US researchers have found significant white matter tract alterations in adolescent patients with bipolar disorder (BD) within pathways involved in emotional, behavioral, and cognitive regulation.

“These results suggest that alterations in white matter are present early in the course of disease in familial BD,” say Naama Barnea??”Goraly (Stanford University, California) and co-authors.

A number of studies indicate that white matter abnormalities are present in BD. To investigate further, the researchers analyzed diffusion tensor imaging (DTI) images using a whole-brain voxel-by-voxel analysis to investigate white matter structure in 21 adolescents with familial BD and 18 age- and intelligence quotient-matched healthy individuals.

BD patients had lower white matter fractional anisotropy (FA) values than healthy individuals within the limbic system (the fornix and the left mid-posterior cingulated gyrus), which has been hypothesized to contribute to the combination of affective, cognitive, and vegetative symptomatology in BD.

The researchers point out that the fornix findings in their study should be interpreted with caution due to the thin nature of the fornix, which could result in partial volume effects.

BD patients also had lower FA values than controls throughout the corpus callosum, in fibers extending from the fornix to the thalamus, and in parietal and occipital radiata bilaterally.

Barnea??”Goraly and team say that their finding of reduced FA in the corpus callosum is at odds with a previous study in adults, which “may indicate an abnormal maturation process in the corpus callosum occurring in individuals with BD, with lower FA in adolescence representing reduced coherence or aberrant myelination with increasing FA with age.”

No significant differences were seen between groups in apparent diffusion coefficient values, a measure of overall diffusivity. Furthermore, there were no significant correlations between behavioral measures or medication exposure and FA values.

“An intriguing and important follow-up study will be to investigate whether early treatment of BD normalizes the development of these pathways and if improvement of particular symptoms is associated with structural changes in regional white matter anatomy,” suggest the researchers.

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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• Eurand Announces FDA Approval Of EUR-1048 (Lamictal(R) ODTTM), Co-Developed With GlaxoSmithKline
• Mood Dysfunction Improved In Gene Knockout Mice

Patients with bipolar disorder are more likely to be admitted to hospital with a cardiovascular (CV) event than individuals without the disorder, results of a longitudinal study suggest.

Crucially, the present study, published in the Journal of Affective Disorders, is one of the few that have measured the incidence of actual CV morbidity in bipolar disorder patients, rather than simply the prevalence of CV risk factors.

“These findings add weight to current treatment guidelines… stressing the importance of integrated psychiatric and somatic care for persons with bipolar disorder,” comment study authors Russell Callaghan and Anbreen Khizar from the Centre for Addiction and Mental Health in Toronto, Ontario, Canada.

Individuals with bipolar disorder are vulnerable to a wide range of metabolic medical conditions, which in turn impacts on CV health. Yet almost all of the research linking bipolar disorder and CV morbidity has come from cross-sectional or case-series studies.

Noting a lack of longitudinal data, Callaghan and Khizar identified all hospital discharges of patients with bipolar disorder (n=5999) in the Ontario area between 2002 and 2006. They also recorded discharges of an equal number of patients with appendicitis, to serve as a matched population-proxy group of control individuals.

They then assessed incidence of readmission to hospital for CV events in both groups of patients in the 4 years after the original admission.

In all, there were 156 CV events in the appendicitis group and 280 in the bipolar group. Regression analysis revealed that after adjustment for age, tobacco use, diabetes, and lipid disorders, patients with bipolar disorder faced a significant 66% increased risk for readmission for CV events relative to patients with appendicitis.

Discussing their findings, the researchers note a recent Veteran’s Affairs study showing that only 50% of patients with bipolar disorder on atypical antipsychotics received the recommended lipid tests and about two-thirds received glucose testing for routine CV disease.

“In light of the elevated risk for CV morbidity among persons with bipolar disorder, our findings add to the importance of screening and intervention programs for metabolic disorders and known CV risk factors among patients with bipolar disorder,” Callaghan and Khizar comment.

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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• Irritability Should Be Considered When Diagnosing Bipolar Disorder In Children

A variant in the 5-hydroxytryptamine (serotonin) receptor 5A (HTR5A) gene may be involved in the pathogenesis of bipolar disorder, says an international team of scientists, although they urge caution in interpreting the findings.

