Anxiety linked to symptom severity in bipolar disorder

Background Bipolar disorder is a lifelong problem with imperfect available treatments. Recent research has shown potential benefit of nutritional treatment for mood symptoms. The goal of the current study was to determine whether adults with bipolar disorder reported treatment benefit from consuming a micronutrient formula. Methods Self-report data were available from 682 adults who reported a diagnosis of bipolar disorder; 81% were taking psychiatric medications. Those reporting additional diagnoses were excluded, as well as those who provided data <60 times during 180 days of using the micronutrients, leaving 358 for analysis. Results Mean symptom severity was 41% lower than baseline after 3 months (effect size = 0.78), and 45% lower after 6 months (effect size = 0.76) (both paired t-tests significant, p < 0.001). In terms of responder status, 53% experienced ≥50% improvement at 6 months. Half the sample were taking medications approved for bipolar disorder (lithium, anticonvulsants, atypical antipsychotics), and half were either medication-free or taking other medications: the magnitude of treatment benefit did not differ between these two groups. Regression analyses indicated that decreased symptom severity over the 6 months was associated with increasing micronutrient dosage and with reducing medication. Symptom improvements were significant and sustained at 6 months, suggesting that benefits were not attributable to placebo/expectancy effects. Conclusions Further research on this micronutrient formula is warranted.

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The course of bipolar disorder in pregnant versus non-pregnant women

International Journal of Bipolar Disorders ◽

10.1186/s40345-021-00239-z ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Anja W. M. M. Stevens ◽

Stasja Draisma ◽

Peter J. J. Goossens ◽

Birit F. P. Broekman ◽

Adriaan Honig ◽

...

Keyword(s):

Bipolar Disorder ◽

Pregnant Women ◽

Symptom Severity ◽

Mood State ◽

Daily Basis ◽

Childbearing Age ◽

Mood Symptoms ◽

Severity Scores ◽

And Cluster Analysis ◽

Course Variables

Abstract Background and rationale Although it has been suggested that pregnancy may influence the course of bipolar disorder (BD), studies show contradictory results. Until now, no studies included a finegrained validated method to report mood symptoms on a daily basis, such as the lifechart method (LCM). The aim of the present study is to investigate the course of BD during pregnancy by comparing LCM scores of pregnant and non-pregnant women. Methods Study design: Comparison of LCM scores of two prospective observational BD cohort studies, a cohort of pregnant women (n = 34) and a cohort of non-pregnant women of childbearing age (n = 52). Main study parameters are: (1) proportions of symptomatic and non-symptomatic days; (2) symptom severity, frequency, and duration of episodes; (3) state sequences, longitudinal variation of symptom severity scores. Results No differences in clinical course variables (symptomatic days, average severity scores, frequency, and duration of episodes in BD were found between pregnant and non-pregnant women. With a combination of State Sequence Analysis (SSA) and cluster analysis on the sequences of daily mood scores three comparable clusters were found in both samples: euthymic, moderately ill and severely ill. The distribution differences between pregnant and non-pregnant women were significant, with a majority of the pregnant women (68%) belonging to the moderately ill cluster and a majority of the non-pregnant women (46%) to the euthymic cluster. In pregnant women the average daily variation in mood symptoms as assessed with Shannon’s entropy was less than in non-pregnant women (respectively 0.43 versus 0.56). Conclusions Although the use of daily mood scores revealed no difference in overall course of BD in pregnant versus non-pregnant women, more pregnant than non-pregnant women belonged to the moderately ill cluster, and during pregnancy the variation in mood state was less than in non-pregnant women. Further research is necessary to clarify these findings.

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Combined influence of medication and symptom severity on visual processing in bipolar disorder

Journal of Psychiatric Research ◽

10.1016/j.jpsychires.2022.01.010 ◽

2022 ◽

Author(s):

Thiago P. Fernandes ◽

Fatima M. Felisberti ◽

Irina I. Shoshina ◽

Natalia L. Almeida ◽

Milena E.C. Oliveira ◽

...

