Misdiagnosis, duration of untreated illness (DUI) and outcome in bipolar patients with psychotic symptoms: A naturalistic study

AbstractObjective:To identify some of the main features of bipolar disorder for both first-episode (FE) mania and the preceding prodromal phase, in order to increase earlier recognition.Methods:One thousand and ninety manic patients (FE=81, multiple-episodes [ME]=1009) were assessed for clinical and temperamental characteristics.Results:Compared to ME, FE patients reported more psychotic and less depressive symptoms but were comparable with respect to temperamental measures and comorbid anxiety. The following independent variables were associated with FE mania: a shorter delay before correct diagnosis, greater substance use, being not divorced, greater stressors before current mania, a prior diagnosis of an anxiety disorder, lower levels of depression during index manic episode, and more suicide attempts in the past year.Conclusion:In FE patients, the diagnosis of mania may be overlooked, as they present with more psychotic symptoms than ME patients. The prodromal phase is characterised by high levels of stress, suicide attempts, anxiety disorders and alcohol or substance abuse. Data suggest to consider these prodromes as harmful consequences of temperamental predispositions to bipolar disorder that may concur to precipitate mania onset. Their occurrence should therefore incite clinicians to screen for the presence of such predispositions, in order to identify patients at risk of FE mania.

Download Full-text

The Expanding Role of Antipsychotics

CNS Spectrums ◽

10.1017/s1092852900027140 ◽

2004 ◽

Vol 9 (S1) ◽

pp. 7-12

Author(s):

Philip G. Janicak

Keyword(s):

Bipolar Disorder ◽

Manic Episode ◽

Acute Mania ◽

Psychotic Symptoms ◽

Primary Therapy ◽

Obsessive Compulsive ◽

Stabilizing Agent ◽

Compulsive Disorder ◽

Bipolar Patients

Antipsychotics have been utilized in the treatment of bipolar disorder for many decades and were the mainstay of treatment before lithium was reintroduced in the late 1960s. Today, many bipolar patients who present with psychotic features are misdiagnosed and prescribed an antipsychotic for another disorder. Estimates of psychotic symptoms in bipolar disorder, particularly during a manic episode, are ≥50% by clinical assessment and even higher by individual reports. Thus, antipsychotics are frequently used: as first treatment for psychosis not recognized as bipolar disorder, and as an adjunct to a mood-stabilizing agent in bipolars with psychotic symptoms.Most recently, antipsychotics have been examined for their mood-stabilizing properties as well (Slide 9). One may conceptualize using a selective serotonin reuptake inhibitor (SSRI) antidepressant for disorders such as panic disorder or obsessive-compulsive disorder, and using an antiepileptic as a mood-stabilizing agent; however, it is more difficult to accept that an agent approved for treatment of psychosis can be a primary therapy for bipolar disorder. Data from the monotherapy trials suggest that second-generation antipsychotics (SGAs) are at least as effective as lithium and valproic acid for acute mania. There is a very large database indicating that SGAs can be utilized as monotherapy for acute mania. However, there is limited data on the role of these agents in prevention of relapse and recurrence and in their efficacy for depression in the context of bipolar disorder. More studies will be needed to clarify whether SGAs should be used as monotherapy or whether they would be best used as augmenting agents in severe and psychotically manic or depressed patients.

Download Full-text

Quality of life and associated factors among chronic mental illness patients in Kaohsiung

European Psychiatry ◽

10.1016/s0924-9338(11)72229-5 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 522-522

Author(s):

F.H.-C. Chou ◽

R.-R. Huang ◽

C.-Y. Su

Keyword(s):

Quality Of Life ◽

Mental Illness ◽

Social Factors ◽

Associated Factors ◽

Family Factors ◽

Psychotic Symptoms ◽

Chronic Mental Illness ◽

Personal Factors ◽

Bipolar Patients

ObjectiveThe purpose of this study was to predict quality of life (QoL) and associated factors in patients with chronic mental illness (CMI) in Kaohsiung, Taiwan.MethodsPatients (N = 2,023; 52.9% male, 47.1% female) were recruited using cross-sectional and convenience sampling. Structured questionnaires, including a living conditions questionnaire, a psychotic symptom assessment scale, the Caregiver Burden Scale, the 5-item Brief Symptom Rating Scale (BSRS-5), and the Medical Outcomes Study Short Form-12 (MOS SF-12) were used to collect data.ResultsSingle-factor analyses showed that those who were single, employed, and younger had better QoL. Additionally, patients who had fewer psychological problems and lower levels of psychological distress reported better QoL. Current psychotic symptoms, especially positive symptoms, were negatively correlated with QoL. For disease factors, schizophrenic patients and hospitalized patients reported better QoL than both bipolar patients and community patients. For family factors, caregiver's attitude and caregiver's burden were negatively correlated with QoL. For social factors, unstable housing and community social dysfunction were negatively correlated with QoL. The results showed that all four dimensions (social, family, disease and personal factors) were significant predictors of the mental component summary (MCS) and physical component summary (PCS) dimensions of QoL.ConclusionsPersonal factors and disease factors were the most important predictors of QoL in CMI patients of this sample. Family factors were more important than social factors in the MCS dimension, but social factors were more important than family factors in the PCS dimension.

