Discuss Bipolar
Blog to discuss being Bipolar
Patients with bipolar disorder have a worsening response to psychoeducation the more previous episodes they have, a proof-of-concept study suggests.
“Psychoeducation should be delivered as soon as possible in the illness course, supporting the idea of early intervention,” say Eduard Vieta, from the University of Barcelona in Spain, and colleagues.
The researchers analyzed data on 120 euthymic bipolar patients who participated in a 5-year study on the efficacy of psychoeducation in the prophylaxis of recurrences in bipolar disorder.
They determined the efficacy of psychoeducation, compared with no psychoeducation, on two outcome measures ??” recurrence and time spent ill.
The risk for recurrence was defined as the time elapsed between baseline and the emergence of a new acute episode (Young Mania Rating Scale [YMRS] score ?20 for manic recurrence; YMRS ?12 for hypomanic recurrence; Hamilton Depression Rating Scale [HDRS] score ?17 for depressive recurrence; HDRS ?12 and YMRS ?20 for mixed recurrence). Time spent ill was judged to be the number of days in which patients fulfilled criteria for a specific episode.
Patients with six or fewer episodes experienced a significant improvement in the time to recurrence compared with patients not receiving psychoeducation. However, there was no significant benefit in patients with seven or more previous episodes.
More than 14 previous episodes were needed before the benefit of psychoeducation was no longer significant with regard to time spent ill.
Patients with nine to 14 episodes showed a benefit in terms of fewer days spent in hypomania and depression but not in mixed states or mania, while patients with up to seven or eight episodes had a benefit in terms of fewer days spent in hypomania, depression, mixed episodes, or any episodes but not mania.
The researchers note that only patients presenting with up to six episodes showed a reduction in time spent in any episode polarity.
The team suggests that patients with more previous episodes may have greater difficulty in changing habits and so benefit less from psychoeducation. [sggn] Alternatively, and more positively, patients with more episodes may as a result have a longer experience in the management of their disorder and so benefit less from the therapy.
Vieta et al note in the journal Acta Neuropsychiatrica that their study had a number of limitations, including not being powered for the outcome tested and some retrospective data collection.
Nevertheless, they conclude that “the present data may have clinical relevance, pointing at the need to start psychoeducation promptly.”
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
Researchers have found that heightened emotional arousal in bipolar disorder patients, compared with mentally healthy individuals, may enhance their reaction time to cognitive tasks.
However, when emotionally aroused, deficits in response inhibition ??” the ability to suppress responses that are no longer needed or are inappropriate ??” may also become more apparent.
“It is well known that optimal performance requires an intermediate level of emotional intensity ??” too little emotional intensity has negative effects on performance, whereas too much emotional intensity may lead to disorganization of thinking and physical self-control,” Stephanie Krüger, from Charite-Universitätsmedizin Berlin in Germany, and colleagues comment.
The researchers induced a transient intense sadness and a relaxed mood state in 34 euthymic patients with bipolar I disorder, 22 of their mentally healthy siblings, and 33 unrelated mentally healthy individuals. After this, the participants performed a stop-signal paradigm to measure response and response inhibition times.
The patients with bipolar disorder and their siblings required less time to become sad as a result of mood induction and cried more frequently than mentally healthy individuals, suggesting emotional vulnerability could be an endophenotype of bipolar disorder.
Following the induction of intense sadness bipolar disorder patients had reaction times on the stop-signal paradigm that were around 100 ms faster than following induction of a relaxed mood state.
In contrast, both mentally healthy siblings and controls reacted faster when in a relaxed mood state than after intense sadness induction. The researchers note that the reaction times of bipolar disorder patients were similar to those of mentally healthy individuals following intense sadness induction, but were much slower following relaxed mood induction.
In contrast, response inhibition times were longer in bipolar disorder patients after induction of transient sadness compared with controls in both sad and relaxed states.
Healthy siblings also showed longer inhibition times under relaxation compared with controls, but this was not statistically significant.
“Our data provide evidence that patients with bipolar disorder have faster reaction times under strong emotional arousal. In contrast, under the same emotional arousal the inhibitory deficits become more apparent,” the researchers report.
“It is possible that patients with bipolar disorder will function best under moderate emotional arousal,” they conclude.
“Psychotherapeutic strategies for emotion regulation could help patients with bipolar disorder to deal better with their strong emotions and could improve inhibitory deficits.”
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
- Two Brown Faculty To Study Brain Development In Infants And Children With Bipolar Disorder
- Bipolar Disorder - Eurand Announces FDA Approval Of EUR-1048 (Lamictal(R) ODT(TM)), Co-Developed With GlaxoSmithKline
- Faulty Body Clock May Make Kids Bipolar
- For Bipolar Depression, Surveyed Experts Indicate That Current And Emerging Therapies Have No Advantage Over Seroquel In Decreasing The Syptoms
- AstraZeneca Traveling Exhibit Helps Americans Understand And Manage Bipolar Depression
Correction of excessive goal attainment beliefs in patients with bipolar disorder who enjoy being in a state of “mild hypomania” could help prevent them from assenting to a manic episode, say researchers.
