Poster Abstracts
K
Lithium Response in Bipolar
Adolescents with Substance Use Disorders
V. Kafantaris,
D.J. Coletti, R. Dicker, and G. Padula, Hillside Hospital, Long Island Jewish
Medical Center, Glen Oaks, New York 11004, USA.
Background: Bipolar disorder is associated
with the highest rate of substance use disorders (SUDs) of any population.
Earlier reports describe poorer lithium response in the presence of substance
abuse, depressive symptoms, or psychosis. For the current investigation, we
wished to determine if 1) acutely manic adolescents with past or present SUDs
had poorer response rates to lithium than subjects without SUDs, and 2) if
psychosis and/or prominent depressive symptoms were more frequent in subjects
with SUDs at clinical presentation. Method: DSM-IV diagnoses of bipolar
disorder and past or current SUDs were obtained by parent and child K-SADS
interviews on each adolescent enrolled in our ongoing lithium study. Adolescents
with substance-induced mood disorders or substance dependence were excluded from
the treatment study. Results: Eighteen (26.9%) of 67 study completers had
SUDs: 16 abused cannabis and 2 primarily abused alcohol. Subjects with SUD were
significantly older (mean age= 16.10 years, SD=1.56) than subjects without SUD
(15.11, SD=1.77 years, t= 2.07, df=65, p=.042), but lithium response and
clinical presentation were not associated with age. There was a trend for SUD to
be associated with the presence of depressive symptoms (defined as a 17-item
Ham-D score of 18 or greater; Fisher’s exact test p=.065), but not psychosis.
Lithium response rates did not differ significantly between groups (7 /18 or
38.9% with SUD vs. 27/49 or 55.1% without SUD, c 2 = 1.38, df=1, p= 0.24). Discussion:
A current or past SUD did not significantly decrease likelihood of response to
lithium in this sample. These results are consistent with the study by Geller
and colleagues demonstrating that lithium significantly reduced mood symptoms
and the number of positive urine drug assays in substance dependent bipolar
adolescents. Further exploration of a self-medication hypothesis in depressive
mania is warranted.
Effects of Mood State, Illness
Subtype, and Course on Cerebral Glucose Metabolism in Bipolar Disorders
TA Ketter,
Stanford University School of Medicine, Stanford, California, USA; TA Kimbrell,
MS George, RT Dunn, AM Speer, MW Willis, BE Benson, A Danielson, MA Frye, P
Herscovitch, RM Post, National Institute of Mental Health, Bethesda, Maryland,
USA.
Background:
Functional brain imaging studies in unipolar depressed patients have most
consistently reported decreased anterior cortical activity. Fewer studies have
focused on bipolar illness and have had variable findings. Method:
Forty-three medication-free bipolar (14 BP1, 29 BP2) disorder patients and 43
age- and gender- matched healthy controls had fluorine-18-deoxyglucose positron
emission tomography scans to measure cerebral glucose metabolism while
performing an auditory continuous performance task. Patients were compared with
controls to assess the influence of mood state, disorder subtype, degree of
depression, and illness course. Results:
Two principal patterns of metabolic differences were evident. The most robust
differences were seen in 16 depressed patients compared to controls and included
prominent decreased prefrontal and anterior paralimbic cortical (absolute >
normalized) metabolism, and less extensive increased anterior paralimbic
subcortical and cerebellar normalized metabolism. Similar patterns in attenuated
forms were seen in depressed compared to euthymic patients, and in bipolar II
patients compared to controls. A different pattern was seen in 9 euthymic
patients compared to controls and included no absolute differences, and
decreased anterior cingulate, and increased orbitofrontal and cerebellar
normalized metabolism. Patterns similar to this were seen in all patients
compared to controls, and in bipolar I patients compared to controls. Conclusion:
In bipolar disorder patients, the most robust finding was an association between
depressed mood state and anterior cortical (absolute > normalized)
hypometabolism. This pattern is consistent with that seen in primary unipolar
depression and in secondary depression, suggesting anterior hypometabolism may
be a final common pathway to depressive symptoms independent of illness etiology
(primary versus secondary) and subtype (unipolar versus bipolar). Bipolar II
patients had a similar pattern, consistent with clinical overlap with unipolar
disorder. In contrast, euthymic bipolar patients had a different pattern which
resembled that seen in bipolar I disorder patients, and suggesting possible
trait differences.
Bipolar Disorder and Pregnancy
E.A.M. Knoppert-van der Klein,
P. Kölling, H.A.P.C. Oomen, E.M. van Gent
More and more clinical practice is confronted
with questions about pregnancy and the bipolar disorder. Topics are genetic
counselling, the use of medication during pregnancy, alternatives to mood
stabilizers, management of the partus and postpartum period. Recently the Dutch
Lithium Association composed a practical guideline for clinical management of
women with bipolar disorder considering pregnancy. We intend to present the used
schedules on this poster.
Early Onset
Bipolar Disorder Occuring by Brief Recurrent Episodes of Depression and Mania
Among Cyclothymic Children and Adolescents
F. Kochman,
E.G. Hantouche, M.H. Pham, P.J Parquet University and General Hospital of Lille,
Department of Child and Adolescent Psychiatry, Lille, France.
