bluuebunny/crossref_metadata_2025 huggingface dataset:
Bipolar Disorder and Suicide: 10 Years Follow-up /Retrospective Survey/
Authors: Breznoscakova D. , Palova E. , Dragasek J. , Losonciova K. , Uhrin J.
Published: March 2009

Introduction:

Bipolar disorder (BD) is chronic psychiatric disorder by mood swings, symptoms of BD are serious and life-threating. Suicide risk in patients with BD is 25-50%, more frequent during depressive episode (Compton,2000) but with adequate treatment suicide risk can be presented in nearby 50% of patients only (Goodwin, Jamison,2006). Despite these facts data about the changes of treatment habits over the longer period of time under naturalistic condition are lacking.

The aim of study:

To assess presence of suicidal thoughts and attempts in inpatients with BD and follow-up changes of treatment with lithium over the period of time.

Patients and methods:

It was retrospective survey of in-patient's files hospitalized at the 1st Dept. of Psychiatry, UPJS, Kosice (1997-2007) with typical limitations for retrospective case survey. All patients had diagnosis of BD (DSM-IV), n=125 (67% of women and 33% of men). We discovered changes in suicidal behaviour with/without treatment of lithium.

Results:

The first episode was depressive in 62% of patients, average number of episodes: 8,2. There was trend of decrease in use of lithium over the time (68% vs 84% in men, 29% vs 60% in women). The suicidal thoughts were more frequent during depressive episode (in 50% of women and 18% of men). Suicidal thoughts and attempts were 3 times more frequent in women vs men with BD. Suicidal attempts were 4 times more frequent in women with treatment with lithium vs without lithium.
Does psychoeducatioanal Approach Could Reach the Target Patients with Bipolar Disorder?
Authors: Cakir S. , Bensusan R. , Akca Z. , Yazici O.
Published: March 2009

The recurrent nature of bipolar disorder needs an optimum compliance with long term pharmacotherapy, however the poor adherence is common. Adjunctive psychoeducation seems favorable effects on adherence during the long term pharmacotherapy. Even strong benefits were showed, setting a psychoeducation in clinical practice is still novel and recruiting the patients with long history of bipolar disorder may not be feasible. In literature, recruitment rate, motivation and attitudes of patients for participation in psychoeducation is not studied. The present study was conducted to clarify the intends of patients with bipolar disorder to participate in psychoeducation and the factors that contribute.

The euthymic patients with diagnosis of bipolar disorder I or II, were invited to the 6 week psychoeducation program in prospective study. The demographic and clinical data were obtained from life charts and updated with a clinical interview. The blood levels of mood stabilizers, adherence, response to prophylactic treatment, relapses and hospitalization rates between the participants and non-participants were compared.

84 patients were attended the program, 71 patients were considered as unwilling to attend. The motivation of patients to attend a psychoeducation is limited. The participation rate was only 54.2%. The patients who refused attending to this program have fewer adherences to medication and irregular follow up visits, insufficient blood levels of mood stabilizers, poor response to long term treatment, more likely have mood episodes. Education level between attendees and non-attendees were not different.

Optimum methods are required for recruitment of bipolar patients to a psychoeducation program.
Mania in Old Age: A Case Report
Authors: Castro L.C.
Published: March 2009

Background:

Geriatric bipolar disorder is associated with a significant morbidity, mortality and poor psychosocial outcomes. Bipolar affective disorder contributes substantially to geriatric mood disorders and to geriatric hospitalizations. Mania in late-life is often a tremendous treatment challenge because of frequent medical co-morbidity and age-related variations in response to therapeutics.

Aim:

To report a case of mania in late-life, in order to discuss the impact of bipolar disorder in the elderly, underlining treatment difficulties in the geriatric population.

Methods:

Case study and review of the literature.

Results:

A 70 year old woman was hospitalized in a geriatric service of a psychiatric hospital with a maniac episode. She had a history of bipolar disorder diagnosed during her adult life. She had several co-morbid medical conditions, including diabetes, hypertension, dyslipidemia and psoriasis. There was a successful multidisciplinary approach and intervention, allowing a significant improvement and reintegration in the community.

Conclusions:

Geriatric patients with bipolar disorder carry a substantial burden of general medical conditions. There are few studies and a lack of specific algorithms concerning bipolar management in the elderly. It is urgent the development of specific interventions that target medical burden in patients with bipolar disorder and further research on the treatment of bipolar disorder in old age. A multidisciplinary approach is essential to allow a holistic treatment and improvement of quality of life parameters in this population.
Neuropsychiatric Lupus in an Adolescent Presenting with Bipolar Disorder with Catatonic Features
Authors: Alao A. , Chung C.
Published: March 2009

Case presentation:

We describe a 15-year-old African American female with a family history positive for Bipolar I disorder and schizophrenia who presented with symptoms consistent with an affective disorder. The patient was diagnosed with Bipolar I disorder with catatonic features and required multiple hospitalizations for mood disturbance. Two years after her initial presentation, the patient was noted to have a malar rash and subsequently underwent a full rheumatologic workup, which revealed cerebral vasculitis. Neuropsychiatric lupus (NPSLE) was diagnosed and, following treatment with steroids, the patient improved substantially and no longer required further psychiatric medication or therapy.

