| Serretti
A, Mandelli L, Lattuada E, Cusin C, Smeraldi E. Clinical and demographic
features of mood disorder subtypes. Psychiatry Res 2002
Nov 15;112(3):195-210 "THE AIM OF THIS STUDY WAS TO INVESTIGATE DEMOGRAPHIC,
CLINICAL AND SYMPTOMATOLOGIC FEATURES OF THE FOLLOWING MOOD DISORDER SUBTYPES:
bipolar disorder I (BP-I); bipolar disorder II (BP-II); major depressive disorder,
recurrent (MDR); and major depressive episode, single episode (MDSE). A total
of 1832 patients with mood disorders (BP-I=863, BP-II=141, MDR=708, and MDSE=120)
were included in our study. The patients were assessed using structured diagnostic
interviews and the operational criteria for psychotic illness checklist (n=885),
the Hamilton depression rating scale (n=167), and the social adjustment scale
(n=305). The BP-I patients were younger; had more hospital admissions; presented
a more severe form of symptomatology in terms of psychotic symptoms, disorganization,
and atypical features; and showed less insight into their disorder than patients
in the other groups. Compared with the major depressive subgroups, BP-I patients
were more likely to have an earlier age at onset, an earlier first lifetime psychiatric
treatment, and a greater number of illness episodes. BP-II patients had a higher
suicide risk than both BP-I and MDSE patients. MDSE patients presented less severe
symptomatology, lower age at observation, and a higher number of males. The retrospective
approach and the selection constraints due to the inclusion criteria are the main
limitations of the study. Our data support the view that BP-I disorder is quite
different from the remaining mood disorders from a demographic and clinical perspective,
with BP-II disorder having an intermediate position to MDR and MDSE, that is,
as a less severe disorder. This finding may help in the search for the biological
basis of mood disorders." [Abstract] Reichenberg
A, Weiser M, Rabinowitz J, Caspi A, Schmeidler J, Mark M, Kaplan Z, Davidson M.
A population-based cohort study of premorbid intellectual, language,
and behavioral functioning in patients with schizophrenia, schizoaffective disorder,
and nonpsychotic bipolar disorder. Am J Psychiatry 2002
Dec;159(12):2027-35 "OBJECTIVE: The premorbid intellectual, language,
and behavioral functioning of patients hospitalized for schizophrenia, schizoaffective
disorder, or nonpsychotic bipolar disorder was compared with that of healthy comparison
subjects. METHOD: The Israeli Draft Board Registry, which contains measures of
intellectual, language, and behavioral functioning for the unselected population
of 16- to 17-year-olds, was merged with the National Psychiatric Hospitalization
Case Registry, which contains diagnoses for all patients with psychiatric hospitalizations
in Israel. The database was used to identify adolescents with no evidence of illness
at their draft board assessment who were later hospitalized for nonpsychotic bipolar
disorder (N=68), schizoaffective disorder (N=31), or schizophrenia (N=536). The
premorbid functioning of these subjects was compared to that of nonhospitalized
individuals matched for age, gender, and school attended at the time of the draft
board assessment. The diagnostic groups of hospitalized subjects were also compared.
RESULTS: Relative to the comparison subjects, subjects with schizophrenia showed
significant premorbid deficits on all intellectual and behavioral measures and
on measures of reading and reading comprehension. Subjects with schizophrenia
performed significantly worse on these measures than those with a nonpsychotic
bipolar disorder, who did not differ significantly from the comparison subjects
on any measure. Subjects with schizoaffective disorder performed significantly
worse than the comparison subjects only on the measure of nonverbal abstract reasoning
and visual-spatial problem solving and performed significantly worse than subjects
with nonpsychotic bipolar disorder on three of the four intellectual measures
and on the reading and reading comprehension tests. CONCLUSIONS: The results support
a nosologic distinction between nonpsychotic bipolar disease and schizophrenia
in hospitalized patients." [Abstract] Recognize
the subtleties of depression in primary care. Dis Manag
Advis 2002 Feb;8(2):28-32, 17 "PCPs: learn how to recognize bipolar disorder
in your depressed patients. Experts maintain that a high percentage of depressed
patients who are treatment-refractory may actually suffer from a milder form of
bipolar disorder known as bipolar II. Not only is this condition much more prevalent
than previously thought, it is often misdiagnosed, leading to poor outcomes and
continuing utilization. While PCPs may not be comfortable prescribing the mood-stabilizing
drugs generally indicated for bipolar cases, they can easily learn how to recognize
the potential for this condition so patients can get the help they need quickly."
[Abstract] Kupfer
DJ, Frank E, Grochocinski VJ, Cluss PA, Houck PR, Stapf DA. Demographic
and clinical characteristics of individuals in a bipolar disorder case registry.
J Clin Psychiatry 2002 Feb;63(2):120-5 "BACKGROUND: The goal of this
analysis was to characterize a cohort of 3000 persons who self-identified as having
bipolar disorder by demographic, clinical, and treatment characteristics and to
document the burden that this disorder imposed on their lives. METHOD: The Stanley
Center Bipolar Disorder Registry used a variety of recruitment methods to reach
people with bipolar disorder. The cohort included those currently in treatment
and those active in support groups. Registrants completed an interviewer-administered
questionnaire to obtain information on demographic characteristics, clinical history,
and treatment history. RESULTS: The median age of the 2839 patients who were analyzed
was 40.1 years, 64.5% were women, and over 90% were white. The median age at onset
was 17.5 years, and the mean was 19.8 years. Despite the fact that over 60% completed
at least some college and 30% completed college, 64% were currently unemployed.
The patients' family histories point to a high prevalence of mental disorder in
the families, especially mood disorders. Patients were concurrently taking multiple
medications, and more than one third were taking at least 3 types of psychotropic
medications. This pattern of pharmacotherapy was consistent with participants'
overall mood ratings, which demonstrated how unusual it was for them to be symptom-free
over a 6-month period. CONCLUSION: Our present findings point to the chronicity
and severity of bipolar disorder as experienced in the community. We still need
to develop better interventions, ensure access to care consistent with current
consensus guidelines, and initiate care as early as possible in the course of
the condition." [Abstract] Wang
J, Chen X, Lou F. [Event-related potentials and suicide behavior
in patients with affective disorder] Zhonghua Yi Xue Za
Zhi 2000 Apr;80(4):275-7 "OBJECTIVE: To investigate P300 and contingent
negative variations (CNV) of patients with affective disorder and its clinical
significance. METHODS: 39 depressives, 22 maniacs and 33 normal controls were
included in this study. Both P300 and CNV were recorded in every subject, using
a nicolet spirit instrument. RESULTS: Both depression and mania groups presented
prolonged P300-P3b latency and decreased P300-P3 and CNV amplitudes compared with
normal controls. Decreased P300 & CNV amplitudes were further related to the
history of suicide behavior in the two patient groups. CONCLUSION: The clinical
significance of event-related potentials was confirmed in this study, while the
biological correlates of suicide behavior need further and intensive study."
[Abstract]
Benazzi F. Prevalence and clinical correlates
of residual depressive symptoms in bipolar II disorder.
Psychother Psychosom 2001 Sep-Oct;70(5):232-8 "BACKGROUND: Most patients
with unipolar and bipolar I disorder have residual symptoms, despite successful
treatment. The appraisal of subsyndromal symptomatology has important implications
for pathophysiological models of disease and relapse prevention. Residual symptoms
in bipolar II disorder were studied insufficiently. The study of residual symptoms
in bipolar II disorder is important, because many depressed outpatients may suffer
from it and because bipolar II disorder may be distinct from type I. The study
aims were to assess the prevalence and clinical correlates of persistent residual
depressive symptoms in bipolar II disorder. METHODS: 138 consecutive patients
with bipolar II disorder and 83 unipolar disorder outpatients, presenting for
major depressive episode treatment in private practice, were interviewed with
the Structured Clinical Interview for DSM-IV Axis I Disorders - Clinician's Version.
