scholarly journals Prophylaxis Latency and Outcome in Bipolar Disorders

2003 ◽  
Vol 48 (7) ◽  
pp. 449-457 ◽  
Author(s):  
Christopher Baethge ◽  
Leonardo Tondo ◽  
Irene M Bratti ◽  
Tom Bschor ◽  
Michael Bauer ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Treatment Response ◽  
Prophylactic Treatment ◽  
Bipolar Disorders ◽  
Mood Stabilizer ◽  
Adult Patients ◽  
Apparent Reduction

Objective: To analyze new and reviewed findings to evaluate relations between treatment response and latency from onset of bipolar disorder (BD) to the start of mood-stabilizer prophylaxis. Method: We analyzed our own new data and added findings from research reports identified by computerized searching. Results: We found 11 relevant studies, involving 1485 adult patients diagnosed primarily with BD. Reported latency to prophylaxis averaged 9.6 years (SD 1.3), and follow-up in treatment averaged 5.4 years (SD 3.1). Greater illness intensity and shorter treatment latency were closely associated, resulting in a greater apparent reduction in morbidity with earlier treatment. However, this finding was not sustained after correction for pretreatment morbidity, and treatment latency did not predict morbidity during treatment. Therefore, assessments based on improvement with treatment, or without correction for pretreatment morbidity, can be misleading. Conclusions: Available evidence does not support the proposal that delayed prophylaxis may limit response to prophylactic treatment in BD and related disorders.

A preliminary study of group therapy intervention for bipolar disorder based on the integrative cognitive model

2020 ◽  
Vol 13 ◽  
Author(s):  
Zeynep Maçkalı ◽  
Gülin Güneri ◽  
Arın Korkmaz ◽  
Sibel Çakır
Keyword(s):  
Bipolar Disorder ◽  
Group Therapy ◽  
Cognitive Model ◽  
Bipolar Disorders ◽  
Satisfaction With Life Scale ◽  
Post Test ◽  
Self Acceptance ◽  
Therapy Intervention ◽  
Group Cbt

Abstract The main aim of this research was to investigate the effect of the 8-week group therapy intervention based on the integrative cognitive model (ICM) of bipolar disorder. The sample was composed of 10 patients with bipolar I and bipolar II diagnoses. The group sessions were held once a week for 1.5 hours. For the quantitative measures, the group participants were assessed during pre-test, post-test and 3-month follow-up using the Turkish versions of the Beck Depression Inventory, the Hypomanic Attitudes and Positive Predictions Inventory, the Psychological Well-being Scale and the Satisfaction with Life Scale. Quantitative analyses revealed that a reliable change was seen only in pre-test and post-test depression scores. However, this change could not be maintained at 3-month follow-up. For the qualitative analyses, data collected during semi-structured interviews were used. The thematic analyses results showed that the 8-week ICM-based group therapy was found to help participants make sound observations about their behaviors, decrease their feelings of loneliness and increase self-acceptance, and acceptance of the role of mood swings in their lives. Moreover, the results showed that participants found the following activities very beneficial: describing their emotions, evaluating the intensity of their emotions, identifying their life goals, coping with interpersonal conflicts, evaluating resources and going over strengths. In conclusion, the 8-week ICM-based group therapy had a positive impact on participants’ self-awareness, self-acceptance and self-perception. Key learning aims (1) To learn more about the integrative cognitive model and how it has been reconceptualized for group-based intervention. (2) To understand the structure and content of group CBT protocol for bipolar disorders based on the integrative cognitive model. (3) To consider possible advantages of group CBT for bipolar disorders during the recovery process.

scholarly journals DNA Methylation as a Biomarker of Treatment Response Variability in Serious Mental Illnesses: A Systematic Review Focused on Bipolar Disorder, Schizophrenia, and Major Depressive Disorder

2018 ◽  
Vol 19 (10) ◽  
pp. 3026 ◽  
Author(s):  
Charanraj Goud Alladi ◽  
Bruno Etain ◽  
Frank Bellivier ◽  
Cynthia Marie-Claire
Keyword(s):  
Dna Methylation ◽  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Treatment Response ◽  
Bipolar Disorders ◽  
Mental Illnesses ◽  
Mood Stabilizers ◽  
Major Depressive ◽  
Meta Analyses

