Discuss Bipolar
Blog to discuss being Bipolar
The offspring of bipolar disorder patients have an increased risk for anxiety, sleep, mood, and substance use disorders, which, in turn, places them at an increased risk for bipolar disorder, say Canadian scientists.
A broad range of symptoms and disorders from across the spectrum of psychiatric problems have been diagnosed in bipolar offspring. It has not been established, however, whether or not there is a predictable clinical sequence from non-specific, non-mood psychopathology to specific, mood psychopathology in offspring.
Anne Duffy, from Dalhousie University in Halifax, Nova Scotia, and colleagues therefore studied 207 offspring with one bipolar disorder parent (high risk individuals) and 87 offspring with two parents who did not have a major psychiatric disorder (controls).
The participants were assessed annually or at any time that symptoms developed for up to 15 years using the Schedule for Affective Disorders and Schizophrenia for School-Age Children ??” Present and Lifetime Version (KSADS-PL).
All available clinical material were reviewed to make blind DSM-IV diagnoses, and the age-adjusted risks for lifetime psychopathology were compared between high-risk and control participants.
The results show that high-risk participants had, compared with control individuals, significantly higher age-adjusted rates of major mood, anxiety, sleep, and substance use disorders, at 52.8% versus 1.3%, 23.2% versus 7.8%, 18.0% versus 0.0%, and 25.7% versus 1.6%, respectively.
However, there were no significant differences in the prevalence of minor mood disorders and attention deficit/hyperactivity disorder and/or learning disabilities, the team notes in the Journal of Affective Disorders.
Cox proportional hazards analysis revealed that the presence of an anxiety disorder increased the risk for a major mood disorder among high-risk individuals, from 40% to 85%, at an odd ratio of 2.60. In all patients with both an anxiety and mood disorder, the anxiety disorder preceded the onset of the index major mood episode by an average of 8 years.
The presence of a substance use disorder increased the risk for a major mood disorder, at a hazard ratio of 2.12. In addition, the presence of major mood disorder significantly increased the risk for substance use disorder from 18% to 35%, at a hazard ratio of 2.4.
The proposed sequence of non-mood to minor mood/adjustment to major depression to hypomania/mania was occurred in 71% of 21 participants who met a lifetime diagnostic criteria of bipolar disorder, while 90% showed a progression from non-mood to minor mood/adjustment disorders to major mood disorders.
Noting that the findings could help to explain illness progression to bipolar disorder, the team concludes: “For now, it is clear that we need to incorporate the family history and the nature of the longitudinal course in diagnostic assessments of young patients manifesting psychiatric symptoms in order to put these relatively non-specific early presentations in a clinically meaningful context.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
Attitudes toward medication among bipolar disorder patients, as revealed by the Necessity-Concerns Framework, have a significant impact on adherence, UK researchers have discovered.
Medication non-adherence in bipolar disorder is a common and costly problem that is associated with poor clinical outcomes. While treatment studies have suggested that the adverse effect profile of medications is the main cause of non-adherence, this is unlikely to be the primary factor, as rates have not changed since the 1950s.
To investigate further, Rob Horne, from the University of London, and colleagues administered the Medication Adherence Report Scale (MARS) and the Beliefs About Medication Questionnaire to 2223 patients prescribed bipolar disorder medication recruited via an advert in a bipolar disorder newsletter.
The average age of the patients was 48 years, the average duration of illness was 14.0 years, and 90% had been hospitalized at least once. MARS scores revealed that 30.2% of the patients were low adherers, while Beck Depression Inventory and Altman Self-Rating Mania Scale scores were 14.4 and 3.8, respectively, suggesting the presence of moderate sub-syndromal symptoms.
The median number of medications prescribed per patient was three, with the most commonly prescribed being lithium (52%), anticonvulsant mood stabilizers (45%), antidepressants (41%), and atypical antipsychotics (40%), the team reports in the Journal of Affective Disorders.
The Necessity-Concerns Framework revealed that low adherers had, compared with high adherers, a significantly lower perceived need for treatment and greater concerns about treatment.
This was confirmed on logistic regression analysis, which showed that, after controlling for current mood state, illness, and demographic characteristics, low adherence was associated with both greater concerns about treatment and a lower perceived need for treatment, at odds ratios of 2.00 and 0.50, respectively.
While noting the limitations of the study, the team writes: “Prescribing is unlikely to be associated with adherence unless it incorporates a process of eliciting and responding to individuals’ personal beliefs about the treatment.
“The potential importance of the Necessity-Concerns Framework is that it could provide clinicians in day-to-day practice with a meaningful and readily applicable approach to identifying common barriers to adherence with proposed treatment and offers a template for them to make targeted interventions.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
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