Study variables were persistent (more than 2 years) residual depressive symptoms,
age, gender, age at onset, illness duration, recurrences, axis I comorbidity,
severity, psychotic, melancholic and atypical features. RESULTS: The prevalence
of residual depressive symptoms was 44.9% in bipolar II disorder and 43.3% in
unipolar disorder. Residual depressive symptoms in bipolar II and unipolar disorders
were significantly and positively associated with illness duration and recurrences.
CONCLUSIONS: Persistent residual depressive symptoms were common in bipolar II
disorder. Residual unipolar and bipolar II depressive symptoms were related to
duration of illness and number of recurrences. Reducing these variables could
reduce and prevent residual symptoms. A mechanism of kindling (more mood episodes
leading to worse outcome) could be that of leaving a larger and larger amount
of residual symptoms after the acute episode has subsided. Copyright 2001 S. Karger
AG, Basel." [Abstract] Nath
J, Sagar R. Late-onset bipolar disorder due to hyperthyroidism.
Acta Psychiatr Scand 2001 Jul;104(1):72-3; discussion 74-5 "OBJECTIVE:
Bipolar disorder starts typically in early age and late-onset cases are rare.
Late-onset cases are more likely to have comorbid medical illnesses responsible
for them. This case report highlights late-onset bipolar disorder due to hyperthyroidism.
METHOD: A 65-year-old patient of bipolar disorder has been described. RESULT:
Physical examination and laboratory investigations detected presence of hyperthyroidism
and the patient was treated with antithyroid and anxiolytics. CONCLUSION: A thorough
examination and investigation are required in late-onset cases of bipolar disorder
to rule out secondary causes. Definitive antimanic agents or mood stabilizers
may not be required in such cases." [Abstract] Gassab
L, Mechri A, Gaha L, Khiari G, Zaafrane F, Zougaghi L. [Bipolarity
correlated factors in major depression: about 155 tunisian inpatients]
Encephale 2002 Jul-Aug;28(4):283-9 "Concerning the validity of predictive
factors of bipolarity proposed by Akiskal, we found: history of bipolar disorders
(Sensibility: 29.2%, specificity: 96.6%, Positive Predictive Value (PPV): 93%),
hypersomnia (Sensibility: 51%, specificity: 80%, PPV: 80%), onset before the age
of 25 years (Sensibility: 62.5%, specificity: 70%, PPV: 77%), psychomotor inhibition
(Sensibility: 83.3%, specificity 58%, PPV: 76%), and psychotic characteristics
(Sensibility: 69.8%, specificity: 62.7%, PPV: 75%)." [Abstract] Maj,
Mario, Pirozzi, Raffaele, Magliano, Lorenza, Bartoli, Luca The
Prognostic Significance of "Switching" in Patients With Bipolar Disorder:
A 10-Year Prospective Follow-Up Study Am J Psychiatry 2002
159: 1711-1717 "OBJECTIVE: This study explored whether "switching"
(i.e., the direct transition from one mood polarity to the other) has significant
prognostic implications in patients with bipolar disorder. METHOD: Bipolar disorder
patients (N=97) whose first prospectively observed episode included at least one
mood polarity switch and 97 bipolar disorder patients whose index episode was
monophasic were compared with respect to several demographic and historical variables,
symptomatic features of the index episode, time to recovery from the index episode,
time spent in an affective episode during a prospective observation period, and
psychopathological and psychosocial outcome at a 10-year follow-up interview.
RESULTS: Patients whose index episode included at least two mood polarity switches
spent significantly more time in an affective episode during the observation period
and had a significantly worse psychopathological and psychosocial outcome 10 years
after recruitment than those whose index episode included only one mood polarity
switch or was monophasic. Patients whose polyphasic index episode started with
depression spent a significantly higher proportion of time in an affective episode
and had a significantly worse 10-year outcome than those whose polyphasic index
episode started with mania or hypomania. Retention of the switching pattern throughout
the observation period was seen in 42.4% of patients whose index episode started
with mania and in 65.2% of those whose index episode started with depression.
CONCLUSIONS: An index episode including at least two mood polarity switches, especially
if starting with depression, is associated with a poor long-term outcome in patients
with bipolar disorder. This pattern represents a significant target for new pharmacological
and psychosocial treatment strategies. " [Abstract]
Lenox RH, Gould TD, Manji HK. Endophenotypes
in bipolar disorder [This article was prepared by a group consisting of both United
States Government employees and non-United States Government employees, and as
such is subject to 117 U.S.C. Sec. 105.] Am J Med Genet
2002 May 8;114(4):391-406 "Findings in patients with bipolar disorder
that may eventually be useful as endophenotypes include abnormal regulation of
circadian rhythms (the sleep/wake cycle, hormonal rhythms, etc.), response to
sleep deprivation, P300 event-related potentials, behavioral responses to psychostimulants
and other medications, response to cholinergics, increase in white matter hyperintensities
(WHIs), and biochemical observations in peripheral mononuclear cells."
[Abstract] Begley
CE, Annegers JF, Swann AC, Lewis C, Coan S, Schnapp WB, Bryant-Comstock L.
The lifetime cost of bipolar disorder in the US: an estimate for new
cases in 1998. Pharmacoeconomics 2001;19(5 Pt 1):483-95
"OBJECTIVE: To develop a cost model that estimates the total and per case
lifetime cost of bipolar disorder for 1998 incident cases in the US. STUDY DESIGN:
Lifetime cost simulation model. PERSPECTIVE: Societal. METHODS: Age- and gender-specific
incidence of bipolar disorder in 1998 was estimated by simulation based on existing
prevalence data. The course of illness and mental health service cost of 6 clinically
defined prognostic groups was estimated based on the research literature and the
judgement of panels of experts. Excess cost of general medical care was estimated
based on claims data from a large insurer. Indirect cost was projected including
excess unemployment and reduced earnings reported in the National Comorbidity
Survey. Comorbidity treatment and indirect cost related to alcohol (ethanol) and
drug abuse was added based on a National Institute on Drug Abuse study. RESULTS:
The present value of the lifetime cost of persons with onset of bipolar disorder
in 1998 was estimated at 24 billion US dollars ($US). Average cost per case ranged
from $US11,720 for persons with a single manic episode to $US624,785 for persons
with nonresponsive/chronic episodes. CONCLUSION: The model indicates the potential
cost savings of preventing a case of bipolar disorder and underscores the importance
of achieving a stable outcome in new cases to limit the economic consequences
of the disorder." [Abstract] Salloum
IM, Cornelius JR, Mezzich JE, Kirisci L, Daley DC, Spotts CR, Zuckoff A. Characterizing
female bipolar alcoholic patients presenting for initial evaluation.
Addict Behav 2001 May-Jun;26(3):341-8 "This study examined gender differences
of age and race-matched group of bipolar disorder (BPO) patients with comorbid
alcohol dependence (AD; n = 65; males = 35, females = 30) to a group of BPO patients
without comorbid AD (n = 61; males = 22, females = 39). The two groups were also
similar on marital status and frequency of BPO subtypes. The results revealed
that female bipolar alcoholic patients were more likely to report depressive symptoms
as compared to either male bipolar alcoholics or both male and female non-alcoholic
bipolar patients. When compared to male bipolar alcoholics, they had higher frequency
of depressed mood, slow motor behavior, low self-esteem, decreased libido, decreased
appetite, and higher general anxiety symptoms. On the other hand, female bipolar
alcoholics differed from female non-alcoholic bipolar patients on reports of mood
lability, depressed mood, low self-esteem, suicidal indicators, decreased libido,
and general anxiety symptoms. These results raise the question of whether alcohol
increases the frequency of depressive symptoms among female bipolar patients."
