Bipolar disorder is one of the psychological disorders that camefrom mood disorders. Individuals with bipolar disorder have two distinct episodes of this disorder, manic episodes and depressive episodes. Individuals with bipolar disorder need to have knowledge on how to regulate their emotions, so that they can identify, analyze, and control their behavior. Individuals are expected to be able to both interact with their environment and are able to improve emotional stability in individuals with bipolar disorder. This research uses single case experimental research design, where the model used is A-B-A and analyzed by using descriptive qualitative analysis. The results showed that the emotional regulation interventions performed, proved to be effective for improving emotional stability in individuals with bipolar disorder.
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It is not clear what role personality factors may play in the relationship between BP disorder and BAs. In par- ticular, traits related to disinhibition or behavioral under- control may mediate the diathesis to both bipolar disorder and behavioral addictions. The psychobiological model of personality, developed by Cloninger (Cloninger et al. 1993; Cloninger and Svrakic 1997), is a two-tier system. The first tier, the temperament traits, includes Harm Avoidance (HA), Novelty Seeking (NS), Reward Dependence (RD), and Persistence (PS). The second tier, the character traits, includes Self-directedness (SD), Cooperativeness (CO), and Self-transcendence (ST). Mardaga and Hansenne (2007) explored the connection between these two models in an undergraduate sample of 150 participants and found that BAS scores were pre- dicted by high novelty seeking and high persistence scores. We decided to further explore the interrelation- ships between bipolar disorder, behavioral addictions, and personality/temperament traits by comparing re- sponses on two self-report questionnaires, one for behav- ioral addictions and one a measure of personality according to Cloninger’ s model, administered to euthymic adult bipolar patients and to a matched healthy control group. This study was approved by the BGU Institutional Review Board.
Our primary aim is to evaluate the effect of CR on cog- nition in patients with BDP compared to a computer- based control. The primary outcome measures of interest are MCCB scores. Primary analyses will be based on composite scores; secondary analyses will examine domain scores if composite findings are signifi- cant. The main analysis will be an intent-to-treat analysis, which includes all randomized subjects regardless of com- pliance to reduce potential for post-randomization bias and inflation of Type I errors. We will use a linear mixed effects model; inclusion of random effects accounts for the correlation among repeated measures. Outcome measures will include the three post-baseline measures of cognition; the baseline measure will be adjusted for by including it as a covariate. The test of no treatment differ- ence will be based on a joint test of the group and group- by-time interaction.
The statistical assumptions for the two main hypoth- eses are as follows: Hypothesis 1 Over a period of ≥24 months, ≥15% of at-risk individuals will develop a first (hypo)manic episode. The assumption of a 15% conversion rate is generally considered conservative. Hypothesis 2 Specific risk factors or risk factor constella- tions will be predictive of mania development during the observation period. We will test this hypothesis in vari- ous ways. First, univariate analyses will be run to deter- mine individual predictors of conversion to BP-I. Second, we will conduct a multivariate logistic regression model to determine risk factor constellations that are predictive of mania with each individual factor also being significant within the model. In addition to the logistic regression model approach, this hypothesis will also be tested using survival analysis-based Cox regression analyses to pre- dict time to onset of first mania, recognizing that individ- uals will have variable follow-up times. All analyses will use a backward selection approach to ascertain variables that have unique predictive associations with conversion at an initially liberal threshold of p ≤ 0.10. After that, omnibus regression will be conducted in which variables
These support groups are cheap to fund as they are largely run by charities using expert patients rather than trained professional therapists. Thus this study is designed primarily to establish whether it is the content and style of the intervention delivered in group psychoe- ducation that is more effective and cost effective than an active control intervention of the same length and dura- tion of treatment, taken by therapists of the same profes- sional background and with the same specific aim of trying to develop a plan of care to stay well over time. However, the study has been adapted to be a pragmatic randomised controlled trial of these interventions to reflect a model that might be used in everyday clinical practice in England. Thus unlike the Barcelona trials, there is an expert patient as a facilitator. In England it is increasingly common to use such patients in this role in England. There may also be advantages in terms of relat- ing the therapists’ interventions more closely to patient experience and also costs to health services [15,59]. Furthermore we have used a range of different health professionals to reflect clinical practice in England rather than only psychiatrists and clinical psychologists as in the Barcelona trials.
