Special Issue:
Challenges and Opportunities in Bipolar Disorder
Sermin Kesebir
Professor of Psychiatry Üsküdar University NPİstanbul Brain Hospital
Abstract
Background: Although self theory was initially interested in narcissism, it began to explain depression over time. In our previous study, we showed that there was a relationship between self-inventory and mood disorder questionnaire scores in healthy individuals. Self-inventory defensive subscale scores of cases diagnosed with bipolar disorder were higher than healthy individuals. The aim of this study is to investigate whether there is a relationship between self-inventory scores and EEG spectral power densities in bipolar patients.
Methods: For this purpose, 50 cases diagnosed with bipolar disorder according to DSM-V were evaluated consecutively during their regular check-ups in our outpatient clinic. Subjects who gave voluntary consent to participate in the study were required to be in remission period for at least 8 weeks. Self Inventory and EEG applied.
Results: A relationship was found between compensatory grandiose self and FP1 alpha activity, and between defensive grandiose self and F3, Pz, T4, T5 beta activity (Table-1). There is a relationship between compensatory idealized parent image and FP1 delta ve theta, F7, P4, T4 theta, and between defensive idealized parent image and O1, O2 theta T6 beta activity.
Conclusion: According to our results, self-pathology and bipolar disorder overlap electrophysiologically. This suggests that more investigation should be done on the structural origin of mood disorders, in other words, whether the predisposition is a trait or not. As a matter of fact, the mind uses the brain as an interface. Self-pathology is a spatiotemporal disorder.
Fuad Zeid
Department of Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA; Pulmonary and Critical Care Medicine, Department of Internal Medicine Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
Yonas Raru
Department of Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA; Pulmonary and Critical Care Medicine, Department of Internal Medicine Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
Abstract
Valproic acid (VPA) is widely used for the treatment of epilepsy, migraine, and a variety of psychiatric symptoms, including bipolar disorder, borderline personality disorder, and alcohol withdrawal. Valproate is associated with severe idiosyncratic adverse effects, the most notable being valproate-induced hyperammonemic encephalopathy (VHE). Topiramate is also a broad-spectrum anticonvulsant that is also extensively used for migraine prophylaxis, as a mood stabilizer, and for alcohol dependency. There is increased occurrence of VHE when valproate is used with other medications like phenytoin, phenobarbital, and topiramate. We report a young patient who was on valproic acid and topiramate and developed metabolic encephalopathy with hypoxic respiratory failure with review of the causes and management of the hyperammonemic encephalopathy. We believe that clinicians should be aware of possible hyperammonemic encephalopathy in any patient who is taking valproic acid and presenting with impaired consciousness and cognitive decline. We also underline the importance of early recognition and high index of suspicion of encephalopathy related to hyperammonemia.
Marlies ter borg
Independent Bipolar Philosopher
Abstract
This article traces ideas on the link between mood-swing and brilliance, from Greek/Roman to present times. From Plato, Aristotle, Seneca and the physician Aretaeus the story moves to the monasteries: Anthony, Cassian, Benedict, and Augustine ending with Luther who suffered recurrent depression. With his opponent Erasmus we enter the Renaissance. The physician Ficino picks up the Aristotelean concept of melancholy and outstanding achievement. Burton illustrates the two poles of melancholy in a poem.
19th century physicians in France, Pinel and Gachet develop this concept. The German physicians Kraepelin and Leonhard take us into the 20th century, and we end in the US, with DSM-5 in 2013. The terminology develops from melancholy, via acedia, cirkuläres Irresein, manic-depressive to bipolar disorder. Through these terminological and cultural differences a consensus appears that extremes of destructive mania and deep, suicidal depression must be avoided. To achieve this medication is advised.
Creativity is located in the mood just under mania, light hypomania. The term ‘bipolar creativity’ is coined to shift attention from creative persons with a bipolar disorder to the process of creativity itself. It demands the enthusiasm, high self-esteem, and quick thinking, typical of hypomania. In this process light depression is also important. It’s critical stance can play a positive role in breaking the ground for new creations. It is not only the high mood but the alternation of opposite moods that gives scope to creativity. There is a fortunate ‘match’ between mild bipolar disorder and the bipolar creative process.
Sermin Kesebir
Psychiatry
Rüştü Murat Demirer
Abstract
Background: Current classification systems ignore the family histories of patients and psychiatric and medical comorbidity.
