Social cognition in euthymic bipolar disorder: systematic review and meta-analytic approach.

Objective: Deficits in social cognition have been reported in euthymic subjects with bipolar disorder (BD). However, some studies have failed to find differences favoring controls. As most investigations have been conducted with small samples, they have not had sufficient power to detect statistically significant differences. Furthermore, studies communicating positive results have scarcely attempted to estimate effect sizes for patient-control differences. The aim of this study was to summarize the findings of reports on social cognition in patients with euthymic BD and to combine their data to identify possible deficits and quantify their magnitude. Method: Systematic literature review and meta-analysis. Results: Impairments of moderate magnitude (0.5 < d < 0.8) were noted across mentalizing skills, whereas small but significant effect sizes (d < 0.5) were observed for facial emotion recognition. No patient–control differences were found for decision-making. Conclusion: Meta-analytic findings provide evidence for emotion processing and theory of mind deficits in remitted bipolar patients. However, it is not yet clear whether these areas of impairment are related to neurocognitive dysfunctions or to medication effects. The results are discussed with regard to targets for future neuropsychological research on BDs.Fil: Samame, Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro; ArgentinaFil: Martino, Diego Javier. Universidad Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Strejilevich, Sergio. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro; Argentin

Neurocognitive functioning in early-onset and late-onset older patients with euthymic bipolar disorder

Objective Most neurocognitive studies have not taken into account the fact that older patients with bipolar disorder (BD) are a heterogeneous population. The main goal of this study was to compare neurocognitive performance and extrapyramidal symptoms in older patients with early-onset BD (EO-BD) and late-onset BD (LO-BD). Methods Euthymic older patients with EO-BD (n = 20), LO-BD (n = 20), and healthy controls (n = 20) were evaluated with traditional clinical instruments and measures of exposure to psychotropic drugs, as well as extrapyramidal symptoms. All subjects completed an extensive neuropsychological battery. Results Patients with EO-BD showed poorer performance than healthy controls in two measures of verbal memory and two measures of executive functions, whereas patients with LO-BD exhibited lower performance scores than healthy controls in almost all of the measures assessed. Impairments in the LO-BD group included even neurocognitive domains typically spared in mixed-age patients. Additionally, there was a trend toward displaying higher extrapyramidal symptoms in the LO-BD group compared with both EO-BD and healthy control groups. In both patient groups, psychosocial functioning was related with executive dysfunction and extrapyramidal symptoms. Conclusions Patients with LO-BD may have more extensive and severe cognitive impairments, as well as higher vulnerability to extrapyramidal symptoms, compared with patients with EO-BD. Cognitive-motor disturbances may help to explain impairments in daily functioning among older patients with EO-BD and LO-BD during remission.Fil: Martino, Diego Javier. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Strejilevich, Sergio. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias; Argentina. Instituto de Neurología Cognitiva; ArgentinaFil: Manes, Facundo Francisco. Instituto de Neurología Cognitiva; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias; Argentin

