Ajay K. Parsaik, Aanchal Chaudhary, Shivy Sharma, Brooke Ellen Delgoffe, Rachel Gabor, Balwinder Singh
{"title":"Effects of long-term lithium therapy on kidney functioning in mood disorders: A population-based historical cohort study","authors":"Ajay K. Parsaik, Aanchal Chaudhary, Shivy Sharma, Brooke Ellen Delgoffe, Rachel Gabor, Balwinder Singh","doi":"10.1111/bdi.13501","DOIUrl":"10.1111/bdi.13501","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Lithium is Food and Drug Administration-approved for bipolar disorder (BD) and is also used in depressive disorders but is underutilized due to concerns about chronic kidney disease (CKD). We explored clinical and demographic profiles of patients on long-term lithium therapy (LTLT) and assessed kidney function. Our aims were to identify the predictors for CKD stage ≥3 and the impact of lithium discontinuation post-CKD diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a population-based historical cohort study of adult patients with mood disorders on LTLT at the Marshfield Clinical Health System from 1990 to 2019. Data on lithium therapy and kidney-related information (estimated glomerular filtration rate and CKD) were extracted from electronic medical records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1603 patients with mood disorders (mean age 42.1 years, 60% females), 15.3% (<i>n</i> = 246) developed CKD stage ≥3. Patients without CKD were on lithium for 4.5 years, compared to 6.6 years for those with CKD. Hypertension, age, and BD were significant CKD risk factors. Kidney function declined linearly with lithium duration, returning to pre-treatment trajectory in patients without CKD but showed no improvement in those with CKD after lithium discontinuation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings suggest that CKD occurs in 15% of patients with mood disorder receiving LTLT, with its progression potentially influenced by existing comorbidities rather than lithium alone. These results underscore the importance of monitoring kidney function in patients on LTLT and considering individual risk factors for CKD development. In patients who developed CKD, Li discontinuation did not impact change in kidney function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"27 1","pages":"28-35"},"PeriodicalIF":5.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248544","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":"Recent trends in hospital admission due to bipolar disorder in 10–19-year-olds in Spain: A nationwide population-based study","authors":"Teresa López-Cuadrado, Ezra Susser, Gonzalo Martínez-Alés","doi":"10.1111/bdi.13500","DOIUrl":"10.1111/bdi.13500","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Bipolar disorder (BD) hospitalization rates in children and adolescents vary greatly across place and over time. There are no population-based studies on youth BD hospitalizations in Spain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified all patients aged 10–19 hospitalized due to BD in Spain between 2000 and 2021, examined their demographic and clinical characteristics, and assessed temporal trends in hospitalizations – overall and stratified by age and presence of additional psychiatric comorbidity. We used Joinpoint regressions to identify inflection points and quantify whole-period and annual percentage changes (APCs) in trends.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 4770 BD hospitalizations in 10–19-year-olds between 2000 and 2021 (average annual rate: 4.8 per 100,000), over half indicated an additional psychiatric comorbidity, most frequently substance abuse (62.2%), mostly due to cannabis (72.4%). During the study period, admissions increased twofold with an inflection point: Rates increased annually only between 2000 and 2008, for APCs 34.0% (95% confidence interval: 20.0%, 71.1%) among 10–14-year-olds, 10.3% (6.4%, 14.3%) among 15–19-year-olds, and 15.5% (11.5%, 22.7%) among patients with additional psychiatric comorbidity. Between 2009 and 2021, rates decreased moderately among 10–14-year-olds – APC: −8.3% (−14.1%, −4.4%) and slightly among 15–19-year-olds without additional psychiatric comorbidity – APC: −2.6(−5.7, −1.0), remaining largely stable among 15–19-year-olds overall.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Recent trends in hospitalization due to BD in 10–19-year-olds in Spain indicate salient increases in the early 2000s – especially among (i) patients aged 10–14 (decreasing moderately after 2009 among 10–14-year-olds and plateauing among 15–19-year-olds) and (ii) patients with additional psychiatric comorbidity (i.e., cannabis use disorder). These findings suggest links with recent changes in clinical practices for children and recent trends in substance use among Spanish youth.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"26 8","pages":"801-809"},"PeriodicalIF":5.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139223","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}
