scholarly journals Chronic stressors and trauma: prospective influences on the course of bipolar disorder

2013 ◽  
Vol 43 (12) ◽  
pp. 2583-2592 ◽  
Author(s):  
A. Gershon ◽  
S. L. Johnson ◽  
I. Miller
Keyword(s):  
Bipolar Disorder ◽  
Support Groups ◽  
Life Stress ◽  
Bipolar I Disorder ◽  
Course Of Illness ◽  
College Life ◽  
Manic Symptoms ◽  
Chronic Stressors ◽  
Bipolar Patients ◽  
Exposure To Trauma

BackgroundExposure to life stress is known to adversely impact the course of bipolar disorder. Few studies have disentangled the effects of multiple types of stressors on the longitudinal course of bipolar I disorder. This study examines whether severity of chronic stressors and exposure to trauma are prospectively associated with course of illness among bipolar patients.MethodOne hundred and thirty-one participants diagnosed with bipolar I disorder were recruited through treatment centers, support groups and community advertisements. Severity of chronic stressors and exposure to trauma were assessed at study entry with in-person interviews using the Bedford College Life Event and Difficulty Schedule (LEDS). Course of illness was assessed by monthly interviews conducted over the course of 24 months (over 3000 assessments).ResultsTrauma exposure was related to more severe interpersonal chronic stressors. Multiple regression models provided evidence that severity of overall chronic stressors predicted depressive but not manic symptoms, accounting for 7.5% of explained variance.ConclusionsOverall chronic stressors seem to be an important determinant of depressive symptoms within bipolar disorder, highlighting the importance of studying multiple forms of life stress.

Personality and bipolar disorder: dissecting state and trait associations between mood and personality

2010 ◽  
Vol 41 (8) ◽  
pp. 1593-1604 ◽  
Author(s):  
J. H. Barnett ◽  
J. Huang ◽  
R. H. Perlis ◽  
M. M. Young ◽  
J. F. Rosenbaum ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Latent Growth ◽  
Major Depressive ◽  
Course Of Illness ◽  
Personality Variables ◽  
Manic Symptoms ◽  
Increased Risk ◽  
Neo Five Factor Inventory ◽  
Depressed Symptoms ◽  
Trait Associations

BackgroundSome personality characteristics have previously been associated with an increased risk for psychiatric disorder. Longitudinal studies are required in order to tease apart temporary (state) and enduring (trait) differences in personality among individuals with bipolar disorder (BD). This study aimed to determine whether there is a characteristic personality profile in BD, and whether associations between BD and personality are best explained by state or trait effects.MethodA total of 2247 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder study completed the NEO Five-Factor Inventory administered at study entry, and at 1 and 2 years.ResultsPersonality in BD was characterized by high neuroticism (N) and openness (O), and low agreeableness (A), conscientiousness (C) and extraversion (E). This profile was replicated in two independent samples, and openness was found to distinguish BD from major depressive disorder. Latent growth modeling demonstrated that manic symptoms were associated with increased E and decreased A, and depressed symptoms with higher N and lower E, A, C and O. During euthymic phases, high N and low E scores predicted a future depression-prone course.ConclusionsWhile there are clear state effects of mood on self-reported personality, personality variables during euthymia predict future course of illness. Personality disturbances in extraversion, neuroticism and openness may be enduring characteristics of patients with BD.

Telemedicine and bipolar disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S121-S121
Author(s):  
A. García-Alocén ◽  
C. Bermudez-Ampudia ◽  
M. Martínez-Cengotitabengoa ◽  
I. González-Ortega ◽  
S. Ruiz de Azua ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Psychoeducational Intervention ◽  
Treatment As Usual ◽  
Patient Functioning ◽  
Manic Symptoms ◽  
Intervention Treatment ◽  
Competing Interest ◽  
Additional Support ◽  
Bipolar Patients ◽  
Web Platform