[Abstract] Potash
JB, Willour VL, Chiu YF, Simpson SG, MacKinnon DF, Pearlson GD, DePaulo JR Jr,
McInnis MG. The familial aggregation of psychotic symptoms in bipolar
disorder pedigrees. Am J Psychiatry 2001 Aug;158(8):1258-64
"OBJECTIVE: Symptomatic overlap between affective disorders and schizophrenia
has long been noted. More recently, family and linkage studies have provided some
evidence for overlapping genetic susceptibility between bipolar disorder and schizophrenia.
If shared genes are responsible for the psychotic manifestations of both disorders,
these genes may result in clustering of psychotic symptoms in some bipolar disorder
pedigrees. The authors tested this hypothesis in families ascertained for a genetic
study of bipolar disorder. METHOD: Rates of psychotic symptoms-defined as hallucinations
or delusions-during affective episodes were compared in families of 47 psychotic
and 18 nonpsychotic probands with bipolar I disorder. The analysis included 202
first-degree relatives with major affective disorder. RESULTS: Significantly more
families of psychotic probands than families of nonpsychotic probands (64% versus
28%) contained at least one relative who had affective disorder with psychotic
symptoms. Significantly more affectively ill relatives of psychotic probands than
of nonpsychotic probands (34% versus 11%) had psychotic symptoms. An analysis
of clustering of psychotic subjects across all families revealed significant familial
aggregation. Clustering of psychosis was also apparent when only bipolar I disorder
was considered the affected phenotype. CONCLUSIONS: Psychotic bipolar disorder
may delineate a subtype of value for genetic and biological investigations. Families
with this subtype should be used to search for linkage in chromosomal regions
10p12-13, 13q32, 18p11.2, and 22q11-13, where susceptibility genes common to bipolar
disorder and schizophrenia may reside. Putative schizophrenia-associated biological
markers, such as abnormal evoked response, oculomotor, and neuroimaging measures,
could similarly be explored in such families." [Abstract] MURPHY,
F.C., SAHAKIAN, B.J. Neuropsychology of bipolar disorder
Br J Psychiatry 2001 178: 120-127 "Unavoidable methodological problems
often weaken the conclusions drawn from neuropsychological studies of bipolar
disorder, with group differences confounded by differences in medication regimen,
severity of illness and other general illness factors." [Full
Text] MacQueen GM, Young LT, Joffe RT. A
review of psychosocial outcome in patients with bipolar disorder.
Acta Psychiatr Scand 2001 Mar;103(3):163-70 "OBJECTIVE: The aim of this
paper is to review outcome in patients with bipolar disorder as assessed by interepisode
level of functioning, as until recently this dimension of outcome has been relatively
under-emphasized. METHOD: Studies that examined psychosocial outcome in bipolar
disorder were reviewed on the basis of rating measurements employed, length of
follow-up, number of subjects followed and degree of impairment reported. Studies
were included only if results from patients with bipolar and unipolar disorder
were reported in such a way that the groups could be distinguished. RESULTS: When
studies of psychosocial outcome in bipolar disorder are examined in aggregate,
it appears that 30-60% of individuals with this disorder fail to regain full functioning
in occupational and social domains. CONCLUSION: This review highlights the fact
that inter-episode functional recovery is incomplete in some patients, suggesting
that comprehensive rehabilitative assessment and intervention may be essential
to reduce the morbidity associated with this disorder." [Abstract] Wendel
JS, Miklowitz DJ, Richards JA, George EL. Expressed emotion and
attributions in the relatives of bipolar patients: an analysis of problem-solving
interactions. J Abnorm Psychol 2000 Nov;109(4):792-6
"Among the relatives of schizophrenic and depressed patients, high expressed
emotion (EE) attitudes are associated with "controllability attributions"
about the causes of patients' symptoms and problem behaviors. However, previous
studies have judged EE attitudes and causal attributions from the same assessment
measure, the Camberwell Family Interview (CFI; C. E. Vaughn & J. P. Leff,
1976). The authors examined causal attributions among relatives of 47 bipolar
patients, as spontaneously expressed to patients in family problem-solving interactions
during a postillness period. Relatives rated high EE during the patients' acute
episode (based on the CFI) were more likely than relatives rated low EE to spontaneously
attribute patients' symptoms and negative behaviors to personal and controllable
factors during the postillness interactional assessment. Thus, the EE-attribution
linkage extends to the relatives of bipolar patients evaluated during a family
interaction task." [Abstract] Johnson
SL, Sandrow D, Meyer B, Winters R, Miller I, Solomon D, Keitner G.
Increases in manic symptoms after life events involving goal attainment.
J Abnorm Psychol 2000 Nov;109(4):721-7 "Bipolar disorder has been conceptualized
as an outcome of dysregulation in the behavioral activation system (BAS), a brain
system that regulates goal-directed activity. On the basis of the BAS model, the
authors hypothesized that life events involving goal attainment would promote
manic symptoms in bipolar individuals. The authors followed 43 bipolar I individuals
monthly with standardized symptom severity assessments (the Modified Hamilton
Rating Scale for Depression and the Bech-Rafaelsen Mania Rating Scale). Life events
were assessed using the Goal Attainment and Positivity scales of the Life Events
and Difficulties Schedule. As hypothesized, manic symptoms increased in the 2
months following goal-attainment events, but depressed symptoms were not changed
following goal-attainment events. These results are congruent with a series of
recent polarity-specific findings." [Abstract]
Woods SW. The economic burden of bipolar
disease. J Clin Psychiatry 2000;61 Supp 13:38-41 "This
article reviews the prevalence of bipolar disorder, as well as the studies quantifying
the burden of illness and cost of illness of this condition. It also discusses
barriers to treatment. Multiple epidemiologic studies suggest a lifetime prevalence
of bipolar I disorder of nearly 1%, making it a common illness. Bipolar illness
is not only common, but for those affected, it is a significant source of distress,
disability, loss of life through suicide, and burden on relatives and other caregivers.
In 1990, the World Health Organization identified bipolar disorder as the sixth
leading cause of disability-adjusted life years in the world among people aged
15 to 44 years. Costs to society appear to be roughly 70% of those for schizophrenia.
Despite the burden imposed by bipolar illness and the availability of several
effective treatments for the illness, many bipolar patients in the United States
continue to face significant barriers to care." [Abstract] Hinkle
P. Bipolar illness in primary care: an overview.
Lippincotts Prim Care Pract 2000 Mar-Apr;4(2):163-73 "Primary care providers
are in the front line of detecting and diagnosing psychiatric illness. Managed
care barriers to direct psychiatric treatment have made it necessary for primary
care providers to increase their sophistication in the recognition of psychiatric
disorders. Primary care providers often formulate provisional diagnoses and initiate
treatment or specialty referral in spite of the time constraints of the primary
care setting. The patient presenting in primary care with an affective disturbance
must be evaluated for a major mood disorder, which includes unipolar and bipolar
illness. Research has shown that more patients than previously estimated have
milder forms of bipolar illness disorder, such as bipolar type II and cyclothymia.