Despite a wealth of research into the etiology of bipolar disorder and evidence to suggest that it is the result of an interaction between genetic and environmental factors, no single gene has been identified as being definitively associated with the disorder.

Yusuke Nakamura, from the University of Tokyo in Japan, and colleagues genotyped 94 bipolar disorder patients and 184 healthy controls from Bulgaria for 191 single nucleotide polymorphisms (SNPs) in 65 candidate genes using TaqMan and/or Invader assays.

In all, 17 SNPs were significantly associated with bipolar disorder and these were further genotyped in an additional set of 78 bipolar disorder patients and 372 controls, with the results pooled with the previous analysis to give a combined set of 172 patients and 556 controls.

The most significant association with bipolar disorder was found for the rs1800883 SNP in a promoter region of the HTR5A gene, which was unaffected by sequential Bonferroni correction, the team notes in the Journal of Affective Disorders.

Analysis revealed that 56.7% of the patients were homozygous for the G risk allele, compared with 42.1% of controls, giving an odds ratio of 1.80. In addition, the risk allele was more common in patients than in controls, at 73.7% versus 62.1%.

A weak association was also found for the rs6265 SNP located in exon 2 of the brain-derived neurotrophic factor gene, with the risk C allele more frequently seen in patients than controls, while a possible association was observed for the rs5443 SNP in exon 10 of the guanine nucleotide binding protein, beta polypeptide 3 gene. However, neither survived Bonferroni correction.

“In conclusion, our findings suggest that HTR5A gene could be one of many genes of importance in the etiology of bipolar disorder in the Bulgarian population, but the effect by the genetic substitution seemed to be small even if the association is further confirmed,” the team writes.

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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• 1A binding reductions in euthymic bipolar disorder patients]]>
• Communication Within The Brain Impaired By Genetic Variant With Possible Consequences Schizophrenia Or Manic Depression

A novel scale is able to identify the key features of mixed states in bipolar disorder, and reinforces the notion that the mixed state is a distinct clinical entity, conclude UK researchers.

The received view of bipolar disorder regards the mixed state as merely the sum of its parts, yet a mixture of symptoms is often present in predominantly manic or depressive episodes. There is little consensus as to the diagnosis or measurement of mixed states, and there is no scale for specifically assessing the phenomenon.

A novel scale, developed by Jonathan Cavanagh, from the University of Glasgow, and colleagues, aimed to address this gap. The scale included items on physical activity, verbal activity, thought process, voice level, mood, self-esteem, social contact, sleep, sexual interest, eating habits, weight change, meaning in life, anxiety, feelings of pressure, passage of time, future plans, pain sensitivity, and work capacity.

Each pole of the scale ranged from 1 to 4 and respondents were asked to recall their last manic episodes. It was made clear that they could endorse more than one of the manic and depressive symptoms, as both types may apply at different times during an episode.

The clinical sample consisted of 189 bipolar disorder patients with a confirmed diagnosis, ?1 previous manic episode, ?1 affective episode, and age 18??”65 years. In addition, a community sample of 220 bipolar affective disorder patients were posted the scale, resulting in 122 usable replies.

The average age of the clinical and community samples was 36.7 years and 43.0 years, respectively, the average number of mania episodes was 11.45 and 5.8, respectively, and the average number of depressive episodes was 15.24 and 5.8, respectively.

Factor analysis for the sum total manic plus depression item scores indicated the presence of a two-factor solution for the manic and depressed items, with factor 1 representing physical activity, verbal activity, thought processes, and mood and factor 2 representing eating habits, weight change, passage of time, and pain sensitivity. The two factors accounted for 61.2% in the variance in scores.

The team concludes: “It is important to pursue the question of whether mixed states represent a separate category or are an important dimension on the spectrum of symptoms that constitute bipolar affective disorder. Either way, it is a challenge to the existing nosology of bipolar.”

They add in the journal Clinical Psychology and Psychotherapy: “If mixed states are a variant within the bipolar spectrum, it raises the question as to whether such patients should be treated with mood stabilizers rather than antidepressants.”

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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• New Certified Reference Materials Offer Greater Certainty In Monitoring 3 Therapeutic Medications

The U.S. Food and Drug Administration has approved Saphris tablets (asenapine) to treat adults with schizophrenia, a chronic, severe and disabling brain disorder, and to treat bipolar I disorder in adults, a serious psychiatric disorder that causes shifts in a person’s mood, energy, and ability to function.

