INTRODUCTION: Schizophrenia (SZ) and bipolar disorder (BD) are neurodegenerative psychotic disorders hallmarked by reductions in gray and white matter volume. Limitations in neuroimaging have led to the use of OCT to study retinal layer biomarkers and their relation to brain pathology. This thesis includes a meta-analysis of current literature and an exploratory analysis of retinal layer thickness in relation to SZ and BD. METHODS: For the meta-analysis, twelve articles were identified using PubMed, Web of Science, and Cochrane database. Diagnostic groups were proband (SZ and BD combined), SZ only, BD only, and healthy control (HC) eyes. Analyses utilized fixed and random effects models, in addition to assuring that bias was adjusted for and that results were cross-validated. Statistical analyses were performed using the “meta” package in R, with results reported as standard mean differences (SMD). The exploratory analysis included a total of 38 subjects (24 probands and 14 HC). Retinal measures were co-varied for age, sex, race, body mass index (BMI), and best-corrected visual acuity (BCVA). Correlations between retinal and clinical and cortical measures were also performed. Clinical data included illness duration, symptom severity, antipsychotic dosage, and smoking status. Neuroimaging data included gray matter (GM) thickness, gray matter volume, and intracranial volume (ICV). Linear effects and mixed effects models were used to study mean eye and right/left eye measures, respectively. Statistical analysis was done in R. RESULTS: A total of 820 patient eyes (541 SZ and 279 BD) and 904 HC eyes were used for the meta-analysis. Compared to HC eyes, probands, SZ, and BD eyes showed significant thinning the peripapillary retinal nerve fiber layer (RNFL), with atrophy greatest in the nasal, temporal, and superior regions. In addition, all diagnostic groups demonstrated significant reductions in the combined ganglion cell layer and inner plexiform layer (GCL-IPL) compared to HC. No significant differences were found for choroidal and macular measures. No significant relationships were seen from meta-regression analysis for clinical measures. For the exploratory analysis, retinal measures from a total of 24 probands (18 SZ and 6 BD) and 14 HC was studied. Compared to HC, probands showed reductions in overall RNFL in mean eye measures, while increases in the inner and outer RNFL were seen in left eye measures. No significant group differences were seen in the GCL, IPL, and inner nuclear layer (INL). The outer plexiform layer (OPL) showed significant thickening in probands and SZ compared to HC for all eye measures. Probands showed trending reductions in the outer nuclear layer (ONL) in the left eye compared to HC. No significant correlations were found between retinal layers and illness duration, overall PANSS (Positive and Negative Syndrome Scale) score, PANSS negative symptom subscore, and smoking status. PANSS positive symptom subscore showed significant and trending negative correlations to the RNFL and GCL, respectively. Antipsychotic medication dosage displayed a trending negative relationship with the IPL. GM thickness showed a significant and trending negative correlation to the RNFL and ONL, respectively. Furthermore, a trending inverse relationship was observed between GM volume and the OPL. Finally, ICV demonstrated a trending and significant negative relationship with GCL and OPL thickness, respectively. CONCLUSION: The meta-analysis showed that atrophy in RNFL and GCL-IPL measures are widely associated with psychosis. Furthermore, it supports previous findings of gray and white matter reductions in SZ and BD. The exploratory analysis showed psychosis-associated reductions in the RNFL and ONL layers, consistent with previous literature. Contradictory findings, the thickening of the ONL, can be attributed to the conflicting findings, but might also be explained by neuro-inflammatory pathways related to psychotic disorders.