Conclusion:

Neuropsychiatric manifestations of lupus (NPSLE) have been shown to occur in 80-91% of adults and up to 95% of pediatric patients with SLE. In the case we described, diagnosis was hindered by the patient's presentation of what appeared to be isolated psychiatric symptoms and her strong family history of psychiatric disease. Thus, given the especially high prevalence of NPSLE in pediatric patients with lupus, it is important for clinicians to recognize that neuropsychiatric symptoms in an adolescent may indeed be the initial manifestations of SLE.
Potential Misdiagnosis of Bipolar Disorder
Authors: Correia D. , Correia L. , Gandra T. , Silva F.
Published: March 2009

Background:

Several reports indicate that Bipolar Disorder (BD) is frequently underdiagnosed

leading to overuse of antidepressants and underuse of mood stabilizers.

Aims and methods:

The aim is to review literature concerning this subject published since 2000.

Results:

BD seems to be frequently underdiagnosed. Several studies, as EPIDEP and NEMESIS, reveal insufficiencies on the diagnosis of this disorder, suggesting that clinicians miss this diagnosis about half of the times, and that about three quarters of these patients are not receiving appropriate treatment, respectively.

BD is often misdiagnosed as Major Depression Disorder (MDD), with approximately 40% of BD patients being initially diagnosed as MDD. On the other hand, a large fraction of patients initially diagnosed as MDD will change diagnosis to BD during follow-up, with some authors presenting values as high as 67%. Studies comparing the depressive features of MDD and BD point to some strong clinical indicators of bipolarity in patients presenting with depression, such as family history, seasonal pattern, postpartum onset, psychotic symptoms, younger age, suicidal behaviours, among others.

To a lesser extent, BD can also be misdiagnosed as: substance abuse, borderline personality, obsessive-compulsive disorder, among others.

It is also important to consider that a large fraction of patients with BD diagnosis will change diagnosis during the follow-up period.

Conclusion:

BD patients with the diagnosis may represent only a fraction of the subjects with this disorder, and the true epidemiological extent of this problem needs further investigation.
Effectiveness of Extended-release Formulation of Quetiapine as Monotherapy for the Treatment of Acute Bipolar Mania (Trial D144CC00004)
Authors: Datto C. , Nordenhem A. , Minkwitz M. , Dettore B. , Acevedo L. , Darko D. , Cutler A.
Published: March 2009

Objectives:

To evaluate the effectiveness of extended release quetiapine fumarate (quetiapine XR) as once-daily monotherapy for manic symptoms in bipolar I disorder.

Methods:

In this 3-week, randomized, parallel-group, double-blind study, adults with bipolar I disorder (most recent episode manic or mixed; with or without rapid cycling) were randomized to once-daily treatment with either quetiapine XR (n=149; Day 1, 300 mg; Day 2, 600 mg; Day 3 through Week 3, 400-800 mg flexibly dosed) or placebo (n=159). Primary outcome measure was change from baseline to Week 3 in Young Mania Rating Scale (YMRS) total score. Secondary outcome measures included YMRS response and remission and change in Clinical Global Impression-Bipolar (CGI-BP)-Severity of Illness and -Change scales. Change from baseline was compared between groups with analysis of covariance, using the last observation carried forward approach for missing data.

Results:

Once-daily quetiapine XR was associated with significant, sustained improvement in manic symptoms compared with placebo, beginning on Day 4 (P< 0.001) and continuing through Week 3 (mean change: -14.34 versus -10.52; P< 0.001). At Week 3, quetiapine XR-treated patients showed significantly greater response (P< 0.01) and remission (P< 0.01) rates and improvement in CGI-BP-associated scores than placebo-treated patients. Adverse events were mild to moderate in intensity, the most common being sedation, dry mouth, and somnolence for quetiapine XR.

Conclusions:

Once-daily quetiapine XR monotherapy (400-800 mg) was efficacious (from Day 4 through Week 3) and generally well tolerated in the treatment of manic episodes associated with bipolar I disorder.

Supported by funding from AstraZeneca Pharmaceuticals LP.
Effectiveness of the New Extended-release Formulation of Quetiapine as Monotherapy for the Treatment of Acute Bipolar Depression (Trial D144CC00002)
Authors: Datto C. , Minkwitz M. , Nordenhem A. , Walker C. , Darko D. , Suppes T.
Published: March 2009

Objectives:

To evaluate the effectiveness of extended-release quetiapine fumarate (quetiapine XR) as once-daily monotherapy for bipolar depression.

Method:

Patients in this double-blind, placebo-controlled study were acutely depressed adults with bipolar I or II disorder (with or without rapid cycling), and were randomized to 8 weeks of once-daily treatment with quetiapine XR 300 mg (n=133) or placebo (n=137). The primary outcome measure was change from baseline to endpoint (Week 8) in Montgomery-Åsberg Depression Rating Scale (MADRS) total score. Secondary outcome measures included response (MADRS total score reduction ≥50%) and remission (MADRS total score ≤12) rates at endpoint, changes from baseline to endpoint in MADRS item scores, and Clinical Global Impressions-Bipolar (CGI-BP) severity of illness and change. Change from baseline was compared between groups with analysis of covariance using last observation carried forward approach.

Results:

Quetiapine XR 300 mg/d was significantly more effective than placebo in improving depressive symptoms, from first assessment (Week 1; P< 0.001) to endpoint (P< 0.001). Compared with placebo, quetiapine XR was associated with higher response (P< 0.001) and remission (P< 0.05) rates and greater improvements from baseline to endpoint in MADRS total score (-17.43 vs -11.92; P< 0.001), MADRS item scores for core symptoms of depression, and CGI-BP-related outcomes at Week 8. Most common adverse events with quetiapine XR were dry mouth, somnolence, and sedation.

