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Advances in Clinical Management of Bipolar Disorder
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Advances in Clinical Management of Bipolar Disorder

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (10 June 2022) | Viewed by 14206

Special Issue Editor

Dr. Georgios Floros

E-Mail Website
Guest Editor
2nd Department of Psychiatry, Aristotle University of Thessaloniki, 54624 Thessaloniki, Greece
Interests: psychiatric diagnostic criteria; behavioral addictions; technological addictions
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

I am pleased to invite you to submit your original research work for inclusion in this Special Issue of the Journal of Clinical Medicine, titled “Advances in the Clinical Management of Bipolar Disorder”.

Bipolar disorder is a multifaceted illness involving multiple episodes of severe affective disturbance. If left uncontrolled or undertreated, bipolar disorder is associated with lasting neuropsychological deficits, diminished function, reduced quality of life, and increased psychosocial burden on the patient and their family. Bipolar disorder is linked to premature mortality from both suicide and medical comorbidities. It is currently one of the leading causes of disability worldwide.

This Special Issue seeks to identify novel strategies for the clinical management of bipolar disorder, aiming to:

  1. Improve clinical response during the acute phase of the disease, either in a manic, depressive, or mixed episode;
  2. Improve patient adherence to long-term treatment;
  3. Reduce the psychosocial burden of disease upon the patient, the patient’s family, and caregivers;
  4. Reduce harm in the form of preventable hospitalizations, medical complications, self-harm, and long-lasting neuropsychological sequelae of untreated disease.

Dr. Georgios D. Floros
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • bipolar disorder
  • manic episode
  • mixed episode
  • patient adherence
  • psychosocial burden
  • harm reduction

Published Papers (5 papers)

