scholarly journals The current state of benzodiazepines and Z-drugs use and their influences on bipolar disorder outcomes-A small sample analysis

2021 ◽  
Author(s):  
Yiming Chen ◽  
Fan Wang ◽  
Lvchun Cui ◽  
Haijing Huang ◽  
Shuqi Kong ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicide Attempt ◽  
Sleep Disturbance ◽  
Affective Disorder ◽  
Sleep Disturbances ◽  
Small Sample ◽  
Mood Stabilizers ◽  
Psychotic Symptoms ◽  
Psychiatric Drugs ◽  
Bipolar Patients

Abstract Background: Sleep disturbance and benzodiazepines (BZDs)/Z-drugs use are known to be common during affective episodes. Hence, we identified the probable outcomes of bipolar disorder that correlate with BZDs/Z-drugs use, aside from mood symptoms. We conducted an open-label, prospective study to describe the current use of BZDs and Z-drugs by patients with bipolar disorder during affective episodes. We evaluated the difference of characteristics between bipolar patients with sleep disturbance who chose BZDs/Z-drugs, and those who did not chose the drugs during and after affective disorder. The influences of BZDs/Z-drugs use on suicide attempt and psychotic symptoms during affective disorder were also investigated. Results: Seventy patients with current affective episodes were studied. Among them, 61 had sleep disturbances. The amount of mood stabilizers use in the BZDs/Z-drugs group was significantly greater than that in the no BZDs/Z-drugs group (p=0.038) during affective episodes. After affective episode, sleep disturbances, especially midnight wakes, became more improved in BZDs/Z-drugs group compared to the no BZDs/Z-drugs group. By contrast, attention and decisiveness became more improved in the no BZDs/Z-drugs group than in the BZDs/Z-drugs group. Furthermore, we observed that BZDs/Z-drugs had an OR of 4.338 (95% CI 1.068-17.623, p=0.040), and other psychiatric drugs had an OR of 1.835 (95% CI 1.105-3.047, p=0.019) in relation to suicide attempt. After nine months, we found that BZDs/Z-drugs use was of no significant effect to depressive or manic severity, or to recurrence rate.Conclusion: BZDs/Z-drugs use have no significant influence on variations in depressive or manic severity during the course of an affective episode. Nevertheless, BZDs/Z-drugs users took a greater amount of mood stabilizers than no BZDs/Z-drugs users. Finally, BZDs/Z-drugs or other psychiatric drugs polytherapy was regarded as a risk factor of suicide attempt during an affective episode.

Prodromal Symptoms to Relapse in Bipolar Disorder

2007 ◽  
Vol 41 (5) ◽  
pp. 385-391 ◽  
Author(s):  
Pilar Sierra ◽  
Lorenzo Livianos ◽  
Sergio Arques ◽  
Javier Castelló ◽  
Luis Rojo
Keyword(s):  
Bipolar Disorder ◽  
Coping Strategies ◽  
Sleep Disturbances ◽  
Psychotic Symptoms ◽  
Prodromal Symptoms ◽  
Hand Search ◽  
Mood Changes ◽  
The Individual ◽  
Bipolar Patients ◽  
Psychomotor Symptoms

In a cyclical and recurring illness such as bipolar disorder, prodrome detection is of vital importance. This paper describes manic and depressive prodromal symptoms to relapse, methods used in their detection, problems inherent in their assessment, and patients’ coping strategies. A review of the literature on the issue was performed using MEDLINE and EMBASE databases (1965–May 2006). ‘Bipolar disorder’, ‘prodromes’, ‘early symptoms’, ‘coping’, ‘manic’ and ‘depression’ were entered as key words. A hand search was conducted simultaneously and the references of the articles found were used to locate additional articles. The most common depressive prodromes are mood changes, psychomotor symptoms and increased anxiety; the most frequent manic prodromes are sleep disturbances, psychotic symptoms and mood changes. The manic prodromes also last longer. Certain psychological interventions, both at the individual and psychoeducational group level, have proven effective, especially in preventing manic episodes. Bipolar patients are highly capable of detecting prodromal symptoms to relapse, although they do find the depressive ones harder to identify. Learning detection, coping strategies and idiosyncratic prodromes are elements that should be incorporated into daily clinical practice with bipolar patients.

