Recurrent unipolar mania in a psychiatric hospital setting in the Fiji Islands

This study aimed to determine the rate of unipolar mania and compare its characteristics with those of other bipolar affective disorders in a psychiatric hospital in the Fiji Islands. Fifty-one patients with unipolar mania seen between January 1999 and October 2000, had their diagnosis confirmed using the Schedules for Clinical Assessment in Neuropsychiatry and the International Classification of Diseases, 10th edition. Their demographic and clinical characteristics were compared with those of 31 manic-depressive patients seen during the period under review. Unipolar mania constituted 47.2% of the bipolar affective disorders in this sample. The frequency of episodes, duration of affective illness, mean age at onset, gender distribution, marital status, employment status and race were not significantly different for the unipolar manic and manic-depressive groups (p > 0.05). Family history of major psychiatric morbidity was 9.8% for the unipolar manic patients and 22.6% for the manic-depressive group (p > 0.05). Recurrent unipolar mania may be considered a useful category based on its high rate, although its demographic and clinical characteristics do not clearly distinguish it from manic-depression.     

Acute confabulatory psychosis: A rare form of unipolar mania?

Emil Kraepelin's paper on false memories (Erinnerungsfälschungen) was probably the most extensive and incisive analysis of these phenomena ever made. Using his views as a starting point, the concept of confabulation is then defined in a Kraepelin-oriented manner, making it also applicable to the phantastic false memories found in some rarer forms of functional psychotic illness. Kraepelin and Leonhard have been preeminent in their concern with such clinical states; thus, Leonhard's confabulatory euphoria and confabulatory paraphrenia can be symptomatically and syndromally linked up with points of view on paranoid mania and confabulatory paraphrenia held by Kraepelin. An “ideally typical” case is also presented to highlight some of the difficulties involved in trying to distinguish mania from schizophrenia when the clinical picture is dominated by phantastic “functional” confabulations.     

Clomipramine-induced mania in unipolar depression.

Manic behavior during randomly assigned treatment with clomipramine (chlorimipramine) or amitriptyline hydrochloride developed in seven of 50 hospitalized unipolar depressed patients. Six of the 25 clomipramine-treated patients became manic. Only one patient in the amitriptyline-treated group developed manic behavior. The switch into mania occurred at the mean age of 63, much later than the reported age of risk for mania. Significant correlations were observed between the age at onset of mania, the number of days of clomipramine treatment, and the duration of the manic episode. We hypothesize that such a switch into mania in unipolar patients is triggered by the psychopharmacological effect of clomipramine through an alleged change in activity of the central dopamine and serotonin systems.     

The mathematical case against unipolar mania

A mathematical model is developed based on several assumptions to predict frequency of admission for apparent unipolar mania given that such patients have the same illness as bipolars. The model is compared with data from previous studies of unipolar mania and with data from the author's own study of 77 unipolar manic patients. The observations generally supported the model. It is concluded that the same DSM III convention of classifying unipolar manics under the heading “Bipolar disorder” is upheld.     

Treatment-emergent mania/hypomania in unipolar patients

Objective:  The aim of this study was to estimate the incidence of treatment-emergent mania/hypomania (TEMH) and to describe the clinical characteristics of patients with major depression experiencing this event during treatment with a selective serotonin reuptake inhibitor (SSRI) and/or interpersonal psychotherapy (IPT).
Methods:  Following an algorithm-based protocol, 344 patients with major depression confirmed with the Structured Clinical Interview for DSM-IV disorders were treated with an SSRI, interpersonal psychotherapy, or their combination for nine months. The emergence of mania/hypomania was carefully monitored throughout the study using the Young Mania Rating Scale and clinical assessment.
Results:  Overall, eight patients experienced TEMH. The incidence of this event was 3.0% in patients treated with an SSRI and 0.9% in patients treated with IPT alone. Among patients treated with an SSRI, the difference between sites was higher than expected by chance alone (6.8% at Pisa and 0% at Pittsburgh, p = 0.002). Despite the adoption of an identical protocol at the two sites, some demographic and clinical characteristics of participants may account for this unexpected result. Alternatively, the greater number of episodes and earlier age of onset at the Pittsburgh site suggests that the unipolar course of illness was more clearly established prior to study entry.
Conclusions:  TEMH is an infrequent event, occurring in 2.3% of patients treated for major depression. Nevertheless, its consequences are clinically relevant and require prompt and appropriate therapeutic interventions. For this reason, recognising those patients at risk for such an event is of paramount clinical significance. The observed difference in the incidence of TEMH between the two sites requires further investigation.     