Download Full-text

P.2.e.003 Duration of untreated illness (DUI) in bipolar disorder: a naturalistic study

European Neuropsychopharmacology ◽

10.1016/s0924-977x(08)70510-8 ◽

2008 ◽

Vol 18 ◽

pp. S360-S361 ◽

Cited By ~ 1

Author(s):

B. Dell'Osso ◽

M. Buoli ◽

G. Camuri ◽

V. Vecchi ◽

A.C. Altamura

Keyword(s):

Bipolar Disorder ◽

Naturalistic Study ◽

Duration Of Untreated Illness

Download Full-text

Faculty Opinions recommendation of Visual and verbal memory in euthymic bipolar patients: impacts of subtypes, psychotic symptoms and suicide behavior.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.5364970.5315071 ◽

2010 ◽

Author(s):

Parvaneh Mohammadkhani ◽

Mahboobe Haghighi ◽

Mehran Jokar

Keyword(s):

Verbal Memory ◽

Psychotic Symptoms ◽

Suicide Behavior ◽

Bipolar Patients

Download Full-text

A double blind randomized clinical trial of buprenorphine augmentation for treatment of psychotic symptoms in opioid addicted bipolar patients

Journal of Opioid Management ◽

10.5055/jom.2019.0525 ◽

2019 ◽

Vol 15 (5) ◽

pp. 362-366 ◽

Cited By ~ 1

Author(s):

Navid Khalili, MD ◽

Abdolreza Sabahi, MD ◽

Mostafa Vahedian, PhD ◽

Mehdi Alimardanzadeh, MD

Keyword(s):

Psychiatric Symptoms ◽

Repeated Measure ◽

Secondary Outcome ◽

Psychotic Symptoms ◽

Type I ◽

Manic Symptoms ◽

Significant Difference ◽

Bipolar Patients ◽

Depressive Episodes ◽

Depressive And Manic Symptoms

Objective: To assess the efficacy of buprenorphine augmentation in treatment of psychotic symptoms in bipolar disorder type I.Design: Bipolar type I patients with manic or depressive episodes and psychotic feature and with opioid dependency comorbidity were randomly included and allocated. Both groups of buprenorphine (4 or 6 mg/d) and placebo were also treated with enough dosages of sodium valproate and risperidone. Psychosis as primary outcome and depressive and manic symptoms as secondary outcome were assessed at baseline and after 1 and 2 weeks. Data were analyzed through t test and repeated measure ANOVA.Results: Twenty-four patients remained in each group. Both groups displayed significant reduction in psychotic, depressive, and manic symptoms during the 2 weeks of study, although there was not any significant difference between them. Conclusions: Buprenorphine did not add any efficacy to usual treatment of psychotic episodes of bipolar, although did not aggravate psychiatric symptoms.

Download Full-text

Duration of untreated illness and suicide in bipolar disorder: a naturalistic study

European Archives of Psychiatry and Clinical Neuroscience ◽

10.1007/s00406-009-0085-2 ◽

2009 ◽

Vol 260 (5) ◽

pp. 385-391 ◽

Cited By ~ 96

Author(s):

A. Carlo Altamura ◽

Bernardo Dell’Osso ◽

Heather A. Berlin ◽

Massimiliano Buoli ◽

Roberta Bassetti ◽

...

Keyword(s):

Bipolar Disorder ◽

Naturalistic Study ◽

Duration Of Untreated Illness

Download Full-text

Age at onset and latency to treatment (duration of untreated illness) in patients with mood and anxiety disorders: a naturalistic study

International Clinical Psychopharmacology ◽

10.1097/yic.0b013e3283384c74 ◽

2010 ◽

Vol 25 (3) ◽

pp. 172-179 ◽

Cited By ~ 67

Author(s):

Alfredo Carlo Altamura ◽

Massimiliano Buoli ◽

Alessandra Albano ◽

Bernardo DellʼOsso

Keyword(s):

Anxiety Disorders ◽

Treatment Duration ◽

Age At Onset ◽

Naturalistic Study ◽

Duration Of Untreated Illness ◽

Mood And Anxiety Disorders

Download Full-text

Social Cognition and General Functioning in Bipolar Disorder

European Psychiatry ◽

10.1016/s0924-9338(09)70816-8 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1 ◽

Cited By ~ 2

Author(s):

G. Lahera ◽

E. Herrería ◽

S. Ruiz-Murugarren ◽

C. Ruiz-Bennásar ◽

P. Iglesias ◽

...

Keyword(s):

Social Cognition ◽

Theory Of Mind ◽

Emotion Recognition ◽

Sustained Attention ◽

Psychotic Symptoms ◽

Clinical Variables ◽

General Functioning ◽

Low Functioning ◽

Bipolar Patients ◽

Face Emotion Recognition

Introduction:Bipolar patients show a significant degree of psychosocial disfunction even in euthymia. Recent studies have reported deficits in Theory of Mind and emotion recognition in BD. Our hypothesis is that social cognition deficit could be associated with a poor general functioning and psychosocial disadvantage in BD.Methods:A sample of 27 euthymic bipolar patients were recluted. Based on Global Assessment of Functioning, they were divided into two groups: good or low general functioning. Euthymia was defined as YMRS < 6 and HDRS < 8, during a 3-month period. Patients with high (n 18) and low (n 9) functioning were compared on several clinical variables and on social / general cognitive measures. Both verbal and non verbal Theory of Mind capacities were assesed (faux pas test and face emotion recognition test). Finally, sustained attention and executive functions were evaluated (Asarnow Test and WSCT).Results:High- and low-functioning groups did not differ with respect to demographic and clinical variables (age, sex, age at onset, years of evolution of illness, history of prior psychotic symptoms; p = n.s.). However, low-functioning group showed poorer performance than high-functioning group both in faux pas test (U Mann Whitney; p=0.035) and face emotion recognition (U; p = 0.021). In addition, low-functioning group also showed a significant impairment in general cognitive funtions such as sustained attention (U, p = 0.007) and executive funtions (U, p = 0.046).Conclusion:Social cognition deficit is associated with a poorer general functioning and psychosocial disadvantage.

Download Full-text