September 25, 2007

New Studies Guide Treatment Recommendations for Bipolar Disorder

Two new studies provide information on best practices for treating people with bipolar disorder. The two studies are part of the NIMH-funded Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Both were published in the September 2007 issue of the American Journal of Psychiatry.

Antidepressants provide no added benefit for people with mixed symptoms, and may worsen existing mania

Among STEP-BD participants who experienced manic symptoms while also in the midst of a depressive episode, those who received antidepressant medication along with a mood stabilizer recovered no faster than those who received a mood stabilizer plus placebo (sugar pill). The results, reported by Joseph Goldberg, M.D, of the Mount Sinai School of Medicine, and colleagues, are consistent with the March 2007 STEP-BD results that indicated a mood stabilizer alone appears to be just as effective as a mood stabilizer plus antidepressant for treating bipolar patients in a major depressive episode.

Moreover, Goldberg and colleagues found that at the three-month follow-up, manic symptoms were more severe among those who had received the antidepressant, compared to those who had received the placebo. Hence, the researchers caution that adjunctive antidepressant medication may actually exacerbate existing manic symptoms.

Intensive psychotherapies improve relationships and life skills

STEP-BD participants who received intensive psychotherapy in addition to medication reported better life satisfaction and better relationship skills than those who received only brief therapy and medication. However, patients in intensive psychotherapy fared no better in vocational skills.

David Miklowitz, PhD., of the University of Colorado, and colleagues evaluated participants' improvements in relationship, life and work skills over a nine-month period of psychotherapy. Participants received one of three types of psychotherapy:

Family-focused therapy (FFT), which required the participation and input of participants' family members and focused on enhancing family coping with the illness, communication, and problem-solving.

Cognitive behavioral therapy (CBT), which focused on helping the person understand distortions in thinking and activity, and learn new ways of coping with the illness.

Interpersonal and social rhythm therapy (IPSRT), which focused on helping the participant stabilize his or her daily routines and sleep/wake cycles, and solve key relationship problems.

All three therapies incorporated ways to overcome life challenges, such as finding a place to live, finding a satisfying job, or improving personal finances. They also taught participants strategies for managing mood states that interfere with enjoyment of activities.

Previous STEP-BD results reported in April 2007 revealed that those participants who received any of the three intensive psychotherapies recovered from depression faster and stayed well longer than those who received a brief, three-session educational program. In this follow-up study, the researchers found that although relationship skills improved and participants felt more satisfied with life overall, they reported little or no improvement in their work functioning.

Miklowitz and colleagues suggest that a different approach that targets specific vocational skills may be necessary. For example, certain vocational rehabilitation programs designed for people with schizophrenia may be adapted to the needs of people with bipolar disorder.

Source: release provided by the National Institutes of Health:

Posted by szadmin at 11:14 AM | Comments (7)

September 13, 2007

"A Day in the Life" of a Person who has Bipolar Disorder - Contest

One of the goals of our web site is to educate people about what living with bipolar disorder is like. AstraZeneca Pharmaceuticals wants to help you tell that story... and a lucky winner will even win $1000 for their submission!

"A Day in the Life..." is a competition aimed at raising awareness of what it is like to live with bipolar disorder. Submissions are being accepted until September 28, 2007 and can include essays, drawings or paintings, music, video or audio.

Following is a brief description:

A Day in the Life…
Contest Guidelines 2007

WHAT: As part of the 2007 World Mental Health Day observation, AstraZeneca is once again sponsoring a contest among people with bipolar disorder. “A Day in the Life…” is an artistic contest designed to educate on living with bipolar disorder with a goal of providing a deeper understanding of what these diseases are like from the point of view of those who live with them.

Through the entries collected for this contest, and subsequent educational and promotional programs/activities/projects, people will gain a stronger understanding of how these diseases impact individuals in different ways and the range of ways people are coping, surviving and thriving with them.

WHO: This contest is open to U.S. individuals who have been diagnosed with and are living with Bipolar Disorder and to relatives or caregivers of those individuals.

WHEN: Entries are due into AstraZeneca by September 28. Winning entries will receive notification in early October; other entries may not be acknowledged. Award winners may be invited to a special awards presentation and presentation of their winning entry on the AstraZeneca campus. .

WHY: World Mental Health Day (WMHD) occurs during the second week of October each year and is a key activity of the World Federation for Mental Health (WFMH) to help raise awareness about mental health worldwide. AstraZeneca is supporting WMHD 07 as part of its commitment to promoting mental health awareness among the public.

