Lithium is considered the gold standard mood stabiliser for bipolar disorder, yet its use during pregnancy remains controversial, demanding careful consideration of potential risks and benefits. Classically, it has been associated with an increased risk in congenital heart defects, however, recent studies point towards a much lower absolute risk than was previously believed. Furthermore, discontinuation of lithium before or during pregnancy poses a high risk of destabilisation and lithium has been shown to reduce the risk of relapse both in pregnancy and in the postpartum period. Hence, treatment planning is of the upmost importance in this patient group and individual risk stratification should be undertaken for patients to make informed decisions about their treatment.

To describe the case of a patient with bipolar disorder who discontinued lithium treatment while attempting to conceive and subsequently presented with a manic episode and to expand the scientific knowledge on this topic.

Case report and brief literature review.

A 41-year-old patient with a diagnosis of bipolar disorder, previously on lithium 900mg/day, was admitted to the emergency department with symptoms suggestive of a manic episode. One month prior, the patient had discontinued treatment with lithium due to her desire to pursue pregnancy and interrupt treatment while trying to conceive. The patient had a history of postpartum psychosis followed by various depressive and manic episodes with psychotic symptoms, leading to a bipolar disorder diagnosis and commencing treatment with lithium. Her consultant psychiatrist had informed her of the individualised risks of interrupting treatment with lithium and had advised to continue treatment alongside frequent follow-up due to the high-risk of relapse. Despite her consultant’s recommendation, she decided to interrupt treatment and hence a personalised lithium tapering regime and advice to continue treatment with quetiapine 200mg/day was given.

During the ED stay, treatment with olanzapine was introduced which helped to stabilise her symptoms. Lithium levels were subtherapeutic (lithium serum level 0.11 mmol/L). Inpatient psychiatric admission was avoided due to rapid symptom improvement, strong social support in the community and her preference for ambulatory care. Lithium was gradually reintroduced and antipsychotic treatment was adjusted at follow up appointments, which ultimately led to the resolution of symptoms and stabilisation.

This case highlights the significance of considering continuing lithium treatment in bipolar disorder during pregnancy planning. Decisions about medication in pregnancy are multifaceted, making appropriate risk stratification imperative in order to inform individualised care plans to minimise the risk of relapse in these patients.

None Declared

In the review of recent literature, we found very few presentations of case reports in which the presumed association between psychiatric disorders and arachnoid cysts is discussed. Arachnoid cysts are rare brain tumors with little apparent symptomatic impact and in most cases, they are diagnosed incidentally. We present the case of a 15-year-old adolescent with a personal history of a previous severe depressive episode, as well as suspicion of serious mental pathology in the family. It presents a subacute onset episode, in the context of regular cannabis consumption, consisting of intense emotional lability and psychomotor restlessness, a tendency toward irritability, decreased sleep needs, and the appearance of delusional ideas of harm and self-referential interruption. During the study of the case, and incidentally, the cranial magnetic resonance imaging revealed the presence of an arachnoid cyst located in the left frontotemporal location, approximately 4 cm in diameter.

(1) To describe the clinical particularities of this case, focusing on the diagnostic difficulties we faced. (2) To review current scientific evidence regarding the possible association between neuropsychiatric symptoms and arachnoid cysts.

A review of the patient’s clinical history was carried out and complementary tests were performed. Likewise, a review of the available scientific literature was also performed in relation to the appearance of neuropsychiatric symptoms associated with the presence of arachnoid cysts.

The literature regarding the possible association between psychosis and arachnoid cysts is scarce. However, it is proposed that arachnoid cysts may be associated with various neuropsychiatric alterations, such as affective alterations, schizophrenia-like psychosis or amnestic symptoms. The atypicality in the symptoms sometimes leads us to suspect an organic origin of the condition, with some features such as associated memory deficits, emotional incontinence, movement disorders or neurological focal data; some of which are present in the case at hand.

There is controversy among different sources regarding the role of the cyst in the development of symptoms or, on the contrary, its presentation only as a chance finding. Further investigation focusing on clinical observations and neuroimaging is needed.

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Lithium nephropathy can occur in long-term lithium-treated bipolar disorder patients. Key risk factors include duration of lithium exposure, cumulative dose, acute intoxication episodes, advanced age, and comorbidities such as hypertension, diabetes mellitus, hyperparathyroidism, and hyperuricemia, along with concurrent use of antipsychotics. The clinical presentation is gradual, with mild proteinuria, often accompanied by arginine vasopressin resistance. Histological studies show a correlation between interstitial fibrosis and cumulative lithium duration. Approximately 15 to 25 per cent of exposed patients may experience a gradual decline in glomerular filtration rate. The outcome after lithium discontinuation varies.

This case study aims to analyze and document the clinical presentation, diagnosis, and management of lithium nephropathy in a patient with Bipolar Disorder.