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5 relationships and self-concept is central to the ongoing management of BD (Goldberg & Harrow, 2005), with BD patients reporting significantly more interpersonal problems compared to community controls (Drieling, Scherer-Klabunde, Schaerer, Biedermann, Post & Langosch, 2010). Whilst interpersonal and social rhythm therapy has an interpersonal element (i.e. via emphasising the bidirectional nature of mood and interpersonal events), it does not make explicit use of the therapeutic relationship as a means of analysing (and changing) intra and interpersonal difficulties that are often related to childhood trauma. There is therefore a clear clinical need to trial a relational therapy for BD that can additionally formulate the role of childhood trauma. The rationale for taking a more relational approach, is that if a therapy was able to facilitate changes in the relationship the BD patient has with themselves, the disorder and/or their broader interpersonal relationships, then the stress-diathesis model of BD (Scott, 2001) would state that this had the potential to change the dynamics of BD itself (or at least the manner in which the patient copes with the disorder).
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Challenges arise for women with bipolar disorder who are pregnant and are stable on maintenance pharmacotherapy. For patients who are currently stable, the factors to consider when deciding whether or not to continue effective maintenance treatment during pregnancy include the number of lifetime bipolar mood episodes, severity of past episodes (including the presence of psychotic features and suicide attempts), psychotic comorbidities (particularly anxiety and substance- use disorders), medical illnesses, past treatment response, (during prior gravid and nongravid periods), time to relapse after prior discontinuation of maintenance treatment (and time to recovery following reinitiation of pharmacotherapy), level of residual symptomatology (and current impact on functioning), and the reproductive and lactational safety profile of current treatments. With the assumption that specific pharmacotherapies have been effective, continuing medications during pregnancy may be appropriate if the risk of prenatal exposure is outweighed by the risk of relapse with drug discontinuation. 241 Ultimately, the decision will often
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right-handed, without previous hypnosis experience. A semi-structured interview was performed with each healthy participant to ensure that they were not suffering from any psychiatric or neurological problem. All patients were diagnosed by an experienced psychiatrist (WW), ac- cording to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria . Recent computer tomog- raphy or magnetic resonance imaging scans conducted on patients displayed normal skulls, midlines, and paren- chyma, including cerebella and brain stems. The patients were not currently requiring in-patient care, and were not suffering from dissociative identity disorder, personality disorders, posttraumatic stress disorder, drug/ alcohol abuse or schizophrenia. Moreover, participants declared to be free from any drug or alcohol for at least 72 h prior to the test.
Abstract: Bipolar disorder is a common, complex genetic disorder, but the mode of transmission remains to be discovered. Many researchers assume that common genomic variants carry some risk for manifesting the disease. The research community has celebrated the first genome-wide significant associations between common single nucleotide polymorphisms (SNPs) and bipolar disorder. Currently, attempts are under way to translate these findings into clinical practice, genetic counseling, and predictive testing. However, some experts remain cautious. After all, common variants explain only a very small percentage of the genetic risk, and functional consequences of the discovered SNPs are inconclusive. Furthermore, the associated SNPs are not disease specific, and the majority of individuals with a “risk” allele are healthy. On the other hand, population-based genome-wide studies in psychiatric disorders have rediscovered rare structural variants and mutations in genes, which were previously known to cause genetic syndromes and monogenic Mendelian disorders. In many Mendelian syndromes, psychiatric symptoms are prevalent. Although these conditions do not fit the classic description of any specific psychiatric disorder, they often show nonspecific psychiatric symptoms that cross diag- nostic boundaries, including intellectual disability, behavioral abnormalities, mood disorders, anxiety disorders, attention deficit, impulse control deficit, and psychosis. Although testing for chromosomal disorders and monogenic Mendelian disorders is well established, testing for common variants is still controversial. The standard concept of genetic testing includes at least three broad criteria that need to be fulfilled before new genetic tests should be introduced: analytical validity, clinical validity, and clinical utility. These criteria are currently not fulfilled for common genomic variants in psychiatric disorders. Further work is clearly needed before genetic testing for common variants in psychiatric disorders should be established.