Content-specificity of dysfunctional cognitions for patients with bipolar mania versus unipolar depression: a preliminary study

OBJECTIVE: Dysfunctional beliefs or cognitions are considered to be fundamental to both the phenomenology and pathogenesis of depression. However, the cognitive aspects of mania have not been as thoroughly investigated. We sought to compare the maladaptive beliefs and cognitions of 23 bipolar manic or hypomanic patients, 28 patients with unipolar major depression, and 24 normal adults. METHOD: The Cognition Checklist for Mania (CCL-M) was used to assess the beliefs. This 61-item self-report instrument is scored for seven subscales measuring (a) self-importance, (b) interpersonal grandiosity, (c) inappropriate spending, (d) excitement and risk-taking, (e) interpersonal frustrations, (f) goal-driven activity, and (g) past or future outlooks on life, and also yields a total score. RESULTS: The mean CCL-M total score of the bipolar-manic patients was significantly higher than the mean CCL-M total score of the unipolar-depressed patients, and the patients' mean CCL-M total score was also higher than that of the normal adults. The mean scores of the subscales measuring excitement and past and future memories and expectations were also significantly higher for the bipolar-manic than unipolar-depressed patients. CONCLUSIONS: Bipolar-manic patients endorse with maladaptive beliefs and cognitions that are associated with mania more than do unipolar-depressed patients and normal adults. The implications for the early identification of cognitions associated with prodromal states of mania, and for psychotherapeutic interventions, are discussed.     

The symptom pattern variations of unipolar depression during life span: a cross-sectional study

The psychopathological syndromes are analyzed for 436 patients suffering from a unipolar affective psychosis, depressed type, without any further psychiatric or somatic diagnosis, separately for the second to eighth decade of life. The intensity of the depressive syndrome, as well as the apathy syndrome according to the Manual for the Assessment and Documentation of Psychopathology (AMDP) system, does not decrease. The autonomic syndrome increases for the group in the involutional age, and the psycho-organic syndrome for the group in the old age. The analysis of special symptom patterns, as for the agitated behavior or symptoms of the psycho-organic syndrome, is presented.     

Tedium vitae in stroke survivors: a comparative cross-sectional study

Objectives: Suicide is best studied by deconstructing the psychological experiences preceding suicidal death. We assessed the characteristics of tedium vitae (feeling tired of life) after first ever stroke in Nigerian survivors.

Methods: Using the Schedule for Clinical Assessment in Neuropsychiatry, tedium vitae was assessed in 130 stroke survivors attending rehabilitation in a large Nigerian university hospital. Global cognitive and executive dysfunctions were evaluated, respectively, using the Mini Mental State Examination and the modi?ed Indiana University Token test. All participants had their index stroke 3 to 24 months before recruitment into the study. We also examined a comparative group of 130 age, gender, and education matched apparently normal persons who were unrelated to the stroke survivors. Associations were explored using univariate and multivariate logistic regression analyses.

Results: Tedium vitae was experienced by 16 (12.3%) stroke survivors compared with 5 (3.9%) in the comparative group (O. R = 3.5, 95% C. I = 1.3–9.9, p = 0.018). Among stroke survivors, those who were retired were more likely to experience tedium vitae (56.2%, p = 0.045). In analyses adjusting for the effect of systemic hypertension, cognitive dysfunction, retirement and marital separation, there was a 3.5-fold increase in the odds of experiencing tedium vitae after surviving a stroke (O. R = 3.5, 95% C. I = 1.1–11.6, p = 0.042).

Conclusions: Tedium vitae is a common suicidal experience after stroke and may be among the earliest perceptible pointer to impending poststroke suicide. It is easy to assess and may be less costly to obtain an adequate sample size in studies aiming to understand the phenomenon of suicide in the stroke population.     

奥氮平合并碳酸锂治疗躁狂发作临床对照研究

目的研究奥氮平合并碳酸锂与氟哌啶醇合并碳酸锂治疗躁狂发作的疗效及安全性。方法将72例躁狂发作患者随机分为两组,其中奥氮平组和氟哌啶醇组各36例,进行为期6周的对照研究,采用躁狂量表和不良反应症状量表评定疗效及安全性。结果奥氮平组与氟哌啶醇组疗效相当(P>0.05),而奥氮平组副作用明显少于氟哌啶醇组。结论奥氮平合并碳酸锂是治疗躁狂发作安全有效的药物。     

单相抑郁与双相情感障碍遗传效应及方式的对照研究

为寻找情感性障碍可能是一组异源性疾病的根据，调查了１７例单相抑郁和９６例双相情感障碍患者一、二级亲属中的情感性障碍患病率，并对二组亚型的遗传效应及方式作了对照分析。结果显示，单相抑郁的家族聚集性明显高于双相情感障碍。单相抑郁和双相情感障碍的加权平均遗传率分别为１３１．２％和８８．９％。单相抑郁和双相情感障碍都符合多基因遗传，但单相抑郁的遗传率明显高于双相情感障碍，且单相抑郁的二级亲属同病者均集中在母系。提示两者可能属异源性疾病。     

奥氮平、氯氮平合并碳酸锂治疗躁狂症对照研究

目的 观察奥氮平、氯氮平分别合并碳酸锂治疗躁狂症的疗效和副反应。方法 将符合CCMD-3诊断标准的60例门诊或病房躁狂症患者随机分为两组，在使用碳酸锂的基础上分别合并奥氮平或氯氮平进行4周的治疗。使用躁狂量表（BRMS）及大体评定量表（GAS）、病情严重度量表（CGI-SI）评定疗效，使用副反应量表（TESS）评定副反应。结果 奥氮平组与氯氮平组疗效相当，总有效率分别为86．67％，83．33％，奥氮平组副反应显著低于氯氮平组。结论 奥氮平是一种治疗躁狂症安全有效的药物。     

