Thursday, April 9, 2009

Bipolar Research Update April 9, 2009

In a Swedish study of more than 9 million individuals, it was found that first degree relatives of people with bipolar disorder and schizophrenia were more likely to get these illnesses. Relatives of people with bipolar disorder were also more at risk of schizophrenia, including children adopted by a parent with bipolar disorder. Heritability for schizophrenia and bipolar disorder was 64% and 59% respectively.
Lichtenstein et al (2009). Common genetic determinants of schizophrenia and bipolar disorder among Swedish families: A population-based study. Lancet, 373(9659): 234-239.

In a family study there was no relationship between mood disorder in parents and personality traits in their children. Furthermore, parent's personality traits were not associated with risk of depression in their children.
Rothen et al. (2009). Personality traits in children of parents with unipolar and bipolar mood disorders. Journal of Affective Disorders, 113(1-2), 133-141

In a retrospective cohort study of more than 75,000 inmates in the largest prison system in the USA, it was found that inmates with serious mental illnesses, such as schizophrenia, bipolar disorder and major depressive disorder among others, were more likely to have had previous incarcerations. The greatest increase in risk of prior incarcerations were inmates with bipolar disorder who were 3.3 times as likely as inmates with no mental illness to have had 4 or more previous incarcerations in the 6 years prior to the study.
Baillargeon et al (2009). Psychiatric disorders and repeat incarcerations: The revolving prison door. American Journal of Psychiatry, 166(1), 103-109

Thursday, February 26, 2009

Bipolar Research Update February 26, 2009

The goal of this randomized, double-blind study was to measure the safety and effectiveness of aripiprazole (sold as Abilify) as monotherapy for acute biolar mania. Aripiprazole casued significantl more improvement than placebo and the same was shown for lithium. Most common side effects with aripiprazole were headache, nausea, sedation, constipation and akathisia, which is a feeling of inner restlessness that causes people to have an inability to stay still. Within 2 days, aripiprazole provided relief of symptoms of acute mania within 2 days, which continued over 3 weeks and sustained over 3 months. At twelve weeks both medications had similar outcomes.
Keck, P.E., et al (2009). Aripiprazole monotherapy in the treatment of acute bipolar I mania: A randomized, double-blind, placebo and lithium-controlled study. Journal of Affective Disorders, 112(1-3), 36-49

New scientific evidence show that the long-term course of bipolar disorder (BD) is lnked with high rates of other psychiatric conditions and increased mortality rates due to medicl disease. This leads to chronic BD, involvement in many health and social welfare sysmptoms. Add this to the disturbances in circadian rhythms, unstable moods and cognitive difficulties lead to a high rate of medical burden. Therefore the authors propose a multidimensional approach that addresses all these symptom domains.
Sorcella, I., E. Frank, and D.J. Kupfer (2009). The phenomenology of bipolar disorder: What drives the high rate of medical burden and determines long-term prognosis? Depressiona and Anxiety, 26(1), 73-82.

The objective of this study was to observe more than 3,000 people with bipolar disorder I (BDI) with a focus on those with rapid cycling (RC) in a large, prospective, observational study that followed people over many years in 14 European countries. Findings imiply that in non-clinical settings, people with mania and RC have different socio-demographics, treatment prescriptions and clinical outcome, with worse work outcomes and more co-existing conditions. It was also indicated that people with RC BPI have a severe form of BD over time with diagnostic and therapeutic tools that do not have rigorous evidence to support their usefulness.
Cruz, N, et al. (2008). Rapid-cycling bipolar I disorder: Course and treatment outcome of a large sample across Europe. Journal of Psychiatric Research 42(13), 1068-1075.

The research question in this study was to find out if advanced paternal age was associated with higher incidence of BD in offspring since advanced paternal age is known to increase risk for neurodevelopmental disorders. Starting with a database of 7,328,100 individuals and their biological parents, the sample was more than 13,00 people with a BD diagnosis. Taking account number of prior births, maternal age, socioeconomoic status and family history of psychotic disorders, the children of men who were 55 years and older were at a one-third increase in risk of having BD than the children of men who were aged 20-24 years.
Frans, E. M. et al. (2008) Advancing paternal age and bipolar disorder. Archives of General Psychiatry 65(9), 1034-1040.

