Discuss Bipolar
Blog to discuss being Bipolar
Patients with bipolar disorder are more than twice as likely to experience suicidal behavior if they also have alcohol use disorders, survey findings show.
Maria Oquendo, from Columbia University in New York, USA, and colleagues report, however, that despite this increased risk for suicidal behavior, patients with bipolar disorder and alcohol use disorders did not receive more psychiatric treatment.
“This was the case even though bipolar respondents with alcohol use disorder had considerably higher rates of drug use disorders and were more often afflicted with character pathology,” the researchers say.
They therefore suggest that “interventions to improve adherence and venues to make care more accessible for this population with high disease burden would be of utility.”
The team analyzed data on 1643 patients from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) with a lifetime diagnosis of bipolar disorder.
More than half (54%) of the patients met the criteria for alcohol use disorder on the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version.
These patients were at greater risk for suicide attempt than individuals without alcohol use disorders, at an odds ratio of 2.25.
The researchers note that the bipolar patients with alcohol use disorders were more likely than those without such disorders to have comorbid nicotine dependence and drug use disorders. However, these comorbidities did not increase the risk for suicidal behavior among the bipolar patients and did not confer additional risk to that associated with alcohol use disorders.
Patients with alcohol use disorders had an earlier age at onset of bipolar disorder and a propensity to endorse alcohol use as self-medication, relative to other patients. But neither these factors nor the number of previous major depressive episodes experienced affected the link between alcohol use and suicidal behavior.
“Given the high disease burden suffered by these individuals and the increased risk for morbidity and mortality when bipolar disorder and alcohol use disorder are comorbid, targeting them for treatment is a public health imperative,” Oquendo and team conclude in the Journal of Clinical Psychiatry.
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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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
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Major depressive disorder (MDD) is a heterogeneous disorder that contains a substantial proportion of patients with clinically significant subthreshold bipolar disorder, study results indicate.
MDD is the most common mood disorder and is highly comorbid with anxiety and substance use disorders, while bipolar disorder is considerably less prevalent. However, concerns have been raised that MDD is overdiagnosed and bipolar disorder consequently underdiagnosed.
To investigate further, Petra Zimmermann, from the Max Planck Institute of Psychiatry in Munich, Germany, and colleagues studied 2210 community individuals aged 14??”24 years, assessing mental disorders, personality traits, sociodemographic characteristics and criminal acts, and parental disorder, and following-up the participants annually for 3 years.
Overall, 23.2% of patients were diagnosed with MDD by the third follow-up, while 3.0% had bipolar I disorder and 1.4% bipolar II disorder. Of those with MDD, 58.6% met the criteria for pure MDD and 41.4% were found to have subthreshold bipolar disorder, at a cumulative incidence of 9.3%.
MDD patients with subthreshold bipolar disorder were more likely to convert to any bipolar disorder than other MDD patients, at 7.2% versus 1.7%, or an odds ratio of 4.57, with DSM-IV criterion D particularly associated with conversion.
Subthreshold bipolar disorder was also associated with a significantly higher rate of panic disorder than pure MDD, at 12.3% versus 4.7%, as well as nicotine dependence and alcohol dependence, at 43.6% versus 32.7% and 17.9% versus 9.9%, respectively. Furthermore, subthreshold bipolar disorder was linked with a tendency toward more criminal acts than pure MDD, at 25.1% versus 18.9%.
The researchers conclude in the Archives of General Psychiatry: “This study might be seen as additional evidence that MDD is a heterogeneous phenotype that is overdiagnosed at the expense of bipolar disorder.
“A broadening of the concept of bipolarity and a more comprehensive screening of bipolarity might be substantial not only for future research but also for providing adequate treatment to patients with a serious mental disorder characterized by a considerably increased risk of a chronic course with a debilitating decrease in functioning.”
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