Discuss Bipolar
Blog to discuss being Bipolar
Bipolar disorder patients experiencing an episode of depression are more likely to switch into manic, mixed, or hypomanic states before recovery if they have a history of substance or alcohol use disorder, research shows.
However, the time to recovery from a new-onset major depressive episode did not differ significantly between users and non-users.
Michael Ostacher (Massachusetts General Hospital, Boston, USA) and colleagues comment in the American Journal of Psychiatry: “Drug and alcohol use is perceived to be a modifiable risk factor for poor outcome, so it is understandable that clinicians might focus on changing drug and alcohol use in an effort to improve treatment outcome.
“What these data suggest, however, is that alcohol and drug history, past or present, may not be a reliable indicator of outcome for recovery from major depressive episodes in bipolar disorder, and that a singular focus on substance use might be less useful, perhaps, than aggressive treatment of anxiety.”
The researchers prospectively followed-up 3750 patients with bipolar disorder who were enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).
After 2 years, 2154 patients had developed a new-onset major depressive episode, of whom 457 switched to a manic, hypomanic, or mixed episode prior to recovery.
Of the 2154 patients with a new depressive episode, 693 (32.2%) had a past alcohol use disorder and 254 (11.8%) had a current alcohol use disorder, while (21.7%) had a past drug use disorder and 158 (7.3%) had a current drug use disorder.
Time to recovery from a depressive episode varied between 182 and 224 days but did not differ significantly between patients with a history of substance or alcohol use disorder and patients with no history of comorbidity.
However, those with current or past substance use or alcohol disorder were more likely to switch from depression directly to a manic, hypomanic, or mixed state than those with no history of comorbidity.
“Our results further suggest that patients with bipolar disorder and lifetime substance use disorder comorbidity ??” whether current or in the past ??” have inherent characteristics that may differentiate them from those without substance use disorder,” say Ostacher and colleagues.
Nevertheless, they caution: “Treatment for bipolar depression should not be withheld from patients with co-occurring alcohol or drug use disorders, especially given that the prognosis for an episode of bipolar depression is no worse than for those with bipolar depression and no alcohol or drug use disorder.”
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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Young men who report an unstable pattern of alcohol consumption including binge drinking have an elevated risk for experiencing hypomania, study results show.
Notably, the effect was independent of total alcohol consumption and the presence of clinical alcohol use disorders.
“This fits with the idea that instability in different biological and behavioral systems is a core feature of risk for hypomania and finally risk for bipolar disorders,” say study authors Thomas Meyer (Newcastle University, UK) and Larissa Wolkenstein (University of Tübingen, Germany) in the journal Comprehensive Psychiatry.
Recent studies have suggested that vulnerability to hypomania is related to instability in certain psychologic processes.
For example, individuals at risk for hypomania do not generally sleep less than others, but report a much more unstable sleeping pattern. Similarly fluctuations in self-esteem are much more characteristic of vulnerability to hypomania than are consistently low or high levels of self-esteem.
In the current study, the researchers assessed whether alcohol use might show a similar relationship to hypomania. They recruited 120 male students who completed the Hypomanic Personality Scale and were independently interviewed with the FORM 90 to assess alcohol consumption.
The latter comprised an interview about a typical weekly drinking pattern and a calendar to assess drinking behavior over the last 90 days, noting special days with unusual drinking behavior.
The researchers found that intra-individual fluctuations in alcohol consumption predicted hypomania after accounting for clinical diagnoses of abuse or dependency.
In addition, vulnerability for hypomania was significantly associated with mean standard ethanol content per drinking day.
Discussing their findings, the researchers note a recent theory that bipolar disorder is related to a hypersensitivity to reward-related cues, which is due to a dysregulation of the behavioral activation system.
“To extend this work further, it would be reasonable to look more closely at the motivational and affective processes associated with drinking alcohol and bipolar disorder and how mood and drinking are related,” Meyer and Wolkenstein comment.
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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Current guidance on monitoring the physical health of people with serious mental illness is not supported by any evidence from randomized controlled trials, indicates a review in The Cochrane Collaboration.
“It is possible clinicians are expending much effort, time, and financial expenditure on monitoring the physical health of people with serious mental illnesses, which is unnecessary, intrusive, and costly,” says the group, led by Graeme Tosh, from East Midlands Workforce Deanery in Nottingham, UK.
“Clinicians should, therefore, take a much more critical view of current guidance and attempt to initiate or get involved with any studies which could provide an evidence-base for this practice.”
Increasing focus on physical health problems in people with serious mental illness has led to a number of different guidelines (eg, National Institute of Clinical Evidence and The Maudsley Prescribing Guidelines) advising clinicians to monitor the physical health of their patients to prevent deterioration of physical health and maintain quality of life.
Tosh and team set out to review the medical literature to determine the effectiveness of physical health monitoring.
Their selection criteria consisted of all randomized clinical trials comparing physical health monitoring with standard care, or those comparing self-monitoring with monitoring by a healthcare professional; simple versus complex monitoring; specific versus non-specific checks; once only versus regular checks; or comparison of different guidance.
The reviewers failed to find any randomized trials which assessed the effectiveness of physical health monitoring in people with serious mental health problems.
They therefore conclude that “guidance and practice are based on expert consensus, clinical experience, and good intentions rather than high quality evidence.”
Tosh and colleagues acknowledge that the lack of evidence does not necessarily mean that health monitoring has no effect on the physical health of people with severe mental illness.
But they remark that “history is littered with treatments and policies, which ‘seemed like a good idea at the time’ but which, with the benefit of hindsight, were, at best, ineffective and, at worst, resulted in harm.”
As it is possible to evaluate the effects of physical health monitoring in people with mental illness, they argue that, as part of a duty of care, “what could be known, should be shown.”
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