Clinical characteristics of women with reproductive cycle–associated bipolar disorder symptoms

2016 ◽  
Vol 51 (2) ◽  
pp. 161-167 ◽  
Author(s):  
Tania A Perich ◽  
Gloria Roberts ◽  
Andrew Frankland ◽  
Carina Sinbandhit ◽  
Tanya Meade ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Anxiety Disorders ◽  
Reproductive Cycle ◽  
Clinical Characteristics ◽  
Age Of Onset ◽  
Rapid Cycling ◽  
Mood Symptoms ◽  
Mood Changes ◽  
The Relationship ◽  
Sydney Australia

Objective: Although there is clear evidence that reproductive cycle events are associated with mood episodes for women with bipolar disorder, few studies have examined for relationships between these and specific clinical characteristics of the disorder. This study aimed to explore the relationship between mood symptoms associated with reproductive cycle events and features of the disorder indicative of a more severe lifetime course. Method: Totally, 158 women of at least 18 years of age participated in the study. Subjects were recruited through a specialist clinic at the Black Dog Institute, Sydney, Australia. Results: In total, 77% of women reported increases in mood symptoms during perimenstrual, postnatal or menopausal periods. These women had an earlier age of onset for depressive and hypo/manic episodes and a greater likelihood of comorbid anxiety disorders, rapid cycling and mixed mood compared to those who did not report such reproductive cycle–associated mood changes. Women who experienced postnatal episodes were also more likely to experience worse mood symptoms perimenstrually and menopausally. Conclusion: First, reproductive cycle event–related worsening of mood was associated with a more severe lifetime course of bipolar disorder, and, second, it appears that some women have a greater propensity to mood worsening at each of these reproductive cycle events. If replicated, these findings provide important information for clinicians treating women with reproductive cycle event mood changes and highlight the need for improved therapeutics for such presentations.

Manic-depressive illness — II: treatment outcome in bipolar disorder subtypes

1992 ◽  
Vol 9 (1) ◽  
pp. 9-12 ◽  
Author(s):  
Patrick McKeon ◽  
Patrick Manley ◽  
Gregory Swanwick
Keyword(s):  
Bipolar Disorder ◽  
Treatment Outcome ◽  
Antidepressant Drugs ◽  
Depressive Illness ◽  
Tricyclic Antidepressant ◽  
Rapid Cycling ◽  
Manic Depressive Illness ◽  
Mood Changes ◽  
Manic Depressive ◽  
Manic Patients

AbstractThe treatment outcome of 100 bipolar disorder patients (B.P.) was examined retrospectively to determine whether bipolar subtypes had a differential prophylactic response to lithium, carbamazepine, neuroleptics and antidepressant drugs when these treatments were given in a predetermined sequence. Sixty-eight per cent of 53 B.P.-I patients with a mania-depression-normothymic-interval (M.D.I.) sequence of mood changes had a good response to lithium, and all but one of the remainder responded with the addition of carbamazepine or an antidepressant. While only 17% of 12 unipolar manic patients achieved prophylaxis with lithium and a further 17% when carbamazepine was added, the other 66% remained normothymic when a neuroleptic was prescribed with lithium. Of the seven rapid cycling patients where depression preceded mania, 28% had a good prophylactic effect with lithium, a further 28% when a tricyclic antidepressant was added and 14% with lithium and carbamazepine. None of the 18 rapid cycling M.D.I. group had a good response to lithium, but 39% stabilised when carbamazepine was added to lithium. Twenty-eight per cent of this group failed completely to respond to any of the treatments used. Neuroleptics increased the severity and duration of depressive phases for all subtypes except the unipolar mania group.

scholarly journals Explaining why childhood abuse is a risk factor for poorer clinical course in bipolar disorder: a path analysis of 923 people with bipolar I disorder

2019 ◽  
Vol 50 (14) ◽  
pp. 2346-2354 ◽  
Author(s):  
Steven Marwaha ◽  
Paul M. Briley ◽  
Amy Perry ◽  
Phillip Rankin ◽  
Arianna DiFlorio ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Risk Factor ◽  
Anxiety Disorders ◽  
Path Analysis ◽  
Childhood Abuse ◽  
Clinical Features ◽  
Clinical Course ◽  
Rapid Cycling ◽  
Bipolar I Disorder ◽  
Affective Instability

