The impact of age at onset of bipolar I disorder on functioning and clinical presentation

Background: Most studies investigating maternal mood across the transition from pregnancy to the postnatal period have focused on depression. In contrast, little is known about patterns of anxiety across this period. This study aimed to 1) assess patterns of anxiety and depression across pregnancy and the postpartum, 2) investigate associations between antenatal mood and HPA axis hormones and 3) determine the extent to which antenatal anxiety, depression and HPA axis activity predict postnatal mood disorders. Methods: Participants were recruited antenatally as part of a prospective study undertaken at the Royal Hospital for Women, Sydney. Ninety-four women completed self-report measures of anxiety and depression at 30–32 and 36-38 weeks gestation, and at 6 months postpartum. They were also administered a structured diagnostic interview (MINI-Plus) at 36–38 weeks gestation and at 6 months postpartum to determine the presence of DSM-IV anxiety and depression. Blood samples were collected at 30–32 weeks gestation for bioassays of HPA axis hormones (CRH, ACTH and cortisol). Results: The data indicate signifi cant stability in maternal mood across pregnancy and the postpartum and associations between anxiety and depression were moderate-high at each assessment. Despite the stability of depression, an anxiety disorder in pregnancy appears to be a greater risk factor for a postnatal anxiety [odds ratio (OR) = 10.20, P < 0.005] or depressive disorder (OR = 7.90, P < 0.005) than antenatal depression. Antenatal neuroendocrine parameters were unrelated to either antenatal or postnatal anxiety or depression. Conclusion: These results clearly highlight the importance of anxiety in both the pre- and postnatal periods.2 page(s

Treatment and outcomes of an Australian cohort of outpatients with bipolar 1 or schizoaffective disorder over twenty-four months : implications for clinical practice

Background The Bipolar Comprehensive Outcomes Study (BCOS) is a 2-year, prospective, non-interventional, observational study designed to explore the clinical and functional outcomes associated with &lsquo;real-world&rsquo; treatment of participants with bipolar I or schizoaffective disorder. All participants received treatment as usual. There was no study medication.Methods Participants prescribed either conventional mood stabilizers (CMS; n&thinsp;=&thinsp;155) alone, or olanzapine with, or without, CMS (olanzapine&thinsp;&plusmn;&thinsp;CMS; n&thinsp;=&thinsp;84) were assessed every 3&thinsp;months using several measures, including the Young Mania Rating Scale, 21-item Hamilton Depression Rating Scale, Clinical Global Impressions Scale &ndash; Bipolar Version, and the EuroQol Instrument. This paper reports 24-month longitudinal clinical, pharmacological, functional, and socioeconomic data.Results On average, participants were 42 (range 18 to 79) years of age, 58%; were female, and 73%; had a diagnosis of bipolar I. Polypharmacy was the usual approach to pharmacological treatment; participants took a median of 5 different psychotropic medications over the course of the study, and spent a median proportion of time of 100%; of the study on mood stabilizers, 90%; on antipsychotics, 9%; on antidepressants, and 5%; on benzodiazepines/hypnotics. By 24&thinsp;months, the majority of participants had achieved both symptomatic and syndromal remission of both mania and depression. Symptomatic relapse rates were similar for both the CMS alone (65%;) and the olanzapine&thinsp;&plusmn;&thinsp;CMS (61%;) cohorts.Conclusions Participants with bipolar I or schizoaffective disorder in this study were receiving complex medication treatments that were often discordant with recommendations made in contemporary major treatment guidelines. The majority of study participants demonstrated some clinical and functional improvements, but not all achieved remission of symptoms or syndrome.<br /

Impact of diagnostic definition on prevalence of mixed episodes in 12 month prospective bipolar cohort study

Abstract not available

Improvement of schizophrenia negative and positive symptoms with memantine as add-on therapy to clozapine: a double-blind, randomized, placebo-controlled trial

Objectives: Subthreshold mixed states are common, yet their clinical significance is unclear. This study investigated the clinical outcomes of subthreshold mixed states in participants with bipolarI disorder or schizoaffective disorder, using the Cassidy and Benazzi criteria for manic and depressive mixed states, respectively.Methods: The Bipolar Comprehensive Outcomes Study (BCOS) is a prospective observational study of treatment and outcomes for patients with bipolar I or schizoaffective disorder, bipolar type. Participants (N=239) were grouped based on study entry clinical presentation as having pure depression (n=63) if they satisfied DSM-IV-TR criteria for a Major Depressive Episode (MDE), depressive mixed state (DMX) if they also had at least three concurrent hypomanic symptoms (n=33), or not depressed (n=143) if they did not satisfy the criteria for MDE. Participants were similarly grouped as having pure mania (n=3) if they satisfied DSM-IV criteria for a Manic Episode, manic mixed state (MMX) if they also had at least two concurrent depressive symptoms (n=33), or not manic (n=203). Clinical data were collected by interview every 3-months over a 24-month period.Results: Measures of quality of life, mental and physical health over the 24-month period were significantly worse for participants who were classified as having mixed states at study entry on most outcome measures compared to participants who were not in an illness episode at study entry. DMX was predictive of greater manic symptomatology over the 24 months compared to participants with pure depression.Conclusion: In participants with a current episode of mood disorder, the presence of subthreshold symptoms of opposite polarity was associated with poorer clinical outcomes over a 24-month period.<br /