Discuss Bipolar
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Individuals with bipolar disorder (BD) are at greater risk for developing gout than those without the mood disorder, research shows.
“Metabolic abnormalities are more prevalent in patients with BD than the general populations of both Western and Eastern countries,” write Herng-Ching Lin (Taipei Medical University, Taiwan) and colleagues in the journal Psychiatry Research.
They add that uric acid is the final product of purine nucleotides metabolism, and previous studies have suggested that BD and gout may share similar pathophysiological mechanisms, but “no study, according to our knowledge, has attempted to explore the association between bipolar disorder and the risk of gout.”
The researchers therefore studied data from the Taiwan National Health Insurance Research Database on 24,262 patients with BD who received treatment at outpatient departments in Taiwan in 2000, and 121,310 age- and gender-matched individuals without the mood disorder (controls).
Only BD patients with a first episode, or those who had been in full remission for at least 4 years in 2000 were included in the analysis to avoid the potential confounding factors of institutionalization and chronicity.
During a follow-up period of 6 years, 16.4% of BD patients developed gout compared with 13.6% of controls.
After accounting for factors such as age, gender, monthly income, and geographical region, and the presence of the metabolic syndrome, ischemic heart disease, renal disease, and alcohol or substance dependence, the researchers found that patients with BD were 1.19 times more likely to develop gout during follow up than controls.
Lin and team conclude: “This study finds increased risk of developing gout among patients with BD, even controlling for demographic characteristics, comorbid medical disorders, and substance or alcohol dependence.”
They add: “The results of this study should alert clinicians to assess and monitor the presence of metabolic abnormalities including hyperuricemia and gout in bipolar patients.”
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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A considerable number of older patients with bipolar II disorder or bipolar disorder not otherwise specified (BP-II/BP-NOS) are initially misdiagnosed as having major depressive disorder (MDD), study findings show.
As monotherapy with antidepressants can have adverse effects in elderly patients with bipolar disorder as well as in younger patients, the researchers call for clinicians to keep “the soft forms of bipolar disorder in the differential diagnosis for late-life depression.”
They found that younger age at onset of the first major depressive episode, more frequent prior major depressive episodes, and the existence of depressed mixed state could help clinicians identify elderly bipolar patients.
Minoru Takeshima and Koichi Kurata, from Ishikawa Prefectural Takamatsu Hospital in Kahoku City in Japan, reviewed the medical charts of 87 patients aged at least 60 years who had been hospitalized due to a major depressive episode.
The final diagnoses were MDD in 55 (63.2%) patients and bipolar disorder in 32 (36.8%) patients. Among the bipolar disorder diagnoses, six were for bipolar I disorder, 24 were for BP-II, and two were for BP-NOS.
The researchers note, however, that most of the 26 patients with BP-II/BP-NOS had initially been misdiagnosed. Nineteen (73%) were initially diagnosed with MDD (61.0%) or other disorders (dementia, adjustment disorder; 12.0%).
In contrast, only 9.0% and 34.0% of patients who were finally diagnosed with MDD or bipolar I disorder, respectively, were initially misdiagnosed.
The results, published in the Journal of Affective Disorders, show that patients with BP-II/BP-NOS were significantly younger than patients with MDD at the onset of the first major depressive episode, at a median of 52 versus 66 years.
In addition, patients with BP-II/BP-NOS were significantly more likely to have three or more major depressive episodes than were patients with MDD, at a rate of 40.0% versus just 5.5%.
Depressed mixed state also distinguished patients with BP-II/BP-NOS from those with major depressive disorder, occurring in 61.5% and 16.4% of patients, respectively.
Multiple logistic regression analysis confirmed that younger age at onset of first major depressive episode (odds ratio [OR]=0.94) and depressed mixed state (OR=6.22) were independent markers of bipolarity.
The researchers conclude: “The present study showed that a considerable number of older patients who were hospitalized due to major depressive episode had been initially misdiagnosed with MDD and were actually BP-II/BP-NOS patients, similar to younger bipolar cohorts, in whom such misdiagnosis is a major problem.”
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 may be associated with an inherited abnormality of a neural network that incorporates the left prefrontal cortex and bilateral retrosplenial cortex, study findings suggest.
The functional magnetic resonance imaging (fMRI) study showed that when performing a verbal fluency task, bipolar disorder patients showed reduced deactivation the retrosplenial cortex and under-activation of the left prefrontal cortex compared with mentally healthy individuals.
A similar pattern was also seen in their unaffected first-degree relatives, “consistent with an inherited abnormality of functional brain architecture in bipolar patients and their relatives,” say Matthew Allin (King’s College London, UK) and colleagues.