Methods: We study a new approach of applying spectral clustering to determine distinct bipolar disorder subtypes, which is data whose clusters are of various sizes and densities. We discovered clusters by processing a SRB (Sinai-Ruelle-Bowen) similarity matrix that reflects the proximity of Von Bertalanffy’s functions fitted to phase growth dynamics of EEG (electroencephalography) within a new pipeline architecture. For this purpose, 109 patients diagnosed with bipolar disorder according to DSM-V (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) were evaluated in remission period cross-sectionally.
Results: We found three distinct bipolar disorder subtypes with the p-values < 0.001. We exhibit mixing sub-shifts of EEG phase gradients such that there are chaotic phase transitions but higher order phase gradients in a cone basin is always strictly convex. More surprisingly, we show that the SRB entropy measures on some time interval although there exist several equilibrium states each corresponds to equilibrium state.
Conclusion: It seems subtypes of the bipolar spectrum were shaped according to seasonality, comorbidity for anxiety disorder and presence of psychotic symptom.
19th century physicians in France, Pinel and Gachet develop this concept. The German physicians Kraepelin and Leonhard take us into the 20th century, and we end in the US, with DSM-5 in 2013. The terminology develops from melancholy, via acedia, cirkuläres Irresein, manic-depressive to bipolar disorder. Through these terminological and cultural differences a consensus appears that extremes of destructive mania and deep, suicidal depression must be avoided. To achieve this medication is advised.
Creativity is located in the mood just under mania, light hypomania. The term ‘bipolar creativity’ is coined to shift attention from creative persons with a bipolar disorder to the process of creativity itself. It demands the enthusiasm, high self-esteem, and quick thinking, typical of hypomania. In this process light depression is also important. It’s critical stance can play a positive role in breaking the ground for new creations. It is not only the high mood but the alternation of opposite moods that gives scope to creativity. There is a fortunate ‘match’ between mild bipolar disorder and the bipolar creative process.
Marlies ter borg
Independent bipolar philosopher, Bentveldsweg 102, 2111 ED Aerdenhout, the Netherlands
Abstract
That Aristotle connected excellence, creativity to (bipolar) melancholy is known. This article adds depth and detail by distilling from his work characteristics of hot and cold melancholy, placing them in pairs of opposites, and comparing them with the diagnostic criteria for bipolar disorder in DSM. The Greek warned against extreme mood. He named two examples of mythical persons who suffered the tragic consequences; Ajax’ suicide and Hercules’ manic destruction of his wife and children. More recent examples are Vincent van Gogh, who committed suicide and his brother Theo who attacked his wife and child, was interned and finally succumbed from the consequences of extreme mania.
Aristotle urged melancholics to temper their mood. For it was only from mild melancholy that sustained creativity could be expected. He advocated hellebore as medicine. His general ethical advice to strive towards the opposite extreme is especially relevant for melancholics. Aristotle’s work on excellence and bipolar melancholy can inspire those confronted with bipolar disorder today to temper their mood. The examples of famous melancholics throughout the ages bring comfort and a sense of belonging.
The author, who is stabilized on lithium, holds up the example of the van Gogh family who, lacking the effective the medicine available today, communicated openly with each other about their disorder. With the new 20th century medication, perfected in our own time, it is from increased openness that the major advances in mental health are now to be expected.
Sermin Kesebir
Üsküdar University, School of Medicine
Abstract
The nature of the relationship with the self-object is the source of mental energy. At this point, the self is a spatiotemporal formation. The self has been found to be associated with the GAD enzyme activity responsible for GABA production at the molecular level. GABA is a metabolite of Krebs. Bipolar disorder is a biphasic state of energy dysregulation as a circadian rithms. Phasic nature of mitochondria to produce ATP may be crucial to the switching of affective states in bipolar disorder. The GABA shunt is an alternative energy production pathway that is activated in response to stress. The GABA shunt plays an important role in preventing the accumulation of reactive oxygen intermediates and cell death. On the other hand, GABA shunt impairs phosphorylation processes. Mitochondrial dysfunction is reflected in glucose, lipid and protein metabolism. A bipolar spectrum is possible at this point, including physical illnesses. A classification of mood disorders based on entropy levels is framed by medical comorbidity.
Giácomo de Carli da Silva
Ph.D. candidate in the Graduate Program in Cultural Diversity and Social Inclusion at Universidade Feevale – Novo Hamburgo/ RS/ Brazil; and Specialist in training in Human Rights and Health at the National School of Public Health (ENSP) of the Oswaldo Cruz Foundation (FIOCRUZ) – Rio de Janeiro/RJ/Brazil.
