{"title":"A tale of two viruses: A bipolar disorder patient's path to Varicella Zoster Meningoencephalitis diagnosis in the pandemic era","authors":"Johannes Piepgras, Max Scheller, Susanne Englisch","doi":"10.1111/bdi.13428","DOIUrl":"10.1111/bdi.13428","url":null,"abstract":"<p>Bipolar disorder (BD) is a chronic psychiatric condition, presenting with manic and depressive episodes interspersed with periods of euthymia. However, an array of somatic conditions can mimic or exacerbate symptoms of BD, requiring an in-depth differential diagnosis. The SARS-CoV-2 pandemic has been associated with a spectrum of neuropsychiatric symptoms, further complicating the diagnostic landscape. Here, we present an unusual case of Varicella Zoster Virus (VZV) reactivation, manifesting as Varicella Zoster Meningoencephalitis (VZME), in a 63-year-old female with a long-standing diagnosis of BD, following SARS-CoV-2 infection.</p><p>The patient, with a history of BD since 1987 and an episode of shingles in 2016, embarked on an exhaustive journey through various specialists' offices after her bout with SARS-CoV-2 in October 2022, in which she suffered from fever and respiratory symptoms. After her viral infection, she experienced symptoms including transient perioral herpes, severe persisting headaches with recurrent exacerbation, fatigue, paraesthesia, episodes lasting up to 60 min in which she was incapable of moving her head and limbs, increased startle response and altered psychopathology such as affective incontinence and heightened impulsivity. These were dismissed as manifestations of her existing psychiatric disorder. This oversight likely delayed a comprehensive evaluation of her condition.</p><p>The turning point came in June 2023 when she was admitted to our psychiatric hospital. A comprehensive examination, including a lumbar puncture, revealed inflammatory changes, and VZV in her cerebrospinal fluid (CSF), a pivotal discovery in guiding the subsequent course of action. The patient was promptly started on intravenous aciclovir, resulting in significant improvement. Her sensomotoric symptoms and increased startle response resolved completely, headaches diminished, and her affect greatly stabilized.</p><p>This case underscores the need to consider organic causes when new or worsening neurological or psychiatric symptoms arise, even in the presence of a known psychiatric diagnosis. Affective incontinence, impulsivity, and frontal disinhibition, despite being congruent with BD, can also be manifestations of viral encephalitis. Especially during the SARS-CoV-2 pandemic, there is a rising number of reports on neurological syndromes postinfection, and this patient's case of VZME adds to the growing body of evidence of these complications.<span><sup>1</sup></span></p><p>Notably, the psychopathological symptoms blurred the diagnostic boundaries, leading to an initial misattribution of symptoms to BD. The phenomenon of “diagnostic overshadowing,” where physical symptoms are wrongly attributed to mental health disorders, played a role in delaying our patient's diagnosis.<span><sup>2</sup></span></p><p>Such overshadowing significantly impacts healthcare outcomes, leading to reduced life expectancy in patients with psychiatric disorders. The","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"26 5","pages":"505-506"},"PeriodicalIF":5.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.13428","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140304803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Armin Birner, Marco Mairinger, Clemens Elst, Alexander Maget, Frederike T. Fellendorf, Martina Platzer, Robert Queissner, Melanie Lenger, Adelina Tmava-Berisha, Susanne A. Bengesser, Eva Z. Reininghaus, Markus Kreuzthaler, Nina Dalkner
{"title":"Machine-based learning of multidimensional data in bipolar disorder – pilot results","authors":"Armin Birner, Marco Mairinger, Clemens Elst, Alexander Maget, Frederike T. Fellendorf, Martina Platzer, Robert Queissner, Melanie Lenger, Adelina Tmava-Berisha, Susanne A. Bengesser, Eva Z. Reininghaus, Markus Kreuzthaler, Nina Dalkner","doi":"10.1111/bdi.13426","DOIUrl":"10.1111/bdi.13426","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Owing to the heterogenic picture of bipolar disorder, it takes approximately 8.8 years to reach a correct diagnosis. Early recognition and early intervention might not only increase quality of life, but also increase life expectancy as a whole in individuals with bipolar disorder. Therefore, we hypothesize that implementing machine learning