Olcay Yazici

Comorbidity of personality disorders with bipolar mood disorders

The aim of the study was to assess the prevalence of personality disorders in a group of outpatients with bipolar I disorder. The Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) was administered to 90 bipolar outpatients who met the DSM-III-R criteria and 58 control subjects. Of the patients and controls, 47.7% and 15.5%, respectively, had at least one personality disorder. At least one personality disorder in clusters A, B, and C and obsessive-compulsive, paranoid, histrionic, and borderline personality disorders were significantly more prevalent in bipolars. Suicide attempts were more frequent in patients with a history of personality disorder.

The clinical impact of mood disorder comorbidity on obsessive-compulsive disorder

The present study examines the effect of concomitant major depressive or bipolar disorder on clinical symptoms of patients with obsessive–compulsive disorder (OCD). Forty–nine patients classified as OCD without a mood disorder, 26 classified as OCD with bipolar disorder (OCD–BD) and 42 classified as OCD with major depressive disorder (OCD–MDD) according to DSM–IV diagnostic criteria were included in the study. The groups were compared with respect to demographic variables and scores obtained on various scales. The OCD–BD group had more symmetry/exactness obsessions and ordering/arranging compulsions, and a more episodic course of illness and had better insight compared to the other two groups. Levels of anxiety, depression, disability and obsessive–compulsive symptom severity were significantly higher in the OCDMDD group. The rate of social phobia was higher in OCD–BD patients, whereas the rates of generalized anxiety disorder and simple phobias were higher in OCDMDD group. These findings suggest that comorbidity of major depressive disorder may increase the severity of OCD symptoms. On the other hand, bipolar disorder comorbidity may constitute a subgroup which is characterized by a higher rate of episodic course and better insight.

Impact of obsessive-compulsive disorder comorbidity on the sociodemographic and clinical features of patients with bipolar disorder

BACKGROUND In this study, our aim is to determine the prevalence rates of obsessive-compulsive disorder (OCD) comorbidity and to assess the impact of OCD comorbidity on the sociodemographic and clinical features of patients with bipolar disorder (BD). METHODS Using the Yale-Brown Obsessive Compulsive Scale Symptom Checklist and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-IV/Clinical Version on bipolar patients, 2 groups, BD with OCD comorbidity (BD-OCD) and BD without OCD comorbidity, were formed. These groups were compared for sociodemographic and clinical variables. RESULTS Of 214 patients with BD, 21.9% of them had obsession and/or compulsion symptoms and 16.3% had symptoms at the OCD level. Although there was no statistically significant difference between the frequency of comorbid OCD in BD-I (22/185, 11.9%) and BD-II (3/13, 23.1%) patients, but OCD was found to be significantly high in BD not otherwise specified (10/16, %62.5) patients than BD-I (P < .001) and BD-II (P = .03). Six patients (17.1%) of the BD-OCD group had chronic course (the presence of at least 1 mood disorder episode with a duration of longer than 2 years), whereas the BD without OCD group had none, which was statistically significant. There were no statistically significant differences between BD-OCD and BD without OCD groups in terms of age, sex, education, marital status, polarity, age of BD onset, presence of psychotic symptoms, presence of rapid cycling, history of suicide attempts, first episode type, and predominant episode type. LIMITATIONS Main limitation of our study was the assessment of some variables based on retrospective recall. CONCLUSIONS Our study confirms the high comorbidity rates for OCD in BD patients. Future studies that examine the relationship between OCD and BD using a longitudinal design may be helpful in improving our understanding of the mechanism of this association.

Unipolar mania: a distinct disorder?

BACKGROUND This study aimed to identify the differences between unipolar mania and classical bipolar disorder. METHODS Patients with at least four manic episodes and at least 4 years of follow-up without any depressive episodes were classified as unipolar mania. This group was compared to other bipolar-I patients defined according to DSM-IV regarding their clinical and socio-demographic variables. RESULTS The rate for unipolar mania as defined by the study criteria was found to be 16.3% in the whole group of bipolar-I patients. Unipolar manic patients tended to have more psychotic features and be less responsive to lithium prophylaxis compared to other bipolar-I patients. LIMITATIONS Because it was a retrospective study, there may be some minor depressive episodes left unrecorded in the unipolar mania group despite careful and thorough investigation. In addition, even with our fairly strict criteria for the diagnosis of unipolar mania, the possibility of a future depressive episode cannot be excluded. CONCLUSIONS Unipolar mania may be the presentation of a nosologically distinct entity.

Does a psychoeducational approach reach targeted patients with bipolar disorder

OBJECTIVES The goal of this paper was to determine factors which are related to motivation of bipolar patients to attend a psychoeducation program. METHODS Patients with bipolar disorder which had at least four years of prospective follow-ups were invited to a 6-week psychoeducation program. Patients who accepted and those who refused the participation were compared using several clinical characteristics. RESULTS Of the 173 patients who were invited, 84 participated in the program. Participants had significantly more family history of bipolar disorder and suicide, good response to prophylactic treatment, full medication adherence, therapeutic blood levels of mood stabilizers, regular follow-up visits, mixed episodes, and significantly less total number of episodes. Presence of mixed episodes, full medication adherence and therapeutic blood level of mood stabilizers were found predictive for attendance in logistic regression analysis. CONCLUSIONS Our results suggest motivation and participation rates of patients who attended a psychoeducation program were constrained. Factors associated with a poor response to psychopharmacologic treatments also seem valid for non-attendance to the psychological interventions.

