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1
Brieger, P. "Der Verlauf bipolarer Störungen." Nervenheilkunde 33, no. 12 (2014): 849–54. http://dx.doi.org/10.1055/s-0038-1627763.
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ZusammenfassungVerlaufsbeobachtungen sind von zentraler Bedeutung für das Verständnis bipolar affektiver Störungen. Eine reiche Literatur zu diesem Thema nennt auch entsprechende Prädiktoren. Dieser Artikel stellt neue Herangehensweisen vor: 1. Staging-Modelle bipolar affektiver Störungen, 2. die Frage zur Existenz des Kindling-Phänomens, 3. die Frage zum Einfluss der Polarität auf den Verlauf, 4. Überlegungen zur Entität „bipolare Störung” und 5. der Einfluss von Versorgungskonzepten auf den Verlauf bipolarer Störungen. Eine kritische, reflektierte und patientenorientierte Herangehensweise ohne Dogma tut Not.
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Karamatskos, Evangelos, and Jürgen Gallinat. "Bipolar-II-Störungen." Fortschritte der Neurologie · Psychiatrie 90, no. 04 (April 2022): 173–90. http://dx.doi.org/10.1055/a-1680-7187.
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Die bipolare affektive Störung (kurz: bipolare Störung) beschreibt eine Gruppe von affektiven Störungen, die durch depressive sowie manische/hypomane Episoden gekennzeichnet sind. Der Artikel befasst sich mit den diagnostischen und therapeutischen Herausforderungen der Bipolar-II-Störung.
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Pålsson, Erik, Lydia Melchior, Kristina Lindwall Sundel, Alina Karanti, Erik Joas, Axel Nordenskjöld, Mattias Agestam, Bo Runeson, and Mikael Landén. "Cohort profile: the Swedish National Quality Register for bipolar disorder(BipoläR)." BMJ Open 12, no. 12 (December 2022): e064385. http://dx.doi.org/10.1136/bmjopen-2022-064385.
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PurposeThe Swedish National Quality Register for bipolar affective disorder, BipoläR, was established in 2004 to provide nationwide indicators for quality assessment and development in the clinical care of individuals with bipolar spectrum disorder. An ancillary aim was to provide data for bipolar disorder research.ParticipantsInclusion criteria for registration in BipoläR is a diagnosis of bipolar spectrum disorder (ICD codes: F25.0, F30.1–F30.2, F30.8–F31.9, F34.0) and treatment at an outpatient clinic in Sweden. BipoläR collects data from baseline and annual follow-up visits throughout Sweden. Data is collected using questionnaires administered by healthcare staff. The questions cover sociodemographic, diagnostic, treatment, outcomes and patient reported outcome variables. The register currently includes 39 583 individual patients with a total of 75 423 baseline and follow-up records.Findings to dateData from BipoläR has been used in several peer-reviewed publications. Studies have provided knowledge on effectiveness, side effects and use of pharmacological and psychological treatment in bipolar disorder. In addition, findings on the diagnosis of bipolar disorder, risk factors for attempted and completed suicide and health economics have been reported. The Swedish Bipolar Collection project has contributed to a large number of published studies and provides important information on the genetic architecture of bipolar disorder, the impact of genetic variation on disease characteristics and treatment outcome.Future plansData collection is ongoing with no fixed end date. Currently, approximately 5000 new registrations are added each year. Cohort data are available via a formalised request procedure from Centre of Registers Västra Götaland (e-mail: registercentrum@vgregion.se). Data requests for research purposes require an entity responsible for the research and an ethical approval.
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Gersonde, Rainer. "BIPOMAC (Bipolar Climate Machinery)." PAGES news 16, no. 1 (January 2008): 5. http://dx.doi.org/10.22498/pages.16.1.5.
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Trexler, E. Brady, Wei Li, and Stephen C. Massey. "Simultaneous Contribution of Two Rod Pathways to AII Amacrine and Cone Bipolar Cell Light Responses." Journal of Neurophysiology 93, no. 3 (March 2005): 1476–85. http://dx.doi.org/10.1152/jn.00597.2004.
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Rod signals traverse several synapses en route to cone bipolar cells. In one pathway, rods communicate directly with cones via gap junctions. In a second pathway, signals flow rods-rod bipolars-AII amacrines-cone bipolars. The relative contribution of each pathway to retinal function is not well understood. Here we have examined this question from the perspective of the AII amacrine. AIIs form bidirectional electrical synapses with on cone bipolars. Consequently, as on cone bipolars are activated by outer plexiform inputs, they too should contribute to the AII response. Rod bipolar inputs to AIIs were blocked by AMPA receptor antagonists, revealing a smaller, non-AMPA component of the light response. This small residual response did not reverse between −70 and +70 mV and was blocked by carbenoxolone, suggesting that the current arose in on cone bipolars and was transmitted to AIIs via gap junctions. The residual component was evident for stimuli 2 log units below cone threshold and was prolonged for bright stimuli, demonstrating that it was rod driven. Because the rod bipolar-AII pathway was blocked, the rod-driven residual current likely was generated via the rod-cone pathway activation of on cone bipolars. Thus for a large range of intensities, rod signals reach the inner retina by both rod bipolar-AII and rod-cone coupling pathways.
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Vloet, Jennifer A., and Ulrich F. Hagenah. "Pharmakotherapie bipolarer Störungen im Kindes- und Jugendalter." Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 37, no. 1 (January 2009): 27–50. http://dx.doi.org/10.1024/1422-4917.37.1.27.
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Zusammenfassung: Hintergrund: Bipolare Störungen im Kindes- und Jugendalter sind seltene, aber ernste und oft zu weitreichenden Behinderungen in allen Lebensbereichen führende Erkrankungen. Im Zentrum der Behandlung steht die Pharmakotherapie, die über die Akutbehandlung hinaus meist mehrjährig als Rückfallprophylaxe fortgesetzt werden muss. Methodik: Durchgeführt wurde eine Medline-Recherche (Pubmed), mit der Suchstrategie: bipolar - mania - adolescents - early onset - pediatric onset - randomized - controlled trial - neuroleptics - antipsychotics - lithium - moodstabilizer. Ergebnisse: Trotz weit verbreiteter Anwendung von für das Erwachsenenalter etablierten Substanzen bei bipolar erkrankten Kindern und Jugendlichen existiert aktuell eine nur unzureichende Datenlage zur Wirksamkeit und Sicherheit der Anwendung in dieser Altersgruppe. Die Interpretation der Datenlage aus überwiegend offenen Studien wird durch die Kontroverse bezüglich der diagnostischen Validität bipolarer Störungen bei Kindern erschwert. Nebenwirkungen treten bei Kindern und Jugendlichen unter allen eingesetzten Substanzen häufiger und ausgeprägter auf als bei Erwachsenen und limitieren den Einsatz. Schlussfolgerungen: Auch wenn die vorliegenden Daten auf eine Wirksamkeit und ausreichende Verträglichkeit von atypischen Neuroleptika und Moodstabilizern in der Akutbehandlung von Kindern und Jugendlichen mit bipolarer Störung weisen, sind zusätzliche Placebo-kontrollierte Studien und Studien zur Langzeitbehandlung dringend erforderlich.
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Fietz, Cornelia. "Krankheitskosten – Summieren sich die Krankheitskosten bei multiplen psychiatrischen Erkrankungen?" Gesundheitsökonomie & Qualitätsmanagement 24, no. 02 (April 2019): 59–60. http://dx.doi.org/10.1055/a-0888-6301.
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Broder MS et al. Health Care Resource Use, Costs, and Diagnosis Patterns in Patients With Schizophrenia and Bipolar Disorder: Real-world Evidence From US Claims Databases. Clin Ther 2018; 40(10): 1670–1682 Schizophrenie und bipolare Störung sind schwerwiegende psychiatrische Erkrankungen, die trotz eigener ICD-Klassifikation nicht immer klar voneinander abzugrenzen sind. Bei vielen Patienten überlappen die Symptome beider Krankheitsbilder. Die Autoren untersuchen Diagnose-Muster, Ressourcenverbrauch und Krankheitskosten bei Patienten mit Schizophrenie und bipolarer Störung allein und in Kombination.
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Burkhardt, Dwight A., and Patrick K. Fahey. "Contrast Enhancement and Distributed Encoding by Bipolar Cells in the Retina." Journal of Neurophysiology 80, no. 3 (September 1, 1998): 1070–81. http://dx.doi.org/10.1152/jn.1998.80.3.1070.
