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Manic symptoms of patients with bipolar disorder by early (age o 15 years) and late (age X 15 years) adolescence subgroups.
Source publication
Objective:
Presence of psychotic symptoms seems to be a commonplace in early-onset bipolar disorder (BD). However, few studies have examined their occurrence in adolescent-onset BD. We sought to investigate the frequency of affective and psychotic symptoms observed during the first manic episode in adolescents.
Methods:
Forty-nine adolescents wi...
Contexts in source publication
Context 1
... frequency of all psychopathological symptoms during first manic episode for the total sample and stratified by the early and late adolescent groups is displayed in Figures 1 and 2. Regarding acute manic symptoms, 67% of patients presented with euphoric mood, and 45% with irritable mood. ...
Context 2
... in goaldirected activity was observed in 67%, and 47% manifested grandiosity. There were no significant differences between age groups concerning major manic symptoms, with exception of grandiosity, which was more common in the early adolescent subgroup (Figure 1). The global functioning of this sample was severely impaired, with a mean CGAS score of 15 at index time. ...
Citations
... Second, consistent with previous studies reporting higher rates of mood incongruent features and first-rank symptoms [19,20], greater likelihood of schizophrenia spectrum diagnosis [21], or more florid psychotic symptoms among early-onset bipolar patients, we found that early-onset bipolar patients were characterized by a higher frequency of broadcasting delusions at first hospitalization than in the adult-onset group [22]. This factor probably adds to the diagnostic complexity and confusion in these patients, particularly when the expansive-excited component loses intensity and thought disturbances emerge quite openly, often resulting in a misdiagnosis of schizophrenia. ...
... Indeed, a considerable proportion of patients with schizophrenia may experience manic or depressed episodes either before or during psychotic episodes, whereas individuals with BD may experience psychotic symptoms during manic or depressive episodes. Furthermore, common etiological factors for these two disorders have been largely reported, such as infectious agents, drug use, obstetric complications, and environmental and genetic factors [22]. Therefore, early identification between the two disorders greatly influences the pharmacologic and psychological therapy regimens, as well as the prognoses. ...
Background: The present study aimed to examine clinical differences between subjects with early-onset (<21 years) and adult-onset (>30 years) bipolar I disorder, in particular, in relation to anxiety comorbidity.
Method: Subjects were selected from a cohort of 161 consecutive patients with bipolar disorder type I as diagnosed by the Structured Clinical Interview for DSM Disorder (SCID-I). Clinical characteristics and axis I comorbidity were compared between those whose illness first emerged before the age of 21 years (n=58) and those whose first episode occurred after the age of 30 years (n=27). Psychopathology was assessed using the 18-item version of the Brief Psychiatric Rating Scale (BPRS). The frequency of delusions, hallucinations, and formal thought disorders was evaluated with the SCID-I. Overall, social and occupational functioning was assessed by the Global Assessment of Functioning (GAF).
Results: Most subjects with early-onset bipolar disorder were males, had panic disorder and substance abuse comorbidity, longer duration of illness, exhibited mood-incongruent delusions, and presented with a mixed episode at onset more frequently than the later adult-onset subjects. Mixed mania at the first episode of illness and lifetime panic disorder comorbidity predicted mixed polarity at the first hospitalization episode in the early-onset subjects.
Conclusions: Overall, early age at onset seems to delineate a distinct bipolar I disorder subtype characterized by a greater likelihood of mixed episodes, lifetime panic disorder comorbidity, and schizophrenia-like delusions.
... Early onset and psychotic features have been analyzed as separate subgroups in (Sarrazin et al., 2018). We chose to consider both criteria together since they have been described as major features of neurodevelopmental phenotype and frequently associated (Fu-I et al., 2019;Kloiber et al., 2020). Moreover, early age of onset was set at 21 in (Sarrazin et al., 2018) while we used a more selective threshold (i.e., age of onset <18) consistently with previous reports (Arango et al., 2014;Geoffroy et al., 2013;Perlis et al., 2004). ...
... C) Each sulcal pit is the deepest point of its corresponding sulcal basin. The sulcal pits and corresponding basins are matched across individuals using a dedicated pipeline described in(Fu-I et al., 2019). D) The atlas of sulcal pits used in this study. ...
Background:
Analyzing cortical folding may provide insight into the biological underpinnings of neurodevelopmental diseases. A neurodevelopmental subtype of bipolar disorders (BD-ND) has been characterized by the combination of early age of onset and psychotic features. We investigate potential cortical morphology differences associated with this subtype. We analyze, for the first time in bipolar disorders, the sulcal pits, the deepest points in each fold of the cerebral cortex.
Methods:
We extracted the sulcal pits from anatomical MRI among 512 participants gathered from 7 scanning sites. We compared the number of sulcal pits in each hemisphere as well as their regional occurrence and depth between the BD-ND subgroup (N = 184), a subgroup without neurodevelopmental features (BD, N = 77) and a group of healthy controls (HC, N = 251).
