Between Bipolar Disorder Patients Research Articles

Prevalence of Circadian Rhythm Sleep-Wake Disorders and Associated Factors in Euthymic Patients with Bipolar Disorder.

Recent studies have suggested that there are certain pathophysiological relationships between bipolar disorder (BD) and circadian rhythm dysfunction. However, apparently no studies have clarified the prevalence of circadian rhythm sleep-wake disorders (CRSWD) in patients with BD. This study was set out to investigate the prevalence of CRSWD and associated factors in patients with BD. One hundred four euthymic BD outpatients participated in this study. The subjects were asked to answer questionnaires including demographic variables, clinical course of BD, and family history of psychiatric disorders and suicide. Severity of BD was assessed by the Montgomery-Åsberg Depression Rating Scale and Young Mania Rating Scale. CRSWD was diagnosed by clinical interview, together with sleep logs, according to the International Classification of Sleep Disorders, third edition (ICSD-3). Thirty-five subjects (32.4%) met the criteria for CRSWD. The age at the time of investigation and that at the onset of BD were both lower in the CRSWD group than in the non-CRSWD group. The rates of family history of psychiatric disorders and suicide in the CRSWD group were higher than those in the non-CRSWD group. Multiple logistic regression analysis revealed that the presence of CRSWD was significantly associated with younger onset age of BD and family history of suicide. The prevalence of CRSWD could be quite high in BD patients. Younger onset age of BD and family history of suicide were associated with presence of CRSWD in BD patients.

C-reactive protein levels and cognitive functions in patients with bipolar I disorder

Background In the previous studies, the relevance of inflammatory processes to disorders of the brain and body may serve as an important touchstone for increasing integration of psychiatry and medicine. Until recently, few studies had examined the potential role of inflammation in bipolar I disorder. We aimed at comparing C-reactive protein (CRP) serum levels as a marker of systemic inflammation between bipolar disorder (BD) patients in different affective phases and matched healthy controls and investigating the possible effects of CRP elevations on the cognitive impairment in BD remitted patients group. Methods Forty-two patients with bipolar I disorder subdivided into (manic, depressive, full remitted) groups were examined. We measured the circulating levels of high-sensitivity C-reactive protein (hs-CRP), The results were compared with 42 age- and sex-matched healthy control, Then the neuropsychological function for the full remitted group only was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) test and examine the correlation between the neuropsychological function and hs-CRP levels in this group. Results It showed that hs-CRP levels were significantly higher in BD patients than healthy controls. By comparing each group (manic, depressed and remitted) separately with healthy controls, the difference was still statistically highly significant ( P P P >0.05). Conclusion Our finding adds to the growing evidence that inflammation has a role in mood disorders psychopathology.

Marital adjustment and family functioning in bipolar disorder type I in comparison with rheumatoid arthritis

Objective: Marriage is known to affect health and functioning. Beside the importance of the marital status, le vels of marital adjustment and family functioning are found to have greater impact on health. Chronic di seases could have negative effects on marital adjustment and family functioning. Our aim in this study was to compare marital adjustment and family functioning between bipolar disorder (BD) type I and RA patients and their spouses. Method: Study sample included 49 BD type I and 48 RA patients and their spouses. BD patients were evaluated by the Structured Clinical Interview for DSM-IV Axis I Disorders, the Hamilton Rating Scale for Depression, and the Young Mania Rating BD patients in remission state and RA patients in chronic state were included, patients in acute state were excluded. The patients with RA and their spouses and the spouses of the BD patients were evaluated fort he detection of comorbid psychiatric disorders and the individuals who had any psychiatric disorder were excluded from the study. Marital adjustment and family functioning were assessed by using the Berksun-Soylemez-Kavacýk Marital Adjustment and Family Functioning Scale. The scale has three subscales; 1.family functioning and adjustment, 2.trust-loyalty-violence, and 3.marital dysphoria. Higher scores are interpreted as worse adjustment and functioning.Results: BD-I patients had higher total marital adjustment and family functioning scores compared to the RA patients (p = 0.004). Spouses of BDI patients had also higher scores than the spouses of RA patients (p = 0.001). When the scale is compared between the spouses, RA patients and their partners had similar scores. BD-I patients' partners had worse scores than the BD-I patients. Conclusion: BD-I even in remission state disrupts marital adjustment and family functioning more than a disease presenting with chronic pain. This result must be considered in treatment of the BD patients. It should be kept in mind that the spouses of BD patients are more dissatisfied with their marriages than the BD patients. Especially, adjustment of the spouse to the marriage is important.

