There is generally a lack of studies examining prevalence and phenomenology of bipolar disorder in Africa. In literature, a unipolar manic course of illness in particular is reported to be rare. The purpose of this study was to investigate and describe the course of illness and clinical features in a cross-section of patients diagnosed with bipolar disorder attending public hospitals in Limpopo Province, South Africa and to determine the rate of a unipolar manic course in this sample of patients. This was a descriptive, cross-sectional study of patients presenting with a history of mania between October 2009 and April 2010, to three hospitals in Limpopo Province. A purposeful sample of 103 patients was recruited and interviewed using the Affective Disorders Evaluation. This study confirms that a unipolar manic course is indeed much more common than rates suggested in present day literature with57% of the study sample only ever experiencing manic episodes. The study also confirms the debilitating nature of bipolar disorder with more than two-thirds being unemployed in spite of a quarter of the study subjects having a tertiary education. The high rates of attempted suicide, history of violence and history of drug abuse all furthermore points to the devastating effects bipolar disorder has on individuals and their families. Treatment choice appeared to be a combination of a mood-stabilising agent in combination with an anti-psychotic. It was found that two-thirds of study subjects had consulted with faith- or traditional healers. Significant gender differences appeared in that females were more likely to suffer from comorbid anxiety disorders, have a history of sexual trauma, and be HIV positive whilst men were more likely to have a forensic- and substance-abuse history, experience hallucinations and receive clozapine. Patients presenting with a unipolar manic course of illness, as described in this thesis, may contribute to the search for an etiologically homogeneous sub-group which presents unique phenotype for genetic research and the search for genetic markers in mental illness. A unipolar manic course therefore needs to be considered as a specifier in diagnostic systems in order to heighten the awareness of such a course of illness in bipolar disorder, with a view to future research. / Thesis (MD)--University of Pretoria, 2012. / Psychiatry / unrestricted

The current work assesses the relationship between reinforcement sensitivity theory (RST) and Personality Traits for the DSM-5 (PID-5), to explore the degree to which they are associated with mood disorder symptoms. Participants (N = 138) from a large public university in the South were administered a semi-structured interview to assess for current mood disorder and anxiety symptoms. They were also administered self-report inventories, including the Behavioral Inhibition System (BIS) and Behavioral Approach System (BAS) scales and the Personality Inventory for DSM-5 (PID-5). Results indicate that both the BIS/BAS scales and the PID-5 scales were strongly associated with current mood symptoms. However, the maladaptive personality traits demonstrated significantly greater associations with symptoms compared to the BIS/BAS scales. Results also indicated support for using a 2-factor model of BIS as opposed to a single factor model. Personality models (such as the five factor model) are strongly associated with mood symptoms. Results from this study add to the literature by demonstrating credibility of an alternative five-factor model of personality focused on maladaptive traits. Knowledge of individual maladaptive personality profiles can be easily obtained and used to influence case conceptualizations and create treatment plans in clinical settings.

Introduction: Bipolar disorder is a serious mental illness, but medications and psychosocial approaches designed to treat it leave significant room for improvement. This study investigated Progressive Muscle Relaxation (PMR), a treatment originally designed to reduce anxiety, as a way to reduce manic symptoms. Methods: Participants with bipolar I disorder (n = 44) were assigned via stratified randomization to complete PMR or a control condition (self-focused calming). Participants underwent a positive mood induction procedure, and completed several measures of manic symptoms at Session 1 and Session 2 (several weeks later). Results: Among those who experienced a successful positive mood induction, PMR and the control condition generally resulted in similar reductions in high-arousal positive affect. Participants who practiced PMR between the two sessions tended to experience greater reductions in positive affect at Session 2 compared to those who did not practice. Discussion: The relative parity of the PMR and control conditions suggests that people with bipolar I disorder have effective strategies for regulating positive emotions. Rather than teaching additional strategies, it may be more fruitful to develop methods for helping people with bipolar disorder to implement the strategies that work for them.

Diss. / Tiivistelmäosa. - University of Helsinki, Faculty of Medicine, Institute of Clinical Medicine, Department of Psychiatry, Department of Mental Health and Alcohol Research, National Public Health Institute. Myös paperimuodossa (ISBN 978-951-740-693-2).

