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A look into the phenomenon of bipolar affective disorder

Pregnancy current or within the last 6 months Use of exogenous steroids and drugs causing ovarian failure Presence of adrenal and pituitary disorders Patients with diabetes mellitus. Written informed consent was obtained from each patient in the local language understandable to the patient; those who were considered incapable of consenting participated in the study with the consent of their closest family member or custodian. A detailed history was taken from the patients.

Relevant data in the history, apart from sociodemographic profile, included age of onset of BPAD, duration of illness, duration of treatment, course of illness number of mood episodeshistory of valproate intake anytime during the illness and its duration, current drug history, family history, and menstrual history.

Menstrual history included age of menarche, regularity, duration of cycles, and number of cycles per year or intermenstrual interval. Amenorrhea was defined as the absence of menstruation for the last 6 or more months. The physical examination, apart from a general review of the systems, focused on the assessment of androgen status hirsutism, temporal recession of hair, acneevidence of IR acanthosis nigricansand anthropometry, BMI, waist-to-hip ratio [WHR].

Body weight and body height were measured while standing with light clothing and no shoes. BMI was calculated as weight kg divided by height m squared.

Waist circumference was measured in centimeters at the midpoint between the iliac crest and lower rib margin at the end of expiration. Hip circumference was measured in centimeters at the widest point between waist and thighs. WHR was calculated as the ratio of waist and hip circumferences. Quantification of hirsutism was done using modified Ferriman—Gallwey score [17] by counting of nine body areas by a single observer.

All patients were assessed by an endocrinologist. Patients reporting menstrual disturbances or having any stigmata of PCOS were further subjected to hormonal analysis, which included luteinizing hormone LHfollicle-stimulating hormone FSHprolactin, and testosterone. The fasting blood sample was taken in the early follicular phase 2nd day of menstrual cycle of spontaneous or medroxyprogesterone-induced cycle for hormonal profile. Pooled samples of LH, FSH, prolactin, and total testosterone were estimated by chemiluminescent immunoassay.

In addition, routine investigations, wherever deemed necessary, were carried out. Nominal categorical data between the groups were compared using Chi-square a look into the phenomenon of bipolar affective disorder or Fisher's exact test as appropriate. The comparison of normally distributed continuous variables between the groups was performed using Student's t-test.

The mean age of our study population was 24. All patients were seen in remission phase. Mean dose of divalproex sodium was 1087. The mean age of patients with PCOS was 22.

The prevalence of PCOS was 18. The prevalence of PCOS was 27. Discussion BPAD is a chronic remitting and relapsing illness that causes significant burden to patients, families, and society. It has been identified as the sixth leading cause of disability-adjusted life years worldwide among people between 15 and 44 years of age by the World Health Organization.

First, many of the medications commonly used in the treatment of BPAD can have deleterious effects on blood levels of reproductive hormones and consequently on the HPG axis and reproductive function.

Second, there is evidence of reproductive dysfunction in women with BPAD before treatment.

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We further sought to identify various factors which can put the women with bipolar illness at risk of getting PCOS.

In a recent study comparing various diagnostic criteria, it was found that the Rotterdam and Androgen Excess Society prevalence estimates were up to twice than that obtained with the NIH criteria. However, the study is still in its initial phase and definitive conclusions cannot be drawn as of now Ganaie, unpublished data.

Although there are no published community studies from our state, PCOS has been studied in various specific groups. In one such study by Zargar et al.

This is in accordance with the observations made by Rasgon et al. In one such study by O'Donovan et al. However, no hormonal assays were obtained from women with menstrual abnormalities who were not taking valproate to assess the rate of hypertestosteronemia.

  • Menstrual history included age of menarche, regularity, duration of cycles, and number of cycles per year or intermenstrual interval;
  • The mean age of patients with PCOS was 22.

Similarly, data from the Systematic Treatment Enhancement Program for Bipolar Disorder on the prevalence of PCOS in women with bipolar disorder receiving mood stabilizers also suggest that valproate use in adult women may carry an elevated risk of PCOS, as nine out of 86 women, or 10.

In addition, menstrual cycle irregularities improved, and there was a trend toward lower serum testosterone among the women who discontinued valproate. However, independent of therapeutic agent used, the bipolar women in this study reported high rates of menstrual disturbances. In our study, the prevalence of PCOS was 27. Moreover, the mean duration of valproate intake was greater in the group with no PCOS 13. It is possible that those PCO-like changes occur in association with drugs only after years of exposure and that a false-negative result was obtained in the current study due to a relatively short length of exposure.

The impact of both length and timing of exposure to valproate on reproductive functioning require further study with larger sample sizes, longitudinal designs, and longer lengths of exposure. These endocrine changes increase gonadal steroidogenesis and permit a greater proportion of the released serum testosterone to be bioactive.