Jennifer B. Levin, Melissa DelBello, Avani C. Modi, Farren Briggs, Larry F. Forthun, Molly McVoy, Joy Yala, Raechel Cooley, Jessica Black, Carla Conroy, Martha Sajatovic
{"title":"A 6-month, prospective, randomized controlled trial of customized adherence enhancement versus a bipolar-specific educational control in poorly adherent adolescents and young adults living with bipolar disorder","authors":"Jennifer B. Levin, Melissa DelBello, Avani C. Modi, Farren Briggs, Larry F. Forthun, Molly McVoy, Joy Yala, Raechel Cooley, Jessica Black, Carla Conroy, Martha Sajatovic","doi":"10.1111/bdi.13489","DOIUrl":"10.1111/bdi.13489","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Few studies have addressed medication adherence in adolescents and young adults (AYAs) with bipolar disorder (BD). This 6-month prospective randomized-controlled trial (RCT) tested customized adherence enhancement for adolescents and young adults (CAE-AYA), a behavioral intervention for AYAs versus enhanced treatment as usual (ETAU).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Inclusion criteria were AYAs age 13–21 with BD type I or II with suboptimal adherence defined as missing ≥20% of medications. Assessments were conducted at Screening, Baseline, and weeks 8, 12 and 24. Primary outcome was past 7 day self-reported Tablets Routine Questionnaire (TRQ) validated by electronic pillbox monitoring (SimpleMed). Symptom measures included the Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean sample age (<i>N</i> = 36) was 19.1 years (SD = 2.0); 66.7% (<i>N</i> = 24) female, BD Type I (81%). The mean missed medication on TRQ for the total sample was 35.4% (SD = 28.8) at screening and 30.4% (SD = 30.5) at baseline. Both CAE-AYA and ETAU improved on TRQ from screening to baseline. Baseline mean missed medication using SimpleMed was 51.6% (SD = 38.5). Baseline HAM-D and YMRS means were 7.1 (SD = 4.7) and 6.0 (SD = 7.3), respectively. Attrition rate at week 24 was 36%. Baseline to 24-week change on TRQ, adjusting for age, gender, educational level, living situation, family history, race, and ethnicity, showed improvement favoring CAE-AYA versus ETAU of 15%. SimpleMed interpretation was limited due to substantial missing data. There was a significant reduction in depression favoring CAE-AYA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CAE-AYA may improve adherence in AYAs with BD, although conclusions need to be made cautiously given study limitations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Trials Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT04348604.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"26 7","pages":"696-707"},"PeriodicalIF":5.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142131752","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":"A case of delirious mania in the context of concurrent cardiac comorbidities and autonomic instability","authors":"Cathy Daichang, Eric Rutkowski, Zeshawn Ali","doi":"10.1111/bdi.13502","DOIUrl":"10.1111/bdi.13502","url":null,"abstract":"<p>The authors declare that they have no conflict of interest.</p><p>Written informed consent was obtained from the patient to write about and publish his clinical case.</p>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"27 1","pages":"77-80"},"PeriodicalIF":5.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.13502","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118922","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":"Postpartum rage attacks in a female with bipolar II disorder and obsessive-compulsive disorder: Diagnostic and treatment challenges","authors":"Verinder Sharma","doi":"10.1111/bdi.13499","DOIUrl":"10.1111/bdi.13499","url":null,"abstract":"<p>A 26-year-old first-time mother was referred for assessment and management of postpartum depression. A few weeks before her first visit to the clinic, she was prescribed sertraline which she had previously taken with for treatment of non-puerperal episodes of depression. Within 2 weeks of the retrial of sertraline 75 mg daily, there was a marked improvement in symptoms of depression and anxiety. She also had obsessions and compulsions, but these were not severe enough to reach the diagnostic criteria of obsessive-compulsive disorder (OCD). The diagnosis