Suicidality, mood, psychomotor, and neurovegetative symptoms are stable across depressive episodes in bipolar disorder whereas the overall dimensional structure is not temporally stable, US researchers have discovered.

It has been suggested that depressive subtypes in bipolar disorder, characterized by groups of symptoms, have predictive or diagnostic value. However, this assumes that symptoms are stable across mood episodes, a hypothesis that has not been thoroughly investigated.

Roy Perlis, from Massachusetts General Hospital in Boston, and colleagues therefore studied 583 patients with bipolar I and II disorder from the Systematic Treatment Enhancement Program for Bipolar Disorder study who had two depressive episodes during 2 years of follow-up. Syndromal depressive mood episodes were determined using the DSM-IV criteria.

Of the participants, 66.2% had bipolar I disorder, 62.6% were female, 35.9% had a history of psychotic symptoms, 73.4% had a history of rapid cycling, and 41.2% had a history of suicide attempt. In total, 149 patients experienced a third depressive episode, at a median time to recurrence of 168 days.

The greatest stability between first and second depressive episodes was seen for neurovegetative symptoms, psychomotor symptoms, suicidal ideation, and depressed mood, while the least stable symptoms were loss of interest and fatigue.

Significant stability was also observed for the percentage of days irritable and days anxious, as well as for Clinical Global Impression scale scores and the count of DSM-IV mood symptoms. Similar findings were recorded for patients with three depressive episodes.

While a three-factor model including sleep, interest, and guilt had an excellent fit for data from the initial visit, a confirmatory model derived from first-episode data did not fit the second-episode data. Substantial differences in symptom correlations between first and second episodes also reduced the fit of a model in which all factor loadings were constrained to be equal across the two episodes.

The team concludes in the journal Bipolar Disorders: “We identified evidence of consistency of many symptoms between two episodes but with wide variation in the extent of correlation, and substantially less correlation when the episodes are separated by another depressive episode.”

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; 2009

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The clinically significant weight gain observed in bipolar disorder patients begins with the first manic episode, regardless of previous episodes, and may be due to the treatment required, say Canadian researchers.

Many studies have shown that bipolar disorder is associated with obesity, but these investigations have typically been retrospective or cross-sectional in design and focused on patients with long-term illnesses.

To determine the patterns of weight gain in early bipolar disorder, Lakshmi Yatham and colleagues from the University of British Columbia in Vancouver obtained weight gain data and laboratory metabolic measurements over a 12-month period from 47 bipolar disorder patients receiving maintenance therapy after their first manic episode and 24 age- and gender-matched healthy controls.

At baseline, there were no significant differences between patients and controls in terms of average body mass index (BMI), rates of overweight and obesity, and laboratory metabolic indices.

Over the first 6 months of follow-up, 46.8% of patients and 4.2% of controls gained ?7% over their baseline weight, at an average weight gain of 4.57 kg and 0.51 kg, respectively. However, rates of overweight and obesity did not differ significantly between patients and controls.

On logistic regression analysis, significant weight gain was associated with lower initial weight, male gender, and treatment with olanzapine and risperidone. Obese patients had significantly greater average serum triglyceride and fasting glucose levels than non-obese patients.

At 12 months, 19% of patients and 4% of controls gained ?15% over their baseline weight, and the average weight gain was 4.76 kg and 1.50 kg, respectively. Interestingly, the changes at 12 months were primarily due to changes over the first 6 months, as average weight change during the second 6 months was 0.19 kg for patients and 0.98 kg for controls, and 13% and 8.3%, respectively, gained ?7% over their 6-month body weight.

There were no significant associations between significant weight gain from 6??”12 months and any of the variables analyzed, the team notes in the Journal of Affective Disorders.

They write: “Given the long-term health consequences of overweight and obesity, these findings underscore the importance of considering weight and metabolic factors when making even the earliest treatment decisions for patients with bipolar disorder, and of frequently monitoring for and addressing weight gain.”

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; 2009

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Bipolar disorder patients who have psychotic features have a worse prognosis and response to lithium monotherapy than patients without such features, the results of a Turkish study indicate.

It has previously been suggested that up to 50% of bipolar disorder patients in an acute manic episode have psychosis, with rates in child and adolescent patients higher than those seen in adult patients. However, the impact of psychotic symptoms on prognosis and clinical course has rarely been investigated.

I ?-zyildirim, from Ünye State Hospital in Ordu, and colleagues therefore studied 97 bipolar I disorder patients who had suffered from the condition for at least 4 years and had at least three mood episodes, comparing the clinical features and response to long-term prophylaxis between those with and without psychosis.

The results, published in the journal European Psychiatry, indicate that 43 patients were psychotic in all mood episodes, while 54 had never experienced psychotic symptoms.

There were no significant differences between the psychotic and non-psychotic groups in terms of age, gender distribution, age of onset, and cycling interval. A family history of bipolar disorder was significantly more common in the non-psychotic than psychotic group, at 29.6% versus 11.6%.

Non-psychotic patients were also significantly more likely to have a predominantly depressive episode type than psychotic patients, at 25.0% versus 5.0%, and were significantly less likely to having a predominantly manic/mixed episode type, at 68.8% versus 85.0%.

Psychotic patients were significantly more likely to have severe mood episodes and had significantly more hospitalizations than non-psychotic patients, at 100% versus 27.8% and 1.9 versus 1.4, respectively.

Psychotic patients were significantly less likely to have a response to lithium monotherapy and more likely to have a response to anticonvulsant plus antipsychoctic therapy than non-psychotic patients, at 43.3% versus 89.7% and 100% versus 55.6%, respectively.

The team concludes: “Determination of psychotic subtype might be predictive for the clinical course of illness and establishing the optimum prophylactic treatment.”

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; 2009

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