Over one-third of bipolar disorder (BD) patients do not receive adequate provision or continuity of maintenance treatment during their first follow-up maintenance phase, indicate study findings.

Studies investigating maintenance treatment in BD have lacked agreement on how the longitudinal treatment phases should be defined, thus presenting inconsistent results.

Erkki Isometsä (Helsinki University Central Hospital, Finland) and co-authors say that their study is “one of the first to investigate maintenance treatment received using life chart methodology, with the possibility of reporting longitudinal patterns of maintenance treatment.”

For the study, the researchers assessed the adequacy of pharmacologic treatment received by 154 BD patients who had taken part in the Jorvi Bipolar Study during the first maintenance phase (at least 2 weeks) after the index episode. Treatment information was collected in interviews and using psychiatric records and adequate maintenance-hase pharmacotherapy was based on published treatment guidelines, where patients had to be treated with lithium, valproate, carbamazepine, or olanzapine. Monotherapy with lamotrigine was defined as adequate in bipolar II disorder.

Overall, 63.0% of patients experienced depression prior to the maintenance phase, which lasted on average 220 days.

Adequate maintenance treatment was received by 69.3% of all patients during the time indicated and by 77.9% of patients with a clinical diagnosis of BD (n=129).

Furthermore, adequate treatment was received by 75.3% of patients for some time, but only by 61.0% of all patients throughout the maintenance phase. Again, a higher proportion of patients with a clinical BD diagnosis (72.1%) received treatment throughout the maintenance phase than did patients diagnosed with BD II (47.0%).

Most patients (81.0%) with adequate maintenance treatment some time during the maintenance phase received it throughout the phase, and nearly all patients (91.4%) with adequate maintenance treatment when the maintenance phase began received adequate treatment when the phase ended or follow-up was finished.

Logistic regression analysis revealed that a clinical diagnosis of BD was the most important predictor for adequate maintenance treatment throughout the first follow-up maintenance phase (odds ratio [OR]=106.5), followed by treatment in hospital during the episode before the maintenance phase (OR=11.1), rapid cycling (OR=3.4), and absence of comorbid personality disorders (OR=0.37 for any personality disorder).

“Further longitudinal effectiveness studies are needed to assess strategies to enhance the adequacy of interventions during the continuation and treatment phases in patients with bipolar disorders,” conclude Isometsä and team in the Journal of Affective Disorders.

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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Older bipolar disorder patients have inferior frontal lobe gray matter volume deficits, including in areas associated with the anterior limbic network, US researchers have discovered.

Although structural magnetic resonance imaging (MRI) studies have revealed inconsistent results in the assessment of volumetric changes in bipolar disorder patients, several investigations have indicated that regional abnormalities are present in such patients, predominantly in the frontal and temporal lobes.

John Beyer and colleagues from Duke University Medical Center in Durham, North Carolina administered structured clinical interviews and performed MRI scanning on 56 bipolar disorder patients with an average age of 60.5 years and 43 healthy individuals with an average age of 58.1 years. The cerebrum was divided into 16 units using image parcellation.

There were no significant differences between patients and controls in terms of age, gender, or race, the team notes in the International Journal of Geriatric Psychiatry. There were also no differences in total gray matter volume between patients and controls.

However, analysis revealed a significant bilateral difference in gray matter volume in patients versus controls in the anterior half of the brain, particularly in the anterior??”inferior brain regions. This difference remained significant even after controlling for age and gender.

Again, no overall total white matter volume differences were observed between patients and controls. Some differences were found in anterior brain regions, but these did not remain after taking into account age and gender.

“Our observation of decreased gray matter volume in the inferior frontal areas of the brain suggests that these areas may play a primary role in the mood and cognitive symptoms of bipolar disorder, and complements previous structural neuroimaging studies that suggest an underlying neuropathology in the anterior limbic network,” the researchers 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

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