Bakgrund: Bipolär sjukdom är en kronisk sjukdom som kännetecknas av kraftiga humörsvängningar i maniska och depressiva skov. Den har påverkan på personens livsvärld och upplevelse av hälsa. Sjukdomen är kronisk och för med sig lidande för personen. Sjuksköterskan har en väsentlig roll i att ge stöd och undervisning. Syfte: Är att beskriva personers upplevelser av att leva med bipolär sjukdom. Metod: Kvalitativ metod där fem självbiografier lästes. Analysmetoden är analys av narrativer. Resultat: I resultatet framkom det sex kategorier. Dessa är: den känslomässiga berg och dalbanan, den euforiska gränslösheten, som mörkast före gryning, den annorlunda verkligheten, påverkan på det vardagliga, i kontakt med vården. Diskussion: Personer med bipolär sjukdom upplever hälsa, ohälsa och lidande beroende på vilket skov i sjukdom de befinner sig i. Det är viktigt att ha personer i sin omgivning som är förstående och bryr sig för att kunna finna ro. Sjuksköterskan agerar som stöd i det dynamiska humöret hos personerna och kan bidra med information för att lättare hantera sjukdomen. Konklusion: Att leva med bipolär sjukdom innebär ett ständigt varierande humör. Vården ska vara öppen och bemöta personen i dennes livsvärld. Det är viktigt som sjuksköterska att skapa balans för att lindra lidande och uppmuntra till hälsa. / Background: Bipolar disorder is a chronic condition which is characterised by elevated mood swings with manic and depressive episodes. It has impact on the person’s lifeworld and his or her experience of health. The chronic disorder causes suffering for the person. The essential role of the nurse is to be supportive and educate. Aim: To describe peoples’ experiences to live with bipolar disorder. Method: A qualitative study were five autobiographies was studied. The method of analytics is narrative analysis. Results: The result has six categories. Those are: the emotional rollercoaster, the euphoric boundlessness, darkest before dawn, the different reality, impact on the social life, in contact with care. Discussion: People with bipolar disorder experiences health, illness and suffering depending on which episode they are in. It’s important to have people in their vicinity who is understanding and who cares to find peace. The nurse acts as support in the dynamic mood swings the people can have and can contribute with information how to handle the disorder. Conclusion: To live with bipolar disorder means constant mood swings. The care should have a open mind and answer to the person in their lifeworld. It’s important as nurse to create a balance to ease suffering and encourage health.

The aim of the diploma thesis is to survey characteristics in the experience of people with bipolar disorder. The choice of the topic is based on the lack of research of the experience of people suffering with bipolar disorder in the Czech environment. The aim of this thesis is to comprehend the life of people with bipolar disorder. The theoretical part of the thesis is focusing on the description of the historical and contemporary concept of bipolar disorder including the so-called bipolar spectrum. This part presents treatment options as well as comorbidities which are often a part of the clinical course of the disease. The aim of the theoretical part is to introduce the reader to the issue of bipolar disorder which allows a better understanding of the empirical part. In the empirical part, six respondents were interviewed to collect data. The grounded theory method was chosen for data processing and the Atlas.ti software was used for coding purposes. As a result of the data processing a process of learning how to live with bipolar disorder has emerged. The process of learning how to live with bipolar disorder is an active process that leads to a deeper understanding of the disease and skill gains mitigating manifestation of the disease. At the beginning of the learning, there are motivation...

Syftet med studien var att undersöka hur bipolär sjukdom kan påverka en människas identitet. Tidigare forskning har föreslagit  att människor med bipolär sjukdom kan ha svårt att identifiera vem de verkligen är och att de kan ha en mindre utvecklad identitet. I denna kvalitativa studie genomfördes tio djupintervjuer som sedan kodades. En tematisk analys utfördes. Fyra teman identifierades: Uppfattning om identitet, acceptans, föräldraskap och sjukdomens påverkan på livet. En övervägande del av respondenterna uppgav att sjukdomen är en del av deras identitet, detta motsäger tidigare forskning. Acceptans uppges ske i olika steg och förenkla livet när sjukdomen väl är accepterad, forskning stöder detta fynd. Respondenterna beskriver en rädsla att sjukdomen ska påverka föräldraskap eller att sjukdomen redan har påverkat föräldraskapet. Flera respondenter uppger att sjukdomen har lett till ett misslyckat föräldraskap vilket, enligt tidigare forskning, kan leda till mindervärdeskomplex. Sjukdomen anses i övervägande del påverka livet negativt och skapa en funktionsnedsättning. Flera respondenter uppgav att sjukdomen har varit ett hinder i deras arbete och enligt forskning kan även detta påverka respondenternas uppfattning om eget värde negativt. Bipolär sjukdom anses i denna studie påverka identiteten kraftigt och i största mån negativt. Fortsatt forskning bör fokusera på ”mixet-method” studier med kvantitativa korrelationer mellan till exempel typ av bipolär sjukdom och grad av funktionsnedsättning. / The purpose of this study was to investigate how bipolar disorder affects a person’s identity. In this qualitative study ten in-depth interviewes were conducted. The interviews were seperated into pieces that were assigned a specific code and a thematic analysis was performed. Four themes were identified: perception of identity, acceptance, parenting and the impact of the illness on life. The majority of the participants stated that the disease is part of their identity, which contradicts previous research. Acceptance is stated to occur in various stages and simplifies life once the disease is well accepted, reasearch supports this finding. Participants described a fear that the disease will affect parenthood or that the disease has already affected parenthood. Several participants stated that the disease has led to failed parenting which, according to previous research, can lead to inferiority complex. The disease is predominantly affecting life negatively and creating disability. Several participants stated that the disease has been an obstacle in their career and according to research this can also have a negative impact on the participants’ perception of their own value. In this study, bipolar disorder is considered to have a strong negative impact on identity. Continued research should focus on “mixed-methods” studies with quantitative correlations between for example type of bipolar disorder and level of disability.