General public knowledge,attitudes, and practices towards persons with epilepsy in South Ethiopia: A comparative community-based cross-sectional study

IntroductionDespite being a common disorder, epilepsy is misunderstood by the general public, leading to fear, secrecy, stigmatization, and the risk of social discrimination.ObjectiveThis study aimed to compare knowledge, attitudes, and practices (KAP) towards persons with epilepsy among rural and urban dwellers in South Ethiopia.MethodsA comparative cross-sectional community-based study was conducted among 1316 (656 from rural and 660 from urban) adult respondents in South Ethiopia.ResultsThe most cited causes of epilepsy were brain disease (40.6%) by urban respondents and evil spirits (34.6%) by rural respondents. More urban (21.7%) than rural (16.5%) respondents believed that epilepsy is contagious (P = 0.016). About 39% of rural compared with 7% of urban respondents would not allow their children to associate with a person with epilepsy (P < 0.001), and 56.7% of rural compared with 24.8% of urban respondents objected to themselves or their children marrying someone with epilepsy (P < 0.001). The majority of the respondents in both groups (75.5% from urban and 56.4% from rural) would recommend a medical doctor for the treatment of epilepsy, but herbal medicine and spiritual treatments such as prayers and Holy water were still commonly practiced.ConclusionThis study demonstrated a significant difference in epilepsy KAP between urban and rural dwellers, with the former having more positive attitudes. A comprehensive epilepsy educational campaign is necessary to advance understanding among the general population, thereby improving patient care.     

Clinical features of delusional beliefs in schizophrenic and unipolar mood disorders: a comparative study

We assessed comparatively 13 clinical features of delusions in a sample of 132 deluded inpatients of both sexes with schizophrenic (n = 89) or unipolar mood disorders (n = 43). Patients with schizophrenic disorders exhibited higher levels of severity than those with unipolar depression with respect to the features of vagueness-illogicality, bizarreness, systematization, conviction, duration and affective incongruence, whereas the reverse held true with respect to the feature of emotional impact. Furthermore, the two diagnostic groups were compared to each other with respect to patients' scores on five dimensions of their delusions obtained through factor analysis, namely emotional and behavioral impact, cognitive disintegration, delusional certainty, volitional dyscontrol and affective inappropriateness. Schizophrenic patients exhibited higher levels of severity than depressives on the second and fifth dimensions, whereas the reverse held true with respect to the fourth one. Our results suggest that particular features of delusions as well as broader dimensions thereof, may assist in the differential diagnosis of unipolar depression with psychotic features from schizophrenic disorders.     

Cardiovascular risk factors among people with severe mental illness in Italy: A cross-sectional comparative study

ObjectiveThis study aimed to explore the prevalence of cardiovascular disease (CVD) risk factors in people with severe mental illness (SMI), estimating its weight on related risks in Southern Europe, an area with distinct dietary traditions. People with SMI may be more likely than general population to have high prevalence of risk factors for CVDs, due to several reasons, including poor health behaviours and psychopharmacological medications.MethodA cross-sectional study has been conducted, comparing inpatients with and without SMI. Univariate and multivariate analyses and logistic regression models have been carried out, exploring the effect of SMI on the prevalence of CVD risk factors.ResultsAlthough obesity and hypertriglyceridemia were more prevalent among people with SMI, controlling for relevant confounders in multivariate analyses we could not detect any significant difference.ConclusionsPeople with SMI may not necessarily have higher CVD risk, as compared with general population. Mediterranean healthy dietary habits, universal health coverage, families providing strong support, all are possible explanations for our findings. Further research is needed, exploring different mechanisms, with more detailed biological and genetics measures.     

托吡酯与碳酸锂治疗躁狂症的双盲对照研究

目的为探讨碳酸锂与托吡酯治疗躁狂症的疗效及安全性。方法采用随机双盲、对照研究，对符合入组标准的96例躁狂症患者单一服用碳酸锂、托吡酯治疗。并在入组前和入组后1、2、4周进行血、尿、肝功能检查、心电图、血压、体重的检查及BRMS、CGI、TESS量表评定，疗程最终为4周。结果托吡酯有效率80．85％，碳酸锂有效率87．76％，二者无明显差异（P〈0．05），托吡酯组BRMS、CGI—SI评分疗后4周极显著低于治疗前（P〈0．01），且与碳酸锂组无明显差异（P〉0．05），在第2周时BRMS评分显著低于治疗前（P〈0．05），第2周就有明显的疗效，托吡酯的平均治疗剂量为（261．35±52．38mg）；碳酸锂组在副反应方面特别是消化系统、神经系统高于托吡酯组，有显著差异（P〈0．05或P〈0．01），而托吡酯组体重下降明显多于碳酸锂组（P〈0．01）。结论托吡酯在第2周就见效，疗效与碳酸锂相当，不良反应少，安全、有效，因有降低体重的作用，易为大多数女患者所接受。