International Journal of Bipolar Disorders最新文献

Background: The postpartum period is associated with a high risk of illness episodes in women with bipolar disorder (BD) and is a critical developmental phase for both a new mother and her infant. This mixed-methods study aimed to investigate the occurrence of mood symptoms among infant mothers with BD in the first year postpartum, as well as their perceptions of the first year, their challenges and their strategies for wellbeing.

Methods: Twenty-six women with BD participated. Mood symptoms were assessed at 3 and 12 months postpartum with the Inventory of Depressive Symptomatology and Young Mania Rating Scale. Occurrences of additional postpartum mood deviations were investigated through an interview at 12 months, which also covered the women's postpartum experiences. Thematic analysis was applied to the qualitative dataset (interviews and field notes).

Results: 42% of the women were euthymic or had only mild mood symptoms at 3 and 12 months. 58% had moderate to severe symptoms at either or both time points. A positive (38%) vs. mixed (62%) perception of the first year was strongly associated with euthymia-mild vs. moderate-severe mood deviations, as was the experience of maternal developmental achievement vs. struggles. The women experienced postpartum mood deviations and illness episodes as being particularly poorly timed. Further challenges included balancing self-care and infant mothering, familial relations, and negative experiences with the health and care systems. Illness acceptance with mindfulness of one's own and the infant's needs was a primary strategy for wellbeing, which was complemented by the support of one's partner and family and postpartum treatment.

Conclusions: Our findings propose that without impeding mood deviations and concomitant challenges, infant mothers with BD can enjoy their new motherhood and experience phase-specific growth equally to healthy mothers. On the other hand, moderate to severe mood deviations can adversely impact the experience of the postpartum year and one's own sense of mothering. Efforts to prevent postpartum mood deviations need to be complemented with interventions that target phase-specific BD challenges and support wellbeing strategies for both the mother and her infant. In summary, women's needs to function as infant mothers must be considered in the postpartum treatment of BD.

Background: Little is known about the effect of ethnicity on drug treatment in patients with an acute manic episode. The aim of this study is to determine whether ethnicity moderates the response to drug treatment in patients with an acute manic episode, and whether this moderation is independent of potential confounders.

Methods: We analysed ten short-term placebo-controlled registration trials of atypical antipsychotics and anticonvulsive mood stabilizers in patients with an acute manic episode (n = 2199). A one-step random effects individual patient data meta-analysis (IPD) was applied to establish the moderating effect of ethnicity on symptom improvement on the Young Mania Rating Scale (Y)MRS and on response defined as 50% (Y)MRS symptom reduction. These analyses were corrected for baseline severity, age, and gender. A two-step IPD comparing these outcomes between White, Black and Asian patients. Additionally, a conventional meta-analysis was performed to determine the effect size of drug treatment separately for these ethnic groups.

Results: In the complete dataset, 60.4% of the patients was White, 8.0% was Black, 12.7% was Asian, 33.7% was of other ethnicities. Ethnicity did not significantly moderate the efficacy of drug treatment: pooled beta-coefficient (β) for the interaction between treatment and the ethnicities White, Black and Asian, varying from 0.889 to 0.899 with overlapping confidence-intervals ranging from 2.356 to 2.430 in the main analysis. The drug treatment effects were significant in all three analysable ethnicity groups compared to placebo.

Discussion: In White,Black, and Asian patients with an acute manic episode drug treatment is equally effective.

Background: Improving quality of life (QoL) is important for the treatment of people with bipolar disorder (BD). Early-BipoLife is a German multicentre naturalistic, prospective-longitudinal observational cohort study investigating early recognition and intervention in people at increased risk of developing a BD. This analysis aims to investigate influencing factors and changes in QoL as a basis for the development of early intervention strategies in patients with at risk syndrome for BD.

Method: A cohort of 1086 participants (15-35 years) with at least one risk factor (EPIbipolar criteria) for BD was assessed over the course of 2 years. Changes in QoL (WHOQOL-BREF) were evaluated in a mixed model for repeated measures.

Results: Compared to an age-matched comparison group, people at risk for BD showed significant lower QoL in all domains at baseline. The overall QoL of the psychological well-being domain of the WHOQOL-BREF increased over the 2 year study course (p < 0.001). The bipolar risk group (EPIbipolar) change from baseline divided into (a) decreasing, (b) increasing and (c) constant risk group in the course of 2 years. Baseline risk group assignment was not a significant predictor of change in QoL over 2 years for any of the QoL domains, but participants with an increase in risk over the 2-year course had a significantly smaller gain in QoL than the group with constant risk (p = 0.014) or decreasing risk (p < 0.001). Higher levels of QoL were associated with a higher self-rated ability to use coping strategies. Moreover, a higher level of functioning (GAF) at baseline was positively correlated with improvement of different QoL domains after 2 years.