We gathered data on the medical history, lab results, and treatment approach for a patient with Bipolar Disorder.

The patient, a 50-year-old woman, had been under the care of Psychiatry since 2008 due to a diagnosis of Bipolar Disorder Type I. During this time, she had experienced depressive and manic episodes but had not presented significant symptom decompensation for the past 14 years, successfully managed with lithium at a current dose of 600 mg per day. However, on this occasion, the patient sought hospitalization due to recent behavioural disturbances, including restlessness, disinhibition, abrupt changes in behaviour, pressured speech, sleep problems, agitation, and aggression. The patient also reported an increased sense of polyuria and polydipsia. Evaluation in the emergency department revealed elevated lithium levels of 1.47 mmol/L and hypokalemia, that justified lithium withdrawal. After lithium levels decreased, an estimated glomerular filtration rate remained low. She was diagnosed with lithium nephropathy, an adverse effect of long-term lithium therapy. Treatment with lithium changed to sodium valproate. Treatment with asenapine started and sustained for two months. Over the following two years, the patient experienced four additional hospital admissions in Psychiatry due to manic episodes.

Long-term lithium therapy can lead to lithium nephropathy with symptoms such as polyuria, polydipsia, and acute kidney failure. Consistent monitoring of patients receiving lithium is crucial to detect potential adverse effects.This case highlights the challenges in managing bipolar patients, as discontinuing lithium exacerbated symptoms despite switching to sodium valproate for nephropathy prevention. Long-term lithium treatment, while effective for bipolar disorder, poses significant renal risks. We emphasize continuous renal function monitoring and assessing the risk-benefit of lithium treatment while actively researching lithium nephropathy and its impact on glomerular function.

None Declared

Bipolar disorder is a chronic, recurrent, and disabling condition that typically begins in late adolescence or early adulthood. It is characterized by alternating phases of depression, mania, or hypomania. Childhood traumas are more frequently found in adults with bipolar disorder, suggesting their contribution to its development. They are also associated with more severe and complex clinical forms and a less favorable prognosis.

Our objective is to assess the prevalence of childhood trauma rates in adults with bipolar disorder and to study the impact of childhood traumas on the clinical course of bipolar disorder, in comparison with a group of patients with bipolar disorder who did not experience trauma during their childhood.

This is a descriptive cross-sectional study using a questionnaire comprising sociodemographic criteria and the Childhood Trauma Questionnaire Short Form (CTQ-SF) to evaluate the connection between physical and psychological traumas during childhood and bipolar disorder. The study also examines the types of these traumas and their impact on the course of bipolar disorder in these categories.

Data were collected from 54 patients with bipolar disorder at Ar-Razi Psychiatric University Hospital. Among this sample, 60% were female and 40% were male. The age of the participants in our study ranged from 18 to 54 years. According to the Childhood Trauma Scale, approximately one-third of patients with bipolar disorder had experienced childhood trauma. Moreover, most participants who had survived childhood trauma experienced more relapses than patients who had not experienced traumatic incidents during their childhood.

Childhood traumas and bipolar disorder appear to have a significant causal association, both in the development of the disease and its course. The results of our study support evidence published in articles to better clarify the nature of this association. However, our study has several limitations, including a limited sample size and difficulties in long-term follow-up during the disease. Therefore, further studies exploring this subject are desirable for better management of this condition.

None Declared

Assessing the medical fitness of workers with mood disorders remains a topical issue, because of its organizational, socioeconomic and professional impact.

To assess the medical and occupational characteristics of workers with mood disorders.

To evaluate the impact of these psychiatric disorders on the medical decision of fitness for work.

Descriptive and retrospective study, over six years (January 1, 2018 to August 30, 2023) including all medical records of workers with mood disorders (bipolar disorder, anxiety disorder, and depression), referred to the occupational department of the Charles-Nicolle Hospital in Tunis for a medical fitness for work.

The study included 101 patients, mostly female (sex ratio = 0.4), with a mean age of 43.3 ± 9.2 years. The most represented sector of activity was health care. The participants were mainly nurses (25%), followed by technicians (22%) and workers (21%). The mean job seniority was 16.5 ± 9.3 years. A pathological history was found in 74.3% of cases, of which 47.5% were psychiatric disorders. Mood disorders identified in our population were: bipolar disorder (53.5%), anxiety disorder (43.5%), and depression (3%). After medical examination and the decision of treating physician, 39% of the patients (N=39) were declared fit for work, and 31.4% (N=32) were fit with ergonomic adjustments. These accomodations consisted mainly of night shift exemptions in 75% of cases. Temporary unfitness was declared in 24 patients (23.6%). Job mutation was recommended for four patients. Early retirement due to invalidity was proposed for two patients.

The decision on the medical fitness of workers with psychiatric disorders remains a delicate issue that requires the attention of both legislators and occupational health practitioners.