Dopamine sudden depletion as a model for mixed depression

Up to date research on Bipolar Disorders' phenomenology is in keeping with early descriptions made by E. Kraëpelin regarding the overlap in clinical presentation of both manic and depressive symptoms, namely, mixed states. The latter constitute a highly prevalent and characteristic clinical presentation of Bipolar Disorders' and entail therapeutic difficulties, prognostic implications and increased suicidal risk. Notwithstanding, mixed states', more specifically mixed depression, have been underestimated and bypassed to the point where currently neither diagnostic criteria nor specific therapeutic recommendations are provided. In addition to the lack of agreement on nosography and diagnostic criteria, mixed depression is usually excluded from Bipolar Disorders' neurobiological models. Furthermore, renewed interest in the role of dopamine in Bipolar Disorders' physiopathology has left aside hypothesis that may account for the aforementioned clinical presentation. Interestingly enough, other syndromes arising from sudden dopamine depletion such as neuroleptic dysphoria or withdrawal syndromes from dopaminergic drugs, bear remarkable clinical similarities with mixed depression. These syndromes have been subject of further research and may thus provide a model for mixed states' physiopathology.Indeed, this article accounts for clinical similarities between mixed depression, neuroleptic induced dysphoria, and other behavioural syndromes arising from sudden dopamine depletion. After reviewing neurochemical basis of such syndromes we present, to the best of our knowledge, the first neurobiological hypothesis for mixed depression. Specifically, such hypothesis regards over activation symptoms as auto regulatory attempts to compensate for sudden dopaminergic depletion. This hypothesis provides with a beginning step for the neglected problem of mixed depression, a non-antithetic link between the dopaminergic hypothesis for both manic and depressive symptoms, a plausible explanation regarding inter individual variability to mixed depression susceptibility, and suggests new approaches for the development of novel treatments in which dopamine dysregulation should be targeted.Fil: Strejilevich, Sergio. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias; ArgentinaFil: Teitelbaum, J.. Instituto de Neurología Cognitiva; ArgentinaFil: Martino, Diego Javier. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Quiroz, D.. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias; ArgentinaFil: Kapczinski, F.. No especifíca

The long-term course of cognition in bipolar disorder:A systematic review and meta-analysis of patient-control differences in test-score changes

Neuropsychological impairment represents a key aspect of bipolar disorder (BD) that is evident even in early-course patients and is a strong predictor of functional outcomes among those affected. Previous meta-analyses of longitudinal studies suggest that BD-related cognitive deficits may not progress along the course of the disorder. However, short test-retest periods were used in most primary studies and comparisons with healthy controls were limited. The aim of this review was to synthesize the findings of research reports comparing long-term neurocognitive trajectories between BD patients and healthy individuals. PubMed, PsycINFO, and Scopus databases were searched from inception through July 2021. Publications were considered for inclusion if they reported cognitive test scores of BD patients and healthy controls at two different time points, with a minimum test-retest interval of 5 years. Fifteen studies compared the long-term course of cognition in BD patients with that of healthy controls. Ten of these were included in the quantitative analysis and involved 540 BD patients and 644 healthy individuals (mean follow-up period: 8.9 years). Patient-control effect sizes (standardized mean differences) were calculated for test-score changes in 24 neuropsychological variables and combined by means of meta-analytic procedures. No significant differences were found between patients and controls regarding long-term cognitive outcomes. These findings are consistent with previous shorter-term longitudinal meta-analyses and do not provide evidence for progressive cognitive deterioration in most bipolar individuals. Future studies should address the longitudinal course of cognition in different subgroups of BD patients and its prognostic and therapeutic value

Deficits in tasks of executive functioning that mimic real-life scenarios in bipolar disorder

Background: A growing body of evidence suggests that patients with bipolar disorder (BD) have cognitive impairments even during euthymic periods. The main cognitive domains affected are verbal memory, attention, and executive function. Nevertheless, some studies suggest that at least a subgroup of euthymic patients demonstrates intact executive functioning in classic neuropsychological tests, which could be due to the lack of real-life, or ecological validity. Objective: In this study, we highlight the usefulness of incorporating more ecological tests of executive function in assessment batteries in order to detect specific cognitive deficits in BD patients with otherwise normal performance in standard executive tests. Methods: Nineteen euthymic BD patients and 15 healthy controls completed a standard neuropsychological battery assessment and two experimental tasks (the Multiple Errands Test-Hospital Version and the Hotel Task) to measure executive functioning in highly demanding cognitive settings that mimic real-life scenarios. Results: No significant differences were found between the groups' demographic variables. We found, as predicted, that the group of euthymic BD patients who had control-comparable performance in classic executive tasks showed important deficits in more ecological tasks of executive functioning of the type that mimic real-life scenarios. Conclusions: Together, these data suggest that the inclusion of ecological tests in the assessment of BD patients can contribute to providing a more realistic cognitive profile of this patient population, which will undoubtedly allow for a better design of therapeutic and rehabilitation strategies that can help patients to minimize impact in real-life settings.Fil: Torralva, Teresa. Universidad Diego Portales; Chile. Instituto de Neurología Cognitiva; Argentina. Universidad Favaloro; ArgentinaFil: Strejilevich, Sergio. Universidad Favaloro; Argentina. Instituto de Neurología Cognitiva; ArgentinaFil: Gleichgerrcht, Ezequiel. Instituto de Neurología Cognitiva; Argentina. Universidad Favaloro; ArgentinaFil: Roca, María. Universidad Favaloro; Argentina. Instituto de Neurología Cognitiva; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Martino, Diego Javier. Universidad Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Cetkovich, Marcelo. Universidad Favaloro; Argentina. Instituto de Neurología Cognitiva; ArgentinaFil: Manes, Facundo Francisco. Universidad Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Neurología Cognitiva; Argentin

