Homicidal ideation with intent during a manic episode triggered by antidepressant medication in a man with brain injury

BACKGROUND: Mood disorders are more frequent after brain injury and both depressive and manic episodes are associated in these patients with an increased risk of aggression. Antidepressant medications are associated with a risk of manic induction. CASE REPORT: We describe a case of homicidal ideation with intent during the onset of a manic episode in a patient with prior brain injury on antidepressant medication at low dosage. The manic episode could have been secondary to brain injury and/or triggered by antidepressant medications. This case raises the possibility of the sensitizing role of brain injury for antidepressant-induced mania. CONCLUSIONS: Further studies are needed to assess the role of brain injury as a risk factor for antidepressant-induced mania. Physicians should be cautious when prescribing antidepressants to patients with prior brain injury and inform them and their relatives of the possibility of a switch into mania.     

Double-blind randomized controlled study comparing short-term efficacy of bifrontal and bitemporal electroconvulsive therapy in acute mania

Background:  Bifrontal electrode placement is as efficacious as bitemporal placement during electroconvulsive therapy (ECT) in depression but is associated with fewer cognitive adverse effects. There are no studies comparing these techniques in acute mania. This study compared the short-term efficacy and adverse effects of bifrontal and bitemporal ECT in the treatment of acute mania.
Method:  Thirty-six DSM-IV mania inpatients referred for ECT were recruited for study. They were randomized to receive bifrontal (BFECT; n = 17) or bitemporal (BTECT; n = 19) ECT. None of the subjects were on mood stabilizers during the course of ECT. Severity of mania was measured on the Young Mania Rating Scale (YMRS) before beginning ECT and then on Days 3, 7, 11, 14, and 21 of treatment. Cognitive functions were assessed eight hours after the fifth ECT session using the Mini-Mental Status Examination (MMSE), Paired Associate Learning Test, Complex Figure Test, Verbal Fluency Test (animals and fruits categories), and Trail Making Test, Part A.
Results:  The subjects in the two groups were comparable on sociodemographic and clinical variables, including severity of mania at baseline. They were also similar in ECT parameters, including seizure threshold and seizure duration. Mean YMRS scores showed faster decline in the BFECT than in the BTECT group. Kaplan–Meier survival analysis showed that a greater proportion of subjects in the BFECT group responded (50% reduction in YMRS score) significantly earlier than in the BTECT group. There were no significant differences between the groups in performance on cognitive function tests.
Conclusion:  In this pilot study, mania patients treated with BFECT responded faster than those treated with BTECT, with comparable cognitive adverse effects. Since ECT is usually prescribed for rapid control of symptoms, BFECT may be preferred over BTECT in the treatment of acute mania.     

Construct validation of Minnesota Multiphasic Personality Inventory-3 (MMPI-3) scales relevant to the assessment of bipolar spectrum disorders

Background

The Minnesota Multiphasic Personality Inventory-3 (MMPI-3) is a commonly used psychological test that includes several scales relevant to measuring manic and depressive symptoms of bipolar spectrum disorders.

Aims

The goal of the present study was to evaluate the construct validity of MMPI-3 scale scores with respect to self-report measures of bipolar psychopathology.

Materials & Methods

Using a sample of 644 university students in New Zealand, we calculated correlations between scores on the MMPI-3 and the Hypomanic Personality Scale-Short Form (HPS-SF) total and factor scores and the Altman Self-Report Mania Scale (ASRM) total and item scores.

Results

For associations against the HPS-SF, almost all of the hypotheses were supported, whereas for the ASRM scale, several were not. We also estimated a series of regression models predicting HPS-SF and ASRM scores from meaningfully associated MMPI-3 scores. Hypomanic Activation (RC9), Activation (ACT), and Self-Importance (SFI) scores emerged as the most consistent and substantial predictors of criteria, with SFI scores being more specifically associated with total scores and criteria related to Social Vitality. Several internalizing and thought dysfunction MMPI-3 scales were also meaningfully associated with scores on the HPS-SF and ASRM.

Discussion & Conclusion

Implications and limitations, such as the use of a university student convenience sample, are discussed.