Patients with these milder forms of bipolar are less likely to present for treatment
in a psychiatric setting and more likely to share symptoms of the illness in a
primary care setting. This article provides an overview for the primary care provider
in the detection, assessment, and treatment of bipolar patients with an emphasis
on the differentiation of unipolar and bipolar depression." [Abstract] Mynett-Johnson
L, Kealey C, Claffey E, Curtis D, Bouchier-Hayes L, Powell C, McKeon P. Multimarkerhaplotypes
within the serotonin transporter gene suggest evidence of an association with
bipolar disorder. Am J Med Genet 2000 Dec 4;96(6):845-9
"Previously we obtained modest linkage evidence implicating 17q11. 1-12 in
bipolar disorder. A modified genome screen, based on gene-rich regions, on a collection
of Irish sib-pair nuclear families revealed excess allele sharing at markers flanking
the gene encoding the serotonin transporter (5-HTT; hSERT). Here we describe a
study designed to combine the advantages of family-based association studies with
the consideration of multiple polymorphic markers within a candidate gene. Ninety-two
Irish families, with a total of 106 proband-parent trios, have been genotyped
for 3 previously known polymorphisms within hSERT (5-HTTLPR, intron 2 VNTR, and
3' UTR G/T). Data from two and three polymorphic marker haplotypes revealed a
number of marker combinations that showed evidence supportive of association;
the most significant being for polymorphisms 5-HTTLPR and 3' UTR G/T (global chi(2),
12.91, df 3, P = 0.005). In addition, modest evidence of association also was
observed for 5-HTTLPR alone. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:845-849,
2000. Copyright 2000 Wiley-Liss, Inc." [Abstract] Benabarre
A, Vieta E, Lomena F, Martinez-Aran A, Bernardo M, Corbella B, Colom F, Reinares
M, Gasto C. [Functional neuroimaging of emotions and bipolar disorder]
Actas Esp Psiquiatr 2000 Jul-Aug;28(4):257-61 "In
this review we comment the results of functional neuroimaging works of emotions
on normal population and some parallelisms with the emotional changes of bipolar
disorder correlated with their functional neuroimaging. Initially we refer the
emotional ontogenetical development of human brain based on regional cerebral
sanguineous flow evolution (FSC). Secondly we describe the differences of FSC
between the externally generated emotions versus internally; between positive
versus negative emotions and the correlation between FSC and some facial expressions.
When FSC of bipolar disorder is compared with normal emotions on general population,
we observe that temporal cortex, the prefrontal medial and insular anterior cortex,
change their perfusion with the switch or the change of emotional expression.
It is possible to determine if the findings obtained in samples of healthy subjects
and bipolar patients converge in a dimensional model, or if on the contrary they
support the categorical hypotheses, moving the emotional aspects to a second term
on bipolar disorder." [Abstract]
Zarate CA Jr, Tohen M, Land M, Cavanagh S. Functional
impairment and cognition in bipolar disorder. Psychiatr
Q 2000 Winter;71(4):309-29 "Bipolar disorder is a common, chronic and
severe mental disorder, affecting approximately 2% of the adult population. Bipolar
disorder causes substantial psychosocial morbidity that frequently affects the
patient's marriage, children, occupation, and other aspects of the patient's life.
Few studies have examined the functional impairment in patients with affective
illness. Earlier outcome studies of mania reported favorable long-term outcomes.
However, modern outcome studies have found that a majority of bipolar patients
evidence high rates of functional impairment. These low reports of functional
recovery rates are particularly surprising. The basis for such limited functional
recovery is not entirely clear. Factors associated with functional dysfunction
include presence of inter-episode symptoms, neuroleptic treatment, lower social
economic class, and lower premorbid function. Cognitive dysfunction, a symptom
domain of schizophrenia, has been identified as an important measure of outcome
in the treatment of schizophrenia. Recently, there has been some suggestion that
there may be impaired neuropsychological performance in euthymic patients with
recurring mood disorders. Whether impaired neuropsychological performance in associated
with the functional impairment in bipolar patients who have achieved syndromal
recovery is an intriguing question. The literature on functional impairment and
cognition in bipolar disorder is reviewed." [Abstract] Ospina-Duque
J, Duque C, Carvajal-Carmona L, Ortiz-Barrientos D, Soto I, Pineda N, Cuartas
M, Calle J, Lopez C, Ochoa L, Garcia J, Gomez J, Agudelo A, Lozano M, Montoya
G, Ospina A, Lopez M, Gallo A, Miranda A, Serna L, Montoya P, Palacio C, Bedoya
G, McCarthy M, Reus V, Freimer N, Ruiz-Linares A. An association
study of bipolar mood disorder (type I) with the 5-HTTLPR serotonin transporter
polymorphism in a human population isolate from Colombia.
Neurosci Lett 2000 Oct 13;292(3):199-202 "The short variant of a functional
length polymorphism in the promoter region of the serotonin transporter has been
associated with several behavioural and psychiatric traits, including bipolar
mood disorder. The same short allele has also been implicated as a modifier of
the bipolar phenotype. Here we evaluate the etiologic/modifier role of this polymorphism
in a case (N=103) / control (N=112) sample for bipolar mood disorder (type I)
collected from an isolated South American population. We did not detect an association
between bipolar disorder and the 5-HTT promoter polymorphism in this sample. However,
an excess of the short allele was seen in younger cases and in cases with psychotic
symptoms. When combined with data from the literature, the increased frequency
of the short allele in patients with psychotic symptoms was statistically significant."
[Abstract] Furukawa
TA, Konno W, Morinobu S, Harai H, Kitamura T, Takahashi K. Course
and outcome of depressive episodes: comparison between bipolar, unipolar and subthreshold
depression. Psychiatry Res 2000 Nov 20;96(3):211-20
"It is pragmatically important to know the comparative prognoses of bipolar,
unipolar and subthreshold depressions after they present to clinical attention.
Previous studies focusing on bipolar and/or unipolar depressions have questionable
generalizability because of overrepresentation of inpatients and/or refractory
patients, and no study has yet focused on the length of subthreshold depression.
The Group for Longitudinal Affective Disorders Study (GLADS) in Japan is conducting
a prospective, serial follow-up study of broadly defined mood disorder patients,
who had not received treatment for their index episode before study entry. The
median time to recovery for bipolar depression was 2.0 months (95%CI: 0.9-3.1),
that for unipolar depression 3.0 (2.5-3.6), and that for subthreshold depression
3.2 (0-12.3). Survival analyses revealed no statistically significant difference
among the three. Neither was the total time unwell significantly different among
the three: on average, these patients were symptomatic with two or more significant
affective symptoms for 9.5 (8.0-10.9) months out of the initial 24 months of follow-up.
The bipolar depressed patients tended to present with graver functional impairment
at intake, but thereafter there was no statistically significant difference in
the global functioning of these three diagnostic subgroups. In our sample, patients
with depressive disorder not otherwise specified appeared to suffer both symptomatologically
and functionally as much as patients with major mood disorders." [Abstract] Berrettini
WH. Are schizophrenic and bipolar disorders related? A review of
family and molecular studies. Biol Psychiatry 2000 Sep
15;48(6):531-8 "Schizophrenic and bipolar disorders are similar in several
epidemiologic respects, including age at onset, lifetime risk, course of illness,
worldwide distribution, risk for suicide, gender influence (men and women at equal
risk for both groups of disorders), and genetic susceptibility. Despite these
similarities, schizophrenia and bipolar disorders are typically considered to
be separate entities, with distinguishing clinical characteristics, non-overlapping
etiologies, and distinct treatment regimens. Over the past three decades, multiple
family studies are consistent with greater nosologic overlap than previously acknowledged.