Human cells are exposed to exogenous insults and continuous production of different metabolites. These insults and unwanted metabolic products might interfere with the stability of genomic DNA. Recently, many studies have demonstrated that different psychiatric disorders show substantially high levels of oxidative DNA damage in the brain accompanied with morphological and functional alterations. It reveals that damaged genomic DNA may contribute to the pathophysiology of these mental illnesses. In this article, we review the roles of oxidative damage and reduced antioxidant ability in some vastly studied psychiatric disorders and emphasize the inclusion of treatment options involving DNA repair. In addition, while most currently used antidepressants are based on the manipulation of the neurotransmitter regulation in managing different mental abnormalities, they are able to prevent or reverse neurotoxin-induced DNA damage. Therefore, it may be plausible to target on genomic DNA alterations for psychiatric therapies, which is of pivotal importance for future antipsychiatric drug development.

Schizophrenia and bipolar disorder both have strong inherited components. Recent studies have indicated that schizophrenia and bipolar disorder may share more than half of their genetic determinants. In this study, we performed a meta-analysis (combined analysis) for genome-wide association data of the Affymetrix Genome-Wide Human SNP array 6.0 to detect genetic variants influencing both schizophrenia and bipolar disorder using European-American samples (653 bipolar cases and 1034 controls, 1172 schizophrenia cases and 1379 controls). The best associated SNP rs11789399 was located at 9q33.1 (p=2.38×10-6, 5.74×10-4, and 5.56×10-9, for schizophrenia, bipolar disorder and meta-analysis of schizophrenia and bipolar disorder, respectively), where one flanking gene, ASTN2 (220kb away) has been associated with attention deficit/hyperactivity disorder and schizophrenia. The next best SNP was rs12201676 located at 6q15 (p=2.67×10-4, 2.12×10-5, 3.88×10-8 for schizophrenia, bipolar disorder and meta-analysis, respectively), near two flanking genes, GABRR1 and GABRR2 (15 and 17kb away, respectively). The third interesting SNP rs802568 was at 7q35 within CNTNAP2 (p=8.92×10-4, 1.38×10-5, and 1.62×10-7 for schizophrenia, bipolar disorder and meta-analysis, respectively). Through meta-analysis, we found two additional associated genes NALCN (the top SNP is rs2044117, p=4.57×10-7) and NAP5 (the top SNP is rs10496702, p=7.15×10-7). Haplotype analyses of above five loci further supported the associations with schizophrenia and bipolar disorder. These results provide evidence of common genetic variants influencing schizophrenia and bipolar disorder. These findings will serve as a resource for replication in other populations to elucidate the potential role of these genetic variants in schizophrenia and bipolar disorder.

Research on rates of HIV testing among individuals diagnosed with Bipolar Disorder (BPD) is limited, while HIV infection continues to rise among BPD individuals. The problem is that BPD individuals are at high risk for HIV infection due to non-adherence to treatment for bipolar disorder and manic episodes that can lead to high-risk behaviors. The goal of the study was to examine the association between selected demographic variables, having a bipolar diagnosis, engaging in high-risk behaviors, inability to afford treatment for bipolar disorder, non-adherence to treatment for bipolar disorder, and substance abuse, and their relationship to obtaining an HIV test (the dependent variable) for individuals with BPD. The epidemiologic triangle model served as the theoretical model to assist with interpreting findings. Data collected from 383 BPD diagnosed individuals from the 2007 National Health Interview Study were analyzed using binary logistic regression, chi-square, and multiple logistic regression methods. The results indicated that all 5 behavioral independent variables were significantly associated (p=.000) with obtaining an HIV test. Significant associations were also found for demographic variables (race, gender, and homelessness) as confounding factors that influenced HIV testing among BPD individuals. Implications for positive social change are increased education on the risks of HIV infection and the need for appropriate HIV testing among BPD diagnosed individuals in an effort to protect the health and welfare of this vulnerable population.