Sunday, February 15, 2009

Most (97%) of people in this study with co-occurring diagnoses of both bipolar disorder I and alcohol or drug abuse disorders had attempted suicide.
Sublette et al, (2009). Substance use disorder and suicide attempts in bipolar subtypes
Journal of Psychiatric Research Vol 43 #3, p. 230-238

A comparison of 39 bipolar I disorder clients with 53 healthy controls found that regardless of suicidal history, people with bipolar I scored lower on neuropsychological tests of memory, executive function, attention and decision-making. Those who had attempted suicide had lower performance on decision-making tests compared to those who had not. Caution: the small sample may detract from the validity of these findings.
Malloy-Diniz, L.F. et al (2009). Suicide behavior and neuropsychological assessment of Type I bipolar patients. Journal of Affective Disorders, Vol 112 #1-3, p. 231-236.

Electroconvulsive therapy (ECT) was found to have more effectiveness in subjective & objective measures of mood in people diagnosed with unipolar depression than in people with bipolar depression, where there was no improvement in subjective (client) measures of mood. In the latter only clinician-rated measures were found to have improvement. In people with unipolar depression, improvement was shown on both clinician (objective) and client (subjective) measures of improvement. The study suggests that ECT may be more useful for people with unipolar depression than those with bipolar depression.
Hallam, K.T., Smith, D. I., & Berk, M. (2009). Differences between subjective and objective assessments of the utility of electroconvulsive therapy in patients with bipolar and unipolar depression. Journal of Affective Disorders, Vol 112 #1-3, p. 212-218

Although no causal relationship can be determined from this cross-sectional study, children and adolescents with a history of physical abuse were more likely to have longer duration of bipolar disorder, non-intact family, PTSD, psychosis and first degree family history of mood disorder than those without a history of physical abuse.
Romero, S. et al (2009). Prevalence and correlates of physical and sexual abuse in children and adolescents with bipolar disorder. Journal of Affective Disorders, Vol 112 #1-3, p. 144-150

A small study (results to be taken with caution) explored the effectiveness of psychoeducation as compared to an unstructured support group for people diagnosed with bipolar II. Results showed that after 5 years people who were in the psychoeducation group had fewer and shorter bipolar episodes and fewer manic and depressive episodes with higher levels of functioning.
Colom, F. et al (2009). Psychoeducation for bipolar II disorder: an exploratory, 5-year outcome sub-analysis. Journal of Affective Disorders, Vol 112 #1-3, p. 30-35

Interview with Dr. Ruth C. White, author Bipolar 101

Thursday, January 8, 2009


The genes that influence our circadian rhythms and sleep cycles also influence the clinical features and age of onset of bipolar disorder.
Benedetti, F., Dallaspezia, S., Colombo, C., et al., (2008). A length polymorphism in the circadian clock gene Per3 influences age at onset of bipolar disorder. Neuroscience Letters, 14, 445(2), 184-187.

Cannabis abuse causes bipolar-related psychosis to start an average of three years earlier than for people who did not abuse cannabis.
Ongur, D., Lin, L., & BM Cohen (2009). Clinical characteristics influencing age at onset in psychotic disorders. Comprehensive psychiatry, 50(1), 13-19.

Treating even minor depressive symptoms after a first manic episode is integral to recovery after depression following a first manic episode because only depression was found to be related to functional outcomes at 6 months post a manic episode.
Kauer-Sant’anna, M, Bond, DJ, Lam, RW, Yatham, LN (2009). Functional outcomes in first-episode patients with bipolar disorder: a prospective study from the Systematic Treatment Optimization Program for Early Mania project. Comprehensive Psychiatry, 50(1), 1-8.

A 16-week trial found that aripiprazole seems to show promise as an adjunctive treatment or monotherapy in people with bipolar disorder who are unresponsive to mood stabilizers. Akathisia (inner restlessness) and slight weight gain were the main side effects. However, double-blind, placebo-controlled studies are necessary to measure the drug’s efficacy, tolerability and safety for bipolar patients.
Mazza, M, Squillacioti, MR, Pecora, JD, et al (2008). Beneficial acute antidepressant effects of aripiprazole as an adjunctive treatment or monotherapy in bipolar patients unresponsive to mood stabilizers: results from a 16-week open-label trial. Expert opinion on pharmacotherapy, 9(18), 3145-9.

A study of the effectiveness of acute treatment with interpersonal and social rhythm therapy on occupational functioning found that despite the lack of statistical significance, there was more improved occupational functioning than with a pscyhoeducational and supportive approach with no emphasis on functional capacity.
Frank, E, Soreca, I, Swartz, HA et al. (2008). The role of interpersonal and social rhythm therapy in improving occupational functioning in patients with bipolar I disorder. American Journal of Psychiatry, 165(12), 1559-65.