Comorbidity of Cerebral Palsy and Bipolar Disorder in Two Adolescents: Case Series

Clinical Characteristics and Health Service Use of Veterans With Comorbid Bipolar Disorder and PTSD

What are the consequences of comorbidity in bipolar disorders? Two aspects deserve further consideration. First, comorbidity may delineate subtypes. Bipolar disorder and OCD together might be another type of disorder than each alone. Secondly, several studies have indicated that, when a patient suffers from more than one psychiatric disorder, treatment becomes more difficult and the course is more unfavourable (Sharma et al. 1995, Shwartz et al. 1996, Vogel and Huguelet 1997). However, is this also true for bipolar disorders? Recent studies, for example the NCS (Kessler 1999), have found that during their lifetime virtually all bipolar patients suffer from an additional psychiatric disorder. This casts some doubt on the relevance of such “lifetime comorbidity”. Can it actually worsen course and treatment response, when suffering from such a comorbid disorder seems to be the rule for patients with bipolar disorders? Furthermore, hardly any prospective studies have compared the course of comorbid and non-comorbid bipolar patients. Therefore, and due to the chronicity of bipolar disorders, comorbidity in bipolar disorder has to be assessed in a more complex way. In addition to the mere — categorical — diagnosis of a second disorder, its course, duration, severity and consequences must be assessed dimensionally. Truly multidimensional or multiaxial diagnostic strategies have to be developed further.

This study tested the hypothesis that patients with comorbid bipolar and substance use disorders use health services to a greater extent than patients with either bipolar or substance use disorder alone. A retrospective chart review was conducted among patients who used health services at the Ralph H. Johnson Department of Veterans Affairs medical center in Charleston, South Carolina, and had bipolar disorder alone, substance use disorder alone, and comorbid bipolar and substance use disorders. Patients with a psychiatric admission between 1999 and 2003 were included in the study. Information was collected on the use of health services one year before and including the index admission. The records of 106 eligible patients were examined for this study: 18 had bipolar disorder alone, 39 had substance use disorder alone, and 49 had both bipolar and substance use disorders. Compared with the other two groups, the group with comorbid bipolar and substance use disorders was significantly more likely to be suicidal. Compared with the group with bipolar disorder alone, the group with comorbid disorders had significantly fewer outpatient psychiatric visits and tended to have shorter psychiatric hospitalizations. Among patients with an alcohol use disorder, those who also had bipolar disorder were significantly less likely than those with an alcohol use disorder alone to have had an alcohol-related seizure. Patients with comorbid bipolar and substance use disorders were significantly less likely than those with substance use disorder alone to be referred for intensive substance abuse treatment, even though both groups were equally likely to enter and complete treatment when they were referred. Despite significant functional impairment among patients with comorbid bipolar and substance use disorders, they had significantly fewer psychiatric outpatient visits than those with bipolar disorder alone and were referred for intensive substance abuse treatment significantly less often than those with substance use disorder alone.

This study aimed to evaluate aspects of second messenger function in the brain of suicide victims and patients with bipolar disorder. Inositol and its synthetic enzyme, inositol monophosphatase, were measured in postmortem brain samples of 10 suicide victims, eight patients with bipolar affective disorder, and 10 normal comparison subjects. The frontal cortex inositol levels of the suicide victims and the patients with bipolar disorder were significantly less than those of the normal comparison group. No differences in cerebellum or occipital cortex inositol levels were found among the three groups. The groups also showed no differences in inositol monophosphatase activity in any brain area. These results could suggest a deficiency of second messenger precursor in patients with bipolar disorder and suicide victims.

