http://forum.psychlinks.ca/ Bipolar Disorder or Manic-Depression - causes, symptoms, and treatment. Bipolar I and Bipolar II Disorders. en Thu, 09 Sep 2010 04:40:22 GMT vBulletin 60 http://forum.psychlinks.ca/images/misc/rss.png http://forum.psychlinks.ca/ http://forum.psychlinks.ca/bipolar-disorder/24258-dysfunctional-beliefs-specific-to-bipolar-disorder-identified-new-post.html Mon, 06 Sep 2010 23:36:32 GMT Dysfunctional beliefs specific to bipolar disorder identified... Dysfunctional beliefs specific to bipolar disorder identified
By Liam Davenport, MedWire News
01 October 2009
J Affect Dis 2009; Advance online publication

Remitted bipolar disorder patients have unique dysfunctional beliefs compared with unipolar patients and healthy individuals, say UK scientists who believe the findings could help the development of specific behavioral therapies.

To date, cognitive behavioral therapy modified for bipolar disorder has yielded disappointing results. While differences in dysfunctional beliefs noted between unipolar and bipolar patients have been identified that could improve therapeutic approaches, until recently there has been no reliable method of assessing beliefs in remitted bipolar disorder patients.

Y Alatiq and colleagues from the University of Oxford therefore administered the Hypomanic Attitudes and Positive Prediction Inventory (HAPPI), as well as the Dysfunctional Attitudes Scale (DAS) to 40 remitted bipolar disorder patients, 20 remitted unipolar patients, and 20 healthy controls.

There were no significant differences in terms of the history of depression or current depressive mood symptoms between bipolar and unipolar patients, both scoring significantly more than controls. Bipolar patients scored more highly on current manic symptoms than both unipolar patients and controls, with no significant differences between the latter.

There were no significant differences between the groups in DAS scores, whether in terms of total scores of any of the subscales, or after taking age into account, the team reports in the Journal of Affective Disorders.

Bipolar patients had significantly higher HAPPI scores than unipolar patients and controls in terms of total scores as well as scores on the self-catastrophic beliefs, other negative beliefs, and response style, even after controlling for age. There were no significant differences between unipolar patients and controls.

The team writes: “To conclude, the study has confirmed that bipolar patients when in remission hold dysfunctional beliefs related to the elevated mood experience which are found to be specific to bipolar disorder. Further study is now needed to look at whether cognitive behavioural therapy for bipolar disorder might benefit from working on such beliefs.”

Free abstract ]]> Bipolar Disorder David Baxter http://forum.psychlinks.ca/bipolar-disorder/24258-dysfunctional-beliefs-specific-to-bipolar-disorder-identified.html http://forum.psychlinks.ca/bipolar-disorder/24257-melatonin-light-super-sensitivity-identified-in-bipolar-i-disorder-new-post.html Mon, 06 Sep 2010 23:33:32 GMT Melatonin light super-sensitivity identified in bipolar I disorder... Melatonin light super-sensitivity identified in bipolar I disorder
By Liam Davenport, MedWire News
15 October 2009
Acta Neuropsychiatrica 2009; 21: 246–255

Patients with bipolar I disorder have melatonin super-sensitivity to light compared with healthy individuals, which may serve as an endophenotypic marker for the condition, conclude Australian researchers.

Several studies have suggested that bipolar disorder patients have super-sensitivity to light at night, with plasma melatonin levels suppressed more than in patients with other affective disorders and healthy individuals. However, the findings have not been supported by all investigations, with some suggesting sensitivity in only bipolar I disorder patients.

To examine melatonin sensitivity to light over a range of light intensities, Karen Hallam, from the University of Melbourne in Victoria, and colleagues studied seven patients with bipolar I disorder and 34 healthy controls.

The participants were administered a series of questionnaires and then attended 1 to 4 testing nights separated by at least a 7-day recovery period, with melatonin levels measured in blood samples obtained throughout the night. They were kept in complete darkness between 21:00 h and 24:00 h, exposed to light intensities of 0, 200, 500, and 1000 lux between 24:00 h and 01:00 h, and then returned to complete darkness for the remainder of the night.

