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Background: Mood disorders, including unipolar and bipolar depression, contribute significantly to the global burden of disease. Psychological therapy is considered a gold standard non-pharmacological treatment for managing these conditions; however, a growing body of evidence also supports the use of lifestyle therapies for these conditions. Despite some clinical guidelines endorsing the application of lifestyle therapies as a first-line treatment for individuals with mood disorders, there is limited evidence that this recommendation has been widely adopted into routine practice. A key obstacle is the insufficient evidence on whether lifestyle therapies match the clinical and cost effectiveness of psychological therapy, particularly for treating those with moderate to severe symptoms. The HARMON-E Trial seeks to address this gap by conducting a non-inferiority trial evaluating whether a multi-component lifestyle therapy program is non-inferior to psychological therapy on clinical and cost-effectiveness outcomes over 8-weeks for adults with major depressive disorder and bipolar affective disorder. Methods: This trial uses an individually randomised group treatment design with computer generated block randomisation (1:1). Three hundred and seventy-eight adults with clinical depression or bipolar affective disorder, a recent major depressive episode, and moderate-to-severe depressive symptoms are randomised to receive either lifestyle therapy or psychological therapy (adjunctive to any existing treatments, including pharmacotherapies). Both therapy programs are delivered remotely, via a secure online video conferencing platform. The programs comprise an individual session and six subsequent group-based sessions over 8-weeks. All program aspects (e.g. session duration, time of day, and communications between participants and facilitators) are matched except for the content and program facilitators. Lifestyle therapy is provided by a dietitian and exercise physiologist focusing on four pillars of lifestyle (diet, physical activity, sleep, and substance use), and the psychological therapy program is provided by two psychologists using a cognitive behavioural therapy approach. Data collection occurs at baseline, 8-weeks, 16-weeks, and 6 months with research assistants blinded to allocation. The primary outcome is depressive symptoms at 8 weeks, measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) (minimal clinically important difference = 1.6). A pre-specified within-trial economic evaluation will also be conducted. Discussion: Should lifestyle therapy be found to be as clinically and cost effective as psychological therapy for managing mood disorders, this approach has potential to be considered as an adjunctive treatment for those with moderate to severe depressive symptoms. Trial registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12622001026718, registered 22nd July 2022. Protocol version: 4.14, 26/06/2024 [ABSTRACT FROM AUTHOR]

Studies of cognitive impairment in bipolar affective disorder (BAD) combined with anxious-phobic disorders, as a very common comorbid pathology, is a new and as yet poorly researched but relevant area for further investigations of BAD, with promise for clarifying the neurocognitive mechanisms of the disorder and improving the quality of the diagnostic process. The PubMed and Google Scholar databases were searched with the combinations of the keywords "bipolar disorder," "anxiety disorders," "cognitive impairment," "cognitive dysfunction," "meta-analysis," and "review" to identify meta-analytical, review, and individual research articles on this topic. Summarizing the data accumulated in the literature indicates that both phase-dependent and persistent cognitive impairments occur in BAD and that these also occur during the euthymic period; different structures and severities of neurocognitive impairments occur in cases of "pure" bipolar disorder and anxious-phobic disorders; cognitive impairments have a unique structure in bipolar disorder with comorbid anxious-phobic disorders, incorporating the features of neurocognitive impairments characteristic of both disorders with greater severity than in either alone. The results obtained in this review are of interest for planning further empirical studies of this topic in the Russian patient population. [ABSTRACT FROM AUTHOR]

A search for publications in the PubMed/MEDLINE and RINTS databases and other sources from the mid-19th century to the present was conducted using the keywords "pharmacoinduced mania" and "bipolar affective disorder" with the aim of analyzing the stages of the formulation of the challenge, identification of the evolution of views, and the main directions of current research in the field of bipolar affective disorder (BAD) occurring with psychopharmacotherapy-induced manic phases. The issue of adequate therapy for bipolar depression became relevant in the 20th century, when numerous observations indicated that there were risks associated with the use of antidepressants in patients with BAD: the likelihood of affect inversion and exacerbation of the disorder (acceleration of cyclicity, continuous course). Expansion of research capabilities and the introduction of biological psychiatry in recent years have led to the appearance of studies addressing this problem from the perspectives of clinical, pharmacodynamic, genetic, and neurophysiological features, which opens up the prospect of developing advanced methods of personalized medicine for the diagnosis and treatment of bipolar disorders, taking into account the need to minimize iatrogenic effects. [ABSTRACT FROM AUTHOR]

Language disorders are criteria of psychopathology diagnostics listed both in the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the Diagnostic and Statistic Manual of Mental Disorders (DSM). However, structure and grammar remain understudied in this aspect, which makes structural analysis a relevant research topic. A structural analysis of written narrative may objectivize particular language disorders, thus facilitating psychodiagnostics of different mental disorders. The research objective was to describe the structural features of written narratives obtained from 127 patients with schizophrenic, bipolar, and personality disorders. The narratives were subjected to structural and statistical analyses. Schizophrenic narratives demonstrated a poor vocabulary, a low volume, and a high degree of formality with a passive narrator. Bipolar texts tended to be long, detailed, egocentric, and active, with multiple participles. Patients with personality disorders emotionally relived their memories, producing reflective written narratives with a lot of actors. The final list of written speech indicators to be used to distinguish between schizophrenic, bipolar, and personality disorders included such variables as text volume, verb tense, non-finite verb forms, first-person singular pronoun, number of actors, passive / active narrator, and laconic / detailed narration.

Objective: Stigma is very common among patients and caregivers of patients with severe mental disorders; however, there is a lack of comparative study data between schizophrenia and bipolar affective disorder in the Indian setting. Methods: For this, caregivers of patients with schizophrenia (n = 50) or bipolar affective disorder (n = 50) were assessed on the Affiliate Stigma Scale (ASS). Patients with schizophrenia (n = 50) or bipolar affective disorder (n = 50) were assessed on the Internalized Stigma of Mental Illness Scale (ISMIS). Results: Patients and caregivers of patients with schizophrenia have significantly higher mean scores on ISMIS and ASS, respectively, as compared to patients and caregivers of patients with bipolar affective disorder. Conclusion: This study suggests that patients with schizophrenia and their caregivers experience higher stigma than the caregivers of patients with bipolar affective disorder. Higher stigma is associated with higher psychological morbidity in the patients and caregivers. Therefore, clinicians managing patients with severe mental disorders must focus on stigma and psychological distress among the patients and caregivers and plan intervention strategies to reduce stigma.

Background: Bipolar affective disorders are dimensional illnesses in which patients experience, during the long-term course of illness, fluctuating levels of severity of manic and depressive symptoms interspersed with symptom-free periods. It is a highly exhausting and relapsing psychiatric disorder associated with significant morbidity and comorbidity. The World Health Organization Disability Assessment Schedule (WHODAS) is an International Classification of Functioning-based multidimensional instrument that was developed for measuring disability. Aim and Objective: The present study aimed to check the correlation and inter-rater agreement amongst the patient, caregiver, and clinician-administered version of the WHODAS 2.0 among persons with bipolar affective disorder. Materials and Methods: The study was cross-sectional in nature. Thirty samples of patients with bipolar affective disorder as per ICD-10 criteria were selected using a consecutive sampling technique. Patients above 18 years of age with a total duration of illness of at least more than 2 years were included and used self, proxy, and interviewer-administered versions of WHODAS 2.0. Results: The total score of WHODAS 2.0 shows that the interclass correlation coefficient between the patient and caregiver, caregiver and clinician, and patient and clinician was 0.655 (0.469–0.802), 0.599 (0.395–0.767), and 0.722 (0.586–0.820), respectively, indicative of moderate reliability. Caregivers showed a higher mean in cognition, 3.73 (3.13); mobility, 2.63 (1.73); and self-care, 0.867 (1.25), than other raters. Clinicians showed a higher mean (standard deviation) in getting along with people, 4.13 (1.69); life activities of the household, 5.46 (2.67); and participation in society, 10.70 (2.56), than other raters. Conclusion: People suffering from bipolar affective disorder are prone to disability albeit in the mild-to-moderate variety. The findings show that there was moderate reliability between the patient and caregiver, caregiver and clinician, and patient and clinician among the patient rated, caregiver rated on the overscore of WHODAS 2.0.

