Clinical and prognostic implications of seasonal pattern in bipolar disorder: a 10-year follow-up of 302 patients

ABSTRACTBackgroundMore than 20% of bipolar patients may present with seasonal pattern (SP). Seasonality can alter the course of bipolar disorder. However, to date, long-term follow-up studies of bipolar patients presenting with SP are scarce. We present a 10-year follow-up study comparing clinical and demographic features of bipolar patients with and without SP.MethodThree hundred and twenty-five bipolar I and II patients were followed up for at least 10 years. SP was defined according to DSM-IV criteria. Clinical variables were obtained from structured interviews with the patients and their relatives. Patients with and without SP were compared regarding clinical and sociodemographic variables and a stepwise logistic regression was performed.ResultsSeventy-seven patients (25·5%) were classified as presenting with SP, while 225 (74·5%) were considered as presenting with no significant seasonal variation. Twenty-three patients (7%) were excluded from the study because it was unclear whether they had seasonality or not. There were no differences between groups regarding demographic variables. Patients with SP predominantly presented with bipolar II disorder, depressive onset, and depressive predominant polarity. The greater burden of depression did not correlate with indirect indicators of severity, such as suicidality, hospitalizations or psychotic symptoms.ConclusionsOur study links the presence of SP with both bipolar II disorder and predominant depressive component. However, we could not find any difference regarding functionality or hospitalization rates. Modifications in the criteria to define SP are suggested for a better understanding of bipolar disorder.

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A Prospective Comparison of Bipolar I and II Subjects With and Without Comorbid Alcohol Dependence From the COGA Dataset

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.522228 ◽

2020 ◽

Vol 11 ◽

Author(s):

Ulrich W. Preuss ◽

M. N. Hesselbrock ◽

V. M. Hesselbrock

Keyword(s):

Bipolar Disorder ◽

Alcohol Use ◽

Alcohol Dependence ◽

Collaborative Study ◽

Structured Interviews ◽

Prospective Comparison ◽

Bipolar Ii ◽

Bipolar Patients ◽

Alcohol Dependent

Objective: Comorbidity of alcohol use disorders in bipolar subjects is high as indicated by epidemiological and clinical studies. Though a more severe course of bipolar disorder in subjects with comorbid alcohol dependence has been reported, fewer studies considered the longitudinal course of alcohol dependence in bipolar subjects and the prospective course of comorbid bipolar II subjects. Beside baseline analysis, longitudinal data of the COGA (Collaborative Study on Genetics in Alcoholism) were used to evaluate the course of bipolar I and II disordered subjects with and without comorbid alcohol dependence over more than 5 years of follow-up.Methods: Characteristics of bipolar disorder, alcohol dependence and comorbid psychiatric disorders were assessed using semi-structured interviews (SSAGA) at baseline and at a 5-year follow-up. Two hundred twenty-eight bipolar I and II patients were subdivided into groups with and without comorbid alcohol dependence.Results: Of the 152 bipolar I and 76 bipolar II patients, 172 (75, 4%) had a comorbid diagnosis of alcohol dependence. Bipolar I patients with alcohol dependence, in particular women, had a more severe course of bipolar disorder, worse social functioning and more suicidal behavior than all other groups of subjects during the 5-year follow-up. In contrast, alcohol dependence improved significantly in both comorbid bipolar I and II individuals during this time.Conclusions: A 5-year prospective evaluation of bipolar patients with and without alcohol dependence confirmed previous investigations suggesting a more severe course of bipolar disorder in comorbid bipolar I individuals, whereas bipolar II individuals were less severely impaired by comorbid alcohol use disorder. While severity of alcohol dependence improved during this time in comorbid alcohol-dependent bipolar I patients, the unfavorable outcome for these individuals might be due to the higher comorbidity with personality and other substance use disorders which, together with alcohol dependence, eventually lead to poorer symptomatic and functional clinical outcomes.

