Outcome Of Bipolar Patients Research Articles

Clinical, Biochemical and Neurological Outcomes in Bipolar Patients with Lithium Intoxication at A Tertiary Care Hospital Sindh

Background: Bipolar disorder (BD) affects a significant portion of the global population, with lithium being a cornerstone in its treatment. However, the therapeutic index of lithium is narrow, and its effectiveness can be overshadowed by the risk of toxicity, especially at higher serum levels. Understanding the impact of varying lithium concentrations on clinical, biochemical, and neurological outcomes is crucial in the management of BD. Objective: To assess the clinical, biochemical, and neurological changes associated with different levels of lithium toxicity in patients with bipolar disorder and to determine the safe and effective range of lithium serum levels. Methods: A prospective cross-sectional study was conducted at Jinnah Post Graduate Medical Center, Karachi, involving 100 bipolar disorder patients on lithium therapy, categorized into three groups based on their serum lithium levels: Category I (<1.2 mmol/L), Category II (1.2 – 2.5 mmol/L), and Category III (>2.5 mmol/L). Clinical assessments, laboratory investigations (including renal and thyroid function tests), and neurological evaluations were conducted. Data were analyzed using SPSS version 25, with the t-test and Chi-square test employed for quantitative and qualitative comparisons, respectively. Results: Patients with serum lithium levels above 2.5 mmol/L (Category III) demonstrated significantly higher rates of clinical toxicity, renal dysfunction, and neurological complications compared to lower lithium level groups. Renal function parameters (serum creatinine and urea) and thyroid function (TSH levels) were notably altered in Category III. The incidence of neuropsychiatric symptoms was also significantly higher in this group, with severe neurotoxic effects observed in 27% of these patients. Conclusion: The study highlights the critical importance of maintaining serum lithium levels within a therapeutic range to avoid severe adverse effects. Lithium levels above 2.5 mmol/L significantly increase the risk of renal dysfunction, thyroid abnormalities, and neurotoxicity. Regular monitoring and individualized treatment adjustments are essential for optimizing patient safety and treatment efficacy.

Predicting functional outcome in bipolar patients: Effects of cognitive psychoeducational group therapy after 12 months

IntroductionCognitive impairment is known as a core feature in bipolar patients. Persisting neurocognitive impairment has been associated with low psychosocial functioning.ObjectivesThe goal of this work was to identify clinical and cognitive predictors for functional impairment, symptom severity and early recurrence in bipolar disorder, as well as to compare the neurocognitive performance of bipolar patients with that of healthy probands.Methods43 remitted bipolar patients and 40 healthy controls were compared using a neurocognitive battery testing specifically attention, memory, verbal fluency and executive functions. In a randomized controlled trial, the 43 remitted patients were assigned to two treatment conditions as add-on to state-of-the-art pharmacotherapy: cognitive psychoeducational group therapy over 14 weeks or treatment-as-usual. At 12 months after therapy, functional impairment and severity of symptoms were assessed.ResultsAs compared to healthy probands, bipolar patients showed lower performance in executive function (perseverative errors p<0.01, categories correct p<0.001), sustained attention (total hits p<0.001), verbal learning (delayed recall p<0.001) and verbal fluency (pwords p<0.002). Cognitive psychoeducational group therapy and attention predicted occupational functioning with a hit ratio of 87.5%. Verbal memory recall was found to be a predictor for symptom severity (hit ratio 86.8%). Recurrence in the follow-up period was predicted by premorbid IQ and by years of education (hit ratio 77.8%).ConclusionsOur data show that bipolar patients benefit from cognitive psychoeducational group therapy in the domain of occupational life. Reductions in sustained attention have an impact on occupational impairment.DisclosureNo significant relationships.

Bipolar Disorder and Comorbid Borderline Personality Disorder: Patient Characteristics and Outcomes in US Hospitals.

