Iranian Journal of Psychiatry and Clinical Psychology
Year:2009 | Volume:15 | Issue:2 (57)|Papers Count:13

Objectives: Given the importance of refraining from underand overdiagnosing bipolar disorders, the author has searched for appropriate diagnostic strategies. Method: In a selective review of literature, Medline and PsycLIT were used to cite articles in the field of bipolar spectrum disorders. Also, SID (the Scientific Information Database of Iran) was used for citing related published articles in Farsi. Results: The findings related to the issue’s importance, the existing evidence, and the strategies for approaching an appropriate diagnosis are presented in two parts: underdiagnosis and overdiagnosis. Conclusion: The rates of both false negative and positive diagnoses for bipolar disorders are remarkable. Although various diagnostic strategies are available, using these strategies and current knowledge are not sufficient to assure us of an accurate diagnosis.

Objectives: Defining bipolar disorder in children is a topic of multiple debates. DSM-IV criteria can not cover all clinical phenotypes. This paper represents a literature review on this topic. Method: In a review study, data were collected through searching in relevant databases and assessing available texts. Results: Developmental processes may change clinical presentation of bipolar disorder in children. Comorbidity with other disorders and normal childhood phenomena adds to the diagnostic debates. Atypical presentation appears to be the common clinical picture of bipolar disorder in childhood. Its premorbid symptoms, longitudinal course and continuity to adulthood are still not completely understood. Some investigators have proposed three clinical phenotypes for childhood bipolar disorder. Wide researches are trying to evaluate the validity of broad phenotype bipolar disorder or "severe mood dysregulation". Conclusion: Defining clinical phenotypes is important in planning the treatment and anticipating the course and prognosis of the illness. The diagnostic subtyping will have higher validity if based on data from multiple sources namely phenomenology, course of illness, biological markers, familial clustering, and treatment response.

Broadening the concept of bipolar spectrum, selective attention to similarities between the spectrum and other disorders and ignoring the differences, abandonment of skillful clinical judgment and permissiveness in diagnosing this spectrum have led to the inclusion of several disorders such as borderline personality disorder in this spectrum. Grouping together borderline personality disorder and bipolar disorder might have therapeutic consequences for patients and, may even deprive them from appropriate treatment; therefore, clarifying the differences between the two is of significant importance. Biological aspects such as neurotransmitter abnormalities, serum cortisole level, dexamethasone suppression test and sleep abnormalities of borderline patients resemble MDD more than they resemble bipolar disorders. From a phenomenological perspective, mood abnormalities of borderline patients are different from that of mood disorders in essence. Also, there are significant differences between the two disorders in terms of course and treatment. Therefore, if we pay attention to these disorders from different perspectives, we will find significant differences, which preclude the simple inclusion of borderline personality disorder within the bipolar spectrum.

Objectives: The studies on the burden of disease in Iran have revealed that psychiatric disorders ranked second among all medical illnesses. Furthermore, depressive disorders were shown to be the most common morbid illness among women. To define a prospective view of the studies on mood disorders in Iran, we performed a bibliometric study on the relevant literature. Method: The present research is a descriptive analysis and a secondary and research upon research study. Two Iranian databases Iranmedex and Iranpsych, and two international databases Medline and EMBASE were searched by two psychiatrists with good inter-rater reliability. Results: From a total of 973 articles meeting the inclusion criteria, 78.4%, 7.8%, and 4% of the articles were dedicated to depressive disorders, bipolar disorders, and suicide respectively. The majority of the studies (i.e. 53%) were on the epidemiology, Methodologies of researches were descriptive, descriptive/analytic and analytic in 32.8%, 39.5%, and 28% of the articles, respectively. While 32.8% of studies were cross-sectional. Others such as cohort, hypothetical, systematic review, and economic studies, each constituted less than 1% of the studies. Nearly two-thirds of the articles were published in Iranian journals. Conclusion: There is a growing trend in the publication of articles on mood disorders and mood disorder studies. Nevertheless, considering the prevalence of these disorders, the whole scientific output is still insignificant in some areas.

Objectives: The aim of this study was to evaluate the outcome of a group of patients with bipolar I disorder admitted to Roozbeh Hospital, Tehran, Iran, during one year follow up. Method: In this prospective naturalistic study, 131 subjects with bipolar I disorder who were consecutively admitted to the hospital were enrolled. Patients were assessed at baseline, discharge, and 6 and 12 months after admission to the hospital. Different aspects of response to treatment including severity of mood and psychotic symptoms, extra pyramidal side effects, global functioning and service satisfaction were assessed using a demographic questionnaire, Young Mania Rating Scale (Y-MRS), and Hamilton Rating Scale for Depression (HAM-D). Results: Severity of symptoms and function showed significant improvement only at discharge (p<0.001), and was not significant afterwards. Patients showed a response rate of 65.4% based on 50% decrease on (Y-MRS), at discharge. Conclusion: Improvement in symptom severity and global functioning was significant at discharge but there was no significant improvement after discharge and during one year follow up.

