Discuss Bipolar
Blog to discuss being Bipolar
The overall outcome of bipolar disorder patients is improved by treatment in a specialized bipolar clinic, but the treatment of bipolar II disorder appears to be suboptimal, the results of a European study indicate.
Due to beliefs over the apparent “soft” nature of bipolar II disorder, despite patients being symptomatic for longer and having more chronicity and comorbidity than those with bipolar I disorder, the condition may be undertreated, with a risk for a more recurrent course.
To investigate the course of bipolar disorder further, Benedikt Amann, from Complex Assistencial en Salut Mental in Barcelona, Spain, and colleagues studied 18 bipolar II disorder and 31 bipolar I disorder patients. The patients were assessed monthly for an average of 26 months using the life-chart methodology “clinician version, the Young Mania Rating Scale, the Inventory of Depressive Symptoms, the Clinical Global Impression ” Bipolar Version, and the Global Assessment of Functioning.
Dividing follow-up into three terms “ first year, third to fifth half year, and sixth to eighth half year ” the team found that the increase in euthymic days in the second versus the third term was significant, but the difference between the second and third terms was not significant. A similar pattern was seen for depressive and manic days.
In each 6-month interval, both bipolar I and II disorder patients had more days marked as (sub)depressive than (hypo)manic, aside from in the last three intervals, during which bipolar II patients had more hypomanic days than bipolar I disorder patients.
While both bipolar I and II patients had reductions in the number of high “moderate to severe depressive days between the first and eighth half years, the number of high “moderate to severe manic days increased slightly by 2.0% in bipolar I disorder patients from the first to the second term and then decreased slightly by 1.9% until the end of follow-up. Similar findings were observed for hypomanic days.
Interestingly, the percentage of days on anticonvulsants increased during follow-up for bipolar I disorder patients but decreased in bipolar II disorder patients, with the opposite pattern seen for antidepressant use. Bipolar I disorder patients were also prescribed significantly more mood stabilizers than bipolar II disorder patients.
The team concludes in the journal Acta Psychiatrica Scandinavica: “Bipolar II disorder seems to be correlated with a worse course as regards to depressive episodes and a more difficult-to-treat course of the illness.
“Our results suggest pronounced differences in terms of an increase of euthymic days between bipolar I and bipolar II favoring bipolar I disorder after therapy.”
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
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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
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Sleep disturbance between episodes of bipolar disorder can affect illness course and may therefore be an important intervention target, say researchers.
“While several psychologic therapies for bipolar disorder target sleep disturbance, there remains significant room for improvement in treatment outcome and a need for basing treatments in empirical research,” say Allison Harvey and colleagues from the University of California in Berkley, USA.
The researchers enrolled 21 participants aged an average of 37 years with bipolar disorder who were inter-episode and asked them to complete sleep diaries for a week. Illness course and symptoms were assessed via validated semi-structured interviews.
Average total wake time ranged from 12.83 to 193.00 minutes, while average total sleep time ranged from 264.67 to 546.86 minutes and average sleep efficiency ranged from 61% to 96%.
The findings, published in the Journal of Behavior Therapy and Experimental Psychiatry, showed that participants experiencing a greater number of depressive episodes had significantly poorer and more variable sleep efficiency and more variable total wake time than other patients.
A greater number of depressive episodes also correlated, albeit not significantly, with more variability in the time at which they went to bed.
“It may be the case that experiencing a greater number of depressive episodes, which are marked by disturbed sleep, leads to spending more time in bed than is spent sleeping, possibly as the bed comes to be associated with poor sleep and depression,” suggest the researchers.
“Alternately, spending excessive time awake in bed may have detrimental effects on mood.”
The researchers also found that sleep efficiency correlated positively with concurrent manic symptoms, and although not statistically significant, there was a negative correlation between total wake time and manic symptoms other than sleep disturbance.
“This is surprising because sleep efficiency is typically considered to be a sign of good sleep,” note Harvey and team.
“These findings raise the possibility that experiencing more manic symptoms may be associated with a greater likelihood of leaving the bed during awakenings in the night or getting up earlier in the morning and starting the day rather than attempting to return to sleep.”
The researchers conclude: “Our findings support the theory that sleep disturbance may be a potential trait marker of bipolar disorder, and they extend previous research by raising the importance of sleep efficiency and sleep variability as critical sleep parameters in 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