Abnormal expression of microRNAs is connected to brain development and disease and could provide novel biomarkers for the diagnosis and prognosis of bipolar disorder. We performed a PubMed search for microRNA biomarke...Abnormal expression of microRNAs is connected to brain development and disease and could provide novel biomarkers for the diagnosis and prognosis of bipolar disorder. We performed a PubMed search for microRNA biomarkers in bipolar disorder and found 18 original research articles on studies performed with human patients and published from January 2011 to June 2023. These studies included microRNA profiling in bloodand brain-based materials. From the studies that had validated the preliminary findings,potential candidate biomarkers for bipolar disorder in adults could be miR-140-3p,-30d-5p,-330-5p,-378a-5p,-21-3p,-330-3p,-345-5p in whole blood, miR-19b-3p,-1180-3p,-125a-5p, let-7e-5p in blood plasma, and miR-7-5p,-23b-5p,-142-3p,-221-5p,-370-3p in the blood serum. Two of the studies had investigated the changes in microRNA expression of patients with bipolar disorder receiving treatment. One showed a significant increase in plasma miR-134 compared to baseline after 4 weeks of treatment which included typical antipsychotics, atypical antipsychotics, and benzodiazepines. The other study had assessed the effects of prescribed medications which included neurotransmitter receptorsite binders(drug class B) and sedatives, hypnotics, anticonvulsants, and analgesics(drug class C) on microRNA results. The combined effects of the two drug classes increased the significance of the results for miR-219 and-29c with miR-30e-3p and-526b* acquiring significance. MicroRNAs were tested to see if they could serve as biomarkers of bipolar disorder at different clinical states of mania, depression, and euthymia. One study showed that upregulation in whole blood of miR-9-5p,-29a-3p,-106a-5p,-106b-5p,-107,-125a-3p,-125b-5p and of miR-107,-125a-3p occurred in manic and euthymic patients compared to controls, respectively, and that upregulation of miR-106a-5p,-107 was found for manic compared to euthymic patients. In two other studies using blood plasma,downregulation of miR-134 was observed in manic patients compared to controls, and dysregulation of miR-134,-152,-607,-633,-652,-155 occurred in euthymic patients compared to controls. Finally, microRNAs such as miR-34a,-34b,-34c,-137, and-140-3p,-21-3p,-30d-5p,-330-5p,-378a-5p,-134,-19b-3p were shown to have diagnostic potential in distinguishing bipolar disorder patients from schizophrenia or major depressive disorder patients, respectively. Further studies are warranted with adolescents and young adults having bipolar disorder and consideration should be given to using animal models of the disorder to investigate the effects of suppressing or overexpressing specific microRNAs.展开更多
BACKGROUND Phelan-McDermid syndrome(PMS)is a rare genetic disorder characterized by intellectual disability,delayed language development,autism spectrum disorders,motor tone abnormalities,and a high risk of psychiatri...BACKGROUND Phelan-McDermid syndrome(PMS)is a rare genetic disorder characterized by intellectual disability,delayed language development,autism spectrum disorders,motor tone abnormalities,and a high risk of psychiatric symptoms,including bipolar disorder.CASE SUMMARY This report presented an 18-year clinical history of a 36-year-old woman with PMS,marked by intellectual disabilities,social withdrawal,and stereotyped behaviors.Diagnosed with bipolar disorder at the age of 18 years old,she encountered significant treatment challenges,including severe adverse reactions to antipsychotic medications in 2022,which led to speech and functional regression.Through rehabilitation and comprehensive therapy,her condition gradually improved.In 2024,after further treatment,her symptoms stabilized,highlighting the complexities and successes of long-term management.CONCLUSION Effective management of PMS requires a thorough clinical history,genetic testing,and long-term supportive care.展开更多
BACKGROUND Bipolar disorder(BD)is a severe mental illness characterized by significant mood swings.Effective drug treatment modalities are crucial for managing BD.AIM To analyze the current status and future trends of...BACKGROUND Bipolar disorder(BD)is a severe mental illness characterized by significant mood swings.Effective drug treatment modalities are crucial for managing BD.AIM To analyze the current status and future trends of global research on BD drug treatment over the last decade.METHODS The Web of Science Core Collection database spanning from 2015 to 2024 was utilized to retrieve literature related to BD drug treatment.A total of 2624 articles were extracted.Data visualization and analysis were conducted using CiteSpace,VOSviewer,Pajek,Scimago Graphica,and R-studio bibliometrix to identify RESULTS The United States,China,and the United Kingdom have made the most significant contributions to research on BD drug treatment and formed notable research collaboration networks.The University of Pittsburgh,Massachusetts General Hospital,and the University of Michigan have been identified as the major research institutions in this field.The Journal of Affective Disorders is the most influential journal.A keyword analysis revealed research hotspots related to clinical symptoms,drug efficacy,and genetic mechanisms.A citation analysis identified the management guidelines published by Yatham et al in 2018 as the most cited paper.CONCLUSION This study provides a detailed overview of the field of BD drug treatment,highlighting key contributors,research hotspots,and future directions.The study findings can be employed as a reference for future research and policymaking,which may enable further development and optimization of BD pharmacotherapy.展开更多
Sleep is a critical yet often underestimated physiological parameter in psychiatric disorders.In their article,Gokcay et al examined sleep quality in bipolar disorder patients treated with lithium or valproic acid,sho...Sleep is a critical yet often underestimated physiological parameter in psychiatric disorders.In their article,Gokcay et al examined sleep quality in bipolar disorder patients treated with lithium or valproic acid,showing lithium’s advantage in habitual sleep efficiency and reduced disturbances.While this study provides valuable data in a chronic and clinically challenging cohort,reliance solely on self-reported sleep measures remains a limitation.Polysomnography,although the gold standard,is not always practical;therefore,actigraphy and wearable technologies represent feasible alternatives to capture objective sleep patterns.This letter emphasizes the importance of integrating objective,scalable technologies and pharmacological monitoring into longitudinal designs to clarify whether improvements in sleep translate into better clinical outcomes and reduced relapse risk in bipolar disorder.展开更多
BACKGROUND Sleep disturbances and residual functional impairment are increasingly recognized as important determinants of outcome in mood disorders,even during remission.Persistent disruptions in sleep may reflect und...BACKGROUND Sleep disturbances and residual functional impairment are increasingly recognized as important determinants of outcome in mood disorders,even during remission.Persistent disruptions in sleep may reflect underlying pathophysiological mechanisms and contribute to impaired psychosocial recovery.By comparing remitted bipolar disorder(BD)and major depressive disorder(MDD)patients with healthy controls,the present study sought to clarify the extent of these disturbances and their correlates.AIM To evaluate differences in sleep quality,psychosocial functioning,and insomnia severity among remitted patients with BD and MDD,in comparison with healthy controls.A secondary aim was to examine the clinical and psychosocial factors influencing sleep quality within these groups.METHODS The study included 135 participants:45 remitted BD patients,45 remitted MDD patients,and 45 healthy controls.Sleep quality was assessed with the Pittsburgh Sleep Quality Index,psychosocial functioning with the global assessment of functioning,and insomnia severity with the Insomnia Severity Index.Sociodemographic and clinical characteristics were also recorded.Comparative analyses were conducted to evaluate differences between groups,and regression models were used to identify predictors of sleep quality.RESULTS Both BD and MDD groups demonstrated significantly poorer sleep quality and higher insomnia severity compared with healthy controls.Poor sleep quality was observed in 75.6%of BD patients and 57.8%of MDD patients.Group differences were most pronounced in Pittsburgh Sleep Quality Index subdomains including sleep latency,sleep duration,and habitual sleep efficiency.Regression analysis identified insomnia severity(β=0.510)and functional capacity(β=-0.043)as significant correlates of sleep quality,indicating that greater insomnia severity and lower functioning were independently associated with poorer sleep.CONCLUSION The findings underscore that even during remission,BD and MDD are accompanied by substantial impairments in sleep quality and psychosocial functioning.These results highlight the importance of addressing residual symptoms,particularly insomnia and functional difficulties,in long-term management strategies.Interventions aimed at improving sleep and enhancing daily functioning should be considered essential components of treatment to promote recovery and quality of life in remitted patients.展开更多