“Mental illnesses like schizophrenia and bipolar disorder can be devastating to patients and families, requiring lifelong treatment and therapy,” said Thomas Laughren, M.D., director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research. “Effective medicines can help people with mental illness live more independent lives.”

The most common symptoms of schizophrenia include hearing voices, or seeing things that are not there, having false beliefs (for example, believing that others are controlling thoughts, reading minds, or plotting harm), and being inappropriately suspicious or paranoid. These thoughts may be terrifying and can cause fearfulness, withdrawal, agitation or violence.

Bipolar I disorder is a chronic, severe, and recurrent psychiatric disorder that causes alternating periods of depression and high, increased activity and restlessness, racing thoughts, talking fast, impulsive behavior, and a decreased need for sleep.
Saphris is in a class of drugs called atypical antipsychotics. All atypical antipsychotics contain a boxed warning, the FDA’s strongest warning. The warning alerts prescribers to an increased risk of death associated with off-label use of these drugs to treat behavioral problems in older people with dementia-related psychosis (a brain disorder that lessens the ability to remember, think, and reason). Saphris is not approved for these patients.

The efficacy of Saphris in treating schizophrenia was studied in three short-term placebo-controlled and active-drug controlled clinical trials. In two of the trials Saphris demonstrated superior efficacy compared to an inactive pill (placebo) in reducing the symptoms of schizophrenia.

The efficacy of Saphris in the treatment of bipolar disorder was studied in two short-term placebo-controlled and active-drug controlled clinical trials in which Saphris was shown to be superior to placebo in treating symptoms of bipolar disorder.

The most common adverse reactions reported by patients in clinical trials being treated for schizophrenia with Saphris were the inability to sit still or remain motionless (akathisia), decreased oral sensitivity (oral hypoesthesia) and drowsiness (somnolence).

The most common adverse reactions reported by patients in clinical trials using Saphris to treat bipolar disorder were drowsiness, dizziness, movement disorders other than akathisia and weight increase.

Saphris is manufactured by Schering-Plough, Kenilworth, N.J.

Source: FDA

• Yale Researchers Repair Brain Damage Caused By Chronic Stress Work Has Implications For Bipolar Disorder, PTSD
• A Combination Of Common Genetic Variations Can Lead To Schizophrenia
• Brain activity determines risk or resilience in bipolar disorder

As part of its ongoing effort to support bipolar depression awareness and education, AstraZeneca (NYSE: AZN) is bringing The Bipolar Journey: Living With Bipolar Depression interactive exhibit to patients and caregivers across America. Those who have been touched by bipolar depression — the depressive phase of bipolar disorder — are encouraged to visit a nearby exhibit site and learn more about living with this disease and how to help manage it.

“The more you understand about bipolar depression, the better equipped you are to cope with your disease or help a loved one do the same,” said Janet Taylor, M.D., a New York-based Psychiatrist in private practice. “In my experience working with patients and families, I’ve learned that an engaging, interactive approach can be very effective. The Bipolar Journey exhibit’s consumer-focused activities provide insight and clarity into the life of a patient living with and managing bipolar depression.”

The Bipolar Journey features imagery, multimedia activities, and interactive tools to help patients connect with experts as well as other patients and caregivers who have dealt with the impact of bipolar depression in their own lives. For example, a unique tool lets visitors select questions that interest them and hear tailored video responses from Dr. Taylor. Through a powerful feature called “My Story,” visitors can step into a photo booth to give a short message of inspiration about their experience with bipolar depression. Select messages are then posted on an “inspiration wall” to travel around the country with the exhibit, inspiring hope in others. Additional features include a podcast listening station and a short video.

One of the main goals of The Bipolar Journey is to give patients the resources they need to help find appropriate support to manage their disease. In addition to encouraging patients to work with a physician to develop a treatment plan, the exhibit offers opportunities to register for Thinking Forward(TM), a support program that provides free information, resources, and practical advice for people with bipolar depression.

Be sure to click on the links to your right to download a tour schedule, examples of featured activities, a fact sheet about bipolar disorder, photos, and additional resources.