Background Aim Method Results Conclusion Pharmacotherapy treatment is used to manage women with schizophrenia and bipolar affective disorder admitted to a mother–baby unit (MBU).The aims of this study were (1) to examine prescribing practices for women with schizophrenia and bipolar affective disorder in an MBU, (2) to assess alignment with the Mental health care in the perinatal period: Australian clinical practice guideline and (3) to examine the classes of typical and atypical antipsychotics prescribed to mothers with schizophrenia.A retrospective audit of women with schizophrenia and bipolar affective disorder admitted to a psychiatric MBU, located in Queensland, Australia, was conducted from March 2017–July 2019. The exclusion criteria included women admitted with depression, anxiety, personality disorders, and postpartum psychosis. Pharmacotherapy treatment details were extracted at commencement of admission, mid‐way through admission, and discharge. Descriptive statistics were completed. This project was exempt due to the local policy requirements that constitute research by the Gold Coast Hospital and Health Service Human Research Ethics Committee (Reference no: EX/2023/QGC/102306). The justification for this exemption was as follows: the study was deemed a quality improvement activity and complied with Chapter 2.3 of the National Statement of Ethical Conduct in Research and involved only routinely collected data.Of the 53 mothers included in the study, 29 (55%) had schizophrenia and 24 (45%) had bipolar affective disorder. In addition, 97% of women with schizophrenia received atypical antipsychotics. Five women (21%) with bipolar affective disorder (mean age = 31.60 years, standard deviation = 6.19 years) were prescribed sodium valproate, with four women given contraception. Sodium valproate or lamotrigine were prescribed to four women (67%) with bipolar affective disorder whilst breastfeeding. Of mothers prescribed lithium, 92% did not breastfeed. Overall, 44% of women involuntarily admitted received antipsychotic depot medication compared with 38% of voluntary patients. Results are discussed in relation to the national guidelines.This is the first naturalistic study to examine the pharmacotherapy management of postpartum women admitted to a psychiatric MBU with schizophrenia and bipolar affective disorder. The study highlights that prescribing patterns across three time points during admission were generally in alignment with Australian national guidelines. [ABSTRACT FROM AUTHOR]

Background: The etiology of Bipolar Affective Disorder (BPAD) is influenced by a variety of factors, possibly related to gene-environment interactions. Childhood trauma (CT) has been associated with an increased risk of developing BPAD. It also impacts the course of illness. The association of subcomponents of CT with BPAD and its various characteristics has not been studied in detail. Aim: This study was conducted to evaluate the association of CT with BPAD and compare it with age and sex-matched healthy controls. Materials and Methods: Fifty cases of BPAD diagnosed as per International Classification Diseases 10 (Diagnostic Criteria for Research) and 50 years age and sex-matched healthy control were studied. The required sample size was 38. Assessment of CT was done using the Childhood Trauma Questionnaire and statistical methods were applied. Results: Among all cases of BPAD, 38 (76%) cases had experienced moderate to severe CT as compared to 10 (20%) of controls. This was statistically significant. All subtypes of CT were significantly associated with BPAD as compared to healthy controls. Among subtypes, emotional abuse had the highest association with BPAD (odds ratio 7.37, confidence interval 1.98-27.31). Conclusion: CT is significantly associated with BPAD. All subtypes of CT are associated with BPAD and among them, emotional abuse appeared to exert the biggest impact. A multicentric study with larger sample sizes will further substantiate this finding regarding subtypes. [ABSTRACT FROM AUTHOR]

Mental illnesses are one of the biggest contributors to the global disease burden. Despite the increased recognition, diagnosis and ongoing research of mental health disorders, the etiology and underlying molecular mechanisms of these disorders are yet to be fully elucidated. Moreover, despite many treatment options available, a large subset of the psychiatric patient population is nonresponsive to standard medications and therapies. There has not been a comprehensive study to date examining the burden and impact of treatable genetic disorders (TGDs) that can present with neuropsychiatric features in psychiatric patient populations. In this study, we test the hypothesis that TGDs that present with psychiatric symptoms are more prevalent within psychiatric patient populations compared to the general population by performing targeted next‐generation sequencing of 129 genes associated with 108 TGDs in a cohort of 2301 psychiatric patients. In total, 48 putative affected and 180 putative carriers for TGDs were identified, with known or likely pathogenic variants in 79 genes. Despite screening for only 108 genetic disorders, this study showed a two‐fold (2.09%) enrichment for genetic disorders within the psychiatric population relative to the estimated 1% cumulative prevalence of all single gene disorders globally. This strongly suggests that the prevalence of these, and most likely all, genetic diseases is greatly underestimated in psychiatric populations. Increasing awareness and ensuring accurate diagnosis of TGDs will open new avenues to targeted treatment for a subset of psychiatric patients. [ABSTRACT FROM AUTHOR]

Background: In psychiatry, resilience stands for one's capacity to recover from extremes of trauma and stress. It is an attribute of some people who manage to endure and recover fully, despite suffering significant traumatic conditions of extreme deprivation, serious threat, and major stress. Schizophrenia is a complex, chronic mental health disorder characterised by an array of symptoms, including delusions, hallucinations, disorganised speech or behaviour, and impaired cognitive ability. Bipolar affective disorder is a chronic and complex disorder of mood that is characterised by a combination of manic (bipolar mania), hypomanic and depressive (bipolar depression) episodes, with substantial subsyndromal symptoms that commonly present between major mood episodes. Materials and Methods: This is an Observational, cross-sectional and a comparative study was conducted in the Department of Psychiatry in Government Medical College and Nizamabad, Telangana. With a sample size of 90, 30 caregivers of patients with Schizophrenia, 30 caregivers of patients with Bipolar Affective Disorder and 30 caregivers of patients with Alcohol Dependence Syndrome, i.e. a total of 90 caregivers were assessed during the study period. They were assessed for resilience using appropriate scales and compared. Results: The mean resilience score was 68 in the children (n=8/90) and was the highest. The mean Resilience scores are highest in the Upper middle SE strata (70.8) and nearly the same in the Lower middle (63.16) and Upper lower (65.16) groups. The resilience scores seem to be the lowest in the Lower SE strata (49.8). The difference showed a high statistical significance of (p value=0.001). Conclusions: Caregiver resilience is an important aspect to be assessed and addressed, and the comparison of caregiver resilience between major psychiatric illnesses has often been under-studied. There was statistically significant difference between the resilience score of caregivers of Group 1 and Group 3. Caregivers who were children of the patients were more resilient than others. Sharing the burden of care of the patient showed better resilience for the caregivers. [ABSTRACT FROM AUTHOR]

1- To find out rates of medication adherence in patients with bipolar affective disorder. 2 - To find out the impact of demographic factors, use of substances, and positive family history of bipolar affective disorders on medication adherence in patients with bipolar affective disorder. Materials And Methods: In this study, 386 patients who were suffering from Bipolar Affective Disorder (BAD), were included through a convenient sampling technique from Government Sarhad Hospital for Psychiatric Diseases Peshawar. Data was collected through a self-prepared questionnaire. Odds ratio (OR) with 95% confidence interval (CI) were calculated with the help of SPSS version 24, while using Chi square test and Logistic Regression Analysis. Results: Among 386, 302 (78.2%) were males while 84 (21.8%) were females. Regarding education 164 (42.5%) were educated up to the primary level. Familial and sporadic cases were 138 (35.8%) and 248 (64.2%) respectively. Moreover, 232 (60.1%) had poor while 154 (39.9%) had good medication adherence. The frequencies of use of any substance, tobacco, and substance other than tobacco were 222 (57.5%), 214 (55.4%) and 114 (29.5%) respectively. There is a statistically significant impact of gender, education, positive family history of BAD, use of any substance, tobacco, and substance other than tobacco on medication adherence. At the same time, marital status, age of onset of BAD, and current age have no statistically significant impact on medication adherence. Conclusion: Gender, education, positive family history of BAD, use of any substance, tobacco, and substances other than tobacco are statistically significant while marital status, age of onset of BAD, and current age have no significant impact on medication adherence in BAD. [ABSTRACT FROM AUTHOR]