Bipolar disorder(BD)affects 1%of the global population.BD is a group of chronic psychiatric disorders characterized by recurrent manic or hypomanic episodes that may alternate with depressive episodes.Given the curren...Bipolar disorder(BD)affects 1%of the global population.BD is a group of chronic psychiatric disorders characterized by recurrent manic or hypomanic episodes that may alternate with depressive episodes.Given the current diagnostic modalities,accurately diagnosing BD,particularly distinguishing it from unipolar depression(UD),is challenging.Biomarkers have emerged as potent instruments for estab-lishing objective diagnostic criteria for BD,and their identification,which reflects the pathophysiological processes of BD,can facilitate the precise diagnosis of the disorder.In this review,the search terms"BD"and"diagnosis"or"biomarker"were used as the key search syntax.In total,110 studies were included.This review systematically examines the research in the field and summarizes current studies on bio-markers of BD in omics and neuroimaging.We hope that this review will benefit research aimed at establishing objective diagnostic criteria for BD and developing novel therapeutic interventions.展开更多
BACKGROUND Bipolar disorder(BD),marked by recurring manic and depressive episodes,often coexists with anxiety disorder(AD),which increases treatment complexity and morbidity.Although quetiapine,an atypical antipsychot...BACKGROUND Bipolar disorder(BD),marked by recurring manic and depressive episodes,often coexists with anxiety disorder(AD),which increases treatment complexity and morbidity.Although quetiapine,an atypical antipsychotic,has demonstrated efficacy in treating BD and AD,further investigation is needed regarding its effectiveness and safety in patients with AD at high-risk factors for BD.AIM To explore the application and efficacy of quetiapine in combination therapy for patients with AD at high-risk factors for BD.METHODS This study included 67 patients,with two excluded,leaving 65 divided into Group A(sertraline treatment)and Group B(combination treatment).All patients received sertraline,with Group B additionally receiving quetiapine.Efficacy was assessed using the Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),and Bech-Rafaelsen Mania sale(BRMS)throughout the treatment period.Side effects and physiological indicators were also monitored.RESULTS No significant baseline differences existed between the two groups at treatment onset.Over the treatment course,Group B exhibited significantly lower HAMA scores than Group A at the end of weeks 1 and 24.HAMD scores gradually decreased over time,with Group B consistently showing lower scores than Group A.BRMS scores decreased significantly from baseline by week 8.In Group A,27.27%of patients received zolpidem treatment compared to 10.53%in Group B,which was a significant difference.Incidence of adverse reactions did not differ significantly between groups at treatment onset,but most patients experienced relief from adverse reactions within 4 weeks.CONCLUSION Combination of quetiapine and sertraline can more rapidly alleviate anxiety and depressive symptoms in patients with AD at high-risk factors for BD,improving treatment outcomes.展开更多
BACKGROUND Sleep disturbances are a prominent feature of bipolar disorder(BD)and often persist even in remission,thereby contributing to poor clinical outcomes.Despite the widespread use of lithium and valproic acid a...BACKGROUND Sleep disturbances are a prominent feature of bipolar disorder(BD)and often persist even in remission,thereby contributing to poor clinical outcomes.Despite the widespread use of lithium and valproic acid as mood stabilizers,their effects on sleep quality have not been examined in adequate detail.AIM To evaluate and compare the effects of lithium and valproic acid on sleep quality in BD patients under remission.METHODS A total of 130 patients meeting the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition criteria for BD in remission were included in this crosssectional study.The participants were receiving either lithium(n=78),or valproic acid(n=52),for a minimum of six months either alone or in combination with antipsychotics.Sleep quality was measured using the Pittsburgh Sleep Quality Index(PSQI).Comparative analyses between the lithium and valproic acid groups were conducted using independent t-tests,χ^(2)tests,and ANCOVA,adjusting for key variables such as age,sex,and body mass index.RESULTS Both groups demonstrated poor sleep quality,with the mean PSQI scores above the clinical threshold of 5.Patients in the lithium group exhibited significantly better habitual sleep efficiency(lithium:0.47±0.65,valproic acid:0.78±0.87,P=0.009)and fewer sleep disturbances(lithium:1.26±0.57,valproic acid:1.61±0.84,P=0.005).Other sleep parameters,including total sleep duration(P=0.082)and sleep latency(P=0.625),did not differ significantly.CONCLUSION Patients in the lithium group showed significantly better habitual sleep efficiency and fewer sleep disturbances compared to those receiving valproic acid,although other sleep parameters did not differ.These findings suggest a potential advantage of lithium in certain aspects of sleep quality in BD patients under remission.Future studies using objective sleep measures and longitudinal designs are warranted to confirm these findings.展开更多
Bipolar disorder(BD)is a severe mood disorder characterized by recurrent episodes of mania and depression,and it is prone to delayed diagnosis,which can lead to worsened outcomes,including more frequent mood episodes,...Bipolar disorder(BD)is a severe mood disorder characterized by recurrent episodes of mania and depression,and it is prone to delayed diagnosis,which can lead to worsened outcomes,including more frequent mood episodes,greater functional impairment,and comorbidities.Early diagnosis of BD remains a significant challenge,although recent advances offer promising insights,such as research in molecular biomarkers,neuroimaging,exosomes,genetics,and epigenetics.This mini-review highlights their potential for providing earlier,more accurate identification of BD and discusses the underlying reasons why current research has not yet succeeded.For instance,the high heterogeneity of symptomatic presentations leads to low consistency in study participants;delayed BD diagnosis results in the inclusion of potential BD patients in the depression group;low specificity of biomarkers stems from limited understanding of BD pathophysiology;and there is a possibility that BD is not innate but develops over the course of the disease.Deepening our understanding of BD pathology,identifying more specific biomarkers,and integrating multiomics approaches for validation studies in well-defined homogeneous cohorts hold promise for significant breakthroughs.展开更多