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Potential Misdiagnosis of Bipolar Disorder

European Psychiatry ◽

10.1016/s0924-9338(09)70805-3 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1 ◽

Cited By ~ 1

Author(s):

D. Correia ◽

L. Correia ◽

T. Gandra ◽

F. Silva

Keyword(s):

Bipolar Disorder ◽

Seasonal Pattern ◽

Large Fraction ◽

Review Literature ◽

Mood Stabilizers ◽

Psychotic Symptoms ◽

Obsessive Compulsive ◽

Clinical Indicators ◽

Compulsive Disorder

Background:Several reports indicate that Bipolar Disorder (BD) is frequently underdiagnosedleading 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.

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Parents with bipolar disorder: Are disease characteristics good predictors of psychopathology in offspring?

European Psychiatry ◽

10.1016/j.eurpsy.2012.03.006 ◽

2012 ◽

Vol 28 (4) ◽

pp. 240-246 ◽

Cited By ~ 13

Author(s):

M. Garcia-Amador ◽

E. de la Serna ◽

M. Vila ◽

S. Romero ◽

M. Valenti ◽

...

Keyword(s):

Bipolar Disorder ◽

Psychotic Symptoms ◽

Global Assessment Of Functioning ◽

Bipolar Ii Disorder ◽

Hyperactivity Disorder ◽

Disease Characteristics ◽

Bipolar Ii ◽

Axis I Disorders ◽

History Of ◽

Axis I

AbstractPurposeTo investigate rates of psychopathology in the offspring of subjects with bipolar disorder (BP-offspring) compared to the offspring of healthy subjects (HC-offspring) in a Spanish sample and to study possible predictors of psychopathology in BP-offspring.SubjectsFifty BP-offspring from 36 families and 25 HC-offspring from 25 families.MethodsPsychopathology was compared in BP-offspring and HC-offspring. Factors associated with DSM-IV axis I disorders in BP-offspring were analyzed using logistic regression.ResultsHalf of BP-offspring fulfilled the diagnostic criteria for at least one axis I disorder with attention-deficit/hyperactivity disorder (30%), anxiety disorders (14%) and affective disorders (10%) as the most frequent. After controlling for having more than one sibling in the study, the odds ratio for BP-offspring presenting an axis I disorder was 15.02 when a biological parent had bipolar disorder with a lifetime history of psychotic symptoms and 3.34 when one parent had bipolar II disorder. Moreover, a higher Global Assessment of Functioning score in the biological co-parent was associated with a significantly lower frequency of axis I disorders in BP-offspring.Discussion and conclusionsPsychopathology in BP-offspring should be routinely assessed, with special emphasis on children from parents with specific disease characteristics (psychosis, BP II disorder) in order to establish an early diagnosis and appropriate interventions.

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Impact of number of episodes on neurocognitive trajectory in bipolar disorder patients: a 5-year follow-up study

Psychological Medicine ◽

10.1017/s0033291718001885 ◽

2018 ◽

Vol 49 (08) ◽

pp. 1299-1307 ◽

Cited By ~ 10

Author(s):

Eva María Sánchez-Morla ◽

Ana López-Villarreal ◽

Estela Jiménez-López ◽

Ana Isabel Aparicio ◽

Vicente Martínez-Vizcaíno ◽

...

Keyword(s):

