Discuss Bipolar
Blog to discuss being Bipolar
Results from a US study support the existence of a bipolar disorder (BD) prodrome that is similar to the schizophrenia prodrome.
“There is an increased interest in early intervention strategies for severe mental disorders with hopes of mitigating the emergence and impact of the illness,” write Doreen Olvet (North Shore-Long Island Jewish Health System, Glen Oaks, New York) and team in the journal Schizophrenia Research.
They explain that “although BD and schizophrenia may have overlapping etiologies, few studies have investigated the potential prodrome in BD.”
To address this, the researchers studied baseline data on 147 patients, aged an average of 16 years, who were deemed to be at clinical high-risk (CHR) for schizophrenia.
Of these, 24 eventually developed schizophrenia or a psychotic disorder (pre-SZ), eight unexpectedly developed BD (pre-BD), and the remaining 115 did not develop either disorder (non-converters).
The researchers found that pre-SZ and pre-BD patients had significantly more severe attenuated positive symptoms at baseline than non-converters, with positive symptoms scores of 13.25 and 10.88 versus 7.25, respectively, on the Scale of Prodromal Symptoms (SOPS). The difference in positive symptom scores between pre-SZ and pre-BD patients was not significant.
Pre-SZ and pre-BD patients were also more likely to be taking antipsychotic medications at baseline than non-converters, at 58.3% and 50.0% versus 14.8%, respectively.
There were no significant differences between the pre-SZ and pre-BD patients regarding global measures of functioning or global neurocognitive scores.
Olvet and team conclude: “Results from this study support the notion that patients can be identified during the bipolar prodrome, and that at least some of its features may overlap clinically and neurocognitively with the schizophrenia prodrome.”
They add: “Overall, these data are preliminary, but they suggest that the [schizophrenia] CHR approach is feasible in bipolar disorder, and call for the need to develop prodromal measures specific for defining CHR for bipolar disorder.”
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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Bipolar patients with a current mood episode who have subthreshold symptoms of the opposite polarity have worse outcomes than those without such symptoms, Australian study findings suggest.
Mixed clinical states in bipolar disorder are diagnostically complex and have treatment implications. While the current criteria specify that mixed states require the presence of full symptoms for both depressive and manic episodes, the impact of subthreshold symptoms of opposite polarity has not been fully examined.
To investigate further, S Dodd, from the University of Melbourne in Victoria, and colleagues studied 239 patients with either bipolar I disorder or schizoaffective disorder, bipolar type, dividing them into either those having pure, mixed (?3 concurrent hypomanic symptoms), or no depression (63, 33, and 143 patients, respectively) or pure, mixed (?2 concurrent depressive symptoms), or no mania (3, 33, and 203 patients, respectively). Clinical data were collected every 3 months for 24 months.
At 24 months, mixed depression and pure depression groups had significantly worse outcomes on almost all measures than patients with no depression at study entry. Young Mania Rating Scale (YMRS) total scores were significantly higher in the mixed depression than pure depression groups. In addition, both manic and depressive symptomatologies were higher in mixed depression patients than other participants at every visit during follow-up.
Compared with other patients, those with mixed mania had significantly worse scores on the Short Form Health Survey Physical Component Score, 21-item Hamilton Depression Rating Scale total score, YMRS total score, Clinical Global Impressions Scale Mania, Depression, and Bipolar subscales, and Streamlined Longitudinal Interview Clinical Evaluation from the Longitudinal Interval Follow-up Evaluation total score.
Again, depressive and manic symptom scores were higher for mixed mania patients versus other participants at every visit, the team notes in the Journal of Affective Disorders.
“In participants with a current mood episode, the presence of subthreshold symptoms of the opposite polarity predicted an adverse prognosis,” the team says.
“Identification of three or more hypomanic symptoms in currently depressed participants or two or more depressive symptoms in currently manic participants was associated with poorer clinical outcomes over a 24-month period.”
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
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