Conclusions:

Quetiapine XR (300 mg) once-daily monotherapy was efficacious (from Weeks 1 through 8) compared with placebo and generally well tolerated in bipolar depression.

Supported by funding from AstraZeneca Pharmaceuticals LP.
Depressive Mixed States: Symptomatology, Prevalence and Principles of Treatment
Authors: Drozdz W. , Borkowska A.
Published: March 2009

Current diagnostic systems (DSM-IV-TR and ICD-10) do not include depressive mixed state (DMS) as a separate category. However, both historical descriptions and data from recent research clearly indicate that cooccurrence of (hypo)maniacal and depressive symptoms is standard in clinical picture of affective disorders. Most frequently employed criterion for DMS is the presence of at least three symptoms of (hypo)mania for 7 days during a major depressive episode. Not only formal diagnostic criteria for DMS are lacking but also psychometric assessment tools (for example the Hamilton Depression Scale or the MADRS) were designed around the features of “classical” depression. The other obstacles to recognize DMS could be lack of insight into the (hypo)maniacal symptoms in patients and cognitive dysfunctions present during an episode. On the other hand, newly created instrument, the Bipolar Depression Rating Scale, may assist clinical evaluation of DMS. Despite predominating depressive symptomatology, the principles of treatment of DMS suggest avoidance of antidepressant monotherapy in favor of mood stabilizers' administration. Actually DMS may emerge as a complication of antidepressant monotherapy in some bipolar patients or may be induced with interferon-alpha treatment in some chronic hepatitis C patients. Important consequences of both spontaneous and drug-induced DMS could be the roughening of affective symptomatology, resistance to antidepressants and the increase of suicidality. Thorough appraisal of symptoms seen in patients with affective disorders for indicators of DMS could have critical consequences for functional outcomes.
A Double-Blind, Placebo-controlled Trial of Divalproex and Olanzapine in Bipolar I Disorder, Mixed Episode
Authors: Houston J. , Tohen M. , Degenhardt E. , Jamal H. , Liu L. , Ketter T.
Published: March 2009

Aims:

This unique study of treatment of the mixed state of bipolar I disorder using simultaneous depression and mania response criteria compared divalproex monotherapy versus olanzapine augmentation in a 6-week, randomized, double-blind trial.

Methods:

Patients (age 18-60 years) with 14-28 days of divalproex monotherapy (blood levels of 75-125 μg/mL) were randomized to augmentation with olanzapine 5-20 mg/day or placebo. Data collected included: Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Clinical Global Impression for Bipolar Illness (CGI-BP), hospitalizations, concomitant medications, and adverse events (AEs). Primary co-objectives were comparisons of baseline to endpoint changes in HDRS and YMRS. Secondary objectives included comparisons of times to onset (25% reduction) and response (50% reduction) in both HDRS and YMRS, change in CGI-BP, hospitalizations, and safety.

Results:

Patients were 59% female, 51% Caucasian, 33% African American, and 14% Hispanic with mean standard deviation (SD) HDRS and YMRS scores of 22.2 (4.5) and 20.9 (4.4). Mean standard error (SE) score changes for the olanzapine (n=100) or placebo (n=101) arms, respectively, were: HDRS, -9.37 (.55) and -7.69 (.54), p=.022; YMRS, -10.15 (.44) and -7.68 (.44), p< .001; and CGI-BP, -1.34 (.11) and -1.06 (.11), p=.056. Times-to-onset (median 7 vs 14 days) and response (median 25 vs 49 days) were significantly shorter for olanzapine augmentation. One olanzapine patient required hospitalization (p=1.0). Treatment-emergent AEs were consistent with previously-published rates.

Conclusion:

Six-week olanzapine treatment augmentation was associated with greater and earlier reduction of manic and depressive symptoms in mixed episode patients on divalproex treatment.
Substance Use and Physical Health in Patients with Bipolar Disorder Under Maintenance Treatment
Authors: Garcia-Portilla M.P. , Saiz P.A. , Florez G. , Bascaran M.T. , Al-Halabi S. , Bousoño M. , Bobes J.
Published: March 2009

Background:

To date, little is known about the impact of substance use on physical health of patients with bipolar disorder. This study provides data on the impact of tobacco, alcohol and cannabis upon weight, metabolic profile and cardiovascular risk in these patients.

Methods:

Naturalistic, cross-sectional, multicenter study conducted in Spain. Current use of tobacco, alcohol and cannabis was registered based on patient’ self-reports. Patients were evaluated for presence of metabolic syndrome (MetS) according to modified NCEP ATP III criteria, for cardiovascular risk using the Framinghan function (CHD) and the Systematic COronary Risk Evaluation (SCORE) function (CMR).

Results:

The mean age was 46.6 years and 49% were male. Fitty-one percent used tobacco, 13% alcohol and 12.5% cannabis. Mean body mass index (BMI) was 27.9 kg/m2, 22.4% had MetS and ten-year CHD and CMR risks were 7.6% and 1.8% respectively. Patients who used tobacco had significantly higher CHD risk (8.82 versus 5.74, p < 0.01), and used more antipsychotic (1.23 versus 1.04, p 0.002) and overall (3.18 versus 2.71, p 0.01) drugs for the treatment of their bipolar disorder. Patients who used cannabis had significantly lower BMI (26.0 versus 28.2, p < 0.05) and lower CMR (0.37 versus 1.99, p < 0.001), however, when controlling by age, severity of mania and presence of metabolic syndrome these associations disappear.