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Burkhardt, Dwight A. and Patrick K. Fahey. Contrast enhancement and distributed encoding by bipolar cells in the retina. J. Neurophysiol. 80: 1070–1081, 1998. Responses of bipolar cells, cone photoreceptors, and horizontal cells were recorded intracellularly in superfused eyecup preparations of the tiger salamander ( Ambystoma tigrinum). Contrast flashes of positive and negative polarity were applied at the center of the receptive field while the entire retina was light adapted to a background field of 20 cd/m2. For small contrasts, many bipolar cells showed remarkably high contrast gain: up to 15–20% of the bipolar response was evoked by a contrast step of 1%. There was considerable variation from cell to cell but, on average, no striking differences in contrast gain were found between the depolarizing (Bd) and hyperpolarizing (Bh) bipolar cells. Quantitative comparisons of contrast/response measurements for cone photoreceptors and cone-driven bipolars suggest that the high contrast gain of bipolars is the consequence of a 5–10 × amplification of small signals across the cone → bipolar synapse. Bipolar cells had a very restricted linear range of response and tended to saturate at stimulus levels that were within the linear range of the cone response. The contrast/response of horizontal cells was similar to that of cones and differed markedly from that of Bh cells. For steps of equal contrast, the latency of the Bh cells was ∼20 ms shorter than that of the Bd cells regardless of the contrast magnitude. For both bipolar cells and cones, the effect of contrast polarity on latency seems largely due to the absolute value of the light step, Δ L. In the large signal domain, properties of the contrast responses of bipolar cells varied appreciably, both within and between the Bd and Bh classes. Cells of either class could be positive- or negative-contrast dominant. These and additional results show that in the light-adapted retina, the bipolar population is functionally diverse and has the potential to provide a rich substrate for distributed encoding of visual images.
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Wässle, Heinz, Masayuki Yamashita, Ursula Greferath, Ulrike Grünert, and Frank Müller. "The rod bipolar cell of the mammalian retina." Visual Neuroscience 7, no. 1-2 (August 1991): 99–112. http://dx.doi.org/10.1017/s095252380001097x.
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AbstractThree approaches to study the function of mammalian rod bipolar cells are described. Extracellular recordings from the intact cat eye under light- and dark-adapted conditions showed that in dark-adapted retina all light responses can be blocked by 2-amino-4-phosphonobutyrate (APB). Immunocytochemical staining with an antibody against protein kinase C (PKC) labeled rod bipolar cells in all mammalian retinae tested. When rat retinae were dissociated, PKC immunoreactivity was also found in isolated bipolar cells and could be used for their identification as rod bipolars. Patch-clamp recordings were performed from such dissociated rod bipolar cells and their responses to APB were measured. APB closed a nonselective cation channel in the cell membrane. The actions of GABA and glycine were also tested and both opened chloride channels in dissociated rod bipolar cells. These results suggest that rod bipolar cells are depolarized by a light stimulus and that GABA as well as glycine modulate their light responses.
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QIN, PU, and ROBERTA G. POURCHO. "Localization of AMPA-selective glutamate receptor subunits in the cat retina: A light- and electron-microscopic study." Visual Neuroscience 16, no. 1 (January 1999): 169–77. http://dx.doi.org/10.1017/s0952523899161121.
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The distribution of AMPA-selective glutamate receptor subunits was studied in the cat retina using antisera against GluR1 and GluR2/3. Both antisera were localized in postsynaptic sites in the outer plexiform layer (OPL) as well as the inner plexiform layer (IPL). Immunoreactivity for GluR1 was seen in a subpopulation of OFF cone bipolar cells and a number of amacrine and ganglion cells. Within the IPL, processes staining for GluR1 received input from OFF and ON cone bipolar cells but not from rod bipolars. Labeling for GluR2/3 was seen in horizontal cells, an occasional cone bipolar cell, and numerous amacrine and ganglion cells. In the IPL, GluR2/3 staining was postsynaptic to cone bipolar cells in both sublaminae. AII amacrine cells which receive rod bipolar input were also labeled for GluR2/3. With both antisera, staining was limited to a single member of the bipolar dyad complex, providing morphological evidence for functional diversity in glutamatergic pathways.
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McIntyre, Roger S., and Jakub Z. Konarski. "Bipolar Disorder: A National Health Concern." CNS Spectrums 9, S12 (November 2004): 6–15. http://dx.doi.org/10.1017/s1092852900028844.
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AbstractBipolar disorders are prevalent, disabling, and costly diseases that often pursue an inexorable course. Underdetection, misdiagnosis, and diagnostic delay frequently and unnecessarily interfere with appropriate treatment of the disorder. Mortality studies in bipolar disorder underscore the relevance of both unnatural and natural causes of death, inviting the need for improved preventative and primary health care for bipolar patients. The treatment framework for bipolar disorder must recognize and anticipate the multidirnensionality and comorbidity of this illness. Pharmacotherapy is necessary, with multiple concomitant medications required for most patients, In addition, adjunctive psychosocial interventions offer enhanced compliance and may beneficially influence psychopathological and functional outcomes. This article emphasizes the public health concern of bipolr disorder, and provides tactics to enhance detection of cryptic bipolar states, underscore the clinical and pathophysiological relevance of comorbidity in bipolar disorder, and provide a framework for multimodality therapy for this condition.
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Tonelli, Hélio Anderson. "Processamento cognitivo "Teoria da Mente" no transtorno bipolar." Revista Brasileira de Psiquiatria 31, no. 4 (December 2009): 369–74. http://dx.doi.org/10.1590/s1516-44462009000400015.
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OBJETIVO: O transtorno afetivo bipolar está associado ao comprometimento funcional persistente. Apesar de muitas pesquisas demonstrarem que bipolares podem apresentar déficits cognitivos, um número menor de trabalhos avaliou o papel de prejuízos no processamento cognitivo social, a Teoria da Mente (relacionado à capacidade de inferir estados mentais), no aparecimento de sintomas e complicações sociais em bipolares. O objetivo deste trabalho é o de revisar sistemática e criticamente a literatura sobre possíveis alterações do processamento Teoria da Mente no transtorno afetivo bipolar. MÉTODO: Foi realizada uma busca na base de dados Medline por trabalhos publicados em língua inglesa, alemã, espanhola ou portuguesa nos últimos 20 anos, utilizando a frase de busca "Bipolar Disorder"[Mesh] AND "Theory of Mind". Foram procurados por estudos clínicos envolvendo indivíduos bipolares e que empregaram uma ou mais tarefas cognitivas desenvolvidas para a avaliação de habilidades Teoria da Mente. Foram excluídos os relatos de caso e cartas ao editor. A busca inicial resultou em cinco artigos, sendo selecionados quatro. Outros quatro foram também selecionados a partir da leitura dos artigos acima. DISCUSSÃO: Os artigos selecionados avaliaram populações de bipolares adultos e pediátricos, incluindo indivíduos eutímicos, maníacos e deprimidos. A maioria dos trabalhos avaliados sugere que existam prejuízos no processamento Teoria da Mente em portadores de transtorno afetivo bipolar e que estes podem estar por trás dos sintomas e dos déficits funcionais do transtorno afetivo bipolar. CONCLUSÃO: Pesquisas futuras a respeito do tema em questão poderão esclarecer muito acerca do papel das alterações sociocognitivas no surgimento dos sintomas do transtorno afetivo bipolar, bem como ajudar no desenvolvimento de estratégias preventivas e terapêuticas do mesmo.
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Boycott, B. B., and J. M. Hopkins. "Cone bipolar cells and cone synapses in the primate retina." Visual Neuroscience 7, no. 1-2 (August 1991): 49–60. http://dx.doi.org/10.1017/s0952523800010932.
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AbstractPrimate retinal bipolar cells synapsing with two adjacent cones (2C bipolars) are further described. Their synaptic contacts are either as the central (invaginating) component of the cone triads or as basal (flat) contacts on the membrane of the cone pedicle base. Correspondingly, their axons end either in the b (inner) half or in the a (outer) half of the inner plexiform layer. The shape and size of the axon terminals of 2C bipolars are indistinguishable from those of adjacent midget bipolars. Therefore 2C bipolars, like midget bipolars, probably synapse with midget ganglion cells. Two C bipolars have not been identified as connected to foveal cones. But they are not restricted to the retinal periphery, as has previously been supposed, since they occur, mixed with midget (single cone) bipolars, throughout all parts of the retina from about 2.5 mm to atleast 10.0 mm from the fovea. It is likely that 2C bipolars are a variant of the midget bipolars; and that they contact some members of the same population of cones, instead of the midgets. This paper briefly reviews, and raises some new, problems concerning our current understanding of the synaptic connectivity patterns of the midget, 2C, and diffuse cone bipolar cells.
