Bipolar Disorder

Patients with bipolar disorder with psychotic symptoms with a longer duration of untreated illness are worse off than patients diagnosed with the condition earlier, a retrospective study shows.

The duration of untreated psychosis (DUP), duration of untreated illness (DUI), and initial diagnosis of 240 bipolar disorder (BD) patients with psychotic symptoms were extrapolated through a retrospective review of clinical charts, Lombardy database, and, if necessary, through clinical interviews with patients and their relatives. DUP was defined as the time between the onset of psychotic symptoms and the start of antipsychotic treatment, while DUI was defined as the time between the onset of any symptoms of BD and the start of the appropriate mood-stabilizing therapy.

Most (61.5%) of the study’s participants initially were diagnosed with illnesses other than bipolar disorder with psychotic symptoms; the top most common misdiagnosis was delusional disorder.

For patients with DUIs of less than or equal to 8 years, Global Assessment of Functioning (GAF) scores were significantly higher than for patients with DUIs of greater than 8 years. Another significant difference that was found between these two groups was in the number of hospitalizations; participants in the group with longer DUIs faced significantly more of these.

The results of the study suggest that DUI, but not DUP, “seem to affect [at least partly] long-term prognosis” in patients with [bipolar disorder] with psychotic symptoms, according to Dr. A. Carlo Altamura and his colleagues.

Among the study’s conclusions is that “early-onset [bipolar disorder] patients with psychotic features have a long-term poorer working functioning” than late-onset BD patients with psychotic symptoms, according to the researchers.

Read the full study in the Journal of Affective Disorders (doi:10.1016/j.jd2015.04.024).

[email protected]

Patients with bipolar disorder with psychotic symptoms with a longer duration of untreated illness are worse off than patients diagnosed with the condition earlier, a retrospective study shows.

The duration of untreated psychosis (DUP), duration of untreated illness (DUI), and initial diagnosis of 240 bipolar disorder (BD) patients with psychotic symptoms were extrapolated through a retrospective review of clinical charts, Lombardy database, and, if necessary, through clinical interviews with patients and their relatives. DUP was defined as the time between the onset of psychotic symptoms and the start of antipsychotic treatment, while DUI was defined as the time between the onset of any symptoms of BD and the start of the appropriate mood-stabilizing therapy.

Most (61.5%) of the study’s participants initially were diagnosed with illnesses other than bipolar disorder with psychotic symptoms; the top most common misdiagnosis was delusional disorder.

For patients with DUIs of less than or equal to 8 years, Global Assessment of Functioning (GAF) scores were significantly higher than for patients with DUIs of greater than 8 years. Another significant difference that was found between these two groups was in the number of hospitalizations; participants in the group with longer DUIs faced significantly more of these.

The results of the study suggest that DUI, but not DUP, “seem to affect [at least partly] long-term prognosis” in patients with [bipolar disorder] with psychotic symptoms, according to Dr. A. Carlo Altamura and his colleagues.

Among the study’s conclusions is that “early-onset [bipolar disorder] patients with psychotic features have a long-term poorer working functioning” than late-onset BD patients with psychotic symptoms, according to the researchers.

Read the full study in the Journal of Affective Disorders (doi:10.1016/j.jd2015.04.024).

[email protected]

Patients with bipolar disorder with psychotic symptoms with a longer duration of untreated illness are worse off than patients diagnosed with the condition earlier, a retrospective study shows.

The duration of untreated psychosis (DUP), duration of untreated illness (DUI), and initial diagnosis of 240 bipolar disorder (BD) patients with psychotic symptoms were extrapolated through a retrospective review of clinical charts, Lombardy database, and, if necessary, through clinical interviews with patients and their relatives. DUP was defined as the time between the onset of psychotic symptoms and the start of antipsychotic treatment, while DUI was defined as the time between the onset of any symptoms of BD and the start of the appropriate mood-stabilizing therapy.

Most (61.5%) of the study’s participants initially were diagnosed with illnesses other than bipolar disorder with psychotic symptoms; the top most common misdiagnosis was delusional disorder.

For patients with DUIs of less than or equal to 8 years, Global Assessment of Functioning (GAF) scores were significantly higher than for patients with DUIs of greater than 8 years. Another significant difference that was found between these two groups was in the number of hospitalizations; participants in the group with longer DUIs faced significantly more of these.