Conclusions:

Substance use, mainly tobacco, is high in patients with bipolar disorder. Use of tobacco is associated with higher cardiovascular risk and greater number of antipsychotic and overall drugs for the bipolar disorder.
Predictors of Mania in a Sample of Patients Treated with Antidepressants (Preliminary Results) [P01-190]
Authors: Amedei S. Gorini
Published: March 2009

Aims:

From 35% to 60% of cases the initial presentation of illness in bipolar disorder is different from mania or hypomania. So far the studies that have investigated predictors of (hypo)mania have been concentrated on samples suffering from depression. On one hand is well known that antidepressant drugs are commonly prescribed in a broad spectrum of disorders other than depression. On the other hand there are strong connections within bipolar disorder and anxiety disorders that have been reported to be a possible clinical onset of a subsequent bipolar disorder.In all these cases patients are likely to be treated with antidepressants drugs, the effects of which has been associated with a worsened course of bipolar illness, from switching to mania to a rapid cycling course. This is the reason that led to perform a research on predictors of bipolar evolution on an antidepressant treated sample of outpatients irrespective of the diagnosis.This study examines clinical features at the first presentation of the illness that can be considered predictive of the subsequent bipolar course of illness.

Method:

A sample of outpatients treated for the first time in their life with antidepressant drugs has been prospectively evaluated in order to assess the clinical features associated with the later onset of bipolar disorder.
Recognizing the Similarities and Differences Between Pediactric Bipolar Disorder (PBPD) and Autistic Spectrum Disorders (ASD)
Authors: Greenberg R.
Published: March 2009

Recent studies have indicated a significant increase in the number of children diagnosed with psychiatric disorders. This is especially true for pediatric bipolar disorder and autistic spectrum disorders this includes autism, Asperger's and pervasive developmental disorder not otherwise specified. The purpose of this presentation is to define these two disorders and help elucidate the overlap and the differences between them, as well as help elucidate when a youngsters has both.

On the surface these two diagnoses can look quite similar. In both the child can show signs of inappropriate and an excessive of response to frustration, overreaction to sensory stimuli, and rigid behavior with difficulty accepting change and transitions, as well as an intense and obsessional interest in certain topics. Sleep difficulties, limited eating repetitore, problems with inattention, poor social skills etc. are also common to both disorders. The number of children that have both disorders is still unknown but clinically appears more common than previously believed. The importance of recognizing the coexistence of both disorders can have a major effect on the approach to treatment and the individual's resultant level of functioning.

This presentation will address the following question:

1.

How are BPD and ASD identified?

2.

What are the differences between adult and pediatric bipolar disorder?

3.

In what ways do the symptoms of PBPD and ASD overlap?

4.

How does one separate the two disorders?

5.

When should both diagnoses be given?

6.

How does having both affect the approach to treatment?
Metabolic Syndrome in Bipolar Illness: Patient Concepts and Screening Effectivity
Authors: Guerreiro D. , Navarro R. , Telles D. , Carvalho M. , Martins P. , Trigo E. , Silva M. , Gois C. , Figueira L.
Published: March 2009

Introduction:

Metabolic Syndrome (MS) is constituted by a set of specific metabolic alterations being postulated that the main dysfunction is insulin resistance. Estimates point to higher prevalence of MS in bipolar patients, between 30 to 35%. Cost-effective screening methods, not recurring to blood test, have been researched.

Objectives:

Analyse knowledge and importance given to MS in bipolar patients. Test the viability of MS screening without blood tests.

Methodology:

Observational, cross-sectional study. Random sample of 15 adult bipolar patients, in euthymic phase. Semi-structured interview, YMRS, HAMD were applied. MS diagnosis investigated according to the International Diabetes Federation (IDF) criteria. MS screening was defined positive if blood pressure ≥ 130/85 or anti-hypertensive medication and abdominal perimeter > 90 in males or > 80 in females. A questionnaire about knowledge, attitudes and concerns on MS was applied.

Main results:

14 patients completed the investigation protocol. Five (36%) met IDF criteria for metabolic syndrome. Screening sensitivity was 80% and specificity 78%. Twelve patients (80%) were overweigh or obese. Mean IMC in patients that met IDF criteria for MS was 30 while in the other group mean IMC was 26. Only 3 (20%) have ever heard about MS, but the majority of the patients were concerned, in decreasing order, about weight gain, blood pressure cholesterol and hyperglycemia control.

Conclusions:

Although limited by small sample size, this study strengthens the idea that MS screening can be effective in clinical practice, it also indicates the need to educate BP patients about MS and to prevent overweight.
No Association Between Catecholamine-O-Methyltransferase Gene Polymorphism and Bipolar Disorder and it Subtypes
Authors: Leszczyńska-Rodziewicz A. , Dmitrzak-Weglarz M. , Skibinska M. , Rybakowski J. , Hauser J.
Published: March 2009

Aims:

The catecholamine hypothesis of affective disorders suggests that depression is associated with a functional decrease of catecholamines. There is consistent evidence that COMT gene would be a candidate gene for studies of bipolar disorder.