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Dolan, Robert P., and Peter H. Schiller. "Evidence for only depolarizing rod bipolar cells in the primate retina." Visual Neuroscience 2, no. 5 (May 1989): 421–24. http://dx.doi.org/10.1017/s0952523800012311.
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AbstractThe mammalian rod bipolar, for which only one class has been identified, has been described as being hyperpolarizing by some investigators and depolarizing by others. We now report the effects of 2-amino-4-phosphonobutyrate (APB), a potent blocker of depolarizing bipolar cells, on visual behavior in the dark-adapted monkey. While in mesopic and photopic conditions only the monkeys' ability to detect incremental stimuli is impaired, under scotopic conditions all light mediated response in the monkey is eliminated. Assuming APB is acting on rod bipolars in the same fashion as it does on cone bipolars, we conclude that the primate rod bipolars all depolarize to light and that the ON and OFF channels are formed by the amacrine cell network.
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Koontz, Margaret A., and Anita E. Hendrickson. "Distribution of GABA-immunoreactive amacrine cell synapses in the inner plexiform layer of macaque monkey retina." Visual Neuroscience 5, no. 1 (July 1990): 17–28. http://dx.doi.org/10.1017/s0952523800000043.
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AbstractThe distribution patterns of GABA immunoreactive (+) and immunonegative (−) amacrine cell synapses and profiles in the inner plexiform layer (IPL) were analyzed in three macaque monkey retinas using postembedding electron-microscopic (EM) immunogold cytochemistry. Synapses and profiles were counted at 5% intervals throughout the IPL depth in three EM montages (total area = 6509 μm2), with 0% depth at the inner nuclear layer/IPL border. Nearly 70% of all amacrine synapses were GABA+, and they contacted all major classes of neurons that arborize in the IPL: bipolars (45%), ganglion cells (25%), and GABA+ (20%) and GABA− (10%) amacrines. A major relationship was seen between GABA+ amacrine processes and bipolar terminals: 76% of all amacrine-to-bipolar synapses were GABA+, and 82% of bipolar output dyads contained at least one GABA+ amacrine.GABA+ amacrine profiles (N = 2455) were concentrated in three wide bands at IPL depths of 0–25%, 40–60%, and 75–100%, corresponding to the dense bands seen with light-microscopic immunocytochemistry. In contrast, GABA+ amacrine synapses (N = 1081) were distributed evenly throughout the IPL depth, rather than being confined to the three dense bands. GABA− amacrine synapses (N = 516) were concentrated at 40% and 60% depths.Each category of amacrine output synapses had a characteristic pattern of stratification in the IPL. GABA+amacrine-to-bipolar synapses occurred throughout the IPL but were most frequent at 20% and 80% IPL depths, where the dendrites of midget cone bipolars arborize (Polyak, 1941). In contrast, GABA+amacrine-to-ganglion cell synapses were concentrated at 30% and 70% IPL depths, near the dendritic arborizations of parasol ganglion cells (Watanabe & Rodieck, 1989). GABA+ synapses onto bipolars and amacrines were also concentrated at the level of rod bipolar terminals. GABA+ amacrines must play significant but different roles in ON and OFF midget and parasol pathways as well as the rod pathway.
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BURKHARDT, DWIGHT A., PATRICK K. FAHEY, and MICHAEL A. SIKORA. "Retinal bipolar cells: Temporal filtering of signals from cone photoreceptors." Visual Neuroscience 24, no. 6 (November 2007): 765–74. http://dx.doi.org/10.1017/s0952523807070630.
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The temporal dynamics of the response of neurons in the outer retina were investigated by intracellular recording from cones, bipolar, and horizontal cells in the intact, light-adapted retina of the tiger salamander (Ambystoma tigrinum), with special emphasis on comparing the two major classes of bipolars cells, the ON depolarizing bipolars (Bd) and the OFF hyperpolarizing bipolars (Bh). Transfer functions were computed from impulse responses evoked by a brief light flash on a steady background of 20 cd/m2. Phase delays ranged from about 89 ms for cones to 170 ms for Bd cells, yielding delays relative to that of cones of about 49 ms for Bh cells and 81 ms for Bd cells. The difference between Bd and Bh cells, which may be due to a delay introduced by the second messenger G-protein pathway unique to Bd cells, was further quantified by latency measurements and responses to white noise. The amplitude transfer functions of the outer retinal neurons varied with light adaptation in qualitative agreement with results for other vertebrates and human vision. The transfer functions at 20 cd/m2 were predominantly low pass with 10-fold attenuation at about 13, 14, 9.1, and 7.7 Hz for cones, horizontal, Bh, and Bd cells, respectively. The transfer function from the cone voltage to the bipolar voltage response, as computed from the above measurements, was low pass and approximated by a cascade of three low pass RC filters (“leaky integrators”). These results for cone→bipolar transmission are surprisingly similar to recent results for rod→bipolar transmission in salamander slice preparations. These and other findings suggest that the rate of vesicle replenishment rather than the rate of release may be a common factor shaping synaptic signal transmission from rods and cones to bipolar cells.
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Peukert, Peter, and Thomas D. Meyer. "Anzeichen für vermehrte subsyndromale affektive Episoden bei Vulnerabilität für bipolar affektive Störungen." Zeitschrift für Klinische Psychologie und Psychotherapie 35, no. 3 (July 2006): 215–24. http://dx.doi.org/10.1026/1616-3443.35.3.215.
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Zusammenfassung. Hintergrund: Die Identifikation von Personen mit erhöhtem Risiko für bipolare Störungen kann das Verständnis ätiologischer Aspekte verbessern und langfristig präventive Optionen eröffnen. Verschiedene Studien der letzten Jahre zeigen einen Zusammenhang zwischen dem hypomanen Temperament (Skala Hypomane Persönlichkeit (Hyp)) und einem erhöhten Erkrankungsrisiko für bipolar affektive Störungen. Fragestellungen: Ziel der vorliegenden Arbeit war es zu prüfen, ob sich bei Personen, die eine psychometrisch definierte erhöhte Vulnerabilität für das bipolare Spektrum haben und bei denen bislang keine psychische Störung diagnostiziert wurde, Anzeichen für affektive Symptome bzw. subsyndromale Episoden finden lassen. Methode: Anhand der Skala Hyp wurden Jugendliche und junge Erwachsene (N = 112) in eine Gruppe mit hohen Werten in Bezug auf die Hyp-Skala (Hyp-Gruppe) und niedrige Werte (Kontrollgruppe) aufgeteilt. Sie wurden 2 Jahre später mit dem SKID für DSM-IV interviewt und füllten vier Wochen lang prospektiv ein Stimmungstagebuch aus. Ergebnisse: Auch wenn man Personen mit diagnostizierbaren psychischen Störungen einschließlich Achse-II-Störungen ausschließt, zeigen Personen der Hyp-Gruppe vermehrt Anzeichen subsyndromaler bipolarer Episoden. Auch prospektiv berichten sie von mehr affektiv depressiven und maniformen Symptomen und eine erhöhte affektive Instabilität. Schlussfolgerungen: Mit der Skala Hypomane Persönlichkeit werden Personen identifiziert, die sowohl retrospektiv als auch prospektiv vermehrt depressive und maniforme Symptome berichten, auch wenn sie nicht die Kriterien für eine psychische Störung erfüllen. Dies macht die Skala geeignet zur Untersuchung subsyndromaler bipolarer Zustände und deren Korrelate und Prozesse.
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Brieger, P. "Komorbidität bei bipolar affektiven Störungen." Nervenheilkunde 30, no. 05 (2011): 309–12. http://dx.doi.org/10.1055/s-0038-1627813.
