Discuss Bipolar
Blog to discuss being Bipolar
Among bipolar disorder patients living in the community, previous manic episodes appear to impair disability at work and in family life, whereas previous depressive episodes seem to impact on social life disability, study results show.
Reporting their findings in the journal Psychiatry Research, Luis Gutierrez-Rojas (University of Granada, Spain) and colleagues say that “clinicians should make every effort to prevent relapses, to efficiently treat residual symptoms, and to enhance the social support of these patients.”
In the 2004 Global Burden of Disease study, bipolar disorder was reported to be the seventh and eighth leading cause of years lived with a disability for men and women, respectively.
To investigate mediators of this disability in work, social, and family life, the researchers interviewed 108 outpatients with bipolar disorder regarding previous course-of-illness and current psychopathology.
Work disability was defined as being on a disability pension or in the process of obtaining it; while social life or family life disability was defined by a score of 7 or less in the respective subscales of the Sheehan Disability Scale.
At least one type of disability (work, social, family) affected around half of the patients while two types affected 37%.
Work disability was significantly associated with previous repeated manic episodes, three or more hospitalizations, and current depressive symptoms, and inversely associated with education.
Social life disability significantly increased with the number of hospitalisations, previous repeated depressive episodes, and current depressive symptoms.
Current nicotine dependence and lack of social support were also significantly associated with work and social life disability, respectively.
Family life disability significantly increased with the number of hospitalizations, previous repeated manic episodes, and current depressive symptoms.
“This study shows that disability affects an important proportion of bipolar disorder patients and that previous course-of-illness variables, particularly a high number of manic episodes, and current psychopathology - as indicated by the presence of nicotine dependence or depressive symptoms - may be indicators of disability,” Gutierrez-Rojas 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
Less than half of patients with bipolar disorder achieve functional recovery, report researchers who note that married patients, those with greater education, and those with fewer years of illness are more likely to recover.
“Psychosocial and occupational impairments in patients diagnosed with bipolar disorder are highly prevalent despite modern therapeutic advances,” Aliza Wingo (Emory University, Atlanta, Georgia, USA) and co-authors comment in the journal Bipolar Disorders.
“An important question is what factors might facilitate or impede functional recovery of bipolar disorder patients, particularly considering those in or near symptomatic recovery.”
To investigate they assessed 65 euthymic or residually depressed bipolar disorder patients with the Residential Status Index (RSI) and Vocational Status Index (VSI), adapted from the McLean-Harvard First-Episode project.
In all, 28 (43%) patients achieved functional recovery, defined as regaining individual premorbid or previous highest level of residential and occupational status within a year.
Wingo et al report that patients were more likely to achieve functional recovery if they had more education (odds ratio[OR]=1.45 for each addition year) or were married (OR=4.27); by contrast, longer illness duration decreased the likelihood of functional recovery (OR=0.95 for each additional illness year).
The results remained significant after controlling for residual depressive symptoms, diagnostic type (I versus II), and psychiatric comorbidity.
Functionally unrecovered bipolar disorder patients were more likely to be taking antidepressants than recovered patients (68% versus 27%) and to have mild residual depressive symptoms (22% versus 4%). These differences were not significant, however.
Fewer bipolar II disorder than bipolar I disorder patients attained functional recovery (35% versus 48%), although with the relatively small samples involved, this difference was not statistically significant.
“This comparison adds to growing evidence that bipolar II disorder patients do not have a lesser illness, but rather one marked by more time in depressive states, with similar risks of both suicide and disability as in bipolar disorder,” Wingo et al remark.
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
- ">
- New National Online Survey Says Bipolar Depressive Symptoms Have Impact On Day-To-Day Tasks As Well As Social Activities
Individuals with bipolar disorder (BD) who have low cholesterol levels may be predisposed to a greater burden of manic symptomatology than those with normal or high cholesterol levels, show study findings.
This finding “supports prior case-control and cross-sectional findings,” say Jess Fiedorowicz (University of Iowa, Iowa City, USA) and colleagues.
