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Over one-third of bipolar disorder (BD) patients do not receive adequate provision or continuity of maintenance treatment during their first follow-up maintenance phase, indicate study findings.
Studies investigating maintenance treatment in BD have lacked agreement on how the longitudinal treatment phases should be defined, thus presenting inconsistent results.
Erkki Isometsä (Helsinki University Central Hospital, Finland) and co-authors say that their study is “one of the first to investigate maintenance treatment received using life chart methodology, with the possibility of reporting longitudinal patterns of maintenance treatment.”
For the study, the researchers assessed the adequacy of pharmacologic treatment received by 154 BD patients who had taken part in the Jorvi Bipolar Study during the first maintenance phase (at least 2 weeks) after the index episode. Treatment information was collected in interviews and using psychiatric records and adequate maintenance-hase pharmacotherapy was based on published treatment guidelines, where patients had to be treated with lithium, valproate, carbamazepine, or olanzapine. Monotherapy with lamotrigine was defined as adequate in bipolar II disorder.
Overall, 63.0% of patients experienced depression prior to the maintenance phase, which lasted on average 220 days.
Adequate maintenance treatment was received by 69.3% of all patients during the time indicated and by 77.9% of patients with a clinical diagnosis of BD (n=129).
Furthermore, adequate treatment was received by 75.3% of patients for some time, but only by 61.0% of all patients throughout the maintenance phase. Again, a higher proportion of patients with a clinical BD diagnosis (72.1%) received treatment throughout the maintenance phase than did patients diagnosed with BD II (47.0%).
Most patients (81.0%) with adequate maintenance treatment some time during the maintenance phase received it throughout the phase, and nearly all patients (91.4%) with adequate maintenance treatment when the maintenance phase began received adequate treatment when the phase ended or follow-up was finished.
Logistic regression analysis revealed that a clinical diagnosis of BD was the most important predictor for adequate maintenance treatment throughout the first follow-up maintenance phase (odds ratio [OR]=106.5), followed by treatment in hospital during the episode before the maintenance phase (OR=11.1), rapid cycling (OR=3.4), and absence of comorbid personality disorders (OR=0.37 for any personality disorder).
“Further longitudinal effectiveness studies are needed to assess strategies to enhance the adequacy of interventions during the continuation and treatment phases in patients with bipolar disorders,” conclude Isometsä and team in the Journal of Affective Disorders.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
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Study findings highlight the need for clinicians to recognize comorbid eating disorders in patients with bipolar disorder.
M Fornaro (University of Genoa, Italy) and colleagues found that one in three women with bipolar disorder had at least one eating disorder. Also, the presence of comorbid eating disorders may influence both the clinical characteristics and course of bipolar disorder.
The researchers assessed the prevalence of comorbid DSM-IV-defined anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) in 148 women with a lifetime history of bipolar I disorder, bipolar II disorder, and/or cyclothymia.
In all, 46 (31%) of the patients reported a lifetime history of at least one eating disorder. AN was the most common, affecting 23 (15.5%) patients, followed by BED and BN, which affected 21 (14.2%) and eight (5.4%) patients, respectively. Six (4.1%) patients reported multiple lifetime eating disorders.
As expected, the researchers found that body mass index was highest in patients with BED and lowest in patients with AN.
Fornaro et al also note in the Journal of Affective Disorders that “the presence of BED among bipolar disorder patients has relevant clinical and therapeutic implications.”
They explain: “In these patients the use of anti-dopaminergic drugs may induce weight gain not only by an appetite increase, but also favoring impulsive eating.”
The type of eating disorder did not influence clinical characteristics such as diagnostic distribution, psychotic and melancholic features, suicidal thoughts and attempts, hospitalization, seasonal pattern, post-partum onset, or premenstrual dysphoria.
The researchers suggest that the female-only sample and the small number of women with eating disorders may have affected the ability of the study to detect group differences.
However, women with comorbid BED were more likely than women with comorbid AN and those without eating disorders to experience rapid cyclicity (42.9% versus 32.0% and 18.6%, respectively) and comorbid drug abuse (28.5% versus 16.0% and 20.7%, respectively).
“Our results prompt for the recognition of [eating disorder] comorbidity among bipolar spectrum patients, indicating that BED and AN may influence in different extents both clinical characteristics and course of the illness,” says the team.
“Focusing on a ‘BED versus non-BED’ distinction, potentially relevant therapeutic implications should also be taken into account.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
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Research findings suggest that there are unique neural mechanisms mediating face??”emotion processing deficits in patients with attention deficit/hyperactivity disorder (ADHD), bipolar disorder, and severe mood dysregulation.
Diagnosing these three psychiatric illnesses is difficult because deficits in emotion processing and hyperarousal symptoms are clinical features common to all three conditions, note Melissa Brotman (National Institute of Mental Health, Bethesda, Maryland, USA) and colleagues.
Evidence of unique neural mechanisms mediating face??”emotion processing deficits could therefore assist in the differential diagnosis of bipolar disorder, ADHD, and severe mood dysregulation in children, they say.
The researchers used functional magnetic resonance imaging (fMRI) to examine blood-oxygen-level-dependent (BOLD) signal in the amygdala of 43 children with bipolar disorder, 18 with nonirritable ADHD, and 29 children with chronic irritability known as severe mood dysregulation, and 37 mentally healthy children. The children were aged between 8 and 17 years.
During imaging, the children were shown pictures of adult faces, displaying neutral expressions. The children viewed the faces passively and were then asked to rate the perceived threat (how hostile is this face?) and subjective fear (how afraid are you of this face?) associated with the faces.
The results, published in the American Journal of Psychiatry, show that patients with bipolar disorder and those with severe mood dysregulation were more afraid of neutral faces than healthy individuals, while there was no difference for children with ADHD. There were no group differences with regard to hostility ratings.
Moreover, patients with severe mood dysregulation showed left amygdala hypoactivity when completing subjective fear ratings of neutral faces relative to mentally healthy children and those with bipolar disorder or ADHD.
In contrast, children with ADHD showed left amygdala hyperactivity relative to the other three groups when rating subjective fear of neutral faces.
Amygdala activity in children with bipolar disorder did not differ significantly from that in mentally healthy children.
“These findings suggest that there may be functional differences among ADHD, bipolar disorder, and severe mood dysregulation patients, despite the presence of overlapping behavioral deficits and clinical symptoms,” say Brotman et al.
In a related editorial, Mary Phillips, from University of Pittsburgh Medical Center in Pennsylvania, USA, said the findings “highlight the future promise of neuroimaging to identify biomarkers of psychiatric illnesses in youth.”
She added: “Further studies are clearly needed to elucidate whether functional abnormalities in key neural circuitry in emotion processing and emotion regulation, including not only the amygdala but also other neural regions interconnected with the amygdala, can accurately differentiate between bipolar disorder and other psychiatric illnesses in youth.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
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