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ZusammenfassungPatienten mit bipolar affektiven Störungen erfüllen in über 50% der Fälle die (Lebenszeit-)diagnose einer weiteren psychischen Störung, außerdem erkranken sie gehäuft an nicht psychiatrischen körperlichen Erkrankungen. Besonders häufig treten Angsterkrankungen, Suchterkrankungen, Persönlichkeitsstörungen und Aufmerksamkeitsdefizithyperaktivitätssyndrome zusätzlich auf. Komorbide Störungen komplizieren den Verlauf der bipolaren Störung: Im Schnitt haben Patienten mit bipolar affektiver Störung plus Komorbidität eine schlechteres Funktionsniveau, sie haben ein früheres Ersterkrankungsalter und sprechen schlechter auf die Therapie an. Es gibt wenig gesicherte Erkenntnis zur Therapie “komorbider” Störungen plus bipolar affektiver Störungen. Auch ist die nosologische Einordnung der zusätzlichen Erkrankungen nicht unumstritten: Manche genetischen und Verlaufsuntersuchungen weisen darauf hin, dass hinter dem gleichzeitigen Auftreten mehrerer psychischer Störungen eigenständige Krankheitsprozesse (im Sinne breiter Spektra oder “Formenkreise”) stehen könnten.
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Akiskal, H. S., and K. Akiskal. "Reassessing the prevalence of bipolar disorders : clinical significance and artistic creativity." Psychiatry and Psychobiology 3, S1 (1988): 29s—36s. http://dx.doi.org/10.1017/s0767399x00002625.
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SummaryKraepelin's broad concept of manic-depressive illness was challenged in the 1960s by several European and American investigators. This led to the unipolar-bipolar distinction, with considerable restriction of the boundaries of bipolar disorder in favor of unipolar depressions. This concept has now been implicity adopted by official systems of classification worldwide. This review summarizes recent research data that suggest that a partial return to Kraepelin's broad concept of manic-depressive illness is in order. In reassessing the unipolar-bipolar dichotomy, the authors propose that the classification of depressions should incorporate such nonsymptomatologic considerations as family history, temperament, abruptness of onset, recurrence (periodicity and seasonality), and Pharmacologie response.Depending on the definitions used, the unipolar-bipolar ratio has ranged from 10:1 to 4:1. Recent American and European investigations, including studies by the authors and their Italian collaborators, suggest that this ratio may be closer to 2:1 and even as low as 1:1. This conclusion is further supported by genetic data, prospective follow-up studies, pharmacologie response, and examination of interepisodic temperaments. Thus, many depressives with premorbid or intermorbid hyperthymie, irritable or cyclothymie temperaments can now be classified as bipolar. Variously referred to as pseudo-unipolar, unipolar II, bipolar III, bipolar II, or the “ soft” bipolar speetrum, these depressive conditions present diagnostic and therapeutic challenges to the clinician. Special subgroups may be at risk for rapid cycling when overexposed to tricyclic antidepressants. Finally, a significant minority of soft bipolars uppear to be prominent in leadership positions and artistic domains.
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Rocha, Fernanda Perez, Natalia Batista Zanetti, Juliana Marques Santos Ferreira, Vitor Augusto Alves da Silva, Pedro Henrique Ferreira Maia, Raquel Lourenço Silva, Alexandra Claudia Ferreira, Eduardo Expedito Valeriano Batista, Karinne Nancy Sena Rocha, and Andréa Ramos de Souza. "Atualizações sobre a abordagem e o tratamento da depressão bipolar maior em adultos." Brazilian Journal of Health Review 5, no. 5 (October 31, 2022): 21654–73. http://dx.doi.org/10.34119/bjhrv5n5-304.
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Os princípios e questões gerais envolvidos no tratamento da depressão bipolar incluem a avaliação inicial, objetivos do tratamento, cenário, farmacoterapia, duração de um ensaio clínico adequado, monitoramento, psicoterapia adjuvante e comorbidade. O transtorno bipolar é um transtorno de humor caracterizado por períodos de elevação patológica do humor (mania ou hipomania). Os pacientes com transtorno bipolar I apresentam episódios maníacos e quase sempre apresentam episódios hipomaníacos e episódios depressivos maiores. O transtorno bipolar II é caracterizado por pelo menos um episódio de hipomania e um ou mais episódios depressivos maiores. Além disso, características psicóticas, como delírios e alucinações, frequentemente acompanham episódios depressivos bipolares, particularmente em pacientes com transtorno bipolar I. O termo droga antimaníaca é utilizado para nos referir a medicamentos que podem reduzir os sintomas agudos de mania/hipomania, sem causar uma mudança para a polaridade oposta, exemplos incluem lítio, antiepilépticos, como carbamazepina e valproato, e antipsicóticos de segunda geração, como aripiprazol, cariprazina, lurasidona, olanzapina, quetiapina e risperidona. Os pacientes com depressão bipolar I podem não responder ou tolerar a monoterapia com quetiapina e monoterapia com lurasidona.
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JOO, HANNAH R., BETH B. PETERSON, TONI J. HAUN, and DENNIS M. DACEY. "Characterization of a novel large-field cone bipolar cell type in the primate retina: Evidence for selective cone connections." Visual Neuroscience 28, no. 1 (December 15, 2010): 29–37. http://dx.doi.org/10.1017/s0952523810000374.
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AbstractParallel processing of visual information begins at the first synapse in the retina between the photoreceptors and bipolar cells. Ten bipolar cell types have been previously described in the primate retina: one rod and nine cone bipolar types. In this paper, we describe an 11th type of bipolar cell identified in Golgi-stained macaque retinal whole mount and vertical section. Axonal stratification depth, in addition to dendritic and axonal morphology, distinguished the “giant” cell from all previously well-recognized bipolar cell types. The giant bipolar cell had a very large and sparsely branched dendritic tree and a relatively large axonal arbor that costratified with the DB4 bipolar cell near the center of the inner plexiform layer. The sparseness of the giant bipolar’s dendritic arbor indicates that, like the blue cone bipolar, it does not contact all the cones in its dendritic field. Giant cells contacting the same cones as midget bipolar cells, which are known to contact single long-wavelength (L) or medium-wavelength (M) cones, demonstrate that the giant cell does not exclusively contact short-wavelength (S) cones and, therefore, is not a variant of the previously described blue cone bipolar. This conclusion is further supported by measurement of the cone contact spacing for the giant bipolar. The giant cell contacts an average of about half the cones in its dendritic field (mean ± s.d. = 52 ± 17.6%; n = 6), with a range of 27–82%. The dendrites from single or neighboring giant cells that converge onto the same cones suggest that the giant cell may selectively target a subset of cones with a highly variable local density, such as the L or M cones.
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Robles, Carina Schifino, Onofre Francisco de Quadros, and Solange Bercht. "O manejo odontológico do paciente bipolar em litioterapia, com ênfase para a cárie dentária, no método clínico de intervenção : estudo de casos." Revista da Faculdade de Odontologia de Porto Alegre 40, no. 2 (October 28, 2021): 7–13. http://dx.doi.org/10.22456/2177-0018.110984.
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The present work is a case study of 8 bipolar patients under lithium therapy, being all of them members of the lithium group of the Hospital de Clínicas de Porto Alegre. It describes the dental management of bipolar patients under lithium therapy, emphasizing dental caries and the clinical method of intervention. The work was divided into three phases, existing a ninety-day interval between each ofthem. In the first part ofthe research, dental examinations were carried out and the patients were interviewed with the special purpose of describing each one of them regarding his buccal health. They were also inquired about their experience in living with the bipolar disease, about the medication taken and its side effects. The patients received dental treatment according to the clinical method as they also attended health educational sessions destined to increase their autonomy up to the dental dismissal. In the second and third phases, the exams that had been carried out in the first phase were repeated in order to analyze the commitment of each bipolar patient to the proposed dental treatment. The questions about the relationship between the bipolar patient and the treatment of this disease were also repeated. It was concluded that the results of the dental exams were related to the degree of stabilization of the bipolar disease; the patients detaining the best results in the dental treatment were those who had the bipolar disease stabilized. It was concluded that, having in mind the occurrence frequency of bipolar disease, it would be plausible that a denfist who works in the Public Service sooner or later would attend bipolar patients; bipolar patients are a peculiar population group that need a specific dental program; the planning and scheduling of these specific odontological programs for bipolars should take into account the disruptions in the dental therapy, caused by the disease and it is also necessary to renegotiate with the bipolar, his responsibilities and his motivation for buccal self-care, which will result in more frequent dental visits.
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LAMEIRÃO, SORAIA VALÉRIA O. C., DANIA E. HAMASSAKI, ANDERSON R. RODRIGUES, SILENE MARIA A. DE LIMA, BARBARA L. FINLAY, and LUIZ CARLOS L. SILVEIRA. "Rod bipolar cells in the retina of the capuchin monkey (Cebus apella): Characterization and distribution." Visual Neuroscience 26, no. 4 (July 2009): 389–96. http://dx.doi.org/10.1017/s0952523809990186.