Molecular linkage studies (conducted during the 1990s) reveal that some susceptibility
loci may be common to both nosologic classes. This indicates that our nosology
will require substantial revision during the next decade, to reflect this shared
genetic susceptibility, as specific genes are identified." [Abstract] Dunayevich
E, Keck PE. Prevalence and description of psychotic features in
bipolar mania. Curr Psychiatry Rep 2000 Aug;2(4):286-90
"Psychotic symptoms are common in both the manic and depressive phases of
bipolar disorder. More than half of patients with bipolar disorder will experience
psychotic symptoms in their lifetime. Grandiose delusions are the most common
type of psychotic symptom, but any kind of psychotic symptom, including thought
disorder, hallucinations, mood-incongruent psychotic symptoms, and catatonia can
present as part of a manic episode. Psychotic symptoms suggest poor prognosis
when they occur in the absence of affective symptoms. However, psychotic symptoms
can mask affective symptoms and make the distinction between manic-depressive
illness and other psychiatric disorders difficult, especially in minorities. Careful
assessment of prior psychiatric history, family history, and treatment response
can aid in the differentiation of affective disorders with psychotic features
from psychotic disorders." [Abstract] Somnath
CP, Janardhan Reddy YC, Jain S. Is there a familial overlap between
schizophrenia and bipolar disorder? J Affect Disord 2002
Dec;72(3):243-7 "BACKGROUND: Most investigators accept that schizophrenia
and bipolar disorders are distinct entities. The proponents of continuum model
have challenged this dichotomy model. METHODS: Information about the first-degree
relatives of probands with DSM-IV diagnosis of schizophrenia (n=90), bipolar disorder
(n=90), and epilepsy (n=60) was collected by using the Family Interview for Genetic
Studies (FIGS). A trained psychiatrist blind to the status of index probands obtained
the information. Morbid risk in relatives was calculated using abridged Weinberg's
method of age correction. RESULTS: Rates of schizophrenia and bipolar disorder
were elevated in the relatives of schizophrenia and bipolar probands, but there
was no evidence of coaggregation. The risk for major depression was significantly
elevated in the relatives of schizophrenia probands and was comparable to the
risk in the relatives of bipolar probands. LIMITATIONS: Family history method
was used to obtain information about relatives. Schizoaffective disorder patients
were not included in the study and this may have amplified the distinction between
schizophrenia and bipolar disorder. CONCLUSIONS: The findings suggest that schizophrenia
and bipolar disorders are familially independent, but there could be a familial
relationship between the predisposition to schizophrenia and to major depression."
[Abstract] |
Scott J, Pope M. Nonadherence with
mood stabilizers: prevalence and predictors. J Clin Psychiatry
2002 May;63(5):384-90 [Abstract] Lingam
R, Scott J. Treatment non-adherence in affective disorders.
Acta Psychiatr Scand 2002 Mar;105(3):164-72 "OBJECTIVE: The aim of this
paper is to review the prevalence, predictors and methods for improving medication
adherence in unipolar and bipolar affective disorders. METHOD: Studies were identified
through Medline and PsycLit searches of English language publications between
1976 and 2001. This was supplemented by a hand search and the inclusion of selected
descriptive articles on good clinical practice. RESULTS: Estimates of medication
non-adherence for unipolar and bipolar disorders range from 10 to 60% (median
40%). This prevalence has not changed significantly with the introduction of new
medications. There is evidence that attitudes and beliefs are at least as important
as side-effects in predicting adherence. The limited number of empirical studies
of how to reduce non-adherence offer encouraging evidence that, if recognized,
the problem can be overcome. CONCLUSION: Only 1-2% of all publications on the
treatment of affective disorders explore factors associated with medication non-adherence.
This is disappointing as research and clinical data highlight the importance of
extended courses of medication in improving the long-term prognosis of affective
disorders." [Abstract] Cardno
AG, Rijsdijk FV, Sham PC, Murray RM, McGuffin P. A twin study of
genetic relationships between psychotic symptoms. Am J
Psychiatry 2002 Apr;159(4):539-45 "OBJECTIVE: Biometrical model fitting
was applied to clinical data from twins to investigate whether operationally defined
schizophrenic, schizoaffective, and manic syndromes share genetic risk factors.
METHOD: Seventy-seven monozygotic and 89 same-sex dizygotic twin pairs in which
the proband met the Research Diagnostic Criteria (RDC) for lifetime-ever schizophrenic,
schizoaffective, or manic syndrome were ascertained from the Maudsley Twin Register
in London. The syndromes were defined non-hierarchically. Correlations in liability
were calculated for each syndrome in the monozygotic and dizygotic pairs and across
the three pairings of schizophrenic-manic, schizophrenic-schizoaffective, and
schizoaffective-manic syndromes both within probands and within pairs. For the
three syndromes considered together, an independent pathway model was fitted.
RESULTS: The model fitting showed significant genetic correlations between all
three syndromes. There was evidence of both common and syndrome-specific genetic
contributions to the variance in liability to the schizophrenic and manic syndromes,
but the genetic liability to the schizoaffective syndrome was entirely shared
in common with the other two syndromes. In contrast, environmental liability to
the schizoaffective syndrome was not shared with the other syndromes. CONCLUSIONS:
If diagnostic hierarchies are relaxed, there is a degree of overlap in the genes
contributing to RDC schizophrenic, schizoaffective, and manic syndromes. Supplementing
the traditional approach of assigning a single main lifetime diagnosis with information
on within-person comorbidity of psychotic syndromes may provide valuable information
about the familial aggregation of psychotic symptoms." [Abstract] Omahony
E, Corvin A, O'Connell R, Comerford C, Larsen B, Jones R, McCandless F, Kirov
G, Cardno AG, Craddock N, Gill M. Sibling pairs with affective
disorders: resemblance of demographic and clinical features.
Psychol Med 2002 Jan;32(1):55-61 "BACKGROUND: As part of a collaborative
linkage study, the authors obtained clinical and demographic data on 160 families
in which more than one sibling was affected with a bipolar illness. The aim of
the study was to identify clinical characteristics that had a high degree of familiality.
METHOD: Data on age at onset, gender, frequency of illness-episodes and proportion
of manic to depressive episodes were examined to determine intra-pair correlations
in affected sibling pairs. Dimension scales were developed measuring frequency
and severity of lifetime mania, depression, psychosis and mood-incongruence of
psychotic symptoms; degree of familial aggregation for scores on these dimensions
was calculated. RESULTS: Sibling pairs correlated significantly for age at onset
(p = 0.293, P < 0 001); dimension scores for psychosis (p = 0.332, P < 0.001);
and proportion of manic to depressive episodes (p = 0.184, P = 0.002). These findings
remained significant when correcting for multiple testing. Of the other test variables;
mania (p = 0.171, P = 0.019); incongruence dimensions (p = 0.242, P = 0.042);
.frequency of manic episodes (p = 0.152, P = 0.033); and frequency of depressive
episodes (p = 0.155, P = 0.028) were associated with modest correlations but these
were not significant after correction. Degree of familial aggregation was not
significant for sex (kappa = 0.084) or dimension scores for depression (p = 0.078,
P = 0.300). CONCLUSIONS: Significant but modest familial resemblance has been
shown for some specific features of bipolar illness, particularly age at onset
and degree of psychosis. Further research may establish the extent to which these
findings are mediated by genetic and/or environmental factors." [Abstract] Tse
SS, Walsh AE. How does work work for people with bipolar affective
disorder? Occup Ther Int 2001;8(3):210-225 "Despite
modern treatments, bipolar disorder remains a chronic, relapsing disorder that
leads to long-term psychosocial disability. A review of the literature suggests
that while employment rates amongst individuals with bipolar disorder may improve
over time, and are relatively better compared to some other chronic mental disorders,
employment prospects do not match the high scholastic achievements seen amongst
this group of people before the onset of their illness. For those with bipolar
disorder, clinical recovery does not necessarily mean functional recovery, and
the usual early age of onset may further reduce an individual's preparedness for
employment. Two brief vignettes are used to discuss how occupational therapists
can help their clients maintain their sense of hope in vocational recovery, gain
better self-awareness and work with clients at various stages of recovery rather
than waiting for full functional recovery. Further research is required to help
identify specific factors that contribute to the success of employment integration
amongst people with bipolar disorder." [Abstract]
Muller-Oerlinghausen B, Berghofer A, Bauer M.
