High-Sensitive c-Reactive Protein Levels in Euthymic Bipolar Patients: Case-Control Study.

Background:Despite significant advances in pharmacological and psychological therapies for bipolar disorder, many people continue to have less than optimal outcomes, which are associated with significant disability and poor quality of life (QOL). This study aimed to assess the disability and QOL and factors associated with such suboptimal outcomes in subjects with bipolar disorder in remission.Methods:Consecutive patients diagnosed to have bipolar disorder in remission attending the Department of Psychiatry, MOSC Medical College, Kerala, India were recruited for the study. They were assessed using the International Classification of Diseases Diagnostic Criteria for Research-10, Hamilton Scale for Depression, Young's Mania Rating Scale, World Health Organization-QOL (WHO QOL-BREF), WHO-Disability Assessment Scale (WHO-DAS), and Kuppuswamy's scale for socioeconomic status assessment.Results:Eighty-four patients were evaluated. The mean total WHO-DAS score was 19.2 ± 2.09, the maximum disability in domain 4 (getting along) followed by domain 2 (mobility). The mean total WHO-QOL BREF score was 54.26 ± 2.85, the lowest subscore in domain 3 (social interactions). Disability scores were significantly associated with increasing age, female gender, not being an earning member of the family, and lower QOL scores. Poorer QOL scores were significantly associated with increasing age and higher disability score.Conclusions:Many bipolar patients in remission have significant disability and poorer QOL. There is a need for longitudinal studies to explore such associations and develop interventions to reduce the disability thereby enhancing the QOL.

Chronotype is trait-like construct reflecting long-term morningness-eveningness preferences. Higher eveningness scores are linked to sleep disturbances, night-eating, and addictive behaviors but remain understudied in subjects with bipolar disorder (BD). This study aimed to explore the clinical and behavioral factors associated with chronotype in a euthymic cohort with BD. Adult individuals (18-45 years) with DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) diagnosis of BD in clinical remission (≥3 months) were enrolled, if they did not have current psychiatric or substance use disorder as per Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST score < 27). Participants were assessed using the validated Hindi version of Composite Scale of Morningness-Eveningness (CSM), the National Institute of Mental Health (NIMH)-Life Chart Method, IGLSI (International Group for Study of Lithium) Scale for typical/atypical features, Pittsburgh Sleep Quality Index, Cognitive complaints in BD Rating Assessment, Seasonal Pattern Assessment Questionnaire, Bipolar Eating Disorder Scale, Internet Disorder Scale, and Functioning Assessment Short Test. After data normalization, exploratory factor analysis was conducted using principal component analysis with varimax rotation on the study variables excluding the CSM. Subsequently, regression analysis was performed with CSM as the dependent variable. The mean age of the sample was 32.43 ± 7.68 years (n = 100; 35% females). Factor analysis revealed a latent structure with three factors: Factor 1 (global functioning), Factor 2 (disordered biological functions and rhythms), and Factor 3 (dysfunction due to sleep and internet use). The regression model was found to be statistically significant [F (3,96) = 5.520, P = 0.002; R2 = 0.147, adjusted R2 = 0.120). Factor-2 was a significant predictor of CSM score (B = -2.201, SE: 0.606, P < 0.001). For every unit increase in Factor 2 score, the CSM total score reduced on average by 2.2 units. This study highlights the role of disrupted sleep, eating behaviors, and seasonality in influencing the chronotype and their interconnectedness in individuals with BD.

Changes in beliefs about the self are a central feature of bipolar disorder, with grandiose self-belief common in mania and low self-esteem evident in periods of depression. We investigated whether unstable self-esteem is a characteristic of bipolar disorder in remission. We compared 18 patients with DSM-IV bipolar disorder in remission, 16 patients with unipolar disorder in remission, and 19 healthy controls. The primary measure was a diary kept for one week and completed twice each day, measuring self-esteem and positive and negative affect. We also administered Winters and Neale's (J Abnorm Psychol 1985; 94: 282-290) implicit measure of attributional style. Whereas mean levels of self-esteem and affect were not abnormal in the remitted bipolar patients, the bipolar patients showed strong fluctuations in these processes. In common with the unipolar patients, they also showed a pessimistic attributional style on the Pragmatic Inference Task (PIT). Instability of self-esteem and affect is present in bipolar patients, even when their symptoms are in remission, and has previously been found in people at genetic risk of the disorder. It may be a marker of vulnerability to the disorder.