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AbstractRod bipolar cells in Cebus apella monkey retina were identified by an antibody against the alpha isoform of protein kinase C (PKCα), which has been shown to selectively identify rod bipolars in two other primates and various mammals. Vertical sections were used to confirm the identity of these cells by their characteristic morphology of dendrites and axons. Their topographic distribution was assessed in horizontal sections; counts taken along the dorsal, ventral, nasal, and temporal quadrants. The density of rod bipolar cells increased from 500 to 2900 cells/mm2 at 1 mm from the fovea to reach a peak of 10,000–12,000 cells/mm2 at 4 mm, approximately 5 deg of eccentricity, and then gradually decreased toward retinal periphery to values of 5000 cells/mm2 or less. Rod to rod bipolar density ratio remained between 10 and 20 across most of the retinal extension. The number of rod bipolar cells per retina was 6,360,000 ± 387,433 (mean ± s.d., n = 6). The anti-PKCα antibody has shown to be a good marker of rod bipolar cells of Cebus, and the cell distribution is similar to that described for other primates. In spite of the difference in the central retina, the density variation of rod bipolar cells in the Cebus and Macaca as well as the convergence from rod to rod bipolar cells are generally similar, suggesting that both retinae stabilize similar sensitivity (as measured by rod density) and convergence.
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Daskalopoulou, E. G., D. G. Dikeos, G. N. Papadimitriou, D. Souery, S. Blairy, I. Massat, J. Mendlewicz, and C. N. Stefanis. "Self-esteem, social adjustment and suicidality in affective disorders." European Psychiatry 17, no. 5 (September 2002): 265–71. http://dx.doi.org/10.1016/s0924-9338(02)00681-8.
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SummarySelf-esteem (SE) and social adjustment (SA) are often impaired during the course of affective disorders; this impairment is associated with suicidal behaviour. The aim of the present study was to investigate SE and SA in unipolar or bipolar patients in relation to demographic and clinical characteristics, especially the presence of suicidality (ideation and/or attempt). Forty-four patients, 28 bipolar and 16 unipolar, in remission for at least 3 months, and 50 healthy individuals were examined through a structured clinical interview. SE and SA were assessed by the Rosenberg self-esteem scale and the social adjustment scale, respectively. The results have shown that bipolar patients did not differ from controls in terms of SE, while unipolar patients had lower SE than bipolars and controls. No significant differences in the mean SA scores were found between the three groups. Suicidality during depression was associated only in bipolar patients with lower SE at remission; similar but not as pronounced was the association of suicidality with SA. It is concluded that low SE lasting into remission seems to be related to the expression of suicidality during depressive episodes of bipolar patients, while no similar pattern is evident in unipolar patients.
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Baldassano, Claudia F., Christos A. Ballas, and John P. O'Reardon. "Rethinking the Treatment Paradigm for Bipolar Depression: The Importance of Long-Term Management." CNS Spectrums 9, S9 (September 2004): 11–18. http://dx.doi.org/10.1017/s1092852900004351.
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ABSTRACT:The need for long-term management of bipolar disorder is evident. Bipolar patients spend more time depressed than manic; however, few agents used for maintenance therapy of bipolar disorder have demonstrated good efficacy in delaying relapse into depression. This article provides a comprehensive review of open-label and randomized, controlled studies examining prophylactic efficacy in bipolar disorder, especially bipolar depression. Lithium, considered the gold standard for bipolar disorder maintenance therapy may be more effective in delaying manic relapse than in delaying depressive relapse. Evidence for the efficacy of divalproex and carbamazepine in delaying depressive relapse is yet to be fully elucidated. Lamotrigine has demonstrated efficacy in delaying time to depressive relapse. Unpublished studies show ohnzapine's efficacy in preventing manic recurrence, while its efficacy in preventing depressive recunence is yet to be proven. As patients with bipohr disorder are prone to experiencing depressive episodes, more attention needs to be focused on preventing depressive relapse. To date, three agents—lithium, lamotrigine, and olanzapine—have been shown to have prophylactic benefits in treating this highly recunent disorder.
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Silva, Rafael de Assis da, Daniel C. Mograbi, Evelyn V. M. Camelo, Luiza Nogueira Amadeo, Cristina M. T. Santana, Jesus Landeira-Fernandez, and Elie Cheniaux. "The relationship between insight and affective temperament in bipolar disorder: an exploratory study." Trends in Psychiatry and Psychotherapy 40, no. 3 (September 2018): 210–15. http://dx.doi.org/10.1590/2237-6089-2017-0073.
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Abstract Introduction In recent years, the association between temperament and clinical characteristics of mood disorders has been studied. Most bipolar patients show deficits in their awareness of signs and symptoms. The relationship between affective temperament and insight in bipolar patients has not been carried out in the literature so far. Objective To evaluate the relationship between affective temperament and insight in bipolar disorder. Method A group of 65 bipolar patients were followed during a year. Patients underwent a clinical assessment and were diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Insight was evaluated through the Insight Scale for Affective Disorders (ISAD), and affective temperament, through the TEMPS-Rio de Janeiro. The relationship between affective temperament and insight was explored with Spearman rho correlations between scores on each item of the ISAD and on the TEMPS-Rio de Janeiro subscales. Results In euthymic phases, bipolars with depressive temperament were associated with a higher level of insight about the consequences of the disorder; when in mania, patients showed better insight about having an affective disorder, presenting psychomotor alterations, and suffering from guilt or grandiosity. Similarly, bipolar patients with higher scores of anxious temperament, when in mania, had better insight on alterations in attention. Bipolar patients with higher scores of hyperthymic temperament, when in mania, showed the worst insight about thought disorder. Conclusion In addition to being determined by the phase of the disease and several varying symptoms, the level of insight in bipolar patients is also influenced by affective temperament.
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Cetkovich-Bakmas, Marcelo, Andrea Abadi, Sebastián Camino, Gerardo García Bonetto, Luis Herbst, Eliana Marengo, Fernando Torrente, et al. "Tercer Consenso Argentino sobre el manejo de los Trastornos Bipolares. Segunda Parte B." Vertex Revista Argentina de Psiquiatría 34, no. 160 (July 10, 2023): 25–53. http://dx.doi.org/10.53680/vertex.v34i160.459.
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Este documento constituye la segunda parte B del Tercer Consenso Argentino sobre el Manejo de los Trastornos Bipolares llevada a cabo por la Asociación Argentina de Psiquiatría Biológica (AAPB). Siguiendo con el direccionamiento iniciado en el parte 2A sobre el tratamiento integral de los trastornos bipolares, esta sección se ha enfocado en sintetizar la evidencia más actualizada sobre abordajes terapéuticos para pacientes adultos. El alcance de esta sección es proporcionar recomendaciones terapéuticas para el manejo de los trastornos bipolares en adultos, (i) manía aguda, (ii) depresión bipolar, (iii) estado mixto, (iv) el suicidio en el trastorno bipolar, (v) intervenciones psicológicas. Además, el presente manuscrito aborda la evaluación y el manejo de los efectos secundarios de los tratamientos farmacoterapéuticos.
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Steffen, Julia K., Paul Reker, Fiona K. Mennicken, Till A. Dembek, Haidar S. Dafsari, Gereon R. Fink, Veerle Visser-Vandewalle, and Michael T. Barbe. "Bipolar Directional Deep Brain Stimulation in Essential and Parkinsonian Tremor." NeuroTarget 15, no. 3 (October 10, 2021): 71–79. http://dx.doi.org/10.47924/neurotarget202176.
