Discuss Bipolar
Blog to discuss being Bipolar
Results from a Spanish study suggest that postpartum mood episodes (PMEs) do not influence disease course and prognosis in women with bipolar disorder (BD).
“Postpartum mood symptoms show well-defined clinical features and appear to be mainly influenced by genetic predisposition and family-related factors and not as much by psychosocial factors,” explain Eduard Vieta (University Clinic Hospital of Barcelona, Spain) and team.
“However, [their] influence on the outcome of BD remains unclear, as there is little data showing differences on illness outcome according to the lifetime history of postpartum onset.”
To address this, the researchers assessed data on 200 women with BD who were enrolled in the Bipolar Disorders Program at the University Clinic Hospital of Barcelona for at least 10 years.
In total, 43 women had a history of PMEs, defined as the occurrence of a mood episode within 4 weeks postpartum, and 137 did not. The remaining 20 women were excluded from the study due to lack of agreement between the two independent psychiatrists as to their history of mood episodes.
The researchers found that there were no significant differences between women with and without a history of PMEs regarding clinical features, such as rapid cycling (18.6 vs 20.9%), Axis I comorbidity (26.2 vs 24.6%), and Axis II comorbidity (30.2 vs 31.8%).
The proportion of patients with a family history of psychiatric disorders and affective disorder was also similar between the groups, at 72.1% and 75.8%, and 65.1% and 62.9%, respectively.
Furthermore, both groups were similar in terms of occupational status, mood episode frequency, and functionality.
The only significant difference found between women with and without a history of PMEs was duration of bipolar illness, with PME patients showing a longer duration of the illness, at 20.16 versus 15.02 years in non-PME patients.
Vieta and team conclude in the Journal of Affective Disorders: “Course and prognosis of bipolar disorder with and without PME hardly differ.”
They add: “This result may suggest reconsideration of PME as a proper course modifier.”
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
- 1A binding reductions in euthymic bipolar disorder patients]]>
- FDA Advisory Committee Votes In Favor Of SAPHRIS(R) (asenapine) For Acute Bipolar I Disorder And Acute Schizophrenia
- MTHFR gene not linked to bipolar disorder]]>
- New Certified Reference Materials Offer Greater Certainty In Monitoring 3 Therapeutic Medications
Results from a Korean study show that Asian patients with bipolar disorder are at increased risk for the metabolic syndrome.
“In recent years, metabolic syndrome has emerged as an important concern in both psychiatry and public health, as it constitutes a major risk factor for cardiovascular disease and diabetes in both Western and Asian countries,” explain Yong Min Ahn (Seoul National University College of Medicine) and team.
However, they add that “despite growing concerns about the comorbidity of metabolic syndrome and bipolar disorder, few studies have been conducted on this topic in Asian populations.”
To investigate further, the researchers studied 152 patients with bipolar disorder, aged 18 to 65 years, who received treatment with antipsychotics or mood stabilizers at Seoul National University Hospital between 2007 and 2008. A control group of 152 individuals without the mood disorder who were matched for socioeconomic status, age, and gender were also included in the study.
All of the participants were assessed for the metabolic syndrome using criteria from the American Heart Association and the National Heart, Lung, and Blood Institute’s adaptation of the Adult Treatment Panel III (AHA), the National Cholesterol Education Program for Adult Treatment Panel III (ATPIII), and the International Diabetes Federation (IDF).
The researchers also used the Fourth Korean National Health and Nutrition Examination Survey (KNHNES, 2007) to calculate the indirectly standardized prevalence ratio (ISPR) for the metabolic syndrome in the Korean population.
The researchers found that the prevalence of the metabolic syndrome among the bipolar patients was 27.0%, 25.0% and 25.7% using the AHA, ATPIII, and IDF criteria, respectively.
The respective prevalence rates were significantly lower among the control group, at 13.2%, 11.8%, and 11.8%.
Overall, the risk for the metabolic syndrome was significantly greater among bipolar patients than controls, at odds ratios of 2.44, 2.48, and 2.57 based on AHA, ATPIII, and IDF criteria, respectively.
The researchers note the ISPR for the metabolic syndrome in the Korean population based on these criteria was 1.48, 1.54, and 1.98, respectively.