Bipolar disorder comorbidity in patients with obsessive-compulsive disorder: Prevalence and predictors

The impact of comorbid premenstrual dysphoric disorder (PMDD) in women with bipolar disorder (BD) is largely unknown. We compared illness characteristics and female-specific mental health problems between women with BD with and without PMDD. A total of 1 099 women with BD who participated in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were studied. Psychiatric diagnoses and illness characteristics were assessed using the Mini International Neuropsychiatric Interview. Female-specific mental health was assessed using a self-report questionnaire developed for STEP-BD. PMDD diagnosis was based on DSM-5 criteria. Women with comorbid BD and PMDD had an earlier onset of bipolar illness (P < 0.001) and higher rates of rapid cycling (P = 0.039), and increased number of past-year hypo/manic (P = 0.003), and lifetime/past-year depressive episodes (P < 0.05). Comorbid PMDD was also associated with higher proportion of panic disorder, post-traumatic stress disorder, generalized anxiety disorder, bulimia nervosa, substance abuse, and adult attention deficit disorder (all P < 0.05). There was a closer gap between BD onset and age of menarche in women with comorbid PMDD (P = 0.003). Women with comorbid PMDD reported more severe mood symptoms during the perinatal period and while taking oral contraceptives (P < 0.001). The results from this study is consistent with research suggesting that sensitivity to endogenous hormones may impact the onset and the clinical course of BD. The comorbidity between PMDD and BD is associated with worse clinical outcomes and increased illness burden.

We investigated whether women diagnosed with comorbid bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD) experience higher disruptions in biological rhythms in two independent study samples. The first study has a population-based sample of 727 women, including 104 women with PMDD only, 43 women with BD only, 24 women with comorbid PMDD and BD, and 556 women without BD or PMDD (controls). Biological rhythm disruptions were cross-sectionally evaluated using the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN). The second study enrolled 77 outpatient women who completed prospective assessments at two timepoints: during the mid-follicular and the late-luteal phases of their menstrual cycles, using the BRIAN, and included 19 women with PMDD, 16 with BD, 17 with comorbid PMDD and BD, and 25 controls. In the population-based sample, all the diagnostic groups (BD, PMDD, BDPMDD) presented greater biological rhythm disruption than controls. In addition, women with BD presented greater overall biological rhythms disruption, and greater disruption in sleep, activity, and eating patterns, than women with PMDD. In the outpatient sample study, women with BDPMDD showed greater disruption in the social domain than women with PMDD. In the outpatient sample, women with BDPMDD reported significantly higher disruptions in biological rhythms across both the follicular and the luteal phases of the menstrual cycle. The comorbidity between BD and PMDD may affect biological rhythms beyond the luteal phase of the menstrual cycle. These results support previous literature on the increased illness burden of women diagnosed with comorbidBD and PMDD.

PurposeThe aim of this study was to evaluate the prevalence of comorbid bipolar disorder (BD) among migraineurs and the impact of migraine–BD comorbidity on disease characteristics.Patients and methodsA total of 120 adult patients diagnosed with migraine at a single tertiary care center were included in this cross-sectional study. Data on sociodemographic and migraine-related characteristics, family history of psychiatric diseases, comorbid psychiatric diseases, and first-episode characteristics were recorded. Mood Disorders Diagnosis and Patient Registration Form (SCIP-TURK), Mood Disorder Questionnaire (MDQ), and Hypomania Checklist-32-Revised (HCL-32-R) were applied to all patients by experienced clinicians, and clinical diagnoses were confirmed using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Migraine Disability Assessment Scale (MIDAS) was used to evaluate the headache-related disability. Study parameters were compared between migraineurs with and without comorbid BD.ResultsThe diagnosis of comorbid BD was confirmed in 19.2% of migraineurs. A significantly higher percentage of patients with comorbid BD than those without comorbid BD had family history of BD (39.1% vs 6.2%, P<0.001), suicide attempt (30.4% vs 5.2%, P<0.001), and physical abuse (52.2% vs 26.8%, P=0.019). MIDAS scores were significantly higher (50.6 [43.2] vs 33.8 [42.7], P=0.0422) in migraineurs with comorbid BD than in those without comorbid BD. Multivariate logistic regression model revealed that a positive family history of type I BD (odds ratio [OR], 14.42; 95% confidence interval [CI], 2.94–70.73; P=0.001) and MIDAS scores >30 (OR, 3.69; 95% CI, 1.12–12.19; P=0.032) were associated with 14.42 times and 3.69 times increased likelihood of BD, respectively.ConclusionOur findings revealed comorbid BD in a remarkable percentage of migraineurs and a higher likelihood of having BD in case of a positive family history of type I BD and MIDAS scores >30. Comorbid BD was associated with a higher rate for a family history of BD, suicide attempt, and childhood physical abuse as well as aggravated migraine-related disability among migraineurs. Migraineurs with and without comorbid BD showed similar sociodemographic and migraine disease characteristics as well as similar high rates for comorbid anxiety and first-episode depression.