This study reviewed the clinical characteristics of adolescent bipolar disorder,the shortcomings of traditional treatment models in a systematical manner,analyzed the application status of virtual reality(VR)technolog...This study reviewed the clinical characteristics of adolescent bipolar disorder,the shortcomings of traditional treatment models in a systematical manner,analyzed the application status of virtual reality(VR)technology in mental and psychological diseases,and explored the potential mechanism of VR intervention for adolescent bipolar disorder patients,especially the value of PET/CT in the evaluation of brain energy metabolism.Studies have shown that VR treatment may optimize the neurological function of patients with bipolar disorder by enhancing the prefrontal-limbic system network,regulating the reward circuit and improving the executive function,and show positive changes in the metabolism of key brain areas at the PET/CT imaging level.展开更多
Rapid-cycling bipolar disorder(RCBD)is a phase of bipolar disorder defined by the presence of≥4 mood episodes in a year.It is a common phenomenon characterized by greater severity,a predominance of depression,higher ...Rapid-cycling bipolar disorder(RCBD)is a phase of bipolar disorder defined by the presence of≥4 mood episodes in a year.It is a common phenomenon characterized by greater severity,a predominance of depression,higher levels of disability,and poorer overall outcomes.It is resistant to treatment by conventional pharmacotherapy.The existing literature underlines the scarcity of evidence and the gaps in knowledge about the optimal treatment strategies for RCBD.However,most reviews have considered only pharmacological treatment options for RCBD.Given the treatment-refractory nature of RCBD,nonpharmacological interventions could augment medications but have not been adequately examined.This review carried out an updated and comprehensive search for evidence regarding the role of nonpharmacological therapies as adjuncts to medications in RCBD.We identified 83 reviews and meta-analyses concerning the treatment of RCBD.Additionally,we found 42 reports on adjunctive nonpharmacological treatments in RCBD.Most of the evidence favoured concomitant electroconvulsive therapy as an acute and maintenance treatment.There was preliminary evidence to suggest that chronotherapeutic treatments can provide better outcomes when combined with medications.The research on adjunctive psychotherapy was particularly scarce but suggested that psychoeducation,cognitive behavioural therapy,family interventions,and supportive psychotherapy may be helpful.The overall quality of evidence was poor and suffered from several methodological shortcomings.There is a need for more methodologically sound research in this area,although clinicians can use the existing evidence to select and individualize nonpharmacological treatment options for better management of RCBD.Patient summaries are included to highlight some of the issues concerning the implementation of adjunctive nonpharmacological treatments.展开更多
Early distinction of bipolar disorder(BD)from major depressive disorder(MDD)is difficult since no tools are available to estimate the risk of BD.In this study,we aimed to develop and validate a model of oxidative stre...Early distinction of bipolar disorder(BD)from major depressive disorder(MDD)is difficult since no tools are available to estimate the risk of BD.In this study,we aimed to develop and validate a model of oxidative stress injury for predicting BD.Data were collected from 1252 BD and 1359 MDD patients,including 64 MDD patients identified as converting to BD from 2009 through 2018.30 variables from a randomly-selected subsample of 1827(70%)patients were used to develop the model,including age,sex,oxidative stress markers(uric acid,bilirubin,albumin,and prealbumin),sex hormones,cytokines,thyroid and liver function,and glycolipid metabolism.Univariate analyses and the Least Absolute Shrinkage and Selection Operator were applied for data dimension reduction and variable selection.Multivariable logistic regression was used to construct a model for predicting bipolar disorder by oxidative stress biomarkers(BIOS)on a nomogram.Internal validation was assessed in the remaining 784 patients(30%),and independent external validation was done with data from 3797 matched patients from five other hospitals in China.10 predictors,mainly oxidative stress markers,were shown on the nomogram.The BIOS model showed good discrimination in the training sample,with an AUC of 75.1%(95%CI:72.9%–77.3%),sensitivity of 0.66,and specificity of 0.73.The discrimination was good both in internal validation(AUC 72.1%,68.6%–75.6%)and external validation(AUC 65.7%,63.9%–67.5%).In this study,we developed a nomogram centered on oxidative stress injury,which could help in the individualized prediction of BD.For better real-world practice,a set of measurements,especially on oxidative stress markers,should be emphasized using big data in psychiatry.展开更多
OBJECTIVE： To examine the efficacy and safety of short-term and long-term use of antidepres- sants in the treatment of bipolar disorder. DATA SOURCES： A literature search of randomized, double-blind, controlled tria...OBJECTIVE： To examine the efficacy and safety of short-term and long-term use of antidepres- sants in the treatment of bipolar disorder. DATA SOURCES： A literature search of randomized, double-blind, controlled trials published until December 2012 was performed using the PubMed, ISI Web of Science, Medline and Cochrane Central Register of Controlled Trials databases. The keywords ＂bipolar disorder, bipolar I disorder, bipolar II disorder, bipolar mania, bipolar depression, cyclothymia, mixed mania and depression, rapid cycling and bipolar disorder＂, AND ＂antidepressant agent, antidepressive agents second- generation, antidepressive agents tricyclic, monoamine oxidase inhibitor, noradrenaline uptake in- hibitor, serotonin uptake inhibitor, and tricyclic antidepressant agent＂ were used. The studies that were listed in the reference list of the published papers but were not retrieved in the above-mentioned databases were supplemented. STUDY SELECTION： Studies selected were double-blind randomized controlled trials assessing the efficacy and safety of antidepressants in patients with bipolar disorder. All participants were aged 18 years or older, and were diagnosed as having primary bipolar disorder. Antidepressants or antidepressants combined with mood stabilizers were used in experimental interventions. Placebos, mood stabilizers, antipsychotics and other antide pressants were used in the control interventions. Studies that were quasi-randomized studies, or used antidepressants in combination with antipsy- chotics in the experimental group were excluded. All analyses were conducted using Review Man- ager 5.1 provided by the Cochrane Collaboration.展开更多
The aim of this study was to investigate proton magnetic resonance spectroscopy metabolite values in the medial prefrontal cortex of individuals with euthymic bipolar disorder. The subjects consisted of 15 patients wi...The aim of this study was to investigate proton magnetic resonance spectroscopy metabolite values in the medial prefrontal cortex of individuals with euthymic bipolar disorder. The subjects consisted of 15 patients with euthymic bipolar disorder type I and 15 healthy controls. We performed proton magnetic resonance spectroscopy of the bilateral medial prefrontal cortex and measured levels of N-acetyl aspartate, choline and creatine. Levels of these three metabolites in the medial prefrontal cortex were found to be lower in patients with bipolar disorder compared with healthy controls. A positive correlation was found between illness duration and choline levels in the right medial prefrontal cortex. Our study suggests that during the euthymic period, there are abnormalities in cellular energy and membrane phospholipid metabolism in the medial prefrontal cortex, and that this may impair neuronal activity and integrity.展开更多