Comparative Analysis for Direct Costs and Global Functions in Persons Affected By Bipolar Disorders I and II in Outpatient Treatment

Objetivo: Evaluar los costos directos, el nivel de funcionamiento y la tasa de empleo reportada en una muestra aleatoria de personas con trastorno bipolar (TB) I y II que se atienden en forma ambulatoria. Métodos: Se analizaron y compararon los costos directos de los tratamientos ambulatorios de 165 pacientes con diagnóstico de trastorno bipolar tipo I y II (el costo mensual del tratamiento farmacológico, el número de consultas mensuales, el número de internaciones y días de internación). Se estimó el funcionamiento global y se consignó la condición laboral. Resultados: El 51,5% (n=85) de los pacientes presentaba diagnóstico de TB tipo I y 48,5% (n=80) de TB tipo II. El 40,6% de los pacientes se encontraba desocupado; el puntaje de GAF fue 73 ± 12,59. Los costos mensuales del tratamiento farmacológico fueron de $480 ±$350,4 por paciente sin diferencia entre los TB. Un mayor porcentaje de pacientes con TB I había tenido internaciones y recibía antipsicóticos, mientras que un mayor porcentaje de pacientes con TB II recibía antidepresivos y asistía al psicólogo. Discusión: Los pacientes con diagnóstico de TB I y TB II deben afrontar tratamientos farmacológicos que implican un costo promedio equivalente a un cuarto del ingreso mínimo en nuestro país, independientemente del tipo de trastorno bipolar que padezcan. Ambos grupos de pacientes presentaban una elevada tasa de desempleo y puntajes de funcionamiento global relativamente bajos.Objective: To evaluate the direct costs, the functional level and the employment rate reported for a random sample of people with Bipolar Disorders (BD) I and II that are cared for as outpatients. Methods: The direct costs of outpatient treatment for 165 patients diagnosed with types I and II bipolar disorders were compared and analyzed (the monthly cost of pharmacological treatments, the number of consultations per month, the number of hospitalizations and the days spent in hospital). Global functioning was estimated and their employment was recorded. Results: 51,5% (N=85) of the patients had been diagnosed with type I BD and 48.5% (N=80) with BD type II. 40,6% of the patients were unemployed; the GAF score was 73 ± 12,59. Monthly costs of pharmacological treatment were $480 ±$350,4 per patient, with no difference between the type of BD. A larger percentage of type I BD patients had been hospitalized and received anti-psychotic drugs, whereas a greater percentage of BD II patients received anti-depressants and went to a psychologist. Discussion: Patients diagnosed with BDI and BD II must face pharmacological treatments that imply an average cost equal to one quarter of the minimum income in our country, independent of the type of bipolar disorder they suffer. Both groups of patients presented a high level of unemployment and relatively low global functioning scores.Fil: Igoa, Ana. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias; ArgentinaFil: Martino, Diego Javier. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias; ArgentinaFil: Khan, Clara. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Scchiavo, Patricia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Marengo, Eliana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias; ArgentinaFil: Strejilevich, Sergio. Universidad Favaloro. Facultad de Medicina. Instituto de Neurociencias; Argentin

