Sashi Shukla

Failure to differentiate bipolar disorder from schizophrenia on measures of neuropsychological function

30 inpatients diagnosed with schizophrenia were compared to 35 inpatients with bipolar affective disorder, manic type, on a large group of neuropsychological measures. Separate factor analyses were performed on measures of verbal, spatial, and speed variables in order to generate summary scales. Controlling for the effects of age, education, sex, duration of illness, number of previous hospitalizations, and medications at time of testing, there were no significant differences between diagnostic groups on the three factors or on individual test variables. Patients on medication performed more poorly on speed variables than those off medication. These findings call into question the notion of differential patterns of cognitive deficit among psychotic diagnoses.

Relapse in delusional depression : A retrospective study of the course of treatment

Abstract This study naturalistically followed the clinical course of 52 patients with delusional depression for an average of 32 months. Over 80% of the patients relapsed an average of two times during this period. The majority of relapses occurred while patients were either medication free or on tapering doses of neuroleptics during combination treatment with antidepressants or lithium carbonate. Bipolar and unipolar delusional depressives followed different clinical courses. The results suggest that clinicians should be more conservative about tapering patients off medications during the first year post-hospital, and point to a need for controlled prospective studies.

Life events and relapse in bipolar disorder: the impact of a catastrophic event.

ABSTRACT— The literature on life events and the precipitation of bipolar disorder is reviewed. The authors describe an unexpected increase in bipolar relapses in a Lithium Clinic following a catastrophic life event, a hurricane, and contrast the patients who relapsed with an age and sex matched control of bipolars who did not. Though retrospective, the study avoids the question of the independence of life events. The results suggest that certain bipolar patients, especially those recently unstable, may be more vulnerable to the impact of life events.

EEG abnormalities in bipolar affective disorder.

Forty-six patients with bipolar illness were evaluated with scalp-recorded electroencephalograms. Familial pattern of psychopathology was evaluated between groups with clinically normal and abnormal EEG tracings. Those with abnormal EEGs were noted to have a significantly negative family history of affective disorder when compared to the EEG normal group. These results may support the concept of some patients with mania having an acquired illness which occurs independent from its genetic loading.

Lithium-carbamazepine versus lithium-neuroleptic prophylaxis in bipolar illness

Fourteen DSM-III diagnosed patients with lithium-resistant bipolar affective disorder treated with a combination of lithium and carbamazepine were followed in a lithium clinic for one year to study the prophylactic benefit and side effects of this drug regimen. Comparison data for the previous year on lithium and neuroleptics showed that for the 9 patients who completed the study, the lithium-carbamazepine regimen was superior to lithium-neuroleptics in decreasing the number of affective episodes and side effects. Carbamazepine blood levels appeared to be a possible contributing factor in the development of side effects.

Lithium in the treatment of bipolar disorders associated with epilepsy: an open study.

Eight DSM-III bipolar patients with seizure disorders were treated in an open study evaluating the effects of maintenance lithium treatment on affective relapses and clinical seizure activity. Lithium was effective in preventing the recurrence of affective episodes without worsening seizure frequency in patients with active seizures and did not induce seizures in those whose seizures were in remission. One patient showed remission of both affective and seizure symptoms on lithium alone. Lithium appears to be safe and effective in bipolar disorders associated with epilepsy and may have an anticonvulsant effect in some patients.

Proposed delusional depression subtypes: preliminary evidence from a retrospective study of phenomenology and treatment course

An analysis of the phenomenology and treatment course of 52 subjects with delusional depression suggests that there may be various subtypes: bipolar, early-onset unipolar and possibly a late-onset unipolar. The bipolar subgroup tended to relapse in different but always psychotic directions, and was resistant to lithium carbonate treatment alone. Treatment refractoriness, delusional depressive recurrences, and a dementia-like presentation were associated with a small late-onset subgroup. A high rate of delusionally depressive relapses also characterized the early-onset unipolar group, however, patients with single episodes were found only in this subgroup.

Mania with associated organic factors.

Thirty‐nine patients with bipolar illness preceded by organic factors were compared to age and sex matched bipolar controls. The patients with pre‐existing organic factors were older at onset of their bipolar illness, had fewer depressive episodes, less family history of affective disorder, and were symptomatically different in a number of respects. The nosology of such disorders is discussed and the literature reviewed.

Cognitive function in manics with associated neurologic factors

Researchers studying cognition in mania have assumed that mania is a homogeneous entity. Recent preliminary evidence indicates that some manic syndromes may be preceded by medical, pharmacological, and neurologic antecedents. While DSM-III suggests that mild cognitive impairment may be associated with these manic syndromes, studies to date have not documented this assertion. We compared bipolar patients with antecedent neurologic factors (neurologic manics, NM) to bipolar patients without such histories (primary manics, PM) on standard neuropsychological measures and clinical parameters to ascertain whether cognitive testing could be used as an adjunctive diagnostic tool in defining this subgroup of patients. Results indicated that the NM group was more dysfunctional in intellectual functioning and course of psychiatric illness than the PM group.

Failure to detect organic factors in mania

Forty patients from an outpatient lithium clinic were studied who had a clear history of organic abnormalities which predated their affective symptomatology. In the course of reviewing the clinical histories regarding these patients, it was observed that only 37.5% of the patients had ever received a clinical diagnosis of organic affective syndrome. Variables associated with a failure to consider a diagnosis of organic affective syndrome were investigated.