Bipolar disorder patients in mixed states appear to have more active private religious lives, including prayer or meditation, compared with their counterparts in depressed, manic, or euthymic states, US researchers report.

This finding supports the theory that being both depressed and manic poses a greater level of distress than being depressed or manic alone, say Mario Cruz, from Western Psychiatric Institute and Clinic in Pittsburgh, Pennsylvania, and colleagues. This in turn could prompt individuals in mixed states to increase the frequency of their religious behaviors.

The researchers note that, although some studies have suggested potential beneficial effects of different forms of religious coping for patients with psychiatric illness, others have found spiritual beliefs conflict with illness models and medical advice.

They therefore recommend that “providers should assess the religious activities of individuals with bipolar disorder in mixed states and how they may complement/deter ongoing treatment.”

A total of 334 patients receiving care for bipolar disorder at an urban Veterans Affairs mental health clinic were surveyed to assess their public (frequency of church attendance), private (frequency of prayer/meditation), and subjective forms (influence of beliefs on life) of religious involvement.

Among the patients, 73 were currently manic/hypomanic, 96 were in a mixed episode, 62 were in a depressed episode, and 103 were euthymic.

The results of multivariate analyses, controlling for functional disability, anxiety, and binge drinking, showed that patients in a mixed state had a significantly higher rate of prayer/meditation than other patients, at an odds ratio of 1.29.

Conversely, the rate of prayer/meditation was significantly lower in patients who were euthymic, compared with other patients, at an odds ratio of 0.84.

Depression and mania were not associated with religious involvement and no significant associations were found between church attendance and influence of beliefs and participants’ bipolar state.

“We recommend to mental health providers that if an individual suffering from bipolar disorder is religious, his/her religious activities should be explored to assess the presence of a mixed state and to determine how his/her religious activities influence treatment-seeking behaviors,” Cruz et al conclude in the journal Bipolar 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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Study results suggest that the lifetime presence of recurrent panic attacks may differentiate between subgroups of patients with mood disorders, especially in those with bipolar disorder.

To elucidate the relationship between the comorbidity of panic and affective disorders, UK researchers compared lifetime clinical illness characteristics and items of symptomatology in 290 patients with bipolar I disorder (BPI) and 335 patients with major depressive disorder (MDDR) according to the lifetime presence of recurrent panic attacks.

Nick Craddock (Cardiff University) and co-authors found that 47% and 58% of patients with BPI and MDDR, respectively, had a lifetime history of panic attacks.

A higher score on the Beck Depression Inventory was significantly associated with the lifetime presence of panic attacks in patients with BPI and MDDR (odds ratio [OR]=1.05), as did a younger age at the baseline interview in patients with BPI (OR=0.97).

Compared with patients with BPI and without a lifetime history of recurrent panic attacks, those with a history of panic attacks were significantly more likely to experience suicidal behavior, more severe impairment during the worst depressive episode (as rated using the Global Assessment Scale), and more frequent and severe depressive episodes (according to the Bipolar Affective Disorder Dimension Scale [BADDS]) with corresponding odds ratios (ORs) of 1.82, 0.97, and 1.02.

Patients with MDDR and a positive history of recurrent panic attacks were twice as likely to have had inpatient treatment at least once in their lifetime as their counterparts without a panic attack history, and scored higher on the BADDS (OR=1.03).

The researchers also looked at items of psychopathology in BPI and MDDR patients using the Operational Criteria symptom checklist. They found that patients with BPI and a history of panic attacks were approximately twice as likely to experience diurnal variation, slowed activity, and insomnia, and almost four times more likely to early-morning waking and agitated activity compared with BPI patients without panic attacks.

Furthermore, MDDR patients with a panic attack history were approximately twice as likely to experience suicidal ideation and slowed activity as MDDR patients without this history.

The authors note that no association was seen between the lifetime presence of panic attacks and clinical characteristics of illness relating to mania.

“The presence of recurrent panic attacks in bipolar and unipolar disorder may be indicative of a course of illness associated with a greater depressive morbidity,” conclude the authors in the journal Bipolar Disorders.

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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