Introduction:
Although several recent studies suggest that bipolar disorder most commonly
begins during childhood or adolescence, the illness still remains
underrecognized and underdiagnosed in this age group. In this 2 years
prospective study, we evaluated the prevalence of onset of bipolar disorders
among a sample of depressed juvenile patients with or without cyclothymic
temperaments. Methods:
28 depressed children and adolescents were assessed with Kiddie-SADS
semi-structured interview, according to DSM IV criteria. They were also assessed
with Akiskal and Hantouche questionnaire of cyclothymic temperament, Child
Depression Inventory (CDI), CGI, Overt Agressive Scale (OAS). Results:
Among these young patients, 7 were diagnosed as bipolar, and 21 were suffering
from brief recurrent episodes of mania, hypomania and depression, thus not
strictly fulfilling the DSM IV duration criteria. Nevertheless, we deeply think
that these patients are to be considered as suffering from a specific onset of
bipolar disorder occuring by ultra-rapid cyclings. Plus 15 among these 21
ultra-rapid cycling bipolar patients were cyclothymic (71%), 2 were cyclothymic
among the 7 strictly bipolar young patients (29%). Conclusion:
We argue that children and adolescents with brief recurrent episodes of
depression and mania, particularly in the presence of a cyclothymic temperament,
may herald an early onset bipolar disorder. The results of this study underscore
the need for greater efforts to build standardized algorythms for both diagnosis
and treatment : for example, antidepressants shouldn’t be used alone in
cyclothymic young patients, because they could induce manic switches, and
probably worsen the natural course of an early onset bipolar disorder.
The Influence of the Menstrual
Cyclus n the Course of Bipolar Disorder
P. Kölling,
E.A.M. Knoppert-van der Klein, A.C.G. Hoenderboom, E.O. Noorthoorn, H.F. Kraan
Publications regarding the relationship between
the menstrual cyclus and psychiatric symptomatology have been appearing
frequently ever since the 1960's.
The influence of the menstrual cyclus on the
course of a bipolar disorder however, has not received much attention in
professional literature, whereas in daily practice female patients with a
bipolar disorder frequently report increasing complaints around the beginning of
their menstruation.
In a literature survey along with a case study,
the authors aim to present different aspects of diagnostics, treatment and
research.
Topiramate Augmentation in
Women with Refractory Rapid Cycling Bipolar Disorder and Significant Weight Gain
from Previous Treatment
V. Kusumakar1,
L. N. Yatham2, C. O. Donovan1, S. P. Kutcher1 1Dalhousie
University and QE II Health Sciences Centre, Halifax, Nova Scotia, Canada; 2University
of British Columbia and affiliated hospitals, Vancouver, British Columbia,
Canada
Introduction:
This purpose of this study is to study the effectiveness of Topiramate
augmentation in women with refractory rapid cycling bipolar disorder that had
significant weight gain from previous psychotropic treatment. Methods: We
studied 19 women who 1) were diagnosed with Bipolar I or II Disorder, 2) had a
rapid cycling and chaotic biphasic mood instability course for at least 12
months, 3) were refractory to treatment to two or more trials of mood
stabilizers over 12 months, and 4) had a weight gain of over 20% over the
previous 24 months. Before entry into the study subjects medication was reduced
to being on only one mainstream mood stabilizer, either Lithium or Divalproex.
Then Topiramate 25 mg per day was added, in an open-labeled fashion, to the
subjects’ current mood stabilizer regime at Week 0, and was titrated up by 25
mg every week. Information from daily mood and sleep, and weekly weight charts,
random medication compliance checks and random urine drug screens, and adverse
events checklists were collated weekly up to week 8, and biweekly between weeks
8 and 16. Results: 15 out of 19 subjects completed the study. 4 subjects
discontinued Topiramate during the study. 8 out of the 15 subjects who completed
the 16-week study of Topiramate augmentation achieved euthymia, 2 were much
improved in their mood stability although they still experienced difficulties,
and 5 were no better than at baseline. Improvement in mood stability had
occurred on or before week 10 in all subjects. 5 of the 15 subjects lost more
than 5% weight, 2 lost between 1-4% weight, while 8 showed no weight change
during the study. Conclusions: Topiramate shows much promise not only as
a mood stabilizer but also in effectively dealing with morbid weight gain in a
significant number of subjects in this open study. Further study, using
double-blind placebo controlled design, is needed with this compound.
Impairment in Bipolar
Disorder: Findings at Initial Diagnosis
A. Kusznir,
R.G. Cooke, and S.V. Parikh, Bipolar Clinic, Centre for Addiction and Mental
Health, Toronto, Ontario, Canada
Although bipolar disorder is associated with
substantial levels of disability, efforts to investigate the initial signs of
impairments have been meagre. As part of a larger study of the effects of a
psychoeducational program on newly diagnosed or untreated bipolar patients, a
detailed assessment of the functional status of each patient was completed.
These sixty newly diagnosed patients with bipolar I or II disorder completed a
SCID interview along with additional instruments. In the interest of
generalizability, the patients were accepted into the study regardless of
comorbidity and mood status with few exception of severe depressive and manic
states. The level of disability was evaluated at the onset of treatment with the
administration of the Occupational Performance Questionnaire (OPQ). Validated in
an earlier study, the OPQ is a 40-item self-report questionnaire measuring the
involvement, satisfaction, and functioning in various life roles and provides
indices for an adequate level of community functioning (Kusznir et al, 1996). In
our earlier study, we employed the OPQ to assess the community functioning of
sixty-one euthymic patients with an established diagnosis of bipolar disorder
and found that one third of these patients did not meet the criteria for
adaptive level of community functioning. This presentation will offer the
preliminary data of this comparison of these two groups of patients and detail
some of the unique features of impairment of the newly diagnosed group of
patients.
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