AbstractBackgroundChildhood abuse is a risk factor for poorer illness course in bipolar disorder, but the reasons why are unclear. Trait-like features such as affective instability and impulsivity could be part of the explanation. We aimed to examine whether childhood abuse was associated with clinical features of bipolar disorder, and whether associations were mediated by affective instability or impulsivity.MethodsWe analysed data from 923 people with bipolar I disorder recruited by the Bipolar Disorder Research Network. Adjusted associations between childhood abuse, affective instability and impulsivity and eight clinical variables were analysed. A path analysis examined the direct and indirect links between childhood abuse and clinical features with affective instability and impulsivity as mediators.ResultsAffective instability significantly mediated the association between childhood abuse and earlier age of onset [effect estimate (θ)/standard error (SE): 2.49], number of depressive (θ/SE: 2.08) and manic episodes/illness year (θ/SE: 1.32), anxiety disorders (θ/SE: 1.98) and rapid cycling (θ/SE: 2.25). Impulsivity significantly mediated the association between childhood abuse and manic episodes/illness year (θ/SE: 1.79), anxiety disorders (θ/SE: 1.59), rapid cycling (θ/SE: 1.809), suicidal behaviour (θ/SE: 2.12) and substance misuse (θ/SE: 3.09). Measures of path analysis fit indicated an excellent fit to the data.ConclusionsAffective instability and impulsivity are likely part of the mechanism of why childhood abuse increases risk of poorer clinical course in bipolar disorder, with each showing some selectivity in pathways. They are potential novel targets for intervention to improve outcome in bipolar disorder.

scholarly journals Impulsivity in adolescent bipolar disorder

2011 ◽  
Vol 23 (2) ◽  
pp. 57-61 ◽  
Author(s):  
Kirsten E. Gilbert ◽  
Jessica H. Kalmar ◽  
Fay Y. Womer ◽  
Philip J. Markovich ◽  
Brian Pittman ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Mood State ◽  
The Self ◽  
Self Report ◽  
Rapid Cycling ◽  
Mood Symptoms ◽  
Barratt Impulsiveness Scale ◽  
Course Features ◽  
Report Measure ◽  
Motor Subscale

Objective: Increased impulsivity has been shown to be a trait feature of adults with bipolar disorder (BD), yet impulsivity has received little study in adolescents with BD. Thus, it is unknown whether it is a trait feature that is present early in the course of the disorder. We tested the hypotheses that self-reported impulsiveness is increased in adolescents with BD, and that it is present during euthymia, supporting impulsiveness as an early trait feature of the disorder.Methods: Impulsiveness was assessed in 23 adolescents with BD and 23 healthy comparison (HC) adolescents using the self-report measure of impulsivity, the Barratt Impulsiveness Scale (BIS), comprised by attentional, motor and non-planning subscale scores. Effects of subscale scores and associations of scores with mood state and course features were explored.Results: Total and subscale BIS scores were significantly higher in adolescents with BD than HC adolescents. Total, attentional and motor subscale BIS scores were also significantly higher in the subset of adolescents with BD who were euthymic, compared to HC adolescents. Adolescents with BD with rapid-cycling and chronic mood symptoms had significantly higher total and motor subscale BIS scores than adolescents with BD without these course features.Conclusion: These results suggest increased self-reported impulsiveness is a trait feature of adolescents with BD. Elevated impulsivity may be especially prominent in adolescents with rapid-cycling and chronic symptoms.

The Maudsley bipolar disorder project Clinical characteristics of bipolar disorder I in a Catchment area treatment sample

2003 ◽  
Vol 18 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Vanessa Raymont ◽  
David Bettany ◽  
Sophia Frangou
Keyword(s):  
Bipolar Disorder ◽  
Substance Abuse ◽  
Catchment Area ◽  
Clinical Characteristics ◽  
Age Of Onset ◽  
Psychiatric Service ◽  
Male Gender ◽  
Younger Age ◽  
Male Patients ◽  
Psychotic Features