Show the efficacy of an innovate telemedicine psyeducational invention based on a psychoeducational intervention treatment with a group of bipolar patients.ObjetivesTo assess the efficacy of an innovate telemedicine psyeducational treatment (TPT) based on a psychoeducational intervention (21 sessions) with an additional support through telemedicine which has 12 videos versus treatment as usual (TAU) based on psychiatry reviews. Specifically, the objective was to evaluate patients’ efficacy of psyeducational treatment with telemedicine (TPT) in the fuctionalitity, depressive symptoms and manic symptoms.MethodsThirty-eight patients with bipolar disorder were included in the study and randomly distributed in the two groups. The telemedine treatment is performed through a www.puedoser.es web platform provided by Astra Zeneca. In the web platform is available forums, emails and digital-course with the sessions worked as a reminder. In order to assess the effectiveness of treatments, FAST scale was administered at baseline and 6 months after the intervention. To obtain the results we used coparative data analysis.ResultsIn patients, we found a low daily functionality. The main issues were: interpersonal cognitive area (t = –2.611; P = 0.014) and interpersonal-area (t = –2.617; P = 0.014). We found, at baseline, that TPT group had worse overall results in daily functionality (t = –2.876; P = 0.008). After intervention, there is an improvement in the daily functionality of the TPT group. This improvement occurred in cognitive area (z = –3.24; P < 0.001), leisure area (z = –1.85; P = 0.065) and interpersonal area (z = –1.72; P = 0.086).ConclusionsThe psychoeducational program combined with telemedicine shows to be more effective than TAU in the improvement of general patient functioning in bipolar disorder patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Treatment Guidelines for Acute Manic and Mixed Episodes of Bipolar Disorder

CNS Spectrums ◽  
2009 ◽  
Vol 14 (S15) ◽  
pp. 8-11
Author(s):  
Mark A. Frye
Keyword(s):  
Bipolar Disorder ◽  
Drugs Of Abuse ◽  
Treatment Guidelines ◽  
Mood Stabilizer ◽  
Primary Treatment ◽  
Acute Mania ◽  
Data Set ◽  
Bipolar I Disorder ◽  
Manic Symptoms ◽  
The Impact

Bipolar disorder is a lifelong condition, and pharmacotherapy is essential to its long-term management. Once a comprehensive diagnostic assessment for acute or mixed mania has been completed, it is important to look at an evidence-based data set to guide treatment selection for mood stabilization.For most patients, lifetime adherence to pharmacotherapy is necessary for maximal mood stability. Pharmacotherapy is the primary treatment for bipolar disorder, as it has been found to be efficacious in treating acute episodes and preventing future episodes of bipolar I disorder. Combination therapy, including at least one mood stabilizer, may be necessary to treat acute depression and mania and to further prevent both depressive and manic recurrences. The goal is to minimize frequency, duration, and severity of depressive and manic symptoms with a treatment regimen, ideally a combination of pharmacotherapy and psychotherapy, that is positioned to maximize treatment adherence and minimize side effects.This discussion reviews some treatment guidelines for acute manic and mixed episodes associated with bipolar I disorder. Through the context of a case study, this discussion will attempt to provide an understanding and appreciation of Food and Drug Administration-approved and non-FDA-approved treatments for acute mania. In addition, the impact of alcohol as an example of drugs of abuse and its impact on the presentation of acute mania will be discussed.

Impact of psychotic features on morbidity and course of illness in patients with bipolar disorder

2010 ◽  
Vol 25 (1) ◽  
pp. 47-51 ◽  
Author(s):  
İ. Özyıldırım ◽  
S. Çakır ◽  
O. Yazıcı
Keyword(s):  
Bipolar Disorder ◽  
Clinical Features ◽  
Psychotic Episode ◽  
Response Patterns ◽  
Course Of Illness ◽  
Comparison Groups ◽  
Bipolar Patients ◽  
Psychotic Features ◽  
Depressive Episodes