Objective: Stigma is very common among patients and caregivers of patients with severe mental disorders; however, there is a lack of comparative study data between schizophrenia and bipolar affective disorder in the Indian setting. Methods: For this, caregivers of patients with schizophrenia (n = 50) or bipolar affective disorder (n = 50) were assessed on the Affiliate Stigma Scale (ASS). Patients with schizophrenia (n = 50) or bipolar affective disorder (n = 50) were assessed on the Internalized Stigma of Mental Illness Scale (ISMIS). Results: Patients and caregivers of patients with schizophrenia have significantly higher mean scores on ISMIS and ASS, respectively, as compared to patients and caregivers of patients with bipolar affective disorder. Conclusion: This study suggests that patients with schizophrenia and their caregivers experience higher stigma than the caregivers of patients with bipolar affective disorder. Higher stigma is associated with higher psychological morbidity in the patients and caregivers. Therefore, clinicians managing patients with severe mental disorders must focus on stigma and psychological distress among the patients and caregivers and plan intervention strategies to reduce stigma. [ABSTRACT FROM AUTHOR]

ObjectiveBipolar affective disorder (BAD) is a mood disorder with high morbidity and mortality. Quetiapine can be used in the treatment of patients with BAD; however, the precise administration regimen of quetiapine in these patients is still unknown. In this study, a population pharmacokinetic (PPK) model of quetiapine in patients with BAD was constructed based on model-informed precision dosing (MIPD) and real-world clinical data and an optimal initial dose of quetiapine in these patients was recommended.MethodsA total of 99 patients with BAD treated with quetiapine were included. At the same time, the quetiapine concentrations, the physical and chemical indices of the patients, and the drug combination information were collected. A quetiapine PPK model for patients with BAD was then constructed and an initial dose based on Monte Carlo simulation was recommended.ResultsIn the final model of quetiapine for patients with BAD, the apparent oral clearance (CL/F) and the apparent volume of distribution (V/F) were 76.1 L/h and 530 L, respectively. For patients with BAD weighing 40–66 kg, the initial dose recommendation was 16 mg kg−1 day−1, the probability of reaching the therapeutic window was 78.8%–82.2%, and the probability of exceeding the upper limit of the therapeutic window was 5.2%–10.3%. For patients with BAD weighing 66–120 kg, the initial dose recommendation was 12 mg kg−1 day−1, the probability of reaching the therapeutic window was 81.5%–85.5%, and the probability of exceeding the upper limit of the therapeutic window was 3.6%–8.1%.ConclusionThe present study, for the first time, recommended an initial dose of quetiapine in patients with BAD based on MIPD and real-world data, providing an individualized reference for the administration of quetiapine in these patients.

Background: The role of expressed emotions (EEs) in relapse is poorly understood in bipolar affective disorder (BPAD). Understanding the association between EE and relapse will be useful in predicting further relapse and improving the prognosis. Aims and Objectives: The present study was conducted with the objectives of assessing the relationship between EEs of caregivers and relapse of the illness in patients with BPAD on regular medication and to assess the relationship between severity of illness and EEs. Materials and Methods: Fifty consecutive bipolar disorder patients diagnosed as per the International Classification of Diseases-10 criteria, who were admitted into the department of psychiatry with relapse while on regular medication, and their caregivers were recruited into the study. Data were collected using a semi-structured pro forma designed for the study. Clinical details of illness were obtained from the informant and the records. The severity of the current episode was assessed with the rating scales (Young Mania Rating Scale and Hamilton Depression Rating Scale). The Expressed emotions(EE) among the caregivers were assessed using the Family Attitude Scale, association between EE and relapses as well as the severity of illness was analyzed with appropriate tests. Results: The mean age of the patients was 43.8 ± 15.4. Majority of them were male and married (68% and 68%). The mean age of the caregivers was 47.1 ± 10.5. The majority of the caregivers were female (60%). Sixty-four percent of the caregivers had high EEs. The mean age of onset of illness was 26.2 ± 4.6, and the number of previous episodes was 3.9 ± 2.5. The total duration of illness was 17.7 ± 13.4 years, and the number of previous admissions was 3.3 ± 2.2. Among clinical variables of patients and caregivers with high EEs, a significant association was found between duration of illness (Chi-square test: 11.82, P = 0.003), previous episodes (Chi-square test: 12.26, P < 0.01), and the number of previous admissions (Chi-square test: 9.79, P = 0.002). Conclusion: There was a significant association between high EE and relapse.

Background: While expressed emotions (EEs) have been extensively explored in schizophrenia, there is a notable scarcity of literature concerning their study in bipolar affective disorder (BPAD). Few studies have directly compared EEs in these two psychiatric conditions. This research addresses this gap by examining the nuanced dynamics of emotional expression within familial and social contexts in both schizophrenia and BPAD. Hence, this study was done to investigate and compare the EEs in caregivers of patients with schizophrenia and BPAD. Methodology: Sociodemographic data were collected in intake pro forma from caregivers of outpatient and inpatients with a diagnosis of schizophrenia and BPAD as per the International Classification of Diseases 10. Primary caregivers of patients who met inclusion criteria were administered the Family Emotional Involvement and Criticism Scale (FEICS). Patients were administered the Positive and Negative Syndrome Scale (PANSS), Young Mania Rating Scale (YMRS), and Hamilton Depression Rating Scale to study psychopathology. Descriptive statistics such as mean, standard deviation (SD), and unpaired t-test were applied for continuous variables. Chi-square for categorical data, Spearman correlation test was used to study the correlation between the psychopathology of patients and EEs among caregivers. Results: The mean score of the perceived criticism subscale of FEICS of caregivers of BPAD was found to be 2.22 ± 0.68 SD and the emotional involvement subscale was 1.54 ± 0.58 SD. The mean score of the perceived criticism subscale of schizophrenia caregivers was 1.72 ± 0.73 and the emotional involvement subscale was 1.34 ± 0.471. The EE score across both perceived criticism and emotional involvement subscales was more in BPAD than in schizophrenia (P ≤ 0.001). There was a statistically significant positive correlation between the YMRS score and perceived criticism subscale scores (P ≤ 0.001), and there was also a statistically significant positive correlation between PANSS scores and perceived criticism and emotional involvement subscales of EE (P ≤ 0.001). No association was found between the severity of EE and sociodemographic factors of caregivers. Conclusions: The presence of high scores of EE among caregivers of BPAD signifies psychopathology in the family. This calls for providing psychosocial measures for caregivers so that they can take care of their ill family members effectively.

Parkinson's disease is a progressive neurodegenerative disorder characterized by damage to dopaminergic neurons in the substantia nigra, pars compacta and nigrostriatal pathways. This translates into a low level of dopamine which is responsible for the appearance of specific motor manifestations such as tremors, rigidity, bradykinesia, akinesia and postural instability. The clinical picture of Parkinson's disease is complemented by non-motor symptoms such as affective disorders, psychotic manifestations, neurocognitive disorders, hypnic disorders or autonomic dysfunction. This paper represents a critical assessment of the symptomatology, risk factors and treatment of affective disorders in Parkinson's disease, making a comparative analysis between the most common clinical manifestations and the pharmacological treatments used. Studies show an extremely variable rate (2.7%-90%) regarding the presence of depression in patients diagnosed with Parkinson's disease. In general, all antidepressants are effective and safe in treating depression in Parkinson's disease. The most commonly used in practice are SSRIs and mirtazapine, and the best results have been obtained with tricyclic antidepressants (such as desipramine, nortriptyline), SNRIs (venlafaxine) and SSRIs (citalopram, sertraline, paroxetine). Using the UPDRS scale, pramipexole (dopaminergic agonist) has been shown to have the best antidepressant effect results (both in major depressive disorder and in bipolar affective disorder) among antiparkinsonians. The number of studies evaluating bipolar affective disorder in Parkinson's disease is much smaller than those addressing unipolar depressive disorder. However, it has been shown that the presence of bipolar affective disorder ((hypo)manic, mixed and depressive episodes) predisposes to the appearance of this neurodegenerative disease (having a much higher incidence compared to the general population). The treatment of this condition is carried out with mood stabilizers, but lithium (the first line in bipolar affective disorder) is not recommended in patients with Parkinson's disease due to adverse effects (it can worsen tremors). Thus, valproic acid (especially for rapid-cycling bipolar affective disorder) and antipsychotics with a thymostabilizing effect such as clozapine, quetiapine and pimavanserin are preferred. [ABSTRACT FROM AUTHOR]