AbstractThe clinical characteristics of bipolar I disorder (BD1) have prognostic and therapeutic importance. The aim of this study was to examine the effect of demographic and clinical variables on the course of BD1. We reviewed the case notes of all BD1 patients (n = 63) receiving treatment in a London psychiatric service during a 1-month period. Depressive and manic onsets were equally likely without any gender difference. The earlier the age of onset, the more likely it was for patients to experience psychotic features. Only depressive onsets predicted a higher number of episodes of the same polarity. Male gender and substance abuse were associated with younger age at first presentation, while women with co-morbid substance abuse had more manic episodes. Male patients were more likely than females to be unemployed or single.

scholarly journals Reproductive cycle-associated mood symptoms in women with major depression and bipolar disorder

2007 ◽  
Vol 99 (1-3) ◽  
pp. 221-229 ◽  
Author(s):  
Jennifer L. Payne ◽  
Patricia S. Roy ◽  
Kathleen Murphy-Eberenz ◽  
Myrna M. Weismann ◽  
Karen L. Swartz ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Major Depression ◽  
Reproductive Cycle ◽  
Mood Symptoms

P01-209-The comparison between manic and mixed episodes

2011 ◽  
Vol 26 (S2) ◽  
pp. 210-210
Author(s):  
A. Ghaffarinejad ◽  
A. Mirghiasi
Keyword(s):  
Bipolar Disorder ◽  
Significant Relationship ◽  
Age Of Onset ◽  
Strong Relationship ◽  
Young Mania ◽  
Significant Relationships ◽  
Duration Of Hospitalization ◽  
History Of ◽  
The Relationship ◽  
Spearman’S Correlation

This study was designed for comparing between manic and mixed episodes and the relationship between these episodes and special scores were evaluated.This analytical - observational study was performed in Kerman Beheshti hospital / Kerman / Iran : one hundred and eighty six bipolar inpatients with diagnosis of manic and mixed episodes were included in study. They were assessed with the Young mania and Beck Depression Inventory.Frequency of pure mania was 22.6%. The mean of age of onsent was lower in mixed type (P = 0.02). Young score was higher in pure mania (p = 0.026).Spearman's correlation coefficient show strong relationship between duration of hospitalization and young score (p = 0.0001).These is significant relationship between Beck score and family history of bipolar disorder (p < 0.05). and there was significant relationship between Beck score and patient’s insight overlay,comorbidity of personality disorder was 26.3 was similar in both groups.There were significant relationships between age of onset of illness and positive familial history of bipolar disorder and major depressive disorder,and between suicidal attept and panic disorder and social phobia,however rapid cycling was higher in mixed patients significantly (p = 0.009).As far as we know This is the first study regarding relationship between bipolar subtypes and severity of mood disorders in Iran. This study is a part of a larger study including several provinces in Iran.We believed the prevalence of mixed state is not well known and in many cases it could be underdiagnosed.

scholarly journals Clinical characteristics and unlicensed applications of licensed psychotropic drugs within a regional tertiary service for patients with affective disorders

2018 ◽  
Vol 10 ◽  
pp. 204512531879513
Author(s):  
Nupur Tiwari ◽  
David S. Baldwin
Keyword(s):  
Bipolar Disorder ◽  
Anxiety Disorders ◽  
Secondary Care ◽  
Clinical Characteristics ◽  
Depressive Disorders ◽  
Treatment Recommendations ◽  
Specialist Service ◽  
Off Label ◽  
Illness Burden ◽  
Retrospective Examination

Background: Referral to tertiary services is recommended when patients with mood and anxiety disorders have not responded to multiple treatments in primary or secondary care. Within specialist services, some patients undergo treatment with licensed psychotropic medications outside the narrow terms of their market authorization (‘unlicensed applications’). We examined the demographic and clinical characteristics of patients referred to a regional specialist service to determine the extent of and factors associated with recommendations for unlicensed (‘off label’) prescriptions. Methods: Retrospective examination of demographic and clinical characteristics and treatment recommendations in patients seen within a 5-year period. Patients were allocated to three broad diagnostic clusters (unipolar depressive disorders, bipolar disorder, anxiety disorders), and two groups (with or without comorbid disorders). We compared patients in whom all treatment recommendations were for licensed applications with patients in whom at least one treatment was for an unlicensed application, across a range of variables reflecting illness ‘burden’ (duration, inpatient treatment, electroconvulsive therapy, nonfatal self-harm, psychosis). Results: From 177 new referrals, 148 patients (91 females, 57 males) could be placed within one of the three clusters. Many patients with bipolar disorder had not undergone treatment with lithium or formal psychological interventions in secondary care. Treatment recommendations involving unlicensed applications of medications were common (approximately 50%) in all clusters, but there were no significant differences in measures of illness burden between groups of patients, categorized according to licensed or unlicensed prescriptions. Limitations: Retrospective examination of notes recorded for other purposes, within a single service, in which treatment recommendations might reflect idiosyncratic practice is a limitation of our findings. Also, examined variables could not provide a comprehensive indication of illness severity or functional impairment. Conclusion: Our findings confirm that ‘off label’ prescribing is common in psychiatric practice. Treatment decisions relating to unlicensed applications appear to be influenced by factors other than overall illness burden.