Methods:

The study was performed on patients with bipolar disorder n=298 (male n=126, female n=172). Control subjects were blood donors n=336 (male n=130, female n=206), who were not psychiatrically assessed. The subgroup of patients with psychotic features not congruent with mood contained n=88 patients, males n=41, females n=47. The subgroup of patients with psychotic features congruent with mood contained n=89 patients, males n=47, females n=42. The subgroup of patients with melancholic depression contained n=197 patients, males n=76, females n= 121. A polymorphism was analysed by PCR-RFLP method.

Results:

There were no differences in the frequency of genotypes, alleles between patients and controls in the whole group (p=0,286 for genotypes, p= 0,652 for alleles). Dividing the patients according to the gender, no differences in the frequency of either genotypes or alleles were found (p=0,298 for genotype males, p=0,456 for genotypes females). We did not find the association in the subgroup of patients with psychotic features congruent (p=0,828 for genotypes, p= 0,866 for alleles), or not congruent with mood (p=0,116 for genotypes, p= 0,673 for alleles) and with the subgroup of patients with depression with melancholic features (p= 0,758 for genotypes, p= 0,849 for alleles).

Conclusion:

Results of our study suggest that the polymorphism of COMT gene is not associated with the susceptibility to bipolar disorder.
All Available Treatments of Bipolar Disorders
Authors: Misic P. , Arandjelovic D. , Stanojkovic S. , Vladejic S. , Mladenovic J.
Published: March 2009

Bipolar disorder is a treatable brain disorder that causes changes in person’s mood, thought, energy and behaviour.

All available resources were searched and combined with the experince from everyday practice in Specialized Psychiatric Hospital “Gornja Toponica” and this is a rewiev of the various treatments that are currently available for the treatment of bipolar disorders.

Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time. In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidality, Electroconvulsive therapy (ECT), Transcranial Magnetic Stimulation (TMS), Vagus Nerve Stimulation (VNS), Magnetic Stimulation Therapy (MST) and even herbal or natural supplements may be considered.

Lithium, the first mood-stabilizing medication is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.

Anticonvulsant medications, such as valproate or carbamazepine, also can have mood-stabilizing effects.

Newer anticonvulsant medications, including lamotrigine, gabapentin, and topiramate, are also very effective in stabilizing mood cycles.

Atypical antipsychotic medications, including clozapine, olanzapine, risperidone, quetiapine, and ziprasidone, are are also used for bipolar disorder treatment.

If insomnia is a problem, a high-potency benzodiazepine medication such as clonazepam or lorazepam may be helpful to promote better sleep. However, since these medications may be habit-forming, they are best prescribed on a short-term basis. Other types of sedative medications, such as zolpidem, are sometimes used instead.
Group Cognitive Behaviour Therapy for Depression - Does it Help Bipolar Patients Too?
Authors: Moore L. , Gibson J. , Carr A.
Published: March 2009

Aims:

To compare the effectiveness of a manualised group cognitive behaviour therapy (CBT) programme for people with bipolar disorder (BPD) and major depressive disorder (MDD).

Method:

In addition to treatment as usual (TAU), 17 people with BPD and 17 matched controls with MDD completed 8 or 12 sessions of twice weekly group CBT, followed by 6 booster sessions, held at monthly intervals. Participants completed the Structured Clinical Interview for DSM-IV Axis 1 Disorders, Clinician Version (SCID-1) and the University of Rhode Island Change Assessment (URICA) prior to therapy. They completed the Beck Depression Inventory - II (BDI), the Beck Anxiety Inventory (BAI), the Clinical Outcomes in Routine Evaluation (CORE), the World Health Organisation Quality of Life Brief Version (WHOQoL - BREF) and the Dysfunctional Attitudes Scale (DAS) before and after therapy and at the final follow-up session. The BDI and BAI were also completed at each group session.

Results:

Both groups showed statistically and clinically significant improvement on the BDI and BAI after treatment and at follow-up. Both groups showed a significant improvement on the psychological health sub-scale on the WHOQoL-BREF.

Conclusions:

Manualised group CBT leads to a reduction in the symptoms of depression and anxiety in people with both BPD and MDD and helps improve their perceived quality of life.

Declaration of interest:

None.
Cardiovascular and Respiratory Comorbidities in Patients with Bipolar Disorder: A Systematic Review
Authors: Montes J.M. , Mostaza J. , Rico-Villademoros F. , Saiz-Ruiz J. , Bobes J. , Vieta E.
Published: March 2009

Objective:

To synthesize the available knowledge on cardiovascular and respiratory comorbidities in patients with bipolar disorder (BD).

Methods:

Relevant studies were identified by a MEDLINE search from 1966 to January 2008, and supplemented by a manual review of reference lists of the articles identified and previous review articles. When available, priority was given to comparative studies.

Results:

We identified 21 studies, 15 (71%) comparative. As compared to the general population, two studies reported higher point-prevalence rates of hypertension (28-60.8% vs 11.9-43%), two studies lower point-prevalence rates (10.4-34.8% vs 14.9-36.8%), one study a higher lifetime-prevalence rate (28.7% vs 14.8%), and one study a significantly increased incidence rate ratio (1.24 females and 1.34 for males). In addition, two studies reported higher point-prevalence rates of hypertension than in medical samples (4.6-18.1% vs 2.2-9.2%) and one study reported a higher risk than in patients with schizophrenia (OR 1.13, 95%CI 1.01-1.26). Point-prevalence rate of stroke was not different than in the general population (n=1, 1.7 vs 2.1, p=0.063); four studies evaluating the risk of stroke as compared to clinical samples provide contradictory results. Point-prevalence rates (n=2, 15.9-17% vs 8.3-10%) and lifetime-prevalence rate (n=1, 16.7% vs 9.7%) of asthma were higher than in the general population. Point-prevalence rates of COPD were also higher than in the general population (n=1, 10.6% vs 9.4%) and in clinical samples (n=3, 1-12.9% vs 0.6-3.6%).

