Discuss Bipolar
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Bipolar disorder patients who have high levels of anxiety during an episode are more likely to have greater long-term depressive morbidity, the results of a US study indicate.
It is known that there are differences between bipolar disorder patients with and without comorbid anxiety, but the long-term prognostic significance of comorbid anxiety is unclear, argue William Coryell, from University of Iowa Hospitals and Clinics in Iowa City, and colleagues.
The team therefore studied 427 participants from the National Institute of Mental Health Collaborative Depression Study who were followed-up prospectively for an average of 17.4 years. The manifestations of anxiety at baseline were characterized and related to the proportion of follow-up weeks in episodes of major depression and mania or hypomania.
Overall, 92 patients had mania only at baseline, while 168 had depression only and 167 were cycling. Using the Schedule for Affective Disorders and Schizophrenia, the researchers found that the patients’ somatic anxiety scores were 1.7, 3.2, and 2.8, respectively, while their psychic anxiety scores were 1.9, 4.0, and 3.5, respectively. The global anxiety level was 3.6, 7.2, and 6.3, respectively.
The percentage of weeks in depressive episodes was not predicted by gender, age at intake, age at illness onset, the presence of antisocial personality disorder, alcoholism, or drug dependence.
Patients with past or future manic episodes spent a smaller percentage of weeks in depressive episodes than those with only episodes of hypomania, at 27.4% and 36.5%, respectively. The proportion of weeks spent in depressive episodes was 13.2% for patients with purely manic episodes at baseline, 37.7% for those who had a purely depressive episode at baseline, and 33.0% for those who had a cycling episode.
Time spent in depressive episodes was not predicted by either panic attacks or any anxiety disorder. However, psychic anxiety was significantly associated with time in depressive episodes, while somatic anxiety had borderline significance.
Global anxiety was found to have a continuous relationship with number of weeks in depressive episodes, with no clear threshold for separating anxious and non-anxious patients.
However, the team was able to determine that patients with a purely manic index episode and a global anxiety level below the median value of 7 spent only 12.4% of weeks in depressive episodes, compared with 18.8% for patients with mania and an anxiety score ?7. The rates for patients with depressed or cycling index episodes were 29.7% and 40.4% depending on whether they had anxiety levels below or above the median, respectively.
The team writes in the American Journal of Psychiatry: “The combination of presenting phase and anxiety level appears to offer a potent clinical tool for predicting whether an individual is likely to follow a course dominated by depressive symptoms or one in which mania is more prominent.
“Such prediction is inherently valuable but may also have practical importance in the selection of a mood-stabilizer regimen designed to offer more protection against one or the other pole of bipolar illness.”
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
Patients with bipolar disorder are more likely to regularly fill out an online mood chart than the standard paper-based version, and generally give more detail about their current condition online, study results show.
“By bringing the chart directly to the patient via email, and leveraging the behaviorally reinforcing properties of email checking, an Internet-based chart reduces the effort needed to record moods, and makes this tool available to a broader range of patients,” comment Daniel Lieberman (George Washington University, Washington, DC, USA) and colleagues.
In bipolar disorder mood can fluctuate on a daily basis, and is influenced by multiple interacting variables including social support, environmental stress, medication use, sleep disruption, and internal cyclic processes.
“Optimal treatment management requires data that is both accurate and comprehensive, however, patient recall is often unreliable and subject to inaccuracies and biases,” Lieberman and colleagues note in the Journal of Affective Disorders.
Recently the National Institute of Mental Health developed the daily Life Chart Methodology (LCM) as an alternative to retrospective weekly assessments.
However, adherence has proved to be a problem and only the most motivated patients regularly fill out the chart.
In the study the researchers recruited 48 patients with bipolar disorder, assigning 25 to receive the standard paper LCM chart and 23 to receive a specially adapted online version of the LCM, and followed-up their loggings for 90 days.
The online group filled out approximately twice as many days as the standard group (44.3% vs 20.4%) and also entered complete data for a larger portion of days (55.2% vs 27.7%).
Two thirds of the participants who were assigned to receive paper charts, returned them blank, while nearly 80% of the online participants rated at least 1 day.
Although participants given the online chart were allowed to respond to old emails to rate mood for previous days, 77.0% of the days rated were done on the same day, and 92.3% were recorded within 2 days of the date being rated.
“Rating via email eliminated the need for the rater to incorporate a new routine into his or her life,” Lieberman and colleagues comment.
They add: “As long as the participant was already using email, the mood chart accommodated to his or her routine rather than forcing the participant to accommodate to the program.”
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