“These results indicate that, regardless of how metabolic syndrome is defined, its prevalence in patients with bipolar disorder is higher than in both the control group… and the general Korean population,” conclude Ahn and team.
They add: “This study is the first report of the prevalence of metabolic syndrome in Korean patients with medication for bipolar disorder and can provide a reference point for comparisons with other studies, especially on Asian populations.”
The research is published in the journal Progress in Neuro-Psychopharmacology and Biological Psychiatry.
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
Results from a Norwegian study suggest that, overall, individuals with bipolar disorder (BD) have lower socio-economic status than the general population, despite having similar education levels.
Writing in the Journal of Affective Disorders, Helle Schoeyen (Stavanger University Hospital) and team explain: “In the general population, there is a strong correlation between degree of education and social and occupational function in later life.”
But they add that “the relationship between length of education and social and occupational function has, to the best of our knowledge, not previously been investigated in BD.”
To address this, the researchers studied 257 patients with BD (51.4% women), aged at least 18 years, from the Norwegian Bipolar Research and Innovation Network. Of these, 69.3% had BD I, 25.7% BD II, and 5.1% had BD not otherwise specified.
Education, marital status, income, and disability levels were compared between the BD patients and a reference sample of 56,540 individuals from the general population who were matched for geographic area, age, and gender.
The researchers found that mean length of education was the same in the BD patients and the population sample, at 12.6 years. However, 31.9% of BD patients had completed some college education compared with just 26.9% of the general population sample.
Despite this, 35.0% of BD patients had an income below the 10% percentile, compared with just 9.9% of individuals from the general population sample. Furthermore, mean annual household income was NOK 259,640 (€32,754, US $43,662) in the BD patients, compared with NOK 572,820 (€72,265, US $96,319) in the general population sample.
The researchers also found that BD patients were more likely to be single and receiving a disability pension than individuals in the general population sample, at 66.0% versus 39.4%, and 47.9% versus 11.5%, respectively.
Schoeyen and team conclude: “The main finding of this study was that BD patients had the same level of education but significantly lower social and occupational function than the general population.”
They add: “The present findings suggest that early identification and adequate follow-up treatment of BD throughout the life span could prevent a decline in social and occupational function.”
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
- Blocked Enzyme Reverses Schizophrenia-like Symptoms - MIT Study Of Mice Could Lead To Drug Treatments For The Brain Disorder
- Buy Paxil Online
- Lack Of Grey Matter In Brain Is Linked To Schizophrenia And Bipolar Disorder
A family-focused intervention significantly reduces depression levels and health risk behaviors in caregivers of patients with bipolar disorder, US research shows.
The researchers also found that depression levels decreased in bipolar patients after their caregivers completed the family-focused intervention program.
Deborah Perlick (Mount Sinai School of Medicine, New York) and colleagues studied 43 primary caregivers of patients with bipolar I or II disorder who were assigned to the Family-Focused Treatment-Health Promoting Intervention (FFT-HPI) or to health education (HE) delivered via videotapes.
The FFT-HPI involved 12-15 sessions of family-focused, cognitive behavioral therapy designed to provide the caregiver with the skills for managing their relative’s illness, attaining self-care goals, and reducing strain, depression, and health risk behavior.
Caregivers were assessed before and after the interventions for depression symptoms, health behaviors, and coping using the Quick Inventory of Depressive Symptomatology (QIDS), the Health Risk Behavior Scale (HRB), and the Ways of Coping Questionnaire (WCQ). The caregivers’ relatives with bipolar disorder were also assessed for depression and mania symptoms before and after the interventions using the Hamilton Rating Scale for Depression (HAM-D), and the Young Mania Rating Scale (YMRS), respectively.
The researchers found that among caregivers assigned to FFT-HPI (n=24), mean QIDS and HRB scores fell from a respective 8.2 and 4.7 at baseline to 4.6 and 2.0 after the intervention - a significant improvement.
Caregivers assigned to HE showed significantly less improvement in QIDS and HRB scores, from a respective 9.0 and 3.8 at baseline to 8.5 and 3.7 after the intervention.
The bipolar relatives of caregivers assigned to FFT-HPI also showed greater improvements in HAM-D and YMRS scores, from a respective 15.2 and 8.1 at baseline to 5.6 and 1.6 after the intervention, compared with bipolar relatives of caregivers assigned to HE, whose scores fell from a respective 14.5 and 9.3 at baseline to 11.2 and 5.8 after the intervention.