About Bipolar Disorder

Approximately 8 million American adults may be affected by bipolar disorder, a serious psychiatric condition also known as manic depressive illness.(1,2) Bipolar disorder consists of recurring episodes of mania and depression.(3) Bipolar I disorder is characterized by one or more manic or mixed episodes, often with one or more episodes of major depression, whereas bipolar II disorder is distinguished by one or more major depressive episodes accompanied by at least one hypomanic episode.(3)

Throughout their lives, patients with bipolar I disorder experience depressive symptoms approximately three times longer than manic symptoms.(4) Similarly, patients with bipolar II disorder spend almost forty times longer in the depressed state than in hypomania.(5) Up to 50 percent of patients with bipolar disorder attempt suicide, and approximately 15 to 20 percent complete suicide.(6)

Bipolar disorder is often misdiagnosed as major depressive disorder. This misdiagnosis can lead to unfocused treatment that may exacerbate the disease. In fact, many patients face ten years or more before a correct diagnosis is made.(7) Therefore, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.(8)

Bipolar disorder is typically managed through a treatment strategy with several phases — including acute and maintenance phases. In the acute phase, the goal is to treat the patient until symptoms remit; the maintenance treatment phase aims to reduce the risk of recurrence of future episodes.(8)

About AstraZeneca

AstraZeneca is engaged in the research, development, manufacturing and marketing of meaningful prescription medicines and in the supply of the healthcare services. AstraZeneca is one of the world’s leading pharmaceutical companies with global healthcare sales of $31.6 billion and is a leader in gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infectious disease medicines. In the United States, AstraZeneca is a $ 13.5 billion dollar healthcare business.

References

1. Hirschfeld RMA, Calabrese JR, Weissman MM, et al. Screening for Bipolar in the Community. J Clin Psychiatry. 2003; 64:53-59.

2. US Bureau of the Census.

3. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: APA; 2000; 382-397.

4. Judd LL, Akiskal HS, Schettler PJ, et al. The Long-term Natural History of the Weekly Symptomatic Status of Bipolar I Disorder. Arch Gen Psychiatry. 2002; 59:530-537.

5. Judd LL, Akiskal HS, Schettler PJ, et al. A Prospective Investigation of the Natural History of the Long-term Weekly Symptomatic Status of Bipolar II Disorder. Arch Gen Psychiatry. 2003; 60:261-269.

6. MA, Chaudhury SR, Mann JJ. Pharmacotherapy of Suicidal Behavior in Bipolar Disorder. Archives of Suicide Research. 2005; 9(3):237-250.

7. Hirschfeld RMA, Lewis L, Vornik LA. Perceptions and Impact of Bipolar Disorder: How Far Have We Really Come? Results of the National Depressive and Manic-Depressive Association 2000 Survey of Individuals With Bipolar Disorder. J Clin Psychiatry. 2003; 64:161-174.

8. American Psychiatric Association. Practice Guideline for the Treatment of Patients With Bipolar Disorder, Second Edition. April 2002.

Source: AstraZeneca

• DTNBP1 gene mutations linked to bipolar disorder]]>
• FDA Grants Approval For Use Of RISPERDAL(R) CONSTA(R) As Both A Monotherapy And Adjunctive Therapy In The Maintenance Treatment Of Bipolar I Disorder

Specific genes are associated with the presence of mood-incongruent psychosis in patients with bipolar disorder, conclude European researchers who say the findings should be taken into account in future bipolar disorder studies.

It is traditionally assumed that schizophrenia and bipolar disorder are separate disease entities. However, clinical and genetic studies have challenged this assumption, with a recent investigation indicating that two specific genes are linked to mood-incongruent psychotic features that may represent a homogenous subset of the bipolar phenotype.

To investigate further, Nick Craddock, from Cardiff University in the UK, and colleagues studied families multiply affected by bipolar spectrum mood disorder from the UK, the Republic of Ireland, Germany, Italy, and Andalusia. In total, 383 affected relative pairs were genotyped for 1441 markers and covariate linkage analysis for chromosomal regions linked to bipolar disorder was perfomed.

Of the genotyped relative pairs, 152 had neither member of the pair affected by mood-incongruent psychosis, while 131 had one member affected, and 100 had both members affected.