During zero light conditions, there were no significant differences in the changes in melatonin levels between patients and controls. However, during exposure to 200, 500, and 1000 lux, patients showed significantly more sensitivity to light than controls, with the sensitivity consistently elevated across the light–response curve.

Sensitivity to light was dose-dependent in both groups, with a regression analysis indicating that patients and controls had a similar regression slope, although it was steeper for patients than controls., Bipolar disorder patients had a significantly greater rebound in melatonin levels 30 minutes following the light being turned off, although this difference had been eliminated by 60 minutes, the team notes in the journal Acta Neuropsychiatrica.

They write: “This study further investigates the usefulness of melatonin super-sensitivity to light as an endophenotypic marker of bipolar disorder. The use of endophenotypic markers that integrate both clinical and biological observations may provide a powerful tool to target genetic, molecular, and behavioral changes in the disorder. Ideally, these observations will inform both etiological and neurobiological studies of the disorder and ultimately improve clinical treatment of the illness.”

Free abstract ]]> Bipolar Disorder David Baxter http://forum.psychlinks.ca/bipolar-disorder/24257-melatonin-light-super-sensitivity-identified-in-bipolar-i-disorder.html http://forum.psychlinks.ca/bipolar-disorder/24256-unstable-alcohol-consumption-linked-to-hypomania-vulnerability-new-post.html Mon, 06 Sep 2010 23:30:14 GMT Unstable alcohol consumption linked to hypomania vulnerability... Unstable alcohol consumption linked to hypomania vulnerability
By Lucy Piper, MedWire News
25 February 2010
Compr Psychiatry 2010; 51: 171–176

Unstable alcohol consumption and binge drinking may be a marker of increased risk for hypomania, say researchers.

They note that a generally increased consumption of alcohol was not associated with an increased risk for hypomania, however.

“Therefore, individuals at risk for hypomania might not necessarily drink more over a given period of time but show greater fluctuations in their drinking,” explain Thomas Myer and Larissa Wolkenstein, from the University of Tübingen in Germany.

“This supports the idea that instability in different areas of behavior is characteristic of vulnerability to hypomania,” they write in the journal Comprehensive Psychiatry.

In an interview with 120 male students who had completed the Hypomanic Personality Scale (HPS), the researchers administered the FORM 90 to assess daily drinking in the 90 days prior to the interview. The participants also completed the Composite Diagnostic Interview to derive psychiatric diagnoses.

Regression analyses of the data showed that, as expected, men with alcohol-related disorders drank significantly more alcohol than other men, and more frequently.

When they looked at individual fluctuations in the amount of alcohol consumed, the researchers found that only men at risk for hypomania showed intra-individual fluctuations in alcohol consumption beyond the clinical diagnosis of abuse or dependency.

Vulnerability for hypomania was also significantly associated with the amount of alcohol drank on each drinking day, whereas it was not associated with the number of abstinent days.

This means “that people scoring high on the HPS did not drink more often than did those low in risk, but when they started drinking alcohol, they drank more,” say Myer and Wolkenstein.

They conclude: “Our results suggest that risk for hypomania is associated with a specific pattern of alcohol consumption characterized by a more variable drinking pattern and binge drinking. This association was not explained by the presence of an alcohol-related or affective disorder, so that it is unlikely just to be a symptom of them.”

The researchers say that this specific drinking pattern highlights instability as a core factor in vulnerability for bipolar disorder.

They recommend further research into the motivational and affective processes associated with drinking alcohol and bipolar disorder to determine how mood and drinking are related.

Free abstract ]]> Bipolar Disorder David Baxter http://forum.psychlinks.ca/bipolar-disorder/24256-unstable-alcohol-consumption-linked-to-hypomania-vulnerability.html http://forum.psychlinks.ca/bipolar-disorder/24255-bipolar-disorder-ocd-may-be-separate-disease-entity-new-post.html Mon, 06 Sep 2010 23:28:44 GMT Bipolar Disorder-OCD may be separate disease entity... Bipolar Disorder-OCD may be separate disease entity
By Andrew Czyzewski, MedWire News
06 April 2010
Acta Neuropsychiatrica 2010: 22: 81–86

Patients with bipolar disorder and comorbid obsessive-compulsive disorder (OCD) present with more depressive episodes and are at a greater risk for treatment-emergent mania than their peers with bipolar disorder alone, research shows.