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A repeat search in PubMed and Cochrane Library was conducted in March 2016, using the same methodology, to check for any new papers that should be included in the discussion section, for comparison. Fifty-eight papers were found in PubMed in this second search and no pa- pers in the Cochrane Library. Four new papers [51–54] were found to be topical for this review. Logsdon et al. 2015  described maternal-infant interaction at 12 months postpartum in women with BD compared to women with unipolar depression and a control group without a major mood disorder. Marengo et al. 2015  looked at how women with BD made reproductive decisions. Both of these papers are included in the dis- cussion section only, for noting, as they were published too late to be included in the review. Taylor et al. 2015  was excluded, as their description of the character- istics of pregnant women and their use of psychotropic medication was not relevant for this review. The fourth
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At the core of any psychiatric disorder is an abnormality in neurotransmitter signaling. It is well known that the disruption of circadian physiology has widespread effects on all aspects of neural and neuroendocrine function, which leads to psychiatric disorders. The aforementioned information regarding neural substrates of biologic rhythm is frequently reported impaired in many mental disorders. Following the comprehensive conceptual framework of neural substrates of chronobiologic processes mentioned above, we will next discuss the reciprocal associations between circadian rhythm disturbances and psychiatric disorders, and draw a clinical picture for common diagnoses.
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many studies showing that it is a highly prevalent condi- tion with clinical implications, and there is a need to re- define comorbidities according to this knowledge (Akiskal et al. 2000). The Zurich definition of BS (Angst et al. 2003), epidemiology based, enriched the understanding of soft bipolarity challenging the current DSM concepts. The broader definitions result directly in strong increase of the prevalence of BS. A reanalysis of the database of the Epi- demiological Catchment Area (ECA) study indicated that 6.4% of the general population met the criteria for bipolar spectrum (Judd and Akiskal 2003), while the original study found 0.8% for BD. Data from the Sao Paulo Epi- demiological Catchment Area study showed that the life- time prevalence of BS was 8.3% (the softer forms of BD representing 6.6%) and it was of great clinical importance (Moreno and Andrade 2005; Moreno and Andrade 2010). Merikangas et al. (2011) in a large study across 11 coun- tries found that the overall prevalence of BS was 2.4%. In addition to the findings mentioned above, we extended previous investigations by demonstrating that ED is asso- ciated with BS in its broader definition.
RESPONSE: We agree with the point that pre-pubertal onset has had less research, particularly internationally, and remains both under-studied and a potential source of controversy and diagnostic ambiguity. The inconsistency and imprecision of reporting often worsens the situation. Fifteen of the seventeen epidemiological studies included cases with bipolar diagnoses other than BPI, but none reported rates of CYC separately, and few reported BP-NOS separately (or provided an operational definition of NOS). The apparently higher rate of NOS in the United States is confounded with reporting, where the Lewinsohn and NCS-A studies are two of the only that provided details about separate rates. Some of the specifics the reviewer mentions are examples of differences across studies that are difficult to interpret without more data points for comparison. We have not added detailed discussion of study specifics due to space constraints, but have added the following language, found in the second paragraph of the Conclusions:
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Polygenic Risk Scores (PRS). In the current study, Psychi- atric Genomics Consortium (PGC) schizophrenia  and PGC bipolar disorder  stage-1 GWAS mega-analysis full results were used to create two PRS; one for schizophrenia and one for bipolar disorder. First, linkage disequilibrium (LD) clumping at p- value thresholds of 0.01, 0.05, 0.1, 0.2, 0.3, 0.4, 0.5, and 1.00 was performed on 943,564 SNPs with high imputation information ($ 0.90) in PLINK version 1.07 ; http://pngu.mgh.harvard.edu/ purcell/plink/), an open-source whole genome association analysis toolset. MHC region (26–33 Mb) was excluded based on a complex LD structure in this region . The procedure undertaken pruned to r 2 = 0.25 within 200 kb windows. The SNPs in the TEDS sample were also required to have a minor allele frequency (MAF) .0.02; genotyping .0.90; and Hardy- Weinberg Equilibrium p.1 6 10 -6 . PRS were then calculated in PLINK for each genotyped individual in the TEDS sample by summing the risk alleles weighted by the estimated log of odds ratios obtained from the PGC results. PRS were calculated for eight p-value thresholds (p T ). Numbers of SNPs per threshold are
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Findings from twin studies suggest that heritabilities of psychotic disorders are higher than for adolescent psychotic experiences. Estimates of heritability of both schizophrenia and bipolar disorder have been shown to be ,80% [17–19] and the bivariate heritability between the two disorders to be 63% . Common genetic variants have been shown to play an important role in the aetiology of both disorders . GWAS that investigate common single nucleotide polymorphisms (SNPs) have identified several SNPs in genic and non-genic regions that associate with schizophrenia risk (reviewed in ). A review of these loci  refers to 16 reliably replicated genes/regions that harbour SNPs that are GWAS significant. A different approach is to use a polygenic risk score (PRS), which aggregates genome-wide individual SNPs into a single score. Currently available PRS from the Psychiatric Genomics Consortium account for 23% of variation in schizophrenia liability  and a much smaller but significant proportion of ,3% in bipolar disorder liability . PRS can be used as predictors of phenotypes in other samples.