Misdiagnosis and psychotic symptoms in bipolar disorder

2011 ◽  
Vol 26 (S2) ◽  
pp. 255-255
Author(s):  
A. Ugarte ◽  
M. Fernández ◽  
I. González ◽  
J.R. Peciña ◽  
A. Villamor ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Basque Country ◽  
Correct Diagnosis ◽  
Age At Onset ◽  
Mood Stabilizers ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Psychotic Episode ◽  
Diagnostic Systems ◽  
Bipolar Patients

IntroductionEarly onset forms of bipolar disorder may be difficult to distinguish from schizophrenia. Although operational criteria have become more precise, and there are more diagnostic systems to catalogue a psychotic adolescent, the clinicians continue having difficulties.ObjectiveTo know the stability of the diagnosis of definitively bipolar patients with psychotic symptoms during the episodes, and factors that can influence other psychotic diagnoses in the first episode of the illness.Method140 bipolar patients of Araba, (Basque country) were included during 2 years. Patients were divided into two groups: unstable diagnoses (UD)(bipolar patients with an initial diagnosis of other psychosis) and stable diagnoses (SD) of bipolar disorder. Clinical and sociodemographic data were obtained.ResultsThe mean age at onset was significantly lower in the UD group (p = 0.004). It was rare to have an unstable diagnosis when the first psychotic episode occurred after age 38 (p = 0.008). There were more singles in the UD group (p = 0.010).The presence of mood incongruent psychotic symptoms was more frequent in the UD group (p < 0.001).Mood incongruent psychotic symptoms variable was the only independent factor significantly associated with an unstable diagnosis in the multivariate analysis (p = 0.036).DiscussionOne third of the patients have been previously diagnosed with other psychotic illness.This study suggests that the most important factor is the clinical picture, especially the presence of mood-incongruent psychotic symptoms. A correct diagnosis is important because patients who are prescribed mood stabilizers have lower rates of rehospitalisation than those who are not treated with mood stabilizers.

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

2011 ◽  
Vol 27 (8) ◽  
pp. 557-562 ◽  
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.

Thought overactivation as a marker of bipolar disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. s222-s223 ◽  
Author(s):  
M. Ferrari ◽  
P. Ossola ◽  
V. Lucarini ◽  
V. Accardi ◽  
C. De Panfilis ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Mood Disorders ◽  
Subjective Experience ◽  
Small Sample Size ◽  
Mental States ◽  
Small Sample ◽  
Bipolar Spectrum ◽  
Global Functioning ◽  
Competing Interest ◽  
Bipolar Patients

IntroductionRecent studies have underlined the importance of considering the form of thoughts, beyond their content, in order to achieve a better phenomenological comprehension of mental states in mood disorders. The subjective experience of thought overactivation is an important feature of mood disorders that could help in identifying, among patients with a depressive episode, those who belong to the bipolar spectrum.ObjectivesPatients with a diagnosis of bipolar disorder (BD) were compared with matched healthy controls (HC) on a scale that evaluates thought overactivation.AimsValidate the Italian version of a scale for thought overactivation (i.e. STOQ) in a sample of bipolar patients.MethodsThirty euthymic BD and 30 HC completed the Subjective Thought Overactivation Questionnaire (STOQ), the Ruminative Responses Scale (RRS), the Beck Depression Inventory-II (BDI-II) and global functioning (VGF).ResultsThe 9-items version of the STOQ has been back translated and its internal consistency in this sample was satisfactory (alpha = .91). Both the brooding subscore of RRS (b-RRS) (r = .706; P < .001) and STOQ (r = .664; P < .001) correlate significantly with depressive symptoms whereas only the first correlate with VGF (r = –.801; P < .001). The two groups did not differed in the b-RRS (HC = 8.41 vs BD = 9.72; P = .21), whereas BD where significantly higher in the STOQ total score (HC = 6.62 vs. BD = 14.9; P = .007).ConclusionOur results, although limited by the small sample size, confirm the validity of the STOQ and suggest that this scale could grasp a feature characteristic of BD, independently from their tendency to ruminate. The latter seems to impact more on global functioning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Sexual dysfunction and mood stabilizers in bipolar disorder: A review