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Objetivo: Comparar la estimulación cerebral profunda (ECP) talámica direccional monopolar, bipolar y direccional bipolar en pacientes con temblor. Métodos: Se seleccionaron catorce pacientes con temblor (7 con temblor esencial y 7 con Enfermedad de Parkinson) implantados con electrodos direccionales de ECP en el núcleo intermedio ventral del tálamo (VIM). Se compararon los umbrales de efectos adversos de la estimulación monopolar direccional (DIREC) con la ECP circular y con un diseño randomizado, con dos programaciones bipolares diferentes (BIPOLAR = ánodo circular; BI-DIREC = ánodo direccional). También se evaluó la supresión del temblor (Escala de Evaluación del Temblor, EET), justo por debajo del umbral de efectos adversos. Resultados: La ECP direccional en la mejor dirección individualizada mostró un umbral de efectos adversos más alto que la ECP circular (p = 0.0063). Los umbrales se elevaron aún más utilizando cualquiera de los programas de estimulación bipolar (BIPOLAR p = 0.0029, BI-DIREC p = 0.0022). No hubo diferencias en los umbrales de efectos adversos de los dos programas de estimulación bipolar, pero hubo menor frecuencia de efectos adversos con BI-DIREC. Tampoco hubo diferencias en los puntajes de la EET con la estimulación justo por debajo del umbral de efectos adversos de todas las condiciones de estimulación. Conclusiones: Los umbrales de efectos adversos de la estimulación monopolar direccional y bipolar con ánodos circulares y direccionales fueron más elevados comparados con la estimulación monopolar circular en el VIM. La ECP bipolar con ánodos direccionales provocó efectos adversos con menor frecuencia que la estimulación bipolar y monopolar direccional. Todos los programas de estimulación tuvieron efectos comparables en la supresión del temblor justo por debajo del umbral de efectos adversos. Por ende, se debería explorar la programación direccional y diferentes opciones de estimulación bipolar en pacientes con efectos adversos por la estimulación talámica, cuando la programación monopolar no resulte satisfactoria. Se requiere un mayor número de estudios para explorar la eficacia de los diferentes paradigmas de estimulación bipolar.
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ROCHA, MARLOS FERNANDO VASCONCELOS, AMANDA GALVÃO-DE ALMEIDA, FABIANA NERY-FERNANDES, and ÂNGELA MIRANDA-SCIPPA. "NEUROIMAGING IN BIPOLAR DISORDER." Revista Debates em Psiquiatria Ano 5 (April 1, 2015): 6–12. http://dx.doi.org/10.25118/2236-918x-5-2-2.
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Nas últimas décadas, pesquisas de neuroimagem no transtorno bipolar (TB) têm demonstrado anormalidades nos circuitos neuronais supostamente envolvidos no processamento e na regulação da emoção, bem como no processamento de recompensas. Entretanto, os resultados relativos a diversas estruturas do sistema nervoso central são escassos e difíceis de serem comparados, devido à grande heterogeneidade do TB e às diferentes metodologias empregadas para a coleta das imagens. Esta revisão teve como objetivo sintetizar os principais achados em neuroimagem estrutural e funcional no TB, descrevendo as estruturas corticais e subcorticais do encéfalo mais relevantes e que embasam a provável fisiopatologia desse transtorno.
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Habala, Petr. "Stationary incompressible bipolar fluids." Czechoslovak Mathematical Journal 44, no. 2 (1994): 347–56. http://dx.doi.org/10.21136/cmj.1994.128461.
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HAVERKAMP, SILKE, HELGA KOLB, TODD A. BLUTE, LUXIANG CAO, and WILLIAM D. ELDRED. "Gamma-atrial natriuretic peptide 1–25 is found in bipolar cells in turtle and rat retinas." Visual Neuroscience 16, no. 4 (July 1999): 771–79. http://dx.doi.org/10.1017/s0952523899164150.
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Immunocytochemistry was used to reveal a population of bipolar cells that contain γ-atrial natriuretic peptide 1–25 (γ-ANP) in turtle retina. This same antibody was also used in rat retina as a comparative control. The retinas were examined by both conventional light microscopy and confocal microscopy with double-labeling to determine whether protein kinase C-α-like immunoreactivity (PKC-α-LI) was colocalized with the γ-ANP-LI. Some thick sections of turtle retina immunostained with only the γ-ANP antibody were also examined by electron microscopy. In rat, a subpopulation of bipolar cells with axons terminating close to the ganglion cell layer was labeled. Double-labeling experiments indicated that the γ-ANP-LI and PKC-α-LI were colocalized in rat retina, and thus all the bipolar cells with γ-ANP-LI were rod bipolar cells. In turtle, the γ-ANP antibody labeled certain bipolar cells that were characterized by bistratified axon terminals arborizing on the borders of strata S2/3 and S3/4 in the inner plexiform layer (IPL). Double labeling with PKC-α antibody indicated that bipolar cells with γ-ANP-LI were not the same bipolar cell types with PKC-α-LI. Thus, γ-ANP-LI appears to be a new marker for a distinct type of bipolar cell in turtle retina. At the ultrastructural level, the γ-ANP-LI was visible throughout the cytoplasm of the bipolar cells from dendrites to axon terminals. In the outer plexiform layer (OPL), labeled dendrites contacted photoreceptor pedicles almost exclusively at narrow-cleft basal junctions, but infrequently formed the central element at a photoreceptor ribbon synapse. In the IPL, axon terminals with γ-ANP-LI made ribbon synapses onto a combination of amacrine and ganglion cells. Since narrow-cleft basal junctions and photoreceptor ribbon-related junctions are known to be associated with ON-center bipolar cells in turtle, and since the axon terminals of bipolars with γ-ANP-LI stratify primarily in the ON-strata of the IPL, we suggest that these cells are likely to be ON-center cells. It is possible that the γ-ANP may be involved in regulating the activity of Na+/K+ ATPase or in the modulation of cGMP levels.
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Benabarre, A., E. Vieta, F. Colom, A. Martínez-Arán, M. Reinares, and C. Gastó. "Trastorno bipolar, trastorno esquizoafectivo y esquizofrenia: diferencias epidemiológical clínicas y de pronóstico." European psychiatry (Ed. Española) 8, no. 5 (June 2001): 311–17. http://dx.doi.org/10.1017/s1134066500006469.
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ResumenLa validez y la entidad nosológica del trastorno esquizoafectivo es todavía una cuestión polémica. Este estudio se realizó para analizar las variables demográficas, clínicas y de pronóstico que deter-minan la validez del diagnóstico de trastorno esquizoafectivo de tipo bipolar. Se analizaron y compararon a 138 pacientes ambulatorios: 67 con trastorno bipolar de tipo I, 34 con trastorno esquizoafectivo de tipo bipolar y 37 con esquizofrenia. El diagnostico se llevó a cabo según los criterios diagnósticos de investigación (RDC) y se los evaluó conforme al Inventario para Trastornos Afectivos y Esquizofrenia. Se excluyeron a los pacientes esquizoafectivos unipolares. Los resultados reafirmaron que, desde el punto de vista de la demográfico, los rasgos clínicos y el pronóstico, los trastornos esquizoafectivos de tipo bipolar se pueden clasificar como una forma fenotípica en un punto intermedio entre el trastorno bipolar I y la esquizofrenia. Estos resultados subrayan la importancia del seguimiento longitudinal en el diagnóstico y la evaluación de los síndromes psicóticos. Aunque los síntomas transversales estaban más próximos al espectro de la esquizofrenia, el curso de la enfermedad se parecía más al de los pacientes bipolares, lo que resultó en un desenlace clínico intermedio.
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Del Porto, José Alberto. "Evolução do conceito e controvérsias atuais sobre o transtorno bipolar do humor." Revista Brasileira de Psiquiatria 26, suppl 3 (October 2004): 3–6. http://dx.doi.org/10.1590/s1516-44462004000700002.
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O autor revê o conceito de transtorno bipolar como um processo em evolução. Suas raízes podem ser encontradas no trabalho de Araeteus da Capadócia, que assumia serem a melancolia e a mania duas formas da mesma doença. A compreensão atual da doença bipolar começou na França, através dos trabalhos de Falret (1851) e Baillarguer (1854). Os conceitos fundamentais de Kraepelin mudaram as bases da nosologia psiquiátrica, e o conceito unitário de Kraepelin sobre a insanidade maníaco-depressiva passou a ser amplamente aceito. Depois de Kraepelin, no entanto, as idéias de Kleist e Leonhard, na Alemanha, e o trabalho subseqüente de Angst, Perris e Winokur enfatizaram a distinção entre as formas monopolares e bipolares da depressão. Mais recentemente a ênfase mudou novamente para o espectro bipolar, que em suas formas leves expande-se às bordas dos temperamentos normais. Finalizando, o autor sumariza os aspectos polêmicos da nosologia da doença bipolar e seus limites com as esquizofrenias, a doença esquizoafetiva e as psicoses ciclóides.
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Issler, Cilly Klüger, Marcia Kauer Sant'Anna, Flavio Kapczinski, and Beny Lafer. "Comorbidade com transtornos de ansiedade em transtorno bipolar." Revista Brasileira de Psiquiatria 26, suppl 3 (October 2004): 31–36. http://dx.doi.org/10.1590/s1516-44462004000700008.