If mania and depression are part of the same pathological processes, one would predict that episodes of one prospectively increase the odds of episodes of the other. The aim of the present study was to test this hypothesis. For comparison purposes, their relationship was contrasted to the relationship between mania and periods of psychosis. Exploratory analyses also tested the degree to which episodes of each occur with greater frequency over time (i.e., kindling). Participants for the present study came from the Suffolk County Mental Health Project (N = 628), a study of first-admission patients with psychosis. Of these participants, 144 met diagnostic criteria for bipolar I disorder and were analyzed for the current study. Results indicated that mania in a given month predicted depression the following month, even after controlling for other symptoms. The reverse, however, was not the case. Mania and psychosis, in contrast, were found to be robust predictors of one another from month to month. Effects were not due to treatment or demographic differences. These findings provide evidence that mania and depression are weakly related. In contrast, mania and psychosis are more closely linked. Findings are consistent with suggestions that psychiatric nosology regroup mania more closely with thought disorders rather than with internalizing or depressive ones. They also alert clinicians to the strong, longitudinal persistence and comorbidity among these syndromes.

Déficits na regulação serotoninérgica dos circuitos catecolaminérgicos tem sido propostos como um mecanismo relacionado à etiologia dos transtornos de humor. Projeções do núcleo mediano da rafe (MnR) modulam a atividade dopaminérgica no prosencéfalo e são também parte de um sistema de inibição/desinibição comportamental que se assemelha às variações nos níveis de atividade apresentados durante os polos do transtorno bipolar. O objetivo do presente estudo foi avaliar se as alterações comportamentais induzidas pela inativação do MnR podem ser um modelo animal para estudo da mania humana. No Capítulo I, o procedimento de lesão eletrolítica do MnR foi realizado em ratos Wistar machos, tendo como controles os grupos lesão fictícia e intacto. Os resultados confirmaram a capacidade desta manipulação experimental em reproduzir hiperatividade e estereotipia crônicas, aumento na frequência de respostas positivamente reforçadas por solução de sacarose e padrão comportamental de dominância social. Ainda, foi demonstrada a potencialidade do tratamento crônico com lítio em reduzir a hiperatividade. No Capítulo II foram realizadas lesões eletrolíticas do MnR em camundongos C57BL/6J machos, tendo novamente como controles os grupos lesão fictícia e intacto. Os resultados demonstraram desenvolvimento de hiperatividade, estereotipia e maior frequência de exposição a situações aversivas/de risco nos testes do labirinto em cruz elevado e do claro/escuro. O tratamento crônico com lítio atenuou ou reverteu parte destas alterações comportamentais. Análises do tecido encefálico demonstraram níveis terapêuticos equivalentes de LiCl em todos os grupos submetidos ao tratamento e a histologia confirmou o sítio de lesão. O conjunto dos dados obtidos sugere a adequação do modelo proposto pelo atendimento aos critérios de validade de face e preditiva apresentando como vantagens a mimetização de diversos sintomas do transtorno e a cronicidade destes. Ainda, a reprodutibilidade dos efeitos da lesão em diferentes espécies sugere a existência de homologia evolutiva, acrescentando fundamentos à validade de constructo hipotetizada. Por fim, destaca-se que este modelo de mania parece ser heurístico pela possibilidade de contribuir para a investigação dos mecanismos de ação do lítio e para a compreensão das relações de oposição entre os sistemas neurotransmissores excitatórios e inibitórios como parte da neurobiologia dos transtornos de humor / Deficits in serotoninergic regulation of catecholaminergic circuits have been proposed as a mechanism related to the etiology of mood disorders. Projections from the median raphe nucleus (MnR) modulate the dopaminergic activity in the forebrain and are also part of a behavioral disinhibition/inhibition system that resembles the variations in activity levels shown during the poles of bipolar disorder. The aim of the present study was to evaluate if the behavioral effects induced by the inactivation of the MnR can be considered an animal model for studying the human mania. In Chapter I, the MnR electrolytic lesion was performed in male Wistar rats, having as control groups sham operated and intact animals. The results confirmed the capacity of this experimental manipulation to reproduce chronic hyperactivity and stereotypy, increased response frequency positively reinforced by sucrose solution and a social dominant behavioral pattern. Furthermore, it was shown the potentiality of the lithium treatment in reducing the hyperactivity. In Chapter II MnR electrolytic lesions were performed in C57BL/6J mice, having as control groups sham operated and intact animals. The results demonstrated the development of hyperactivity, stereotypy and increased frequency of exposure to aversive situations/\"risk taking\" in the elevated plus maze and light/dark box tests. Chronic treatment with lithium attenuated or reversed some of these behavioral alterations. Encephalic tissue analysis showed equivalent lithium therapeutic levels in all treated groups and the histology confirmed the lesion site. The set of data obtained suggests the suitability of the proposed model for attending criteria for face and predictive validities presenting advantages such as the mimicking of several disorder symptoms and the chronicity of them. Also, the reproducibility of the effects of the lesion in different species suggests the existence of evolutionary homology and adds basis to the construct validity hypothesized. Finally, it is emphasized that this model of mania seems to be heuristic by the possibility to contribute to the investigation of lithium mechanisms of action and for understanding the opposite relations between excitatory and inhibitory neurotransmitter systems as part of the neurobiology of mood disorders