The study participants included 18 remitted individuals with bipolar disorder, 19 of their unaffected first-degree relatives, and 19 mentally healthy controls. There were no significant differences among the groups with regard to age at assessment, gender distribution, or parental socio-economic status.
The participants completed a cued verbal fluency task, in which they generated a word in response to a letter displayed on a screen. The task, which has two levels of difficulty, involves both visual and verbal memory, evaluation of the presented letter along, and the selection of an appropriate word from memory.
The bipolar patients made significantly more errors on the easy level of the verbal task than their relatives and controls, at an average of 5.11 versus 1.95 and 2.10, respectively.
Analysis of fMRI data showed that all three groups showed deactivation in the retrosplenial cortex and adjacent precuneate cortex during task performance relative to a neutral or rest condition.
Both bipolar patients and unaffected relatives showed significantly less deactivation in the retrosplenial/posterior cingulate cortex than controls during both the easy and hard task, however.
The researchers note that the primary group difference was between unaffected relatives and controls, and that, counter-intuitively, activation patterns in bipolar patients seemed to be more similar to controls than to their relatives.
“Since bipolar disorder is likely to be influenced by genetic and epigenetic factors, the lack of a simple linear relationship here is perhaps not surprising,” they say.
Post-hoc group comparisons also revealed relative prefrontal hypo-activation in both bipolar patients and unaffected relatives compared with controls.
Allin and team acknowledge that treatment effects cannot be ruled out, but they report that there was “no evidence for any effect on task performance or on blood-oxygen-level-dependent signal in the posterior cingulate and the results were not altered by entering medication as a confounding variable.”
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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Faulty Body Clock May Make Kids Bipolar
Posted by admin on April 04th, 2010
Apr
Malfunctioning circadian clock genes may be responsible for bipolar disorder in children. Researchers writing in the open access journal BMC Psychiatry found four versions of the regulatory gene RORB that were associated with pediatric bipolar disorder.
Alexander Niculescu from Indiana University School of Medicine, Indianapolis, US, worked with a team of researchers at Harvard, UC San Diego, Massachusetts General Hospital and SUNY Upstate Medical University to study the RORA and RORB genes of 152 children with the condition and 140 control children. They found four alterations to the RORB gene that were positively associated with being bipolar. Niculescu said, “Our findings suggest that clock genes in general and RORB in particular may be important candidates for further investigation in the search for the molecular basis of bipolar disorder”.
RORB is mainly expressed in the eye, pineal gland and brain. Its expression is known to change as a function of circadian rhythm in some tissues, and mice without the gene exhibit circadian rhythm abnormalities. According to Niculescu, “Bipolar disorder is often characterized by circadian rhythm abnormalities, and this is particularly true among pediatric bipolar patients. Decreased sleep has even been noted as one of the earliest symptoms discriminating children with bipolar disorder from those with attention deficit hyperactivity disorder (ADHD). It will be necessary to verify our association results in other independent samples, and to continue to study the relationship between RORB, other clock genes, and bipolar disorder”.
Pediatric bipolar disorder is a controversial diagnosis characterized by alternating bouts of depression and mania in children, although it does not affect all young people in the same way and the duration and severity of the disorder can vary enormously.
Notes:
Evidence for Genetic Association of RORB with Bipolar Disorder
Casey L McGrath, Stephen J Glatt, Pamela Sklar, Helen Le-Niculescu, Ronald Kuczenski, Alysa E Doyle, Joseph Biederman, Eric Mick, Stephen V Faraone, Alexander B Niculescu and Ming T Tsuang
BMC Psychiatry (in press)
http://www.biomedcentral.com/bmcpsychiatry/
Source: Graeme Baldwin
BioMed Central
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Bipolar patients with a current mood episode who have subthreshold symptoms of the opposite polarity have worse outcomes than those without such symptoms, Australian study findings suggest.
Mixed clinical states in bipolar disorder are diagnostically complex and have treatment implications. While the current criteria specify that mixed states require the presence of full symptoms for both depressive and manic episodes, the impact of subthreshold symptoms of opposite polarity has not been fully examined.
To investigate further, S Dodd, from the University of Melbourne in Victoria, and colleagues studied 239 patients with either bipolar I disorder or schizoaffective disorder, bipolar type, dividing them into either those having pure, mixed (?3 concurrent hypomanic symptoms), or no depression (63, 33, and 143 patients, respectively) or pure, mixed (?2 concurrent depressive symptoms), or no mania (3, 33, and 203 patients, respectively). Clinical data were collected every 3 months for 24 months.