Conclusion:

BD seems to be associated with increased rates of hypertension, asthma and COPD. Available data do not support the association between BD and stroke.
Nutritional, Metabolic and Endocrine Disorders in Patients with Bipolar Disorder: A Systematic Review
Authors: Vieta E. , Mostaza J. , Bobes J. , Saiz-Ruiz J. , Rico-Villademoros F. , Montes J.M.
Published: March 2009

Objective:

To evaluate the frequency of nutritional, metabolic and endocrine disorders in patients with bipolar disorder (BD).

Methods:

A Medline search (up to January 2008) in and manual review of reference lists of relevant primary articles and review articles. All studies in Spanish or English, all study designs, BD diagnosis by any criteria, with a sample size of ≥ 30 patients, and which reported any measure of frequency measure or association.

Results:

Thirty studies were identified: 18 (60%) cross-sectional and 12 (40%) retrospective cohort; 2 (6.7%) population- based; and 2 (6.7%) random sampling. The frequency of obesity in patients with BD was higher than that of the general population (n=4, 19-53% vs 9-14%), of other medical populations (n=1, 4.6% vs 1.1%) and of patients with schizophrenia (n=1, 11.6% vs 9.9%). The frequency of diabetes in patients with BD was higher than (n=5, 6-26% vs 2-16%) or similar to (n=2, 3.5-4.3% vs 3.4-4.8%) that of the general population; higher than that of other medical samples (n=2, 1.8-4.4% vs 0.6-2.2%) and similar to that in of patients with schizophrenia (n=1, 17.7% vs 17.6%). The frequency of dyslipidaemia was higher than that found in a medical sample (n=1, 0.9% vs 0.3%) and in patients with schizophrenia (n=1, 27% vs 23%). The frequency of hypothyroidism was higher than that of a medical sample (n=1, 10% vs 3%).

Conclusion:

BD appears to be associated with obesity. It may also be associated with dyslipidaemia and hypothyroidism. Data on the association between BD and diabetes are inconclusive.
Protocadherin Alpha Gene Polymorphisms in Bipolar Disorder. Results from the Czech Cohort
Authors: Novak T. , Stopkova P. , Pedrosa E. , Lachman H.
Published: March 2009

Aims:

Protocadherins (PCHD) are cell adhesion proteins with an important role in neuronal migration, differentiation and synaptogenesis. The linkage studies suggest that the 5q31-linked protocadherin family locus should be considered as potential candidate locus in schizophrenia and bipolar disorder. In this study, we focused particularly on single-nucleotide polymorphisms (SNPs) located in PCHDα enhancer. Results from the Czech cohort of patients with bipolar disorder (BD) will be presented.

Methods:

Unrelated inpatients and outpatients with BD based on Schedule for Affective Disorders and Schizophrenia - Lifetime (n=167) and blood bank donors as control subjects (n=211) were recruited in the study. Four SNPs posted in dbSNP (rs31745, rs10036519, rs3756337 and rs59497) in the PCDHα gene enhancer were analyzed. The data sets were analysed using a case control design.

Results:

In case of SNP, rs31745, a significant increase in homozygosity for the minor allele (T) was detected in patients with BD; 5% had this genotype, but no controls (p=0.001). The distribution of allels did not differ between patients and controls. No significant differences were found in allele or genotype distribution for three other SNPs.

Conclusions:

The findings suggest that the PCHDα is an interesting gene family to consider in BD susceptibility.
Bipolar Disorder Treatment in an Acute Inpatient Unit
Authors: Torres C. , Nunes P. , Cunha S. , Viana M.
Published: March 2009

Bipolar disorder is a chronic, debilitating psychiatric disease. The management of this disorder involves treating current episodes and preventing their long-term recurrence.

Many patients with Bipolar Disorder are hospitalized at some point in the course of their illness. Although most bipolar patients do not require extended inpatient psychiatric hospitalizations, short-term hospitalizations may be necessary during acute or potential crises.

Hospitalization is among the most expensive treatment options available, and it is therefore offered sparingly and generally only when no other treatment options will prove sufficient to ensure patient safety.

A hospital setting should be considered when safety is in question due to suicidal, homicidal, or aggressive impulses or actions, as well as inability to care for self. Other clear indications for hospital admission are the need for diagnostic procedures, history of rapidly progressive symptoms (especially psychotic phenomena), the rupture of patient"s usual support systems and a patient"s grossly reduced ability to take care of themselves.

The aim of this study is to characterize the inpatient treatment of bipolar patients admitted in the Hospital São João's Psychiatry Department. Data were collected from clinical files using an investigation protocol especially developed for this purpose. This protocol includes sociodemographic information, the referral source, the admission path, reason for hospitalization, current phase of disease, voluntary versus involuntary status, number of previous admissions, prescribed medications and length of stay.
Metabolic Syndrome in Patients with Bipolar Disorders (BD): Findings from the BIMET study
Authors: González-Pinto A. , Vieta E. , Montes J.M. , Rejas-Gutiérrez J. , Mesa F.
Published: March 2009

Purpose:

To evaluate the 12-months prospective evolution of metabolic and cardiovascular risk factors in patients with types I or II Bipolar Disorder (BD) in Spain.