AIM To study if anxiety, depression and experience of stress are associated with gastrointestinal(GI) symptoms in patients with bipolar disorder.METHODS A total of 136 patients with bipolar disorder(mean age 49.9 year...AIM To study if anxiety, depression and experience of stress are associated with gastrointestinal(GI) symptoms in patients with bipolar disorder.METHODS A total of 136 patients with bipolar disorder(mean age 49.9 years; 61% women) and 136 controls from the general population(mean age 51.0 years; 60% women) were included in the study. GI symptoms were assessed with The Gastrointestinal Symptom Rating Scale-irritable bowel syndrome(GSRS-IBS), level of anxiety and depression with The Hospital Anxiety and Depression Scale(HADS) and stress-proneness with Perceived Stress Questionnaire. Over a ten year period, all visits in primary care were retrospectively recorded in order to identify functional GI disorders.RESULTS In subjects with low total HADS-score, there were no significant differences in GI-symptoms between patients and controls(GSRS-IBS 7.0 vs 6.5, P = 0.513). In the patients with bipolar disorder there were significant correlations between all GSRS and HADS subscores for all symptom clusters except for "constipation" and "reflux". Factors associated to GI symptoms in the patient group were female sex(adjusted OR = 2.37, 95%CI: 1.07-5.24) and high HADS-Depression score(adjusted OR = 3.64, 95%CI: 1.07-12.4). These patients had also significantly more visits for IBS than patients with low HADS-Depression scores(29% vs 8%, P = 0.008). However, there was no significant differences in consulting behaviour for functional GI disorders between patients and controls(25% vs 17%, P = 0.108).CONCLUSION Female patients and patients with high HADS depression score reported significantly more GI symptoms, whereas patients with low HADS scores did not differ from control subjects.展开更多
Schizophrenia and bipolar disorder are disabling psychiatric disorders with a worldwide prevalence of approximately 1%.Both disorders present chronic and deteriorating prognoses that impose a large burden,not only on ...Schizophrenia and bipolar disorder are disabling psychiatric disorders with a worldwide prevalence of approximately 1%.Both disorders present chronic and deteriorating prognoses that impose a large burden,not only on patients but also on society and health systems.These mental illnesses share several clinical and neurobiological traits;of these traits,oligodendroglial dysfunction and alterations to white matter(WM)tracts could underlie the disconnection between brain regions related to their symptomatic domains.WM is mainly composed of heavily myelinated axons and glial cells.Myelin internodes are discrete axon-wrapping membrane sheaths formed by oligodendrocyte processes.Myelin ensheathment allows fast and efficient conduction of nerve impulses through the nodes of Ranvier,improving the overall function of neuronal circuits.Rapid and precisely synchronized nerve impulse conduction through fibers that connect distant brain structures is crucial for higher-level functions,such as cognition,memory,mood,and language.Several cellular and subcellular anomalies related to myelin and oligodendrocytes have been found in postmortem samples from patients with schizophrenia or bipolar disorder,and neuroimaging techniques have revealed consistent alterations at the macroscale connectomic level in both disorders.In this work,evidence regarding these multilevel alterations in oligodendrocytes and myelinated tracts is discussed,and the involvement of proteins in key functions of the oligodendroglial lineage,such as oligodendrogenesis and myelination,is highlighted.The molecular components of the axo-myelin unit could be important targets for novel therapeutic approaches to schizophrenia and bipolar disorder.展开更多
Bipolar disorder(BD) is a chronic and recurrent disorder characterized by biphasic mood episodes of mania or hypomania and depression.It affects more than 1% of the global population and is a leading cause of disabili...Bipolar disorder(BD) is a chronic and recurrent disorder characterized by biphasic mood episodes of mania or hypomania and depression.It affects more than 1% of the global population and is a leading cause of disability in young people.Currently available treatments for BD are still fairly limited in terms of efficacy,with high rates of non-adherence,non-response,and undesirable side effects.Traditional Chinese medicine(TCM) has a long history and rich experience in stabilizing mania and improving quality of life.Aiming at rebalancing Yin and Yang in BD,therapy of replenishing Yin and regulating Yang(RYRY therapy) has been in clinical use for years in China.The present prospective,double-blind,randomized controlled trial is designed to investigate the efficacy and safety of RYRY therapy for bipolar mania and its possible mechanism from the point of regulating gut microbiota and anti-inflammation.A total of 60 eligible participants will be recruited from Beijing Anding Hospital.They will be randomized to either the study group or the control group in a ratio of 1∶1.Participants allocated to the study group will receive RYRY granule,while placebo granule will be applied in the control group.Participants in both groups will be prescribed conventional therapy for manic episode in BD.Four scheduled visits will be conducted over 4 weeks.Outcome measurements include Young Mania Rating Scale,TCM Symptom Pattern Rating Scale,Treatment Emergent Symptom Scale,levels of C-reactive protein,interleukin-6 and tumor necrosis factor-α and the gut microbial community profile of stool samples.Safety outcomes and adverse events will also be recorded.In this study,we set a number of scientific and objective assessments to evaluate the efficacy of RYRY therapy and study into its possible mechanism,hopefully offering clinicians an alternative approach to BD.展开更多
BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder(BD)and can have an adverse effect on its course,outcome,and treatment.However,despite a considerable amount of rese...BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder(BD)and can have an adverse effect on its course,outcome,and treatment.However,despite a considerable amount of research,the impact of psychotic symptoms on BD remains unclear,and there are very few systematic reviews on the subject.AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed.An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021.Combinations of the relevant Medical Subject Headings terms were used to search for these studies.Articles were selected after a screening phase,followed by a review of the full texts of the articles.Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.RESULTS This systematic review included 339 studies of patients with BD.Lifetime psychosis was found in more than a half to two-thirds of the patients,while current psychosis was found in a little less than half of them.Delusions were more common than hallucinations in all phases of BD.About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms,particularly during manic episodes.Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression.Although psychotic symptoms were not more severe in BD,the severity of the illness in psychotic BD was consistently greater.Psychosis was usually associated with poor insight and a higher frequency of agitation,anxiety,and hostility but not with psychiatric comorbidity.Psychosis was consistently linked with increased rates and the duration of hospitalizations,switching among patients with depression,and poorer outcomes with mood-incongruent symptoms.In contrast,psychosis was less likely to be accompanied by a rapid-cycling course,longer illness duration,and heightened suicidal risk.There was no significant impact of psychosis on the other parameters of course and outcome.CONCLUSION Though psychotic symptoms are very common in BD,they are not always associated with an adverse impact on BD and its course and outcome.展开更多
The World Health Organization’s 11^(th)revision of the International Classification of Diseases(ICD-11)including the chapter on mental disorders has come into effect this year.This review focuses on the“Bipolar or R...The World Health Organization’s 11^(th)revision of the International Classification of Diseases(ICD-11)including the chapter on mental disorders has come into effect this year.This review focuses on the“Bipolar or Related Disorders”section of the ICD-11 draft.It describes the benchmarks for the new version,particularly the foremost principle of clinical utility.The alterations made to the diagnosis of bipolar disorder(BD)are evaluated on their scientific basis and clinical utility.The change in the diagnostic requirements for manic and hypomanic episodes has been much debated.Whether the current criteria have achieved an optimum balance between sensitivity and specificity is still not clear.The ICD-11 definition of depressive episodes is substantially different,but the lack of empirical support for the changes has meant that the reliability and utility of bipolar depression are relatively low.Unlike the Diagnostic and Statistical Manual of Mental Disorders,5th edition(DSM-5),the ICD-11 has retained the category of mixed episodes.Although the concept of mixed episodes in the ICD-11 is not perfect,it appears to be more inclusive than the DSM-5 approach.Additionally,there are some uncertainties about the guidelines for the subtypes of BD and cyclothymic disorder.The initial results on the reliability and clinical utility of BD are promising,but the newly created diagnostic categories also appear to have some limitations.Although further improvement and research are needed,the focus should now be on facing the challenges of implementation,dissemination,and education and training in the use of these guidelines.展开更多