Some individuals with bipolar disorder value the characteristics associated with being in a state of mild hypomania ??” termed a high “sense of hyper-positive self”, D Lam and colleagues from King’s College, London, UK, explain.
These characteristics include being particularly creative, dynamic, entertaining, and outgoing, and make individuals more likely to engage in goal-driven behavior.
Bipolar patients who identify with early warning signs as desirable self-descriptive traits are less inclined to see them as warning signs of a manic relapse, and may therefore engage in activities that cause further stimulation and a greater risk for a manic state, say the researchers.
To investigate, the team asked 54 bipolar I disorder patients to complete a self-report questionnaire that assessed preferred mood state, coping with scenarios, dysfunctional attitudes, and SHPS.
They found that patients’ Sense of Hyper-positive Self Scale (SHPSS) score predicted their preferred internal state of mania, with higher “ideal” scores and lower “usual” scores significantly associated with a higher preferred mania mood.
Indeed, a unit increase in SHPSS-Ideal score produced an increase of 0.169 points on the modified version of the Altman Self-Rating Mania scale (M-ASRM), while a unit increase in SHPSS-Usual score produced a decrease of 0.202 points on the M-ASRM, the researchers report.
Multiple linear regression showed that patients with high scores on the Dysfunctional Attitude Scale (DAS) were more likely than those with low scores to have high SHPSS scores, and the higher the DAS score the greater the tendency for the patient to identify with self-descriptors linked to hypomania.
Moreover, the DAS total score and the DAS Goal-attainment score correlated significantly with mania-escalating activities in response to hypothetical scenarios described in the Scenarios Rating Task, with goal-attainment explaining a further 12.8% of the variance in activity ratings after accounting for mood measures.
“Goal-attainment attitudes, characterized by a desire to strive for success and be admired, were predictive of the extent to which individuals indicated that they would increase their activity, eg, work harder, make more contributions to a project, and be more sociable, in these specified vulnerable situations,” Lam et al report in the journal Psychological Medicine.
“However, clinical experience would suggest that an increase in these activities in the scenario would stimulate the patient further, possibly resulting in an assent to a manic episode.”
The researchers therefore conclude that “excessive goal-attainment beliefs should be tackled in therapy.”
They recommend: “Clinicians could implement cognitive techniques to modify these beliefs and find alternatives that are more consistent with relapsed prevention goals.”
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
- A receptor genes have selective influence on bipolar disorder phenotype]]>
- Childhood ADHD impacts on clinical course of bipolar disorder
- Patients With Bipolar Disorder At Increased Risk For Wide Range Of Health Problems, Thomson Reuters Study Finds
Study findings suggest attenuation of normal pseudoneglect in patients with schizophrenia and accentuation of pseudoneglect in patients with bipolar affective disorder (BPAD).
“Together, these findings indicate less cerebral lateralization in schizophrenia and perhaps greater lateralization in BPAD,” say Ganesan Venkatasubramanian and colleagues from the National Institute of Mental Health and Neurosciences in Bangalore, India.
Cerebral asymmetry is a unique feature of the human nervous system, and previous research has shown aberrant lateralization in patients with schizophrenia, increasing rates of left-handedness and reversing normal cerebral symmetries. Lateralization in patients with BPAD, however, has not been greatly studied.
The researchers used the line bisection task to examine laterality in 31 patients with BPAD in remission, 30 patients with schizophrenia, and 103 mentally healthy controls.
The test involves participants bisecting horizontal lines printed and arranged on either side of a sheet of paper. Mentally healthy individuals will have a tendency to bisect lines left of midline, as the right hemisphere dominates in spatial tasks; this is known as “right pseudoneglect.”
Damage in the right hemisphere results in the neglect of left hemispace and a marked tendency to bisect horizontal lines to the right of midline, the researchers explain.
The results showed that, on the whole, patients with schizophrenia or BPAD bisected significantly fewer lines at center than mentally healthy controls, with schizophrenia patients bisecting the fewest lines at center.
Using the right hand, schizophrenia patients showed significant deviation to the right of midline (total percentage deviation 10.6%), while BPAD patients showed significant deviation to the left (total percentage deviation 51.73%). However, no significant differences were seen with the left hand. Mentally healthy controls showed a tendency toward left deviation, but not to the extent seen in BPAD patients, at a total percentage deviation of just 2.02%
When the percentage deviation from both hands for each direction was calculated for the patients, a significant rightward deviation was evident for patients with schizophrenia, while a trend toward leftward deviation was seen for BPAD patients.
“Our study findings suggest attenuation of normal pseudoneglect in schizophrenia and its accentuation in BPAD, indicating less lateralization in schizophrenia and possibly greater lateralization in BPAD,” the team reports in the journal Bipolar Disorders.
