Depression

Atypical bipolar disorder features predict reduced treatment response


 response

July 2010 Browse Archive: Go

MedWire News: Bipolar disorder patients with atypical features of illness, such as psychotic symptoms and rapid cycling, are more likely than other patients to relapse while on long-term treatment with mood stabilizers, study results show.

“Our findings should prompt physicians to reassess response to lithium in patients with atypical features regularly and, if necessary, to modify treatment – for instance, by adding anticonvulsants to lithium after an inadequate treatment response has been realized,” comment Andrea Pfennig (Dresden University of Technology, Germany) and colleagues in the journal Bipolar Disorders.

 response

July 2010 Browse Archive: Go

MedWire News: Bipolar disorder patients with atypical features of illness, such as psychotic symptoms and rapid cycling, are more likely than other patients to relapse while on long-term treatment with mood stabilizers, study results show.

“Our findings should prompt physicians to reassess response to lithium in patients with atypical features regularly and, if necessary, to modify treatment – for instance, by adding anticonvulsants to lithium after an inadequate treatment response has been realized,” comment Andrea Pfennig (Dresden University of Technology, Germany) and colleagues in the journal Bipolar Disorders.

Bipolar disorder is a serious psychiatric disease, which has a recurrent, chronic course in the majority of patients. Although many patients experience only a few episodes during their lifetime, around 10-15% will suffer more than 10 episodes.

Lithium has proved to be effective for acute and prophylactic treatment and is recommended in current guidelines.

Some studies have suggested an association between so-called atypical features and the quality of response to lithium; however, the impact of atypical features on long-term prophylaxis has not been assessed.

In the present study, the researchers recruited 336 patients with bipolar disorder who all showed response to treatment with lithium.

Over an average period of 10 years (range, 1-33 years) the researchers recorded episodes of recurrence and measured atypical illness features, namely mood-incongruent psychotic symptoms, interepisodic residual symptomatology, more manic than depressive episodes, psychiatric comorbidity, and rapid cycling.

In all, 205 (61%) patients experienced a new episode after initiating lithium treatment (range: 0-19 episodes). Of these, 52 patients experienced one episode, 43 two episodes, 22 three, 25 four, and 62 experienced five or more episodes.

The first recurrence was observed within 12 months of starting lithium treatment in 32% of patients and within 2 years after starting treatment in 50%.

Patients with at least two atypical features had a 50% increased risk for a further relapse compared with patients without any atypical features. The risk for a new episode increased significantly by 21% with each additional atypical feature.

“There are still differences in long-term outcome, even among patients who respond relatively well to long-term lithium prophylaxis,” say Pfennig and colleagues who recommend modifying existing treatment where necessary.

MedWire  is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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