The results of the study suggest that DUI, but not DUP, “seem to affect [at least partly] long-term prognosis” in patients with [bipolar disorder] with psychotic symptoms, according to Dr. A. Carlo Altamura and his colleagues.

Among the study’s conclusions is that “early-onset [bipolar disorder] patients with psychotic features have a long-term poorer working functioning” than late-onset BD patients with psychotic symptoms, according to the researchers.

Read the full study in the Journal of Affective Disorders (doi:10.1016/j.jd2015.04.024).

[email protected]

Creativity is linked to ambition in patients with bipolar disorder, according to study results published in the Journal of Affective Disorders.

Sheri L. Johnson, Ph.D., and her colleagues in the department of psychology at the University of California, Berkeley, performed two studies: The first assessed accomplishment in 22 patients with bipolar disorder who self-identified as highly creative; the second study examined creative accomplishment and mania risk in 221 undergraduates.

The results from the first study showed that WASSUP scores, a measure of mania risk, were higher in highly creative bipolar patients (27.45) than in normative bipolar patients (14.10) and patients with no mood disorder (9.06). The second study found that mania risk and ambition were both linked to greater creativity, the authors reported.

“Findings across two studies strongly suggest that across the bipolar spectrum, ambition and creativity are linked,” Dr. Johnson and her associates wrote.

Read the full article in the Journal of Affective Disorders.

Creativity is linked to ambition in patients with bipolar disorder, according to study results published in the Journal of Affective Disorders.

Sheri L. Johnson, Ph.D., and her colleagues in the department of psychology at the University of California, Berkeley, performed two studies: The first assessed accomplishment in 22 patients with bipolar disorder who self-identified as highly creative; the second study examined creative accomplishment and mania risk in 221 undergraduates.

The results from the first study showed that WASSUP scores, a measure of mania risk, were higher in highly creative bipolar patients (27.45) than in normative bipolar patients (14.10) and patients with no mood disorder (9.06). The second study found that mania risk and ambition were both linked to greater creativity, the authors reported.

“Findings across two studies strongly suggest that across the bipolar spectrum, ambition and creativity are linked,” Dr. Johnson and her associates wrote.

Read the full article in the Journal of Affective Disorders.

Creativity is linked to ambition in patients with bipolar disorder, according to study results published in the Journal of Affective Disorders.

Sheri L. Johnson, Ph.D., and her colleagues in the department of psychology at the University of California, Berkeley, performed two studies: The first assessed accomplishment in 22 patients with bipolar disorder who self-identified as highly creative; the second study examined creative accomplishment and mania risk in 221 undergraduates.

The results from the first study showed that WASSUP scores, a measure of mania risk, were higher in highly creative bipolar patients (27.45) than in normative bipolar patients (14.10) and patients with no mood disorder (9.06). The second study found that mania risk and ambition were both linked to greater creativity, the authors reported.

“Findings across two studies strongly suggest that across the bipolar spectrum, ambition and creativity are linked,” Dr. Johnson and her associates wrote.

Read the full article in the Journal of Affective Disorders.

New research into bipolar I disorder (BPI) suggests the existence of an externalizing disorder subphenotype within BPI with greater severity of mood disorder and possible specific genetic features that differ from standard bipolar, according to a study published in the Journal of Affective Disorders.

Shanker Swaminathan, Ph.D., of Indiana University, Indianapolis, and his associates analyzed a cohort of 2,505 patients with bipolar I, taken from the National Institute of Mental Health (NIMH) Bipolar Disorder Genetics Initiative over 18 years and split into nonexternalizing and externalizing groups.

They noticed increased severity and frequency of mood disorder symptoms and episodes in the externalizing group, particularly in the early-onset externalizing subgroup. For example, nonsuicidal self-harm was seen in 30.2% of early-onset subjects, compared to 10% of nonexternalizing subjects (and 26% of externalizing subjects as a whole). Rapid switching was seen in 70.6% of early-onset subjects, compared to 48.6% of nonexternalizing subjects (and 62.8% of externalizing subjects as a whole), reported Dr. Swaminathan.

“In every parameter tested, subjects with externalizing disorders show evidence of greater symptomatology, earlier onset, and more impairment. This is true even when care is taken to exclude the direct effects of substances,” the authors wrote.

