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Bipolar disorder patients experiencing their first acute mania episode present with different illness characteristics and achieve recovery and remission more quickly than patients with multiple episodes, findings from the EMBLEM study show.
First-episode patients were significantly younger, had a lower body mass index, and a higher incidence of past or current cannabis abuse than multiple-episode patients.
First-episode patients also had, on average, significantly higher baseline Young Mania Rating Scale (YMRS) total and Clinical Global Impressions-Bipolar Disorder (CGI-BP) mania scores, compared with multiple-episode patients (28.5 vs 26.3 and 5.0 vs 4.8, respectively).
The researchers note, however, that while first-episode patients had greater illness severity than multiple-episode patients, the latter patients had greater functional impairment, based on self-reports.
They also had higher levels of baseline depressive symptoms than first-episode patients, according to CGI-BP depression and Hamilton Depression Rating Scale total scores.
Mauricio Tohen, from the University of Texas Health Science Center at San Antonio, USA, and colleagues therefore suggest that “the level of functional impairment may not be directly related to the symptomatic severity of the index manic episode but, rather, reflect the extent of prior illness course.”
Of 3115 patients enrolled in the EMBLEM (European Mania in Bipolar Longitudinal Evaluation of Medication) study, 256 presented with a first manic or mixed episode while the remaining patients had previously experienced manic or mixed episodes. All the patients had a CGI-BP mania score of at least 3.
In addition to determining differences in illness characteristics between first- and multiple-episode patients at baseline, the researchers compared the two groups with regard to recovery and remission after 12 weeks of antipsychotic treatment.
A significantly greater percentage of patients in the first-episode group than in the multiple-episode group met the criteria for recovery at the 12-week endpoint (CGI-BP overall score of 2 or below at endpoint), at 39.6% versus 33.1%, respectively. Recovery also occurred more quickly in first-episode than multiple-episode patients.
Significant differences in rates of remission were also seen at the 12-week endpoint, at 80.4% for single-episode patients versus 69.0% for multiple-episode patients, and times to remission were shorter for first-episode patients.
“These findings highlight important distinctions in illness characteristics, outcome and possibly treatment response between patients at different points in the longitudinal course of bipolar disorder,” Tohen et al write in the Journal of Clinical Psychiatry.
They therefore recommend consideration of the longitudinal dimension of bipolar disorder in the determination of prognosis and treatment strategies.
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
GPR50 gene linked to affective disorder]]>
Posted by admin on July 16th, 2010
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Variation in the melatonin-related G protein-coupled receptor 50 (GPR50) gene appears to play a role in affective disorder, particularly in women, say UK researchers.
G protein-coupled receptors mediate transmembrane signal transduction in response to ligand binding, and are involved in many diseases including depression and anxiety, Douglas Blackwood (University of Edinburgh) and colleagues explain.
Indeed, “they are the therapeutic targets for approximately 50% of all recently released drugs, including 5-hydroxytryptamine 2C antagonists which are used to treat depression,” they add.
A recent study detected an association between the GPR50 gene and bipolar disorder in a Scottish population. Blackwood et al replicated this study in a second sample from the same population, consisting of 338 patients with bipolar disorder, 359 with major depressive disorder (MDD), and 913 mentally healthy individuals.
They also investigated the effects of the GPR50 genotype on the clinical phenotype and treatment response of a subset of 56 patients with early-onset MDD.
As reported in the journal Neuroscience Letters, an intronic single nucleotide polymorphism of the GPR50 gene ??” rs1202874 ??” was significantly associated, albeit relatively weakly, with bipolar disorder in women, at an odds ratio of 1.9. This association remained significant after correction for multiple testing.
The association was strengthened when women with MDD fulfilling Ghaemi’s criteria for bipolar spectrum disorder were also included.
The researchers say that the association between the GPR50 gene and bipolar disorder may be restricted to women “because gene expression level may be influenced by hormonal factors, particularly given that GPR50 is expressed in the hypothalamic??”pituitary axis.”
The investigators failed to find a significant association between the ?”502-505 deletion polymorphism, which was associated with bipolar disorder in women in the original study, and any disorder regardless of gender.
Even after combining the original data with the current data to give a total sample of 336 women with bipolar disorder and 542 female mentally healthy controls, the association was only just significant and the effects size was reduced compared with the original findings, at an odds ratio of 1.41.
However, detailed study of patients with early-onset MDD showed that men who were homozygous for the ?”502-505 deletion polymorphism were more likely to have a family history of depression, while homozygous women had an earlier age of illness onset, a greater number of depressive episodes, higher scores on the hypomania checklist, and lower initial thinking time on the Stockings of Cambridge test than other patients.
“This suggests carriers of the deletion may have an illness of greater severity [and] be more likely to develop a bipolar type illness in later life,” Blackwood and team write.
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
Around 20% of children and adolescents with an initial diagnosis of bipolar disorder also meet criteria for obsessive??”compulsive disorder (OCD), while a similar number of obsessive??”compulsive disorder patients have underlying bipolar disorder, study results show.
The findings highlight the importance of evaluating patients with bipolar disorder and OCD for reciprocal comorbidity, say study author Gagan Joshi (Massachusetts General Hospital, Boston, USA) and colleagues.
“Considering the extreme severity of juvenile mania, its emergence in children with OCD seriously complicates their treatment, as anti-OCD agents have the risk of exacerbating mood symptoms, and precipitating mania and antimanic agents show marginal efficacy in treating OCD symptoms,” they comment in the journal Bipolar Disorders.
Although clinical studies have begun to address the issue of bipolar disorder??”OCD comorbidity in adult patients, there are little data in pediatric populations.
To investigate the researchers recruited 82 youths with bipolar disorder from a pediatric bipolar family genetic study and 125 youths with OCD from a pediatric OCD family genetic study. All participants were aged between 6 and 17 years.
Detailed clinical interviews revealed that 17 (21%) patients in the bipolar disorder groups and 19 (15%) patients in the OCD group met DSM-III-R diagnostic criteria for both disorders. This shows bidirectional and symmetrical overlap between bipolar disorder and OCD, which is unlikely to be the result of referral or ascertainment bias, say the researchers.
Among patients with bipolar disorder, the number and frequency of mania symptoms were similar in those with and without OCD. Likewise, the number and frequency of obsessive and compulsive symptoms did not differ between OCD with and without BPD comorbidity.
Thus, the clinical characteristics of each disorder run true and are analogs to their clinical presentation in youth without reciprocal comorbidity, Joshi et al comment.
Notably though, there was an increased prevalence of multiple anxiety disorders and selective increase in frequency of obsession and compulsion of hoarding/saving when bipolar disorder and OCD were comorbid than as single disorders.
Joshi et al comment: “Whether hoarding/saving could emerge as a symptom marker for BPD comorbidity in youth with OCD requires further investigation in larger populations.”
They add: “Future studies examining the patterns of familial aggregation of OCD and BPD, along with longitudinal studies addressing the impact of comorbidity on the clinical presentation, course, and response to treatment, would assist in further defining this comorbid condition.”
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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