Mental health issues present challenges to the mentally ill, and to the family members who are their caregivers. Among the challenges faced by caregivers are conflict and stress. This transcendental phenomenological study explored the experiences and perceptions of caregivers of conflict, stress, and the role of faith. In addition, this study sought to learn what lessons and strategies caregivers utilized and often created while caring for their family member with bipolar disorder. In this study ten caregivers were interviewed, telephonically or face-to-face, using a semi-structured interview format. Coming from four states, some were employed, some were retired, and one was currently unemployed, but seeking employment. The data analysis reflected four themes: stress, conflict, faith, and strategies learned or created from taking care of a family member with bipolar disorder. This study contributes to the field of conflict resolution, particularly in light of increased diagnoses and treatment of mental health illnesses, such as bipolar disorder. As diagnoses of mental health illness increase, more family members are becoming caregivers, thus prompting the need for enhanced conflict management and resolution skills and training.

Bipolär sjukdom är en allvarlig och komplex psykiatrisk sjukdom. Den kännetecknas av fluktueringar i stämningsläget som inkluderar depressiva, maniska och blandade episoder av olika grad. Av världens befolkning är drygt 1% drabbad av sjukdomen. Att vara anhörig kan innebära en sämre hälsa än normalbefolkningen och de tar ofta på sig ett stort ansvar att vårda, hjälpa och stötta den som är sjuk. Eftersom anhöriga har en betydande roll i den sjukes vård behövs kunskap om anhörigas upplevelser. Syftet med denna studie var att undersöka hur det upplevs att vara anhörig till en person med bipolär sjukdom.  Metoden var en litteraturöversikt över kvalitativa studier som syftade till att analysera och sammanställa kunskapsläget inom det valda ämnet. Urvalet bestod av 13 kvalitetsgranskade originalartiklar publicerade mellan år 2008–2021 från databaserna PubMed, CINAHL och PsycINFO. Ett familjecentrerat förhållningssätt har använts som teoretisk referensram. Inom familjecentrerad omvårdnad, som föreligger denna litteraturöversikt, ses familjen som en dynamisk helhet där alla delar påverkar varandra.  Resultatet påvisade att anhöriga påverkades mycket av den närståendes sjukdom. Resultatet delades in i fem teman med tillhörande underteman. Dessa teman var Påverkan på anhörigas hälsa, Påverkan på relationen till den sjuke, Hanteringsstrategier och personlig utveckling, Behov av stöd och problematik kring stigmatisering samt Upplevelser av involveringen i den sjukes vård.  Slutsatsen visade att anhöriga upplever många bördor och en stor belastning av att leva med en person med bipolär sjukdom. Det är av stor vikt att inom hälso-och sjukvården inkludera anhöriga i omvårdnaden. / Bipolar disorder is a serious and complex psychiatric disorder. It is characterized by fluctuations in the mood that include depressive, manic and mixed episodes of varying degrees. More than 1% of the world's population is affected by the disease. Being a relative can mean a poorer health than the normal population and they often take on a great responsibility to give care, help and support to the person who is ill. Since relatives have a significant role in the patient's care, knowledge of relatives' experiences is needed.  The aim of this study was to investigate how it is perceived to be a relative of a person with bipolar disorder.  The method was a qualitative literature review aimed at analysing and compiling the state of knowledge within the chosen subject. The sample consisted of 13 original studies published between 2008 and 2021 from the databases PubMed, CINAHL och PsycINFO. A family-centerd approach has been used as a theoretical frame of reference. In family-centred care, which is referred to in this literature review, the family is seen as a dynamic unit where all parts affect each other. The results showed that relatives were greatly affected by the relative's illness. The result was divided into five themes and related sub-themes. These themes were The impact on the health of the relatives, The impact on the relationship with the sick person, Cooping strategies and personal development, The need for support and problems around stigma and Experiences of involvement in the patient's care.  The conclusion showed that relatives experience many burdens and a great strain of living with a person with bipolar disorder. It is of great importance to include relatives in the healthcare.

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