Discuss Bipolar
Blog to discuss being Bipolar
Around a quarter of patients with fibromyalgia also suffer from bipolar disorder, results from a US study suggest.
Writing in the journal Bipolar Disorders, William Wilke, from the Cleveland Clinic Orthopedic and Rheumatologic Institute in Ohio, and team explain that the prevalence of lifetime depression in patients with fibromyalgia is known to be particularly high, at around 90%, compared with 17% in the general population.
They add that bipolar disorder is known to affect around 1.5% of the general population, but less is known about the prevalence of the condition in fibromyalgia patients.
To investigate, the team studied 128 fibromyalgia patients referred to the Cleveland Clinic between January and June 2005.
All patients were assessed using the Mood Disorder Questionnaire (MDQ) for bipolar disorder, the Beck Depression Inventory (BDI), the Epworth Sleepiness Scale (ESS) for daytime sleepiness, and the Fibromyalgia Impact Questionnaire Disability Index (FIQ-DI).
The researchers found that 25.2% of fibromyalgia patients screened positive for bipolar disorder, with a score of 7 or higher on the MDQ.
Furthermore, 78.1% had clinical depression, as indicated by a BDI score of 10 or higher, and 52.1% reported daytime sleepiness, as indicated by a score of at least 10 on the ESS.
Among the patients with symptomatic depression, nearly one third (32.0%) screened positive for bipolar disorder.
Fibromyalgia patients who screened positive for bipolar disorder were significantly more depressed than those with a negative screen, with scores on the BDI of 26.0 versus 15.0.
Wilke and team conclude: “The most important finding of our study pertains to the high prevalence of a positive screen for bipolar disorder in patients with fibromyalgia. With the exception of more severe depression, no other clinical clues were present to help identify patients with fibromyalgia and bipolar disorder.”
They add: “We urge that bipolar disorder risk be carefully assessed in all patients with fibromyalgia prior to initiation of drug therapy, particularly since norepinephrine serotonin reuptake inhibitors may carry elevated risk for induction of mania.”
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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Study results show that amygdala activation during motor response inhibition decreases between mania and remission in patients with bipolar disorder (BD).
Arthur Kaladijan (Universite de la Mediterranee, Marselle, France) and co-authors say that the study findings “place emphasis on amygdala responsiveness as one critical determinant of mood regulation in BD,” and suggest that psychotropic medications should reduce amygdala responsiveness in order to treat manic symptoms effectively.
For the study, the researchers used a longitudinal design to examine the functional changes associated with symptomatic remission from mania the brain network underlying motor response inhibition.
In total, 10 BD patients and 10 healthy controls were imaged twice, first during a manic state and then during full remission, using event-related functional magnetic resonance imaging (MRI) while performing a Go/NoGo task.
The researchers found that the left amygdala was the only brain region that showed a time-dependent change in activation, which was significantly different between BD patients and healthy individuals.
Further analysis showed that BD patients had a lower activation while in full remission than in a manic state, whereas no difference was seen in between both time points in healthy individuals. Additionally, BD patients showed a reduced activation at the left amygdala during remission compared with healthy individuals.
“This indicates that a decrease of the left amygdala activation over time distinguishes the BD group from the [healthy control] group,” write the researchers in the journal Bipolar Disorders.
Kaladijan and team say that clear explanation cannot be provided for why the mood-related change in amygdala activation was observed in only the left hemisphere. They do note, however, that the left and right amygdale have been shown to play different roles in emotional processing.
“Thus, a brain dysregulation that involves the amygdala may lead to different clinical expression according to which side of this structure is affected,” comment the authors.
The researchers also say that the decrease in amygdala activation associated with remission is unlikely to reflect the direct effect of drug administration, since no changes in regimen occurred during the study.
“Further longitudinal studies comparing drug responders to nonresponders are needed to confirm this hypothesis,” they say.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
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The benefits of marriage appear to be greater for women with bipolar disorder than for men with the disorder, US researchers report.
They note, however, that the extra benefit in women was limited to a reduction in depressive symptoms.
“Mental illnesses in general are responsive to varying levels of social support, and women appear to react more strongly to these variations than men do,” say Daniel Lieberman and colleagues from George Washington University School of Medicine and Health Sciences.
“The interpersonal and social rhythm therapy literature also suggest that women may benefit more from the increased lifestyle regularity that can be seen in stable marriages.”
The researchers used the National Institute of Mental Health Life Chart Methodology to collect data on episodes of depression, mania, and mixed states from the previous 2 years for 282 individuals (71 men and 211 women) with bipolar disorder.
