Discuss Bipolar
Blog to discuss being Bipolar
In bipolar disorder patients with mania, those with mixed episodes, anxiety, or rapid cycling, as well as individuals at high risk for depression relapse, are more likely to receive antidepressants than other patients with the mood disorder, researchers have found.
“The primary goal of treatment of mania is to restore behavioral control as quickly as possible in order to minimize danger to self and others and to limit the high economic, social, and personal costs of manic episodes,” explain Eduard Vieta (University Clinic Hospital of Barcelona, Spain) and team.
They add that although guidelines recommend the discontinuation of antidepressant treatment during episodes of mania, as it may exacerbate symptoms, some bipolar patients with mania continue to receive such treatment.
To assess the prevalence of antidepressant use during episodes of mania, and factors associated with antidepressant use during mania, the researchers studied data on 3684 bipolar disorder patients with mania/mixed mania who participated in the 2-year EMBLEM (The European Mania in Bipolar Longitudinal Evaluation of Medication) study.
Overall, 345 (14%) of 2416 patients with mania who continued into the maintenance phase of the study were taking antidepressant medications at baseline. Most antidepressant prescriptions were for selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors (74.1%).
Analysis revealed that patients with mixed episodes were 3.28 times more likely to be prescribed antidepressants than those with mania-only episodes, and patients with rapid cycling were 1.67 times more likely to be prescribed antidepressants than those without rapid cycling.
Furthermore, a greater number of previous depressive episodes and a higher anxiety score were associated with an increased likelihood of antidepressant treatment during mania compared with a lower number of previous depressive episodes and a lower anxiety score.
The researchers also found that patients who were prescribed antidepressants had significantly higher depression scores on the Clinical Global Impressions-Bipolar Disorder scale at both 12 weeks and 24 months than those who were not prescribed antidepressants, at scores of 2.11 and 2.02, versus 1.65 and 1.60, respectively.
Similarly, patients who were prescribed antidepressants had a higher depression relapse rate at 12 weeks and 24 months compared with other patients, at 26.6% and 31.3%, versus 15.6% and 19.3%, respectively.
Vieta and team summarize: “Patients with mania receiving antidepressants are more likely to be outpatients with mixed episodes, anxiety, or rapid cycling and have a higher risk of depression relapse during follow-up.”
They conclude: “These findings suggest that there is an unmet need to treat effectively the depressive burden within bipolar disorder, even during manic episodes, and that clinicians (regardless of whether they are right or wrong) use what they think might help, even against all the evidence.”
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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The seasonal spring peak in suicide rates is particularly high among patients with a history of mood disorders, research shows.
Previous research has consistently shown a spring peak in suicide rates and exacerbations of mood disorders, which is “conducive to a hypothesis that the Spring peak in suicide is driven by a seasonal decompensation of mood disorders in spring,” explain Teodor Postolache (University of Maryland School of Medicine, Baltimore, USA) and team.
“If so, one would expect a greater suicide peak in spring among individuals with a history of hospitalization for mood disorders,” they add.
To investigate, the researchers used the Danish Cause of Death Registry to identify all 37,987 individuals who died by suicide in the country between 1970 and 2001.
They also used the Danish Psychiatric Central Register to assess any history of mood disorders among the suicide victims.
The team found that, overall, 17.1% of the suicide victims had been previously hospitalized for bipolar disorder, unipolar depression, or other mood disorders.
A spring peak in suicide rates was evident in individuals with and without a history of hospitalization for mood disorders, but was more prominent in those with such as history.
Specifically, men and women with a history of hospitalization for mood disorders were 1.18 and 1.20 times, respectively, more likely to commit suicide in spring than at other times of the year, while the respective risks in men and women without such a history were 1.07 and 1.11.
Analysis of a smaller sample of suicide victims from between 1981 and 1997, which allowed for adjustment of socioeconomic factors, indicated that a history of hospitalization for mood disorders was associated with a greater risk for spring suicide in men than women, at relative risks of 1.25 and 1.20, respectively.
Postolache and team conclude in the Journal of Affective Disorders: “The key finding of this study suggests that the history of hospitalization for mood disorder increases the spring peak of suicide.”
They add: “The results support the need to further investigate if exacerbation of mood disorders in spring triggers seasonal peaks of suicide. Identifying triggers for seasonal spring peaks in suicide may lead to uncovering novel risk factors and therapeutic targets for suicide prevention.”
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
Childhood ADHD impacts on clinical course of bipolar disorder
Posted by admin on May 23rd, 2009
May
A childhood history of attention deficit/hyperactivity disorder (ADHD) has a significant impact on the course of bipolar disorder, regardless of whether ADHD symptoms persist in to adulthood, researchers have found.
“Cross-sectional studies suggest that up to 85% of prepubertal children with bipolar disorder also meet the criteria for ADHD, and, conversely, that up to 22% of children with ADHD also meet the criteria for bipolar disorder,” explain Mikael Landen (Karolinska Institute, Stockholm, Sweden) and team.
However, less is known about the prevalence of comorbid ADHD in adults with bipolar disorder and whether such symptoms influence the clinical course of the mood disorder.
“The question whether childhood ADHD has the same impact on bipolar disorder regardless of whether the ADHD symptoms remain in adulthood or not is critical, because it opens up the possibility that a mere history of childhood ADHD symptoms defines an etiologically distinct, early-onset bipolar sub-phenotype,” they add.
To investigate, the researchers studied 60 men and 99 women with bipolar disorder who were aged an average of 39 years.
The participants underwent comprehensive evaluations to assess affective symptoms, childhood ADHD, and current ADHD symptoms. An interview with a parent was also conducted to obtain objective information about a history of childhood ADHD.
Overall, 114 (71.7%) patients had “pure” bipolar disorder without childhood or adulthood ADHD symptoms, 19 (12.0%) had a history of childhood ADHD without symptoms in adulthood, and 26 (16.4%) met criteria for ADHD in both childhood and adulthood.
Analysis revealed that the presence of either childhood only ADHD or childhood plus adult ADHD had a similar impact on the clinical course of bipolar disorder.
Patients with childhood only ADHD and those with childhood plus adult ADHD had a significantly earlier age at onset of their first psychotic symptom, at a combined average age of 14.2 years, than those with pure bipolar disorder, at an average age of 21.9 years.
Furthermore, both ADHD groups had a significantly earlier combined average age (16.7 years) at first affective episode than those with pure bipolar disorder (22.7 years).
The researchers also found that patients with childhood only and childhood plus adult ADHD experienced significantly more hypomanic, depressive mixed, and total affective episodes, and they more often had a history of interpersonal violence than those with pure bipolar disorder.
Landen et al conclude in the journal Acta Psychiatrica Scandinavica: “We found that childhood ADHD is common in bipolar patients and that a mere history of childhood ADHD irrespective of current ADHD is an important factor for the clinical course of bipolar disorder.”
They add: “A review of childhood ADHD symptoms in adult bipolar patients is warranted both clinically and in pathophysiological studies.”
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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