2017 ◽  
Vol 41 (S1) ◽  
pp. s849-s849 ◽  
Author(s):  
C. Gómez Sánchez-Lafuente ◽  
R. Reina Gonzalez ◽  
M. Hernandez Abellán
Keyword(s):  
Bipolar Disorder ◽  
Medication Adherence ◽  
Side Effects ◽  
Sexual Dysfunction ◽  
Clinical Studies ◽  
Side Effect ◽  
Small Sample ◽  
Mood Stabilizers ◽  
Cochrane Library ◽  
Short Period

IntroductionMood stabilizers can cause many side effects. Although many of these are well known, like thyroid and renal failure after taking lithium, sexual dysfunction side effects remains unclear.MethodsWe made a systematic computerized literature search of clinical studies using MEDLINE, The Cochrane Library and Trip for clinical studies of sexual dysfunction published up to December 2015.ResultsOnly eight relevant papers were identified. All of them studied lithium sexual dysfunction in bipolar disorder patients. Valproic acid, carbamazepine and lamotrigine were not studied in patients with bipolar disorder. Nevertheless, the three were studied in epilepsy. Clinical reports usually used Arizona Sexual Experience Scale or Psychotropic Related Sexual Dysfunction Questionnaire to measure sexual dysfunction and Brief Adherence Rating Scale to measure medication adherence. They suggest lithium could decrease desire and sexual thoughts, worse arousal and cause orgasm dysfunction. In overall, those patients with sexual dysfunction had lower level of functioning and poor compliance. Taking benzodiazepines during lithium treatment may increase the risk of sexual dysfunction even more.ConclusionThere are few studies that focus on mood stabilizers sexual dysfunction. This inevitably entails a number of limitations. First, the small sample size and, in some studies, the relative short period of follow-up may underestimate the results. Besides, practical management was not treated in any study. Actually, handling this side effect have not been well established.To conclude, this revision suggest that approximately 30% patients receiving lithium experience this side effect, and it is associated with poor medication adherence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Bipolar affective disorder

2017 ◽  
Author(s):  
Tom Burns ◽  
Mike Firn
Keyword(s):  
Bipolar Disorder ◽  
Affective Disorder ◽  
Therapeutic Relationship ◽  
Bipolar Affective Disorder ◽  
Psychosocial Interventions ◽  
Mood Stabilizers ◽  
Psychotic Illness ◽  
Early Admission ◽  
Outreach Workers

This chapter deals with the other major psychotic illness, bipolar affective disorder. Bipolar disorder poses a difficult question for outreach workers, as patients are often well recovered between episodes—so should persisting outreach be provided? We report very good results in severe bipolar disorder where continuity of care has paid off. The chapter also deals with theories of causation and classification. The section on treatment identifies the importance of early admission in hypomania, the use of mood stabilizers, and the value of identifying and agreeing on relapse signatures. It also confirms the value of working hard to strengthen the therapeutic relationship and of psychosocial interventions such as psycho-education. Long-term work with these patients brings home just how persistent and disabling the depressive phases can be.

The Expanding Role of Antipsychotics

CNS Spectrums ◽  
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.