Using data from the Collaborative Depression Study, a prospective cohort study, the researchers identified 131 individuals with a major affective disorder who had fasting total cholesterol measured at study enrolment and were followed-up for a mean of 15.7 years.
The 66 patients with unipolar depression spent 37.6% of weeks with clinically significant depressive symptoms, on average, while those with BD spent 30.9% and 4.5% of weeks with depressive and manic symptoms, respectively.
Regression analysis showed no relationship between cholesterol levels and depressive symptomatology after controlling for age, gender, and use of mood-stabilizing medication.
There was no significant inverse, linear association with depressive symptomatology among bipolar patients either, but in this group lower cholesterol predicted a higher proportion of follow-up weeks spent with manic symptoms.
The researchers note that the relationship between cholesterol and subsequent manic symptom burden was not confounded by hypertension, diabetes mellitus, thyroid disease, or weight loss over 10 lb during the present episode.
Fiedorowicz et al say that cholesterol may influence affect through a variety of mechanisms, such as its impact on modulatory serotonergic pathways.
They therefore suggest that inconsistencies in published findings may be a result of “a complex relationship yet to be elucidated, consistent with diversity of proposed physiological mediators.”
Writing in the journal Psychiatry Research, the team concludes: “The convergence of further clinical research with expansion of scientific knowledge at the basic level will be critical to eventually elucidate a presumably complex relationship between cholesterol and affective symptomatology.”
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
- DISC1 gene variants show mixed associations with psychiatric illness]]>
- DTNBP1 gene mutations linked to bipolar disorder]]>
US researchers have found thyroid function is inhibited in bipolar I disorder patients taking maintenance lithium monotherapy, which may exacerbate the illness, particularly in the depressive pole.
It is known that lithium can impair thyroid function, but the potential relationship between the induced thyroid changes and prospective mood changes has not been extensively studied.
To investigate, Mark Frye (Mayo Clinic, Rochester, Minnesota) and co-authors pooled data from two 18-month maintenance studies of lamotrigine and lithium monotherapy. The post hoc analysis included 109 bipolar I patients with normal thyroid-stimulating hormone (TSH) levels at baseline who received lamotrigine (n=55), lithium (n=32), or placebo (n=22) monotherapy for a mean period of 52 weeks.
The researchers found that by week 52, patients treated with lithium had a statistically significant increase in mean TSH levels from baseline (+1.0 µIU/ml) compared with those treated with lamotrigine (-0.2 µIU/ml) or placebo (+0.1 µIU/ml). Additionally, three patients taking lithium developed above normal TSH levels by week 52 (8.4, 6.5, and 7.8 µIU/ml).
“This finding is consistent with the possibility that llithium-associated inhibition of thyroid function might have contributed to the development of depressive symptoms. If so, then the results suggest that reduction in thyroid function can exacerbate bipolar symptoms even in euthyroid patients,” write Frye et al in the journal Acta Psychiatrica Scandinavica.
Furthermore, lithium-treated patients who required an intervention for a depressive episode had significantly higher TSH levels compared with those who did not need intervention (4.4 vs 2.4 µIU/ml). This significant difference was not seen in other groups or in the manic episode.
The authors suggest that this may indicate that bipolar depressive symptoms may be influenced by reductions in thyroid function that are captured as values within the normal range (0.3??”5.0 µIU/ml).
However, the team cautions that TSH at screening is not as accurate an assessment as levels at time of randomization due to the possibility of TSH changes prior to analysis.
“Studies prospectively designed to assess thyroid function and its association with subsyndromal and syndromal mood symptoms in patients receiving maintenance therapy for bipolar disorder should be considered,” they 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
- Buy Paxil Online
- Optimism For Bipolar Disorder And Schizophrenia If Psychiatrists Abandon 19th Century Dogma, UK
- ">
- Mental Illness Was The Costliest Condition Between 1996 To 2006
- Schering-Plough Submits Response To FDA For SAPHRIS(TM) (asenapine) In The Acute Treatment Of Both Schizophrenia And Bipolar I Disorder