Bipolar disorder. Lancet 2002 Jan 19;359(9302):241-7
"Bipolar, or manic-depressive, disorder is a frequent, severe, mostly recurrent
mood disorder associated with great morbidity. The lifetime prevalence of bipolar
disorder is 1.3 to 1.6%. The mortality rate of the disease is two to three times
higher than that of the general population. About 10-20% of individuals with bipolar
disorder take their own life, and nearly one third of patients admit to at least
one suicide attempt. The clinical manifestations of the disease are exceptionally
diverse. They range from mild hypomania or mild depression to severe forms of
mania or depression accompanied by profound psychosis. Bipolar disorder is equally
prevalent across sexes, with the exception of rapid cycling, a severe and difficult
to treat variant of the disorder, which arises mostly in women. Because of the
high risk of recurrence and suicide, long-term prophylactic pharmacological treatment
is indicated." [Abstract]
Shyovitz M. A family member's legal
experience with an insurer's refusal to recertify inpatient mental health treatment.
J Clin Psychiatry 2001;62 Suppl 25:44-50 "My son Nathaniel has bipolar
disorder and was hospitalized for 6 months, during which time our insurance company
was prepared to refuse certification more than once despite a policy that included
365 days of inpatient mental health treatment. A break in coverage by the insurance
company would have meant that Nathaniel, still suicidal, would not receive the
life-saving care he needed. Fortunately, I am a lawyer, which enabled me to act
as a legal advocate for my son when our insurer threatened not to recertify. Because
my son's experience with the insurance company is not unusual--many patients with
mental illness struggle with insurance companies who refuse to certify treatment--I
believe that the family or support people of seriously ill psychiatric patients
should be prepared to act in circumstances similar to mine. Psychiatric inpatient
units should, as a matter of course, provide information on legal remedies that
can be obtained before irreparable harm occurs." [Abstract] Lam
D, Wong G, Sham P. Prodromes, coping strategies and course of illness
in bipolar affective disorder--a naturalistic study. Psychol
Med 2001 Nov;31(8):1397-402 "BACKGROUND: Psychosocial interventions for
bipolar patients often include teaching patients to recognize prodromal symptoms
and tackle them early. This prospective study set out to investigate which bipolar
prodromal symptoms were reported frequently and reliably over a period of 18 months.
Furthermore, we have also investigated which types of coping strategies were related
to good outcome. METHOD: Forty bipolar patients were interviewed for their bipolar
prodromal symptoms and their coping strategies at recruitment and 18 months later.
Patients were also assessed as to whether they had experienced relapses. RESULTS:
Bipolar patients were able to report bipolar prodromal symptoms reliably. Mania
prodromal symptoms tended to be behavioural symptoms. A quarter of patients reported
difficulties in detecting depression prodromes, which tended to be more diverse
and consisted of a mix of behavioural, cognitive and somatic symptoms. Significantly
fewer patients who reported the use of behavioural coping strategies to curb excessive
behaviour during the mania prodromal stage experienced a manic episode. Similarly,
significantly fewer patients who reported the use of behavioural coping strategies
experienced depression relapses. How well patients coped with mania prodromes
predicted bipolar episodes significantly when the mood levels at baseline were
controlled. Ratings of how well subjects coped with mania prodromal symptoms also
predicted manic symptoms significantly at T2 when manic symptom at T1 was controlled.
CONCLUSION: Our study suggests that bipolar patients are able to report prodromal
symptoms reliably. It is advisable to teach patients to monitor their moods systematically
and to promote good coping strategies." [Abstract] Rubinsztein
JS, Fletcher PC, Rogers RD, Ho LW, Aigbirhio FI, Paykel ES, Robbins TW, Sahakian
BJ. Decision-making in mania: a PET study.
Brain 2001 Dec;124(Pt 12):2550-63 "Poor decision-making is often observed
clinically in the manic syndrome. In normal volunteers, decision-making has been
associated with activation in the ventral prefrontal cortex and the anterior cingulate
gyrus. The aim of this study was to evaluate task-related activation in bipolar
manic patients in these regions of the prefrontal cortex using PET. Six subjects
with mania, 10 controls and six subjects with unipolar depression (an affective
patient control group) were scanned using the bolus H(2)(15)O method while they
were performing a decision-making task. Activations associated with the decision-making
task were observed at two levels of difficulty. Task-related activation was increased
in the manic patients compared with the control patients in the left dorsal anterior
cingulate [Brodmann area (BA) 32] but decreased in the right frontal polar region
(BA 10). In addition, controls showed greater task-related activation in the inferior
frontal gyrus (BA 47) than manic patients. A positive correlation (r(s) = 0.88)
between task-related activation in the anterior cingulate and increasing severity
of manic symptoms was found. Depressed patients did not show significant task-related
differences in activation compared with control subjects in the regions of interest.
In conclusion, these patterns of activation point to abnormal task-related responses
in specific frontal regions in manic patients. Moreover, they are consistent with
neuropsychological observations in patients with lesions in the ventromedial prefrontal
cortex, who show similar difficulties with decision-making and provide early evidence
for context-specific neural correlates of mania." [Abstract] Visscher
PM, Yazdi MH, Jackson AD, Schalling M, Lindblad K, Yuan QP, Porteous D, Muir WJ,
Blackwood DH. Genetic survival analysis of age-at-onset of bipolar
disorder: evidence for anticipation or cohort effect in families.
Psychiatr Genet 2001 Sep;11(3):129-37 "Age-at-onset (AAO) in a number
of extended families ascertained for bipolar disorder was analysed using survival
analysis techniques, fitting proportional hazards models to estimate the fixed
effects of sex, year of birth, and generation, and a random polygenic genetic
effect. Data comprised the AAO (for 171 affecteds) or age when last seen (ALS)
for 327 unaffecteds, on 498 individuals in 27 families. ALS was treated as the
censored time in the statistical analyses. The majority of individuals classified
as affected were diagnosed with bipolar I and II (n = 103) or recurrent major
depressive disorder (n = 68). In addition to the significant effects of sex and
year of birth, a fitted 'generation' effect was highly significant, which could
be interpreted as evidence for an anticipation effect. The risk of developing
bipolar or unipolar disorder increased twofold with each generation descended
from the oldest founder. However, although information from both affected and
unaffected individuals was used to estimate the relative risk of subsequent generations,
it is possible that the results are biased because of the 'Penrose effect'. Females
had a twofold increased risk in developing depressive disorder relative to males.
The risk of developing bipolar or unipolar disorder increased by approximately
4% per year of birth. A polygenic component of variance was estimated, resulting
in a 'heritability' of AAO of approximately 0.52. In a family showing strong evidence
of linkage to chromosome 4p (family 22), the 'affected haplotype' increased the
relative risk of being affected by a factor of 46. In this family, there was strong
evidence of a time trend in the AAO. When either year of birth or generation was
fitted in the model, these effects were highly significant, but neither was significant
in the presence of the other. For this family, there was no increase in trinucleotide
repeats measured by the repeat expansion detection method in affected individuals
compared with control subjects. Proportional hazard models appear appropriate
to analyse AAO data, and the methodology will be extended to map quantitative
trait loci (QTL) for AAO." [Abstract] Perry
W, Minassian A, Feifel D, Braff DL. Sensorimotor gating deficits
in bipolar disorder patients with acute psychotic mania.