At 24 months, mixed depression and pure depression groups had significantly worse outcomes on almost all measures than patients with no depression at study entry. Young Mania Rating Scale (YMRS) total scores were significantly higher in the mixed depression than pure depression groups. In addition, both manic and depressive symptomatologies were higher in mixed depression patients than other participants at every visit during follow-up.
Compared with other patients, those with mixed mania had significantly worse scores on the Short Form Health Survey Physical Component Score, 21-item Hamilton Depression Rating Scale total score, YMRS total score, Clinical Global Impressions Scale Mania, Depression, and Bipolar subscales, and Streamlined Longitudinal Interview Clinical Evaluation from the Longitudinal Interval Follow-up Evaluation total score.
Again, depressive and manic symptom scores were higher for mixed mania patients versus other participants at every visit, the team notes in the Journal of Affective Disorders.
“In participants with a current mood episode, the presence of subthreshold symptoms of the opposite polarity predicted an adverse prognosis,” the team says.
“Identification of three or more hypomanic symptoms in currently depressed participants or two or more depressive symptoms in currently manic participants was associated with poorer clinical outcomes over a 24-month period.”
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; 2009
Bipolar I disorder patients with a predominant manic/hypomanic polarity (MP) are similar in temperament to those with a predominant depressive polarity (DP), but differ from patients with unipolar major depression (UP), research shows.
Writing in the Journal of Affective Disorders, Eduard Vieta (University of Barcelona, Spain) and team explain: “Recently, the concept of predominant polarity… has been introduced to further characterize subtypes of bipolar disorders.”
They add: “This concept has been proven to have diagnostic and therapeutic implications, but little is known on the underlying psychopathology and temperaments.“
To validate the concept of predominant polarity and investigate the relationship with temperament, the team studied 124 patients with bipolar I disorder and 19 with UP.
The bipolar patients were assessed for predominant polarity, with DP defined as at least two thirds of past episodes fulfilling the DSM-IV criteria for major depressive episode, and MP defined as at least two thirds of past episodes fulfilling DSM-IV criteria for manic or hypomanic episodes.
All the participants underwent temperament assessments using the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto questionnaire (TEMPS-A). Temperament was assessed when patients were in full remission according to the DSM-IV criteria (no significant signs or symptoms of the disorder during the past 2 months).
The team found that 55% of the bipolar disorder patients met criteria for predominant polarity, with 47 classified as MP and 22 as DP.
Age at onset was lower in both the MP and DP bipolar groups compared with the UP group. Unipolar patients showed a longer duration of depression compared with both the MP and DP bipolar groups, but there were no significant differences in the number of suicide attempts between the groups.
Regarding temperament assessments, the mean TEMPS-A scores on the hyperthymic and cyclothymic subscales were higher in MP and DP patients compared with UP patients, while the UP group scored significantly higher than both MP and DP bipolar groups on the depressive temperament scores.
Anxious temperament scores were statistically higher in the UP group than the MP group, but did not differ between DP and UP groups. Irritable temperament scores did not differ among the three groups.
Overall, there were no significant differences in temperament profiles between the MP and DP bipolar groups.
Vieta et al conclude: “Our results show that both bipolar I MP and DP subgroups are temperamentally similar and different from UP. Depression in DP bipolar I patients should be viewed as the overlap of depression on a hyperthymic/cyclothymic temperament.”
They add: “These findings confirm the value of the predominant polarity concept as well as the importance of temperaments to separate bipolar from unipolar disorders.”
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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Patients With Bipolar Disorder Have Higher Specialty Care Costs Than Patients With Diabetes And Other Chronic Diseases
Posted by admin on May 27th, 2009
May
Mayo Clinic researchers have found that bipolar disorder (BPD) is a more costly chronic condition than asthma and coronary artery disease (CAD), based on a review of health care claim costs. Specialty care costs (the costs of seeing any specialist and all tests ordered) were especially higher for bipolar patients. Results of this review were presented at the Annual Meeting of the American Psychiatric Association in San Francisco.
“Psychiatric care costs represented only a portion of the specialty care costs for these chronic conditions, explains Mark Williams, M.D., a Mayo Clinic psychiatrist and lead researcher. This suggests that many of the specialty costs for bipolar patients are not directly related to seeing a mental health provider.”
A data review of health care claims over a four-year period, showed patients with BPD had significantly higher total per member per month costs when compared with the other groups. Only patients with both CAD and diabetes had higher costs than patients with BPD. Total costs, specialty care visits, specialty care costs, outpatient psychiatric costs and outpatient psychiatric visits were compared.
Source:
John Murphy
Mayo Clinic
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