Read the full article here.

New research into bipolar I disorder (BPI) suggests the existence of an externalizing disorder subphenotype within BPI with greater severity of mood disorder and possible specific genetic features that differ from standard bipolar, according to a study published in the Journal of Affective Disorders.

Shanker Swaminathan, Ph.D., of Indiana University, Indianapolis, and his associates analyzed a cohort of 2,505 patients with bipolar I, taken from the National Institute of Mental Health (NIMH) Bipolar Disorder Genetics Initiative over 18 years and split into nonexternalizing and externalizing groups.

They noticed increased severity and frequency of mood disorder symptoms and episodes in the externalizing group, particularly in the early-onset externalizing subgroup. For example, nonsuicidal self-harm was seen in 30.2% of early-onset subjects, compared to 10% of nonexternalizing subjects (and 26% of externalizing subjects as a whole). Rapid switching was seen in 70.6% of early-onset subjects, compared to 48.6% of nonexternalizing subjects (and 62.8% of externalizing subjects as a whole), reported Dr. Swaminathan.

“In every parameter tested, subjects with externalizing disorders show evidence of greater symptomatology, earlier onset, and more impairment. This is true even when care is taken to exclude the direct effects of substances,” the authors wrote.

Read the full article here.

New research into bipolar I disorder (BPI) suggests the existence of an externalizing disorder subphenotype within BPI with greater severity of mood disorder and possible specific genetic features that differ from standard bipolar, according to a study published in the Journal of Affective Disorders.

Shanker Swaminathan, Ph.D., of Indiana University, Indianapolis, and his associates analyzed a cohort of 2,505 patients with bipolar I, taken from the National Institute of Mental Health (NIMH) Bipolar Disorder Genetics Initiative over 18 years and split into nonexternalizing and externalizing groups.

They noticed increased severity and frequency of mood disorder symptoms and episodes in the externalizing group, particularly in the early-onset externalizing subgroup. For example, nonsuicidal self-harm was seen in 30.2% of early-onset subjects, compared to 10% of nonexternalizing subjects (and 26% of externalizing subjects as a whole). Rapid switching was seen in 70.6% of early-onset subjects, compared to 48.6% of nonexternalizing subjects (and 62.8% of externalizing subjects as a whole), reported Dr. Swaminathan.

“In every parameter tested, subjects with externalizing disorders show evidence of greater symptomatology, earlier onset, and more impairment. This is true even when care is taken to exclude the direct effects of substances,” the authors wrote.

Read the full article here.

In a small study, five themes were identified with regard to creativity and how it is influenced by bipolar disorder, according to Sheri L. Johnson, Ph.D., and her associates.

Study participants took three tests: the Seven-up Seven-down scale, the Brief Quality of Life in Bipolar Disorder scale, and the Creative Achievement Questionnaire. After qualitative analysis, several themes emerged: the pros and cons of manic energy, benefits of altered thinking, finding a balance of medication that promotes creativity, the idea of creativity as central to the identity of a person with BD, and the importance of creativity in reducing stigma and improving treatment.

“Participants were eager to see their creativity taken into account within treatment as a way to help foster more positive communication and to combat the stigma that they all too often experience. As such, creativity appears to be a positive focus for promoting growth and wellness, and for reducing stigma,” the investigators said.

Find the full study in Qualitative Health Research (doi: 10.1177/1049732315578403).

[email protected]

In a small study, five themes were identified with regard to creativity and how it is influenced by bipolar disorder, according to Sheri L. Johnson, Ph.D., and her associates.

Study participants took three tests: the Seven-up Seven-down scale, the Brief Quality of Life in Bipolar Disorder scale, and the Creative Achievement Questionnaire. After qualitative analysis, several themes emerged: the pros and cons of manic energy, benefits of altered thinking, finding a balance of medication that promotes creativity, the idea of creativity as central to the identity of a person with BD, and the importance of creativity in reducing stigma and improving treatment.

“Participants were eager to see their creativity taken into account within treatment as a way to help foster more positive communication and to combat the stigma that they all too often experience. As such, creativity appears to be a positive focus for promoting growth and wellness, and for reducing stigma,” the investigators said.

Find the full study in Qualitative Health Research (doi: 10.1177/1049732315578403).

