious, cost-effective treatment approach for acute mania. Conclusion: The discovery of BAD endophenotypes can enhance early diagnosis, prevent errors in treatment and help elucidate the genetic vulnerability for this grave disease

Lifetime Bipolar Disorder comorbidity and related clinical characteristics in patients with primary Obsessive Compulsive Disorder: a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS)

IntroductionBipolar disorder (BD) and obsessive compulsive disorder (OCD) are prevalent, comorbid, and disabling conditions, often characterized by early onset and chronic course. When comorbid, OCD and BD can determine a more pernicious course of illness, posing therapeutic challenges for clinicians. Available reports on prevalence and clinical characteristics of comorbidity between BD and OCD showed mixed results, likely depending on the primary diagnosis of analyzed samples.MethodsWe assessed prevalence and clinical characteristics of BD comorbidity in a large international sample of patients with primary OCD (n = 401), through the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) snapshot database, by comparing OCD subjects with vs without BD comorbidity.ResultsAmong primary OCD patients, 6.2% showed comorbidity with BD. OCD patients with vs without BD comorbidity more frequently had a previous hospitalization (p < 0.001) and current augmentation therapies (p < 0.001). They also showed greater severity of OCD (p < 0.001), as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).ConclusionThese findings from a large international sample indicate that approximately 1 out of 16 patients with primary OCD may additionally have BD comorbidity along with other specific clinical characteristics, including more frequent previous hospitalizations, more complex therapeutic regimens, and a greater severity of OCD. Prospective international studies are needed to confirm our findings.Peer reviewe

The neuropsychology of obsessive-compulsive personality disorder : a new analysis

Background: Obsessive compulsive personality disorder (OCPD) is characterized by perfectionism, need for control, and cognitive rigidity. Currently, little neuropsychological data exist on this condition, though emerging evidence does suggest that disorders marked by compulsivity, including obsessive-compulsive disorder (OCD), are associated with impairment in cognitive flexibility and executive planning on neurocognitive tasks.Aim: The current study investigated the neurocognitive profile in a nonclinical community-based sample of people fulfilling diagnostic criteria for OCPD in the absence of major psychiatric comorbidity.Method: Twenty-one nonclinical subjects who fulfilled Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for OCPD were compared with 15 healthy controls on selected clinical and neurocognitive tasks. OCPD was measured using the Compulsive Personality Assessment Scale (CPAS). Participants completed tests from the Cambridge Automated Neuropsychological Test Battery including tests of set shifting (Intra-Extra Dimensional [IED] Set Shifting) executive planning (Stockings of Cambridge [SOC]), and decision making (Cambridge Gamble Task [CGT]).Results: The OCPD group made significantly more IED-ED shift errors and total shift errors, and also showed longer mean initial thinking time on the SOC at moderate levels of difficulty. No differences emerged on the CGT.Conclusions: Nonclinical cases of OCPD showed significant cognitive inflexibility coupled with executive planning deficits, whereas decision-making remained intact. This profile of impairment overlaps with that of OCD and implies that common neuropsychological changes affect individuals with these disorders.Peer reviewe

Standards of care for obsessive–compulsive disorder centres

In recent years, many assessment and care units for obsessive–compulsive disorder (OCD) have been set up in order to detect, diagnose and to properly manage this complex disorder, but there is no consensus regarding the key functions that these units should perform. The International College of Obsessive- Compulsive Spectrum Disorders (ICOCS) together with the Obsessive Compulsive and Related Disorders Network (OCRN) of the European College of Neuropsychopharmacology (ECNP) and the Anxiety and Obsessive Compulsive Disorders Section of the World Psychiaric Association (WPA) has developed a stand- ards of care programme for OCD centres. The goals of this collaborative initiative are promoting basic standards, improving the quality of clinical care and enhance the validity and reliability of research results provided by different facilities and countries

Обсесивно-компулсивно разстройство : връзка на когнитивните нарушения в коморбидитета с етиологията и патофизиологията на болестта

Дисертационен труд за присъждане на образователна и научна степен "Доктор" /CD/ / Георги Лъчезаров Хранов . - София, 2014 . - 194 с. + Автореферат /CD

BIPOLAR DISORDER – FROM ENDOPHENOTYPES TO TREATMENT

Introduction: There are a lot of unresolved issues associated with the classification, diagnosis, clinical management and understanding of the underlying pathogenic mechanisms of bipolar affective disorder. Aim: To search for discrete endophenotypes in BAD. Subjects and methods: We studied various bipolar I and II and recurrent depression patient samples and healthy controls using descriptive data, self and clinician-rated scales for neurological and psychopathological symptoms, neurocognitive instruments, and inventories for temperamental and characterological features. We also looked into the efficacy, tolerability and cost/benefit ratio of sodium valproate in the treatment of acute mania. Results: BAD patients display deficits in the domains of memory, selective attention, working memory and psychomotor speed. Sensory, motor and complex neurological soft signs can be considered part and parcel of the symptomatology of BAD. The evidence linking hyperthymic temperament to the bipolar spectrum is not supported, while cyclothymia seems to be a marker of vulnerability to affective psychopathology. In contrast to others, we found significantly lower self-transcendence in BAD patients compared to controls. Early age of onset, abrupt onset, lability of mood and energy with late-day brightening and activation, discriminate bipolar from unipolar depression. Sodium valproate (especially if started intravenously) is a highly efficacious, cost-effective treatment approach for acute mania. Conclusion: The discovery of BAD endophenotypes can enhance early diagnosis, prevent errors in treatment and help elucidate the genetic vulnerability for this grave disease

Problematic use of the internet in low- and middle-income countries before and during the COVID-19 pandemic: A scoping review

© 2022 Published by Elsevier. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1016/j.cobeha.2022.101208People from low- and middle-income countries (LMICs) represent large portions of the world population, often occupy less favorable living conditions, and typically suffer greater health risks, yet frequently receive little research and global health attention. The present study reviews emerging evidence on problematic use of the internet (PUI) in LMICs prior/during the COVID-19 pandemic. Analyzed studies mainly focused on general properties of PUI in university students, problematic gaming in youth, or problematic use of social media in adults, registering higher prevalence estimates, as compared to earlier reports. Research mainly focused on initially affected regions and COVID-exposed populations. Overall, unfavorable circumstances including poor social support, family relationships and lifestyle tendencies/habits may present potential risk for PUI in LMICs, likely exacerbated during the pandemic.Peer reviewe

2nd EPA Academia Summer School: a unique experience

status: accepte

Cigarette smoking in patients with obsessive compulsive disorder: a report from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS)

Obsessive compulsive disorder (OCD) showed a lower prevalence of cigarette smoking compared to other psychiatric disorders in previous and recent reports. We assessed the prevalence and clinical correlates of the phenomenon in an international sample of 504 OCD patients recruited through the International College of Obsessive Compulsive Spectrum Disorders (ICOCS) network. Cigarette smoking showed a cross-sectional prevalence of 24.4% in the sample, with significant differences across countries. Females were more represented among smoking patients (16% vs 7%; p <.001). Patients with comorbid Tourette's syndrome (p <.05) and tic disorder (p <.05) were also more represented among smoking subjects. Former smokers reported a higher number of suicide attempts (p <.05). We found a lower cross-sectional prevalence of smoking among OCD patients compared to findings from previous studies in patients with other psychiatric disorders but higher compared to previous and more recent OCD studies. Geographic differences were found and smoking was more common in females and comorbid Tourette's syndrome/tic disorde