Background and objectives: The quality of life and disease outcomes in bipolar patients, including increased risk of psychiatric hospitalizations and suicide, are adversely affected by the presence of borderline personality disorder (BPD). Our study aims to determine the impact of BPD on the inpatient outcomes of bipolar disorder patients. Methods: We used Nationwide Inpatient Sample from the US hospitals and identified cases with bipolar disorder and comorbid BPD (N = 268,232) and controls with bipolar disorder only (N = 242,379), using the International Classification of Diseases, 9th Revision, and Clinical Modification codes. We used multinomial logistic regression to generate odds ratios (OR) and evaluate inpatient outcomes. Results: The majority of the bipolar patients with BPD were female (84.2%), Caucasian (83.1%) and 18–35 years age (53.9%). Significantly longer inpatient stays, higher inpatient charges, and higher prevalence of drug abuse were noted in bipolar patients with BPD. The suicide risk was higher in bipolar patients with BPD (OR = 1.418; 95% CI 1.384–1.454; p < 0.001). In addition, utilization of electroconvulsive treatment (ECT) was higher in bipolar patients with comorbid BPD (OR = 1.442; 95% CI 1.373–1.515; p < 0.001). Conclusions: The presence of comorbid BPD in bipolar disorder is associated with higher acute inpatient care due to a longer inpatient stay and higher cost during hospitalization, and higher suicide risk, and utilization of ECT. Further studies in the inpatient setting are warranted to develop effective clinical strategies for optimal outcomes and reduction of suicide risk in bipolar patients with BPD.

Misdiagnosis, duration of untreated illness (DUI) and outcome in bipolar patients with psychotic symptoms: A naturalistic study

BackgroundA number of data show the negative role of duration of untreated illness (DUI) on outcome in mood disorders, but no investigation has been carried out about the impact of this variable in bipolar disorder (BD) with psychotic symptoms. Clinical experience shows that many bipolar patients with psychotic symptoms receive other diagnoses and often are chronically treated with first generation antipsychotics, with the effect to reduce duration of untreated psychosis/untreated episode with psychotic symptoms (DUP), but not DUI. Purpose of the study was to define the rate of misdiagnosis and the impact of DUP/DUI on outcome of bipolar patients with psychotic symptoms. MethodClinical information (DUP, DUI, first received diagnosis) about bipolar outpatients with psychotic symptoms (N=240) were extrapolated through a retrospective review of the clinical charts, Lombardy database and, if necessary, through clinical interviews with patients and their relatives. Outcome measures included psychiatric and substance abuse comorbidity, occupational status, Global Assessment of Functioning (GAF), number of hospitalizations and of suicidal attempts, number of depressive/manic recurrences. Patients were divided in two groups according to the DUP (1 year) and DUI (8 years) median, and the groups were compared through analyses of variance (ANOVAs) for continuous variables or χ2 tests for dichotomous ones. Multivariate analysis of variance (MANOVA) with duration of illness as covariate was then performed to eliminate the effect of this variable. Finally, binary logistic regressions were performed considering age at onset, DUI, DUP as independent variables and outcome variables as dependent ones (presence of hospitalizations/suicidal attempts, GAF scores<50, occupational status). ResultsMost of patients (61.5%) received a first diagnosis different from BD with the most frequent DSM-diagnosis being delusional disorder (17.9%). Patients with longer DUP were not different in outcome measures with respect to patients with shorter DUP. Patients with a DUI >8 years presented higher number of hospitalizations (F=6.04, p=0.015), higher number of manic recurrences (F=5.25, p=0.023), higher number of depressive recurrences (F=7.13, p=0.008) and lower GAF scores (F=17.74, p<0.001). Statistical significance persisted for number of hospitalizations (p<0.001) and GAF scores (p=0.003) after MANOVA. Finally binary logistic regression showed that a longer DUI was predictive of GAF scores<50 (F=17.74, p<0.001). DiscussionMore than half of bipolar patients with psychotic symptoms receive a different diagnosis at first contact with psychiatric services. DUI (but not DUP) is a predictor of outcome in bipolar patients with psychotic symptoms. This indicates that an early diagnosis and proper treatment with a mood stabilizer (or an atypical antipsychotic with mood stabilizing effects) may improve long-term outcome of these patients. In the light of the naturalistic design of the present paper, these results have to be considered as preliminary and have to be confirmed by prospective controlled studies.