So far, genetic studies of treatment response in schizophrenia, bipolar disorder, and major depression have returned results with limited clinical utility. A gene × environment interplay has been proposed as a factor influencing not only pathophysiology but also the treatment response. Therefore, epigenetics has emerged as a major field of research to study the treatment of these three disorders. Among the epigenetic marks that can modify gene expression, DNA methylation is the best studied. We performed a systematic search (PubMed) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA guidelines for preclinical and clinical studies focused on genome-wide and gene-specific DNA methylation in the context of schizophrenia, bipolar disorders, and major depressive disorder. Out of the 112 studies initially identified, we selected 31 studies among them, with an emphasis on responses to the gold standard treatments in each disorder. Modulations of DNA methylation levels at specific CpG sites have been documented for all classes of treatments (antipsychotics, mood stabilizers, and antidepressants). The heterogeneity of the models and methodologies used complicate the interpretation of results. Although few studies in each disorder have assessed the potential of DNA methylation as biomarkers of treatment response, data support this hypothesis for antipsychotics, mood stabilizers and antidepressants.

scholarly journals Neuroprotective effect of lithium on hippocampal volumes in bipolar disorder independent of long-term treatment response

2013 ◽  
Vol 44 (3) ◽  
pp. 507-517 ◽  
Author(s):  
T. Hajek ◽  
M. Bauer ◽  
C. Simhandl ◽  
J. Rybakowski ◽  
C. O'Donovan ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Treatment Response ◽  
Brain Structure ◽  
Neuroprotective Effect ◽  
Mood Stabilizer ◽  
Term Treatment ◽  
Healthy Controls ◽  
Neuroprotective Effects ◽  
Long Term Treatment

BackgroundNeuroimaging studies have demonstrated an association between lithium (Li) treatment and brain structure in human subjects. A crucial unresolved question is whether this association reflects direct neurochemical effects of Li or indirect effects secondary to treatment or prevention of episodes of bipolar disorder (BD).MethodTo address this knowledge gap, we compared manually traced hippocampal volumes in 37 BD patients with at least 2 years of Li treatment (Li group), 19 BD patients with <3 months of lifetime Li exposure over 2 years ago (non-Li group) and 50 healthy controls. All BD participants were followed prospectively and had at least 10 years of illness and a minimum of five episodes. We established illness course and long-term treatment response to Li using National Institute of Mental Health (NIMH) life charts.ResultsThe non-Li group had smaller hippocampal volumes than the controls or the Li group (F2,102 = 4.97, p = 0.009). However, the time spent in a mood episode on the current mood stabilizer was more than three times longer in the Li than in the non-Li group (t51 = 2.00, p = 0.05). Even Li-treated patients with BD episodes while on Li had hippocampal volumes comparable to healthy controls and significantly larger than non-Li patients (t43 = 2.62, corrected p = 0.02).ConclusionsOur findings support the neuroprotective effects of Li. The association between Li treatment and hippocampal volume seems to be independent of long-term treatment response and occurred even in subjects with episodes of BD while on Li. Consequently, these effects of Li on brain structure may generalize to patients with neuropsychiatric illnesses other than BD.

The Use of Topiramate in Mood Stabilization

2002 ◽  
Vol 36 (7-8) ◽  
pp. 1277-1281 ◽  
Author(s):  
Ian D Maidment
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Disorders ◽  
Mood Stabilizer ◽  
Mood Stabilizers ◽  
Double Blind ◽  
Data Synthesis ◽  
Complex Disorder ◽  
Search Terms ◽  
Clinical Literature ◽  
Mood Stabilization

OBJECTIVE: To review data on the effectiveness of topiramate as a mood stabilizer. DATA SOURCES: Clinical literature accessed through MEDLINE (1985–September 2001) and the manufacturer. Key search terms included topiramate, mania, mood stabilizer, and bipolar disorder. DATA SYNTHESIS: The traditional standard therapy for bipolar disorder has been lithium. Other mood stabilizers are increasingly being used to manage this complex disorder. Studies that used topiramate in bipolar disorders were evaluated. CONCLUSIONS: The present data from open trials suggest that topiramate may possibly possess antimanic properties. Controlled, double-blind studies are required to confirm this efficacy.