Conclusion: Patients with a risk syndrome for BD reported significantly reduced QoL compared to their age-matched comparison group. Risk status monitoring might be beneficial to identify individuals who could profit from an intervention to increase their QoL. Further studies promoting the development of coping strategies for successful self-management could be helpful to improve overall mental health and positively influence QoL.

Background: Little attention has been paid to the generalizability of cohort studies in bipolar disorder (BD) to patient with BD in everyday clinical practice.

Methods: A sample of patients with bipolar I disorder (BD-I) treated at a Dutch outpatient clinic for BD were compared with Dutch participants with BD-I of four clinical cohort studies, and participants with BD-I in a general population study in the Netherlands, on sociodemographic and clinical characteristics.

Results: On many variables participants from the outpatient sample matched with those of the included studies. However, compared with participants of several of the clinical cohort studies, these outpatients were significantly younger, had an earlier age of onset of mood symptoms, and had a shorter duration of illness. Compared with participants in the general population study, outpatients had significant higher levels of education and less often lived together or were married. One cohort study reported much lower comorbidity rates of alcohol use disorders, drug use disorders, and anxiety disorders than in the outpatient sample. In contrast, comorbidity rates were higher in the population study.

Limitations: Due to methodological differences between studies, comparisons between several variables was limited, and for some variables data was lacking.

Conclusions: Our findings suggest that many findings from cohort studies and general population study in BD-I are generalizable to everyday clinical practice, especially mood disorder outpatient centers. However, differences between samples indicate some selection and referral bias.

Objectives: To study the prospects for lithium treated patients who develop end stage renal disease (ESRD) and the role of renal replacement therapy (RRT).

Methods: Retrospective analysis of survival, somatic comorbidity, lithium treatment and eligibility for renal replacement therapy in adult patients with at least one eGFR < 30 ml/min/1.73 m². Subjects were selected from our laboratory database (s-Lithium and s-creatinine) from 1980 to 2017.

Results: 620 (14%) of 4396 patients with a lithium history had at least one measurement of eGFR < 30 ml/min/1.73 m². 302 (49%) patients had a transient decrease in renal function with subsequent improvement, 135 (22%) patients died with acute renal failure, while 153 (25%) developed chronic kidney disease stage 4 (CKD4) and 33 (5%) required RRT. RRT-treated patients represent only a fraction of the total ESRD population. Median survival time from the debut of CKD4 was 13.9 years in patients < 65 years and 4.4 years in older patients. 100 of the 153 patients with CKD4 continued lithium treatment. There was no significant difference in survival after the debut of CKD4 between the patients who stopped lithium treatment and those who continued.

Conclusions: A measurement of eGFR < 30 ml/min/1.73 m² reflects a significant loss of renal function. In half of the patients it was due to a transient functional disturbance without long-term consequences. A quarter of patients had acute renal failure and died within days while the remaining quarter progressed to CKD4. Despite irreversible renal damage, patient survival can be counted in several years after debut of renal insufficiency with appropriate care including RRT. As the treating psychiatrist, it is important to consult with nephrology when renal function starts to deteriorate, to optimise somatic treatment.

Background: Approximately half of people with bipolar disorder type I (BD-I) report the presence of psychotic symptoms at least at some point during their illness. Previous data suggest that more than 20% of people with BD-I report the presence of auditory verbal hallucinations (AVHs), or "voice-hearing" in particular. While work in other disorders with psychotic features (e.g., schizophrenia) indicates that the presence vs. absence of AVHs is associated with poorer clinical outcomes, little is known about their effects on clinical and socioeconomic features in BD-I.

Methods: We investigated whether people with BD-I (N = 119) with AVHs (n = 36) and without AVHs (n = 83) in their lifetime differ in terms of demographic features and clinical measures. Relations with AVHs and other positive symptoms were explored.

Results: People with BD-I and AVHs vs. without AVHs had higher manic and positive symptom scores (i.e., higher scores on the hallucinations, delusions, and bizarre behavior subscales). Further, a greater proportion of those with vs. without AVHs reported lower subjective socioeconomic status and tended to have higher rates of unemployment, thus, speaking to the longer-term consequences of AVH presence.

Conclusion: Our findings suggest that people with BD-I with AVHs exhibit more severe psychotic features and manic symptoms compared to those without. This might be associated with more socioeconomic hardship. More in-depth characterization of people with BD-I with/without AVHs is needed to fully understand this subgroup's unique challenges and needs.