HOW: Submissions should illustrate what an average day is like living with bipolar disorder. Participants may enter in a variety of ways:

• Write an original 800-1200 word essay, poem, or short story
• Submit a short video, 2 minutes or less (MPEG, avi or wmv formats only)
• Create a painting or drawing (must be no larger than 14 x 16, non-mounted)
• Record an original song, 2 minutes or less (mp3 or MPEG formats only)

Entries will be judged based on how well they are considered to enable someone to understand what a day in the life of someone with one of these diseases is like. Each submission must reflect the entrant’s own original thinking. Entrants may submit only one piece for consideration.

All submissions, including non-winning entries, may be used to promote WHMD and other non-branded AstraZeneca efforts. Entrants’ first names may be displayed with their work but their last name will not be used.
All contestants must sign a written release authorizing AstraZeneca to use their entry in this and future educational and promotional projects. Entries that do not follow submission guidelines or that are not accompanied with the required signed release and entry form will not be considered for the contest. Submissions will not be returned. Please mail completed entries to:

Day in the Life Contest
Attn: Hugo Perez
AstraZeneca Pharmaceuticals
1800 Concord Pike, B2B-517A
Wilmington, DE 19850

Please include a separate 8 ½ x 11 sheet with the following entry information included (please print or type):
First and Last Name
Street Address
Phone number and/or email address
Best time to contact you
Type of entry (written, video, visual art, song)
1-paragraph description of your entry and why you chose to submit your entry in this medium

Also - Print out and include the following document
in the letter you send:

Day in the Life: Authorization for Release
(PDF File)

Contact information will be used solely to inform winning participants, unless entrants check the box allowing AstraZeneca to contact them about the possibility of using their submission in connection with the future marketing of AstraZeneca products. An entrant’s submission will not be used for these purposes without the entrant’s consent.

A selection committee will judge entries, and the top three will be awarded certificates and cash prizes ($1000/first, $500/second, $250/third). Entries will be judged on how well they are considered to communicate the experience of the individual


Posted by szadmin at 9:20 PM | Comments (15)

September 4, 2007

Bipolar Diagnosis Increasingly Common in Youth

The number of visits to a doctor's office that resulted in a diagnosis of bipolar disorder in children and adolescents has increased by 40 times over the last decade, reported researchers funded in part by the National Institutes of Health (NIH). Over the same time period, the number of visits by adults resulting in a bipolar disorder diagnosis almost doubled.

The cause of these increases is unclear. Many experts theorize that the jump reflects that doctors are more expansively applying the diagnosis to children, and don't believe that the incidence of the disorder has increased. "From a developmental point of view, we simply don’t know how accurately we can diagnose bipolar disorder or whether those diagnosed at age 5 or 6 or 7 will grow up to be adults with the illness." John March, chief of child and adolescent psychiatry at the Duke University School of Medicine, told the New York Times. “The label may or may not reflect reality.” The study was published in the September 2007 issue of the Archives of General Psychiatry.

Mark Olfson, M.D., M.P.H., of New York State Psychiatric Institute of Columbia University, along with National Institute of Mental Health (NIMH) researcher Gonzalo Laje, M.D., and their colleagues examined 10 years of data from the National Ambulatory Medical Care Survey (NAMCS), an annual, nationwide survey of visits to doctors' offices over a one-week period, conducted by the National Center for Health Statistics.

The researchers estimated that in the United States from 1994--1995, the number of office visits resulting in a diagnosis of bipolar disorder was 25 out of every 100,000 for youths ages 19 and younger. By 2002--2003, the number had jumped to 1,003 per 100,000 youth visits. In contrast, for adults ages 20 and older, 905 per 100,000 office visits resulted in a bipolar disorder diagnosis in 1994--1995; a decade later the number had risen to 1,679 per 100,000 visits.

While the increase in bipolar diagnoses in youth far outpaces the increase in diagnosis among adults, the researchers are cautious about interpreting these data as an actual rise in the number of people who have the illness (prevalence) or the number of new cases each year (incidence).

"It is likely that this impressive increase reflects a recent tendency to overdiagnose bipolar disorder in young people, a correction of historical under recognition, or a combination of these trends. Clearly, we need to learn more about what criteria physicians in the community are actually using to diagnose bipolar disorder in children and adolescents and how physicians are arriving at decisions concerning clinical management," said Dr. Olfson.

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) provide general guidelines that can help doctors identify bipolar disorder in young patients. However, some studies show that youths with symptoms of mania (over-excited, elated mood)--one of the classic signs of bipolar disorder--often do not meet the full criteria for a diagnosis of bipolar disorder.