Comorbid Bipolar Disorder and Obsessive-Compulsive Disorder: An Old Debate Renewed.

To the Editor, Apparent comorbidity between bipolar disorder (BD) and anxiety disorders is a common condition in psychiatry with higher prevalence rates for generalised anxiety disorder, social phobia, panic disorder.1 Overlapping clinical criteria for many diagnoses, especially mood and anxiety disorders, produced by the Diagnostic and Statistical Manual of Mental Disorders (DSM) might lay behind these high prevalence rates.2 Using DSM, it is unclear whether concomitant diagnoses actually reflect the presence of distinct clinical entities or refer to multiple manifestations of a single clinical entity. With regard to anxiety disorders, one of the most difficult additional psychiatric diagnosis to manage in BD patients is obsessive-compulsive disorder (OCD).3,4 In our recent meta-analysis, the pooled prevalence of OCD in BD was 17.0%, which was comparable to the results reported by the pooled prevalence of BD in OCD (18.35%).5 In line with previous studies,6 OCD prevalence rate was higher among BD children and adolescents (24.2%, compared to 13.5% in adults). The co-occurrence of symptoms of BD and OCD was noted 150 years ago by Morel,7 but the topic is insufficiently studied and the relationship between BD and OCD remains unclear. In agreement with Kraepelin's thought a psychiatric diagnosis is best established by its longitudinal course of illness, the evidence so far supports the view that, especially among patients with a primary diagnosis of BD, the majority of comorbid OCD cases appeared to be related to mood episodes.8 OC symptoms in comorbid patients appeared more often-and sometimes exclusively-during depressive episodes, and comorbid BD and OCD cycled together, with OC symptoms often remitting during manic/hypomanic episodes. Therefore, only a substantial minority of comorbid BD-OCD may represent OCD independent of BD with OC symptoms that improve or worsen during mood episodes without being related to these. These findings are in line with Feinsteins definition of comorbidity, as any distinct additional entity that has existed or may occur during the clinical course of a patient who has the index disease under study.2 True OCD comorbid with BD would represent the random co-occurrence of two independent diseases, estimated by multiplication of prevalence rates, which are about 1% for each condition, and producing a very low expected true comorbidity of 0.1% in the general population. The treatment of BD-OCD patients remains a great challenge, since the gold standard for one disease (serotonin reuptake inhibitors for OCD) can worsen the other (antidepressants can cause mania and/or more mood episodes in BD). The clinical features of comorbid BD-OCD patients would explain why OCD and BD symptoms respond to adequate mood stabilizer treatment.3 Only in a minority of comorbid patients with persistent OCD, despite improvement in mood episodes, addition of low doses of antidepressants could be considered while strictly monitoring emerging symptoms of mania or mixed states. Benefit with antipsychotics was also seen, although a few reports also exist of exacerbation of OC symptoms with neuroleptic agents. Considering the growing interest over the last decades into shared pathophysiologies across psychiatric disorders, studies addressing neurobiological substrates are essential to illuminate pathogenetic mechanisms that underlie comorbid BD-OCD.

Executive dysfunction in bipolar disorder and borderline personality disorder

ObjectiveThe boundary between bipolar disorder (BD) and borderline personality disorder is a controversial one. Despite the importance of the topic, few studies have directly compared these patient groups. The aim of the study was to compare the executive functioning profile of BD and BPD patients. MethodExecutive functioning (sustained attention, problem-solving, planning, strategy formation, cognitive flexibility and working memory) was assessed in BD (n=30) and BPD outpatients (n=32) using a computerized assessment battery (Cambridge Neuropsychological Test Automated Battery, CANTAB). The groups were compared to one another as well as to healthy controls. ResultsBD patients showed deficits in strategy formation and in planning (indicated by longer execution time in the ToL task) in comparison to BPD patients and healthy controls. BPD patients showed deficits in planning (short deliberation time in the ToL task) in comparison to BD patients and in comparison to healthy controls. In comparison to healthy controls, BPD patients displayed deficits in problem-solving. ConclusionsDifferences in executive dysfunction between BD and BPD patients suggest that this cognitive dimension may be relevant for the clarification of the boundary between the disorders.