As the comorbid patients also had a greater burden of anxiety and impulse control disorders the findings raise the possibility that this group represents a distinct disease entity.

A recent analysis of the US Epidemiological Catchment Area Study data set found that lifetime rates of OCD in patients with bipolar disorder and major depression were 21% and 12.2%, respectively.

“Although OCD-bipolar disorder comorbidity is now considered highly prevalent, very few controlled studies have examined the impact of comorbid OCD on the course and treatment of bipolar disorder,” Beny Lafer (University of Săo Paulo School of Medicine, Brazil) and colleagues comment in the journal Acta Neuropsychiatrica.

For the present study the researchers recruited 30 clinically stable female outpatients with bipolar disorder, divided into two groups: bipolar disorder-OCD, consisting of 15 patients; and bipolar disorder only, also 15 patients.

The groups were matched for age, ethnicity, education, and socioeconomic status.

Following structured clinical interview with the DSM-IV, Lafer and team found that the bipolar disorder-OCD patients presented with a greater number of previous depressive episodes, more chronic episodes, and more residual symptoms after an episode, than the bipolar disorder only patients.

Of the bipolar disorder-OCD patients, 86% had a history of treatment-emergent mania, compared with only 40% of the bipolar disorder only patients.

In addition patients with bipolar disorder-OCD showed a higher prevalence of several psychiatric disorders compared with the bipolar disorder only patients, including any anxiety disorder (93.3 vs 53.3%); impulse control disorders (60% vs 13.3%); eating disorders (33.3 vs 0%); and tic disorders (33.3 vs 0%).

“Although the data available are insufficient to allow us to define OCD-bipolar disorder comorbidity as a distinct entity, future research examining the familial-genetic and neurobiological aspects of this comorbidity will further the understanding of its exact nature,” Lafer and colleagues conclude.

Free abstract ]]> Bipolar Disorder David Baxter http://forum.psychlinks.ca/bipolar-disorder/24255-bipolar-disorder-ocd-may-be-separate-disease-entity.html http://forum.psychlinks.ca/bipolar-disorder/24254-bipolar-disorder-linked-to-certain-positive-psychological-traits-new-post.html Mon, 06 Sep 2010 23:26:48 GMT Bipolar disorder linked to certain positive psychological traits... Bipolar disorder linked to certain positive psychological traits
By Andrew Czyzewski, MedWire News
01 June 2010
J Affect Disord 2010; Advance online publication

Patients with bipolar disorder frequently display positive psychological traits including spirituality, empathy, creativity, realism, and resilience at a level equal or higher to that of mentally healthy controls, a review of the literature shows.

Clinicians should aim to preserve and enhance these traits since they may improve illness outcomes, say co-author Nassir Ghaemi (Tufts Medical Center, Boston, Massachusetts, USA) and colleagues.

They add that a better appreciation of the positive aspects of mental illness is one way to combat the stigma frequently experience by patients with bipolar disorder.

Ghaemi and colleagues performed a literature search for studies assessing the positive psychological characteristics of bipolar disorder. They found a total of 81 articles, with the key positive traits being spirituality, empathy, creativity, realism, and resilience.

One study found that 20–66% of patients with bipolar disorder rely on spiritual belief and practice their faith without negative impact on their affective illness, while another study found that strength of beliefs was a better predictor of good outcomes in bipolar disorder than any other psychiatric comorbidity in the General Health Questionnaire (GHQ).

Two studies found increased empathy in depressed bipolar disorder patients relative to mentally healthy controls, and a third found that compassion predicted decreased mania severity after 6 months of follow-up, suggesting it may serve as a protective factor.

While anecdotal evidence has long suggested enhanced creativity in bipolar disorder, a recent controlled study found patients with bipolar disorder and creative controls, but not major depressive disorder patients, had similarly enhanced creativity on the Baron & Welsch Art Scale (BWAS) compared with healthy controls.

It has been repeatedly shown that depressed bipolar patients are more realistic than the non-depressed in several experiments that measure one's sense of control. In one study patients with high self-reported depression scores correctly attributed errors to themselves in studies where errors were sometimes experimentally introduced; by contrast, healthy individuals reported more control over experimental tasks than they actually possessed.