The study aimed to examine the perceptions of illness in self and among others in patients with bipolar disorder in remission. The effect of a structured educational programme on the perceptions of illness was also tested. We examined the perceptions of illness in self and in others (using a vignette) among patients with bipolar disorder in remission attending the Department of Psychiatry, Christian Medical College, Vellore, India. We also examined the effect of a structured educational programme on explanatory models in a randomized controlled trial. Explanatory models were assessed using the Tamil version of the Short Explanatory Model Interview. Eighty two subjects were recruited for the trial; half of them received structured education while the other half received treatment as usual. There was agreement between perceptions related to the individual's own illness and their opinion of illness in others as assessed using a vignette at baseline and at follow-up. There were no significant differences in explanatory models between patients who received education and those who did not. The results of this study show that during periods of remission, patients can clearly see the relationship between their own illness and that described in others, suggesting that insight is state dependent and may be related to psychopathology with good recovery of insight during periods of remission. These findings also argue for the fact that the current multi-dimensional models of insight which focus on biomedical explanations and treatments are not culturally sensitive. The assessment of insight demands universal conventions with comparison to the local cultural standards rather than universal definitions and yardsticks which employ Western and biomedical perspectives.

Perturbations de la réactivité émotionnelle et du sommeil dans les troubles bipolaires en période intercritique

ABSTRACTBackground:Medication adherence in patients with unipolar depression and bipolar disorder is a critical factor influencing treatment outcomes. Despite remission, medication adherence remains a challenge, with various clinical and sociodemographic factors potentially affecting patient attitudes toward drug compliance. Understanding these factors can help tailor interventions to improve adherence and provide a better primary care.Aim:The aim of this study was to assess drug adherence attitudes and identify factors influencing adherence in patients with unipolar depression and bipolar disorder currently in remission.Material and Methods:This cross-sectional study was conducted with patients diagnosed with unipolar depression and bipolar disorder in remission. Sociodemographic and clinical variables were collected through structured interviews. Drug adherence was measured using the Drug Adherence Inventory scale. Statistical analyses were performed to identify factors correlating with drug adherence.Results:The study found that older age, male gender, and formal education were significantly associated with better drug adherence. Clinically, a higher number of episodes were linked to improved adherence as patients with more episodes demonstrated better compliance. Other clinical factors, including comorbidities and medication type, did not significantly impact adherence attitudes. The study highlighted the importance of sociodemographic factors in shaping drug adherence.Conclusion:Sociodemographic factors, particularly age, gender, and education, play a significant role in medication adherence among patients with unipolar depression and bipolar disorder. The number of episodes also positively impacts adherence, suggesting that patients with frequent episodes may develop stronger commitment to treatment. Targeted interventions, addressing these factors, could improve medication adherence and patient outcomes in these populations. Further research is needed to explore personalized approaches for enhancing drug adherence.

Lots of patients with bipolar disorder (BD) continue to have residual symptoms after treatment in their remission, BD exhibits intricate characteristics and transformation patterns in its residual symptoms, residual symptoms of different polarities and degrees can mix with and transform to each other. There is a need for further investigation of BD as a comprehensive multivariate disease system. The current research lacks network analyses focusing on BD's residual and subsyndromal symptoms. 242 patients were included with bipolar disorder in remission. We compared demographic data and differences in symptoms between populations with and without residual symptoms using t-tests and chi-square tests, with FDR applied for multiple comparison correction. Logistic regression was used to identify influencing factors for residual symptoms. Symptom networks were compared by network analysis to analyze the relationships between different types of residual symptoms. Depressive residual symptoms (N=111) were more common than manic residual symptoms (n=29) in the patients included. The comparison between two groups with and without residual symptoms shows no difference in demographic data and medical history information. The main influencing factors related to residual symptoms were time from diagnosis to first treatment (OR=0.88), the first(OR=1.51) and second (OR=17.1)factors of the Mood Disorder Questionnaire (MDQ), the Quick Inventory of Depressive Symptomatology Self-Report (QIDS)(OR=5.28), the psychological(OR=0.68) and environment (OR=1.53) subscale of the World Health Organization Quality of Life Short Form (WHOQOL-BREF). There was a significant difference in network structure between the groups with and without residual symptoms (network invariance difference=0.4, p =0.025). At the same time, there was no significant difference between the groups with and without depressive residual symptoms. However, the symptom network in patients with depressive residual symptoms is more loosely structured than in those without, with symptoms exhibiting weaker interconnections. When there is no depressive or manic residual symptom, it can still form a symptom network and cause an impact on social function. This study underscores the complexity of bipolar disorder's residual symptoms. Although it primarily manifests as loosely structured depressive residual symptoms, manic residual symptoms should not be ignored. Future research should explore network-based interventions targeting specific symptom clusters or connections to improve residual symptom management and patient outcomes.