Déficits na regulação serotoninérgica dos circuitos catecolaminérgicos tem sido propostos como um mecanismo relacionado à etiologia dos transtornos de humor. Projeções do núcleo mediano da rafe (MnR) modulam a atividade dopaminérgica no prosencéfalo e são também parte de um sistema de inibição/desinibição comportamental que se assemelha às variações nos níveis de atividade apresentados durante os polos do transtorno bipolar. O objetivo do presente estudo foi avaliar se as alterações comportamentais induzidas pela inativação do MnR podem ser um modelo animal para estudo da mania humana. No Capítulo I, o procedimento de lesão eletrolítica do MnR foi realizado em ratos Wistar machos, tendo como controles os grupos lesão fictícia e intacto. Os resultados confirmaram a capacidade desta manipulação experimental em reproduzir hiperatividade e estereotipia crônicas, aumento na frequência de respostas positivamente reforçadas por solução de sacarose e padrão comportamental de dominância social. Ainda, foi demonstrada a potencialidade do tratamento crônico com lítio em reduzir a hiperatividade. No Capítulo II foram realizadas lesões eletrolíticas do MnR em camundongos C57BL/6J machos, tendo novamente como controles os grupos lesão fictícia e intacto. Os resultados demonstraram desenvolvimento de hiperatividade, estereotipia e maior frequência de exposição a situações aversivas/de risco nos testes do labirinto em cruz elevado e do claro/escuro. O tratamento crônico com lítio atenuou ou reverteu parte destas alterações comportamentais. Análises do tecido encefálico demonstraram níveis terapêuticos equivalentes de LiCl em todos os grupos submetidos ao tratamento e a histologia confirmou o sítio de lesão. O conjunto dos dados obtidos sugere a adequação do modelo proposto pelo atendimento aos critérios de validade de face e preditiva apresentando como vantagens a mimetização de diversos sintomas do transtorno e a cronicidade destes. Ainda, a reprodutibilidade dos efeitos da lesão em diferentes espécies sugere a existência de homologia evolutiva, acrescentando fundamentos à validade de constructo hipotetizada. Por fim, destaca-se que este modelo de mania parece ser heurístico pela possibilidade de contribuir para a investigação dos mecanismos de ação do lítio e para a compreensão das relações de oposição entre os sistemas neurotransmissores excitatórios e inibitórios como parte da neurobiologia dos transtornos de humor / Deficits in serotoninergic regulation of catecholaminergic circuits have been proposed as a mechanism related to the etiology of mood disorders. Projections from the median raphe nucleus (MnR) modulate the dopaminergic activity in the forebrain and are also part of a behavioral disinhibition/inhibition system that resembles the variations in activity levels shown during the poles of bipolar disorder. The aim of the present study was to evaluate if the behavioral effects induced by the inactivation of the MnR can be considered an animal model for studying the human mania. In Chapter I, the MnR electrolytic lesion was performed in male Wistar rats, having as control groups sham operated and intact animals. The results confirmed the capacity of this experimental manipulation to reproduce chronic hyperactivity and stereotypy, increased response frequency positively reinforced by sucrose solution and a social dominant behavioral pattern. Furthermore, it was shown the potentiality of the lithium treatment in reducing the hyperactivity. In Chapter II MnR electrolytic lesions were performed in C57BL/6J mice, having as control groups sham operated and intact animals. The results demonstrated the development of hyperactivity, stereotypy and increased frequency of exposure to aversive situations/\"risk taking\" in the elevated plus maze and light/dark box tests. Chronic treatment with lithium attenuated or reversed some of these behavioral alterations. Encephalic tissue analysis showed equivalent lithium therapeutic levels in all treated groups and the histology confirmed the lesion site. The set of data obtained suggests the suitability of the proposed model for attending criteria for face and predictive validities presenting advantages such as the mimicking of several disorder symptoms and the chronicity of them. Also, the reproducibility of the effects of the lesion in different species suggests the existence of evolutionary homology and adds basis to the construct validity hypothesized. Finally, it is emphasized that this model of mania seems to be heuristic by the possibility to contribute to the investigation of lithium mechanisms of action and for understanding the opposite relations between excitatory and inhibitory neurotransmitter systems as part of the neurobiology of mood disorders