P01-200-Validation of the french version of the affective disorder evaluation (ADE)

2011 ◽  
Vol 26 (S2) ◽  
pp. 201-201
Author(s):  
C. Delmas ◽  
V. Bourgeois ◽  
S. Haouzir ◽  
F. Bretel ◽  
D. Campion ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Affective Disorder ◽  
Rating Scales ◽  
Age At Onset ◽  
Structured Interview ◽  
Diagnostic Interview ◽  
Panic Attacks ◽  
French Version ◽  
Compulsive Disorder ◽  
Bipolar Patients

ObjectiveDespite the number of rating scales for mood disorder and semi-structured interview in psychiatry, they are few evaluations focused on bipolar disorder. Here, we report the validation of the French version of the ADE used in STEP-BD (Systematic Treatment Enhancement Program for Bipolar Disorder) studies.MethodA total of 63 bipolar patients completed the ADE and French version of the DIGS (Diagnostic Interview for Genetic Studies). We compared the results between the two evaluations.ResultsThere was a very good concordance between the two interview for the diagnosis of the type of bipolar diagnosis (κ = 1) and non-significative difference between the age at onset. The concordance coefficient was weak for addictions: alcohol (κ = 0.22) and cannabis (κ = 0.16), for anxiety disorder: panic attacks (κ = 0.35), phobia (κ = 0.36), obsessive-compulsive disorder (κ = 0) and anorexia (κ = 0.04), but stronger for psychosis: delusion (κ = 0.78), hallucinations (κ = 0.69), suicidal attempts (κ = 0.97), violence (κ = 0.47) and bulimia (κ = 0.47).ConclusionsThe affective disorder evaluation seems to be a useful instrument in clinical practice and in psychopharmacological studies, but not when the diagnosis of comorbities is necessary.

Potential Misdiagnosis of Bipolar Disorder

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1 ◽  
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.

Psychoeducation: improving outcomes in bipolar disorder

2005 ◽  
Vol 20 (5-6) ◽  
pp. 359-364 ◽  
Author(s):  
Francesc Colom ◽  
Dominic Lam
Keyword(s):  
Bipolar Disorder ◽  
Health Beliefs ◽  
Relapse Prevention ◽  
Treatment Guidelines ◽  
Bipolar Affective Disorder ◽  
Mood Stabilizers ◽  
Psychological Interventions ◽  
Bipolar Patients ◽  
Depressive Episodes ◽  
Positive Results

AbstractBackgroundA relevant paradigm shift in the treatment of bipolar disorder started a few years ago; crucial findings on the usefulness of psychological interventions clearly support switching from an exclusively pharmacological therapeutic approach to a combined yet hierarchical model in which pharmacotherapy plays a central role, but psychological interventions may help cover the gap that exists between theoretical efficacy and “real world” effectiveness. Hereby we review the efficacy of several adjunctive psychotherapies in the maintenance treatment of bipolar patients.MethodsA systematic review of the literature on the issue was performed, using MEDLINE and CURRENT CONTENTS databases. “Bipolar”, “Psychotherapy”, “Psychoeducation”, “Cognitive-behavioral” and “Relapse prevention” were entered as keywords.ResultsPsychological treatments specifically designed for relapse prevention in bipolar affective disorder are useful tools in conjunction with mood stabilizers. Most of the psychotherapy studies recently published report positive results on maintenance as an add-on treatment, and efficacy on the treatment of depressive episodes. Interestingly, several groups from all over the world reported similar positive results and reached very similar conclusions; almost every intervention tested contains important psychoeducative elements including both compliance enhancement and early identification of prodromal signs — stressing the importance of life-style regularity — and exploring patients' health beliefs and illness-awareness.ConclusionsThe usefulness of psychotherapy for improving treatment adherence and clinical outcome of bipolar patients is nowadays unquestionable, and future treatment guidelines should promote its regular use amongst clinicians. As clinicians, it is our major duty, to offer the best treatment available to our patients and this includes both evidence-based psychoeducation programs and newer pharmacological agents.

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