“Thus, from an evolutionary perspective, schizophrenia, and BPAD might have antithetical origins.”
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
- Antiepileptic Drugs Not Associated With Increased Risk Of Suicide Attempts In Patients With Bipolar Disorder
- Childhood ADHD impacts on clinical course of bipolar disorder
Students who gain higher than average grades at school are at increased risk for developing bipolar disorder, study findings suggest.
The results support the hypothesis that “exceptional intellectual ability is associated with bipolar disorder,” say James MacCabe, from King’s College London in the UK, and colleagues.
They report that individuals with excellent scholastic achievement, defined as grades of two or more standard deviations above the mean, at age 15??”16 years old were almost four times more likely to develop bipolar disorder between the ages of 17 and 31 years than individuals with average grades.
Students with the poorest grades, at two or more standard deviations below the mean, were also at increased risk for bipolar disorder compared with average-grade students, but the risk was only moderately increased at almost two fold.
The study involved 713,596 individuals who finished compulsory schooling in Sweden between 1988 and 1997. The students’ scholastic achievement was assessed alongside hospital admission for bipolar disorder.
The researchers note in the British Journal of Psychiatry that the increased risk for bipolar disorder associated with scholastic achievement remained after accounting for factors such as parental education and socioeconomic status.
Interestingly, they also found that the association between A grades and a heightened risk for bipolar disorder was particularly evident for pupils achieving this grade in subjects such as humanities and Swedish and Music.
“This provides support for the biographic literature which consistently finds associations between linguistic and musical creativity and bipolar disorder,” say MacCabe et al.
They discuss possible explanations for the associations between scholastic achievement and bipolar disorder. Hypomania may be one factor, as it is thought to enhance access to vocabulary, memory and other cognitive resources, helping individuals link successive ideas in innovative ways. It also gives people extraordinary stamina and can considerably enhance concentration. Also, people with bipolar disorder often show exaggerated emotional responses, which may facilitate their talent in art, music, and literature.
Conversely, a predominance of depressive symptoms may explain why individuals with low scholastic achievement might be at increased risk for bipolar disorder, the team suggests.
The study indicated that the association between high grades and risk for later bipolar disorder may be stronger in men than women, but this association did not reach statistical significance and needs further study.
MacCabe makes the important point that, “although having A grades increases your chance of bipolar disorder in later life, we should remember that the majority of people with A grades enjoy good mental health.”
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
- MTHFR gene not linked to bipolar disorder]]>
- Pitt Researchers To Study Effects Of Early Intervention For Children Of Parents With Bipolar Disorder
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
- Link Between Bipolar Disorder And Risk Of Early Death From Natural Causes
- DISC1 gene variants show mixed associations with psychiatric illness]]>
- Depressive, social anxiety symptoms severe among anxiety disordered patients
Long-term poor functional outcome among bipolar disorder patients may be linked to both cognitive impairment and the time spent with subsyndromal depressive symptomatology, Argentinean study findings indicate.
Cognitive impairment has been shown to be negatively associated with measures of disability and social and occupational functioning, but there is a lack of data examining the ability of cognitive impairments to predict long-term functional outcome.
Sergio Strehilevich and colleagues from the Favaloro Foundation in Buenos Aires therefore administered a neurocognitive battery assessing verbal memory, attention, and executive function to 35 patients with euthymic bipolar disorder and 30 mentally healthy controls matched for age and years in education.
The patients were assessed every 1??”4 weeks for ?1 year, with the course of illness documented using a modified life charting technique. The General Assessment to Functioning (GAF) and the Functioning Assessment Short Test (FAST) were used to determine psychosocial functioning at the end of the follow-up period.
Patients had lower performance than healthy controls on measures of verbal memory, attention, and executive function. There were no significant differences between patients and controls in terms of age, gender, years in education, and baseline scores on the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HDRS).
The team found significant association between GAF scores at the end of follow-up and subsyndromal depressive symptomatology, along with impairments in verbal memory, attention, and executive function. Further analysis revealed that around 43% of the variance in GAF scores was accounted for by subsyndromal depressive symptomatology, and impairments in attention and verbal memory.
Similar results were seen for FAST scores, the researchers note in the Journal of Affective Disorders, with 28% of the variance of scores at the end of follow-up accounted for by impairments in attention and executive function. The results for both functioning assessments were unmodified by YMRS and HDRS scores.
“In summary, our findings bring further evidence that both cognitive impairments as well as subsyndromal depressive symptomatology are illness features associated with long-term functional outcome,” the team says.
“These results point out the importance of in which way developing strategies to improve cognitive impairments and subsyndromal symptomatology may lead to more comprehensive treatments and contribute to enhance the long-term functional outcome in patients with bipolar disorder.”
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
- Mental Health America Applauds Bipartisan Legislation To Help Treat Depression And Bipolar Disorders
- Eighth International Conference On Bipolar Disorder To Be Held In Pittsburgh, June 25 To 27