A distinct set of characteristics distinguishes bipolar II disorder (BDII) from bipolar I disorder (BDI), and can be adopted for differential diagnosis in clinical practice, say Korean researchers.

Writing in the Journal of Affective Disorders, Kyung Sue Hong (Samsung Medical Center, Seoul) and team explain that, according to the DSM-IV classification, “BDI and BDII are distinguished only by the presence of a manic or hypomanic episode.”

To investigate other characteristics that may distinguish BDII from BDI, the team conducted a comprehensive assessment of 71 patients diagnosed with the former and 34 with the latter condition using the Diagnostic Interview for Genetic Studies, Korean version.

Furthermore, 374 of the patients’ first-degree relatives underwent psychiatric assessment using the modified version of the Family History-Research Diagnostic Criteria.

The researchers found that BDII patients had a higher frequency of depressive episodes than BDI patients, at 4.0 versus 2.0 per year. Seasonality of symptoms and rapid-cycling were also more common in BDII than BDI patients, at 63.6% versus 41.4%, and 13.3% versus 2.8%, respectively.

Regarding expression of mania symptoms, “elated mood” was the predominant expression in BDII patients, while “elated mood” and “irritable mood” were equally dominant in BDI patients.

Regarding depressive symptoms, psychomotor agitation, feelings of guilt, and suicidal ideation were more common in BDII than BDI patients.

BDII patients also had a higher lifetime trend for axis I diagnoses (52.9% vs 35.2%) and a significantly higher incidence of phobias (20.6% vs 4.3%) and eating disorders (27.3% vs 8.7%).

Furthermore, psychiatric illnesses were more common in the first-degree relatives of BDII than BDI patients, at 26.5% versus 15.4%.

Sue Hong and team conclude: “Distinctive characteristics of BDII were identified in the current study and could be adopted to facilitate the differential diagnosis of BDI and BDII in ordinary clinical settings.”

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; 2011

Free abstract

• Yale Researchers Repair Brain Damage Caused By Chronic Stress Work Has Implications For Bipolar Disorder, PTSD
• Patients With Bipolar Disorder Have Higher Specialty Care Costs Than Patients With Diabetes And Other Chronic Diseases

Patients with bipolar disorder who experience frequent mood episodes show a greater level of life disruption than their peers with less frequent episodes, results of a large community study show.

The investigators also found that only about half of those with recent bipolar disorder report treatment for depression or mania/hypomania.

“It seems that efforts to encourage access to treatment and maintenance of treatment could do much to ameliorate the course of disorder,” say J Elisabeth Wells (University of Otago, Christchurch, New Zealand) and colleagues in the Journal of Affective Disorders.

A number of cross-sectional epidemiological studies have examined the prevalence of bipolar disorder ??” with estimates ranging from 0.5% for euphoric-grandiose bipolar I disorder to 5.5% for generally defined bipolar disorder.

However, most such studies have not collected information on the frequency of mood episodes, and it remains unclear to what extent disability results from rapid cycling or from the severity of mood episodes regardless of frequency.

The New Zealand Mental Health Survey is a national cross-sectional survey with a multi-stage probability sample of individuals aged 16 years or more living in the community.

From a total sample size of 12,992, the lifetime prevalence of broadly defined bipolar disorder was 3.8% ??” with a prevalence of 1.0% for bipolar I disorder and 0.7% for bipolar II disorder.

When lifetime bipolar disorder cases were grouped by mood episode frequency in the past 12 months, the prevalence was 0.3% with frequent mood episodes (FME), 0.7% with 1??”3 episodes (no FME), and 0.7% with no episodes.

Patients with 12-month FME had earlier onset of bipolar disorder than 12-month cases without FME or those with lifetime bipolar disorder but with no episode in the past 12 months ((16.0 vs 19.5 and 20.1 years, respectively).

The number of weeks in episode, total days out of role, and role impairment in were all worse for the FME group. Both the FME and no-FME groups experienced severe and impairing depression, and lifetime suicidal behaviors and comorbidity were high in all three bipolar groups with little difference between them.

“In summary, these results indicate that predictors and correlates are similar in those with and without FME but that the burden of bipolar disorder is more for those with frequent episodes,” Wells and colleagues conclude.

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

Free abstract

• New National Online Survey Says Bipolar Depressive Symptoms Have Impact On Day-To-Day Tasks As Well As Social Activities
• Faulty Body Clock May Make Kids Bipolar
• Antiepileptic Drugs Not Associated With Increased Risk Of Suicide Attempts In Patients With Bipolar Disorder
• ">

Results presented today at the 162nd American Psychiatric Association (APA) congress in San Francisco, CA, demonstrated the efficacy and tolerability of SEROQUEL® (quetiapine fumarate) for treating depressive episodes in bipolar disorder, including the difficult-to-treat bipolar II patient population.1,2 The data are from combined analyses of four large-scale clinical trials to examine SEROQUEL as a treatment for depressive episodes associated with bipolar I and II disorders. SEROQUEL and SEROQUEL XR™, a once-daily, extended-release formulation of SEROQUEL, is one of the most widely studied atypical antipsychotic in bipolar depression and the only agent approved as monotherapy to treat the spectrum of mood episodes associated with bipolar disorder.