Abstract
This article outlines the experience reported in the Pioneer Case of an adult law student with multiple mental disorders seeking their rights. The disorders and their respective interrelationships are explained to be considered disabilities according to the Brazilian Inclusion Law (LBI, BRAZIL, 2015). The objective of the work was to show the reality of a Law student who has Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), Generalized Anxiety Disorder (GAD), Depression, Bipolar Disorder, and Borderline Personality Disorder in a Brazilian public university that excludes and persecutes him for asserting his rights as a person with a disability. The guiding question is whether Brazilian higher education, especially public institutions, is concerned with the mental health of its students, in this case, its students with mental disorders. The conclusion emphasizes that it is essential to enforce laws and public policies related to the inclusion of People with Disabilities (PwD). The Pioneer Case proves that even with clear laws in Brazil, they are not being enforced.
Abstract
I aim to demonstrate the movement of the argument of the Aristotelian Problem XXX.1 as it illuminates the phenomena of melancholy, which it is argued is more rightly understood as manic depression, and black bile. The discussion will aid contemporary researchers in psychiatry as well as those in ancient philosophy and medicine. An appeal to both Emil Kraeplin and the Aristotelian author will demonstrate surprising resonances. An appeal to Aristotle’s discussion of anger in the De Anima will make clearer what is at stake in Problem XXX.1.
Abstract
Bipolar disorder often starts on childhood or adolescence but is too often poorly recognized and treated leading to the evolution of an illness with considerable disability. While lithium is widely recognized a first line treatment option its use is declining in comparison to other less effective agents. Here we review the major assets of lithium a drug that can prevent many aspects of illness progression as a function of increased numbers of episodes experienced. More episodes are related to faster and more severe recurrences cognitive deficits, and treatment refractoriness. Many of the side effects of lithium, such as renal dysfunction, are based on earlier and uncontrolled literature and are over emphasized. Given lithium’s unique therapeutic profile, a re-evaluation of its under-utilization is definitely indicated.
Abstract
This narrative review analyzes the body of literature on known physiological mechanisms impacting bipolar disorder (BD) and how patient-centered nutrition in conjunction with prescribed medications may positively impact patient health outcomes. Additional topics include understanding the current state of research on nutrition and BD, impact of specific micronutrient imbalances on BD, dietary tendencies including current research on whole dietary patterns and potential applications for patients with BD. The totality of research included in this review indicate that inflammatory processes play a central role impacting health outcomes in patients with BD which can be addressed with not only medication, but also with targeted nutrition therapy.
Abstract
Dysfunctional self-regulation has been proposed to be the hallmark of almost all types of poor mental health. Although many prominent researchers have emphasized the role that executive attention control plays in self-regulation, the link between the two in mental health has been less apparent. According to the neurovisceral integration model, cardiac vagal tone, which refers to the parasympathetic influence on the heart at rest, can indicate the functional integrity of self- regulatory systems. A series of recent experiments demonstrate how individual differences in cardiac vagal tone indexed by heart rate variability (HRV) were associated with a varying degree of attentional control to emotional stimuli. The current paper reviewed recent research findings that showed how HRV modulated key components of executive control. These new findings provide evidence linking self-regulatory capacity and executive control, which may play an important role in supporting healthy mental health.
American Psychiatric Association defines mental illnesses as “health conditions involving changes in emotion, thinking or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities.” 2 Unfortunately, the number of people affected by mental illness is staggering and increasing at an alarming rate. According to the American Psychiatric Association 2 , nearly one in five (19 percent) U.S. adults experience some form of mental illness in a given year. One in 24 (4.1 percent) percent of individuals are being diagnosed with debilitating mental illnesses such as schizophrenia, bipolar disorder, or major depression and one in 12 (8.5 percent) with a substance use disorder.
There is a growing body of literature showing that dysfunctional self-regulation is one of the important contributing factors of the etiology and maintenance of various mental illness. 1, 2-6 Self- regulation refers to the ability to regulate cognition, emotion, and behavior to make an adaptive response to meet constantly changing environmental demands, which has been recognized as a key concept that helps understand human development and psychopathologies. 1, 7-9, 10-11 Of particular interest is the link between attention and self-regulation. Attention involves selecting and focusing on information, which shapes and guides thoughts and actions. 10, 12-13 Also, attention plays a critical role in producing self-regulatory responses not only by selecting and focusing on stimuli in the physical environment but also by internally modulating cognitive processes of different information processing.
