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Challenges and Opportunities in Bipolar Disorder

Challenges and Opportunities in Bipolar Disorder

Bipolar disorder, characterized by oscillating periods of mania and depression, presents a complex challenge to mental health professionals. This special theme issue delves into the multifaceted nature of bipolar disorder, exploring the latest advancements in diagnosis, treatment, and management. We aim to illuminate the intricacies of patient care, from innovative therapeutic strategies to the impact of societal perceptions. The articles within offer an overview of current research, highlighting both the hurdles faced by those living with bipolar disorder and the promising opportunities emerging in the field. Through a collaborative effort, this issue seeks to foster a deeper understanding and encourage a dialogue that bridges the gap between clinical practice and patient experience, ultimately contributing to improved outcomes and quality of life for individuals affected by this dynamic condition.

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.

Maria Rita Zoéga Soares and Deivid Regis Santos
Postgraduate Program in Behavior Analysis
Londrina State University

Marlies ter borg

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 and 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.

Marlies ter Borg

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” programme are mentioned: sterilisation, forbidding marriage, gassing, poisoning, starvation.

This dark page of German Psychiatry is lightened up by:

    • Its contrast with the author’s experience of compassionate and professional psychiatric therapy today.
    • The inspiring sermons of the Bishop of Munster in 1941 leading 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.

Crayton E. Rowe, Jr., MSW, BCD-P

Abstract

It is proposed that the undifferentiated selfobject is the key to understanding the formation and treatment of disorders that are characterized by preoccupations with destructive thoughts and actions.  By destructive I am referring to preoccupations that can be harmful to oneself. They include but not limited to major depressive disorders, bipolar affective disorders, obsessive-compulsive disorders, obsessive-compulsive personality disorders, paranoid personality disorders, eating disorders, and impulsive disorders. This paper emphasizes how therapists can be attuned to the undifferentiated selfobject needs of their patients and develop a treatment of disorders that is based on understanding these needs.

Marlies ter Borg

Abstract

Dedicated to Meerten ter Borg.

During Vincent van Gogh’s two months in Auvers he painted 74 masterpieces and then he shot himself. In this article, I investigate the possible connection between his ecstatic creativity and his tragic end. For this, I turn to Aristotle, who investigated the connection between warm melancholy and eminent creativity. In modern terms, it is the increased neurotransmission during a hypomanic episode that allows the magnifying of existing talent. This ‘bipolar melancholy’ can foster creativity but also lead to abrupt suicide. Attempts to find, in his letters and paintings, omens foretelling this tragedy fall short. He was exuberantly celebrating nature in his paintings creative until the last canvas. Then came a sudden slowing down of neurotransmission. His suicide was an escape from the looming depression he had experienced in Arles before deep depression made such an action impossible. The tragic fate of Vincent’s brother Theo, who succumbed to the other extreme, mania, suggests a genetic basis for this ‘ bipolar melancholy’. It was for Dr Gachet, expert in Melancholy, that Vincent moved to Auvers. He offered a broad and compassionate medical therapy, not excluding medication. Gachet’s understanding of the link between melancholy and genius was known to the van Gogh brothers. At the funeral Dr Gachet praised Vincent’s great achievements.