Clinical and therapeutic implications of predominant polarity in bipolar disorder
ABSTRACT To determine the clinical and therapeutic relevance of longitudinally predominant polarity for bipolar disorders long-term outcome.
Two hundred twenty-four patients (n=224) were enrolled for the study in the Bipolar Disorders Program of Barcelona, which provides integrated care for difficult-to-treat bipolar patients derived from all over Spain, but also provides clinical care to all bipolar patients coming from a specific catchment area (Eixample Esquerre) in Barcelona. Data collection regarding predominant polarity started on October 1994 and lasted for the following ten years. Patients were divided according to the predominance of depressive or manic/hypomanic episodes. The two groups were compared regarding clinical and sociodemographic variables.
135 patients (60.3%) were classified as Depressive Polarity, whilst 89 (39.7%) were considered as Manic Polarity. Manic Polarity was more prevalent amongst bipolar I patients than bipolar II. Depressive Polarity was strongly associated with depressive onset of bipolar disorder. Lifetime history of attempted suicide was strongly associated with Depressive Polarity, who also had a higher mean number of suicide attempts. As for therapeutic issues, acute and maintenance use of atypical antipsychotics and conventional neuroleptics were more common amongst Manic Polarity whilst antidepressants and lamotrigine use was highly prevalent amongst Depressive Polarity.
Prevention of depression is crucial for the maintenance treatment of bipolar II patients, whilst prevention of mania and depression would be equally important in the case of bipolar I patients. Predominant polarity is a valid prognostic parameter with therapeutic implications.
- SourceAvailable from: Gianfranco Spalletta
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- "The polarity of episodes over the course of BD as well as the polarity of the initial or index episode may be among the strongest predictors of recurrence of a specific episode  . Approximately one-half of BD patients were reported to have a predominant polarity  , and various studies have detected clinical differences between predominantly manic and predominantly depressed patients   . In a naturalistic study by Popovic and colleagues , several clinical differences were detected between the two groups: manic predominant polarity was characterized by higher prevalence of BD I, male gender, younger age, younger age at illness onset and at first hospitalization, higher hospitalization rate, more manic and hypomanic episodes, primary substance abuse and psychotic symptoms; depressive predominant polarity was characterized by higher rates of BD II, depressive onset, more depressive episodes, stressful events preceding illness onset, melancholia and more suicide attempts. "
ABSTRACT: Although diagnosis is a central issue in medical care, in psychiatry its value is still controversial. The function of diagnosis is to indicate treatments and to help clinicians take better care of patients. The fundamental role of diagnosis is to predict outcome and prognosis. To date serious concern persists regarding the clinical utility and predictive validity of the diagnosis system in psychiatry, which is at the most syndromal. Schizophrenia and bipolar disorder, which nosologists consider two distinct disorders, are the most discussed psychiatric illnesses. Recent findings in different fields of psychiatric research, such as neuroimaging, neuropathology, neuroimmunology, neuropsychology and genetics, have led to other conceptualizations. Individuals with schizophrenia or bipolar disorder vary greatly with regard to symptoms, illness course, treatment response, cognitive and functional impairment and biological correlates. In fact, it is possible to find heterogeneous correlates even within the same syndrome, i.e., from one stage of the disorder to another. Thus, it is possible to identify different subsyndromes, which share some clinical and neurobiological characteristics. The main goal of modern psychiatry is to ovethrow these barriers and to obtain a better understanding of the biological profiles underlying heterogeneous clinical features and thus reduce the variance and lead to a homogeneous definition. The translational research model, which connects the basic neuroscience research field with clinical experience in psychiatry, aims to investigate different neurobiological features of syndromes and of the shared neurobiological features between two syndromes. In fact, this approach should help us to better understand the neurobiological pathways underlying clinical entities, and even to distinguish different, more homogeneous, diagnostic subtypes. Copyright © 2015. Published by Elsevier B.V.Clinica Chimica Acta 02/2015; DOI:10.1016/j.cca.2015.02.029 · 2.82 Impact Factor
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- "Seasonal forms are positive predictors for a response to light therapy (Golden et al., 2005), while forms with predominant depressive episodes predict a good prophylactic effect of lamotrigine (Colom et al., 2006). Since lithium has a potent anti-suicidal effect and reduces suicide risk by 80% in individuals with affective disorders (Baldessarini et al., 2006), an increased suicidal risk is an important predictor for the use of lithium-treatment, irrespective of its mood-stabilizing effect. "
ABSTRACT: In bipolar disorders, there are unclear diagnostic boundaries with unipolar depression and schizophrenia, inconsistency of treatment guidelines, relatively long trial-and-error phases of treatment optimization, and increasing use of complex combination therapies lacking empirical evidence. These suggest that the current definition of bipolar disorders based on clinical symptoms reflects a clinically and etiologically heterogeneous entity. Stratification of treatments for bipolar disorders based on biomarkers and improved clinical markers are greatly needed to increase the efficacy of currently available treatments and improve the chances of developing novel therapeutic approaches. This review provides a theoretical framework to identify biomarkers and summarizes the most promising markers for stratification regarding beneficial and adverse treatment effects. State and stage specifiers, neuropsychological tests, neuroimaging, and genetic and epigenetic biomarkers will be discussed with respect to their ability to predict the response to specific pharmacological and psychosocial psychotherapies for bipolar disorders. To date, the most reliable markers are derived from psychopathology and history-taking, while no biomarker has been found that reliably predicts individual treatment responses. This review underlines both the importance of clinical diagnostic skills and the need for biological research to identify markers that will allow the targeting of treatment specifically to sub-populations of bipolar patients who are more likely to benefit from a specific treatment and less likely to develop adverse reactions. Copyright © 2015. Published by Elsevier B.V.European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 01/2015; 58(3). DOI:10.1016/j.euroneuro.2014.12.006 · 5.40 Impact Factor
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- "). And, in order to make possible various analysis of long-term outcome, the BDP had been performing since 1992 a prospective data collection on the illness course of all BP included in its program, as already described elsewhere (Colom et al., 2006; Jimenez et al., 2013). Therefore, this cross-sectional analysis includes both retrospective and prospective collected data. "
ABSTRACT: Bipolar patients present increased levels of impulsivity even during remission periods. It is known that this dimensional trait negatively impacts on the course of illness and worsens their prognosis and outcome. Evidence from both basic and clinical researches supports that Lithium (Li) may decrease impulsivity. Owing to the fact that Li inhibits both glycogen synthetase kinase-3 (GSK3) isoenzimes, our aim was to analyze the potential impact of genetic variants located at the GSK3 α and β genes on impulsivity levels in a bipolar sample. Our sample consisted of 199 unrelated Caucasian bipolar outpatients who were recruited from the Bipolar Disorder Unit of the Hospital Clinic of Barcelona and from primary care settings from Oviedo. Four polymorphisms at the GSK3 α and β genes were genotyped in order to analyze the impact of genetic variability on impulsivity as measured by the BIS-11 scale. Single SNP analysis showed that patients carrying T and G alleles at the rs1732170-GSK3β and the rs334558-GSK3β, respectively, presented increased levels of attentional impulsivity compared to non-carriers. These results were also confirmed by haplotype analysis. Our results suggest that genetic variability at GSK3β gene is associated to increased impulsivity in bipolar patients.European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 01/2014; 24(4). DOI:10.1016/j.euroneuro.2014.01.005 · 5.40 Impact Factor