Background: Efficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders. Aims: To compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive-behavioural therapy (CBT). Method: We undertook a multicentre, pragmatic, randomised controlled treatment trial (n = 253). Patients were assessed every 8 weeks for 18 months. Results: More than half of the patients had a recurrence by 18 months, with no significant differences between groups (hazard ratio = 1.05; 95% CI 0.74–1.50). Post hoc analysis demonstrated a significant interaction (P = 0.04) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes, but less effective in those with more episodes. Conclusions: People with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT. However, such cases form the minority of those re...

Cognitive-Behavioural Therapy for Severe and Recurrent Bipolar Disorders: Randomised Controlled Trial

Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia Rating Scale, can guide the clinician through the neuropsychiatric examination. Although severe and life-threatening, catatonia has a good prognosis. Research on the treatment of catatonia is scarce, but there is overwhelming clinical evidence of the efficacy of benzodiazepines, such as lorazepam, and electroconvulsive therapy.

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A Clinical Review of the Treatment of Catatonia

OBJECTIVE
To determine the rate of diagnostic conversion from an operationalized diagnosis of bipolar disorder not otherwise specified (BP-NOS) to bipolar I disorder (BP-I) or bipolar II disorder (BP-II) in youth over prospective follow-up and to identify factors associated with conversion.


METHOD
Subjects were 140 children and adolescents recruited from clinical referrals or advertisement who met operationalized criteria for BP-NOS at intake and participated in at least one follow-up evaluation (91% of initial cohort). Diagnoses were assessed at follow-up interviews using the Longitudinal Interval Follow-Up Evaluation. The mean duration of follow-up was 5 years and the mean interval between assessments was 8.2 months.


RESULTS
Diagnostic conversion to BP-I or BP-II occurred in 63 subjects (45%): 32 (23%) to BP-I (nine of whom had initially converted to BP-II) and 31 to only BP-II (22%). Median time from intake to conversion was 58 weeks. First- or second-degree family history of mania or hypomania was the strongest baseline predictor of diagnostic conversion (p = .006). Over follow-up, conversion was associated with greater intensity of hypomanic symptoms and with greater exposure to specialized, intensive outpatient psychosocial treatments. There was no association between conversion and exposure to treatment with particular medication classes.


CONCLUSIONS
Children and adolescents referred with mood symptoms that meet operationalized criteria for BP-NOS, particularly those with a family history of BP, frequently progress to BP-I or BP-II. Efforts to identify these youth and effectively intervene may have the potential to curtail the progression of mood disorders in this high-risk population.

The Course of Subthreshold Bipolar Disorder in Youth: Diagnostic Progression From Bipolar Disorder Not Otherwise Specified

https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20869

Preventive psychiatry: a blueprint for improving the mental health of young people

Catatonia is an independent syndrome that co-occurs with several mental and medical conditions. We performed a systematic literature review in PubMed/Scopus until February 2017 and meta-analyzed studies reporting catatonia prevalence. Across 74 studies (cross-sectional = 32, longitudinal = 26, retrospective = 16) providing data collected from 1935 to 2017 across all continents, mean catatonia prevalence was 9.0% (k = 80, n = 110764; 95% CI = 6.9-11.7, I2 = 98%, publication bias P 1000 (2.3%, 95% CI = 1.3-3.9, I2 = 99%, k = 16). Meta-regression showed that smaller sample size (P < .01) and less major depressive disorder (P = .02) moderated higher catatonia prevalence. Year of data collection did not significantly moderate the results. Results from this first meta-analysis of catatonia frequencies across time and disorders suggest that catatonia is an epidemiologically and clinically relevant condition that occurs throughout several mental and medical conditions, whose prevalence has not decreased over time and does not seem to depend on different rating scales/criteria. However, results were highly heterogeneous, calling for a cautious interpretation.

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Prevalence of Catatonia and Its Moderators in Clinical Samples: Results from a Meta-analysis and Meta-regression Analysis

Resume La pharmacologie dans les troubles bipolaires chez l’enfant et l’adolescent beneficie d’un interet croissant mais peu d’etudes concernent le lithium. L’efficacite du lithium en monotherapie est moderee, avec des taux de reponse de l’ordre de 35 a 63 %. Le benefice des combinaisons therapeutiques (association au divalproate de sodium, a la carbamazepine ou a la risperidone) est net avec des taux de reponse atteignant 70 a 90 %. Le taux de rechute sous lithium en monotherapie est eleve (37 a 56 %) mais peu etudie. Si le profil de tolerance du lithium est rassurant, les effets secondaires rapportes semblent plus frequents que chez l’adulte, et l’on ne dispose d’aucune donnee a long terme. Enfin, la lisibilite de tous ces resultats souffre d’une limite majeure liee a l’heterogeneite clinique avec l’usage extensif du diagnostic de bipolarite chez l’enfant prepubere. Les etudes futures beneficieront du cadre diagnostique distinguant les diagnostics de « Dysregulation Emotionnelle Severe » (ou « Temper Dysregulation Disorder with Dysphoria » dans le DSM-5) chez l’enfant et de trouble bipolaire de type I chez l’adolescent.

Traitement par lithium dans le trouble bipolaire du sujet jeune

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Dysrégulation émotionnelle et comportementale sévère : une nouvelle entité pour des enfants irritables ? Disruptive mood dysregulation disorder: A new category for irritable children?

Vanessa Milhiet

Papers

Traitement par lithium dans le trouble bipolaire du sujet jeune

Dysrégulation émotionnelle et comportementale sévère : une nouvelle entité pour des enfants irritables ? Disruptive mood dysregulation disorder: A new category for irritable children?