Background: Caring for patients with severe mental illness could be stressful. Information regarding the burden and quality of life (QOL) of the family caregivers of patients with bipolar affective disorder (BD) is scant from India. It was intended to study the burden and QOL of the caregivers of patients with BD and their association with sociodemographic factors. Materials and Methods: It was a cross-sectional study in a tertiary-level psychiatric hospital. Caregivers (n = 60) of patients with BD were assessed using the Family Burden Interview Schedule and World Health Organization QOL‑BREF, along with their sociodemographic data. Results: Caregivers reported considerable burden in various areas, and a large proportion (71.7%) had higher burden and this group had significantly lower QOL in all domains. Burden and QOL had variations among demographic groups. There was no difference in the burden reported by male and female caregivers, however, the former appeared to have better QOL. Caregivers with the lowest income had considerable burden and poor QOL, besides the caregivers with lower education and from nuclear families. Conclusions: Family caregivers of patients with BD experienced considerable burden and had poorer QOL. Caregivers with lower education, the lowest income, and nuclear families had greater challenges. Assessment of caregivers’ needs and provision of appropriate support require prioritization. [ABSTRACT FROM AUTHOR]

Background: The role of expressed emotions (EEs) in relapse is poorly understood in bipolar affective disorder (BPAD). Understanding the association between EE and relapse will be useful in predicting further relapse and improving the prognosis. Aims and Objectives: The present study was conducted with the objectives of assessing the relationship between EEs of caregivers and relapse of the illness in patients with BPAD on regular medication and to assess the relationship between severity of illness and EEs. Materials and Methods: Fifty consecutive bipolar disorder patients diagnosed as per the International Classification of Diseases-10 criteria, who were admitted into the department of psychiatry with relapse while on regular medication, and their caregivers were recruited into the study. Data were collected using a semi-structured pro forma designed for the study. Clinical details of illness were obtained from the informant and the records. The severity of the current episode was assessed with the rating scales (Young Mania Rating Scale and Hamilton Depression Rating Scale). The Expressed emotions(EE) among the caregivers were assessed using the Family Attitude Scale, association between EE and relapses as well as the severity of illness was analyzed with appropriate tests. Results: The mean age of the patients was 43.8 ± 15.4. Majority of them were male and married (68% and 68%). The mean age of the caregivers was 47.1 ± 10.5. The majority of the caregivers were female (60%). Sixty-four percent of the caregivers had high EEs. The mean age of onset of illness was 26.2 ± 4.6, and the number of previous episodes was 3.9 ± 2.5. The total duration of illness was 17.7 ± 13.4 years, and the number of previous admissions was 3.3 ± 2.2. Among clinical variables of patients and caregivers with high EEs, a significant association was found between duration of illness (Chi-square test: 11.82, P = 0.003), previous episodes (Chi-square test: 12.26, P < 0.01), and the number of previous admissions (Chi-square test: 9.79, P = 0.002). Conclusion: There was a significant association between high EE and relapse. [ABSTRACT FROM AUTHOR]

Background: Bipolar affective disorders are dimensional illnesses in which patients experience, during the long-term course of illness, fluctuating levels of severity of manic and depressive symptoms interspersed with symptom-free periods. It is a highly exhausting and relapsing psychiatric disorder associated with significant morbidity and comorbidity. The World Health Organization Disability Assessment Schedule (WHODAS) is an International Classification of Functioning-based multidimensional instrument that was developed for measuring disability. Aim and Objective: The present study aimed to check the correlation and inter-rater agreement amongst the patient, caregiver, and clinician-administered version of the WHODAS 2.0 among persons with bipolar affective disorder. Materials and Methods: The study was cross-sectional in nature. Thirty samples of patients with bipolar affective disorder as per ICD-10 criteria were selected using a consecutive sampling technique. Patients above 18 years of age with a total duration of illness of at least more than 2 years were included and used self, proxy, and interviewer-administered versions of WHODAS 2.0. Results: The total score of WHODAS 2.0 shows that the interclass correlation coefficient between the patient and caregiver, caregiver and clinician, and patient and clinician was 0.655 (0.469--0.802), 0.599 (0.395--0.767), and 0.722 (0.586--0.820), respectively, indicative of moderate reliability. Caregivers showed a higher mean in cognition, 3.73 (3.13); mobility, 2.63 (1.73); and self-care, 0.867 (1.25), than other raters. Clinicians showed a higher mean (standard deviation) in getting along with people, 4.13 (1.69); life activities of the household, 5.46 (2.67); and participation in society, 10.70 (2.56), than other raters. Conclusion: People suffering from bipolar affective disorder are prone to disability albeit in the mild-to-moderate variety. The findings show that there was moderate reliability between the patient and caregiver, caregiver and clinician, and patient and clinician among the patient rated, caregiver rated on the overscore of WHODAS 2.0. [ABSTRACT FROM AUTHOR]

Background: The etiology of Bipolar Affective Disorder (BPAD) is influenced by a variety of factors, possibly related to gene-environment interactions. Childhood trauma (CT) has been associated with an increased risk of developing BPAD. It also impacts the course of illness. The association of subcomponents of CT with BPAD and its various characteristics has not been studied in detail. Aim: This study was conducted to evaluate the association of CT with BPAD and compare it with age and sex-matched healthy controls. Materials and Methods: Fifty cases of BPAD diagnosed as per International Classification Diseases 10 (Diagnostic Criteria for Research) and 50 years age and sex-matched healthy control were studied. The required sample size was 38. Assessment of CT was done using the Childhood Trauma Questionnaire and statistical methods were applied. Results: Among all cases of BPAD, 38 (76%) cases had experienced moderate to severe CT as compared to 10 (20%) of controls. This was statistically significant. All subtypes of CT were significantly associated with BPAD as compared to healthy controls. Among subtypes, emotional abuse had the highest association with BPAD (odds ratio 7.37, confidence interval 1.98-27.31). Conclusion: CT is significantly associated with BPAD. All subtypes of CT are associated with BPAD and among them, emotional abuse appeared to exert the biggest impact. A multicentric study with larger sample sizes will further substantiate this finding regarding subtypes.

BACKGROUND: Self-stigma remains one of the most vexing issues in psychiatry. It complicates the treatment and social functioning of patients with endogenous psychiatric disorders. Identifying the specific features of self-stigma depending on the type and duration of the endogenous mental illness can help solve this problem. AIM: The aim of this study was to establish the level and specific features of self-stigma in patients with various types of chronic endogenous psychiatric disorders at different disease stages and to establish the correlation between the level of self-stigma and the attitude of the patient to his/her disease and treatment. METHODS: Clinical psychopathology assessment, psychometric scales and questionnaires: “Positive and Negative Syndrome Scale” (PANSS), “Questionnaire for Self-Stigma Assessment in Mentally Ill Patients”, and Russian versions of the “Insight Scale for Psychosis” (ISP), and “Drug Attitude Inventory” (DAI-10). The cross-sectional study included 86 patients with endogenous mental illnesses (bipolar affective disorder and schizophrenia spectrum disorders. RESULTS: The analysis of the results of the “Questionnaire for Self-Stigma Assessment in Mentally Ill Patients” showed that at the initial disease stages the highest level of self-stigma is observed in patients with bipolar affective disorder (M±σ=1.22±0.73; Me [Q1; Q3]=1.10 [0.83; 1.60]), while the lowest level was observed in patients with schizophrenia spectrum disorders (M±σ=0.86±0.53; Me [Q1; Q3]=0.77 [0.31; 1.25]). Patients with schizophrenia and schizoaffective disorder and a disease duration more than five years participating in a long-term comprehensive psychosocial rehabilitation program also demonstrated high rates of self-stigma (M±σ=1.20±0.57, Me [Q1; Q3]=1.26 [0.89; 1.47]). The study groups showed differences in terms of the structure of components of self-stigma and their severity; significant correlations were uncovered between the self-stigma parameters and the attitude of patients to their disease and therapy. CONCLUSION: The results of this study contribute to a better understanding of the specific features of self-stigma in patients with various endogenous disorders at different stages of the disease. These data can be used as part of a comprehensive psychosocial treatment program for this patient cohort, as well as for future research.