Regarding resilience, one study reported that patients with bipolar disorder who were previously diagnosed with post-traumatic stress disorder (PTSD) and exposed to a new traumatic experience had a lower prevalence of new PTSD symptoms compared with patients without PTSD.

If mood episodes in bipolar disorder can be conceptualized as discrete traumata then each recovery from a mood episode can be seen as an opportunity for post-traumatic growth, the researchers say.

“Paying attention to positive psychological issues may be an innovative strategy to obtain better clinical outcomes in this illness,” Ghaemi et al conclude in the Journal of Affective Disorders.

Free abstract ]]> Bipolar Disorder David Baxter http://forum.psychlinks.ca/bipolar-disorder/24254-bipolar-disorder-linked-to-certain-positive-psychological-traits.html http://forum.psychlinks.ca/bipolar-disorder/24253-intrusive-memories-increased-in-bipolar-mood-states-new-post.html Mon, 06 Sep 2010 23:25:07 GMT Intrusive memories increased in bipolar mood states... Intrusive memories increased in bipolar mood states
By Lucy Piper, MedWire News
18 June 2010
Behav Res Ther 2010; 48: 698–703

Patients with bipolar disorder often experience intrusive memories of the past that become more distressing during depressive episodes, UK study findings show.
The results also showed that bipolar depression was associated with seeing vivid images focussed on death and suicide.

In contrast, intrusive memories were rare in hypomanic states, and these episodes were more associated with vivid, enjoyable images of future events.

“Behaviors and emotions in different bipolar states may be amplified by characteristic intrusive memories and images, suggesting novel opportunities for therapeutic intervention,” say Chris Brewin, from University College London, and colleagues.

The researchers studied the presence of memory and image intrusions in 29 euthymic patients with bipolar disorder. Intrusive memories were defined as visual images of a particular event or episode from the past that were recalled spontaneously and repeatedly, while intrusive images were scenes that came to mind repeatedly but that did not correspond directly to an event from the past and could be an imaginary situation.

The participants were asked to report on intrusive memories and images from the previous week when they were euthymic and from their most recent episode of depression and hypomania.

In all, 17 (59%), 22 (76%), and four (14%) participants reported experiencing intrusive memories during euthymia, depression, and hypomania, respectively.

For intrusive images, none were reported during euthymia, and 13 (45%) and 19 (66%) patients reported experiencing them during depression and hypomania, respectively.

Follow-up tests indicated that there was no difference in the frequency of intrusive memories between euthymia and depressed states, but they occurred significantly more during these times than during hypomania.

Intrusive images were equally prevalent during depression and hypomania, and were significantly more common during these episodes than during euthymia.

The characteristics of intrusive cognitions differed according to mood states. During euthymia and depression they appeared to encapsulate past-focused negative experiences, which were more distressing and interfered more with daily activities during depression.

Depression was also associated with vivid and distressing future-focused images that typically involved death or suicide.

In contrast, intrusive images in hypomania rarely featured past-focused negative experience; instead, they tended to be vivid positive future-oriented events involving goal-oriented events that were interpersonal in nature.

Brewin and team suggest in the journal Behavior Research and Therapy that treatments that have shown promise for reducing intrusive memories in patients with unipolar depression may also be effective for bipolar disorder patients.

The two possibilities they cite are: imagery rescripting to create an alternative representation that will compete effectively with the intruding image or memory to prevent the amplification of an unwanted mood state; and more general, meta-cognitive strategies such as detached mindfulness in response to intruding memories and images.

Free abstract ]]> Bipolar Disorder David Baxter http://forum.psychlinks.ca/bipolar-disorder/24253-intrusive-memories-increased-in-bipolar-mood-states.html http://forum.psychlinks.ca/bipolar-disorder/24251-atypical-bipolar-disorder-features-predict-reduced-treatment-response-new-post.html Mon, 06 Sep 2010 23:20:52 GMT Atypical bipolar disorder features predict reduced treatment response... Atypical bipolar disorder features predict reduced treatment response
By Andrew Czyzewski, MedWire News
06 July 2010
Bipolar Disord 2010; 12: 390–396

Bipolar disorder patients with atypical features of illness, such as psychotic symptoms and rapid cycling, are more likely than other patients to relapse while on long-term treatment with mood stabilizers, study results show.