Biol Psychiatry 2001 Sep 15;50(6):418-24 "BACKGROUND: Deficits in sensorimotor
gating as assessed by prepulse inhibition (PPI) and habituation of the human startle
response have been noted in schizophrenia and other patients with known dysfunction
in the brain substrates that regulate PPI. During acute mania, bipolar disorder
(BD) and schizophrenia patients present with symptoms that are similar. To determine
if these clinical similarities extend to neurophysiologic domains, PPI and startle
habituation were assessed in BD patients with acute psychotic mania and compared
with a sample of acutely psychotic schizophrenia patients and a normal comparison
group. METHODS: Fifteen BD patients, 16 schizophrenia patients, and 17 control
subjects were assessed on PPI and startle habituation. RESULTS: The BD patients
had significantly lower PPI than did the control subjects in two of the three
PPI conditions (60- and 120-msec interstimulus intervals) as well as less startle
habituation. The BD patients did not statistically differ from the schizophrenia
patients in PPI or habituation. CONCLUSIONS: These findings of sensorimotor gating
deficits among bipolar disorder patients are consistent with other findings using
different measures of information processing and suggest that the neurobiological
substrates underlying sensorimotor gating may be dysregulated during acute manic
and psychotic states." [Abstract] Watson
S, Young AH. Bipolar disorders: new approaches to therapy.
Expert Opin Pharmacother 2001 Apr;2(4):601-12 "This article reviews the
evidence supporting different somatic treatment strategies in the acute and maintenance
treatment phases of bipolar disorder. Bipolar affective disorder is a chronic
disorder with a life time incidence of 0.3 - 1.5/100 [1]. Severe affective disorder
is associated with a risk of completed suicide of 6 - 15% [2,3]. Traditionally,
bipolar disorder has been considered as an episodic disorder with good inter-episode
recovery [4]. This is being increasingly challenged with patients demonstrating
social, marital, occupational and cognitive dysfunction, even when euthymic [5].
The management of bipolar disorder should be considered in the context of; the
type of episode, this may be manic, depressed or mixed; the degree and rate of
recovery; the cycling frequency and precipitant, if any, for recurrence and the
onset and evolution of the underlying illness. On average, four episodes occur
every 10 years. However 13 - 24% of patients develop rapid cycling disorder, in
which four or more episodes occur within a year. Patients with bipolar disorder
often have co-morbid anxiety and substance abuse. Moreover, axis I co-morbidity
may be associated with an earlier age at onset and worsening course of bipolar
illness. [6]. Axis II co-morbidity is also common, this was highlighted in a study
by Kay and colleagues who, after excluding patients with a history of alcohol
misuse, demonstrated axis II co-morbidity in almost a quarter of euthymic bipolar
patients [7]. Good practice relies on an overall management plan that incorporates
somatic, psychological and social approaches. This paper will focus on one element
of such a plan, the currently available somatic management strategies for bipolar
disorder." [Abstract] Perugi
G, Maremmani I, Toni C, Madaro D, Mata B, Akiskal HS. The contrasting
influence of depressive and hyperthymic temperaments on psychometrically derived
manic subtypes. Psychiatry Res 2001 Apr 15;101(3):249-58
"The present investigation focused on symptomatological subtypes of mania
and their relationships with affective temperaments and other clinical features
of bipolar disorder. In 153 inpatients with mania diagnosed according to DSM-III-R,
symptomatological subtypes have been investigated by means of principal component
factor analysis of 18 selected items of the Comprehensive Psychopathological Rating
Scale (CPRS). We compared other clinical features, depressive and hyperthymic
temperamental attributes, and first degree-family history for mood disorders among
the various manic subtypes on the basis of the highest z-scores obtained on each
CPRS factor (dominant CPRS factor groups). Five factors--Depressive, Irritable-Agitated,
Euphoric-Grandiose, Accelerated-Sleepless, Paranoid-Anxious--emerged, accounting
for 59.8% of the total variance. When the factor-based groups were compared, significant
differences emerged in terms of the duration of the current episodes, rates of
chronicity and incongruent psychotic features--being highest in the 'Depressive'
and 'Paranoid-Anxious' dominant groups. The patients with highest z-scores for
the 'Euphoric-Grandiose', 'Paranoid-Anxious' and 'Accelerated-Sleepless' factors
were those most likely to belong to the hyperthymic temperament, while the 'Depressive'
dominant group had the highest rate of depressive temperament. Finally, it is
noteworthy that the 'Irritable-Agitated' group was high for both temperaments.
The foregoing multidimensional structure of mania--revealing five factors--is
generally concordant with the emerging literature. Consistently with our original
hypothesis, a hyperthymic temperament seems to underlie the most extreme manic
excitement with euphoric-accelerated-paranoid phenomenology. By contrast, the
depressive temperament seemed to mute the expression of mania into a depressive-manic
phenomenology." [Abstract] Sharma
V. Loss of response to antidepressants and subsequent refractoriness:
diagnostic issues in a retrospective case series. J Affect
Disord 2001 Apr;64(1):99-106 "BACKGROUND: The loss of response to antidepressant
drugs is not an uncommon phenomenon. While some patients respond to changes in
the drug regimen, others develop resistance to various treatment modalities. METHOD:
I describe 15 cases who had a loss of response to repeated trials of antidepressants
before developing a chronic and severe, refractory depression. RESULTS: These
patients had failed to respond to various treatment strategies including substitution
with other antidepressant drugs, augmentation with agents such as T3 and lithium;
and finally electroconvulsive therapy (ECT). Following discontinuation of antidepressants
and treatment with mood stabilizers, there was a sustained improvement. Notably
some of the patients who had earlier failed to respond to mood stabilizers in
combination with unimodal antidepressants improved upon discontinuation of antidepressants
and continued treatment with mood stabilizers. LIMITATIONS: Open trial, retrospective
design and small sample size. CONCLUSION: These clinical findings suggest that
some refractory depressives represent cryptic bipolar disorders. Prospective validation
is necessary to support this conclusion." [Abstract]
Rosenfarb IS, Miklowitz DJ, Goldstein MJ, Harmon L, Nuechterlein
KH, Rea MM. Family transactions and relapse in bipolar disorder.
Fam Process 2001 Spring;40(1):5-14 "This study examined whether patient
symptoms and relatives' affective behavior, when expressed during directly observed
family interactions, are associated with the short-term course of bipolar disorder.
Twenty-seven bipolar patients and their relatives participated in two 10-minute
family interactions when patients were discharged after a manic episode. Results
indicated that patients who showed high levels of odd and grandiose thinking during
the interactions were more likely to relapse during a 9-month followup period
than patients who did not show these symptoms during the family discussions. Relapse
was also associated with high rates of harshly critical and directly supportive
statements by relatives. Patients' odd thinking and relatives' harsh criticism
were significantly more likely to be correlated when patients relapsed (r = .53)
than when they did not relapse (r = .12). Results suggest that bipolar patients
who show increased signs of residual symptomatology during family transactions
during the post-hospital period are at increased relapse risk. The data also suggest
that relatives of relapsing patients cope with these symptoms by increasing both
positive and negative affective behaviors. Moreover, a bidirectional, interactional
relationship between patients' symptoms and relatives' coping style seems to capture
best the role of the family in predicting relapse in bipolar disorder." [Abstract] Janowsky
DS, Morter S, Hong L, Howe L. Myers Briggs Type Indicator and Tridimensional
Personality Questionnaire differences between bipolar patients and unipolar depressed
patients. Bipolar Disord 1999 Dec;1(2):98-108 "OBJECTIVES:
The current study was designed to compare personality differences between bipolar
patients and unipolar depressed patients, as evaluated on the Myers Briggs Type
Indicator (MBTI) and the Tridimensional Personality Questionnaire (TPQ). METHODS:
A group of bipolar and a group of unipolar depressed patients filled out the MBTI,
the TPQ, the Beck Depression Inventory, and the CAGE questionnaire. The two groups
were compared with each other as to responses on the above surveys, and subgroups
of bipolar depressed and bipolar patients with manic symptoms were also compared.
RESULTS: Bipolar patients were found to be significantly more extroverted (p =
0.004) and less judging (p = 0.007) on the MBTI. They were significantly more
novelty seeking (p = 0.004) and less harm avoidant (p = 0.002) on the TPQ. Of
the above differences, only the TPQ harm avoidance scale appeared strongly linked
to the patients' level of depression. CONCLUSION: Significant differences in personality
exist between bipolar disorder and unipolar depressed patients." [Abstract] Benedetti
F, Colombo C, Barbini B, Campori E, Smeraldi E. Morning sunlight
reduces length of hospitalization in bipolar depression.
