Phenomenology, socio-demographic factors and outcome upon discharge of manic and mixed episodes in hospitalized adolescents

Abstract

Med J 29, 2006). Little is known on the phenomenology and potential short-term prognosis factors of bipolar episodes in this age population. In particular, very few studies examine this issue on inpatients in the European context of free access to care. Objective To describe the phenomenology of acute manic and mixed episodes in hospitalized adolescents and to analyse potential predictive factors associated with clinical improvement at discharge and length of hospitalization. Methods A total of 80 subjects, aged 12-20 years, consecutively hospitalized for a manic or mixed episode. Sociodemographic and clinical data were extracted by reviewing patients' charts. We used a multivariate analysis to evaluate shortterm outcome predictors. Results The sample was characterized by severe impairment, high rates of psychotic features (N = 50, 62.5%), a long duration of stay (mean 80.4 days), and an overall good improvement (86% very much or much improved). Thirtythree (41.3 %) patients had a history of depressive episodes, 13 (16.3%) had manic or brief psychotic episodes but only 3 (3.7%) had a history of attention deficit/ hyperactivity disorders. More manic episodes than mixed episodes were identified in subjects with mental retardation (MR) and in subjects from migrant and/or low socio-economic families. Overall severity and female gender predicted better improvement in GAF scores. Poor insight and the existence of psychotic features predicted longer duration of stay. Conclusion These results suggest that severe manic and mixed episodes in adolescents with BD-I need prolonged inpatient care to improve and that socio-cultural factors and MR should be examined more closely in youth with BD.j Key words bipolar disorder type I -acute episodeadolescent -prognosissocio-cultural factors BRIEF REPORT

Development of the insight scale for affective disorders (ISAD): Modification from the scale to assess unawareness of mental disorder

“…Some studies (Adida et al, 2008;Brunelle et al, 2009;Cassidy, 2010;Gazalle et al, 2007;Schuepbach et al, 2006) used specific item or items assessing insight from more general questionnaires, such as the Scale for Manic States (SMS; Cassidy et al, 1998), the Young Mania Rating Scale (Young et al, 1978), or the Hamilton Depression Scale (Hamilton, 1960). Other studies (Amador et al, 1994;Dell'Osso et al, 2000;Dias et al, 2008;Ghaemi et al, 1995Ghaemi et al, , 1996Ghaemi et al, , 2000Lam and Wong, 1997;Michalakeas et al, 1994;Pini et al, 2001) used instruments specifically designed to address insight in psychosis, including the Insight and Treatment Attitudes Questionnaire (ITAQ; McEvoy et al, 1989), the Scale to Assess Unawareness of Mental Disorder (SUMD; Amador et al, 1993), and the Schedule for the Assessment of Insight (SAI; David et al, 1992).…”

Bipolar Disorder Type 1 in a 17-Year-Old Girl with Wolfram Syndrome

“…BD can be conceptualized as the fruit of interplay between factors that are present in M's history, genetic vulnerability (mood disorders, depression in family history), and environmental factors (low socioeconomic status and a history of maltreatment) (Brunelle et al 2009). Otherwise, mood swings and aggressive behavior in WS are said to also be caused by recurrent episodes of severe hypoglycemia, which have been shown to cause brain structure anomalies in children suffering from type 1 DM, including brain atrophy (Ho et al 2008).…”

“…The syndrome occurs in 1 in 770,000 children and has a carrier frequency of 1 in 354 people (Barrett et al 1995;Cano et al 2007). This progressive condition has a mortality rate before the age 35 of *65%, due to central respiratory failure associated with brainstem atrophy, renal failure (Kinsley et al 1995), food aspiration, or suicide (De Heredia et al 2013).…”

“…In addition, organized along a spectrum, the disorder encompasses central diabetes insipidus (DI), deafness, abnormalities of the endocrine glands (e.g., hypothyroidism and hypogonadism), urinary tract abnormalities, and multiple neurological abnormalities (e.g., cerebellar ataxia, brainstem dysfunction, peripheral neuropathy, and epilepsy; Barrett et al 1995;Hardy et al 1999;Cryns et al 2003;Medlej et al 2004;Cano et al 2007;Chaussenot et al 2011;Marshall et al 2013). Magnetic resonance imaging studies have indicated that neurodegeneration occurs in optic neurons and brain neurons.…”

Cost-Effectiveness of Asenapine in the Treatment of Patients with Bipolar I Disorder with Mixed Episodes in an Italian Context

“…Hospitalizations generate the most important costs, which account for about 85–90% of total expenses and, as highlighted by Brunelle et al [43], this burden increases because inpatients that experienced a bipolar I mixed episode may have a prolonged hospitalization.…”