Caregivers assigned to FFT-HPI also had greater reductions in subjective burden associated with the patients’ symptoms than those assigned to HE.
The researchers note that reductions in caregivers’ depression symptoms were partially mediated by reductions in their levels of avoidance coping, while reductions in patients’ depression levels were partially mediated by reductions in caregivers’ depression levels.
Perlick and team conclude in the journal Bipolar Disorders: “Caregivers treated with a psychoeducational and cognitive-behavioral approach in the FFT-HPI condition experienced a significant reduction in depressive symptoms and improvement in health behaviors relative to caregivers who received education alone.”
They add: “FFT-HPI offers a viable alternative for treating patients with bipolar disorder when concerned family members are available for treatment but the patient is not.”
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
Bipolarity features are significantly associated with treatment resistance in patients diagnosed with unipolar depression, research shows.
Writing in the Journal of Affective Disorders, Dominika Dudek (Jagiellonian University, Poland) and team explain that “an undiagnosed and therefore inadequately treated bipolarity may be an important cause of drug resistance in depression diagnosed as unipolar.”
To investigate, the team studied 1051 patients (752 women), aged an average of 46 years, from 150 outpatient psychiatric clinics in Poland who were diagnosed with single or recurrent major depressive episodes, based on DSM-IV criteria.
Of the patients, 569 had treatment-resistant (TR) depression, defined as failure to achieve remission after a minimum of two courses of antidepressant treatment, and 482 responded to treatment (non-treatment-resistant depression [NTR]).
All of the participants were interviewed to assess demographic and clinical characteristics, and bipolarity symptoms were assessed using the Mood Disorder Questionnaire (MDQ) and the 32-item Hypomania Checklist (HCL-32).
The researchers found that significantly more TR patients tested positive for bipolarity on the HCL-32 than did NTR patients, at 43.9% versus 30.1%. Total mean HCL-32 score was also significantly higher in TR than NTR patients, at 11.9 versus 8.5.
Furthermore, significantly more TR than NTR patients had bipolarity features detected by the MDQ, at 13.6% versus 5.6%, and total mean MDQ score was also significantly higher in TR patients, at 4.3 versus 2.7 in NTR patients.
Multiple logistic regression analysis revealed that independent risk factors for treatment resistance included a score of 14 or higher on the HCL-32 scale, at an odds ratio (OR) of 1.61, and a score of 6 or higher on the MDQ, at an OR of 1.1.
Other risk factors included age at first onset of 20 years or younger (OR=2.30), more than three previous depressive episodes (OR=1.52), and lack of remission (OR=22.07) or partial remission (OR=10.4) after the previous depressive episode.
Dudek and team conclude: “Bipolarity features as assessed by MDQ and HCL-32 were identified as significant factors of treatment resistance. Some other clinical variables connected with treatment resistance may also be associated with bipolarity features.”
They add: “We believe that the results of our study may add to other ones showing bipolarity as [a] risk factor of treatment resistance.”
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
- DISC1 gene variants show mixed associations with psychiatric illness]]>
- Long-Term Tolerability And Safety Data Of Abilify(R) In Combination Treatment For Patients With Bipolar I Disorder
The unaffected siblings of patients with bipolar disorder show deficits in executive functions and memory relative to mentally healthy individuals without a family history of the condition, researchers have found.
“These deficits are consistent with the proposed neurobiological model of bipolar disorder involving the frontotemporal and subcortical circuits,” and suggest potential endophenotypes for genetic studies, say YC Janardhan Reddy (National Institute of Mental Health and Neurosciences, Bangalore, India) and team.
Reddy and team compared neuropsychological performance between 30 unaffected siblings of BD patients and 30 mentally healthy controls without such a family history who were matched for age, gender, and education level.
All of the participants, who were aged between 18 and 45 years, underwent a battery of tests to assess attention, executive functions, and memory.
The researchers found no significant differences between the groups on tests of attention.
However, with regard to executive functions, unaffected siblings performed significantly worse than controls on the total number of moves item of the Tower of London test, which assesses planning ability, with scores of 80.43 versus 63.63.
Unaffected siblings also performed significantly worse than controls on Rey’s auditory verbal learning test, with total learning scores of 53.70 versus 61.60.