Results:
In whole brain analysis, BD-ND group have a higher number of sulcal pits in comparison to the BD group. The local analysis revealed, after correction for multiple testing, a higher occurrence of sulcal pits in the left premotor cortex among the BD-ND subgroup compared to the BD and the HC groups.
Conclusion:
Our findings confirm that BD-ND is associated with a specific brain morphology revealed by the analysis of sulcal pits. These markers may help to better understand neurodevelopment in mood disorder and stratify patients according to a pathophysiological hypothesis.
... The clinical management of PMA and irritability is no easy task during manic episodes. While several studies focused on PMA and irritability in adolescents with BD (Fu et al., 2020;Salazar de Pablo et al., 2020;Weintraub et al., 2020), the co-occurrence of both condition remained an unresolved research entity. A recent study showed that the risk of suicide increased during manic episode when anxiety, irritability and PMA co-occurred (Eberhard & Weiller, 2016). ...
Objectives
We aimed to investigate the characteristics of adolescents with Bipolar disorder-I with irritability and agitation (Mania+IA) compared to those without irritability and agitation (Mania-IA) in a multi-center representative sample.
Methods
Data of 145 patients from three tertiary-care inpatient units between 2016 and 2021 were obtained. Psychomotor agitation was defined as a score of ≥3 on the YMRS “Increased Motor Activity––Energy” item, irritability as a score of ≥4 on the YMRS ‘irritability’ item, and severity anchors of speech and thought disturbance on the YMRS ‘6 and 7’ items.
Results
Previous manic episodes ( p = 0.013), involuntary hospitalization ( p = 0.006), psychotic features ( p = 0.001), formal thought disorder ( p = 0.010) and aggressive/disruptive behavior ( p = 0.021) were more frequent in the Mania+IA group. Conversely, depressive episodes ( p = 0.006) and family history of depression ( p = 0.024) were more frequent in the Mania-IA group. The Mania+IA had poorer functioning at the time of discharge.
Conclusions
Irritability and agitation were closely related to complications, psychotic symptoms and thought disorder. Assessment and monitoring of psychomotor agitation and irritability may help child and adolescent psychiatrists to predict clinical difficulties and appropriate interventions.
... Bipolar disorder (BD) is a pathological and complex genetic disorder that is usually accompanied by mood and behavioral dysfunctions ranging from extreme depression to mania or vice versa, in which delusions and hallucinations occur during affective periods. 1 BD typically includes remission between episodes, and modern operational diagnostic criteria indicate that it is equally common in men and women, with onset at a mean age of 21 years. Although genetic and family studies strongly suggest that neurobiological deterioration underlies the pathophysiology of BD, its etiology remains unclear. 2 Genetic approaches have provided valuable information about the pathophysiology of BD. ...
Objective:
Bipolar I disorder (BD-I) is a type of bipolar spectrum disorder characterized by manic or mixed episodes. Detecting microRNA regulations as epigenetic actors in BD-I is important to elucidate the pathogenesis of the disease and reveal the potential of microRNAs (miRNAs) as biomarkers.
Methods:
We evaluated the expression profile of six candidate miRNAs (hsa-miR-145-5p, hsa-miR376a-3p, hsa-miR-3680-5p, hsa-miR-4253-5p, hsa-miR-4482-3p, and hsa-miR-4725) in patients with BD-I and in healthy controls (aged 11-50 years). We also determined the potential target genes of these miRNAs through in silico analysis. The diagnostic values of the miRNAs were calculated through receiver operating characteristic curve analysis.
Results:
Four miRNAs were upregulated (hsa-miR-376a-3p, hsa-miR-3680-5p, hsa-miR-4253-5p, hsa-miR-4482-3p) and hsa-miR-145-5p was downregulated in patients (p < 0.001). The target gene analyses showed that hsa-miR-145-5p specifically targets the dopamine decarboxylase (DDC) gene. The area under the curve of hsa-miR-145-5p was 0.987.
Conclusion:
: Differential expression of five miRNAs in peripheral blood may be associated with the pathogenesis of BD-I, and hsa-miR-145-5p has potential as a BD-I biomarker. This miRNA can be used in dopamine-serotonin regulation and dose adjustment in drug therapy via the DDC gene.
... According to the literature, the presence of psychotic symptoms seems to be more frequent in child and early-onset bipolar patients and relates to poorer long-term outcome, more hospitalizations, lower interepisodic functioning, and a lower clinical recovery rate [4]. The most common mood disturbance in manic children is severe irritability, prolonged and aggressive temper outbursts and aggressive symptoms which may be the primary reason for the high rate of psychiatric hospitalization seen in manic children like in our cases [8 and 10]. ...
