Triggers for acute mood episodes in bipolar disorder: A systematic review

Examining the Relationships between the Incidence of Infectious Diseases and Mood Disorders: An Analysis of Data from the Global Burden of Disease Studies, 1990–2019

“…There are several case reports of manic episodes being triggered by infection with these viruses [ 65 , 66 , 67 , 138 ]. A recent systematic review also concluded that viral infections could serve as a trigger for acute mania, but not for depression; however, the authors of this review relied on case reports and could not establish a specific relationship with URI [ 139 ]. A more recent study failed to find an association between bipolar disorder and the presence of antibodies to seasonal coronaviruses [ 140 ], which may be due to the milder nature of the infections caused by these viruses.…”

“…Fourth, the current study highlights an important limitation of all the above models, namely that they do not consider possible relationships between infectious diseases and bipolar disorder. Though some researchers have highlighted possible associations between both past and recent infections and BD [ 139 , 145 ], these findings have not been integrated into a broader model as has been attempted in the case of MDD. Bowins [ 53 ] suggested that milder forms of BD (hypomania) could represent a natural “override mechanism” that guards against the maladaptive aspects of depression.…”

Proposition of a transdiagnostic processual approach of emotion dysregulation based on core triggers and interpersonal styles

“…Notably, emotion dysregulation can be found in euthymic bipolar patients ( 90 ). Specific triggers are often found in mood episodes ( 91 , 92 ), with some authors suggesting different types of triggers for depressive and manic episodes. However, regarding emotion dysregulation and affective instability, several authors have proposed that ED in BD patients may not have specific triggers compared to patients with BPD, with emotional swing being quite autonomous and non-driven by specific types of interpersonal or intrapsychic events ( 27 ).…”

Predictive Value of qEEG in Manic Switch of Depressed Patients

“…The most frequent triggers for a manic episode as antidepressant treatment, mostly tricyclic antidepressants, transcranial magnetic stimulation (TMS) and deep brain stimulation, seasonal changes, hormonal imbalance, use of energy drinks acetyl-L-carnitine, biological rhythm changes such as sleep deprivation and fasting, whereas stressful life events were found to be contradictory factors for a manic episode. 37 The neurobiological underpinnings of the MS are reported as altered catecholamine levels resulting in abnormal monoaminergic activity, upregulation of neuroplastic and neurotrophic factors, hypothalamic-pituitary-adrenal axis hyperactivity, and increased locus coeruleus firing rate at rapid eye movement period with sleep deprivation. 38 Although some potential clinical risk factors of the manic shift are proposed in the literature, there are no criteria for predicting which unipolar depression patients switch to manic episodes during treatment.…”

“…The total YMRS score varies between 0 and 60. YMRS scores are categorized as follows: remission (0-12), minimal symptoms (13)(14)(15)(16)(17)(18)(19), mild symptoms (20)(21)(22)(23)(24)(25), moderate symptoms (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37), and severe symptoms (38-60). 40 qEEG Recording Procedure A 19-channel (FP1, F7, T3, T5, F3, C3, P3, O1, Fz, Cz, Pz, F4, C4, P4, O2, FP2, F8, T4, and T6) electro-cap was used to record resting-state qEEG recordings.…”