AbstractObjectiveIn this study, we aimed to compare the clinical features and response patterns to the long-term prophylaxis of bipolar patients with or without psychotic features.MethodThe life charts of patients with bipolar I disorder were evaluated. Two hundred and eighty-one patients who suffer with bipolar disorder for at least 4 years and who had at least three mood episodes were included to the study. The patients whose all episodes are psychotic (psychotic group) and the patients who never experienced psychotic episode (non-psychotic group) were assigned as comparison groups. The clinical features and the response to long-term prophylaxis were compared across the groups.ResultsThe psychotic group consists of 43 patients; non-psychotic group consists of 54 patients. The history of bipolar disorder among the first-degree relatives was remarkably more prevalent in non-psychotic group (p = 0.032). The predominance of manic/hypomanic episodes was significantly higher in psychotic group than non-psychotic group; and the rate of depressive episodes were higher in non-psychotic group than psychotic group (p = 0.013). Episodes were more severe (p < 0.001) and hospitalization rates were higher (p = 0.023) in psychotic group. The response to lithium monotherapy was better in non-psychotic group (p < 0.001).ConclusionThe well identified psychotic subtype of bipolar patients may give important predictions about long term course and prophylaxis of bipolar disorder.

scholarly journals Associations between mood instability and emotional processing in a large cohort of bipolar patients

2016 ◽  
Vol 46 (15) ◽  
pp. 3151-3160 ◽  
Author(s):  
A. C. Bilderbeck ◽  
Z. E. Reed ◽  
H. C. McMahon ◽  
L. Z. Atkinson ◽  
J. Price ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Emotional Processing ◽  
Memory Task ◽  
Large Cohort ◽  
Mood Variability ◽  
Manic Symptoms ◽  
Mood Instability ◽  
Current Medication ◽  
Emotional Bias ◽  
Bipolar Patients

BackgroundAberrant emotional biases have been reported in bipolar disorder (BD), but results are inconsistent. Despite the clinical relevance of chronic mood variability in BD, there is no previous research investigating how the extent of symptom fluctuations in bipolar disorder might relate to emotional biases. This exploratory study investigated, in a large cohort of bipolar patients, whether instability in weekly mood episode symptoms and other clinical and demographic factors were related to emotional bias as measured in a simple laboratory task.MethodParticipants (N = 271, BDI = 206, BDII = 121) completed an ‘emotional categorization and memory’ task. Weekly self-reported symptoms of depression and mania were collected prospectively. In linear regression analyses, associations between cognitive bias and mood variability were explored together with the influence of demographic and clinical factors, including current medication.ResultsGreater accuracy in the classification of negative words relative to positive words was associated with greater instability in depressive symptoms. Furthermore, greater negative bias in free recall was associated with higher instability in manic symptoms. Participants diagnosed with BDII, compared with BDI, showed overall better word recognition and recall. Current antipsychotic use was associated with reduced instability in manic symptoms but this did not impact on emotional processing performance.ConclusionsEmotional processing biases in bipolar disorder are related to instability in mood. These findings prompt further investigation into the underpinnings as well as clinical significance of mood instability.

scholarly journals 156 The Broad Efficacy of Cariprazine Across Symptoms in Patients with Bipolar I Disorder: Post Hoc Analysis of Randomized, Placebo-Controlled Trials

CNS Spectrums ◽  
2020 ◽  
Vol 25 (2) ◽  
pp. 300-300
Author(s):  
Lakshmi N. Yatham ◽  
Eduard Vieta ◽  
Roger S. McIntyre ◽  
Rakesh Jain ◽  
Willie R. Earley ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Rating Scale ◽  
Bipolar Depression ◽  
Partial Agonist ◽  
Controlled Trials ◽  
Bipolar I Disorder ◽  
Manic Symptoms ◽  
Bipolar Mania ◽  
Post Hoc