In addition, unaffected siblings had poorer performances than controls on two items of Rey’s Complex Figure Test, which assesses recall, but the differences did not reach significance.
Reddy and team conclude in the journal Bipolar Disorders: “Our study of the unaffected siblings of bipolar disorder probands suggests that impairments in verbal learning and memory and planning are potential endophenotype markers for bipolar disorder.”
They add: “Studies involving larger sample sizes of unaffected relatives may help identify the cognitive endophenotypes that are robust.”
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
- Buy Paxil Online
- Faulty Body Clock May Make Kids Bipolar
- Depressive, social anxiety symptoms severe among anxiety disordered patients
- Lack Of Grey Matter In Brain Is Linked To Schizophrenia And Bipolar Disorder
- Mental Illness Was One Of The Costliest Conditions Between 1996 To 2006
Results from a US study support the existence of a bipolar disorder (BD) prodrome that is similar to the schizophrenia prodrome.
“There is an increased interest in early intervention strategies for severe mental disorders with hopes of mitigating the emergence and impact of the illness,” write Doreen Olvet (North Shore-Long Island Jewish Health System, Glen Oaks, New York) and team in the journal Schizophrenia Research.
They explain that “although BD and schizophrenia may have overlapping etiologies, few studies have investigated the potential prodrome in BD.”
To address this, the researchers studied baseline data on 147 patients, aged an average of 16 years, who were deemed to be at clinical high-risk (CHR) for schizophrenia.
Of these, 24 eventually developed schizophrenia or a psychotic disorder (pre-SZ), eight unexpectedly developed BD (pre-BD), and the remaining 115 did not develop either disorder (non-converters).
The researchers found that pre-SZ and pre-BD patients had significantly more severe attenuated positive symptoms at baseline than non-converters, with positive symptoms scores of 13.25 and 10.88 versus 7.25, respectively, on the Scale of Prodromal Symptoms (SOPS). The difference in positive symptom scores between pre-SZ and pre-BD patients was not significant.
Pre-SZ and pre-BD patients were also more likely to be taking antipsychotic medications at baseline than non-converters, at 58.3% and 50.0% versus 14.8%, respectively.
There were no significant differences between the pre-SZ and pre-BD patients regarding global measures of functioning or global neurocognitive scores.
Olvet and team conclude: “Results from this study support the notion that patients can be identified during the bipolar prodrome, and that at least some of its features may overlap clinically and neurocognitively with the schizophrenia prodrome.”
They add: “Overall, these data are preliminary, but they suggest that the [schizophrenia] CHR approach is feasible in bipolar disorder, and call for the need to develop prodromal measures specific for defining CHR for 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
Results from a brain imaging study suggest that young people with bipolar disorder (BD) have reduced corpus callosum volumes compared with their mentally healthy counterparts.
“Aberrant communication between specific regions of the cerebral hemispheres, particularly the prefrontal, parietal, and temporal lobes, may be important in the pathophysiology of several neuropsychiatric disorders including BD,” explain Melissa Lopez-Larson (University of Utah, Salt Lake City, USA) and team.
They add that although a number of studies have found corpus callosum abnormalities in adults with BD, corpus callosum volume in youth with the mental health disorder has not been assessed.
To investigate, the researchers studied 44 young people, aged 6-16 years, with DSM-IV BD and 22 mentally healthy age-matched controls. All of the participants underwent magnetic resonance imaging scans of the brain to analyze corpus callosum volumes.
The team found that participants with BD had significantly smaller anterior midbody and posterior body callosal regions compared with controls, at 1.45 versus 1.52 cm3, and 1.17 versus 1.38 cm3, respectively.
BD patients also had reduced age-related increases in total corpus callosum volume compared with controls.
Furthermore, comparing the findings with results from traditional cross-sectional area measurements showed similar differences in corpus callosum size between BD patients and controls.
Lopez-Larson and team conclude: “Consistent with emerging neurodevelopmental models of psychiatric disorders, this study documents corpus callosum volume and growth abnormalities in youth with BD.”
They add: “Further cross-sectional and longitudinal studies of the corpus callosum are clearly warranted to understand more fully how neurodevelopmental changes in this important brain structure are mediated by interactions with symptom type and severity, comorbidity, psychosocial factors (eg, stress), and medications.”