Assessing cognitive function in bipolar disorder: challenges and recommendations for clinical trial design.

Neurocognitive impairment in schizophrenia has been recognized for more than a century. In contrast, only recently have significant neurocognitive deficits been recognized in bipolar disorder. Converging data suggest the importance of cognitive problems in relation to quality of life in bipolar disorder, highlighting the need for treatment and prevention efforts targeting cognition in bipolar patients. Future treatment trials targeting cognitive deficits will be met with methodological challenges due to the inherent complexity and heterogeneity of the disorder, including significant diagnostic comorbidities, the episodic nature of the illness, frequent use of polypharmacy, cognitive heterogeneity, and a lack of consensus regarding measurement of cognition and outcome in bipolar patients. Guidelines for use in designing future trials are needed. The members of the consensus panel (each of the bylined authors) were selected based upon their expertise in bipolar disorder. Dr Burdick is a neuropsychologist who has studied cognition in this illness for 15 years; Drs Ketter, Calabrese, and Goldberg each bring considerable expertise in the treatment of bipolar disorder, both within and outside of controlled clinical trials. This consensus statement was derived from work together at scientific meetings (eg, symposium presentation at the 2014 Annual Meeting of the American Society of Clinical Psychopharmacology, among others) and ongoing discussions by conference call. With the exception of the public presentations on this topic, these meetings were closed to outside participants. A literature review was undertaken by the authors to identify illness-specific challenges relevant to the design and conduct of treatment trials targeting neurocognition in bipolar disorder. Expert opinion from each of the authors guided the consensus recommendations. Consensus recommendations, reached by unanimous opinion of the authors, are provided here as a preliminary guide for future trial design. Recommendations comprise exclusion of certain syndromal-level comorbid diagnoses and current affective instability, restrictions on numbers and types of medications, and use of prescreening assessment to ensure enrollment of subjects with adequate objective evidence of baseline cognitive impairment. Clinical trials to address cognitive deficits in bipolar disorder face distinctive design challenges. As such trials move from proof-of-concept to confirmation of clinical efficacy, it will be important to incorporate distinctive design modifications to adequately address these challenges and increase the likelihood of demonstrating cognitive remediation effects. The field is now primed to address these challenges, and a comprehensive effort to formalize best practice guidelines will be a critically important next step.

Clinical Challenges of Bariatric Surgery for Patients with Psychiatric Disorders. Commentary on: "Lithium Toxicity Following Roux-en-Y Gastric Bypass"1.

Clinical Challenges of Bariatric Surgery for Patients with Psychiatric Disorders. Commentary on: "Lithium Toxicity Following Roux-en-Y Gastric Bypass"1.

Herausforderungen der ambulanten Behandlung von Patienten mit bipolar-affektiven Störungen

The course of bipolar illness comprises a wide range, which may vary between one single episode once every five years and a severe ultra rapid cycling course with mood changes within days. Even with optimal pharmacological treatment the functional outcome in bipolar patients is still poor. Underlying pathomechanisms are not fully understood yet. This article addresses three possible illness specific-aspects: cognitive defects, high relapse frequency and poor adherence. Causes as well as therapeutic interventions for these therapeutic pitfalls are summarised.