In all, 28 (39%) of the men and 112 (53%) of the women were married, indicating that women with bipolar disorder were significantly more likely to be married than men with the condition. The remaining study participants had never been married.
Married women had fewer episodes of depression during the past 2 years than never-married women, at 6.1% versus 7.3%, and the cumulative severity of depression was lower, with average depression scores of 11.7 versus 14.5.
Married and unmarried women with bipolar disorder did not differ with regard to diagnostic subtype or age of onset, however.
By contrast, among men, bipolar I disorder was more common among those who had never been married (n=22 versus 9), and unmarried men had an earlier age at onset of bipolar disorder than their married peers (13.6 versus 20.2 years).
But there was no difference between married and unmarried men with bipolar disorders in terms of frequency, duration, or severity of mood episodes.
The researchers suggest in the journal Comprehensive Psychiatry that the gender differences in their study may be the “result of potential male spouses placing less weight on bipolar disorder as a selection factor or the illness manifesting itself differently in men and women.”
They conclude: “The finding that women with bipolar disorder may be more sensitive to the benefits of being married than men may be helpful in understanding bipolar disorder in men and women and in developing effective 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
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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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Bipolar disorder patients treated with lithium appear to have a reduced rate of dementia compared with patients who receive anticonvulsants, antidepressants, or antipsychotics, the results of a Danish study indicate.
It has been suggested that patients with bipolar disorder have an increased risk for dementia that increases with each affective episode. While it also seems that lithium may have neuroprotective effects, the results have so far been conflicting.
To investigate further, Lars Kessing, from the University Hospital of Copenhagen, and colleagues studied 4856 patients discharged from psychiatric healthcare services with a diagnosis of mania or bipolar disorder between 1995 and 2005, of whom 216 (4.5%) were diagnosed with dementia.
In all, 50.4% patients were exposed to lithium, 36.7% were exposed to anticonvulsants, 88.1% to antidepressants, and 80.3% to antipsychotics. Only 0.7% of patients were exposed to lithium alone.
Adjusting for age, gender, calendar period, and purchasing of and exposure to the other drugs, two or more prescriptions of lithium was associated with a significant decrease in the rate of dementia, at rate ratios for 2??”4, 5??”9, 10??”19, and ?20 prescriptions of 0.46, 0.38, 0.39, and 0.44, respectively, compared with one prescription for lithium.
In contrast, no associations between number of prescriptions and the rate of dementia were found for the other drugs groups studied, the researchers note in the journal Bipolar Disorders.
They say: “Among patients with mania or bipolar disorder, continued use of lithium was associated with a decreased rate of dementia.”
However, the team adds: “Methodologic reasons for these findings cannot be excluded due to the nonrandomized nature of the data.”
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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The pathological process of bipolar disorder and schizophrenia may be due, in part, to oxidative damage, say Canadian researchers in findings that may point to novel treatment approaches.
There is increasing evidence to suggest that mitochondrial dysfunction is present in the brains of bipolar disorder patients. Furthermore, the mitochondrial electron transport chain is a major source of reactive oxygen species, which cause oxidative stress.
To examine associations between bipolar disorder and oxidative stress, Jun-Feng Wang and colleagues from the University of British Columbia in Vancouver studied postmortem anterior cingulate brain sections from 15 bipolar disorder patients, 15 major depressive disorder (MDD), patients, 15 schizophrenia patients, and 15 controls matched for age, gender, postmortem interval (PMI), pH, and messenger RNA quality.
As a surrogate for oxidative stress, levels of 4-hydroxynonenal (4-HNE), which s a major product of lipid peroxidation, were determined via immunohistochemical analysis of 4-HNE protein adducts.
Compared with controls, 4-HNE levels were significantly increased in bipolar disorder and schizophrenia patients by 59% and 47%, respectively. Although levels were 33% higher in MDD patients than in controls, the difference was not significant.
Studying medication-free patients only, the team found that 4-HNE levels were increased significantly compared with controls in both bipolar disorder and schizophrenia patients, at 94% and 72%, respectively, with no change recorded in MDD patients.
Four-HNE levels were unaffected by age, gender, and PMI. In all brain samples, 4-HNE levels were negatively correlated with pH, the team says in the journal Bipolar Disorders.
However, 4-HNE levels were still significantly increased in bipolar disorder patients and there was a trend for an increase in schizophrenia patients when pH was used as a covariate. In addition, 4-HNE levels were negatively correlated with pH only in bipolar disorder patients.
“Oxidative damage in the brain may contribute to the pathological process of bipolar disorder and schizophrenia, and anti-oxidative stress may well serve as an alternative approach to pharmacological treatment of these psychiatric disorders, the researchers conclude.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
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