Background: The Behavioural Activation System dysregulation theory of Bipolar Disorder (BD) proposes that (hypo)manic episodes represent prolonged periods of elevated approach-motivation and high-activation positive affect (PA). Excessive goal-setting behaviour and increased engagement in stimulating activities have been found amongst people with BD and may interact with elevated approach-motivation, contributing to an “upward spiral”. Hypotheses were: both i) approach-related behaviours in response to PA; and ii) high-activation PA, will be more common in individuals with BD than those without; iii) individuals with BD will be more likely to respond to high-activation PA than to low-activation PA with approach-related behaviours, compared to individuals without BD. Method: Individuals with BD and a non-clinical control group were tested. Participants completed measures of current hypomanic/depressive symptoms, trait PA, and two versions of two measures of response to PA, asking about low-activation and high-activation PA. Results: The BD group used more approach-related responses to PA, particularly within high-activation mood states, compared to controls. The groups differed in their experience of different types of PA, due to the control group experiencing more low-activation PA. Limitations: It is unclear whether the findings are specific to BD or affective disorders in general, due to a lack of a clinical control group. The groups may also differ in their expectations of PA due to medication use and previous experience of mania. Conclusions: It may be therapeutically beneficial to help individuals with BD use non-approach-related strategies in response to high-activation PA. Further research would identify which strategies are most useful.

Bakgrund: Patienter med bipolär sjukdom har episoder med depression och manier. Vid dessa episoder försvåras patientens förmåga att hantera känslor, arbete samt ekonomi. Genom en ökad förståelse kring sjukdomen kan tabubeläggning om bipolär sjukdom minskas. Syfte: Syftet är att beskriva patienters upplevelser av att leva med bipolär sjukdom. Metod: Kvalitativ innehållsanalys användes för att analysera fem självbiografiska böcker som är skrivna av patienter som lever med bipolär sjukdom. Resultat: I resultatet framkom olika teman som beskriver hur patienter upplever att leva med bipolär sjukdom. De teman som framkom var: Viljan att få hjälp, att acceptera bipolär sjukdom och betydelsen av anhörigas stöd samt känslan av att vara annorlunda. Slutsats: Patienter med bipolär sjukdom behöver stöd från anhöriga och bli mer uppmärksammad i sin sjukdom från sjukvårdspersonal. Vid tidig diagnostisering kan behandling sättas in som minskar risk för suicidförsök och självskadebeteende hos patienten. Ökad förståelse om bipolär sjukdom kan leda till att patienter mer accepterar sin sjukdom. / Backround: Patients with bipolar disorder/disease has episodes with depression and mania. During these episodes the ability to manage emotions, work and economy becomes more difficult. With increased understanding of their disorder, the taboo subject of bipolar disorder can decrease. Aim: The aim to this study was to describe patient´s experiences of living with bipolar disorder. Method: A qualitative research was used to analyze five biographies, which are written by patients living with bipolar disorder. Result: In the result different themes emerged which describe patient´s experiences living with bipolar disorder/disease. The themes which stood out were: The desire to get help, to accept bipolar disorder and the importance of relatives support and the feeling of being different. Conclusion: Patients with bipolar disorder needs support from relatives to get more attention from medical staff to view the entirety of the patient´s disease. Early diagnosis, treatment can be initiated which reduces the risk of suicide attempts and self harm in the patient. Increased knowledge about bipolar disorder can lead to a better working life for the patients.