[email protected]

In a small study, five themes were identified with regard to creativity and how it is influenced by bipolar disorder, according to Sheri L. Johnson, Ph.D., and her associates.

Study participants took three tests: the Seven-up Seven-down scale, the Brief Quality of Life in Bipolar Disorder scale, and the Creative Achievement Questionnaire. After qualitative analysis, several themes emerged: the pros and cons of manic energy, benefits of altered thinking, finding a balance of medication that promotes creativity, the idea of creativity as central to the identity of a person with BD, and the importance of creativity in reducing stigma and improving treatment.

“Participants were eager to see their creativity taken into account within treatment as a way to help foster more positive communication and to combat the stigma that they all too often experience. As such, creativity appears to be a positive focus for promoting growth and wellness, and for reducing stigma,” the investigators said.

Find the full study in Qualitative Health Research (doi: 10.1177/1049732315578403).

[email protected]

Comorbid panic attacks and mania-associated symptoms are the most significant risk factors for manic switch during a depressive episode in bipolar patients, according to Dr. Tomihisa Niitsu and associates.

Risk factors for manic switch in any bipolar patient included younger age and recent histories of rapid cycling, severe manic symptoms, and certain pharmacological and psychotherapeutic treatments. Along with panic attacks and manic symptoms, any mood elevation during a depressive episode also indicated a risk for manic switch. During a depressive episode, the odds ratio of a switch if all three primary risk factors were present was 7.28 (95% confidence interval, 4.15-12.78; P < 0.001).

“These findings may represent useful clinical information for monitoring the risk of manic switch when treating depressive bipolar patients,” the investigators concluded.

Find the full study in the Journal of Psychiatric Research (doi: 10.1016/j.jpsychires.2015.04.014).

Comorbid panic attacks and mania-associated symptoms are the most significant risk factors for manic switch during a depressive episode in bipolar patients, according to Dr. Tomihisa Niitsu and associates.

Risk factors for manic switch in any bipolar patient included younger age and recent histories of rapid cycling, severe manic symptoms, and certain pharmacological and psychotherapeutic treatments. Along with panic attacks and manic symptoms, any mood elevation during a depressive episode also indicated a risk for manic switch. During a depressive episode, the odds ratio of a switch if all three primary risk factors were present was 7.28 (95% confidence interval, 4.15-12.78; P < 0.001).

“These findings may represent useful clinical information for monitoring the risk of manic switch when treating depressive bipolar patients,” the investigators concluded.

Find the full study in the Journal of Psychiatric Research (doi: 10.1016/j.jpsychires.2015.04.014).

Comorbid panic attacks and mania-associated symptoms are the most significant risk factors for manic switch during a depressive episode in bipolar patients, according to Dr. Tomihisa Niitsu and associates.

Risk factors for manic switch in any bipolar patient included younger age and recent histories of rapid cycling, severe manic symptoms, and certain pharmacological and psychotherapeutic treatments. Along with panic attacks and manic symptoms, any mood elevation during a depressive episode also indicated a risk for manic switch. During a depressive episode, the odds ratio of a switch if all three primary risk factors were present was 7.28 (95% confidence interval, 4.15-12.78; P < 0.001).

“These findings may represent useful clinical information for monitoring the risk of manic switch when treating depressive bipolar patients,” the investigators concluded.

Find the full study in the Journal of Psychiatric Research (doi: 10.1016/j.jpsychires.2015.04.014).

Rapid cycling bipolar disorder and migraines are independently associated with each other, a cross-sectional study shows.

“Our findings provide further evidence that comorbid migraine in [bipolar disorder] represents a more homogenous subgroup of [bipolar disorder] that may be associated with an unstable rapid cycling illness course,” wrote K. Gordon-Smith, Ph.D., and her colleagues.

The United Kingdom–based study included 1,488 individuals with lifetime clinical characteristics of bipolar disorder (BD). Of the study’s sample, 375 had comorbid migraines. Both patients with bipolar disorder I and bipolar disorder II participated in the self-report research project.