Mood Stabilizer Monotherapy versus Adjunctive Antidepressant for Bipolar Depression

2018 ◽  
Author(s):  
João Paulo De Aquino ◽  
Robert Beech
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Mood Stabilizer ◽  
Current Evidence ◽  
Clinical Implications ◽  
Clinical Question ◽  
Stabilizing Agents ◽  
Study Intervention ◽  
Landmark Study

This chapter provides a summary of a landmark study on bipolar disorder, which aims to address the following question: In patients with bipolar disorder receiving mood-stabilizing agents, does adjunctive antidepressant therapy reduce the symptoms of bipolar depression without increasing the risk for mania? Starting with that question, the chapter describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints and results, in addition criticisms and limitations. Subsequently, other relevant studies are briefly reviewed and their clinical implications are discussed. Finally, a relevant clinical exemplifies the application of the current evidence behind the clinical question addressed by the study.

Bipolar Disorder and Outcomes of Monotherapy with Lithium, Valproate, Quetiapine, Olanzapine, Venlafaxine, and Citalopram

2021 ◽  
Author(s):  
Jens Bohlken ◽  
Steffi Riedel-Heller ◽  
Michael Bauer ◽  
Karel Kostev
Keyword(s):  
Bipolar Disorder ◽  
Retrospective Study ◽  
Treatment Failure ◽  
Maintenance Treatment ◽  
Bipolar Disorders ◽  
Mood Stabilizer ◽  
Hazard Ratio ◽  
Bipolar Patients

Abstract Introduction The aim of this study was to compare the outcomes of monotherapy in individuals with bipolar disorder who are prescribed lithium, valproate, quetiapine, olanzapine, venlafaxine, or citalopram in private psychiatric practices in Germany. Methods This retrospective study included bipolar disorder patients who had initially started on a monotherapy with lithium, valproate, quetiapine, olanzapine, venlafaxine, or citalopram in 93 private neuropsychiatric practices in Germany between January 2006 and December 2017. Treatment failure was defined as time to discontinuation of medication or addition of another mood stabilizer, antipsychotic, antidepressant, or benzodiazepine. Results A total of 4990 bipolar patients was examined for the period between 2006 and 2019. Initially, monotherapy with lithium (n=1.098), valproate (n=502), quetiapine (n=927), olanzapine (n=927), venlafaxine (n=574), or citalopram (n=962) was prescribed. Within 24 months, treatment failure had occurred in 76.3% (lithium), 85.1% (valproate), 84.6% (quetiapine), 85.2% (venlafaxine), 92.1% (olanzapine), and 86.6% (citalopram) of patients, respectively. The hazard ratio for treatment failure compared to lithium as reference was highest for olanzapine at 1.66 (1.46–1.88), followed by citalopram 1.27 (1.15–1.39), quetiapine 1.18 (1.07–1.29), valproate 1.18 (1.06–1.33), and venlafaxine 1.14 (1.02–1.27). Conclusions Our results underline the importance of lithium in the maintenance treatment of bipolar disorders.

Impact of cognitive-psychoeducational interventions in bipolar patients and their relatives

2006 ◽  
Vol 21 (2) ◽  
pp. 81-86 ◽  
Author(s):  
Britta Bernhard ◽  
Annette Schaub ◽  
Petra Kümmler ◽  
Sandra Dittmann ◽  
Emanuel Severus ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Group Intervention ◽  
Bipolar Disorders ◽  
Warning Signs ◽  
Psychoeducational Group ◽  
Before And After ◽  
Expressed Emotions ◽  
Bipolar Patients ◽  
Psychoeducational Interventions

AbstractBackground.In recent years, several controlled studies could show that psychoeducational interventions have been effective for relapse prevention in bipolar disorders. We therefore established a cognitive-psychoeducational group intervention with 14 sessions providing information about the illness, early warning signs, cognitive and behavioural strategies for stress management and social rhythm. Additionally we offered a group intervention for the patients' relatives. The objective of this study was to describe the outcome associated with our psychoeducational intervention in bipolar patients and their relatives.Methods.Sixty-two bipolar patients attended 14 sessions (à 90 min) of cognitive-psychoeducational group therapy. Patients' knowledge of bipolar disorder and their satisfaction with the treatment were assessed using self-developed questionnaires before and after the group intervention. Additionally, 49 relatives of bipolar patients received two psychoeducational workshops of 4 hours each. We assessed demographic variables, burden, high expressed emotion and depressive symptoms of the relatives before and after the two workshops and at 1-year follow-up.Results.Patients significantly improved their knowledge of bipolar disorder. They also have benefited from the discussions and the exchange of useful coping strategies. Burden and high expressed emotions showed no significant reductions at post-assessment, however they were significantly reduced at 1-year follow-up. Relatives also felt significantly better informed about the illness.Conclusions.These findings show that psychoeducational interventions in bipolar patients and their relatives improve patients' and their relatives' knowledge of the illness and the burden of the disorder as well as high expressed emotions are reduced in relatives at 1-year follow-up.