Parkinsonian motor impairment predicts personality domains related to genetic risk and treatment outcomes in schizophrenia

Identifying endophenotypes of schizophrenia is of critical importance and has profound implications on clinical practice. Here we propose an innovative approach to clarify the mechanims through which temperament and character deviance relates to risk for schizophrenia and predict long-term treatment outcomes. We recruited 61 antipsychotic naïve subjects with chronic schizophrenia, 99 unaffected relatives, and 68 healthy controls from rural communities in the Central Andes. Diagnosis was ascertained with the Schedules of Clinical Assessment in Neuropsychiatry; parkinsonian motor impairment was measured with the Unified Parkinson’s Disease Rating Scale; mesencephalic parenchyma was evaluated with transcranial ultrasound; and personality traits were assessed using the Temperament and Character Inventory. Ten-year outcome data was available for ~40% of the index cases. Patients with schizophrenia had higher harm avoidance and self-transcendence (ST), and lower reward dependence (RD), cooperativeness (CO), and self-directedness (SD). Unaffected relatives had higher ST and lower CO and SD. Parkinsonism reliably predicted RD, CO, and SD after correcting for age and sex. The average duration of untreated psychosis (DUP) was over 5 years. Further, SD was anticorrelated with DUP and antipsychotic dosing at follow-up. Baseline DUP was related to antipsychotic dose-years. Further, ‘explosive/borderline’, ‘methodical/obsessive’, and ‘disorganized/schizotypal’ personality profiles were associated with increased risk of schizophrenia. Parkinsonism predicts core personality features and treatment outcomes in schizophrenia. Our study suggests that RD, CO, and SD are endophenotypes of the disease that may, in part, be mediated by dopaminergic function. Further, SD is an important determinant of treatment course and outcome