Keyword(s):

Bipolar Disorder ◽

Symptom Severity ◽

Visual Processing

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S85. Individual Functional Abnormalities in the Default-Mode Network Predict Symptom Severity in Bipolar Disorder

Biological Psychiatry ◽

10.1016/j.biopsych.2019.03.836 ◽

2019 ◽

Vol 85 (10) ◽

pp. S330

Author(s):

Gaelle Doucet ◽

Delfina Janiri ◽

David Glahn ◽

Sophia Frangou

Keyword(s):

Bipolar Disorder ◽

Default Mode Network ◽

Symptom Severity ◽

Default Mode

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Age-Related Differences in Medication Adherence, Symptoms, and Stigma in Poorly Adherent Adults With Bipolar Disorder

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/0891988719874116 ◽

2019 ◽

Vol 33 (5) ◽

pp. 250-255 ◽

Cited By ~ 1

Author(s):

Stephen Smilowitz ◽

Awais Aftab ◽

Michelle Aebi ◽

Jennifer Levin ◽

Curtis Tatsuoka ◽

...

Keyword(s):

Older Adults ◽

Bipolar Disorder ◽

Medication Adherence ◽

Symptom Severity ◽

Psychiatric Symptoms ◽

Significant Finding ◽

Internalized Stigma ◽

Age Related ◽

Severity Scores ◽

Over Time

Objective: We present a secondary analysis of data reporting differences in medication adherence, psychiatric symptom severity, and internalized stigma levels in older (age ≥ 55 years) versus younger (age < 55 years) adults with bipolar disorder (BD) and poor medication adherence. Methods: Data used for this analysis came from 184 participants in a National Institute of Mental Health–funded randomized controlled trial, comparing a customized adherence enhancement (CAE) intervention intended to promote BD medication adherence with a BD-specific educational program (EDU). At screen, study participants were ≥20% nonadherent with BD medications as measured by the Tablets Routine Questionnaire (TRQ). Psychiatric symptoms, functional status, and internalized stigma were measured using validated scales. Results: Older adults had significantly lower anxiety disorder comorbidity ( P < .01 for 1 or more anxiety disorders), depressive symptom severity scores ( P = .011), and self-stigma scores ( P = .001) compared to their younger counterparts. In the analyses evaluating change over time in TRQ between older and younger participants by treatment arm (ie, CAE and EDU), there was a significant finding of interaction between time, age-group, and treatment arm ( P = .007). Conclusions: Older adults may be less anxious and depressed, with less self-stigma, compared to younger people with BD and poor adherence. With respect to medication adherence, older individuals in EDU appear to do less well than younger individuals over time.

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Symptom severity, self-reported adherence, and electronic pill monitoring in poorly adherent patients with bipolar disorder

Bipolar Disorders ◽

10.1111/bdi.12326 ◽

2015 ◽

Vol 17 (6) ◽

pp. 653-661 ◽

Cited By ~ 16

Author(s):

Martha Sajatovic ◽

Jennifer B Levin ◽

Johnny Sams ◽

Kristin A Cassidy ◽

Kouri Akagi ◽

...

Keyword(s):

Bipolar Disorder ◽

Symptom Severity

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White blood cell count correlates with mood symptom severity and specific mood symptoms in bipolar disorder

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867416644508 ◽

2016 ◽

Vol 51 (4) ◽

pp. 355-365 ◽

Cited By ~ 13

Author(s):

Ole Köhler ◽

Louisa G Sylvia ◽

Charles L Bowden ◽

Joseph R Calabrese ◽

Michael Thase ◽

...

Keyword(s):