"Our findings should prompt physicians to reassess response to lithium in patients with atypical features regularly and, if necessary, to modify treatment - for instance, by adding anticonvulsants to lithium after an inadequate treatment response has been realized," comment Andrea Pfennig (Dresden University of Technology, Germany) and colleagues in the journal Bipolar Disorders.

Bipolar disorder is a serious psychiatric disease, which has a recurrent, chronic course in the majority of patients. Although many patients experience only a few episodes during their lifetime, around 10-15% will suffer more than 10 episodes.

Lithium has proved to be effective for acute and prophylactic treatment and is recommended in current guidelines.

Some studies have suggested an association between so-called atypical features and the quality of response to lithium; however, the impact of atypical features on long-term prophylaxis has not been assessed.

In the present study, the researchers recruited 336 patients with bipolar disorder who all showed response to treatment with lithium.

Over an average period of 10 years (range, 1-33 years) the researchers recorded episodes of recurrence and measured atypical illness features, namely mood-incongruent psychotic symptoms, interepisodic residual symptomatology, more manic than depressive episodes, psychiatric comorbidity, and rapid cycling.

In all, 205 (61%) patients experienced a new episode after initiating lithium treatment (range: 0-19 episodes). Of these, 52 patients experienced one episode, 43 two episodes, 22 three, 25 four, and 62 experienced five or more episodes.

The first recurrence was observed within 12 months of starting lithium treatment in 32% of patients and within 2 years after starting treatment in 50%.

Patients with at least two atypical features had a 50% increased risk for a further relapse compared with patients without any atypical features. The risk for a new episode increased significantly by 21% with each additional atypical feature.

"There are still differences in long-term outcome, even among patients who respond relatively well to long-term lithium prophylaxis," say Pfennig and colleagues who recommend modifying existing treatment where necessary.

Abstract ]]> Bipolar Disorder David Baxter http://forum.psychlinks.ca/bipolar-disorder/24251-atypical-bipolar-disorder-features-predict-reduced-treatment-response.html http://forum.psychlinks.ca/bipolar-disorder/24250-eating-disorders-common-in-bipolar-patients-new-post.html Mon, 06 Sep 2010 23:18:44 GMT Eating disorders common in bipolar patients (http://www.medwire-news.md/47/88727/Psychiatry/Eating_disorders_common_in_bipolar_patients.html) By... Eating disorders common in bipolar patients
By Mark Cowen, MedWire News
04 August 2010
J Affect Disord 2010; Advance online publication

Eating disorders affect around one in seven patients with bipolar disorder, are more common in women, and are associated with an earlier age of onset and a more severe course of illness, US study results suggest.

"Substantial clinical and community data indicate that bipolar disorder co-occurs with substance use, anxiety, and impulse control disorders, and that these comorbidities are associated with negative effects on the course, outcome, and treatment response of bipolar disorder," explain Susan McElroy (Craig and Frances Lindner Center of HOPE, Mason, Ohio) and team.

"Another comorbidity which has received far less systematic attention but which may also be important is that between bipolar disorder and eating disorders," they add.

To investigate further, the researchers studied 875 outpatients (56% women) with bipolar I or II disorder who were aged an average of 41.1 years. Bipolar illness characteristics and comorbid Axis I disorders, including the eating disorders anorexia nervosa, bulimia nervosa, and binge eating disorder, were assessed using the Structured Clinical Interview for DSM-IV (SCID-P).

The patients also underwent clinical examinations and were interviewed about demographic factors, family history of psychiatric illness, and historical illness variables, such as age of onset of mood symptoms, rapid cycling, suicide attempts, and course of illness.

In total, 125 (14.3%) patients met criteria for at least one lifetime eating disorder, 104 (83.0%) of whom were women. The most common eating disorder was binge eating (n=77), followed by bulimia nervosa (n=42) and anorexia nervosa (n=27).