With the advancements in gene sequencing technologies,including genome-wide association studies,polygenetic risk scores,and high-throughput sequencing,there has been a tremendous advantage in mapping a detailed bluepr...With the advancements in gene sequencing technologies,including genome-wide association studies,polygenetic risk scores,and high-throughput sequencing,there has been a tremendous advantage in mapping a detailed blueprint for the genetic model of bipolar disorder(BD).To date,intriguing genetic clues have been identified to explain the development of BD,as well as the genetic association that might be applied for the development of susceptibility prediction and pharmacogenetic intervention.Risk genes of BD,such as CACNA1C,ANK3,TRANK1,and CLOCK,have been found to be involved in various pathophysiological processes correlated with BD.Although the specific roles of these genes have yet to be determined,genetic research on BD will help improve the prevention,therapeutics,and prognosis in clinical practice.The latest preclinical and clinical studies,and reviews of the genetics of BD,are analyzed in this review,aiming to summarize the progress in this intriguing field and to provide perspectives for individualized,precise,and effective clinical practice.展开更多
文摘Abnormal expression of microRNAs is connected to brain development and disease and could provide novel biomarkers for the diagnosis and prognosis of bipolar disorder. We performed a PubMed search for microRNA biomarkers in bipolar disorder and found 18 original research articles on studies performed with human patients and published from January 2011 to June 2023. These studies included microRNA profiling in bloodand brain-based materials. From the studies that had validated the preliminary findings,potential candidate biomarkers for bipolar disorder in adults could be miR-140-3p,-30d-5p,-330-5p,-378a-5p,-21-3p,-330-3p,-345-5p in whole blood, miR-19b-3p,-1180-3p,-125a-5p, let-7e-5p in blood plasma, and miR-7-5p,-23b-5p,-142-3p,-221-5p,-370-3p in the blood serum. Two of the studies had investigated the changes in microRNA expression of patients with bipolar disorder receiving treatment. One showed a significant increase in plasma miR-134 compared to baseline after 4 weeks of treatment which included typical antipsychotics, atypical antipsychotics, and benzodiazepines. The other study had assessed the effects of prescribed medications which included neurotransmitter receptorsite binders(drug class B) and sedatives, hypnotics, anticonvulsants, and analgesics(drug class C) on microRNA results. The combined effects of the two drug classes increased the significance of the results for miR-219 and-29c with miR-30e-3p and-526b* acquiring significance. MicroRNAs were tested to see if they could serve as biomarkers of bipolar disorder at different clinical states of mania, depression, and euthymia. One study showed that upregulation in whole blood of miR-9-5p,-29a-3p,-106a-5p,-106b-5p,-107,-125a-3p,-125b-5p and of miR-107,-125a-3p occurred in manic and euthymic patients compared to controls, respectively, and that upregulation of miR-106a-5p,-107 was found for manic compared to euthymic patients. In two other studies using blood plasma,downregulation of miR-134 was observed in manic patients compared to controls, and dysregulation of miR-134,-152,-607,-633,-652,-155 occurred in euthymic patients compared to controls. Finally, microRNAs such as miR-34a,-34b,-34c,-137, and-140-3p,-21-3p,-30d-5p,-330-5p,-378a-5p,-134,-19b-3p were shown to have diagnostic potential in distinguishing bipolar disorder patients from schizophrenia or major depressive disorder patients, respectively. Further studies are warranted with adolescents and young adults having bipolar disorder and consideration should be given to using animal models of the disorder to investigate the effects of suppressing or overexpressing specific microRNAs.
基金Supported by the Zhejiang Province Medicine and Health Science and Technology Program,No.2023KY980Hangzhou Municipal Health and Family Planning Commission,No.A20220133.
文摘BACKGROUND Phelan-McDermid syndrome(PMS)is a rare genetic disorder characterized by intellectual disability,delayed language development,autism spectrum disorders,motor tone abnormalities,and a high risk of psychiatric symptoms,including bipolar disorder.CASE SUMMARY This report presented an 18-year clinical history of a 36-year-old woman with PMS,marked by intellectual disabilities,social withdrawal,and stereotyped behaviors.Diagnosed with bipolar disorder at the age of 18 years old,she encountered significant treatment challenges,including severe adverse reactions to antipsychotic medications in 2022,which led to speech and functional regression.Through rehabilitation and comprehensive therapy,her condition gradually improved.In 2024,after further treatment,her symptoms stabilized,highlighting the complexities and successes of long-term management.CONCLUSION Effective management of PMS requires a thorough clinical history,genetic testing,and long-term supportive care.
基金Supported by the National College Students’Innovative Entrepreneurial Training Plan Program,No.202410403067the Innovation and Entrepreneurship Training Program for College Students in Jiangxi Province,No.S202410403035.
文摘BACKGROUND Bipolar disorder(BD)is a severe mental illness characterized by significant mood swings.Effective drug treatment modalities are crucial for managing BD.AIM To analyze the current status and future trends of global research on BD drug treatment over the last decade.METHODS The Web of Science Core Collection database spanning from 2015 to 2024 was utilized to retrieve literature related to BD drug treatment.A total of 2624 articles were extracted.Data visualization and analysis were conducted using CiteSpace,VOSviewer,Pajek,Scimago Graphica,and R-studio bibliometrix to identify RESULTS The United States,China,and the United Kingdom have made the most significant contributions to research on BD drug treatment and formed notable research collaboration networks.The University of Pittsburgh,Massachusetts General Hospital,and the University of Michigan have been identified as the major research institutions in this field.The Journal of Affective Disorders is the most influential journal.A keyword analysis revealed research hotspots related to clinical symptoms,drug efficacy,and genetic mechanisms.A citation analysis identified the management guidelines published by Yatham et al in 2018 as the most cited paper.CONCLUSION This study provides a detailed overview of the field of BD drug treatment,highlighting key contributors,research hotspots,and future directions.The study findings can be employed as a reference for future research and policymaking,which may enable further development and optimization of BD pharmacotherapy.
文摘Sleep is a critical yet often underestimated physiological parameter in psychiatric disorders.In their article,Gokcay et al examined sleep quality in bipolar disorder patients treated with lithium or valproic acid,showing lithium’s advantage in habitual sleep efficiency and reduced disturbances.While this study provides valuable data in a chronic and clinically challenging cohort,reliance solely on self-reported sleep measures remains a limitation.Polysomnography,although the gold standard,is not always practical;therefore,actigraphy and wearable technologies represent feasible alternatives to capture objective sleep patterns.This letter emphasizes the importance of integrating objective,scalable technologies and pharmacological monitoring into longitudinal designs to clarify whether improvements in sleep translate into better clinical outcomes and reduced relapse risk in bipolar disorder.