Bipolar Disorder ◽

Visual Memory ◽

Positive Impact ◽

Composite Index ◽

Neurocognitive Impairment ◽

Psychotic Symptoms ◽

Control Group ◽

Cross Sectional ◽

Bipolar Patients

AbstractBackgroundThe neurocognitive trajectory in bipolar disorder (BD) is variable, with controversial findings, and most evidence come from cross-sectional studies. We aimed to examine the course of neurocognitive functioning in a sample of euthymic BD patients in comparison with a control group during a 5-year follow-up.MethodsNinety-nine euthymic bipolar patients and 40 healthy controls were assessed using a comprehensive neurocognitive battery (six neurocognitive domains) at baseline (T1) and then at 5-year follow-up (T2) in a longitudinal study.ResultsNo evidence of a progression in neurocognitive dysfunction was found either in cognitive composite index or in any of the neurocognitive domains for the whole cohort. However, there was a negative correlation between number of manic episodes and hospitalisations due to manic episodes and change in neurocognitive composite index (NCI) during the follow-up. Moreover, patients with higher number of manic and hypomanic episodes have a greater decrease in NCI, working memory and visual memory. History of psychotic symptoms was not related to the trajectory of neurocognitive impairment.ConclusionsOur results suggest that, although the progression of cognitive decline is not a general rule in BD, BD patients who have a greater number of manic or hypomanic episodes may constitute a subgroup characterised by the progression of neurocognitive impairment. Prevention of manic and hypomanic episodes could have a positive impact on the trajectory of cognitive function.

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Suicidal Attempts Among Bipolar Patients: Correlation with Affective Temperaments and Life Events

European Psychiatry ◽

10.1016/s0924-9338(09)70791-6 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

G. Amara ◽

N. Ben Salah ◽

S. Ben Nasr ◽

B. Ben Hadj Ali

Keyword(s):

Bipolar Disorder ◽

Life Events ◽

Negative Impact ◽

Bipolar Ii Disorder ◽

Affective Temperaments ◽

Bipolar Ii ◽

Suicidal Attempts ◽

Affective Temperament ◽

Dsm Iv ◽

Bipolar Patients

Aims:In this study, we focused on the correlations between life events, affective temperaments and suicidal attempts among patients with bipolar disorder.Methods:Patients with DSM IV diagnosis of bipolar I or bipolar II disorders were recruited from psychiatric consultation of the Farhat Hached Hospital in Sousse. All bipolar patients were in remission for at least four weeks. Suicidal attempts were checked by interrogating patients and consulting medical observations. Affective temperament dimensions were determined by using the Arabic version of TEMPS-A. The assessment of life events was based on the Paykel scale.Results:A total of 57 patients (47 with bipolar I disorder and 10 with bipolar II disorder) have participated in the study, with a mean age of 41,8 ± 11,3 years and a gender ratio of 2,29. Suicidal attempt number was positively correlated with depressive (p=0,021) and anxious (p=0,015) temperament, early orphanage (p=0,008) and the total number of life events (p=0,011). It was also correlated with the global negative impact of these events (p=0,036).Conclusion:According to our findings, life events and their negative impact, early parental loss and anxious and depressive temperaments predispose to suicidal attempts among patients with bipolar disorder. Further prospective studies are required to confirm these results.

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Polarised views about bipolar disorder(s): A critique of the 2020 College guidelines for mood disorders

Australian & New Zealand Journal of Psychiatry ◽

10.1177/00048674211020095 ◽

2021 ◽

pp. 000486742110200

Author(s):

Gordon Parker

Keyword(s):

Bipolar Disorder ◽

Mood Disorders ◽

International Classification Of Diseases ◽

Bipolar Ii Disorder ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Bipolar Ii ◽

Classification Of Diseases ◽

Formal Status

The 2020 College guidelines for mood disorders banish bipolar II disorder – despite its formal status in Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases manuals for more than two decades – and argue that there is no need to partition bipolar disorder into separate sub-types. Their single-entity model is seemingly based on opinion rather than any support from referenced scientific studies. The author challenges the Committee’s model of there being only one bipolar disorder and argues that it presents several clinical management risks, particularly of ‘over-treatment’.

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A Qualitative Study of Developing Competency in Thyroid Surgery: A Resident’s Perspective With 5 Year Follow Up

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489421996918 ◽

2021 ◽

pp. 000348942199691

Author(s):

Gabriela DeVries ◽

Megan Rudolph ◽

Howard David Reines ◽

Philip E. Zapanta

Keyword(s):