This study aimed to assess the prevalence of bipolar disorder (BPD) in children and adolescents with attention deficit hyperactivity disorder (ADHD), and to compare the clinical characteristics of a group with ADHD with a group with co-morbidity of ADHD and BPD. The study includes 121 individuals, aged 6–16 years, with a diagnosis of ADHD. Co-morbidity of BPD was evaluated using the Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime version (K-SADS-PL) and the Parent-Young Mania Rating Scale (P-YMRS). The Child Behavior Checklist (CBCL) was used to assess psychopathology in two groups. Ten children (8.3%) in the ADHD sample received the additional diagnosis of BPD. The ADHD + BPD group had significantly higher scores than the ADHD group on withdrawn, anxiety/depression, social problems, thought problems, attention problems, aggression, externalization, total score items of CBCL, and on the P-YMRS. It could be concluded that BPD is not a rare co-morbid condition in children with diagnosis of ADHD and subjects with this co-morbidity show more severe psychopathology than subjects with pure ADHD. Differential diagnosis of BPD disorder in subjects with ADHD seems crucial in establishing an effective treatment program, and therefore improving mental health outcomes.

Patients with comorbidity of antisocial personality disorder and bipolar affective disorder represent a specific category due to permeation of clinically frequent and most serious mood disorder and a personality disorder of a particularly destructive type such as antisocial personality disorder. Previous studies of comorbidity of bipolar affective disorder and antisocial personality disorder showed relatively high prevalence rates of bipolar affective disorder in patients with antisocial personality disorder. In patients with bipolar affective disorder with the presence of antisocial personality disorder it is expected that there is a deterioration of the primary symptoms of the disease, particulary in manic phases, which is the reason of investigation of these phenomena, and why it is essential. Professional community has been familiar with the impact of neuroanatomic and neurophysiological factors on bipolar affective disorder as well as with antisocial personality disorder for more than two centuries. The most common neuroanatomic studies of patients with bipolar affective disorder and antisocial personality disorder are related to injuries and defects of the frontal cortex in general, whereas neurophysiological tests indicate deficits in brain hemispheres, a low level of excitation of the central and peripheral nervous system, abnormal EEG findings and reduced skin conductivity. Experts have paid special attention to similarities between the so-called "frontal lobe personality" and patients with comorbidity of these disorders. Analysing some of the basic characteristics of patients with "frontal lobishness" and comparing some research results of neuroanatomic and neurophysiological characteristics of patients with comorbid bipolar disorder and antisocial personality disorder, we try to distance ourselves from the trend that the etiological basis of these disorders is far away from the neurophysiological basis.

