Subsyndromal states in bipolar disorder

Serum glial cell derived neurotrophic factor (GDNF) as a predictor of response to HD-tDCS in bipolar affective disorder

Serum glial cell line derived neurotrophic factor (GDNF) homeostasis within brain circuits represent target for focal neuromodulation techniques such as high-definition transcranial direct current stimulation (HD-tDCS). In current trial 37 inpatients with bipolar disorder (BD) received active (n = 18) or sham (n = 19) anodal HD-tDCS over right dorsolateral prefrontal cortex (DLPFC). Outcome measures evaluated by YMRS (p = 0.001, effect size=0.946), BPRS (p = 0.015, effect size=0.220) scales and serum GDNF (p = 0.003, effect size = 0.287) at baseline, before and after receiving HD-tDCS revealed significant improvement (active>sham) with modest effect size. However, the study findings are limited due to small sample size and shorter duration of follow-up.

Prevalence and clinical correlates of residual symptoms in remitted patients with bipolar disorder: An exploratory study

OBJECTIVE

This cross-sectional study aimed to evaluate the prevalence and factors associated with residual symptoms (both depressive and manic) in subjects with bipolar disorder (BD).

MATERIALS AND METHODS

A total of 844 subjects diagnosed BD with an illness of 2 years' duration and minimum of two lifetime episodes and in clinical remission were evaluated for residual symptoms using Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS). Based on the severity of residual symptoms, the study groups were divided into four groups.

RESULTS

Sixty-nine percent of the subjects had residual depressive symptoms (i.e., HAM-D score in the range of 1-7) and 59% had residual manic symptoms (i.e., YMRS score in the range of 1-7). The most common residual depressive symptom was psychic anxiety (34%) followed by impaired insight (29%). The most common manic symptom was poor insight (31%) followed by sleep disturbances (25%). Subjects with both sets of residual symptoms had onset of BD at a relatively young age, when compared to those with only residual depressive symptoms. Presence of any comorbid physical illness and substance abuse disorder was significantly higher in those with both sets of residual symptoms.

CONCLUSIONS

The present study suggests that a substantial proportion of patients with BD have residual symptoms of both types. Comorbid physical illness and substance use were associated with residual symptoms. Identification and management of residual symptoms are highly essential to improve the overall outcome of patients with BD.

Interepisodic Functioning in Patients with Bipolar Disorder in Remission

BACKGROUND AND OBJECTIVES

Patients with bipolar disorder (BD), despite recovering symptomatically, suffer from several functional impairments even in remission. The actual causes of impaired functioning are less known.

MATERIALS AND METHODS

The study aimed to examine the clinical and psychosocial determinants of functioning in patients with BD in remission. A cross-sectional single-group design was adopted (n = 150). Participants meeting the study criteria were screened with Mini-International Neuropsychiatric Interview Scale. The selected participants were administered various tools to assess the level of functioning and the clinical, psychosocial determinants of functioning.

RESULTS

The clinical characteristics of the sample included early age of onset of illness, presence of precipitating factors, fewer episodes, minimal comorbidities, history of psychotic episodes, family history of mental illness, good medication adherence, and low depression and mania scores. Psychosocial factors included higher stress and moderate social support and self-esteem in the sample. Poor functioning patients had a history of longer hospital stay and had greater scores on depression, mania, stress, and maladaptive coping styles than better functioning patients.

CONCLUSION

Higher depression, mania, stress, and maladaptive coping strategies were related to poor functioning, while higher medication adherence, self-esteem, and social support were related to better functioning.