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Bipolar disorder (BD) often has symptoms similar to other mental disorders (BD), and there are no paraclinical criteria for differential diagnosis. (Geoffroy et al. Bip Dis 2017; 5 7). Published work on MD proteomics is scarce and focused on schizophrenia. (Dmitrieva et al. PeerJ. 2022; 10 e13907). Therefore, it is important to study potential biomarkers of BD using easily accessible material—blood serum (Rhee et al. Transl Psy 2023; 13 44). Identification of proteins involved in the pathogenesis of BD will help in the study of the pathogenetic mechanisms of BD, the development of differential diagnostic methods and pathogenetically based drugs.

Carrying out a comparative proteomic analysis of blood serum from patients with BD and healthy individuals to identify potential biomarkers

We analyzed the protein spectrum of the blood serum of 14 patients with BD who were admitted during a depressive episode at the age of 32 [21;52] years with a disease duration of 8[5;11] years. The control group consisted of 10 mentally and somatically healthy individuals corresponding to the gender and age of the BD group. Blood serum was purified from 14 major proteins using affinity chromatography and separated by electrophoresis using the Laemmli method. After trypsinolysis, proteins were identified using HPLC/mass spectrometry on an Orbitrap instrument. Mass spectrometric analysis was performed on the Advanced Mass Spectrometry Core Facility of Skolkovo Institute of Science and Technology. Protein identification was carried out using the UniProtKB database using the Mascot search engine. The results were tested for significance using the nonparametric Fisher exact test with Yates correction.

In patients with BD, qualitative mass spectrometry revealed differential expression of 21 neurospecific proteins. Among them: Protein dispatched homolog 3, Ceroid-lipofuscinosis neuronal protein 6, SWI/SNF complex subunit SMARCC1, Neurogenic differentiation factor 4, Protein furry homolog-like, REST corepressor 1 – are involved in the proliferation, development and differentiation of neurons; Hemicentin-2, Dystrophin, Voltage-dependent L-type calcium channel subunit alpha-1D, Syntaxin-binding protein 5, Small conductance calcium-activated potassium channel protein 1– participate in synaptic transmission of ion transport and form receptors.

Studying the role of these proteins in BD and their quantitative content in a larger number of patients is promising. This will help in the development of new diagnostic criteria and targets for drug therapy for BD.

Support by the Russian Science Foundation grant No. 23-75-00023.

None Declared

The diagnosis and treatment of depression are complex due to its diverse forms. Recent focus in clinical practice has been on identifying markers for mono- and bipolar depression, as early diagnosis significantly impacts treatment.

To identify clinical characteristics of unipolar and bipolar depressive disorders and assess their correlation with aggression levels in patients.

We studied patients at the Mental Health Research Institute of Tomsk NRMC: ICD-10 codes: Bipolar Affective Disorder (BD) (n=28), Recurrent Depressive Disorder (RDD) (n=33). Patients with BD were older (49 (33; 52) years) than those RDD (40 (31; 51) years) (p=0.018). The current depressive episode duration was shorter for BD (3 (2; 7) months) compared to RDD (5 (2; 12) months) (p=0.018). Gender distribution was comparable (p=0.568). We measured clinical symptoms (depression, anxiety, anhedonia) using psychometric tools (HAM-D, HAM-A, SHAPS) at admission and after 3 weeks of therapy. Aggression was assessed with the Buss-Durkee Hostility Inventory (BDHI) at admission.

Patients with RDD demonstrated a higher severity of depressive symptoms upon admission (Table 1).Table 1.

Clinical Characteristics of Unipolar and Bipolar Depression Course

The severity of some aggressive patterns was higher in patients with bipolar disorder (Table 2).Table 2.

The severity of aggressiveness in unipolar and bipolar depression.

As a result of the study, no statistically significant correlations were found (p>0.05, Spearman’s test).

The conducted research did not yield convincing data that would allow us to make judgments about specific clinical patterns in the course of unipolar and bipolar depression. Thus, the problem of searching for unique biological markers of the courses of affective disorders remains relevant. Support by the Russian Science Foundation grant No. 23-75-00023.

None Declared

Multiple Sclerosis (MS) is an inflammatory disease affecting primarily the central nervous system, characterized by focal lesions of white-matter demyelination. It can present with a variety of neurological symptoms, including monocular vision loss, sensory loss, paresthesias, limb weakness, ataxia and bladder dysfunction, and has a typically chronic and progressive course. Neuropsychiatric manifestations including depressive or manic symptoms, anxiety disorders and psychosis, are also frequently observed, and are of particular importance to mental health practitioners.

To describe a case of a 45-year-old female patient with a history of suspected MS presenting with manic symptoms, and to discuss the possible neuropsychiatric manifestations of Multiple Sclerosis.

Clinical case report and literature review.