Bipolar Disorder ◽

Confidence Interval ◽

Blood Cell ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

Symptom Severity ◽

Rating Scale ◽

Blood Cell Count ◽

Mood Symptom

Objective: Immune alterations may play a role in bipolar disorder etiology; however, the relationship between overall immune system functioning and mood symptom severity is unknown. Methods: The two comparative effectiveness trials, the Clinical and Health Outcomes Initiatives in Comparative Effectiveness for Bipolar Disorder Study (Bipolar CHOICE) and the Lithium Treatment Moderate-Dose Use Study (LiTMUS), were similar trials among patients with bipolar disorder. At study entry, white blood cell count and bipolar mood symptom severity (via Montgomery-Aasberg Depression Rating Scale and Bipolar Inventory of Symptoms Scale) were assessed. We performed analysis of variance and linear regression analyses to investigate relationships between deviations from median white blood cell and multinomial regression analysis between higher and lower white blood cell levels. All analyses were adjusted for age, gender, body mass index, smoking, diabetes, hypertension and hyperlipidemia. Results: Among 482 Bipolar CHOICE participants, for each 1.0 × 109/L white blood cell deviation, the overall Bipolar Inventory of Symptoms Scale severity increased significantly among men (coefficient = 2.13; 95% confidence interval = [0.46, −3.79]; p = 0.013), but not among women (coefficient = 0.87; 95% confidence interval = [−0.87, −2.61]; p = 0.33). Interaction analyses showed a trend toward greater Bipolar Inventory of Symptoms Scale symptom severity among men (coefficient = 1.51; 95% confidence interval = [−0.81, −3.82]; p = 0.2). Among 283 LiTMUS participants, higher deviation from the median white blood cell showed a trend toward higher Montgomery-Aasberg Depression Rating Scale scores among men (coefficient = 1.33; 95% confidence interval = [−0.22, −2.89]; p = 0.09), but not among women (coefficient = 0.34; 95% confidence interval = [−0.64, −1.32]; p = 0.50). When combining LiTMUS and Bipolar CHOICE, Montgomery-Aasberg Depression Rating Scale scores increased significantly among men (coefficient = 1.09; 95% confidence interval = [0.31, −1.87]; p = 0.006) for each 1.0 × 109/L white blood cell deviation, whereas we found a weak association among women (coefficient = 0.55; 95% confidence interval = [−0.20, −1.29]; p = 0.14). Lower and higher white blood cell levels correlated with greater symptom severity and specific symptoms, varying according to gender. Conclusion: Deviations in an overall immune system marker, even within the normal white blood cell range, correlated with mood symptom severity in bipolar disorder, mostly among males. Studies are warranted investigating whether white blood cell count may predict response to mood-stabilizing treatment.

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Comorbidity of Bipolar Disorder and Medical Disorders

Bipolar Disorder ◽

10.1093/med/9780190908096.003.0008 ◽

2020 ◽

pp. 99-115

Author(s):

Awad Chowdhury ◽

Benjamin I. Goldstein

Keyword(s):

Bipolar Disorder ◽

Neurotrophic Factors ◽

Symptom Severity ◽

Excess Mortality ◽

Biological Pathways ◽

Cardiometabolic Health ◽

Medical Comorbidities ◽

Medical Disorders ◽

Cardiometabolic Disorders ◽

Negative Impacts

Much of the excess mortality in bipolar disorder can be attributed to medical comorbidities, particularly cardiometabolic disorders. This observation has been noted for more than a century. The proportion of excess mortality attributable to cardiovascular disease has increased in recent years. In addition to mortality, there are increased cardiovascular risk factors in bipolar disorder across the life span. The prevalence of these comorbidities is thought to be elevated by aberrations in particular biological pathways, including inflammation, oxidative stress, and neurotrophic factors. Medical comorbidities significantly affect the lives of patients with bipolar disorder in the form of decreased treatment response, increased symptom severity, and increased mortality risk. To successfully ameliorate the negative impacts of medical comorbidities on patients with bipolar disorder, an integrated emphasis on cardiometabolic health alongside mental health is warranted, including behavioral, pharmacological, and systems-related approaches.

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Bipolar Disorder in Children With ADHD: A Clinical Sample Study

Journal of Attention Disorders ◽

10.1177/1087054714539999 ◽

2014 ◽

Vol 21 (9) ◽

pp. 715-720 ◽

Cited By ~ 3

Author(s):

Renato Donfrancesco ◽

Michela Di Trani ◽

Elda Andriola ◽

Daniela Leone ◽

Maria G. Torrioli ◽

...

Keyword(s):

Bipolar Disorder ◽

Psychiatric Disorders ◽

Symptom Severity ◽

Rating Scale ◽

Clinical Sample ◽

Pediatric Bipolar Disorder ◽

Children With Adhd ◽

Adhd Children ◽

Adhd Subtype ◽

The Impact

Objective: To explore the impact of early-onset bipolar disorder (pediatric bipolar disorder [PBD]) on ADHD. Method: We compared ADHD symptom severity, ADHD subtype distribution, and rates of comorbid and familial psychiatric disorders between 49 ADHD children with comorbid PBD and 320 ADHD children without PBD. Results: Children with ADHD and PBD showed higher scores in the Hyperactive and Inattentive subscales of the ADHD Rating Scale, than children with ADHD alone. The frequency of combined subtype was significantly higher in ADHD children with PBD, than in those with ADHD alone. ADHD children with PBD showed a higher rate of familial psychiatric disorders than ADHD children without PBD. The rate of conduct disorder was significantly greater in children with PBD and ADHD compared with children with ADHD alone. Conclusion: ADHD along with PBD presents with several characteristics that distinguish it from ADHD alone, suggesting that these may be distinct disorders.

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