Methods:

The BIMET study is a 12-month, prospective, multicentre, naturalistic study which enrolled patients with type I or II BD according to DSM-IV TR criteria. Fasting blood levels of glucose, total, HDL, LDL cholesterol and triglycerides as well as weight, height, waist circumference and blood pressure were recorded. The National Cholesterol Educational Program (NCEP)-ATP III definition was applied to consider presence of metabolic syndrome (MS).

Results:

A total of 524 patients were enrolled; 73% type I and 27% type II. 61.9% women, mean age 46.3 years. 28.4% of subjects work regularly. Smokers were 42.2%, 15.1% had a substance abuse history, 34.2% were obese according with WHO criteria (obesity class I; 23.2%, class II; 7.5%, and class III; 3.5%) and overweight was found in 37.4% of sample. Prevalence of diabetes was 7.3%, hypertension was present in 24.7%, 18.5% had cholesterol ≥240 mg/dL and 36.2% had triglycerides ≥150 mg/dL. Overall prevalence of MS was 27.0% (95% CI: 22.7%-31.3%), with 27.3% (22.2%-32.3%) in type I BD and 27.1% (19.0%-36.6%) in type II (p=0.973).

Conclusions:

The prevalence of metabolic syndrome in type I / II BD patients was considerably higher than in the general population. As an excess of mortality due to metabolic and cardiovascular reasons pointed out in these patients, it is recommended a close clinical monitoring of such parameters in the routine medical practice.
Cardiovascular Risk in a Spanish Population of Bipolar Disorder Patients: Results from the BIMET Study [P01-213]
Authors: Montes J.M. , Vieta E. , González-Pinto A. , Rejas-Gutiérrez J. , Mesa F.
Published: March 2009

Purpose:

To estimate the 10-years coronary heart disease and cardiovascular mortality risks in a Spanish population of bipolar disorder (BD) patients.

Methods:

BIMET study is a 12-month, prospective, multicentre, naturalistic study which enrolled type I or II BD patients according to DSM-IV TR criteria. A fasting blood sample was drawn to evaluate glucose, total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. Weight, height, waist circumference at the umbilicus and blood pressure were also recorded. Framinghan and SCORE functions were used to calculate the 10-year risk for coronary hearth disease or cardiovascular death respectively.

Results:

A total of 320 and 417 patients, mean age 46.3 (13.0) years, were included for the Framingham and SCORE calculations respectively. The overall mean (standard deviation) risk for coronary heart disease was 7.3% (7.8) according to Framingham algorithm, with 6.3% of patients classified as having a high risk of coronary disease (Framingham higher than 10%). The mean overall risk for cardiovascular mortality was 1.2% (2.4) according to SCORE algorithm, with 6.5% of patients falling within the high cardiovascular mortality risk segment; SCORE higher than 5%. No statistically significant differences were observed between type I and II patients.

Conclusion:

This study reflects a substantial risk for cardiovascular events or mortality in a Spanish cohort of bipolar disorder patients. Results were comparable to those seen in subject with schizophrenia spectrum disorders. Therefore, an effort for controlling all cardiovascular risk factors in bipolar disorder patients should be carried out by clinicians and health decision makers.
Psychoeducation in Bipolar Disorder: A Clinical Perspective
Authors: Castro L.C. , Rodrigues T. , Pereira J. , Coelho I. , Maia H. , Pereira M. , Pereira H.
Published: March 2009

Background:

Bipolar disorder is a chronic, recurrent and debilitating mood disorder with a major impact on several aspects of everyday life. Although pharmacotherapy plays a central role in bipolar disorder treatment, psychosocial interventions are essential to a more complete and successful treatment.

Aims:

To present a psychoeducation program for bipolar patients runned in a Portuguese psychiatric hospital - Hospital de Magalhães Lemos, Oporto. To review the impact of psychoeducative measures on bipolar patients.

Methods:

A psychoeducative program for bipolar patients was developed and adapted, based on the Barcelona Bipolar Disorders Program"s experience. The psychoeducative program was applied to bipolar patients as an adjuvant of maintenance treatment.

Results:

Fifteen sessions were runned during 15 weeks. Twelve patients were recruited to integrate the psychoeducative group. The sessions addressed several topics including information about the illness, early detection of prodromal symptoms and symptoms management, stress management and the importance of maintaining routines.

Conclusions:

The best treatment available for patients with bipolar disorder includes, along with the pharmacological treatment, psychosocial interventions aimed to target issues as early identification of prodromal symptoms, coping skills, medication adherence and understanding of the disorder. This broader approach of bipolar disorder treatment has proved to be efficient in reducing relapse rates, and improving patients’ feelings of self-efficacy and quality of life.
Clinical Factors as Predictors on Functional Impairment in Bipolar Disorder
Authors: Rosa A. , Reinares M. , Franco C. , Comes M. , Torrent C. , Sanchez-Moreno J. , Martinez-Aran A. , Kapczinski F. , Vieta E.
Published: March 2009

Introduction:

Recent studies have suggested that functional impairment in bipolar disorder may be strongly associated with residual depressive symptoms. However, there is a notable disparity between functional recovery and symptomatic recovery. This study was carried out to investigate clinical factors as potential predictors on functional impairment in a well defined euthymic bipolar sample.