文摘BACKGROUND Sleep disturbances and residual functional impairment are increasingly recognized as important determinants of outcome in mood disorders,even during remission.Persistent disruptions in sleep may reflect underlying pathophysiological mechanisms and contribute to impaired psychosocial recovery.By comparing remitted bipolar disorder(BD)and major depressive disorder(MDD)patients with healthy controls,the present study sought to clarify the extent of these disturbances and their correlates.AIM To evaluate differences in sleep quality,psychosocial functioning,and insomnia severity among remitted patients with BD and MDD,in comparison with healthy controls.A secondary aim was to examine the clinical and psychosocial factors influencing sleep quality within these groups.METHODS The study included 135 participants:45 remitted BD patients,45 remitted MDD patients,and 45 healthy controls.Sleep quality was assessed with the Pittsburgh Sleep Quality Index,psychosocial functioning with the global assessment of functioning,and insomnia severity with the Insomnia Severity Index.Sociodemographic and clinical characteristics were also recorded.Comparative analyses were conducted to evaluate differences between groups,and regression models were used to identify predictors of sleep quality.RESULTS Both BD and MDD groups demonstrated significantly poorer sleep quality and higher insomnia severity compared with healthy controls.Poor sleep quality was observed in 75.6%of BD patients and 57.8%of MDD patients.Group differences were most pronounced in Pittsburgh Sleep Quality Index subdomains including sleep latency,sleep duration,and habitual sleep efficiency.Regression analysis identified insomnia severity(β=0.510)and functional capacity(β=-0.043)as significant correlates of sleep quality,indicating that greater insomnia severity and lower functioning were independently associated with poorer sleep.CONCLUSION The findings underscore that even during remission,BD and MDD are accompanied by substantial impairments in sleep quality and psychosocial functioning.These results highlight the importance of addressing residual symptoms,particularly insomnia and functional difficulties,in long-term management strategies.Interventions aimed at improving sleep and enhancing daily functioning should be considered essential components of treatment to promote recovery and quality of life in remitted patients.
基金the Health System Key Discipline of Shanghai(Program No.:2024zDxK0013).
文摘Bipolar disorder(BD)affects 1%of the global population.BD is a group of chronic psychiatric disorders characterized by recurrent manic or hypomanic episodes that may alternate with depressive episodes.Given the current diagnostic modalities,accurately diagnosing BD,particularly distinguishing it from unipolar depression(UD),is challenging.Biomarkers have emerged as potent instruments for estab-lishing objective diagnostic criteria for BD,and their identification,which reflects the pathophysiological processes of BD,can facilitate the precise diagnosis of the disorder.In this review,the search terms"BD"and"diagnosis"or"biomarker"were used as the key search syntax.In total,110 studies were included.This review systematically examines the research in the field and summarizes current studies on bio-markers of BD in omics and neuroimaging.We hope that this review will benefit research aimed at establishing objective diagnostic criteria for BD and developing novel therapeutic interventions.
基金Supported by Huzhou City Science and Technology Plan Public Welfare Technology Application Research Project[Key Project],No.2020GZ42.
文摘BACKGROUND Bipolar disorder(BD),marked by recurring manic and depressive episodes,often coexists with anxiety disorder(AD),which increases treatment complexity and morbidity.Although quetiapine,an atypical antipsychotic,has demonstrated efficacy in treating BD and AD,further investigation is needed regarding its effectiveness and safety in patients with AD at high-risk factors for BD.AIM To explore the application and efficacy of quetiapine in combination therapy for patients with AD at high-risk factors for BD.METHODS This study included 67 patients,with two excluded,leaving 65 divided into Group A(sertraline treatment)and Group B(combination treatment).All patients received sertraline,with Group B additionally receiving quetiapine.Efficacy was assessed using the Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),and Bech-Rafaelsen Mania sale(BRMS)throughout the treatment period.Side effects and physiological indicators were also monitored.RESULTS No significant baseline differences existed between the two groups at treatment onset.Over the treatment course,Group B exhibited significantly lower HAMA scores than Group A at the end of weeks 1 and 24.HAMD scores gradually decreased over time,with Group B consistently showing lower scores than Group A.BRMS scores decreased significantly from baseline by week 8.In Group A,27.27%of patients received zolpidem treatment compared to 10.53%in Group B,which was a significant difference.Incidence of adverse reactions did not differ significantly between groups at treatment onset,but most patients experienced relief from adverse reactions within 4 weeks.CONCLUSION Combination of quetiapine and sertraline can more rapidly alleviate anxiety and depressive symptoms in patients with AD at high-risk factors for BD,improving treatment outcomes.
文摘BACKGROUND Sleep disturbances are a prominent feature of bipolar disorder(BD)and often persist even in remission,thereby contributing to poor clinical outcomes.Despite the widespread use of lithium and valproic acid as mood stabilizers,their effects on sleep quality have not been examined in adequate detail.AIM To evaluate and compare the effects of lithium and valproic acid on sleep quality in BD patients under remission.METHODS A total of 130 patients meeting the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition criteria for BD in remission were included in this crosssectional study.The participants were receiving either lithium(n=78),or valproic acid(n=52),for a minimum of six months either alone or in combination with antipsychotics.Sleep quality was measured using the Pittsburgh Sleep Quality Index(PSQI).Comparative analyses between the lithium and valproic acid groups were conducted using independent t-tests,χ^(2)tests,and ANCOVA,adjusting for key variables such as age,sex,and body mass index.RESULTS Both groups demonstrated poor sleep quality,with the mean PSQI scores above the clinical threshold of 5.Patients in the lithium group exhibited significantly better habitual sleep efficiency(lithium:0.47±0.65,valproic acid:0.78±0.87,P=0.009)and fewer sleep disturbances(lithium:1.26±0.57,valproic acid:1.61±0.84,P=0.005).Other sleep parameters,including total sleep duration(P=0.082)and sleep latency(P=0.625),did not differ significantly.CONCLUSION Patients in the lithium group showed significantly better habitual sleep efficiency and fewer sleep disturbances compared to those receiving valproic acid,although other sleep parameters did not differ.These findings suggest a potential advantage of lithium in certain aspects of sleep quality in BD patients under remission.Future studies using objective sleep measures and longitudinal designs are warranted to confirm these findings.
基金Supported by Research Plan Project of Tianjin Municipal Education Commission,No.2022KJ264.
文摘Bipolar disorder(BD)is a severe mood disorder characterized by recurrent episodes of mania and depression,and it is prone to delayed diagnosis,which can lead to worsened outcomes,including more frequent mood episodes,greater functional impairment,and comorbidities.Early diagnosis of BD remains a significant challenge,although recent advances offer promising insights,such as research in molecular biomarkers,neuroimaging,exosomes,genetics,and epigenetics.This mini-review highlights their potential for providing earlier,more accurate identification of BD and discusses the underlying reasons why current research has not yet succeeded.For instance,the high heterogeneity of symptomatic presentations leads to low consistency in study participants;delayed BD diagnosis results in the inclusion of potential BD patients in the depression group;low specificity of biomarkers stems from limited understanding of BD pathophysiology;and there is a possibility that BD is not innate but develops over the course of the disease.Deepening our understanding of BD pathology,identifying more specific biomarkers,and integrating multiomics approaches for validation studies in well-defined homogeneous cohorts hold promise for significant breakthroughs.
文摘This study reviewed the clinical characteristics of adolescent bipolar disorder,the shortcomings of traditional treatment models in a systematical manner,analyzed the application status of virtual reality(VR)technology in mental and psychological diseases,and explored the potential mechanism of VR intervention for adolescent bipolar disorder patients,especially the value of PET/CT in the evaluation of brain energy metabolism.Studies have shown that VR treatment may optimize the neurological function of patients with bipolar disorder by enhancing the prefrontal-limbic system network,regulating the reward circuit and improving the executive function,and show positive changes in the metabolism of key brain areas at the PET/CT imaging level.