Sleep quality predicts mood outcomes in bipolar patients with SUDs

Sleep quality predicts mood outcomes in bipolar patients with SUDs

Prevalence and clinical impact of eating disorders in bipolar patients

To study the impact of eating disorders (EDs) on the severity of bipolar disorder (BD). The Structured Clinical Interview for DSM-IV Axis I (SCID-I), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D-17), Hamilton Anxiety Rating Scale (HAM-A), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), and the World Health Organization Quality of Life Assessment (WHOQOL-BREF) were used. Clinical and sociodemographic data were also collected. Among the 356 bipolar patients included in this study, 19 (5.3%) were also diagnosed with ED. Of these, 57.9% had bulimia nervosa (BN) and 42.1% had anorexia nervosa (AN). Among ED patients, 94.7% were female. Bipolar patients with EDs presented with lower scores in the mental health domain of the WHOQOL-BREF, higher scores of depressive symptoms, and more psychiatric comorbidities. ED comorbidities imposed important negative outcomes in bipolar patients. This finding suggests that attention should be given to the presence of EDs in BD patients and that better treatments focused on this population should be developed.

Is there an association between suicide attempt and delay of initiation of mood stabilizers in bipolar I disorder?

Little is known about the extent to which delay of initiation of mood-stabilizing treatment may influence outcomes in bipolar patients (BP). In this study, our aim was to investigate the association between delay of mood stabilizer treatment in bipolar patients and lifetime history of suicide attempts. A consecutive sample of 268 bipolar I outpatients from two teaching hospitals in Brazil was recruited. The assessment included a socio-demographic history form, a clinical interview regarding clinical variables and the Structured Clinical Interview for DSM-IV. Participants were divided into three groups: BP that initiated the first mood stabilizer in the same year of the first episode of the disease (FMS≤1), between 1 and 5 years after the first episode of the disease (1<FMS≤5), and after 5 years after the first episode of BD (FMS>5). The mean time from the first episode until the first mood stabilizer medication was 8.6 years (SD 9.8 years). The FMS>5 group, showed a higher lifetime prevalence of suicide attempts than the other two groups (PR=1.75, 95% CI: 1.24-2.47), p=0.001. These results remained significant after adjusting for potential confounders, (PR=1.82, 95% CI: 1.29-2.60), p=0.001. This study evaluated patients retrospectively and does not permit a cause-effect relationship. The present study supports the importance of early diagnosis and early intervention for BP in order to limit the potentially lethal impact of the disease.

Impulsivity and functional impairment in bipolar disorder

Impulsivity is substantially higher in bipolar patients (BP) and may be associated with a more severe course of illness, but no studies have so far examined the relationship between impulsivity and functional outcome in BP. Our goal was to investigate the functional impact of trait-impulsivity in BP. 138 euthymic BP were recruited. All patients were assessed using an interview based on the Structured Clinical Interview for DSM Disorders (SCID). The Functioning Assessment Short Test (FAST) and the Barratt Impulsiveness Scale (BIS-11) were used to assess functional outcome and impulsivity, respectively. Seven multiple linear regressions, with each individual FAST subscale scores and overall FAST score as dependant variables, were conducted in order to evaluate the predictive role of trait-impulsivity on functional outcome. After a multiple linear regression model, with the FAST total score as dependent variable, we found that depressive symptoms (β=1.580; p<0.001), number of hospitalizations (β=0.837; p=0.019) and impulsivity (β=0.319; p=0.004) were independently associated with overall functional impairment (F=6.854, df=9, p<0.001, adjusted R2=0.311). The cross-sectional design of the study. Our results indicate that impulsivity, as well as depressive symptoms and the number of hospitalizations, is associated with overall functional impairment in BP. The assessment and treatment of impulsivity may be useful in improving functional outcome in BP.