Methods:

Seventy-one patients were recruited from the Bipolar Disorder Program at the Clinic Hospital of Barcelona. A Structured Clinical Interview for DSM-IV-TR, HAM-D and YMRS were used to diagnostic assessment and euthymia criteria. The Functioning Assessment Short Test (FAST) was employed to assess functional impairment. The FAST is a reliable and valid, interview-administered scale, rapid and easy to apply (3-6 min). It consists of 24 items which allow to assess six specific areas of functioning such as autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time.

Results:

The sample comprised 36 (51%) men, aged 48±13.56 years. Several clinical variables were associated with poor functioning on a linear regression model, such as age, depressive symptoms, number of previous mixed episodes and number of previous hospitalizations. This model explained 44% of the variance (F=12.54, df=58, p< 0.001).

Discussion:

In this study, specific clinical and socio-demographic characteristics were identified as predictors of functional impairment in remitted bipolar patients. Poor functioning was identified in patients with older age and more severe illness course.
The Paradox of Social Anxiety and Bipolar Disorder: Implications for Presentation and Treatment
Authors: Ruggero C. , Dalymple K. , Zimmerman M.
Published: March 2009

Several reports have recently highlighted the close association between anxiety disorders and bipolar disorder. These reports have indicated a worse course for patients with such comorbidity, including more severe symptoms and poorer outcomes. Fewer studies, however, have closely looked at how social anxiety in particular impacts the clinical presentation and treatment-seeking behavior of people with bipolar disorder. The present report addresses this question using data from the Methods to Improve Diagnostic Assessment and Services (MIDAS) project, one of the largest ongoing clinical epidemiology studies in the United States with over 2,500 participants enrolled to date. Participants were outpatients seeking psychiatric treatment, all of whom underwent an extensive assessment via semi-structured interviews by highly trained diagnosticians. Patients with bipolar disorder and social anxiety (n = 85) were compared to patients with bipolar disorder alone (n = 150) on a series of clinical characteristics, including comorbidity, to determine how social anxiety impacts the clinical presentation of bipolar disorder. Results indicate that comorbid social anxiety is associated with a more severe clinical presentation. Follow-up analyses explored the extent to which this was due to social anxiety specifically versus comorbidity in general. Discussion focuses on how differences in presentation due to comorbid social anxiety and bipolar disorder are likely to impact treatment.
Omega 3 and Depression - State of Art
Authors: Pereira J. , Abreu A. , Fonte D. , Carvalho S.
Published: March 2009

Aims:

Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are omega-3 polyunsaturated fatty acids (ω-3 PUFAs) involved in the structure and function of cell membranes in the brain. Because both compounds must be obtained from diet, by eating oily fish or fish oil, the consumption of fish or supplements of omega-3 could be correlated with neuropsychiatric disorders, as depression disorder.

Methods:

Search of relevant studies in Scirus database.

Results:

Epidemiological studies suggest that populations with high consumption of fish have low annual prevalence of major depression. Laboratorial research verified that major depression in acute coronary syndrome patients is associated with significantly lower plasma levels of ω-3 PUFAs, in particular of DHA; red blood cells membrane levels of total ω-3 PUFAs and of DHA are significantly lower in depressive patients; low plasma concentrations of DHA predict low concentrations of 5-hydroxyindolacetic acid, a marker of brain serotonin turnover, which, in turn, is strongly associated with depression and suicide. Clinical trials demonstrated the efficiency of EPA in the alleviating the symptoms of major depression in adults, childhood depression and postpartum depression.

Conclusions:

Although the depression appears to be related with low levels of DHA in plasma and blood cells, controlled trials have found no effect of DHA supplementation in depression. On the contrry, EPA might have an adjunctive therapeutic value in the treatment of depression disorder. Much research is required to compare the effectiveness of the different fatty acids in the treatment of depressive disorder, as well as the relevant dose-response curves.
The Bipolar Spectrum; Do we Need a Single Algorithm for Affective Disorders?
Authors: Agius M. , Tavormina G.
Published: March 2009

Increasing understanding of the bipolar spectrum of disorders has led to an increasing integration of concepts regarding the aetiology and treatment of affective disorders.

Thus, for example, we now understand that an illness, previously believed to be recurrent depressive disorder, may develop over time into a bipolar illness, and bipolar II illnesses may develop into bipolar I.

Agitated depression may in fact be a mixed affective state, and injudicious use of powerful antidepressants in patients with undiagnosed bipolar disorder may lead to the development of mixed states or rapid cycling illness, as well as a complete switch from depression to mania.

Mixed states and rapid cycling states are linked with increased suicidality.

Meanwhile bipolar disorder, especially bipolar II disorder, remains a condition which is underdiagnosed and often inappropriately treated.

Unfortunately, NICE guidelines are separate for Unipolar Depression and Bipolar Illness; those for Unipolar illness advocate a 'stepped care’ model, centred round primary care, while bipolar guidelines warn against injudicious use of antidepressants and the use of mood stabilisers to prevent ‘switching’ to mania.

Primary care physicians are not warned to take a full longitudinal history in depressed patients, to identify bipolar illness, nor are they trained to use mood stabilisers in patients with bipolar II disorder, and in the risks of injudicious use of antidepressants.

We need a single algorithm for identifying and treating affective disorders.

The symposium will consider these issues as a prelude to a Europe Wide meeting planned for later in 2009, to develop guidelines about these issues.