J Affect Disord 2001 Feb;62(3):221-3 "BACKGROUND: Bright artificial light
improves non-seasonal depression. Preliminary observations suggest that sunlight
could share this effect. METHODS: Length of hospitalization was recorded for a
sample of 415 unipolar and 187 bipolar depressed inpatients, assigned to rooms
with eastern (E) or western (W) windows. RESULTS: Bipolar inpatients in E rooms
(exposed to direct sunlight in the morning) had a mean 3.67-day shorter hospital
stay than patients in W rooms. No effect was found in unipolar inpatients. CONCLUSIONS:
Natural sunlight can be an underestimated and uncontrolled light therapy for bipolar
depression. LIMITATIONS: This is a naturalistic retrospective observation, which
needs to be confirmed by prospective studies." [Abstract] Marneros
A. Expanding the group of bipolar disorders.
J Affect Disord 2001 Jan;62(1-2):39-44 "The concept of bipolar disorder
is an ongoing process. Its roots can be found in the work of the ancient Greek
physician Aretaeus of Cappadocia, who assumed that melancholia and mania are two
forms of one and the same disease; he actually believed that mania was a more
severe form of melancholia. Falret [Bull. Acad. Natl. Med., Paris (1851)] and
Baillarger [Ann. Med-psychol. 6 (1854) 369] from France are the fathers of the
modern understanding of bipolar disorders. But the definitive distinction of bipolar
from unipolar disorders occurred in 1966 by Jules Angst and Carlo Perris in Europe,
and later supported by Winokur and colleagues in the United States. Schizoaffective
disorders should also be dichotomized into unipolar and bipolar forms. Another
extension of the group of bipolar disorders is the contemporaneous rebirth of
cyclothymia, originally described in the work of Kahlbaum (1882) and Hecker (1898)
[Z. Prakt. Arzte 7 (1898) 6]; the main importance of cyclothymia today is its
relevance for what Akiskal [Clin. Neuropharm. 15(1) (1992) 632] considers the
realm of the 'soft bipolar spectrum.' A further interesting development is the
renewed research in the field of 'mixed states' which originated in the classic
Handbook of Kraepelin a century ago (1899)." [Abstract] Craighead
WE, Miklowitz DJ. Psychosocial interventions for bipolar disorder.
J Clin Psychiatry 2000;61 Supp 13:58-64 "Patients with bipolar disorder
are prone to recurrences even when they are maintained on lithium or anticonvulsant
regimens. The authors argue that the outpatient treatment of bipolar disorder
should involve both somatic and psychosocial components. Psychosocial interventions
can enhance patients' adherence to medications, ability to cope with environmental
stress triggers, and social-occupational functioning. Family and marital psychoeducational
interventions and individual interpersonal and social rhythm therapy have received
the most empirical support in experimental trials. These interventions, when combined
with medications, appear effective in improving symptomatic functioning during
maintenance treatment. A beginning literature also supports the utility of individual
cognitive-behavioral and psychoeducational approaches, particularly in enhancing
medication adherence. Identifying the optimal format for psychosocial treatments
and elucidating their mechanisms of action are topics for further study."
[Abstract] Mendez
MF. Mania in neurologic disorders. Curr Psychiatry
Rep 2000 Oct;2(5):440-5 "Neurologic disorders can produce "secondary"
mania. Clinicians must distinguish secondary mania from primary, idiopathic manic-depressive
illness (MBI). In addition to medical and drug-induced causes of secondary mania,
neurologic causes usually develop in older patients who may lack a strong family
history of MDI. Neurologic causes of mania include focal strokes in the right
basotemporal or inferofrontal region, strokes or tumors in the perihypothalamic
region, Huntington's disease and other movement disorders, multiple sclerosis
and other white matter diseases, head trauma, infections such as neurosyphilis
and Creutzfeldt-Jakob disease, and frontotemporal dementia. Patients with new-onset
mania require an evaluation that includes a thorough history, a neurologic examination,
neuroimaging, and other selected tests. The management of patients with neurologic
mania involving correcting the underlying disorder when possible and the judicious
use of drugs such as the anticonvulsant medications." [Abstract]
Rossi A, Arduini L, Daneluzzo E, Bustini M, Prosperini P,
Stratta P. Cognitive function in euthymic bipolar patients, stabilized
schizophrenic patients, and healthy controls. J Psychiatr
Res 2000 Jul-Oct;34(4-5):333-9 "Studies on cognitive function in bipolar
disorder have led to contrasting results and few data are available on affected
subjects during the euthymic phase. In the present study we investigated the cognitive
function of a cohort of bipolar (n=40) and schizophrenic (n=66) patients compared
to healthy controls (n=64). Patients were evaluated in the outpatient setting
over at least 3 months using a computerized version of Wisconsin Card Sorting
Test. Schizophrenic patients showed the worst performance while that of the bipolar
patients was somewhere between schizophrenic and controls. A discriminant analysis
was able to classify correctly 60.59% of the subjects (schizophrenics 48.5%, bipolars
40%; healthy controls 85. 9%). The scores of the Wisconsin Card Sorting Test were
entered into a principal component analysis, which yielded a 2-factor solution.
Even in that analysis bipolar patients showed intermediate features in comparison
with the other groups. These data indicate that bipolar patients have subtle neurocognitive
deficits even after the resolution of an affective disorder. As well as observing
quantitative differences between groups, the results show different dimensions
of cognitive performance within groups suggesting that the deficit of euthymic
bipolars could be a dishomogeneous entity, probably more heterogeneous than that
in schizophrenia. Studies administering a more complete neuropsychological battery
could further clarify the nature and meaning of the cognitive deficits in schizophrenia
and bipolar disorder." [Abstract]
Stender M, Bryant-Comstock L, Phillips S. Medical
resource use among patients treated for bipolar disorder: a retrospective, cross-sectional,
descriptive analysis. Clin Ther 2002 Oct;24(10):1668-76
"BACKGROUND: Detailed assessments of the direct costs related to bipolar
disorder and of the burden it places on the health care system are limited. OBJECTIVE:
In this retrospective, cross-sectional, descriptive analysis, we assessed prescription
medication and other medical resource use in bipolar disorder in an insured population
in the northeastern United States. METHODS: Number and types of prescription drugs,
medical encounters, and respective costs were derived from a New England insurer
database for 1996. This analysis was purely descriptive in nature and no statistical
comparisons were made. RESULTS: Patients with bipolar disorder (N = 3120) were
compared with a randomly selected age- and sex-matched nonbipolar population (N
= 3120). A subgroup of patients with bipolar I disorder (n = 336), defined as
having at least 1 hospital admission for mania, also were examined. A total of
$2,803,673 was spent on all drugs for patients with bipolar disorder, who received
a mean of 15 central nervous system (CNS) drug prescriptions per person, at an
average cost of $582. This compares with $461,354 spent on drugs for nonbipolar
patients, who received a mean of 1 CNS drug prescription per person, at an average
cost of $33. Medical encounters for bipolar patients cost more than for nonbipolar
patients ($16,230,840 vs $4,074,797). In patients with bipolar disorder, medical
encounters for mental disorders accounted for 45.8% of costs. In nonbipolar patients,
medical encounters for mental disorders accounted for 4.2% of costs. The inpatient
cost for mental disorders in the bipolar patients was $4,846,311, with most of
this cost (69.3%) attributed to patients with bipolar I disorder ($3,357,036).
CONCLUSIONS: The number and cost of both prescriptions and health care encounters
suggest that bipolar disorder, especially bipolar I, is both difficult and costly
to manage." [Abstract] |