Fernanda Novis

Insight Across the Different Mood States of Bipolar Disorder

AbstractIn bipolar disorder, levels of insight vary as a function of the mood state and appear to influence pharmacology compliance, quality of life, the presence of suicidal ideations, and aggressive behavior. To establish a comparison among different mood states in bipolar with regard to level of insight. Forty-eight patients were evaluated in different affective states (i.e., euthymia, mania, depression, and mixed state). Identifying information, sociodemographic data, and clinical records were recorded. The following scales were applied: Hamilton Depression Scale, Young Mania Rating Scale, Positive and Negative Syndrome Scale positive symptoms subscale, and Global Assessment of Functioning and Clinical Global Impressions Scale for use in bipolar disorder. Insight was evaluated using items 11 and 17 of the Young Mania Rating Scale and Hamilton Depression Scale, respectively. Insight in bipolar disorder was found to be more compromised during manic phases and mixed episodes than during periods of depression or euthymia. The factors associated with lower levels of insight were the following: shorter illness duration, older age, and greater severity in mania; the female gender and older age in depression; and shorter illness duration and more severe depressive symptoms in mixed episodes. In the same individual, levels of insight vary as a function of the affective state over the course of bipolar disorder and appear to be influenced by several clinical variables.

Mood self-assessment in bipolar disorder: a comparison between patients in mania, depression, and euthymia

BACKGROUND Some studies indicate that mood self-assessment is more severely impaired in patients with bipolar disorder in a manic episode than in depression. OBJECTIVES To investigate variations in mood self-assessment in relation to current affective state in a group of individuals with bipolar disorder. METHODS A total of 165 patients with a diagnosis of bipolar disorder type I or type II had their affective state assessed using the Clinical Global Impressions Scale for use in bipolar illness (CGI-BP), the Positive and Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF). In addition, participants completed a self-report visual analog mood scale (VAMS). Patients were divided into three groups (euthymia, mania, and depression) and compared with regard to VAMS results. RESULTS Manic patients rated their mood similarly to patients in euthymia in 14 out of 16 items in the VAMS. By contrast, depressed patients rated only two items similarly to euthymic patients. CONCLUSION Patients with bipolar disorder in mania, but not those in depression, poorly evaluate their affective state, reinforcing the occurrence of insight impairment in the manic syndrome.

The reliability of self-assessment of affective state in different phases of bipolar disorder.

Abstract Some studies have indicated that the capacity of self-assessment of affective state is more compromised during mania than during depression. In the present study, we investigated whether the reliability of self-assessment in bipolar disorder varies as a function of actual affective state (i.e., euthymia, mania, or depression). Sixty-five patients with a diagnosis of type I and type II bipolar disorder were evaluated with regard to the occurrence of an affective syndrome using the Clinical Global Impressions Scale for use in bipolar illness, the Positive and Negative Syndrome Scale, and the Global Assessment of Functioning scale. In parallel, we applied the Analog Visual Mood Scale, a self-assessment tool to evaluate mood changes. The same individual prospectively completed the self-assessment scale in different affective states. During depression, the patients’ evaluation was significantly different from when they were in manic or euthymic mood states. However, when in mania, the patients evaluated their mood state similarly to when they were euthymic. The bipolar patients in mania but not in depression did not reliably evaluate themselves with regard to their affective state.