Objectives: The aim of the present study was to evaluate the quality of life in a group of patients with bipolar disorder at admission, discharge and six month after hospitalization in Roozbeh Hospital, Tehran, Iran. Method: In a cohort study, one hundred and twenty hospitalized patients with bipolar disorder type I or mixed episode, aged between 18 and 65 years, were included in a consecutive manner from May, 2005 to September, 2006. Data were collected using World Health Organization-Quality of Life-Bref scale (WHO-QoLBREF), Young Mania Rating Scale (YMRS), Hamilton Rating Scale for Depression-17 (HAM-D-17), Positive And Negative Symptom Scale (PANSS), Global Assessment of Functioning (GAF), and Client Satisfaction Questionnaire (CSQ) at admission, discharge and six months after hospitalization. Results: Quality of life was not significantly different between the time of admission and six months after hospitalization. The most significant finding was the reverse relationship between depressive symptoms and quality of life at admission (p<0.001), discharge (p<0.001), and after six months follow-up (p=0.001). General psychotic symptoms also showed a reverse relationship at admission (p<0.001), discharge (p<0.01), and six months after hospitalization (p<0.001). Negative psychotic symptoms showed a significant reverse relationship with quality of life at admission (p<0.005) and discharge (p<0.05). Conclusion: Quality of life shows no significant improvement six months after hospitalization.

Objectives: The present study was carried out to determine the incidence of Bipolar Spectrum Disorders (BSD) among pregnant women in rural areas of the province of Isfahan using Mood Disorder Questionnaire (MDQ), and its relationship with the development of post-partum depression (PPD). Method: This cohort prospective study was carried out on all pregnant women in their third trimester, residing in rural areas covered by Isfahan University of Medical Sciences. In the first stage, all subjects were assessed for present depression and life-time BSD, by Beck Depression Inventory (BDI) and MDQ respectively. In the second stage, 6-8 weeks after delivery, all women who did not have depression at the first stage were screened for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS). Results: Results showed the incidence of 24.65% for PPD. Significant correlation between life-time prevalence of BSD and incidence of PPD was shown (p<0.05, r=0.24). The sensitivity and specificity of the MDQ for predicting PPD were 46.6% and 75.6% respectively. Its positive and negative predictive values to predict PPD were 2.6% and 98.8% respectively. Conclusion: Significant correlation between the long-life prevalence of BSD and incidence of PPD supported the hypothesis that PPD belongs to BSD. In addition, in instances where other risk factors of PPD are present, this questionnaire can be used to predict the probability of not developing PPD.

Objectives: The present study was carried out to determine the effect of the family’s knowledge and skills on the improvement of patients with mood disorder.Method: In a clinical experiment, 31 patients with mood disorders presenting to Golestan Hospital in the city of Ahwaz, Iran, were randomly assigned to two experimental and control groups. The control group took part in six weekly psychoeducation sessions. Data were collected using Mc Master Family Questionnaire, Hamilton Rating Scale for Depression, Beach-Rafaelsen Mania Scale, and Global Assessment of Functioning. Results: After intervention, the two groups showed significant statistical difference with regard to family adaptation (P<0.01). There was no significant difference in the two groups regarding the severity of symptoms and general functioning of the patients before discharge, at discharge, and three months after intervention. Also, results showed a significant difference regarding medication compliance between the two groups. Conclusion: Psychological training of the family can affect family adaptation. These findings imply the necessity for the provision of educational, social, and consulting services and the formation of social networks for the patients and their families.

Objectives: In this study behavioral and emotional problems of child and adolescent offsprings of bipolar parents were compared to that of their peers with normal parents. Method: In a descriptive cross-sectional study, 86 child and adolescent offsprings of patients with bipolar disorder (subject group) and 93 offsprings of healthy parents who had presented to  Iran Psychiatric Hospital and Hazrat-e-Rasool Hospital (control group) were selected using convenience sampling, and were evaluated using demographic form and Child Behavior Checklist (CBCL). Comparison between mean scores of CBCL subscales was done using t-test and Multivariate Analysis of Variance. Results: Mean scores of the subject group in somatic complaints, anxious/ depressed, attention problems, aggression, internalizing, and general problems subscales were higher than that of the control group (p<0.05). Conclusion: Behavioral problems in the offsprings of parents with bipolar disorder are more prevalent than the individuals in the control group.

Objectives: The aim of this study was to evaluate bilirubin level changes in patients with schizophrenia and other psychotic disorders. Method: This was a comparative cross-sectional study. Hospitalized patients of at least 20 years of age, with the primary diagnosis of psychosis, were first evaluated using Structured Clinical Interview DSM-IV for Axis I disorders (SCID-I) and 162 patients with schizophrenia and 155 patients with bipolar mood disorders entered the study. Ninety five cardiac patients who were admitted to CCU with no personal and family history of psychosis were selected as the control group. Plasma levels of total and direct bilirubin, lactate dehydrogenase (LDH), alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and prothrombin time (PT) as well as the reticulocyte count were measured for all of the subjects. Also, bilirubin levels at admission and at discharge were compared. Results: Distribution of age, sex and also positive and general psychopathology subscales were not signif-icantly different in the relevant groups. Initial total bilirubin levels were higher in patients with schizophrenia (p<0.001) and were more associated with general psychopathology subscale rather than positive subscale. Bilirubin level was decreased in all three groups at discharge (p<0.05) and the rate of decrease was higher in schizophrenic group (p<0.001). Conclusion: Mild increase in serum bilirubin level is an usual finding in acute psychosis and does not require further clinical or laboratory investigation, but the difference observed between the admission and discharge bilirubin levels is higher in patients with symtoms of psychosis especially in schizophrenics (more than that expected to be caused merely by imposed stress of acute mental illness or hospitalization).