Introduction: One of India’s most valuable resources is its young people, and this generation needs to be nurtured for the bright future of the nation. However, when the young generation is affected by chronic mental disorders, families find it difficult to take care of them and are burdened with the responsibility for several years. Aim: To explore the lived experiences of Family Caregivers (FCGs) of young adults with chronic mental disorders. Materials and Methods: This qualitative study was conducted at the selected mental inpatient and outpatient Department of a selected mental health facility in Urban Bangaluru, Karnataka, India from April 2021 to December 2021. The authors used a phenomenological qualitative study to explore the lived experiences of family caregivers of young adults with chronic mental disorders {mania, depression, Bipolar Affective Disorder (BPAD), schizophrenia} aged between 18-40 years. The Family Caregivers of young adults undergoing treatment were approached for written informed consent and recruited through purposive sampling. Data were collected using face-to-face, in-depth, semi-structured interviews. Each interview lasted around 45 minutes to one hour, and data saturation was achieved with 15 samples. Interviews were conducted over a period of nine months. The audio-recorded interviews were transcribed, interpreted, and investigated using Colaizzi’s data analysis framework. Baseline variables were analysed using descriptive statistics. Results: In the present, the family caregivers’ ages ranged from 28 to 60 years, with the majority (67%) being females and employed. One of the family members was affected by a mental disorder. A rehabilitation facility was unavailable to the majority (67%) of them near their residence. Regarding the young adults with chronic mental disorders, the majority (74%) were unemployed and diagnosed with affective disorders. The maximum duration of illness was 20 years, with onset typically at the age of 17-21 years. From the analysis, six main themes and 36 subthemes emerged. The main themes were as follows: family caregivers experience difficulty in identifying the responsible person and support system, providing physical care, tackling emergencies, problems with medication and early identification of relapse, problems with indecent behaviour, and knowledge deficit related to mental disorders and their management. Conclusion: The study concludes that family caregivers of young adults with chronic mental disorders experience various psychosocial and economic issues and problems while caring for a young adult with chronic mental disorders. The knowledge generated from the present study can be utilised by mental health professionals to plan home-based care strategies to improve the quality of life and reduce the burden of care for FCGs.

Abstract Background Patients with mental disorders have a higher prevalence of sleep problems than the general population. Sleep problems may include insomnia, circadian rhythm disorders, or hypersomnia. A transdiagnostic approach combining cognitive behavioral therapy for insomnia (CBT-I) with chronotherapy addressing a broad range of sleep problems has shown promising results in a limited number of studies. The aim of the study is to investigate the efficacy of a transdiagnostic sleep intervention for patients with sleep problems comorbid to bipolar disorder, unipolar depression, or attention deficit disorders. The primary hypothesis is that the intervention improves sleep quality compared with a control group. The secondary hypotheses are that the intervention increases subjective and objective sleep efficiency, reduces sleep onset latency, wake after sleep onset, number of awakenings, and severity of insomnia; and that it improves well-being, personal recovery, work ability, and consumption of sleep medication compared with a control group. Methods The study is a randomized controlled trial enrolling 88 outpatients with bipolar disorder, major depression, or attention deficit disorder with symptoms of various sleep problems (insomnia, circadian rhythm disorders, or hypersomnia). Patients are allocated to either an intervention group receiving six sessions of transdiagnostic sleep treatment or to a control group receiving a single session of sleep hygiene education. Assessments are made at baseline, at week two, and after 6 weeks in both groups. Actigraphy is performed continuously throughout the 6-week study period for all patients. The primary outcome is changes in the subjective appraisal of sleep quality (Pittsburgh Sleep Quality Index). The secondary outcomes are changes in sleep efficiency, sleep onset latency, wake after sleep onset, number of nocturnal awakenings (based on actigraph and sleep diary data), changes in insomnia severity (Insomnia Severity Index), well-being (WHO-5 Well-Being Index), personal recovery (INSPIRE-O), work ability (Work Ability Index), and consumption of sleep medication (sleep-diaries). Discussion The study was initiated in 2022 and the inclusion period will continue until mid-2024. The results may have implications for the development and implementation of additional treatment options for patients with mental disorders and comorbid sleep problems. Trial registration ClinicalTrials.gov. NCT05406414. Registered on June 6, 2022.

Bipolar affective disorder (BP) causes major functional impairment and reduced quality of life not only for patients, but also for many close relatives. We aimed to investigate mRNA levels in BP patients to find differentially expressed genes linked to specific clinical course variants; assuming that several gene expression alterations might indicate vulnerability pathways for specific course and severity of the disease. We searched for up- and down-regulated genes comparing patients with diagnosis of BP type I (BPI) vs type II (BPII), history of suicide attempts, psychotic symptoms, predominance of manic/hypomanic episodes, and history of numerous episodes and comorbidity of substance use disorders or anxiety disorders. RNA was extracted from peripheral blood mononuclear cells and analyzed with use of microarray slides. Differentially expressed genes (DEGs) were found in all disease characteristics compared. The lowest number of DEGs were revealed when comparing BPI and BPII patients (18 genes), and the highest number when comparing patients with and without psychotic symptoms (3223 genes). Down-regulated genes identified here with the use of the DAVID database were among others linked to cell migration, defense response, and inflammatory response. The most specific transcriptome profile was revealed in BP with psychotic symptoms. Differentially expressed genes in this variant include, among others, genes involved in inflammatory and immune processes. It might suggest the overlap of biological background between BP with a history of psychotic features and schizophrenia. [ABSTRACT FROM AUTHOR]

Introduction: Treatment adherence rates among patients of affective disorders remain sub-par across the world. Sociocultural factors affecting the same remain poorly understood. The current study aimed to explore and conceptualize the same. Methodology: The study utilized a qualitative grounded and phenomenological approach study design. The patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders -- Fifth edition (DSM-5) criteria of unipolar depression or bipolar affective disorder, and were presently under our treatment for at least three months and currently in remission, aged 18-60 years, and were able to understand Hindi or English, scored less than 6 on the Medication Adherence Rating Scale were included. Furthermore, key caregivers were also included in the study. Using purposive sampling and data saturation, a total of 30 participants were recruited. In-depth interviews were conducted using the cultural formulation interview as given in DSM-5, which was used as the interview tool. Thematic analysis of data was performed using Atlas.ti version 8.4.3. Results: A total of 14 themes (deductive and inductive) emerging from 171 codes were identified. Some of the important inductive themes included cultural and societal attitude toward illness and treatment-seeking, trust, experience, and expectations from available health care, faith healing-related practices and beliefs. The implicit themes such as cultural understanding of the problem and cultural factors affecting help-seeking, also showed prudent findings. Conclusion: The study findings demonstrate the various features of the sociocultural milieu and identity of an individual and family that have an influence on treatment-seeking behavior. [ABSTRACT FROM AUTHOR]