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
Results from a US study suggest that greater efforts are needed to encourage the continued use of weight counseling services among bipolar disorder (BD) patients.
“Cardiovascular disease is the leading cause of mortality in persons with BD,” comment Amy Kilbourne (VA Ann Arbor Health Services Research and Development Center of Excellence, Michigan), and team.
They explain that guidelines recommend weight counseling for patients with BD, with particular emphasis on the management of cardiometabolic risks associated with taking second generation antipsychotics (SGA).
But they add: “To date, little is known about the use or effectiveness of weight counseling among patients with BD.”
To investigate weight counselling uptake among BD patients, the team surveyed 298 patients with the mood disorder who were enrolled in the Continuous Improvement for Veterans in Care: Mood Disorders (CIVIC-MD) study between 2004 and 2006.
The researchers found that 73% of participants reported receiving some weight counseling over the previous year.
The use of weight counseling services was more likely among patients with a high body mass index (BMI) or those who were taking a SGA compared with patients with a normal BMI and those who were not prescribed a SGA, at odds ratios (ORs) of 1.12 and 1.80, respectively.
However, just 41% of patients who reported some weight counseling received two or more dietary consultations, with such consultations more likely among patients with illicit substance use and those taking a SGA, at ORs of 1.9 and 2.4, respectively.
Furthermore, just 24% of patients received two or more exercise consultations, with such consultations more likely among patients taking an SGA, at an OR of 2.13.
Illicit substance use, binge drinking, and ethnicity other than Black or White were associated with a reduced likelihood of exercise consultations.
Kilbourne and team conclude in the Journal of Affective Disorders: “The majority of [BD] patients received some weight counseling, with obesity and SGA predicting service use over time.”
However, they add that “low utilization patterns underscore the need for research into determinants of long-term counseling utilization to improve patient health outcomes.”
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
- DISC1 gene variants show mixed associations with psychiatric illness]]>
- Funding Supports ADA Technologies' Development Of Home Monitor For Bipolar Disorder
Elevated symptoms of mania (ESM) in children do not necessarily indicate the presence of a bipolar spectrum disorder (BPSD), say US researchers.
Indeed, Robert Findling (Case Western Reserve University, Cleveland, Ohio) and team found that three-quarters of children in their study with ESM did not meet criteria for a BPSD.
The team studied 707 children, aged 6-12 years, who attended one of 10 university-affiliated mental health centers between 2005 and 2008.
Parents and guardians were asked to complete the Parent General Behavior Inventory-10-Item Mania Scale (PGBI-10M).
In total, 621 children tested positive for ESM, defined as a score of 12 or higher on the PGBI-10M, while 86 tested negative for ESM.
All of the participants were assessed using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (K-SADS-PL) and the Children’s Global Assessment Scale.
The researchers found that children with ESM more frequently met DSM-IV criteria for a mood disorder, BPSDs, and disruptive behaviour disorders than those without ESM, at 43.0 versus 22.1%, 25.0 versus 8.1%, and 53.1 versus 31.0%, respectively.
Children with ESM also showed poorer overall functioning and more severe manic, depressive, attention-deficit/hyperactivity, disruptive behavioral, and anxiety symptoms than those without ESM.
The researchers note, however, that the proportion of children with ESM who had a BPSD was low, at 25%, with around half of such children meeting DSM-IV criteria for bipolar disorder not otherwise specified.
Findling and team conclude in the Journal of Clinical Psychiatry: “Although ESM may be commonly found in children and adolescents this does not necessarily indicate that BPSDs are common in youth. In fact, the children and adolescents in the ESM group were more likely to have attention-deficit hyperactivity disorder and/or disruptive behaviour disorder than a BPSD.”
They add: “Results suggest that longitudinal assessment of ESM is needed to examine which factors are associated with diagnostic evolution to a BPSD in patients with ESM and whether such evolution even occurs.”
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
- What Rorschach Tests Really Tell Us
- Mental Illness Was The Costliest Condition Between 1996 To 2006
- Bipolar Disorder - Eurand Announces FDA Approval Of EUR-1048 (Lamictal(R) ODT(TM)), Co-Developed With GlaxoSmithKline
- Schizophrenia-Linked Gene Controls The Birth Of New Neurons
- 1A binding reductions in euthymic bipolar disorder patients]]>