techniques can be used to support the diagnostic process of bipolar disorder and minimize misdiagnosis rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>To test this hypothesis, a de-identified data set of only demographic information and the results of cognitive tests of 196 patients with bipolar disorder and 145 healthy controls was used to train and compare five different machine learning algorithms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The best performing algorithm was logistic regression, with a macro-average F1-score of 0.69 [95% CI 0.66–0.73]. After further optimization, a model with an improved macro-average F1-score of 0.75, a micro-average F1-score of 0.77, and an AUROC of 0.84 was built. Furthermore, the individual amount of contribution per variable on the classification was assessed, which revealed that body mass index, results of the Stroop test, and the d2-R test alone allow for a classification of bipolar disorder with equal performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Using these data for clinical application results in an acceptable performance, but has not yet reached a state where it can sufficiently augment a diagnosis made by an experienced clinician. Therefore, further research should focus on identifying variables with the highest amount of contribution to a model's classification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"26 4","pages":"364-375"},"PeriodicalIF":5.4,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.13426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140292725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aldo Stoppa, Ester Roda, Lluïsa Garcia-Esteve, Alba Roca-Lecumberri
{"title":"A case of pregnancy with severe polyhydramnios related to long-term use of lithium","authors":"Aldo Stoppa, Ester Roda, Lluïsa Garcia-Esteve, Alba Roca-Lecumberri","doi":"10.1111/bdi.13427","DOIUrl":"10.1111/bdi.13427","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Severe polyhydramnios during pregnancy may be associated with long-term lithium use and presents considerable challenges. This complication, which has been linked to induced nephrogenic diabetes insipidus (NDI), underscores the necessity for cautious management of pregnant women with bipolar disorder. This case report aims to elucidate the relationship between long-term lithium use, pregnancy, and the development of severe polyhydramnios, emphasizing the importance of diagnosing NDI in order to prevent obstetric and neonatal complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We present the case of a 42-year-old primigravida undergoing long-term lithium treatment for bipolar disorder type I, who developed severe polyhydramnios at 34 weeks of gestation. Clinical data including obstetric monitoring and neonatal outcomes were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This case emphasizes the need for heightened awareness and proactive measures to mitigate the risk associated with lithium treatment during pregnancy. Close monitoring and timely interventions are essential to ensure optimal outcomes for both mother and fetus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our article puts forth the hypothesis that there is a link between lithium use during pregnancy and the occurrence of polyhydramnios and Nephrogenic Diabetes Insipidus (NDI), which may lead to severe obstetric and neonatal complications. This case report contributes to the limited literature on the subject and gives doctors practical advice that may help them make a better risk-benefit analysis. Further research is warranted in order to refine risk assessment protocols and management strategies in this complex clinical scenario.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"26 4","pages":"405-408"},"PeriodicalIF":5.4,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140288164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Albert Stachura, Łukasz Banaszek, Katarzyna Jurkin, Łukasz Święcicki
{"title":"Vitamin B12 overdose may trigger the onset of mixed-state bipolar disorder: A case report","authors":"Albert Stachura, Łukasz Banaszek, Katarzyna Jurkin, Łukasz Święcicki","doi":"10.1111/bdi.13424","DOIUrl":"10.1111/bdi.13424","url":null,"abstract":"","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"26 3","pages":"293-295"},"PeriodicalIF":5.4,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140183608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sergi Salmerón, Iñaki Ochandiano, Helena Andreu, Luis Olivier, Oscar de Juan, Tabatha Fernández-Plaza, Lorenzo Bracco, Lluc Colomer, Pablo Barrio, Marc Valentí, Anna Giménez-Palomo, Eduard Vieta, Isabella Pacchiarotti