Introduction: One of India's most valuable resources is its young people, and this generation needs to be nurtured for the bright future of the nation. However, when the young generation is affected by chronic mental disorders, families find it difficult to take care of them and are burdened with the responsibility for several years. Aim: To explore the lived experiences of Family Caregivers (FCGs) of young adults with chronic mental disorders. Materials and Methods: This qualitative study was conducted at the selected mental inpatient and outpatient Department of a selected mental health facility in Urban Bangaluru, Karnataka, India from April 2021 to December 2021. The authors used a phenomenological qualitative study to explore the lived experiences of family caregivers of young adults with chronic mental disorders {mania, depression, Bipolar Affective Disorder (BPAD), schizophrenia} aged between 18-40 years. The Family Caregivers of young adults undergoing treatment were approached for written informed consent and recruited through purposive sampling. Data were collected using face-to-face, indepth, semi-structured interviews. Each interview lasted around 45 minutes to one hour, and data saturation was achieved with 15 samples. Interviews were conducted over a period of nine months. The audio-recorded interviews were transcribed, interpreted, and investigated using Colaizzi's data analysis framework. Baseline variables were analysed using descriptive statistics. Results: In the present, the family caregivers' ages ranged from 28 to 60 years, with the majority (67%) being females and employed. One of the family members was affected by a mental disorder. A rehabilitation facility was unavailable to the majority (67%) of them near their residence. Regarding the young adults with chronic mental disorders, the majority (74%) were unemployed and diagnosed with affective disorders. The maximum duration of illness was 20 years, with onset typically at the age of 17-21 years. From the analysis, six main themes and 36 subthemes emerged. The main themes were as follows: family caregivers experience difficulty in identifying the responsible person and support system, providing physical care, tackling emergencies, problems with medication and early identification of relapse, problems with indecent behaviour, and knowledge deficit related to mental disorders and their management. Conclusion: The study concludes that family caregivers of young adults with chronic mental disorders experience various psychosocial and economic issues and problems while caring for a young adult with chronic mental disorders. The knowledge generated from the present study can be utilised by mental health professionals to plan home-based care strategies to improve the quality of life and reduce the burden of care for FCGs. [ABSTRACT FROM AUTHOR]

People living with severe mental illness, such as schizophrenia and bipolar affective disorder, frequently experience poorer physical health compared to those without mental illness. This issue has hitherto been approached through the disease-centred construct of comorbidity, where subsequent conditions are viewed as secondary to an 'index condition'. In contrast, this Viewpoint sets out to explain why multimorbidity, a patient-centred concept that instead refers to the coexistence of multiple chronic illnesses, is a more versatile and robust framework for tackling the issue of poor physical health in people with severe mental illness. In establishing this argument, this Viewpoint has sought to address three key areas. First, this article will discuss the epidemiology of both physical and psychiatric multimorbidity, with respect to how they manifest at greater frequency and at younger ages in people with severe mental illness. Second, the profound consequences of this multimorbidity burden will be explored, with respect to the 'three D ' s ' of death (premature mortality), disability (functional impacts) and deficit (health-economic impacts). Finally, the utility of multimorbidity as a framework will be illustrated through a proposal for a three-dimensional multimorbidity construct composed of (1) quantity, (2) severity and (3) duration of an individual's chronic illnesses. Consequently, this Viewpoint aims to capture why it is necessary for modern psychiatry to grasp the concept of multimorbidity to facilitate holistic healthcare for people living with severe mental illness. [ABSTRACT FROM AUTHOR]

SUMMARY: Acute behavioural disturbance is relatively common during the perinatal period. The management of agitation in pregnant women is similar to that in the general population, although with some additional considerations, such as modifications to restraint techniques, careful medication selection, monitoring of maternal and fetal well-being and the importance of a debrief. There are benefits of agreeing a pre-determined care plan for women who are at risk. [ABSTRACT FROM AUTHOR]

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The polymorphism of the clinical manifestations of schizophrenia and bipolar affective disorder (BD), late referral to the doctor, comorbidity with somatic diseases and the use of somatotropic medications by psychiatric patients, as well as the frequent development of adverse events (AEs), require constant analysis and improvement of the methods and means of psychopharmacotherapy.Objective: to study the characteristics of the use of quetiapine (Seroquel®) in real outpatient clinical practice.Material and methods. A patient was enrolled in the program if there was a need to prescribe quetiapine (Seroquel®) or to switch from the current therapy to quetiapine. During the program visit, the doctor filled in an individual registration card with information about patient and therapy. The data were statistically analyzed.Results. Quetiapine is prescribed by practicing psychiatrists in Russia not only according to the official indications, but also for psychopathological disorders of other nosology with similar clinical manifestations, such as dementia, organic and affective (depressive episode, recurrent depressive disorder), as well as psychogenic disorders. Up to 27.3% of physicians consider the effect of quetiapine to be quite sufficient in a mixed affective state within the framework of BD dynamics. Quetiapine is used by physicians to treat patients with varying duration of mental disorder (mean 5.1–13.5 years), severity of current mental state (mean CGI-S score 4.3–4.97) and a wide age range (mean age 34.5–60.8 years). When prescribing quetiapine, physicians note that the drug has antidepressant, anxiolytic, sedative and hypnotic effects, regardless of the type of mental disorder. Quetiapine is mainly prescribed as a monotherapy, either primary or resumed after a break – 815 (64.5%) observations. At the same time, quetiapine is used significantly more frequently as monotherapy for BD (69.4%) and mental illnesses of other origin (64.7%) than for schizophrenia (53.8%; p

Poor medication adherence of patients with bipolar affective disorder is associated with stigma, drug adverse reactions and family economic burden. However, high-quality studies about n medication adherence in patients with bipolar affective disorder are relatively scarce. This paper reviewed studies on influencing factors, assessment tools and interventions of medication adherence in patients with bipolar affective disorder. Efforts should be made to investigate the intelligent tele-healthcare system and tele-healthcare-based interventions, and provide reference for establishment of a long-term accessible extended care. (双相情感障碍患者因病耻感、药物不良反应、家庭经济因素等原因, 其用药依从性水平较低。目前国内针对双相障碍服药依从性的高质量研究仍较少。本文对双相情感障碍服药依从性现状进行综述, 包括影响因素、评估工具及干预措施等。建议未来进一步探索适合我国的远程智能医疗系统、开展基于远程医疗的护理干预, 为患者提供更加便捷、远期的延续护理干预。)

Background: Post-COVID is a multifactorial disease that describes the residual effects of acute COVID-19 infection that are continuous or relapsing and in remission. The study found that 87% of people who recovered and were discharged from the hospital showed persistence of at least one symptom even within 60 days. COVID-19 patients who have bipolar disorder require therapeutic adjustments to avoid specific drug interactions between psychotropic drugs and those used in COVID-19 protocols. Objective: To determine the treatment of post-COVID patients with bipolar affective disorder. Methods: Collect and analyze research articles on Update Therapy for Post-COVID Syndrome Patients with Bipolar Affective Disorder. These articles were obtained by searching using Google Scholar, PubMed/NCBI, and SAGE Journal. Results: The use of combination drugs between antipsychotics and antidepressants with hydroxychloroquine/azithromycin is not recommended because it has side effects that can induce psychiatric symptoms. COVID-19 patients with bipolar disorder (BD) who do not respond to pharmacotherapy may receive electroconvulsive therapy (ECT). Non-pharmacological therapies such as counseling and the use of telepsychiatry are effective in treating mental health and overcoming adverse psychological effects. Conclusion: COVID-19 patients with bipolar affective disorder require unique therapy to avoid drug interactions and pharma-cotherapy. Non-pharmacological efforts include counseling and telepsychiatry to cope with emotional distress and mental health challenges. However, challenges remain in providing care for these patients.

The review article highlights the problem of using hematological coefficients of systemic inflammation in clinical practice, as well as the results of studies aimed at its use in the diagnosis and evaluation of therapeutic response in the treatment of mood disorders. The contribution of each individual link of the immune system to the pathogenesis of an inflammatory reaction is known, but currently of most interest are neutrophil-lymphocytic (NLR), monocyte-lymphocytic (MLR) and platelet-lymphocytic (PLR) ratios, as well as indices of systemic immune-inflammation (SII, platelet count x number of neutrophils / lymphocytes) and system inflammation response (SIRI, number of neutrophils x number of monocytes / lymphocytes). All coefficients are available for calculation based on a routine complete blood count. The analysis of the literature demonstrates the significance of these ratios, but emphasizes the need for further research. A more detailed study of these ratios will allow achieving their prognostic value and a more objective assessment of their validity and specificity for the diagnosis, prediction of risks and variants of the affective disorders course.