A 45-year-old woman was brought to the emergency department presenting with severe acute agitation, irritable mood, rapid speech and persecutory delusions. She had no prior history of neuropsychiatric symptoms, but her medical history was notable for a suspected diagnosis of MS, having suffered an episode of optic neuritis 16 years before the present episode. Magnetic Ressonance Imaging performed 3 months before emergency admission documented non-specific white-matter lesions presenting as hyper-intense in long TR sequences, as well as a cervical lesion of atypical characteristics, representing possible spondylotic myelopathy or demyelination. A head CT performed at emergency admission did not reveal relevant acute findings. The patient was hospitalized and initiated risperidone and valproic acid therapy. She responded favorably to medication, with progressive stabilization of mood and remission of delusional ideas over three weeks.

Neuropsychiatric symptoms are a common and concerning manifestation of Multiple Sclerosis. The present case illustrates that clinicians should be on alert for signs of mood and psychotic symptoms in patients with suspected or confirmed MS, as these can manifest at any point during the disease course.

None Declared

Lithium is a well-established mood stabilizer used in the management of bipolar disorder, that is generally well-tolerated; however, it is associated with rare but potentially severe neurological side effects. Lithium-induced encephalopathy is characterized by a spectrum of symptoms, ranging from subtle cognitive deficits to severe manifestations such as altered mental status to overt delirium, seizures and coma. Risk factors include advanced age, concomitant medication and underlying renal impairment. This symptoms do not consistentely correlate with lithium concentrations.

This abstract aims to provide an overview of the clinical characteristics, underlying mechanisms, and management of lithium-induced encephalopathy.

We discuss a case of a 62-years-old woman diagnosed with bipolar disorder under treatment with lithium and olanzapine, without recent changes of posology. She presented to emergency department with subacute and fluctuating neuropsychiatric symptoms, including confusion, disorientation in time and space, complex visual hallucinations, delusional ideas, alteration in memory and logic thinking, dysarthria and dyspraxia. Neuroimaging showed no structural abnormalities, blood tests were normal and serum lithium levels were within the therapeutic range (0.8 mEq/L). Upon discontinuation of lithium, the patient exhibited a gradual resolution of symptoms. We conducted a comprehensive search of medical databases, including PubMed, to identify relevant articles related to lithium encephalopathy published up to September 2023.

This case challenges the conventionally established threshold of elevated serum lithium levels in the development of encephalopathy. The underlying pathophysiology is complex and multifactorial, with proposed mechanisms including alterations in neurotransmitter balance, oxidative stress, mitochondrial dysfunction and individual susceptibility to idiosyncratic reactions. Early diagnosis is challenging, necessitating a high clinical suspicion, neuroimaging and exclusion of other etiologies. Management strategies involve discontinuation of lithium, even when serum lithium levels are within the therapeutic range, supportive care, and, in severe cases, hemodialysis to reduce lithium levels rapidly.

Clinicians should maintain a high index of suspicion of lithium-induced encephalopathy, especially in patients presenting with neurological symptoms while on lithium treatment. Early recognition and intervention are essential for minimizing morbidity and preventing potentially irreversible neurological damage. Further research is needed to better understand the precise mechanisms underlying it, risk factors and to refine treatment strategies.

None Declared

Manic episodes have a multifactorial etiology, with frequent association with genetic factors, comorbidities such as systemic diseases or secondary to infectious diseases, and environmental exposure factors. The prevalence of bipolar disorder is markedly higher in patients with autoimmune disease. The risk of developing bipolar disorder in some studies has been seen to be higher among patients with rheumatoid arthritis, therefore chronic inflammation would be a potential mechanism and could be a modifiable risk factor for bipolar disorder. Growing evidence indicates that Sars-CoV-2 may also trigger the acute onset of mood disorders or psychotic symptoms.

We present the case of a patient who presents symptoms compatible with an acute manic episode after an outbreak of rheumatoid arthritis and comorbid COVID infection.

52-year-old patient. She went to the hospital emergency room presenting affective symptoms compatible with a manic episode and psychomotor agitation. Personal medical history: rheumatoid arthritis, antiphospholipid syndrome. Psychiatric personal history: Depressive disorder under follow-up by a private psychiatrist under treatment with antidepressants. During the interview, the patient presented accelerated speech, with great emotional incontinence. Saltigrade thought and tachypsychia. She verbalizes delusional ideas of megalomaniacal and mystical and religious characteristics. She verbalizes that she is the reincarnation of the holy spirit, that God has taken her body and speaks through her. In the emergency room, a Sars-CoV-2 infection that the patient was unaware of was diagnosed. She is admitted to the hospital in the mental health unit, in the first interviews the patient maintains speech with delusional ideas “I notice the stigmata of Christ on my body”.