“Bipolar disorder is a chronic illness with patients experiencing severe debilitating mood swings. Patients spend a majority of their time ill in the depressed phase of the illness. These important findings confirm that SEROQUEL is an effective agent for the treatment of bipolar depression, and particularly encouraging are the results in bipolar II patients who historically have not responded well to treatment,” said Professor Alan Young of the Department of Psychiatry, University of British Columbia, Vancouver, Canada.

Results from a combined analysis of all patients with bipolar I or II disorder (n=2593) demonstrated that SEROQUEL monotherapy was significantly more effective than placebo for treating depressive episodes associated with bipolar disorder as measured by improvements in the Montgomery-?sberg Depression Rating Scale (MADRS) total score (P<0.001 for both doses of SEROQUEL). Similar results were observed in a combined analysis of patients with bipolar II disorder (n=819). In both analyses, improvements were evident as early as week 1 and continued through week 8. The four studies, BOLDER (BipOLar DEpRession) I and II and EMBOLDEN (Efficacy of quetiapine Monotherapy in BipOLar DEpressioN) I and II, had a similarly designed 8-week, randomised, double-blind, placebo-controlled phase to evaluate the efficacy and safety of SEROQUEL monotherapy (fixed dose 300 mg or 600 mg daily) compared with placebo in adult patients with bipolar I or II disorder. The EMBOLDEN studies also included an active comparator arm, lithium in EMBOLDEN I and paroxetine in EMBOLDEN II.

The EMBOLDEN studies also included a 26- to 52-week continuation phase, where patients who achieved remission continued on the same dose of SEROQUEL or were switched to placebo. In the combined analysis of this phase, both doses of SEROQUEL significantly increased the time to recurrence of any mood event (hazard ratio 0.59 [95% CI, 0.41-0.84; P=0.004] for 300 mg/day and 0.45 [95% CI, 0.30-0.67; P<0.001] for 600 mg/day). In the subpopulation of patients with bipolar II disorder, both doses of SEROQUEL significantly reduced the risk of recurrence of any mood event compared with placebo (hazard ratio 0.47 [95% CI, 0.25-0.92; P<0.05] for 300 mg/day and 0.18 [95% CI, 0.07-0.51; P<0.001] for 600 mg/day).

The combined data indicate that SEROQUEL was generally well-tolerated and adverse events were consistent with the known safety profile of quetiapine. The most common adverse events in patients with bipolar disorder were dry mouth, somnolence, sedation, and dizziness. In the subpopulation of patients with bipolar II disorder, the most common adverse events were dry mouth, somnolence, sedation, dizziness, and headache. In the continuation phase of the EMBOLDEN studies, the most common treatment-emergent adverse events with SEROQUEL were headache, somnolence, nasopharyngitis, nausea, diarrhoea, and dry mouth and in the subpopulation of patients with bipolar II disorder were headache, dry mouth, somnolence, nasopharyngitis, dizziness, and nausea.

Similar findings have been observed for SEROQUEL XR, which was approved in the U.S. and Europe in 2008 for the acute treatment of depressive episodes associated with bipolar disorder. In an 8-week study (D144CC00002), SEROQUEL XR 300 mg/day demonstrated significant improvements in MADRS total scores from week 1 though week 8 (both P<0.001) compared with placebo.3

The mechanism of action of SEROQUEL, which involves both antipsychotic and antidepressant activities, may help explain its unique efficacy across the spectrum of mood episodes associated with bipolar disorder. The efficacy of quetiapine in depressive episodes may be partly explained by norepinephrine reuptake inhibition by norquetiapine, the active metabolite of quetiapine.

About SEROQUEL and SEROQUEL XR

Launched in 1997, it is estimated that SEROQUEL has been prescribed to more than 22 million patients worldwide. SEROQUEL has been approved in 94 countries for schizophrenia, 92 countries for bipolar mania, in 41 countries for bipolar depression and in 6 countries for bipolar maintenance.

SEROQUEL XR has been approved in 53 countries for schizophrenia, 19 countries for bipolar mania, in 20 countries for bipolar depression, in 9 markets for bipolar maintenance, in 1 market for Major Depressive Disorder (MDD), and in 1 market for Generalised Anxiety Disorder (GAD).

References

1. Calabrese JR, et al. The efficacy of quetiapine monotherapy in bipolar depression: combined data from the BOLDER and EMBOLDEN studies. Presented at the American Psychiatric Association, San Francisco, CA, USA, 16-21 May, 2009.

2. Young AH, et al. The efficacy of quetiapine monotherapy in bipolar II depression: combined data from the BOLDER and EMBOLDEN studies. Presented at the American Psychiatric Association, San Francisco, CA, USA, 16-21 May, 2009.

3. Suppes T, et al. Effectiveness of the new extended release formulation of quetiapine as monotherapy for the treatment of acute bipolar depression (trial D144CC00002). Presented at the Eighth International Review of Bipolar Disorder Conference, Copenhagen, Denmark, 14-16 April, 2008.

Source
AstraZeneca

View drug information on Seroquel.

• Yale Researchers Repair Brain Damage Caused By Chronic Stress Work Has Implications For Bipolar Disorder, PTSD
• For Bipolar Depression, Surveyed Experts Indicate That Current And Emerging Therapies Have No Advantage Over Seroquel In Decreasing The Syptoms
• National Audience Of Psychiatrists Assembling In Chicago For Conference On Bipolar Disorder And ADHD