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A shortened version of integrated group therapy is an effective treatment for bipolar disorder patients with substance dependence, with better outcomes than group drug counseling, US study findings indicate.
While previous studies have demonstrated that integrated group therapy reduces substance use in bipolar disorder patients, its adoption in community treatment programs may be limited by the need for 20 sessions and highly trained therapists.
To determine the benefits of a shorter version of the therapy led by substance use disorder counselors without previous cognitive-behavioral training (CBT) or bipolar disorder experience, Roger Weiss (Harvard Medical School, Boston, Massachusetts) and colleagues randomly assigned 61 bipolar disorder patients with substance dependence treated with mood stabilizers to 12 sessions of integrated group therapy or group drug counseling.
Both drug and alcohol dependence was recorded in 65.6% of patients. Alcohol dependence only was identified in 26.2% and drug dependence only in 8.2%. The most commonly used drugs were cocaine and marijuana.
Integrated group therapy decreased the days of substance use from baseline marginally significantly more than drug counseling, at an additional 2.7 days by the end of treatment and 2.9 days by the end of follow-up.
Patients assigned to integrated group therapy were significantly more likely to achieve ?1 month total abstinence during treatment and throughout all 3 months of treatment than those assigned to group drug counseling, at 71.0% versus 40.0% and 35.5% versus 13.3%, respectively. They also had a significantly shorter time to the first abstinent month, at a hazard ratio of 2.02.
Furthermore, the risk for a mood episode decreased significantly more with integrated group therapy than with group drug counseling, at an 82% versus 67% relative reduction by the end of treatment, with the risk for both depression and mania episodes significantly reduced.
The composite measure of good clinical outcome for both substance use and mood favored integrated group therapy at the end of treatment, as 45.2% of patients on integrated group therapy achieved abstinence and no weeks ill with a mood episode in the final month of treatment compared with 20% of patients participating in drug counseling.
“It is noteworthy that integrated group therapy can be delivered with a high degree of fidelity and competence by substance use disorder counselors without previous CBT experience or knowledge of bipolar disorder; this finding supports the feasibility of implementing integrated group therapy in real-world substance use disorder community treatment settings,” the team writes in the journal Drug and Alcohol Dependence.
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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Study results suggest that bipolar spectrum disorders in young patients are episodic disorders characterized most often by subsyndromal than syndromal episodes, with mainly depressive and mixed symptoms and rapid mood changes.
In this study, Boris Birmaher (University of Pittsburgh Medical Center, Pennsylvania, USA) and co-authors extended findings from the Course and Outcome of Bipolar Youth (COBY) program in a larger sample of youths (ages 7??”17 years) with bipolar I disorder (n=244), bipolar II disorder (n=28), and bipolar disorder not otherwise specified (n=141). Symptoms were retrospectively evaluated on average every 9.4 months for 4 years.
The researchers found that 81.4% of patients had fully recovered approximately 2.5 years after the onset of the first episode. A lower likelihood of full recovery was associated with a diagnosis of bipolar disorder not otherwise specified (hazard ratio [HR]=0.62), children with childhood onset as opposed to adolescents with adolescent onset (HR=0.50) or childhood onset (HR=0.70), non-Caucasian race (HR=0.60), longer duration of illness (HR=0.83 per year of illness), and a family history of mania/hypomania in first- or second-degree relatives (HR=0.79).
Of the patients who recovered, 62.5% had a syndromal recurrence approximately 1.5 years later, which was mainly a major depressive episode (59.5%). One-third of patients had one syndromal recurrence and 30% had two or more.
The authors further found that the polarity of the index episode predicted that of subsequent episodes.
Youths with bipolar spectrum disorders were symptomatic during 60% of the follow-up period, during which they spent about 2.5 times more time with subsyndromal (mixed and depressive) than with syndromal (manic) symptomatology.
Patients with bipolar II disorders spent more time in hypomania than did those with bipolar disorder not otherwise specified, and more time in depression than did others.
Lastly, 25% of youths with bipolar II converted to bipolar I disorder, and 38% of those with bipolar disorder not otherwise specified converted to bipolar I or II.
“The course of bipolar disorder, the relative infrequency of syndromal DSM manic episodes, the effects of development in symptom manifestation, and the high prevalence of comorbid disorder may account, at least in part, for the difficulties in recognizing and managing this illness in youths,” conclude the authors in the American Journal of Psychiatry.
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
Patients with broadly defined bipolar schizoaffective features either have a strong genetic contribution to their condition or are genetically homogenous compared with other bipolar groups, conclude UK researchers.
While the descriptive criteria currently used to define psychiatric phenotypes have acceptable reliability, the phenotypes themselves are not necessarily valid clinical entities, which may have an impact on the basis for clinical practice.
To examine the relative genetic support for different descriptive diagnostic categories, Nick Craddock, from Cardiff University, and colleagues examined genome-wide genetic association data on 1868 bipolar disorder patients and 2938 controls from the Wellcome Trust Case Control Consortium study.
The patients consisted of 1316 with bipolar I disorder, 279 with schizoaffective disorder bipolar type, 171 with bipolar II disorder, and 102 with manic disorder using the Research Diagnostic Criteria (RDC), and 1594 with bipolar I disorder, 98 with schizoaffective disorder bipolar type, 134 with bipolar II disorder, and 42 with bipolar disorder not otherwise specified using the DSM-IV criteria.
Using stringent quality filters, the researchers selected 276,122 singe nucleotide polymorphisms (SNPs) for analysis, determining association with bipolar disorder group versus controls, with the number of significantly associated independent SNPs used as a metric for the overall genetic signal.
The results demonstrated that, compared with controls, the category RDC schizoaffective disorder bipolar type had significantly more associated independent SNPs than the other categories, at nine hits versus ?5 hits.
Assessing the independent SNPs for the number of nearby SNPs in linkage disequilibrium with the index SNP, the team found an additional SNP on chromosome 16p13.3 (rs4786811) that had an acceptable clusterplot and a closely correlated SNP. Genes with ?1 associated SNP included B3GALTS, A2BP1, GABRB1, AUTS2, BSN, PTRG, GIRK2, and CDH12.
“Strong consideration is currently being given to abolishing the schizoaffective concept and category from the revisions of the official psychiatric diagnostic classifications,” the team writes in the British Journal of Psychiatry.
“This is unlikely to be unhelpful to the progress of psychiatric knowledge, given that it is emerging as a diagnostic entity that receives strong research support. We hope that psychiatry is moving towards the time when our patients can benefit from diagnostic concepts that are built on solid foundations of empirical biological evidence rather than being perched precariously on the shifting sands of expert opinion.”
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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