文摘Rapid-cycling bipolar disorder(RCBD)is a phase of bipolar disorder defined by the presence of≥4 mood episodes in a year.It is a common phenomenon characterized by greater severity,a predominance of depression,higher levels of disability,and poorer overall outcomes.It is resistant to treatment by conventional pharmacotherapy.The existing literature underlines the scarcity of evidence and the gaps in knowledge about the optimal treatment strategies for RCBD.However,most reviews have considered only pharmacological treatment options for RCBD.Given the treatment-refractory nature of RCBD,nonpharmacological interventions could augment medications but have not been adequately examined.This review carried out an updated and comprehensive search for evidence regarding the role of nonpharmacological therapies as adjuncts to medications in RCBD.We identified 83 reviews and meta-analyses concerning the treatment of RCBD.Additionally,we found 42 reports on adjunctive nonpharmacological treatments in RCBD.Most of the evidence favoured concomitant electroconvulsive therapy as an acute and maintenance treatment.There was preliminary evidence to suggest that chronotherapeutic treatments can provide better outcomes when combined with medications.The research on adjunctive psychotherapy was particularly scarce but suggested that psychoeducation,cognitive behavioural therapy,family interventions,and supportive psychotherapy may be helpful.The overall quality of evidence was poor and suffered from several methodological shortcomings.There is a need for more methodologically sound research in this area,although clinicians can use the existing evidence to select and individualize nonpharmacological treatment options for better management of RCBD.Patient summaries are included to highlight some of the issues concerning the implementation of adjunctive nonpharmacological treatments.
基金supported by the National Key Research and Development Program of China(2016YFC1307100)the National Natural Science Foundation of China(81930033,81771465,and 91232719)+3 种基金the Shanghai Mental Health Centre Clinical Research Center Special Project for Big Data Analysis(CRC2018DSJ01-1)Shanghai Municipal Science and Technology Major Project(2018SHZDZX05)Scientific Research Project of Hongkou District Health Commission(2101-03)Shanghai Clinical Research Center for Mental Health(SCRC-MH and 19MC1911100)。
文摘Early distinction of bipolar disorder(BD)from major depressive disorder(MDD)is difficult since no tools are available to estimate the risk of BD.In this study,we aimed to develop and validate a model of oxidative stress injury for predicting BD.Data were collected from 1252 BD and 1359 MDD patients,including 64 MDD patients identified as converting to BD from 2009 through 2018.30 variables from a randomly-selected subsample of 1827(70%)patients were used to develop the model,including age,sex,oxidative stress markers(uric acid,bilirubin,albumin,and prealbumin),sex hormones,cytokines,thyroid and liver function,and glycolipid metabolism.Univariate analyses and the Least Absolute Shrinkage and Selection Operator were applied for data dimension reduction and variable selection.Multivariable logistic regression was used to construct a model for predicting bipolar disorder by oxidative stress biomarkers(BIOS)on a nomogram.Internal validation was assessed in the remaining 784 patients(30%),and independent external validation was done with data from 3797 matched patients from five other hospitals in China.10 predictors,mainly oxidative stress markers,were shown on the nomogram.The BIOS model showed good discrimination in the training sample,with an AUC of 75.1%(95%CI:72.9%–77.3%),sensitivity of 0.66,and specificity of 0.73.The discrimination was good both in internal validation(AUC 72.1%,68.6%–75.6%)and external validation(AUC 65.7%,63.9%–67.5%).In this study,we developed a nomogram centered on oxidative stress injury,which could help in the individualized prediction of BD.For better real-world practice,a set of measurements,especially on oxidative stress markers,should be emphasized using big data in psychiatry.
基金supported in part by the Key Projects of Science and Technology Research of the Department of Education in Henan Province,China,No.13A320869a special fund from Henan Health Science and Technology Innovation Talent Project,No.4173(2010-2015)
文摘OBJECTIVE： To examine the efficacy and safety of short-term and long-term use of antidepres- sants in the treatment of bipolar disorder. DATA SOURCES： A literature search of randomized, double-blind, controlled trials published until December 2012 was performed using the PubMed, ISI Web of Science, Medline and Cochrane Central Register of Controlled Trials databases. The keywords ＂bipolar disorder, bipolar I disorder, bipolar II disorder, bipolar mania, bipolar depression, cyclothymia, mixed mania and depression, rapid cycling and bipolar disorder＂, AND ＂antidepressant agent, antidepressive agents second- generation, antidepressive agents tricyclic, monoamine oxidase inhibitor, noradrenaline uptake in- hibitor, serotonin uptake inhibitor, and tricyclic antidepressant agent＂ were used. The studies that were listed in the reference list of the published papers but were not retrieved in the above-mentioned databases were supplemented. STUDY SELECTION： Studies selected were double-blind randomized controlled trials assessing the efficacy and safety of antidepressants in patients with bipolar disorder. All participants were aged 18 years or older, and were diagnosed as having primary bipolar disorder. Antidepressants or antidepressants combined with mood stabilizers were used in experimental interventions. Placebos, mood stabilizers, antipsychotics and other antide pressants were used in the control interventions. Studies that were quasi-randomized studies, or used antidepressants in combination with antipsy- chotics in the experimental group were excluded. All analyses were conducted using Review Man- ager 5.1 provided by the Cochrane Collaboration.
基金supported by Pamukkale University(Scientific Research Projects Coordination Unit)
文摘The aim of this study was to investigate proton magnetic resonance spectroscopy metabolite values in the medial prefrontal cortex of individuals with euthymic bipolar disorder. The subjects consisted of 15 patients with euthymic bipolar disorder type I and 15 healthy controls. We performed proton magnetic resonance spectroscopy of the bilateral medial prefrontal cortex and measured levels of N-acetyl aspartate, choline and creatine. Levels of these three metabolites in the medial prefrontal cortex were found to be lower in patients with bipolar disorder compared with healthy controls. A positive correlation was found between illness duration and choline levels in the right medial prefrontal cortex. Our study suggests that during the euthymic period, there are abnormalities in cellular energy and membrane phospholipid metabolism in the medial prefrontal cortex, and that this may impair neuronal activity and integrity.
文摘AIM To study if anxiety, depression and experience of stress are associated with gastrointestinal(GI) symptoms in patients with bipolar disorder.METHODS A total of 136 patients with bipolar disorder(mean age 49.9 years; 61% women) and 136 controls from the general population(mean age 51.0 years; 60% women) were included in the study. GI symptoms were assessed with The Gastrointestinal Symptom Rating Scale-irritable bowel syndrome(GSRS-IBS), level of anxiety and depression with The Hospital Anxiety and Depression Scale(HADS) and stress-proneness with Perceived Stress Questionnaire. Over a ten year period, all visits in primary care were retrospectively recorded in order to identify functional GI disorders.RESULTS In subjects with low total HADS-score, there were no significant differences in GI-symptoms between patients and controls(GSRS-IBS 7.0 vs 6.5, P = 0.513). In the patients with bipolar disorder there were significant correlations between all GSRS and HADS subscores for all symptom clusters except for "constipation" and "reflux". Factors associated to GI symptoms in the patient group were female sex(adjusted OR = 2.37, 95%CI: 1.07-5.24) and high HADS-Depression score(adjusted OR = 3.64, 95%CI: 1.07-12.4). These patients had also significantly more visits for IBS than patients with low HADS-Depression scores(29% vs 8%, P = 0.008). However, there was no significant differences in consulting behaviour for functional GI disorders between patients and controls(25% vs 17%, P = 0.108).CONCLUSION Female patients and patients with high HADS depression score reported significantly more GI symptoms, whereas patients with low HADS scores did not differ from control subjects.
