Keck Pe

The costs of treatment of bipolar disorder

From the studies reviewed above, a number of aspects regarding the economic impact of bipolar disorder are clear. First, the cost of this illness in disability and human suffering is profound. Second, the economic cost of the illness far outweighs the costs of treatment. Third, cost savings may differ among the available mood-stabilizing medications, depending on clinical and pharmacological variables. Fourth, the costs of hospitalization contribute the single greatest share of treatment costs, greatly outweighing the costs of drug acquisition. Thus, decisions regarding the inclusion of medications for patients with bipolar disorder on formularies require consideration of the impact of successful treatment on preventing morbidity and mortality, enhancing productivity and preventing hospitalization (Keck et al. 1998b).

Prevalence rate of mixed depression and its impact on remission: a controlled evaluation

Introduction: Comorbid psychiatric diagnoses such as panic disorder and drug and alcohol abuse are common in both major depressive disorder (MDD) and bipolar disorder (BD). Although screening instruments such as the Hypomania Checklist (HCL-32) may be useful in distinguishing between bipolar and unipolar patients, very little work has assessed whether comorbidities, for example, substance abuse, may be related to ratings of hypomanic symptoms on such instruments. In this study we assess whether a lifetime diagnosis of comorbid panic disorder, drug abuse, alcohol abuse or alcohol dependence in patients with MDD is associated with increased ratings of hypomanic symptoms on the HCL-32. Methods: 50 patients with MDD (according to DSM-IV) recruited from out-patient psychiatric services were assessed for a range of diagnoses according to the Mini International Neuropsychiatric Interview (MINI). Subjects also completed a detailed structured clinical assessment and the HCL-32 questionnaire. A number of previous reports have found that a score of 14 or more on the HCL-32 is an optimal threshold for the correct identification of bipolar disorder (with a sensitivity of 80% and specificity 51%) so this threshold was applied to our sample of MDD patients. Two groups were identified according to whether they scored above or below 14 on the HCL-32 and were compared on rates on lifetime comorbid diagnosis of panic disorder, drug abuse, alcohol abuse and alcohol dependence. Results: 27 out of 50 MDD patients (54%) scored above the threshold of 14 or more on the HCL-32. There were no significant differences between these subjects and subjects not meeting the threshold on rates of comorbid panic disorder (48.1% versus 47.8%; OR = 1.01, 95%CI 0.60–1.68), drug abuse (7.4% versus 4.3%; OR = 1.25, 95%CI 0.54–2.92) or alcohol abuse (37.0% versus 21.7%; OR = 1.37, 95%CI 0.84–2.25). However, subjects scoring above the threshold had significantly higher rates of comorbid alcohol dependence (18.5% versus 0%; OR = 2.05, 95%CI 1.52–2.76). Discussion: 54% of MDD patients in this sample scored above the threshold of 14 on the HCL-32, suggestive of a bipolar diagnosis. Cormorbid alcohol dependence was significantly associated with scoring above the threshold. In fact, all of the MDD patients in this sample who also had a lifetime history of alcohol dependence scored 14 or more on the HCL-32. Future studies involving screening measures for bipolar disorder, particularly the HCL-32, should carefully consider the role played by comorbidities such as alcohol dependence.