Tuesday, May 14, 2024

Yoga as an adjunct treatment for BPAD



Patients suffering from psychological issues are constantly on the lookout for newer treatment options. The most common reasons are as follows

  1. Slow onset of action and low to moderate efficacy of the currently available medication.
  2. Poorly explained and understood details of how the medication actually works.
  3. Uncertainty on how long to use the medication once initiated.
  4. Effort and time that needs to be put into therapies
  5. Fear of side effects.
One such alternative treatment that is being tried by a lot of patients with bipolar disorder (BD) is Yoga. People have tried it as a standalone treatment or as an adjunct to medication/therapy. Scientific literature currently available does not give us a definitive answer to whether it is helpful or harmful as people have reported both feeling better and worse after trying this form of treatment. 

As with most therapies and techniques which aim to improve mental health, yoga could be beneficial if it is done with proper guidance and in conjunction with therapy or/and medication. 


References:

  • Jean M, Umair M, Muddaloor P, Farinango M, Ansary A, Dakka A, Nazir Z, Shamim H, Paidi G, Khan S. The Effects of Yoga on Bipolar Disorder: A Systematic Review. Cureus. 2022 Aug 4;14(8):e27688. doi: 10.7759/cureus.27688. PMID: 36072189; PMCID: PMC9440796.
  • Uebelacker LA, Weinstock LM, Kraines MA. Self-reported benefits and risks of yoga in individuals with bipolar disorder. J Psychiatr Pract. 2014 Sep;20(5):345-52. doi: 10.1097/01.pra.0000454779.59859.f8. PMID: 25226195.

Saturday, May 11, 2024

Iloperidone for Bipolar Disorder


Most recent medication to be approved for bipolar disorder is an atypical anti-psychotic, Iloperidone. To be more specific, this drug was approved by the US Food and Drug Administration for treatment of manic or mixed episodes associated with bipolar I disorder in adults. This can be considered a significant development because new medications and treatments in the field of psychiatry are few.

Iloperidone is an atypical anti-psychotic, with a mixed D2/5HT2A antagonism as its mechanism of action. It was first approved for acute treatment of schizophrenia in adults. 


References:

  •  Vanda Pharmaceuticals' Fanapt (iloperidone) receives US FDA approval for the acute treatment of bipolar I disorder. News release. Vanda Pharmaceuticals Inc. April 2, 2024. Accessed April 2, 2024. https://www.prnewswire.com/news-releases/vanda-pharmaceuticals-fanapt-iloperidone-receives-us-fda-approval-for-the-acute-treatment-of-bipolar-i-disorder-302106405.html
  • Torres R, Czeisler EL, Chadwick SR, Stahl SM, Smieszek SP, Xiao C, Polymeropoulos CM, Birznieks G, Polymeropoulos MH. Efficacy and Safety of Iloperidone in Bipolar Mania: A Double-Blind, Placebo-Controlled Study. J Clin Psychiatry. 2024 Jan 15;85(1):23m14966. doi: 10.4088/JCP.23m14966. PMID: 38236020.

Friday, May 10, 2024

Solar radiation and Bipolar Disorder

There has been much interest recently in investigating the role of environmental variables (ex. sunlight exposure, photo-period and solar radiation) in bipolar disorder (BD) patients. Studies have found a significant impact on both the onset and course of BD and also on sleep-wake cycle, mood and energy levels.

It is well recognized that a lot of BD patients tend to show a seasonal vulnerability, as described in Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM 5) within the specifier criteria of BD. 

One possible mechanism that could explain this phenomenon is the exposure to UV-B and better vitamin D levels, which may have a protective role in the development of bipolar disorder. 

There is also evidence that shows increased exposure to solar radiation and the resultant weather conditions results in an earlier age of onset of BD.

There is a need for further, more conclusive studies in this subject.


References:

  • Aguglia A., Borsotti A., Maina G. Bipolar disorders: Is there an influence of seasonality or photoperiod? Rev. Bras. Psiquiatr. 2018;40:6–11. doi: 10.1590/1516-4446-2016-2144
  • Bauer M., Glenn T., Alda M., Andreassen O.A., Angelopoulos E., Ardau R., Baethge C., Bauer R., Baune B.T., Bellivieri F., et al. Influence of light exposure during early life on the age of onset of bipolar disorder. J. Psychiatr. Res. 2015;64:1–8. doi: 10.1016/j.jpsychires.2015.03.013.
  • Geoffroy P.A., Bellivier F., Scott J., Etain B. Seasonality and bipolar disorder: A systematic review, from admission rates to seasonality of symptoms. J. Affect. Disord. 2014;168:210–223. doi: 10.1016/j.jad.2014.07.002.
  • Bauer M, Glenn T, Achtyes ED, Alda M, Agaoglu E, Altınbaş K, Andreassen OA, Angelopoulos E, Ardau R, Aydin M, Ayhan Y, Baethge C, Bauer R, Baune BT, Balaban C, Becerra-Palars C, Behere AP, Behere PB, Belete H, Belete T, Belizario GO, Bellivier F, Belmaker RH, Benedetti F, Berk M, Bersudsky Y, Bicakci Ş, Birabwa-Oketcho H, Bjella TD, Brady C, Cabrera J, Cappucciati M, Castro AMP, Chen WL, Cheung EYW, Chiesa S, Crowe M, Cuomo A, Dallaspezia S, Del Zompo M, Desai P, Dodd S, Etain B, Fagiolini A, Fellendorf FT, Ferensztajn-Rochowiak E, Fiedorowicz JG, Fountoulakis KN, Frye MA, Geoffroy PA, Gitlin MJ, Gonzalez-Pinto A, Gottlieb JF, Grof P, Haarman BCM, Harima H, Hasse-Sousa M, Henry C, Hoffding L, Houenou J, Imbesi M, Isometsä ET, Ivkovic M, Janno S, Johnsen S, Kapczinski F, Karakatsoulis GN, Kardell M, Kessing LV, Kim SJ, König B, Kot TL, Koval M, Kunz M, Lafer B, Landén M, Larsen ER, Lenger M, Licht RW, Lopez-Jaramillo C, MacKenzie A, Madsen HØ, Madsen SAKA, Mahadevan J, Mahardika A, Manchia M, Marsh W, Martinez-Cengotitabengoa M, Martini J, Martiny K, Mashima Y, McLoughlin DM, Meesters Y, Melle I, Meza-Urzúa F, Mikolas P, Mok YM, Monteith S, Moorthy M, Morken G, Mosca E, Mozzhegorov AA, Munoz R, Mythri SV, Nacef F, Nadella RK, Nakanotani T, Nielsen RE, O'Donovan C, Omrani A, Osher Y, Ouali U, Pantovic-Stefanovic M, Pariwatcharakul P, Petite J, Petzold J, Pfennig A, Ruiz YP, Pinna M, Pompili M, Porter RJ, Quiroz D, Rabelo-da-Ponte FD, Ramesar R, Rasgon N, Ratta-Apha W, Ratzenhofer M, Redahan M, Reddy MS, Reif A, Reininghaus EZ, Richards JG, Ritter P, Rybakowski JK, Sathyaputri L, Scippa AM, Simhandl C, Smith D, Smith J, Stackhouse PW Jr, Stein DJ, Stilwell K, Strejilevich S, Su KP, Subramaniam M, Sulaiman AH, Suominen K, Tanra AJ, Tatebayashi Y, Teh WL, Tondo L, Torrent C, Tuinstra D, Uchida T, Vaaler AE, Vieta E, Viswanath B, Yoldi-Negrete M, Yalcinkaya OK, Young AH, Zgueb Y, Whybrow PC. Exploratory study of ultraviolet B (UVB) radiation and age of onset of bipolar disorder. Int J Bipolar Disord. 2023 Jun 22;11(1):22. doi: 10.1186/s40345-023-00303-w. PMID: 37347392; PMCID: PMC10287592.

Monday, May 6, 2024

Neurological soft signs in bipolar disorder

Q: What are neurological soft signs (NSS)?
Ans. These include subtle deficits of motor coordination, sensory integration and sequencing of complex motor acts. 


Q. Why are these called "soft" signs?
Ans. These are termed soft signs because they cannot be localized to a particular area in the brain.

Q. Why are these being studied?
Ans. NSS are being studied in a variety of psychiatric illnesses because they might have a bearing on severity of symptoms and clinical outcome of psychiatric illnesses such as bipolar disorder

References

  • Chrobak AA, Soltys Z, Dudek D, Siwek M. Neurological and cerebellar soft signs in bipolar disorder: The role of staging, type and history of psychotic symptoms. Prog Neuropsychopharmacol Biol Psychiatry. 2023 Mar 8;121:110673.
  • Negash, A., Kebede, D., Alem, A., Melaku, Z., Deyessa, N., Shibire, T., Fekadu, A., Fekadu, D., Jacobsson, L. and Kullgren, G., 2004. Neurological soft signs in bipolar I disorder patients. Journal of affective disorders, 80(2-3), pp.221-230.

Friday, May 3, 2024

Bipolar Disorder - Signs and symptoms of the initial prodrome

Following are the common signs and symptoms of Bipolar Disorder (prodrome)

  • Irritability and aggressiveness
  • sleep disturbances
  • depression and mania symptoms/signs
  • hyperactivity
  • anxiety
  • mood swings 

Ref: Skjelstad DV, Malt UF, Holte A. Symptoms and signs of the initial prodrome of bipolar disorder: a systematic review. J Affect Disord. 2010 Oct;126(1-2):1-13. doi: 10.1016/j.jad.2009.10.003. Epub 2009 Nov 1. PMID: 19883943.