scholarly journals The use of pharmacogenetic testing in patients with schizophrenia or bipolar disorder: A systematic review

2018 ◽  
Vol 8 (6) ◽  
pp. 294-302 ◽  
Author(s):  
Melanie Routhieaux ◽  
Jessica Keels ◽  
Erika E. Tillery
Keyword(s):  
Systematic Review ◽  
Bipolar Disorder ◽  
Mental Illness ◽  
Mood Stabilizer ◽  
Adult Patients ◽  
Mood Stabilizers ◽  
Response To Treatment ◽  
Pharmacogenetic Testing ◽  
Disease Predisposition ◽  
Therapeutic Recommendations

Abstract Introduction: Pharmacogenetic testing may assist in identifying an individual's risk of developing a mental illness as well as predict an individual's response to treatment. The objective of this study is to report published outcomes of pharmacogenetic testing in patients with schizophrenia or bipolar disorder. Methods: A systematic review using PubMed and EBSCOhost through April 2017 was performed to identify articles that reported pharmacogenetic testing in adult patients with either bipolar disorder or schizophrenia using the keywords pharmacy, pharmacogenomics, pharmacogenetics, psychiatry, bipolar disorder, schizophrenia, mood stabilizer, and antipsychotic. Results: A total of 18 articles were included in the final literature review. A wide variety of genes amongst adult patients with varying ethnicities were found to be correlated with the development of schizophrenia or bipolar disorder as well as response to antipsychotics and mood stabilizers. Discussion: While current studies show a correlation between genetic variations and medication response or disease predisposition for patients with schizophrenia and bipolar disorder, research is unclear on the type of therapeutic recommendations that should occur based on the results of the pharmacogenetic testing. Hopefully interpreting pharmacogenetic results will one day assist with optimizing medication recommendations for individuals with schizophrenia and bipolar disorder.

scholarly journals Are rating scales for bipolar disorders fit for purpose?

2018 ◽  
Vol 213 (5) ◽  
pp. 627-629
Author(s):  
Jan Scott ◽  
Greg Murray
Keyword(s):  
Bipolar Disorder ◽  
Treatment Response ◽  
Rating Scales ◽  
Sleep Problems ◽  
Bipolar Depression ◽  
Bipolar Disorders ◽  
Icd 10 ◽  
Research Consortium ◽  
The Uk ◽  
Cardinal Symptom

The DSM-5 definition of bipolar disorder elevates increased activity or energy as a cardinal symptom (alongside mood changes) for mania and hypomania (‘hypo/mania’). The ICD-10 likewise requires increases in activity and energy (alongside mood) for hypo/mania, as well as decreases for bipolar depression. Using bipolar disorder as an example, we propose that, when diagnostic criteria are revised, instruments used to measure clinical course and treatment response may need revisiting. Here, we highlight that the ‘gold-standard’ symptom rating scales for hypo/mania and depression were developed in an era when abnormalities of mood were viewed as the cardinal symptom of bipolar disorder. We contend that archetypal measures fail to give proportionate weighting to activity or energy, undermining their utility in monitoring bipolar disorder and treatment response in clinical and research practice.Declarations of interestJ.S. and G.M. are members of mMARCH, (Motor Activity Research Consortium for Health), which is led by Dr Kathleen Merikangas, National Institute for Mental Health. J.S. reports being a visiting professor at Diderot University, the Norwegian University of Science and Technology, Swinburne University of Technology and The University of Sydney; receiving grant funding from the UK Medical Research Council and from the UK Research for Patient Benefit programme; and receiving a personal fee from Janssen-Cilag for a non-promotional talk on sleep problems.

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