Is comorbid borderline personality disorder in patients with major depressive episode and bipolarity a developmental subtype? Findings from the international BRIDGE study

The nature of the relationship between bipolar disorder (BD) and borderline personality disorder (BPD) is controversial. The aim of this study was to characterize the clinical profile of patients with BD and comorbid BPD in a world-wide sample selected during a major depressive episode (MDE). From a general sample of 5635 in and out-patients with an MDE, who were enrolled in the multicenter, multinational, transcultural BRIDGE study, we identified 2658 subjects who met bipolarity specifier criteria. Bipolar specifier patients with (BPD+) and without (BPD-) comorbid BPD were compared on diagnostic, socio-demographic, familial and clinical characteristics. 386 patients (14.5%) met criteria for BPD. A diagnosis of BD according to DSM-IV criteria was significantly more frequent in the BPD- than in BPD+, while similar rates in the two groups occurred using DSM-IV-Modified criteria. A subset of the BD criteria with an atypical connotation, such as irritability, mood instability and reactivity to drugs were significantly associated withthe presence of BPD. BPD+ patients were significantly younger than BPD- bipolar patients for age, age at onset of first psychiatric symptoms and age at first diagnosis of depression. They also reported significantly more comorbid Alcohol and Substance abuse, Anxiety disorders, Eating Disorder and Attention Deficit Hyperactivity Disorder. In comparison with BPD-, BPD+ patients showed significantly more psychotic symptoms, history of suicide attempts, mixed states, mood reactivity, atypical features, seasonality of mood episodes, antidepressants induced mood lability and irritability, and resistance to antidepressant treatments. Centers were selected for their strong mood disorder clinical programs, recall bias is possible with a cross-sectional design, and participating psychiatrists received limited training. We confirm in a large sample of BD patients with MDE the high prevalence of patients who meet DSM-IV criteria for BPD. Further prospective researches should clarify whether the mood reactivity and instability captured by BPD DSM-IV criteria are distinguishable from the subjective mood of an instable, dysphoric, irritable manic/hypomanic/mixed state or simply represent a phenotypic variant of BD, related to developmental factors.

Catechol-O-methyltransferase gene Val108/158Met polymorphism in bipolar disorder

Backgrounds Although several studies have tested the association between bipolar disorder (BD) and the Val108 (H, high-activity allele)/158Met (L, low-activity allele) polymorphism of the catechol-O-methyltransferase (COMT) gene, most of the results showed no significant association. However, an association between the H or L allele and bipolar disorder (BD), particularly, between L allele and rapid-cycling form has been reported; it has also been suggested that the variation in the COMT gene modifies the course of BD and there is a tendency for the L allele amongst the female patients. In this study, the researchers aimed to evaluate the association between BD and COMT gene H/L polymorphism considering the influence of gender in a group of Turkish patients. Method One hundred and thirty-five BD patients (71 male and 64 female) and 171 controls were included. Polymerase chain reaction-based endonuclease digestion method was used. Results Genotypic distribution in patients and controls were in Hardy–Weinberg equilibrium. No significant difference was found in genotypic and allelic frequencies between patients and controls. However, female patients had H allele more frequently than male patients and female healthy controls. Females had more depressive and less manic episodes than males. Number of total episodes was associated with H allele in all patients. Conclusion Distribution of COMT genetic polymorphism was not significantly different between the patients and controls. However, it has been found an association of H allele with female patients and number of episodes among all patients.

Differences in temperament and character dimensions in patients with bipolar I or II or major depressive disorder and general population subjects

Whether temperament and character differ between bipolar disorder (BD) and major depressive disorder (MDD) patients and general population subjects, or between BD I and BD II patients, remains unclear. BD patients (n=191) from the Jorvi Bipolar Study and MDD patients (n=266) from the Vantaa Depression Study (VDS) and the Vantaa Primary Care Depression Study were interviewed at baseline, at 6 and 18 months, and in the VDS at 5 years. A general population comparison group (n=264) was surveyed by mail. BD patients' scores on the Temperament and Character Inventory-Revised were compared at an index interview, when levels of depression and mania were lowest, with scores of MDD patients and controls. BD I (n=99) and BD II (n=92) patients were compared. Compared with controls, both BD and MDD patients had higher harm avoidance [odds ratio (OR) 1.027, p<0.001 and OR 1.047, p<0.001, respectively] and lower persistence (OR 0.983, p=0.006 and OR 0.968, p<0.001, respectively) scores. Moreover, BD patients had lower self-directedness (OR 0.979, p=0.003), MDD patients lower reward dependence (OR 0.976, p=0.002) and self-transcendence (OR 0.966, p<0.001) scores. BD patients scored lower in harm avoidance (OR 0.980, p=0.002) and higher in novelty seeking (OR 1.027, p<0.001) and self-transcendence (OR 1.028, p<0.001) than MDD patients. No differences existed between BD I and II patients. The patterns of temperament and character dimensions differed less between BD and MDD patients, than patients from their controls. The most pronounced difference was higher novelty seeking in BD than MDD patients. The dimensions investigated are unlikely to differ between BD I and BD II patients.