  1. Considering that the basic premise of GD is constant comparison, the data collection and analysis were carried out concomitantly. I Risperdal trashed me, left me completely unable to have sexual relationships with my wife, I complete abstained for a year and four months, completely crazy.
  2. Figure 2 shows the subjects' distribution according to the total number of pills taken per day.
  3. Diet history was not taken because of which important information has been missed which might have contributed to metabolic abnormalities directly and hormonal abnormalities indirectly. Without these modern treatments, patients usually spent a quarter of their adult life in hospital and half of it disabled 4.

Increased bioactive androgen may act locally in the ovary to block ovulation or may accomplish this through aromatization to estrogen and negative feedback on FSH secretion.

It was further suggested that there is possibility that epilepsy may promote PCOS and that PCOS is treated by most enzyme-inducing antiepileptic drugs but not by enzyme-inhibiting drugs such as valproate.

Most commonly used antiepileptic drugs, including barbiturates, phenytoin, and carbamazepine, induce cytochrome P-450 and accelerate hepatic biotransformation, whereas valproate does not. Antiepileptic drugs that induce hepatic enzymes reduce biologically active testosterone levels in the serum by increasing the binding and metabolism of testosterone.

The phenomenon of bipolar affective disorder and therapy techniques

Antiepileptic drugs other than valproate, therefore, may treat hyperandrogenism and thus PCOS, whereas valproate therapy may not.

This mechanism thereby could also contribute to a higher occurrence of PCOS in valproate-treated women with epilepsy. Although PCO is no longer deemed necessary for the diagnosis of PCOS, they represent arrest in antral follicle development and in many cases anovulation.

Similarly, Zargar et al. Our results are comparable to the results of other similar studies. This is in accordance with various studies that show a positive correlation between valproate and menstrual disturbances.

Similarly, women in studies by O'Donovan et al. Lack of BMI differences across studies, and independence of this finding from the type of treatment, suggests further that weight gain and obesity are common phenomena among women treated for bipolar disorder.

Studies have suggested an association between menstrual abnormalities and an increased risk for diabetes and cardiovascular disease, which is independent of obesity. These results are not surprising as PCOS is largely considered as a lifestyle-related disease and has been attributed to a rapid nutritional transition toward an obesogenic diet and lifestyle which has become a norm in urban areas.

Although lack of community studies in this part of the world precludes proper comparisons, the rates of PCOS among bipolar women are high, a look into the phenomenon of bipolar affective disorder of the medication type Lack of association with type and duration of treatment suggest that the PCOS arises out of the basic illness rather than as a complication of its treatment Women with preexisting menstrual abnormalities may represent a group at risk for further endocrine dysfunction while treated for the disorder.

Prospective, longitudinal studies will be better able to define the natural history of ovulatory function before and after introduction and discontinuation of valproate and other medications Women with bipolar disorder appear to have not only reproductive abnormalities that may contribute to fertility problems but also metabolic abnormalities that may contribute to long-term medical comorbidity. Limitations There were a few limitations in our study. It was a hospital-based study which may not be representative of the individuals with less complex presentations in the community The cross-sectional design does not allow us to discern potential changes with time on concurrent medications or changes in menstrual patterns that can occur as a result of changing medications.

In addition, it is quite possible that the women reporting menstrual disturbances were put on a safer medication by treating clinician at the outset of treatment leading to misattribution in our study.

  1. I started to spend too much, to buy things without being able to, you know? I couldn't manage to work, how do you work?
  2. Recommendations We recommend initial assessment of reproductive and metabolic endocrine status of all women diagnosed with bipolar disorder before treatment.
  3. Figure 2 shows the subjects' distribution according to the total number of pills taken per day.
  4. With a view to guaranteeing that all patients received standardized questions, a script was used with the subjects' identification data gender, age, education, among others and identification data of their drugs treatment profile number of medication types used, total number of pills taken per day, number of times per day the medication is taken, among others.

Effects of an individual medication are difficult to determine in an illness such as bipolar disorder, in which individuals are likely to have taken multiple medications over the course of the illness. Studies evaluating this phenomenon in newly diagnosed women with bipolar disorder receiving treatments de novo will be better able to disentangle specific drug effects The study design does not allow the separation of the effects of the disorder per se from the effects of the treatment agents The retrospective nature of some components of this study is a limitation in that women may over report or miss information related to duration and type of drug intake, course of illness, etc.

Diet history was not taken because of which important information has been missed which might have contributed to metabolic abnormalities directly and hormonal abnormalities indirectly. Recommendations We recommend initial assessment of reproductive and metabolic endocrine status of all women diagnosed with bipolar disorder before treatment.

During treatment, regular monitoring of weight and endocrine status should be done in all patients. If an endocrine disorder develops, the role of current medication should be assessed.

Development of menstrual abnormalities may not constitute a reproductive disorder but should alert the treating clinician for closer monitoring. Early detection and prompt treatment can to a large extent prevent morbidity and mortality. Therapeutic lifestyle modification, healthy food habits, maintenance of high level of physical activity and normal weight, and family education about PCOS are most important strategies which can improve quality of life in these women.

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