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Research

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8 pages, 735 KiB  
Article
A New Treatment Protocol of Combined High-Dose Levothyroxine and Repetitive Transcranial Magnetic Stimulation for the Treatment of Rapid-Cycling Bipolar Spectrum Disorders: A Cohort Evaluation of 55 Patients
by Antonis C. Zamar, Christos Kouimtsidis, Abbi Lulsegged, Robin Roberts, Theodoros Koutsomitros and Daniel Stahl
J. Clin. Med. 2022, 11(19), 5830; https://doi.org/10.3390/jcm11195830 - 30 Sep 2022
Cited by 3 | Viewed by 4351
Abstract
Background: Bipolar spectrum disorders (BSD) are highly disabling, with rapid cycling being treatment resistant. High-dose levothyroxine (HDT) has been reported to be effective. Diagnosis is associated with mutations in thyroid-activating enzymes and cerebral transporter protein carrier. Repetitive transcranial magnetic stimulation (rTMS) has neuroplastic [...] Read more.
Background: Bipolar spectrum disorders (BSD) are highly disabling, with rapid cycling being treatment resistant. High-dose levothyroxine (HDT) has been reported to be effective. Diagnosis is associated with mutations in thyroid-activating enzymes and cerebral transporter protein carrier. Repetitive transcranial magnetic stimulation (rTMS) has neuroplastic effects. Methods: We report data on 55 severely symptomatic patients with rapid-cycling BSD treated with a combination protocol of HDT and rTMS. Of the patients, 31 patients (56.4%) were female and 40 (72.7%) had at least one additional diagnosis. Results: Patients were evaluated at three monthly intervals after acute treatment. Remission was measured using the Sheehan Disability Scale (SDS). The average number of medications prescribed was 1.8, with 32 patients (58.2%) needing only levothyroxine. The average dose of levothyroxine was 303.7 mcg (50 mcg–1000 mcg). A total of 53 patients were in remission (96.4%), with an average duration of 2.0 years. The SDS scores decreased significantly (Cohen’s d = 2.61 (95% C.I. 1.81 to 2.83, p < 0.001). One patient had reversible side effects. A total of 52 (94.3%) patients had Deiodinase 1 and 2 (DiO1/DiO2) or SLCO1C1 protein carrier gene mutations. Conclusion: The data support the safety and acceptability of combined HDT/rTMS. Patients achieved long remissions with substantial improvements in quality of life. Full article
(This article belongs to the Special Issue Advances in Clinical Management of Bipolar Disorder)
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13 pages, 982 KiB  
Article
A Different rTMS Protocol for a Different Type of Depression: 20.000 rTMS Pulses for the Treatment of Bipolar Depression Type II
by Theodoros Koutsomitros, Kenneth T. van der Zee, Olympia Evagorou, Teresa Schuhmann, Antonis C. Zamar and Alexander T. Sack
J. Clin. Med. 2022, 11(18), 5434; https://doi.org/10.3390/jcm11185434 - 16 Sep 2022
Cited by 1 | Viewed by 2433
Abstract
In this open-label naturalistic study, we assess the feasibility, tolerability, and effectiveness of a repetitive transcranial magnetic stimulation protocol with a reduced total pulse number for treating patients suffering from bipolar disorder type II. All patients received one rTMS treatment session of 1000 [...] Read more.
In this open-label naturalistic study, we assess the feasibility, tolerability, and effectiveness of a repetitive transcranial magnetic stimulation protocol with a reduced total pulse number for treating patients suffering from bipolar disorder type II. All patients received one rTMS treatment session of 1000 pulses for 20 consecutive working days, accumulating to 20.000 rTMS pulses applied over 4 weeks. We measured the patients’ symptoms before the start, halfway through, directly after, and one month after treatment. We quantified the depression symptoms using both the Beck depression inventory scale and the symptom checklist-90 depression subscale. Patients showed a significant reduction in depression symptoms directly after treatment and an even further reduction one month after treatment. The remission rates were at 26% halfway through treatment (after the 10th session), 61% directly after treatment (after the 20th session), and increased to 78% at the 1-month follow-up. Importantly, the protocol proved to be feasible and highly tolerable in this patient population, with no adverse effects being reported. Considering these positive results, further research should focus on replicating these findings in larger clinical samples with control groups and longer follow-up periods, while potentially adding maintenance sessions to optimize the treatment effect and stability for bipolar disorder type II patients. Full article
(This article belongs to the Special Issue Advances in Clinical Management of Bipolar Disorder)
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16 pages, 423 KiB  
Article
Development of a Psychosocial Intervention to Promote Treatment Adherence in Patients with Bipolar Disorder at Risk of Cardiovascular Disease
by Sandra I. Ralat, Giselle Alicea-Cuprill, Yashira Arroyo and William Otero
J. Clin. Med. 2021, 10(24), 5890; https://doi.org/10.3390/jcm10245890 - 15 Dec 2021
Viewed by 2449
Abstract
Nonadherence to treatment is a serious concern that affects the successful management of bipolar disorder (BD) patients. The aim of this study was to pilot test a psychosocial intervention (previously developed by this team) intended to increase adherence to medication and health behaviors [...] Read more.
Nonadherence to treatment is a serious concern that affects the successful management of bipolar disorder (BD) patients. The aim of this study was to pilot test a psychosocial intervention (previously developed by this team) intended to increase adherence to medication and health behaviors targeting cardiovascular disease (CVD) risk factors in BD patients. An open, single-group design was used to assess the feasibility and acceptability of the intervention. The participants had BD, type I/II or unspecified, and CVD risk factors. Baseline demographic measures were taken. We also obtained preliminary effect sizes related to pre-post changes on measures of self-reported adherence to psychiatric medication, depressive and manic symptoms, and pharmacy records. At baseline, 29% of the participants reported recent adherence to psychiatric medications. A total of 71% of the participants completed the intervention. Pre-post improvements by medium and large effect sizes (Cohen’s d = 0.52–0.92) were seen in medication adherence, attitudes toward medication, and mania symptoms. The participants reported high levels of satisfaction with the intervention. A culturally sensitive psychosocial intervention for Puerto Rican BD patients who are at risk of CVD was found to be feasible and acceptable. Improvements in the key outcomes were seen in this small, preliminary study. Further research is needed with a larger sample size. Full article
(This article belongs to the Special Issue Advances in Clinical Management of Bipolar Disorder)
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15 pages, 724 KiB  
Article
Exploring Clinical Correlates of Metacognition in Bipolar Disorders Using Moderation Analyses: The Role of Antipsychotics
by Paul Roux, Nathan Faivre, Anne-Sophie Cannavo, Eric Brunet-Gouet and Christine Passerieux
J. Clin. Med. 2021, 10(19), 4349; https://doi.org/10.3390/jcm10194349 - 24 Sep 2021
Viewed by 1425
Abstract
The determinants of metacognition are still poorly understood in bipolar disorders (BD). We aimed to examine the clinical determinants of metacognition, defined as the agreement between objective and subjective cognition in individuals with BD. The participants consisted of 281 patients with BD who [...] Read more.
The determinants of metacognition are still poorly understood in bipolar disorders (BD). We aimed to examine the clinical determinants of metacognition, defined as the agreement between objective and subjective cognition in individuals with BD. The participants consisted of 281 patients with BD who underwent an extensive neuropsychological battery and clinical evaluation. To assess subjective cognition, participants provided a general rating of their estimated cognitive difficulties. Clinical characteristics of BD were also recorded, along with medication. We studied the potential moderation of the association between cognitive complaints and global objective cognitive performance by several clinical variables with ordinal logistic regressions. Depression and impulsivity were associated with greater cognitive complaints. The only variable that moderated the relationship between objective and subjective cognition in the global model was the prescription of antipsychotics. Patients taking antipsychotics had a poorer association between cognitive complaints and objective neuropsychological performance. This result suggests a role for dopamine in the modulation of metacognitive performance, and calls for the systematic control of antipsychotic medication in future studies documenting metacognitive deficits in severe and persistent mental disorders. Depression and impulsivity should be investigated as potential therapeutic targets for individuals with BD and cognitive complaints, before proposing an extensive neuropsychological evaluation. Full article
(This article belongs to the Special Issue Advances in Clinical Management of Bipolar Disorder)
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Review

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15 pages, 295 KiB  
Review
Blue Light Blocking Treatment for the Treatment of Bipolar Disorder: Directions for Research and Practice
by Ioanna Mylona and Georgios D. Floros
J. Clin. Med. 2022, 11(5), 1380; https://doi.org/10.3390/jcm11051380 - 2 Mar 2022
Cited by 2 | Viewed by 2448
Abstract
Recent results from a small number of clinical studies have resulted in the suggestion that the process of blocking the transmission of shorter-wavelength light (‘blue light’ with a wave length of 450 nm to 470 nm) may have a beneficial role in the [...] Read more.
Recent results from a small number of clinical studies have resulted in the suggestion that the process of blocking the transmission of shorter-wavelength light (‘blue light’ with a wave length of 450 nm to 470 nm) may have a beneficial role in the treatment of bipolar disorder. This critical review will appraise the quality of evidence so far as to these claims, assess the neurobiology that could be implicated in the underlying processes while introducing a common set of research criteria for the field. Full article
(This article belongs to the Special Issue Advances in Clinical Management of Bipolar Disorder)
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