The patient recovers after treatment for the COVID infection, remaining asymptomatic. It was decided to start lithium to stabilize mood and the patient presented good tolerance and treatment with antipsychotics. The patient presented a favorable response, remitting the psychotic symptoms of which she was critical and stabilizing the affective symptoms. The patient is diagnosed with Severe Manic Episode with Psychotic Symptoms, as the main diagnosis and we could conclude the diagnosis of Bipolar Disorder since she has presented 2 depressive episodes in the past that have required treatment and follow-up by psychiatry.

Manic episodes have a multifactorial etiology and require an individualized approach, and comorbid medical conditions must always be assessed in order to establish a therapeutic plan with patients.

None Declared

Carbamazepine is effectively used in treatment of bipolar disorder for its thymoregulatory virtues, but it can induce numerous side effects, including skin eruptions that can be severe sometimes.

To study the relationship between toxidermia and treatment with carbamazepine.

We report the case of a patient who developed a toxidermia following the intake of carbamazepine.

Mr. AD, 19 years old, with medical history of diabetes, has been diagnosed with bipolar disorder since the age of 17. He was initially treated with risperidone with an irregular follow-up.

He was hospitalized in our department for a manic episode with psychotic features with agitation and refusal of treatment.

The patient was put on injectable treatment 15 mg/day of Haloperidol and 20 mg/day of diazepam.

After 5 days in hospital, we switched to the oral route, gradually increasing haloperidol doses to 30mg, reducing diazepam doses and introducing carbamazepine for thymoregulatory purposes.

Carbamazepine was progressively increased up to a dose of 800mg per day.

Fourteen days after the introduction of carbamazepine, the patient presented a generalized rash requiring the discontinuation of this medication. He was treated with an anti-histamine and local corticosteroids, on the advice of dermatologists.

In the days following discontinuation of carbamazepine, skin lesions regress and then disappear.

Biologically, we observed a rise in eosinophilic polynuclear cells to 580, followed by a gradual decrease after stopping the treatment.

A pharmacovigilance opinion was sought, concluding that carbamazepine was responsible for the toxidermia, given the delay in onset and the favorable evolution after discontinuation of the incriminating treatment. Moreover, this undesirable effect is well described in the literature.

Hence the contraindication to further use of carbamazepine in Mr. AD.

In addition, the patient was put on sodium valproate with good tolerance.

Each prescribed drug must be considered as potentially capable of causing cutaneous reactions as an adverse effect. Both the prescriber and the patient must be made aware of this phenomenon. The attitude can be modulated on a case-by-case basis, after specialist advice, depending on the severity of the rash and the disease to be treated.

None Declared

Bipolar disorder is a severe and chronic mental pathology, with an estimated prevalence of 1% in the general population. It is a complex pathology, encompassing a wide variety of severe and contradictory symptoms, with harmful repercussions on the patient’s personal, emotional, social, professional and conjugal life, precipitating relapse. By improving our knowledge of bipolar disorder, we can support and accompany patients, helping them to understand their illness, to be able to manage it, to resolve the problems that may arise from it, and to prevent relapses and the occurrence of further episodes.

The aim of our work is to explore maladaptive early patterns in people with bipolar disorder in the intercritical period in relation to their symptomatology and functional disability, given that consideration of maladaptive early patterns (IAPs) could lead to better identification, understanding and management of bipolar disorder.

We conducted a cross-sectional, descriptive and analytical study. The sample in our study consisted of 40 bipolar adults and 40 control adults, recruited from the various inpatient and outpatient departments of our hospital. They were all university graduates, aged between 20 and 60, followed for at least 06 months and stabilized on treatment. After collecting the various socio-demographic and clinical data, we used the Young schema questionnaire-short form (YSQ-S1).

Our study sample seemed to be characterized by certain specificities: high “self-sacrifice”, “high demands” and “exaggerated personal rights”. Feelings of dependence and incompetence were also high among our patients, especially those with type I bipolar disorder, leading to a marked decline in self-esteem and autonomy.

The data we have retained from this work show us the importance of drug, psychotherapeutic and family management in achieving thymic stability and psychological and relational well-being.

None Declared

Corticosteroid treatment has been associated with the appearance of psychiatric symptoms such as depression, mania or psychosis. It is believed that manic symptoms appear with lower doses than psychotic ones. Furthermore, manic symptoms are usually associated with brief treatments against depressive ones that often appear with chronic administration of corticosteroids. The symptoms can persist for to 2 months, with an average duration of 3 weeks. The prognosis is favorable with a complete remission of symptoms in more than 90% of patients. Treatment initially consists in reducing or removing corticosteroids. However, sometimes symptomatic treatment with antipsychotics or mood stabilizers is necessary.

To review about corticosteroid-induced mania

We carry out a literature review about corticosteroid-induced mania, accompanied by a clinical description of one patient previously diagnosed of bipolar disorder who presents a manic episode after corticosteroids treatment.