Qualitative Study ◽

Learning Strategies ◽

Thyroid Surgery ◽

Washington Dc ◽

Structured Interviews ◽

Self Directed Learning ◽

Surgical Specialty ◽

Long Term Follow Up ◽

The Individual

Objectives: The Accreditation Council for Graduate Medical Education has guidelines on assessing surgical qualifications based on experience. Attending surgeons have various assumptions on how their trainees learn and acquire surgical skills. This study primarily investigates the resident’s perspective on gaining experience and achieving competency in thyroid surgical procedures. Methods: A qualitative study using semi-structured interviews was designed to derive themes that discuss the acquisition of competency in thyroid surgery. After IRB approval, data was collected from 2012 to 2014 at 4 academic centers in the Washington, DC area. Fourteen chief residents specializing in either general surgery or otolaryngology were interviewed until saturation was achieved. These semi-structured interviews were transcribed and broken up into codes utilizing Moustakas’ analysis. A comprehensive list of master themes in regards to achieving competency in thyroid surgery was developed. A follow up survey of the surgeons was undertaken at 5 years to determine if the perceptions during residency persisted in practice. Results: Surgical specialty residents experience and learn thyroid surgery in 5 learning themes: 1. Self—directed learning is significant during residency. 2. Repetition with graduated autonomy is key. 3. Effective mentors are competent surgeons who challenge residents and use positive teaching techniques. 4. Residents employ active learning through the “see one, do one, teach one” philosophy. 5. Learning from complexity is of importance to residency training. After several years in practice, the most important theme in learning after residency was repetition of cases. Conclusions: This study demonstrates how residents progress in approaching competency in thyroid surgery. Adult learning strategies are preferred, and programs should incorporate tailored techniques to meet the individual needs of the residents. Perceptions of what is most important shifted in long-term follow up. Further study is needed to assure competency in residency and in practice.

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Baseline and prodromal characteristics of first- versus multiple-episode mania in a French cohort of bipolar patients

European Psychiatry ◽

10.1016/j.eurpsy.2010.11.001 ◽

2011 ◽

Vol 27 (8) ◽

pp. 557-562 ◽

Cited By ~ 8

Author(s):

J.-M. Azorin ◽

A. Kaladjian ◽

M. Adida ◽

E. Fakra ◽

E. Hantouche ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicide Attempts ◽

Correct Diagnosis ◽

Manic Episode ◽

Psychotic Symptoms ◽

First Episode ◽

Prodromal Phase ◽

Multiple Episode ◽

Patients At Risk ◽

Bipolar Patients

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.

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Hypomanic Symptoms in Female Undergraduate Students Diagnosed with Unipolar Depression Based on Scores on the Hypomania Checklist

Clinical Practice and Epidemiology in Mental Health ◽

10.2174/1745017900905010022 ◽

2009 ◽

Vol 5 (1) ◽

pp. 22-25 ◽

Cited By ~ 4

Author(s):

Thomas Richardson ◽

Hugh Garavan

Keyword(s):

Bipolar Disorder ◽

Undergraduate Students ◽

Unipolar Depression ◽

Female Undergraduate ◽

Bipolar Ii Disorder ◽

Bipolar Ii

Background: A number of studies have documented high levels of hypomanic symptoms in those diagnosed with depression, suggesting a potential misdiagnosis of bipolar disorder as unipolar depression. Research suggests that undergraduate students have high levels of depression, but whether such misdiagnosis occurs in this population has not been examined. The aim of this study was therefore to examine levels of hypomania in undergraduate students reporting diagnosed depression. Methods: An international sample of undergraduate students completed the 32-item Hypomania Checklist (HCL-32). A cohort was analysed for this study, consisting of female undergraduate students reporting a formal diagnosis of depression (n=28). Results: Participants scored high on the HCL-32, with a mean total score of 19.9 (SD=5.4) out of 32. Overall, 85.7% (n=24) scored equal to or above the original cut off point of 14 suggested for bipolar II disorder. Conclusions: Two possible conclusions are suggested by this study. Firstly, there are high levels of hypomanic symptoms in undergraduate students diagnosed with depression, suggesting that a formal diagnosis of bipolar disorder should be pursued in those with high scores. Alternatively, the cut-off points previously suggested for the HCL-32 may not be accurate for use with undergraduate students.

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