The team reports in the journal Bipolar Disorders that there was significant familiality of incongruent psychosis, at an intra-class correlation coefficient of 0.309.

It was estimated that a logarithm of the odds (LOD) score of 4.96 would be required for genome-wide significance, and a score of 2.86 for suggestive linkage. While no chromosomal region met genome-wide significance, three regions at chromosomes 1q32.2, 7p13, and 20q13.31 had suggestive evidence for linkage.

Chromosome 1q32.3 had a covariate LOD score of 4.15, and would be expected to occur by chance 0.12 times per genome scan. In comparison, chromosome 7p12.3 had a covariate LOD score of 3.32 and would be expected to occur by chance 0.47 times per genome scan, while the equivalent values for chromosome 20q13.31 were 2.98 and 0.82 times per genome scan.

The team writes: “Our linkage findings, together with our demonstration of the familiality of the occurrence of mood-incongruent psychotic features, support the likely general utility of this phenotypic variable in genetic investigation of bipolar spectrum disorders.

“Moreover, our findings suggest specifically that further work aimed at identifying susceptibility or course modifying genes in these regions should take into account the level of mood-incongruent psychosis features within the clinical samples being used.”

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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The gating ratio of auditory brain potentials at 85 ms (P85) may help clinicians differentiate between bipolar disorder patients and healthy individuals, conclude US researchers.

There are few potential biomarkers that are able to accurately predict the occurrence of bipolar disorder. Sensory gating, as measured using the amplitude of the evoked potential at 50 ms (P50) in response to two paired clicks, which assesses the integrity of brain inhibitory function, is a biological marker for schizophrenia, but no similar marker has been identified for bipolar disorder.

To investigate further, Julie Patterson, from the University of California at Irvine, and colleagues measured P50 and P85 auditory evoked potentials in 45 patients with schizoaffective disorder, 66 patients with paranoid schizophrenia, 42 bipolar I disorder patients, and 56 healthy controls.

The results, published in the journal Bipolar Disorders, indicate that there were significant differences in the average P85 gating ratio between the groups, at 124.8 for bipolar I disorder patients, 96.0 for schizoaffective disorder patients, 84.7 for patients with paranoid schizophrenia, and 70.5 for healthy controls.

The results were confirmed when the S1 and S2 amplitudes for each component on the P85 amplitude analysis were measured, with S1 significantly higher than S2 for each group except the bipolar I disorder patients.

The P50 sensory gating ratio significantly differentiated individuals with schizoaffective disorder from controls, at an average gating ratio of 61.7 for controls, 68.5 for paranoid schizophrenia patients, 92.7 for schizoaffective disorder patients, and 75.4 for bipolar I disorder patients.

While the P85 and P50 S1 amplitudes were significantly correlated for each of the patient groups, no such relationship was seen in controls, and there were no significant correlations between P85 and P50 S2 amplitudes for any of the groups. The measures were not correlated with symptom scores or with psychotic mood status.

The researchers write: “In contrast with schizophrenia, endophenotypic markers have been difficult to identify in bipolar disorder, but if confirmed, our findings suggest that the previously unstudied P85 component may represent a new biological marker for bipolar disorder, and that further study of its potential as an endophenotype is warranted.”

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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• First Time-Door Is Open For Family Discussion Of Bipolar Disorder
• ">
• Irritability Should Be Considered When Diagnosing Bipolar Disorder In Children
• Eighth International Conference On Bipolar Disorder To Be Held In Pittsburgh, June 25 To 27

Unipolar and bipolar mood disorders are more common in adolescence and young adulthood than previously assumed, says an international team of scientists that also found conversion from unipolar to bipolar disorder is not particularly high.

There have been a number of large, community-based surveys on the occurrence of mood disorders and conversion from unipolar to bipolar disorders, but they have commonly been limited by their cross-sectional design and the inclusion of a broad age spectrum, which introduces the possibility of recall bias.

To circumvent these problems, Katja Beesdo, from Technische University Dresden in Germany, and colleagues administered the Munich-Composite International Diagnostic Interview to a representative sample of 3021 individuals aged 14??”24 years at baseline. The participants were then followed-up three times during the subsequent 10 years, when they were aged 21??”34 years.