A 25-year-old male was admitted to the short-term hospitalization unit from the emergency department due to manic symptoms. He had a previous diagnosis of attention deficit hyperactivity disorder sin adolescence and also a diagnosis of bipolar disorder established 7 years ago. During the last year he had received treatment with asenapine 10 mg and lamotrigine 200 mg, with good response. Several weeks before his admission he received corticosteroid treatment during several days, due to an respiratory infection. In this context he appeared more nervous, dysphoric, hyperthymic, impulsive, with increased speech pressure, insomnia and tachypsychia. Despite the withdrawal of corticosteroid treatment, manic symptoms persisted. During admission, asenapine´s dose was increased with a complete remission of the manic symptoms.

Corticosteroids are associated in a high percentage with the appearance of manic symptoms. The prognosis is usually favorable after the withdrawal of corticosteroid treatment. However, sometimes the symptoms do not disappear despite withdrawal - mainly due to individual vulnerability - or this one is not possible. In these cases, treatment with antipsychotics or mood stabilizers is indicated.

None Declared

Mental health in the deaf community is a complex issue. Challenges in diagnosis and treatment arise from a lack of experienced interpreters and difficulties in translating Sign Language to spoken language. Deaf individuals, due to auditory limitations, are more vulnerable to abuse, increasing their risk of mental health disorders, including bipolar affective disorder (BPAD). BPAD is a prevalent, debilitating condition with varied prevalence estimates. Managing it is tough due to its lifelong, unpredictable nature. A new approach called Psychiatric Home Hospitalization Unit aims to provide acute mental health care at home as an alternative to hospitalization.

To show the management of severe bipolar disorder with comorbidity from a Psychiatric Home Hospitalization Unit

A clinical case of bipolar disorder with deafness attended at the Psychiatric Home Hospitalization Unit of our hospital is presented.

A 24-year-old deaf woman borned in Pakistan and later moving to Catalonia, she faced educational challenges but ultimately completed her studies with sign language support. Afterward, she struggled to find suitable employment, and her family had a history of bipolar disorder.

She exhibited a sudden change in behavior, characterized by irritability, paranoia, and distrust. Communication was challenging due to her speech difficulties, but assessments using sign language and observation were conducted. Her physical examination was normal, but her speech was disorganized and pressured, suggesting possible auditory hallucinations and thought disturbances. She was hospitalized and diagnosed with bipolar disorder with psychotic features.

During her initial hospitalization, she received lithium, olanzapine, clotiapine and benzodiacepines. After discharge, she continued treatment through a home hospitalization service during almost 4 month. During follow-up she presented a course with high affective instability, rapid cycling alternating brief periods of stability with other presenting manic and mixed features with high disorganization.

Due to the rapid cycling pattern Valproic acid was considered. Valproic acid was introduced up to 700 mg/d (97.1 mcg/mL). Treatment with lithium carbonate 800 mg/d (0.91 mEq/L) was maintained. Previous antipsychotic regimen was changed to quetiapine 400mg/d, olanzapine 5mg/d. Her condition improved significantly with the adjusted treatment regimen. She was discharged to an outpatient service.

Diagnosing and treating bipolar affective disorder (BPAD) in a deaf and mute patient posed unique challenges. The rapid mood cycling pattern and complexity of her case made treatment challenging. Family information and interpreter support were vital. Cultural factors were considered, and home hospitalization was crucial in managing symptoms that lasted over four months.

None Declared

Relationship between sleep and bipolar disorder involves the following aspects: decreased need for sleep is a fundamental marker of the manic state, sleep deprivation is one cause of mania and may in fact be a fundamental etiological agent in mania, total sleep time is a predictor of future manic episodes, and total sleep time may be a marker of response as well as a target of treatment in mania.

This e-poster aimed to summarize evidence regarding the sleep disturbance in Bipolar Disorder.

Bibliopgraphical review was performed using PubMed platform. All relevant articles were found using the keywords: sleep disturbance, bipolar disorder, mania.

Sleep disturbances are frequent in BD patients in different phases of illness, including the euthymic state and remission. These sleep aberrations are represented not only by insomnia but also by sleep–wake rhythm disorders, especially delayed sleep–wake phase disorders. During the manic state, most patients experience a reduced need for sleep and longer sleep onset latency. Likewise, in the depressive state, insomnia and hypersomnia are commonly observed. Meta-analyses of trials conducted on remitted BD patients demonstrated prolonged total sleep time, increased awakenings after sleep onset, greater variability of sleep–wake variables, and reduced sleep efficiency.

Overall, all kinds of sleep disorders and parasomnias are very common especially in youth patients with BD. Thus, compared to the general population, youth with BD exhibit lower sleep efficiency, longer slow wave sleep, and reduced REM sleep, features that could affect the genesis and prognosis of the disorder. Sleep disturbances may also be used as predictors of the onset of BD in a subset of high-risk young subjects.

None Declared

A 56-year-old patient diagnosed with bipolar affective disorder type II, who remains stable, with no manifest episodes, thanks to aripiprazole 60mg daily.