Use of complementary and alternative medicine by patients with bipolar disorder

Vol. 39. Núm. 4. Páginas 665-682 (Dezembro 2010) Compartilhar Imprimir Baixar PDF Artículos originales DOI: 10.1016/S0034-7450(14)60207-9 Acesso de texto completo Uso de medicinas complementarias y alternativas en pacientes con trastorno afectivo bipolar en Colombia Use of Complementary and Alternative Medicine by Patients with Bipolar Disorder María José Sarmiento Suárez1, , Sergio Strejilevich2, Carlos Gómez-Restrepo3, Laura Gil Lamus4, Fabián Gil5 1 Médica psiquiatra. Pontificia Universidad Javeriana. Práctica privada. Bogotá, Colombia 2 Médico psiquiatra. Grupo de Trastornos Afectivos. Instituto de Neurociencias Favaloro. Buenos Aires, Argentina 3 Médico psiquiatra. Psicoanalista. MsC en Epidemiologia Clínica. Director del Departamento de Epidemiología Clínica y Bioestadística y profesor asociado del Departamento de Psiquiatría y Salud Mental de la Pontificia Universidad Javeriana. Bogotá, Colombia 4 Médica psiquiatra. Pontificia Universidad Javeriana. Hospital Federico Lleras. Ibagué, Colombia 5 Bioestadístico. Departamento de Epidemiología Clínica y Bioestadística de la Pontificia Universidad Javeriana. Bogotá, Colombia Este item recebeu NOTICE Undefined index: INICIO (controladores/procedimientos.php[17]) 809 Visitas (Atualização diária de dados) Informação do artigo Resume Bibliografia Baixar PDF Estatísticas Resumen Introducción La medicina complementaria y alternativa (MCA) está adquieriendo un papel importante en el contexto de la atención sanitaria en salud mental. Objetivo Describir el uso de las MCA en pacientes con trastorno afectivo bipolar (TAB), realizando una aproximación al impacto que este tipo de medicinas puede generar en el diagnóstico temprano de la enfermedad y la adherencia al tratamiento. Método Se recogió una muestra consecutiva de pacientes adultos con diagnóstico de TAB, quienes asistían a tratamiento psiquiátrico en las instituciones participantes entre mayo del 2008 y mayo del 2009. Se administró una encuesta anónima, estructurada y autoaplicada. Resultados Se obtuvo información sobre 66 mujeres y 34 hombres; edad promedio, 45,5 años (desviación estándar 14,9 años). El 29,3% reportó que desde el inicio de los síntomas del TAB hasta el diagnóstico por un psiquiatra transcurrieron más de 5 años; el 31,6% refería haber recurrido a MCA como primera atención sanitaria. Las consultas a sacerdotes y la asistencia a misas de sanación constituyeron las prácticas más utilizadas, junto con la medicina homeopática, la bioenergética, las esencias florales, la acupuntura y el yoga. Discusión y conclusiones Aunque existen demoras en recibir un diagnóstico adecuado y un tratamiento oportuno, y a su vez insatisfacción con los servicios de la MC, este estudio permite un acercamiento al impacto de las MCA; sin embargo, se requiere más investigación orientada a conocer las expectativas y necesidades de los pacientes, que en lo posible integre los recursos terapéuticos disponibles para el tratamiento del TAB.Q4665-682Introduction Complementary and alternative medicine (CAM) has acquired an important role in the context of mental health care. Objective To describe the use of Complementary and Alternative Medicine in patients with bipolar affective disorder (BD), examining the impact this kind of medicine can have on the early diagnosis of the illness and on the adherence to treatment. Method A structured, anonymous, and self-administered survey was conducted among 100 adult patients affected by Bipolar Disorder in Colombia, between May 2008 and May 2009. Results We obtained data on 100 subjects, 66 women and 34 men, with a mean age of 45.5 years (SD 14.9 years). 29.3% reported that from the onset of symptoms until the diagnosis of BD by a psychiatrist more than 5 years had passed; 31.6% confirmed the use of CAM as primary health care. Consultations with priests and attending healing masses were the most commonly used practices, along with homeopathic medicine, bioenergetic medicine, flower essences, acupuncture, and yoga. Discussion and conclusions Although there can be delays in receiving proper diagnosis and timely treatment, as well as dissatisfaction with CM services, this study gives us an initial approach to the impact of CAM in this regard. More research is needed, however, in this field in order to discover patients’ expectations and needs, as well as an adequate mental health care which integrates, as much as it is possible, all the therapeutic resources available for the treatment of BD

OpenSIMPLe: A real-world implementation feasibility study of a smartphone-based psychoeducation programme for bipolar disorder

Background: Few evidence-based mental health apps are widely available to patients and, conversely, many of the available apps have not been appropriately evaluated. Given that the ultimate goal is to scale-up and open internet-based platforms (IBP), it is crucial to appropriately evaluate their real-world feasibility beforehand. We aimed to evaluate the implementation feasibility of a smartphone-based psychoeducational programme for bipolar disorder, exploring its long-term retention, usability, perceived helpfulness and satisfaction, alongside its impact on secondary health outcomes. Methods: Participants were recruited via the project website after completing an online screening questionnaire. They were requested to complete web-based questionnaires before using the app and after 6 months of use which included sociodemographic, illness and treatment variables, the world health organisation-five well-being index (WHO-5) and the short form health survey (SF-36). The follow-up questionnaires also contained satisfaction and usefulness questions. Results: 201 participants took part in the study. According to their retention, 66.2% of the participants were classified as noncompleters and 33.8% as completers. The only predictor significantly associated with higher odds of retention was older age (OR = 1.021, p < 0.001). 62% of the users reported they were satisfied with the programme with a higher percentage among completers. Who-5 baseline and follow-up scores showed a significant improvement as well as 6 out of 8 domains of the SF-36. Limitations: Screening and outcome measures were administered using exclusively self-reported online methods. Conclusion: The 6-month attrition rate of the programme was high. Positive outcomes regarding satisfaction were found predominantly among completers. The optimal dosage and retention of IBP mental health programmes remain challenging issues that need further research