of major depressive disorder was confirmed due to the history of at least 10 episodes over as many years (see Figure 1). She had made two suicide attempts including a drug overdose following which she was hospitalized. She denied hypo/manic symptoms; however, she reported a history of bipolar I disorder in a sibling. Due to the history of sustained response to sertraline, we recommended continuation of the current dose (75 mg daily). She took it for several months before discontinuing it during her subsequent pregnancy. She remained well after stopping it but had a recurrence of depression immediately following her delivery. She was prescribed sertraline by her family physician, and after a few weeks, quetiapine 25 mg was added. She was also taking lorazepam 0.5 mg/daily, as needed.</p><p>She was referred to our clinic again 8 months after giving birth to her second child for evaluation of intrusive thoughts of harm coming to her children. She had become increasingly worried about their safety since the abrupt cessation of breastfeeding 4 months earlier. In particular, she was afraid of them dying in a motor vehicle accident, or a fire at home. She had spent thousands of dollars on car seats, strollers, mattresses, baby monitors, car window breakers, and fire alarms to safeguard her children. She also reported a history of compulsive skin-picking and hair-pulling. She had become overly sensitive to noises in the house, such as the dishwasher, breathing sounds, and chewing. On the Mood Disorder Questionnaire, she endorsed all items with co-occurrence and moderate functional impairment. She reported having had brief hypomanic and mixed episodes lasting up to a week since her last delivery. She did not have psychotic features and denied abusing alcohol or using illicit drugs.</p><p>Of her extant symptoms, she was particularly concerned about the daily occurrences of episodes of intense anger toward her husband and children. These episodes lasted 45–60 min and were accompanied by yelling, and destruction of property. There were no acts of violence, but she was afraid that she might harm others. She experienced anger attacks after her first delivery, but these were less intense, and less frequent than her rage attacks over the last few months. Her diagnosis was revised to bipolar II disorder and OCD. The sertraline dose was tapered off over 2 weeks due to lack of effectiveness and concerns about ind","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"27 1","pages":"84-86"},"PeriodicalIF":5.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.13499","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118924","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":"Concept article: Antidepressant-induced destabilization in bipolar illness mediated by serotonin 3 receptor (5HT3)","authors":"Irem Hacisalihoglu Aydin, Rif S. El-Mallakh","doi":"10.1111/bdi.13494","DOIUrl":"10.1111/bdi.13494","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Antidepressants used by patients with bipolar disorder have been associated with destabilization with an increase in mania, depression, and cycling. The most commonly proposed mechanism, that antidepressants ‘overshoot’ their antidepressant effect to create a manic or mixed state, is unlikely since antidepressants have actually been found to be ineffective in treating bipolar depression. Beginning with known bipolar-specific pathophysiologic abnormalities provides the greatest likelihood of insight.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed was queried with ‘bipolar’, ‘sodium’, ‘intracellular sodium’, ‘serotonin 3’, ‘5HT<sub>3</sub>’, ‘5-hydroxytryptamine type 3 receptors’, and ‘antidepressant’ either individually or in combination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Pathologic mood states (both mania and depression) are associated with increased intracellular sodium (Na) concentrations that depolarize the resting membrane potential to increase cellular excitability (mania) or cause depolarization block (depression). Stimulation of the serotonin (5HT) receptors depolarizes the post-synaptic neuron. Stimulation of 5HT<sub>3</sub> may be of particular importance since it is coupled to a cation channel that directly depolarizes the membrane. These effects <i>directly</i> impact the physiology of patients with bipolar disorder to alter neuronal excitability in a fashion that worsens both mania and depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Proposed Concept</h3>\u0000 \u0000 <p>The most consistently observed biological abnormality in individuals going through mania or bipolar depression involves a decline in Na pump activity, with consequent elevation of intracellular Na levels. Antidepressant treatment potentiates this, particularly by activation of 5HT<sub>3</sub>. This hypothesis can be tested by coadministering a 5HT<sub>3</sub> antagonist (e.g., vortioxetine or ondansetron) to achieve blockade of that receptor while treating bipolar depression with a serotoninergic antidepressant.