Excessive substance use in bipolar disorder is associated with impaired functioning rather than clinical characteristics, a descriptive study

BackgroundThere is a strong association between bipolar disorder (BD) and substance use disorder (SUD). The clinical and functional correlates of SUD in BD are still unclear and little is known about the role of excessive substance use that does not meet SUD criteria. Thus, the aims of the current study were to investigate lifetime rates of illicit substance use in BD relative to the normal population and if there are differences in clinical and functional features between BD patients with and without excessive substance use.Methods125 consecutively recruited BD in- and outpatients from the Oslo University Hospitals and 327 persons randomly drawn from the population in Oslo, Norway participated. Clinical and functional variables were assessed. Excessive substance use was defined as DSM-IV SUD and/or excessive use according to predefined criteria.ResultsThe rate of lifetime illicit substance use was significantly higher among patients compared to the reference population (OR = 3.03, CI = 1.9-4.8, p < .001). Patients with excessive substance use (45% of total) had poorer educational level, occupational status, GAF-scores and medication compliance, with a trend towards higher suicidality rates, compared to patients without. There were no significant group differences in current symptom levels or disease course between groups.ConclusionThe percentage of patients with BD that had tried illicit substances was significantly higher than in the normal population. BD patients with excessive substance use clearly had impaired functioning, but not a worse course of illness compared to patients without excessive substance use. An assessment of substance use beyond SUD criteria in BD is clinically relevant.

COMT GENOTYPE INFLUENCES CORPUS CALLOSUM DEVELOPMENT IN ADOLESCENTS BORN PRETERM

Although several studies have tested the association between bipolar disorder (BD) and the Val108 (H, high-activity allele)/158Met (L, low-activity allele) polymorphism of the catechol-O-methyltransferase (COMT) gene, most of the results showed no significant association. However, an association between the H or L allele and bipolar disorder (BD), particularly, between L allele and rapid-cycling form has been reported; it has also been suggested that the variation in the COMT gene modifies the course of BD and there is a tendency for the L allele amongst the female patients. In this study, the researchers aimed to evaluate the association between BD and COMT gene H/L polymorphism considering the influence of gender in a group of Turkish patients.One hundred and thirty-five BD patients (71 male and 64 female) and 171 controls were included. Polymerase chain reaction-based endonuclease digestion method was used.Genotypic distribution in patients and controls were in Hardy–Weinberg equilibrium. No significant difference was found in genotypic and allelic frequencies between patients and controls. However, female patients had H allele more frequently than male patients and female healthy controls. Females had more depressive and less manic episodes than males. Number of total episodes was associated with H allele in all patients.Distribution of COMT genetic polymorphism was not significantly different between the patients and controls. However, it has been found an association of H allele with female patients and number of episodes among all patients.

Early age at onset of bipolar disorder is associated with more severe clinical features but delayed treatment seeking

Our aim was to obtain a comprehensive view of differences between bipolar disorder (BD) patients with onset at early versus adult age in a representative study cohort. In the Jorvi Bipolar Study (JoBS), 1,630 psychiatric in- and outpatients were systematically screened for BD using the Mood Disorder Questionnaire (MDQ). A total of 191 bipolar I and II patients with a current DSM-IV episode were interviewed to obtain information about age at onset of mood symptoms, clinical course, treatment, comorbidity, and functional status. The patients were classified as either early onset (<18 years) or adult onset. One-third of subjects with BD (58/191, 30%) had early onset. This was associated with female gender, more lifetime psychotic symptoms, greater overall comorbidity, and a greater length of time from first episode to treatment. Although BD patients with early age at onset have more severe clinical features and illness course, the delays from first episode to treatment and to correct diagnosis are longer than for those with adult onset disorder. To reduce morbidity rates related to the most severe forms of BD, the recognition and diagnosis of BD during adolescence needs to be improved.