Diagnostic Features, Prevalence, and Impact of Bipolar Disorder
ABSTRACT Bipolar disorder shares depressive symptoms with unipolar major depressive disorder but is defined by episodes of mania or hypomania. Bipolar disorder in its broadest sense has a community lifetime prevalence of 4% and is a severely impairing illness that impacts several aspects of patients' lives. Race, ethnicity, and gender have no effect on prevalence rates, but women are more likely to experience rapid cycling, mixed states, depressive episodes, and bipolar II disorder than men. Patients with bipolar disorder have high rates of disability and higher rates of mortality than individuals without bipolar disorder. Natural causes such as cardiovascular disease and diabetes, as well as suicide and other "unnatural" causes are key contributors to the high mortality rate. The costs associated with bipolar disorder include not only the direct costs of treatment, but also the much greater indirect costs of decreased productivity, excess unemployment, and excess mortality.
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ABSTRACT: Objective Individuals with bipolar disorder (BD) usually report significant disability and psychosocial impairment. Both the nature and causes associated with this impairment are poorly understood. In particular, research examining the impact of pharmacotherapy on the different aspects of psychosocial functioning in bipolar patients is currently lacking. The aim of this study was to assess to what extent the psychotropic medications used during psychiatric hospitalization and at discharge can predict clinical psychosocial functioning and the severity of the illness at follow-up in inpatients with bipolar disorder (BD).Methods Patients were 71 adult BD patients contacted on average 31 months after discharge who completed at the follow-up a telephone interview based on the Health of the Nation Outcome Scales (HoNOS).ResultsAll the subjects completed the follow-up assessment between 5 and 75 months after discharge. The mean raw score for the HoNOS-6 was 5.70 ± 5.37. Patients with more severe behavior problems more often had been prescribed atypical antipsychotics and anticonvulsants at discharge. Patients with more severe psychosocial functioning problems more often had a history of suicide attempts, and were more often prescribed anxiolytics during hospitalization and less often prescribed lithium at discharge.Conclusions Having been prescribed anxiolytics and atypical antipsychotics during hospitalization predicted reduced psychosocial functioning, whereas prescription of lithium at discharge was associated with better psychosocial functioning at follow-up. Future studies are needed in order to investigate how psychosocial functioning may be related in the long-term to pharmacological treatment in patients after discharge. Copyright © 2014 John Wiley & Sons, Ltd.Human Psychopharmacology Clinical and Experimental 11/2014; 29(6). DOI:10.1002/hup.2445 · 1.85 Impact Factor
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ABSTRACT: Bipolar disorder (BD) in its broadest sense has a community lifetime prevalence of 4% and is associated to high rates of disability and higher rates of mortality. BD may be considered a multifactorial disorder resulting from interaction between genetic and nongenetic factors and many studies demonstrate that environmental factors play an important role in the etiopatogenesis and in the development of BD. The nongenetic factors include early childhood trauma, stressful life events, virus infections, cannabis use, obstetric complications, and even very distant environmental factors such as solar cycles. Childhood traumatic events are probably the most promising environmental determinant to have been investigated. The identification of childhood trauma as a potential risk factor and/or course disease modifier in BD (not only in terms of comorbid conditions, but also in terms of affective functioning) may improve our understanding of the complex interactions between genetic susceptibility factors and the environment. Many researchers suggest that childhood trauma predisposes subjects to BD; in particular, it has been demonstrated that childhood trauma is related to a more severe prognosis and more severe clinical expression. This review shows how an unacceptably large number of children in our society are subjected to early adverse experiences, exposing these children to an increased risk for the development of BD that may persist throughout adulthood. Furthermore, we focus our attention on the importance of childhood trauma for the development of BD, underlying how they modulate the clinical expression, and the course of the disease.
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ABSTRACT: Neuropsychological deficits constitute enduring trait-like features in bipolar disorder (BD), and persist in euthymia. White matter (WM) abnormalities are one of the most consistently reported findings in neuroimaging studies of BD. We hypothesized that neuropsychological performances could correlate with WM integrity in a sample of bipolar patients in core WM tracts. Seventy-eight patients affected by BD were evaluated for verbal memory, working memory, psychomotor coordination, executive functions, attention and information processing, and verbal fluency through the Brief Assessment of Cognition in Schizophrenia. White matter integrity was evaluated using DTI and tract-based spatial statistics with threshold free cluster enhancement (p>0.949). We observed that cognitive performances in attention and information processing, working memory, executive functions and psychomotor coordination were associated with DTI measures of WM integrity in several association fibres: inferior and superior longitudinal fasciculus, inferior fronto-occipital fasciculus, cingulum bundle, corpus callosum, and corona radiata. The drug treatments administered during the course of the illness could have influenced DTI measures and neurocognitive function. Other limitations include issues such as generalizability due to the lack of a control group, possible undetected past comorbidities, population stratification, and the presence of a 28% of patients which previously experienced delusions. This is the first study to use a validated cognitive battery to investigate the principal cognitive domains in BD. Our data confirm the importance of WM integrity as a neurobiological underpinning of cognitive deficits. Copyright © 2014 Elsevier B.V. All rights reserved.Journal of Affective Disorders 12/2014; 174C:342-352. DOI:10.1016/j.jad.2014.12.030 · 3.71 Impact Factor