Poor medication adherence is a pervasive problem that causes disability and suffering as well as extensive financial costs among individuals with bipolar disorder (BD). Barriers to adherence are numerous and cross multiple levels, including factors related to bipolar pathology and those unique to an individual's circumstances. External factors, including treatment setting, healthcare system, and broader health policies, can also affect medication adherence in people with BD. Fortunately, advances in research have suggested avenues for improving adherence. A comprehensive review of adherence-enhancement interventions for the years 2005-2015 is included. Specific bipolar adherence-enhancement approaches that target knowledge gaps, cognitive patterns, specific barriers, and motivation may be helpful, as may approaches that capitalize on technology or novel drug-delivery systems. However, much work remains to optimally facilitate long-term medication adherence in people with BD. For adherence-enhancement approaches to be widely adapted, they need to be easily accessible, affordable, and practical.

Individuals with post-traumatic stress disorder (PTSD) experience many debilitating symptoms, including intrusive memories, persistent anxiety and avoidance of trauma-related cues. PTSD also results in numerous physiological complications, including increased risk for cardiovascular disease (CVD). However, characterization of PTSD-induced cardiovascular alterations is lacking, especially in preclinical models of the disorder. Thus, we examined the impact of a psychosocial predator-based animal model of PTSD on myocardial sensitivity to ischemic injury. Male and female Sprague-Dawley rats were exposed to psychosocial stress or control conditions for 31 days. Stressed rats were given two cat exposures, separated by a period of 10 days, and were subjected to daily social instability throughout the paradigm. Control rats were handled daily for the duration of the experiment. Rats were tested on the elevated plus maze (EPM) on day 32, and hearts were isolated on day 33 and subjected to 20 min ischemia and 2 h reperfusion on a Langendorff isolated heart system. Stressed male and female rats gained less body weight relative to controls, but only stressed males exhibited increased anxiety on the EPM. Male, but not female, rats exposed to psychosocial stress exhibited significantly larger infarcts and attenuated post-ischemic recovery of contractile function compared to controls. Our data demonstrate that predator stress combined with daily social instability sex-dependently increases myocardial sensitivity to ischemic injury. Thus, this manipulation may be useful for studying potential mechanisms underlying cardiovascular alterations in PTSD, as well as sex differences in the cardiovascular stress response.

Sleep deprivation is associated with increased risk of myocardial infarction. However, it is unknown whether the effects of sleep deprivation are limited to increasing the likelihood of experiencing a myocardial infarction or if sleep deprivation also increases the extent of myocardial injury. In this study, rats were deprived of paradoxical sleep for 96 h using the platform-over-water method. Control rats were subjected to the same condition except the control platform was large enough for the rats to sleep. Hearts from sleep deprived and control rats were subjected to 20 min ischemia on a Langendorff isolated heart system. Infarct size and post ischemic recovery of contractile function were unaffected by sleep deprivation in male hearts. In contrast, hearts from sleep-deprived females exhibited significantly larger infarcts than hearts from control females. Post ischemic recovery of rate pressure product and + dP/dT were significantly attenuated by sleep deprivation in female hearts, and post ischemic recovery of end diastolic pressure was significantly elevated in hearts from sleep deprived females compared to control females, indicating that post ischemic recovery of both systolic and diastolic function were worsened by sleep deprivation. These data provide evidence that sleep deprivation increases the extent of ischemia-induced injury in a sex-dependent manner.

Individuals with bipolar disorder (BD) have high rates of non-adherence, medical illness, and premature mortality. This analysis reexamined correlates of poor adherence to non-psychiatric medication in 73 patients with BD and medical comorbidities. The majority was female (74%) and African-American (77%) with mean age of 48.08 (SD = 8.04), mean BD duration of 28.67 years (SD = 10.24), mean years of education of 12.01 (SD = 1.87), and mean proportion of days with missed doses in past week of 43.25 (SD = 31.14). Sex, age, education, race, and living alone did not correlate with adherence. More BD medications and more severe psychiatric symptoms correlated with worse adherence. Specifically, poor adherence correlated with Retardation and Vegetative factors of MADRS and Affect factor of BPRS. Among poorly adherent patients with BD and medical comorbidities, number of BD medications, tension/anxiety and somatic symptoms of depression related to worse non-psychiatric medication adherence.

Sensitivity of normotensive Wistar rats and NISAG rots (with hereditmy arterial hypertension) to heat stress is compared at the organism and cell levels. High temperature sensitivity of NISAG rats correlates with a low content of the main heat shock protein HSP70. This relationship can serve as a biochemical marker of predisposition to arterial hypertension.

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The present study examines the Rey Auditory Verbal Learning Test (RAVLT) Embedded Performance Validity Indicator (EPVI) for detecting performance validity. This retrospective study analyzes the performance of four groups of 879 participants comprised of 464 clinically referred patients with suspected dementia, 91 forensic patients identified as not exhibiting adequate effort on other measures of response bias, 25 patients with well documented TBI, and a random sample of 198 adults collected in the Gulf State of Oman. The EPVI was also put to the test using normative data collected from the literature. Using sensitivity and specificity analyses, the results indicate moderate to high sensitivity yet low specificity. In conclusion, the study shows that the EPVI is a reasonably good indicator for inadequate effort on the RAVLT but those who fail this measure might not necessarily be exhibiting adequate effort. The limitations and benefits of utilizing the EPVI in clinical practice are discussed.

Background: Posttraumatic stress disorder (PTSD) is a psychological disorder characterized by the formation of traumatic memories following exposure to a life threatening event. In addition to psychological manifestations, PTSD promotes atherosclerosis and increases the incidence of myocardial infarction. However, it is unknown whether the effects of PTSD are limited to increasing the incidence of myocardial infarction or if PTSD also increases infarct severity. Therefore, we used an animal model of PTSD to determine whether posttraumatic stress influences infarct size and postischemic recovery of cardiac contractile function. Methods: Rats were subjected to a well-established animal model of PTSD that is based on predator exposure and psychosocial stress (Zoladz et al., Stress 11:259-281). Rats subjected to this model exhibit many PTSD-like characteristics including the formation of traumatic memories, increased anxiety, increased startle reflex, hypertension, and alterations in the hypothalamic-pituitary adrenal axis. Male rats (7 weeks of age) were either subjected to psychosocial stress (n = 9) or continuously housed in their home cages (n = 8) for 31 days. Hearts were subsequently isolated and subjected to 20 minutes of ischemia and 2 hours reperfusion on a Langendorff isolated heart system. Results: Stressed rats exhibited significantly elevated corticosterone concentrations and anxiety-like behavior in the elevated plus maze. Infarct sizes were significantly larger in hearts from stressed rats (44.7 ± 1.7 % of area at risk) compared to nonstressed rats (31.0 ± 5.4 % of area at risk). Consistent with increased myocardial injury, postischemic recovery of rate pressure product (stressed = 16,922 ± 1,554 mmHg*bpm; nonstressed = 26,407 ± 2,977 mmHg*bpm) and +dP/dT (stressed = 1,901 ± 189 mmHg/sec; nonstressed =3,259 ± 498 mmHg/sec) were significantly attenuated in hearts from stressed rats. Furthermore, postischemic end diastolic pressure was significantly elevated in hearts from stressed (57 ± 6 mmHg) compared to nonstressed (32 ± 7 mmHg) rats. Conclusion: This animal model suggests that PTSD may make the myocardium more sensitive to ischemic injury through a mechanism that is independent from its ability to promote atherosclerosis.