{"title":"Cannabis withdrawal and manic episodes: Three cases of an unknown trigger for bipolar disorder","authors":"Sergi Salmerón, Iñaki Ochandiano, Helena Andreu, Luis Olivier, Oscar de Juan, Tabatha Fernández-Plaza, Lorenzo Bracco, Lluc Colomer, Pablo Barrio, Marc Valentí, Anna Giménez-Palomo, Eduard Vieta, Isabella Pacchiarotti","doi":"10.1111/bdi.13425","DOIUrl":"10.1111/bdi.13425","url":null,"abstract":"","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"26 3","pages":"296-299"},"PeriodicalIF":5.4,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140179300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thalles Rodrigues Alves Leite, Sergio Andre de Souza Junior, Ana Leticia Souza da Silva, Sarah Pereira Gomes, Fabio Gomes de Matos e Souza, Luisa Weber Bisol
{"title":"Challenges and missed opportunities in lithium monitoring for bipolar disorder: A reflection on Bosi et al.'s finding","authors":"Thalles Rodrigues Alves Leite, Sergio Andre de Souza Junior, Ana Leticia Souza da Silva, Sarah Pereira Gomes, Fabio Gomes de Matos e Souza, Luisa Weber Bisol","doi":"10.1111/bdi.13417","DOIUrl":"10.1111/bdi.13417","url":null,"abstract":"","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"26 4","pages":"388-389"},"PeriodicalIF":5.4,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140157473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gabriel R. Fries, Sarah H. Sperry, Tamsyn E. Van Rheenen, Emma Morton
{"title":"The critical role of mentorship in academic career development: A commentary on proposed initiatives by the International Society for Bipolar Disorders Early Mid-Career Committee","authors":"Gabriel R. Fries, Sarah H. Sperry, Tamsyn E. Van Rheenen, Emma Morton","doi":"10.1111/bdi.13422","DOIUrl":"10.1111/bdi.13422","url":null,"abstract":"","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"26 3","pages":"284-285"},"PeriodicalIF":5.4,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140157474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is maintenance therapy warranted for recurrent mania in a woman with a positive family history of Huntington's disease?","authors":"Amarins Gaastra, Erik van Duijn, Annemiek Dols","doi":"10.1111/bdi.13420","DOIUrl":"10.1111/bdi.13420","url":null,"abstract":"<p>A 63-year-old woman visited our outpatient clinic 2 months after being involuntarily admitted for a manic psychotic episode. She had been convinced that a bomb would hit her home and that she could talk to angels. When she was admitted, she was initially reluctant to take medication, but she quickly recovered with 10 mg of olanzapine per day and she was discharged after 3 weeks and 2 days. Her physical health is good except for osteoporosis and hypothyroid function. She does not use alcohol or drugs. She works as a legal assistant and will retire soon. She is divorced and has two daughters and two grandchildren.</p><p>Her psychiatric history revealed several (hypo)manic episodes (Figure 1). Her first manic episode likely resulted from sleep deprivation when she was 23 years old, and she recovered without needing medication after being admitted to a psychiatric ward. Her second episode of mania occurred at the age of 42 and was attributed to stress as a result of her divorce. This time around, she had to be admitted involuntarily. Then, she had three hypomanic episodes at ages 48, 51, and 58 of which she recovered without any intervention by mental healthcare professionals. She did not recall the duration of any of these last three episodes.</p><p>Despite her doubts about having bipolar disorder, she attended a psychoeducational course and attributed her episodes to psychosocial stressors, such as work-related problems and worries about her grandchild. There is no family history of psychiatric disorders, but she has a positive family history of Huntington's disease (HD), comprising seven genetically confirmed cases in one generation and symptomatic suspected cases in three successive generations. Her mother passed away at the age of 84, without an official HD diagnosis as shown in Figure 2. Our patient chose not to be genetically tested for HD as there is no cure yet. However, her two daughters decided to be tested. One of her daughters tested positive for HD, with a relatively low number of trinucleotide CAG repeats. While the exact number is not known, she was informed that a very late onset of HD was to be expected. The other daughter tested negative.