We write to correct some misconceptions evident in the recent editorial by Ferrier & Thompson ([2002][1]). Previously, we reported impairment in accuracy measures on recognition memory tasks and increased latencies on executive tasks in patients with bipolar disorder in remission ([Rubinsztein et al

Many subjects with bipolar disorder experience significant cognitive dysfunction, even when euthymic, but few studies assess biological correlates of or treatment strategies for cognitive dysfunction. Nineteen subjects with bipolar disorder in remission, who reported subjective cognitive deficits, were treated with open-label galantamine-ER 8-24 mg/day for 4 months. Ten healthy volunteers matched for age and gender were also assessed. Mood and subjective cognitive questionnaires were administered monthly. At the beginning and the end of the trial all subjects were administered neuropsychological tests, including tests of attention (Conners CPT) and episodic memory (CVLT). Bipolar subjects underwent proton magnetic resonance spectroscopy (1H-MRS) measurements before and after treatment, healthy volunteers completed baseline 1H-MRS. We acquired 1H-MRS data at 4.0 T from voxels centered on the left and right hippocampus to measure hippocampal N-acetyl aspartate (NAA, a measure of neuronal viability) and choline containing compounds (Cho, a marker of lipid metabolism and membrane turn-over). Compared to healthy volunteers, bipolar subjects had higher baseline subjective cognitive deficits and lower scores on objective tests of attention (Conner's CPT) and verbal episodic memory (CVLT). After treatment, bipolar subjects experienced significant improvement of subjective cognitive scores and on objective tests of attention (Conner's CPT) and verbal episodic memory (CVLT). In the left hippocampus NAA increased and choline (Cho) decreased in bipolar subjects during treatment. Bipolar subjects had cognitive dysfunction; treatment with Galantamine-ER was associated with improved cognition and with increases in neuronal viability and normalization of lipid membrane metabolism in the left hippocampus. This study was registered on ClinicalTrials.gov (NCT00181636).

This study aims to determine and investigate COVID-19 fear level, quality of life, and follow-up-related data during the pandemic in patients with bipolar disorder in remission who were followed up at a Community Mental Health Center (CMHC). The study included 42 individuals who admitted to the CMHC unit between June and July 2022. Participants were assessed by using a sociodemographic data form, the COVID-19 Fear Scale, the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and the Clinical Global Impression Scale (CGI). The data were analyzed using independent groups T-test and Pearson correlation test. During the pandemic, no change was determined in the frequency of psychiatric hospitalizations in 95.2% (n=40), and manic and/or depressive episodes in 69% (n=29) of the patients. While 92.9% (n=39) of the patients reported no difficulty attending psychiatric follow-ups, 64.3% (n=27) stated that they did not experience COVID-19-related challenges accessing non-psychiatric services. The average COVID-19 fear score was 15.21±7.57, WHODAS 2.0 was 10.29±7.27, and CGI was 2.57±0.77. No significant relationships were found between the variables (p&amp;gt;0.05). In conclusion, the stability in episode frequency and hospital follow-ups during the pandemic highlights the importance of CMHC monitoring, emphasizing the need to enhance such services, especially during crises.

Mindfulness integrated cognitive behavior therapy in bipolar disorder in remission: A case study