At age 33 years, the age-specific cumulative incidence of manic episodes was 2.9%, while the incidence of hypomanic episodes, major depressive episodes, and minor depressive episodes was 4.0%, 29.4%, and 19.0%, respectively, the team reports in the journal Bipolar Disorders.

The estimated cumulative incidence up to age 33 years of unipolar mania, unipolar hypomania, unipolar major depression, and bipolar depression was 1.5%, 3.6%, 26.0%, and 4.0%, respectively. Excluding patients with minor depressive episodes, the results indicate that the strictly defined incidence of unipolar mania and unipolar hypomania was 0.6% and 1.8%, respectively.

Among patients with primary unipolar (hypo)mania, the conversion rate to bipolar depression was 29.2%, and the rate was greater among those with primary manic episodes than those with primary hypomanic episodes, at 49.6% and 15.8%, respectively, yielding an odds ratio of 5.2. The conversion rate to bipolar depression among manic episode patients when minor depressive episodes were also included was 75.6%, compared with 44.3% among hypomanic episode patients.

Onset of (hypo)manic episodes occurred in 3.6% of patients with primary major depressive episodes, with rates highest among those with onset of major depressive episodes before 17 years of age, at 9.0%. Rates of (hypo)mania among patients aged 17??”20 years, 21??”25 years, and ?26 years at major depressive episode onset were 0.5%, 0.7%, and 0.0%, respectively.

There were no significant differences between unipolar (hypo)mania cases and bipolar cases in terms of clinical disease course, severity of impairment, and likelihood of receiving treatment. In contrast, bipolar cases had more adverse clinical and course depression characteristics than unipolar depressed patients, as well as higher treatment rates.

The team concludes: “Overall, our study suggests that both unipolar and bipolar mood disorders seem to be more frequent than previously thought in adolescence and young adulthood, a time period when both the recognition and the intervention rates by the healthcare system have remained relatively low.”

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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• Mood Dysfunction Improved In Gene Knockout Mice
• Parents And Researchers To Receive Top Honors At International Conference On Bipolar Disorder
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Bipolar disorder (BD) patients with elevated body mass index (BMI) are more likely to experience a more severe disease course in terms of chronicity, duration of illness, and overall functioning, suggest study results.

“Our study has further identified this subgroup as lithium nonresponders, who may represent a particular phenotype of BD patients with a distinct pathophysiology and less favorable outcome,” add Martin Alda (Dalhousie University, Halifax, Nova Scotia, Canada) and colleagues.

Obesity is common in patients with BD, with a 20??”49% prevalence, compared with 18% in the general US population.

To investigate the relationship between elevated BMI and prognosis and outcome in BD, Alda and team investigated differences in sociodemographic, clinical, and medical characteristics with respect to BMI in 276 tertiary care patients with BD.

In total, 39.1% of patients were classified as obese (BMI of ?30 kg/m²)and 36.6% as overweight (BMI of ?25??”30 kg/m²), with no difference in BMI distribution between BD type I and II.

Obese patients were generally not responsive to lithium and had a more chronic, fluctuating course of illness than those with lower BMIs. These patients also had a longer duration of illness, lower global assessment of functioning scores, higher rates of disability, and more comorbid subthreshold anxiety and personality disorders than those with lower BMIs.

The authors also found that patients who achieved complete remission of psychiatric symptoms on lithium had a significantly lower BMI compared with those who showed partial or no therapeutic benefit (mean of 32.4 kg/m² vs 30.0 and 26.5 kg/m², respectively) ??” a finding that is at odds with reports stating that most mood stabilizers cause weight gain.

Commenting on this finding, the researchers write in the journal Bipolar Disorders: “We speculate that lithium-responsive patients spend more time in a state of wellness and are better able to exercise and follow a healthy diet.”

Alda and team add that the subgroup of BD patients with high BMI and poor prognosis “may have impaired metabolism that could underlie obesity, diabetes mellitus Type II, and response to lithium.

They suggest that until a prospective study is performed to assess causality, physicians should provide nutrition and exercise counseling, and screen for and treat the metabolic syndrome and risk factors for cardiovascular disease in this group of BD patients.

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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• FDA Approves Saphris Tablets (asenapine) To Treat Schizophrenia And Bipolar Disorder
• Mental Health America Applauds Bipartisan Legislation To Help Treat Depression And Bipolar Disorders