Longitudinal research on bipolar disorders

McLean Hospital, Cambridge, Massachusetts, United States
Epidemiologia e psichiatria sociale (Impact Factor: 3.16). 06/2007; 16(2):109-17. DOI: 10.1017/S1121189X00004711
Source: PubMed


Longitudinal assessment of the course of major psychiatric disorders has been advanced by studies from onset, but only rarely have large numbers of patients with a range of psychotic and major affective disorders been studied simultaneously and systematically from illness-onset. The decade-long McLean-Harvard First Episode Project & International Consortium for Bipolar Disorder Research has systematically followed-up large numbers of patients with DSM-IV bipolar or psychotic disorders from first-hospitalization. Major findings among patients with bipolar I disorder include: [a] full functional recovery from initial episodes was uncommon, and full symptomatic recovery, much slower than early syndromal recovery; [b] risks of relapse, recurrence, and switching were very high in the first two years; [c] most early morbidity was depressive-dysphoric, as reported in mid-course; [d] initial depression or mixed-states predicted more later depressive and overall morbidity, whereas initial mania or psychosis predicted later mania and a better prognosis; [e] based on within-subject modeling, most patients did not show progressive cycling over time, and illness-course was rather chaotic within and among patients; [f] treatment-latency or episode-counts were unassociated with responsiveness to long-term mood-stabilizing treatment; [g] very high rates of suicidal behavior and accidents occurred early; [h] early substance-use comorbidity associated with anxiety; [i] factor-analysis of prodromal symptoms predicted bipolar disorder much better than non-affective psychotic disorders. Project findings indicate that the course of bipolar I disorder is much less favorable than had been believed formerly, despite clinical treatment with modern mood-stabilizing and other treatments.

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Available from: Mauricio Tohen
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    • "It is still an underdiagnosed disease among clinicians and health professionals, with a high prevalence of misdiagnosis and diagnostic shifts from other psychiatric disorders to bipolar disorder. For this reason, a large percentage of this population remains untreated (Salvatore, Tohen, Khalsa, Baethge, Tondo & Baldessarini, 2007). High rates of misdiagnosis and lack of recognition often lead patients with bipolar disorder to have a chronic illness course with high disability, unemployment rates, and mortality (Leboyer & Kupfer, 2010). "
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    ABSTRACT: Bipolar disorder is a recurrent and chronic disorder with significant morbidity and mortality. Currently, pharmacological treatment is considered indispensable in bipolar disorder. However, despite advances in this area, treatment remains suboptimal. A large body of research has shown that innumerable psychosocial factors influence the emergence of mood disorders. Therefore, in addition to pharmacological strategies, psychological interventions are increasingly recognized as an essential component in the treatment of bipolar patients. Among the various approaches of psychosocial interventions, psychoeducation (PE) has been one of the most used. Thus, the aim of this review was to evaluate the efficacy of PE in the clinical course, treatment adherence, and psychosocial functioning of bipolar patients by collecting data from controlled trials that used solely PE as a psychosocial approach. A systematic review of the literature was performed in the PubMed and SCOPUS databases, without date limits, using the following keywords: Psychoeducation and Bipolar disorder. We found 13 randomized controlled trials. Psychoeducation significantly improved the clinical course, treatment adherence, and psychosocial functioning of bipolar patients. It also reduced the number of relapses and recurrences per patient and increased the time to depressive, manic, hypomanic, and mixed recurrences. The number and length of hospitalizations per patient were also lower in patients who received PE. Although we found a limited number of randomized controlled trials that evaluated the efficacy of PE in bipolar disorder, the studies showed positive results in reducing relapse rates and improving long-term treatment adherence. Additionally, PE intervention improves the knowledge of the illness for both patients and caregivers to reduce their distress and improve overall social functioning.
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    • "Impaired intra-and inter-hemispheric white matter communication has been suggested in bipolar disorder, which is a severe and chronic disease (Salvatore et al., 2007). Magnetic resonance (MR) diffusion weighted imaging (DWI) is a non-invasive technique that evaluates in vivo white matter directionality and integrity. "
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