Impact of psychotic features on morbidity and course of illness in patients with bipolar disorder

OBJECTIVE In this study, we aimed to compare the clinical features and response patterns to the long-term prophylaxis of bipolar patients with or without psychotic features. METHOD The life charts of patients with bipolar I disorder were evaluated. Two hundred and eighty-one patients who suffer with bipolar disorder for at least 4 years and who had at least three mood episodes were included to the study. The patients whose all episodes are psychotic (psychotic group) and the patients who never experienced psychotic episode (non-psychotic group) were assigned as comparison groups. The clinical features and the response to long-term prophylaxis were compared across the groups. RESULTS The psychotic group consists of 43 patients; non-psychotic group consists of 54 patients. The history of bipolar disorder among the first-degree relatives was remarkably more prevalent in non-psychotic group (p=0.032). The predominance of manic/hypomanic episodes was significantly higher in psychotic group than non-psychotic group; and the rate of depressive episodes were higher in non-psychotic group than psychotic group (p=0.013). Episodes were more severe (p<0.001) and hospitalization rates were higher (p=0.023) in psychotic group. The response to lithium monotherapy was better in non-psychotic group (p<0.001). CONCLUSION The well identified psychotic subtype of bipolar patients may give important predictions about long term course and prophylaxis of bipolar disorder.

Controlled lithium discontinuation in bipolar patients with good response to long-term lithium prophylaxis

BACKGROUND This study aims to investigate whether the risk of recurrence following lithium discontinuation is less than reported in discontinuation of a successful, long-term prophylaxis in bipolar patients. METHODS A total of 32 bipolar patients discontinued lithium according to the controlled lithium discontinuation (CLD) protocol following a definite good response to lithium maintenance of at least 5 years. Subjects were followed for up to 9 years. RESULTS The total rate of recurrence was 7% in the first week, 32% in the first month, 62% in the first year, and 81% at the end of the 9th year following discontinuation. Only six of the 32 patients (19%) did not have a recurrence during the follow-up period. CONCLUSIONS Discontinuation of lithium seems to be followed by a high rate of recurrence in bipolar patients even after good response to a long-duration illness-free period. A controlled discontinuation protocol can reduce the risks of morbidity.

Noradrenergic and serotoninergic depression

The aim of this study was to test the hypothesis of noradrenergic and serotoninergic depressive subtypes. For this purpose, the correlation between three variables was investigated: urinary 3-methoxy-4-hydroxyphenylglycol (MHPG), dexamethasone suppression test (DST), and clinical response profiles to clomipramine and maprotiline, the effects of which are relatively selective on the uptake of noradrenaline (NA) and 5-hydroxytryptamine (5HT). Our results showed no correlation between these measures. Therefore, the hypothesis of two subtypes of depression was not supported. The only significant finding in this study was the obvious decrease in MHPG excretion during the antidepressant treatment in the group with high pretreatment MHPG.

Unipolar mania: A distinct entity?

BACKGROUND Whether or not unipolar mania is a separate nosological entity remains a subject of dispute. This review discusses that question in light of recent data. METHODS Unipolar mania studies in the PUBMED database and relevant publications and cross-references were searched. RESULTS There seems to be a bipolar subgroup with a stable, unipolar recurrent manic course, and that 15-20% of bipolar patients may be unipolar manic. Unipolar mania may be more common in females. It seems to have a slightly earlier age of illness onset, more grandiosity, psychotic symptoms, hyperthymic temperament, but less rapid-cycling, suicidality and comorbid anxiety disorders. It seems to have a better course of illness with better social and professional adjustment. However, its response to lithium prophylaxis seems to be worse, although its response to valproate is the same when compared to that of classical bipolar. LIMITATIONS The few studies on the subject are mainly retrospective, and the primary methodological criticism is the uncertainty of the diagnostic criteria for unipolar mania. CONCLUSIONS The results indicate that unipolar mania displays some different clinical characteristics from those of classical bipolar disorder. However, whether or not it is a separate nosological entity has not been determined due to the insufficiency of relevant data. Further studies with standardized diagnostic criteria are needed. Considering unipolar mania as a course specifier of bipolar disorder could be an important step in this respect.

Decreased responsiveness following lithium discontinuation in bipolar disorder: A naturalistic observation study

Lithium is a cornerstone in treatment of bipolar disorder. Findings are conflicting as to whether acquired unresponsiveness occurs following the discontinuation. Retrospective life chart data were evaluated to investigate the incidence of loss of response. Sixty-five patients chosen from a larger cohort, followed with prospective life charts, who discontinued lithium and had a second lithium treatment. Patients who had at least 2 mood episodes when they were drug naïve to describe the natural frequency of illness and 3 mood episodes before the discontinuation were included. The type of response was defined as excellent, partial, or poor according to mirror design method. Eighteen of 65 patients (27.6%) had a decreased response to lithium following its discontinuation. Nine of these patients (13.8%) were unresponsive and nine patients (13.8%) had attenuated response to second lithium treatment. The mean time of discontinuation was longer in the patients who show decreased response (245.8+268.2 vs. 117.9+149.8 days, p=.01). Those who had episode recurrences during the discontinuation were more likely to show reduced responsiveness upon re-treatment. After discontinuation of lithium treatment, more than a quarter of the patients showed an attenuated response or unresponsiveness, and initial partial responders more likely to show unresponsiveness than excellent responders.