Sex difference in the progression of manic symptoms during acute hospitalization: A prospective pilot study

Abstract

Objectives Acute mania is a serious medical condition that impacts men and women equally. Longtime presentation of manic symptoms is sex‐dependent; however, little is known about acute symptoms of mania. The objective of this study is to track and compare acute manic symptoms for sex differences during inpatient hospitalization. Methods All patients with bipolar mania admitted to a large university hospital between January and October 2017 were invited to participate in this longitudinal naturalistic follow‐up study. Manic (YMRS), depressive (MADRS), and psychotic (PAS) symptoms were tracked daily from admission to discharge. Results The total YMRS scores decreased significantly overtime (p < .0001) in both male (n = 34) and female (n = 23) patients (p = .7). However, male patients scored significantly higher in sexual interest (p = .01), disruptive and aggressive behavior (p = .01), and appearance (p < .001) while females had better insight into their illness (p = .01). Males and females received similar doses of lithium (p = .1), but males received significantly higher doses of valproic acid (VPA) in comparison with females (p = .003). However, plasma lithium and VPA concentrations at discharge were not significantly different between sexes. Conclusion Our results show sex differences in the progression of certain domains of manic symptoms in a cohort of 23 female and 34 male patients admitted to a large academic center in Turkey. Males, in this sample, exhibited more sexual interest, disruptive and aggressive behaviors, better grooming, and less insight compared to females. While these results are concordant with our preclinical findings and with anecdotal clinical observations, replication in larger samples is needed.

Lifetime and point prevalence of psychotic symptoms in adults with bipolar disorders: a systematic review and meta-analysis

“…There were 24 studies reporting data on the point prevalence of psychotic symptoms in BD. For an overview of included studies, see online Supplementay Material 5: Studies included in the meta-analyses of the point prevalence of psychotic symptoms in bipolar disorders (Abulseoud et al, 2020 ; Asaad et al, 2014 ; Azorin, Adida, & Belzeaux, 2015 ; Azorin, Akiskal, & Hantouche, 2006 ; Basterreche et al, 2008 ; Benazzi, 2001 ; Bonnin et al, 2015 ; Caldieraro et al, 2017 ; Carroll, Vohs, O'Donnell, Shekhar, & Hetrick, 2007 ; Ciapparelli et al, 2001 ; Fiedorowicz et al, 2011 ; Goldberg & Harrow, 2004 ; Guven, Kesebir, Demirer, & Bilici, 2015 ; Kessing, 2004 ; Kessing, Jensen, & Christensen, 2008 ; Levy & Weiss, 2010 ; Lindenmayer, Bossie, Kujawa, Zhu, & Canuso, 2008 ; Lundin, Bartolomeo, O'Donnell, & Hetrick, 2018 ; Novis et al, 2014 ; Reddy, Meyer, Wittlin, Miller, & Weinstock, 2017 ; Salem et al, 2019 ; Samalin et al, 2014 ; Schwartzmann et al, 2007 ; Yildiz, Guleryuz, Ankerst, Ongur, & Renshaw, 2008 ).…”

“…The pooled point prevalence for psychotic symptoms in the 20 studies using DSM BD diagnoses ( n = 4856) was 41.5% (95% CI 32–52) (Abulseoud et al, 2020 ; Asaad et al, 2014 ; Azorin et al, 2006 , 2015 ; Basterreche et al, 2008 ; Benazzi, 2001 ; Bonnin et al, 2015 ; Caldieraro et al, 2017 ; Carroll et al, 2007 ; Ciapparelli et al, 2001 ; Guven et al, 2015 ; Levy & Weiss, 2010 ; Lindenmayer et al, 2008 ; Lundin et al, 2018 ; Novis et al, 2014 ; Reddy et al, 2017 ; Salem et al, 2019 ; Samalin et al, 2014 ; Schwartzmann et al, 2007 ; Yildiz et al, 2008 ).…”

“…For the 11 studies (n = 1263) that gave information about the age span for the included patients, the pooled point prevalence was 45% (95% CI 32-59) (Abulseoud et al, 2020;Asaad et al, 2014;Azorin et al, 2006;Caldieraro et al, 2017;Guven et al, 2015;Levy & Weiss, 2010;Lundin et al, 2018;Novis et al, 2014;Salem et al, 2019;Schwartzmann et al, 2007;Yildiz et al, 2008).…”

“…Point prevalence of psychotic symptoms in BD according to treatment setting (DSM) A total of nine studies (n = 2947) reporting on inpatient samples found a pooled point prevalence of 54% (95% CI 39-68) (Abulseoud et al, 2020;Azorin et al, 2006Azorin et al, , 2015Basterreche et al, 2008;Levy & Weiss, 2010;Lindenmayer et al, 2008;Reddy et al, 2017;Salem et al, 2019;Yildiz et al, 2008).…”

Exploring factors influencing risky behaviors in patients with bipolar disorders using logistic regression model

“…Patients who had weaker awareness of their own symptoms were more likely to have worse behaviors [32]. Abulseoud et al reported that male patients with more disruptive and aggressive behaviors had less insight compared to female ones [33]. Volavka et al indicated that treatment non-adherence greatly increased the risk of risky behavior, and poor insight as well as hostility was associated with nonadherence [24].…”