Variables as mediators or moderators in predicting relapse to any type of mood episode in a bipolar maintenance study
Division of Mood and Anxiety Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA. The Journal of Clinical Psychiatry
(Impact Factor: 5.5).
08/2012; 73(7):e913-7. DOI: 10.4088/JCP.10m06737
Post hoc mediator/moderator analyses were designed to identify risk factors and their relationships in predicting relapse in olanzapine- or lithium-treated bipolar patients with an index manic or mixed episode. The aim was to identify moderators that precede and influence other variables to affect relapse and mediators that explain how or why a second variable affects relapse.
We examined DSM-IV-diagnosed bipolar I disorder patients who met symptomatic remission criteria of an index manic or mixed (6.3%) episode after acute (6-12 weeks), open-label, combined therapy with olanzapine (5-20 mg/d; mean dose = 13.5 mg/d) plus lithium (300-1,800 mg/d; mean dose = 1,003.3 mg/d) followed by double-blind randomization to lithium (n = 214) or olanzapine (n = 217) for up to 52 weeks. The study started on August 5, 1999, and finished on June 14, 2002. Mediator/moderator analyses with α cut at .05 were used to understand how variables work together to impact rate of relapse.
For lithium-treated patients, variables identified for relapse were country of residence, smoking status, previous episode history, and previous lithium use. For olanzapine-treated patients, risk factors included smoking status, previous episode history, amount of time patients had a 21-Item Hamilton Depression Rating Scale (HDRS-21) score ≤ 8 at pre-randomization, and HDRS-21 score at randomization. For lithium-treated patients, no mediators/moderators were identified among relapse variables. For olanzapine-treated patients, several baseline variables--such as previous number of mood episodes (manic or depressive)--operate through severity of depressive symptoms prior to remission (mediator) to affect relapse rate. On the other hand, the effect of the patient's pre-remission depressive symptoms on outcome is moderated by the polarity of the first episode, whether manic, depressive, or mixed.
Mediators and moderators may provide valuable information in the treatment planning of patients with bipolar disorder and potentially influence treatment outcomes.
Available from: Anastasiya Slyepchenko
- "Smoking strongly predicts treatment dropout [137, 138] and non- adherence . Variables predicting relapse for treatment of manic treatments in BD with olanzapine or lithium include smoking status . Furthermore, individuals with rapid cycling, psychiatric comorbidities and substance abuse presently experiencing an episode of BD are more likely to smoke cigarettes. "
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ABSTRACT: Several biological systems are implicated in the neuroprogression of bipolar disorder including but not limited to cytokine levels, oxidative stress markers, monoamine levels, tryptophan catabolite and glutamate-mediated excitotoxicity, microglial activation as well as structural and functional changes. The high rate of smoking behaviour in individuals with bipolar disorder provides the impetus for exploring shared and discrete pathogenetic mechanisms. In addition to contributing to increased mortality, smoking activates several neurobiological effector systems implicated in the progression of bipolar disorder. Here, a narrative review provides evidence and putative mechanisms of comorbid effects of BD, cigarette use, and nicotine dependence, and discusses the clinical implications of these interactions.
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ABSTRACT: To examine the differences and potential changes that occur in smoking habits among psychiatric and somatic patients due to and during their hospital stay in a general hospital.
Inpatients of three departments (psychiatry, cardiology, pulmology) were given a questionnaire that asked for epidemiologic data and their smoking habits, including the Fagerstrom-Test. In order to achieve sufficient data, the questionnaire was administered twice on two different dates. Primary goal of this examination was to determine a potential change in smoking behaviour whereas the secondary goal was to check for differencies between psychiatric and somatic inpatients and within the psychiatric diagnostic groups according to their smoking habits respectively. According to a lack of normal distribution of the data non parametric tests und visual classifying were used for statistical analysis.
A substantial proportion (26.4 %) of psychiatric inpatients reported an increase in cigarette consumption or have restarted or newly started smoking cigarettes due to their admission. On the other hand, none of the somatic patients did so, actually they showed higher proportion of being non-smokers. There were statistically significant differences between psychiatric and somatic patients in two age-groups due to their change in smoking habits and severity of nicotine dependence as measured by the Fagerstrom-test. Among the psychiatric patients sampled, those with schizophrenia and affective disorders showed high prevalence of being highly addicted smokers in 85.7 and 44.4 % respectively.
As a result of this small sample and hindered comparability of somatic and psychiatric groups of inpatients further investigations are needed to evaluate the influence of hospitalisations on smoking behaviour and to tailor suitable actions controlling tobacco consumption in health services.
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