Discuss Bipolar
Blog to discuss being Bipolar
One quarter of patients with bipolar I disorder presenting with a first episode of psychotic mania have suffered sexual and/or physical abuse (SPA) in childhood and adolescence, a study shows.
Moreover, exposed individuals appear to have lower premorbid functional levels and are less likely to engage in treatment than other bipolar I disorder patients, the study team reports.
Philippe Conus, from University of Lausanne in Switzerland, and co-workers stress that “clinicians should therefore imperatively explore this issue [history of SPA] when treating such patients.”
The team assessed the prevalence and correlates of SPA in 118 patients who were admitted to the Early Psychosis Prevention and Intervention Centre for a first psychotic episode between 1998 and 2000 and received a final diagnosis of bipolar I disorder.
In all, 80.0% of patients had been exposed to stressful life events during childhood and adolescence, with 24.9% exposed to SPA specifically. In all cases, the stressful life event had occurred before the onset of psychosis.
The researchers note that women were significantly more likely to have been exposed to SPA than men, at 36.2% (29.8% sexual abuse and 19.1% physical abuse) versus 16.9% (5.6% sexual abuse and 14.1% physical abuse).
They add, however, that, “despite the magnitude of this difference in prevalence according to gender, clinicians should be aware that this issue should not be ignored in male patients with bipolar I disorder, since rates of 14% for physical abuse and 6% for sexual abuse are far from negligible.”
Bipolar I disorder patients who had been exposed to SPA had poorer premorbid functioning than patients not exposed, with significantly reduced mean Global Assessment of Functioning scores (76.4 versus 67.6) and significantly increased Premorbid Adjustment Scale scores (2.7 versus 1.9).
Exposure to SPA also increased a patient’s likelihood of not complying with treatment, at an average rate of 59.3% compared with 52.4% for patients not exposed to SPA.
Conus et al suggest in the journal Bipolar Disorders that delays in treating patients with bipolar I disorder could make them vulnerable to SPA during phases where they display high-risk behavior.
“If confirmed, this would be a strong argument to pursue the effort to develop early-intervention strategies in bipolar I disorder,” they say.
The team also calls for the development of well-adapted psychologic interventions to help bipolar I disorder patients exposed to SPA deal with their issues.
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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