Abstract
This is the story of the murder, by psychiatrists, of patients with genetically based psychiatric disorders in Nazi Germany. It is told from the viewpoint of a person with bipolar disorder, reflecting on the suffering of people like herself. The various stages in the so-called “Euthanasia” program are mentioned: sterilization, forbidding marriage, gassing, poisoning, and starvation.
This dark page of German Psychiatry is lightened up by:
- It contrasts with the author’s experience of compassionate and professional psychiatric therapy today.
- The inspiring sermons of the Bishop of Munster in 1941 led to protests among patients and their families, the largest protest movement in Nazi Germany.
- The informative and uplifting group of monuments in Berlin commemorating the victims.
- The speech by the chairman of the German association of psychiatrists in 2010 asking for the victims to forgive them.
- The incorrect use of the term ‘Euthanasia’ for the memorial and its correct use in a humane Dutch law, passed in 2002.
Abstract
Cones are primarily involved in photopic vision and light adaptation. Rods are responsible for scotopic vision and dark adaptation. The typical time-courses of light and dark adaptations have been known for century. However, information regarding the minimal adaptation time for electroretinography (ERG) and pupillography would be helpful for practical applications and clinical efficiency. Therefore, we investigated the relationship between adaptation time and the parameters of ERG and pupillography. Forty-six eyes of 23 healthy women (mean age, 21.7 years) were enrolled. ERG and pupillography were tested for right and left eyes, respectively. ERG with a skin electrode was used to determine amplitude (µV) and implicit time (msec) by the records of rod-, flash-, cone-, and flicker-responses with white light (0.01–30 cd·s/m2). Infrared pupillography was used to record the pupillary response to 1-sec stimulation of red light (100 cd/m2). Cone- and flicker- (rod-, flash-, and pupil) responses were recorded after light (dark) adaptation at 1, 5, 10, 15, and 20 min. Amplitude was significantly different between 1 min and ≥5 or ≥10 min after adaptation in b-wave of cone- or rod-response, respectively. Implicit time differed significantly between 1 min and ≥5 min after adaptation with b-wave of cone- and rod-response. There were significant differences between 1 min and ≥10 or ≥5 min after dark adaptation in parameter of minimum pupil diameter or constriction rate, respectively. Consequently, light-adapted ERGs can be recorded, even in 5 min of light adaptation time without special light condition, whereas dark-adapted ERGs and pupillary response results can be obtained in 10 min or longer of dark adaptation time in complete darkness.
Abstract
Background: There is limited epidemiological data on chronic diseases in the Middle East, and obtaining such data on a large scale and in a standardised manner is challenging. The objective of the SNAPSHOT program was to assess quality of life and to estimate the prevalence and burden of multiple diseases in the adult general population of five Middle Eastern countries using an omnibus approach.
Methods: Large random samples from the general populations of Egypt, Turkey, Saudi Arabia, Kuwait and the United Arab Emirates were interviewed by telephone. Validated questionnaires were administered via a computer-assisted personal interviewing system to identify subjects fulfilling criteria for one of the four diseases of interest (asthma, allergic rhinitis, bipolar disorder and benign prostatic hyperplasia) and the three level EuroQoL EQ-5D questionnaire (EQ-5D-3L) administered to collect quality of life data. Respondents who screened positively for a disease of interest were invited to answer further questions on disease burden and healthcare resource utilisation.
Results: Overall, 33,486 subjects completed the screening questionnaire and 27,882 completed the EQ-5D-3L. At least one of the four diseases was identified in 4,418 (13.2%) of subjects. The mean EQ-5D-3L utility value was 0.89±0.21. It was significantly different among countries (Turkey: 0.84±0.24, Egypt: 0.88±0.23; Saudi Arabia: 0.93±0.16; Kuwait: 0.94±0.16; United Arab Emirates: 0.96±0.13), among age groups (18-34: 0.91±0.19; 35-49: 0.90±0.20; ≥50: 0.85±0.25), between genders (men: 0.92±0.18; women: 0.86±0.24), and significantly lower in subjects who screened positive for any of the four diseases (p <0.0001 for all comparisons; Kruskal-Wallis test).
Conclusions: This program emphasises the benefit of an omnibus approach to collecting population data for multiple diseases in multiple countries. The program also generated reference values for the EQ-5D-3L in the Middle East for the first time. Such programs respond to a need for data to support informed decision-making by healthcare authorities in the region.