Bipolar disorder is an extremely devastating illness, and increasingly robust evidence indicates that it emerges during adolescence. Also during adolescence, peer relationships, particularly close friendships and romantic relationships, become a central mechanism for social maturation and emotional development. The consequences of mania on the development of peer relationships have received little attention. Thus, the purpose of the current study was to examine the association between mania and close peer relationship quality in a community sample of adolescents. Two types of close peer relationships, close friendships and romantic relationships, were evaluated. In addition, the current study examined two potential mediators of the association between mania and close relationship quality, social skills and social dominance. Due to the substantial overlap between symptoms of mania and Attention Deficit Hyperactivity Disorder (ADHD), and the documented peer relationship difficulties experienced by youth with ADHD, symptoms of ADHD were controlled in study analyses. Participants were 571 adolescents (57% female; 19% 10th grade, 30% 11th grade, 51% 12th grade; 66% Hispanic, 17% White, 7% African-American and Caribbean American, 4% Asian, and 6% mixed or other ethnicity) from 2 public high schools in the Southeastern United States. Adolescents completed self-report questionnaires during school. The Hypomanic Personality Scale (HPS) was used to assess adolescents' risk for mania. Adolescents reported on their social skills (empathy, cooperation, and assertion) using the Social Skills Rating System (SSRS). The Social Dominance Scale (SDS) was used to assess adolescents' tendency to be overly intrusive or dominant in social situations. The Conners-Wells' Adolescent Self-Report Scale (CASS) was used to assess adolescents' self-reported symptoms of ADHD. Parent-report was obtained for 50 adolescents by phone interview. Parent-reported symptoms of mania, social skills, and symptoms of ADHD were assessed. Four hypotheses guided study analyses. First, it was expected that greater levels of mania would be associated with fewer positive qualities and more negative qualities in a close friendship and romantic relationship. Second, it was hypothesized that more symptoms of mania would be associated with poorer social skills and greater levels of social dominance. Third, social skills and social dominance were expected to mediate the association between mania and close relationshp quality. Fourth, it was expected that the hypothesized relationships between mania, social skills, social dominance, and close relationship quality would remain significant after controlling for the association between mania and symptoms of ADHD. Gender was examined as a moderator in the main study analyses. Ethnicity and age were used as control variables. Data analyses were conducted using structural equation modeling with Mplus. Gender was found to be a moderator, and so all study analyses were examined separately for boys and girls. All adolescents reported having at least one close friend. Fifty-four percent (n = 307) of adolescents reported having a romantic partner. Analyses examining qualities of adolescents' romantic relationships were conducted using only those adolescents who reported having a romantic partner. In terms of the first hypothesis, for boys, higher levels of mania were directly associated with more positive qualities in a close friendship, and were also indirectly associated with more positive qualities in both a close friendship and romantic relationship. For girls, higher levels of mania were indirectly associated with more positive qualities in a close friendship, fewer negative qualities in both a close friendship and romantic relationship, and also more negative qualities in both a close friendship and romantic relationship. In terms of the second hypothesis, higher levels of mania were associated with greater empathy for both boys and girls. Higher levels of mania were also associated with more social dominance for both boys and girls. In terms of the third hypothesis, for boys, empathy mediated the association between mania and more positive qualities in a close friendship and romantic relationship. For girls, empathy mediated the association between mania and more positive qualities in a close friendship, and also mediated the association between mania and fewer negative qualities in a close friendship and romantic relationship. For girls, assertion also mediated the association between mania and fewer negative qualities in a close friendship. Finally, for girls, social dominance mediated the association between mania and more negative qualities in both a close friendship and romantic relationship. With regard to the fourth hypothesis, despite significant associations with some study variables, the associations described above remained significant with symptoms of ADHD entered as a control variable in the models. Findings suggest that empathy is an important strength associated with risk for mania in both boys and girls. Through empathy, close friendship and romantic relationship quality was positively associated with risk for mania in boys and girls. Social dominance was also strongly associated with risk for mania in both boys and girls, indicating that social dominance might be one way to differentiate emerging mania from other disorders, such as ADHD, in adolescents. Social dominance, however, was only associated with relationship quality for girls, and specifically, was associated with more negative qualities in both close friendships and romantic relationships. This may be one area, therefore, that girls at-risk for mania might be able to target in order to improve peer relationships. Future research might examine these associations longitudinally in order to determine causality. Additionally, studying close peer relationship quality in adolescents diagnosed with bipolar disorder would be of interest in future research.