Bipolar disorder patients with an eating disorder had a younger current mean age (38.8 vs 41.4 years), a younger mean age at bipolar illness onset (18.2 vs 21.3 years), a greater mean number of prior hypomania/mania episodes (18.9 vs 14.8), and a greater mean number of prior episodes of depression (21.1 vs 17.2) compared with those without an eating disorder.

Bipolar patients with an eating disorder also had a higher mean body mass index (31.1 vs 27.2 kg/m2), and were more likely to have history of rapid cycling and suicide attempts, and a family history of depression, bipolar disorder, alcoholism, and drug abuse than those without an eating disorder.

McElroy and team conclude in the Journal of Affective Disorders: "Our findings are consistent with others suggesting that bipolar disorder may co-occur with eating disorders, and this relationship likely has clinical and theoretical significance."

They add: "Further research examining the overlap of these disorders would therefore appear to be just as important as further research into their differences."

Abstract ]]> Bipolar Disorder David Baxter http://forum.psychlinks.ca/bipolar-disorder/24250-eating-disorders-common-in-bipolar-patients.html http://forum.psychlinks.ca/bipolar-disorder/24249-medication-plus-psychotherapy-best-for-refractory-bipolar-disorder-new-post.html Mon, 06 Sep 2010 23:16:28 GMT Combination treatment benefits patients with refractory bipolar disorder... Combination treatment benefits patients with refractory bipolar disorder
By Mark Cowen, MedWire News
07 September 2010
J Affect Disord 2010; 126: 80–87

Results from a Spanish study suggest that psychotherapy combined with pharmacotherapy has greater short- and long-term benefits for patients with refractory bipolar disorder than pharmacotherapy alone.

"Current pharmacological treatments fail to control the course of bipolar disorder in half of the cases," explain Ana González Isasi (Las Palmas de Gran Canaria, Spain) and team.

They add: "Patients with a refractory bipolar disorder… frequently have a poor prognosis; they usually present residual symptoms, rapid cycling, and suicide attempts, in spite of an appropriate treatment with mood stabilizers. Furthermore, even without presentation of rapid cycling, these patients may suffer frequent relapses and have severe difficulties in their social-occupational functioning."

To investigate the short- and long-term benefits of combining psychotherapy (psycho-education and cognitive-behavioral therapy) with pharmacotherapy, the researchers enrolled 40 patients with refractory bipolar disorder who were receiving treatment with mood stabilizers.

Of the participants, 20 were randomly assigned to an intervention group that received combined psychotherapy and pharmacotherapy, while the remainder were assigned to a control group that continued to receive pharmacotherapy alone. Psychotherapy consisted of 20 weekly 1.5-hour sessions led by a clinical psychologist assisted by psychiatric nurses.

There were no significant differences between the two groups at baseline regarding gender distribution, age, number of prior hospitalizations, number of recent hospitalizations, use of mood stabilizers, adherence, persistent affective symptoms (Beck's Depression Index score >7, Young Mania Rating Scale score >6), and/or severe difficulties in social-occupational functioning (Inadaptation Scale score >14).

The researchers found that immediately after completion of the psychotherapy program (post-treatment evaluation), 45% of patients in the intervention group still had persistent affective symptoms and/or difficulties in social-occupational functioning. In contrast, 80% of controls met these criteria at this time.

At the 6-month evaluation, 40% of patients in the intervention group still had persistent affective symptoms and/or difficulties in social-occupational functioning compared with 80% of controls, and 30% and 83%, respectively, were affected by these problems at the 12-month evaluation.

All of these between-group differences were significant, the researchers note.

They also found that, overall, patients in the intervention group were hospitalized less often than those in the control group, although intervention patients had been hospitalized more often than controls at the time of the post-treatment evaluation.

Isasi and team conclude in the Journal of Affective Disorders: "Our results suggest that a combined treatment is effective in patients with refractory bipolar disorder. Further research lines could address the evaluation of each of the components of the psychological program (psycho-education and cognitive-behavioral therapy) or other psychological approaches (behavioral experiments or exposure techniques), as well as the possible additive effect of setting up a psycho-education program for relatives who live with the patients."

Abstract ]]> Bipolar Disorder David Baxter http://forum.psychlinks.ca/bipolar-disorder/24249-medication-plus-psychotherapy-best-for-refractory-bipolar-disorder.html