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