</p><p>Since HD is an autosomal-dominant hereditary disease, it is highly probable that our patient has an HD gene expansion in a similar range as her daughter's. Although she had decided not to be tested for HD, our patient wondered if this could explain her vulnerability to developing psychiatric symptoms in response to psychosocial triggers and whether maintenance therapy with medication would be warranted.</p><p>Unipolar mania is classified as bipolar disorder in DSM 5 and is typically defined by three manic episodes without a depressive episode over the course of more than 5 years. Unipolar mania is a rare disorder and is clinically distinct with male predominance, earlier age at onset, shorter episodes, fewer suicide attempts, and lower lifetime comorbidities. The prevalence of unipolar ma","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"26 3","pages":"300-302"},"PeriodicalIF":5.4,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.13420","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140130634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advancing clinical practice and discovery research through revised taxonomy: Case in point bipolar disorder diagnosis","authors":"Anne Duffy, Paul Grof","doi":"10.1111/bdi.13415","DOIUrl":"10.1111/bdi.13415","url":null,"abstract":"<p>In the well-articulated paper by Malhi et al.<span><sup>1</sup></span> in this journal, several problems with diagnosing bipolar disorder in children are discussed and as rightly pointed out “impede our ability to conduct meaningful research and advance clinical practice”. In fact, one could argue that the diagnostic challenges outlined apply to the diagnoses of mood disorders more generally. That is, reliance on a diagnostic checklist that reflects largely non-specific symptoms that cross diagnostic boundaries and are open to interpretation yield a highly heterogeneous population of mood disordered patients that share the same diagnosis but little else—differing in clinical course, family history, prognosis, treatment response and genetic and neurobiological correlates.</p><p>Malhi et al. offer a novel solution to the current diagnostic dilemma. The authors express hope that revising the current taxonomy so as to focus on developmentally sensitive symptom clusters, reflecting the evolution of the disorder over development, will advance the field past the current stalemate and improve diagnostic accuracy. While we agree that a developmental lens provides an informative perspective through which to view psychopathology, there is no evidence that a sole focus on symptoms, no matter how well developmentally nuanced, will improve diagnostic classification. Rather, substantive evidence supports the need to identify more homogenous subtypes from within the current heterogeneous bipolar diagnostic construct to advance risk prediction, pharmacotherapy, and discovery research. Three bipolar subtypes based on distinct clinical profiles have been described based on research extending over six decades, each with preferential response to stabilizing treatment with lithium, antipsychotics and antiepileptics, respectively (Figure 1).<span><sup>2</sup></span> Therefore, an alternative evidence-based solution would be to include these bipolar subtypes in a revised taxonomy.</p><p>Specifically, substantive evidence supports that a long-term response to lithium identifies a more homogeneous subtype of bipolar disorder characterized by a recurrent episodic course, complete remission, a history of episodic mood disorders in family members, and distinctive genetic correlates.<span><sup>3</sup></span> This distinctive clinical profile, identified by multivariate analyses, was actually delineated by Kraepelin over a century ago. Further, prospective longitudinal studies of the offspring of lithium responsive (LiR) and lithium non-responsive (LiNR) bipolar parents have provided evidence that bipolar disorder debuts as a depressive episode in adolescence, years on average before emergence of the first manic episode.<span><sup>4</sup></span> The developmental history and clinical course differ between subgroups, with offspring of LiRs having normal or gifted development and offspring of LiNRs manifesting neurodevelopmental disorders (ADHD, learning difficulties). Childh","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"26 3","pages":"286-288"},"PeriodicalIF":5.4,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.13415","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140058586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}