For most women, pregnancy and the postpartum period are times of great joy and expectation. However, for women with a diagnosis of bipolar affective disorder, there is an exceptionally high risk of deterioration in their mental health. There is the real possibility of developing postpartum psychosis, possibly requiring acute psychiatric admission and being separated from their baby. This can have devastating consequences for a woman, her baby, the family and society. Multiple services/disciplines across primary, secondary and tertiary care settings need to work together to enhance outcomes for these women. In Ireland, a relatively new collaborative way of working is emerging, as specialist perinatal mental health teams are developed. This case review aims to illustrate the complexities of and potential in collaborative team working to support a woman with a pre-existing a mental health disorder, and her family, during pregnancy. This was done through a specialist perinatal mental health teams collaboration co-ordinated by a clinical nurse specialist. [ABSTRACT FROM AUTHOR]

Background: Persons with bipolar affective disorder (BPAD) need long-term care and support. As most of the expenses for this are met personally by the caregivers, it will have financial implications for them. However, we do not know how much financial well-being is associated with the caregivers’ burden as compared to the illness severity. Aim: This study aimed to examine the association between financial well‑being and illness severity with the caregivers’ burden in the context of BPAD. Materials and Methods: This study adopted a cross‑sectional descriptive design. The first 50 consenting caregivers of persons with an International Classification of Diseases (ICD)‑10 diagnosis of BPAD, who visited the National Institute of Mental Health and Neurosciences (NIMHANS) within 2019–2021, were included in the study. The patients were assessed on the Clinical Global Impression (CGI) and the Global Assessment of Functioning (GAF) for the severity of the symptoms and the current level of functioning, respectively. Caregivers were assessed on the Personal Finance Well-Being Scale. Results: In this study, the majority of caregivers were males (62%), with a median, monthly household income of Rs. 24,000, and expenditure of Rs. 12,000. The median cost of medicine was Rs. 1000 per month. The majority (64%) of patients did not have any health insurance. A total of 28 (56%) caregivers reported the cost of damage due to illness behavior. It was found that the severity of illness and current level of functioning had a significant negative correlation with caregivers’ burden. The financial well‑being as reflected through income and health expenditure did not have a significant correlation with the caregivers’ burden. Conclusions: Caregivers of persons with BPAD meet the treatment expenditure out of their pocket. Though they have the financial burden, it is the illness severity and functioning capacities that are associated with caregivers’ burden. These findings have implications for mental health care in persons with BPAD. [ABSTRACT FROM AUTHOR]

Abstract Background Bipolar affective disorder (BAD) is a common severe mental health condition with a relapsing course that may include periods of hospital re-admissions. With recurrent relapses and admissions, the course, prognosis, and patient’s overall quality of life can be affected negatively. This study aims to explore the rates and clinical factors associated with re-admission among individuals with BAD. Method This study used data from a retrospective chart review of all records of patients with BAD admitted in 2018 and followed up their hospital records for four years till 2021 at a large psychiatric unit in Uganda. Cox regression analysis was used to determine the clinical characteristics associated with readmission among patients diagnosed with BAD. Results A total of 206 patients living with BAD were admitted in 2018 and followed up for four years. The average number of months to readmission was 9.4 (standard deviation = 8.6). The incidence of readmission was 23.8% (n = 49/206). Of those readmitted during the study period, 46.9% (n = 23/49) and 28.6% (n = 14/49) individuals were readmitted twice and three times or more, respectively. The readmission rate in the first 12 months following discharge was 69.4% (n = 34/49) at first readmission, 78.3% (n = 18/23) at second readmission, and 87.5% (n = 12/14) at third or more times. For the next 12 months, the readmission rate was 22.5% (n = 11/49) for the first, 21.7% (n = 5/23) for the second, and 7.1% (n = 1/14) for more than two readmissions. Between 25 and 36 months, the readmission rate was 4.1% (n = 2/49) for the first readmission and 7.1% (n = 1/14) for the third or more times. Between 37 and 48 months, the readmission rate was 4.1% (n = 2/49) for those readmitted the first time. Patients who presented with poor appetite and undressed in public before admission were at increased risk of being readmitted with time. However, the following symptoms/clinical presentations, were protective against having a readmission with time, increased number of days with symptoms before admission, mood lability, and high energy levels. Conclusion The incidence of readmission among individuals living with BAD is high, and readmission was associated with patients’ symptoms presentation on previous admission. Future studies looking at BAD using a prospective design, standardized scales, and robust explanatory model are warranted to understand causal factors for hospital re-admission and inform management strategies.

Abstract Background Hospitalization is often necessary for individuals with Bipolar affective Disorder (BAD) during severe manic or depressive episodes, as well as for stabilizing treatment regimens. However, a significant proportion of patients admitted for treatment of BAD abscond or leave the hospital without permission during their stay. In addition, patients managed for BAD may have unique characteristics that might force them into absconding. For example, the high prevalence of co-morbid substance use disorder – craving to use substances, suicidal behaviors – attempts to die by suicide, and cluster B personality disorders – characterized by impulsive acts. It is, therefore, essential to understand the factors contributing to absconding among patients with BAD, to facilitate designing strategies for preventing and managing this behavior. Method This study was based on a retrospective chart review of the inpatients diagnosed with BAD at a tertiary psychiatry facility in Uganda from January 2018 to December 2021. Results Approximately 7.8% of those with BAD absconded from the hospital. The likelihood of absconding among those with BAD increased with the use of cannabis [adjusted odds ratio (aOR) = 4.00, 95% confidence interval (CI) = 1.22–13.09, p-value = 0.022] and having mood lability [aOR = 2.15, 95% CI = 1.10–4.21, p-value = 0.025]. However, receiving psychotherapy during the admission (aOR = 0.44, 95 CI = 0.26–0.74, p-value = 0.002) and treatment with haloperidol (aOR = 0.39, 95% CI = 0.18–0.83, p-value = 0.014) reduced the likelihood of absconding. Conclusion Absconding among patients with BAD is common in Uganda. Those with symptoms of affective lability and those with comorbid cannabis use tend to abscond more, while those who receive haloperidol and psychotherapy are less likely to abscond.

Background: Bipolar Affective Disorder (BPAD) is a challenging psychiatric illness which burdens both the patient as well as the caregiver. As a consequence, many psychiatric symptoms are reported in the spouses and caregivers of patients with BPAD. Caregivers adopt various coping behaviors to tackle their stress and overcome these situations. The objective is to study psychopathology and coping strategies among wives of inpatients with BPAD admitted under the psychiatry department of a tertiary care teaching institute. Methods: This cross-sectional observational study was done at the inpatient wards of the Department of Psychiatry of Jubilee Mission Medical College & Research Institute, Kerala. The sample size was 70 and the study duration was 18 months. After approval from the institutional ethics committee, the study was done. Psychopathology was assessed using Comprehensive Psychopathological Rating Scale (CPRS) and psychiatric morbidity using Mini International Neuropsychiatric Interview Plus (Mini-Plus). Coping behavior was assessed using Brief-COPE. Results: Most commonly reported psychopathology was reduced sleep (71.4%). Nearly three-fourth were having psychiatric morbidity, with a majority having adjustment disorder – brief depressive reaction. The most commonly used coping behaviors were approach coping/problem-focused coping rather than avoidant coping. Conclusion: From this study, it was found that the majority of the wives of patients with BPAD had depressive symptoms and most of them were diagnosed to have adjustment disorder. Therefore, while planning the management of patients with BPAD we have to ensure that adequate psychosocial support is being provided to their primary caregivers also.