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Comorbidade elevada de transtornos de ansiedade em bipolares é freqüentemente relatada em estudos epidemiológicos e clínicos. A associação tem implicações importantes no diagnóstico, evolução clínica, tratamento e prognóstico do transtorno bipolar, que são apresentadas nesta revisão.
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Patra, Rishavdeb. "Bipolar." Journal of Indian Association of Pediatric Surgeons 22, no. 4 (2017): 260. http://dx.doi.org/10.4103/0971-9261.214456.
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Abraham, Philip. "Bipolar." National Medical Journal of India 31, no. 5 (2018): 313. http://dx.doi.org/10.4103/0970-258x.261185.
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Merton, Andrew. "Bipolar." AJN, American Journal of Nursing 107, no. 5 (May 2007): 51. http://dx.doi.org/10.1097/01.naj.0000268169.25736.b9.
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Goldberg, JF. "On being bipolar without being bipolar." Journal of Psychopharmacology 22, no. 4 (June 2008): 402–3. http://dx.doi.org/10.1177/0269881108092123.
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Skeppar, Peter, and Rolf Adolfsson. "Bipolar II and the bipolar spectrum." Nordic Journal of Psychiatry 60, no. 1 (January 2006): 7–26. http://dx.doi.org/10.1080/08039480500504685.
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Amos, Andrew. "Bipolar II – not just Bipolar ‘lite’." Australasian Psychiatry 23, no. 2 (March 23, 2015): 110–11. http://dx.doi.org/10.1177/1039856215575421a.
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Bourgeois, M. L. "Bipolar temperaments and subthreshold bipolar disorders." European Neuropsychopharmacology 9 (September 1999): 154–55. http://dx.doi.org/10.1016/s0924-977x(99)80034-0.
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Singh, Anupam K. "Bipolar Fuzzy Preorder, Alexandrov Bipolar Fuzzy Topology and Bipolar Fuzzy Automata." New Mathematics and Natural Computation 15, no. 03 (October 7, 2019): 463–77. http://dx.doi.org/10.1142/s1793005719500261.
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This work is dedicated to finding the connection between bipolar fuzzy preorders (BFPs) and Alexandrov bipolar fuzzy topologies (ABFT). Likewise, we demonstrate that for any bipolar fuzzy preordered space (BFPS) an ABFT will be constructed. On the other hand, for any ABFT, tend to create a BFPS thereon set. Subsequently, the acquired outcomes are utilized as a part of the investigation of bipolar fuzzy automata theory with the help of BFPS.
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Janicak, Philip G. "The Expanding Role of Antipsychotics." CNS Spectrums 9, S1 (2004): 7–12. http://dx.doi.org/10.1017/s1092852900027140.
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Antipsychotics have been utilized in the treatment of bipolar disorder for many decades and were the mainstay of treatment before lithium was reintroduced in the late 1960s. Today, many bipolar patients who present with psychotic features are misdiagnosed and prescribed an antipsychotic for another disorder. Estimates of psychotic symptoms in bipolar disorder, particularly during a manic episode, are ≥50% by clinical assessment and even higher by individual reports. Thus, antipsychotics are frequently used: as first treatment for psychosis not recognized as bipolar disorder, and as an adjunct to a mood-stabilizing agent in bipolars with psychotic symptoms.Most recently, antipsychotics have been examined for their mood-stabilizing properties as well (Slide 9). One may conceptualize using a selective serotonin reuptake inhibitor (SSRI) antidepressant for disorders such as panic disorder or obsessive-compulsive disorder, and using an antiepileptic as a mood-stabilizing agent; however, it is more difficult to accept that an agent approved for treatment of psychosis can be a primary therapy for bipolar disorder. Data from the monotherapy trials suggest that second-generation antipsychotics (SGAs) are at least as effective as lithium and valproic acid for acute mania. There is a very large database indicating that SGAs can be utilized as monotherapy for acute mania. However, there is limited data on the role of these agents in prevention of relapse and recurrence and in their efficacy for depression in the context of bipolar disorder. More studies will be needed to clarify whether SGAs should be used as monotherapy or whether they would be best used as augmenting agents in severe and psychotically manic or depressed patients.
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Gorwood, P., F. Bellivier, J. Adés, and M. Leboyer. "El gen de DRD2 y el riesgo de dependencia de alcohol en pacientes bipolares." European psychiatry (Ed. Española) 7, no. 7 (October 2000): 440–45. http://dx.doi.org/10.1017/s1134066500008109.
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ResumenLa elevada comorbilidad entre el trastorno bipolar y la dependencia de alcohol puede tener explicaciones diferentes, una de las cuales es la existencia de factores genéticos comunes para los dos trastornos. Es posible que estén implicados varios genes candidatos, pero los que actúan en la vía dopa-minérgica pueden estarlo más específicamente. Así, hemos examinado el papel del gen que codifica el receptor D2 de dopamina (alelo Al Taql) en la vulnerabilidad potencialmente compartida a la dependencia de alcohol y el trastorno bipolar. Se seleccionó a 122 pacientes franceses (durante dos genera-ciones al menos) sobre la base de los ficheros hospitalarios u ambulatorios y se los entrevistó con la DIGS. Las frecuencias del alelo Al se compararon entre cuatro grupos, a saber: pacientes bipolares con dependencia de alcohol comórbida (n = 21), pacientes bipolares sin morbilidad de alcohol (n = 31), pacientes con dependencia de alcohol sin trastorno del estado de ánimo (n = 35) y controles no afecta-dos (n = 35). El equilibrio de Hardy-Weinberg para los genotipos Al Taql del DRD2 se respetó para la muestra como un todo, y para cada submuestra. Observamos que el 42,9% de los sujetos de control tie-nen un alelo Al al menos, una frecuencia que no difiere significativamente de la observada en la muestra afectada como un todo (39,1%), ni de la frecuencia de los pacientes con dependencia de alcohol (37,1%), los pacientes con trastorno bipolar (48,4%) o los pacientes con dependencia de alcohol y trastorno bipolar (28,6%). El análisis de regresión basado en las tres variables (trastorno bipolar, dependencia de alcohol e interacción entre estos dos trastornos) no explica la presencia del alelo Al del gen del DRD2. Así, no encontramos datos para un papel significativo del alelo Al del gen del receptor D2 de dopamina en la asociación específica entre el trastorno bipolar y la dependencia de alcohol en nues-tra muestra.
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Thalbourne, Michael A., and Darryl L. Bassett. "The Manic Depressiveness Scale: A Preliminary Effort at Replication and Extension." Psychological Reports 83, no. 1 (August 1998): 75–80. http://dx.doi.org/10.2466/pr0.1998.83.1.75.
Full textAbstract:
In a previous paper, an 18-item scale was presented to measure the extent to which a person had experienced symptoms resembling mania or clinical depression. There was evidence that, within a group of 37 bipolar persons, scores on this Manic Depressiveness Scale correlated significantly positively with number of manic-depression-relevant medications currently being taken by the subject. In the present study, 24 subjects (9 unipolar depressives, 15 bipolars) were administered this scale, and aspects of their clinical history were taken. For the bipolar subjects only, scores on the scale correlated significantly with number of relevant medications ( r = .45, p <.05, one-tailed), with number of hospitalizations ( r = .46, p<.05), and with psychiatrist-rated severity of illness ( r = .45, p<.05). Bipolar patients also scored significantly higher than did unipolar patients on the Manic Experience subscale. The Manic Depressiveness Scale thus appears to have some predictive validity.
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Ahmed Abdallah, Enmar Habib, Mostafa Abdel-Mohsen, Omar Abdel-Razzak, and Omar Abdel-Aziz. "Prospective Randomized Study Comparing the Intra-Operative and Postoperative Outcomes of Bipolar Enucleation of the Prostate Versus Thulium Laser Enucleation." Journal of Advanced Zoology 44, S6 (November 22, 2023): 208–12. http://dx.doi.org/10.17762/jaz.v44is6.2030.