The impact of a groupal family treatment in the outcome of bipolar patients

The impact of a groupal family treatment in the outcome of bipolar patients

Harm avoidance moderates the influence of serotonin transporter gene variants on treatment outcome in bipolar patients

Response to pharmacological treatments is moderated by both genetic and environmental factors. The contribution of such factors is relatively small and complex interactions are likely to be involved. Serotonin transporter gene (SLC6A4) is a major candidate gene associated to response to antidepressant treatment. Moreover, the 5-HTTLPR polymorphism has been associated with anxiety-related traits such as neuroticism and harm avoidance (HA), which are known to influence the risk to develop mood disorders and response to treatments. In the present study we aimed to investigate the interaction between 3 SLC6A4 variants and HA on medium term antidepressant response in a sample of depressed bipolar-spectrum patients followed for 12 months. Contrary to expectations, SLC6A4 variants did significantly influence neither the course of depressive symptoms nor HA scores. However, a significant interaction was observed between HA and 5-HTTLPR genotype. Indeed, a high HA impaired outcome in patients carrying the LG/S or the S/S genotype more than in LA/LA patients. Though a number of limitations characterize the present study, our results indicate HA as a potential moderator of the effect of 5-HTTLPR on the outcome of depression. Given that many factors may influence response to pharmacological treatments, studies that consider personality and other individual characteristics are warranted also in pharmacogenetic investigations.

Erratum

Bipolar DisordersVolume 10, Issue 5 p. 657-657 Free Access Erratum This article corrects the following: Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: a randomized controlled trial María Reinares, Francesc Colom, José Sánchez-Moreno, Carla Torrent, Anabel Martínez-Arán, Mercè Comes, José M. Goikolea, Antoni Benabarre, Manel Salamero, Eduard Vieta, Volume 10Issue 4Bipolar Disorders pages: 511-519 First Published online: April 30, 2008 First published: 04 July 2008 https://doi.org/10.1111/j.1399-5618.2008.00612_1.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat In (1), ‘CIBER-SAM’ was omitted from the author affiliations. The correct listing should be: aBipolar Disorders Program, bClinical Psychology Department, Institute of Neurosciences, Hospital Clinic, IDIBAPS, CIBER-SAM, University of Barcelona, Barcelona, Spain. In (1), the order of the sessions in Table 1 is incorrect. The correct order for the sessions should be: Table 1. Sessions of the Barcelona Bipolar Disorder Program psychoeducational intervention for caregivers of bipolar patients 1. Understanding the nature of the illness 2. Identification of triggering factors 3. Main symptoms and early identification of prodromes: manic and hypomanic episodes 4. Main symptoms and early identification of prodromes: depressive and mixed episodes 5. Treatment: mood stabilizers 6. Treatment: antipsychotics and antidepressants 7. Family and treatment: enhancing compliance 8. Planning of coping strategies 9. Emergencies: suicidal thoughts, hospitalization, pregnancy and counseling on genetic factors 10. Prevention and management of family stress: communication skills training 11. Prevention and management of family stress: problem solving training 12. Legal and social resources References 1 Reinares M, Colom F, Sánchez-Moreno J, et al. Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: a randomized controlled trial. Bipolar Disord 2008; 10: 511– 519. Wiley Online LibraryPubMedWeb of Science®Google Scholar 2 Bruno S, Cercignani M, Ron MA. White matter abnormalities in bipolar disorder: a voxel-based diffusion tensor imaging study. Bipolar Disord 2008; 10: 460– 468. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar We apologize for these errors. Volume10, Issue5August 2008Pages 657-657 ReferencesRelatedInformation

What We have Learned from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) Study

