Discuss Bipolar
Blog to discuss being Bipolar
Scandinavian researchers have found significant correlation between the number of manic episodes experienced and the extent of grey matter volume reduction in patients with bipolar disorder.
“Several investigations using magnetic resonance imaging (MRI) have demonstrated anatomical abnormalities in the brain of patients with bipolar disorder,” explain Carl Ekman (Karolinska Institute, Stockholm, Sweden) and team.
However, they add that few studies have investigated whether such abnormalities, including the loss of grey matter volume, are associated with illness duration, and if specific brain regions are more vulnerable than others to depressive and/or manic episodes.
To investigate further, the researchers enrolled 55 adult patients (60% women) with bipolar I disorder who were free of co-morbid conditions associated with regional cortical volume changes, such as alcohol or drug dependence, attention-deficit hyperactivity disorder, panic disorder, or anorexia.
Information on duration of bipolar illness and lifetime number of mood episodes was gathered from patient interviews and medical records.
All of the patients underwent brain MRI and the resulting images were analyzed using voxel-based morphometry.
After accounting for age and gender, the researchers found that the lifetime number of manic episodes significantly correlated with reductions in local grey matter volume in both the right and left inferior frontal gyrus, corresponding to Brodmann’s area 46.
The lifetime number of depressive episodes or years of illness did not correlate with any changes in grey matter volume, however.
Writing in the journal Acta Psychiatrica Scandinavica, Ekman and team conclude that the findings indicate that “abnormalities in the prefrontal regions appear to develop with repeated affective episodes.”
They add: “To further assess the possibly progressive nature of these reductions in brain tissue, longitudinal studies with repeated scans of clinically homogenous patients with bipolar disorder are required.”
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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Delays in diagnosis and poor treatment adherence are associated with a high frequency of mood episodes in patients with bipolar disorder (BD), research shows.
Among patients with BD, “the frequency of affective disorder (episode frequency) can range from once in lifetime to many per year,” explain Luis Gutierrez-Rojas and colleagues from the University of Granada in Spain.
They add that previous studies have shown that an increased frequency of mood episodes predicts poor outcomes in patients with BD.
To investigate factors associated with an increased frequency of mood episodes among such patients, the team studied 108 outpatients (69% women) with BD who were aged an average of 42 years.
Clinical interviews with the patients were used to gather data on variables such as age at onset of BD, age at diagnosis, duration of illness, polarity of first episode, lifetime number of mood episodes, number of hospital admissions, and history of suicide attempts.
The participants’ treating physicians and family members were also consulted to confirm these data, and to assess treatment compliance.
Median split criteria were used to divide the patients into two groups based on a high (nine or more) or low (less than nine) frequency of mood episodes. A high frequency of manic episodes was defined as four or more, and a high frequency of depressive episodes as five or more.
The researchers found that the mean delay in diagnosis was 8.84 years, with each year of delayed diagnosis associated with a 1.1-fold increased risk for having a high frequency of mood episodes.
Other factors associated with an increased frequency of mood episodes included poor adherence to medication (odds ratio [OR]=3.6), being age 36-55 years (OR=3.5) and over 55 years (OR=2.7), versus less than 36 years, and current use of antipsychotic medication (OR=2.7).
Factors significantly associated with a high frequency of manic episodes included female gender (OR=2.5), age 36-55 years (OR=7.5) and age over 55 years (OR=10.1), versus less than 36 years, and a manic onset of the illness (OR=3.0).
Factors significantly associated with a high frequency of depressive episodes included a delay in diagnosis (OR=1.1 per year) and poor adherence to medication (OR=4.2).
Gutierrez-Rojas and team conclude in the Journal of Affective Disorders: “Avoiding delay in diagnosis and enhancing treatment adherence might be important targets for reducing recurrences in BD.”
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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People with bipolar disorder commonly exhibit functional impairment despite being euthymic and clinically “in remission”, say the authors of a new study.
The team believes that a number of clinical factors can predict functional impairment in bipolar disorder, such as previous mixed mood episodes, current subclinical depression, previous hospitalization, and older age.
Eduard Vieta (University of Barcelona, Spain) and coworkers studied 71 patients with a diagnosis of bipolar disorder but currently defined as euthymic (scoring ?8 on the 17-item Hamilton Depression Rating Scale) and 61 healthy controls.
All subjects underwent a battery of tests including the Functioning Assessment Short Test (FAST), which assesses autonomy, occupational functioning, cognition, relationships, financial issues, and leisure time.
In all, 60% of the bipolar patients were considered to be functionally impaired (based on a FAST score >11) compared with just 13.1% of controls. In multivariate analysis, four variables ??” older age, depressive symptoms, previous mixed episodes, and previous hospitalizations ??” were significantly associated with impaired functioning.
Together, these four factors accounted for 44% of the variance in global functioning, Vieta’s team calculated.
Writing in Bipolar Disorders journal, the researchers say their study supports the hypothesis that more severe forms of bipolar disorder have long-term adverse consequences, notably cognitive and functional impairment, that are apparent in-between acute episodes.
“Psychosocial interventions in combination with pharmacotherapy should be considered to treat residual depressive symptoms and enhance the level of functioning,” write Vieta et al.
“In addition, low rates of functional recovery as shown here underscore the importance of including specific functioning measures as well as symptomatic assessments in the comprehensive evaluation of 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
For bipolar disorder patients, longer admission to hospital is associated with more severe executive functioning deficits at discharge, the results of a US study indicate.
A more severe disease course in bipolar disorder is associated with greater cognitive impairments, with cognitive deficits in euthymic patients predicted by a greater number and longer duration of mood episodes.
To determine whether length of hospitalization to stabilize from an acute episode of mood disturbance is linked to cognitive functioning, Boaz Levy, from Harvard Medical School in Boston, Massachusetts, and colleagues studied 41 patients with bipolar disorder.
In all, 20 patients had a hospital stay that lasted longer than the median stay of 12 days, while the remaining 21 patients had a shorter stay. The participants were administered a neuropsychological battery at discharge and group differences in clinical data and test performance were analyzed.
There were no significant differences between long- and short-stay patients in terms of age at onset of bipolar disorder, previous number of psychiatric admissions, number of psychiatric medications taken on the day of testing or diagnostic subtype on admission. There were also no differences in depressive or manic symptoms, gender, marital status, age, or years of education.
Patients with longer hospital stays had significantly worse performance than those with a short hospital stay on immediate recall and recognition of the figure’s parts on the Rey Complex Figure Test, as well as marginally significant impairment of delayed recall and significant impairments in overall verbal memory.
In addition, performance on tests of executive functioning was significantly worse for patients with longer hospital stay compared with those with a short stay, specifically on the Stroop, Wisconsin Card Sorting Test, and Controlled Oral Word Association Test. There were no significant differences in attention, working memory, and IQ.
The team concludes in the journal Comprehensive Psychiatry: “The current data indicate that longer duration of hospital stay is correlated with more severe deficits in executive functioning during the phase of early remission.
“These results illuminate the challenges patients with bipolar disorder may face after discharge from a long inpatient admission and underscore the need to develop better care for their outpatient recovery.”
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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