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.
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Springer Healthcare Limited. © Springer Healthcare Ltd;
2010
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