Search

INTRODUCTION: Bipolar disorders (BD) are frequent mood disorders associated with a poor prognosis mainly due to a high relapse rate. Depressive relapses may follow a seasonal cyclicality, and bright-light therapy (BLT) has been established as the treatment of choice for seasonal affective disorder (SAD). The use of BLT for seasonal unipolar depression is well known, but the scientific literature is much poorer on the management of seasonal depressive episodes in BD. In addition, some specificities related to BD must be taken into account. METHODS: We conducted a comprehensive review using Medline and Google Scholar databases up to August 2014 using the following keywords combination: "bipolar disorder" and "light therapy" or "phototherapy". Papers were included in the review if (a) they were published in an English or French-language peer-reviewed journal; (b) the study enrolled patients with BD and SAD; and (c) the diagnosis was made according to the DSM or ICD criteria. RESULTS: BLT was considered among the first-line treatments for SAD with a size effect similar to antidepressants. Most of the studies did not distinguish between patients with unipolar and bipolar disorders. However, it has been demonstrated that the most significant risk of BLT in patients with BD is the mood shift. Thus, the most important therapeutic adaptation corresponds to the use of an effective mood stabilizer, as with any antidepressant. Another therapeutic adaptation in first intention is that the times of exposure to light should be shifted from morning to midday. This review also includes therapeutic guidelines regarding the management of BLT in seasonal bipolar depressive episodes. DISCUSSION: There are very few specific data on seasonal bipolar depressive episodes. This literature review has highlighted that BLT should be handled as a regular antidepressant treatment in patients suffering from seasonal bipolar depressive episodes.

CONTEXT: The high prevalence of psychiatric disorders in prison and the aging of inmates should lead to the consideration of gerontopsychiatry in the prison environment. OBJECTIVE: This review aims to emphasize the clinical characteristics and associated comorbidities of elderly prisoners with psychiatric disorders. We examined the international literature in September 2013 and performed the literature search with PubMed electronic database using the following Mesh headings: "prisons", "prisoners", "geriatric psychiatry", "geriatric assessment", "geriatric nursing". RESULTS: Fourteen studies were retained by the literature search strategy and were included in the qualitative analysis. More than one out of two elderly prisoners (>60 year-old) suffer from a psychiatric disorder. Major depressive disorder (MDD) is the first psychiatric disorder diagnosed among elderly prisoners, affecting 30 to 50% of them. Personality disorders are also very common demonstrating a prevalence of about 30%. Psychotic disorders concern 5% of the elderly prisoners and thus largely exceed the prevalence in the general population. Furthermore, stress events are frequent in prison and might precipitate or worsen psychiatric disorders. This review highlights the difficulties and complexities of care plans and management for the elderly in prison. CONCLUSION: The situation of elderly prisoners with psychiatric disorders is extremely worrying. In addition, both the aging of the population and the lengthening of incarcerations increase the number of elderly prisoners, widely exposed to psychiatric disorders, and thus will probably worsen these issues in the future.

International audience; Bipolar disorder (BD) is a severe chronic multifactorial disease that requires maintenance therapy with mood stabilizers (MS). Even with medications, the rate of response among patients with BD is low and the risk of relapse is high. Therefore, in this context of the urgent need for reliable and reproducible predictors of individual responses to MS, pharmacogenetics research is expected to provide helpful progress. Most pharmacogenetic studies of MS have focused on the response to lithium with several good putative candidate genes but informative results are sparse. There have been few studies on valproate, lamotrigine or atypical antipsychotics. Overall, the results of pharmacogenomics studies have not provided sufficient data to change daily practices in BD significantly and further investigation is warranted to identify highly relevant genetic predictors of response their roles. Although progress still remains to be made, the clinical assessment of a subject including the identification of specific individual phenotypic and pharmacogenetic characteristics is likely to become a powerful instrument for the development of personalized therapies.

International audience; Bipolar disorder is a multifactorial psychiatric disorder with developmental and progressive neurophysiological alterations. This disorder is typically characterized by cyclical and recurrent episodes of mania and depression but is heterogeneous in its clinical presentation and outcome. Although the DSM-IV-TR criteria identify several features that are of phenomenological relevance, these are of less utility for defining homogeneous subgroups, for analyses of correlations with biomarkers or for directing focused medication strategies. We provide a comprehensive review of existing evidence regarding to age at onset in bipolar disorder. Eight admixture studies demonstrate three homogeneous subgroups of patients with bipolar disorder identified according to age at onset (early, intermediate and late age at onset), with two cutoff points, at 21 and 34 years. It is suggested that the early-onset subgroup has specific clinical features and outcomes different from those of the other subgroups. Early-onset subgroup may be considered a more suitable clinical phenotype for the identification of susceptibility genes with recent data demonstrating associations with genetic variants specifically in this subgroup. The use of age at onset as a specifier may also facilitate the identification of other biological markers for use in brain imaging, circadian, inflammatory and cognitive research. A key challenge is posed by the use of age at onset in treatment decision algorithms, although further research is required to increase the evidence-base. We discuss three potential benefits of specifying age at onset, namely: focused medication strategies, the targeted prevention of specific comorbid conditions and decreasing the duration of untreated illness. We argue that age at onset should be included as a specifier for bipolar disorders.

International audience; Kraepelin's observations of the differences in the course and outcome of dementia praecox and manic depression fundamentally influenced thinking about bipolar disorder (BP) and schizophrenia (SZ) for over a century. In modern times, there is increasing awareness that a greater understanding of the similarities between these two highly prevalent and disabling conditions can teach us as many lessons about the pathophysiology of severe mental disorders as does the pursuit of differentiating factors. We review publications on developmental, genetic, epidemiological, and outcome research that challenges the Kraepelian dichotomy. We highlight the increasing evidence of the overlap in genetic susceptibility. Neuro-developmental studies provide evidence of shared early pathological processes, whilst neurophysiological investigations also suggest that different genes may have a role in the development of both phenotypes. There is also evidence of overlapping neurocognitive phenotypes. It has become increasingly clear that a simple binary classification of these disorders represents an oversimplification. It may be more apposite to think in terms of genetic influences on six continuous symptom dimensions: neurobiological, cognitive, positive, negative, depressive and manic symptoms.