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"26 8","pages":"772-778"},"PeriodicalIF":5.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103932","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":"NMDA antagonists use in bipolar depression: A case report","authors":"Kirolos Ibrahim, Sara Abell, Rif El-Mallakh","doi":"10.1111/bdi.13496","DOIUrl":"10.1111/bdi.13496","url":null,"abstract":"","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"27 1","pages":"81-83"},"PeriodicalIF":5.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103935","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}
Vincent Zhang, Alexis June Wirtz, Anmol Dhingra, Ashar Zahid, Najeeb Hussain
{"title":"Conceptualizing the relationship between synthetic cannabinoid use and neuroleptic malignant syndrome","authors":"Vincent Zhang, Alexis June Wirtz, Anmol Dhingra, Ashar Zahid, Najeeb Hussain","doi":"10.1111/bdi.13503","DOIUrl":"10.1111/bdi.13503","url":null,"abstract":"<p>The patient is a 29-year-old female with history of bipolar disorder (multiple past psychiatric admissions) and cannabis/synthetic cannabinoid (SC) use disorder who was recently admitted to an inpatient psychiatric facility for disorganization and agitation. Following this hospitalization, she was discharged on aripiprazole 20 mg daily and lithium 300 mg twice daily. Four days later, she presented to the emergency room following multiple seizure-like episodes and aggressive behavior. Due to ongoing agitation with violence, patient required multiple doses of droperidol, midazolam, hydroxyzine, and was status post administration of soft restraints. The patient's mother described and recorded three episodes of diffuse jerking that lasted 5 min each, with urinary incontinence and oral frothing. Each episode self-resolved, and the patient was conversant throughout episodes with no post-ictal state nor tongue-biting. Neurology was consulted and concluded that her presentation was not consistent with seizures. The patient subsequently was found to have bradykinesia, rigidity, and a rapid increase in creatine kinase from 310 on arrival to a level of 2428 during evaluation- mild neuroleptic malignant syndrome (NMS) was suspected. Her symptoms were thought to be due to use of aripiprazole and droperidol, leading to NMS; however, toxicity from SC's could not be ruled out. Indeed, this was actually suspected, given that the patient had previously been admitted multiple times with similar medication regimens (with higher doses of antipsychotics) without developing NMS. Antipsychotics were discontinued, restraints were avoided as much as possible, and benzodiazepines were instead started for agitation. This resulted in eventual resolution of both her psychiatric and physical symptoms following a short stay in the inpatient unit.</p><p>Neuroleptic Malignant Syndrome (NMS) is a well-known side effect of potentially all antipsychotics, as antagonism of dopamine receptors lead to drops in neurotransmitter activity within dopaminergic pathways.<span><sup>1</sup></span> It has a textbook triad of fever, muscle rigidity, and altered mental status (AMS), but in clinical practice, the majority of cases actually present heterogeneously.<span><sup>2</sup></span> Similarly, synthetic cannabinoids (SC) possess a widely varying drug profile, due to the vast number of derivatives sold. In recent years, SC have become increasingly popular due to their lower cost, easy obtainability and non-detectability on traditional drug screens.<span><sup>3</sup></span> This is of increasing concern, due to their vastly more unpredictable, severe side-effects compared to cannabis- zero fatalities have been seen with cannabis toxicity, while many have been reported due to SC. Psychiatrically, SC has been show to drastically exacerbate certain conditions including schizophrenia, anxiety, and bipolar disorder. For psychosis in particular, it has been shown that SC use serves as an agonist ","PeriodicalId":8959,"journal":{"name":"Bipolar Disorders","volume":"27 2","pages":"161-162"},"PeriodicalIF":5.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bdi.13503","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103933","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}