Tag: Bipolar

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Flumazenil for Benzodiazepine Reversal in Electroconvulsive Therapy

Conditions: Depression – Major Depressive Disorder; Bipolar Disorder (BD); Functional Magnetic Resonance Imaging (fMRI); Cognition; Autobiographical Memory; Electroconvulsive Therapy; ECT; Treatment Outcome; Inpatients

Interventions: Drug: Flumazenil; Procedure: Electroconvulsive therapy (ECT)

Sponsors: Anders Jørgensen

Recruiting
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<![CDATA[Phase 3 at-home data show sublingual dexmedetomidine cuts severe agitation in bipolar disorder and schizophrenia, supporting FDA label expansion.]]>
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<![CDATA[Study finds most bipolar depression outpatients have multiple comorbidities; many seek care, but substance use and phobias often go untreated.]]>
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<![CDATA[Psychiatrist Gus Alva highlights new depression therapies, neuromodulation, and why screening for bipolar disorder prevents antidepressant harm.]]>
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Baseline working memory was associated with improvement in psychological quality of life in patients with persistent depressive symptoms: a prospective observational study

BackgroundCognitive dysfunction is prevalent in patients with depressive symptoms and contributes to impaired quality of life (QOL) and functional outcomes. However, the prognostic significance of specific cognitive domains for long-term outcomes remains unclear in patients with persistent depressive symptoms.MethodsIn this prospective observational study, 119 patients completed the detailed examination program in routine clinical care. Of these, 84 patients with persistent depressive symptoms provided consent for study participation and met the eligibility criteria for inclusion in the present study, including completion of the baseline assessment with the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV). The diagnostically heterogeneous cohort included patients with major depressive disorder/dysthymia as well as bipolar and related disorders. The World Health Organization Quality of Life Instrument, Short Version (WHO-QOL-26) and the World Health Organization Disability Assessment Schedule 2.0 were assessed at baseline, three, and six months; 60 participants provided 3-month follow-up data and 50 provided 6-month follow-up data. Primary hierarchical regression analyses were exploratory and conducted using complete-case data.ResultsAt baseline, participants exhibited relatively higher verbal ability and lower processing speed compared to normative data. While no significant group-level improvement in QOL was observed over six months and functioning did not improve overall, the WHODAS 2.0 standardized total score was temporarily higher at 3 months than at baseline. In exploratory analyses of complete cases, higher baseline working memory was significantly associated with greater improvement in the psychological domain of the WHO-QOL-26 at six months (β = 0.40; ΔR² = 0.14; p < 0.01). No other cognitive domains showed such associations.ConclusionsWorking memory was associated with subsequent improvement in psychological well-being and may represent a candidate prognostic marker in patients with persistent depressive symptoms. Given the exploratory nature and modest sample size, these findings require replication in larger, diverse populations.
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<![CDATA[Learn how to spot bipolar mixed features, avoid antidepressant pitfalls, and choose evidence-based antipsychotics.]]>
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Detecting bipolarity using the Lebanese Arabic hypomania checklist (HCL-32): validation of shortened HCL versions

IntroductionDue to the under diagnosis of bipolar disorder, screening instruments such as the hypomania checklist 32 items (HCL-32) is used to differentiate between Bipolar Disorder (BD) and Major Depressive Disorder (MDD). However due to its lengthy format, efforts were done to validate a shorter alternative without compromising its ability to differentiate between BD and MDD. We aimed to shorten the HCL-32 and assess the screening performance of the three Lebanese Arabic abbreviated HCL versions (HCL-20, -16, and -8) relative to the full HCL-32 in a sample of clinically diagnosed patients with BD and MDD in Lebanon.MethodsIn a sample of 760 patients (BD-I=29, BD-II=142, MDD=589) clinically diagnosed with BD and MDD, the screening performance of the three Lebanese Arabic abbreviated HCL versions (HCL-20, -16, and -8) as well as the full HCL-32, was assessed, looking at the reliability, sensitivity, and specificity.ResultsAll the shortened HCL versions showed strong reliability (a=0.78-0.90.) They also demonstrated good screening ability (AUC=0.8520- 0.8835) in differentiating BD from MDD. For the sensitivities across the shortened versions, they were consistently higher in BD-II vs MDD compared to BD-I vs MDD across all scales showing that the shortened versions have the ability to detect BD-II cases much more effectively.DiscussionThis study is the first to validate the shortened HCL versions in an Arabic speaking population. The HCL- 16 appears to be the most optimal shortened scale for distinguishing between BD versus MDD. However, these findings should be interpreted in light of the study’s limitations including the use of retrospective data collection and item interdependence of the HCL-32.
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Correlation of non-suicidal self-injury with SLC6A4 promoter DNA methylation in children and adolescents with bipolar depression

PurposeTo investigate the association between non-suicidal self-injury (NSSI) and DNA methylation of the SLC6A4 promoter region in individuals diagnosed with bipolar depression.Patients and methodsA total of 48 children and adolescent patients meeting ICD-10 criteria for bipolar disorder with current depressive episodes (Hamilton Depression Rating Scale-24 score >20) were recruited, and stratified into two groups according to the presence or absence of non-suicidal self-injurious (NSSI) behavior(NSSI group and non-NSSI group). Negative life events were evaluated using the Adolescent Self-Rating Life Events Checklist (ASLEC). The methylation levels of five CpG sites within the SLC6A4 promoter region were determined by pyrosequencing, and mRNA expression was assessed by quantitative reverse transcription polymerase chain reaction (qRT-PCR).ResultsIn 48 adolescents with bipolar depression, the two groups were comparable in age, gender, education, only-child status, family history of mental illness, and disease course (all p > 0.05). Compared with the non-NSSI group, the NSSI group showed significantly lower CpG2 methylation at the SLC6A4 promoter, higher SLC6A4 mRNA expression, and higher ASLEC scores. The other four CpG sites showed no significant differences. Spearman’s correlation revealed a strong negative association between CpG2 methylation and mRNA expression (ρ = -0.547, p < 0.001). Two logistic regression models both fit the data well. Higher CpG2 methylation was a protective factor against NSSI (OR = 0.131, p = 0.021), while higher mRNA expression was a risk factor (OR = 10.957, p = 0.015). ASLEC scores and interaction terms were not significant.ConclusionThese preliminary findings suggest that lower CpG2 methylation and higher SLC6A4 mRNA expression are each independently associated with NSSI in adolescents with bipolar depression. Stressful life events were higher in the NSSI group, but did not significantly moderate these associations in the current sample. Given the small sample size and cross-sectional design, the results should be viewed as exploratory and require replication in larger studies.
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Personalized Pharmaco-Lifestyle Interventions for Severe Mental Illnesses (LIFETRAIN)

Conditions: Severe Mental Illness; Depression / Major Depressive Disorder; Bipolar Disorder (BD); Schizophrenia

Interventions: Drug: Semaglutide (SEMA); Behavioral: Exercise module; Behavioral: Anti-inflammatory diet module; Behavioral: Sleep intervention module; Behavioral: Social prescribing module; Device: Closed-loop transcranial alternating current stimulation (CL-tACS); Behavioral: Structured lifestyle psychoeducation; Device: Sham CL-tACS

Sponsors: Ludwig-Maximilians – University of Munich

Not yet recruiting