To assess the global functioning and clinical outcomes of children and adolescents with bipolar disorder, children and adolescents with bipolar disorder and substance use disorder (SUD) comorbidity and healthy controls. This study had a cross-sectional design. Participants were children and adolescents aged between 6 and 17 years, and data were collected between 2003 and 2015. Psychiatric diagnosis was established according to DSM-IV criteria using the Kiddie-SADS-Present and Lifetime Version or the Mini-International Neuropsychiatric Interview for Children and Adolescents. Global functioning was assessed using the Children's Global Assessment Scale. Depressive symptoms were assessed using the Children's Depression Rating Scale. Manic symptoms were measured using the Young Mania Rating Scale, and the severity of anxious symptoms was assessed using the Screen for Child Anxiety Related Disorders. The sample included 187 children and adolescents with bipolar disorder, 29 with BD and SUD comorbidity, and 115 healthy controls. Children and adolescents with BD and SUD comorbidity presented later onset of mood disorder (P < .001); higher rates of lifetime history of suicide attempt (P < .001), lifetime history of psychosis (trend toward significance: P = .076), and lifetime hospitalization (P < .001); and higher severity of depressive symptoms (trend toward significance: P = .080) as compared to those with BD without SUD comorbidity. In addition, both diagnosis groups presented higher rates of functional impairment when compared to controls (P < .001). Moreover, BD and SUD comorbidity presented higher functional impairment, as compared to BD without SUD comorbidity (P = .020). Children and adolescents with bipolar disorder and substance use disorder comorbidity present a worse clinical course than those with bipolar disorder but without substance use disorder comorbidity.

ABSTRACTIntroductionPost‐traumatic stress disorder (PTSD) is more prevalent in those with bipolar disorder (BD) than in the general population, with rates of PTSD as high as 55% in some BD cohorts. Despite this, little research explores the effects of pharmacotherapy treatments in those with comorbid BD and PTSD. This study aims to explore patterns of pharmacotherapy use at baseline and their impact on symptoms in individuals with BD alone and comorbid BD and PTSD.MethodsThe Systematic Treatment Enhancement Program for BD (STEP‐BD) cohort was utilised to examine and compare BD symptoms and pharmacotherapy treatments between those with BD alone (n = 3393) and those with comorbid BD and PTSD (n = 304). We conducted regression models to compare those with and without comorbid PTSD. Models included measures of depression, mania, functioning and quality of life over 24 months of the STEP‐BD study. We included baseline pharmacotherapies (lithium, valproate, antidepressants, antipsychotics and benzodiazepines) as predictor outcome variables in all models.ResultsAt baseline, reported use of lithium was lower in the comorbid BD and PTSD group, while the use of antidepressants, antipsychotics and benzodiazepines was significantly higher in the comorbid BD and PTSD than in the BD alone group. Benzodiazepine use was associated with a small improvement in depression symptom scores and poorer quality of life in those with comorbid BD and PTSD. Lastly, those with comorbid PTSD experienced higher levels of mania and depression symptoms and lower functioning and quality of life compared to BD alone, irrespective of pharmacotherapy treatment.ConclusionClinical trial participants with BD and PTSD reported worse symptoms and outcomes across 24 months of the STEP‐BD study compared to those without comorbid PTSD, regardless of baseline medication use. These results highlight the importance of considering comorbidity in the treatment of mental health conditions, specifically BD, and the need for further exploration of effective treatment options.

In recent years, much has been written on the comorbidity of bipolar disorders with other mental illnesses. The comorbidity of medical conditions and bipolar affective disorders is a topic that warrants systematic research. Rapid cycling has been reported in various other neuropsychiatric disorders, such as head injury, stroke, learning disability, or rarer illnesses, such as cerebral sarcoidosis or tuberous sclerosis. Rapid-cycling bipolar affective disorders may concur with higher rates of substance-abuse disorders, but such an idea is mainly based on clinical observation or preliminary data. There is an overall tendency that mixed states and rapid-cycling forms of bipolar affective disorder constitute more unfavorable forms of the underlying illness. Mixed affective episodes have a link with anxiety disorders and anxious-dependent personality disorders. Rapid cycling may have a link with substance abuse and with certain neuropsychiatric disorders, or, perhaps, these neuropsychiatric disorders may mimic rapid cycling.

What Do We Know for Sure About Bipolar Disorder?

Ask the Expert: Treatment Strategy for Co-occurring Bipolar Disorder and Alcohol Abuse