Among the study’s findings is that numerous clinical characteristics occurred significantly more often in the migraine group. Such characteristics included having a history of panic attacks, rapid cycling (defined as experiencing four or more episodes in a 12-month period), family history of affective disorders, and younger age at illness onset. The study also found that significantly more subjects in the migraine group had a lower history of psychiatric admission, and less impairment in functioning during their worst episode of (hypo)mania. The study confirmed the finding of previous research showing that bipolar patients with comorbid migraines are more likely to be female.

Further in-depth analyses of this patient population with more detailed information about the migraine phenotype is needed, the researchers said.

Read the full study in Journal of Affective Disorders (doi: 10.1016/j.jad.2015.01.024).

Rapid cycling bipolar disorder and migraines are independently associated with each other, a cross-sectional study shows.

“Our findings provide further evidence that comorbid migraine in [bipolar disorder] represents a more homogenous subgroup of [bipolar disorder] that may be associated with an unstable rapid cycling illness course,” wrote K. Gordon-Smith, Ph.D., and her colleagues.

The United Kingdom–based study included 1,488 individuals with lifetime clinical characteristics of bipolar disorder (BD). Of the study’s sample, 375 had comorbid migraines. Both patients with bipolar disorder I and bipolar disorder II participated in the self-report research project.

Among the study’s findings is that numerous clinical characteristics occurred significantly more often in the migraine group. Such characteristics included having a history of panic attacks, rapid cycling (defined as experiencing four or more episodes in a 12-month period), family history of affective disorders, and younger age at illness onset. The study also found that significantly more subjects in the migraine group had a lower history of psychiatric admission, and less impairment in functioning during their worst episode of (hypo)mania. The study confirmed the finding of previous research showing that bipolar patients with comorbid migraines are more likely to be female.

Further in-depth analyses of this patient population with more detailed information about the migraine phenotype is needed, the researchers said.

Read the full study in Journal of Affective Disorders (doi: 10.1016/j.jad.2015.01.024).

Rapid cycling bipolar disorder and migraines are independently associated with each other, a cross-sectional study shows.

“Our findings provide further evidence that comorbid migraine in [bipolar disorder] represents a more homogenous subgroup of [bipolar disorder] that may be associated with an unstable rapid cycling illness course,” wrote K. Gordon-Smith, Ph.D., and her colleagues.

The United Kingdom–based study included 1,488 individuals with lifetime clinical characteristics of bipolar disorder (BD). Of the study’s sample, 375 had comorbid migraines. Both patients with bipolar disorder I and bipolar disorder II participated in the self-report research project.

Among the study’s findings is that numerous clinical characteristics occurred significantly more often in the migraine group. Such characteristics included having a history of panic attacks, rapid cycling (defined as experiencing four or more episodes in a 12-month period), family history of affective disorders, and younger age at illness onset. The study also found that significantly more subjects in the migraine group had a lower history of psychiatric admission, and less impairment in functioning during their worst episode of (hypo)mania. The study confirmed the finding of previous research showing that bipolar patients with comorbid migraines are more likely to be female.

Further in-depth analyses of this patient population with more detailed information about the migraine phenotype is needed, the researchers said.

Read the full study in Journal of Affective Disorders (doi: 10.1016/j.jad.2015.01.024).

Patients with bipolar disorder I have increased verbal learning impairment compared with those who have bipolar II, according to Corin Bourne, D.Phil., and associates.

The investigators looked at the performance of 183 bipolar I (BDI) patients with 96 bipolar II (BDII) outpatients on a modified version of the Rey Verbal Learning Task. They found that VLT scores were significantly lower in bipolar I patients, with effect sizes ranging from 0.13 to 0.17. Drug treatment and other illnesses were unrelated to the impairment, but age of onset affected outcomes in three of the five measured categories, and mood elevation incidence affected one measured category.

“Initially, both bipolar subtypes may have similar levels of verbal learning and memory performance” but BDI patients suffered steeper declines, noted Dr. Bourne of the department of psychiatry at the University of Oxford (England) and Warneford Hospital in Oxford.

Find the full study in the Journal of Affective Disorders (doi: 10.1016/j.jad.2015.04.021).

Patients with bipolar disorder I have increased verbal learning impairment compared with those who have bipolar II, according to Corin Bourne, D.Phil., and associates.