Objective: This case report highlights the importance of genetic contribution to the liability of bipolar disorder and atypical complex presentation. Methods: We describe a pair of monozygotic twins presented with acute manic symptoms with psychosis that occurred simultaneously. Results: The cases were chosen as they illustrate various presentations of bipolar disorder in children and adolescent and the importance of early treatment. Conclusions: Bipolar disorder should be considered in children and adolescent presented with episodic mood and behaviour changes.
... We also found the rate of psychotic symptoms in the depression group was higher than the mania group, similar to a recent study (31). This study found many patients with bipolar disorder had prominent psychotic symptoms as a feature of a depressive episode. ...
Background: Bipolar disorder is a serious mental disease marked by episodes of depression, mania, hypomania, or mixed states. Patients with bipolar disorder may present with different symptoms at first onset. The aim of this study is to compare demographic and clinical variables based on a patient's first episode of bipolar disorder, including risk of recurrence over a 2-year period.
Methods: A large cohort (N = 742) of patients with bipolar disorder in China was analyzed. Patients were divided into two groups according to their first episode of bipolar disorder, either depression or mania. Patients in mixed state first episode were classified based on predominant symptoms. Three hundred eighteen patients of the cohort had a first episode of mania and 424 patients had initial symptoms of depression. Demographic and clinical data were collected. All patients were followed up for 24 months. Data on compliance with follow-up appointments and recurrence of symptoms after 6, 12, 18, and 24 months were collected. Clinical characteristics (course of disease, age of onset, psychiatric family history, etc.) were compared between the mania group and depression groups.
Results: More patients with bipolar disorder had a first episode of depression than mania (57.14 vs. 42.86%). Compared with the depression group, the mania group had later age of diagnosis of bipolar disorder [(38.64 ± 13.50) vs. (36.34 ± 14.94), P = 0.028], lower education level [(9.37 ± 4.34) vs. (10.17 ± 4.81), P = 0.017] and longer latency between an initial episode of psychiatric symptoms and formal bipolar diagnosis [(10.80 ± 10.76) vs. (8.85 ± 9.90), P = 0.012]. More patients in the mania group were male and without psychotic symptoms (all P < 0.05). In comparison with the mania group, more patients in the depression group were female, with higher frequency of a reported precipitating event before first mood episode (all P < 0.05). Compared with the depression group, the mania group had more recurrences of illness at the end of 12 months (Z =-2.156, P = 0.031), 18 months (Z =-2.192, P = 0.028), and 24 months (Z = −2.364, P = 0.018).
Conclusions: In our study, there are a number of differences in demographic and clinical characteristics of patients with different onset syndromes of bipolar disorder. These differences include gender, education level, diagnosis age, the rate of recurrences, and others. These data of a cohort of Chinese patients add to the growing international literature on the relationship between index episode of bipolar disorder and clinical variables and outcomes. These results and further study may allow clinicians to offer patients and families more reliable prognostic information at the onset of disease.
Schizophrenia (SCZ) and bipolar disorder (BPD) are two of the most relevant mental disorders, in terms of cognitive and functional impairment, inadequate clinical response and relapsing course. Major efforts have been made to identify diagnosis-specific biomarkers that can help differentiate between SCZ and BPD in the early stage of illness. In this chapter, we aim to better understand what is known in literature about first-episode psychosis (FEP)’s trajectory toward SCZ or BPD diagnosis, in order to establish whether there are indicators in the early stages of disease that could be used to improve targeted therapy and to reduce the significant burden of these serious mental illnesses. In order to do so, we gathered evidences present in modern literature about FEP and we selected four macro-areas of interest to deepen: differences and overlaps in genetics, cognition, neuroimaging, and prodrome/clinical features of FEP patients considering their later diagnoses.KeywordsSchizophreniaBipolar disorderFirst-episode psychosisHigh-risk mental stateTrajectories
Introduction: Disorganization is a crucial domain in affective psychoses. However, it has received poor research attention, especially at the illness onset. The aims of this study were: (a) to monitor the longitudinal course of disorganization in young people with First Episode Affective Psychosis (FEAP) across 2 years of follow-up, and (b) to investigate any relevant correlation of disorganized symptoms with psychopathology, functioning and the specific treatment elements of an “Early Intervention in Psychosis” (EIP) protocol along the follow-up period.
Materials and Methods: Seventy-five FEAP participants (aged 12-35 years) completed the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). Spearman’s rank correlation coefficients were calculated.
Results: During the follow-up, disorganized symptoms showed significant enduring positive correlations with PANSS items representing delusional thought content and uncooperativeness, as well as a persistent negative association with the GAF score. Across the 2-year follow-up period, FEAP individuals also had a relevant reduction in disorganization levels. This symptom decrease was specifically related with the combination of antipsychotic medication with the specific psychosocial components of our EIP intervention offered to FEAP patients during the first 12 months of treatment.
Conclusions: Disorganization is relevant in FEAP subjects already at their enrollment in specialized EIP protocols. However, it decreases over time, together with the delivery of specific, combined (person-tailored) EIP interventions.