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The results from this prescription survey, among various types of psychiatric disorder Bipolar Mood disorder, Dissociative identity disorder, Psychotic Disorder, Neurodevelopment disorders, Attention deficit hyperactivity disorder, Schizophrenia are most common. The mostly used therapeutic class in the treatment of mental disorder is Benzodiazepine. Depending on use of drugs to the patients, Midazolam, Sodium Evaporate, Clonazepam, Propanolol, Procyclidine are found most common. Finally the study being done on a limited scale, only a few prescriptions are collected, additionally this can be done on overall population of Bangladesh.
There have not yet been any published studies specifically assessing the efficacy of asenapine in bipolar depression. A registered clinical trial (NCT01807741) is actively recruit- ing participants to evaluate the role of asenapine in the treatment of bipolar depression. However, there have been several published studies of post hoc analyses of original study data focusing specifically on patients presenting with bipolar mixed states, and the efficacy of asenapine in the management of depressive symptoms (Table 2). All of the following studies utilized study data reported by McIntyre et al (NCT00159744 and NCT00159796), which compared asenapine to either olanzapine or placebo in the treatment of bipolar patients in acute manic or mixed states. 18,19
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Mc Gorry et al.(Melbourne)(12) pointed out that early phases of bipolar disorders are difficult to diagnose and have specific treatment issues. The initial polarity of the illness is more commonly misdiagnosed. There is an important delay before starting with appropriate therapy until mania is evident and required for the diagnose.
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Although LAI aripiprazole was substantially more effec- tive than placebo, only about half of the participants who made it to the randomization phase and were given LAI aripiprazole remained stable for the entire 52-week study period. Among those who were randomized to placebo, a little more than a quarter remained stable. These numbers reflect the fact that bipolar disorder is a cyclic illness, and it is unrealistic to expect maintenance treatment to eliminate abnormal mood episodes completely. These results also highlight the challenges of treating bipolar disorder with monotherapy. In clinical practice, fewer than 20% of bipolar patients are treated with mood stabilizer monotherapy. Most require at least three medications. 51 Further emphasizing the
Measures: AAS anxiety analogue scale, ACQ alcohol consumption questionnaire, ADIS anxiety disorders interview schedule, ASI addictions severity index, AUDIT alcohol use disorder identification test, BDI beck depression inventory, BMI body mass index, PRS brief psychiatric rating scale, CALS child affect liability scale, CBCL child behaviour checklist, CDI children ’ s depression inventory, CDRS children ’ s depression rating scale; R revised, CGAS children ’ s global assessment scale, CGI clinical global impression scale, ChIPS children ’ s interview for psychiatric syndromes, CDDR customary drinking and drug use record, CGAS child global assessment scale, C-CASA Columbia Classification Algorithm of Suicide Assessment, CSHF Colombia Suicide History Form, DTI diffuse tensor imaging, DUSI drug use screening inventory, FH-RDC family history-research diagnostic criteria, fMRI functional magnetic resonance imaging, GAF global assessment of functioning, HAMA Hamilton anxiety rating scale, HDRS Hamilton depression rating scale, K-SADS kiddie schedule for affective disorders and schizophrenia, LHAUD lifetime history of alcohol use disorder, LIFE modified longitudinal interval follow-up examination, LOI-CV Leyton Obsessive Inventory-Child Version, LSAS Liebowitz social anxiety scale, MASC multidimensional anxiety scale for children, MCQ meta cognition questionnaire, MFQ Mood frequencies questionnaire, MRS magnetic resonance spectroscopy, PET positron emission tomography, PRS Pfeffer rating scale, OCDAS obsessive compulsive disorder analogue scale, RCADS the revised child anxiety and depression scale, SAC substance abuse course-modified life II, SCARED screen for child anxiety related disorders, SCID structured clinical interview for DSM, SIQ suicide ideation questionnaire, SIS suicide intent scale, SOFAS social and occupational functioning assessment scale, sMRI structural magnetic resonance imaging, STAI-C state- trait anxiety inventory – child version, TLFB time-line followback, VBM voxel-based morphometry, Y-BOCS Yale–Brown obsessive-compulsive scale, YMRS young mania rating scale, YSRS the youth self-report scale
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