The aim is to carry out a brief review of the use of the drug as the only stabiliser in bipolar affective disorder.

A 56-year-old patient, who has been suffering from episodes of hypomania since the age of 40, with episodes of depression. After poor tolerance to the use of the usual stabilisers, and the impossibility of using antidepressants due to hypomanic swings, it was decided to start treatment with aripiprazole orally, up to a maximum of 60mg daily. Despite the fact that the patient, with this treatment, had no side effects and remained more stable psychopathologically, the patient did not comply adequately with the correct dosage, due to his rotating work shifts. This fact explained that although he acknowledged an improvement, he continued with episodes of depressive symptoms lasting several days followed by episodes of hypomanic characteristics.

For this reason, it was decided to change treatment to aripiprazole long-acting injectable, in order to ensure linear blood levels of the drug. Initially, it was decided to prescribe 400mg every 28 days. However, after the first administration, 20 days later, the patient began to show dysphoric mood, with marked emotional lability, living in an egodystonic manner. For this reason, the dose was increased to 600mg on a monthly basis. Since then, after a year and a half with the same treatment, the patient has been stable and in line. There has been no further decompensation of the underlying psychopathology and no side effects.

Aripiprazole in TAB is superior to placebo in type I patients, mainly affecting manic and mixed episodes, but not so much in depressive episodes. It has also been observed that it not only acts in the acute phases, but also has a stabilising function, preventing manic episodes.

One study showed that up to 65% of patients on oral aripiprazole in whom it was replaced by AOM remained clinically stable. In the same study, approximately 50% of those who completed 52 weeks of follow-up were able to maintain clinical stability.

None Declared

Sleep disruptions are frequently observed in individuals with bipolar disorder and have been linked to various unfavorable consequences, such as an elevated risk of relapse and lower quality of life. Nonetheless, the impact of sociodemographic factors on the development and progression of these disruptions remains largely unexplored. Gaining insight into the relationship between sleep disruptions and sociodemographic factors is essential for designing effective interventions and enhancing clinical outcomes for individuals affected by bipolar disorder

The objective of this study is to examine the association between sleep disorders in patients with bipolar disorder II (BDII) and sociodemographic characteristics.

This is a cross-sectional, descriptive, and analytical study that was conducted over a one-month period from October 1 to October 31, 2022, with patients attending the follow-up unit of the mental health department at Nabeul Hospital ,Tunisia.The study employed a questionnaire as a tool for data collection, and participants provided voluntary and informed consent before responding. The protection of participant confidentiality and anonymity was carefully observed during all stages of the study.

In this study, we enrolled patients who satisfied the following eligibility criteria: age range of 18 to 60 years, a confirmed diagnosis of type II bipolar disorder based on DSM V criteria, and psychiatric stability as demonstrated by no hospitalization within the preceding 6-month period.

Our study included a sample of 40 male patients diagnosed with type II bipolar disorder. The participants had a mean age of 36 ± 13.2 years, and the majority were unmarried and living with their families or alone. Over two-thirds of the participants had attained a university level of education, while a large proportion of the patients, specifically 80%, reported being regular smokers.

The results of the study revealed that the mean global score on the Pittsburgh Sleep Quality Index (PSQI) was 7.28 ± 3.35, indicating an overall low quality of sleep. The majority of the participants, that is 65% (26), had poor sleep quality scores (> 5), while 45% (18) reported experiencing poor sleep (PSQI ≥ 8).

Our analyses further demonstrated that there was a significant association between tobacco consumption and PSQI scores (p=0.003). Additionally, we found that participants who were above 40 years old had a higher likelihood of experiencing sleep disturbances (p=0.0017).

According to the findings of our study, it appears that patients diagnosed with type II bipolar disorder may experience impaired sleep quality, which can be influenced by age and tobacco consumption. These results underscore the need for a holistic approach to patient care that addresses both the biological and sociodemographic factors that can impact sleep in this population.

None Declared

Cognitive impairment in Bipolar Disorder (BD) is frequent and is associated with reduced function in several areas. Close to half of the patients with BD have persistent cognitive dysfunction. The causes of cognitive impairments and factors associated with normal cognitive function are not clearly described.

Some preliminary evidence links sleep disturbances and cognition impairment in BD. A limited number of studies have investigated the link between sleep and cognitive function in BD using objective measures.

We aim to investigate associations between sleep and objective and subjective cognitive function in patients with BD in full or partial remission.

This is a cross-sectional study. The participants will be 90 adults meeting criteria for DSM 5 BD type 1 or type 2 in full or partial remission. Participants are recruited from psychoeducational groups for BD and from a specialist outpatient clinic.