Manic-depressive illness — I: clinical characteristics of bipolar disorder subtypes

1992 ◽  
Vol 9 (1) ◽  
pp. 6-9 ◽  
Author(s):  
Patrick McKeon ◽  
Patrick Manley ◽  
Gregory Swanwick
Keyword(s):  
Bipolar Disorder ◽  
Family History ◽  
Age Of Onset ◽  
Rapid Cycling ◽  
Manic Depressive Illness ◽  
Bipolar Ii ◽  
History Of ◽  
Bipolar Patients ◽  
Depressive Episodes ◽  
Manic Patients

AbstractThe clinical and demographic features of 100 bipolar disorder patients, who were categorised into bipolar I, bipolar II, unipolar mania and rapid cycling groups, and who were further classified on the basis of the sequence of occurrence of the manic and depressive episodes within each cycle, are compared. Bipolar I (including unipolar manic) patients, 77% of whom had a sequence of moods where mania preceded depression (Mania-Depression – normothymic Interval: M.D.I.) constituted 69% of the total sample. Six per cent were classified as bipolar II and 25% has a rapid cycling disorder. Patients who had an M.D.I. sequence of moods, whether rapid or non-rapid cycling, had a younger age of onset, a higher male:female ratio and a stronger family history of bipolar disorder than patients whose depression preceded mania (D.M.I.). Unipolar manic patients, 12% of the sample, had a comparable age of onset, a greater family history of bipolarity and more frequent hospitalisations than the bipolar I-M.D.I. group. Rapid cycling patients had a lower mean serum thyroxine concentration than the non-rapid cycling bipolar disorder patients. This study supports the rationale for distinguishing bipolar patients with an M.D.I, sequence from those with a D.M.I, pattern and rapid cyclers from non-rapid cyclers.

Rapid Cycling in Children

CNS Spectrums ◽  
2004 ◽  
Vol 9 (S2) ◽  
pp. 5-6
Author(s):  
Kiki D. Chang
Keyword(s):  
Bipolar Disorder ◽  
Pediatric Patients ◽  
Mood State ◽  
Rapid Cycling ◽  
Mixed States ◽  
Clinical Interviews ◽  
Mood Symptoms ◽  
Younger Age ◽  
The Difference ◽  
Bipolar Patients

Presence of rapid cycling appears to be the rule rather that the exception in children with bipolar disorder, although there is not much data to support this clinical notion. Geller and colleagues studied 93 pediatric patients with bipolar disorder, mean age 10.9 years. They found that 87% had rapid cycling defined as ≥4 episodes/year and 77% had ultradian cycling, defined as >365 episodes/year. In addition, Findling and colleagues studied 90 bipolar patients with a mean age of 10.8 years and found that 50% had rapid cycling by veteran CV criteria. (The study did not look at ultra-rapid or ultradian cycling.) Finally, using clinical interviews to study children with affective illness, Schraufnagel and colleagues found that 41% experienced >365 cycles/year (Slide 6).It is difficult to figure out the difference between a cycle and an episode when children are cycling so quickly. Tillman and Geller proposed that any kind of mood switching constitutes a cycle. An episode, they proposed, is defined as having ≥2 weeks of mood symptoms with either onset and offset of one mood state within that 2 weeks, or onset and offset of a period of ultra-rapid or ultradian cycling. It appears that with younger age comes more rapid cycling and more mixed states, which can be confused with ultra-rapid cycling. In turn, the older the child gets, the less rapid cycling occurs, and the more episodic the disorder becomes with more euphoria and less irritability. However, this tendency has not been well studied.

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