&lt;p&gt;The first publications from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) began to appear in 2003. STEP-BD was conceived in response to an initiative by the National Institutes for Mental Health (NIMB) seeking a public health intervention model that could generate externally valid answers to questions related to bipolar disorder. The study uses a hybrid design to collect longitudinal data for a patient’s transition between naturalistic studies and randomized clinical trials. About 4,360 patients were admitted to the STEP-BD program, receiving a systematic assessment battery at entry and treated by a range of psychiatrists trained to deliver care and measure outcomes in bipolar patients. A registry of all bipolar patients of every subtype = / &gt; 15 was maintained. A report of the first 1,000 patients enrolled in this study found that the sample was 92.6% white and 58.6% female, less racially diverse than the national population, with higher than average education but also higher than average unemployment and lower than average income. &lt;/p&gt; &lt;h4&gt;ABOUT THE AUTHOR&lt;/h4&gt; &lt;p&gt;Jan Fawcett, MD, is Editor of &lt;cite&gt;Psychiatric Annals&lt;/cite&gt;, and is Professor, Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque. &lt;/p&gt; &lt;p&gt;Address correspondence to: Jan Fawcett, MD, &lt;a href="mailto:jan.fawcett@comcast.net"&gt;jan.fawcett@comcast.net&lt;/a&gt;. &lt;/p&gt; &lt;p&gt;Dr. Fawcett has disclosed the following relevant financial relationships: Eli Lilly &amp; Co.: Member of Speakers’ Bureau; and Abbott Laboratories: Member of Medical Advisory Board.&lt;/p&gt; &lt;h4&gt;EDUCATIONAL OBJECTIVES&lt;/h4&gt; &lt;ol&gt;&lt;li&gt; Describe the findings of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study.&lt;/li&gt; &lt;li&gt;Discuss how the course and treatment of bipolar disorder and the difficulties in treating and preventing recurrences of bipolar depression.&lt;/li&gt; &lt;li&gt;Demonstrate the difficulties of successfully treating bipolar disorder and its comorbidities.&lt;/li&gt;&lt;/ol&gt;

Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: a randomized controlled trial

Although there are some randomized controlled trials that highlight the positive role of family-focused treatment added to pharmacotherapy in bipolar disorder, no trials using contemporary methodologies have analyzed the specific effect of working with caregiver-only groups. The aim of this study was to assess the efficacy of a psychoeducational group intervention focused on caregivers of euthymic bipolar patients. A total of 113 medicated euthymic bipolar outpatients who lived with their caregivers were randomized into an experimental and a control group. Caregivers in the experimental group received twelve 90-min group psychoeducation sessions focused on knowledge of bipolar disorder and training in coping skills. The patients did not attend the groups. Caregivers assigned to the control group did not receive any specific intervention. Patients were assessed monthly during both the intervention and the 12 months of follow-up. The primary outcome was time to any mood recurrence. Psychoeducation group intervention focused on the caregivers of bipolar patients carried a reduction of the percentage of patients with any mood recurrence (chi2 = 6.53; p = 0.011) and longer relapse-free intervals (log-rank chi(2) = 4.04; p = 0.044). When different types of episodes were analyzed separately, the effect was significant for both the number of patients who experienced a hypomanic/manic recurrence (chi2 = 5.65; p = 0.017) and the time to such an episode (log-rank chi2 = 5.84; p = 0.015). The differences in preventing depressive and mixed episodes were not significant. A psychoeducation group intervention for the caregivers of bipolar patients is a useful adjunct to usual treatment for the patients in reducing the risk of recurrences, particularly mania and hypomania, in bipolar disorder.

A long-term prospective study on the outcome of bipolar patients treated with long-acting injectable risperidone

Background: Risperidone is the first atypical antipsychotic to become available in a long-acting, injectable formulation. This is the first prospective study to assess the effectiveness of long-acting risperidone in a cohort of bipolar patients. Methods: Twenty-nine DSM-IV acutely manic bipolar inpatients with a history of poor or partial adherence to medication entered the mirror-design observational study. They received naturalistic treatment for a manic episode plus long-acting, injectable risperidone for a mean period of 2 years. The following measures were used to assess the effectiveness of risperidone: the number of hospitalizations, the number of manic, mixed, and depressive episodes leading to hospitalization, the mean duration of hospitalizations, time to relapse, treatment adherence, aggression and suicide attempts. The Clinical Global Impressions (CGI) was used for clinical relevance as well. Results: During the follow-up, there was a significant decrease in the number of hospitalizations per patient (Z−2.72 P<0.006), in the number of manic or mixed episodes leading to hospitalization (Z−2.68 P<0.007) but not in the hospitalizations due to depressive episodes, a decrease in the average length of hospitalization per patient (Z−3.27 P<0.001), a significant increase in the time to any new episode (first relapse) (Z−3.28, P<0.001), and significant improvements in treatment adherence (P<0.0001) and hetero-aggressive episodes (P<0.0001), but not suicide attempts (P=NS). At study endpoint 14 patients (48%) were very much improved according to the CGI. Discussion: This observational long-term study provides support to long-acting injectable risperidone being effective for the maintenance treatment of mania and improving treatment adherence, reducing relapses and re-hospitalization rates.