Abstract:Study Objective:Patients with bipolar disorder experience a wide range of depressive and manic symptoms. Only 2 drugs are FDA-approved to treat episodes of both mania and depression in patients with bipolar disorder, highlighting the need for treatments with proven efficacy at opposite poles of the bipolar spectrum. Cariprazine, a dopamine D3-preferring D3/D2 receptor partial agonist and serotonin 5-HT1A receptor partial agonist, is approved in the US for the treatment of both bipolar depression and manic and mixed episodes associated with bipolar I disorder. Cariprazine has previously demonstrated broad efficacy in patients with bipolar mania, with significantly greater improvement in favor of cariprazine vs placebo (PBO) across all individual symptom domains (P<.001) measured by the Young Mania Rating Scale (YMRS). Additionally, cariprazine has demonstrated efficacy vs PBO in 3 phase II/III clinical studies in patients with depressive episodes associated with bipolar I disorder (NCT01396447, NCT02670538, NCT02670551). To further assess the broad efficacy of cariprazine in patients with bipolar I disorder, we performed post hoc analyses to evaluate the range of depressive symptoms comprising the individual items of the Montgomery-Åsberg Depression Rating Scale (MADRS) in patients from the bipolar depression studies.Methods:Data from the 3 randomized, double-blind, PBO-controlled trials in patients with bipolar depression were pooled. Least squares (LS) mean change from baseline to week 6 in MADRS individual items was assessed in the pooled cariprazine 1.5 and 3 mg/d groups vs PBO using a mixed-effects model for repeated measures in the intent-to-treat (ITT) population.Results:There were 1383 patients in the ITT population (placebo=460; cariprazine 1.5-3 mg/d=923). At week 6, LS mean change from baseline was significantly greater for cariprazine 1.5-3 mg/d vs PBO on 9 of 10 individual MADRS items: Apparent Sadness (-2.0 vs -1.6, P<.0001); Reported Sadness (-2.0 vs -1.6, P<.0001); Reduced Sleep (-1.6 vs -1.4, P=.0357); Reduced Appetite (-1.2 vs -1.0, P=.0001); Concentration Difficulties (-1.5 vs -1.2, P=.0002); Lassitude (-1.7 vs -1.4, P=.0003); Inability To Feel (-1.7 vs -1.5, P=.0009); Pessimistic Thoughts (-1.4 vs -1.2, P=.0054) and Suicidal Thoughts (-0.3 vs -0.2, P=.0383); differences between cariprazine and PBO on the Inner Tension item were not significant.Conclusions:Significant improvement in most MADRS single items suggests broad efficacy in depressive symptoms for cariprazine 1.5-3 mg/d vs PBO in patients with bipolar depression. Coupled with broad efficacy in manic symptoms as demonstrated by significant improvement in all YMRS individual items in patients with bipolar mania or mixed episodes, cariprazine appears be effective across the range of symptoms that affect patients with bipolar disorder.Funding Acknowledgements:Supported by Allergan plc.

scholarly journals Comorbid Premenstrual Dysphoric Disorder and Bipolar Disorder: A Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Anastasiya Slyepchenko ◽  
Luciano Minuzzi ◽  
Benicio N. Frey
Keyword(s):  
Bipolar Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Clinical Presentation ◽  
Premenstrual Dysphoric Disorder ◽  
Severe Form ◽  
Course Of Illness ◽  
Manic Symptoms ◽  
Mixed Features ◽  
Depressive Episodes ◽  
Degrees Of Severity

Bipolar disorder (BD) differs in its clinical presentation in females compared to males. A number of clinical characteristics have been associated with BD in females: more rapid cycling and mixed features; higher number of depressive episodes; and a higher prevalence of BD type II. There is a strong link between BD and risk for postpartum mood episodes, and a substantial percentage of females with BD experience premenstrual mood worsening of varying degrees of severity. Females with premenstrual dysphoric disorder (PMDD)—the most severe form of premenstrual disturbances—comorbid with BD appear to have a more complex course of illness, including increased psychiatric comorbidities, earlier onset of BD, and greater number of mood episodes. Importantly, there may be a link between puberty and the onset of BD in females with comorbid PMDD and BD, marked by a shortened gap between the onset of BD and menarche. In terms of neurobiology, comorbid BD and PMDD may have unique structural and functional neural correlates. Treatment of BD comorbid with PMDD poses challenges, as the first line treatment of PMDD in the general population is selective serotonin reuptake inhibitors, which produce risk of treatment-emergent manic symptoms. Here, we review current literature concerning the clinical presentation, illness burden, and unique neurobiology of BD comorbid with PMDD. We additionally discuss obstacles faced in symptom tracking, and management of these comorbid disorders.