The importance of the timely detection and differential diagnosis of depressive disorder and bipolar affective disorder (BAD) is beyond doubt. In cases with difficult differential diagnoses, clinicians can call on objective investigation methods such as electroencephalography. This review summarizes and systematizes current methods for the differential diagnosis of unipolar and bipolar depression based on electroencephalography data. A literature search was conducted using the search terms depression, bipolar disorder, unipolar depression, differential diagnosis, neuromarkers, electroencephalography, and quantitative EEG. This search was run in the PubMed, NCBI, ResearchGate, RSCI, Scopus, and Google Scholar databases from 2000 to 2022. Resting EEG parameters in patients are generally ambiguous and require further clarification; however, data have been obtained showing differences in the asymmetry of bioelectrical activity, spectral power, and coherence between patients with bipolar disorder and unipolar depression. A number of studies of evoked potentials (EP) have yielded similar results – longer P300 latency and decreases in its amplitude in patients with bipolar disorder as compared with those with unipolar depression, indicating that the EP method has promise in solving the problem of differential diagnosis. [ABSTRACT FROM AUTHOR]

Background: Persons with bipolar affective disorder (BPAD) need long-term care and support. As most of the expenses for this are met personally by the caregivers, it will have financial implications for them. However, we do not know how much financial well-being is associated with the caregivers' burden as compared to the illness severity. Aim: This study aimed to examine the association between financial well-being and illness severity with the caregivers' burden in the context of BPAD. Materials and Methods: This study adopted a cross-sectional descriptive design. The first 50 consenting caregivers of persons with an International Classification of Diseases (ICD)-10 diagnosis of BPAD, who visited the National Institute of Mental Health and Neurosciences (NIMHANS) within 2019–2021, were included in the study. The patients were assessed on the Clinical Global Impression (CGI) and the Global Assessment of Functioning (GAF) for the severity of the symptoms and the current level of functioning, respectively. Caregivers were assessed on the Personal Finance Well-Being Scale. Results: In this study, the majority of caregivers were males (62%), with a median, monthly household income of Rs. 24,000, and expenditure of Rs. 12,000. The median cost of medicine was Rs. 1000 per month. The majority (64%) of patients did not have any health insurance. A total of 28 (56%) caregivers reported the cost of damage due to illness behavior. It was found that the severity of illness and current level of functioning had a significant negative correlation with caregivers' burden. The financial well-being as reflected through income and health expenditure did not have a significant correlation with the caregivers' burden. Conclusions: Caregivers of persons with BPAD meet the treatment expenditure out of their pocket. Though they have the financial burden, it is the illness severity and functioning capacities that are associated with caregivers' burden. These findings have implications for mental health care in persons with BPAD.

Background: Bipolar affective disorder (BAD) is a common severe mental health condition with a relapsing course that may include periods of hospital re-admissions. With recurrent relapses and admissions, the course, prognosis, and patient's overall quality of life can be affected negatively. This study aims to explore the rates and clinical factors associated with re-admission among individuals with BAD. Method: This study used data from a retrospective chart review of all records of patients with BAD admitted in 2018 and followed up their hospital records for four years till 2021 at a large psychiatric unit in Uganda. Cox regression analysis was used to determine the clinical characteristics associated with readmission among patients diagnosed with BAD. Results: A total of 206 patients living with BAD were admitted in 2018 and followed up for four years. The average number of months to readmission was 9.4 (standard deviation = 8.6). The incidence of readmission was 23.8% (n = 49/206). Of those readmitted during the study period, 46.9% (n = 23/49) and 28.6% (n = 14/49) individuals were readmitted twice and three times or more, respectively. The readmission rate in the first 12 months following discharge was 69.4% (n = 34/49) at first readmission, 78.3% (n = 18/23) at second readmission, and 87.5% (n = 12/14) at third or more times. For the next 12 months, the readmission rate was 22.5% (n = 11/49) for the first, 21.7% (n = 5/23) for the second, and 7.1% (n = 1/14) for more than two readmissions. Between 25 and 36 months, the readmission rate was 4.1% (n = 2/49) for the first readmission and 7.1% (n = 1/14) for the third or more times. Between 37 and 48 months, the readmission rate was 4.1% (n = 2/49) for those readmitted the first time. Patients who presented with poor appetite and undressed in public before admission were at increased risk of being readmitted with time. However, the following symptoms/clinical presentations, were protective against having a readmission with time, increased number of days with symptoms before admission, mood lability, and high energy levels. Conclusion: The incidence of readmission among individuals living with BAD is high, and readmission was associated with patients' symptoms presentation on previous admission. Future studies looking at BAD using a prospective design, standardized scales, and robust explanatory model are warranted to understand causal factors for hospital re-admission and inform management strategies. [ABSTRACT FROM AUTHOR]

Background: Hospitalization is often necessary for individuals with Bipolar affective Disorder (BAD) during severe manic or depressive episodes, as well as for stabilizing treatment regimens. However, a significant proportion of patients admitted for treatment of BAD abscond or leave the hospital without permission during their stay. In addition, patients managed for BAD may have unique characteristics that might force them into absconding. For example, the high prevalence of co-morbid substance use disorder – craving to use substances, suicidal behaviors – attempts to die by suicide, and cluster B personality disorders – characterized by impulsive acts. It is, therefore, essential to understand the factors contributing to absconding among patients with BAD, to facilitate designing strategies for preventing and managing this behavior. Method: This study was based on a retrospective chart review of the inpatients diagnosed with BAD at a tertiary psychiatry facility in Uganda from January 2018 to December 2021. Results: Approximately 7.8% of those with BAD absconded from the hospital. The likelihood of absconding among those with BAD increased with the use of cannabis [adjusted odds ratio (aOR) = 4.00, 95% confidence interval (CI) = 1.22–13.09, p-value = 0.022] and having mood lability [aOR = 2.15, 95% CI = 1.10–4.21, p-value = 0.025]. However, receiving psychotherapy during the admission (aOR = 0.44, 95 CI = 0.26–0.74, p-value = 0.002) and treatment with haloperidol (aOR = 0.39, 95% CI = 0.18–0.83, p-value = 0.014) reduced the likelihood of absconding. Conclusion: Absconding among patients with BAD is common in Uganda. Those with symptoms of affective lability and those with comorbid cannabis use tend to abscond more, while those who receive haloperidol and psychotherapy are less likely to abscond. [ABSTRACT FROM AUTHOR]

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has made it difficult for patients with Schizophrenia and Bipolar Affective Disorder (BPAD) to receive ongoing care, which has led to non adherence to medication and undesirable health outcomes. Lower treatment adherence in severe mental illness might lead to symptom exacerbation and relapses and might cause a strain on the health system during COVID-19 pandemic. Aim: To assess the treatment adherence in Schizophrenia and BPAD patients during prevailing COVID-19 situation in India. Materials and Methods: This cross-sectional study was conducted among 92 patients with Schizophrenia and BPAD through a questionnaire between January to September 2021 in a COVID-19 care hospital Government Medical College Palakkad/District hospital Palakkad, Kerala, India. Demographic and clinical data, adherence to treatment, along with Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Hamilton Rating Scale for Depression (HAM-D). Clinical Global impression (CGI S&I), Work and Social Adjustment Scale (WSAS), Modified COVID Threat Scale (CTS) and Medication Adherence Rating Scale (MARS) were collected. The outcomes included adherence to medication, deterioration of the psychopathology, improvement in severity, social functioning. Descriptive statistics was used to define the sample characteristics and presented as mean and standard deviation and frequency and percentages. Spearman's Correlation coefficient was used to find the correlation between MARS and other variables: CTS, BPRS, YMRS, HAM-D, CGI and WSAS. Results: A total of 92 patients were interviewed which comprised of 43 patients with Schizophrenia and 49 patients with Bipolar disorder. As assessed by MARS rating scale 19 patients (20.65%) had a MARS score less than six suggesting poor adherence and 73 (79.35%) had MARS score 6 and greater suggesting better adherence to the treatment. This was supported by negative correlation with BPRS, YMRS, HAM-D and CGI-S and CGI-I scales which implies that the COVID-19 pandemic did not hinder the patients to take the medication. The mean MARS score was 7.31±2.11. A total of 37 (40.2%) patients had acute exacerbation of the illness during the COVID-19 related lockdown and 37 (40.2%) had exacerbation during the six months prior to COVID-19 lockdown. There was negative correlation between MARS scores and the CTS but was not statistically significant. Conclusion: Despite the COVID-19 pandemic related restriction, patients with Schizophrenia and BPAD were adherent to the medication and the number of relapses during COVID-19 pandemic was similar to the period before the pandemic. COVID-19 related anxiety didn't have an impact on medication adherence and relapse in this study. [ABSTRACT FROM AUTHOR]

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