基金Supported by Fondo Sectorial de Investigación para la Educación(FSIE SEP/CONACyT)to MV-T,No.287115Fondo Sectorial de Investigación en Salud y Seguridad Social(FOSISS SS/IMSS/ISSSTE-CONACyT)to BC,No.261459.
文摘Schizophrenia and bipolar disorder are disabling psychiatric disorders with a worldwide prevalence of approximately 1%.Both disorders present chronic and deteriorating prognoses that impose a large burden,not only on patients but also on society and health systems.These mental illnesses share several clinical and neurobiological traits;of these traits,oligodendroglial dysfunction and alterations to white matter(WM)tracts could underlie the disconnection between brain regions related to their symptomatic domains.WM is mainly composed of heavily myelinated axons and glial cells.Myelin internodes are discrete axon-wrapping membrane sheaths formed by oligodendrocyte processes.Myelin ensheathment allows fast and efficient conduction of nerve impulses through the nodes of Ranvier,improving the overall function of neuronal circuits.Rapid and precisely synchronized nerve impulse conduction through fibers that connect distant brain structures is crucial for higher-level functions,such as cognition,memory,mood,and language.Several cellular and subcellular anomalies related to myelin and oligodendrocytes have been found in postmortem samples from patients with schizophrenia or bipolar disorder,and neuroimaging techniques have revealed consistent alterations at the macroscale connectomic level in both disorders.In this work,evidence regarding these multilevel alterations in oligodendrocytes and myelinated tracts is discussed,and the involvement of proteins in key functions of the oligodendroglial lineage,such as oligodendrogenesis and myelination,is highlighted.The molecular components of the axo-myelin unit could be important targets for novel therapeutic approaches to schizophrenia and bipolar disorder.
基金Supported by Beijing Municipal Administration of Hospitals Incubating Program(No.PZ2021031),which plays no role in the design of the studycollection,analysis,and interpretation of data,and in writing the manuscript。
文摘Bipolar disorder(BD) is a chronic and recurrent disorder characterized by biphasic mood episodes of mania or hypomania and depression.It affects more than 1% of the global population and is a leading cause of disability in young people.Currently available treatments for BD are still fairly limited in terms of efficacy,with high rates of non-adherence,non-response,and undesirable side effects.Traditional Chinese medicine(TCM) has a long history and rich experience in stabilizing mania and improving quality of life.Aiming at rebalancing Yin and Yang in BD,therapy of replenishing Yin and regulating Yang(RYRY therapy) has been in clinical use for years in China.The present prospective,double-blind,randomized controlled trial is designed to investigate the efficacy and safety of RYRY therapy for bipolar mania and its possible mechanism from the point of regulating gut microbiota and anti-inflammation.A total of 60 eligible participants will be recruited from Beijing Anding Hospital.They will be randomized to either the study group or the control group in a ratio of 1∶1.Participants allocated to the study group will receive RYRY granule,while placebo granule will be applied in the control group.Participants in both groups will be prescribed conventional therapy for manic episode in BD.Four scheduled visits will be conducted over 4 weeks.Outcome measurements include Young Mania Rating Scale,TCM Symptom Pattern Rating Scale,Treatment Emergent Symptom Scale,levels of C-reactive protein,interleukin-6 and tumor necrosis factor-α and the gut microbial community profile of stool samples.Safety outcomes and adverse events will also be recorded.In this study,we set a number of scientific and objective assessments to evaluate the efficacy of RYRY therapy and study into its possible mechanism,hopefully offering clinicians an alternative approach to BD.
文摘BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder(BD)and can have an adverse effect on its course,outcome,and treatment.However,despite a considerable amount of research,the impact of psychotic symptoms on BD remains unclear,and there are very few systematic reviews on the subject.AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed.An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021.Combinations of the relevant Medical Subject Headings terms were used to search for these studies.Articles were selected after a screening phase,followed by a review of the full texts of the articles.Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.RESULTS This systematic review included 339 studies of patients with BD.Lifetime psychosis was found in more than a half to two-thirds of the patients,while current psychosis was found in a little less than half of them.Delusions were more common than hallucinations in all phases of BD.About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms,particularly during manic episodes.Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression.Although psychotic symptoms were not more severe in BD,the severity of the illness in psychotic BD was consistently greater.Psychosis was usually associated with poor insight and a higher frequency of agitation,anxiety,and hostility but not with psychiatric comorbidity.Psychosis was consistently linked with increased rates and the duration of hospitalizations,switching among patients with depression,and poorer outcomes with mood-incongruent symptoms.In contrast,psychosis was less likely to be accompanied by a rapid-cycling course,longer illness duration,and heightened suicidal risk.There was no significant impact of psychosis on the other parameters of course and outcome.CONCLUSION Though psychotic symptoms are very common in BD,they are not always associated with an adverse impact on BD and its course and outcome.
文摘The World Health Organization’s 11^(th)revision of the International Classification of Diseases(ICD-11)including the chapter on mental disorders has come into effect this year.This review focuses on the“Bipolar or Related Disorders”section of the ICD-11 draft.It describes the benchmarks for the new version,particularly the foremost principle of clinical utility.The alterations made to the diagnosis of bipolar disorder(BD)are evaluated on their scientific basis and clinical utility.The change in the diagnostic requirements for manic and hypomanic episodes has been much debated.Whether the current criteria have achieved an optimum balance between sensitivity and specificity is still not clear.The ICD-11 definition of depressive episodes is substantially different,but the lack of empirical support for the changes has meant that the reliability and utility of bipolar depression are relatively low.Unlike the Diagnostic and Statistical Manual of Mental Disorders,5th edition(DSM-5),the ICD-11 has retained the category of mixed episodes.Although the concept of mixed episodes in the ICD-11 is not perfect,it appears to be more inclusive than the DSM-5 approach.Additionally,there are some uncertainties about the guidelines for the subtypes of BD and cyclothymic disorder.The initial results on the reliability and clinical utility of BD are promising,but the newly created diagnostic categories also appear to have some limitations.Although further improvement and research are needed,the focus should now be on facing the challenges of implementation,dissemination,and education and training in the use of these guidelines.
基金supported by the Zhejiang Provincial Key Research and Development Program(2021C03107)the Leading Talent of Scientific and Technological Innovation“Ten Thousand Talents Program”of Zhejiang Province(2021R52016)+1 种基金the Innovation Team for Precision Diagnosis and Treatment of Major Brain Diseases(2020R01001)the Research Project of Jinan Microecological Biomedicine Shandong Laboratory(JNL-2023001B).
文摘With the advancements in gene sequencing technologies,including genome-wide association studies,polygenetic risk scores,and high-throughput sequencing,there has been a tremendous advantage in mapping a detailed blueprint for the genetic model of bipolar disorder(BD).To date,intriguing genetic clues have been identified to explain the development of BD,as well as the genetic association that might be applied for the development of susceptibility prediction and pharmacogenetic intervention.Risk genes of BD,such as CACNA1C,ANK3,TRANK1,and CLOCK,have been found to be involved in various pathophysiological processes correlated with BD.Although the specific roles of these genes have yet to be determined,genetic research on BD will help improve the prevention,therapeutics,and prognosis in clinical practice.The latest preclinical and clinical studies,and reviews of the genetics of BD,are analyzed in this review,aiming to summarize the progress in this intriguing field and to provide perspectives for individualized,precise,and effective clinical practice.