Previous studies have found that treatment with lithium over a 4-week period may increase the concentration of N-acetyl-aspartate (NAA) in both bipolar patients and controls. In view of other findings indicating that NAA concentrations may be a good marker for neuronal viability and/or functioning, it has been further suggested that some of the long term benefits of lithium may therefore be due to actions to improve these neuronal properties. The aim of the present study was to utilize H magnetic resonance spectroscopy ( H MRS) to further examine the effects of both lithium and sodium valproate upon NAA concentrations in treated euthymic bipolar patients. In the first part of the study, healthy controls (n =18) were compared with euthymic bipolar patients (type I and type II) who were taking either lithium (n =14) or sodium valproate (n =11), and NAA : creatine ratios were determined. In the second part, we examined a separate group of euthymic bipolar disorder patients taking sodium valproate (n =9) and compared these to age- and sex-matched healthy controls (n =11), and we quantified the exact concentrations of NAA using an external solution. The results from the first part of the study showed that bipolar patients chronically treated with lithium had a significant increase in NAA concentrations but, in contrast, there were no significant increases in the sodium valproate-treated patients compared to controls. The second part of the study also found no effects of sodium valproate on NAA concentrations. These findings are the first to compare NAA concentrations in euthymic bipolar patients being treated with lithium or sodium valproate. The results support suggestions that longer-term administration of lithium to bipolar patients may increase NAA concentrations. However, the study suggests that chronic administration of sodium valproate to patients does not lead to similar changes in NAA concentrations. These findings suggest that sodium valproate and lithium may not share a common mechanism of action in bipolar disorder involving neurotrophic or neuroprotective effects.

Background and Aim:Treatment outcomes in bipolar disorder are highly variable, and several sociodemographic, clinical characteristics, and comorbidities play an important role. Early recognition of these factors will help the physicians to implement individualized treatment and a better clinical outcome. The present study was aimed at identifying the factors affecting treatment outcomes in bipolar disorder.Materials and Methods:All patients diagnosed with bipolar disorder as per diagnostic and statistical manual-IV criteria were included in the study. Patients were followed for 6 months from the day of enrollment. Patient demography, age at bipolar disorder was diagnosed, age at treatment was started, social habits, signs and symptoms, comorbidities, symptoms, treatment pattern, and compliance to treatment were recorded in case record form. Based on the changes in young mania rating scale and Hamilton Depression Rating Scale (HAM-D) score from baseline to last follow-up, the patients were classified as remission and non-remission. Multiple logistic regression was used to identify risk factors associated nonremission in bipolar disorder patients and calculation of odds ratio (OR).Results:The mean age of the study population was 37.6 ± 14.1 years. Out of the 121 patients, 68 (56.2%) were female. At the end of the follow-up period, 41 (33.9%) had remission, and 80 (66.1%) had nonremission. Early onset (OR: 9.77; confidence intervals [CI]: 1.77–86.01), treatment delay (OR: 6.48; CI: 1.27–32.92), treatment noncompliance (OR: 4.64; CI: 1.37–15.64), and single living (OR: 4.26; CI: 1.56–11.66) were independently associated with nonremission in bipolar disorder patients.Conclusions:Early-onset bipolar disorder, delay in treatment, treatment non-compliance, and single living adversely affect remission in bipolar disorder.

Background and methodsThis study aimed to determine time to relapse and remission of mood episodes in Thai patients with bipolar disorder (BD). The Thai Bipolar Disorder Registry was a multicenter, prospective, naturalistic, observational study conducted in Thailand. Participants were adult inpatients or outpatients with Diagnostic and Statistical Manual of Mental Disorders bipolar disorder. The diagnosis of bipolar disorder, current psychiatric comorbidity, mood relapse, and mood remission were determined by using the Mini International Neuropsychiatric Interview. Relapse and remission were assessed every 2 months.ResultsOf 424 BD participants, 404 (95.3%) were BD I, and 258 (60.8%) were female. At entry, 260 (61.3%) had recovered, and 49 (11.6%) were recovering. During 1-year follow-up (381.7 person-years), 92 participants (21.7%) had 119 relapses or 0.31 (95% confidence interval 0.25–0.35) episodes per person-year. Among 119 relapses, 58 (48.7%), 39 (32.7%), and 21 (17.6%) of them were depressive, hypomanic, and manic episodes, respectively. Using the Kaplan–Meier method, we found that 25% of the participants relapsed in 361 days. Of the 400 participants who reached remission, 113 (28.2%) had mood relapses. Of 173 mood events accountable for remission analysis, the median time to remission was 67.5 days (72.5 days for depressive episodes versus 58.0 days for manic episodes, log rank P = 0.014).ConclusionsThe 1-year relapse rate in Thai patients with BD was 21.7% or 0.31 episodes per person-year. About one-fifth of recovered patients had mood relapses within 371 days. On average, a mood episode would remit in 67.5 days.

Thiol-disulphide homeostasis, ischemia-modified albumin, complete blood count-derived inflammatory markers and C-reactive protein from acute mania to early remission in bipolar disorder