Clinical variables and implications of the personality on the outcome of bipolar illness: a pilot study

Outcome in bipolar patients is affected by comorbidity. Comorbid personality disorders are frequent and may complicate the course of bipolar illness. This pilot study examined a series of 40 euthymic bipolar patients (DSM-IV criteria) (bipolar I disorder 31, bipolar II disorder 9) to assess the effect of clinical variables and the influence of comorbid personality on the clinical course of bipolar illness. Bipolar patients with a diagnosis of comorbid personality disorder (n = 30) were compared with "pure" bipolar patients (n = 10) with regard to demographic, clinical, and course of illness variables. Comorbid personality disorder was diagnosed in 75% of patients according to ICD-10 criteria, with obsessive-compulsive personality disorder being the most frequent type. Sixty-three per cent of subjects had more than one comorbid personality disorder. Bipolar patients with and without comorbid personality disorder showed no significant differences regarding features of the bipolar illness, although the group with comorbid personality disorder showed a younger age at onset, more depressive episodes, and longer duration of bipolar illness. In subjects with comorbid personality disorders, the number of hospitalizations correlated significantly with depressive episodes and there was an inverse correlation between age at the first episode and duration of bipolar illness. These findings, however, should be interpreted taking into account the preliminary nature of a pilot study and the contamination of the sample with too many bipolar II patients.

Carnitine does not improve weight loss outcomes in valproate‐treated bipolar patients consuming an energy‐restricted, low‐fat diet

Carnitine deficiency impairs fatty acid beta-oxidation and may partly explain weight gain in valproate-treated patients. The aim of this study was to determine whether l-carnitine supplementation improves weight loss outcomes in bipolar patients taking sodium valproate. Sixty bipolar patients with clinically significant weight gain thought to be related to sodium valproate, who had been taking sodium valproate for >or=6 months, were randomized to l-carnitine (15 mg/kg/day) or placebo for 26 weeks, in conjunction with a moderately energy-restricted, low-fat diet. The primary outcome measure was weight change. l-carnitine had no effect on mean weight loss compared with placebo (-1.9 kg versus - 0.9 kg) (F = 0.778, df = 1,58, p = 0.381). The number of people in each group able to lose any weight was identical ( = 0, p = 1.0); more patients in the carnitine group (nine versus five) achieved a clinically significant weight loss (>or=5%) but this was not statistically significant (p = 1.0, Fisher's exact test). At the dose prescribed in this study carnitine supplementation did not improve weight loss outcomes in valproate-treated bipolar patients consuming an energy-restricted, low-fat diet.

Patients' expectancies, the alliance in pharmacotherapy, and treatment outcomes in bipolar disorder.

Bipolar disorder is characterized by a chronic and fluctuating course of illness. Although nonadherence to pharmacotherapy is a frequent problem in the disorder, few studies have systematically explored psychosocial factors related to treatment discontinuation. Previous research with depressed patients receiving psychotherapy has suggested that expectancies for improvement are related to treatment outcomes and that the therapeutic alliance may partially mediate this relationship. The current study found evidence for a similar relationship between patients' initial expectancies for improvement, patient and doctor-rated alliance, and long-term outcomes in bipolar patients treated with pharmacotherapy for up to 28 months following an acute episode. The results highlight the need for the assessment of expectancies and alliance in bipolar treatment and suggest possible targets for psychosocial interventions.