Discuss Bipolar
Blog to discuss being Bipolar
A novel mania rating scales allows non-professionals in regular contact with a patient to diagnose a manic/mixed episode, say researchers who suggest the scale will complement current rating scales.
The risk for misdiagnosing a manic patient with schizophrenia is high, and can have important consequences for acute and long-term treatment. Misdiagnosis is partly due the clinician’s diagnostic window being small and often encompassing only a cross-sectional impression.
To harness the experience of relatives and other people close to the patient, Stephanie Krüger, from Universitätsmedizin in Berlin, Germany, and colleagues developed the 49-item Observer-Rated Scale for Mania (ORSM). The scale covers the domains of euphoric/dysphoric mood, disinhibition, affective lability, motor symptoms, cognitive function, psychotic symptoms, disturbance of biorhythm, and insight.
The scale was applied to 113 inpatients, all of whom had one significant person who was in regular contact with the patient including the 2 weeks prior to admission. The results were compared with a range of current rating scales.
In all, 28% of the patients fulfilled the DSM-IV criteria for a manic episode, 21% were diagnosed with schizophrenia, 36% with depression, and 15% with anxiety disorders. The average duration of illness for manic patients was 14.2 years, and the average number of depressive episodes was 12.
The ORSM was found to have high test??”retest reliability and be highly homogenous, and each item was found to contribute independently to the total score. The OSRM was, as expected, found to have significant negative correlations with the Hamilton Depression Scale and the Beck Depression Inventory, but a high positive correlation with the Young Mania Rating Scale and a previously developed self-rating scale for mania.
On the ORSM, the average score at 2 days after admission was 34.4 for manic patients, compared with 2.1 for nonmanic patients. Three weeks after admission, the average scores on the ORSM were 30.1 and 5.6, respectively. At a cut-off score of 16, 94% of manic patients were correctly identified.
It was also shown that a four-factor model for the scale accounted for 75.1% of the variance in scores, with the fourth item, composed of two items, accounting for
<5% of the variance. A three factor solution, comprising euphoric mania, instable mania, and psychotic mania, was accepted as the most suitable.
“The ORSM is the first mania rating scale developed to obtain information by lay observers,” the team writes in the Journal of Affective Disorders.
“It was designed to facilitate communication between physicians and families in situations where an accurate account of signs of mania is required.”
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
Patients with bipolar disorder show
enlarged pituitary gland volume relative to mentally healthy
controls, results from a magnetic resonance imaging study (MRI)
show.
However, the first-degree relatives of these patients showed no
such enlargement, arguing against an overt genetic component of
pituitary volume.
“Abnormalities of the hypothalamic-pituitary-adrenal (HPA) axis,
the primary biological system mediating the stress response, are
thought to reflect stress-related dysregulation and have been
described in patients with bipolar disorder,” Tsutomu Takahashi
(Melbourne Neuropsychiatry Centre, Victoria, Australia) and
colleagues comment in the Journal of Affective
Disorders.
Imaging studies of pituitary volume in bipolar disorder patients
have so far been inconsistent, perhaps owing to illness
heterogeneity and different sample characteristics such as
psychosis, symptom severity, illness stage, and treatment
status.
In the current study, the researchers used MRI to assess
pituitary volume in 29 remitted patients with chronic bipolar
disorder, 49 of their first-degree relatives (of whom 15 had a
diagnosis of major depressive disorder [MDD] ), and 52 age- and
gender-matched mentally healthy controls.
Bipolar disorder patients had a significantly larger pituitary
volume than their relatives and controls, but there was no
difference between the bipolar disorder relatives and controls.
Also, pituitary volume did not differ between the MDD relatives,
non-MDD relatives, and control individuals.
Bipolar disorder patients treated with lithium (n=12) tended to
have smaller pituitary volumes compared to those not on lithium,
but this did not reach statistical significance.
“It may be possible that trait-related HPA axis dysregulation
precedes the illness onset but development of clinical phenotype of
bipolar disorder and pituitary volume changes depends on additional
environmental (eg, life events, stress) and other factors,” the
researchers comment.
They say that additional assessment of both pituitary volume and
hormonal levels, for example cortisol and corticotropin, at various
illness stages would be required to further examine the role of HPA
axis dysfunction in the pathophysiology of bipolar 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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Exaggerated response to emotional signals
in cortico-limbic brain regions may represent heritable functional
abnormalities underlying the development of bipolar disorder,
neuroimaging study findings indicate.
Functional neuroimaging studies have shown overactivity in the
anterior limbic structures of the brain in patients with bipolar
disorder in response to fearful and happy facial expressions.
But “it is unclear whether such abnormalities are associated
with the illness state, or represent stable or heritable traits,”
note Simon Surguladze, from King’s College London, UK, and
colleagues.
To investigate, they carried out functional magnetic resonance
imaging experiments of facial emotion processing in 20 patients
with bipolar I disorder, 20 of their unaffected first degree
relatives, and 20 mentally healthy volunteers.
In one experiment, the participants watched faces expressing
fear of varying intensities (moderate and high) intermixed with
non-emotional faces, and in the second experiment, they watched
faces expressing moderate or high degrees of happiness intermixed
with non-emotional faces.
The brain data were then entered into 2 (fear and happy) x 3
(neutral, moderate, and high) x 3 (patients, relatives, and
controls) repeated measures ANOVA.
This showed that brain activity differed significantly among the
groups in two main areas: the prefrontal cortex and the left
putamen.
Activity in the medial prefrontal cortex was greater in patients
and relatives, compared with controls, in response to moderate and
intensive expressions of either fear or happiness. There was no
difference in their response to neutral faces.
Moreover, the group differences were paralleled by a familiality
effect, whereby a significant proportion of activation in the
medial prefrontal cortex was accounted for by the activation in
individuals belonging to the same families.
Activity in the putamen was greater in patients and relatives in
response to moderate fear, compared with controls, while patients,
but not relatives, also showed greater activity than controls in
response to high intensity happy faces.
Thus, “relatives did not demonstrate as universally hyperactive
a striatum as bipolar patients,” say Surguladze and team in the
journal NeuroImage.
The study findings also confirmed increased amygdala activity in
patients and relatives, compared with controls, in response to
intensively happy faces.
“Our study indicates that overactivation of medial prefrontal
cortex and subcortical structures in response to facial emotion
processing tasks may represent a neurobiological abnormality
associated with genotypic variation conferring susceptibility for
bipolar disorder, and provides a possible neurobiological substrate
for further studies combining genetics and neuroimaging in the
search for the effects of such genotypic variation,” the team
concludes.
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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