Diagnoses are set with SCID-5 and are confirmed in a consensus meeting with at least two psychiatrists and/or specialists in psychology. Symptoms of depression and mania are measured with Montgomery Asberg depression rating scale (MADRS) and Young Mania Rating Scale (YMRS). Sleep is measured subjectively with Insomnia Severity Index (ISI) and objectively with actigraphs which participants wear on their non-dominant hand for ten days. Subjective cognition is measured with Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA). Participants undergo neurocognitive testing with a self-administered validated web-based neuropsychological test platform. The testing is carried out in the participant’s home on their smart phones. The tests include measures of learning, storing, recalling, and recognizing visual and verbal information, working memory and reaction time. Normal cognitive function is defined as scores within or above mean on all cognitive subtests. The test-platform has been validated.

We will use descriptive statistics to examine distribution of demographic characteristics. We will test for correlations between sleep factors and subjective and objective measures of cognitive function.

The Regional Committees for Medical and Health research ethics approved the study.

Results will be presented at the conference. So far, 74 out of 90 participants have been included.

We anticipate that normal sleep may be associated with good cognitive functioning. The findings of this study could offer supplementary insights into BD heterogeneity and potential treatment targets.

Abbreviations: SCID-5, Structured Clinical Interview for DSM-5

None Declared

With the rapid changes of attitude, investigation and legislation around cannabis and its subproducts in the Western world, there is a need to profoundly examine the consequences of its use in the general population and, specifically, in people affected by mental disorders. There is a clear relationship between cannabis use and psychosis, but there is also growing evidence of its relationship with manic episodes (Sideli et al, 2019).

A systematic review published by the CANMAT Task Force in 2022 examined again the relationship between cannabis use and bipolar disorder (BD), establishing association with worsened course and functioning of BD in frequent users (Tourjman et al., 2023). On the other hand, some recent papers have highlighted the role of the endocannabinoid system (ECS) in BD, suggesting even possible beneficial effects, mainly through the CB2 receptor (Arjmand et al, 2019).

To describe the impact of cannabis in the psychiatric readmission in BD and to approach the differences in course in cannabis users with regards to non-users.

We conducted a prospective cohort study including the patients admitted to our acute psychiatric unit with the diagnosis of manic or mixed episode during the period between 2015 and 2019 (including patients with one of both final diagnosis: BD or schizoaffective disorder). We established a follow-up of 3 years from the date of admission in which hospital readmissions are examined.

The study, which included 309 patients, concluded that cannabis users were admitted and had the first episode at a younger age (p=0.005), a higher percentage of them did not have a previous diagnosis (p=0.026) nor a previous history of mental health issues (p=0.019) and it was more likely to be their first admission (p=0.011) and to suffer psychotic symptoms (p=0.002).

As of treatment, the results were statistically significant regarding the fact that a lower proportion of patients had received previous psychiatric treatment (p=0.004) and previous electroconvulsive therapy (p=0.003). There was a higher chance of them being non-adherent with medication (p<0.001) and to be administered extended-release antipsychotic treatment during admission (p<0.001).

The study did not find a statistically significant relationship with cannabis use and a higher rate of readmission in the 3 years of follow-up.

Although a higher relapse rate could not be proven in our study, other previously identified factors related to a worse illness course (Sajatovic et al., 2009) did show a significant association with cannabis use, which could lead to one suggesting that our results are compatible with the actual evidence and that cannabis products are detrimental to people who suffer from BD and schizoaffective disorder.

None Declared

Bipolar disorder (BD) is a severe and chronic mental illness characterized by recurrent major depressive episodes and mania (BD-I) or hypomania (BD-II). In addition to the burden of the disease and its consequences, people living with BD, like many other people suffering from mental illness, must deal with their difficulty of integration which can influence their personal and professional life and consequently their quality of life (QOL).

The aim of our study is to assess the QOL among working patients with BD.

A cross-sectional study was carried out in the occupational medicine department of the Charles-Nicolle hospital in Tunisia. Sociodemographic and occupational data were collected from the medical records of patients with bipolar disorder who consulted our department during the period 2022 to 2023. and a telephonic survey was carried out to complete the SF 12 international scale, which is a general health questionnaire that consists of 12 questions which investigates the patient’s state of health via 8 different dimensions: General health perception, Physical health, Limited physical role function, Physical pain, Vitality, Mental health, Limited emotional role function and social functioning.

We enrolled a total of 46 cases where 76% with BD type 1 with an average age of 43±9 years. Most participants were female (76%) and the most frequent sectors of activity were healthcare and administration (80% and 12% respectively). BD was well balanced in 39% of cases with an average bipolar history of 7 years. The median annual absence due to psychiatric problems was 92±61 days per year. The average score was 44±18 for the General Health, 57±35 for physical health and 67±18 for mental health.

This study revealed that people living with BD’s QOL seems to be altered. Clinicians need to be attentive to the QOL of their patients, its assessment, and its empowerment in their daily clinical practice. Future work is required to establish valid strategies to fight low QOL among patients suffering from BD.

None Declared