Limitations: The modest sample size of the AVH group and a study population with low racial diversity/representation may limit generalizability.

Background: Global pharmacoepidemiological evidence suggests dynamically changing prescription patterns in patients with bipolar disorders. We assessed trends in the use of pharmacological agents used in the management of bipolar disorders in inpatients.

Methods: We examined drug use data provided by the Drug Safety in Psychiatry Programme AMSP (German: "Arzneimittelsicherheit in der Psychiatrie"), including psychiatric hospitals in Germany, Austria and Switzerland. We included data from adult inpatients with bipolar disorders (ICD-10: F31) treated between 1994 and 2017. We compared prescription patterns between patients receiving therapeutic regimens with vs. without lithium. Patients with manic and depressive episodes were also analyzed separately.

Results: We identified a total of 8,707 patients (58% females, mean age 50.8 ± 14.8 years). Our analysis revealed a decrease of lithium use (up to 2004) and a consistent increase of prescription rates for second-generation antipsychotics (SGA) among which quetiapine (n = 2,677) and olanzapine (n = 1,536) were the most common. Among psychotropic drugs, quetiapine was most frequently combined with lithium (n = 716, 25.6%). Lithium-treated patients received a higher number of drugs compared to patients not receiving lithium (mean number of drugs in patients with vs. without lithium 4.99, n = 2,796 vs. 4.75, n = 5,911, p = 0.002). Thyroid therapeutics were given more often, valproate and quetiapine less often in the lithium group. Antidepressants were consistently prescribed to more than 60% of patients with bipolar depressive episodes.

Conclusions: Our findings suggest that SGAs are gradually becoming the mainstay treatment option in bipolar disorder, continuously replacing lithium. The use of antidepressants remains concerningly high. We call for action to improve adherence to evidence-based guidelines.

Background: A surrogate marker (a substitute indicator of the true outcome) is needed to predict subgroups of long-term lithium users at risk of end-stage kidney disease (ESKD). In this narrative review the aim is to determine the optimal surrogate endpoint for ESKD in long-term lithium users in a scientific context. MAIN: In a literature search in long-term lithium users, no studies on surrogate measurements on ESKD were identified. Therefore, comparable ESKD populations were sought, based on baseline eGFR, age, somatic comorbidity and sex. Articles were scored on comparability and risk of bias. Seventeen studies were included; ten studies evaluated a percentual decline (between 20 and 50% decline in eGFR) and seven studies focused upon a declining slope (from 1.63 to 6 ml/min/1,73m² decline per year), using an interval of one to five years. Study populations mostly included patients with cardiovascular disease and chronic kidney disease.

Conclusion: Currently, the most appropriate marker for ESKD in long term lithium users appears a 30% decline in eGFR in at least one year. In order to confirm this hypothesis, further research in a cohort of long-term lithium users is needed. Better feasible research on lithium induced nephropathy could result in more knowledge about the risk on kidney function decline in lithium users and guide clinical decision making on lithium use.

Background: Patients with bipolar disorder (BD) are at increased risk of dementia. The underlying mechanisms are debated. FDG-PET elucidates glucose metabolic reductions due to altered neuronal activity in the cerebral cortex, allowing detection and identification of neurodegenerative processes. This study aims to investigate cerebral glucose metabolism in cognitively impaired elderly patients with BD using FDG-PET imaging, to elucidate potential underlying mechanisms and improve diagnostic accuracy.

Methods: We conducted a retrospective analysis of FDG-PET scans from 32 cognitively impaired elderly patients with BD (mean age 70.4 years). These were compared with scans from 35 non-degenerative controls (NDC) and patients diagnosed with Alzheimer's disease (AD, n = 27), frontotemporal dementia (FTD, n = 26), and dementia with Lewy bodies (DLB, n = 18). Voxel-wise statistical analysis was performed using SPM software, adjusting for age and sex.

Results: No significant cortical hypometabolism was found in patients with BD compared to NDC. In contrast, typical patterns of hypometabolism were observed in the AD, FTD, and DLB groups. The findings suggest that late-life cognitive impairment in patients with BD is not due to a single common neurodegenerative process.

Conclusion: The absence of abnormal cortical metabolism in cognitively impaired elderly patients with BD suggests that cognitive impairment in this population may not be driven by a common neurodegenerative pathway. Further studies using other biomarkers are needed to investigate the brain processes involved, which could lead to improved understanding and management of cognitive impairment in patients with BD.