The investigators looked at the performance of 183 bipolar I (BDI) patients with 96 bipolar II (BDII) outpatients on a modified version of the Rey Verbal Learning Task. They found that VLT scores were significantly lower in bipolar I patients, with effect sizes ranging from 0.13 to 0.17. Drug treatment and other illnesses were unrelated to the impairment, but age of onset affected outcomes in three of the five measured categories, and mood elevation incidence affected one measured category.

“Initially, both bipolar subtypes may have similar levels of verbal learning and memory performance” but BDI patients suffered steeper declines, noted Dr. Bourne of the department of psychiatry at the University of Oxford (England) and Warneford Hospital in Oxford.

Find the full study in the Journal of Affective Disorders (doi: 10.1016/j.jad.2015.04.021).

Patients with bipolar disorder I have increased verbal learning impairment compared with those who have bipolar II, according to Corin Bourne, D.Phil., and associates.

The investigators looked at the performance of 183 bipolar I (BDI) patients with 96 bipolar II (BDII) outpatients on a modified version of the Rey Verbal Learning Task. They found that VLT scores were significantly lower in bipolar I patients, with effect sizes ranging from 0.13 to 0.17. Drug treatment and other illnesses were unrelated to the impairment, but age of onset affected outcomes in three of the five measured categories, and mood elevation incidence affected one measured category.

“Initially, both bipolar subtypes may have similar levels of verbal learning and memory performance” but BDI patients suffered steeper declines, noted Dr. Bourne of the department of psychiatry at the University of Oxford (England) and Warneford Hospital in Oxford.

Find the full study in the Journal of Affective Disorders (doi: 10.1016/j.jad.2015.04.021).

The Workplace Bipolar Inventory, a 39-item questionnaire used to screen for bipolar disorder in the workplace, showed promise in a small study, according to Kotaro Imamura, Ph.D., and his associates.

The investigator asked workers who were on sick leave because of mental health problems to complete the Workplace Bipolar Inventory (WBI), the Mood Disorder Questionnaire, and the Bipolar Spectrum Diagnostic Scale. A subscale of the WBI called the WBI-AB4 proved to have the screening performance that was most informative.

“According to the optimal cut-off point, WBI-AB4 would be useful for occupational mental health staffs to screen out bipolarity among workers who have depressive symptoms at the workplace; however, more information of the suspected subjects about the manic/hypomanic episode from their supervisor, colleagues, or family was needed,” reported Dr. Imamura of the department of mental health at the University of Tokyo, and his associates.

Find the full study in the Journal of Affective Disorders (doi:10.1016/j.jad.2015.02.034).

The Workplace Bipolar Inventory, a 39-item questionnaire used to screen for bipolar disorder in the workplace, showed promise in a small study, according to Kotaro Imamura, Ph.D., and his associates.

The investigator asked workers who were on sick leave because of mental health problems to complete the Workplace Bipolar Inventory (WBI), the Mood Disorder Questionnaire, and the Bipolar Spectrum Diagnostic Scale. A subscale of the WBI called the WBI-AB4 proved to have the screening performance that was most informative.

“According to the optimal cut-off point, WBI-AB4 would be useful for occupational mental health staffs to screen out bipolarity among workers who have depressive symptoms at the workplace; however, more information of the suspected subjects about the manic/hypomanic episode from their supervisor, colleagues, or family was needed,” reported Dr. Imamura of the department of mental health at the University of Tokyo, and his associates.

Find the full study in the Journal of Affective Disorders (doi:10.1016/j.jad.2015.02.034).

The Workplace Bipolar Inventory, a 39-item questionnaire used to screen for bipolar disorder in the workplace, showed promise in a small study, according to Kotaro Imamura, Ph.D., and his associates.

The investigator asked workers who were on sick leave because of mental health problems to complete the Workplace Bipolar Inventory (WBI), the Mood Disorder Questionnaire, and the Bipolar Spectrum Diagnostic Scale. A subscale of the WBI called the WBI-AB4 proved to have the screening performance that was most informative.

“According to the optimal cut-off point, WBI-AB4 would be useful for occupational mental health staffs to screen out bipolarity among workers who have depressive symptoms at the workplace; however, more information of the suspected subjects about the manic/hypomanic episode from their supervisor, colleagues, or family was needed,” reported Dr. Imamura of the department of mental health at the University of Tokyo, and his associates.

Find the full study in the Journal of Affective Disorders (doi:10.1016/j.jad.2015.02.034).