Electrical mapping in bipolar disorder patients during the oddball paradigm

Bipolar disorder (BD) is characterized by an alternated occurrence between acute mania episodes and depression or remission moments. The objective of this study is to analyze the information processing changes in BP (Bipolar Patients) (euthymia, depression and mania) during the oddball paradigm, focusing on the P300 component, an electric potential of the cerebral cortex generated in response to external sensorial stimuli, which involves more complex neurophysiological processes related to stimulus interpretation. Twenty-eight bipolar disorder patients (BP) (17 women and 11 men with average age of 32.5, SD: 9.5) and eleven healthy controls (HC) (7 women and 4 men with average age of 29.78, SD: 6.89) were enrolled in this study. The bipolar patients were divided into 3 major groups (i.e., euthymic, depressive and maniac) according to the score on the Clinical Global Impression--Bipolar Version (CGI-BP). The subjects performed the oddball paradigm simultaneously to the EEG record. EEG data were also recorded before and after the execution of the task. A one-way ANOVA was applied to compare the P300 component among the groups. After observing P300 and the subcomponents P3a and P3b, a similarity of amplitude and latency between euthymic and depressive patients was observed, as well as small amplitude in the pre-frontal cortex and reduced P3a response. This can be evidence of impaired information processing, cognitive flexibility, working memory, executive functions and ability to shift the attention and processing to the target and away from distracting stimuli in BD. Such neuropsychological impairments are related to different BD symptoms, which should be known and considered, in order to develop effective clinical treatment strategies.

A five year follow-up study of 11 patients with bipolar disorder

OBJECTIVE: To study the long-term follow-up of patients with bipolar disorder (BPD). METHOD: Eleven outpatients with BPD type I were followed up naturalistically for five years at a university teaching hospital. The Clinical Global Impression Scale (BPD version) was used to evaluate the occurrence of affective episodes, and the Strauss-Carpenter Outcome Scale was used to evaluate social and occupational functioning. RESULTS: The majority of patients were symptomatic most of the time, with predominantly depressive episodes. Overall, patients remained euthymic a mean of 47.7% of the time. Despite a low rate of hospitalization, social and occupational functioning was poor in the majority of patients. A poor disease course with respect to work-related functioning was associated with fewer months of euthymia with a longer duration of depressive episodes. The total number of months of euthymia negatively correlated with the patients age and disease duration. CONCLUSION: Despite the small sample size, the present findings appear to corroborate previous studies on the evolution of BPD. Most of the patients had a poor disease course, with long symptomatic periods, particularly depressive episodes, and significantly impaired social and occupational functioning.

Changes in absolute theta power in bipolar patients during a saccadic attention task

The present study analyzed absolute theta power (ATP) in brain areas involved with attention in the three phase of BD while the patients performing a saccadic attention task. We hypothesized that patients in depression and mania states show a higher ATP compared to euthymic patients, since a higher ATP is indicative of attention deficit. We analyzed the frontal (F7, F3, Fz, F4 and F8) and central (C3, Cz and C4) areas. Thirty bipolar patients were enrolled in this study. The subjects performed a saccadic attention task while their brain activity pattern was recorded using quantitative electroencephalography (20 channels). Our results showed a main effect for group over C3, C4, Cz, F7, F4, F8 electrodes, and a main effect for moment over Cz, F7, F8 electrodes. These results indicate that both task and groups produce changes in theta activity in distinct cortical areas that participate in the organization of attention. Our results therefore demonstrate that, although it is well established in the literature that theta has a relevant role in the attention process, it is necessary to deepen the investigations to better understand the specifics of theta during visual processing tasks that have a demand for attention.

The progression of 102 Brazilian patients with bipolar disorder: outcome of first 12 months of prospective follow-up.

INTRODUCTION Prospective studies have shown that the course of bipolar disorder (BD) is characterized by the persistence of symptoms, predominantly depression, along most of the time. However, to our knowledge, no studies in Latin America have investigated it. OBJECTIVES To replicate international studies using a Brazilian sample to prospectively analyze treatment outcomes in the first year and to determine potential chronicity factors. METHODS We followed up 102 patients with BD for 12 months and evaluated the number of months with affective episodes and the intensity of manic and depressive symptoms using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAM-D17). Sociodemographic and retrospective clinical data were examined to determine possible predictors of outcome. RESULTS Almost 50% of the patients had symptoms about half of the time, and there was a predominance of depressive episodes. Disease duration and number of depressive episodes were predictors of chronicity. Depressive polarity of the first episode and a higher number of depressive episodes predicted the occurrence of new depressive episodes. CONCLUSION In general, BD outcome seems to be poor in the first year of monitoring, despite adequate treatment. There is a predominance of depressive symptoms, and previous depressive episodes are a predictor of new depressive episodes and worse outcome.