Prodromes, coping strategies and course of illness in bipolar affective disorder – a naturalistic study

2001 ◽  
Vol 31 (8) ◽  
pp. 1397-1402 ◽  
Author(s):  
D. LAM ◽  
G. WONG ◽  
P. SHAM
Keyword(s):  
Coping Strategies ◽  
Bipolar Affective Disorder ◽  
Manic Episode ◽  
Psychosocial Interventions ◽  
Naturalistic Study ◽  
Prodromal Stage ◽  
Prodromal Symptoms ◽  
Course Of Illness ◽  
Manic Symptoms ◽  
Bipolar Patients

Background. Psychosocial interventions for bipolar patients often include teaching patients to recognize prodromal symptoms and tackle them early. This prospective study set out to investigate which bipolar prodromal symptoms were reported frequently and reliably over a period of 18 months. Furthermore, we have also investigated which types of coping strategies were related to good outcome.Method. Forty bipolar patients were interviewed for their bipolar prodromal symptoms and their coping strategies at recruitment and 18 months later. Patients were also assessed as to whether they had experienced relapses.Results. Bipolar patients were able to report bipolar prodromal symptoms reliably. Mania prodromal symptoms tended to be behavioural symptoms. A quarter of patients reported difficulties in detecting depression prodromes, which tended to be more diverse and consisted of a mix of behavioural, cognitive and somatic symptoms. Significantly fewer patients who reported the use of behavioural coping strategies to curb excessive behaviour during the mania prodromal stage experienced a manic episode. Similarly, significantly fewer patients who reported the use of behavioural coping strategies experienced depression relapses. How well patients coped with mania prodromes predicted bipolar episodes significantly when the mood levels at baseline were controlled. Ratings of how well subjects coped with mania prodromal symptoms also predicted manic symptoms significantly at T2 when manic symptom at T1 was controlled.Conclusion. Our study suggests that bipolar patients are able to report prodromal symptoms reliably. It is advisable to teach patients to monitor their moods systematically and to promote good coping strategies.

Leukemia Support Groups: How Are They Doing?

1997 ◽  
Vol 4 (5) ◽  
pp. 407-412
Author(s):  
Donna Corwin Moss
Keyword(s):  
Quality Of Life ◽  
Support Groups ◽  
Age Groups ◽  
Cancer Treatments ◽  
Future Directions ◽  
Course Of Illness ◽  
New Concepts ◽  
Sources Of Support ◽  
Practical Impact

Background Support groups help their participants to cope with the emotional and practical impact of their illnesses. Methods The effectiveness of the Leukemia Society of America support groups in enhancing the quality of life for their participants is reviewed. The groundwork, purpose, and structure of such groups, as well as alternate sources of support, are presented. Evaluation and future directions for oncology groupwork are discussed. Results Support groups complement the therapies provided by clinical practitioners and scientists by addressing the additional needs of cancer patients over the course of illness and survival. Conclusions New concepts and methods that address the needs of specific age-groups and incorporate the newly generated data on cancer treatments will further enhance the benefits provided by support groups.

scholarly journals Patients’ adherence to smartphone apps in the management of bipolar disorder: a systematic review

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Marie-Camille Patoz ◽  
Diego Hidalgo-Mazzei ◽  
Bruno Pereira ◽  
Olivier Blanc ◽  
Ingrid de Chazeron ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bipolar Disorder ◽  
Mobile Health ◽  
Smartphone Apps ◽  
Exclusion Criteria ◽  
Future Studies ◽  
Health Apps ◽  
Definition Of ◽  
Bipolar Patients ◽  
Digital Or

Abstract Background Despite an increasing number of available mental health apps in the bipolar disorder field, these tools remain scarcely implemented in everyday practice and are quickly discontinued by patients after downloading. The aim of this study is to explore adherence characteristics of bipolar disorder patients to dedicated smartphone interventions in research studies. Methods A systematic review following PRISMA guidelines was conducted. Three databases (EMBASE, PsychInfo and MEDLINE) were searched using the following keywords: "bipolar disorder" or "mood disorder" or “bipolar” combined with “digital” or “mobile” or “phone” or “smartphone” or “mHealth” or “ehealth” or "mobile health" or “app” or “mobile-health”. Results Thirteen articles remained in the review after exclusion criteria were applied. Of the 118 eligible studies, 39 did not provide adherence characteristics. Among the selected papers, study length, sample size and definition of measures of adherence were strongly heterogeneous. Activity rates ranged from 58 to 91.6%. Conclusion The adherence of bipolar patients to apps is understudied. Standardised measures of adherence should be defined and systematically evaluated in future studies dedicated to these tools.

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