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Background: Benign prostatic hyperplasia (BPH) is an age-dependent patho-physiological condition. Bipolar enucleation of prostate (BipolEP) is now considered a rather effective method for the management of BPH patients. Aim and objectives: to assess the functional outcome of patients post plasma-kinetic enucleation in patients with large size prostate glands more than 80 cc as measured by Trans-rectal ultrasound. Patient and method: Our study involved 40 patients with symptomatic BPH who underwent endoscopic enucleation of the prostate using bipolar energy. Result: As regard the intraoperative complications our study showed that there were two patients (6.7%) complicated by small bladder perforation during morcellation and four patients (13.3%) had intra-operative bleeding necessitating blood transfusion and in the early postoperative period (the first 48 hours); one patient (3.33%) developed postoperative hematuria. After one month follow up we found that: 12 patients (30%) developed urge incontinence, 7 patients (17.5%) developed stress urinary incontinence and 5 patients (12.5%) developed mixed incontinence one with predominant urge and the other with predominant stress Conclusion: Bipolar enucleation (BipoLEP) is very effective for managing patients with symptomatic or complicated BPH with large gland size above 80 cc, having a high safety profile and low complications rate. Bipolar enucleation proved to be a very effective technique of endoscopic enucleation of the prostate and can stand out as a strong alternative to laser enucleation whenever laser facilities are not available with comparable results.
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Arkin, M. S., and R. F. Miller. "Bipolar origin of synaptic inputs to sustained OFF-ganglion cells in the mudpuppy retina." Journal of Neurophysiology 60, no. 3 (September 1, 1988): 1122–42. http://dx.doi.org/10.1152/jn.1988.60.3.1122.
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1. The synaptic inputs to sustained OFF-center ganglion cells of the mudpuppy retina were studied using a superfused retina-eye-cup preparation. Intra- and extracellular electrophysiological recording techniques were carried out during bath application of 2-amino-4-phosphonobutyrate (APB), a glutamate analog that selectively blocks the light responses of ON-bipolars but has minor effects on OFF-bipolar or horizontal cells. 2. The use of APB reduced ganglion cell inputs to those arising from the OFF-bipolar channel. In this way, the existence and polarity (depolarizing vs. hyperpolarizing) of direct or indirect bipolar connections to ganglion cells was determined. 3. Cobalt application was used to block synaptic transmission and demonstrate that APB does not have a direct excitatory action on ganglion cells. 4. Intracellular recording experiments included the use of pulsatile and sustained current injection to evaluate the input resistance changes associated with light, the action of APB, and the excitatory, inhibitory, or disafacilitory nature of the postsynaptic potentials. 5. Some intracellularly recorded cells were stained with horseradish peroxidase (HRP) to verify the ganglion cell origin of the recordings. 6. The OFF-ganglion cell population of the mudpuppy appears to be a heterogeneous group of cells. Sustained OFF-ganglion cells can receive dominant inputs through either the ON- or OFF-bipolar cell pathway or through a mixture of the two. 7. Based on the analysis of this study, we divided sustained OFF-ganglion cells into three subclasses. For one class, light causes the removal of a sustained excitatory input which originates from the OFF-bipolar channel (i.e., a light-evoked disfacilitation); a second class of cells is almost entirely driven by the ON-bipolar channel through a sustained light-evoked inhibitory input; and a third class receives both a light-evoked sustained disfacilitory input from the OFF-bipolar channel and a sustained inhibitory input through the ON-bipolar pathway. Thus the retina appears to use a variety of mechanisms that result in a common response to flashing light stimuli. 8. The results of this study show that APB can be a powerful tool for pharmacologically deciphering the functional connections that exist between outer and inner retinal neurons.
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Wong, Kwoon Y., Alan R. Adolph, and John E. Dowling. "Retinal Bipolar Cell Input Mechanisms in Giant Danio. I. Electroretinographic Analysis." Journal of Neurophysiology 93, no. 1 (January 2005): 84–93. http://dx.doi.org/10.1152/jn.00259.2004.
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Electroretinograms (ERGs) were recorded from the giant danio ( Danio aequipinnatus) to study glutamatergic input mechanisms onto bipolar cells. Glutamate analogs were applied to determine which receptor types mediate synaptic transmission from rods and cones to on and off bipolar cells. Picrotoxin, strychnine, and tetrodotoxin were used to isolate the effects of the glutamate analogs to the photoreceptor–bipolar cell synapse. Under photopic conditions, the group III metabotropic glutamate receptor (mGluR) antagonist (RS)-α-cyclopropyl-4-phosphonophenylglycine (CPPG) only slightly reduced the b-wave, whereas the excitatory amino acid transporter (EAAT) blocker dl- threo-β-benzyl-oxyaspartate (TBOA) removed most of it. Complete elimination of the b-wave required both antagonists. The α-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA)/kainate receptor antagonist 2,3-dioxo-6-nitro-1,2,3,4-tetrahydrobenzo[f]quinoxaline-7-sulfonamide (NBQX) blocked the d-wave. Under scotopic conditions, rod and cone inputs onto on bipolar cells were studied by comparing the sensitivities of the b-wave to photopically matched green and red stimuli. The b-wave was >1 log unit more sensitive to the green than to the red stimulus under control conditions. In CPPG or l-AP4 (l-(+)-2-amino-4-phosphonobutyric acid, a group III mGluR agonist), the sensitivity of the b-wave to the green stimulus was dramatically reduced and the b-waves elicited by the 2 stimuli became nearly matched. The d-wave elicited by dim green stimuli, which presumably could be detected only by the rods, was eliminated by NBQX. In conclusion: 1) cone signals onto on bipolar cells involve mainly EAATs but also mGluRs (presumably mGluR6) to a lesser extent; 2) rods signal onto on bipolars by mainly mGluR6; 3) off bipolar cells receive signals from both photoreceptor types by AMPA/kainate receptors.
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Lo, Ka Lun, Kevin Lim, Siu Fai Ma, David Leung, Joseph K. M. Li, Siu King Mak, Hon Ming Wong, and Chi Fai Ng. "The Initial Clinical Experience of a New Generation Bipolar Electrosurgical and Morcellator Unit for Bipolar Transurethral Enucleation of the Prostate." Journal of Endoluminal Endourology 3, no. 1 (March 2, 2020): e47-e56. http://dx.doi.org/10.22374/jeleu.v3i1.80.
Full textAbstract:
Background and Objective
To assess the feasibility and safety of performing bipolar transurethral enucleation of the prostate (BIPO-LEP) with a new generation of bipolar electrosurgical and morcellator system.
Material and Methods
Forty-five consecutive patients scheduled for endoscopic surgery for benign prostatic obstruction were pro-spectively recruited. BIPOLEP was performed with the use of the third generation Karl Storz AUTOCON III 400 and morcellator unit. All patients had a trial without a catheter on Day-1 after surgery. Demographical, preoperative, intraoperative and follow-up data up to 3 months post-surgery were collected and analyzed.
Results
Between May 2018 and April 2019, 45 consecutive patients underwent BIPOLEP in our institution were prospectively recruited for this study. The mean age was 76 years old. Thirty-four patients (75.6%) were in refractory retention or obstructive uropathy. The mean enucleation efficiency was 1.76 grams per minute of enucleation time (SD = 0.7 gram per minute). The mean bladder irrigation and catheterization times were 5.3 hours and 20.7 hours respectively. Only one patient failed voiding trial on Day-1 after surgery. The postoperative Day-1 discharge rate was 73.3% (n = 33). The median length of hospital stay was 1 day. No patient required clot evacuation or blood transfusion. Seven patients (15.6%) were readmitted within thirty days postoperatively for complications, due to hematuria (8.9%, n = 4) and febrile urinary tract infection (6.7%, n = 3). Nevertheless, none was readmitted for acute urinary retention.
Conclusion
The use of a new generation of bipolar electrosurgical and morcellator unit for BIPOLEP was safe and the majority could be discharged without catheter within one day after surgery.
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Bauwens, F., A. Tracy, D. Pardoen, M. Vander Elst, and J. Mendlewicz. "Social Adjustment of Remitted Bipolar and Unipolar Out-patients." British Journal of Psychiatry 159, no. 2 (August 1991): 239–44. http://dx.doi.org/10.1192/bjp.159.2.239.
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Various areas of social adjustment were compared using the Social Adjustment Scale in 27 remitted bipolars, 24 remitted unipolars and 25 normal controls matched for age and sex. Scores for global adjustment and for social and leisure activities were significantly worse in patients than in controls. The maladjustment in social and leisure activities appeared only in ‘contact with friends' for bipolar patients and ‘diminished social interactions' for unipolar patients. Unipolar patients differed significantly from controls on the items investigating sexual adjustment. In unipolars, social maladjustment seemed to be independent of the course of the disease; in bipolars, it was partly related to the mean number of lifetime episodes and current residual symptoms.