Other disorders, such as attention-deficit hyperactivity disorder (ADHD) may have symptoms that overlap, so some of these conditions may be mistaken for bipolar disorder as well. For example, in a study conducted in 2001, nearly one-half of bipolar diagnoses in adolescent inpatients made by community clinicians were later re-classified as other mental disorders.

Doctors also face tough questions when deciding on proper treatment for young people. Guidelines for treating adults with bipolar disorder are well-documented by research, but few studies have looked at the safety and effectiveness of psychiatric medications for treating children and adolescents with the disorder. Despite this limited evidence, the researchers found similar treatment patterns for both age groups in terms of use of psychotherapy and prescription medications.

Of the medications studied, mood stabilizers, including lithium--which was the only medication approved at the time of the study by the U.S. Food and Drug Administration for treating bipolar disorder in children--were prescribed in two-thirds of the visits by youth and adults. Anticonvulsant medications, such as valproate (Depakote) and carbamazepine (Tegretol), were the most frequently prescribed type of mood stabilizers in both groups.

Doctors prescribed antidepressant medications in slightly over one-third of visits by youth and adults. Antidepressant medications include the older classes of antidepressant medications, such as tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs); selective serontonin reuptake inhibitors, such as fluoxetine (Prozac) and paroxetine (Paxil); and also newer types of antidepressants, including venlafaxine (Effexor). In both age groups, about one-third of the visits where antidepressant medications were prescribed did not include prescription of a mood stabilizer.

This trend raises concerns, considering an earlier NIMH-funded study (Thase & Sachs, 2000) which reported that treating adults who have bipolar disorder with an antidepressant in the absence of a mood stabilizer may put them at risk of switching to mania. Also, a recent NIMH study showed that for depressed adults with bipolar disorder who are taking a mood stabilizer, adding an antidepressant medication was no more effective in managing bipolar symptoms than a placebo (sugar pill).

Roughly the same percentage of youth and adult bipolar visits included a prescription for an antipsychotic medication, although young patients were more likely to be prescribed one of the newer, atypical antipsychotic medications, such as aripiprazole (Abilify) or olanzapine (Zyprexa), than other types of antipsychotics. This finding suggests that doctors may be basing their treatment choices for bipolar youth on prescribing practices for adults with the disorder.

However, one main difference between youth and adult treatment was that children and teens were more likely than adults to be prescribed a stimulant medication--usually prescribed for treating ADHD--and adults were more likely than youth to be prescribed benzodiazepines, a type of medication used to treat anxiety disorders.

More than half of all diagnosed youths and adults were prescribed a combination of medications. Given the relative lack of studies on appropriate treatments for youth with bipolar disorder, the researchers noted the urgent need for more research on the safety and effectiveness of medication treatments that are commonly prescribed to this age group.

The study had several important limitations. For example, the survey relied on the judgment of the treating physicians, rather than an independent assessment. As a result, the researchers' findings reveal more about patterns in diagnosis among office-based doctors than about definitive numbers of people affected by the illness. Another limitation is that the survey recorded the number of office visits instead of the number of individual patients, so some people may have been counted more than once.

"A forty-fold increase in the diagnosis of bipolar disorder in children and adolescents is worrisome," said NIMH Director Thomas R. Insel, M.D. "We do not know how much of this increase reflects earlier under-diagnosis, current over-diagnosis, possibly a true increase in prevalence of this illness, or some combination of these factors. However, these new results confirm what we are hearing increasingly from families who tell us about disabling, sometimes dangerous psychiatric symptoms in their children. This report reminds us of the need for research that validates the diagnosis of bipolar disorder and other disorders in children and the importance of developing treatments that are safe, effective, and feasible for use in primary care."

"This research, performed at a National Center on Minority Health and Health Disparities Center of Excellence, underscores the need to fully engage the community with their health care providers to better understand the actual prevalence of bipolar disease in children and adolescents," said John Ruffin, Ph.D., Director of NCMHD.

Reference: Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, Olfson M. National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Arch Gen Psychiatry. 2007 Sep;64(9).


The study was funded by the NIMH Intramural Research Program, National Institute on Drug Abuse (NIDA), NCMHD, the Agency for Healthcare Research and Quality (AHRQ), the Alicia Koplowitz Foundation, and the New York State Psychiatric Institute.

Source: NIH/National Institute of Mental Health.

Posted by szadmin at 9:53 AM | Comments (2)